MEDICAL DEPARTMENT

UNITED STATES ARMY

IN WORLD WAR 11

IDTIC QUALITY INSTPECTED 2

4103225v 62- A. 3 0~I 45
Body Armor in Korea
MEDICAL DEPARTMENT, UNITED STATES ARMY

WOUND BALLISTICS

Prepared and published under the direction of

Lieutenant General LEONARD D. HEATON

The Surgeon General, Uanit(d States Army

Editor in Chief

Colonel JAMES BOYD COATES, Jr., MC Accession Fo,

NTIS GRA&I

Editor for Wound Ballistics DTIC TAB 5

Major JAMES C. BEYER, MC Unannounced "

Justification

By

Distribution/' -,

Availability Coden

Avail and/or

Dist Special

OFFICE OF THE SURGEON GENERAL

DEPARTMENT OF THE ARMY

WASHINGTON, D.C., 1962
WOUND BALLISTICS IN WORLD WAR II

Supplemented by Experiences in the Korean War

The Historical Unit, United States Army Medical Service

Colonel JOHN BOYD COATES, Jr., MC, Director

Colonel REX P. CLAYTON, MSC, Executive Officer

Colonel R. L. PARKER, MSC, Special Assistant to Director

Lieutenant Colonel R. J. BERNUCCI, MC, Special Assistant to Director

Major WARREN W. DAROLL, MSC, Special Assistant to Director

Lieutenant Colonel MATTHEW GINALICK, MSC, Chief, Special Projects Branch

CHARLES M. WILTSE, Ph. D., Litt. D., Chief, Historians Branch

ERNEST ELLIOTT, Jr., Chief, Editorial Branch

Lieutenant Colonel LEONARD L. COLLIER, MSC, Chief, Information Activities Branch

Major ALBERT C. RIGGS, Jr., MSC, Chief, General Reference and Research Branch

HAZEL G. HINE, Chief, Administrative Branch

Library of Congress Catalog Card Number: 62-60002

For sale by the Superintendent of Documents. U.S Government Printing Office

"Washington 25, D.C.
WOUND BALLISTICS
MEDICAL DEPARTMENT, UNITED STATES ARMY

The volumes comprising the official history of the Medical Department

of the U.S. Army in World War I are prepared by The Historical Unit, U.S.

Army Medical Service, and published under the direction of The Surgeon

General, U.S. Army. These volumes are divided into two series: (1) The

administrative or operational series; and (2) the professional, or clinical and

technical, series. This is one of the volumes published in the latter series.

VOLUMES PUBLISHED

ADMINISTRATIVE SERIES

Hlospitalization and Evacuation, Zone of Interior

CLINICAL SERIES

Internal Medicine in World War TI:

Vol. I. Activities o/ Medical Consultants

Preventive Medicine in World War IT:

Vol. II. Environmental Hygiene

Vol. III. Personal Health Measures and Immunization

Vol. IV. Communicable Diseases Tramnsmitted Chiefly Through Respiratory and Alimentary Tracts

Vol. V. Communicable Diseases Transinitted Through Contact or By

Unknown Means

Surgery in World War II:

General Surgery, vol. II

[Iand Surgery

Neurosurgery, vol. I

Neurosurgery, vol. II

Ophth almology and Otolaryngology

Orthopedic Surgery in the European Theater of Operations

Orthopedic Surgery in the Mlediterranean Theater of Operations

The Physiologic Effects of Wounds

Vascular Surgery

M\iscellaneous:

Cold Injury, Ground Type

Dental Service in World BITar II

Veterinary Service in World War II
Contributors

JAMES K. ARIMA, Major, MSC, USA.

The Historical Unit, U.S. Army Medical Service.

JAMES C. BEYER, Major, MC, USA.

Research and Development Command, U.S. Army Mledical Service.

ELMER G. BUTLER, Ph. D., D. Sc.

Professor of Biology, Princeton University, Princeton, N.J.

GEORGE R. CALLENDER, Brigadier General, USA (Ret.).

Director, Pathology and Allied Sciences Service, Department of Medicine and Surgery,

Veterans' Administration, Washington, 1).C.

GEORGE B. COE, Captain, Ordnance Corps, USA.

JAMES W. CULBERTSON, M.D.

Professor of Medicine, Department of Internal Medicine, College of Medicine, The

University of Tennessee, Memphis, Tenn. Formerly Major, MC, AUS.

WILLIAM F. ENOS, M.D.

Pathologist, Arlington Hospital, Arlington, Va. Associate in Pathology, George

Washington University Medical School, Washington, D.C. Consultant, Wound

Ballistics and Body Armor, to The Surgeon General, U.S. Army. Formerly Major,

MC, AUS.

RALPH W. FRENCH, Major, USA (Ret.).

DANIEL JAMES GREINER, M.D.

Pathologist, The McLeod Infirmary, Florence, S.C. Formerly Lieutenant Colonel,

MC, AUS.

E. NEWTON HARVEY, Ph. D., Sc. D., L.L.D.

Professor of Biology, Princeton University, Princeton, N.J.

CARL M. I[ERGET, Ph. D.

Director of Clinical Research, U.S. Army Chemical Corps, Research and Development

Laboratory, Army Chemical Center, Md.; formerly Chief, Biophysics Division, Directorate of Medical Research, Chemical Warfare Laboratories, Army Chemical Center.

ROBERT H1. HOLMES, Colonel, MC, USA.

Headquarters, Defense Atomic Support Agency.

JAMES E. T. HOPKINS, M.D.

Baltimore, Md. Formerly Captain, MC, AUS.

HARRY C. HULL, M.D.

Professor of Clinical Surgery, University of Maryland School of Medicine, Baltimore,

Md. Formerly Colonel, MC, AUS.

DORIS W. JOHNSON.

Falls Church, Va. Formerly Historian (National Defense), The Historical Unit,

U.S. Army Medical Service.

J. HOWARD MCMILLEN, Ph. D.

Program Director for Physics, National Science Foundation, Washington, D.C.

ASHLEY W. OUGHTERSON, M.D. (deceased).

Formerly Colonel, MC, USAR; later Clinical Professor of Surgery, School of Medicine,

Yale University, New Haven, Conn.

ALLAN PALMER, M.D.

San Francisco, Calif. Brigadier General, California (Army Reserve) National Guard.

VII
Viii CONTRIBUTORS

WILLIAM 0. PUCKETT, Ph. D.

Professor of Biology, Davidson College, Davidson, N.C. Formerly First Lieutenant,

Infantry, ORC, AUS.

HOWARD E. SNYDER, M.D.

Snyder Clinic, Winfield, Kans. Colonel, MC, USAR.

FRANCIS A. SUTHERLAND, M.D.

Chief of Surgery, The Charlotte Hungerford Hospital, Torrington, Conn. Formerly

Lieutenant Colonel, MC, AUIS.

WILLIAM W. TRiBBY, M.D., F.C.A.P.

Pathologist and Director of Laboratory, Methodist Hospital, Memohis, Tenn.

Colonel, MC, USAR.
Foreword

War, which has been a bane to man since his earliest days, has always

been characterized by the presence of those who attempt to devise more and

more effective ways to maim and destroy the enemy, of others who strive to

develop the means to protect their comrades from the implements of the foe,

and of still others on both sides who devote themselves to improving techniques

for the care and repair of the unfortunates who are the casualties of war.

These three facets of war are interdependent, and one group cannot achieve

the best results without the advice and assistance of the others. The thread

which binds and correlates their activities is the science and application of

the principles of wound ballistics.

Field Service Regulations, 100-5, Operations, provides that coordinated

action of all arms and services is essential to success. It is to such coordinated

action that accomplishments within the U.S. Army in tile field of wound ballistics owe their success. This volume relates the part played by the Army

Medical Service in this mutual endeavor during World War II and, in briefer

fashion, during the Korean War.

In the development of personnel armor, the approach of the Army Medical Service is very similar to its approach to a disease entity. Primarily, the

Army Medical Service is interested in the treatment and recovery of the casualty and in his speedy return to the fighting force. It is also interested in and

vitally concerned with any methods which can reduce the severity of the wound

or any devices which can bring about complete defeat of a wounding agent.

When, as in Korea, the mortality rate of the wounded reaching medical treatment facilities was reduced to approximately 2.3 percent, these secondary

interests loom large. Capitalizing on the experiences of World War II and

the early experiences of the Korean War, the Army in 1951-52 introduced

body armor with most significant results. There was a decrease in the number

of wounded and the killed in action. There was a decrease in the severity

of wounds, which in turn resulted in more rapid and early convalescence and,

because of the lightened workload, permitted surgical units to provide better

care to those requiring it. While these results were gratifying, they most

definitely indicated the need for continuing research and development to

provide adequate ballistic protection for the head and those regions of the

body which received the largest number of lethal wounds.

The message which this volume contains for the physician who will be

treating the wounds of war is clear. War wounds, in many respects, are different from those found in peacetime civilian practice. Unless the physician

has some knowledge of the weapons and missiles which are creating the wounds

and of the wound track characteristic of these causative agents, his clinical

Ix
x FOREWORD

decision as to the treatment necessary is perforce shortsighted, and unwarranted

errors may result. Examples of errors of this type are fully discussed in this

and other volumes of the World War II history of the Medical Department,

but the basic data contained in this volume, if they are studied and the lessons

learned, should go a long way in dispelling the ignorance which leads to such

errors.

Finally, the Army Medical Service expresses its deepest gratitude to the

contributors to this volume and to all individuals, both civilian and military,

whose zeal and patriotism made possible, often under trying circumstances

and without precedent, the collection and preparation of the original data

upon which this work is based. My appreciation is extended to Maj. James C.

Beyer, MC, for so admirably accomplishing the arduous and major task of

compiling and editing this volume. His keen interest in this special field of

military medicine and his exemplary work and experience in Korea and at

the Armed Forces Institute of Pathology, Washington, D.C., made him the

ideal individual to undertake this project.

LEONARD D. HEATON,

Lieutenant General,

The Surgeon General.
Preface

Medical interest in the battle casualty as to the type and anatomic location of his wounds, the correlated visceral damage, and the causative missiles

has been in evidence since the earliest days of organized combat. The founding

of the Army Medical Museumn during the Civil War and the resultant collection

of case histories, drawings, anatomic specimens, and recovered missiles was

a major milestone in the accurate documentation of wartime medical history.

Notwithstanding its seeming antiquity in the light of present-day standards,

the collection is of unique and unparalleled value, and its complete exploitation

has never been fully realized. Near the close of the 19th century, Col. Louis

A. La Garde of the U.S. Army Medical Corps, in conjunction with the Ordnance

Department, conducted numerous experiments in basic wound ballistics and

later extended his observations to the casualties of the Spanish-American

War.

During World War I, there were numerous small casualty surveys conducted by medical personnel of great vision and foresight, but there were no

formal directives governing such activities. Col. Louis B. Wilson of the U.S.

Army Medical Reserve Corps mnade a rather extensive study of the wounds in

casualties of World War I, and this, coupled with his interest in the subject of

ballistics, enabled him to reach a number of basic conclusions regarding the

wounding effect of a bullet. In later years, Colonel Wilson was active in

directing the ballistic research of Col. (later Brig. Gen.) George R. Callender,

MC, and M. Sgt. (later Major, SnC) Ralph W. French. Much of this work was

an attempt to carry out on a scientific basis experiments which would prove,

disprove, or nmodify statements Colonel Wilson had made regarding the wounding potentials of small arms missiles.

Unfortunately, the excellent collection of pathologic specimens by the

British Army Medical Service from World War I was partially destroyed

during the bombing of London in World War II. This collection at the Royal

College of Surgeons resulted from the activity of the British Medical History

Committee which from its origin had a duty "to collect examples of the wounds

and diseases suffered by soldiers in the present war [World War I]; to dissect

and examine such specimens in order to fully understand their extent and

nature so that the best means for their treatment might be adopted; and to

preserve instructive examples so that they might be examined and studied not

only by Army surgeons of today but also by medical men for many generations

to come." According to Sir Alfred Keogh, Director-General of the Army

Medical Service (20 Oct. 1917): "Such specimens are original documents,

they constitute an original and reliable source of knowledge for all time, and

supply the most valuable basis possible for present and future medical and

xi
xHi PREFACE

surgical treatment of the diseases and injuries of war." Such sentiments are

still applicable in the elucidation of the value and function of a battle casualty

survey unit. The collected information and specimens can be channeled into

various fields for instruction, training, and developmental purposes, both

within the medical service and within the other technical services, and for

permanent display and historical storage.

In addition to determining the location and types of wounds in battle

casualties, it is also essential that the members of a survey team be familiar

with enemy ordnance materiel. One must learn to recognize the characteristics

of the external wound and the permanent wound track and, in addition, attempt

an identification of the causative missile, of its approximate mass, and of its

striking velocity. In small arms missiles, it is desirable to be aware of the

effective rate of fire and range of the weapon and the types and makeup of the

ammunition. With fragment-producing weapons, it is essential to determine

the types of shells and the mass distribution and initial velocity of the fragments. By means of such information, a more adequate and intelligent

analysis can be made of wounds and their causative agents, and valuable data

can be made available for dissemination to other technical services for weapons'

evaluation and development of personnel armor. This leads to an excellent

liaison and interchange of ideas, test results, interpretations, and guidance

between the interested technical services.

Chapter I of this volume deals with the enemy ordnance materiel of

World War II and Korea insofar as it had a bearing on casualty surveys. An

attempt was made to make it as informative and readable as possible while

still maintaining the security of information classified in the interest of national

defense. Maj. James K. Arima, MSC, and Mrs. Doris Johnson (nee Walther)

of The Historical Unit, U.S. Army Medical Service, were responsible for the

collection and compilation of much of the information, and this was possible

only after a review of a large number of publications, principally ordnance, and

correlating the various weapon specifications which in many cases had a great

variability. In addition, members of the various sections of the Ordnance

Technical Intelligence Service, U.S. Army, were very helpful in reviewing the

material for accuracy and security. The wholehearted cooperation of various

members of the Ordnance Department in compiling the material and in its

final review for publication has been most encouraging.

During the interim between World Wars I and II, active research on a

probable mechanism of wound production by high-velocity missiles was conducted by General Callender. Most of this pioneer work was done in collaboration with Major French. In chapter II, they have utilized some of their

original material to elaborate upon the correlation between a missile, its mass

and velocity, and its wounding potential. Both authors are to be commended

for the quality and originality of their research and for the particular correlation

which has existed between their laboratory experiments and later fieldwork.

In September 1943, Mr. R. H. Kent, physicist at the Aberdeen Proving

Ground, Md., contacted Dr. Lewis H. Weed, chairman of the Division of
PREFACE X111

Medical Sciences of the National Research Council, regarding the establishment of a research project designed to test the casualty-producing effectiveness

of U.S. weapons. As a result of this request, a meeting of the newly created

Conference on Wound Ballistics, later called the Conference on Missile Casualties, was held on 25 September 1943. General Callender presided and Dr.

John F. Fulton was secretary of the meeting. After accepting the general

tenets of Mr. Kent's proposal, the Conference granted contracts for research

projects to several groups of investigators. One of these contracts led to the

monumental work reported by E. Newton Harvey, Ph. D., and his associates

(chapter III). Much of this material has been published in separate medical

journal articles, but this volume would be grossly deficient if it were not present.

Many of the original conclusions of this work have been the basis for continuing

ballistic research after World War II. Floyd A. Odell, Ph. D., Technical

Director of Research, U.S. Army Medical Research Laboratory, Fort Knox,

Ky., and formerly of the Biophysics Division, Medical Laboratories, Army

Chemical Center, Md., kindly furnished a copy of the original manuscript and

a complete set of negatives for illustrations. The excellence of the illustrations

in chapter III is due solely to the availability of these negatives.

The natural extension of basic wound ballistic laboratory research into

field surveys and the increasing awareness of the need for data on battle wounds

was recognized by the Conference on Missile Casualties, and in early October

1943, a general recommendation was made that special teams be appointed to

conduct battle casualty surveys and that some attention be given to the training of personnel qualified to conduct these field activities. On 14 October 1943,

the Conference prepared a formal proposal directed to The Surgeon General

of the Army concerning the formation of a special survey unit which could

receive its initial indoctrination in the United States and its subsequent training with Prof. Solly Zuckerman's group at Princes Risborough in England. It

was felt that such a team should consist of approximately six to eight persons,

including medical personnel qualified in pathology and surgery and other technical service personnel having training in physics, interior and exterior ballistics,

and other ordnance specialties.

Subsequent to this proposal, General Callender informed the Conference

on 5 November 1943 that The Surgeon General and Brig. Gen. Fred W. Rankin,

Director, Surgical Consultants Division, were in agreement concerning the need

for data on wounds in battle casualties but felt that the immediate shortage of

trained men precluded the appointment of any special team. Instead, it was

recommuended that theater commanders be advised of the need for the information and that they then assign medical officers under their command to

collect wound ballistic data for transmittal to the Conference on Missile Casualties. General Callender prepared an article in which he described the startling

lack of available information and outlined the overall scope and organization

of a casualty team and the type of data which was needed. This article was

published in the March 1944 issue of the Bulletin oJ the U.S. Army Medical
XIv PREFACE

Department. Before general publication, copies of the article were sent to all

theaters of operations.

As a result of General Callender's article, a survey team was organized

under Col. Ashley W. Oughterson, MC, to cover a phase of the Bougainville

Island campaign from February to April 1944. Because of his tragic and

untimely death near Cali, Colombia, in November 1956, Dr. Oughterson was

never able to review the revision of his original report as it was prepared for

chapter V of this volume. However, this manuscript was recovered through

the gracious cooperation of his widow, the late Dr. Marion E. Howard, and was

reviewed by another member of the original survey team, Dr. (then Colonel,

MC) Harry C. Hull. The Bougainville survey team performed an outstanding

and pioneer effort, and their organization and report served as the basis for

the development and efforts of later casualty survey units. It is most regrettable that the death of Dr. Oughterson prevented him from seeing his report

reach the final publication and public recognition which it so justly deserves.

Even before the dissemination of the directive prepared by General Callender, another young Army Medical Corps officer was actively engaged in the

study of battle casualties. This officer was Capt. James E. T. Hopkins, MC,

whose work in the New Georgia and Burma campaigns is reported in chapter

IV. Because of his own innate interest and ambition, Captain Hopkins undertook a study of casualties in the New Georgia campaign for tile period, July to

August 1943. Following this, he was stationed in Burma and studied casualties

there in the period, February through May 1944. Both of these surveys have

produced unusual and valuable information regarding the type of casualty and

causative agent in jungle warfare. Since case reports from this survey are

unique in that they describe the battlefield duty and anatomic position of the

soldier at the time he was wounded, they have been included in their entirety

in appendixes A, B, and C. Some of the conclusions which were reached by

the author regarding the training of infantrymen and their use and conduct in

the field were highly pertinent and valuable at the time the original material

was prepared and would undoubtedly prove of equal importance in the event

of similar jungle-type warfare.

Simultaneous with the conduct of casualty surveys in the various areas in

and about the Pacific, additional survey teams were being organized in Europe.

Brig. Gen. (later Maj. Gen.) Joseph I. Martin, Surgeon, Fifth U.S. Army,

Mediterranean theater, arranged for and obtained authority to study the killed

in action, and Capt. (later Lt. Col.) William W. Tribby, MC, was assigned to

this duty.

Captain Tribby worked in association with Quartermaster graves registration units at U.S. military cemeteries in Italy and studied a thousand Americans killed in action in the Fifth U.S. Army from April to November 1944.

This survey probably represents the largest single study of killed-in-action

casualties conducted during World War II, and its scope was not surpassed

until the Korean War. The survey was concerned primarily with the accurate

anatomic location of wounds, their probable causative agents, and the cause of
PREFACE Xv

death. The original report contains an outline figure of the body for each case

with exact location and extent of all wounds. Limitations of space precluded the

inclusion of these anatomic drawings in chapter VI of this volume, but the

original work is still available as an invaluable reference.

In addition to the survey of Fifth U.S. Army killed in action, another

survey was conducted by Col. Howard E. Snyder, MC, and Capt. James W.

Culbertson, MC, on battle casualty deaths in hospitals of the Fifth U.S. Army

(chapter VII). A statistical analysis was made of case reports from field and

evacuation hospitals on 1,450 fatally wounded American soldiers during the

period from April through September 1945. Only a small fraction of the original

material is contained in the present chapter. The authors concerned themselves

not only with the anatomic location of wounds, the probable causative agent,

and cause of death of the casualties but thoroughly investigated all the possible

surgical avenues which might have had a bearing upon the fatal outcome of the

soldier. Therefore, they investigated a wide variety of subjects ranging from

time lapse between wounding and entrance into a medical facility and early

surgery, possible effect of anesthesia, use of blood transfusions, and a wide

variety of other topics all of which are immensely important to the military

surgeon of any war.

Next, there are three chapters (VIII, IX, and X) and appendixes G and H

all prepared and written by Maj. (later Lt. Col.) Allan Palmer, MC. Perhaps

no other author in this volume has waited so long and so patiently for the

publication of his works. Nevertheless, he was still able to maintain a wholesome interest in his original work and a genuine desire to cooperate in its final

review. In April 1943, Major Palmer became associated with Professor

Zuckerman for the purpose of studying field casualty survey methods. The

first survey conducted by Major Palmer was with the Fifth U.S. Army during

the Rapido River conflict south of Cassino in January 1944 (chapter VIII).

Notwithstanding the small number of casualties in the survey, it still serves as a

model for future field casualty survey studies. In addition, certain valuable

information can be gathered concerning the type of casualties to be expected

under certain specific forms of ground combat.

Major Palmer's major effort was concerned with a survey of all Eighth

Air Force heavy bomber battle casualties returning to the United Kingdom

during June, July, and August 1944. At this time, Major Palmer was chief of

the Medical Operational Research Section, Office of the Chief Surgeon,

European Theater of Operations, U.S. Army. The section had been organized

under the direction of Maj. Gen. Paul R. Hawley, Chief Surgeon, and Col.

(later Brig. Gen.) Elliott C. Cutler, MC. In addition to making a study of

casualties (chapter IX), an exhaustive survey was made of the effects of flak

striking aircraft and their correlation with the associated casualties among crew

members (chapter X). Appendix G relates the accidental discharge of an aerial

bomb at an airfield in England. Again, this survey can serve as a model for

future studies of accidental discharges of weapons during wartime or during

training procedures. Unfortunate as these accidents are, they can still serve as
XVI PREFACE

a source of some valuable information concerning the potential and possible

lethal effects of our own weapons.

After the work with the Eighth Air Force, the Medical Operational

Research Section was reconstituted as a survey unit and moved into the Third

U.S. Army area on the European Continent. The unit finally became fully

operational just 2 days before V-E Day. Major Palmer prepared a very interesting and informative diary of the experience of this unit from the time it

left England until the cessation of the war. It is of great interest for anyone

who has been associated with a field casualty survey unit to read the diary and

see the many pitfalls and complications which developed in the unit's attempt

to become operational.

Owing to his field experience, Major Palmer was able to study the various

casualty surveys from World War II and to correlate all the surveys in regard

to anatomic location of wounds and to the possible causative agent (appendix

H). Even though there is a mixture of casualty surveys conducted under

different collecting criteria and composed of airerew and ground force casualties, many interesting correlations can be obtained.

Despite the fact that this volume was originally intended to include only

the work of World War II, the casualty surveys and subsequent development

of personnel armor during the Korean War was such a natural outgrowth of the

World War I1 experience that the Korean material could logically be included

in this volume. Numerous investigators during World War II had advocated

the development and use of some form of body armor for ground troops.

Through the untiring efforts of Brig. Gen. Malcolm C. Grow of the U.S. Army

Air Forces, personnel armor was provided for members of bomber crews and

was of undenied success in reducing the number of overall wounds and the

number of lethal wounds. Numerous prototypes had been developed for

ground forces, and a test model was ready for field testing at the time of the

conclusion of the war with Japan. Therefore, it would seem that body armor

should have been a standard item of equipment at the onset of the Korean War.

However, it was tragic to see the effect that peacetime had had on the thinking

of those individuals who could have been responsible for the use of body armor

at the immediate onset of the conflict. It was only due to the administrative

ability and guidance of Col. (later Brig. Gen.) John R. Wood, MC, and several

field surveys conducted under the leadership of Lt. Col. (later Col.) Robert H.

Holmes, MC, that the responsible agencies would consent to the development

of prototypes and the field testing of models. New statistics had to be

compiled from field surveys, and old arguments had to be refought and won

before any models were developed for field usage. Initially, Colonel Holnes

laid the basic groundwork for the development and successful acceptance of

personnel body armor for Army ground troops. Later, Lt. Col. (later Col.)

William W. Cox, MC, and Maj. William F. Enos, MC, were instrumental in

the final testing and standardization of the present all-nylon model. Numerous

other medical officers as well as Quartermaster, Ordnance, and infantry officers
PREFACE xvn

were also concerned with the gathering and interpretation of valuable field

statistics.

It is perhaps a natural consequence of the American philosophy not to

maintain a constant interest in certain military matters in peacetime. However, it is costly both from the usual sense of time and money lost and from the

even more fundamental and irreplaceable point of view of human lives being

lost when certain fundamental suggestions and conclusions reached in one war

are completely lost in intervening times, and the points have to be regained in

subsequent wars.

Chapter XI is concerned with the development of personnel armor for

ground troops as seen as in World War II. The major portion of this chapter

must of necessity be concerned with various forms of helmet design and protection which were developed in response to varying needs of specific forms of

combat duties. Most of the source material for this chapter was obtained from

the historical files of the Ordnance Department. It was only due to the unlimited cooperation of historians in the office of the Chief of Ordnance, in offering

all the available materials in their files to the authors, that this chapter is possible. Major Enos was one of the medical officers on the survey teams testing

one of the prototypes of the Army personnel armor in Korea, and despite his

resignation from the service he has still maintained an active interest in the

field and has always been available to the Office of the Surgeon General for

invaluable consultation and advice.

Development of personnel armor in the Korean War was so intimately

associated with and a direct consequence of casualty surveys conducted in that

conflict that both aspects have been combined in chapter XII. There is also a

natural association of authors in this chapter for Carl M. Herget, Ph. D., is

perhaps the foremost leader in laboratory investigations on basic wound ballistics and testing of personnel armor and Capt. George B. Coe, Ordnance Corps,

was one of the foremost leaders in Korean casualty surveys. Dr. Herget and

his able associates in the Biophysics Division, Medical Laboratory, Army Chemical Center, were instrumental in directing many of the Korean casualty survey

units, since laboratory experiments had disclosed fields in which knowledge was

vitally needed, and conversely much of the information that could be gained by

field units was of utmost value to laboratory workers in directing their own

research programs and in interpretation of some of their results. Captain Coe,

then 1st Lieutenant, Medical Service Corps, made numerous trips to Korea as

a member or as a leader of missions conducted for the field testing of body armor

and the gathering of information concerning various types of battle casualties.

In addition to this immense amount of fieldwork, he was also vitally concerned

with and instrumental in the development of various prototypes of Army body

armor, and before his transfer from the Army Chemical Center he was a mainstay in the development and the testing of newer models.

Mvany of the contributors to this volume have been most patient in awaiting

publication of their World War II battle casualty surveys or results of research

603225-*-62-1
xviii PREFACE

in basic wound ballistics. Those whose work was done under the rigors and

expediencies of combat conditions are to be commended for their devotion and

zeal to the immediate treatment of the wounded soldier and, additionally, for

their great desire to study the factors which were important in producing the

casualty. Many of these contributors came into considerable conflict with

their immediate superiors, who at the moment did not see the possible value or

application of their investigations. Undismayed, they continued their vital

studies while performing outstandingly their prescribed duties.

One of the most valuable lessons to be gathered from much of the reported

work is the relative constancy of warfare up to the Korean War. Anatomic

location of wounds, causative agents, ratio between the wounded and the killed

in action have all remained relatively constant since the various studies originated during the Civil War. In addition, the importance of close liaison between the Army Medical Service and the other technical services is shown to be

of utmost importance in the gathering and dissemination of fundamental

information which can be utilized by all services in the greater fulfillnent of

their primary duty and in the development of future lines of endeavor. The

editor is firmly convinced that there should be a small group of readily available

and highly trained medical personnel who could be utilized for the conduct of

battle casualty surveys or the investigation of peacetime training accidents on

very short notice.

Because of the limited and technical nature of much of the original source

material, the sole responsibility for the final preparation and interpretation of

all the chapters is assumed by the editor.

A great many individuals other than the authors themselves were responsible for the final preparation and publication of this volume. Foremost among

those who have patiently awaited its publication and have always been available

for consultation and invaluable advice is General Callender. Col. Calvin H.

Goddard, MC, was originally scheduled to be a coeditor, but his untimely death

cut short an association which had always been most stimulating and enlightening to the present editor and had held great promise of future training and

guidance for him. Colonel Goddard was one of those unique individuals who

was most proficient and efficient in performing a number of varied tasks.

Firstly, he was a medical officer, but he was also a noted historian and writer

and a pioneer investigator and world-renowned authority on ballistics, small

arms missiles, and weapon identification. His absence will be very evident in

certain portions of this volume, but it was fortunate that the basic plan of the

book had been formulated before his death. All the contributors have been

most generous in consenting to review their material which, after a lapse of a

number of years, must have seemed relatively foreign. Numerous members of

various casualty surveys conducted during the Korean War have all been

available for consultation and criticism of the manuscript.

A major vote of thanks must be tendered to Col. John Boyd Coates, Jr.,

MC, Director of The Historical Unit, USAMEDS, and to the members of the
PREFACE XIX

various branches of that unit who were most cooperative and more than patient

in waiting for the final delivery of the entire manuscript from the editor.

Special appreciation is tendered to Col. Charles A. Pendlyshok, MSC,

former chief of the Special Projects Branch, for his never-failing interest in the

progress of this volume; to Miss Elizabeth P. Mason, cartographic compilation

aid in the Special Projects Branch, for her preparation of the maps; to Mrs.

Josephine P. Kyle, former chief of the Research and Archives Branch, who,

with her staff, provided much of the archival material and corroborated data

obtained from other sources; and to members of the Medical Illustration Service,

Armed Forces Institute of Pathology, who, under the direction of Mr. Herman

Van Cott, chief of that service, prepared the excellent layouts for the illustrations and mounted them for printing.

Finally, the editor gratefully acknowledges the assistance of Miss Rebecca

L. Duberstein, publications editor of the Editorial Branch, who performed the

final publications editing and prepared the index for this volume.

JAMES C. BEYER,

1lajor, MAl[edical Corps.
Contents

Page

FOREWORD ...- Ix

PREFACE - XI

Chapter

I Enemy Ordnance Materiel (Maj. James C. Beyer, MC, Maj. James K. Arima,

MSC, and Doris W. Johnson) ---------------------------------------- 1

Japanese Ordnance -------------------------------------------------- 4

German Ordnance --------------------------------------------------- 35

Causative Agents of Battle Casualties in World War II ------------------- 76

North Korean Forces Ordnance Materiel ------------------------------- 77

II Ballistic Characteristics of Wounding Agents (Maj. Ralph W. French, MAC,

USA (Ret.), and Brig. Gen. George R. Callender, USA (Ret.)) ------------ 91

Physical Aspects of the Missile Casualty -------------------------------- 91

Physical Aspects of the Missile ---------------------------------------- 115

The Wound as a Physical Entity -------------------------------------- 132

III Mechanism of Wounding (E. Newton Harvey, Ph. D., J. Howard McMillen,

Ph. D., Elmer G. Butler, Ph. D., and William 0. Puckett, Ph. D.) ------- 143

Historical Note ------------------------------------------------------ 143

Methods Used in Studying Wounding ---------------------------------- 147

Underwater Ballistics as a Guide to the Wounding Mechanism ----------- 152

The Wound Track or Permanent Cavity in Muscle --------------------- 158

The Explosive or Temporary Cavity in Muscle -------------------------- 167

The Explosive or Temporary Cavity in Abdomen, Thorax, and Head ------ 177

Movements Following Collapse of the Explosive Cavity ------------------ 181

Nature and Extent of Damage Around the Wound Track ---------------- 189

Damage to Bone by High-Velocity Missiles ----------------------------- 200

Damage to Blood Vessels and Nerves Near Wound Track ---------------- 205

Pressure Changes Accompanying the Passage of Missiles ------------------ 211

Retardation of Missiles by Soft Tissue and Tissuelike Substances --------- 223

Penetration of Missiles Into Soft Tissue and Bone ---------------------- 227

Casualties in Relation to Missile Mass and Velocity ---------------------- 231

IV Casualty Survey-New Georgia and Burma Campaigns (James E. T. Hopkins,

M.D.) ------------------------------------------------------------ 237

New Georgia Campaign ---------------------------------------------- 237

Burma Campaign --------------------------------------------------- 245

Analysis of Casualties ------------------------------------------------ 253

Causative Agents --------------------------------------------------- 259

Circumstances of Wounding ------------------------------------------ 268

Disposition of Casualties --------------------------------------------- 273

Influence of Protective Armor ----------------------------------------- 275

U.S. Casualties Caused by U.S. Missiles ------------------------------- 277

Conclusions -------------------------------------------------------- 280

XXI
XXII CONTENTS

Chapter Page

V Study on Wound Ballistics-Bougainville Campaign (Ashley W. Oughterson,

M.D., Harry C. Hull, M.D., Francis A. Sutherland, M.D., and Daniel J.

Greiner, M.D.) ----------------------------------------------------- 281

Factors Peculiar to the Bougainville Campaign -------------------------- 283

Bougainville Campaign During Survey Period (15 Feb.-21 Apr. 1944)< - _ 293

Disposition of Battle Casualties and Anatomic Distribution of Wounds- - ---- 311

The Different Weapons Causing Battle Casualties ----------------------- 322

Treatment of the Wounded ------------------------------------------- 347

Morbid Anatomy ---------------------------------------------------- 369

Circumstances and Protective Measures -------------------------------- 416

Summary ---------------------------------------------------------- 430

Conclusions -------------------------------------------------------- 434

VI Examination of 1,000 American Casualties Killed in Italy (William W.

Tribby, M.D.) ----------------------------------------------------- 437

Purpose of Study ---------------------------------------------------- 437

Methods of Study --------------------------------------------------- 438

Statistical Studies --------------------------------------------------- 443

Case Reports -------------------------------------------------------- 454

VII Study of Fifth U.S. Army Hospital Battle Casualty Deaths (Howard E.

Snyder, M.D., and James W. Culbertson, M.D.) ------------------------ 473

Region, Type, and Distribution of Wounds ----------------------------- 477

Causes of Death ---------------------------------------------------- 485

Special Studies on Intra-Abdominal Wounds --------------------------- 502

Cases in Which the Immediate Cause of Death was Shock --------------- 511

Pigment Nephropathy in Battle Casualties ----------------------------- 515

VIII Casualty Survey, Cassino, Italy (Allan Palmer, M.D.) --------------------- 531

Medical Facilities and Evacuation of Casualties ------------------------ 533

Analysis of Casualties ----------------------------------------------- 537

IX Survey of Battle Casualties, Eighth Air Force, June, July, and August 1944

(Allan Palmer, M.D.) ---------------------------------------------- 547

Collection of Data -------------------------------------------------- 548

Analysis of Battle Casualties ------------------------------------------ 555

Casualties Due to Flak ----------------------------------------------- 570

Casualties Due to Secondary Missiles ---------------------------------- 589

Casualties Due to Missiles From Enemy Fighter Aircraft ---------------- 594

KIA Casualties-June Through November 1944 ------------------------- 598

Summary and Conclusions -------------------------------------------- 603

X Directional Density of Flak Fragments and Burst Patterns at High Altitudes

(Allan Palmer, M.D.) ---------------------------------------------- 613

German 88 ram. High Explosive Antiaircraft Shell ----------------------- 613

Aircraft Battle Damage Data ----------------------------------------- 620

General Conclusions ------------------------------------------------- 638

XI Personnel Protective Armor (Maj. James C. Beyer, MC, William F. Enos,

M.D., and Col. Robert H. Holmes, 30) -------------------------------- 641

Helmet Development ------------------------------------------------ 641

Helmet Design ----------------------------------------------------- 649

Body Armor -------------------------------------------------------- 660
CONTENTS xxIII

Chapter Page

XII Wound Ballistics and Body Armor in Korea (Carl M. Herget, Ph. D., Capt.

George B. Coe, Ord Corps, and Maj. James C. Beyer, MC) --------------- 691

Battle Casualty Survey-November 1950 ------------------------------- 691

Joint Army-Navy Body Armor Field Test, 14 June-13 October 1951 ------ 727

Army Body Armor Test Team, February-July 1952 --------------------- 728

Medical Study of KIA Casualties -------------------------------------- 749

Lower Torso Armor -------------------------------------------------- 764

Improvised Armor for Special Purposes --------------------------------- 765

APPENDIXES

A Casualties, 1st Battalion, 148th Infantry, 37th Division --------------------- 769

B Casualties, 1st Battalion, 5307th Composite Unit (Provisional) --------------- 783

C Casualties, 3d Battalion, 5307th Composite Unit (Provisional) --------------- 789

D Principal and Associated Wounds ---------------------------------------- 807

E Combined Wound Groups ----------------------------------------------- 811

F Detailed Observations on Wound Groups ---------------------------------- 813

G Bomb Incident -------------------------------------------------------- 827

H Comparison of World War II Missile Casualty Data ----------------------- 843

I Medical Program for the Study of Wounds and Wounding ------------------ 851

INDEX- ----------------------------------------------------------- 855

Illustrations

Figure

1 Model 14 (1925) 8 mm. pistol --------------------------------------------- 7

2 Model 100 (1940) 8 mm. submachinegun ---------------------------------- 8

3 Model 38 (1905) 6.5 mm. rifle --------------------------------------------- 9

4 Model 96 (1936) 6.5 mm. light machinegun --------------------------------- 10

5 Model 97 (1937) 81 mm. infantry mortar ----------------------------------- 13

6 Model 97 (1937) 90 mm. mortar ------------------------------------------- 14

7 Model 90 (1930) 75 ram. gun --------------------------------------------- 17

8 Model 91 (1931) 105 mm. howitzer ----------------------------------------- 17

9 6.5 mm. ball ammunition ------------------------------------------------- 19

10 Model 100, 81 mm. mortar shell ------------------------------------------- 22

11 Fragments from Japanese 81 mm. mortar shell ------------------------------ 25

12 Model 91 (1931) hand grenade .-.----------------------------------------- 27

13 Model P 38 (Walther) 9 ram. pistol --------------------------------------- 38

14 MP 40 (Schmeisser) 9 mm. submachinegun -------------------------------- 39

15 Model 98, 7.92 mm. German Mauser rifle ----------------------------------- 40

16 Model FG 42, 7.92 mm. automatic rifle ------------------------------------ 41

17 Model 35, 7.92 mm. AT rifle ---------------------------------------------- 42

18 MG 34 (Solothurn) 7.92 mm. dual-purpose machinegun- --------------------- 43

19 81 mm. mortar with bipod and baseplate ----------------------------------- 45

20 Pak 38, 50 mm. AT gun -------------------------------------------------- 46

21 Pak 43, 8.8 cm. AT gun --------------------------------------------------- 47

22 7.92 mm. German ball ammunition ----------------------------------------- 52

23 Fragments from one of two 5 cm. mortar shells ------------------------------ 55

24 Fragmentation characteristics, German 8 cm. mortar shell -------------------- 56

25 High explosive mortar shells ---------------------------------------------- 58

26 Fragments from one of two 50 mm. high explosive shells of a German antitank

gun ------------------------------------------------------------------ 63
XXIV CONTENTS

Figure Page

27 Fragments from German 75 mm. high explosive shell ------------------------- 64

28 Fragments from German 75 mm. hollow-charge shell ------------------------- 65

29 Fragments from German 88 mm. high explosive shell ------------------------- 66

30 Fragmentation characteristics, German 88 mm. high explosive artillery shell -- 67

31 Fragments from two rounds of German 105 mm. howitzer ammunition -------- 68

32 Antipersonnel mine ------------------------------------------------------ 71

33 Antipersonnel shrapnel mine ---------------------------------------------- 72

34 CCF Maxim heavy machinegun ------------------------------------------ 80

35 Soviet 120 mm. mortar --------------------------------------------------- 81

36 Soviet 120 mm. mortar --------------------------------------------------- 82

37 Soviet 122 mm. howitzer -------------------------------------------------- 82

38 Soviet 152 mm. gun howitzer ---------------------------------------------- 83

39 CCF 82 mm. mortar shell ------------------------------------------------- 87

40 CCF 82 mm. mortar shell- ----------------------------------------------- 87

41 CCF short 120 mm. mortar shell ------------------------------------------- 88

42 CCF extra long 120 mm. mortar shell -------------------------------------- 88

43 CCF 75 mm. high explosive shell ------------------------------------------ 89

44 Soviet fragmentation hand grenade ---------------------------------------- 89

45 Japanese 6.5 mm. bullet -------------------------------------------------- 97

46 Japanese bullets -------------------------------------------------------- 97

47 Smoothbore .30 caliber gun ----------------------------------------------- 148

48 Wooden sabots to carry steel spheres --------------------------------------- 148

49 Water tank for study of shot into liquid ------------------------------------ 148

50 High-speed motion picture cameras --------------------------------------- 151

51 Apparatus for spark shadowgram technique --------------------------------- 152

52 Westinghouse Micronex apparatus for X-ray pictures ------------------------ 153

53 Frames from high-speed motion picture of 1⁄4e-inch steel sphere entering water-- 154

54 Frames from high-speed motion picture of 1⁄4-inch steel sphere striking water_-- 155

55 Frames from motion picture of ps-inch steel sphere entering gelatin gel -------- 156

56 Frames from high-speed motion picture of gelatin block shot with 1⁄4ý-inch steel

sphere --------------------------------------------------------------- 156

57 Temporary cavities formed in water ---------------------------------------- 158

58 Spark shadowgrams of '8 -inch spheres striking water ------------------------- 159

59 Pressure-time record of shock wave ---------------------------------------- 159

60 Spark shadowgram of 3i6-inch steel sphere in water--- ----------------------- 160

61 Record of pressure changes in water ---------------------------------------- 160

62 Frames from high-speed motion picture of 3%6 -inch steel sphere entering water-- 160

63 Muscle of cat thigh with entrance and exit holes produced by steel sphere ------ 162

64 Muscle of cat thigh with entrance and exit holes produced by steel fragment--- 163

65 Roentgenograms of cat thigh showing permanent cavity after passage of steel

sphere --------------------------------------------------------------- 164

66 Blocks of 20 percent gelatin gel. ------------------------------------------- 165

67 Soft tissues of thigh of cat ------------------------------------------------ 166

68 Blocks of 20 percent gelatin gel -------------------------------------------- 167

69 Roentgenogram of thigh of cat after passage of steel sphere ------------------- 168

70 Spark shadowgraph of %2-inch sphere in water ------------------------------ 169

71 Block of Plasticine ------------------------------------------------------ 169

72 Spark shadowgraph of %2-inch steel sphere in gelatin gel ---------------------- 170

73 Spark shadowgraph of cat thigh after passage of %2-inch steel sphere ----------- 171

74 Microsecond roentgenograms of 1⁄22-inch steel spheres passing through block of

butcher meat and container of water ------------------------------------ 172

75 Microsecond roentgenograms of thigh of dog after passage of steel sphere ------ 173

76 Frames from high-speed motion picture of 1⁄4-inch steel sphere through leg of cat- 174
CONTENTS xxv

Figure Page

77 Roentgenograms of thigh of cat before and after passage of 42-inch steel spher• 175

78 Microsecond roentgenogram of thigh of cat showing temporary cavity after

passage of %2-inch steel sphere ----------------------------------------- 176

79 Microsecond roentgenogram of thigh of cat showing temporary cavity after

passage of shell fragment ---------------------------------------------- 177

80 Microsecond roentgenogram of thigh of cat showing temporary cavity after

passage of wire nail --------------------------------------------------- 178

81 Microsecond roentgenogram of thigh of dog showing temporary cavity after

passage of rifle bullet -------------------------------------------------- 179

82 Microsecond roentgenograms of thigh of cat showing temporary cavities after

passage of 4 2-inch steel sphere ----------------------------------------- 180

83 Microsecond roentgenograms of thigh of cat showing temporary cavity after

passage of %' 2-inch steel sphere ----------------------------------------- 181

84 Frames from high-speed motion picture showing volume changes in abdomen

of cat --------------------------------------------------------------- 182

85 Frames from high-speed motion picture showing volume changes in tube filled

with water ----------------------------------------------------------- 183

86 Microsecond roentgenogram of abdomen of cat showing temporary cavity after

passage of %2-inch steel sphere ---------------------------------------- 184

87 Roentgenograms of abdomen of cat --------------------------------------- 184

88 Microsecond roentgenogram of abdomen of cat showing temporary cavity after

passage of steel cylinder ---------------------------------------------- 185

89 Frames from high-speed motion picture of thorax of cat after passage of %2-inch

steel sphere ---------------------------------------------------------- 186

90 Roentgenograms of thorax of cat ------------------------------------------ 186

91 Microsecond roentgenogram of head of dog showing temporary cavity after

passage of f'-inch steel sphere ----------------------------------------- 187

92 Roentgenograms of head of cat ------------------------------------------- 188

93 Skull of head of cat ----------------------------------------------------- 189

94 Skull of head of cat ---------------------------------------------------- 190

95 Frames from motion picture of cavity in gelatin after passage of %2-inch steel

sphere -------------------------------------------------------------- 191

96 Microsecond roentgenograms of abdomen of cat ----------------------- 192

97 Frames from motion picture of skinned leg of cat after passage of 5ý2-inch

sphere -------------------------------------------------------------- 193

98 Frames from motion picture of cat thigh after passage of %2-inch steel sphere- 193

99 Microsecond roentgenograms of thigh of cat -------------------------------- 194

100 Frames from high-speed motion picture of thigh of cat after passage of 1

8-inch

steel sphere --------------------------------------------------------- 195

101 Frames from motion picture of pig spleen after passage of %-inch steel sphere-- 196

102 Photomicrographs of muscle fibers ---------------------------------------- 198

103 Photomicrograph of muscle fibers ---------------------------------------- 200

104 Microsecond roentgenogram of thigh of cat after passage of %2-inch steel

sphere -------------------------------------------------------------- 201

105 Microsecond roentgenogram of thigh of cat after passage of shell fragment- -_. 202

106 Microsecond roentgenogram of beef rib after passage of %2-inch steel sphere__- 202

107 Roentgenogram of thigh of cat ------------------------------------------- 203

108 Roentgenogram of thigh of dog ------------------------------------------- 204

109 Roentgenogram of thigh of cat ------------------------------------------- 205

110 Microsecond roentgenogram of thigh of cat showing temporary cavity after

passage of %2-inch steel sphere ----------------------------------------- 206

111 Microsecond roentgenogram of thigh of cat showing temporary cavity after

passage of steel fragment ---------------------------------------------- 206

6032251-62- 2
xxvI CONTENTS

Figure Page

112 Cat skulls ------------------------------------------------------------- 207

113 Roentgenograms of thigh of cat ------------ 208

114 Roentgenograms of thigh of cat--- 209

115 Photomicrograph of sciatic nerve of cat ------------------------------------ 210

116 Photomicrograph of sciatic nerve of cat 210

117 Photomicrograph of sciatic nerve of cat- ---------------------------------- 210

118 Shadowgram of shock wave ---------------------------------------------- 212

119 Shadowgrams of shock waves --------------------------------------------- 212

120 Shadowgram of shock wave ------------------------------------- - 213

121 Shadowgram of shock wave ---------------------------------- 213

122 Shadowgrams of shock waves- 214

123 Shadowgrams of shock waves -_- 214

124 Shadowgrams of shock waves -------------------------- 215

125 Records of shock wave pressures ----------------------------------------- 216

126 Microsecond roentgenogram of abdomen of cat after passage of •c,-inch steel

sphere -------------------------------------------------------------- 216

127 Spark shadowgram of shock wave complex ---- 217

128 Crystal record of pressure changes ---------------------------------------- 218

129 Crystal record of pressure changes ---------------------------------------- 219

130 Frames from high-speed motion picture of abdomen of cat after passage of

•L-inch steel sphere -------------------------------------------------- 220

131 Frames from motion picture of 1 -inch steel sphere striking water ------------- 221

132 Frames from motion picture of frog hearts after passage of }W-inch steel sphere- 222

133 Frames from motion picture of frog hearts after passage of %-inch steel sphere- 223

134 Frames from motion picture of colon of cat suspended in Ringer's solution - 224

135 Frame from high-speed motion picture of cavity formed by steel sphere ----- 226

136 Spark shadowgraphs of cavities formed by spheres ------------------------- 227

137 Spark shadowgraphs of cavities produced by cylindrical slugs ----------------- 228

138 Spark shadowgram of layers of skin after passage of %2-inch steel sphere ------ 229

139 Tank filled with 20 percent gelatin gel ------------------------------------- 230

140 Roentgenogram of thigh of dog ------------------------------------------- 231

141 Roentgenogram of butcher meat after passage of steel spheres ---------------- 231

142 Roentgenogram of abdomen of cat ---------------------------------------- 232

143 Roentgenogram of beef femur----------------------------------------- 233

144 Medical aidmen carrying wounded man to ambulance jeep ------------------- 243

145 Members, 37th Division Clearing Company, completing a surgical procedure,

New Georgia Island --------------------------------------------------- 244

146 Wounded soldiers lying in vessel, awaiting transportation to 17th Field Hospital ----------------------------------------------------------------- 244

147 View of the Ledo Road -------------------------------------------------- 245

148 U.S. troops and Kachin natives watching a parachute supply drop ------------ 248

149 Kachins from a friendly native village leading men of the 5307th Composite

Unit (Provisional) through the jungle ----------------------------------- 250

150 Wounded soldiers awaiting evacuation, Myitkyina airfield ------------------- 250

151 Operating room of surgical team in field hospital -------------------------- 251

152 Litter bearers carrying wounded Chinese soldier to ambulance pickup point_ __ 252

153 One of the routes of evacuation between clearing station of Americal Division

and 21st Evacuation Hospital ----------------------------------------- 284

154 Perimeter road near junction of Americal and 37th Divisions -- 285

155 Roadway along the Laruma River, outside the perimeter -------------------- 285

156 Ward area, 21st Evacuation Hospital on Bougainville ----------------------- 286

157 Underground operating room, 21st Evacuation Hospital on Bougainville ------ 287

158 Interior, underground ward, 21st Evacuation Hospital on Bougainville ------- 287
CONTENTS XXVII

Figure Page

159 Situation map ----------------------------------------------------------- 289

160 Focal point of entire Hill 260 battle --------------------------------------- 295

161 Variety of banyan tree -------------------------------------------------- 296

162 Jungle growth on Hill 260 ----------------------------------------------- 297

163 Hill 260 being shelled by Americal Division artillery fire --------------------- 297

164 Enemy pillbox on Hill 260 ----------------------------------------------- 298

165 Partially cleared jungle growth on Hill 700 ------------------------------- 300

166 Precipitous hillside off the perimeter road ---------------------------------- 300

167 Wounded being transferred from halftrack to jeep --------------------------- 301

168 Wounded soldier being helped down the side of Hill 700 --------------------- 301

169 Japanese 75 mm. gun emplacement on Blue Ridge -------------------------- 302

170 Enemy dead on Hill 700 ------------------------------------------------- 303

171 A cleared field of fire in front of the 129th Infantry sector ------------------- 305

172 Light tank of the 754th Tank Battalion ----------------------------------- 305

173 Soldiers crawling up to barbed wire------------------------------------- 306

174 An area devastated by U.S. artillery shell fire ------------------------------ 307

175 Scene of action of Japanese infiltration, 2d Battalion, 129th Infantry, 37th

Division ------------------------------------------------------------- 307

176 General Sherman medium tank and infantrymen attacking Japanese positions

along perimeter of 129th Infantry, 37th Division ------------------------- 308

177 Japanese killed on perimeter of Company F, 129th Infantry, 37th Division---- 308

178 Japanese foxholes ------------------------------------------------------ 309

179 Roentgenogram of skull showing artillery shell fragment lodged in sinus cavity- 333

180 Roentgenogram of compound comminuted fracture of humerus -------------- 341

181 Roentgenogram of thoracic cavity ----------------------------------------- 342

182 Roentgenogram of thoracic cavity ---------------------------------------- 343

183 Roentgenograms of lower and upper extremities ---------------------------- 348

184 Litter carry ------------------------------------------------------------ 366

185 A screened operating room in a clearing station ----------------------------- 367

186 Jeep ambulance -------------------------------------------------------- 368

187 Entrance sites of lethal wounds in 104 autopsied casualties ------------------- 370

188 Widespread destruction of cranial vault and brain --------------------------- 381

189 Extensive fracture of skull at site of entrance wound ------------------------ 382

190 Missile fragments ------------------------------------------------------- 383

191 Extensive fracture of skull ----------------------------------------------- 384

192 Deformed .25 caliber bullet ---------------------------------------------- 385

193 Head wound ----------------------------------------------------------- 385

194 Entrance wound in head and wounds of left upper extremity- 386

195 Head wound-------------------------------------------------------- 387

196 U.S. 75 mm. shell fragment ---------------------------------------------- 388

197 Perforating head wound---------------------------------------------- 389

198 Entrance wound in head --------------------------------- 389

199 Large defect in skull at site of entrance wound ----------------------------- 390

200 Chest wound of exit ---------------------------------------------------- 392

201 Mortar shell fragment --------------------------------------.----------- 393

202 Chest wound ------------------------------------------- 394

203 Japanese hand grenade fragments --------------------------------------- 395

204 Japanese .25 caliber bullet ---------------------- ------------------------ 396

205 U.S. artillery shell fragment_ --------------------------------------------- 397

206 Deformed Japanese rifle bullet ------- ----------------------------------- 398

207 Wound of scapular area ------- ----------------------------------------- 399

208 Japanese artillery shell fragments -- -------------------------------------- 401

209 Gutter wound of left side of face and neck --------------------------------- 402
XXVIII CONTENTS

Figure Page

210 Deformed .25 caliber machinegun bullet -----------.--------------------- 402

211 Recovered metal fragments, identified as parts of first aid box --------------- 403

212 Fragments of Japanese hand grenade ------------------------------------- 404

213 Fragments of U.S. hand grenade ----------------------------------------- 405

214 Laceration of abdominal wall and evisceration ------------------------------ 408

215 Traumatic amputation stump -------------------------------------------- 410

216 Multiple mutilating wounds and traumatic amputations-_ ------------------ 411

217 Multiple wounds ------------------------------------------------------- 412

218 Small mortar shell fragment ---------------------------------------------- 413

219 Wounds of head and chest ----------------------------------------------- 414

220 Perforating wound of abdomen ------------------------------------------- 415

221 Recovered fragments of U.S. landmine ------------------------------------- 416

222 Well-constructed pillbox ------------------------------------------------- 424

223 Wire netting covering firing slits --------------- 425

224 Natural jungle growth ---- ---------------------------------------------- 426

225 "Necessary" and "unnecessary" exposure ---------------------------------- 427

226 "Little" and "moderate" protection --------------------------------------- 428

227 Unnecessary exposure and concentration of men ---------------------------- 429

228 Infantry advancing behind tanks ----------------------------------------- 429

229 Worksheet, with anatomic views of body and location of wounds ------------- 440

230 High explosive steel fragments (primary missiles) --------------------------- 442

231 Multiple fatal and nonfatal wounds due to high explosive shell fragments ----- 444

232 Traumatic decapitation -------------------------------------------------- 452

233 Extensive multiple and mutilating wounds --------------------------------- 453

234 Single head wound ------------------------------------------------------ 455

235 Multiple wounds of the head --------------------------------------------- 455

236 Single neck wound ----------------------------------------------- 456

237 Single neck wound ------------------------------------------------------ 456

238 Single chest wound ----------------------------------------------------- 457

239 Multiple wounds of the chest-- --- --------------------------------------- 457

240 Single thoracic wound --------------------------------------------------- 458

241 Single abdominal wound ------------------------------------------------- 458

242 Multiple wounds of loxxer extremities ------------------------------------- 459

243 Multiple wounds of lower extremities ------------------------------------- 460

244 Multiple wounds of lower extremities ------------------------------------- 460

245 Multiple wounds ------------------------------------------------------- 461

246 Multiple wounds of chest and left upper extremity -------------------------- 462

247 Multiple wounds of head, neck, chest, and upper extremities ----------------- 462

248 Multiple wounds of head, chest, and right upper extremity ------------------- 463

249 Multiple wounds of head, chest, abdomen, right upper extremity, and both lower

extremities--- ----------------------------------------------------- 464

250 Multiple wounds of chest, abdomen, and upper and lower extremities --------- 465

251 Multiple wounds of neck and chest --------------------------------------- 465

252 Multiple wounds of head, neck, chest, and upper and lower extremities ------- 466

253 Multiple wounds of head, neck, chest, abdomen, and right upper extremity -- 467

254 Multiple wounds of pelvis, lower extremities, and genitalia ------------------- 468

255 Multiple wounds of head, neck, chest, abdomen, and upper extremities ------- 469

256 Single wound of neck --------- ------------------------------- ----------- 470

257 Multiple wounds of abdomen, pelvis, and upper and lower extremities -------- 471

258 Building occupied by field hospital platoon and four surgical teams, Porretta,

Italy --------------------------------------------------------------- 474

259 95th Evacuation Hospital, Monghidoro, Italy ------------------------------ 475
CONTENTS XXIX

Figure Page

260 Capt. James W. Culbertson, MC, obtaining information concerning battle casualties --------------------------------------------------------------- 477

261 Col. Howard E. Snyder, MC, Surgical Consultant, Fifth U.S. Army ----------- 478

262 Location of field hospital platoon used as a forward surgical unit before the

breakthrough into the Po Valley ---------------------------------------- 480

263 Plasma being administered at a battalion aid station ------------------------ 505

264 Rapido River valley area, Italy, 6 February 1944 -------------------------- 532

265 Town of Cassino, Italy, 6 February 1944 ----------------------------------- 533

266 Map of Cassino area ----------------------------------------------------- 534

267 View from center of Monte Lungo, Italy, 18 February 1944 ------------------ 535

268 German emplacements south of Monte Lunge, Italy, 26 December 1943 ------ 536

269 Aerial view of Monte Lungo, Italy, 1944 ----------------------------------- 537

270 Cassino area, Italy, 6 March 1944 ---------------------------------------- 538

271 Approach to Monte Cassino, 30 May 1944 --------------------------------- 538

272 Town of Cassino being destroyed, 15 March 1944 -------------------------- 539

273 Cassino area, Italy, 18 May 1944 ----------------------------------------- 539

274 Operational Research Section, Office of the Chief Surgeon, ETOUSA --------- 551

275 Outline form with demarcations of body regions ---------------------------- 560

276 Lamport's curve II ----------------------------------------------------- 578

277 Chart showing relationship between "military loss" and weight of flak fragments

causing wounds ------------------------------------------------------ 579

278 Primary missiles (flak) --------------------------------------------------- 583

279 Secondary missiles (dural) ----------------------------------------------- 589

280 Secondary missiles (body armor) ------------------------------------------ 590

281 Secondary missiles (Plexiglas) -------------------------------------------- 591

282 Secondary missiles (miscellaneous) ---------------------------------------- 592

283 Location of 85 wounds due to Plexiglas fragments ------------------------- 593

284 Primary missiles (7.92 mm.) ---------------------------------------------- 594

285 Primary missiles (13 mm.) ----------------------------------------------- 595

286 Primary missiles (20 mm.) ----------------------------------------------- 596

287 Radio operator in B-17 aircraft ------------------------------------------ 604

288 Waist gunner in B-17 aircraft -------------------------------------------- 605

289 Radio operator in B-17 aircraft ------------------------------------------- 606

290 Navigator in B-17 aircraft ----------------------------------------------- 607

291 Radio operator in B-17 aircraft ------------- ------------------------------ 608

292 Pilot of B-24 aircraft ---------------------------------------------------- 609

293 Structure of German 88 mm. HEAA shell ---------------------------------- 614

294 Diagrammatic representation of directional fragmentation density of a spherical

burst ---------------------------------------------------------------- 615

295 Directional fragmentation density ----------------------------------------- 616

296 Location of flak hits, B-17 aircraft, plane surfaces only ---------------------- 621

297 Location of flak hits, B-24 aircraft, plane surfaces only --------------------- 622

298 Directional fragmentation density ----------------------------- 624

299 Location of flak hits, fuselages only --------------------------------------- 627

300 Location of flak hits, B-17 aircraft ---------------------------------------- 631

301 Location of flak hits, B-24 aircraft ---------------------------------------- 632

302 Projected body surface areas --------------------------------------------- 636

303 Directional fragmentation density ----------------------------------------- 637

304 Helmet, M1917A1 ------------------------------------------------------ 643

305 Army M1 helmet ------------------------------------------------------ 644

306 Helmet, TS3 .---------------------- 645

307 MI helmet ------------------------------------------------------------ 646

308 Ball-and-clevis release for chinstrap of M1 helmet -------------------------- 647
xxx CONTENTS

Figure Page

309 Helmet, Steel, MiC (Parachutist's) --------------------------------------- 650

310 Tank crash helmets in use in November 1941 ------------------------------ 651

311 Series of helmets -------------------------------------------------------- 652

312 Helmet, T19EI --------------------------------------------------------- 653

313 Combat vehicle crewman's helmet ---------------------------------------- 654

314 Ground troop helmet, T21 ----------------------------------------------- 655

315 Aero Medical Laboratory standard head models ---------------------------- 656

316 Flyer's helmet, M3 --------------------------------------------------- 657

317 Flyer's helmets --------------------------------------------------------- 659

318 Face armor (T6 type) --------------------------------------------------- 660

319 Jettisoning of flyer's armor ----------------------------------------------- 665

320 Flyer's vest, Ml -------------------------------------------------------- 667

321 Flyer's vest, M2 -------------------------------------------------------- 668

322 Flyer's apron ---------------------------------------------------------- 668

323 Flyer's groin armor ----------------------------------------------------- 669

324 Flyer's vest, M6 ------------------------------------------------------- 670

325 Flyer's neck armor ------------------------------------------------- 671

326 Japanese body armor --------------------------------------------------- 674

327 Japanese body armor --------------------------------------------------- 675

328 Japanese body armor --------------------------------------------------- 676

329 Japanese body armor --------------------------------------------------- 677

330 Armor, vest, M12 ------------------------------------------------------ 678

331 Crotch armor, T16E4 --------------------------------------------------- 680

332 Eye armor, T45 series --------------------------------------------------- 681

333 Mobile shield, TIE2 ---------------------------------------------------- 682

334 Lt. Col. I. Ridgeway Trimble, MC, wearing captured Japanese vest ---------- 686

335 Armorplates ----------------------------------------------------------- 687

336 Japanese body armor --------------------------------------------------- 688

337 Orientation map, Korea ------------------------------------------------- 693

338 Anatomic location of body regions ---------------------------------------- 697

339 Location of wounds in Turkish soldiers wounded in action ------------------- 716

340 Slipover thoracoabdominal vest ------------------------------------------ 726

341 Doron slipover vest ----------------------------------------------------- 727

342 Army all-nylon vest, T52-1 ---------------------------------------------- 729

343 Map showing disposition of Body Armor Test Team, March-July 1952 ------- 730

344 Typical fragments and missiles removed from casualties in Korea ------------ 734

345 Typical missiles removed from armor vest, T52-1, in Korea ----------------- 737

346 Protection provided by Army all-nylon vest, T52-1 ------------------------- 740

347 Lt. Rodney M. Brigg, Body Armor Team, points to skin bruise on back of Lt.

Frank H. Bassett ---------------------------------------------------- 741

348 Effect of armor on evaporation of perspiration ------------------------------ 742

349 World War II M12 vest, Korea, 25 May 1952 ----------------------------- 744

350 World War II M12 vest and all-nylon, T52-1, vest -------------------------- 745

351 Types of armored vest -------------------------------------------------- 746

352 Types of armored vest -------------------------------------------------- 747

353 World War II M12 body armor, Korea, 3 July 1953 ------------------------- 748

354 Body armor ------------------------------------------------------------ 749

355 Body armor, T52-1 ----------------------------------------------------- 750

356 Body armor, T52-1 ----------------------------------------------------- 750

357 Body armor ------------------------------------------------------------ 751

358 Armor vest, T52-2 ------------------------------------------------------ 751

359 Armor vest, T52-3 ----------------------------------------------------- 752

360 Marine Corps doron-nylon vest, M1951, 27 September 1952 ------------------ 756
CONTENTS XXXI

Figure Page

361 Demarcation of anatomic surface regions ---------------------------------- 762

362 All-nylon lower torso armor --------------------------------------------- 765

363 Armored suit for mine clearance ----------------------------------------- 766

364 Armored suit for demolition work ----------------------------------------- 767

Tables

Number

1 Japanese guns and howitzers --------------------------------------------- 16

2 Japanese small arms ammunition ----------------------------------------- 20

3 Japanese mortar ammunition ---------------------------------------------- 23

4 Frequency distribution of Japanese grenade discharger and mortar shells ------ 24

5 Hit probability, Japanese grenade discharger and mortar shells ---------------- 24

6 Japanese artillery ammunition -------------------------------------------- 28

7 Distribution of weapons in Japanese triangular infantry division --------------- 34

8 German guns and howitzers -------------------------------------------- 48

9 German small arms ammunition ------------------------------------------ 54

10 German mortar ammunition ---------------------------------------------- 59

11 German artillery ammunition --------------------------------------------- 60

12 Fragmentation characteristics, German 75 mm. shells ------------------------- 64

13 Weapons and equipment of German divisions -------------------------------- 74

14 Frequency distribution of casualty-producing agents in wounded, First and Third

U.S. Armies, 1944-45 -------------------------------------------------- 77

15 NKA and CCF small arms ammunition ----------------------------------- 84

16 NKA and CCF mortar ammunition --------------------------------------- 85

17 NKA and CCF artillery ammunition -------------------------------------- 86

18 Pressures from point of detonation of bombs -------------------------------- 106

19 Fragments from aerial bombs --------------------------------------------- 113

20 Retardation of effective fragments ---------------------------------------- 123

21 Retardation of effective fragments ---------------------------------------- 124

22 Effect of mass on retardation of fragments ---------------------------------- 126

23 Values of ya- ---------------------------------------------------------- 132

24 Volumes of cavities ----------------------------------------------------- 141

25 Data on steel spheres ---------------------------------------------------- 147

26 Distribution of 4,994 casualties of New Georgia campaign, 20 June-22 September

1943 ---------------------------------------------------------------- 240

27 Distribution of 181 casualties, 1st Battalion, 148th Infantry, 18 July-5 August

1943, by category ----------------------------------------------------- 242

28 Estimated number of troops, Burma campaign, 15 February-8 June 1944 ------ 249

29 Distribution of 212 casualties, Burma campaign, February-June 1944, by category ----------------------------------------------------------------- 252

30 Distribution of 393 casualties, New Georgia Island-Burma, by category and

survey period --------------------------------------------------------- 253

31 Distribution of 393 casualties, New Georgia-Burma campaigns, by category ---- 254

32 Distribution of wounds in 369 battle casualties, by anatomic location ---------- 255

33 Distribution of wounds in 101 dead, by anatomic location -------------------- 256

34 Distribution of wounds in 268 living wounded, by anatomic location ----------- 256

35 Mean projected body area and wound distribution -------------------------- 257

36 Distribution of 369 battle casualties, by anatomic location of wounds and by

disposition ----------------------------------------------------------- 258

37 Disposition of casualties with wounds of upper and lower extremities ----------- 259

38 Distribution of 369 battle casualties, by effect of causative agent ------- 260
XXXII CONTENT'S

Number Page

39 Relative lethal effect of weapons, by anatomic location of wounds -------------- 261

40 Relative effect of weapons causing wounds of upper and lower extremities ------ 263

41 Distribution of 101 fatal casualties, by causative agent ----------------------- 263

42 Relative lethal effect of U.S. weapons -------------------------------------- 264

43 Disposition of 66 U.S. casualties produced by U.S. weapons, by category ------- 265

44 Relative effect of weapons on disposition of casualties ------------------------ 266

45 Relative effect of weapons: Casualties returned to duty ----------------------- 267

46 Relative effect of weapons: Casualties lost to combat duty -------------------- 267

47 Relative effect of weapons: Casualties lost immediately to combat ------------- 268

48 Distribution of 349 casualties, by position and causative agent ---------------- 269

49 Distribution of 287 casualties, by position ---------------------------------- 270

50 Distribution of 270 casualties, by position ---------------------------------- 270

51 Distribution of 362 casualties, by type of action and causative agent ----------- 271

52 Distribution of 208 casualties, by category and range of missiles --------------- 272

53 Distribution of 85 casualties wounded by mortar and artillery shells ----------- 272

54 Distribution of 47 casualties wounded by hand grenade ----------------------- 273

55 Anatomic distribution of fatal wounds of the head, thorax, and abdomen in 173

casualties ------------------------------------------------------------- 276

56 Distribution of lethal wounds in 496 casualties, by anatomic location ----------- 276

57 Japanese weapons responsible for 1,569 Allied casualties ---------------------- 290

58 Distribution of 713 casualties among 1,350 U.S. Army troops engaged on Hill

260, by category ------------------------------------------------------- 299

59 Distribution of 426 casualties among 800 men, 182d Infantry, engaged on Hill

260, by category ------------------------------------------------------- 299

60 Distribution of 519 casualties among 2,600 U.S. troops engaged on Hill 700, by

category -------------------------------------------------------------- 304

61 Distribution of 450 casualties among 1,850 U.S. troops engaged on 129th Infantry sector, by category ------------------------------------------------- 309

62 Distribution of 2,335 Allied casualties in Bougainville campaign, 15 February-21

April 1944, by category ------------------------------------------------- 312

63 Comparison of wounds in living wounded of two past wars and World War II

with casualties of Bougainville campaign ---------------------------------- 314

64 Distribution of wounds in 1,788 battle casualties, by anatomic location (regional

frequency) ------------------------------------------------------------ 315

65 Distribution of wounds in 395 dead, by anatomic location -------------------- 316

66 Distribution of wounds in 1,393 living wounded, by anatomic location --------- 316

67 Distribution of 1,788 battle casualties, by disposition and anatomic location of

wounds (regional frequency) -------------------------------------------- 317

68 Distribution of 505 casualties with head wounds (including multiple wounds), by

category -------------------------------------------------------------- 318

69 Disposition of 319 casualties with wounds of upper extremities and 393 casualties with wounds of lower extremities ------------------------------------- 320

70 Mean projected body area and wound distribution (excluding multiple wounds)- 322

71 Distribution of 1,788 battle casualties, by relative lethal effect of causative

agent ---------------------------------------------------------------- 324

72 Relative lethal effect of weapons, by anatomic location of wounds and for multiple wounds ---------------------------------------------------------- 325

73 Disposition of 123 and 196 casualties with upper extremity wounds, by relative

effectiveness of bullets and HE fragments, respectively --------------------- 328

74 Disposition of 110 and 283 casualties with lower extremity wounds, by relative

effectiveness of bullets and HE fragments, respectively --------------------- 328

75 Relative effect of weapons causing wounds of upper and lower extremities,

among the living wounded ---------------------------------------------- 329
CONTENTS xxxIII

Number Page

76 Disposition of 16 and 215 casualties with multiple wounds, by relative effectiveness of bullets and HE fragments, respectively --------------------------- 330

77 Distribution of 395 fatal casualties, by relative effect of causative agent ------ 330

78 Relative effect of weapons: Probability of hits resulting in death, by anatomic

location of wounds (excluding multiple wounds) -------------------------- 332

79 Relative effect of weapons: Probability of causing light wounds --------------- 334

80 Relative effect of weapons: Probability of causing serious nonfatal wounds-... 334

81 Relative effect of weapons: Lost to service in the theater -------------------- 335

82 Relative effect of weapons: Casualties returned to duty from first echelon ----- 336

83 Relative effect of weapons: Casualties lost to Bougainville campaign ---------- 336

84 Relative effect of weapons: Casualties lost to combat ----------------------- 337

85 Days lost by 700 casualties returned to duty from first echelon hospitals, by

causative agent ------------------------------------------------------- 338

86 Days lost by 700 casualties returned to duty from first echelon hospitals, by

anatomic location ---------------------------------------------------- 338

87 Anatomic distribution (regional frequency) of wounds, by causative agents .... 339

88 Disposition of 1,337 nonfatal casualties, by causative agent ------------------- 341

89 Disposition of patients with multiple wounds as related to number of anatomic

regions hit and to severity of wounds, by causative agent ------------------ 344

90 Ratio of number of anatomic regions hit per patient evacuated in each echelon,

by causative agent ---------------------------------------------------- 345

91 Distribution of 219 U.S. casualties produced by U.S. weapons, by category .... 346

92 Relative lethal effect of U.S. weapons on 219 U.S. casualties ------------------ 346

93 Relative lethal effect of Japanese weapons on 1,569 U.S. casualties ----------- 347

94 Distribution of fatal wounds in 104 autopsied casualties, by anatomic location- 371

95 Cause of death in 104 casualties, as determined by post mortem examination.- 373

96 Weapons causing wounds in 104 casualties, as determined by post mortem

examination --------------------------------------------------------- 374

97 Anatomic distribution of wounds among 44 casualties killed by rifle fire, and

weapon from country of origin ------------------------------------------ 375

98 Size of wounds of entrance and exit, caused by rifle bullet, at various ranges-_ 376

99 Anatomic distribution of wounds among 24 casualties killed by mortar fire, and

weapon from country of origin ------------------------------------------ 377

100 Distribution of 1,557 casualties, by causative agent and by position and protection -------------------------------------------------------------- 417

101 Distribution of 1,240 casualties, by aimed and random fire and by position ---- 418

102 Distribution of 1,164 casualties, by aimed and random fire and by position ---- 418

103 Distribution of 1,620 casualties, by aimed and random fire of causative agent

and by type of action ------------------------------------------------- 420

104 Distribution of 460 casualties produced by small arms weapons, by range of fire

and disposition ------------------------------------------------------- 421

105 Distribution of 799 casualties produced by shell fragments, by distance from

point of burst and disposition ------------------------------------------ 421

106 Distribution of casualties wounded by hand grenade fragments, by distance

from point of burst ---------------------- ----------------------------- 422

107 Distribution of 1,707 casualties, by aimed and random fire of causative agent,

15 February-21 April 1944 --------------------------------------------- 423

108 Regional frequency of wounds in 1,788 casualties, by anatomic location and

order of frequency------------------------------------------------- 431

109 Percent distribution of 1,788 casualties, by relative effectiveness of weapons_-- 432

110 Percent distribution of casualties lost to battle and combat, by distribution

and effectiveness of causative agent ------------------------------------- 433
xxxIv CONTENTS

Nmber Page

111 Period of time, location of cemetery, and number of cases studied at each

cemetery ------------------------------------------------------------ 439

112 Distribution of wounds in 983 KIA casualties, according to body areas and

probable causative agents ---------------------------------------------- 445

113 Distribution of 396 injuries in 171 cases with multiple regional involvements

of upper half of body ------------------------------------------------- 447

114 Distribution of 67 injuries in 30 cases with multiple regional involvements of

lower half of body ---------------------------------------------------- 447

115 Distribution of 1,648 injuries in 452 cases with wounds involving regions both

above and below the diaphragm ---------------------------------------- 447

116 Distribution of 2,445 injuries in the various groups of the 987 KIA casualties,

by anatomic location -------------------------------------------------- 449

117 Distribution of 2,183 injuries in 983 KIA casualties, by anatomic location ------ 449

118 Distribution of 7,006 wounds in 983 KIA casualties, by anatomic location ----- 450

119 Comparison of regions actually involved and regions recorded on EMT's ------ 451

120 Distribution of 91,63l Fifth U.S. Army casualties, from I January 1944 to May

1945, by category --------------------------------------------------- 473

121 Post mortem studies available and total hospital battle casualty deaths studied,

1 January 1944-2 May 1945 ------------------------------------------- 474

122 Correction of total battle casualty admission figures to agree with proportion

of total deaths analyzed, 1 January 1944-2 May 1945 --------------------- 476

123 Distribution of 1,450 deaths as related to hospital admission, anesthesia, and

surgery, 1 January 1944-2 May 1945 --------------------------- -------- 479

124 Percent of 1,411 hospital deaths studied to total battle casualty hospital admissions, 1 January 1944-2 May 1945 -------------------------------------- 479

125 Effect of increased efficiency of evacuation from forward areas on hospital

mortality ------------------------------------------------------------ 481

126 Distribution of battle casualty hospital deaths (1,450 cases), by region of principal wound ---------------------------------------------------------- 481

127 Distribution of battle casualty hospital deaths (1,450 cases), by principal

wound -------------------------------------------------------------- 482

128 Distribution of 20,747 battle casualties admitted to Fifth U.S. Army hospitals,

I August 1944-2 May 1945, by principal wound group --------------------- 482

129 Hospital battle casualty deaths listed as to principal wound with percentage of

hospital battle casualty admissions ------------------------------------- 483

130 Distribution of 1,450 casualties, by causative agent as related to principal

wound ---------------- -------------------------------- ------------- 484

131 Distribution of 1,450 battle casualty deaths as related to hospital admission

anesthesia, and surgery, by principal wound ----------------------- -- - 485

132 Distribution of battle casualty hospitals deaths, 1 January 1944-2 May 1945,

by region of primary trauma leading to death ---------------------- 486

133 Distribution of 1,450 battle casualty deaths, 1 January 1944-2 May 1945, by

cause of death -------------------------------------------------------- 488

134 Distribution of 1,450 battle casualty deaths, showing percent of the total battle

casualty admissions, 1 January 1944-2 May 1945, by cause of death ------- 489

135 Comparison of principal wound with region of immediate cause of death (1,450

cases) ------------------------ ----------------------------- -------- 490

136 Region of immediate cause of death as related to region of principal wound

(1,450 cases) --------------------------------------------------------- 490

137 Region of primary trauma leading to death, by period ---------------------.. 491

138 Reported incidence of shock in 1,450 battle casualty deaths ------------------ 491

139 Reported incidence of intracranial conditions in 1,450 battle casualty deaths- 492

140 Reported incidence of shock in 1,450 battle casualty deaths ------------------- 492
CONTENTS xxxv

Num ber Page

141. Reported incidence of maxillofacial conditions in 1,450 battle casualty deaths-- 493

142 Reported incidence of cervical conditions in 1,450 battle casualty deaths ------ 493

143 Reported incidence of intravertebral conditions in 1,450 battle casualty deaths- 493

144 Reported incidence of extremity conditions in 1,450 battle casualty deaths- ... 494

145 Reported incidence of thoracic conditions in 1,450 battle casualty deaths ------ 494

146 Reported incidence of abdominal conditions in 1,450 battle casualty deaths - -. 496

147 Reported incidence of clostridial myositis or cerebritis in 1,450 battle casualty

deaths -------------------------------------------------------------- 498

148 Reported incidence of embolism, infarction, and thrombosis in 1,450 battle

casualty deaths ------------------------------------------------------- 498

149 Reported incidence of miscellaneous conditions in 1,450 battle casualty deaths- 499

150 Hospital admission, anesthesia, and surgery, in 178 cases where the principal

wound was intra-abdominal and the immediate cause of death was shock--- 503

151 Intra-abdominal pathology in 178 cases 'a here the principal wound was intraabdominal and the immediate cause of death was shock ------------------- 504

152 Transfusion record in 178 cases where the principal wound was intra-abdominal

and the immediate cause of death was shock ----------------------------- 506

153 Distribution of 178 cases where the principal wound was intra-abdominal and

the immediate cause of death was shock, by causative agent --------------- 506

154 Hospital admission, anesthesia, and surgery, in 230 cases where the principal

wound was intra-abdominal and the immediate cause of death was not

shock ----------------------------------------------- 508

155 Hospital admission, anesthesia, and surgery, in 175 cases where the principal

wound was intra-abdominal and peritonitis was evident or suspected to be

present -------------------------------------------------------------- 509

156 Operating time for primary surgery, in 175 cases where the principal wound

was intra-abdominal and peritonitis was evident or suspected to be present- 509

157 Primary surgery on 175 cases where the principal wound was intra-abdominal

and peritonitis was evident or suspected to be present --------------------- 510

158 Immediate cause of death in 175 cases where the principal wound was intraabdominal and peritonitis was evident or suspected to be present ---------- 510

159 Shock as a contributory condition in 175 cases where the principal wound was

intra-abdominal and peritonitis was evident or suspected to be present ----- 511

160 Location of principal wound in 523 cases where the immediate cause of death

was shock -------------------------------------------------------- 512

161 H-ospital admission, anesthesia, and surgery, in 523 cases where the immediate

cause of death was shock --------------------------------------------- 513

162 Shock in 523 cases where shock was the immediate cause of death ----------- 512

163 Lowest recorded blood pressure and other evidence in 498 cases where the immediate cause of death was shock ----------------------------------------- 514

164 Primary op.erations performed on 327 cases where the immediate cause of death

was shock ----------------------------------------------------------- 514

165 Miscellaneous observations on 219 cases where the immediate cause of death

was shock ----------------------------------------------------------- 515

166 Distribution of 1,411 hospital battle deaths, by result or status of pigment nephropathy ----------------------------------------------------------- 516

167 Anesthesia in 68 patients who died of pigment nephropathy ------------------ 522

168 Anesthesia in 31 patients in which pigment nephropathy contributed to death --- 522

169 Analysis of 7 cases where death occurred before anesthesia and where pigment

nephropathy contributed to death -------------------------------------- 523

170 Incidence of fractures in 100 casualties, by causative agent---------- 541

171 Distribution and weight of fragments, by distance from shellburst ------------- 542
XXXVI CONTENTS

Number Page

172 Distribution of single and multiple wounds in 100 casualties, by anatomic location --------------------------------------------------------------- 542

173 Estimated casualty rates from Allied and enemy artillery and mortar shells- - 544

174 Eighth Air Force heavy bombardment groups, by divisions ------------------- 549

175 Distribution of 69,682 Eighth Air Force heavy bomber day operations, 1 June31 August 1944 ------------------------------------------------------ 549

176 Distribution of 657,096 man-combat missions, 1 June-31 August 1944, by Eighth

Air Force heavy bomber day operations ---------------------------------- 550

177 Distribution of 541 casualties in flak-damaged B-17 aircraft ------------------ 553

178 Distribution of 193 casualties in flak-damaged B-24 aircraft ------------------ 554

179 Distribution of 28 casualties in B-17 aircraft ------------------------------- 554

180 Distribution of 9 casualties in B-24 aircraft ------------------------------- 554

181 Distribution of 1,117 aircrew battle casualties of 1st, 2d, and 3d Divisions, by

heavy bombardment group -------------------------------------------- 555

182 Freauency distribution of 1,117 battle casualties in 944 heavy bombers ------- 556

183 Distribution of 1,117 aircrew battle casualties, by category and causative agent

of wounds ----------------------------------------------------------- 557

184 Distribution of 1,117 battle casualties due to all missiles, by category and combat position ---------------------------------------------------------- 558

185 Distribution of 1,553 wounds due to all missiles, by anatomic location (regional

distribution) --------------------------------------------------------- 562

186 Distribution of 1,117 aircrew battle casualties, by anatomic location (regional

frequency) of wounds ------------------------------------------------- 563

187 Case fatality rates in casualties of Eighth Air Force and in ground force casualties at Bougainville ------------------------------------------------ 564

188 Distribution of 1,117 battle casualties, by number of regions wounded -------- 565

189 Regional distribution of fracture wounds in 1,109 aircrew battle casualties due

to all missiles --------------------------------------------------------- 565

190 Wounds and fractures in aircrew battle casualties due to all missiles, by anatomic location -------------------------------------------------------- 566

191 Distribution of 34 traumatic amputations in 32 battle casualties ------------- 566

192 Distribution of 221 aircrew battle casualties with wounds of head and neck, by

disposition ----------------------------------------------------------- 567

193 Distribution of 38 aircrew battle casualties with wounds of the chest, by disposition ------------------------------------------------------------- 568

194 Distribution of 18 aircrew battle casualties with abdominal wounds, by disposition ------------------------------------------------------------ 568

195 Distribution of 243 aircrew battle casualties with wounds of upper extremity, by

disposition ---------------------------------------------------------- 569

196 Distribution of 421 aircrew battle casualties with wounds of lower extremity, by

disposition ---------------------------------------------------------- 569

197 Distribution of 176 aircrew battle casualties with multiple wounds, by disposition ------------------------------------------------------------ 570

198 Distribution of 963 casualties due to flak ---------------------------------- 571

199 Mean projected area of body --------------------------------------------- 572

200 Distribution of 1,222 flak hits on 961 aircrew battle casualties ---------------- 573

201 Distribution of 963 casualties by regional frequency of flak hits -------------- 573

202 Comparison of case fatality rates of Bougainville ground force casualties with

Eighth Air Force flak casualties ----------------------------------------- 574

203 Altitude of aircraft at which casualties due to flak sustained wounds ---------- 575

204 Distribution of 375 WIA casualties due to flak, by time interval between injury

and surgical treatment ------------------------------------------------ 576

205 Distribution of casualties due to flak, by disposition ------------------------- 576
CONTENTS xxxvII

Number Page

206 Days lost from active duty and resulting military loss ----------------------- 577

207 Weight distribution of 505 flak fragments ---------------------------------- 582

208 Weight distribution of 30 flak fragments ---------------------------------- 582

209 Weight distribution of 56 flak fragments ----------------------------------- 584

210 Comparison of aircrew casualties with ground force casualties, in Cassino area- 584

211 Relative vulnerability of different body regions ----------------------------- 586

212 Regional distribution of flak hits according to combat position --------------- 586

213 Relative vulnerability of body regions in different combat positions ---------- 587

214 Regional distribution of flak wounds in unarmored and armored aircrew personnel -------------------------------------------------------------- 588

215 Distribution of 458 casualties with cranial injuries due to flak, by protected or

unprotected helmet area ----------------------------------------------- 588

216 Distribution of 104 aircrew battle casualties, by causative agent ------------ 591

217 Distribution of 104 aircrew battle casualties due to Plexiglas fragments, by disposition ------------------------------------------------------------- 593

218 Distribution of 50 aircrew battle casualties, by missile fired from enemy aircraft- 594

219 Distribution of 50 aircrew casualties due to missiles fired from fighter aircraft- - 595

220 Distribution of 83 wounds in 50 aircrew battle casualties, by anatomic location

of wounds ----------------------------------------------------------- 597

221 Distribution of 50 aircrew battle casualties, by number of regions wounded .... 597

222 Distribution of 50 aircrew battle casualties, by altitude --------------------- 598

223 Distribution of 164 KIA aircrew casualties, by missile ----------------------- 599

224 Distribution of 164 KIA aircrew casualties, by combat position -------------- 600

225 Distribution of 451 wounds in 164 KIA aircrew casualties, by anatomic location- 600

226 Distribution of 164 KIA casualties, by anatomic location of wounds ---------- 600

227 Distribution of 164 KIA aircrew battle casualties by regions wounded -------- 601

228 Distribution of 265 fractures in 149 KIA aircrew battle casualties, by anatomic

location ------------------------------------------------------------- 602

229 Distribution of 164 aircrew battle casualties, by anatomic location in which the

primary fatal wound occurred ----------------------------------------- 602

230 Distribution of 164 KIA aircrew battle casualties, by anatomic location and type

of fatal wound ------------------------------------------------------- 603

231 Distribution of flak casualties sustained according to combat position --------- 610

232 Mean projected body areas and regional distribution of flak wounds in unarmored and armored battle casualties ---------------------------------- 611

233 Directional fragmentation densities for a static spherical burst --------------- 615

234 Directional fragmentation densities, German 88 ram. HEAA shell ------------- 617

235 Directional fragmentation densities, 90 mm. shell, static burst ---------------- 619

236 Directional fragmentation densities, 90 mm. HE shell ------------------------ 619

237 Densities of flak hits on plane surfaces, B-17 and B-24 aircraft -------------- 623

238 Directional fragmentation densities of flak against B-17 aircraft -------------- 624

239 Directional fragmentation densities of flak against B-24 aircraft ------------- 626

240 Densities of flak hits on fuselages, B-17 and B-24 aircraft ------------------- 628

241 Densities of flak hits on B-17 aircraft ------------------------------------ 629

242 Densities of flak hits on B-24 aircraft ------------------------------------ 630

243 R6sum6 of density of flak hits, B-17 and B-24 aircraft ---------------------- 633

244 R~sum6 of standardized densities, B-17 and B-24 aircraft ------------------- 633

245 Directional fragmentation densities of flak on B-17 aircraft ----------------- 635

246 Directional fragmentation densities of flak on B-24 aircraft ----------------- 636

247 Directional fragmentation densities of flak against personnel, B-17 aircraft---- 638

248 Directional fragmentation densities of flak against personnel, B-24 aircraft-... 638

249 Production figures for flyers' armor, World War II, 1943-45 ------------------ 672

250 Flyers' armor, weight and area protection --------------------------------- 672
XXXVIII CONTENTS

Number Page

251 Ground troop armor, weight and area protection --------------------------- 679

252 Regional distribution of 7,773 wounds in 4,600 WIA casualties --------------- 698

253 Regional distribution of 7,773 wounds in 4,600 WIA casualties, by wounding

agent --------------------------------------------------------------- 699

254 Area distribution of 1,275 head wounds in 4,600 WIA casualties, by wounding

agent ---------------------------------------------------------------- 700

255 Distribution of 613 wounds of the thorax in 4,600 WIA casualties, by wounding

agent --------------------------------------------------------------- 701

256 Area distribution of 481 wounds of the abdomen in 4,600 WIA casualties, by

wounding agent ------------------------------------------------------ 701

257 Area distribution of 1,948 wounds of the upper extremities in 4,600 WIA casualties, by wounding agent --------------------------------------------- 701

258 Area distribution of 3,394 wounds of the lower extremities in 4,600 WIA casualties, by wounding agent --------------------------------------------- 702

259 Area distribution of 62 wounds of the genitalia in 4,600 W1A casualties, by

wounding agent ------------------------------------------------------ 702

260 Distribution of 7,773 wounds in 4,600 WIA casualties, by type of wound ------ 702

261 Area distribution of 1,275 head wounds in 4,600 WIA casualties, by type of

wound -------------------------------------------------------------- 703

262 Distribution of 613 wounds of the thorax in 4,600 WIA casualties, by type of

wound -------------------------------------------------------------- 703

263 Area distribution of 481 wounds of the abdomen in 4,600 WIA casualties, by type

of wound ------------------------------------------------------------ 704

264 Area distribution of 1,948 wounds of the upper extremities in 4,600 WIA casualties, by type of wound ---------------------------------------------- 705

265 Area distribution of 3,394 wounds of the lower extremities in 4,600 WIA casualties, by type of wound ---------------------------------------------- 705

266 Area distribution of 62 wounds of the genitalia in 4,600 WIA casualties, by type

of wound ------------------------------------------------------------ 705

267 Distribution of 7,467 wounds in 4,600 WIA casualties, by type of wounding ----- 706

268 Area distribution of 1,189 wounds of the head in 4,600 WIA casualties, by type

of wounding --------------------------------------------------------- 707

269 Area distribution of 594 wounds of the thorax in 4,600 WIA casualties, by type

of wounding --------------------------------------------------------- 707

270 Area distribution of 466 wounds of the abdomen in 4,600 WIA casualties, by

type of wounding ----------------------------------------------------- 708

271 Area distribution of 1,908 wounds of the upper extremities in 4,600 WIA casualties, by type of wounding ------------------------------------------- 709

272 Area distribution of 3,252 wounds of the lower extremities in 4,600 WIA casualties, by type of wounding ------------------------------------------- 709

273 Area distribution of 58 wounds of the genitalia in 4,600 WIA casualties, by type

of wounding --------------------------------------------------------- 709

274 Distribution of 1,762 fractures in 4,600 WIA casualties, by site of fracture ------- 710

275 Disposition of 4,566 WIA casualties, by region wounded --------------------- 711

276 Distribution of 200 cases with peripheral nerve wounds, by causative agent and

anatomic location of nerves -------------------------------------------- 712

277 Distribution of 100 cases of vascular damage, by type of wound -------------- 713

278 Distribution of 100 cases of vascular damage and associated bone and nerve

injury -------------------------------------------------------------- 713

279 Distribution of 100 cases of vascular injury, by type of missile causing damage- 713

280 Distribution of 116 self-inflicted wounds in 2,605 casualties, by region ----------- 714

281 Distribution of 950 wounds in 286 Turkish WIA casualties, by number of hits

on surfaces of body region --------------------------------------------- 715
CONTENTS XXXiX

No tber Page

282 Distribution of 950 hits on 286 Turkish WIA casualties, by type of missile---- 717

283 Distribution of 233 determinations of degree of damage caused by each type of

missile -------------------------------------------------------------- 718

284 Distribution of 250 casualties, by type of missile ---------------------------- 719

285 Distribution of estimated number of enemy casualties caused by Turkish soldiers, by weapon used ------------------------------------------------- 719

286 Frequency of causative agent producing wounds in 125 DOW casualties, by

body region ---------------------------------------------------------- 720

287 Anatomic cause of death and body region wounded in 125 DOW casualties .... 721

288 Regional frequency of fatal wounds in 1,500 KIA casualties, by anatomic location -------------------------------------------------------------- 722

290 Eighth U.S. Army units participating in test of Army nylon vest ------------- 731

291 Regional distribution of 1,474 wounds in 908 WIA casualties not wearing body

armor -------------------------------------------------------------- 733

292 Regional distribution of 850 wounds in 552 WIA casualties wearing body armor-- 733

293 Distribution of 1,460 armored and unarmored WIA casualties, by causative

agent --------------------------------------------------------------- 735

294 Distribution of 1,460 armored and unarmored WIA casualties, by type of wounding ----------------------------------------------------------------- 735

295 Distribution of 415 KIA casualties, by wounding agent ---------------------- 736

296 Regional frequency of lethal and associated wounds in 547 KIA casualties,

by anatomic location -------------------------------------------------- 736

297 Causative agent and disposition of 254 vest-wearing KIA and WIA casualties-- 738

298 Distribution of 874 hits on 254 armor vests, by causative agent ----------------- 739

299 Regional distribution of 1,346 wounds in 346 KIA casualties ------------------- 754

300 Distribution of 1,346 wounds in 346 KIA casualties, by causative agent -------- 755

301 Distribution of 1,346 wounds in 346 KIA casualties, by type of wound------ --- 755

302 Entrance location of 128 lethal wounds in 103 KIA casualties, by body region- 756

303 Regional distribution of wounds in Army and Marine Corps personnel killed

in action ----------------------------------- 757

304 Regional distribution of lethal wounds in Army and Marine Corps personnel

killed in action ------------------------------------------------------- 758

305 Status of armor vests available to major Army units, 31 December 1952 ------ 758

306 Status of armor vests available to major Army units, 29 February 1953---- ---- 759

307 Entrance location of lethal wounds in unarmored and armored casualties ------ 760

308 Regional distribution of 3,510 wounds in 500 KIA casualties wearing body

armor --------------------------------------------------------------- 761
CHAPTER I

Enemy Ordnance Materiel

Maj. James C. Beyer, MC, Mffaj. James K. Arima, MSC, and Doris W.

Johnson

In conducting a casualty survey to get information for a study on wound

ballistics, it is imperative that the members of a survey team be cognizant of

the types and capabilities of enemy ordnance materiel. To facilitate the

collection of such data and to recognize and evaluate the wounding potential of

enemy missiles, the medical personnel of such a survey team should be familiar

with enemy weapons and missile types and their ballistic properties. This

information is necessary to evaluate completely external and internal wound

characteristics and concomitant tissue and organ damage. If an ordnance

officer is included as a member of the team, the collection and dissemination

of pertinent information on enemy ordnance characteristics is greatly facilitated.

Such information is vital to medical personnel both in making the study itself

and in developing ballistic protective devices, such as helmets and body armor.

During the preliminary research stages before the adoption of body armor in

the Korean War, casualty surveys conducted under the guidance of the U.S.

Army Medical Service and other technical services established the priority of

body areas to receive protection, determined the most commonly encountered

wounding agents, and fixed the criteria for minimum protection in terms of

ballistic properties.

In addition to these medical applications, wound-ballistic studies can be

of value to ordnance technical intelligence personnel in their evaluation of

enemy weapons and to ordnance engineers in their design of new weapons.

Conversely, any casualty survey conducted among enemy casualties can furnish vital information regarding the effectiveness of friendly small arms and

artillery.

During World War II, casualty surveys conducted on Bougainville, New

Georgia, and Burma correlated the missile casualty and his wounds with the

type of causative agent. The Bougainville report (p. 289), especially, contained an excellent analysis of the Japanese weapons used in the Bougainville

area. Unfortunately, none of the casualty surveys from the European and

Mediterranean Theaters of Operations contained similar information for German weapons. Therefore, much of the following material had to be abstracted

from various manuals and reports which contained excellent descriptions of

1
2 WOUND BALLISTICS

the external and internal details of the weapons and their mechanics of operation

but often failed to consider their casualty-producing properties.

Before proceeding with the descriptions of enemy materiel, a definition

of some of the technical vocabulary of the ordnance expert and the officer of

the line is presented for the benefit of the reader who may be quite unfamiliar

with these terms. This presentation will serve the double purpose of making

the subsequent material easier to understand for the uninitiated reader, and it

will define our use of the terms to the expert who may have for each many

connotative shades of meanings.

Blowbacic operated.-The operating principle of a weapon which uses the

force of gases expanding to the rear against the face of the bolt to furnish all

energy necessary for the bolt to extract the expended cartridge and to reload and

fire another. This type of weapon is said to fire from an open bolt because the

bolt is held to rear when the weapon is cocked. The bolt loads and fires the

cartridge when the trigger is pulled. Blowback-operated weapons are not

positively locked at the moment of firing, but the bolt is held closed either by

its own weight or its weight plus that of a heavy recoil spring or some other

mechanical system, such as a trigger joint, until the bullet has left the bore and

breech pressures have dropped.

Cyclic rate offire.-The rate at which a weapon fires automatically, expressed in terms of shots per minute; synonymous with maximum rate when

the period of measure is 1 minute.

Effective rate of fire.-The rate at which a weapon may be expected to

fire accurately in actual use and with due consideration for the prevention of

damage to the weapon by overheating resulting from an excessive rate of fire

and the time required to reload the weapon.

Gas operated.-The operating principle of a weapon which uses the force

of expanding gases passed through an opening in the barrel to a separate gas

cylinder to operate the extracting, reloading, and cocking phases. The breech

is locked at the time of firing, which may be semiautomatic or automatic.

There may be gas ports in the cylinder to control the amount of gases entering

it, and a piston encased in the cylinder operates the bolt. The rate of fire is,

accordingly, controllable to some extent in weapons with adjustable gas ports.

Hollow charge.-A hollow, cone-shaped arrangement of the charge in

shells designed to concentrate the explosive force in one direction; a shaped

charge.

Hotchkciss machinegun.-A simple, air-cooled, gas-operated automatic

machinegun developed by the Societ6 Anonyme des Anciens Etablissements,

Hotchkiss et Cie., of France and England, from an original design by Capt.

Baron Adolph von Odkolek, Austrian Army, in 1895. A port drilled through

the barrel a few calibers from the muzzle communicated with a cylinder attached

below the barrel and housing a piston. When the projectile passed the port,

expanding gases entered the cylinder and forced the piston to the rear until

the gases escaped through an exhaust port. The compressed mainspring,

working directly on the gas piston, returned it to its original position. The
ENEMY ORDNANCE MATERIEL 3

bolt, itself, was similar to that of an ordinary hand-operated rifle, only in this

case, the operating rod (piston) connected to it did all the work. Ammunition

was fed in metal strips. The Czech ZB 26 (Brno) was a modification and

improvement of these principles. The Brno was widely copied by the Japanese,

Germans, and British. In British terminology, the name appeared as Bren,

and in German parlance, Brunn.

Lewis machinegun.-A light, air-cooled, gas-operated automatic machinegun developed by Col. Isaac N. Lewis, U.S. Army, in 1911, with the Automatic

Arms Co., Buffalo, N.Y. The gun featured a pinion gear which articulated

with the racked underside of the gas piston. A clock-type winding spring

was mounted inside the pinion. The entire pinion and spring mechanism was

mounted inside a casing on the pistol-grip, trigger-housing unit. The gas

piston and bolt traveling to the rear extracted the spent cartridge, positioned

a new cartridge, and wound the spring, which provided the energy for the

loading and firing phases. Thus, the operating spring was located out of the

way of reciprocating parts; it was easily accessible; changes in rate of fire could

be made even while firing; and the separate housing kept it free of dirt, water,

or other damaging elements. Because ammunition was fed from a 47- or

96-cartridge drum mounted flat on the gun, one man could operate the Lewis

machinegun. Accordingly, it found great use in World War I and immediately

thereafter as aircraft armament.

Maxim machinegun.-The first automatic machinegun was invented by an

American, Hiram Maxim, in 1884. It was recoil operated and belt fed. The

barrel recoiled three-quarters of an inch on a forward and rear bearing. This

recoil operated the feeding belt and imparted the energy necessary for the bolt

to free itself from the barrel, travel to the rear, fully extend the driving spring,

and compress the firing-pin spring. The counterrecoiling bolt, actuated by

the extended spring, ejected the spent cartridge, firmly grasped and chambered

the cartridge to be fired, locked the bolt with the barrel, and freed the firing

pin. Starting in 1888, Vickers Sons and Maxim, Ltd. produced the Maxim

machinegun in great quantity until, eventually, the production model became

better known as the "Vickers."

Maximum rate offJre.-The rate at which a weapon fires automatically

and continuously; cyclic rate of fire when the period of measure is 1 minute.

Mluzzle velocity.-The speed of a projectile at the instant it leaves the

muzzle of a gun; a function of the amount and type of propellent charge, the

length of the barrel, and the weight of the projectile.

Recoil operated.-The operating principle of a weapon which uses the

energy of recoil to operate the extracting, reloading, and cocking phases. The

weapon may be semiautomatic or automatic. The breech is locked at the

moment of firing; the barrel and bolt assembly move to the rear together with

the recoil and separate later.

Setback.-The rearward (relative) jerk, caused by inertia, of free-moving

parts in a projectile when it is fired. This force may be used to push back a

spring or plunger to start operation of a time fuze.
4 WOUND BALLISTICS

Shaped charge.-An explosive charge shaped so that the explosive energy

is focused and concentrated to move in one direction, thus giving the projectile

greater penetration. A hollow-cone charge is one form of a shaped charge.

JAPANESE ORDNANCE

The reader must realize, in considering Japanese ordnance, that Japan

was one of the last countries to shed the cloak of feudal times and partake of

the discoveries of the industrial revolution. For some 200 years, the feudal

lords of Japan had handcuffed the Emperor and had closed Japan to all foreigners. At the time when the sanguinary Civil War was being fought in

America, the only guns known to the Japanese were antiquated pistols, muskets,

and cannon which had been obtained from the few Dutch who were permitted

to trade at one of Japan's southern ports or the even more primitive weapons

which had been obtained from earlier European explorers and traders before

the period of self-imposed exile. When this period of feudal isolation was

ended with the restoration to the throne of Emperor Meiji in 1867, the Japanese

set out with fervent zeal to catch up with the rest of the world which had passed

them by.

One of Japan's first considerations was to build up her armed forces. The

still-revered traditions and code of the warrior were great assets toward this

end and stood the Mikado's forces in good stead even as late as World War II.

By 1895, Japan had already fought the Chinese, often mentioned as the inventors of gunpowder, and had annexed Formosa and the Pescadores. In 1904,

Japan saw fit to engage Imperial Russia in war. A little more than a year

later, the entire Russian fleet was destroyed at the Battle of Tsushima Bayone of the major naval disasters of modern times until the United States and

her Allies were able to turn the tables in the Pacific battles of World War II.

By 1905, in the 38th year of the reign of Emperor Meiji, the Japanese had

already developed and were manufacturing a basic rifle for its ground soldiers

which was quite comparable to the then new U.S. Springfield, M1903. This

model 38 rifle was the mainstay of Japanese troops during World War II.

With her nearly constant warfare against the Chinese for some 50 years, with

wars and skirmishes against Imperial and Soviet Russia over a period nearly

as long, and with her participation in World War I on the side of the Allies,

Japan had gained extensive knowledge in the arts of modern warfare. While

circumstances dictated that her weapons be copies of those used by the world's

leading powers, they were modified to suit her needs, and the Emperor's

arsenals were quite complete with the gamut of modern weapons at the time

of the dastardly strike at Pearl Harbor.

In evaluating both the weapons to be described and the casualty surveys

which form later chapters of this volume, the reader should bear in mind that

the Japanese Army was built around the foot soldier, just as the armies of the

feudal lords of a not too distant past. Accordingly, the design of Japanese
ENEMY ORDNANCE MATERIEL 5

weapons featured lightness and mobility. Supporting weapons were specifically designed as aids to the infantry. Tactical doctrine specified that the

aim of all battle was for the foot soldier to engage the enemy and completely

annihilate him. In offense or defense, the aggressiveness of the feudal warrior

was the keynote, even to the extent of the final banzai raid when all was

hopelessly lost.

This overdevotion to aggressive conduct of battle and adherence to the

role of the infantrymen predominated in the consideration of an overall weapons

system, and many forms of weapons were sacrificed or underdeveloped because

of this concept. Thus, the weapons of the infantrymen were well developed

and quite adequate to the extent that the mortars of the Japanese Army were

more numerous in kind and number than in any of the armies engaged in

World War II. At the same time, considerably less attention was given to

larger artillery pieces, to AA (antiaircraft) artillery, and to AT (antitank)

weapons.

The theme of lightness is quite evident when Japanese weapons are compared with the comparable U.S. weapons of World War II. The bore of

Japanese rifle was 0.256 inch, while the United States had used an 0.30-inch

bore for years. American submachineguns fired snub-nosed 0.45-inch bullets,

while the Japanese guns fired 0.315-inch missiles. The same was generally

true of pistols. The standard caliber of Japanese light machineguns was, as

was that of the rifles and carbines, 0.256 inch, which corresponded to the

American light machinegun of 0.30 inch. Japanese heavy machineguns,

however, equalled in bore sizes those used by the U.S. Army. A similar

analogy can be made with artillery. The basic gun of the Japanese infantry

division, as encountered by the Allies in combat, was 75 mm. Division

artillery of U.S. infantry divisions was 105 and 155 mm. Only in mortars did

the Japanese foot soldier possess both smaller and larger bores at the advent

of World War II. The most commonly encountered Japanese mortars were

81 and 90 rmm. Standard U.S. mortars used by the infantry were 60 and 81

mm.

Another consideration in the Japanese design of lighter, smaller weapons

was the combat for which they were designed. The weapons were adapted to

the use of unmotorized units chasing inadequately armed Chinese over great

expanses of countryside; they were particularly useful in jungle fighting and in

the type of terrain which was encountered throughout most of the earlier

fighting in the Pacific. An omen which was insufficiently heeded, or which

could not be followed through, was the definite inadequacy of these weapons

in more conventional warfare as pointed out in large-scale border skirmishes

against Soviet forces in northern Manchuria and Siberia just before World

War II. As the war progressed from the smaller islands and isolated areas of

the Pacific and moved ever closer to the homeland, Japan had to manufacture

larger bore weapons and better AA artillery and AT guns. But, by this time,

Allied bombers had taken their toll of Japan's manufacturing potential.

While Japanese infantry weapons ultimately reached bore sizes close to
6 WOUND BALLISTICS

those used by U.S. forces, Japan developed but never produced a semiautomatic rifle or automatic carbine; hence, the Japanese soldier could not match

the tremendous advantage in firepower which the American soldier held over

him. Japanese artillery never reached the stage where it could lay down

massed fires and rolling barrages as did U.S. artillery. It still remained aimed

fire or, at most, point fire at the close of the war. It is doubtful whether

Japanese logistics could have ever supplied the ammunition for such weapons

or artillery practices, had they been feasible. As it was, the last months of

World War II found the Japanese using mortars improvised from whatever

was available, and captured documents explained in detail how such improvisations could be made by units in the field. More than 5 years after the

Japanese surrender, the United States was to rediscover in Korea that these

same Japanese weapons in the hands of Chinese Communists were still quite

effective.

Edged Weapons, Hand Actuated

Although bayonets were attached to most Japanese rifles, they were not

considered a primary cause of wounds. Among the 2,335 casualties studied

in the Bougainville campaign, only 2 were listed as having had wounds caused

by this weapon. A New Georgia-Burma casualty survey unit studied 393

casualties. Of 319 of these casualties that required hospitalization or that

were killed in action, there were only 3 bayonet-wound cases. Two of these

were accidentally inflicted with a U.S. bayonet, and in the third case the

bayonet wound was secondarily inflicted following primary small arms wounds

to the lower extremities. Notwithstanding this relatively small sampling of

the total U.S. casualties incurred against the Japanese forces, it would appear

that the bayonet was not a major, primary wound-producing weapon and that

most bayonet and knife wounds were secondarily inflicted following a primarymissile wound. Infantry personnel through their personal experiences could

probably reveal some variations as to the comparative effectiveness of bayonets

and knives, but, in general, edged weapons were relegated to secondary

functions.

Small Arms

Pistols and revolvers.-Japanese ground forces utilized several models of

an 8 mm. semiautomatic pistol and of one obsolescent 9 mm. revolver. The

Japanese Nambu, 8 mm. (0.315 in.) semiautomatic pistol, was named for its

inventor, Col. Kijiro Nambu, and before 1925 was the standard sidearm in the

Japanese Army. The weapon was recoil operated and magazine fed with the

8-round magazine fitting into the butt similar to the U.S. service automatic,

caliber .45. Notwithstanding its independent development by the Japanese, the

pistol had a superficial resemblance to the German Luger automatic. Originally,

a separate shoulder stock was issued which, when attached to the butt of the

pistol, enabled it to be used as a light carbine.
ENEMY ORDNANCE MATERIEL 7

The Nambu used an 8 mm. bottlenecked semirimless cartridge. Its

muzzle velocity was about 950 f.p.s. (feet per second) with maximum ranges,

published in several sources, varying between 547 and 1,400 yards. Effective

range was from 50 to 75 yards.

A 7 mm. (0.276 in.) model was also manufactured and represented a

scaledown version of the 8 mm. model.

In 1925, the Model 14, 8 mm. semiautomatic pistol (fig. 1), replaced the

Nambu as the standard sidearm and represented a further development of the

earlier model. The Model 14 possessed a few external and internal modifications which facilitated the mass production of the weapon, but it used the

same type of ammunition as, and had ballistic characteristics similar to, the

Nambu.

OCO, D/A 82433

FIGuRE 1.-Model 14 (1925) 8 mm. pistol,

The Model 94 (1934) 8 mm. semiautomatic pistol was of later design and

manufacture, but it was considered inferior to the Model 14 (1925) in manufacturing quality and pointing properties. A dangerous feature of this model

was that the weapon could discharge following rough handling without any

manipulation of the trigger. It used the same type of 8 mm. ammunition as

the Nambu and Model 14 pistols and had ballistic characteristics standard to

this type of cartridge.

Submachineguns.-The basic design of Japanese submachineguns closely

resembled corresponding German weapons as was well demonstrated in the

standard 8 mm. submachinegun, Type 100 (1940). The Japanese had two

modifications of this gun. The early model was designated the Paratrooper's

Submachine Gun and was a light, blowback, bolt-action operated automatic

weapon which fired the regular issue bottlenecked 8 amm. pistol cartridge. The
8 WOUND BALLISTICS

stock was cut through and hinged just behind the receiver and could be swung

forward to lie parallel with the barrel. The curved box magazine had a capacity

of 30 rounds, and the gun had an estimated cyclic rate of fire of 400 to 1,000

rounds per minute. The muzzle velocity was about 1,100 f.p.s.

The later model (fig. 2) differed from the Paratrooper's Model 100 in the

absence of the folding stock, fixation of the rear sight, alteration in the bayonet

fixture, and some minor modifications in the principle of operation. It had a

straight blowback operation, and the curved box magazine held 30 rounds of

standard 8 mm. pistol ammunition. The estimated cyclic rate of fire was from

800 to 1,000 rounds per minute with a muzzle velocity of nearly 1,100 f.p.s.

OCO, D/A A18645

FIGURE 2.--Model 100 (1940) 8 mm. submachinegun, late model.

Rifles and carbines.-Japanese rifles and carbines developed for ground

troops before 1939 were 6.5 mm. (0.256 in.) in caliber (fig. 3), while the models

issued after that date showed a trend toward a 7.7 mm. (0.303 in.) rifle. At

one time, the Model 38 (1905) (Arisaka) 6.5 mm. rifle was the basic Japanese

infantry weapon, and it continued to be used during World War II despite the

development of other models. This weapon was a modified Mauser-type rifle

with a manually operated bolt action and was designed to fire ammunition of

medium velocity. Its length was 50.39 inches without bayonet, and it weighed

only 9 to 9)ý pounds without sling or bayonet. The mechanism of Model 38

was strong and sturdy, and, in its action, it was very similar to the U.S. rifle,

M1903 (Springfield). Two noteworthy characteristics of the Model 38 were

the slight amount of recoil and the minimal muzzle flash. The Arisaka fired

ball, tracer, or a reduced-charge (practice) ball-type ammunition with a muzzle

velocity of 2,400 to 3,000 f.p.s. and had an extreme range of over 4,000 yards.

The rifle's effective range was from 400 to 500 yards.
ENEMY ORDNANCE MIATERIEL 9

OCO, D/A 76111

FIGURE 3.- Model 38 (1905) 6.5 mm. rifle, showing bolt open and rear sight leaf up.

A carbine, Model 38 (1905), was also produced with the same operating

mechanism as the rifle, Model 38. It, however, was only 38 inches long and

and weighed about 742/ pounds. It was equipped to hold the Model 30 bayonet

and, like the rifle, was magazine fed from a 5-round clip. The ammunition

was of the Model 38, 6.5 mm. ball and reduced-charge (practice) ball types.

Muzzle velocity and maximum range were slightly less than for the Model 38

rifle because of the decreased barrel length.

Another carbine model which evolved from the Model 38 was designated

the Model 44 (1911) 6.5 mm. cavalry carbine. It had the same bolt action,

trigger mechanism, and receiver as the Model 38 rifle, but the bayonet was of

the permanently attached folding type. The carbine, with bayonet folded,

measured 38h inches and weighed about 8•24 pounds.

A sniper's rifle, Model 97 (1937), was also based on the Model 38 rifle and

had a folding monopod, turned-down bolt handle, and telescopic sight.

In some of the battle areas during World War II, the Model 99 (1939)

7.7 mm. (0.303 in.) rifle began to replace the Model 38 (1905) as the basic

Japanese infantry weapon. While still a manually operated, bolt-action,

5-round-clip weapon, it was only 44 inches long and weighed approximately

8%2 pounds. In addition, it had a folding monopod, AA leading sight arms,

and a hand guard extending to the front end of the stock. It used 7.7 mm.

Model 99 (1939) rimless ball-type ammunition with the projectile weighing

181 grains. The muzzle velocity was about 2,390 f.p.s., with a maximum

603225v-62 3
10 WOUND BALLISTICS

range estimated between 3,000 and 4,500 yards and an effective range of 450

to 600 yards.

Two modifications of the Model 99 were the paratrooper rifle, Model 99,

and the paratrooper rifle, Model 2 (1942). Both weapons had the same

operating mechanism and utilized the same ammunition as the parent rifle but

were designed to incorporate a takedown feature which facilitated their use

by paratroop units.

Machineguns.-One of the earlier types of Japanese light machineguns

which saw service in World War II was the Model 11 (1922) 6.5 mm. machinegun. This weapon derived its model number from the fact that it was issued

in 1922, the 11th year after the accession of Emperor Taisho in 1911. The gun

was patterned after the Czech Brno machinegun and was gas operated with

automatic fire only. One of its distinguishing characteristics was the feed

hopper on the left side which held six 5-round rifle clips of Model 38, 6.5 mm.

ball ammunition. The muzzle velocity was between 2,300 and 2,400 f.p.s., with

a maximum range of over 4,000 yards and an effective range between 600 and

800 yards. The cyclic rate of fire was 500 rounds per minute and the effective

rate from 120 to 150 rounds per minute.

The more commonly encountered 6.5 mm. light machinegun was the Model

96 (1936) (fig. 4). This model, like the Model 11, followed the Czech Brno

0CO, D/A 78331

FicuRE 4.-Model 96 (1936) 6.5 mm. light machinegun.

principle of operation and also had its outward appearance. It was still a

gas-operated automatic weapon, but the feeding device was improved to

accommodate a curved box holding 30 rounds of the Model 38 reduced-charge

ball tracer ammunition. The rate of fire was increased to a maximum rate of

550 rounds per minute and an effective rate of 120 to 150 rounds per minute.

One model of a 6.5 mm. heavy maebinegun recovered in small numbers

from the Pacific battle area, Model 3 (1914), contained many parts which

could be interchanged with the 7.7 mm. heavy machinegun, Model 92 (1932).
ENEMY ORDNANCE MATERIEL 11

Because of a smaller feedport, however, the Model 3 could not be converted

to fire 7.7 mm. ammunition. It was a gas-operated, air-cooled automatic

weapon, and its feeding device consisted of metal strips containing 30 rounds

of Model 38, 6.5 mm. ball ammunition. The muzzle velocity was 2,434 f.p.s.,

with a maximum range of 4,376 yards and an effective range of 1,500 yards.

It had a rather low cyclic rate of fire of 450 to 500 rounds per minute and a

practical rate of 200 rounds per minute.

Following the trend from the 6.5 mm. (0.256 in.) to the 7.7 mm. (0.303 in.)

weapon, the 7.7 mm. light machinegun, Model 99 (1939), was developed from

the 6.5 mm. Model 96. Basically, the two weapons were identical in principle

of operation and feeding, but the Model 99 used the 7.7 mm. rimless ball

ammunition. The muzzle velocity was around 2,300 f.p.s., with a maximum

range of 3,800 to 4,500 yards and an effective range of 600 to 1,000 yards.

The cyclic rate of fire was from 550 to 850 rounds per minute. The effective

rate was from 120 to 250 rounds per minute.

A modification of the Czech Brno gun was issued as the Japanese Model

97 (1937) 7.7 mm. tank machinegun. This was a gas-operated, air-cooled

automatic weapon that was designed for a tank mount but was available with

conventional sights and a bipod so that it could be used from ground positions.

A vertical box magazine held 30 rounds of Model 99, 7.7 mm. rimless-type

ammunition, and the cyclic rate of fire was approximately 500 rounds per

minute.

The standard Japanese 7.7 mm. heavy machinegun for ground forces

consisted of two models, the Model 92 (1932) and the Model 01 (1941). Model

92 was a modified Hotchkiss-type, gas-operated, air-cooled automatic weapon

with a metal-strip feeding device holding 30 rounds. It used Model 92, 7.7

mm. semirimmed ball, AP (armor-piercing), and tracer ammunition. Model

99, 7.7 mm. rimless-type ammunition could be used if loaded in strips. The

muzzle velocity was estimated at 2,400 f.p.s., with a maximum range of 4,587

yards and an effective range of 1,500 yards. Normal cyclic rate of fire was

from 450 to 500 rounds per minute, and the effective rate was from 150 to 250

rounds per minute.

The Model 01 (1941) was a direct modification of the Model 92 (1932)

with the primary changes involving the overall dimensions and weight of the

weapon. A total reduction in weight of approximately 41 pounds was made

in the gun and tripod mount, and the barrel was shorter, with a resultant

decrease in muzzle velocity. Both guns used the 30-round metal-strip feeding

device, but the Model 01 used rimless ball, tracer, and AP ammunition.

A 7.7 mm. machinegun of the standard Lewis design was identified in

several areas and was standard in the Japanese Navy. This machinegun,

Model 92 (1932), had the Lewis gas-operated system and used a 47-round

drum as the feeding device. It fired the 7.7 mm. rimmed Navy ammunition,

which was the same as the British .303. Muzzle velocity was 2,400 f.p.s., with

a maximum range of 4,000 yards or more and an effective range of 500 yards.

The cyclic rate of fire was 600 rounds per minute.
12 WOUND BALLISTICS

With the strafing of ground troops by enemy aircraft, the identification

of aircraft-type machineguns was of some value. The following is a list of

some of the major models:

1. Model 89 (1929), a 7.7 mm. fixed aircraft maebinegun. This gun was a

copy of the British Mark V (caliber .303 Vickers-Maxim type).

2. Model 98 (1938), a 7.92 mm. flexible aircraft machinegun. Certain

principles of design and operation not seen previously in Japanese weapons

were employed in this gun, which actually was the German MG 15 manufactured in Japan. It had a cyclic rate of fire of approximately 1,000 rounds

per minute.

3. A 12.7 mm. (0.50 in.) fixed aircraft machinegun which was a close copy

of the U.S. .50 caliber Browning aircraft machinegun, M1921.

Grenade Dischargers

The grenade discharger was designed for use by the individual soldier

and served to extend the range of the hand grenade as an intermediary weapon

approaching the true mortars. It had a curved baseplate which made it

appear as though it could be fired while the weapon was resting on a part of

the human body and, therefore, was frequently, but incorrectly, referred to as

the "knee mortar." Actually, the baseplate was made to fit over a tree trunk

or a log or to be stuck into soft earth. The weapon was never intended to be

fired while resting against the thigh, as some gullible individuals discovered to

their dismay.

The 50 mm. grenade discharger, Model 10 (1921), was a steel, smoothbore

weapon with an overall length of 20 inches, a barrel length of 9h2 inches, and

a total weight of 5%4 to 5Y2 pounds. The ammunition, a Model 91 hand grenade with safety pin removed or a pyrotechnic grenade, was inserted into the

muzzle. Upon pulling an external trigger lever, the propellent train was

ignited. The setback activated and armed the fuze. With the Model 91

hand grenade, the estimated range was from 65 to 250 yards.

In 1929, the Japanese perfected the 50 mm. Model 89 grenade discharger

which was an improvement over the Model 10. The discharger had an overall

length of 24 inches, the barrel measured 10 inches, and the total weight was

10% pounds. A distinguishing feature of the barrel was its rifling. A Model 89

HE (high explosive) shell was designed with a rotating band which expanded

against the rifling. In addition, the Model 91 hand grenade could be used as

ammunition. The Model 89 HE shell had a range of 131 to 710 yards, and the

Model 91 hand grenade had a range of 44 to 208 yards.

Mortars

Intermediate between the grenade dischargers and more conventional mortar

designs was the 70 mm. mortar, Model 11 (1922). This weapon had a rifled

tube and fired an HE projectile of the same design as that used in the Model
ENEMY ORDNANCE MATERIEL 13

89 grenade discharger. The propellent charge was contained within the base

of the projectile, and firing was accomplished by the impact of a percussion

hammer against the firing pin. The weapon had an approximate range of

1,700 yards.

The most commonly encountered Japanese mortars were 81 mm. and

90 mm., and they were very similar in appearance to the U.S. 81 mm. mortar,

MI. Among the 81 mm. mortars were two models, Model 97 (1937) and Model

99 (1939). The Model 97, 81 mm. mortar (fig. 5) was operated in the same

OCO, D/A 98392

FIGutB 5.-Model 97 (1937) 81 mm. infantry mortar. A. Three-quarter front view with

shell next to baseplate. B. Close view of elevation mechanism.

manner as the U.S. 81 mm. mortar and used an HE shell, Model 100, weighing

7.52 pounds. The shell was also similar in appearance to the U.S. 81 mm.

M43A1 mortar shell. Model 99 was a smoothbore mortar which weighed

only 52 pounds but was found to fire a 7.2-pound shell approximately 2,200

yards. The projectile for Model 99 was again similar to the U.S. M43A1

ammunition, and the two forms were found to be interchangeable. One

distinguishing feature of the Model 99 mortar was a movable firing pin which

was brought into action by striking a firing-pin camshaft with a mallet.
14 WOUND BALLISTICS

Of the 90 mm. mortars, the prototype was the Model 94 (1934). This

was a smoothbore, muzzle-loading weapon which was characterized by its

heavy recoil mechanism. This mechanism furnished greater stability with

higher powder pressures but increased the weight of the weapon to 353 pounds.

The mortar had a fixed firing pin and was fired in the same manner as the

U.S. 81 mm. mortar. Its HE rounds weighed 11.9 pounds. The approximate

range was 4,050 yards. A Model 97, 90 mm. mortar (fig. 6) was issued in

1937 and had the same general appearance as the Model 97 (1937) 81 ram.

mortar. It differed from the Model 94 mortar in the absence of the heavy recoil

mechanism and tube reinforcing hoop and weighed 120 pounds less. Otherwise, it fired the same ammunition as the Model 94 and apparently had the

Siit

OCO, D/A A19573

FIGURE 6.-Model 97 (1937) 90 mm. mortar with telescopic sight as

commonly used on most Japanese mortars.
ENEMY ORDNANCE MATERIEL 15

same range. If instantaneous contact action was not required, a delay element

could be placed in the nose of the fuze.

In addition to these commonly found mortars, the Japanese had others of

conventional design in 120 and 150 mm. sizes with unconfirmed estimates

of ranges as high as 5,000 yards. For sheer size, the Japanese had a 320 mm.

spigot mortar which fired a 674-pound shell. Ammunition for a 250 mm.

spigot mortar reportedly produced a radius of burst of 273 yards. In these

models of the mortar, the Japanese principle of the heavy shell-that is,

designing weapons to fire the largest possible shell from the lightest possible

weapon-was expressed in its most extreme form.

Artillery, Conventional Guns, and Howitzers

Because of her complete isolation for such a long period of time, Japan

ranked far behind other nations in the development of modern artillery weapons and tactics. Her artillery program was instituted in 1905 with the production of two types of field guns and two types of howitzers. These were

identical to, or modifications of, European designs, as was her artillery of later

times. As stated earlier in this chapter, Japanese models were invariably

lighter than their foreign counterparts. This lightness was achieved by

reducing the weight of the tube, equi]ibrators, recoil system, and trails, which

make up the bulk of the weight of conventional artillery. Sometimes, this

practice resulted in a loss of range, and some accuracy was sacrificed. On

the other hand, these sacrifices were more apparent than real. Most of the

Japanese artillery which was used in any great numbers was light artillery.

The supporting function of artillery dictated that it be brought as far forward

as possible for employment. Furthermore, most of the fire was aimed fire

which, at the same time, had to be observed fire. Thus, the decrease in range

with the lightening of the pieces was not a great loss. Because of the absence

of modern fire-control and fire-direction methods, Japanese artillery used much

time and many rounds to register itself. It was not adequate for counterbattery, nor was counterbattery a real mission of Japanese artillery. Since

Japanese AA artillery was also inadequate, the field artillery was very vulnerable to observation and destruction from the air. Consequently, Japanese

artillery did not fire long from any one position and was kept constantly on

the move as a passive measure to protect it from hostile counterbattery and

aircraft. The greater accuracy which heavier equipment might have given

was really not required when the registration of pieces was accomplished as

it was and when firing sites were so frequently changed.

Japanese artillery, when it did fire, was deliberate and accurate.

Table 1 presents a fairly comprehensive listing of Japanese artillery which

was used in World War II. Figure 7 shows one model of the 75 mm. class

and figure 8, one of 105 mim.
16 WOUND BALLISTICS

TABLE 1.-Japanese guns and howitzers used in World War II

Weapon Type Caliber Muzzle velocity Maximum range

mfr. F.p.s. Yards

Model 97 (1937)-- ATrifle --------------- 20 2,640 ------------ 5,450.

Model 98 (1938)_ AA/AT automatic 20 3,000-_ 7,000.

cannon.

Model 96 (1936) ------- do --------------- 25 2,850-_ 7,435.

Model 11 (1922)_ Infantry gun ----------- 37 1,480 (HE) -------

Model 94 (1934) ------- do ---------------- 37 2,330 (APHE) .... 5,000.

Model 97 (1937)_ AT gun --------------- 37 2,625 -------- 4,400.

Model 1 (1941) ------- do ---------------- 47 2,735 (HE) - -..-}8,400.

Model 92 (1932)- Howitzer ------------- 70 650 --------- 3,060.

Model 31 (1898)- Mountain gun -------- 75 (1) ------ (1).

Model 38 (1905)- Field gun -------------- 75 1,670 (HE) ------- 9,000.

Model 38 (1905) - d1,640 (HE)- 8938 (HE).

(Improved). -1-,977 (pointed) .... 13,080 (pointed).

Model 41 (1908) - - Mountain (infantry) 75 1,160 ------------ 7,000 (HE).

gun.

Model 41 (1908)-- Cavalry gun ------------ 75 1,672 --------- 11,600.

Model 90 (1930)- Mobile field gun ------- 75 2,296 - - - 16,350.

Model 94 (1934)-- Mountain (pack) gun_ 75 1,285 (pointed) ---- 8,938 (pointed).

11,165 (shrapnel)--- 7,957 (HE).

Model 95 (1935)- Field gun ------------- 75 1,700 (pointed) .... 11,660 (pointed,

HE).

Model 14 (1925) ------- do ---------------- 105 2,033 14,500.

Model 38 (1905) ------- do ---------------- 105 1,770- 10,900.

Model 91 (1931)- Howitzer -------------- 105 1,450 (HE, 11,500 (HE,

pointed), pointed).

Model 92 (1932)_ Field gun ------------- 105 2,500 (HE, 20,000 (HE,

pointed), pointed).

Model 99 (1939)- Mountain howitzer ---- 105 1,150 ---------- _ 6,000 (HE).

Model 38 (1905)- Howitzer -------------- 120 900_-------_-- 6,300.

Model 38 (1905) ------- do ---------------- 150 900 --------- 6,450.

Model 4 (1915) ------- do ---------------- 150 1,430- 10,800 (HE,

pointed).

Model 45 (1912)-- Heavy army artillery- 150 2,870- 27,250.

Model 89 (1929)-- Heavy artillery -------- 150 2,250 ------------ 21,800 to

27,450.

Model 96 (1936)-- Field gun -------------- 150 (1) ---- 28,400.

Model 96 (1936)-- Howitzer -------------- 150 1,770 ---------- 13,000 (HE,

pointed).

Model 45 (1912) ------- do ---------------- 240 1,300 ---------- 11,000.

Model 90 (1930) - Railway gun ----------- 240 3,440 -------_- 54,600.

Model 96 (1936)-- Howitzer -------------- 240 (1) ------ 15,300.

Model 7 (1918)-- Short howitzer -------- 305 (1) ------ 13,000.

Model 7 (1918)-- Long howitzer -------- 305 (1) ---- 16,600.

1 Undetermined.
ENEMY ORDNANCE MATERIEL 17

t

OcO, D/A A25876

FIGURE 7. Model 90 (1930) 75 mm. gun, with high-speed carriage.

OCO, D/A A4435

FIGURE 8.-Model 91 (1931) 105 mm. howitzer.

Rocket Launchers

Japanese rockets and rocket launchers were of no great significance in

World War II, although their development and production was rapid after

they were introduced near the end of the conflict. Late models showed a

strong German influence in their design. The early types of launchers for

ground-to-ground rockets were crude metal or wood trough-shaped ramps of

various lengths supported at the forward end by some simple form of bipod,

603225V 62 4
18 WOUND BALLISTICS

usually iron pipe. Through German influence, these models were replaced by

the tube-type launcher, some of which were supported by a light two-wheeled

carriage with fixed metal frame. Rocket-assisted AA and aircraft missiles

were still in the experimental stage at the end of the war.

Ammunition

For small arms.-The Japanese made both good and bad ammunition

for use in their small arms. One of their principal problems was to keep the

ammunition from "going bad" because of the dampness of the jungles. Much

of the ammunition, especially grenades and mortar shells, was ruined because

manufacturers tried to avoid waterproofing it. Good ammunition, often

packed in flimsy crates, deteriorated through rough transportation and the

influence of bad weather.

Small arms service ammunition (intended for actual combat use) was

classified according to type as follows: Ball, AP, tracer, incendiary, and

explosive. The ball type, oldest of the service types, was intended primarily

for use against personnel and light materiel targets. Originally, the ammunition was shaped like a ball, but, with the advent of rifling in weapons, this

ball was replaced by a cylindrically shaped bullet which would engage the

rifling. The AP cartridge was intended to be used against armored aircraft

and vehicles, concrete shelters, and other bullet-resisting targets. Incendiaries

were used for incendiary purposes against aircraft and were sometimes combined

with one or two of the other types. Tracers were intended to be used with

other types to show the gunner, by their trace, the path of the bullets, thus

assisting in correcting his aim.

The nose of most service rifle, carbine, and machinegun bullets was ogival

(curved taper) and was round in those for pistols, revolvers, and submachineguns. The body in both types was cylindrical.

In the 6.5, 7.7, and 7.9 mm. classes, the Japanese had ball, AP, tracer,

incendiary, and explosive types of ammunition. Ball, AP, and tracers were

used in ground guns, while incendiaries and explosives were aircraft ammunition. There was also a ball ammunition with a core of mild steel, instead of

lead, which was mistakenly referred to as semi-armor-piercing ammunition

during the war. During the closing stages of the Iwo Jima operation, however,

some use was made by the Japanese of 7.7 mm. explosive incendiary bullets

in ground fighting. This condition became evident when some casualties

were found to have one wound of entry and several wounds of exit. An explanation for this unusual condition was that aircraft ammunition may have

been salvaged from grounded planes and air force depots and used when

normal types of machinegun ammunition were no longer available. Cupronickel, steel, brass, copper, or zinc were the metals used in projectile jackets

with cupronickel being used most often. No steel jackets were reported in

tie 8 mm. Nambu pistol cartridge.
ENEMY ORDNANCE MATERIEL 19

The 6.5 mm. (0.256 in.) (fig. 9) bullet, especially one made with a gilding

metal (an alloy of copper and zinc) jacket, when it hit a target had an explosive

effect and tended to separate, leaving the entire jacket in the wound while the

bullet went on through. Small globules of lead scattered through the wound

and embedded themselves elsewhere in the flesh. This condition was the result of the fact that the rear-section walls of the bullet jacket, which was filled

with a lead core, were thinner than the forward walls. The sudden stoppage of

the high-velocity bullet when it hit an object produced a tendency to burst the

rear walls causing an "explosion." The lead core, which had a greater specific

gravity, penetrated, leaving behind the relatively lighter jacket from which it

had been discharged. The bullets made with cupronickel jackets had more of a

tendency to retain their lead cores because of the greater tensile strength of the

alloy when compared with the strength of the gilding-metal-jacketed bullet.

The unusually large exit wound openings often found with this caliber bullet were due to the natural instability of the bullet and possibly to its being fired

from inferior weapons. Similarly, there were elliptic entry wounds, a result of

the "keyholing" effect of bullets hitting with their sides.

Table 2 gives a description of small arms ammunition. Weights of projectiles in the table will vary somewhat from figures given in other sources.

This is true because manufacturers did not always load the cartridges in exactly

oco, D/A A23812

Fie~uE 9.-6.5 mm. ball ammunition.
20 WOUND BALLISTICS

C)

"C"s)C ~C)~S -C) It "

1:71

C))

C, o)

C) LO CC) !'lI , , 0000

- _ _l - -: -

C) C)

141

Cl) I C 0' 0 r)'l~C C C C)~~ l) '-'CcC ) C'ýCC

C) 4 -- 10 - I) )

C)~c n)I)

C) 'C~ ~ ~ t Z~Cc t

C)C 1 ) I ,CC-6C C C C

C)~~~c I I E I III

75 I75 C) I
ENEM.NY ORDNANCE 'MATERIEL 21

C S

2$

-$ C) P ma -C 

~ 0

0 0

af o

.Ina
22 WOUND BALLISTICS

the same manner. Samples taken from different factory lots showed many

slight variations.

For mortars.-Mortar shells were classified as HE, smoke, illuminating,

practice, and training. However, only the HE type was of any concern in

producing casualties. These are shown in table 3.

During the war, the South Pacific Area detonated 5 rounds of the Type

89, 50 mm. grenade discharger shell, 5 rounds of the Type 100, 81 mm. mortar

shell (fig. 10), and 4 rounds of the Type 94, steel 90 mm. mortar shell in order

to determine the frequency distribution of fragments from these missiles. The

shells were fired statically in a vertical position with their noses approximately

1 inch in the ground. Panels of Celotex, 4-feet high and k2-inch thick, were

placed in concentric circles with radii of 5, 10, 15, 20, 25, and 30 yards from

the point of burst at the center. The panels in each circle covered only onesixth of the circumference, thus making it possible to arrange them so that

no panel obstructed any other panel in a circle of greater circumference. The

number of hits for each circle, had it been possible to enclose it completely

with 4-feet-high Celotex panels, was extrapolated from the hits observed on the

assumption that the distribution of fragments was random. The results are

shown in table 4. If the mean projected area of a soldier is taken as 4.2 square

feet, the probable number of hits he would receive at various distances from the

point of burst are shown in table 5. To paraphrase table 5 in terms of the

949

oCO, D/A A27532

FIGURE 10.-Model 100, 81 mm. HE mortar shell, showing ignition cartridge,

propelling increment, and Model 100 fuze.
ENEMY ORDNANCE MATERIEL 23

c5 t ct

00'Z 00 0ý 0C

.0. C1 m ýo 000 F 1

c o5 tS, 

75 75o "o V

0 s*s.U

L t00 c

00 ~ ) ~ . O O

>, co C Cq o0

HHH7zH

00 Cm~ CC) 100 500 a)

P0- - oc
24 WOUND BALLISTICS

probability of receiving one hit, a soldier at 6.5 yards from the point of burst

would receive a hit from the Type 89 grenade; at 8.2 yards, from the 81 mm.

mortar; and at 8.93 yards, from the 90 mm. mortar.

TABLE 4.-Frequency distribution of Japanese grenade discharger and mortar shells

Counted hits on panels I Number of hits 2

Distance of panels from burst (radius Type 89 81 mm. 90 mm. Type 89 81 mm. 90 mm.

of circle in yards) grenade mortar mortar grenade mortar mortar discharger (5 rounds) (4 rounds) discharger (1 round) (1 round)

(5 rounds) (5 round)

5 132 327 276 158 392 414

10 48 19 104 58 95 156

15 37 42 65 44 50 98

20 26 22 20 31 26 30

25 21 17 21 25 20 32

30 18 8 14 22 10 21

I Panels cover one-sixth of each circle.

2 Calculated for full coverage of circles.

TABLE 5.-Hit probability for human targets, Japanese grenade discharger and mortar shells

Probable number of hits for type of shell Distance of panels from burst

(radius of circle in yards) Type 89 grenade 81 mm. mortar 90 mm. mortar discharger

5 1.56 4.4 5.7

10 .39 .55 .7

15 .17 .16 .21

20 .10 .07 .09

25 .06 .04 .05

30 .04 .02 .03

The reader should note that this was just one test. Under different

circumstances, results could also be expected to differ. For example, a mortar

shell does not hit the ground perpendicularly when fired for effect. The more

acute the angle a shell assumes when striking the ground, the more the distribution of fragments will vary from pure randomness in all directions. Those

emanating from the upper surface will go high into the air, those from the

sides will come closest to a random dispersion within limited bilateral areas,

and those on the underside of the shell will imbed themselves in the ground.

This results in a butterfly pattern of dispersion which is ascribed to many

types of shells. While the foregoing experiment arrived at some figures for

the dispersion of fragments from these Japanese missiles, it did not tell what

the wounding capabilities of the hits were. This is the core of the subject

of wound ballistics and will be fully developed in later chapters of this volume.

Neither could the study just described determine by actual count the number
ENEMY ORDNANCE MATERIEL 25

of fragments produced by each type of shell. Of the fragments which were

recovered, their size was generally small, about one-eighth to one-sixteenth of

an inch in diameter.

A study conducted in the Zone of Interior in December 1944, however,

had as its purpose the recovery of as many fragments as possible from the detonations of each of five 81 mm. mortar shells. From 542 to 696 fragments per

shell were recovered. The mean was 608.6 fragments per shell. This corresponds remarkably well with the sum of the entries in the column pertaining to

the number of hits for the 81 mm. mortar calculated for full coverage of circles

in table 4. Figure 11 shows the number, size, and shape of the fragments recovered from one of the five shells tested.

GROUP NO 4

200 RN$Sd

A * A

FIGURE Ii LFragments recovered from Japanese 81 mam. mortar shell exploded

under test conditions in Zone of Interior in December 1944.
26 WOUND BALLISTICS

The foregoing studies were presented to give the reader an appreciation of

the wounding potential of Japanese mortar shells as he reads subsequent chapters of this vohlme. It would have been desirable to note the initial and terminal velocity of the fragments and their weight, since the actual wound production of a missile is, to a great extent, a function of its mass and velocity.

These data were not available, unfortunately, but it can be assumed, based on

the initial velocity of fragments from other mortar shells of similar properties,

that the initial velocity of fragments from the Japanese 81 mm. shell was over

2,500 f.p.s. The weight of the fragments of the Japanese 81 mm. mortar shell

can be estimated in that the average gross weight for one shell of fragments

collected from detonations of the December 1944 test was 5.50 pounds. Thus,

it took more than 100 fragments of the Japanese 81 mm. mortar shell to make 1

pound of steel. These data, taken in conjunction with the distribution data

presented, should give the reader a good idea of the value of the mortar in

ground combat-a weapon which was so fully exploited by the Japanese.

For guns and howitzers.-A Japanese artillery round was conventional in

design with the usual components-projectile, fuze, propelling charge, and

primer. The projectiles were cylindrical with ogival heads and could be classified as HE, AP, incendiary, tracer, or shrapnel according to their purposes and

construction. Many embodied combinations of these elements. There were

also hollow and shaped charges in the AT, AP types. Fuzes to detonate the

projectile at the target were PD (point detonating) or BD (base detonating)

according to their position on the projectile. They also differed as to whether

the action was to be instantaneous, delay, or instantaneous-delay in

combination.

With respect to the fuze action of enemy artillery shells, it should be noted

that none of the Axis Powers possessed the proximity fuze, a device which permitted the airburst of shells. That is, the Axis forces could delay the detonation of their shells after impact, but they could not make them explode at

predetermined altitudes over a target, except by time fuzes. An airburst is

highly desirable because fragmentation then more evenly saturates the whole

area of the shell's effective radius with pieces of steel. A shell striking the

ground at an oblique angle with nose down, as explained in the preceding section

on mortar ammunition, has a fragmentation pattern more or less limited to the

lateral aspects. German attempts to achieve the airburst effect, without a

mechanical time fuze, will be described in that section.

Japanese artillery rounds ranged in weight from a little over 1 pound for

the smaller guns to well over 100 pounds in the heavy-artillery classes. The

bursting charges were either TNT, picric acid, RDX (cyclonite) and beeswax,

black powder, or dinitronaphthalene and combinations thereof. Many of the

various types of shells could be used interchangeably in Japanese artillery if

the bore size was comparable. Because of the many sizes and types, it would

be neither feasible nor worthwhile to attempt a comprehensive survey of

Japanese artillery ammunition here. Moreover, the most essential data concerning fragmentation characteristics could not be obtained. The lack of this
ENEMY ORDNANCE MATERIEL 27

data greatly limits the value of any information which could be presented.

Accordingly, only general features of the most commonly encountered types of

Japanese artillery ammunition will be described. The data are presented in

table 6.

Other Missile-Producing Agents

Grenades.-Because of its widespread use in the grenade discharger

(knee mortar), the Japanese fragmentation hand grenade was responsible for

a considerable number of casualties sustained by U.S. forces in the Pacific

islands. The Model 91 (1931) (fig. 12) hand grenade was most versatile.

It had a cylindrical cast iron body, 2.75 inches long and 1.97 inches in diameter,

which was divided into 50 serrated segments. The bursting charge consisted

of 65 grams of pressed TNT. When used as a hand grenade, the firing pin

FIGURE 12. Model 91 (1931) hand grenade.
28 WOUND BALLISTICS

>2 >

-C) -Cn

> > o

75 (C to ,CC - -d~C hcCC

-r -r tko -t b

C CC 'oCC'oCCI r) -0ý' l)CC 

-: C) -) Go 

0 

c

1 0)

m 7: tCZ'4C5 m)ZCCZ) C~)-) C))C

C)"0cl 75 C) o ~ CfS0n~b~s ~ ~ ~ ~ 0 0 0CCCC 0C ZC0C

006 CIS ) C)C C)C3 c)C) C) 4 C6 C))q

I -

.5q

S 8 q

:1ý c'
ENE-TNlY ORDNANCE MATERIEL 29

00 00

U

bD

00 :z 00

00 00 11 00 bo

lcý tx

75

br ;z ýz ol Qc bj0 w ZX w co >

cq cq

bo >0 b=0

00 W ýxo -Cl bB bo co 0

C) 0 bc bD 0 bD

1=1 ý, C=) q,. > Cý 0 41-

Do oc 00 a) - - Cz cllý cý

c c), ol 0 0 o I;z ra rZ5 -E C, rZ5 Q 00 X0 00 Z tý , 00 co 0000 00 0000 0ý) 00 0ý 1 00 L'I

Q0 coo "ti cc -0 ,1, Q:) 0 a. 'ti cllý llztý m cq m C cq t- cý cý N

4 4 06 4 16 L6 4 4 c-15 c6 16 m cc m m m m m

a, z cd

Z4

,:j ct

otý 0, 0, q

Pý

"d 75 a) (1) "o

00 f- 00 CYD cm 00 Cll
30 WOUND BALLISTICS

0 0

00

0,2

0 00 q ; P;8 0

75 -'-

00 00 0 000 t 0000 0 c, c CD

CcC - - t 00 't -1 't CZ c

r, m) ccCtCD CD m r - - t - 0 -t o

'0t

00

bEC EN

0 0

0 ~ I I I I I rI I

0 C-lf :2 C,, +Cý I
ETNEMIY ORDNANCE MATERIEL 3

* * 0 ; o to oo t

00

Z z ~ :r, 

C) 0

000

-t 00 e1c- Oct

6 d 46W _'j 06 06 ts- ol = 00000 000C

Q)

U-
32 WOUND BALLISTICS

was screwed down as far as possible, the safety pin removed, and the head of

the grenade struck on a hard object-rock, shoe heel, helmet, and so forthto activate the fuze. The delay was from 8 to 9 seconds. There was an

opening in the base of the grenade into which could be screwed a steel propellent container when it was used in the grenade discharger or a fintail stabilizer

when it was used as a rifle grenade. As a rifle grenade, a 6.5 mm. wood-bullet

blank cartridge propelled the grenade from a spigot-type launcher which was

affixed to the rifle. In both cases-as a projectile for the grenade launcher

or as a rifle grenade-the setback initiated the fuze.

There were two other Japanese hand grenades of this same general design.

One, the Model 97 (1937), was similar to the Model 91 grenade except for the

fact that a solid base prevented its use in the grenade discharger or as a rifle

grenade. This grenade also differed from the Model 91 in that it had only a

4- to 5-second delay, and it was 4 inches long and 2 inches in greatest diameter.

A smaller grenade, Model 99 (1939 (Kiska)), had a smooth-surfaced cast steel

body filled with picric acid. The overall length was 3%' inches; diameter,

1% inches; and total weight, approximately 10 ounces. The fuze delay was

from 4 to 5 seconds. Although the bottom of the body was solid, the Kiska

grenade could be fired from a rifle with the use of a Type 100 launcher especially

designed for this grenade.

Among other miscellaneous types of grenades, the Japanese had a sticktype (potato-masher) grenade which had a smooth cylindrical body of onequarter of an inch cast steel and a wood handle. There was also an HE rifle

grenade, Model 3, which could be fired from both the Model 38 and Model

99 rifles with a spigot-type launcher and the blank wood-bullet cartridge.

While similar to the Model 91 hand grenade, it was smaller and had a smooth

wall rather than the serrated body. The fuze for this rifle grenade was instantaneous upon striking an object.

Landmines.-The Japanese employed both AT and antipersonnel mines

in greater numbers as defensive weapons as the war reached closer to their

homeland.

The Model 93 (1933) (tape-measure) mine was a small circular-shaped

mine 7 inches in diameter, 1% inches high, with four metal rings on each side

for carrying or tying the mine in place. It weighed 3 pounds and had approximately 2 pounds of explosive within a sheet metal container.

The yardstick mine, so-called because it was exactly 36 inches long, was

oval in cross-section and had four fuzes or pressure points. Its charge consisted of eight %4-pound blocks of picric acid in a tin tube.

The Model 98 (1938) hemispherical antiboat mine was designed by the

Japanese for beach defense against landing craft but was also used on land as

an AT mine. It had a hemispherical appearance with two protruding, hornlike electrochemical fuzes. The body was of mild steel with two carrying

handles. Total weight of the mine was 106 pounds, with 46 pounds of explosives. The single-horn antiboat mine (teakettle mine) was smaller, had only

one horn, weighed 66 pounds, and contained 22 pounds of explosives.
ENEMY ORDNANCE MATERIEL 33

The Model 99 AP mine was also called the magnetic AT bomb or the

magnetic AP hand grenade. This mine was small, circular, 4% inches in diameter, and 1 Y inches high. Four permanent magnets were fastened to its sides

by khaki webbing to hold it in place against a metal surface until it detonated.

It weighed 2 pounds and 11 ounces.

The Japanese also used several other types of mines which will not be

discussed in detail here.

Boobytraps.-Most of the Japanese boobytraps encountered during the

early stages of the war were constructed with ordinary hand grenades with

friction-type fuze igniters or improvised electrical fuzes. Later, machinemade fuzes were also used. These fuzes were rigged to an explosive charge

which would easily detonate when pressure was applied or when an electrical

circuit was closed.

Ingenious methods were used to boobytrap the charges. Phonographs

were wired using the pickup arm as an electric contact so that, when moved

to play a record, a circuit to a charge beneath the floor would be closed. Hand

grenades were often trip-wire-operated and either buried just below the surface or left lying on the ground in brush or rubble where troops could step

on or kick them. Others were found attached to coconuts by means of a

string. When the coconut was picked up, the grenade exploded. Bamboo

poles were similarly fixed with the expectation that troops would pick up the

poles to make huts. Common objects such as fruit cans, toothpaste tubes,

flashlights, umbrellas, pipes, pistols, and soap were also boobytrapped. The

Japanese were even known to place hand grenades or packages of picric acid

in the armpits or underneath bodies of their partially buried dead to explode

when the bodies were moved.

Bangalore torpedoes, used by the Japanese to demolish barbed wire

entanglements, were occasionally also used as boobytraps. The torpedo consisted of an explosive charge placed into a piece of common iron pipe capped

on both ends. To operate, the caps had to be removed and a fuze inserted

in one end. Casualties resulted when American soldiers tried to use the pipes

as crowbars or fire grates.

Distribution of Weapons

While the foregoing paragraphs have attempted to summarize the characteristics of Japanese ordnance, a true picture of its capabilities requires

some information as to the distribution of weapons to units in the field. This

is a very difficult picture to draw for any army because army organization

is by necessity flexible and subject to frequent metamorphoses with changing

circumstances and missions. In the Japanese Army, as in most of the armies

of World War II, the division was the basic unit of the combined arms, and

an inventory of its armament should give a good idea of the distribution of

primary infantry weapons. Unfortunately, the situation is not so simple.

There were many types of divisions. The writers of this chapter, after con-
34 WOUND BALLISTICS

siderable deliberation, chose to describe what has been called the Japanese

triangular infantry division with RCT's (regimental combat teams). This

choice was made since the surveys described in other chapters of this study

relate to combat conditions in which this type of division organization was

most probably used.

The RCT triangular division was specially organized for island warfare

and differed radically from the standard and standard-reinforced triangular

divisions. Its strength, somewhat less than the standard divisions, varied

considerably according to the degree of reinforcement which was made. While

the average strength of this division with only one of the combat teams reinforced was 13,600, it could range as high as 16,000. Table 7 presents the weapons of this type of division with one reinforced and two standard RCT's. The

division troops included tank, signal, intendance, ordnance, land transportation

and sea transportation units; a field hospital; and a water supply and purification section. A reinforced regiment had three infantry battalions, each with

three rifle companies, one mortar company, one artillery company, and one

engineer platoon; a machine cannon company; tank company; engineer company; signal company; and a medical detachment. A standard regiment in

this type of division had three infantry battalions, each with three rifle companies and an infantry gun company; an artillery battalion; engineer company;

signal company; transport company; and a medical detachment.

TABLE 7.-Distribution of weapons in a Japanese triangular infantry division with 1 reinforced and 2 standard RCT's (regimental combat teams)

Division

Reinforced Standard Standard headquar- Weapons ROT ROT ROT ters and Aggregate

troops

Rifles --------------------------------- 1,950 1,650 1,650 900 6, 150

Grenade dischargers --------------------- 108 108 108 4 328

Light machineguns ---------------------- 108 108 108 13 337

Heavy machineguns ---------------------- 18 is 18 -------- 54

20 mm. AT rifles ------------------------ 9 --------.-------- -10 19

20 mm. AA machine cannon -------------- 6 --------- ----------------- 6

37 mm. AT guns ------------------------ 6 6 6 -------- 18

70 mm. battalion howitzers --------------.--------------- 6 6 12

81 rmm. mortars ------------------------ 54 --------.--------.-------- 54

75 mm. mountain guns ------------------. 9 ------------------------ 9

75 mm. field guns ------------------------.-------- 12 12 -------- 24

Flamethrowers ------------------------- 7 4 4 --------- 15

Tank ----------------------------------- 9 ---------------- 17 26

The reader may have noticed that, in table 7, many of the previously described weapons are missing. Some of these helped make up the arms of a

standard infantry division. In a standard infantry division, there was, for

instance, a field artillery regiment with twenty-four 75 mm. field guns and
ENEMY ORDNANCE MATERIEL 35

twelve 105 mm. howitzers. The regiments of the standard division had both

70 mm. battalion howitzers and 75 mm. regimental guns. The other weapons

were in many different types of independent units, such as artillery regiments

and mortar battalions, which usually made up army troops. (There was no

Japanese corps organization similar to the corps organization in the U.S. Army.

The Japanese field army had the tactical functions of a U.S. Army corps and

the administrative and operational responsibilities of a U.S. field army.)

GERMAN ORDNANCE

The history of Germany in modern times closely parallels, in many respects, the history of Japan. At a time when the New World was being settled and the other powers of Europe were in their period of greatest territorial

and commercial expansion, Germany was beset by internal strife. The country was split into small principalities and kingdoms for over 200 years following

the Thirty Years' War (1618-48). It was not until the latter half of the 19th

century that two powers arose which were strong enough to contest each other

for control of all Germany. This struggle culminated in the Seven Weeks'

War in 1866 which saw Prussia emerge on top. In 1867, the same year as the

Meiji Restoration in Japan, a semblance of a united Germany came into being

in the North German Confederation created by the Prussian Chancellor,

Otto von Bismarck. In 1870, the establishment of the German Empire

(Deutsches Reich) was proclaimed, and Wilhelm I of Prussia was made Emperor on 18 January 1871.

Unlike Japan, the German peoples had not let themselves become isolated

from the rest of the world during this interim of internal conflict. Trhe Prussian Army was first rate for its time and a victorious army in the fight for the

control of Germany. By 1870, Bismarck was ready for war. It was a simple

matter to trick Napoleon III of France into a war with the new German State,

and it was an equally simple matter for the disciplined Prussian Army to

defeat the demoralized French forces. France ceded Alsace and most of

Lorraine to Germany by the Treaty of Frankfurt on 10 May 1871 and enriched

the treasury of the just formed Deutsches Reich by paying an indemnity of

5 billion francs.

These successes firmly established the high position of Prussian officers

in the government of the new State and guaranteed the establishment and

maintenance of, what they hoped, was a second to none fighting machine as a

part of the country's national policy. The military spirit became the fiber of

the country; the military band, commonplace. The duel with swords was

the most respected form for settling disputes between individuals and was the

ultimate recourse for the preservation of one's honor. On such a political

and sociological base was built a mighty force which rose to challenge the peace

of Europe and the world in 1914. It required the combined might of the
36 WOUND BALLISTICS

Allies to stop this force in 1918, but the Treaty of Versailles did not destroy the

spirit of militarism nor the men who possessed the know-how to conduct such

a war. Shackled and frustrated during the period of the German Republic,

the military spirit emerged afresh with Hitler's establishment of the Third

Reich. The somber strains of Deutschland Uber Alles once again threatened

the world-a phoenix arising from its ashes not yet cold.

The German Army of World War II was the end product of nearly a

century devoted continuously to the exhaustive study of all aspects of the

science of war. It was the product of a totalitarian country which had accepted

total war as an instrument of its national policy and which supported the

armed forces with every scientific, economic, political, and psychological

resource available. The weapons were the best that keen scientific and military

minds could devise and which the country's economic resources could provide.

The overall weapons system was tailored to fit the new tactical doctrine created

and taught by the general staff, a tactical doctrine new in the means by which

it would be carried out but employing every ruse and effect which had been

known to succeed in wars through the ages. They called this type of warfare

the blitzkrieg. The main components of the blitzkrieg included deep penetration on a narrow front by huge armored vehicles and demoralization of the

enemy and destruction of his lines of communications by screaming dive

bombers. Penetrate, surprise, shock, encircle, demoralize, and mop up-this

was the simple theme. The blitzkrieg proved singularly effective in the early

days of World War II against troops woefully and inadequately prepared by

training and by their equipment to stop such a force.

In this type of warfare, the infantry was more or less relegated to the

position of mopping up a confused enemy force cut off from reinforcements and

from contact with the rear. If the infantry was used as an initial assault

element, the purpose was limited to achieving a penetration or wedge to permit

the armor to go through the infantry for the primary phase of the attack. The

infantry was also used to follow up the tank assault in order to protect the

flanks and to consolidate the ground gained before the phase of general moppingup operations. Accordingly, many weapons of the infantryman were automatic. While having less accuracy or range than conventional aimed small

arms, they better suited the missions of the German infantry. Initially,

however, the basic arm of the German infantryman was the carbine, Kar.

(Karabiner) 98K, a bolt-action weapon which was just as efficient at long

ranges as any other European rifle. At the time of the attack on Soviet

Russia, the German infantryman did not have as many automatic weapons as

his counterpart in the Red Army.

German artillery doctrine closely resembled that of the U.S. Army, but,

in practice, greater emphasis was given to assault guns for close support of the

attacking infantry or armor. Less emphasis was given to AA artillery during

the earlier periods of the war, since it was expected that the Luftwaffe would

have general air superiority over any of the foreseeable enemies of the German

Reich.
ENEMY ORDNANCE MATERIEL 37

However, it has always been the fate of new offensive weapons and methods

to meet their equal, eventually, in adequate defensive weapons and tactics.

As the war progressed, the Germans were to find that armor sent alone against

adequate AT defenses soon became "sitting ducks." In tank-versus-tank

warfare, the Germans were chagrined to discover that the Soviet Union had

developed tanks with sufficient armorplate protection and long-range guns to

enable them to hold their own against German tanks. The other Allies had,

meanwhile, fielded enough armor and developed tactics which enabled them to

"gang up" on German armor. An unforeseeable eventuality to the Nazi war

chiefs was the drastic loss in air superiority which the Luftwaffe suffered.

The greater strength of the Allies in artillery and in longer range, high-velocity

infantry weapons was a great deterrent to the successful employment of the

German foot soldier. The period of "blitzkrieging" had come to an end.

To meet these changes, the German Army created units of motorized and

armored infantry to be employed with the armor to destroy enemy AT defenses

and protect friendly tanks. More artillery was made self-propelled and

mounted on armored vehicles to facilitate their deployment and to make Allied

counterbattery more difficult, but fuel shortages eventually erased these

advantages. Effective AA artillery systems were developed. Antitank and

AA weapons were ingeniously used as assault and defensive weapons. Rockettype artillery, although less accurate than conventional or recoilless types,

was created to make up for shortcomings in German artillery, especially in

laying massed fires ahead of attacking formations and in the protection of the

flanks of attacking columns. The original overdevotion to the principle of

providing automatic weapons to the infantry could not be changed for new

reasons. Critical manpower shortages hit the Wehrmacht, and it became

necessary to cut down the personnel strengths of ground units while at the same

time increasing firepower by using even more automatic weapons. Finally,

the German concept of an aggressive, mobile, and fluid defense had to be

abandoned for linear-type defenses in depth and in strongly fortified, organized

positions.

The German Army which had started the war with arrogant confidence

in its sensational offensive techniques finished the war with great despair

while desperately employing every defensive means possible to forestall the

obvious end and in order, perhaps, to obtain a peace short of unconditional

surrender.

The foregoing summary, it is hoped, will provide the reader with background information to help him better understand and evaluate the descriptions

of individual items of German ordnance which follow.

Small Arms

Pistols.-Perhaps the most widely known official sidearm of the German

Army was the 9 mm. (0.354 in.) Parabellum pistol or Luger (P (Pistole) 08).

The 1908 model was a modification of an original Borchardt pistol which the
38 WOUND BALLISTICS

Germans had redesigned in 1900 and designated the Luger. This weapon was

well recognized for its power and accuracy and customarily utilized an 8-round

magazine with 9 mm. Parabellum ball ammunition. Variations in the propelling charge of the cartridge resulted in muzzle velocities ranging from as low as

1,025 to as high as 1,500 f.p.s. The maximum range with lowest powered cartridge was about 1,200 yards, and the effective range was from 50 to 75 yards.

A later issue standard German sidearm was the 9 mm. Walther semiautomatic pistol (P 38) (fig. 13). One of the distinguishing features of this weapon

4 ....... ."

OCO, D/A 95122

FIGURE 13.-Model P 38 (Walther) 9 mm. pistol. A. View of pistol and

magazine. B. View of pistol with magazine inserted.
ENEMY ORDNANCE MATERIEL 39

was its double action, which enabled it to be fired by squeezing the trigger

without first cocking the hammer when there was a cartridge in the chamber.

The Walther fired the regular issue German 9 mm. Parabellum ammunition

and could also use the 9 mm. ammunition manufactured for the British Sten,

British Lanchester, and the Italian Beretta submachineguns. Ballistic data

were the same as for the Parabellum (Luger) pistol.

Submachineguns.-The 9 mm. MP (Maschinenpistole) 18 was the original German submachinegun introduced toward the end of World War I and

continued in limited use-police, concentration camp guards-through World

War II. It fired the standard 9 mm. Parabellum ammunition with a 32-round

drum magazine. The cyclic rate of fire was 550 rounds per minute; the effective range, 218 yards.

A more recent model of the 9 mm. submachinegun was the Bergmann MP

34. This was a semiautomatic or full-automatic, air-cooled, blowback-operated

weapon which was fed by a 32-round box magazine. The effective range was

218 yards; the maximum rate of fire was from 500 to 600 rounds per minute;

and the practical rate of fire, 120 rounds per minute. Another 9 mm. submachinegun was originally designed for use by paratroopers but gradually

came to be used by all general combat units. It was first brought out as the

model MP 38 and later modified as the MP 40 (Schmeisser) (fig. 14). Both

models were equipped with a folding shoulder stock and could be used as either

a shoulder or a hip weapon. Standard 9 mm. Parabellum ammunition was

used with a 32-round box magazine, and both had muzzle velocities of 1,040 to

1,250 f.p.s. The effective range was 200 yards; cyclic rate of fire, from 450 to

600 rounds per minute, depending upon the type of ammunition and the tension of the recoil spring. The practical rate of fire was 180 rounds per minute.

OCO, D/A 72210

FIGURE 14.-MP 40 (Sehmeisser) 9 mm. submachinegun, stock extended.
40 WOUND BALLISTICS

When fired fully automatically, however, these weapons could not have been

accurate at ranges over 100 yards.

During the course of the war, the Germans issued various models of a 7.92

mm. (0.312 in.) submachinegun. The most commonly encountered models

were the MP 43, MP 43/1 and the MP 44. The designation of the MP 44 was

later changed to Sturmgewehr 44 (assault rifle 44). The original design from

which these weapons were developed was the 7.92 mm. M. Kb. 42 (machine

carbine 42). Many parts were constructed from steel stampings, but the gun

was very serviceable with reliable operation and general accuracy. The ammunition was 7.92 mm. type MP 43 Patronen with mild steel core and had a

muzzle velocity of approximately 2,250 f.p.s. The effective range was 400

yards, with an effective automatic rate of fire of 100 to 120 rounds per minute

and a semiautomatic rate of fire of 40 to 50 rounds per minute.

Rifles and carbines.-The standard shoulder weapon of the German Army

was a 7.92 mm. carbine, Kar. 98K of Mauser design (fig. 15). It could be

OCO, D/A 72748

FIGURE 15.-Model 98, 7.92 mm. German Mauser rifle.

regarded as a carbine or a short rifle. In general design, it was similar to the

U.S. M1903 rifle, and certain parts were interchangeable with the later model

German carbine, G. (Gewebr) 33/40. The Kar. 98K weighed 9 pounds and

had an overall length of 43.5 inches. It fired 7.92 mm. Mauser, ground-type

ammunition with a muzzle velocity of 2,600 to 2,800 f.p.s. The maximum

range was approximately 2,500 to 3,000 yards with an effective range of approximately 600 to 800 yards.

Three older models of this gun, which varied only in barrel length and other

minor design features (the Gewehr 98, the Kar. 98, and the Kar. 98B) were

auxiliary and supplementary.

The 7.92 mm. carbine, Gewehr 33/40, was typical of the German carbine

design. This gun had an overall length of 39% inches, weighed 7 pounds 11

ounces, and had a manually operated bolt action. The carbine fired 7.92 mm.
ENEMY ORDNANCE MATERIEL 41

Mauser ball-type ammunition. The G. 33/40 was actually the Czech 7.92

Model 33, slightly modified, and manufactured by the Germans at Ceska

Zobrovka Brno.

A number of 7.92 mm. semiautomatic rifles were also issued, and these

appeared to fulfill the same function as the U.S. .30-caliber rifle, Mi. The G.

41 (W) and G. 41 (M) were basically the same, except for minor external

changes, different bolt mechanisms, and manufacturing methods. Both rifles

were gas operated, air cooled, and fed by a 10-round box magazine. On thorough testing at the Aberdeen Proving Ground in Maryland, the G. 41 (W)

proved to be much inferior to the U.S. rifle, caliber .30, M1 in reliability under

severe conditions. It fell down especially in mud and rain tests, and breakages

were numerous.

In an attempt to reduce the expense and to expedite the manufacture of

the semiautomatic rifle, the Germans also produced the 7.92 mm. Kar. 43 which

used a maximum number of forgings and stampings in its construction.

The 7.92 mm. German paratroop rifle, FG (FallschirmjaLger Gewehr) 42,

(fig. 16), was used by ground troops and was employed either as a submachinegun, a rifle, or as a light machinegun. Its action was a modification of the

Lewis light machinegun, and it fired the 7.92 mm. Mauser ground-type ammunition with a cyclic rate of fire of 600 rounds per minute.

OCO, D/A B19212

FIGURE 16.-Model FG 42 (1st version) 7.92 mm. automatic rifle.

6032251-62-5
42 WOUND BALLISTICS

During the invasion and occupation of Poland, the Germans captured

large numbers of the Mascerzek 7.92 mm. AT rifle, Model 35 (fig. 17). These

rifles were issued to the German ground forces and were used extensively in

the early stages of World War II. The Polish weapon was a bolt-action gun

of the modified Mauser type and resembled the IMlauser rifle except that it

was longer and heavier and had a muzzle brake. The ammunition, which had

a steel jacket with an AP steel core and a lead antimony filler, was contained

in a 5-round clip. The muzzle velocity was very high, 4,100 f.p.s.

oco, D/A 78874

FIGURE 17.-Model 35 (ex-Polish) 7.92 mm. antitank rifle.

Following the Polish design, the Germans produced several rifles identified as Pz.B (Panzerbtichse) 38 and 39. The Pz.B 39 was manually loaded

and fired a single shot from the shoulder with the aid of a bipod. The ammunition was a 13 mm. cartridge case necked down to 7.92 mm., similar to that

used in the Polish AT rifle. The projectile had a tungsten carbide core with

a lacrimator pellet and tracer mixture. The muzzle velocity was 3,540 f.p.s.,

with a 14-inch penetration of face-hardened plate at a range of 100 yards.

By means of minor design alterations, the Pz.B 39 was modified to a

grenade throwing rifle (Granatbiiebse 39). The attached launcher was the

Scheissbecher which was the same type used on the Mauser Kar. 98K rifle.

Both large and small AT grenades and antipersonnel grenades could be fired

from the rifle. The propelling medium was a wood-bullet blank cartridge.

Machineguns.-The most commonly encountered automatic weapon used

by the German armed forces was the 7.92 mm. dual-purpose machinegun,

Model 34 (MG (Maschinengewehr) 34) (fig. 18). This weapon possessed an

unusual degree of adaptability since it could be used as alight or heavy machinegun against ground targets and troops or as an AA machinegun. It could

also be mounted on tanks and other vehicles. The ammunition consisted of

the 7.92 mm. Mauser ground type and was supplied in 75-round saddle-type

drums, 50-round belt drums, and nondisintegrating metallic link belts. The
ENEMY ORDNANCE MATERIEL 43

oCo, D/A 80852

FIGURE 18.-MG 34 (Solothurn) 7.92 mm. dual-purpose machinegun.

muzzle velocity varied between 2,500 to 3,000 f.p.s., depending upon the type

of ammunition. The cyclic rate of fire was from 800 to 900 rounds per minute,

and the practical rate of fire as a light machinegun was from 100 to 120 rounds

per minute. As a heavy machinegun, this rate increased to 300 to 350 rounds

per minute. The maximum range was about 5,000 yards with an effective

range as a light machinegun of 600 to 800 yards and as a heavy machinegun

of 2,000 to over 3,800 yards.

In the later developments of the MG 34, a number of models were produced (MG 34 modified, MG 34 S, and MG 34/41)-all of them retaining

the original pattern of the weapon-but each modification tended toward

simplification and elimination of machine parts. One of the latest models

of German ground machineguns was the 7.92 mm. MG 42 which was intended

to replace the MG 34. The MG 42 continued to be a multipurpose machinegun which could be mounted on a bipod as a light machinegun and on a tripod

as a heavy machinegun. The MG 34 and 42 could also be used as AA machineguns and could be mounted on armored vehicles. The feeding device consisted

of 50-round links of metallic nondisintegrating link belt or 50-round belt

drums. The muzzle velocity was from 2,500 to 3,000 f.p.s., with a cyclic

rate of fire of 1,335 rounds per minute. When used as a light machinegun,

the maximum range was 2,200 yards and the effective range, from 600 to 800

yards.
44 WOUND BALLISTICS

After the occupation of Czechoslovakia, the Germans adopted one of

the Czechoslovak 7.92 mm. heavy machineguns and labeled it MG 37 (T)

(Brno). This weapon appeared to have been designed primarily for use on

tanks and other armored vehicles, but it was also very effective as a heavy

machinegun when mounted on a tripod.

Although primarily intended as an aircraft machinegun, the 7.92 mm.

MG 15 was frequently utilized as a ground weapon by adding a standard

bipod and a butt extension. The standard 7.92 mm. rimless ammunition

was used in this gun with a cyclic rate of fire of 1,000 rounds per minute and

a practical rate of fire of 300 rounds per minute. This gun was produced in

Japan as the Model 98 (1938) flexible aircraft machinegun.

Mortars

At the onset of World War II, the Germans had two principal mortars,

the 50 mm. company and the 81 mm. battalion. When it became apparent

that they could not match the firepower of their enemies, especially the Soviet

forces, a short 81 mm. mortar was designed to supplement the 50 mm.

The German 50 mm. (1.969 in.) light mortar (5 cm. l.Gr.W. (Leichter

Granatenwerfer) 36) consisted of a tube, cradle, and baseplate and differed

from the conventional American mortar design in being trigger fired. This

weapon had a total weight of 31 pounds, and, owing to its compact structure,

it could easily be broken down into two loads for transportation. It fired

an HE projectile weighing 2.2 pounds with a muzzle velocity of 230 f.p.s.

and a maximum range of 550 yards at 450 elevation. The rate of fire was

from 12 to 20 rounds per minute.

A power-operated automatic 50 mm. mortar (5 cm. Machinengranatwerfer) was found in special concrete turrets in fixed defensive systems. This

weapon was almost twice as long as the standard 50 mm. mortar. A 6-round

clip was manually loaded into a rack, and as each round was fed into the

breechblock the tube would slide down over the shell and lock into place.

The feeding, locking, and firing mechanisms were electrically operated.

The German 81 umm. (3.19 in.) mortar (8 cm. s.Gr.W. (Schwerer Granatenwerfer) 34) (fig. 19) was the equivalent of the U.S. 81 mm. mortar, MI. This

weapon was a smoothbore, muzzle-loaded mortar with a fixed firing pin and

weighed 124 pounds. Standard smoke and HE ammunition were used. The

HE shell weighed 7.7 pounds and had a maximum range varying between

1,094 and 2,625 yards, depending upon the number of propellent increments.

In addition, a modified HE shell known as the "bouncing bomb" was developed

to provide an airburst, but it proved unsuccessful.

In an attempt to combine the firepower of a medium mortar with the

mobility and lighter weight of a light mortar, the Germans produced a short

81 mm. mortar (8 cm. Kz. Gr.W. (Kurzer Granatenwerfer) 42). This weapon,

with a shorter barrel and smaller baseplate and bipod than the standard 81 mm.
ENEMY ORDNANCE MATERIEL 45

000, TI/A 69245

FIGURaE 19.--81 mm. mortar with bipod and baseplate.

mortar, weighed 62 pounds and fired the HE shell with a maximum range of

1,200 yards.

Among the heavy mortars, the 105 mam. (4.13 in.) smoke mortar (10 cm.

Nebeiwerfer 35) was an enlarged version of the standard 81 mam. mortar and

corresponded to the U.S. 4.2-inch chemical mortar. Although it was issued

originally to chemical warfare troops for firing smoke and chemical shells, a

16-pound HE shell with a maximum range of 3,300 yards was also issued.

Another 105 mm. chemical mortar (10 era. Nebclwerfer 40) was a smoothbore, breechloaded weapon transported on a carriage from which it could be

fired. This mortar fired an HE shell weighing 19.1 pounds and had a maximum range of 6,780 yards.

After the invasion of the U.S.S.R. and the capture of large numbers of the

Soviet 120 mam. (4.7 in.) mortar (fig. 36), the Germans adopted this weapon

and began to manufacture it in Germany. This mortar (12 cm. Gr.W. 42) was

conventional in design and had a total weight in the firing position of 616

pounds and a barrel length of 6.12 feet. The German model could be percussion

or trigger fired and used four types of German HE shells as well as captured

Soviet ammunition. The HE ammunition weighed 35 pounds and, with a

maximum range of 6,600 yards, provided artillery support comparable with
46 WOUND BALLISTICS

that from the 105 mm. field howitzer. Because of its high degree of mobility,

it could quickly be towed or manhandled into a new firing position. This was

accomplished by means of an easily attached two-wheeled carriage and by

having the bipod carried clamped to the mortar ready for action. This same

mortar was destined to be used again in Korea against American troops.

A 200 mm. (7.87 in.) spigot mortar (20 cm. Leichter Ladungswerfer) was

developed for use by engineering units in the destruction of minefields, concrete

fieldworks, and wire obstructions. It fired a standard HE shell that weighed

46 pounds and had a maximumn range of 776 yards. A 380 mm. heavy spigot

mortar with an HE shell weighing 331 pounds was probably an enlarged version of the 200 mam. weapon.

Artillery, Guns, and Howitzers

As in the case of Japanese ordnance, the variety of German guns and howitzers defies a description of each. Moreover, the details of the construction

and functioning of any of these pieces would not contribute materially to an

understanding of their casualty-producing capabilities. In view of these considerations, table 8 lists the primary conventional artillery pieces of the German

Army and shows the type, caliber, ammunition used, projectile weights, and

maximum range. The models with a designation of "18" signify those which

constituted the standard artillery of the German Army when it entered World

War II. Some of these were originally developed in World War I. In addition

to the guns and howitzers shown in table 8, there were many models of heavy

artillery-mostly long-range guns-which ranged in size from 21 cm. (8.27 in.)

to 80 cm. (31.5 in.). These will not be described because they were not intended to be casualty producing in frontline areas and are not significant in

the casualty surveys which make up some of the later chapters of this volume.

While AT (fig. 20) and AA weapons do not normally function as primary

casualty-producing instruments of war against ground troops, they must be

considered here because of the widespread use by the Germans of their 8.8 cm.

(88 mm.) HE shell against ground formations. In almost all cases, German

8.8 cm. guns were either AA or AT weapons.

OCO, D/A 82354

FIGURE 20.-Pak 38, 50 mm. antitank gun.
ENE-MY ORDNANCE MATERIEL 47

The basic 8.8 cm. gun was the Flak 18 which appeared as early as 1934

as the standard AA artillery of the German Army. Later models were the

Flak 36 and 37 which differed only in mounts and data-transmission systems.

Characteristic of AA artillery, these guns had an extremely long tube of 15

feet 5 inches. The maximum horizontal range was 16,200 yards with the

20-pound HE round. The muzzle velocity with the HE shell was 2,690

f.p.s. Standing on its AA platform, these models could traverse a complete

360', be deflected 30 below the horizontal, and elevated 85' above the

horizontal.

The Flak 36 gun also appeared as the standard armament of the heavy

Tiger tanks. These tanks were designed primarily for defensive warfare

or for breaking through strong lines of defense and were relatively slow and

cumbersome-stark evidence of the German turnabout from the blitzkrieg

theory. Because of the huge gun-it extended 8 feet 10 inches beyond the

forward end of the King Tiger tank-the hulls of the Tiger tanks were of

interlocked welded steel, and their turrets were constructed in one piece in

order to give sufficient rigidity. The King Tiger was virtually invulnerable

to frontal attack.

The 8.8 cm. Flak 41 was basically similar in design to the Flak 18, 36,

and 37 but was larger all around, platform mounted on a highly mobile wheeled

base, and designed specifically as a multipurpose gun-AA, AT, and antipersonnel. The 21-foot 5.75-inch tube increased the muzzle velocity to 3,280

f.p.s., with an accompanying increase in maximumn horizontal range to 21,580

yards. An automatic rammer and electrical firing mechanism allowed a

practical rate of fire of 20 rounds per minute. By a special device incorporated in the platform, it could be fired from its wheels.

The 8.8 cm. gun also appeared in several models of the 8.8 cm. Pak 43

(fig. 21) which were mounted in tank destroyers and in the Jagdpanther, a

self-propelled gun on the Panther heavy tank chassis. The tank destroyers

OCO, D/A A40055

FIGURE 21.-Pak 43, 8.8 cir. antitank gun.
48 WOUND BALLISTICS

C)-ý - ý o - .1 Iill

00

0 t,,: lccl 0---,c 00 r0 =' cc N~ I-

~~ 0 ~~~ ocJ C0 0cccc -

1- cc qe~-- o - ~ -~

N m0 co ccm mc~ mo0~ 

I~ 0 -F ;oc ,c 1-1 - - !ý cc1 

cc -d

ccc

bt C) C9'0C

-~ c- ~ cc 0c

oo Lo ýn ID 't 1f

pCC ý Cý c C i C' c3oý a--C 40 4 I>-616

__-o c~ o c-occý ýof 10c c co

t- t t: t: t 1* t: C 0d 6 6 c f

I O 0 bt -D. ~

C a- co c- o o c

co a-c- ac-a- O a-- CO ac- ~ ~a-~)-i o m -~~ 0 CO 0 0 00 06C - ,,, 0C C bf c
ENTEMY ORDNANCE MATERIEL 49

C.

CC1 C) 

00mc0l. oo 

~tN cl o C 

o OQCCC~PI

t- C-C1 -

_ _ g__ - C u o

*~ m 0

CC C) CC - -iCC CCCCCC cC '

603225v-62 -6C
50 WOUND BALLISTICS

carried from 20 to 70 rounds of HE ammunition in addition to the AP types.

The muzzle velocity was 2,400 f.p.s., with a 20.7-pound HE round. While

these tank destroyers were primarily designed to fight enemy tanks at long

range, they and the Jagdpanther could be used for many other purposes where

a highly mobile, rapid-firing gun with plenty of power was required.

Artillery, Recoilless Weapons, and Rocket Launchers

With the use of a funneled tube (venturi) attached to the rear of the

bored breechblock to allow the gases to escape to the rear, the heavy recoil

and counterrecoil systems of artillery weapons can be eliminated. The result

is a lighter recoilless weapon. Therefore, most of the German recoilless

weapons were originally designated for use in airborne operations, but they

also saw extensive use in general ground combat.

The German recoilless 44 mm. AT grenade launchers (Panzerfaust) can

hardly be classified as artillery weapons, since the entire launcher tube was

handled by the individual soldier. The Panzerfaust Klein 30 was an even

smaller version. Four models which varied only in overall size and weight

of the tube and in the sighting rail were produced.

There was also an 8.8 cm. rocket launcher which was very similar to the

U.S. 2.36-inch rocket launcher (Bazooka) and a heavy 8.8 cm. rocket launcher

mounted on a two-wheeled carriage with single trail. The latter more nearly

approached the proportions of recoilless artillery, but it did not have traversing or elevating mechanisms characteristic of artillery pieces.

German recoilless artillery weapons were 7.5 cm. or 10.5 cm. in caliber

and designed to break down into loads for pack or airborne artillery. The

75 mm. (2.95 in.) airborne recoilless gun (7.5 cm. L.G. 40) had its weight,

325 pounds, reduced to a minimum so that it could be dropped by parachute

in two wicker containers. In comparison, the standard German 75 mm.

light mountain howitzer weighed 1,650 pounds. The HE ammunition weighed

12 pounds, and this recoilless weapon had a muzzle velocity of 1,238 f.p.s.,

with an estimated maximum range of 8,900 yards. In addition, hollowcharge and AP projectiles were available for AT purposes.

There were two types of the 10.5 cm. (4.14 in.) airborne recoilless gun

employed by the German Army. The 10.5 cm. L. G. 40 was the earlier model

and appeared to be the type most frequently encountered. The tube and

venturi jet made the overall length 6 feet 3 inches, and the gun in action

weighed 855 pounds. Both HE and hollow-charge projectiles could be fired.

Armed with the HE shell which weighed 32.6 pounds, the gun had a muzzle

velocity of 1,099 f.p.s. and a maximum range of 8,694 yards. A modification

of the L. G. 40 was introduced in 1943 and designated the 10.5 cm. L. G. 42.

Modifications in the carriage design, elevating mechanism, and breechblock

increased the weight of the gun to 1,217 pounds, but it could still be broken

down into five loads for use as pack or airborne artillery. With all these

recoilless weapons, the discharge of the propellent gases through the venturi
ENEMY ORDNANCE MATERIEL 51

tube created a danger zone approximately 20 yards wide and 50 yards long

to the sides and rear of the gun.

German rocket-type weapons appeared in combat in 1941, and, during

the ensuing war years, a considerable number of models were developed and

standardized. Some of specialized design were encountered during their experimental trial. Rocket projectors were far more mobile than standard

field artillery and were more effective for diffuse smoke and massed HE shellfire over a target area. They did not possess the same degree of accuracy

as the more conventional artillery piece. The main use of rocket projectiles

was against fortified positions and troop concentrations.

The original tube-type rocket projector was the 15 cm. Nebelwerfer 41

which consisted of a six-barrel assembly mounted on a two-wheeled carriage.

It took the crew approximately 90 seconds to fire the six rockets which

could be HE or smoke. The HE round weighed 75.3 pounds with which the

range of the weapon was 7,330 yards. This type of tube was mounted in

two banks of five tubes each on a halftrack and was called the 15 cm. Panzerwerfer 42. The 21 cm. Nebelwerfer 42 was similar in design to the 15 cm.

Nebelwerfer 41 and could be adapted with detachable rails to fire the 15 cm.

ammunition. The 248-pound HE round gave this weapon a maximum range

of 8,600 yards.

An entirely different type of launcher utilized steel or wood frames from

which rockets were fired. The first of this type was the wood-frame 28/32 cm.

Schweres Wurfgerat 40. Both 28 cm. HE and 32 cm. incendiary rockets

could be fired with a maximum range of 2,100 yards in the case of the 184.5-

pound, nearly 4-feet-long, HE rocket. The Schweres Wurfgerat 41 was a

steel-rack version, and the Schweres Wurfrahmen used the wood Schweres

Wurfgerat 40 racks on an armored halftrack. A mobile version of the Sehweres

Wurfgerat 41 was the 28/32 cm. Nebelwerfer 41 which mounted six racks on

a two-wheeled trailer.

The largest of the rocket weapons was the six-frame 30 cm. Nebelwerfer

42. This frame-type launcher used a 30 cm. HE round with a bursting charge

of 100 pounds of amatol as compared to the total weight of 75.3 pounds for

the 15 cm. rocket and a bursting charge of 28 pounds for the 21 cm. rocket.

The range of this 30 cm. rocket weapon was 5,000 yards.

Ammunition

For small arms.-The two principal calibers of small arms ammunition

which the Germans used in World War II were 9 mm. and 7.92 mm. In the

9 mm. class, used mainly in pistols and submachineguns, the PPO8 or Parabellum cartridge outnumbered all the other varieties in the field combined.

In fact, the Parabellum (or Luger) was probably the most widely used and

most efficient military pistol cartridge in the world.

The true pistol cartridge had a brass case and gilding metal or gildingmetal-plated bullet, but this varied according to scarcity of desirable metals,
52 WOUND BALLISTICS

As substitutes, cases of steel with a copper wash or steel blackened with a

protecting lacquer were used. Bullets were made with copper and nickelalloy jackets, pure nickel jackets, and with gilding-metal-plated steel jackets.

The PPOS m.E. (mit Eisenkern, with iron core) replaced the standard

PPO8 in 1943 and had a steel case, steel-jacketed bullet with mild steel core,

and copper-plated jacket inside and out. The bullet weighed only 98 grains

as compared with the standard's 124. There was also a 9 mm. sintered iron

bullet, PPO8SE.

Two other German 9 mm. cartridges were the M/34 Austrian (Steyer),

a 127-grain bullet with considerably more power than the Parabellum, and the

9 mm. Kurz, or "short" (equivalent to the .308 automatic bullet). A third

bullet used to some extent by the Germans was the 9 mm. Mauser.

In the 7.92 mm. group, the Germans had many versions, and they never

stopped development of different variations until the war was officially over.

The bullet lengths varied a great deal through the different types, but all were

loaded to an overall length of 80.5 mm. The standard ball bullet was long,

boattailed, and very well made (fig. 22). It was lead filled, bad a gildingmetal-plated jacket, and weighed about 197 grains. Muzzle velocity varied

between 2,400 and 2,500 f.p.s., depending on the weapon in which fired. The

Germans had started using steel cases in World War I, and by the end of 1943,

most German ammunition had that type of case.

tr tii fd1--,

oco, D/A Alsolo

FiGUnE 22-7.92 mm. German ball ammunition.
ENEMY ORDNANCE MATERIEL 53

German tracer bullets were the best put out by any country-beautifully

streamlined and with excellent ballistics. German armor piercers were also

very good, being very stable and accurate at long ranges. The commonest

type of armor piercer had a hardened-steel core with plated-steel jacket and

weighed 178 grains. Other types appeared which used tungsten carbide and

combinations for cores. Sintered iron and mild steel cores also came into use

in ball ammunition.

The HE incendiary, called the observation bullet by the Germans, had

a pellet in it which exploded on contact with any target, however frail. The

Germans maintained that it was used mainly for observation and rangefinding, but observers report having seen them in rifle clips and machinegun

belts.

The two main types of 7.92 mm. HEAT rifle cartridges were the Patr.

(Patronen) 318 S.m.K. (Spitzgeschoss mit Stahlkern, pointed bullet with steel

core) and the Patr. 318 Polish. The first was an original German type, while

the second was a Polish model adopted by the Germans. Muzzle velocity for

the German type was given as 3,550 f.p.s., and that for the Polish one a little

lower in the weapons for which they were intended.

Table 9 lists the principal types of small arms ammunition along with

the guns in which they were used.

For mortars.-As in the case of Japanese mortar ammunition, information

available for German mortar ammunition was negligible. The reader is asked

to take the descriptions of the German 5 cm. and 8 cm. mortar shells and compare and consider them along with descrip tions of Japanese mortar ammunition

(p. 22). In this way, perhaps, he may obtain a better picture of the fragmentation and wounding potential of German mortar shells.

Two 5 cm. (50 mm.) HE German mortar shells were tested in 1943 (fig.

23). Each shell, without explosive filler, weighed 1.57 pounds. The 284

fragments recovered from one shell weighed 0.98 pounds, thus representing

a 62.4 percent recovery of fragments. For the other shell, 272 fragments

were recovered. The fragments weighed 1.13 pounds and represented a 71.9

percent recovery. These data show that there were some 270 fragments per

pound of original metal, a proportion roughly twice as large as that for the

Japanese 81 mm. mortar shell (p. 22). It should be noted, however, that the

many factors which cause variances in experiments of this nature make these

comparisons extremely crude.

The 8 cm. (81 mm.) mortar shell incorporated the German attempt to

obtain an airburst. It was no reflection of endearment, but, in all probability,

familiarity which led the American soldier to call it "Bouncing Betty." This

HE shell was quite conventional in design except for a cast nosecap which

was secured to the projectile body by four shearpins. Upon impact, a nondelay fuze in the cap ignited a smokeless powder charge. The resulting explosion

sheared the pins holding the cap to the body and threw the shell from 5 to 10

feet into the air. In the meantime, a delay pellet was ignited, which in turn

ignited a booster charge that detonated the main TNT explosive charge at
54 WOUND BALLISTICS

CC Co 0 

CCC CC)

cc C, 00 

000

00ccý c~ ~-~ bD C CC) CC" .

e~ 1ý4 C,

00 *.6,CID ;6.5 

0C0 a)C "C5

gil cc~ CC

3 C) 5 1-

42 .4

'tCo cqC ~cO cq c cl cC) c q l l

CC C

0-q N0 ~ lc cz.i o.l N0qci c 00- ý c ýc 00ý ý c 0ýc 

cý t t t t t
ENEMY ORDNANCE MATERIEL 55

AA

!p I +

* P

FIGURE 23--Fragments recovered from one of two 5 cm. high explosive mortar shells

detonated under test conditions in the Zone of Interior in 1943.

the approximate peak height of the bounce. This ingenious device produced

an airburst without the use of a precision time fuze. It was not as effective

or reliable as the time fuze but, on the other hand, neither did the Allies have

a mortar shell which was equipped for bursting in midair.

The standard 8 cm. HE mortar shell filled with TNT weighed 3.5 kg.

(714i lb.). It was 12.95 inches in overall length, and the diameter was 3.16

inches. The mean wall thickness was approximately 0.33 inches. The metal

used in the body of the shell was a high quality casting of low carbon cast iron.

Given certain basic facts on any particular shell-type of metal, total

weight, diameter and thickness of the shell wall, type of powder and density

of filling, outward velocity of shell wall at time of detonation, and the likesuch factors as the distribution of fragments by size, velocity of fragments of
56 WOUND BALLISTICS

various sizes, and retardation of velocity of fragments with distance can be

reliably estimated. These factors, or variables, can be extrapolated for their

entire range when even limited empirical data are available.

Using such techniques and given certain data from static fragmentation

tests, some characteristics of the German 8 cm. mortar shell were derived of

considerable interest. The conclusions are presented in figure 24. The only

Distance from

Number and size point of burst

of fragments (yards)

386 FRAGMENTS (12 PERCENT) 00

10 10

/ 12020

160 160

1/20 to 1/2 OZ. 320• 320

1,632 FRAGMENTS (48 PERCENT) 00

10 10

2 20

160 160

1/200 to 1/20 oz. 320320

1,350 FRAGMENTS (40 PERCENT) 0

20 20

40 40

80 80

16 160

1/2,000 to 1/ 2 00 oz. 320 320

0 1,000 2,000 3,000 4,000

Velocity (f.p.s.)

FIGURE 24.-Fragmentation characteristics, German 8 cm. mortar shell. The horizontal lines for velocity give expected ranges of velocities and the vertical intersecting

lines give the most probable velocities. The shaded portions show velocities below the

incapacitation criterion.
ENEMY ORDNANCE MATERIEL 57

basic assumption required was that the minimum velocity of fragments was

1,000 f.p.s., a very conservative assumption. The criterion for incapacitation

(roughly equivalent to hospitalization) was the ability of fragments to penetrate 1 inch of wood. The cubes representing fragment size were obtained by

taking the geometrical mean of the class and, as illustrated, show proper

relative sizes; absolute size is shown only in scale. Of course, the shape of

fragments is generally not cubical, although one dimension must be limited

to wall thickness (0.33 in., in this case) and the second dimension in larger

fragments is usually found to equal wall thickness. Thus, in the larger

fragments, variance in size is often limited to the dimension of length. Finally,

it should be observed that, while some fragments were of insufficient mass

and velocity to meet the criterion of incapacitation, these could incapacitate,

although there is a good chance that they will not.

Many armies of the world were, eventually, to feel the burst of Soviet

120 mm. HE mortar shells-or their imitations-and the German Army was

one of them. Germany retaliated against the Red Army, however, by manufacturing, herself, the Soviet-type 120 mm. mortar and shell. Figure 25 shows

both the Soviet and German shells. Figures 42 and 43 show the Chinese

Communist versions.

Gross dimensions and characteristics of other German mortar ammunition

are presented in table 10.

For artillery.-General characteristics of German artillery ammunition

commonly used during World War II are presented in table 11. Scattered

references to fragmentation characteristics of German artillery ammunition

used during World War II were available and are reviewed. While the

information is still meager, there is, fortunately, some variety.

Two 50 mm. HE shells for German AT guns were detonated by U.S.

Army ordnance personnel. While the specific model of the shells tested was

not identified, the weights, empty, of the two specific rounds tested were 3.52

and 3.54 pounds. A total of 202 fragments weighing 3.29 pounds was recovered

from one shell, and 193 fragments weighing 3.46 pounds were recovered from

the second (fig. 26). This made the percent of fragments recovered 93.4 and

98.3 percent, respectively. Taking, arbitrarily, a ratio of 200 fragments for

3.35 pounds of metal, the number of fragments for 1 pound of metal, a rough

measure which was previously adopted for comparative purposes, becomes 60

in this case. It must be noted in this and the other examples for which this

rough approximation was calculated that, in all probability, the unrecovered

portions represent large numbers of extremely small fragments which would

greatly increase the total number of fragments if they could have been recovered

and counted. On the other hand, it was previously shown that these minute

fragments have considerably less wounding potential. If, as was stated, one

dimension of shell fragments is usually a function of the thickness of the shell

wall, then many of these extremely small pieces must be sliver shaped. They

might not incapacitate a soldier immediately, but it is obvious that they could
58 WOUND BALLISTICS

-10 -:4

S°I.

oFo, :D/I A9172

FIG-UTE 25.-High explosive mortar shells. (Left) Soviet 120 mm. mortar shell with

point-detonating fuze, showing four propelling charges and ignition cartridge. (Right)

German version of the Soviet 120 mm. mortar shell with point-detonating fuze, showing

six propelling charges.
ENEMAY ORDNANCE MATERIEL 59

44

C ) 1

4o0 c

00 0 0 00ý

CCC)l

6a -i 'a' '4a5

C) a) 0 a) 0 IV a

UCC ID UIl

itI C). C
60 WOUND BALLISTICS

cc ~0cc

c6 4

$-.

.5, . (. p

,...~ C) C

.0 .) 0

CD .~ .- 

0 C, 0 5cýr,

F ~ ~ F ~ ~ cl 00rF I I

00

C73, ) 0a 0 0

C).

C) 0 Ol) 0 )) ~p* o00~ '0 '0 W~~~

0

C)~~~t ~ ~c 00o oc
ENEMY ORDNANCE MATERIEL 61

00 0

to cc cc oo 0 oo o6

0) C) :0. . . .

0L -~ - 4- C) 4

Io Io Il co Ic I.0 I. I ~ coI oG

I0 I- CI I. CI 10 I Ic I0 Iý C

0 ') ' co '0 0' 0 '0

E- E-( -C :ý :1 *.-.- i. S .

bb'- cco ccc +

cc : cc : o 0~ o cc ~ ' I *C I

0 '0' 0' ''

M0 0 H E'

~00 0 K o u Qi Q, Q0

cc0..c~oc 0 0 0- ' 0 c ' 01100 '

to t cc ccc c 0 czoocccc r-totoaoOO~~~~~~ 0o tob0oCPCOt o-ct

666~Aci6c"S 4 c cccc 44 cii~r6ct~iu4
62 WOUND BALLISTICS

06 066 6 .0 c

00 .oclr-t -

vs 6-i iX c6 G0y 

) C: ) c- C) c) c)

0 ____ - _7_

0 I I II IZ

I I I I C) C4 C) i I I

0> 0 - C

4-.~~~r '' cPb0 ý:s-:4 - qC) Z o 0.9 :4 'o9- + 89

c, c)4jý
ENEMIY ORDNANCE MATERIEL

~4x

FwuRL 26.-Fragments recovered from one of two 50 mm. high explosive shells of a German

antitank gun detonated in Zone of Interior.

become real surgical problems when their localization and removal is mandatory, such as in the case of foreign bodies in the eyeball.

Two types of 75 mm. ammunition were tested in August 1943 in the Zone

of Interior. One was a standard 75 mm. HE shell, and the other was a 75 mm.

HE hollow-charge shell. The fragmentation results are shown in table 12

and figures 27 and 28. It can be seen that the number of fragments per pound

for the HE shell was 170, while that for the hollow-charge shell was approximately 185.
64 WOUND BALLISTICS

TABLE 12.-Fraginentation characteristics, German 75 mm. HE and hollow-charge artillery

shells

Fragments

Empty ___ ___

Type of shell Round shell

weight Total Weight Recovered

Pounds Numnber Pounds Percent

Hih -- x loiv -- - -- -- - -- -- - 1 10. 70 1, 753 10. 35 96.6

Hig eplsiv------------------ 10. 70 1, 634 9. 20 85. 9

Hihexlsieholw-hrg ------- 1 8.50 1,374 6.56 77.1

Hig olowchrg eplsie 8. 51 1, 263 7. 73 90. 8

uj ~ , IG~ROUP N 150 TO 750 GRAINS

It HAIMkit/ to 11 ( 1 Iiý1 

GROUP NO!

7S TO010 GRAINS

lie Vf~f1[* 4,I ýJ 0 3 '4 .,R # 14k

41

f1.*VtV%~e~ A *,03 bi lt

N 07 V. 0. it 

FIGURE 2-rgets fi reoee fro a Gemn7Jm.hg xloiesel
ENE-MY ORDNANCE IATERIEL

9, ý' , -;j, PAt tmC ? O

Y• t

II 4

~~~EJV,***•**

%#OU Nit0

* 1 f .jV 4'-j 

CROuF> NO 0

FIGURE 28.-Fragments recovered from a German 75 mm. hollow-charge shell.

In the introduction to this section on German ordnance, it was stated

that the German Army made extensive and telling use of AA/AT guns against ground targets as the war went along. Later, it was shown that the original Flak 18 AA gun was so used and eventually modified into the 8.8 cm. Flak 41, which was designed specifically as a multipurpose weapon. Thus, the "88"

became a feared weapon, and an AA/AT gun became a casualty-producing

weapon of no small consequence.

The HE 88 mm. shells tested were filled with amatol (43/57) and weighed

approximately 22ý/ pounds. The external diameter was 88 mm. (approximately 3•/ inches), and the average wall thickness was 0.60 inches. When fired

against ground targets, a percussion or time fuze was employed. Two rounds

were detonated in January 1943 (fig. 29). The rounds when empty weighed 19.17 and 20.37 pounds. For the first shell, 84.6 percent of fragments-1,488 pieces, 16.2 pounds-were recovered. For the second shell, there was a 78.6

percent recovery consisting of 1,543 fragments weighing 16 pounds. The

number of fragments per pound in this experiment was not quite 95, one of
66 WOUND BALLISTICS

L t + ,el I %

!ii\ ' "I,.. 4++,,

K# *A'

I t ;a ,,• -V': -- $I s-+ Ixqj I 6t A - ii9 ;0

FIGURE 29.-Fragments recovered from a German 88 mm. high explosive shell.

the lowest ratios encountered so far. This finding is actually more apparent

than real when one considers the low percent of recovery. The smaller fragments, which are many, were probably not recovered.

Other static detonation tests of the 88 mmn. HE shell were conducted. The

basic data included fragmentation results and the mean, miniium, and maximum velocities of fragments over the first 10 feet. From this basic data, the

data shown in figure 30 were derived. The method of derivation was basically the same as that explained in the preceding section on mortar ammunition

(p. 53).

Fragmentation tests conducted in January 1942 on two rounds of German

105 mmn. howitzer ammunition (fig. 31) showed the following characteris tics:

The rounds when emipty weighed 28.55 pounds. For both shells, 91 percent

of the, fragments were recovered. For the first shell, there were 2,540 pieces,
ENEM-Y ORDNANCE MATERIEL 67

Distance from

Number and size point of burst

of fragments (yards)

101 FRAGMENTS (8 PERCENT) 0 0

10 10

20 -t---20

S' o

40 40

80 80

160 160

1/2 to 5oz. 320 1+320

595 FRAGMENTS (47 PERCENT) 0 0

10 10

20 20

40 40

80 +80

160/ 160

1/20 to 1/2 oz. 320 320

574 FRAGMENTS (45 PERCENT) 0 -±--- 0

10 10

20 20

40 40

80 80

160 160

1/200 to 1/20 oz. 320 320

0 1,000 2,000 3,000

Velocity (f.p.s.)

FIGURE 30-Fragmentation characteristics, German 88 mm. high explosive artillery

shell. The horizontal lines for velocity give expected ranges of velocities, and the

vertical intersecting lines give the most probable velocities. The shaded portions show

velocities below the incapacitation criterion.

weighing 25.98 pounds; for the second, 2,063 pieces, weighing 26.03 pounds.

In this case, the number of fragments per pound was considerably below 100,

but it, is obvious that the fragments are larger in size when their numbers are

less per pound. This may be due to the fact that the shell wall is thicker.

While the number of fragments is less, their size and the amount of bursting

charge will make a larger percent capable of inflicting casualties. The reader
GS WOUND BALLISTICS

ii

4 A

j kt

'~ 40

S...... • ! il i . ] ' f 7 ' t tt If 4

i 7 * WIi

FIGURE 31.-Fragments recovered from two rounds of German 105 mm. howitzer

ammunition.

should note that, while stressing the number of fragments in these reviews

of detonation tests, there was usually no information available on any criterion

of wounding, particularly in relation to the effective radius of burst. The

latter should be considered in relation to absolute number of fragments.

Other Missile-Producing Agents

The German ground forces employed a wide variety of hand, rifle, and

signal pistol grenades for both antipersonnel and AT purposes. The standard

HE hand grenade was a stick hand grenade (Stielhandgranate 24) which

consisted of a hollow wood handle and a thin sheet metal head containing the

explosive filler. The grenade would detonate from 4 to 5 seconds after a pull
ENEMY ORDNANCE MATERIEL 69

on the porcelain ball located at the base of the wood handle. This grenade

had a total length of 14 inches and weighed 1 pound 5 ounces. Stielhandgranate 43 was a modified version of the foregoing grenade with a detachable

solid wood handle. The grenade could be thrown with or without the wood

handle. A smooth or serrated fragmentation sleeve could be clipped around

the head of the grenade to increase its antipersonnel effect.

In addition to the standard stick-type grenade, two other offensive-type

hand grenades had a similar design. A wood improvised grenade (Behelfshandgranate-Holz) consisted of a hollow cylindrical wood head screwed on a

hollow wood handle. The head contained a 50-gram bursting charge. The

other offensive-type grenade was a concrete improvised hand grenade (Behelfshandgranate-Beton). This was very similar to the wood grenade except

that the head was made of concrete and contained a full 100-gram bursting

charge. Both grenades were designed to produce blast effects rather than

primary fragmentation and were used by troops advancing in the open.

Of the standard German hand grenades, Stielhandgranate 24 and the

egg-type grenade (Eierhandgranate 39) were the most commonly used forms.

This latter grenade consisted of a thin sheet metal egg-shaped case filled with

a 4-ounce bursting charge and had a friction pull ignitor with a 4- to 5-second

delay. The grenade had a total length of 3 inches, was 2 inches in maximum

diameter, and weighed 12 ounces.

Another offensive type was a disk grenade which had no outer casing but

consisted of a disk cut from a precast or pressed pellet of explosives. The disk

was prepared from the explosive RDX/wax and measured 3ý/6 inches in diameter and 1'2 inch in thickness. A standard pull ignitor and detonator assembly with a 6-second delay was inserted into the disk.

During the latter stages of World War IT, the Germans issued a unique

hollow-charge AT hand grenade (Panzerwurfmnine 1 (L)) which was designed to

be hand thrown at tanks from a distance of 20 to 30 yards. The grenade body

consisted of a metal core containing the explosive filler and concave metal

retaining plates at the forward end. A hollow-charge sticky hand grenade

was also recovered which consisted of a tapered steel body with a flat sticky

pad at the nose.

Several HE rifle grenades were used by the Germans and, since these

were primarily antipersonnel weapons, they were capable of producing missile casualties. The Gewehr Sprenggranate antipersonnel rifle or hand grenade could be fired from a standard cup-type rifle discharger or thrown as a

hand grenade. It consisted of a tubular steel body containing a penthrite

wax explosive filler, a direct-action nose fuze, and a base assembly incorporating a flash pellet, delay train, and self-destroying system. When the grenade was launched from the rifle, it was initiated normally by the PD fuze,

but if this failed the flash pellet in the base would ignite a friction composition

which in turn would ignite a 41i-second delay pellet initiating the detonation

of the main bursting charge. The latter method of detonation was, of course,
70 WOUND BALLISTICS

designed primarily to function when the grenade was used as a hand grenade.

Various modifications of this grenade were issued and these included models

in which the pull ignitor for hand throwing was omitted, the self-destroying

assembly was lacking, or an "all-ways" point fuze was embodied which would

initiate the charge no matter which way the grenade would strike. The standard model had a maximum range of 265 yards as a rifle grenade. A later model

(Gewehr Sprenggranate mit Gesteigerter Reichweite) of the HE hand or

rifle grenade was fired by a new propelling charge and had a maximum range

of only 71 yards. In addition, the sell-destroying device was eliminated.

In both cases, the propelling charge was a standard 7.92 mm. blank cartridge

with a wood bullet crimped at the neck and sealed with wax.

Antitank grenades, although intended for use against armor, would

frequently inflict secondary-missile casualties. The standard AT rifle grenade

(Gewehr Panzergranate 30) consisted of a seamless steel tubular forward

section containing a ballistic cap, hollow-charge cone, and TNT bursting

charge and a rear portion made up of light aluminum alloy containing a fuze

and exploder system. The large AT rifle grenade (Gross Cewehr Panzergranate 40) was a slight modification of the Gewelir Panzergranate 30 to

accommodate a greater bursting charge. Two additional hollow-charge rifle

grenades were also issued, and they were similar in design but varied in that

one (S.S. Gewehr Panzergranate 46) had a maximum diameter of 46 mam.

and the other (S.S. Gewehr Panzergranate 61) had a maximum diameter of

61 mm.

An HE hollow-charge grenade (G-ewehr Granatpatrone 30) consisted of

a streamlined bell-shaped body with a slightly convex aluminum closing

disk, an aluminum hollow-charge liner cast with an RDX/wax filler, and a

graze fuze screwed into a projection at the base of the body. The grenade

exploded when it hit an object or merely grazed a target.

A number of antipersonnel and chemical grenades could be fired from

the 27 mm. signal and grenade pistol. The standard German signal pistol

(Leuchtpistole) was a smoothbore weapon and fired a variety of 40 different

signal cartridges and two kinds of HE pistol grenades. One of the latter,

Wurfgranatpatrone 326, consisted of a small HE projectile fitted to a signal

cartridge case. The second type, Wurfk6rper 361, consisted of a standard eggtype grenade attached to a projectile stem which fitted into a loose smoothbore

barrel liner.

The Kampfpistole was a later modification of the Leuchtpistole with

the addition of a small sight and rifling of the bore. With these alterations,

a nose-fuzed HE grenade could be fired in addition to the standard signal

cartridges. In the latest development of the signal pistol, the original model

was fitted with a loose steel rifled liner, a combination front and rear sight,

and a folding stock. By means of these alterations, the pistol could fire a

new-type hollow-charge grenade at close quarters against tanks.
ENEMY ORDNANCE MATERIEL 71

Other Fragment-Producing Agents, Landmines

German landmines had undergone a rather extensive developmental

program and a wide variety of models were encountered in the field. The

Tellermines (T. Mi. 29, 35, 42, and 43) were metal AT mines of a flat circular,

design which varied in size, shape, area of pressure plate, and in type and

amount of the bursting charge. The Sprengriegel 43 was a rectangular,

encased charge of TNT which could be fired electrically but required a pressure of approximately 440 pounds for activating the ignitors. A wood box

mine (Holzmine 42) was also issued for use as an AT device or as a boobvtrap.

The body consisted of a wood box of three-quarters of an inch lmnber which

was divided into four compartments by removable partitions. Two explosive

charges of 50/50 amato] were placed in the two side compartments; the central

compartment contained the primer charges and the end compartment, the

operating mechanism. A completely nonmetallic AT mine was the Tophnine

which had '• hard pulplike outer casing and a glassed ignitor,

One of the most commonly encountered antipersonnel mines was the

"Potmine" (Behelfs-Schi•tzemnine S.150) (fig. 32). The pressed steel body

CRUSH IGNITER GLASS CAPSULE

WHITE POWDER ACID

" :* BAKELITE ADAPTER

TOP PLATE STE•L RING

DETONATOR !: f, i i •'.: . BODY

:: i! '.-i:• •2 POWEJERED PICRIC ACID

FIGURE 32.--Antipersonnel mine, Behelfs-Seht'ltzenmine S.150.

was 2}2/ inches in diameter and 2 inches high. When filled with a 5}•-ounce

explosive charge of powdered picric acid, the total weight of the mine was

12}•/ ounces. A moderate pressure on the top of the ignitor would crush the

metal drum, break a glass ampule filled with acid, and thereby permit a chemical interaction between the acid and a white powder flash composition. The

resulting flash set off the detonator which ignited the main bursting charge.

During the course of World War II, the Germans utilized a number of

mines which depended upon shrapnel for their antipersonnel effect. One

of these, the S. Mine 35 (fig. 33) was 5 inches high, 4 inches in diameter, and

weighed 9}2/ pounds. There was an outer steel casing within which was fitted

an inner steel cylinder. The latter contained an ignitor, a central delay tube,
72 WOUND BALLISTICS

SHIPBAS PUA

TUBES__,ILL

SAND COVER

CORD

STEEL

CYLINDERS

STEEL •TE AL

TUBESTE BAL

4.5S SECONDS

DELAY. C . P.A.

--BODY DETONATOR_

TUBE

HIOLLOWý

SCREW /BASE PLATE

TUBES FILLED WITHi COMI>RESSE" POWDER

- •STEEL ING

BLACK POWDE R•., ,PROP.. CHARGE 4 SOFT'MTLPA

FIGURE 33.-Antipersonnel shrapnel mine (S. Mine 35).

a black powder propelling charge, a main explosive charge, and approximately

350 steel balls, rods, or scraps of metal alined along the cylinder wall. A

direct pressure of approximately 15 pounds activated a push-type ignitor.

A pull-type ignitor could be connected to trip wires, while an electric squibtype ignitor could be fired by electrical means. In any case, when the ignitor

fired, flashes of flame descended the central steel tube and set off the black

powder propelling charge which threw the inner cylinder into the air. Concurrent with this, the detonator was ignited which, in turn, set off the main

charge. The delay in the detonation of the main charge permitted the inner

cylinder to rise from 6 to 7 feet above the ground before its casing would be

fragmented to release the steel shrapnel balls. The latter would be effective

up to a radius of 150 to 200 yards.

The S. Mine 44 was of the same basic design as the S. Mine 35 but varied in

the method of igniting the main charge and in the use of many layers of small

steel shot. An inner cylinder contained a detonator, a pull ignitor, and a percussion ignitor. The latter was actuated by a direct pressure of 21 pounds or by a

tension of 14 pounds applied through lateral trip wires. The pull ignitor was

located in the base of the cylinder immediately below the detonator. It was

attached to the base of the outer casing by a 3-foot length of coiled wire. Operation of the percussion ignitor fired a fast-burning gunpowder propellant

which caused the inner cylinder to be thrown upward. When the coiled wire

was fully extended at about 1 )/ feet above ground level, the pull ignitor activated the detonator which, in turn, set off the main explosive charge. Accordingly, the small steel shrapnel balls were released at a lower level than in the S.

Mine 35 and the effective radius was less-110 yards with a 22-yard lethal

radius.
ENEMY ORDNANCE MAkTERIEL 73

In an attempt to reduce the metallic content of the antipersonnel mine

and increase the difficulty in its detection, a glass mine (Glasmine 43 (f)) was

developed. This consisted of an outer glass casing 4.2 inches in height, from

4i2/ to 6 inches in diameter, and from 0.25 to 0.40 inch in thickness. Approximately 40 pounds of direct pressure was required to break the glass shear plate

and activate either a chemical or a mechanized ignitor. Several models of wood

antipersonnel mines were also manufactured and employed against infantry,

cavalry, and light vehicles. The Schii-Mine 42 consisted of a casing of impregnated plywood or hardened compressed fibrous cardboard filled with a 100-gram

explosive charge. Two other wood mines-Models 42(N) and 43(N)-were

also encountered which consisted of an impregnated wood body with a cast

TNT filler. The 42(N) mine functioned when a pressure was applied to an

ignitor located in the top of the body, and the 43 (N) was detonated when pressure on the lid sheared two wood dowels on the front of the body and released the

safety pin. The functioning load of the ignitors used in both of these mines

was approximately 75 pounds. Mines similar to the Schii-Mine were to become favorite defensive weapons of the Communist forces in North Korea.

Distribution of Weapons

As in the case of Japanese ordnance, the reader would be left unaware of

the relative amount of use made of the weapons described unless he had some

idea of how they were distributed. The division organization in the German

Army (table 13) was the basic unit of combined arms. From the outbreak of

the war until the late summer of 1943, comparatively minor changes occurred in

the tables of organization of most types of German divisions. The average

strength for that period was from 15,000 to 17,000 and, with normally attached

troops, usually reached some 20,000 men. From the summer of 1943 on, however, several series of new tables of organization and equipment were issued.

In all the reorganizations, the trend was clearly toward economizing manpower

and simultaneously increasing firepower by a careful distribution of large numbers of automatic small arms, by lowering the number of mortars, AT guns, and

tanks, and, at the same time, by increasing potentially their calibers and

weights. These changes resulted in lowering the table of organization strength

of a division to approximately 11,000 to 13,000 in January 1945. By that time,

however, many divisions were actually of only about regimental strength in able

bodies.

The infantry division, old type, was the basic German division from the

fall of Poland until summer, 1943. Like the American triangular division, it

consisted of three regiments, each with three battalions. The 1944-type division was the midpoint in a reorganization from the old type to a drastically

reduced division in 1945. The fundamental revision was the reduction of

battalions from three to two per regiment, platoons from four to three in the

rifle companies, and accompanying reductions throughout the division. The

Volks Grenadier division, three regiments of two battalions each, was one of

603225--62--7
74 WOUND BALLISTICS

Scq eq e

z Lo q M eq o c) q

cqq 't e

c- F F F

CC)C0CC) 'eoeq F ~ FCC

C> 10 0 C) co 00FcC)0 FC

F re - cq c ,t e -q q~ eq -,

_ _ _ ~ _ ~ _t_ ' ,:

co 1C)' DocoF c 1 1 1 1 F 0 -o c coF ýr : ~ Fc 

. . .: . . . . .

IFIFFz eqA i 1 1 1 1 1 F- -e ,F~F
EiNEMAY ORDNANCE MATERIEL 75

It Cl: q Cl cl - c

clq cqClC 

-- -q Ic

al laZ 

-M - I I

Cl 5

Ic 0 D I 

0
76 WOUND BALLISTICS

the latest organizations and reflected in name and weapons the emergency

which had approached the fatherland. There is a further decrease in personnel, an increase in the proportion of small automatic weapons per man, and

the substitution of medium artillery with larger numbers of light artillery.

The other types of divisions are shown for comparative purposes and to round

out the picture.

CAUSATIVE AGENTS OF BATTLE CASUALTIES IN WORLD

WAR II

In order to determine which type of enemy weapon was most effective

against U.S. troops in World War II, it would be necessary to know the causative agent for each wound inflicted. Not only was such information impossible to get for all areas for the entire war period but what was available was

often inaccurate. Casualties who survived were frequently not able to

determine the weapons that had wounded them. For those killed outright

or who died of wounds, no opinion was available if there had been no witnesses.

Prompt interment of bodies seldom left time for recovery of the missile that

killed. Casualty surveys which supplied this type of information were made

only in certain areas at specified times. However, these studies used different methods of reporting, and the lack of a uniform system made assessment and comparison of reports difficult.

Nevertheless, many interesting facts can be brought out from the material

available. A report on the causative agents of battle casualties in World War

II showed the comparative incidence of casualties from different types of

weapons for several theaters. Compilers of the report believed that, while

the more detailed subdivisions within their three major classes were open to

question, their findings on the percent of total casualties due to small arms,

artillery and mortars, and "miscellaneous" were reasonably accurate. From

these they drew the following conclusions:

1. Small arms fire accounted for between 14 and 31 percent of the total

casualties, depending upon the theater of action: The Mediterranean theater,

14.0 percent; the European theater, 23.4 percent; and the Pacific theaters,

30.7 percent.

2. Artillery and mortar fire together accounted for 65 percent of the

total casualties in the European and Mediterranean theaters, 64.0 and 69.1,

respectively. In the Pacific, they accounted for 47.0 percent.

The report showed the relative effectiveness of causative agents which

inflicted casualties on 217,070 living wounded of the First and Third U.S.

Armies, European Theater of Operations, 1944-45 (table 14).

It is also interesting to note from two tables taken from studies conducted

on Bougainville and in Italy that more casualties in the South Pacific were

caused by rifle or machinegun fire than in the North African theater:
ENEMY ORDNANCE MATERIEL 77

South Pacific North Africa

Agent Percent Agent Percent

Shell fragments ---------------------- 50 Shell fragments -------------------- 75

Bullets: Bullets ----------------------------- 20

Rifle ----------------------- 25 Mines ------------------------------ 2

Machinegun ----------------- 8 Bombs ----------------------------- 1

S33 Other ------------------------------- 2

Grenade ---------------------------- 12

Mines ------------------------------- 2 Total ------------------------- 100

Other ------------------------------- 3

Total ------------------------ 100

TABLE 14.-Frequency distribution of casualty-producing agents in 217,070 living wounded,

First and Third U.S. Armies, 1944-45

Woumded

Causative agent

Number Percent

Small arms- ---------------------------------------------- 53, 334 24. 6

Artillery and mortar:

Shell fragments -------------------------------------- 130, 718 60. 2

Blast ------------------------------------------------ 6,880 3.2

Bombs -------------------------------------------------- 10, 559 4. 9

Burns -------------------------------------------------- 2, 498 1. 2

Other --------------------------------------------------- 13, 081 5.9

Total ---------------------------------------------- 217, 070 100. 0

NORTH KOREAN FORCES ORDNANCE MATERIEL

The weapons used by the CCF (Chinese Communist Forces) in the Korean

War were of diverse origins and types. The relatively limited munitions

production in China before 1950 had forced the CCF to rely heavily upon

weapons captured from the Japanese, the Chinese Nationalists, and the U.S.

forces. With the signing of the Chinese Communist-Soviet 30-year mutual

assistance pact in February 1950, Soviet weapons became available in increasing

numbers, but, initially, the CCF entered Korea without Soviet weapons.

Later, these Soviet weapons were supplemented by Chinese copies of foreign

designs and by limited quantities of weapons from almost every other armsmanufacturing country including Great Britain and France.

The NKA (North Korean Army) was from the outset equipped with Soviet

weapons of World War II vintage. Throughout the period of the Korean

War, Soviet weapons captured in Korea continued to be those manufactured

in or earlier than 1950.
78 WOUND BALLISTICS

Pistols and revolvers.-Pistols and revolvers among the Communist

forces in North Korea had little combat significance because of the much

more effective use by half-trained troops of the machine pistol or the submachinegun. They were, however, still issued to officers, service troops,

combat and transportation vehicle crews, and flying personnel as weapons of

personal defense. Over a dozen types were available in calibers from 6.35

mm. to 11.4 mm. The most common pieces used were the Japanese 8 mm.

pistols, 7.63 mm. Mauser pistols of both German and Chinese manufacture,

and Soviet 7.62 mm. pistols and revolvers.

Submachineguns.-The submachinegun was one of the principal weapons

of the Communist troops in Korea. Various models of the U.S. Thompson

submachinegun and the caliber .45 M3, including copies made in Chinese

arsenals, were widely distributed to CCF troops.

Before 1950, the U.S.S.R. began supplying the North Koreans with

Soviet 7.62 mm. PPSh1941 and PPS1943 submachineguns. These were also

issued to the CCF following their disastrous spring offensive of 1951. The

PPSh1941, the more prevalent, was a blowback operated, semiautomatic or

full-automatic weapon with a 71-round drum or 35-round box magazine.

The improved all-metal version of 1943, the PPS43, was also blowback operated

but fired full automatic only. Both weapons used the standard 7.62 mm.

Soviet auto-pistol cartridge. Effective ranges in the earlier model were

approximately 330 yards semiautomatic, 220 yards in short bursts, and 110

yards in long bursts. The practical rate of fire varied between 40 and 150

rounds per minute depending on whether it was firing semiautomatic, in short

bursts, or in long bursts. The PPS1943 had a practical rate of fire of 100

rounds per minute and an effective range of approximately 220 yards for short

bursts and 110 yards for long bursts. As the war progressed, the Chinese

Communists began to produce copies of these models in substantial numbers.

Rifles and carbines.-TThe enemy in North Korea used rifles obtained

mainly from four sources: Those captured from U.S. forces or from forces

armed by the United States, those captured from the Japanese, those supplied

by the Soviet Union, and those manufactured for or by China during or after

the days of the Republic.

The most important of the U.S. weapons used were the .30-caliber M1

rifles and carbines. It was reported that whole units of the CCF were armed

with the Ml carbine. The 1903 Springfield was also used extensively.

Japanese 6.5 and 7.7 mm. rifles and carbines were very popular during the

first years of the Korean War. These were gradually replaced by the Soviet

bolt-action rifles and carbines chambered for the powerful 7.62 mm. Soviet

service cartridge. The 7.62 mm. M1944 carbine, formerly the standard

shoulder arm of the Soviet infantry, was also frequently employed by the

Communist forces. This was a shorter version of the earlier Russian standard

infantry rifle, the M1891/30, also commonly used by the North Koreans.

The M1944 weighed 8.6 pounds with sling and had a practical rate of fire of

approximately 10 rounds per minute and an effective range of 440 yards.
ENEMY ORDNANCE MXINTERIEL 79

Those arms manufactured earlier for, or by, Nationalist China were all

chambered for the 7.92 mm. service cartridge. Among these were different

models of the conventional bolt-action Mauser rifles, the ZH 29 Czech autoloading rifle, and some 1888 German rifles.

Machineguns.-The CCF in North Korea acquired their machineguns

in much the same way as they did their rifles and carbines. In the light

machinegun class, they had captured a limited supply of Browning Automatic

rifles and 1919A4 light machineguns from U.S. forces and from forces of other

countries armed with weapons made by the United States. Some caliber .50

Browning heavy machineguns of U.S. manufacture were also used. From the

Japanese, they had taken substantial quantities of 6.5 and 7.7 mm. light and

heavy machineguns, including the 6.5 mm. Model 11 (1922), the 6.5 mm.

Model 96 (1936), and the 7.7 mm. Model 99 (1939) light machineguns and the

Types 92 and 01, 7.7 mm. heavy machineguns. These types were discussed

in the section on Japanese ordnance materiel.

Of Soviet origin were the various Degtyarev machine rifles and light

machineguns represented by the DP, the DPM, and the DTM. All three

types were gas operated and air cooled, and all used the standard 7.62 mm.

series of cartridges. The feeding device of the DP and the DPM was a 47-

round drum magazine, and each model weighed about 26 pounds with loaded

drum. The practical rate of fire was 80 rounds per minute with an effective

range up to 880 yards against group targets. The DTM had a 60-round drum

magazine and was used both as a tank and as a ground gun.

Two other Soviet weapons used were the 7.62 mm. Maxim M1910 heavy

machinegun (with an effective range of 1,100 yards and a rate of fire of 250-

300 rounds per minute) and the 7.62 mm. Goryunov M1943 heavy machinegun

which was a modification of the Maxim with similar performance but much

lighter. There was also a 12.7 mm. (caliber .50) DShK M1938 AA machinegun.

The DShK M1938 had a practical rate of fire of 300-350 rounds per minute

and an effective range of approximately 3,000 feet when used against aircraft

and approximately 3,300 yards when used as a ground gun.

The Chinese themselves manufactured copies of two excellent weaponsthe ZB 26 light machinegun and the Maxim heavy machinegun (fig. 34), both

of which fired 7.92 mm. ammunition. The ZB 26 was gas operated and either

semiautomatic or full automatic. It weighed close to 20 pounds and had a 20-

round box magazine. Effective range was 875 yards with a rate of fire of 150-

200 rounds per minute. The Chinese Maxim was practically identical to the

1908 Maxim but with considerable changes in the mount.

Mortars.-Mortars manufactured in Chinese Communist factories and

those captured from the Japanese, the Chinese Nationalists, and the United

Nations Forces in Korea were used extensively by Communist forces in North

Korea, often as a substitute for artillery. Those produced in Chinese Communist arsenals were the 60 mm. Model 31 (copy of the U.S. M2), the 82 mm.

Model 20, and the 120 mm. Model 44. Captured U.S. materiel included the

60 mm., the 81 mm., and the 4.2-inch mortars. Japanese models used were all
80 WOUND BALLISTICS

OCO, D/A A67073

FIGURE 34.-CCF Ma-im heavy machinegun, 7.92 rmm., Model 24.

81 mm. weapons. Three models of the Soviet 82 mm. battalion mortars, the

M1937, M1941, and M1943, were widely used. These Soviet weapons weighed

about 12.7 pounds each and fired HE shells up to 3,326 yards. The Soviet

120 mm. mortar (figs. 35 and 36) remained as effective in Korea as it was during

World War II when used by both the Red Army and the Germans.

Artillery.-Until the close of World War II, when they acquired quantities

of Japanese-made artillery, the CCF lacked both artillery materiel and experience in its use. Their supply of artillery was increased between 1946 and 1949

with the capture of considerable amounts from the Chinese Nationalists, including modern U.S. made field artillery. With Soviet aid in the Korean War,

the CCF received quantities of Soviet artillery, as the North Koreans had

before them.

Captured Japanese infantry guns and mountain artillery which the CCF

used were the Type 92 (1932) 70 mm. battalion howitzer and the 75 mm. Type

41 (1908) infantry and Type 94 (1934) mountain guns. Limited quantities of

the U.S. 75 mm. pack howitzer M1A1 and Soviet 76 mm. regimental and

mountain guns and 76 mm. howitzers were also used in addition to various

other 75 mm. pieces of French, German, Japanese, and Swedish origin.

Field artillery employed by enemy troops consisted primarily of weapons

made in Japan, the United States, and the Soviet Union. Light artillery used

was made up largely of several types of Japanese 75 mm. guns and 105 mm.

howitzers and field guns, Soviet 76 mm. divisional guns, and the U.S. 105 mm.

howitzer M2A1. Ballistic characteristics for the Japanese models have been

given previously. The Soviet 76 mm. (M1942) divisional gun, weighing 2,460

pounds, was capable of firing a 13.7-pound HE projectile a maximum distance

of 14,550 yards. The Soviet 57 mm. AT Gun (M1943) was also extensively

used.
ENEMY ORDNANCE MATERIEL 81

OCO, D/A A63950

FIGURE 35.-Two versions of the Soviet 120 mm. mortar. A. Model 38 from the European

Theater of Operations, World War II. B. Weapon captured in Korea.

603225'-62--8
82 WOUND BALLISTICS

OCO, D/A A75101

FIGURE 36.-Soviet 120 mm. mortar, Model 1943. Weapon in firing position after firing

two seating rounds. Elevation 45'.

Most important of the Soviet medium field artillery pieces used included

the 122 mm. howitzer M1938 (fig. 37), the 122 mm. corps gun M1931/37, and

the 152 mm. gun howitzer M1938. The M1938 howitzer weighed 4,960 pounds,

had a maximum range of 12,900 yards, and fired an HE projectile weighing 48

pounds. The 122 mm. M1931/37 corps gun weighed over three times as much

as the M1938 howitzer and was capable of firing a 55-pound projectile 22,750

OCO, D/A A73412

FIGURE 37.-Soviet 122 mm. howitzer, Model 1938, in firing position.
ENEMY ORDNANCE MATERIEL 83

yards. The 152 mm. (M1938) gun howitzer (fig. 38), heaviest of the three,

fired a 96-pound shell approximately 18,880 yards.

Japanese 150 mm. howitzers and guns and a small number of U.S. 155 mm.

howitzers M1917A1 were employed along with a variety of British, French,

and German weapons ranging in caliber from 75 mm. to 150 mm.

The Chinese Communists manufactured fairly exact copies of the smaller

Japanese artillery pieces but did not attempt to duplicate the larger ones.

Among the principal models copied were the 75 mm. Type 41 (1908) infantry

gun, the 75 mm. Type 94 (1934) mountain gun, and the 70 mm. Type 92 (1932)

infantry howitzer.

OCO, D/A B18645

FIGURE 38.-Soviet 152 umm. gun howitzer, Model 1938 (M10), with carriage.

Rocket launchers.-The Communists in North Korea were again supplied

by the Soviet Union in the matter of rocket launchers. The model issued was

the 8-railed 132 mi. M13 which fired 16 fin-stabilized HE rockets. Maximum

range of the 94-pound rockets was approximately 9,500 yards. This weapon,

normally mounted on a 6 x 6 truck, possessed relatively good mobility and

heavy-fire effect but lacked the range and accuracy of conventional artillery.

For this reason, it was used primarily to cover area targets since fire against

point targets was not practical.

The Chinese Communists designed and manufactured a six-round rocket

launcher, 102 mm. A3, from which they fired a Chinese copy of the U.S. 4.5-

inch rocket. This launcher was mounted on a two-wheeled carriage and was

light enough to be transported by truck.

Ammunition.-North Korea was almost completely dependent upon the

Soviet Union for the ammunition it used during the Korean War. Some

Japanese and captured U.S. ammunition was also used.
84 WOUND BALLISTICS

The Chinese Communists depended largely on ammunition derived from

different foreign nations, but they also manufactured some modified or exact

copies of products of several other nations. At the close of World War II,

they acquired quantities of Japanese ammunition. When they gained control

of the Chinese mainland in 1949, large Chinese Nationalist stocks were captured,

and Nationalist arsenals were seized. These arsenals, many originally inherited from the Japanese by the Nationalists at the close of World War II,

continued to produce Japanese-type ammunition for the Communists. Varying amounts of British, Swedish, French, Italian, and German types were

TABLE 15.-Communist China and U.S.S.R. small arms ammunition used by NKA and CCF

Projectile Nomenclature Type of construction Weapons in which used

Length Weight

7. 62 smm: Inches Grains

Type 50 ------------- Ball ----------- 0. 55 87 Type 50 submachinegun,

Type 51 automatic pistol.

Type R -------------- Unidentified . 65 108 Nagant revolver M1895.

Type P ------------------- do ---------. 55 87 TT Pistol M1933; all Soviet

submachineguns.

Model 1908, Type L___ Ball ----------- 1. 12 150 All Soviet 7.62 mm. rifles,

carbines, and machineguns.

Model 1930, Type D -------- do --------- 1. 30 185 Do.

Model 1930, Type B- AP ------------ 1. 30 184 All Soviet 7.62 mm. ground

30. machineguns, rifles, and

carbines.

Type unidentified ----- AP, tracer ------ 1. 58 157 Soviet 7.62 ground machineguns and rifles.

Model 1940, Type BS- AP, incendiary-- 1.20 187 In shoulder weapons only.

40.

Model 1932, Type B- - do --------- 1.44 155 All Soviet 7.62 mm. machine32. guns and rifles.

Type BZT ----------- AP, incendiary, 1. 58 142 Do.

tracer.

12.7 mm:

Type unidentified ----- HE. incendiary-- 2. 48 660 DShK M1938 AA machinegun.

Model 1930, Type AP ------------ 2. 45 788 Do.

B-30.

Type BS-41 -------------- AP, incendiary-- (2) (2) Do.

Type unidentified ---------- do --------- 2. 50 725 Do.

Model 1932, Type ----- do --------- 2. 46 745 Do

B-32.

Type BZT ----------- AP, incendiary, 2. 49 681 Do.

tracer.

I Communist China was the country of origin for the Type 50 small arms ammunition; the U.S.S.SR. was the country

of origin for all the other ammunition. 2 Unconfirmed.
ENEMY ORDNANCE MATERIEL 85

also collected. Soviet ammunition was received in large amounts following

CCF entry into the Korean War and was used along with the U.S. ammunition

which the enemy captured. The Chinese Communists manufactured .45

caliber small arms ammunition which literally defied differentiation from U.S.

.45 caliber ammunition when discovered in casualties. Initially, CCF use of

this ammunition caused considerable consternation since no foreign nation

had ever manufactured and used .45 ammunition against American soldiers.

Ammunition manufactured by the Chinese Communists was erratic in

quality-sometimes good and sometimes poor. Reasons for this were loose

manufacturing standards, lack of adequate forces of skilled workers, unsatisfactory machinery, and shortages of raw materials. Often, small arms cartridges were picked up after firing with cracked necks. Deficient packaging

of the ammunition frequently resulted in serious deterioration of originally

undefective contents.

General characteristics of ammunition commonly used by the enemy in

Korea and not previously described are presented in tables 15, 16, and 17.

TABLE 16.-Communist China and U.S.S.R. mortar ammunition used by the NKA and CCF I

Weight Projectile Explosive charge Fuze (Corn- Weapons in which used

plete

round)2

60 mm: Pounds

HE mortar shell --- TNT ---------- Point detonating_- 3. 25 Type 31 mortar.

HE mortar shell

(long). 3 RDX ----------.----- do ----------- 8. 0 Do.

82 mm:

HE mortar (6 fins) 4 Cast TNT ------ Instantaneous- 8.59 Type 20 (1931)

mortar.

HE mortar (8 fins) --.----- do --------- Point detonating-_ 8.29 Do.

0.832 mortar shell, Schneiderite/ ------ do ----------- 6. 95 Various 82 mm.

fragmentation. TNT. mortars.

0.832 D ------------- Amatol 90/10 ---.----- do ----------- 6. 95 Do.

120 mm:

HE mortar (short) I- Potassium ni------- -do ----------- 28. 75 Type 33 (1944)

trate/TNT mortar.

50/50.

HE mortar (long) 6-- Cast TNT ----------- do ----------- 27. 88 Do.

HE mortar (extra TNT ---------- Point detonating 46 Do.

long), impact.

I The U.S.S.R. was the country of origin for the 0.832 and 0.832 D mortar ammunition; Communist China was the

country of origin for the other mortar ammunition.

2 Without increments.

3 This shell has supplementary 120 mm. warheads filled with TNT.

4 This shell has 6 fins for stabilization.

SThis shell has 8 fins.

6 This shell has 12 fins.
86 WOUND BALLISTICS

d ct

be .08. 0

I, O cg4

0 C-

-~ 0 l

bO--~,

~.2 2

0l c0 T

I0 cq - - ~ p

0 -* -E3

0 ~ CC)

0 CCC-$ b

~0 ,o 4-'

j+C z 4-C Z 04- CC

0~~~P 7;. aC~lC -

4

p C

C4, C4
ENEMY ORDNANCE MATERIEL 87

Again in Korea, the mortar was used extensively. It was the ideal weapon

for the relatively close-in fighting in rugged mountainous terrain which characterized much of the operations in Korea. Whether it was inadvertent or

intentional is debatable, but, in Korea, the Communist use of cruder cast

metals in mortar shells seemed greatly to increase the number of fragments

per shell and the effectiveness of their antipersonnel mortar fire when compared

to conventional steel-walled shells. Often, the number of fragments per shell

was many times that described previously for Japanese and German rounds.

The apparent crudeness of the CCF mortar shells can be seen in figures 39, 40,

41, and 42, showing various 82 mm. and 120 rmm. shells.

Figure 43 shows the CCF copy of the American M48, 75 mm. artillery

round.

Mini

oco, D/A A93396 OCO, D/A A97076

FIGURE 39.-CCF 82 mm. mortar shell, FIGURE 40.-CCF 82 mm. mortar shell,

model unidentified. model unidentified, with eight fins and pointdetonating fuze.
88 WOUND BALLISTICS

OCO, D/A B7475 OCO, D/A B1900

FIGURE 41.-CCF short 120 mm. mortar FIGURE 42.-CCF extra long 120 mm.

shell, high explosive, mortar shell, high explosive model unidentifled, with long fin shaft and six fins.

Grenades.-Grenades of wide variety were used liberally by the Communist

forces in Korea because of the relative ease and cheapness of their manufacture

and because of the general shortage of heavy weapons and artillery among the

troops. The most common, as well as the most effective types, were stick

hand grenades, fragmentation hand and rifle grenades, and HEAT hand

grenades, all of Chinese manufacture. Effective also were Soviet RPG-43 and

RPG-6 HEAT hand grenades and the Soviet F-1 fragmentation grenade

(fig. 44).

The Chinese-made stick hand grenades were similar to the German

"potato-masher" type in design. They were liable to be filled with anything,

but picric acid was common. Even dynamite-filled grenades were found!

Most of the grenades had a friction pull-type ignitor. The fuze was instantaneous to 6-second delay. The HEAT grenades depended upon a fiber or
ENE-MY ORDNANCE MATERIEL 89

FIGURE 43.-CCF copy of U.S.

M48, 75 mm. high explosive shell,

with adapter and point-detonating

fuze, Model 88 (instantaneous or

delay).

OCO, D/A B1953

0C0, D/A 50530

FIGURE 44.-Soviet fragmentation hand grenade, F-i, with fuze.
90 WOUND BALLISTICS

cloth tail for stabilization. One of this type, the Type 3 HEAT hand grenade

had an overall length of 7 inches and an instantaneous impact type of fuze.

The Soviet RPG-43 HEAT hand grenade was filled with 1.35 pounds of

cyclotol and had an instantaneous impact fuze. Average range was 17-22

yards with an effective radius of fragmentation of 22 yards. The Soviet

RPG-6 had about the same average range as the RPG-43 but was filled with

TNT and had an effective radius of fragmentation of 25 yards.

Landmines.-Landmines were used extensively by the enemy because

their use afforded them a chance to improvise and allowed them to utilize fairly

effective "homemade" weapons. Their standard antipersonnel models were

designated Landmine No. 8 and Armor-Piercing No. 4. Two Soviet models

commonly employed were the PMD-6 and PMD-7 which closely resembled

the German Schii-Mine. Weighing under a pound each, these wood boxshaped mines had a cylindrical charge of TNT and an MUV pull fuze. Because

of the lack of metal parts in their construction, they were hard to detect with

mine detectors.

Improvised models were in many different forms such as bangalore torpedoes, artillery and mortar shells, aerial bombs, and hand grenades. They

also were in explosive-filled containers such as tin cans, wood boxes, fuel

drums, barrels, glass bottles, clay pots, or other types of containers. Detonation could be accomplished either by trip wire, pressure, or automatic firing

circuit.

Because of fluctuations in battle-up and down the length of Korea-a

large number of mine casualties were caused by mines planted by friendly

personnel in the defense and during retrograde movements.
CHAPTER II

Ballistic Characteristics of Wounding Agents

Maj. Ralph W. French, MAC, USA (Ret.), and Brig. Gen. George R.

Callender, USA (Ret.)

PHYSICAL ASPECTS OF THE MISSILE CASUALTY

Warfare between individuals or nations to be carried to a successful conclusion requires rendering the enemy noncombatant through injury, or death,

and concomitant loss of his ability to function within his assigned duties. In

modern warfare, antipersonnel weapons have been developed which are capable

of injuring the enemy at a considerable distance from the origin of attack, and

means, such as the atomic bomb, have been devised for the wholesale destruction

of enemy personnel and materiel. While destruction of materiel plays a role

in modern warfare, inflicting injury to cause incapacitation of personnel still

remains the most important consideration.

To develop perspective for fair appreciation of modern warfare and its

weapons, it is necessary to go back to prehistoric time. It is logical to presume

that the earliest warfare was hand-to-hand combat. This was probably

quickly augmented by sticks, clubs, or other similar and readily available aids.

Following this, prehistoric man no doubt commenced to hurl stones or other

missiles easily grasped and thrown. From this stage, it was not too great a

step to increasing missile velocity through the aid of the sling, throwing stick,

or other means to add to the missile velocity and consequent effectiveness. In

brief, man took advantage of the physical law of kinetic energy which remains

as the fundamental law in the study of missiles and the formation of wounds.

Considering early history as recorded in the Bible, it is noted that David,

in his encounter with the giant, Goliath, was conversant with the advantage

to be gained through augmenting his personal strength with small, smooth

stones which could be hurled effectively with the sling. This offset the inherent

advantage of the giant's strength. It resulted in a missile casualty.

As we come down through recorded military history, we see man aiding

his military effectiveness in rendering the enemy hors de combat with the handhurled spear or javelin followed by the arrow propelled by the bow or crossbow.

In this stage, we see man also adding to his ability by using the horse as a means

for increased velocity and force in propelling the spear. However, the arrow

was often capable of inflecting injury at greater ranges than possible for handto-hand encounter and had excellent ballistic qualities. In this period, there

91
92 WOUND BALLISTICS

also was the use of various antimateriel weapons, such as the catapult for

throwing stones. Ever since this era, there has been a decrease in the size of the

missile and an increase in velocity and consequent range of effectiveness.

With the advent of gunpowder at the battle of Cr6cy in the 14th century,

the potential for greatly increased missile velocities with ability to produce

injuries at greater ranges became apparent. However, development was

relatively slow, as gunpowder in its earliest applications was often more dangerous to friend than to foe. Metallurgy, chemistry, physics, and the manufacture of weapons had yet to be developed to permit the commonplace

applications of modern warfare.

The gunpowder available for many years was dangerous as its rate of

transformation into gas could not be accurately controlled and as it also deteriorated on slight provocation. This resulted in many serious disasters

through weapon failure. Only with the advent of the so-called smokeless

powders could rate of burning be controlled and pressures be held within safe

limits.

From the 14th to the 19th centuries was seen the development of small

arms through the blunderbuss, musket, and rifle and the development of

artillery from the crude wooden cannon to the metal smoothbore and the rifled

artillery piece. Smokeless powder with its controllable rate of burning was a

19th century invention. In this period also was seen the use of explosive

charges in grenades and landmines, as well as the development of explosive

missiles for artillery use.

In the 20th century came the airplane with its potentialities of transporting bombs many miles from the point of origin to inflict injury on enemy

personnel and to destroy materiel. There also was marked improvement in

powders and other explosive agents.

Analytical retrospection of the entire development of warfare from prehistoric time reveals man's continual struggle to augment his human capability

to inflict injury through the utilization of the law of kinetic energy as applied

to the moving object. There is a continual trend down through the centuries

toward the infliction of injury at even greater distances through increase in

missile velocity. In this respect, the airplane is only an agent to carry the

missile of destruction to yet greater distances from the point of origin. It

results in greatly increased effective battle ranges.

Along with this general trend, it also is noted that an increasingly greater

number of people are involved in major military operations with ever-increasing

effort toward the development of more and more firepower.

Missile effectiveness has been observed to be a function of velocity, and,

in keeping with this, it was but natural that through the ages there has been a

continual increase in missile speeds. Before the advent of gunpowder, missile

velocities at best could not exceed several hundred feet per second. From the

14th to the beginning of the 20th century, missile velocities were increased to

approximately 2,000 f.p.s. (feet per second). In the period 1900-1918, velocities were again increased up to approximately 4,000 f.p.s. From that
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 93

date to 1953, and taking the atomic bomb into consideration, missile velocities

have been increased to approximately 20,000 miles a second. No doubt

some of the radiation components of the atomic bomb have greater velocities

than this. However, gunpowder and its related agents were responsible only

for a velocity increase to something more than 7,000 f.p.s., the greater increase being due solely to the nature of atomic fission and its reactions.

Progressively, the outstanding steps in this analysis of missile warfare

and its development down through time follow: Clubs, stones, sling, bow to

propel an arrow, gunpowder, rifle, smokeless powder, TNT and related propellants, airplane, rockets and rocket-propelled bombs, and the atomic bomb.

From this brief r6sum6 of the progressive development of the missile as an

antipersonnel agent, it is natural to inquire just how that missile produces a

casualty. While medical men have served with the armies for many years,

it was only recently that studies to determine the mechanics of wound production have been instituted. There has been some observation and many

reports but little organized research, mainly because available instrumentation was inadequate for a serious, comprehensive study.

Better appreciation of the detailed mechanics of wound production has a

dual purpose. First, a more complete knowledge of the wound and its extent

permits better definitive treatment by the military surgeon; second, this

knowledge permits the design of ordnance materiel for antipersonnel purposes

on scientific grounds. It also lessens the need for costly rule-of-thumb or

"cut and try" methods by either the military surgeon or the ordnance engineer.

It is the purpose of this chapter to bring together the salient principles

regarding the missile casualty as a physical entity, a cause and effect phenomenon. These principles explain many apparent anomalies as seen by the

surgeon unacquainted with the detailed mechanics of wound formation and

may aid the ordnance engineer in his design problems.

Frequently, the military surgeon has seen small entrance and exit holes

in the skin of a gunshot casualty and taken it for granted that the internal

damage was correspondingly small. Had he known more of the modern

high-velocity rifle bullet and what is known as yaw, the trivial external wounds

would not have misled him in his initial treatment of the wound. Also, had

he been appreciative of the true magnitude of the forces involved, his mental

picture of the wound would have been far more accurate.

For many years, the ordnance designer gaged the effectiveness of missiles

by their ability to penetrate pine boards or similar materials. However,

when an accidental discharge of a shrapnel round raised a serious doubt as to

the real value of shrapnel as an antipersonnel agent, this rule-of-thumb gage

was found to be valueless as a criterion. The ordnance designer wanted some

"real" information from the medical man of what was necessary to produce a

casualty.

For the sake of a comparable yardstick in evaluation of ordnance materiel,

a missile with 58 ft.-lb. (foot pounds) of kinetic energy was considered to be

capable of producing a casualty. While this has not been fully substantiated
94 WOUND BALLISTICS

as a fair criterion, it is well supported I and is definitely superior to pine boards,

No doubt, under optimal conditions, a missile with considerably less energy

than 58 ft.-lb. can produce a serious wound, but on the average it is probable

that this amount of energy will insure a casualty.

Though much has been accomplished in a comparatively short time in

explaining many of the factors entering into the physical formation of the

wound, much remains to be learned. There is the question of how the yawing

rifle bullet produces such damaging injuries. There also is the question of

nerve injuries-their cause, extent, and repair. Again, just how much debridement is necessary to insure repair? These are but a few of the physical,

physiological, and pathological problems yet to be answered.

The Missile Source 2

Small arms.-In considering the missile casualty, small arms naturally

fall into several classifications based on the character of wound. For the

purpose of this discussion, small arms will be considered as those weapons so

classified by the Office of the Chief of Ordnance, U.S. Army, A.ith a caliber of

approximately 0.60 inch or less.

Sidearms.-These are small weapons designed primarily for personal

defense. In World War II, some automatic weapons in this category also

were designed for effective offensive employment at near ranges. Muzzle

velocities ranged from a little more than 800 f.p.s. for the U.S. sidearms up

to nearly 1,200 f.p.s. for those used by the Germans. The comparatively low

velocities produced minimal wounds.

Carbine.-In the U.S. Army, the .45 caliber pistol was often replaced by

a .30 caliber carbine firing a 110-grain bullet with a muzzle velocity of 1,975

feet per second. This was a semiautomatic weapon useful for offensive as

well as defensive action. It also was used by paratroopers and others requiring

a small, effective weapon. While essentially a shoulder weapon, the ballistic

characteristics placed it more in the category of a super sidearm, and missile

casualties from this weapon were more of the sidearm type.

Shoulder weapons.-The basic offensive weapon of the foot soldier is the

shoulder weapon. From the lessons learned in World War I, the trend in

military weapons has been toward the development of semiautomatic arms

to relieve the soldier of the interruption due to loading the weapon. Consequently, there has been an increase in the rate of aimed fire and firepower.

However, many repeating rifles of the older magazine type were used in World

War II. From the missile-casualty standpoint, the most important consider1 The 58 ft.-lb. rule was never completely acceptable to all the workers in the field, and a major effort has been

initiated to supplant this rule with more definitive medical criteria. The 58 ft-lb. of kinetic energy was based upon an

early German principle and probably was meant to be applicable only to lead spheres weighing half an ounce and

measuring half an inch in diameter.--. C. B.

2 (1) Catalogue of Standard Items. 2d ed. Office of the Chief of Ordnance, Washington, D.C., 1944, vols. I, If, and

111. (2) Catalogue of Enemy Ordnance Materiel, Office of the Chief of Ordnance, Washington, D.C., 1945, vol. I

(German); vol. II (Japanese).
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 95

ation is the muzzle velocity of the shoulder weapon projectile, as this largely

determines the effective range and the type of wound. In World War II, the

muzzle velocities of the Japanese rifles ranged from 2,200 to 2,400 f.p.s.; of

the German rifles, from 2,500 to 2,700 f.p.s.; and the muzzle velocities of some

of the U.S. shoulder rifles were slightly more than 2,800 f.p.s. In general, at

combat ranges, comparatively severe wounds are to be expected from any of

these weapons, much more so than the wound produced with the usual sidearms

missile and velocity.

Machineguns.-In the machinegun category are the antipersonnel full

automatic weapons using essentially the same ammunition as the shoulder

weapons of corresponding caliber. Weapons of this type in the larger calibers

are primarily antimateriel agents and will be considered later in their secondary

antipersonnel aspect. As a missile-casualty agent, machineguns are essentially

the same as shoulder weapons except for one important factor. Full automatic

weapons fire at a high cyclic rate, 400-800 rounds a minute. This commonly

results in multiple wounds, all of a severity to be expected with the shoulder

weapon missile. This also accounts for the fact that the machinegun missiles

proportionately produce a greater number of fatal casualties.

Automatic weapons larger than 8 mm. (0.315 in.).-While classed as

small arms, weapons in this category (most of them 0.50 inch in caliber) are

designed primarily for aircraft, AA (antiaircraft), and antimateriel purposes.

The larger size of projectile permits the practical use of an HE (high explosive)

bullet as well as other types of missiles designed for specific purposes. While

some wounds are certain to be caused by these missiles, the casualty is usually

incidental to the use of the weapon for other missions.

Antitank small arms.-The Germans had three types of 7.92 mm. (0.312

in.) nonautomatic AT (antitank) guns of interest. One, an ex-Polish model,

had a muzzle velocity of 4,100 f.p.s., while the other two had muzzle velocities

of 3,540 f.p.s. Early in World War II, these weapons were quite effective

and were capable of penetrating more than an inch of armor at a range of

100 yards. However, with the increase of tank armor protection, they lost

their value and became effective only against light-armored vehicles. The

high-muzzle velocities are of interest, though it is unlikely that many missile

casualties can be ascribed to these weapons.

Ammunition.-For sidearms and shoulder weapons, ball-type ammunition

is generally employed. This usually consists of a lead core protected with a

jacket of gilding metal or similar material. Most bullets in military use are

sharp pointed, having the so-called spitzer nose. Some have a flat base while

others are boattailed. Some medium-velocity ball ammunition is used with

the carbines or other special defensive weapons.

Small arms ammunition commonly used with machineguns and aircraft

and AA weapons in the small arms category includes:

1. Ball ammunition.

2. Incendiary ammunition.

3. Incendiary with tracer ammunition.
96 WOUND BALLISTICS

4. Tracer ammunition.

5. Armor-piercing ammunition.

6. Ball with tracer ammunition.

7. High explosive ammunition.

While casualties may occur with any or all of these various types of

bullets, other than ball, the primary use of these bullets is for other purposes.

Most of the varied types of ammunition find their greatest use in aircraft and

AA work. However, under certain ground conditions, tracer, incendiary, and

AP (armor-piercing) types are of value in maehinegun missions.

Wounds resulting from tracer, incendiary, or HE bullets are complicated

by various effects peculiar to the particular missile. Tracer and incendiary

bullets not only introduce the factors peculiar to their chemical characteristics

but usually produce severe wounds because of their comparative lack of stability, their low cohesiveness, and their poor ballistic characteristics resulting

from loss of mass. They often yaw badly and break up on impact. Wounds

often suggest the use of explosive bullets. While international agreement had

prescribed the HE missile for small arms use, the Japanese had such bullets

for their 7.7 and 12.7 mm. weapons, presumably for use in aircraft and AA

weapons. However, in view of the fact that aircraft often strafed personnel,

the complaint regarding wounds from HE bullets was logical.

Japanese 6.5 mm. bullet with enlarged core in the base.-In correspondence, 3 it was suggested that this bullet was probably launched at velocities

higher than those usually credited to the Japanese 6.5 mm. ammunition.

This was believed erroneous because of the weight of the bullet. The 6.5

mm. rifle was a comparatively old gun, and no doubt materials inferior to those

available in modern weapons had been used in its construction. It also was

not designed for chamber pressures common in more modern weapons. The

bullet weighed 138 grains (figs. 45 and 46) and was homologous with a 161-

grain .30 caliber bullet. A bullet homologous with the 150-grain .30 caliber

bullet would weigh 129 grains.

Knowing the chamber pressures necessary to launch a 161-grain bullet

in the .30 caliber rifle with a velocity comparable to the 150-grain bullet,

it was logical to presume that the Japanese fired this bullet at a muzzle velocity

of 2,300-2,400 f.p.s., usually credited to their standard 137.3-grain bullet.

However, the spin imparted to the bullet by the rifling would have a

negligible effect in effecting stabilization in denser mediums, such as tissues.

In fact, the increased mass in the tail of the bullet would undoubtedly operate

to increase greatly the degree of yaw on entering a dense medium. This bullet

would probably have slightly less stability in air than one of a more conventional design, so that the degree of yaw on impact would normally be somewhat larger also.

3 Memorandum, Deputy Chief, Small Arms Development Branch, Technical Division, Office of Chief of Ordnance,

19 Feb. 1943, for Col. George R. Callender, MC, Army Medical Center, Washington, D.C., subject: Sapanese Caliber

.256 Bullets, with enclosures thereto.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 97

FIGURE 45.-Japanese 6.5 mm.

(0.256 in.) bullet with odd-shaped

core of antimony lead mixture.

Shape of core changed dynamic -

characteristics of the bullet so

that it was apt to cause severe

wounds at near range because of

excessive yaw. Weight of the

bullet was 138 grains. (Magnification three times actual size.)

40

FIGURE 46.-Japanese bullets with peculiar core recovered after

being fired into water. To the left is a U.S. Ml bullet fired and

recovered in the same manner for comparison. The Japanese

bullets deformed at the base as is commonly noted with military

full metal patch bullets with the spitzer nose on impact at velocities

in excess of 2,000 f.p.s. It was also noted that the core separated

from the jacket in two cases. This last was also noted in wounds

produced by this Japanese bullet in jungle fighting at near ranges.

In general, it has been observed that with sufficient velocity all cored

metal-jacketed bullets will break tip or deform on impact. The most resistant

to disintegration is the sharp-pointed spitzer bullet. However, at close ranges

and impact velocities in excess of 2,400 f.p.s., this bullet often shows deformation, with breakup appearing first in the base of the bullet. On the other

hand, the round-nosed bullets break up at velocities from 1 to 2 thousand

feet less, but their first deformation occurs at the nose. Bullet breakup or

deformation of the full metal patch missile is most apt to occur on impact

with hard bone.
98 WOUND BALLISTICS

Soft-nose hunting-type bullets break up at lower velocities and often

commence to disintegrate in the skin immediately after impact. Fragments

of jacket and lead core are found in quite superficial tissues when impact

velocities are excessively high--2,200 f.p.s. or more.

Projectile, artillery.-Although in all wars before World War 11 various

antipersonnel loads such as canister, grapeshot, chain shot, and shrapnel

were used, experience had conclusively demonstrated the comparative ineffectiveness of these agents for antipersonnel purposes. The HE projectile,

however, had proved to be not only more effective in producing casualties

but had also proved capable at the same time of inflicting materiel damage

which is often of greater importance in carrying out the artillery mission.

The HE projectile is capable not only of penetrating an earthwork but,

after the penetration, of detonating and producing casualties in the personnel,

supposedly protected by the earthwork, by the many high-velocity fragments

resulting from the detonation. Various types of contact, delayed action, and

time fuzes permit almost uncanny timing of projectile detonation.

Ineffectiveness of the special antipersonnel cannon loads has been due

in the past to the comparatively low projectile velocities at battle ranges.

Though this was not so apparent at the battle ranges common to warfare

before the 20th century, it became a certainty with the experiences of World

War I. The advent of smokeless powder, better types of steel, and manufacturing improvements made practicable increased artillery muzzle velocities,

but these factors did not materially increase the effective remaining projectile

velocities. The battle ranges increased commensurately with the increase

in muzzle velocities so that remaining velocities remained essentially constant.

On the other hand, fragments resulting from the detonation of HE projectiles have increased materially in effectiveness as antipersonnel agents.

Control of burst has been much improved through more accurate fuzing.

Initial fragment velocities have been more than doubled (from less than 3,000

to more than 6,000 f.p.s.) by the utilization of new explosives. Fragmentation

has been controlled also through improved projectile design and through the

selection of better fragmenting materials in construction.

High-explosive detonation charges have resulted in a much greater number

of effective fragments than was possible with the other types of antipersonnel

projectiles. For instance, the total number of balls in a 3-inch shrapnel load

was less than 300 compared to the thousand-odd effective fragments from a

75 mm. HE shell at 20 feet from the point of burst. The 81 mm. HE shell

with an initial fragment velocity of 6,180 f.p.s. has more than 2,500 effective

fragments at a distance of 20 feet from the point of burst. The fragment

distribution from HE projectiles also covers a greater area than shrapnel

balls.

Casualties resulting from high velocity HE fragments sustain more severe

wounds than do those resulting from the relatively low velocity shrapnel

balls. In fact, shrapnel velocities were often so low that neither clothing

nor skin penetration was effected within a few yards of the burst.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 99

Though the application came in the latter part of World War II, the use

of the radar proximity fuze materially enhanced the value of the HE projectile as an antipersonnel weapon. It insured the burst's occurring under

optimum conditions for casualty production. This development undoubtedly

points the way to the HE projectile's being used much more in the future as

a specific antipersonnel weapon. Somewhat similar effects were noted in

jungle warfare when fuzed projectiles were detonated by contact with the

trees. In effect, this resulted in an airburst under optimum conditions.

A canister projectile was used in the 37 mm. gun at close ranges against

tank personnel. The canister was loaded with 122 lead balls weighing approximately 100 grains each. Velocity was imparted to the balls by the 2,500

f.p.s. muzzle velocity of the canister. This load could only be effective at

pointblank ranges where remaining velocities would be adequate. The canister was designed to release the balls immediately on firing, so rapid retardation of the balls could be anticipated because of the lack of desirable ballistic

characteristics.

In artillery work, the only other projectiles usually used were the shot or

AP loads and various chemical loads, such as flare and smoke. These loads

have little significance as antipersonnel agents, casualties only being incidental

to their primary purpose. Of course, some casualties result from direct hits

by AP projectiles as well as by the secondary missiles resulting from their

impact. In some phases of tank warfare, both can be major causes of tank

casualties. Both also may be significant in naval warfare.

The Japanese still used some shrapnel of conventional design with their

75, 105, and 150 mm. guns. At near ranges in jungle fighting, shrapnel could

have greater antipersonnel value as the remaining projectile velocity added to

the initial velocity imparted to the shrapnel balls by the black powder bursting

charge could make the balls effective missiles for a short distance. However,

the usual muzzle velocity of Japanese artillery was low as compared with that

common to modern weapons. It is apparent that the Japanese were either not

cognizant of the value of velocity or were unable to produce weapons capable

of sustaining the higher powder pressures necessary to secure the increased muzzle velocities.

The Germans had an interesting and effective antipersonnel 8 cm. HE

mortar shell known as the "Bouncing Betty." On impact, a nondelay fuze

ignited a smokeless powder charge which in turn ignited a delay pellet. The

explosion of the smokeless powder charge sheared off pins holding the nose cap

to the projectile body and threw the shell from 5 to 10 feet into the air. In the

meantime, through the action of the delay pellet and a booster charge, the main

TNT bursting charge was detonated at approximately the moment the projectile was at the height of its bounce. This was a simple means to obtain the

effect of an airburst. Initial fragment velocities with TNT of approximately

3,500-4,000 f.p.s. resulted in effective fragment distribution for a considerable

range.
100 WOUND BALLISTICS

Aerial Bombs 4

Though World War I saw the first application of the airplane to warfare,

it remained for World War II to demonstrate its use as a formidable military

weapon. Personnel were attacked in one of two ways: By gunfire in strafing

or by aerial bombs.

Missile casualties due to strafing have characteristics typical of small arms

injuries except for several possible details. The speed of the airplane can add

to wound severity by augmenting the bullet velocity by as much as 800 feet per

second. Some casualties may also be due to tracer, AP, explosive, or other

special bullets commonly used in airplane weapons. Another important factor

is excessive yaw, as many gun barrels are in such a condition that the bullets

are not stabilized. In rapid fire, the generated heat also expands the barrel to

such an extent that the bullet may not follow the rifling.

Peculiar to the airplane as an antipersonnel weapon is the aerial bomb.

While bombs are used for many other purposes, the fragmentation bombs are

designed particularly for antipersonnel use. They are so constructed that on

detonation there will be a spray of effective fragments capable of producing

casualties over a considerable area. These antipersonnel bombs come in several

sizes, ranging in weight from 20 to 260 pounds each.

Fragmentation bombs are somewhat similar to HE projectiles in that the

bursting charge constitutes approximately 10 percent of the weight of the bomb.

However, the bomb is specially constructed to yield a greater number of effective

fragments. Fragment size is roughly controlled by design and construction.

At 100 feet from the point of burst, the 20-pound fragmentation bomb

averages 829 effective fragments; the 90-pound bomb, 2,880; and the 260-pound

bomb, 5,450 effective fragments. Because of the bomb design and the ratio of

bursting charge to bomb weight, fragments are fairly large and at 100 feet from

the point of burst have velocities of a little more than 1,000 feet per second.

The smaller 20-pound fragmentation bombs are commonly dropped in

clusters of six bombs so that a salvo effect is obtained. A single plane may

simultaneously drop a number of clusters. Planes in a group may drop their

bombs all at about the same time, so that a considerable area can be blanketed

with effective fragments. Many casualties are certain to result among exposed

personnel. Small bombs dropped simultaneously in groups are more effective

than a single bomb of the same weight.

Other bombs, though not designated for antipersonnel purposes, can cause

missile casualties. The general-purpose type, usually with a bursting charge

approximately one-half of the bomb's weight, is often used under conditions

in which personnel will be exposed. As an example of performance, the 100-

pound general-purpose bomb has 3,310 effective fragments at a distance of 100

feet from the burst moving at a velocity of 1,870 feet per second. The higher

velocity makes fragments of a smaller size more effective than would be true

4 Terminal Ballistic Data, Office of the Chief of Ordnance, Washington, D.C., 1944-45, vols. I, 11, and In1.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 101

with the fragmentation bomb. However, this bomb has a much greater blast

effect and depends largely on that effect in accomplishing its primary mission.

In some of the very large light-case bombs, the detonating charge accounts

for 75 percent of the bomb's weight. These bombs, designed particularly for

demolition work, accomplish their mission almost entirely through the blast

effect. There also are other special-purpose bombs, such as AP, flare, and

flashlight. The Germans had an AP bomb which was equipped with auxiliary rocket propulsion to give acceleration to aid in penetration.

Fragment distribution from a bombburst is fairly symmetrical with respect to the longitudinal axis. When a bomb drops with its axis vertical and

detonates on contact, fragments fly in all directions. However, most bombs

actually fall with their axis at such an angle to the perpendicular that there is

considerable asymmetry in actual fragment distribution. The most dangerous sector is that from which the bomb's axis is leaning on detonation. On

the opposite side from the burst, effective fragment range is much less.

Bomb detonation is effected through the action of a fuze which is armed

when the bomb is dropped from a plane or shortly thereafter by the action of

a wind vane. Fuzes are of two basic types-instantaneous contact or delayed

action. Delay may be a small fraction of a second, or it may be some definite

longer interval. Time fuzes similar to those used with artillery projectiles are

only used with aerial bombs carrying flares or flash powder for night photography. It has not been practical to initiate airbursts through the use of time

fuzes as time of flight is not sufficiently constant.

Though contact fuzes are designed to function instantaneously, there is,

in fact, some time lapse between initiation of the primer and detonation of

the bursting charge. In this interval, a bomb may penetrate the earth to such

an extent that much of the force of the explosion is expended against the earth

and upward. The earth acts in a degree to protect personnel. In the case of

firm or impacted earth, the bomb may also disintergrate on impact so as to

fail to function.

Obviously, for antipersonnel purposes, optimum results can only be

expected from an accurately controlled airburst over exposed personnel.

Application of the proximity fuze to the aerial bomb may accomplish this.

However, in World War II, the most effective antipersonnel bomb was either

the properly designed fragmentation-type or the general-purpose bomb, each

neither so large nor so heavy that dampening earth penetration would occur

before detonation. Under some conditions, small bombs lowered by parachutes to delay the descent were found to be particularly effective as antipersonnel weapons against personnel in the open or in foxholes.

Hand and Rifle Grenades

Most hand grenades are primarily offensive weapons of the fragmentation

type. Some have fairly thick cast iron walls divided into serrated segments

and others have comparatively thin steel casings. The Germans used one
102 WOUND BALLISTICS

offensive hand grenade which consisted of a pressed disk of explosive RDX

(cyclonite) and wax with a fuze inserted in a hole in the side of the disk. This

grenade depended on blast effect alone for performance.

One of the cast iron, fragmentation-type hand grenades loaded with TNT

as a bursting charge had 254 effective fragments with an impact velocity of

nearly 2,000 f.p.s. at 20 feet from the point of burst. Many of the fragments

had sharp, serrated edges and at impact velocities of nearly 2,000 f.p.s. would

produce severe wounds. However, velocity was rapidly retarded so that

effective range was not great.

Grenades are of various shapes, some for direct throwing, while others of

the so-called potato-masher type have a wooden handle to aid in hurling.

Rifle grenades are similar to hand grenades, except that they are launched by

means of a rifle and consequently have greater range. Some special grenades,

hand and rifle, of the AP hollow-charge type were developed for AT use. Their

value as missile-casualty agents is quite secondary.

Grenades can only be thrown or propelled to a limited range, so usefulness

is restricted to certain conditions. While the range must be such as not to

endanger friendly troops with resultant fragments, it also must permit of

reasonably accurate throwing. Grenades are particularly effective when

tossed into a pillbox or thrown into an occupied dugout. In World War I,

hand grenades were especially useful in clearing trench bays. When fragmentation grenades detonated in close groups of personnel, casualties with

severe, multiple wounds resulted.

The Japanese had a hand grenade made of terra cotta. It was charged

with 312 ounces of explosive which would burst the terra cotta container into

fragments dangerous at near ranges. Many of the Japanese grenades were

odd, in that the fuze mechanism had to be armed by a sharp blow before hurling. After arming, there was a 4- to 5-second delay pending detonation.

Many hand grenades were used for the preparation of boobytraps. Once

armed, grenades are sensitive and make a dangerous boobytrap which cannot

be easily unarmed. Severe wounds can be expected, as the victim is usually

close to the explosion, where many high-velocity fragments and secondary

missiles will be the rule.

Landmines

Landmines are of two categories-AT and antipersonnel. The former

usually requires so much weight to initiate the primer that it is of little direct

interest as a casualty-producing agent. On the other band, the sensitively

fuzed antipersonnel mine is highly effective and is often responsible for many

and severe casualties.

Basically, the landmine is a defensive or protective weapon, hence more

likely to inflict casualties on an advancing force. The antipersonnel mine also

quickly exacts its toll of the careless or inexperienced soldier. It may be
BALLISTIC CHARACTERISTICS 'OF WOUNDING AGENTS 103

equally dangerous to friend or foe, especially when the soldier is careless and

disregards warning signs of a minefield intended to protect a bivouac or beachhead.

Mines commonly inflict severe wounds as the victim is usually very close

to the detonation, often standing directly over the mine. Many lower extremity casualties can be expected. When individuals are advancing in close

formation, a single mine can be responsible for multiple, severe casualties.

Many mines not only have a considerable immediate range but often are so

sensitive as to be detonated by neighboring detonations, so that the tripping

of a single mine may fire one or more in the near vicinity.

Though landmines of various types have been used in warfare almost

since the inception of gunpowder, before World War I they were crude improvisations. Most were comparatively ineffective. In World War I, the tank

and armored vehicle on one hand and the hand grenade on the other hand

naturally led to the development of the boobytrap and antivehicle and antipersonnel mine. This development was greatly favored through the use of

TNT, a powerful but at the same time a comparatively safe explosive to handle.

Modern production methods as well as modern explosives made wholesale use of landmines both practicable and effective in World War II. Boobytrapping was developed to a new high, with grenades or antipersonnel mines

commonly providing the effective part of the boobytrap. Any soldier could

handle deadly TNT with impunity until it was set in place and sensitively

fuzed.

Antipersonnel landmines commonly carry a charge of a pound or less of

TNT or similar explosive and are generally no more than 4 to 5 inches in their

greatest dimension. They may be detonated by the direct pressure of 15 to

40 pounds or by a few pounds pull on an apparently innocuous trip wire. Early

in the war, mines usually were in metallic containers, but with the development

of magnetic mine detectors many were made of glass, earthenware, or plastic

to prevent detection.

Early types depended on the fragmentation of the mine container and

component parts together with secondary missiles of sand, pebbles, and dirt

for their effectiveness. Later, mines were developed which bounced from 6 to 7

feet into the air before the main detonation occurred, thereby effecting an

airburst making the fragmentation effective over a much greater area. The

Germans developed several mines of this type which also carried shrapnel balls

to add to the missiles of normal casing fragmentation. One of these mines had

350 steel balls weighing approximately 53 grains each. This shrapnel filling

propelled by 8 to 16 ounces of TNT had an effective range of 150 to 200 yards.

There also was a very effective wooden box German antipersonnel mine which

did not activate the magnetic mine detectors. This mine was simple and cheap

to construct. It also was constructed in a larger size for AT use.
104: WOUND BALLISTICS

Blast 5

The hot gases ejected by a detonating bomb sweep out and compress the

surrounding air and throw that compressed body of air against adjacent layers

of air. In this way, a belt is formed within which the air has high pressure and

high outward velocity. This belt is limited by an extremely sharp front (less

than one-thousandth of an inch) called the shock front in which the pressure

rises abruptly.

The shock front travels away from the point of detonation with an extremely high initial velocity (3,000 f.p.s. at 60 feet from a 4,000-pound lightcase bomb where the pressure jump is 100 pounds per square inch). The

velocity then decreases rapidly towards the velocity of sound (about 1,100

f.p.s.) as the shock front travels on and the pressure jump decreases.

For a better appreciation of the comparable velocity of the blast wave, it

is well to consider some of the better-recognized air velocities encountered in

winds and storms. Winds of 50-60 miles per hour are classified as gales, and

in hurricanes wind velocities of 80 miles per hour are common with now and

then velocities in excess of 100 miles an hour being reported. Wind velocities

in tornadoes have not been accurately recorded but are judged to be of the

order of 200-300 miles per hour. The fact that tornadic winds often blow

straws into tree trunks is well established in weather bureau documents. The

highest wind recorded by a weather bureau was slightly more than 230 miles

an hour at the top of Mount Washington, N.H. Though the blast wave

travels at a velocity of 4,000 f.p.s. or more when initiated, it quickly damps

down to the velocity of sound in air. This is approximately 1,100 f.p.s., the

equivalent of 750 miles per hour. It is due only to their very short duration

that blast waves are not far more destructive than they are in fact.

The excess pressure prevailing at a point in the air after the arrival of the

shock front decreases and vanishes in a short time (about 0.04 second at 400

feet from a 4,000-pound light-case bomb; about 0.006 second at 50 feet from a

100-pound general-purpose bomb) and is followed by minor disturbances

which often include a partial vacuum. The entire disturbance produced in

air by the detonation of a bomb is called blast.

Peak pressure.-The peak pressure-the highest excess pressure which

is attained right at the shock front-gives a measurement of the maximum

force exerted against a structure by the blast (pressure X area = force).

Effects of confinements.--The presence of obstacles which prevent the

travel of blast in some directions may increase the effect of blast in other

directions.

A blast traveling along a tunnel, a corridor, a trench, and, in the case

of large bombs, even along a street is effectively confined, so that its intensity

decreases much more slowly than in the open.

When a bomb detonates inside a house, demolition of the walls may occur

even if the distance from the point of detonation to the walls exceeds the

5 See footnote 4, p. 100.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 105

radius of damage for the same type of bomb bursting in the open. This is

due to a variety of effects, among which is the "multiple punch" effect created

by the blasts' hitting on a wall in quick succession after having been reflected

by other walls. If the effect of blast is intensified on one side of a wall by its

confining action, it is reduced by the same token on the opposite side of the

wall by its screening action.

Protection from blast.-A wall effectively reduces blast pressure and

impulses on objects close to it if it is about 10 feet by 10 feet or larger and if

it is of sufficient strength to withstand the blast.

Foxholes, slit trenches, or ditches reduce the blast pressure by about 50

percent. A system of four right angles reduces it to about 15 percent.

Position of the body can have a considerable influence in protection from

blast effects. Lying prone on the ground will often materially lessen direct

blast effects because of the protective defilade effects of irregularities in the

ground surface. Ground also tends to deflect some of the blast forces upward.

Standing close to a wall, even on the side from which the blast is coming, also

lessens some of the effect.

Many of the persons said to have been injured by blast were actually

injured through the secondary effect of being knocked down and forcibly

coming in contact with the earth or with other hard objects. If the head of

a person thrown down comes in contact with a stone or similar hard object,

injury may be quite severe. Any lessening of the distance through which

one falls will lessen the probable degree of injury.

Orientation of the body also affects severity of the effect of blast. Anterior exposure of the body may result in lung injury, lateral position may result

in more damage to one ear than the other, while minimal effects are to be

anticipated with the posterior surface of the body toward the source of the

blast. Defilade and reflection of the blast from the body itself may have some

effect.

Blast pressure and the orientation of an object.-At a distance of 20

feet from the point of detonation, the peak pressure on a wall parallel to the

direction of travel of the blast wave is only about one-seventh of the pressure

measured on a similar wall placed at right angles to the direction of travel of

the blast. This factor varies with distance, and at 200 feet from the point of

detonation the ratio is about 1 : 2. Pressures on oblique surfaces vary

accordingly.

The effects of peak pressures (table 18) follow:

At peak pressures of 500 pounds to the square inch, 50 percent killed.

At peak pressures of from 60 to 100 pounds to the square inch, 50 percent

seriously injured.

At peak pressures of 15 pounds to the square inch, eardrums ruptured.

At the nearest point, peak pressures would be between seven and eight

times greater on an object oriented at right angles to the travel of the shock

wave; at a distance of 90 feet, the factor would be approximately four; and

at 150 feet, about three.

603225v-62- 9
106 WOUND BALLISTICS

TABLE 18.-Peak pressures in pounds per square inch at varping distances from point of

detonation for general-purpose bombs of various weights on a surface parallel to direction

of travel of shock wave

Pressure at--

General-purpose Pressure atbomb 30 feet 60 feet 90 feet 120 feet 150 feet 180 feet

Pounds

100 17 4 ......

500 80 6 3

1,000 200 20 7 4

2,000 400 50 13 7 4.5

4,000 1, 000 170 40 16 10 7

Blast alone may cause serious injury or death at distances from 120 feet

for the 4,000-pound light-case bomb to less than 60 feet for the 100-pound

general-purpose bomb. However, it also is more than likely that within such

ranges bomb fragments or secondary missiles will be responsible for injury.

Secondary Missiles

For this discussion, a secondary missile will be considered to be a missile

which has been set into motion by another or primary missile and which has

traveled for an appreciable distance in the air or more mediums before causing

a casualty. This eliminates body-armor fragments, pieces of clothing, and

other articles on the person from consideration as secondary missiles at this

time. Fragments of bone or other tissues may be secondary missiles under

certain conditions.

Many wounds are produced by secondary missiles given their velocity

by the blast of tile primary bomb, mine, or projectile. Bullets may strike

dry sand, rock, or other material which may be moved or broken and thereby

set into motion secondary missiles capable of producing a wound. Such

wounds may be comparatively trivial but painful and may be fully capable

of rendering a man a noncombatant for some time. A face peppered with

sand can be quite bloody and painful, though actual injury is but skin deep.

Secondary missiles probably produce more casualties than all other causes

combined in the aerial bombing of the unprotected civilian city habitations.

Flying glass is particularly bad, even at a considerable distance from the

source of the blast. Two factors make glass particularly bad: First, it is

easily broken; and, second, the fragments are usually of a shape and type

which will readily penetrate the flesh.

The landmine probably attains its maximum antipersonnel qualities from

the many high-velocity secondary missiles of sand, dirt fragments, and other

materials immediately over the mine. The way it is planted and detonated
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 107

is designed to make the most of the secondary missile as a casualty-producing

agent. High-velocity propellents are commonly used in mines; the case

holding the propellent is comparatively light; and the detonation occurs close

to the victim, often within a few inches or at most only a foot or so. Impact

velocities are certain to be high.

Light secondary missiles may have high velocities, approaching the maximum possible with any given propellent. Heavier missiles have correspondingly lower velocities. Under certain conditions, for instance, a rifle bullet

can spall out a fragment of armor and in so doing impart to the spall a velocity

greater than 50 percent of the bullet's impact velocity. Such a spall may

produce a more serious wound than the original bullet, because of its size and

sharp, irregular edges.

In the immediate vicinity of a bomb or shell detonation, large objects,

such as bricks and stones, may be set in motion as secondary missiles. Initial

velocities as a rule are not so great, but their greater mass gives them a considerable danger range. Lighter fragments lose velocity more rapidly.

When metal objects, such as nails, screws, and nuts, are set in motion as

secondary missiles, they can produce serious wounds. Such objects have been

used in artillery projectiles as well as in the older types of landmines (fougasse).

Retardation is a function of sectional density (AAIM) (p. 121) and, in general,

the greater the density of material the longer it will remain dangerous because

of impact velocity.

Secondary missiles may be important also in connection with the detonation of HE artillery projectiles, though normally not to the same degree as in

the case of aerial bombs, as the detonating charge is comparatively smaller.

The projectile design also favors the production of projectile fragments, which

generally range farther and are a much more potent factor as a casualty producer

than the secondary missile.

Probability of a Missile Casualty

From time to time, the ordnance engineer asks the military surgeon for

an opinion on the probable effectiveness of a proposed antipersonnel agent in

producing effective casualties. The ordnance engineer is also seeking a mathematical expression which will permit a calculation of the probable effectiveness

of a given antipersonnel agent.

The designer of a shell or bomb can usually predetermine the probable

fragment size, velocity, and average distribution. He has also adopted an

arbitrary criterion of 58 ft.-lb. of kinetic energy as determining a fragment

which is capable of producing a casualty. However, he lacks mathematical

information as to human body vulnerability and is commonly unable to

predicate very accurately the battlefield performance of a given agent.

Some research and analysis has been attempted to bridge this important

gap of equal interest to the ordnance designer and military surgeon. So far,

the arbitrary criterion of 58 ft.-lb. of energy for an effective wound-producing
108 WOUND BALLISTICS

missile has proved to be reasonable. It provides a basis upon which the

relative effectiveness of antipersonnel agents may be compared.

Before absolute predictions are possible, however, much more must be

known about the target. What is the target area? What proportion of that

area is actually incapacitatingly vulnerable to an effective missile?

Target area is variable due to body presentation. Black, Burns, and

ZuckermanI in England, calculated the average projected area of the full

standing figure as follows:

Region: Percent Square feet

Head and neck -------------------------- 12 0. 50

Thorax --------------------------------- 16 .67

Abdomen ------------------------------- 11 .46

Upper limbs ---------------------------- 22 .92

Lower limbs ---------------------------- 39 1. 65

Total ---------------------------- 100 4. 20

This projected area can vary and can be reduced to a much smaller amount

as the figure turns sidewise, kneels, or lies prone. The kneeling position

presents approximately 55 percent of the full figure, sidewise some 45"-•50

percent, and the end-on prone figure less than 25 percent of the full figure.

After determining the area of presentation, the question of incapacitating

vulnerability must be determined, as many wounds in the total body area will

not necessarily incapacitate a soldier. There is some difference of opinion as

to the proportion of this incapacitating vulnerable area. Zukerman and coworkers considered that some 10 to 15 percent of the projected area represented

the projection of vital organs. They also concluded that the effective vulnerable area to small high-velocity fragments was 2.83 square feet or 67 percent

of the total area. McMillen and Gregg, 7 in an independent approach to the

problem through anatomical analysis, found the projected incapacitating vulnerable area of the full, standing figure as follows:

Valnerable anterior

projection area as per- Region: cent of total body area

Head and neck ------------------------------------- 3. 5

Trunk -------------------------------------------- 26.0

Arms -------------------------------------------- 4.5

Legs ---------------------------------------------- 9.0

Total ------------------------------------------ 43. 0

Relative percent of vulnerable area also varies to a marked degree with

the position of the figure. For instance, in the prone figure, head on toward

the missile source, at least 75 percent of the presented area is vulnerable.

6 Black, A. N., Bums, B. D., and Zuckerman, S.: Experimental Study of the Wounding Mechanism of High Velocity Missiles. Brit. M.. 2: 872-874, 1941.

7 McMillen, J. H., and Gregg, J. R.: The Energy, Mass and Velocity Which is Required of Small Missiles in Order

to Produce a Casualty. National Research Council, Division of Medical Sciences, Office of Scientific Research and Development, Missile Casualties Report No. 12, 6 Nov. 1945.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 109

Another potent variable is the angle of incidence of the missile with respect

to the target area. For instance, a missile striking the thorax at a low angle of

incidence will often produce a superficial wound, while one striking more nearly

at a right angle to the target will penetrate and produce a severe wound or fatal

casualty. The first may not immediately materially impair the soldier's fighting ability nor require any prolonged hospitalization or treatment. The severe

wound could, on the other hand, permanently remove the soldier from the

fighting forces.

While the extremities account for less than one-third of the projected vulnerable area, casualty statistics commonly ascribe well over one-half of the

casualties and resultant time lost to the service to extremity injuries. This in

part is attributed to the fact that fractures are more common in the extremities

and that fractures are injuries which definitely require immediate as well as

prolonged treatment.

This apparent bias in wound distribution may be influenced by several

factors. First, available casualty statistics are based on a study of the wounded

rather than the wounded and the killed. It is well established that much data

based on the killed are quite erroneous.

Another variable and unknown factor which could materially affect casualty statistics interpreted on the premise of random distribution of missiles is

the degree of earth penetration effected by a projectile or bomb before detonation. Any penetration will result in some defilade effect and in turn affect the

purely random distribution of fragments. There usually is some penetration

and in soft earth it may be considerable before the bursting charge actually

functions. Where there is penetration, fragments are naturally deflected upward by the earth surrounding the projectile. This results in some increase

in fragment density in the lower zones, while the earth surface will be protected

from fragments by the defilade effect of the earth immediately surrounding the

projectile.

Personnel in the immediate vicinity of the burst will be subjected to a

shower of high-velocity fragments from the knee level up. Many fragments

will be capable of producing severe wounds. Those bitting the extremities will

often cause severe fractures, while the same fragment striking a vital area in

the soft tissues will frequently result in a fatality. In general, extremity injuries are not so fatal as those in the body or head areas.

Study of detailed statistics supports this approach to the problem of

apparent bias in casualty statistics. There is an increasing number of fractures

upward from the ground-more in the upper than in the lower extremities,

though the area of presentation of the upper is less than that of the lower

extremities. Fractures below the knee are definitely fewer than those above

that point, indicating a fairly definite defilade effect as just predicated.

Though there would often be fractures in the case of the killed in action,

it is known that only too often the statistical studies fail to record them with

the cause of death being ascribed to another more apparently fatal effect.
110 WOUND BALLISTICS

Another factor in World War I fighting which could have materially influenced the wound distribution and statistical studies was the machinegun. In

many sectors, it was the practice to defend areas by cones of machinegun fire

close to the ground level. Leg injuries would be more common than all others

combined under such circumstances.

Fragment-damage tables,8 published by the Office of the Chief of Ordnance,

give the average distribution of effective fragments at various distances from

the point of burst. With such tables, the distance at which a soldier has a

given chance of being hit may be calculated. For example, a soldier is required

to take a 1 to 100 chance of being hit by a fragment from a 20-pound fragmentation bomb. Suppose that the soldier is on open terrain in such a position

that a 2-square-foot area of his body is exposed to fragments coming directly

from the bomb. Under these circumstances, the effective fragments per square

foot to which the soldier is exposed are Yo0 x )• equals 0.005 per square foot.

From the fragment-damage table for that bomb, it is found that the soldier

should be about 150 feet from the bombburst. In the case of the 260-pound

fragmentation bomb, he should be not less than 300 feet from the burst. Under

similar conditions, the danger zone for a 75 mam. HE shell is approximately 100

feet and for the 105 mm. shell between 100 and 150 feet.

Depending on the orientation of the bomb or projectile at time of burst,

effective fragment distribution varies considerably from the average on

which the cited example is based. Effect of penetration before burst also is

disregarded. In the most dangerous sector, fragment density may be increased

as much as six times the average, increasing the danger zone severalfold. On

the other hand, in the less dangerous zones, the fragment density is materially

decreased.

In general, the wound factor varies something more than the square of the

distance from the point of burst. Retardation of fragment velocity reduces

the number of effective fragments, while the density per unit area of exposure

also is affected by the distance from the point of origin. Fragment distribution too is materially influenced when a shell or bomb penetrates the ground

appreciably before detonation.

The probability of a missile casualty as well as the character of a missile

casualty also can be expected to vary from offensive to defensive warfare. The

offensive soldier is of necessity more exposed. He is forced to advance in the

face of prepared zones of fire, mined areas, and various protective devices calculated to minimize the exposure of the defenders.

In advancing, the experienced soldier takes advantage of all possible cover.

However, he has to look for his enemy, so he must more or less expose his head.

If ranges are sufficiently close to permit aimed shots, a preponderance of head

casualties can be expected. This should be especially true of jungle warfare.

s Terminal Ballistic Data, Office of Chief of Ordnance, Washington, D.C., 1945, vol. III.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 111

The Casualty Criterion

Terminal ballistics and the missile casualty become of importance to the

military surgeon when the ordnance engineer asks for an opinion on the probable value of any given missile in producing a casualty. The ordnance engineer

also requires a significant yardstick which may be mathematically applied in

developing his designs of bullets, bombs, shells, grenades, or other missile

casualty-producing agents.

Technical advancement has too often demonstrated the validity of the

theoretical approach in design problems to permit the older rule-of-thumb or

trial-and-error methods to be used in working up the instruments of modern

warfare. Knowing the metal and detonating charge to be used in a given bomb,

the ordnance engineer can readily calculate the number of fragments as well as

their size and weight with probable distribution and velocities at any given

distance from the point of burst. However, a criterion as to probable effectiveness is necessary if the data just cited are to be applied to practical design.

During World War IT, a criterion of a missile with weight and velocity sufficient to give it 58 ft.-lb. of kinetic energy was used in practice.

Though the adoption of the 58 ft.-lb. figure was arbitrary or empirical, it

was much more practical than using the penetration of pine boards or other inanimate objects for the purpose. Selection of the figure was in a measure substantiated by the work of Gurney.9 This figure also was subsequently reasonably substantiated by the research of Harvey and his associates. It did

supply a fully comparable yardstick on which to base theoretically relative

efficiency.

A criterion of the potential wounding possibilities of a missile was first

brought to the fore in the late 1920's when bullets of various calibers were under

consideration in the development of a semiautomatic weapon. When this

problem was presented to the U.S. Army Medical Department, it quickly

became apparent that not only was there no criterion but that the military

surgeon knew little, if anything, regarding the physical laws underlying the

mechanics of wound formation or the production of a casualty.

For many years, ordnance engineers had been using the penetration of 1-

inch pine boards separated by a small air space (1 inch) for judging the relative

efficiency of bullets. Subsequent investigation revealed this test to be far

from precise because of variations in pine boards, as well as many other factors

beyond reasonable control. The motions of a spinning missile vary greatly as

it passes through mediums of different densities or are modified by other variable physical characteristics. This greatly influences the retardation of the

bullet and resultant conditions under which its kinetic energy is given up in

the retarding material and influences the physical nature of the wound to a

considerable degree.

SGurney, R. W.: A New Casualty Criterion. Ballistic Research Laboratory Report No. 498, Aberdeen Proving

Ground, Md., 31 Oct. 1944.
112 WOUND BALLISTICS

Kinetic energy is computed from the formula rnv2

/2, in which m is the mass

and v the velocity. It is noted that velocity plays much the greater part. If

it is borne in mind that the usual bullet employed in military use varies in

weight from around 135 to something more than 200 grains, the following tabulation showing the weight of missile necessary at various velocities to produce

a kinetic energy of 58 ft.-lb. is of interest:

Velocity of missile Weight of Velocity of missile Weight of missile missile

F.p.s. Grains F.p.s. Gr.ins

500 ----------------------------- 104.0 4,500 - ----------- 1.3

1,000 ---------------------------- 26.1 5,000 ----------- 1.0

1,500 ---------------------------- 11.6 5,500 - ------------ .9

2,000 --------------------------- 6. 5 6,000 .------------ .7

2,500 ---------------------------- 4.2 6,500 - ------------ .6

3,000 --------------------------- 2. 9 7,000 .------------ .53

3,500 ---------------------------- 2. 1 7,500 - ------------ .46

4,000 ---------------------------- 1.6

The fallacy of the pine-board penetration as a criterion of missile effectiveness was strikingly demonstrated quite accidentally when a shrapnel projectile

was detonated in a close group of observers. The only real casualty was the

man holding the projectile for he lost a couple of fingers from one hand. The

shrapnel balls were well sprayed amongst the group of observers at close range

and, yet, only a few black and blue places resulted-without penetration of the

clothing. This total inefficiency of shrapnel was further demonstrated by

study of known battlefield occurrences. However, shrapnel balls had penetrated many pine boards in the usual tests. Needless to say, the manufacture

and use of shrapnel was promptly discontinued. In passing, it is also interesting to note that there is evidence of few true shrapnel wounds in World War I

in which many tons of shrapnel were used. So-called shrapnel wounds on

investigation were usually found to be due to HE missile fragments (table 19).

Distribution of Effective Missiles

In discussing the probability of a missile casualty, reference was made to

fragment-damage tables. These tables are based on the assumption that a

projectile or bomb breaks into a certain number of effective fragments and that

the fragments are evenly distributed in all directions. In reality, this assumption is quite fallacious.

There is a marked variation in fragment distribution, even in the airburst.

Sidewall fragmentation is quite different in character from that of base or nose

fragmentation. Even in the light-case "blockbuster" bomb, there are differences in sidewall and nose or base fragmentation because of the relative thickness and distribution of the metal of the bomb. There also are fragments of
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 113

the fuze mechanism to be considered as these pieces are usually heavier and larger

than wall fragments. They consequently have a greater danger range, and,

while initial velocity may be slightly less, remaining velocity is better sustained

because of greater mass.

TABLE 19.--Weights, velocities, and distribution of effective fragments from various aerial bombs

and artillery projectiles, showing variations to be expected

Lightest effective

Distance Initial Total Fragments fragments

Source of fragment from fragment effective per square burst velocity fragments feet Weight Velocity

AFeet F.p.s. Number Number Grains F.p.s.

Aerial 20----nds- bombs 80 2,810 895 0. 0183 18. 4 1, 190

pond-------------200 '576 .0019 48. 6 731

0 n - - 3, 490 0712 15. 8 1, 280 90 pounds-- 200 1, 770 0058 45. 9 753

100 pounds---------------- 80 7,320 3, 943 0804 4. 8 2, 320

200 1, 880 0061 27. 1 980

5 80 7, 390 13, 450 .274 5. 3 2, 230 500 pounds- - - - 200 6, 100 0199 26. 7 990

Artillery projectiles: f 80 370 29. 3 943

3-inch HE shell ------------ t 200 2, 260 244 .004 5 29. 9 660

90 rmi. HE shell_------ 80 2, 900 427 003 24. 1 1, 040

200 319 0006 52. 5 705

81mm. HE shell-----------f 80 3 930 459 .0057 16. 6 1, 250

200 0 169 0003 45. 5 758

81 mm. HE shell----------- 80 6180 614 0076 9. 2 1,680

200 112 0002 35.0 862

4.5-inch HE rocket shell: 801 152 0057 18. 8 1, 180

Nose section --------------- 200 3, 500 93 0006 47. 7 738

80 4 000 353 0104 17. 5 1,220

B 200 1 0u0 207 0010 45. 5 758

Source: Terminal Ballistic Data, Office of Chief of Ordnance, Washington, D.C., 1945, vol. III.

Fragmentation bombs are specially designed to produce the greatest

number of effective fragments in the sidewalls. Such bombs usually strike in

a more or less nosedown position, so that nose fragments are necessarily forced

into the ground. Tail fragments commonly fly up into the air and in falling

are impelled only by the force of gravity so that their velocity is insufficient to

produce more than minor casualties.

In the HE shells, both the base and the nose of the projectile are definitely

thicker than the sidewalls. Sidewalls produce many more high-velocity fragments than either the base or nose. However, base and nose fragments, being

larger, are less retarded in flight and have a correspondingly greater danger

603225v-,62- 10
114 WOUND BALLISTICS

range. Density of fragment distribution from the nose or base is less than in

the case of sidewall fragments.

Rocket projectiles present another anomalous situation. Depending on

the type of rocket, these projectiles have a velocity of 400 to 800 feet per second.

They are fuzed with supersensitive fuzes so that they commonly detonate in the

air, and the remaining velocity of the rocket affects the fragment velocities.

This results in a distinct butterfly pattern of fragment distribution. The

rocket sidewall section bursts into more than twice as many effective fragments

as compared with the nose in the 4.5-inch HE rocket shell. At 20 feet from

the burst, fragment velocities vary from 2,440 to 2,570 feet per second.

Fragment-damage patterns are published by the Office of the Chief of

Ordnance. These show fragment distribution presupposing a graze or airburst

close to the ground surface with a particular orientation of the projectile.

Even under these ideal conditions, most damage patterns are of a distinct butterfly type. In some directions from the burst, there may be very few fragments,

while in other directions there may be many effective fragments of a mass

capable of maintaining a dangerous velocity over a considerable distance.

There is no allowance in the fragment-damage patterns for any earth

penetration by the projectile or bomb before detonation. However, in almost

every case, more or less penetration occurs, which materially modifies the

damage pattern. In the case of large HE projectiles, there usually is so much

penetration that almost all of the energy of detonation is expended in cratering

the earth. Soldiers often expressed little fear for these larger shells as their

antipersonnel effect was essentially nil, barring a direct hit.

With the usual contact fuze and even with the superquick contact type,

there is sufficient delay in firing the bursting charge to permit considerable

penetration, especially into soft earth. Standard-type fuzes operate progressively through primer and booster to fire the detonating charge. Some time

interval is required to initiate a primer which in turn initiates the booster which

fires the main charge. During the delay, the projectile or bomb can effect some

penetration. For that matter, it also requires appreciable time for the main

charge to rupture the holding case and set the fragments into motion. Slowmotion pictures readily demonstrate an appreciable timelag before fragments

are flying freely accelerated to their maximum velocity. Case rupture takes

place in a progressive manner requiring a lapse of time for its accomplishment.

Used only during the latter days of World War II, the proximity fuze

appears to make possible the accurately controlled airburst of artillery projectiles and perhaps aerial bombs. This application insures an airburst with a

much wider distribution of effective fragments. It can be expected that distribution will also follow a much more random pattern under these circumstances. This type of burst obviates the loss of effective fragments through "cratering" or the defilade effect of earth penetration.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 115

PHYSICAL ASPECTS OF THE MISSILE

Missile Velocity

Motion of translation, velocity, is the only factor common to all missles.

It is probably the most important single factor in consideration of the missle

as a potential casualty-producing agent. It is the major factor in making the

mnissile capable of producing a wound.

For simplicity in discussion, velocities of less than 1,200 f.p.s. will be considered as low; those from 1,200 to 2,500 f.p.s., as medium; and velocities in

excess of 2,500 f.p.s., as high.

Velocity is a continuously varying factor, and for ease in consideration as

a function of the missile several phases of the missile trajectory will be discussed.

First, the initial or muzzle velocity; second, the impact velocity or the speed

of translation at the time the missile strikes a target; and third, the remaining

(residual) or that velocity with which a missile leaves a target through which it

has passed. In considering the missile and the production of a casualty, the

second and third types of velocity are the more important. The impact velocity commonly determines the probable severity of a wound, while the difference

between the impact and residual velocity determines the amount of energy

doing work in producing the casualty. Initial velocity is important in that

it insures an adequate impact velocity at the time a missile reaches the

target. It also determines the probable danger range.

Initial velocity.-Initial velocity of a missile may be anything from a few

feet a second up to much more than a mile a second. Small arms missiles have

muzzle velocities ranging from around 800 up to approximately 3,000 f.p.s.

Some of the recently developed AT weapons have muzzle velocities of slightly

more than 5,000 f.p.s. Bomb fragments may have initial velocities of more

than 7,000 f.p.s., and some of the fragments from HE artillery projectiles approach this initial velocity. Some artillery projectiles are launched with muzzle velocities greater than 3,000 f.p.s., though most have muzzle velocities between 2,500 and 3,000 f.p.s. The 21 em. K12 German gun was credited with a

muzzle velocity of 5,330 f.p.s. and a range in excess of 70 miles.'0

In the antipersonnel weapon group, most sidearms, including the comparatively new carbines and small automatic weapons, launch bullets with muzzle

velocities in the low-velocity category. On the other hand, most military rifles

fire ammunition with muzzle velocities from 2,400 to 2,800 f.p.s. The older

Japanese 6.5 mm. rifle fired ball ammunition with a muzzle velocity of 2,400

f.p.s., while most of the U.S. rifles and those of the Germans used ammunition

with muzzle velocities near 2,700 feet per second.

Investigations in the late twenties and early thirties demonstrated the effectiveness of higher velocity missiles in the penetration of armor and led to

10 Catalogue of Enemy Ordnance Materiel, Office of the Chief of Ordnance, Washington, D.C., 1945, vol. I (German), p. 100.1.
116 WOUND BALLISTICS

AT weapons of small caliber with velocities ranging from somewhat more than

3,000 up to more than 5,000 f.p.s. The soldier's inability to withstand more

than a certain amount of recoil coupled with excessive barrel erosion accompanying the higher velocities operated to prevent the development of military

weapons of the sidearm or shoulder type in this category for routine use.

High muzzle velocities in artillery weapons are seldom of more than didactic interest to the student of the missile casualty. Such velocities are usually

for the purpose of increasing the effective artillery range, and at these excessive

ranges the remaining projectile velocity is likely to be relatively low. Missiles

from artillery projectiles attain their effective velocity more from the bursting

charge in the projectile than from the motion imparted to the projectile in firing

from the artillery piece. Suffice it to say that in general the higher the initial

velocity of artillery ammunition, the more costly will be the gun that launches

it. Such guns also have extremely short effective use periods without relining

of the barrel, which is a major task.

Basically, most artillery has become primarily an antimateriel weapon

with the antipersonnel characteristics only secondary factors. Of course, the

exception to this is the target of massed men against which HE artillery projectiles are highly effective and their use militarily justified.

Initial or muzzle velocity is of interest only to the student of the missile

casualty in that this velocity predetermines to a considerable degree the impact

or effective velocity of the missile in producing the casualty. Once the accelerating force ceases to operate on a missile, deaccelerating forces take over, and

the velocity is retarded. Retardation factors will be discussed later in more

detail (p. 120). However, proximity to the missile source largely determines

the impact velocity, and this in turn has much to do with the severity of the

casualty. It is this proximity which makes the landmine a particularly vicious antipersonnel weapon. Velocities are high and missiles are many. The

victim is often standing right over the mine or very close to it.

Impact velocity.-Of all factors to be considered in the missile casualty as

a physical phenomenon, impact velocity is decidedly the most important. It

determines the character of the wound and in turn only too often the fate of

the victim. Research has demonstrated that a missile velocity of from 125 to

possibly 170 f.p.s. is necessary to effect penetration of the human skin when

using steel spheres one-sixteenth to one-fourth inch in diameter. Velocities of

less than this produce only contusion without a break in the skin. Clothing

also exerts a threshold penetration factor, at present undetermined. However,

it is believed to be less than that of skin, which, comparatively speaking, is

quite high. Of course, amount of clothing and its particular nature as well as

other factors will affect the threshold velocity.

In the light of available information, few missiles with impact velocity of

less than 200 f.p.s. are likely to cause more than a trivial wound in the clothed

subject. Exceptions to this are the few missiles which may penetrate vital

body cavities through apertures, or the more easily penetrated portions of the

anatomy such as the eye.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS i1l

The military surgeon is generally interested in missiles with impact velocities in excess of 200 or 250 f.p.s. In practice, it is probable that few wounds

are caused by missiles with velocities much less than 500 f.p.s., and that most

of the battlefield wounds are caused by missiles with velocities two and three

times that figure. Some wounds are caused by missiles with impact velocities

well above 2,500 f.p.s. High explosive shell fragments account for many

wounds, and these velocities are apt to be well above 3,000 f.p.s. at near ranges.

With the use of the proximity fuze in antipersonnel shells and aerial bombs,

many missile casualties occur from fragments with velocities of 3,000 f.p.s.

and upward.

With low-impact velocities, wounds are found to be relatively "cleaner"

and free from the so-called explosive effect. With medium velocities, wounds

are more extensive with considerable tissue destruction and with some explosive effects when conditions are favorable, High-impact velocities result in

many so-called explosive wounds, with a maximum of tissue destruction.

Superhigh velocities make small missiles deadly. Comparatively, enormous tissue damage can result from the penetration of a very small fragment

of a grain or so in weight when propelled at the supervelocities. In English

bomb incidents, it was noted that minute missiles could be forced through the

head with through-and-through wounds of the brain with slight, if any, visible

evidence of a wound. The victims often walked away from the incident without even so much as a headache to show for the occurrence. It is known that

the minute jins used by d6ntomologists for the mounting of mosquitoes can be

readily forced through a person's hand without evidence of blood or trauma

and without sensation to the victim.

Remaining velocity.-Remaining velocity is of importance to the investigator in that it permits the determination of the kinetic energy expended in the

production of the wound when a missile perforates a target. When a missile

fails to pass through the target, all of the kinetic energy due to impact velocity

is expended in wound formation. Apparently, the only fair measure of wound

comparison on a physical basis is the expenditure of energy. Wounds cannot

readily be compared on mere appearances alone, especially superficial appearances. In practice,remaining velocity can seldom be known,while in research

it should always be measured or otherwise determined in some strictly comparable manner.

Momentum, Energy, Power

There has been much speculation and some observation as to the magnitude of the missile wound and its correlation with either the momentum,

kinetic energy of the missile, or the rate with which energy does its work

(power)-all physical attributes due to velocity. Momentum is a function of

the mass times the velocity; energy a function of the mass times the square of

the velocity; and the rate of doing work or power, a function of the mass times

the cube of the velocity.
118 WOUND BALLISTICS

Before modern research, factual information on the various physical

events actually occurring in the formation of a wound was lacking. Events

transpire too quickly for the human senses to perceive the details. Earlier

serious research studies had been inadequately instrumented to permit recognition of details. Results also were beclouded by the presence of indeterminate

variables, such as deforming bullets, yaw, and other form factors.

To bring out and to evaluate fundamental postulates, basic research was

conducted with nondeforming steel balls devoid of yaw or other complicated

form factors. Simple mediums, such as water and 20 percent gelatin block

tissue models, were used, as well as animal tissues. The cathode ray oscillograph and microsecond X-ray permitted the recording and accurate measurement of phenomena often completed in a few microseconds.

Results from this study were carefully analyzed, and it became apparent

that all physical phenomena connected with the wound and its formation were

direct functions of the kinetic energy doing work. Neither momentum nor

the rate with which the energy did its work (power) could be correlated smoothly

without excessive deviation with any of the various events which occur in the

missile wound.

Hunters have entered into many acrimonious arguments on what constitutes an effective bullet in the taking of game. Here some claim that momentum is the factor. However, this opinion is believed to be due to the fact

that hunters are continually observing the effects of bullets which usually

deform seriously or more often break up on impact. In the latter case, the

greater the mass, consequently the greater the momentum, the greater the

apparent effectiveness of the bullet as it is less apt to disintegrate into such

small pieces as to be almost useless after penetrating the hide of the animal.

It is known experimentally that this last commonly occurs with the soft-nose

hunting loads at impact velocities in excess of 2,000 feet per second."

While velocity is the most important single factor in making the missile

potent as a casualty producer, it attains that importance only through the fact

that it gives the missile kinetic energy with which to produce the casualty.

Physics recognizes two types of energy: Potential energy due to position and

kinetic energy due to motion. The latter is computed from the formula mV2/2

(p. 112). In the English system, m is in pounds and v in feet per second. The

corresponding results are in absolute units (poundals) which may be converted

to the more conventional foot pounds by dividing by the acceleration due to

gravity, (g) or 32.2.

From the formula, it is noted that kinetic energy varies as the square of

the velocity. In practice, this means that doubling the velocity multiplies

available kinetic energy by four. The following tabulation gives the kinetic

"11 (1) Callender, G. R., and French, R. W.: Wound Ballistics: Studies in the Mechanism of Wound Production

by Rifle Bullets. Mil. Surgeon 77: 177-201, October 1935. (2) Callender, G. R.: Wound Ballistics: Mechanism

of Production of Wounds by Small Arms Bullets and Shell Fragments. War Med. 3: 337-350, 1943.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 119

energy (ft.-lb.) at different velocities for a missile weighing 100 grains and

readily demonstrates why small missiles become lethal at the higher velocities:

"Velocity Energy Velocity Energy

(F.p.s.) (Ft.-lb.) (F.p.s.) (Ft.-lb.)

500 ----------------------------- 55 5,000 --------------------------- 5, 545

1,000 ---------------------------- 222 6,000 --------------------------- 7,985

2,000 ---------- 887 7,000 --------------------------- 10, 868

3,000 ---------------------------- 1,996 8,000 --------------------------- 14, 196

4,000 --------------------------- 3,549

Kinetic energy varies directly as the mass of the missile. Hence, weight

is of much less importance than velocity. Doubling the weight only doubles

the energy.

Most bullets used by the military vary in weight from around 150 to

approximately 200 grains. The corresponding kinetic energy at the usual

initial velocities is between 1,500 and 2,500 ft.-lb., while some distance from

the point of launching with lower impact velocities kinetic energies are much

less, usually well under 2,000 ft.-lb. and often less than 1,000 foot pounds.

Again considering the tabulation just presented, it can be readily seen

that considering the 150-200 ft.-lb. necessary for skin penetration that, at

impact velocities of 7,000 f.p.s., missiles of less than 2 grains in weight are

potential casualty-producing agents. This fact makes the modern bomb and

artillery HE shells potent antipersonnel agents. At close ranges, there are

many fragments which weigh at least 2 grains and which have velocities of

7,000 f.p.s. or more with the newer propellents. Multiple severe wounds can

be expected.

With impact velocities of 5,000 f.p.s., missiles must weigh nearly twice as

much to have energy equivalent to those at the higher impact (7,000) velocity.

However, compared to the usual military bullet, these are still very small

fragments.

The mass-velocity relationship and kinetic energy makes the landmine a

particularly vicious weapon in that fragment velocities are of the order of

5,000 f.p.s., and there are many secondary missiles in addition to the fragments

of the mine itself flying about with these supervelocities. Multiple severe

wounds are to be expected, especially when the victim trips the mine by walking

on it. In addition, there is quite an area within which missiles have velocities

in excess of 3,000 f.p.s., and small objects can continue to be serious casualty

producers.

Hand grenades with initial fragment velocities of 2,900 f.p.s. produce

many fragments of a weight sufficient to have adequate kinetic energy to

produce a severe wound. Grenades also are able to start effective secondary

missiles into motion.

In HE shellburst with initial fragment velocities often a little more than

6,000 f.p.s., severe wounds are the rule. These too can readily produce severe

casualties at the closer ranges.
120 WOUND BALLISTICS

Even water can be a casualty-producing missile when propelled with

sufficient velocity. One of the more efficient metal-cutting tools is simply a

small stream of water under high pressure (supervelocity).

Drag, Retardation, Ballistic Coefficient

Retardation varies directly as the square of the velocity and as the diameter of the missile. It varies directly as the density of the retarding medium

and inversely as the mass of the missile. These are the more important

factors affecting the retardation of a missile. They also largely determine

the amount of kinetic energy which is utilized in the production of a missile

casualty.

While complicated in detail, pertinent facts and relationships can be

gained from a study of the formulas regarding the missile motions which are

applicable to the military surgeon's study of the missile as a casualty-producing

agent, as well as the wound as a physical entity. The following basic formulas

are presented:

Drag (D)

D = pd2

v

2

f (v/a) or D = KDpd2

v

2 (1)

in which p=density of the medium

d=diameter of projectile

J(v/a) = function v/a or KD, the drag coefficient

where v/a=Mach number

v=velocity of projectile

a=velocity of sound in the medium

This formula applies particularly to motion in air and to missiles without

particular ballistic shape, such as spheres.

For pointed projectiles the formula becomes

D=ktpd2 v

2J(v/a) (2)

J(v/a) is the same for all shapes

k is a constant determined by shape

6 is a constant to allow for the effect of wobble, yaw, or other

deviation from true flight.

Let F(v)=v2

f(vla)

F(v) =function v

M=mass

C=ballistic coefficient (ability of a projectile to overcome air resistance)

then

C = M or C = M where i is a form factor.

k5pd 2 id2 (3)
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 121

Retardation due to drag (D) then becomes

r = D = E(v)

M71 C (4)

For the purpose of determining the factors controlling retardation, we

will substitute the value of D in (2) for D in DIM in (4) which results in

kbpd2v

2J (v/a) (5)

M

In evaluating the effect of each of the several elements affecting retardation, the constants k and a may be disregarded. d2

/_V[ is simply another expression for the term "sectional density" (AIM where A is the area). Retardation decreases as this fraction approaches zero as a limit. Hence as d2

decreases, retardation decreases. In other words, the most efficient shape

for sustained velocity is the needle or cylinder of maximum mass and minimum

area of presentation.

Velocity of the moving projectile affects retardation as v2. The greater

the velocity the greater the rate of retardation. Doubling the velocity multiplies the retardation factor by four.

During the air flight of a projectile, the density, p, is considered to be

unity under average conditions near the ground. However, when considering

retardation in a dense medium such as water or tissue, p is a factor of 800

or more.

Mach number, or the function v/a, is important in that it has been determined

that the velocity of sound in a medium is a critical velocity. Using 1,100

f.p.s. as the average velocity of sound in air near the ground level, some values

of v/a are tabulated:

v(f.p.s.) v/a v(f.p.s.) v/a

500 ------------------------------ 0. 45 4,000 ---------------------------- 3. 64

1, 000 ------------------------------ 91 5, 000 ---------------------------- 4. 55

1 500 ---------------------------- 1.36 6,000 ---------------------------- 5.45

2, 000 ---------------------------- 1. 82 7, 000_ ------------------------- 6. 36

3, 000 ---------------------------- 2. 73

From this tabulation, it is immediately apparent that a missile moving in

air at 7,000 f.p.s. is retarded more than six times as quickly as the same missile

moving at the rate of 1,000 f.p.s. This is an explanation of the fact that

supervelocities and the consequent devastating wounds are only to be encountered quite close to the point of fragment departure. Supervelocity missiles

are rapidly retarded to the lower velocities even in air.

Extrapolation of the formulas for the motion of a projectile in air to the

motion in much denser mediums such as water and tissues is questionable.

Too many little known, or unknown, factors are involved. However, by
122 WOUND BALLISTICS

collecting the unknown factors in KD, the drag coefficient (CD) in a dense

medium may be represented by

C6 - KDpv2d

2 (o)

where KD=summation of unknown factors affecting drag.

p =density

V=velocity

d= diameter

The drag coefficient can be determined experimentally when the velocity

of a missile can be plotted against the time. Let a= the retardation coefficient

and we have

d V ý aV ' 7

it(7)

where V=the instantaneous velocity

and t=the time

For the determination of the drag coefficient we have:

pA CD

a 2M (8)

where p= density

A~area

M=mass

High-speed motion pictures of missiles moving in water and gelatin gel

have permitted the determination of dV/dt and from this a and in turn CD (6).

The work was done with steel and aluminum spheres ranging in diameter from

one-sixteenth to one-fourth of an inch. In water, C, was found to fall between

0.30 and 0.33 from a summary of coefficient data, and the observed value was

0.314.

While it is presumed logical that f(v/a) is equally applicable to retardation

formulas pertaining to the denser mediums, its application is less important

because of the usually higher value of a. In water, the velocity of sound is

more than 4,500 f.p.s. and much greater than this in many metals and other

hard materials. It is presumed that the velocity of sound in most tissues is

similar to that in water, considering their average composition and density.

In view of this, at most impact velocities, the factor v/a is less than one and

comparatively unimportant in affecting retardation. For example, suppose

v to equal 900 f.p.s. while a is 4,500 f.p.s. Then v/a equals 900/4,500 or 0.2.

This leaves as significant factors in considering retardation in dense mediums, p, and AIM and v2. Compared to air, p is much greater-800 or more.

AIM and v2 retain their same significance.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 123

In considering missile penetration of armor, concrete, and stone, other

factors inherent in the material penetrated must be considered. Similar factors

do not appear to be pertinent in tissue penetration with the possible exception

of bone. However, for our purpose, any special properties of bone can be temporarily; at least, disregarded, as the extent of bone penetration compared to

soft-tissue damage is usually insignificant.

Shape

Random shape.-In shell or bomb fragments, pieces of glass, sand, and

stones, missiles may have any possible shape. Few have the shapes or are so

propelled that AIM or sectional density is a minimal value. Retardation in

air is rapid. Table 20 illustrates how rapidly velocity falls with fragments

from the burst of a 100-pound general-purpose bomb (the lightest effective

fragment is one capable of penetrating %-inch mild steel).

TABLE 20.-Retardation of effective fragments at varying distances from point of burst of a 100-

pound general-purpose aerial bomb

Distance from burst Weight of fragment Velocity

Feet Ounces F.p.s.

20 0. 022 7, 320

30 029 6, 390

40 .039 5,660

60 . 060 4, 760

80 086 4, 140

100 .115 3, 780

120 150 3, 470

140 191 3, 110

Bullets, artillery projectiles, and rockets are launched point on so that the

factor AIM is minimal. Bullets and artillery projectiles are further essentially

stabilized in this minimal presentation through a high rate of spin about the

long axis imparted by the rifling in the gun barrel. Random missiles seldom

have a spin about the axis of flight but are more apt to whirl or tumble through

the air. Retardation is more rapid because of the excessive area presented

for the air to act upon.

Random fragments frequently have a shape conducive to excessive retardation as compared with the ideal form. Here the function v/a also plays

an important role. The ideal shape when a is greater than v is the so-called

teardrop section with the round portion to the front. When v exceeds a, the

ideal shape is a pointed form, ogival or paraboloidal in section with the point

to the front. For minimal retardation, surfaces should be smooth. Random

missiles from bombs, artillery, and rocket projectiles are usually rough. Secondary missiles of sand and pebbles may be quite smooth and perhaps approach
124 WOUND BALLISTICS

the teardrop so far as leading edge presentation is concerned. Secondary missiles of glass may be quite pointed and are often likely to fly point on because

of the vane action of their surfaces. In glass fragments, A1IM may be favorable,

A being minimal for the fragment and M fairly high considering the density

of slightly more than 2 for glass as compared to nearly 8 for steel and more than

11 for lead. The density of sand is similar to that of glass.

Fragments consistently have less mass than bullets, size for size, owing to

the approximately 50 percent greater density of lead as compared with that of

steel, a representative fragment material.

Shell and rocket-projectile fragments are apt to be larger and consequently

heavier than those from the usual general-purpose bomb and so have a better

sustained velocity. Special antipersonnel aerial bombs may be constructed in

such a fashion that fragments will be of a mass sufficient to sustain impact

velocities at a level adequate to produce casualties at some distance from the

point of burst. Also, through selection of metal and design, there can be some

control of fragment shape. An instance of shape control is the corrugated

casting used in the Mills hand grenade of World War' I.

Ballistic shape.-The term "ballistic shape" as applied to missiles is

employed to refer to those missiles specially designed to have the best possible

exterior ballistic characteristics. In the missile-casualty field, the small arms

bullet is probably the only missile falling properly in this category because of

shape and controlled flight through spin imparted by rifling in the gun.

The effect of missile shape on retardation is strikingly shown in table 21

which lists the remaining velocities at different distances from the point of

origin for fragments from a 4.5-inch HE shell and the M1 150-grain bullet.

Initial velocities are similar, approximately 2,800 f.p.s., in each case.

TABLE 21.-Retardation of effective fragments from an HE shell as compared with the M1

bullet

Velocity ofDistance from point of

origin Effective shell M1 bullet

fragment

Feet F.p.s. F.p.s.

0 2, 800 2, 800

50 1, 560 2, 710

100 1,360 2, 645

150 1, 150 2, 580

200 1, 020 2, 525

300 890 2, 440

400 2, 365

500 2,300

Three major types of shape are encountered in military small arms missiles:

Flat base with rounded nose; flat base with pointed nose; and tapered or

so-called boattail base with pointed nose.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 125

The first form is commonly used in sidearms, carbine, or other ammunition where velocities at battle ranges will be less than that of sound in air.

The second shape was developed in the first decade of the 20th century to

improve the flight of military bullets when muzzle velocities were developed to

twice or more the velocity of sound in air. The taper-base bullet was a later

development to permit of greater mass and better flight when the moving

bullet was retarded to or below the velocity of sound in air. At first, many

observers considered the taper-base bullet to be more accurate, but its accuracy

was found to be due, in all probability, more to necessary improvements in

manufacturing methods than to its shape alone. This bullet is slightly more

stable in air flight because of the greater distance from center of gravity to

center of pressure.

Careful analysis of bullets manufactured for match competition has demonstrated that care in base design and production is more important to accuracy

than similar care regarding precision in the nose shape.

Theoretically, the bullet, or any projectile for that matter, to be accurate

should be a perfect form of revolution with the center of gravity in the axis of

revolution. While this attainment is approximated, perfection is impossible,

especially in a missile assembled of various nonhomogeneous materials. Some

asymmetry of mass distribution or shape or both is the rule rather than the

exception.

Futhermore, when a bullet passes through the gun bore in launching, there

is an asymmetrical engraving by the lands of the rifling. Again in manufacture, bullets are usually pressed into form at pressures of something less than

10 tons to the square inch. In firing, powder gas pressures against the base of

the bullet are usually of more than 20 tons to the square inch. This results

in deformation.

In the .30 caliber rifle barrel, the bore diameter is 0.300 inch and the groove

diameter 0.308 inch. Bullets made of a homogenous material on a lathe and

measuring 0.310 inch in diameter have been fired through accuracy barrels with

a groove diameter of 0.308 inch and recovered after firing. On recovery, they

still measured 0.310 inch in diameter, demonstrating either gun barrel stretch

or temporary compression of the bullet or both.

Considerable heat is developed by the friction of the bullet in passing

through the gun bore, and the temperature of the powder gases is high (above

that of molten steel). There is some evidence that the lead core of bullets under certain conditions can be altered at least during the earlier portion of its

flight. This permits some core deformation with consequent asymmetry of

mass distribution.

Inherent and induced asymmetry in the bullet results in more or less yaw

(deviation of the longitudinal axis from the line of flight) in the bullet during

flight. Yaw is an important factor in the physical consideration of the bulletproduced wound and will be discussed later in greater detail (p. 127).
126 WOUND BALLISTICS

Mass

Table 22 shows the velocities of fragments of varying weight and random

shapes at several distances from the point of a bombburst and demonstrates

clearly the effect of mass (really the factor AIM) on impact velocities. The

initial fragment velocity in all cases was 7,390 feet per second.

TABLE 22.-Effect of mass on the retardation of fragments

Distance from Weight of Velocity Retardation

burst fragment

Peet Ounces F.p.s. F.p.s.

80 0. 012 2, 230 5, 160

80 .023 3, 150 4,240

80 .085 4, 160 3,230

80 390 5, 180 2, 210

200 061 990 6, 400

200 148 1,710 5, 680

200 345 2,510 4,880

200 1.05 3, 550 3,840

500 . 214 531 6, 859

500 1. 08 972 6, 418

500 2. 12 1,400 5, 990

From this table, it is immediately apparent that at any given distance

from the point of launching, initial velocities being comparable, the heavier

missile will have the greater impact velocity. This follows from the retardation

formula, retardation varying inversely as the mass.

Furthermore, the factor d2

/M or AIM will consistently decrease as M increases, presupposing the fragment to be of the same material. Mass increases

as the third power, while the corresponding area increases as the square. Doubling the size of a mass increases the weight eight times and the area four times

in homologous shapes.

This principle underlay the development of the taper-base bullet. For

instance, the .30 caliber flat-base bullet weighs 150 grains versus 172 grains for

the taper-base bullet. Both have essentially the same bearing in the gun

rifling, barrel friction is comparable, and gas check is equally efficient. In the

German 7.92 mm. bullets, the weights are 154 grains for the flat-base versus

197 grains for the corresponding taper-base bullet. Impact velocities at any

given range with these bullets will vary almost as the weight ratio, that is, as

172 : 150 or 197: 154, if the bullets are launched with the same initial velocity.

Originally, the .30 caliber 172-grain taper-base bullet was loaded in ammunition for a muzzle velocity of 2,700 f.p.s., the same as that of the 150-grain

flat-base bullet. For ballistic reasons, muzzle velocities were subsequently reduced to approximately 2,640 f.p.s. Some personnel also complained of recoil

as being excessive and impairing marksmanship.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 127

In this connection, it is to be noted that the recoil of a weapon is a function

of the relative masses of the gun and bullet and the muzzle velocity of the projectile. Any decreases in weight of gun, increase in weight or muzzle velocity

of the bullet will increase the recoil.

The Germans launched their 197-grain taper-base bullet with a muzzle

velocity of approximately 200 f.p.s. less than that used with the flat base, 154-

grain bullet (2,480 to 2,500 f.p.s.). The Japanese also launched their 196.9-

grain 7.7 mm. taper-base bullet at a fairly low velocity, 2,239 feet per second.

Area of Presentalion of Random Fragments

Theoretically, the area of presentation of a random fragment may be

anything from a minimum (a) to a maximum (A) possible for any given fragment. However, mathematical investigation indicates that the average area

of presentation in random fragments will be approximately 70 percent of A.12

Explanation for this lies in the fact that, because of the asymmetry of

form as well as the unequal application of the impelling forces, fragments

commonly have whirling or tumbling motions in addition to the motion of

translation. In general, the greater the area of presentation in relation to

the mass, the greater will be the retardation and the lower the impact velocity.

Shape can affect area of presentation. A round ball, for instance, has

only one possible area. On the other hand, a rectangular object may have

many possible areas of presentation from the minimum to the maxinum

section possible.

Bullets and projectiles are designed to afford the minimum area of presentation combined with the maximum possible mass. Minimum area of presentation is maintained through the action of the spin about its longitudinal

axis imparted to a projectile by the rifling in the gun barrel. Rifling of a

gun barrel was a major improvement accomplished in the latter part of the

18th century.

Yaw

Yaw, deviation of the longitudinal axis from the line of flight, in a bullet

without doubt plays a most important role in explaining many of the anomalies

encountered in the study of bullet wounds. Yaw is increased proportionately

to the relative densities of the retarding medium as compared to air, so in

tissues it is augmented some 800 times, with resulting very complex, rapid

bullet motions. This rapid, complex motion accounts for wound damage

much more extensive than attributable to motion of translation alone. Yaw

augments the retardation of a bullet in tissue, thereby materially increasing

the amount of kinetic energy entering into the wound production.

12 Morse, H. M., Baldwin, R., Kolchin, E.: Report on the Uniform Orientation and Related Hypotheses for Bomb

Fragments, With Applications to Retardation and Penetration Problems. Report No. T.D.B.S. 3, Office of Chief

of Ordnance, Washington, D.C., 30 Jan. 1943.
128 WOUND BALLISTICS

Yaw results from two factors: (1) Spin imparted by rifling; (2) imperfections in the bullet due to construction or deformation in the bore of the

gun and imperfections in the gun.

To have a yaw, a bullet must have a length greater than its diameter.

There can be no yaw in a round ball. In flight, the forces of retardation can

be resolved in a point within the moving object. In addition, there is within

the solid the center of gravity and in the sphere the two points coincide, hence

there is no lever between the two points about which an overturning force

can operate.

In the bullet, or cylinder, in flight in a point-on orientation, the point at

which the opposing forces are resolved will be different from the center of

gravity. An overturning force will operate on the lever between these two

points. Without spin, the bullet will tumble end over end.

With the muskets and smoothbore guns of the 17th and 18th centuries,

round balls were employed. Bore diameters of guns were larger than in modern

weapons, and powder pressures and velocities were comparatively low.

American hunters required accuracy and range. This naturally led to

smaller bore weapons and longer barrels which, while decreasing the mass of

the ball, resulted in increased velocities and range. As velocities are increased

with the round ball in a smoothbore barrel, accuracy is lost. The ball may be

quite erratic in flight. The idea of imparting spin to the missile by means of

rifling naturally followed. This restored accuracy. It is now known that the

inaccuracy of the ball is due to air piling up in front of it and that spinning

the ball prevents this accumulation of air. Tile cylindrical bullet gradually

evolved during the 19th century, and rifle calibers declined with powder

improvement. The U.S. military weapon for some years was the Springfield

.45-70, which fired a heavy lead bullet weighing more than 400 grains. This

was followed near the end of the 19th century by the Krag-Jorgesen rifle of

.30 caliber and a 220-grain jacketed bullet. In 1903, the Springfield magazine

rifle of .30 caliber was adopted. At first, a rounded-nose bullet was used,

but this was replaced in 1906 with the so-called spitzer bullet with an ogival

head having the ogive struck with a radius of 7 diameters (calibers). This

ogival head was developed in Germany early in the 20th century, and the

first patent application in the United States was filed in 1905.

Most of this gradual change and improvement in bullets up to the period

of World War I was largely accomplished by rule-of-thumb or crude scientific

methods as judged by modern standards.

In the period of a little more than a century and a quarter following

1775, the following changes in military weapons slowly evolved:

1. The rifled bore, putting spin on the bullet.

2. Gradual transition of the bullet from the round to the elongated shape.

3. Gradual change from a round nose to the sharp pointed, ogival, socalled spitzer nose.

During this transition, the pitch of the rifling was gradually changed

until most military weapons used a twist of approximately one turn in a distance
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 129

of 30 calibers.' While it is customary to state that the rifling makes a turn

in so many inches, it is better to specify the pitch in calibers, which immediately

permits of comparisons between weapons of differing calibers.

Pitch of rifling through determining the rate of spin is a factor in controlling the stability of the bullet in flight and in turn the degree of yaw on impact.

The rate of spin in the usual military rifle is high. With the .30 caliber flatbase bullet at a muzzle velocity of 2,700 f.p.s. and a rifling pitch of 30 calibers,

the spin is more than 3,500 revolutions a second. This spin is only adequate

to stabilize the 150-grain bullet in air flight. The spin has a negligible effect in

maintaining the bullet in a point-on position in denser mediums, such as water

or tissues.

Spin maintains the bullet essentiMly in a point-on position through its

effect on what is known as the overturning couple. In the elongated bullet,

all retarding forces are, xesolved in a point somewhere in the axis of the bullet

toward the nose. The center of gravity also will be in the axis but at a point

nearer the'base in the pointed-nose bullet. The distance between these points

i'sthe overturning couple, or lever arm, through which the forces resulting from

the spin operate to stabilize the bullet.

Because a bullet is never a perfect form of revolution and because neither

the center of pressure nor center of gravity is exactly in the axis, there is always

some degree of yaw or tip or gyroscopic precession. Owing to the gyroscopic

action of the high rate of spin, this yaw goes through a definite period which

varies throughout the bullet's flight. Another factor inducing initial yaw is

that, while the bullet passes through the gun barrel, the center of gravity is

forced to travel in a circle so it will not be in the axis of the bore, whereas, once

the bullet is in free air flight, the rotation is about the center of gravity, which

immediately takes over.

Length of bullet determines the relative location of the centers of pressure

and gravity and through that the length of the lever arm through which the

forces of spin operate. This makes the longer, taper-base bullet somewhat

more stable than the usual flat-base form.

However, density of resistant materials is a direct factor on the retardation

and other motions of a missile. Water with a density 800 times that of air and

tissues of slightly greater densities act much as a magnifying glass, magnifying

all of the retardations, yaw, and gyrations of the bullet 800 or more times. A

very slight tip or yaw will become one of more than 50' by the time a .30 caliber

110-grain solid bullet homologous in shape with 150-grain flat-base bullet has

traversed 3 inches of water. Not infrequently, the increase in yaw will exceed

100'. Changing from one density to another also induces marked variations in

the degree of yaw.

This, of course, immediately changes the area of presentation; a bullet

enters tissue point on but in a few inches may be tipped up to 90' or more and the

13 The caliber of a weapon is the diameter of the bore not including the depth of the grooves. A unit of caliber is

also used to express the length of an artillery weapon from breech face to muzzle and is equal to the diameter of the

bore. For instance, many naval guns have a length of 50 calibers.-J.C.B.
130 WOUND BALLISTICS

presentation area is its broadside. The forces of spin are still operating, however, through the overturning couple and tend to stabilize and maintain the

bullet in point-on flight. Consequently, in another few inches, the bullet is

again point on and may leave the body through a small exit wound. Neither

entrance nor exit wounds give any idea regarding the extensive interior destruction occasioned by the extreme tip and periodic bullet gyrations within the

tissues.

While in flight, the bullet goes through all of the motions of the spinning

top, except that it is much quicker because of its higher rate of spin. Some

conception of the rate of spin may be visualized when it is realized that it is

more than 100 times that of what is usually termed a high-speed electric motor

armature which is rotating more than 1,700 revolutions per minute. The Mii

bullet with a muzzle velocity of 2,800 f.p.s. spins at a rate of more than 200,000

revolutions per minute. The usual top spins at a few hundred turns a minute

but is relatively better balanced than the bullet.

When a top is started spinning, it wobbles more or less in a periodic manner. Then it stabilizes and, if well made, spins quite stably for an appreciable

interval. Then, as it loses spin, it again becomes unstable and wobbles more

and more as the spinning motion retards. The spinning bullet goes through

similar gyrations while moving through the air. However, while the top goes

through its gyrations with its point as a fulcrum, the fulcrum about which the

bullet's axis tips is the center of gravity of the bullet.

These varied motions are gyroscopic in nature and strictly periodic. At

one instant, the bullet is point on, and at the next instant the bullet axis is at

an angle to the line of flight. This angle of yaw increases to a certain amount

and then progressively decreases until it is again zero, when a node is reached

and another similar gyration commences.

In air flight, degree of yaw is normally comparatively slight-less than 30

in properly designed military bullets. This spin is sufficient to stabilize the

bullet in an essentially point-on position. The bullet goes through a complete

gyration in a distance of 10 to 20 feet, at less than 0.001 second of time.

As the bullet leaves the muzzle of the gun, the actual angle of yaw is very

small, only a few minutes of are, but the angular velocity of yaw is considerable

so that as the bullet moves along its trajectory the yaw increases until it

reaches a maximum at some 10 or 15 feet in front of the muzzle. From here,

it then proceeds to yaw in an approximately periodic manner throughout the

remainder of its flight.

The angular velocity of the yaw is usually due to one of the following

causes or a combination of them. It may be due to the fact that the axis of

the bullet makes an angle with the bore so that the axis of the bullet is moving

in a cone around the axis of the bore. This conical motion provides for the

angular velocity just mentioned. Another cause is due to some asymmetry or

inhomogeneity in the bullet which may result in the major axis of the ellipsoid

of inertia of the bullet having a different direction from the axis of form. The

result of this sort of angle is equivalent to the result produced when the axis of
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 131

the bullet makes an angle with the axis of the bore. The gyroscopic forces of

spin quickly damp out the initial yaw so that at a distance of a hundred yards

or so the bullet is flying almost exactly nose on. 14

Bullet spin is retarded less rapidly than the motion of translation. However, at long ranges, several thousand yards or more, the bullet presentation

is further complicated by the fact that the gyroscopic forces of spin tend to

maintain the bullet's axis parallel to the axis of the gun throughout its flight.

The axis of the bullet does not tend to follow the trajectory except for a short

distance from the gun. As an example, if a bullet is fired from a gun elevated

at an angle of 30', the axis of the bullet tends to maintain this 30' angle throughout its flight. This results in asymmetry of the retarding air forces with

respect to the bullet axis and consequent increase in angle of yaw at extreme

ranges as the axis of the trajectory deviates from the direction of the axis of

the gun bore.

Surgeons have often noted "key-hole" entrance wounds at extreme ranges

and erroneously attributed them to "tumbling" bullets. In unimpeded air

flight, a bullet given adequate initial spin seldom "tumbles" or flies end over

end. Of course, a bullet often tumbles badly after striking a glancing blow in

ricochet. However, at extreme ranges, a bullet seldom flies with its axis

parallel to the ground, so often hits with its axis far from perpendicular to the

surface struck. The entrance wound is usually an accurate record of the

bullet's presentation at the instant of impact.

On entering a medium denser than air, all of these motions, especially the

degree of yaw, are magnified. On entrance, yaw may be only a fraction of a

degree, but it is quickly increased by approximately the ratio of the medium

densities which for water and tissues is some 800 times. Likewise, period of

gyration or distance from node to node is correspondingly shortened. A bullet

may be essentially point on at impact and in a space of 3 inches be tipped in

yaw at right angles to its line of flight and in another 3 inches again be essentially point on.

Moving from a medium of one density to that of another density influences

the bullet's motions and can result in extreme angles of yaw. For instance,

moving from air to tissue, from soft tissue to bone, and again from bone to

soft tissue will have a profound influence in inducing extreme changes in the

gyrations of the bullet and all of its motions, including retardation.

Retardation for any bullet also varies as the square of the angle of yaw in

degrees so that a yaw of 130 will double the retardation."0 Letting 5 be the

angle of yaw in degress, the retardation factor due to yaw is

52

1+ 16

11 Personal communication, R. II. Kent, Physicist, Aberdeen Proving Ground, Md., to Maj. R. r. French, 28 Mar.

1947.

15 Kent, R. H.: The Theory of the Motion of a Bullet About Its Center of Gravity in Dense Media, With Applications to Bullet Design. [An undated manuscript sent to Major French in the period 1931-32.]
132 WOUND BALLISTICS

Table 23 gives the retardation factor for varying values of yaw.

TABLE 23.-Values of yaw

Yaw Yaw2 Yaw2/169 l±Yaw2/169

-D egree D e g " "

2 4 0.'0236 1.02

4 16 .0944 1.09

8 64 .3776 1.38

16 256 1. 5104 2. 51

32 1, 024 6. 0416 7. 04

64 4, 096 24. 1664 25. 17

128 16, 384 96. 6656 97. 67

Yaws of more than 170' have been observed in bullets in passing through

6 inches of water. Theoretically, yaw can be of any value to just under 180

degrees. A yaw of 170' increases the retardation factors 172 times and a yaw

of 179', 190 times. This readily explains why a superspeed bullet is stopped

in a very few feet of a homogeneous medium such as water.

This also explains why a supervelocity bullet is retarded so greatly in

producing a casualty. The extreme retardation of such bullets can result in

a wound with comparatively enormous destruction, tissue pulping, bone

shattering, and other extreme manifestations only possible with the modern,

fast-moving military bullet.

THE WOUND AS A PHYSICAL ENTITY

Permanent manifestation of the missile wound is a hemorrhagic area

surrounding the track of cut and torn tissue left in the missile wake. However,

while cutting through the tissue, a missile also imparts radial velocity to the

tissue elements resulting in a development of a temporary cavity as the tissues absorb the kinetic energy lost by the missile through retardation. In

absorbing this energy, some tissues more elastic than others react in such a

manner that this cavity goes through several pulsations, each successive

temporary cavity being smaller in volume than the preceding cavity. In

longitudinal section, the temporary cavity is a conic section, usually an oblate

ellipsoid in the case of a missile without yaw or particular form factor, such as

a sphere.

In producing a casualty, the missile is commonly moving in the tissue a

thousandth of a second or less, and the actual wound is produced too rapidly

for human perception to appreciate all that goes on. As examples of actual

time intervals involved, the following two instances are cited, considering the

thigh with a thickness of 8 inches to be the part injured:
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 133

First, consider a bullet weighing 150 grains with an impact velocity of

2,500 f.p.s. and a residual exit velocity of 1,500 f.p.s. It will traverse the 8

inches of tissue and bone in 0.00033 second and expend 1,330 ft.-lb. of energy

during its passage through the thigh.

Second, the same bullet with an impact velocity of 2,000 f.p.s. and an exit

velocity of 1,000 f.p.s. will traverse the thigh in 0.00045 second, and 998 ft.-lb.

of kinetic energy will be absorbed in the wound.

On dissection by the military surgeon, the most prominent feature of the

wound will be the permanent cavity or wound track which on close inspection

is found to be surrounded by a zone of more or less damaged tissues filled with

extravasated blood. Partially or completely disrupted nerves may be found

along with damaged blood vessels, though, barring a direct hit by the missile,

most of the larger veins will be intact and the arteries uninjured. Bone may

be found to be fractured without evidence of a direct hit. Such fractures are

usually fairly simple, while those which result from a direct hit will show more

comminution, especially at the cited impact velocities.

Research with spheres 16 as missiles has demonstrated that both the volume of the permanent cavity and the tissue showing evidence of devitalization

and extravasation of blood is a function of the kinetic energy entering into

the wound; also, that the volume of the tissue showing extravasation is 11.8

times the volume of the permanent cavity. It is anticipated that with bullets

the degree of yaw will modify the direct relationship between volume and impact

energy or square of velocity.

Further research with steel spheres has demonstrated that, some 400

microseconds after impact, a temporary cavity some 26 times the volume of

the permanent cavity reaches its greatest diameter perpendicular to the path

of the missile. This cavity may go through several pulsations with corresponding negative and positive pressure phases. All of these phenomena are

too rapid to be perceived by the human eye.

This temporary cavity and associated phenomena explain the so-called

explosive effects often noted with high-velocity missiles. It accounts for

tissue pulping and other damage some distance outside of the permanent

cavity or apparent bullet track. During the stretching of tissue concurrent

with the expansion of the temporary cavity, nerve trunks are often stretched

to such a degree that function is destroyed without apparent gross injury.

Permanent Cavity

As the missile tears through the tissues, there are two immediate results:

(1) The cutting or tearing of a permanent cavity along its track; and (2) the

initiation of severe shock waves, with pressures of well over 1,000 pounds to

the square inch, which travel ahead of and out from the missile at the velocity

of sound in the tissues, approximately 4,800 feet per second.

16 For the complete report of this work, see pages 147-233.
134: WOUND BALLISTICS

Experiment has demonstrated that for every foot pound of energy doing

work in wound formation there will be a permanent cavity remaining with

a volume of 2.547 x 10-l cubic inches. With the average military rifle bullet

and resultant wound, this presages a permanent cavity slightly larger in average diameter than the bullet. Yaw may modify the shape of the permanent

cavity from point to point along the track, but the total volume should follow

this expression as yaw also modifies the amount of energy doing work.

In the case of slow low-energy missiles, the permanent cavity will be

distinctly smaller in diameter than the missile which produced it. Tissue

elasticity accounts for the reduction in volume.

While the passage of the missile is responsible for the permanent cavity,

it actually comes into permanent being sometime after the missile's passage.

As the bullet passes through the tissue, considerable radial motion is imparted

to the tissue elements, and a large temporary cavity is formed. Slow-motion

pictures and other experimental evidence show that there are several pulsations before the wound track becomes wholly quiescent. This again is

probably due to tissue elasticity, particularly the restraining action of the

skin as it absorbs the energy imparted to it by the missile.

Area of Extravasation

On dissection of the wound track, the adjacent tissue is found to be quite

sanguineous and, in the case of the average rifle-bullet wound, full of extravasated blood for an inch or more away from the track. In this region, histologic examination reveals a separation of muscle bundles with capillary

hemorrhages into the interspaces.

In cross section of a wound track, this hemorrhagic area is found to be

well defined. Experiment has shown that for every foot pound doing work

in producing the wound there will be 30.105 x 10-1 cubic inches of this

hemorrhagic tissue.

Survival studies have suggested that much of the tissue in this area of

extravasation will regenerate if it is kept clean. However, in the battlefield,

cleanliness is often impossible, and this pulped, hemorrhagic tissue provides

an excellent pabulum for pyogenic bacteria and the clostridia which are responsible for gas gangrene. Early, adequate debridement is the indicated procedure

in order to guard against secondary invaders and to insure early healing.

Temporary Cavity

Microsecond X-ray and high-speed motion picture studies have demonstrated the formation of a temporary cavity with a volume almost 27 times

larger than that of the permanent cavity. This cavity reaches its greatest

size after the impact of the missile and after it has entirely left the wound

track. Its maximum volume is 66.247 x 10-1 cubic inches for each foot pound

doing work in producing the wound.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 135

In the first hypothetical thigh wound (p. 133) in which 1,330 ft.-lb. of

energy were expended, the temporary cavity would have a maximum diameter

of perhaps 12 or 15 inches, depending on the presentation of the bullet. Its

total volume would be 88.1 cubic inches.

This temporary cavity, long suspected but never before perceived in

tissue, is the logical sequence to the passage of a missile through an elastic

medium. Tissues are known to be quite elastic. The pulsation likewise

is to be expected in some tissues, such as muscle, as would occur when a ball

suspended by a rubber band is dropped. However, the pulsations damp out

rapidly, and the human senses are only able to perceive that there has been

some general disturbance of the tissues.

Shape of the temporary cavity is a function of the shape and presentation

of the missile. With a sphere, the shape of the cavity is quite symmetricala conic section of revolution, fusiform in longitudinal section. In the case

of a fragment, it may be quite asymmetrical as the presentation of the irregular

fragment varies. In the case of the bullet, yaw will result in asymmetry.

In fact, where the bullet goes through a node and then again into yaw, there

may be several larger temporary fusiform cavities connected by much smaller

ones, the so-called scalloped wound remaining in the permanent cavity.

Variations in tissue also affect the type and shape of cavity.

This cavity is the result of particles set into motion by the passage of

the bullet. Time is required to overcome their inertia, hence the lag in full

development of the temporary cavity as compared to the passage of the bullet.

While the missile imparts outward moving forces to the particles at the instant

of its passage, it, requires some microseconds for the particles to move outward

to their greatest distance and for the physical properties of the tissues to

absorb the forces involved. Average particle velocities are not particularly

great. In the hypothetical thigh shot, they would be 125 feet per second.

While foot pounds, units of energy, have been used in discussing the

mechanics of the missile wound, a better conception of the magnitude of the

forces involved may come from a consideration of the power utilized in wound

formation. Power is the measure of work done by the energy expended by

the missile in the wound. The 1,330 ft.-lb. absorbed in 0.00033 second in

the first hypothetical wound is the equivalent of some 7,200 horsepower of

work. In the second wound (p. 133) with 998 ft.-lb. absorbed in 0.00045

second, the work equivalent is more than 4,100 horsepower. Work done in

anyn missile wound will seldom be less than several hundred horsepower and

will often considerably exceed the figures cited. The larger numerical values

of horsepower can be expected when it is realized that 1 horsepower is the

lifting of 550 pounds for 1 foot in 1 second. In the wound, more than 1,000

ft.-lb. of energy may do its work in much less than one-half of a thousandth

of a second.

With this realization of the forces involved in the production of the missile

casualty, some of the otherwise anomalous manifestations in the wound appear

much more logical. For instance, fractures occur at some distance from the
136 WOUND BALLISTICS

missile track and without any direct contact between the bone and the missile.

Forces may be transmitted through the essentially noncompressible blood and

rupture a vein some distance from the missile's path. Nerves may be paralyzed and yet fail to show gross evidence of physical damage. In some wounds

in muscle, splitting along fascial planes will be noted for a considerable distance

from the path of the bullet.

Fluid-filled viscera are often blown asunder by the operation of hydraulic

forces. High-velocity missiles may pulp the brain substance. In some cases,

the bones of the skull are separated along the suture lines as though an explosion has occurred within the brain case. This is but another manifestation

of the forces operating in the formation of the temporary cavity, and examination often reveals clean holes of entrance and exit of the missile showing that

the bony rupture occurred after its passage. Similarly, in shooting through

a can filled with water, the rupture of the can occurs after the through-andthrough passage of the bullet.

Knowing the relationship between the permanent cavity, zone of extravasation, and temporary cavity, the military surgeon can make use of this

knowledge in determining the extent of the wound. The zone of extravasation

is readily seen and can indicate the total involvement. For instance, if an

area of tissue full of extravasated blood is seen extending for a distance of 2

inches from the axis of the permanent cavity, it is known that damage along

fascial planes, perhaps some blood vessel rupture, and some nerve injury can

be expected to a further distance of some 21% inches beyond the zone of extravasation. If note is made of the extent of extravasation, some idea as to the

amount of energy expended in the wound is determinate.

The military surgeon should never be misled, especially in the case of

bullets, by small entrance and exit wounds. These small skin openings may

be no indication whatever of the possible extent of the internal wound. This

is particularly true of the yawing bullet and may be true of the high-velocity,

spinning fragment. Elasticity of the skin often results in almost complete

closure of skin wounds.

Temporary Cavity Pulsations

In water and certain tissues, such as the muscular thigh surrounded by

highly elastic skin, the temporary cavity goes through a series of pulsations.

As the cavity expands, a negative, subatmospheric gage pressure develops

within the tissues. This is followed by a positive pressure of greater intensity

but of shorter duration with the collapse of the cavity. In water, these pulsations may continue for as many as seven or eight cycles, disappearing as the

cavity disintegrates. While measurements of tissue phenomena have not been

made as complete as those in water, definite indications are that the tissue often

behaves in a manner wholly analogous to water. There may be two or more

pulsations.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 137

For water, the period of the pulsations is related to the amount of energy

doing work. The time of a cycle in seconds is equal to 2.35 x 10-3 times the

cube root of the foot pounds of energy absorbed. This relationship also is

reasonably applicable to most tissue wounds. The following tabulation gives

the computed time of a complete pulsation in milliseconds for varying amounts

of energy in foot pounds:

Duration. of pulsation Energy (ft.-lb.) : (milliseconds)

250 ----------------------------------------------- 15

500 ----------------------------------------------- 19

1, 000 --------------------------------------------- 23

1, 500 --------------------------------------------- 27

2, 000 -------------------------------------------- 30

Coupled with the temporary cavity in water and its pulsations there are

internal pressure changes. When the cavity is fully expanded, pressures in the

medium are at their lowest value, often a full atmosphere or more subnormal.

As the temporary cavity decreases in size, pressures increase reaching a maximum value of three or four times atmospheric pressure. Oscillograms reveal

that, while the positive pressures are greater in intensity, the duration of the

negative pressure phase is twice as long.

While the initial shock wave shows very high pressures (1,000 pounds per

square inch and more), oscillograms show its duration to be short, 15 to 25

microseconds. Available evidence indicates that this short duration may explain the apparent fact that little if any true tissue damage in gas-free tissues

can be attributed to this initial shock wave despite its intensity. Other studies

have shown that tissue elements withstand much higher static pressures without damage.17 However, when gas is present in the tissue, damage often occurs.

Experimental studies afford quite conclusive evidence that subatmospheric

pressures connected with cavity behavior are responsible for much tissue

destruction.

Though cavity pulsation has been detected in water, in gelatin block and

in some tissues, in abdominal shots in the cat, no pulsations were noted in microsecond X-rays. Here, a single temporary cavity followed by rapid collapse

appears to be the rule. However, extensive damage to the intestines occurred

which was due largely to the expansion of gas in the intestines in the subatmospheric pressures during the expansion of the temporary cavity and following the

shock wave. This expansion of gas results in great stretching of tissues and

consequent. rupture or other severe damage. This stretching is not due directly

to either the shock wave or cavity formation behind the missile but rather to

the expansion of the air pocket already present within the tissues. This air

responds to the pressure changes around the temporary cavity, and the stretching occurs as the result of the subatmospheric pressures when the included air

expands.

17 (1) Brown, D.E.S.: Effects of Rapid Compression Upon Events in Isometric Contraction of Skeletal Muscle.

J. Cell. & Comp. Physiol. 8: 141-157, 1936. (2) Cattell, M.: The Physiological Effects of Pressure. Biological Rev. of

Cambridge 11: 441-476, 1936.

603225v-62- 11
138 WOUND BALLISTICS

Though not established experimentally, it is anticipated that the subatmospheric pressures may likewise lead to sudden expansion of gas in the alveoli

in the lungs so as to stretch the walls and rupture small blood vessels. Such

injury is indicated from field observations.

The extent of the temporary cavity formation and the relationship of tissue damage to the permanent wound track may be influenced by constricting

clothing, tenseness of muscles, or other variables at the time of wounding. For

instance, removing the skin from a cat's leg before wounding resulted in a

larger temporary cavity with more of a wound "blow-out." On the other hand,

reinforcing the skin with Scotch tape changed the shape of the cavity and

resulted in tissue damage to a greater distance from the missile track. Elasticity of the skin and muscle fibers appeared to play a considerable part in predetermining the physical nature of the missile wound.

Skin Penetration and Energy Absorption 18

Skin and bone both appeared from experimental data to offer a particular

resistance to penetration differing from other tissues. There was a critical

velocity in each case below which a missile would not effect penetration.

There was comparatively little difference in the value of this critical velocity

irrespective of the size of the missile.

Initial velocity required for a %32-inch steel sphere weighing 2 grains was

found to be 170 f.p.s. for penetration of human skin. Lead spheres having an

1

%64-inch diameter, weighing approximately 7 grains with a velocity of 161

f.p.s., did not effect penetration. Even extremely large missiles will lose about

125 f.p.s. of their impact velocity in penetrating the surface of the skin. Area

of presentation affects skin penetration to such degree that the loss in velocity

is proportional to the reciprocal of the diameter of the spheres.

Skin was found to be more resistant than other tissues. The drag coefficient, a value dependent on the resistance encountered by a missile and independent of the missile, for human skin was 0.528 as compared to 0.297 for

water. The coefficient for cat muscle was 0.448 and for 20 percent gelatin

block, 0.350. Human skin had a drag coefficient more than 20 percent greater

than cat muscle. While the drag coefficient was not determined, indications

were that cat skin was slightly more resistant to penetration than human skin.

The skin resistance offered a logical explanation for the fact that shrapnel,

formerly used as an antipersonnel agent, was commonly ineffective. It was

usually employed at such ranges that remaining projectile velocity was low.

The bursting charge propelling the shrapnel balls was commonly incapable

of imparting sufficient velocity to effect skin penetration. Shrapnel balls also

had a poor ballistic shape and were rapidly retarded in air flight.

18 Grundfest, H., Korr, I. M., McMillen, J. H., and Butler, E. G.: Ballistics of the Penetration of Human Skin by

Small Spheres. National Research Council, Division of Medical Sciences, Office of Research and Development, Missile

Casualties Report No. 11, 6 July 1945.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 139

An anomaly in skin penetration was the threshold velocity necessary

to effect penetration, rather than a certain amount of energy. A 2-grain

sphere required a velocity of 170 f.p.s. for penetration or a negligible amount

of energy when measured in foot pounds. For a 150-grain bullet to penetrate skin, a velocity of approximately 125-150 f.p.s. was required corresponding

to approximately 5 ft.-lb. of energy. The 2-grain sphere would have less than

one-fiftieth this amount of energy.

Bone Penetration 19

Bone offered a situation similar to that found in skin. Here a minimal

velocity of approximately 200 f.p.s. was necessary to effect penetration. Once

penetration had been effected, any velocity remaining above the 200 f.p.s.

would operate to effect deeper penetration in direct proportion to the square

of the velocity and the sectional density of the missile. Penetration and

damage to bone was effectively gaged by the amount of energy performing

work, essentially proportional to the square of the velocity.

While specific experiments were conducted with beef bone, results are

substantiated by other work with human and horse cadavers. Results were

essentially the same.

In conjunction with these critical velocities necessary to effect penetration,

some consideration should be given to the .45 caliber automatic pistol and its

load. From time to time, complaint has been registered that this weapon is

not as efficient under all conditions as could be desired in a self-defense

weapon. A 234-grain fuil metal patch bullet is used, and it is launched with

a muzzle velocity of 825 feet per second. Following is a tabulation of the

kinetic energy available with this bullet at various velocities:

Velocity (f.p.s.): Kinetc.lb.)energy

825 ---------------------------------------------- 383

700 ---------------------------------------------- 254

600 ----------------------------------------------- 187

500 ----------------------------------------------- 130

400 ---------------------------------------------- 83

300 ----------------------------------------------- 47

Considering the 125 f.p.s. required to effect skin penetration, it can be

seen that the remaining velocity and energy are dropped down to at least 700

f.p.s. and 254 ft.-lb., respectively. The penetration of bone requires another

200 f.p.s. and dropping remaining velocity to 500 f.p.s. and energy to 130 ft.-lb.

In addition to these losses, passage through tissue results in some retardation,

so remaining velocity and energy will certainly be something less than the

figures cited. Furthermore, impact seldom occurs at pointblank ranges, and

19 Grundfest, HT.: Penetration of Steel Spheres Into Bone. National Research Council, Division of Medical Sciences

Office of Research and Development. Missiles Casualty Report No. 10, 20 July 1945.
140 WOUND BALLISTICS

the initial velocity is certain to be something less than 825 f.p.s. when the bullet

hits the skin.

From an analysis of these facts and the requirements for penetration of

skin and bone, it can be readily appreciated that the .45 caliber bullet is of

little value as a wound-producing agent except in the softer tissues and at near

ranges. The bullet often fails either to penetrate or to fracture bone and

practically never shatters bone in the manner common to the rifle bullet or

fragment. The Japanese and German sidearms with muzzle velocities of

approximately 1,100 f.p.s. were much more effective as antipersonnel weapons

than the .45 caliber weapon. While the same bullet with its characteristics

was used in the submachinegun, multiple hits probably compensated for the

wealmesses, so apparent in single shots.

Of course, the carbine with its much higher muzzle velocity has largely

replaced the .45 automatic pistol and is a more effective antipersonnel weapon

than any of the sidearms.

Histologic Character of Tissue Damage

Muscle damage is evidenced by swelling and coagulation in a region a

few millimeters from the permanent cavity of the wound. Often, no muscle

damage is noted in regions where blood extravasation from ruptured capillaries

is pronounced.

Expansion of the temporary cavity along fascial planes results in an accumulation of blood from the rupture of small blood vessels, but the larger vessels

are remarkably resistant to injury, probably because of their elasticity. Sometimes, a blood vessel is left spanning a permanent cavity. In other cases,

nerves are severed, while blood vessels running parallel with the nerve in the

same fascia are intact. Veins with their comparatively thin walls often rupture

as the result of transmitted forces, while arteries with their more resistant walls

are usually patent barring a direct hit.

Cavity Formation by the Moving Missile

As a function of the amount of kinetic energy doing work, the speeding

missile results in a permanent cavity, a zone of tissue full of extravasated blood,

and a temporary cavity in tissue. In water, it also produces a cavity. The

volumes of the various cavities in cubic inches are related to the foot pounds

of energy expended by the following formulas:

In tissue:

Permanent cavity-2.547 X 10- ft.-lb.

Zone of extravasation-30.105 X 10- ft.-lb.

Temporary cavity-66.247X10-1 ft.-lb.

In water:

Temporary cavity-737.7X10- 3 ft.-lb.
BALLISTIC CHARACTERISTICS OF WOUNDING AGENTS 141

Table 24 shows the comparative volumes of the various cavities in cubic

inches for varying amounts of energy expended.

TABLE 24.-Volumes of cavities

Cavity in tissue (in cubic inches)

Cavity in

Energy water

Permanent Zone of extrav- Temporary (cubic inches) asation

F.p.s.

250 0. 63 7. 53 16. 57 184

500 1. 27 15. 05 33. 13 369

1,000 2. 55 30. 11 66. 25 738

1, 500 3. 82 45. 16 99. 37 1, 107

2, 000 5. 09 60. 21 132. 49 1, 476

2, 500 6. 36 75. 26 165. 61 1, 845

3, 000 7. 63 90. 31 198. 73 2, 214

3, 500 8. 91 105. 37 231. 86 2, 583
CHAPTER III

Mechanism of Wounding1

E. Newton Harvey, Ph. D., J. Howard McMillen, Ph. D., Elmer G. Butler,

Ph. D., and William 0. Puckett, Ph. D.

HISTORICAL NOTE

Pictures of rifle bullets in rapid flight have always aroused interest and

admiration-interest from the resemblance to moving ships with prominent

bow and stern waves and a turbulent wake; admiration that so rapid a movement can be stopped in a photograph and the detail of events clearly visualized.

Since the first spark pictures of moving bullets in air, obtained by Mach 2 in

1887 and Boys 3 in 1893, a mass of information has been gathered on trajectories,

stability, spin, yaw, and precession of projectiles. This field of inquiry is usually classified as exterior ballistics to distinguish it from what happens within

the gun, or interior ballistics.

The events which occur when a bullet strikes and enters the body have

received much less attention-in part, owing to the rapidity of changes which

take place in an opaque medium and the difficulty of measuring them and, in

part, to the complexity of the body and the feeling that few significant generalizations could be made regarding it. Actually, the changes which occur when

a high-velocity bullet enters soft tissue are remarkably independent of body

structure, and a common series of events can be outlined. The recent technical development of high-speed cameras that can take moving pictures at the

rate of 8,000 frames a second and an X-ray apparatus that requires only onemillionth of a second for exposure have eliminated the previous barriers to understanding the mechanism of wounding. It is now possible to analyze events

that are all over in a few thousandths of a second.

1 The research on which this chapter is based was carried out under a contract, recommended by the Committee on

Medical Rcsearch, between the Office of Scientific Research and Development and Princeton University. Work under

this contract began on 15 October 1943 and continued to 1 November 1945. On the latter date, the contract was trans

ferred to the Office of the Surgeon General. The work was brought to completion on 28 February 1946. All of the research was conducted in the Biological Laboratories of Princeton University, Princeton, N. J. It is important to record

here that the success of the work has been due in great measure to the wholehearted cooperation of the professionally

and technically trained persons who, at one time or another, were members of the "Wound Ballistics Research Group."

In addition to the authors of this chapter, the following persons took part in the investigation: Mr. Delafield DuBois,

Mr. Joseph C. Gonzalez, Mr. Vincent Gregg, Dr. Harry Grundfcst, Mr. James I. Hay, Dr. William Kleinberg, Dr.

Irvin MI. Korr, Mr. Daniel B. Leyerle, Dr. William D. McElroy, Mr. John R. Mycock, Dr. Gerald Oster, Mr. R. G.

Stoner, Miss Mary Jane Thompson, Mr. Harold A. Towne, and Dr. Arthur H. Whiteley.

2 Mach, von E., and Salcher, P.: Photographische Fixirnug der durch Projectile in dot Luft eingeleiteten Vorgange.

Der Kais. Acad. der Wiss. zu Wein, 1887 and 1889. (Also in Nature, London 42: 250-251, 1890.)

SBoys, C. V.: On Electric Spark Photographs; or Photography of Flying Bullets, etc., by the Lights of the Electric

Spark. Nature, London 47: 415-421, 440-446, 1893.

143
144 WOUND BALLISTICS

Thus, a new field of inquiry has arisen, that of wound ballistics, a study

of the mechanics of wounding and related subjects. The field has two aspects.

One is a determination of the factors involved in injury and the relation between

the severity of the wound and such characteristics of the missile as its mass,

velocity, shape, momentum, energy, and power. The attempt is made to

relate the ability to wound or to kill with some physical property of the projectile. Such inquiry gives an answer to the question, whether an antipersonnel

bomb is more effective if it breaks into a large number of small fragments or a

smaller number of relatively large fragments.

The second aspect of wound ballistics involves a study of the nature of

the damage to tissues, whether it results from stretching and displacement or

from pressure changes accompanying the shot. Of particular interest is the

commonly observed injury of organs far away from the bullet path. Such

knowledge greatly aids the surgeon in his treatment of the wound and is

necessary for the establishment of rules for removal of dead tissue and the

amount of debridement necessary for proper recovery. The knowledge of

wound ballistics is, therefore, important not only in offense but also in defense.

With the perfection of guns that could shoot high-velocity missiles came

the observation that the resulting wounds appeared as though they had been

caused by an actual explosion within the body. External signs of injury were

often slight, the entrance and exit holes small, but an unbelievable amount of

damage occurred within. Hugier (cited by Horsley 4) noted this explosive

effect as early as 1848 in Paris, and it has been emphasized by all subsequent

writers. Such action has led to mutual accusation by both sides in warfare

that the enemy was using explosive bullets. Not only is the tissue pulped

within a large region about the bullet path but intact nerves lose their ability

to conduct impulses and bones are found to be broken that have not suffered

a direct hit.

It is in this explosive effect that high-velocity missiles differ from

those of low velocity. The wounds from a spear or a nearly spent revolver

bullet correspond more closely to the expected cylinder of disintegrated tissue,

little larger than the spear itself. This type of wound can be compared to

what happens when a rod is plunged into soft snow. Snow piles up in front

and is pushed ahead and to the side, and when the rod is withdrawn a bole is

left whose diameter is little more than that of the rod. The situation is far

different with high-velocity missiles. They leave behind a large temporary

cavity whose behavior is quite comparable to the gas bubble of an underwater

explosion. Later, the cavity collapses, but far-reaching destructive effects have

occurred during the expansion. A detailed description of what happens during

the cavity formation will be found in this chapter.

Much of the early work on wounding was concerned with an explanation

of the explosive effect of high-velocity projectiles. Shots were made into

various materials, such as gelatin gel or dough, which served as models to

4 Hlorsley, V.: The Destructive Effect of Small Projectiles. Nature, London 50: 104-108, 1894.
MECHANISMI OF WOUNDING 145

explain what must happen in the body. Kocher (1874-76) at Berne, Switzerland, was a pioneer in this study, which he rightly thought was a hydrodynamic

problem. Delorme and Chevasse I in Paris, Bruns 1 (1892) in Germany, and

Horsley in England continued the work.

In 1898, Stevenson 7 brought out his monograph "Wounds in War," to be

followed by La Garde's 8 "Gunshot Injuries" and by Wilson's I account of

casualties during World War I. The monumental "Lehrbuch von Ballistik"

by Cranz and Becker,"0 now in its fifth edition, first appeared in 1910. In

addition to a valuable description of the small arms in use by various nations

at the time of publication, these books consider the theories which have been

advanced to explain the explosive effect of bullets.

One of the earliest views was that the "wind" of the bullet (that is, its

shock wave), or the air compressed on the face of the bullet, was responsible

for the explosion. It is quite certain that this view is incorrect since the

explosive effects appear if a mass of flesh is shot in a vacuum. Neither can

the explosive effect be connected with the shock wave which appears when

tissue is hit, since this wave moves through the tissue at the rate of 4,800

f.p.s. (feet per second) and has passed well beyond the wound region before

the explosive expansion occurs.

It is a simple matter also to eliminate such theories as invoke rotation

of the bullet, flattening of the bullet, or heating of tissues by the bullet as the

cause of the explosion. Steel spheres shot from a smoothbore rifle which do

not rotate and do not flatten on impact are known to cause explosive effects.

Moreover, the kinetic energy of these spheres is not sufficient, even if all were

converted into the energy of steam, to account for the explosion.

There remains, as the correct explanation of the explosive cavity, what

early workers called the accelerated particle theory. This view regards the

energy of the bullet as being transferred to the soft tissue in front and to each

side, thus imparting momentum to these tissue particles, so that they rapidly

move away from the bullet path, thus acting like "secondary missiles." Once

set in motion, the "inertia of the fluid particles" continues its motion, and a

large space or cavity is left behind. As Stevenson puts it, the bullet causes

damage not only by crushing and attrition of tissue directly but also indirectly

by the fluids moving away from its path. Wilson 11 compares this "blasting

out" of soft tissues to the effect of the stream of water from a firehose.

Later work has been largely concerned with special aspects of wound

5 Delorme, E., and Chevasse, Prof.: Etude Comparative des tffets Produits Par les Balles du Fusil Gras de 11 mm

et du Fusil Lebel de 8 mm. Arch. d. Med. et Pharm. Mil. 17: 81-112, 1892.

6 Bruns, Paul: Ueber die Kriegschirurgische Bedeutung der Neuen Feuerwaffen. Berlin: August Hirschwald,

1892.

7 Stevenson, W. F.: Wounds in War. New York: Wm. Wood and Co., 1898.

SLa Garde, L. A.: Gunshot Injuries. 2d ed. New York: Win. Wood and Co., 1916.

S Wilson, Louis B.: Firearms and Projectiles; Their Bearing on Wound Production. In The Medical Department of

the U.S. Army in the World War. Washington: Government Printing Office, 1927, vol. XI, pt. 1, pp. 9-56.

10 Cranz, C., and Becker, K.: Handbook of Ballistics. Vol. I, Exterior Ballistics. Translated from 2d German ed.

London: His Majesty's Stationery Office, 1921, pp. 442-450.

11 Wilson, L. B.: Dispersion of Bullet Energy in Relation to Wound Effects. Mil. Surgeon 49: 241-251, 1921.

603225--62- 12
146 WOUND BALLISTICS

ballistics. Callender and French 12 and Callender 18 used Plasticine as a

model for tissues and studied especially the yaw of bullets and the relation of

wound damage to the power delivered. They introduced more modern

methods of measuring velocities and also obtained records of the pressure

changes during the passage of a bullet through Plasticine.

Black, Burns, and Zuckerman 14 have described the enormous damage

done by minute fragments of metal from bombbursts. These fragments

move with velocities far higher than those of ordinary rifle bullets. Using

the spark shadowgraph method and steel spheres, weighing only 53 Mg., they

were able to imitate the destructive effect of bomb splinters and obtained

spark shadow outlines of rabbit legs during passage of the missile. These

shadowgrams indicated a large swelling due to the cavity within.

The present work '5 is an attempt to place wound ballistics on a sound

quantitative basis. It regards the phenomena observed in wounding of soft

tissue as fundamentally like the phenomena which occur when a high-velocity

missile enters a liquid. The subject is treated as a branch of underwater

ballistics. By means of high-speed motion pictures, spark shadowgrams, and

microsecond roentgenograms, measurements have been made of all the changes

occurring during passage of a projectile through various parts of the body,

and certain constants have been established relating mass, velocity, shape,

and other characteristics of the missile to wound phenomena. By means

of these constants, it is now possible to predict exactly what, damage may be

expected from the impact of a known mass moving with any known velocity.

The data on which this survey is based are given in later sections, together

with reproductions of the photographs and roentgenograms.

The basic purpose of a study of wounding is to obtain data with which

to predict the degree of incapacitation (the weeks of hospitalization) which

may result from a hit by a missile of given mass (M) moving with a given

velocity (1). The incapacitation will naturally depend on the region of the

body which is struck. This region in turn will depend on the tactical situation,

for example, trench or open warfare, as determined by the military command,

which must also decide the length of hospitalization permissible. The probability of a hit is thus a function of the projected body areas exposed. The

probable time of hospitalization will vary with the severity of the wound for a

12 Callender, G. R., and French, R. W.: Wound Ballistics: Studies on the Mechanism of Wound Production by

Rifle Bullets. Mil. Surgeon 77: 177-201, 1935.

13 Callender, G. R.: Wound Ballistics: Mechanism of Production of Wounds by Small Arms Bullets and Shell

Fragments. War Med. 3: 337-350, 1943. "14 Black, A. N., Burns, B. D., and Zuckerman, S.: An Experimental Study of the Wounding Mechanism of High

Velocity Missiles. Brit. M. J. 2: 872-874, 1941.

15 Among the difficult problems encountered during the investigation, particularly in its early stages, was that of

assembling under the stress of wartime conditions necessary apparatus and supplies. The beginning of the work would

have long been delayed had it not been for the generous loan of equipment by the Ballistics Research Laboratory of the

Aberdeen Proving Ground, Aberdeen, Md., and the continued cooperation of members of the staff of this laboratory.

We are indebted, also, to the Frankford Arsenal, Philadelphia, Pa., for the loan, until our own equipment was available,

of a surge generator, which was essential for the taking of microsecond roentgenograms. Certain items of apparatus

originally constructed at the Climatic Research Laboratory of the Signal Corps, Fort Monmouth, N.J., was also made

available on loan. The staff of the Princeton University Section, Division 2, National Defense Research Committee,

had aided greatly throughout the investigation, both with advice and in respect to securing promptly the needed

equipment.-Authors' Note.
MECHANISM OF WOUNDING 147

particular region and can best be estimated by a military surgeon with considerable field experience. With such knowledge, effectiveness of antipersonnel

bombs in terms of casualties can be accurately evaluated, since the distribution

of fragment masses and their velocities at various distances from the explosion

can be readily determined. This chapter, however, does not propose to

estimate time of hospitalization as a result of wounds received from any

specific weapon but rather to determine the basic laws governing damage to

the various tissues in the body.

METHODS USED IN STUDYING WOUNDING

Army rifles are designed to shoot a 9.6-gram bullet with a velocity of

2,700 f.p.s. and to incapacitate or kill a human target weighing approximately

70 kg. (kilograms). To investigate directly the mechanism of wounding on

such a scale would require many large animals and an extensive firing range

for the experiments. It is far more economical and fully as instructive to

reduce the size of missile and target in proportion. The investigation can

then be carried out in any laboratory. For example, a 0.4-gram missile moving

2,700 f.p.s. and striking a 3-kg. animal represents a situation, so far as mass of

missile and mass of target are concerned, analogous to those of standard army

rifle ammunition and the human body. Therefore, deeply anesthetized cats

and dogs have been used for study with steel spheres as missiles (table 25).

Fragments of varied shape and corresponding mass and velocity have also

been studied.

To supplement the direct experiments on animals, it is highly instructive

to study nonliving models. These models simplify the physical conditions

and serve to illustrate what can happen in a homogeneous medium. Blocks

of gelatin gel, rubber tubes filled with a liquid, or a tank, with Plexiglas sides,

filled with water served as targets to record the phenomena connected with

the passage of high-velocity missiles. The tank of water, particularly, allows

high-speed photography and a complete analysis of all that happens.

TABLE 25.-Data on steel spheres

Momentum (MV) Energy 0, MV')

Diameter Mass (gram-cm./sec., (ergs, 109X) at- 104X) atInches Centi- Grains Grams 500 f.p.s. 4, 000 f.p.s. 500 f.p.s. 4, 000 f.p.s.

meters

S .159 0. 251 0. 0163 0. 0248 0.199 0. 0194 1.21

%2 .238 .842 .0549 .0836 .670 .0654 4.08

%8 .317 2. 00 .1300 .1981 1.58 .154 9.65

r, .476 6. 77 .4397 .6700 5.35 .522 32. 60

% .635 16. 05 1. 0413 1. 588 12. 70 1. 240 77. 30
148 WOUND BALLISTICS

FIGURE 47. (See opposite page for legend.)

a|

FiGURE 48. (See opposite page for legend.)

FIGURE 49.

(See opposite page for legend.)
MECHANISM OF WOUNDING 149

Since many wounds in modern warfare come from steel bomb fragments

of small size but of high velocity, a gun was selected which could be used for

shooting either fragments or spheres of a mass around 1 gram or less. The

gun was a standard caliber .30 Winchester smoothbore which was proof shot

with pressures of 65,000 to 68,000 pounds per square inch (fig. 47). The

fragment or sphere was carried in a depression in the front of a cylindrical

wood sabot about 16 mm. long, split in half longitudinally, and lathe turned

to fit the caliber .30 Army standard primed shell (fig. 48). The wooden sabot

was satisfactory except for very high velocities (velocities in excess of 3,800

f.p.s.), when it pulverized. In such instances, a similar Textolite plastic sabot

was substituted. When the missile emerged from the gun, air resistance

separated the two halves of the sabot. These halves were caught by a wooden

screen with a hole in the center through which the missile could pass. The

shells were filled with fast-burning, 60 mm. mortar powder which was adequate

for the sabot and fragments. Variations of velocity were obtained by varying

the powder charge from 0.1 gram (1,120 f.p.s.) to 1 gram (4,430 f.p.s.). If

care was taken in fitting the sabot, variations in the velocities showed a percentage deviation of only 2.4 for a given powder charge. Figure 49 shows a

vertical gun above a water tank with Plexiglas sides to permit high-speed

motion picture photography. The lights used for illumination are to the left

and the camera to the right.

The velocity of missiles is fairly constant for a given charge of powder,

provided the sabots are carefully made to give uniform fit in the ends of the

shells. This statement has been checked by three different methods of measuring velocity. One method makes use of the shock wave of the missile in air.

This shock wave is allowed to impinge on a metal plate containing a row of

small holes. On passing through the holes, the shock wave is converted into

a series of sound waves whose shadow is recorded on a photographic plate by a

spark discharge. The velocity of the missile is equal to the velocity of sound

in air, divided by the sine of the angle between the envelope of sound wave

fronts emerging from the holes and the path of the missile.

The well-known Aberdeen chronograph was also used to measure the velocity. This instrument records, on a strip of paper fixed to a drum rotating at

a known speed, the time taken by the missile to pass between two stations.

FIGURE 47.-Smoothbore .30 caliber gun mounted in front of wooden sabot screen.

The apparatus for spark shadowgram method of velocity measurement is at right and part

of an impact record at left.

FIGURE 48.-Wooden sabots used to carry a 3 /,s-inch steel sphere (above) and a 1⁄4s-inch

steel sphere (below). At right is the sabot inserted in a .30 caliber army shell.

FIGURE 49.-General view of the tank of water with lights (behind), sabot screen (top),

and high-speed motion picture camera (front) for study of phenomena during a shot into a

liquid. The gun pointing vertically downward is attached to a beam above the tank.

The bright spot of light on the left side of the front of the tank is a sodium lamp running

on 60 cycle a.c. which records '/ 20-second intervals in the film.
150 WOUND BALLISTICS

As the missile passes each station (two tinfoil sheets), a contact is made,

thereby triggering a spark which perforates the revolving paper. The time

interval can then be read as distance between the two perforations.

The third instrument used for recording velocities was the Remington

chronoscope. This also necessitates two trigger screens. When the bullet

passes one screen, a condenser begins to charge from a source of voltage and

when the second screen is passed charging is stopped. The electrical charge on

the condenser then represents a certain time interval which the missile has

taken to pass between the stations and can be read with a ballistic galvanometer.

High-speed moving pictures were taken either with the Western Electric

8 mm. Fastax camera (fig. 50 A), capable of 8,000 frames per second, or with

the Eastman 16 mm. high-speed camera (fig. 50 B), capable of 3,000 frames per

second. Both cameras use the optical compensation principle, in which the

film moves across the lens continuously and a rotating prism throws successive

images on the film with the same speed as the film itself. Trigger devices were

necessary to fire the gun at the proper moment by means of an electromagnet,

as a 100-ft. roll of 16 mm. film takes only 1.5 seconds to pass across the lens.

Time intervals were recorded by photographing a sodium lamp running on 60

cycles a.c. (alternating current). For illumination, banks of 2 to 12 150-watt

projection spotlights, run on 220 volts instead of the rated 110 volts, were used.

The light of these bulbs was directed on the object or, for transmitted light,

illuminated evenly a ground glass plate placed on the rear wall of the tank.

The spark shadowgraph technique for shock wave recording depends upon

a change in refractive index of the medium resulting from a change in pressure.

The change in refractive index can be detected on a photographic plate as a

shadow, if a point source of light is used for illumination. The point source of

light used for high-velocity missiles in water was a high-voltage spark from the

discharge of a condenser (fig. 51). The spark, whose duration is less than a

millionth of a second, is about 5 feet in front of the tank of water through which

the missile will pass, and the photographic plate is on the rear wall of the tank.

When the bullet breaks a contact in a screen, the spark is triggered through a

thyratron controlled high-voltage surge across the spark gap. By means of a

delay circuit, any time interval after the breaking of the screen can be selected

for the spark shadowgram.

For taking roentgenograms with an exposure of a millionth of a second,

the Westinghouse X-ray surge generator, or Micronex, was used. This apparatus requires a special X-ray tube, with a large tungsten target and a cold

cathode. The discharge of a bank of condensers through the tube supplies the

current of thousands of amperes, lasting less than a microsecond. Voltage can

be varied from 180 to 360 kv. (kilovolt), by charging the six condensers (each

of 0.04 microfarad capacity) in parallel at 30 to 60 kv. and then discharging

in series. A control box makes operation automatic, and a trigger and delay

circuit times the X-ray surge for any desired moment, measured in microseconds. The entire outfit is shown in figure 52.
MECHANISM OF WOUNDING 151

AL

FIGURE 50.-High-speed motion picture cameras. A. Fastax 8 mm. motion picture

camera with cover removed to show film looped over sprocket behind rotating prism. The

arrow points to a neon lamp which can be used for timing. Two wire grid trigger screens

are below camera and a thyratron trigger circuit is at right. B. Eastman 16 mm. high-speed

motion picture camera with cover removed to show film reels and rotating prism.
152 WOUND BALLISTICS

-A ,,k

FIGURE 51.-Apparatus for spark shadowgram technique. The water tank with photographic plate behind it is at right. The spark electrodes are in the cylindrical tube (9 cm.

long) above the high-voltage condenser at the left. Mounted on the same platform are the

high-voltage transformer, rectifying tube, and accessory parts.

For accurately recording pressure changes in an animal, a calibrated piezoelectric tourmaline crystal was used. As a result of changes in pressure, the

crystal develops an electrical charge which can be amplified and applied to a

cathode ray oscillograph with a single sweep. The phosphorescence of the

electron beam on the face of the oscillograph is then photographed. Trigger

screens in the proper position before the target were used to start the sweep,

whose duration was varied between 130 microseconds and 45 milliseconds.

The time calibration was made with a sine wave oscillator. Great precautions

must be taken to shield the circuits from electrical and mechanical disturbances

which might cause artefacts in the record.

UNDERWATER BALLISTICS AS A GUIDE TO THE WOUNDING

MECHANISM

In order to predict the severity of a wound, it is necessary to know what

happens when a missile enters the body. The missile's retardation and penetration must be determined and all other phenomena measured quantitatively

and related to its mass and impact velocity. Since the material of the body is

heterogeneous and opaque, the investigation would be greatly simplified if a

homogeneous transparent medium could be substituted and used as a model

for the establishment of fundamental laws.

Fortunately, this can be done. The nature of the forces which act on a

moving missile will depend on its velocity. For fast missiles, such as have been

used in this investigation, these forces are chiefly inertial forces. They depend
MECHANISM OF WOUNDING 153

FIGURE 52.-Westinghouse Micronex apparatus for X-ray pictures with exposure of

one-millionth of a second. The X-ray tube is at left and the large surge generator containing banks of high-voltage condensers in the middle. In front of the surge generator (from

left to right) is the trigger-delay circuit, the control box, and the high-voltage transformer.

primarily on the density of the medium rather than on its viscosity or its

structure. Except where there are very strong structural bonds, as in bone,

ballistic laws for soft tissue must be similar to those for a liquid or a gel.

Most soft tissues contain about 80 percent water, and it has been found

that many of the important events in wounding can be reproduced by shooting

into a tank of water. Such a shot is pictured in figures 53 and 54, frames from

a high-speed moving picture of a steel sphere entering water with a velocity of

approximately 3,000 f.p.s. The large explosive temporary cavity is initially

cone shaped but later becomes more spherical and pulsates several times before subsiding to a mass of air bubbles. The cavity behind a sphere shot into

water elongates as the sphere proceeds through the water. It also expands

radially and then shrinks. Along the narrow neck of the cavity not far behind

the sphere, the cavity eventually collapses, creating two cavities. The smaller

cavity continues to trail behind the sphere, while the larger one begins to pulsate. The time at which the cavity separation or sealing off takes place
154 WOUND BALLISTICS

0 4 8 20 24 28 32

1 51 9132 29 33

2 6 10 140 30 34

... ...... 7 ... 7 3135

FIGURE 53-Frames (1,920 per second) from a high-speed motion picture of a bsr-inch

steel sphere entering water with a velocity of 3,160 feet per second. The surface of the water

is at the top of each frame and the depth of water 55 cm. Note the initial expansion and

later contraction of the temporary cavity to minimum volume at frame 25, with subsequent

expansion. (Experiment No. 4, of 4 Mar. 1944.)

depends on the size and density of the bullet. After the cavity behind the

sphere separates, the larger main cavity moves slowly in the direction of the

sphere. As it pulls away from the surface, a narrow neck develops between it

and the surface. The neck soon disintegrates leaving the cavity completely

isolated. The isolated cavity continues in slow motion in the direction of the

sphere and eventually disintegrates. During all of this process, the cavity

undergoes a series of pulsations and grows and shrinks in a regular manner.

The pulsations may continue for as many as 7 or 8 cycles and disappear as the

cavity disintegrates.

The velocity of radial movement of the water away from the sphere track

is about one-tenth that of the sphere velocity. The maximum displacement of
MECHANISM OF WOUNDING 155

0 3 69 1321

1 4710 15 25

5 11 17 _ _ 49

FIGURE 54.-Frames (1,920 per second) from a high-speed motion picture of a %-inch

steel sphere (velocity 2,300 f.p.s.) striking the surface of water to show the splash and cavity

formation. The dots at left are 5 cm. apart. (Experiment No. 191, of 23 Mar. 1945.)

the cavity wall is proportional to the square root of the kinetic energy of the

sphere at any level, and the maximum volume of the explosive cavity is determined by the initial kinetic energy of the sphere. This is expressed as an

expansion coefficient which gives the volume of cavity formed for each unit of

energy and is equal to 8.92 X 10-1 cc./erg. for water. The period of the first

few pulsations of the temporary cavity depends on the cube root of the missile

energy and can be expressed numerically (pp. 181-189).

A gel behaves like water, as is illustrated in the frames from a high-speed

moving picture of a Y8-inch steel sphere entering 20 percent gelatin gel with a

velocity of 3,800 f.p.s. (fig. 55). The phenomena are nearly the same, even to

the splash, although the numerical values of the constants are different. In

addition, there is left in gelatin a permanent cavity or track, which is also

observed in tissues. The volume of this permanent cavity can be expressed by

an excavation coefficient, which gives the volume of cavity formed for each

unit of missile energy. The behavior of a rectangular block of gelatin is shown

in figure 56.

Rapid retardation of the sphere can be observed in figures 53 and 54,

where the tip of the cavity represents the progress of the sphere in equal units

of time. This retardation is proportional to the square of the velocity of the

sphere, a general law for liquids expressed as a retardation coefficient, a. If the

material or size of spheres differ, the various quantities are related in the following way: a=pACD/2M, where QD is the drag coefficient, p the density of the
156 WOUND BALLISTICS

L I _ FIGURE 55.-Frames (6,000 per sec-

____ ond) from a motion picture of

.- tn-inch steel sphere entering a tank of

20 percent gelatin gel with a velocity

of 3,800 feet per second. The scale

marks at left are 5 cm. apart. Note

the splash and cavity formation which

is quite similar to that of water. The

permanent cavity of a previous shot L shows at right as a vertical line.

•:+Frames are numbered below. Temperature: 24' C. (Experiment No. 8G,

of 12 June 1944.)

1 -6 13-18 31-36 55-60 85-90 115-120

0 3031 42 4 

K ... 47ý 5k +•

FIGURE 56.--Frames (6,000 per second) from a high-speed motion picture of a gelatin

block shot from right to left with a h-inch steel sphere moving 3,800 feet per second. Note

the expansion of the block and the two bubblelike protuberances at entrance and exit sites.

The bubbles collapse; then the entrance bubble reappears (frames 18 to 35) and again collapses. The background squares are centimeters. (Reel 2, 31 Dec. 1943.)
MECHANISM OF WOUNDING 157

liquid, M the mass, and A the sphere projected cross-sectional area. For water

CDO0.297 and for 20 percent gelatin at 24°C., CD--0.350.

If the missile is a fragment instead of a sphere, the projected area will

change as the fragment turns. Hence, the velocity in the water will vary in an

irregular manner. The retardation coefficient, the drag coefficient, and the

energy delivered to the water will all differ during the advance of the fragment.

Turning of the fragment thus leads to the formation of irregular temporary

cavities, as shown in figure 57. The cavity is widest when a fragment moves

broadside and smallest when the movement is head on.

The velocity squared law holds for spheres in water until the velocity

becomes very small. It is difficult to speak of a penetration distance in water.

In a gel, however, after decrease to a certain critical velocity V,, another retardation law is obeyed. Structural bonds and viscous forces quickly bring the sphere

to a stop at a definite penetration distance (pp. 227-230).

The pressure on the front of a sphere moving through water is proportional to the square of the velocity V and is numerically equal to ý2pV 2 CD.

For the shot illustrated in figure 53, the pressure at impact is about 1,500

atmospheres, and the water in front of the sphere is compressed and its refractive index changed. This region of compression at the surface of the water

moves away as a spherical shock wave, with a velocity slightly greater than

sound in water (4,800 f.p.s.). Spark shadowgrams showing the successive

movements of the shock wave are reproduced in figure 58. Each wave consists

of an instantaneous rise in pressure to a peak, with an approximately logarithmic fall behind. A pressure time curve for a shock wave is reproduced in

figure 59. For the shock wave of figure 59, the peak pressure 10 cm. from the

surface is 40 atmospheres and the half decay time about 30 microseconds. The

peak intensity of a shock varies directly as the equare of the impact velocity

and the projected area of the missile and inversely as the distance from the

water surface; it is independent of the density of the missile. Shock waves are

reflected from surfaces as either pressure or tension waves, depending on the

wave velocity in the material and the density of the material.

Behind the shock wave, the pressure distribution in the water is complicated and continually changing. The very high pressure region in front of the

sphere can be visualized by inspection of figure 60, a spark shadowgram of a

3/16-inch steel sphere moving in water behind a grid of lines on a Plexiglas

plate. The distortion of the lines in front and at the sides of the sphere is due

to a change of refractive index, resulting from compression of the water. Later

on, much lower and slower pressure changes, with a phase of decreased pressure,

appear around the temporary cavity. A record of these slower pressure

changes connected with pulsation of the cavity is shown in figure 61 and the

corresponding motion picture of the shot in figure 62.

All the events just cited-shock waves, cavity formation, movements of

the medium, and pressure changes-occur when a high-velocity sphere enters

soft parts of the body. A retardation coefficient, a drag coefficient, and ex-
158 WOUND BALLISTICS

FIGURE 57.-Irregular temporary cavities formed in water by fragments which rotate

during penetration. A. A cylinder striking broadside. B. A disk striking broadside. C.

A cylinder striking head on, then turning broadside, and finally head on before slowing down.

Note that the width of cavity at any level reflects the projection area of the cylinder. Similar

cavities occur in tissues when fragments penetrate. Scale marks are 5 cm. apart.

pansion coefficient (of the temporary explosive cavity) and an excavation

coefficient (of the permanent cavity) can all be given numerical values.

Among tissues, the numerical constants vary slightly. They differ somewhat from those of water or gel because (1) tissues vary greatly in structural

makeup and (2) the body is enclosed in a layer of elastic muscle and skin,

rather than the fairly rigid walls of a tank, as in the case of experiments with

liquid mediums. Wound ballistics is actually a special branch of underwater

ballistics. The remarkable similarity of the phenomena in tissues and in

water will be brought out in the following sections.

THE WOUND TRACK OR PERMANENT CAVITY IN MUSCLE

The passage of a high-velocity missile through soft tissues results in the

immediate formation of an explosive or temporary cavity many times larger

than the missile. After the passage of the missile, the large temporary cavity

decreases in volume and a much smaller permanent cavity remains. The size

of the permanent cavity is undoubtedly governed by the size of the temporary

cavity, which, in turn, is dependent on the size of the missile, as well as on the

nature of the tissues involved.

Small, high-velocity steel spheres passing through soft tissue, such as the

thigh of a cat, produce rather small entrance and exit holes (fig. 63). The

entrance hole produced by a Si2-inch steel sphere striking the thigh with a

velocity of 3,000 f.p.s. is shown in figure 63A. The exit hole made by this same
MECHANISM OF WOUNDING 159

.......

FIGuRE 58.-A series (S68, S31, S71, S90, and S21) of spark shadowgrams of ý4-inch spheres taken at successively longer time intervals after

the sphere has hit the water surface. Note how the shock wave, moving

4,800 f.p.s. leaves the retarded sphere behind. The striking velocity in

all shadowgrams is 3,000 f.p.s. except in the second where it is 1,772 f.p.s.

FIcURE 59.-A pressure-time record of a shock wave resulting from impact on the surface

of water of a ý/is-inch steel sphere moving 3,000 f.p.s. The crystal gage was 6 inches from the

point of impact, at a 450 angle with the missile path. The time marks are 20 microseconds

apart. The peak pressure is 600 pounds per square inch. (Experiment No. 41g, July 1945.)
160 WOUND BALLISTICS

r. m

FIGURE 60. (See opposite page for legend.)

FIGURE 61. (See opposite page for legend.)

0 10 20 30 40 50 68

ULMLWýLAJAi--

ILI W1 kJWWLi

LLW

L• tA141--.4 •AL :FIGURE 62. (See opposite

page for legend.)

9 ~~ 29 39 ~ 119 49
MECHANISM OF WOUNDING 161

sphere is shown in figure 63B. In general, exit holes produced by spheres are

smaller than entrance holes, because of the decreased velocity of the sphere

after it has traversed the thigh. In many cases, the exit hole in muscle is

slitlike as contrasted with the circular entrance hole. This slitlike opening is

due to the fact that the muscle fibers split apart along their long axes.

The size and configuration of the entrance and exit holes produced by an

irregular fragment is dependent on the orientation of the fragment at the

instant it enters or emerges from the tissues (fig. 64). The entrance hole made

by a small elongate steel fragment (mass 612 mg.) which struck the thigh with

a velocity of approximately 3,000 f.p.s. is shown in figure 64A. Yaw cards

showed that the fragment struck the thigh broadside, inflicting a very large

wound. Had the missile presented a smaller surface to the tissues at the time

of impact, a much less severe wound of entrance would have resulted.

A microsecond roentgenogram showed that this same fragment emerged

from the thigh oriented along its long axis. Hence, the exit hole is comparatively small, as is shown in figure 64B.

The approximate size and configuration of the wound track or permanent

cavity can be determined in several ways. These include (1) roentgenograms

of the tissue made immediately after each shot, (2) exploration and dissection

of the wound, and (3) reconstruction of the cavity from thin (1-2 mm.) sections

of the tissues.

Study of the wound track from roentgenograms (fig. 65) reveals that the

permanent cavity formed by the passage of a steel sphere through the thigh is

FIGURE 60.-Enlargement of a spark shadowgram of the region around a 3/16-inch

steel sphere (impact velocity 3,800 f.p.s.) which has penetrated 5 cm. of water. The high

pressure near the missile is revealed by the distortion of a 1 mm. grid placed between spark

and sphere. (Experiment No. P105.)

FIGuRE 61.-A record of pressure changes in a tank of water during penetration of a

3/16-inch steel sphere with a striking velocity of 3,800 f.p.s. The first peak at left is that

of the shock wave pressure. The first, second, and third peaks corresponding to three

minimum cavity volumes are well marked. Note the subatmospheric pressures below the

baseline. The high-frequency (3,000 per second) pressure excursions in the first third of

the record are due to vibrations of the steel frame of the tank. One vertical division represents a pressure of 13.1 pounds per square inch. The time record is 1000 cycles. (Experiment No. 3, of 8 Jan. 1946.)

FIGURE 62.-Frames (2,120 per second) from a high-speed motion picture of a 3/16-

inch steel sphere entering a tank of water with a velocity of 3,000 f.p.s. The formation

behind the sphere of a large cone-shaped temporary cavity which later becomes nearly

spherical and pulsates is apparent. Frames are numbered at top and bottom. The first

maximum volume is in frame 12, the first minimum in frame 23; the second maximum is in

frame 36 and the second minimum in frame 47. The dots to the left are 5 cm. apart. The

pressure record for this particular shot is reproduced in figure 61. The crystal gage is

visible at the end of the slightly curved line at right of each frame. (Experiment No. 3, of

8 Jan. 1946.)
162 WOUND BALLISTICS

CENTIMETERS 175-1 t

2 3 4 5 8 9

J 2

FIGURE 63.-Muscle of cat thigh with entrance and exit holes produced by a 4//2-

inch steel sphere with a striking velocity of 3,000 feet per second. A. Entrance hole. B.

Exit hole.

somewhat fusiform in shape, having its greatest diameter in the central portions

of the thigh. This is illustrated by the roentgenogram shown in figure 65A.

This simple configuration of the permanent cavity is quite often modified

by the fact that individual muscles are blown apart along fascial planes as a

result of the passage of the missile. These newly created spaces tend to become

a part of the permanent cavity and to give it an irregular pattern as shown in

figure 65B.

This same type of fusiform cavity is produced when a small high-velocity

steel sphere is fired through a block of 20 percent gelatin gel (fig. 66A). The

permanent cavities formed by the passage of several / 2-inch steel spheres

through a block of gelatin gel are shown in figure 66B.

Dissection of the wound track in the thigh reveals that the permanent

cavity is largest near the center of the thigh and smallest at the points of entrance and exit of the sphere. This fact is illustrated by the thigh shown in

figure 67. Figure 67A shows the entrance hole in the thigh of a cat made by a

/a-inch steel sphere which struck the thigh with a velocity of 3,800 f.p.s.

Figure 67B shows the much larger cavity deeper in the tissues of this same thigh.

These photographs demonstrate clearly that the small wound of entrance gives

no true picture of the amount of damage produced deeper in the tissues.
MECHANISM OF WOUNDING 163

FIGURE 64.-Muscle of cat thigh with entrance and exit holes produced by a small

steel fragment which struck the thigh broadside. The dimensions of the fragment were

14 x 5 x 2.5 ram.; the mass of the fragment, 612 mg. The impact velocity of the missile was

approximately 3,000 feet per second. A. Entrance hole. B. Exit hole. The fragment

emerged from the thigh oriented along its long axis.

The most exact method of determining the size and configuration of the

permanent cavity is by a study of serial sections of the tissues cut in a plane at

right angles to the path of the missile. A representative set of these sections,

each approximately 2 mm. thick, is shown in figure 67C.

Study of a number of sets of serial sections reveals that the permanent

cavity in the thigh actually consists of a series of fusiform cavities. This manner

of cavity formation is related to the anatomy of the thigh muscles. It appears

that as a sphere traverses the thigh a permanent fusiform cavity is formed in

each of the larger muscles. The permanent cavity left in the intermuscular

connective tissue is quite small, probably because of the elastic properties of

this type of tissue. Thus, the permanent cavity or wound track in the thigh is

really a series of fusiform cavities, individual muscles giving rise to what might

be called a scalloped wound.

Essentially, this same type of behavior can be obtained by firing a highvelocity steel sphere through a series of three blocks of gelatin gel, separated by
164 WOUND BALLISTICS

A s

FIGURE 65.-Roentgenograms of thigh of cat showing permanent cavity (light area)

left in the tissues after the passage of a %32-inch steel sphere whose impact velocity was 3,000

feet per second. A. Roentgenogram (No. 43) shows the fusiform-shaped permanent cavity.

B. Roentgenogram (No. 200) shows irregular shape of the cavity.

several sheets of cellophane to simulate the intermuscular fascia. The results

of this experiment are shown in figure 68. The sphere passed from right to left

in the photograph. This photograph, taken immediately after the shot, shows

that fusiform cavities are formed in each block, the size of the cavity decreasing

as the velocity of the sphere decreased from block to block. It is not proposed

that the behavior of the gelatin block system is precisely identical with that of

muscle and fascia, but the general characteristics of the cavities in the two cases

are quite similar.

The shape and size of the temporary cavity is often modified by the fact

that the cavity may come in contact with a rigid structure, such as bone.

Then, as the large temporary cavity continues to expand, soft tissues are

pulled away from the bone, and these tissues fail to regain their normal position after the collapse of the temporary cavity. This type of behavior is

illustrated by the roentgenogram shown in figure 69.

The question of what becomes of the mass of tissues which originally

occupied the site of the permanent cavity is a significant one. High-speed
MECHANISM OF WOUNDING 165

FIGURE 66.-Blocks of 20 percent gelatin gel.

A. Block of 20 percent gelatin gel showing the

permanent cavity left after the passage of a %2-

inch steel sphere whose impact velocity was 3,000

f.p.s. Note the similarity of this cavity to that

shown in the thigh in figure 65A. B. Block of

20 percent gelatin gel showing the fusiform permanent cavities left after the passage of several

5•2-inch steel spheres whose impact velocities were

approximately 2,400 f.p.s.

motion pictures and spark shadowgrams

show clearly that large amounts of material are lost to the outside during the

passage of the missile. This is easily

demonstrated by the spark shadowgrams

shown in figure 70, of a high-velocity

steel sphere passing into a tank of water.

The penetration of the missile brings

about a marked "splash" at the point of

entrance, with the water moving backward at a high velocity. The splash

which occurred at the point of exit of a

%32-inch steel sphere in a block of Plasticine is shown in figure 71.

In cases where complete perforation of

an object is obtained, large amounts of

material are thrown out at both the

points of entrance and exit of the sphere. B "
166 WOUND BALLISTICS

1! 2 3 4 5 6 7 8 9 40 1 1 CENTIMEIERS

A - 4 5 7, 9 e CENTIMIETERS

FicURE 67.-Photographs of soft tissues of the thigh of a cat. A. Relatively small

entrance hole made by a %2-inch steel sphere which struck the thigh with a velocity of 3,800

feet per second. B. Tissue shown in A dissected open to show the much larger permanent

wound cavity deeper in the tissues of the thigh. C. Serial sections of the soft tissues, cut in

a plane at right angles to the path of the missile. Note the permanent cavity and the dark

area around it filled with extravasated blood.

This is clearly shown in figure 72, a spark shadowgram of a block of gelatin gel

taken immediately after the passage of a %2-inch steel sphere.

The situation in soft tissues of living animals appears to be very similar

to that described for a gel. Figure 73 is a spark shadowgram of the thigh of

a cat, taken immediately after the passage of a %2-inch steel sphere. A definite splash has occurred at the point of entrance of the missile, and materials

are flying out at a high velocity. Large amounts of material are also being
MECHANISM OF WOUNDING 167

FICURE 68.-Photograph of three blocks of 20 percent gelatin gel taken after the blocks

were traversed by a r2-inch steel sphere whose initial impact velocity was 3,000 f.p.s. The

sphere passed from right to left in the photograph. Note that fusiform cavities have formed

in each block, the size of the cavity decreasing as the velocity of the sphere decreased from

block to block.

swept out by the missile as it emerges at the left. The loss of materials at

the points of entrance and exit of a missile can be demonstrated in shots through

the abdomen and excised organs, such as the brain, liver, and kidneys.

THE EXPLOSIVE OR TEMPORARY CAVITY IN MUSCLE

A missile entering soft tissues at a relatively high velocity produces a

temporary or explosive cavity of large dimensions. The cavity, at its maximum size, has a cross-sectional diameter many times that of the permanent

cavity, which remains after the temporary cavity has collapsed. The temporary cavity persists for a relatively short time, reaching its maximum size

in less than a millisecond and lasting for not more than several milliseconds.

The penetration of a small high-velocity steel sphere into a large mass of

butcher meat results in the formation of an initially cone-shaped cavity, very

similar to the cavity formed by the same type of missile in water (pp. 152-158).

Figure 74A is a microsecond roentgenogram showing the large cavity formed in

butcher meat by a %32-inch steel sphere which struck the meat with a velocity

of 2,800 f.p.s. and bad penetrated a distance of 10.2 cm. when the roentgenogram was made. The sphere eventually perforated the block of meat completely, so that this roentgenogram does not show the final configuration of the

temporary cavity. Its chief value lies in demonstrating the striking similarity
168 WOUND BALLISTICS

FICURE 69.-Roentgenogram (No. 171) of the thigh of a cat taken immediately after

the passage of a %2-inch steel sphere whose impact velocity was 3,000 f.p.s. Note the outlines of the permanent cavity (light area) and the manner in which it has "blown out" to

the femur. Also note that the femur is fractured, although it was not struck by the sphere.

of the early cavity in animal tissue and that in water, shown by the microsecond roentgenogram in figure 74B.

The greatest mass of muscle in an intact animal is the thigh. In the largest

dogs used in this study, the thigh was from 6 to 9 cm. in its greatest dimension.

A single microsecond roentgenogram of a thigh can show only one particular

stage in the development of the temporary cavity. However, by varying the

interval between the time at which the missile struck the thigh and the time

at which the roentgenogram was made, it is possible to obtain a series of pictures which together will show successive stages in the development of the

cavity. A series of five such microsecond roentgenograms, showing the development of the cavity in the thighs of dogs, is shown in figure 75. In each case,

the thigh was struck by a %2-inch steel sphere whose impact velocity was

approximately 2,800 feet per second.
MECHANISM OF WOUNDING 169

* A

FieruE 70-Spark shadowgraph of a %2-

inch steel sphere passing into a tank of water.

Note the conical-shaped temporary cavity and

the backward "splash" of water at the point

where the sphere entered the water.

FihaRE 71.-Photograph of a block of Plasticine showing the cavity made by the

passage of a f%2-inch steel sphere whose impact velocity was 3,000 f.p.s. Compare size of

cavity with size of the sphere placed in lower left of block. Note the large amount of material thrown out at the point of exit of the sphere. A similar "splash" also occurred at the

point of entrance.

603225V 62 13
170 WOUND BALLISTICS

FICURE 72.-Spark shadowgraph of a rectangular block of 20 percent gelatin gel made

immediately after the passage of a hý2-inch steel sphere whose impact velocity was 2,800

f.p.s. The missile passed from right to left in the shadowgraph. Note the manner in which

the block has expanded and the large amounts of material being thrown out at both the

entrance and exit sites.

Figure 75A is a microsecond roentgenogram showing the temporary cavity

56 microseconds after the sphere struck the thigh. A cone-shaped cavity has

formed behind the sphere, whose walls are relatively smooth. It is at this

stage of development that the similarity of the temporary cavity in animal

tissues and in water is the greatest.

Figure 75B shows the cavity 71 microseconds after the sphere struck the

thigh. The sphere has emerged from the thigh and has moved several centimeters from it. The conical cavity is expanding, and its walls are becoming

somewhat irregular.

The roentgenogram in figure 75C shows a cavity whose age is 139 microseconds. The sphere has now moved out of the field of the photograph to the

right. The cone-shaped cavity has continued to expand, and its walls have

become very irregular, probably owing to the irregular stretching and tearing of

tissues being displaced by the cavity.

Figure 75D shows the cavity photographed 390 microseconds after the

sphere struck the thigh. The cavity has expanded still more and has assumed

the shape of a prolate ellipsoid. Observation of many of these cavities indicates

that a cavity with this configuration is near its maximum size. The cavity

shows marked irregularities on its walls, as well as strands of tissue of different

densities, which can be interpreted as areas of stretched and torn tissues. The

sphere which produced this cavity had an initial energy of 3.7 X 101 ergs (35 ft.-

lb.) and lost approximately 85 percent of this energy in producing the cavity.

Roentgenograms made from 600 to 800 microseconds after the sphere

struck the thigh show that the cavity, after reaching its maximum size, col-
MECHANISM OF WOUNDING 171

FiouRE 73.-Spark shadowgraph of the thigh of a cat made immediately after the

passage of a 512-inch steel sphere whose impact velocity was 3,000 f.p.s. The missile passed

from right to left in the shadowgraph. Note the large amount of materials being ejected

at both the points of entrance and exit of the missile. Note the similarity to the gelatin

block in figure 72.

lapses. Figure 75E shows a cavity whose age is 819 microseconds. The cavity

has practically collapsed, and only a small rounded space remains near the

center of the thigh. High-speed motion pictures of the exterior of a thigh,

such as those of figure 76, show the temporary swelling, indicative of the internal

formation of this cavity.

The temporary cavity in the thigh of a cat, formed by the passage of a

)/2-inch steel sphere with an impact velocity of 2,800 f.p.s., is shown in figure

77A. Although this cavity has not reached its maximum size and the sphere

did not strike the femur directly, a fracture linehasappeared in this bone. Figure

77B is a roentgenogram of this same thigh made before the shot and figure 77C

a similar roentgenogram made after the shot. In this latter picture, the permanent cavity is well outlined. This type of "indirect" fracture is dealt with

in greater detail on pages 200-204.

All the temporary cavities just described were photographed to show the

path of the missile and the cavity in lateral view. Other microsecond roentgenograms show that the cavity formed in soft tissues by a sphere is circular
172 WOUND BALLISTICS

•1'

FicURE 74-Microsecond roentgenograms. A. Roentgenogram (No. 105) of a

inch steel sphere passing through a block of butcher meat. The sphere struck the meat with

a velocity of 2,800 f.p.s. Compare with B and note the similarity of the cone-shaped temporary cavity to that formed in water. B. Roentgenogram (No. 25) of a 4 1 -inch steel

sphere passing into a container of water.

FIGURE 75.-Microsecond roentgenograms of the thigh of a dog showing the temporary

cavity formed by a 5j1-inch steel sphere whose impact velocity was 2,800 feet per second.

A. Roentgenogram (No. 22) was made 56 microseconds after the sphere struck the thigh

and shows the cone-shaped temporary cavity formed by the sphere. B. Roentgenogram

(No. 18) was made 71 microseconds after the sphere struck the thigh. Note that the sphere

has just emerged at the right and that the temporary cavity is expanding. C. Roentgenogram (No. 32) was made 139 microseconds after the sphere struck the thigh. Note the continued expansion of the cavity which results in a stretching and tearing of the tissues. D.

Roentgenogram (No. 28) was made 390 microseconds after the sphere struck the thigh. The

cavity has assumed the shape of a prolate ellipsoid and is judged to be at its maximum size.

E. Roentgenogram (No. 31) was made approximately 819 microseconds after the sphere

struck the thigh. Note that the cavity has practically collapsed and only a small cavity

remains near the center of the thigh.
MECHANISM OF WOUNDING17

TA

FIG URE 75. (See opposite page for legen ds.)
174 WOUND BALLISTICS

0 3

IM

Fic, RE 76.-A series of prints from a high-speed motion picture (4,500 frames per

second) of the leg of an anesthetized cat, with skin intact, shot with a %-inch steel sphere

moving 3,000 f.p.s. The sphere entered from the right and exited from the left side. The

foot is up. The temporary swelling, indicating a large cavity within, can be clearly seen.

(Reel 11, 6 Jan. 1944.)

when seen in cross section. The latter is well shown in the roentgenogram

in figure 78, taken 200 microseconds after the sphere struck the thigh. The

small black spot in the center of this photograph marks the point at which

the sphere penetrated the X-ray film.

In the case of irregular fragments, the size and configuration of the temporary cavity depends not alone on the energy of the fragment but also on its

projected area as it strikes the tissue. The projected area varies along the path

of the missile as changes in orientation of the fragment occur. This is illustrated by the microsecond roentgenogram shown in figure 79. The thigh

of a cat was struck by a small elongated fragment (originally part of a 75 mm.

shell) whose mass was 630 mag. and whose impact velocity was 3,000 f.p.s.

The fragment struck the thigh broadside and emerged with the orientation

shown in this photograph. The cavity is very large at the point of entry

and much smaller near the point of exit of the missile. The femur, struck

directly by the missile, was badly shattered.

A second case is shown in figure 80, where a thigh was struck by an elongated fragment made from a small wire nail. The fragment was cylindrical,

11 mam. in length, 2.5 mm. in diameter, and bad a mass of 380 mg. Its striking velocity was approximately 3,000 f.p.s. The irregular shape of this cavity

indicates that the orientation of the fragment changed slightly as the missile

passed through the tissues.
MECHANISM OF WOUNDING 175

Fio URE 77.-Rontgenograms of thigh of a cat made before and after thigh was struck

by a %2-inch steel sphere whose impact velocity was 2,800 f.p.s. A. Roentgenogram made

170 microseconds after the shot. Note the expanding temporary cavity and the fracture

line appearing in the femur, although this bone was not struck by the sphere. B. Roentgenogram (No. 135) made immediately before the shot. C. Roentgenogram made immediately after the shot. Note the permanent wound track (light areas), which indicate regions

where muscles have been separated, and the fractured femur.

The temporary cavities produced by standard .22 caliber ammunition

are very similar to those produced by spheres, as long as the bullet remains

oriented on its long axis. This is illustrated by the roentgenogram in figure 81.

If the bullet wobbles, or in any way changes its orientation, the result is similar to that just described for fragments.

A temporary cavity, very similar to those described in cat thighs, can be

obtained by firing a steel sphere through the excised skin of a cat thigh which

has been filled either with gelatin gel or with water. The cavity in a gelatinfilled skin is shown in figure 82A and in a water-filled skin in figure 82B. These

photographs again emphasize the similarity of the temporary cavities in animal

tissues and in the nonliving materials used.

Study and measurement of a large number of temporary cavities show

that the total volume of the cavity is proportional to the energy delivered by

the missile. Data obtained have made it possible to obtain a value for an

expansion coefficient, L. The expansion coefficient, le, in muscle has a value of

80.1 x 10-' cm. 8/erg. This can be restated as follows: For every erg of energy

lost by a missile in muscle, there is formed a temporary cavity with a volume

of 80.1 x 10' cm. 3
176 WOUND BALLISTICS

FICURE 78.-Microsecond roentgenogram (No. 232) of the thigh of a cat showing

the temporary cavity formed after the passage of a % 2-inch steel sphere whose impact velocity was 3,000 f.p.s. The cavity age is 200 microseconds. The sphere was fired in a

line parallel to the X-ray beam, and the temporary cavity (dark area) is seen in cross section. Note the approximately circular shape of the cavity.

The relationship of total cavity volume to energy expended can be demonstrated in another way. Steel spheres of two different masses (%12-inch spheres,

mass 1.04 gin., and '%-inch, mass 0.130 gin.) were fired through the thighs of

cats. The striking velocities of the two spheres were adjusted so that each

size of sphere would lose approximately the same amount of energy in passing

through the tissues. The striking velocity of the %2-inch sphere was approximately 1,500 f.p.s.; that of the %,2-inch sphere, 3,000 f.p.s. In cases where

measured energy losses were approximately equal, the volumes of the temporary

cavities produced by the two-sized spheres were likewise approximately equal.

An illustration of this equality is shown in figure 83.

The formation of this high explosive cavity results in great displacement

and tearing of muscle and connective tissues, rupture of small blood vessels,

and stretching and compression of larger blood vessels and nerves. This behavior is sufficient to account for the very serious damage often observed in

wounds at a considerable distance from the missile track. A more detailed

description will be found on pages 189-200.
MECHANISM OF WOUNDING lit

FIGURE 79.-Microsecond roentgenogram (No. 277) of the thigh of

a cat showing the temporary cavity

formed by the passage of a small,

irregular fragment of a 75 mm. shell.

The fragment is seen emerging from

the thigh at the right. Note the

irregular shape of the temporary

cavity and the fractured femur.

THE EXPLOSIVE OR TEMPORARY CAVITY IN ABDOMEN,

THORAX, AND HEAD

Phenomena quite similar to those which have been discussed for muscle

occur when a high-velocity missile enters the abdomen, the thorax, or the head.

A temporary cavity, filled largely with water vapor, forms behind the projectile. After expanding to a certain volume, the cavity collapses. During

the expansion, tissue is stretched and torn, and, following the pulsation and

collapse of the cavity, tissue is violently pushed together with additional

injury.

Although the general structural makeup of the abdomen is similar to that

of muscle, the thorax and head are quite different. The thorax is largely air

filled, because of the large volume occupied by the lungs. Its walls are also

more rigid than are those of the abdomen, because of the supporting ribs. The

head is made up of a brain, essentially liquid, enclosed in rigid cranial walls.

The temporary cavity in thorax or head will, therefore, be modified by various

secondary conditions, and the expansion coefficient can be expected to be quite

different in the three regions.

The chief changes resulting from a shot through the abdomen of a deeply

anesthetized cat are shown in figure 84. The two bulges of the temporary

cavity on each side are apparent in frames 2 to 4. These bulges later collapse

(frames 5 to 14) and then appear again (frame 15) as small, wrinkled projections

603225V-62 14
178 WOUND BALLISTICS

FIGURE 80-.Microsecond roentgenogram (No. 264) of the thigh of a

cat showing the temporary cavity

formed by the passage of a small

elongate section of a wire nail.

SlNote the irregular shape of this

cavity as contrasted with those

4 formed by spheres.

which later merge with the general violent, twisting movements of the abdomen. A similar type of swelling, indicative of a large temporary cavity

within, results from a shot through a rubber tube filled with water (fig. 85).

The abdomen behaves like this model liquid system.

The large temporary cavity within the abdomen is revealed in the microsecond roentgenogram of figure 86, triggered just as the cavity is beginning to

collapse, as indicated by the slight indentation on each side. In this figure and in

figure 87, the intestine has been made radiopaque by barium sulfate. A smaller

cavity in process of growth is shown in figure 87A, B, and C, which allows

comparison of the abdomen before, during, and after the shot. The increased

diameter of the intestine is readily apparent in the center microsecond roentgenogram, probably because of the flattening against the abdominal walls. Note

that the barium sulfate has leaked out into the body cavity after the shot,

indicating extensive perforation and damage to the intestine, a point corroborated

by autopsy.

Microsecond roentgenograms, taken at a time when the second protuberances of frame 15 (fig. 84) have appeared, show no second internal cavity.

The collapse of the initial temporary cavity seems to be complete. Since

entrance and exit holes in the skin are small and a marked splash of material
MECHANISM OF WOUNDING 179

FIGL•RE 81.-Microsecond roentgenogram (No. 126) of the thigh of a small dog

showing the conical-shaped temporary

cavity formed by the passage of a .22

caliber long rifle bullet. Note the similarity of this cavity to that formed by a

sphere as shown in figure 75.

has been observed to move out from each hole, it is very likely that little or no

air can rush into the cavity. The cavity is filled mostly with water vapor, and

consequently complete collapse will occur, with only a few small gas pockets

undergoing pulsation. In this respect, a shot into the abdomen differs from a

shot into a tank of water where the partially air filled temporary cavity (fig. 62)

undergoes a series of marked pulsations. If a steel fragment instead of a sphere

is shot through the abdomen, irregular temporary cavities appear (fig. 88).

During a shot through the thorax, very little movement is evident (fig. 89).

The lack of movement is connected in part with the air-filled lungs, which do

not fulfill conditions for cavity formation, and in part to the strong rib-reinforced

walls of the thorax. In roentgenograms (fig. 90) giving views before, during,

and after the shot, no clearly visible cavity is apparent. Because of the large

amount of air in the lungs and the difficulty of distinguishing cavity from air,

a clear-cut temporary cavity is hardly to be expected. It is apparent, however,

that the heart has been displaced upward and to the right as a result of the shot,

so that some type of temporary cavity is presumably formed.

The pressures which accompany a high-velocity missile moving through

tissue are enormous (pp. 211-223). Therefore, it is not surprising to find that

a steel sphere fired into the head can produce a temporary cavity in brain tissue,

despite the apparent strength of the cranium which must resist the pressure.

The cavity formed by a missile in the brain of an intact cranium is of finite size,

partly because brain tissue is forced through regions of less resistance (such as

the frontal sinuses and the various foramina of the skull) and partly because of

the stretching of the cranium itself. When the energy delivered is very great,

skull bones are actually torn apart along suture lines.
180 WOUND BALLISTICS

A B

FIGURE 82.-Microsecond roentgenograms of skin of cat thigh, showing temporary

cavities formed after passage of a fi2-inch steel sphere whose impact velocity was 2,800 feet

per second. A. Roentgenogram (No. 147) shows cavity in skin filled with 20 percent gel- atin get. Note the similarity of this cavity to those formed in the thigh as shown in figures

75 and 77. B. Roentgenogram (No. 150) shows cavity in skin filled with water. Note the

similarity of this cavity to those cavities formed in animal tissues.

The temporary cavity within the skull is apparent in the microsecond

roentgenogram of figure 91, a dog's head perforated by a )N-inch steel sphere

moving 4,000 f.p.s. Figure 92 is a similar microsecond roentgenogram of the

head of a cat showing views before, during, and after the shot. A cavity similar to that in the dog's head is apparent in the microsecond roentgenogram of

the cat.

The explosive effect of a high-velocity missile within the cranium increases

with increased energy. With very high velocities, there is complete shattering

of the skull, usually along suture lines. This effect is illustrated in figure 93.

Movement of brain tissue during expansion of the temporary cavity pushes the

bone apart.

To demonstrate the necessity of a liquid medium for the development of

these pressure effects, the brain of a cat was removed through the forainen

magnum and the air-filled head was then shot with a )/8-inch steel sphere moving

3,800 feet per second. A photograph of the cleaned skull of this cat is reproduced in figure 94. It will be noted that no shattering has occurred, the only

damage being rather neat entrance and exit holes. Without a liquid medium,

the high pressure necessary to blow skull bones apart cannot be built up.
MECHANISM OF WOUNDING 181

A B

FIGURE 83.-Microsecond roentgenograms of thigh of a cat. A. Roentgenogram

(No. 261) shows temporary cavity formed by a h2-inch steel sphere whose impact velocity

was approximately 3,000 f.p.s. The energy lost by this sphere was approximately equal to

that lost by the hi2-inch sphere as shown in B. Note the similarity of the two cavities.

B. Roentgenogram (No. 262) shows the temporary cavity formed by the passage of an %.-

inch steel sphere whose impact velocity was approximately 1,500 f.p.s. Compare with A.

MOVEMENTS FOLLOWING COLLAPSE OF THE EXPLOSIVE

CAVITY

In the preceding pages, the explosive cavity in soft tissue, with its volume

many times greater than the volume of material swept out by the missile, was

clearly demonstrated. It was reasonable to suppose that when the cavity

collapsed such violent motion would not immediately stop. Investigation of

the movement in soft tissue after the cavity has collapsed bears out this conjecture. The motion continues for a considerable length of time, long after the

missile has passed by. Once again, it is instructive to examine the action in

water and gelatin gel before proceeding to animals.

In water, the collapsing cavity closes in, entrapping the air that rushes in

after the bullet. When the cavity is compressed to its minimum volume, it

springs open again and the process is repeated. The cavity thus undergoes a

series of pulsations. For a h18-inch steel sphere traveling with an impact velocity

of 3,000 f.p.s., the first few pulsations have a period of about 8 milliseconds.

The period is greatest for the spheres of greater energy. The period in seconds

for all spheres was found to equal the product of 9.85 X 10-1 and the cube root
182 WOUND BALLISTICS

'.. ~~-1 A&•; 

FIGURE 84.-Frames (2,880 per second) from a high-speed motion picture showing

volume changes and movements in the abdomen of a cat resulting from the passage of a

%2-inch steel sphere whose impact velocity was 3,800 f.p.s. The squares painted on the

shaved abdomen are 1. inch apart. (Experiment No. 1, of 20 Nov. 1945.)
MECHANISM OF WOUNDING 183

fait

5 was °°j OWN N N

sm n,01 , n-0

La

F~l •85 gFrame rmahg rot240prseod -spe 16 io RA h Oit wn

volume in chages a ubber tub filled wth water, reslipg "x o h asaeo ml

hih-elciystelsper.Noe hesmiartyinbhaio t ta o te bome r hw n

figur 84.
184 WOUND BALLISTICS

FIGURE 86.-Microsecond roentgenogram (No. 183) of the temporary cavity

formed in the abdomen of a cat after the

passage of 542-inch steel sphere with an

impact velocity of 3,200 f.p.s. Cavity

age 400 microseconds.

A C

FIGURE 87.-Roentgenograms of abdomen of a eat. The alimentary tract has been

made radiopaque with barium sulfate. A. Roentgenogram (No. 186) made before the shot.

B. Microsecond roentgenogram (No. 186) showing the large temporary cavity formed after

the passage of a %32-inch steel sphere with an impact velocity of 3,200 feet per second. C.

Roentgenogram (No. 186) made immediately after the shot. Note distribution of opaque

material as compared with that shown in A.
MECHANISM OF WOUNDING 185

FIGURE 88--Microsecond roentgenogram (No. 267) of the abdomen of a cat showing

the temporary cavity formed by the passage of a small cylinder of steel (11 X 2.5 mm.)

weighing 420 ing. Its striking velocity was 3,000 f.p.s. Note the irregular shape of the

cavity.

of the impact energy in ergs. The periodicity of the cavity is clearly illustrated

in figure 62, the first minimum appearing in frame 23 and the second in frame

47. The pulsations in water for a %2-inch sphere traveling with a velocity of

3,000 f.p.s. have been observed to last at least one twenty-fifth of a second.

The pulsations in water occur because air is trapped within the missile track.

As air rushes into the cavity, the cavity is sealed off by Bernouilli forces.

In gelatin gel, the cavity also appears to pulsate about an air bubble, but

in this case the pulsations are directed along the track of the missile. A typical

pulsation cavity is shown in figure 95. The cavity closes in from the top and

bottom to form two internal nipples, as can be seen in frame 11. Eventually

the cavity breaks up in two segments, as shown in frame 22 (see also fig. 55).

When missiles pass through soft structures, such as the abdomen of a cat,

violent motion of the tissues occurs. The larger the energy of the shot, the

greater the action on the abdomen. Some concept of the violence of this movement can be obtained from inspection of figure 84. In frames 10 and 13 of

figure 84, the abdomen is considerably indented where the bullet perforated.

This is also shown in figure 96. Some of the expansive movement is directly

upward toward the thoracic cavity. However, the motion in the abdomen is
186 WOUND BALLISTICS

FIGURE 89.-Frames from a high-speed N

motion picture of the thorax of a cat, traversed

by a %ý2-inch steel sphere with an impact

velocity of 3,200 f.p.s. Compare with figure

84 and note the absence of pronounced movements and volume changes in the thorax. ...

FIGURE 90.-Roentgenograms of the thorax of a cat. A. Roentgenogram

(No. 189) taken immediately before the shot. B. Microsecond roentgenogrami (No. 189) made 370 microseconds after the thorax was struck by a Y•2-

inch steel sphere whose impact velocity was 3,200 f.p.s. Note that the temporary cavity does not show-, up well in the thorax. C. Roentgenogram (No.

189) made immediately after tbe shot. Note the manner in which the heart

is displaced, although the missile did not strike the heart.
MECHANISM OF WOUNDING 187

S~ genogram of the head of an anesS~ thetized dog, showing a large S~ temporary cavity wvithin the crani- S utm produced by thle passage of a

S..... .... i 1⁄2-inch steel sphere. At impact

S~Entrance of the sphere was at the left

S~in the roentgenogram, exit. at the

S....right. (Experiment No. 248.)

not like that of the pulsating cavity in the water tank but rather like the distortion waves which are set up in a block of gel when it is given a sharp blow.

The microsecond roentgenograms show a complete absence of an oscillation

bubble, as was seen in water.

The shot into the thigh of a cat also produces a violent action. The highspeed motion picture frames in figure 76, showing a cat leg, reveal this. When

the leg is skinned, waves resembling waves on a water surface are produced, as

in the "bullet-view" moving pictures of figures 97 and 98. These waves travel

down the thigh with velocities ranging from 4.1 to 5.2 meters per second. It

is not clear whether this wave was the regular muscular contraction wave

(velocity between 6 and 12 meters per second) or rather a mechanical disturbante.

Unlike the abdomen, the cavity in the thigh pulsates on a partially air

filled cavity. When the moving pictures are studied, these pulsations can be

observed and timed. For example, a sphere traveling with a velocity of about

3,000 f.p.s, was observed to start pulsations having a period of about 3 milliseconds. Microsecond roentgenograms show an air bubble in the thigh at a

late stage. Figure 99B is a microsecond roentgenogram taken 3.5 milliseconds

after tbe missile passed through the leg. This is at a time when the second

expansion of the cavity occurs and the entrapped bubble of air is plainly

visible.

It is of interest to conjecture on what would happen to parts of the body

when struck by a missile, if these parts were not confined by such structures as
188 WOUND BALLISTICS

FIGURE 9

2 .-- Roentgenograms of the head of a cat. A. Roentgenogram (No. 76)

made before the shot. B. Microsecond roentgenogram (No. 76) shows an early cavity.

The /N-inch sphere struck with a velocity of 3,800 f.p.s. C. Roentgenogram (No. 76) made

after the shot.
MECHANISM OF WOUNDING 189

Li

FiGURE 93.-Skull from head of cat struck in right temporal region by a ý-inch steel

sphere with an impact velocity of approximately 3,800 feet per second. (Experiment No.

240.)

skin, abdominal wall, or skull. The disintegration of the tissue will presumably

be greater when it is unconfined. In figure 100 is shown the bare muscles of

the thigh as they are struck by a missile. The muscles are extensively separated, and the bullet hole shows clearly, although the path of the bullet was in

the plane of the picture. In figure 101 is shown a pig spleen when struck by a

missile. This picture was taken with two mirrors; the one above provides a

top view, while the one on the left shows the entrance hole. The tissue flies

apart in all directions.

NATURE AND EXTENT OF DAMAGE AROUND THE WOUND

TRACK

The chief emphasis in this section will be on wounds of the thigh. Some

attention, however, will be given to wounds of the abdomen and thorax. The

nature of the damage produced in the thighs of anesthetized dogs and cats by

high-velocity missiles is representative of that occurring in muscular and connective tissues. In consideration of such a wound, it is necessary to distin-
190 WOUNI) BALLISTICS

FIGURE 94.-Photographs of the skull of a cat, showing entrance and exit holes produced by a %-iflch steel sphere Nvith an impact velocity of 3,800 f p s. H-ead of cat severed

from body and brain removed before the shooting. A. Entrance site in left temporal

region. B. Exit site in right temporal region.
MECHANISM OF WOUNDING 191

911 12 13

14 15 18

26 30 AO 48

FIGURE 95.-Frames (1,920 per second) from a motion picture (No. 147) of the cavity

in gelatin produced by a . 2-inch steel sphere with impact velocity of about 3,000 f.p.s. The

distance between two black marks on left is 5 cm. In frames 7 to 11, the top and the bottom

of the cavity are moving toward each other producing internal nipples which later (frame 15)

separate again. The single cavity breaks into two cavities (frame 22) which again join and

slowly collapse to produce a permanent missile track, similar to the one which can be seen on
192 WOUND BALLISTICS

FIGURE 96.-Microsecond roentgenograms of abdomen of a cat. A. Roentgenogram

(No. 463) shows barium sulfate in stomach. B. Roentgenogram (No. 464) taken 5.5 milliseconds after a %2-inch steel sphere (impact velocity 3,800 f.p.s.) passed through at the level

of the narrow line. The time corresponds to the collapse of the temporary cavity. Note

that the abdomen is still enlarged at the stomach level and narrow at the missile level but

that there is practically no cavity within; the collapse is complete.

guish between damage to soft tissues, such as muscle and connective tissues,

and damage to the more specialized structures of the thigh, such as the femur,

nerves, and larger blood vessels. Only those in the first category will be described here, while damage to the more specialized structures will be considered

later (pp. 200-211).

FIGURE 97.-Frames (2,280 per second) from a motion picture (No. 154) of the skinned

leg of a cat struck by a %2 -inch sphere moving with a velocity of about 2,000 f.p.s. The

right side of each frame shows the entrance hole and subsequent changes as the sphere strikes

head on; the left side is the reflection in a mirror viewed perpendicular to the missile path.

Note that the entrance hole in frame 1 is obscured by spray in the next three frames. A

definite bulge appears on the profile of the right hand picture in frame 7 and travels down

the muscle like a wave (velocity 4-5 meters per second), passing out of view about frame 19.

FIGURE 98.-Frames (2,160 per second) from a motion picture (No. 153) of a skinned

cat thigh struck by a Y3 2-inch steel sphere (0.3 gram) traveling with a velocity of about 3,000

f.lp.s. The right side of each frame shows the entrance hole and subsequent changes as the

sphere strikes head on; the left side is a reflection in a mirror viewed at right angles to

the bullet path. Note in frame 2 that the explosive cavity produces a bulge on the side of

the thigh. The gyrations of the entrance hole are clearly shown in frames 1, 2, and 3.
MECHANISM OF WOUNDING 193

18

19

... 7 17

FIGURE 97. (See opposite page for legend.)

l ii d` c!k, -o

FIGURE 98. (See opposite page for legend.)
194 WOUND BALLISTICS

•B

FIGURE 99.-Microsecond roentgenograms of the thigh of a cat. A. Roentgenogram before a shot. B. Roentgenogram (No. 474) taken 3.5 milliseconds after a h//s-inch steel sphere with an impact velocity of 3,000 f.p.s. has

perforated the thigh. The entrapped air bubble causes the thigh to pulsate

a few times.

Obviously, soft tissues directly in the path of a missile are badly damaged.

These tissues are reduced to a pulp and much of the material is actually thrown

out of the thigh during the expansion of the temporary cavity, as discussed

previously (pp. 167-180). The loss of this material leaves an excavation, the

permanent cavity.

It has been shown earlier that the expansion of the temporary cavity results in a stretching and tearing of the tissues for a considerable distance away

from the missile track. With the collapse of the temporary cavity, these tissues regain their original positions and, except for darkened areas of extravasated

blood, may have a fairly normal appearance, macroscopically.

A more complete assessment of the exact type of damage suffered by these

soft tissues can be had from a histologic study. In each case to be described,

a considerable volume of tissue adjacent to the wound cavity was fixed and

sectioned at thicknesses ranging from 20 to 50 microns.
MECHANISM OF WOUNDING 195

10 15

* u r. . *.u 33 Is 

! IR smalll Samong

tmop ** "fiE Milian

* 'I Ir

it wa is 0. mn

FIGU;RE 100.--Frames from a high-speed motion picture (No. 152) of the muscles of the

thigh of a cat blown apart by a h-inch steel sphere traveling with a velocity of about 3,000

f.p.s. The sphere is passing from left to right. Note how the muscle which is first struck by

the missile swings out at right angle to the missile patb so tbat the entrance hole is clearly

visible.

Tissues bordering the wound cavity in the thigh suffer two primary types

of damage: (1) That affecting the muscle fibers and (2) that affecting the intermuscular and intramuscular connective tissues and small blood vessels. Damage to the muscle fibers is manif'ested by a coagulation and swelling of the fibers
196 WOUND BALLISTICS

0 10 15

4 14 19

FIGURE 101-Frames (1,800 per second) from a motion picture (No. 20, 26 May 1944)

of a %-inch steel sphere (striking velocity 3,000 f.p.s.) passing through a pig spleen. The

squares on background are centimeters. A mirror above shows the top view and one to the

left shows the entrance view. Note the marked splash of material at entrance and exit with

complete disintegration of tissue.
MECHANISM OF WOUNDING 197

in a region extending for some distance from the wound cavity. The muscle

fibers (fig. 102) in this region are unique in their staining properties and often

swell to twice the diameter of normal fibers. Swollen fibers are well shown by

the photomicrograph in figure 102A. These fibers should be compared with

normal undamaged fibers, photographed at the same magnification and shown

in figure 102B. More distal to the wound cavity, "muscle clots" are formed,

accompanied by other phenomena of cellular disorganization. Still further

distally, however, the muscle fibers exhibit a remarkably small amount of damage despite the fact that they have been moved considerably by the expansion

of the temporary cavity. The three regions just mentioned are visible in the

photomicrograph in figure 102C. Normal undamaged fibers are seen at the

left of the section, muscle clots in the central region, and swollen fibers to the

right.

Vascular damage is extensive for a considerable distance from the permanent wound cavity. Multiple ruptures of the capillaries occur, and the

muscle fibers are widely separated by accumulations of extravasated blood.

This is illustrated by the photomicrograph in figure 103. These areas of

hemorrhage may extend for considerable distances along fascial lines. Histologic sections show that the larger blood vessels, even though they lie close

to the wound cavity, are undamaged. Bleeding around the wound appears

to be a matter of capillary bleeding, unless a larger blood vessel is struck directly.

It should be emphasized that these observations are based on materials

fixed within an hour or so after the shot. No attempt has been made to conduct

survival studies or to follow the course of wound healing.

Because of their structural characteristics, it is very difficult to determine

the exact type of damage suffered by the diffuse intermuscular connective

tissues. They are elastic, and, as a result, the permanent cavity formed in

them is quite small. Examination of areas around the wound shows that the

individual muscles are often widely separated and stripped from their surrounding connective tissues. It appears quite likely that a great deal of the

expansion caused by a missile follows these intermuscular fascial planes and

causes damage in these tissues at considerable distances from the wound

cavity.

Because of the heterogeneous nature of the tissues and organs involved,

wounds of the abdomen are much more difficult to evaluate accurately. If

the missile passes through the intestinal mass, regions of the intestine directly

in the path of the missile are usually completely severed or exhibit large tears.

A chief factor in causing damage in the abdomen is the rapidly expanding temporary cavity which momentarily blows apart the components of the intestinal

mass, as illustrated by high-speed motion pictures and microsecond roentgenograms on pages 182 through 185. This cavity may produce large tears in the

mesenteries with damage to such organs as the pancreas and spleen. Breaks

in many of the mesenteric blood vessels occur, causing severe hemorrhage into

the peritoneal cavity.
198 WOUND BALLISTICS

4#

FICuRE 102.-Phiotomicrographs showing damaged and undamaged mnuscle fibers adjacent to the wound cavity in the thigh of a dog, produced by a %'2 -inch steel sphere wvith an

impact velocity of 3,035 feet per second. A. Photomicrograph showing damaged muscle

fibers. Compare with uninjured muscle in B and note that the muscle fibers are approximately two times the diameter of normal muscle fibers. Note the large amount of extravasated blood between the fibers. B. Photomicrograph showing apparently undamaged

muscle at a distance from the -wound cavity. Compare with the damaged muscle in A.

C. Photomicrograph of section of muscle adjacent to the wound cavity. Undamaged regions

of the fibers are shown at the left, areas with "muscle clots" in the center, and badly swollen

portions of the fibers to the right.

Perforations of the intestine are often observed at points quite distant

from the path of the missile. These are undoubtedly due to rapid pressure

changes associated with the temporary cavity, acting on gas contained in the

intestine. A short period of lowered pressure in the cavity around the intestine

causes the intestine to explode at points where these gas pockets are present,

as explained on pages 211-223.

Damage to thoracic structures was restricted primarily to lunig tissue,

as in none of the experiments were the heart or great vessels struck directly.

The wound track in lung tissue was never large, probably because of the sponginess and elasticity of this type of tissue. Trhe thorax, on autopsy, usually

contained a considerable amount of blood, a result of hemorrhages of the smaller
MECHANISM OF WOUNDING19

AA

.,0 y (Jl*

-4 -

l~r

A: $*
200 WOUND BALLISTICS

# FIGURE 103.-Photomicro-

_ - graph showing swollen muscle

Sfibers of a dog's thigh in cross

section. Note the large amount

of extravasated blood between

the fibers.

pulmonary vessels. In all the animals studied, the lungs were greatly collapsed,

much more so than is usually observed after pneumothorax (pp. 171-180).

DAMAGE TO BONE BY HIGH-VELOCITY MISSILES

Damage to bone can be discussed under two headings: (1) Damage to the

long bones, particularly the femur and humerus; and (2) damage to flat bones,

such as those which comprise the skull.

The most obvious type of fracture of a long bone is one which results from

a missile striking the bone directly. In none of the experiments was a deliberate attempt made to strike either the femur or the humerus. However, an

occasional stray shot did hit the bone, and a number of microsecond roentgenograms were obtained of thighs in which this was the case.

Figure 104 is a microsecond roentgenogram of the thigh of a cat, made

immediately after the passage of a %32-inch steel sphere whose impact velocity

was 3,000 f.p.s. The sphere struck the femur directly. The fact that the

bone has been hit has not markedly affected the expansion of the temporary

cavity. In fact, it appears from this roentgenogram that the femur also

"explodes," in a manner very similar to the soft tissues around it.

A second case is shown in the microsecond roentgenogram in figure 105

where the femur was struck by a small fragment (originally part of a 75 mm.

shell). In this case, the fragment was broken into two pieces as a result of its

impact with the bone. One piece has remained in the thigh, the second has

emerged. Figure 106 is a microsecond roentgenogram of a beef rib, made

immediately after the passage of an '/32-inch steel sphere whose impact velocity

was 2,800 f.p.s. The behavior of the bone is very remindful of the manner of

formation of the temporary cavity in soft tissues.

The question whether bone fragments may be driven out into the soft

tissues and act as secondary missiles is a significant one. The present observa-
MECHANISMI OF WOUNDING 201

F tcURE 104.-Microsecond roentgenogram (No. 11) of the thigh of a cat made

immediately after the passage of a ho2-

inch steel sphere with an impact velocity

of 3,000 f.p.s. The sphere struck the

femur directly. Note the "explosive"

behavior of the femur.

tions indicate that fragments fly out into the temporary cavity and, with the

collapse of the cavity, are forced back to approximately their former position.

Dissection of wounds, where such extensive shattering of a bone has occurred,

rarely discloses fragments at any distance from the bone. This finding is

supported by the roentgenogram of a cat thigh, shown in figure 107, which was

made shortly after the femur was struck by a h3i2-inch steel sphere whose impact

velocity was 3,000 f.p.s. The sphere was fired parallel to the X-ray beam so

as to pass into the plane of the paper. Although the bone is badly shattered,

the fragments are closely clumped together and seem to retain a connection

with the parent bone, possibly being held there by the fibrous periosteum.

They are free to move but actually are not separated from the bone."6

A second and less severe type of fracture is that produced by a missile

which passes near but does not strike the bone directly. This can be termed

an indirect fracture. Roentgenograms of a large number of thighs show that

the femur can be broken even though the missile passed as far as 2 or 3 centimeters from the bone. A roentgenogram of this type of fracture is shown in

figure 69. The wound cavity appears as a light area to the right of the femur.

16 The wounds of battle casualties frequently contain bone fragments along the course of the permanent wound track.

This is especially true in penetrating wounds of the head where small bone fragments derived from the skull are commonly

found in the permanent wound track in the brain. In penetrating wounds of the thorax where there have been fractures

of the vertebras, ribs, or sternum, bone fragments are frequently embedded in lung tissue. In wounds of the extremities

caused by high-velocity shell fragments, fragments of long bones are frequently embedded in the soft tissue adjacent to

the permanent wound track. This does not indicate that bone fragments are important as secondary wounding agents,

but it does show that bone fragments are not always retained in close approximation to the parent bone.-J. C. B.

6032251-62-15
202 WOUND BALLISTICS

FIGURE 105.-Microsecond roentgenogram (No. 276) of the thigh of a cat made FiCITRE 106.-Microsecond roentgenoimmediately after the passage of a fragment gram (No. 144) of a heef rib made immnedi-.

of a 75 mm. shell with an impact velocity ately after the rib was struck by an %32-inch

of 3,000 f.p.s. The fragment broke into steel sphere with an impact velocity of

two pieces as a result of striking the bOne. 2,800 f.p.s. Note the "explosive" natu're of

One piece has heen retained in the thigh; the fracture.

the second has exited and does not show in

the picture.

It is also clear that the cavity has expanded toward the femur and that the

bone is fractured, as if it bad received a heavy blow fromi the direction of the

cavity.

Figure 108 is a roentgenogram of the thigh of a dog made after the thigh

was struck by an %32-inch steel spbere with an impact velocity of 4,000 f.p.s.

The femur has been fractured although the sphere passed at a considerable

distance from it.

A second case is illustrated by the roentgenogram shown in figure 109.

In this case, the thigh was struck midway between the femur and the sciatic

nerve. The nerve in this case has been made radiopaque by the injection of

iodophenylundecylate. The femur shows a simple fracture. This type of

fracture should be compared with the marked comminution of that shown in figure 107, which resulted from a direct hit on the bone (see also roentgenograms

on pp. 173-181).

The incidence of the indirect type of fracture appears to be related to the
MECHANISMI OF WOUNDING 203

striking energy of the missile. In the case of 42i-ch steel spheres, it was

found that no fractures of this type occurred at velocities ranging from 1,000

to 2,400 f.p.s. At 2,800 to 3,000 f.p.s., fractures were found in 20 percent of

the cases and at the highest velocities used, 4,500 to 4,800 f.p.s., in 45 percent

of all the cases.

It is significant that, of the total number of indirect fractures, 80 percent

were of the femur and only 20 percent of the humerus. These data are based

on 172 cats in which both forelimbs and hind limbs were shot. A probable

explanation of this result is that the humerus is architecturally better able to

stand the high pressures imposed on it by the missile than is the femur. Also,

the humerus appears to be better protected by the surrounding muscle and

fascia than is the femur.

The explanation of the indirect type of fracture is found in the rapidly

expanding temporary cavity. As this cavity expands, high pressures are

brought to bear against the rigid bone. The situation is similar to that of

striking the bone a hard blow with a hammer. Figure 110 illustrates this point

nicely. This figure shows a microsecond roentgenogram of the thigh of a cat made immediately after the passage of a 4'-inch steel sphere whose impact

velocity was 2,800 f.p.s. The temporary cavity is expanding, and careful

examination of the femur shows that a clean fracture line has appeared in the

bone. A second and similar case is shown in figure 111.

FIGURE 107.-Roentgenogram (No. 288) of

the thigh of a cat made after the femur was

struck by a 5%2-inch steel sphere with an

impact velocity of 3,000 f.p.s. Note the

shattered femur and the manner in which

the fragments are clustered around it. The

sciatic nerve also shows in this figure as the

dark line to the right of the femur.
204 WOUND BALLISTICS

FIGURE 108.-Roentgenogram (No. 108)

of the thigh of a dog made after the thigh

was struck by an %,2-inch steel sphere

with a velocity of 4,000 f.p.s. The femur

has been shattered, although not struck

directly by the sphere.

Studies on skull damage were made chiefly with %2-inch steel spheres.

Damage to the skull varied from the presence of neat holes, at the points of

entrance and exit, to extensive fractures, sometimes resulting in complete

shattering of the skull into a large number of separate fragments. Splitting

along suture lines was often a prominent type of damage.

The degree of skull damage was found to increase with missile velocity and

probably depends on the striking energy of the spheres. This is illustrated by

the series of skulls shown in figure 112. Figure 112A demonstrates the neat

type of hole which ordinarily occurs when the skull is hit by a '/ 2-inch steel

sphere with an impact velocity of approximately 1,100 f.p.s. The more extensive damage which occurs at higher velocities is shown in figure 112B, a case

where the skull was struck with a sphere having a velocity of approximately

4,000 f.p.s. The extensive splitting along sutures and shattering which frequently occurred at the higher velocities is illustrated in figure 112C, a skull

struck with a sphere whose impact velocity was approximately 4,600 f.p.s. In

most of these latter cases, the skull is completely shattered and must be

recovered piece by piece.

Much of this extreme damage to the skull undoubtedly results from pressure developed within the skull at the time a temporary cavity is formed in the

brain immediately after passage of the missile. A complete account of the role of

the temporary cavity in head wounding has already been presented (pp.1 77-180).
MECHANISM OF WOUNDING 205

DAMAGE TO BLOOD VESSELS AND NERVES NEAR WOUND

TRACK

It has been pointed out (pp. 189-200) that bleeding from a wound in the soft

tissues of the thigh resulted primarily from the rupture of capillaries and small

blood vessels. It has been a matter of frequent observation that the larger

blood vessels, particularly the arteries, passing in or near the wound cavity were

apparently undamaged. These vessels are very elastic, and the assumption

was made that, unless they lay directly in the path of the missile, they were

merely blown aside during the expansion of the temporary cavity and sprang

back to their original positions with its collapse.

The correctness of this assumption is confirmed by microsecond X-ray

studies (fig. 113). Figure 113A shows a roentgenogram of the thigh of a cat

in which the femoral artery and its tributaries have been made radiopaque

with barium sulfate. An attempt was made to fill the femoral vein, but too

much blood remained in this vessel to give a complete injection. Figure 113B

is a microsecond roentgenogram of the same thigh made immediately after

the passage of a /3%2-inch steel sphere with a velocity of 3,200 f.p.s. The large

temporary cavity, resulting from the passage of the missile, is seen in cross

section. It is evident that, although the sphere passed at a considerable

distance from the vessels, they have been forced aside and follow the contour

of the margin of the cavity. Figure 113C shows the same thigh immediately

FIGURE 109.-Roentgenogram (No. 229)

of the thigh of a cat made after the passage of a 5 2-inch steel sphere with a

velocity of 3,000 f.p.s. Note that the

femur has been fractured, although not

struck directly by the missile. The sciatic nerve to the left has been injected

with iodophenylundecylate. Compare

with figure 107.
206 WOUND BALLISTICS

F•oITRE 110.-Microsecond roentgen- FIcURE 111 -Microsecond roentgenogram (No. 135) of the thigh of a cat showing ograin (No. 276) of the thigh of a cat showing

the temporary cavity formed after the pas- the temporary cavity formed after the passage of a % 2-inch steel sphere whose impact sage of a small steel fragment. Note fracvelocity was 2,800 f.p.s. Note the fracture ture line in the femur.

line appearing in the femur.

after the shot. The location of the permanent cavity is well defined. The

blood vessels have moved back to their original position as shown in figure

113A. Subsequent dissection disclosed that both the artery and the vein were

undamaged. The magnitude of the blow suffered by these vessels was such

as to fracture the femur.

Unlike arteries and veins, large nerves, as the sciatic nerve of the cat,

are often severely damaged as a result of being displaced by the temporary

cavity. This displacement may cause a stretching and a compression of the

nerve sufficient to block its ability to conduct impulses, even though there

is no detectable break in the continuity of the nerve.

The sciatic nerve can be made radiopaque by injecting it with either

iodobenzene or iodophenylundecylate (fig. 114). The exact manner in which

these substances follow the nerve is not well understood and, in many cases,

only a single small channel in the rather broad nerve is outlined.

Microsecond roentgenograms show that the nerve is greatly displaced

as the temporary cavity expands. Figure 114C is a microsecond roentgenogram of the thigh shown in figure 114B, made immediately after the passage

of a 4%2-inch steel sphere with a velocity of 3,200 f.p.s. The cavity is seen in

cross section. The roentgenogram shows that the nerve has been pushed aside
MECHANISM OF WOUNDING 207

E N.

FIGURE 112.-Photographs of cat skulls. A. Neat type of hole formed by the passage

of a %2-inch steel sphere with an impact velocity of 1,100 feet per second. B. More extensive

damage to the skull produced by a %32-inch steel sphere which struck with a velocity of 4,000

feet per second. Note the extensive splitting along suture lines. C. Extreme damage produced by a % 2-inch steel sphere which struck with a velocity of 4,600 feet per second.

and follows around the margin of the cavity. Because of the extreme rapidity

with which this displacement occurs, the situation is comparable to striking

the nerve a sharp blow. Figure 114D shows this same nerve immediately

after the shot. Subsequent dissection showed no break in the continuity of

the nerve and nothing to suggest gross anatomic damage to the nerve.

In a number of cases where the nerve had been subjected to compression

and stretching by the expansion of the temporary cavity, conduction, as determined by electrical stimulation, was blocked. In general, it was necessary for

the missile to pass within 1 centimeter of the nerve in order to block conduction.

Nerves at a greater distance showed normal conduction.

Nerves in which conduction was blocked as a result of a "near miss"

showed no externally detectable break in continuity. However, histologic

examination of the nerves showed structural changes which accounted for the

loss of conduction. Figure 115 is a photomicrograph of a longitudinal section
208 WOUND BALLISTICS

FIGURE l13.-Roentgenograms of the thigh of a cat. A. Roentgenogram (No. 245)

showing femoral artery and vein injected with barium sulfate. B. Microsecond roentgenogram showing displacement of the blood vessels by the large temporary cavity formed after

the passage of a %2-incb steel sphere with an impact velocity of 3,200 f.p.s. The dark circular temporary cavity is shown in cross section with missile hole in center. C. Roentgenogram made immediately after the shot. Note that the vessels bave returned to their original

positions and that the femur is fractured. The permanent cavity shows as a dark area

to the right of the blood vessels.

of an undamaged control sciatic nerve of a cat. Figure 116 is a similar photomicrograph of a nerve in which conduction was blocked. This figure shows

that the nerve fibers have been widely separated and that many fibers are

completely severed, with their ends badly frayed. A critical study of many

of the fibers at very high magnifications indicated that the axis cylinders of

many of them were broken, but the myelin sheath and neurilemma showed no

signs of damage. Figure 117 shows a section from another nerve. In this
MECHANISM OF WOUNDING 209

FIGURE 114.-Roentgenograms of the thigh of a cat. A. Roentgenogram (No. 228)

showing the sciatic nerve made radiopaque with iodobenzene. B. Roentgenogram (No.

232) made immediately before a shot. C. Microsecond roentgenogram showing the displacement of the sciatic nerve by the temporary cavity (seen in cross section; missile hole in

center) which is formed after the passage of a %2-inch steel sphere whose impact velocity

was 3,200 f.p.s. D. Roentgenogram made immediately after the shot. Note relation of

the permanent cavity (small dark area) to the nerve.

6032251--62---16
210 WOUND BALLISTICS

FIGURE 115.--Photomicrographr

of a section of an undamaged

control sciatic nerve of a cat.

FIGURE 116-Photomicrograph

of a section of the sciatic nerve of

a cat, showing type of damage pro- c j°

duced by a } 2 -inch steel sphere *

which did not strike the nerve

directly. Note the separated and -

broken nerve fibers.

FIGURE 117.-Photomicrograph : "

of a section of the sciatic nerve of.

a cat, showing type of damage

produced by a %2 -inch steel sphere

which did not strike the nerve. tY • 

Note the manner in which the nerve ,, "

fibers are kinked. -

A\,
MECHANISM OF WOUNDING 211

case, the nerve fibers have been thrown into prominent kinks, as though they

had undergone abnormal stretching. In all of the cases described here, the

nerve sheath (epineurium) appeared undamaged.

PRESSURE CHANGES ACCOMPANYING THE PASSAGE OF

MISSILES

When a high-velocity missile strikes the body and passes through soft

tissues, three kinds of pressure change appear: (1) Shock wave pressures, or

sharp high-pressure pulses, formed when the missile hits the body surface; (2)

very high pressure regions immediately in front and to each side of the moving

missile; (3) relatively slow low-pressure changes connected with the behavior

of the large explosive temporary cavity formed behind the missile.

Some characteristics of shock waves in water have already been considered

(pp. 152-158). Attention was also directed to the high-pressure regions around

the moving sphere, whose effects are seen in figure 60. Shock wave pressures

and cavity pressure changes in the body can be investigated in two ways: (1)

The pressures can be accurately recorded by a proper type of gage, or (2) their

existence can be visualized in models simulating conditions found in the body.

For accurate recording, a calibrated tourmaline piezoelectric crystal gage was

placed in the stomach of the deeply anesthetized animal which was then shot

through the posterior part of the abdomen. The method is described on pages

147-152. In order to record shock wave pressures, the amplifier gain was low

and the sweep rapid, calibrated in microseconds. To record pressure changes

around the temporary cavity, the gain was high and the sweep relatively slow,

calibrated in milliseconds.

For visualizing the shock wave pressures, the spark shadowgram method

described on page 150 was used. The tissue, placed on the surface of a

tank of Ringer's solution, was shot with a high-velocity missile and the spark

triggered to catch the shock waves as they moved from tissue to solution: or

the tissue was suspended in the solution and the behavior of shock waves on

reflection or transmission recorded.

Shock waves in tissue arise at the impact of the missile with the skin or

other tissue surface. The velocity of shock waves in tissue is approximately

the same as in water, 4,800 f.p.s. The chief difference in behavior of shock

waves in the body, as compared with water, is associated with the heterogeneity

of the tissues. The wave is dispersed on transmission through, or on reflection

from, surfaces. Instead of a single clean wave, there appears a mass of wavelets

with a series of high-pressure peaks. Figure 118 shows a shock wave in water

partially reflected and partially transmitted by a slab of gelatin gel suspended

in the tank. The gelatin is sufficiently homogeneous to give good reflection.

Figure 119A shows waves which have arisen in, and passed out of, a mass of

thigh muscle suspended at the surface of Ringer's solution. Figure l19B shows

a shock wave which has originated from a thigh muscle surface. In both cases,

the dispersion of the wave is apparent.
212 WOUND BALLISTICS

A.

FIGURE 118.-Shadowgram (P 132) of a wave reflected from and

transmitted through a 11⁄4-inch block of 20 percent gelatin gel

suspended in water. The original wave, from a bc6-inch steel sphere

with an impact velocity of about 2,500 f.p.s, can be seen at each

side of the block.

FIGURE 119.-Shadowgrams of a shock wave. A. Shadowgram (S 115) of wave whose

origin is at the upper surface of a fresh skinned thigh of a cat. The wave has been dispersed

and passed from the tissue to water. B. Shadowgram (S 143) of a wave arising at the surface of water and reflected from a fresh skinned thigh of a cat suspended in water. Note

the-convection trails below the muscle tissue.

Reflection and transmission also occur from a piece of cat's stomach spread

on a frame, as illustrated in figure 120. The behavior of a shock wave at the

body wall is illustrated in figure 121, which shows a piece of the abdominal wall

(skin and muscle) of a cat stretched on the surface of a tank of Ringer's solution.

The tank has then been penetrated by a horizontal shot (to right). The shock
MECHANISM OF WOUNDING 213

FiGURE 120.-Shadowgram (P 130) of a

wave in Ringer's solution after reflection

from and transmission through a piece of

cat stomach stretched on a frame. The

wave arose from a %o6-inch steel sphere

with an impact velocity of 3,000 feet per

second.

FiGURE 121.-Spark shadowgram (P 201) of a shock wave reflected from the inner

surface of cat's abdominal wall, which is resting on the surface of Ringer's solution. The

cone-shaped cavity behind the ý46-inch steel sphere, which hit the tank horizontally with

a velocity of 3,000 f.p.s., is at right. The reflected wave is not so regular as the incident

wave and has a light band forward, indicating that it has been inverted to a tension wave

on reflection. The low pressure resulting from inversion is indicated by the cavitation,

which appears as fine black dots. The secondary waves following the shock wave are

due to vibration of the steel sphere. The missile is 6 cm. below the surface of the water.
214 WOUND BALLISTICS

wave can be seen toward the left and has been reflected frlom the undersurface

of the body wall. Note that a light band precedes the dark band of the shock

wave, indicating that, on reflection, a pressure pulse has been changed to a

tension pulse. Such reversal occurs whenever the acoustic impedance (defined

as the density multiplied by the wave velocity) of the reflecting medium is less

than that of the medium in which the wave was moving. At an air surface,

the pressure wave is always reflected as a tension wave.

Reflection from bone, in this case the surface of a human skull suspended

in water, is illustrated in figure 122, while figure 123 depicts a row of beef

FIGURE 122.-A. Shadowgram (P 158) of wave in water reflected from the outer

surface and also transmitted by a top section of water-soaked human skull. The original

wave from a %-inch steel sphere, with impact velocity of about 3,000 f.p.s., can be seen

near the lower right corner of the bone. B. A wave transmitted through a skull section.

FIGURE 123.-A and B. Shadowgrams

(S 147 and S 148) showing reflection and

transmission of water shock waves by a

rack of beef ribs seen in cross section,

A imitating the thorax. The %-inch steel

S(sphere had an impact velocity of 3,000 f.p.s. S~Note the reflection of waves (A and B) and

the origin of new wavelets in the space

between the ribs (B).
MECHANISM OF WOUNDING 215

A B

FIGURE 124.-Shadow grams of a beef femur and a steel bar almost completely immersed in water. The top of each has been struck by a }

1

8-inch steel

sphere moving 3,000 f.p.s. Note that the shock waves within the steel bar

have passed into the water but that no such waves pass out of the bone. A.

Shadowgram (S 129) of beef femur. B. Shadowgram (P 128) of steel bar.

ribs (seen in cross section.) tied together so as to represent the skeleton of the

thoracic wall. Reflection from each bone is clearly apparent, as well as the

secondary wavelets formed when a shock wave moves through the opening

between ribs.

Shock waves do not appear to pass into water when a bone is hit directly

by a high-velocity missile. Figure 124A is part of a beef femur whose upper

end has been struck. No waves are visible moving from the bone to water,

as appear when a bar of steel, shown in figure 124B, is substituted for the bone.

Tourmaline crystal pressure records of four shock waves in the abdomen

of a cat are reproduced in figure 125. It will be observed that these records

differ from a shock wave in water in that the descending limb of the pressure

peak is steep and the shock waves themselves are often multiple. In all

these records, the pressures stop abruptly at a certain point. This is an

artifact due to blocking of the piezoelectric amplifiers by the surge of current

through the microsecond X-ray apparatus used to record conditions within

the abdomen at the time the pressure record is made. Such a microsecond

roentgenogram is reproduced in figure 126.
216 WOUND BALLISTICS

muE.ENu Niuu immrE

- - immdm ELm~i mmmmmmm-i

m=0m on

iMmFGRE" -Fur rord kave " •pressures(crystalinstmah f f

in (at33),m71pond per square inchim

FIGUR•E 125.-Micosr econds rofgesgamofk thve abdomuen ofacaytali showinghe crystalu

prfessren gage inpsiton, takenourin thepassage a oft 3

6 1 -inch steel sphere (atvinght withf~~

sTrikeing veklociyol380efps. The tertigger dvscreen fo th X-ray surge is at3 londeft Notae tnhe

larg tempoa ry cavity whic s han eprsq anded aron d h aiu ufthfle.toah h

peu r

FIGsURE 15 recordfrthsig u eis ofeprodck inrfig aed ure s (2crytli.tmah rmfu
MECHANISM OF WOUNDING 217

c a

FIGURE 127.-Spark shadowgram (P 199) of a shock wave complex from a %l-inch

steel sphere which has struck the water surface with a velocity of 3,800 f.p.s, and moved

through a gas-filled segment of the colon of a cat. Two other gas-filled segments of the

intestines of a cat are to right and left. Capital letters indicate the origin of waves and

small letters the wave front. Depending upon the position of the crystal, various types of

pressure record would be obtained.

It will be noted from figure 125 that the first pressure pulse of a series

may not be so high as the succeeding pulses. This can be explained in part

by the reflection of shock waves in the abdomen and in part by the presence

of gas pockets in the alimentary tract. Whenever a missile perforates a gas

pocket and enters tissue on the opposite side, a new shock wave will be generated. Since the new wave is nearer the crystal, its peak will be higher than

the original one started at the body wall. It is not possible, therefore, to

present a typical record of shock waves in the abdomen, since so much depends

upon reflection and distribution of gas in any particular case.

The manner in which a series of shock waves could appear within the

abdomen is illustrated in the spark shadowgram of figure 127, which shows

three loops of a cat's colon, each containing an air pocket, suspended in

Ringer's solution in the form of a triangle. A shot was fired through one

loop of colon and shock wave A-a was formed at the liquid surface. This

wave was reflected from each of the other loops of colon and shock waves

B-b and C-c were formed. When the shot had passed the gas mass and
218 WOUND BALLISTICS

lmumummwpm~nmuuuumummuununl

limmmmmmmmmmmmmmmm

FIGURF 128.-A crystal record of pressure changes in the stomach of a cat when the

thigh is shot with a 816-inch steel sphere moving 3,800 f.p.s. Time in 100 kilocycles.

hit the further side of the middle piece of colon, another large shock wave

was formed, D-d. If a crystal had been placed at X, it would have recorded

a medium, followed by a weak and then a strong shock wave, giving a multiple

record somewhat like that of figure 125.

When the crystal is in the stomach and the animal is shot through the

thigh, about 14 cm. from the crystal, the type of pressure record shown in

figure 128 is obtained. There results a jumble of small pressure peaks about

5 microseconds apart and of an intensity of about 10 to 20 pounds per square

inch. The pressure record is very similar to what might be expected from the

appearance of the shock shadowgram shown in figure 119B.

The relatively slow pressure changes in the cat's abdomen, recorded from

a crystal gage in the stomach, are reproduced in figure 129. The timing is in

milliseconds. The first peaks mark the shock wave, whose pressure is so

great as to rise completely off the record. From measurements of the highspeed motion picture of the shot, taken simultaneously with the pressure

record and reproduced in figure 130, it is found that the second maximum

pressure corresponds to the collapse of the temporary cavity. The subatmospheric pressure between the shock wave and the second pressure peak corresponds to the maximum of the temporary cavity, visible as two prominent

bulges, as shown in frames 3 and 11.

After the large temporary cavity collapses, microsecond roentgenograms

show no second expansion, such as occurs after a shot into a tank of water.

Although the motion picture of the cat's abdomen does show indications of

new wrinkled bulges on each side of the abdomen, these second bulges merge

with the subsequent distortion of the abdomen. The two small pressure

oscillations in the pressure record appear to have no counterpart in the external

movements of the abdomen, visible in the motion picture. The pressure

record is, in fact, quite flat during the long period of wavelike abdominal

movements.

In the respect just mentioned, a shot into the body differs from a shot

into water in a tank, where pulsations of the gas making up the temporary
MECHANISM OF WOUNDING 219

Is "amummuuuummumummmfl

rwwwnwnn mmwim muu

FIGURE 129.-A crystal record of pressure changes in the abdomen of a cat shot with a

V16-inch steel sphere moving 3,000 f.p.s. The time curve is 1000 cycles, and the vertical

pressure divisions are 13.1 pounds per square inch. The shock wave at left moves off the

screen and is indicated by the line of white ink. There follows a subatmospheric-pressure

period which corresponds to the expansion of the temporary cavity and then a pressure

peak (3.5 milliseconds after the shock wave) that is represented by frame 11 of figure 130.

The later pressure oscillations are believed to be due to pulsation of gas pockets in the

intestines. (24 Jan. 1946, cat 364.)

cavity is a striking phenomenon and the pressure changes during these pulsations are found to agree exactly with the expansion (decreased pressure) and

contraction (increased pressure) of the cavity, illustrated in figure 60.

It is very probable that the opening made by the shot in the body wall

closes almost immediately, so that little air can rush in behind the missile.

In an animal, therefore, the initial large temporary cavity may be considered

as almost entirely filled with water vapor. When the cavity collapses, only

small pockets of gas are left, comparable in volume and scarcely distinguishable

from the gas pockets already present in the intestine. In the pressure record

of figure 129, the pulsation of these gas pockets is represented by the small

pressure oscillations, spaced 2 to 3 milliseconds apart. They are quite comparable to the pulsation observed in small submerged balloons when a sphere

is shot into a tank of water.

Small balloons, filled with air and suspended in a tank of water, are instructive for visualizing pressure changes around the temporary cavity resulting

from a shot into the tank (fig. 131). As can be seen, the balloons are at first

contracted by the high pressure of the shock wave, but very quickly they expand

to a large size, as a result of the decreased pressure during expansion of the

cavity. In addition to the expansion and contraction of the balloons, synchro-
220 WOUND BALLISTICS

0 10 20 30 40 50 60

2Lo

Ai . j

FIGURE :.ra ( per son fo a h spe mtn iu ot:e

ad eoactsvdh l ls 1 inc as .

ha efro t f .Fs of th m t

cor UREsod t3the-Firstmpessure36 peakatr theod shock wavhghse e moinptre fh

aboe at o hve n are it lcklns nhapr.A {-nc telshr

hspR:7 ae h boe rn h et rme3i hto h aiu eprr

caiy n cresodst temaiumsbamspe rsueo ic iur 2.Fae1

coresond frstprssue tth eakaf h Er so4 ae
MECHANISM OF WOUNDING 221

FIGURE 131.-Frames (2,160 per second)

7' , •from a motion picture (166) of a h/8-inch

steel sphere (impact velocity 3,000 f.p.s.)

striking the surface of water (at top of each 4. frame) in which are suspended small rubber

balloons. The development of the tempo2 rary cavity is well shown. Pressure changes

6 in the water are indicated by contraction

and expansion of the balloons. The vertical dots on left are 5 cm. apart.

f3

nized with the volume changes of the cavity, they also pulsate with their own

period (about 500 a second), and in this respect they serve as models for the

behavior of small gas pockets in the body.

The importance of gas pockets in tissues in relation to pressure changes

has been emphasized in the foregoing discussion. That these gas pockets are

important in wounding can be determined by suspending in Ringer's solution

small masses of tissue, with and without gas pockets, and then shooting into

the solution near the tissue masses. Excised hearts of frogs have been used to

investigate the mechanism of wounding by this method.

When isolated frog hearts containing no gas are fixed in position in a tank

of Ringer's solution, it has been determined that damage from a shot into the

solution occurs only when the hearts are rapidly stretched on their moorings by

the expansion of the temporary cavity. They suffer no damage from shock

waves beyond the boundary of the temporary cavity. The arrangement of

such an experiment is illustrated in figure 132. Only the hearts engulfed by

the cavity, or greatly stretched by it, were damaged.

In order to eliminate the cavity formation, a piece of armorplate was

placed on the water surface and struck by a very high velocity missile. By

this method, shock waves of great intensity can be produced, but only a minute

cavity forms underneath the armorplate. Water movement is thereby reduced

to a minimum. It was found that these high-intensity shock waves did not
222 WOUND BALLISTICS

affect frog hearts suspended underneath. However, if gas has first been injected

into a heart, as in A and F of figure 133, the sudden expansion of this gas from

negative pressures in the water around the minute cavity was found to cause

damage. The A heart (near the small cavity) was seriously injured, while the

F heart (farther away) suffered no severe damage.

These, and other similar experiments, indicate that it is the subatmospheric pressure around the temporary cavity, recorded in the crystal records of

figures 60 and 129, that causes the damage and that this damage results from

the expansion of gas pockets rather than from the high pressures connected with

the shock wave. Damage by gas expansion may be spoken of as secondary

damage, whereas damage from expansion of the temporary cavity itself is primary damage. In both cases, the destructive effects are due to severe tearing

of tissue.

A striking demonstration of gas effects is illustrated in figure 134 which

shows a loop of cat intestine, with an air bubble within the right end, suspended

FIGURE 132-Frames (2,400 per second)

from a motion picture (168) of six frog hearts

tied to two vertical strings in a tank of

Ringer's solution. The surface of the water

is at the top edge of each frame. A >(-inch 3 1]

steel sphere, with impact velocity of 3,100

f.p.s., penetrated the solution between the

vertical rows of hearts, and the development 7 ýW

of the temporary cavity is clearly seen. The 4I4 12 20

effect on the hearts is described in the text.

The vertical dots on left are 5 cm. apart. The b

circle in upper left is a mirror reflection of a

sodium lamp flashing 120 times a second.

-JL
MECHANISM OF WOUNDING 223

0 - 6" ' : 12:

"7 FicURE 133-Frames (above 2,000 per ... second) from a motion picture (SW 5) of six 9 frog hearts tied to horizontal strings (invisiSble) below a sheet of armorplate which has

been struck (without perforation) by a 1⁄2-

2 8 • 14 inch steel sphere moving about 4,000 f.p.s.

... A small cavity appears under the plate in

• frames I to 6. The upper left (A) and lower

Sright (F) hearts contain air, and the expan3 9 15 sion of the air in the upper left heart is

clearly visible. The effect on the hearts is

described in the text. The horizontal lines

at left are 5 cm. apart. A circular mirror

in lower middle of each frame reflects a

4 7 1 16 sodium lamp flashing 120 times a second.

in a tank of Ringer's solution. When a shot is fired through the ring of intestine, the gas bubble at the right can be seen to first contract and then expand

markedly. When the intestine was later examined, the mucosa and submucosa

were found to have been perforated in the gas-containing region, although the

muscularis layer was intact. Such effects are exactly comparable to damage

to the human body from underwater blast. This damage is restricted to gas

pockets in the alimentary canal, leading to intestinal perforation, or to gas in

the lungs, where severe hemorrhage occurs. Although secondary damage

from gas is important in rifle shots, it never equals the primary damage which

results from the expansion and tearing caused by the formation of the temporary cavity.

RETARDATION OF MISSILES BY SOFT TISSUE AND

TISSUELIKE SUBSTANCES

The slowing down or retardation of a missile as it traverses tissue is an

important factor in determining how and where the missile delivers its energy

to the tissue. In order to understand the mechanism of wounding, it is essential to know the law of force which retards the missile. Here, the studies of

retardation in water and in 20 percent gelatin gel are very helpful. It has
224 WOUND BALLISTICS

t to o iol f lO

0 18 Fi.URE 134.-Frames (2,280 per second)

from a motion picture (173) of a loop of

cat colon with an air pocket in the right

end, suspended in a tank of Ringer's solution. A %{-inch steel sphere with a velocity of 3,100 f.p.s. entered the water and

passed through the center of the loop of

colon without hitting it. The large temporary cavity can be seen to expand and

4 12 0 touch the colon. Note especially the slight

constriction of the air pocket in frame I

and its expansion in frames 2 to 5. The

2 distance between horizontal lines at left is

5 cm.; the timing mirror is also at left in

6: 1.. 22

been found that the retardation, dV/dt, is proportional to the square of the

missile's velocity, V. This is usually written dV/dt= -a V2. a is called the

retardation coefficient, V is the instantaneous velocity of the missile, and T

the time. The retardation of the missile at high velocities is produced almost

entirely by the inertia of the water and gel which was originally in the missile's

path and which is forced aside. Since the inertia depends only on the density,

it is to be expected that soft tissues, gelatin, and water will behave in nearly

the same manner. This proves to be the case-all three offering a resistance

to the missile which is proportional to the square of the missile's velocity.

The retardation coefficient of a )•-inch steel sphere in water, gelatin gel,

and muscle has been measured and is as follows:

Water ------------- 0. 091 cm.-

20 percent gelatin gel (24°C.) -----------------. 106 cm.-I

Cat muscle (living) -------------------------- 136 cm.- 1
MECHANISM OF WOUNDING 225

Living cat muscle, therefore, is only 50 percent more retarding than water and

only 28 percent more retarding than gelatin gel.

These retardation coefficients for missiles were calculated from the loss of

velocity which a sphere experienced in going through the thigh of a deeply

anesthetized cat. The length of the missile track was also used in the calculation. The retardation coefficients in water and gelatin gel were calculated

from the position-time relationship as measured from the high-speed motion

pictures. The retardation coefficient, a, is equal to • A CD where A is the

projection area, M the mass, p the density of the medium, and CD the drag

coefficient. The measured values of CD for these three substances were : Tissue,

0.45; 20 percent gelatin gel at 24' C., 0. 35; and water, 0. 30.

A sphere or nontumbling fragment loses its energy rapidly in traversing

soft tissues and waterlike substances. The energy, E, falls off exponentially

with penetration distance, s, as follows: E=Eoe- 2as. A )/-inch steel sphere

loses half its impact energy after penetrating 2.22 cm. of muscle and nine-tenths

of its energy after penetrating 8.3 centimeters. A Y16-inch sphere will lose

these same percentages of energy in just half these distances, while a X-inch

sphere will require twice the distance.

In the case of high-velocity missiles, certain characteristics of the explosive

or temporary cavity are related to the energy dissipated by the missile. It is

possible, therefore, to determine how and where the missile lost its energy

simply by inspecting a microsecond roentgenogram of the temporary cavity.

It turns out that the diameter of the temporary cavity, D (measured perpendicular to the missile path) is proportional to the square root of the space rate

of energy change or D= (8 k a E/7r), where k is a constant having an experimentally measured value of 8.92 X 10- cm. i/erg for water and 0.80 X 10- cm.i/

erg for living muscle of a cat thigh.

This decrease in energy is clearly observable in a cavity produced in water

by its decrease in diameter as the missile is slowed down (fig. 135). This is

also shown in figure 75, where a cavity in the thigh can be seen to be wide near

entrance and narrow near exit.

The rate at which energy is lost and the cavity diameter also increase

with the ratio AIM, which is the ratio of projection area to mass of the missile.

This signifies that a missile of large projection area and small mass will lose

energy rapidly and will produce a wide, but short cavity. When two spheres

of different masses having the same projection area and velocity are allowed to

enter the water, the light sphere loses energy rapidly, producing a short, but

wide cavity. This is shown in figure 136 (S25, S59) where the dissipation of

energy by an aluminum (left) and a steel (right) sphere is contrasted.

When a fragment is shot, tumbling of the fragment changes the projection

area, and this change is reflected in the shape of the cavity. Several cavities,

formed by tumbling missiles, are shown in figures 56 and 137. This phenomenon is also shown in figure 88, where a cavity in the abdomen of a cat was formed

by a tumbling cylindrical fragment (a section of a wire nail).
226 WOUND BALLISTICS

FIGURE 135.-A frame from a high-speed motion picture of the cavity formed by a

steel sphere, showing that its diameter (measured perpendicular to the bullet path) falls off

as the energy of the sphere decreases. The diameter is proportional to velocity of the missile

at any instant. Water surface is at left.

The retardation suffered by small steel spheres when traversing human

skin was also measured. This was done by mounting several layers of skin

in the path of a small steel sphere and measuring the velocity before and after

impact. Figure 138 shows the skin pocket mounted in the middle of a shock

wave velocity recorder. The inclination of the lines of dashes gives the before

and after velocity of the missile. The missile is traveling from right to left.

For equivalent thicknesses, the retardation coefficient for skin was 40 percent larger than that of muscle. The velocity lost by a %-inch steel sphere

when perforating 8 cm. of skin was found to be 0.182(Vo 170)s+ 170, where

the velocity is expressed in feet per second. The 170 f.p.s. represents the

velocity required to enter the skin without penetrating it. For other missiles,

the relationship just cited may be extrapolated to give 0.30 AM-'(Vo 170)

s+170. The effect which skin exerts on certain missiles has been calculated

from this formula, and the results are as follows:

'1 6-inch sphere:

Impact velocity ---------------------------- f.p.s.__ 3, 000

Velocity lost ------------------------------- f.p.s.__ 370

Velocity loss ----------------------------- percent-- 12.3

Energy loss -------------------------------- do. 24. 6

'%-inch sphere:

Impact velocity ---------------------------- f.p.s.__ 3, 000

Velocity lost ------------------------------- f.p.s.-- 235

Velocity loss_ --------------------------- percent-- 7. 8

Energy loss -------------------------------- do---- 15. 6

.30-06 bullet:

Impact velocity ---------------------------- f.p.s.__ 3,000

Velocity lost ------------------------------- f.p.s.__ 175

Velocity loss ----------------------------- percent-- 5. 8

Energy loss -------------------------------- do 11.6
MECHANISM OF WOUNDING 227

FIcURE 136-Spark shadowgraphs of cavities formed by an aluminum sphere and a

steel sphere. Both were traveling with velocities of about 3,000 f.p.s. Note the short,

wide cavity of the aluminum sphere (A), indicating that it lost energy at a more rapid rate

than the steel sphere (B). A. Shadowgraph (S 25) of %-inch aluminum sphere. B.

Shadowgraph (S 29) of %-inch steel sphere.

PENETRATION OF MISSILES INTO SOFT TISSUE AND BONE

When wound damage to various internal organs of the body, vascular

channels, and nerves is to be considered, the question of how deeply a missile

can penetrate different types of tissues becomes a highly important one.

Various soft tissues, but more particularly bone, often overlay and serve as a

protective layer to important structures underneath. This section presents

data which have been secured regarding the problem of penetration.

The distance which a missile travels into soft tissue before being brought

to rest depends not only on its impact velocity, Vo, but also on its projection

area, A, its mass, M, and its shape factor, F. Such an inference can be drawn

from studies on penetration in a tissuelike substance as 20 percent gelatin gel.

That the law of penetration for tissue should be the same as the law for gelatin

follows from the observation that they both obey the same retardation law.

The penetration, P, into 20 percent gelatin gel at 24' C. by steel spheres

is given by P=a-c ln(Vo/74)=5.72 A-' 1n(1T/74)=59.5R ln(Vo/74) where A
228 WOUND BALLISTICS

FIGURE 137.-Spark shadowgraphs of cavities produced by tumbling cylindrical slugs.

The width of cavity indicates when they presented the largest projection area and hence

delivered the most energy to the water. A. Shadowgraph (P 10) of cavity formed by a

i'•2- by 'h 2-inch steel cylinder with an entrance velocity between 2,000 and 3,000 f.p.s. It

presented a small area just after entering but near the end of its flight seems to be turning

rapidly. B. Shadowgraph (P 90) of cavity formed by a %s6- by '% 2-inch aluminum cylinder.

C. Shadowgraph (P 11) of cavity formed by a cylinder like the one shown in A.

is the projection area in cmi., a the retardation coefficient in cm.->, M the mass

of the sphere in grams, V, the impact velocity in meters per second, and R the

radius of the sphere in centimeters. The penetration into gelatin gel of eight

aluminum spheres having the same velocity but different radii, R, is shown in

figure 139 where it is evident that spheres of larger radii penetrate a greater

distance.

The penetration of small spheres into living soft tissue was determined by

shooting into the thighs of deeply anesthetized dogs. It was assumed that

the penetration law was the same as for gelatin gel and that only the constants

which appear in the formula needed to be ascertained. The penetration formula for soft tissue was found to be:

P=a--I ln(V,/84)=4.45A-'M ln(V0 /84=46.3R ln(Vj/84).

Larger spheres having the same velocity undergo the greatest penetration.

This is shown in the roentgenogram of figure 140 where several 2'2- and %2-
MECHANISM OF WOUNDING 229

FIGURE 138.-Spark shadowgram (27 Mar. 1945) of several layers of skin just after

perforation by a %32-inch steel sphere. The missile moved from right to left. A plate with

small holes converted the shock wave to a sound wave. The inclination of these waves to

the missile path is used to measure the impact and residual velocities of the missile. Before

impact, the velocity was 3,030 f.p.s, and after, 2,805 f.p.s. Note the debris flying back from

entrance side and moving forward on exit side of skin.

inch steel spheres are shown embedded in the thigh of a dog. The spheres

had nearly the same velocity, but the lighter %2-inch spheres succeeded in

going only about two-thirds the distance of the %2-inch spheres. For spheres

having exactly the same velocity, the penetration distance is inversely proportional to their radius. For spheres having the same radius, the penetration

varies as the log of the impact velocity. This is illustrated in figure 141, where

two S2-inch spheres having impact velocities at 2,400 and 1,220 f.p.s. are

shown imbedded in butcher meat. The faster ball is further advanced in the

tissue.

When missiles other than spheres are considered, it is necessary to distinguish between a tumbling and a nontumbling missile. In a tumbling missile

or fragment, the projection area may undergo considerable change in magnitude

during flight, and the penetration of the same shaped fragment may vary

considerably for different shots. For nontumbling fragments in soft tissue, it

is supposed that the formula for penetration would be P=6.67FMIA-' ln(V0 /

V,), where F is a shape factor (one for a sphere) and V, is a constant, which

probably does not differ much from the one for a sphere having an equivalent

projection area. In figure 142 is shown a fragment which has traveled broad-
230 WOUND BALLISTICS

FIGURE 139. Photograph of tank filled

* • with 20 percent geb•tin gel, showing the

comparative penetration of varying size

Sspheres and .22 caliber long and short bul- ': • lets. The spheres were aluminum and had 8/•2•,! %2-, }•2-, and 3/•"/3_-inch diameters. Their impact velocity was about 2,800 f.p.s.

22 Ca[ The largest spheres penetrate the greatest

dr •hort distance. Scale in centimeters.

I % GeL

side and has been stopped after traversing only 6.1 era. of a cat's .•bdolnen.

A sphere of the same mass, or the same fragment traveling end on, would have

passed entirely through the abdomen without any difficulty. It is apparent

that missiles other than spheres or spin stabilized bullets will have a considerable range of penetration distances, depending on their behavior during flight.

Spongy bone opposes the motion of a spherical missile with a force which

acts in a different way from the one for soft tissues. In soft tissues, the force

is proportional to the square of the velocity, while in bone the force is independent of the velocity. When the end of a beef femur was cut and spherical

missiles shot into the spongy bone, it was found that the penetration was given

by P--8.15-sR2 (Vo-200)•, where R is the radius of the sphere in inches, Vo the

impact velocity in feet per second, and P the penetration in inches. The penetration is greatest for large spheres and increases with the square of the radius.

The soft spongy bone of the femur stops missiles more readily than soft. tissue.

A }a/2-ineh steel sphere traveling with a velocity of 2,000 f.p.s, in tissue will

penetrate 23.3 em., while the same sphere in bone will travel only 2.65 em.

before being stopped. It may be assumed that the penetration into bony

tissues harder than those found in the femur will be correspondingly smaller.

The spongy bone of the femur was used in these tests, because it afforded "• 4/ large mass of fairly uniform bony material. Figure 143 shows three /32-meh

spheres that have penetrated different distances into the end of a beef femur.

The bone was sawed along a plane parallel to the axis to give a flat plane of

entry. The sphere of highest ve!oeity penetrated the greatest distance.
MECHANISM OF WOUNDING 231

FIGURE 140.-Roentgenogram (No. 124)

of the left thigh of a dog, showing the greater penetration of two 32 -inch steel spheres

in contrast to that of three Y12-inch steel

spheres. The spheres entered the lateral

surface with a velocity of about 1,190 f.p.s.

The pins indicate the entrance holes for two

of the shots.

FIGURE 141.-Roentgenogram (No. 119) showing butcher meat penetrated by two

5%2-inch steel spheres of different velocities. The faster sphere (velocity 2,400 f.p.s ) travels

further than the slower one (velocity 1,220 f.p.s.). The spheres entered the meat at the

left, and the nails at the bottom are 5 cm. apart.

CASUALTIES IN RELATION TO MISSILE MASS AND

VELOCITY

An investigation was made to determine the mass and velocity relationship for a missile which is just, capable of producing a casualty. The type of

casualty chosen was that which would result when a certain vulnerable region

in the body was pierced by the missile.
232 WOUND BALLISTICS

FIGURE 142.-Roentgenogram

(No. 324) of a fragment (to right of

vertebral column) which has penetrated about 6.1 cm. into the abdomen of a cat. It traveled with its

largest projection area foremost

(broadside). A sphere of the same

mass would have passed completely

through the abdomen. The fragment (from a 75 mm. shell) weighed

S\ 0.345 grams and entered from the

left with an impact velocity of from

2,000 to 3,000 feet per second.

The total projection area of an erect man and the projection area of the

vulnerable region in the body was measured by using anatomic drawings of

body sections. The vulnerable regions included the organs, cavities, canals,

and those nerves and blood vessels which have a diameter greater than 0.25

centimeter. The total projection area from the anterior aspect was 5.3 square

feet, and the vulnerable projection area was 43 percent of this. Hands and

feet were not included in the survey.

The thickness of the protective layer, made up of skin, bone, and soft

tissue, was measured for each section of the vulnerable region. The average

thickness of bone and soft tissue on the front and back of the body was 0.6 cm.

and 3.3 cm., respectively. The vulnerable region was found to be better protected by soft tissue and bone from missiles coming from the rear than from

those coming from directly in front.

The data on velocity losses in living cat muscles and in fresh human skin

were used, in conjunction with penetration measurements on spongy beef bone,

to calculate the minimum energy required to perforate the protective layer and

pierce the vulnerable region. The calculation was made for Y6-, }K8-, and %-inch

steel spheres. These perforation energies for the %-inch sphere varied from

2 to 216 ft.-lb. and depended on the composition and thickness of the protective layer immediately above the region being considered.

The probability that a hit by a given missile will result in a casualty was

determined from the ratio of vulnerable projection area to total projection

area, where the vulnerable projection area is a projection of those vulnerable

regions which the missile is capable of piercing. This probability for any one

missile was observed to rise rapidly with the missile's energy and velocity as

soon as the threshold energy and velocity were attained. After passing an

optimum energy, the probability of wounding increased at a smaller rate until

a maximum was reached. This optimum energy was chosen as an index of

the energy required of the missile in order to produce the type wound being
MECHANISM OF WOUNDING 233

considered. The average optimum energy for %2-, %32-, and %2-inch steel

spheres, when calculated for missiles striking a man from directly in front or

directly behind, was 15 foot-pounds. The average probability of wounding

which this optimum energy gave was 60 percent of the maximum possible

probability or was 0.25 in absolute units.

It was pointed out that the relationship between the mass and velocity

of all missiles which produce a casualty of a given type depends on two factors:

(1) The severity of the wound which causes this casualty, and (2) the probability

that a hit on the body will produce such a wound. In the present analysis, it

has been assumed that there is a large group of wounds which have the same

severity and the probability of the occurrence of such wounds has been evaluated; the resulting relationship 'between the mass and velocity which was

evaluated was too complex to present in any other way except pictorially.

The mass-velocity data showed that the energy necessary to wound a man

increases as the mass of the missile is increased. This is true for the optimum

energies and for those energies which give probabilities of wounding equal to

25, 50, and 75 percent of the maximum probability. This increase in energy

with mass is shown to be generally true for any analysis in which penetration

plays the predominant role.

FIGURE 143.-Roentgenogram (31 Jan. 1945) showing %2-inch steel spheres that have

penetrated various depths into the spongy end of a beef femur. The impact velocities of

these spheres were 1,670, 2,790, and 3,110 f.p.s., the fastest one having penetrated the greatest

distance. The spheres entered the upper flat surface. The shaft, of the bone is represented

in cross section by the dark circular area.

603225- 62 17
234 WOUND BALLISTICS

BIBLIOGRAPHY

Beyer, H. G.: Observations on the Effects Produced by the 6 mm. Rifle Projectile. An Experimental Study. J. Boston Soc. M. Sc. 3: 117-136, 1898-99.

Bowlby, A.: The Bradshaw Lecture on Wounds in War. Brit. M. J. 2: 913-921, 1915.

Lancet 2: 1385-1398, 1915. J. Roy. Army M. Corps 26: 125-152, 1916. Brit. J. Surg.

3: 451-474, 1916.

Breden, N. P., d'Abreu, A. L., and King, D. P.: Sudden Compression Injuries of the Abdomen

at Sea. Brit. M.J. 1: 144-146, 1942.

Butler, E. G., Puckett, W. 0., Harvey, E. N., and McMillen, J. H.: Experiments on Head

Wounding by High Velocity Missiles. J. Neurosurg. 2: 358-363, 1945.

Clark, S. L.: Blast Injury. Quart. Bull. Northwestern Univ. M. School 18: 81-90, 1944.

and Ward, J. W.: The Effects of Rapid Compression Waves on Animals Submerged

in Water. Surg., Gynec. & Obst. 77: 403-412, 1943.

Corey, E. L.: An Experimental Study of Underwater Concussion. U.S. Nav. M. Bull. 41:

339-352, 1943.

Daniel, R. A., Jr.: Bullet Wounds of the Lungs; Experimental Study. Surgery 15: 774-782,

1944.

Friedell, M. T., and Ecklund, A. M.: Experimental Immersion Blast Injury; Preliminary

Report. U.S. Nav. M. Bull. 41: 353-363, 1943.

Gage, E. Lyle: Immersion Blast Injury; Clinical Experiences. U.S. Nay. M. Bull. 44: 225,

1943.

Harvey, E. N., Butler, E. G., McMillen, J. H., and Puckett, W. 0.: Mechanism of Wounding.

War Med. 8: 91-104, 1945.

- Korr, J. M., Oster, G., and McMillen, J. H.: Secondary Damage in Wounding Due to

Pressure Changes Accompanying the Passage of High Velocity Missiles. Surgery 21:

218-239, 1947.

- and McMillen, J. H.: An Experimental Study of Shock Waves Resulting From the

Impact of High Velocity Missiles on Animal Tissues. J. Exper. Med. 85: 321-328,

1947.

- Whiteley, A. H., Grundfest, H., and McMillen, J. H.: Piezoelectric Crystal Measurements of Pressure Changes in the Abdomen of Deeply Anaesthetized Animals During

the Passage of High-Velocity Missiles. Mil. Surgeon 98: 509-528, 1946.

Horsley, V.: Gunshot Wounds of the Head. Brit. M. J. 1: 321-323, 1915.

Journee, Colonel of Infantry: Rapport Entre la Force Vive des Balles et la Gravit6 des Blessures. Qu'elles Peuvent Causer. Revue d'Artillerie 70: 81-120, 1907.

Livingston, W. K., Davis, E. W., and Livingston, K. E.: "Delayed Recovery" in Peripheral

Nerve Lesions Caused by High Velocity Projectile Wounding. J. Neurosurg. 2: 170-

179, 1945.

Makins, George Henry: On Gunshot Injuries of the Blood Vessels. Bristol: John Wright

and Sons, Ltd. 1916, pp. 1-121.

Masima, M., and Sasaki, S.: Effects des Balles de sur les Mati6ries Plastiques. Memorial

de l'artilleries Francaise 11: 563-571, 1932.

McMillen, J. H.: Shock Wave Pressures in Water Produced by Impact of Small Spheres.

Physical Rev. 68: 198-209, 1945. [New series.]

and Harvey, E. N.: A Spark Shadowgraphic Study of Body Waves in Water. J.

Applied Physics 17: 541-555, 1946.

McMullin, J. J. A., Greaves, F. J., Draeger, R. H., Brines, 0. A., and Shaver, J. S.: Symposium on Immersion Blast Injuries. U.S. Nav. M. Bull. 41: 1-32, 1943.

Powell, E. Baden: Killing Power. Washington: National Rifle Association, 1944.
MECHANISM OF WOUNDING 235

Puckett, W. 0.: The Wounding Effect of Small High-Velocity Fragments as Revealed by

High-Speed Radiography. J. Elisha Mitchell Sc. Soc. 62: 59-64, 1946.

McElroy, W. D., and Harvey E. N.: Studies on Wounds of the Abdomen and Thorax

Produced by High Velocity Missiles. Mil. Surgeon 98: 427-439, 1946.

-Grundfest, H., McElroy, W. D., and McMillen, J. H.: Damage to Peripheral Nerves

by High Velocity Missiles Without a Direct Hit. J. Neurosurg. 3: 294-305, 1946.

Seddon, H. J.: Three Types of Nerve Injuries. Brain 66: 238-283, 1943.

Webster, J. E., and Gurdjian, E. S.: Acute Physiological Effects of Gunshot and Other

Penetrating Wounds of the Brain. J. Neurophysiol. 6: 255-262, 1943.

Williams, E. R. P.: Blast Effects in Warfare. Brit. J. Surg. 30: 38-49, 1942.

Woodruff, C. E.: The Causes of the Explosive Effect of Modern Small-Caliber Bullets.

New York M. J. 67: 593-601, 1898.

Yaguda, A.: Pathology of Immersion Blast Injury. U.S. Nay. M. Bull. 44: 232-240, 1945.
CHAPTER IV

Casualty Survey-New Georgia and Burma

Campaigns

James E. T. Hopkins, M.D.

NEW GEORGIA CAMPAIGN

1ST BATTALION, 148TH INFANTRY, 37TH DIVISION

The material in this chapter is based on an attempt to survey and analyze

the circumstances related to the production of battle casualties in three infantry

battalions in combat, as follows:

The 1st Battalion, 148th Infantry, 37th Division, in the New Georgia

campaign.

The 1st and 3d Battalions, 5307th Composite Unit (Provisional), in the

Burma campaign.'

Materials and Methods

The same method of collecting data was followed in the New Georgia and

Burma campaigns. Information on the circumstances in which the casualties

occurred was obtained by questioning the surviving casualties; their friends and

the friends of those killed in action; platoon leaders; company commanders;

and medical officers. It should be emphasized that both the surviving casualties and those questioned concerning them and concerning the casualties

killed in action were usually known to the writer of this chapter: in this type

of warfare, officers and men lived in close association with each other. The

opinions expressed are the writer's own, and many of them are no more than

presumptions, especially as they concern comments that are strictly military.

I The author of this chapter, Dr. James E. T. Hopkins, a captain in the U. S. Army Medical Corps during World War

11, served for 18 days of combat on New Georgia Island in 1943 as assistant battalion surgeon with the lst Battalion, 148th

Infantry, 37th Division. lHe also served as combat team surgeon and later as battalion surgeon for the 3d Battalion of the

6307th Composite Unit (Provisional) in Burma in 1944 ("Merrill's Marauders"). i

After only a few days of combat experience, Captain Hopkins was deeply impressed by the many casualties among

U.S. troops which apparently resulted from carelessness. He was also impressed by the fact that a considerable number of

casualties killed in action died from head and chest wounds in which the missiles entered from the front or from the side of

the body. These observations led him to considei seriously the possibility of the use of body armor for the protection of

vital areas of the body (p. 275).

During his time in combat, therefore, Captain Hopkins collected all possible data on combat casualties in order to

demonstrate how combat losses could be reduced. The results of his studies were compiled with the help and encouragement of Col. (later Brig. Gen.) George R. Callender, MC, of the U.S. Army Medical Center and Chairman of the Missile

Casualties (Wound Ballistics) Committee; Brig. Gen. Albert G. Love, of the Historical Division, Office of the Surgeon

General; and Col. Michael E. DeBakey, MC, of the Surgical Consultants Division of the same office.-. C. B.

237
238 WOUND BALLISTICS

On the other hand, all of the opinions expressed are based on a genuine effort

to secure the precise facts. The writer secured much information on the

battlefield, where he often acted as an aidman, and from close association with

company commanders during actual fighting and with others in a position to

know the facts.

The following data were obtained whenever this was possible:

1. The name of the casualty, with his rank, serial number, and unit.

2. The type of action; the type of terrain with available cover, and the

duty of the casualty.

3. The weather conditions and the time of day.

4. The anatomic location of the wound and the degree of severity.

5. The type of causative agent and the approximate range.

6. The treatment received.

7. The classification of the casualty as to type and eventual disposition.

8. The classification of the casualty as to the possible avoidability of his

injury. That is, an attempt was made to determine whether the injury might

have been avoided by a more appropriate order from his officer, or by a better

planned action on his own part, or for any other reason.

From the standpoint of type of casualty and eventual disposition, the

following classification was used:

1. KIA (killed in action).-Those found dead or who died up to 30 minutes

after being found.

2. DOW (died of wounds).-Those wounded casualties who reached a

medical installation and survived more than 30 minutes and those who received

treatment from a medical officer before death.

3. WIA (wounded in action).-Casualties wounded in action in New

Georgia and in Burma were classified into four categories:

a.-Those returned to duty from the battalion aid station. Because

of the terrain in New Georgia and the tactical nature of fighting in the jungle,

wounded men were often retained in, and sent back to duty from, the battalion

aid station, who, under more favorable circumstances, would have been evacuated for treatment. This was also true in the Burma campaign.

b.-Those returned to duty from a medical facility, within 1 month of

wounding.2 In New Georgia, there were no field, portable, or evacuation hospitals and no surgical teams, and the chain of evacuation was from the battalion aid station, usually through a collecting company, to a station hospital,

in which urgent surgery was performed.

In Burma, during the first half of the campaign, casualties were evacuated

by Piper Cub to the 20th General Hospital for initial wound surgery, which

they frequently did not receive for 24 hours. During the second half of the

campaign, the 42d Portable Hospital was flown in and operated in close proximity to the battalion aid station. After emergency treatment, the majority of

these men were evacuated to the 20th General Hospital. Smaller numbers

were evacuated to the 14th Evacuation Hospital and the 111th Station Hospital.

2 For convenience of discussion hereafter termed "first echelon hospital."
CASUALTY SURVEY, NEW GEORGIA-BURMA 239

c.-Those returned to duty from a medical facility within 4 months

of wounding.3 On New Georgia, those men who did not require urgent surgery

or who, for various reasons, were not operated on in a first echelon hospital,

were evacuated by LST's to a station hospital in Guadalcanal, which they

usually reached within 24 to 36 hours. Some casualties were also evacuated

to the station hospital in New Caledonia. The nearest general hospital was

in the Fiji Islands.

d.-Those evacuated to the United States, after spending more than

4 months in hospital.

Geography and Climate

The New Georgia group of islands, which lie approximately 250 miles

northwest of Guadalcanal, are chiefly made up of coral except for Kolombangara and Rendova, which are of volcanic origin. These islands, which

are not so rugged and mountainous as the islands of the Guadalcanal group,

are covered with tbick jungle made up of large trees; tall, leafy jungle plants;

and tangled vines and roots. Although the jungle growth is thick, it offers

little actual obstruction for even men or machines. In many instances, bulldozers were able to weave around the larger trees and advance as much as a

mile a day through the growth.

The casualties included in this study all took place on New Georgia

Island between 18 July and 5 August 1943, inclusive. Even though this is a

coral island, many areas are extremely marshy, and in the section about the

Munda airfield very little coral is visible. The majority of the foxholes were

dug in the red clay which made up the topsoil covering the coral.

During the period of combat, the climate was very mild, with temperatures

ranging from 70' to 90' F. The humidity was very high, but rainfall was

minimal.

Military Operation and Forces Involved

Military operation.-The New Georgia campaign, a combined military

operation, had as its main objective seizure of the Munda airfield and driving

the Japanese from New Georgia and the surrounding islands. The operation

was started on 30 June 1943 and completed by 22 September 1943, with the

occupation by U.S. troops of all important islands in the New Georgia group.

Elements of the 172d and 169th Infantry Regiments of the 43d Division

landed on New Georgia Island at Zanana Beach between 2 and 6 July to proceed to a line of departure on the Barike River. After considerable fighting,

with heavy casualties, these two regiments drove west on the Munda trail

and established a new beachhead at Liana, at which the 103d Infantry of the

43d Division was landed.

On 11 July 1943, these three regiments started an attack on the Japanese

defensive position along the coastal strip. On 18 July, the 148th and 145th

3 For convenience of discussion hereafter termed "second echelon hospital."
240 WOUND BALLISTICS

Infantry Regiments of the 37th Division landed at the Zanana and Liana

beachheads. These regiments, together with the 161st Infantry of the 25th

Division, started a coordinated attack on 25 July which ended in the seizure

of the Munda airfield on 5 August 1943.

Forces involved.-It is difficult to make an accurate estimate of the number

of men engaged in the campaign on New Georgia because of the many types of

military units involved and the various locations of the islands on which the

fighting took place. For the first 17 days of the campaign, no more than 8,000

infantrymen fought on New Georgia. By 25 July, this force had increased

to 15,000 men. The total strength of all U.S. forces involved in the New

Georgia campaign was approximately 35,000. Table 26 lists the total U.S.

casualties of the New Georgia campaign; 95 percent of these losses occurred

during the first 5 weeks.

Southwest sector.-Between 18 July and 5 August 1943, the period covered

by this survey of casualties in the 1st Battalion, the 148th Infantry operated

in the southwest sector of New Georgia Island with this battalion, the 2d

Battalion, and a regimental headquarters. The 3d Battalion operated

separately with a force of Marines on the north side of the island.

TABLE 26.-Distribution of 4,994 casualties of the New Georgia campaign, 30 June-22

September 1943, by category and division

Total casualties 25th Division 37th Division 43d Division Other

Category Officers Enlisted Officers Enlisted Officers Enlisted Officers Enlisted Enlisted

mlen men men men men

Killed in action --------- 48 924 11 120 11 179 26 436 189

Wounded in action ------ 169 3, 704 35 515 47 840 87 1,855 494

Died of wounds --------- 7 115 1 9 ------ 36 6 70

Missing in action ------- 2 21 ..... 1 ------ 5 2 15

Accidental deaths -------. ------ 4 ------ 2 ------ 2 ..... ......

Total ------------ 226 4,768 47 647 58 1,062 121 2, 376 683

The 1st and 2d Battalions of this regiment arrived at Zanana Beach on

18 July. The 2d Battalion proceeded to relieve the 43d Division command

post, which had been surrounded, and to open the supply route to the 169th

and 172d Infantry Regiments of the 43d Division. The 1st Battalion, which

arrived early in the morning, after a few minor contacts with the Japanese,

succeeded in advancing within 1 mile of the Barike River along the Munda

trail.

At 1100 hours on 19 July, when the battalion was advancing along this

trail, it came under automatic weapons fire at the Barike River; several men

were killed and several wounded. The river was not crossed until 20 July,
CASUALTY SURVEY, NEW GEORGIA-BURMA 241

when the battalion succeeded in advancing to a parachute drop where the

169th Infantry was relieved. A few casualties occurred during the day from

enemy automatic weapons fire and from friendly artillery fire.

At 0600 hours on 25 July, the battalion attacked from a line of departure

in front of O'Brien Hill on a 270' azimuth, which it was to follow until the

end of the campaign for the Munda airfield.

The 37th Division had been assigned a sector north of the north flank of

the 43d Division and had been given the primary mission of securing the high

ground commanding the Munda airfield. From right to left toward the beach

front, U.S. forces were disposed as follows:

1st and 2d Battalions, 148th Infantry Regiment.

The 161st Infantry Regiment.

2 battalions of the 145th Infantry Regiment.

The 176th Infantry Regiment.

The 103d Infantry Regiment.

This general alinement of regiments was to be maintained until the fall

of the Munda airfield on 5 August 1943.

By the afternoon of 27 July, the two battalions of the 148th Infantry had

advanced slightly beyond and to the right of O'Brien Hill and had begun to

set up a supply dump in this area. There was considerable patrol activity

during this time. On the following day, after losing five men in an ambush,

the 1st and 2d Battalions advanced 1,000 yards on the 270' azimuth to a

point overlooking Biblo Hill. Very little opposition was offered by the enemy.

One company was left to protect the supply dump, but on 29 July it was

surrounded by a superior Japanese force and all communications were severed.

Following this action, the two battalions were forced to withdraw. The 2d

Battalion, minus Companies G and E, withdrew to the 37th Division area by

traveling single file through the jungle.

The 1st Battalion, together with Companies G and E of the 2d Battalion,

fought the Japanese along the trail and about the supply dump until the

morning of 1 August, when they routed the enemy forces and again established

contact with the 161st Infantry, which had been advancing westward on

their left flank.

The action just described resulted in a large proportion of the casualties

sustained by the 148th Infantry during this campaign. For 4 days, the 1st

Battalion had no means of evacuating its wounded.

On 1 August, the regiment again began its advance to the right of the

161st Infantry. During the next 4 days, it continued in a coordinated attack

with the other regiment until it finally reached the beach approximately 1,000

yards north of the Munda airfield.

During this operation, the majority of U.S. casualties resulted from automatic weapons fire, though a considerable number were due to friendly artillery

and mortar fire. There was no enemy aerial activity during the later stages of

this campaign.

603225 -62--18
242 WOUND BALLISTICS

Casualties of 1st Battalion, 148th Infantry

U.S. troops in the southwest sector of New Georgia Island never exceeded

18,000 infantrymen. It was estimated that there were never more than 6,000

Japanese troops involved in the fighting in this sector, which was the heaviest

in the campaign.

Table 27 lists the casualties incurred by the 1st Battalion, 148th Infantry,

during the 18 days of this survey. Approximately 2,000 enemy dead were

counted during the period between 3 July and 5 August. During the 18 days

the 1st Battalion was in combat, it was estimated that they killed between

300 and 400 Japanese with small arms and mortar fire and that artillery fire

directed by officers of the rifle companies accounted for an additional 100 to

200 Japanese dead.

TABLE 27.-Distribution of 181 casualties, 1st Battalion, 148th Infantry, 18 July-5 August

1913, by category

Casualties

Category - - - - -

Number Percent

Killed in action -------------------- 35 19.3

Wounded in action:

Died of wounds --------------- 11 6. 1

Survived wounds -------------- 135 74. 6

Total ---------------------- 146 80.7

Grand total --------------- 181 100. 0

Hospitalization and evacuation.-When the 1st Battalion, 148th Infantry,

37th Division, arrived at Zanana Beach, New Georgia Island, on 18 July 1943,

one collecting company (Company B, 118tlh Medical Battalion) was serving the

elements of the 43d Division about the Munda area. For the first 5 days of the

campaign, only this company served the 1st Battalion. On 22 July, the 112th

Clearing Company moved to Liana Beach about 1 mile behind the 1st Battalion sector, but its collecting companies did not reach the battalion aid

station until 3 August, the 17th day of combat. In the meantime, some

medical care was provided by a collecting company from the 25th Division.

While no attempt will be made to discuss routes of evacuation and types

of medical care for units involved in the campaign other than the 1st Battalion,

148th Regiment, it might be added that according to a report from the Office

of the Surgeon, South Pacific Area, entitled "Medical Service, New Georgia

Campaign," the medical and surgical care provided during the greater part of

the New Georgia campaign was deficient in many respects and medical facilities
CASUALTY SURVEY, NEW GEORGIA-BURMA 243

from battalion aid levels through the hospital echelon were also often inadequate.

Most of the 1st Battalion casualties were evacuated on regimental supply

trucks or ambulance jeeps (fig. 144). During the first 5 days of combat, they

were taken from Zanana Beach to Guadalcanal by LST's, a distance of 200

miles which required from 20 to 24 hours' travel time. As a rule, no treatment

other than first aid was provided before the trip. En route, medical care for

the 100 to 200 casualties usually carried on each ship was provided by one

Navy medical officer.

SC 180136

FIGURE 144.-Medical aidmen carrying wounded man to ambulance

jeep.

After the fifth day of combat, casualties were evacuated through the

112th Clearing Company, and in many instances surgery was provided at this

level (fig. 145). Because of the 24-hour evacuation policy, however, many

casualties who had been treated inadequately took the long trip to Guadalcanal.

It was not until 28 July that the 17th Field Hospital was set up on Kokorana Island, 5 miles from the Liana beachhead. With the facilities thus

provided, the wounded from the 1st Battalion had the benefit of hospitalization

about 3 miles distant by land routes and about 5 miles by water evacuation

(fig. 146).

During the 5-day period between 28 July and 1 August, all supply lines

were cut, as already mentioned, and casualties from the Ist Battalion and from

Companies G and E of the 2d Battalion could not be evacuated from the
244 WOUND BALLISTICS

SC 186540

FIGURE 145-Members of 37th Division Clearing Company completing

a surgical procedure, New Georgia Island.

SC 180533

FIGURE 146-Wounded soldiers lying in vessel, awaiting transportation to the 17th Field Hospital.
CASUALTY SURVEY, NEW GEORGIA-BURMA 245

battalion area; a large number of them therefore received no surgical treatment

for several days.

Details of the 181 casualties sustained on New Georgia Island, as they

were related to the various tactical situations, appear in appendix A (p. 769).

BURMA CAMPAIGN

1ST AND 3D BATTALIONS, 5307TH COMPOSITE UNIT (PROVISIONAL)

Geography and Climate

Northern Burma is separated from India and China by the high mountain

ranges which make up the foothills of the Himalayas, some of which reach an

altitude of 20,000 feet. As in all of northern Burma, the jungle is very heavy

but is usually not impenetrable. The terrain is the main factor that makes

it difficult to pass through the jungle growth.

The unit reached Burma after a march up the Ledo Road (fig. 147) and

through the Pangsau Pass of the Kumon Range at 2,400 feet. They then

passed into the Hukawng Valley, a very narrow valley bordered by very hilly,

rugged, mountainous terrain. Much of the operation took place on the

razorback ridges of the hills on the eastern border of the valley.

SC 189289

FIGURE 147.-View of the Ledo Road.
,246 WOUND BALLISTICS

Practically all of the unit's operations in this area, as well as in the Mogaung

and Myitkyina Valleys, were confined to the century-old native and game

trails that are seen throughout all of northern Burma. The Hukawng Valley

is extremely flat and is covered in some areas with dense jungle growth and in

others with elephant grass. The average altitude is approximately 500 feet.

Numerous Kachin villages, with a few native inhabitants, were repeatedly

encountered throughout this area. The Mogaung Valley was approached

through difficult terrain over the Ywangabum Mountains, along the course of

the Tanai Hka River.

After its operations in this area, the unit retraced its route for perhaps 50

miles and passed over the 6,500-foot Jaupadu Burn Mountains that separate

the Mogaung Valley from the Mvitkyina Valley. This terrain was perhaps

the most rugged encountered during the North Burma campaign; in some

places, 1-mile stretches of the overgrown trails had a rise of 3,000 feet.

During February and March 1944, the days were very hot, and the temperature averaged about 80 F. The nights, however, were cool, and additional

clothing was required. There was a minimum amount of rainfall during the

entire campaign.

April was very warm during the day, and there was practically no rainfall. May was hot and humid, with almost daily showers. This was the

beginning of the monsoon season, which continued until the end of October,

but it did not materially affect operations as the majority of the troops had

left the area by the end of June.

Organization of 5307th Composite Unit (Provisional)

In September 1943, 650 men and officers, all volunteers, congregated in

New Caledonia to form a special infantry battalion. They had been selected

from the 37th, 43d, 25th, and Americal Divisions. Later, 250 additional men

and officers arrived, from the 32d and 41st Divisions and from the 98th Pack

Artillery, from Australia. Most of these men had been overseas for more than

a year and had seen action in the South Pacific or Southwest Pacific Areas.

These men made up the 3d Battalion of what was to become the 5307th

Composite Unit (Provisional). They traveled to India on a transport with a

battalion from the United States, which was to become the 1st Battalion of

this Unit, and a battalion from the Carribean area which was to become the

2d Battalion.

These three battalions, organized as an infantry regiment, trained in India

from November 1943 to January 1944. During this time, there were many

transfers of men within the battalions, and about 150 replacements arrived from

casual units. The 31st Quartermaster Pack Troop was also absorbed by the

regiment. On 1 January 1944, the three battalions were formally activated as

the 5307th Composite Unit (Provisional).

After ship and train travel, the entire regiment arrived at Ledo, Assam,
CASUALTY SURVEY, NEW GEORGIA-BURMA 247

during the first week of February 1944. Its primary mission was to spearhead

the Chinese movement into North Burma.

After a march of 125 miles up the Ledo Road, the regiment left the Chinese

in the vicinity of Nyenbien, on the Chindwin, in the third week of January

and set out on a campaign which was to carry them on foot between 700 and

1,000 miles over the mountainous and jungle terrain of northern Burma. They

were to aid the Chinese in the occupation of the Hukawng, Mogaung, and

Myitkyina Valleys. Their mission was climaxed by the capture of the Mvitkyina airfield on 17 May 1944.

Early in June 1944, most of the 1st Battalion were evacuated to various

hospitals. The few who were not were reinforced with 300 to 400 men who had

been released from hospitals in late May and early June. The reorganized battalion fought in the attack on Myitkyina during the latter part of June, during

July, and during the first 2 weeks of August. The casualties sustained after 8

June are not included in this survey.

Military Operation and Forces Involved

During the second week of February 1944, the three infantry battalions

which made up "Merrill's Marauders" entered northern Burma. After making

a wide flanking movement to the left of the Hukawng Valley, they arrived in

the vicinity of Walawbum during the first week of March. The numerous

skirmishes and several engagements which took place resulted in complete success for the U.S. troops, and the operation enabled the Chinese to occupy the

entire Hukawng Valley. Shortly after their arrival near Walawbum during the

first week of March, the regiment was relieved by Chinese troops.

During the next 3 weeks, the 1st Battalion, reinforced by a regiment of

Chinese, marched across the Aipawn Bum Mountains to engage the Japanese

at Shaduzup in the northern sector of the Mogaung Valley. This operation,

which was also very successful, enabled the Chinese divisions to enter the

upper part of the Mogaung Valley, after passing down the Japanese-built

road through the Jamba Bum Pass.

Meantime, the 2d and 3d Battalions of the regiments crossed the Wangabum Mountains to the east, where they engaged the Japanese at Inkangatawng,

about 50 miles distant and 20 miles above Kamaing. The success of this

operation enabled the Chinese troops to advance rapidly down the Mogaung

Road toward Kamaing, but because these troops failed to fulfill their assigned

mission, the 2d and 3d Battalions were forced to withdraw to the mountains

in the vicinity of Nhpum Ga, where one battalion was surrounded. The

other, with the aid of air-dropped pack artillery (fig. 148), engaged the Japanese for 9 days in a major battle to relieve the encircled troops.

After the Japanese had been routed, in the third week of April, the three

battalions of the unit assembled at the base of the Jaupadu Bum Mountains

for the Myitkyina campaign. For this campaign, two forces were organized:

(1) The 3d Battalion with the 88th Infantry Regiment (Chinese) and (2) the
248 WOUND BALLISTICS

SC 1894068

FIGURE 148.-U.S. troops and Kachin natives watching a parachute

supply drop.

1st Battalion with the 150th Infantry Regiment (Chinese). The 2d'Battalion was held in regimental reserve.

While these troops were passing through the Myitkyina Valley, two

major battles developed, both of which eventually ended in complete success

for the U.S. forces. The Myitkyina airfield was captured by the 1st Battalion and the attached Chinese regiment on 17 May 1944. Shortly afterward,

some 4,000 engineer and infantry troops were flown in.

For the greater part of the original 5307th Composite Unit (Provisional),

the campaign in the Myitkyina area lasted another 3 weeks. The town

itself did not fall for 22 months; then it was taken by Chinese forces with

the remnants of less than a battalion of the original unit.

Forces involved.-It is estimated (table 28) that a total of 8,700 U.S.

troops were involved in the Myitkyina campaign. Official, reliable figures

are not available for the size of the enemy forces or casualties, nor are reliable

figures available for Chinese casualties.

Casualties, 15 Februarv-8 June 1944

Table 28, in addition to listing the numbers of U.S. troops involved, and

the estimated numbers of Japanese and Chinese troops involved, in the North

Burma campaign during the study period from 15 February to June 1944,

also lists the casualties of the three forces. Certain of the 2d Battalion engagements are not included in this table; their casualties would total about

40 KIA and about 200 WIA. Also excluded from the table are the several

hundred casualties, KIA and WIA, sustained by the two infantry and two
CASUALTY SURVEY, NEW GEORGIA--BURMA 249

TABLE 28.-Estimated number of troops involved and casualties sustainea, Burma campaign,

15 February-8 June 1944

Troops involved Casualties sustained

Locality United Japanese, United

United Chinese Japanese States, killed in States, States killed in action wounded action in action

Walawbum-----------_- 2 700 -------- 1,000 5 850 28

Shaduzuip ------------------ 800 3,000 1,000 8 600 23

Inkangahtaung -------- - 1,200 -------- 1,000 2 350 3

Nhpun Ga, Auche, Warong

Poakum ------------ 1, 600 -------- 1,000 22 600 67

Riptong 700 3,000 200 1 185 4

Tingkrukawng 700 2,900 400 6 350 15

Myitkyina:

1st Battalion .---- 500 ..... 50-200 3 (5) 9

3d Battalion - --------- 500 -------- 200-400 6 85 15

Total ----------- 8, 700 8,900 4, 850-5, 200 53 3, 020 164

1Undetermined.

engineer battalions flown into Myitkyina after the airfield was captured by

U.S. troops.

While it was seldom possible to examine or count enemy dead, it is believed that about 3,000 Japanese were killed in North Burma. During the

same period, including the 40 casualties KIA from the 2d Battalion, almost

100 U.S. troops were killed.

Evacuation and hospitalization.-The three battalions of the 5307th

Composite Unit (Provisional) operated along separate trails for the greater

part of the campaign in Burma. Evacuation of the wounded was frequently

not possible for periods of a week or more, but the majority were evacuated

between a few hours to 10 days after wounding. During most of the major

engagements, landing strips were built on the rice paddies of the native villages, and the wounded were evacuated by aircraft. A few casualties were

put in the care of Kachins (fig. 149), who evacuated them by litter or by elephant transport.

After the capture of the Myitkyina airfield (fig. 150), casualties were

evacuated by C-46's and C-47's to hospitals in the Ledo area; namely, the

20th General Hospital, the 14th Evacuation Hospital, and the 111th Station

Hospital. During the first 3 months of the campaign, the patients were

deposited in various collecting and clearing companies along the Ledo Road,

behind the advancing Chinese troops. In many instances, they did not reach

the 20th General Hospital until several days after they had been wounded.

For the first 3 weeks of March, during the Shaduzup campaign, the 1st

Battalion had the services of a surgical team supplied by the Seagrave Unit.
250 WOUND BALLISTICS

SC 189893

FIGURE 149.-Kachins from a friendly native village leading

men of the 5307th Composite Unit (Provisional) through the

jungle.

U.S. Army photo

FIGURE 150.-Wounded soldiers awaiting evacuation, 1\yitkyina

airfield.
CASUALTY SURVEY, NEW GEORGIA-BURMA 251

After they had been treated, these casualties were picked up by a platoon from

a collecting company of the 13th Medical Battalion.

During the first 3 weeks of May, the 1st and 3d Battalions had the support

of the 42d Surgical Portable Hospital and the Seagrave Portable Hospital.

As a result, the majority of their casualties received surgery within a few

minutes (fig. 151) to a few hours after wounding.

SC 189393

FIGcURE 151.-Operating room of surgical team in field hospital.

During the march up the Ledo Road, about 70 litter patients (fig. 152) were

carried for as much as 10 miles to an airstrip 40 miles north of Myitkyina.

Aside from the variable, and sometimes inadequate, facilities for their

evacuation, the men of the 5307th Composite Unit (Provisional) received excellent surgical care.

Casualties sustained.-Table 29 lists the casualties of the 1st and 3d Battalions, 5307th Composite Unit (Provisional), during the Burma campaign for

the period 15 February to 8 June 1944, inclusive. Detailed reports of these

casualties in relation to the various tactical situations appear in appendix B for

the 1st Battalion (cases 1-61, p. 783) and in appendix C for the 3d Battalion

(cases 1-151, p. 789). Table 30 is a compilation of tables 27 and 29, comparing the casualties of the survey periods in the New Georgia and Burma

campaigns.
252) WOUND BALLISTICS

SC 189657

FiaURE 152-Litter bearers carrying wounded Chinese soldier to an

ambulance pickup point.

TABLE 29.-Distribution of 212 casualties, 1st and 3d Battalions, Burma campaign,

February-June 1944, by category

Total casualties

Category I1st Battalion 3d1 Battalion ________ ________

5 Mar.--S June 28 Feb.-21 May Number Percent

Killed in action ----------------------- 7 24 31 14. 6

Wounded in action:

Died of wounds ------------------- 8 17 25 11. 8

Survived wounds ----------------- 46 110 156 73. 6

Total ------------------------- 54 127 181 85. 4

Grand total --------------- 61 151 212 100.0
CASUALTY SURVEY, NEW GEORGIA-BURMA 253

TABLE 30.--Distribution of 393 casualties, 1st Battalion, New Georgia Island, and 1st and 3d

Battalions, 5307th Composite Unit (Provisional), Burma, by category and survey period

lst Battalion, 1st and 3d Bat- Total casualties

Category New Georgia, 18 talions, Burma,

July-5 August February-June

1943 1944 Number Percent

Killed in action ------------------ 35 31 66 16.8

Wounded in action:

Died of wounds -------------- 11 25 36 9. 2

Survived wounds ------------ 135 156 291 74.0

Total --------------------- 146 181 327 83. 2

Grand total -------------- 181 212 393 100.0

ANALYSIS OF CASUALTIES

Basic Data

The units involved in the survey described in the preceding pages included:

The 1st Battalion, 148th Infantry, 37th Division, on New Georgia Island,

18 July-5 August 1943, inclusive.

The 1st and 3d Battalions, 5307th Composite Unit (Provisional), in Burma,

15 February-8 June 1944, inclusive.

In the preceding pages, in which each of these units was considered separately, the background for the New Georgia and the Burma campaigns was

described, including the geography; the climate; the general order of battle,

including the troops involved; and the evacuation and hospitalization setup.

In the appendixes for each of these campaigns, there are provided further details

of the tactical situation as related to the number and location of the wounds

sustained and the disposition of thie WIA casualties. The military situation has

been clarified by the arrangement of all actions into tactical situations, and

each individual injury (injuries) has been described in such a way that it is possible to demonstrate what part each casualty played in the particular tactical

situation. Injuries that seemed preventable are frankly indicated.

For ease of reference, the combined figures for the two campaigns are

brought together here. They consist of:

369 casualties, exclusive of 23 casualties carded for record only (CRO)

and 1 KIA casualty not sustained in combat. These 24 casualties are not

considered further in most of the discussion.

101 fatal wounds, made up of 65 KIA casualties and 36 DOW casualties.
254 WOUND BALLISTICS

268 survivors, whose wounds were distributed as follows:

42 head

31 chest

14 abdomen

143 extremities, broken down into:

62 wounds of upper extremities

81 wounds of lower extremities

38 multiple wounds.

Table 31 lists the total casualties sustained during the survey period,

with their general disposition among the various categories. The analysis

reveals the following facts:

1. The ratio of the total 393 casualties to the 102 total dead (KIA and

DOW) was 3.9 : 1.

2. The ratio of the 291 survivors (WIA excluding DOW) to the 102 total

dead (KIA and DOW) was 2.9 : 1.

TABLE 31.-Distribution of 393 casualties, 1st Battalion, 148th Infantry, 37th Division, New

Georgia Island, 18 July-4 August 1943, and 1st and 3d Battalions, 5307th Composite

Unit (Provisional), Burma campaign, February-June 1941j, by category

Casualties

Category

Number Percent

Dead:

Killed in action ----------------------------------- 66 16.8

Wounded-treated-died-later ------------------------ 36 9.2

Total ----------------------------------------- 102 26. 0

Living wounded:

Returned to duty from:

Aid post ------------------------------------ 74 18.8

Hospital, first echelon ------------------------- 61 15.5

Hospital, rear echelon ------------------------- 91 23.2

Evacuated to United States ------------------------ 42 10. 7

Minor wounds, no record -------------------------- 23 5.8

Total ------------------------------------------ 291 74.0

Grand total ------------------------------------ 393 100.0

3. If the 23 casualties carded for record only are excluded from the analysis, the ratio of total wounded to true KIA was 4.7: 1. This is the more

commonly used ratio. In this survey, it is undoubtedly related to the close

proximity of the medical installations to the frontlines and to the fact that
CASUALTY SURVEY, NEW GEORGIA-BURMA 255

a considerable number of casualties listed as DOW might well have been

tabulated as KIA under other circumstances.

4. Among the total 393 casualties, 249 (63.3 percent) were returned to

duty. If the 23 CRO casualties are excluded, 226 (57.5 percent) were returned

to duty.

Anatomic Frequency

Table 32 lists the anatomic distribution (regional frequency) of wounds

in the 369 battle casualties and table 33 the distribution among the 101 dead.

The following comments seem warranted:

1. Wounds of the head and of the thorax accounted for the same proportion of deaths among the KIA and the DOW. Among the 32 casualties

with head injuries were 23 KIA's and 5 DOW's with brain injuries and 2 KIA's

and 2 DOW's with injuries to the face and neck.

2. The fact that more thoracic wounds were observed in this survey than

in the Bougainville study (p. 318) is related to the greater proportion of

patrol and offensive action in this study. All casualties who died from thoracic

wounds had perforating injuries.

3. Although no KIA's are found among the abdominal injuries listed as

such, some casualties tabulated under multiple injuries had abdominal wounds.

Of the 25 casualties with abdominal wounds, 13 had visceral lesions, but only

one was operated on. Three of the casualties listed in the multiple injuries

group had laparotomies, but none survived. During the survey period,

most casualties with abdominal wounds were not killed instantly but died of

shock and hemorrhage before they could be operated on. Early, adequate

surgery would have decreased considerably the number of DOW's in the New

Georgia-Burma campaigns.

TABLE 32-Distribution of wounds in 369 battle casualties, by anatomic location (regional

frequency) 1

Total casualties Dead Living

Anatomic location

Number Percent Number Percent 2 Number Percent 2

Head ------------------------- 74 20. 1 32 43.2 42 56.8

Thorax ------------------------ 63 17.1 32 50.8 31 49.2

Abdomen --------------------- 25 6.8 11 44.0 14 56.0

Extremities:

Upper --------------------- 63 17. 1 1 1.6 62 98.4

Lower -------------------- 83 22.4 2 2.4 81 97.6

Multiple ---------------------- 61 16.5 23 37.7 38 62.3

Total -------------------- 369 100.0 101 27.4 268 72.6

1 Twenty-three cases with very minor wounds and one nonbattle casualty excluded from total number of casualties.

SPercent for dichotomy, dead versus living, by each anatomic location and for total dead versus living.
256 WOUND BALLISTICS

TABLE 33.-Distribution of wounds in 101 dead, by anatomic location

Total casualties Killed in action Died of wounds Anatomic location

Number Percent Number Percent 1 Number Percent I

Head -------------------------- 32 31.7 25 78. 1 7 21.9

Thorax ------------------------ 32 31.7 25 78. 1 7 21.9

Abdomen ---------------------- 11 10.9 .0 11 100.0

Extremities:

Upper -------------------- 1 1.0 .0 1 100.0

Lower -------------------- 2 2.0 .0 2 100.0

Multiple ---------------------- 23 22. 7 15 65. 2 8 34.8

Total -------------------- 101 100.0 65 64.4 36 35.6

1 Percent for dichotomy, killed in action versus died of wounds, by each anatomic location and for total killed in

action versus died of wounds.

Table 34 lists the regional frequency of wounds among the 268 casualties

who survived their wounds. It is apparent in this surveil, as it has been apparent in others, that wounds of the extremities predominate among the WIA and

that this group sustained fewer wounds in the anatomic regions in which vital

organs are located.

Table 34 also indicates the results of surgical skill in the management of

wounds of the extremities. The lack of definitive care in these campaigns is

shown by the fact that few casualties with serious abdominal wounds lived to be

evacuated to the United States. A high proportion of those who survived to

be evacuated bad only flesh wounds in this critical area.

TABLE 34.-Distribution of wounds in 268 livinq wounded, by anatomic location

Total casualties Returned to duty Evacuated to United

States Anatomic location - - _____._____-_____

ANumber Percent Number Percent I Number Percent I

Head -------------------------- 42 15. 7 30 71.4 12 28.6

Thorax ------------------------ 31 11.6 28 90.3 3 9.7

Abdomen ---------------------- 14 5.2 13 92.9 1 7.1

Extremities:

Upper ---------------------- 62 23. 1 56 90. 3 6 9. 7

Lower --------------------- 81 30. 2 69 85. 2 12 14. 8

Multiple ----------------------- 38 14. 2 30 78. 9 8 21.1

Total -------------------- 268 100.0 226 84. 3 42 15.7

1 Percent for dichotomy, duty versus evacuated to United States, by each anatomic location and for total duty versus

evacuated to United States.
CASUALTY SURVEY, NEW GEORGIA-BURMA 257

Distribution of Wounds in Relation to Projected Body Area

Missiles from a given weapon usually move in one direction toward a

casualty. If the projected area, of the body is completely exposed, it therefore

offers a better measure for the study of probable hits than the area of the total

unprotected body surface. The mean projected body area is obtained from

projection in the standing, kneeling, and sitting positions.4

Table 35 presents a comparison of mean projected body areas with body

areas hit. The wound distribution for the thorax exceeds the mean projected

body area by 4.5 percent, while wounds of the head exceed it by 7.9 percent.

TABLE 35.-Mean projected body area and wound distribution (dead and living, including

multiple wounded) and type of weapon

Mean Wound MachineAnatomic location projected distribution Rifle gun Mortar Artillery Grenade

body area

Percent Percent Percent Percent Percent Percent Percr, t

Head ----------------- 12.0 19.9 21. 1 20.3 20.2 19. 4 18. 7

Thorax --------------- 16.0 20.5 22. 1 19. 5 21.3 19.4 20.0

Abdomen ------------- 11.0 9. 6 7.4 12.8 12.8 5.6 9.3

Extremities:

Upper ----------- 22. 0 21.0 26. 2 20. 3 18. 1 16. 7 24. 0

Lower ----------- 39.0 29.0 23. 2 27. 1 27. 6 38. 9 28.0

Total ---------- 100. 0 100. 0 100. 0 100. 0 100. 0 100. 0 100. 0

Distribution of Wounds in Relation to Disposition of Casualties

Table 36 presents a breakdown of the anatomic distribution of wounds in

relation to the general disposition of wounded casualties who survived. Casualties with wounds of the extremities show a very low mortality rate, a high

percentage of returns to duty, and a relatively high incidence of evacuation to

the United States.

Table 37 presents the incidence of fractures of the extremities (62 upper,

81 lower) among surviving casualties. Of the 143 with wounds of the extremities, 31 (44.0 percent) had associated fractures. There were 15 fractures

(24.2 percent) among the 62 wounds of the upper extremity and 16 (19.8 percent)

among the 81 wounds of the lower extremities. Among the 42 casualties

evacuated to the United States, 18 were returned because of fractures.

4 Burns, B. D., and Zuekerman, S.: The Wounding Power of Small Bomb and Shell Fragments. R. C. No. 350

of the Research and Experiments Department of the Ministry of Home Security.
258 WOUND BALLISTICS

Pý cc nc i e c:3 06 ' C.

Net eqý0 t --

C~~" I 6-j~-

cl ce -e 00 0

t- tIc 0 ~

Z1r

CCI n 6 eo c666 qi cc -.

NI 0 ý ,I r ýid C: c C5 6 6 N

P- Cc C= ~l 1

C5 cc6 t"Z C. rI .6

Vq C qq 

C~~a qe 0, 

- Z ___ 

't 'o-
CASUALTY SURVEY, NEW GEORGIA-BURMA 259

TABLE 37.-Disposition of 62 casualties with wounds of upper extremities and 81 casualties

with wounds of lower extremities

Total living wounded Fractures Nonfractures

Disposition

Number Percent Number Percent I Number Percent I

Upper extremity wound

Returned to duty from:

Aid post ------------------- 15 24. 2 ---------- 0.0 15 100.0

First echelon --------------- 19 30. 6 3 15.8 16 84.2

Rear echelon --------------- 22 35. 5 7 31. 8 15 68. 2

Evacuated to United States ----- 6 9. 7 5 83. 3 1 16. 7

Total -------------------- 62 100.0 15 24. 2 47 75.8

Lower extremity wound

Returned to duty from:

Aid post ------------------- 17 21.0 --------- 0.0 17 100.0

First echelon --------------- 15 18.5 ........ .0 15 100.0

Rear echelon --------------- 37 45. 7 9 24. 3 28 75. 7

Evacuated to United States ------ 12 14.8 7 58. 3 5 41.7

Total -------------------- 81 100. 0 16 19. 8 65 80. 2

1 Percent for dichotomy, fractures versus nonfractures, under each disposition category and for total fractures versus nonfractures by upper and lower extremity wounds.

CAUSATIVE AGENTS

The number of battle casualties produced by various weapons depends upon

many factors, such as the type of warfare (defensive, offensive, patrol); the

number of weapons; the ammunition available; the training of personnel on

both sides; tactics; terrain; and weather. This study presents the various

types of casualties produced because the enemy used their weapons to advantage

at a particular time. It does not show the maximum effectiveness of any

weapon, information which could be obtained only from a controlled experiment. The study does show, however, certain facts about the weapons employed and about the way they were employed which can reasonably be expected to be approximated in future campaigns.

The effectiveness of a particular weapon can be determined by studying

the percentage of deaths among the total number of casualties caused by it.

This percentage, which is termed the weapon's "relative lethal effect," is

shown in table 38.
260 WOUND BALLISTICS

TABLE 38.-Distribution of 369 battle casualties, by relative lethal effect of causative agent

Total casualties Dead Living

Causatvie agent

Number Percent Number Percent 1 Number Percent 1

Machinegun -------------------- 119 32.3 53 44.5 66 55.5

Rifle --------------------------- 94 25. 5 24 25.5 70 74.5

Mortar ------------------------ 62 16. 8 10 16. 1 52 83.9

Grenade ----------------------- 52 14. 1 6 11.5 46 88.5

Artillery ----------------------- 33 8.9 6 18.2 27 81.8

Miscellaneous ------------------- 9 2.4 2 22. 2 7 77. 8

Total -------------------- 369 100.0 101 27. 4 268 72.6

1 Percent for dichotomy, dead versus living, by each causative agent and for total dead versus living.

In the Bougainville survey (ch. V), mortars caused the greatest number

of casualties (38.7 percent) and had a relative lethal effect of 11.8 percent. The

rifle ranked second, with 24.8 percent casualties and 32.2 percent relative

lethal effect. In the New Georgia-Burma study, the machinegun leads with

32.3 percent casualties and a relative lethal effect of 44.5 percent. The higher

effectiveness of this weapon would appear to be characteristic of jungle warfare.

Relation to Anatomic Distribution of Wounds

Table 39 presents a breakdown of the relative lethal effect of weapons as

related to anatomic distribution of the wounds which they caused. The following comments seem warranted:

1. A comparison of wounds of the head and of the thorax indicates a considerable increase in the relative lethal effect in wounds of the thorax caused by

both small arms and fragment-type wounds of the thorax. The figures might

be interpreted as reflecting the protection provided by both the skull and the

helmet.

2. Fragmentation-type weapons carried a very high relative lethal effect

in abdominal wounds, obviously because of the ease with which the abdomen is

penetrated and the subsequent high mortality rate. The machinegun also

carried a very high lethal effect in abdominal wounds, but there were no deaths

in this group as a result of rifle wounds.

3. The relative lethal effect for all weapons was very low for wounds of

the extremities.

4. Of the 61 casualties with multiple wounds, 32 (52.5 percent) were

wounded by fragmentation weapons. Among the 26 surviving casualties who

were wounded by shell fragments, 59 percent returned to duty from the first

echelon and 31.7 percent from the second echelon.

Since relatively few deaths result from wounds of the extremities, the

effectiveness of weapons in relation to them must be judged by the disposition
CASUALTY SURVEY, NEW GEORGIA-BURMA 261

of the casualty. Since fractures were one of the chief reasons for evacuation

to the United States, the relative effectiveness of weapons on the extremities

can also be judged by the number of fractures they cause. Table 40 contains

these data. As might be expected, small arms were generally more effective

than fragments in producing fractures.

TABLE 39.-Relative lethal effect of weapons, by anatomic location of wounds and for multiple

wounds

Total casualties Dead Living

Causative agent

Number Percent Number Percent 1 Number Percent I

Head wounds

Machinegun -------------------- 25 33. 8 16 64.0 9 36.0

Rifle -------------------------- 20 27.0 9 45.0 11 55.0

Mortar ------------------------ 11 14. 9 2 18. 2 9 81.8

Grenade ----------------------- 10 13. 5 1 10.0 9 90.0

Artillery ----------------------- 6 8. 1 3 50.0 3 50.0

Miscellaneous ------------------- 2 2.7 1 50. 0 1 50. 0

Total ------------------- 74 100.0 32 43.2 42 56. 8

Thoracic wounds

Machinegun.. -------------------- 18 28. 6 13 72. 2 5 27. 8

Rifle -------------------------- 21 33.3 13 61.9 8 38. 1

Mortar ------------------------ 10 15. 9 3 30.0 7 70.0

Grenade ---------------------- 8 12.7 2 25.0 6 75.0

Artillery ----------------------- 6 9.5 1 16. 7 5 83.3

Total -------------------- 63 100.0 32 50. 8 31 49. 2

Abdominal wounds

Machinegun ------------------- 11 44.0 8 72.7 3 27.3

Rifle -------------------------- 6 24.0 .0 6 100. 0

Mortar ------------------------ 5 20.0 1 20.0 4 80.0

Grenade ----------------------- 2 8.0 1 50.0 1 50.0

Artillery ----------------------- 1 4.0 1 100.0 .0

Total -------------------- 25 100.0 11 44.0 14 56.0

See footnote at end of table.
262 WOUND BALLISTICS

TABLE 39 -Relative lethal effect of weapons, by anatomic location of wounds and for multiple

wounds-Continued

Total casualties Dead Living

Causative agent

Number Percent Number Percent I Number Percent I

Upper extremity wounds

Machinegun ------------------- 18 28.6 --------- 0.0 18 100.0

Rifle -------------------------- 23 36. 5 ........ .0 23 100.0

Mortar ------------------------ 7 11. 1------1 .0 7 100.0

Grenade--------------------- 10 15.9 1 10.0 9 90.0

Artillery --------------------- 5 7.9 ------ .0 5 100. 0

Total ------------------- 63 100.0 1 1.6 62 98.4

Lower extremity wounds

Machinegun------------------ 24 28. 9 2 8.3 22 91.7

Rifle ...--------------------------- 21 25.3 ....... .0 21 100. 0

Mortar ------------------------ 13 15.7 ...... .0 13 100.0

Grenade ----------------------- 11 13.3 ....... .0 11 100.0

Artillery ----------------------- 10 12.0 ........ .0 10 100.0

Miscellaneous ----------------------- 4 4. 8 .0 4 100.0

Total -------------------- 83 100.0 2 2. 4 81 97. 6

Multiple wounds

Machinegun ------------------- 23 37. 7 14 60. 9 9 39. 1

Rifle -------------------------- 3 4. 9 2 66. 7 1 33.3

Mortar ----------------------- 16 26. 2 4 25. 0 12 75. 0

Grenade ----------------------- 11 18. 1 1 9. 1 10 90. 9

Artillery ----------------------- 5 8.2 1 20.0 4 80. 0

Miscellaneous ------------------- 3 4. 9 1 33.3 2 66. 7

Total ------------------- 61 100.0 23 37.7 38 62.3

1 Percent for dichotomy, dead versus living, by each causative agent and for total dead versus living by anatomic

location of wounds and for multiple wounds.

As table 41 shows, small arms were responsible for 77 (76.3 percent) of the

101 casualties KIA and DOW. The proportion for the same group in the

Bougainville campaign was 58.2 percent.

Neither the New Georgia-Burma nor the Bougainville records contain any

information concerning the effect of U.S. weapons on enemy dead. It is
CASUALTY SURVEY, NEW GEORGIA-BURMA 263

TABLE 40.-Relative effect of weapons causing wounds of upper and lower extremities, among

the living wounded

Total wounds Fractures Nonfractures Causative agent

Number Percent Number Percent I Number Percent I

Upper extremity

Machinegun -------------------- 18 29.0 5 27. 8 13 72. 2

Rifle -------------------------- 23 37. 1 7 30. 4 16 69.6

Mortar ------------------------ 7 11.3 1 14.3 6 85.7

Grenade ----------------------- 9 14.5 2 22.2 7 77.8

Artillery ----------------------- 5 8. 1 .0 5 100.0

Total -------------------- 62 100.0 15 24. 2 47 75.8

Lower extremity

Machinegun -------------------- 22 27. 2 8 36. 4 14 63. 6

Rifle -------------------------- 21 26. 0 3 14. 3 18 85. 7

Mortar ------------------------ 13 16. 0 2 15. 4 11 84. 6

Grenade ---------------------- 11 13. 6 .0 11 100. 0

Artillery ----------------------- 10 12. 3 2 20.0 8 80.0

Miscellaneous ------------------- 4 4. 9 1 25. 0 3 75. 0

Total ------------------- 81 100. 0 16 19. 8 65 80. 2

I Percent for dichotomy, fracture versus nonfracture. by each causative agent and for total fracture versus nonfracture,

by upper and lower extremity wounds.

TABLE 41.-Distribution of 101 fatal casualties, by relative effect of causative agent

Total dead Killed in action Died of wounds

Number Percent Number Percent I Number Percent

Machinegun -------------------- 53 52. 5 37 69. 8 16 30. 2

Rifle -------------------------- 24 23. 8 16 66. 7 8 33. 3

Mortar ------------------------ 10 9. 9 6 60. 0 4 40. 0

Grenade ----------------------- 6 5. 9 3 50. 0 3 50. 0

Artillery ----------------------- 6 5. 9 2 33.3 4 66. 7

Miscellaneous ------------------ 2 2. 0 1 50. 0 1 50. 0

Total -------------------- 101 100. 0 65 64. 4 36 35. 6

I Percent for dichotomy, killed in action versus died of wounds, by causative agent and for total killed in action versus

died of wounds.
26-= WOUND BALLISTICS

characteristic of U.S. troops to use all firepower available, which means that

there was a high incidence of wounds per enemy casualty. This consideration,

together with other factors, made it impossible to gather reliable information

on this phase of the survey.

Relative Lethal Effect of U.S. Weapons on U.S. Casualties

Table 42 lists 66 U.S. casualties caused by U.S. weapons fired by U.S.

soldiers, chiefly because of mistaken identity; leaving foxholes at night; and

accidental discharges and shorts from artillery and mortar fire.

Table 43 presents the disposition of these casualties.

Relative Lethal Effect of Weapons on Disposition of Casualties

A weapon can be evaluated by the disposition of the casualties it causes

in addition to the number of wounds it produces in each body area. The

criterion of disposition furnishes an excellent means of predicting what percentage of casualties injured by various weapons will be killed instantly or die

later, what percentage of returns to duty will occur within certain time periods,

and what proportion of casualties wounded in various body areas will survive.

Table 44 lists the disposition of casualties in relation to the various types

of weapons which caused their wounds. Those who returned to duty usually

returned within 30 days or less from first echelon hospitals and within 120 days

or less from second echelon hospitals.

As this table shows, a very high proportion (60.5 percent) of all machinegun casualties were considered as "lost to the service." This group includes

the total KIA (53) plus the number evacuated to the United States (19). A

considerable number of those evacuated could, of course, continue in service

after a period of hospitalization.

TABLE 42.-Relative lethal effect of U.S. weapons on 66 U.S. casualties

Total casualties Dead Living wounded Weapons___________________________________

Number Percent Number Percent 1 Number Percent

Machinegun -------------------- 3 4. 5 1 33. 3 2 66. 7

Rifle --------------------------- 19 28. 8 8 42. 1 11 57. 9

Mortar ------------------------ 15 22. 7 4 26. 7 11 73. 3

Grenade ----------------------- 8 12. 1 2 25. 0 6 75. 0

Artillery ----------------------- 17 25. 8 1 5. 9 16 94. 1

Miscellaneous ------------------ 4 6. 1 .0 4 100. 0

Total -------------------- 66 100. 0 16 24. 2 50 75. 8

1 Percent for dichotomy, dead versus living, by each weapon and for total dead versus living.
CASUALTY SURVEY, NEW GEORGIA-BURMA 265

TABLE 43.-Disposition of 66 U.S. casualties produced by

U.S. weapons, by category

Casualties

Category

Number Percent

Dead:

Killed in action ------------------- 11 16. 7

DOW (died of wounds) ------------ 5 7. 6

Total -------------------------- 16 24.3

Wounded, living:

Returned to duty from:

Aid station ------------------ 15 22. 7

First echelon ---------------- 8 12. 1

Rear echelon ----------------- 19 28.8

Evacuated to United States ...... 8 12. 1

Total -------------------------- 50 75. 7

Grand total -------------------- 66 100. 0

The rifle was second to the machinegun in the production of casualties,

but only 31.9 percent of the casualties it caused (24 KIA plus 6 evacuated to

the United States) were lost to the service. Fragmentation-type weapons

closely approximated the rifle in effectiveness.

The grenade continued to have the lowest relative lethal effect and the

highest return to duty rate in the casualties it caused.

To demonstrate further the relative effectiveness of various weapons, tables

45 and 46 were prepared from the figures listed in table 44. These tables show:

1. Very few casualties with small arms wounds returned to duty from the

first echelon (7.6 percent machinegun and 14.9 percent rifle).

2. The majority of small arms casualties were either KIA or were evacuated

to the rear echelon or to the United States (84.0 percent macbinegun and 67

percent rifle).

3. The rest of casualties wounded by small arms were returned to duty

from the battalion aid station.

4. Approximately 21 percent of the casualties with wounds caused by mortars and 24 percent of those with wounds caused by artillery fire returned to

duty from first echelon hospitals.

603225v-62- 19
266 WOUND BALLISTICS

CC)) t 00p

4' 00c - c

Ctn, cC C

C0)0 c) c

CC

C) C)cqc C C) -C~~~lclC C l C

E

CC t5~

S C-'i ) C

C 5C-C- m
CASUALTY SURVEY, NEW GEORGIA-BURMA 267

TABLE 45.-Relative effect of weapons: Casualties returned to duty from first echelon

Casualties returned to duty Weapon Total casualties

Number Percent of total

Number

Machinegun -------------------------------- 119 9 7.6

Rifle --------------------------------------- 94 14 14.9

Mortar- ------------------------------------- 62 13 21.0

Grenade ------------------------------------- 52 16 30.8

Artillery ------------------------------------- 33 8 24.2

TABLE 46.-Relative effect of weapons: Casualties lost to combat duty (dead or evacuated to the

rear echelon or to the United States)'

Casualties lost to combat Weapon Total casualties

Number Percent of total

Number

Machinegun -------------------------------- 119 100 84.0

Rifle ---------------------------------------- 94 63 67.0

Mortar ------------------------------------- 62 28 45.2

Grenade ------------------------------------ 52 20 38.5

Artillery -------------------------------------- 33 17 51.5

1 This includes men who were lost to immediate combat. It also includes men who could perhaps have offered

resistance to the enemy for hours or days in spite of their wounds.

Casualties "Lost to Combat"

A final method of determining the effectiveness of weapons is presented in

table 47, the basis of which is the casualties lost to combat because they were

killed in action or because they were so incapacitated that they would be unable

to fight under any circumstances.

The Bougainville report utilized a number of traumatic conditions by

which to evaluate the seriousness of wounds. The same criteria were used in

the analysis of the New Georgia-Burma casualties to determine those who were

classified as "Lost to Combat":

1. Wounds of the head and central nervous system that produced unconsciousness and paralysis.

2. Wounds of intrathoracic structures that produced hemorrhage and

shock.

3. Wounds of intraperitoneal structures that produced hemorrhage and

shock.

4. Wounds of the extremities that produced fractures of the long bones,

severance of major vessels, or major traumatic amputations.

5. Extensive soft-tissue wounds that produced shock.
268 WOUND BALLISTICS

TABLE 47.--Relative effect of weapons: Casualties lost immediately to combat 1

Casualties lost to combat

Weapon Total casualties

Number Percent of total

Number

Machinegun --------------------------------- 119 66 55.5

Rifle --------------------------------------- 94 36 38.3

Mortar -------------------------------------- 62 15 24.2

Grenade ------------------------------------- 52 9 17.3

Artillery ------------------------------------- 33 12 36.4

1 This includes men who could not have fought during any period before evacuation or death, their injuries putting

them immediately out of action.

CIRCUMSTANCES OF WOUNDING

In addition to determining the relative effectiveness of various weapons,

the survey unit was interested in evaluating the circumstances in which casualties were produced. Information collected concerning the position of the

casualty when he was hit, the available protection, the type of action, and the

distance from the wounding agent was classified under the following headings:

1. The cover group:

a. Best protection (in a pillbox, usually constructed of heavy logs).

b. Moderate protection (in a foxhole or trench with no overhead

cover).

c. Least protection (a tree, shallow hole, or log; or in the open

with no protection at all).

2. The position of the casualty:

a. Standing (includes walking and running).

b. Sitting (includes crouching or kneeling).

c. Prone.

3. The type of action:

a. Patrol (small groups moving through jungle often determine the

presence of the enemy by running into fire).

b. Defensive (troops usually dug in with fixed positions).

c. Offensive (applied to attack which develops after the enemy has

been located by patrol activity).

Influence of Cover

Table 48 presents the influence of cover on the production of casualties

by the various wounding agents.

In the Bougainville report, 20.1 percent of 1,557 casualties were wounded

in well-covered pillboxes or well-dug holes (p. 418). This report shows that

the pillbox offers relatively greater protection against aimed fire.
CASUALTY SURVEY, NEW GEORGIA-BURMA 269

In the New Georgia-Burma survey, pillboxes were not used because of

the offensive-type action and the extremely fluid frontlines. Only one man

was hit in a pillbox, which was of Japanese construction. The bullet passed

between the logs and killed him, which could not have occurred if the pillbox

had been properly constructed.

Of the 369 casualties, 17.5 percent were wounded in foxholes, many of

which were of poor construction. A well-constructed foxhole offers excellent

protection from flat trajectory weapons but not as good protection from shell

fragments, particularly when there are a number of tree bursts.

TABLE 48.-Distribution of 349 casualties, by position and protection and by causative agent

Causative agent Total casualties

Position and protection Rifle Machine- Grenade Mortar Artil- Number Percent

gun lery

Standing:

No cover ------------------------ 43 76 22 17 3 161 46. 1

Partial cover --------------------- 1 1 ------.------.------ 2 .6

Total -------------------------- 44 77 22 17 3 163 46.7

Sitting:

No cover ------------------------ 20 3 1 15 1 40 11.5

Partial cover -------------------- 4 1 ------.------.------ 5 1.4

Total -------------------------- 24 4 1 15 1 45 12. 9

Prone: "No cover ------------------------ 15 29 12 3 8 67 19.2

Partial cover --------------------- 2 1 3 6 ------ 12 3.4

Total -------------------------- 17 30 15 9 8 79 22. 6

Pillbox ----------------------------- ------- 1 ------------------- 1 .3

Trench hole ------------------------- 13 3 10 15 20 61 17. 5

Total ------------------------- 13 4 10 15 20 62 17.8

Grand total ------------------- 98 115 48 56 32 349 100.0

Influence of Position

The influence of position can be used to determine whether the number

of hits depends solely upon the body surface exposed or is greater for aimed

fire (table 49). For both aimed and unaimed fire, twice as many casualties

occurred among standing as among prone soldiers. When the factor of cover
270 WOUND BALLISTICS

is removed (table 50), the relative proportions remain about the same, which

is what might be expected if all missiles were unaimed and were traveling at

random. In this jungle study, apparently a considerable proportion of all

casualties resulted from random unaimed hits.

Rifles and machineguns are considered aimed weapons. Weapons which

produce shell fragments, such as mortars, artillery, and grenades, are unaimed

weapons. Bullets in jungle warfare came largely from weapons aimed only

in the approximate direction and elevation.

The Japanese utilized their aimed weapons (rifle and machinegun) most

efficiently when U.S. troops were on patrol or on offensive action (table 51).

Their unaimed weapons (mortar, grenade, artillery) were used to best advantage when they were on the offensive or U.S. troops were on the defensive.

TABLE 49.-Distribution of 287 casualties, by aimed and random fire and by position (with

and without cover)

Aimed fire I Random fire 2 Casualties Position_____________

Number Percent Number Percent Number Percent

Standing ------------------------ 121 61. 7 42 46. 1 163 56. 8

Sitting -------------------------- 28 14. 3 17 18. 7 45 15. 7

Prone -------------------------- 47 24. 0 32 35. 2 79 27. 5

Total -------------------- 196 100. 0 91 100. 0 287 100. 0

1 Rifle and machinegun.

2 Mortar, artillery, and grenade.

TABLE 50.- Distribution of 270 casualties, by aimed and random fire and by position (no cover)

Aimed fire I Random fire 2 Casualties Position

Number Percent Number Percent Number Percent

Standing ----------------------- 119 64. 0 44 52.4 163 60.4

Sitting ------------------------- 23 12.4 17 20. 2 40 14. 8

Prone -------------------------- 44 23. 6 23 27.4 67 24. 8

Total -------------------- 186 100. 0 84 100.0 270 100. 0

1 Rifle and macbinegun.

2 Mortar, artillery, and grenade.
CASUALTY SURVEY, NEW GEORGIA-BURMA 271

TABLE 51.-Distribution of 362 casualties, by type of action and causative agent

Total casualties Patrol Defensive Offensive Causative agent

Number Percent Number Percent I Number Percent I Number Percent 1

Aimed weapon:

Rifle ---------------------- 96 43.8 15 15.6 46 47.9 35 36. 5

Machinegun --------------- 123 56. 2 47 38. 2 23 18. 7 53 43. 1

Total ------------------- 219 100. 0 62 28. 3 69 31.5 88 40. 2

(86. 1) (45. 1) (64. 2)

Unaimed weapon:

Mortar ------------------- 62 43.4 1 1. 6 40 64. 5 21 33. 9

Grenade ------------------ 50 35. 0 9 18. 0 13 26. 0 28 56. 0

Artillery ------------------ 31 21. 6 .0 31 100.0 . 0

Total ------------------- 143 100. 0 10 7. 0 84 58. 7 49 34. 3

(13. 9) (54. 9) (35. 8)

Grand total ------------- 362 100. 0 72 19. 9 153 42. 3 137 37. 8

1 Percent for trichotomy, patrol versus defensive versus offensive, by type weapon, and for total patrol versus defensive versus offensive.

NoTE.-Figures in parentheses express percent of total type of weapon for total type of activity.

Influence of Range of Small Arms Missiles

Any information that can be collected concerning the range of small arms

or the distance from a shellburst at the time of wounding is of extreme importance in assessing the wounding potential of a weapon, as well as in designing

and constructing personnel armor. If the weight of the bullet or fragment is

known, plus its approximate velocity (by interpolation from range or distance

values), the kinetic energy of the missile at the time of impact can be determined. All of these data are of interest and of fundamental importance in the

basic studies on wound ballistics. (See chapters II and III.)

Table 52 presents the data on 208 casualties (93 from rifle fire and 115 from

machinegun fire) in which the approximate range was known. As the table

shows, the greater number of injuries occurred at distances under 75 yards. The

observation is typical of jungle warfare, in which small arms are seldom actually

aimed at distances greater than 50 yards.

Table 53 presents the data on 85 casualties (56 from mortar and 29 from

artillery fire) in which the range was known. The majority of the injuries

occurred at distances under 10 yards from the burst. The enemy hand grenade

was seldom effective as a wounding agent at distances greater than 3 yards

(table 54).
272 WOUND BALLISTICS

TABLE 52.-Dislribution of 208 casualties, by category and by approximate range of small

arms (rifle and machinegun) missiles

Approximate rangc (yards) of small arms Living__ wounded

missile Dead Total casualties

Returned to Evacuated to duty United States

Rifle: Number Number Number Number

o to 25 -------------------------- 8 13 2 23

25 to 50 ------------------------- 5 4 1 10

50 to 75 ------------------------- 2 26 2 30

Over 75 -------------------------- 7 22 1 30

Total ------------------------- 22 65 6 93

Machinegun:

0 to 25 -------------------------- 7 2 3 12

25 to 50 ------------------------- 8 5 3 16

50 to 75 ------------------------- 23 18 6 47

Over 75 ------------------------- 15 22 3 40

Total ------------------------- 53 47 15 115

Grand total ------------------- 75 112 21 208

TABLE 53.-Distribution of 85 casualties wounded by mortar and artillery shells, by distance

from point of burst of causative agent

Distance (yards) from point of burst of Lvn one

causative agent Dead Total casualties

Returned to Evacuated to duty United States

Mortar shells: Number Number Number Number

0 to 10 -------------------------- 8 35 6 49

10 to 20 ------------------------- 1 5 1 7

2 0 to 5 0 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

O v e r 5 0 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Total -------------------------- 9 40 7 56

Artillery shells:

0 to 10 -------------------------- 6 7 ------- 13

10 to 20 -------------------- ----------------- 4 4

20 to 50 -------------------- ------------------ 1 3 4

Over 50 -------------------------------------- 8 ------- 8

Total -------------------------- 6 20 3 29

Grand total ------------------- 15 60 10 85
CASUALTY SURVEY, NEW GEORGIA-BURMA 273

TABLE 54.--Distribution of 47 casualties wounded by hand grenade, by distance from detonation

of causative agent

Number of casualties

Distance from detonation of causative

agent (yards) Dead Total

Returned to Evacuated to duty United States

0 to 3 ---------------------- 6 28 4 38

3 to 5 --------------------- ------------ 99 9

Over 5

Total ------------------ 6 37 4 47

In summary, the following distances were typical for the offensive type

action which characterized the New Georgia-Burma fighting:

Records show that 90 percent of the dead killed by bullets were hit at

ranges under 100 yards. Furthermore, many of these bullets had low velocities because they had passed through brush or trees. Mortars and artillery

seldom killed at distances greater than 10 yards from the burst, and close to

100 percent of casualties from these weapons occurred at less than 50 yards.

No records are available that show men killed at distances greater than 5

yards from a grenade burst.

Over 75 percent of casualties killed by fragments from mortar and

artillery shells were less than 10 yards from the source of the fragments.

Over 80 percent of casualties killed by fragments from hand grenades

were less than 3 yards from the detonation.

DISPOSITION OF CASUALTIES

A review of the disposition of battle casualties furnishes much valuable

information. In the type of warfare discussed in this chapter, between 16

and 25 percent of all men hit were killed. Approximately the same proportions

were returned to duty immediately, and 40 percent were returned to duty

within 4 months. The remaining 10 to 15 percent were evacuated to the

United States.

Disposition According to Anatomic Distribution of Wounds

The anatomic distribution of wounds played the most important role in

the disposition of casualties:

1. Casualties who received wounds of the head, chest, or abdomen had

a 50-percent chance of being killed in action. Of those who survived penetrating wounds of the head, chest, or abdominal cavity, only a very few could

be returned to duty. Most of the men with wounds in these three areas who

603225"--62- 20
274 WOUND BALLISTICS

could be returned to duty had only flesh wounds. In these areas, a little

protection might have made the difference between death or disability and

a minor wound.

2. More than three-quarters of all casualties with wounds of the extremities returned to duty without leaving the theater of action. Fatalities due

to these wounds were so few as to be insignificant. When they occurred,

most of then could be attributed to carelessness.

Disposition According to Causative Agent

Disposition of casualties according to the agents which caused their

wounds was one way of establishing the effectiveness of weapons used by

Japanese infantry. In descending order of effectiveness, these weapons were

machinegun, rifle, artillery, mortar, and grenade.

Machineguns of a caliber equivalent to that of rifles caused greater losses

than rifles principally because they caused multiple wounds involving multiple

regions. Sixty percent of all casualties struck by machinegun bullets were

lost to service, a proportion which conclusively demonstrates the deadly

effectiveness of this and other automatic weapons.

Shell fragments did not approach the effectiveness of bullets unless they

hit men who were upright and unprotected or the shell had a tree burst.

Artillery and mortars, as employed in the Pacific areas with little use of

time fuzes, were much more effective than grenades, which, as already noted,

seldom killed at distances greater than a few feet. Artillery and mortars

accounted for about 30 percent of men lost to service (casualties killed or

evacuated to the United States) in each of their respective categories.

When casualties killed in action, those evacuated to the rear echelons,

and those evacuated to the United States are totaled, a comparison of the

wounds produced by each weapon provides figures which further substantiate

the results just cited. The machinegun leads with 84 percent and the grenade

comes last with 38.5 percent. The ratio remains the same when the dead are

added to the group of men who could not continue to fight for even a short

time in an emergency. On the other hand, casualties who returned to duty

from the first echelon did so with increasing frequency according to whether

they were wounded by grenades, mortars, artillery, rifles, or machineguns.

About 75 percent of the 101 dead in the New Georgia-Burma survey

died because of wounds from small arms. Two-thirds of these fatalities were

caused by machineguns, generally the .25 caliber weapon that the Japanese

used as the equivalent of the U.S. Browning automatic rifle. A large but

undetermined number of Japanese casualties were caused by U.S. automatic

weapons: In a single brief engagement involving only one combat team, two

U.S. heavy machineguns fired 10,000 rounds, and more than 400 Japanese were

killed.

In the type of warfare in which troops tended to seek cover in natural

vegetation and did not always build strong fortifications, the Browning auto-
CASUALTY SURVEY, NEW GEORGIA-BURMA 275

matic rifle proved a very valuable weapon. The Japanese light machinegun

also proved extremely effective against U.S. troops. With both of these

weapons, it was possible to throw a large volume of fire rapidly into a group

of men before any of them could assume prone positions. In jungle warfare,

in which brief glimpses of the enemy were the rule, these automatic guns

were decisive; a burst often caught men on their feet, with vital areas of their

bodies exposed.

In this type of jungle warfare, tremendous U.S. artillery concentrations

in all probability caused the largest percentage of Japanese casualties. On

the other hand, the value of the automatic weapon, often firing initial bursts

in the general direction of groups of enemy above ground, should not be underestimated.

The great value of time fuzes for artillery was well demonstrated by the

large numbers of casualties U.S. troops sustained from the very light and

inaccurate Japanese artillery fire when they were subjected to it while near

trees and large bushes. The time fuze, when properly used, would certainly

have been as effective as these so-called tree bursts.

INFLUENCE OF PROTECTIVE ARMOR

In the Bougainville study, head wounds exceeded the proportion pre.-

dicted for the mean projected body area by twice the expected percentage.

Wounds of the abdomen and lower extremities did not quite reach the theoretical number of bits for the mean projected body areas of these regions.

In the New Georgia-Burma report, as already noted, the expected proportion of wounds of the head is exceeded by 7.9 percent and of wounds of the

thorax by 4.5 percent. Wounds of the lower extremities and abdomen, as in

the Bougainville report, are below the expected proportions.

A great increase over the theoretical proportion of head injuries can be

expected in defensive warfare. In fact, no matter what the type of warfare,

wounds of the head can be expected to exceed the theoretical. Apparently

this is also true of thoracic wounds. Adequate studies are not available for

wounds of the back, front, and right and left sides of the body, but personal

experience leads to the tentative conclusion that at least two-thirds of all

hits in both dead and living will occur on the anterior body surface.

Table 55 presents the distribution and entrance sites of the lethal wounds

in 173 casualties (78 in the New Georgia-Burma campaigns, 95 in the Bougainville campaign) who were killed in action with wounds of the head, chest, and

abdomen. There is a decided concentration of wounds in the frontal region

of the bead and on the left side of the chest as compared to the right side.

The data secured when the total dead of all jungle campaigns were combined are shown in table 56.

Approximately 40 percent of U.S. dead had head wounds as the cause of

death. The larger proportion of these casualties, however, showed no penetra-
276 WOUND BALLISTICS

tion of the helmet, thus indicating that ballistic protection was of some value.

On the other hand, the coverage provided by the standard M1 helmet seemed

inadequate to protect against the sort of missiles which entered the brain.

Further investigation will be necessary to prove this point, but this study

indicates that the greater percentage of head wounds, as well as the many

deaths due to such wounds, could be prevented by a more scientifically designed

helmet. Such a helmet should (1) be made of better armor material and (2)

should also protect the brain from every approach, including a large part of

the face. The unprotected upper portion of the face was the point of entrance

for most missiles which penetrated the brain and produced lethal wounds.

Casualties with superficial but severe injuries of the face and neck had an

excellent chance for survival.

TABLE 55.-Anatomic distribution of fatal wounds of the head, thorax, and abdomen in 173

casualties (95 Bougainville campaign; 78 New Georgia-Burma campaigns)

Region wounded

Anatomic location Region wounded Total number of

casualties

Anterior Posterior

Head -------------------------------------- 49 11 60

Thorax ------------------------------------- 53 26 79

Abdomen ------------------------------------ 24 10 34

Total -------------------------------- 126 47 173

TABLE 56.-Distribution of lethal wounds in 496 casualties (395 Bouigainville campaign;

101 New Georgia-Burma campaigns), by anatomic location (regional frequency)

Total casualties Anatomic location

Number Percent

Head -------------------------------------------- 176 35.5

Thorax ----------------------------------------- 119 24. 0

Abdomen_ --------------------------------------- 59 11. 9

Extremities- ------------------------------------- 18 3. 6

Multiple_ ---------------------------------------- 124 25.0

Total -------------------------------------- 496 100.0

As already mentioned, only an insignificant and largely unnecessary

proportion of deaths were due to wounds of the extremities.

Practical experience with war dead, as well as knowledge of anatomy

and of the possibilities of good surgery, leads to the conclusion that a great

saving in life could be effected by the proper use of one square foot of armor

on the anterior surface of the chest. The base figure of 60 (31% lb.) ounces per
CASUALTY SURVEY, NEW GEORGIA-BURMA 277

square foot for armor capable of resisting 20 mm. fragments at close range

provides a strong argument for such protection. The weight of this piece of

equipment would not equal the 7-pound weight of the old-type gas mask.

The equipment would certainly not be as cumbersome.

The possibility of designing the infantry rifle belt to increase its ability

to resist low-velocity missiles should also be considered.5

U.S. CASUALTIES CAUSED BY U.S. MISSILES

Of the 369 casualties in New Georgia and Burma, 66 (17.9 percent) were

caused by U.S. fire, as were 219 (12.2 percent) of the 1,788 Bougainville casualties. All types of weapons were represented, with rifle and artillery leading

in both reports. It is doubtful that higher command is aware that U.S.

soldiers killed and wounded such a large proportion of their fellow soldiers as

these figures suggest. Accurate figures exist only for isolated reports, such

as the reports for the Bougainville and the New Georgia-Burma campaigns.

There were a variety of reasons for this tragic situation: Individual

carelessness, usually on the part of the men hit; poor training in the use of

weapons: poor unit discipline; lack of dissemination of information; poor

leadership; and faulty judgment.

Limited experience suggests that artillery casualties were for the most

part due to poor fire direction by inexperienced observers and also suggests

that many casualties could probably have been prevented if adequate containers

had been provided for grenades and if the length of safety time had been

stamped on each grenade.

The majority of rifle and machinegun casualties occurred at night and

were caused by mistaken identity. In most instances the casualty showed

poor judgment-he stood up in his foxhole; moved about the perimeter; entered

a perimeter without proper caution; or performed other foolish acts.

Nearly all rifle and machinegun casualties in the group hit by U.S. fire

occurred when U.S. units were in defensive positions, in which there was little

need for hasty decisions. The men should have had more confidence in camouflage and in their ability with specific weapons. Good communications and

a general knowledge of the tactical situation would also have appreciably

reduced the number of such casualties.

Most self-inflicted wounds were caused by carelessness and were not

intentional.

Methods of Prevention

A consideration of the circumstances in which each injury caused by U.S.

fire occurred would include: (1) The position of the casualty; (2) the type of

action; (3) the natural protection; (4) the terrain, time, and weather; (5) the

6 These suggestions were made by Dr. Hopkins in 1944, immediately after he bad completed his surveys. His remarks

demonstrate the widespread interest in body armor on the part of many of the medical officers engaged in the initial treatment of battle casualties.-J. C. B.
278 WOUND BALLISTICS

type of weapon; (6) the range of the bullet or shellburst; (7) the planning of the

operation; and (8) leadership. Some of these factors require discussion.

Position.-Too many commanding officers and their men apparently did

not realize the protective value of the crawling position. Frequently, soldiers

would hit the ground when firing commenced but rise to a semierect position

in order to advance toward a known enemy position at short range. If a squad

could knock out a pillbox in an hour of crawling, without casualties, there was

no point to trying to do it in 30 minutes by advancing in a crouch and sustaining

casualties. The odds were too great to justify the time saved.

The great value of the prone position should also be emphasized. Records

available indicate that in jungle warfare very few men were hit when they

stuck close to the ground. Of 646 casualties (460 in Bougainville and 186 in

New Georgia and Burma) hit by bullets and without protection of any sort,

only 146 were injured while prone. Of 788 casualties (704 in Bougainville and

84 in New Georgia and Burma) hit by shell fragments, only 233 were injured

while prone.

Protection.-TThe value of protection is clear in figures from both the

Bougainville and the New Georgia-Burma campaigns. In the Bougainville

campaign, which was chiefly defensive, only 484 of the 1,906 men hit had protection of any sort. On New Georgia, 30 Japanese were killed at night inside

the perimeter of the 1st Battalion, 148th Infantry. The U.S. troops were in

shallow holes and did not have a single casualty. In the Burma campaign, a

combat team of 450 men were well dug in on a river bend but had only open

foxholes. During an enemy attack lasting 1 hour and 15 minutes, 400 Japanese

were killed while trying to cross the river. Not a single U.S. soldier was killed,

in spite of a tremendous concentration of Japanese machinegun and rifle fire.

Three minor injuries were caused by mortar fragments. This illustration is

only one of many possible examples of the value of even shallow foxholes.

Type of combat.-In the type of warfare encompassed by this survey,

about 50 percent of the casualties occurred in defensive action. The Japanese,

in spite of the great odds, usually attacked in the early morning or late afternoon. Well-indoctrinated troops, who were aware of this fact, could be prepared for the attacks by digging adequate foxholes, preparing fire lanes, and

generally showing alertness.

A fair average for U.S. casualties caused by offensive action against the

Japanese seems to be about 35 percent, while patrol activity accounts for 15

percent. In the patrol group, 75 percent of the casualties were probably caused

by aimed weapons. In defensive and offensive warfare, aimed weapons accounted, respectively, for 30 and 60 percent of casualties.

The Japanese made use of defensive warfare and excelled in the use of

terrain and camouflage for defensive purposes. In New Georgia, 16 of the 1st

Battalion's initial casualties (5 dead and 11 wounded) were caused by fire from

2 enemy heavy machineguns covering a small bridge. These guns were placed

in an area of thick jungle and steep hills which made flanking movements almost
CASUALTY SURVEY, NEW GEORGIA-BURMA 279

impossible. The entire battalion was held up for 36 hours and did not locate

the positions of the guns until the area had been pulverized by artillery and

mortar fire.

In Burma, the enemy invariably set up trail blocks at the crests of steep

hills, locations which usually provided perfect fire lanes and in which flanking

was difficult. Nor did they neglect to have similar positions prepared in

advance of a withdrawal.

Without pack artillery, dive bombers, expert use of mortars, and strafing

(all in small quantities), it is doubtful that the 3d Battalion of Merrill's Marauders would ever have relieved the 2d Battalion after an offensive against one

battalion of Japanese over a 5-mile jungle trail. The Japanese had favorable

terrain, but the tree burst of U.S. artillery and mortars, plus close fighting with

grenades, finally defeated them. The great effect of mortar and artillery tree

bursts can hardly be overemphasized.

Leadership.-In accounting for U.S. combat casualties, the role of leadership is clearly evident. A careful review of the causes of casualties in New

Georgia among men of the 1st Battalion, 148th Infantry, shows that a very

large number of them could be explained by poor leadership, chiefly at the

battalion and regimental level.

The Intelligence and Reconnaissance Platoon of the 3d Battalion of

Merrill's Marauders in Burma accounted for approximately 400 Japanese casualties in 26 engagements with the loss of only 3 U.S. soldiers KIA. The

platoon leader (1st Lt. Logan E. Weston, Inf.), who devised the tactical formation used by the platoon, was the man chiefly responsible for the small number

of casualties. Incidentally, the health of this platoon was always relatively

good, and it had an insignificant number of accidents during the campaign.

The platoon realized the value of their particular standard operational procedures for patrol and for defensive and offensive activities. Their excellent

record is largely attributable to the excellent leadership exercised by their

platoon commander.

Other factors.-Poor distribution of plans and combat information was

often responsible for injuries. Infantrymen participating in patrols and in

offensive action in such circumstances did not understand the general purpose

of the engagement.

Face and hand camouflage was seldom used by troops fighting jungle warfare, yet the split second of hesitation occasioned by camouflage might frequently

be prolonged, with disastrous results for the enemy. This would be especially

true on patrol activity but would also play an important part in any type of

action in which aimed weapons might cause casualties.

Greater stress should have been laid on the necessity for foxholes, and their

preparation and occupation should have been more strictly enforced by the unit

command. More attention should have been given to the physical and mental

condition, as well as to the personal needs, of the troops. Elective actions

should not have been undertaken without adequate food and rest.
280 WOUND BALLISTICS

Needless casualties caused by neglect of the simple principles of selfpreservation, firepower, sound tactics, and the physical well-being of the troops

should not have been tolerated.

CONCLUSIONS

In the past, the attention of both Medical Corps and combat officers

has been focused on the care of the wounded after they were injured. The

purpose of this survey was to call attention to means of reducing the number

of wounded and particularly the number of casualties killed in action. In

other words, the point has now been reached when more consideration should

be given to the individual U.S. soldier who, even with superior equipment

and supplies, will be killed or wounded in combat.

Body armor has been used in warfare in the past and its weight willingly

tolerated by soldiers once its effectiveness was demonstrated. The stakes

for the individual and for the Army are so high that the most careful investigation of existing armor and experimentation with improved types of armor

and helmets are fully justified.

In addition, all tactical lessons of combat should be exploited fully. The

Army cannot afford to neglect any suggestion which promises to save the

lives of U.S. citizens who are temporarily subject to its orders. It is believed

that the survey reported in this chapter points to the possibility of saving

many lives and avoiding many wounds.
CHAPTER V

Study on Wound Ballistics-Bougainville

Campaign

Ashley W. Oughterson, M.D., Harry C. Hull, M.D., Francis A. Sutherland,

M.D., and Daniel J. Greiner, M.D.

The purpose of the wound ballistics study I conducted on Bougainville

was to obtain information on the relative effectiveness of different weapons

as casualty-producing agents. To obtain this information, a study was made

of all battle casualties (living and dead) which had occurred in the U.S. Army

Ground Forces on Bougainville Island from 15 February to 21 April 1944.

Though it was possible to obtain information on all casualties, living or

dead, for the entire period from 15 February to 21 April, post mortem examinations were limited to the interval from 22 March to 21 April. The number

of autopsies was further curtailed because the bodies of some of those killed

in action were not obtained before decomposition was far advanced. It was

also hoped to study the effect of U.S. Army weapons on the enemy dead.

The character of the fighting resulting in multiple wounds by rifle, machinegun, grenade, mortar, and artillery fire made it almost impossible, however,

to determine what weapon was responsible for death. Furthermore, because

of delay in obtaining the Japanese dead, the state of deterioration frequently

precluded post mortem examination. Also, during this period, it often required all the available personnel to perform post mortem examinations on

U.S. Army killed-in-action casualties.

Since the effect of weapons may be observed on the living as well as the

dead, a clinical appraisal especially with regard to end results was needed.

Furthermore, the relative effect of weapons may be greatly influenced by the

quality of medical care. For this reason, the ballistics team after completing

the study in the forward area followed the patients through the hospitals of

the rear echelon.

The battle casualties studied may be divided into two large groups: The

killed in action and the wounded in action.

1 In accordance with instructions from The Surgeon General, 21 January 1944, a team was organized for the purpose

of conducting a study on wound ballistics. This team included Col. Ashley W. Oughterson, MC, Surgeon; Lt. Col.

Harry C. Hull, MC, Surgeon; Maj. Francis A. Sutherland, MC, Surgeon; Ma]. Daniel 5. Greiner, MC, Pathologist;

Sgt. Reed N. Fitch, T4g. Charles J. Berzenyi, and TIg. Charles R. Restife. The team was organized to participate in

the contemplated New Ireland operation and was ordered to Guadalcanal for training and organization. The New

Ireland operation was cancelled, and the team was then ordered on detached service with the XIV Corps on Bougainville

and reported there on 22 March 1944.

281
2IV WOUND BALLISTICS

Killed in action.-Those killed in action prior to 23 March were recorded

in the graves registration files. While some of these records were excellent,

many were inadequate. Information on the circumstances attending death,

such as type of missile, distance from burst, terrain, time, and type of protection, was supplemented by personal interviews with the medical officers

and aidmen or with comrades who, during the action, had seen the soldier

killed or had seen him before he expired. This information is better obtained

by personal interview than by questionnaire because the circumstances attending death are so varied. In order to obtain reasonably accurate data, evaluation of the situation by trained and interested personnel is necessary at the

time of interview. Subsequent to 23 March 1944, all the dead were brought

to the 21st Evacuation Hospital which was located near the cemetery. Here,

excellent facilities and assistance for post mortem examinations were available.

This work was carried on by the pathologist who was assisted by a clerk and

a photographer. When the number of autopsies exceeded 10 or 12 per day,

additional assistance was provided by the surgeons. A few additional post

mortem examinations were obtained on those wounded in action who died

later in hospitals of the rear echelon. A card index was kept on all wounded,

and this was checked for death against the records of the hospitals in the rear

echelon.2 This check was made at a later date, and for the majority of patients,

a period of 1 to 4 months had elapsed since they were wounded; hence, there is

reason to believe that all or nearly all of the dead are recorded in this study.

Wounded in action.-The wounded in action fell into three groups:

(1) The more seriously wounded who were evacuated from Bougainville,

(2) the relatively minor wounds treated in the clearing stations or hospitals

and returned to duty in 1 to 3 weeks, and (3) the very minor wounds and

abrasions returned to immediate duty from the battalion aid and collecting

stations. This latter group was not studied. The second group, of minor

wounds treated and returned to duty from the clearing stations and hospitals,

were studied in detail, as were those evacuated from the island. Factors

relating to ballistics in the wounded in action were obtained by questionnaire and by personal interview. The personal interview was undoubtedly

superior, but since these troops were still in battle it was sometimes impossible

to obtain an interview with an eyewitness. When emergency medical tags

and hospital records were checked with eyewitness accounts, many discrepancies were found as to the weapon, the distance, what the soldier was doing,

and the exact circumstances surrounding his injury. Allied officers and

enlisted men were questioned regarding effectiveness of enemy weapons and

tactics, as well as their own. Questions were also asked regarding the construction of pillboxes and the use of camouflage with reference to their effectiveness as a means of protection.

2 Throughout this chapter, hospitals in the rear echelon refer to those on Guadalcanal, Espiritu Santo, and New

Caledonia.-I. C. B.
BOUGAINVILLE CAMPAIGN 283

FACTORS PECULIAR TO THE BOUGAINVILLE CAMPAIGN

Geography

Bougainville Island is in the northernmost part of the Solomon Islands

group, lying between latitudes 50'28' S. and 5051' S. It is approximately

130 miles long with an average width of 30 miles. It is a tropical island of

volcanic origin with a backbone of rugged mountain ranges. Behind the

Empress Augusta Bay sector, the Crown Prince Range rises to a height of

6,560 feet with an active volcano, Mount Bagana. The Empress Augusta

Bay and Torokina Point sectors present a low sandy shoreline with heavy

surf. The south shore of this island has very little coral, and behind the

shoreline a sandy alluvial plain rises gently to the foothills of the Crown Prince

Range, about 4,000 yards inland. Near the shore are some lagoons and in

the region of the Torokina River extensive swamps. The subsoil of the plain

is black volcanic sand providing good drainage. The rainfall which is fairly

uniform throughout the year averages approximately 11 inches per month.

The typical heavy tropical showers wash and erode the hillsides and make

constant road maintenance a necessity.

The Empress Augusta Bay beachhead was virgin jungle except for a small

coconut plantation on Torokina Point. The elaborate system of roads shown

in the situation map (fig. 159) had all been built since the initial landing during

the first week of November 1943. At the time of the enemy attack on 8

March 1944, this system of roads was nearly completed except for a section

of the perimeter road connecting the Americal and 37th Division sectors.

The perimeter at its greatest depth was carried along the high ridges of the

foothills, and this extremely rugged terrain presented a major problem in

evacuation where roads were not present or were under fire. This road system

alone played an important role in saving the lives of many casualties which

might otherwise have been lost. However, the problem of evacuation of

wounded within the perimeter was simple when compared to the difficulties

encountered in evacuating men wounded on patrol. Patrols constantly covered this rugged terrain beyond the perimeter for distances of 1,000 to 8,000

yards. Even a 1,000-yard carry over these ridges and draws was exhausting

to both the litter bearers and the patient.

Medical Installations and Routes of Evacuation

The medical installations and routes of evacuation (fig. 153) were better

developed on Bougainville at the time of the attack than for any other island

campaign in the South Pacific. This was due to the fact that the beachhead

had been developed steadily over a period of 4 months before the Battle of

the Perimeter began.
284 WOUND BALLISTICS

U.S. Army photo

FIGURE 153.-One of the routes of evacuation between the clearing station

of the Americal Division and the 21st Evacuation Hospital.

Two-way all-weather roads made all parts of the perimeter easily accessible with one exception. This one sector lay near the boundary line between

the Americal and 37th Divisions, where the perimeter road had not been

completed (fig. 154). Furthermore, the roads were kept open throughout

the battle except on Hill 700. The one-way all-weather road over very rugged

terrain leading to the latter Hill was for a time under enemy fire, and as a

result a difficult litter carry of 1,200 yards was necessary during the attack.

Later at this point, and at others where sporadic fire was encountered, halftracks were used for evacuation, and patients were then transferred to jeep

ambulances and taken to the hospital. The greatest distance from the frontline to a clearing station was found on the Americal sector at the mouth of

the Torokina River which was approximately 10, 000 yards over a good road.

Figure 155 is an illustration of the type of road which existed outside of the

perimeter area.

Owing to this excellent system of good roads, the majority of patients arrived at the hospitals within 3 hours, and frequently within an hour. A sample

of 142 patients showed that 87 percent were on the operating table within 3

hours. Patrol missions presented the most difficult problems of evacuation.

Small patrols, frequently no larger than a platoon, were so numerous that it was

impractical to send a medical officer with each one. Larger combat patrols

were usually accompanied by a medical officer. On only one occasion, however,

was a patrol large enough to warrant the use of a portable surgical hospital. As

a consequence, some patients who were wounded on patrol did not reach the

hospital until after 24 to 48 hours had elapsed. However, every effort was
BOUGAINVILLE CAMPAIGN 285

S!----

U.S. Army photo

FIGURE 154.-Perimeter road near junction of Americal and 37th Divisions. A good route of evacuation over difficult terrain built by the 117th

Engineer Combat Battalion.

U.S. Army photo

FIGURE 155.-Roadway along the Laruma River, outside the perimeter.
286 WOUND BALLISTICS

made to reduce delay to the minimum and to provide surgery at the earliest

possible moment.

The medical installations available for the Bougainville campaign were

more than adequate. The clearing stations of both the Americal and 37th Divisions had been augmented with additional surgical equipment before the hospitals were established on the beachhead. The 31st Portable Surgical Hospital

had been assigned to the Americal Division and the 33d Portable Surgical

Hospital, to the 37th Division. Owing to the fact that more adequate medical

facilities became available later, the portable surgical hospitals were not necessary, although they were both utilized. The 52d Field Hospital was utilized

for the care of service troops and functioned chiefly as a station hospital for the

island. The 21st Evacuation Hospital (figs. 156 and 157), an affiliated unit

from the University of Oklahoma, Norman, Okla., had an exceptionally well

qualified staff, including the various specialists. The construction of this hospital was completed on S March 1944; however, the hospital had functioned

for a limited number of patients since 15 February. The normal capacity of

the 21st Evacuation Hospital was 750 beds with facilities available for an additional 250 beds (fig. 158). Casualties from all combat troops were cared for

at this hospital. Since the 21st Evacuation Hospital was situated only 4,000

yards from the frontlines at the nearest point of attack (forward of some

artillery batteries), the majority of the seriously wounded patients were sent

directly to the hospital to avoid delay at the clearing stations.

p%

AL i

U.S. Army photo

FIG•RE 156.-Ward area of the 21st Evacuation Hospital on Bougainville.
BOUGAINVILLE CAMPAIGN 287

U.S. Army photo

FIGUIRE 157-Underground operating room of the 21st Evacuation

Hospital on Bougainville. There was a similar operating room aboveground providing space for eight tables.

U.S. Army photo

FIGURE 158.--Interior of underground ward, 21st Evacuation Hospital

on Bougainville. Space was provided for 120 litter patients. This would

have been inadequate if shelling had been heavy.
288 WOUND BALLISTICS

All patients from the island were evacuated through the 21st Evacuation

Hospital. Nearly all patients evacuated to the rear were sent by air transport

to Guadalcanal and were cared for there in one of three 500-bed station hospitals. Patients requiring a long period of convalescence were evacuated from

Bougainville by ship or air transport to Espiritu Santo and to New Caledonia.

Allied and Japanese Forces

Allied forces on Bougainville were concentrated in the Empress Augusta

Bay beachhead. The perimeter line of defense had been extended previously

in three phases until, by the time of the Japanese attack on 8 March 1944, it

enclosed about 20 square miles and was approximately 22,000 yards in length.

The total strength within this perimeter as of 31 March 1944 was 60,583. Included were 11,220 Navy and Marine personnel and civilians. The few casualties from these groups were due mostly to shelling and bombing and are not

included in this study. The casualties included in this study were derived,

therefore, from a total strength of 49,363. Of this number, 40,404 were U.S.

Army Ground Force combat troops of which 27,831 constituted the 37th and

Americal Divisions. The remainder of the ground force combat troops were

attached to the XIV Corps and the 25th Regimental Combat Team. Allied

forces other than U.S. troops, chiefly Royal New Zealand Air Force and Fijian

Infantry, numbered 3,424. It should be noted that, of these forces, the number

actually involved in combat was comparatively few. This number could not

be ascertained except for certain specific engagements. The perimeter line of

defense was divided between the 37th and Americal Divisions although other

forces were used in the line at various times. The Fijian troops, among whom

there were a considerable number of casualties, were used chiefly on patrol

missions.

Immediately before the attack, the effective strength of the Japanese Army

and Navy forces on Bougainville numbered about 27,000. Of these, about

18,000 were believed to be Army combat troops. The remaining strength consisted of Army and Navy antiaircraft, base, service, and labor troops. No surface ships had been observed in the Bougainville area since mid-November 1943

and whatever supplies were brought in were carried by submarine or barge.

With the exception of small arms ammunition, there was evidence that the

enemy was short of basic supplies. Although elements of the 17th Division

(one battalion each from the 81st and 53d Infantry Regiments) were identified

in the Torokina area, the brunt of the attack was borne by the Japanese 6th

Division. The backbone of the enemy's strength was the 13th, 23d, and 45th

Infantry Regiments (fig. 159). These units were supported by the 6th Field

Artillery Regiment (2d Battalion) elements of the 4th Heavy (Medium) Artillery

Regiment, as well as miscellaneous mortar, artillery, engineer, and road construction units. The 1st Battalion, 13th -Inantry (minus one company), was to

be the division reserve. The total strength of these units actually in combat

in the Battle of the Perimeter was believed to be only slightly more than 10,000.
BOUGAINVILLE CAMPAIGN 289

0 ":.....

S..3.*. -Tr. c ..... iA..... N::t'B00....

MILE

4 ... 00"" • .] • :. ' .... • . i'.ag R ..... ....... •,•e~ ... ... ,, C, . ..... • f L cke '.- Hill ""

FIGUE 19.-Stuaion ap.Disositon 11f prnia eneyuisg9 eray14

sK- h a om hleen H m r ill o t n x p 4e o o i till a no.air.suppor.

1/ .- : : . / ...:.' G ...ns?

I': 13(3(

"C • Hioll/ • 0

Dsii tmh of 

(Estimatens basfed upncpue epn niat httertoo . m

0~ 132

I ZI PLNE MOEMN

MILES

FIGURE 159.--Situation map. Disposition of principal enemy units, 29 February 1944.

The enemy forces faced great difficulties of transportation in the maneuvering

of various units, especially heavy artillery, into positions favorable for attack.

This had to be accomplished over the most rugged type Of terrain at great expenditure of manpower. Finally, they attacked with almost no air support.

Description of the Weapons Commonly Employed by the JapaneseI

In the period under study, Japanese weapons accounted for 1,569 casualties, including killed and wounded, Table 57 is a breakdown of the type of

Japanese weapons responsible for 1,569 Allied casualties.

Estimates based upon captured weapons indicate that the ratio of 6.5 mam.

(caliber .256) to the 7.7 ram. (caliber .303) rifle was approximately 4 to 1.

3 A complete description of Japanese ordnance is con tained in chapter I, pp. 4-35.
290 WOUND BALLISTICS

TABLE 57.-Japanese weapons responsible for 1,569 Allied casualties

Allied casualties

Type of weapon

Number Percent

Mortar ------------------------------------------ 659 42.0

Rifle -------------------------------------------- 393 25. 1

Grenade ------------------------------------------ 205 13. 1

Machinegun ------------------------------------- 151 9.6

Artillery ----------------------------------------- 151 9.6

Miscellaneous ----------------------------------- - 10 .6

Total -------------------------------------- 1,569 100.0

Furthermore, of the smaller caliber (6.5 mm.) weapon, roughly 90 percent

were "long," 7 percent "short," and 3 percent "medium" types.

The almost complete absence of muzzle flash in the Model 38 (1905) is a

characteristic commented upon favorably by U.S. soldiers. Since the latest

Japanese rifle, Model 99, did not possess this feature, it was apparently considered unimportant by the enemy.

Most commonly employed by the enemy at Bougainville, in a ratio of

approximately 4 to 1, were the Model 96 (1936) 6.5 mm. light and the Model

92 (1932) 7.7 mm. heavy machineguns. Extremely rare was Model 11 (1922)

6.5 mm. light machinegun ("Nambu Keiki") among the 200 captured machineguns. Closely resembling the British Bren light caliber .303 model, the Model

96 (1936) 6.5 mam. light machinegun was considered an excellent weapon by

American officers.

Wounds ascribed to the mortar at Bougainville in many instances were

actually produced by the grenade discharger. Mistakenly called the knee

mortar, this weapon, because of its accuracy and efficiency, had earned the

respect of the American combat troops and was more feared than any other

Japanese weapon. If the "knee mortar" was grouped with the other types

of captured mortars, it was found to constitute approximately 90 percent of

the total. Among the conventional mortar types, the ratio of the 81 mm. to

the 90 mm. was about 3 to 2. A total of 96 mortars were captured, only one

of which was the 90 mrnn. Model 97 (1937).

Because it could be thrown by hand, fired from a grenade discharger, or

used as a rifle grenade, Model 91 (1931) hand grenade, "Kyuichi Shiki Shuryudau," was a useful, versatile, and frequently employed weapon. Model 97

(1937) hand grenade was similar to Model 91 except that it had no propelling

charge and could not be fired from a grenade discharger. It was carried by all

Japanese frontline troops but was said to have poor fragmentation, the fragments being small and of short range. The effective range from the burst

was estimated at 5 yards and the danger zone, 30 yards.

In the plan to neutralize and seize the three Torokina airfields, the artil-
BOUGAINVILLE CAMPAIGN 291

lery support was the most extensive yet employed by the enemy in the South

Pacific. The Japanese were able to transport a considerable number of heavy

weapons through dense jungle and over exceedingly rough terrain to positions

overlooking the U.S. perimeter. Assuming all units at full strength, an order

of battle indicates that the maximum number of weapons available to them

was 136. Actual observation suggested the presence of approximately 40 or

50 pieces.

With the exception of the 10 and 15 cm. pieces, all weapons were of pack

type and were undoubtedly carried by hand. Possibly the 150 mm. howitzers

may have been dismantled also, as some of these were reported on Mount

Bagana. These weapons were brought by water to Koaris and thence by

road to the vicinity of Hills 500 and 501. Limited use of horses was reported

on the Kahili-Empress Augusta Bay track. Apparently there was no serious

shortage of ammunition by Japanese standards, fire having continued intermittently from some positions for 3 weeks. Considerable quantities of ammunition were generally found with the captured weapons.

Principal targets were the airstrips, supply and command post areas,

road junctions, and the tank areas. Massing of fire was not utilized and gunfire

seemed independent. The heaviest concentration occurred in the early morning and evening hours. On 23 March, in less than 2 hours, 70 rounds fell on

the Piva airfields. After the first 2 days of attack, during which some parked

planes were destroyed, rarely in a single day did more than five or six shells

fall on these same airfields. Difficulties inherent in jungle warfare precluded

the use of artillery in close support of attacking Japanese infantry. For this

purpose, the Japanese relied principally upon 90 mm. mortar fire.

The Japanese employed at least thirty-five 75 mm. guns, Model 41 (1908)

and Model 94 (1934), the former predominating. These pieces were situated

north and northeast of the perimeter. Four 150 mm. howitzers were located

on the northeast and east and two 105 mm. howitzers on the east near Hill

501. Mortar fire received was principally from the north and northwest sections. The greatest concentration of fire in any one day was 200 rounds.

In contrast to the experience during the weeks after the landing in November,

the proportion of "duds" was remarkably low. Observers were able to identify by type of burst or by duds about 1,300 rounds received. Of these, 885

were 75 mm. shells and 130 were 150 mm. shells. Many types of artillery

weapons were captured. The five most commonly encountered models will

be described briefly.

Model 94 (1934) 37 mm. gun was designated "Kyuyon Shiki Sanjunana

Miri Ho," and commonly called Sanjunana Miri Ho. It could be used both as

an AT (antitank) and antipersonnel weapon, employing AP (armor-piercing),

HE (high explosive), and shrapnel ammunition. This gun had a long, slender

barrel measuring 66.5 inches in length. The effective range was 2,500 yards

and the maximum range 5,000 yards. The total weight of the weapon in

action was 714 pounds. The effective burst of the HE shell was said to be 10

yards with a zone of danger extending about 75 yards. Fragmentation tests
292 WOUND BALLISTICS

revealed that the 560 grams of metal in the shell broke into 490 fragments.

Only 143 of these fragments were classified as lethal (average weight of lethal

fragment being 3.1 grams).

The Model 92 (1932) 70 mm. howitzer (Battalion Gun), "Kyuni Shiki

Hoheiho" was a horse-drawn infantry support howitzer. It weighed 468

pounds and could be handled by a 10-man section. It had an effective range

of 1,500 yards and a maximum range of 3,000 yards. The estimated effective

range of burst was 20 yards, and the area of danger was 200 to 300 yards.

Issued for use as an infantry regimental gun, the Model 41 (1908) 75 mm.

mountain (infantry) gun was originally used as a field artillery pack gun. The

effective range of this weapon was 2,100 yards, and it fired both HE and AP

shells. With the long, pointed shell, its maximum range was 7,675 yards and

with the ordinary shell, 6,575 yards. The total weight was 1,200 pounds. Its

muzzle velocity was listed as 1,200 f.p.s. (feet per second). The shell had a

probable effective burst of 20 yards with a danger zone of 300 feet.

The Model 96 (1936) 150 amm. mobile field howitzer has a range of 13,200

yards. The effective range of the shellburst was said to be 50 yards with an

area of danger of 500 yards. The effect produced was that of blast and

fragmentation.

The Model 98 (1938) 20 mm. AA/AT (antiaircraft, antitank) machine

cannon was an all-purpose weapon. It was gas operated and semiautomatic

or full automatic. The ammunition for this weapon was HE, tracer, and AP

and was fed by a 20-round box magazine. This weapon was very maneuverable, weighing without wheels 836 pounds. The rate of fire was 120 rounds

per minute. The muzzle velocity was 2,720 f.p.s. and the maximum ranges,

horizontal 5,450 and vertical 12,000 feet.

A list of Japanese rifles, machineguns, mortars, grenades, and artillery

weapons captured on Bougainville follows.

Nomenclature Nomenclature

Model 38 (1905) 6.5 mm. Rifle (Long)' Model 97 (1937) Grenade 1

Model 38 (1905) 6.5 mm. Rifle (Short) Model 91 (1931) Grenade 1

Model 97 (1937) 6.5 mm. Snipers Rifle Model 23 (1923) Boobytrap Grenade 1

Model 38 (1905) 6.5 mm. Rifle (Medium) Model 94 (1934) 37 mm. Gun

Model 44 (1911) 6.5 mm. Cavalry Carbine Model 1 (1934) 47 mm. Gun

Model 99 (1939) 7.7 mm. Rifle I Model 92 (1932) 70 mm. Howitzer (BatModel 11 (1922) 6.5 mm. Light Machinegun talion Gun)I

("Nambu") Model 41 (1908) 75 mm. Mountain (InfanModel 96 (1936) 6.5 mm. Light Machinegun try) Gun (or Regimental Gun)1

Model 99 (1939) 7.7 mm. Light Machinegun Model 94 (1934) 75 mm. Mountain Gun

Model 92 (1932) 7.7 mm. Heavy Machine- Model 91 (1931) 105 mm. Light Field

gun I Howitzer

Model 97 (1937) 81 mm. Mortar 1 Model 96 (1936) 150 mm. Mobile Field

Model 94 (1934) 90 mm. Mortar 1 Howitzer 1

Model 97 (1937) 90 mm. Mortar Model 97 (1937) 20 rmm. AT Rifle

Model 89 (1929) 50 mm. Grenade Dis- Model 98 (1938) 20 mm. AA/AT Machine

charger ("knee mortar") Cannon

'Models most frequently employed.
BOUGAINVILLE CAMPAIGN 293

BOUGAINVILLE CAMPAIGN DURING SURVEY PERIOD

(15 FEB.-21 APR. 1944)

The Allied beachhead was established during the first week of November

1943. The period before the Battle of the Perimeter was characterized by

consolidation of the defenses of the airfields which were being used for attacking enemy installations in the Bismarck Archipelago and on Bougainville. By

15 February, the airstrips were completed and the perimeter established with

the 37th Division on the left flank and the Americal Division on the right flank.

From 15 February to 8 March, the perimeter defense was strengthened, and an

extensive system of roads was further developed within the perimeter. During

this period, patrols made contact with enemy forces moving into position

north and east of the perimeter. Some artillery installations were discovered,

and strong enemy positions were noted on Hills 1000, 1111, and 600 east of the

Torokina River mouth (fig. 159). However, during this period, contact with

the enemy was limited to patrol skirmishes and an occasional bombing raid at

night.

The Battle of the Perimeter extended from 8 March to 24 March. The

Japanese had laid plans for this offensive sometime around the turn of the year.

Allied intelligence obtained information that the enemy attack was to be

launched on 8 or 9 March, thereby permitting ample preparation for defense

of the perimeter.

Enemy plan.-The three infantry regiments were to leave their respective

lines of departure following an artillery barrage. This barrage was to commence at 0430 Y-day from the main strength of the 6th Artillery Regiment

(fig. 159) located near Blue Ridge (mountain guns) and the medium field

artillery (10 and 15 cm. field pieces) deployed near Hill 500. It appears that

the 45th Infantry was to constitute the main thrust and was to strike Allied

lines near the point where the Piva-Numa-Numa Road enters the perimeter

(129th Infantry sector). Simultaneously, the 23d Infantry was to launch its

attack from approximately 1,000 yards northeast of Hill 700 with the 3d

Battalion on the left and the 2d Battalion on the right and the 1st Battalion

in reserve. By the end of Y-day, the 3d Battalion was to have captured Hill

700 and the 2d Battalion was to have occupied Cannon Hill. These heights

overlooked the Piva airstrip, and the main strength of the 23d Infantry was

to have attacked the strip from the east while the 45th attacked from the

west. The 13th Infantry was to attack Hill 260 and then join with elements

of the 23d Infantry to proceed in the general direction of the airstrip.

The enemy's Torokina operation began on 8 March with preliminary

artillery fire directed mostly on the Piva airstrips. Blue Force counterfire

against hostile positions located in the general areas of Hills 1111 and 501

began immediately. The main Japanese drives began under the cover of

darkness during the night of 8 March and the morning of 9 March at the three

points on the perimeter. In the east sector patrol, contacts and fire fights

took place in the vicinity of Hill 260. To the north on Hill 700, the Japanese
294 WOUND BALLISTICS

infiltrated through Allied lines and occupied the northwest slope of the hill.

Blue Force counterattack reduced the Japanese positions, and the perimeter

was reestablished. In the northwest sector, several fire fights occurred. The

Japanese had occupied strong points on Hill 260 and severe fighting resulted

in retaking these points, but by 11 March two Blue Force companies occupied

Hill 260 with the exception of strong points on the southeast slope. Another

attack on the northern sector was repulsed. Meanwhile, preparations for an

enemy drive from the northwest continued. On 12 March, three major

attacks from the northwest near the Numa-Numa Trail placed the Japanese

within the U.S. perimeter. American tank-infantry teams reestablished the

lines next day. The same Blue Forces on Hill 700 received and repelled the

third attack on that position. On 15 March, another attempt was made by

the Japanese to break through the sector held by the 129th Infantry. Tankinfantry counterattack again restored the perimeter. The next strike by the

enemy was again from the northwest near the Piva-Numa-Numa Trail on 17

March. Although a 75-yard penetration was made for the third time, tanks

and infantry drove the enemy back. For a week, the Japanese remained relatively quiet, regrouping their forces opposite the northwest sector of the

perimeter. Smaller holding forces which were dug in were contacted on the

other sectors. On 24 March, after a feeble attempt at laying an artillery barrage, the Japanese struck toward the Piva airstrips once more, penetrated the

129th Infantry lines, and again were driven back, losing 300 men and a field

gun. On each occasion when penetration was made, the enemy succeeded in

occupying pillboxes within the U.S. perimeter only to be dislodged with heavy

losses.

The Japanese did not again attack in force after the repulse on 24 March

and began a general withdrawal. Hill 260, however, was not evacuated by

the enemy until 28 March. From 28 March to 22 April when this study was

completed, contact with the enemy was limited to a few fire fights, patrol skirmishes, and occasional shelling of the airstrips. There were 5,522 Japanese

dead counted between 8 March and 22 April. This, however, did not include

all areas subjected to U.S. artillery fire.

Battle of the Perimeter

Operations on Hill 260 4

The original garrison on Hill 260, a reinforced platoon from Company C,

was attacked by a Japanese force of undetermined size at dawn on 10 March.

The enemy generally occupied the area south of the outpost tree (fig. 160),

and, from this date until the termination of the battle, the Japanese tried to

increase their garrison and improve their positions on that side of the hill in

order to secure observation for an all-out attack on the main line of resistance.

4 Report, Lt. Col. Wim. J. Mahoney, Executive Officer, Headquarters, 182d Infantry, Americal Divieion.
BOUGAINYILLE CAMPAIGN 295

FIGURE 160.-Focal point of entire Hill 260 battle. Banyan

tree used as an Americal Division artillery spotting post. In

the 20-day fight for the hill, 541 Japanese were killed.

The terrain was that of an elongated hill with moderately steep sides

covered by rain jungle. The outpost tree (fig. 160), around which the heaviest

fighting occurred, was one of a common variety of trees on Bougainville, the

roots of which plus excavation make a very strong defensive position (fig. 161).

After the initial attack, the Japanese held the south end of Hill 260.

They greatly increased the force which had made the original attack because

they beat back the Allied attempt to storm the northwest, southwest, and

southeast ridges of the hill during the period 11-17 March. Apparently,

their main route of supply and evacuation was down the steep east side of

the hill, then north clinging to the east side of the west bank bluff overlooking

the Torokina River. This route was well concealed and in defilade and difficult

to reach by fire. After the initial engagement, reinforcements were sent to

secure the north side of Hill 260. The establishing of a perimeter there and

the continual pressure on the Japanese positions completely neutralized the

effect of the offensive action taken by the Japanese. The possession of Hill
296 WVOUND BALLISTICS

U.S. Army photo

FIGURE 161.-Banyan trees are common in the jungle on Bougainville

and offer excellent protection. The outpost tree on Hill 260 was of this

variety.

260 by the enemy would have jeopardized a considerable portion of the Allied

main line of resistance.

From the outset, the problem on Hill 260 was one of ejecting the Japanese

from the south end of the hill. Their positions were well dug in (fig. 162),

and the various American assaults to take the hill were turned back with

heavy casualties. Artillery and mortars were useful in blasting Japanese positions in the general area, but because of the proximity of American troops,

prepared fires could not be used on the Japanese positions just outside the U.S.

perimeter. Artillery was effective on the exposed southwest slope, and after

a week's fighting the Japanese were pretty well removed from that area (fig.

163). But those in defilade on the southeast slope dug in and countered every

American move. Various means were used to force the Japanese from their

dugouts during the closing 10 days of the battle. It was obvious at that time

that the Japanese garrison was considerably reduced in numbers although

there was no corresponding lessening of firepower. Flamethrowers and gasoline ignited with thermite grenades reduced a few pillboxes (fig. 164). As

late as the morning of 28 March, Japanese were seen near pillboxes on the

southeast slope. On the morning of 28 March, three patrols were sent around

the base of the hill to fire on the Japanese. When there was no fire, the Allied

patrols investigated and found that the Japanese had evacuated. At 1246,

28 March, Hill 260 was secured. On the morning of 30 March, the 2d Battalion, 182d Infantry, was replaced on the hill by 1st Battalion, 24th Infantry.
BOUGAINVILLE CAMPAIGN 297

ift

U.S. Army photo

FIGURE 162.-Jungle growth on Hill 260, showing protection afforded by

trees.

FIGURE 163.-Hill 260 being shelled by Americal Division artillery fire, on

19 March. The firing continued for several hours at the end of which time

it was believed that all enemy resistance had been neutralized. Note partial

destruction of jungle growth.

603225ýv62- 21
298 WOUND BALLISTICS

FIGURE 164.-Enemy pillbox on Hill 260. The dense jungle growth has been

entirely cleared away by artillery fire.

American forces engaged.-Companies B, E, F, G, and H plus one platoon

of Company K, 182d Infantry, and Company G, 164th Infantry, actively took

part in the action on the hill. All other companies in the regiment were in

general support plus A and B Companies, 57th Engineer Combat Battalion;

246th and 247th Field Artillery Battalions; 82d Chemical Battalion-total,

1,350 men.

Japanese forces engaged.-Elements of the 13th and 23d Infantry Regiments, both part of the 6th Division, were identified as taking part in the battle

for Hill 260. It was estimated that 1,400 Japanese were involved in this action.

Table 58 lists the casualties sustained by the 1,350 U.S. troops engaged

on Hill 260.

In comparison to the other two main thrusts by the enemy on the perimeter,

there was more offensive action by U.S. troops on Hill 260. The enemy in

the initial attack had captured and had managed to defend the outpost tree

which was the focal point on the hill. Furthermore, the character of the

terrain lent itself readily to defense and prevented the effective use of tanks.

The heaviest casualties were in the 182d Infantry with 800 troops involved

(table 59).

Estimates of Japanese killed and wounded were difficult to make because

of their practice of carrying away and burying their own dead. A total of 212

Japanese bodies were found by U.S. troops on Hill 260, and the Americal

Division G-2 (intelligence) listed 541 Japanese as the total killed. The ratio

of Japanese to U.S. troops killed was 7.6 to 1. In addition, many wounded
BOUGAINVILLE CAMPAIGN 299

were seen going to the rear, and it is believed an entire battalion plus a number

of supporting troops were virtually wiped out. The heaviest fighting occurred

during the period 10-14 March and, as indicated later by prisoner-of-war

reports, this engagement broke up the initial attack of the entire Japanese

18th Infantry Regiment on the Bougainville perimeter.

TABLE 58.--Distribution of 713 casualties among 1,350 U.S. Army troops engaged on Hill

260, by category

Number of casualties Percent ofCategory Enlisted Total Total

Officers men Total casualties troops

engaged

Killed-in-action -------------------------- 8 63 71 9. 9 5.2

Wounded:

Seriously --------------------------- 9 204 213 29.9 15.8

Slightly ---------------------------- 37 370 407 57. 1 30.2

Missing-in-action ----------------------- 4 18 22 3. 1 1.6

Total ---------------------------- 58 655 713 100.0 52.8

TABLE 59.-Distribution of 426 casualties among 800 men of the 182d Infantry engaged on

Hill 260, by category

U.S. casualties Category Total troops engaged

Number Percent

Percent

Killed-in-action ------------------------------ 63 14.8 7. 9

Wounded:

Seriously --------------------------------- 106 24.9 13.2

Slightly --------------------------------- 256 60. 1 32. 0

Self-inflicted ---------------------------- 1 .2 . 1

Total --------------------------------- 426 100. 0 53. 2

Operations on Hill 700

The terrain here was mountainous but mostly second growth (fig. 165)

rather than virgin jungle. The sides of the ridges were very steep (fig. 166)

and at one point of the assault were almost precipitous. The action by U.S.

troops was largely defensive but did involve the recapture of certain positions

into which the Japanese had infiltrated. A one-way road leading along behind

Allied lines for a time was under enemy fire (fig. 167), necessitating a difficult

carry (fig. 168) for the litter bearers of more than a thousand yards.

5 Report, After Action Operations, 37th Infantry Division, pt. II, G-3 Operations Narrative, 8 Nov. 1943-30 Apr. 1944.
300 WOUND BALLISTICS

U.S. Army photo

FIGURE 165.-Partially cleared jungle growth on Hill 700. Through this

draw, the Japanese made their approach to the hill.

FIGURE 166.-Precipitous hillside off the perimeter road. Grenades

were rolled down this bank causing many casualties.
BOUGAINVILLE CAMPAIGN 301

FIGURE 167-Wounded being transferred from halftrack to jeep. Halftrack

was used because road was under fire.

FIGURE 168.-Wounded soldier being helped down the side of Hill 700

by two medical aidmen.
302 WOUND BALLISTICS

On the morning of 8 March, the Japanese attack began with some artillery

and spasmodic small arms fire which continued throughout the day. During

the night of 9 March, boobytraps warned of attack followed by hostile fire

from mortars and rifles. At dawn, it was found that at least one company of

Japanese had occupied the north slope and crest of Hill 700 and had penetrated

the Allied line to a depth of 75 yards over a 100-yard front. During the day,

a counterattack by the 1st and 2d Battalions of the 145th Infantry regained

several pillboxes on the south slope of the hill. One tank was used with fair

success along the road which was under fire. On 10 March, the enemy retained

possession of the crest of the hill in spite of continued ground action. Efforts

to reach the Japanese positions on Hill 700 by engineer" polecharges," bangalore

torpedoes, and bazookas were without avail and resulted in numerous casualties due to the excellent Japanese field of fire.

At 1700 hours on 10 March, a determined attack was made by U.S. forces

who, in spite of intense enemy light and heavy mortar and artillery fire (fig.

169), succeeded in driving the enemy from the crest of Hill 700. Japanese

concentrations coming up to reinforce this area were subjected to heavy

bombing and artillery fire which was very effective. On 11 March at daylight,

the enemy made a general assault on Cannon Hill held by the 3d Battalion of

U.S. Army photo

FIGURE 169.-Japanese 75 mm. gun emplacement on Blue Ridge

that was used by the enemy in their attack on Hill 700. Interior

view; note the large window.
BOUGAINVILLE CAMPAIGN 303

the 145th Infantry. The attack was repulsed with the exception of one pillbox

gained by the enemy on Hill 700 (fig. 170). Japanese losses were reported as

enormous with the enemy assault wave attacking over piles of their own dead.

On 12 March after severe fighting, U.S. forces succeeded in driving the enemy

from Hill 700. A total of 399 Japanese dead were counted within the wire on

the crest and on the forward slope of the hill. On the night of 13 March, the

enemy again attacked in the draw west of Hill 700. Searchlights were used

successfully to reflect light from the overhanging clouds, and the attack was

repulsed. After this date, only intermittent contact was made with the

enemy in this area.

FIGURE 170.-Enemy dead killed while defending their position in a

pillbox on Hill 700.

During the engagement on Hill 700, there were approximately 2,600 U.S.

troops involved. Table 60 summarizes the various types of casualties among

the 519 total casualties.

A total of 2,219 (719 counted, 1,500 estimated) Japanese were killed in

action during the engagement of Hill 700. For this encounter, the ratio of U.S.

dead (KIA plus DOW) to Japanese dead was 1 to 36.

The large number of enemy dead estimated rather than counted was due

to the enemy custom of burying several bodies in one grave and also to the

large number killed by U.S. bombing and artillery fire behind the lines, making

it impossible to obtain an immediate count.
304 WOUND BALLISTICS

TADLE 60.-Distribution of 519 casualties among 2,600 U.S. troops engaged on Hill 700, by

category

Casualties

Category Total troops

engaged Number Percent

Percent

Killed-in-action ------------------------------- 45 8. 7 1.7

Wounded-treated-died ------------------------- 16 3. 1 . 6

Total-------------------------------- 61 11.8 2.3

Wounded living:

Returned to duty -------------------- 215 41.4 8.4

Hospitalized ----------------------------- 243 46. 8 9.3

Total --------------------------------- 458 88. 2 17.7

Grand total ---------------------------- 519 100.0 20.0

Operations on 129th Infantry sector6

The terrain here was fairly flat (fig. 171) covered with second growth and

provided fair ground for tank maneuvers. The action here was characterized by

temporary withdrawals of U.S. troops from forward positions under the pressure

of Japanese attacks followed by highly effective tank supported counterattacks

(fig. 172).

Oil 6 March, there were numerous patrol contacts and clashes with superior

Japanese forces advancing'along'tlhe Laruma River, and Allied outposts were

forced back. The main attacklby theJapanese 45th Infantry was launched on

the morning of 12 March and succeeded 'in penetrating Allied wire and in

occupying several pillboxes, some of which were retaken by counterattack.

Again, in the early morning of 13 March, the enemy succeeded in taking six

more pillboxes, and counterattacks supported by tanks resulted in retaking all

but two pillboxes (fig. 173). The Japanese were attacking very strong positions in relatively open terrain, and their losses were heavy, estimated at 350-

500 dead on this day, compared with 2 killed and 10 wounded in the 129th

Infantry sector. The next day, 14 March, was a relatively quiet day during

which Allied wire was repaired under cover of the tanks. On 15 March at

0400 hours, the Japanese again attacked and, after heavy fighting, penetrated

to a depth of 100 yards over a 1,000-yard front. A tank-supported counterattack failed to dislodge the enemy who had now brought in at least one 77 mrm.

field gun. A second counterattack, supported by tanks and by a heavy concentration of artillery, reestablished the Allied line. Spasmodic fire occurred

6 See footnote 5, p. 299.
BOUGAINVILLE CAMPAIGN 305

;ýJ;

FIGUIRE 171.-A cleared field of fire in front of the 129th Infantry sector.

U.S. Army photo

FIGURE 172-Light tank of the 754th Tank Battalion. This tank was

in action against the Japanese at Company G, 129th Infantry, 37th

Division perimeter. The cleared area in front of perimeter greatly

facilitated the use of tanks.

603225-62---22
306 WOUND BALLISTICS

FIGURE 173.-Soldiers of Company F, 129th Infantry, 37th Division,

crawling up to barbed wire. Japanese were just in front of and to left

of the wire and occupied the American pillboxes to the left and to the

right (not shown in picture). American troops were surrounded until

tanks were called upon to knock out the enemy.

on 16 March, but on 17 March at 0400 hours the enemy again attacked, breaching Allied wire to a depth of 75 yards where the attacks stopped and the enemy

dug in. Prisoners' statements indicated that Allied artillery had taken a huge

toll in the support and reserve units. Allied artillery continued a heavy harassing fire (fig. 174), and except for sporadic fire fights the sector was relatively

quiet until 24 March when shortly after midnight the Japanese began to infiltrate. By daylight, the enemy had penetrated 300 yards (fig. 175). During

the day, there was heavy hole-to-hole fighting and tank-supported counterattacks (fig. 176) which regained control of the high ground. During the latter

fighting, the Japanese losses were large (fig. 177), 310 dead were counted within

Allied wire compared to U.S. losses of 16 killed and 42 wounded. The artillery

placed an extremely heavy concentration in front of Allied lines (fig. 178)

following which only sporadic attempts to penetrate Allied wire occurred.

Table 61 gives a breakdown of the 450 casualties that were sustained by

the 1,850 U.S. troops engaged on the 129th infantry sector.

Approximately 4,300 Japanese troops were engaged on the 129th sector

up to 16-17 March when an additional 600 men were brought into the area.

The actual count of enemy dead was 2,373. The ratio of U.S. dead (KIA

plus DOW) to Japanese dead was 1 to 30.
BOUGAINVILLE CAMPAIGN 307

U.S. Army photo

FIGURE 174.-An area devastated by U.S. artillery shell fire.

FIGURE 175.-Scene at area command post during action of Japanese

infiltration of 2d Battalion, 129th Infantry, 37th Division. Reinforcing

troops of Company A are in prone positions as an enemy machinegun opens

fire. Tanks in background were called upon to knock out enemy positions.

Burning jeep is the result of a Japanese grenade.
gO• WOUND 1lALLIRTIC9

FIGURE 176-Scene of a General Sherman medium tank and infantrymen attacking

Japanese positions along the perimeter of 129th Infantry, 37th Division.

FIGURE 177.-Japanese killed on the perimeter of Company F, 129th Infantry,

37th Division. The enemy dead were hit by so many missiles it was impossible

to determine cause of death.
BOUGAINVILLE CAMPAIGN 309

4,4,

U.S. Army photo

FIGURE 178.-Japanese foxholes under bank of draw in 129th Infantry sector.

Note how jungle was cleared by artillery fire.

TABLE 61.-Distribution of 450 casualties among 1,850 U.S. troops engaged on 129th Infantry

sector, by category

Casualties

Category Total troops

engaged

Number Percent

Percent

Killed in action ------------------------------- 64 14.2 3. 5

Wounded-treated-died---------------------- 14 3. 1 .7

Total --------------------------------- 78 17. 3 4.2

Wounded living:

Returned to duty ------------------------- 160 35. 6 8. 6

Hospitalized ---------------------------- 212 47. 1 11.5

Total --------------------------------- 372 82. 7 20. 1

Grand total ---------------------------- 450 100.0 24.3

Comment on Relatively Large Number of Japanese Casualties

Since one of the purposes of this study was to make observations on the

relative lethal effects of weapons, the great disproportion between enemy and

U.S. casualties deserves some comment. It is estimated that the enemy had

8,527 killed in action out of 10,000 troops involved in combat, as contrasted
310 WOUND BALLISTICS

to 210 killed (180 KIA plus 30 DOW) out of 5,800 U.S. troops involved. This

is a ratio of 23.9 Japanese for each 1 of U.S. forces killed.

The approximate time for the Japanese attack was known, as well as the

most likely points of attack. Consequently, the enemy attacked against

extremely well prepared positions. United States supplies of ammunition

were abundant and easily accessible to the front by an excellent system of

roads. The concentration of firepower, especially artillery and mortar, was

intensive. United States artillery concentration on Japanese reinforcements

moving over restricted jungle tracks was particularly effective. United States

forces had complete control of the air making it easy to observe, as well as to

bomb, enemy troop concentrations. The limited supply of enemy artillery

and ammunition had to be transported under great difficulties over the most

rugged terrain. Furthermore, as in other campaigns in the South Pacific,

enemy artillery was never used in concentration as judged by U.S. standards.

Whenever the Japanese broke through Allied lines, which they did repeatedly,

they never appeared to have sufficient reserves to follow up the advantage.

There is evidence that the concentration of U.S. artillery fire on Japanese

reinforcements prevented the accumulation of any effective body of troops.

On Hill 260, the ratio of Japanese dead to U.S. dead was 8 to 1. This

was the most favorable ratio for the Japanese in any of the three sectors. The

enemy had taken the hill very early and acquired the advantage of the terrain.

Consequently, the action of U.S. troops was mostly offensive under the disadvantage of retaking a hill in which the enemy occupied well dug-in positions.

The terrain prevented the use of tanks, and the proximity of the lines limited

the use of U.S. artillery.

On Hill 700, the ratio of Japanese dead to U.S. dead was 36.3 to 1. While

it was necessary here, also, to retake the crest of the hill, the major part of

U.S. action was defensive in well-prepared positions. The enemy approach

to this sector was limited because of the terrain, making artillery concentrations on their reinforcements highly effective and accounting for the greater

number of enemy dead. On reaching the vicinity of U.S. lines, the enemy

attacked up steep slopes in great concentration.

On the 129th sector, the ratio of Japanese dead to U.S. dead was 30 to 1.

Here the approach for the enemy via the Numa-Numa Trail was easier, and

the terrain permitted attack on a wider front. The terrain was also favorable

to the use of tanks, and these were highly effective in retaking positions lost

after the enemy had exhausted the force of their initial impact and their

reserves had been disrupted by U.S. artillery. On this sector, also, the enemy

attacked in great concentration on a narrow front against strongly prepared

positions. Against these concentrated attacks, the use of canister-type ammunition was highly effective.

Control of the air, the use of tanks, and superior firepower in defensive

positions, in addition to the greater and more effective concentrations of

artillery fire, were the chief factors accounting for the large number of the

enemy dead.
BOUGAINVILLE CAMPAIGN 311

DISPOSITION OF BATTLE CASUALTIES AND ANATOMIC

DISTRIBUTION OF WOUNDS

In this chapter, the term "battle casualty" is used to designate only

those combatants who were killed or wounded by weapons. All deaths or

injuries produced by other agents, such as falling trees, motor vehicle accidents, or others of a similar nature have been excluded. The total number

of casualties includes all those wounded both by Allied and enemy weapons.

Wounds caused by Japanese weapons and those resulting from U.S. weapons

have been separated and are discussed under separate sections. It was impossible to ascertain which of the self-inflicted wounds were due to the soldiers'

willful misconduct and which were accidental. These wounds are included

and discussed in the section on U.S. weapons. It is known that 12.3 percent

of the total casualties were produced by U.S. weapons. The actual percentage,

however, may be slightly greater, for it is known that the enemy did use some

U.S. captured weapons, particularly rifles and grenades.

There were 2,335 battle casualties. Of these, 547 (23.4 percent) were

lightly wounded and were returned to duty immediately from the battalion

aid or collecting stations. These 547 casualties are included in the initial

total for the sake of completeness, for it was assumed that reports of casualty

studies in other armies are based on computations which also include this

group of minor wounds. However, in the remainder of the study, these patients

have been excluded, because of the insignificant disability entailed by their

injuries. Therefore, this study was based primarily on 1,788 casualties who

were killed in action or who sustained wounds which necessitated hospital

treatment. The term "hospital" includes two augmented clearing stations.

The majority of patients returned to duty in the first echelon I were treated

in these clearing stations. With few exceptions, all patients who were returned

to duty in the first echelon left the hospital within 30 days. Those patients

in a hospital of the rear echelon, who were not evacuated to the United States,

were usually returned to duty within 120 days.

Since no exact definition for the term "killed in action" S has been established, an arbitrary standard was selected. In this study, KIA (killed in action)

includes only those killed instantly, those found dead, and those who were

mortally wounded and died shortly thereafter. Reports from division surgeons

invariably contained a greater number of KIA than are found in this study.

Explanation for this discrepancy is apparent and lies in the fact that the battalion surgeon frequently included, among the KIA's, patients who were

initially seen alive but who were known to have died later. In this particular

campaign, because of the close proximity of hospitals to the front, a large number

7 In this chapter, "first echelon" is defined as the beachhead perimeter on Bougainville Island.-J. c. B.

8 The usual definition is: Wounds directly due or attributable to enemy action which result in death before

the casualty is admitted to a medical installation or receives treatment from a medical officr.-J. C. B.
312 WOUND BALLISTICS

of casualties are included under WIA (wounded in action), 9 who perforce,

under less favorable circumstances, would have been classified as killed in action.

Table 62 gives a breakdown of the Bougainville casualties during the

survey period and the general disposition of the WIA. It may be seen that

the 395 dead (320 KIA and 75 DOW) constitute 16.9 percent of the total

casualties. Thus, there was approximately one battle death (KIA plus DOW)

among every six casualties (WIA, including DOW, plus KIA). Nearly 70

percent of all casualties were returned to duty within the theater and, of the

1,940 living wounded, 1,622 (83.6 percent) were returned to duty. However,

547 of these were returned to duty from a first aid post and did not require

hospitalization. These soldiers had very minor wounds and were not lost to

battle. Since the incapacitating effect of weapons on this group was negligible,

they were eliminated from the remainder of this study, leaving 1,788 casualties

who were killed or whose wounds were of such severe degree that they were

lost to the battle. Using this criterion, there was approximately one battle

death (KIA plus DOW) among every four and a half casualties (WIA, including

DOW, plus KIA). The WIA (including DOW)/KIA ratio was 4.6 : 1. Those

who died and those who were evacuated to the United States were classed as

"lost to service" and comprised 30.5 percent of the total casualties.

A study of both the living and the dead is essential in order to gain an

accurate and complete picture of the anatomic distribution of wounds produced

TABLE 62-Distribution of 2,335 Allied casualties in Bougainville campaign, from 15

February to 21 April 1944, inclusive, by category

Casualties

Category _

Number Percent

Killed-in-action --------- ------------------------- 320 13.7

Wounded-treated-died ----------------------------- 75 3.2

Total ------------------------------------- 395 16.9

Wounded, living:

Evacuated to United States ---------------------- 318 13.6

Returned to duty fromAid station ---------------------------------- 547 23.4

First echelon hospital -------------------------- 700 30. 0

Rear echelon hospital - --------- - 375 16. 1

Total -------------------------------------- 1,940 83. 1

Grand total -------------------------------- 2,335 100.0

SThe usual definition is: Wounds directly due or attributable to enemy action which necessitate admission of the

casualty to a medical installation and treatment by a medical officer. This generally includes those who are wounded

treated, and died later (died-of-wounds (DOW)) or preferably wounded-treated-died (WTD).-J. C. B.
BOUGAINVILLE CAMPAIGN 313

by various weapons. Although many wound studies have been made on the

living, few records are available which analyze the effect of weapons on both

the dead and living. In this investigation, data concerning all those who were

killed in action as well as those who were wounded in action and died later have

been collected and combined with the records of the living wounded.

Information regarding the circumstances of wounding in the living is

relatively easy to obtain. Frequently, the facts may be elicited by an interview with the person wounded. However, the information will be still more

accurate if checked with an eyewitness. To secure accurate details concerning

the dead, however, is much more difficult. Post mortem examinations should

be done, of course, whenever possible. Autopsies, however, were limited by

the fact that all bodies could not be recovered and also by the fact that some

were decomposed when recovered. Unfortunately, rapid deterioration occurs

in the tropical climate of Bougainville, and for sanitary reasons the dead must

be buried as soon as possible. The dead, when recovered, frequently exhibit

wounds other than those which produced death. Wounds inflicted after death

were especially common in areas subjected to concentrated artillery or mortar

fire. Furthermore, it was often difficult and frequently impossible to identify

the lethal weapon from the appearance of the wound or the missiles recovered

at autopsy. In many instances, discrepancies were found when the emergency

medical tag, hospital record, and post mortem findings were compared. It

became apparent, therefore, that the true sequence of events leading to death

could be secured only by careful personal questioning of witnesses who saw

the soldier killed or who knew personally of the circumstances surrounding his

death. By adhering to this method of investigation, a relatively high degree

of accuracy was achieved, not only in the records of the dead but also of the

living.

All casualties were classified under anatomic regions according to the location of the wound. In many instances, a major wound was accompanied by

one or more minor wounds. In this event, the anatomic location of the major

wound alone determined the classification. Furthermore, if a single wound

among others was responsible for death or disability, the anatomic location of

that wound determined the classification. In the classification of the casualties, it became necessary to add to the conventional division by anatomic

regions, an additional group which was designated "Multiple Wounds." The

term "multiple wounds" is used for those casualties sustaining two or more

wounds, either one of which might have been responsible for the soldier's death

or for rendering him unfit for action. It was difficult or impossible to classify

accurately all casualties who received more than one wound. In many instances, the dead were struck by other missiles after death, under which

circumstances it was not possible to decide which of several wounds produced

death. In other instances, decomposition of the body made examination

unsatisfactory. For these and other reasons, some patients were placed in the

multiple wound classification, who probably should have been included properly with those grouped under single anatomic regions. Because of the diffi-
314 WOUND BALLISTICS

culty in analysis of the "multiple wounded," every effort was made to keep to

a minimum the number so classified. Nevertheless, the "multiple wounded"

constituted 18.6 percent of the casualties (table 64).

It is desirable in a study of this kind, if possible, to evaluate the influence

of various factors on the anatomic distribution of wounds. Particular consideration should be given to the type of action (defensive or offensive), available

cover or protection, armor, terrain, and type of weapon and projectile employed.

Furthermore, if a true representation of the distribution of wounds is to be

established, the data should be derived from a study of the dead as well as the

living.

In table 63, the anatomic distribution of wounds in the living and dead in

Bougainville is compared with similar wound distributions in the living in two

past wars and in World War II. It will be observed that head wounds were

more frequent at Bougainville than elsewhere. Perhaps this was due to the

relatively close range of rifle fire in jungle warfare. Another discrepancy is

observed by comparing the percentage of wounds of the head, chest, and upper

extremities in the living. For example, wounds of these regions on Bougainville attained a total of 60.5 percent, whereas the Russians in World War II

reported a total of only 48.5 percent.

TABLE 63.-Comparison of wounds in living wounded of two past wars and World War II with

casualties of Bougainville campaign, 15 February to 21 April 1944, inclusive, by anatomic

location

Living wounded Bougainville campaign

Anatomic location World War I World War II Civil Living War wounded I Dead I

U.S. Army British U.S. Army Russian

Army Army

Head, face, neck ------ 9. 1 11.4 16. 8 16. 1 9. 1 20. 7 49. 0

Chest ----------------- 11.7 3. 6 7. 8 9. 8 11.4 12. 4 29. 6

Abdomen ------------- 6. 0 3. 4 4. 7 5. 6 6. 2 5. 7 16.3

Upper extremities ----- 36. 6 36. 2 30.4 28. 2 28. 0 27. 4 . 3

Lower extremities ----- 36. 6 45. 4 40. 3 40. 3 45. 3 33. 8 4. 8

Total ----------- 100. 0 100. 0 100. 0 100. 0 100. 0 100. 0 100. 0

1 Multiple wounds excluded.

Source: Monthly Progress Report, Army Service Forces, War Department, April 1944, Section 7: Health.

With the exception of head wounds, the anatomic distribution of wounds

in jungle warfare does not appear to differ greatly from the distribution of

wounds reported for other types of warfare. In the absence of available data

on other types of warfare, it is difficult to derive an adequate explanation for

this high frequency of head wounds. The mortar followed closely by the rifle

was the most frequent cause of wounds of the head. Since rifles are used frequently, and at close range, in jungle warfare, it is suggested that the greater
BOUGAINVILLE CAMPAIGN 315

number and accuracy of bullets might account for the high incidence of head

wounds. However, no proof can be offered for this hypothesis. The factor of

exposure appears to offer no better explanation, since the head is apparently

exposed to the same degree in jungle as in other types of warfare. The predominance of lower extremity wounds is accounted for by the high incidence of

mortar hits.

Table 64 shows the anatomic distribution (regional frequency) of wounds

in the 1,788 Bougainville battle casualties.

TABLE 64.-Distribution of wounds in 1,788 battle casualties, by anatomic location (regional

frequency) 1

Total casualties Dead Living

Anatomic location

Number Percent Number Percent 2 Number Percent 2

Head -------------------------- 384 21.5 144 37. 5 240 62.5

Thorax ------------------------ 231 12.9 87 37. 7 144 62.3

Abdomen ---------------------- 114 6.4 48 42. 1 66 57.9

Extremities:

Upper --------------------- 320 17.9 1 .3 319 99.7

Lower --------------------- 407 22. 7 14 3. 5 393 96.5

Multiple ----------------------- 332 18. 6 101 30.4 231 69. 6

Total -------------------- 1, 788 100. 0 395 22. 1 1,393 77. 9

1 Any casualty with major wounds in more than one anatomic region is cataloged under "Multiple." Therefore

total number of wounds is same as total number of casualties.

2 Percent for dichotomy, dead versus living, by each anatomic location and for total dead versus living.

The anatomic distribution of wounds in the dead (table 65) is in striking

contrast to the distribution of wounds in the living (table 66). The low

incidence of extremity wounds among the dead is a rough index of the effectiveness of modern surgery, when dealing with wounds which do not involve

a vital organ. Multiple wounds hold second place among the dead. Bullets

(rifle and machinegun), mostly at close range, caused 58.2 percent of all deaths

(table 77), while high explosives (artillery, mortar, grenade, and mine) caused

38.8 percent. A consideration of those who were wounded in action and

died later (table 65) indicates that the major problem is encountered in wounds

of the abdomen and thorax. These two regions accounted for 65.3 percent

of all those who were wounded in action and died later.

An index of the degree of the residual disability may be obtained by a

consideration of the number of patients returned to duty or evacuated to the

United States (table 66). It should be noted that while the total number

of patients in the anatomic divisions varies considerably, the percentage

of patients returned to duty in each anatomic region remains remarkably

constant.
316 WOUND BALLISTICS

TABLE 65.-Distribution of wounds in 395 dead, by anatomic location

Total casualties Killed in action Died of wounds Anatomic location

Number Percent Number Percent I Percent 2 Number Percent I Percent 2

Head --------------- 144 36. 5 134 41. 9 93. 1 10 13. 3 6. 9

Thorax ------------- 87 22. 0 66 20. 6 75. 9 21 28. 0 24. 1

Abdomen ----------- 48 12. 2 20 6. 2 41. 7 28 37. 3 58.3

Extremities:

Upper ---------- 1 .2 1 .3 100. 0

Lower --------- 14 3.5 6 1. 9 42. 9 8 10. 7 57.1

Multiple ------------ 101 25. 6 93 29. 1 92. 1 8 10. 7 7. 9

Total -------- 395 100. 0 320 100. 0 81.0 75 100. 0 19. 0

1 Percent killed in action or died of wounds by each anatomic location of total killed in action or died of wounds, respectively.

2 Percent for dichotomy, killed in action versus died of wounds, by each anatomic location and for total killed in

action versus died of wounds.

TABLE 66.-Distribution of wounds in 1,393 living wounded, by anatomic location

Total casualties Returned to duty Evacuated to United

States

Anatomic location

Number Percent Number Percent I Number Percent

Head -------------------------- 240 17.2 199 82.9 41 17. 1

Thorax ------------------------ 144 10.3 110 76.4 34 23. 6

Abdomen ---------------------- 66 4.8 42 63. 6 24 36. 4

Extremities:

Upper --------------------- 319 22.9 243 76. 2 76 23.8

Lower -------------------- 393 28.2 308 78.4 85 21.6

Multiple ---------------------- 231 16. 6 173 74. 9 58 25. 1

Total -------------------- 1,393 100. 0 1,075 77. 2 318 22. 8

'Percent for dichotomy, returned to duty versus evacuated to United States, by each anatomic location and for

total returned to duty versus evacuated to United States.

Table 67 lists the regional frequency of wounds and the disposition of

the living wounded in the 1,788 casualties.

Head wounds alone were responsible for 384 or 21.5 percent of all battle

casualties. Of the 134 KIA in this group, death resulted from brain injury

in 125 and from wounds of the face and neck in 9. In the 10 patients who

were wounded in action and died later, 9 sustained brain injuries and 1 a

transection of the cervical spinal cord. A more detailed description of these 10

patients will be found in another section under "Treatment of the Wounded."

Of the surviving 240 patients, 157 (65.4 percent) were returned to duty in

the first echelon.
BOUGAINVILLE CAMPAIGN 317

I zý I -= 00 o

I' -, m- 1- 00

02 C C3~ 6 C~1

cq N 1icq -q

oq m

'C0 10 cc rC-.

0-.N I q r-~ r~-.

0 k- cD

cCC: 16CC 1-.i

o.20 tCC: ~ o 0Cý oo

m co eC:0 C9:

o *-z- tz C -i c ~C5 c

E- I- I

"il 00 C) C

C CC COCC C> C): QC

CC 0

C:. CC p.

~~0

ECO-- C i
218 WOUND BALLISTICS

In table 68, the head wounds previously summarized (in table 67) are

combined with those head wounds which are described later under "Multiple

Wounds," making a total of 505. It is evident by comparison of the two

tables that the ratio of the dead to those evacuated to the United States,

and to those returned to duty, remains relatively unchanged. The inclusion

of multiple wounds with those classified under single anatomic regions may

lead to duplication and confusion. For this reason, multiple wounds have

not been included in any tables except those devoted to the analysis of head

wounds.

TABLE 68.-Distribution of 505 casualties with head wounds (including multiple wounds), by

category

Casualties

Category

Number Percent

Killed-in-action ----------------------------------- 165 32. 7

Died of wounds ----------------------------------- 12 2. 4

Total -------------------------------------- 177 35. 1

Wounded, living:

Evacuated to United States -------------------- 62 12. 3

Returned to duty fromFirst echelon 1 -------------- 196 38. 8

Rear echelon 2 --------------- 70 13. 8

Total ---------------------------------- 328 64. 9

Grand total --------------------------- 505 100. 0

I Defined as the beachhead perimeter on Bougainville Island.

2 From hospitals on Guadalcanal, Espfritu Santo, and New Caledonia.

Thoracic wounds accounted for 12.9 percent of all battle casualties. Of

the dead, 66 were killed in action. Of the 21 who were wounded in action and

died later, 15 died during or following operation. Perforating wounds of the

thorax were present in all those who were killed or died later. Of 63 patients

returned to duty in the first echelon, only 3 bad wounds which penetrated

the pleural cavity; all others had wounds of the chest wall only. In the group

of 47 patients returned to duty from the rear echelon, 33 sustained chest wall

wounds only. Among the remaining 14 with lesions involving the lung or

pleura, 6 underwent lung operation. Of 34 patients who were evacuated to

the United States, 24 had injuries of the lung; 19 of this latter group were

treated by surgical operation and 5 by conservative measures. The remaining

10 patients had wounds of the chest wall which did not communicate with

the pleural cavity.
BOUGAINVILLE CAMPAIGN 319

A total of 114 patients sustained abdominal wounds. The abdomen was

struck less frequently than any other anatomic region, and these wounded

constituted the smallest number (6.4 percent) of all casualties. In 10 patients,

wounds involving both the abdomen and thorax with perforation of the diaphragm were present. Twenty patients were killed in action, one of whom

sustained a transection of the spinal cord. A relatively greater number (28,

24.6 percent) of patients were wounded in action and died later in this group

than any other. Of these 28 patients, only 3 died without operation. In

most instances, death resulted either from shock and hemorrhage or from

peritonitis. The entire group of 19 patients returned to duty in the first

echelon had wounds of the abdominal wall only. Of 23 patients returned to

duty from the rear echelon, 13 had abdominal wall wounds; 1 had a combined

thoracoabdominal wound; and the remainder bad visceral lesions distributed

as follows: Liver, 4; colon, 2; spleen, kidney, and bladder, 1 each. Fewer

patients wounded in the abdomen (36.9 percent) were able to return to duty,

than were those wounded in any other region. Of the 24 patients evacuated

to the United States, 18 had injuries of the abdominal viscera, 5 had abdominal

wall wounds, and 1 a transection of the cauda equina. The visceral lesions

among these patients were distributed as follows: Small intestine, 6; small

intestine and colon, 4; colon, 3; spleen and diaphragm, 2; stomach and liver,

colon and diaphragm, and bladder, 1 each.

Wounds of the upper extremity alone constituted 17.9 percent of all battle

casualties, yet wounds of this region carry a death risk of only 0.3 percent.

No patients died who received treatment. The number of patients returned

to duty in the first echelon is greater among those receiving upper extremity

wounds than among those wounded in any other region. Of these 175 patients,

4 had fractures of the hand and 2, incomplete fractures of the arm. In the

68 patients returned to duty from the rear echelon, there were 12 fractures as

follows: 6 of the bones of the hand and 2 each of the scapula, humerus, and

forearm. In the 76 patients evacuated to the United States, there were 58

compound fractures and 5 amputations. The fractures were distributed as

follows: Humerus, 23; bones of the forearm, 19; bones of the hand, 12; and

scapula, 4. The percentage of patients evacuated to the United States was

higher in upper extremity wounds than in wounds of any other anatomic

region.

Wounds of the lower extremity were the most numerous of all battle

wounds (22.7 percent) and accounted for next to the lowest mortality of any

region (1.5 percent KIA). There were six casualties classed as killed in action,

although with one exception all were alive when first seen. These soldiers

either could not be reached or else died before adequate medical aid could be

given. There were eight patients who were wounded in action and died later.

Seven of these died in the first echelon and one in the second echelon. Of

the seven deaths in the first echelon, two resulted from gas gangrene and five

from shock and hemorrhage. Two deaths in the latter group might have been

avoided by the use of a tourniquet. From the first echelon, 195 patients were
3920 WOUND BALLIRTICS

returned to duty. With the exception of one patient who had a chip fracture

of the tibia, all of these patients had soft-tissue wounds only. From the rear

echelon, 113 patients were returned to duty, 8 of whom had fractures of the

bones of the leg and 4 of the bones of the foot. In 85 patients evacuated to

the United States, there were 58 compound fractures distributed as follows:

Bones of the leg, 31; femur, 18; and bones of the foot, 9. In addition, there

were 10 amputations of the thigh or leg.

The risk of death in wounds of the extremities is low. In 727 casualties

with wounds of the upper and lower extremities, there were 15 deaths (2.0

percent). On the other hand, wounds of the extremities constituted half of

all patients evacuated to the United States. The majority of patients with

wounds of the extremities, who were lost to the service by evacuation, had

fractures as shown in table 69. Fractures among upper extremity wounds

are more common (29.5 percent) than among the lower extremity lesions (18.3

percent). The greater relative volume of soft tissue to bone in the lower

extremity may explain the lower incidence of fracture. On the other hand,

the explanation may lie in the fact that the percentage of high-velocity missile

TABLE 69.-Disposition of 319 casualties with wounds of upper extremities and 393 casualties

with wounds of lower extremities

Total living wounded Fractures Nonfractures nisposition ____________

Number Pcrcent _Number Percent 1 Number Percent I

Upper extremity wound

Returned to duty from- I

First echelon 2- - - - - - - - - - - - - - - - 175 54.9 6 3.4 169 96 6

Rear echelon3 - - - - - - - - - - - - - - - 68 21. 3 20 29. 4 48 70. 6

Evacuated to United States ----- 76 23. 8 08 89. 5 8 10. 5

Total --------------------- 319 100.0 94 29.5 225 70. 5

Lower extremity wound

Returned to duty fromFirst echelon2

2 .............. - 195 49. 0 1 0. 5 194 99. 5

Rear echelon3 --------------- 113 28. 8 13 11.5 100 88. 5

Evacuated to United States 85 21. 6 58 68. 2 27 31.8

Total -------------------- 393 100.0 72 18.3 321 81. 7

1 Percent for dichotomy, fractures versus nonfractures, under each disposition category and for total fractures versus

nonfractures by upper and lower extremity wounds.

2 Defined as the beachhead perimeter on Bougainville Island.

3 From hospitals on Guadalcanal, Espiritu Santo. and New Caledonia.
BOUGAINVILLE CAMPAIGN 321

wounds are slightly greater in the upper than in the lower extremity. Bullets

produced 36.9 percent of all wounds of the upper extremity and 27.9 percent

of the wounds of the lower extremity. Patients who returned to duty in the

first and second echelons usually had fractures of small bones, chip and perforating fractures, and other fractures with minimal bone damage. It should

be noted that 89.5 percent of the patients with wounds of the upper extremity

and 68.2 percent of those with wounds of the lower extremity were evacuated

to the United States because of fractures. The cause of fractures is discussed

further in a later section devoted to the relative effect of weapons.

Wounds were classed as multiple only if two or more wounds of different

regions could have caused death or disability. Such wounds caused 18.6

percent of all battle casualties. As in wounds of the head when death occurred, it was usually instantaneous. On the other hand, a relatively high

percentage of patients with multiple wounds were returned to duty. In a

group of 91 patients returned to duty from the first echelon, there were 203

soft-tissue wounds distributed as follows: Upper extremity, 73; lower extremity, 61; thoracic wall, 22; face and neck, 20; scalp, 14; abdominal wall, 8; and

eye, 5. Present also were chip fractures of the clavicle, finger, and leg. From

the rear echelon, 82 patients were returned to duty with 186 soft-tissue

wounds distributed as follows: Upper extremity, 62; lower extremity, 61;

thoracic wall, 24; face and neck, 17; scalp, 10; abdominal wall, 8; abdominal

perforations, 2 (spleen and rectum); eye, 1; and lung perforation, 1. There

were 8 chip fractures, 6 of the upper and 2 of the lower extremity, and also 2

perforating fractures of the pelvis; in addition, there were 2 finger amputations.

There was a total of 151 soft-tissue wounds and fractures in 58 patients who

were evacuated to the United States. The 38 fractures were distributed as

follows: Upper extremity, 20; lower extremity, 16; and jaw, 2. The following soft-tissue wounds were present: Upper extremity, 36; lower extremity, 34; thoracic wall, 16; face and neck, 12; eye, 5; amputations, 5; scalp,

3; brain, 1; and abdominal wall, 1. Among these patients with multiple

wounds, fractures were the chief cause for evacuation to the United States.

The anatomic distribution of wounds may vary according to the type of

weapon causing the wound, the degree of exposure of different parts of the

body, the protection afforded by various means, and the direction of fire. If

the body were unprotected in an atmosphere of flying missiles of equal distribution, wounding should occur in direct proportion to the exposed surface

area. However, such a theoretical condition never exists. On the contrary,

missiles usually move in one direction at a given time. The projected area

of the body if completely exposed, therefore, offers a better measure for the

study of the probable hits. The mean projected body area1° is obtained from

projection in three positions, standing, kneeling, and lying. The hits with

all weapons are compared with the mean projected body area (table 70). The

head is the only region in which the percentage of wounds appreciably ex10 Burns, B. D., and Zuckerman, S.: The Wounding Power of Small Bomb and Shell Fragments. R. C. No. 350

of the Research and Experiments Department of the Ministry of Home Security.
322 WOUND BALLISTICS

ceeded the percentage of the projected area for that region. The percentage

of hits in the abdominal area is considerably less than the percentage of its

projected area. The question may be raised why wounds of the head so far

exceed the projected head area. Was this due to good marksmanship or

exposure? Obviously, the head must be exposed for marksmanship to be

effective. Since wounds caused by rifle bullets and mortar shell fragments

were found in significant numbers and the circumstances were known with

reasonable accuracy, they may be compared. The directed fire of the rifle

and the undirected hits with mortar fragments were found to approximate

closely the total hits by all weapons. This is evidence that exposure is one

of the chief factors in accounting for the high incidence of head wounds.

Nevertheless, the number of wounds caused by rifle fire does exceed the number

caused by mortar fragments in the head, upper extremity, and thorax. This

may be interpreted as evidence that marksmanship does play a small but

important part in the high incidence of head wounds. This observation is

further substantiated by the fact that the lower extremity presents the reverse

of these findings.

TA3LE 70.-Mean projected body area and wound distribution (excluding multiple wounds)

Total hits for all Total bits for rifle Total hits for mortar Mean weapons' Anatomic location projected

body area

Number Percent Number Percent Number Percent

Percent

Head ---------------- 12.0 384 26. 4 119 29. 1 127 23. 7

Thorax --------------- 16. 0 231 15. 9 66 16. 2 79 14. 7

Abdomen ------------- 11.0 114 7. 8 30 7. 3 39 7.3

Extremities:

Upper ----------- 22.0 320 22. 0 99 24. 2 119 22. 2

Lower ----------- 39.0 407 27. 9 95 23. 2 172 32. 1

Total ----------- 100. 0 1,456 100.0 409 100.0 536 100. 0

I Includes all other weapons in addition to rifle and mortar which arc shown specifically.

THE DIFFERENT WEAPONS CAUSING BATTLE CASUALTIES

It is obvious that the number of battle casualties produced by various

weapons will depend upon the type of warfare, the number of weapons employed, and the training and tactics of the opposing forces. Thus, the measure

of effectiveness of a given weapon must, of necessity, vary according to the circumstances under which it is used. The effectiveness of a weapon depends not

only upon the total number of casualties it produces but also upon the ratio

of the killed to wounded and upon the severity of the wound. In a certain local situation, the most effective weapon might be one which temporarily disabled

the greatest number of the enemy and hence allowed the capture of a particular
BOUGAINVILLE CAMPAIGN 323

objective or the winning of a single battle. If the effectiveness of a weapon is

to be measured by this latter criterion, it would be necessary to set up an arbitrary definition of "temporary disability." In this event, a solution of the

problem would be found in classifying the wounded on the basis of "ability to

continue combat if life depended upon it."

The ratio of the killed to wounded is subject to various interpretations

and must be clarified. As previously stated, the term "killed in action" in

this study indicates those killed instantly and those who were mortally wounded

and died within a relatively short time. Because of the proximity of medical

installations on Bougainville, many mortally wounded patients lived to reach

the hospital and were classified among those who were wounded in action and

died later. Doubtless, under other less propitious circumstances, many of

these casualties would have been classified with those who were killed in action.

The term "dead" refers to the total number of those killed in action and those

who were wounded-treated-died-later.

Since the severity of a wound is an abstract quality, open to individual

interpretation and judgment and hence to consequent error, it was necessary

to establish another criterion by which to judge the degree of disability sustained. The ultimate disposition of the patient seemed to offer a more reasonable basis for this estimation. All wounded, therefore, were separated into

three groups depending upon whether the nature of the wound allowed the

patient to be returned to duty from the first or from the rear echelon or whether

it necessitated his evacuation to the United States. It is recognized that this

is an arbitrary standard and open to the criticism that it is also an index of

medical care; nevertheless, it is a factual and objective measure of the relative

effect of weapons in the living wounded.

A fairly comprehensive description of the common types of Japanese weapons used on Bougainville has already been presented (pp. 289-292). From

wound examination alone, it was never possible to distinguish the caliber of

rifle or machinegun bullets nor the size of explosive shells. It was frequently

impossible to judge with any accuracy whether the wound had been produced

by a bullet or grenade shell or bomb fragment. Aerial bombing by the enemy

did not occur during the Battle of the Perimeter. Miscellaneous weapons producing wounds were the bomb (U.S. aerial bombs), 13; pistol, 13; bangalore torpedo, 9; powder explosion, 5; bayonet, 2; bazooka, 1; and parachute flare, 1.

The Relative Lethal Effect of Weapons

The phrase "relative lethal effect" of a weapon refers to the percentage

of deaths among the total number of casualties (dead and wounded) caused by

that particular weapon. As previously stated, the ratio of the number of

deaths to the number of casualties produced by any given weapon depends

upon such variable factors as the type of action (offensive or defensive), number

of weapons employed, terrain, exposure, and available protection. These factors
324 WOUND BALLISTICS

determine primarily the necessary degree of exposure of the soldier and consequently the number of hits, other factors being equal. The type and number

of the particular weapon employed is then of prime importance in determining

the relative lethal effect. For example, a small number of machineguns may

produce few casualties but a "high lethal effect,"" whereas a great many casualties may result from heavy mortar fire yet thle lethal effect will remain relatively

low.'2

A comparison of the incidence of casualties caused by different weapons

(table 71) shows that the mortar wounded more men (38.8 percent) than any

other weapon. This was the weapon most feared by Allied troops. However,

the relative lethal effect of the mortar is low (11.8 percent), rating next to the

grenade which has the lowest (6.2 percent) relative lethal effect. There were

1,741 casualties caused by HE shells, grenades, landmines, and bullets and 47

casualties produced by miscellaneous weapons. High explosive shells, grenades,

and mines caused wounds in 1,145 men (64.1 percent), but only 153 deaths

(38.7 percent) occurred in this group. In contrast, bullets hit a total of 596

men (33.3 percent), but they accounted for 230 deaths (58.3 percent of total

hit). The rifle was responsible for wounds in 445 casualties with a lethal effect

of 32.1 percent. The machinegun, while causing fewer casualties (151), had

the highest lethal effect of 57.6 percent. The very low lethal effect of the

grenade (6.2 percent) is a characteristic probably peculiar to the Japanese

hand grenade. Of the 34 landmine casualties, 33 were produced by U.S. mines.

The 47 casualties (2.6 percent) listed under miscellaneous weapons were caused

by pistols, bangalore torpedoes, bazookas, flares, powder explosions, and bayonet

wounds.

Table 72 is a breakdown of the various causative agents according to the

anatomic distribution (regional frequency) of wounds in the 1,788 casualties.

TABLE 71.-Distribution of 1,788 battle casualties, by relative lethal effect of causative agent

Total casualties Dead Living Causative agent

Number Percent Number Percent 1 Number Percent I

Rifle -------------------------- 445 24. 9 143 32. 1 302 67. 9

Machinegun -------------------- 151 8.4 87 57.6 64 42.4

Artillery ----------------------- 194 10.9 44 22. 7 150 77. 3

Mortar ------------------------ 693 38.8 82 11.8 611 88.2

Grenade ----------------------- 224 12.5 14 6. 2 210 98.3

Mines ------------------------- 34 1.9 13 38.2 21 61.8

Miscellaneous ------------------- 47 2.6 12 25. 5 35 74. 5

Total ----------------- 1,788 100.0 395 22. 1 1,393 77. 9

1 Percent for dichotomy, dead versus living, by each causative agent and for total dead versus living.

11 High mortalitv-low morbidity.-I. C. B. 12 High morbidity-low mortality.-J. C. B.
BOUGAINVILLE CAMPAIGN 325

There were 384 casualties (21.4 percent of the total number) due to wounds

of the head alone. Moreover, wounds of the head (144) accounted for 37.5

percent of all dead. Excluding the 5 wounded by miscellaneous weapons, 208

head casualties (54.2 percent) were produced by high explosives (fragments)

and 171 (44.5 percent) by bullets. However, high explosives accounted for

TABLE 72.-Relative lethal effect of weapons, by anatomic location of wounds and for mrltiple

wounds

Total casualties Dead Living

Causative agent

Number Percent Number Percent I Number Percent I

Head wounds

Rifle --------------------------- 119 31.0 65 54. 6 54 45.4

Machinegun -------------------- 52 13. 5 40 76. 9 12 23. 1

Artillery ----------------------- 46 12.0 15 32. 6 31 67.4

Mortar ------------------------ 127 33. 1 20 15. 7 107 84. 3

Grenade ----------------------- 32 8.3 1 3. 1 31 96.9

Mine -------------------------- 3 .8 3 100.0 ...............

Miscellaneous ------------------ 5 1.3 3-------- --------- 5 100.0

Total -------------------- 384 100.0 144 37. 5 240 62. 5

Thoracic wounds

Rifle -------------------------- 66 28. 6 34 51. 5 32 48. 5

Machinegun ------------------- 25 10. 8 18 72.0 7 28.0

Artillery ----------------------- 29 12.5 16 55.2 13 44. 8

Mortar ----------------------- 79 34. 2 14 17. 7 65 82.3

Grenade ----------------------- 24 10.4 3 12.5 21 87. 5

Mine -------------------------- 3 1. 3 1 33.3 2 66. 7

Miscellaneous ------------------ 5 2. 2 1 20. 0 4 80. 0

Total -------------------- 231 100. 0 87 37.6 144 62. 3

Abdominal wounds

Rifle -------------------------- 30 26. 3 14 46. 7 16 53.3

Machinegun -------------------- 17 14. 9 13 76. 5 4 23.5

Artillery ----------------------- 8 7.0 3 37. 5 5 62. 5

Mortar ------------------------ 39 34. 2 12 30. 8 27 69. 2

Grenade ----------------------- 14 12.3 3 21.4 11 78.6

M in e ------------------------- -. . . . .

Miscellaneous ------------------ 6 5. 3 3 50. 0 3 50.0

Total -------------------- 114 100.0 48 42. 1 66 57.9

See footnote at end of table.
326 WOUND BALLISTICS

TABLE 72.-Relative lethal effect of weapons, by anatomic location of wounds and for multiple

wounds-Continued

Total casualties Dead Living

Causative agent

Number Percent Number Percent I Number Percent I

Upper extremity wounds

Rifle --------------------------- 99 30.9 ----------------- 99 100.0

Machinegun -------------------- 21 6.6 --------.-------- 21 100.0

Artillery ----------------------- 36 11.3 --------.-------- 36 100.0

Mortar ------------------------ 119 37.2 1 .8 118 99.2

Grenade ----------------------- 33 10.3 --------.-------- 33 100.0

Mine ------------------------- 1 .3 --------.-------- 1 100.0

Miscellaneous ------------------ 11 3.4 --------.-------- 11 100.0

Total ------------------- 320 100.0 1 .3 319 99. 7

Lower extremity wounds

Rifle -------------------------- 95 23.3 6 6.3 89 93. 7

Machinegun ------------------- 17 4. 2 1 5.9 16 94. 1

Artillery ----------------------- 52 12.8 1 1. 9 51 98. 1

Mortar ------------------------ 172 42.3 5 2. 9 167 97. 1

Grenade ----------------------- 59 14.5 1 1.7 58 98.3

Mine ------------------------- 5 1.2 --------.-------- 5 100.0

Miscellaneous ------------------. 7 1.7 ---------------- 7 100.0

Total -------------------- 407 100.0 14 3.4 393 96. 6

Multiple wounds

Rifle --------------------------- 36 10.9 24 66. 7 12 33. 3

Machinegun -------------------- 19 5. 7 15 78.9 4 21. 1

Artillery ----------------------- 23 6.9 9 39. 1 14 60.9

Mortar ------------------------ 157 47.3 30 19. 1 127 80. 9

Grenade ----------------------- 62 18.7 6 9. 7 56 90.3

Mine ------------------------- 22 6.6 9 40.9 13 59. 1

Miscellaneous ------------------- 13 3.9 8 61.5 5 38.5

Total -------------------- 332 100.0 101 30.4 231 69. 6

1 Percent for dichotomy, dead versus living, by each causative agent and for total dead versus living by anatomic

location of wounds and for multiple wounds.

only 27.1 percent of the dead, whereas bullets were responsible for 72.9 percent.

Thus, while high explosives caused more casualties, the lethal effect produced

was relatively low. This may be explained by the average lower velocity of

shell fragments and the relative greater protection afforded against them by
BOUGAINVILLE CAMPAIGN 327

the helmet and skull. This is further substantiated by the fact that in 92.3

percent of the deaths due to head wounds, the skull had been penetrated.

Wounds of the thorax accounted for 12.9 percent of all casualties and for

22.0 percent of all deaths. Excluding 5 wounded by miscellaneous weapons,

high explosives (fragments) produced 135 casualties (60 percent) and bullets

91 (40 percent). However, again contrasting relative lethal effects, bullets

accounted for 59.7 percent of the deaths and high explosives for 40.3 percent.

In thoracic wounds, the contrast between the lethal effect of wounds due to

high explosives and bullets is not so pronounced as in wounds of the head.

Possibly, this is due to the fact that the thoracic cage offers less protection to

the vital organs than does the skull and helmet. This hypothesis seems to be

substantiated further by the fact that while the lethal effect of both mortar and

artillery fragments is increased in the thorax, the lethal effect of the grenade is

increased fourfold. Bullet wounds were limited to the chest wall in only 18

instances, while high explosives caused 85 wounds which did not penetrate the

thoracic cavity. The relatively lower velocity of some of the HE shell fragments would appear to account for its frequent failure to penetrate the thorax.

Casualties occasioned by wounds of the abdomen had the lowest incidence

and accounted for only 6.4 percent of the total wounded and 12.1 percent of

of the dead. Whereas, high explosives (fragments) caused 56.2 percent of the

casualties due to abdominal wounds, bullets accounted for 62.5 percent of the

deaths from these wounds. This ratio may represent a distorted picture when

compared to findings in other theaters, since it is based on such a small number

(8) of wounds of the abdomen caused by artillery shells. However, the mortar

and the grenade show almost twice the relative lethal effect in wounds of the

abdomen as they do in wounds of the thorax. This is further evidence that

the bony structures of the body wall may offer considerable effective protection

against these low-velocity fragments. High explosive fragments caused 30 of

the 53 wounds perforating the abdominal cavity, which would appear to indicate

a relatively high index of penetration. Nevertheless, the relative protection

afforded by the abdominal wall to low-velocity fragments should also be

mentioned. Of 38 wounds limited to the abdominal wall, 30 were caused by

HE fragments.

Wounds of the upper extremity accounted for 17.9 percent of all casualties

and for only 0.3 percent of the dead. High explosive fragments caused 59.1

percent of these wounds. More than half of all wounds caused by high explosives were due to mortar shells. The relative effectiveness of bullets and HE

fragments may be judged from the severity of the wound as indicated by the

disposition of the patients shown in table 73.

The one death among the upper extremity casualties was caused by a

mortar shell. Since the lethal effect of wounds of the upper extremity was

negligible, it deserves no discussion.

Wounds of the lower extremity accounted for the highest number of

casualties (22.7 percent). However, lower extremity wounds were responsible

for only 3.5 percent of all deaths. High explosives caused 70.8 percent of lower
WOUND BALLIMTIC9

extremity casualties; of these, mortar shells alone were responsible for more than

half. Bullets, however, caused 7 of the 14 deaths. The severity of wounds

caused by bullets and high explosives may be judged by the disposition of

casualties as shown in table 74.

TABLE 73.-Disposition of 123 and 196 casualties with uipper extremity wounds, by relative

effectiveness of budlets and HE fragynents, respectively

Casualties wounded byDisposition Bullets nE fragments

Number Percent Number Percent

Returned to duty fromFirst echelon 1 ---------- 44 35. 7 131 66. 8

Rear echelon 2 ---- ..................... 33 26. 8 35 17. 8

Evacuated to United States -------------- 46 37. 5 30 15. 4

Total ----------------------------- 123 100. 0 196 100. 0

I Defined as the beachhead perimeter on Bougainville Island.

2 From hospitals on Guadalcanal, Espiritu Santo, and New Caledonia.

TABLE 74-Disposition of 110 and 283 casualties with lower extremity wounds, by relative

effectiveness of bullets and HEIfragments, respectively

Casualties wounded byDisposition Bullets TIE fragments

Number Percent Number Percent

Returned to duty fromFirst echelon ----------- 44 40. 0 151 53. 4

Rear echelon 2 ... .. .. ... . - - - 30 27. 3 83 29. 3

Evacuated to United States -------------- 36 32. 7 49 17. 3

Total ---------------------------- 110 100. 0 283 100. 0

SDefined as the beachhead perimeter on Bougainville Island.

2 From hospitals on Guadalcanal, Espiritu Santo, and New Caledonia.

Wounds of the extremities constituted the largest group of battle casualties in this survey and accounted for 40.6 percent of all wounds. These

wounds, however, accounted for the smallest number of dead (3.8 percent).

Since relatively few deaths resulted from wounds of this region, the effectiveness of weapons on the extremities must be judged by the duration of the

soldiers' incapacity and by the number of casualties lost to the service by

evacuation to the rear echelon and to the United States. In view of the fact

that fractures were the chief cause of evacuation to the United States, the
BOUGAINVILLE CAMPAIGN 329

relative effect of weapons on the extremities was also judged by the number of fractures they caused. The rifle caused the greatest number of fractures

in both the upper and lower extremities (table 75). In the upper extremity,

the rifle led not only in the number but also in the percentage chance of fracture. In general, the chance of fracture appeared to parallel the velocity of

the missile. Bullets caused only 37.5 percent of upper extremity and 26.3

percent of lower extremity wounds, whereas these missiles caused 66 percent

of upper extremity and 60 percent of lower extremity fractures.

TABLE 75.-Relative effect of weapons causing wounds of upper and lower extremities, among

the living wounded

Total wounds Fracture Nonfracture

Causative agent

Number Percent Number Percent I Number Percent I

Upper extremity

Rifle -------------------------- 99 31.0 55 55. 5 44 44.5

Machinegun -------------------- 21 6. 6 7 33. 3 14 66. 7

Artillery ----------------------- 36 11.3 6 16.7 30 83. 3

Mortar ------------------------ 118 37.0 18 15. 3 100 84.7

Grenade ----------------------- 33 10. 3 4 12. 2 29 87. 8

Miscellaneous ------------------- 12 3. 8 4 33.3 8 66. 7

Total ---------------------- 319 100. 0 94 29. 5 225 70. 5

Lower extremity

Rifle -------------------------- 89 22. 6 28 31.5 61 68. 5

Machinegun 16 4.1 9 56.2 7 43.8

Artillery ----------------------- 51 13,0 9 17.6 42 82.4

Mortar ------------------------ 167 42. 5 15 8. 9 152 91. 1

Grenade ----------------------- 58 14.7 4 6.9 54 93. 1

Mine -------------------------- 5 1.3 5 100. 0

Miscellaneous ------------------- 7 1.8 2 28. 6 5 71.4

Total -------------------- 393 100.0 72 18. 3 321 81.7

1 Percent for dichotomy, fracture versus nonfracture, by each causative agent and for total fracture versus nonfracture,

by upper and lower extremity wounds.

Casualties due to multiple wounds rated third in incidence and constituted 18.6 percent of the total number. High explosives caused 79.5 percent

of these wounds and 53.5 percent of the resultant deaths; however, the machinegun and rifle showed the highest relative lethal effect. The severity

of multiple wounds caused by bullets and high explosives as judged by the

disposition of casualties is shown in table 76.

60322f5-62-23
330 WOUND BALLISTICS

TABLE 76-Disposition of 16 and 215 casualties with multiple wounds, by relative effectiveness

of bullets and HE fragments, respectively

Casualties wounded by- Disposition_______

Bullets HE fragments

Number Percent Number Percemt

Returned to duty fromFirst echelon 1 -- ---- 2 12. 5 89 41.4

Rear echelon ----------------------- 8 50. 8 74 34.4

Evacuated to United States --------------- 6 37.5 52 24.2

Total ----------------------------- 16 100.0 215 100.0

1 Defined as the beachhead perimeter on Bougainville Island.

2 From hospitals on Guadalcanal, Espiritu Santo, and New Caledonia.

The Dead

Table 77 shows the distribution of the dead according to the causative

weapon. There were 395 dead of whom 230 or 58.2 percent were killed by

bullets. Of these 395 dead, 75 (19 percent) were wounded in action, treated,

and died later. Of these 75 patients, 50 died within 24 hours; of these 50,

40 were classed as mortally wounded. IHad medical facilities been further

removed from the frontline or had transportation problems been more difficult,

a large number of those who were wounded and died later would, no doubt,

have been classed as KIA. Bullet wounds tended to produce more immediate

fatalities than did wounds produced by mortar and artillery shells. Among

those who were wounded and died later, wounds were produced by the mortar

in 28.0 percent, by artillery in 27.3 percent, and by the rifle in 14.7 percent.

TABLE 77.-Distribution of 395 fatal casualties, by relative effect of causative agent

Total dead Killed in action Died of wounds

Causative agent

Number Percent Number Percent 1 Number Percent I

Rifle --------------------------- 143 36. 2 122 85.3 21 14.7

Machinegun -------------------- 87 22. 0 72 82. 8 15 17.2

Artillery ----------------------- 44 11. 1 32 72. 7 12 27.3

Mortar ------------------------- 82 20.8 59 72.0 23 28.0

Grenade ---------------------- 14 3.6 11 78.6 3 21.4

Mine ------------------------- 13 3.3 12 92.3 1 7.7

Miscellaneous ------------------ 12 3.0 12 100.0 ........

Total -------------------- 395 100. 0 320 81.0 75 19.0

1 Percent for dichotomy, killed in action versus died of wounds, by causative agent and for total killed in action versus

died of wounds.
BOUGAINVILLE CAMPAIGN 331

Effectiveness of Weapons

To measure the effectiveness of a weapon by the number of casualties it

produces may lead to erroneous conclusions. To reiterate, the number of

casualties depends on such factors as the necessary exposure of the soldier,

the concentration of troops, the number of weapons employed, and the effect

of the missile. It is seldom that all these varying conditions of battle can be

duplicated. On the other hand, the percentage chance of death and the length

of disability when hit by a given weapon should remain relatively constant

and, therefore, should offer a fairly accurate index of the effectiveness of various missiles.

The percentage chance of death when hit by various weapons is shown in

table 78. Casualties receiving two or more wounds, either one of which

might have produced death, are not included in this table, but are discussed

under "Multiple Wounds." Nevertheless, many of these casualties did have

more than one wound. The order of these weapons suggests that the chance

of being killed is a function of the velocity of the missile. The risk of death

when hit by a machinegun in the head, chest, or abdomen is approximately

equal. The contrast in death risk between the machinegun (54.5 percent)

and the rifle (29.1 percent) is not entirely due to multiplicity of hits, since

multiple hits were found not infrequently with rifle fire. On the average,

machinegun fire originated at a closer range than rifle fire, 61 percent of the

hits being from less than 50 yards. The chance of death when hit by a grenade

(4.9 percent) is approximately half that when hit by the mortar (9.7 percent).

The risk of death when hit in the abdomen by mortar or grenade is relatively

greater than when hit in the head or thorax. This suggests that the helmet

and skull (fig. 179) as well as the ribs may offer considerable protection

against many of these relatively low-velocity fragments.

The relative effect of weapons may be judged by the percentage chance

of a light wound or of a severe wound (tables 79 and 80). These tables are

based on living wounded only. A light wound was defined as one which

allowed return to duty in the first echelon and a severe wound as one which

necessitated evacuation to the United States. There appears to be considerable difference in the severity of a wound according to the anatomic

region bit, as well as to the weapon causing it. In general, high explosives

(fragments) tend toward light wounds while small arms (bullets) tend toward

more severe wounds.

The relative effectiveness of weapons may also be evaluated by a consideration of the total dead plus the total evacuated to the United States.

Together, these may be considered as "lost to the service" (table 81), although

some who were returned to the United States may serve in future campaigns.

It should be noted by this criterion that wounds of the extremities and abdomen

assume a far greater relative importance than when death alone is utilized as

an index of weapon effectiveness.
332 WOUND BALLISTICS

Co Go 0 C

00

cy mo 

,v Go 0 co-I'c

Co Co L6 

'0 Co c

N 00

06 f

7-. t
BOUGAINVILLE CAMPAIGN 333

78

FIGURE 179.-Roentgenogram of skull showing artillery shell fragment lodged in sinus

cavity. A soldier, standing in the company area, was hit by a Japanese 75 mm. artillery

shell which exploded at a distance of 100 yards. A fragment of the shell penetrated the

outer wall of the maxillary sinus and lodged in the sinus cavity. This is a good example

of the relative protection afforded by bony structures to low-velocity fragments, even of

large size. A. X-ray of skull. B. Recovered fragment.

Table 82 shows the number of patients returned to duty from the first

echelon (Bougainville). Table 83 shows the total number of casualties dead

and evacuated to the rear echelon and to the United States. These were lost

to the Bougainville campaign. Note that the percentage effectiveness of each

weapon suggests a possible correlation with the average velocity of hits.

Conditions of battle may be such that the effectiveness of a weapon can

best be measured by whether the wounded soldier was able to continue fighting.

Hence, the number of casualties per se is not a sufficient criterion since many

of the wounded may continue to fight and hold off the enemy, at least temporarily. It is, therefore, desirable to know the number who are put out of

action immediately and the number who could continue combat for a period

of hours, if life depended on it. A questionnaire to determine whether an

individual did or did not continue combat was found to be misleading, since

conditions of battle were frequently such as to permit the soldier to seek

immediate treatment. This he usually did when possible, since he had been

so instructed by Medical Corps personnel. However, there were numerous

instances of soldiers who were severely wounded and yet who continued to

hold their position in the line until relieved. (For example: Two soldiers

were holding a pillbox at night under Japanese attack. Eventually, each

had a hand blown off, but with two hands between them, they cared for their

wounds, manned their guns, and held off the attack until relieved at daybreak.)
334 WOUND BALLISTICS

c c 00 o C., 005tC) oo CID 000

0CC0-j

00t

0i C6c- C

C) mC) 0- cqr

-n - co.10 C) -

C. - . C.0 't - t 01C m C 0

c m 00 Q0 - M_______

C-' COCO0C 0 C m0~ 0 

-t oo 0. 'xCC)0

_ _ *C _ _ "00 __

"t 0 m0 

0 C0C5C-0t~ ' ~. '0 -0C5C)0k---
BOUGAINVILLE CAMPAIGN 335

on. cl 00 t- Cl

000 - cli

Cf 00kCC 0

C ~ _ _ ~ -0 _ __ t __ _

o ~ CCC'Cl' ~ ~ -C z N

L- "tc)Cl M C

CN 00 co C

El u

cO)lmlt-C m C
336 WOUND BALLISTICS

TABLE 82.-Relative effect of weapons: Casualties returned to duty from first echelon 1

Casualties returned to duty

Weapon Total casualties

Number Percent of total

Number

Rifle ---------------------------------------- 445 112 25. 2

Machinegun --------------------------------- 151 22 14.6

Artillery ------------------------------------- 194 84 43. 3

Mortar -------------------------------------- 693 325 46.9

Grenade ------------------------------------- 224 133 59.4

1 Defined as the beachhead perimeter on Bougainville Island.

TABLE 83.-Relative effect of weapons: Casualties lost to Bougainville campaign (dead or

evacuated to rear echelon 1 or to United States)

Casualties lost to Bougainville campaign

Weapon Total casualties - campaign

Number Percent of total

Numsber

Rifle- --------------------------------------- 445 333 74.8

Machinegun -------------------------------- 151 129 85.4

Artillery ------------------------------------- 194 110 56. 7

Mortar -------------------------------------- 693 368 53. 1

Grenade ------------------------------------ 224 91 40. 6

1 To hospitals on Guadalcanal, Espiritu Santo, and New Caledonia.

An arbitrary criterion based on the seriousness of the wound seemed

justified in order to determine whether a soldier will be able to continue in

battle for a number of hours, if his life were at stake. For this purpose, an

arbitrary schedule was derived, and the following wounded were classed as

"Lost to Combat":

1. Wounds of the head and central nervous system producing unconsciousness or paralysis.

2. Wounds of intrathoracic structures producing hemorrhage and shock.

3. Wounds of intraperitoneal structures producing hemorrhage and shock.

4. Wounds of the extremities producing fractures of long bones, severance

of major blood vessels, or major traumatic amputations.

5. Extensive wounds of soft tissue producing shock.

The wounded were classified according to the criteria listed and added

to the dead to determine the total lost to combat (table 84). This table again

suggests that the percentage effectiveness of the weapon is a function of the

average velocity of the missiles.

Callender and others have shown that the wounding power of a missile

is in proportion to the cube of the velocity, the mass and other factors being

equal. In this report, the percentage effectiveness of weapons as judged by
BOUGAINVILLE CAMPAIGN 337

the chance of death, and the severity of the wound, appears to be in accord with

the observation that the wounding power of a missile is chiefly a function of

velocity. When hits occur, the weapons in order of effectiveness are (1)

machinegun, (2) rifle, (3) artillery, (4) mortar, and (5) grenade.

TABLE 84.-Relative effect of weapons: Casualties lost to combat

Casuslties lost to combat

Weapon Total casualties

Number Percent

Nu mber

Rifle ---------------------------------------- 445 233 52. 4

Machinegun --------------------------------- 151 114 75. 5

Artillery ------------------------------------- 194 59 30. 4

Mortar -------------------------------------- 693 170 24. 5

Grenade ------------------------------------- 224 42 18. 8

The Relative Effect of Weapons on the Disposition of Patients

An evaluation of the effectiveness of each weapon may be obtained by

considering both the number killed and the severity of the wound as determined

by the disposition of the patient.

There were 700 casualties returned to duty from the first echelon (defined

as the beachhead perimeter on Bougainville Island). These patients spent an

average of 12.7 days in the hospital (table 85). However, if the requirement

had existed, the majority of these men would have been available for emergency

combat duty in a shorter time. Nevertheless, the problem of the lightly

wounded, treated in the first echelon, is of considerable importance, both

because of days lost to the service and because these casualties occupy beds

which might be needed for the more seriously wounded. Wounds caused by

HE shell fragments constituted the major problem in the first echelon. Wounds

of the extremities and multiple wounds comprised a majority of these lesions

(table 86).

The rear echelon included hospitals on Guadalcanal, Espiritu Santo, and

New Caledonia; the evacuation distances ranged from 400 to 1,500 miles

from Bougainville. Consequently, patients evacuated to hospitals in the rear

were lost to the service insofar as the Battle of the Perimeter was concerned.

Subsequently, some of these patients were returned to duty from the rear

echelon and performed service in combat units, hence were not lost to the

South Pacific theater. The severity of the wounds in these casualties usually

justified their removal to a rear echelon for convalescence. Only a very few

were evacuated because of the need for additional vacant hospital beds on

Bougainville. Hence, transfer to the rear echelon may be taken as a fair

measure of the severity of a soldier's wound from the standpoint of his ability

to undergo combat. The wounded were usually returned to duty from the

603225V 62- 24
338 WOUND BALLISTICS

TABLE 85.-Days lost by 700 casualties returned to duty from first echelon 1 hospitals, by causative agent

Casualties Average number Causative agent of days in

hospital Number Percen t

Rifle_ --------------------------------------- 112 16.0 14.2

Machinegun --------------------------------- 22 3. 1 16. 6

Artillery -------------------------------------- 84 12. 0 12. 0

Mortar -------------------------------------- 325 46.5 12.0

Grenade ------------------------------------ 133 19.0 12. 2

Mines and miscellaneous ----------------------- 24 3. 4 18.0

Total --------------------------------- 700 100.0 12.7

1 Defined as the beachhead perimeter on Bougainville Island.

TABLE 86.-Days lost by 700 casualties returned to duty from first echelon 1 hospitals, by anatomic location

Casualties Average number

Anatomic loeatfon _of days in

hospital Number Percent

Head ---------------------------------------- 157 22.4 9.0

Thorax --------------------------------------- 63 9. 0 11.2

Abdomen ------------------------------------- 19 2.7 18.4

Extremities:

Upper ----------------------------------- 175 25. 0 11.7

Lower ----------------------------------- 195 27. 9 14.9

Multiple--- --------------------------------- 91 13. 0 15. 8

Total --------------------------------- 700 100.0 12.7

1 Defined as the beachhead perimeter on Bougainville Island.

rear echelon or were evacuated to the United States within 120 days. However, the average elapsed time before return to duty was considerably less than

this.

Though many patients evacuated to the United States were returned to

duty eventually, they must be considered as lost to the service for a long period.

Table 87 presents the anatomic distribution of the hits by the various

causative agents, and table 88 lists the general disposition of the nonfatal

casualties.

In number of wounds produced, the rifle was exceeded only by the mortar

and was responsible for 24.9 percent of all battle casualties. However, the

rifle ranked first as a lethal agent, accounting for 36.2 percent of all dead.

Moreover, it was second in percentage relative lethal effect (32.1 percent),

being exceeded only by the machinegun (57.6 percent). The rifle produced
BOUGAINVILLE CAMPAIGN 339

wounding in 53.7 percent of all casualties lost to the service by death and

evacuation to the United States. The rifle caused more head wounds than any

other weapon and was second only to the machinegun in relative lethal effect in

head wounds. It ranked third in relative lethal effect in thoracic wounds,

TABLE 87.--Anatomic distribution (regional frequency) of wounds, by causative agents

Total casualties Dead Living

Anatomic location

Number Percent Number Percent I Number Percent I

Rifle

Head -------------------------- 119 26. 7 65 54. 6 54 45.4

Thorax--------------------- 66 14.8 34 51.5 32 48.5

Abdomen ---------------------- 30 6. 7 14 46.7 16 53.3

Extremities:

Upper --------------------- 99 22. 3 --------.-------- 99 100.0

Lower -------------------- 95 21.4 6 6.3 89 93.7

ultiple ----------------------- 36 8. 1 24 66. 7 12 33.3

Total -------------------- 445 100.0 143 32. 1 302 67.9

Machinegun

Head -------------------------- 52 34. 4 40 76.9 12 23. 1

Thorax ------------------------ 25 16.5 18 72.0 7 28.0

Abdomen ---------------------- 17 11.3 13 76. 5 4 23.5

Extremities:

Upper --------------------- 21 13.9 --------.-------- 21 100.0

Lower --------------------- 17 11.3 1 5.9 16 94.1

Multiple ----------------------- 19 12.6 15 78.9 4 21.1

Total ---------------------- 151 100. 0 87 57. 6 64 42.4

Mortar

Head -------------------------- 127 18.3 20 15.7 107 84.3

Thorax---------------------- 79 11.4 14 17.7 65 82.3

Abdomen ---------------------- 39 5. 6 12 30. 8 27 69.2

Extremities:

Upper------------------- 119 17.2 1 .8 118 99.2

Lower -------------------- 172 24. 8 5 2.9 167 97.1

Multiple ------------------------ 157 22.7 30 19. 1 127 80.9

Total --------------- 693 100. 0 82 11.8 611 88. 2

See footnote at end of table.
340 WOUND BALLISTICS

TABLE 87.-Anatomic distribution (regional frequency) of wounds, by causative agents-Con.

Total casualties Dead Living

Anatomic location

Number Percent Number Percent 1 Number Percent I

Artillery

Head -------------------------- 46 23. 7 15 32. 6 31 67. 4

Thorax ------------------------ 29 14. 9 16 55. 2 13 44. 8

Abdomen ---------------------- 8 4. 1 3 37.5 5 62. 5

Extremities:

Upper --------------------- 36 18. 6 --------.-------- 36 100. 0

Lower -------------------- 52 26. 8 1 1.9 51 98. 1

Multiple ----------------------- 23 11. 9 9 39. 1 14 60. 9

Total -------------------- 194 100.0 44 22.7 150 77. 3

Grenade

Head -------------------------- 32 14.3 1 3. 1 31 96. 9

Thorax 24 10.7 3 12.5 21 87. 5

Abdomen_-- -- -- -- -- -- -- 14 6. 3 3 21.4 11 78. 6

Extremities:

Upper-_ 33 14.7 --------.-------- 33 100. 0

Lower ---------------------- 59 26. 3 1 1.7 58 98.3

Multiple ----------------------- 62 27. 7 6 9.7 56 90. 3

Total -------------------- 224 100.0 14 6.3 210 93.7

1 Percent for dichotomy, dead versus survived, by each anatomic location and for total dead versus survived by

each causative agent.

being exceeded by the machinegun and artillery shell, and second in abdominal

wounds. While the rifle was second to the mortai in causing wounds of both

the upper and lower extremities, it produced more fractures than any other

weapon (fig. 180).

The machinegun caused fewer casualties than any other weapon, 8.4

percent. However, its percentage relative lethal effect was the highest of all

weapons, 57.6 percent. It was not possible to separate the casualties produced

by the 6.5 mm. weapon from those produced by the 7.7 mm. machinegun.

The percentage lost to the service by death and evacuation to the United

States was also the highest of any weapon, 78.1 percent. Measured by the

number of patients lost to the service, machinegun wounds were the most

severe among those produced by any weapon. This high degree of effectiveness

of the machinegun bullet may be explained partially by close range fire in this

campaign and also by the multiplicity of wounds. The percentage relative
BOUGAINVILLE CAMPAIGN 341

FIGURE 180.--Roentgenogram of compound comminuted fracture of the humerus caused by a Japanese .25 caliber rifle bullet fired from a distance of 75

yards. This is a typical example of the explosive effect of the .25 caliber rifle

bullet when it strikes bone or a solid organ. Many of these bullets caused similar damage to the arm and then passed through the chest.

TABLE 88.-Disposition of 1,337 nonfatal casualties, by causative agent

Returned to duty

_Evacuated to Total survived United States

Causative agent Total From first From rear echelon 1 echelon 2

Number Percent 3 Number Percent .Number Percent 4 Number Percent 4 Number Percent 3

Rifle ------------- 302 67. 9 206 46. 3 112 54. 4 94 45. 6 96 21. 6

Machinegun - ----- 64 42. 4 33 21.9 22 66.7 11 33. 3 31 20.5

Mortar ----------- 611 88. 2 495 71. 5 325 65. 7 170 34. 3 116 88. 2

Artillery --------- 150 77.3 123 63. 4 84 68. 3 39 31.7 27 13.9

Grenade --------- 210 93. 7 173 77. 2 133 76. 9 30 23. 1 37 16. 5

Total ----- 1,337 78. 4 1, 030 60. 4 676 65. 6 354 34. 4 307 18. 0

1 Defined as the beachhead perimeter on Bougainvillc Island.

2 From hospitals on Guadalcanal, Espiritu Santo, and Now Caledonia.

3 Percent of total casualties inflicted by causative agent.

4 Percent for dichotomy, first echelon, versus rear echelon of those returned to duty (= 100 percent).
342 WOUND BALLISTICS

FIGURE 181. Roentgenogram of thoracic cavity of soldier who was prone on

the ground when a mortar shell of unknown size exploded 1-yard distant. This

soldier was also wounded in the arm, thigh, and both ankles. An open operation

was performed, and the numerous lacerations in the lung, caused by the small

fragments, were sutured and the intercostal vessels ligated. The soldier made

a good recovery.

lethal effect was uniformly high for all regions of the body with the exception

of the extremities.

The mortar caused more wounds than any other weapon and accounted

for 38.8 percent of all battle casualties. However, its relative lethal effect

was only 11.8 percent (fig. 181). The only weapon having a lower lethal effect

was the grenade. Furthermore, 71.5 percent of the living wounded were

returned to duty, a higher percentage than for any other weapon except the

grenade. The dead and evacuated to the United States (lost to the service)

totaled 28.5 percent. The highest relative lethal effect (30.8 percent) was

observed in wounds of the abdomen, whereas the greatest number of deaths

occurred in multiple regional involvement.

The use of artillery by the enemy in this campaign was relatively limited.

Wounds caused by artillery shells, however, accounted for 10.9 percent of the

casualties and were fourth in frequency. Artillery ranked fourth in cause of

death (11.1 percent) and fifth in percentage lethal effect, 22.7 percent. Among

casualties evacuated to the United States, artillery produced the lowest number

of wounds, 13.9 percent. However, the percentage of those lost to the service

by death and evacuation to the United States was 36.6 percent. While wounds
BOUGAINVILLE CAMPAIGN 343

FIGURE 182.-Roentgenogram of thoracic cavity of soldier who was prone

in a foxhole when a Japanese hand grenade exploded at a distance of not more

than 1 foot from the chest wall. This X-ray shows the characteristic small

fragments of the hand grenade. Most of the fragments were stopped by the

chest wall, but some of them penetrated the pleura. The fragmentation of the

Japanese hand grenade is irregular but usually very small.

of the extremities were frequent, only one death occurred. This death was

produced by a lower extremity wound. Lethal wounds in order of frequency

by regions were the thorax, head, multiple, abdomen, and lower extremity.

The grenade ranked third in wound production and accounted for 12.5

percent of all battle casualties (table 71). However, its relative lethal effect

was the lowest of all weapons, 6.2 percent. Furthermore, the majority of the

wounds were of a minor nature (fig. 182). The grenade was first among all

weapons as gaged by the percentage of wounded returned to duty, 77.2 percent,

and three-fourths of these patients were returned to duty from the first echelon.

The grenade was responsible for the lowest number of casualties (22.8 percent)

among those who were lost to the service by death and evacuation to the United

States. Of all wounds produced by the grenade, 68.7 percent were classified

as extremity wounds and multiple wounds.

Weapon Evaluation by Multiplicity of Wounds

The question has been frequently asked: Do missiles causing multiple

wounds result in more serious casualties because of the number of wounds per

se? The data available do not answer this question satisfactorily. Multiple
344 WOUND BALLISTICS

wounds were analyzed according to the number of different anatomic regions

involved rather than by the total number of wounds. Thus, a patient with

10 wounds of the leg and 5 of the hand was classified under multiple wounds

in two anatomic regions; that is, as an upper and a lower extremity casualty

without regard to the number of lesions present.

Table 89 relates the casualties with multiple wounds to the number of

anatomic regions involved and the severity of the wounds. The disposition

of the patient was used to determine the severity of the wounds. The number

of the multiple wounded casualties discharged in each echelon is tabulated

by weapon. The corresponding number of anatomic regions hit is also recorded by weapon. Thus, there were 53 patients, with mortar wounds in

117 different anatomic regions, returned to duty in the first echelon. Therefore, among the patients returned to duty in this echelon, there were mortar

wounds in 2.21 of the various anatomic regions per patient (table 90). The

ratio of anatomic regions wounded per patient is slightly higher for each

weapon among the casualties evacuated to the United States. However,

the difference is so slight as to suggest that multiplicity of wounds alone is

not a factor of great importance. The relatively low mortality of 3.3 percent

for all patients with multiple wounds seen alive suggests that the multiple

wounds per se add little to the risk. It is likely that the actual severity of the

wound is the more important factor in determining death and disability. It

would be desirable, however, to have data which include a count of the actual

number of wounds by anatomic region in both the living and the dead.

TABLE 89.-Disposition of patients with multiple wounds as related to number of anatomic

regions hit and to severity of wounds, by causative agent

Patients Anatomic regions hit in patientsRe- Re- Re- Re- Causative agent turned turned Evaeu- turned turned Evacu- to duty to duty ated to Total to duty to duty ated to Total from from United from from United

first rear States first rear States

echelon ' echelon 2 echelon I echelon 2

Number Number Number Number Number Number Number Number

Mortar ----------------------- 53 41 33 127 117 99 85 301

Grenade ----------------------- 29 16 11 56 70 40 29 139

Landmine --------------------- 2 7 5 14 4 20 16 40

Artillery shell ------------------ 4 6 3 13 9 12 8 29

Rifle -------------------------- 2 7 3 12 4 17 7 28

Machinegun ------------------ ------ 1 3 4 3 8 1]

Total ------------------- 90 78 58 226 204 191 153 548

I Defined as the beachhead perimeter on Bougainville Island.

SFrom hospitals on Guadalcanal, Espiritu Santo, and New Caledonia.
BOUGAINVILLE CAMPAIGN 345

TABLE 90.-Ratio of number of anatomic regions hit per patient evacuated in each echelon, by

causative agent

Returned to duty from--

Causative agent Returned t _Evacuated - to Totol United States

First echelon I Rear echelon 2

Mortar ------------------------- 2.21 2.41 2.58 2. 37

Grenade ------------------------ 2.41 2. 50 2. 64 2.48

Landmine ----------------------- 2.00 2. 86 3. 20 2. 86

Artillery shell -------------------- 2.25 2.00 2. 67 2. 23

Rifle --------------------------- 2. 00 2.43 2. 33 2. 33

Machinegun -------------------- ------------- 3.00 2.67 2. 75

Total -------------------- 2. 27 2.45 2.64 2. 44

I Defined as the beachhead perimeter on Bougainville Island.

2 From hospitals on Guadalcanal, Esplritu Santo, and New Caledonia.

Relative Lethal Effect of U.S. Weapons and Japanese Weapons

It had been the intention of the survey team to study the effect of U.S.

weapons on the enemy dead. Unfortunately, this plan was found impracticable because of difficulty in obtaining the enemy dead before decomposition

had occurred and also because of the paucity of team personnel. Certain

local conditions prevailed which circumvented accuracy in such a study. In

the first place, because of the character of the fighting and the extensive use,

by Allied forces, of artillery and mortar fire, the enemy dead were frequently

struck by many different missiles before the bodies could be recovered. Furthermore, it was impossible to obtain any detailed information regarding the

circumstances surrounding death.

It was possible, however, to investigate the effect of U.S. weapons on a

limited number of American soldiers who were wounded (table 91). There

were 219 casualties (12.3 percent of the total) due to U.S. weapons in the

hands of American troops. Though the Japanese used some U.S. weapons,

particularly rifles and grenades, as a rule it was impossible to know when

this occurred. Among Allied forces, there were 63 deaths (16.0 percent of the

total dead) produced by U.S. weapons.

There were 52 casualties caused by the rifle, 16 of whom died (table 92);

19 were wounded by the accidental discharge of a rifle by a fellow soldier.

Mistaken identity resulted in 13 deaths and the wounding of 6 others. Of

these deaths, 8 were occasioned by the soldier seeking to relieve himself at the

toilet during the night. Self-inflicted wounds, accidental or intentional, were

responsible for 10 casualties, 3 of whom died. Mortarand artillery fire accounted

for 54 of the wounded and 22 of the dead. Among these, 13 were killed and 40

wounded by mortar and artillery "shorts." Among the 16 casualties who were
346 WOUND BALLISTICS

wounded on patrol by U.S. artillery, 8 died. The accidental tripping of landmines and boobytraps produced 14 deaths in a total of 40 wounded. Hand

grenades, other than those used in boobytraps, were responsible for 8 deaths

and 4 wounded. M~iscellaneous weapons including bangalore torpedoes, bombs,

pistols, knives, and powder explosions accounted for 38 casualties; 7 of these

casualties died.

TABLE 91.-Distribsition of 219 U.S. casualties produced by U.S. weapons, by category

Casualties

Category--____________________

Number Percent

Dead:

Killed in action ------------------------------------- 48 22. 0

DOW (died of wounds) ------------------------------ 15 6.8

Total -------------------------------------------- 63 28.8

Wounded, living:

Evacuated to United States -------------------------- 25 11.4

Returned to duty fromnFirst echelon'1------------------------------------85 38.8

Rear echelons2------------------------------------46 21. 0

Total ----------------------------------------- 156 71.2

Grand total ------------------------------------ 219 100.0

1 Defined as the beachhead perimeter on Bougainville Island.

2 rosm hospitals on Guadalcanal, Espfritu Santo, and New Caledonia.

TAB3LE 92.-Relative lethal effect of U.S. weapons on 219 U.S. casualties

WepnTotal casualties Dead Living wounded

Number Percent Number Percent I Number Percent 1

Rifle ----------------------------- 52 23. 7 16 30.8 36 69. 2

Machinegun------------------- 1 . 5 1 100.0 0 --------

Mortar -------------------------- 34 15. 5 5 14.7 29 85. 3

Artillery ------------------------- 42 19.2 17 40. 5 25 59. 5

Grenade ------------------------- 19 8.7 5 26.3 14 73.7

Mine ---------------------------- 33 15. 1 12 36.4 21 63. 6

Miscellaneous --------------------- 38 17.3 7 18. 4 31 81.6

Total ---------------------- 219 100.0 63 28.8 156 71.2

1 Percent for dichotomy, dead versus living, by each causative ageut and for total dead versus living.
BOUGAINVILLE CAMPAIGN 347

Though the number of casualties just cited was too small to allow adequate

comparison between the effect of Japanese and U.S. weapons, it was the only

available data and has been utilized (tables 92 and 93). It is evident that the

relative lethal effects of the Japanese mortar and rifle are essentially similar to

the lethal effects of these same U.S. weapons. However, the relative lethal

effect of U.S. artillery is 40.5 percent, while that of the Japanese artillery is

only 17.8 percent. A possible explanation for this discrepancy may lie in the

proportion of different weapons employed by the opposing forces. The predominant Japanese artillery piece was the 75 mm. gun, whereas most of U.S.

artillery weapons were 105 mm. or larger caliber. In relative lethal effects, a

sharp contrast is observed between the U.S. grenade, 26.3 percent, and the

Japanese grenade, 4.4 percent (fig. 183). This finding is in accord with the

generally observed ineffectiveness of the Japanese grenade.

TABLE 93.-Relative lethal effect of Japanese weapons on 1,569 U.S. casualties

Total casualties Dead Living wounded

Weapon

Number Percent Number Percent 1 Number Percent I

Rifle --------------------------- 393 25.0 127 32. 3 266 67.7

Machineg-un ------------------- 150 9.6 86 57.3 64 42. 7

Mortar ------------------------ 659 42.0 77 11.7 582 88.3

Artillery--------------------- 152 9. 6 27 17.8 125 82.2

Grenade ----------------------- 205 13.0 9 4.4 196 95. 6

Mine -------------------------- 1 .1 1 100.0 -

Miscellaneous ------------------- 9 .6 5 55. 6 4 44.4

Total -------------------- 1,569 100. 0 332 21.2 1,237 78. 8

1 Percent for dichotomy, dead versus living, by each causative agent and for total dead versus living.

TREATMENT OF THE WOUNDED

A detailed clinical study would be out of place in a report on wound ballistics. On the other hand, a r~sum6 of end results in the treatment of the

wounded is essential to the proper evaluation of the effect of weapons. This

is well illustrated by the results obtained in the treatment of compound fractures of the femur early in World War I, when the mortality at first was 50

percent. Such a mortality would materially change the evaluation of the effect

of weapons causing wounds in the lower extremities.

The purpose of this section on the treatment of the wounded is to indicate

the quality of the treatment, good or bad; to account for all of those wounded

in action and who died later; to record the amount of disability as indicated

by the disposition of the patients; and to give a very brief classification of the
348 WOUND BALLISTICS

FIGURE 183.-Roentgenograms of lower and upper extremities. A. Lower extremity

wound caused by a U.S. hand grenade thrown by a Japanese. The grenade exploded 3

yards from the leg. The typical large fragment is shown. B. Fracture of the ulna and the

usual small fragments characteristic of the Japanese hand grenade. The soldier was lying

in a foxhole, and the grenade exploded almost in contact with the arm. Under these circumstances, there may be considerable brisance effect on the soft tissues.

types of wounds encountered in the various anatomic regions. A recording of

the circumstances on how each wound was acquired and even a brief description of the wound would make this section far too lengthy. On the other hand,

such descriptions are helpful in giving the reader an appreciation of the type

of warfare encountered. For this reason, a brief description is given of the

circumstances associated with the wounding of each patient who was wounded

in action and died later.

Wounds of the Head and Neck

There were 250 patients "3 with wounds of the head and neck alone who

were seen alive (table 67); 10 of this number (4 percent) died. These 10

patients were considered as mortally wounded, and 7 died without operation

(Cases 1 to 7). Three patients died following operation, making an operative

mortality for all head and neck wounds of 1.2 percent (Cases 8, 9, and 10).

Of these 250 patients, 198 had wounds of the scalp, face, and neck. There

were 55 patients who had injuries of the eye, 19 of whom (35.5 percent) were

13 There were 90 patients listed under multiple wounds who also had wounds of the head and neck. However, these

wounds did not constitute major problems of the head and neck, and, in order to avoid duplication, such patients were

considered only under multiple wounds.
BOUGAINVILLE CAMPAIGN 349

returned to the United States because of permanent visual impairment. The

most serious wounds encountered in the group of face and neck injuries were 4

perforations of the trachea, 9 compound fractures of the mandible, and 4 of

the maxilla. The majority of face and neck wounds were not serious, and

86.6 percent of the patients who received such wounds were returned to duty

within 4 months. There were 52 patients who sustained brain injury; 27 of

these had concussion, and 3 were evacuated to the United States.

Of the remaining 25 patients who had brain injury, 9 were mortally

wounded. Nineteen of these patients underwent operation and three died,

making a mortality of 15.7 percent. All three of these patients may be considered as having been mortally wounded (Cases 8, 9, and 10). Among the 19

cases having operation, the dura was open and the brain lacerated in 14, and

in 5 there were depressed fractures without opening of the dura.

CASE REPORTS: WOUNDED-TREATED-DIED-LATER

Head and neck wounds

Case 1.-A Fijian soldier, while on patrol, was wounded by a fragment of a U.S. 90 mm.

shell which exploded at a 20-yard distance, at 1700 hours on 30 March 1944. At the 21st

Evacuation Hospital, he was found to have a penetrating wound of the skull through the

right frontal bone with extensive laceration of the brain and severe intracranial hemorrhage.

He died shortly after arrival, at 2000 hours on 30 March 1944, of respiratory failure and

extensive brain damage. (See autopsy protocol Case 3, p. 381.)

Case 2.-A Fijian soldier, while on patrol, was struck by a U.S. 90 mm. shell fragment

25 yards from the burst at 1700 hours on 30 March 1944. He received a penetrating wound

of the head in the right temporal region and was taken directly to the 21st Evacuation

Hospital. The patient was moribund and died at 1855 hours on 30 March 1944. (See

autopsy protocol Case 12, p. 386.)

Case 3.-A soldier of the 145th Infantry, 37th Division, was struck in the head by a

Japanese machinegun bullet fired from a distance of 30 yards at 1250 hours on 9 March 1944.

He was given first aid, including plasma, but never regained consciousness and died in the

battalion aid station 2 hours later.

Case 4.-A Fijian soldier was mistaken for the enemy and shot in the head and abdomen

by a U.S. .30 caliber rifle at a distance of 15 yards. He was wounded at 1810 hours on 23

March 1944 and taken directly to the 21st Evacuation Hospital. Examination disclosed a

severe gutter wound of the right side of the head with extensive brain damage and a wound

of the abdomen. He was given 1 unit of plasma but, being moribund, died at 2055 hours

on 23 March 1944. (See autopsy protocol Case 22, p. 390.)

Case 5.-A soldier of the 182d Infantry, while withdrawing from enemy fire, was hit

in the back of the neck by a .25 caliber Japanese bullet fired by a sniper from a distance of

35 yards. He was wounded at 0600 hours on 15 March 1944, kept in the battalion aid

station about 2 hours, and then taken to the 21st Evacuation Hospital. He was paralyzed

and in shock and no operation was done. His death was associated with hyperthermia and

occurred at 1300 hours on 15 March 1944. The clinical impression was transection of the

cervical cord at the level of cervical fifth vertebra, but post mortem revealed that the cord

had not been penetrated. (See autopsy protocol Case 21, p. 388.) (NOTE.-This was the

only instance of trauma to the spinal cord in which the dura was intact.)

Case 6.-A soldier of the 145th Infantry, 37th Division, was struck by fragments of a

mortar shell which exploded in a tree 15 feet overhead. He sustained multiple wounds of

the head and shoulder and a partial avulsion of the leg. A tourniquet was applied to the leg,
350 WOUND BALLISTICS

plasma was given, and the patient was removed from the lines within an hour. He died on

the way to the hospital. Death was thought to have been due to head injury.

Case 7.-A soldier of the 129th Infantry, 37th Division, was wounded by a .25 caliber

bullet fired by a Japanese sniper from a distance of 75 yards. The bullet passed through the

helmet producing a severe gutter wound of the right parieto-occipital region. The injury

occurred at 1430 hours on 24 March 1944. The patient received aid promptly and was

given 9 units of plasma before arriving at the 21st Evacuation Hospital. He was mortally

wounded, however, and died at 1920 hours on 24 March 1944 without operation. (See

autopsy protocol Case 25, p. 391.)

Case 8.-A soldier of the 145th Infantry, 37th Division, was struck by a Japanese

machinegun bullet fired from a distance of 30 yards on Hill 700. Because the road was under

enemy fire, a 1,000-yard litter carry was necessary over very rough terrain. He was given

plasma at the aid station but arrived at the hospital in a semiconscious condition. He had

a gutter wound of the left frontotemporal region and a severe laceration of the brain. The

wound was debrided and shock treatment instituted, but the patient died 24 hours later.

Death was due to extensive brain damage.

Case 9.-A soldier of the 129th Infantry, 37th Division, was struck by a fragment

of a Japanese mortar shell (90 mm.) which burst 20 feet distant at 0630 hours on 17 March

1944. He was removed to the aid station at 0830 hours and thence to the 21st Evacuation

Hospital. He had a gutter wound of the right temporal region which measured 4X2 inches

and a deep laceration of the brain measuring 2 X 2 X 2 inches. Though the patient appeared

to be mortally wounded, a sanguine attempt was made to control hemorrhage. In spite of

supportive treatment, the patient died at 2000 hours on 17 March 1944 with hyperthermia.

(See autopsy protocol Case 26, p. 391.)

Case 10.-A soldier of the 145th Infantry, 37th Division, was struck by a fragment

of a Japanese mortar shell which burst 3 yards distant at 1800 hours on 10 March 1944.

He was evacuated promptly to the 21st Evacuation Hospital and found to have a severe

wound penetrating the right eye and base of the skull with intracranial hemorrhage. In

spite of supportive treatment, he died at 2400 hours on 10 March 1944. (See autopsy

protocol Case 23, p. 390.)

Wounds of the Thorax

A discussion of wounds of the thorax is complicated by the fact that

frequently the causative missiles pass through the diaphragm causing wounds

of abdominal organs which in turn may be responsible for the death of the

patient. For this reason, wounds involving both the thorax and abdomen

are discussed in a separate section. Multiple wounds present a special problem, since they include many wounds of the thorax, and they also are discussed

in a separate section. Included under multiple wounds were 62 wounds of

the thoracic wall alone and 3 wounds perforating the lung. None of these

patients died, and the three perforating wounds were treated conservatively.

Excluding the groups previously mentioned, there were 156 patients

with wounds of the thorax who were seen alive. Thirteen of these patients

died, giving a mortality of 8.3 percent; the operative mortality for the entire

group, however, was much lower since seven of these patients died of shock

and hemorrhage without operation (Cases 1 through 7).

Wounds of the thorax may be divided into two general groups, those

involving the chest wall only and those perforating the thoracic cage. There

were 102 patients (65.4 percent) who had wounds limited to the thoracic
BOUGAINVILLE CAMPAIGN 351

wall. None of these patients died. The majority of these had penetrating

wounds caused by small fragments from HE shells. Only 10 of these patients

(9.8 percent) were evacuated to the United States and the remainder returned

to duty.

There were 54 patients with perforating or lacerating wounds of the lung

who were seen alive. All 13 deaths occurred in this group, making a mortality of 24.1 percent. Eighteen of these patients were known to have had

sucking wounds. There were 29 open operations on the chest with 6 deaths,

an operative mortality of 20.7 percent (Cases 8 through 13). Eighteen patients

with penetrating or perforating wounds were treated conservatively with

debridement only. There were no deaths in this group. The total operative

mortality for perforating or lacerating wounds of the lung was 12.7 percent;

47 patients underwent operation and 6 died.

CASE REPORTS: WOUNDED-TREATED-DIED-LATER

Thoracic wounds

Case 1.-A soldier of the 246th Field Artillery Battalion, America] Division, was riding

in the back of an uncovered truck when a Japanese 105 mm. shell exploded at a distance

of 5 yards to the rear, at 0730 hours on 8 March 1944. He was struck by a shell fragment

which caused a large wound of the posterior aspect of the left side of the chest. He was

taken immediately to a battalion aid station, a dressing applied, and plasma given. He

did not recover from shock, however, and died at 1120 hours on 8 March 1944.

Case 2.-A soldier of the 148th Infantry, 37th Division, was lying prone on the ground

when a mortar shell exploded at a distance of 2 feet at 0800 hours on 12 March 1944. On

arrival at the 21st Evacuation Hospital 50 minutes later, he was moribund with multiple

wounds of the left side of the jaw, upper right arm, and profuse hemorrhage from a large

perforating wound which extended through the right shoulder into the chest cavity. He

was mortally wounded and died without treatment at the hospital at 0910 hours on 12

March 1944.

Case 3.-A soldier of the 182d Infantry, Americal Division, was manning a machinegun

in a foxhole on Hill 260. This soldier slipped out to look for the enemy position and was

struck by a fragment of a Japanese mortar shell which burst at a distance of 40 yards. He

received multiple severe wounds of the left side of the chest and of the left arm and did

not regain consciousness. While in the battalion aid station, he died from hemorrhage

at 1300 hours on 11 March 1944.

Case 4.-A soldier of the 182d Infantry, Americal Division, was advancing in an upright position in a skirmish line on Hill 260 when he was struck by Japanese .25 caliber

machinegun bullets at 1430 hours on 10 March 1944. He received multiple wounds of

the chest and arm, was given first aid which included plasma, but died at the collecting

company at 1530 hours on 10 March 1944.

Case 5.-A soldier of the 145th Infantry, 37th Division, was standing in a covered

foxhole by a machinegun when he was hit by a Japanese mortar fragment at a distance

of 5 yards from the burst. The shell fragment penetrated the soldier's left shoulder and

entered the chest. He received immediate first aid, including plasma, at the aid station.

The wounding occurred at 0545 on 12 March 1944, and the patient died in the aid station

of pulmonary hemorrhage 3 hours later.

Case 6.-A soldier of the 129th Infantry, 37th Division, was advancing behind a tank

when he was wounded by a Japanese .25 caliber machinegun bullet fired from a distance of

25 yards at 1245 hours on 24 March 1944. The bullet entered the chest and transected the
352 WOUND BALLISTICS

spinal cord. His death at the 21st Evacuation Hospital 24 hours later was accompanied

by shock and hyperthermia. (See autopsy protocol Case 52, p. 398.)

Case 7.-A soldier of the 132d Infantry, Americal Division, was wounded by a shell

fragment from a U.S. artillery "short" at 0815 hours on 7 April 1944. The distance from

the burst was unknown. A large sucking wound of the left side of the chest and multiple

penetrating wounds of the left thigh were evident. He died in the clearing station at 1145

hours on 7 April 1944, as a result of severe hemorrhage from the chest wound.

Case 8.--A Fijian soldier was crouching on patrol when he was struck by a .25 caliber

Japanese sniper bullet fired from a distance of 30 yards. An extensive wound of the lower

part of the left side of the chest was accompanied by profuse hemorrhage. On arrival at

the 21st Evacuation Hospital, it was evident that fatal exsanguination was imminent;

accordingly, an immediate but futile attempt was made to relieve intrathoracic pressure

and to control hemorrhage. During operation, the patient was given 1,500 cc. of whole

blood and 6 units of plasma, but he died on the operating table. (See autopsy protocol

Case 56, p. 400.)

Case 9.-A soldier of the 182d Infantry, Americal Division, was lying prone on Hill

260 operating a machinegun when he was hit by a .25 caliber Japanese machinegun bullet

fired from a distance of 50 yards at 1200 hours on 12 March 1944. He sustained a sucking

wound of the lower part of the right side of the chest accompanied by multiple fractured

ribs posteriorly and disruption of the rib cartilages anteriorly. At the 31st Portable Surgical Hospital, 2,000 cc. of plasma and 1,200 cc. of whole blood were administered and the

skin rapidly closed over the sucking wound. After transfer to the 21st Evacuation Hospital, the patient continued to have severe respiratory difficulty because of the crushing

chest wound. An attempt was made to reconstruct the posterior thoracic cage by wiring

the fourth, fifth, sixth, seventh, and eighth ribs to their paravertebral stumps. At operation,

the lung was stated to have the appearance of "blast injury" 14 (consolidation). There

were several rents in the lung but no bleeding. On 14 March 1944, it was apparent that

the patient had pneumonia, his temperature had risen to 1060 F., and his respiratory rate

to 50. Accordingly, 100,000 units of penicillin were given. The paradoxical breathing

due to the disrupted anterior cartilages became worse, and the patient died of respiratory

failure at 2300 hours on 14 March 1944.

Case 10.-A soldier of the 129th Infantry, 37th Division, was prone on the crest of a

ridge behind a tank attack when he was hit by a .25 caliber Japanese rifle bullet fired from a

distance of 100 yards. He received a severe wound of the posterior aspect of the left side

of the thorax, at 1100 hours on 24 March 1944, and was removed at once to the 2 1st Evacuation Hospital. At operation, the lacerated lung was repaired and the wound closed

tightly. On the following day, because of the development of pneumonia, penicillin therapy

was instituted, using 25,000 units every 4 hours. A severe right pneumothorax was aspirated.

On 26 March, the patient's temperature was 1050 F. and his condition poor. Slight improvement occurred, but on 28 March the patient suddenly cried out, ceased breathing,

and died at 0730 hours. The radial pulse was perceptible for a brief interval after respiration ceased. A diagnosis of pulmonary embolism was made. (See autopsy protocol

Case 50, p. 398.)

Case 11.-An airman of the Thirteenth Army Air Force accidentally shot himself

with a .30 caliber carbine at 1300 on 4 April 1944. The bullet perforated the left side of

the chest. He was taken immediately to the 52d Field Hospital and given 3 units of plasma.

At operation 2 hours later, the patient died on the table. The cause of death was not entirely clear, although a large intrapleural hemorrhage may have been sufficient to account

for the fatal termination. A contusion of the heart muscle was found at post mortem.

(See autopsy protocol Case 53, p 399.)

14 This type of pulmonary hemorrhage is seen with the large temporary cavity produced by the passage of high-velocity

missiles. The term "blast injury" is used rather frequently throughout the case reports, and in most instances, especially

where it is associated with small arms wounds, the pulmonary damage is related to the temporary cavity effect. Small

patchy areas of pulmonary hemorrhage are related to blood aspiration.-I. C. B.
BOUGAINVILLE CAMPAIGN 353

Case 12.-A soldier of the 129th Infantry, 37th Division, was standing by his foxhole

when he was struck by a fragment of a 4.2-inch U.S. mortar shell which fell short and burst

at a distance of 7 feet. At the 33d Portable Surgical Hospital, a sucking wound of the right

side of the chest was sutured. Since this hospital had no thoracic surgeon, the patient was

transferred to the 21st Evacuation Hospital. En route, severe bleeding occurred because

of dehiscence of the recently sutured thoracic wound. While 1,500 cc. of blood and 10 units

of plasma were being administered, a second operation was done. A rib fragment was removed from the lung and active bleeding of the intercostal arteries controlled. The wound

was closed tightly with through-and-through sutures. At the termination of the operation,

the blood pressure was 80/50. A penicillin solution containing 17,500 units was left in the

pleural cavity. The patient did not recover consciousness and died at J500 hours on 30

March 1944. Autopsy showed acute dilatation of the heart, hemorrhage in the right lung

and right hemothorax. (NoTE.-Interhospital transfer of this patient was obviously

inadvisable.)

Case 13.-A soldier of the 182d Infantry, Americal Division, was moving up a hill

when he was struck by a .25 caliber Japanese bullet fired from a distance of 30 yards at 1130

hours on 20 March 1944. The bullet fractured the posterior portion of the ninth rib, perforated the upper lobe of the right lung, and made its exit in the right supraclavicular fossa.

Sucking wounds were present on the posterior and anterior aspects of the chest, with free

bleeding from the posterior wound. At the 31st Portable Surgical Hospital, plasma was

given, and the sucking wounds were debrided and closed. The lung appeared consolidated

from intrapulmonary hemorrhage. The patient died of shock and hemorrhage shortly

after operation.

Wounds of Thorax and Abdomen

The anatomic divisions of thorax and abdomen are satisfactory for a

consideration of wounds of entrance. From a clinical standpoint, however,

those wounds which are caused by missiles which pass from one cavity into

the other present special problems of sufficient importance to warrant placing

them in a separate category.

There were 24 patients with wounds in which the missile penetrated both

the thoracic and abdominal cavities. More than half of these wounds were

caused by bullets entering the chest. The various missiles entered through

the thorax in 17 cases; through the abdomen, in 4; and through both the

abdomen and chest, in 3. Bullets caused 16 of these wounds; mortar

fragments, 5; and artillery shell fragments, 3.

The mortality of these wounds is higher than for wounds of the thorax

or abdomen alone. Of the 24 cases, 15 died, resulting in a mortality of 75.0

percent. Three of these patients died of hemorrhage and shock without

operation. Twenty-one patients underwent operation; of these, 15 died,

giving an operative mortality of 71.4 percent. Brief case histories are given

for all patients who were wounded in action and died later.

The high operative mortality requires some further explanation. If

medical installations had not been so easily available, some of these patients

probably would have been classed as killed in action. Shock from hemorrhage was usually severe, and occasionally, when bleeding continued, it was

necessary to attempt "heroic surgery" (Case 5) in an effort to control it.

Bleeding into both the thorax and abdomen resulting from explosive wounds
354 WOUND BALLISTICS

of the liver, spleen, and kidney frequently contributed to the shock. On

the whole, anesthesia appeared to have been well done but occasionally left

something to be desired. More whole blood would have been beneficial in

some instances, since blood loss was frequently great and could be replaced

by plasma only within limits. Hemorrhage and shock were the chief causes

of death as seen in Cases 5, 6, 8, 10, 11, 14, 16, 17, and 18. Case 15 was moved

immediately after operation. This may have contributed to the shock.

Case 4 illustrates the sequelae which may be encountered from the temporary

cavity effect due to high-velocity bullets. Case 12 died with uremia associated with a high sulfathiazole blood level. (This patient also had an explosive wound of one kidney.) Extensive liver damage appeared to account

for one death (Case 7). Two patients who were evacuated to the rear echelon died; one from sepsis and empyema (Case 9) and the other from secondary

bemorrhage (Case 13). The strain of evacuation may have contributed to

death in these cases.

CASE REPORTS: WOUNDED -TREATED -DIED -LATER

Thoracic and abdominal wounds

Case 1.-A soldier of the 132d Infantry, Americal Division, was running between

foxholes on Hill 260 when he was shot by a .25 caliber rifle at 40 yards. The bullet entered

the thorax at the level of the left seventh rib in the anterior axillary line. He was wounded

at 1530 hours on 14 March 1944. Within 15 minutes after receiving first aid, he was taken

to the aid station and from there transferred directly to the 31st Portable Surgical Hospital.

The wound was extensive as the bullet had passed tangentially from the thorax into the

abdomen and had lacerated the left lung, perforated the diaphragm, and had produced a

massive hemothorax. The spleen was shattered, gastrosplenic artery and renal vein divided, and entire descending colon avulsed. Because he was mortally wounded, the patient

was given supportive treatment only. He died at 0515 hours on 15 March 1944.

Case 2-A soldier of the 145th Infantry, 37th Division, was souvenir hunting when

he was hit by a .25 caliber Japanese rifle bullet fired from a distance of 70 yards. He was

in severe shock when first seen at 1420 hours on 12 March 1944. At the aid station, he

was given 3 units of plasma and then transferred to the clearing station. The bullet had

entered the posterior aspect of the left side of the chest and had produced a large wound

of exit in the left upper quadrant of the abdomen from which omentum protruded. He

did not respond to therapy and died in the shock tent at 1700 hours on 12 1\Iarch 1944.

Case 3.-A soldier of the 82d Chemical Battalion, supporting the 37th Division, was

standing in a pit beside his mortar when a Japanese 81 mm. mortar shell exploded 4 yards

distant at 1930 hours on 8 March 1944. He was taken directly to the 21st Evacuation

Hospital and on arrival was found to be in profound shock from multiple wounds of the

thorax and abdomen and both lower extremities. A severe compound fracture of the left

femur was present. He did not respond to shock therapy and died without operation at

0530 hours on 9 MAIarch 1944. Death resulted from hemorrhage, shock, and respiratory

failure. Cursory post mortem examination revealed multiple penetrating wounds of the

left side of the chest and abdomen involving the large bowel.

Case 4.-A soldier of the 129th Infantry, 37th Division, was prone on the ground in

front of the tanks when he was shot by a .30 caliber Japanese machinegun at a 35-yard

distance. He was struck by two bullets in the back, at 0830 hours, and taken directly to

the 21st Evacuation Hospital. He had an obvious left hemothorax, a sucking wound of

the chest, and questionable abdominal involvement. After preliminary shock treatment,
BOUGAINVILLE CAMPAIGN 355

the explosive wound of the chest was debrided and closed. The abdomen was then opened,

but no lesion was found. He responded well to operation but developed increasing respiratory difficulty requiring frequent aspiration and died at 0645 hours on 28 March 1944.

(See autopsy protocol Case 54, p. 399.)

Case 5.-A soldier of the 145th Infantry, 37th Division, was among a group of men

preparing to climb into a truck when four shells struck within a radius of 15 yards at 0730

hours on 18 March 1944. This man received first aid immediately and arrived at the 21st

Evacuation Hospital within an hour. He had a large sucking wound of the posterior aspect

of the chest with a laceration of the lower lobe of the left lung, perforation of the diaphragm,

and laceration of the spleen and cardia of the stomach. He received 2,000 cc. of blood and

8 units of plasma within 6 hours but neither regained conciousness nor recovered from shock.

Thoracotomy was necessitated because of continued intrathoracie bleeding which produced

a shift of the mediastinum. At operation, 3,000 cc. of blood were removed from the pleural

cavity and lacerations in the lung and dome of the diaphragm were repaired. In spite of

continuous shock therapy, recovery was not sufficient to allow repair of the abdominal

defects. He died at 0545 hours on 19 March 1944. (See autopsy protocol Case 74, p. 406.)

Case 6.-A soldier of the 24th Infantry, 93d Division, was prone on the ground on a

combat patrol when he was shot by a .30 caliber Japanese machinegun from a distance of

30 yards. He received multiple wounds. At 1000 hours on 19 April 1944, he was given

first aid and arrived at the 52d Field Hospital at 1400 hours. In order to combat severe

shock, he was given 1,000 cc. blood and 1,250 cc. of plasma. Because of suspected lung

hemorrhage, thoracotomy was performed. A bone fragment was removed from the lung and

the pleura and diaphragm were sutured. He did not respond to shock therapy and died at

2125 hours on 19 April 1944. (See autopsy protocol Case 73, p. 406, for description of multiple

wounds.)

Case 7.-A soldier of the 145th Infantry, 37th Division, was climbing a hill when he

was hit by a .25 caliber Japanese sniper bullet fired from a distance of 30 yards. He was

wounded at 1745 hours on 11 March 1944, given first aid, and taken directly to the 21st

Evacuation Hospital. After adequate shock therapy, thoracotomy was performed. The

lower lobe of the right lung was lacerated and showed consolidation, the eighth and ninth

ribs were shattered, and in addition a rent in the diaphragm and a severe explosive wound

of the liver were discovered. The lung was sutured, the diaphragm transplanted, and the

liver packed. Death occurred at 1600 hours on 15 March 1944, prior to which time recovery

had seemed satisfactory. Post mortem examination showed no cause of death other than

extensive liver damage.

Case 8.-A soldier of the 57th Engineer Combat Battalion, Americal Division, was

accidentally shot by a .30 caliber M1 rifle, at 1300 hours on 22 February 1944, at a 1-foot

distance. After receiving immediate first aid and plasma, he was taken to the 52d Field

Hospital. A large sucking wound of the right side of the chest was present. Because of

continued hemorrhage, plasma and 1,000 cc. of blood were administered during operation.

Thoracotomy revealed a perforation of the diaphragm and explosive wound of the liver and

large hemothorax. An attempt was made to control bleeding from the liver by packing it

with muscle. The patient died of shock and hemorrhage, a half hour after the conclusion of

the operation, at 1615 hours on 22 February 1944.

Case 9.-A soldier of the 145th Infantry, 37th Division, was kneeling, when he was

shot by a .25 caliber Japanese rifle at 15 yards, on 16 March 1944. A sucking wound of

the lower portion of the right side of the chest resulted. After blood and plasma transfusions, the thorax was explored at the 21st Evacuation Hospital. It was found that the

bullet had perforated the lower lobe of the left lung, guttered a large wound in the diaphragm,

and transected the spinal cord at the level of the 12th dorsal vertebra. A right lower lobectomy was done and the diaphragm repaired. He was evacuated to the rear echelon in good

condition on the eighth postoperative day. Later, he developed empyema and, in spite of
356 WOUND BALLISTICS

adequate drainage and penicillin therapy, died on 25 April 1944. (See autopsy protocol

Case 55, p. 400.)

Case 10.-A Fijian soldier was mistaken for the enemy and shot by a .30 caliber machinegun at a 30-yard distance. He was wounded at 1500 hours on 1 April 1944 and was evacuated immediately to the 21st Evacuation Hospital. After shock treatment, thoracotomy

was done because of suspected hemorrhage. At operation, a right lower lobectomy was

performed and an extensive wound in the liver packed. He did not recover from this operation and died at 2030 hours on 1 April 1944. (See autopsy protocol Case 72, p. 406.)

Case 11.-A soldier of the 37th Reconnaissance Troop, 37th Division, was on a combat

patrol which was ambushed. He was shot by a .25 caliber Japanese rifle at a 25-yard

distance at 1815 hours on 4 March 1944. He received first aid treatment but did not arrive

at the hospital until 0800 hours on 5 March 1944. The bullet entered the abdomen through

the left flank and made its exit through the anterior aspect of the right side of the chest wall.

After shock therapy, perforations of the small and large bowel were sutured. The patient

did not recover from shock and died at 1615 hours on 5 March 1944. (See autopsy protocol

Case 71, p. 406.)

Case 12.-A soldier of the 132d Infantry, Americal Division, while on combat patrol,

was shot by a Japanese rifle as he entered an enemy pillbox at 1700 hours on 29 March 1944.

After a long carry, he arrived at the 121st Clearing Station at 2000 hours on 30 March 1944.

The bullet had entered the chest in the sixth interspace in the posterior axillary line and had

perforated the diaphragm, large bowel, and kidney. At operation, a laceration of the diaphragm was repaired, the large bowel perforation sutured, a transverse colostomy performed,

and sulfonamide therapy instituted. On the third day, the urinary output having decreased

to 200 cc., a diagnosis of uremia was made. The sulfonamide level was then 24. After

transfer to the 21st Evacuation Hospital, he died at 0600 hours on 4 April 1944. (See

autopsy protocol Case 68, p. 404.)

Case 13.-A soldier of the 129th Infantry, 37th Division, was shot through the arm and

chest by a .25 caliber Japanese rifle bullet on 13 March 1944. After receiving plasma, he

was taken directly to the 21st Evacuation Hospital. The bullet had fractured the left

humerus, penetrated the chest, perforated the diaphragm, and produced a hemothorax.

The wound was debrided and the pleura closed. The patient was evacuated by air on 15

March 1944. He died on 21 March 1944 of secondary hemorrhage. (See autopsy protocol

Case 69, p. 405.)

Case 14.-A soldier of the 182d Infantry, Americal Division, was in a foxhole on Hill

260 when he was hit by a .25 caliber Japanese machinegun bullet fired from a distance of

40 yards. He was wounded at 1200 hours on 11 March 1944. At the 31st Portable Surgical Hospital, it was found that the bullet had entered the left side of the chest in the

seventh interspace posterior axillary line and had coursed downward and forward into the

abdomen. A sucking wound of the chest was closed and the abdomen opened. The bullet had

perforated the diaphragm, stomach, and liver, and had shattered the spleen. The various

perforations were closed and the spleen removed. The patient did not rally and died at 0700

on 12 March 1944. Autopsy revealed that a perforation of the jejunum had been overlooked at operation. Death was attributed to peritonitis although shock was also a factor.

Case 15.-A soldier of the 182d Infantry was advancing with a combat patrol when he

was shot by a machinegun at close range on 8 March 1944. He continued to command for

20 minutes but was then evacuated to the 31st Portable Surgical Hospital. The bullet had

entered just media] to the anterior axillary line in the 5th interspace and made exit near

the 12th rib posterior. In its course, it had perforated the lung, diaphragm, stomach, and

spleen. At operation, the diaphragm and stomach were repaired. The patient was transferred to the 21st Evacuation Hospital on 9 March 1944 and died the following day at 1845

hours. (NOTE.-The transfer of this patient on the first day after operation was inadvisable.)

Case 16.-A soldier of the 145th Infantry, 37th Division, was struck by a fragment of

a Japanese knee mortar shell on Hill 700. He was approximately 25 yards from the burst.
BOUGAINVILLE CAMPAIGN 357

Having received plasma and immediate first aid dressings, he was taken to the 21st Evacuation Hospital. Because of multiple perforating wounds of the chest and abdomen, laparotomy was done. Extensive laceration of the liver and several perforations of the jejunum

and duodenum were repaired. He died of shock and hemorrhage on the day of operation

at 2240 hours on 11 March 1944.

Case 17.-A soldier of the 920th Air Base Security Battalion was riding on a truck

when a Japanese artillery shell exploded 5 feet behind his vehicle at 0600 hours on 24 March

1944. He was taken directly to the 52d Field Hospital and treated for shock. There were

two wounds; one traversed the fourth and fifth ribs in the midaxillary line, perforated the

lower lobe of the left lung, and entered the posterior mediastinum. The second fragment

entered the left ilial region and perforated the sigmoid colon. Massive hemothorax was

present. At operation the perforation of the lung was sutured, and the sigmoid colon was

exteriorized. The patient was given 4,000 cc. of plasma and 1,000 cc. of whole blood. He

did not respond, however, and died 8 hours after the operation. (See autopsy protocol Case

57, p. 400.)

Case 18.-A Fijian soldier was crawling on a combat patrol when a Japanese mortar

shell exploded at a distance of 20 yards on 29 March 1944. On arrival at the 21st Evacuation Hospital, he received treatment for shock. Perforating wounds involved the lung,

diaphragm, colon, spleen, pancreas, and left kidney; the patient also had a fracture of the

left humerus. The spleen was removed, the colon exteriorized, and the diaphragm repaired.

He died at 2215 hours on 30 March 1944. (See autopsy protocol Case 70, p. 405.)

Wounds of the Abdomen

This anatomic division is used to designate not only the abdominal cavity

and contents but also the various structures surrounding it, including the muscles of the abdominal wall, the vertebral column, and the ilia. Wounds involving both the thorax and abdomen are considered in a separate section.

There were 86 patients who had wounds of the abdomen; in 49 the wounds

were limited to the abdominal wall and in 37 they penetrated the abdominal

cavity. The majority of wounds limited to the abdominal wall were caused

by HE missiles, chiefly mortar fragments. There were 5 deaths among the

49 patients who received wounds of the abdominal wall; only Cases 1 and 2

died before operation. One death followed a negative abdominal exploration

(Case 18).

Penetration of the abdominal cavity was found in 37 patients. There

were 12 deaths among 36 patients undergoing operation making a total operative mortality of 33.3 percent. However, it must be borne in mind that this

high operative mortality is accounted for in part by many mortally wounded

patients who died of shock and upon whom operation was undertaken with

little hope of success (Cases 5, 7, 10, 11, 12, 13, and 14). One patient died

of shock before operation (Case 3), two died of peritonitis (Cases 6 and 8),

and one of unexplained uremia (Case 17). No deaths occurred because of failure to explore the abdomen, but in two patients (Cases 4 and 9) death resulted

from visceral perforations which were overlooked at operation. The very early

evacuation of patients from the portable surgical hospitals undoubtedly contributed to shock and was the factor which may have precipitated death in a

few instances (Cases 4, 5, 7, and 17). It is also known that patients do not
35S WOUND BALLISTICS

tolerate air transportation well soon after abdominal operations, and this type

of evacuation may have contributed to the death of one patient (Case 18).

The large bowel was perforated in 15 patients among whom there were

5 deaths, making an operative mortality of 33.3 percent (see Cases 4, 5, 6, 7, 8).

Among these 15 patients, the colon alone was perforated in 5, the colon and

spleen in 1, and the colon and small intestine in 9. Four of the five deaths

occurred in this latter group. The small intestine alone was perforated in 6

patients, the liver in 4, the stomach in 1, and the bladder in 1. All these

patients recovered. In addition, three patients recovered who had wounds

perforating the abdominal cavity in which the injury was limited to the perntoneum and mesenteric vessels.

CASE REPORTS: WOUNDED-TREATED -DIED -LATER

Abdominal wounds

Case 1.-A soldier of the 145th Infantry, 37th Division, having returned from patrol,

was preparing to get into a truck when four Japanese artillery shells landed within a radius

of 15 yards. He was wounded at 1930 hours on 18 March 1944 and taken directly to the

21st Evacuation Hospital. Multiple wounds were present which included spinal cord injury

and an extensive avulsion of the tissues of the lumbar region exposing the vertebras, spinal

canal, and both kidneys. The patient was treated for shock but died without operation at

1300 hours on 19 March 1944.

Case 2.-A soldier of the 145th Infantry, 37th Division, while crawling in attack on

Hill 700, was hit by a Japanese machinegun bullet fired from a distance of 30 yards. He

was wounded at 0700 hours on 10 March 1944 and arrived at the 21st Evacuation Hospital

at 1500 hours on the same day. Extensive compound fractures involving the sacrum, fourth

and fifth lumbar vertebras, and the ilium were found. There was apparently no intraabdominal injury, but the patient failed to recover from profound shock and died at 2330

hours on 11 March 1944.

Case 3.-A soldier of the 132d Infantry, Americal Division, returning from patrol,

was shot with a .25 caliber Japanese machinegun at 1600 hours on 6 April 1944. He received

first aid and remained in the command post overnight. After receiving plasma, he was

evacuated to the clearing station. Multiple wounds involving the lower part of the thorax,

abdomen, and sacrum were found. There was no response to shock therapy and death

occurred on 8 April 1944. Post mortem examination showed peritonitis, resulting from

nmltiple perforations of the colon and terminal ileum, destruction of fifth lumbar to second

sacral vertebras, and retroperitoneal hemorrhage.

Case 4.-A soldier of the 132d Infantry, Americal Division, while walking along a trail

on Hill 260, was wounded by a 90 rmm. Japanese mortar shellburst 25 yards distant at 1530

hours on 13 March 1944. After immediate first aid treatment, he was taken to the 31st

Portable Surgical Hospital. Multiple wounds were present involving the right knee, thigh,

right side of the chest, and abdomen. A shell fragment entered the abdomen through the

left flank, passed transversely, and perforated the large and small bowel. At operation, the

ileum, colon, and mesocolon were repaired. On 15 March 1944, the patient was transferred

to the 21st Evacuation Hospital. After the administration of 1,000 cc. of blood and 4 units

of plasma, a transverse colostomy was done under local anesthesia because of severe abdominal distention. The patient died at 1115 hours on 16 March 1944. Post mortem examination revealed peritonitis resulting from the two perforations of the jejunum which had been

overlooked at operation. (See autopsy protocol Case 83, p. 408.) (NoTE.-Interhospital

transfer was inadvisable in this case.)
BOUGAINVILLE CAMPAIGN 359

Case 5.-A soldier of the 37th Division was running along a road carrying a box of

ammunition when he was struck by a .25 caliber bullet fired by a Japanese tree sniper from

a distance of 75 yards. He was wounded in the abdomen at 0739 hours on 10 March 1944

and transported immediately to the 33d Portable Surgical Hospital. In preparation for

laparotomy, he was given 4 units of plasma. At operation, resection of 18 inches of lower

ileum with a side-to-side anastomosis was done, and a transverse laceration of the sigmoid

colon was sutured. On 11 March, he was transferred to the 21st Evacuation Hospital and

died there of shock at 0700 hours on 12 March 1944. (NoTE.-It was inadvisable to have

transferred this patient before recovery.)

Case 6.-A soldier of the 82d Chemical Battalion, 37th Division, was standing in the

gunpit of a mortar battery when he was struck by fragments of an 81 mm. Japanese mortar

shell which burst at a distance of 10 yards. Following wounding at 1930 hours on 8 March

1944, he was removed immediately to the 21st Evacuation Hospital. Severe wounds of the

left flank and abdomen involving the sigmoid colon and retroperitoneal tissues were found

at operation. The sigmoid colon was exteriorized, but the patient died of peritonitis at

1700 hours on 13 March 1944.

Case 7.-A soldier of the 25th Infantry, 93d Division, was returning from a patrol when

he was wounded by a grenade which exploded in his right hand at 1700 hours on 9 April 1944.

At the 31st Portable Surgical Hospital, five penetrating wounds of the right side of the

abdomen and a compound fracture of the right hand were discovered. Because of the

presence of shock, he received 8 units of plasma, 1,000 cc. of blood, and 4,000 cc. of glucose

solution. The wounds were debrided and 8 inches of jejunum were resected and 8 perforations of the jejunum were sutured. Perforations of the descending colon, sigmoid colon,

and cecum were also repaired and a transverse colostomy done. The patient was transferred

to the 21st Evacuation Hospital on 10 April 1944 and died at 2355 hours on 11 April 1944.

(See autopsy protocol Case 85, p. 409.) (NoTE.-It was inadvisable to have transferred

this patient on the first postoperative day.)

Case 8.-A soldier of the 129th Infantry, 37th Division, while operating a machinegun,

was hit by a .25 caliber Japanese sniper bullet, distance unknown, at 1130 hours on 13 March

1944. He received first aid within 20 minutes, was evacuated from the line within 1 hour,

and arrived at the 21st Evacuation Hospital shortly thereafter. After appropriate measures

to combat shock, laparotomy was done. The bullet, coursing upward after entering the

abdomen on the left side, had produced two perforations of the descending colon, severed the

right middle colic artery, perforated the jejunum in three places, and then made its exit

through the right rectus muscle. The visceral perforations were closed, and after resection

of 4 inches of jejunum a catheter was placed in the bowel for decompression. After a few

days, severe abdominal distention developed, and it became obvious that the enterostomy was

unsatisfactory. The patient died at 1400 hours on 20 March 1944. At autopsy, it was

found that the catheter had slipped out of the bowel, probably because the bowel had not been

sutured to the abdominal wall. Bile peritonitis produced by leakage was stated to have

caused death.

Case 9.-A soldier of the 82d Chemical Battalion, while walking along a column of

vehicles which were moving into new positions, was shot without challenge with a U.S. Ml

rifle at a distance of 10 feet. He immediately received first aid dressings and plasma and 2

hours later was taken to the 21st Evacuation Hospital. A severe wound of the abdomen was

present, and the sigmoid colon was perforated in three places. A bladder wound which was

overlooked at the first operation was discovered on the following day. A suprapubic cystotomy

was done at once, and at the same operation the left external iliac artery was ligated because

of a contused area which had weakened its wall. The patient did not rally, appeared to be

in shock, and died at 0344 hours on 16 March 1944.

Case 10.-A soldier of the 145th Infantry, 37th Division, was carrying ammunition to

a gun position when a Japanese knee mortar shell burst 10 yards away. He was wounded

in the lumbar region at 1330 hours on 10 March 1944 and immediately transported to the

21st Evacuation Hospital. The shell fragment had passed through the left kidney, spleen,
360 WOUND BALLISTICS

transverse colon, and jejunum. The operation consisted of splenectomy, exteriorization of

the transverse colon lesion, and resection of a 3-inch segment of jejunum. Because of the

patient's poor condition, nephrectomy was not done. He did not recover completely from

shock and died on 14 March 1944.

Case 11.-A soldier of the 82d Chemical Battalion, while standing in a gunpit of a mortar

battery, was hit by a fragment of a 77 mm. Japanese mortar shell which burst at a 5-yard

distance. He received his wounds at 1930 hours on 8 March 1944 and was taken immediately

to the 21st Evacuation Hospital. Following treatment for shock, laparotomy was done.

One shell fragment passing laterally had perforated the transverse colon in three places, lacerated the right lobe of the liver, and made an exit wound 4 inches in diameter in the lateral

abdominal wall. Present also were a compound fracture of the left ulna and a large wound

of the right ankle. There were other smaller wounds of the legs, thighs, buttocks, back, and

face. At operation, the wounds were debrided, the perforations of the transverse colon

sutured, and the defect in the liver repaired. The patient did not recover from shock and

died on the following day at 2330 hours on 9 March 1944.

Case 12.-A soldier of the 132d Infantry, Americal Division, while advancing on Hill

260, was struck by a fragment of a 90 mm. Japanese mortar shell, distance unknown. He

was wounded at 0900 hours on 13 March 1944, given immediate first aid, and then transported

directly to the 2

1st Evacuation Hospital. The left arm was avulsed, an extensive wound of

the right leg was present, and the great vessels of this extremity were severed. There were

multiple wounds of the abdomen, and the ileum was perforated. Because of severe shock,

only the perforations of the ileum were sutured at the initial operation. On the following day, because of an extension of gangrene of the leg, amputation was done. The

patient died at 2112 hours on 15 March 1944. Post mortem examination showed no leakage

from the repaired bowel. In this case, death was attributed to traumatic shock despite the

fact that there had been adequate blood replacement. (The surgeon expressed the opinion

that the operation should have been postponed and the limb packed in ice.)

Case 13.-A soldier of the 24th Infantry, 37th Division, while on patrol, was struck by

a Japanese .25 caliber bullet fired from a distance of 25 yards. While being moved, he was

shot again by the same rifleman. This second wound resulted in evisceration. He was

wounded at 1030 hours on 16 March 1944 and taken directly to the 21st Evacuation Hospital. There he received 1,000 cc. of blood and 3 units of plasma. The first bullet entered

2 inches below the right costal margin, passed downward along the rectus muscle into the

flank, then through the wing of the ileum, and made its exit in the right buttock. The

bullet causing the evisceration entered 2 inches below the left costal margin, traveled downward destroying the rectus muscle, perforated the jejunum and ileum, and passed under the

inguinal ligament into the thigh. Moderate shock was present. At operation, the eviscerated intestine was enclosed in a pack while the rents in the jejunum and ileum were

resected. Profound shock developed from which the patient did not recover, and he died at

1515 hours on 16 March 1944.

Case 14.-A soldier of the 135th Field Artillery Battalion, 37th Division, accompanied

a party burying the Japanese dead in front of the 129th Infantry perimeter. He wandered

away and was shot by a Japanese .25 caliber rifle at 1545 hours on 27 March 1944. He

was taken immediately to the hospital. The bullet entering the lumbar region had shattered

the 12th rib, driving bone fragments into the kidney, and had then passed through the

right lobe of the liver, causing an extensive laceration. Following appropriate shock

therapy, the abdomen was explored and the liver packed. Because of the poor condition

of the patient, only the loose fragments of kidney were removed. He did not recover from

shock and died at 1830 hours on 27 March 1944. (See autopsy protocol Case 81, p. 407.)

Case 15.-A soldier of the 140th Field Artillery Battalion, 37th Division, while on

patrol looking for the enemy who had infiltrated the lines, was shot by a .25 Japanese rifle

at a 10-yard distance. He was wounded at 1605 hours on 14 March 1944, received immediate first aid, and arrived at the hospital within an hour. A wound was present in the left

axilla, and the axillary vein was severed. The major lesions consisted of compound fractures
BOUGAINVILLE CAMPAIGN 361

of the femur and ileum with an extensive wound penetrating the right hip joint. Severe

shock was present. The axillary vein was ligated. Because of the presence of abdominal

symptoms, laparotomy was done but no lesion found. During this operation, the urinary

bladder was explored and closed. Because of the poor condition of the patient, only a

simple debridement of the hip wound was done. The patient showed a severe toxic reaction,

developed gas gangrene of the hip, and died on the second postoperative day at 1450 hours

on 16 March 1944. (See autopsy protocol Case 103, p. 415.)

Case 16.-A soldier of the 145th Infantry, 37th Division, while attacking on Hill 700,

was shot by a Japanese machinegun at 30 yards. He was wounded at 1630 hours on 9

March 1944 and taken immediately to the battalion aid station. After he had received 3

units of plasma, he was evacuated by halftrack because the road was under fire. At the

hospital, in order to combat severe shock, he was given 12 units of plasma and 500 cc. of

blood. The bullet had entered the right iliac crest and passing downward had shattered

the entire right wing of the pelvis. Exploration of the abdomen through a McBurney

incision was negative. The hip wound was debrided and packed. He failed to recover

from shock and died at 2300 hours on 10 March 1944.

Case 17.-A soldier of the 129th Infantry, 37th Division, was standing by a foxhole

when a 4.2-inch U.S. mortar shell fell short and burst 7 feet away, on 27 March 1944. He

received treatment for shock at the 33d Portable Surgical Hospital. One shell fragment

produced a large wound over the region of the right iliac crest; it also fractured the fifth

lumbar vertebra and shattered the lower pole of the right kidney. Another fragment

caused a wound of the right shoulder and arm. Shock therapy was continued while the

wounds were debrided. The development of severe abdominal distention necessitated

ileostomy. On 31 March, he was transferred to the 21st Evacuation Hospital and died

there on 1 April 1944 with unexplained uremia. (See autopsy protocol Case 84, p. 409.)

Case 18.-A soldier of the 182d Infantry, Americal Division, was standing in the open

when a Japanese hand grenade burst 3 feet away. He was wounded at 1345 hours on 13

March 1944. After arrival at the 31st Portable Surgical Hospital, examination disclosed

many wounds over the left side of the trunk and extremities. Following transfer to the

clearing station, abdominal exploration was done with negative results. He was evacuated

by air on 18 March 1944. On arrival at the 137th Station Hospital on Guadalcanal on the

same day, evisceration was discovered. A secondary wound closure was done, but the

patient developed peritonitis and died on 25 March 1944. (See autopsy protocol Case 82,

p. 408.) (NOTE.-Air evacuation might have caused evisceration, although planes transporting casualties usually fly at low altitudes.)

Wounds of the Extremities

Wounds of the extremities are of great importance because of their

frequency. Wounds of the upper and lower extremities together (excluding

multiple wounds) accounted for 40.6 percent of all casualties. As a surgical

problem, these wounds were of major significance since they comprised more

than half of all the living wounded.

Of 320 patients with wounds of the upper extremities, one was killed in

action. This patient had a traumatic amputation. There was not a single

death in the 319 treated wounds of the upper extremities. Gas gangrene

infection did not occur. In this group, there were 119 compound fractures of

which 44 were in the humerus, 33 in the bones of the forearm, and 42 in the

bones of the hand. There were 10 amputations, 2 through the humerus

because of extensive destruction of tissue and impairment of blood supply, 1

traumatic amputation of the hand, and 7 of the fingers.

603225--62-25
362 WOUND BALLISTICS

There were 401 patients with wounds of the lower extremity (not including

multiple wounds), 8 of whom died; I of unexplained cause (Case 1 ); 2 of shock

and hemorrhage (Cases 2 and 3); 1 of uremia associated with a probable "crush

syndrome nephrosis" (Case 4); 2 not seen by a medical officer, of shock and

hemorrhage following traumatic amputations of the feet (Cases 5 and 6); and

2 of gas gangrene (Cases 7 and 8). Therefore, the total mortality for the

wounded who were seen alive was 2 percent.

There were 90 compound fractures of the lower extremities distributed as

follows: Femur, 23; bones of the leg, 51; and bones of the feet, 16. All fractures were treated with plaster. There were no deaths due directly to compound fracture (Case 4). There were 18 amputations of the lower extremity

of which 7 were " traumatic" and 11 elective. Of the 7 traumatic amputations,

3 died (Cases 3, 5, and 6). Of the 11 elective amputations, 8 were done because

of extensive tissue destruction and blood vessel injury. The one death in

this group occurred in the rear echelon (Case 4). The remaining three amputations were necessary because of gas gangrene infection, although in two

of these patients impending circulatory gangrene was also present. One of

this group died (Case 8). All amputations were of the guillotine type.

CASE REPORTS: WOUNDED-TREATED-DIED-LATER

Extremity wounds

Case 1.-A soldier of the 132d Infantry, 37th Division, was lying prone in open jungle

when he was struck by a .25 caliber Japanese machinegun bullet fired from a distance of

30 yards at 1800 hours on 2 April 1944. He was taken immediately to the battalion aid

station and found to have a severe perforating wound of the right knee joint. While receiving first aid treatment, he became hysterical and died suddenly at 1900 hours on 2

April 1944. While some hemorrhage had occurred, he had not lost enough blood to cause

severe shock. Death was unexplained.

Case 2.-A soldier of the 132d Infantry, 37th Division, leaving the trail to the observation post to try a "short cut," tripped the wire of a U.S. land mine which exploded a few

feet away. He was wounded at 0715 hours on 22 March 1944. Plasma and morphine

were administered by a medical officer within 10 minutes, and the patient was immediately

evacuated. At the clearing station, examination disclosed an extensive wound of the dorsal

aspect of the left thigh. Because of severe hemorrhage from the larger vessels, three blood

transfusions were given. Following debridement of the wound and ligation of the profunda

artery, the patient did not recover from shock and died at 1500 hours on 22 March 1944.

Case 3.-A soldier of the 129th Infantry, 37th Division, was firing a machinegun

when a Japanese knee mortar shell burst between his legs. He was wounded at 1000

hours on 12 March 1944 and taken immediately to the 33d Portable Surgical Hospital. A

traumatic amputation at the upper third of the right femur was completed by guillotine

amputation under Sodium Pentothal (thiopental sodium) anesthesia, and several small

wounds of the posterior aspect of the left leg were dressed. Following operation, during

which he received 4 units of plasma, the patient was transferred immediately to the 21st

Evacuation Hospital. On arrival there, the systolic blood pressure could not be obtained.

While awaiting blood transfusion, he was given 1 unit of plasma but died before this could

be completed at 1450 hours on 12 March 1944. Cause of death was shock and hemorrhage.

(NoTE.-This patient should not have been transferred to another hospital.)
BOUGAINVILLE CAMPAIGN 363

Case 4.-A soldier of the 129th Infantry, 37th Division, was lying prone in the open

when he was struck by a fragment of a Japanese knee mortar shell which burst nearby.

He was wounded on 15 March 1944 and taken to the 21st Evacuation Hospital. He had

a severe wound of the right leg involving the vessels and nerves and a compound fracture

of the tibia. This wound was debrided. The next day because of destruction of the blood

supply a guillotine amputation was done 2 inches proximal to the knee joint. He was

evacuated to a station hospital in the rear echelon on 19 March 1944. On 23 March, he

developed anuria and died with uremia at 0845 on 25 March 1944. Post mortem examination

revealed nephrosis which was thought to have been due to "crush syndrome." (See autopsy

protocol Case 93, p. 411.)

Case 5.-A soldier of the 132d Infantry, 37th Division, while on a combat patrol lying

in an open foxhole, sustained a direct hit by a Japanese knee mortar shell. He was wounded

at 1800 hours on 4 April 1944, was taken to the command post, given 2 units of plasma and

morphine, and kept there overnight. He had a traumatic amputation of the right foot. On

the following day, an attempt was made to transport this soldier to the hospital, but he died

en route while crossing a river at 1300 hours on 5 April 1944. The wound was not bleeding

when inspected before the journey, hence a tourniquet was not applied. However, during

the long carry, bleeding occurred and death was apparently due to shock from hemorrhage.

This might have been prevented by the use of a tourniquet. (See autopsy protocol Case

91, p. 410.)

Case 6.-A soldier of the 182d Infantry, Americal Division, was digging a foxhole on

Hill 260 when he was struck in the ankle by a ricochetting .25 caliber Japanese bullet fired

from an unknown distance. He was wounded at 1800 hours on 11 March 1944 and received

immediate first aid. "There was practically no bleeding when bandaged. It was dark.

We put him on a litter and started down the hill." The patient complained of feeling cold,

and when the bottom of the hill was reached he was found dead. Profuse hemorrhage had

occurred. The rough journey down the hill in the absence of a tourniquet had apparently

dislodged a blood clot, thus initiating a fatal hemorrhage.

Case 7.-A soldier of the 182d Infantry, Americal Division, was patrolling on Hill 260 a

short distance beyond the perimeter when he tripped the wire of a U.S. grenade boobytrap at

1200 hours on 28 March 1944. He threw himself on the ground but was struck in the left

buttock by a fragment at a distance of 3 yards from the burst. He was evacuated immediately to the clearing station and found to have a penetrating wound of the buttocks extending

upwards 7 inches into the soft tissues of the lumbar region. The point of entrance was 1

inch in diameter. Through a 3-inch incision, the fragment was removed and the wound

closed without drainage. The wound of entrance was debrided but not sutured. The track

was not debrided, but the wound was irrigated and dusted with sulfanilamide powder. After

transfer to the 21st Evacuation Hospital on 3 April 1944, a diagnosis of gas gangrene was

made. Despite the administration of 20,000 units of gas gangrene antitoxin and 1,000 cc.

of blood, death occurred 4 hours later as a result of the very virulent Clostridium welchii

infection.

Case 8.-A soldier of the 37th Division was near Hill 700 prone behind a tree when a

Japanese knee mortar shell burst within a few feet. He was wounded at 0430 hours on 11

March 1944 and taken immediately to the battalion aid station. After receiving plasma, he

was transferred directly to the 21st Evacuation Hospital. He had multiple severe wounds

of both legs, thighs, buttocks, scrotum, and back. Following the administration of an

additional 3 units of plasma and 1,000 cc. of blood, wound debridement was done under

ether anesthesia. On 13 March 1944, he developed signs of gas gangrene of the right leg and

was given 60,000 units of gas gangrene antitoxin. On 14 March, a guillotine amputation of

the lower third of the thigh was done, following which the patient became rapidly more

toxic and died at 1415 hours on 15 March 1944.
364 WOUND BALLISTICS

Multiple Wounds

Only those patients who had two or more wounds in different anatomic

regions either one of which might have produced death or disability are included

in the classification "Multiple Wounds." When a single wound was considered

responsible for the disability, even though several additional minor wounds

were present, that patient was classified according to the anatomic location of

the major wound. Many factors are involved when multiple wounds occur

simultaneously in different parts of the body. For this reason, endeavor was

made to limit to a minimum the number of casualties included under the division

designated "Multiple Wounds." Nevertheless, despite this effort, there were

239 patients seen alive who were so classified.

In this group of 239 patients who received multiple wounds, there were 8

deaths, making a mortality of 3.3 percent. With one exception (Case 3), those

who died underwent surgical operation. These operations were usually sanguine procedures, and in most instances death resulted from shock and hemorrhage (Cases 1, 2, 4, 5, 6, and 7). In one patient (Case 8), death was caused

by gas gangrene infection.

In these 239 patients, 569 anatomic regions were hit with wounds distributed as follows: Upper extremity, 202 (35.5 percent); lower extremity, 181

(32.0 percent); head, 92 (16.1 percent); thorax, 69 (12.2 percent); and abdomen

25 (4.4 percent). The number of wounds was actually in excess of these figures

because several wounds frequently occurred in one anatomic region. There

were 2.8 anatomic regions wounded per patient or well in excess of 3 wounds

per patient, since many minor wounds from small fragments were not even

tabulated.

CASE REPORTS: WOUNDED-TREATED-DIED-LATER

Multiple wounds

Case 1.-A soldier of the Americal Division was struck by a fragment of a shell which

burst near him in the messhall at 0730 hours on 11 March 1944. He reached the operating

room of the clearing station within 15 minutes and, although shock did not appear to be

severe, was given 2 units of plasma. He had sustained a large perforating wound of the left

leg, a compound fracture of the bones of the left foot, a wound of the left forearm, a severed

temporal artery, and many small penetrating wounds. Following wound debridement,

shock supervened, and, despite the administration of 1,500 cc. of blood and 2 units of plasma,

the patient died at 1450 hours on 11 March 1944. Death was attributed to irreversible

shock, although brain injury may have been a factor since bleeding from the ears was present.

Case 2.-A soldier of the 246th Field Artillery was riding in the back of a truck when

a Japanese 105 mm. shell burst 5 yards to the rear at 0730 hours on 8 March 1944. Because

hemorrhage was profuse, a tourniquet was immediately applied to the leg and plasma administered. At the nearby 36th Naval Hospital, the patient was treated for shock in association

with a severe wound of the left thigh and right forearm and an extensive wound of the back

accompanied by compound fractures of the third and fourth lumbar vertebras. The wounds

were cleaned, but the patient did not recover from shock and died at 0120 hours on 9 March

1944.
BOUGAINVILLE CAMPAIGN 365

Case 3.-A soldier of the 131st Engineer Combat Battalion, leaving his foxhole to rescue

a friend, was struck by fragments of a Japanese 90 mm. mortar shell which burst 6 feet away

at 0500 hours on 24 March 1944. He was taken directly to the hospital. It was apparent

that the patient was mortally wounded, a blood pressure reading could not be obtained, and

profound shock was present. A severe wound involving the brain was found in the temporal region and a penetrating abdominal wound in the region of the right flank. He died

without operation at 0830 hours on 24 March 1944. At post mortem, extensive lacerations

of the liver and kidney were discovered. (See autopsy protocol Case 99, p. 413.)

Case 4.-A soldier of the 132d Infantry, Americal Division, was investigating a mine

field when an M3 antipersonnel mine exploded within a few feet at 0830 hours on 27 March

1944. He received immediate first aid including 3 units of plasma, following which he was

removed to the clearing station. A traumatic amputation of the left foot and extensive

lacerated wounds of both buttocks and the right forearm were found. Operation under ether

anesthesia was started at 1000 hours and completed at 1115 hours. During the operation,

500 cc. of blood and 1 unit of plasma were given, but at the conclusion of the procedure the

blood pressure was only 90/60. While recovering from ether, the patient struggled violently and died suddenly at 1455 hours on 27 March 1944. (See autopsy protocol Case 104,

p. 415.)

Case 5.-A soldier of the 148th Infantry, 37th Division, was running across a jungle

trail when a U.S. 81 mm. mortar shell fell short and burst "right between his legs." He was

wounded at 0945 hours on 1 April 1944 and was taken directly to the 33d Portable Surgical

Hospital. A traumatic amputation of the right foot, an incomplete traumatic amputation

of the left leg, and lacerated wounds of the right elbow and hand were evident. After the

administration of 2,000 cc. of blood and 1 unit of plasma, the traumatic amputation of the

left leg was completed at operation. The patient died on the operating table at 1500 hours

on 1 April 1944. (See autopsy protocol Case 94, p. 411.)

Case 6.-A soldier of the 182d Infantry, Americal Division, was in a slit trench covering

a bazooka man when a Japanese knee mortar shell burst in the trench at 0830 hours on

11 March 1944. Both legs were blown off below the knees as well as the left arm and a portion of the right buttock. He received 2 units of plasma, remained rational, and reached

the 31st Portable Surgical Hospital with comparatively little bleeding. At operation, the

partial amputation of the arm was completed, and the other wounds were debrided. He

died at 1300 hours on 11 March 1944 of shock and hemorrhage.

Case 7.-A soldier of the 182d Infantry, Americal Division, while in a foxhole on Hill

260, was wounded by a Japanese knee mortar shell which burst in the foxhole. The aidmen

had difficulty in reaching him, and 5 hours elapsed before he could be removed. At the 31st

Portable Surgical Hospital, shock was apparent and resulted from compound fractures of the

right femur and leg and severe wounds of the right arm, chest, and pelvis. After a plasma

transfusion, a Steinmann pin was inserted in the distal end of the femur and the lower leg

amputated. The patient did not survive the operation, however, and died at 1350 hours on

13 March 1944. Autopsy showed multiple perforating wounds of the right thigh and a compound fracture of the femur. The right lower leg had been amputated at the junction of the

upper and middle thirds, and a compound fracture of the bones of the left foot and deep

lacerations of the scrotum, chest wall and medial aspect of the thigh were present. The abdominal and thoracic cavities were negative. Death was attributed to shock and hemorrhage.

Case 8.-A soldier of the 117th Engineer Combat Battalion, 37th Division, while

driving a vehicle along a jungle trail, was struck by fragments of a Japanese mortar shell

which burst in a tree at a distance of 25 feet. He was wounded at 1030 hours on 9 March

1944 and taken at once to the 21st Evacuation Hospital. Severe multiple wounds of the

right thigh and buttocks involving the perineum and scrotum were discovered. The sciatic

nerve had been transected. After appropriate shock therapy, the wounds were debrided,

and the patient was given a prophylactic injection of 5,000 units of gas gangrene antitoxin.

Immediately after a diagnosis of gas gangrene had been established, multiple incisions were
366 WOUND BALLISTICS

made in affected areas in the right groin and thigh. The patient expired at 2045 hours on

10 March 1944, approximately 30 minutes after the termination of the operation. Death

was ascribed to gas gangrene infection.

Comment on Treatment of the Wounded

Perhaps never in the history of jungle warfare were professional talent and

medical facilities so excellent and routes of evacuation so favorable as in the

Bougainville campaign. Hence, the care of the wounded did achieve a very

high standard. That this was accomplished is evidenced by the foregoing

description of the treatment of all those who were wounded in action and died

later.

The first aid treatment was prompt and efficient. Great credit should be

given to the aidmen who fearlessly exposed themselves, and high approbation

should be accorded to the many who were killed in order that their comrades

might live. Plasma was given promptly and in large quantities. Hemorrhage

was efficiently controlled in all patients, with only two exceptions. Both of

these patients bled to death from traumatic amputations of the foot. Bleeding

had ceased while the patient was at rest but began anew during transportation

(fig. 184). These patients might have been saved by the use of a tourniquet.

Considerable criticism was heard because sucking wounds of the chest were not

tightly sealed by the adequate use of adhesive. However, no patient was

known to have died for this reason.

The division medical services were adequately staffed to care for the type

of surgery they were expected to do. Most of the major surgery was done

U.S. Army photo

Fionan 184.-Litter carry. Long and difficult litter carries contributed

to some deaths.
BOUGAINVILLE CAMPAIGN 367

U.S. Army Photo

FICURE 185.-A screened operating room in a clearing station.

Note excellent sterile technique.

at the 21st Evacuation Hospital, because of its proximity to the front. The

clearing stations and portable surgical hospitals were usually bypassed in

order to save time in the case of the seriously wounded. Minor surgery was

done in the clearing stations (fig. 185). One clearing station sutured approximately 50 superficial wounds and obtained primary healing in all. This was

done as a trial, and no untoward results ensued as the procedure was limited

strictly to superficial flesh wounds. Though two portable surgical hospitals

were available, they were not necessary in the Bougainville campaign. A few

patients who underwent operation at these hospitals were transferred immediately or shortly after operation before recovering from shock. This factor

may have contributed to a fatal termination in some instances. Rapid evacuation of patients (fig. 186) to the hospitals was possible, because of excellent

roads and the short distance from perimeter to hospital. More than 80

percent of all patients reached the hospital within 3 hours.

The 21st Evacuation Hospital was staffed with well-qualified specialists,

and no patient here failed to achieve adequate specialized care. The value

of a neurosurgeon at the front is frequently a disputed point. In island

warfare, unless a competent surgeon is assigned locally, the patient may have

to be evacuated for a distance of hundreds of miles. Hence, the various

specialists should be available, if possible, on the island where combat occurs.

Especially is the thoracic surgeon of great value at the front, if the lives of

patients needing his services are to be saved. The chief deficiency in the ranks
368 WOUND BALLISTICS

U.S. Army photo

FIGURE 186.-Jeep ambulance. The jeep ambulance carrying three

litters was well adapted for use over jungle trails.

of the specialists is the lack of adequately qualified anesthetists. One such

anesthetist was available at the 21st Evacuation Hospital, but, when faced

with the problem of anesthetizing eight patients simultaneously, his problem

was insurmountable. As is the case so frequently, it was impossible to determine which deaths to attribute to improper anesthesia. Good anesthesia

is of first importance in dealing with wounds which require major surgical

procedures in the presence of impending shock.

Plasma was used in large quantities in the hospitals as well as in the

forward areas. Blood transfusions were more liberally used in this campaign

than in any other in the South Pacific. Over 400 transfusions were given in

the 21st Evacuation Hospital, with only three reactions. Blood loss was

usually great, and very large quantities of blood were required to restore blood

volume. Blood counts and hemoglobin determinations revealed these huge

blood deficits, and further confirmation was frequently obtained at post

mortem. All blood was donated by troops on the island and furnished from

a blood bank maintained at the hospital.

Professional care of the wounded was excellent and even the unavoidable

errors of judgment incident to war surgery were at a minimum. There were

four patients who died of gas gangrene infections, but only one death could

be attributed to an error of surgical judgment. In this instance, closure of

the wound by suture was probably responsible. There were no deaths due

directly to compound fractures of the extremities. Only three patients died
BOUGAINVILLE CAMPAIGN 369

in the rear echelon. The total mortality among 2,015 treated wounded was

3.7 percent. The total mortality among 1,788 treated in hospitals was 5.1

percent. The total operative mortality was 3.5 percent.

MORBID ANATOMY

The study of morbid anatomy in battle casualties is limited by the faeilities' 5 and the personnel available as well as the circumstances of battle. In

the tropics, it is still further limited by the number of dead which must be

studied before decomposition, which occurs early.

This report includes 395 dead on which 104 post mortem examinations

were performed. Explanation for the relatively small number of autopsies is

twofold. First, the assigned pathologist was on detached service at Bougainville for less than one-half of the period covered in this study. Second,

many deaths occurred on patrol or in areas which remained under enemy

fire, and the bodies were not recovered until decomposition had ensued and

consequently examinations were omitted.

All autopsies were performed at Bougainville except in three instances in

which death occurred in hospitals in the rear echelon. Allied dead numbered

99 of which 19 were Fijian Scouts and their New Zealand officers. Five

Japanese bodies were examined to make the total of 104.

The completeness of the post mortem examinations was determined by

the circumstances, such as the condition of the body, whether the cause of

death was obvious, and the number of bodies awaiting autopsy (largest number

was 26 on one afternoon). Every effort was made to determine the cause of

death and to record the gross effects of the missile, its wounds of entrance

and exit, and its effects on tissues and organs.

The wounds of entrance responsible for death are shown in figure 187. In

the case of multiple wounds, whenever it was possible to decide which of two

or more were responsible for death, the wound which caused instantaneous

death was recorded. Missiles entering the body in the lateral plane are indicated at the extreme edge of the profile diagram.

Although the number of wounds is small, these figures may give some

indication of the number of lives which might possibly be saved by protective

armor. A proposed armor chest plate (9" x 8") covered a square outlined by

the sternal notch above, the xiphoid process below, and the nipples laterally.

Such a plate could possibly have prevented perforations of the chest cavity in

16 Facilities for post mortem examination were courteously provided by the 21st Evacuation Hospital. The morgue,

a screened storage tent with a concrete floor, running water, and electric lights, exceeded expectations for a combat zone.

The tent was surrounded by a 6-foot canvas wali which helped to isolate it from the hospital wards. Vehicles could reach

the area without driving past the ward installations. Technicians to assist with the work were detailed by the 21st

Evacuation Hospital and the 52d Field Hospital. A stenographer and photographer recorded all significant wounds

and photographed all recovered missiles, fragments, or foreign bodies. When identification of fragments was difficult,

they were taken to the Ordnance Section of the XIV Corps for expert opinion. The Cemetery and Graves Registration

Office was conveniently located near the hospital, and all dead as they were received at the cemetery were transferred

to the morgue for examination.

603225--62--26
370 WOUND BALLISTICS

J

A B

FIGURE 187.-;-Entrance sites of lethal wounds in 104 autopsied casualties.

A. Anterior view. B. Posterior view.

16 of these chest wounds (59 percent) illustrated in the anterior view. A

central abdominal armorplate (8" x 6") could possibly have prevented 4 of

the 7 fatal perforations of the peritoneal cavity.

Morbid Anatomy of Wounds by Region

The autopsied dead were classified under anatomic regions (table 94)

according to the location of the wound considered responsible for death. In

many instances, multiple wounds were present. For this reason, it was necessary to reserve the classification "Multiple Wounds" for those cases in which

two or more wounds could have been responsible for death. There were 104

post mortem examinations; 68 of these dead were killed instantly, and 36 were

wounded, treated, and died later.

Head.-In this study, 26 (25 percent) of the autopsied dead sustained

fatal head wounds; 20 of these were killed instantly, and 6 were wounded and

died later. Characteristic of this group was the extent and magnitude of the

fragmentation of the skull found at autopsy. Extensive comminution of the

vault with radiating basal fracture lines was almost invariably present in these
BOUGAINVILLE CAMPAIGN 371

compound fractures. Indriven bone splinters were common. The accompanying severe laceration, herniation, or avulsion of the brain was obviously

the cause of death in all head cases. None of the four patients on whom

operation was undertaken survived longer than 48 hours. In three of these,

an apparently hopeless prognosis existed from the time of injury.

TABLE 94.-Distribution of fatal wounds in 104 autopsies, by anatomic location

Total dead Killed instantly Wounded-treateddied-later

Anatomic location

Number Percent Number Percent Number Percent

Head -------------------------- 26 25.0 20 76.9 6 23. 1

Thorax ------------------------ 32 30.8 23 71.9 9 28.1

Thoracoabdominal ------------- 16 15.4 9 56.3 7 43. 7

Abdomen ---------------------- 12 11.5 6 50.0 6 50.0

Lower extremity ---------------- 10 9. 6 4 40. 0 6 60. 0

Multiple wounds ---------------- 8 7.7 6 75. 0 2 25. 0

Total ------------------- 104 100.0 68 65. 4 36 34. 6

Thorax.-There were 32 (30.8 percent) deaths from thoracic wounds, and

of this number 23 died instantly and 9 died later. Almost half (46.2 percent)

of all deaths resulted from a combination of thoracic and thoracoabdominal

wounds. Remarkable to note was the widespread destruction produced by

high-velocity bullets. Gross damage or "blast effect" 16 in the opposite lung

by such missiles was clearly demonstrated in six instances and later confirmed

by microscopic sections. In two such cases, death was attributed to cardiac

failure, and in these right ventricular dilatation was found. It was suggested

that the pulmonary injury may have produced a partial obstruction of the

pulmonary circulation. The rapid administration of intravenous fluids may

have contributed to the cardiac dilatation.

Laceration of the lung by perforating or penetrating missiles was present in

all cases. The left lung was involved in 15 cases, the right in 9, and in 8

instances bilateral lesions were present. Injury to the lung alone resulting in

massive unilateral hemothorax caused death in 13 cases. It was not uncommon

to find from 3 to 4 liters of blood in the pleural cavity. Of the 13 patients,

7 survived to undergo operation; the others died instantly. The size of the

various external chest wall wounds bore no relation to the amount of underlying

damage. Particularly striking were the small external wounds of the highvelocity bullet which were so frequently accompanied by extensive laceration

16 Damage resulting from formation of temporary cavity and not related to the pulmonary hemorrhage seen in air blast

injuries. The latter is due to the destructive force of the pressure wave set up by the detonation of bigh explosives. Any

pulmonary (or visceral) damage resulting from the passage of a high-velocity missile is dependent upon the formation of

a temporary cavity. Blast injuries are seen in association with aerial bombardment and detonation of high explosives,

such as dynamite, bangalore torpedoes, and landmines. See also footnote 14, p. 352.-J. C. B.
301.2 WOUND BALLISTICS

and destruction of intrathoracic structures. The lower velocity fragments of

explosive shells and bombs as a rule produced more extensive external defects.

Bone fragments derived from ribs were common along the wound track. With

the exception of Case 36, in which a metal button was removed, no foreign

material was recovered.

In order of frequency, perforation or laceration of the intrathoracic structures occurred as follows: Heart, 8; aorta, 5; pulmonary artery, 4; and trachea

and esophagus, 2. The thoracic cord was transected in 3 cases and the cervical

cord in 1. Wounds of the heart and great vessels were found in approximately

50 percent of these cases. Hemorrhage was the cause of death in 85 percent

of thorax wounds.

Thoracoabdominal wounds.-Multiple lesions of the abdominal and

thoracic cavities in the same individual accounted for 16 (15.4 percent) deaths.

Only those cases in which one missile was responsible for the combined injury

are included in this group. The wound of entry was through the thoracic

wall in 12 of the 16 cases. Nine were killed instantly, and the remaining

seven underwent operation and died later. Four patients had thoracotomy,

two laparotomy, and one had both laparotomy and thoracotomy. Five of

these patients died within 24 hours from hemorrhage and shock, one after

8 days from secondary hemorrhage, and one (Case 68) after 6 days from

cardiorespiratory failure.

The cause of death in 15 of the 16 cases was hemorrhage and shock,

hemothorax and hemoperitoneum being frequently combined. The lung was

injured in all cases, the heart perforated in one, the thoracic aorta in one, and

the abdominal aorta in another. The abdominal organs injured in order of

frequency were liver, spleen, hollow viscus, kidney, and pancreas.

Abdomen.-There were 12 (11.5 percent) fatal abdominal wounds. In 5

of the 6 patients who died instantly, death resulted from hemorrhage, and,

in the sixth patient, it was due to shock from evisceration. Of the six patients

who had laparotomy, none lived longer than 4 days following operation. In

these cases, 1 death was attributed to hemorrhage, 1 to paralytic ileus and

uremia (Case 84), and 4 to peritonitis.

Multiple lesions were usually present. In order of frequency, the abdominal organs injured were as follows: Jejunum, ileum, transverse colon, and

rectum, 11; major vessels, 5; kidneys, 4; liver, 2; pancreas, 2; and spleen, 1.

Fractures of the vertebral bodies were found in four instances. Damage to

the spinal cord occurred in one case and to the cauda equina in another.

Lower extremities.-Wounds of the lower extremities were responsible

for 10 (9.6 percent) deaths. Hemorrhage from the femoral artery accounted

for death in four of the soldiers who died instantly. In the other casualties,

both Japanese and about whom little is known, death apparently resulted

from shock associated with severe compound fractures of the femur. Six

patients were wounded and died later; four of this group underwent operation.

Gas gangrene accounted for death in 3 (2 Japanese and 1 American) patients;

hemorrhage, in 2; and uremia, in one.
BOUGAINVILLE CAMPAIGN 373

Multiple wounds.-Under this heading are classified those cases in which

two or more wounds could have been the cause of death. Of the 8 casualties

so classified, 5 died instantly with wound distribution as follows: Head and

abdomen, 2; head, thorax, and abdomen, 1; thorax and multiple fractures of

the femur and extensive multiple wounds, 1; and head with multiple fractures

of the femur and tibia and fibula, 1. In all cases, the immediate cause of

death was hemorrhage, extensive brain damage, or shock, or a combination

of these three.

Two of the remaining patients had undergone operative procedures.

One who sustained a traumatic amputation of the leg and multiple wounds

and fractures died from shock within 10 hours. The second patient died

from gas gangrene after 48 hours following fracture of the femur and other

extensive wounds.

Causes of death.--Table 95 lists the various causes of death as determined

by post mortem examination among the 104 casualties. Hemorrhage was the

most common cause (54.8 percent), and this was followed by brain and spinal

cord damage (26 percent). The remaining cases died from a number of other

conditions. The following general conclusions were reached as a result of the

autopsy study:

1. Hemorrhage, frequently occult, was the most common cause of death.

2. Extensive brain damage was the second most common cause of death.

3. It was impossible to determine with accuracy the causative missile

from the appearance of a wound.

4. The extent of the underlying structural damage bears no constant

relationship to the size of the wound of entrance or exit. This fact is frequently

not appreciated by the young, inexperienced battle surgeon and is of great

significance in the proper care of the patient.

TABLE 95.-Cause of death in 104 casualties as determined by post mortem examnination

Dead Cause

Number Percent

Hemorrhage -------------------------------------- 57 54. 8

Brain or spinal cord damage ------------------------ 27 26.0

Shock not due to hemorrhage ----------------------- 5 4. 9

Peritonitis --------------------------------------- 4 3.9

Gas gangrene ------------------------------------- 4 3.9

Cardiac failure ----------------------------------- 2 1. 9

Uremia ----------------------------------------- 2 1.9

Pulmonary edema -------------------------------- 1 .9

Pulmonary embolus -------------------------------- 1 .9

Empyema with sepsis ------------------------------ 1 .9

Total -------------------------------------- 104 100.0
374 WOUND BALLISTICS

5. Foreign material, except for the wounding missile, was seldom found.

6. Contralateral brain and lung damage from high-velocity missiles was a

frequent finding. Temporary cavity effect on the contralateral lung may

result in sequelae further impairing the pulmonary circulation.

7. High-velocity missiles striking large blood vessels or solid organs usually

produced an explosive effect rather than a perforation.

Morbid Anatomy of Wounds by Weapon

Table 96 lists the types of weapons responsible for the lethal wounds

in the autopsied cases.

Wounds caused by rifle.-The rifle was the weapon responsible for death

in slightly less than half (42.3 percent) of the autopsied cases. Table 97

shows the anatomic distribution of wounds among those killed by rifle fire.

Head.-Head wounds produced by rifle fire were characterized without

exception by extensive destruction of the brain and skull. Laceration, massive herniation, or total absence of large portions of the brain were the usual

findings. Large areas of bony skull and scalp were frequently avulsed with

shattering or widespread comminution of the residual portions of the skull.

Ofttimes, bone fragments were driven deep into the brain tissue. Perforating

skull wounds were more common than gutter wounds. Frequently, long,

stellate fracture lines radiated across the base of the skull. Extensive damage

was sometimes observed in one hemisphere of the brain, when the traversing

missile track lay entirely in the opposite hemisphere. All these findings were

interpreted as additional evidence in support of the modern hypotheses 1" of

wound production by high-velocity missiles.

TABLE 96.-Weapons causing wounds in 104 casualties, as determined by post mortem

examination

Total casualties Killed instantly Wounded-treated-diedlater

Weapon

Number Percent Number Percent Number Percent

Rifle -------------------------- 44 42. 3 31 70. 5 13 29. 5

Mortar ------------------------ 24 23. 1 13 54. 0 11 46.0

Machinegun -------------------- 13 12. 5 8 61. 5 5 38. 5

Grenade ----------------------- 7 6. 7 4 57. 1 3 42.9

Mine ------------------------- 7 6. 7 5 71.4 2 28. 6

Artillery ----------------------- 6 5. 8 5 83. 3 1 16. 7

Miscellaneous ------------------ 3 2. 9 2 66. 7 1 33. 3

Total -------------------- 104 100. 0 68 65. 4 36 34. 6

17 The observation that a high-velocity bullet produces terrific destruction of tissue at a considerable distance from

its permanent wound track is well established. See chapter III, p. 144.
BOUGAINVILLE CAMPAIGN 375

TABLE 97.-Anatomic distribution of wounds among 14 casualties killed by rifle fire, and

weapon .from country of origin

Casualties Weapon

Anatomic location

Killed Wounded- United instantly treated- Total Japanese States died-later

Number Number Number Number Number

Head --------------------------------- 12 3 15 13 2

Abdomen-thorax ------------------------ 1 3 4 4 0

Thorax -------------------------------- 12 5 17 15 2

Abdomen ------------------------------ 2 1 3 3 0

Lower extremities ----------------------- 3--3 3 1 2

Multiple ------------------------------- 1 1 2 2 0

Total ---------------------------- 31 13 44 38 6

There were no features present to distinguish the wounds produced by

the Japanese rifle from those produced by the U.S. rifle nor were there any

dissimilar findings in the wounds of those killed instantly and those who

were wounded and died later. Perforating wounds completely traversing

the skull were recorded frequently by the Japanese .25 caliber bullet at varying

distances from 10 feet to 150 yards.

Perforation of the U.S. helmet by enemy rifle fire was found in six instances. The maximum recorded distance at which this occurred was 100

yards. A sample of the sizes of the entrance and exit wounds, respectively,

of the head produced by the Japanese rifle at various distances follows: At

150 yards, 0.6 and 1.2 cm.; at 100 yards, 2.5 and 3 cm.; at 20 yards, 0.5 and

1.2 cm.; and at 15 yards, 3.7 and 8.7 centimeters.

Thorax.-All rifle wounds of the chest were with two exceptions complete

perforating wounds. In both these instances, the enemy .25 caliber bullet

failed to perforate the thorax at a distance of 25 yards.

Massive intrathoracic hemorrhage was the immediate cause of death in

all those killed instantly and in two patients who were wounded and died a

few hours later. Transection of the spinal cord with fracture of vertebra

was present in four instances. In two of these, death occurred immediately,

and in both cases massive hemothorax was found. In one of the other two

cases, death occurred in 24 hours associated with terminal hyperthermia and

in the other after 1 month following an extensive empyema complicated by

a bronchopleural fistula.

Fairly typical of the extensive thoracic damage caused by the .25 caliber

Japanese rifle bullet is Case 40. This soldier was struck in the chest at moderately close range. The entrance wound was situated in the seventh posterior intercostal space, and the exit wound was over the clavicle. All ribs

from fourth to eighth, inclusive, were fractured in addition to the clavicle.
376 WOUND BALLISTICS

The upper and lower lobes were severely lacerated, and a massive hemothorax

was present.

Table 98 lists the sizes of known wounds of entrance and exit at various

ranges.

TABLE 98.-Size of wounds of entrance and exit, caused by rifle bullet, at various ranges

Wound of- Distance of range

Entrance Exit

Yards Cm. Cm.

-1 0.6 2.5

5 .5 1.2

5 1.8 3.8

20 .5 3.7

20 3x1 3.8x2.5

25 .5 L.5x 1

30 .6 4.3

30 .6 2.5

30 .5 2.5

35 .5

Thorax and abdomen.-The force of the .25 caliber Japanese rifle bullet

when fired at moderately close range (25 yards or less) was well demonstrated

by the great number of structures and organs injured when the thorax and

abdomen were traversed by the same missile. Structures perforated in each

of four illustrative cases are listed here: Case 67-anterior chest wall, upper

lobe of left lung, left ventricle, right ventricle, lower lobe of right lung, diaplhragm, liver, lateral chest wall; Case 71-abdominal wall, jejunum, ileum,

transverse colon, liver, diaphragm, lower lobe of right lung, chest wall; Case

68-chest wall, lung, diaphragm, colon, spleen, kidney; Case 69-left elbow

(fracture of humerus), chest wall, both lobes of left lung, diaphragm, spleen,

kidney, chest wall. The latter patient lived 8 days and died of secondary

hemorrhage from lung and spleen. Death in the third case occurred on the

following day and resulted from cardiorespiratory failure. In the first two

cases, massive hemothorax and hemoperitoneum were present at autopsy.

Abdomen.-The powerful disruptive effect of the rifle bullet on various

abdominal structures can be appreciated best by enumerating its destructive

effects in the individual case. Three patients were struck in the abdomen by

Japanese rifle bullets at distances of 20 yards, 75 yards, and at an unknown

distance. Respectively, their important injuries were: Case 77-fracture of

the ilium and sacrum, perforation of the rectum, and massive hemoperitoneum;

Case 78-fracture of the rib and vertebra, extensive lacerations of the liver,

kidney, and transverse colon, and hemoperitoneum; and Case 81-extensive

lacerations of the kidney and liver with hemoperitoneum. Common to all

these cases and characteristic in the wounds of the solid organs in the kidney,
BOUGAINVILLE CAMPAIGN 377

liver, and spleen was the widespread "shattering" and fragmentation produced

by the explosive effect of the missile in its passage.

Lower extremity.-A Fijian soldier (Case 87) was struck in the groin by an

enemy rifle bullet which severed the femoral artery and vein. Ile died within

a few minutes from exsanguination. A Japanese soldier (Case 89) sustained a

severe compound comminuted fracture of the middle third of the femur and

died from shock several hours later despite therapy. Cursory examination of

the decomposed body of another Japanese soldier (Case 90) revealed an extensive compound comminuted fracture of the femur with a very large wound

of exit (16.6 x 13.9 cm.) but with intact femoral vessels. In these last two

cases, death apparently resulted from severe shock without significant concomitant hemorrhage.

Multiple.-Two patients sustained multiple rifle wounds. One of these

(Case 101) died instantly, the other (Case 103) died 2 days later from peritonitis and gas gangrene.

Mortars and grenade discharges.-Mortar fire accounted for death in

approximately one-fourth (23.1 percent) of the autopsied cases. The anatomic distribution of wounds among those killed by this weapon is shown in

table 99.

TABLE 99.-Anatomic distribution of wounds among 24 casualties killed by mortar fire, and

weapon from country of origin

Casualties Weapon

Anatomic region Killed Wounded- instantly treated-died- Total Japanese United States later

Head ------------------------ 4 2 6 3 3

Abdomen-thorax -------------- 2 2 4 4 0

Thorax ---------------------- 5 1 6 4 2

Abdomen ------------------- 1 2 3 2 1

Lower extremity -------------- 0 4 4 2 2

Multiple --------------------- 1 0 1 1 0

Total --------------------- 13 11 24 16 8

It is interesting to observe that the immediate lethal effect of the lowvelocity mortar fragment is appreciably less than that of the high-velocity

rifle bullet. Only slightly more than half of the autopsied dead, wounded by

the mortar, died instantly; whereas, over two-thirds of all autopsied cases

struck by rifle bullets were killed instantly.

Head.-In cases in which perforation of the skull occurred, the size of the

skull wounds and distance from the burst was known in three. At 25 yards,

a fragment (3 x 1 x 0.8 cm.) of a U. S. 90 mm. shell perforated the skull and

resulted in death 2 hours later from the extensive brain damage (Case 12).
378 WOUND BALLI8TICS

The entrance wound in this case measured 2.5 cm. in diameter. A U.S. 90 mm.

shell exploding at a distance of 20 yards produced a large gutter wound in the

skull measuring 6.2 x 1.8 cm. (Case 3). Death followed in 3 hours. A small

metal fragment (20 x 4 x 4 mm.) was recovered from the inner table of the

skull. In the third instance (Case 26), a soldier was struck by a fragment from

a Japanese 90 umm. shell at a distance of 7 yards. An entrance wound of 2.5 x

0.5 cm. was produced. This soldier expired after 12 hours from the cerebral

injury.

Thorax.-A fairly characteristic feature of mortar wounds of the thorax

was the extraordinary extent of the defect identified as the wound of entrance.

For example, a Fijian soldier (Case 29) was killed instantly by a fragment from

a U.S. 90 mm. shell which burst 20 yards away. Even from that distance, the

fragment completely traversed the thorax and produced a wound of entrance

8.2 x 6.8 cm. and a wound of exit 20 x 12.5 cm. In another instance (Case 46),

an entrance wound defect over the region of the scapula measuring 20 x 10 cm.

was produced by a fragment of a 90 mm. Japanese mortar shell bursting at a

distance of 20 yards. On the other hand, a mortar fragment in its greatest

dimension measuring a little more than 1.0 cm. caused death from intrathoracic

hemorrhage (Case 48). This fragment originated from an enemy 90 mam.

shellburst at 10 yards. The wound of entrance in this case measured only

1.5 cm. One patient (Case 51) survived for a period of 3 days following severe

chest injuries resulting from the explosion of a U.S. 4.2-inch mortar shell at a

distance of 3 yards.

Abdomen.-In the abdomen, extensive laceration of multiple organs and

structures was frequently observed. Death in these, if immediate, resulted

from hemorrhage and shock. Two patients surviving for 3 and 5 days, respectively, after laparotomy, died of peritonitis. The first patient (Case 83) was

struck in the abdomen by a fragment of an enemy 90 mm. mortar shell at a

distance of 25 yards. Multiple perforations of the jejunum and colon resulted,

but unfortunately the jejunal lacerations were overlooked at operation. The

second patient (Case 84) was wounded by the burst of a 4.2-inch U.S. mortar

shell at a distance of 3 yards. The largest external defect in this case was an

entrance wound measuring 10 x 5 cm. over the region of the right iliac crest.

Laceration of the right kidney and cauda equina and a large retroperitoneal

hematoma were found at operation.

Lower extremity.-There were four autopsied dead who had sustained lower

extremity wounds only. One of these deaths might have been prevented. In

this case, a soldier's foot was blown off by the pointblank burst of an enemy

shell (Case 91). Evacuation of this patient was effected at night, 24 hours

later. In the process of transportation by litter, and unknown to the aidmen,

delayed hemorrhage occurred and the soldier expired. In another case (Case

93), amputation was performed 1 day after injury, because of damaged blood

supply to the extremity. This patient died 5 days later with uremia, the cause

of which was unknown. A U.S. 81 mam. "short" exploded between the legs
BOUGAINVILLE CAMPAIGN 379

of a soldier (Case 94) who lived thereafter for 6 hours. Traumatic amputations

of both lower extremities resulted, the left thigh and right leg at the level of

their upper thirds. A Japanese soldier (Case 96) died of gas gangrene 4 days

after being wounded. The femoral vessels were intact but thrombosed, and

the femur was not fractured. In this instance, the wound on the medial surface

of the thigh measured 17 x 16.2 centimeters.

Two small external wounds resulted from the explosion of a 90 rmm. Japanese mortar shell at a distance of 2 yards in a patient (Case 99) who survived

only a few hours. One wound over the parietal region measuring only 1.5 cm.

in diameter had resulted in extensive intracranial injury and hemorrhage. The

liver and right kidney were extensively lacerated, and a massive hemoperitoneum was present. This was the only case listed under "Multiple Wounds"

by mortar fire.

Machinegun.-The only distinguishing feature between rifle and machinegun wounds is that the latter are more often multiple. In all other respects,

wounds produced by rifle and macbinegun bullets of like caliber and muzzle

velocity are identical. There were 26 separate wounds in these 13 dead.

Grouped anatomically, the wounds responsible for death were divided as follows:

Head, 2; thorax, 4; thorax-abdomen, 5; and abdomen, 2. Eleven were killed

by enemy weapons and two by U.S. weapons. Eight of the thirteen autopsied

were killed instantly; with one exception, the remaining wounded died within a

few hours. Two of the dead were struck by .25 caliber bullets at distances of

150 yards, this being the maximum range recorded. In one of these (Case 27),

a perforation of the thorax resulted, the entrance wound of which measured 2

cm. and the exit wound 3 x 1.5 cm. In the other (Case 5), a larger gutter

wound of the skull was found, measuring 6.5 x 2.5 centimeters.

Grenades.-The grenade produced death in seven (6.1 percent) of the antopsied cases. Four of these deaths resulted from the U.S. grenade and three

from the Japanese. The anatomic distribution of fatal wounds among the

autopsied dead was: Abdomen and thorax, 2; thorax, 1; abdomen, 2; lower extremity, 1; and multiple, 1. With one exception, all patients wounded by

grenades had multiple wounds. This soldier (Case 92) while on guard tripped

the wire of a U.S. grenade boobytrap and was struck in the buttock by a single

fragment. He died 6 days later from gas gangrene. A U.S. grenade exploded in

the hand of an American soldier (Case 85) returning from patrol. Multiple

abdominal organs and intestinal loops were perforated. Despite laparotomy

and supportive treatment, this patient died on the following day. Multiple

wounds and massive intrathoracic hemorrhage were found in two soldiers

whose deaths resulted from pointblank bursts of U.S. grenades. In one instance (Case 98), a soldier returning to his own foxhole was mistaken for the

enemy, and in the other (Case 64) an unexplained explosion occurred in the

pocket of a soldier returning from patrol. Three deaths resulted from pointblank explosions of Japanese hand grenades, and in all instances multiple

wounding was present. The cause of death was intrathoracic hemorrhage in
380 WOUND BALLISTICS

the two cases in which death was instantaneous. In the other case, the patient

died after 12 days from generalized suppurative peritonitis due to evisceration

following laparotomy. The grenade fragments did not perforate the abdominal

cavity. No conclusions can be drawn from these dead as to different effects

of the Japanese and U.S. grenades.

Artillery.-Of the six autopsied dead resulting from artillery fire, four were

killed instantly by U.S. weapons. Two of these dead (Cases 9 and 16) sustained

severe head wounds from 75 mm. shellbursts at distances of 5 and 12 yards,

respectively. In the other two cases, death resulted from extensive thoracic

wounds, produced in one (Case 34) by a U.S. 37 mm. shellburst at 3 yards and

in the other (Case 42) by a U.S. shell of unknown caliber at a distance of 5

yards. One patient (Case 13) was killed instantly and another (Case 57) lived

for only a few hours following the explosion of a Japanese shell (probably 150

mm.) at distances of less than 2 yards.

Landmines.-That the U.S. landmine is a most deadly weapon is convincingly demonstrated by the autopsy findings in seven cases. Each of these dead

had multiple wounds, and all except two were killed instantly. One of the two

who survived the initial blast was a Japanese soldier (Case 95). His death

later in an American hospital was due to gas gangrene. The other was an

American soldier (Case 104) who lived a little more than 6 hours and died from

shock. The post mortem findings in this instance well illustrate the multiplicity of wounds found. The soldier sustained a traumatic amputation of

the foot and 13 penetrating wounds. Present also were compound comminuted

fractures of the patella, internal malleolus of the tibia, sacrum, and ulna.

Other examples of the extreme degree of trauma caused by these landmines as seen are the cases of five soldiers who were killed instantly. A striking

illustration is that of a soldier (Case 102) in whom avulsion of the right and

left frontal lobes and part of the right parietal lobe occurred with destruction

of the orbit, frontal bone, and an area of skull measuring 10 x 6 cm. In addition, compound fractures of the tibia (bilateral), fibula, femur, ulna, and

mandible were present. Altogether, there were 18 widely distributed perforating and penetrating wounds. One other case will suffice to illustrate the

lethal effect of this weapon. Post mortem examination showed seven penetrating and perforating wounds (Case 100). A fragment passed through the

skull, fracturing the maxilla, zygoma, and temporal bones, and then made its

exit through the frontotemporal region. In its course, the missile destroyed

the right frontal lobe. Another fragment entered the abdomen, severed or

perforated the pylorus, duodenum, jejunum, and small intestine mesentery,

and finally lodged in the bifurcation of the aorta. The peritoneal cavity was

filled with blood, the brachial plexus was severed, and there were numerous

other wounds of the thoracic and abdominal walls and thigh.

In all these instances, it is assumed that the victim either stepped directly

on the mine or was injured at close range by having tripped a mine wire.
BOUGAINVILLE CAMPAIGN 381

AUTOPSY PROTOCOLS

Case 1.-A soldier of the 164th Infantry, while walking through thick jungle toward

Allied lines returning from patrol, was mistaken for the enemy and shot through the head

with an M1 rifle at a distance of 30 yards by a fellow soldier. He was wearing a helmet

when struck and this was perforated in the front and back. He was killed instantly at

1700 hours on 1 April 1944.

Examination revealed a perforating wound of the skull. The bullet produced a wound

of entrance (3 cm. in diameter) through the left orbit and a wound of exit (2.5 cm. in diameter) at the junction of the parietal and occipital bones. Comminution of the cranial vault

with diffuse disruption of the brain was present (fig. 188).

7h

FiEuRo 188.-Widespread destruction of cranial vault and brain (scalp retracted).

Case 2.-A Fijian soldier, while on patrol, was standing behind a tree when he was struck

by a .25 caliber Japanese bullet fired from a distance of 20 yards. He was killed instantly

on 31 March 1944.

Examination revealed a perforating wound of the head. The entrance wound (0.5 cm.

in diameter) was situated over the lateral border of the right supraorbital ridge and the exit

wound (1.2 cm. in diameter) over the occipital bone. Stellate fractures of the frontal and

occipital bones radiated from both perforations. The frontal and parietal lobes of the brain

were perforated, and the cerebellum was grooved.

Case 3.-A Fijian soldier, while on patrol, was standing digging a foxhole when he was

struck by a fragment from a U.S. 90 mm. shell. The shell exploded on the ground at a

20-yard distance. He was wounded at 1700 hours on 30 March 1944 and died 3 hours later

in the hospital. Death was attributed to severe brain damage.

Examination revealed a gutter wound (6.2 x 1.8 cm.) in the right frontal region. A

stellate fracture involved the vault of the skull (fig. 189). The fragment coursed obliquely
382 WOUND BALLISTICS

FiaURE 189.-Extensive fracture of skull at site of entrance wound.

through the right cerebral hemisphere to the posterior aspect of the left parietal lobe. A

metallic fragment (20 x 4 x 4 mm.) was recovered at this point and was found to be partially

imbedded in the inner table of the skull.

Case 4.-A soldier of the 129th Infantry, crouching behind a tree stump, stood to throw

a hand grenade and was struck in the head by a .25 caliber Japanese bullet fired from a distance of 10 feet; he was wearing a helmet which was perforated on the left side. He was

killed instantly at 0930 hours on 24 March 1944.

Cursory examination 18 revealed a perforating wound of the left side of the skull. The

entrance wound involved the left orbit. The exit wound was found over the left parietooccipital region. Brain tissue exuded from both openings. The cranial vault was severely

comminuted and the left cerebral hemisphere destroyed.

Case 5.-A Fijian soldier, while on patrol, peered over a ridge and was struck in the head

by a .25 caliber Japanese machinegun bullet fired from a distance of 150 yards. He was

killed instantly at 1000 hours on 26 March 1944. After death from the head wound, he was

struck again in the chest by a fragment from an artillery shell.

Examination revealed a gutter wound (6.5 x 2.5 cm.) in the center of the forehead with

a portion of the frontal bone blown away. Fracture lines radiated through the temporal,

parietal, and occipital bones. Both frontals and the right temporal lobes were lacerated. A

bullet was recovered from the right temporal fossa. The chest was penetrated by a shell

fragment entering through a wound (10 x 5.6 cm.) in the left seventh and eighth intercostal

spaces in the anterior axillary line. In its course, the fragment fractured the 8th, 9th, 10th,

and l1th ribs, lacerated the lower lobe of the left lung, the upper and lower lobes of the

right lung, fractured and perforated the bodies of the seventh and eighth dorsal vertebras,

18 On this afternoon, 26 bodies were received, and, since time did not permit a complete examination of all cases, some

of these in which the cause of death was obvious received only cursory examinations.
BOUGAINVILLE CAMPAIGN 383

N

AcAt

OD

I 2 3 4 5 6 7 8 9 10 !11 1

FIGURE 190.-Missile fragment of (left) .25 caliber Japanese machinegun

and of (right) artillery shell recovered from head and chest wounds.

transected the spinal cord, and fractured the third, fourth, fifth, and sixth ribs at the

costovertebral junctions. The fragment was- lodged in the subcutaneous tissue of the right

posterior chest wall.

Figure 190 shows the two recovered missiles.

Case 6.-A soldier of the 117th Engineer Combat Battalion, while lying in an open

foxhole in a cleared area of the jungle, was struck by fragments of a Japanese mortar shell.

The shell exploded on the ground at a distance of 1 yard. He was killed instantly at 2015

hours on 24 March 1944.

Examination revealed a penetrating wound of the head. The entrance wound (2.5 cm.

in diameter) perforated the left occipital bone. There was severe comminution of the

cranial vault, and several fracture lines continued inferiorly through the base of the skull

traversing the foramen ovale and cribiform plate. The left occipital amd temporal lobes

were severely lacerated, and small indriven bone fragments were removed from these lobes.

Two metal fragments were recovered from the depth of an irregular laceration of the left

cerebellar hemisphere. The fragments measured 15 x 5 x 1 Rum. and 15 x 10 x 2 mm. Figure

191 shows the extensive skull fractures and the recovered fragments.

Case 7. A soldier of the 129th Infantry was lying behind a tree root and was struck

by a Japanese .25 caliber bullet fired from a distance of 10 yards. He was killed instantly

at 1000 hours on 24 March 1944.

Cursory examination revealed a perforating wound of the skull. The entry wound

traversed the right orbit, and the exit wound was found over the parieto-occipital region.

The cranial vault was extensively fractured, and marked destruction of the right cerebral

hemisphere was evident.

Case 8.-A soldier of the 129th Infantry, 37th Division, was standing on his bunk in

an open tent in battalion headquarters firing at the enemy, when he was struck by a .25

caliber Japanese bullet fired from a distance of 25 yards. He was killed instantly at 0630

hours on 24 March 1944.
384 WOUND BALLISTICS

1- lII!IIII 2 3 4B 5

FIGURE 191.-Extensive fracture of skull. A. Site of entrance wound. B. Mortar

shell fragments recovered from wound.

Examination revealed a gutter wound (5 x 2'2 cm.) of the left parietal region. Brain

tissue exuded through the perforation in his helmet. Lacerated brain tissue, portions of

the frontal and parietal lobes, was herniated through the wound. Marked subgaleal hemorrhage was present. The cranial vault was comminuted by stellate fractures. Both hemispheres of the brain were extensively lacerated. A mushroomed.25 caliber bullet was found

in the right anterior fossa (fig. 192).

Case 9.-A soldier of the 164th Infantry, while on patrol in cleared jungle lying in an

open foxhole, was struck by a fragment of U.S. 75 mm. shell which fell short. The shell

exploded on the ground at a distance of 5 yards. He was killed instantly at 1600 hours on

26 March 1944.

Examination revealed an extensive gutter wound traversing the left side of the skull.

The occipital, parietal, and temporal bones were almost entirely destroyed. Only fragmentary portions of the left cerebral hemisphere remained.

Case 10.-A Fijian soldier, peering over the edge of an open foxhole to fire at the enemy,

was struck by a .25 caliber Japanese bullet fired from a distance of 15 yards. He was killed

instantly at 1400 hours on 1 April 1944. The body was not recovered immediately and

received other wounds from shell fragments after death.

Examination revealed a perforating wound of the head and multiple wounds of the

extremities. The head wound of entry (3.7 cm. in diameter) was located at the inner canthus

of the left eye and the exit wound (8.7 cm. in diameter) at the vertex of the skull. The

skull was comminuted, and there was almost complete destruction of the left half of the

brain. Present, in addition, were a perforating wound of the right elbow associated with

compound comminuted fracture of the radius, a perforating wound of the soft parts of the

right calf, and an extensive gutter wound of the left hand.
BOUGAINVILLE CAMPAIGN 385

4'.

S) 2 3

FIGURE 192.-Deformed .25 caliber bullet recovered from right anterior fossa.

Case 11.-A soldier of the 129th Infantry was crouching and moving forward in a skirmish line when he was struck by a Japanese .25 caliber bullet fired from a distance of 20

yards. He was killed instantly at 1300 hours on 24 March 1944.

Cursory examination revealed an extensive gutter wound 15 x 10 cm. involving the

left temporal, occipital, and parietal regions. Large portions of these bones and underlying

brain were absent. Extensive comminution of the remaining cranial vault was present.

Figure 193 shows the destructive effect of the missile.

LGR 

FIGURE 193. Head 

w

wound.
386 WOUND BALLISTICS

Case 12.-A Fijian soldier, while on patrol, was standing digging a foxhole when he

was struck by a fragment of a U.S. 90 mm. shell. The shell exploded on the ground 25 yards

distant. He was wounded at 1700 hours on 30 March 1944 and died 2 hours later. Death

was caused by extensive brain damage.

The wound of entry (2.1 cm. in diameter) in the head was located 2 cm. above the right

tragus. Brain tissue exuded from this wound. The fragment perforated the temporal

bone producing stellate fractures of the temporal and frontal bones. The wound track

traversed the right temporal, frontal, and left frontal lobes. A fragment (3 x 1 x 0.8 cm.) "was found in the left frontal lobe. Examination revealed additional wounds; traumatic

amputation of the left thumb, extensive laceration of the dorsum of the left hand and wrist,

and perforating wounds of the soft tissue of the anterior right and left midthighs.

Figure 194 shows a metal probe inserted into the wound of entry in the head and also

the extensive hand wound.

FIGURE 194.-Entrance wound in head (with metal probe inserted) and

wounds of left upper extremity.

Case 13.--A soldier of the 182d Infantry, while in a covered pillbox on top of a hill,

was struck by fragments from a 150 mm. Japanese shell which exploded on the ground 1

yard from the hole. He was killed instantly at 1400 hours on 26 March 1944.

Examination revealed a gutter wound (15 x 5.5 cm.) of the left side of the neck with

extensive soft-tissue damage and transection of the external jugular vein. Another gutter

wound (10 x 3.7 cm.) extended obliquely across the fifth and sixth cervical vertebras. The

vertebras were shattered. At autopsy, the dura was opened and the cervical cord was exposed and found intact. No foreign bodies were found.

Case 14.-A soldier of the 129th Infantry was found dead in the 129th sector on 24

March 1944. He was struck in the left arm and leg by a Japanese .25 caliber bullet. In

addition, a head wound was believed to have been caused by a fragment from a Japanese

mortar shell.
BOUGAINVILLE CAMPAIGN 387

FIGURE 195 -Head wound.

Cursory examination revealed perforating wounds of the soft parts of the left thigh

and arm. A severe penetrating wound through the left orbit was present as illustrated in

figure 195. Marked comminution of the cranial vault was found with brain tissue exuding

from the head wound.

Case 15.-A soldier of the 132d Infantry was on patrol duty and had bivouaced in the

open for the night. During the middle of the night, he stood up to void and was shot by an

apprehensive fellow soldier with an M1 rifle at a distance of 10 yards. He was killed instantly

at 2550 hours on 21 April 1944.

Examination revealed a perforating wound of the neck. The entrance wound (1.2 cm.

in diameter) penetrated the left submental triangle, and the exit wound (12.5 x 7.5 cer.)

occupied the posterior cervical region from the third to the sixth vertebras. The fourth and

fifth vertebras were shattered; the cord was exposed and was partially severed at the same

level.

Case 16.-A soldier of the 164th Infantry, while on patrol in the jungle, was lying on

a slope under a tree when he was struck by a fragment of a U.S. 75 mm. shell which fell short.

The shell exploded in a tree 12 yards above the soldier. He was killed instantly at 1600

hours on 26 March 1944.

Examination revealed a penetrating wound of the left occipital region 3.7 cm. in diameter.

Brain tissue exuded through this wound. The fragment pierced the left occipital bone, left

occipital lobe, and left cerebellar hemisphere. A shell fragment was found on the inferior

surface of the cerebellum. A linear fracture line extended across the left occipital, parietal,

and temporal bones.

The recovered fragment measured 6 x 5 x 4 mm.(fig. 196).

Case 17.-A soldier of the 129th Infantry, while walking up a jungle trail, was struck

by a Japanese .25 caliber bullet fired from a distance of 100 yards. He was killed instantly

at 1320 hours on 24 March 1944.
388 WOUND BALLISTICS

0

N)

0 234

FiouRE 196.-U.S. 75 mm. shell fragment recovered from brain wound.

Examination revealed a perforating wound of the head. The wound of entrance

(2.5 cm. in diameter) traversed the right infraorbital ridge; the exit wound (3 cm. in diameter)

was located in the left parieto-occipital region. When the body was received, the helmet

had not been removed and brain tissue was extruded over its surface.

Case 18.-A U.S. soldier was standing in a cleared area digging a foxhole when he was

struck in the head by a .25 caliber bullet. The shot was fired by a Japanese sniper at a

distance of over 150 yards. The soldier was killed instantly at 1500 hours on 26 Mlarch 1944.

Examination revealed a perforating wound of the head. The entrance wound (0.6 cm.

in diameter) was posterior to the left mastoid process, and the exit wound (1.2 cm. in diameter) was at the outer canthus of the right eye. The bullet coursed in a superior and anterior

direction and perforated the atlas; it then crossed the foramen magnum and severed the

brain stem at the lower level of the pons. The track continued through the base of the skull,

right ethmoid, and right orbit to the point of exit. Figure 197 shows a catheter in the wound

track.

Case 19.-A U.S. soldier, while on duty as a sniper in the jungle, peered over a protecting log and was struck in the head by a .25 caliber bullet. The shot was fired by a

Japanese sniper from an unknown distance. The soldier was killed instantly on 24 March

1944.

Cursory examination revealed a penetrating wound of the skull, with the wound of

entrance in the left orbit. A compound comminuted fracture of the skull with marked

brain destruction was present. The large number of dead received on this day prevented

a more complete examination.

Figure 198 shows the extent of the wound of entrance.

Case 20.-A soldier of the 129th Infantry was sitting on a log holding a flamethrower

when he was struck in the head by a .25 caliber Japanese bullet fired from a distance of 75

yards. His perforated helmet was found lying on the ground. He was killed instantly at

1130 hours on 27 March 1944.

Examination revealed a gutter wound 17.5 x 4 cm. involving the right temporal and

frontal regions (fig. 199). There were deep lacerations of the frontal, parietal, and temporal

lobes. Disorganized brain tissue filled the wound. Extensive comminution of the cranial

vault was found.

Case 21.-A soldier of the 182d Infantry, while crouched, withdrawing from enemy fire,

was struck in the back of the neck by a .25 caliber Japanese bullet fired by a sniper from a
]3OUGANVILLE CAMPAIGN 389

FiGURE 197.-Perforating head wound with catheter in wound track.

FIGURE 198.-Entrance wound in head.
390 WOUND BALLISTICS

FIGURE 199.-Large defect in skull at site of entrance wound.

distance of 35 yards. He was wounded at 0600 hours on 15 March 1944. His death, about

8 hours later, was accompanied by a terminal hyperthermia.

Examination revealed a perforating wound of the posterior cervical region. The

entrance wound (0.5 cm. in diameter) was located to the right of the spinous process of the

fifth cervical vertebra and the exit wound (5 cm. in diameter) over the vertebral border of

the left scapula. A fracture of the transverse process and lamina of the fifth cervical was

discovered. The dura and the cord were intact, but the cord was bulbous and hemorrhagic

for a distance of 2 cm. Because of the patient's profound shock, no operative interference

was attempted.

Case 22.-A Fijian soldier, while walking toward his own lines returning from patrol,

was mistaken for the enemy and shot. He was struck in the right side of the head and abdomen by .30 caliber bullets fired from a Lee-Enfield rifle at a distance of 15 yards. He was

wounded at 1810 hours on 23 March 1944 and died at 2055 hours. The soldier died on the

operating table, while an attempt was being made to stop bleeding from the brain.

Post mortem examination revealed a gutter wound of the right side of the head extending from the inner canthus of the right eye to the occipital bone. The diffusely lacerated

right cerebral hemisphere was herniated through the wound. Bone fragments had been

driven into the brain, and extensive hemorrhage was present. The abdominal cavity was

filled with blood from severe lacerations of the right kidney and the liver.

Case 23.-A soldier of the 145th Infantry, while standing on the crest of a hill in the

open observing mortar fire, was struck by a fragment of a Japanese mortar shell. The shell

burst on a pillbox 3 yards distant from the soldier. After injury, the patient walked to the

bottom of the hill; he was then placed in an ambulance and taken directly to the 21st Evacuation Hospital. He was wounded at 1800 hours on 10 March 1944. Craniotomy was performed, but the patient died 6 hours later. Death was attributed to severe intracranial

hemorrhage.
BOUGAINVILLE CAMPAIGN 391

Examination at autopsy revealed a penetrating wound of the right orbit with destruction of the globe. Craniotomy incision was present. A stellate fracture of the right frontal

bone with laceration of the frontal lobe and marked intracranial hemorrhage was found.

Case 24.-A soldier of the 182d Infantry, while walking through the jungle on patrol,

was struck by a Japanese machinegun bullet. He was wounded at 1800 hours on 30 April

1944 and arrived at the hospital 3 hours later. A gutter wound of the left frontoparietal

region was debrided and closure of the wound attempted. His death at 1210 hours on 2 May

1944 was accompanied by terminal hyperthermia.

Examination revealed a gutter wound 8.7 x 5 cm. in the left frontoparietal region through

which an infected fungus protruded. Closure of the wound at the time of operation had

not been complete. Portions of the frontal and parietal bones were absent. Bone edges had

been rongeured. From the bone margins, stellate fracture lines radiated over the cranial

vault. The remnants of the frontal and parietal lobes were grossly infected.

Case 25.-A soldier of the 129th Infantry was standing in an open foxhole when he was

struck by a .25 caliber Japanese bullet fired by a sniper from a distance of 75 yards. His

helmet was perforated. He was wounded in action at 1430 hours on 24 March 1944 and

died 5 hours later, despite shock therapy.

Examination revealed a gutter wound (15 x 7% cm.) occupying the right parietooccipital region. Portions of these bones as well as the underlying cerebral hemisphere were

absent. A small metal fragment was recovered from the remaining brain tissue and was

identified as part of the jacket of a .25 caliber Japanese bullet. The right lateral ventricle

was filled with blood. Petechial hemorrhages were present in the left half of the brain.

Stellate fracture lines coursed through the bones of the vault.

Case 26.-A soldier of the 129th Infantry was standing in a covered pillbox when a

Japanese 90 rmm. artillery shell exploded on the ground 7 yards distant destroying one corner

of the box. A fragment of the shell struck the soldier, penetrating his skull. He was

wounded at 0630 hours on 17 March 1944. Supportive treatment was given and debridement performed. Terminal hyperthermia was present at death, about 12 hours later.

Post mortem examination limited to the head revealed compound linear fractures of the

right parietal and temporal bones. Present also were large extra and subdural hemorrhages.

A laceration 2.5 x 0.5 cm. with a surrounding area of contusion was present in the right

temporal lobe. Destruction of the preoptic area was noted.

Case 27.-A Fijian soldier was behind a tree directing his platoon on patrol when he

was struck by a .25 caliber Japanese machinegun bullet fired from a distance of 150 yards.

He was killed instantly at 1200 hours on 25 March 1944.

The wound of entrance (2 cm. in diameter) was found over the right fifth intercostal

space in the postaxillary line and the exit wound (3 x 1.5 cm.) at the right sternoclavicular

articulation. The bullet fractured the fourth, fifth, and sixth ribs, lacerated the middle and

upper lobes of the right lung, and fractured the first rib, clavicle, and sternum at its exit.

A right hemothorax (2,500 cc.) was present.

Case 28.-A soldier of the 129th Infantry, while running in open terrain toward his foxhole, was struck by a .25 caliber Japanese machinegun bullet fired from a distance of 30

yards. He was killed instantly at 0500 hours on 24 March 1944.

The entrance wound (1.0 cm. in diameter) was located on the right side of the suprasternal notch. The wound of exit was found in the fifth left intercostal space at the costosternal junction. In its course, the bullet fractured the sternum and first rib, severed the

aortic arch and trachea, grooved the esophagus, and perforated the lower lobe of the left lung.

Massive bilateral hemothorax and mediastinal emphysema were present.

Case 29.-A Fijian soldier, while on patrol standing and digging a hole, was struck in

the chest by a fragment of a 90 mm. U.S. shell which burst on the ground 20 yards away.

He was killed instantly at 1700 hours on 30 March 1944.

The wound of entry (8.2 x 6.8 cm.) in the posterior aspect of the left side of the chest

extended from the level of the third to the seventh rib. The wound of exit (20 x 12.5 cm.)

(fig. 200) destroyed the anterior aspect of the chest wall above the nipple. In its course, the
392 IWOUND BALLISTICS

FIGURE 200.-Chest wound of exit.

fragment fractured the left scapula, destroyed all but a small portion of the left lung, and

lacerated or severed the heart, thoracic aorta, and inferior vena cava.

Case 30.-A soldier of the 129th Infantry was creeping up on a Japanese pillbox when

he was struck by a .25 caliber Japanese rifle bullet fired from a distance of 20 yards. He

was killed instantly at 1000 hours.

Examination revealed the wound of entry (3 x 1 cm.) in the fourth right intercostal

space in the midaxillary line and the wound of exit (3.8 x 2.5 cm.) in the third left intercostal

space in the anterior axillary line. In its course, the bullet fractured the fourth rib and

lacerated the left auricle ventricle. There was marked extravasation of blood in both lungs

and a massive bilateral hemothorax.

Case 31.-A U.S. soldier, while walking through the jungle on patrol, was struck by a

.25 caliber Japanese bullet fired from a distance of 30 yards. He was killed instantly at 1145

hours on 8 April 1944.

Examination revealed the wound of entry (0.6 cm. in diameter) in the anterior left

second intercostal space in the midelavicular line and the wound of exit (2.5 cm. in diameter)

in the posterior right fifth intercostal space in the posterior axillary line. In its course, the

bullet perforated the upper lobe of the left lung, pericardium, pulmonary artery, the upper

lobe of the right lung, and fractured the right fifth rib in its exit. Hemothorax (left, 400 cc.;

right, 1,500 cc.) and hemopericardium were present.

Case 32.-A soldier of the 117th Engineer Combat Battalion, while walking and covering the evacuation of a casualty, was struck by a .25 caliber Japanese bullet fired from a

distance of 35 yards. He was killed instantly at 1300 hours on 24 March 1944.

Examination revealed a perforating wound of the chest. The wound of entry (0.5 cm.

in diameter) was located in the anterior axillary line in the fourth left intercostal space and

the wound of exit in the seventh intercostal space in the right midaxillary line. In its course,

the bullet grooved the anterior medial border of the lower lobe of the left lung, pierced the
BOUGAINVILLE CAMPAIGN 393

pericardial sac, right ventricle, and middle and lower lobes of the right lung. Bilateral

hemothorax (2,500 cc.) and hemopericardium were present.

Case 33.-A soldier of the 129th Infantry, while walking beyond the perimeter, stepped

on a U.S. landmine and was killed instantly at 1015 hours on 12 April 1944.

Examination revealed seven penetrating and perforating wounds. A chest wound was

responsible for instantaneous death. One fragment entered the left side of the chest through

the second rib in the midclavicular line and made its exit through the right sixth intercostal

space in the midaxillary line. In its course, the fragment fractured the second rib, lacerated

the upper lobe of the left lung, avulsed the anterior wall of the ascending aorta, perforated the

middle lobe of the right lung, lacerated the lower lobe of the right lung, and fractured the

sixth and seventh ribs at its exit. There were 2,000 cc. of blood in each pleural cavity. A

compound comminuted fracture of the mandible was present. In addition, wounds of the

right forearm and arm, left frontal region, and left thigh were found.

Case 34.-A soldier of the 182d Infantry was in an open foxhole with his "buddy," when

he was struck by fragments of a U.S. 37 mm. shell which burst on the ground 3 yards distant.

The other occupant was not injured. This soldier was killed instantly at 0710 hours on 24

March 1944.

Examination revealed a perforating wound of the chest. The entrance wound (7.5 x 4

cm.) was in the right third intercostal space at the costosternal junction and the exit wound

(6.5 x 4 cm.) in the left fourth intercostal space in the midaxillary line. The fragment

severed the left intercostal and the internal mammary arteries. The lower lobe of the left

lung and the middle lobe of the right lung were contused, and massive hemopericardium and

left hemothorax were present. The right ventricle and auricle were lacerated, but the pericardial sac was intact.

Case 35.-A U.S. soldier was standing in a covered pillbox when he was struck by a

fragment of a Japanese mortar shell which came through the peepslit. The shell burst on

the ground at a 25-yard distance. He was killed instantly at 2000 hours on 23 March 1944.

Examination revealed a penetrating wound of entry (2.5 cm. in diameter) in the right

side of the chest in the second intercostal space, anterior axillary line. The fragment (fig.

201) in its course fractured the second rib, perforated the upper lobe of the right lung, partially severed the thoracic aorta, perforated the lower lobe, fractured the eighth rib, and

lodged in the subcutaneous tissues over the ninth rib in the right midscapular line. Massive

hemothorax was present.

Case 36.-A soldier of the 129th Infantry was killed in action in the 129th sector at 2140

hours on 25 March 1944. He was struck by fragments from a Japanese mortar shell. Other

circumstances are not known.

Examination revealed a large entrance wound (12.5 x 10 cm.) on the left extending from

the nipple to the midaxillary line and from the level of the third to the sixth rib (fig. 202).

The fragments shattered the fifth and sixth ribs creating an opening (4 cm. in diameter) into

0 2

FIGURE 201.-Mortar shell fragment recovered from chest wounds.

603225-62--27
394 WOUND BALLISTICS

FIGURE 202.-Chest wound. A. Wound of entrance. B. Recovered mortar shell

fragments.

the left side of the pleural cavity. Bone fragments were driven into the lower lobe of the left

lung producing an irregular laceration. A small metal fragment penetrated the left dome of

the diaphragm, and a button from the soldier's jacket was found in the omentum. A lacerated wound (3.2 x 3 cm.) was found in the left ventricle. The seventh and ninth ribs posteriorly were fractured, and in the subcutaneous tissue in this region five metal fragments were

found. Massive left hemothorax was present.

Case 37.-A soldier of the 148th Infantry, on 1 April 1944, having been struck in the

arm by a Japanese .25 caliber bullet fired from a distance of 7 yards, walked back toward the

first aid station. En route he was mistaken for the enemy and was struck in the chest with

a .30 caliber bullet fired from a U.S. M1 rifle from a distance of 30 yards. He was killed

instantly.

Examination revealed a perforating wound of the right side of the thorax and a wound

of the right shoulder. The entrance wound in the chest (0.5 cm. in diameter) was located

in the first intercostal space in the midclavicular line and the exit wound (2.5 cm. in diameter)

at the level of the 12th rib in the midscapular line. The bullet perforated the upper and lower

lobes of the right lung and fractured the 10th and 11th ribs. Massive hemothorax was present. The penetrating wound of the left shoulder (0.5 cm. in diameter) involved only the

left deltoid muscle. No foreign body was found.

Case 38.-A Fijian soldier, while on patrol, was kneeling behind a rotten log when

struck by a .25 caliber Japanese bullet fired from a distance of 5 yards. He was killed

instantly at 1545 hours on 31 March 1944.

The entrance wound (0.5 cm. in diameter) was found over the sternum at the junction

of the manubrium with the body and the exit wound (1.2 cm. in diameter) in the left eighth

intercostal space in the anterior axillary line. In its course, the bullet fractured the sternum,
BOUGAINVILLE CAMPAIGN 395

N_

0 1 2 3 5 6

FIGURE 203.-Japanese hand grenade fragments recovered from chest wound.

perforated the aorta, pulmonary artery and lower lobe of the left lung, and fractured the

eighth rib in making its exit. Massive bilateral hemothorax was present.

Case 39.-A soldier of the 129th Infantry, while attacking a Japanese pillbox, was killed

instantly by the pointblank explosion of a Japanese hand grenade at 0800 hours on 24 March

1944.

Examination revealed multiple penetrating wounds of the chest, head, face, and abdomen. One fragment, entering the thorax through the third right intercostal space in the

nipple line, had lacerated and lodged in the upper lobe of the right lung. A massive hemothorax was present. The 12th dorsal vertebra and the mandible and temporal bones were

fractured.

The recovered fragments are shown in figure 203.

Case 40.-A soldier of the 164th Infantry, while walking through the jungle on patrol,

was struck by .25 caliber Japanese bullets fired from a distance of 5 yards. He was killed

instantly at 1130 hours on 29 March 1944.

Examination of the chest revealed an entrance wound (1.8 cm. in diameter) in the

posterior aspect of the left side of the chest in the seventh intercostal space and an exit wound

(3.8 cm. in diameter) in the left midclavicle. In its course, the bullet had fractured the

fourth, fifth, sixth, seventh, and eighth ribs in the axillary line, severely lacerated both lobes,

and fractured the clavicle at its exit. Massive left hemothorax was present. Another

bullet had penetrated the soft tissues of the left thigh, making its entrance through the

lateral side of the upper third. It was found in the vastus medialis. A third bullet perforated the left foot through the first metatarsophalangeal joint.

Figure 204 shows the bullet recovered from the thigh.

Case 41.-A U.S. soldier, while kneeling in the open administering first aid to a casualty, was struck by a .25 caliber bullet fired by a sniper from a distance of 35 yards. He

was killed instantly at 1300 hours on 24 March 1944.

Examination revealed a perforating wound of the left side of the chest. The entrance

wound (0.5 cm. in diameter) lay over the third rib anteriorly 4 cm. from the midline and the

exit wound (1.5 x 1 cm.) over the angle of the left scapula. In its course, the missile fractured

the third rib and lacerated the hilum of the left lung severing a large branch of the pulmonary

artery and a secondary bronchus. The upper lobe of the left lung was severely lacerated.

Hemothorax (1,500 cc.) was present on the left. Blood exuded from the mouth.

Case 42.-A soldier of the 129th Infantry, while squatting in a shallow hole on patrol,

was struck by a fragment of a U.S. artillery shell which burst on the ground 5 yards distant.

He was killed instantly at 1230 hours on 29 March 1944.
396 WOUND BALLISTICS

FIGURE 204.-Japanese .25 caliber bullet recovered from thigh.

Note deformity of tip of bullet.

Examination revealed a penetrating wound of the right side of the chest. The wound

of entrance (3.7 cm. in diameter) was situated in the third right intercostal space in the

midaxillary line. The fragment fractured the fourth rib, perforated the middle lobe of the

right lung, the right auricle, the right ventricle, and lodged in the lower lobe of the left lung.

Htemopericardium and massive right hemothorax were present.

Figure 205 shows the only fragment recovered.

Case 43.-A soldier of the 129th Infantry was killed in action in the 129th sector. He

was struck by .25 caliber Japanese bullets and killed instantly at 1345 hours on 24 March

1944.

The thoracic entrance wound (0.5 cm. in diameter) was found in the sixth right intercostal space in the posterior axillary line and the exit wound in the eighth left intercostal

space in the midscapular line. The bullet produced fractures of the right sixth, seventh, and

eighth ribs, severe lacerations of the posterior surface of the middle and posterior lobes of

the right lung, fractures of the bodies of the seventh and eighth vertebras, transection of the

spinal cord, perforation of the lower lobe of the left lung, and fracture of the left eighth rib

in the posterior axillary line. A flattened bullet, 1.2 x 1 x 0.2 cm., was recovered in this

region. Massive bilateral hemothorax was present. A severe comminuted fracture of the

middle third of the right femur had resulted from another bullet. The wound of entrance on

the thigh was very small.

Case 44.-A Fijian soldier, while on patrol kneeling behind a tree and firing at the enemy,

was struck by a .25 caliber Japanese bullet fired from a distance of 20 yards. He was killed

instantly on 31 March 1944.

The wound of entrance (0.5 cm. in diameter) was located in the left fourth intercostal

space in the parasternal line and the exit wound (3.7 cm. in diameter) in the left sixth intercostal space in the midaxillary line. The bullet produced irregular lacerations of the right

and left ventricles and perforated the upper lobe of the left lung. Massive hemothorax and

hemopericardium were present.

Case 45.-A soldier of the 129th Infantry stepped out of his pillbox and was struck by

a .25 caliber Japanese sniper bullet from a distance of 25 yards. He fell back into the pillbox

and died instantly at 0730 hours on 25 March 1944.

Examination revealed a penetrating wound of the anterior aspect of the left side of the

chest wall. The entrance wound (1 cm. in diameter) was found in the fourth intercostal

space at the costochondral junction. Demonstrated at autopsy were a fracture of the fourth

rib and sternum, right hemothorax (3,000 cc.), perforation of the right auricle and ventricle,

and a laceration of the hilus of the right lung.
BOUGAINVILLE CAMPAIGN 397

0

FIGURE 205.-U.S. artillery shell fragment recovered from chest wound.

Figure 206 shows the flattened .25 caliber bullet which was found lying free in the right

side of the pleural cavity.

Case 46.-A soldier of the 129th Infantry, while sitting in the cleared open jungle, was

struck by fragments of a 90 mm. Japanese shell which exploded on the ground at a distance

of 20 yards. He was killed instantly at 1425 hours on 25 March 1944.

Examination disclosed an entrance wound (20 x 10 cm.) over the left scapula and an

exit wound (2 cm. in diameter) on the left arm 6 cm. below the acromion process (fig. 207).

The head of the left humerus was shattered, and there were fractures of the third, fourth,

fifth, sixth, seventh, and eighth ribs in the midaxillary line and the fifth, sixth, and seventh

ribs in the anterior axillary line. The parietal pleura was torn, both lobes of the left lung

were severely lacerated, and the left scapula was extensively comminuted. A hemothorax

(3,500 cc.) was present.

Figure 207A shows the large wound of entrance and figure 207B the small wound of exit

of one of the fragments. Several small metal fragments recovered from the scapular area

are shown in figure 207C.

Case 47.-A New Zealand soldier, while walking through the jungle on patrol, was

struck by a .25 caliber Japanese sniper bullet fired from a distance of 30 yards. He was killed

instantly at 0930 hours on 14 March 1944.

Examination revealed a perforating wound of the neck with the entrance (0.6 cm. in

diameter) situated below the tip of the left mastoid and the exit (4.3 cm. in diameter) below

the right acromioclavicular articulation. In its oblique course, the bullet perforated the

third cervical vertebra, severed the spinal cord, fractured the first, second, and third ribs at

their costovertebral junctions, entered the pleural cavity, perforated the upper lobe of the

right lung, and made its exit between the clavicle and scapula. Present on the right was a

hemothorax of 2,000 centimeters.

Case 48.-A Fijian soldier, while moving forward on patrol in a crouched position, was

struck by a fragment of a 90 mm. Japanese mortar shell which burst on the ground 10 yards

away. He died en route to the hospital at 1000 hours on 26 March 1944.

Examination revealed a penetrating wound of the posterior aspect of the right side of

the chest. The fragment entered 8 cm. from the midline at the level of the sixth dorsal

vertebra through a wound 1.5 cm. in diameter. It coursed under the skin to enter the left

side of the chest in the sixth intercostal space, 5 cm. from the midline. The seventh rib was

fractured at this point. The posterior surface of the lower lobe of the left lung was severely

lacerated. A metal fragment was recovered from the pleural cavity. A left hemothorax

(2,000 cc.) was present.

Case 49.-A soldier of the 129th Infantry, while walking behind a tank, was struck

twice by .25 caliber Japanese bullets fired from a distance of 40 yards. He was killed instantly at 1030 hours on 24 March 1944.
398 WOUND BALLISTICS

FIGURE 206. -Deformed Japanese rifle bullet recovered from pleural cavity.

Examination revealed two penetrating wounds of entry (4 x 2.4 em. and 3.5 x 2 cm. in

diameter); one through the right and the other through the left second costosternal junction.

Post mortem examination showed compound comminuted fractures of the second ribs

(right and left) and sternum, severance of the right intercostal and internal mammary arteries, bilateral hemothorax, complete transection of the aortic arch and right pulmonary

artery and vein, perforation of the left auricle, laceration of the upper lobe of the right lung,

incomplete division of the esophagus and trachea at the level of bifurcation, and perforation

of the body of the seventh thoracic vertebra.

Case 50.-A soldier of the 129th Infantry was prone in the open behind a tank assault

when he was struck by a .25 caliber Japanese bullet fired from a distance of 100 yards. He

was wounded at 1100 hours on 24 March 1944. Several hours later, thoracotomy was performed at the 21st Evacuation Hospital, and a lacerated left lung was sutured. He received

penicillin daily and seemed to improve. Death from pulmonary embolus occurred suddenly

at 0730 hours on 28 March 1944.

Examination revealed a curved incision (22.5 cm. in length) in the posterior aspect of

the left side of the chest wall extending from the fifth dorsal vertebra to the axillary line. A

left fibrinous pleuritis with effusion (500 cc.) was present. A laceration of the lower lobe of

the left lung had been closed by suture. The lung was congested, and a thrombus was found

lodged in the pulmonary artery.

Case 51.-A soldier of the 129th Infantry, while standing in an open foxhole, received a

serious wound at 1500 hours on 27 March 1944 from a fragment of a U.S. 4.2-inch mortar

shell which burst on the ground 3 yards away. At the portable surgical hospital, the sucking wound of the chest was closed. The following day, the patient was transferred to the

21st Evacuation Hospital. Upon admission to the ward, dehiscence of the wound was

present. A second operation was performed and bone fragments were removed from the

lung and bleeding was controlled. The patient never regained consciousness and died at

1700 hours on 30 March 1944.

Autopsy revealed an oblique operative incision 17.5 cm. long, extending from the third

dorsal spine to the ninth rib, in the posterior aspect of the right side of the chest. The right

scapula and the seventh and eighth ribs were fractured. A right hemothorax was found,

and sutures were present in the middle and lower lobes of the right lung. The lungs were

emphysematous, and there was marked dilatation of the right ventricle. Death was attributed to heart failure. In this case, death may have been precipitated by the rapid administration of necessary intravenous fluids in the presence of some pulmonary obstruction.

Case 52.-A soldier of the 129th Infantry, while walking in a crouched position following

a tank assault, was struck by a .25 caliber Japanese bullet fired from a distance of 25 yards.

He was wounded at 1245 hours on 24 March 1944 and died 24 hours later. Death resulted

from transection of the thoracic spinal cord and was associated with terminal hyperthermia.
BOUGAINVILLE CAMPAIGN 399

sow1

FIGURE 207.-Wound of scapular area. A. Wound of entrance. B. Wound of exit.

C. Metal fragments recovered from scapular area.

The wound of entrance (3 cm. in diameter) was located in the center of the left supraclavicular region. The bullet entered the chest through the first intercostal space, fractured

the first and second ribs, and produced a gutter wound in the upper lobe of the left lung. The

body of the second dorsal vertebra was fractured and the spinal cord severed at the same

level. A massive left hemothorax was found. The bullet was not recovered.

Case 53.-An airman of the 13th Army Air Force shot himself with a .30 caliber carbine

at 1300 hours on 4 April 1944. He arrived at the hospital in 10 minutes, was given three

units of plasma, and underwent immediate thoracotomy. An attempt was made to suture

the lacerations of the lung, but the patient died on the table from shock due to hemorrhage.

Post mortem examination revealed an entry wound 6 mm. in diameter in the anterior

aspect of the left side of the chest, 10 cm. from the midline in the seventh intercostal space.

The wound of exit, located posteriorly in the third intercostal space 5 cm. from the midline,

was 2.5 cm. in diameter. The bullet in its course lacerated the lower lobe of the left lung. A

contusion of the left ventricle and a hemothorax (1,000 cc.) were found.

Case 54.-A soldier of the 129th Infantry, while prone firing at the enemy, was hit

twice by .303 caliber bullets fired from a Japanese machinegun from a distance of 35 yards.
400 WOUND BALLISTICS

He was wounded at 0830 hours on 24 March 1944 and taken to the hospital immediately.

After adequate shock therapy, the chest wound was debrided and closed and laparotomy

performed. The patient died at 0645 hours on 28 March 1944 of pulmonary edema.

Post mortem examination revealed two wound tracks. One bullet produced an entry

wound (3.2 x 2.5 cm.) lateral to the spinous process of the first lumbar vertebra; this missile

coursed superiorly and laterally, fractured the 12th rib, perforated the diaphragm, and was

found lodged under the l1th rib in the midaxillary line. The other wound was perforating

in type with its entrance (1.2 cm. in diameter) located 1 cm. below the right clavicle at the

outer third and exit (17.9 cm. in length) located 9 cm. to the left of the l1th dorsal vertebra.

In its course, this bullet produced a temporary cavity injury of the right lung, perforated the

lower lobe of the left lung, and fractured the ninth rib. Edema of the lower lobe of the left

lung, fibrinous pleuritis, and hemopneumothorax were present. The right lung was diffusely discolored. The abdominal examination was negative, as the bullet had traversed

the retroperitoneal space.

Case 55.-A soldier of the 145th Infantry, while kneeling in the open firing at the

enemy, was struck by a .25 caliber Japanese bullet fired from a distance of 15 yards. He

was wounded on 16 March 1944. Thoracotomy was performed at the 21st Evacuation

Hospital several hours later. The lower lobe of the right lung was removed, the diaphragm

closed, and bleeding from the perforation in the body of the 12th dorsal vertebra was controlled by electrocoagulation. The spinal cord was severed at the level of 12th dorsal.

The patient was evacuated from the island on the eighth postoperative day. He developed

an empyema at the 31st General Hospital. Surgical drainage of the empyema was established. In spite of adequate drainage, penicillin, and supportive therapy, the patient died

from the infection on 25 April 1944.

Post mortem examination revealed gross infection of the right side of the pleural cavity.

The remaining upper and middle lobes were shrunken and adherent and the pleura markedly

thickened. The right lower bronchus communicated with the pleural cavity. The spinal

cord was transected at the level of the fracture of the 12th dorsal vertebra. The diaphragm

had been repaired. Generalized intestinal distension and focal necrosis of the liver were

present.

Case 56.-A Fijian soldier, while crouching and advancing on patrol, was shot through

the left side of the chest by a .25 caliber Japanese bullet from a distance of 30 yards. He

was wounded in the morning of 30 March 1944. Upon arrival at the 21st Evacuation

Hospital, immediate thoracotomy was performed in an attempt to control pulmonary

bleeding. The patient died several hours later (1420 hours on 30 March 1944) of acute

cardiac dilatation and hemorrhage. The cardiac dilatation was thought to be secondary to

obstruction of the pulmonary circulation (see Case 51, p. 398.)

Post mortem examination showed a wound of entry (1.2 cm. in diameter) through the

second left intercostal space above the costosternal junction. The wound of exit had been

closed at the time of operation. A curved anteriolateral incision from the second to sixth

rib was noted. Lacerations of the upper and lower lobes had been sutured. The right

heart was markedly dilated. Moderate left hemothorax was present.

Case 57.-A soldier of the 920th ABS, while stepping out of a truck, was hit by fragments

of a Japanese artillery shell which burst on the ground 2 yards away. He was wounded at

0600 hours on 24 March 1944. Within an hour, he was at the 52d Field Hospital, and the

wound on the left side of the chest was excised, the lung sutured, and the chest closed. In

addition, a loop colostomy of the sigmoid was done because of a perforation of the colon.

The patient died several hours later from massive pulmonary hemorrhage.

Examination revealed penetrating wounds of the chest and left gluteal region. The

entry wound in the anterior aspect of the left side of the chest through the fifth interspace

had been excised and closed. The fifth and sixth ribs were fractured. Massive hemothorax was present. A large mattress suture partially closed the laceration in the lower

lobe of the left lung. The abdominal cavity had been entered by a fragment which perforated the left wing of the ilium leaving a wound of entrance 7.5 cm. in diameter. Fragments
BOUGAINVILLE CAMPAIGN 401

-

FIGURE 208.-Japanese artillery shell fragments recovered from chest wall.

of bone had been dispersed extensively lacerating the gluteal muscles. As just stated, the

perforation of the sigmoid colon had been treated by exteriorization through a left rectus

incision.

Figure 208 shows metal fragments removed from the chest wall.

Case 58.-A soldier of the 182d Infantry, while crawling through the jungle on patrol,

was struck by .25 caliber Japanese machinegun bullets. He was wounded at 2100 hours

on 2 May 1944 and reached the hospital within 3 hours. Thoracotomy was decided upon

because of intrathoracic bleeding. The patient died on the operating table during induction

of the anesthetic at 0515 hours on 3 May 1944.

Examination revealed a perforating wound of the left side of the chest and a penetrating wound of the right axilla. One entrance wound (1.2 cm. in diameter) into the chest

was situated in the left midscapular region and the exit wound (5 x 2 cm.) in the left supraclavicular fossa. In its course, the bullet fractured the scapula and the second, third, and

fourth ribs. The broken ribs had severely lacerated the pleura and the upper lobe of the

left lung. The bullet had not entered the pleural cavity. A massive left hemothorax was

present. Another bullet penetrated the apex of the right axilla through a wound 3.7 cm.

in diameter and in its course severed the radial and median nerves and fractured the upper

third of the humerus. The bullet was found in the belly of the triceps muscle.

Case 59.-A soldier of the 24th Infantry, while running forward in a skirmish line,

was struck by .25 caliber Japanese machinegun bullets fired from a distance of 75 yards.

He was killed instantly at 1100 hours on 14 April 1944.

Examination revealed multiple wounds. A missile which produced a penetrating wound

of the right side of the abdomen and traversed the right thorax was responsible for rapid

death. This bullet entered the right kidney region opposite the spinous process of the

second lumbar vertebra. In its course, it lacerated the lower pole of the right kidney, perforated the hepatic flexure of the colon, right lobe of the liver and diaphragm, lacerated the

lower right lobe of the lung, and fractured the 8th, 9th, 10th, 11th, and 12th ribs in the posterior axillary line. Hemoperitoneum and a right hemothorax (1,000 cc.) were present.

The bullet was recovered in the subcutaneous tissue. Another bullet perforating the neck

entered the right side in the posterior cervical triangle and made its exit below the tip of

the left mastoid process. The trachea was severed at the level of the cricoid cartilage.

Another bullet struck the left side of the face (fig. 209) producing a gutter wound 12.5 x 3.7

x 0.25 cm., which destroyed the left temporomandibular joint. Present also was a perforating wound in the right infraclavicular space with fracture of the right clavicle.

603225v62 28
402 WOUND BALLISTICS

FIGURE 209.-Gutter wound of left side of FIGURE 210.-Deformed .25 caliber machineface and neck. gun bullet recovered from chest wall.

Figure 210 shows the distorted bullet and a part of the jacket removed from the right

side of the chest wall.

Case 60.-A soldier of the 129th Infantry, while crouching following a tank assault,

was shot by a .25 caliber Japanese machinegun bullet from a distance of 25 yards. He

was killed instantly at 0800 hours on 13 March 1944.

Examination showed an entrance wound (0.6 cm. in diameter) through the anterior

aspect of the right side of the chest in the second intercostal space in the nipple line and an

exit wound (7.5 cm. in diameter) through the left loin above the wing of the ilium. In its

oblique course, the bullet perforated or severed the middle lobe of the right lung, the diaphragm, the right lobe of the liver, the pancreas at the junction of the head and body, the

transverse duodenum, the jejunum, and the left colon at the sigmoid junction. Moderate

hemothorax and hemoperitoneum were present.

Case 61.-A soldier of the 129th Infantry, while standing in a foxhole covered by light

roofing, was killed instantly by the direct burst of a Japanese mortar shell; 4 other men were

wounded. The soldier was killed at 0530 hours on 24 March 1944.

Multiple penetrating wounds of the back, chest, and abdomen were sustained. A large

chest wound caused death. The wound of entrance was 9 cm. in diameter and situated in

the posterior aspect of the left side of the chest 2.5 cm. from the spinous processes of T-11

and T-12. In its course, this fragment fractured the fifth and sixth ribs anteriorly and the

8th, 9th, and 10th ribs posteriorly; fragmented the lower lobe of the left lung; perforated the

diaphragm; disrupted the spleen; and transected the descending colon. The bodies of the

11th and 12th dorsal vertebras were badly comminuted. Massive left hemothorax and

hemoperitoneum were present.

Figure 211 shows metal fragments identified as parts of a first aid box.

Case 62.-A soldier of the 129th Infantry, while in a pillbox, was surrounded by Japanese. He was killed by fragments of a Japanese hand grenade which exploded at pointblank range; 2 other men in the pillbox were wounded. The soldier died instantly at 0800

hours on 24 March 1944.

Examination revealed multiple penetrating wounds of the chest, right thigh, right leg,

and right arm. The wounds of the thorax were fatal. There were multiple, small penetrating wounds through the right posterior axillary line from the 7th to 12th rib. The

largest was 1.2 cm. in diameter. Small fragments perforated the lower lobe of the right

lung and diaphragm and produced a laceration (7 x 3 x 1.3 cm.) in the dome of the liver.
BOUGAINVILLE CAMPAIGN 403

0

0)

0 I2 3 4 5 6 7 8 9.10 UI 12 13

FIGURE 211.-Recovered metal fragments identified as parts of first aid box.

Massive right hemothorax and moderate hemoperitoneum were present. The remaining

wounds were not extensive.

Figure 212 shows the recovered grenade fragments.

Case 63.-A Fijian soldier, while running on patrol, stepped on a U.S. landmine and

was killed instantly at 1100 hours on 26 March 1944.

Examination revealed nine penetrating wounds. Three fragments entered the left

side of the chest anteriorly in the first intercostal space in the nipple line and perforated or

severed the upper lobe of the left lung, pulmonary artery, aortic arch, trachea, lower lobe of

the right lung, diaphragm, and liver. Two metallic fragments were found in the liver.

Hemothorax (left, 2,500 cc., and right, 250 cc.) was present. In addition, there were wounds

of the left elbow, thigh, cheek, chin and eye, and an extensive gutter wound of the left buttock.

Case 64.-A soldier of the 21st Reconnaissance Troop was killed by a U.S. hand grenade

which exploded in his pocket, while returning from patrol. He was killed instantly at 0920

hours on 25 April 1944.

Examination revealed 12 penetrating wounds, 4 of which penetrated the thorax. The

fragments entered the left side of the chest in the midaxillary line at the levels of the fourth,

sixth, and ninth ribs. The left fourth, fifth, and sixth ribs were fractured; the diaphragm,

spleen, and pancreas were lacerated; and the stomach was perforated in two places. Massive left hemothorax and hemoperitoneum were present. One grenade fragment was recovered from the pleural cavity and two fragments from the lumen of the stomach. The

remaining wounds were in the upper extremities.

Figure 213 shows the recovered fragments, the largest of which was removed from the

thorax.

Case 65.-A Japanese soldier (unknown) was killed on 22 March 1944 by fragments

from an HE shell.

Examination revealed an entrance wound (2 cm. in diameter) in the 11th left intercostal

space. The fragments in their course lacerated the lower lobe of the left lung and diaphragm

and spleen and were found in the subcutaneous tissue at the exit wound. Present also

were a bilateral hemothorax and a hemoperitoneum (300 cc.).
404 WOUND BALLISTICS

0

o_--

FIGURE 212.-Fragments of Japanese hand grenade recovered from multiple wounds.

Case 66.-A soldier of the 21st Reconnaissance Troop, while crouching and moving

forward in a skirmish line, was struck three times by .25 caliber Japanese machinegun bullets fired from a distance of 20 yards. He was killed instantly at 1600 hours on 27 March

1944.

An abdominal wound was responsible for death. The wound of entrance (0.5 cm. in

diameter) was placed in the midline 7.5 cm. above the umbilicus. This bullet severed the

abdominal aorta and fractured the first lumbar vertebra. Another bullet perforated the

right deltoid muscle and entered the right side of the thoracic cavity through the fourth

intercostal space in the anterior axillary line. The fifth, sixth, and seventh ribs were fractured, the lower lobe of the lung and the dome of the diaphragm were lacerated, the liver

was perforated, and the right kidney was fragmented. There were also superficial wounds

of the left hip and left forearm.

Case 67.-A soldier of the 129th Infantry was struck by a .25 caliber Japanese bullet

fired by a sniper from a distance of 25 yards. His position when hit was not known. He

was killed instantly at 1300 hours on 24 March 1944.

The bullet entered the left side of the thorax through a wound (0.5 cm. in diameter)

in the anterior fourth intercostal space in the anterior axillary line and made its exit through

a wound (2.5 x 1.5 cm.) in the right sixth intercostal space in the midaxillary line. The

bullet in its course perforated the upper lobe of the left lung, left ventricle, right ventricle,

lower lobe of the right lung, and the diaphragm and produced an irregular laceration in the

vertex of the liver 7.5 cm. in length before making its exit. Massive bilateral hemothorax

and hemoperitoneum were found.

Case 68.-A soldier of the 132d Infantry, while on patrol entering a Japanese pillbox,

was struck by a .25 caliber Japanese bullet fired at close range. He was wounded at 1700

hours on 29 March 1944. Laparotomy was performed several hours later at the clearing

station. At operation, the left side of the diaphragm was repaired, and a transverse colostomy was performed after suture of a perforation in the splenic flexure of the colon. The

patient died at 0600 hours on 4 April 1944 with signs of cardiorespiratory failure.

Examination revealed a penetrating bullet wound of the left side of the chest entering

the sixth intercostal space in the posterior axillary line. Transverse colostomy had been

performed through an upper left rectus incision. The seventh, eighth, and ninth ribs were

fractured, and moderate left hemothorax was present. The lower lobe of the left lung was

discolored. The pericardial sac contained a small amount of blood, although it had not
BOUGAINVILLE CAMPAIGN 405

FIGURE 213.-Fragments of U.S. hand grenade recovered from multiple wounds.

been perforated. An area of epicardial ecehymosis was found on the left ventricle.19 Present also were a laceration of the spleen and an explosive wound of the left kidney with a

large hematoma. A perforation in the splenic flexure of the colon had been sutured. The

repair of the diaphragm was unsuccessful.

Case 69.-A soldier of the 129th Infantry, while leading his platoon against the enemy,

was struck by a .25 caliber bullet fired from a short distance. He was wounded at 0900

hours on 13 March 1944. An hour later, debridement and closure of the chest wound were

done at the 21st Evacuation Hospital. He was evacuated by air on 15 March and died on

21 March 1944, at the 9th Station Hospital, of secondary hemorrhages from the left lung

and spleen.

Post mortem examination revealed a perforated wound of the left elbow and a compound fracture of the humerus. The same bullet had entered the left side of the chest in

the sixth intercostal space in the posterior axillary line and made its exit in the left seventh

intercostal space. The thoracotomy incision was well healed. The left side of the pleural

cavity contained a liter of blood. Both lobes of the left lung were lacerated, and the diaphragm, spleen, and kidney were perforated. Old and fresh blood were present in the peritoneal cavity. A retroperitoneal hematoma was well organized.

Case 70.-A Fijian soldier, while crouching in a skirmish line on patrol, was struck by

fragments of a Japanese mortar shell which burst on the ground 20 yards distant. He was

wounded on 29 March 1944. Splenectomy, exteriorization of the colon, closure of a chest

wound, and debridement of an arm wound were performed the same day. He died at 2215

hours on 30 March 1944 of shock and hemorrhage.

Examination revealed wounds of the chest, abdomen, and left arm. A linear incision

extended in the ninth left intercostal space from the nipple to the axillary line. The pleural

cavity contained 3,000 cc. of blood. Fibrinous pleuritis, congestion of the lung, and dilatation of the right heart were found. The rent in the left side of the diaphragm was incompletely closed. A left rectus incision was present through which protruded the exteriorized

loop of the perforated transverse colon. A small amount of free blood was present in the

abdominal cavity. The spleen had been removed. The body and tail of the pancreas were

lacerated. An explosive wound of the left kidney and a large retroperitoneal hematoma

were found. Present also in the lower third of the left arm was the wound of a severe compound comminuted fracture of the humerus.

19 This type of injury is similar in origin to the pulmonary hemorrhage seen at some distance from the permanent

wound track and is a result of the formation of the temporary cavity during the passage of high-velocity missiles.-J. C. B.
406 WOUND BALLISTICS

Case 71.-A soldier of the 37th Reconnaissance Troop, while walking in a crouched

position through thick jungle on patrol, was struck in the left lumbar region by a Japanese

.25 caliber bullet fired from a distance of 25 yards. He was wounded at 1815 hours on 4

March 1944. Laparotomy was performed at the 21st Evacuation Hospital several hours

later. Perforations in the bowel were sutured, and an attempt was made to arrest hemorrhage

from a laceration in the liver. The patient died at 1615 hours on 5 March 1944 from shock

and hemorrhage.

Examination revealed a wound of entry (0.5 cm. in diameter) in the left lumbar region

directly below the 12th rib and an exit wound (1 cm. in diameter) through the right midaxillary line in the eighth intercostal space. In its course, the bullet perforated jejunum, ileum,

transverse colon, liver, diaphragm and the lower lobe of the right lung, and fractured the

right ninth rib. Moderate hemoperitoneum and hemothorax (right) were present.

Case 72.-A Fijian soldier, while standing in the jungle, was mistaken for the enemy

and shot by a fellow soldier with a Bren submachinegun at a 30-yard distance. He was

wounded at 1500 hours on 1 April 1944. At the 21st Evacuation Hospital, after shock

therapy, right lower lobectomy was performed, and a wound in the liver was tamponaded.

He died of hemorrhage at 2030 hours on 1 April 1944.

There were two perforating wounds of the right side of the chest. The wounds of entry

(each 0.5 cm. in diameter) were both situated in the sixth intercostal spaces 2.5 and 3.7 cm.,

respectively, from the midline, and the exit wounds were in the eighth intercostal space in

the midaxillary line. The ninth rib was fractured. A recent anteriolateral sixth intercostal

space incision was present. The lower lobe of the right lung had been removed and the rent

in the diaphragm incompletely closed. A large wound occupied the dome of the right lobe

of the liver.

Case 73.-A soldier of the 24th Infantry, while lying prone in the jungle on patrol, was

struck by Japanese .303 caliber machinegun bullets fired from a distance of 30 yards. At

1000 hours on 19 April, he received shock treatment followed by right thoracotomy. At

operation, a bullet and a bone fragment were removed from the right lung, and the diaphragm

and lung were sutured. This soldier did not recover from shock and died at 2125 hours on

19 April 1944.

Examination revealed two major wounds. One bullet produced a perforating wound of

the right thigh and a compound fracture of the femur. The other bullet penetrated the left

buttock and coursed superiorly to terminate in the right side of the pleural cavity. This

bullet fractured the fifth lumbar vertebra, severed the cauda equina, lacerated the right

kidney, and perforated the diaphragm and lower lobe of the right lung. In addition, there

were superficial gutter wounds of the right and left forearms.

Case 74.-A soldier of the 145th Infantry, preparing to climb into a truck, was struck

by a fragment of a Japanese mortar shell which burst on the ground 15 yards away. He

was wounded at 0730 hours on 18 March 1944. After arriving at the hospital within 1 hour,

continuous shock therapy was instituted. Thoracotomy was performed at 0200 on 19 March

1944 in an attempt to arrest hemorrhage.

Examination revealed a sutured wound over the posterior lower left side of the chest 10

cm. in length. A laceration in the lower lobe of the left lung had been sutured. The diaphragm, stomach, and spleen were lacerated. A moderate left hemothorax and hemoperitoneum (2,500 cc.) were present.

Case 75.-A soldier of the 25th Infantry, at 2230 hours on 2 April 1944, left his foxhole

to void. On return, he was shot through the abdomen, by an apprehensive bunkmate, with

a U.S. .45 caliber revolver from a distance of 2 yards. He died within an hour.

Examination revealed a penetrating wound (1.5 cm. in diameter) in the upper right

quadrant of the abdomen. The peritoneal cavity was filled with blood from a perforation

of the vena cava. In addition, several loops of jejenum had been perforated.

Case 76.-A soldier of the 145th Infantry, while standing in the open, was struck by

fragments of a Japanese 90 mm. mortar shell which burst on the ground 2 yards distant. He

was killed instantly on 18 March 1944. Apparently, a fragment had struck the abdominal
BOUGAINVILLE CAMPAIGN 407

wall tangentially in the midline, 0.5 cm. above the symphysis. A loop of ileum was protruding. Only remnants of the urinary bladder remained. The right ilium, right pubic

ramus, and sacrum were severely comminuted. The peritoneal cavity contained 2 liters of

blood.

Case 77.- A Fijian soldier, while crouching on patrol, was struck in the right lumbar

region by a .25 caliber Japanese bullet fired from a distance of 20 yards. He was shot at

1030 hours on 29 March 1944 and died 1 hour later in the aid station from internal hemorrhage.

Examination revealed a perforating wound of the right lumbar region. The entrance

wound (0.5 cm. in diameter) was located in the right lumbar region 3 cm. above the posterior

superior spine of ilium and the exit wound (0.6 cm. in diameter) on the left buttock on a

level with the greater trochanter of the femur. The bullet in its course fractured the wing

of the right ilium, severed the right spermatic and pudendal arteries and rectum, and fractured the sacrum. Massive hemoperitoneum was present.

Case 78.-A Medical Department soldier of the 129th Infantry, while lying prone beside his medical officer, was struck by a .25 caliber Japanese bullet fired from the rear at a

distance of 75 yards. He spoke a few words, had several convulsive seizures, and died at

1100 hours on 24 March 1944.

Examination revealed a perforating wound of entrance (0.5 cm. in diameter) over the

right 12th rib in the posterior axillary line and an exit wound (10 x 0.5 cm.) through the left

lumbar region at the level of the fifth spinous process, 15 cm. from the midline. In its

oblique course, the bullet fractured the 12th rib, mutilated the right kidney, lacerated the

right lobe of the liver and mesenteric border of the midportion of the transverse colon, and

fractured the body of the first lumbar vertebra. Massive hemoperitoneum was present.

Case 79.-A soldier of the 25th Infantry left his foxhole at night to defecate. While

returning to his hole, he was shot by a fellow soldier with a .30 caliber U.S. machinegun

from a distance of 30 yards. He was killed instantly at 1200 hours on 16 April 1944.

One wound had its entrance (0.6 cm. in diameter) over the right scapula and exit (1.2

cm. in diameter) through the left side of the neck. The bullet producing this wound fractured the third cervical vertebra and severed the spinal cord. Another bullet produced a

long (32.5 cm.) gutter wound of the right side of the abdomen which resulted in evisceration

(fig. 214). This missile pierced the ascending and transverse colon, the ileum, and the liver.

Case 80.-A soldier of the 129th Infantry, while running forward over open terrain, was

shot by a .25 caliber Japanese machinegun from a distance of 30 yards. He was killed

instantly at 0830 hours on 24 March 1944. Of the two bullet wounds, one (1 cm. in diameter)

was classified as penetrating and was situated 7 cm. superior to the umbilicus in the midline;

the other was a perforating wound with the entry wound (1 cm. in diameter) through the

right lower quadrant and the exit wound (4 x 2 cm.) through the right transverse process of

the fourth lumbar vertebra.

Examination of the abdominal cavity revealed a massive hemoperitoneum, severance

of the middle colic artery, linear laceration of the midportion of the transverse colon, division

of the right common iliac vein and artery, and a compound fracture of the fourth and fifth

lumbar vertebras.

Case 81.-A soldier of the 135th Field Artillery, while assigned to a detail burying the

Japanese dead in front of the perimeter, wandered away from the main party. He was

struck by a .25 caliber bullet which was thought to have been fired by a sniper. He was

wounded at 1545 hours on 27 March and arrived at the hospital within 2 hours. Laparotomy

was performed, and an extensive wound of the liver was found. He died at 1830 hours on

27 March 1944 of shock from hemorrhage.

Examination revealed a penetrating wound (0.5 cm. in diameter) in the 11th right intercostal space in the anterior axillary line. A recent T-incision was present in the right upper

quadrant of the abdomen. The abdominal cavity contained 2 liters of blood. An extensive

laceration of the right lobe of the liver had been filled with transplanted muscle. The 12th

rib was fractured. Approximately one-third of the shattered right kidney remained, and
408 WOUND BALLISTICS

FPIURE 214.-Laceration of abdominal wall and evisceration.

bone fragments were found in the remnant of this kidney. There was no wound of exit. No

foreign body was recovered.

Case 82.-A soldier of the 182d Infantry, while standing in the open, was struck by

multiple fragments of a Japanese hand grenade which exploded 1 yard away. He was

wounded at 1345 hours on 13 March 1944. Abdominal exploration which was performed at

the clearing station several hours later was reported negative. Multiple penetrating wounds

of the left side of the chest wall were debrided at the same time. The patient was evacuated

by air from the island on 18 March 1944. Upon arrival at a hospital in the rear echelon on

the same day, evisceration was discovered. Secondary wound closure and ileostomy were

done. He received penicillin and general supportive treatment but died at 0835 hours on

25 March 1944 of peritonitis. (It is suggested that air evacuation resulted in evisceration.)

Post mortem examination revealed multiple healed wounds involving the left side of the

body from the axilla to the knee in a band between the anterior and posterior axillary lines.

The abdomen was distended. Incomplete visceral herniation was present below the ileostomy in the partially closed incision. Advanced diffuse suppurative peritonitis was present.

Case 83.-A soldier of the 132d Infantry, while following a jungle trail, was struck by

fragments of a 90 mm. Japanese mortar shell which burst on the ground at a 25 yard distance

away. He was wounded at 1530 hours on 13 March 1944. Laparotomy was performed at

the portable surgical hospital and a rent in the colon sutured. After transfer to the 21st

Evacuation Hospital 2 days later, because of severe distension, a colostomy was done. The

patient died at 1115 hours on 16 March 1944. Death was attributed to peritonitis.

The wound responsible for death had its entrance at the lower right costal margin and

its exit just left of the umbilicus. Diffuse peritonitis resulting from leakage from two perforations in the jejunum which had been missed at the time of operations was discovered.

In addition, penetrating wounds of the left and right thigh and the right knee were present.
BOUGAINVILLE CAMPAIGN 409

Case 84.-A soldier of the 129th Infantry, while standing outside his foxhole, was

struck by a fragment of a 4.2-inch U.S. mortar shell. The shell fell short and burst on the

ground at a 3-yard distance. He was wounded on 27 March 1944. One fragment struck

the right hip and coursed retroperitoneally. On 31 March 1944, an ileostomy was performed

because of abdominal distention. The patient died on 1 April 1944. Death was attributed

to paralytic ileus and unexplained uremia.

The major wound had its entrance (10 x 5 cm.) at the level of the right iliac crest. The

fragment producing this wound fractured the ilium and fifth lumbar vertebra, severed the

cauda equina, entered the right retroperitoneal space, and shattered the lower pole of the

right kidney. A metal fragment was recovered in this area. An ileostomy had been performed through a right paramedian incision. The peritoneal cavity contained a small

amount of free serous fluid. All coils of intestine were markedly distended. A large hematoma was present in the right kidney area. A penetrating wound of the right shoulder and

a perforating wound through the soft tissues of the right arm were observed.

Case 85.-A soldier of the 25th Infantry, while on patrol, was carrying a grenade in his

right hand, when it exploded. He was wounded at 1700 hours on 9 April. Laparotomy

was performed at the 31st Portable Surgical Hospital at which time several loops of intestine

were resected. On the following day, the patient was transferred to the 21st Evacuation

Hospital and died at 2355 hours on 11 April 1944.

Examination revealed five penetrating wounds of the anterior left side of the abdomen,

varying from 1.8 to 5 cm. in diameter. The peritoneal cavity contained a moderate amount

of sanguinopurulent fluid. End-to-end anastomosis of the upper jejunum and left splenic

flexure of the colon had been performed. Early gangrenous changes were noted in the

descending colon. Small, multiple lacerations of the spleen, pancreas, and left kidney

were present. One grenade fragment was recovered from the splenic fossa, another from

the lumen of the transverse colon. Present also was a penetrating wound of the right hand

with fracture of the fourth metacarpal and fourth proximal phalanges.

Case 86.-A soldier of the 145th Infantry, while lying in an open foxhole, was struck

by a fragment of a 500-pound U.S. aerial bomb, which exploded in a tree 5 yards above.

The bomb was dropped accidentally by a U.S. plane leaving on a bombing mission on 19

March 1944. The wound was debrided at the portable hospital shortly thereafter. The

soldier was transferred to the evacuation hospital on the following day and died at 0830

hours on 23 March 1944. Death was attributed to peritonitis.

Examination revealed a large penetrating wound (21.4 x 15 x 7.5 cm.) over the crest and

wing of the right ilium. This wound was grossly infected. The lamina and spinal process

of the fifth lumbar vertebra were destroyed. The retroperitoneal space was filled with

purulent exudate. Diffuse fibrinopurulent peritonitis had resulted from direct extension of

infection from the wound. A small perforating wound of the right shoulder was clean and

granulating.

Case 87.-A Fijian soldier, while on patrol, was struck in the left side of the groin by a

.25 caliber Japanese bullet fired from a distance of 25 yards. Though aid reached him

immediately, he died in several minutes at 1515 hours on 29 March 1944.

Examination revealed a penetrating wound of the left side of the groin. The wound of

entrance (3.1 cm. in diameter) was located 1 cm. below the middle third of the left inguinal

ligament. The femoral artery and vein were severed. The markedly deformed rifle bullet

was imbedded in the pubis.

Case 88.-A soldier of the 25th Infantry left his foxhole at night to void. On returning,

he was mistaken for the enemy and in the resulting confusion was stabbed to death by fellow

soldiers. He died within an hour of hemorrhage, on 17 April 1944.

Examination revealed 10 stab wounds in the upper and lower extremities. The right

femoral artery was severed in its upper third, and the left radial artery was divided. No

other important structures were injured.

Case 89.-A Japanese soldier was brought by American soldiers to the aid post and

treated for shock. Despite treatment, he died in several hours.
410 WOUND BALLISTICS

Examination revealed a perforating bullet wound of the right thigh. The entrance

wound (2.5 cm. in diameter) was found on the lateral surface and the exit wound (2.5 cm. in

diameter) on the medial aspect. The right femur was shattered in its middle third. Present

also was a perforating bullet wound of the abdominal wall in the right lumbar region with

wounds of entrance and exit both 2.5 cm. in diameter. This bullet did not enter the peritoneal cavity.

Case 90.-The body of an unknown Japanese soldier was partially decomposed when

received for examination. It appeared that the soldier had been wounded by bullets.

Death was attributed to shock associated with a severe fracture of the left femur.

Examination revealed a perforating wound of the lower third of the left thigh. The

wound of entrance (0.5 cm. in diameter) was medial, and the extensive wound of exit (16.6 x

13.9 cm.) was located on the lateral aspect of the thigh. The lower third of the femur had

been shattered, but the great vessels were intact. Present also was a perforating wound of

the right buttock.

Case V1.-A soldier of the 132d Infantry, while on patrol lying in an open foxhole,

was wounded by the direct burst of a Japanese mortar shell. His right foot was blown

away (fig. 215). He was taken to the command post and remained there over night. On

the following day, he bled to death while being carried to the rear on a litter. This was a

preventable death. The aidman, when questioned, stated that he did not apply a tourniquet before beginning the litter carry because the stump was not bleeding at that time.

The soldier was wounded at 1800 hours on 4 April 1944 and died at 1300 hours on 5 April.

Case 92.-A soldier of the 182d Infantry, while on guard beyond the perimeter, tripped

the wire to a U.S. boobytrap (grenade). He heard a noise and hit the dirt but was struck

on the left buttock by a fragment from a distance of 3 yards. He was wounded in the

morning of 29 March 1944. At the clearing station, the wound was debrided and another

incision made to remove the fragment. This incision was sutured. Sulfanilamide powder

was insuffiated into the entrance wound, and it was left open. The patient died at 1100

hours on 4 April 1944 of the gas gangrene which was diagnosed on the same day.

Fi

Figure 215--Traumatie amputation stump.
BOUGAINVILLE CAMPAIGN 411

Post mortem examination revealed necrosis and infection of the wound and blood

stream infection due to Clostridium welchii.

Case 93.-A soldier of the 129th Infantry, while lying prone in the open firing at the

enemy, was struck by fragments from a Japanese mortar shell which burst on the ground

nearby. He was wounded on 15 March 1944. On the following day, a guillotine amputation was performed through the lower third of the right thigh because of impairment of

blood supply. A shattered fourth left toe was removed, and small wounds of the right

buttock, lumbar region, right shoulder, and arm were debrided. He was evacuated on 19

March to a station hospital. He developed anuria on 23 March and died at 0845 on 25

March 1944. Death was attributed to uremia and cardiorespiratory failure. The uremia

was thought to have been associated with "crush syndrome nephrosis."

At post mortem examination, the various wounds were healing and uninfected.

Case 94.-A soldier of the 148th Infantry, while running along a jungle trail, was struck

by fragments of a "short" U.S. 81 mm. mortar shell which exploded between his legs. He

was wounded at 0945 on 1 April 1944. At a portable surgical hospital, disarticulation of

the left hip was done for an incomplete high traumatic amputation of the left thigh. Whole

blood (2,000 cc.) was administered before and during the operation. The patient died of

shock 6 hours later.

Examination revealed traumatic amputation of the right leg in the upper one-third,

surgical disarticulation of the left hip, and mutilation of the right hand with multiple fractures

(fig. 216).

Case 95.-A Japanese soldier was wounded in action on an unknown date. He sustained

multiple penetrating wounds of the right lower extremity and a superficial wound of the

scalp from fragments of a U.S. landmine. He was treated at the 21st Evacuation Hospital,

developed gas gangrene of the right leg, and died at 1530 hours on 12 March 1944.

FIGURE 216.-Multiple mutilating wounds and traumatic amputations.
412 WOUND BALLISTICS

FIGURE 217.--A. Multiple wounds produced by U.S. landmino. B. Recovered fragments of U.S. landmine.

Examination revealed the characteristic odor and edematous discoloration of gas infection. The right tibia and fibula were fractured in the middle third. The largest of the

penetrating wounds measured 2.5 centimeters.

Case 96.-A Japanese soldier was wounded in action on 24 March and died at 2000

hours on 28 March 1944. Death was caused by gas gangrene of the left thigh.

Examination revealed a large wound (17 x 16.2 cm.) involving the medial surface of the

thigh. The wound apparently had been caused by an HE shell fragment. The femoral

vessels were intact but thrombosed. The femur was intact. The wound exhibited characteristic features of gas bacillus infection.

Case 97.-A soldier of the 129th Infantry, while walking beyond the perimeter hunting

for souvenirs, stepped on a U.S. landmine and was killed instantly on 30 March 1944.

Examination revealed multiple wounds of the head, chest, and abdomen (fig. 217).

One missile destroyed the antral, orbital, and frontal areas of the skull. Only remnants of

brain tissue remained. Another fragment entering the right side of the thorax had resulted

in perforation of the right ventricle and almost total destruction of the right lung. Two

fragments were recovered (fig. 217B), one from the pericardial sac and the other from the

pleural cavity. A fragment penetrating the abdominal cavity had completely severed the

right lobe of the liver.

Case 98.-This soldier was one of four men assigned to a pillbox. Thinking they were

being surrounded by Japanese, the soldiers became alarmed and left the box and separated

to seek other cover. Three of the men took cover in another foxhole. After a time, the
BOUGAINVILLE CAMPAIGN 413

FIGURE 218.-Small mortar shell fragment recovered from brain.

fourth man came to join them. He was met with rifle fire and hand grenades from his

apprehensive companions as he walked down the trench to enter the hold. He was killed

instantly at 2130 hours on 20 April 1944.

Examination revealed seven wounds of the chest, scalp, back, and lower extremities.

These wounds were all produced by grenade fragments; no bullet wounds were found.

Instantaneous death resulted from the thoracic injury. One fragment traversed the left

supraclavicular fossa and the posterior first right intercostal space. The entrance wound

was 2.5 cm. in diameter. This missile fractured the first rib, lacerated the upper lobe of the

left lung, and, in crossing the midline, fractured the bodies of the fourth, fifth, sixth, and

seventh dorsal vertebras. Massive hemothorax was found. Bilateral fractures of the tibia

and fibula and fracture of the left femur were present.

Case 99.-A soldier of the 131st Engineer Combat Battalion left his foxhole to rescue

a friend who had been wounded. While running, he was struck by fragments of a Japanese

90 mm. mortar shell which burst on the ground 2 yards away. He died in the hospital

several hours later at 0830 hours on 24 March 1944.

Examination revealed penetrating wounds of the left parietal and right kidney regions.

The wound of entrance (1.5 cm. in diameter) in the left parietal region was filled with brain

tissue. Stellate fracture lines coursed the cranial vault. The parietal lobe was lacerated,

and intracranial hemorrhage was marked. A small fragment of metal was removed from

the brain tissue (fig. 218). Another fragment pierced the 12th rib right to enter the abdominal cavity, fragmented the right kidney, and lacerated the right lobe of the liver. Massive

hemoperitoneum was present.

Case 100.-A Fijian commando, while on patrol, stepped on a U.S. landmine. He

was killed instantly at 1300 hours on 26 March 1944.

Examination revealed seven wounds (fig. 219A). A fragment entering the head produced an entrance wound (1.2 cm. in diameter) through the right frontotemporal region.

In its course, this fragment fractured the maxilla, zygoma, the frontal and temporal

bones, and destroyed the right frontal lobe of the brain. A penetrating wound (2 cm. in

diameter) of the abdomen was located 6 cm. above the umbilicus. The fragment producing

this wound severed or perforated the pylorus, duodenum, jejunum, and mesentery of the

small bowel and was found lodged in the soft tissue at the aortic bifurcation. The peritoneal cavity was filled with blood. Another missile which produced a penetrating wound

(2.2 cm. in diameter) in the left pectoral region severed the brachial plexus. This fragment

was found in the subcutaneous tissue over the sixth rib in the posterior axillary line. In

addition, 2 penetrating wounds of the chest wall, 1 of the abdominal wall, and 1 of the left

thigh were discovered. Figure 219B shows the metal fragments recovered from the chest

wall and peritoneal cavity.
414 WOUND BALLISTICS

• AAL

FIGURE 219.-A. Wounds of head and chest produced by U.S. landmine. B. Recovered

fragments from chest wall and peritoneal cavity.

Case 101.-A soldier of the 164th Infantry, while crouching and advancing on patrol,

was struck by several .25 caliber Japanese bullets fired by a sniper from a distance of 50 to

75 yards. The soldier was killed instantly at 1620 hours on 29 March 1944.

Examination revealed six perforating wounds. The thorax was perforated by a bullet

entering posteriorly. The entrance wound (1.5 cm. in diameter) was found in the left third

intercostal space at the costovertebral junction and the exit wound (6.2 cm.) over the right

deltoid prominence. In its course, this missile fractured the third rib, perforated the upper

lobes of the left and right lungs, and fractured the right clavicle and scapula. Massive

bilateral hemothorax resulted.

The entrance wound (2.5 cm. in diameter) in the abdominal wall was situated in the

left lower quadrant and the exit wound (5 cm. in diameter) on the right side of the scrotum

(fig. 220). The missile producing these wounds lacerated the sigmoid colon, fractured the

symphysis pubis, and avulsed the right testicle. The left femur was fractured in its lower

third by a bullet which produced an oblique perforating wound. This bullet traversed the

thigh from the lateral aspect of the upper third to the medial aspect of the lower third. In

addition, perforating wounds of the left buttock, left shoulder, and left ear were present.

Case 102.-A U.S. soldier, while in front of the perimeter cutting down trees to improve

line of fire, stepped on a U.S. landmine and was killed instantly at 1015 hours on 1 April 1944.

Examination revealed 18 widely distributed wounds. The head wound was obviously

responsible for immediate death. The fragment which produced the extensive head wound

(10 x 5 cm.) destroyed the right orbit and right frontal bone and avulsed both frontal lobes

and part of the right parietal lobe of the brain. In addition, there were numerous penetrating and perforating wounds of the upper and lower extremities and abdominal and chest

walls. The following compound fractures were found: Right tibia, left tibia and fibula,

right femur, right ulna, and mandible.

Figure 221 shows the recovered landmine fragments.
BOUGAINVILLE CAMPAIGN 415

FIcURE 220.-Perforating wound of abdomen, with catheter in place.

Case 103.-A soldier of the 140th Field Artillery Battalion, while walking through

thick jungle on patrol, was shot by .25 caliber Japanese bullets fired from a distance of 10

yards. He was wounded at 1600 hours on 14 March 1944 and reached the hospital 1 hour

later. The wounds sustained necessitated multiple operations. The severed left axillary

vein was ligated and the wound left open. Exploratory cystotomy revealed no perforation of

the urinary bladder making suprapubic drainage unnecessary. Compound comminuted

fractures of the right femur and ilium were accompanied by extensive wounds of soft tissue

about the right hip joint and buttocks. These wounds were debrided. The patient died

at 1450 hours on 16 March 1944. His death was attributed to gas gangrene and peritonitis.

Examination revealed a foul, edematous, discolored crepitant wound of the right hip.

A sinus track containing a serosanginous exudate led to the fractured head and neck of the

femur. The edema and discoloration extended above to the wound into the right buttock.

An operative incision was present in the low midline. The terminal ilium was gangrenous

as a result of an unexplained thrombosis of the mesenteric vessels. Gangrene of the ilium

accounted for the presence of a diffuse seropurulent peritonitis.

Case 104.-A soldier of the 132d Infantry stepped on a mine while on an authorized

mission in front of the perimeter arming U.S. landmines at 0830 hours on 27 March 1944. He

was taken immediately to the clearing station. There his numerous wounds, including the

wound of a traumatic amputation of the left foot, were debrided. He died of shock at 1445

hours on 27 March 1944.

Examination revealed 13 wounds. The four wounds of the left lower extremity were

the wound of an amputation stump in the lower third of the leg, a linear wound (12.5 x 6.2

cm.) over the knee accompanying a compound comminuted fracture of the patella, an irregular wound 10 cm. in length on the medial aspect of the knee, and a superficial wound on the

medial surface of the thigh. Three wounds of the right leg were seen: A gutter wound 7.5

cm. long on the dorsum of the foot, a small penetrating wound of the ankle accompanying

a fracture of the internal malleolus, and a superficial wound of the calf. A large wound
416 WOUND BALLISTICS

"!

FIc•U•E 221. Recovered fragments of U.S. landmine.

(12.5 x 7.5 em.) of the right buttock was associated with a compound fracture of the sacrum.

Present also was a compound eomminuted fracture of the right ulna. In addition, wounds

of the back (2), right forearm (2), and left buttock (1) were found.

CIRCUMSTANCES AND PROTECTIVE MEASURES

A study of the circumstances under which wounds occur may yield information regarding the effectiveness of weapons under battle conditions, the

results of training, and the need for protective measures. Wounds occur under

a variety of conditions which make classification difficult. However, an attempt was made to determine the position and occupation of the soldier when

wounded, the type of cover, and the distance from the shellburst or weapon.

This information was obtained from the wounded man or from his comrades

or from both. Tlie circumstances 1ruder which the soldier was wounded

usually could be obtained in considerable detail. However, the caliber and

exact type of weapon frequently could not be identified other than as belonging

to the general classification of weapons, such as rifle, machinegun, and mortar.

Influence of Position and Cover on Number of Casualties

When the subject of "cover" is viewed broadly, casualties fall naturally

into three general groups depending upon the relative degree of protection

available at the time of wounding. In the first group are placed those who had

the best protection, usually a well-constructed pillbox covered by fairly heavy

logs. In the second group are those who had no overhead cover but were

protected on all sides by well dug-in holes or trenches. The third group comprised those with the least protection and was subdivided into those who had no

protection whatsoever and those who had partial protection. A soldier in a

shallow foxhole or behind a tree or log would be considered one with partial

protection. There were 81 casualties produced by miscellaneous weapons; however, their positions at the time of wounding were not considered significant.
BOUGAINVILLE CAMPAIGN 417

These 81 casualties are excluded from the present discussion but will be discussed later in this chapter. In 150 instances, the position was not stated,

therefore data regarding "protection and position" were available in 1,557 cases

and are summarized in table 100.

TABLE lO0.-Distribution of 1,557 casualties by causative agent and by position and protection

Causative agent Total casualties

Position and protection Rifle Machine- Grenade Mortar Artillery Number Percent

gun

Standing:

No cover --------- 184 57 49 189 88 567 36.4

Partial cover ------ 4 1 1 5 2 13 .8

Total ----------- 188 58 50 194 90 580 37.2

Sitting:

No cover --------- 92 25 39 114 15 285 18.3

Partial cover ------ 10 0 1 15 2 28 1.8

Total ------------ 102 25 40 129 17 313 20. 1

Prone:

No cover --------- 72 30 62 122 26 312 20.0

Partial cover ------ 13 3 5 12 2 35 2.3

Total ----------- 85 33 67 134 28 347 22. 3

Pillbox --------------- 11 6 33 64 26 140 9.0

Trench hole ------------ 29 12 19 91 26 177 11.4

Total ------------- 40 18 52 155 52 317 20.4

Grand total ----- 415 134 209 612 187 1,557 100.0

Those who were erect, standing, walking, or running were included under

the classification "Standing." Those who had considerably less body area

exposed, whether they were sitting or crouching or kneeling, were placed in

the group designated "Sitting." The term "prone" does not require explanation. Among the 1,557 cases, the weapons were distributed as follows: Mortar,

39.3 percent; rifle, 26.6 percent; grenade, 13.4 percent; artillery, 12.0 percent;

and machinegun, 8.7 percent.

It is obvious that the body surface exposed depends upon the position of

the soldier when wounded and should bear some correlation with the number

of hits. It is important to know whether the number of hits depends solely

upon the body surface exposed or whether it is greater for aimed weapons.

Data relating to this problem were obtained by examining the least protected
418 WOUND BALLISTICS

group (standing, sitting, and prone) which constituted 1,240 (79.9 percent) of

the total 1,557 casualties.

By reference to table 101, it is apparent that there are approximately

twice as many casualties among the standing as there are among either the

sitting or the prone. Furthermore, the number of casualties is approximately

equally divided between the two latter groups. When the factor of partial

cover is excluded by omitting the small number (76 casualties) who had slight

protection, the relative proportion of casualties in the three subdivisions

remains unchanged (table 102). This is what might be expected were all

missiles unaimed and traveling at random. In this event, the number of

wounds received would be in approximate proportion to the projected body

area exposed. On the basis of the foregoing finding, it appears that, in this

particular jungle campaign, the number of casualties depended upon random

unaimed hits which were roughly in proportion to the body area exposed

(table 70).

In the total group (1,557), 317 or 20.1 percent (table 100) were wounded

in well-covered pillboxes or well dug in but uncovered holes or trenches. These

TABLE 101.-Distribution of 1,240 casualties, by aimed and random fire and by position

(with and without cover)

Aimed fire 1 Random fire 2 Casualties

Position

Number Percent Number Percent Number Percent

Standing ----------------------- 246 50. 1 334 44.6 580 46.8

Sitting ------------------------ 127 25. 9 186 24. 8 313 25.2

Prone ------------------------ 118 24.0 229 30.6 347 28.0

Total -------------------- 491 100.0 749 100. 0 1,240 100.0

I Rifle and maebinegun.

2 MIortar, artillery, and grenade.

TABLE 102.-Distribution of 1,164 casualties, by aimed and random fire and by position

(no cover)

Aimed fire I Random fire 2 Casualties

Position

Number Percent Number Percent Number Percent

Standing ----------------------- 241 52.4 326 46. 3 567 48. 7

Sitting ------------------------ 117 25.4 168 23. 9 285 24.5

Prone ------------------------- 102 22. 2 210 29. 8 312 26. 8

Total -------------------- 460 100. 0 704 100. 0 1, 164 100. 0

I Rifle and machinegun.

2 Mortar, artillery, and grenade.
BOUGAINVILLE CAMPAIGN 419

casualties were nearly equally divided between the pillbox (44.8 percent) and

the open trench (55.2 percent). In this relatively well protected group, 259

(81.7 percent) were wounded by random fire and 58 (18.3 percent) were wounded

by aimed fire. Among the casualties produced by aimed weapons, 70.7 percent

were in the open trench but only 29.3 percent in the pillbox. Casualties from

random fire were approximately equally distributed between the pillbox (48.1

percent) and the open trench (51.9 percent). One may, therefore, conclude

that the covered pillbox offers relatively greater protection against aimed

weapons.

Type of Action

Among the total casualties, there were 1,620 cases in which information

was available concerning the type of action in which the men were involved.

The number wounded on patrol or in defensive and offensive action is shown

in table 103.

Range of Small Arms or Distance From Burst

The approximate range was known in 339 casualties resulting from rifle

fire and in 121 casualties resulting from machinegun fire. In table 104, this

group is tabulated in percentages according to range and disposition of casualties. The higher lethal effect of bullets at close range should be noted. At

longer range (over 75 yards), it would appear that the casualties received

either minor or nonvital wounds since none received wounds of sufficient

severity to cause evacuation to the United States. The distance from the weapon or sbellburst was estimated in most instances and is, therefore, open to

considerable error. It is likely that the actual distance from a shellburst was

greater than the estimated distance. In future studies, suitable samples might

be used to check on this error. Furthermore, indoctrination of troops, before

combat, regarding the importance of such data might lead to more accurate

observation.

Approximate distances from shellbursts (including knee mortars) were

known in 623 casualties produced by mortar shell fragments (including knee

mortars) and in 176 caused by artillery shell fragments. The percentage

distribution of these casualties according to the disposition of the patient is

shown in table 105. In the jungle, the effect of a shellburst should be more

limited than in open terrain. Approximately 60 percent of the casualties

were under 10 yards from the burst.

Similar results are tabulated for the grenade in table 106. It is rather

surprising to find that the effectiveness of the Japanese hand grenade extends

beyond 5 yards, as evidenced by the fact that 25.1 percent were wounded at

this distance. However, it is possible that some of these casualties were produced by U.S. grenades.
420 WOUND BALLISTICS

C-. CA

0 C) 0 q - ý 

CCC) -0 ~ _ c _ _ _ m_ - _ _

XO 00 Cl

cq 00 C)

1, 00C .c o0C

C)6C

CC _ _ _ __ _ __ _ C

C)Ca,'
BOUGAINVILLE CAMPAIGN 421

TABLE 104.-Distribution of 460 casualties produced by small arms weapons, by range of fire

and disposition

[Values expressed as percentages according to type of weapons]

Living wounded

Weapon and range (yards) of fire Dead Total average Returned to Evacuated to

duty United States

Rifle:

0 to 25 ----------------------------- 54.7 17.9 37.7 33.9

25 to 50 ----------------------------- 27.3 8.3 19.4 16. 8

50 to 75 ----------------------------- 8.6 37. 2 42.9 29.5

Over 75 ----------------------------- 9.4 36. 6 .0 19.8

Total ----------------------------- 100.0 100.0 100.0 100.0

Machinegun:

0 to 25 ------------------------------ 40.3 3.2 28.6 28. 1

25 to 50 ---------------------------- 45. 1 6.5 35.7 33. 1

50 to 75 ----------------------------- 6.5 51. 6 35.7 24.8

Over 75 ---------------------------- 8. 1 38. 7 .0 14.0

Total ----------------------------- 100.0 100.0 100.0 100.0

TABLE 105.-Distribution of 799 casualties produced by shell fragments, by distance from point

of burst and disposition

[Values expressed as percentages according to type of shell fragments]

Living wounded

Shell fragment and distance (yards) from point of burst Dead Total average Returned to Evacuated to duty United States

Mortar:

0 to 10 ------------------------------ 79.4 64. 5 66.6 66.7

10 to 20 ----------------------------- 8.2 19. 1 22.0 18.3

20 to 50 ----------------------------- 11.0 12. 1 7.6 11.2

Over 50 ---------------------------- 1.4 4.3 3.8 3.8

Total ----------------------------- 100.0 100.0 100.0 100.0

Artillery:

0 to 10 ----------------------------- 86.0 50. 5 53.8 59.6

10 to 20 ----------------------------- 9.3 21.5 19.2 18.2

20 to 50 ---------------------------- 4. 7 15. 9 16. 6 12.9

Over 50 ----------------------------- .0 12. 1 15.4 9.7

Total ---------------------------- 100.0 100.0 100.0 100.0
422 WOUND BALLISTICS

TA1LE 106.-Distribution of casualties wounded by hand grenade fragments, by distance from

point of burst

[Values expressed as percentages according to weapon]

Living wounded

Distance from point of burst Dead Total average

Returned to Evacuated to duty United States

Yards:

0 to 3 ------------------------------- 100.0 67.3 56.7 67. 6

3 to5 ------------------------------- .0 6.4 13. 6 7.3

Over 5 ------------------------------ .0 26.3 29.7 25. 1

Total ----------------------------- 100. 0 100.0 100.0 100.0

Time Phase

In table 107, casualties are separated according to the period of time in

which they occurred. The first phase extends to the beginning of the Battle

of the Perimeter, 15 February to 7 March; the second phase covers the intensive

period of perimeter activity of 8 March to 28 March; and the last phase, the

subsequent relatively inactive period of 29 March to 21 April 1944. Eighty

percent of the casualties occurred during the Battle of the Perimeter.

Miscellaneous Weapons and Circumstances

A total of 81 casualties (4.5 percent of 1,788) resulted from the following

miscellaneous weapons: Landmine (excluding grenade boobytraps), 34; aerial

bomb, 15; .45 caliber pistol, 14; powder explosions and flares, 6; bangalore

torpedoes, 9; bazooka, 2; and bayonet, 1. Enumeration of the very varied

circumstances surrounding the wounding of these patients serves no purpose

since no general conclusion can be derived.

In jungle warfare, a fair number of casualties result from the overhead

explosion of mortar or artillery shells, or aerial bombs overhead, as a result

of detonation on impact with a tree or its branches. Such explosions are

designated "tree bursts" as distinguished from "ground bursts." In 900

instances, there were 93 (11.5 percent) tree bursts. Mortar shells constituted

58.1 percent of all tree bursts; artillery shells, 34.4 percent; and aerial bombs,

7.5 percent. Ground bursts were divided as follows: Mortar shells, 79.1

percent; artillery shells, 20.0 percent; and aerial bombs, 0.9 percent.
BOUGAINVILLE CAMPAIGN 423

00

00 0

- 0l

1 1 Z5

C) li C

'CC

) C) 

C) - _ - _ ____t

'75

C) 'C . ~ E-1
424 WOUND BALLISTICS

Protective Measures and Recommendations

Pillboxes.-Opinion has been expressed that the large size of the firing

slit resulted in casualties which might have been avoided by a smaller opening.

In some instances, nearby tree snipers were able to direct fire through the

firing slit. Because of this fact, it has been suggested that an eave overhanging the firing slit might be a useful additional means of protection. The

findings of the survey team indicate that gunfire directed through the slit is

of little importance. Wounding through the firing slit did occur in 104 (6.7

percent) instances in 1,557 casualties. However, in this group, the aimed

weapons (rifle and machinegun) were responsible for only 9 (8.6 percent) of

those so wounded. In view of this small number, the advisability of the

overhanging eave is doubtful. However, a considerable number of casualties

(95) were caused by shell fragments passing through the firing slit. This

would indicate the need for keeping the size of the firing slit as small as is

consistent with observation and maneuverability of weapons within the

pillbox (fig. 222).

Protection against the hand grenade was afforded by the use of wire

(chicken) net (fig. 223) at night to cover peepslit openings and was favorably

recommended. Some type of rubber net might serve to "bounce off" the

unexpected grenade even better than the wire net. The earth should be

sloped from the slit opening so that grenades will roll away.

The construction of pillboxes might be improved by the use of heavier

(12 inch) logs. Hardwood is recommended if obtainable as termites destroy

bA

U.S. Army photo

FIGURE 222.-Well-constructed pillbox showing size of firing slit.
BOUGAINVILLE CAMPAIGN 425

FIGUJRE 223.-Wire netting covering firing slits. This netting was used successfully

to "bounce off" enemy grenades.

soft timber quickly. Some concrete could be used to advantage. Since the

location of the pillbox is usually known to the enemy, camouflage should be

sacrificed for sturdy construction. The earth floor in a square log pillbox

should not be excavated out to the edges of the logs. On the contrary, a

stronger pillbox results if the central excavation is made circular in shape,

thus leaving more earth in the corners.

Combat training.-The majority of the experienced combat personnel

expressed the opinion that the Japanese soldier made better use of cover than

(lid Allied troops and were better trained at "digging in" quickly. They

utilized all natural cover (fig. 224). They crawled close to the ground, and

their foxholes were small, efficient, and well suited to the purpose intended.

On the contrary, Allied troops were frequently careless in exposing themselves

unnecessarily (fig. 225) and ofttimes were content with foxholes which were

entirely too shallow (fig. 226). Many wounds were received because soldiers

crawled with buttocks elevated, making a large silhouette. In training and

staging areas, more time devoted to digging in would serve not only to stress

the importance of adequate cover but would also develop the necessary muscle.

When under fire, the importance of dispersion (figs. 227 and 228) should

be emphasized. For example, in one instance, 13 men preparing to enter

a truck were killed or wounded by a single shell. Neglect of this principle

by enemy troops resulted in 600 enemy killed by Allied artillery fire in one

area.

603225'"-62-29
426 WOUND BALLISTICS

rU.S. Army photo

Fic•unR 224.-Natural jungle growth which provided excellent camouflage.

Medical suggestions.-Aidmen should receive more preliminary training

in vena puncture. Lack of familiarity and practice in this technique frequently delayed the administration of plasma. Since patients cannot be evacuated at night from frontline positions, every soldier should knowA the principles

of first aid. Under combat conditions similar to those at Bougainville, it

is felt that the oral administration of sulfanilamide medication should be

discontinued in the field unless on patrol far from medical installations. It

was often difficult to know later in the hospital whether a man had received

this medication and, if so, in what amounts. It was estimated that less thaan

10 percent took the drug by mouth after having been wounded. This uncertainty

as to dose frequently delayed adequate sulfonamide therapy. Finally, the

practice of sending aidmen forward to remove the dead under fire is very demoralizing and should be condemned.

Body armor.-The subject of protection would not be complete without

some expression of opinion regarding the advisability of body armor. Many

line officers believe that under certain tactical situations the judicious employment of some type of body armor would be definitely advantageous. Its

routine use is not recommended. The objections most frequently raised are

that the infantry foot soldier is already burdened with a maximum amount

of weight, that any further equipment would be cumbersome and would

interfere with fighting efficiency, and, finally, that too much protection induces

an "oyster complex." These objections could be overcome if the use of armor

were restricted to a special circumstance. When the tactical situation demanded body armor, it could be transported to that point, issued, and later
BOUGAINVILLE CAMPAIGN 427

No t

FIGURE 225.-"Necessary" and "unnecessary" exposure. A. Necessary exposure of

head and upper extremities. B. Necessary and unnecessary exposure in a position on

Hill 700.
428 WOUND BALLISTICS

FIGURE 226.-"Little" and "moderate" protection. A. Machinegun emplacement with

little protection. B. Shallow 81 mm. mortar emplacement with moderate protection.
BOUGAINVILLE CAMPAIGN 429

FIGURE 227.-Unnecessary exposure and concentration of men.

FIGURE 228.---Infantry advancing behind tanks. Many casualties occurred

when the Japanese withheld fire until the tanks had passed.
430 WOUND BALLISTICS

collected Nxhen the objective had been attained. In the type of combat at

Bougainville, the soldier did not carry a full pack, and for brief intervals all

unessential equipment could.have been discarded in favor of armor.

SUMMARY

The primarv purpose of this report was to evaluate the relative effectiveness of the different weapons as casualty-producing agents. In order to

achieve this aim, it was necessary to determine and to correlate the varied

circumstances surrounding wound production in each individual case. It was

essential to know what weapon caused the wound, the anatomic region wounded, the range and distance from the burst, the available protection, the degree

of disability, the treatment and disposition of the patient, and all details

relating to death. This report comprises a studY of all battle casualties

(living and dead) occurring in the U.S. Army ground forces on Bougainville

Island from 15 February to 21 April 1944.

The Bougainville campaign possessed certain features which are not

ordinarily found in jungle warfare. A beachhead was made in virgin jungle

for the purpose of establishing airfields. Not until 4 months later did the

enemy engage in the major large scale attack referred to as the "Battle of the

Perimeter." During this interval, the perimeter was extended and strongly

fortified, and an excellent system of roads was constructed within the defended area. When the enemy attack came, the Allied force was superior

both in numbers and in equipment. They had gained control of the air and

in addition had the advantage of overwhelming artillery superiority. Ample

vehicular transportation and smooth all-weather roads facilitated supply and

evacuation. Medical installations had been completed which were easily

accessible and adequate to meet all exigencies. Consequently, a high standard

of medical care was maintained. The Japanese on the contrary were handicapped by the necessity of taking offensive action against a well-established

perimeter defended by a greater number of better equipped troops. Furthermore, their supply problem was very difficult. They were compelled to transport supplies chiefly by pack through dense jungle and over narrow, rugged

mountain trails. However, with the exception of artillery weapons and

shells, the enemy by dogged effort was able to keep adequate supply of

arms and ammunition.

The U.S. forces at Bougainville sustained 2,335 casualties from 15 February to 21 April 1944. Of these, 16.9 percent died; 69.5 percent were returned to duty; and 13.6 percent were evacuated to the United States. In

the total group, there were 547 who were so lightly wounded that they were

returned directly to duty from the battalion aid stations or collecting stations.

Since the effect of weapons on this group was minimal and since these soldiers

were not actually lost to combat, they were excluded from the remainder

of the study. Therefore, all subsequent percentage figures were based on
BOUGAINVILLE CAMPAIGN 431

1,788 battle casualties who were admitted to hospitals or were killed in action.

Using the 1,788 casualties as a basis, it was found that approximately 1 battle

death (KIA and DOW) occurred among every 4.5 casualties, making a mortality of 22.1 percent. The living wounded numbered 1,393; of these, 77.2

percent were returned to duty and 22.8 percent were evacuated to the United

States.

The majority of casualties (78.8 percent) occurred during the Battle of

the Perimeter, a period arbitrarily defined as extending from 8 to 28 March

1944. Most of these casualties occurred within U.S. lines. Because of the

fortuitous circumstances of hospital accessibility, these wounded obtained adequate medical care, usually within 1 hour and in most instances in much less

time. Patrol activity was chiefly responsible for the small number of casualties

which occurred before and after this battle. These casualties constituted the

major problem in the evacuation of the wounded. During the Battle of the

Perimeter, the American loss was 210 killed in action as contrasted to 8,527

Japanese (lead, a ratio of 1 : 24.6.

Anatomic distribution of wounds.-A striking contrast is observed in the

percentage distribution (regional frequency) of wounds in the dead, in the

living, and in both groups combined, when classified according to the anatomic

region involved (table 108).

Wound distribution.-It was found that the distribution of wounds was

dependent largely upon exposure to the random missile and not upon directed

fire. This was demonstrated clearly by comparing the actual with the expected number of hits in each anatomic region. This was done by superimposing the percentage of hits over the percentage mean of the projected body

area. In this way, the directed fire (rifle) was compared to the undirected fire

(mortar) and to the total bits by all weapons. A close correlation exists between the expected number of hits and the mean projected body area except

in the case of a single region, the head. In the head, the number of hits exceeded

the expectancy by more than 100 percent. This would indicate that in combat

TABLE 108.-Percentage distribution (regional frequency) of wounds in 1,788 casualties (395

dead, 1,393 living wounded), by anatomic location and order of frequency

Total casualties Dead Living wounded

Order of

frequency Regional Regional cgionaI

Anatomic location fre- Anatomic location Ifre- Anatomic location fre- quency quency quency

1 Lower extremity_ 22. 7 Head ------------ 36. 5 Lower extremity--- 28. 2

2 Head ------------ 21.5 Multiple --------- 25.6 Upper extremity--- 22. 9

3 Multiple --------- 18. 6 Thorax ----------- 22.0 Head ------------- 17.2

4 Upper extremity_- 17.9 Abdomen --------- 12. 1 Multiple --------- 16.6

5 Thorax ---------- 12.9 Lower extremity--- 3.5 Thorax ------------ 10.3

6 Abdomen -------- 6.4 Upper extremity--- .3 Abdomen --------- 4.8
432 WOUND BALLISTICS

exposure of the head exceeds that of any other anatomic region. However,

the fact that percentage of rifle hits exceeded the percentage of unaimed mortar

hits by a perceptible margin would tend to indicate that the factor of marksmanship does account for a moderate number of head wounds.

Effectiveness of weapons.-In table 109, the number of battle casualties

produced by the different weapons is shown in relation to the relative lethal effect

of each weapon. A clear distinction exists. The total number of casualties produced by a given weapon reflects not only the extent of its use by the enemy

but also the effectiveness of that weapon when employed under the particular

circumstances of that battle. On the other hand, the relative lethal effect of

a weapon is defined as the percentage killed by all hits and is a measure of the

effectiveness of that weapon under all conditions (providing facilities for medical

care are comparable and constant). For example, though the mortar produced

more casualties in the Bougainville campaign, the machinegun had the highest

lethal effect.

TABLE 109.--Percent distribution of 1,788 casualties (395 dead, 1,393 living wounded) by

relative effectiveness of weapons

Percent of Relative

Weapon frequency total Weapon effectiveness lethal effect

(percent)

Mortar------------------------ 38. 8 Machinegun --------------------- 57.6

Rifle --------------------------- 24.9 Rifle ---------------------------- 32. 1

Grenade ------------------------ 12. 5 Artillery ------------------------ 22. 7

Artillery ----------------------- 10. 9 Mortar -------------------------- 11.8

Machinegun --------------------- 8. 4 Grenade ------------------------- 6. 2

1 Mines and miscellaneous weapons are excluded (4.5 percent of total casualties).

A true measure of the effectiveness of a weapon cannot be obtained by a

consideration of the total number of casualties and the relative lethal effect

alone. A third factor must be considered; namely, the severity of the wound in

the living. An estimate of the severity of the wound may be obtained by classifying the living casualties according to the ultimate disposition of the patient,

whether he was returned to duty from the first or second echelon or evacuated

to the United States. A still more important criterion of the effectiveness of

a weapon from the standpoint of winning a battle is the ability of the wounded

soldier to continue combat. This was determined by classifying the wounded

according to arbitrary criteria based on whether the soldier could have continued combat for a few hours if his life were at stake (table 110). When

measured by both of these standards, the relative effectiveness of the different

weapons was found to be of the same order as follows: (1) machinegun, (2)

rifle, (3) artillery, (4) mortar, (5) grenade.

Sufficient ballistics data were not available in this theater to determine

the average velocity of shell fragments producing casualties. The exact size
BOUGAINVILLE CAMPAIGN 433

of the shell causing these casualties was also unknown. Furthermore, there

were insufficient clinical data to determine the size and mass of the fragments

causing casualties. However, if one assumes that the average velocity of

bullets is greater than that of shell fragments at the point of impact, these

findings suggest that the effectiveness of a weapon is a function of the velocity

of the missile.

TABLE 110.-Percent distribution of casualties lost to battle and combat, by distribution and

effectiveness of causative agent 1

[Values expressed as percentages according to type of weapon and effectiveness of weapon to total casualties]

Lost to battle 2 Lost to combat 3

Order of frequency

Weapon Percent Weapon Percent

Distribution by weapon:

1 -------------------------- Mortar --------- 35.7 Rifle ----------- 37. 7

2 -------------------------- Rifle ----------- 32. 3 Mortar --------- 27. 6

3 ------------------------- Machinegun_--__ 12. 5 Machinegun .... 18. 4

4 -------------------------- Artillery -------- 10. 6 Artillery -------- 9. 5

5 -------------------------- Grenade -------- 8. 9 Grenade -------- 6. 8

Effectiveness of weapon:

1 -------------------------- Machinegun .... 85. 4 Machinegun.__ 75. 5

2 -------------------------- Rifle ----------- 74. 8 Rifle ------------ 52. 4

3 -------------------------- Artillery -------- 56. 7 Artillery -------- 30. 4

4 -------------------------- Mortar --------- 53. 1 Mortar --------- 24. 5

5 -------------------------- Grenade -------- 40. 6 Grenade ---------- 1 8

I Mines and miscellaneous weapons are excluded.

2 Includes the dead and those casualties evacuated to the rear echelon or to the United States.

s Includes the dead or those casualties unable to continue to fight "if life were at stake."

Comparison of Japanese and U.S. Weapons.-A comparison of the effects

of Japanese and U.S. weapons 21 showed a lower lethal effect for both the enemy

artillery and the grenade. The fact that U.S. artillery was predominantly

heavier than that of the Japanese may explain its greater relative effectiveness.

The low lethal effect of the enemy grenade appeared to be characteristic of

that weapon.

Circumstances.-On the basis of the study of a large group (79.9 percent)

who had relatively little or no protection when wounded, it was found that

the number of casualties depended upon random unaimed hits which were

distributed roughly in proportion to the body area exposed. The remaining

casualties which occurred under the circumstance of relatively good protection

were equally distributed between the pillbox and the uncovered foxhole or

trench. Aimed fire was responsible for 70.7 percent of the casualties in the

uncovered trench or foxhole and for only 29.3 percent in the pillbox. On

20 A comparison of weapons was possible in only a relatively small number of instances, since records were available

for only 219 casualties produced by U.S. weapons.

603225--62- 30
434 WOUND BALLISTICS

patrol and offensive action, the majority were wounded by the aimed fire,

whereas, on defensive action, the reverse obtained. Eighty percent, of the

casualties in this study occurred during the Battle of the Perimeter.

A number of casualties resulted from careless exposure, failure to dig in,

and failure to take advantage of natural cover. A large number of casualties

(219) resulted from U.S. weapons. These findings indicate the need for even

greater emphasis on the importance of cover. The training program should

also stress the avoidable circumstances under which troops are killed or wounded

by careless behavior.

Medical treatment.-Exceedingly advantageous circumstances surrounded

the treatment of the wounded at Bougainville. In the treatment of 2,015

casualties, the low mortality of 3.7 percent was obtained. Experience in this

campaign indicates a need for portable blood banks. Shock and hemorrhage

were well treated by the liberal use of plasma. Whole blood transfusions

were used more extensively than in any previous campaign in the South Pacific.

Nevertheless, a wider utilization of blood transfusions would have been beneficial, because of the large blood volume replacement needed. Fractures were

well treated by plaster immobilization. There were no deaths due to compound

fractures of the extremities. First aid treatment was excellent and in only

two instances did a death occur which might have been attributed to an

aidman's error of judgment. Inadvisable evacuation of patients before recovering from shock possibly contributed to a fatal outcome in a few instances.

Post mortem examinations.-Hemorrhage was the most common cause of

death in 104 autopsies. Frequently, 4 or more liters of blood were found in the

pleural or peritonal cavities. Extensive brain damage ranked second in producing death. Accurate determination of the causative missile by the appearance of the wound was not possible in either the dead or the living. There was

no constant relationship between the size of the wound of entrance and exit and

the underlying structural damage. Temporary cavity effect of high-velocity

missiles was frequently noted in the more solid organs as well as in the lung

and brain.

CONCLUSIONS

The ultimate aim in the study of wound ballistics is to provide data which

will permit the production of weapons which will produce more casualties among

the enemy. These data may enable an army to devise more efficient weapons,

develop better protective measures, and will eventually reflect in improving

the care of the wounded.

Data Required

Field studies should yield information which permits the proper evaluation

of weapons as casualty-producing agents. The effectiveness of a weapon may
BOUGAINVILLE CAMPAIGN 435

be measured by the number of casualties it produces and by the severity of the

wound. Wound severity in turn must be gaged not by local appearance but

by the ultimate disposition or length of disability of the patient. The following factors, therefore, must be considered:

Weapons.-Type and proportion of weapons employed, the range or distance from the shellburst, and the mass or velocity of the missile should be

determined.

Local circumstances.-The number and character of casualties reflect battle

condition; hence, local conditions must be ascertained. It is desirable to know

the position and occupation of the soldier when wounded, the available cover,

terrain, and the tactical situation.

Medical care.-A detailed study of the patient's medical record is essential

and should include a description of the wound, with tile exact location of the

point of entry, evaluation of the treatment, and post mortem findings in case

of death. The degree of disability measured in time lost from combat must

be ascertained and evaluated, together with the mortality rates for each weapon.

Methods and Results

Data in this chapter were obtained by personal interview and by questionnaire. Because the wounded man frequently knew less about the circumstances of wounding than his uninjured companion, witnesses were interviewed

at the front as soon as possible after the action. Hospital staff officers were

not trained in the study of wound ballistics, and when casualties were heavy

they were fully occupied with the care of the wounded. For this reason, it was

found desirable to have an officer of the ballistics team assemble clinical data at

the various hospitals. Since the action was confined to a small geographic

area and transportation facilities were excellent, the collection of essential information was relatively easy. Under these rather ideal circumstances, the

report falls short of attaining the full advantage of the opportunity presented

for the study of wound ballistics. Its merit, if such there be, lies in the fact

that it presents data on all who were killed and wounded in one battle.

Lessons Learned

The personal interview is preferable to the questionnaire. The questionnaire may be utilized as an adjunct, if its use is supervised by a ballistics investigator and its accuracy repeatedly checked.

There is need for the definition and standardization of terms used in the

study of wound ballistics. To obtain comparable reports, it is necessary to

adhere to some uniform plan of collecting and recording data.

The number of the wound ballistics team personnel was inadequate. For

a comparable volume of work, the number should be doubled.
436 WOUND BALLISTICS

A wound ballistics team2

" should be assigned to the combat unit a month

before D-day. This will allow for indoctrination of medical officers, aidmen,

and troops. In this interval, experienced team members can furnish valuable

instruction by outlining the avoidable circumstances under which troops are

killed or wounded.

Surgeons in hospitals along the line of evacuation should be instructed

regarding the clinical data desired. They should understand the general

objectives of the study in order to enable them subsequently to furnish the

desired information.

The study of wound ballistics in the field requires special training and

aptitude. It necessitates an attention to detail which an overloaded hospital

staff does not have the time to devote during battle. Information collected

in the routine manner without the aid of trained investigators lacks uniformity

and accuracy. In order to collect adequate and accurate data, it is essential

that a full-time wound ballistics team be assigned for that purpose.

21 This could be identified as a battle casualty survey unit since it would be concerned with the identification of the

types of battle casualties, the anatomic distribution of wounds, the causative agents, and the eventual disposition of the

wounded. In addition, the ancillary factors contributing to the number of casualties should be investigated; for example,

combat experience, type of action, and terrain. The survey team would also be in an advantageous position to collect information pertaining to other forms of trauma associated with modern day warfare. These could include vehicular accidents, bunker cave-ins, and airplane crashes. A casualty survey team should be an integral portion of the comnbat unit

during peacetime maneuvers as well as in wartime. It is only in this way that a complete understanding of the purpose

and scope of such a team could be adequately realized by the participating services. This unit should also investigate all

accidents involving U.S. weapons during training procedures.-J. C. B.
CHAPTER VI

Examination of 1,000 American Casualties

Killed in Italy

William WV Tribby, M.D.

PURPOSE OF STUDY

The purpose ot this study was to provide accurate source material on the

distribution of wounds in the bodies of American soldiers killed in action. The

project was conceived and initiated by Brig. Gen. (later Maj. Gen.) Joseph I.

Martin, Surgeon, Fifth U.S. Army, who requested that it be done by personnel

of the 2d Medical Laboratory. Fieldwork, restricted to the bodies of those

who died before reaching field or evacuation hospitals, was begun on 29 April

1944 at the U.S. Military Cemetery, Carano, Italy, under the supervision of

Col. Kenneth F. Ernest, MC, then commanding officer of the 2d Medical Laboratory. It was completed on 6 November 1944 at the U.S. Military Cemetery,

Monte Beni, Italy, with the very helpful advice and direction of Lt. Col.

(later Col.) Harold E. Shucy, MC, who became commanding officer of the laboratory in July 1944. Results of the study were presented in a six-volume

report,2 for which General Martin prepared the following foreword:

It is quite apparent to anyone who has seen the human wastage in war that provisions

for the best possible protection of the soldier from enemy fire on the battlefield have not

been achieved, nor has the problem received the study it deserves. If the Medical Department is to carry out its mission fully, we should do our part in furthering improvement in

this field. This study was conceived in that light and as a necessary step in the process of

final solution of the problem.

The extent of the effort required to complete this study should be apparent on the face

of the data presented. It is only when'it is known that this work was done as an additional

1 The suggestions and assistance of Col. Charles G Bruce, MC, Executive Officer, Office of the Surgeon, lteadquarters, Fifth U.S. Army, facilitated the preparation of the original six-volume report, The author wishes to acknowledge

his indebtedness to the following enlisted men of the 2d Medical Laboratory whose assistance made possible the work

presented in the report: Sgt. Warren G. Dougherty, T4g. William E. Metnale, T5g. Edward S. Werner, and Pfc. Ruben J.

Anderson for their technical help in examining the bodies; and T4g. Arthur F. Labrado for the laborious task of typing

the text, tables, and case descriptions. Special credit is due to Sergeant Dougherty for his invaluable assistance in assembling the data and for his faithful reproduction of the diagrams of the wounds. The well-executed outline form of the

body, upon which the wounds were reproduced, was drawn by S. Sgt. John M. Watson, Office of the Surgeon, Headquarters, Fifth U.S. Army. The author wishes to thank the 47th Quartermaster Graves Registration Company for their

willing and cheerful cooperation and the Fifth U.S. Army branch of the Army Pictorial Service for the use of one of their

cameras and for their expert processing of the films and prints. The author is also indebted to Maj. Alfred G. Karlson

for his suggestions and assistance in editing.

2 This six-volume report, other than the part which serves as the basis for this chapter, consists of case reports on the

1,000 casualties examined. Since lack of space precludes inclusion of all 1,000 cases, representative case reports have been

chosen for inclusion in this chapter (p. 454).

437
438 WOUND BALLISTICS

duty by hard pressed personnel of a very active field laboratory that the monumental scope

of the undertaking is realized. The author has amply justified his right to ask that others,

less actively engaged than he in the pursuit of the present conflict, develop the data presented here into terms of usefulness.

On several occasions it seemed that lack of time, obstinate weather of all kinds, the need

for secrecy, the difficulty of working under battlefield conditions and the constantly changing

military situation would contrive to halt this work. The reader is asked to consider these

factors before becoming too critical. The completion of this unique project in its present

form is a tribute to the indomitable desire for scientific investigation and [to the] * * *

adherence to a high standard of scientific endeavor.

During the organization of tile survey, it appeared that a study of this

scope and character had not been done previously in the U.S. Army. Other

casualty surveys were in progress (pp. 237-280 and pp. 281-436), but the details

of the surveys were not available nor were either of them confined solely to the

study of the killed in action. In the Bulletin of the U.S. Army Medical Department, No. 74, March 1944, a footnote to an article entitled "Need for Data on

the Distribution of Missile Wounds" states: "The only data available in the

Office of the Surgeon General are those from 1,175 Union soldiers who were

killed in action during the Civil War. This footnote refers to the following

statement:

The records in this office [Surgeon General of the U.S. Army] show the seat of injury in

only one thousand one hundred and seventy-three cases of soldiers killed on the battlefield.

Of these, four hundred and eighty-seven (487) were of the head and neck, six hundred and

three (603) of the trunk, thirty (30) of the upper extremities, and fifty-three (53) of the

lower extremities.3

It is evident that a thorough study of these cases was not made.

It was believed that the contemplated survey would partially satisfy the

need for data on the distribution of missile wounds. More specifically, it was

hoped that the material would be useful in helping to devise one or more forms

of body armor which could be used in some of the varying conditions encountered in battle. The data should also be useful to ballisticians although much

of the material required by this group was unobtainable, as explained later.

METHODS OF STUDY

It was decided that this work should be done in the U.S. military cemeteries because it is here that bodies become available in groups large enough to

make possible the study of a thousand cases within a reasonable period of time.

Information regarding the circumstances attending death could not be augmented by working farther forward. Furthermore, the removal of clothing

from bodies cannot be permitted before they have been searched for identification tags and personal effects by personnel of the Graves Registration Service

in preparation for burial. This latter function was performed in the ceme3 Medical and Surgical History of the War of the Rebellion. Surgical History. Washington: Government Printing

Office, 1883, pt. III, vol. 11, pp. 691-692.
EXAMIINATION OF 1,000 AMERICAN CASUALTIES 439

teries. The data for this study, therefore, were collected in the U.S. military

cemeteries at Carano, Follonica, Castelfiorentino, and Monte Beni, Italy. The

periods of time and numbers of cases studied in each location are shown in

table 111.

TABLE 111.-Period of time, location of cemetery, and number of cases studied at each cemetery

Date Location Cases studied

1944 Number

29 April-27 May ------------------- Carano --------------------------- 250

4-20 July ------------------------- Follonica ------------------------- 240

6-21 October ---------------------- Castelfiorentino -------------------- 328

27 October-6 November ------------ Monte Beni ----------------------- 182

Quartermaster Graves Registration Service

The methods employed by the Quartermaster Graves Registration Service

for collection and delivery of bodies to the cemeteries are related to certain

aspects of this study, and they merit brief description. The division quartermaster is responsible for evacuation of bodies to the Graves Registration

Service. He, or his appointed representative, may act as the divisional graves

registration officer. Each regiment has a graves registration officer who

organizes collecting teams. These teams are composed of enlisted men who

collect the dead and write the EMT's (emergency medical tags). One platoon

of a graves registration company is capable of operating a cemetery provided

the number of burials is not too great. In Italy, it was usually possible for

the 47th Quartermaster Graves Registration Company to have one of its platoons operate four collecting points so spread out behind the front as to cooperate with the divisional collecting teams. It was intended that regimental

collecting teams would evacuate their dead to Graves Registration Service

collecting points whence they were evacuated to the cemetery. This plan was

not always followed because at times the regimental collection point was closer

to the cemetery than it was to a Graves Registration Service collecting point.

In static situations, the divisional collecting and evacuation system usually

functioned without delay in cooperation with the Graves Registration Service.

Most bodies were recovered promptly. However, when the army was advancing rapidly and actions occurred in widespread areas, it was more difficult

to find bodies, and frequently they did not reach the cemetery for many days

after death. When the divisional collecting system was forced to leave bodies

behind, the task of finding and collecting them fell to the Graves Registration

Service.

Examinations

Bodies were examined as received in the cemeteries, without selection but

with the requirement that they be in a condition fit for examination; that is,
440 WOUND BALLISTICS

0

o !

FIGURE 229.-Worksheet with anatomic views of body and location of wounds.

not so decomposed nor so heavily infested with fly larvae as to make the location or extent of the wounds uncertain. In practice, the bodies were stripped

of all clothing after having first been searched by graves registration personnel.

The wounds were then described and recorded promptly so as not to delay

interment. Every wound was probed and its extent determined as exactly

as possible from external examination.

All data were recorded on mimeographed sheets on one side of which were

outline forms of front and rear views of the body with three views of the head.

Rough sketches of the wounds were made (fig. 229). On the reverse of the

sheet was entered identifying information to include, when available, name,

rank, Army serial number, organization, army branch of service, type of missile,

type of action, position at time of injury, treatment, and description of wound

and wound track. This information is essentially the same as that suggested
EXAMINATION OF 1,000 AMERICAN CASUALTIES 441

in the article in the March 1944 Medical Department bulletin. The worksheets

were saved as a permanent record.

Certain difficulties were encountered in attempting to obtain the items of

information just cited. All of these items, except descriptions of wounds and

names and serial numbers, had to be obtained from EMT's or from Graves

Registration forms. Names and serial numbers were usually copied from identification tags. When the latter were missing, other means of identification

were sought, such as AGO cards, letters, and membership cards. Ranks, organizations, and serial numbers could not always be recorded at the time when

the bodies were examined. After 1,000 cases had finally been studied, it was

found that information on approximately one-third was incomplete. The

missing data were obtained from the office of the Fifth U.S. Army Graves

Registration Officer and the Adjutant General Casualty Section.

Causative Agents

Efforts to ascertain and tabulate the missiles in this series met with almost

insurmountable difficulties. A man killed in battle will be seen to fall only by

his comrades who cannot know with certainty what type of missile caused a

man's death. They may know that a man was hit by machinegun or rifle fire

or that he encountered a mine, but they cannot state with accuracy the caliber

of a high explosive shell which has been fired at them. In any event, even if

accurate information regarding missiles is known to a man's comrades, it does

not often find its way to the EMT's which are filled in by company aidmen or

other medical personnel who arrive on the scene after the action has occurred.

Those who actually see the death occur are seldom present when the body is

tagged. Ballistic data on EMT's cannot therefore be depended upon since it

is not known which ones are accurate. The best method of obtaining accurate

information of this type is to perform an autopsy to locate and identify missiles 4

(fig. 230) and to determine the extent of tissue damage. Early in this study,

it became evident that the performance of an autopsy in every case was impracticable because of the time required for such a procedure. The first body

autopsied in this project was thoroughly dissected in search of the missile.

After a period of 3 hours, the missile had still not been found, and the search

for it was abandoned. Even when fragments of metals are found, their small

size usually precludes determination of their origin. Frequently, missiles were

discovered near the surface of the body, in wounds, or in the clothing adjacent

to wounds. The size and shape of all such pieces of metal were incorporated in

4 This information should be supplemented by interviews with soldiers present at the time the man was wounded.

They can identify the causative agent with a surprising degree of accuracy and can also furnish invaluable data pertaining to type of activity, position of soldier, terrain and protective cover, and approximate range. Therefore, surveys on killed- in-action casualties should be conducted by two teams working simultaneously but in widely separated locations. One

team should be available for interrogation of eyewitnesses in the forward area where the body is recovered. This team can be composed of nonmedical personnel. The second team, composed of medical and certain essential nonmedical personnel. should be located at the main collecting point for the bodies (interment site or current death embalming area) where a complete wound ballistics examination can be conducted. Ideally, the latter should entail a complete external examination of the wounds with their location and description, adequate color photographs of the wounds, X-ray examina- tion, autopsy examination of the major wounds, recovery of missiles, photographs and preservation of gross organs, prepq- ration of tissue blocks, and determination of cause of death.-J. C. B.
442 WOUND BALLISTICS

Caml

S4d

FIGURE 230.-High explosive steel fragments (primary missiles). All of these fragments were retained in and removed from the fatal wounds of infantrymen killed in action

with the Fifth U.S. Army in Italy. The fragments range from 1 to 120 grams in weight.

the descriptions of each case. The data concerning missiles were copied from

the EMT's with the important exception that the term "high explosive" did

not occur on the tags. Under this heading were placed all casualties who

obviously died as the result of having been hit by high explosive missiles but

whose EMT's did not indicate a missile. Also included in this category were

all cases for which there was definite evidence that the missile was erroneously

stated on the EMT but which were manifestly hit by high explosive missiles.

It was believed that the data as finally recorded on the case report were in

general accurate with regard to gross categories of causative agents.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 443

Problems Encountered

In warm weather, the condition of most of the bodies received in the

cemeteries was so unsatisfactory that even external examinations were not

done. During the months of August and September, the work was discontinued because too few bodies in fresh condition were received at the cemeteries

to make an effort worth while. For this reason, the proportion between the

number of cases included in this series and the number of interments varied

considerably from one cemetery to another. For example, the sample of

battle deaths included in this study was larger at Castelfiorentino in October

than it was at Follonica in July.

The 1,000 casualties of the survey though not representative of casualties

from all types of action during different seasons were not significantly different

from those observed in areas other than where the survey was conducted.

There was also no apparent difference in the types of cases received when the

front was static as compared with those received during an offensive.

The exact type of action in which these battle casualties occurred could

not be determined at the cemeteries. The available information consisted of

the location where bodies were recovered, which was indicated on a majority

of the emergency medical tags. The usual statement consisted of "Vic [victim]

of," followed by the name of the nearest landmark or inhabited locality, often

misspelled. Coordinates were usually not given. To obtain accurate type-ofaction data, it would be necessary to study the history of each organization.

The position of the body at the time of injury could not be determined

because it was impossible to make contact with anyone able to give this information.

As it was impossible to obtain the services of a photographer for an extended period of time, a camera was borrowed from the Army Pictorial Service.

Photographs of 82 representative cases were made by the author and processed

by the Army Pictorial Service (fig. 231). The photographs were made under

an agreement with the Fifth U.S. Army Graves Registration Officer that no

names would be associated with them.

STATISTICAL STUDIES

At the beginning of the description of each case in the complete report is a

statement which classifies the wounds as single or multiple and lists the various

parts of the body which are involved. Tables 112, 113, 114, 115, and 116 are

presentations of these data in tabular form. Each wound is mentioned separately in most of the cases except in instances where multiple wounds were

present. In the latter cases, each wound is not described separately.
444 WOUND BALLISTICS

FIGURE 231-Typical photograph of a casualty (Case No. 635) with multiple fatal and

nonfatal wounds due to high explosive shell fragments. There are many penetrating wounds

in the posterior surface of the torso and left arm varying from a few millimeters to 11 x 12

centimeters. This largest wound is a penetrating laceration in the left buttock and sacral

area.

Classification

A compilation of the cases, arranged according to parts of the body which

were affected and according to probable missiles, is presented in table 112.

Emphasis must be placed upon the word "probable" when reference is made to

missiles. It must not be forgotten that the placing of the majority of the cases

in any particular group, with respect to missiles, is based upon the appearance

of wounds and EMT data rather than upon actual finding of missiles. The

columns labeled "Upper half of the body" and "Lower half of the body" list,

the cases which had wounds confined to the areas above and below the diaphragm, respectively, but with more than one region involved. The column

labeled "Upper and lower halves of the body" lists the cases in which the wounds

were distributed above and below the diaphragm. It will be seen that some of

the cases in these three columns have single wounds. This means that from

external examination it was determined that more than one region was affected.

For example, a single wound in the chest, with intestine herniated through it,

is of the thoracoabdominal type, and the case belongs in the group of cases

with wounds both above and below the diaphragm. Undoubtedly, many of

the cases with wounds which were too small to be probed would have been
EXAMINATION OF 1,000 AMERICAN CASUALTIES 445

found to have parts affected other than those listed had it been possible to

perform autopsies in all such instances. The data, however, were uniformly

recorded from the standpoint of external examination.

TABLE 112.-Distribution of 983 KIA casualties,1 according to body areas and

probable causative agents

Upper Probable causative Ab- Upper Lower Upper Lower and Pelagent 2 Head Neck Thorax do- extrem- extrem- half of half of lower vis Total men ity ity body body halves

of body

Casualties with single wounds

Highexplosive------61 1 31 6 3 7 4 5 9 2 129

Shell fragments ---- 39 5 26 7 4 8 6 4 99

Small arms -------- 24 7 27 3 3 2 7 3 2 3 81

Total ------- 124 13 84 16 3 11 17 17 8 15 5 3310

Casualties with multiple wounds

High explosive-... 7 1 16 1 14 87 14 202 ---- 342

Shell fragments ---- 1 .... 9 .. . 1 8 55 8 201 ---- 283

Small arms ---------. ---1 - 4 ----------- 1 9 11 ---- 26

Total -------- 9 1 29 1 1 23 4 154 22 1 433 .... 41673

Grand total-- 133 14 113 17 12 40 171 30 448 5 983

Does not include 4 casualties cremated in a tank and 13 casualties due to blast injury. See text, p. 446.

2 Identified from appearance of the wound and from information on EMT's rather than by recovery of the actual

missile.

Includes a wound caused by a landmine.

'Includes 3 wounds caused by landmines.

'Includes 19 additional wounds-3 caused by hand grenades, 15 by landmines, and 1 by aerial bombs.

Some difficulty was encountered in attempting to classify wounds located

in marginal areas; for instance, deciding whether axillary wounds should be

listed as upper extremity wounds or as chest wounds. Axillary and shoulder

girdle wounds were classified as chest wounds except in cases where they

extended into or were distal to the head of the humerus. The same criteria

were applied to wounds in the inguinal and buttock areas where they were

classified as pelvic unless they extended into or were distal to the head of the

femur. The terms "back" and "lumbar area" were not included in the classifications. Wounds located in the back above the level of the first lumbar

vertebra were listed as "chest." Similarly, posterior wounds in the lumbar

region above the iliac crests were classified as abdominal.
446 WVOUND BALLISTICS

Four cases I were classified as cremation in a tank, and thirteen cases were

designated as blast injury. (These 17 cases are not included in table 112.)

The latter cases were those with nonpenetrating wounds with blast injury the

probable cause of death. Autopsies were performed upon four of these bodies

and diffuse pulmonary hemorrhage was found in all four cases and pulmonary

edema in three of them. Microscopic tissue studies were done in only one of

the cases, the others having been decomposed to such an extent that tissues

were not saved for this purpose. All cases in this group, except one, showed

the presence of blood either in the nose or mouth or in body places. This

finding, in the absence of penetrating wounds, was presumed to indicate pulmonary hemorrhage probably due to blast. Several other cases, without

penetrating wounds sufficient to explain death, may have died of blast injury.

Even though the actual missiles were not recovered, the general breakdown of the causative agents was comparable to that determined in other

ground force casualty surveys where witnesses were interrogated and autopsies were performed. Small arms accounted for 107 (10.9 percent) of the

983 missile-wounded casualties. Fragment-producing weapons were tentatively identified in the remaining 876 (89.1 percent) of these casualties. Shell

fragments were identified with certainty in 382 (38.9 percent) of the casualties.

However, the noncommittal term "high explosive" was used for 471 (47.9

percent) of the cases, and it was presumed that most of the missiles were derived from mortar and artillery shells. Hand grenades were positively identified in 3 (0.1 percent) of the casualties, landmines in 19 (1.9 percent), and

aerial bombs in 1 (0.1 percent). If the exact identification of the missiles

could have been made, the proportion of hand grenade and landmine casualties might have increased.

Multiple Wounds

From the group of cases with wounds involving the upper half of the body,

the lower half of the body, and the combined upper and lower halves of the

body, data were compiled on regional incidence (number of times an anatomic

region was involved). These data are presented in tables 113, 114, and 115.

Table 116 is a compilation of all the data on actual distribution of wounds in

the whole series and also lists the regional frequency of the probable lethal

wounds. The thorax was most frequently involved, followed, in order, by the

head, the upper and lower extremities, and the abdomen.

SThe author had originally included these cases with the casualties receiving mnissile-inflicted injuries (upper and lower halves of the body). Since only a few pounds of charred body remains were recovered, it is felt that they should be

considered in a separate category.-J. C. B.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 447

TABLE 113.-Distribution of 396 injuries in 171 cases with wounds confined to the upper half

of the body but with more than one region involved, by anatomic location

Anatomic location Number of wounds Percent of cases

Head -------------------------------------------- 88 51. 5

Neck ------------------------------------------- 67 39. 2

Thorax ------------------------------------------ 120 70. 2

Upper extremity ----------------------------------- 121 70.8

TABLE 114-Distribution of 67 injuries in 30 cases with wounds confined to lower half of the

body but with more than one region involved, by anatomic location

Anatomic location Number of wounds Percent of cases

Abdomen ---------------------------------------- 20 66. 6

Pelvis ------------------------------------------- 24 80.0

Genitalia ------------------------ 2 6. 6

Lower extremity ---------------------------------- 21 70. 0

TABLE 115-Distribution of 1,648 injuries in 452 cases I with wounds involving regions both

above and below the diaphragm, by anatomic location

Anatomic location Number of wounds Percent of cases

Head -------------------------------------------- 210 46. 5

Neck ------------------------------------------- 97 21.5

Thorax ----------------------------------------- 339 75.0

Abdomen --------------------------------------- 232 51.3

Pelvis ------------------------------------------- 146 32. 3

Extremities:

Upper --------------------------------------- 276 61. 1

Lower -------------------------------------- 327 72. 3

Genitalia ---------------------------------------- 21 4. 6

1 Includes 4 cases cremated in a tank not included in table 112.
448 WOUND BALLISTICS

With a view to determining the approximate total number of wounds and

their regional distribution, the author's original case reports were reexamined. 6

The total number of cases (983, table 112) remained the same, but a slight

change was made in the distribution of the single and multiple regional involvements (missile wounds), as follows:

Number Single region involved: of cases

Head -------------------------------------------- 138

Neck -------------------------------------------- 21

Thorax ------------------------------------------- 126

Abdomen ----------------------------------------- 25

Extremities:

Upper ------------------------------------- 18

Lower ------------------------------------ 72

90

Total ------------------------------------------- 400

Multiple regions involved -------------------------------- 583

Grand total ------------------------------------- 983

No change in classification was made for the 4 cases cremated in a tank and

the 13 casualties which were due to blast injury, and they were not included

in any of the tabulations.

Reevaluation

In the original tabulation, a number of cases with perforating wounds had

a missile track involving several body regions and were classified as multipleregion-type cases. It was decided that these should be considered as a singleregion involvement of the entrance site regardless of the location of the exit

wound. The demarcation of the anatomic regions was also based upon slightly

different criteria ' and accounts for some of the changes in the regional frequency

of wounds (table 117, compare with table 116). The buttocks, though considered as a portion of the lower extremity, were listed separately because of

interest in this region in the development of lower torso body armor. Table

118 lists the regional distribution of the estimated 7,006 wounds in the 983

casualties. Of the total wounds, 55.4 percent (more than a half) occurred in

the extremities and 25.7 percent were located in the thorax. Approximately

6,130 (87.5 percent) were penetrating I type of wounds and 876 (12.5 percent)

were perforating ' type of wounds. The wound incidence per casualty was

approximately 7.1 percent, and this is very similar to that found in the study

of KIA in the Korean War.

SBy the editor (J. C. B.).

7 Holmes, R. R., Enos, W. F., and Boyer, J. C.: Demarcation of Body Regions and Battle Casualty Analysis. U.S.

Armed Forces M. J. 5: 1610-1618, -November 1954.

8 Wound of eatrance only and major portion of missile retained within the body.-J. C. B.

9 Wounds of entrance and exit and major portion of missile not retained within the body.-J. C. B.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 449

TABLE 116.-Distribution of 2,445 injuries in the various groups of the 987 KIA casualties,1

by anatomic location and probable fatal wounds

Regional involvement in groups Total wounds Probable fatal

with wounds of - wounds2

Anatomic location

Upper Lower Upper Single half half and lower region Number Percent Number Percent

of body of body balves of (334 (171 (30 body cases) cases) cases) (452 cases)

Head ----------------- 88 210 133 431 17.6 401 28.1

Neck ----------------- 67 97 14 178 7. 3 121 8.5

Thorax --------------- 120 339 113 572 23.4 422 29.6

Abdomen -------------------- 20 232 17 269 11.0 167 11.7

Pelvis ---------------- ------- 24 146 5 175 7. 2 79 5.5

Extremities:

Upper ----------- 121 276 12 409 16.7 98 6.9

Lower ------------------ 21 327 40 388 15.9 138 9. 7

Genitalia -------------------- 2 21 23 .9

Total ---------- 396 67 1, 648 334 2,445 100.0 1,426 100. 0

i Includes 4 casualties cremated in a tank and not included in table 112.

2 Included in total wounds but probably responsible for mortality.

TABLE 117.-Distribution of 2,183 regional involvements 1 in 983 KIA casualties,

by anatomic location (regional frequency)

Regional involvement Total regional

involv ement Regional

frequency

Anatomic location in

Single Multiple 983 cases wound wounds Number Percent

(400 cases) (583 cases)

Percent

Head ---------------------------------- 138 258 396 18. 1 40.3

Neck --------------------------------- 21 128 149 6. 8 15.1

Thorax -------------------------------- 126 390 516 23. 6 52.5

Abdomen ------------------------------ 25 192 217 10.0 22. 1

Extremities:

Upper ---------------------------- -18 358 376 17.2 38.2

Lower ----------------------------- 68 342 410 18.8 41.7

Buttocks ------------------------------ 4 115 119 5. 5 12. 1

Total -------------------------- 400 1, 783 2, 183 100.0

1 Indicates frequency of anatomic regional incidence of wounds per casualty but not total number of wounds.
450 WOUND BALLISTICS

TABLE 118.-Distribition of 7,006 wounds in 983 KIA casualties, by anatomic location

(regional distribution)

Regional distribution Total wounds

of wounds

Anatomic location

Single wound Multiple (400 cases) wounds Number Percent

(583 cases)

Head ----------------------------------- 156 458 614 8. 8

Neck ----------------------------------- 21 238 259 3. 7

Thorax_ -------------------------------- 186 1,616 1,802 25. 7

Abdomen ------------------------------- 26 420 446 6. 4

Extremities:

Upper ----------------------------- 21 1,439 1,460 20. 8

Lower- ----------------------------- 275 1,806 2,081 29. 7

Buttocks ---------------------------- 10 334 344 4. 9

Total ----------------------------- 695 6,311 7, 006 100. 0

Rank and Type of Duty

The rank and type of duty of the 1,000 killed in action examined are listed

in the following tabulations:

Rank: jNcItcer Rank-Continued Nrmbnr

Private ------------------------ 454 Technical sergeant --------------- 18

Private, first class --------------- 277 Sergeant, first class --------------- 4

Technician, fifth grade ------------ 33 2d lieutenant -------------------- 31

Corporal ------------------------ 34 1st lieutenant ------------------- 15

Technician, fourth grade --------- 12 Captain ------------------------- 10

Sergeant ------------------------ 67 Major --------------------------- 2

Staff sergeant ------------------- 42 Lieutenant colonel ----------------- 1

Type of duty: ANsmter Type of duty-Continued Nsmnter

Infantry and armored infantry ---- 875 Reconnaissance ----------------- 7

Field artillery ------------------- 27 Antiaircraft artillery -------------- 5

Tank -------------------------- 27 Signal --------------------------- 4

Engineer ----------------------- 21 Division headquarters ------------ 1

Infantry medical detachment ----- 13 Division headquarters, Military

Tank destroyer 9 police ------------------------ 1

Chemical 8 Division band -------------------- 1

Medical battalion ---------------

Emergency Medical Tag

Of the EMT's attached to the bodies examined, 119 gave indication that

the casualties had been seen alive after having been hit. Data collected

partly by examination of the bodies and partly from EMT's showed that 109

of the cases had received the following types of treatment:
EXAMINATION OF 1,000 AMERICAN CASUALTIES 451

Number Nusmber

treated treated

Sulfonamide, local__ __---------------80 Tourniquets ------------------------ 9

Dressings --------------------------- 89 Sulfonamide, tablets ------------------ 2

Plasma ----------------------------- 27 Oxygen ---------------------------- 1

Splints ----------------------------- 16 Shock therapy ----------------------- 2

Mkedicine (for example, morphine) ----- 9

For the remaining 10 cases listed as "WIA" on Graves Registration Burial

Forms (GRS No. 1), no treatment was noted.

At the time this study was being done, diagnoses from the EMT's were

not copied on the worksheets. The diagnoses on the tags were not changed

or influenced by this study except in six cases which were autopsied. It

became evident as the study progressed that diagnoses on EMT's were often

erroneous. Since EMT's were frequently the only source of information on

battlefield deaths available to the Medical Department, an effort was made to

determine the accuracy of the diagnoses contained thereon. The EMT diagnosis was obtained for each case in this study from the Graves Registration

Burial Form No. 1. A comparison of the diagnoses is presented in table 119.

It is seen, for example, that 15.3 percent of the EMT's for these 1,000 cases

had erroneous diagnoses for wounds of the head and 13.9 percent were in

error for wounds of the neck. For the abdomen and pelvis, the errors were

20.2 percent and 16.3 percent, respectively. This deficiency was only partially

the fault of those who wrote the EMT's for battlefield deaths. Accurate

diagnoses are not to be expected unless the body is stripped of all clothing

and examined by a medical officer.'

TABLE 119.-Cossparison of regions actually involved and regions recorded on EMT's

(1) (2) (3) (4) (5a Region Regional Noted on Number of Percentage o Body region actually involvement EMT and not EMT's with errors in

involved present and actually pre- errors 1 EMT's in

noted on sent 1,000 cases EMT

Head ------------------------ 431 327 49 153 15.3

Neck ------------------------- 178 58 19 139 13.9

Thorax ---------------------- 572 338 42 276 27. 6

Abdomen --------------------- 269 114 47 202 20. 2

Pelvis ------------------------ 175 26 14 163 16. 3

Extremities:

Upper -------------------- 409 113 42 338 33. 8

Lower ------------------- 88 190 34 232 23. 2

Genitalia -------------------- 23 3 3 23 2. 3

Total ------------------ 2,445 1, 169 250 1,526 100.0

I Figures iua column 1 minus figures in column 2 plus figures in column 3.

10 In addition, the EMT could be designed to contain several small anatomic outlines so that the exact location of

all wounds could be quickly but accurately located-I. C. B.
452 WOUND BALLISTICS

Indication for Body Armor

The following 198 cases with severe inultiple mutilating wounds (figs. 232

and 233) are grouped according to the regions affected:

Number

of cases

Group withSevere wounds involving the head, including decapitations and crushing and mutilating wounds (20 of this group are included in one or more of the other groups

listed) --------------------------------------------------------------- 103

Traumatic amputation of all or part of one lower extremity (10 of this group are

included in one or more of the other groups listed) ------------------------- 33

Traumatic amputation of all or part of both lower extremities (12 of this group are

included in one or more of the other groups listed) ------------------------- 23

Traumatic amputation of all or part of one upper extremity (18 of this group are

included in one or more of the other groups listed) ------------------------- 33

Traumatic amputation of all or part of both upper extremities (10 of this group

are included in one or more of the other groups listed) ---------------------- 12

Other mutilating or dismembering wounds (29 of this group are included in one

or more of the other groups listed) ---------------------------------------- 54

FIci Ga 232.-Traumatic (partial) decapitation due to high explosive shell. Vault of

skull laid open and brain completely eviscerated. Severe fragmentation of the bones of the

vault and of bones of base of skull on left side.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 453

1

FIGURE 233.-Extensive multiple and mutilating wounds of all regions of the body due

to high explosive shell. A. Front of body. B. Back of body. C. Multiple wounds of

lower extremities. There is almost complete dismemberment of the upper half of the body

from the iliac crests upward. The head is missing. The chest and abdomen are completely

mutilated and laid open from a posterior direction. Both arms are attached to the remainder

of the body by segments of skin. Numerous lacerated penetrating wounds are found in

both legs.
454 WOUND BALLISTICS

These 198 cases plus 4 which were cremated represent 20 percent of the total

number examined which could not have been saved from death by any type of

body armor.

In many cases with multiple wounds, it is difficult to determine which

wound is the immediate cause of death. Undoubtedly, some of the traumatic

amputations of extremities would not have resulted in death had they been the

only wounds. Wounds of the head were considered as more likely to have

been fatal than wounds of other regions. Of 432 head wounds, only 31 were

either nonpenetrating or not serious enough to have been fatal. Although

no study has been made to determine the percentage of head wounds involving

the areas not protected by the helmet, the impression was obtained that a

helmet could be designed to cover more of the head and neck and reduce the

number of serious wounds of these regions. Other sites which would be difficult

to protect by armor are the attachments of the extremities to the trunk, of

which no studies were made in this report. About 20 percent of the cases could

not have been protected by any type of body armor. Possibly some type of

body armor could be designed to protect vital areas most often involved, such

as the head and trunk. The data in the original report are source materials

which can be studied further in an attempt to clarify this problem.

CASE REPORTS

The case reports which are included in this section were selected from

the original report as illustrative of the types of wounds inflicted on the various

anatomic regions of the casualties studied in this survey. In all instances,

the case numbers assigned in the original report have been used.

HEAD

Case No. 633.-Pfc., 168th Infantry, 14 Oct. 1944; missile: high explosive; single

wound in the head (fig. 234). There was a through-and-through wound in the head with the

wound of entrance, 2 x 4 cm., in the left cheek area and the wound of exit, 3.5 x 5 cm., in

the right temporal and zygomatic area, passing through the external ear. The right temporal bone and bones of the face were severely crushed.

Case No. 641.-Pvt., 338th Infantry, 15 Oct. 1944; missile: shell fragments; multiple

wounds in the head (fig. 235); treatment: plasma, 2 units local sulfonamide and dressing.

Three deep lacerations were present in the right posterior half of the head. The right

temporal bone was penetrated immediately behind the external ear in an area which measures 3 cm. in diameter.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 455

FIGURE 234.-Single head wound. A. Wound of entrance. B. Wound of exit.

FIGURE 235.-Multiple wounds of the head.
456 WOUND BALLISTICS

NECK

Case No. 501.-Pfc., 362d Infantry, 7 Oct. 1944; missile: shell fragment; single wound

in the neck (fig. 236). A large mutilating wound was present in the left anterior and lateral sides of the neck. There was exposure and fragmentation of several cervical vertebras.

FIGURE 236.-Single neck wound.

Case No. 970.-Pfc., 362d Infantry, 5 Nov. 1944; missile: shell fragment; single wound

in the neck (fig. 237). A wound, 1.3 x 2.5 cm., penetrated the anterior side of the neck

immediately to the right of the midline and immediately inferior to the larynx. The trachea was perforated and the body of the C7 vertebra was crushed. The wound bled

profusely.

FIGURE 237.-Single neck wound.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 457

CHEST

Case No. 760.-Pvt., 338th Infantry, 19 Oct. 1944; missile: high explosive; single

wound track in the chest (fig. 238). This through-and-through wound had its entrance,

1 x 2.5 cm., in the posterior left side of the chest at the level of the T5 vertebra, 10 cm.

from the midline. The wound of exit, 4 x 6 cm., was located in the anterior left side of

the chest at the level of the second and third ribs. There was a large opening into the

thoracic cavity through the second, third, and fourth ribs.

FIGURa 238.-Single chest wound. A. Wound of entrance. B. Wound of exit.

Case No. 824.-Pfc., 936th Field Artillery, 27 Oct. 1944; missile: shell fragments;

multiple wounds in the chest (fig. 239). There was a through-and-through wound in the

chest with the entrance, 2 x 2.5 cm., in the left anterior axillary line. The wound track

traversed the thoracic cavity in a slightly posterior and medial direction through compound comminuted fractures in the fourth and fifth ribs. The wound of exit, 3.5 x 4 cm.,

was located in the anterior lateral right side of the chest, where it passed through a compound comminuted fracture in the fifth rib. A superficial through-and-through lacerated

wound was present in the posterior left side of the chest in the midscapular area. Another

laceration was found near the medial angle of the right scapula.

FIGuRE 239.-Multiple wounds of the chest.

603225--62- 31
458 WOUND BALLISTICS

Case No. 908.-Sgt., 755th Tank Battalion, 1 Nov. 1944; missile: high explosive;

single wound track in the chest (fig. 240). This through-and-through wound in the chest

had its entrance, 2 x 2.5 cm., through the body of the left pectoralis muscle group, near

the axilla. The track proceeded downward and posteriorly through the fractured third

rib. The wound of exit, 2.5 cm. in diameter, was found in the posterior side of the chest,

immediately to the left of the midline at the level of the T4 vertebra. The wound opened

into the spinal canal through the T4 and T5 vertebras and extended to the left of the spinal

column into the thorax. The left fourth rib was fractured transversely at the site of exit.

FIGnuR 240.-Single thoracic wound. A. Wound of entrance. B. Wound of exit.

ABDOMEN

Case No. 986.-Pvt., 363d Infantry, 5 Nov. 1944; missile: high explosive; single wound

in the abdomen (fig. 241); treatment: local sulfonamide and dressings. A penetrating

wound, 6.5 cm. in diameter, was located in the midline of the abdomen in the epigastrium.

There was evisceration of numerous loops of small intestine through the wound.

FIGURE 241.-Single abdominal wound.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 459

LOWER EXTREMITY

Case No. 644.-Pfc., 338th Infantry, 14 Oct. 1944; missile: high explosive; multiple

wounds in both lower extremities (fig. 242). There was traumatic amputation of both

legs immediately distal to the knee joints. Lacerations extended into the distal medial

third of the left thigh.

FiGURE 242.-Multiple wounds of lower extremities.

Case No. 759.-Cpl., 337th Infantry, 19 Oct. 1944; missile: high explosive; multiple

wounds in both lower extremities (fig. 243). Numerous penetrating wounds were found

in the left leg between the knee and the ankle. They varied in diameter from 1 cm. to 2.5

cm. There was traumatic amputation of the right leg through the middle third. The

distal portion was attached by muscle and was completely mutilated. Two lacerated

penetrating wounds were present in the lateral and anterior sides of the right knee. There was a compound comminuted fracture in the right patella. A laceration, 3 x 5 cm., was

located in the anterior side of the right knee and leg. Maggots, visible in figure 243, were

contaminants from another body.

Case No. 966.--Pfc., 339th Infantry, 4 Nov. 1944, missile: high explosive; multiple

wounds in both lower extremities (fig. 244); treatment: local sulfonamide and dressings.

There was traumatic amputation of the left leg through the proximal third of the tibia

and fibula, with lacerations extending into and above the knee joint for a distance of 10

cm. There was essential traumatic amputation of the right foot through the ankle joint

with severe mutilation of the entire foot; lacerations extended 12 cm. above the distal end

of the tibia and fibula. Two intercommunicating lacerations in the right medial thigh were

6 cm. apart; the lower opening measured 1.5 x 2.5 cm. and the upper opening, 4 x 5 cm.

A superficial laceration, 3.5 cm. in diameter, was found in the anterior proximal aspect of
460 WOUND BALLISTICS

the right thigh. There was a comminuted fracture in the middle third of the right femur,

with a penetrating wound over the fractured area, in the middle of the thigh, anteriorly.

A laceration, 2 x 4 cm., in the medial side of the right leg exposed the periosteum of the tibia.

FICURE 243.-Multiple wounds of the lower extremities.

FIGURE 244.-Multiple wounds of the lower extremities.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 461

MULTIPLE WOUNDS

Case No. 80.-T5g., 338th Infantry, 15 May 1944; missile: shell fragments; multiple

wounds in the head, neck, chest, and both upper extremities (fig. 245). A penetrating

wound, 1 x 2 cm., was present in the vertex of the skull in the midline; the point of exit,

4 cm. in diameter, was located in the right parietal region; there was avulsion of brain tissue

and extensive lacerations of the scalp. A through-and-through wound was noted in the

right side of the neck: The point of entry, to right of the larynx anteriorly, was 1 cm. in

diameter; the point of exit, 4 cm. in diameter, was at the anterior border of the trapezius

muscle; two other small penetrating wounds were seen in the right side of the neck posteriorly. A penetrating wound, 3.5 cm. in diameter, was found in the left shoulder over the

upper portion of the scapula; there were many other small penetrating wounds of both

shoulders, posteriorly, and of the right arm and shoulder, anteriorly. A penetrating wound

was present in the base of the left thumb. There was traumatic amputation of the right

hand immediately distal to the wrist joint.

FIGURE 245.-Multiple wounds.

Case No. 631.-Pvt., 133d Infantry, 14 Oct. 1944; missile: high explosive; multiple

wounds (two) in the chest and left upper extremity (fig. 246). There was traumatic amputation of the left arm through the proximal end of the humerus. The joint cavity was not

involved. The arm remained attached by a small segment of skin. The wound extended

into the left upper anterior side of the chest where the skin and muscles were extensively

mutilated. A laceration, 4 x 6 cm., was located in the left lateral aspect of the thorax.
462) WOUND BALLISTICS

FIGURE 246.-Multiple wounds of the chest and the left upper extremity.

Case No. 678.-T. Sgt., 361st Infantry, 15 Oct. 1944; missile: shell fragments; multiple

wounds in the head, neck, chest, and both upper extremities (fig. 247). Many penetrating

wounds were found in the face, anterior neck, chest, left arm and shoulder. They varied

in diameter from a few millimeters to 1.5 centimeters. The largest wound entered the

chest anteriorly, at the level of the sixth intercostal space 6 cm. from the midline through

FIGURE 247.-Multiple wounds of the head, neck, chest, and upper extremities.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 463

compound comminuted fractures of the second and third ribs. Another penetrating wound

in the right anterior side of the chest at the level of the fourth intercostal space adjacent

to the sternum extended downward into the thoracic cavity. Three penetrating wounds

in the posterior left side of the chest measured 1 cm. in diameter, 3 x 5 cm. and 1 x .3 cm.

A laceration, 2 x 5 cm., was present in the top of the right shoulder. The track passed

through comminuted fractures of the proximal end of the humerus and lateral angle of

the scapula.

Case No. 907.-T. Sgt., 755th Tank Battalion, 31 Oct. 1944; missile: high explosive;

multiple wounds in the head, chest, and right upper extremity (fig. 248). There was a

through-and-through wound in the vault of the skull with the entrance, 2 x 3 cm., in the

left posterior parietal area and the wound of exit, 5 cm. in diameter, in the right posterior

04,4

FIGTURE, 248.-Multiple wounds of head, chest, and right upper extremity.

parietal area near the midline. The frontal, both parietal, and occipital bones were fragmented and the brain was partially eviscerated. A through-and-through wound in the

lower jaw had its entrance, 1 x 2 cm., in the left cheek anterior to the angle of the mandible

and its wound of exit, 1.5 x 4.5 cm., in the right side immediately anterior to the angle of

the mandible. The entire mandible was fragmented. A laceration, 3.5 x 7 cm., was present

in the anterior left side of the chest, with an irregular steel fragment, 2.3 x 1.2 x 0.6 cm.,

embedded in one end of it. Another laceration, 2 x 5 cm., was found in the right anterior

side of the chest at the same level. A lacerated wound, 8 x 11 cm., was seen in the middle

of the right arm, anteriorly. A penetrating wound, 3 x 5.5 cm., located proximal to the

right wrist in the ventral surface, exposed a compound comminuted fracture in the distal

end of the ulna.
464 WOUND BALLISTICS

Case No. 254.-Pvt., 437th Antiaircraft Artillery (Air Warning) Battalion, 4 July 1944;

missile: landmine; multiple wounds in the head, chest, abdomen, right upper extremity,

and both lower extremities (fig. 249). Many large severe penetrating wounds were found

in the ventral surface of the body. There was complete mutilation of the head with total

loss of the brain. A large opening in the left side of the chest revealed multiple fractures

of the ribs. A large penetrating wound in the right upper quadrant of the abdomen had

intestine eviscerated through it. The right arm was mutilated. Numerous small and

large penetrating wounds were present in both thighs and legs and there was a compound

comminuted fracture of the left femur in the distal third.

4% %

FIGuRE 249.-Multiple wounds of head, chest, abdomen, right

upper extremity, and both lower extremities.

Case No. 655.-Pfe., 19th Engineer Battalion, 15 Oct. 1944; missile: shell fragments;

multiple wounds in the chest, abdomen, left upper and both lower extremities (fig. 250 A

and B). A penetrating wound, 1 cm. in diameter, was present in the anterior right side of

the chest at the level of the second rib. Three other penetrating wounds were found in the

anterior aspect of the chest, each 5 mm. in diameter. A laceration, 10 x 13 cm., was located

in the lateral left side of the chest without penetration of the thorax. A penetrating wound,

2 x 3 cm., entered the abdominal cavity in the mid epigastrium. A mutilating wound,

10 x 20 cm., in the left ventral arm revealed a compound comminuted fracture through

the middle third of the humerus. A through-and-through wound in the left proximal

forearm had a ventral opening, 5 x 8 cm., and a dorsal opening, 6 x 12 cm. There was

laceration of the muscles and a compound comminuted fracture of the radius in the track.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 465

FIGURE 250 A and B.-Multiple wounds of chest, abdomen, and upper and lower extremities.

Three other penetrating wounds in the left arm and forearm varied from 5 mm. to 5 cm. in

diameter. A penetrating laceration, 20 x 30 cm., was located in the left anterior and medial

thigh; a comminuted fracture of the femur was visible in this wound. Mutilating penetrating wounds were present in both knees, with compound comminuted fractures of the

tibia, fibula, patella, and femur in the left leg and compound comminuted fractures of the

same bones, except the patella, in the right leg.

Case No. 663.-Pfc., 351st Infantry, 15 Oct. 1944; missile: shell fragments; multiple

wounds in the neck and chest (fig. 251) and left lower extremity. A mutilating wound,

K 1⁄4

FIGURE 251.-Multiple wounds of neck and chest.

603225v-62 32
466 WOUND BALLISTICS

11 x 21 cm., was present in the superior anterior side of the chest and the lower portion of

the neck. There were compound comminuted fractures of both clavicles and of the first

and second ribs on both sides in the wound. The right lung was visible through the opening.

A superficial through-and-through wound in the left anterior distal thigh had a lateral

opening, 1.5 x 2 cm., and a medial opening, 1.7 x 2 cm.

A

FiGURE 252 A and B.-Multiple wounds of head, neck, chest, and upper and lower extremities.

Case No. 731.-2d Lt., 755th Tank Battalion, 18 Oct. 1944; missile: high explosive;

multiple wounds in the head, neck, chest, and both upper and left lower extremities (fig. 252 A

and B). A penetrating wound, 1.5 cm. in diameter, entered the skull in the midline through

the coronal suture. There was slight evisceration of the brain through this opening. A

lacerated penetrating wound, 2.5 x 7 cm., in the left cheek involved the lower and upper

lips. Compound comminuted fractures of the mandible and maxilla were visible in this

wound. A penetrating wound, 1.5 x 2 cm., entered the right cheek inferior to the zygomatic

arch. A penetrating wound, 1 cm. in diameter, entered the base of the right side of the neck.

A mutilating wound, 9 x 11 cm., was found in the posterior side of the right shoulder; there

were fractures in the head of the humerus, the scapula, clavicle and first four ribs, and an

opening into the thoracic cavity. A mutilating wound, 11 x 23 cm., in the anterior left side

of the chest extended from the second intercostal space to the lateral left thoracic margin,

accompanied with fractures of the fourth, fifth, and sixth costal cartilages and exposure

of the pericardium but no penetration of the pericardial sac. A superficial laceration, 3 x 6

cm., was located in the left antecubital space. A lacerated wound in the left thumb and left

fourth and fifth digits exposed compound comminuted fractures in the metacarpals and the

first and second phalanges of the fourth and fifth digits. A deep laceration, 17 x 35 cm., in

the left posterior and medial thigh extended from the popliteal space to the crease of the

buttock. The left femur was not fractured. A penetrating wound, 1.5 cm. in diameter,

entered the left anterior superior thigh. Four penetrating wounds were present in the left

anterior leg and thigh. They varied from 1 cm. to 1.5 em. in diameter.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 467

FIGu•E 253.-Multiple wounds of head, neck, chest, abdomen, and right upper extremity.

Case No. 780.-Pfc., 760th Tank Battalion, 20 Oct. 1944; missile: shell fragments;

multiple wounds in the head, neck, chest, abdomen, right upper extremity (fig. 253), and

both lower extremities. A lacerated penetrating wound, 3 x 10 cm., in the face involved the

right cheek, upper and lower lips, and part of the chin. It opened into the right maxillary

sinus and passed through the right lower jaw. The right ear was lacerated adjacent to a

penetrating wound, 2 x 3 cm., in the right mastoid process. The track extended downward

and medially behind the sternomastoid muscle. A wound, 1 cm. in diameter, penetrated the

neck above the middle third of the right clavicle. The track passed downward and medially

and entered the thorax above the first rib. A wound, 4 cm. in diameter, entered the thoracic

cavity in the anterior right side of the chest at the level of the first and second ribs, through

compound comminuted fracture in the second and third ribs. The track penetrated in a

downward medial direction. Six wounds in all four quadrants of the abdomen varied from

1 x 2 cm. to 2.5 x 3.5 cm. None of these wounds entered the abdominal cavity. A mutilating laceration in the right lateral distal forearm was located adjacent to the wrist. A

compound comminuted fracture in the distal end of the radius was seen in this wound. A

wound, 2 cm. in diameter, penetrated the left anterior superior thigh. An irregular steel

fragment, 2 x .8 cm., was embedded in this wound. A laceration, 3 x 5 cm., was present in

the medial side and dorsum of the right foot. Compound comminuted fractures were visible

in the first and second matatarsal bones.
468 WOUND BALLISTICS

T

FIGURE 254.-Multiple wounds of pelvis, lower extremities, and genitalia.

Case No. 831.-Pfc., 401st Antiaircraft Artillery, 27 Oct. 1944; missile: shell fragments;

multiple wounds in thie head, chest, pelvis, both upper and both lower extremities, and

genitalia (fig. 254). There was a through-and-through wound in the head. The probable

wound of entrance was an opening, 1.3 x 2.5 cm., in the left temple and the point of

exit, a wound inside the mouth which perforated the left maxilla. The left superior canine

tooth, both premolars, and the first molar were avulsed. A penetrating wound, 2.5 x 3.5 cm.,

entered the posterior left side of the chest through a compound comminuted fracture in the

11th rib. The left leg was amputated through the pelvis, the perineum, genitalia, and medial

side of the right thigh as far down as the knee. The bones of the left side of the pelvis were

severely crushed and displaced. The right femur was also fragmented in its lower third.

Three penetrating wounds entered the lateral proximal side of the left arm. They measured

from 1 x 1.5 cm. to 2.5 cu. There was a comminuted fracture in the middle third of the

humerus. Three lacerated open wounds were present in the left mid forearm revealing compound comminuted fractures in both bones. The left hand and wrist was severely mutilated.

Several small wounds entered the right wrist. Numerous penetrating lacerations were found

in both buttocks.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 469

4

FIGURE 255.-Multiple wounds of the head, neck, chest, abdomen, and upper extremities.

Case No. 882.-Sgt., 351st Infantry, 30 Oct. 1944; missile: shell fragments; multiple

wounds (fig. 255) in the head, neck, chest, abdomen, pelvis, and both upper and both lower

extremities. A superficial laceration, 1 x 5 cm., was present in the right side of the forehead.

A wound, 3 x 3 cm., entered the anterior side of the neck in the midline, severing the trachea

inferior to the larynx. A through-and-through wound in the abdomen had the wound of

entrance, 6 x 12 cm., located in the left posterior flank and the wound of exit, 20 x 20 cm., in

the left upper quadrant. There was partial evisceration of the intestine through the larger

wound, which extended superficially into the left lower thorax. Other penetrating wounds

were located in the left superior axillary margin, anterior left shoulder, left inguinal area,

left anterior forearm adjacent to the elbow, where all three bones of the arm were comminuted

in the wound, right antecubital space, where a compound comminuted fracture was visible

in the distal end of the humerus, right anterior superior thigh, left anterior mid thigh and

both anterior mid-legs, with compound comminuted fractures in both bones of both legs.

The distal end of the left femur was also comminuted.
470 WOUND BALLISTICS

FIGURE 256.-Single wound of neck. A. Wound of entrance. B. Wound of exit.

Case No. 904.-S. Sgt., 361st Infantry, 31 Oct. 1944; missile: high explosives; multiple wounds (two) in the neck (fig. 256) and left lower extremity. There was a throughand-through wound in the neck with the wound of entrance, 3 x 4 cm., in the left anterior

side, where it passed through the body of the sternomastoid muscle. The wound of exit,

3 x 6.5 cm., was found in the midline posteriorly at the base of the skull. Fractures, at

the site of exit, extended into the spinal canal through the third and fourth cervical vertebras.

A lacerated wound, 1 x 1.5 cm., in the medial side of the left knee had an irregular steel

fragment, 2 x 1.6 x .5 cm., embedded in it.
EXAMINATION OF 1,000 AMERICAN CASUALTIES 471

FIGURE 257.-Multiple wounds of abdomen, pelvis, and upper and lower extremities.

Case No. 929.-T5g., 532d Antiaircraft Artillery (Air Warning) Battalion, 3 Nov.

1944; missile: shell fragments; multiple wounds (fig. 257) in the head, neck, chest, abdomen,

pelvis, and both upper and lower extremities. There were many lacerated penetrating

wounds present on the anterior surface of the body, including both arms and both thighs,

the chest, abdomen, face, and neck; the wounds varied in size up to 4 x 6 cm., which

was the measurement of a wound located in the anterior superior margin of the left axilla.

There was an avulsive wound in the right lower quadrant of the abdomen which extended

from a point midway between the symphysis pubis and the thoracic margin into the right

anterior mid thigh. Numerous loops of small intestine were eviscerated through the upper

extremity of the wound. There was a compound comminuted fracture in the proximal

third of the shaft of the right femur. The pelvis was not definitely fractured. The" right

leg was amputated through the middle third. The distal portion was attached by strips

of skin. There was essential traumatic amputation of the left leg through the knee joint.

The distal end of the femur was shattered; the severely mutilated distal portion of the leg

was attached by a segment of skin; lacerations extended into the medial mid thigh. A

lacerated wound, 6 x 10 cm., was present in the dorsum of the left wrist, with mutilation

of the third, fourth, and fifth digits of the left hand and fragmentation on the proximal

phalanges of all three digits. Compound comminuted fractures were found in both bones

of the left forearm in their distal thirds.
CHAPTER VII

Study of Fifth U. S. Army Hospital Battle

Casualty Deaths'

Howard E. Snyder, M.D., and James W. Culbertson, M.D.

From 1 January 1944 until the surrender of the German armies in Italy

on 2 May 1945 (the period covered in this study), 91,631 American soldiers

serving in the Fifth U.S. Army were killed or wounded in action (table 120).

Of this total, 16,648 (18.2 percent) died on the battlefield or before reaching

a medical installation; 11,959 (13 percent) were treated and returned to duty

from the division area (fig. 258). Of the remaining 63,024 (68.8 percent)

who were admitted to Fifth U.S. Army hospitals (fig. 259), only 1,631 (1.8

percent) died after their admission. Records of 1,411 (86.47 percent) of these

hospital battle casualty deaths were available for this study. In addition,

the records of 39 casualties who were DOA (dead on arrival) at a hospital

were utilized in many sections of this report. Gross post mortem findings

formed a part of 733 of these records (table 121). Microscopic autopsy reports were received on 349. Most of the clinical records were fairly complete,

TABLE 120.-Distribution of 91,631 Fifth U.S. Army casualties in Italy, from 1 January

1944 to 2 May 1945, by category

Category Number of Percent of

casualties casualties

Kil]ed in action ------------------------------------------ 16, 648 18. 2

Wounded in action:

Hospitalized, DOW (died of wounds) ------------------- 1, 631 1. 8

Hospitalized, lived ----------------------------------- 61, 393 67. 0

Returned to duty without hospitalization ---------------- 11, 959 13. 0

Total --------------------------------------------- 91, 631 100. 0

1 The original three-volume report on which this chapter is based was submitted as a comprehensive survey and

partial analysis of available information on 1,450 fatally wounded American soldiers. There has been a partial attempt

to consolidate and interpret some of the findings, but there are still many lessons which may be drawn from this study.

Brig. Gen. (later Maj. Gen.) Joseph I. Martin, Surgeon, Fifth U.S. Army, at the time the study was started, encouraged and helped make possible the report. Col. Charles 0. Bruce, MC, the Fifth U.S. Army surgeon during the latter

months of the study, furnished needed advice. Maj. Richard A. Morrissey, SnC, statistician in the Fifth U.S. Army

surgeon's office was a source of great encouragement.

To the cited personnel, as well as to the many individuals who have not been mentioned, we express sincere appreciation for their unselfish contributions.-H. E. S. and J. W. C.

473
474 WOUND BALLISTICS

FIGURE 258.--Building occupied by field hospital platoon and four surgical teams,

Porretta, Italy.

but, in some, much desirable information was missing. However, most of

the autopsies were performed by the operating surgeons already engaged in

the arduous surgical tasks associated with an offensive, and the records are

a tribute to the scientific zeal of the surgeons working in the Fifth U.S. Army

hospitals.

TABLE 121.-Post mortem studies available and total hospital battle casualty deaths studied,

during survey period, 1 January 1944-2 May 1945

Gross findings available Microscopic reports Total num- available ber of hosPeriod pital battle casualty

Number Percent Number Percent deaths

studied I

1944

January-March ------------------------- 171 32. 3 37 7. 0 529

April-July ------------------------------ 254 52. 7 119 24. 7 482

August-December ---------------------- 180 63. 4 99 34. 9 284

1945

January-May --------------------------- 128 82. 6 94 60. 6 155

Total ---------------------------- 733 50. 6 349 24. 0 1,450

1 Includes records of 39 casualties who were DOA at a hospital.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 475

FIGURE 259-95th Evacuation Hospital, Monghidoro, Italy.

It. may be assumed that the 1,411 hospital battle casualty deaths studied

are truly representative of the total of 1,631 who (according to MTOUSA MD

Form 86f) died in Fifth U.S. Army hospitals. Beginning with 1 January

1944, General Martin requested submission of a complete record on all battle

casualties dying in Fifth U.S. Army hospitals. From 1 January 1944 to 2

May 1945, the Adjutant General's "Wound Classification Report" submitted

by the hospitals listed 58,677 battle casualty admissions and 1,562 battle casualty deaths in hospitals. These figures are lower than those reported on the

MTOUSA MD Form 86f. From the latter, the figure for battle casualty hospital admissions is 63,024 and for battle casualty hospital deaths, 1,631. These

larger figures have been used in setting 86.5 percent as the portion studied of

all the hospital battle casualty deaths and have been correspondingly reduced

when calculating percentage mortalities. In calculating percentages of total

battle casualties or of battle casualty hospital admissions, by period, correction

has been made for the percentage of cases studied during each period (table

122).

The Adjutant General's figures and the MTOUSA MD Form 86f include

the injured in action as well as the WIA and the KIA casualties. Of the

deaths studied, only a few who had crush injuries might be regarded as injured

rather than as wounded in action. All of the casualties (20) due to crush injuries resulted from falling stones or bricks set in motion by the explosion of
476 WOUND BALLISTICS

TABLE 122.-Correction of total battle casualty admission figures to agree 'With proportion of

total deaths analyzed, by survey period, 1 January 1944-2 May 1945

Battle casualty deaths Battle casualty admissions I

Survey period Studied 2 UnReported I corrected Corrected

(number) (number) (number) Number Percent Correction

factor

1944

January-March ----------------- 570 522 91. 6 8. 4 14, 498 13, 282

April-July ---------------------- 542 466 86. 0 14. 0 23, 111 19, 876

August--December --------------- 332 275 83. 0 17. 0 16, 221 13, 464

1945

January-May ------------------ 187 148 79. 2 20. 8 9,194 7,282

Total -------------------- 1,631 1,411 86. 5 13. 5 63, 024 53, 904

1 Data obtained from MTOUSA MD Form 86f.

2 Excludes records of 39 casualties who were DOA at a hospital.

an enemy shell, and most of these casualties had wounds in addition to the

crush injury. It may be said, then, that the deaths studied represent a considerably larger percentage of WIA casualties who died than is indicated by

the percentage of 86.5 percent which is based upon the total (1,631) of wounded

and injured in action who died in Fifth U.S. Army hospitals during the period

studied. The breakdown of injured in action and wounded in action is not

available either for hospital battle casualty admissions or for the total resulting from the sum of the Adjutant General's figures on wounded in action plus

killed in action.

The 39 records of battle casualties DOA at a hospital comprise all the

records submitted on this class of deaths. Statistics are not available to determine their percentage of the entire group of DOA's. Most of them were unquestionably patients who, when seen by the last medical officer, were expected

to reach the hospital alive. The DOA group has been included in the tables

on wound classification and causes of death and, in many instances, has been

singled out for individual study as compared to the group of casualties who

died shortly after admission, before anesthesia, during anesthetic induction,

during primary surgery, and after primary surgery. The cases have not been

included in tables dealing with hcspital battle casualty deaths or in any of the

percentage tables based on hospital battle casualty admissions or the total of

wounded in action plus killed in action.

The information recorded in the tables of this report was first recorded in

code form so that it might be transferred to machine records cards. Study of

the cases and the primary recording of these data consumed the entire time of

Capt. (later Maj.) James W. Culbertson, MC, (fig. 260), for a period of a little
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 477

FIGURE 260.-Capt. James W. Culbertson, MC, (right) obtaining information

from hospital personnel concerning battle casualties.

over 3 months. Col. Howard E. Snyder, MC, (fig. 261) then studied each case

and checked the recorded data.2 Each item was carefully weighed, matters

calling for opinion were discussed, and all questionable data were recorded

as questionable. The completed machine records cards were checked by

hand for accuracy. Colonel Snyder and Captain Culbertson, with their

clerical assistants, did all machine counting and recording of data. Many

cbecks were made on the validity of the machine tabulations. It is considered

that the margin of error in this method was no greater than, if as great as, the

personal error in manual counting.

REGION, TYPE, AND DISTRIBUTION OF WOUNDS

Table 123 lists the general breakdown of the 1,450 casualties as related to

hospital admission, anesthesia, and surgery. With experience and improvement in the preparation of battle casualties for surgery, the number of those

dying before anesthesia decreased throughout the period covered in the report.

When one compares the distribution of hospital deaths during the various time

2 More data were accumulated than are presented in this chapter. In the original report, figures on timelags are

available in all cases in which the information was in the record. Studies on all cases with nephropathies, fat embolisms,

shock, thoracoabdominal wounds have been made. These studies are comparable in scope to that study on cases with

intra-abdominal wounds which is presented in this report. It is hoped that the statistical information in the complete

preliminary report will be of value to those studying and writing upon war surgery.-II. E. S. and J. W. C.
478 WOUND BALLISTICS

J... :

FIGURE 261.-Col. Howard E. Snyder, MC, Surgical Consultant, Fifth U.S.

Army, at the time the original report was compiled.

periods to the total hospital battle casualty admissions (table 124), there is a

consistent reduction in the percentage of those dying before, during, and after

anesthesia. Casualties at the Anzio beachhead were included in the first two

periods of the survey (January-March 1944; April-July 1944) and unquestionably increased the percentage of those dying before anesthesia and the total

hospital battle casualty mortality in the first two periods. The reduction in the

latter mortality figure from 3.9 percent in the first period to 2.0 percent in the

last is dependent on more than the Anzio casualties. The reduction in the percentage of those dying before anesthesia is in part due to the general adoption

of improved methods of resuscitation and to a more available supply of blood.

A hospital battle casualty mortality rate is influenced not only by the hospital's

proximity to the battlefront but also by the quality of care administered the

wounded who reach it alive.

Morrissey has called attention to the direct relationship of the percentage

mortality of battle casualties admitted to hospitals, the percentage mortality of

battle casualties admitted to hospitals and dying before anesthesia, and the percentage hospital battle casualty deaths comprised of the total who die of wounds

(includes KIA) (table 125). He has shown that the latter percentage varies

widely. At Anzio, 16 percent of all battle casualty deaths occurred in hos-
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 479

TABLE 123.-Distribution of 1,450 deaths1 as related to hospital admission, anesthesia, and

surgery, during survey period, I January 1944-2 May 1945

Dying on Died before Died during Died during Died after

admission 2 anesthesia 3 anesthetic primary primary induction surgery surgery Total

Survey period deaths

Num- Percent Num- Percent Num.- Percent Num- Percent Num- Percent

ber her her bar ber

1944

January-March ------ 27 5. 2 157 30. 1 8 1.5 20 3. 8 310 59. 4 522

April-July ---------- 27 5. 8 108 23.2 3 . 6 25 5.4 303 65. 0 466

August-December .... 12 4. 4 48 17. 4 4 1.5 19 6. 9 192 69. 8 275

1945

January-May ------- 8 5.4 24 16.2 1 .7 11 7.4 104 70. 3 148

Total --------- 74 5. 3 337 23. 9 16 1. 1 75 5. 3 909 64. 4 1,411

1 Excludes 39 DOA casualties. Their distribution was as follows: For the January-March 1944 period, 7; for AprilJuly 1944, 16; for August-December 1944, 9; and for January-May 1945, 7.

2 Lived less than an hour.

3 Excludes those dying on admission.

TABLE 124.-Percent of 1,411 hospital deaths studied to total battle casualty hospitat

admissions (53,904), during survey period, 1 January 1944-2 May 1945

Hospital deaths 1 Battle casualty hospital admissions 2

Survey period Total Before During Died Diedduring Died in

studied anesthesia3 anesthesia Total before anesthesia Army or surgery 4 anesthesia or surgery hospitals

1944 Number Percent Percent Number Percent Percent Percent

January-March - 522 35. 3 5. 3 13, 282 1.39 0. 21 3. 9

April-July ----------- 466 29.0 6.0 19, 876 . 68 .14 2. 3

August-December--- 275 21.8 8. 4 13, 464 .44 .17 2. 0

1945

January-May ------- 148 21.6 8. 1 7,282 .44 .16 2. 0

Total ---------- 1,411 29. 1 6.4 53, 904 .75 .16 2. 6

1 Excludes 39 D OA casualties. 2 Corrected to allow for percentage of deaths not studied during each period. (See table 122.) 3 From table 123, includes those dying on admission. 4 From table 123.

pitals (hospital mortality, 5.7 percent). In May 1944, 4.21 percent of all

battle casualty deaths occurred in hospitals (hospital mortality, 1.7 percent).

In June 1944, 15 percent of all battle casualty deaths were in hospitals (hospital mortality, 2.8 percent). In October 1944, 7.65 percent of all battle casualty deaths were in hospitals (hospital mortality, 2.1 percent). When evacuation of the wounded to the forward hospital (fig. 262) is easily accomplished,
480 WOUND BALLISTICS

:'(:4

FIGURE 262.-Location of field hospital platoon used as a forward surgical unit before the

breakthrough into the Po Valley.

the hospital mortality rises. Thus, hospital mortality tends to vary inversely

with the percentage who are killed in action or who die of wounds before reaching a hospital. However, as is shown in table 125, there has been a steady,

gradual decrease in the percentage which deaths occurring during and after

surgery comprise of total battle casualty deaths. Table 124 shows a slight

increase throughout the four periods in the percentage which deaths during

surgery comprise of the deaths studied but a decrease in the percentage these

deaths comprise of battle casualties admitted to hospitals.

The simple classification of cases by region of principal wound in table 126

is presented for comparison with similar tables on hospital battle casualty admissions and deaths which were available for all of the Tunisian, Sicilian, and

Italian campaigns.

Table 127 lists battle casualty hospital deaths according to principal

wound groups. It was found that in only 33.3 percent of the casualties studied

were the wounds limited to one of the wound groups listed in this table,

and 66.7 percent of the casualties bad wounds involving multiple regions of

the body. Many of the 33.3 percent had multiple wounds, but these wounds

were limited to only one of the anatomic regions.3

3 (1) A more detailed breakdown of thc cases listed in table 127 is presented in tables 1 and 2, appendix D (p. 807).

Table 1 presents the distribution of associated wounds as related to the region of the principal wound; table 2 presents

the regional distribution of principal and associated wounds with the number of cases exhibiting each. (2) A furtherclarification of the three wound classes in table 127, involving intrathoracic, thoracoabdominal, and combined intraabdominal and intrathoracic wounds, is presented in appendix E (p. 811).
W3IFTH U.S. ARMY HOSPITAL BATTLE DEATHS 481

TABLE 125.-Demonstration of effect of increased efficiency of evacuation from forward areas on

hospital mortality (an increase) and the remaining favorable trend after exclusion of those cases I

dying before anesthesia

August- Category January- April-July December January- March 1944 1944 1944 May 1945

Killed, wounded, and injured in action ---- number-- 24, 351 32, 026 22, 469 12, 556

Killed in action plus died of wounds 2 ------- do -- 5, 042 6, 366 4, 234 2, 506

Mortality of the killed, wounded, and injured in

action ------------------------------ percent-- 20. 70 19. 88 18. 84 19. 96

Battle casualties admitted to hospitals ..- number-_ 14, 498 23, 111 16, 221 9, 194

Battle casualties dying in hospitals ---------- do---- 570 542 332 187

Mortality of battle casualties admitted to hospitals -------------------------------- percent-- 3.94 2.34 2.05 2. 04

Total battle casualty deaths dying in hospitals

-------------------------------------- percent-- 11.3 8. 5 7. 8 6. 8

Hospital battle casualty deaths who died before anesthesia ------------------------------ percent-- 35. 3 29. 0 21.8 21. 6

Hospital battle casualty deaths who died after reaching anesthesia ------------------------ percent-- 7. 3 6. 2 6. 14 5. 3

Total killed, wounded, and injured in action who

died after reaching anesthesia- -- ------- percent-_ 1. 515 1. 200 1. 160 1. 050

' A variable quantity influenced by conditions affecting efficiency of evacuation to hospitals as well as by professional

care before and after admission. 2 Does not include those few deaths which occurred in base hospitals.

Source: History of Fifth Army Medical Service, 1945. [Official record.]

TABLE 126.-Distribution of battle casualty hospital deaths (1,450 cases),

by region of principal wound

Region of principal wound Number of cases Percent of cases

Abdomen ------------------------------------------------ 543 37.4

Head --------------------------------------------------- 297 20. 5

Chest -------------------------------------------------- 277 19. 1

Lower extremity ------------------------------------------ 145 10. 0

Spine --------------------------------------------------- 27 1. 9

Neck ---------------------------------------------------- 25 1. 7

Upper extremity ----------------------------------------- 14 . 9

Face and jaws ------------------------------------------- . 6

Unclassified multiple wounds ------------------------------- 114 7.9

Total ---------------------------------------------- 1,450 100.0

Table 127 may be compared with the distribution of wounds among all

battle casualties admitted to Fifth U.S. Army hospitals during the period of

1 August 1944 to 2 May 1945 (table 128). Intra-abdominal wounds comprise

only 2.84 percent of battle casualties admitted to a hospital but 20 percent of

them died and these comprise 28.1 percent of all hospital battle casualty deaths.
482 WOUND BALLISTICS

TABLE 127.-Distribution of battle casualty hospital deaths (1,450 cases), by principal wound

Total cases Cases without associated wounds

Principal woundt

Number Percent Number Percent

Intra-abdominal -------------- 408 28. 1 131 32. 1

Intracranial ------------------------------------ 297 20. 5 138 46.5

Thoracoabdominal 2- ........... 212 14. 6 98 46.2

Intrathoracic 2 -------------- 138 9. 5 37 26. 8

Lower extremity, with bone involvement ------------ 114 7. 8 4 49 43. 0

Unclassified, multiple wounds --------------------- 114 7. 8 ................

Combined intra-abdominal and intrathoracic 2 ...... 59 4. 1 7 11.9

Lower extremity, soft tissue only ------------------ 31 2. 2 14 45. 2

Intravertebral ----------------------------------- 27 1.9 1 3. 7

Cervical ----------------------------------------- 25 1.0 5 20.0

Upper extremity, with bone involvement ----------- 5 10 .7 2 20. 0

Maxillofacial, with bone involvement --------------- 8 . 6 1 12. 5

Upper extremity, soft tissue only --------------------- 4 .3-

Abdominal wall ---------------------------------- 3 .2 ...

Total ------------------------------------ 1, 450 100. 0 483 33. 3

1 A more detailed classification is listed in appendix D, p. 8C7. 4 Includes 17 traumatic amputations.

2 A more detailed classification is listed in appendix E, p. 811. 5 Includes 2 traumatic amputations.

3 Includes 43 traumatic amputations.

TABLE 128.-Dietribution of 20,747 American battle casualties admitted to Fifth. U.S. Army

hospitals, 1 August 1944-2 May 1945, by principal wound group

Percent of all Percent that

Principal wound battle casualty died

admissions

Intra-abdominal ------------------------------------------ 2.84 20.0

Thoracoabdominal plus combined intra-abdominal and intrathoracic ------------------------------------------------ 1.66 20.4

Superficial abdominal -------------------------------------.. 74 . 0

Intrathoracic -------------------------------------------- 4. 64 7. 8

Superficial thoracic ---------------------------------------- 3.73 .2

Intracranial ---------------------------------------------- 1.95 26. 00

Scalp --------------------------------------------------- 3. 7 .0

Lower extremity:

Soft tissue and bone ---------------------------------- 9. 35 1.74

Soft tissue only --------------------------------------- 32. 48 .25

Upper extremity:

Soft tissue and bone ---------------------------------- 6.25 .28

Soft tissue only --------------------------------------- 19.30 .02

Neck --------------------------------------------------- 2.07 .87

Spine ---------------------------------------------------- .94 7. 10

Maxillofacial:

Soft tissue only --------------------------------------- 4.68 .29

Bone and soft tissue ---------------------------------- 1.22 1. 50

Eye and ear ---------------------------------------------- 2.00 .00

Other ---------------------------------------------------- 2.30 .55

NOTE.-O.0 indicates a rate of more than zero but less than 0.05, and 0.00 a rate of more than zero but less than 0.005.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 483

The intra-abdominal, intrathoracie, thoracoabdominal, combined intra-abdominal and intrathoracic, and intracranial wounds comprise only 11.09 percent of

hospital battle casualty admissions, and yet they account for 76.8 percent of

all hospital battle casualty deaths. Table 129 relates the 1,411 hospital

battle casualty deaths to the total hospital battle casualty admissions during

the survey period.

TABLE 129.-Hospital battle casualty deaths listed as to principal wound with percentage of

hospital battle casualty admissions

Percent of toNumber tal 2 hospital

Principal wound of deaths I battle casu- alty admissions

(53, 904)

Intra-abdominal ----------------------------------------- 402 0. 745

Intracranial --------------------------------------------- 288 .534

Thoracoabdominal --------------------------------------- 210 .389

Intrathoracic --------------------------------------------- 131 .241

Lower extremity (bone involvement) ------------------------ 110 .204

Unclassified, multiple wounds ------------------------------ 106 .196

Combined intra-abdominal and intrathoracic ---------------- 57 .105

Lower extremity, soft tissue only ---------------------------- 30 .055

Intravertebral -------------------------------------------- 27 .050

Cervical ------------------------------------------------- 25 .046

Upper extremity (bone involvement) ------------------------ 10 .018

Maxillofacial --------------------------------------------- 8 .014

Upper extremity, soft tissue only --------------------------- 4 .007

Abdominal wall ------------------------------------------- 3 . 005

Total ---------------------------------------------- 1,411 2. 61

1 Does not include 39 DOA casualties.

SFigure of total 63,024 admissions corrected to allow for 13.5 percent of hospital battle casualty deaths not studied.

The type of causative agent as related to the principal wound is listed in

table 130. Small arms accounted for approximately 15.11 percent of the

hospital deaths while high explosive shell fragments (exclusive of mine, boobytrap, and bomb) were identified in 59.38 percent of the cases.

Table 131 correlates the principal wound with the time of death and the

hospital admission, anesthesia, and surgery.
484 WOUND BALLISTICS

ac- 41D m -t - Ia

CYq '-a t- O q

cC q

0 't C1 C1 I

OK8 1 I I = O

0

-0 m -q I tI -

a~~~C i i, I II I

ocl ~ CC mm 

a m) Cc C) -i t- c a .= 

C1 00

t- C'lCC "t.~C 0 C 00C) C C''l 

C0 '-- =o 0 C a Caco'

tI r-0 matN C 0

Cý c aq 'a' 'd Cc-- El aaO Ia

E ~

0 EC) ___ - __ ____ ___ ___ ____ -- ~ _ ____ ___ ___

~ t~~a r a ai i

71~ - ~ ~ J o i-1:a1 a ~ CU5 a a a Pq 

C)] a i a7C

I I I I 0

El 0 . -, i 4C
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 485

TABLE 131.-Distribution of 1,450 battle casualty deaths as related to hospital admission,

anesthesia, and surgery, by principal wound

Dying on Died before Died during Died during Died after

Principal wound DOA admission I anesthesia 2 anesthetic primary primary induction surgery surgery

Intra-abdominal ---------------- 6 12 45 5 20 317

Intracranial -------------------- 9 17 142 -------- 6 123

Thoracoabdominal------------ 2 3 20 2 29 156

Intrathoracic ------------------ 7 13 35 2 8 73

Lower extremity, bone and soft

tissue ----------------------- 4 14 is -------- 5 73

Unclassified multiple ------------ 8 7 45 2 3 49

Combined intra-abdominal and

intrathoracic ----------------- 2 3 6 1 2 45

Lower extremity, soft tissue only- 1 2 5 -------- -------- , .23

Intravertebral -------------------------.--------- 10 --------.-------- 17

Cervical -------------------------------- 2 5 -------- 2 16

Upper extremity, bone and soft

tissue ------------------------------- 1 2 --------.--------- 7

Maxillofacial ------------------.--------.----------------- 1 - 7

Upper extremity, soft tissue only ---------.--------------- 4 .................

Abdominal wall only --------------------.--------.--------.-------- --------- 3

Total -------------------- 39 74 337 16 75 909

I Lived less than I hour.

2 Excludes the DOA cases and those casualties who lived less than 1 hour.

CAUSES OF DEATH

General Observations

Certain problems were encountered in the classification and arrangement

of this material. The Adjutant General of the Fifth U.S. Army and The

Adjutant General of the U.S. Army report battle casualty deaths as "killed

in action" or "died of wounds" (the latter includes those dying of injuries

incurred in action). Hospitals report deaths according to a classification of

principal wounds. Generally speaking, all battle casualties who die are said

to die of wounds or injuries incurred in action. All of the cases reported in

this study may be said to have died either of wounds or of injuries incurred in

action against the enemy. Table 132 classifies the cases as to region of primary

trauma leading to death. This classification is comparable to those just

mentioned. For the purposes of this study, however, such classifications have

been deemed inadequate.

A battle casualty who suffers a laceration of the popliteal artery may or

may not lose sufficient blood to lead to severe shock, and death. If he does,

the primary cause of death according to conventional reports is a wound of
486 WOUND BALLISTICS

TABLE 132.-Distribution of battle casualty hospital deaths (1,450 cases) during survey period,

1 January 1944-2 May 1945, by region of primary trauma leading to death

January-March April-July August-December January-May Total Region of 1944 1944 1944 1945

primary trauma

Number Percent Number Percent Number Percent Number Percent Number Percent

Shock 1---- 183 34. 6 192 39. 9 93 32. 7 55 35. 5 523 36. 1

Intracranial ------ 73 13. 7 71 14. 7 48 16. 9 42 27. 1 234 16. 1

Thoracic -------- 45 8.4 45 9. 4 47 16. 5 21 13. 6 158 10. 9

Abdominopelvic_- 30 5. 6 59 12. 3 47 16. 5 18 1i. 6 154 10. 6

Extremity ------- 32 6.0 8 1.7 3 1. 1 2 1.3 45 3. 1

Spinal ------------ 6 1. 1 1 .2 9 3. 2 3 1.9 19 1.3

Miscellaneous

(general) ------ 5 .9 3 .4 3 . 1------ ------ 11 .8

Cervical ----------. . 6 1 . 2 ------------------------ 2 . 1

Maxillofacial ----- ------------- 1 . 2 ------------------------ . 1

Undetermined,

unclassified ---- 154 29. 1 101 21.0 34 12. 0 14 9. 0 303 20. 9

Total ------ 529 100. 0 482 100.0 284 100. 0 155 100. 0 1,450 100. 0

I Generalized conditions involving more than one region.

the posterior aspect of the knee, with laceration of the popliteal artery. For

the purposes of this report, the important desideratum in such a case is that

the immediate or precipitating cause of death is shock (peripheral vascular

failure).

While fully aware of the controversial nature of the subject, the decision

was made to include the uncorrected state of shock as an immediate or precipitating cause of death, along with other more specific, standard diagnoses.

It may be contended, of course, that such patients actually die of their wounds

and the severity of the trauma attending them and that the shock which is

present is a syndrome reflecting a profound pathologic alteration of normal

hemodynamics and is not an acceptable diagnosis. However, in this study,

as just stated, each case has been classified as to primary trauma leading to

death (the conventional primary or basic diagnosis), and the liberty of

employing the concept of the state of shock as a "diagnosis" for the immediate

or precipitating cause of death (the conventional secondary diagnosis) allows

for a more complete classification of the causes of death for comparison and

study. This sets in relief that important group of cases which succumbed

from the gravity of their wounds in a state of uncontrolled shock. It seems

that this group of cases is worthy of the special attention afforded by such a

classification.

Shock was selected as the immediate cause of death in 523 cases in this

series. A special study was made on this group and is presented on page 511.

The criteria used in naming shock as an immediate cause of death are discussed

there and are apparent in the information tabulated.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 487

"Neural trauma and/or intracranial hemorrhage or clot" was listed as the

immediate cause of death in 212 cases and is second on the list of the immediate causes of death, as is shown in tables 133 and 134 and in the tabulation

which is to follow. The relative importance as a lethal factor of the brain

damage produced by the missile and the damage produced by an expanding

intracranial hematoma was often difficult to determine. It seemed unwise,

considering the available information and the qualifications necessary for evaluation, to attempt to separate these cases into two groups. It may be mentioned here that only 15 cases in whom the principal wound was intracranial

were listed as dying of shock, while 210 were listed as dying of neural trauma

or clot. (All 235 cases in these two categories were listed also under the heading "Primary trauma leading to death, intracranial.") Nephropathies were

third on the list, and their incidence was relatively constant except during the

first 3 months of the period covered by this report. The low incidence at that

time may be attributed to failure of recognition and is therefore apparent rather than real. Number of Number of

case8 caose

Immediate cause of death: Immediate cause of death-Con.

Shock ------------------------ 523 Pulmonary blast and other

Neural (brain) trauma and/or trauma ---------------------- 2

intracranial hemorrhage or Ventricular arrest -------------- 2

clot ------------------------ 212 Abscess, intracranial ----------- 1

Pigment nephropathy ------------ 68 Infarction, brain and lung ------ 1

Peritonitis -------------------- 65 Mediastnial hemorrhage --------- 1

Clostridial myositis ------------ 51 Mediastinitis ----------------- 1

Pneumonia -------------------- 49 Meningitis, spinal ------------

Fat embolism ----------------- 27 Pneumonitis ------------------ 1

Thrombotic embolism ----------- 20 Respiratory failure, cause unSpinal cord trauma ------------ 16 determined ------------------ 1

Traeheobronchial obstruction: Sepsis unclassified, abdominal-- 1

Aspirated vomitus ---------- 11 Sepsis unclassified, extremity-- 1

Blood and mucus ---------- 11 Septicemia -------------------- 1

Cerebral ischemia -------------- 8 Thoracoabdominal trauma, unAnesthetic agent --------------- 7 classified -------------------- 1

Empyema thoracis ------------- 7 Transfusion reaction ----------- I

Intracranial blast trauma alone- 5 Other intra-abdominal condiCellulitis (extraperitoneal) ------ 4 tion ----------------------- 2

Myocardial decompensation ---- 4 Other intracranial condition ..-- 1

Coronary occlusion ------------- 3 Undetermined thoracic condiPulmonary blast trauma alone-- 3 tion ------------------------ 12

Respiratory obstruction above Undetermined intra-abdominal

trachea -------------------- 3 condition -------------------- 4

Abscess, intra-abdominal ------- 2 Undetermined abdominal wall

Air embolism ----------------- 2 condition -------------------- 1

Infarction of lung -------------- 2 Undetermined intracranial conIntestinal obstruction ---------- 2 dition ---------------------- 2

Intracranial blast and other Undetermined, unclassified------ -303

trauma --------------------- 2

Meningitis, intracranial -------- 2 Total ---------------------- 1,450
488 WOUND BALLISTICS

TABLE 133.-Distribution of 1,450 battle casualty deaths1 during survey period, 1 January

1944-2 May 1945, by cause of death

January- April-July August- January- January 1944

March 1944 1944 December May 1945 through May

1944 1945

Cause of death

Num- Percent Num- Percent Num- Percent Num- Percent Number Percent

ber ber ber her

Shock ------------------- 183 34. 6 194 40. 3 91 32. 0 55 35. 5 523 36. 1

Neural trauma and/or intracranial hemorrhage

or clot ---------------- 65 12. 3 66 13. 7 45 15. 8 36 23. 2 212 14.7

Nephropathy ------------- 9 1. 7 25 5. 2 26 9. 2 8 5. 2 68 4. 7

Peritonitis --------------- 13 2. 5 26 5. 4 19 6. 7 7 4. 5 65 4.5

Clostridial myositis ------- 35 6. 6 11 2.3 4 1.4 1 .6 51 3. 5

Pneumonia -------------- 20 3. 8 6 1.2 17 6. 0 6 3. 9 49 3.4

Fat embolism ------------ 5 . 9 9 1.9 9 3. 2 4 2.6 27 1. 9

Thrombotic embolism- 5 .9 12 2. 5 1 .4 2 1. 3 20 1. 4

Spinal cord trauma ------- 6 1. 1 1 .2 6 2. 1 3 1.9 16 1. 1

Tracheobronchial obstruction:

Aspirated vomitus ---- 3 . 6 1 .2 3 1. 1 4 2. 6 11 .8

Blood and mucus ---- 1 .2 4 .8 3 1. 1 3 1.9 11 .8

Cerebral ischemia_-- 2 .4 1 .2 2 .7 3 1.9 8 .6

Others in which immediate

cause of death is known- 28 5. 3 25 5. 2 24 8. 4 9 5. 9 86 5. 6

Remainder in which immediate cause of death is

undetermined, unclassified ------------------- 154 29. 1 101 20.9 34 11.9 14 9.0 303 20.9

Total ------------- 529 100.0 482 100.0 284 100.0 155 100.0 1,450 100.0

SSee tabulation on text page 487 for the total list of the immediate causes of death in the 1,450 cases.

In the first survey period, clostridial myositis was the third leading cause

of death, the 35 cases comprising 6.5 percent of all deaths, and 0.28 percent of

hospital battle casualty admissions. In the last period, it fell to the bottom

of the list, with only one death attributed to it, comprising 0.6 percent of the

deaths studied, and only 0.01 percent of all battle casualties admitted to hospitals. The educational program concerning clostridial myositis and the study

of the problem conducted by Maj. Floyd HI. Jergesen, MC, and Lt. Col. F. A.

Simeone, MC, coupled with the more complete surgery on all wounds, the more

liberal use of blood, and the advent of the extensive use of penicillin were important factors in effecting this striking reduction in mortality and the corresponding reduction in the incidence.

Peritonitis tended to show a slight increase in its percentage of the total

battle casualty admissions and a more pronounced increase in its percentage of

the deaths studied. There are two factors which may have contributed. First is

the reduction in mortality from shock, clostridial myositis, extremity wounds,
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 489

TABLE 134.-Distribution of 1,450 battle casualty deaths, showing percent of the total battle

casualty admissions (53,904) 1 during survey period, 1 January 1944-2 May 1945, by

cause of death

August- January Cause of death January- April-July December January- 1944 March 1944 1944 1944 May 1945 through

May 1945

Shock ---------------------------------- 1.38 0. 98 0. 676 0. 750 0. 960

Neural trauma and/or intracranial hemorrhage or clot --------------------------. 49 35 .334 .490 .390

Peritonitis ----------------------------- . 068 126 . 193 . 110 125

Clostridial myositis ----------------------. 280 .055 . 030 . 010 .094

Pneumonia -----------------------------. 160 . 030 126 . 080 090

Fat embolism ---------------------------. 040 .040 .067 .050 050

Thrombotic embolism ------------------- . 040 060 . 010 . 030 040

Spinal cord trauma ---------------------. 050 005 . 050 . 040 030

Tracheobronchial obstruction:

Aspirated vomitus ------------------ . 020 005 . 020 . 050 . 020

Blood and mucus ------------------- . 010 020 . 020 . 040 . 020

Cerebral ischemia ------------------------. 020 .005 .015 . 040 . 015

1 Corrected to allow for the percentage of hospital battle casualty deaths not studied in each period.

and unclassified wounds in the course of the 17 months covered by the study.

This has led to a relative increase in peritonitis deaths, deaths from intracranial

wounds, and other wounds or complications, the incidence of which was more

or less inevitable. The second factor is the increase in the percentage of autopsies performed which probably accounts for the apparent but slight increase in

the number of peritonitis deaths as compared to hospital battle casualty

admissions.

The only striking variation in mortality from pneumonia is in the AprilJuly 1944 period, in which pneumonia deaths comprised only 1.2 percent of the

deaths studied as compared to the average of 3.4 percent for all four periods.

It is the only one of the four periods which did not include winter months.

Tables 135, 136, and 137 compare the region of principal wound, the immediate cause of death, and the region of primary trauma. Attention is

directed to the incidence of fat embolism. This diagnosis was not recorded

except when microscopic reports indicated large amounts of fat in the pulmonary sections and the record indicated a clinical behavior justifying the diagnosis.

It may be noted (table 148) that the diagnosis of fat embolism was evident in

22 additional cases in which it was listed as a contributory condition rather

than as the immediate cause of death.

Thrombotic embolism and tracheobronchial obstruction from aspirated

vomitus, blood, or mucus appear quite prominently in the leading causes of

death. Their relative incidence showed a definite increase and the actual

incidence perhaps a slight increase in spite of recognition of their importance

and the inauguration of prophylactic measures early in the campaign.

603225V-62- 33
490 WOUND BALLISTICS

TABLE 135.-Comparison of principal wound with region of immediate couse of death

(1,450 cases)

Region of principal wound Region of immediate cause of in- death in- Anatomic rogion

Cases Percent of Case, Peroent of

(number) cases studied (number) cases studied

Abdominal ------------------------------ 543 37, 5 154 10. 6

Intracranial ----------------------------- 297 20. 5 234 16. 1

Thoracic -------------------------------- 277 19, 1 158 10. 9

Extremity ------------------------------- 159 11.0 45 3. 1

Intravertebral -------------------------- 27 1. 8 19 1.3

Cervical -------------------------------- 25 1. 7 2 . 1

Maxillofacial ---------------------------- 8 . 5 1 . 1

Unclassified ----------------------------- 1 114 7. 9 2 303 20. 9

G eneral 3 ............................... -

.. -....... -.. -..... - - - - 11 .8

Shock ------------------------------------------------------ 523 36. 1

Total ---------------------------- 1,450 100.0 1,450 100. 0

I Multiple wounds.

2 Cause of death undetermined.

3 -More than one region involved by cause of death, excluding shock.

TABLE 136.-Region of immediate cause of death as related to region of principal

wound (1,450 cases)

UndeterPrincipal wound Abdomi- Cer- Ex- Intra- Max- Spi- Thora- Gee- Shock mined, nal vical trem- cranial illo- nal Cic eral unclassiity facial fled

Intracranial ------------------ 2 3 221 ---- 1 15 ---- 15 40

Intravertebral --------------------------------------- 16 4 -- _- 4 3

Maxillofacial -------------------------------------------- 3 -- _ 1 4

Cervical ------------------- 1 2 _ 4 --------- 4 -_ 11 3

Intrathoracic --------------- 3 _- 1 3 --------- 37 1 70 23

Thoracoabdominal ---------- 25 ------------ 1 1- 20 1 118 46

Combined intra-abdominal

and intrathoracic --------- 14 ---- ----...---- ----- 7 1 25 11

Intra-abdominal ------------- -89 7 --------------- 39 4 178 91

Abdominal wall only --------- . 1 -------------- ---------- 1 ---- ------- 1

Upper extremity:

Soft tissue only --------.. 1.-------- -------------------------- 2 1

Bone and soft tissue ---------- ---------------------------- 1 3 5

Lower extremity:

Soft tissue only -------- 5 _ 8 ----------- 1 3 1 9 4

Bone and soft tissue .... 8 --- 22 1 --------- 15 2 41 25

Unclassified, multiple ------- 5 ---- 3 3 1- 10 -_- 46 46

Total --------------- 154 2 45 234 1 19 158 11 523 303

1 Involving more than one region, a miscellaneous group, excluding shock.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 491

TABLE 137.-Region of primary trauma leading to death, by period

January- April-July August- January-May Total

March 1944 1944 Decembher 1944 1945

Primary trauma __--__ . . . .....

Num- Percent Num. Percent Num- Percent Num- Percent Num- Percent ber her her her her

Abdominopelvic ---------- 124 23. 5 131 27. 2 80 28.2 33 21.3 368 25.4

Intracranial -------------- 97 18. 3 81 16. 8 57 20. 1 46 29. 7 281 19. 4

Thoracoabdominal -------- 62 11. 7 74 15. 3 43 15. 1 23 14. 8 202 13. 9

Extremity ---------------- 83 15. 7 58 12.0 28 9.9 9 5.8 178 12.3

Unclassified, multiple ---- 83 15. 7 55 11.4 25 8.8 12 7. 7 175 12. 1

Thoracic ---------------- 44 8.3 49 10.2 30 10.5 11 7. 1 134 9.2

Combined thoracic and

abdominal ------------- 18 3.4 17 3. 6 10 3.5 8 5. 2 53 3. 7

Cervical ------------------ 8 1.5 10 2. 1 2 . 7 6 3. 9 26 1.8

Spinal ------------------- 7 1.3 4 .8 8 2.8 6 3.9 25 1. 7

Maxillofacial ------------- 1 . 2 3 . 6 1 .4 1 . 6 6 .4

Undetermined I ------ 2 .4 ----.----------.------.----------- 2 .1

Total ------------- 529 100.0 482 100.0 284 100.0 155 100.0 1,450 100.0

I Record inadequate in description of wounds.

Tables 138 through 149 deal with the total reported incidence of immediate and contributing causes of death. In this report, they are the best source

of information regarding the incidence of any one condition. All the figures

in the column under "Immediate cause of death" represent evident or confirmed incidence. The figures in the middle column represent both evident

and suspected evidence, but in every instance they are separated and properly

identified by the index colunm. The same applies to the total figures in the

last column.

TABLE 138.-Total reported incidence of shock in 1,450 battle casually deaths

Immediate Contributory Total Etiology or type of shock cause of or associated reported I

death condition incidence

Cardiorespiratory embarrassment plus trauma and

hemorrhage -------------------------------------- 147 135 282

Cardiorespiratory embarrassment plus trauma and

hemorrhage plus contamination or sepsis ------------ 72 58 130

Contamination or sepsis plus trauma and hemorrhage-- 120 186 306

Trauma and hemorrhage ---------------------------- 182 370 552

Type undetermined -------------------------------- 2 1 3

Total --------------------------------------- 523 750 1,273

I Probably somewhat lower than the actual incidence.
492 WOUND BALLISTICS

The figures are believed to be lower than the actual incidence inasmuch

as they represent only the reported incidence, and inasmuch as the records at

times are not complete, The incidence figures on shock are perhaps nearer the

actual than most of the other figures, because many indications of the presence

of shock may be found in the record when it is present.

TABLE 139.-Total reported incidence of intracranial conditions in 1,450 battle casualty deaths

Immediate Contributory Total

Intracranial condition cause of or associated reported 1

death condition incidence

Abscess ------------------------------------------ 1 10 11

Blast trauma:

Evident --------------------------------------- 7 17 24

Suspected ----------------------------------------------- 29 29

Cerebral death suspected -------------------------------------- 57 57

Encephalomalacia ------------------------------------------- 60 60

Fungus, cerebral, septic --------------------------------------- 2 2

Hygroma ----------------------------------------- ----------- 4 4

Ischemia ----------------------------------------- 8 14 22

Meningitis ----------------------------------------- 2 7 9

Trauma and/or hemorrhage, evident, unclassified 2 ..... 212 155 367

Intracranial trauma,2 unclassified, suspected --------------------- 16 16

Other ------------------------------------------------- 1 1

Undetermined ----------------------------------------- 2 2

Respiratory failure, cause undetermined ------------------- 1 1

Total --------------------------------------- 234 371 605

1 Probably somewhat lower than the actual incidence.

2 As distinguished from blast trauma.

TABLE 140.-Total reported incidence of shock in 1,450 battle casualty deaths

Immediate Contributory Total

Shock condition cause of or associated reported 1 death condition incidence

Corrected by therapy ----------------------------------------- 339 339

Suspected, not proved ------------------------------ ---------- 276 76

Successful correction doubtful ----------------------- ----------- 207 207

Uncorrected -------------------------------------- 523 128 651

Total ---------------------------------------- 523 750 1,273

1 Probably somewhat lower than actual incidence.

2 In an additional 128 cases, shock was suspected as being a contributory cause of death.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 493

TABLE 141.-Total reported incidence of maxillofacial conditions in 1,450 battle casualty

deaths

Immediate Contributory Total

Maxillofacial condition cause of or associated reported I

death condition incidence

Trauma ----------------------------------------------------- 182 182

Hemorrhage ------------------------------------------------ 9 9

Respiratory obstruction:

Due to plugging of airway ----------------------- 1 2 3

Due to edema or hemorrhage ------------------- ----------- 2 2

Sepsis -------------------------------------------- --------- 4

Total --------------------------------------- 1 199 200

I Probably somewhat lower than the actual incidence.

TABLE 142.-Total reported incidence of cervical conditions in 1,450 battle casualty deaths

Immediate Contributory Total

Cervical condition cause of or associated reported 1 death condition incidence

Trauma ---------------------------------------------------- 108 108

Hemorrhage ------------------------------------------------ 27 27

Laceration, fatal, carotid, or subelavian artery ------------------- - 4 4

Respiratory obstruction:

Due to edema or hematoma ---------------------. 2 10 12

Due to plugging of airway ---------------------- ----------- 9 9

Sepsis -------------------------------------------- ---------- 3 3

Total --------------------------------------- 2 161 163

1 Probably somewhat lower than the actual incidence.

2 Immediate cause of death, listed as shock.

TABLE 143.-Total reported incidence of intravertebral conditions in 1,450 battle casualty

deaths

Immediate Contributory Total

Intravcertebral condition cause of or associated reported I death condition incidence

Trauma ------------------------------------------ 16 88 104

Hematomyelia ----------------------------------------------- 19 19

Hemorrhage ------------------------------------------------- 13 13

Meningitis ----------------------------------------- 1 1 2

Transection of cord:

Complete ------------------------------------- ----------- 2 24 24

Partial ---------------------------------------.---------- 11 11

Total -------------------------------------- -17 156 173

1 Probably somewhat lower than the actual incidence.

2 Includes cases from those in whom the immediate cause of death was intravertebral trauma.
494 WOUND BALLISTICS

TABLE 144.-Total reported incidence of extremity conditions in 1,450 battle casualty deaths

Immediate Contributory Total

Extremity condition cause of or associated reported I death condition incidence

Trauma, unclassified ------------------------------------------ 669 669

Clostridial myositis of extremity:

Evident -------------------------------------- 2 44 2 8 52

Suspected ----------------------------------------------- 2 28 28

Crushing trauma --------------------------------------------- 3 3

Hemorrhage ------------------------------------------------- 142 142

Sepsis (not clostridial) ----------------------------------------- 53 53

Sepsis, unclassified ---------------------------------.... I 1

Frostbite or immersion syndrome --------------- 8

Total --------------------------------------- 45 911 956

I Probably somewbat lower than the actual incidence.

2 Also included in clostridial infections (table 147).

TABLE 145.-Total reported incidence of thoracic conditions in 1,450 battle casaalty deaths

Immediate Contributory Total Thoracic condition cause of or associated reported 1 death condition incidence

Trauma, unclassified ------------------------------------------ 176 176

Thoracoabdominal trauma --------------------------- 1 14 15

Combined intra-abdominal and intrathoracic trauma --- ----------- 4 4

Atelectasis:

Severe ------------------------------------------------- 33 33

Slight or moderate --------------------------------------- 71 71

Blast trauma:

Evident --------------------------------------- 5 84 89

Suspected ----------------------------------------------- 77 77

Bronchial fistula:

Evident ------------------------------------------------ 21 21

Suspected ---------------------------------------------- 5 5

Cardiac trauma:

Evident --------------------------------------- 2 2 31 33

Suspected ----------------------------------------------- 29 29

Continuing intrapleural hemorrhage ------------------ ---------- 8

Coronary occlusion --------------------------------..- -3. 3

Crushing trauma:

Evident ------------------------------------------------- 5 5

Suspected ----------------------------------------------- 1 1

Dilatation of heart:

Severe --------------------------------------- ------------ 28 28

Slight or moderate ----------------------------- ----------- 61 61

Empyema:

Mild or moderate ------------------------------------------ 17 17

Severe ----------------------------------------- - 7 6 13

Suspected ----------------------------------------------- 12 12

See footnotes at end of table.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 495

TABLE 145.-Total reported incidence of thoracic conditions in 1,460 battle casualty deathsContinued

Immediate Contributory,,, Total

Thoracic condition cause of or associate reported'

death condition incidence

External hemorrhage from chest wall ------------------------------- 2 2

Fat embolism, pulmonary:

Evident ------------------------------------------ 27 20 47

Suspected --------------------------------------------------- 65 65

Hemopnueniothorax:

Evident -------------------------------------- -------------- 347 347

Suspected -------------------------------------------------- 61 61

Hydrothorax:

Severe ------------------------------------------------------ 9 9

Slight or moderate ------------------------------------------- 77 77

Infarction of lung -------------------------------------- 3 3 3 6 9

Intrapulmnonary hemorrhage:

Mild or moderate -------------------------------------------- 192 192

Severe ------------------------------------------------------ 68 68

Suspected -------------------------------------------------- 36 36

Lung abscess ---------------------------------------------------- 14 14

Mediastinal edema ----------------------------------------------- 5 5

Mediastinal emphysema ------------------------------------------ 16 16

Mediastinal hemorrhage --------------------------------- 1 29 30

Mediastinitis ------------------------------------------ 1 4 5

Myocardial decompensation:4

Evident ------------------------------------------- 4 112 116

Suspected -------------------------------------------------- 211 211

Other -------------------------------------------- -------------- 14 14

Pleural contamination from abdomen, evident___------- -------------- 22 22

Pneumonia:

M\ild or moderate ------------------------------ -------------- 1.00 100

Severe ------------------------------------------- 49 22 71

Suspected -------------------------------------------------- 28 28

Pneumonitis-------------------------------------------- 1 14 15

Pnoumothorax without hemothorax ------------------ ----------

Pulmonary edema:

Severe ----------------------------------------------------- 204 204

Slight or moderate ----------------------------- -------------- 145 145

Purulent bronchitis -------------------------------- -------------- 35 35

Subplenral emphysema ----------------------------- ----------

Tension pneumothorax:

Evident ---------------------------------------------------- 18 1s

Suspected ------------------------------------ --------------- 7 7

Thsrombotic embolism, pulmonary:

Evident ------------------------------------------- 20 314 34

Suspected ------------------------------------ -------------- 17 17

Tracheobronchial obstruction:

Aspirated vomitus --------------------------------- 11 21 32

Blood and mucus --- -------------------------------- 11 103 114

Suspected -------------- ------------------------------------ 25 25

See footnotes, at end of table.
496 WOUND BALLISTICS

TABLE 145.-Total reportod incidence of thoracic conditions in 1,450 battle casualty deathsContinued

Immediate Contributory Total Thoracic condition cause of or associated reported 1 death condition incidence

Unrepaired wound of diaphragm -------------------------------- 26 26

Ventricular arrest ------------------------------------ 2--2 2

Undetermined --------------------------------------- -- 12 12

Total --------------------------------------- 160 2,782 2,942

I Probably somewhat lower than the actual incidence.

2 Also included with coronary occlusions and raises the total conditions to 160 rather than the 158 as listed in table 136.

3 Also included with embolism, thrombosis, and infarction (table 148).

4 Does not include the three cases of coronary occlusion.

TABLE 146-Total reported incidence of abdominal conditions in 1,450 battle casualty deaths

Immediate Contributory Total

Abdominal condition cause of or associated reported I death condition incidence

Abdominopelvic trauma --------------------------------------- 147 147

Combined intra-abdominal and intrathoracie trauma ------------- 4 4

Thoracoabdominal trauma --------------------------.---------- 14 14

Abscess:

Extraperitoneal ------------------------------------------ 12 12

Intraperitoneal --------------------------------- 2 15 17

Adrenal hemorrhage ------------------------------------------ 15 15

Adrenal trauma ----------------------------------- ----------- - 8

Adynamic ileus:

Mild or moderate ------------------------------ ----------- 36 42

Severe ------------------------------------------------- 42 42

Suspected ---------------------------------------------- _1 1

Blast trauma:

Evident ------------------------------------------------- 26 26

Suspected ---------------------------------------------- 20 20

Cellulitis, mural and extraperitoneal ------------------ 4 20 24

Clostridial myositis of trunk (abdominal):

Evident -------------------------------------- 2 7 2 4 11

Suspected ----------------------------------------------- 2 10 10

Contamination from hollow viscus ------------------------------ 467 467

Crushing trauma:

Evident -------------------------------------- ----------- 6 6

Suspected ---------------------------------------------- 6 6

Evisceration:

Postoperative --------------------------------- ----------- 7 7

Preoperative --------------------------------------------- 78 78

Postoperative and preoperative ---------------------------- 2 2

Gangrene of bowel:

Advanced ---------------------------------------------- 9 9

Early --------------------------------------------------- 13 13

Gastric dilatation ---------------------------------- ----------- 38 38

Hemorrhage, primary ----------------------------------------- 499 499

See footnotes at end of table.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 497

TABLE 146.-Total reported incidence of abdominal conditions in 1,450 battle casualty deathsContinued

Immediate Contributory Total

Abdominal condition cause of or associated reported 1 death condition incidence

Hemorrhage, recurrent or delayed ------------------------------ 26 26

Hepatic degeneration, toxic ------------------------- ----------- 75 75

Hepatitis, epidemic:

Evident -------------------------------------- ----------- 7 7

Suspected ---------------------------------------------- 4 4

Hepatitis, septic, secondary to trauma:

Evident --------------------------------------.----------- -1 18

Suspected ---------------------------------------------- 18 18

Inflammation of G-I tract --------------------------- ----------- 7 7

Intestinal obstruction (mechanical):

Mild or moderate ----------------------------------------- 8 8

Severe ---------------------------------------- 2 6 8

Suspected ---------------------------------------------- 3 3

Leaking suture line -------------------------------- ----------- - 8

Nephropathy, pigment:

Evident --------------------------------------- 68 31 99

Suspected ----------------------------------------------- 8 8

Nephropathy, toxic, degenerative ------------------------------- 26 26

Operative wound infection -------------------------- ----------- 17 17

Other abdominal condition --------------------------. 2 23 25

Pancreatic:

Hemorrhage ---------------------------------- ----------- 6 6

Trauma -------------------------------------- ----------- 25 25

Peritonitis:

Mild or moderate ----------------------------------------- 92 92

Severe --------------------------------------- 65 48 113

Suspected ---------------------------------------------- 63 63

Renal sepsis (parenchymal) ------------------------- ----------- 5 5

Renal trauma:

Evident -------------------------------------- ----------- 127 127

Suspected ------------------------------------ ----------- 11 11

Sepsis, abdominal, unclassified ------------------------- 1 -- 1

Splenic degeneration, toxic ------------------------------------- 28 28

Splenomegaly ------------------------------------- ----------- 31 31

Unrepaired wound of hollow viscus 3 .................------------ 33 33

Ureter traumatized or tied:

Evident ------------------------------------------------- 12 12

Suspected ---------------------------------------------- 3 3

Urinary tract sepsis ------------------------------------------- 11 11

Undetermined abdominal wall condition --------------- 1---1 1

Undetermined intra-abdominal condition -------------...---- 4 4

Undetermined: contamination and/or hemorrhage suspected ---------------------------------------------------- 86 86

Total --------------------------------------- 154 2,365 2,521

1 Probably somewhat lower than the actual incidence.

2 Also reported with clostridial myositis (table 147).

3 Recorded only for patients who had intraperitoneal surgery.

603225v-62- 34
498 WOUND BALLISTICS

TABLE 147.-Total reported incidence of clostridial myositis or cerebritis in 1,450 battle casualty

deaths

Immediate Contributory Total

Clostridial infections cause of or associated reported I death condition incidence

Clostridial myositis of extremity:

Evident -------------------------------------- 46 8 54

Suspected ----------------------------------------------- 28 28

Clostridial myositis or cerebritis of head, neck, or trunk:

Evident -------------------------------------- 5 4 9

Suspected ----------------------------------------------- 10 10

Total -------------------------------------- 51 50 101

I Probably somewhat lower than the actual incidence.

TABLE 148.-Total reported incidence of embolism, infarction, and thrombosis in 1,.50 battle

casualty deaths

Immediate Contributory Total

Pathological condition cause of or associated reported I

death condition incidence

Embolism, air:

Evident --------------------------------------- 2 2 4

Suspected ----------------------------------------------- 12 12

Embolism, fat:

Evident --------------------------------------- 27 22 49

Suspected ----------------------------------------------- 65 65

Embolism, thrombotic:

Evident --------------------------------------- 20 14 34

Suspected ----------------------------------------------- 17 17

Embolism, thrombotic, and infarction ---------------- ----------- 5 5

Infarction alone ------------------------------------ 3 13 16

Infarction and thrombosis ------------------------------------- 9 9

Thrombosis alone:

Evident ------------------------------------------------ 35 35

Suspected ----------------------------------------------- 3 3

Total -------------------------------------- 52 197 249

I Probably somewhat lower than the actual incidence.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 499

TABLE 149-Total reported incidence of miscellaneous conditions in 1,450 battle casualty

deaths

Immediate Contributory Total Miscellaneous conditions cause of or associated reported I

death condition incidence

Anaphylaxis, suspected ----------------------------- ----------- 2 2

Anemia, refractory or severe ------------------------ ----------- 13 13

Anesthetic agent:

Cause of death --------------------------------....--. . 7

Suspected ------------------------------------ ---------- 25 25

Blast death, suspected ---------------------------------------- 29 29

Jaundice --------------------------------------------------- 24 24

Malnutrition, severe ----------------------------------------- 10 10

Morphine poisoning:

Cause of death ....

Suspected ---------------------------------------------- 4 4

Other contributory conditions ----------------------- ----------- 2 2

Septicemia (excluding clostridial) --------------------- 1 1 2

Transfusion reaction, severe ------------------------- 1 6 7

Respiratory failure, cause undetermined --------------- I---1 1

Undetermined, unclassified ---------------------------- -303 303

Total --------------------------------------- 313 116 429

I Probably somewhat lower than the actual incidence.

Detailed Observations 4

In this section, the cases in each of the principal wound gToups are considered separately, and in each of the subdivisions a tabulation lists the immediate cause of death for the cases in that particular group.

1. The immediate cause of death in the 297 cases in which thle principal

wound was intracranial is as follows:

Number of Nomber ef cases cases

Neural trauma and!or intracranial Pigment nephropathy --------------- 2

hemorrhage or clot ---------------- 210 Brain abscess ---------------------- 1

Shock (all trauma and hemorrhage)_ _ 15 Fat embolism (pulmonary) --------- 1

Pneumonia ----------------------- 12 Tracheobronchial obstruction, aspiIntracranial blast trauma alone - 5 rated vomitus ----------------------

Clostridial myositis, extremity ------ 3 Undetermined, intracranial condiIntracranial blast and other trauma- 2 tion --------------------------- 1

Thrombotic embolism (pulmonary)-- 2 Undetermined, unclassified --------- 40

Meningitis, intracranial ------------ 2

4 Additional detailed information on surgery, anesthesia, replacement therapy, chemotherapy, oxygen therapy, and

other miscellaneous data are presented in appendix F, p. 813.
500 WOUND BALLISTICS

2. The immediate cause of death in the 27 cases in which the principal

wound was intravertebral is as fol]ows: Number of

Cases

Spinal cord trauma or hematomyelia ------------------------------------------ 16

Shock (all trauma and hemorrhage) -------------------------------------------- 4

Pneumonia ------------------------------------------------------------------ 3

Tracheobronchial obstruction, aspirated vomitus --------------------------------- 1

Undetermined, unclassified --------------------------------------------------- 3

3. The immediate cause of death in the eight cases in which the principal

wound was maxillofacial is as follows:

Number of

Cases

Tracheobronchial obstruction, blood and mucus --------------------------------- 2

Fat embolism (pulmonary) ---------------------------------------------------- 1

Shock (trauma and hemorrhage) ----------------------------------------------- 1

Undetermined, unclassified ---------------------------------------------------- 4

4. The immediate cause of death in the 25 cases in which the principal

wound was cervical is as follows:

Number of Number of cases cases

Shock ---------------------------- 1 1 Pigment nephropathy --------------- 1

Cerebral ischemia ------------------ 4 Pneumonia- 1-------------------

1

Thrombotic embolism (pulmonary)-- 2 Tracheobronchial obstruction, blood

Respiratory obstruction (above and mucus ---------------------- 1

trachea) ---------------------- 2 Undetermined, unclassified -----.... 3

1 Includes 5 cases of cardiorespiratory embarrassment plus trauma and hemorrhage and 6 cases of trauma and hemorrhage.

5. The immediate cause of death in the 138 cases in which the principal

wound was intrathoracic is as follows:

Number of Number of cases cases

Shock ---------------------------- 1 70 Clostridial myositis:

Pneumonia ----------------------- 7 Trunk ----------------------- 1

Empyema ------------------------ 5 Extremity --------------------- 1

Fat embolism (pulmonary) ---------- 4 Pulmonary infarction -------------- 1

Thrombotic embolism (pulmonary)-- 3 Mediastinal hemorrhage ------------- 1

Cerebral ischemia ------------------ 3 Myocardial decompensation, general- 1

Pigment nephropathy --------------- 3 Tracheobronchial obstruction:

Coronary occlusion ----------------- 2 Aspirated vomitus ------------- 1

Anesthetic agent ------------------- 1 Blood and mucus --------------- 1

Pulmonary blast and other trauma- - 1 Undetermined pulmonary complicaPuhnonary blast trauma alone -- 1 tion ----------------------------- 8

Undetermined, unclassified --------- 23

1 Includes 66 cases of cardiorespiratory embarrassment plus trauma and hemorrhage, 2 eases of contamination or

sepsis plus trauma and hemorrhage, and 2 eases of trauma and hemorrhage.

6. The immediate cause of death in the 212 cases in which the principal

wound was thoracoabdominal is as follows:
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 501

Number of Number of cases eases

Shock: Clostridial myositis, trunk ---------- 2

Trauma and hemorrhage alone-- 2 Myocardial decompensation, general- 2

Contamination or sepsis plus Anesthetic agent ------------------ 1

trauma and hemorrhage ----- 1 Pulmonary blast and other trauma- - 1

Contamination or sepsis plus Fat embolism (pulmonary) ---------- 1

cardiorespiratory embarrass- Empyema ------------------------- 1

ment plus trauma and hemor- Pulmonary infarction -------------- 1

rhage ----------------------- 59 Respiratory obstruction above traCardiorespiratory embarrass- chea (maxillofacial wound) -------- 1

ment plus trauma and hemor- Tracheobronchial obstruction, asrhage ----------------------- 56 pirated vomitus ------------------ 1

Pigment nephropathy --------------- 12 Ventricular arrest ------------------ 1

Peritonitis ------------------------- 11 Thoracic trauma, unclassified ------- 1

Pneumonia ------------------------ 3 Undetermined intracranial complicaTracheobronchial obstruction, blood tion ---------------------------- 1

and mucus ---------------------- 3 Undetermined thoracic complication- 3

Thrombotic embolism (pulmonary).__ 2 Undetermined, unclassified --------- 46

7. The immediate cause of death in the 59 cases in which the principal

wound was combined intra-abdominal and intrathoracic is as follows:

Number of Number of cases cases

Shock: Pigment nephropathy --------------- 6

Trauma and hemorrhage alone-- 4 Fat embolism (pulmonary) ---------- 2

Cardiorespiratory embarrass- Tracheobronchial obstruction, blood

ment and trauma and hemor- and mucus ---------------------- 2

rhage ----------------------- 7 Pulmonary blast trauma alone ------ 1

Cardiorespiratory embarrass- Air embolism --------------------- 1

ment and contamination or Clostridial myositis, trunk ----------- 1

sepsis plus trauma and hem- Neural trauma and/or hemorrhage or

orrhage --------------------- 10 clot ----------------------------- 1

Contamination or sepsis plus Pneumonitis ---------------------- 1

trauma and hemorrhage ------ 4 Undetermined pulmonary condition- 1

Peritonitis ------------------------- 7 Undetermined, unclassified --------- 11

8. The immediate cause of death in the 408 cases in which the principal

wound was intra-abdominal is as follows:

Number of Number of cases cases

Shock ---------------------------- 179 Air embolism ---------------------- 1

Peritonitis ------------------------- 46 Blast trauma alone (pulmonary) .... 1

Pigment nephropathy --------------- 26 Myocardial decompensation (genPneumonia ----------------------- 17 eral) ---------------------------- 1

Clostridial myositis ---------------- 9 Sepsis, abdominal, unclassified ------ 1

Thrombotic embolism -------------- 8 Septicemia ------------------------ 1

Tracheobronchial obstruction, aspi- Tracheobronchial obstruction, blood

rated vomitus ------------------- 5 and mucus -------------- -------- 1

Fat embolism --------------------- 4 Transfusion reaction --------------- 1

Cellulitis, extraperitoneal ------------ 3 Ventricular arrest ------------------ 1

Abdominal abscess ----------------- 2 Other condition (abdominal) -------- 2

Anesthetic agent ------------------- 2 ndetermined, abdominal cause ----- 4

Intestinal obstruction -------------- 2 Undetermined, unclassified ---------- 91
502 WOUND BALLISTICS

9. The immediate cause of death in the three cases in which the principal

wound was of the abdominal wall is as follows: NuTmber of

cases

Clostridial myositis, trunk --------------------------------------------------- 1

Undetermined, thoracic complication ------------------------------------------ 1

Undetermined, unclassified ------------------------------------------------------ 1

10. The immediate cause of death in the four cases in which the principal

wound was upper extremity, soft tissue only, is as follows: Number of

cases

Shock (trauma and hemorrhage) ---------------------------------------------- 1

Pigment nephropathy ------------------------------------------------------- 1

Undetermined, unclassified --------------------------------------------------- 1

11. The immediate cause of death in the 10 cases in which the principal

wound was upper extremity, bone and soft tissue, is as follows: Number of

case•

Shock (trauma and hemorrhage) --------------------------------------- 33-------- 

Anesthetic agent ------------------------------------------------------------ 1

Clostridial myositis ----------------------------------------------------------- 1

Undetermined, unclassified ----------------------------------------------------- 5

12. The immediate cause of death in the 31 cases in which the principal

wound was lower extremity, soft tissue only, is as follows:

Number of 1Vumber of

eases eases

Shock (all trauma and hemorrhage)- 9 Anesthetic agent -- ---------------- 1

Clostridial myositis, extremity 8 S----- Fat embolism (pulmonary) ---------- 1

Pigment nephropathy --------------- 5 Meningitis, spinal ------------------ 1

Pneumonia ------------------------ 2 Undetermined, unclassified --------- 4

13. The immediate cause of death in the 114 cases in which the principal

wound was unclassified multiple is as follows:

Namber of Number of cases cases

Shock ----------------------------- 46 Cerebral ischemia ------------- !------

Fat embolism (pulmonary) --------- 4 Mediastinitis --------------- - 1----- 

Pigment nephropathy --------------- 4 Respiratory failure, cause undeterClostridial myositis, extremity ------ 3 mined ---------------- l-----------

Intercranial, neural trauma and/or Tracheobronchial obstructions:

hemorrhage ---------------------- 2 Aspirated vomitus ----------- !---

Pneumonia ------------------------ 2 Blood and mucus -------------- 1

Abdominal cellulitis ----------------- Undetermined, unclassified --------- 46

Thrombotic embolism (pulmonary). - 4

SPECIAL STUDIES ON INTRA-ABDOMINAL WOUNDS

In 408 cases (28.1 percent) of the 1,450 deaths studied, the principal

wound was intra-abdominal. Adding the 212 cases having thoracoabdominal

wounds and the 59 cases having combined intra-abdominal and intrathoracic

wounds, a total of 679 (46.8 percent) deaths were due to wounds of the abdomen. The latter two groups are not included in the study in this section.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 503

The group of 408 cases in which the principal wound was intra-abdominal

have been studied as a group in the preceding sections of this chapter (p. 501).

In this section, the 408 cases are considered in further detail.

Shock was the immediate cause of death in 43.6 percent of those 408

deaths in which the principal wound was intra-abdominal. An analysis of

this group of shock deaths in abdominal wounds (178 cases) is presented in

tables 150 through 153 and the tabulations which follow. It was found that

30.9 percent died before surgery in this group as compared to 7 percent in the

remaining cases (table 154). Contamination from a perforated hollow viscus

was a factor in 65 percent of those dying from shock (table 151) which was less

than the incidence of 74 percent in the rest of the group. Hemoperitoneum

or continuing hemorrhage was noted in 64 percent of the shock group and in

70 percent of the remainder. There was very little difference in the incidence

of peritonitis in the two groups, the figure approximating 21 percent. Likewise, there was little difference in the incidence of associated wounds in the

two groups (table 152).

In the study of the time interval between wounding to death in the cases

with intra-abdominal wounds and dying of shock, it was found that 11 cases

lived less than 1 hour and 35 cases died before induction of an anesthesia with

an average survival time of 16 hours.

TABLE 150.-Data relative to hospital admission, anesthesia, and surgery in 178 cases in

which the principal wound was intra-abdominal and the immediate cause of death was shock

Total Time of death

Number Percent

Dead on arrival ------------------------------------------ 6 3. 4

Dying on admission --------------------------------------- 11 6.2

Died before anesthesia I ---------------- 35 19. 6

Died during anesthetic condition --------------------------- 3 1. 7

Died during primary surgery ------------------------------- 16 9. 0

Died subsequent to primary surgery ------------------------- 107 60. 1

Total ---------------------------------------------- 178 100.0

I Excludes the DOA and the dying on admission.

The following is a breakdown of the 178 cases in which the principal

wound was intra-abdominal and the immediate cause of death was shock:

Number of Number of cases cases

Etiology of shock: Etiology of shock-Continued

Trauma and hemorrhage ------- 57 Trauma and hemorrhage plus

Trauma and hemorrhage plus contamination or sepsis plus

contamination or sepsis ------ 114 cardiorespiratory embarrassTrauma and hemorrhage plus ment ----------------------- 2

cardiorespiratory embarrass- Type or etiology undetermined- 2

ment ----------------------- 3
504 WOUND BALLISTICS

TABLE 151.-Intra-abdominal pathology in 178 cases 1 in which the principal wound was

intra-abdominal and the immediate cause of death was shock

Incidence

Intra-abdominal pathology

Number Percent

Contamination or sepsis a factor: 2

Peritonitis:

Severe ---------------------------------------------- 20 10. 81

Mild or moderate ------------------------------------- 17 9. 20

Suspected -------------------------------------------- 6 3. 24

Primary abdominal hemorrhage ----------------------------- 389 48. 11

Recurrent or delayed abdominal hemorrhage ----------------- 5 2. 70

Hemorrhage, profuse in hospital --------------------------- 12 6.49

Total -------------------------------------------------- 149 80. 55

Contamination or sepsis not a factor:

Peritonitis:

Severe ........

Mild or moderate ------------------------------------ - 1 . 54

Suspected--

Primary abdominal hemorrhage ----------------------------- 3 25 13. 51

Recurrent or delayed abdominal hemorrhage ----------------- 4 2. 16

Hemorrhage, profuse in hospital --------------------------- 6 3. 24

Total ------------------------------------------------- 36 19.45

Grand total ------------------------------------------- 185 100. 00

1 Contamination or sepsis was a factor in 116 cases and not a factor in the remaining 62 cases.

2 Contamination from hollow viscus.

3 Includes those cases in which note was made of hemoperitoneum or of active intra-abdominal bleeding.

In the 178 cases in which the principal wound was intra-abdominal and the

immediate cause of death was shock, there was an incidence of 193 associated

and, in many instances, multiple wounds, as follows:

Number of Number of wounds wounds

Intracranial: Intrathoracic, suspected ------------- 7

Known ----------------------- 1 Upper extremity:

Suspected --------------------- 5 Bone and soft tissue ----------- 9

Scalp ------------------------------ 4 Soft tissue only ---------------- 37

Maxillofacial: Traumatic amputation-- -------- 1

Bone and soft tissue ------------ 3 Lower extremity:

Soft tissue only-------------- 8 Bone and soft tissue ----------- 14

Cervical, general ------------------- 3 Soft tissue only ---------------- 68

Intraspinal ------------------------ 13 Traumatic amputation --------- 3

Chest wall ----------------------- 17

Pulmonary blast injury ------------- 1 Total ---------------------- 193

There were no associated wounds in 60 of these 178 cases.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 5015

FIGURE 263.-Plasma being administered to a casualty at a battalion aid station.

The records of plasma and blood administered can be very difficult to interpret. In a surprisingly large percentage of cases, there was no record of any

blood transfusion. It is possible that some received blood and no record was

made, but also probable that in the majority no blood was administered. The

averages given (table 152) are based only on those cases in which blood was

given and a record made of its administration. The data on the amount of

plasma administered before admission represent the replacement therapy

carried out in battalion aid stations (fig. 263), collecting stations, and clearing

stations. While it is believed that only the minimum amount of plasma necessary to insure transportability of the patient should be given, just what that

amount is in each case has to be determined by the individual medical officer

in charge. That his judgment had been excellent in nearly every case is a

statement to which medical officers in Army hospitals will attest. Comparing the averages and the number receiving blood in the group dying in shock

with the whole group of cases, it was found that a larger percentage of cases

received a larger average amount of blood in the shock group than in the group

as a whole. Inasmuch as this series involved only deaths and there were no

figures at hand for the cases with intra-abdominal wounds who lived, comparisons could not be made with a group of cases in which therapy was adequate.A

SIt is our opinion that in the group of cases who died the amount of blood administered was inadequate.-il. E. S.

and J. W. C.
506 WOUND BALLISTICS

TABLE 152.-Transfusion record in group of 178 cases an which the principal wound was introabdominal and the immediate cause of death. was shock

Number receiving Average number of

transfusion of- units administered

Time of transfusion

Plasma Blood

Plasma Blood (250 cc. (500 cc. units) usnits)

Before admission --------------------------------- 130------------3. 18-----

After admission, before surgery. --------------------- 77 112 3. 16 3. 03

During sur~gery--------------------------------------- 23 55 2.95 3 19

After surgery-------------------------------------- 16 27 2. 25 3 07

The percent of bullet wounds in the shock deaths in the intra-abdominal

group was 17.4 percent (table 153) as compared with 19.6 percent in the entire

intra-abdomitial group, while in tile whole series (1,450) it was only 15.0 percent.

TABLE 153-Distribution of group of 178 cases in which the principal wound I was introabdossinal and the imamediate cause of death was shock, by causative agent

Caunsative -agent Number of cases Perrcent of cases

Bullet:

Unclassified ---------------------------------------------- 23 12.9

Rifle ----------------------------------------------------- 2 1. 1

Machinegun ---------------------------------------------- 6 3. 4

Hi-gh explosive:

Unclassified ---------------------------------------------- 17 9.5

Shell ---------------------------------------------------- 116 65. 2

Mine ---------------------------------------------------- 3 1. 7

B o o b y trap - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Bomb ---------------------------------------------------- 8 4. 5

B la s t - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - -

No record ---------------------------------------------------- 3 1. 7

Total ------------------------------------------------- 178 100.0

I The type of wounsd in this group wvas penetrating in 125 cases and perforating in 53 cases.

The following tabulation lists the miscellaneous conditions occurring ill

the group of 178 cases with intra-abdominal wounds who died of shock:

Numbcr sf Nsnst~er si cases ca ses

Myocardial decompensation: Tracheobronchial obstruction-Con.

Evident ------------------------- 2 Blood and mucus ----------------- 3

Stuspected ----------------------- 14 Suspected -------------------- 1

Pulmonary edema: Thoracic trauma (chest -wall)------18

Severe --------------------------- Pigment nephropathy:

Slight, or moderate-----.----------12 Evident ---------------------

Tracheobronchial obstruction: Suspected ------------------------ 5

Aspirated vomnitus -------------------- Renal trauma, evident ---------------- 24
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 507

Myocardial decompensation was evident in only two cases, and, in these,

excessive administration of plasma and blood was thought responsible. Pulmonary edema was noted in 13 cases in the group. As this is an unusual

occurrence in uncomplicated shock, a search was made for factors predisposing

to pulmonary edema. All 13 cases received plasma and blood before surgery.

The average units received were little different from the averages for those

receiving plasma and blood in the rest of the group in which, however, a substantial number received none. It was difficult to draw any conclusions

regarding the role plasma and blood played in the appearance of pulmonary

edema in this group. Thoracic trauma, blast trauma, and pneumonia probably

contributed to the incidence of "pulmonary edema."

Study of blood pressure records revealed that 17 of the 55 recorded admission blood pressures were zero. The lowest pressure recorded was zero in 34

of the 70 cases where records were available. The average duration of surgery

in this shock group approached 2ýi hours. All cases coming to surgery received

ether anesthesia. Thiopental sodium (Pentothal sodium) was used once and

nitrous oxide 40 times for induction.

Table 154 and the tabulations which are to follow deal with those cases

(230) in which the principal wound was intra-abdominal but the immediate

cause of death was not shock. It should be noted that there was no evidence

of shock in only six of these cases. The remainder had evidence of shock at

some time during the course of their hospital stay.' Analysis of shock as a

contributory or associated condition is included in the study of this group of

cases.

The incidence of shock as a contributory or associated condition in the

group of 230 cases in which the principal wound was intra-abdominal and the

immediate cause of death was not shock follows:

Number of Contributory or associated condition of shock: cases

Corrected by therapy ---------------------------------------------------- 121

Suspected, not proved ---------------------------------------------------- 16

Present, successful correction doubtful -------------------------------------- 66

Uncorrected ------------------------------------------------------------ 21

No evidence ------------------------------------------------------------ 6

6 The terminal fall in blood pressure occurring in every case immediately before death was not regarded as evidence

of shock.
508 WOUND BALLISTICS

TABLE 154.-Data relative to hospital admission, anesthesia, and surgery, in 230 cases in

which the principal wound was intra-abdominal and the immediate cause of death

was not shock

Time of death Number of cases Percent of cases

Dead on arrival--

Dying on admission --------------------------------------- 1 0.4

Died before anesthesia I ------------------------------------ 10 4.4

Died during anesthetic induction --------------------------- 5 2. 2

Died during primary surgery ------------------------------- 4 1.7

Died subsequent to primary surgery ------------------------- 210 91.3

Total ---------------------------------------------- 230 100. 0

I Excludes the D OA and those dying on admission.

Miscellaneous findings in 230 cases in which the principal wound was intraabdominal but the immediate cause of death was not shock but with shock as

a contributory or associated condition (224 cases) were as follows:

Number of Hemorrhage: cases

Profuse in hospital ------------------------------------------- 11

Primary ------------------------------------------------------ 156

Recurrent or delayed ----------------------------------------- 10

Peritoneal contamination from hollow viscus -------------------------- 165

Peritonitis:

Severe ------------------------------------- 17

Mild or moderate --------------------------------------------- 31

Suspected --------------------- 40

In the 230 cases in which the principal wound was intra-abdominal but

the immediate cause of death was not shock, the incidence of associated wounds

was as follows:

Number of Number of Associated wounds: cases Associated wounds-Continued cases

Intracranial: Pulmonary blast -------------- 4

Known ------------------- 1 Intrathoracic, suspected -------- 10

Suspected ---------------- 1 Thoracoabdominal --------------- 1

Scalp ------------------------ 3 Upper extremity:

Maxillofacial, bone and soft tis- Soft tissue only__ 28

sue ------------------------- 1 Traumatic amputation .... 1

Eye or orbit ------------------- 2 Lower extremity:

Maxillofacial and soft tissue only- 7 Soft tissue only ----------- 72

Neck, general ------------------ 6 Bone and soft tissue ------- 46

Intraspinal, unclassified -------- 13 Traumatic amputation. 2

Chest wall only ---------------- 22

There were no associated wounds in 70 of the 230 cases.

A further breakdown of the group of 408 cases in which the principal

wound was intra-abdominal is presented in tables 155 through 159. The data

presented in those tables are for a group of 175 cases in which peritonitis was
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 509

evident or suspected to be present. It was believed that a better picture of

intra-abdominal wounds might be obtained if they were not complicated by

factors originating from concomitant wounds of the chest and diaphragm.

Those with peritonitis and suspected peritonitis were examined in three groups

(table 155). The first group was composed of those in which peritonitis was

the immediate cause of death. In the second group, peritonitis was evident

but not the immediate cause of death. This included the cases listed under

contributory or associated conditions as "peritonitis, severe" and "peritonitis,

mild or moderate." The third group was made up of those cases in which

peritonitis was suspected but the evidence was not sufficient to confirm its

presence.

TA13LE 155.-Data relative to hospital admission, anesthesia, and surgery, in 175 cases in which

the principal wound was intra-abdominal and peritonitis was evident or suspected to be present

Peritonitis Peritonitis Peritonitis Time of death immediate contributory suspected cause of death to death

Before anesthesia ----------------------------------.----------- - 2----

During anesthetic induction ------------------------- _ ---------- 2---

During primary surgery ---------------------------- 3---------------3

After primary surgery ------------------------------ 46 76 46

Total --------------------------------------- 46 83 46

TABLE 156.-Operating time for primary surgery in 175 cases in which the principal wound

was intra-abdominal and peritonitis was evident or suspected to be present

Peritonitis Peritonitis Peritonitis

Operating time (minutes) immediate contributory suspected cause of death to death

Less than 30 ----------------------------------------------------- 2

30 to 59 ------------------------------------------.------------ 1---

60 to 89 ------------------------------------------- 1 I-- -- 1

90 to 119 ------------------------------------------ 1 3 1

120 to 149 ---------------------------------------- 5----------- 5 3

150 to 179 ----------------------------------------- 3 4----------

180 to 209 ---------------------------------------------- 4 6

210 to 239 ---------------------------------------------- 2 1

240 to 299 ---------------------------------------------- 1 1

300 to 360 ---------------------------------------- 1---------------1

Not stated ----------------------------------------- 34 59 41

Total --------------------------------------- 46 83 46

Average time __------------- 180 154 117
510 WOUND BALLISTICS

TABLE 157.-Data relative to primary surgery on 175 cases in which the principal wound was

intra-abdominal and peritonitis was evident or suspected to be present

Peritonitis imme- Peritonitis con- Peritonitis sus- Total

diate cause of tributory to death pected

Type of surgery 

death

Number Percent Number Percent Number Percent Number Percent of oper- of oper- of oper- of oper- ations ations ations ations

Laparotomy ------------------- 45 49. 4 80 49. 1 44 48. 9 169 49

Debridement, abdominal wall

wound only ------------------------------ 2 1. 2 1 1. 1 3 .9

Debridement, other wounds:

Associated with primary

operation --------------- 41 45. 1 44 27. 0 26 28. 9 111 32.3

Omitted deliberately ------- 1 1. 1 4 2. 5 1 1. 1 6 1.7

Partially done ------------- 1 1. 1 8 4.9 ------------- 9 2. 6

Not stated -------------------- 3 3. 3 25 15.3 18 20. 0 46 13.4

Total ----------------- 91 100.0 163 100. 0 90 100. 0 344 100.0

TABLE 158.-The immediate cause of death in 175 cases in which the principal wound was

intra-abdominal and peritonitis was evident or suspected to be present

Peritonitis Peritonitis Peritonitis

Immediate cause of death immediate contributoly suspected

cause of death

Peritonitis -------------------------------------------- -46 -

Shock ------------------------------------------------------- 39 6

Pigment nephropathy ------------------------------ 121----------- 

Pneumonia ------------------------------------------------- 9 2

Fat embolism (pulmonary) -------------------------------------- 3--

Thrombotic embolism (pulmonary) ------------------------------- 2--

Cellulitis, abdominal ------------------------------- ---------- -1 1

Clostridial myositis:

Trunk ----------------------------------------.---------- 1

Extremity ------------------------------------ 1 1----------- 1

Intestinal obstruction ------------------------------ --------------- 1

Sepsis, abdominal, unclassified ----------------------------------- 1--

Tracheobronchial obstruction, aspirated vomitus ----------------- 1---1

Transfusion reaction ------------------------------- -------------------- 1

Undetermined:

Abdominal ----------------------------------------------- 2

Unclassified ----------------------------------- ----------- 14 35

Total -------------------------------------- 46 87 46
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 511

TABLE 159.-Etiology of shock as a contributory or associated condition in 175 cases in which

the principal wound was intra-abdominal and peritonitis was evident or suspected to be present

Peritonitis Peritonitis Peritonitis

Etiology or type of shock immediate contributory suspected cause of death

Cardiorespiratory embarrassment plus trauma and

hemorrhage-------------------------------------- -- - I

Cardiorespiratory embarrassment plus trauma and

hemorrhage plus contamination or sepsis ------------------ 1----1

Contamination of sepsis plus trauma and hemorrhage-- 42 41 35

Trauma and hemorrhage --------------------------- 1 6 4

CASES IN WHICH THE IMMEDIATE CAUSE OF DEATH

WAS SHOCK

The 523 cases which have been listed under this heading were those in

which there was good evidence of peripheral circulatory failure initiated by

the initial trauma and hemorrhage and perpetuated by trauma and hemorrhage

with or without the added shock-producing factors of cardiorespiratory embarrassment, peritoneal contamination from a wound of a hollow viscus or early

sepsis, or any combination of these factors. The data on the "Etiology of

shock" reveal the evidence of these various factors. No effort was made to

separate the factors of trauma and hemorrhage, as both occurred in varying

degrees and proportions in every battle casualty. In 13 cases, recurrent or

delayed abdominal hemorrhage was a factor. In the 245 cases who died of

shock after primary surgery, only 43 lived more than 24 hours after the surgery.

Tables 160 through 165 which follow relate to the 523 cases in the series

of 1,450 deaths in which shock was listed as the immediate cause of death.

In addition, there were 750 other cases in which shock was a contributory or

associated condition. There was no evidence of shock in only 177 of the

1,450 deaths studied. It is not within the province of this report to discuss

in detail the etiology of shock. However. it should be stated that clinical

experience and laboratory investigations demonstrated that loss of whole

blood was the most important factor in the vast majority of battle casualties

in shock. The amount of blood lost was far in excess of previous estimates.

In 1945, whole blood was given to 40.6 percent of the battle casualties admitted

to Fifth U.S. Army hospitals at a rate of 2.52 pints per casualty transfused.'

Many casualties were given as much as 6 or 8 pints of blood and a few even

more in the first 24 hours after their admission to the hospital. Plasma loss

per se was found only in burns, crush injuries, gas gangrene, sepsis, and gross

7 Data based on reports of hospitols to the Fifth U.S. Army surgeon.
512 WOUND BALLISTICS

contamination of the peritoneal or pleural cavities.8 In the latter two categories, plasma loss was often less than whole blood loss. Inasmuch as blood

was not available except in exceptional circumstances at battalion aid and

collecting and clearing stations, some of the most severely wounded casualties,

or those in the most severe grade of shock from their wounds, were often given

large quantities of plasma to render them transportable to the hospital. These

casualties were frequently again in severe shock by the time they arrived at

the hospital, and further resuscitation was complicated because the remaining

blood in their vascular tree was well diluted with plasma.

Among contributing factors in shock deaths were the following:

1. The use of large quantities of plasma to combat lowered blood volume

when the loss has been of whole blood.

2. Unrecognized and/or uncontrolled continued bleeding.

3. Inadequate or poorly timed blood replacement with whole blood.

4. Delayed surgery in those cases in which there has been gross contamination of peritoneal and pleural cavities with contents of the gastrointestinal

tract, or in which sepsis is developing.

TABLE 160-Location of principal wound in 523 cases in which the immediate cause of death

was shock

Location of principal wound Number of cases Percent of cases

Intra-abdominal ----------------------------------------- 178 34.03

Thoracoabdominal ---------------------------------------- 118 22.56

Intrathoracic --------------------------------------------- 70 13. 39

Unclassified, multiple ------------------------------------- - 46 8. 80

Lower extremity, bone and soft tissue ---------------------- 41 7. 84

Combined intra-abdominal and intrathoracic ----------------- 25 4. 78

Intracranial ---------------------------------------------- 15 2.87

Cervical ------------------------------------------------- 11 2. 10

Lower extremity, soft tissue -------------------------------- 9 1.72

Intravertebral -------------------------------------------- 4 .77

Upper extremity:

Bone and soft tissue ----------------------------------- 3 .57

Soft tissue ------------------------------------------ 2 .38

Maxillofacial -------------------------------------------- 1 .19

Abdominal wall--

Total ---------------------------------------------- 523 100.0

(1) Stewart, J. D., and Warner, F. F.: Observations on the Wounded in Forward Field Hospitals With Special

Reference to Wound Shock. Ann. Surg. 122: 129, 1945. (2) Simeone, F. A.: Personal communication to the authors

based on work of the Board for the Study of the Severely Wounded.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 513

5. Failure to recognize and/or control factors leading to cardiorespiratory

embarrassment. Included in this group are hemothorax, pneumothorax,

cardiac tamponade, tracheobronchial obstruction from blood or mucus,

painful chest wall wounds, and gastric dilatation.

6. Failure to control pain by morphine, procaine hydrochloride (Novocain) nerve block, proper splinting of painful extremity wounds, and timely

surgery.

TABLE 161.-Data relative to hospital admission, anesthesia, and surgery in 523 cases in which

the immediate cause of death was shock

Time of death Number of cases Percent of cases

Dead on arrival ------------------------------------------- 25 4. 8

Dying on admission --------------------------------------- 55 10.5

Died before anesthesia 1 ------------------------------------ 135 25. 8

Died during anesthetic induction --------------------------- 6 1. 1

Died during primary surgery ------------------------------- 48 9. 2

Died subsequent to primary surgery ------------------------- 254 48. 6

Total ---------------------------------------------- 523 100. 0

1 Excludes the DOA and those dying on admission.

TABLE 162.-Etiology of shock in 523 cases in which shock was the immediate cause of death

Number of cases in group- Total

Etiology of shock number

of cases I If III IV V VI

Trauma and hemorrhage -------------------------- 15 35 71 ---- 10 53 184

Contamination or sepsis plus trauma and hemorrhage- 1 2 10 3 11 93 120

Cardiorespiratory embarrassment plus trauma and

hemorrhage plus contamination or sepsis ---------- 1 1 10 .... 12 48 72

Cardiorespiratory embarrassment plus trauma and

hemorrhage ------------------------------------ 8 17 44 3 15 60 147

Total ------------------------------------- 25 55 135 6 48 254 523

NOTE.-Key for roman numerals:

I Dead on arrival.

II Dying on admission.

III Died before anesthesia (excludes I and 11).

IV Died during anesthetic induction.

V Died during primary surgery.

VI Died subsequent to primary surgery.
514 WOUND BALLISTICS

TABLE 163--Lowest recorded blood pressure and other evidence in 498 cases in which the

immediate cause of death was shock

Number of cases in group- Total

Blood pressure record and evidence of shock number

of cases

II III IV V VI

Shock present:

0 ----------------------------------------------- 10 26 1 7 47 91

2 to 38 ----------------------------------- --------------- 1 1 2 4

40 to 58 --------------------------------------------- 10 ---- 2 16 28

69 to 78 ----------------------------------------- 1 9 1 3 28 42

80 to 88 ----------------------------------------- 2 7 ---- 2 18 29

90 to 98 ------------------------------------------- 3 .... 2 8 13

100 or more, but pulse rapid and weak 2 ------------------------- 1 3 4

Presence of shock recorded ---------------------------- 18 52 2 15 77 164

Shock suspected by inference - 9 7 ---- 2 4 22

Treatment suggests shock ----------------------------- 15 21 1 13 51 101

1 Excluding the gradual terminal decline immediately preceding death.

2 No comment on shock in record.

NOTE.-IKey for roman numerals:

II Dying on admission.

III Died before anesthesia (excludes II).

IV Died during anesthetic induction.

V Died during primary surgery.

VI Died subsequent to primary surgery.

TABLE 164.-Primary operations performed on 327 cases in which the immediate cause of

death was shock

Type of operation Died during Died following Total number primary surgery primary surgery of eases

Abdominal stab incision ----------------------- 1 6 7

Amputation --------------------------------- 2 17 19

Craniotomy ---------------------------------- 1 4 5

Debridement only ---------------------------- 5 36 41

Laminectomy ------------------------------- 1 3 4

Laparotomy --------------------------------- 5 168 173

Other operation ------------------------------- 1 3 4

Thoracolaparotomy --------------------------- 3 7 10

Thoracotomy -------------------------------- 14 50 64
FIFTH U.S. ARMY HOSPITAL BATTLE DEATIIS 515

TABLE 165.-Miscellaneous observations in 219 cases in which the immediate cause of death

was shock

Number of cases in group- Total Miscellaneous observations number

of cases

It 111 IV V VI

Burns present ---------------------------------------- 2 3 .--- 4 9

Coma on admission ----------------------------------- 8 20 1 7 36

Cyanosis, marked ----------------------------------------- 2 3 4 9

Dying on admission ---------------------------------- 55-------- ---- ---- 55

Exposure, severe, before admission -------------------------- ------------ 2 2

Hemorrhage, profuse, in hospital --------------------------- I-- 9 19 29

Pallor noted ----------------------------------------- 4 2 1 2 9

Peritoneal closure impossible ------------------------------------------ 4 4

Sweating noted --------------------------------------- 1 2 ---------- 2 5

Tourniquet used before admission ----------------------- 6 10 1 12 29

Two or more of these present --------------------------- S 6 1 7 32

NOTE.-Key for roman numerals:

II Dying on admission.

III Died before anesthesia (excludes II).

IV Died during anesthetic induction.

V Died during primary surgery.

VI Died subsequent to primary surgery.

PIGMENT NEPHROPATHY IN BATTLE CASUALTIES

The development of progressive oliguria and anuria in battle casualties

resuscitated from shock and apparently on the road to recovery following extensive surgical procedures led to the death of a significant number of severely

wounded soldiers. Death usually occurred between the fourth and eighth days

after the wound was incurred. At autopsy, the kidneys were observed to be

somewhat enlarged, and on microscopic examination pigment casts were seen

in the distal convoluted and collecting tubules. The proximal tubules were

dilated, and a varying degree of necrosis of the distal tubules was observed,

with some inflammatory reaction in the adjacent stroma. The capillary tufts

in the glomeruli showed no changes, but there was in some cases slight swelling

of the cells in Bowman's capsule. This lesion has been variously termed pigment nephropathy, hemoglobinuric nephrosis, and lower nephron nephrosis.

Among the 1,411 deaths, lower nephron nephrosis or pigment nephropathy

led to death in 68 cases (table 166) and contributed to death in 31 others. It

was suspected to have been present in 57 additional cases. Autopsy was performed in all but 9 of the 99 cases in which pigment nephropathy was known

to be present, and microscopic study of renal sections was reported in 67 of the

90 cases in which autopsy was performed.
516 WOUND BALLISTICS

TABLE 166.-Distribution of 1,411 hospital battle casualty deaths, by result or status of pigment

nephropathy

Result or status of pigment nephropatby Number of cases Percent of cases

Led to death --------------------------------------------- 68 4. 8

Contributed to death -------------------------------------- 31 2. 2

Suspected ------------------------------------------------ 57 4

Total ---------------------------------------------- 156 11

A study of the 99 cases in which pigment nephropathy was known to be

present forms the basis of this presentation. Of significance are the severity

and multiplicity of wounds encountered in this group. The following tabulations list the site of the principal wounds and of the associated wounds in this

group of 99 cases of pigment nephropathy:

Number of Number of

Site of principal wounds: cases Site of principal wounds-Con. cases

Intra-abdominal area ---------- 45 Lower extremity --------------- 18

Combined intra-abdominal and Upper extremity --------------- 1

intrathoracic area ------------ 6 Cervical area ------------------ 2

Thoracoabdominal area -------- 8 Unclassified, multiple areas ----- 5

Intrathoracic area -------------- 4

Intracranial area -------------- 8 Total ----------------------- 99

Intraspinal area ---------------- 2

Number of Number of

Site of associated wounds: wounds Site of associated wounds-Con. wounds

Intracranial area -------------- 5 Combined intra-abdominal and

Maxillofacial area (bones and soft intrathoracie area ----------- 1

tissue) ---------------------- 3 Intra-abdominal area ----------- 1

Eye or orbit ------------------- 3 Suspected intra-abdominal area- 3

Maxillofacial area (soft tissue Upper extremity (includes 2 trauonly) ----------------------- 9 matic amputations) ---------- 44

Neck ------------------------ 9 Lower extremity (includes 2 trauIntraspinal area --------------- 7 matic amputations) ---------- 49

Thoracic wall ------------------ 6

Intrathoracie area -------------- 10 Total --------------------- 149

Suspected intrathoracic area --- 2

Abdominal wall (exclusive of

intra-abdominal cases) ------- 7

It will be noted that the abdominal cavity was involved in 59 cases and that

intra-abdominal wounds were present as associated wounds in 2 more cases

and suspected in 3 others. In only 20 cases were no wounds present other than

the one or ones listed as principal wounds. The 149 associated wounds occurred

in 79 cases, for a total of 238 wounds.9

9 Multiple wounds confined to one region of tbe body. such as the lower extremity or the intra-abdominal area, were

listed as only one wound. The same is true of the 20 cases in which no associated wounds are listed, as in many of these

cases there were multiple shell fragment or bullet wounds confined to one region of the body.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 517

In all the deaths in battle casualties studied, attempt was made to ascertain

an immediate cause of death. Lower nephron nephrosis was regarded as the

immediate cause of death in 68 cases. In 31 cases, some other cause was

thought to be the immediate cause of death, as is shown in the following

tabulation:

Number of Number of

Immediate cause of death: cases Immediate cause of death-Con. cases

Fat embolism ------------------ 3 Pneumonia -------------------- 2

Thrombotic pulmonary embo- Shock ------------------------ 5

lism ------------------------- 3 Spinal cord trauma ------------ 1

Clostridial myositis (gas gan- Undetermined intra-abdominal

grene) ---------------------- 4 lesion ---------------------- 2

Intracranial hemorrhage, trauma- 3 Unclassified, undetermined ------ 7

Peritonitis -------------------- i1

The so-called immediate cause of death, however, fails to give a complete picture

of the multiplicity of pathologic conditions existing in this group of 99 cases.

The contributory or associated conditions existing in this group are shown in

the tabulation which follows.

Number of Contributory or associated condi- Number of cases cases

Contributory or associated condition: I tion '-Continued

Intracranial abscess ------------- 1 Sepsis in extremity ----------- 8

Intracranial blast trauma ---- 1 Extremity trauma ------------- 66

Encephalomalacia ---------------- 6

Intracranial hemorrhage or hema- Total extremities-...........-93

toma ------------------------ 7

Cerebral ischemia -------------- 2 Abdominopelvic trauma- -------- 14

Meningitis --------------------- 1 Extraperitoneal abscess -.-.-.-.-.- 2

Cerebral trauma, unclassified___ 6 Intraperitoneal abscess- - 6

Maxillofacial trauma ----------- 14 Adrenal hemorrhage ----------- 3

Adynamia ileus, severe ---------- 5

Total intracranial ------------ 38 Adynamia ileus, mild or moderate ---------------------

Cervical hemorrhage -------------- 3 Abdominal blast trauma ...----- 2

Cervical trauma-- - Abdominal blast trauma, sus- pected --------------------- 3

Total cervical ---------------- 11 Cellulitis, mural and extraperitoneal---------__ ---------- 3

Hematomyelia ---------------- 4 Peritoneal contamination from

Spinal cord hemorrhage -------- I hollow viscera ---------------- 39

Transection of spinal cord ------ 2 Crushing trauma of abdomen__- 1

Partial transection of spinal cord. 1 Crushing trauma of abdomen,

Spinal cord trauma ------------ 8 suspected ------------------- 1

Evisceration, postoperative ----- 1

Total intraspinal ------------- 16 Gangrene of bowel -------------- 1

Gastric dilatation ------------- 6

Crushing trauma of extremity__- 3 Abdominal hemorrhage, primary. 50

Frostbite or immersion syndrome- 1 Abdominal hemorrhage, recurExtremity hemorrhage --------- 15 rent or delayed --------------- 2

See footnote on page 518.
518 WOUND BALLISTICS

Contributory or associated condi- -uniber of Contributory or associated condi- Nnitber of

tion '-Continued cases tion '-Continued cases

Hepatic degeneration, toxic ----- 16 Intrapulnonary hemorrhage,

Hepatitis, epidemic ------------- 4 severe --------------------- 7

Hepatitis, epidemic, suspected-- I Intrapulnonary hemorrhage,

Inflammation of gastrointestinal mild or moderate ------------ 21

tract --------------------- 2 Mediastinal edema ------------- 3

Intestinal obstruction, severe -- 1 Mediastinal hemorrhage -------- 3

Intestinal obstruction, mild or Myocardial decompensation -.-- 27

moderate ------------------- 1 Myocardial decompensation, susLeakin'g suture line ------------- 1 pected ---------------------- 27

Nephropathy evident, unclassi- Pneumonia, severe ------------- 4

fled -------------------------- 31 Pneumonia, mild or moderate __ 19

Operative wound infection ------ 3 Pneumonia, suspected ----------- 3

Pancreatic hemorrhage --------- 1 Pneumonitis -------------------- 3

Pancreatic trauma -- 1----------- Pulmonary edema, severe ------ 45

Peritonitis, severe - 7 Pulmonary edema, slight, modPeritonitis, mild or moderate -- 18 crate ------------------------ 12

Peritonitis, suspected-------- 2 Purulent bronchitis------------ 3

Renal repair, parenchymal ------ 2 Tension pneumothorax --------- 3

Renal trauma ----------------- 18 Tracheobronchial obstruction

Renal trauma, suspected ------- 2 with blood and mucus ------- I

Splenic degeneration, toxic .... 4 Thoracic trauma --------------- 13

Splenomegaly ------------------ 6 Pleural contamination from holUnrepaired wound of hollow low viscera in abdomenviscus ---------------------- 1

Ureter traumatized or tied- .-.-- 3 Total thoracic ------------- 305

Urinary tract repairs ----------- 1

Gas gangrene of extremity ------ 2

Total abdominal ------------- 262 Gas gangrene of extremity, suspected ----------------------- 3

Pulmonary atelectasis, severe___ 1 Gas gangrene of head, neck or

Pulmonary atelectasis, mild or trunk ----------------------- 1

moderate -------------------- 13 Pulmonary fat embolism ------- 8

Pulmonary blast trauma ------- 9 Pulmonary fat embolism, susPulmonary blast trauma, sus- pected ---------------------- 4

pected ---------------------- 6 Thrombosis, renal artery ------- 3

Bronchial fistula --------------- 1 Pulmonary thrombotic emboCardiac trauma ----------------- 1 lism ------------------------- 5

Cardiac trauma, suspected ------ 1 Pulmonary thrombotic emboContinuing intrapleural hemor- lism, suspected -----------

rhage ------------------------ 1 Infarction of kidney ------------ 1

Crushing trauma of chest ------- 1 Infarction of lung -------------- -1

Dilatation of heart, severe ------ 9 Thrombosis, intracranial vessel- I

Dilatation of heart, slight or Thrombosis, extremity artery--- 2

moderate ------------------- 11 Thrombosis, extremity veins- -_ 1

Empyema, mild or moderate ---- I Anemia, refractory or severe---- 8

Empyema, suspected ---------- 1 Jaundice --------------------- 10

Hemopneumothorax ------------ 27 Malnutrition, severe---_ ------- -1

Hemothorax without pteumo- Transfusion reaction, severe -.-- 3

thorax --------------------- 3

Hydrothorax, severe ------------ 1 Total general --------------- 57

Hydrothorax, slight or moderate- 23

'Those are in addition to the condition listed as the immediate cause of death.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 519

Pulmonary complications were so frequent as to be almost the rule.

In many cases, the giving of intravenous fluids in the absence of urinary

excretion led to high volume of the blood, cardiac failure, and pulmonary

edema. Toxic hepatic degeneration was present in 16 cases, epidemic hepatitis in 4 cases (suspected in 1 more), and septic hepatitis secondary to

trauma in 2 cases (suspected in 3 more). There was recorded evidence of

renal trauma in 18 of the 99 cases, and a ureter had been traumatized or tied

in 3 other cases. Fat embolism was the immediate cause of death in 3 cases,

contributing cause of death in 8 cases, and was suspected as contributory

to death in 4 more cases. The 11 cases in 99 represent an incidence of 11

percent, which is considerably higher than in the whole series of 1,411 battle

casualty deaths, in which 49 cases constitute only 3.5 percent. It is also

interesting to note that, in the 49 patients known to have pulmonary fat embolism, 11 had pigment nephropathy. Severe reactions from blood transfusion were noted in only 3 of the 99 cases. Gross infection was evident in

61 cases.

One outstanding feature in the cases in which anuria developed was the

severity of the shock which occurred sometime between wounding and the

development of renal insufficiency. In the 99 cases in which pigment nephropathy was known to exist, the lowest recorded blood pressures, along

with other data relative to shock, are as follows:

Number of

Systolic blood pressure recording: cases

0 ---------------------------------- 22

2-38 ----------------------------------------------------- 1

40-58 ----------------------------------------------------- 9

60-78 -------- --------- --------------------------------- 13

80-88 ---------------------------------------------------- 6

90-98 ---------------------------------------------------- 5

Presence of shock stated (no other data) --------------------- 13

Treatment suggests shock (no other data) -------------------- 25

No evidence of shock --------------------------------------- 5

Total -------------------------------------------------- 99

The five cases, the records of which gave no evidence of shock, are of sufficient

interest to warrant presentation of case summaries (cases 3, 4, 5, 6, and 7).

It must be remembered that many of the records were rather incomplete.

Data regarding the duration of low blood pressure were available in only

a few instances. No data concerning the level of blood pressure before admission to a hospital are available. The amount of plasma administered before

admission is perhaps the best index of shock at that time. The number of
520 WOUND BALLISTICS

units of 250 cc. of plasma administered in 99 cases of pigment nephropathy

before admission to a hospital installation was as follows:

Units of plasma: caseso Units of plasma-Continued caseso

None or no record ---------------- 25 5 -------------------------------- 3

1 ------------------------------- 16 6 -------------------------------- 1

2 ------------------------------- 19 8 -------------------------------- 1

3 ------------------------------- 22 10 -------------------------------- 1

4 ------------------------------- 10 11 ------------------------------- 1

There was evidence of shock in 94 of the 99 cases of pigment nephropathy.

Trauma and hemnorrhage were the leading causative factors in the development of shock. Additional contributory factors were cardiorespiratory embarrassment and contamination of the peritoneum or of an extremity. The

amounts of plasma and blood used after admission to the hospital are further

indexes of the degree of shock in these patients. The recorded data available

concerning the administration of plasma and of blood are shown in the following tabulation:

Units of plasma administered- Number of Uinits of plasma administered-Con.Nubro

Before admission: cases During operation-Con, cases

No record ------------------- 25 7 -------------- -

1 --------------------------- 16 8 ------------- -

2 --------------------------- 19 9 ------- -

3 - --------- -- --- -- 2 2 1 0 - - - - - - - - - - - - - - -

4 ------------- -------------- 10 11---------------

5 ---------------------------- 3 After operation:

6-------------------------- No record ------------------- 68

7 --- ------- ---- --- -- - - I------ --------------------- 7

8 ---------------------------- 1 2 -------- ------------------- 7

9 -------------------------- --- 3----------------------------5

10 -------------------------- 1----------------------5

11 -------------------------- 1-------------- - After admission, before operation: 6---------------4

No record ------------------- 60---------------------2

1 --------------------------- 12----------------------1

2---------------------------- 169

4 ---------------------------- 2 1 ------------ - 5 ---------------------------- 2

6 2 Pints of blood administered7-------------------Before operation:

8--------------------N o record ------------------- 33

9---------------------1--------------------------- 10

10 ------------------------- --------- 2 --------------------------- 10

11--------------1--------------------------- ------- 13

During operation: 4 --------------------------- 14

No record ------------------- 75-----------------------------------11

1 ----------------------------------- 6----------------------------3

2 ---------------------------- 8-----------------------------------2

3 ---------- ------------------ 2 8 ---------------------------- 1

4 -- --------- - - -2 - - - - -- -- - -- -- - -- -- - -- - -- 9

4 ---------------------------- 2 1M---------------------------

5 --------------------------- 110------------------------- -
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 521

Pints of blood administered-Con. Number of Pints of blood administered-Con. Number of

During operation: cases After operation: cases

No record ------------------ 45 No record ------------------ 49

1 -------------------------- 14 1 --------- 23

2_ ------------------- 14 2 --------------------------- 8

3 --------------------------- 6 3 --------------------------- 5

4 -------------------------- 6 4 --------------------------- 8

5 --------------------------- 2 5 --------------------------- 4

6 --------------------------- 5 6 -------------------------- 1

7 -------------------------- 2 7 ----.--------------------- 1

8 --------------------------- 2 8__

9 -------------------------- 2 9.

10 ----------------- ---- 1------- 10

11 -------------------------- 1 11----------------------------

Treatment with oxygen might be expected in a larger percentage of

patients than is shown in the following tabulation:

Number of Number of

Oxygen therapy: cases Oxygen therapy-Continued cases

No record ---------------------- 36 During operation ---------------- 47

Before operation ---------------- 13 After operation- --------------- 27

The operating time for primary surgical treatment, shown in the tabulation which follows, is a further index of the severity of the wounds in this group

of cases.

Number of .Number of Operating time (minutes): cases Operating time (minutes)-Con. cases

Less than 30 --------------------- 180-209 ------------------------- 7

30-59 --------------------------- 210-239 ------------------------ 2

60-89 -------------------------- 1 240-299 ------------------------ 4

90-119 ------------------------- 3 300-359 ------------------------ 2

120-149 ------------------------ 2 More than 360 ------------------- 2

150-179 ------------------------- 3

Unfortunately, the time was not stated in 62 of the cases; no operation was

performed in 11 cases. In the remaining 26 cases, however, it was seen

that in only one case did the operation last less than 1Y hours, while in the

largest group of cases the operating time was from 3 to 3%2' hours.

Data concerning anesthesia in the 68 patients who died of pigment nephropathy are presented in table 167. It will be noted that, with the exception

of four patients who died before anesthesia was complete, all of whom had

crush injuries, all had been given ether. In table 168, the anesthesia in 31

cases in which pigment nephropathy was a contributing cause of death is recorded. Of this group, seven patients died before anesthesia was complete;

one had local anesthesia only; and all of the rest had ether anesthesia in one

form or another. The patient who had local anesthesia only had an intracranial wound and died of pneumonia, septic hepatitis, and jaundice. There

was a record of adequate urinary output and no evidence of shock. On the

basis of microscopic autopsy alone, the diagnosis of pigment nephropathy was

made. Data for seven patients who died before the induction of anesthesia

6o0225-6,2- 35
522 'WOUND BALLISTICS

in this group are presented in table 169. The diagnosis of pigment nephropathy

in each of these cases is based on microscopic study of renal sections. All the

patients had severe wounds; most of them died after a comparatively short

time of being wounded, and correction of shock was doubtful or shock was

completely uncorrected in all but one patient. Data concerning the amount of

urine passed were unavailable. Since ether was considered to be the anesthetic

of choice in all battle casualties with shock or severe wounds, no significance

can be attached to the high incidence of ether anesthesia in this group of patients with pigment nephropathy.

TABLE 167.-Anesthesia in 68 patients who died of pigment nephropathy

Number of patients atType of anesthesia Primary Secondary

operation operation

Ether:

Closed system --------------------------------------- 31 2

Open drop ------------------------------------------- 3 0

Unclassified ------------------------------------------ 15 2

Endotracheal ------------------- - 28 1

Nitrous oxide 1------------------------------------------ 28 2

Thiopental sodium I --------------------------------------- 3 2

No record ------------------------------------------------ 14 3

Death occurred before induction of anesthesia 2 -------- 4 3

I All were known to have had ether, alone or in combination with another agent.

2 All had crush injuries.

TABLE 168.-Anesthesia in 31 patients in which pigment nephropathy contributed to death

Number of patients atType of anesthesia Primary Secondary operation operation

Ether:

Closed system ---------------------------------------- 13 1

Flagg method ---------------------------------------- 1 4

Open drop ------------------------------------------- 1 0

Unclassified ------------------------------------------ 5 0

Endotracheal --------------------------------------------- 7 0

Nitrous oxide -------------------------------------------- 11 1

Local 1----------------------- 1 1

Thiopental sodium --------------------------------------- 0 0

No record ----------------------------------------------- 3 2

Death occurred before anesthesia was complete -------------- 7 0

1 Specific agent not known.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 523

TABLE 169.-Analysis of 7 cases in which death occurred before anesthesia and in which pigment

nephropathy contributed to death

Timelag

from Urinary

Wounds Immediate cause of death Shock wounding output

to death (hours)

Intracranial and the abdomi- Pulmonary embo- Uncorrected; low- Not re- Record

nal wall. lism (thrombot- est blood pres- cord- inadeic). sure recorded ed. quate.

60/20.

Intraspinal, neck, intrathor- Undetermined ----- Corrected; 14 ----- No

acic (bilateral), and upper administered recextremity. blood; pressure ord.

50/0.

Intracranial (bilateral) and Shock ------------ Uncorrected ------ 33 ----- Do.

multiple.

Intraspinal, intracranial, Spinal cord Shock; correction 113 ---- Do.

maxillofacial, neck, and trauma, doubtful.

upper extremity.

Traumatic amputation and Fat embolism ---------- do ----------- 25 ----- Do.

lower extremity.

Multiple, extremities, and Gas gangrene- Uncorrected ------ 76 ----- Record

face. inadequate.

Intracranial, both lower ex- -- do ---------------- do ----------- 73

tremities, and one upper

extremity.

Diagnosis of pigment nephropathy in each instance was based on microscopic study of renal sections.

When the first cases of anuria were encountered, the sulfonamide drugs

were regarded as the probable causative factor. Sulfanilamide powder was

dusted into almost every wound on the battlefield, and most of the wounded

soldiers had taken 4 gin. by mouth before reaching the hospital. Early in

the period under study, it was common practice to administer 5 gm. of a sulfonamide drug intravenously to all with abdominal wounds immediately on

admission to the hospital and to repeat this dose at intervals of 12 to 24 hours

thereafter. With the appearance of anuria, this practice was discontinued,

and no sulfonamide drug was given intravenously until 12 hours after operation

and only after the patient had fully reacted from shock. At the same time,

the amount of sulfanilamide dusted into the peritoneal cavity was limited to

5 gin. and the amount in all wounds to 10 gin. That sulfonamide drugs were
524 WOUND BALLISTICS

a causative factor at least in one case, cannot be refuted. That they were

not the only factor except in a few cases, likewise, was evident from subsequent studies. In 30 of the 68 cases in which pigment nephropathy was the

direct cause of death and in 14 of the 31 cases in which pigment nephropathy

contributed to death, there was no record of sulfonamide therapy, excluding

the sulfanilamide powder dusted into wounds at the time of the first aid

dressing.

The microscopic observation of a lesion termed hemoglobinuric nephropathy focused attention on blood transfusion as a causative factor. Before

the establishment of a blood bank unit in the Mediterranean theater, reactions

from mismatched and unmatched transfusions did occur in a few instances.

However, anuria continued to develop after the use of group 0 blood from

the blood bank. Then it was thought that the transfusion of a large quantity

of group 0 blood to group A or group B recipients might be responsible for

anuria in some of the cases; however, low titer group 0 blood (containing

anti-A and anti-B iso agglutinins in a titer of less than 1 to 120) was used for

all except group 0 recipients, and it was later ascertained"1 that the incidence

of pigment nephropathy in the persons of the four blood groups paralleled

the relative incidence for persons of the four groups in the general population.

In a separate article," a case of Maj. James M. Mason's was mentioned in which

a group A recipient received 5,500 cc. of low titer group 0 blood before and

during operation for a thoracoabdominal wound, which involved the removal

of one kidney. There was no evidence of insufficiency in the remaining kidney,

and the patient made an uneventful recovery. It was likewise demonstrated 12

that the shock occurring in battle casualties was due in most instances to loss

of whole blood and that the apparently massive doses of blood used in resuscitation of these patients were excessive in only a few instances. In most cases,

determinations of the volume of blood established the fact that not enough

whole blood was being used in the resuscitation of these patients. It was

also observed that many patients showing gross hemoglobinuria did not always

experience renal insufficiency, while, on the other hand, in many of the fatal

cases of pigment nephropathy hemoglobinuria was never apparent grossly.

Early in 1944, at the same time that a reduction in the use of sulfonamide

drugs was effected, the use of sodium bicarbonate to render the urine alkaline

was encouraged. In many cases, it was given by mouth as soon as treatment

with sulfonamide drugs was started; in others, it was given intravenously

before sulfonamide medication and blood transfusion. Records regarding this

treatment were seldom complete, but in the 99 cases of nephropathy the use of

sodium bicarbonate was reported in 21 cases.

10 Mallory, T. B.: Hemoglobinuric Nephrosis in Traumatic Shock. Am. J. Clin. Path. 17:427-443, June 1947.

11 Snyder, Ht. E., and Culbertson, J. W.: Causes of Death in Battle Casualties Reaching Hospitals. Am. J. Surg.

73:184-198, February 1947.

12 (1) Report, J. J. Lalich, to Commanding Officer, 2d Auxiliary Surgical Group, June 1944, subject: Transfusion

Therapy in the Battle Casualty Exhibiting Evidence of Circulatory Failure. (2) Report, J. J. Lalich, to Surgeon, Mediterranean Theater of Operations, U.S. Army, November 1944, subject: Hematocrit and Plasma Protein Findings in

Battle Casualties Treated in a Field Hospital.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 525

The hepatorenal syndrome was considered as a mechanism which might

account for anuria in some of the cases. The reports of Orr, Helwig, and

Schutz"3 constituted the chief source of information for American surgeons concerning renal shutdown associated with trauma. It was apparent, however,

that the majority of patients seen did not present evidence of hepatic damage,

although such damage was present in no inconsiderable percentage. Review

of the microscopic renal observations in the cases reported by Orr and Helwig

would lead one to believe that the condition they described was pigment

nephropathy.

Luck6 1" reviewed 538 cases in which the disease was fatal, the records

and material of which were received at the Army Institute of Pathology during

the war. He found the characteristic renal lesion in 11 groups, which included

cases in which there were battle wounds, crushing injuries, abdominal operations, burns, reactions from blood transfusion, intoxication due to sulfonamide

drugs, heat prostration, malaria due to infection with Plasmodium falciparum

(black-water fever), poisoning due to a variety of agents, hemolytic anemia,

edema, and such unrelated conditions as uteroplacental damage, acute pancreatitis, and rickettsial disease.

With increasing experience with the condition, it became the opinion of

many that the severe degree of shock occurring in most of the cases must be

responsible at least in part for the development of nephrosis. In the fall of

1944, a board 15 for the study of the severely wounded was appointed by Col.

Edward D. Churchill, MC, Consultant in Surgery, Mediterranean theater.

This board made elaborate studies, both clinical and laboratory, on battle casualties in severe shock 10 when admitted to forward hospital installations and

all observations of practical value were made available immediately in the forward hospitals. Before this time, clinical observation by many and laboratory

investigation by Stewart, Lalich, and others had led to the general belief that

shock in persons suffering injury in battle was in most cases due to loss of whole

blood. The studies of the board confirmed this opinion and defined the exceptions to the rule. It was learned that in the cases in which nephropatby

developed the observation of a benzidine-reacting pigment in the specimens

of urine was a constant feature. Study of this pigment by a chemical method

showed that it was myoglobin in cases of crush injury but that in the other

cases it might be hemoglobin or myoglobin or a combination thereof. Except

in the cases in which there were crush injuries, it was impossible to predict

from the nature of the injury what type of pigment would be seen in the urine.

Mallory, a member of the board, observed that it was not possible by micro13 (1) Orr, T. G., and Helwig, F. D.: Liver Trauma and the Hepatorenal Syndrome. Ann. Surg. 110:682-692, October

1939. (2) Helwig, F. D., and Schutz, C. B.: A Liver Kidney Syndrome. Surg., Gynec. & Obst. 55:570-580, November

1932.

14 Luck6. B.: Lower Nlephron Nephrosis. Mil. Surgeon 99:371-396, November 1946.

15 Members of the Board for the Study of the Severely Wounded were as follows: Lt. Col. Henry K. Beecher, MC,

Lt. Col. Fiorindo A. Simeone, MC, Lt. Col. Tracy B. Mallory, MC, Maj. Eugene R. Sullivan, MC, Capt. Charles H.

Burnett, MC. Capt. Louis D. Smith, SnC, and Capt. Seymour L. Shapiro, SnC. "16 Medical Department, United States Army. Surgery in World War II. The Physiologic Effects of Wounds.

Washington: U.S. Government Printing Office, 1952.
52-6 WOUND BALLISTICS

scopic study of the kidneys to determine whether a lesion had been produced

by poisoning due to sulfonamide drugs, mismatched transfused blood, or

other factors. Mallory pointed out that the deposit of pigment in the distal

convoluted and collecting tubules does not seem to be the first pathologic

change in the kidneys. Tn 11 of their patients who died of injury within 72

hours, only 2 showed pigment casts in significant numbers.

Before the appearance of pigment casts, a fine fat vacuolization of ascending

limbs of Henle's loops appears. Mallory stated that this appears in 75 or 80

percent of patients who experienced shock, regardless of whether clinical evidence of renal insufficiency develops or not, and that the process is reversible.

He expressed the belief that the pigment casts play no role in the initiation of

renal insufficiency following shock but that one cannot state that they have no

effect in the later stages of the disease. The dilatation of the renal tubules

proximal to the casts and about them would lead to the assumption that they

do produce a degree of obstruction, at least in the involved tubules.

CASE REPORTS

Case 1.-An infantryman suffered a perforating wound of the left lower part of the

abdomen and the left hip from a machinegun bullet. He was admitted to the battalion

aid station 10}, hours later; 6h'2 hours more elapsed before his admission to a field hospital.

At this time, the blood pressure was unmeasurable. He was given 500 cc. of plasma and

2,500 cc. of low titer group 0 blood prior to operation. A catheterized specimen of urine

appeared blood stained. A laparotomy was performed 7 hours after admission and 24 hours

after the wound had been incurred, and a laceration of the jejunum and early severe peritonitis were observed. The laceration was sutured; the peritoneum was irrigated with

isotonic solution of sodium chloride and 100,000 units of penicillin; and 10 gin. of sulfanilamide were deposited in the peritoneal cavity. The wound at the left hip, which had produced a compound fracture of the greater trochanter, was debrided. He was then given

5 gin. of sodium sulfadiazine intravenously. Treatment with penicillin, 25,000 units every

3 hours, was started on admission. The blood pressure at the end of operation was unmneasurable, but within 2 hours it rose to 100 systolic and 80 diastolic. His postoperative course

was characterized by progressive oliguria, edema, uremia, disorientation, and respiratory

distress. Death occurred on the eighth postoperative day. On the first postoperative day,

he received 500 cc. of blood, 500 cc. of plasma, 1,000 cc. of dextrose in isotonic solution of

sodium chloride, and 5 gin. of sulfadiazine. On the second postoperative day, he was given

500 cc. of blood, 2 units of plasma, 2,000 cc. of dextrose in isotonic solution of sodium chloride,

and 5 gin. of sulfadiazine. No more sulfadiazine was given and no more blood except 1

pint (about 473 cc.) the day before death. Two days before death, the nonprotein nitrogen

in the blood was 91 mg., chlorides 605 mg., and sulfadiazine 13.23 mg. per hundred cubic

centimeters. His urinary output on the day of operation was 150 cc., and on successive

days it was 200 cc., 350 cc., 300 cc., 600 cc., 400 cc., undetermined, and 75 cc.

At autopsy, the peritoneal cavity contained a small amount of thick grayish yellow

foul-smelling pus, and the viscera were plastered to one another and to the parietes by a

coating of exudate up to 4 amm. in thickness. The liver was approximately 50 percent

heavier than normal, and the capsule was tense beneath the sheet of exudate on its surface.

On sectioning, the cut surface was nutmeg brown, with well-defined architectural units.

The spleen was doubled in size, and the capsule beneath the exudate was grayish red. The

kidneys were moderately enlarged; the capsules stripped readily, revealing surfaces which

were darker brown than normal, with fine dark red points and lines scattered throughout.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 527

The cortices were slightly widened; the pyramids were swollen and discolored by brown and

red lines paralleling the tubules. The apexes of the pyramids were dark brownish yellow.

The lungs did not collapse normally, and their weight was decidedly increased, particularly

on the right side. Cut surfaces were moist and released blood-stained mucoid fluid on pressure. There were slightly firm purplish red areas scattered throughout all the lobes, but

these were confluent only in the lower parts of the right upper and right lower lobes. Examination of the renal sections showed that the glomeruli were moderately congested; the

tubules were slightly dilated. The distal convoluted and collecting tubules contained numerous brown granular and hyaline casts. Many tubules contained desquamated epithelial

cells and polymorphonuclear cells. One tubule showed a decided proliferative reaction

interspersed with polymorphonuclear cells. Here the inflammatory process extended into

the interstitium. There were scattered crystals of a sulfonamide drug within the lumens

of the distal tubules. The interstitial tissues contained engorged blood vessels, and there

was extravasation of small red cells. Microscopic pathologic diagnoses included pigment

nephrosis, hemorrhagic bronchopneumonia, acute purulent perihepatitis, and perisplenitis.

Case 2.-A 21-year-old soldier was injured during a bombing raid when a stone building

collapsed on him. He was extricated from beneath a pile of stone after 3% hours

and reached an evacuation hospital 15 minutes thereafter. There was no visible evidence

of traumatism, and skeletal roentgenograms revealed nothing of significance. His blood

pressure was 104 systolic and 74 diastolic, and the pulse rate was 120. The urine was wine

colored, with no red cells. Approximately 7 hours after admission, he was given 500 cc. of

type 0 blood and then 1,000 cc. of 5 percent dextrose. Four or five hours later, he went into

a state of shock. This was evident by pallor, loss of radial pulse, and no blood pressure.

A transfusion was started, but when the hematocrit was observed to be 70 percent it was

discontinued, after 300 cc. were given, and dextrose with isotonic solution of sodium chloride substituted. The blood pressure rose to 100 systolic and 80 diastolic. A specimen of

urine was chocolate colored. He complained of many points of muscular soreness and tenderness, and the areas were tense and brawny on palpation.

During the succeeding 9 days, he remained oliguric, the daily output of urine ranging

from 50 to 100 cc., with an intake of about 3,000 cc. of fluid. Sodium bicarbonate was

given daily in 2.5 percent of solution. The patchy muscular induration increased. The

urine became normal in color on the third day but still had a positive benzidine reaction.

On the sixth day, the face was puffy, and there was pitting edema over the sacrum. The

blood pressure was 150 systolic and 110 diastolic. Magnesium sulfate was given intramuscularly. During the next 3 days, the edema increased and the hypertension persisted;

epistaxis became frequent; and death occurred with relative suddenness a little less than 10

days after the injury. The level of nonprotein nitrogen in the blood reached a total of 291

mg. and creatinine 12.2 mg. per hundred cubic centimeters the day before death occurred.

A check for myoglobin on one specimen of urine early showed a concentration of 588 mg.

per hundred cubic centimeters. At autopsy, all muscles appeared paler than normal and

scattered throughout the skeletal musculature were many focal areas of traumatic damage.

In most instances, these were segments of muscles closely proximate to bone. Larger foci noted

were in the flexor group of the left forearm, the left vastus medialis, the lower quarter of the

right sartorius, and all of the right soleus. The general pattern was a pigmented grayish

white area in the muscles surrounded by a hemorrhagic border. Some of these areas appeared translucent and like fish flesh; others were frankly necrotic, with an opaque slighty

grayish infiltration, Some foci appeared almost chalky, and the muscle fibers in the involved

areas were friable and easily torn. The kidneys weighed 550 gm. They were symmetrically enlarged, and the vessels of the perirenal fat were engorged. One focus of hemorrhage

in this fat was noted at the lower pole of the right kidney. It was entirely extracapsular.

The capsules stripped readily and left pale smooth surfaces. The arteries and veins were

patent. On sectioning, the cortex was pale and swollen. The surfaces appeared moist;
528 WOUND BALLISTICS

the pyramids were dark, with a hint of brown in predominant redness. The vessels were

not engorged, and no gray zone was present at the corticomedullary junction. 17

Case 3.-A soldier was wounded in action near Cassino, Italy, by artillery shell burst.

He was admitted to an evacuation hospital approximately 4% hours later, in good condition

and showing no signs of significant loss of blood. In the shock tent, he was given 60 grains

(3.9 gm.) of sulfadiazine and 500 cc. of plasma. Thirty minutes later, in the operating

tent, the wound of entrance overlying the head of the left femur posteriorly was debrided,

and the track followed up toward the anterior-superior iliac spine, where a counterincision

was made. A foreign body was removed without difficulty, along with two or three comminuted bone fragments. A penetrating wound of the left forearm was then debrided

and the foreign body removed. Both wounds were treated with sulfanilamide powder

and petrolatum-impregnated gauze. During the operation with the patient under gas,

oxygen, and ether anesthesia, a blood transfusion was started. Later, while the patient

was still on the operating table and still under anesthesia, generalized shaking chill, or

rigor, began. The transfusion was discontinued and 500 cc. of plasma given. The same

blood was matched again and observed to be compatible, and the rest of it was administered

without untoward reaction. Following the operative procedure, a catheter was inserted,

and 120 cc. of dark blood-stained urine was obtained. From this time on, a catheter was

employed every 12 hours. The bladder was still empty after 24 hours. His general condition remained essentially unchanged until approximately 8 hours before death, when he

became irrational, breathing became irregular, and increasing pulmonary edema developed.

He died approximately 72 hours following operation.

He had received no blood other than that previously noted. In addition to the aforementioned amount of sulfadiazine, he was given 8 gm. by mouth the first 24 hours but none

thereafter. Post mortem, the gross examination of the kidneys, ureters, and the bladder

failed to reveal any abnormality; however, microscopic examination of the kidneys revealed

nephrosis of the lower nephron.

Case 4.-A crush syndrome developed in a soldier, similar to the one presented in Case

3, except that there was no history of low blood pressure at any time during the 4% days

that he lived after injury.

Case 5.-A soldier suffered a perforating wound of the brain, a penetrating wound of

the left jaw, and a perforating wound of the right shoulder. He was admitted to an

evacuation hospital over 10 hours after the wound had been incurred. On admission, his

blood pressure was 130 systolic and 74 diastolic; the pulse rate, 78; and respiration, 20.

A roentgenogram of the skull showed that a foreign body 1.6 cm. in size had perforated

the skull in the left parietal region, had passed through the parietal lobes, and had perforated

the right frontal aspect of the skull, and had come to rest with the bone fragment before

it under the scalp. A linear fracture, 12 cm. long, extended backward in the frontal bone

on the left, from the depressed fracture entrance. The patient was comatose on admission.

He exhibited palsy of the right seventh nerve and spasticity in all extremities. Debridement

of the wound of the skull and the brain was performed about 6 hours after the patient's

admission to the hospital. In addition, the wounds of the jaw and the shoulder were debrided. He was given 1,500 cc. of blood and 1,000 cc. of plasma during the operation.

He remained comatose until his death. He had a relatively high temperature, with increased pulse rate and respiration. He received sodium sulfadiazine intravenously in a

dosage calculated to produce a level in the blood of 20 mg. per hundred cubic centimeters.

Oliguria developed about 5 days postoperatively, which progressed to complete anuria in 2

more days. Cystoscopy was performed, and the renal pelves were lavaged with sodium

bicarbonate solution. Numerous sulfadiazine crystals were observed, particularly in the

left renal pelvis. He died 7 days after he was wounded. Microscopic observations at

17 The report of the microscopic study was not available in this case, but it may be said that essentially the same picture was seen in patients with crush injury as in those with pigment nephropathy resulting from transfusion, poisoning

due to sulfonamide drugs, and wounds attended with severe shock.
FIFTH U.S. ARMY HOSPITAL BATTLE DEATHS 529

autopsy included indications of encephalomalacia, bronchopneumonia, and pigment

nephrosis.

Case 6.-A soldier was wounded in action by a high explosive shell fragment 1 or 2

days before admission to an evacuation hospital. The exact date and the time of his

wounding on Mount Porchia, Italy, were unknown. On admission, he was semistuporous

and showed changes in his reflexes, and the roentgenogram showed depressed fracture of the

right parietal bone, with a large bone defect and fragments of bone and metallic foreign

bodies driven into the right cerebral hemisphere. The operative risk was considered poor,

and the patient was given 500 cc. of plasma before operation, 500 cc. of blood during operation, and 500 cc. of blood shortly thereafter. Operation was performed under block anesthesia with procaine hydrochloride approximately 8 hours after his admission to the hospital.

Partial craniectomy, with thorough debridement of the wound of the brain and dural repair,

was accomplished. At termination of the operation, the patient was sent to the ward in

satisfactory condition, with a blood pressure of 120 systolic and 70 diastolic, a pulse rate of

120, and a temperature of 100.20 F. Postoperatively, he received 10 gm. of sodium sulfa.-

diazine intravenously, in two doses of 5 gm. each in the first 24 hours and 5 gm. intravenously

in divided doses in the second 24 hours. Subsequently, he received sulfadiazine, 6 gm.

daily by mouth, through the eighth postoperative day. He also received one unit of concentrated plasma twice daily for 8 days and four blood transfusions postoperatively. He

was never entirely rational or lucid, but at times he responded moderately well to questions

and talked coherently. Four days postoperatively, the patient had a crisis, characterized

by clonic contractions of the right side of the body and face for a few seconds, followed by

twitching for several minutes and a sudden rise of temperature to 1070 F; the pulse rate

was 160 and respirations, 52. All subsided quickly. His daily temperature, aside from

this one episode, was from 1020 to 1030 F. On the ninth postoperative day, the patient

was much weaker and drowsier and responded poorly to questions. He showed hemiplegia

and facial paralysis on the left side, which had been present all along, plus weakness of

several cranial nerves. Treatment with sulfadiazine was discontinued on this date, and

his condition was considered critical. The next day he was much worse, presenting dyspnea,

cyanosis, tachycardia, decided pulmonary congestion, jaundice, and coma. A diagnosis of

terminal bronchopneumonia was made; the cause of the jaundice was not clear. At post

mortem examination, it was noted that the common duct and larger branches were not

obstructed and that the gallbladder was not enlarged. On sectioning, the hepatic tissue

appeared to be deeply jaundiced, and the appearance was somewhat suggestive of a diffuse

necrotic process. The parenchyma of both kidneys appeared to be within normal limits;

the kidneys were about normal size, and the capsules stripped normally. The pelves of

the kidneys were stained with bile, and the mucosa contained numerous pinpoint hemorrhages. No crystals were evident. There were no signs of infection in the wound of the

brain. The diagnoses, based on gross pathologic studies, were nonobstructive jaundice,

the cause of which was undetermined; bronchopneumonia; and hepatitis. The report

of microscopic examination of the section of the liver was not available, but the following

diagnoses, based on microscopic studies, were made: (1) Bronchopneumonia, (2) jaundice,

and (3) slight hemoglobinuric nephropathy. The significance of the latter diagnosis is

not entirely clear. This patient was carefully studied, and his daily urinary output was

over 1,000 cc., except on the day of his death. It is perhaps incorrect to assume that

hemoglobinurie nephropathy contributed to death in this case.

Case 7.-A soldier was admitted to a field hospital approximately 1 day after being

wounded by enemy shellfire near Montecatini, Italy. He suffered compound fractures of the

left tibia and fibula in the middle third, a compound fracture of the left clavicle, a compound

fracture of the left scapula, and multiple penetrating wounds of the left buttock. All of his

wounds were debrided under open drop ether anesthesia in the field hospital. Six days later,

he was evacuated to an evacuation hospital, where he died 1 hour and 20 minutes after

admission. There was nothing further in his record concerning his clinical course. Post

mortem examination was done, and it was observed that both kidneys were enlarged, that

603225v-62- 2R6
530 WOUND BALLISTICS

the cortex was pale and swollen and irregular in both kidneys, and that the capsule stripped

easily. A diagnosis, based on gross pathologic studies, of nephrosis was made, the cause of

which was unknown. There were no microscopic observations in this case. Also presented

were bilateral pleural effusion, a hematoma in the upper lobe of the left lung, and pulmonary

congestion and edema, as well as the wounds previously noted. While there was no evidence

of shock recorded, it probably should be stated that the record was too inadequate to permit

the conclusion that shock did not exist at one time or another.

The condition described as pigment nephropathy, or lower nephron nephrosis, occurs with a variety of conditions. In battle casualties, the renal

damage is probably dependent on renal ischemia plus the excretion of pigment.

The renal ischemia is vasoconstrictive in origin and occurs in patients in a

state of shock and with related conditions. Whether or not the vasoconstriction is induced by a toxin elaborated from damaged tissues or by reflex vasomotor stimulation has not been definitely established. The pigment excreted

may be myoglobin or hemoglobin. The source of the hemoglobin may be from

transfused blood, intravascular hemolysis, and probably from other sources.

The role of infection has not been clearly defined and should be made the subject of investigation. The influence of the various anesthetic agents should

be studied.

Treatment should be prophylactic. Shock should be combated vigorously,

with prompt restoration of the volume of blood to normal. This should be

accomplished with the proper medium, which for most battle casualties is

whole blood. Treatment with oxygen is of value in combating anoxia, which

must result from vasoconstriction in the renal circulation. Injudicious use of

sulfonamide drugs should be avoided, and discontinuance of their use in conditions predisposing to nephropathy should be considered. Dehydration

should be avoided when possible and otherwise corrected as promptly as possible. Thorough surgical removal of all devitalized tissue and foreign bodies

and provision of adequate drainage to infected areas is important.
CHAPTER VIII

Casualty Survey, Cassino, Italy

Allan Palmer, M.D.1

Casualty surveys of civilians killed or injured in air raids in England had

yielded detailed information about the wounding power of bombs and about

the relative value of different measures of protection. The advantage of such

surveys was that the investigator could conveniently study not only the casualties themselves but also the circumstances under which they were injured.

Useful information had also been obtained in the past from surveys of

battle casualties undergoing treatment in base hospitals. However, this information was limited since the casualties seen represented only a small and usually

a selected proportion of the total.

It had long been felt that more useful information could be obtained by

studying the casualties incurred by selected units engaged in a specific operation

for which full details were available and, particularly, if such a survey could be

made further forward than the base hospitals. While the survey had to be

limited 2 because of shortage of time and personnel, it has shown that studies of

a similar kind could be successfully carried out, and it has also provided useful

guides for further procedures.

The scene of the battle was about 75 miles southeast of Rome along a

6-mile sector, the front of which lay along the Rapido River (fig. 264) immediately south of the town of Cassino (fig. 265). This front flanked a railroad

and a main road to Rome (Highway No. 6, fig. 266). Figures 267 and 268

show the terrain in the vicinity of Monte Lungo with the highly advantageous

enemy defensive positions.

Operations to bridge and advance across the Rapido River were begun

during the night of 19 January 1944 and were successfully completed on 12 May.

1 In November 1943, Maj. Allan Palmer, MC, was relieved of his assignment as chief of the laboratory service, 30th

General Hospital, European theater, for the purpose of joining Prof. Solly Zuckerman, C.B., F.R.S., in the Mediterranean theater for indoctrination in field casualty survey methods. Professor Zuckerman, as scientific advisor to the

Allied Air Forces leaders, held an honorary commission as Group Captain and later was the commanding officer of a component of the Royal Air Force known in the Mediterranean theater first as the Special Air Mission and later as the Bombing Survey unit. When the Secretary of War established the U.S. Strategical Bombing Survey in 1944, Zuckerman's

organization finally became known as the British Bombing Survey Unit. Major Palmer was one of the two American

Scientific observers attached to this unit. With the help of a Royal Air Force medical officer, Squadron Leader C. Spicer,

from Professor Zuckerman's unit, and an American medical officer, Maj. (later Lt. Col.) Roberto F. Escamilla, of the 59th

Evacuation Hospital, who was detailed by the Seventh U.S. Army saugcon, and in liaison with General Martin, Fifth

U.S. Army surgeon, Major Palmer conducted the specimen survey of 100 battle casualties sustained by the Fifth

U.S. Army during the Rapido River conflict south of Cassino from 20 to 27 January 1944.-J. C. B.

2 While it is true that this survey covers only relatively few casualties, incurred during a short interval of

the total campaign, it is an excellent demonstration of the organization and conduct of a casualty survey and the scope of

information available.-J. C. B.

531
532 WOUND BALLISTICS

SC MM-5-44-844

FIGUTRE 264.-Rapido River valley area, Italy, 6 February 1944. German's Gustav

Line. Monte Cassino with Benedictine monastery on the summit of the hill (left) and

Cassino at the base.

The main U.S. troops engaged in the operation were the 141st and 143d Infantry Regiments, 36th Infantry Division, and the 34th Infantry Division,

Fifth U.S. Army.

Fighting was of the static kind and was confined for many days to an

isolated area of mountainous country, as shown in figures 269 and 270. Allied

and enemy forces were not visible to each other, and there was little small

arms fire. Most wounds were inflicted by artillery and mortar shells and by

landmines. The bulk of the fighting with the casualties sustained, occurred

during the hours of darkness, especially when river crossings were attempted.

In general, the enemy's guns and mortars were zeroed in (fig. 271) to cover

the area traversed by U.S. troops, and periodically a harassing fire was laid

down, inflicting a very large number of casualties as wave after wave of troops

advanced in the region of the river.

The U.S. Army units engaged in this action had obtained previous experience of this type of warfare in operations which had resulted in the capture

of three mountain strongholds, Trocchio, Porchia, and Lungo. These hills

lay to the rear of the Rapido front and between U.S. troops and Highway No. 6.

The mountainous terrain necessitated the use of mules for the transport of

supplies and ammunition.
CASUALTY SURVEY, CASSINO 533

SC 239682

FIGURE 265.Town of Cassino, Italy, 6 February 1944. The Cassino castle is on the small

hill in the foreground and the Benedictine monastery is on the summit.

The stubborn resistance by the enemy in his attempts to maintain control

of Highway No. 6, and the considerable advantage of the terrain and entrenched

enemy positions, made the fighting the bitterest experienced by U.S. troops

in the whole Italian campaign. During the later stages of the campaign,

concentrated aerial bombardment assisted in the capture of Cassino (figs.

272 and 273).

MEDICAL FACILITIES AND EVACUATION OF CASUALTIES

Figure 266 shows the layout of the medical installations which served

the Fifth U.S. Army front in the Cassino area. They included six evacuation

and three field hospitals and two clearing companies, in the following order:

llth Field Hospital (near Venafro) 94th Evacuation Hospital (Semimobile)

422d Field Hospital (French) 15th Evacuation Hospital (Semimobile)

16th Evacuation Hospital 8th Evacuation Hospital

11th Evacuation Hospital (Semimobile) 601st Medical Clearing Company (Separate)

602d Medical Clearing Company (Separate) 10th Field Hospital

38th Evacuation Hospital
534 WOUND BALLISTICS

CASSINO 0 23

- ~MILES VENAFRO

141( 0/c6 SAN PIETRO ..2 1 Fid

PIETRAVAIRANO

0~~I ... 16 c

CALVI RISRORT

Epm~~GNT 5Eo ROx-- 

ssinoTEANO8 Eva

CASSIO 0

40.-7

FIGRE26.-apofth aea n hih hecauatysuveywa cndctd.Th rut of6 evcainadlcaino .. mdia ntlainsaeidctd
CASUALTY SURVEY, CASSINO 535

8C 188154

FIGURE 267.-View from center of Monte Lungo, Italy, 18 February 1944. (Center)

Monte Sammucro. (Right) San Pietro. Highway No. 6 is along the bottom and the

San Pietro road up center to San Pietro. This tremendously advantageous defensive

position held by the enemy for some weeks accounted for many casualties sustained by the

Fifth U.S. Army. Note shell craters in the foreground.

Casualties were carried out of the actual battle zone by litter squads and

jeeps. The ALP (ambulance loading points) (fig. 266) were located immediately outside the battle zone. The routes followed by the ambulances to

Highway No. 6 are also shown in figure 266. One of them consisted of a

railway track from which the rails had been removed.

Casualties were sorted in the vicinity of the ALP. Those whose main injuries were either cranial, thoracic, or abdominal were sent daily to the 15th

and 38th Evacuation Hospitals. The majority of other casualties were evacuated alternately to the 11th and 94th Evacuation Hospitals on even-numbered

days and to the 8th and 16th Evacuation Hospitals on odd-numbered days.

On occasions when full loads could not be made up with cranial, thoracic, or

abdominal casualties, all types of casualties were taken to the 15th and 38th

Evacuation Hospitals.
536 WOUND BALLISTICS

Sc 184383

FIGURE 268.-German emplacements south of Monte Lungo, Italy, 26 December 1943.

Tank trap and approaches where Germans removed everything but stumps, then mined

the field.

The dead, including some German dead, were removed from the casualty

areas by the Graves Registration Service and taken to one of the two burial

grounds (CEM, fig. 266) which were located in advance of the evacuation

hospitals.

Within a few minutes after they were wounded, men who could not help

themselves were given first aid either by a medical aidman or by one of their

fellow soldiers. Walking casualties were then directed to the nearest aid station or left where they had fallen to be transported later by litter.

The following information on the time taken to evacuate casualties from

the battle zone was provided by Col. John W. McKoan, Jr., MC, Commanding

Officer, 8th Evacuation Hospital, who had made a special study of 100 casualties received at his hospital on 21 January, the second day of the Rapido River

operation. The average time taken for a casualty to reach the nearest aid

station after wounding proved to be 5 hours and 55 minutes. Some men had

to be brought from the far side of the river which they had already crossed,

and a few such casualties did not reach aid stations for a period of 24 hours

or even longer. The average time from aid station to clearing station was 2

hours and 48 minutes and from clearing station to evacuation hospital, 58 rminutes. The average total time required from the time of injury to entry into a

hospital for definitive treatment was 9 hours and 41 minutes.
CASUALTY SURVEY, CASSINO 537

SC 321011

FIGURE 269.-Aerial view of Monte Lunge (Cassino-Mignano-Esperia area), Italy, 1944,

showing the rugged terrain.

ANALYSIS OF CASUALTIES

An initial survey of the problem indicated clearly that, with only three

medical officers available to carry out the work, it would be impossible to do

more than survey a sample of those casualties who reached the 8th and 38th

Evacuation Hospitals. While it was realized that this procedure would impose

a bias on the information collected, it was hoped that the missing factors in

the analysis could be obtained later by a study of central records. The whole

complex of data which would have to be collected was as follows:

1. Strength of forces engaged in the operation during the relevant period.

2. Total number of killed and wounded for the two units concerned (the

141st and 143d Infantry Regiments).

3. Data about the causes of death and regional distribution of wounds in

the dead. These data were being collected by the Graves Registration Service

on special forms for transmission to Washington, D.C. However, the EMT

(emergency medical tags), filled out by the medical aidman on the battlefield

and then attached to the body of the dead soldier, was the only recorded information about wounds and cause of death. The bodies were buried fully

clothed without preliminary examination by a medical officer.
538 WOUND BALLISTICS

1VMM-44--2099

FIGURE 270.-Cassino area, Italy, 6 March 1944. The terrain traveled by the mortar

squads is tough, rocky, and hard to get over.

US. Army photo

FIGURE 271.-Approach to Monte Cassino, showing the German's excellent line of

fire, 30 May 1944. The trees were parched by shellfire and bombings. White tapes indicate the limit to which the terrain has been cleared of landmines. Ruins of Benedictine

monastery in background.
CASUALTY SURVEY, CASSINO 539

SC 188096

FIGURE 272.-Town of Cassino being destroyed, 15 March 1944. In one of the war's

most concentrated air bombings, the town of Cassino was completely destroyed. Germanheld Cassino had long blocked the Allied advance toward Rome.

SC 189950

FIGuRE 273.-Cassino area, Italy, 18 May 1944. Ruins of Cassino castle, "Hangman's

Hill," towers above the city.
540 WOUND BALLISTICS

4. Details about those casualties from the two units concerned who were

selected by the clearing companies for treatment in the 15th and 38th Evacuation Hospitals, which dealt predominantly with injuries of the head, thorax,

and abdomen. A daily report of casualties, which includes a statement about

the regional distribution of wounds, was made by all hospitals to the Surgeon,

Fifth U.S. Army. A study of these reports, together with an analysis of the

records of the cranial and trunk casualties, and of the dead, of the two units

concerned would complete the casualty picture for these two infantry regiments

during the first week they were engaged in the crossing of the Rapido River

(20-27 January).

A few casualties from other units which were engaged in the same operation as the 141st and 143d Infantry Regiments were also studied.

During the survey period (20-27 January 1944), 100 WIA (wounded in

action) casualties were interviewed-73 at the 8th Evacuation Hospital and

27 at the 38th Evacuation Hospital. This group of casualties consisted of 6

officers and 94 enlisted personnel. The majority of the casualties were able

to give their approximate geographical position in relation to the Rapido River,

state their assigned duty at the time they were wounded, and describe and identify the type of enemy weapon responsible for their wounds. Of the casualties,

90 were hit while advancing toward the enemy. The majority were engaged

as infantry troops armed with either rifles or machineguns, and a smaller number were wounded while carrying a footbridge or a boat or when they were in

a boat. Of the remaining 10 men, 5 were on guard duty and the other 5 were

wounded while engaged in carrying the dead from the firing zone.

Effect of Posture on Wounds

Of the 90 casualties who were hit while advancing toward the enemy, 40

received their wounds when standing erect, and the remaining 50 men were hit

either when lying or kneeling or after they had taken cover in a ditch or a foxhole. The following tabulation lists the incidence of single and multiple wounds

in relation to the position of the casualty:

Standing: Number

Single wounds --------------------------------------- 18

Multiple wounds ----------------------------------- 25

Kneeling or lying:

Single wounds --------------------------------------- 38

Multiple wounds ------------------------------------ 15

The tabulation indicates very clearly that men lying down, or otherwise taking

cover, are less likely to receive multiple wounds than men standing erect.

The difference in the incidence of multiple wounds in soldiers taking

simple cover and those not taking cover is highly significant statistically according to the chi-square test which gives x'= 7 .84 (n-1, P<0.01).
CASUALTY SURVEY, CASSINO 541

Weapons Responsible for Wounds

Almost all of the casualties who were interviewed felt certain that they

knew what type of weapon had caused their wounds. Table 170 shows the

number of casualties caused by different weapons and the incidence of fractures.

The preponderance of wounds due to artillery and mortar shells and mines

is what would be expected in operations of the kind studied.

TAnLE 170.-Incidence of fractures in 100 casualties, by causative agent

Causative agent Number of Number of

casualties fractures

Shell:

Artillery --------------------------------------------- 42 9

Mortar --------------------------------------------- 31 10

Artillery or mortar ------------------------------------ 3 2

Landmine ------------------------------------------------ 13 3

Hand grenade ------------------------------------------- 9 2

Bullet:

Machinegun ------------------------------------------- 1 1

Rifle ------------------------------------------------ I 1 ----- 

Total ---------------------------------------------- 100 27

The sizes of the fragments responsible for wounds were estimated from

X-rays in 28 cases. The weights of the fragments were estimated in grams

from their linear dimensions. A large series of X-rays of fragments of known

weight were available as a standard.

All but 1 of the 28 casualties in question had been wounded by either

artillery- or mortar-shell fire. The exceptional case had been wounded by

a landmine. Table 171 summarizes the information obtained on this point

and also gives the distances from the burst at which the casualties stated they

were injured. Of the 28 casualties, 10 sustained injuries only from fragments

weighing 1 gin. or more, while another 5 were hit by smaller fragments in addition to hits by fragments of the larger size. The remaining 13 casualties were

injured by fragments weighing less than 1 gm. and in 4 of these only fragments

of less than 50 mg. were found.

Regional Distribution of Wounds

Table 172 shows the regional incidence of wounds in the total sample

studied. Since four of the casualties had no obvious external injury, their

wounds have been included in the table as injuries of the head.

Although none of the casualties seen had been wounded in more than

three regions of the body, the number of wounds in any one casualty was often
542 WVOUND BALLISTICS

TABLE 171.-Distribution and weight of fragments in 28 casualties, by distance from shellburst

Weight of fragments Total

Distance from shellburst (in feet) _____--____ - frog- Casu- ments alties

1-50 50-250 250-1,00t0 1-5

Artillery shells: A19 AMg. Mg. Cm. Nsimber Nsmnber

0-10 ---------------------------------- 17 ---- 8 7 32 5

10-20 --------------------------------- 3 7 7 ---- 17 2

20-30 ------------------------------- ------ ------ ----------- 1 1 1

3 0 - 4 0 -- - - - - - - - - - - - - - - -- - -- - - -- - - - - - - -- - -- - -

4 0 - 5 0 -- - - - - - - - - - - - - - - -- - -- - - -- - - - - - - -- - -- - -

Over 50 ----------------------------- ------ ---------- 4 2 6 3

Total ------------------------------- 20 7 19 10 56 11

Mortar shells:

0-10 ---------------------------------- 48 21 12 2 83 8

10-20 ---------------------------------- 1 1 2 ---- 4 3

20-30 ------------------------------- ------ ------ ----------- 1 1 1

3 0 - 4 0 - - - - - - - - - - - - - - - -- - - - - -- - - - - - - - -- - -

40-50 --------------------------------- 6------- -------- --------- 6 1

Over 50 -------------------------------- 2------- ----------- 5 7 3

Total ------------------------------- 57 22 14 8 101 16

Landmine, 0-10 ----------------------------- 2------- -------- --------- 2 1

Total -------------------------------- 2------- -------------- 2 1

Grand total ------------------------- 79 29 33 18 159 28

TABLE 172-Distribution of 133 single and multiple wounds in 100 casualties, by anatomic

location

multiple wounds Total wounds

Single ____ ____ _____-_____ Anatomic location wound

2 regions 3 regions Number Percent

involve involved

Head ------------------------------------- 20 5 1 26 19. 5

Thorax ----------------------------------- 5 8 1 14 10. 5

Abdomen and scrotum ------------------------------ 8 1 9 7. 0

Extremities:

Upper -------------------------------- 17 11 2 30 22. 5

Lower -------------------------------- 28 23 3 54 40. 5

Total ------------------------------ 70 55 8 133 100. 0
CASUALTY SURVEY, CASSINO 543

as many as six or eight. Table 172 also includes several cases in which men

were wounded either in both upper or in both lower extremities.

Only 4 of the 100 casualties required amputations. In two, toes had to

be removed because of compound fractures due to shell fragment wounds of

the foot. The other two casualties were men who had to have a lower limb

removed because they had stepped on a landmine. One of the two was a

squad leader who was advancing with a mine detector which did not respond

to the mine which caused his injury. This casualty thought the mine probably

had a plastic case.

Blast Injuries

The blast pressures necessary to cause injury to the lungs are only likely

to be experienced close to the burst of large bombs at distances where severe

or fatal injuries from fragments are almost certain to occur. Since artillery

shells have a very much lower charge-weight ratio than bombs (a 155 mim.

shell only contains 4.8 pounds of explosive), the chances of receiving blast

injuries to the lungs without serious fragment injuries are even more unlikely

from shellfire than from bombs.

There is no reliable evidence that so-called blast concussion is a direct

consequence of the impact of a blast wave on the head. Cranial symptoms,

amnesia, and mental confusion are probably due to blows on the head from

flying debris or from sudden body displacement. Rupture of the eardrums,

however, occurs at very much lower blast pressures than does lung damage,

and it is the most sensitive indicator of injury due to blast. In the group

of casualties surveyed, there were no instances of damage to the lungs. In

15 casualties, one or both eardrums had been ruptured. Of these men, 11

had also received other injuries from fragments and only 4 had ruptured

eardrums as their sole injury.

Of these 15 casualties, 13 were standing erect or had their head and

shoulders exposed when they were injured. The other two, although apparently lying protected in slit trenches, were also close enough to the shellburst

to experience earth movement, displacement, and partial burial by loose

earth nearby. The stated distances (in feet) at which the casualties sustained

a blast injury from bursting projectiles is as follows: Numbcr of

Distance from burst (feet) : casualties

0-5 ----------------------------------------------- 9

5-10 ---------------------------------------------- 2

10-15 --------------------------------------------- 1

15-20 --------------------------------------------- 1

20-25 --------------------------------------------- 1

Unknown ------------------------------------------ 1

Total ---------- -------------------------------- 15

It is a remarkable fact that 11 of the 15 casualties were within 10 feet of

bursting projectiles and sustained injury due to blast but escaped fatal

fragmentation wounds.
544 WOUND BALLISTICS

Casualty Rates

When a small group of casualties is surveyed, the probability of an incident

being reported is proportional to the number of casualties it involves or, if

wounded men only are reported, to the number of wounded. Having recognized that in this survey an individual incident may be reported more than once,

it is necessary to make use of Haldane's method for correcting for this factor.

By making use of his formula

C-N±C-NXT-C

T_-_N X (T-N)3

where N equals the number of incidents reported, C the number of casualties

(killed and injured grouped together) and T the total number of men exposed

to injury, it is found that the estimated casualty rates from artillery shells is

26.5±2.85 percent. The estimated casualty rate from mortar shells is 28.5±

2.25 percent. These rates do not differ significantly from each other.

Table 173 summarizes these and the casualty rates estimated for the

same two weapons in previous casualty surveys.

Excluding the American casualties at Cassino, it would thus seem that

Allied artillery and mortar were both more efficient than those of the enemy.

Such a conclusion would only be justified, however, if it could be assumed

that the tactical use of both weapons was the same on both sides. American

casualties from enemy mortar shells at Cassino are of the same order as those

inflicted by the enemy in other theaters and significantly fewer than enemy

casualties from the same weapon. On the other hand, American casualties

due to enemy artillery at Cassino are significantly greater than Allied casualties

have been in other theaters and are of the same order as U.S. soldiers have

inflicted upon the enemy by that weapon.

TABLE 173.-Estimated casualty rates from Allied and enemy artillery and mortar shells

Probability of becoming a casualty fromMen at risk Area

Artillery shells Mortar shells

Percent Percent

New Zealanders ----------------- Tunisia ------------- 16.87±1.88 26. 30±1.83

English ----------------------------- do ------------- 18. 18±5. 81 39. 74±5. 54

Enemy ------------------------------ do -------------- 25.51±3. 11 60. 00+9. 80

Americans ---------------------- Cassino ------------- 26. 5 + 2. 85 28. 5 2. 25

NOTE .- Statistics were obtained by author while serving as scientific observer with Professor Zuckerman (see footnote

1, p. 531).
CASUALTY SURVEY, CASSINO 545

As already emphasized, this casualty survey was initiated to discover

whether useful and complete information could be obtained in the battle area.

While this objective was not achieved in the present case, the investigation

has definitely shown that it could be in a future survey, if special arrangements

were made in advance to obtain from central records a complete picture of the

tactical problem and of the casualties incurred and if the survey itself were

adjusted in advance to the size of the staff available to carry out the work.

The advantages of surveying casualties in the forward evacuation hospitals

and of examining the dead at their burial grounds are obvious. In these

locations, complete casualty data for a specific tactical operation, pertaining

to the uninjured, slightly and severely wounded, and the dead can be obtained

before the various types of casualties are dispersed, before original X-rays are

separated from the casualties, before memory of specific details of incidents is

clouded by time or colored by self-interest, and before the dead are buried and

lost to detailed examination.
CHAPTER IX

Survey of Battle Casualties, Eighth Air Force,

June, July, and August 1944

Allan Palmer, M. D.

The need for information regarding causes of death in KIA (killed in

action) battle casualties resulted in the organization of the Medical ORS

(Operational Research Section), Professional Services Division, Office of the

Chief Surgeon, ETOUSA (European Theater of Operations, U.S. Army).

Maj. Allan Palmer,' MC, was appointed chief of the section on 1 June 1944.

The purpose of the Medical ORS was to investigate battle casualties from

an operational point of view in order to evaluate more accurately the wounding

power of various weapons and the effectiveness of protective measures. At

the start, it also seemed that information would be obtained which would be

of value and interest to officers, not only in the medical but also in the other

services. It was postulated that the machinery for collecting data provided

adequate liaison with the various branches of the Armed Forces.

Aside from occasional accidents or special incidents (appendix G, p. 827)

in the United Kingdom, which were investigated by the Medical ORS, the

first operational project to be dealt with was a survey of battle casualties

sustained by the heavy bombardment groups of the Eighth Air Force. The

survey was carried out with the cooperation of Brig. Gen. Malcom C. Grow,

USSTAF (U.S. Strategic Air Forces) surgeon, the Eighth Air Force Operational Analysis Section, the Ordnance Department, the Royal Air Force,

and the Royal Canadian Air Force. A period of 3 months was taken as the

time during which the day operations of the Eighth Air Force might yield

a satisfactory sample of casualty data for study. The 3 months chosen were

June, July, and August 1944 (D-5 to D+86). In September 1944, additional personnel were provided by the Army Air Forces, Air Technical Service

Command, for a 3-month continuation of the study which was to include

examination of KIA casualties from the Ninth Air Force and Troop Carrier

Command.

An ideal casualty survey would provide complete information about all

battle casualties and about all individuals exposed to risk, irrespective of the

I Following the completion of the Eighth Air Force casualty survey, Major Palmer participated in and reported on

a ground force battle casualty survey. This survey was conducted with the Third U.S. Army's XII Corps during the

last 2 days of the war in Europe.

Based on the experience he had gained in collecting missile casualty data, Major Palmer prepared a draft of a proposed

table of organization and equipment for the establishment of a casualty research detachment.-J. C. B.

547
548 WOUND BALLISTICS

severity of injury. The points which pertain to such a survey of aircrew

battle casualties follow.

1. Strength of forces engaged in operations for the survey period.-

(1) Bombardment divisions and groups taking part in operations; (2) types

and number of aircraft and combat personnel involved, such as "man-combat

missions" carried out; and (3) hospitals serving the Eighth Air Force.

2. Losses.-(1) Aircraft and personnel about which no information could

be secured because of failure to return from enemy territory; and (2) casualty

data, including the causes of death and regional distribution of wounds, fractures, and amputations in the personnel killed or wounded by enemy gunfire

and returned to the United Kingdom in aircraft, which could be obtained

from post mortem examination of the killed, interrogation and X-ray examination of the wounded in hospital, survey of "Care of Flyer" reports and

group operations at AAF (Army Air Force) stations, and identification of

missiles.

3. Battle damage data pertaining to aircraft in which casualties were

sustained.-This information would be of the greatest importance for the

identification of the weapon causing wounds in cases where the responsible

missile was not retained by the casualty. As far as protection to personnel

is concerned, a knowledge of the relative frequencies of hits by enemy missiles on aircraft bearing casualties, from various directions, would enable

one to place protective armor more advantageously in the aircraft or on aircrew personnel.

4. Flight formations.-The formation of heavy bombers in flight should

be studied from the point of view of risk to combat crew personnel.

COLLECTION OF DATA

Strength of Forces

The 40 heavy bombardment groups of the Eighth Air Force, divided

into 3 divisions, are listed in table 174.

All the groups of the 1st Division were composed of B-17 aircraft and

those of the 2d Division, of B-24 aircraft. Five groups of the 3d Division

(34th, 486th, 487th, 490th, and 493d) were originally composed of B-24 aircraft but were changed to B-17's on 24 August, in mid-July, on 1 August,

on 18 August, and on 18 August, respectively. Thus, the 3d Division also

consisted entirely of B-17 aircraft on and after 24 August. Tables 175 and

176 give a summary of Eighth Air Force heavy bomber day operations, by

divisions and man-combat missions, for the 3 months' period of this survey.

These data were obtained through the Office of the Surgeon, USSTAF. The

total number of aircrew personnel taking part in Eighth Air Force heavy

bomber day operations is given in terms of "man-combat missions," the
BATTLE CASUALTIES, EIGHTH AIR FORCE 549

average crew of a B-17 being 9 and the average crew of a B-24 being 10.

Thus, a total of 69,682 sorties corresponds to a total of 657,096 man-combat

missions for the 3 months' period.

TABLE 174.-Eighth Air Force heavy bombardment groups, by divisions

Group 1st Division Group 2d Division Group 3d Division

91st 44th 34th

92d 93d 94th

303d 389th 95th

305th 392d 96th

306th 445th 100th

351st 446th 385th

379th 448th 388th

381st 453d 390th

384th 458th 447th

398th 466th 452d

401st 467th 486th

457th 489th 487th

491st 490th

492d 493d

TABLE 175.-Distribution of 69,682 Eighth Air Force heavy bomber (B-17, B-24) day operations .for the period 1 June to 31 August 1944, inclusive, by divisions

Aircraft missing in Aircraft returning from

action I enemy territory 2

Division Number of

sorties

Number Percent Number Percent

B-17's

1st ---------------------------------- 23, 488 237 1.01 23, 251 98. 99

3d ------------------------------- - 16, 236 153 .94 16, 083 99.06

Total --------------------------- 39, 724 390 .98 39, 334 99.02

B-24's

3d ------------------------------- - 5, 510 31 .56 5,479 99.44

2d -------------------------------- 24, 448 272 1. 11 24, 176 98. 89

Total --------------------------- 29, 958 303 1.01 29, 655 98. 99

Grand total ------------------- 69, 682 693 .99 68, 989 99.01

SCasualty data are not available.

2 Casualty data are available.
550 WOUND tlALLISTIC9

TABLE 176.-Distribution of 657,096 man-combat missions, 1 June to 31 August 1944,

inclusive, by Eighth Air Force heavy bomber (B-17, B-24) day operations

Sorties Man-combat missions

Aircraft

Number Percent Number Percent

B-17:

Missing in action I - - - - - - - - - - - - - - - - - - - 390 0. 98 3, 510 0. 98

Returning from enemy territory 2 ..... 39, 334 99. 02 354, 006 98. 99

Total ---------------------------- 39, 724 57.00 357, 516 54. 4

B-24:

Missing in action 1 --------- 303 1.01 3,030 1.01

Returning from enemy territory 2 .. ... 29, 655 98. 99 296, 550 98. 99

Total ----------------------------- 29, 958 43. 00 299, 580 45. 6

Grand total ---------------------- 69, 682 100.00 657, 096 100.0

I Casualty data are not available.

2 Casualty data are available.

The medical installations which served the Eighth Air Force during the

period, in addition to sick quarters at each AAF station, were the 1st, 7th,

65th, 91st, 97th, and 184th General Hospitals and the 49th, 121st, 136th,

231st, 280th, and 303d Station Hospitals.

Losses

Of the 69,682 sorties in which 657,096 man-combat missions were accomplished, 693 aircraft (0.99 percent) and 6,540 aircrew personnel (1.00 percent

or 10.0 per 1,000) were MIA (missing in action), leaving a balance of 650,556

man-combat missions in 68,989 aircraft, from which battle casualty data were

available for survey. The casualty survey study pertained specifically to

battle casualties resulting from enemy gunfire, sustained by the personnel

carrying out and returning from a total of 650,556 man-combat missions.

A few incidental facts were collected in relation to the 6,540 aircrew

personnel MIA during the 3 months. Followup records at Eighth Air Force

headquarters showed that, for the first 8 months of 1944, 2 out of 5 (40 percent)

\IIA personnel were possibly KIA and 3 out of 5 (60 percent) were known to

be WIA (wounded in action), prisoners of war, or evaders.

By arrangements through official channels, all KIA aircrew battle casualties

returning to the United Kingdom in heavy bombers, as well as all those dying

in hospital within 24 hours of entry or before surgical treatment, were brought

for examination to the Medical ORS laboratory, located on the grounds of the
BATTLE CASUALTIES, EIGHTH AIR FORCE 551

FIGURE 274.-Operational Research Section, Office of the Chief Surgeon, ETOUSA,

located on the grounds of the Cambridge American Military Cemetery, Cambridge, England

A. Workroom. B. Laboratory.
552 WOUND BALLISTICS

Cambridge American Military Cemetery (fig. 274). Examinations for the

missile and injuries caused by the missile were made. No search was made in

any part of the body where it was obvious a missile had not penetrated. The

Graves Registration Service of the Quartermaster Corps at the Cambridge

American Military Cemetery was very cooperative in notifying the Medical

ORS when aircrew battle casualties were received for burial, so that the bodies

could be brought immediately to the laboratory for examination.

Questionnaire forms, requesting such data as the circumstances of death,

combat crew position, and altitude, were completed and forwarded by the group

surgeons of the AAF stations from which the KIA casualties came. Of the

110 KIA casualties for the 3 months' period, 89 (81 percent) were examined

at the Medical ORS. Of the 21 not examined, 7 were casualties who died in

a hospital 1 to 6 days after being wounded.

Daily admission and disposition reports were received from the 12 hospitals

serving the Eighth Air Force. From these, the entries of aircrew battle

casualties were noted. There were 1,007 WIA battle casualties for the 3

months' period. Since ORS consisted of only one medical officer and one enlisted man during the first 2 months of the survey, it was impossible to visit

and interrogate all battle casualties in hospitals before they were discharged.

However, during the tbird month of the survey, interrogations were accomplished with the aid of additional enlisted men, and a total of 434 (43 percent)

of the WIA were seen. X-ray records of the majority of the remaining WIA

casualties were examined for missile size, number, and location, and for fractures. The hospital admission and disposition reports further served the

purpose of determining the time spent in hospitals by WIA casualties and their

redisposition to duty, to the Zone of Interior, or to a Detachment of Patients.

Further checking of the completeness of the casualty survey was accomplished by a medical officer of ORS visiting each of the 40 heavy bomber stations.

The purpose of these visits was to verify the battle casualty status of aircrew

members from a perusal of "Care of Flyer" reports of those patients missed in

hospitals and to obtain information on battle casualties whose injuries were so

slight as not to require hospitalization. The Care of Flyer reports also provided more accurate information on the final disposition of WIA casualties

and on the time lost from flying status.

Missiles were identified from British and U.S. 2 ordnance publications and

when necessary by consultation with a member of the Ordnance Office, USSTAF.

Photographic records of missiles were made periodically by a photographer

supplied by the Army Pictorial Service. It was not possible to have photographic equipment issued to the Medical ORS I for making photographic recSUSSTAF Ordnance Memorandum No. 5-2, 24 Mar. 1944, subject: German Ammunition.

3 It is a sad reflection upon the imaginative foresight of the responsible officers to see this reluctance to furnish essential

equipment. One of the most important aspects of any casualty survey is the photographic and X-ray record of the casualties. For the immediate purpose of the survey and to furnish a permanent record for future study and teaching, photographs of the external wounds and internal wound track with X-rays of the body regions involved are of paramount

interest and value.-J. C. B.
BATTLE CASUALTIES, EIGHTH AIR FORCE 553

ords of fatal wounds. The only such records available were those photographs

taken at the AAF stations for the USSTAF surgeon's "Body Armor Reports."

These photographs were borrowed and photostatic copies of them obtained.

A 39-percent photographic coverage of KIA casualties from the 1st and 2d

Divisions was achieved in this way. No photographs were available of casualties sustained by the 3d Division.

Aircraft Battle Damage

Group and squadron operations offices at each of the heavy bomber stations provided the identification number of each aircraft in which a KIA or a

WIA battle casualty occurred, so that a report on the damage to the plane

might be secured.

Permission was obtained from the Commanding General, Eighth Air Force,

for the Medical ORS to borrow, for photostatic copying, the battle damage

reports of heavy bomber aircraft in which casualties had occurred. These reports were prepared by the AAF station engineers on most damaged B-17 and

B-24 aircraft and were forwarded to the Operational Research Section of the

Eighth Air Force. The serial numbers of aircraft in which casualties occurred

were obtained from every AAF station operations office and submitted to the

Eighth Air Force Operational Research Section. Since only one copy of these

battle damage reports was prepared, it was necessary to obtain, deliver for

photostating, and return personally the reports at regular intervals. Battle

damage reports pertaining to a total of 656 aircraft, in which there were 771

casualties, were obtained. This represents a 70-percent coverage of aircraft

battle damage data associated with 70 percent of the casualties in the survey.

Tables 177, 178, 179, and 180 give the number and types of the aircraft examined in this way by divisions, the cause of the damage, and the number of

casualties per aircraft.

TABLE 177.-Distribution of 541 casualties in 461 flak-damaged B-17 aircraft examined

1st Division 3d Division

Casualties in Aircraft Total Casualties in Aircraft Total

each aircraft examined casualties each aircraft examined casualties

1 221 221 1 176 176

2 33 66 2 18 36

3 4 12 3 6 18

4 2 8 4 1 4

260 307 201 1 234

1 Two of these casualties were hit with 20 mm. cannon shell fragments.

603225--62- 37
554 WOUND BALLISTICS

TABLE 178.-Distribution of 193 casualties in 172 flak-damaged B-24 aircraft examined

3d Division 2d Division

Casualties in Aircraft Total Casualties in Aircraft Total

each aircraft examined casualties each aircraft examined casualties

1 33 33 1 122 122

2 1 2 2 12 24

3 1 3 3 3 9

35 38 137 155

TABLE 179.-Distribution of 28 casualties in 19 examined B-17 aircraft damaged by missiles

from fighter aircraft

Ist Division 3d Division

Casualties in Aircraft Total Casualties in Aircraft Total

each aircraft examined casualties each aircraft examined casualties

1 10 10 1 3 3

2 2 4 2 1 2

3 3 9

15 23 4 5

TABLE 180.-Distribu tion of 9 casualties in 4 examined B-2/P aircraft damaged by missiles

from fighter aircraft

2d Division

Casualties in each aircraft Aircraft examined Total casualties

1 1 1

2 1 2

3 2 6

4 9

Flight Formations

The flight formations of heavy bombers over enemy territory on missions,

during which there were battle casualties, were studied. Diagrammatic

flight formations were obtained from the Operations Office, Operational

Research Section, Eighth Air Force. A total of 288 complete group flight

formation plans of Eighth Air Force heavy bombers was available. These

formations were selected on the basis that in each one there was at least one
BATTLE CASUALTIES, EIGHTH AIR FORCE 555

casualty in one aircraft. Thus, the relationship between casualties and

flight formations for 539 battle casualties (48 percent of the total sample)

was observed.

ANALYSIS OF BATTLE CASUALTIES

General

During the 3 months in which this survey of battle casualties returning

to the United Kingdom was conducted, there were 1,117 battle casualties of

whom 110 were killed and 1,007 wounded by enemy fire. Table 181 shows

their distribution between the heavy bombardment groups. This represents

a casualty rate of 0.172 percent (1.72 per 1,000) in terms of man-combat

missions about which casualty data were available and 0.170 percent (1.70

per 1,000) of all man-combat missions. The ratio of MIA personnel to known

battle casualties is approximately 6 to 1 (5.85 percent).

These figures may be compared with those given by the Surgeon, USSTAF,

in his "Annual Report of Health" for 1943-44. For 1 year ending with the

first month of the present survey, the battle casualty rate for the Eighth Air

Force is reported as 0.201 percent (2.01 per 1,000) of man-combat missions

credited. The MIA rate for the same period was 1.95 percent (19.5 per 1,000).

The ratio of MIA personnel to known battle casualties was 9.7 percent or

TABLE 181.-Distribution of 1,117 aircrew battle casualties of 1st, 2d, and 3d Divisions, by

heavy bombardment group

1st Division B-17's 2d Division B-24's 3d Division B-17's

Group Men Men Group Men Men Group Men Men

wounded killed wounded killed wounded killed

91st ------ 20 2 44th ------- 23 1 34th I 19 3

92d -------- 49 2 93d -------- 24 2 94th ------- 56 5

303d ------ 38 4 389th ------ 17 4 95th -------- 17 2

305th ----- 44 7 392d ------- 28 5 96th ------- 32 2

306th ----- 33 3 445th ------ 18 ------ 100th ------ 25 1

351st ----- 29 1 446th ------ 12 4 385th ------ 20 1

379th ----- 35 7 448th ------ 23 1 388th ------ 20 4

381st ----- 28 4 453d ------- 12 1 390th ------ 33 7

384th ----- 32 5 458th ------ 13 1 447th ------ 27 1

398th - 27 ------ 466th ------ 27 5 452d ------- 34 4

401st ----- 15 5 467th ------ 15 3 486th ----- 25 2

457th ----- 36 1 489th ------ 36 3 487th . 9 2

491st ------ 19 3 490th . 9 2

492d - 16 ------ 493d 1 ..... 12

386 41 283 33 338 36

IChanged from B-24 aircraft to B-17 aircraft during July and August 1944.
556 WOUND BALLISTICS

nearly 10 to 1. Thus, the casualty rate and MIA rate for the 3 months which

are the subject of this report are, respectively, 15.4 and 48.7 percent less than

the corresponding figures for 1943-44.

In the present survey, the 1,117 battle casualties occurred in a total of

944 aircraft. Table 182 gives their frequency and distribution in the two types

of heavy bombers. Approximately 72 percent of the casualties occurred with

a distribution of one per aircraft. Multiple casualties per aircraft in the two

types of heavy bombers did not differ significantly in their occurrence.

From the data in tables 176 and 182, it can be seen that the aircrew

battle casualty rate is 2.10 per 1,000 man-combat missions in B-17's and 1.26

per 1,000 in B-24's. Thus, the risk of becoming a battle casualty was approximately two-thirds (67 percent) greater to B-17 personnel than it was to B-24

aircrew personnel. Since this conclusion is derived from an analysis of only

those casualties who were brought back to the United Kingdom, it cannot

be assumed that the real risk rates in the two types of bombers are as represented by the cited figures. If, for example, there was a higher casualty rate

in missing B-24 personnel than in missing B-17 personnel, the figures could

change significantly. However, with the available information, one must

take account of the apparent difference which is very clearly significant. The

reasons or causes for the difference merit further investigation. A fuller

analysis of flak hits on aircraft in which casualties occurred appears in another

chapter (p. 620).

TABLE 182.-Frequency distribution of 1,117 battle casualties, by category, in 944 heavy bombers (B-17's and B-24's)

Category Number of aircraft Casualties per aircraft

WIA KIA Total casualties

B-17:

533 1 482 51 533

70 2 130 10 140

16 3 44 4 48

4 4 14 2 16

1 5 3 2 5

624 673 69 742

B-24:

277 1 256 21 277

34 2 54 14 68

8 3 20 4 24

1 6 4 2 6

320 334 41 375

944 1,007 110 1, 117
BATTLE CASUALTIES, EIGHTH AIR FORCE 557

Causes of Casualties

Table 183 gives the causes of the wounds sustained by the 1,117 casualties.

Approximately 86 percent of the casualties were hit by flak fragments. Less

than 4 percent were hit by shells or shell fragments fired from enemy fighter

planes. Practically all of the 7.8 percent of casualties hit by secondary missiles were the result of flak hits on the aircraft. Secondary missiles include

fragments of Plexiglas; pieces of dural from the skin of, or objects in, the plane;

bulletproof glass; brass fittings; and parts of electrical heating and radio equipment and .50 caliber machinegun ammunition.

Two unidentified missiles causing one KIA and one WIA casualty were

found to be pieces of commercially pure zinc, the origin of which was not ascertained. There were three individuals who sustained injuries during more than

one mission. Two were struck by flak fragments on two different missions and

one was struck by Plexiglas on one mission and by flak on another. One of the

two hit twice by flak was killed as a result of the second hit.

TABLE 183.-Distribution of 1,117 aircrew battle casualties, by category and causative agent

of wounds

Category of casualty Total casualty

Causative agent

WIA KIA Number Percent

Flak fragments -------------------------- 865 98 963 86.2

Shells:

20 mm ------------------------------ 37 7 44 3.9

13 mm ----------------------------- 3 1 4 .4

7.92 mm ------------------------------ --- 2 2 .2

Secondary missiles ----------------------- 84 3 87 7.8

Unknown ------------------------------- 16 1 17 1.5

Total ----------------------------- 1,007 110 1,117 100.0

Distribution of Casualties According to Combat Position

Table 184 shows the frequency with which aircrew personnel in different

combat positions became missile casualties. In this and similar tables and

figures, the positions of bombardier, togglier, and nose gunner, like those of the

top turret gunner and engineer, are regarded as the same.

The high casualty rate for waist gunners was partially due to the fact that

heavy bombers frequently carried two waist gunners. This practice was discontinued to a large extent, but accurate information as to the frequency with

which aircrews included two waist gunners during the survey was not known.

The high casualty rates for navigators and bombardiers was to be expected

from their positions in the nose of the aircraft. They lacked the protection

provided by other personnel and portions of the ship's structure and by being
558 WOUND BALLISTICS

in the most forward compartments of the aircraft; they were exposed to the

greatest density of flak. The leading edges of the wings and other parts of

aircraft are known to receive a greater density of flak hits than trailing edges.

The lowest incidence of casualties appears to occur in the ball turret gunner's

position. This was partially due to the fact that only one of the two types of

aircraft (B-17) carried a man in that combat position.

TABLE 184.-Distribution of 1,117 battle casualties due to all missiles, by category and combat

position

WIA casualties KIA casualties Total casualties Case fatalPosition ity

rate Number Percent Number Percent Number Percent (percent)

Pilot ------------------ 75 7.4 8 7.3 83 7.4 9.6

Copilot ---------------- 68 6.8 6 5.5 74 6. 6 8. 1

Navigator--- --------- 123 12.2 13 11.8 136 12. 2 9. 6

Bombardier ----------- 178 17.7 18 16.3 196 17. 6 9. 1

Radio operator -------- 87 8.6 8 7.3 95 8.5 8.4

Waist gunner ---------- 212 21. 1 21 19. 0 233 20. 9 9. 0

Ball turret gunner - 59 5.9 7 6.4 66 5.9 10.6

Top turret gunner ----- 84 8.3 10 9. 1 94 8.4 10.6

Tail gunner ------------. 121 12.0 19 17.3 140 12.5 13.6

Total- ----------- 1,007 100.0 110 100.0 1,117 100.0 9.9

The Demarcation of Body Regions

The lack of a standardized method of demarcation of the regions of the

body makes it impossible to compare accurately the distribution of wounds in

any two or more collections of casualty data. Most of the available information pertains only to the wounded so that the true distribution of wounds or,

more accurately, hits by bullets and fragments from high explosive shells has

not been recorded. The military surgeons who cared for WIA casualties were

the ones who recorded the locations of wounds. Their records have been the

source of material from which casualty statistics have been compiled, and

little information was obtained from their records concerning the difference

between the wounds of entrance and of exit. Frequently, two or more wounds

may have been produced by a single missile, but the surgeon was more concerned about the treatment of wounds than about the effectiveness of weapons

or the development and use of body armor. Consequently, he usually failed

to record the information which would enable those interested in body armor

to compile accurate data pertaining to the regional distribution of hits and

the type of causative agent.

In the Medical and Surgical History of the War of the Rebellion,4 ref4 The Medical and Surgical History of the War of the Rebellion. Surgical History. Washington: Government

Printing Office, 1883, vol. I1, pt. Ill, p. 691.
BATTLE CASUALTIES, EIGHTH AIR FORCE 559

erence is made to the relative amounts of superficial area presented by the

principal divisions of the human body from Longmore.A However, the relative percentages given for the different body regions are at variance with

more recently determined measurements, particularly that for the head and

neck region. Longmore's figure for the head region was 8.51 percent as

compared with Burns and Zuckerman's figure of 12 percent.6 In view of the

fact that all complete casualty samples studied during World War II show

wounds of the head and neck to be even in excess of 12 percent, it is likely

that the measurement of Burns and Zuckerman is the more accurate one.

In this survey, the lines of demarcation between the body regions (fig.

275) were uniformly adhered to in accordance with those recorded by Burns

and Zuckerman. The following is quoted from the British report:

There are no agreed surface markings by which one region of the body can be definitely demarcated from another-e.g., the thorax from the neck. No absolute demarcation

is possible because a line projected from the surface through the body would, in certain

places, pass through two or more regions. For example a shot penetrating the body horizontally just below the ribs might easily pass both through the liver (an abdominal organ)

and through the lower part of the lung (a thoracic organ). Again, shots in the buttock

region could be regarded as wounds of the lower limb as well as wounds of the pelvis-if

they penetrated deep enough. It was therefore necessary to define certain arbitrary lines

of demarcation. The following were chosen as a fair compromise.

Head and Neck Region (Symbol H)

The demarcation of the head and neck region from the thorax presents difficulties in

view of the fact that the domes of the pleurae extend an inch or so above the clavicles. A

line passing transversely across the body an inch above the clavicles would, however, cut

out a large part of the neck, and the part which lies below the cricoid cartilage. A compromise is suggested in a line which passes transversely one inch above the upper limit of the

manubrium sterni. At the back the line chosen passes immediately below the spine of the

seventh cervical vertebra (vertebra prominens). This point can easily be found as it lies

immediately above the most prominent vertebra when the neck is slightly bent. In side

view the lower limit of the neck is taken as a line which passes immediately above the line

of the clavicle.

Chest Region (Symbol C)

The shoulders, both in front and behind, are most readily demarcated from the thorax

and neck by a line which joins the upper limits of the anterior and posterior axillary folds

with the point where the vertical neck joins the sloping shoulders.

The demarcation of the thoracic cage from the abdomen presents difficulties. A compromise has been effected in a simple line which approximately demarcates the lower limit

of the pleural cavities. In front this line is taken as passing from the lower end of the

sternum obliquely downward and laterally to the eighth intercostal space. Where this

line meets the anterior end of the eighth space a horizontal line is carried directly around

the body, approximately across the spine of the first lumbar vertebra, to meet the anterior

end of the eighth intercostal space on the opposite side.

Consideration of the relations given in several works on surface anatomy suggests

that this line, though not entirely accurate, is a fair compromise between the various

statements that are made about the inferior margin of the pleural cavities.

5 Longmore, T.: Gunshot Injuries: Their History, Characteristics, Features, Complications, and General Treatment.

London: Longmans, Green and Co., 1887, p. 595.

6 Burns, B. D., and Zuckerman, S.: The Wounding Power of Small Bomb and Shell Fragments. R. C. No. 350 of

the Research and Experiments Department of the Ministry of Home Security.
560 WOUND BALLISTICS

H H

H C

U U U U

AA

L L L L

THE REGIONS OF THE BODY AS DEMARCATED

ACCORDING TO THE DESCRIPTION IN THE TEXT

SYMBL REION PER CENT OF TOTAL

SYMOL EGIN ODY SU RFACE AREA

H HEAD AND NECK 12

C CHEST 16

A ABDOMEN 11

U UPPER EXTREMITIES 22

L LOWER EXTREMITIES 39

IVRAM C-4606-A

FIGURE 275.-Outline form with demarcations of body regions.

It does not, however, clearly demarcate the thorax from the abdomen in so far as penetrating wounds of a lower part of the thoracic cage might very well enter the upper abdominal organs, and especially the liver. Furthermore, some shots through the subeostal angle

might hit the posterior and inferior parts of the lungs.

Abdominal Region (Symbol A)

Lines chosen to demarcate the lower limits of the abdomen in front are those passing

along the inguinal lines and meeting over the pubes. At the back the line curves from the

region of the anterior superior spine, up laterally and then downward to just below the

middle of the natal cleft. The latter point is approximately at the level of the ischial tuberosities.

Upper Extremity Region (Symbol U)

The lines of demarcation between the upper extremity region and head-and-neck and

chest regions are as described under Chest Region.
BATTLE CASUALTIES, EIGHTH AIR FORCE 561

Lower Extremity Region (Symbol L)

The lines of demarcation between the lower extremity and abdominal regions are as

described under Abdominal Region. Any hit from the front or back above the level of

these lines would penetrate into the lower part of the abdominal cavity. They therefore

provide an adequate demarcation between the abdomen and lower limbs from these two

aspects. Laterally, however, they are deficient as landmarks, since a shot could smash

below their level through the hip region into the pelvis.

It should be noted again that the demarcations suggested above represent useful and

practical compromises, and not absolute anatomical lines of limitation. Even were the

latter definable, it is doubtful whether the results obtained would have been materially

affected by their use, or indeed by any other set of practical lines of demarcation which

might be suggested.

A great many difficulties were encountered in the analysis of extensive

and multiple wounds, especially those observed in KIA casualties. The following criteria were adhered to closely:

1. Only wounds of entrance located in the region where missiles first

struck the body were recorded as hits regardless of other regions traversed by

the missile.

2. A wound or hit which appeared to be located on a line of demarcation

between two regions was regarded as occurring in that region in which the

missile track extended beyond the point of entry. For example, a wound

at the junction of the chest and upper extremity would be a wound of the

chest if the missile entered the chest or would be an upper extremity wound

if it was confined to the shoulder or other part of the upper extremity.

3. Bruises and abrasions were disregarded, but all missile wounds in

which the skin's surface continuity was interrupted were recorded.

4. Although it is possible for a soldier who has been killed by fragments

from a bursting projectile to be struck after death by other shell fragments,

an effort was made to disregard such secondary hits when it was obvious that

they had occurred. For example, when there were wounds of entrance on

opposite surfaces which could not have occurred from the burst of a single

shell, only those hits thought to be inflicted primarily were recorded.

5. When there was doubt as to which was an entrance and which an exit

wound, the choice depended arbitrarily on the missile track being directed

above the horizontal plane, with the man standing erect.

6. In the case of extensive mutilating wounds of one or several regions

of the body-obviously due either to very large fragments or direct hits by

projectiles at the instant of or just before detonation-the location of such hits

was regarded as being in the region located nearest the center of the area of

mutilation.

7. When a mutilating wound involved an extremity and the area of

mutilation was not continuous with the mutilation of the torso, an additional

hit was recorded for the extremity, and its location was regarded as being at

the most proximal level of traumatic amputation.

8. Wounds resulting from an injury in addition to wounds caused by

missiles were disregarded unless they could have been the cause of death.

603225-62- 38
562 WOUND BALLISTICS

Regional Distribution of Wounds Due to All Missiles

A distinction is made between the regional distribution and the regional

frequency of wounds. In the former, a large number of wounds, considerably

in excess of the number of casualties, may be distributed over the various

regions of the bodies in a sample of casualties. Percentages in the tables that

pertain to the regional distribution of wounds refer to the total number of

wounds. In the case of regional frequency, one is concerned only with the

frequency with which the various regions of the body are wounded regardless

of the number of wounds in each body region. Percentages in the tables

which pertain to the regional frequency of wounds refer to the number of

casualties. From such tabulations, casualties who sustained wounds in more

than one region of the body must either be excluded or an additional entry

made for them; that is, for those hit or wounded in more than one region

(Multiple, Symbol = M). Regional frequency tabulations in this survey

include an additional entry for casualties wounded in more than one region of

the body.

Table 185 shows the regional distribution of all wounds due to all missiles

in 1,115 aircrew battle casualties. Two casualties, not included in table 185,

were known to have been killed by flak before the crashlanding of their aircraft.

They were badly burned, and the location of all their wounds could not be

determined.

TABLE 185.-Distribution of 1,553 wounds due to all missiles in 1,115 aircrew battle casualties,

by category of casualty and by anatomic location (regional distribution) of wounds

Wounds in WIA Wounds in KIA Total wounds

casualties casualties Anatomic location

Number Percent Number Percent Number Percent

Head -------------------------- 258 19. 8 69 27. 1 327 21. 1

Chest ------------------------- 63 4. 9 37 14. 5 100 6.4

Abdomen ---------------------- 28 2.2 23 9. 0 51 3. 3

Extremities:

Upper --------------------- 382 29.4 65 25. 5 447 28.8

Lower --------------------- 567 43. 7 61 23. 9 628 40.4

Total ------------------- 1,298 100. 0 255 100. 0 1,553 100. 0

On the basis of surface area presented by the different regions of the body,

the wounds of the head and neck in all casualties (21.1 percent) are more

frequent than would be expected. The projected surface area of this region is

approximately 12 percent of the entire body (table 199). On the other hand,

the wounds of the chest and abdomen, whose mean projected surface area is

approximately 27 percent of the entire body, are far below the expected number.
BATTLE CASUALTIES, EIGHTH AIR FORCE 563

This and other indications of the protective value of body armor will be discussed in the section on flak casualties (p. 570). In table 185 are included all

wounds even though two or more may have been produced by a single missile

following a straight path. The regional distribution of wounds or, more

accurately, of hits caused by flak fragments only is given in table 200.

Regional Frequency of Wounds Due to All Missiles

Table 186 shows the regional frequency of wounds due to all missiles in

1,117 casualties. A comparison of the total percentages in tables 185 and 186

reveals the slight differences between regional distribution and regional frequency tabulations of wounds in the same complete sample of WIA and KIA

casualties. If the regional frequency percentages had been calculated on the

basis of casualties wounded in single regions only and if those wounded in

multiple regions had been omitted from the sample, the differences in values

by the two methods of presentation would have been even less significant.

TA13LE 186-Distribution of 1,117 aircrew battle casualties, by category and by anatomic

location (regional frequency) of wounds due to all missiles

WIA casualties KIA casualties Total casualties Anatomic location

Number Percent Number Percent Number Percent

Head -------------------------- 182 18. 1 39 35.5 221 19. 8

Chest ------------------------- 27 2. 7 11 10. 0 38 3. 4

Abdomen --------------------- 10 1.0 7 6. 4 17 1.5

Extremities:

Upper --------------------- 246 24.4 1 .9 247 22.1

Lower -------------------- 419 41.6 9 8. 2 428 38.3

Multiple regions --------------- 123 12. 2 43 39.0 166 14.9

Total -------------------- 1,007 100.0 110 100. 0 1,117 100.0

On the other hand, a comparison of the values from tables 185 and 186

demonstrates the relative differences in regional distribution and regional frequency tabulations of wounds that exist when samples of casualty data are

broken down into WIA only and KIA only. The differences are only very

slight in the case of the wounded but are very marked and of a different order

entirely in the case of the killed. The reason for these differences is that the

killed were much more frequently struck in multiple regions or rather that those

casualties with multiple wounds were much more apt to die. Thus, head-andneck and multiple regions were wounded in 74.5 percent of the KIA as compared

with 30.3 percent in WIA casualties.
564 WOUND BALLISTICS

Fatality Rates

A survey of ground force casualties at Bougainville, S.I., from 15 February to 21 April 1944 (p. 281), was the first of its kind prepared by U.S. Army

medical personnel that included an evaluation of wounds in both fatal and nonfatal American battle casualties. The overall case fatality rate among the

ground force casualties in this sample was approximately twice as great as in

the casualties of Eighth Air Force personnel. Probably, the main reason for

this difference is the speed with which the air force casualties received adequate

medical care. Table 187 compares the regional frequency of wounds and the

case fatality rates in the Eighth Air Force in Europe and in the ground forces

at Bougainville.

The marked difference in fatality rates in wounds of the head and neck

(17.6 percent for Eighth Air Force casualties as compared with 37.5 percent at

Bougainville) is at least partly due to the fact that a large number of the wounds

of the head in Eighth Air Force casualties were mild lacerations due to Plexiglas

fragments. Casualties due to flak fragments only in the Eighth Air Force and

the casualties at Bougainville are compared in table 202.

TA.BLE 187.-Case fatality rates in the 1,117 battle casualties of the Eighth Air Force and in

the 1,788 casualties of the ground forces at Bougainville

Eighth Air Force Ground forces at Bougainville

Anatomic location

Number of Percent Number of Percent casualties ElA casualties EIA

Head ------------------------------------------ 221 17.6 384 37. 5

Chest ------------------------------------------ 38 28. 9 231 37.6

Abdomen --------------------------------------- 17 41. 1 114 42. 1

Extremities:

Upper -------------------------------------- 247 .4 320 .3

Lower -------------------------------------- 428 2. 1 407 3.4

Multiple regions --------------------------------- 166 25. 9 332 30.4

Total ------------------------------------- 1,117 9. 8 1,788 22. 1

Single and Multiple Wounds

Table 188 gives the incidence of wounds occurring in one or more than

one region of the body. The head and neck are regarded as one region.

Wounds of both upper or both lower extremities are regarded as occurring in

one region, whereas wounds in one or both upper and one or both lower extremities are regarded as occurring in two regions. Thus, 39.1 percent of the KIA

casualties as compared with 12.2 percent of the WIA casualties sustained

wounds in more than one region.
BATTLE CASUALTIES, EIGHTH AIR FORCE 565

TABLE 188.-Distribution of 1,117 battle casualties due to all missiles, by category and by

number of regions wounded

wWIA casualties KIA casualties Total casualties Regions wounded_______________

Number Percent Number Percent Number Percent

Number:

1 -------------------------- 884 87. 8 67 60. 9 951 85. 1

2 -------------------------- 97 9. 6 29 26. 4 126 11.3

3 -------------------------- 25 2. 5 9 8. 2 34 3.0

4 -------------------------- 1 . 1 3 2. 7 4 .4

5 ---------------------------------- .0 2 1.8 2 .2

Total -------------------- 1,007 100.0 110 100.0 1,117 100.0

Fractures and Amputations

The regional distribution of fractures due to all missiles is shown in table

189. In this analysis, fractures of both bones of the leg or forearm and of any

number of bones of the shoulder, hip, wrist, or ankle joints and of the hand or

foot or of the cranium are regarded as single fractures when produced at the

same instant by one missile. When it was apparent that one missile had

produced fractures in more than one region or, for example, when one missile

had made an entrance and an exit wound of the same region, such as the chest

or skull, and had fractured skeletal structures at both wounds, two fractures

were counted. Fractures due to all missiles occurred in 31.8 percent of the

casualties (26.3 percent of the wounded and 85.3 percent of the killed). In

the study of fractures, the total 1,007 WIA casualties were available for study.

TABLE 189.--Regional distribution of fracture wounds in 1,109 aircrew battle casualties due

to all missiles

1,007 WIA casualties 102 KIA casualties I Total casualties 2

(265 or 26.3 percent (87 or 85.3 percent (31.8 percent

with fractures) with fractures) with fractures)

Region

Number of Percent Number of Percent Number of Percent

fractures fractures fractures

Head -------------------------- 28 10. 0 48 45. 7 76 19. 8

Chest -------------------------- 12 4. 3 22 21.0 34 8.9

Abdomen -----------------------------.. 0 1 1.0 1 .3

Extremities:

Upper -------------------- -111 39.8 16 15. 2 127 33. 0

Lower --------------------- 128 45.9 18 17. 1 146 38.0

Total -------------------- 279 100.0 105 100. 0 384 100.0

1 Of the total 110 KIA casualties, only 102 were available for study in regard to fracture occurrence.

2 Of the total 1,117 WIA and KIA casualties, 1,109 were available for study in regard to fracture occurrence.
566 WOUND BALLISTICS

However, only 102 of the 110 KIA casualties were included in the fracture

survey. This explains the variation in the figures for KIA casualties and

wounds and total casualties as seen in tables 185, 189, and 190.

The relationship between wounds and fractures is given in table 190.

Thus, for all wounds, the incidence of fractures was 24.8 percent. In the

WIA casualties, 21.5 percent of the wounds were complicated by fractures,

and in the KIA, 42.3 percent of the wounds were complicated by fractures.

(Compare with table 189.)

Amputations are included as fractures in tables 189 and 190 and are shown

separately in table 191. There was only one instance of a surgical amputation

necessary following a soft-tissue wound. The injury was a through-andthrough wound of the soft tissues anterior to the left femur, necessitating

amputation of the left thigh. This amputation is not included in table 191.

TABLE 190.-Relationship between wounds and fractures in 1,109 aircrew battle casualties due

to all missiles, by anatomic location

WIA casualties KIA casualties I WIA and KIA casualties

Anatomiclocation Number Number Number Number Number Number

of of frac- Percent of of frac- Percent of of frac- Percent wounds tures wounds tures wounds tures

Head ------------------ 258 28 10.9 67 48 71.6 325 76 23. 4

Chest ------------------ 63 12 19. 0 34 22 64. 7 97 34 35. 1

Abdomen --------------- 28 ------ . 0 23 1 4. 3 51 1 .2

Extremities:

Upper -------------- 382 111 29. 1 64 16 25. 0 446 127 28. 5

Lower -------------- 567 128 22. 6 60 18 30. 0 627 146 23.3

Total------ 1,298 279 21. 5 248 105 42. 3 1,546 384 24. 8

1 Data are for 102 of the total 110 KIA casualties.

TABLE 191.-Distribution of 34 traumatic amputations in 32 battle casualties, by anatomic

location

Amputations

Anatomic location

In WIA casualties In KIA casualties Total

Number Number Nsumber

Thigh --------------------------------------- 6 6 12

Leg ------------------------------------------ 6 6

Foot. --------------------------------------- 5 1 6

Hand 6----------------------------------------- 6

Arm ---------------------------------------.------------ 4 4

Total -------------------------------- 23 11 34
BATTLE CASUALTIES, EIGHTH AIR FORCE 567

Of the WIA battle casualties, 23 (2.3 percent) sustained traumatic amputations;

20 of these amputations were due to flak. Of the remaining three, two were

due to 20 mm. shells. The missile responsible for the amputation in the

third case was not discovered. Two casualties had two amputations, one of

both thighs and the other of one thigh and one arm. In the KIA group, all

but one arm amputation, for which a 20 mm. cannon shell was responsible,

were due to flak.

Return to Duty Status of Aircrew Battle Casualties

The severity of wounds sustained by aircrew battle casualties may be evaluated on the basis of time lost from flying status. For this analysis, casualties

are regarded as KIA, permanently grounded, or grounded for periods of less

than 24 hours, for 1 to 7 days, for 7 to 30 days, or for 30 to 90 days. The

period of observation after injury was limited to 90 days. Thus, any casualty

still in hospital or who had not returned to his organization after 90 days was

regarded as permanently grounded. Tables 192 through 197 show the relative

severity of wounds of different regions on the basis of time lost from flying status.

By regarding KIA casualties and those permanently grounded together, it

is noted that 378 (33.8 percent) of the 1,117 battle casualties were permanently

lost from flying status. Of the 739 casualties who returned to air-combat duty

99 (13.4 percent) lost less than a day; 256 (34.6 percent), less than a week; and

TAKLE 192.-Distribution of 221 aircrew battle casualties with wounds of the head and neck,

due to all missiles, by disposition

Missile causing casualty

Total casualties Flak From fiuhetr Secondary or Disposition aircraft unknown

Number Number Number

of casu- Percent of casu- Percent of casu- Percent Number Percent

alties alties alties

Returned to flying status after0-1 day ------------------- 11 8.3 ------- 0.0 27 32. 1 38 17.2

1-7 days ------------------ 21 15.9 3 60.0 36 42.9 60 27. 1

7-30 days ----------------- 32 24.2 .0 12 14.3 44 19.9

30-90 days ---------------- 10 7.6 .0 ------------- 10 4.6

Total ------------------- 74 56.0 3 60.0 75 89.3 152 68. 8

Permanently grounded ---------- 22 16. 6 .0 8 9. 5 30 13.6

Killed in action ---------------- 36 27. 4 2 40.0 1 1.2 39 17. 6

Total ------------------- 58 44.0 2 40.0 9 10. 7 69 31.2

Grand total ------------- 132 100.0 5 100.0 84 100.0 221 100.(0
568 WOUND BALLISTICS

563 (76.1 percent), less than a month from flying status. Wounds of the abdomen and of more than one body region accounted for the greatest relative

loss of men from air-combat duty, the rates being 55.6 and 54.5 percent, respectively. Of those whose wounds were confined to the upper extremity, only

25.5 percent were permanently lost to air-combat duty.

TABLE 193.-Distribution of 38 aircrew battle casualties with chest wounds due to flak fragments,'

by disposition

Flak fragments

Disposition Number of Percent of

casualties casualties

Returned to flying status after0-1 day --------------------------------------------- 2 5.2

1-7 days --------------------------------------------- 5 13. 2

7-30 days -------------------------------------------- 8 21. 1

30-90 days ------------------------------------------- 6 15. 8

Total -------------------------------------------- 21 55. 3

Permanently grounded ----------------------------------- 6 15. 8

Killed in action ------------------------------------------- 11 28.9

Total --------------------------------------------- 38 100.0

I During the survey period, flak fragments were responsible for all chest wounds.

TABLE 194.-Distribution of 18 aircrew battle casualties with abdominal wounds due to all

missiles, by disposition

Missile causing casualty

Total casualties

Flak From fighter Secondary or

Disposition aircraft unknown

Number Number Number

of casu- Percent of casu- Percent of casu- Percent Number Percent

alties alties alties

Returned to flying status after0-1 day ------------------------- 0 0 ------ 0 0

1-7 days ----------------- 4 26. 7 ------ 0 0 4 22. 2

7-30 days ---------------- 3 20.0 ------- 0 0 3 16. 7

30-90 days ---------------- 1 6. 6 ------- 0 0 1 5. 5

Total ------------------ 8 53.3 ------- 0 0 8 44. 4

Permanently grounded ---------- 3 20.0 ----- 0 - 0 3 16. 7

Killed in action ---------------- 4 26. 7 2 100.0 1 100. 0 7 38. 9

Total ------------------- 15 100.0 2 100. 0 1 100. 0 18 100. 0
BATTLE CASUALTIES, EIGHTH AIR FORCE 569

TABLE 195.-Distribution of 243 aircrew battle casualties with upper eatremity wounds due to

all missiles, by disposition

Missile causing casualty

Total casualties

Flak From fighter Secondary or

Disposition aircraft unknown

Number Number Number

of casu- Percent of casu- Percent of casu- Percent Number Percent

alties alties alties

Returned to flying status after0-1 day ------------------- 23 9. 7 ------ 0 2 66.7 25 10.3

1-7 days ------------------ 26 11.0 ------- 0 0 26 10.7

7-30 days ------------------ 87 36. 9 3 75.0 1 33.3 91 37. 5

30-90 days ---------------- 38 16. 1 1 25.0 ------- 0 39 16.0

Total ------------------ 174 73.7 4 100.0 3 100.0 181 74.5

Permanently grounded ---------- 61 25. 9 ------ 0 0 61 25. 1

Killed in action --------------- 1 .4 ------- 0 0 1 .4

Total ------------------ 236 100. 0 4 100. 0 3 100. 0 243 100. 0

TABLE 196.-Distribution of 421 aircrew battle casualties with lower extremity wounds due to

all missiles, by disposition

Missile causing casualty

Total casualties

Flak From fighter Secondary or

Disposition aircraft unknown

Numb er Number Number

of casu- Percent of casu- Percent of casu- Percent Number Percent

alties alties alties

Returned to flying status after0-1 day ------------------- 30 7. 6 1 5.5 ------- 0 31 7.4

1-7 days ----------------- 47 11.8 2 11. 1 ------- 0 49 11.6

7-30 days ----------------- 105 26.5 8 44.5 1 16. 7 114 27. 1

30-90 days ---------------- 99 24.9 2 11.1 2 33.3 103 24.5

Total ------------------- 281 70. 8 13 72. 2 3 50. 0 297 70. 6

Permanently grounded ---------- 107 27. 0 5 27. 8 3 50. 0 115 27. 3

Killed in action ---------------- 9 2.2 ------- 0 0 9 2. 1

Total ------------------ 397 100. 0 18 100.0 6 100.0 421 100. 0
570 WOUND BALLISTICS

TABLE 197.-Distribution of 176 aircrew battle casualties with multiple wounds due to all

missiles, by disposition

Missile causing casualty

Total casualties

Flak From fighter Secondary or

Disposition aircraft unknown

Number Number Number of casu- Percent of casu- Percent of easu- Percent Number Percent alties alties alties

Returned to flying status after0-1 day----------------- 3 2. 1 ------- 0 0 3 1.7

1-7 days------------. 9 6. 2 3 14.3 1 10.0 13 7.4

7-30 days ----------------- 35 24. 2 9 42.9 3 30.0 47 26. 7

30-90 days ---------------- 15 10.3 1 4.8 1 10.0 17 9. 7

Total ------------------- 62 42.8 13 62. 0 5 50.0 80 45.5

Permanently grounded -------- 46 31. 7 4 19.0 3 30.0 53 30. 1

Killed in action --------------- 37 25.5 4 19.0 2 20.0 43 24.4

Total ------------------- 145 100. 0 21 100.0 10 100.0 176 100.0

Blast Injury

Otoscopic examination of eardrums failed to reveal any case of blast

injury in any of the 434 WIA battle casualties who were interrogated. The

only instances of ruptured membrana tympani in the 89 KIA casualties examined were those that were torn as a result of basal skull fractures. It

is known that rupture of the eardrums occurs at very much lower blast pressure

than does lung damage and the absence of the former probably precludes the

occurrence of any blast injury of the lungs.

CASUALTIES DUE TO FLAK

Distribution of Flak Casualties According to Combat Position

Because of the relatively large proportion (86.2 percent) of casualties due

to flak, it was thought desirable to analyze them separately. Data pertaining

to protection by body armor, altitude at which injuries were sustained, time

interval between injury and adequate surgical treatment, time lost from

flying status, sizes of fragments causing wounds, and the relative vulnerability

of different parts of the body in different aircrew combat positions, will be

discussed in this section. The frequency with which aircrew personnel in

different combat positions became casualties due to flak is shown in table 198.

The fact that heavy bombers occasionally carried two waist gunners

probably accounts for the highest flak casualty rate for that combat position
BATTLE CASUALTIES, EIGHTH AIR FORCE 571

TABLE 198.-Distribution of 963 casualties due to flak, by category and by combat position in

heavy bombers

WIA KIA Total Case

Position casualties __________ casualties _________ casualties fatality fatality__ 

rate

Number Percent Number Percent Number Percent (percent)

Pilot ------------------------------- 67 7. 7 6 6. 1 73 7. 7 8. 2

Copilot ----------------------------- 58 6. 7 6 6. 1 64 6. 6 9. 4

Navigator --------------------------- 114 13.2 13 13. 2 127 13. 2 10. 2

Bombardier -------------------------- 136 15. 7 16 16. 4 152 15. 8 10.5

Radio operator ----------------------- 78 9.0 6 6. 1 84 8. 7 7. 1

Waist gunner ------------------------ 191 22. 2 18 18. 5 209 21. 6 8. 6

Ball turret gunner -------------------- 46 5.3 7 7. 1 53 5. 5 13.2

Top turret gunner -------------------- 71 8. 2 9 9.2 80 &. 3 11. 3

Tail gunner ------------------------- 104 12. 0 17 17. 3 121 12. 6 14. 0

Total ------------------------- 865 100. 0 98 100. 0 963 100. 0 10. 1

Also, the reasons for the relatively high casualty rates for bombardiers and

navigators and the low casualty rate for ball turret gunners have been discussed

previously.

Projected Body Surface Area

It was to be expected and it had been observed that high explosive shell

fragments hit the body more at random than the "aimed" fire of bullets.

Thus, it was to be expected that an analysis of wound distribution in a complete

sample of WIA and KIA casualties due only to flak fragments might best

reveal information pertaining to the relative degree of protection or lack of

protection to the various body regions. In order to determine the mean

projected area of the body and to make a correct estimate of the proportions

of its different parts, it was necessary to weight observations according to the

probable frequency of different positions of the body in actual operations.

Unfortunately, there was no information on which to base an estimate of the

correct weighting values. An arbitrary mean figure was obtained for the

present study from the three views of the standing and kneeling figures and

from the photograph taken from the front of the proneposition(Burnsand

Zuckerman). By including the two other views of the prone position, the

average value derived for the size of the human target may be slightly greater

than the true mean projected service position. It is hardly likely that

the error is as much as 5 percent. It should be noted that variations in the

weighting factor would have a far greater influence on estimates of the mean

projected area of the body and its parts than would alterations in the lines of

regional demarcation discussed earlier. Seven men were measured, and, in

spite of the differences in their size, the measurements showed a remarkable
572 WOUND BALLISTICS

similarity in the proportions of the mean projected area of each part of the

body. Their heights and body weights were as follows:

Body

Height weight

Subject: (inches) (pounds)

1 ---------------------------------------- 72 144

2 ---------------------------------------- 72 182

3 ---------------------------------------- 72 146

4 ---------------------------------------- 70hý 168

5 ---------------------------------------- 70 182

6 ---------------------------------------- 69 140

7 ---------------------------------------- 67 126

Table 199 gives the mean smoothed values for the actual projected surface

areas in square feet and percent as determined from measurements of subjects

1, 2, 3, and 4. These percentage values may be regarded as the relative proportion of hits or wounds expected to be present in the various regions of the

body in a random complete sample of casualties due only to high explosive

shell fragments. Less than the expected number of wounds observed in any

region would be a reflection of the protection of that region, while more than

the expected number of wounds observed in any region would be due to a

lack of protection to that region.

TABLE 199.-Mean projected area of body

Region Square feet Percent

Head and neck ------------------------------------------- 0. 50 12

Chest -------------------------------------------------- -. 67 16

Abdomen ----------------------------------------------- -. 46 11

Extremities:

Upper ---------------------------------------------- .92 22

Lower ----------------------------------------------- 1.65 39

Total ---------------------------------------------- 4.20 100

The Regional Distribution of Hits Due to Flak

Table 200 shows the location of 1,222 flak hits sustained by 961 battle

casualties. Table 200 also shows the relationship between the wounds expected

and the wounds observed for each of the body regions on the basis of the projected surface area of each of the regions. The lower incidence of wounds in

the thoracic and abdominal regions protected by body armor is quite marked.

Secondary wounds due to flak fragments traversing more than one region of

the body were not counted here but were included in table 185, which lists all

wounds due to all missiles. The rather noticeable decrease in the incidence of

wounds of the head and neck in the flak casualties (15.6 percent) as compared

with those due to all missiles (21.1 percent) was due to the frequency of Plexiglas wounds in the unprotected area of the head in bombardiers and navigators.
BATTLE CASUALTIES, EIGHTH AIR FORCE 573

Surgeons' records frequently gave diagnoses of wounds of the face or head due

to "Flak," when in reality interrogation of the casualties revealed that fragments of flak had penetrated Plexiglas covered areas of the noses of aircraft,

dispersing myriads of Plexiglas fragments. The latter, however, seldom caused

wounds of any part of the body other than the eyes, the circurnorbital regions,

and the neck. These wounds were usually mild and caused very little loss of

time from flying status. The instances in which Plexiglas was found in other

parts of the body usually occurred when fragments lodged in soft tissues after

being driven ahead or along the track of the shell or other metallic fragments.

TABLE 200.-Distribution of 1,222 frala hits on 961 aircrew battle casualties, by anatomic location

Hits in WIA casualties Hits in KIA casualties Total hits Wounds

expected Anatomic location (body sur- Number Percent Number Percent Number Percent face area) (percent)

Head ----------------- 137 13. 1 54 30.3 191 15.6 12

Chest ---------------- 51 4. 9 26 14. 6 77 6.3 16

Abdomen ------------- 19 1.8 10 5.6 29 2.4 11

Extremities:

Upper ------------ 330 31.6 52 29.3 382 31.3 22

Lower ----------- 507 48.6 36 20.2 543 44.4 39

Total ----------- 1, 044 100. 0 178 100. 0 1,222 100. 0 100

The Regional Frequency of Hits Due to Flak

Table 201 shows the regional frequency of flak hits sustained by 963 flak

casualties. Again, the marked differences in the regional frequency of wounds

in WIA as compared with KIA casualties are shown in this table.

TABLE 201.-Distribution of 963 casualties, by category and by anatomic location (regional

frequency) of flqk hits

WIA casualties KIA casualties Total casualties

Anatomic location

Number Percent Number Percent Number Percent

Head -------------------------- 96 11. 1 36 36.7 132 13.8

Chest -------------------------- 27 3. 1 11 11.2 38 3.9

Abdomen ---------------------- 11 1.2 4 4. 1 15 1.6

Extremities:

Upper --------------------- 235 27.2 1 1.0 236 24.5

Lower --------------------- 388 44. 9 9 9.2 397 41. 1

Multiple regions ---------------- 108 12. 5 37 37. 8 145 15. 1

Total -------------------- 865 100.0 98 100.0 963 100.0
574 WOUND flALLISTICN

Fatality Rates

A comparison of fatality rates is shown in table 202. The first two

columns compare the case fatality rates of wounds due to all missiles with

those due to flak only in aircrew personnel. The larger percentage of fatal

wounds of the head due to flak (27.4 percent as compared with 17.6 percent

for all missiles) is explained by the relative mildness of Plexiglas wounds of

the face which are included in the first column of the table. The lower fatality

rate for flak wounds of the abdomen (26.7 percent as compared with 41.1

percent for all missiles) is explained by the severity of abdominal wounds due

to missiles from enemy fighter aircraft. The third column shows the case

fatality rates for ground force casualties at Bougainville. The higher case

fatality rates which occurred in every region of the body in the series of Bougainville casualties must clearly be due in a large part to the fact that the

wounds sustained by the ground forces concerned were more severe than the

TABLE 202.-Comparison of case fatality rates of wounds due to all missiles with those due

to flak in Eighth Air Force and in the ground forces in Bougainville, by anatomic location

of wounds

Eighth Air Force Ground forces at Anatomic location B_ ougainville

(all missiles)

All missiles Flak

Percent Percent Percent

Head --------------------------------------- 17.6 27.4 37.5

Chest -------------------------------------- 28. 9 28. 9 37. 6

Abdomen ----------------------------------- 41.1 26. 7 42. 1

Extremities:

Upper ------------------------------------ .4 .4 .3

Lower ---------------------------------- 2. 1 2.2 3.4

Multiple regions ----------------------------- 25. 9 25.5 30.4

Average ------------------------------ 9. 8 10.2 22. 1

flak injuries received by the aircrews, which are the subject of the present

report. It is known too that in jungle warfare as fought at Bougainville

there was a preponderance of small arms or "aimed" fire, and it is known

that a bullet is relatively much more lethal than a shell fragment. Another

possible reason for the difference in case fatality rates in the Ground Forces

and the Air Forces may be the greater speed with which air force casualties

received surgical treatment. (See appendix H, page 843, for a detailed

comparison of World War II missile casualty data.)

In general, the number of wounding missiles per casualty in the Air Forces

was lower than in the ground force casualties. A possible explanation may
BATTLE CASUALTIES, EIGhTH AIR FORCE 575

be the proximity of ground force casualties to bursts of exploding projectiles

and to a greater degree of fragmentation of mortar and artillery shells as

compared with antiaircraft shells.

Altitudes at Which Casualties Sustained Wounds

The altitude at which 441 (386 WIA and 55 KIA) casualties due to flak

sustained wounds was known. Table 203 shows the manner in which the

casualties were distributed between the two types of heavy bombers. Approximately 70 percent of casualties due to flak in B-17's were wounded at

an altitude of 24,000 feet or above, whereas 92 percent in B-24's were wounded

at 23,000 feet or below. This difference in altitude may in some way account

for the difference in casualty rates in the two types of aircraft.

TABLE 203.-Altitude of B-17 and B-24 aircraft at which 441 casualties due to flak sustained

wounds

Casualties in B-17's Casualties in B-24's Altitude in feet__________ __________

WIA KIA Total WIA KIA Total

Above 26,000 ------------------------------- 42 3 45 ..................

24,000-26,000 ----------------------- ------- 149 18 167 8 3 11

22,000-24,000 ------------------------------- 35 2 37 45 9 54

20,000-22,000 ------------------------------- 26 5 31 34 ------ 34

18,000-20,000 ------------------------------- 2 3 5 12 1 13

Below 18,000 -------------------------------- 12 9 21 21 2 23

Total -------------------------------- 266 40 306 120 15 135

Time Interval Between Injury and Surgical Treatment

The time interval between injury and adequate surgical treatment in

hospital was recorded for 375 WIA casualties due to flak. Table 204 shows

the period of time which elapsed between injury and surgical treatment for

casualties in the two types of aircraft. Approximately 90 percent of all WIA

battle casualties were adequately treated in hospital within 4 hours after they

were wounded.

Return to Flying Status

The relative severity of wounds due to all missiles, as judged by time

lost from flying status, was shown in tables 192, 193, 194, 195, 196, and 197.

Table 205 shows the time lost from flying status by the 963 casualties due to

flak in the two types of aircraft. Thus, 64.3 percent of all casualties due to

flak were returned to flying status within 3 months after being wounded.
5,16 WOUND BALLISTICS

TABLE 204.-Distribution of 375 WIA casualties due to flak in B-17 and B-24 aircraft,

by time interval between injury and surgical treatment

Number of casualties Time interval

In B-17's In B-24's Total

Hours:

1 -------------------------------------- -18 24 42

2 --------------------------------------- 52 37 89

3 --------------------------------------- 113 29 142

4 --------------------------------------- 50 11 61

5 --------------------------------------- 23 6 29

6 --------------------------------------- 2 2 4

More than 6 ----------------------------- 6 2 8

Total -------------------------------- 264 111 375

TABLE 205.-Distribution of 634 and 329 casualties due to flak in B-17 and B-24 aircraft,

respectively, by disposition

B-17 B-24

Disposition Number of Percent Number of Percent

casualties casualties

Returned to flying status after loss of0-1 day ----------------------------- 56 8. 8 13 4. 0

1-7 days ---------------------------- 69 10.9 43 13. 3

7-30 days --------------------------- 184 28. 9 86 26. 5

30-90 days -------------------------- 108 17. 0 61 18.8

Total ---------------------------- 417 65. 6 203 62. 6

Permanently grounded ------------------- 157 24. 7 88 27. 2

Killed in action ------------------------- 60 9. 7 38 10.2

Total ----------------------------- 217 34. 4 126 37.4

Grand Total ----------------------- 634 100. 0 329 100. 0

Relationship Between Flak Fragments and Disability

If the purpose of wounding enemy personnel is to cause military loss,

then it is apparent that some means must be devised for evaluating that loss

on the basis of severity of the wounds. Lamport I has stated: "If the tactical

value of causing a casualty is considered as directly proportional to the days

lost from full service, an incongruous result arises with a single casualty causing

7 Lamport, H.: Missile Casualties Report No. 15, Office of Scientific Research and Development, Washington, D.C.,

September 1945.
BATTLE CASUALTIES, EIGHTH AIR FORCE 577

100 days lost from duty being presumably equivalent in the military sense to

putting each of ten men out of action for 10 days." Lamport has developed

two hypotheses which may be used to demonstrate gradation of disability produced by wounds. For both of his methods, it was necessary to choose some

period of disability, in days lost from active duty, that would correspond to

the total military loss of a man. By the means described in his report, he

arrived at the conclusion that a wound causing a man to lose 45 days amounts

to a 100 percent mihtary loss for that man and that a wound causing 6 days'

loss amounts to a 50 percent military loss. Figure 276 is the curve representing

Lamport's second hypothesis and shows the relationship between days lost

from active duty and the percent tactical military loss.

The severity of wounds has been evaluated in terms of military losses

ranging from 1 to 100 percent, and the values for these losses have been interpolated from a table which is contained in Lamport's report and reproduced

here (table 206).

TAELE 206.-Relationship between days lost from active duty by a casualty and the resulting

military loss

Days lost (T) Military loss (L)1 Grouping Days lost (T) Military loss (L)l Grouping (number) (percent) (percent) (number) (percent) (percent)

0 0 0 21 91

1 11 1-10 22 92

2 21 11-20 23 93

3 29• 21-30 24 94

4 37 31-40 25 95

5 44 41-50 26 95

6 50 1 27 96

7 56 51-60 28 96

8 61 1 29 97

9 65 61-70 30 97

10 69 31 97

11 72 32 98

12 75 71-80 33 98

13 78 34 98

14 80 35 98

15 83 36 98 96-100

16 84% 37 99

17 86 81-90 38 99

18 88 39 99. 0

19 89 40 99. 1

20 90 41 99.2

42 99.3

43 99.4

44 99.4

45 99.45

1 Maximal loss (L) is 100 percent for T=45 days, when T=days lost from active duty. Method II (Annuity law)

T L= 100 - 100 x 0. 5005-
578 WOUND BALLISTICS

L(9/o) 1 00

90

70

60

50 TACTICAL LOSS DUE TO A SINGLE CASUALTY IN

PER CENT (L) RELATED TO DAYS LOST FROM

ACTIVE DUTY (T). ONE HUNDRED PER CENT

LOSS IS TAKEN AT 45 DAYS, FIFTY PER

CENT LOSS AT 6 DAYS

40

LAMPORT'S CURVE f1. L= 100-100 X 0.5066

(ANNUITY LAW

_0

20

0

0 10 20 30 40 50 ---- T =DAYS LOST

FIGURE 276.-Lamport's curve II, showing relationship between days lost

from active duty and percent tactical military loss.

There were 376 instances where the complete flak fragments causing the

wound were recovered. Added to these were casualties with through-andthrough fatal wounds with either no fragment or only part of a fragment

retained, fatal avulsions, amputations, and decapitations. For reasons to be

given later, all of the latter fatalities were regarded as being due to fragments

heavier than 20 grams. The total sample of data numbers 443 observations.

These include the slightly and severely wounded, as well as those who were

permanently disabled or killed. In calculating the correlation coefficient, the

two variables taken into account were the days lost from flying status, inter-
BATTLE CASUALTIES, EIGHTH AIR FORCE 579

MILITARY LOSS

(PER CENT)

95

THE RELATIONSHIP BETWEEN "MILITARY LOSS"

AND WEIGHT OF FLAK FRAGMENTS CAUSING

WOUNDS IN AIRCREW PERSONNEL

0 5 10 I5 20

FRAGMENT WEIGHT (GRAMS)

WRAMC-4924-Al

FIGURE 277.-Chart showing relationship between "military loss" and weight of flak

fragments causing wounds in aircrew personnel.

polated from Lamport's table into percent military loss, and the size of the

fragment in grams.

For the purpose of analysis, all casualties who were lost to flying status

longer than 26 days, or who were permanently disabled or killed, were grouped

together with those who lost from 27 to 45 days, or in terms of military loss,

from 95 to 100 percent. The correlation coefficient for the two variables

was found to be 0.288±0.047. The test of significance (t) for the coefficient

was found to be 6.13 (P=less than 0.01). The mean value for military loss

per casualty was 90.0 percent (which corresponds to a loss of 21 days) and the

mean fragment weight was 10.07 grams. A regression equation was calculated

which was found to be:

x--0.44y+86.5

where x=percent military loss and y=fragment weight in grams. It may

be observed, for example, from this equation that fragments weighing 1 gram

generally may be expected to produce casualties, the average of which may

be regarded as a military loss of 87 percent. From table 206, this is seen to
580 WOUND BALLISTICS

correspond to the loss of about 17 days. Figure 277 shows the relationship

between "military loss" and fragment weight in the form of a curve plotted

for the 443 observations upon which this report is based.

Despite all of the other variables that must be present, the observed

correlation coefficient as calculated is statistically significant and may be

regarded as real. It should be pointed out, as can be seen from the table of

values for the two variables x and y, that fragments weighing more than 20

gm. produced the greatest number of permanently disabled or killed casualties.

It may be assumed that fragments weighing more than 20 gm. were probably

so damaging to personnel, as well as to aircraft, that they were responsible for

casualties in aircraft that were shot down in enemy territory, and thus the

casualties could not be included in the sample of data under survey. Otherwise, the number of observations in this group might have been greater still.

Correlation Between Wound Size and Fragment Size

It seems advisable to examine the relationship between the size of a

wound and the size of the fragment causing it. It should be pointed out again

that the lack of available information on the velocity of fragments prevents

taking that important variable into consideration here. Accurate surface

areas of wounds were not determined in most instances because of the irregular

outline of the area margins. Instead, the surface area of a wound has been

arbitrarily regarded as the product of two dimensions in centimeters. There

were 75 instances in KIA flak casualties in which both the area of the wound

of entrance and the fragment size were fairly accurately determined. In all

of the observations, the flak fragments were completely retained along the

wound track. The wounds ranged in size from 1 cm.2 to 50 cm.2 . The flak

fragments ranged from 1 to 100 gm. in weight and from 1 to 9 cm. in their

greatest dimension.

Correlation coefficients were calculated to show the relationship between

(1) wound size and fragment weight and (2) wound size and greatest dimension

of fragment. In the case of the former, the correlation coefficient was found

to be 0.49±0.12 (t=4.1; P=less than 0.01). This correlation is highly significant. The degree of correlation between the size of the wound and the

greatest dimension of the flak fragment is even greater as shown by the

correlation coefficient of 0.63±0.12 (t=5.3; P=less than 0.01).

A further correlation coefficient was calculated; namely, that for the area

of the wound against the product of the weight and maximum dimension of

fragment. Although it was found to be significant, it was less so than either

of the coefficients just given.

For this purpose, 36 fatal wounds due to flak fragments were available

for study. Decapitations, avulsions, and amputations, obviously due to very

large flak fragments, were deleted. Of the 36 fatal wounds, 6 retained part

of the fragment along the wound track. The identity of the missile causing the

wound in the other cases was confirmed by the knowledge that it was flak
BATTLE CASUALTIES, EIGHTH AIR FORCE 581

that had damaged the aircraft in which the casualty occurred. The range

of sizes in the fatal wounds in this group was from 1 cm.' to 108 cm.2 . The

mean wound size was 20 cm.2 , for this sample. The difference between the

means of the sizes of through-and-through wounds and the sizes of wounds

with retained fragments is not statistically significant. However, if only

those wounds due to retained fragments weighing less than 20 gm. (54 observations) are compared with through-and-through fatal wounds, the difference

in their respective mean sizes is significant-the difference being 13.80 cm.2

(standard error ±5.14). Therefore, through-and-through fatal wounds in

this series of observations may be regarded generally as being caused by

fragments weighing more than 20 grams.

Sizes of Fragments Causing Wounds

The sizes of flak fragments responsible for wounds were determined by

weighing those recovered from the dead and estimating the weights of others

from their X-ray silhouettes. In the case of the latter, the fragments were

estimated in grams from their linear dimensions. A large series of X-rays of

fragments of known weight were available as a standard. A total of 505 flak

fragments seen in X-ray films or recovered from 438 (361 WIA and 77 KIA)

casualties were available for study.

The KIA casualties from whom flak fragments were available were only

those examined in the Medical ORS laboratory during the 6 months' period,

June through November 1944. There were 164 bodies examined from the

Eighth Air Force and Ninth Air Force and Troop Carrier Command. Of the

total, 144 (87.8 percent) were flak casualties. The 81 fragments causing fatal

wounds in 77 casualties represent the recovery of 54.0 percent of flak fragments

causing fatal wounds. Although some flak fragments were recovered from the

other KIA casualties, they were not included in this analysis because there was

evidence that the fragments found were only portions of the fragments causing

the fatal wounds. In several instances, fragments smaller than expected were

found along a missile track having both entrance and exit wounds.

In general, it may be assumed that those fragments which were completely

recovered were of lower velocity and of smaller size than those which caused

fatal wounds in the remaining 67 (46.5 percent) KIA casualties, from whom none

or only partial fragments were recovered. In instances where more than one

fragment was found in a fatal wound with one point of entrance, it was assumed

that refragmentation of the primary fragment had occurred. In nearly all

such cases, the refragmented fragments could be fitted together. The weight

credited for such multiple fragments was the total weight of the pieces. Fragnients which caused secondary wounds in KIA casualties are included in the

group of fragments causing nonfatal wounds. Table 207 shows the weight distribution of flak fragments according to nonfatal and fatal wounds.

In three KIA casualties, there were two fragments, both of which caused

fatal wounds. Four fragments are credited with having caused fatal wounds,
582 WOUND BALLISTICS

TABLE 207.- Weight distribution of 505 flak fragments recovered from nonfatal and fatal

wounds in 438 casualties

Number and weight of fragments

Type of wound Number of _ Total casualties fragments 0-50 50-250 1W-1 1-5 5-20 >20

A qg. Mlg. am. m G m. Cm. am. Nutmber

Nonfatal ----------------- 361 56 64 46 100 100 58 424

Fatal -------------------- 77 ------------------- 6 43 32 81

Total --------------- 438 56 64 46 106 143 90 505

although they were recovered from the extremities. Two of these were recovered from the knee joint of one casualty and weighed 15.29 and 6.10 gmi.,

respectively. The other two were removed from the thighs of two casualties

and weighed 12.04 and 31.74 gin., respectively. In each of these cases, the

actual cause of death was attributed to hemorrhage, shock, and anoxia.

A series of flak fragments of varying sizes are seen in figure 278.

Sizes of Fragments Causing Fracture Wounds

Thirty flak fragments were recovered which had caused thirty fracture

wounds of the skull. Twenty-three (77 percent) of these produced fatal

wounds. The 30 fragments were distributed according to weight as shown in

table 208. Again, it should be stated that many fatal skull fracture wounds

were observed from which no fragments were recovered. Thus, it may be concluded that flak fragments weighing more than 5 gin. are much more likely to

cause fatal penetrating wounds of the skull than fragments weighing less than

5 grams.

TABLE 208.--Weight distribution of 30 flak fragments recovered from nonfatal and fatal fracture

wounds of the skull

Number and weight of fragments

Type of wound Total

fragments 1-5 5-20 >20

Gm. am. GiM. Ntumber

Nonfatal ---------------------------------------- 3 3 1 7

Fatal ------------------------------------------- 1 16 6 23

Total -------------------------------------- 4 19 7 30

Fifty-six flak fragments were recovered which had caused fracture wounds

of the extremities. The distribution of these fracture wounds is shown in table

209. Only complete fractures of the bones or joints listed, in which the mis-
BATTLE CASUALTIES, EIGHTH AIR FORCE 583

{i~ ~ ~ ~ IIII1.t[iI1 ~~I l It,

WWud.I wasosrve Wha woo oza framen weghng es than M .hdbe on

FIGURlE ofprodu ing ar missiesgh fa k). Eacu h wound. othsfrge sca edafatal 

-obrarrwcsat.Te ag nwegtfo o16g.Sm fte r

brknofrtie otoso agrfamet htpoue aa hog-n-hog

wons twsosre ht ofa rgetwihn*es hnIg.hdbe on

FIGURle 278.prou imgat missiles hary flak) talh wofuhsn ramnscasdafaa.ev
584 WOUND BALLISTICS

siles were retained at the site of the fracture, were included. Thus again, in

general, only fragments weighing more than 5 gm. produced fatal fracture

wounds of the extremities.

TABLE 209.-Weight distribution of 56 flak fragments recovered from fracture wounds of the

extremities

Weight and number of fragments

Fracture wound of- Total fragments

50-250 Y4-1 1-5 5-20 >20

Mg. Gm. Gm. Om. Gm. Number

Humerus ------------------------------.--------.--------- 5 1 6

Elbow -------------------------------- 1 1 2 1 5

Radius and/or ulna ------------- ---------------- 1 2 1 4

Wrist -------------------------.--------- 1 -1 2

Femur --------------------------------.--------- 2 4 4 10

Knee ---------------------------------.---------------- 6 1 7

Tibia and/or fibula ------------- 1 2 2 6 4 15

Ankle -------------------------.--------.-------- 2 2 3 7

Total -------------------- 1 4 8 1 28 2 15 1 56

1 Includes 6 fatal fracture wounds; 1 of the humerus, 2 of the femur, 2 of the knee, and I of the tibia and/or fibula.

2 Includes 1 fatal fracture wound of the femur.

Flak, Mortar, and Artillery Shell Fragments

In a report by the Bombing Survey Unit on American ground force casualties sustained in the Cassino area (p. 541) are some data on the sizes of mortar

and artillery shell fragments causing nonfatal wounds. The sizes of fragments

causing fatal wounds were not determined. Table 210 compares the sizes and

distribution of 424 flak fragments which caused nonfatal wounds in 361 aircrew casualties with 157 mortar and artillery shell fragments which caused

wounds in 27 ground force casualties.

TABLE 210.-Comparison of flak fragments in nonfatal wounds in 361 aircrew casualties with

mortar and artillery shell fragments in 27 ground force casualties in the Cassino area

Flak fragments in 361 aircrew casualties Mortar and shell fragments in 27 ground force casualties

Weight Number Percent of total Weight Number Percent of total

fragments fragments

M-g. Mg.

0-50 56 13. 2 0-50 77 49. 0

50-250 64 15. 1 50-250 29 18. 5

Cm. Gm.

46 10. 8 %-1 33 21.0

1-5 100 23. 6 1-5 18 11. 5

5-20 100 23. 6 5-20 ------------.............

>20 58 13. 7 >20
BATTLE CASUALTIES, EIGHTH AIR FORCE 585

The increased average number of fragments per casualty in the ground

forces (5.8 percent as compared with 1.2 percent per aircrew casualty) may be

partially explained by the breakup of fragments after hitting. The lower carbon content of the steel from which mortar and artillery shells are made would

account for the finer breakup and the greater irregularity in the shape of their

fragments. The preponderance of wounds in ground force casualties associated

with fragments smaller than 1 gin. in weight (88.5 percent as compared with

39.1 percent for aircrew casualties) attests to the greater vulnerability of ground

force troops and to the greater protection of aircrew personnel against small

low-velocity fragments. The casualty risk rate for troops from mortar and

artillery fire in the Cassino area was estimated to be approximately 27 percent.

This was the estimated casualty rate for two infantry regiments exposed to

enemy mortar and artillery fire during 7 days of combat. Even with all MIA

aircrew personnel included as battle casualties, the casualty rate for the Eighth

Air Force for 3 months was only 1.2 percent.

The Effect of Body Armor on the Distribution of Flak Wounds

It has been impossible to collect accurate data to show the incidence of

personnel hit but uninjured by flak in the regions of the body protected by

armor. Records in the Office of the Surgeon, USSTAF, showed only 15 such

instances for the 3 months' period of this survey. An evaluation of the protection afforded by armor may be obtained from a study of the quantitative

relationship between flak hits and projected body surface areas. This relationship is shown in table 211. The values in the table are based on the 1,222 flak

hits observed in the 961 casualties referred to in table 200 and may be regarded

as indices of vulnerability. The mean areas of the different regions of the body

used in the calculations are the same as those referred to in table 199 and are

shown in table 211 as "Hits expected." The application of mean projected

surface areas as measured to a man usually seated in a heavy bomber is a purely

arbitrary one. The presence of combat equipment and the structure of the

aircraft in addition to the wearing of body armor probably influenced the

regional distribution of flak hits materially. A purely random distribution of

hits on unprotected individuals would cause all the indices in the table to be

1.00. The effective protection to the chest and abdomen is apparent as indicated by indices of 0.39 and 0.22 for these regions, respectively. An index of

1.42 for the upper extremities reveals this region to be most vulnerable to hits

in aircrew personnel. It should be pointed out that the relatively high vulnerability index of 1.30 for the head-and-neck region is due largely to the relatively greater vulnerability of the neck rather than of the head itself. When

one compares the vulnerability of different body regions as demonstrated in

table 211 with the regional distribution of hits (table 200), the point that is

demonstrated in the former is the relatively high vulnerability of the head and

neck and upper extremities in proportion to the surface area projected by these

regions.

603225v1--62-39
586 WOUND BALLISTICS

TABLE 211.-Relative vulnerability of different body regions as compared with the 1,222 flak hits

observed on body surface area of 961 casualties

961 WIA and KIA aircrew casuBody surface altics (body armor worn)

Body region area or hits

expected Hits observed Index I

Percent Percent

Head --------------------------------------- 12.0 15. 6 1.30

Chest --------------------------------------- 16.0 6.3 .39

Abdomen ------------------------------------ -11.0 2.4 .22

Extremities:

Upper ---------------------------------- 22.0 31. 3 1.42

Lower ---------------------------------- 39. 0 44. 4 1. 14

Total --------------------------------. 100. 0 100.0

Percent of hits observed I Index = Percent of hits expected

Table 212 is a breakdown of the regional distribution of flak hits given in

table 200 according to combat position. The values are expressed as percentages of total hits received in each combat position.

Table 213 shows the quantitative relationship between flak hits and body

surface areas in terms of vulnerability indices for each of the combat positions

in U.S. heavy bomber aircraft. Here again, it may be said that a purely random distribution of hits on unprotected individuals would cause all the values

in the table to be 1.00. Thus, for example, the ball turret gunner appears to

have the greatest protection from flak hits of the abdomen. The copilot appears to have the least chest protection, or at least lie sustains the greatest

number of chest hits. However, it is clearly apparent that throughout the

TABLE 212.-Regional distribution of flak hits according to combat position

[Values expressed as percentages of total hits received in each position]

Combat position Head Chest Abdomen Upper Lower extremity extremity

Pilot ---------------------------------- 20. 2 5.3 2. 1 28. 7 43. 7

Copilot --------------------------------- 15.2 9.4 1. 1 30. 6 43.7

Navigator ------------------------------ 18.9 9. 1 3. 2 32. 0 36.8

Bombardier ----------------------------- 19. 7 5. 7 1.5 37. 9 35. 2

Radio operator -------------------------- 9.7 2. 9 1.9 29. 1 56. 4

Waist gunner -------------------------- 14. 9 6. 0 2. 6 30. 6 45. 9

Ball turret gunner ----------------------- 9. 2 4.6 0 27. 7 58.5

Top turret gunner ----------------------- 20. 2 5. 7 2. 9 18.3 52. 9

Tail gunner ---------------------------- 9. 5 7.0 3. 8 36. 9 42. 8

Average ------------------------- 15. 6 6.3 2.4 31.3 44.4
BATTLE CASUALTIES, EIGHTH AIR FORCE 587

different combat positions the number of flak hits of the chest and abdomen in

proportion to the areas these regions present is relatively low. It is also apparent that one of the vital regions of the body, that is, the head and neck, of a

man in any combat position is relatively poorly protected from flak. The head

and neek are most vulnerable in the pilot's and top turret gunner's positions.

TABLE 213-Relative vulnerability (index of vulnerability) of body regions in different combat

positions

Combat position Head Chest Abdomen Upper Lower

extremity extremity

Pilot ---------------------------------- 1.68 0.33 0. 19 1.31 1. 12

Copilot --------------------------------- 1.27 .59 .11 1.39 1. 12

Navigator ------------------------------ 1.58 .57 .30 1.46 .94

Bombardier ---------------------------- 1.64 .36 . 14 1.72 .90

Radio operator ------------------------- .81 . 18 . 18 1.32 1.44

Waist gunner --------------------------- 1.24 .37 .24 1.39 1. 18

Ball turret gunner ----------------------- . 77 .29 0 1. 26 1. 50

Top turret gunner ----------------------- 1. 68 .36 .26 . 83 1.36

Tail gunner -----------. 80 .44 .35 1.68 1.09

The choice of the measurements for projected surface areas was purely

arbitrary and since the areas were measured for a man not in an aircraft are

likely to be quite different for a man in his airerew combat position. Perhaps

a more accurate estimate of the projected surface areas of body regions for

airerew personnel and the effectiveness of body armor could be obtained

from an analysis of flak wound distribution in samples of armored and unarmored aircrew personnel. The available material for such an analysis

consisted of 104 of the flak casualties in the present survey (88 WIA and

16 KIA) who were known not to be wearing body armor. In addition to

these, a perusal of Eighth Air Force records before the introduction of body

armor revealed 307 known flak casualties (294 WIA and 13 KIA) which were

sustained during the period August 1942 to December 1943.

Table 214 shows the distribution of flak wounds in unarmored and armored

aircrew personnel. The figures in column 3 for armored individuals are those

given in table 200 for all casualties due to flak, less those known to have been

sustained in unarmored personnel.

Flak wounds of the chest and abdomen before the use of body armor

accounted for 13.3 percent of the casualties as compared with 8.2 percent

since the use of body armor. Chi-square test of the significance of the differences between these figures gives the value x2= 9 .

7 0 (n=l, P less than

0.005). From the numbers available, this difference is very highly significant.

A number of unarmored KIA casualties were omitted from columns 1

and 2 of table 214 because the identity of the missiles causing the fatal wounds

could not be ascertained from the old records. Could these have been in-
588 WOUND BALLISTICS

TABLE 214.-Regional distribution of flak wounds in unarmored and armored aircrew

personnel

Wounds in unarmored Wounds in armored

casualties i casualties 2

Region

Number Percent Number Percent

Head ----------------------------------- 92 16. 1 173 16. 1

Chest ---------------------------------- 56 9. 8 59 5.5

Abdomen ------------------------------- 20 3.5 29 2.7

Extremities:

Upper ------------------------------ 151 26.4 349 32. 5

Lower ----------------------------- 252 44. 2 465 43. 2

Total ---------------------------- 571 100. 0 1,075 100.0

i 382 WIA; 29 KIA.

2 777 VIA; 80 KIA.

cluded, the incidence of wounds of the head, chest, and abdomen undoubtedly

would have been greater and the apparent beneficial effect of body armor

marked. Protective steel helmets were generally worn by aircrew personnel

both before and since the introduction of body armor and, as might be expected, the incidence of flak wounds of the head remained unchanged.

An analysis was made of the incidence and case fatality rates of flak

injuries of the head sustained by men wearing and not wearing steel helmets.

Information was obtained from 458 aircrew casualties, 369 of whom wore

helmets and 89 of whom did not wear helmets (table 215). Only those regions of the head normally protected by a steel helmet were considered in

this analysis.

TABLE 215.-Distribution of 458 casualties with cranial injuries due to flak, by protected or

unprotected helmet area

Total wounds Fatal wounds Number of

Helmet area casualties Number Percent Number Percent

fatality

Protected ------------------------------- 369 33 8. 9 19 58

Unprotected ---------------------------- 89 13 14. 6 10 77

Total ---------------------------- 458 46 10. 1 29 63

It would appear that both the incidence and case fatality rate of injuries

of the head due to flak were decreased by the wearing of the steel helmet.

However, the sample of data was not sufficient to give statistical significance to

the differences between either the incidence or the case fatality rate for cranial

wounds of protected and unprotected individuals.
BATTLE CASUALTIES, EIGHTH AIR FORCE 589

CASUALTIES DUE TO SECONDARY MISSILES

The Distribution of Casualties Due to Secondary Missiles

A total of 104 aircrew battle casualties (100 WIA and 4 KIA) were due to

secondary or unknown missiles. This represents 9.3 percent of the total of

1,117 casualties in the 3 months' survey. As stated previously, secondary

missiles include fragments of Plexiglas, pieces of dural from the skin of or objects

in the plane, bulletproof glass, brass fittings, parts of electrical heating and

radio equipment, and .50 caliber machinegun ammunition (figs. 279, 280, 281,

and 282). In this analysis, however, secondary missiles left in wounds along

ýh

WRAMC-4859-A1

FIGuRE 279.-Secondary missiles (dural). The most common of secondary missiles in

aircrew casualties are the aluminum alloy fragments from the skin and other parts of aircraft

known as dural. Only the top left fragment, the tip of the throttle of a B-17, produced a

fatal wound by transecting a man's trachea and lodging in his neck alongside his vertebral

column. The other pieces were found along the fatal wound tracks caused by primary

missiles.

the path of enemy missiles were not included. Only those missiles which alone

were responsible for wounds, secondary to hits elsewhere by flak or fire from

enemy aircraft, were included. Table 216 shows the distribution of battle casualties due to secondary and unknown missiles.

Plexiglas Wounds

All of the WIA casualties due only to Plexiglas sustained injuries from

fragments of Plexiglas set in motion by flak. In one instance, a fragment of

a 20 mam. cannon shell, in addition to a fracture wound of the right arm, caused
590 WOUND BALLISTICS

N|

Ap

Centimeters WRAMC-4859-A14

FIGURE 280.-Secondary missiles (body armor). The second most common of secondary

missiles found in the tracks of fatal wounds in aircrew personnel are plates and fragments of

body armor and helmet. These are most readily recognized by their uniform thickness of

approximately 1 millimeter and by the fact that they are nonmagnetic though obviously of

greater density than fragments of dural.

a secondary Plexiglas wound of the face. In 73 of the casualties, the wounds

produced by the fragments of Plexiglas were the only ones sustained, and all

of these occurred in the unprotected area of the face and neck with the exception of one, which was in the forearm. Two others sustained two wounds

from Plexiglas fragments, one each of the head and forearm. Out of the total

of 88 Plexiglas wounds in 76 individuals, there were only 3 that occurred on

protected parts of the body; that is, parts of the body protected by as little

as the sleeves of the man's uniform. These three wounds occurred on the

forearms of three individuals. Figure 283 shows diagrammatically the loca-
BATTLE CASUALTIES, EIGHTH AIR FORCE 591

tion of the 85 (97 percent) Plexiglas wounds that occurred on the unprotected

part of the body. Plexiglas wounds were sustained by men in all combat

positions. However, bombardiers, navigators, and top turret gunners accounted for 68 percent of them.

TABLE 216.-Distribution of 104 aircrew battle casualties, by category and by causative agent

(secondary missile)

Causative agent WIA casualties KIA casualties Total casualties

Plexiglas ------------------------------------ 76 -76 76

Dural --------------------------------------- 4 1 5

Bulletproof glass ------------------------------ - 3 -- 3

Motor bearing ------------------------------------------- 1 1

Zinc fragment -------------------------------- 1 1 2

.50 caliber machinegun ammunition ------------------------- 1 1

Unknown --------------------------------------- -16 16

Total -------------------------------- -100 4 104

WRAMC-4859-All

FIGuRE 281.-Secondary missiles (Plexiglas). The third most common of secondary

missiles causing wounds in aircrew personnel are fragments of Plexiglas. These fragments

do not produce fatal wounds and never penetrate deeply into tissue except when driven in

by a heavier primary missile. Plexiglas fragments produce only slight superficial wounds and

lacerations by themselves.
WOUND BALLITTIC9

V 

-

Centimeters

WRAMG-4859-A15

FIGURE 282.-Secondary missiles (miscellaneous). These consist of a bearing from an

aircraft's engine, parts of electrical apparatus, clothing, personal equipment, oxygen line,

rubber, zipper, and "dog tag" chain. With the exception of the bearing which by itself produced a fatal head wound, all of these were found in aircrew personnel along the fatal wound

tracks caused by primary missiles.

Return to Flying Status of Casualties Caused by Secondary Missiles

Table 217 shows the relative severity of wounds due to Plexiglas and other

secondary and unknown missiles as judged by the time lost from flying status.

There is a striking difference in the severity of wounds due to Plexiglas

fragments as compared with wounds due to flak and other missiles. Thus,
BATTLE CASUALTIES, EIGHTH AIR FORCE 593

WRAAIC-4937-Al

FIGURtE 283.-Location of 85 wounds due to Plexiglas fragments in 75 WIA battle casualties.

TABLE 217.-Distribution of 104 aircrew battle casualties due to Plexiglas fragments and

other secondary or unkcnown missiles, by disposition

Plexiglas fragments Otber secondary or unknown missiles

Disposition- ___

Number Perrent Number Percent

Returned to flying status after loss of0-1 day -------------------------------- 24 32 5 18

1-7 days ------------------------------- 31 41 5 18

7-30 days ------------------------------ 14 18 4 14

30-90 days ------------------------------ 1 1 2 7

Total -------------------------------- 70 92 16 57

Permanently grounded ----------------------- 6 8 8 29

Killed in action ----------------------------------- --------------- 4 14

Total -------------------------------- 6 8 12 43

Grand total -------------------------- 76 100 28 100

603225,-62--40
594 WOUND BALLISTICS

none were killed and only 8 percent of men wounded by fragments of Plexiglas

were permnanently grounded, whereas 43 percent of men wounded by flak or

other missiles were permanently grounded or killed.

CASUALTIES DUE TO MISSILES FROM ENEMY FIGHTER

AIRCRAFT

Causes of Casualties

In the present survey, 50 battle casualties (4.5 percent) were known to

be due to missiles fired from enemy aircraft. Their distribution according

to missile (figs. 284, 285, and 286) and type of casualty is shown in table 218.

Cannon shells (20 nmm.) accounted for 88 percent of the casualties.

WRAMC-4859-AIO

FIGURE 284.-Primary missiles (7.92 mm.). The top specimen is the steel core of an

armor-piercing 7.92 mm. Mauser bullet. The fragments in the bottom group are from the

jacket of the same type of bullet.

TABLE 218.-Distribution of 50 aircrew battle casualties, by category and by missile fired

from enemny aircraft

Category Total casualties Missile

IVIA KIA Number Percent

Numrber Number

20 mm --------------------------------- 37 7 44 88

13 mm --------------------------------- _ 3- 1 4 8

7.92 mm -------------------------------- 2 2 4

Total ---------------------------- 42 8 50 100
BATTLE CASUALTIES, EIGHTH AIR FORCE 595

WRAM C-4859-A6

FIGURE 285.-Primary missiles (13 mm.). Each fragment or group of fragments was

found in fatal wounds of aircrew personnel. The two on the left are from armor-piercing

and the two on the right are from high explosive shells. The 13 mm. cannon shell was the

smallest caliber missile in which a high explosive charge was used.

Distribution of Casualties According to Combat Position

Table 219 shows the distribution of the 50 casualties according to combat

position. Although the number of casualties is quite small, it may be noted

that, as in the case of casualties due to flak, the waist gunner appears to be the

man most vulnerable to fighter attack. This is at least partially accounted for

by the fact that two waist gunners were frequently carried in heavy bombers.

The tail gunner is probably most vulnerable to fighter attack. This is in

agreement with the findings of the Eighth Air Force Operational Research

Section that the greatest directional density of hits on heavy bombers by

enemy cannon and machineguns is from dead astern.

TABLE 219.-Distribution of 50 aircrew casualties due to missiles fired from fighter aircraft, by

category and combat position

Category

Combat position

WIA KIA

Number Number

Pilot ---------------------------------------------------. 2 1

Copilot -------------------------------------------------- 44 --

Navigator ------------------------------------------------- 2----2

Bombardier -

Radio operator ------------------------------------------- 7 2

Waist gunner -------------------------------------------- 11 2

Ball turret gunner ------------------------------------------ --- 5

Top turret gunner ---------------------------------------- 3 1

Tail gunner ---------------------------------------------- 8 2

Total ---------------------------------------------- 42 8
596 WOUND BALLISTICS

S~C

WRAMC-4859-AF

FIGURE 286.-Primary missiles (20 mm.). Each fragment or group of fragments

caused, and was found in, a fatal wound of aircrew personnel. All except the bottom group

were from high explosive shells. The bottom specimen has been reconstructed from the

retained fragments found in a through-and-through fatal wound produced by a 20 mm.

armor-piercing incendiary cannon shell. The shell broke up in the wound as the result of

its having perforated a flak suit worn by the casualty. Plates and fragments of the man's

body armor were also found in the wound.

It is apparent from the distribution of casualties in table 219 that bombardiers and navigators were least likely to be casualties from enemy fighter attack.

This might be expected on the basis that enemy fighters are least likely to attack

the nose of an aircraft from the front. The low incidence of casualties due to

missiles from fighter aircraft as compared with the high incidence due to flak

for the bombardier and navigator positions substantiates the finding that these

positions are susceptible to an increased density of flak hits because of their

leading and exposed positions with respect to the rest of the aircraft.

Regional Distribution of Wounds Due to Missiles From Enemy

Fighter Aircraft

Table 220 shows the distribution of 83 wounds in 50 casualties struck by

missiles fired from enemy fighter aircraft. The wound distribution in this
BATTLE CASUALTIES, EIGHTH AIR FORCE 597

group of casualties differs from that in flak and other missile casualties in that

there is an increase in the occurrence of wounds of the vital regions of the body.

Less than 25 percent of flak wounds occurred in the head and trunk regions as

compared with an incidence of 35 percent for head and trunk wounds due to

missiles from enemy fighter aircraft.

TA13LE 220.-Distribution of 83 wounds in 50 aircrew battle casualties due to missiles fired from

fighter aircraft, by category of casualty and anatomic location (regional frequency) of wounds

WIA casualties KlA casualties Total casualties

Anatomic location Number of Percent Number of Percent Number of Percent

wounds wounds wounds

Head -------------------------- 13 19 6 38 19 23

Chest ------------------------- 3 5 3 19 6 7

Abdomen --------------------- 2 3 2 12 4 5

Extremities:

Upper --------------------- 20 30 3 19 23 28

Lower --------------------- 29 43 2 12 31 37

Total -------------------- 67 100 16 100 83 100

Single and Multiple Wounds Due to Missiles From Enemy

Fighter Aircraft

Table 221 shows the frequency with which one and more than one region of

the body was wounded by missiles fired from enemy fighter aircraft in the 50

casualties. The increased multiplicity and severity of wounds in this group of

casualties may be compared with those sustained by casualties due to all missiles (table 186) and flak casualties (table 201). In both of the latter, only 15

TABLE 221-Distribution of 50 aircrew battle casualties due to missiles fired from fighter aircraft,

by category and number of regions wounded

WIA casualties KIA casualties Total casualties

Regions wounded

Number Percent Number Percent Number Percent

Number:

1 -------------------------- 25 59. 5 4 50.0 29 58.0

2 -------------------------- 10 23.8 1 12.5 11 22.0

3 ------------------------- 6 14.3 2 25.0 8 16.0

4 ------------------------- 1 2.4 1 12.5 2 4.0

Total -------------------- 42 100.0 8 100.0 50 100.0
598 WOUND BALLISTICS

percent were wounded in more than one region as compared with 42 percent of

casualties wounded in more than one region due to missiles from enemy fighter

aircraft.

Altitude at Which Casualties Sustained Wounds

The altitude at which 27 of the 50 (54 percent) casualties sustained wounds

was known. Table 222 shows distribution of the casualties and the type of

aircraft in which they were wounded.

There are no significant variations in the distribution of B-17 casualties

according to altitude. Of 5 B-24 casualties, 4 were wounded or killed below

22,000 feet. This is in agreement with the observations made pertaining to the

altitude at which casualties due to flak were sustained; namely, that B-24 aircraft usually operated at a lower altitude than B-17 aircraft.

The difference in the occurrence of casualties in the two types of aircraft is

marked (76 percent in B-17's and 24 percent in B-24's). However, the frequency with which B-17's and B-24's were attacked by enemy fighter aircraft

is not known. Thus, the relationship between fighter damage to aircraft and

the occurrence of casualties was not determined, and an evaluation of the significance of the difference in the occurrence of casualties in the two types of aircraft could not be made.

TABLE 222.-Distribution of 50 aircrew battle casualties (38 in B-17's; 12 in B-24's)

due to missiles fired from enemy fighter aircraft, by altitude

Casualties in B-17's Casualties in 1-24's

Altitude in feet

1v IA R IA Total WIA 1IA Total

Above 26,000 feet __-------_ 1 ---------- 1 ----------------.--------

24,001 to 26,000 feet ------------ 7 1 8 ........................

22,001 to 24,000 feet ------------- 1 2 3 1 -------- 1

20,001 to 22,000 feet ------------- 2 - - 2 - - 1

18,001 to 20,000 feet ------------- 7 ------- 7 1 1 2

Below 18,000 feet - -------- 1 1 1 -------- 1

Unknown ---------------------- 14 2 16 6 1 7

Total ------------------- 33 5 38 9 3 12

KIA CASUALTIES-JUNE THROUGH NOVEMBER 1944

During the 6 months from June through November 1944, the bodies of

164 KIA battle casualties from the Eighth Air Force and Ninth Air Force and

Troop Carrier Command were examined in the laboratory of the Medical ORS.
BATTLE CASUALTIES, EIGHTH AIR FORCE 599

During the last 2/k2 months of the survey period, the Office of the Surgeon,

USSTAF, provided additional facilities and personnel to aid the ORS in the

examinations.'

Causes of the Fatalities

The missiles causing fatal wounds in 164 casualties are shown in table 223.

The proportion of fatalities due to flak (87.8 percent) is approximately the same

as the incidence of all aircrew battle casualties due to flak (86.2 percent).

TABLE 223.-Distribution of 164 KIA aircrew casualties, by missile

Casualties

Missile

Number Percent

Flak ---------------------------------------------------- 144 87.8

From fighter aircraft_ -------------------------------------- 10 6. 1

Secondary ----------------------------------------------- 4 2. 4

"Unknown ----------------------------------------------- 6 3. 7

Total --------------------------------------------- 164 100.0

1 Of these, 8 casualties were due to 20 mm. missiles and 1 each to 13 mum. and 7.92 mm. missiles.

Distribution of KIA Casualties According to Combat Position

Table 224 shows the distribution of 164 KIA casualties according to combat

position. The positions of KIA casualties of the Ninth Air Force and Troop

Carrier Command not accounted for in heavy bombers are included under

"Position unknown." The occurrence of fatal casualties and thus the case

fatality rates for casualties in any combat position do not appear to differ significantly except as previously noted in table 184.

Regional Distribution of Wounds

Table 225 shows the regional distribution of all entrance wounds due to all

missiles in this larger sample of 164 KIA battle casualties. The distribution of

wounds in the different body regions is not appreciably different from that of

the smaller sample of 110 KIA casualties described previously in table 185.

Regional Frequency of Wounds

Table 226 shows the regional frequency of wounds in the larger sample of

KIA casualties.

8 From the examination of the casualties referred to in this section, complete data pertaining to the morbid anatomy,

histopathology, arteiiography, and X-ray appearance of fatal wounds were compiled. Lack of space, however, precludes

inclusion of this information on the 164 casualties examined. Another report on these casualties is also contained in AAF

Memorandum Report, TSEAL-3697-7B, 1945, by I. B. Htickam, Aero Medical Laboratory, Wright Field, Ohio.
coo WOUND DALLISTICS

TABLE 224.-Distribution of 164 KIA aircrew casualties, by combat position

Casualties Position____________________

Number Percent

Pilot ---------------------------------------------------- -- 9 5. 5

Copilot ------------------------------------------------- 10 6. 1

Navigator ----------------------------------------------- 20 12. 2

Bombardier --------------------------------------------- 22 13. 4

Radio operator ------------------------------------------ 17 10. 4

Waist gunner -------------------------------------------- 32 19. 5

Ball turret gunner ---------------------------------------- 7 4. 2

Top turret gunner ---------------------------------------- 10 6. 1

Tail gunner --------------------------------------------- 28 17. 1

Unknown- ----------------------------------------------- 9 5. 5

Total ---------------------------------------------- 164 100.0

TABLE 225.-Distribution of 451 wounds in 164 KIA aircrew casualties due to all missiles

by anatomic location

Wounds

Anatomic location

Number Percent

Head ---------------------------------------------------- 105 23. 3

Thorax -------------------------------------------------- 58 12. 9

Abdomen ------------------------------------------------ 32 7. 1

Extremities:

Upper ----------------------------------------------- 145 32. 1

Lower ---------------------------------------------- 111 24. 6

Total ------------------------------------------ 451 100. 0

TABLE 226.-Distribution of 164 KIA casualties due to all missiles, by anatomic location

(regional frequency) of wounds

Casualties

Anatomic location I -_ Casualties

Number Percent

Head ---------------------------------------------------- 50 30. 5

Chest ---------------------------------------------------- 16 9. 8

Abdomen ----------------------------------------------- 3 1. 8

Extremities:

Upper ---------------------------------------------------------- 0

Lower ----------------------------------------------- 11 6. 7

Multiple regions ------------------------------------------ 84 51. 2

Total ---------------------------------------------- 164 100.0
BATTLE CASUALTIES, EIGHTH AIR FORCE 601

Comparison of tables 225 and 226 reveals again that the differences in

the regional incidence of wounds by the two methods of tabulation, that is,

wounds versus casualties, are quite marked. These differences are characteristic of all samples of KIA casualties and as stated before are due primarily

to the high incidence of multiple wounds in the dead.

Single and Multiple Wounds

Table 227 shows the incidence of single and multiple wounds in KIA

casualties. The KIA casualties were struck in more than one region four

times as often as the WIA casualties. In the 3 months' survey of all casualties

as discussed earlier in this chapter, multiple wounds were more than three

times as frequent in KIA as in WIA casualties (39.0 percent in the KIA as

compared with 12.2 percent in the WIA). The incidence of multiple regions

wounded in this larger sample of KIA casualties (includes 89 of the 110 KIA

from the smaller sample) was 50.0 percent. The increased number of multiple

wounds in the larger sample was most marked in about half of the sample;

that is, those casualties sustained during September, October, and November

1944. Such a significant increase, which would be even more marked if the

incidence of multiple wounds for the first 3 months were to be compared

separately with that for the second 3 months, may be regarded as being due

to the increased use of higher burst velocity shells by the enemy.

TABLE 227.-Distribution of 164 KIA aircrew battle casualties, by single and multiple regions

wounded

Number of regions wounded Number of Percent of

casualties casualties

1 ------------------------------------------------------- 82 50. 0

2 ------------------------------------------------------- 49 29.9

3 -------------------------------------------------------- 22 13.4

4 -------------------------------------------------------- 7 4.3

5 ------------------------------------------------------- 4 2.4

Total ---------------------------------------------- 164 100.0

Incidence of Fractures in KIA Casualties

Table 228 shows the distribution of 265 fractures according to body

regions. Of the fractures in KIA casualties, 72.9 percent were associated with

wounds of the vital areas of the head and trunk regions as compared with

14.3 percent in WIA casualties (table 189).

The 91 percent incidence of fractures in KIA casualties (in 149 of the

164) reported here as compared with 85.3 percent reported for the smaller

sample (87 of the 102) may be explained by the increased multiplicity of

wounds in the larger sample.
602 WO'UND BALLISTICS

TABLE 228.-Distrib tion of 265 fractures in 14+9 KIA aircrew battle casualties due to all

missiles, by anatomic location

Anatomic location Number of Percent of

fractures fractures

Head ---------------------------------------------------- 102 38. 5

Chest --------------------------------------------------- 86 32. 5

Abdomen ------------------------------------------------ 5 1. 9

Extremities:

Upper ----------------------------------------------- 34 12. 8

Lower ----------------------------------------------- 38 14. 3

Total ---------------------------------------------- 265 100. 0

Causes of Death in KIA Battle Casualties Due to All Missiles

Table 229 shows the regional distribution of wounds which were the

causes of death in 164 KIA casualties. There were 11 casualties in which

either of 2 hits could have been fatal and 2 casualties in which any 1 of 3 hits

could have been fatal. However, for this tabulation, the following criteria

were followed in order to determine the primary fatal wound:

1. Only the severest one of multiple fatal wounds was regarded as the

cause of death in any one casualty.

2. When the severity of a head and a chest or abdominal wound appeared

to be the same, the cause of death was arbitrarily attributed to the head wound.

3. When the severity of a chest and an abdominal wound appeared to be

the same, the cause of death was attributed to the chest wound.

4. Decapitations were regarded as causes of death due to wounds in the

head-and-neck region in cases where the head was missing as well as in other

cases where a head wound was very extensive and associated with complete

evulsion of the brain.

TA1LE 229.-Distribution of 164 aircrew battle casualties due to all missiles, by anatomic

location in which the primary fatal wound occurred

Anatomic location Number of Percent of casualties casualties

Head ---------------------------------------------------- 74 45. 1

Chest --------------------------------------------------- 63 38.4

Abdomen ------------------------------------------------ 12 7.4

Extremities:

Upper ----------------------------------------------------------- 0

Lower ---------------------------------------------- 15 9. 1

Total ---------------------------------------------- 164 100. 0
BATTLE CASUALTIES, EIGHTH AIR FORCE 603

TABLE 230.-Distribution of 164 KIA aircrew battle casualties due to all missiles, by

anatomic location and type of fatal wound

Anatomic location and type of wound Number of Percent of

casualties casualties

Head:

Penetration ----------------------------------------- 65 39. 6

Decapitation ---------------------------------------- 7 4.3

Fracture, without penetration -------------------------- 2 1. 2

Total --------------------------------------------- 74 45. 1

Thorax:

Penetration ----------------------------------------- 60 36. 6

Mutilation ------------------------------------------ 3 1.8

Total --------------------------------------------- 63 38.4

Abdomen, penetration ------------------------------------ 12 7. 4

Lower extremity:

Perforation --------------------------------------- 11 6. 7

Traumatic amputation -------------------------------- 4 2. 4

Total --------------------------------------------- 27 16. 5

Grand total --------------------------------------- 164 100. 0

5. In the case of extensive mutilating wounds, the cause of death was

attributed to a wound of the region of the body nearest the center of the area

of tnutilation.

Table 230 gives the breakdown of cause of death data. Figures 287, 288,

289, 290, 291, and 292 depict typical examples of fatal wounds in aircrew

casualties.

SUMMARY AND CONCLUSIONS

The survey of aircrew casualties presented here covers a period of 3

months of operational missions carried out by heavy bombers of the Eighth

Air Force (D-5 to D±86). A survey of KIA casualties was continued for

a further 3 months and was extended to include casualties from the Ninth

Air Force and Troop Carrier Command. A total of 69,682 heavy bomber

sorties (39,724 by B-17's and 29,958 by B-24's) was credited during the 3

months' period. This represents 657,096 man-combat missions completed

of which 357,516 were in B-17's and 299,580 were in B-24's. During the

period, 693 heavy bombers (390 B-17's and 303 B-24's) were reported "Missing-in-Action." Thus, casualty data pertaining to 6,540 (1.00 percent)
604 WOUND BALLISTICS

loC D

U.S. Army photos

FIGURE 287.-Radio operator in B-17 aircraft. Typical example of fatal wound in

the neck region caused by large low-velocity flak fragment. A. Wound of entrance 1.5 x 4.2 cm. B. Bruised areas overlying flak fragment. C. Flak fragment in larynx. D.

Flak fragment 47.30 grams.
BATTLE CASUALTIES, EIGHTH AIR FORCE 605

T

U.S. Army photos

FIGURE 288.-Waist gunner in B-17 aircraft. Example of through-and-through fatal

wound produced by high-velocity flak fragment. A. Wound of entrance, right (4 x 4 cm.),

and wound of exit, left (4 x 7 cm.). B. Missile track laid open showing extensive mutilation

of thoracic cage. C. Thoracic viscera showing widespread damage to lungs and posterior

mediastinum.
606 WOUND BALLISTICS

A8

U.S. At-my photos

FiGURE 289.-Radio operator in B-17 aircraft. Example of a fatal wound of the

unprotected flank and extending into the chest, produced by a large low-velocity flak

fragment. A. Entrance wound 5.5 x 14.7 cm. B. Damage to abdominal organs. C. Extensive laceration of heart with missile in situ. D. Flak fragment 83.66 grams.

officers and enlisted men were not available. Casualty data were available

and studied on the 99 percent of aircraft and personnel that successfully

completed and returned from 68,989 sorties or 650,556 man-combat mlissions.

There were 1,117 known battle casualties sustained by the Eighth Air Force

during the 3 months of the survey of whom 110 had been killed and 1,007

wounded as a result of enemy gunfire. The 1,117 casualties represent an

overall casualty rate of 0.172 percent (1.72 percent per 1,000 man-combat

missions completed). When distributed according to types of aircraft, the

casualty rates in B-17's and B-24's were 2.10 and 1.26 per 1,000 man-combat

missions, respectively. The case fatality rate was 9.8 percent and did net

differ significantly for casualties in the two types of aircraft.

The ratio of MIA personnel to known casualties was approximately 6

to 1. The data pertaining to casualties among MIA personnel, could they have

been included in the study, might have materially influenced the observations

that have been made. Of airerew personnel, 1 percent (10.1 per 1,000 mancombat missions) were kniown to be missing in action. The incidence of MIA
BATTLE CASUALTIES, EIGHTH AIR FORCE 607

4:4

U.S. Army photos

FIGURE 290.-Navigator in B-17 aircraft. Example of fatal cranial wound due to unexploded 88 mm. higher explosive antiaircraft shell. A. Entrance hole in the nose of a B-17

aircraft of an unexploded 88 mm. high explosive antiaircraft shell. B. Fatal wound of the

head produced by unexploded 88 mm. shell as it passed through the nose of a B-17 aircraft.

aircraft and personnel for the two types of bombers did not differ significantly.

Flak fragments caused 86.2 percent of the casualties. Since 7.8 percent

of the casualties were due to secondary missiles, that is, those set in motion

usually by flak, 94 percent of all the casualties studied may be regarded as

being due to flak. Of the total casualties, 4.5 percent were caused by missiles

from enemy fighter aircraft and the remaining 1.5 percent were caused by

unidentified missiles.

The incidence of multiple wounds in KIA casualties during the first 3

months of the survey was 39.1 percent. This incidence increased to 50.0

percent when the KIA casualties examined during the second 3 months were

included in an analysis of all KIA casualties. The increase in the multiplicity
608 WOUND BALLISTICS

i/

U.S. Army photos

FIGURE 291.-Radio operator in B-17 aircraft. Typical example of fatal wound in

axillary region caused by flak fragment. A. Wound of entrance 3 x 3.6 cm. B. Wound

of exit 1.5 x 2 centimeters.

of wounds may be regarded as evidence of an increase in the use of higher burst

velocity shells by the enemy. Further evidence of this is given when a comparison is made of the incidence of fractures in the two samples of KIA casualties. During the first 3 months, the incidence of fractures was 85.3 percent,

whereas for the 6 months the incidence of fractures increased to 91 percent.

The severity of wounds sustained by aircrew battle casualties was evaluated

on the basis of time lost from flying status. The period of observation after

injury was limited to 90 days. Of the total number of casualties (including

the KIA), 33.8 percent were permanently lost from flying status. Of the

WIA casualties, 9.8 percent lost a day or less from flying status, 25.4 percent
BATTLE CASUALTIES, EIGHTH AIR FORCE 609

B

C D ULS. Army photos

FIGURE 292.-Pilot of B-24 aircraft. A. Wound of entrance 8.4 x 13.2 cm. B.

Multiple wounds of exit. C. Partial reconstruction of a 20 mm. armor-piercing incendiary

cannon shell from retained fragments, 75.46 gin. D. Pieces of body armor and other personal

equipment in fatal wound.

lost a week or less, 55.9 percent lost a month or less, and 17.5 percent lost from

1 to 3 months.

Approximately 70 percent of the casualties in B-17's occurred at an altitude of 24,000 feet or above, whereas 92 percent in B-24's occurred at 23,000

feet or below.

Of all WIA aircrew battle casualties, 90 percent received adequate surgical

treatment in hospitals within 4 hours after they were wounded.

Since by far the majority of casualties was caused by flak, an independent

analysis of all flak casualties was made. Their distribution according to combat

position is shown in the order of frequency (table 231). Heavy bomber aircraft formerly carried two waist gunners, which probably accounts for the

highest incidence of casualties in that combat position. The lowest incidence

of casualties in the ball turret gunner's position is at least partially due to the

fact that only B-17 aircraft carry a ball turret gunner.
610 WOUND BALLISTICS

No fragments smaller than 1 gm. were recovered from fatal wounds due to

flak in KIA casualties; 92.6 percent of those recovered weighed 5 gin. or more.

In WIA casualties, 39.1 percent of the fragments weighed less than 1 gram.

Plexiglas fragments set in motion by other missiles produced 88 wounds;

of these 85 were on the exposed regions of the face and neck and 3 were on the

forearms. There were no Plexiglas wound fatalities. Of those wounded by

Plexiglas fragments, 92 percent were returned to flying duty within 90 days. it

would appear that protection of the eyes and circumorbital regions with any

relatively thin, shatterproof, transparent material would probably have eliminated most casualties due to Plexiglas fragments.

TABLE 231.-Distribution of flak casualties sustained according to combat position, in order of

frequency

Position of- Order of frequency

WIA casualty ITA casualty

1 Waist gunner ----------------- Waist gunner.

2 Bombardier ------------------- Tail gunner.

3 Navigator -------------------- Bombardier.

4 Tail gunner ------------------- Navigator.

5 Radio operator ---------------- Top turret gunner.

6 Top turret gunner ------------- Radio operator.

7 Pilot ------------------------- Pilot.

8 Copilot ---------------------- Ball turret gunner.

9 Ball turret gunner ------------- Copilot.

Of the casualties due to missiles from fighter aircraft, 88 percent were

produced by 20 mm. shells. The tail gunner was found to be the most vulnerable combat position, while bombardier and navigator were the least vulnerable

to enemy fighter aircraft. This is the reverse of the relative vulnerability of

the same combat positions to flak and is in accordance with the findings of the

Operational Research Section, Eighth Air Force, that enemy fighter aircraft

usually attack heavy bombers from the rear.

A comparison is made of the regional distribution of wounds in flak casualties with and without protective body armor. From table 232, it may be

seen that the incidence of flak wounds of the trunk has fallen from 13.3 percent

in unarmored casualties to 8.2 percent (38 percent decrease) in casualties wearing body armor. It is apparent that the thoracic and abdominal regions have

been protected by the wearing of body armor. It has been observed that the

neck and axillary regions are the most highly vulnerable to penetration by

enemy missiles on men wearing body armor.
BATTLE CASUALTIES, EIGHTH AIR FORCE 611

The separation of casualties into "unarmored" and "armored" in table

232 does not hold so far as the occurrence of wounds of the head is concerned.

Data pertaining to the protective value of head armor (steel helmet) were not

sufficient to evaluate statistically.

TABLE 232.-Mean projected body areas and regional distribution of flak wounds in unarmored

and armored battle casualties

Mean projected Wounds in Wounds in

Region area of region unarmored armored

casualties casualties

Percent Percent Percent

Head -------------------------------------- 12 16. 1 16. 1

Chest 16 9. 8 5. 5

Chest -------------------------------------- 19.855

Abdomen ----------------------------------- 11 3. 5 2. 7

Extremities:

Upper ---------------------------------- 22 26. 4 32. 5

Lower ---------------------------------- 39 44. 2 43. 2

Total -------------------------------- 100 100.0 100.0
CHAPTER X

Directional Density of Flak Fragments and

Burst Patterns at High Altitudes1

Allan Palmer, M.D.

GERMAN 88 MM. HIGH EXPLOSIVE ANTIAIRCRAFT SHELL

The material in this chapter was obtained at the same time that a survey

of missile casualties was being conducted by the Medical Operational Research

Section, Professional Services Division, Office of the Chief Surgeon, ETOUSA

(p. 547). The survey covered all of the battle casualties sustained by the

Eighth Air Force during a 6 months' period beginning on I June 1944. More

than 99 percent of the flak fragments recovered during the survey were probably

from German 88 mm. HEAA (high explosive antiaircraft) shells. Only two

fragments observed were definitely identifiable as fragments from shells larger

than 88 mm. Because of this, a discussion of German ammunition will be

limited to the 88 mm. shell.

Details of the structure of the shell are contained in USSTAF Ordnance

Memorandum No. 5-6, 29 March 1944, and are shown in figure 293. The

filled weight of the shell is about 21% pounds, the average weight of the filling

is approximately 2 pounds, and the charge-weight ratio is 8.6 percent. The

body of the shell which gives rise to the majority of the fragments is composed

of 0.72 percent carbon steel and its wall averages nine-sixteenths of an inch in

thickiess. The mean burst velocity of fragments observed in trials carried

out at Millersford was 2,280 f.p.s. The velocity of the projectile at the instant

of burst at the altitude at which the shell is fired at heavy bomber aircraft is

estimated to range from 1,000 to 2,000 f.p.s., being greatest when the angle of

fire is nearest vertical and lowest the more the angle of fire deviates from the

vertical.

In order to bring out certain points with respect to the flak risk run by

aircrew personnel, it is necessary to consider certain elementary facts relating

to the manner in which the shell wall breaks up into fragments. For the sake

of simplicity, certain properties of the static burst of a completely spherical

projectile breaking up over its entire surface into fragments of uniform weight

and size, all traveling at the same velocity, will be considered.

I The mathematical treatment of the data in this report was provided by the combined efforts of Prof. Sir

Ronald A. Fisher, Sc. D., F.R.S., Department of Genetics, University of Cambridge, Cambridge, England, and Prof.

F. Yates, Sc. D., F.R.S., Department of Statistics, Rothamsted Experimental Station, Harpenden, Herts, England.

613
614 WOUND BALLISTICS

ADAPTOR TO DD/L/15371

FUZE TO DD/L/12820 - REPRESENTING FUZE NO.241

ANNULAR LEATHER WASHER

TRACING CLOTH DISC

GERMAN GAINE 23 MM.

DIA. X 75 MM. LONG

STEEL CONTAINER

CARD DISC

-BI-METAL DRIVING BANDS

WRAM C-4829-A7

FIGURE 293.-Structure of German 88 mm. HEAA shell.

Considering the distribution of fragments from such a projectile after

they had traveled, say, 100 feet from the point of burst, would amount to

considering the distribution of fragments in a sphere whose radius was 100 feet.

Since the projectile broke up uniformly, the relative density of fragmentsthat is, the number of fragments per unit area on the surface of the spherewould be the same all over the sphere. Since, however, the annular bands

subtended on the surface of the sphere, per unit angle at its center with respect

to the equatorial plane, decrease in area as one proceeds from the "equator"

to its "north or south pole," the number of fragments in each annulus will

decrease accordingly in spite of the fact that the density per unit surface area

remains the same. This is shown in table 233 and figure 294. Column 1 of

the table lists the annular zones with respect to the equatorial plane in 30'

bands. Column 2 indicates the percent of fragments which will be found in

successive annular zones on the surface of the sphere, if the boundary of each

of these zones subtends an angle of 30' at the center of the sphere. Column 3

is merely a statement that the density per unit area on the surface of the sphere

is constant.
FLAK FRAGMENTS AND BURST PATTERNS 615

DIRECTIONAL FRAGMENTATION DENSITY

ZONE DENSITY IS EXPECTED FRAGMENTS PER ANNULAR ZONE

CONSTANT (PER CENT

(D) (A)

+90 ..... .... 6......

±60 TO +30------

+30 OT 0 25.0

0 TO -30 2.

-30 TO -60 -----.....

-60 TO -90 18.3

S.. ... .. .. .. .. .. 6 .7

PROJECTED SURFACE AREAS OF ANNULAR ZONES

SPHERICAL

BURST

NOTE

THE SURFACE AREA OF THE ANNULAR ZONE (SHOWN SHADED)

EXPRESSED AS PER CENT OF

THE SURFACE AREA OF A

SPHERE;

sin/3 - sino( 2 xlO00

WRAMC-4829-A13

FIcURE 294.-Diagrammatic representation of directional fragmentation density of a

spherical burst.

TABLE 233.-Directional fragmentation densities for a static spherical burst

(1) (2) (3)

Annular zone (with respect to Expected fragments per annular zone Density per area on surface equatorial plane) (percent) (n) and (A) of sphere (D)

Degree

90 to 60 6. 7 1

60 to 30 18. 3 1

30 to 0 25. 0 1

0 to -30 25. 0 1

-30 to -60 18. 3 1

-60 to -90 6. 7 1
616 WOUND BALLISTICS

These figures provide a basis for standardizing values for fragmentation

density for shells of different types in different zones around the burst. Such

standardized values will be referred to in the following paragraphs as "directional fragmentation densities."

In actual fact, the concept of a spherical burst is entirely theoretical.

Antiaircraft shells are not spherical, and their fragments are dispersed from

the bursting projectiles in annular zones of varying density. This is shown in

tables 234, 235, and 236 and in figure 295 which give the results of certain

A B

C

WRAMC-4829-A28, A15, A8

FIGURE 295.-Directional fragmentation density. A. 88 rmm. shellburst (static, nose.

down; density in shaded zones not observed). B. 90 mm. shellburst (static, nose up)

C. 90 ram. shellburst (moving vertically 2,000 f.p.s.).

trials in which AA shells were detonated experimentally in such a way that it

was possible to measure the number of fragments in different annular zones

with respect to the equatorial plane of the shell (that is, the equatorial plane

being at right angles to the axis of the shell and cutting through its center).

Figure 294, constructed from the data in table 233, may be regarded

as the diagrammatic representation of a spherical burst from which there

is a uniform distribution of fragments and for which the relative directional

fragmentation densities (D) are the same. The values of 1 for the densities

in all directions are shown by the constant length of the radii of the circle

(representing a sphere) in zones of 30 with respect to the equatorial plane.

The values under A (column 2 of table 233) are those areas of the annular

bands expressed in percentages of the total area of the sphere, subtended
FLAK FRAGMENTS AND BURST PATTERNS 617

by 300 angles at its center with respect to the equatorial plane. These areas

are projected in figure 294.

Consider next a variation from a spherical burst. For example, a value

of 5 in column 3 of table 233 for a given annular zone would mean a density

of fragments per unit area on the surface of the sphere relatively five times

as great as would be expected for a spherical burst. The fivefold increase

in this zone would involve relative decreases in densities in other zones. The

values for directional fragmentation density as used are representations of

densities per unit solid angle. Because of the lack of complete fragmentation

data for any of the burst patterns to be discussed, a relative value as opposed

to an absolute value is desirable.

Fragmentation trials on three rounds of the German 88 mm. HEAA

shell were conducted at Millersford. 2 The shells were set up vertically, nose

down, 5 feet above the ground. For each detonation, two sets of three strawboard panels, 10 feet high by 40 and 60 inches wide, were placed vertically

5 feet and 10 feet from the shell and so staggered that they did not overlap

each other. For each trial, the number of strikes was counted on the panels

in such a way as to separate the strikes that occurred at 10-inch intervals

above and below the equatorial plane of the center of the shell. Column

1 of table 234 indicates those zones in inches. Column 2 specifies those zones

in terms of the angle each subtended at the center of the shell. Columns

3 and 4 show the number and percent of fragments observed in each zone.

TABLE 234.-Directional fragmentation densities of German 88 mn. HEAA shell

(1) (2) (3) (4) (5) (6)

Percent (n) of Corresponding Density

Zone Angle subtended Number of frag- fragments ob- values for spher- a

by 10-inch zone ments observed served ical burst (per- DA

cent) (A)

Inches

50 to 60 5012' 24 2.0 3. 3 0. 6

40 to 50 607f 46 3. 8 4. 3 . 9

30 to 40 707f 80 6. 5 5. 3 1. 2

20 to 30 808, 33 2. 7 6. 5 .4

10 to 20 8058' 37 3. 1 7. 6 .4

0 to 10 90281 495 40. 4 8. 3 4. 9

-l10 to 0 90281 253 20. 5 8. 3 2. 5

-20 to -10 8'581 63 5. 1 7. 6 7

-30 to -- 20 808I 54 4. 4 6. 5 7

-40 to -30 7071 61 4. 9 5. 3 .9

-50 to -40 607' 54 4. 5 4. 3 1. 1

-- 60 to -50 50121 21 2. 1 3. 3 .6

9000, 1, 221 100. 0 70. 6

NOTE.-Table, based on data obtained at Millersford trials, shows conversion of fragment distribution in 10-inch

zones at 5 feet detonation distance into relative directional densities.

2 Armament Research Department Explosives Report 224/43, October 1943.

603225v-,62 -41
618 WOUND BALLISTICS

A value for directional fragmentation density in any zone may be obtained from the equation

A

in which n is the number of fragments observed in the zone, expressed as the

percentage of the total number of fragments observed, and A is the area of

the annular band on the surface of a sphere subtended by an angle at its

center, expressed as the percentage of the total surface area of a sphere.

Values for A may be obtained from the equation entered as a note in figure

294.

It should be emphasized that figure 294 is a two-dimensional drawing

representing a three-dimensional burst pattern. Thus, the radius in figure

294 that deviates 30' from the vertical would describe a relatively small

cone subtending the "north polar" surface of a sphere, whereas the radius

that makes a 30' angle with the equatorial plane would describe an annular

zone on the surface of a sphere comparable to the northern half of the Torrid

Zone on the surface of the earth.

In the Millersford trials, no observations were made about the densities

of fragments projected upward from the base and downward from the nose

of the shell. If the burst is regarded as a spherical projection of fragments

from the center of the projectile, the unobserved zones (shaded in fig. 295A)

above and below the 900 zone, in which observations on fragmentation were

not made, account for 29.4 percent of the surface area of the sphere. The

1,221 fragments noted in table 234, while they represent 100 percent of the

observed number of fragments dispersed by an 88 mm. shell, were dispersed

in directions which represent only 70.6 percent of what would be expected

for a spherical burst (column 5 of table 234). Previous experience has shown

that the number of fragments dispersed upward and downward in the unobserved zones in similar experiments is negligible.

Figure 295A shows for comparison with a spherical burst (fig. 294) the

burst pattern of a nose-down 88 mm. shell detonated statically. It is pointed

out again that the lengths of the lines or radii from the point of burst (D,

column 6 in table 234) are measures of relative directional fragmentation

densities.

A report by the Operational Analysis Section, Mediterranean Allied Air

Forces I gives the observed data pertaining to fragment distribution from a

statically detonated, nose-up, U.S. 90 mm. HE shell. Tables 235 and 236

are similar to table 234 except that the annular zones in which fragments were

counted are specified only by the angles by which they are subtended at the

center of the burst (column 1).

3 Report, Operational Analysis Section, Mediterranean Allied Air Force, subject: The Physical Basis for Evasive

Action to Reduce Flak Losses, May 1944.
FLAK FRAGMENTS AND BURST PATTERNS 619

TABLE 235.-Directional fragmentation densities for U.S. 90 mm. shell, static burst

(1) (2) (3) (4) (5)

Zone (with respect to the Number of frag- Percent (n) of frag- Corresponding Density

equatorial plane) ments observed ments observed values for spherical D=n

burst (percent) (A) A

- 90' to -- 20' 0 0 32. 90 0

-- 20' to -5' 441 50. 9 12. 74 3. 95

-5° to 100 300 34. 6 13. 04 2. 66

10' to 20' 39 4. 5 8. 42 .54

20' to 40' 40 4. 6 15. 04 .31

40' to 60' 20 2. 3 11. 16 .21

60' to 70' 7 . 8 3. 68 .22

70' to 80' 10 1.2 2.25 .53

80' to 85' 7 .8 .57 1.40

85° to 90' 3 .3 .19 1.58

867 100. 0 100. 0

TABLE 236.-Directional fragmentation densities for U.S. 90 mm. HE shell, moving burst,

2,000 f.p.s. vertically

(1) (2) (3) (4) (5)

Zone (w th respect to the Number of frag- Percent (n) of frag- Corresponding Density

equatorial plane) ments observed ments observed values for spherical D=

burst (percent) (A)A

90' to 25'59' 0 0 71. 90 0

25°59' to 350351 441 50. 9 7. 20 7. 07

35035' to 44'40' 300 34. 6 6. 06 4. 03

44040' to 50033' 39 4. 5 3. 46 1. 30

50'33' to 62002' 40 4. 6 5. 55 .83

62'02' to 730181 20 2. 3 3. 73 .62

73018' to 780581 7 .8 1. 18 .68

78058' to 840271 10 1.2 .69 1. 74

84027' to 87013' 7 . 8 . 17 4. 70

87013' to 90000' 3 .3 .06 5. 00

867 100. 0 100. 0

The divergence of the burst pattern of a shell from the burst pattern of a

theoretical spherical projectile can easily be demonstrated if one first calculates the percent of all fragments which would be expected in the area of each

annular zone of a sphere which would be subtended by the angles indicated

in column 2 of table 234 and colunm 1 of tables 235 and 236. These percentages are determined in the same way as those calculated for column 2 of table

233. The values obtained are shown in column 5 of table 234 and column 4

of tables 235 and 236. Since the density of strikes per unit area in the theoretical spherical burst is unity, the divergence of the actual fragment pattern
620 WOUND BALLISTICS

of a shell for each annular zone is given by the ratio of the percent of fragments

observed in each zone to the percent of fragments expected in that zone had the

burst been that of the theoretical spherical projectile. These ratios, which

are referred to as the directional fragmentation densities, are shown for the

three projectiles considered in columns 6, 5, and 5, of tables 234, 235, and

236, respectively.

Figure 295B and C shows the burst patterns of the U.S. 90 mm. shell

detonated statically and in motion. The static burst patterns of the German

88 mm. and the U.S. 90 mm. shells are approximately similar when one or the

other is inverted. The apparent differences in figure 295A and B are due to

the fact that the 88 mm. was nose down while the 90 mm. was nose up.

AIRCRAFT BATTLE DAMAGE DATA

Density of Flak Hits on Aircraft

If all AA shells were fired vertically, the burst pattern shown in figure

295C would represent the directional fragmentation densities of flak in the

atmosphere. This figure would also represent the relative importance of the

different directions from which protection would be required by aircrew personnel in heavy bombers. However, an enemy AA battery may fire at a

formation of heavy bombers throughout approximately 12 miles (3 minutes)

of the bombers' flight course and is actually unable to fire directly vertically.

Therefore, fragments from bursting projectiles from one battery are likely to

produce a composite burst pattern that differs from that of shells bursting only

in a vertical orientation.

It was thought desirable to construct a composite burst pattern that would

represent the aggregate of flak bursts that actually occur under operational

conditions. In order to do this, the frequency of flak hits on plane horizontal

and vertical surfaces of a sample of aircraft was determined. All the B-17 and

B-24 aircraft that were hit by flak and returned to the United Kingdom during

July 1944 were examined. If the number of MIA aircraft due to flak damage

were sufficiently great, the distribution of flak hits on them might materially

influence the observations made on the July sample of aircraft. Accurate data

as to how many MIA aircraft were lost because of damage due to flak were not

available. However, 15 percent of MIA personnel were evaders who returned

to the United Kingdom and who were interrogated by representatives of the

Operational Research Section, Eighth Air Force. It is estimated on the basis

of information obtained from the personnel questioned that approximately 60

percent of both types of MIA aircraft were lost because of damage due to flak

during July 1944. During that month, 134 B-17's and 107 B-24's were missing

in action. Thus, 3,053 B-17 aircraft, of which 2,973 were examined and of

which approximately 80 (2.6 percent) were missing in action, were possibly

damaged by flak. Also, 958 B-24 aircraft, of which 894 were examined and of
FLAK FRAGMENTS AND BURST PATTERNS 621

..... . .. .. ..

TOP

BOTTOM

RIGHT SIDE LEFT SIDE

WRAM C-4829 A5

FIGURE 296.-Location of flak hits on 2,961 B-17 aircraft, plane surfaces only.

which approximately 64 (6.7 percent) were missing in action, were possibly

damaged by flak. It is unlikely that the small incidence of MIA flak-damaged

aircraft, could they have been included in the analysis, would have greatly

changed the observations pertaining to either type of aircraft.

Only the flat portion of the main wings lateral to the numbers 1 and 4

engines and the "unprotected" surfaces of the vertical stabilizers of both aircraft were used for these observations. Figures 296 and 297 show the location

of flak bits on the plane surfaces of the two types of aircraft. The surface areas

were determined by planimeter measurements of scale drawings of the aircraft

and are given in column 1 of table 237. This table shows the data obtained from

the battle damage reports for 2,961 B-17's and 888 B-24's. The manner of
622 WOUND BALLISTICS

TOP

BOTTOM

RIGHT SIDE LEFT SIDE

W RAM C-4829-A20

FIGURE 297-Location of flak hits on 888 B-24 aircraft, plane surfaces only.

calculating the "standardized" densities of hits on plane surfaces was the

same as that given for the calculation of "standardized" directional fragmentation densities, and the values obtained are given in column 6 of table 237.

The figures in columns 3 and 6 of table 237 show that the greatest density

of hits occurred on the bottom surfaces of B-17 aircraft. The density of hits

on vertical surfaces was only slightly less, whereas the density of hits on top

surfaces was approximately one-third as great as that on bottom or vertical

surfaces.

Corresponding figures for B-24 aircraft (columns 3 and 6) show that vertical surfaces suffered the greatest density of flak hits. The latter was 54 percent
FLAK FRAGMENTS AND BURST PATTERNS 623

TABLE 237.-Densities of flak hits on the plane surfaces of 2,961 B-17 and 888 B-24 aircraft,

respectively, during July 1944

(1) (2) (3) (4) (5) (6)

Area Number of Percent (W) Percent (A) StandardSurface struck (square Hits observed observed expected ized denfeet) hits I hits 1 hits ing random assum- sities

distribution (D=)

B-17 aircraft:

Top ----------------------- 368 487 0. 45 6.4 16.7 0.38

Bottom -------------------- 368 1,554 1.43 20.3 16. 7 1.22

Sides --------------------- 156 598 5. 16 73.3 66. 6 1.10

(1. 29)

Total -------------------- 892 2,639 7.04 100.0 100.0

B-24 aircraft:

Top ----------------------- 272 143 0. 59 5.8 16.7 0.35

Bottom ------------------- 272 327 1.35 13. 2 16.7 . 79

Sides ---------------------- 194 359 8. 32 81.0 66.6 1.22

(2. 08)

Total -------------------- 738 829 10.26 100.0 100.0

I Data calculated per square foot per 1,000 aircraft.

NOTE.-Figures In parentheses for one side only.

greater than the density of hits on bottom surfaces and three and a half times

the density of hits on top surfaces. The figures in column 3 (table 237) show

in general a slightly greater density of flak hits per unit surface area on B-24

than on B-17 aircraft. There was an average density of 1.00 hit per square

foot on B-17's as compared with 1.26 per square foot on B-24's.

Directional Density of Flak in Relation to Distribution

of Observed Hits

The densities of flak hits on different plane surfaces cannot be regarded

directly as representing the densities of fragments proceeding in space in given

directions. It stands to reason that only a small part of the total density of

hits on a plane surface are caused by fragments which struck it normally. If

the densities of flak hits on a large number of aircraft, the plane surfaces of

which were oriented in several different directions in space (say six), were

known, it would be possible to calculate the directional fragmentation densities of flak fragments to which the aircraft were exposed. With plane surfaces oriented in three directions only, as in the present case, the data are not

adequate to make an exact determination of directional fragmentation densities.

In other words, a number of different sets of directional fragmentation densities
624 WOUND BALLISTICS

can be calculated, all of which will give the densities of hits on plane horizontal

and vertical surfaces which were actually observed.

One such set of directional fragmentation densities, which may be regarded

as the distribution of flak in the atmosphere to which B-17 aircraft were

exposed, is shown diagrammatically in figure 298A. The standardized values

of r(6) in table 238 were calculated from the equation

r(O) = a+b cos O+c cos2 6+d coss 0

in which a, b, c, and d are constants that were solved so that the equation

would fit the observed densities of hits on the plane horizontal and vertical

surfaces of the aircraft. They are represented in the composite burst pattern

(fig. 298A) by the length of the radii from the point of burst.

A B

WRAMC-4829-A18, A9

FIGURE 298.-Directional fragmentation density. A. Composite flak burst,

constructed from the flak hits on the plane horizontal and vertical surfaces of 2,961

B-17 aircraft. B. Composite flak burst, constructed from the flak hits on the

plane horizontal and vertical surfaces of 888 B-24 aircraft.

TARLE 238.-Directional fragmentation densities of flak against B-17 aircraft

(1) (2)

Direction Standardized

(0) density r(6)

Degree

10 0.08

30 .12

60 .72

2 90 1.40

120 1. 48

150 .88

S180 .32

1 Vertically downward.

2 Horizontally.

3 Vertically upward.
FLAK FRAGMENTS AND BURST PATTERNS 625

The number of flak fragments striking an object will vary directly with

the surface area it presents and inversely with the square of the distance from

the point of a burst. The densities of hits will be further influenced by the

shape of the target and its movement in space. The figures in column 3 of

table 237 are absolute values and those in column 6 of the same table are

standardized values for the densities of hits on the plane surfaces of B-17

aircraft. In contrast, the figures in column 2 of table 238 represent relative

values for directional fragmentation densities of fragments dispersed in space

from the point of a burst. These values are represented graphically in the

composite burst pattern shown in figure 298A. Relative directional fragmentation densities are measures of the densities of fragments dispersed in different

directions toward aircraft and in this case may be regarded as constant for

the altitude at which the B-17's operate. These directional fragmentation

densities will not vary or be influenced by any of the factors which determine

variations in the density of hits received on different surfaces of the B-17's.

The mathematical form chosen to determine relative values for directional

fragmentation densities of fragments which would account for the observed

distribution of hits displayed in table 237 (for B-24 aircraft)

r(O) - a-b cos O+c cos2 0-d cos3 0±e cos4 O-J cos' 0

has the defect that it does not immediately yield a reasonable curve to account

for the observed densities of hits. This failure is not necessarily due to any

special feature of the directional fragmentation density distribution for the

B-24. The standardized values of r(O) in table 239 are the "smoothed" values

calculated from the equation.

Figure 298B is a diagrammatic representation of the values in column 2

of table 239. It shows a pattern of directional fragmentation densities which

will account for the observed densities of hits on B-24 aircraft. The smoothed

parts of the curve are indicated by dotted lines.

Density of Flak Hits on Fuselages of Aircraft

It is the hits on fuselages of aircraft which principally cause casualties,

and therefore it was thought worthwhile to determine the densities of flak

hits on the fuselages of the two types of aircraft. Actually, the standardized

values for such hits should agree with those for hits on plane surfaces. Flak

hits on MIA aircraft, while they might not have influenced the observed

densities and distribution on plane surfaces, might materially affect the observed

density and distribution of hits on the more vital fuselage surfaces, could

they have been included in the observations. Differences could be due in

part to the personal error introduced by the engineer officer who makes a

record of flak damage to an aircraft and who has to distinguish between hits

on the top and side or side and bottom of a tapering cylindrical structure

"whose curved surfaces cannot readily be demarcated from each other.

6O3225v,62-42
626 WOUND BALLISTICS

TABLE 239.--Directional fragmentation densities of flak against B-24 aircraft

(1) (2)

Direction Standardized

(0) density r(O)

Degree

10 0.01

30 .01

40 .03

50 .08

60 .52

70 1.06

80 1.60

2 90 1.97

100 1.95

110 1.75

120 1. 32

130 .79

140 .33

150 .09

3 180 .03

1 Vertically downward.

2 Horizontally.

3 Vertically upward.

However, the greatest differences are more likely to be due to "selection."

In general, the greatest density of hits by flak on certain regions of the fuselage

vital for an aircraft's safe return to the United Kingdom could not be included

in the observations. The sample of aircraft studied for hits on the fuselage

would be biased in favor of aircraft struck in regions of the fuselage not vital

to the aircraft's return.

Column 6 of table 240 gives the standardized densities of flak hits on the

fuselages of B-17 and B-24 aircraft. The projected surface areas chosen for

the observations do not include the bomb bay or those portions of the sides

of the fuselage protected by the main wings. The samples of 2,973 B-17

and 894 B-24 aircraft used include the 2,961 B-17's and 888 B-24's referred

to previously. Figure 299 shows the location of flak hits on the projected

surfaces for which the relative densities were determined.

Table 240 for B-17's shows a somewhat different order of densities of

fuselage hits when compared with hits on plane surfaces; that is, the greatest

density appears to be on the sides instead of on the bottom of the fuselage.

The ratio of densities for hits on top and bottom surfaces is 1: 1.8 as compared

with 1: 3.2 for densities of bits on plane surfaces, and the density of hits on the

sides is twice that for hits on the bottom. Table 240 for B-24's also shows

the greatest density of hits on the sides of the fuselage and a change in the

ratio of densities on top and bottom surfaces from 1:2.3 to 1:0.7. The deficiencies of hits on bottoms of fuselages, as shown by decreases in the ratios
FLAK FRAGMEN; AN FURST PATTERNS 627

TOP

BOTTOM

LEFT SIDE

RIGHT SIDE

BOTTOM

LEFT SIDE

RIGHT SIDE

B

WRAMC-4829--A21, A17

FbouaE 299.-Location of flak hits, fuselages only, on 2,973 B-17 and on 894 B3-24

aircraft, respectively. A. B3-17 aircraft. B. B3-24 aircraft.
628 WOUND BALLISTICS

of top to bottom bits for both types of aircraft, may be regarded as hits sustained by MIA aircraft. In other words, aircraft shot down by flak probably

sustained hits chiefly on the bottoms of fuselages. Could these hits have

been included in the observations, they probably would be sufficient to restore

the observed ratios of top to bottom fuselage hits so that they would correspond to the ratio of top to bottom plane surface hits. The differences

observed between the densities of hits on plane and fuselage surfaces of all

aircraft will be compared later with the differences between the densities on

the plane and fuselage surfaces of casualty-bearing aircraft.

TABLE 240.-Densities of flak hits on fuselages of 2,973 B 17 and 894 B-24 aircraft, respectively, during July 1944

(1) (2) (3) (4) (5) (6)

Projected Percent (A) Standardized

Surface struck area Number of Percent expected densities

(square Hlits observed (n) ob- hits assuming

feet) hits I served hits I random AnD- distribution

B-17 aircraft:

Top ------------------ 408 293 0. 24 5. 8 16.7 0.35

Bottom ---------------- 408 537 .44 10. 6 16.7 . 63

Sides ------------------ 430 1, 106 3.48 83. 6 66. 6 1.26

(. 87)

Total ---------------- 1,246 1, 936 4. 16 100. 0 100. 0

B-24 aircraft:

Top ------------------- 270 170 .70 10. 6 16. 7 .63

Bottom ---------------- 270 120 .50 7.6 16. 7 .46

Sides ------------------ 540 653 5.4 81.8 66. 6 1. 23

(1.35)

Total ---------------- 1,080 943 6. 60 100.0 100.0

I Data calculated per square foot per 1,000 aircraft.

NOTE.-Figures in parentheses for one side only.

Density of Flak Hits on Casualty-Bearing Aircraft

In a selected sample of casualty-bearing aircraft, one might expect to find

an increase in the number and variations in the distribution of flak hits on all

surfaces generally. The casualty-bearing portion of the aircraft, that is, the

fuselage, in a sample selected for casualties might be expected to show the

greatest increases in density and variations in the distribution of hits. The

observed relationship between flak hits and casualties is likely to be greatly

different from observations that would include MIA flak-damaged casualtybearing aircraft. The fatality rate in MIA aircrew personnel is known to be
FLAK FRAGMENTS AND BURST PATTERNS 629

approximately 20 percent. Such a high fatality rate would correspond to an

even greater casualty rate. Thus, it is likely that most MIA aircraft due to

flak damage were also casualty-bearing aircraft. If all MIA flak-damaged aircraft were to be regarded as bearing one or more flak casualties, then there

were approximately 781 B-17 flak-damaged casualty-bearing aircraft during

June, July, and August 1944. Of this number, 461 aircraft returned and were

examined and 320 (41 percent) were not examined (86 returned and not examined and 234 MIA). There were 465 B-24 flak-damaged casualty-bearing

aircraft during the same period. Of this number, 172 aircraft returned and

were examined and 293 (63 percent) were not examined (112 returned and not

examined and 181 MIA). Such proportions of casualty-bearing aircraft, for

which observations were not available, would therefore greatly alter the flakdamage data pertaining to both types of aircraft.

Tables 241 and 242 show the densities of flak hits for plane surfaces and

fuselages of all the aircraft examined in which there were flak casualties. The

aircraft concerned were examined in the same way and by the same personnel

who examined all aircraft to which the data in tables 237, 238, 239, and 240

pertain. Figures 300 and 301 show the location of flak hits on casualty-bearing

B-17 and B-24 aircraft from which the data in tables 241 and 242 were obtained.

TABLE 241.-Densities of flak hits on 461 B-17 aircraft in which there were 539 battle

casualties

(1) (2) (3) (4) (5) (6)

Percent (A) Standardized

Surface struck Area I Hits Number of Percent (7) expected bits densities

(square observed observed assuming ( A

feet) hits 2 hits 2 random D=

distribution

Plane surfaces only:

Top ------------------- 368 236 1.39 8. 6 16.7 0. 51

Bottom --------------- 368 485 2. 86 17. 6 16.7 1.05

Sides ------------------ 156 215 11. 96 73. 8 66. 6 1. 11

(2. 99)

Total ---------------- 892 936 16.21 100.0 100.0

Fuselage only:

Top ------------------ 408 288 1. 53 9.4 16.7 .56

Bottom ---------------- 408 218 1. 16 7. 1 16.7 .43

Sides ------------------ 430 675 13. 60 83. 5 66. 6 1.25

(3.40)

Total ------------- 1,246 1, 181 16.29 100. 0 100.0

I Projected for "fuselage only."

2 Data calculated per square foot per 1,000 aircraft.

NoTE.-Figures in parentheses for one side only.
630 WOUND BALLISTICS

TABLE 242.-Densities of flak hits on 172 B-24 aircraft in which there were 193 battle casualties

(1) (2) (3) (4) (5) (6)

Percent (A) Standardized

Surface struck Area 1 Number of Percent (n) expected hits densities (square Hlits observed observed assuming (A)

feet) hits 2 hits 2 random D=

distribution

Plane surfaces only:

Top ------------------- 272 65 1.39 4. 9 16. 7 0. 29

Bottom ---------------- 272 205 4.38 15. 5 16. 7 . 93

Sides ----------------- 194 188 22. 52 79. 6 66. 6 1.20

(5. 63)

Total --------------- 738 458 28. 29 100. 0 100.0

Fuselage only:

Top ------------------- 270 107 2.30 8. 0 16. 7 .48

Bottom ---------------- 270 73 1. 57 5. 4 16. 7 .32

Sides ------------------ 540 580 25.0 86. 6 66. 6 1.30

(6. 25)

Total ---------------- 1,080 760 28. 87 100.0 100.0

1 Projected for "fuselage only."

2 Data calculated per square foot per 1,000 aircraft.

NOTE.-Figures in parentheses for one side only.

Column 3 of table 243 (compare with column 1) shows significant increases

in the number of flak hits on plane surfaces of B-17 aircraft. The standardized

values given in columns 3 and 1 of table 244, however, show no change in the

relative density of hits on vertical surfaces. However, there is an apparent

decrease in the ratio of hits on top and bottom surfaces of casualty-bearing

B-17's, from 1:3.2 to 1:2.1 (36 percent decrease).

Column 4 of table 243 (compare with column 2) shows even greater increases in the density of flak hits on the fuselages of casualty-bearing B-17's.

The standardized values in columns 2 and 4 of table 244 show again no

change in the relative density of hits on the sides of the fuselages. However,

there is an apparent decrease in the ratio of top to bottom hits from 1:1.8 for

the fuselages of all B-17's to 1:0.8 for the fuselages of casualty-bearing B-I 7's

(57 percent decrease).

Column 7 of table 243 (compare with column 5) shows greatly increased

densities of flak hits on plane surfaces of casualty-bearing B-24 aircraft. The

standardized values for the B-24 in columns 5 and 7 of table 244 show, as in the

case of B-17 aircraft, no significant difference in the relative density of bits on

vertical (sides) surfaces of casualty-bearing aircraft. However, in contrast to

a reduced ratio of top to bottom hits on plane surfaces of B-17's, there appears

to be an increased ratio of top to bottom hits on plane surfaces of casualtybearing B-24's from 1:2.3 to 1:3.2 (42 percent increase).
FLAK FRAGMENTS AND BURST PATTERNS 631

TOPK

BOTTOM •

b1L1

RIGHT SIDE LEFT SIDE •

A

TOP

BOTTOM

LEFT SIDE

RIGHT SIDE

B

WRAMC-4829-A6, A3

FIGURE 300.-Location of flak hits on 461 casualty-bearing B-17 aircraft.

A. Plane surfaces only. B. Fuselage only.
632 WOUND BALLISTICS

TOP

RIGHT SIDE LEFT SIDE

i::.s

TO P

BOTTOM

LEFT SIDE :4. C-3

RIGHT SIDE

B

WRAMC-4829-A2, A-4

FIGURE 301 -Location of flak hits on 172 casualty-bearing B-24 aircraft.

A. Plane surfaces only. B. Fuselage only.
FLAK FRAGMENTS AND BURST PATTERNS 633

TABLE 243.-R6sumA of density of flak hits on B-17 and B-24 aircraft

[Data represent number of bits per square foot per 1,000 aircraft]

(1) (2) (3) (4) (5) (6) (7) (8)

Plane Fuselage Plane Fuselage

Surface struck Plane Fuselage surface 3 surface 3 Plane Fuselage surface 4 surface 4

surface I surface 2 (casualty- (casualty- surface I surface 2 (casualty- (casualty-

(total B-17 (total B-17 bearing bearing (total B-24 (total B-24 bearing bearing

aircraft) aircraft) B-24 air- B-24 air- aircraft) aircraft) B-24 air- B-24 air- craft) craft) craft) craft)

Top --------- 0. 45 0.24 1.39 1.53 0.59 0.70 1.39 2.30

Bottom ------- 1.43 .44 2.86 1. 16 1.35 .50 4.38 1.57

Sides -------- 5. 16 3.48 11.96 13.60 8.32 5.4 22.52 25.0

(1.29) (. 87) (2. 99) (3.40) (2. 08) (1. 35) (5. 63) (6. 25)

Total_ 7. 04 4. 16 16. 21 16. 29 10. 26 6. 60 28. 29 28. 87

Data are from column 3, table 237.

2 Data are from column 3, table 240.

3 Data are from column 3, table 241.

4 Data are from column 3, table 242.

NOTE.-Figures in parentheses are for one side only.

TABLE 244.-Rdsum6 of standardized densities for B-17 and B-24 aircraft

[Data represent number of hits per square foot per 1,000 aircraft]

(1) (2) (3) (4) (5) (6) (7) (8)

Plane Fuselage Plane Fuselage Surface struck Plane Fuselage surface s surface 3 Plane Fuselage surface 4 surface 4

surface I surface 2 (casualty- (casualty- surface 1 surface 2 (casualty- (casualty- (total B-17 (total B-17 bearing bearing (total B-24 (total B-24 bearing bearing

aircraft) aircraft) B-24 air- B-24 air- aircraft) aircraft) B-24 air- B-24 air- craft) craft) craft) craft)

Top --------- 0.38 0.35 0.51 0.56 0.35 0. 63 0.29 0.48

Bottom ------ 1.22 .63 1.05 .43 .79 .46 .93 .32

Sides -------- 1. 10 1.26 1. 11 1.25 1.22 1.23 1.20 1.30

I Data are from column 6, table 237.

2 Data are from column 6, table 240.

s Data are from column 6, table 241. 4 Data are from column 6, table 242.

Column 8 of table 243 (compar3 with column 6) shows greatly increased

densities of flak hits on the fuselages of casualty-bearing B-24's. The standardized values in columns 6 and 8 of table 244 show a very slight (5 percent) decrease in the relative density of side hits and a slight apparent decrease in the

ratio of top to bottom hits on casualty-bearing B-24's from 1:0.7 to 1:0.67 (8

percent decrease).

The analysis of hits on casualty-bearing B-17 aircraft listed in table 241

shows deficiencies of flak hits on the bottom surfaces primarily of the fuselage

and secondarily of the planes. These data suggest that MIA B-17 aircraft

due to flak damage were lost primarily due to hits on the bottom surfaces of
634 WOUND BALLISTICS

the fuselage and thus possibly due in part to the occurrence of casualties produced by these hits. The "moth-eaten" appearance in the distribution of hits

on the bottom of the fuselages of casualty-bearing B-17's, shown in figure 300B

in the regions carrying personnel and parts vital to the aircraft's safe return,

further supports this possibility. Hits on the ball turret, a combat position

relatively unimportant as far as the integrity of the aircraft is concerned,

appear to be distributed normally.

The analysis of hits on casualty-bearing B-24 aircraft listed in table 242

shows deficiencies of flak hits primarily on the top surfaces of planes and secondarily on the sides and bottom of the fuselages. These data suggest that MIA

B-24 aircraft due to flak damage were lost primarily because of hits on the top

surfaces of planes and only secondarily because of hits on the sides and bottom

of their fuselages. Figure 301B also shows a somewhat moth-eaten appearance

in the distribution of flak hits on the bottom of the fuselages. However, the

disturbed distribution of hits observed on casualty-bearing B-24's suggests that

MIA aircraft of that type, due to flak, were more likely lost because of damage

to mechanical parts rather than to the production of casualties.

Directional Fragmentation Density of Flak That Caused Casualties

If a man were suspended in the atmosphere in which flak shells were

bursting, unprotected by armor or any part of an aircraft, he would be exposed

to a distribution of flak fragments as shown in figure 298A if he were at the

altitude at which B-1 7's operate or, as shown in figure 298B, if lie were at the

altitude at which B-24's operate. However, since a man is in a heavy bomber,

he is protected in varying degrees by different parts of the aircraft, by its

armament, by the proximity of other men in the aircraft, and usually by body

armor either worn or placed in various positions about his aircrew station.

The observations made from an analysis of the directional fragmentation density of flak that had caused casualties would differ from those made from an

analysis of hits on the outer surfaces of aircraft since many of the fragments

flying in space would first strike the exterior of the aircraft, some object within,

or body armor and be stopped, thus preventing a casualty from occurring. In

other words, the flak fragments that caused casualties would appear to be most

reduced in density in the directions from which the man had the best protection and most increased in density in the directions from which he had the least

protection. If the unobserved hits on MIA casualty-bearing flak-damaged

aircraft would materially affect the observations made on casualty-bearing

B-17's and B-24's, then the unobserved hits causing casualties among MIA

personnel would be likely to have an even greater effect on the observations

made on flak casualties sustained in the two types of aircraft.

It was possible to determine the direction traveled by the flak fragments

that caused 545 casualties in B-17's and 215 casualties in B-24's. The location

of flak hits on the battle damage reports for the aircraft in which the casualty

occurred, the location of the wounds on the casualty, the direction of the wound
FLAK FRAGMENTS AND BURST PATTERNS 635

track, and the wounds of entrance and exit were all taken into account to

determine in which of four "directional zones" the flak fragment which caused

each wound traveled. The four directions that were arbitrarily chosen were

450 zones with respect to the equatorial p]ane. All wounds that were caused

by fragments traveling vertically downward or in a downward direction deviating not more than 45' from the vertical were grouped in the 0'-45' zone.

Wounds caused by fragments traveling downward in the zone between the

horizontal and 45' below the horizontal were grouped in the 450-90' zone.

Wounds caused by fragments traveling upward in the zone between the horizontal and 45' above the horizontal were grouped in the 900-1350 zone.

Wounds caused by fragments traveling vertically upward or in an upward

direction deviating not more than 450 from the vertical were grouped in the

135'-180' zone. Wounds that could not definitely be placed in one of these

four zones were not included in the analysis. Tables 245 and 246 show the

grouping of wounds or "hits," by zones, sustained by the casualties in the two

types of aircraft.

The standardized densities of hits causing casualties given in column 6 of

tables 245 and 246 were obtained by correcting for the varying projected areas

of the body (column 1 of the tables). The projected area of a man viewed at

an angle of 0' is taken to be 2.3 (1+0.9 sin 0) square feet. This formula,

though approximate, agrees with the observed projected area sufficiently well

for this purpose. The way in which the projected surface area of the body

varies with the angle at which it is viewed is demonstrated in figure 302.

Viewed from directly above or below, the area is approximately 2.30 square feet,

TABLE 245.-Directional fragmentation densities of flak that caused 545 casualties in

B-17 aircraft

(1) (2) (3) (4) (5) (6)

Percent (A)

Direction Body area Number of Percent (n) expected hits Standardized

(0) (square Hiits observed observed assuming densities feet) hits1 hits I random D.An

distribution A

Degree:

0-45 ---------------- 3.31 78 4. 32 12. 0 16. 7 0. 72

45-90 ------------------ 16. 72 225 9. 88 27.45 33. 3 .82

(2. 47)

90-135 ---------------- 16. 72 309 13. 56 37. 71 33. 3 1. 13

(3. 39)

135-180 --------------- 3.31 148 8. 20 22. 8 16. 7 1.37

Total ---------------- 40. 06 760 35. 96 100. 0 100. 0

1 Data calculated per square foot per 100 casualties.

NOTE.-Figures in parentheses for one side of body surface only.
636 WOUND BALLISTICS

TABLE 246.-Directional fragmentation densities of flak that caused 215 casualties in

B-24 aircraft

(1) (2) (3) (4) (5) (6)

Percent (A)

Direction Body area Number of Percent (n) expected hits Standardized

(0) (square Hits observed observed assuming densities

feet) hitsI hits' Irandom (D=A)

distribuotion

Degree:

0-45 ------------------- 3. 31 43 6. 04 16. 8 16. 7 1.01

45-90 ------------------ 16. 72 96 10. 68 29. 8 33. 3 .89

(2. 67)

90-135 ----------------- 16. 72 103 11.44 31. 9 33. 3 96

(2. 86)

135-180 ---------------- 3. 31 55 7. 73 21.5 16. 7 1. 29

Total ---------------- 40. 06 297 35. 89 100. 0 100. 0

1 Data calculated per square foot per 100 casualties.

NOTE-Figures in parentheses for one side of body surface only.

ANGLE OF PROJECTED PROJECTION AREA MEAN PROJECTED AREAS

() (SQ. FT) EXPOSED TO FLAW

ZONE AREA

00 2.30 - - - - - - - --...... .... (e) (SQ.FT)

450 3.76 ----- --

go 4.7

I

S SI

"5 450 900 16.72

* I.. I S /1

- .1

1350 3.76-350 1- 37

1800 2.30-----------

WRAMC-4829-A19

FIGU•RE 302.-Projected body surface areas.
FLAK FRAGMENTS AND BURST PATTERNS 637

whereas, from any direction horizontally, the area is approximately 4.37 square

feet. At an angle of say 450 above or below the horizontal, the projected area

of the body is approximately 3.76 square feet.

It is seen that over two-thirds of the casualties were caused by flak fragments proceeding roughly horizontally. The standardized directional fragmentation density of fragments causing this large proportion of casualties

however (column 6, tables 24 5 and 246) was at a minimum, particularly in the

case of B-24 casualties. Figure 302 shows that a man viewed horizontally

presents an area nearly twice as large as a man viewed vertically. Also, the

frequency with which the larger surface area is presented is greatest in the

horizontal direction and decreases as the more vertical directions are approached. Thus, the largest proportion of casualties were caused by fragments

proceeding, in general, in the direction in which the greatest density of fragments occurred. The apparent decrease in density of fragments that caused

casualties by proceeding horizontally however is due to the factor of "protection" to personnel from horizontally dispersed fragments.

From the figures for the hits on casualties (column 2, tables 245 and 246),

a curve of the form

r(O)=a+b cos O+c cos' O+d cos' 0

can be fitted to give the directional fragmentation densities of fragments that

caused the casualties. These curves together with the curves representing the

directional fragmentation densities on the aircraft (indicated dotted) are shown

in figure 303 to show the relationship between hits on aircraft and hits that

, • /".-:: ...- --: --"--"' -

A B

WRAMC-4829-A27, A26

FIGURE 303.-Directional fragmentation density. A. Composite flak burst, constructed from 760 flak hits sustained by 545 casualties in B-17 aircraft. B. Composite

flak burst, constructed from 297 flak hits sustained by 215 casualties in B-24 aircraft.
638 WOUND BALLISTICS

caused casualties. The standardized density values used for the construction

of the curves are shown in tables 247 and 248.

TABLE 247-Directional fragmentation densities of flak against personnel in B-17 aircraft

Direction Standardized Density

(0) r (0)

Degree

10 1.03

30 .91

60 .70

290 .74

120 1. 16

150 1. 74

3 180 2. 01

I Vertically downward.

2 Horizontally.

Vertically upward.

TABLE 248-Directional fragmentation densities of flak against personnel in B-24 aircraft

Direction Standardized density (0) r (0)

Degree

10 1.62

30 1.37

60 .83

290 . 55

120 .94

150 1. 76

1180 2. 19

1 Vertically downward.

2 Horizontally.

3 Vertically upward.

Figure 303A thus indicates that, while a B-17 aircraft receives the greatest

density of hits from a direction 10o-30' above the horizontal with comparatively small density in directions within 45' of the vertical, the casualties suffer

the greatest density of hits from below, with lesser density from the sides.

Figure 303B, for casualties sustained in B-24's, shows in the same way the

lowest density of hits causing casualties proceeding in approximately the same

direction from which the greatest density of hits occurred on the aircraft.

GENERAL CONCLUSIONS

With reference to the protective armor in aircraft (p. 585), the significant

difference in battle casualty rates in two types of heavy bombers merits special

attention. There was one known battle casualty for every 54 B-17's dis-
FLAK FRAGMENTS AND BURST PATTERNS 639

patched to enemy territory as compared with one for every 80 B-24's dispatched. The relationship between casualties and flak damage to the two

types of aircraft may be well expressed by the ratio of casualties to flak hits

sustained on the fuselages. For every 100 hits sustained on the fuselages of

casualty-bearing aircraft, there were 34 casualties in B-17's as compared with

only 19 casualties in B-24's.

It has been learned unofficially that the more difficult and more heavily

defended enemy targets were attacked by B-17's and that the targets of lesser

importance were usually attacked by B-24's. If this is true and in view of the

fact that the rate of planes failing to return from enemy territory was the same

for both aircraft (approximately 1 percent), it is possible that the B-24 is more

vulnerable to attack by lower burst velocity projectiles. The lower incidence

of casualties in proportion to hits in B-24 aircraft may be regarded as a measure

of the relative ineffectiveness against personnel of low-velocity flak and the

relative effectiveness of low-velocity fragments against B-24 aircraft.

The total projected surface areas of the personnel-bearing portion of both

types of aircraft exposed to flak (that is, the fuselage) were approximately the

same. The B-24 fuselage presented approximately a 5 percent greater total

exposed surface than the fuselage of a B-17. However, the area of an aircraft

exposed to highest velocity flak fragments is its bottom surface. The projected

bottom surface of the fuselage of a B-17 was 25 percent greater than that of a

B-24 (476 square feet for a B-17 as compared with 380 square feet for a B-24).

This difference may account in part for the increased vulnerability of B-17 personnel to flak. The "lateral" projected surface of a B-24 fuselage exposed to

flak (of relatively lower velocity) was approximately 36 percent greater than

the corresponding surface of a B-17.

Aircraft are "lost" or reported missing in action only when the enemy has

been successful in crippling a ship to such an extent that it is unable to return

to its base. A ship is unable to return to its base if its engines are "knocked

out" or if certain vital mechanical parts of the ship are damaged. Also vital

to a ship, however, are certain of its crew members or combinations of personnel

and mechanical parts of aircraft, and an aircraft might not return to its base if

its pilot or copilot should be killed or wounded. Other crew members might

not be so vital to a ship's operation, but if these men were killed or wounded

it might still influence the ship's chance of returning to its base. Followup

studies have shown that the fatality rate in MIA aircrew personnel is approximately 20 percent (I out of 5) as compared with 1.2 percent for all aircrews that

sustained battle casualties and only 0.017 percent (approximately 1 out of

6,000) for aircrew personnel returning from combat missions. The known high

fatality rate among MIA personnel implies that there is as well a higher casualty rate in MIA personnel. It is likely that most aircraft that did not return

to their bases carried casualties, if not fatal casualties.

By regarding all MIA aircraft as casualty-bearing aircraft, it was found

that 1,014 (390 MIA and 624 known to be casualty bearing) B-17's probably

carried casualties and that 623 (303 MIA and 320 known to be casualty bearing)
640 WOUND BALLISTICS

B-24's probably carried casualties. Thus, 2.55 percent of B-17 as compared

with 2.08 percent of B-24 aircraft sustained casualties or were missing in action.

A chi-square test of the significance of the difference in these values gives

x2= 1 6 .

3 5 (where n=1, P less than 0.01). The difference is very clearly significant.

With respect to body armor, the main conclusion reached in the case of

B-17 aircraft was that personnel were protected laterally by body armor and

neighboring equipment and personnel and that a given weight of armor would

provide the best protection from below in addition to, but not instead of, the

protection already apparent from horizontally dispersed fragments. In the

case of the B-24, a need for protection of personnel from above, as well as from

below, was indicated. The B-24 was subjected to the greatest density of hits

from just above the horizontal, and vulnerable parts would be best protected

from this direction.
CHAPTER XI

Personnel Protective Armor

Maj. James C. Beyer, MC, William F. Enos, M.D.,

and Col. Robert H. Holmes, MC

The development and field usage of helmets and body armor in warfare

before World War II has been adequately documented by a number of excellent

books and reports.' Most of these references have been utilized in the preparation of this chapter, and in many instances they have provided the sole

source of available material. 2

HELMET DEVELOPMENT

During modern times, the helmet has had a rapid rise in general troop

acceptability with remarkably little variation in design. The first protection

provided for the head in World War I came about in a purely fortuitous manner.

General Adrian of the French Army noted that a soldier who had received

a head wound due to a rifle bullet explained his escape from death on the fact

that he had carried his metal food bowl under his cloth cap. Therefore,

following initial experiments in 1914, steel cap liners ("casque Adrian") were

issued to French troops in 1915 and led to the characteristic World War I

French helmet in 1916. Many of the other countries soon realized the value

of a helmet. The British adopted their own design in 1915; the Germans, in

1915; and the Belgians and Italians, in 1916.

1 (1) Helmets and Body Armor. Handbook of Ordnance compiled by H-. T. Wade. Washington: Government

Printing Office, 1919, pp. 413-418. (2) Dean, Bashford: Helmets and Body Armor in Modem Warfare. New Haven:

Yale University Press, 1920. (3) Dean, Basbford: Helmets and Body Armor-The Medical Viewpoint. In Medical

Department of the United States Army in the World War. Surgery. Washington: Government Printing Office, 1925,

vol. XI, pp. 1-8. (4) Helmets and Body Armor, Office of the Chief of Ordnance, Washington, 1 June 1945. (5) Gregg,

Anne J.: Project Supporting Paper No. 44 Relating to Helmets and Body Armor, 1917-August 1945, Ordnance Department, Washington, D.C. (6) Peterson, H. L.: Body Armor in Civil War. Ordnance 34: 432-433, May-Tune 1950,

(7) Ward, Gordon B.: Personnel Anti-Fragmentation Equipment. Library of Congress, Technical Information Division, Washington, D.C., July 1955. A bibliography, 63 pages.

2 The members of the Historical Division, Office of the Chief of Ordnance, have been most gracious in locating material

in their files and in providing free access to many of the original manuscripts. The illustrations for this chapter were made

available through the complete cooperation of Dr. HT. C. Thomson, chief of the Historical Branch, Office of the Chief of

Ordnance. Much of the material pertaining to helmets can only be written in regard to the history of the development

of a particular helmet model, and there is a great lack of medical documentation which really should be the sole purpose

of this chapter. Therefore, in many ways, the relating of the development of helmets and personnel body armor would

seem to be more of a history of the participation of the Quartermaster Corps and the Ordnance Department rather than

the Army Medical Service. However, it is felt that there has been an intimate association and liaison between all of the

interested technical services and that the inclusion of this chapter in the present volume follows a natural and logical

selection of materials. Full recognition must be offered to the major participation which the Quartermaster Corps and

Ordnance Department had in the development of personnel protective armor, and the inclusion of the Medical Service

for consultation and advice on development of new prototypes has been gratifying.-T. C. B., W. F. E., and R. H. II.

641
642 WOUND BALLISTICS

Following the decision in 1917 to equip the American Expeditionary

Forces with a helmet, 400,000 helmets were initially procured through the

British Quartermaster's Department. Subsequently, the same type of helmet

was manufactured in the United States under the direction of the Ordnance

Department, and approximately 2.7 million helmets, M1917, were produced

by Armistice day, 1918. The American helmet was a slightly modified version of the British MkI helmet. The helmet was made of 13 percent pressed

manganese steel alloy, 0.035 inch thick, and could be ruptured only by a

blow of 1,600 pounds or more. The British helnet had twice the ballistic

strength of the French helmet. The helmets of British design produced in

the United States had an overall ballistic strength 10 percent greater than that,

of the original British helmet. The ballistics specifications of the M1917

helmet required it to resist penetration by a 230-grain caliber .45 bullet with

a velocity of 600 f.p.s. Numerous experimental models were developed to

provide (1) additional protective coverage; (2) improved ballistic properties;

(3) adaptability for special functions, such as machinegunner, tank operator,

aviator, and so forth; (4) a more adequate suspension lining; and (5) a distinctive patriotic design. Because of the large numbers of helmets of the M1917

design which were produced in the United States, none of the experimental

models developed by the U.S. Army Ordnance Department received adoption

before the end of World War 1.

In the interval between World Wars I and II, the United States continued

its research and development program on helmets in an attempt to increase

the area coverage, to improve the protection ballistics limit (V50 or that

velocity level at which there is 50 percent probability of a complete penetration

of the test ballistic material by the projectile), and to facilitate troop acceptance

by modification of the suspension system. Changes designed to improve the

first two factors required careful consideration in order to be compatible with

the weight and comfort limitation imposed by other testing technical services.

Concurrent with the changes in weapon design were the demands for modification in the helmet specifications. With the advent of new weapons in the

hands of belligerent countries, countermeasures can follow several patterns,

such as increasing firepower to overcome the advantages of the new weapon,

developing specific antitype weapons, or producing interim personnel protective

devices.

Between 1918 and 1934, interest and progress in helmet development were

maintained by the Ordnance Department and the Infantry Board. Following

a series of experimental models (the model 5A was of pot-shaped design and

received extensive testing before it was discontinued in 1932) and tests, it was

recommended in 1934 that the M1917 helmet with a modified lining of a hairfilled pad be standardized as Helmet, M1917A1 (fig. 304). The final end item

with an adjustable headpad weighed 2 pounds and 6 ounces.

A lull in helmet development occurred in the period from 1934 to 1940

when the first draft call was issued. With the resurge of military life and

expenditures, new overtures were made to American industrial firms and to
PERSONNEL PROTECTIVE ARMOR 643

the Metropolitan Museum of Art in New York in an attempt to improve the

protective coverage and ballistic limit of the M1917A1 and to take advantage

of recent advances in steel alloy manufacture, liner materials, and mass production methods. In addition, a two-piece helmet was considered desirable to

meet the increasing variety and complexity of tactical and climatic conditions.

FIGURE 304.-Helmet, M11917A1.

The following quotation from one of the reports of the Infantry Board reveals

the natural evolution of the new helmet from the original M1917 design:

The ideal shaped helmet is one with a dome-shaped top following the full contour of

the head and supplying uniform headroom for indentation, extending down the front to

cover the forehead without impairing vision and down the sides as far as possible to be

compatible with the rifle, etc., and down the back as far as possible without pushing the helmet forward when in a prone position, and with a frontal plate flanged forward as a cap-style

visor and the sides and rear flanged outward to deflect rain from the collar opening.

Therefore, the M1917 model was considered suitable for protecting the

top of the head and by removing its brim, by adding sidepieces and rearpieces,

and by incorporating the suspension system into a separate inner liner, the

World War II Army helmet came into being.3 The original test item was

known as the TS3, and it received a favorable report from the Infantry Board

in February 1941.

The Army M1 helmet (fig. 305) was standardized on 30 April 1941 and

was approved on 9 June 1941. It was of two-piece design with an outer

Hadfield steel shell and a separate inner liner containing the suspension system.

The complete item weighed approximately 3 pounds, with the outer shell

accounting for approximately 2.3 pounds and the inner liner, 0.7 pound.

3 Studler, R. R.: The New Combat Helmet. Army Ordnance No. 132, 22: 933-934, May-June 1942.
644 WOUND BALLISTICS

Ballistic protection was afforded only by the Hadfield manganese steel outer

shell with the plastic-impregnated fabric liner serving as a light-weight headpiece outside of the frontline area and facilitating the attachment of the suspension system. Various utilitarian functions were also ascribed to the outer

steel shell. The ballistics properties of the outer shell had been improved so

that it would resist penetration by a 230-grain caliber .45 bullet with a velocity

of 800 f.p.s. The Riddell type of suspension (fig. 305C) used in football

helmets was modified for the inner liner. The principle of the original Riddell

suspension did not contain an adjustable headband, and this feature was

developed for the helnet liner. The M/ helmet was a marked improvement

AB c

FiGURE 305.-Army Ml helmet. A. Outer steel shell. B. Inner liner. C. Liner

with head suspension system and adjustable headband.

over former models (fig. 306) since it furnished increased coverage (fig. 307)

over the sides and back of the head and provided a more comfortable fit with

the partial elimination of the "rocking" tendency of the older helmets.

Following adoption of the MI1 helmet, the Ordnance Department retained

development and procurement of the outer steel shell and the Quartermaster

Department made development and production progress of the inner liner

and suspension system.

During the course of the North African campaigns in 1943, the rigid hook

fastener of the chinstrap was found to be a source of potential danger by

remaining intact under the impact of a blast wave resulting from a nearby

detonation and thereby jerking the head sharply and violently with the production of fractures or dislocations of the cervical vertebras. Therefore, it

was necessary to redesign the helmet strap with a ball-and-clevis release so

that it would remain closed during normal combat activities but would allow

for a quick voluntary release or automatic release at pressures considerably

below the accepted level of danger. Following extensive tests by ordnance

engineers, a new release device was developed which would release at a pull of

15 pounds or more. This device (fig. 308) was standardized in 1944.
PERSONNEL PROTECTIVE ARMOR 645

4.

SC 118701

FIGURE 306.-Rehnet, TS3, later standardized as Helmet, M1 (left), and Helmet, M1917A1

(right), April 1941.

The Ml helmet was the standard item of issue to ground troops, Army

and Marine, during World War II and the Korean War. Before the standardization of the M1 helmet, 904,020 M1917A1 helmet bodies were manufactured

from January to August 1941. During the period from August 1941 to August

1945, 22,363,015 Ml helmets were produced. Troop acceptability was fairly

high, but a common complaint was the lack of stability of the helmet. This

problem had its origin, in good part, from the type of ballistic test in practice

at the time the helmet was being developed. The caliber .45 pistol ball was

the major test weapon, and this type of projectile with its soft lead core and

thin gliding-metal jacket will deform easily against the Hadfield steel. When

the helmet causes the defeat of this missile at service-weapon velocities, it will

be deeply indented, and it was deemed necessary to allow a 1-inch offset
646 WOUND BALLISTICS

SC 122394, 122408

FIGURE 307.-M1 helmet. A. Front view, illustrating offset and area coverage.

B. Side view, showing increased coverage to sides and back of head.

between the helmet and the head. However, battle casualty survey studies

during World Wars I and II and the Korean War have shown that the primary

wounding agent among the WIA and the KIA casualties was the fragmentationtype weapon. The World War II experiences are universal except for the

surveys of some of the Pacific island campaigns where small arms missiles

accounted for a greater proportion of casualties. After World War II, fragment

simulators in a range of 5 calibers were widely used in ballistics evaluation

tests of prospective ballistic materials for helmets and body armor. The

advisability or necessity of the present 1-inch helmet offset requires a thorough

investigation and evaluation in the development of any new helmet.

A suitable offset will always be necessary to counteract the denting of a

metallic helmet or the transient deformation of a nonmetallic helmet, but the

prime objective of any protective military headgear is to prevent the entrance

of missiles into the cranial cavity. This entrance might be prevented over a
PERSONNEL PROTECTIVE ARMOR 647

wider range of missile weights and velocities by modification of the present

offset concept in helmet design. The missile defeat might result in skull fractures in a number of casualties, but the skull fracture type of injury is amenable

to successful treatment by the neurosurgeon.

Despite the widespread use of the M1 helmet by all the U.S. fighting forces

during World War II, no definite survey was ever conducted to obtain an

accurate evaluation of the value of the helmet. Numerous investigators in

24-78e40 LBCD- 1O0

REMOVE SPRING

ON BUCKLE SIDE

(o AND ASSEMBLE

d AS SHOWN WITH i ,t ,.

BALL TONGUE TO * II• ii'-

THE OUTSIDE

CHIN STRAP RELEASE IN AUTOMATIC 03

RELEASE POSITION

REMOVE OLD

H A CHIN STRAP RELEASE IN LOCKED 0 REPLACE WITH POSITION (BALL TONGUE RAISED)

NEW HOOK AS

S SHOWN.

FIGURE 308.-Ball-and-clevis release for chinstrap of M1 helmet.

various surveys and separate publications in medical journals allude to the

undoubted value of the Mi helmet in preventing a considerable number of

deaths and nonfatal wounds in ground troops. However, because of the

marked variability of collection methods and evaluation techniques of the investigators, it is most difficult to derive an accurate correlation based on sound

statistical methods.

Some aspects of the value of the Ml helmet are discussed by Beebe and

DeBakey in their book on battle casualties.' More recently, Norman Hitchman I of the Army's Operations Research Office reviewed some of the World

War II casualty statistics and reached some important and timely conclusions

regarding the value of wearing a helmet in combat. The following observations resulted from this statistical analysis:

1. Of all hits upon the helmet, 54 percent were defeated.

2. For every 100 men wounded while wearing helmets, 9.6 men received

wounds in the cranium. Without the helmet, it would be expected that 11.4

men would be wounded in the head.

3. The Ml helmet prevented a number of incapacitating hits equal to 10

percent of the total hits on the body.

4 Beebe, Gilbert W., and DeBakcy, Michael F.: Battle Casualties. Springfield: Charles C Thomas, 1952, p. 176.

Hitehman, N. A.: Keep Your Head . . . Keep Your Helmet. Army 8:42-44, September 1957.
648 WOUND BALLISTICS

4. The estimated savings in total battle casualties means that the helmet

in World War II probably prevented wounds in more than 70,000 men. A

significant proportion of these men would have been killed had the helmet not

been worn.

5. To get the same amount of saving by protecting other regions, body

armor weighing more than twice as much as the helmet would have to be

provided.

The numerous casualty surveys conducted during the Korean War provide

more accurate anatomic localization of wounds in the head region covered by

the helmet as related to the total head, face, and neck region, but again it was

not always possible accurately to determine whether the man was wearing a

helmet at the time of wounding. One survey was conducted by Capt. George

B. Coe, Cm1C, in an attempt to determine more accurately the relationship

between incidence of head wounds and the wearing of the helmet. One interesting observation was related where men wearing the helmet would assume a

prone position to escape missiles from a mortar or an artillery shell and upon

striking the ground the helmet would be released from the head and they would

sustain a head wound from a second group of shells detonating in the same area.

Accurate information regarding the exact value of the helmet as a protective device is of vital importance in the training and indoctrination of troops.

If it can be graphically shown that the helmet is a main line of defense against

the greater proportion of projectiles commonly encountered on the battlefield,

troop acceptability might be higher. Against the cast iron fragmentation projectiles which were commonly used by the North Korean and Chinese Communist Armies during the Korean War, the M1 helmet probably gave a better

performance than with the steel fragments which predominated during the World

War II fighting. The relatively soft and brittle character of the cast iron

fragments would lend itself to low hardness and toughness and to greater ease

of refragmentation and defeat upon impact against the helmet. The U.S. high

explosive shell fragment has an average Rockwell "C" hardness of 29-31 and

the Soviet cast iron shell fragment has a hardness of 8-14.

Research programs following the Korean War have been directed toward

an increase in both the ballistic protection limit and the troop acceptability

under varied combat conditions. A multiplicity of factors must be reconciled

and coordinated in order efficiently to effect significant changes in either of

these properties. World War II investigations proved the efficacy of nonmetallic ballistic materials (nylon and doron) alone or in conjunction with metallic outer shells, but satisfactory field tests were not completed before the

termination of hostilities in Korea. With the recent success of these plastics

in the body armor developed for ground forces during the Korean fighting,

increased emphasis has been given to all forms of research bearing upon helmet

development and design.

Notwithstanding the respectable performance of the M1 helmet during

World War II and the Korean War, continued improvement should be actively

supported. The doldrums of peacetime can prove very lethal to worthwhile
PERSONNEL PROTECTIVE ARMOR 649

and unspectacular research programs directed toward the development of

items of equipment where the present standard items might appear acceptable.

Any new helmet, regardless of its V50 superiority, will have to pass the ultimate

test of combat troop acceptance, and this is primarily dependent upon the fit

and stability of the helmet. . The frontline combatant must be indoctrinated

and impressed with the protective integrity and necessity of the helmet and

equally witb the ease and comfort with which it can be worn. Therefore, this

is one field of military design where correct tailoring should be obtained commensuirate with the imposed limits of the protective ballistic materials. Certain testing procedures on newer experimental helmets would appear to have

been excessively delayed, and active aggressive interest in the problem has

frequently dropped to a very low level.

HELMET DESIGN

Ground Troop Models

In addition to the Ml helmet, a variety of other designs were developed

by the Ordnance Department during World War II. These will be discussed

in the paragraphs to follow.

Helmet, steel, MLC (Parachutist's).-This helmet (fig. 309) included a

modification of the M1 liner (Liner, Helmet, M1, Parachutist's) with a special

chinstrap which insured that the helmet would stay on during the opening

shock and descent of the parachute. This liner chinstrap was provided with

a chin cup, and two snap fasteners secured the steel shell to corresponding

fasteners on the inside of the liner and prevented the separation of the two

components during parachute jumping. The regular helmet shell chinstrap

was worn behind the head. This item was standardized in January 1945, and

392,000 helmets were produced during the period from January to April 1943.

Helmet, T14 series (Signal Corps).-This was an experimental series

of helmets designed to provide the combat Signal Corps photographer with

maximum protection under extreme operating conditions. The standard M1

helmet restricted necessary movement and adjustments of still and motion

picture cameras and prompted the dangerous habit of removing the helmet

while being exposed to enemy fire. In May 1944, the Signal Corps proposed

that the front segment of the M1 helmet be cut away and an adjustable, hinged

visor flap be placed over the cutaway area. The Ordnance Department prepared test models which did not gain wide acceptance during field tests in the

European theater. One objection was due to the fact that, when the visor was

locked in its upright position, the helmet bore a superficial resemblance to the

German helmet. The Metropolitan Museum of Art incorporated this problem

in their work on a helmet for the Armed Forces and developed several promising models. Cessation of hostilities in 1945 prevented the completion of an

end item.

6032225-62-43
650 WOUND BALLISTICS

FIGURE 309.-Helmet, Steel, MIC (Parachutist's).

Helmets, T19 and T20 series (Tank).-In November 1940, Headquarters,

Armored Force, Fort Knox, Ky., requested the cooperation of the Ordnance

Department in modifying the then existing tank helmets to make them more

compatible with the varied functions and hazards of tank crewmen. Concurrently, the Quartermaster Corps was engaged in a design of a new tank

crash helmet which would offer protection from blows to the head. In 1944,

subsequent correspondence requested that the tank helmet designs embody

(1) a liner, incorporating a crash-type suspension, over which could be fitted a

modified M1 ballistic shell and (2) the ballistic steel shell with an integral

crash-type suspension. The proposed military characteristics required that

the helmet would (1) protect the wearer from blows to the head during maneuvers over rough grounds, (2) be relatively light in weight with a comfortable

fit, (3) permit full access to and the usage of various sighting devices, (4) permit wearing of radio headsets, (5) allow the forehead of the wearer to rest directly against the tank headrest, and (6) be capable of furnishing either ballistic

or crash (bump) protection.

The Ordnance Department developed six experimental series, and the

Metropolitan Museum of Art evaluated the models in accordance with the

Armed Forces specifications. Series T8 incorporated a ballistic helmet with a

crash suspension and T9 provided a ballistic cover for the existing tank crash

models (fig. 310). During this same period (1944), extensive work had resulted

in a number of prototypes of flyer's helmets, and certain of these were considered

as being adaptable to the needs of the combat tank crewmen. The TIO series
PERSONNEL PROTECTIVE ARMOR 651

b I N

SC 130819

FIGURE 310.-Tank crash helmets in use in November 1941.

(fig. 311A) was very similar to the helmet, T9, but provided an associated crash

suspension in the steel shell. Helmet, T12 (fig. 311B) was based directly on the

Helmet, M3 (Flyer's) with an internal crash suspension, and T13 (fig. 311C) was

prepared without the latter feature and was designed to fit over a cut down M1

liner. The T16 (fig. 311D) series was a modified M3 flyer's helmet with a

reduction in certain dimensions to bring it within the limitations of the requisite

military characteristics.

Between October and December 1944, helmets of the T10, T12, T13, and

T16 series were tested by the Armored Force Board, Fort Knox, Ky. All the

samples were found to be excessive in weight and overall dimensions and

incompatible with the operation of the various sighting devices. The extensive

offset and posterior extension of the helmets were developed to accommodate

the radio headset and to provide adequate neck protection, respectively.

In 1944 and 1945, a coordinated effort of the Ordnance Department and

the Quartermaster Corps was directed toward the development of an acceptable

modification of the M1 helmet shell to be used with the crash suspension-type

M1 liner. Helmet, T19E1 (fig. 312) was derived from an Ml helmet shell.

Changes in its contour permitted the use of various optical equipment while

allowing the helmet to be used in conjunction with the new quartermaster
652 WOUND BALLISTICS

FIGURE 311-Series of helmets. A. T10. B. T12. C. T13. D. T16.

liner which offered bump protection and clearance for the headsets. An

unfavorable report on this helmet was rendered in May 1945 because of the

instability of the helmet-liner combination.

After this work on the T19E1 helmet, helmets T20 and T20E1, produced

in sample lots, incorporated a head suspension directly within the T19E1

ballistic shell. Finally, the T19E2 and T20E2 series evolved and were based

upon a new contour design developed at the Armored Medical Research Laboratory. Definitive reports on these four items were not available before the

cessation of hostilities in World War II. However, the consensus was to the

effect that further attempts to produce a helmet for use in tanks by modifications of the standard Ml helmet should be abandoned and that the search

should be directed toward a completely new and specific tank helmet design.

More recent advances in the design of helmets for crewmen of combat vehicles
PERSONNEL PROTECTIVE ARMIOR 653

FIGuRE 312.-Helmet, T19E1.

have made increasing use of nonmetallic ballistic materials and have attempted

to provide a headgear with high user acceptability and possessing primary bump

protection and secondary ballistic protection. Figure 313 illustrates the present

combat vehicle crewman's helmet. The following information on this helmet

was released on 25 February 1958 by the Public Information Division, Office of

the Chief of Information and Education, Department of the Army:

Tank crewmen will have the first helmet specifically designed for their protection when

mass protection tests of a new helmet developed by the U.S. Army Quartermaster Corps are

completed. Up to the present time, tank soldiers have worn either the standard M-1

Steel Helmet with liner or football helmets, none of which met their requirements. The

new helmet, officially designated Combat Vehicle Crewman's (CVC) Helmet, is constructed

of multi-layers of laminated nylon fabric, and has a built-in communications system developed by the U.S. Army Signal Corps. The total assembly weighs about three pounds.

Nylon employed in its construction is similar to that of the Army's armor vest. Mounted

outside the helmet, the communications equipment includes a microphone on an adjustable

boom, a three-way switch for listening or talking by radio or through the tank's intercommunications system, and a cable with a quick-disconnect plug for emergency evacuation

from the vehicle. Inside the helmet, snug-fitting earphones reduce outside noise and help

guard the ears against injury.

Helmets, T21-24 (ground troops).-Throughout the World War II period,

investigative work continued in an attempt to improve the standard MI helmet.

In conjunction with the Ordnance Department and the Aero Medical Labora-
654 WOUND BALLISTICS

SC 528662

FIGURE 313.-Combat vehicle crewman's helmet, February 1958.

tory, at Wright Field, Ohio, the Metropolitan Museum of Art designed the T21,

T22, and T23 series.

The T21 (fig. 314) was patterned after the crown of Helmet, M5 (Flyer's),

but without the earflaps and with a brim contour based on the M1 shell.

Its shape had been established through anthropometric studies of the human

head (fig. 315) and provided a curvature in all directions at all points on the

body of the helmet. This latter feature was purported to provide a decrease

in the size of the helmet with no sacrifice in area coverage while increasing

the strength and protection beyond previously possible limits. The shell

weighed 2 pounds and 2 ounces and was to be worn with the conventional

inner plastic liner.

Helmet T22 was smaller than T21, was a one-piece unit incorporating

a head suspension, and was designed to be worn without a liner. Conversely,

the T23 was larger in size than the T21 and permitted the use of thicker liners.

In the interim between 1945 and the outbreak of the Korean War, modifications of the series just mentioned and additional new series were developed

but none obtained approval or standardization.

Shortly after the adoption of the M1 helmet, various investigations

revealed that other materials might possess superior ballistic protective limits
PERSONNEL PROTECTIVE ARMOR 655

FIGURE 314.-Ground troop helmet, T21.

and that these materials might obviate certain metallurgical and production

difficulties inherent in the Hadfield manganese steel. In 1942, a one-piece

helmet was fabricated from the resin-impregnated glass fiber laminate known

as doron (p. 682). At this time, doron was under consideration primarily

for use in a proposed nonmetallic helmet for civil defense workers, but subsequent tests by interested military agencies showed that existing prototypes

did not stand up well when exposed to the rigors of combat life.

Aluminum and nylon in combination had received extensive ballistic

testing in the development of body armor for ground troops and flyers, and

by 1945 samples of helmets utilizing these materials were being produced.

Coupled with the high degree of protection against fragmentation-type weapons

was the additional possibility of furnishing equivalent coverage to the M1

helmet with an appreciable reduction in weight. Therefore, the T24 helmet

was produced consisting of an outer aluminum shell, modeled after the M1,

with an inner laminated-nylon liner. Despite the cessation of World War HI

hostilities, the helmets were tested and deficiencies noted in the ability of the

nylon insert to resist delamination and warpage. The T21E utilized the

aluminum and nylon elements but was based upon the contour pattern of the

T21. This pattern had evolved from scientific anthropometric studies of the

human head and permitted a lower silhouette and closer fit than the M1 design.

At the present time (1958), the Helmet, M1, is still the standard item of issue

to Army ground troops.
656 WOUND BALLISTICS

FIGURE 315.-Aero Medical Laboratory standard head models.

Flyer's Models (World War II)

Despite the fact that the development of protective devices for air forces

combat personnel in World War II is somewhat beyond the scope of this

volume, it is believed that a brief discussion of the development of some of

the helmet models is very appropriate since many of the problems which were

encountered were very similar to those seen in the development of certain forms

for ground force personnel. The complete story of the development of protective devices for air force personnel has been written by Link and Coleman.6

This work should be consulted by all those who are interested in the medical

participation in the development of helmets and body armor in the Army

Air Forces in World War I1.

By 1943, it had become very apparent that the standard Army helmet

required redesigning to make it adaptable to the needs of air forces combat

personnel. 7 Similar in nature but more extensive in scope, the problem

£ Link, Mae M., and Coleman, Hubert A.: Medical Support of Army Air Forces in World War It. Washington:

U.S. Government Printing Office, 1955, pp. 617-635.

7 In 1943, Col. Loyal Davis, M C, senior consultant in neurological surgery in the Office of the Chief Surgeon; European

Theater of Operations, U.S. Army, found that the regular issue steel helmet furnished excellent protection against craniocetebral injuries for the soldier but that it did not provide the same excellent protection for crews of aircraft. He realized

the necessity for a helmet designed specifically for air force combat personnel. For an account of his efforts to obtain

a helmet, designed for this personnel, which would allow free and unrestricted movements, would not interfere in any

way with the field of vision, would be lightweight and afford protection from heat and cold, and, most important, would

provide protection, at least equal to that afforded by the regular issue steel helmet, against ecraniocerebral injuries, see

chapter IV in "Medical Department, United States Army, Surgery in World War II. Surgical Consultants. Volume

In." [In preparation.] See also Davis, L.: A Helmet for Protection Against Craniocerebral Injuries. Surg. Gynec. &

Obst. 79: 89-91, July 1944.-1. C. B.
PERSONNEL PROTECTIVE ARMOR 657

paralleled the work performed for the Armored Forces. Combat airmen were

faced with the situation of wearing oxygen masks and goggles and earphones

but still requiring some ballistic protective device for the head. Before an

acceptable helmet was available, 35.7 percent of unarmored bomber combat

crews sustained lethal wounds in the head region. After introduction of the

"Grow helmet" or M4 helmet, this number was substantially reduced. A

few of the helmet models which were developed and standarized are discussed

in the paragraphs which follow.

Helmet, steel, T2 (Flyer's), standardized as Helmet, M3.-This was a

direct modification of the M1 steel helmet shell with an associated adjustable

head suspension and cutaway on each side of the helmet body to accommodate

earphones. A hinged earplate provided protection over the cutaway earphone

area. Because of the immediate need for a flyer's helmet, the T2 received

extended service tests and was eventually standardized in December 1943 as

J

FIGURE 316.-Flyer's Helmet, M3.

Helmet, M3 (fig. 316). This helmet weighed 3 pounds and 3 ounces. Between December 1943 and April 1945, 213,543 helmets of this type were produced. During its development, it was recognized that this type of helmet

was unsuitable for a number of confined combat stations where a closely fitting

skullcap type of helmet was necessary.

Helmet, steel, T3 (Flyer's), standardized as Helmet, M4.-During the

early part of 1943, the Eighth Air Force had combat tested a skullcap type of

helmet, and the Ordnance Department proceeded to develop prototypes based

603225-V62 44
658 WOUND BALLISTICS

upon this design and field experience. By September 1943, this model was

being tested in conjunction with the T2 model. It consisted of overlapping

Hadfield steel plates which were enclosed in cloth pockets and mounted in the

skullcap cover of fabric and leather. Openings were available on the lateral

aspect of the helmet to permit the wearing of headphones. Notwithstanding

the decreased protective coverage of this helmet, it could be worn in the restricted space of aircraft turrets where a larger one would not be acceptable.

This helmet was standardized as Helmet, M4, in December 1943 (fig. 317A).

It weighed 2 pounds and 1 ounce. In February 1944, it was recommended that

the length of the M4 be increased to provide an adequate fit over all types of

summer and winter leather flying helmets.

Helmet, T3E3 (Flyer's), standardized as Helmet, M4AL.-Shortly after

the M4 became standard issue, it was apparent that armored earplates were

required, and a number of experimental models were developed and tested.

Finally, by April 1943, the T3E3 was adopted to replace the M4 and was

standardized as the M4A1 (fig. 317B). It differed from the M4 by having a

slight increase in length and by being equipped with attached metal earplates

over the temporal regions. This helmet weighed 2 pounds and 12 ounces.

A method was also devised to equip the existing M4 helmets with a fitted hood

containing metal earplates. In addition, the M4A1 was later modified (M4A2)

to improve the attachment of the earplates and to increase its compatibility

with other flying gear. After the adoption of the newer model, a considerable

number of experimental helmets were developed and tested in a continuing

effort to produce a universal air force helmet with extended area coverage,

increased protective ballistics limits, wearer acceptability, and compatibility

with associated flying goggles and headphones. Because of fabrication difficulties with the overlapping steel plates in M4 helmet series, emphasis was

centered upon a one-piece closely fitting helmet bowl with attached earplates.

In addition to the Hadfield manganese steel, a number of other metallic materials were considered, and at one time aluminum seemed to provide the promising combination of comparable ballistic protection at a somewhat lower

weight. However, during World War II, Hadfield steel continued to be the

principal ballistic material for helmets.

Helmet, steel, T8 (Flyer's), standardized as Helmet, M5.-The helmet,

T6E4, had a single steel bowl with no associated suspension system, fitted

close to the head, and had large hinged earflaps. It was a most promising

model, and future modifications originated from the T6 series. The T8 models

were based upon the specifications of the T6E4 but incorporated numerous

design changes which increased its acceptability over previous models. The

helmet consisted of a one-piece steel bowl with a head suspension system and

hinged earplates or cheekplates which extended down on to the sides of the face

in line with the leather flyer's helmet. The usual webbing suspension system

was augmented by a nape strap that held the front of the helmet against

the forehead so that there would be no interference with vision. The checkplates permitted the wearing of earphones and goggles. One additional mod-
PERSONNEL PROTECTIVE ARMOR 659

FIGURE 317. -Flyer's helmets. A. M4. B. M4A1 C. M5.

ification provided a slight roll to the back of the helmet to reduce the possibility of injury to the neck region during crashlandings. In January 1945,

the T8 was standardized as Helmet, M5 (fig. 317C), and was designated for all

combat aircraft positions except the upper turret gunner of the A-20 and the

ringsight gunner of the B-29. The M4A2 was still used in the two positions

just mentioned. The M5 helmet weighed 2 pounds and 12 ounces. Between

February and August 1945, 93,495 helmets of this type were produced.

During the period from October 1943 to July 1944, numerous designs

for face armor were studied concurrently with the development of flyers'

helmets. Most of the models were intended to be worn in conjunction with

the helmet and were to provide protection over the lower part of the face,

the neck, and the oxygen mask. Both metallic (fig. 318) and nonmetallic

materials were tested. The project was suspended in 1944 because of the

lack of specific requirement for this type of armor.
660 WOUND BALLISTICS

FIGuRE 318-Face armor (T6 type) designed to be worn in conjunction

with the flyer's helmet.

BODY ARMOR

"Body armor is not new." I Some form of personnel protective device

has probably been used in every war which has been recorded in the pages of

history.

During the Civil War,' a number of types of protective shields and breastplates were developed by interested parties, and some of these were considered

for possible official military usage. However, no standard official form of

armor was available, and all forms were purchased by individual soldiers.

Two types have been described as being most popular among Union soldiers.

These consisted of the "Soldiers' Bullet Proof Vest" manufactured by the

G. & D. Cook & Company of New Haven, Conn., and the second most popular

8 1 have used this simple statement as the introductory remark in numerous lectures given on the subject of the history

of body armor, and it certainly expresses the course of body armor development in modem times.-W. F. E.

9 See footnote 1 (6), p. 64J.
PERSONNEL PROTECTIVE ARMOR 661

type of breastplate was manufactured by the Atwater Armor Company, also

of New Haven. Both types consisted of metallic ballistic material made up

of a number of steel plates. The product from the Cook & Company consisted

of two pieces of steel inserted into pockets in a regular black military vest.

The infantry vest weighed 3•2/ pounds, and another model for cavalry and

artillery weighed 6 pounds. The purchase price of a vest for an officer was

$7 and for that of a private was $5. The Atwater armor consisted of four

large plates of steel held in position on the body by broad metal hooks over

the shoulders and a belt around the waist. In addition, smaller pieces could

be attached to the bottom of this cuirass. This vest was heavier than the

Cook models and cost approximately twice as much. The supply of these

finished commercial products was augmented by specimens of armor apparently

of individual manufacture by some local blacksmith.

During the course of his investigations, Dr. Bashford Dean of the Metropolitan Museum of Art was able to test the Atwater armorplate and found

that it would defeat a jacketed bullet fired from a caliber .45 pistol at a distance of 10 feet. In his short but excellent discussion of body armor in the

Civil War, Harold L. Peterson felt that the chief factors in the discontinuance

of body armor at that time were the inconvenience due to the extra weight and

bulk and the marked ridicule of those individuals who were wearing the armor

by their comrades who did not avail themselves of the protection.

Dr. Dean in his "Helmets and Body Armor in Modern Warfare" presents

a complete account of the history of body armor during World War I. Most

of the participating countries developed various forms of protective devices

for the torso and the extremities, but the excessive weight or lack of adequate

protection restricted their general use in combat. Some form of body armor

was seen on all fronts from 1915 through 1918, but only on experimental basis,

and body armor was never in general usage. The most successful use of armor

was by sentinels, members of patrols, and stationary machinegun crews.

Despite the relative low troop acceptability because of excessive weight, it

was generally believed that these forms of personnel armor had great potential

value.

General Adrian who was instrumental in developing the French helmet

was also interested in a number of other devices, including an abdominal shield,

a breastplate, and leg armor. Some of the medical officers investigating the

casualties of British forces through the year 1916 indicated that more than

three-quarters of the wounded men could have been saved if some form of

armor had been worn. This assumption was based upon a study of the type

of wounds (penetrating rather than perforating) and the preponderance of

causative missiles being derived from fragmentation-type weapons (either

shrapnel or shell fragment). Similar statistics were derived from studies of

French casualties where it was believed that 60 to 80 percent of all wounds

were produced by missiles of low to medium velocity.

Maj. Charles H. Peck, MC, Assistant Director, Surgical Service, American

Expeditionary Forces stated: "Wounds caused by missiles of medium and low
662 WOUND BALLISTICS

velocity constitute about 80 percent of all." Therefore, numerous test models

were developed by the Ordnance Department and a few of these did reach

the stage of field testing, but no final standardization was ever achieved.

The British were interested not only in metallic but also in nonmetallic

ballistic material. They developed a silk-lined necklet which was purported

to stop a 230-grain pistol ball at 600 f.p.s. However, the primary materials,

extremely difficult to obtain, deteriorated very rapidly under combat conditions and were considered costly ($25). In addition, the British also studied

a 6-pound body shield that was approximately 1 inch thick and was made of

many layers of linen, cotton, and silk hardened by a resinous material. Certain responsible military authorities were also convinced of the possible potential

value of body armor, and in 1917 General Pershing said: "Effort should be

continued toward development of a satisfactory form of personal body armor."

In the interim between 1918 and the onset of World War II, experimentation in body armor materials and design was maintained at a very low level.

However, in conjunction with its general program of developing and testing

ballistic materials, the Ordnance Department was aware of the possibilities

of certain materials' being utilized for a protective garment for the individual

soldier.

In the fall of 1941, the British Army was producing a model of body

armor in preparation for a field test, and samples of this model were furnished

to the United States. The armor weighed 2 pounds and 12 ounces and consisted of three plates of 1 mm. thick manganese steel. Two plates were to be

worn over the front and one over the back of the body. In addition, the

Ordnance Department was considering two other forms of British body armor;

namely, the Armorette and the Wisbrod Armored Vest. The Armorette was

composed of metal plates embedded in a vulcanized rubber-duck foundation

which imparted a high degree of flexibility to the model. The Wisbrod vest

utilized cloth-covered steel plates which overlapped to provide protection to

the front of the thorax and abdomen. Both of these latter two models had

been under consideration since the early part of 1941. The models were

studied by various testing boards of the interested technical services, but all

reports indicated that any advantages of such armor would be very slight as

compared to the overall loss of combat efficiency and to the increase in the

soldier's carrying load. Therefore, individual body armor for ground troops

seemed to be a military luxury which could not be indulged in during an all-out

global conflict, and there was no apparent requirement for a standard item of

issue. This latter decision was officially reached in November 1942 and led to

some decline in the overall interest and developmental program for body armor

for ground troops. But shortly after this, an extensive program was initiated

for the development of protective armor for the Air Forces. It is of some

interest to note that in April 1943 an endorsement was written to the Army Air

Forces by the Army Ordnance Department in which it was felt that body armor

for general use by ground troops had been rejected because of the apparent loss

of mobility of the troops and that an application might well be considered for
PERSONNEL PROTECTIVE ARMOR 663

combat Air Forces personnel. It was felt that ballistic protection could be

provided either by use of personnel body armor or by use of plates or curtains

which might be placed in strategic places within the aircraft.

Air Forces (World War II)

The history of the development and usage of body armor by combat crewmen of the Army Air Forces during World War II is adequately discussed in

the publication by Link and Coleman. The development of these items was so

intimately connected with various casualty surveys-some of which are reported in this volume-and by research work of the Army Ordnance Department that a brief r6sum6 would be appropriate in this chapter. No attempt

will be made to give a complete coverage of all items and the rationale behind

their development, but the more important models will be described since many

of these bear a very close relation to subsequent development for Army ground

troops.

The initial impetus to the development of body armor for the American

flyer was due to the research and field testing which the British had performed

in an attempt to develop some form of personnel armor for their ground troops

operating in North Africa. Subsequent to this, in early October 1942, an

analysis of wounds incurred by U.S. Eighth Air Force combat personnel revealed that approximately 70 percent were due to relatively low velocity

missiles. In one survey involving 303 casualties and conducted before the

adoption of body armor, it was found that flak fragments were responsible for

38 percent of the wounds; 20 mm. cannon shell fragments, 39 percent; machinegun bullets, 15 percent; and secondary missiles, 8 percent. A later survey of

1,293 casualties revealed a similar breakdown of missiles. In addition, it

seemed that protection provided to the regions of the chest and abdomen would

bring about the highest rate of return in reducing both fatalities (mortality)

and total numbers of hits (morbidity).

Therefore, it appeared to Col. (later Brig. Gen.) Malcolm C. Grow, MC,

then surgeon of the Eighth Air Force, that some type of body armor might

serve to protect aircrew members and save a considerable number of lives among

the combat crews. The initial consideration of a ballistic material was based

upon previous British experiments which had revealed that a manganese steel

plate 1 mm. in thickness would resist penetration of a caliber .303 bullet at a

velocity of approximately 1,250 f.p.s. In addition, this material was shatterproof, had high resistance, and was comparatively light in weight. After

deciding on this ballistic material, Colonel Grow, in association with the Wilkinson Sword Company, Ltd., of London, formulated plans for a vest made up of

overlapping plates of manganese steel. These 2-inch square Hadfield steel plates

were secured in pockets and sewed to a backing of flax canvas. Preliminary

testing of the armor was so favorable that Lt. Gen. Carl Spaatz, Commanding

General, Eighth Air Force, approved the recommendation on 15 October 1942

for the order of 10 suits of armor for experimental testing. Following this,
664 WOUND BALLISTICS

sufficient armor for crews of 12 B-17's were ordered and received about 1 March

1943. Later, Lt. Gen. Ira C. Eaker who had assumed command of the Eighth

Air Force directed that sufficient armor be produced in England to equip all

heavy bombers located there and also recommended that armor suits be provided for all heavy bomber units destined for the Eighth Air Force.

The original armor provided complete protection for the anterior and posterior aspects of the thorax. The vest was placed across the shoulder and

fastened by closing the dot fasteners over one shoulder. In addition to the vest,

a sporran apron section was suspended from the vest by fasteners and provided

protection for the abdomen, crotch, and part of the lower extremities. A number of models were made to be worn by various crew members, depending upon

their position and function in the aircraft. The pilot and copilot wore a half

vest only in the front, and bombardiers, navigators, and gunners wore full vests

to secure both front and back protection. A full-width sporran was for men

who had to stand during the performance of their combat duty. Other forms

were tapered toward the bottom. The full vest weighed 16 pounds; half vest,

7 pounds; full sporran, 6/2/ pounds; and tapered sporran, 4ýi pounds. The

armor was made to wear over all other clothing and equipment and eventually

was constructed so that the complete suit could be quickly jettisoned (fig. 319)

by pulling a ripcord.

Numerous casualty surveys "I conducted at various times following the

introduction of flyer's armor showed a variable reduction in the total wounds

incurred and in the number of fatal wounds over the parts of the body protected

by armor. Despite the variability expressed by the various surveys, they all

showed one thing in common; namely, that flak suits for combat crewmen were

a highly successful and valuable adjunct in decreasing the total number of

wounds and the number of lethal wounds in the thoracoabdominal region.

Surveys conducted among heavy bomber combat crew members before and

after the adoption of body armor showed the following results. The surveys

in the period before the use of body armor were conducted from March through

September 1943. The period of survey after the use of body armor was from

November 1943 to May 1944. During the March through September 1943

period, 137,130 combat crew members went on bombing missions, and 746 casualties resulted with a total of 896 wounds. This gave a casualty rate of 5.44

men wounded and 6.53 wounds per 1,000 crewmen dispatched on missions.

This gave a ratio of wounds received compared to crew members on missions

of 0.646 percent. In the November 1943 to May 1944 period, 684,350 crewmen

went on missions; 1,567 men were casualties, with a total of 1,766 wounds. This

gave a casualty rate of 2.29 casualties and 2.58 wounds per 1,000 crewmen on

missions. This gave a ratio of wounds received compared to crew members

taking off of 0.248 percent. Therefore, there was a reduction of 58 percent in

persons wounded and a reduction of 60 percent in total number of wounds sustained per 1,000 crewmen on missions.

10 Grow, M., and Lyons, R. C.: Body Armor. Air Surgeons Bull. 2:8-10, January 1945.
PERSONNEL PROTECTIVE ARMOR 665

!r

io

FIGURE 319.-Jettisoning of flyer's armor by means of ripeord and quickrelease fasteners.

Since there was the important question of whether the foregoing results

were due solely to the usage of body armor or due to a number of tactical conditions, such as change either in combat formations or in enemy tactics, a survey was done of the battle damage to aircraft during the same survey period.

In the period before the use of body armor, 26.46 percent of aircraft returning

to their bases from bombing missions were found to have battle damage. In

the period after the use of body armor, 21.47 percent of returning aircraft had

battle damage. Therefore, in a comparison of the two periods, one finds a 60

percent decrease in total number of wounds sustained by crewmen following the

introduction of body armor and a concomitant 18 percent decrease in aircraft

battle damage. Therefore, some of the reduction in the number of casualties

and in the total number of hits sustained by the casualties was undoubtedly

due to factors other than body armor, but there can be no doubt whatsoever

that the main reduction was due solely to the introduction of body armor.

A study pertaining to the anatomic location of wounds sustained during

the two survey periods revealed a reduction of 14 percent in wounds of the head
666 WOUND BALLISTICS

and neck, 58 percent in wounds of the thorax, and 36 percent in wounds of the

abdomen. During the survey period among the heavy bomber combat crew

members, there was a reduction in fatality of thoracic wounds from 36 to 8 percent and of abdominal wounds from 39 to 7 percent. This meant that after

the introduction of body armor there was a reduction of 77.1 percent in the

fatality rate of thoracic wounds and a reduction of 82.8 percent in the fatality

of abdominal wounds. During the survey period, it was also shown that body

armor prevented approximately 74 percent of wounds in the body region

covered. After termination of hostilities in Europe, a comprehensive survey

of casualty figures showed that the fatality rate for individuals with thoracic

wounds fell from 34.9 percent in the unarmored group to 15.3 percent in the

individuals wearing body armor. In those individuals sustaining abdominal

wounds, the fatality rate was reduced from 32.5 to 15.7 percent. Therefore,

because of the untiring pioneer work of General Grow and his fellow medical

officers, the value of body armor for combat crewmen in the Army Air Forces

was definitely established, but not until the Korean War was a similar situation

attained in regard to combat ground troops.

Initially, the flyer's armor, or flak suit, as it was more commonly known,

was produced solely by British manufacturers. However, it soon became

apparent that they should not be required to be the sole source of supply

for the critically needed manganese steel. Nevertheless, a total of 600 suits

were made in England. Samples suits were received in the United States

in July 1943, and the Army Ordnance Department took over the task of

quantity production and improvement in design. From that date until the

termination of World War II hostilities, the Ordnance Department and various civilian institutions were responsible for producing approximately 23

types of flyer's armor. The armor workshop of the Metropolitan Museum

of Art became the main design research laboratory in the development of

flyer's armor. The Air Force Materiel Command at Wright Field, Ohio,

had also been interested in development and production of armor, but this

function was also turned over to the Ordnance Department.

The initial production of the armor in the United States was based solely

on the design which had been developed by General Grow and his British

advisers. Hadfield manganese steel plates, of the same composition as that

used in the M1 helmet, provided the ballistic protection. These plates were

sewed into cloth pockets and fastened to a cotton-duck backing. However,

by the end of 1943, a nylon-duck cloth was substituted for the cotton material.

The nylon duck weighed 20 ounces to the square yard and increased the ballistic protection limits of the vest.

The Flyer's Vest, M1 (fig. 320), was a close copy of the design which

had been submitted from the Eighth Air Force in England. This was made

up of two sections which provided protection for the front and back of the

body and was fastened at the shoulders by quick-release dot fasteners. It

was intended to be worn by gunners, navigators, bombardiers, and radio

operators whose combat duties required them to move about so that they
PERSONNEL PROTECTIVE ARMOR 667

AB

FIGURE 320.-Flyer's Vest, Mi. A. Front section. B. Interior of back section.

would be exposed to injury from both the front and the back. The complete

Mi vest, including both front (fig. 320A) and back sections (fig. 320B),

weighed 17 pounds and 6 ounces and provided an area protection of 3.82

square feet. Between August 1943 and August 1945, 338,780 MI vests were

produced.

The Flyer's Vest, M2 (fig. 321), was made up only of an armored front

section, very similar to the frontpiece of the Mi vest, and an unarmored backpiece. It was intended to be worn by pilots and copilots and other combat

personnel whose duties would allow them to sit in a seat which could have

an armored back and provide the protection for the back of the body. The

weight of the front section for the M2 vest was 7 pounds and 15 ounces and

provided an area of protection of 1.45 square feet. Between August 1943

and July 1945, 95,919 M2 vests were produced. Both the Mi and M2 vests

were standardized on 5 October 1943. As mentioned previously, the ballistic

protection was provided by 2-inch square overlapping HIadfield manganese

steel plates which were enclosed in pockets, and since the original linen canvas

stock for the backing was not available in the United States a cotton canvas

stock was utilized and later replaced by ballistic nylon stock.

The Flyer's Apron, M3 (fig. 322A) had a construction similar to the

frontpiece of the M1 vest and consisted of a roughly triangular piece of armor

intended for use in turrets and other positions in the aircraft where space

limitation was a factor. It could be fastened to the front of the Mi or M2

vests by means of dot fasteners and had a total weight of 4 pounds and 14

ounces. It gave an area protection of 1.15 square feet. The Flyer's Apron,

M4 (fig. 322B), was similar to the M3 but was larger in size and was intended

for use by waist gunners and other individuals who could utilize a full length

armor. It had a weight of 7 pounds and 2 ounces and an area protection

of 1.66 square feet.
668 WOUND BALLISTICS

FIGURE 321.-Flyer's Vest, M2. Interior of armored front section.

FIGURE 322. Flyer's apron. A. M3. B. M4.

In addition to the flyer's apron, it was also believed that some protection

should be provided to the groin, the abdomen, and the thighs for personnel

who remained seated. The first test item was a groin armor, T12 (fig. 323A),

designed in 1943. It consisted of 10 steel plates which were shaped and

hinged to give protection to the anatomic areas just listed. The armor

weighed approximately 8 pounds and gave an area protection of 235 square

inches. A later modification knowvn as T13 was received from the Eighth

Air Force in January 1944 and consisted of three sections of overlapping

steel plates and weighed approximately 14 pounds and gave an area protection

similar to that of the T12. The T13 was modified in March 1944 and standardized as Groin Armor, M5 (fig. 323B and C). It was made in three sections so that the central area could be drawn up between the legs. The side

section spread out to provide protection for the upper aspect of the thighs.
PERSONNEL PROTECTIVE ARMOR 669

FIGURE 323.-Flyer's groin armor. A. T12. B and C. M5, showing interior view.

The entire piece could be attached to the M2 vest. It weighed 15 pounds

and 4 ounces and provided an area protection of 3.72 square feet. All forms

of the armor just described were equipped with quick-release dot fasteners

and tapes and thongs connected by a ripcord for rapid jettisoning of the armor

by the wearer.

The continued research of the Ordnance Department in an attempt to

provide an equal or higher level of ballistic protection with an increase in area

coverage and a decrease in total weight of the armor soon led to the development of other models utilizing different ballistic materials. The Flyer's Vest,

M6 (fig. 324), was standardized on 1 July 1945. This vest had the same

function as the M1 vest but was made of aluminum plates with a nylon back

padding. The vest weighed 14 pounds and 9 ounces, or 2 pounds and 14 ounces

less than the M1 vest, and had an area protection of 4.09 square feet as compared to the 3.82 square feet of the M1 model. The Flyer's Vest, M7, was of

the same construction as the M6 and was made to replace the M2 vest. With
670 WOUND BALLISTICS

A"

AA

CD

FIGUIRF 324.-Flyer's Vest, M6. A. Front section, exterior view. B. Front section,

interior view. C. Back section, exterior view. D. Back section, interior view.

the shift of emphasis to back-packed parachutes in the Pacific areas, the armor

design had to be modified to fit over the parachutes. This gave rise to two

models (M6A1 and M7A1) which fulfilled this function. The models were

constructed of aluminum and nylon. In addition to these last two items, a

number of other experimental models were developed by the Ordnance Department and the Metropolitan Museum of Art. The T5 series of flyer's armor

contained larger overlapping armorplates and were held snugly against the

body by an elastic webbing. This provided an increase in area protection

with a decrease in weight of the end item.

Concurrent with the interest by both the Army and Navy in laminated

layers of woven glass fabric impregnated with plastic (doron), this material

was considered in flyer's armor. The T37 series in experimental models showed

a replacement of the steel plates in the M1 vest by flat doron plates 2 inches

square and 0.130 inch thick. A later modification utilized thicker doron

plates that had an outer curvature. However, with the advent of improved

aluminum and nylon ballistic material, the doron project for flyer's armor was

discontinued.
PERSONNEL PROTECTIVE ARMOR 671

FIGURE 325.-Flyer's neck armor. A. T44. B. T59E1.

In addition to the improvement in the flyer's vest, similar end items and

experimental models were developed in aprons and groin armor. The Flyer's

Apron Armor, M8 and M9, were standardized in July 1945 and were to be

usedwith the M6 and the M7 vests. Bothof thesewere constructed of aluminum

and nylon; the M8 apron armor weighed 4 pounds and 11 ounces while the M9

weighed 6 pounds and 8 ounces. Additional apron armor to correspond with

the M6E1 and M7E1 were also developed. With the replacement of the

Hadfield steel plates by aluminum and nylon, a similar change occurred in

groin armor. The Groin Armor, M10, standardized in July 1945, was made

of aluminum and nylon and was to be used in conjunction with the newer

vest. At the termination of hostilities, many very interesting tests were being

performed to see if flyer's clothing and equipment could be made of nylon-type

cloth and by itself provide some ballistic protection. This would then have

reduced the weight of the aluminum-nylon-cloth combination ballistic armor

and might have provided a higher protection ballistic limit with a decrease in

total weight of the armor end item.

At one time, it was felt that protection should be given to the region of the

neck which might be exposed between the helmet and the armored vest. Therefore, a T44 series (fig. 325A) of experimental models was developed and consisted of a Queen Anne's type of neckpiece which was made to rest on the

shoulders and attached to the M4 series of helmets. This had the same construction as the M1 vest and consisted of 2-inch square Hladfield steel plates.

The development of this item was terminated in June 1945 when a shift was

made to aluminum and nylon as the ballistic material. The T59 series (fig.

325B) consisted of curved aluminum plates with a nylon-duck backing which

was made to fit the contour of the shoulder and neck. Both frontpieces and

backpieces were made to be attached to the armored vest of similar construction. One of the experimental models, T59E2, was standardized as M13 in
672 WOUND BALLISTICS

September 1945. Tables 249 and 250 show some of the production figures for

the various types of flyers' armor and a summary of the weight and area protection. All of the statistics have been derived from various sources and

might show some variation from other compilations.

TABLE 249.-Produncion figures' for flyers' armor in World War II, 1943-45

Type of armor 1943 1944 1945 Total

Flyer's Vest:

Ml ------------------------ 111, 842 130, 937 96, 001 338, 780

M2 ------------------------ 42, 373 29, 546 24, 000 95, 919

M6 ------------------------------------------------- 1,075 1,075

Flyer's Apron:

M3 ------------------------ 57, 513 54, 571 30, 730 142, 814

M4 ------------------------ 68, 467 84, 665 56, 012 209, 144

Flyer's groin armor, M5 ---------------------- 41,872 68, 029 109, 901

Flyer's neck armor:

T44 ------------------------------------------------ 10, 969 10, 969

T59E1 --------------------------------- ------------ 100 100

I

I These figures have been compiled from various sources and do not represent final Ordnance Department compilations.

TABLE 250.-Flyers' armor and corresponding weight and area protection

Material and type of armor Weight Area protection

0.045-inch Hadfield manganese steel:

Vest: Lb. Oz. Square feet

M1 -------------------------------------------- 17 6 3.82

M2 -------------------------------------------- 7 13 1.45

Apron:

M3 ------------------------------------------- 4 14 1. 15

M4 ------------------------------------------- 7 2 1.66

Groin Armor, M5 ---------------------------------- 15 4 3. 72

0.102-inch 24 ST aluminum and 7-ply 19 ounce nylon duck:

Vest:

M6 ------------------------------------------- 14 8 4. 09

M7 __ 7 13 1.82

Apron:

M8 ------------------------------------------- 4 11 1.23

M9 -------------------------------------------- 6 8 1.89

Groin Armor, M10 ---------------------------------- 13 11 3. 62

0.102-inch 75 ST aluminum and 6-ply 13 ounce nylon duck:

Vest:

M6AI ----------------------------------------- 16 15 5. 88

M7A1 ----------------------------------------- 7 12 2.08

Apron:

MSA1 ---------------------------------------- 4 4 1.23

M9A1 ---------------------------------------- 5 12 1.89

Groin Armor, MOA1 -------------------------------- 12 5 3. 62

Neck --------------------------------------------- 3 13 1.33
PERSONNEL PROTECTIVE ARMOR 673

Following the widespread use and adoption of flyer's armor, a considerable

number of other sections of the lighting forces became interested in its possible usage. In October 1943, Motor Torpedo Boat Squadron Number Twenty

Five became interested in possible revision or modification of the flyer's armor

for their usage. Similarly, the Cavalry Board at Fort Riley, Kans., was also

interested in its possible use for mechanized cavalry personnel. In addition,

one of the companies producing flyer's armor also submitted samples of a

modification of the original design for possible usage in amphibious and other

invasion landings. These designs were of various types; some provided

only thoracoabdominal protection, and others provided protection for the

extremities.

Ground Troops (World War II)

Unlike helmet design, which had a considerable carryover from World

War I development and experience, little if any information was available

at the advent of World War II on the possible design of a body armor for

ground troops. Numerous military authorities had advocated the use of

body armor during World War I, but it had only reached a preliminary testing

stage before it was generally rejected. During World War I, the United

States had developed several types of armor. One, the Brewster Body Shield,

was made of chrome nickel steel, weighed 40 pounds, and consisted of a breastplate and a headpiece. This armor would withstand Lewis machinegun

bullets at 2,700 f.p.s. but was unduly clumsy and heavy. In addition, the

Metropolitan Museum of Art in February 1918 had designed a breastplate

based upon certain 15th century armor. Again, this model weighed 27 pounds;

all investigators considered it to be very noisy and thought that it markedly

restricted all movements of the wearer. Another extremely interesting model

was the scaled waistcoats or jazerans which were constructed of overlapping

steel scales fixed to a leather lining. The armor was closely fitting and was

considered comfortable. The total weight was 11 pounds.

Numerous investigators in the Ordnance Department and in the other

technical services had contemplated the development of armor for ground

troops in the early stages of World War II. However, very preliminary

investigations had shown that most models were too heavy, were incompatible

with standard items of equipment, and tended to restrict the mobility of the

soldier. Therefore, the development of armor for ground troops was initially

rejected as an unsound idea, and the development of a flyer's armor received

more or less full attention. However, continued investigation in the development of lighter weight metallic ballistic material and in the relatively new

field of nonmetallic ballistic material led to a resurge in interest for armor for

ground troops. Therefore, the historical study must be traced through both

types of ballistic material, and initially the types of armor utilizing metallic

material will be discussed.

It is difficult to ascertain exactly when the redevelopment of armor for

ground troops was initiated, but it apparently began sometime near the middle
674 WOUND BALLISTICS

WRAMC-55-19050-6

FIGURE 326.-Japanese body armor; the type studied by Lt. Col. I. Ridgeway Trimble, MC.

of 1944. In June 1944, the Army Service Forces requested armor for the

protection of soldiers from antipersonnel mines. Another major initiating

feature was undoubtedly due to some of the excellent work performed by

Lt. Col. I. Ridgeway Trimble, MC, then chief of the surgical service at the

118th General Hospital, Sydney, Australia. Colonel Trimble became very

interested in reports concerning the use of armor by Japanese ground troops.

After a great deal of difficulty and personal disappointment, he was able to

secure a copy of Japanese armor (fig. 326). Based on the Japanese design

and his own personal observation as to the areas to be protected and the most

commonly encountered wounds and causative agents, he developed a model

for ground troop armor.'1

In addition to Colonel Trimble's persistence in presenting his material,

various other members of the consulting division of the Medical Department

of the Army were very instrumental in overcoming some of the prejudice

which was present on the part of the services which would use the body armor.

"11 A chronological report of his development of a design for body armor for ground troops has been prepared by Dr.

Trimble and is presented on pages 685-689. It is of considerable significance to note the general course the development followed, and it is also of some personal interest to us to see the great many obstacles which had to be surmounted

before the responsible individuals developed any great interest and respect for the submitted item. As mentioned by Dr.

Trimble, a report of the body armor design and photographs of the Japanese armor were submitted to Dr. George R.

Harrison, Chief of the Research Section, General Headquarters, Southwest Pacific Area. The initial report was tendered

in April 1944, but owing to the accidentalloss of the report and pictures, it was not until 23 May 1944 that the report was

finally on its way to Washington. After a review of the material, Dr. Karl T. Compton, Chief, Office of Field Service,

Office of Scientific Research and Development, War Department, advised the Commander in Chief, Southwest Pacific

Area, that the Ordnance Department was extremely interested in Colonel Trimble's design and felt that it represented an improvement over the one which they were currently considering.-I. C. B., W. F. E., and R. H. It.
PERSONNEL PROTECTIVE ARMOR 675

A B

OCO-A3751

FIGURE 327.-Japanese body armor. A. Type III. B. Type II.

Other types of Japanese body armor (figs. 327, 328, and 329) which were

captured in the Pacific consisted of an anterior thoracoabdominal shield with

and without lower extremity protection. Various other members of casualty

surveys in the Pacific areas, notably in the New Georgia and Bougainville

campaigns, were also convinced of the apparent importance which body armor

might have in reducing total number of wounds and number of lethal wounds

in ground troops.

Based upon the armor submitted by Colonel Trimble and on the various

other specimens collected by technical observers of the Ordnance Department

in the Southwest Pacific Area, an experimental model was developed and this

design was known as vest, T34. The armor consisted of 0.684-inch thick

carbon steel plates. Owing to the excessive weight of the end item and also

to the development of lighter weight ballistic materials, the T34 series was

discontinued. Various other experimental models were being tested at about

the same time and one of these consisted of the armor, breast, T36, which

was patterned somewhat after a World War I model. The vest, series T39,

consisted of a small piece of anterior armor with a stitched nylon-webb backing

and utilized various metallic ballistic materials, such as steel or aluminum, in

the form of overlapping plates. Numerous other experimental models were
676 WOUND BALLISTICS

O C O-A3790

FIGURE 328.-Japanese body armor, Type III, disassembled.

developed, but only those which resulted in a standardized end item will be

discussed.

The vest, T62E1, consisted of two pieces, front and back, which were

fastened together at the shoulder by quick-release fasteners. The ballistic

materials consisted of 0.102-inch thick aluminum plates and a backing of

5-ply nylon cloth. All of the aluminum plates had a slight overlapping to

provide thorough protection, and there was a small anterior flap on the frontpiece which was designed to give additional protection to the region of the

heart and great vessels. The vest weighed 9 pounds and 10 ounces and had

an area protection of 3.45 square feet. The vest, T62E1, was modified in

order to provide additional ballistic protection and resulted in the T64 series

which was standardized in August 1945 as the Armor, Vest, N112 (fig. 330).

This M12 vest was made of thicker aluminum plates than the T62E1

series and had additional layers of nylon cloth. It weighed 12 pounds and 3

ounces and provided an area protection of 3.45 square feet. The design had

been modified to provide greater protection for the anterior portion of the

thorax both by increasing the width of the main frontpiece and also by

increasing the size of the anterior flap over the heart and great vessels. In

addition, some increase in protection was provided for the axillary regions.

However, the areas of the junction of the neck and thorax and of the axillary

regions were still relatively uncovered and, as it was seen during the use of
PERSONNEL PROTECTIVE ARMOR 677

O C O-A3789

FIGURE 329.-Japanese body armor, Type III, assembled.

the M12 vest during the Korean War, provided a ready access for the entrance

of missiles into the thorax. An Apron, Model T65, was also produced to be

attached to the M12 vest in order to provide ballistic protection for the lower

part of the abdomen and the groin region. The apron could be attached to

the bottom of the vest by quick-release fasteners. It was made of 21-ply

nylon cloth, weighed 1 pound and 9 ounces, and had an area protection of

0.66 square feet.

A considerable number of the vests and aprons were produced and were

scheduled for field testing and observation by a joint medical-ordnanceinfantry team 12 just at the cessation of the war in the Pacific. In July 1945,

1,000 T62E1 vests with the T65 apron and 1,200 T64 vests were shipped to

the Pacific theater for field testing, but this was never accomplished. Therefore, the vest received considerable experimental testing, but it was not until

the Korean War that it was utilized in the field. With the rebirth of body

armor during the Korean War, the M12 vest was used initially by American

troops in conjunction with the newer all-nylon-type vest. Following the

completion of the initial surveys and standardization of the final end item,

all U.S. frontline troops were equipped with the newer all-nylon or doron vests,

and the M12 vests were used by Republic of Korea troops.

12 Montbly Progress Report, Army Service Forces, War Department, 31 July 1945, Section 7: Healtb, p. 15.
678 WOUND BALLISTICS

LB

FiauRE 330.-Armor, Vest, M12, for ground troops. A. Front section with apron,

T65. B. Back section. C. Front view of M12 vest on soldier. D. Side view of M12

vest and T65 apron, on soldier.
PERSONNEL PROTECTIVE ARMOR 679

The following tabulation shows some of the production figures for groundtype armor in World War II:

Type of armor: produced Number

Vest:

T62E1 ------------------------------------- 14,100

M12 .-.-.-..........-------------------. 2 53, 352

Apron, T65 ------------------------------------- ' 8,060

Crotch, T16E4 ---------------------------------- 3 12, 220

Eye, T45E6 (M14) ------------------------------- 4 100

I For June 1945.

2 For June, July, and August 1945.

3 For January-June 1945.

4 For September 1945.

The production of the M12 vest was slated to continue to a certain degree

after August 1945, and before the termination of hostilities it was estimated

that 100,000 vests of this model would have been produced by September

1945. Table 251 is a summary of the type of armor and its corresponding

weight and area protection.

TABLE 251.-Ground troop armor and corresponding weight and area protection

Type of armor Weight Area protection

Vest: lb. Oz. Square feet

T62E1 (0.102-inch 24 ST aluminum plates and 5-ply

nylon duck) -------------------------------------- 9 10 3.45

M12 (0.125-inch 75 ST aluminum plates and 8-ply 13

oz. nylon duck) ----------------------------------- 12 3 3.45

Apron, T65 (21-ply 13 oz. nylon duck) --------------------- 1 9 . 66

Crotch, T16E4 (manganese steel and nylon) ---------------- 3 6 1. 15

Eye, M14 (manganese steel) ------------------------------ 7

Following the termination of hostilities in the Mediterranean and European Theaters of Operations, it soon became very evident that some type of

protective devices would be required by personnel engaged in minefield clearance. As early as June 1944, the Office of the Chief Engineer was engaged in

the development of a protective device for the combat boot. The overall

project was later coordinated with the Ordnance Department and led to the

development of the T16 series of crotch armor.

The model T16E4 was based on a previous flyer's model and originally

consisted of a central crotch section with two overlapping metal plates which

were hinged on the sides. Later, the central hourglass-shaped section was

developed with two lateral phalanges made up of nylon material. The central

area continued to be made of small overlapping metal plates and was fastened

by means of straps to the cartridge belt. A later model, the T16E6, provided

a reduced area coverage through elimination of the central protection in the
680 WOUND BALLISTICS

AB

FIGURE 331.-Crotch armor, T16E4. A. Front view. B. Back view.

rear and a reduction in the size of the lateral leg phalanges. However, some

increased protection was provided in the region of the groin and genitalia.

This model was also constructed of a combination of 2-inch square manganese

steel plates and nylon-duck material. It was believed that the crotch armor

could be used in conjunction with other items of personnel armor and some

locally improvised lower extremity protection for those individuals engaged in

mine clearance. The model T16E4 (fig. 331) weighed 3 pounds and 6 ounces

and provided an area protection of 1.15 square feet.

There is a dearth of medical statistics in regard to the positive importance

of crotch armor for such personnel. However, numerous casualties were seen

during the Korean War who suffered extensive saddle-type injuries due to

detonation of landmines. It is very conceivable that protection in the region

of the groin, the upper part of the thighs, and the buttocks would have been of

some value for these individuals. Therefore, in conjunction with the development of the thoracoabdominal vest during the Korean War, an all-nylon

crotch armor was produced, but it was not intended for general usage. It was

advocated only for personnel engaged in specialized tasks, such as mine

clearance.

In May 1945, samples of eye armor were being manufactured by the French

Army, and designs to fit the U.S. Mi helmet were collected for testing by the

Army Ordnance Department. These models were not considered adequate,

and a new series of eye armor, T45 (fig. 332), was developed. This consisted

of a plate of manganese steel, the same as that in the M1\ helmet, and was

provided with small vision slits. The entire structure was mounted in a rubber

dust-goggle frame. Close coordination between the Ordnance Department,
PERSONNEL PROTECTIVE ARMOR 681

A

FIGURE 332.-Eye armor, T45 series. A. T45E4. B. T45E6.

Engineer Corps, Army Ground Forces, and the Office of'the Surgeon General

showed that the T45E6 (fig. 332B) was the most acceptable design, and it was

standardized on 10 January 1946. Notwithstanding the cessation of hostilities

by this time, it was believed that a standard item was required for the clearance

of minefields in occupied countries.

It is of some interest to note that other types of protection for ground

troops very similar to that which was tested in World War I also saw some

consideration during World War II. An example of this was a project on

mobile shields (fig. 333) which was initiated in September 1943. It was considered that the device could be manipulated by a single man and that it would

provide protection against rifle and machinegun bullets at a very close range.

This would permit the soldier to close in on highly fortified positions and

provide protection for soldiers stationed in advanced observation posts. It

was believed that the ballistic protection would have to be provided by armorplates of considerable weight and thickness and that the entire device would

have to be transported by means of wheels. In order to provide the degree of

ballistic protection considered necessary, the planners thought the weight

would have to range in the neighborhood of 150 to 200 pounds. After a very

brief consideration, the entire project was discontinued.

The use of nonmetallic ballistic material for body armor was a result of

close liaison between various developmental agencies in both the Army and

Navy and only reached the possibility of a possible end item in the Navy.

However, because of the association of the Army Quartermaster Corps and

Ordnance Department in its development, some brief mention of it would be

appropriate at this time. The search for a nonmetallic ballistic material

stemmed partially from a desire to reduce the overall weight of metallic body

armor and also because of the critical shortage of the metallic material during

World War II. Therefore, an active search was carried out by research and

development people in all branches of the military services. Two of the most

active sites of research were the Research and Development Branch of the

Military Planning Division, Office of the Quartermaster General, and the

Naval Research Laboratory. The Quartermaster Corps was interested in

603225- 62 45
682 WOUND BALLISTICS

FIGURE 333.-Mobile shield, T1E2.

obtaining a nonmetallic material both for body armnor tor ground troops and

for usage in civilian defense helmets. The Naval Research Laboratory was

interested in the possibility of body armor for use by Marine ground forces and

certain shipboard personnel. The Army Ordnance Department was also actively engaged in this search and was responsible for all ballistic evaluation

tests. Woven glass-fiber fabric impregnated with plastic (doron) had been

considered in August 1944 for use in flyers' armor, but the program was discontinued following the favorable test results with aluminum-nylon combinations.

The doron was to be utilized in the form of 2-inch square plates, 0.130 inch

thick.

A number of industrial concerns instigated active research programs, and

in May 1943 the Dow Chemical Company laminated a fibrous glass fabric

which immediately proved very promising. The initial product consisted of

layers of glass filaments of Fiberglas bonded together with an ethyl cellulose resin

under high pressure. Some of the individuals working with Col. (later Brig.

Gen.) Georges F. Doriot, then director of the Military Planning Division, Office

of the Quartermaster General, decided that the project should be known as the

" Doron Project'' in his honor. Therefore, the glass fiber laminate manufactured by the Dow Chemical Company became known as and continued to be

called doron.

The initial material was known as doron, Type 1, and future modifications

consisted primarily of variations in the bonding resin in order to give a more

adequate ballistic performance over a wider temperature range. Most of the
PERSONNEL PROTECTIVE ARMOR 683

body armor developed during World War II utilizing doron was prepared from

a form known as doron, Type 2. In addition to the military developmental

agencies, numerous private industries were also involved in the research,

development, and production of doron material. These included the Westinghouse Electric Corporation, the Continental-Diamond Fibre Company, the

United States Rubber Company, the Hercules Powder Company, the American

Cyanamid Company, the General Electric Company, The Firestone Tire and

Rubber Company, The Formica Company, the Monsanto Chemical Company,

and numerous others.'3

Because of biservice interest in the possible usage of doron, a Joint ArmyNavy Plastic Armor Technical Committee was established. This committee included members from the Office of the Army Quartermaster General, the Naval

Research Laboratory, the Navy Bureau of Ships, the Office of the Army Chief

of Ordnance, the Navy Bureau of Medicine and Surgery, and the Navy Bureau

of Aeronautics.' 4 The purpose of the committee was to coordinate all research

and development efforts and also to facilitate the production of doron. Ballistic research had provided sufficient information so that it was possible to

calculate that a K/6-inch plate of 8-ply doron, Type 2, would have a protection

ballistic limit sufficient to stop a caliber .45, 230-grain bullet fired from the

standard service automatic pistol at a velocity of 800 f.p.s. Therefore, in order

to provide some degree of safety over this calculated minimal V50, it was felt

that the material for body armor should be made up of /%-inch 15-ply doron,

Type 2.'" The Army Ordnance Department felt that a better correlation could

be attained between the use of nylon-aluminum combinations and protection

ballistic limit, body coverage, and total weight of the finished item. Therefore,

doron was tested in a considerable number of experimental models, but the

consensus was that Hadfield steel or aluminum-nylon combinations were superior. Therefore, no end items were developed in the Army program utilizing

doron as the ballistic material. However, the Navy felt that doron was a most

promising material and continued toward the development of some form of

armor for Marine ground troops and shipboard personnel.

The Xg-inch thick doron plates were utilized by the Navy in two forms;

namely, (1) by placing eight panels into pockets on the outside of the Navy

kapok lifejacket and (2) by sewing plates on the inside of the pockets of the

standard-issue Marine Corps utility jacket. The armor used in both jackets

weighed 4 pounds and covered a body area of approximately 3 square feet.

In an attempt to provide a more drastic demonstration of the ballistic

properties of doron and also to determine whether the doron armor could be

closely applied to the body or would require some offset, a most courageous

demonstration was conducted by two Navy officers. Lt. Comndr. Edward L.

Corey, USNR, wore the new armored lifejacket vest and permitted an associate,

Lt. Comdr. Andrew Paul Webster, USNR, to fire at him with a caliber .45

13 (1) Fuller, P. C.: Laminated Glass Cloth Used as Body Armor. The Frontier 8:8, December 1945. (2) Fetter,

Edmond C.: Doron Armor. Chemical and Metalluigical Engineering, February 1946, p. 154.

"14 King, L.: Lightweight Body Armor. Quartermaster Rev. Marcb-April 1953, p. 48.

15 Webster, A. P.: Development of Body Armor. Hosp. Corps Quarter. 18:31-33, October 1945.
684 WOUND BALLISTICS

pistol. There was complete defeat of the bullet, and this demonstration was

repeated 21 times with no serious injury.

As a result of the total testing procedure, the Marine Corps requested that

a full battalion of landing troops be equipped with armored jackets. Approximately 1,000 jackets were prepared and were intended to be used with a Marine

division during the Okinawa operation. A survey team from the Naval

Research Laboratory and from the Office of the Quartermaster General of the

Army were to conduct surveys on both armored and unarmored men in an

attempt to ascertain the jacket's actual value and also guide future design in

developmental programs. Unfortunately, the Marine division which was to

conduct these tests was not employed in the Okinawa operations. A few of the

armored jackets were probably used in the last phases of the fighting on Okinawa, but no large-scale survey was conducted.

The development of doron was sufficiently advanced so that armored

doron jackets could have been available for the troops at the time of the invasion in Normandy and undoubtedly would have been very instrumental in

saving a considerable number of lives. However, there is always a great deal

of reluctance and inertia which has to be overcome before the using agencies

will accept body armor. This is not meant as a reflection upon the Ground

Forces but rather exemplifies their innate and natural desires for a battle to

reach a swift and successful conclusion. This can only be accomplished by

having the largest number possible of active fighting men who can swiftly and

completely perform all combat duties. Therefore, any form of personnel

armor has to be completely compatible with all equipment required for the

performance of these duties, impose a minimal additional weight load, be comfortable in all climatic conditions, impose little if any restriction on mobility,

and finally have a high degree of troop acceptability. If it can be graphically

demonstrated that body armor can be constructed so that it will meet all imposed military characteristics, there is a more general acceptance of the item

by the Ground Forces.

Naturally, the Medical Corps is immensely interested in any item which

brings about a reduction in morbidity and mortality of battlefield casualties.

During World War II, medical treatment of the battle casualty had reached a

high degree of excellence, and if hostilities had continued it would have soon

become apparent that some additional means would have to be provided for

the reduction of total number of wounds and number of lethal wounds. In

other words, something would have been required forward of the battalion aid

station level in an attempt to prevent men from being wounded and to reduce

the number of men who were being killed instantly. Unfortunately, this

lesson of body armor was not learned until late in World War II, and it was not

until the Korean War that the numerous sceptics were convinced and body

armor was accepted wholeheartedly.

Let us hope that peacetime stagnation will not completely shackle the

developmental program so that in the advent of any future hostility body armor

will be available at its immediate onset.
PERSONNEL PROTECTIVE ARMOR 685

REPORT OF DEVELOPMENT OF A DESIGN FOR BODY ARMOR FOR

THE FOOT SOLDIER

On or about 1 September 1942 I read in the Sydney newspapers about an armored

Japanese vest captured in New Guinea by Australian soldiers during the Papuan campaign,

and consulted Dr. Dew, Professor of Surgery at Sydney University, as to where I might

procure such a vest. He wrote to Colonel W. J. Hailes, Medical Directorate, L.H.Q. Victoria Barracks, Melbourne, whose letter of 12 September 1942 told me that work along these

lines was being studied in the Middle East by a member of the Medical Research Council of

Great Britain. Lt. Colonel R. V. Graham's letter of 16 November 1942 written from the

103rd Australian General Hospital stated that he had asked his son who was in New Guinea

at the time to try to procure such a vest for me.

Colonel C. A. Jillet, D.D.O.S. First Australian Army, wrote 30 November 1942 that

the First Army had not received such equipment.

Letters written to the Police Departments of the cities of New York, Chicago, Pittsburgh,

and Los Angeles resulted in replies during January and February 1943 telling of the protective armor used by them.

19 November 1942 I wrote Brig. General Hanford MacNider asking him to try to

procure a vest for me in New Guinea, and asking him for his ideas on protection for foot

soldiers.

Colonel C. N. Kellaway, of the Australian Army, and Director of the Walter and Eliza

Hall Institute of Research in Pathology and Medicine, personally brought me from Melbourne information relative to work done by the Body Protection Committee of the Medical

Research Counsel of Great Britain.

25 November 1942 I called on Colonel C. C. Alexander, Chief of Staff to Maj. General

Richard Marshall, Commanding General, SOS, to ask him how to procure a Japanese vest

telling him that I had for a long period thought some practical armor protection could be

worked out for ground troops. Colonel Alexander was most interested and advised me to

see Colonel Carroll, the Chief Surgeon, and Colonel Thorpe of G2. Colonel Carroll was

enthusiastic and spoke of his having thought of including the spade of the entrenching tool

as body protection. Major Suave in Colonel Thorpe's office promised to obtain the Japanese

vest for me.

9 January 1943 a letter came to me from G.H.Q., SWPA., Rear Echelon entitled "Captured Japanese Bullet Proof Vests," which attached a letter from the office of the Director

of Staff Duties, L.H.Q., Australian Army, acknowledging my request on 24 November

1942 for the loan of a Japanese Bullet Proof Vest, adding that the only one in the possession

of the Australian Army was being tested at the Broken Hill Pty. Steel Works, Newcastle,

N.S.P., and suggesting that I inspect the vest at these premises.

17 February 1943 I received a captured Japanese vest (fig. 334) from Commander

J. C. Morrow of the Australian destroyer "Arunta" through one of his officers, Midshipman

Norman H. Smith. I showed it to Colonel Carroll and Colonel Alexander and on 26 Feb.

1943 had the Signal Corps make drawings and pictures of it.

16 April 1943 the U.S. Quartermaster Department of G4, SOS, asked me to try out

some plastic material as possible use in body armor so Major Coleman of that department

and I made some firing tests on the shooting range at Long Bay, N.S.W., the plastic material

being easily pierced and fragmented by the caliber .45 automatic pistol and Thompson

submachinegun bullet.

22 March 1943 Mr. R. M. Service of the Australian Army Inventions Directorate

forwarded to me the analysis of the armor plate of the captured Japanese vest and that of

some Australian steel submitted by an Australian civilian, a Mr. R. Welch, who was trying

to interest the Australian and American armies in a steel jacket made of individual pieces

of steel approximately 4 inches square, linked together with a hinge on all four edges. Mr.

Welch's armor was put on by inserting one's head through a hole in the center of the gar-
686 WOUNI BALLISTICS

WR AM C-55-1905O-5

FIG17RE 334.-Lt. Col. I. Ridgewav Trimble, MC, wearing captured Japanese vest.

ment, like putting on a poncho. Beginning at this time, at the request of Mr. Welch and

Mr. Service, Lt. Colonel D. Garrison of the U.S. Ordnance and myself tested Mr. Welch's

vest on the firing range as well as a model based on the Japanese vest in my possession and

made for me by chief operating room nurse, 1st Lt. A. M. Seney. The plates for my vest

were six large ones (fig. 335), overlapping and placed inside the vest, in accordance with the

Japanese plan (fig. 336). However, my plates were made from plaster casts moulded on

a man of 150 lbs, 5 ft. 7 in. in height and covered more of the regions of the collar bones,

the upper part of the breast bone, the flanks and the lower abdomen than did the Japanese.

Mr. Welch kindly offered to hammer out for me some steel plates in exact accordance

with my plaster casts, and we used these new plates of mine to test on the firing range as

well as testing his linked steel armor.

His armor proved entirely unsuitable, because a missile striking a hinged joint would

penetrate the armor in the majority of instances.

25 Mlarch 1943 I sent to Brig. General C. C. Alexander, Hq. USASOS, APO 501 the

first summary of my study on protective body armor, telling of my possession of the Japanese

vest and recommending a vest "constructed along the lines of the captured Japanese one"

for our own army. This report was forwarded by General Alexander to the Chief Surgeon

and the Chief Ordnance Officer, SOS Headquarters, APO 501.

13 June 1943 Brig. General J. L. Holman wrote to me requesting that my set of Japanese

armor be sent to the Chief Ordnance Officer in Washington, D.C. through Base Section 3,

APO 923. This armor was sent by me 17 June 1943, and acknowledged by General Holman

20 June 1943.
PERSONNEL PROTECTIVE ARMOR 687

B

WRAICTC-55-19002, 4

FIGURE 335-Armorplates developed by Lt. Col. I. Ridgeway Trimble for incorporation

into a proposed armor vest for ground troops. A. Front view. B. Back view.

16 September 1943 I wrote General Holman objecting to a public demonstration of

body armor before the press by Mr. R. Welch at Base Section 7. The armor was apparently

that of his design since the Sydney newspaper account, dated 15 September 1943, spoke

of light steel plates linked together; but the enclosing tunic in the photograph published

by the newspaper was similar to my modification of the Japanese one. Mr. Welch's original

armor had no tunic. The performance of the vest against various types of firearms was

reported in this paper. The demonstration was made without consulting our army or

intelligence at any time.
688 WOUND BALLISTICS

W RVA M C-55-19050-3

FIGURE 336.-Japanese body armor, showing internal construction.

23 December 1943 Colonel W. C. Cauthen, Chief Ordnance Officer, USASOS, APO 501,

wrote asking that the vest which I designed be submitted to the Chief of Ordnance. This

vest was taken to the Ordnance at APO 501 by me 2 January 1944 and kept by Ordnance

501 for me until my return from duty in New Guinea, 15 April 1944.

15 February 1944 Maj. General N. F. Twining, Commanding General of the 15th Air

Force, wrote, asking me to bring my vest to the attention of the Head Flight Surgeon of

the 5th Air Force. I was in New Guinea at the time but submitted the vest to the office of

the Flight Surgeon at APO 501, 15 April 1944.

20 April 1944 a complete set of blue prints of my vest was made at the office of the

Surgeon, 5th Air Force.

23 April 1944, at the direction of the Chief Surgeon, USASOS, APO 501, I submitted

a final report of the body armor to the Research and Development Board, Hq., GHQ, APO

500 with an endorsement by the Chief Surgeon, Brig. General G. B. Denit. The receipt

of this information was acknowledged by Dr. G. R. Harrison, Chairman of this Board.

The final model of the vest submitted by me differed from the Japanese in the following

particulars:

"a. The vest and its metal plates are designed in a larger size than the Japanese. The

plates were hammered out of steel from plaster casts moulded on a soldier 5'7" in height

weighing 150 pounds. These plates should fit all soldiers except those of an extremely

small or large stature. (A marking of "medium" in Japanese characters on one of their

vests indicates that they are manufacturing them in more than one size.)

b. The space at the base of the neck just above the breast bone and the region of the

large blood vessels just beneath the collar bones are covered in the new design.

c. Better metal protection is given the flanks and the lower part of the abdomen.

d. A metal plate is added on the inside of the back of the vest to cover the base of the

spine and the kidney areas.

e. The button arrangement of fastening the vest down the front has been eliminated

because it takes too long to discard the vest by this method. The front of the vest should

be in one piece. The vest should be fastened by one or two clasps along the left side of the

chest and flank, and by a clasp on each broad shoulder strap of the vest. These last two
PERSONNEL PROTECTIVE ARMOR 689

clasps should be arranged sufficiently low on the shoulder so as not to be pressed on by the

rifle when carried on the shoulder or by the butt of the rifle when firing. By this arrangement

the vest can quickly be discarded in any direction even with overlying cartridge belts, etc.

f. A small curved strip of metal should be incorporated into each shoulder strap to help

prevent the wounds incurred by missiles entering the chest through the space above the

collar bones, when a man is charging with the upper part of the body bent forward.

g. In soldiers or sailors in stationary positions, where extra weight is not so important,

such as crews of antiaircraft guns, additional metal plates could be added to protect the back

and shoulders from gun fire."

I. RIDGEWAY TRIMBLE,

Lt. Colonel, MC,

Chief of Surgical Service,

118th General Hospital, APO 927

603225"-62---46
CHAPTER XII

Wound Ballistics and Body Armor in Korea

Carl M. Herget, Ph. D., Capt. George B. Coe, Ord Corps,

and Ma]. James C. Beyer, MC

Wound ballistic and body armor studies duling the Korean War could

draw upon the experiences of studies reported in earlier chapters for valuable

orientation and guidance. In addition, results of basic wound ballistic investigations (including body armor studies) conducted in the laboratory were

available to aid in the interpretation of field findings. Thus, when hostilities

opened in Korea in June 1950, developments for field protection which had

been planned during World War II reassumed vitality.

Before the opening of hostilities in Korea, the Biophysics Division of the

Chemical Corps Medical Laboratories had been carrying out basic research

in the fields of wound ballistics and body armor.1 These studies entailed a

comprehensive evaluation of the wounding potential of many types of missiles,

especially small arms projectiles and fragments, when striking animal tissue.

Samples of armor material, including nylon, doron (fiber glass), steel, aluminum,

and combinations of these had also been tested to ascertain the relative protection these materials afforded the animal head, thorax, and abdomen against

the different types of missiles. This work was facilitated by background

ballistic studies on these materials at Ordnance Department installations,

particularly Watertown Arsenal, Mass., and Aberdeen Proving Ground, Md.

BATTLE CASUALTY SURVEY-NOVEMBER 1950

With the advent of hostilities in Korea, the Biophysics Division, Chemical

Corps Medical Laboratories, in coordination with Brig. Gen. (later Maj. Gen.)

William M. Creasy, Commanding General, Chemical Corps Research and

Engineering Command, recommended to Col. (later Brig. Gen.) John R. Wood,

MC, Chairman, Medical Research and Development Board, Office of the

1 (1) Tillett, C. W. II1, Herget, C. M., and Odell, F. A.: Preliminary Study on Body Armor Protection From Woumding. CmIC Medical Division Report No. 165, October 1948. (2) Tillett, C. W. It, Banfield, W. G. Jr., and Ilerget,

C. M.: The Effect of a Non-Perforating Missile on the Animal Body Protected by Nylon Armor. CmlC Medical Division Report No. 208, August 1949. (3) Tillett, C. W. In1, Banfield, W. G. Jr., and Herget, C. M.: The Effect of a NonPerforating Projectile on the Animal Body Protected by Steel Armor. CmlC Medical Division Report No. 228, December 1949. (4) Tillett, C. W. 1I1, Banfield, W. G. Jr., and Herget, C. M.: The Mechanism of Thoracic Injury Under

Rigid Armor. CmlC Medical Laboratories Research Report No. 93, December 1951. (5) Coe, G. B., Miehalski, J. V.,

Light, F. W., and Herget, C. M.: Effectiveness of Protection From Wounding by Doron and Spot-Bonded Nylon Body

Armor. CmlC Medical Laboratories Research Report No. 103, March 1952.

691
692 WOUND BALLISTICS

Surgeon General, that a wound ballistics team be organized and dispatched to

the Far East Command for the purpose of studying casualties. In response

to this recommendation, a team was organized and dispatched to the Far

East Command on 14 November 1950 under Department of the Army Orders,

AGPA-OS 200.4. Officer members of the team included Lt. Col. Robert H.

Holmes and Capt. Robert F. Palmer of the Medical Corps; Capt. William R.

Phillips, Ordnance Corps; and 1st Lt. George B. Coe, Chemical Corps. The

unit arrived at Haneda Air Terminal, Tokyo, Japan, on 26 November 1950,

and reported directly to Maj. Gen. Edgar Erskine Hume, The Surgeon, Far

East Command.

No specific plan for the actual functioning of this research unit was previously determined; that is, whether to operate as a completely independent

unit with or without T/D (table of distribution) or to arrange an attachment

to a theater organization. After a local evaluation, it was recommended to

the operations officer, Office of the Surgeon, Far East Command, that the

Wound Ballistics Research Team be attached to the 406th Medical General

Laboratory, Tokyo. This recommendation had already been approved by

Lt. Col. (later Col.) Robert L. Hullinghorst, MC, commanding officer of the

laboratory. The attachment was made, and subsequent events proved the

decision most wise. This arrangement afforded a headquarters with easy

accessibility, office space, a simple means of supply and a ready source of

information as to location of medical units and routes of casualty evacuation,

and introduction in general to proper channels of command.

Conduct of Survey

After equipment and enlisted personnel were received, approximately 15

December 1950, request was made for entry into the Eighth U.S. Army Area,

specifically Pyongyang (fig. 337), for attachment to the 171st Evacuation

Hospital. An alternate request was also made for entry into the X Corps

Area with attachment to any available MASH (mobile army surgical hospital).

Because of the entry of Chinese Communist Forces into the Korean War on

about 28 November 1950 and the strategic withdrawal of the United Nations

troops to a position below the 38th parallel, the team's entry into Korea was

denied. The exigencies of such warfare required that all personnel and equipment permitted entry should contribute directly and immediately to the

survival of combat elements.

In the meantime, a study of casualties was begun in Japan at the Tokyo

Army Hospital and the 118th Station Hospital at Fukuoka. Eventually,

authority was obtained for certain members of the team to enter Korea.

These members actually went as blood couriers and were then allowed to remain

in Korea, where they were attached to the 3d Station Hospital at Pusan.

Even though the flow of casualties at this point in Korea was moderate, several

hundred patients with wounds that had received only the minimum in definitive

medical care were studied by the team. The team also spent 2 weeks in the
WOUND BALLISTICS AND BODY ARMOR 693

M A N C HUR I A A

~.1

Kunu-ri

P'YONGYACG KOREAJA N

SEOUL

YELLOW H NSHU •;: • TO0K YO e

SEA Tongnoe

Kakuro

FIGuRE 337-Orientation map, Korea.

prisoner-of-war hospital at Tongnae. Through an interpreter, a thousand

wounded North Korean and Chinese Communist soldiers were interviewed as

to their mode of wounding, whether it be from aircraft or ground arms and

what the wounding missile was. This information furnished some idea of the

effect of United Nations weapons on the enemy. A study of U.S. KIA casualties at the Graves Registration Service was also accomplished at this time.

However, this survey, made from records only, was of a statistical nature and

is not considered a true picture of the type of missiles, wounds, and regional

and area frequency of lethal wounds U.S. KIA actually received. Medical

records giving type of missile and type of wounds were frequently found to be

erroneous. Battlefield surgeons often did not differentiate between a gunshot

wound and a shell fragment wound by external examination and often confused

penetrating and perforating wounds. Correctness of information on these
694 WOUND BALLISTICS

points is extremely important for the accuracy of any wound ballistics study.

Training in experimental wound ballistics is necessary in order to assure

accuracy of the casualty surveys.2

Basic Scope of a Battle Casualty Survey

The basic object of all battlefield casualty studies is to analyze the effect

of firearms and their missiles upon hunman or experimental animal tissue.

Modern warfare has become so versatile and changes in weapons have been

so rapid that for military purposes a study of this nature must be continuous

in both the experimental laboratory and every theater of combat operations.

These studies must extend in range from simple missile laceration to the

complicated effects of atomic weapons explosions and from the first medical

care in a battalion aid station to the point of maximum recovery in a general

hospital or permanent disposition to a veteran's facility. As each new weapon

appears, its wounding properties must be carefully evaluated. This study

entails liaison with military intelligence and ordnance; identification of enemy

weapons and missiles; knowledge of velocities, size, shape, and mass of missiles; percentage incidence of various missiles; and percentage a given body

region is involved, as well as the proper classification of wounds. The study

should also evaluate the inethod, time, and distance of evacuation in relation

to primary wound treatment, wound contamination, and all otber variables

of wound repair. A field wound ballistics study ideally includes a continuous

study of the wound from the time of occurrence until the time of maxilulmn

repair followed by a study of the functional effects of that repair and the

various adaptation phenomena. Therefore, such a study demands the cooperation and coordination of a vertical segment of medical personnel indoctrinated in this continuity of wound evaluation so that sample-type wounds

will receive standardized observations and photographic recording at critical

intervals, throughout the scheme of medical evacuation and hospitalization.

The following criteria were formulated by this first survey team and are

a natural part of any battle casualty survey investigation:

1. Regional frequency of wounds (number of times a region is involved in total number

of cases).

2. Regional distribution of wounds (number of wounds in each region in total number

of wounds).

3. Weapon and missile identification.

4. Missile frequency; that is, the number of times a given missile type is encountered.

5. Type of wound, distribution, and frequency.

6. Photography of wounds and organs and X-rays of body regions.

7. Special studies; for example, vascular and nerve damage, spinal cord damage, eye

and ear damage, fractures, amputations, cold injury, and disease coincident with wounds.

8. SIW (self-inflicted wound) casualties, type of weapon, missile, regional and area

frequency, and distribution.

2 Trained personnel of a battle casualty survey unit and indoctrination of mnedical personnel during peacetime

nmanenvers would facilitate the gathering of accurate data.-J. C. B.
WOUND BALLISTICS AND BODY ARMOR 695

9. Studies on wounded prisoners of war and enemy killed in action to learn the effects

of U.S. weapons.

10. The ratio of single to multiple wounding.

11. The effect of wound contamination, tetanus, and gas gangrene.

12. A survey of the casualty flow as sample days in a battalion aid station, mobile

army surgical hospital, and evacuation hospital. These studies should represent various

tactical circumstances and would aid in future planning procedures.

13. A study of the mode, distance, and time of medical evacuation of casualties and

the effects upon the different types of wounds.

14. A study of wound incidence, type and causative agent in the veteran of 60-90

days' combat as compared to the nonveteran of less than 30 days and the veteran of more

than 120 days.

15. A study of wound incidence in personnel who have received some form of rotation

duty in contrast to a similar group who have not received rotation.

16. A general study of traumas, other than missile-inflicted wounds.

These points are but a partial listing of the studies required in a complete

battle casualty study. Some of them have been accomplished, but others

are only projected. Fortunately, there are a few medical observers from

World War I and many with World War II experience available to thrash

out their varied impressions. Of great importance is the fact that many

precedents in wound classification, treatment, evacuation, and disposition

have been established. Experienced medical personnel are available to lead

the way.3

Sample of Information Desired

A consideration of war wounds thus begins with an emphasis placed

upon the accurate recording of specific medical data. The following items

are a more detailed breakdown of some of the previously listed subjects:

The etiologic agent:

1. What kind of missile was it? Size, weight, shape, type metal?

2. Did the missile go through the tissues, or was it retained?

3. What was the weapon-enemy or friendly? Air or ground?

4. What was the approximate range of fire? Explosion distance? Angle of

incidence?

5. What was the probable velocity of the missile?

6. Was the missile single or multiple?

7. Was the hit direct fire or ricochet?

8. Are any secondary missiles present, such as equipment, clothing fragments,

or other debris?

Accessory military data:

1. What was the individual doing at the time he was struck? Organization?

His assignment?

2. Where was he? (in the open, dugout, etc.)

3. What kind of weapon? Terrain? Tactical situation? Weather?

4. Degree of exposure? Fatigue? Time in combat?

5. Previously wounded? When?

3 Unfortunately, no serious attempt bas been made, as yet, to establish these personnel on a permanent basis and

provide them with the necessary training and liaison with combat and supporting technical services-i. C. B.
696 WOUND BALLISTICS

The wound-general (certain of these factors are applicable to the wounded in action

only):

1. What was the physical state of the individual at the time of wounding?

2. What was his anatomic position when wounded?

3. What clothes or equipment covered the wound?

4. What type of contamination prevails?

5. How old is the wound?

6. What prior treatment has been given?

7. What is the general physical condition of the individual now?

8. What type of wound is it? Contusion? Laceration? Penetration? Perforation, etc.?

9. Are there additional wounds?

10. Is the part warm, hot, or cold, pallid or erythematous?

11. Is it painful or tender? Degree?

12. Is the wound dry, oozing, crusted, infected, clean or dirty?

13. How much blood and plasma have been given? When? Any evidence of

reaction?

14. Is there a disease or other injury complicating the missile wound?

15. Has there been undue physical exposure since wounding?

The wound-special:

1. What is the exact anatomic location of the wound of entrance? Missile passage?

What are the sizes and shapes?

2. Is there a laceration angle of the wound of entrance? Are the edges inverted?

Smooth or ragged? Discolored?

3. Is there a contact ring or erythema?

4. Is there a lymphangitis?

5. Is the wound superficial or deep? Slight, moderate, or severe?

6. Is there a fracture? How much have bone fragments acted as secondary

missiles?

7. Is there nerve or vascular damage?

8. Is the tissue crepitant? Is it air or body fluid? What kind of odor?

9. Is there a retained missile? What kind? Exact location?

10. How much muscle damage?

11. What is the size of the permanent tissue cavity formed by the missile's passage?

12. Is there an incarcerated hematoma?

13. How great is the tissue loss?

14. What is the exact anatomic location of the wound of exit? Are the edges

inverted? Smooth, wedge-shaped? Size?

The conclusions reached by the first wound ballistics team concerning the

administrative conduct of such a team are as follows:

A wound ballistics research team should be available in every theater of combat operation. The personnel component should be flexible and determined by the nature of the

particular mission. No T/D is recommended. Specific advantages are achieved by having

the unit on TDY (temporary duty) to the theater. This permits the complete preservation

of objectivity in the study, enthusiasm of a small group of interested and trained personnel

to see a project quickly and well done, the knowledge of a deadline for completion, and the

opportunity to leave the war zone and review the findings in clear perspective.

A letter of introduction and a careful definition of the mission should precede and

accompany the team. Considerable tact is essential in preserving proper channels. Future

teams are often judged initially on the basis of impressions left by their predecessors.

A wound ballistics research team on TDY to a combat theater should be attached

immediately upon arrival to a local unit with a senior commanding officer. Supply and
WOUND BALLISTICS AND BODY ARMOR 697

housing are thus easily managed. A letter of authority should precede and accompany the

team for the issuance of supplies.

Data regarding regional incidence of wounds and missile frequency should be quickly

disseminated to the theater surgeon for his use in staff presentation.

Findings of Survey Unit

The findings ' of the first battlefield wound ballistics team of the Korean

War will now be summarized, and tables giving the detailed information will

then follow. The body regions and their projected percent of the whole were

determined according to the method of Burns and Zuckerman I using, however,

two additional views of the prone position. Body regions by this method

gave the following mean projected areas (fig. 338) and percentages:

Square feet Percent

Head and neck -------------------------------- 0.50 12

Chest -----------------------------------------. 67 16

Abdomen --------------------------------------. 46 11

Upper extremities ------------------------------. 92 22

Lower extremities ------------------------------ 1.65 39

Total ---------------------------------- 4.20 100

H H

C C

U U U U

AA

L L L L

FIGURE 338.-Anatomic location of body regions.

4 Wound Ballistics Survey, Korea, 15 November 1950-5 May 1951, issued by the Medical Research and Development

Board, Surgeon General's Office, Department of the Army.

5 Burns, B. D., and Zuckerman, S.: The Wounding Power of Small Bomb and Shell Fragments. R. C. No. 350 of

the Research and Experiments Department of the Ministry of Home Security.
698 WOUND BALLISTICS

Wound ballistic data on 4,600 WIA casualties 6 indicated the following:

1. Most wounds in WIA casualties in Korea for the period from 15 November 1950 to 5 May 1951 were caused by fragments (approximately 92

percent) rather than by small arms (approximately 7.5 percent).

2. The shell fragments were primarily mortar and grenade, since the

enemy had used little heavy artillery.

3. Most wounds were of a penetrating (72.7 percent) rather than a perforating (20.3 percent) type.

4. The 4,600 WIA casualties received 7,773 wounds. Therefore, the

wound incidence was 1.69 wounds per casualty.

The regional distribution of wounds in personnel wounded in action by

body region is shown in table 252.

Analysis of the missile type and regional distribution of wounds in these

4,600 casualties is presented in table 253.

The wounding agents and the number of wounds in each area of a body

region are presented in tables 254 through 259.

The type and frequency of the 7,773 wounds analyzed in the 4,600 cases

is shown in table 260 with each area of a body region tabulated in tables 261

through 266.

TABLE 252.-Regional distribution of 7,773 wounds in 4,600 WIA casualties

Region Number of Percent of total

wounds wounds

Head and neck ------------------------------------------- 1,275 16.4

Thorax -------------------------------------------------- 613 7.9

Abdomen ----------------------------------------------- 481 6. 2

Extremities:

Upper ---------------------------------------------- 1,948 25.0

Lower ---------------------------------------------- 3,394 43. 7

Genitalia ------------------------------------------------ 62 .8

Total ---------------------------------------------- 7, 773 100. 0

6 The medical records of a total of 4,600 cases with 7,773 wounds were reviewed at the Tokyo Army Hospital from

1 Dec. 1950 to 15 Feb. 1951. The data for this section were obtained from those records.
WOUND BALLISTICS AND BODY ARMOR 699

TABLE 253-Regional distribution of 7,773 wounds in 4,600 WIA casualties, by wounding

agent

Extremities Total wounds

Wounding agent Head Thorax Abdo- Geni- men talia

Upper Lower Number Percent

Fragment ------------- 1,091 539 414 1,616 2,825 51 6,536 84.09

Mortar --------------- 68 27 14 114 151 7 381 4.90

Grenade --------------- 29 6 9 40 60 1 145 1.87

Landmine ------------ 18 1 2 9 23 ------ 53 . 68

Bomb ------------------------.------- 1 1 2 ..... 4 .05

Machinegun ---------- 7 5 13 17 56 ------ 98 1.26

Rifle ------------------ 40 31 25 128 242 3 469 6.03

Pistol ----------------- I I--- 3 8 ..... 13 . 17

Burn ----------------- 5 2 1 11 9 ------ 28 . 36

Phosphorus ------------ 2 ------------ 9 14 ------ 25 .32

Secondary ------------ - 14 1 2 -------- 4 ..... 21 . 27

Total ----------- 1,275 613 481 1,948 3,394 62 7, 773 100. 0
700 WOUND BALLISTICS

M~Ol- N -o 

50 0.0 C - o-lI- , I ' IJII C

Pi~

C.) ,-

.0 itCC- i1 111 C

o CC liii II I C

0 I i I I

0 I I ] i i

C. C l i I i I I C

Ci I l

Ci 0iI I

q iq

I I IC I I

I ~I I II

n iq

;4 0 ll-4 IO I W

9 t X

9p

bb _ g_-_ _ _I_
WOUND BALLISTICS AND BODY ARMOR 701

TABLE 255.-Distribution of 613 wounds of the thorax in 4,600 WIA casualties (160 cases of

hemothorax), by wounding agent

Wounding agent Number of Wounding agent Number of wounds wounds

Fragment ------------------ 539 Rifle ---------------------- 31

Mortar --------------------- 27 Pistol --------------------- - 1

Grenade ------------------- 6 Burn ---------------------- 2

Landmine ------------------ 1 Secondary ----------------- 1

Machinegun ---------------- 5

Total ----------------- 613

TABLE 256.-Area distribution of 481 wounds of the abdomen in 4,600 WIA casualties, by

wounding agent

Wounding agent Abdo- Stomaec Liver Spleen Small Colon 1Rec- Anus Kid- Blad- Total

men 1 intestine tum ney der wounds

Fragment ------------- 261 17 22 15 35 38 10 1 6 9 414

Mortar --------------- 4 7 1 1 1 ----------------- 14

Grenade -------------- 3 1 1 ------ 2 2 ----.------------- 9

Landmine ------------- - 2 ------.----------.-------------------.--------- 2

Bomb ----------------- 1 ------.----------------------------------.----- - 1

Machinegun ----------- 7 ------- 2 ------ 1 2 ----.---------1 13

Rifle ------------------ 12 ------ 3 2 4 3 ----.---------1 25

Burn ----------------- 1 .----------.------.------.---------.---------.----- 1

Secondary -------------------- 1 1 ------.------.----.--------- -------- 2

Total ------------ 291 26 30 17 43 46 10 1 8 9 481

1 Specific region not specified.

TABLE 257.-Area distribution of 1,948 wounds of the upper extremities in 4,600 WIA casualties,

by wounding agent

Wounding agent Shoulder Axilla Arm Elbow Forearm Hand Fingers Total

wounds

Fragment --------------------- 335 13 529 78 238 303 120 1,616

Mortar ----------------------- 36 36 5 7 28 2 114

Grenade ----------------------- 4 1 10 7 10 8 40

Landmine -------------------- 1 4-... ------------- 4 9

Bomb ------------------------ ------ ------ -- 1------------------- 

Machinegun ------------------- 6 7 1 1 2 17

Rifle ------------------------- 39 28 4 25 27 5 128

Pistol ------------------------ ------ 1 - ------- 1 1 3

Burn ------------------------------------ 4 ------ ------ 7 11

Phosphorus ------------------- - 2 -1 4 9

Total ------------------- 424 14 620 89 279 387 135 1,948
702 WOUND BALLISTICS

TABLE 258.-Area distribution of 3,394 wounds of the lower extremities in t,600 WIA casualties,

by wounding agent

Wounding agent But- Hip Thigh Knee T eg Foot Toes Total toeks wounds

Fragment -------------------- 240 131 797 199 941 478 39 2,825

Mortar ----------------------- 12 2 41 10 60 26 _-_ 151

Grenade ----------------------- 6 1 10 3 25 12 3 60

Landmine --------------------- 2 1 6 2 11 1 _ 23

Bomb ------------------------.------.------.------------------ 2 2

Machinegun ------------------ 3 4 23 1 13 12 56

Rifle ------------------------- 14 7 87 20 71 41 2 242

Pistol ------------------------ 1 2 1 ------ 1 3 8

Burn ------------------------- 3 -1 4 1 9

Phosphorus -------------------- 2 -- 4 1 6 1 14

Secondary ---------------------.------------.------ 1 3 ------.------ 4

Total ------------------- 283 148 970 237 1, 135 577 44 3,394

TABLE 259.-Area distribution of 62 wounds of the genitalia in 4,600 WIA casualties, by

wounding agent

Wounding agent Scrotum Penis Testicles Total

wounds

Fragment --------------------------------------- 31 17 3 51

Mortar --------------------------------------------- 4 3 7

Grenade --------------------------------------- 1 1

Rifle ------------------------------------------- 1 1 1 3

Total ------------------------------------- 37 21 4 62

TABLE 260.-Distribution of 7,773 wounds in 4,600 WIA casualties, by type of wound

Type of wound Number of Percent of total wounds wounds

Penetration --------------------------------------------- 5, 653 72. 7

Perforation --------------------------------------------- 1,578 20.3

Laceration ---------------------------------------------- 338 4. 4

Amputation --------------------------------------------- 96 1. 2

Avulsion ------------------------------------------------ 59 .8

Contusion ---------------------------------------------- 49 .6

Total ---------------------------------------------- 7,773 100. 0
WOUND BALLISTICS AND BODY ARMOR 703

TABLE 261.-Area distribution of 1,275 head wounds in 4,600 WIA casualties, by type of wound

Area Penetra- Perfora- Super- Lacera- Con- Avul- Concus- Total

tion tion ficial tion tusion sion sion wounds

Scalp ------------------------- 31 2 4 18 2 2 ..... 59

Region of skull:

Frontal ------------------- 54 1 2 5 ------.------ 13 75

Temporal ---------------- 47 1 1 4 ------.------ 2 55

Parietal ------------------- 71 1 . 4 ------.------- 2 78

Occipital ----------------- 23 ------------- 2------ ------- 1 26

Brain ------------------------- 38 2 .... 8 7 ------ 9 64

Face ------------------------- 162 7 6 14 ------.------ 1 190

Maxilla ----------------------- 47 3 ..... 6 1 ------.------ 57

Mandible -------------------- 75 15 .... 4 1.... I ..... 95

Nose ------------------------ 17 5 1 ------------.------.------ 23

Eyelid ----------------------- 28 3 _----- 14 1 1 .... 47

Eyeball ----------------------- 254 18 5 8 3 6 --- 294

Ear -------------------------- 30 3 1 5 1 2 1 43

Neck ------------------------- 132 16 4 6 ------.------.------ 158

Cervical vertebra -------------- 8 3 ------------.------.------------- 11

Total ----------------- 1017 80 24 98 15 12 29 1,275

TABLE 262.-Distribution of 613 wounds of the thorax in 4, 600 W4IA casualties, by type of

wound

Type of wound Rib cage Thoracic Back I Total

vertebra wounds

Penetration ------------------------------------- 414 19 80 513

Perforation- ------------------------------------- 51 3 10 64

Superficial ------------------------------------- _ -11 4 15

Laceration ------------------------------------- 10 1 3 14

Contusion --------------------------------------- 2 1 2 5

Avulsion ------------------------------------------ -1 1 2

Total ------------------------------------ 489 24 100 613

1 Specific site not specified.
704 WOUND BALLISTICS

cq i

t ,q

00

S0ti

Co I

0Cc

P ,U
WOUND BALLISTICS AND BODY ARMOR 705

TABLE 264.-Area distribution of 1,948 wounds of the upper extremities in 4,600 WIA

casualties, by type of wound

Type of wound Axilla Shoulder Arm Elbow Forearm Hand Fingers Total

wounds

Penetration -------------------- 13 310 455 67 207 262 90 1, 404

Perforation -------------------------- 92 121 26 68 77 32 416

Superficial -------------------- ------- 8 15 2 2 7 ------ 34

Laceration -------------------- ------- 8 6 ------ 4 11 3 32

Contusion -------------------------- 1 3 1 ..... 3 ..... 8

Avulsion --------------------------- 1 1 ..... 2 5 4 13

Amputation ------------------------------ 6 2 1 6 26 41

Total ------------------- 13 420 607 98 284 371 155 1,948

TABLE 265.-Area distribution of 3,394 wounds of the lower extremities in 4,600 WIA

casualties, by type of wound

Type of wound But- Hip Thigh Knee Leg Foot Toes Total

tocks wounds

Penetration -------------------- 231 117 644 170 779 377 26 2,344

Perforation -------------------- 42 20 275 54 283 171 15 860

Superficial --------------------- 5 1 11 3 17 5 ------ 42

Laceration -------------------- 4 4 16 5 14 10 1 54

Contusion -------------------- ------- 3 -----.------------ 6 4 13

Avulsion ---------------------- 7 - 5 6 3 5 1 27

Amputation ------------------------------ 10 2 25 11 6 54

Total ------------------- 289 145 961 240 1, 127 583 49 3,394

TABLE 266.-Area distribution of 62 wounds of the genitalia in 4,600 WIA casualties, by

type of wound

Type of wound Scrotum Penis Testicle Total

wounds

Penetration ------------------------------------ 32 15 2 49

Perforation ------------------------------------- 3 3 1 7

Laceration -------------------------------------- 3 2 -3 5

Avulsion ---------------------------------------- 1----------------- - 1

Total ------------------------------------- 39 20 3 62
706 WOUND BALLISTICS

Single Versus Multiple Wounding

Another analysis was made for the single and multiple wounding for the

WIA cases studied. The following possibilities were considered: (1) A single

wound in one area, (2) a single wound in one area and a single wound in another,

(3) a single wound in one area with multiple wounds in another, (4) multiple

wounds in one area, (5) multiple wounds in the area under study (called the

local area) and a single wound in another area, and (6) multiple wounds in

the local area and multiple wounds elsewhere. Table 267 summarizes the

incidence of single versus multiple woundings in 4,600 casualties with 7,467

wounds known to be either single (2,621) or multiple (4,846). Of the total

7,773 wounds, the type of wounding (single or multiple) was unknown for

306 wounds.

TABLE 267.-Distribution of 7,467 wounds in 4,600 WIA casualties, by type of wounding

Type of wounding Number of Percent of

wounds wounds

Single local, single elsewhere ------------------------------- 3, 312 44. 3

Single local ---------------------------------------------- 2 621 35. 1

Multiple local, multiple elsewhere --------------------------- 1,001 13. 4

Single local, multiple elsewhere ----------------------------- 257 3.5

M'tultiple local -------------------------------------------- 173 2. 3

Multiple local, single elsewhere ----------------------------- 103 1. 4

Total --------------------------------------------- 7,467 100. 0

Although each casualty averaged a 1.69 wound incidence, 35 percent

showed only a single wound in one area and 44 percent showed a single wound

in one area with only a single wound in another area. These findings are

significant in that such a large percentage of wounded in action (79 percent)

shows only one or two wounds. Since approximately 89 percent of the total

wounds were caused by shell fragments, usually mortar or grenade, the chance

factor of being struck is emphasized even though the missile density is quite

great. It would appear that a bursting mortar shell or grenade if near enougt,

to produce one wound would have an excellent chance to produce many wounds

with its fragmentation-spray pattern. A few instances of this were seen, but

as shown in the tables most of the fragments actually miss. How many strike

another individual is not known. Tables 268 through 273 list the single versus

multiple wounding according to the various body regions.
WOUND BALLISTICS AND BODY ARMOR~ 707

00 v .:)0 -f , c

cqq 1. N 0

00

I, Il

t- N

01

-l cq-~ c-q eq >- o

~ ~e 4

0 ____1 4-

CI Il bJ

eqeq e 0c .

00

C)~e 1O 81

'ae *1- 

bE :. __ _ __ _ _
708 WOUND BALLISTICS

m 0

't I o

0 -- , C

ho boý

EL I I
WOUND BALLISTICS AND BODY ARMOR 709

TABLE 271.-Area distribution of 1,908 wounds of the upper extremities in 4,600 WIA casualties, by type of wounding

Type of wounding Axilla Shoulder Arm Elbow Forearm Hand Fingers Total

wounds

Single local ------------------- 2 149 156 32 116 114 31 600

Single local, single elsewhere ---- 6 206 308 46 113 156 65 900

Single local, multiple elsewhere-- 3 14 21 3 8 14 6 69

Multiple local -----------------.------ 4 5 1 4 13 5 32

Multiple local, single elsewhere --------- 6 9 1 ------ 6 1 23

Multiple local, multiple elsewhere ---------------------- 1 41 115 8 31 66 22 284

Total ------------------- 12 420 614 91 272 369 130 1,908

TABLE 272.-Area distribution of 3,252 wounds of the lower extremities in 4,600 WIA casualties, by type of wounding

Type of wounding But- Hip Thigh Knee Leg Foot Toe Total

tocks wounds

Single local ------------------- 80 49 412 118 406 285 23 1,373

Single local, single elsewhere ---- 133 77 403 86 404 173 10 1, 286

Single local, multiple elsewhere-- 7 6 12 1 28 14 2 70

Multiple local ----------------- 7 2 14 10 15 19 67

Multiple local, single elsewhere-- 3 ------ 2 4 23 7 39

Multiple local, multiple elsewhere ----------------------- 47 13 85 24 189 50 9 417

Total ------------------- 277 147 928 243 1,065 548 44 3,252

TABLE 273.-Area distribution of 58 wounds of the genitalia in 4,600 WIA casualties, by type

of wounding

Type of wounding Penis Scrotum Testicles Total

wounds

Single local ------------------------------------- _ -1 2 3

Single local, single elsewhere ----------------------- 15 30 3 48

Single local, multiple elsewhere ------------------------ 1 1 2

Multiple local --------------------------------------------- -1 1

Multiple local, multiple elsewhere ----------------- --- 2- 2 4

Total. ------------------------------------ 19 36 3 58
710 WOUND BALLISTICS

Incidence of Fractures

Among the 4,600 casualties, there was a total of 1,762 fractures (table

274). The incidence of fractures of the known body areas was 44.4 percent

for the lower extremities, 34.8 percent for the upper extremities, 13.5 percent

for the head, 4.5 percent for the thorax, and 0.9 percent for the vertebral

column. Approximately one out of four casualties had a fracture and almost

one out of two was evacuated to the Zone of Interior.

TABLE 274-Distribution of 1,762 fractures in 4,600 JYIA casualties, by site of fracture

Site of fracture Number of Percent for body fractures area

Lower extremities:

Foot ------------------------------------------------ 261 33. 4

Leg ---------- ---------------------------------------- 246 31.4

Femur ---------------------------------------------- 164 21.0

Knee ------------------------------------------------ 57 7. 3

Toe ------------------------------------------------- 30 3. 8

Hip ------------------------------------------------- 24 3. 1

Total --------------------------------------------- 782 100. 0

Upper extremities:

Arm---------------------------------------------- 154 25. 2

Hand ------------------------------------------------ 150 24. 6

Forearm --------------------------------------------- 108 17. 7

Shoulder --------------------------------------------- 90 14. 7

Fingers --------------------------------------------- 63 10. 3

Elbow ----------------------------------------------- 46 7. 5

Total ---------------------------------------------- 611 100. 0

Head and neck:

Mandible ------------------------------------------- 66 27. 7

Parietal lobe ----------------------------------------- 56 23. 5

Frontal lobe. ----------------------------------------- 37 15.6

Temporal lobe -------------------------------------- -21 8. 8

Maxilla ---------------------------------------------- 13 5. 5

Nose ------------------------------------------------ 7 2. 9

Face ------------------------------------------------ 6 2. 5

Ear ------------------------------------------------- 3 1.3

Eye (orbit) ------------------------------------------- 2 .8

Vertebra (cervical) ------------------------------------ 23 9. 7

Unknown -------------------------------------------- 4 1. 7

Total ----------------------------------------------- 238 100. 0
WOUND BALLISTICS AND BODY ARMOR 711

TABLE 274.-Distribution of 1,762 fractures in 4,600 WIA casualties, by site of fractureContinued

Site of fracture Number of Percent for body fractures area

Thorax:

Ribs ------------------------------------------------- 68 85.0

Vertebra --------------------------------------------- 12 15.0

Total ---------------------------------------------- 80 100. 0

Abdomen:

Lumbar vertebra ------------------------------------- 15 94. 0

Sacral vertebra --------------------------------------- 1 6. 0

Total ---------------------------------------------- 16 100. 0

Site unknown -..... -------------------------------------------- 35

Excluding 51 fractures (16 vertebral and 35 site unknown), it was found

that slightly more than 90 percent of the fractures were compound comminuted.

Of the 4,600 WIA casualties, 34 (0.7 percent) died of wounds. Of the

remnaining 4,566 casualties, 2,893 (62.9 percent) were evacuated to the Zone of

Interior and 1,673 (36.4 percent) were returned to duty (table 275).

TABLE 275.-Disposition of 4,566 T JIA casualties, by region wounded

Region wounded Returned to Evacuated to the Total casualties duty Zone of Interior

Extremities: Number Numbser NAumber

Lower ---------------------------------- 938 1,209 2, 147

Upper ----------------------------------- 284 767 1, 051

Head --------------------------------------- 230 502 732

Thorax -------------------------------------- 132 226 358

Abdomen ------------------------------------ 83 167 250

Genitalia ------------------------------------ 6 22 28

Total --------------------------------- 1,673 2, 893 4,566

Peripheral Nerve Injuries

A study of peripheral nerve wounds was also made, at the Tokyo Army

Hospital, on 200 cases sustaining this type of injury, and the data were analyzed

for causative agent (table 276). In order to obtain these 200 peripheral nerve

cases, it was necessary to examine the records of 1,872 cases.
712 WOUND BALLISTICS

TABLE 276.-Distribution of 200 cases with peripheral nerve wounds, by causative agent and

anatomic location of nerves

Shell

Missile frag- Ma- Anatomic location of nerve un- Gunshot Mortar ment, Hand Artillery Land- chine- Total

known caliber grenade shell mine gun cases

known

Head:

Facial -------------- 7---------------------------------------------- 7

Mandibular -------- 2 1-------------------------------------- 3

Maxillary ---------- 1 2 1------------------------------- 4

Total ------------ 10 3 1 ------------------------------- 14

Upper extremities:

Axillary ------------------ 2-------------------------------------- 2

Radial ------------- 24 7 7 2 1 ------------- 41

Ulnar ------------- 23 9 4 1 1 1 39

Median ------------ 13 1 2 1 1 1 ------ ------- 19

Brachial ------------ 4 2 2------------------------- 8

Total ------------- 64 21 13 6 1 3 1 109

Lower extremities:

Tibial ------------- 19 1 2 1 ------ ------ ------- 232------ 

Femoral ------------ 7 1 1 ------ ------ ------- 1 10

Peroneal ------------ 14 3 2 ------------------------------- 19

Popliteal ------------ 4 ------ ------ ------ ------ ------------- ------- 4

Plantar ------------ ------ ------ ------- 1 1 ------------ ------- 2

Cutaneous --------- 4 2 1------------------------ ------- 7

Sciatic --------------- 8 ------ ------ -------------------------- 1 9

Pudendal ---------- 2 1-------------------------------------- 3

Total ------------- 58 8 5 3 1 ------------- 2 77

Grand total ------ 132 32 19 9 2 2 200

Vascular Wounds

Concurrently, a survey was made on vascular wounds, records of which

were available on 100 cases (tables 277, 278, and 279). In order to obtain this

sample, it was necessary to examine the records of 2,609 battle casualties.
WOUND BALLISTICS AND BODY ARMOR 713

TABLE 277.-Distribution of 100 cases of vascular damage, by type of wound

Type of wound Artery Artery and Vein Total

vein wounds

Penetrating ------------------------------------ 42 12 1 55

Perforating -------------------------------------- 39 3 1 43

Lacerating ------------------------------------- 1-------- -------- I

Contused -------------------------------------- I I

Total ------------------------------------- 83 15 2 100

TABLE 278.-Distribution of 100 cases of vascular damage and associated bone and nerve injury

Vascular and associated injury Artery Artery and Vein Total

vein wounds

Fracture -------------------------------------------- 5 3 8

Nerve damage ---------------------------------- 19 -------- 191--------- 

Fracture and nerve damage ---------------------- 39 -------- 3--------- 39

Fracture, nerve and vascular to be determined 1 ----- 7 -------- 7---------7

Aneurysm --------------------------------------- 3 11 -------- 14

Vascular damage alone --------------------------- 10 1 2 13

Total ------------------------------------- 83 15 2 100

1 In these cases, there was clinical evidence of vascular and/or nerve damage but its exact location had not been defined.

TABLE 279.-Distribution of 100 cases of vascular injury, by type of missile causing damage

Type of missile Artery Artery and Vein Total

vein wounds

Missile, unknown ------------------------------- 58 13 2 73

Shell fragment, unknown -------------------------.. 3-----------------3

Small arms -------------------------------------- 11 2 13

Machinegun ------------------------------------ 3 ----------------- 3

Mortar ----------------------------------------- 8------------------

Total ------------------------------------- 83 15 2 100

603225v--62- 47
714 WOUND BALLISTICS

The regional and area frequency of the vascular damage in the 100 cases

was as follows: A'nmber of

Head and neck: cases

Artery not specified -------------------------------- 4

Temporal artery ------------------------------------ 1

Mandibular artery ---------------------------------- 2

Carotid artery ------------------------------------- 1

Carotid artery and vein ---------------------------- 3

Thorax, artery not specified ---------------------------- 1

Lumbar vertebra, artery not specified --------------------- 1

Upper extremity:

Shoulder, artery not specified ------------------------ 1

Axillary artery ------------------------------------- 2

Brachial artery ------------------------------------- 10

Brachial artery and vein ---------------------------- 2

Radial artery -------------------------------------- 9

Radial artery and vein ------------------------------ 2

Ulnar artery --------------------------------------- 2

Lower extremity:

Pudendal artery ------------------------------------ 2

Femoral artery ------------------------------------- 14

Femoral artery and vein ----------------------------- 3

Femoral vein -------------------------------------- 2

Popliteal artery ------------------------------------ 3

Popliteal artery and vein ---------------------------- 2

Tibial anterior artery ------------------------------- 5

Tibial anterior artery and vein ---------------------- 1

Tibial posterior artery ------------------------------ 3

Tibial posterior artery and vein --------------------- 2

Artery not specified -------------------------------- 20

Sural artery --------------------------------------- 1

Peroneal artery ------------------------------------ 1

Total ------------------------------------------- 100

Self-Inflicted Wounds

A study of self-inflicted wounds, both accidental and deliberate, revealed

that, in the 2,605 wounded cases studied, 116 (4.4 percent) were self-inflicted

(table 280).

TABLE 280.-Distribution of 116 self-inflicted wounds in 2,605 casualties, by region

Region Number of Percent of total "woundis wonds

Left lower extremities ------------------------------------ 53 45. 7

Right lower extremities ----------------------------------- _ 36 31.0

Left upper extremities ------------------------------------ 18 15. 5

Right upper extremities ------------------------------------ 5 4. 3

Miscellaneous -------------------------------------------- 4 3. 5

Total --------------------------------------------- 116 100. 0
WOUND BALLISTICS AND BODY ARMOR 715

Survey of Turkish Brigade

The opportunity presented itself to make a casualty survey on wounded

personnel all from one unit who were injured during a known period of combat.

Members of the Turkish Brigade were interviewed at the Tokyo Army Hospital. This Brigade had been in action for 3 nights and 3 days (from the night

of 27 November 1950 to the day of 30 Novenmber 1950) in the vicinity of Kunuri, Korea. A total of 407 injured were evacuated to Japan of which 387 were

considered to have been hit by enemy missiles (the remainder were disease cases

or nonbattle casualties). Of the 387 wounded in action, 286 were individually

interrogated. This represented 74 percent of all the WIA casualties evacuated

to Japan. The number of WIA casualties who remained in Korea was not

known, but the number was believed to be small, and it was thought all were

promptly returned to duty.

Interrogations, aided by Turkish officers who were available as interpreters, lasted from 5 to 15 minutes per casualty. What error, if any, was

introduced by this procedure is unknown. Answers were usually prompt and

direct. Most of the Turkish soldiers appeared very certain of the type of the

weapons producing the missiles with which they were hit, sometimes stating the

enemy was so close that the weapons were visible, or otherwise being able to

give good reasons for distinguishing between mortar and grenade hits. The

interrogation was accompanied by examination of the casualty.

The 286 WIA casualties incurred a total of 950 wounds (fig. 339), as listed

in table 281.

TABLE 281-Distribution of 950 wounds in 286 Turkish WIA casualties, by number of hits

on anterior and posterior surface of body region

Hits on- Total hits

Percent of

Body region Anterior surface Posterior surface total

body area

Number Percent Number Percent Number Percent

Head ------------------ 61 6.4 15 1.6 76 8. 0 12.0

Chest ----------------- 21 2. 2 117 12.4 138 14.6 16.0

Abdomen -------------- 31 3. 3 16 1. 6 47 4. 9 11.0

Extremities:

Upper ------------- 69 7. 3 119 12.5 188 19.8 22. 0

Lower ------------- 253 26. 6 248 26. 1 501 52. 7 39. 0

Total ------------ 435 45. 8 515 54. 2 950 100. 0 100.0
716 WOUND BALLISTICS

LOCATION OF ALL HITS

950

58-HEAD-II

3 -NECK-4

21-CHEST-IIT

69-UPPER -119.

EXTREMITIES

31 -ABDOMEN-16 .

A ANT 53RIOWEPOSERIO

FImUYE 339.--Location of wounds in 286 Turkish soldiers wounded in action.

The missiles responsible for these wounds are listed in table 282.

An attempt was made to determine the mean estimated length of trajectories for the causative agents fr'om the site of origin to the man hit. No

attempt was made to discard any data (such as mortar shell fr'agment hits

alleged to have occurred a~t a 200-400 meter range). Tim reported mean

ranges were given to establish orders of magnitude, as follows:

Mean estimated

length of trajectories Type of missile: (in meters)

Rifle-------------------------------112. 5±101. 0

MVachinegun----------------------------70. 7±4 83. 1

Mortar fragments--------------------------9. 7± 18. 8

Hand grenade fragments-----------------------5. 1±- 4.6
WOUND BALLISTICS AND BODY ARMOR 717

TABLE 282-Distribution of 950 hits on 286 Turkish WIA casualties, by type of missile

Type of missile Number of hits Percent of hits

Small arms:

Rifle ------------------------------------------------ 149 15. 7

Pistol ----------------------------------------------- 10 1.1

Machinegun ------------------------------------------ 59 6. 2

Submachinegun --------------------------------------- 18 1.9

Unknown -------------------------------------------- 21 2. 2

Total ---------------------------------------------- 257 27. 1

Fragment:

Mortar --------------------------------------------- 559 58.9

Hand grenade --------------------------------------- 111 11.7

Secondary missile ------------------------------------ 2 . 2

Unknown fragment ------------------------------------ 20 2. 2

Total ---------------------------------------------- 692 73.0

Antitank gun I ------------------- 1 . 1

Grand total ---------------------------------------- 950 100. 0

1 Not considered a small arms hit nor a fragment bit.

When the estimated ranges were broken down for missiles causing perforating and penetrating wounds, the results were generally in line with the

expectation that missiles producing perforating wounds would come from

shorter ranges (that is, have higher velocities): Mean estimated ranges

(meters)

Missiles Missiles

causing causi.ng

perforat- penetrat- ing ing

Type of missile: wougds wounds

Rifle -------------------------------------------------------- 109.0 118. 0

Machinegun -------------------------------------------------- 55.3 102.7

Mortar fragment --------------------------------------------- 39. 6 8. 8

Hand grenade fragment ---------------------------------------- 1.2 6.0

It will be noted, in the tabulation just listed, that the mortar fragments

are reversed from the normal expectation. Had the alleged occurrence of

perforating mortar fragment wounds at ranges of over 100 meters been discarded as an error in judgment of range, the mean values would have become

4.3 meters for the perforating missiles and 8.1 meters for the penetrating ones.

This relationship is in the proper order.

Degree of damage from various wounding agents was assessed on a 1

to 4 scale (table 283).
718 WVOUND BALLISTICS

TABLE 283.-Distribution of 233 determinations of the degree of damage caused by each type of

missile

Degree of damage 1 Type of missile Total determinations 1 2 3 4

Small arms:

Rifle ------------------------------ 67 10 2 79

Pistol ----------------------------------- 2 ................- 2

Machinegun --------------------------- 22 - ------- 5 ---- - 27

Submachinegun -------------------- _-_-_ 7 1 2 -- . 10

Unknown -------------------------- 15 1 1 -------- 17

Total --------------------------- 113 12 8 2 135

Fragments fromMortar ----------------------------- 53 10 1 5 69

Hand grenade ---------------------- 19 3 1 2 25

Unknown missile -------------------- 2 1 3

Antitank gun ----------------------------------------------- 1 1

Total --------------------------- 74 14 2 8 98

Grand total ---------------------- 187 26 10 10 233

I Degree .- Size of wound of entrance in any one dimension not more than three times the size of missile, provided

the missile was not greater than 1 cm. in any dimension.

Degree 2.-Size of defect of the wound of entrance greater than 3 cm. in any one dimension (regardless of missile

size) but less than 5 cm. in its greatest dimension.

Degree 3.-Same as degree 2 for defects from 5 to 10 em. in their greatest dimension.

Degree 4.-Same as degree 3 for defects measnring over 10 cm. in any one dimension.

It was also possible to analyze the incidence of casualties occurring during

the day and during the night. A total of 216 casualties were available but,

because 30 sustained hits from more than one type of missile, it was necessary

to list these more than once. Therefore, the data total 250 casualties and are

prescribed in table 284.

Finally, it was possible to estimate the number of enemy casualties

resulting from the efforts of 108 Turkish soldiers (table 285). Not shown in

the table are the numbers of enemy casualties which the Turks claim to have

produced after they (the Turks) had been wounded.

Autopsy Study of DOW Casualties

The reports of autopsy findings on 125 WIA casualties who were hospitalized and died later were made available for study by the 406th Medical

General Laboratory. An analysis of the missile type involved in these cases

and the immediate cause of death are shown in tables 286 and 287. The

head, the thorax, and the abdomen were the principal regions involved, with
WOUND BALLISTICS AND BODY ARMOR 719

TABLE 284.-Distribution of 250 casualties (152 sustaining hits during the day and 98 during

the night), by type of missile

Day casualties Night casualties

Type of missile,

Number Percent Number Percent

Small arms:

Rifle ---------------------------------------- 67 26.8 19 7.6

Pistol -------------------------------------- 1 .4 1 .4

Machinegun -------------------------------- 19 7.6 12 4.7

Submachinegun ------------------------------ 6 2.4 5 2. 0

Unknown ---------------------------------- 9 3. 6 8 3. 2

Total ------------------------------------- 102 40.8 45 17.9

Fragments:

Mortar ------------------------------------- 31 12.4 38 15.2

Hand grenade ------------------------------- 15 6.0 13 5.3

Unknown -------------------------------------- 4 1.6 1 .4

Antitank gun ------------------------------- ---------------- 1 .4

Total ------------------------------------- 50 20.0 53 21.3

Grand total ------------------------------ 152 60. 8 98 39. 2

TABLE 285.-Distribution o.f estimated number of enemy casualties caused by the indicated

number of Turkish soldiers, by weapon used

Weapon Enemy killed Turkish soldiers

or wounded involved

Number Number

Ml rifle ------------------------------------------------- 268 65

Carbine ------------------------------------------------- 5 2

Pistol --------------------------------------------------- 4 2

Machinegun ---------------------------------------------- 838 16

Submachinegun ------------------------------------------- 45 6

Browning automatic rifle ----------------------------------- 6 1

Hand grenade -------------------------------------------- 100 17

Bazooka ------------------------------------------------ 6 3

Bayonet ------------------------------------------------ 22 9

Knife ---------------------------------------------------- 1 1

Strangled ------------------------------------------------ 3 1

Burned -------------------------------------------------- 3 1

Total --------------------------------------------- 1 301
720 WOUND BALLISTICS

14.4 percent of the cases showing involvement of the extremities alone. Small

arms fire accounted for 56.6 percent of the casualties, and this approximates

the incidence seen in KIA casualties. Cases with head wounds showed an

average survival time of 12.6 days; thoracic wounds, 4.5 days; abdominal

wounds, 14 days; extremity wounds, 7.6 days; and wounds of the spine, 19

days.

TABLE 286.-Frequency of causative agent producing wounds in 125 DOW casualties,

by body region

Total Un- Gun- Shell Gre- Bay- Crush- Chem- casualBody region known shot frag- Mortar nade Mine onet ing ieal ties

missile ment burns (numher)

Head ---------------------- 11 14 7 3 1 ---- ---- ------.------ 36

Spine ---------------------- 1 4 1 1 ----.---- 1 ------.------- 8

Thorax --------------------- 1 1 1 1 ----.----.----.------------- 4

Abdomen ------------------ 6 7 1 2 2 -----------. ---1 - 19

Thorax and abdomen ------------- 10 1 1 ----.----.----.------------- 12

Extremities ----------------- 2 6 3 1 1 3 1 ------ 1 18

Abdomen and extremities .... 1 5 2 ------- -1-------------------- 9

Thorax and spine ------------------ 3 --------------.----.----.------.------- 3

Abdomen, thorax, and spine -------- 1 2 ------.---- ---- ----.------.------ 3

Head and extremities ------------- 1 2 ------.----.--------------.------- 3

Abdomen and spine ---------.------ 2---- ------ ---- ----.----.------.------- 2

Miscellaneous -------------- 2 4 1 1 ----.----.----.------------- 8

Total --------------- 24 58 21 10 5 3 2 1 1 125

Source: Autopsy reports from 406th Medical General Laboratory, Tokyo, Japan.

Study of KIA Casualties

A survey of the records of 1,500 personnel killed in action was conducted at

the Quartermaster Graves Registration unit, Pusan, Korea, during January

1951. Of the KIA casualties sustained by the United Nations forces during

this period, 63 percent were due to enemy small arms fire, 26.9 percent to shell

fragments, 2.8 percent to mortar, 2 percent to mines, 0.7 percent to grenades,

0.5 percent to artillery, and 4.1 percent to miscellaneous agents. This was in

marked contrast to the results obtained from an analysis of the WIA cases

which showed that fragments of all types were responsible for about 92 percent

of the wounds. Table 288 shows the regional frequency of fatal wounds in

the 1,500 KIA casualties.
WOUND BALLISTICS AND BODY ARMOR 721

FF I lT I I I I I I I I I I

I II 1 1 1 1 Il 2 I I I I I l [

'o i 2 - 0 ,I i i i I I l I I I FI FI I I I

I :

VI I [ 1 l 1 1 1 I [ I I I I 1 I [ 1I

z I I I lIl2l'2 ILc I l l l I ,I~ l I 1

0 c ' - ' I I lI I lI l l l l I I II I I I I I I 1 [ 1 [I

0 Z i I I Il I Il Il l lI 2l I 1 1 I I I I I lI lI ci - i I I I I I 2 II II I _ C I 1 IJ L 1 I_ I [ i l

SI C.l l Il Il 2I l llI 2I I I I IIi0 I2l 2 I 1 I I I I2 I 2 I2 I t l I lI l lI

S• , 8 I I I 2 I I I , I 2 I I 2 I 2 I I I 2 1 1 11: I

- l l I l l l2 l l l1 1 1I 1l 2l 1 21 I l2 l

00• I I I I I I I2 2 I 1 I I I I I I 2 2 l2 I I2 2 I2 ,

__ __ __ _ I [ I i2 2 i i i i l l l l I [ 1 1

Si i i i i i 2 2 l l2 l l l l 2 2 2 2 1 I I I I

0 '' I T I I I I lF 2 I 2 2l I I II 2 il22 

0 _ _ _ __ -_ _ I.I I 1 [ 2 IF 2 2 2 I II 1 Il F l l l

Sl lll I I i I I cII 

li I I I I 2 2 2 I I 2 2 I 2 2 2 2 2

S2 E- I . . .I l I. 2 1 1 1 1 1 I 2 I II I I II I I I I I I

l l l l l l lI l l I 2 I 2 I:1

2I I I I 2 I 2 I 1 1 12 IN I I I0• 2 II2 l l l l 2

0 :II I I II I Il lF I I I 2 l2 l l

cii I21211 i I F 2 2 1 C•2 I 2 I 2 I2I2 I I I I211 1

, I I I IIIII2 2 2 2 2 2 2 2 I 2 1 2 FII I I I I 1I 1 1 5

0 • I I I I I I I 2 2 2 1 2 1 2 1 2 12 2I% I I I2I 1 1

~' I I I I II Il 2 l 2 l l l 1 1 1 F l l 'l

SI t l 1 1 l 1 1 i l i I I I[ I I I

00

C.I01,l2 2 2 l2 2 I2 12 1 1 1 1 1 1 I t I I 12 [ I2 2-

•_booIIIF I 1 1 1 1 1 1 1 0 I I I 1 2

0 2I lFl 2 2 2 2 2 F l l

'tiIO F I 2 F 2 2 2 2- 2 2 2 .

9 g 0.)~~ ~~ L 2 2 2 I 2

000

4 2 2 03205 0 l2 0 0 04

c"ý2- o'gcd

2ý 2 q 4D 2. '4 '4 P2 2- 24 24 2 02 0 ý- -4. 2

482 26203225 ",'162. 2 2 O i 
722 WOUND BALLISTICS

TABLE 288.-Regional frequency of fatal wounds in 1,500 KIA casoalties, by anatonic location

Anatomic location Number of Percmnt of casualtics casualties

Head and neck:

Head ------------------------------------------------ 375 25. 0

Neck 60 4. 0

Face ------------------------------------------------- 38 2. 5

Total ---------------------------------------------- 473 31.5

Upper extremities:

Arm and shoulder ------------------------------------- 56 3. 7

Hand ------------------------------------------------ 6 .4

Total ---------------------------------------------- 62 4. 1

Thorax -------------------------------------------------- 367 24. 5

Abdomen ------------------------------------------------- 143 9. 5

Total ---------------------------------------------- 510 34. 0

Lower extremities:

Leg ------------------------------------------------- 39 2. 6

Buttock --------------------------------------------- 13 . 9

Thigh__ ---------------------------------------------- 12 .8

Hip ------------------------------------------------- 6 .4

Foot ------------------------------------------------ 4 .3

Total ---------------------------------------------- 74 5. 0

Multiple wounds, region unknown -------------------------- 381 25.4

Grand total ---------------------------------------- 1,500 100.0

Prisoner-of-War Study

The data in the preceding tables represent the effects of enemy fire. A

comparison with the effects of United Nations action against the enemy was

made possible through the study of prisoner-of-war casualties made during

January 1951 at the 3d and 14th Field Hospitals at Tongnae. Data from

1,000 prisoners were gathered through interrogations of the prisoners via an

interpreter. An additional 2,000 medical records of prisoners admitted to

these hospitals were analyzed for wound frequency studies, as follows:
WOUND BALLISTICS AND BODY ARMOR 723

Number of Number of cases cases

Head and neck: Lower extremities:

Head ------------------------- 53 Thorax ----------------------- 102

Face -------------------------- 51 Abdomen --------------------- 63

Eye -------------------------- 22 Leg -------------------------- 408

Neck ------------------------- 20 Thigh ------------------------- 304

Ear -------------------------- 3 Foot -------------------------- 249

Nose ---------------------------- 1 Knee ------------------------ 93

Buttocks --------------------- 61

Total ----------------------- 150 Hip------------------------ 46

Upper extremities: Total ---------------------- 1, 326

Arm ------------------------- 220

Hand ------------------------- 131 Grand total ----------------- 2,000

Shoulder --------------------- 78

Forearm --------------------- 70

Elbow ------------------------ 25

Total ---------------------- 524

The mode of wounding of the 1,000 prisoners of war interrogated revealed

the following:

Number of Nu miner of cases cases

Casualty-producing agent: In air action-Continued

In ground action: Rocket -------------------- 30

Gunshot ----------------- 430 Napalm ------------------- 44

Shell fragment ------------ 235

Grenade ------------------- 12 Total ------------------- 277

Total ------------------- 677 Nonbattle casualties ---------------- 46

In air action: Total ----------------------- 46

Bomb --------------------- 109 _

Aircraft machinegun ------ 94 Grand total ----------------- 1,000

General Observations and Conclusions of Survey Team

From observations and interrogations, this first wound ballistics survey

team was able to conclude that the maximum ranges at which wounding

occurs are comparatively short. Thus, this team's report states: "Most

wounds caused by shell fragments occur within 8 meters of the shell burst.

Most wounds caused by small arms occur within 100 meters to 200 meters,

rarely beyond 500 meters."

Perhaps the most important of all the conclusions reached by this team

concerned the feasibility of body armor. Team members had been impressed

by the large number of penetrating wounds in which the missile remained in
724 WOUND BALLISTICS

the body. They also noted the protective effects of ordinary items of clothing,

finding, for example, small arms bullets retained in the foot even when the shot

was at very close range, as in self-inflicted wounds. Here the combat shoe

seemed to make a considerable reduction in velocity. On the basis of large

numbers of this kind of supporting observation, the team was able to conclude:

Whereas most wounds are caused by shell fragments and are of a penetrating rather

than a perforating nature, it is believed that some type of body armor is feasible. Requirements for this protective clothing are fundamentally that it be light, flexible, comfortable, be able to screen out missiles with velocities of 1200 ft./sec. or more, and will not

handicap combat effectiveness. It is further believed that although the casualty rate per se

may not be appreciably reduced, there will be a valuable reduction in the number of wounds

and in their severity. This solves a considerable problem in evacuation, treatment time

consumed, and total hospital days. If the chest and abdomen are protected, it may well

change many KIA's to WIA's. The problem is not alone that of overall reduction in casualty rate. The psychological effect upon soldiers knowing that they have some protection

for vital areas appears obvious, although needing evaluation by field trial.

Although the hospital mortality rate has fallen below 2% and is approaching an irreducible minimum, the killed in action rate and missing in action rate continue quite high.

Utilizing publicly released figures, about 14% of the total casualty rate is MIA and approximately a similar percentage exists for missing in action. This means that every fourth

casualty is killed or missing. Actually if the 2 % hospital mortality rate were added to the

KIA and MIA rates, 30% of the total casualties would be KIA, MIA, and wounded died

later. It is, therefore, apparent that any further appreciable reduction in casualty rate

lies in 1) use of body armor, 2) faster evacuation of casualties from the battlefield. The

hazard now of battlefield recovery has not halted the courageous company aid man, but

he also becomes a casualty occasionally and replacement in a moment is difficult. The

time when he is needed most probably offers the greatest chance for his being wounded. It

is believed that body armor for him would aid materially in the performance of his duty.

Recommendations made by the first wound ballistics survey team follow:

1. Attach a Medical Officer to all graves registration units for EIlA Survey.

2. Institute exact area frequency for wounds study rather than regional designation;

include type wound, severity, disposition.

3. Survey large numbers of WIA and KIA involving thorax and abdominal wounds

charting exact area of wound, e.g., ventral, dorsal, flank, and quadrant.

4. Follow carefully 50 casualties involving each anatomic region by means of serial

photographs at critical intervals with appropriate surgical notes. This should begin at

the Mobile Army Surgical Hospital. The mode/time/distance of evacuation should be

included.

5. Field trial of a combination doron and nylon armored vest for Medical personnel

in combat units, particularly Medical Company Aid men. If found feasible recommend

use for all field troops.

6. Specific orientation of Medical officers in a basic knowledge of wounds, classification,

and weapon and missile identification. Medical officers stress the etiology of disease, and

many years are spent learning about the varied causative agents. The etiologic agent of a

war wound is a missile, and yet with rather rare exceptions members of the medical profession know little about weapons and missile identification. It is no longer adequate for

a physician to receive his medical training directed only toward civilian practice, because

all doctors now may anticipate military service or the responsibility for civilian populations

under the fire of every conceivable weapon.
WOUND BALLISTICS AND BODY ARMOR 725

Since medical officers usually fill in the EMT, and subsequent field records, and since

so frequently those doctors are relatively new to the service, a few items are worthy of

emphasis and indoctrination:

a. Ask the casualty what hit him. He frequently knows. Specify whether or not he

is a battle casualty, has a missile wound or injury, and the actual missile, e.g., small arms

(rifle, carbine, Burp, Grease, machinegun), grenade, mortar, artillery, landmine, or shell

fragment unknown, etc. Avoid the use of the term shrapnel. Never be content to list

just "missile".

b. State whether it was enemy or friendly fire, air or ground.

c. Self-inflicted wounds may be accidental or intentional. If it is known, so state.

d. Describe the treatment given.

e. Record the mode, time, and distance of evacuation.

f. Record disposition and the patient's condition at that time.

Preparation for Field Trial of Body Armor

The first team returned to the United States and prepared its reports in

May 1941. The recommendation to The Surgeon General, Department of

the Army, for a field trial of an armored vest was readily accepted.

Laboratory tests already completed at that time made it apparent that

it would not be possible to defeat most bullets with any reasonable weight of

body armor material then available. Within practical ranges, the velocity of

bullets is too high. However, it had been found that about 92 percent of the

missiles producing WIA casualties were fragments. Of these fragments, 73

percent did not have enough velocity to cause perforating wounds or extensive

tissue damage, suggesting that in this important class of wounding missiles

the majority were in a lower velocity, lower energy range. It was assumed

that a large number of these could be defeated by an armor which would stop

fragments having velocities of 1,200 f.p.s. or lower. It was immediately

apparent that steel could not be incorporated into any type of thoracoabdominal protective clothing with any degree of success because of its lack of

flexibility and excessive weight. Aluminum proved to have a relatively low

ballistic limit. It was not flexible and would have proved difficult to tailor

into a protective vest. Nylon cloth (12 layers of 2 x 2 basket weave) was

found to have a ballistic limit of 1,275 f.p.s. against a 17-grain simulated fragment, and its great flexibility was thought to offer most feasibility for fabrication

into a protective vest. Doron (multiple layers of fiber-glass cloth laminated

by a methacrylate resin) also proved highly effective in defeating these simulated fragments. Doron surpassed nylon in performance when struck by

the .45 caliber pistol ball but lacked the flexibility of nylon. Doron could,

however, be molded to conform to the contours of the body.

The Naval Field Medical Research Laboratory at Camp Lejeune, N.C.,

had for some time been working on the development of a slipover type of vest,

using doron armor. That installation had pioneered the use of curved doron
726 WOUND BALLISTICS

plates in body armor and had established the fact that the ballistic properties

of doron were unaffected by the manufacturing process. Models of such a

vest were in existence, and the Naval Field Medical Research Laboratory

possessed necessary experimental tailoring facilities to make models of various

designs. Accordingly, members of the first survey team met with personnel

at Camp Lejeune, and it was agreed to incorporate into the vest certain modifications suggested by the Korean battle casualty survey experiences. The

most significant contribution was the addition of 12 layers of nylon to the

area covering the shoulder girdle. The modified vest (figs. 340 and 341) was

described as follows:7

FIGuRE 340.-Slipover thoracoabdominal vest with nylon shoulder girdle and 16 doron

plates. Field tested, 14 June to 13 October 1951.

A slipover, semi-flexible thoraco-abdominal vest weighing 6.1 lb. made of 2 x 2 basket

weave nylon covering the upper chest and shoulder girdle, and a lower portion made of 16

curved doron plates covering the lower chest and upper abdomen. Ballistic properties as

follows: Capable of stopping a .45 caliber pistol or Thompson submachine gun bullet at

the muzzle; all the fragments of the U.S.A. hand grenade at three feet; 75% of the fragments of the U.S.A. 81 mm. mortar at ten feet; and the full thrust of an American bayonet.

7 Medical Project-Body Armor, Korea, 14 June to 13 October 1951, issned by Joint Army-Navy Mission, Medical

Research and Development.
WOUND BALLISTICS AND BODY ARMOR 727

FIOURE 341.-Three views of doron slipover vest on soldier.

In June 1951, 50 such vests were fabricated at the Naval Field Medical

Research Laboratory, partially aided by funds allocated by the Army Quartermaster Corps.

JOINT ARMY-NAVY BODY ARMOR FIELD TEST,

14 JUNE-13 OCTOBER 1951

Upon invitation by Colonel Wood to Adm. Herbert L. Pugh, Chief of the

Bureau of Medicine and Surgery, Department of the Navy, a joint ArmyNavy medical mission was organized and dispatched to the Far East Command

on 14 June 1951 for the purpose of field testing, under actual combat conditions in Korea, an item of equipment designed as body armor for protection

of the chest, the shoulders, and the abdomen. Officer members of the team

were (Army) Colonel Holmes, Captain Phillips, Lieutenant Coe, (Navy)

Comdr. John S. Cowan, MC, and Lt. Comdr. Frederick J. Lewis, Jr., MSC.

Upon arrival in Tokyo, the unit was attached to the 406th Medical General Laboratory for logistical and administrative support. After drawing the

necessary equipment and supplies, the team departed for Korea, arriving at

Headquarters, 5th Regiment, 1st Marine Division, on 4 July 1951.

The specific mission at this time was to (1) determine and evaluate the

reaction under combat conditions of Medical Department personnel, particularly company aidmen, to the proposal of wearing body armor, and (2) determine and evaluate the reaction under combat conditions of personnel of the
728 WOUND BALLISTICS

various services to the proposal of wearing body armor. During the course

of the following 2 months, these 50 vests were worn by approximately 6,000

soldiers and marines. Tests were performed with the 5th Marine Regiment

and the 23d and 38th Infantry Regiments of the 2d Division.

Conclusions of Body Armor Test Team

The conclusions reached by this team were as follows:

1. That body armor or protective clothing of some type for the vital anatomic areas is

almost unanimously desired by all combat troops, particularly the combat veteran after

several actual fire fights with the enemy.

2. That the body armor vest was received quite favorably by most Commanding Officers,

who were eager for its trial, feeling that the psychological effect upon the troops would be of

considerable morale value.

3. That the troops of all arms and services were completely cooperative and constructive

in their trial of the body armor, appearing to sense the responsibility of their judgment upon

an item of equipment designed to save their lives as well ýas others.

4. That thorough indoctrination of all troops should precede the wearing of any body

armor. Such indoctrination should include familiarity with percentage relationships of the

various wounding agents, the anatomic distribution of hits, and the most commom lethal

wounds. The protective ballistic properties of the body armor should be thoroughly demonstrated.

5. That the body armor vest, which weighed 6.1 lb., was not considered an excessive

weight, and that such a weight per se did not hinder or handicap the wearer.

6. That the weight of the body armor was tolerated and carried easily because of its

proper distribution and suspension from the entire shoulder girdle.

7. That such body armor (6.1 lb.) could be and was worn over mountainous terrain of

extremely rugged nature in a hot, humid climate, with only a few adverse complaints of the

weight factor from the men.

8. That such body armor, in the Korean summer, received its severest criticism as being

excessively hot.

9. That a water-proof or water-resistant covering fabric should be used to prevent gain

in weight from perspiration or rain. Gain in weight due to such reasons was 1%i to 2 lb. for

the armored vest tested.

10. That such armor should be utilized as organizational equipment rather than individual equipment, and as such should be transported via organizational vehicles to the

closest possible point of enemy contact.

11. That tests of body armor are far more significant when done under combat conditions than when performed under training or simulated combat conditions.

ARMY BODY ARMOR TEST TEAM, FEBRUARY-JULY 1952

Upon returning to the United States in September 1951, the team recommended that approximately 1,400 vests incorporating those changes suggested

by the field test in Korea be further tested in actual combat in order to determine the effectiveness of the vest in defeating missiles from enemy weapons.

Accordingly, the Army developed a model (fig. 342) made of 12 plies of 2 x 2

basket weave nylon weighing 13 ounces per square yard. The layers of nylon

were triangularly spot bonded together. The Marine Corps realized that

expediency was of paramount importance and developed a design based upon
WOUND BALLISTICS AND BODY ARMOR 729

Sc 400857, 400858

FIGURE 342.-Army all-nylon vest, T52-1. One of prototypes tested in the period

from 1 March to 15 July 1952. A. Front view. B. Rear view.

doron-nylon combination and proceeded to its standardization by 16 November

1951. The Army all-nylon vest was covered with a vinyl-coated nylon poncho

material, olive drab in color, with a one-quarter inch layer of sponge rubber

beneath the covering over the ribs and the shoulder girdle. The sponge rubber

provided an offset of the vest away from the body since it was felt that contusions or fractures might result from impact of nonpenetrating missiles upon

the vest. The vest was provided with two rectangular gusset-type pockets

closed by a triangular flap and a snap fastener. The frontal closure was

effected by means of three dot-type fasteners. Loops or straps of nylon were

provided, two front and two back, for supporting cartridge and pistol belts.

The vest was fabricated in two sizes as follows:

1. Size 42; area of protection, 6.7 square feet; weight, 7 pounds and 12

ounces.

2. Size 46; area of protection, 7.4 square feet; weight, 8 pounds and 4

ounces.

On 18 February 1952, an Army body armor team departed for Korea with

the following objectives:

1. To determine the relative effectiveness of the various body armor prototypes against

various types of enemy fire, delivered under a variety of environmental and tactical situations.

2. To determine the dimensions of soldier acceptance and use of body armor.

3. To determine the most satisfactory methodology to orient soldiers in the use of body

armor.

4. To determine the relative reduction in wound incidence, extent, and severity in

soldiers wearing body armor.
730 WOUND BALLISTICS

At this time, the team consisted of officers representing the Medical Corps,

the Army Field Forces, the Ordnance Corps, and the Quartermaster Corps.

During the course of the test in Korea, the team numbered 24 officers and

33 enlisted men. Initially, the team was directed by Lt. Col. Andrew A. Aines,

QMC; later, Lt. Col. William W. Cox, MC, assumed the role of team commander.8

Special equipment which was not available in the theater was obtained

in the Zone of Interior and accompanied the test team to Korea. These items

T'ong ch'on. "

0 10 20 30 40

MILES

SUB-TEAM 4

2 OFF'ICERS

4 EM

SUB-TEAM 1 B C ' r " "Li MASH

3MDCAMB OFFICERS "lolh•c •• \ U- E M-- OFFICERS DICAL5 I•/'-\'•b•

5 EM POHL PLD O I PHOTOGRAPHER

Uijongbu wac8 EM

Yonch'on ,H:och Ho n

-38' 38'

MASH~ -

I MEDICAL OFFICER MAunscn *oC hu c SUD-TA M 23I

I PHOTOGRAPHER CX *Anh 4 OFFICERS '.

Uijongbu 0

ln c.h'on I MEDICAL OFFICER

A\ & 1PHOTOGRAPHERC

TEAM HEADQUARTERS

6 OFFICERS

F4 EM

FIGURE 343.-Map showing disposition of Body Armor Test Team, March-July 1952.

8 Additional officer personnel serving with the Body Armor Test Team were as follows:

On TDY from the Zone of Interior to Korea: Maj. Henry F. Breezley, Ord C, Development and Proof Services, Aberdeen Proving Ground, Md.; Maj. William F. Enos, MC, Armed Forces Institute of Pathology, Washington, D.C.; Maj.

John W. Irving, QMC, Quartermaster Board, Capt. William If. Bailey, MC, HQ, Army Chemical Center, Md.; Capt.

William L. Camper, Int., Army Field Forces Board No. 3, Fort Benning, Ga., Capt. Anthony J. Daniels, QMC, Quartermaster Board; Capt. John M. Nowell, MSC, Walter Reed Army Medical Center, Washington, D.C.; Capt. Mack Strauss,

QMC, HQ, Fort Lee, Va.; and Lt. Richard B. Stoughton, MC, 11Q, Army Chemical Center.

Detailed from Eighth U.S. Army units in Korea: Maj. Rodney 0. Capps, QMC, 23d QM Group; Capt. William

Barber, QMC, 23d QM Group; Capt. Robert II. Bessey, Jr., Inf., 15th Infantry; Capt. Henry E. Davis, QMC,

23d QM Group; Capt. Gene P. Eardley, MC, 25th Evacuation Hospital; Capt. Richard W. X. Fasey, Inf., 32d

Infantry; Capt. Ellwood R. Lambert, Inf., 15th Infantry; Capt. Robert L. Mignery, QMC, 23d QM Group; Capt. Leonard

K. Pierce, QMC, 23d QM Group; Capt. Donald C. Tanner, MC, 25th Evacuation Hospital; 1st Lt. Gilbert D. Cheney,

Inf., 32d Infantry; lst Lt. William B. Gillett, Inf., 233d Infantry; and 2d Lt. Rodney M. Brigg, Inf., 160th Infantry.
WOUND BALLISTICS AND BODY ARMOR 731

included photographic equipment, weather recording equipment, tape recorders,

instruments for ballistics studies, and other miscellaneous expendables. All

other classes of supplies and equipment were obtained from theater stocks.

These were requisitioned by, and assembled at, team headquarters in Seoul.

From this point, they were issued to subteams operating in forward areas

(fig. 343). Each subteam was self-sufficient for supply, administration, and

operation. Except for rations and petroleum products, no supply burden was

imposed on units participating in the tests. Because of the magnitude of the

test, the team was not attached to the theater medical general laboratory but

operated as an independent unit assigned to Headquarters, Eighth U.S. Army,

Korea.

CoDduct of Test, 1 March Through 15 July 1952

During the course of the test, the Army nylon vest was worn by over

15,000 soldiers for an aggregate of approximately 400,000 man-hours. The

Eighth U.S. Army organizations which participated in the test are shown in

table 290. In addition, other United Nations troops using vests on a limited

distribution were (1) Philippine forces attached to I Corps, 3d Division, 7th

Regiment; (2) ROK (Republic of Korea) troops of the 1st ROK Division,

attached to I Corps, 11th Regiment; (3) Ethiopian forces attached to IX Corps,

2d Division, 23d Regiment; (4) Colombian forces attached to IX Corps, 7th

Division, 31st Regiment; and (5) French Forces attached to IX Corps, 2d

TABLE 290.-Eighth U.S. Army units participating in test of Army nylon vest

Unit Date entered Date terminated

Corps Division Regiment

1952 1952

I 3d 7th 1 Mar 25 Apr

I 3d 15th 29 Mar 25 Apr

I 3d 65th 13 Apr 25 Apr

I 45th 179th 1 May 15 Jul

I 45th 180th 1 Jun 15 Jul

I 45th 279th 1 May 31 May

IX 2d 23d 9 Apr 25 Apr

IX 2d 38th 30 Mar 13 Apr

IX 7th 17th 7 May 15 Jul

IX 7th 31st 7 May 15 Jul

IX 7th 32d 16 Apr 15 Jul

IX 40th 160th 4 Jun 30 Jun

IX 40th 223d 4 Jun 30 Jun

IX 40th 224th 4 Jun 30 Jun

X 25th 14th 2 May 10 Jun

X 25th 27th 18 Apr 10 Jun

X 25th 35th 18 Apr 2 May
732 WOUND BALLISTICS

Division, 23d Regiment. Other personnel using vests on special studies were

pilots serving I Corps; pilots of helicopter detachments serving the 8063d,

8076th, and 8209th Mobile Army Surgical Hospitals; and the 3d Air-Sea

Rescue Squadron.

In this period, there were 2,099 battle casualties and 322 soldiers killed in

action in the divisions in which body armor was used. It must be emphasized

that the total body armor available to division personnel was exceedingly small,

averaging about 350 vests per division during the period of the test. A total

of 1,400 vests were available during the test period and these were received by

the team from the Zone of Interior as follows (48 vests accompanied the initial

team members):

1952 Number

of vests

Feb. 18 ----------------------------------------------- 48

Mar. 6 ----------------------------------------------- 50

26 ----------------------------------------------- 200

Apr. 10 ----------------------------------------------- 200

13 ----------------------------------------------- 200

21 ----------------------------------------------- 200

24 ----------------------------------------------- 200

May 4 ----------------------------------------------- 200

8 ----------------------------------------------- 102

Total ------------------------------------------ 1,400

Wound Ballistic Studies on WIA Casualties

A total of 1,591 wound ballistic studies, in many instances including pictures

and X-rays, were made on soldiers from all of the American divisions on the

frontline. These studies included battle casualties, accidental wounds, and

self-inflicted wounds. Table 291 lists the regional distribution of wounds in

908 WIA casualties not wearing body armor.

In the group of WIA casualties who were not wearing body armor, there

were 278 wounds in the region of the body (chest and upper part of the back)

that would have been covered by the vests. An estimate of the effect of the

vest, had it been worn, is that it would have probably prevented the wound in

204 (73.4 percent) cases; might possibly have prevented the wound in 17 (6.1

percent); been of questionable value in 27 (9.7 percent); and would have bad

no effect in 30 (10.8 percent).

A total of 552 soldiers were wounded in action while wearing body armor

(table 292).

A breakdown of 1,460 battle casualties who were studied during the test

period by causative agents and by type of wounding (that is, multiple or

single) is shown in tables 293 and 294, respectively. Typical fragments and

missiles removed from the casualties are shown in figure 344.
WOUND BALLISTICS AND BODY ARMOR 733

TABLE 291.-Regional distribution of 1,474 wounds in 908 WIA casualties not wearing body

armor

Number of Percent of total

Body region wounds wounds

Head ---------------------------------------------------- 208 14. 1

Neck --------------------------------------------------- 48 3. 2

Chest --------------------------------------------------- 167 11.3

Back:

Upper part ------------------------------------------ 111 7. 5

Lower part ------------------------------------------ 103 7.0

Abdomen ------------------------------------------------ 60 4. 1

Extremity:

Upper ----------------------------------------------- 359 24.4

Lower ---------------------------------------------- 408 27. 7

Genitalia ------------------------------------------------ 10 .7

Total --------------------------------------------- 1,474 100.0

TABLE 292.-Regional distribution of 850 wounds in 552 WIA casualties wearing body armor

Number of Percent of total

Body region wounds wounds

Head ---------------------------------------------------- 121 14. 2

Neck --------------------------------------------------- 23 2. 7

Chest --------------------------------------------------- 40 4.7

Back:

Upper part ------------------------------------------- 34 4.0

Lower part ------------------------------------------ 78 9. 2

Abdomen ------------------------------------------------ 14 1.6

Extremity:

Lower ---------------------------------------------- 294 34. 6

Upper ----------------------------------------------- 241 28.4

Genitalia ------------------------------------------------ 5 .6

Total ---------------------------------------------- 850 100.0

A further breakdown of the fragments that caused these wounds is as

follows:

Percent

Mortar ----------------------------------------------- 38.6

Grenade ---------------------------------------------- 24.0

Artillery ---------------------------------------------- 16. 2

Mine ------------------------------------------------- 9. 5

Undetermined ----------------------------------------- 11.7
734 WOUND BALLISTICS

STICK HAND GRENADE (CHINESE)

56.4 50.8 41.6 24.9 20.4 12.1 10.8 6.3 2.8 0.4

SHALL AkIS BULLETS

US Cal..30, A.P. 7-92 .. Rifle 7.62 ,. Light 7.92mat. Heavy US Cal. so Ball (Chinese) Pointed Ball Pointed Ball

(Russian)

Approx. Cal.50 US Cal. .45 9 sa. (Sten) US Cal. .30 Sub ýaohine Gun Removedfrom Brain or 11 mm. (8r.) Carbine Cal. 7.62 am.

(Soviet)

A

Us Cal. .30

A, . Core 1. Weighto in 1r2inc

ARTILLERY

653.1 510.6

252.9 104.9 85.4 13,.

12.2 5.5 4.4 2,0 1.2 0.5

MORTAR

21.1 15.36.1 15.8 7.2 5.8 0.9

Wei hts in graiirFifmR 344-Typical fragments and missiles removed from casualties in Korea. A.

Stick hand grenades (Chinese) and small arms bullets. B. Artillery and mortar. C.

Secondary missiles.
WOUND BALLISTICS AND BODY ARMOR 735

Windage Knob Base of US Cal. .50 Portion of iagazine

US Rifle P-1 Cartridge US Caring Gl. .30Carbine

Hoe "es of Fatigue Jacket Portion of

iWire Button Identification Tag

Chain

FIGURE 344. Continued.

TABLE 293.--Distribution of 1,4.60 armored and unarmored WIA casualties, by causative agent

Armored casualties Unarmored casualties Total casualties

Causative agent

Number Percent Number Percent Number Percent

Shell fragment ------------------ 467 84.6 769 84.7 1,236 84.7

Small arms -------------------- 85 15.4 139 15.3 223 15.3

Total -------------------- 552 100. 0 908 100. 0 1,459 100.0

TABLE 294--Distribution of 1,460 armored and unarmored WIA casualties, by type of wounding

Armored casualties Unarmored casualties Total casualties

Type at wounding _________ ____

Number Percent Number Percent Number Percent

Single wounds-. ---------------- 326 59. 0 485 53.4 811 55.5

Multiple wounds ---------------- 226 41.0 423 46. 6 649 44.5

Total -------------------- 552 100. 0 908 100.0 1,460 100.0
736 WOUND BALLISTICS

The character of the wounding agent in the 1,460 WIA casualties indicates

that the type of fire to which the vest and nonvest wearers were exposed was in

general the same and thus can not account for the observed difference in the

wound distribution.

Studies on KIA Casualties

During the period of the test, 547 post mortem examinations were made

on soldiers from American divisions along the frontline who had been killed in

action. The wounding agent was determined in 415 cases of the 547 post

mortem examinations that were made (table 295). The regional frequency of

the wounds and their relationship to the cause of death is shown in table 296.

A study was made of the chest wounds in this group of 547 KIA casualties,

TABLE 295-Distribution of -415 KIA casualties, by wounding agent

Wounding agent Number of Percent of

casualties casualties

Shell fragments ------------------------------------------- 278 67. 0

Small arms ----------------------------------------------- 106 25. 5

Mines --------------------------------------------------- 25 6. 0

Blast and burns ------------------------------------------ 6 1.5

Total ---------------------------------------------- 415 100.0

TABLE 296.-Regional frequency of lethal and associated wounds in 547 KJA casualties, by

anatomic location

Lethal wounds Regional total Percent Associated regional Anatomic location wounds wounds

Number Percent Number Percent fatal

Head -------------------------- 221 40. 4 28 249 23. 8 88. 7

Neck -------------------------- 23 4. 2 42 65 6.2 35.4

Chest -------------------------- 154 28. 1 72 226 21.6 68. 1

Back:

Upper part ----------------- 37 6. 8 27 64 6. 1 57.8

Lower part ----------------- 17 3. 1 35 52 5. 0 32. 7

Abdomen ---------------------- 35 6. 4 31 66 6. 3 53. 0

Extremities:

Upper --------------------- 9 1. 6 138 147 14.0 6. 1

Lower --------------------- 38 7.0 138 176 16. 8 21.6

Genitalia ---------------------- ----------------- 2 2 . 2

Miscellaneous ------------------ 13 2.4 --------.--------.--------.--------

Total -------------------- 547 100. 0 513 1,047 100. 0
WOUND BALLISTICS AND BODY ARMOR 737

and an estimate (using the previously described criteria) of the possible beneficial effect of the vest was determined, as follows: For the total 226 chest

wounds, the vest would have prevented a lethal wound in 61 (31.9 percent) of

the primary chest wounds and 24 (24.2 percent) of the associate wounds; would

probably have reduced the severity of the wound in 47 (24.6 percent) of the primary wounds and 24 (24.2 percent) of the associate wounds; and in 58 (30.4

percent) of the primary and 12 (12.2 percent) of the associate wounds would

have been of questionable value.

These studies indicate that 30 to 40 percent of the fatal chest wounds incurred by soldiers in combat would have been prevented by the use of body

armor. From another point of view, this seems to indicate that 10 to 20 percent of the soldiers who were killed in action would have survived if they had

worn body armor. The effectiveness of the vest in preventing chest wounds in

the KIA casualties was not so marked as in the WIA casualties. One explanation of this disparity lies in the higher incidence of small arms wounds in the

KIA (approximately 25 percent) as compared to the WIA casualties (approximately 15 percent).

Study of Vests Used in Test

During the test, 254 vests were recovered which were hit (fig. 345) while

worn by soldiers in combat. A study revealed that of the group of soldiers

ARTILLERY

144.4 25 .4 9. 5.5 4.9 2.3 0.9

14ORTAR

118.7 511.8 23.4 17.4 8.8 4.5 1.5 0.5

GRENADE

liOlip

78.8 57.8 12.0 9,7 5.0 2.3 Ila 0.5

hINES SnALL tdII•

20,9 1.3 1.5 1.4 0.2 Sub bachine 0un

7,62 oýa (Soviet)

Aeights in 'rains

FIGURE 345.-Typical missiles removed from vest, armor, T52-1, in Korea.
738 WOUND BALLISTICS

wearing the vests, 52 (20.5 percent) were returned to duty, 128 (50.4 percent)

were evacuated because of wounds, 55 (21.6 percent) were killed in action, and

in 19 (7.5 percent) the disposition of the soldier was unknown. Of the 128

soldiers who were evacuated, 35 (27.3 percent) sustained wounds through the

vest.

Of the 55 who were killed in action, 24 (43.6 percent) were killed by wounds

through the vests, and 31 (56.4 percent) were killed by wounds in areas that

were not covered by the vest. The wound-missile ratio on these groups is

shown in table 297. In evaluating these figures it should be borne in mind that

approximately 85 percent of wounds were due to fragments which accounts for

the apparent ineffectiveness of the vest against fragmentation.

TABLE 297.-Causative agent and disposition of 254 vest-wearing KIA (55) and WIA (199)

casualties

Wound through vest Wound not through vest Total casualties

Disposition Number Percent 1 Number Percent 1 Number Percent 1

Small arms

Wounded in action:

Evacuated ----------------- 15 42. 9 16 17. 2 31 24. 2

Returned to duty ---------- -------- ------------------------ 7 13. 5

Killed in action ----------------- 14 58. 3 14 45. 2 28 50. 9

Unknown --------------------- -------------------------------- 1 5. 3

Total -------------------- 29 49. 2 30 24. 1 67 26. 4

Shell fragments

Wounded in action:

Returned to duty ------------------------------------------ 45 86. 5

Evacuated ---------------- 20 57. 1 77 82. 8 97 74. 8

Killed in action ----------------- 10 41. 7 17 54. 8 27 49. 1

Unknown ----------------------------------------------------- 18 94. 7

Total -------------------- 30 50. 8 94 75. 9 187 73. 6

Grand Total ------------- 59 100. 0 124 100. 0 254 100. 0

I Percent for dichotomy small arms versus shell fragments.

Among the 254 vests which sustained hits and were available for study,

complete information regarding the type of wound and the disposition of the
WOUND BALLISTICS AND BODY ARMOR 739

casualty was collected in 235 cases. These latter cases were studied and broken down in the following categories:

Number of Percent of

cases total

1. Missiles which did not perforate the vest and which caused no abrasion

or contusion of the underlying area ----------------------------- 101 42. 9

2. Missiles which did not perforate the vest but which caused an abrasion

or contusion of the underlying area ----------------------------- 23 9. 8

3. Missiles which perforated the vest but which did not enter the body- - 30 12. 9

4. Missiles which perforated the vest and entered the body only a short

distance; that is, subcutaneously ------------------------------- 22 9. 3

5. Missiles which perforated the vest and penetrated into one of the major

body cavities or organs ----------------------------------------- 20 8. 5

6. Missiles which perforated the vest and which perforated the body or

which resulted in death ---------------------------------------- 39 16. 6

Total ------------------------------------------------------ 235 100. 0

In categories 1, 2, and 3 are classified those missile hits which were completely defeated by the body armor. Wounds with a reduction in expected

severity are seen in category 4. In category 5, the wounds are severe but

would have been even more severe or fatal if body armor had not been worn.

In category 6 are placed those wounds in which there has been little, if any,

change in wound severity due to the wearing of body armor.

The penetrations as compared to the perforations of the vests, resulting

from all missile hits, are shown in table 298.

TABLE 298.-Distribution of 874 hits on 254 armor vests, by causative agent

Vests hit Penetrating hits I Perforating hits 2

Causative agent

Number Percent Number Percent Number Percent

Small arms -------------------- 63 24. 8 30 24. 4 93 75. 6

Shell fragments ---------------- 184 72. 4 549 75. 7 176 24. 3

Unidentified -------------------- 7 2. 8 14 53. 8 12 46. 2

Total ------------------ 254 100. 0 593 67. 9 281 32. 1

Missiles were defeated by vest, and no wound was produced.

2 Missiles succeeded in perforating vest and in producing a wound.

From the tabulation presented for the 235 casualties, the figures indicate

that wounds of the anterior and posterior aspects of the chest and of the upper

quadrant of the abdomen were prevented (fig. 346) in 154 (65.6 percent) of the

casualties. There were 81 (34.4 percent) casualties who sustained wounds

through the region covered by the vest (fig. 347), and within this group there
740 WOUND BALLISTICS

SC 399215, 399217, 399216

FIGURE 346.-Protection provided by the Army all-nylon vest, T52-1. A. Four

soldiers of Company K, 15th Infantry Regiment, 3d U.S. Infantry Division, whe were protected from shell fragments which struck but did not perforate the armor. B. and C. Closeups of two of the vests shown in A.
WOUND BALLISTICS AND BODY ARMOR 741

S C 409560

FIGURE 347.-Lt. Rodney M. Brigg, Body Armor Team (right), points to skin bruise

on back of Lt. Frank H. Bassett, Company G, 160th Infantry Regiment, 40th Infantry

Division. The vest defeated two hand grenade fragments.

was definite evidence that the severity of the wound had been reduced in 22

(27.2 percent) of the cases, that it was difficult to state whether the vest had an

effect on the severity of the wound in 20 (24.7 percent) cases, and that there

was no evidence that the vest reduced the severity of the wound in 39 (48.1

percent) cases. In these 39 cases, 24 (61.5 percent) casualties were killed by

the missiles which perforated the vest.

Conclusions of Body Armor Team

The body armor team reported I its conclusions under the conditions of

the test as follows:

a. The Armor, Vest, Nylon T-52-1, is much more effective against fragment type missiles than small arms missiles. During the test period 67.9% of all type missiles hitting the

armor were defeated. 75.7 % of all fragments were defeated and 24.4% of all small arm missiles were defeated.

b. This prototype was acceptable to the majority of soldiers who wore it in combat.

The extent of acceptability was, in addition to many other factors, influenced by the unique

SCox, W. W., Irving, J. W., Breezley, IH. F., and Camper, W. L.: Report on the Use of Body Armor in CombatKorea, February 1952-Suly 1952. Issued by the Office of the Assistant Chief of Staff, G-4 Logistics, September 1952.
742 WOUND BALLISTICS

character of the Korean campaign. A desire for body armor was evident early in the test

period, and this prototype was the most suitable armor of its nature available to satisfy

this demand. Acceptance was invariable, often qualified with suggestions for improvements.

c. Of the methods used to orient troops in the use of Nylon Armor, the best results

were obtained by orienting company sized groups in reserve areas. This may not be the

most suitable method of orientation for the Army as a whole, as selection of methods was

determined by conditions existing in Korea.

d. The Armor, Vest, Nylon T-52-1 worn by soldiers in combat during the test period,

reduced the incidence of chest and upper abdominal wounds by 60 to 70%. It is estimated

that 25 to 35% of the chest and upper abdominal wounds sustained by combat soldiers

wearing the armor during this test period were reduced in severity.

The team also considered the psychological effects and stated:

a. Research of body armor would be incomplete without an understanding of the

psychological structure of body armor use and requirements. Factors to be considered are

legion, but some of the most important are motivation, the effect on confidence, the effect on

aggressiveness, the effect on morale, and finally the acceptance by the soldier.

b. The use of body armor is motivated by one of the most powerful impulses in our

psychological makeup, i.e., the desire to survive. In the heat of actual combat, soldiers

have reported later, time and again, that they rarely notice the weight and bulkiness of the

vests (fig. 348). In these tense periods it seems that the desire for protection outweighs the

FIGURE 348.--Effect of armor on evaporation of perspiration. Subjects wore armor

for 30 minutes at temperature of 900 F. When soldiers were under enemy fire, they did

not complain of the excessive perspiration.
WOUND BALLISTICS AND BODY ARMOR 743

physiological deficit resulting from the added burden. On the other hand, interviews with

soldiers returning from patrols which had no fire fights or skirmishes with the enemy, indicate

that the men are less disposed to wearing body armor and are more critical of its weight and

limitation of mobility.

c. The action in Korea is unique in our military history in that the lack of specific battle

goals and the prolonged truce talks resulted in a feeling of caution in all combat echelons.

Commanders, under these conditions, are not quite so ready to sacrifice personnel on the

battlefield. This lack of an overpowering motivation may have an important bearing on

the seemingly widespread acceptance and desire for body armor on the part of the troops

and their commanders. This unique situation suggests, too, the possibility that the need

for body armor by our soldiers in Korea is accentuated if they are to fight with their usual

verve and aggressiveness.

d. The effect of body armor on confidence is probably best expressed in the results of

the post-use interviews where over 85 percent of the men stated that they felt safer and more

confident when wearing body armor. This feeling of increased safety and assurance is

undoubtedly of paramount importance in explaining the widespread acceptability of body

armor in combat.

e. Interviews with commanders, who have led troops wearing body armor in combat,

have repeatedly emphasized that aggressiveness is increased and that there is more of a

desire and willingness to engage the enemy at close quarters. Since one of the great deterrents to aggressiveness in combat is fear of being wounded or killed, it would seem that the

feeling of increased safety and confidence, in part at least, accounts for the increased aggressiveness noted by the troop commanders.

f. A poll of over 100 front line physicians and surgeons has resulted in the almost

unanimous expression of opinion that the use of body armor would result in an increase in

morale among combat troops. The measurement of morale is difficult and varies with many

factors which cannot be controlled while another unknown factor is being tested. In spite

of the rather poor motivation for combat during the period of test, the morale of the troops

was generally good, and the test team members were unable to detect any changes in morale

in the units that were using body armor. It is rational to conjecture, however, that the

morale of our troops would be elevated as long as they possessed an item which would give

them superiority over the enemy and thus diminish their chances of being wounded or killed.

It would seem that if, and when, the enemy develops a similar vest or devises effective

countermeasures to our vest, that the effect of the vest on morale would then be negligible.

g. Under certain conditions the effect of body armor on morale may not be good. For

example, during the last month of the test period there were several instances where soldiers

who had previously used body armor expressed a reluctance to their unit leaders to go out

on patrols when body armor was not available. These instances were precipitated by the

fact that there was not enough of the item to go around or that the vests had been moved

to other sectors or units for more favorable testing. In any situation where the troops had

previously used body armor and for some reason it became limited in supply or not available,

it is conceivable that the effect on morale would be very unfavorable.

h. If the willingness or lack of willingness on the part of troop commanders and their

troops to return body armor to the test team officers after use may be used as an index of

acceptability, then there is no doubt that the test item is almost universally approved of.

Many times, especially during the last period of the test and in areas where there was a lot

of action, it was difficult for the test team officers to tactfully get the troop commanders and

the troops to release their physical possession of the armor when it became necessary to shift

the vest to other personnel. There seems to be no doubt that the desire for protection in

the minds of the men is utmost, and outweighs the physiological handicaps imposed by the

added weight and bulkiness.

i. This is well illustrated by an action of the 45th Division in securing a hill in advance

of the MLR. The action which lasted for several weeks was extremely heavy and the

casualties were high. Demand for the vest became so acute that the test team members
744 WOUND BALLISTICS

lost control of the vest study. Because of the limited quantity of vests available there were

not enough to equip each soldier with one. Soldiers who were wearing the vests and who

were wounded were frequently relieved on the battlefield of their armor by other soldiers

who did not have vests. The vests that reached the forward aid station were usually taken

away by the combat troops before the test team members had an opportunity to study

them. In addition there were several instances where soldiers would be wearing vests in the

usual manner and then in addition have other vests wrapped about the lower abdomen,

groin, and thighs. Other instances were reported in which an additional vest was fitted in

some fashion about the face and head.

j. Many factors have been discussed previously as to why the soldiers in Korea have

accepted body armor so wholeheartedly. One final feature to be considered in regard to

acceptance is the factor of initial contact with any new item (body armor). To what extent

is this acceptance colored by a fad-like reaction because of the newness, the exclusiveness,

the widespread publicity and the fashionability? Only time will tell. It is of interest to

note, however, that prior to the arrival of the Body Armor Team in Korea, several thousand

of the earlier M12 type body armor vests (figs. 349 and 350) were in supply rooms and were

infrequently used. After the team had been in Korea for several months with its attendant

publicity and information campaign, body armor of any type was at a premium (fig. 351)

and was difficult to supply in sufficient quantities (fig. 352). Even the supply of M12's,

which heretofore had not been in demand, was rapidly exhausted (fig. 353).

a l l it .t S5 400559, 400860

FIGURE 349.-World War II M12 vest with aluminum plates and a nylon cloth backing,

Korea, 2a May 1952. A. Front view. B. Back view.
WOUND BALLISTICS AND BODY ARMOR 745

Sc 400861

Ficuax 350.-Front views of World War II M12 vest (left) and all-nylon T52-1 vest.

Note increased body coverage with newer armor vest. Korea, 25 May 1952.

Recommendations of Body Armor Team

Recommendations based on findings submitted by the team were as follows:

a. That continuing study be conducted in the development of body armor materials to

obtain the optimum in protection versus weight, with thought toward a material that will

stop light, medium velocity sub-machine gun bullets, as well as fragments, and to improve

the comfort and utility value.

b. That logistical problems in supplying the body armor to troops be studied.

c. That additional testing be conducted under controlled conditions for improving functional suitability and compatibility with other clothing and equipment.

d. That the use of body armor as an item of clothing be thoroughly explored.

6O3225VO2 49
746 WOUND BALLISTICS

"4W.

SC 436428

FIGURE 351.-Three members of the R & I Platoon, 443d QM Group modeling types of

armored vest. (Left to right) World War II flyer's armor; Army all-nylon vest, T52-3;

and Marine Corps doron-nylon vest. 14 August 1953.

e. That the tactical significance of body armor and methods for employing it be studied.

f. That load studies and climatic factors in relation to body armor be completely

evaluated.

g. That consideration be given to the role of body armor in atomic warfare.

h. That the protective qualities of body armor against radiation and blast injury be

studied.

i. That the protective qualities of body armor against incendiary weapons, especially

white phosphorus, napalm, and flame throwers be evaluated.

j. That consideration be given to modifying the present prototype * *

There followed a list of specific changes which in general were intended to

increase flexibility, improve fit and make the vest in general more comfortable.

Others aimed at increasing the area of protection particularly under the arm,
WOUND BALLISTICS AND BODY ARMOR 77

SC 411153

FIGURE 352.-Men of Company L, 38th Infantry, 2d Division, rebuilding their stronghold near Old Baldy, 21 September 1952. Armor vests of the following types can be identified: (left to right) World War II M12, Marine Corps doron-nylon type, and Army T52-1

type.

and snaking easier removal from casualties. Only a few of them will be listed

and illustrated.

3. Change the method of closure. Recommend an easily operated zipper with a protecting fly, provided with an alternate closing method (fig. 354).

6. Replace the cover with a durable material which has more surface resistance to prevent slippage or carrying straps. The cover material should be non-reflecting (fig. 355),

water resistant and of a color which blends with natural terrain features. It should not create sound when flexed or rubbed against other objects.

8. Replace the pockets with dash-type pockets * * *

9. A means for carrying grenades be provided on the front of the vest * * * A tape

above the pockets into which the handle of the grenade could be inserted would satisfy this

requirement.

10. Replace the present method of side fastening with one that is adjustable, elastic, and

with a quick release mechanism which will permit easy removal from casualties.

11. Construct the vest so as to give maximum protection to the area under the arm

(figs. 356 and 357).
748 WOUND BALLISTICS

SC 423912

FIGURE 353.-Crew of the self-propelled "killer" gun wearing World War II M12 body

armor. Punchbowl Area, Korea, 3 July 1953.

12. Eliminate metal in the construction of the vest wherever possible to reduce secondary

missile potential.

13. Eliminate the sponge rubber layer inside the nylon armor.

During the test period recommendations for modifications of the model

T52-1 were solicited from the troops who had worn it in combat. These

proposed changes were forwarded to the Research and Development Division

of the Office of the Quartermaster General. Some of these tentative design

modifications were incorporated into a new vest, model T52-2 (fig. 358).

A total of 276 of the new models were received on 9 July 1952. Unfortunately,

these were in use for only 6 days when the mission of the Body Armor Test

Team was curtailed. A cursory survey revealed that the T52-2 was much

more acceptable than its prototype.

Upon return of the body armor team in July 1952, three of its members,

Colonel Cox, Major Irving, and Captain Daniels, with the assistance of Mr.

William Persico, Clothing Development Branch, Philadelphia Quartermaster

Depot, Pa., designed and fabricated a nylon body armor vest based upon the

full, final recommendations of the team. This resulted in the armored vest,
WOUND BALLISTICS AND BODY ARMOR 749

T52-3 (fig. 359). Among other improvements, it included a new covering

material, a two-piece sliding back, lace-type expandable side closure, combination metal zipper and snap front closure, and a more flexible type of spot

welding of the layers of nylon cloth. This was the prototype which finally

became the Army standard item of issue in the fall of 1952. The first shipment

of the standard Army nylon vest left the Philadelphia Quartermaster Depot

on or about 3 December 1952.

MEDICAL STUDY OF KIA CASUALTIES

At the same time that the body armor team was operating in Korea,

concurrent studies at the Graves Registration Service Group, Kokura, Japan,

on the killed in action casualties were being accomplished. These wound

ballistics studies entailed a careful examination of each remains as to:

a. Exact anatomical location of all wounds (this to be demonstrated by both pictures

and charts).

FIGURE 354.-Body armor. Front view of recommended design, showing front closure

and grenade carrying loops.
750 WOUND BL9LLISTICS

FIGURE 355.-Reflection of light from surface of body armor, T52-1.

A:N .

FicURE 356.-Unprotected area under arms in body armor, T52-1.

b. Type missiles causing wounds, i.e., shell fragments or small arms. (By the use of

X-rays it was possible in most cases to determine the type missile, provided, of course, it

remained within the body.)

c. Type wound or wounds, i.e., penetrating or perforating; penetrating meaning a

wound having an entrance point but not an exit, perforating meaning a wound having both

an entrance and an exit.

d. Tracing out the missile path and determining the cause of death.

e. Recovery of all wounding missiles when possible so that these may be photographed,

weighed and identified.

f. Take sections of tissue for microscopic study.
WOUND BALLISTICS AND BODY ARMOR 751

FIGURE 357.-Recommended protection and side closure, in body armor.

SC 408567

FIGURE 358.-Armor, vest, nylon, T52-2. This vest is made of 12 layers of spotlaminated nylon cloth. The covering of this model is double; an inner water-resistant

vinyl film layer and an outer layer of 6-ounce nylon fabric. The new slash-type breast

pockets and adjustable side straps also distinguish the revised model. Vest open, showing

the zipper that has been introduced in this model and the fly which covers the same and is

held in place by four snap fasteners. The same type of snap fasteners is used on the pockets.

(Front view)
752 WOUND BALLISTIO

Sc 41633S, 416338, 416.337, 416840

FIehTRE 3,59.-Armor, vest, nylon, T52 3 Note new covering material, redesigned

pockets, grenade and shoulder straps and side closuie (The trousers are not protective

armor.) A. Front view. B. Front view show inclosure. C. Side view. D. Rear view.
WOUND BALLISTICS AND BODY ARMOR 753

The initial survey of KIA casualties " was begun in March 1952 by

Lieutenant Coe, who was joined in April 1952 by Major Enos. During the

month of March 1952, the number of remains that were suitable for autopsying

were relatively few. The majority of the bodies which arrived at Kokura

were badly decomposed and offered little for a wound ballistic study. During

the winter months, the method of using ships for transporting the bodies had

been adequate, but with the coming of warmer weather this method was

wholly unsatisfactory. On 6 April 1952, an air evacuation plan 1 was placed

in effect. Specifically, this meant that the remains arrived in Kokura in

approximately 24 to 36 hours after death on the frontlines in Korea. During

part of this time, the bodies were kept in reefers (refrigerators) so that their

condition upon arrival at Kokura was excellent.

KIA Casualty Survey, 20 March-1 July 1952

In the period from 20 March to 23 April 1952, 268 current deaths were

processed through the American Graves Registration Service Group at Kokura.

Of these cases, 173 with 618 wounds were examined for the area and regional

frequency of wounds and also for the type of wounds. Because of the lack of

time and the shortage of personnel, it was impossible to examine every case.

Therefore, it was decided to examine in detail only cases in which death could

be unquestionably attributed to enemy action and which presented reasonable

promise of furnishing a rather complete picture. Autopsies were performed on

81 cases. Missiles were often hard to recover, but when found they were

photographed, identified, and weighed. Most of the casualties during this

period were incurred by personnel not wearing an armored vest when the lethal

injury was sustained because the number of all types of armored vests available

was small. Because of the small number of cases available, no attempt was

made to draw conclusions.

During the remaining 15 months of the war, numerous wound ballistics

teams from the Zone of Interior conducted surveys at the Graves Registration

Service Group, Kokura, and made surveys of WIA casualties at the Tokyo

Army Hospital. The work at Kokura was continued by Major Enos who,

during the period from 24 April 1952 to 1 July 1952, examined 346 cases with

a total of 1,346 wounds. Autopsies or wound track dissections were performed

on all cases, and the information was forwarded to the Biophysics Division of

the Chemical Corps Medical Laboratories for analysis. This revealed the

regional distribution of wounds presented in table 299.

10 (1) Coe, G. B.: Wound Ballistics, Killed in Action, Korea, 20 March 1952-23 April 1952. Cmlc Medical Laboratories Research Report No. 116, June 1952. (2) Coe, G. B.: Wound Ballistics, Killed in Action, Korea, 24 April 1952-

12 July 1952, vol. II. CmlC Medical Laboratories Research Report No. 144, October 1952. (3) Coe; G. B., Stoughton,

R. B., and Debiec, R. P.: Wound Ballistics, Killed ili Action, Korea, 12 November 1952-1 March 1953, vol. III. CmlC

Medical Laboratories Research Report No. 221, October 1953.

11 Cook, J. C.: Graves Registration in the Korean War. The Quartermaster Rev., pp. 18 and 131-144, March-April

1953.

603225"---62--_50
754 WOUND BALLISTICS

TABLE 299.-Regional distribution of 1,346 wounds in 346 KIA casua!ties

Region Number of Percent of wounds wounds

Thorax:

Upper left side --------------------------------------- 149 11. 1

Upper right side ------------------------------------- 101 7. 5

Lower left side ---------------------------------------- 78 5. 8

Lower right side ------------------------------------- 65 4.8

Total --------------------------------------------- 393 29. 2

Head and neck ------------------------------------------- 351 26. 1

Extremities:

Lower ----------------------------------------------- 325 24. 1

Upper ----------------------------------------------- 207 15.4

Total ---------------------------------------------- 532 39. 5

Abdomen ----------------------------------------------- 70 5.2

Grand total -- 1,346--------------------------------

100.0

The 346 cases showed 209 (60.4 percent) with single wounds and 132 cases

(39.6 percent) having multiple wounds, or a ratio of 1.5 singly wounded to

multiply wounded. Regional breakdown showed this ratio was 4.4 for the

head and neck (140 cases), 1.7 for the thorax (137 cases), 1.2 for the abdomen

(20 cases), and 1.5 and 1.4 for the upper (10 cases) and lower (39 cases) extremities, respectively. Fragmentation-type missiles accounted for about 66 percent

of the wounds (table 300) and about 71 percent of the wounds were penetrating

(table 301). Table 302 shows the regional distribution of 128 lethal wounds in

103 of the KIA casualties which were examined during this period. The partial

selection of the casualty sample is apparent in the high number of lethal wounds

of the thorax and in the low number of lethal wounds of the head.

Comparison of Army and Marine Corps Casualties

In the period between July to November 1952, another survey team

(Colonel Holmes, Capt. James C. Beyer, MC, and Capt. Joseph V. 'Michalski,

MSC) worked at Kokura. Approximately 3,000 current death cases were reviewed and information was obtained on wound distribution in 1,500 KIA

casualties. This was a period of great flux in regard to body armor. The

Marine Corps had standardized a combination doron-nylon vest. This consisted of 13 layers of nylon cloth over the upper part of the thorax and the

shoulder girdle area and 20 overlapping doron plates over the remainder of the

thorax and the upper part of the abdomen. This vest (Af 1951) (fig. 360) was

standardized by 16 November 1951, and by 14 July 1952 approximately 9,772
WOUND BALLISTICS AND BODY ARMOR 755

TABLE 300.-Distribution of 1,346 wounds in 346 KIA casualties, 24 April-1 July 1952, by

causative agent

Causative agent Number of Percent of

wounds wounds

Fragments:

Shell ------------------------------------------------ 485 36.0

Mortar --------------------------------------------- 246 18.3

Artillery --------------------------------------------- 68 5.0

Landmine ------------------------------------------- 44 3.3

Grenade --------------------------------------------- 39 2.9

Total ---------------------------------------------- 882 65.5

Small arms:

Type unspecified -------------------------------------- 217 16.1

"Burp" gun ------------------------------------------ 144 10.7

Rifle ------------------------------------------------ 22 1.6

Pistol ------------------------------------------------ 14 1. 1

Total ---------------------------------------------- 397 29.5

White phosphorus -------------- -------------------------- 2 .2

Burns --------------------------------------------------- 65 4.8

Total ---------------------------------------------- 67 5.0

Grand total ---------------------------------------- 1,346 100.0

TABLE 301.--Distribution of 1,346 wounds in 346 KIA casualties, 24 April-1 July 1952, by

type of wound

Type of wound Number of Percent of wounds wounds

Penetrating 1 --------------------------------------------- 952 70.7

P erforating 2 ............................................ - 244 18. 1

Avulsion 3 -------------------- 133 9.9

Decapitation --------------------------------------------- 17 1.3

Total --------------------------------------------- 1,346 100.0

1 Wounds of entrance but no exit; missile retained.

2 Wounds of entrance and exit.

3 Traumatic loss of large sections of a body area; amputations included.

vests were on hand in the 1st Marine Division in Korea. Therefore, all Marine

Corps frontline personnel were probably equipped with body armor before

this latter date. During this time, the Army was still conducting its field

testing of all-nylon body armor. In order to provide their frontline troops
M56 WOUND BALLISTICS

TABLE 302.-Entrance location of 128 lethal wounds in 103 KIA casualties, 24 April-1 July

1952, by body region

Body region Number of Percent of lethal wounds lethal wounds

Head ---------------------------------------------------- 13 10.2

Neck --------------------------------------------------- 3 2.3

Thorax -------------------------------------------------- 77 60.2

Abdomen ------------------------------------------------ 22 17.2

Extremities:

Upper- --------------------------------------------- 4 3. 1

Lower ----------------------------------------------- 9 7.0

Total --------------------------------------------- 128 100.0

SC 412792

FIGURE 360.-Pfc. David W. Jackson, Company L, 5th Regimental Combat Team, Eighth U.S. Army, wearing the Marine Corps

doron-nylon vest, M1951, 27 September 1952.

with protection, 13,020 Marine vests (M1951) were requested on 11 August

1952 by the Army. The requests continued through March 1953 and by 19

September 1952 approximately 19,705 vests were supplied to the Army. This

number was increased (approximately 63,000) until the Army vest was standardized and in production. The first shipment of this latter vest (T52-3) was

released in the early part of December 1952 (see fig. 359). From December

1952 through September 1953, approximately 26,161 vests of this type were
WOUND BALLISTICS AND BODY ARMOR 757

shipped from continental United States. Before the availability of the Marine-type body armor, Army units were supplied with a limited number of M12

vests developed during World War II.

A comparison of Marine Corps KIA casualties from 1 July to 1 November

1952 and Army KIA casualties from 15 June to 1 September 1952 revealed the

regional distribution of wounds shown in table 303. The Marine Corps personnel can be considered to be wearing body armor and the Army personnel

were generally unarmored. There is a reduction of 9.6 percent in the total

wounds of the thorax in the Marine Corps casualties and a 1.1 percent reduction in wounds of the abdomen as compared to the Army casualties.

TABLE 303.-Regional distribution of 3,526 wounds in 354 Army I and 2,308 wounds in 355

Marine Corps personnel 2 killed in action

Army personnel, Marine Corps personwithout armor nel, with armor

Body region -

Number Percent Number Percent

Head ------------------------------------------- 236 6. 7 198 8. 6

Face ------------------------------------------- 202 5.7 136 5. 9

Neck ------------------------------------------- 191 5.4 108 4.7

Thorax ----------------------------------------- 942 26.7 390 16.9

Abdomen --------------------------------------- 219 6.2 118 5. 1

Extremities:

Upper -------------------------------------- 663 18. 8 513 22. 1

Lower -------------------------------- - 1, 045 29.7 836 36.2

Genitalia --------------------------------------- 28 .8 9 .4

Total --------------------------------- 3, 526 100. 0 2, 308 100. 0

1 Surveyed from 15 June to 1 September 1952.

2 surveyed from 1 July to 1 November 1952.

The Marine Corps casualties included 355 cases with a total of 2,308

wounds for a 6.5 wound incidence per casualty. Among the wounds, 80.9

percent were penetrating in type, 14.9 percent were perforating, and 4.2 percent

were amputations. According to the causative agent, 85.4 percent were produced by fragmentation-type weapons, 12.8 percent by small arms, and 1.8

percent were unknown.

The Army casualties included 354 cases with a total of 3,526 wounds for

a 9.9 wound incidence per casualty. According to wound type, 87.9 percent

were penetrating; 9.1 percent, perforating; and 3.0 percent, amputations.

Fragments were responsible for 86.2 percent of the wounds, small arms for 11.7

percent, and 2.1 percent were unidentified.

Table 304 lists the regional distribution of lethal wounds in the two casualty samples. The armored Marine Corps casualties show a 12.1 percent reduction in lethal wounds of the thorax and a 1.1 percent reduction in lethal

wounds of the abdomen as compared to the Army personnel.
758 WOUND BALLISTICS

TABLE 304.-Regional distribution of lethal wounds in 354 Army I and 355 Marine Corps 2

personnel killed in action

Army personnel, N arine Corps person- without armor nel, with armor Region wounded________________________

Number Percent Number Percent

Head_ -- 155 31. 6 178 32. 1

Face ...... 30 6. 1 52 9.4

Neck ....- - 28 5. 7 47 &. 5

Thorax -.... 177 36. 1 133 24. 0

Abdomen -------------------------------------- 46 9.4 43 7. 8

Extremities:

Upper- ----- 10 2.0 26 4. 7

Lower -- 44 9. 1 75 13. 5

Total -- 490 100. 0 554 100.0

I Survey((d from 15 June to I September 1952.

2 Surveyed front 1 July to 1 November 1952.

Tables 305 and 306 summarize the types and numbers of body armor vests

available to the Eighth U.S. Army, 31 December 1952-29 February 1953.

TABI.E 305.-Status of armor vests, available to major Army units,' 31 December 1952

Type of bodyv armor vest Unit

Marine 2 Army lJ 12 1 Total nylon 3

Na inber Number NA tu7ber Number

2d Division ......- 4, 062 600 1,017 5,679

3d Division ...... 4, 064 948 269 5, 281

7th Division - 4, 604 460 938 6, 002

25th Division -- 4, 600 1,063 492 6, 115

40th Division --------------------- - - - 4, 064 598 1, 111 5, 773

45th Division --------------------------------- 4, 064 598 315 I 4, 977

5th RCT -- 1,454----------------- 91 .... . 1 545

Army troops--------------------------------- -- 56!2 4 ,3 Arm trop_560 226 644 1,430

Reserve and maintenance ------------------------- 504 --------- 6,081 6, 585

1st BCW Division ------------------------------ 1, 558 ........ . 1,558

Total- ------------------------------------ 29,534 4,584 10, 867 44, 985

1 Data derived from Staff Report, Quartermaster Section, lHeadquarters, Eighth U.S. Army, November and December

1952.

2 Constructed of doron plates and nylon cloth.

3 T52-1 and -2 all-nylon body armor. This was the type used during the Army body armor test period.

4 Artiy World War II body armor; altuinum plates with nylon cloth.
WOUND BALLISTICS AND BODY ARMOR 759

TABLE 306.-Status of armor vests, available to major Army units,' 29 February 19532

Type of body armor vest available

Unit

M12 and Marine Standard Army Total

standard issue issue

Number Number Number

2d Division --------------------------------- 7, 500 3, 523 11,023

3d Division ---------------------------------- 6, 100 3, 508 9, 608

7th Division -------------------------------- 5, 500 3, 514 9,014

25th Division ------------------------------- 6, 800 4, 914 11, 714

40th Division -------------------------------- 6, 100 3, 663 9, 763

45th Division -------------------------------- 6,500 3, 646 10, 146

5th RCT ----------------------------------- 3,470 4 ------------ 3,470

1st BCW Division ---------------------------- 1,900 ------------- 1,900

United Nations units ------------------------- 2, 755 ------------- 2, 755

Total --------------------------------- 46, 625 22, 768 69, 393

1 Data derived from Staff Report, Quartermaster Section, Headquarters, Eighth U.S. Army, February 1953.

2 In January and February 1953, armored vests were issued to bring each division up to or over its authorized level of

8,390 vests. Approximately 8,400 excess M12 vests were turned over to the Republic of Korea Army.

After body armor had become widely used, information was desired on the

effect of the body armor vests on the regional frequency of lethal wounds. A

survey of killed in action was accomplished at Kokura during the period of

November 1952 to March 1953 by Lieutenant Coe and 1st Lt. Richard B.

Stoughton.1 2 During the period of this survey, there were approximately 60,000

vests in use by U.S. Army divisions on the frontlines in Korea. Therefore,

only those cases wearing body armor at the time they received the lethal wound

or wounds were used in this survey. It was necessary for members of the team

to travel to every unit on the frontlines of Korea and talk with personnel in the

casualty's squad, platoon, or company to determine accurately if body armor

had been worn at the time the lethal wound was inflicted. From approximately

600 cases investigated, 500 definitely were wearing armor at time of death.

Only these cases were used. These data were then compared with previous surveys conducted between April and July 1952 during which time armor was not

widely used. The general tactical situation had remained appreciably the

same over the whole period of these surveys. Action consisted largely of

aggressive patrolling with stable main lines of resistance. Enemy use of artillery had increased, but there were no massive withdrawals or offensives by

friendly forces during the time between the compared surveys. Table 307

shows the comparison of lethal wounds in the two casualty samples.

12 See footnote 10 (3). p. 753.
760 WOUND BALLISTICS

TABLE 307.-Entrance location of lethal wounds in 2061 casualties not wearing armor and in

5002 wearing armor

Without armor With armor

Entrance location Percent change

Number Percent Number Percent

Head ---------------------------------- 25 12. 1 207 41. 4 +29. 3

Neck ---------------------------------- 11 5. 4 72 14. 4 +9. 0

Thorax ---------------------------- 119 57. 8 110 22. 0 3 -35. 8

Abdomen ------------------------------ 28 13. 6 41 8. 2 -5. 4

Extremities:

Upper ----------------------------- 5 2. 4 13 2. 6 +. 2

Lower --------------------------- 18 8. 7 57 11.4 +2. 7

Total ------------------------- 206 100. 0 500 100. 0

I Survey 20 March to 1 July 1952; 154 KIA casualties with 206 lethal weunds.

2 Survey 15 November 1952 to 1 March 1953; 500 KIA casualties with 500 lethal wounds.

SThe value of body armor for the thorax appears higher than in other comparable surveys due to the fact that a selection of cases was made in the first survey peried. Initially, the main interest was in wounds of the thorax and abdomen

only and a considerable number of cases with wounds in other body regions, for example, head, were excluded. Later,

all types of cases were studied, but the early selection is still reflected in the overall figures.-J. C. B.

There was an apparent reduction of approximately 36 percent 13 in lethal

thoracic wounds in the group wearing the armored vest. The nylon vest also

covered part of the upper part of the abdomen, especially the liver and the

kidneys. This may account for the 5.4 percent reduction in lethal abdominal

wounds among those wearing the armored vest.

Among the 500 KIA casualties wearing body armor, there were 3,510 total

wounds recorded. The types of wounds were distributed as follows: 3,068

wounds (87.4 percent) penetrating, 198 wounds (5.7 percent) perforating, 170

avulsions (4.8 percent), 50 lacerations (1.4 percent) (superficial but extensive

wound), and 24 (0.7 percent) decapitations. With this same casualty sample,

the causative agent for the wound was recovered in 437 instances. A fragment

was identified in 293 (67.1 percent) of the cases and small arms in 110 (25.1

percent) of the cases. Table 308 lists the regional distribution of the 3,510

wounds in the 500 casualties. Multiple wounds were present in 364 (72.8

percent) of the cases and 136 (27.2 percent) had only a single wound.

The importance of multiple wounding in casualty production cannot be

overemphasized. In the survey on casualties wearing body armor, there was

an average of seven wounds per case. This figure is below the actual number

since it was almost impossible to count every wound on some of the cases.

Compared with this, for WIA casualties, the average is about two wounds.

In any one region an additional wound, aside from the lethal wound, might

conceivably increase the chances of death by additive or even synergistic effects.

Also, it is quite possible that one missile entering a body cavity, such as the

thorax, would not strike a vital area, but additional missiles entering the cavity

1i Other surveys would indicate a reduction of only approximately 12 percent.-J. C. B.
WOUND BALLISTICS AND BODY ARMOR 761

TABLE 308.-Regional distribution of 3,510 wounds in 500 KIA casualties wearing body armor,

November 1952-March 1953

Region Number of Percent of

wounds wounds

Head ---------------------------------------------------- 473 13.5

Neck ---------------------------------------------------- 160 4.5

Thorax -------------------------------------------------- 553 15.7

Abdomen ------------------------------------------------ 260 7.4

Extremities:

Upper ----------------------------------------------- 700 20.0

Lower ---------------------------------------------- 1, 364 38.9

Total --------------------------------------------- 3, 510 100.0

would increase the chances of the heart or great vessels being hit. Another

possibility is that KIA casualties are slower to be evacuated than the wounded

from the battlefield. They are thus exposed to enemy fire longer and might

sustain additional hits after receiving a lethal wound. Whatever the reason or

combinations of reasons, reduction of the number of wounds is extremely

desirable.

Collection of Battle Casualty Data

In the early days of the Korean War, medical records of battlefield wounding were too inexact in their nomenclature to permit exhaustive wound ballistic

studies. In 1951, an effort was made to correct this. Medical personnel were

requested to record the exact type of wounding missile on the EMT (emergency

medical tag). For example, instead of recording "shell fragment" or "shrapnel," they were asked to identify the missile as being artillery, mortar, hand

grenades, landmine, and so forth. It was also found that the casualty was

frequently able to identify the exact nature of the missile causing his wound.

By making the effort to get this information on the spot, when events were

fresh and the information most readily available, the data would then appear

on all the patient's medical records and be readily accessible for compiling into

wound ballistics data. The results of this effort were reflected in the more

exact nature of the weapon frequency charts compiled later in the war. In the

first casualty survey, approximately 85 percent of the total number of wounding

missiles were listed by the ambiguous term "shell fragments." In the last

survey conducted in the Korean War, only 39.6 percent of the wounds were

identified as being due to "shell fragments."

In 1952, medical officers and battalion aid station personnel were asked to

note on the record accompanying each KIA casualty whether he had been

wearing an armored vest and helmet at time of wounding. This request met

with considerable success in the latter stages of the war, but with constant
762 WOUND BALLISTICS

changes in personnel many cases came through without a notation concerning

the wearing of a vest or a helmet.

Indoctrination of medical personnel on the importance of accurately recording wound ballistics data on the EMT could best be accomplished at the

Medical Field Service School. A recommendation was made by all wound

ballistic teams operating in Korea that the present EMT be modified by the

adding of "body armor worn or not worn," "helmet worn or not worn," and

"type missile causing wound." This would be of paramount importance in

future wars for the successful operation of all wound ballistic teams. In addition, a simple but comprehensive method for locating wounds, for example,

an anatomic chart with body regions demarcated, would be of great value.

Figure 361 illustrates the demarcation of body regions which is advocated

A B

WRAMIC-53-18130C, B, A

FIGURE 361.-Demarcation of anatomic surface regions. Skeletal views. A. Anterior

view. B. Posterior view. C. Lateral view.

for use by battle casualty survey units. This was the regional demarcation

used by the survey team at Kokura from July to November 1952 and also by

Major Enos and Captain Beyer in the KIA survey from May to August 1953.

"14 Holmes, R. H., Enos, W. F., and Beyer, 1. C.: Demarcation of Body Regions. U.S. Armed Forces M. J. 5:1610-

1618, November 1954.
WOUND BALLISTICS AND BODY ARMIOR 763

Helmet Survey

During the period from 9 January to 1 March 1953, a study on the battlefield performance of the M1 steel helmet was conducted in Korea by Lieutenant

Coe."5 The study was made by collecting all available helmets hit on the

battlefield by enemy fire. The helmets were then forwarded through Graves

Registration channels to the Central Identification Unit, Kokura, with information on (1) the type of missile that hit the helmet (grenade, mortar, "burp"

gun, and so forth), (2) a complete description of what happened to the individual wearing the helmet, (3) the type of wounds sustained, and (4) the exact

location of the wounds. After proper coordination with the Medical and

Quartermaster Sections, an order implementing this was published by the

Adjutant General, Headquarters, Eighth U.S. Army, Korea, and sent to all

division surgeons for their information and coordination with their battalion

aid station personnel.

A total of 45 helmets were received during this period of time. It had

been hoped that many more helmets would be recovered and forwarded with

the information requested. Personal contact with battalion aid station surgeons at a later date revealed the numerous difficulties involved in recovering

the helmets. Soldiers who had sustained hits on their helmets without receiving

a wound did not want to give up their helmets and in many instances did not

turn them in. There was also added danger in attempting recovery of damaged

helmets from exposure to enemy fire during the time required for recovery.

The 45 helmets examined sustained a total of 71 hits. A breakdown on

these is as follows:

N~umber

Missile perforated steel shell and liner ---------------------- 60

Missile perforated steel shell but not liner ------------------- 3

Missile was completely defeated by helmet ------------------ 7

Missile perforated liner only ------------------------------- 1

Total -------------------------------------------- 71

Although 85 percent of the hits did go completely through both helmet

and liner, not all of these resulted in death or even in a serious wound. In

some instances, the steel shell and liner were perforated with the individual

not sustaining a wound. The wounds sustained in these cases revealed the

following:

Numter

Wounded through helmet --------------------------------- 16

Helmet hit, no wounds ----------------------------------- 7

Helmet hit, wounded elsewhere ----------------------------- 2

Killed through helmet ------------------------------------ 16

Helmet hit, killed by wound elsewhere ---------------------- 4

Total -------------------------------------------- 15

15 Coe, G. B.: Battlefield Performance of the M-1 Steel Helmet; CmlC Medical Laboratories Research Report No.

248, February 1954.
164 WOUND BALLISTICS

Thus, 16 of 45 cases were killed as a result of helmet defeat by the missile.

In 13 of 45 cases the missile was defeated successfully, although some of these

cases resulted in death from wounds elsewhere on the body. Many of the 16

nonlethal wounds sustained through the helmet were potentially lethal. (This

was judged from the direction the missile was traveling.) Therefore, in

assessing the effectiveness of helmet protection, these reductions in wound

severity must be considered. From the tabulation just presented, it can be

seen that in over half the cases studied, possible death resulting from head

wounds was prevented by the helmet.

Analysis of the types of missiles involved in the 71 hits showed the

following:

Number

Mortar ------------------------------------------------- 32

Artillery ------------------------------------------------ 16

Small arms --------------------------------------------- 10

Shell fragment, type unknown ----------------------------- 9

Landmine ----------------------------------------------- 1

Hand grenade ------------------------------------------- 1

Secondary missile ---------------------------------------- 1

Unknown ----------------------------------------------- 1

Not all soldiers wore their helmet, because of its weight, lack of stability,

and so forth. Many men on patrols complained about the noise made by the

helmet when it came in contact with bushes and twigs and felt also that the

helmet interfered with their hearing. For these reasons, some men on patrol

preferred not to wear their helmets. These objections to the helmet can be

overcome by continuing indoctrination and by improving the helmet characteristics, especially its stability on the bead.

Information was received on two cases in which soldiers had to seek cover

hurriedly from incoming mortar fire. In both cases, the helmet came off when

the soldier hit the ground. Both men were then killed by head wounds, from

fragments of the next incoming round. It cannot be said that these men

would have been saved had their helmets not come off; however, from the 45

cases studied, it can be seen that they would have had an increased chance of

survival had their helmets stayed on.

LOWER TORSO ARMOR

In addition to the development of the all-nylon body armor vest, a lower

torso armor was also fabricated (fig. 362). The new armor was designed to

be worn with the Army's armored vest and, like the vest, was made of 12

layers of flexible, spot-laminated nylon duck inclosed within a water-resistant

vinyl layer with an outer covering of 6 ounce nylon fabric. The lower torso

armor provided for the hips, abdomen, and groin the same degree of protection

the armored vest gave the upper torso, and there was some degree of overlapping between the two garments. The new lower torso armor resembled

boxer's shorts and was supported by suspenders worn under the armored vest.

766 WOUND BALLISTICS

U.S. Army photo

FIGURE 363.-Armored suit for use by mine clearance personnel, World War II

M12 vest components and World War IT flyer's apron, 15 March 1952.

7. There was an increase in the confidence and fighting spirit of the

majority of troops wearing body armor.

MV{any of the medical officers in Korea felt that the armored vest was

one of the most effective forms of preventive medicine introduced in the

Korean War. It may safely be concluded that use of body armor coupled

with rapid helicopter evacuation of casualties to mobile army surgical hospitals

improved medical and surgical care, and extensive use of whole blood was

responsible for the saving of many lives in Korea.

The advantages gained through the wound ballistics studies and body

armor test teams during the Korean War can only be perpetuated by an active

and purposeful continuation of certain activities during peacetime and immediate, full reactivation of all units in the event of hostilities. A medical program

for the study of wounds and wounding is presented in appendix I, page 851.
WOUND BALLISTICS AND BODY ARMOR 767

SC 461059, 461060

FIGURE 364. Armored suit for use in demolition work, 3 August 1953. A. Front

view, overlapping doron plates. B. Rear view, Marine Corps vest (left) and Army vest,

T52-3.
APPENDIX A

Casualties, 1st Battalion, 148th Infantry, 37th Division

New Georgia Campaign, 18 July-5 August 1943

James E. T. Hopkins, M.D.

In the following pages, the various engagements of the 1st Battalion, 148th Infantry,

are grouped into tactical situations, and casualties are described in the order in which they

occurred in combat.

Tactical Situation No. 1, 18 July 1943

The 2d Battalion of the 148th Infantry landed at Zanana Beach on 18 July and, with a

few men from the 1st Battalion, moved 1 mile up the Munda trail and dug in for the night.

During the day, a patrol from Company G had located a Japanese machinegun emplacement

covering the trail about 300 yards from the Barike River. In spite of this knowledge, the

regimental S-3 (operations and training) advanced along the trail with several vehicles, and

the following casualty occurred:

Case 1.-Severe penetrating wounds of the entire body. This man was a truck driver

in the forward vehicle advancing on the enemy-held Munda trail. He was struck by .25 caliber light machinegun fire at a 60-yard range. Classified as KIA, died instantly. This type

of patrol was unnecessary; the patrol leaders had been warned about the machinegun.

Tactical Situation No. 2, Night of 18 July 1943

The 1st Battalion set up a perimeter for the night along the Munda trail, a half mile

from the beach, deep in the jungle. Two casualties were sustained that night.

Case 2.-Severe penetrating wound of the lower third of the left leg. This man stood

up from his foxhole in the early morning hours of 19 July and was shot by another soldier

with a .30 caliber rifle at a range of approximately 10 to 20 yards. Classified as WIA, second

echelon type. This casualty occurred during the first night that the men were in combat;

they had not had previous contact with the enemy.

Case 3.-Severe perforating wound of the head. This man sat up in his foxhole while

talking in his sleep during the early morning hours of 19 July and was shot by another soldier

with an Mt rifle at a range of approximately 20 to 30 yards. Classified as KIA. This

casualty occurred under circumstances similar to those of Case 2.

Tactical Situation No. 3, 19-20 July 1943

At 1100 hours on 19 July, while the 2d Battalion, 148th Infantry, was held in reserve,

the 1st Battalion advanced west along the Munda trail to the first branch of the Barike River,

with Company A leading the column. The advance was frequently slowed by fire from

enemy snipers.

At 1200 hours, when the medical aidmen were resting at the rear of the column, word

reached them that a litter squad was required. The circumstances were found to be as

follows:

The jungle along this section had been thinned by artillery fire during a previous engagement. The trail on the far side of a small jeep bridge which spanned the Barike River was

769
M70 WOUND BALLISTICS

moderately fiat, and the jungle was thinned out for an area of about an acre. On the right,

on the U.S. Army side of the bridge, a steep hill fell to the water in front and to the road on

the side. On the left of the route, the jungle was flat, but very dense. Several dugouts

were located on each side of the stream. As Company A crossed the bridge, two heavy enemy

machineguns started firing; and, during the course of action for the next 24 hours, 5 men were

killed and 11 wounded. The Japanese sustained at least 25 casualties, half definitely killed

by rifle and automatic weapons fire and the remainder by mortar and artillery fire.

Case 4.-Multiple, severe penetrating wounds of the upper and lower extremities and

of the scrotum. This man, a member of a patrol moving in single file, was struck by the

first burst from a Japanese heavy machinegun. He was wounded at 1100 hours on 19 July

but managed to pull himself into a dugout where he remained for 30 hours during which time

he managed to kill three Japanese. He was evacuated on 20 July and was classified as WIA,

U.S. evacuation type.

Case 5.-Multiple, severe penetrating and perforating wounds of the lower extremities.

This man was wounded while walking single file on an open trail, and 6 hours after his initial

wound he received additional fatal grenade and bayonet wounds. Classified as KIA.

Case 6-Severe perforating wound of the thorax. This man was a member of a patrol

walking single file in an open trail when he was struck by fire from a Japanese heavy machinegun at a range of approximately 100 yards. Classified as KIA.

Case 7.-Severe perforating wound of the thorax. This man was killed under circumstances similar to those of Case 6. Classified as KIA.

Case 8.-Moderately severe laceration of the head. This man was on patrol when he

was struck by Japanese machinegun fire at a range of approximately 100 yards. He received

a dressing for his wound and was evacuated 20 hours later. Classified as WIA, first echelon

type.

Case 9-Moderately severe penetrating wound of the right arm. This man was struck

by heavy machinegun fire at a range of approximately 100 yards. He received a dressing

for his wound and was evacuated 20 hours later. Classified as WIA, second echelon type.

Case 10.-Moderately severe penetrating wound of the left arm. This man was wounded by Japanese machinegun fire. After receiving an initial dressing for the wound, he was

evacuated some 20 hours later. Classified as WIA, second echelon type.

Case 11.-Moderately severe penetrating wound of the left leg. This man was wounded

by Japanese machinegun fire. After an initial dressing, he was evacuated some 20 hours

later. Classified as WIA, second echelon type.

Case 12.-Multiple penetrating wounds of the face. This man, while on patrol, was

injured by Japanese heavy machinegun fire. He was evacuated immediately. Classified as

WIA, U.S. evacuation type.

Case 13.-Penetrating wounds of the foot with fractures of the metatarsal bones. This

man was wounded while on patrol. He was evacuated immediately. Classified as WIA,

U.S. evacuation type.

Case 14.-Severe penetrating wound of the left leg. This man was wounded while on

patrol. Classified as WIA, second echelon type.

Case 15.-Moderately severe laceration of the left arm. This man was a member of a

patrol. He managed to escape the initial burst from a Japanese heavy machinegun but was

wounded several minutes later while attempting to roll out of the lane of fire. He was

wounded at a range of approximately 100 yards. Classified as WIA, immediate duty type.

Case 16.-Multiple penetrating and perforating wounds of the thorax and the abdomen.

This medical aidman was killed while attempting to reach a casualty. He was struck by fire

from several heavy machineguns at a range of approximately 100 yards. This man was

advancing in a standing crouch position and should have been crawling. Classified as KIA.

Case 17.-Multiple, severe penetrating and perforating wounds of both lower extremities. This aidman was advancing in a standing crouch position in an attempt to reach a

casualty. His lower extremities were splinted, and he was evacuated within 1 hour. Am-
APPENDIX A 771

putation of the right lower extremity was performed several days later. Classified as WIA,

U.S. evacuation type.

Case 18.-Moderately severe penetrating wounds of the right arm. This man, a member of a patrol, was struck by the initial burst of Japanese heavy machinegun fire. Classified as WIA, first echelon type.

Case 19.-Severe perforating wound of the head. This man, while on defensive action,

was crawling into a dugout with two other soldiers when a bullet from a Japanese heavy

machinegun passed through the slits between the logs of the dugout and produced a fatal

wound. Classified as KIA.

On 20 July, the following two casualties occurred:

Case 20.-Severe perforating wound of the lower part of the right leg. This man, while

walking about the perimeter shortly after leaving his foxhole, was struck by a .25 caliber

bullet. He received 1 unit of plasma and was evacuated 2 hours later. Classified as WIA,

U.S. evacuation type.

Case 21.-Severe perforating wounds of the right leg. This man, while on offensive

action walking to one side of the trail, was struck by a .25 caliber bullet. Classified as WIA,

second echelon type.

During tactical situation No. 3, the American forces consisted of approximately two

platoons of infantry plus heavy weapons, and the Japanese forces consisted of not more than

one platoon with heavy and light machineguns. The 1st Battalion forces sustained a total

of 21 casualties, 7 KIA and 14 WIA. The Japanese forces sustained about 25 to 50 casualties,

18 of whom were estimated as being due to small arms fire and the remainder as being due to

mortar and heavy artillery fire.

Tactical Situation No. 4, 21 July-1 August 1943

On 21 July 1943, the 1st Battalion advanced against little enemy resistance to a parachute drop at which the 169th Infantry had been relieved the previous day by the 2d Battalion. The 2d Battalion had reached the area by bypassing the Japanese resistance. A

raiding party of 100 to 200 Japanese had attacked a litter party of the 118th Medical Battalion, Collecting Company B, and approximately 40 men were buried in this area; 10 were

casualties and 8 were litter bearers.

Most of the activities during the next 3 days consisted of patrol duty. The 1st Battalion

had four casualties from U.S. artillery fire and six from enemy automatic weapons fire. On

the morning of 25 July, three casualties resulted from friendly artillery fire.

In the late afternoon of 25 July, the 1st Battalion dug in on the right side of O'Brien

Hill. A small patrol was dispatched on what was called a "suicide mission" in an attempt to

obtain prisoners. Although the enemy was said to be poorly armed, the patrol met heavy

resistance from automatic weapons fire and three were wounded. The objective of the patrol

was not accomplished.

On 26 July, two casualties were sustained from grenade fragments.

During the late afternoon of 27 July, the 1st and 2d Battalions dug in 300 yards west

and to the right of O'Brien Hill, at what was to be a supply dump. Very little enemy activity

took place during the day. On the same day, however, a group of engineers had attempted

to build a jeep trail to the area of the supply dump, and, after they had been ambushed by

Japanese snipers, two men were killed and several others wounded.

At 0700 hours on 28 July, the regimental commander requested that the 1st Battalion

send out two litter squads with a protecting rifle squad to pick up the bodies of the two engineers just mentioned. Although no enemy resistance had been anticipated, heavy small arms

fire was encountered; five men were killed and one was wounded. The bodies of the two

engineers were not recovered.

Although at least a company of Japanese troops were known to be on the left flank, the

1st and 2d Battalions were ordered to advance approximately 700 yards on a 2700 azimuth.
772 WOUND BALLISTICS

Company A, with an unprotected mortar squad, was left to guard the ration dump. When

this company sent out a platoon in an attempt to bring back a casualty and clean up enemy

resistance, the platoon was obliged to retreat back to the ration dump without accomplishing

either mission.

In the meantime, the 1st and 2d Battalions successfully advanced to their destination

overlooking Munda airfield, sustaining only one casualty. When a bulldozer trail from the

ration dump followed the advancing battalions, 2 men were killed in action during the late

afternoon of 28 July and 11 were wounded in action.

On the morning of 29 July, it was learned that the ration dump was surrounded by the

enemy and that the trail was not open. All remaining wounded were therefore evacuated

by jeeps over the enemy-held trails.

The two battalions advanced toward the ration dump during the day of 29 July. The

1st Battalion, which was in the rear position, sustained only one casualty. On the morning

of 30 July, the 2d Battalion walked single file around the enemy resistance and retreated

from the area. The 1st Battalion did not disperse the enemy or open the trail to the ration

dump until 1200 hours on I August 1943. Between 30 July and 1 August, it had 92 casualties, 17 of whom were KIA or DOW. No evacuation was available for the wounded from

1600 hours on 28 July until 1200 hours on 1 August.

An interesting sidelight of this particular engagement is that, between 30 July and

1 August, the 160th Infantry was unable to make full use of its supporting artillery during

its attack on the three hills which lay across their line of advance because the location of the

ist Battalion was so uncertain the free use of the artillery would probably have caused many

casualties among U.S. troops.

During the tactical situation described between 21 July and 1 August 1943, U.S. forces

engaged varied in strength, at any single time, from one platoon to a maximum of 1,000

infantry troops. The opposing Japanese strength was estimated at 200 to 500 troops. The

1st and 2d Battalions, 148th Infantry, sustained 219 casualties, of whom 53 were KIA.

A discussion of the 1st Battalion casualties (112) and a description of the circumstances

under which they occurred during the 21 July-i August action follow.

On 21 July 1943, the 1st Battalion took over part of the 169th Infantry area and the

following casualties occurred:

Case 22.-Minor laceration of the right side of the thorax. This man was on defensive

action walking over irregular, thick jungle terrain when he was struck by a .25 caliber rifle

bullet at a range of approximately 100 or 200 yards. Classified as WIA, immediate duty

type.

Case 23.-Minor penetrating wound of the left side of the thorax. This man, while in

a foxhole during an American artillery barrage, was struck by a shell fragment at a range of

approximately 100 yards. Classified as WIA, immediate duty type.

Case 24.-Moderately severe laceration of the lower part of the right thigh directly

over the patella. This man, in a position similar to that of Case 23, was wounded by American artillery fire. Classified as WIA, first echelon type.

Case 25-Moderately severe laceration of the left arm. This man, in a position similar to that of Case 23, was struck by American artillery fire. Classified as WIA, second

echelon type.

Case 26.-Moderately severe penetrating wounds of the head. This man, in a position

similar to that of Case 23, was struck by American artillery fire. Classified as WIA, first

echelon type.

Case 27.-No record available.

The following casualties occurred when a small party protecting a bulldozer ran into an

ambush:

Case 28.-Severe penetrating wound of the thorax. This man, while walking on patrol,

was struck by a burst of .25 caliber machinegun fire at an unknown range. Classified

as KIA.
APPENDIX A 773

Case 29.-Multiple, severe penetrating wounds of the left upper and lower extremities.

This man was on patrol when he was struck by a burst of a .25 caliber machinegun fired at an

unknown range. Classified as WIA, second echelon type.

Case 30.-Penetrating wounds of the left upper extremity. This man was on patrol

when he was struck by bullets from a .25 caliber sniper's rifle at an unknown range. Classified as WIA, first echelon type.

Case 31.-Multiple, moderately severe penetrating wounds of the face and head. This

man, while on patrol, was in a kneeling position firing his rifle when it was struck by a .25

caliber rifle bullet. Numerous small metal fragments penetrated his face and forehead.

Classified as WIA, immediate duty type.

On 25 July, the following casualties resulted from a U.S. artillery barrage:

Case 32.-Severe penetrating wound of the head. This man was in a foxhole when an

American artillery shell burst directly overhead. A fragment of the shell passed through his

helmet. Classified as KIA, died 10 minutes after injury.

Case 33.-Moderately severe lacerating wound of the left shoulder region. This man

was wounded under circumstances similar to those of Case 32. Classified as WIA, first

echelon type.

Case 34.-Moderately severe penetrating wound of the right foot. This man was

wounded under circumstances similar to those of Case 32. Classified as WIA, second

echelon type.

Cases 35 and 36.-Both these casualties sustained moderately severe penetrating

wounds of the thorax and the legs. These men were wounded under circumstances similar

to those of Case 32. Classified as WIA, second echelon type.

On 26 July, a small combat patrol was sent to take prisoners from an isolated enemy

dugout. If the activity of the patrol had been properly planned, all of the following casualties might have been avoided:

Case 37.-Multiple small arms wounds of the thorax and abdomen. This man, while

on patrol, was just climbing over a log in thick jungle when he was struck by a burst of

.25 caliber light machinegun fire at a range of approximately 25 to 50 yards. Classified as

KIA.

Case 38.-Severe penetrating wound of the head. This man, while on patrol, was

standing behind the tree attempting to point out the enemy when he was struck by a burst

of .25 caliber machinegun fire. Classified as KIA.

Case 39.-Severe penetrating wounds of the head. This man was in a prone position

attempting to throw a grenade when he was struck by fragments from a Japanese grenade

and by machinegun fire. The range was approximately 35 yards. Classified as WIA, U.S.

evacuation type.

Case 40.-Multiple, severe penetrating wounds of the lower part of the abdomen and

the lower extremities. This man -was a member of an advancing patrol when he was struck

by fragments from a Japanese grenade. After sustaining his injuries, the soldier walked

200 yards to the regimental aid station where he received primary treatment. He was

evacuated immediately but died 28 hours later without having received any surgical treatment. He received 1 unit of plasma. This man was classified as DOW, 28 hours' survival.

Case 41.-Moderately severe lacerating wound of the right leg. This man was on

patrol when he was struck by fragments of a Japanese hand grenade. Classified as WIA,

first echelon type.

Case 42.-Moderately severe penetrating wound of the left thigh. This man -was on

patrol when he was struck by fragments of a Japanese hand grenade. Classified as WIA,

second echelon type.

On 28 July, the following casualties occurred:

Case 43.-Mild penetrating wounds of the left leg. This man was in a shallow foxhole

when he was struck by fragments from an American artillery shell which burst at a 75- to

100-yard range. Classified as WIA, immediate duty type.
774 WOUND BALLISTICS

Case 44.-Mild lacerating wound of the left arm. This man was wounded under

circumstances similar to those of Case 43.

Case 45.-Severe penetrating wound of the right side of the face. This man was

wounded under circumstances similar to those of Case 43. Classified as WIA, U.S. evacuation type.

Cases 46 through 49.-All these soldiers sustained multiple penetrating and perforating

wounds due to .25 caliber light machinegun fire. Three of the men were killed instantly

and the fourth was bayoneted to death several hours after receiving his primary wound.

The machinegun range was from 50 to 100 yards. All of these men had been sent out to

recover the bodies of two dead engineers. This entire action had been poorly planned and

ill-advised.

Case 50.-Moderately severe laceration of the nose. This man was wounded under

circumstances similar to those of Cases 46 through 49. Classified as WIA, U.S. evacuation

type.

Case 51-Severe perforating wound of the head. This man was killed under circumstances similar to those of Cases 46 through 49. Classified as KIA.

Case 52-Severe mutilating wound of the right arm and moderately severe penetrating

wounds of the thorax. This man was on offensive action, walking single file down an open

trail, when a U.S. hand grenade exploded accidentally in front of him. Classified as DOW,

lived 7 hours after injury. This casualty was due to careless handling of the grenade and,

probably, to poor medical treatment.

Case 53-Severe mutilation of the head and face. This man was on offensive action

crawling toward an enemy machinegun emplacement when he was struck by a burst of .25

caliber machinegun fire at a 20-yard range. Classified as KIA. The platoon to which

this soldier belonged had become disorganized, and this man did not receive any support

in his attack on the enemy emplacement.

Cases 54, 55, and 56.-All of these men received multiple, minor penetrating wounds

of the head and the extremities. These men were in a prone position in a foxhole when

three enemy hand grenades were thrown into the foxhole. Two of the grenades were thrown

out but the third exploded and wounded the men. All of these men were members of a

mortar section that was not receiving adequate protection from a rifle squad, and their

foxhole was poorly located. Classified as WIA.

Case 57.-No record of this casualty, very minor wound.

Case 58.-Moderately severe penetrating wound to the right forearm. This man was

in a position similar to that of Case 54 and was wounded by enemy grenade fragments.

Classified as WIA, second echelon type.

Case 59.-Severe perforating wound of the head. This man, in an unprotected foxhole

with three other members of a mortar crew, was struck by a .25 caliber rifle bullet at a 25-

to 50-yard range. Classified as KIA.

Case 60.-Severe perforating wound of the head. This man was killed under circumstances similar to those of Case 59.

Case 61.-Severe perforating wound of the right leg. This man was walking about the

perimeter organizing the defense when he was struck by a burst of .25 caliber light machine--

gun fire. He was wounded at 1700 hours on 28 July but was not evacuated until 0700 hours

on 29 July. Classified as WIA, U.S. evacuation type.

Case 62.-Moderately severe penetrating wound of the left leg. This man was on

defensive action when he was struck by a bullet from a .25 caliber Japanese rifle. Classified

as WIA, second echelon type.

Case 63.-Moderately severe laceration of the head. This man was struck by a

Japanese rifle bullet. The bullet perforated his helmet. Classified as WIA, immediate

duty type.

Case 64.-Penetrating wound of the head. This man was in a foxhole when he was

struck by a Japanese rifle bullet. Classified as WIA, second echelon type.
APPENDIX A 775

Case 65.-Multiple penetrating and perforating wounds of the right upper extremity

and a penetrating wound of the head. This man was in a foxhole when he was struck by

a burst of enemy light machinegun fire. Classified as WIA, U.S. evacuation type, and was

returned to duty in 8 months.

On 29 July the 1st Battalion sustained the following casualty:

Case 66.-Severe perforating wound of the right hand. This man was in a foxhole when

he accidentally discharged his own rifle. He was wounded at 1800 hours on 29 July and was

evacuated at 1200 hours on 1 August. Classified as WIA, U.S. evacuation type. This

casualty could have been avoided.

On 30 July heavy casualties were sustained:

Case 67.-Moderately severe penetrating wound of the left leg. This man, while on

an offensive action, was advancing in a crouch position when he was struck by a Japanese

rifle bullet at a range of approximately 50 to 100 yards. He was wounded at 1400 hours on

30 July and was evacuated at 1200 hours on 1 August. Classified as WIA, second echelon

type.

Case 68.-Severe perforating wound of the thorax. This man was wounded under circumstances similar to those of Case 67. Following his injury, the soldier walked 100 yards

to the aid station. Classified as WIA, second echelon type.

Case 69.-Moderately severe penetrating wound of the left shoulder. This man was

wounded under circumstances similar to those of Case 67. Classified as WIA, second echelon type.

Case 70.-Severe penetrating wound of the left hand. This man was wounded under

circumstances similar to those of Case 67. Classified as WIA, second echelon type.

Case 71.-Severe penetrating wound of the left forearm and the left leg. This man

was on offensive action in a crawling position when he was struck by fragments from a Japanese hand grenade at a 1-yard range. Classified as WIA, U.S. evacuation type.

Case 72.-Severe penetrating wound of the left thigh. This man was on offensive action in a crawling position when he was struck by enemy light machinegun fire at a 50- to

75-yard range. Classified as WIA, second echelon type.

Case 73.-Moderately severe penetrating wound of the head and face. This man was

in a foxhole on defensive action during a Japanese counterattack when he was struck by

fire from an enemy light machinegun. One bullet perforated his helmet. After being

wounded, he was able to walk back to the aid station. Classified as WIA, first echelon

type.

Case 74.-Moderately severe penetrating wound of the left leg. This man was wounded

by fire from an enemy light machinegun. Classified as WIA, U.S. evacuation type.

Case 75.-Severe penetrating wound of the head. This man was crawling toward an

enemy machinegun emplacement and continued to advance alone even after orders had

been given for a withdrawal. He was struck by fire from the machinegun at a 25-yard

range. Classified as KIA. Deafness probably was responsible for the death of this casualty.

Case 76.-Severe perforating wound of the head. This man was standing in a foxhole

telephoning when he was struck by a rifle bullet at a 75- to 100-yard range. Classified as

KIA. This casualty could have been avoided.

Case 77.-Multiple, severe perforating and penetrating wounds of the thorax and the

upper and lower extremities. This man had just left his foxhole located on the defensive

perimeter in attempt to contact the division when he was struck by a burst of enemy light

machinegun fire. Classified as WIA, U.S. evacuation type.

Case 78.-Moderately severe penetrating wound of the left foot. This man was struck

by an enemy rifle bullet at a range of approximately 50 yards. Classified as WIA, second

echelon type.

Cases 79 and 80.-Minor wounds, no records available.
776 WOUND BALLISTICS

Case 81.-Mild penetrating wound of the left thigh. This man was in a crawling position when he was struck by an enemy rifle bullet at a range of approximately 50 yards.

Classified as WIA, immediate duty type.

Case 82.-Severe penetrating wound of the left thigh. This man was in a foxhole when

he was struck by an enemy rifle bullet at a 75-yard range. Classified as WIA, second echelon type.

Case 83.-Minor, severe penetrating wound of the right leg. This man was on offensive

action advancing against the enemy when he was struck by an enemy rifle bullet at a range

of approximately 75 yards. Classified as WIA, second echelon type.

Case 84.-Multiple penetrating wounds of the face. This man was on offensive action

standing in moderately thick jungle when he -was struck by fragments from an enemy knee

mortar shell. Classified as WIA, second echelon type.

Case 85.-Moderately severe penetrating wounds of the right leg. This man was

wounded under circumstances similar to those of Case 84. Classified as WIA, second echelon type.

Case 86.-Severe perforating wound of the abdomen. This man was on offensive action advancing in a crouched position through moderately thick jungle terrain when he was

struck by a machinegun bullet at a range of approximately 75 yards. Classified as DOW,

died 30 minutes after being hit.

Case 87.-Multiple, moderately severe penetrating wounds of the right lower extremity.

This man was on offensive action crawling through thick jungle terrain when he was struck

by fragments from an enemy hand grenade thrown from a tree. The grenade detonated a

few feet away from the casualty. Classified as WIA, first echelon type.

Case 88.-Multiple, moderately severe penetrating wounds of the left upper and lower

extremities. This man was wounded under circumstances similar to those of Case 87.

Classified as WIA, first echelon type.

Case 89.-Severe penetrating wound of the right shoulder region. This man was advancing in a standing position in moderately thick jungle terrain when he was struck by an

enemy rifle bullet at a range of approximately 75 yards. Classified as WIA, second echelon

type.

Case 90.-Perforating wound of the right foot. This man was on offensive action

advancing through moderately thick jungle when he was struck by an enemy rifle bullet at

a 75-yard range. Classified as WIA, first echelon type.

Case 91.-Moderately severe lacerating wound of the left leg. This man was struck by

an enemy rifle bullet at a 75-yard range. Classified as WIA, second echelon type.

Case 92.-Multiple, severe perforating wounds of the abdomen. This man was on

offensive action advancing in a crouched position through moderately thick jungle when he

was struck by a burst from an enemy light machinegun at a 50- to 100-yard range. Classified

as DOW, lived 1 hour after injury.

Case 93.-Multiple, severe perforating wounds of the thorax. This man was wounded

under circumstances similar to those of Case 92. Classified as KIA.

Case 94.-Severe perforating wound of the thorax. This man, standing in a foxhole

telephoning, was warned to take cover when he was struck by an enemy rifle bullet at a range

of approximately 100 to 200 yards. Classified as KIA. This casualty could have been

avoided.

Case 95.-Severe perforating wound of the thorax. This man was struck by fragments

from an enemy mortar shell at an unknown range. Classified as WIA, U.S. evacuation

type.

Case 96.-Severe perforating wound of the abdomen and multiple, mild penetrating

wounds of the right thigh. This man was walking in the perimeter to deliver a message

when he was struck by fragments of the same mortar shell which struck Case 95. Classified

as DOW, died 9 days after injury.

Case 97.-Severe mutilation of the head. This man had been assisting in the digging

of a hole for a machinegun emplacement when he left the protection of the hole and moved
APPENDIX A 777

a few feet away. He was struck by a burst from an enemy light machinegun at a range of

approximately 50 to 100 yards. Classified as lIA. This man should not have left the

protection of his foxhole.

Case 98.-Perforating wound of the neck. This man was standing in a foxhole in

proximity to the aid station when he was struck by an enemy rifle bullet at a 75-yard range.

Classified as WA/IA, second echelon type. This area had been under fire from enemy snipers,

and this man should not have been standing in an exposed position.

Case 99.-Multiple penetrating wounds of the face and of the upper extremities. This

man was firing his rifle when it was struck by an enemy rifle bullet. Numerous small metal

fragments penetrated his face and arms. Classified as WIA, second echelon type.

Case 100.-Moderately severe penetrating wound of the posterior portion of the right

thigh. This man was entering a foxhole when he accidentally sat on the tip of a bayonet.

Classified as WIA, first echelon type.

On 31 July the following casualties occurred:

Case 101.-Minor wound, no record available.

Case 102.-Severe perforating wound of the abdomen. This man was in a foxhole on

defensive action when he got up to obtain ammunition. He was struck by enemy light

machinegun fire at a 50- to 100-yard range. Classified as DOW, died 2 days after injury.

Case 103.-Severe penetrating wound of the abdomen and moderately severe penetrating

wound of the left shoulder. This man had already prepared one foxhole when he was told

to dig a new one. It was obvious he was to dig this new hole in a lane of enemy fire, and he

attempted to avoid this new order. Shortly after, he was struck in the shoulder by an enemy

light machinegun bullet and, as he was being moved to the aidman's hole, he received the

abdominal wound. This man received no treatment other than morphine and died after

2 hours in the aidman's foxhole. Classified as DOW, with a 2-hour survival. This casualty

probably could have been avoided.

Case 104.--Severe penetrating wound of the left side of the thorax. This man was

digging a foxhole when he was struck by an enemy light machinegun bullet at the same time

as Case 103. He was treated by the aidman but died 2 hours later. Classified as DOW,

with a 2-hour survival time.

Case 105.-Severe penetrating wound of the abdomen. This man was returning from

patrol and was approaching the aidman's foxhole when he was struck by an enemy light

machinegun bullet. He received treatment from the aidman but died in 1 hour. Classified

as DOW, with a 1-hour survival.

Case 106.-Moderately severe penetrating wounds of the right leg. This man was on

offensive action advancing toward the Japanese line in a crouched position when he was

struck by an enemy light machinegun bullet at a 15-yard range. After this man received

his wound, he became confused and crawled toward the enemy line. He was pulled into a

Japanese foxhole, and when his body was recovered it was found that he bad been strangled

to death by a rope. Classified as KIA.

Case 107.-Multiple, superficial penetrating wounds of the face. This man was advancing toward the enemy lines when he was struck by numerous fragments from a Japanese

hand grenade. Classified as WIA, first echelon type.

Case 108.-Moderately severe penetrating wound of the right arm. This man was

advancing toward the enemy line when he was struck by an enemy rifle bullet. Classified

as WIA, first echelon type.

Case 109-Moderately severe penetrating wound of the neck. This man was in a

foxhole furnishing machinegun fire for the advancing troops when he was struck by a Japanese rifle bullet. Classified as WIA, first echelon type.

Cases 110 and 111.-Minor wounds, no records available.

Case 112.-Severe penetrating wound of the left shoulder. This man was struck by

fragments of an enemy hand grenade at an unknown range. Classified as WIA, first echelon

type.

6032258162-51
778 WOUND BALLISTICS

Case 113.-Severe penetrating wound of the right hand. This man was advancing

toward the enemy line when he accidentally fell and discharged his M1 rifle. Classified as

WIA, second echelon type. This casualty could have been avoided.

Case 114.-Severe perforating wound of the right thigh and laceration of the left buttock. This man was on defensive action and left his foxhole to procure rations when he was

struck by an enemy machinegun bullet at a 100- to 150-yard range. Classified as WIA,

second echelon type.

Case 115.-Minor laceration of the head. This man was in his foxhole on defensive

action when a Japanese rifle bullet passed through his helmet and lacerated his scalp. Classified as WIA, second echelon type.

On 1 August 1943, all Japanese resistance described in tactical situation No. 3 (p. 769)

ended at 1200 hours. During the later stages of this engagement, Company A, 1st Battalion, was very successful and was able to knock out a light machinegun and several heavy

U.S. machineguns which the Japanese had taken from the 169th Infantry. The Japanese,

who were dressed in U.S. uniforms and helmets, also used other U.S. equipment.

Fifteen enemy dead were found in the area, and considerable numbers of Japanese were

known to have escaped into the jungle. The 1st Battalion sustained 18 casualties, as follows:

Case 116.-Moderately severe perforating wound of the thorax. This man was on

offensive action and was advancing with his machinegun crew when a Japanese light machinegun opened fire. While attempting to take cover in a shellhole, the soldier was struck by

an enemy light machinegun bullet as he was assuming the prone position. Classified as

WIA, second echelon type.

Case 117.-Moderately severe penetrating wound of the left forearm. This man was

wounded under circumstances similar to those of Case 116. Classified as WIA, second

echelon type.

Case 118.-Severe penetrating wound of the head. This man was advancing against

the enemy lines and was wounded under circumstances similar to those of Case 116. Classified as WIA, second echelon type.

Case 119.-Severe mutilation of the head. This man was on offensive action and was

taking cover behind a tree when he was struck by a burst from an enemy light machinegun.

Classified as KIA.

Case 120.-Moderately severe penetrating wound of the neck. This man was struck

by an enemy rifle bullet at a 50- to 100-yard range. Classified as WIA, immediate duty type.

Case 121.-Minor laceration of the thorax. This man was on offensive action when an

enemy machinegun bullet ricocheted off his helmet. After taking cover, he was wounded

by a fragment from an enemy hand grenade. Classified as WIA, immediate duty type.

Case 122.-Severe penetrating wound of the head. This man was struck by an enemy

light machinegun bullet. Classified as KIA, death occurred in 10 minutes.

Case 123.-Mild laceration of the thorax. This man was struck by a fragment from

an enemy hand grenade at an unknown range. Classified as WIA, first echelon type.

Case 124.-Severe perforating wound of the right foot. This man, while in a prone

position, was attempting to kick away an enemy hand grenade which had fallen near him.

Classified as WIA, U.S. evacuation type.

Cases 125 and 126.-Minor wounds, no records available.

Case 127.-Moderately severe penetrating wound of the left buttock. This man was

near the frontline of the perimeter when he was struck by fragments from an enemy hand

grenade at an unknown range. Classified as WIA, first echelon type.

Case 128.-Moderately severe laceration of the face. This man, a member of a mortar

crew, was struck by an enemy rifle bullet at a range of 150 yards. Classified as WIA, immediate duty type.

Case 129.-Moderately severe penetrating wound of the right leg. This man was on

defensive action and accidentally stabbed himself with his own bayonet. Classified as WIA,

second echelon type. This casualty could have been avoided.
APPENDIX A 781

Case 161.-Moderately severe penetrating wound of the right thigh. This man was in

a standing position on offensive action when he was struck by an enemy light machinegun

bullet. Classified as WIA, first echelon type.

Case 162.-Minor laceration of the right leg. This man was struck by a U.S. rifle

bullet. Classified as WIA, immediate duty type.

Case 163.-Severe penetrating wound of the head. This man was on offensive action

when he stopped to pick up a cigarette butt. He was struck by an enemy light machinegun

bullet. Classified as KIA. This casualty could have been avoided.

Case 164.-Severe penetrating wound of the thorax. This man was advancing against

enemy lines when two American mortar shells fell short of the skirmish line. The first

shell was a dud and did not explode, but the second shell exploded within several yards

from this casualty. Classified as KIA. This casualty was due to carelessness on the part

of the adjacent companies which did not maintain contact with each other.

Case 165.-Moderately severe penetrating wound of the left foot. This man was on

offensive action advancing in a crouched position when he was struck by a Japanese light

machinegun bullet at a 20- to 50-yard range. Classified as WIA, first echelon type.

Case 166-Severe perforating wound of the thorax. This man was advancing in a

standing position against the Japanese pillbox when he was struck by a light machinegun

bullet. Classified as KIA.

Case 167.-Severe perforating wound of the thorax. This man was wounded under

circumstances similar to those of Case 166. Classified as KIA.

Case 168.-Severe perforating wound of the thorax. This man was wounded under

circumstances similar to those of Case 166. Classified as KIA, died within 10 minutes.

Case 169.-Minor wounds, no records available.

Case 170.-Multiple, severe perforating wounds of the left thigh. This man was

digging a shallow foxhole in the company area when an enemy mortar shell burst at a 3-yard

range. Classified as WIA, U.S. evacuation type.

Case 171.-Moderately severe penetrating wound of the right buttock. This man

was digging a foxhole with Case 170 and was wounded by a fragment from an enemy mortar

shell. Classified as WIA, first echelon type.

Case 172.-Moderately severe penetrating wound of the left shoulder area. This man

was in a standing position digging a foxhole when he was wounded by a fragment from an

enemy mortar shell. Classified as WIA, first echelon type.

Case 173.-Multiple, severe penetrating wounds of the head, neck, and shoulder.

This man was sleeping in a very shallow foxhole when an enemy mortar shell struck 3 feet

from his head. Classified as KIA.

Case 174.-Multiple penetrating wounds of the abdomen and the left lower extremity.

This man was in the same foxhole with Case 173 and was wounded by fragments from a

Japanese mortar shell. Since it was very dark and rainy, this man was not located for 10

minutes, and his abdominal wounds received initial treatment before it was found that he

was bleeding from a lacerated femoral artery. He died from hemorrhage in about 15 minutes.

Classified as KIA.

Case 175.-Multiple penetrating wound of the thorax and the upper and lower extremities. This man was sleeping in a foxhole adjacent to Cases 173 and 174 and was wounded

by fragments from the same enemy mortar shell, which burst at a 1-yard range. Classified

as WIA, first echelon type.

Cases 176 through 181.-All these men were in shallow foxholes at a 2- to 10-yard

distance from the enemy mortar shellburst which caused casualties 173, 174, and 175. All

classified as WIA, immediate duty type.
APPENDIX B

Casualties, 1st Battalion, 5307th Composite Unit (Provisional), Burma Campaign, 15 February-8 June 1944

James E. T. Hopkins, M.D.

In the following pages, the various engagements of the 1st Battalion, 5307th Composite

Unit (Provisional), during the Burma campaign are grouped into tactical situations, and

casualties are described in the order in which they occurred in combat.

A comparison of casualties sustained by the 1st Battalion during the period of actual

combat from 5 March through 8 June 1944 with the number of enemy casualties is practically

impossible because of lack of knowledge of either the Japanese forces or the casualties they

sustained. The 1st Battalion sustained a total of 61 casualties, of whom 7 were killed in

action. Of the 54 who survived the initial wounding, 8 died later of their wounds.

1.-While they were guarding the airstrip at Lagang Ga, near Walawbum, soon after

entering Burma, elements of the 1st Battalion came under barrages from Japanese 77 mm.

artillery at a range of 2% miles. The first shells caught the troops without protection of

foxholes, and eight casualties were sustained, as follows:

Case 1.-Multiple penetrating and mutilating wounds of the face and neck. This man

was in a prone position on flat terrain in tall grass and bushes when an enemy artillery shell

burst at a 1-yard range. Classified as DOW, with a 1-hour survival time. This casualty

might have been avoided if the troops had taken advantage of protective cover and foxholes.

Case 2.-Multiple penetrating wounds of the thorax. This man was in a prone position

when he was struck by fragments from an enemy artillery shell which had a tree burst at 25

yards. Classified as WIA, first echelon type.

Case 3.-Mild penetrating wounds of the left leg. This man was wounded under circumstances similar to those of Case 2. Classified as WIA, immediate duty type.

Case 4.-Multiple, severe penetrating wounds of the left thigh and face. This man was

in a prone position when he was struck by fragments of an enemy artillery shell when it

detonated at a 2-yard range. Classified as WIA, first echelon type.

Case 5.--Mild penetrating wound of the thorax. This man was in a prone position on

the ground when he was struck by fragments of an enemy artillery shell which had a tree

burst at 15 yards from his position. Classified as WIA, immediate duty type.

Case 6.-Moderately severe penetrating wound of the thorax and mild penetrating

wound of the left leg. This man was wounded by fragments from an enemy artillery shell

which detonated 10 yards from his position. Classified as WIA, first echelon type.

Case 7.-Mild laceration of the right hand. This man, while walking on patrol, was

ambushed by a Japanese trail block and was struck by an enemy rifle bullet at a 15-yard

range. Classified as WIA, immediate duty type.

Case 8.-Severe perforating wounds of the left upper and lower extremities. This man

was riding horseback on patrol when the trigger of a Thompson submachinegun was caught

in a twig and the weapon discharged. Classified as WIA, second echelon type. This casualty could have been avoided.

2.-After Walawbum, the 1st Battalion was assigned the task of throwing a roadblock

below Shaduzup. A regiment of Chinese with pack artillery was attached to the battalion

for the mission. En route to Shaduzup, the 1st Battalion encountered two enemy road783
784i WOUND BALLISTICS

blocks at Tabayin and Naprawa, and seven U.S. casualties were sustained while reducing

enemy resistance as follows:

Case 9.-Severe penetrating wound of the head. This man, while on offensive action

walking along a trail, was struck by a fragment from a Japanese knee mortar shell at a 3-yard

range. Classified as WIA, U.S. evacuation type. This casualty might have been avoided if

he had worn his helmet and taken advantage of protective cover.

Case 10.-lMultiple, mild penetrating wounds of the neck and thorax. This man, while

on patrol, was standing in the middle of a trail when he was struck by fragments from a

Japanese knee mortar shell. Classified as WIA, first echelon type.

Case 11.-Moderately severe penetrating wound of the left arm. This man was walking

along the side of the trail in rather thick jungle growth when he was struck by an enemy rifle

bullet. Classified as WIA, first echelon type.

Case 12.-Multiple, severe penetrating wounds of the head. This man was walking in

a crouched position along the side of the trail when he was struck by enemy light machinegun

fire at a 25-yard range. Classified as lIA.

Case 13.-Severe perforating wound of the head. This man was in a prone position

when he was struck by an enemy sniper's bullet at a 100-yard range. Classified as KIA.

Case 14.-Moderately severe perforating wounds of the left leg. This man was advancing in a crouched position along the side of a trail when he was struck by fire from an enemy

light machinegun. Classified as WIA, second echelon type.

Case 15.-Multiple, severe penetrating wounds of the left lower extremity. This man

was wounded under circumstances similar to those of Case 14. Classified as WIA, second

echelon type.

3.-The 1st Battalion engaged the enemy at a strongly defended area at Htingdankawing

and sustained the following casualties:

Case 16.-Severe perforating wound of the right leg. This man was in a prone position

behind a clump of bamboo but for some reason was told to leave this position and retreat to

the rear. While running down the center of the trail, he was struck by an enemy machinegun

bullet at a 35-yard range. The wound track involved the right popliteal fossa with laceration of the popliteal artery. This wound was not dressed for 15 minutes following the injury,

and the patient became hysterical and kicked the tourniquet off. The patient bled to death

within a half hour. Clagsified as DOW, with a 30-minute survival time. This casualty

might have been avoided if he had used better judgment about running down the trail and

if he had been cooperative with the aidmen in their attempts at treatment.

Case 17.-Mild penetrating wound of the abdomen. This man was struck by fragments

from a U.S. 60 mm. mortar shell which exploded at an unknown distance. Classified as WIA,

immediate duty type. This casualty might have been avoided if the 60 mm. mortars had

been properly located closer to the frontline.

Case 18.-Mild penetrating wound of the face. This man, while attempting to treat

Case 16, was struck by a fragment from the same shell which wounded Case 17. Classified

as WIA, immediate duty type.

Case 19.-Multiple penetrating wounds of the thorax and the left upper and lower extremities. This man was in a standing position when he was struck by fragments from an

81 mm. mortar shell at a 15-yard range. Classified as WIA, immediate duty type. This

casualty might have been avoided if he had taken advantage of a prone position in protective

cover.

Case 20.-Mild penetrating wound of the left upper extremities; no other record

available.

Case 21.-Mild penetrating wound of the right thigh. This man was in a prone position

in the midst of a bamboo clump when he was struck by fragments of a Japanese hand grenade

which exploded within 5 feet of his position. Classified as WIA, immediate duty type.
APPENDIX B 785

4.-The 1st Battalion, with an attached Chinese regiment, had been advancing on

Shaduzup over very difficult terrain and through virgin jungle for 2 weeks. They had fought

several skirmishes with a few casualties.

On 27 March, the Americans, with the Chinese 24 hours behind, bivouaced with great

care and secrecy on the east bank of the Nam Kawng Chaung, 3 miles below Shaduzup. The

Chinese in the distance attracted attention with their campfires, and they were shelled by

enemy 77 mm. guns. When the Chinese sent back several counterartillery barrages, they

gave away their positions to the enemy and sustained numerous casualties. Shells began to

fall in one of the 1st Battalion platoon areas, but they moved out, sustaining one casualty.

Case 22.-Severe penetrating wounds of the right temporal region of the head. This

man was in a platoon area that was being shelled by the enemy and the platoon was being

moved to a safer location. The man was not wearing a helmet, and in spite of orders to the

contrary he returned to the original area to retrieve his pack. While walking around in the

dark, he was struck by a fragment of an enemy 77 mm. artillery shell. It was 3 hours before

the man was located, and it was 48 hours before he was treated by Seagrave Unit No. 2.

Classified as DOW, with a 4-day survival period. This casualty, which could have been

avoided, was due to the carelessness and disobedience of the soldier.

5.-During the night, an officer made reconnaissance of the Japanese camp across the

river, and the combat team crossed at dawn, catching the Japanese by surprise and killing

many of them. The entire operation was a success, and the enemy suffered many casualties.

The attached Chinese units arrived within 24 hours to take over the position, and several

heavy enemy counterattacks were broken up.

One platoon of the combat team found that in crossing the river they were required to

make two crossings because of the S-shaped character of the river. While making the second

crossing, the platoon came under fire from enemy automatic weapons located on a 20-foot

embankment. Two men were wounded on the approach and two more were wounded during

a rescue attempt. One of the four soldiers was killed.

Case 23.-Moderately severe perforating wound of the left leg with a compound comminuted fracture of the fibula. This man was on offensive action in a prone position in grass

and brush cover when he was struck by a bullet fron an enemy light machinegun at a 125-

yard range. The man was able to bandage his own wound and was evacuated. Classified

as WIA, second echelon type.

Case 24.-Mild penetrating wound of the right leg. This man was struck under circumstances similar to those of Case 23. This man received treatment within 45 minutes

and was classified as WIA, second echelon type.

Case 25.-Multiple, severe penetrating and perforating wounds of the head, the left

arm, and the right foot. This man was wounded under circumstances similar to those of

Case 23. Two hours after this casualty sustained his injuries, he reached an aid station

where he received 6 units of plasma. On the following day, he was treated at the Seagrave

Unit No. 2. Classified as DOW, with a 6-day survival. This man was attempting to reach

a wounded man, and it is possible that his death could have been avoided if he had waited

until more firepower were available.

Case 26.-Severe penetrating and perforating wounds of the right thigh. This man was

wounded under circumstances similar to those of Case 23. Classified as WIA, second echelon

type.

6.-After the Japanese camp was occupied, a platoon patrol advanced north on the road.

A Japanese truck was encountered before cover was available; one American was wounded,

and nine Japanese were killed. Numerous other American casualties occurred in the camp

area.

Case 27.-Moderately severe penetrating wound of the right arm. This man was on

patrol and in a prone position in grass cover along the side of the road when he was struck

603225v-62----52
786 WOUND BALLISTICS

by a fragment from a Japanese hand grenade at a 5-yard range. Classified as, WIA, immediate duty type.

Case 28.-Mild laceration of the left temporal region of the head. This man was on

defensive action when he was struck by a Japanese rifle bullet. Classified as WIA, immediate

duty type.

Case 29.-Moderately severe lacerating wound of the right forearm. This man was on

defensive action and was constructing a foxhole when he was struck by a fragment from a

90 mm. mortar shell which exploded at a 10-yard range. Classified as WIA, second echelon

type.

Case 30.-Moderately severe penetrating wound of the right side of the neck. This man

was sitting in a very shallow foxhole with his head down when he was struck by a fragment

from a 90 mm. mortar shell which had a tree burst at a 5-yard range. Classified as WIA,

U.S. evacuation type. This casualty might have been avoided if he had constructed a deeper

foxhole.

Case 31.-Severe perforating wound of the right forearm. This man, while on defensive action, left his foxhole and was in a standing position when he was struck by a fragment

from a 90 mm. mortar shell -which had a tree burst at a 5-yard range. Classified as WIA,

U.S. evacuation type. This casualty could have been avoided.

Case 32.-Moderately severe laceration of the left hand. This man was on defensive

action in a prone position but had not constructed a foxhole. During an enemy counterattack, he was struck by a .25 caliber rifle bullet at an unknown range. Classified as WIA,

second echelon type. This casualty might have been avoided if he had taken advantage of

protective cover or of a foxhole.

Case 33.-Severe penetrating wound of the abdomen, anteriorly. This man, while

under defensive action, was sleeping in a very shallow foxhole when he was struck by a

fragment from a 77 mm. artillery shell which had a tree burst at a 5-yard range. This man

did not receive any treatment and died within 30 minutes. Classified as DOW. This

casualty might have been avoided if he had constructed a deeper foxhole.

Case 34.-Severe perforating wound of the right buttock. This man was sleeping in

the same foxhole with Case 33 and was wounded under similar circumstances. Classified

as WIA, second echelon type.

Case 35.-Moderately severe penetrating wound of the abdomen, posteriorly. This

man was in a prone position in a foxhole when he was struck by a fragment from a 90 mm.

mortar shell which had a tree burst at a 2- to 3-foot range Classified as WIA, second echelon type.

Case 36.-Moderately severe penetrating wounds of the right forearm and the right

leg. This man was in the same foxhole with Case 35 and was wounded under similar circumstances. Classified as WIA, second echelon type.

7.-During the night of 28 March, sporadic enemy artillery and mortar fire was directed at the perimeter, and three casualties were sustained.

Case 37. Enemy artillery shell made a direct hit in the center of the thorax, posteriorly, and the body was mutilated into three separate pieces. This man was on defensive

action in a foxhole which was considered to be too deep and much too large. He was killed

instantly. This casualty might have been avoided if the foxhole had been properly constructed.

Case 38.-This man was occupying the same foxhole as Case 37 and sustained at least

30 perforating and penetrating wounds of the thorax, abdomen, and lower extremities.

Classified as DOW, with a 30-minute survival period.

Case 39.-Severe penetrating wounds of the left leg. This man was in a foxhole on

defensive action when he was struck by a fragment from an enemy 77 rmm. shell. Classified as WIA, U.S. evacuation type.

8.-A combat team of 250 men from the 1st Battalion threw up a roadblock at Kauri,

1 mile south of Nhpum Ga, at 1800 hours on 8 April. A strong perimeter was set up, and
APPENDIX B 787

two attempts of an enemy food and ammunition train to reach the Japanese lines were repulsed.

One American was killed by fire from a U.S. carbine, and another soldier shot himself while

cleaning his gun. Two casualties resulted from enemy fire.

On 13 April, one man was killed and one man was wounded while out on patrol. Four

other casualties occurred up to 1 May 1944. Two of these casualties were wounded by carbine fire, one was killed by fire from a Thompson submachinegun, and one was wounded by

fire from a Browning automatic rifle. During the first 3 weeks in April, 6 of the 10 casualties

were caused by U.S. weapons.

Case 40.-Severe perforating wounds of the head. This man, while on defensive action,

left his foxhole during the night to investigate a noise. He was killed 10 feet from his foxhole by fire from a U.S. carbine at a few yards range. Classified as KIA. This casualty,

due to carelessness, could have been avoided.

Case 41-Mild laceration of the thorax. This man, while on defensive action, left

his foxhole to reach his pack when he was struck by fire from a Japanese supply train. Classified as WIA, immediate duty type. The Americans had opened fire first, and this man did

not have time to take protective cover.

Case 42-Severe perforating wound of the right foot. This man was on offensive action

moving in a crouched position toward the Japanese when he was struck by a .25 caliber

rifle bullet at an unknown range. Classified as WIA, U.S. evacuation type.

Case 43.-Severe penetrating wound of the right forearm. This man was in a foxhole

on defensive action when he was wounded by an accidental discharge of his own rifle. Classified as WIA, second echelon type. This casualty could have been avoided.

Case 44-Moderately severe perforating wound of the left foot. This man was sitting

cleaning his carbine when it accidentally discharged. Classified as WIA, second echelon

type. This casualty could have been avoided.

Case 45.-Multiple penetrating and perforating wounds of the chest and abdomen.

This man was out on patrol when he was ambushed by the Japanese and was struck by a

burst of light machinegun fire at a 10-yard range. Classified as EIA.

Case 46.-Severe perforating wound of the right leg. This man was wounded under

circumstances similar to those of Case 45. Classified as WIA, U.S. evacuation type.

Case 47.-Severe perforating wound of the thorax. This man was in a foxhole on

defensive action and was awakened by the return of his companion at 0100 hours. This

man then left his foxhole and was mistaken for a Japanese and shot with a Thompson submachinegun. Classified as KIA. This casualty could have been avoided.

Case 48.-Moderately severe perforating wound of the right foot. This man, after

trading his Thompson submachinegun for a carbine, was engaged in cleaning the carbine

when it accidentally discharged. Classified as WIA, second echelon type. This casualty

could have been avoided.

Case 49.-Complete traumatic amputation of the right middle finger. This man was

cleaning his Browning automatic rifle when it accidentally discharged. Classified as WIA,

first echelon type. This casualty could have been avoided.

9.-On 10 May 1944, the 1st Battalion, with the 150th Chinese Infantry attached, bypassed the 3d Battalion, with the 88th Chinese Infantry attached, at Ritpong and proceeded

to take the southern airfield at Myitkyina on 17 May. From this time, until they were reformed early in June, the 1st Battalion defended the airfield, with three casualties, details

of which follow. Later casualties are not included in this study.

Case 50.-Mild laceration of left thigh. This man, while on offensive action, was

wounded by a fragment of a U.S. mortar shell. Classified as WIA, immediate duty type.

This casualty could have been avoided.

Case 51.-Mild penetrating wound to the left side of the thorax. This man was riding

in a jeep at the airfield when he was hit by a ricochet of an enemy rifle bullet which struck

the vehicle. Classified as WIA, first echelon type.
788 WOUND BALLISTICS

Case 52.-Severe perforating wound of the thorax and penetrating wound of the left

arm. This man, while on defensive action, was walking on the airstrip when he was struck

by an enemy sniper's bullet at a 15-yard range. Classified as DOW, died 30 hours later

while being taken to a hospital.

10.-An American patrol of 18 men had moved 750 yards from the base at Zigyum

ferry when the patrol hit a 7-man enemy trail block. Three Americans were wounded, one

dying later of his wounds; there were three Japanese casualties.

Case 53.-Moderately severe penetrating wound of the abdomen. This man was on

offensive action in a standing position when he was struck by a fragment from a Japanese

hand grenade which exploded at a 2-yard range. Classified as WIA, second echelon type.

This casualty could have been avoided if he had taken advantage of cover and concealment.

Case 54.-Moderately severe penetrating wound of the left thigh and the hip. This man

was wounded under circumstances similar to those of Case 53. Classified as WIA, first

echelon type. This casualty could have been avoided.

Case 55.-Severe penetrating wound of the left side of the head and multiple penetrating wounds of the left side of the thorax. This man was on offensive action in a standing

position when he was struck by fragments from an enemy hand grenade which exploded at

a 3-foot range. Classified as DOW with a 58-hour survival period. This casualty could

have been avoided.

11.-The 1st Battalion sustained the following casualties during the period 24-26 May

1944:

Case 56.-Moderately severe penetrating wound of the right forearm. This man was

on a defensive position when he was struck by a fragment from a 60 mm. Chinese mortar

shell. Classified as WIA, first echelon type. This casualty was due to carelessness on the

part of the Chinese forces.

Case 57.-Moderately severe penetrating wound of the left side of the thorax. This

man was wounded under circumstances similar to those of Case 56.

Case 58.-Moderately severe penetrating wounds of the right forearm with a compound

fracture of the radius. This man was on defensive action when he was wounded by an

enemy rifle bullet. Classified as WIA, second echelon type.

Case 59.-Mild penetrating wound of the left side of the thorax. This man was sitting

on the ground at the airfield when he was struck by an enemy rifle bullet. Classified as

WIA, first echelon type.

Case 60.-Moderately severe lacerating wound of the left side of the thorax. This

man was wounded by a fragment from a Japanese 77 mm. artillery shell. Classified as

WIA, immediate duty type.

12.-At 1515 hours on 8 June 1944, a six-man patrol attempted to set up a machinegun

in the vicinity of the airstrip. They saw the body of a Chinese casualty, and in attempting

to reach it they were fired on by two Japanese light machineguns. The first burst took the

heel off one man's shoe, grazed another man, and hit another soldier's carbine. After a

few minutes of action, one man was killed. It was estimated that two Japanese were killed.

Case 61.-Severe perforating wound of the head. This man, while on offensive action

in a prone position in brush cover, attempted to reach his helmet which had fallen off when

he was struck by an enemy light machinegun bullet at a 150-yard range. Classified as KIA.

This man had killed one of the enemy machinegun crew from the spot where he was hit and

apparently did not take advantage of further protective cover.
APPENDIX C

Casualties, 3d Battalion, 5307th Composite Unit (Provisional), Burma Campaign, 15 February-8 June 1944

James E. T. Hopkins, M.D.

In the following pages, the various engagements of the 3d Battalion, 5307th Composite

Unit (Provisional), during the Burma campaign are grouped into tactical situations, and

casualties are described in the order in which they occurred in combat.

1.-On 28 February 1944 in the region of Nzanga Ga, the I and R (Intelligence and

Reconnaissance) Platoon, 3d Battalion, was traveling 6 hours ahead of the main body of

troops. The I and R Platoon consisted of 46 men, 4 animals, 4 Browning automatic rifles,

and 6 Thompson submachineguns.

At 1000 hours, the platoon was on the trail where it crossed a rice paddy which was

overgrown with tall, thick elephant grass, and the first section made contact with the enemy

at the village boundary. Since the platoon was under orders not to engage in any fire fights,

it withdrew 2 miles north to Lanem Ga where a trail block was set up, and they waited the

arrival of the battalion. The enemy force was estimated to be made up of approximately

20 men with rifles, 2 light machineguns, and 1 heavy machinegun. Reconnaissance at a

later time showed that the enemy apparently left the area during the night. Only one

American casualty was sustained.

Case 1.-Mild laceration of the left side of the face. This man, while on patrol, was

firing his Ml rifle from a prone position when he was struck by an enemy .25 caliber light

machinegun bullet at an approximate 30-yard range. Classified as WIA, immediate duty

type.

2.-On 3 March, the 3d Battalion was moving along the north trail leading into the village of Lagang Ga. The I and R Platoon had already passed through the village and was

being followed by several rifle platoons and the Orange and Khaki Columns. As the battalion Headquarters Company of the column passed through the village, a group of Japanese

were noted approaching along the south trail along the river bank. Word was passed along

the column that the enemy was approaching, and, when they were approximately 50 yards

from the Headquarters Company, many of the men in the column opened fire. The party

of Japanese consisted of seven men, and they were carrying a litter. The enemy party was

protected by a light machinegun. Five of the Japanese were killed instantly by the American fire and two escaped. However, they were killed at a later time. There were no

American casualties. The Japanese casualties had multiple wounds inflicted by small arm

weapons, and all had died instantly. It was impossible to examine the bodies carefully because of the continuing engagement with the enemy.

3.-Shortly after the encounter just described, the leading elements of the Orange

Column contacted a small party of Japanese approaching from the vicinity of Walawbum.

A brief fire fight ensued and several of the enemy were killed, but there were no American

casualties.

Perimeters were set up, and the entire column dug in for the night. Later in the same

day, the I and R Platoon was ordered to leave the area and cross the Numpyck Hka River

and protect the right flank of the column as it proceeded toward Walawbum on the following day. The platoon halted at dark and dug in.

At dawn the next morning, the platoon leader took a small group forward about 300

yards and found slightly commanding ground from which the column could receive flank

protection until it reached its position along the river opposite Walawbum. The entire I

and R Platoon then moved forward and took up its new position.

789
790 WOUND BALLISTICS

All of this movement took place at approximately 0700 hours on 5 March. Since it was

quite foggy, the visibility was very poor, and the Americans sustained a casualty along their

perimeter before they realized that they had been surrounded by approximately 90 Japanese.

The platoon leader had available 48 men with 3 Browning automatic rifles and 6 Thompson

submachineguns. The ensuing engagement lasted from 0700 hours until 1100 hours when

the I and R Platoon withdrew under cover of mortar fire and smoke, leaving approximately

60 Japanese casualties. During the engagement, the platoon had sustained three casualties.

Case 2.-Severe perforating wound of the right lower quadrant of the abdomen and multiple penetrating wounds of the right and the left arm. This man, while on defensive action

at the platoon perimeter, was standing gathering camouflage material when he was struck by

enemy small arms fired at a range of approximately 50 yards. This man reached the battalion surgeon in approximately 3 hours and received 5 units of plasma and was evacuated

by plane 10 hours after receiving his injury. Classified as DOW, with a 10wý-hour survival

time. This casualty might have been avoided if he had been more alert and had taken

advantage of protective cover.

Case 3.-Severe perforating wounds of the left temporal region of the head. This man

was on defensive action firing from a prone position in a shallow foxhole when he was struck

by fragments from a Japanese mortar shell which had a tree burst at a 25-yard range. He

was taken to the battalion surgeon but died within 2 hours. Classified as DOW, with a

2-hour survival time. This casualty might have been avoided if he had worn his helmet and

had taken advantage of a deeper foxhole.

Case 4.-Moderately severe penetrating wound of the left forearm. This man was in a

position similar to Case 3 and was wounded under similar circumstances. Classified as

WIA, first echelon type.

4.-During the encounter between the I and R Platoon and the encircling enemy force,

the Orange Column, which had dug in for the night approximately 40 yards from the river,

came under enemy mortar fire. Three American casualties were sustained.

Case 5.-Severe penetrating wounds of the left thigh and the thorax. This man was on

defensive action, and in charging with a mortar section he moved off the trail to construct a

foxhole when he was struck by a fragment from a Japanese knee mortar shell which had a

tree burst at a 15-foot range. Classified as KIA, died instantly.

Case 6.-Mild penetrating wound of the right side of the abdomen. This man was in

a prone position in a foxhole when he was struck by a fragment from the shell which struck

Case 5. Classified as WIA, immediate duty type.

Case 7.-Mild laceration of the abdomen. This man was sitting in the jungle without

advantage of any protective cover or a foxhole when he was struck by the shell which struck

Case 5. Classified as WIA, immediate duty type.

5.-The Khaki Column remained in the vicinity of the village of Lagang Ga in order to

protect the rear of the column as well as the airstrip. No contact had been made with the

enemy on 3 March, but at approximately 0630 hours on 4 March the perimeter was struck

by an enemy force of approximately 30 men armed with 2 light machineguns, 2 knee mortars,

and many rifles. The American troops were engaged in preparing breakfast and were considerably disorganized during the attack. A number of American troops were examining

the bodies of five Japanese killed during the previous day. The entire engagement lasted

approximately 20 minutes when the Japanese withdrew with at least six KIA casualties.

The Americans sustained six WIA casualties.

Case 8.-Severe penetrating wound of the right forearm with a compound fracture of

the radius. This man was on defensive action in a prone position with his machinegun when

he was struck by an enemy .25 caliber light machinegun bullet. Classified as WIA, second

echelon type.

Case 9.-Multiple, moderately severe penetrating wounds of the right and left upper

and lower extremities. This man had approximately 100 small fragments in the skin, the
APPENDIX C 791

subcutaneous tissues, and the muscles of the upper and lower extremities. He was in a

prone position under the same circumstances as Case 8 when he was struck by fragments

of an enemy knee mortar shell which burst at a range of approximately 3 yards. Classified

as WIA, second echelon type.

Case 10.-Multiple, moderately severe penetrating wounds of the right and left lower

extremities. This man was wounded under circumstances similar to those of Case 9. Classified as WIA, first echelon type.

Case ll.-Mild laceration of the left side of the thorax. This man was in a position

similar to that of Case 9 when he was struck by a fragment from an enemy hand grenade

which exploded at a 3-yard range. Classified as WIA, immediate duty type. This casualty might have been avoided if he had taken advantage of protective cover in a foxhole.

Case 12.-Mild laceration of the head and face. This man was wounded under circumstances similar to those of Case 9. Classified as WIA, immediate duty type.

Case 13.-Moderately severe penetrating wound of the head and severe penetrating

wound of the right side of the thorax. This man was on defensive action in a prone position

when he was struck by a fragment from an enemy knee mortar shell which had a tree burst.

Classified as WIA, first echelon type. This casualty might have been avoided if lie had worn

his helmet and taken advantage of a foxhole or of other protective cover.

6.-Later in the day on 4 March, the Khaki Column, with all men and animals, moved

from its position 200 yards south of LagangGato set up a perimeter on the bank of the river

opposite the village of Walawbum. During the afternoon, an extensive mortar barrage

was fired into the village, but the enemy force retaliated with approximately 20 mortar

shells.

During 5 March, there were sporadic artillery exchanges, but there were no American

casualties. However, during the morning and early afternoon of 6 March, the enemy expended about 200 mortar and artillery shells into the Orange Combat Team area and the

Americans had three minor casualties. During the late afternoon, the enemy made a sudden attack in force along the river side of the American perimeter. It was necessary for

the enemy to approach the river by crossing 60 yards of fiat, brush-covered terrain, at least

10 feet below the fairly flat jungle-covered terrain, occupied by the American force. Very

few of the enemy troops were allowed to reach the river.

During this encounter of the Orange Combat Team with the enemy on 4 through 6

March, approximately 400 American troops were engaged and only 4 slightly WIA casualties were sustained. Approximately 1,000 Japanese troops were engaged, and it was estimated that they had at least 400 KIA casualties.

Case 14.-Slight penetrating wound of the right thigh. This man was on defensive

action sitting in a foxhole when he was struck by a fragment of a Japanese mortar which

had a tree burst of a 20- to 30-yard range. Classified as WIA, immediate duty type. This

casualty might have been avoided if he had taken advantage of a prone position in his foxhole.

Case 15.-Moderately severe perforating wound of the right forearm. This man was

walking on patrol when he was struck by a Japanese rifle bullet. Classified as WIA, immediate duty type.

Case 16.-Moderately severe perforating wound of the left leg. This man was on defensive action in a prone position in a foxhole with his lower extremities unprotected. He

was struck by a fragment from a Japanese mortar shell which had a tree burst directly

over his foxhole. Classified as WIA, first echelon type and required 1 month of

hospitalization.

Case 17.-Moderately severe penetrating wound of the right side of the head. This

man was in the same foxhole and was wounded under the same circumstances as Case 16. Classified as WIA, immediate duty type. This casualty could have been avoided if he had

taken advantage of the protection afforded by his helmet.

7. -During the time that the Orange Combat Team was supporting the I and R Platoon, the Khaki Combat Team rested along the trail at Lagang Ga. Though no active
792 WOUND BALLISTICS

fighting took place and no Japanese artillery shells landed in the Khaki Combat Team area,

one casualty was sustained.

The Khaki Column bivouacked during the night of 5 March in the area occupied by

the Orange Column. The Khaki Combat Team remained in this area covering the Orange

Column's supply trail until midafternoon on 6 March. A few 77 mm. artillery shells fell

in the area, and two men were wounded. After leaving the bivouac area, the Khaki Column

attempted to reach the Orange Combat Team by traveling through the jungle to the left

of the main trail. However, this operation was unsuccessful, and the men became lost and

wandered in the jungle for 8 hours. During this time, 4 men were wounded and 1 was

killed by contact with boobytraps which had been set by the Orange Combat Team. Finally, both columns were reunited, and they were relieved by Chinese troops.

Case 18.-Slight lacerations of the left side of the thorax. This man was on patrol

walking along an open trail when he was struck by an enemy rifle bullet at a range of

approximately 200 yards. Classified as WIA, immediate duty type.

Case 19.-Moderately severe perforating wound of the left hand. This man, while on

defensive action guarding a supply line, was in a prone position. He was wounded by a

fragment from an enemy 77 mm. artillery shell which fell 20 yards from his position. Classified as WIA, first echelon type, and required 30 days of hospitalization. This casualty might

have been avoided if he had taken advantage of protective cover or of a foxhole.

Case 20.-Mild lacerations of the thorax. This man was wounded under circumstances

similar to those of Case 19. Classified as WIA, immediate duty type.

Case 21.-Multiple penetrating wounds of the lower extremities. This man while on a

night march through thick jungle, was attempting to reach the Orange Combat Team when

he walked into a boobytrap previously set up by that unit. Classified as WIA, immediate

duty type.

Case 22.-Multiple perforating wounds of the lower extremities. This man was

wounded under circumstances similar to those of Case 21. Classified as WIA, immediate

duty type.

Case 23.-Multiple, mild penetrating wounds of the lower extremities and of the face.

This man was wounded under circumstances similar to those of Case 21. Classified as WIA,

immediate duty type.

Case 24.-Severe, multiple wounds of various body regions. This man was wounded

under circumstances similar to those of Case 21 and several days elapsed before his body

was found. Classified as KIA.

Case 25.-Multiple penetrating and perforating wounds of the thorax and the upper and

lower extremities. This man was wounded under circumstances similar to those of Case 21.

Classified as WIA, second echelon type.

8.-During the period from 7 March to 31 March, the 3d Battalion was engaged in

marching through very rugged and mountainous terrain toward the Japanese-held road at

Inkangahtawng 12 miles north of Kamaing. On 25 March, the Khaki Combat Team of the 3d

Battalion and members of the 2d Battalion reached the area and set up a roadblock. The

2d Battalion became engaged with the enemy, and after inflicting many casualties they withdrew because of a threatened encirclement. The Khaki Combat Team did not take a very

active part in the fighting, and they withdrew with the 2d Battalion to Sharaw. A landing

strip was constructed here for the evacuation of U.S. wounded.

On the following day, the retreat was continued through Manpin toward Auche. The

Orange Combat Team had been holding the trail open at Manpin. On 26 and 27 March,

the Orange I and RI Platoon fought two skirmishes with the forward elements of a Japanese

battalion advancing from Kamaing toward Warawng Ga by another trail. The 2d and 3d

Battalions reached Auche during the afternoon of 27 March. The following casualties were

sustained:

Case 26.-Mutilation of the head and traumatic amputation of the right lower extremity.

This man was watching a supply drop for the Chinese when he was struck by a case of
APPENDIX C 793

mortar ammunition which had become separated from its parachute. Classified as KIA.

It had not been planned to include this casualty in the records of this casualty survey, but

unfortunately he was recorded in the tabulation of multiple wounds due to miscellaneous

causes.

Case 27.-Minor, severe penetrating wounds of the left shoulder and lacerations of the

left leg. This man was on defensive action retreating from bivouac area when he was injured

by a fragment from an enemy 77 mm. artillery shell at an unknown range. Classified as

WIA, first echelon type.

Case 28.-Mild penetrating wound of the left buttock. This man was wounded under

circumstances similar to those of Case 27. Classified as WIA, immediate duty type.

Case 29.-Multiple, severe penetrating and perforating wounds of the right lower

extremity and a severe penetrating wound of the right lower quadrant of the abdomen.

This man was cleaning his Ml rifle when he was struck by a burst of fire from a rifle being

cleaned by another enlisted man at a 10-foot range. Classified as DOW, with a 1-hour

survival. This casualty could have been avoided.

Case 30.-Severe perforating wound of the thorax. This man was a member of a

five-man patrol which had just come out of dense jungle along a narrow trail into fairly open

terrain. Another patrol from the 2d Battalion was sighted 50 yards ahead on the trail.

One of the men of this patrol opened fire with his rifle. Classified as KIA. This casualty

could have been avoided since the light tan British-type coveralls which this casualty was

wearing probably confused the members of the other patrol.

Case 31.-Mild perforating wound of the right thigh. This man was a member of a

60 mm. mortar squad and was wounded by an accidental discharge of a defective propelling

charge. Classified as WIA, immediate duty type.

9.-During the period from 7 March to 31 March 1944, there were approximately 450

Americans engaged against an approximated equal number of the enemy. The Americans

sustained a total of 6 casualties, and the Japanese sustained a total of from 95 to

145 casualties.

On the morning of 28 March, the 3d Battalion arrived at Hsamshingyang with the

mission of supplying the 2d Battalion at Nhpum Ga and of keeping the trail open for the

evacuation of the wounded. On 28 March, the 2d Battalion was engaged by the enemy, and

they evacuated their casualties through the 3d Battalion during the next 3 days.

On 31 March, patrols could not reach the 2d Battalion, and the Orange Combat Team

was ordered to open the trail. During the next 6 days, their attempts were unsuccessful,

and the Khaki Combat Team was called on to take over the job.

During the period of 1 through 6 April, while the Orange Combat Team was engaged

in attempting to lift the Japanese-held trail block, 36 American casualties were sustained of

which 6 were KIA, 2 were DOW, and 28 were WIA. The enemy sustained approximately

200 casualties during this same period.

Case 32.-Severe perforating wound of the right lower quadrant of the abdomen. This

man was a member of a five-man patrol and was in a kneeling position furnishing cover fire

for another scout when he was struck by a Japanese rifle bullet at a 20-yard range. Classified as WIA, first echelon type, and was returned to combat duty within 7 weeks. This

casualty might have been avoided if he had taken advantage of better cover and if he had

been more cautious.

Case 33.-Severe perforating wound of the left side of the face. This man was on patrol

duty advancing on a steep trail flanked by thick jungle and bamboo. He was struck by an

enemy rifle bullet at a range of approximately 10 to 20 yards. The battalion surgeon put

a tight compress over the mutilated left side of the face, and the casualty walked 1 mile to

the regimental aid station. He died during the night. Classified as DOW, with an 18-hour

survival.

Case 34.-Severe perforating wound of the left foot. This man was a member of a

patrol and was wounded by an enemy rifle bullet at an unknown range. Classified as WIA,

U.S. evacuation type.
794 WOUND BALLISTICS

Case 35.-Severe penetrating wound of the right thigh. This man was on offensive

action firing at the enemy from a sitting position when he was wounded by a .25 caliber

rifle bullet at a 30-yard range. Classified as WIA, second echelon type, and returned to

duty within 3 months.

Case 36.-Moderately severe perforating wound of the right arm. This man was on

patrol duty when the patrol encountered a Japanese trail block. The lead scout warned the

others to take cover along the side of the trail. The enemy forces opened fire with a light and

a heavy machinegun. This man was hit by an enemy light machinegun, but he continued

to fire his weapon after being wounded. Classified as WIA, second echelon type. It is

noteworthy to see that this man continued in combat even after being wounded and then

walked 3 to 4 miles to the airstrip before he was evacuated.

Case 37.-Severe penetrating wound of the right thigh. This man was wounded under

circumstances similar to those of Case 36. Classified as KIA.

Case 38.-Severe, multiple penetrating wounds of the right and left lower extremities

and a perforating wound of the thorax. This man was wounded under circumstances similar

to those of Case 36. The first burst of fire had wounded this soldier in the legs, and as a

friend was pulling him to safety he was killed by a bullet through the chest. Classified as

KIA.

Case 39.-Mild laceration of the right arm. This man was in a crawling position when

he was struck by a ricochet of a .25 caliber rifle bullet. Classified as WIA, immediate duty

type.

Case 40.-Mild laceration of the left inguinal region. This man was working with a

mortar squad, during preparation for an infantry attack, when he was struck by a stray .25

caliber bullet. He was in a sitting position with no protective cover. Classified as WIA,

immediate duty type. This casualty might have been avoided if the mortar squad had taken

advantage of defensive cover.

Case 41.-Severe perforating wound of the thorax. This man, while on defensive action,

was a member of a group of about 10 men who were bunched along the trail 30 yards from

the enemy roadblock. An enemy knee mortar shell exploded 5 yards in back of the group

on a slight elevation along the side of the trail. In addition to this casualty, seven others

were injured. Classified as KIA. This casualty, as well as the following seven cases, could

have been avoided if they had taken advantage of dispersion and of protective cover.

Case 42.-Multiple penetrating and perforating wounds of the neck and of the upper and

lower extremities. Classified as WIA, first echelon type.

Case 43.-Multiple perforating wounds of the upper and lower extremities. Classified

as WIA, first echelon type.

Case 44.-Multiple perforating wounds of the upper and lower extremities. Classified

as WIA, U.S. evacuation type.

Case 45.-Mild perforating wound of the thorax. Classified as WIA, immediate duty

type.

Case 46.-Mild penetrating wound of the left shoulder. Classified as WIA, immediate

duty type.

Case 47.-Multiple penetrating wounds of the head and the thorax. Classified as

WIA, immediate duty type.

Case 48.-Severe penetrating wound of the head. Classified as WIA, U.S. evacuation

type.

Case 49.-Multiple, severe wounds of the thorax and the abdomen. This man was on

offensive action and was walking without advantage of protective cover when he was struck

by a burst of fire from an enemy light machinegun at a 10-yard range. Classified as KIA.

This casualty might have been avoided. Cases 49 and 50 were providing protective fire for

a man with a flamethrower. They were at the farthest part of the advance when they became

careless and stepped from the jungle cover onto the trail where both men were shot.
APPENDIX C 795

Case 50.-Severe perforating wounds of the thorax and the right upper extremity.

This man was wounded under circumstances similar to those of Case 49. Classified as WIA,

U.S. evacuation type.

Case 51.-Mild lacerating wound of the right shoulder. This man was in a prone position behind a tree when he was struck by a fragment from a Japanese hand grenade at a

5-yard range. Classified as WIA, immediate duty type.

Case 52.-Mild laceration of the left forearm. This man was in a prone position when

he was struck by a .25 caliber Japanese rifle bullet, at an unknown range. Classified as

WIA, immediate duty type.

Case 53.-Moderately severe perforating wound of the abdomen. This man was

walking on defensive action when he was struck by an enemy sniper's bullet at a 60-yard

range. Classified as WIA, second echelon type. This casualty might have been avoided

if he had taken advantage of protective cover. The enemy sniper had been active in this

area for some time, and the men had been warned to stay out of open areas.

Case 54-Mild laceration of the left arm. This man was in a prone position in a

foxhole when he was struck by a .50 caliber machinegun bullet from a U.S. P-57 during a

strafing attack. Classified as WIA, immediate duty type. Better air-ground communications would have prevented this accident.

Case 55-Severe perforating wound of the abdomen. This man was sitting in a very

shallow foxhole with his upper torso exposed when he was wounded under circumstances

similar to those of Case 54. This man received plasma within 5 minutes after being injured

and was then evacuated 4 miles by litter carry. He died approximately 24 hours after

being injured. Classified as DOW, with a 24-hour survival time. This casualty might

have been avoided if he had taken advantage of more complete protection.

Case 56-Moderately severe lacerating wounds of the left forearm. This man was in

a prone position on offensive action when he was struck by an enemy rifle bullet. Classified

as WIA, immediate duty type.

Case 57.-Moderately severe penetrating wound of the right shoulder. This man was

in a prone position on offensive action when he was struck by an enemy sniper's bullet at a

range of approximately 40 yards. The advance had stopped, and the man was attempting

to reach an old Japanese foxhole. He was injured as he was entering the foxhole. Classified

as WIA, first echelon type. This casualty might have been avoided if he had taken advantage of protective cover instead of exposing himself to sniper fire as he crawled over the

ground to the foxhole.

Case 58.-Moderately severe perforating wound of the right arm. This man was in a

prone position on offensive action when he was struck by a bullet from a Japanese light

machinegun at a 30-yard range. Classified as WIA, first echelon type, and returned to

duty within 30 days.

Case 59.-Severe penetrating wounds of the head. This man was in a prone position

in a shallow foxhole waiting for the mortar barrage to lift when he was struck by a fragment

from a 50 mm. U.S. mortar shell which had a tree burst at a range of approximately 15

yards. Classified as WIA, U.S. evacuation type. This man's helmet probably saved his

life. The mortar was being fired from a position too far back of the frontline.

Case 60.-Mild penetrating wound of the right leg. This man was wounded under

circumstances similar to those of Case 59. Classified as WIA, immediate duty type.

Case 61.-Mild laceration of the left leg. This man was walking on offensive action

when he was struck by an enemy rifle bullet at a range of approximately 30 to 100 yards.

Classified as WIA, immediate duty type.

Case 62.-Mild laceration of the left shoulder. This man was sitting in a shallow

foxhole near the air station when he was struck by a fragment from a Japanese knee mortar

which had a tree burst directly overhead. Classified as WIA, immediate duty type. This

casualty might have been avoided if he had taken advantage of a prone position in the

foxhole.
796 WOUND BALLISTICS

Case 63.-Multiple, moderately severe wounds of the head. This man was wounded

under circumstances similar to those of Case 62. Classified as WIA, immediate duty type.

This casualty might have been avoided if he had worn his helmet and had been in a prone

position.

Case 64.-Mild penetrating wounds of the right upper extremity. This man was in a

prone position in a foxhole when he was wounded by fragments from a U.S. 60 mm. mortar

shell which exploded at a distance of 3 feet from the edge of the hole. Classified as WIA,

first echelon type.

Case 65.-Mild penetrating wound of the head. This man was in a prone position on

offensive action when he was wounded by fragments from a Japanese hand grenade which

exploded at a 2- to 3-yard range. Classified as WIA, immediate duty type.

Case 66.-Severe penetrating wound of the thorax. This man, while on defensive

action, was standing on a trail in a known previous line of fire near the front perimeter

when he was hit by a .25 caliber rifle bullet at a range of approximately 200 yards. Classified

as KIA. This casualty might have been avoided if the man had not engaged in sightseeing

and if he had heeded the warning about the enemy's line of fire.

Case 67.-Severe perforating wound of the head. During the change of guard at

night, this man sat up in his foxhole. The battalion veterinarian, thinking the soldier was

a Japanese, shot him with his .45 caliber pistol. Classified as KIA. This casualty could

have been avoided.

10.-On 4 April, the Khaki Combat Team was ordered to bypass the Japanese resistance

on the Nhpum Ga trail and to make a right flank attack on the Japanese at the northeast

sector of the village where another trail led into the area. After considerable difficulty in

passing through the jungle, the combat team arrived in the vicinity of the village at

approximately 1600 hours. While advancing up the trail, the three lead scouts were wounded

by a burst of Japanese machinegun fire. These men advanced into an ambush without

proper reconnaissance or preparation. All other attempts of the Americans to advance

were repulsed.

On 5 April, after a quiet night without attack from the Japanese, the combat team

advanced along the trail. However, heavy fire from the enemy light machinegun prevented

any flanking movement, and the combat team retired from the area.

Case 68.-Severe perforating wound of the head. This man was a lead scout on patrol

and was walking up a trail when he was struck by a bullet from an enemy light machinegun.

Classified as KIA. This casualty might have been avoided if different tactics had been

adopted.

Case 69.-Moderately severe penetrating wound of the left thigh. This man was

wounded under circumstances similar to those of Case 68. Classified as WIA, first echelon

type.

Case 70.-Severe perforating wound of the neck. This man was wounded under

circumstances similar to those of Case 68. Classified as DOW, with a 7-hour survival time.

This casualty might have been avoided if he had not attempted to reach Case 69. He

should have taken advantage of protective cover until the offensive action could have been

properly organized.

Case 71.-Traumatic amputation of the right third finger. This man was wounded

under circumstances similar to those of Case 68. Classified as WIA, first echelon type.

Case 72.-Moderately severe laceration of the right thigh. This man was on offensive

action and advancing through thick jungle in a low crouched position when he was struck

by an enemy light machinegun bullet at a range of approximately 40 yards. Classified as

WIA, first echelon type.

Case 73.-Moderately severe perforating wound of the right leg. This man was

advancing in a crouched position through thick jungle cover when he was struck by an enemy

light machinegun bullet. This man was seen by the battalion surgeon 15 minutes after he

was injured, but before that time he had not received any first aid nor had a tourniquet been
APPENDIX C 797

applied to his leg. Classified as DOW, with a 40-minute survival time. This casualty

could have been avoided if a tourniquet had been applied to his leg.

Case 74.-Minor laceration of the right shoulder. This man was advancing in a

crouched position on offensive action when he was struck by an enemy light machinegun

bullet. Classified as WIA, immediate duty type.

11.-On 7 April, the Khaki Combat Team took over the perimeter of the Orange Combat

Team. The latter team was dispatched on a wide flanking movement to the left of the main

trail. Their mission was to cut the Japanese supply line south of Nhpum Ga. This maneuver was not successful because of difficult terrain and supply shortages.

During the period of 7 through 9 April, the Khaki Combat Team had numerous contacts

with the enemy forces. The heaviest part of the offensive during 8 April was carried out

by the I and R Platoon of Headquarters Company and the 2d Platoon of I Company. All

of the positions taken on 7 April were given up because of the high ground held by the Japanese.

Five separate attacks were organized during the day. Both 60 and 81 mm. mortars were

used to give a barrage of about 400 shells preceding each attack. Much of the fighting took

place with only a few yards separating the advance elements of the approaching forces.

The fighting throughout most of the day was up steep terrain through closely growing bamboo

and thick jungle growth.

Case 75.-Severe penetrating wound of the left forearm with a compound fracture of

the left radius. This man, while on offensive action in a prone position, crawled into the

fire lane of a Japanese light machinegun. He was wounded at an approximate 60-yard

range. Classified as WIA, second echelon type. This casualty might have been avoided

if he had stayed out of the known machinegun lane.

Case 76.-Mild penetrating wound of the right arm and multiple penetrating wounds

of the left lower extremity. This man was wounded under circumstances similar to those of

Case 74. Classified as WIA, first echelon type.

Case 77.-Mild laceration of the left hand. This man was wounded under circumstances

similar to those of Case 75. Classified as WIA, immediate duty type.

Case 78.-Severe perforating wound of the thorax. This man was on offensive action

and in a crawling position during advancement against the enemy when he was hit by a

burst of fire from a Japanese light machinegun at a 100-yard range. Classified as DOW,

with a 1%-hour survival time.

Case 79.-Moderately severe penetrating wound of the right hand. This man was on

offensive action and was standing throwing a grenade when he was struck by a fragment

from a Japanese hand grenade at a range of approximately 10 feet. Classified as WIA,

first echelon type.

Case 80.-Severe penetrating wound of the right side of the head. This man was on

offensive action and was carrying a radio. The platoon leader informed him that they

were entering a danger zone, and, as the soldier was attempting to assume the prone position,

he was struck by a bullet from a Japanese .25 caliber rifle at a 40-yard range. Classified

as KIA.

Case 81.-Severe penetrating wound of the right side of the head. This man was

walking to the left of the trail toward the enemy line in a known fire lane when he was struck

by an enemy light machinegun bullet at a 50-yard range. Classified as WIA, U.S. evacuation type. This casualty might have been avoided if he had taken advantage of protective

cover and if he had heeded the previous warning in regard to the fire lane.

Case 82.-Mild laceration of the left hand. This man was wounded under circumstances similar to those of Case 81. Classified as WIA, immediate duty type.

Case 83.-Severe perforating wound of the thorax. This man was on offensive action

and his platoon had just been relieved and was going into position for flank protection when

he was struck by a .25 caliber bullet at a 75- to 100-yard range. He was in a prone position.

Classified as DOW, with a 2-hour survival time.
798 WOUND BALLISTICS

Case 84.-Severe perforating wound of the thorax. This man was on offensive action

advancing in a crouched position when he was struck by a .25 caliber rifle bullet at a 20-yard

range. Classified as WIA, second echelon type.

Case 85.-Severe penetrating wound of the right leg with a compound comminuted

fracture of the right tibia. This man was a radio operator and was occupying a shallow

foxhole 50 yards in front of the perimeter and 100 yards in back of the advancing troops.

The foxhole had been dug by the Japanese and had a log in front and in back. A light

machinegun bullet passed through the log and wounded this man. Classified as WIA,

second echelon type. This casualty might have been avoided if he had not occupied this

foxhole which was in a known lane of machinegun fire.

Case 86.-Mild penetrating wound of the right thigh. This man wasthelead scout of his

platoon and in a crouched position when he was struck by a fragment from an enemy hand

grenade which had a tree burst of a 5-foot range. Classified as WIA, first echelon type.

Case 87.-Mild laceration of the head and face. This man was in a prone position

behind a tree when he was struck by a fragment from an enemy hand grenade which exploded at a range of approximately 5 feet. Classified as WIA, immediate duty type.

Case 88.-Mild laceration of the upper part of the left leg. This man was wounded

under circumstances similar to those of Case 86. Classified as WIA, immediate duty type.

Case 89.-Mild penetrating wound of the left side of the face. This squad leader was

standing behind a tree when he was struck by numerous fragments from a Japanese hand

grenade which exploded at a 2-yard range. Classified as WIA, immediate duty type. This

casualty might have been avoided if he had taken advantage of a prone position.

Case 90.-Moderately severe penetrating wound of the left hand. This man was

wounded under circumstances similar to those of Case 89. Classified as WIA, first echelon type.

Case 91.-Mild laceration of the right hand. This man was in a prone position of a

shellhole when he was struck by a fragment from a Japanese hand grenade at a 5- to 10-yard

range. Classified as WIA, immediate duty type.

Case 92.-Severe penetrating wound of the left arm with a compound comminuted

fracture of the elbow region. This man was in a prone position firing at a Japanese light

machinegun crew when he was struck by an enemy machinegun bullet at a range of approximately 30 yards. Classified as WIA, U.S. evacuation type. This casualty might have been

avoided if he had not occupied a known lane of machinegun fire.

Case 93.-Multiple, moderately severe penetrating wounds of the head and the right

upper and lower extremities. This man was on offensive action and delivering Browning

automatic rifle fire from a shellhole when a Japanese hand grenade burst at a 2-yard range.

Despite his multiple wounds, this man continued to deliver effective fire against the enemy

light machinegun crew. Classified as WIA, U.S. evacuation type.

Case 94.-Multiple penetrating wounds of the left lower extremity. This man was in

a prone position when he was struck by a fragment from an enemy hand grenade at a 2-yard

range. Classified as WIA, first echelon type.

Case 95.-Moderately severe perforating wound of the abdomen, posteriorly. This man

was on offensive action and was crawling forward when he exposed himself to enemy rifle

fire by crawling over a slight elevation on the ground. Classified as WIA, second echelon

type. This casualty might have been avoided if he had circled around, rather than crawled

over, the elevation on the ground.

Case 96.-Moderately severe penetrating wound of the right forearm. This man was

on offensive action and was talking in a crouched position into attack when he made an excessive amount of noise in going through a clump of bamboo. He was wounded by fire from a

Japanese sniper's rifle. Classified as WIA, second echelon type. This casualty might have

been avoided.

Case 97.-Mild penetrating wound of the right side of the neck. This man was crawling back to the command post for ammunition when he was wounded by fragments from an

enemy hand grenade which exploded within a few feet of his position. Classified as WIA,

immediate duty type.
APPENDIX C 799

Case 98.-Mild penetrating wound of the right hand. This squad leader was crawling

toward the enemy lines when he was struck by a fragment from an enemy hand grenade at a

5-yard range. Classified as WIA, immediate duty type.

Case 99.-Severe perforating wound of the abdomen and a moderately severe penetrating wound of the thorax. This man was on offensive action and was scouting about in a

dense clump of bamboo when he was struck by the first burst of Japanese heavy machinegun

fire at a 25- to 30-yard range. Classified as DOW, with a 24-hour survival time.

12.-On 8 April, an unfortunate accident occurred. A 60 mm. mortar shell scored a direct

hit on a headquarters company heavy machinegun crew. One man survived, two died of

wounds, and a fourth was killed instantly. A prior air and artillery barrage had cleared

away the bamboo and jungle growth for approximately 100 yards along the trail, and the U.S.

mortars were set up in this area. The frontline of the perimeter was 200 yards in front of the

mortars. At this distance on the left of the trail, there was a large hole in which was placed a

heavy machinegun squad. Across the trail was another hole occupied by the battalion

commander and the officer directing fire. A mortar barrage was planned and the 81 mm.

mortars were zeroed in. It was then decided to add the 60 mm. mortars to the barrage.

The initial range was 350 to 400 yards. Following the primary zeroing round, a second

round was requested, and subsequent investigation revealed that despite the usual precaution this round fell short and landed on the machinegun emplacement. After this accident, the 60 mm. mortar was used only as a frontline weapon.

Case 100.-Multiple, moderately severe penetrating wounds of the neck, thorax, and

upper and lower extremities. This man was crouched in a left posterior corner of the machinegun hole when the 60 mm. mortar shell exploded at an approximate 4-foot range.

Classified as WIA, second echelon type.

Case 101.-Multiple penetrating and perforating wounds of the abdomen and lower

extremity. This man was wounded under circumstances similar to those of Case 100.

Classified as DOW, with a 12-hour survival time.

Case 102.-Multiple penetrating wounds of the face, abdomen, and upper and lower

extremities. This man was wounded under circumstances similar to those of Case 100.

Classified as DOW, with a 2-month survival time.

Case 103.-Large mutilating wounds of the right side of head and body with compound

comminuted fractures of right arm and leg. This man was in very close proximity to the

60 mm. mortar shell when it exploded. Classified as KIA.

13.-On 9 April 1944, an early morning patrol was sent forward from the Khaki Combat

Team perimeter. In the area where the resistance had been the strongest, the patrol encountered only one live Japanese. He appeared to be in a dazed condition and was wandering

about carrying the arm of another soldier which had been cleanly cut off below the elbow.

In his attempt to escape, he was killed.

The Khaki Combat Team Rifle Platoon soon moved into the area and made contact

with the 2d Battalion without meeting any enemy resistance. The 2d Battalion had been

surrounded by elements of one Japanese battalion reinforced with a heavy weapons company

which had opposed all rescue attempts. The 2d Battalion had been subjected to 11 days

of fanatical rushes by the enemy from all sides of their perimeter and daily pointblank artillery fire from two mountain artillery pieces (nicknamed "whiz bangs") and mortar fire.

A combat team from the 1st Battalion, which had been on a flanking mission, entered

the village somewhat later. The long train of wounded men was quickly moved to the

airstrip, 5 miles away.

The Orange Combat Team arrived from its unsuccessful flanking movement, and a

strong perimeter was set up about the village. Strong points were placed along the trail to

keep the 5-mile supply route open.

Elements of the 5307th Composite Unit (Provisional) remained in this area until 24

April, when the entire area was turned over to the Chinese troops. Constant patrol action
800 WOUND BALLISTICS

was carried out during this period. The Japanese had withdrawn south along the trail to

Auche and Warawng.

Case 104.-Severe penetrating wound of the left leg. This man was sitting on the edge

of a previous Japanese foxhole when he was struck by a fragment from an enemy artillery shell

which exploded at a 5-yard range. Classified as WIA, second echelon type.

Case 105.-Multiple penetrating wounds of the right and left lower extremities and the

thorax. This man was on patrol activity when he walked into a U.S. boobytrap armed

with a hand grenade. Classified as WIA, second echelon type. This casualty could have

been avoided.

Case 106.-Moderately severe perforating wound of the left arm and penetrating wound

of the thorax. This man, a member of a five-man patrol, had moved from the protective

cover of the tall grass onto the trail. He was struck by fire from an enemy machinegun at

a range of approximately 75 yards. Classified as KIA. This casualty could have been

avoided if he had refrained from stepping into the trail in this close proximity to the enemy.

Case 107.-Mild laceration of the thorax. This man was a member of the same patrol

as Case 106 and became very nervous after the patrol leader was struck. In his attempt

to crawl to the rear, he was struck by fire from a Japanese sniper's rifle. Classified as WIA,

immediate duty type. This casualty could have been avoided if he had remained at his post.

Case 108.-Moderately severe penetrating wound of the left lower extremity. This

squad leader, becoming very excited when the enemy contact was made, was struck by fire

from an enemy sniper's rifle bullet at a 60-yard range. Classified as WIA, first echelon type.

Case 109.-Severe perforating wound of the right leg. This man was cleaning his Ml

rifle and forgot to remove the cartridge in the clip; the gun was accidentally discharged.

Classified as WIA, U.S. evacuation type. His wound necessitated amputation of the leg.

This casualty could have been avoided.

Case 110.-Severe perforating wound of the left leg. This man was on patrol and

thought he heard a noise. He then proceeded to arm his pistol but forgot to release it to

safety after placing it in his holster. A few minutes later, there was an accidental discharge of the weapon. Classified as WIA, second echelon type. This casualty could have

been avoided.

14.-The entire regiment (5307th Composite Unit (Provisional)) was in the vicinity

of Naubum on the Tanai Hka River from 25 to 30 April. After reorganization at Hsamshingyang, plans were drawn up for the capture of the airfield at Myitkyina. Because of

its reduced strength, the 2d Battalion was to be held in regimental reserve. The 3d Battalion with approximately 350 men in the Orange Combat Team and 250 men in the Khaki

Combat Team was to work with the 88th Infantry Regiment and the 1st Battalion, with the

150th Infantry Regiment of the Chinese Army. The Chinese troops had been trained by

Americans and were equipped with American weapons. The majority of American troops

were in very poor physical condition after their 3 months' stay in Burma. Many had medical conditions which under ordinary circumstances would have required hospitalization.

The 3d Battalion followed by the Chinese 88th Infantry Regiment left Naubum on 30

April for the very difficult trek over the 6,034-foot high Jaupadu Bum mountain range

leading to the Myitkyina Valley. In spite of many alarms, no contact was made with the

enemy by the King Force (the 3d Battalion plus the Chinese 88th Infantry Regiment)

until it reached Ritpong, a typical Kachin hill valley 50 miles north of Myitkyina. The

north trail into the village rises 500 feet within 500 yards, and the south trail runs over a

gentle ridge with steep sides. Therefore, the terrain presented an ideal defensive position

for the enemy.

On 6 May, the 3d Battalion cut a trail through the jungle to the left of the village and

blocked the south trail. The Chinese closed in on the north trail and attacked on 7 May,

finally entering the village on 10 May. The Japanese garrison of one company had been

destroyed, and one wounded Japanese who remained described a small party of about 30

men who escaped.
APrENDIX 0 801

Between 7 and 10 May 1944, about 700 U.S. troops were engaged in the action described,

though never more than 3 platoons were involved at any one time. Of the approximately

3,000 Chinese troops engaged, never more than 500 were used at one time. There were

between 200 and 300 Japanese in the opposing forces. They sustained about 185 casualties,

and the Chinese sustained 30 KIA and 100 WIA.'

The details of the five U.S. troops WIA, one of whom later died of his wounds, are as

follows:

Case ll1.-Severe penetrating wound of the right side of the thorax. This man was on

defensive action in a prone position in a foxhole when he was struck by a stray Japanese

bullet at a 100-yard range. Classified as DOW, with a 4-day survival time.

Case 112.-Severe perforating wound of the right side of the neck. This man was on

offensive action and was bringing up several men to support the light machinegun which

his platoon leader had set up. He knew that snipers had been shooting into this general

area for the past 15 minutes. While moving just to the right of the trail with very poor

jungle cover, he turned to give a command and was struck by a .25 caliber rifle bullet at a.

70-yard range. Classified as WIA, U.S. evacuation type. This casualty might have been

avoided if he had taken advantage of protective cover and concealment.

Case 113.-Moderately severe perforating wound of the thorax. This man was on

offensive action and advancing in a crouched position when he was struck by a .25 caliber

rifle bullet at a 100-yard range. Classified as WIA, second echelon type. This casualty

might have been avoided if he had taken advantage of protective cover and concealment.

Case 114.-Moderately severe perforating wound of the right thigh. This man was in

a prone position in the midst of jungle cover firing at the enemy when he was struck by a

heavy machinegun bullet at a 75-yard range. Classified as WIA, second echelon type.

Case 115.-Penetrating wound of the left foot and multiple penetrating wounds of the

left leg. This man was on defensive action and was withdrawing from contact with the

enemy when he was struck by fragments from 90 mm. Japanese mortar shell which burst 1

yard in front of him. Classified as WIA, second echelon type.

15.-After leaving Ritpong, the I and R Platoon of the Orange Combat Team managed

to cover 12 miles in approximately 24 hours and approached Tingkrukawng on 13 May 1944.

Their route had led up a steep hill on a razorback trail which threaded its way through thick

I During this 4-day engagement, the Chinese, according to their regimental surgeon, sustained between 25 and 30

casualties (KIA). It was never possible to obtain any further information.

No records are available on the Chinese wounded, but the writer of this chapter saw the 100 who were treated in the

42d Portable Surgical Hospital located 400 yards north of the village and can make a fairly accurate statement concerning

them.

Mortar and grenade fragments accounted for at least 80 percent of the casualties and machinegun and rifle bullets

for the remainder. About half of the mortar casualties seemed caused by Chinese fire.

Local anesthesia was used in all cases, supplemented by Penthothal sodium (thiopental sodium) in two abdominal

operations.

No skull fractures or brain wounds were treated, though 10 percent of the casualties had head injuries. One casualty

had a severe perforating mortar wound of the right side of the neck, laterally, with the exit wound through the distal third

of the tongue. This man died in 72 hours, without surgical intervention, and with uremia as the most prominent feature.

The entire end of the tongue was necrotic before his death.

No sucking thoracic wounds and very few penetrating wounds were seen, though thoracic wounds were found in 20

percent of the casualties. One casualty with a wound 6 cm. in diameter over the right scapula had no evidence of penetration of the thoracic cavity. He died after debridement.

Three casualties with abdominal wounds died of hemorrhage and shock a few minutes after they arrived at the aid

station, and two others, apparently with penetrating wounds, were operated on, but no perforations were found. A sixth

casualty survived severe peritonitis without surgical intervention; treatment consisted of sulfadiazine and a liquid diet.

lie had a foul wound of the left lower quadrant of the abdomen, in which the descending colon was visible. No other

penetrating wounds were observed. Twenty percent of the casualties had abdominal wounds.

No amputations of the lower extremities were performed, and only one hand and one arm were removed. Extremity

wounds were found in 50 percent of the casualties, and at least 15 compound fractures of the lower extremities were observed.

Of the 100 Chinese wounded in action, 47 were considered litter cases. They were carried 10 miles to a jungle strip

at Arang, whence they were evacuated by plane. The majority had been on some form of sulfonamide therapy for 3 days.
802 WOUND BALLISTICS

bamboo and jungle growth. As the platoon came down the trail to where it gave a view of

the village, the first scout motioned for his platoon to come to a halt. He saw about 40 men

bunched on the trail 50 yards distant on the far side of the village. Their helmets were

decorated with parachute cloth, such as the Chinese troops often wore. One of these

Japanese gave the Chinese greeting and the American scout replied. Therefore, the American troops thought that they had encountered a group of Chinese. However, the Japanese

soon began to deploy and take cover and opened fire on the American troops. The Americans

did not disperse properly since they were on a very narrow ridge, and a fire fight developed.

Four American casualties were sustained, and numerous casualties were inflicted on the

enemy.

Case 116-Severe penetrating wound of the occipital region of the head and a bayonet

wound of the neck. The latter wound was probably inflicted after the man was killed by

the head wound. This man was attempting to take cover from the enemy when he was

struck by a bullet from a Japanese light machinegun at a 75-yard range. Classified as KIA.

This casualty might have been avoided if some distinction had been made between Japanese

and Chinese uniforms.

Case 117.-Moderately severe lacerating wound of the right side of the head and the

right eye. This man was in a prone position firing his M1 rifle when he was struck by a .25

caliber rifle bullet at a 75-yard range. Classified as WIA, second echelon type.

Case 118.-Severe perforating wound of the thorax. This man was in a standing

position attempting to put a light machinegun into operation when he was struck by a

Japanese light machinegun bullet at a 100-yard range. Classified as KIA. Notwithstanding the fact that this man sustained a perforating wound of the left lung and the heart,

he was conscious for approximately 3 minutes before he died.

Case 119.-Moderately severe penetrating wounds of the abdomen. This man was

attempting to reach the body of Case 116 when he was struck by an enemy light machinegun

bullet. The bullet perforated his canteen before entering his abdomen. Classified as WIA,

immediate duty type. This casualty might have been avoided if the battalion commander

had been aware of the true tactical situation.

16-The first platoon of Company L was engaged in setting up a perimeter for the

night in the vicinity of a somewhat protected ridge to the left of the trail near the entrance to

the village. Two men who had been assigned a sector in back of a small ridge which offered

excellent protection became casualties when they carelessly exposed themselves.

Case 120.-Severe perforating wound of the thorax. This man was on defensive action

and was standing on a small ridge 70 yards from a Japanese-held village when he was struck

by a sniper's bullet. Classified as KIA. This casualty could have been avoided.

Case 121.-Moderately severe laceration of the left buttock. This man was standing

near Case 120 and was attempting to assume a prone position when he was struck by an

enemy sniper's bullet at a 70-yard range. Classified as WIA, first echelon type. This

casualty could have been avoided.

17.-On 13 May 1944, the Khaki Combat Team was sent on a flanking movement to

the left of the village in order to form a trail block on a trail leading north from the village.

At the same time, two Chinese companies were to form trail blocks on two trails entering

from the south. The entire combat team dug in on the sides of the razorback ridge over

which the trail led. During the rest of the day, numerous casualties were sustained.

Case 122.-Multiple, severe penetrating wounds of the abdomen and the right lower

extremity. This man was on offensive action and was walking up the trail in attempt to

locate a Japanese sniper when he was struck by a .25 caliber bullet at a 100-yard range. The

bullet hit and exploded a U.S. grenade which was carried in his belt. Classified as DOW,

with a 4-hour survival time. This casualty might have been avoided if he had taken advantage of protective cover and concealment.
APPENDIX C 803

Case 123.-Mild penetrating wound of the thorax. This man was in a kneeling position

administering blood plasma to Case 122 when he was struck by a fragment from a Japanese

knee mortar which had a tree burst at a 10-yard range. Classified as WIA, immediate duty

type.

Case 124.-Mild penetrating wound of the right thigh. This man was on offensive

action and was walking by the aid station when a knee mortar exploded at a 10-yard range.

Classified as WIA, immediate duty type.

Case 125.-Mild penetrating wound of the left leg. This man was wounded under

circumstances similar to those of Case 124. Classified as WIA, immediate duty type.

Case 126.-Moderately severe perforating wound of the left thigh. This man was a

member of a squad which was being moved across a trail which was exposed to enemy fire.

While running across the trail, he was hit by a sniper's bullet at a 75-yard range. Classified

as WIA, second echelon type. This casualty might have been avoided if he had taken

proper precaution in crossing the trail.

Case 127.-Mild laceration of the face. This man, while on offensive action sitting in

back of a bank, was preparing to cross the trail when fragments from a sniper's bullet struck

him in the face. Classified as WIA, immediate duty type.

Case 128.-Moderately severe penetrating wounds of the occipital region of the head.

This man was on defensive action sitting on the edge of the trail when he was struck by

fragments from a knee mortar shell which had a tree burst at a 3-yard range. Classified as

WIA, first echelon type. This casualty could have been avoided if he had worn his helmet

and if he had attempted to take advantage of protective cover.

Case 129.-Moderately severe penetrating wounds of the head and of the thorax. This

man was wounded under circumstances similar to those of Case 128. Classified as WIA,

first echelon type. This casualty could have been avoided.

Case 130.-Mild penetrating wound of the left leg. This man was wounded under

circumstances similar to those of Case 128. Classified as WIA, immediate duty type.

Case 131.-Moderately severe penetrating wound of the right foot. This man was

wounded under circumstances similar to those of Case 128. Classified as WIA, second

echelon type.

Case 132.-Severe penetrating wound of the head with compound fracture of the skull.

This man was on defensive action and was sitting in a rather well protected spot. When

he removed his helmet to look over the small ridge which was protecting him, he was struck

by a .25 caliber sniper's bullet at a range of approximately 100 yards. He was attended by

a surgeon but did not arrive at a main aid station until 14 hours later. Classified as DOW,

with a 40-hour survival time. He died while being carried on a litter to the evacuation point.

This casualty might have been avoided if he had worn his helmet.

Case 133.-Moderately severe penetrating wound of the right arm. This man was

wounded in the same vicinity as Case 132. He was struck by a .25 caliber bullet at a 70-

yard range. Classified as WIA, first echelon type.

Case 134.-Severe penetrating wound of the thorax. This man was on offensive action

and was advancing in a crouched position when he was struck by the first burst of a Japanese

light machinegun at a range of approximately 50 yards. Classified as KIA. This casualty

might have been avoided if he had taken advantage of protective cover and of a prone

position.

Case 135.-Multiple penetrating and perforating wounds of the right thigh. This man

was wounded under circumstances similar to those of Case 134. Classified as WIA, second

echelon type. This casualty, which might have been avoided, occurred because the man was

attempting to reach Case 134 while the enemy was still firing.

Case 136.-Mild laceration of the left shoulder. This man was on defensive action

walking down a trail when he was wounded by an enemy light machinegun bullet at a range

of approximately 70 yards. Classified as WIA, immediate duty type. This casualty could

have been avoided if he had taken advantage of protective cover.
804 WOUND BALLISTICS

18.-During the afternoon of 13 May, the Chinese casualties began to filter back to the

42d Portable Surgical Hospital. They left an estimated 5 dead in the jungle and sent out

approximately 25 WIA. At least 90 percent of the wounds had been caused by mortar fire.

In this group of casualties, no brain or penetrating abdominal wounds were seen. Surgery

consisted of simple debridement only.

On 13 May, the Khaki Combat Team was ordered to the right flank, and a Chinese company took over the defense of the main trail for 300 or 400 yards in back of the Orange Combat Team which was working up the trail toward the village. The Chinese troops neglected

to make a strong point of the high ground to the left of the trail and put inadequate defense

along the small trail which ran over into the main trail. Five Japanese with a light machinegun set up on this ground and commanded the entire main trail. The Chinese were unable

to cope with the situation and in attempting to knock out the machinegun one of the

American muleskinners was killed and one wounded. Later in the day, a heavy machinegun was brought up from the Orange Combat Team, and the Japanese gun was soon knocked

out.

19.-On 14 May 1944, the King Force received orders to break off contact with the

enemy and proceed toward Myitkyina. The 1st Battalion, with the 150th Chinese Infantry

Regiment, had already proceeded on the way to the airfield. The King Force was disbanded

on 24 May. After 18 May, the 3d Battalion had little contact with the enemy, and the men

were gradually replaced by the 236th Engineer Combat Battalion. Most of the original

unit was evacuated by 1 June, but approximately 150 men remained and fought in various

capacities during the next 2 months.

The Orange Combat Team sustained one casualty on the afternoon of 18 May.

Case 137.-Severe penetrating wound of the right thigh. This man was on offensive

action in a prone position and was protected by a small ground elevation when he was struck

by a .25 caliber rifle bullet at a range of approximately 150 yards. Classified as WIA, second echelon type.

While the 3d Battalion was working its way down the Mogaung-Myitkyina Road

toward its junction with the Sumprabum Road, two casualties were sustained during patrol

activity.

Case 138.-Severe perforating wound of the abdomen. This man, on patrol activity,

had located an enemy automatic weapon emplacement. Instead of taking advantage of

protective cover and waiting for the remainder of his patrol to reach him, he continued to

advance in a standing position and was struck by a Japanese light machinegun bullet at a

range of approximately 100 yards. Despite his wound, he managed to walk 60 yards to an

aid station. He was then evacuated by litter 5 miles to Myitkyina where a laparotomy was

performed. Classified as WIA, U.S. evacuation type. This casualty might have been

avoided if he had used better judgement.

Case 139.-Severe perforating wound of the thorax. This man was on defensive action

and at 2300 hours stood up in his foxhole. A guard who was located 5 yards in front of him

mistook him for a Japanese and shot him with his Ml rifle. Classified as KIA. This

casualty could have been avoided.

On 23 May 1944, while holding a roadblock near Charparte, the Orange Combat Team

had several five-man outposts. Case 140 was in an outpost 400 yards from the perimeter

and had been informed that the Japanese would be through the area during the day. The

outpost was in a well-protected position and was armed with one Browning automatic rifle

and four M1 rifles. Case 140 saw a man approaching the outpost and instead of waiting for

positive identification went to meet him. The American soldier was mortally wounded

before the Japanese soldier was killed.

Case 140.-Severe perforating wounds of the thorax. This man was hit by a .25 caliber

rifle bullet at a 50-yard range. This casualty was carried 400 yards to an aid station where

he was given plasma. No litter planes were available so the man could not be evacuated.
APPENDIX C 805

He died 14 hours later. Classified as DOW, with a 14-hour survival time. This casualty

could have been avoided.

During the night of 23 May, the 3d Battalion continued to hold the Mogaung-Myitkyina

Road as it passed through the village of Charparte. It was the feeling of the majority of the

officers that the perimeter was too large and that the defensive plan was poor. The Charparte

region was quite flat and most of the area occupied open terrain. Early in the evening, 20

Chinese had passed a 5-man American outpost 400 yards west of the perimeter and had continued through the U.S. lines. The night was very dark and it was raining and at 2300 hours

a company of Japanese passed by the outpost before the Americans realized what was happening. The outpost did not have any communication with the perimeter, and the men left

the outpost and started back toward the perimeter by way of the jungle. The Japanese were

first to reach the perimeter, and since they were mistaken for Chinese approximately 30

enemy troops entered the area before they were challenged. The remainder of the enemy

deployed about the area. During the fight which followed, the 3d Battalion sustained five

KIA and five WIA casualties. It was estimated that the Japanese had approximately 50

casualties with 15 dead. Hand grenade fragments killed two Americans and wounded two

others. One man had a bayonet wound, and the rest of the casualties were due to small arms

fire.

Case 141.-Multiple penetrating and perforating wounds of the anterior surface of the

thorax and abdomen. In addition, there were numerous bayonet wounds inflicted after

death. This man was a member of the outpost attempting to reach the perimeter when he

ran into the midst of a group of Japanese. An enemy hand grenade exploded a few inches

from the center of his chest. Classified as KIA.

Case 142.-This man was killed under circumstances similar to those of Case 141.

Case 143.-Multiple penetrating wounds of the head and thorax. This man was on

defensive action in a prone position in a foxhole when he was struck by fragments from an

enemy hand grenade. Classified as WIA, first echelon type.

Case 144.-Multiple penetrating wounds of the thorax. This man was wounded under

circumstances similar to those of Case 143. Classified as WIA, second echelon type.

Case 145.-Severe penetrating wound of the right forearm and a compound comminuted

fracture of the radius. This man was in defensive action in a prone position in a foxhole

when he was struck by an enemy rifle bullet at a 10-yard range. Classified as WIA, second

echelon type.

Case 146.-Multiple penetrating wounds of the thorax, the right upper extremity, and

the left buttock. This man was on defensive action and was a member of a machinegun

section which had become disorganized. In attempting to find the company command post,

he walked into the center of a group of Japanese. He did not have any weapon and was

bayoneted by the enemy. Classified as WIA, second echelon type. This casualty could

have been avoided.

Case 147.-Severe perforating wound of the neck. This man, on defensive action in a

prone position under a shelter half, became excited and attempted to crawl away. He was

shot by another American with an M1 rifle. Classified as KIA. This casualty could have

been avoided. This man's companion continued to stay under the shelter and killed several

Japanese with his pistol.

Case 148.-Severe perforating wound of the left side of the thorax. This man, while on

defensive action, had taken cover under a shelter half without the protection of a foxhole.

He left the shelter half and was in a standing position calling over the radio when he was

struck by an enemy rifle bullet at a close range. Classified as KIA. This casualty could

have been avoided.

Case 149.-Severe perforating wound of the thorax. This man was in a prone position

in a foxhole but assumed a kneeling position in order to use the telephone. He was killed

instantly by an enemy rifle bullet at a 20-yard range. This casualty could have been avoided.
806 WOUND BALLISTICS

Case 150.-Moderately severe penetrating wound of the abdomen. This man had left

the protection of his foxhole in an attempt to aid Case 148. He was struck by an enemy

rifle bullet at a 25-yard range. Classified as WIA, second echelon type. This casualty could

have been avoided.

On 24 May, the 3d Battalion formed a perimeter across the Myitkyina railroad. Numerous night skirmishes took place with the Japanese. Two days later, a 10-man American

patrol, armed with 4 Browning automatic rifles, 1 Thompson submachinegun, and 5 MI

rifles encountered 45 Japanese armed with 4 light machineguns and I knee mortar. Twenty

Japanese were killed and a large number were wounded. There were no American casualties.

On 26 May, Case 151 was told to lead a patrol to the east beyond the advance outpost.

He was aware that Japanese troops were in the area but advanced alone to the designated

spot and was wounded by an enemy hand grenade.

Case 151.-Multiple penetrating wounds of the face, thorax, and abdomen. All the

wounds seemed to involve soft tissue only. This man had advanced 100 yards from the outpost when he was struck by fragments from a Japanese hand grenade which exploded a few

feet in front of him. Classified as WIA, second echelon type. This casualty might have

been avoided if he had taken advantage of protective cover. In addition, it was felt that

this was an unnecessary patrol.

In the period from 18 to 26 May, there were approximately 541 American troops and

276 Japanese troops involved in the fighting. The Americans sustained a total of 15 casualties (5 KIA, 1 DOW, and 9 WIA). The Japanese sustained approximately 83 casualties.
APPENDIX D

Principal and Associated Wounds

A summary of the battle casualty deaths listed as to the site of the principal wound has

already been presented in Chapter VII (p. 499). Considerable more information is available

for each case relating to the region of the principal wound and the presence of associated

wounds in other body regions. These detailed data are presented in tables 1 and 2.

TABLE 1-Distribution of associated wounds as related to the region of the principal wound in

Fifth U.S. Army hospital battle casualty deaths

Region of associated wound 4 o Pi -o

z 0- C E~S w z ESu r tt- -1i E,

Head:

Eye or orbit --------------.--- 22 -------- ------ ------------- ---- ------ ------------------ 25

Intracranial:

Known --------------- 2 ---- 6 2 ------ 39 7 1 2 1 ------------------------ 60

Suspected ------------- 6 __- 2 6 3 10 2 ---------- ---- 1 4 1 23

Scalp only ---------------- 7 --- 2 5 5 1 3 2 1 1 ------ ------ 27

Face and jaws:

Bone and soft tissue ------ 4 35 3 5 1 13 1 -- 1 2 ------------------------ 65

Eye or orbit -------------- 2 11 2 4 3 12 5 ------ -------- 1 5 ------------ 45

Soft tissue only ---------- 15 25 3 14 10 27 9 3 1 4 2 ..... 1 114

Neck:

General (excludingspinal)_ 9 17 12 14 4 23 ------ 1 21 ---------- 3------ ------ 104

With carotid artery involved ---------------------------- 1 1--------- ---- ---- ------ ------ ------ ------ 2

With larynx or trachea

involved ------------------- 2 1 ---------- 2 2 - 1 1 -------------------- 9

Spinal cord or intravertebral

nerves ---------------------- 26 2 19 22 ------ 10 5 1 ------------------------------- 85

Chest:

Chest wall only --------- 41 11 ---------- 8 15 1 1 4 1 1 1 1 1 86

Combined intra-abdominal and intrathoraic - 2 ---------- 1 4 ------ ------ ---- ------------------- 8

Intrathoracir, known ----- 6 24 214---- 2 32 1 - -7 ------ ------ ------------ 94

Thoraeoabdominal --- - 1 1 I 2 ----------------------------------------- 5

Abdomen:

Abdominal wall only --------- 11-- 8 15 19 ------ 6 1 ---- 3 ------ 1 64

Combined intra-abdominal and intrathoracie -------- 1 ------ ---- ------------------------------------------------- I 2

Intra-abdominal:

Known --------------------- 5 1 2 12 ----------------------------------------- 20

Suspected -------------------------- 4 2 22 -------------------------- 1 1 30

Thoracoabdominal ------------ ---------------- 2--------- ---- ---- ------ ------------------ 2

Upper extremity:

Soft tissue only ----------- 63 52 29 28 17 32 14 6 6 4 ------ 3 .... . 2 256

Soft tissue and artery ---- 2 1 1 1 --- ------- --------------------------------- 5

Soft tissue and artery and

bone -------------------- 3 1 - 1 2 4 ------------------------------------ 11

Soft tissue and artery and

bone and nerve --------- - ..............------.... 1-....------.---------- -- 1

Soft tissue and artery and

nerve ---------------- ---- 1 ---------------------------------------------------------- 2

Soft tissue and bone ------ 34 24 31 33 18 27 11 3 4 4 ----------------------- 189

Soft tissue and bone and

nerve ------------------- 1 1 1 1 2 1 1 -------- ----------------------- 8

Soft tissue an d n erve ------ 1 ---- 1 1 ..... ...... .......... ...... ...... .... . 3

Traumatic amputation --- - - I 1 2 .--- 2 10 1 ---- -1 .............. ..... 17

See footnotes at end of table. 807
808 WOUND BALLISTICS

TABLE 1.-Distribution of associated wounds as related to the region of the principal wound in

Fifth U.S. Army hospital battle casualty deaths-Continued

Region of associated wound at,. r,

.loCC_ C,-ý .ncx0 B-' O -', co _ _- ar,~ & C t. C

Lower extremity:

Soft tissue only ---------- 135 37 43 26 39 253----- 3 3 2 1 1 1 316

Soft tissue and artery --. 6 1 ------.---- 1 1------------------------------------ 12

Soft tissue and artery and

bone ----------------- 2 2 3 3 ------ 3------------------------------------------ 13

Soft tissue and artery and

bone and nerve ------------------------------- 1 1------------------------------------ 2

Soft tissue and artery and

n e r v e . . . . . . . . . . . . . . . . . . . . ---.. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Soft tissue and bone ...... 55 21 13 11 1 28 9 3 ---- ----- 3------ I-------- 145

Soft tissue and bone and

nerve ------------------ 3 ---- ------ ---- 2 ------------------------------------------ 6

Soft tissue and nerve - 2 ---- ----- --------- 2------ ---------------------------- 5

Traumatic amputation __ 5 1 1 2 10 2 ------------------------------- 22

Arteries injured (excludinrro

traumatic amputations):

Axillary ---------------- 1- I ---- ------ 1 ------------------------- -1 ----- 1------- 4

Brachial --------------- 4 3 2 1 ------- 1 2------------------------------------ 13

Femoral --------------- 7 1- 1 6 4 ------ 9------- ------------------------ 28

Intra-abdominal --------- 25 4 ----.------ ----------------------------------------- 32

Intrasranial 1----- 28------ ---- ------ 2----------------------------------------- 30

Intrathoracei------------- ---- ---- 31 7 1------ I----- ------------------- ------ ------ ------ g9

M\tultiple --------------- 1 2 1 --- ------ ------ -------- ------------------------

Others ---------- -------------------------------- ---1 3 ------------ ------ ------ 4

Popliteal ------------- ---- ---- ------ 1 5 2 ------ ------- ------ ------ ------ ------ 8

Radial or ulnar ------------------ ------ ------ 1 2 ------ -- ---- 1 ------ ------ ------ 4

Subclavian ------------ ------------------------------------- 3 ------ ------ ------ 3

Tibial or peroneal --------- 1 1 2 2 8 1 2 3 ------------------------------- 20

Nerves injured (excluding

traumatic amputations):

Brachial plexus ------------------ ---- 2 ------------ 2 3 ------.------ ------ ------ 8

Femoral ----------- ------------------------------------ 2 -------------------------------- 2

Median --------------- - 1 ------ ---------------- I ------ ------ ------ ------ 4

ultiple -------------- ---- ---- ---------- 2 1 1------ ---- 2 ------------------ ------ 6

Other nerve1 - - - - - - - - 1----------------- ---- I - - -- 2 - - - ------ 4

Othier plexus ----------- I---- 1 ---- 1 ----- ------ ------ ------ ---- ---- ------ ------ ------ ------ 2

Peroneal ----------------- --- ---- ------ ------ 1-------------------------------------- 2

Radial ----------------- 2 1------ ---------------- 2---------- 1 1 ------------------ 7

Sciatic ------------------- 6.----- ------ ---- 3 1 2.------.---- -- ------.------.------ ------ 10

Tibial -------------------------- 1 2 1 1 ---- ---- ------------ ------ ------ 6

Ulnar ---------------------- 1 I 1 1 3 1 ------ --------------- ------------------ 8

Unclassified ---------- - - - -----.---------------------------- .------- -- ------- - -1 - - 1

1 Artery or venous sinus.

2 Extracranial or extraspinal.

No.TE-KCy for abbreviation.

Abd (intra-abdominal) LE,S (lower extremity, soft tissue only)

Cran (intracranial) Spin (intravertebral)

TbAbd (thoracoabdominal) Cerv (cervical)

Thor (intrathoracic) UTE,B (upper extremity, with bone involvement)

LE,B (lower extremity, with bone involvement) AsaxF (maxillofacial, with bone involvement)

Un-MW (unclassified, multiple wounds) UE,S (upper extremity, soft tissue only)

CoA&T (combined intra-abdominal and intrathoracic) AbdW (abdominal wall)

Figures in parentheses are number of eases in each group.
APPENDIX D 809

TABLE 2.-Regional distribution of principal and associated wounds, showing the number of

cases exhibiting each I in Fifth U.S. Army hospital battle casualty deaths

Principal Associated

Region of associated wound wound wunds Total

evident 2

Head:

Eye or orbit ------------------------------------------------------------------ 25 25

Intracranial, known ------------------------------------------------------- 297 60 357

Scalp (without known intracranial wound) ---------------------------------.------------ 27 27

Total ----------------------------------------------------------------------- 297 112 409

Face and jaws:

Bone and soft tissue ------------------------------------------------------- 8 65 73

Eye or orbit ---------------------------------------------------------------------------- 45 45

Soft tissue only -------------------------------------------------------------------------- 114 114

Total ----------------------------------------------------------------------- 8 224 232

Neck:

General (excluding spinal) --------------------------------------------------- 12 104 116

With carotid artery involved ------------------------------------------------- 7 2 9

With larynx or trachea involved --------------------------------------------- 6 9 15

Total ----------------------------------------------------------------------- 25 115 140

Spinal cord or intravertebral nerves ----------------------------------------------- 27 85 112

Chest:

Chest wall only --------------------------------------------------------------------------- 86 86

Combined intra-abdominal and intrathoracie -------------------------------- 18 8 26

Intrathoracic, known --------------------------------------------------------- 138 94 232

Thoracoabdominal ------------------------------------------------------------ 121 5 126

Total ----------------------------------------------------------------------- 277 193 470

Abdomen:

Abdominal wall only ---------------------------------------------------------- 3 64 67

Combined intra-abdominal and intrathoracic -------------------------------- 41 2 43

Intra-abdominal, known ------------------------------------------------------ 408 20 428

Thoracoabdominal ------------------------------------------------------------ 91 2 93

Total ----------------------------------------------------------------------- 543 88 631

Upper extremity:

Soft tissue only --------------------------------------------------------------- 3 256 259

Soft tissue and artery --------------------------------------------------------------------- 5 5

Soft tissue and artery and bone ---------------------------------------------------- 11 11

Soft tissue and artery and bone and nerve ----------------------------------- 1 1 2

Soft tissue and artery and nerve ---------------------------------------------- 1 2 3

Soft tissue and bone ---------------------------------------------------------- 6 189 195

Soft tissue and bone and nerve ------------------------------------------------ 1 8 9

Soft tissue and nerve ---------------------------------------------------------------------- 3 3

Traumatic amputation ------------------------------------------------------- 2 17 19

Total ------------------------------------------------------------ 14 492 506

See footnotes at end of table.

6032251-62-53
810 WOUND BALLISTICS

TABLE 2.-Regional distribution of principal and associated wounds, showing the number of

cases exhibiting each Iin Fifth U.S. Army hospital battle casuolty deaths-Continued

Principal Associated

Region of associated wound wound wounds Total

evident 2

tower extremity:

Soft tissue only ----------------------------------------------------------- 17 316 3833

Soft tissue and artery------------------------------------------------------ 12 12 24

Soft tissue and artery and bone--------------------------------------------- 14 13 27

Soft tissue and artery and bone and nerve ------------------------------------ 3 2 5

Soft tissue and artery and nerve -------------------------------------- I------------1 1

Soft tissue and bone------------------------------------------------------- 153 145 198

Soft tissue and bone and nerve ---------------------------------------------- 1 6 7

Soft tissue and nerve------------------------------------------------------- 1 1 6

Traumnatic amputation---------------------------------------------------- 43 22 65

Total ----------------------------------------------------------------- 145 121 666

Arteries injured (excluding those in traumatic amputations):

Axillary. --------------------------------------------------------------- ------------ 4 4

Brachiialt--------------------------------------------------------------- ------------ 13 13

Femoral ---------------------------------------------------------------- ------------ 28 28

Innsa-abdominal--------------------------- ------------------------------ ------------ 32 32

Intracranial (artery or venous sinus) --------------------------------------- ------------ 30 30

Intratboracic------------------------------------------------------------ ------------ 9 9

Mulutiple --------------------------------------------------------------- ------------ L15 15

Others------------------------------------------------------------------ ------------ 4 4

Popliteal---------------------------------------------------------------- ------------ 85 

Radial or ulnar ----------------------------------------------------------------------- 4 4

Subelavian-------------------------------------------------------------- ------------ 3 3

Tibial or peroneal-------------------------------------------------------- ------------ 20 20

Total ---------------------------------------------------------------- ------------ 155 155

Nerves injured (excludiug those in traumatic amputatiosn):

Brachiat plexus---------------------------------------------------------- ------------ 8 8

Femoral ---------------------------------------------------------------- ------------ 2 2

Median----------------------------------------------------------------- ------------ 4 4

Multiple---------------------------------------------------------------- ------------ 16 16

Other nerve (extracranial or extraspinal) ------------------------------------ ------------ 4 4

Other plexus------------------------------------------------------------- ----------- 2 2

Peroneal---------------------------------------------------------------- ------------ 2 2

Radial----------------------------------------------------------------------- ------------ 77

Sciatic ----------------------------------------------------------------- ------------ 10 10

Tibial------------------------------------------------------------------ ------------ 6 6

Ulnar------------------------------------------------------------------- ------------ 8 8

Ulnclassified ------------------------------------------------------------- ------------ 1 1

Total ---- ------------------------------------------------------------ ------------ 154 14

Unclassified (as to principal wound):

Multiple wounds (included among associated wounds listed)------------------- 114 ------ 114

Grand total ----------------------------------------------------------- 1,410 2,019 3.489

I Not the total number of wounds present.

2 A total of 126 associated wounds were suspected as follows: Intracranial, 31; ifftrathoracic, 61, and intra-abdomin al, 30.
APPENDIX E

Combined Wound Groups

A detailed classification of three of the wound classes (intrathoracic, thoracoabdominal,

and combined intra-abdominal and intrathoracic wounds) with emphasis upon the relative

importance of abdominal and thoracic components when both are present is presented in

table 1. A summarized listing of this information has already been presented in chapter

VII (p. 502).

TABLE 1.-Classification of cases with principal wounds of chest to show hemothorax and

relative importance of abdominal and thoracic components when both are present

[Data are based on severity of internal injury and surgical approach]

Abdominal and thoracic components Abdomen Chest Total

Combined intra-abdominal and intrathoracie:

Bilateral ---------------------------------------------------------------------- 1 0 6 16

Left ---------------------------------------------------------------------- 15 4 19

Right ------------------------------------------------------------------------- 16 8 24

Total ------------------------------------------------------------ 41 18 59

Intrathoracic:

Bilateral -------------------------------------------------------- ------------ 26 26

Left ------------------------------------------------------------------------ 43 43

Right ----------------------------------------------------------------------- 65 65

Unclassified ........... 4 4

Total ----------------------------------------------------------------------------------- 5 38 138

Thoracoabdominal:

Bilateral ------------------------------------------------------------ 3 4 7

Left --------------------------------------------------------------------------- 41 67 10l

Right ------------------------------------------------------------- 45 50 95

Unclassified --------------------------------------------------------- 2 2

Total ------------------------------------------------------------ 91 121 212

Grand total ------------------------------------------------------- 132 277 409

NoTE.-Data from study of Fifth U.S. Army hospital battle casualty deaths.

811
APPENDIX F

Detailed Observations on Wound Groups

The tables (1 through 15) in this section are largely self-explanatory.1 Primary operations, subsidiary operations, operating time, secondary operations, and anesthesia for

primary surgery are presented in the order named (tables 1, 2, 3, 4, and 5). The recorded

information relative to oxygen therapy is presented in table 6. There was no record of

oxygen therapy in 886 of the 1,450 deaths. It is most probable that oxygen was given at

times without making an entry on the patient's record. It is known, however, that oxygen

therapy was indicated at times when it was not given. The cases listed in the column

devoted to oxygen therapy during operation are, with few exceptions, those to which oxygen

was administered as a part of the anesthetic mixture.

Chemotherapy, plasma and blood therapy, recorded blood pressure, evidence of shock,

urinary output, and other miscellaneous observations as related to the principal wound are

shown in tables 7 through 13.

Table 14 shows that 945 of the deaths studied occurred in evacuation hospitals and 505

in field hospitals. In the group of 65 cases that were seen in a field hospital and transferred

to an evacuation hospital for surgery, those with intracranial wounds (32 cases) head the

list. The policy of transferring nearly all with intracranial wounds to an evacuation hospital

for surgery accounts for this figure, and it is fair to assume that few if any of these would

have survived had they been held in the field hospitals. The same is not true of the 10

TABLE 1.-Primary operations as related to principal wounds

AbDe- domi- Total

Ampu- Crani- bride- Lami- Lapa- Thora- Tbora- nal stab priPrincipal wound tation otomy ment nec- rotomy colapa- cotomy incision Others mary

only tomy rotomy without opera- lapa- tions rotomy

Intracranial --------------------- 3 10 20 ----- 5 .--------.--------.-------- 2 131

Intravertebral -------------------------------- 5 12 --------------------------------------- 17

Maxillofacial ---------------------------------.-------.-------- -------- --------.-------- 2 7

Cervical -----------------------.-------- 1 11 -------------------------------------- 6 18

Intrathoracie --------------------- 2 1 40 4 2 ....... 33 ....... 1 83

Thoracoabdominal ----------------. 5 ---- 6 --------. 100 12 109 18 -------- 250

Combined intra-abdominal and

intrathoracic --------------------- ----- 8 1 1 42 -------- 7 -------- 1 60

Intra-abdominal ----------------- 11 -------- 5 3 327 1 ------------------------ 347

Abdominal wall only --------------------------- 1 2 -------------------------------- 3

Upper extremity:

S o ft tissu e o n ly .... . .. . . .. .. . ... .. ... . . . . .. .. . .. . . ... . .. .. . .. . .. . .. . . ... .. .. .. . . . .. .. . . . .. . . . . ..

Bone and soft tissue ----- -------- 2 . 5 .--------------.--------.--------.---------------- 7

Lower extremity:

Soft tissue only -------------- 5 16 -------- 2 ------------------------------- 23

Bone and soft tissue --------- 40 -------- 36 --- 1---.--------.--------.-------- 1 78

Unclassified multiple ------------- 8 5 25 3 8 1 2 1 2 55

Total --------------------- 84 108 176 23 489 14 151 19 15 1,079

I General observations on wound groups in the 1,450 Fifth U.S. Army hospital battle casualty deaths have been

presented in chapter VII (p. 485).

813
814 WOUND BALLISTICS

00000r0t0C0)00001 ''00 00- .mo -c -;0000

000000

0'0.

0000 0

o.. -0000-. -..- , 00 .00

I ''

T 00

sI 00 -'[ '

o 0.0 00

0000

'0.

00 >' '

00 00

00 '00 ''-.0000 00",0 - ___ 00 00o 00 00o1

00

00 I - - - - - ___

00 '''''''00'

))00

___ ____

00 00,000 ''00

00 ...010)00 00 C ' '000000 ' , '00

00 ______ 1 ___ ______

00>' I - 0000 00000>0-

00 0000

00 I 00 000 -

-0)Ž0)

II "00 ' ' ' ' __ 00 , 000

00 ' ' ' ' 00 ' ' ''

00 '

0000 -, 0000 0000 - 00 00.000 [ -

00 - ' ' - 00

'

00'-v00

00 - __________ _____________

00 - 0000 000 00. I-0

. 00 000.

Oo 0000 00 0000

00 00

I ________ ____

0000

c!i

00

H a '00''>'

.00 ''00 >'' o"00

I ,:00**00 0)000-00 0000>'0000 00 

0 )

o0 0 0 00 0 ) 00

00.0)0)00

'o '0)00)000)0)00.00 I 00.0000 00'.00 000000000) 00'000000 000000 '00000 '000000000)0<000)00 '.00000)0000 0)00000000000000000

.00

''

I 
APPENDIX F 815

cases with unclassified multiple wounds and the 8 cases with intrathoracic wounds in this

group. Many of these might have survived had they been held for surgery in the field

hospital. These two principal wound groups are the ones in which the transportability of

the battle casualty is apt to be overestimated.

Table 15 on post mortem examinations shows that there were 675 cases in which there

was no record of autopsy. It is known that a number of autopsies were done that were not

reported. However, many more should have been done, and in many instances would

have been done, had the pressure of work with living battle casualties not been so great.

It was demonstrated time and again that every surgeon should do or witness the post morteml

examination on all of his patients that die. His judgment and ability in the problems of

war surgery, particularly, develop much more rapidly and to a far greater degree when this

is done routinely. Microscopic examinations of tissues from all the important organs is

likewise most valuable. Excellent reports from the 2d Medical Laboratory and the 15tb

General Medical Laboratory constitute a part of the record of many of the deaths studied.

The high incidence of fat embolism was not appreciated until Colonel Mallory advised of

its incidence in the microscopic sections of tissues from battle casualty deaths. Microscopic

examination of tissues in those dying with pigment nephropathies has been quite valuable.

Gross and microscopic autopsy studies should be required on all battle casualty deaths.

Their educational byproducts contribute to the effectiveness of an army.

TABLE 3.-Operating time (in minutes) for primary surgery as related to principal wounds

Less More No

Principal wound than 30-59 60-89 10-119 120-149 150-179 180-209 210-239 240-299 300-360 than record 30 360

Intracranial ------------------ 2 3 8 7 8 5 5 . . 1 1 2 87

Intravertebral ---------------- 1 -------.------------------ 2-------------------------------------------- 15

Maxillofarial --------------------------------------------- 1 1 1 ------- 44---------------------- 

Cervical --------------------- 1 --------------- 1 1 ------- ------- -------- 2--------------- 13

Intrathoracic ----------------.-------- 4 2 2 4 3 ------- 1 ...... 1 1 63

Thoracoabdominal ----------- 1 2 8 6 11 8 5 4 3 5 1 131

Combined intra-abdominal

and intrathoraic ------------------------- 1 ------- 1 2 4 1 1 1 36

Intra-abdominal -------------- 4 4 6 9 16 17 19 8 6 1--------247

Abdominal wall only --------.-------.-------.-------.-------.-------.-------.-------.-------.-------------------- 3

Upper extremity:

S o ft t is s u e o n ly . . . . . . . . . ... . . . .. ... .. . . . .. . . . . .. .. . . . . . ... . . . . ... .. . . . .. .. . . . ... . . . . . .... . . .. . .. . . . . . ... . . . . . .. . . . . . .

Bone and soft tissue ----- ------- ------- 1--------------------------------------------------6 6-------- 

Lower extremity:

Soft tissue only ----------.------- 1 3 ------------------------------------------------- 18

Bone and soft tissue -----.------- 4 6 3 2 2 2 ------- -------.-------.-------- 5

Unclassified multiple -------- 2 1 2 4 2 3 1 ------- ------- --- 2 35

Total ------------------- 11 19 33 36 48 41 37 14 13 11 4 717
81(5 WOUND BALLISTICS

SIIOTIOd)BO I,

OlOIJI .10 pJ111J1

oinsop ae

S puO ooS :1

-sduaop IBUOH

I Smlolsoloa

JO ;'tuTUao(

Amol

SJo liopstil

- ý i np poS0I(

39~l~up3J(d

0Q I I': I ______

uollvlnpuaoiV

uI~n1)OllJI __________

0 osu 1;

WO3iuaopTqOU

V~ _ 5__ 

0 7 C 4 SC

______________f _______ _______- ____ ___
, APPENDIX F 817

i

SE I I I

• •

- Cl Cl : C C

S~ O I Cl il l gll l~ lll C :C 

0. _ _ zo . .. o. .. . I I ___ ___ =_ oo __

• :, oC-l• *-C C

60325v V6 -- 5
818 WOUND BALLISTICS

TABLE 6.-Oxygen therapy as related to principal wound

Oxygen Oxygen Oxygen No record Principal wound before during after of oxygen

operation operation operation

Intracranial -------------------------------------------------- 25 21 20 240

Intravertebral - -------------------------------------------------- 4 2 3 18

Maxillofacial ------------------------------------------------------------ 2 6

Cervical -------------------------------------------------------------- 8 8 2 13

Intratboracie ------------------------------------------------------ 22 35 24 74

Thoracoabdominal ------------------------------------------------- 18 99 39 90

Combined intra-abdominal and intrathoracic ------------------------- 12 24 9 24

Intra-abdominal ----------------------------------------------------- 26 131 63 227

Abdominal wall only ------------------------------------------------------ 1 1

Upper extremity:

Soft tissue only ------------------------------------------------------------------------ 8

Bone and soft tissue --------------------------------------------- ------------ 1 1 -

Lower extremity:

Soft tissue only ------------------------------------------------- 1 5 7 21

Bone and soft tissue -------------------------------------------- 6 21 21 72

Unclassified multiple ----------------------------------------------- 13 13 4 88

Total -------.-------------------------------------------------- 136 363 194 886

TABLE 7.-Chemotherapy (bacteriostatic drugs 1 and soda) as related to principal wound

Penicillin Sulfona- Penicillin Soda2 No soda No record

Principal wound alone mide alone and sulfon- given reported of ehem- amide otberapy

Intracranial --------------------------------- 50 37 23 17 48 187

Intravertebral ------------------------------ 8 4 4 2 8 11

Maxillofacial ------------------------------- 2 1 ------------------------ 1 5

Cervical ------------------------------------ 5 3 1 4 16

Intratboracic ------------------------------- 12 21 19 3 38 86

Thoracoabdominal -------------------------- 37 58 30 7 85 87

Combined intra-abdominal intrathoracie ---- 13 15 5 4 19 26

Intra-abdominal ---------------------------- 47 127 71 10 191 168

Abdominal wall only ------------------------- ------- - -I------------- ------------ 1 2

Upper extremity:

Soft tissue only ----------------------- 1- -------------------- -------- 1 3

Bone and soft tissue ---------------------- 1 5 ------ 1 4 4

Lower extremity:

Soft tissue only ------------------------- 4 13 3 4 14 11

Bone and soft tissue -------------------- 12 35 14 7 45 58

Unclassified multiple ----------------------- 13 15 9 3 23 77

Total -------------------------------- 205 335 179 59 481 781

1 Excluding sulfanilamide applied to wounds at time of first aid dressing.

2 Including 26 cases in which soda was given without a sulfonamide as an adjuvant to blood transfusion therapy.
APPENDIX F 819

TABLE 8.-Intravenous plasma therapy as related to principal wound

Units of plasma (one unit is 250 cc.)

Principal wound

10 1 2 3 4 5 6 7 8 9 10 11 or

more_

Before admission to hospital

I n t r a c r a n i a l - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 5 5 4 0 1 9 1 4 2 3 2 1 . . . . . . .. .. . . .. . . . .

Intravertebral -------------------------- 10 7 4 4 1 ------.------.------.-------- 1-- ---. 

Maxillofaeial ---------------------------- 5 1 2 ...................................................

Cervical ------------------------------- 13 3 4 2 1 1 ------.-------- -- 1 ---- ------

Intrathoracic --------------------------- 7 12 34 13 9 3 6 3 ------ 1

Tboracoabdominal ---------------------- 65 32 40 34 25 8 3 2 2 1 ............

Combined intra-abdominal and intrathoracic ------------------------------ 1 11 10 8 5 3 2 ------------------------ 2 1

Intra-abdominal ----------------------- 148 43 96 40 34 21 15 5 3 1 1 3 1

Abdominal wall only -------------------...-- 3 ........... ---...... .........................

Upper extremity:

Soft tissue only --------------------- 4 ........... ... .....................

Bone and soft tissue ----------------- 4 1 ------- 1 1 2 ----------------------------- 4 1

Lower extremity:

Soft tissue only --------------------- 18 2 5 3 1 ------ 1 1 .................

Bone and soft tissue ---------------- 36 13 21 16 12 4 4 4 2 1 1 ------

Unclassified, multiple ------------------- 7 19 15 14 3 2 1 ------ 3 ..................

Total cases ----------------------- 60 199 271 154 106 46 35 16 13 5 2 3

After admission to hospital, before surgery

I i

Intracranial ---------------------------- 185 24 43 15 11 8 5 1 1 1 1 5 2

Intravertebral -------------------------- 11 3 8 ------ 1 1 2------------------------- 61

Maxillofacial ---------------------------- 5 ------ 1 1 ------ 1---------------------------------------

Cervical ------------------------------- 20 3 ------ 2 -----------------------------------------------

Intrathoracic --------------------------- 83 13 16 13 7 4 ------.------- --

Thoracoabdominal --------------------- 138 23 26 13 3 4 1 ------ 1 1 1------

Combined intra-abdominal and intrathoracic ------------------------------ 34 6 8 3 4 1 3 ........................... .

Intra-abdominal ----------------------- 248 27 61 33 20 5 6 2 2 2 -... 7 2

Abdominal wall only -------------------- 2 ------.------- ------------------------------------ ------ -----

Upper extremity:

Soft tissue only --------------------- 2 1------------------------------- 1------------------------

Bone and soft tissue ---------------- 7 1 ------ ------ ------.------- 1.------.------ --

Lower extremity:

Soft tissue only --------------------- 20 4 3 1 3 -----------------------------------------

Bone and soft tissue ---------------- 58 14 11 6 6 6 4 2 3 1 1 6 2

Unclassified, multiple------------------- 58 15 18 5 4 5 4 1 1 94

Total cases ----------------------- 871 134 195 93 59 34 26 8 8 6 5 11

See footnotes at end of table.
820 WOUND BALLISTICS

TABLE 8.-Intravenosis plasma therapy as related to principal wound-Continued

Units of plasma (one unit is 250 cc.) Principal wound__________________________ _______

10 1 2 3 4 1 6 7 8 9 10 1lor

more

During surgery

Intracranial ---------------------------- 280 8 6 1 1 1---------------------

Intrax-ertebral -------------------------- 26 ------------ 1------1 --- ------ ------ ------

Maxillofacial ---------------------------- 8 1

Cervical-------------------------------- 22 1--- I---- I--- 1 1 ------ --- ------

Intrathoracic -------------------------- 133 3 1 --- 1 --- ------ ------ ------

Tisoracoabdominal---------------------- 193 4 10 --- 1 1 1 1 1 --- ------

Combined intra-abdominal and intrathoracic ------------------------------ 48 4 2 2 --- 1 1------------ ------ ------ 1

Intra-abdominal ------------------------ 316 8 19 10 6 2 1 ---- 2 1 1 1

Abdominal wall only ------------------ 3------3 --- ------ ------ --- ------ ------

Upper extremity:

Soft tissue only---------------------- 4 - - - - - -- - - - - -- - - - - -- - - - - -- - - - - -- - -

Bone and soft tissue ----------------- 10 - - - - - -- - - - - -- - - - - -- - - - - -- - - - - -- - -

Lower extremity:

Soft tissue only --------------------- 22 2 1 2 4 --- ------ ------ ------

Bone and soft tissue ----------------- 96 3 12 2 1------- ------ ------ --------- 1---

Unclassi fied, multiple------------------- 108 4 2------ ------ ------ ------ ------ ------ ------ ------ 1

Total eases----------------------- 1,309 37 14 16 13 1 4 1 3 2 2 2

After surgery

Intracranial ---------------------------- 271 7 6 1--- I--- 2 1 3 1-------

Intravertebral -------------------------- 25 1 1 --- ------ ------ ------ ------

M axillofacial - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7 -- - - 1 - - - - --- - - - - -- - - - - -- - - - - -- - -

Cervical-------------------------------- 23 2 -- - --- - -- - -- - -- - -- - - --- -- - --- - -- - --

Intratisoracic--------------------------- 127 3 6---------1--------- ------ ------ 1.........

Thoracoabdominal---------------------- 183 11 7 2 3 1 3 1--- I--- 1

Combined intra-abdominal and intrathoracic------------------------------- 46 3 4 2 1 --- 2 1--------------

Intra-abdominal------------------------ 331 16 24 12 12 4 6--------- ------ ------ ------ 31

Abdominal wall only --------------------- 2------- -------- -1 -- ------ ---------- ------

Upper extremity:

Soft tissue only---------------------- 4 - - - - - -- - - - - -- - - - - -- - - - - -- - - - - -- - -

Bone and soft tissue---------------- 9 -- - - I -- - - - -- - - - - -- - - - - --- - - - -- - -

Lower extremity:

Soft tissue only --------------------- 23 1 2------------ 1--- 1-------- ------ ------

Bone and soft tissue ----------------- 93 2 7 4 3 1 1 1 1 1

Unclassified, multiple------------------- 103 3 6 1----- 1 ------ ------ 1 1 --- 2 ---

Total cases----------------------- 1,211 53 61 21 22 6 11 4 7 2 3 1

1 No record of plasma administration, or none giv en. 2 12 units.

3 14 units.

4 11 units.

5 11 units, 17 units.

6 18 units.

7 13 units.

8 12 units, 17 units.

9 13 units, 14 units, 29 units (given over period of 4 days-abdominal wound, severed popliteal artery, multiple frac.

tnres, and clostridial myositis).
APPENDIX F 821

TABLE 9.-Blood transfusion therapy as related to principal wound

Units of blood (one unit is 500 cc.)

Principal wound ________________________________

'0 1 2 3 4 5 6 7 8 9 10 11oc

more

Before surgery

Intracranial -------------------------- 211 37 27 9 6 2 3 1 1 --- ------

Iutravertebral ------------------------ 14 4 5 2 1 1---------------------

M axillofacial -------------------------- 15 1 1 1 ---- ------- ------- ------- ---

Cervical------------------------------ 12 4 3 4 1------ ------ ------ ------ ------ 1 ---

Intratboracie ------------------------- 66 29 18 8 9 6 1 ---- I---1 ------

Thoracoabdominal--------------------- 78 33 39 23 18 6 8 3 1 3-------

Combined intra-abdominal and intrathoracic ---------------------------- 23 9 9 6 5 1 2-------- ------ 1 1 ---

Intra-abdominal ---------------------- 161 16 65 45 41 14 11 5 2 1 3 ---

Abdominal wall only------------------- 2 1 ------- ------- ---- ------- ------- ---

Upper extremity:

Soft tissue only -------------------- 3----------- I------1 --- ------ ------ ------

Bone and soft tissue ---------------- 7 1 1 --- 1 --- ------ ------ ------

Lower extremity:

Soft tissue only-------------------- 22 1 2 3 2 1---------------------

Bone and soft tissue----------------153 16 16 7 10 7 2 2 1 --- ------

Unclassified, multiple------------------ 44 27 15 12 9 3 2--------I-1---- ------ 1

Total eases---------------------- 707 219 201 121 103 41 29 11 7 1 51

During surgery

Intracranial -------------------------- 243 20 21 8 2 2 ---- 1---I ------

Intravertebral ------------------------ 21 2 1 2 I--- 1-- ---------- ------

M axillofacial -------------------------- 8 --- ------ ------ ------ ------ ---- --

Cervical------------------------------ 21 1 2 ------------ ------ ------ ------ 1I--- ------

Intratboracie ------------------------ 117 9 7 1 3 ---- 1---I ------ ------

Thoracoabdominal -------------------- 132 15 34 16 5 3 6 1--- I--- ------

Combined intra-abdominal and intrathoracic ---------------------------- 34 8 6 5 2 2 1 1--------------

Intra-abdominal ---------------------- 217 30 13 29 18 6 5 3 1 4 1

Abdominal wall only ------------------ 3 --- ------ ------ ------ ------ ------

Upper extremity:

Soft tissue only -------------------- 4 - -- - --- - - - - --- - - - -- -- -- ---- - - -- - -

Bone and soft tissue---------------- 16 - - -- - - -- -- -- - - ------ - - -- --- - - - --- -

Lower extremity:

Soft tissue only-------------------- 19 4 3 4 1 --- ------ ------ ------

Bone and soft tissue---------------- 72 6 22 6 1 2 3 1 ----------- I------1

Unclassified, multiple------------------ 96 8 1 --- 1 2 --- 2--------------

Total cases --------------------- 1,037 103 114 71 33 16 18 7 4 4 2 1

See footnotes at end of tablc.
822 WOUND BALLISTICS

TABLE 9.-Blood transfusion therapy as related to principal wound-Continued

Princpal oundUnits of blood (one unit is 500 cc.)

19 0 3 2 3 4 5 6 7 8 9 10 1i1o'

After surgery

Intracranisi--------------------------- 267 11 10 2 4 1 1 --- 1 --- ------

botravertebral ------------------------ 23 2 2 --- ------ ------ ------ ------

M axillofqeaci --------------------------- 6 1 15 ------ ------ --- ------ ------

Cervical ----------------------------- 20 4 1--- I --- ------ --- ------ ------

Inytrathoracic ------------------------ 112 13 5 4 3 1---------------------

Thoracoabdomnifal -------------------- 159 26 14 2 2 4 1 --- 2 2-------

Combined intra-abdominal and intrathoracic ---------------------------- 43 5 7 1 3 --- ------ ------ ------

Itura-abdominal ---------------------- 287 48 30 13 10 9 4 1 2 2 1 2 1

Abdominal wall only------------------- 3 --- ------ ------ ------ ------ ------

Upper extremity:

Soft tissue only -------------------- 4 - - - - - -- - - - - -- -- - - -- - - - --- -- - --- - -

Bone and soft tissue---------------- 9 ---- 1 --- -- ---- -- ---- ------ ------

Lower extremity:

Soft tissue only-------------------- 23 3 2 --- 3 --- ------ ------ ------

Bone and soft tissue---------------- 80 11 4 0 3 5 2 2 1 ---- 1---

Unclassified, multiple ------------------ 093 10 7 2 2 --- ------ ------ ------

Total eases --------------------- 1,129 134 83 30 30 20 S 3 6 4 2 1

1 No record of intravenous administration of blood, or none given.

2 12 units.

TABLE 1O.-Lowest recorded systolic blood pressure 1 for cases in shock as related to principal

wound

Arterial tension in mm. Hg

Principal wound

Zero 2-38 40-58 60-78 80-88 06-08

Intracranial ------------------------------------------ 16 ------ 3 8 10 10

Intravertebral ---------------------------------------- 3 ----- 3 1 2 5

Maxillofacial---------------------------------------- ---------- ---------- 1 ---------------

Cervical --------------------------------------------- 4 ------ 2----- 1 3

Intratboracie----------------------------------------- 13 ----- 2 7 10 0

Tlioraeosbdomissal ------------------------------------ 18 1 10 23 12 5

Combined intra-abdomirial and intrathoracic -------------- 11 ------ 4 6 1

Intra-abdominal-------------------------------------- 58 3 19 21 38 16

A bdom inal wrall only -- - - - - - - - - - - -- - - - - -- - - - -- - -- - -- - - - -- - - - - -- -- -- - - - - -

Upper extremity:

Soft tissue only------------------------------------ 2 ------ 1----- ----------

Bone and soft tissue ------------------------------- 3 ----- --------------------

Lower extremity:

Soft tissue only------------------------------------ 3 1----- 2 1 1

Bonie and soft tissue ------------------------------- 14 1 4 12 3 3

Unclassified, multiple --------------------------------- 13 ------ 0 9 6 5

Total cases ------------------------------------- 158 6 57 97 60 58

1Excluding a gradual terminal decline imniediately preceding death.
APPENDIX F 823

TABLE 11.-N~ature of evidence for shock in cases without recorder? hypotenssion as related to

principal wound

Blood Blood

pressure pressu re Presence Shock sus- Therapy No cviPrincipal wound 100 or more, 100 or more, of shock pected by suggests doeue of

but pulse but shock recorded inference shock shock

rapid and recorded

weak I

Intracranial -------------------------------- 10 ------ 30 13 63 122

Intravertebral---------------------------- ------------ ------------ 3 ------ 4 6

Maxillofacial ---------------------------- ------------ ------------ ------------ 1 4 2

Cervical------------------------------------ 1 ------ 3 1 5a

Intrathoracic ------------------------------- 3 ------ 23 24 407

Thoracoabdominal--------------------------- 5 ------ 44 17 72 5

Combined intra-abdominal and intrathoracic ---------------------------------- ------------ ------------ 10 1 10 2

Intra-abdominal----------------------------- 8 2 93 45 119 0

Abdominal wall only ------------------ ------------ ------------ ------------ ------------ ------------ 3

Upper extremity:

Soft tissue only ---------------------- ------------ ------------ ------------ 1-------------

Bone and soft tissue----------------- ------------ ------------ ------------ ------------ 4 3

Lower extremity:

Soft tissue only ----------------------- ------------ ------------ 10 3 4 6

Bone and soft tissue---------------- I------------1 26 11 345

Unclassified, multiple ------------------ I------------1 31 17 20 7

Total--------------------------------- 29 2 273 134 388 176

1 No comment on shock in the case reports.

TABLE 12- Urinary output as related to principal wound

Apparently

Principal wound Output adequate Anuria 1 Oliguria 2 Oliguria No record

adequate but record recorded suspected incomplete

Intracranial--------------------------------- 3 9 2 3 2 278

tutravertebral ----------------------------- ------------ 3 ------ 1 2 21

Maxillofacial-------------------------- ------------ ------------ ------------ ------------ ------------ 8

Cervical------------------------------------ 2 1 ------ I ------- 21

Intrathoracic ------------------------------- 15 2 1 2 ------ 128

Thoracoabdominal--------------------------- 7 6 5 14 7 173

Combined intra-abdominal and intrathoracic ------------------------------------- 2-------------------- 7------------7 50

Intra-abdominal ---------------------------- 12 7 13 32 11 333

Abdominal wcall only ------------------ ------------ ------------ ------------ ------------ ------------ 3

Upper extremity:

Soft tissue only ----------------------------------- ------------ ------------ 1------ 3

Bone and soft tissue--------------------- -I-1---------- ------------ ------------ ------------- 9

Lower extremity:

Soft tissue only--------------------------- 1 1 1 3 1 24

Bone and soft tissue---------------------- 3 3--------------- 9--g---------- 9

Unclassified, multiple ----------------- II------------1 4 2 106

Total cases---------------------------- 37 33 22 77 21 1,216

1 Less than 100 cc. per diemn.

2 100 to 800 cc. per diemi.
824 WOUND BALLISTICS

TABLE 13.-Miscellaneous observations as related to principal wound

Exposure, Hemor- Peritoneal Tourniquet

Principal wound Burns Coma on severe, rhage, pro- closure used before

present admission before fuse, after impossible admission admission admission

Intracranial -------------------------------- 4 167 4 15 1-----------

Intravertebral ------------------------------ 1 I..............-------------------------------------

M axillofacial -------------------------------- 1 1 ........................... .....................

Cervical ---------------------------------- ------------ 4 ------------ 5 ------------ 1

Intrathoracic ------------------------------- 3 9 1 ------------.------------ 1

Thoracoabdominal ------------------------- 1 2 3 4 1

Combined intra-abdominal and intrathoraic ---------------------------------------------- 3 1 1

Intra-abdominal ---------------------------- 3 8 2 29 3 7

A bdom inal w all only -............ ........................ .............

Upper extremity:

Soft tissue only ------------------------- ------------ 1 ------------...........

Bone and soft tissue -------------------------------- 1 ------------------------------------ 3

Lower extremity:

Soft tissue only -------------------------- 1 1 1 1 ----------- 3

Bone and soft tissue -------------------- 4 4 1 3 ........... 19

Unclassified, multiple ----------------------- 11 16 1 1 ------------ 5

Total cases --------------------------- 28 218 10 58 8 42

TABLE 14.-Data relative to distribution of deaths in field and evacuation hospitals

Principal wound Field Evacuation Transfer 2 Transfer 3

hospital hospital I

Intracranial -------------------------------------------------- 2 272 4 32

Intravertebral -------------------------------------------------------- 2 25 ------------ 5

Maxillofacial --------------------------------------- ------------- - 8 --- - 1

Cervical ------------------------------------------------------- 9 1

Intrathoracic ------------------------------------------------- 54 84 3 8

Thoracoabdominal -------------------------------------------- 113 99 7 2

Combined intra-abdominal and intrathoracic ------------------------ 29 30 1 ------------

Intra-abdominal ---------------------------------------------- 215 193 7 3

Abdominal wall only ------------------------------------------------- 1 2 1 ------------

Upper extremity:

Soft tissue only -------------------------------------------------- 1 3 ........................

Bone and soft tissue ------------------------------------------ 2 8 1 1

Lower extremity:

Soft tissue only ---------------------------------------------- 5 26 2 ------------

Bone and soft tissue ---------------------------------------------- 32 82 2 2

Unclassified, multiple ------------------------------------------- 17 97 2 10

Total cases ----------------------------------------------------- 505 945 30 65

I Including figures in last two columns.

2 Primary surgery done in field hospital, and patient died in evacuation hospital after transfer.

3 Patient seen in field hospital and t-ansferred to evacuation hospital for primary surgery.
APPENDIX F 825

TABLE 15.-Post mortem examinations as related to principal wound

Gross Gross No reported, reported, Gross and

Principal wound autopsy but no mi- micro- microscopic done croscopic scopic not reported

reported

Intracranial -------------------------------------------------- 141 48 10 98

Intravertebral ------------------------------------------------- 1 1 1 12

Maxillofacial -------------------------------------------------- 2 3

Cervical ------------------------------------------------------ 8 9 1 7

Intratboracic ------------------------------------------------- 9 34 2 38

Thoracoabdominal --------------------------------------------- 79 76 13 44

Combined intra-abdominal and intrathoracic ------------------------- 22 1 21

Intra-abdominal ---------------------------------------------- 19 130 14 71

Abdominal wall only -------------------------------------------- 2-------------------

Upper extremity:

Soft tissue only--------------------------------------------- 3 1

Bone and soft tissue ----------------------------------------- 6 2 2

Lower extremity:

Soft tissue only -------------------------------------------- 11 5 5 10

Bone and soft tissue -------------------------------------------- 60 20 10 24

Unclassified, multiple ------------------------------------------- 7 14 4 28

Total cases - ----------------------------------------------- 671 365 61 349
APPENDIX G

Bomb Incident-A Controlled Study

Allan Palmer, M.D.

A bomb, designated as U.S. M41 and described as an antipersonnel fragmentation bomb,

exploded when it was dropped accidentally on the concrete surface of dispersal area No. 3

of AAF (Army Air Force) Station 128 at Deenethorpe, England, on 12 June 1944.' A mission in which aircraft B-17-G No. 42-107210 was to have taken part was cancelled. The

ground crew of the B-17-G ship, together with the ground crew of another ship, were engaged

in unloading the clusters of M41 bombs from the bomb racks. A shackle holding three of

the bombs to one end of the support for a cluster of six was loose or broken, and during the

handing down of the cluster the three bombs fell to the concrete--a distance of approximately

6 feet. One of the bombs exploded, another became armed but did not explode, and the

third remained unarmed.

The official ordnance report of the accident by the ordnance officer of the Eighth Air

Force is extracted as follows:

1. Place of accident: AAF Station 128, 401st Bombardment Group, located near Deenethorpe, England, Grid reference of field 496090.

2. Time of accident: 1535 hours, 12 June 1944.

3. Pombs: One (1) M41 Fragmentation bomb 20 lb in M1Al cluster with AN-Mll0A1, instantaneous fuse.

4. Condition of bombs: Bombs were "safe," being unloaded from aircraft on dispersal site #3.

5. Location of bombs: On dispersal site #3 near buildings of the 614th Bomber Squadron Technical Supply and derelict

farm house.

6. Effects: A. Casualties: Seventeen, of which five were killed and four seriously injured.

B. Damage: The bomb bay wing structure and landing gear of a B-17 #107210 were damaged. The aircraft is to be salvaged.

7. Groap and station to which aircraft belonged: 401st Bomber Squadron Group (H), AAF Station 128.

8. Esents causing accident: While unloading a cluster of 6 M41 bombs, a clasp holding bombs to carrier (adapter)

evidently buckled and broke, releasing three bombs, one of which detonated on striking concrete.

9. Action: The loose bombs and clusters were cleared away, dangerous fuse (in one UXB) removed and destroyed.

All clusters were removed from aircraft.

10. Additional remarks: A. To the best of our knowledge four men of Armament and Ordnance Sections of the 614th

Bomber Squadron 401st Bomber Group (H) were working in each side of the bomb bay, two above and two on the ground

on each side, with a number of other men standing around or helping in various ways. Usually a crew of four will load or

unload a ship, but in this case men who had finished unloading other ships had come over to help finish the job on this one.

Both outboard racks had been unloaded and apparently crews had begun work on the double clustered bombs on the

inboard racks. It was at this time that the explosion occurred, on the left side of the bomb bay. From the information

available, the double clustered bomb on the top station was being removed, although this is not certain. By later comparing lot numbers of bombs and fuses, both loose or partially clustered, it was determined with reasonable certainty from

which cluster the exploded bomb came. There were three intact bombs remaining on the rear of this cluster but, the clasp

attached to the strip designed to hold the three bombs to the adapter had apparently buckled and had broken, evidently

releasing the three bombs which fell to the ground, one of which exploded on impact. The nose portion of the fuse on this

bomb was recovered, proving that the fuse was in an unarmed condition. The adapter was of the type used to repair

bombs in the U.K. and procured here. There were thus two equipment malfunctions, the broken clasp on the adapter and

the AN-Mll0A1 nose fuse, which functioned, even though in "safe" condition.

B. One bomb from a cluster, other than the one mentioned above, fell and became armed and in a dangerous

condition. The striker head and safety collar were missing from the nose of the fuse. The R.A.F. Bomb Disposal Squsd

at Bramnote was notified, but they stated that they were not permitted by the Air Ministry to dispose of U.S. bombs

which had become dangerous during loading or unloading operations, of A/C on the ground. Consequently, the bomb

was later safetied by removing and destroying the fuse.

C. The following precautions will be stressed in an effort to prevent any further accidents with this type of bomb:

During normal inspection of cluster for damage or indications of possible failure, they will be completely prepared for

subsequent loading. The safety pins will be removed from the clasp and replaced with long pieces of arming wire to faciliI One of the primary reasons for reporting this incident is to illustrate the type of investigation which should follow all

accidents involving U.S. weapons. Under these ssmicontrolled circumstances, exact information can be collected in

regard to (1) type of weapon; (2) number of men exposed, posture, duty, equipment and clothing, and distance from

weapon; (3) number of casualties, types and severity of wounds, and extent of hospitalization; (4) recovery of fiagments or

bullets; and (5) documentation with photographs and X-rays. These unfortunate accidents can then be utilized as

biological indicators of the effectiveness of our weapons.--. C. B.

827
828 WOUND BALLISTICS

tate removal after loading. Safety wires are required to be in place during loading. The arming wire will be replaced

with a 500 lb G.P. bomb arming wire or equivalent, and Farbnestock clips attached.

When clusters are to be unloaded, the procedure will be started from the top stations and safety wires inserted in

clasps before removing bombs from racks. Although this has been required procedure, the job has been so difficult,

because of inaccessibility and lack of time, that it is believed it has not been done consistently. However, this accident

is considered attributable primarily to malfunctions resulting from poor equipment designs, rather than the failure to

insert the safety wire. The latter procedure will serve more certainly to prevent breaking of clusters by inadvertent

removal of the arming wire during handling.

D. All casualties were ground force members of the 614th Bomber Squadron 401st Bomber Group (H).

(Signed) JAMES C. DAVID,

Capt., Od. Dept.,

Op. and Sta. Ord. Officer.

SCENE OF THE INCIDENT

Within a 300-foot radius of the point of impact of the bomb that exploded (fig. 1),

there were 24 men, 1 aircraft (B-17-G No. 42-107210), 1 pyramidal tent, 1 technical supply

nissen hut, 1 brick farm building, and 1 bomb-carrying trailer.

" BOMB- IIH , --El -- i L

Or"'r

PMRAMINAL KLENT

0 L

MEN M KNOWN TO BE PRESENT, INJURED AND UNINJURED

MORE THAN 30 FOUR HIGH VELOCITY BOMB FRAGM&ENT HITS

• HIK VELOCITY FRONT END OF THIS T"EcH SUP NISSEN HUT

BOMB FRAMENT

HITS ON EUPOSED SIEO TH!?..

BRICK FARM BLDG QTUW$Y

SCALE I"= 30'O0

WRAMG-4942-A24

FIGURE 1.-Location of men and buildings within a 300-foot radius of the point of impact

of bomb.
APPENDIX G 829

Of the 24 men known to be present within a 300-foot radius (table 1), 6 were located

just less than the full 300-foot range and were uninjured, although one of these, 8, standing

in the doorway of the brick farmhouse, was struck in the right thigh by a bomb fragment.

The missile was reflected against his pocket knife and became buried in the wooden structure of the door. The man furthest from the burst who sustained injury was L, approximately 150 feet away. He was walking in the direction of the aircraft and was knocked

down by a fragment that struck his left elbow and fractured the medial condyle of his left

humerus.

TABLE 1.-Personnel exposed to explosion of a U.S. 20-pound (M41) fragmentation bomb

Distance Personnel from Part of body exposed Protection Classification Disposition

burst

Feet

A ------------- 21 Front ------------ None ------------- Killed ------------ Buried.

B ------------ 25 ----- do --------------- do --------------- do --------------- Do.

C ------------ 5 Front (above burst) - do --------------- do --------------- Do.

D ------------ 8 Front --------------- do --------------- do --------------- Do.

S------------ - 30 Back ---------------- do ------------ Died of wounds ----- Do.

F ------------ 23 Front --------------- do --------------- do --------------- Do.

G ----------- 8 31 ---- do ------------ Partial, by left Severely injured ----- Evacuated to Zone of Inlanding gear. terior after 57 days.

H----------- -- 28 -- do ------------ Head protected by - do ------------ Zone of Interior after 100

chin turret. days.

I-------------32 Back ---------------- None ---------------- ----- do ------------ Returned to duty after 56

days.

J ------------ 31 Front --------------- do --------------- do ------------ Returned to duty after 30

days.

S------------- 36 Left side ----------- Partial, by left ----- do ------------ Returned to duty after 42

landing gear. days.

L ------------ 150 Front ------------ None -------------------- do --------------- Returned to duty after 23

days.

M ----------- 6 Lower limbs (above ----- do --------------- do ------------ Returned to duty after 29

burst). days.

N ------------ 5 Lower limbs (above Partial, by inboard - do ------------ Returned to duty after 10

burst), panel and bomb days.

clusters.

0 ------------ 29 Front --------------- Partial, by casualty - do ------------ Returned to duty after 27

F. days.

P ------------ 23 Front --------------- Partial, by casualty - do ------------ Returned to duty after 35

D. days.

Q------------ 9 Front (above burst). Complete, by in- ----- do --------------- Returned to duty.

board panel and

bomb clusters.

R ----------- 40 Front --------------- Bomb trailer ------- Uninjured ----------- Do.

S ------------ 255 _do .. --------------- Pocket knife ---------- do --------------- Do.

T, U, V, 300 Unknown ----------- None --------------- do --------------- Do.

W, and X.

The remaining 17 men were within a 40-foot radius and all but one (R) were killed or

injured. Four men were killed instantly and two died within 24 hours of the time of injury.

The other casualties sustained injuries of varying severity. The least serious injury was

in a casualty (Q) who suffered a very slight tearing of his left eardrum, resulting in a hemorrhage into the auditory canal. He was not sent to hospital but was examined and taken

care of at the AAF station. This man was standing forward about 9 feet above the burst

in the right bomb bay. He was protected from a direct hit by bomb fragments by the inboard panel still bearing clusters of the M41 bombs.
830 WOUND BALLISTICS

#~ Point of detonation of U41 bomb.

G)One inch hole in center left side of

ring cowl -#4 Nacelle.

LEFTWINGTIP OIN One inch hole in cowl fJlaP #3 Nacelle.

LEFTWINGTIP OIN One inch hole in botton side of ring

cowl 42 NAcelle.

Q One inch hole in bottom side of Fuselage

(3'X 4- rip in leading edge of stabilizer-.

No internal darage.

L. ®DShading indicates area of bomb fraoment

-161 demacre. Numerous holes end fragments - ..-- - throuehout left and right inboard wing

RIGHT WIN TIPls FulOINTdwsgd

0 ~ ~ ~ ~~~WA (Nt-hwnontisfom Potg aph so

FIGURE ~ ~ ~ i ~ oc ~ ~ atedmg ~ ~ 2.Egt ~~dang eo ton tires ano. 42-10721 gaircrft
APPENDIX G 831

AA L i

j -,A

U.S. Army photos

FIGURE 3.-Damaged aircraft. A. Aircraft B-17-G No. 42-107210 of 401st Bomber

Squadron Group (H). B. Bomb fragment holes in wing.
832 WOUND BALLISTICS

FIUa

FIGURE 3--Continued. C. Ramage to bomb bay doors. D. Damage to landing gear.
APPENDIX G 833

The B-17-G aircraft was located with the men grouped about it as shown in figure 1.

Damage to the aircraft is shown in the Eighth Air Force ORS (Operational Research Section) battle damage report (fig. 2) and in figure 3. The category of damage is given as "E"

which, as discussed in USSTAF (U.S. Strategic Air Forces) Regulations No. 80-6, 8 May

1944, refers to an aircraft damaged beyond economical repair, such as in crashlandings.

The pyramidal tent located 150 feet to the west of the burst received no hits by bomb

fragments. The brick farm building (used as a workshop) diagonally 250 to 300 feet to the

southwest was struck by at least 30 high-velocity fragments having a mass estimated to be

from 5 to 10 gin. Pitting of the brick wall of the building to a depth of 1 inch or more served

to indicate which fragmentation marks were the result of high-velocity fragments of the

estimated weight. Most of the fragmentation marks were between 4 and 5 feet above

ground level. Some of the marks seemed to be due to groups of smaller fragments. These

marks were clustered about a larger and deeper mark, the clusters covering an area of 25 or

30 square inches. Two large fragment marks were found approximately 12 feet above

ground level and several at a height of 6 to 7 feet. One fragment made a 4 -inch hole through

"a piece of iron pipe, the walls of which were an eighth of an inch, and came to rest buried in

"a wooden door. The pipe was part of some structural framework on the side of the brick

farm building, and the point at which the building was struck was exactly 252 feet from the

burst, 3 feet above the ground level.

The maximum depth of the bomb crater was 11 inches and was located, as shown in

figure 1, in the concrete dispersal area. The fragmentation pattern was asymmetrical,

indicating that the bomb struck the concrete nose first but with its axis deviating from the

perpendicular. The pattern radiated from the crater toward the nose of the aircraft, through

an arc of 220g. At the center of the are, the pattern extended 6 feet. Maximum extensions

of the pattern, amounting to 10 feet from the crater, occurred at 550 to the right and left of

the center. Here the density of strikes was greatest. At the extremities of the arc, the

pattern extended no more than 3 feet from the crater, with density of strikes very slight.

From these facts, it would appear that the inclination of the bomb axis from the perpendicular was in the direction of the nose of the ship, where the majority of men at work were

congregated. It would appear further that the normal horizontal spray of fragments

occurred to the left and right of the aircraft as indicated by the fragmentation pattern and

the level and distribution of fragmentation marks on the side wall of the brick farm building.

The dispersal of fragments throughout the remaining 1400 of the arc not represented in the

concrete fragmentation pattern appears to have been upward and slightly backward through

the wings of the aircraft. The total area of wing surface hit by bomb fragments was found,

by planimeter measurement on a scale drawing of the aircraft, to be 27 square feet. In this

surface area, there were 180 penetrations or an average of nearly 7 strikes per square foot at

distances varying from 5 to 40 feet from the burst.

It is of interest to note from the configuration of the fragmentation pattern on the

concrete that with the exception of casualty A all the rest of the casualties on the ground

were produced by bomb fragments, the velocity of which may have been considerably

reduced because of the retardation produced by the richochetting of the fragments against

the concrete surface.

The technical supply hut south of the burst (fig. 1) received one through-and-through,

hit on the convexity of the roof structures and three hits on its front about 3 feet above

ground level. The bomb-carrying trailer present at the time of the accident was not available for inspection.
834 WOUND BALLISTICS

DESCRIPTION AND PERFORMANCE OF U.S. 20-POUND

FRAGMENTATION BOMB

Construction

The M41 fragmentation bomb (fig. 4) has a charge-weight ratio of approximately 15

percent. Details of its construction are furnished by Prof. Marston Morse in his statement

communicated to the Wound Ballistic Conference on 27 April 1944. The overall length of

the bomb is 22.2 inches and its diameter about 4 inches. A long rod of square wire 0.44 x 0.44

inch is tightly wrapped about a light cylindrical casing 0.11 inch thick to form the main body

of the bomb. The cylinder is filled with TNT or other explosives. The ends are sealed with

steel plugs. The nose plug contains a cavity for an instantaneous fuse, and the tail plug has

a threaded hole to take the tail fins.

?2,5.5

MIIO ARMS IN 570 TURNS

OR FUNCTIONS INST.

MIIOAI ARMS IN 250 TURNS

"4-

fri TAIL PLUG -1.1I4P

-- FILLER - 2.61F T. N.T.

-BODY-.44 X .44 WIRE-10• STUBE - .109" CYLINDER -2.2:

-- NOSE PLUG - 1.2"'

TOTAL WEIGHT-20P -

WRAMC-4942-A25

FIGURE 4.-U.S. 20-pound (M41) fragmentation bomb.

The bomb is normally clustered into the MIA1 cluster of six bombs (fig. 5). The

following loads, prescribed in USSTAF Ordnance Memorandum No. 3-54, 16 March 1944,

were carried by aircraft in use by the U.S. Air Forces:

Aircraft: Load'

B-17 -------------------------------------------- 38-42

B-24 ---------------------------------------------- 52

B-26 ---------------------------------------------- 30

B-25 --------------------------------------------- 30

In clusters of 6 bombs.

When an M41 bomb falls, 250 revolutions of the propellerlike blade, on the nose of the

bomb, are required before the bomb is armed. This process permits the collarlike safety

block located just ahead of the propeller to fall away, which in turn permits the striker head

to be driven into the fuse upon impact. As stated in the official ordnance report (p. 827) and
APPENDIX G 835

U.S. Army photo

FIGURE 5.--M1A1 clusters of U.S. 20-pound (1\141) fragmentation bombs.

U.S. Army photos

FIGURE 6.-Defective fuze of M41 fragmentation bomb, showing safety block in place.

as shown in figure 6, the safety block on the fuze of the bomb that exploded in the incident

being reported was in place. Thus, the fuse functioned even though in a "safe" condition.

Fragmentation

The effect of wrapping the bomb cylinder with square wire is to produce a large number

of fragments, each of which is a piece of rod 0.4 inch to 1 inch long (fig. 7). These fragments

aremuch more effective per pound of metal than the usual long, narrow shell fragments.
836 WOUND BALLISTICS

WRAMC-4859-A8

FIGURE 7.-Primary missiles (U.S. M41 20-pound fragmentation bomb). Fragments

found in wounds of aircrew personnel killed by the accidental explosion of the 20-pound

fragmentation bomb.

In static and drop trials, the number of fragments recovered is approximately 1,000 for

the TNT loading and is from 40 to 60 percent greater with ednatol or RDX Compound B

loadings. For the TNT loading, 75 percent of the fragments exceed 2.25 gm., 50 percent

exceed 4.0 gm., and 25 percent exceed 7.0 gin. in weight. In static and drop trials at the

ordnance proving grounds at Millersford, England, quoted by Zuckerman, the number of

fragments heavier than 1.3 gm. was 883. Fragments of less than 1.3 gm. were not counted.

Zuckerman reports the actual recovery of 319 M41 bomb fragments, weighing more than 1.3

gm. each, from the roof of the Bocca di Falco Airfield Building, Palermo, Sicily, where a

single M41 bomb had burst. The total weight of the fragments was 3.65 pounds, or about

25 percent of the potential fragmenting metal. Morse gives the figure of 1,274 as being the

total number of fragments weighing more than 0.25 gin. each from one M41 bomb and, for

comparison with the ordnance trials at Millersford, 884 fragments weighing more than 1.3

grams.

The initial velocity of M41 bomb fragments has been reported (Eighth Air Force Ordnance Memorandum No. 3-17, 18 Sept. 1943) to be as high as 4,000-5,000 f.p.s. However,

the mean velocity of fragments heavier than 1.3 gm. measured at the Millersford trials was

2,890 f.p.s. over a distance of from 0 to 10 feet, and Morse gives the average velocity at 20

feet for all fragments exceeding 0.24 gm. in weight as 2,810 f.p.s. He states further that

for ednatol loading the initial velocity is 3,000 f.p.s. and for an RDX Composition B loading,

3,280 f.p.s. The Sachs-Bidelman Memorandum Report No. 267 from the Aberdeen Proving

Ground follows closely if it is not actually the same as Professor Morse's statement of velocities of M41 bomb fragments for the three different loadings given.

Effective Range

Because of its cylindrical construction, the zone of maximum fragment density for an

M41 bomb is extremely narrow, being approximately not more than 3' above the equatorial
APPENDIX G 837

plane and then only when it bursts with its axis vertical. Slight deviations of the bomb from

a vertical position materially affect its effectiveness. Ordnance Memorandum No. 3-17,

18 September 1943, gives as criteria for effectiveness against personnel a minimum of two

fragment hits per individual. Since a man when standing erect is regarded as presenting an

average target area of 4.2 square feet, this corresponds to a minimum fragment density of

approximately 0.5 fragments per square foot for effectiveness. From this, it is estimated

that the effective range for an M41 bomb exploding in the vertical position is 50 feet. Approximate calculations for angles of impact at 10' and 200 from the vertical give the following

figures:

Radius of effective

Angle of impact from the rertical position (degree) range (feet)

Forward Rear

0 ---------------------------------- 50 50

10 ------------------------------------------------ 33 8

20 ------------------------- -- -------- 13 3

The findings at the scene of the accident suggest that the angle of impact of the bomb

was at least 45'. This assumption was made because it was found that a narrow zone of

maximum density of fragmentation occurred against the undersurface of the wings of the

damaged aircraft at a point slightly more above than to the rear of the point of impact.

The decrease in effective range forward, for a bomb striking at an angle, obviously

does not hold for a bomb falling a short distance on a concrete surface.

STUDY OF CASUALTIES

An estimate of the risk of an individual to injury by bomb fragments may be made

from the data in table 1. The factors to be taken into account are as follows:

1. Surface area of the body exposed, less area protected by parts of planes, objects, or

other individuals.

2. Distance from burst.

3. Direction of fragment spray.

The mean projected area of the body and its parts, as recorded by Krohn working

with Burns and Zuckerman,2 enables one to estimate the approximate surface areas of

individuals exposed to injury. From these data, table 2 was compiled. It is shown that,

of the seven individuals within 30 feet of the burst and without any appreciable protection,

six were killed or died as a result of wounds and the seventh injured so severely that he

required more than 3 months' hospitalization and was permanently lost from the service.

Two individuals, M and N, within 15 feet of the burst and with only their lower extremities

exposed, were out of the line of spray of effective bomb fragments and sustained only slight

injuries. Two others, 0 and P, within 30 feet of the burst were in the line of spray but

because they were almost completely protected by other individuals were only slightly

injured. The four remaining individuals, I, J, K, and L, who were further distant than 30

feet from the burst and who received injuries, required hospitalization for periods averaging

longer than 5 weeks. Table 3 shows the casualty rates pertaining to the 24 men known to

be present at the scene of the incident.

2 Burns, B. D., and Zuckerman, S.: The Wounding Power of Small Bomb and Shell Fragments. R. C. No. 350 of

the Research and Experiments Department of the Ministry of Home Security.
838 WOUND BALLISTICS

TABLE 2.-Observed hits by .AI41 bomb fragments sustained by casualties at various distances

from burst

["Area" refers to the approximate body surface area exposed to bomb fragments by each casualty in square feet]

Distance (feet) from point of burst

Casualty 0-15 15-30 30-45 150 >250

Hits Area Hits Area Hits Area Hits Area Hits Area

A ----------------------------------------- 19 4.2 -

B ----------------------------------------- 15 4.2

C -------------------------------- 44 4.2 ... ..

D ---------------------------- 10 4.2 ... .... ,

E ------------------------------------------ 8 4.2

F----------------------------- -------- -------- 18 4.2 ----- --------- --------- ----

G---------------------------- -------- -------- -------- -------- 2 1 ------------------

S-------------------------------------------11 3.7.............................. 4 ... .

I ----------------------- -------------------------------- 12 4.2

J ----------------------- -------- ------------------------ 3 4.2

K ------------------------------- I I----------------------- L -------------------------------------------------------------------- 1 4.2

M ----------------------------- 10 1.65

N -------------------------------- 4 1.65 --------

O ----------------------------- -------- -------- 3 1 ----- --------- --------- ----

P - ---------------------------- -------- -------- 3 1 ----- --------- --------- ----

S ------------------------- -------- -------- -------- -------- -------- --------- -------- ------- 1 4.2

Total----------------------068 11.7 77 22.5 18 10.4 1 4.2 1 4.2

Observed hits per square foot -

surface area -------------------- 5.8 3.4 1.7 0.2 0.2

Expected hits per individual

when exposed area is 4.2 square

feet- ---------------------------- 24 14 7 1 1

TABLE 3.-Casualty rates of 24 men exposed to bomb fragments

Casualties (killed or wounded) Distance from burst Number of

men exposed Number Percent

Feet:

0-15 ------------------------------------------------------------- 5 5 100.0

15-30 -------------------------------------------------------------- 7 7 100.0

30-45 ---------------------------------------------------------- 5 4 83.0

>45 ------------------------------------------------------------- 7 1 14.0

Figure 8 shows graphically the number of hits per square foot of body surface exposed

at varying distances from the burst. These findings show a desirable distribution of fragments for antipersonnel effect and agree closely with the fragment density reported by

Zuckerman in his communication from Sicily on the performance of the U.S. M41 bombs

against grounded aircraft. It is of interest to note again that all of the casualties standing

on the pavement toward the nose end of the aircraft, ahead of the burst, were presumably

struck by fragments ricochetting on the concrete dispersal area.3 Thus, in general, the

3 At a later date, 28 September 1944, the writer recommended by letter, Special Incident Report, to Col. Elliott C.

Cutler, MC, Chief Surgical Consultant, ETOUSA, that "- * * as a safety measure, some thought might be given by the

Air Force to the loading and unloading of bombs * * * into and from airci aft on a specially prepared or selected surface."-J. C. B.
APPENDIX G 839

4

u. 8 SPECIAL INCIDENT NO. I

0

C,-

4

I0

0"..

w

DITACEFRMUSPEIA INCIDENTNOT

0

I-.

W0

0

WRAM€[C-4942-A 26

FIGURE 8.-Graphic presentation of number of hits per square foot of body surface exposed

at varying distances from bomb burst.

distribution of ricochetted fragments against personnel in this incident closely approximated

the distribution of fragments directly striking the wings of the aircraft damaged by the same

burst. Further, the estimated fragment density at 50 feet in this incident was approximately

three times as great as the estimate given in Ordnance Memorandum No. 3-17.

REG10NAL DISTRIBUTION OF WOUNDS

Table 4 shows the regional incidence of wounds in the 17 casualties. Only four individuals sustained single wounds, one of which was casualty Q who had only a slight tearing

TABLE 4.-Distribution of 168 single and multiple wounds in 17 (11 wounded, 6 killed)

casualties, by anatomic location

Multiple wounds Total wounds Single Anatomic location wound

2 regions 3 regions 4 regions 5 regions Number Percent

involved involved involved involved

H ead -- ------------2 1 3 1 5 12 7.4

N eck ---- -- - --- -- - --- --- --.--- --- --- --- --- --- 1 ------------ 3 4 2 .4

Chest.- ------------ 1 1 6 10 29 47 28.8

Abdomen and scrotum -------------.------ 4 1 1 6 3.7

Upper lim b -------------------- 1 1 8 7 18 35 21.5 Lower limb_ 6 31 15 7 59 36.

Total -- ----------. 9 53 34 63 163 100.0

4I
840 WOUND BALLISTICS

of one eardrum. The greatest number of hits was 44, received by casualty C (killed). He

was hit in five regions of the body including both upper and both lower limbs. This is a

very conservative estimate of the number of hits since many of the wounds were so extensive

that it was impossible to determine the number of bomb fragments that may have passed

through the tissues.

The 28.8 percent incidence of thoracic wounds in this incident is greater than that

reported in most casualty surveys of large samples and is obviously due to the inclusion of

the killed with the wounded.

Table 5 shows the incidence and distribution of fractures. Four casualties sustained

a total of 10 traumatic amputations of limbs or parts of limbs. These are included in the

number of fractures. Of the 17 casualties, 13 sustained fractures and of these 10 had more

than one.

TABLE 5.-Distribution of 46 fractures (including amputations) in 17 casualties, by anatomic

location

Number of casu- Total number of

Anatomic location alties with fractures fractures (including

amputations)

Head --------------------------------------------------------------------- 6

Chest ----------------------------------------------------------------------- 4 16

Abdom en ....... .........

Upper limb ---------------------------------------------------------------- 7 11

Lower limb ---------------------------------------------------------------- 6 11

Casualty B (killed) presented the most extensive fracture of the skull, in addition to

fractures of one upper and one lower limb. Besides comminution of the skull at the points

of entrance and exit of a bomb fragment, all the bones of the skull and face, except the mandible, were disarticulated at their suture lines. The brain stem had been transected, and

the entire substance of both cerebral hemispheres was macerated. The skull and brain appeared to have momentarily undergone an explosivelike expansion and cavitation. The

missile stopped subcutaneously in the back of the neck after making its exit from the skull

through the occipital bone.

Of the six dead, four had single or multiple penetrating wounds of the chest and one

the penetrating wound of the skull described in the preceding paragraph. The sixth casualty, D, although he did not have a penetrating wound of the skull or other body cavities,

did sustain traumatic amputations of his lower limbs in three places, multiple perforating

wounds of his upper extremities, and superficial chest wounds. He presumably died almost instantly from shock and hemorrhage. His eardrums were intact.

The only evidence of damage by blast was the slight tearing of an eardrum in casualty

Q who was within 10 feet of the burst but completely protected from a direct hit by the

intervening inboard panel and clusters of bomb still in place. The eardrums of others,

closer to the burst, were intact.

SIZE OF FRAGMENTS CAUSING WOUNDS

The sizes of fragments responsible for wounds were determined by weighing those

recovered from the dead and estimating the weights of others from their X-ray silhouettes.

In the case of the latter, the fragments were estimated in grams from their linear dimensions.

A large series of X-rays of fragments of known weight were available as a standard. Table

6 summarizes the information obtained on this point and also gives the distances from the

burst at which the casualties were struck.
APPENDIX G 841

TABLE 6.-Size of fragments recovered from casualties struck at several distances from point

of burst

Fragment size (grams)

Category of casualty and dis- Number Total tanee (feet) from point of burst of number of

casualties 0. 001 to 0. 05 to 0. 25 to 1 to 5 > 5 fragments 0.05 0.25 1.0

Wounded:

0-15 ------------------------- 1 02 ------------ ------------- 8

15-30 ----------------------- 3 2 7 6 1 16

30-45 - ---- 3------------- 6 9 1 16

Total- -------------------- 7 8 13 17 2 40

Killed:

0-15 is------------------ - 1 ---- 1 2 3------------------------ 3

15-30 ....-------------- 4----4 2 1 7 1 11

Total -------------------- -5 3 3 7 1 14

In all, there were 40 bomb fragments in 7 of the wounded that could be seen in X-ray

filns and 14 fragments recovered from 5 of the killed casualties. This represents a recovery of 90 percent of fragments causing wounds in the living but only 13.4 percent of fragments causing wounds in the dead.

The average weight of fragments causing wounds in the living casualties was 0.43 ± 0.65

gm., whereas the average weight of fragments recovered from the dead was 1.86 ± 1.82 gin.

The difference in mean weight of fragments causing wounds in the killed and in the wounded in this incident involving a small number of people was found to be 1.43 + 0.48 gm. (t=2.98,

P less than 0.01). The difference in the mean weights is statistically significant. It may

be assumed that the mean weight of fragments causing wounds in the dead is considerably

greater than shown in the sample, since, by far, the majority of them caused through-andthrough wounds and were not retained or recovered. On the other hand, the X-rays of

fragments in the wounded that were available for study represent practically all of the fragments responsible for the wounds in the living. From the average fragment weight found

in the X-rays of the living casualties, it may be said that M41 bomb fragments of less than

1 gm. in weight are relatively incapable of producing fatal injuries but are definitely incapacitating in their effect.

Bomb fragmentation trials in which the screens have failed to recover fragments weighing less than one twenty-fifth of an ounce lack ballistic data on fragments of such small size.

However, the wounding power of small fragments has been discussed at great length by

Burns and Zuckerman. Their conclusion that within the 100-foot radius of a bomb burst

50 percent of the wounding power of a 20-pound fragmentation bomb is due to fragments

weighing less than one twenty-fifth of an ounce is well supported by the findings in this

incident.

603225v1-62- 55
APPENDIX H

Comparison of World War II Missile Casualty Data

Allan Palmer, M.D.

Detailed reports of missile casualty data obtained during World War II by special

wound ballistics teams have already been presented in this volume. (See chapters IV,

V, VI, VII, VIII, and IX.) A compilation of these data are presented in the statistical

material in this appendix.' In addition, casualty data from previous wars have also been

included as a matter of interest. However, no extensive comparisons have been made

between casualties sustained during World War II and those sustained in previous wars

because of the difference in weapons employed and of the difference in the medical and

surgical eras during which the casualties were sustained.

The percentages in the tables that pertain to the regional distribution of wounds refer

to the total number of wounds. In the case of regional frequency, only the frequency

with which the various regions of the body are wounded is considered regardless of the

number of wounds in each body region. The percentages in the tables which pertain to

regional frequency of wounds refer to the number of casualties. From such tabulations,

casualties who sustained wounds in more than one region of the body must be excluded

or an additional entry made for them.

Table 1 shows the regional distribution of wounds due to all missiles in WIA (woundedin-action) only, in three wars. The presentation of dissimilar samples is unavoidable since

the statistical data have not been collected in a uniform manner. The outstanding difference in wound distribution in the various surveys is the relatively low incidence of chest

and abdominal wounds in casualties sustained by the Eighth Air Force bomber crew members wearing body armor.2

There are only two surveys available on regional distribution of wounds in KIA (killedin-action) casualties where the exact locations of all entry wounds have been recorded.

Table 2 shows the regional distribution of the entry wounds due to all missiles in these

two studies. Except for the moderately high incidence of chest hits (22.9 percent) in the

Fifth U.S. Army dead, the location of hits approaches a random distribution; that is, the

percentages of hits in the various regions are proportional to the mean projected areas

of the various body regions. The protective effect of body armor in the trunk region, particularly the chest, is again demonstrable in the Eighth Air Force dead as shown by a wound

incidence of 20.0 percent (chest and abdomen combined) as compared with 29.4 percent for

the Fifth U.S. Army dead.

Table 3 shows the regional frequency of wounds due to all missiles in the killed in action

of the Fifth U.S. Army and the Eighth Air Force surveys plus two additional surveys of U.S.

battle deaths in the South Pacific Area. The regional frequency is shown by single and

multiple regions wounded, and the numbers and the percentages refer to the number of

I Some variations will be noted in the statistical data presented in this section as compared to the data presented

in the chapters referred to. This is due in part to the separation and reevaluation of the original survey findings in an

attempt to compare the results from the varied sources upon similar terms. In addition, certain minor changes were

made in the statistical data during the preparation of this volume. The statistical material pertaining to other than

U.S. Army casualties was personally collected by the author during his Army service.-J. C. B.

2 The presentation of data comparing ground troop and aircrew casualties might seem unfeasible, but they do indicate regional incidence of missile-inflicted wsounds with a common implication for the development of personnel armor.-

J. C. B.

843
844 WOUND BALLISTICS

TABLE 1.-Percent regional distribution of wounds due to all missiles, from casualty samples

of wounded in action only, in three wars

Casualty sample Body region

War and survey Number Number Upper Lower

of casual- of Head Chest Abdomen extremity extremity

ties wounds

American Civil War ---------------------------------------- 9.1 11.7 6.0 36.6 36.6

World War I:

United States --------------------- -------------------- 11.4 3.6 3.4 36.2 45.4

British b----------------------------- ----- ----------.---------- 16.8 7.8 4.7 30.4 40.3

World War II:

Canadians ----------------------------------- 469 11.0 11.0 4.0 31.0 43.0

New Zealanders 2 -------- 476 769 13.0 7.0 5.0 25.0 50.0

British 2 ------------------------------ 112 202 14.0 6.0 3.0 28.0 49.0

German 2 ----------------------------- 30 504 9.10 9.0 3.0 40.0 39.0

Allies ------------------------------- 183 352 10.0 11.0 7.0 33.0 39.0

United States:

New Georgia-Burma ----------------- 4230 ---------- 18.2 13.5 6.1 27.0 35.2

Bougainville ------------------ - 41,162 ---------- 20.7 12.4 5.7 27.4 33.8

Cassino ------------------------------ 100 133 20.0 11.0 7.0 22.0 40.0

Normandy -------------------------- 33, 000 ---------- 16.1 9.8 5.6 28.2 40.3

Eighth Air Force -------------------- 51007 , 1,298 19.8 4.9 2.2 29.4 43.7

U.S.S.R --------------------------------- ----------.---------- 9.1 11.4 6.2 28.0 45.3

' At Dieppe Raid.

2 In Tunisia.

3 In Sicily.

4 Casualties with multiple regions wounded are omitted from sample, and percentages are based upon number of

casualties, not number of wounds.

SHeavy bomber aircrew personnel wearing body armor.

TABLE 2.-Regional distribution of wounds due to all missiles in 1,000 Fifth U.S. Army and

164 Eighth Air Force KIA casualties only

Fifth U.S. Army, Italy Eighth Air Force, Europe

Body region

Number of Percent of Number of Percent of wounds wounds wounds wounds

Head ------------------------------------------------------- 680 10.5 105 23.3

Chest ------------------------------------------------ 1,484 22.9 58 12.9

Abdomen ---------------------------------------------------- 425 6.5 32 7.1

Extremities:

Upper --------------------------------------------------- 1,538 23.7 145 32.1

Lower --------------------------------------------- 2,360 36.4 111 24.6

Total -------------------------------------------- 6,487 100.0 451 100.0

casualties. Comparison of tables 2 and 3 shows the striking differences between the regional

distribution of wounds and their regional frequency when dealing with samples of killed in

action and died of wounds only. It has been observed that the dead are more frequently

hit in more than one region of the body than is the case with the wounded. It is of interest

to note that the regional frequency of hits in the Fifth U.S. Army casualties approaches more

closely that for the Eighth Air Force dead than it does that for the dead that were studied

in the Pacific theater. The effect of the wearing of body armor is again apparent in the air

force study. The similarity in these two surveys is probably due to the fact that in both of
APPENDIX H 845

them the preponderance of missiles causing the casualties were high explosive shell fragments.

The incidence of multiple regions hit was at least twice as great in both samples as it was in

either of the samples of dead from the Pacific theater. The increased proportion of small

arms or "aimed" fire characteristic of the warfare in the Pacific theater accounts for the high

incidence of head and trunk wounds in these samples. This is an extreme departure from

the randomness of hits as well as from the high incidence of wounds in more than one region

of the body characteristic of casualties exposed to shell fragments.

TABLE 3.-Regional frequency of wounds due to all missiles in four samples of battle deaths

and KIA casualties

New Georgia- Bougainville 2 Fifth U.S. Army, Eighth Air Force,

Burma I Italy Europe

Body region

Number Percent Number Percent Number Percent Number Percent of cas- of cas- of cas- of cas- of cas- of cas- of cas- of cas- ualties ualties ualties ualties ualtics ualties ualties ualties

Single region wounded:

Head -------------------------- 32 31.7 144 36.4 171 17.4 50 30.5

Chest ------------------------ 32 31.7 87 22.0 138 14.0 16 9.8

Abdomen --------------------- 11 10.9 48 12.2 30 3.0 3 1.8

Upper extremity -------------- 1 1.0 1 .3 25 2.15 ... ........... .

Lower extremity -------------- 2 2.0 14 3.5 62 6.3 11 6.7

Multiple regions wounded --------- 23 22. 7 101 25. 6 559 56. 8 84 51.2

Total ----------------------- 101 100.0 395 100.0 985 100.0 164 100.0

I Includes both KIA casualties and casualties who died of wounds.

2 Primarily KIA casualties only.

In the consideration of causes of death, a distinction has been made between the causes

of death on the one hand and fatal wounds on the other. It was obvious that in many cases

more than one wound could have been the cause of death. The following criteria were followed in order to determine the cause of death: 3

1. Only the severest one of multiple fatal wounds was regarded as the cause of death

in any one casualty.

2. When the severity of a head and a chest or an abdominal wound appeared to be the

same, the cause of death was arbitrarily attributed to the head wound.

3. When the severity of a chest and an abdominal wound appeared to be the same, the

cause of death was attributed to the chest wound.

4. Decapitations were regarded as causes of death due to wounds in the head and neck

region in cases where the head was missing as well as in cases where a head wound was very

extensive and associated with complete evulsion of the brain.

5. In the case of extensive mutilating wounds, the cause of death was attributed to a

wound of the region of the body nearest the center of the area of mutilation.

Table 4 shows the causes of death in six studies of both military and civilian casualties

due to all missiles according to the region of the body in which the primary fatal wound

occurred regardless of the region first struck by the missile and regardless of the multiplicity

of fatal wounds. Thus, the causes of death in these samples are not more numerous than

the number of casualties.

SDuring the conduct of a survey, it is frequently necessary to adopt arbitrary criteria for the determination of the

cause of death. However, autopsy studies have revealed the shortcomings of such a method. A thorough study of

smaller group of casualties can be more informative than a superficial survey of a larger number. Therefore, casualty

surveys should be conducted with adequate personnel to permit complete external examination of all wounds and an adequate autopsy study for the determination of the cause of death-J. C. B.
846 WOUND BALLISTICS

TABLE 4.-Percent distribudion of cause of death in military and civilian casualties, by region in

which the primary fatal wound occurred

American British New Georgia- Bougainville2 Fifth U.S. Eighth Air

Body region Civil War civilians in Burma 2 (78 (294 casual- Army, Italy Force, Italy (1,173 casual- London 1 casualties) ties) (981 casual- (164 casualties) ties) ties)

Head --------------------------- 41.5 37.0 41.0 49.0 43.7 45.1

Chest --------------------------- (3) 20.0 41.0 29.6 36.7 38.4

Abdomen ----------------------- () 33.0 14.0 16.3 8.3 7.4

Extremities:

Upper- ---------------------- 2.6 4.0 2.0 .3 2.3 --------------

Lower ---------------------- 4.5 6.0 2.0 4.8 9.0 9.1

Total --------------------- 4100.0 100.0 100.0 100.0 100.0 100.0

I Killed by bomb splinters during the "blitz" in 1911.

2 Casualties with secondary fatal wounds omitted from sample. SData are not available for the individual body regions; for the combined regions, the figure is 51.4 percent.

4 Includes 51.4 percent for wounds of the chest and the abdomen combined.

It may be seen in all of the casualty surveys that wounds of the head and neck region

account for the greatest number of fatalities. The chest region is second in all samples

except in that of British civilians in London during the "blitz" of 1941. It is possible that

the suddenness of wounding by bomb splinters in unarmed and unprotected civilians, in

contrast with the military, might account for a greater number of deaths due to abdominal

wounds in civilians.

Whether or not there is complete random distribution of wounds in missile casualties

can only be ascertained in complete samples of unselected casualties. The sample must

include the slightly as well as the severely wounded and the killed. Table 5 shows the

relative mean projected surfaces of the various body regions which may be regarded as

the relative regional distribution of wounds expected in a sample of casualties exposed to

random distribution of the missiles causing wounds. The variations from the expected

wound distribution for five samples of casualty data are also shown in table 5. A lower

than the expected number of wounds in the chest and the abdomen in the case of the air

force casualties was due primarily to the wearing of body armor by aircrew personnel. The

higher incidence of head and trunk wounds due to aimed fire or small arms is apparent in

the casualties sustained by the ground forces in the Pacific theaters.

Just as in the case of wounded in action only casualty studies, there are only slight and

insignificant differences in regional distribution and regio.ial frequency of wounds in complete

casualty samples. Table 6 shows the relative regional frequency of wounds due to all

missiles in three of the complete casualty surveys previously discussed. The incidence of

casualties wounded in more than one region of the body in the three complete casualty

samples is fairly constant-ranging as it does from 14.9 to 18.6 percent. By excluding

casualties wounded in multiple regions from the data in table 6, the greatest differences

between the regional distribution and the regional frequency of wounds would be found in

the Eighth Air Force survey. Although 40.4 percent of all wounds occurred in the lower

extremities (table 5), if those wounded in multiple regions were excluded from the sample

instead of being tabulated in table 6 as "multiple regions," the value of 38.3 percent in table

6 would become 45.0 percent, the difference between regional distribution and regional

frequency then being 4.6 percent. Thus, it may be concluded that in an analysis of the

regional distribution or frequency of wounds in complete casualty studies the exclusion of

those casualties wounded in more than one region of the body does not materially alter the

apparent incidence of wounds in the various body regions.
APPENDIX H 847

TABLE 5-Percent regional distribution of wounds due to all missiles, from six surveys of WIA

and KIA casualties, by body region

Body Dieppe North New Bougain- Eighth

Body region surface Raid 2 Africa 3 Georgia- ville 5 Air Force area I Burma 4 Europe 6

Head -------------------------------------- 12.0 16.0 21.5 20.1 26.4 21.1

Chest --------------------------------------- 16.0 13.0 17.3 20.6 15.9 6.4

Abdomen ------------------------------- 11.0 10.0 9.2 10.4 7.8 3.3

Extremities:

Upper ----------.------------------------ 22.0 26.0 (7) 21.5 22.0 28.8

Lower --------.------------------------ 39.0 35.0 (7) 27.4 27.9 40.4

Total -------------------------------- 100.0 100.0 8 100.0 100.0 100.0 100.0

1 Percent expected hits.

SBased on 496 WIA and an estimated 124 KIA casualties.

3 Based on a total of 3,919 casualties.

4 Based on a total of 369 casualties, with 268 WIA casualties and 101 battle deaths, including killed in action and

died of wounds.

SBased on a total of 1,546 casualties, with 1,162 WIA casualties and 294 battle deaths, including killed in action and

died of wounds.

6 Based on a total of 1,115 casualties, with 1,007 WIA and 108 KIA casualties.

7 Data are not available for the individual body regions; for the combined extremities, the figure is 52.0 percent.

8 Includes 52.0 percent for wounds of the upper and lower extremities combined.

It has been observed that shell fragments hit the body more at random than the aimed

fire of bullets. While initial fragment velocity is often high, the striking velocity is commonly

less than that of bullets at battle ranges, due to rapid air retardation. This effect is largely

due to sectional density and form factor. It is this fact which makes body armor of value

in protecting against fragment injury, while it would appear impractical to contemplate an

armor which could materially prevent rifle bullets from causing wounds of the protected areas.

Thus, it is proposed that the protective effect of body armor be evaluated on the basis of

observed hits on personnel struck by shell fragments only. Ideally, a comparison of the

anatomic location of hits on unselected samples of armored and unarmored troops would

best reveal the effectiveness of protection. The exact anatomic locations of all hits by high

explosive shell fragments on the surface of the body have been accurately recorded in one

casualty survey comprised of both the wounded and the killed, that being the 961 Eighth

TABLE 6-Percent regional frequency of hits due to all missiles, from three surveys of WIA

and KIA casualties, by body region

Body region Body sufrace New Georgia- Bougainville Eighth Air area I Burma Force

Single region:

Head ----------------------------------------------------- 12.0 20.1 21.5 19.8

Chest ---------------------------------------------- 16.0 17.1 12.9 3.4

Abdomen ------------------------------------------- 11.0 6.8 6.4 1.5

Upper extremities ------------------------------------- 22.0 17.1 17.9 22.1

Lower extremities ------------------------------------- 39.0 22.4 22.7 38.3

Multiple regions ---------------------------------------------.-------------- 16.5 18.6 14.9

Total -------------------------------------------------- 100.0 100.0 100.0 100.0

I Percent expected hits.
848 WOUND BALLISTICS

Air Force flak casualties sustained during June, July, and August 1944 (ch. IX). All of

these casualties may be regarded as being "armored." Although the exact incidence of

those casualties who were not actually wearing body armor at the time they were wounded

or killed is not known, it is known that at least 11 percent were unarmored.

A further evaluation of the protection afforded by body armor may be made from a

study of the quantitative relationship (indices of vulnerability) between observed hits and

expected hits based upon projected body surface areas. In a relationship of this sort, the

nearest approach to random distribution of hits would be expected in a selected sample

of casualties due to only fragments from high explosive shells, and the least evidence of

randomness would be expected in a selected sample of casualties due only to bullets; that is,

"aimed" fire. Since body armor is the subject under discussion, it is felt that selected

samples of casualties due to high explosive shell fragments are best suited for this demonstration. Warfare in which bullets cause the majority of casualties would not be the type

of warfare in which body armor would be of greatest value. A purely random distribution

of hits on unprotected individuals would cause all the indices to be 1.00.

The regional frequency of hits due only to shell fragments in a sample of unarmored

ground force troops may be compared with the regional frequency of hits sustained by the

armored Eighth Air Force casualties. Table 7 shows the relative regional frequency of

hits in the various body regions of the unarmored Bougainville casualties as compared with

that of the armored Eighth Air Force casualties.

TABLE 7.-Relative vulnerability of different body regions to shell fragments (multiple wounds

excluded) from two surveys of WIA and KIA casualties

Body surface Bougainville 1 Eighth Air Force 2

Body region area or hits - expected Hits observed Index 3 Hits observed Index 3

(percent) (percent) (percent)

Head ----------------------------------------------- 12.0 24.5 2.04 16.1 1.34

Chest ----------------------------------------------- 16.0 15.3 .96 4.6 .29

Abdomen ------------------------------------------------- 11.0 6.6 .60 1.8 .16

Extremities:

Upper ------------------------------------------- 22.0 21.9 1.00 29.0 1.32

Lower ------------------------------------------- 39.0 31.7 .81 48.5 1.24

Total ------------------------------------------ 100.0 100.0 100.0

I Based on 707 casualties.

2 Based on 818 casualties.

Percent of hits observed 3 Index= Percent of hits expected

The action in which the Fifth U.S. Army in Italy participated and in which at times as

many as 85 percent of the casualties were due to shell fragments was the sort of warfare

which defensively would be ideally suited to the wearing of body armor by ground force

troops. Casualty survey observations on the regional distribution of hits due only to shell

fragments in this action, however, were restricted to a sample of KIA only casualties. Table

8 shows for comparison the regional distribution of hits due only to shell fragments and the

indices of vulnerability in samples of 850 unarmored Fifth U.S. Army dead and 144 armored

Eighth Air Force dead.

It is not fair to attempt to evaluate protection afforded by armor on the basis of observations confined to killed in action only. The chest and abdominal regions are still relatively

vital regions of the body even when armored, and the fatalities resulting from fatal wounds

in these regions were obviously due to the relatively higher velocity perforating flak fragments

which struck these regions in armored aircrew personnel. These fragments approached and
APPENDIX H 849

actually may have had velocities which were comparable to the velocities of bullets. A

point which may be observed, however, in the two surveys with reference to protection is the

difference in the distribution of wounds. The sample of air force dead may be regarded

generally as having worn helmets as well as body armor as opposed to the sample of ground

force dead which may be regarded generally as having worn helmets but not body armor.

Therefore, with greater vital body area coverage by body armor as compared to area of

coverage by helmet only, the incidence of head wounds due to shell fragments in air force

dead was more than twice that in ground force dead. The low incidence of head wounds

due to high explosive shell fragments in the dead of the Fifth U.S. Army was the only instance

in all of both the complete and KIA-only casualty surveys studied where the incidence of

wounds was less than the projected surface area of that region; that is, less than the expected

wound incidence. Figures 1 and 2 show the anatomic location of the hits given in table 8

for the ground force and air force casualties, respectively.

.................

'k1

n A

WRAMC-4892-A22

FIGURE 1.-Anatomic location of 6,003 hits on 850 KIA due to shell fragments, Fifth U.S.

Army, Italy.

603225o-62-56
850 WOUND BALLISTICS

WRAMC-4802-A7

FIGURE 2.-Anatomiic location of 373 hits on 144 KIA due to flak fragments, Eighth Air

Force, Europe.

TABLE 8.-Percent regional distribution of wounds and relative vulnerability of body regions to

shsell fragments, from two casualty surveys of KIA casualties only

Body surface Fifth U.S. Army I Eighth Air Force2

Body region area or hitas______________________

exetd Hits observed Index 3 Hits observed Index 3

Head--------------------------------------------------- 12.0e 10.4 0.87 24.7 2.06

Chest -------------------------------------------------- 16.0 22.4 1.40 11.5 .72

Abdomen----------------------------------------------- 11.0 6.6 .60 5.9 .14

Extremities:

Upper ---------------------------------------------- 22.0 23.5 1.07 36.1 1.66

Lower ---------------------------------------------- 39.0 37.1 .91 21.4 .55

Total------------------------------------ --------- 100.0 100.0 100.0

1 800 casualties with 6,003 wounds.

2 144 casualties with 373 wounds.

Percent of hits observed i Index=

Percent of hits expected
APPENDIX I

Medical Program for the Study of Wounds and Wounding

Major James C. Beyer, MC

A comprehensive medical program in the continuing study of wounds and wounding

would include the following:

Functions:

1. To insure a coordinated and standardized reporting of battle casualty statistics.

2. To consolidate and unify operations in order to furnish a complete and continual

coverage of any hostility.

3. To simplify the establishment of a research unit in an overseas theater.

4. To serve as a source of material for all interested developmental and planning

agencies in the Medical Corps, the Quartermaster Corps, the Army Field Forces, and the

Ordnance Corps.

5. To provide a consultation group for all medical problems pertaining to the use

and development of body armor and weapons.

Types of work:

1. The scope of the work should include all types of battle casualties and certain

related nonbattle casualties.

2. Statistical survey as to:

a. Number of wounds per casualty.

b. Regional incidence of all wounds.

c. Regional incidence of lethal wounds.

d. Type of wound.

e. Causative agents-type, weight, velocity.

3. Wound ballistics studies:

a. Size and shape of wounds.

b. Severity of wounds.

c. Photographs of wounds.

d. X-rays.

e. Missile passageway.

f. Recovery of missiles.

4. Pathology:

a. Studies directly related to wound ballistics.

b. General studies related to effects of stress and combat.

c. Companion studies not related to wound ballistics.

5. Studies of survival time and cause of death in DOW's and KIA's.

6. Body armor studies:

a. Effectiveness of body armor.

b. Use and development of protective equipment.

c. Comparison studies of allied troops not wearing body armor.

d. Possible use of body armor in atomic-type warfare.

7. Wounding as related to training, tactics, terrain, type of combat, and so forth.

8. Long-term followup of WIA personnel as to hospital stay, type of recovery,

sequelae, and so forth.

9. Studies of hostile WIA and KIA.

10. During peacetime, the members could be engaged in:

a. Completion of studies and reports.

b. Laboratory experimentation and field tests.

851
852 WOUND BALLISTICS

c. Investigation of accidents involving U.S. weapons.

d. Training and consultation.

A program of this caliber and magnitude would require that at least some of the participating medical officers should be qualified in pathology and have some training at the Ordnance School and the Ballistics Research Laboratory, the Medical Laboratories of the Army

Chemical Center, and Army Field Forces schools. A basic knowledge of the essential

statistical methods would also be of great value.

With the development and greater usage of the nuclear-type weapons on the battlefield,

battle casualty survey units would possess the appropriate organization to continue the studies

on the effects of the conventional weapons and expand to cover the combined effects of both

agents. In order to facilitate the prompt utilization of such a unit in the event of new hostilities, it would appear that some consideration should be given at the present time (1961)

to the planning and conception of the program. Hurriedly placed missions in the field will

fail to realize a comprehensive harvest of all the available material.

The flow of casualties from the main line of resistance into medical installations provides

several ideal locations for the conduct of various phases of a comprehensive battle casualty

survey. In order to gain information regarding the casualty-producing effectiveness of U.S.

weapons and to furnish essential data to the experimental wound ballistician who is collaborating with the ordnance design engineer, a temporary survey of the enemy KIA casualties

should be made. All wound tracks should be charted, measured, and dissected with an

attempt made to recover all retained missiles. Enemy WIA casualties can also be studied

at prisoner-of-war sites.

Permanent teams should be available at mobile army surgical hospitals for the twofold

study of WIA and DOW casualties. In addition, any KIA casualties who reach such an

installation can also be included. A medical officer is required to direct the program, and

he can be supplemented by Medical Service Corps officers and enlisted men with adequate

equipment and personnel within the survey team proper for complete photographic and

X-ray coverage of all casualties. Concurrent with the studies at the mobile army surgical

hospitals, personnel must be available to conduct interviews and to collect data regarding

the immediate circumstances surrounding the time and the place of wounding of each

casualty.

The study of the WIA casualties should be a continuing process extending to evacuation hospitals and on to the Zone of Interior or to the point of final discharge of the casualty.

Therefore, the disposition of each surviving wounded casualty is determined and copies of

the autopsy examinations and abstracts of the clinical records for each DOW casualty are

forwarded to a central agency.

Study of the KIA casualties is contingent upon the type and place of burial utilized by

the Quartermaster Graves Registration Service. This again is dependent upon the scope

and location of the hostilities. When local cemeteries are established in the theater, a survey

team should be attached to each one. Here again, the survey team should be able to function

as an integral but independent unit with minimal dependency upon the local command for

personnel, equipment, and supplies. The survey team members who are conducting interviews and collecting information concerning the circumstances of wounding of the WIA

casualties can gather similar data for the KIA casualties. This information is of prime

concern in determining the effectiveness of any items of personnel armor, such as the helmet

and forms of body armor.

All of these activities, with definite basic plans drawn up concerning the conduct and

scope of each phase, should be considered before the onset of any hostilities. The methodology governing the gathering of data should be investigated, and an acceptable format

should be established. In that way, many of the shortcomings of the statistical data presented in this volume will be avoided and all interested agencies will be willing to accept

any of the findings. Many of the variations in the tables of the preceding chapters have a

valid and logical explanation, but there are numerous other disparities which could have

been eliminated if uniform data collecting procedures had been established.
APPENDIX I 853

Therefore, to achieve any degree of success in such a program, one agency should be

responsible for developmental planning, for training key personnel, and for providing a

single repository for storage and dissemination of the material. In addition, personnel and

loan material would be available for indoctrinating newly appointed medical personnel and

for the continuing education of all interested individuals. A component of the Office of the

Surgeon General would be most qualified to direct the program.
INDEX

Abdomen, 353 Aircraft:

expansion coefficient of, 177 altitudes of, 575, 598

temporary cavity in, 177-180 B-17--548, 549, 553, 556, 575, 598, 599,

wounds of, 357-358, 376, 378, 446, 572, 664

573, 701, 704, 708, 754, 757, 758, 761 B-24-548, 549, 553, 556, 575, 598, 599,

body armor as factor in incidence of, 587 664

case reports, 358-361, 458 C-46-249

evaluation of, 197 C-47-249

in living wounded, 253 crashlanding of, 562

morbid anatomy of, 372 damage of, 553, 620-638

operative mortality for, 357, 358 flak hits on, 620-623

percent of casualties due to, 255, 256, for evacuation, 249

258, 276, 315, 316, 317, 319, 327, 371, of heavy bombardment groups, 548

375, 563, 564, 572, 573, 574, 600, 722 Piper Cub, 238

percentage of projected body area, 275, Aircraft armament:

562 machineguns, 12, 44

statistics, 319, 698, 701, 704, 708 rockets, 17

survival time of casualties with, 720 Aircrew battle casualties, of Eighth Air

Abdominal wall, wounds of, 321, 502 Force, 547-611

Abdominal wounds. See Abdomen; according to combat position, 570-571,

Wounds. 595-596 blast injury in, 570

Aberdeen chronograph, for measuring velocity, 149 causes of, 557

Aberdeen Aberdee Pr Proving n Gdue Ground, to flak fragments, 570-588 691 attdso icat 7

weapns at 41altitudes este of aircraft, 575

disability related to, 576-580

Accelerated particle theory, 145 fatality rates, 574-575

Adjutant General Casualty Section, Fifth projected body surface area, 571-572

U.S. Army, 441 regional distribution of hits, 572

Adjutant General, The, 485 regional frequency of hits, 573

Admission and disposition reports, 552 return to flying status, 575

Admissions, battle. See Casualties. sizes of fragments, causing wounds,

ADRIAN, General, 641 581-584

Aerial bombs, 100-101, 422, 446 time interval between injury and surgiAero Medical Laboratory, 653-654 cal treatment, 575

Aeronautics, Bureau of, U.S. Navy, 683 due to missiles from enemy fighter aircraft,

Aid station, 238 594-598

Aidmen, 426 due to secondary missiles, 589-594

in jungle warfare, 366 incidence of, 557-558

Aimed fire, 94 return to duty status of, 567-568, 575,

Aimed weapons. See Machineguns; Rifles. 592-594

AINEs, Lt. Col. A. A., 730 survey of, 547-611

Aipawn Bum Mountains, 247 time lost from flying status of, 567, 568,

Air evacuation, 238, 249 575, 577, 592, 594

Air Force Materiel Command, 666 wounds of:

Air-Sea Rescue Squadron, 3d-732 evaluation of severity of, 567-568, 575,

Air Technical Service Command, 547 577, 592, 594

Air velocities, comparison of, with velocity regional distribution, 562

of blast wave, 104 regional frequency, 563

Airburst, 99, 101, 103, 112, 114 See also Casualties; Killed in action; Misof high explosive projectiles, 99 sile casualties; Wounded in action.

855
856 WOUND BALLISTICS

Aircrew personnel: Ammunition tests:

armored, 587-588, 664 in South Pacific Area, 22-25

unarmored, 587-588, 664 in Zone of Interior, 25, 63-67

Airfields: Amputation(s), 565-567

Munda, 239, 240, 241 of lower extremities, 320

Myitkyina, 247, 248, 249 of upper extremity, 361

Piva, 291, 293, 294 Analysis of casualties, 253-257, 537-545,

Airplane, application of, to warfare, 92, 100 555-570

See also Aircraft. according to combat position, 557-558

Allied forces, in Bougainville campaign, 288 anatomic frequency of wounds, 255-256

Alloy, manganese steel. See Manganese blast injuries, 543, 570

steel. casualty rates, 544-545

Alsace, 35 causes, 557

Altitudes of aircraft, at which casualties sus- demarcation of body regions, 558-561

tained wounds, 575, 598 effect of posture on wounds, 540

Aluminum, 691 fatality rates, 564

in combination with nylon- fractures and amputations, 565-567

as body armor material, 669, 670, 671, general, 555-556

682, 683, 725 regional distribution of wounds, 541-543,

for helmets, 655 562

Amatol, 51, 65, 71 regional frequency of wounds, 563

Ambulance jeeps, 243, 284 return to duty status, 567-568

Ambulance loading points, 535 single and multiple wounds, 564

Americal Division, 246, 283, 284, 286, 288, weapons responsible for wounds, 541

293 Anatomic areas of fatal wounds, 454

G-2 (intelligence), 298 Anatomic distribution of wounds, 311-321,

See also Infantry division(s). 562, 563, 720

American Civil War, 4, 438, 660, 661 as related to body armor, 759

American Cyanamid Company, 683 factors in, 314, 321

American Expeditionary Forces, 642, 661 in the dead, 314, 315

American helmet. See Helmet(s). in the living, 314, 315

Ammunition, 18-27, 51-66, 83-87, 95, 96-97 lethal effect of weapons on, 260-264

armor-piercing, 11, 18, 26, 96, 100, 291, 292 Anatomic frequency of wounds, 255-256

artillery, 26, 27, 57-67 Anesthesia, 354, 521

ball, 8, 9, 10, 11, 18, 37, 41, 95, 96, 100 as related to battle casualty deaths, 477,

Chinese Communist, 84-85 478, 503, 507, 521

detonation of, for testing- importance of, 368

in South Pacific Area, 22-25 Angle of incidence, of missiles, as related to

in Zone of Interior, 25, 63-67 target area, 109

German, 51-68, 613-620 Angular velocity of yaw, 130

grenades, 12, 27-32 Annual Report of Health, Surgeon, IUSSTAF,

high explosive, 22, 26, 45, 46, 50, 96, 100, 555

291, 292 Antiaircraft artillery weapons, 5

incendiary, 18, 26, 53, 95 Antiaircraft shell, German 88 mm. high exJapanese, 18-27, 96-97 plosive, 613-620

]andmines, 32-33 Antimateriel weapons, 92, 95, 116

mortars, 13, 14, 15, 22, 24, 25, 26, 53-57 Antipersonnel landmines, 102, 103

North Korean Forces, 83-85 Antipersonnel weapons, 91, 95, 100, 291

shrapnel, 291 Antitank grenade launchers, 50

small arms, 7, 8, 9, 10, 11, 18-19, 51-53, Antitank small arms, 95

95. See also Small arms ammunition. Antitank weapons, 5, 291

tracer, 8, 10, 11, 18, 26, 53, 96, 100, 292 muzzle velocities of, 115

See also High explosives; Projectiles; Pro- Anuria, 515, 519, 523, 524

pellents. See also Pigment nephropathy.
INDEX 857

Anzio beachhead, 478 Artillery weapons, 80-83

Area coverage of helmets, 275, 276, 643, 644 ammunition for, 26, 27 47

Area of extravasation, of wound track, 134 development of, 92

Arm, fracture of bones of, 319 explosive missiles for, 92

Armies: German, 50-51, 115

Austrian, 2 Flak 18-47, 65

British, 662 Flak 36-47

French, 641, 680 Flak 37-47

German, 36, 37, 57, 65, 473 Flak 41-47, 65

Japanese, 33, 288 Pak 43-47

United States, 76, 437-471, 473-530, 540, in wound production, 380

692, 731, 758, 763. See also U.S. Army. Japanese, 15, 99, 291, 292

Armistice day, 642 captured in Bougainville campaign, 292

Armor: muzzle velocity of, 47

improvised, for special purposes, 765-766 relative lethal effect of, 342

lower torso, 764 Assam, 246

See also Body armor. Assessment, of degree of damage, from

Armor, Vest, M12, for ground troops, 676, wounding agent, 717-718

679 Atomic bomb, 91, 92, 93

See also Body armor. Atwater armor, 660, 661

Armor material, testing of, 691 Atwater Armor Company, New Haven,

Armored aircrew personnel, 587-588, 664 Conn., 661

Armored Force, Fort Knox, 650, 651 Australia, 246, 674

Armored Force Board, Fort Knox, 651 Austrian Army, 2

Automatic Arms Company, Buffalo, N.Y., 3

Armored Medical Research Laboratory, 652 Automatic Apos 94

Armored vest. See Body armor. Automatic weapons, 94

Armorette, British, 662 csli d t2

Armor-piercing ammunition, 11, 18, 26, 96, cyclic rae o, 95

100, 291, 292 cyclic rate of, 95

Armor-piercing projectiles, 99 larger than 8 mm., 95

Army Air Forces, 547, 662 See also Machinegun(s); Submachinebody armor developed in, 656-659, 663- gun (s).

673 Autopsy protocols, 381-416

casualties in, 547-611 Autopsy study, of casualties died of wounds,

helmets developed in, 656-659 718-720

healmeso dEvegod Ain, 656-9 Aviator's helmet. See Helmet(s). See olso Eighth Air Force.AxsPwr,2

Army Ground Forces, 681

Army Institute of Pathology, 525 B-17 aircraft:

Army-Navy body armor field test, 727-728 Altitudes of, at which casualties sustained

Army Pictorial Service, 443, 552, 553 wounds, 575, 598

Army Service Forces, 674 casualty rate for, 556

Artillery ammunition: crew of, 548

German, 57-67 body armor for, 664

Japanese, 26-27 damage of, 553, 621

Artillery fire, casulties due to, 76, 241, 242, hits on, on260, 261, 262, 263, 265, 266, 267, 268, 290, fuselage, 625-628

324, 325, 330 horizontal surfaces, 623-626

Artillery projectiles, 98-99 vertical surfaces, 623-626

muzzle velocities of, 115 B-24 aircraft:

See also High explosive projectiles. altitudes of, at which casualties sustained

Artillery shell fragments, size of, in nonfatal wounds, 575, 598

wounds, 584-585 casualty rate for, 556
858 WOUND BALLISTICS

B-24 aircraft-Continued Battle of the Perimeter-Continued

crew of, 548 operations, on--

body armor for, 663 Hill 260--294-298

damage of, 553, 621 Hill 700-299-303

hits on, on- 129th Infantry sector, 304-306

fuselage, 625-628 period of, 293

horizontal surfaces, 623-626 See also Bougainville campaign.

vertical surfaces, 623-626 Battle of Tsushima Bay, 4

Ball ammunition, 8, 9, 10, 11, 18, 37, 95, 96 Battle ranges, 92, 125

Ball-and-clevis release, of M1 helmet, 644 increases in, 98

Ball turret gunners. See Gunners. Battlefield deaths. See Killed in action.

Ballistic characteristics, of wounding agents, Battlefield performance of Ml helmet, sur91-141 vey of, 763-764

Ballistic coefficient, 120-123 Bayonets, 323, 422

Ballistic galvanometer, 150 relative lethal effect of, 324

Ballistic protective devices. See Body armor; wounds produced by, 6

HeBlet(s). Bazookas, 50, 323, 422

Ballistic strength, of helmets, 642 relative lethal effect of, 324

Ballistic test, for helmet, 645, 646 BD fuze. See Base detonating fuze.

Bangalore torpedoes, 33, 323, 422 BECKER, K., 145

relative lethal effect of, 324 BEEBE, G. W., 647

Banzai raid, 4 Berne, 145

Barike River, 239, 240 Bernouilli forces, temporary cavity sealed

Barium sulfate, 178, 205 off by. 185

Base detonating fuze, 26 BEYER, Capt. J. C., 754, 762

Battalion(s): BEYEi, 24, 57th Engineer Combat, 298 Biblo Hill, 241

82dh Chgineem 2 , 2Biophysics Division, Chemical Corps Medi- 246th Field Artillery; 298 cal Laboratories, 691-692, 753 247th 

247th 

Field 

F ield Artillery, 

A rtillery, 298B 

298 Bismarck Archipelago, 293 I M R K O T V N,3

See also Infantry battalions. BISMARCK OTTO VON, 35

Battalion aid stations: BLACK, A. N., 108, 146

plasma administration in, 505, 511

wounded returned to duty from, 311 Bladder, 319

Battle casualty: Blast, 104-106

data on, study of, 550 effect of confinement on, 104

definition of, 311 injury from, 446. 543

rate of, for- in aircrew battle casualties, 570

bomber aircraft, 556 pressure of, 104, 105

Eighth Air Force, 555 protection from, 105

See also Casualties. Blast wave, velocity of, 104

Battle casualty survey(s). See Casualty Blitzkrieg, 36, 47

survey(s). Blood, 354, 478

Battle damage: administration of, 505

of bomber aircraft, 553, 620-638 transfusions of, 368

reports of, 553, 621 Blood pressure records, 507, 519

Battle dead. See Killed in action. Blood vessels, damage to, 205-211

Battle of Crdcy, 92 Blowback operated, definition of: 2

Battle of the Perimeter, 283, 288, 293; 323, Blunderbuss, 92

422 Boats, for evacuation of wounded, 239, 243

casualties of, 298, 303, 304: 306 Boattail bullets, 95

enemy plan for, 293-294 See also Bullet(s).

forces engaged, 298, 303 Body areas, incidence of fractures of, 710-711
INDEX 859

Body armor, 1, 426, 438, 563, 587, 588, Bomb(s):

660-684, 691-766 aerial, 100-101, 422

as related to- atomic, 91, 92, 93

anatomic distribution of wounds, 585- detonation of, 101

588, 759 fragmentation, 100, 101, 113

Army and Marine Corps casualties, general-purpose, 100, 101, 106, 123

754-761 light-case, 100, 106, 112

regional distribution of wounds, 757 rocket-propelled, 93

wound incidence, 572-573, 587, 757 special-purpose, 101

British, 662 velocities of fragments of, 115

design of, 666, 729 Bombardiers, 557, 572, 596

development of, 685-689 body armor for, 664, 666

field trial of, 725-727, 731-732 casualty rates for, 557, 558

for air forces, 662, 665-673 Bombardment groups, 548

for combat crews, 664-665 aircraft of, 548

for ground troops, 662, 673-684, 748, 749, casualties of, 555

754 operations of, 548

in Korean War, 676, 677 Bombburst, 146

French, 661 fragment distribution from, 101

in Korean War, 765 Bombers, heavy:

indications for, 452-454 body armor for crews of, 664

Marine Corps model, 728, 754-757 flight formations of, in relation to casualmaterial for, 660, 661, 662, 663, 664 ties, 554, 555

modifications of, 725-726, 748

production figures for, 666, 667 Bong su, protection afforded by, 275-277, 664 Bn~) damage to, by high-velocity missiles,

standard item of, 748-749 200-204

study of, 737-741 penetration of, 139-140, 227-230

troop acceptability of, 661 Boobytrap, 33, 102, 103

types of, during Civil War, 660, 661 Bore sizes, 5, 6

U.S. Navy program for, 683-684 Bougainville, 76, 281, 314, 564, 574

value of, 661, 662, 732, 739-741 geograpby, 28 3 for combat crewmen. 666 gorpy 8

for combat ground forces, 674, 675 Bougainville campaign, 1, 6, 675 weigh combat ground 661, , 674, 6,75 during casualty survey period, 293-310 weight of, 660, 661, 662, 664, 666, 667, Allied casualties, 312

668, 669

wounds of body regions covered by, 732 Battle of the Perimeter, 283, 294-306

Body Armor Reports, 553 Japanese casualties, 309-310

Body Armor Test Team, 748 factors peculiar to, 283-293

conclusions of 728, 741-744 forces involve, 288

equipment for, 730-731 geography, 283

mission of, 727-728 medical installations for, 284-288

objectives of, 729 routes of evacuation in, 283-288

personnel of, 730 weapons employed by Japanese during,

recommendations of, 728, 745-749 289-292

Body regions: wound ballistics study in, 281-436

demarcation of, 558-561 summary, 430

vulnerability index of, 585 "Bouncing Betty," 53, 99

Body surface areas: See also High explosive mortar shell.

number of hits on, from point of burst, 22 Bowman's capsule, 515

protective devices for. See Body armor; Boys, V. C., 143

Helmets. Brain injury, 316, 349

wounds in relation to, 257 Brass, in small arms ammunition, 18
860 WOUND BALLISTICS

Breastplate, 661 Burma campaign-Continued

use of, in Civil War, 660 forces involved, 248

Brewster Body Shield, 673 hospitals in, 238

British armor, 662 military operations of, 247-248

Armorette, 662 BURNS, B. D., 108, 146, 559, 697

necklet, silk-lined, 662 Burst patterns, of flak fragments, 613-640

Wisbrod Armored Vest, 662 Butterfly pattdrnBritish Army, 662 of fragment distribution, 114

British helmet; 641, 642 of missile fragments, 24

British ordnance materiel, 39

British Quartermaster Department, 642 C-46 aircraft, 249

Browning aircraft machinegun, .50 caliber, C-47 aircraft, 249

12 Caliber of weapons:

Browning automatic rifle, 274 German:

BRUNS, P., 145 8.8 cm., 47, 50

Bulldozers, in jungle areas, 239 21 cm., 115

Bullet(s), 18, 315 7.92 mm., 39, 40, 41, 42, 43, 44, 95

boattail, 95 8 mm., 6, 7, 8

cored, metal jacketed, 19, 97 9 mm., 37, 38, 39

deformation of, 125 50 mm., 44

efficiency of, 110 81 mm., 44, 45

external signs of injury produced by, 144, 105 mm., 45

158, 161 120 mm., 45, 46

gyrations of, in various mediums, 131 200 mm., 46

high explosive, 96 380 mm., 46

high-velocity, character of wound from, 93 Japanese:

incendiary, 18, 96 6.5 mm., 8, 9, 10, 78, 79, 289

Japanese 6.5 mm., with enlarged core, 7.7 mm., 8, 9, 10, 78, 79,r289

96-97 8 mm., 6, 7, 8, 78

motion of, in flight, 130 50 mm., 12

ogival, 18 70 mm., 12

percent of death caused by, 315 75 mm., 99

percent of extremity wounds due to, 320 81 mm., 13

relative lethal effect of, 324, 326, 327, 328 90 mm., 13, 14

rifle, 93, 94 105 mm., 99

round-nose, 18, 97 150 mm., 99

sharp-pointed, 95, 97 250 mm., 15

soft-nose, 98 320 mm., 15

theories on explosive effect of, 145 CALLENDER, G. R., 146, 336

tracer, 53, 96 Cambridge American Military Cemetery, 552

weight of, for military use, 112, 119 Camera, high-speed, in measuring velocity,

wounds due to, 320, 663 150

Bullet path. See Wound track. Camouflage:

Bullet Proof Vest, Soldiers', 660 as means of protection, 282

Bulletin of the U.S. Army Medical Depart- in jungle warfare, 279

ment, 438 Camp Lejeune, 725, 726

Burma, 1, 6, 253, 279 Campaign(s):

climate, 246 Bougainville, 281-435

geography, 245-246 Burma, 245-251

hospitals in, 238 Myitkyina, 247

Burma campaign, 237 New Georgia, 239-241

casualties of, 248-251 Shaduzup, 249

evacuation of, 249 Canadian Air Force, 547

hospitalization of, 249 Canister, 98, 99
INDEX 861

Cannon, 4, 92 Casualties--Continued

Cannon Hill, 293, 302 died of wounds, 238, 253, 255

Cannon shell fragments, wounds due to, 663 autopsy study of, 718-720

Carano, 437, 439 disposition of, 264-267, 273-275, 311-321

Carbines, 6, 78-79, 94 distribution of wounds in relation to, 257

ammunition for, 9, 40, 41 evacuation of, 238, 239, 243, 249, 367,

ballistic characteristics of, 94 533-536

German: factor of body armor in, 754--760

G.(Gewehr) 33/40-40, 41 factors in production of, 322

Kar. 98K, 36, 40 fatality rates, 564

Japanese: fractures in, 565-567

Model 38 (1905), 9 hospitalization of, 242, 249

Model 44 (1911), 9 in Bougainville campaign, 312

muzzle velocity of, 9, 40 in Burma campaign, 248-251

United States, 78 in Eighth Air Force, 547-611

Care of Flyer reports, 552 in New Georgia campaign, 240, 242-245

Case reports: in relation to missile mass and velocity,

abdominal wounds, 358-361, 458 231-233

head wounds, 454-456 injured in action, 475, 476

multiple wounds, 364-365, 461-471 Japanese, 248-249, 309-310

pigment nephropathy, 526-529 killed in action, 238, 253, 254, 255, 282,

thoracic and abdominal wounds, 354--357 720, 736-737, 749-764

wounds of- missing in action, 550, 555

extremities, 362-363, 459 number of, influence of position and cover

head and neck, 349-350, 456 on, 416-419

thorax, 351-353, 457-458 pigment nephropathy in, 515-526

"Casque Adrian," 641 ratio of Japanese to American, 303, 306,

See also Helmet(s). 309-310

Cassino, 584, 585 return of, to duty status, 567-568, 575,

battle for, 531-533 592-594

casualty survey in, 531-545 survival time of, 720

medical installations in, 533- 536 treatment of, 347-368

Castelfiorentino, 439, 443 unarmored, 732, 757

Casualties: wounded in action, 238-239, 253, 254, 256,

analysis of, 253-257, 537-545, 555 570 282, 698-711, 732-736

armored, 732, 757 See also Aircrew battle casualties; Killed

bayonet wounds in, 6 in action; Missile casualties; Wounded

blast injury in, 543, 570 in action.

category of, 281-282, 311 Casualty analysis, 253-257

causative agents of, 76, 259-267 basic data, 253-255

automatic weapons, 240-241 Casualty classification:

flak fragments, 634-638 DOW (died of wounds), 238

Japanese weapons, 289-292 KIA (killed in action), 238, 282

small arms, 262, 265 WIA (wounded in action), 238-239, 282

U.S. weapons, 264 wounded-treated-died-later, 312

causes of death in, 238, 485-502, 718, 720 See also Casualties.

classification of, 238, 282 Casualty criterion, 111-112

combat activity of, 419 Casualty-producing weapons, 65

combat position of, 557-558 Casualty rates, 544-545, 557, 558

comparison of Army and Marine Corps, factor of body armor in, 664-665

754-761 Casualty survey(s), 1

crush injuries in, 475, 476 in Bougainville campaign, 281-436

demarcation of body regions in, 558-561 in Burma campaign, 245-251
862 WOUND BALLISTICS

Casualty survey(s)--Continued Chinese Nationalists, 77, 79, 80, 84

in Cassino area, 531-545 Chinese ordnance materiel, use of by North

in Eighth Air Force, 547-611 Korean Forces, 78

in Fifth U.S. Army, 437-471 Chinese units:

in Korean War, 691-727, 761-762 88th Infantry Regiment, 247

in New Georgia campaign, 237-245 150th Infantry Regiment, 248

Category of battle casualties, 281-282, 311 Chi-square test, 540, 587

Cathode ray oscillograph, 118 Chinstrap, of M1 helmet, 644

Cauda equina, 319 Chronograph, Aberdeen, for measuring veCausative agents, of battle casualties, 76, locity, 149

240-241, 259-267, 289-292, 441, 483, Chronoscope, Remington, for measuring

541, 716 velocity, 150

artillery weapons, 15-18 Churchill, Col. E., 525

edged weapons, hand-actuated, 6 Circumstances of wounding, 268-273, 416-

grenade dischargers, 12 430

guns, conventional, 15-18 investigation of, 313

howitzers, 15-18 Civil War, American, 4, 438, 660, 661

motors, 12-15 Clavicle, chip fracture of, 321

rocket launchers, 17 Clearing Company, 112th-242, 243

small arms, 6-12 Clearing stations, plasma administration in,

Causes of death, 238, 718, 720 505, 511

observations on, 485-502 ClimateSee also Death(s). of Burma, 246

Cavalry Board, Fort Riley, 673 of New Georgia Island, 239

Cavity formation, by moving missile, 140 Clostridia, 134

Cellophane, 164 Clostridial myositis, 488

Celotex panels, use of, in ammunition tests, Clothing Development Branch, Philadelphia

22 Quartermaster Depot, 748

Cemeteries. See U.S. military cemeteries. CoE, Capt. G. B.D 648, 692, 727, 753, 759, 763

Central Identification Unit, 763 COLEMAN, H. A., 656, 663

Ceutral Mediterranean Forces, 3 CLMN .A,66 6 Collapse, of temporary cavity, movements

Cervical wounds, 500 following, 181-189

Ceska Zobrovka Brno, 41 Collecting stations:

Chain shot, 98 plasma administration in, 505, 511

Character of wounds. See Wounds, wounded returned to duty from, 311

Chemical Battalion, 82d-298 -

Chemical Corps Medical Laboratories, 691- Colombian Forces, 731

692, 753 Colon, 319

Chemical Corps Research and Engineering Combat, casualties related to types of, 278-

Command, 691 279

Chest, wounds of, 314, 572, 573 See also Defensive action; Offensive

body armor as factor in incidence of, 587 action; Patrol activity.

case reports, 457-458 Combat aircrews:

in living wounded, 253 body armor for, 663, 664-665

percentage of body area, 562 position of, 552

See also Thorax. casualties in relation to, 557-558, 595-

Chest wall, 327 596

Chevasse, Professor, 145 flak hits according to, 586-587

Chief of Ordnance, Office of, 94, 110, 114 Combat patrols. See Patrol activity.

China, 77, 78, 245 Combat teams, regimental, 32, 33, 34

Chindwin, 247 Combat Vehicle Crewman's Helmet, 650-653

Chinese casualties, in Burma campaign, 248 See also Helmet(s).

Chinese Communist Forces, 6, 77 Commanding General, Chemical Corps Reentry of, into Korean War, 692 search and Engineering Command, 691
INDEX 863

Commanding General, Eighth Air Force, 553, Dead:

663 battle, by causative agent, 330

Comparison, of Army and Marine Corps ratio of Japanese to American, 303, 306,

casualties, as related to body armor, 754- 309-310

761 See also Killed in action.

Composite Unit, 5307th (Provisional), 237, Dead on arrival, 473, 476

245-251, 253 DEAN, Dr. B., 661

area of operation of, 246 Death(s):

battle casualties of, 248-251 as related tomission of, 246, 247 anesthesia, 477, 478, 503, 507, 521

organization of, 246-247 hospital admissions, 477, 478

Compound fractures, 320 surgery, 477, 478, 503, 507, 511

Configuration- causes of, 373

of wound of entrance, 161 detailed observations, 499-502

of wound of exit, 161 general observations, 485-492

Configuration of wound track, determination incidence of, 491-492

of, 161-163 circumstances of, 552

Contact fuze, 98, 101, 114 due toContinental-Diamond Fibre Company, 683 abdominal wounds, 502-508

Copper, in small arms ammunition, 18 blast injury, 446

Cored, metal-jacketed bullets, 97 clostridial myositis, 488 Corey, Lt. Comdr. E. L., 683. fat embolism, 489

Corps: gas gangrene, 319, 364, 368

1-o731 intracranial hemorrhage or clot, 487

IX-731 nephropathies, 487, 517

X-731 neural trauma, 487

XIV-28 peritonitis, 488

Corpsof Enpigment nephropathy, 515

Corps of Engineers, 681 pneumonia, 489

COWAN, Comdr. J. S., 727 shock, 485-486, 511-512

Cox, Lt. Col. W. W., 730, 748 thrombotic embolism, 489

CRANZ, C., 145 tracheobronchial obstruction, 489

GREASY, Brig. Gen. W. M., 691 immediate cause of, associated withCrdcy, Battle of, 92 cervical wound, 500

Crew position, 552 intra-abdominal and intrathoracie

body armor for type of, 664 wounds, combined, 501-503

Criteria, for severity of wounds, 267, 323, 336 intra-abdominal wound, 501, 502-511

Crotch armor, 679-680 intracranial wound, 499

See also Body armor intrathoracic wound, 500

Crown Prince Range, 283 intravertebral wound, 500

Crush injuries, 475, 476 lower extremity wound, 502

CULBERTSON, Capt. J. W., 476 maxillofacial wound, 500

Cupronickel, in small arms ammunition, 18, multiple wounds, 502

19 thoracoabdominal wound, 500, 501

Cyclic rate of fire: upper extremity wound, 502

definition of, 2 wound of abdominal wall, 502

of automatic weapons, 95 report of, 485

of German small arms, 39, 41, 42, 43, 44 study of, in Fifth U.S. Army hospitals,

of Japanese small arms, 7, 8, 9, 10, 11, 12 473-530

Cyclonite, 26, 102 See also Killed in action.

Czechoslovakia, 44 DEBAKEY, M. F., 647

Defensive action, casualties of, 278, 419

DANIELS, Capt. A. J., 748 character of, 110
864 WOUND BALLISTICS

Definition, of- Effectiveness of weapons, disposition of

battle casualty, 311 casualties as criterion of, 264-267

killed in action, 323 Eighth Air Force, 613, 620, 657, 663, 666,

ordnance terminology, 2-4 668

Delayed action fuze, 98, 101 aircraft of, battle damage to, 553-554

DELORMIE, E., 145 battle casualties of:

Demarcation, of body regions, 558-561 killed in action, 598

Density of flak hits, on casualty-bearing air- rate of, 555

craft, 620-623 survey of, 547-611

Department of the Navy, bureaus of, 682, bombardment groups of, 548

683, 727 forces of, 548-550

Detonation, of ammunition, 22-25, 63-67 medical installations of, 550

Deutsches Reich, 35 Operational Research Section of, 553, 554,

Diaphragm, perforation of, 319 595

Dinitronaphthalene, 26 Eighth U.S. Army, 692, 731, 758, 763

Directional density, of flak fragments, 613- Electrochemical fuzes, 32

640 Emergency medical tag, 282, 313, 439, 441,

Disposition of casualties, 257, 273-275, 311- 451, 537, 761, 762

321 recording of wound ballistic data on, 761,

according to anatomic distribution of 762

wounds, 273-274 treatment indicated on, 450, 451

according to causative agent, 274-275 Emperor Meiji, 4

as criterion in weapon effectiveness, 264- Emperor Taisho, 10

267, 337-343 Empress Augusta Bay, 283, 288

with abdominal wounds, 319 EMT. See Emergency medical tag.

with extremity wounds, 319, 320 Enemy fighter aircraft, 594-598

with multiple wounds, 321 Enemy ordnance materiel, 1-90

with thoracic wounds, 318 See also German ordnance materiel; JapaDistribution of casualties, according to com- nese ordnance materiel.

bat crew position, 557-558, 595-596 Energy:

Distribution of effective missiles, 112-114 kinetic, 91, 92, 93, 107, 111, 112, 118

Distribution of missile fragments, frequency potential, 118

of, 22 Engineer Combat Battalion, 57th, 298

Distribution of wounds, in battle casualties, Engineer Corps, 681

477-483 Engineers, 557

Divisions. See Infantry division(s); Japa- England, 2, 108, 145, 531, 548, 664, 666

nese units. ENos, Maj. W. F., 753, 762

DORIOT, Col. G. F., 682 ERNEST, Col. K. F., 437

Doron, 655, 677, 682, 683, 691 Espfritu Santo, 288, 337

as body armor material, 725 Ethiopian Forces, 731

"Doron Project," 682 Europe, 35, 666

Dow Chemical Company, 682 European Theater of Operations, U.S. Army,

Drag, 120-123 1, 76

coefficient of, for missiles, 155, 157, 225 Evacuation distances, 337

Dural, 557, 589 Evacuation hospitals. See Hospitals, evacuation.

EAKER, Lt. Gen. I. C., 664 Evacuation of casualties:

Eastman camera, 150 average time for, 536

Edged weapons, as casualty-producing by air, 238, 249

agents, 6 by water, 239

Effective rate of fire, definition of, 2 fractures as major cause for, 321, 328

Effectiveness of missiles, criteria of: in Bougainville campaign, 367

58 ft.-lb kinetic energy, 93 of Burma campaign, 249

pine-board penetration, 93, 112 of New Georgia campaign, 242-243
INDEX 865

Evacuation of casualties--Continued Femur, 320, 362

problems of, 283, 284 damage to, by high-velocity missiles, 200

to Zone of Interior, 256, 257, 260, 265, 315, fracture of, 320, 362

318, 328, 329 Fiberglas, 682

Evacuation planes, 238, 249 Field artillery. See Artillery weapons.

See also Aircraft. Field artillery battalion(s):

Evacuation routes, in Bougainville cam- 246th-298

paign, 283-288 247th-298

Examination(s): Field hospitals. See Hospitals, field.

of American casualties killed in Italy, Fifth U.S. Army, 441, 443, 532, 540

437-471 Adjutant General of, 475, 476, 485

post mortem, 281, 282, 313 casualty survey conducted in, 437-471

Excavation coefficient, of permanent cavity, study of hospital battle casualty deaths in,

155, 158 473-530

Expansion coefficient, of- Fighter aircraft, enemy, 594-598

abdomen, 177 Fiji Islands, 239

head, 177 Fijian Infantry, 288

muscle, 175, 177 Finger, chip fracture of, 321

temporary explosive cavity, 155, 157-158 Firepower, 6, 37, 44, 45, 92, 94, 262, 280, 296,

thorax, 177 310

Explosive cavity. See Temporary cavity. Firestone Tire and Rubber Company, 683

Explosive effect of bullets, theories on, 145 First aid treatment, 366

Explosives. See High explosives; Propel- First U.S. Army, 76

lents. Flak fragments, 557

Exterior ballistics, 143 burst patterns of, at high altitudes, 613-

Extremities: 640

fractures of, 257 casualties produced by, 570-588

wounds of, 257, 314, 321, 361-362, 446, directional density of, 613-640

502, 754, 757, 758, 761 hits by:

case reports, 362-363 regional distribution of, 572

in living wounded, 253 regional frequency of, 573

incidence of, 315 size of, in wound production, 581-584

percent of casualties due to, 255, 256, wounds due to, 663

276, 315, 316, 317, 328, 371, 375, 563, effect of body armor on, 585-588

564, 572, 573, 574, 600, 722 Flak suit. See Flyer's armor.

percentage of projected body area, 275 Flak hits, density of, on aircraft, 620-623

risk of death from, 320 Flamethrowers, 296

survival time of casualties with, 720 Flat bones, damage to, by high-velocity

Eye: missiles, 200

armor for, 680 Flight formations, of heavy bombers, in relainjuries of, 348 tion to casualties, 554

Flyer's apron, 667-671

Face, 321 See also Body armor.

armor for, 659 Flyer's armor, 666

wounds of, 321, 757, 758 See also Body armor.

death due to, 316 Flyer's helmet, 657, 658, 659

Factors peculiar to Bougainville campaign, See also Helmet(s).

283-293 Flyer's vest, 666-667, 669

Far East Command, 692, 727 See also Body armor.

Fat embolism, 489 Follonica, 439, 443

Fatality rates, in air and ground forces, 564, Forearm, fracture of bones of, 319, 361

574-575 Formica Company, 683
866 WOUND BALLISTICS

Formosa, 4 Fuze (s)-Continued

Formulas, for missile motion, 120-123 delayed action, 98, 101

Fort Knox, 650 electrochemical, 32

Fort Riley, 673 in boobytraps, 33

Forward area, hospitals of: nondelay, 99

admissions to, 473, 474, 475, 477, 478, point detonating, 26, 69

481, 483 proximity, 26, 99, 101, 114

evacuation to, 478, 479 time, 26, 98, 274, 275

mortality in, 473, 474, 475, 476, 477, 478,

479 G-2 (intelligence), Americal Division, 298

Foxholes, 101, 105 G. & D. Cook & Company, 660

protection in, 269 Galvanometer, ballistic, 150

Fracture(s), 260 Gas gangrene, 134

in wounded in action, 710-711 amputations due to, 362

indirect, 201, 203 death due to, 319, 364, 368

of extremities, 257, 319, 320 Gas operated, definition of, 2

of mandible, 349 Gas pockets, in tissues, 221

of maxilla, 349 Gelatin gel, 227

regional distribution of, 565 as target, in study of wounding, 147

Fragment(s): collapse of temporary cavity in, 185

agents producing, 71-73 passage of high-velocity missiles through,

causing wounds, 581-582, 725 155, 162, 163, 166

density of, 614 General Electric Company, 683

distribution of, 112-114, 614 General-purpose bomb, 100, 101, 106, 123

from-bomburst, 101 Genitalia, wounds of, 698, 702, 705, 709,

from projectiles, 113, 114 711, 733, 736, 757

pattern of, 114 German Army, 36, 37, 57, 65, 473

size of: German Empire, 35

control of, 100 German ordnance materiel, 35-76

correlated wlth wound size, 576-581 ammunition, 51-66

See also Flak fragments. antitank small arms, 95

Fragmentation bombs, 100, 101, 113 artillery, 46-50

Fragmentation characteristics- by caliber, 37, 38, 39, 40, 41, 42, 43, 44,

of artillery ammunition, 57-67 45, 46, 47, 50, 613-620

of mortar ammunition, 56, 57 distribution of, 73-76

Fragmentation pattern, of missile fragments, grenades, 68-70

24, 26 landmines, 71-73

Fragmentation-type weapon, as primary mortars, 44-46

wounding agent, 646, 661 recoilless weapons, 50-51

France, 2, 35, 77 rocket launchers, 50-51

Frankfurt, Treaty of, 35 small arms, 37-44

FRENCH, R. W., 146 use of, by North Korean Forces, 78

French Army, 641, 680 See also specific weapons by name.

French Forces, 731 Germany, 45, 57, 128, 145

French helmet, 641, 661 Glass, as casualty-producing agent, 106

Frequency distribution, of missile fragments, Grapeshot, 98

22 Graves Registration Burial Form No. 1-

Fukuoka, 692 450, 451

Full automatic weapons. See Machine- Graves Registration Officer, Fifth U.S.

gun(s): Submachinegun(s). Army, 441, 443

Fuze(s): Graves Registration Service, 438, 439, 536,

action of, in bomb detonation, 101 537, 552, 693, 720, 749, 753

base detonating, 26 Great Britain, 77

contact, 98, 101, 114, 116 GREGG, J. R., 108
INDEX 867

Grenade dischargers, Japanese, 27, 290 Head-Continued

ammunition for, 12 wounds of-Continued

Model 10 (1921), 12 percentage of body area, 275, 322, 562

Model 89 (1929), 12 survival time of casualties with, 718-

wounds caused by, 377-379 720

Grenade launchers, 50 Headgear, military. See Helmet(s).

Grenades, 88 90, 92 Heavy bombardment groups:

disposition of casualties caused by, 265 aircraft of, 548, 549

German, 68-70 casualties of, 555

hand, 101-102, 119 operations of, 548, 549

Japanese, 27-32, 292 Heavy bombers:

relative lethal effect of, 260, 261, 262, body armor for crews of, 663

266, 267, 268, 324, 327, 343 flight formations of, in relation to casualrifle, 101-102 ties, 554

wounds produced by 261-263, 340, 379, Helmet(s), 1, 327, 454, 588, 641-642, 650

380 Groin armor, 668, 671 adoption of, 641

Seein alsor Body arm. ballistic properties of, 642, 644

See also Body armor. ballistic test for, 645, 646 GROw, Brig. Gen. M. C., 547, 663, 666 chinstrap of, 644

"Grow helmet," 657 coverage provided by, 275, 644

Guadalcanal, 239, 243, 288, 337 design of, 649-659

Gunners: design of, 643-659

body armor for, 664, 666 description of, 643, 644, 649

casualty rates for, 557, 558, 570, 571 development of, 641-649 Gunpowder, 4, 92, 93 inl Army Air Forces, 656-659

in interval between World Wars I and

Guns. See Artillery weapons. II, 642-643

"Gunshot Injuries," 145

GURNEY, R. W., 111 experimental models of, 642

for ground troops, 653-655

Hadfield manganese steel. See Manganese for Signal Corps, 649

steel. for tank crewmen, 650-653

Halftracks, use of, for evacuation of casual- for ground troops, 649 655

ties, 284 for flyers, 656-659

Hand, fracture of bone of, 319, 361 in Korean War, 763-764

Hand grenades, 27, 32, 101-102, 119, 290, in World War I, 642

446 in World War II, 643

Haneda Air Terminal, Tokyo, 692 materials for, 654-655, 658

Head: military objective of, 646

expansion coefficient of, 177 production of, 642, 645, 649

formation of temporary cavity in, 177- protection afforded by, against low180 velocity fragments, 331

protection for, 641, 642 standardization of, 642, 643, 649, 657, 658,

structural makeup of, 177 659

wounds of, 374, 377, 572, 573, 700, 703, survey of battlefield performance of,

707, 754, 757, 761 -

case reports, 454-456 763-764

frequency of, 314, 562 troop acceptability of, 641, 645

in killed in action, 255 value of, 646-649

in living wounded, 253 weight of, 642, 643, 657, 658, 659

morbid anatomy of, 370 "Helmets and Body Armor in Modern Waroperative mortality for, 348 fare," 661

percent of casualties due to, 255, 256, HELwIG, F. D., 525

258, 276, 315, 316, 317, 371, 375, Hemoglobinuria nephrosis. See Pigment

563, 564, 572, 573, 574, 600, 722 nephropathy.
868 WOUND BALLISTICS

Hemorrhage, 319, 350, 353, 354, 364 Historical note, on mechanism of wounding,

area of, of wound track, 132, 134, 197 143-147

control of, 366 HITCHMAN, N., 647

into peritoneal cavity, 197 Hits, due to flak fragments:

intracranial, 487 regional distribution of, 572-573, 586-587

Henle's loops, 526 regionl frequency of, 573

Hepatorenal syndrome, in anuria, 525 HITLEn, 36

Hercules Powder Company, 683 Hollow charge, 26, 70

High explosive ammunition, 22, 26, 45, 50, definition of, 2

96, 100, 291, 292 HOLMES, Lt. Col. R. H., 692, 727, 754

characteristics of wounds produced by, 96 HORSLEY, V., 144, 145

High explosive antiaircraft shell: Hospital admission and disposition reports,

German 88 mm., 613-620 552

U.S. 90 mm., 618, 620 Hospital battle casualty deaths. See

High explosive motar shell, 99 Death(s).

High explosive projectiles, 99 Hospital mortality, 368, 477, 478

airburst of, 99 Hospitalization:

effectiveness of, 98-99 during Burma campaign, 249

fragment distribution of, 113 during New Georgia campaign, 242

High explosive shell fragments, 483 Hospitals, evacuation:

High explosives, 315 8th-533, 535, 537, 540

amatol, 51, 65, 71 1lth-533, 535

dinitronaphthalene, 26 14th-238, 249

percent of deaths caused by, 315 15th-533, 535

icric acid, 26, 32, 71 16th-533, 535

RDX (cyclonite), 26, 69, 70, 102 21st-282, 286, 287, 367, 368

relative lethal effect of, 324, 326, 327, 328 38th-533, 535, 537, 540

TNT, 26, 27, 53, 55, 70, 71, 93, 99, 102, 103 94th-533, 535

High-speed motion pictures, in study of 171st-692

wounding, 146 Hospitals, field:

High-velocity missiles: 3d-722

bones damaged by, 200-204 10th-533

experiments with, 147 11th-533

explosive effect of, 144, 180 14th-722

external signs of injury produced by, 144, 17th-243

158 52d-286

passage of, through soft tissue, 158 432d (Allied), 533

High-velocity rifle bullet, character of wound Hospitals, general:

produced by, 93 numbered:

Hill 260-293, 294, 298, 310 lst-550

casualties of, 298 7th-550

forces engaged on, 298 20th-238, 249

operations on, 294-298 75th-550

terrain of, 295 91st-550

Hill 500-291, 293 97th-550

Hill 501-291, 293 118th-674

Hill 600-293 184th-550

Hill 700-284, 293, 294, 310 Hospitals, mobile army surgical:

operations on, 299-303 8063d-732

terrain of, 299 8076th-732

Hill 1000-293 8209th-732

Hill 1111-293 Hospitals, portable surgical:

Himalayas, 245 31st-286
INDEX 869

Hospitals, portable surgical-Continued Infantry division(s)-Continued

33d-286 37th-237, 240, 241, 242, 246, 253, 283,

42d-238, 251 284, 286, 288, 293

Hospitals, station: 41st-246

3d-692 43d-239, 240, 241, 242, 246

49th-550 See also Japanese units.

11lth-238, 249 Infantry regiment(s):

118th-692 7th (3d Division), 731

121st-550 llth-731

136th-550 23d (2d Division), 727, 728, 731

231st-550 24th (Americal Division), 296

280th-550 31st (7th Division), 731

303d-550 38th-727, 728

Hotchkiss machinegun, description of, 2 103d (43d Division), 239, 241

See also Machinegun(s). 129th (37th Division), 294, 310

Howitzers. See Artillery weapons. 141st (36th Division), 531, 540

HUGH, Adm. H. L., 727 143d (36th Division), 531, 540

HUGIER, 144 145th (37th Division), 239-240, 241, 302

Hukawng Valley, 245, 246, 247 148th (37th Division), 237, 239-240, 241,

HULLINGHORST, Lt. Col. R. L., 692 242-245, 253

HUME, Maj. Gen. E. E., 692 161st (25th Division), 240, 241

Humerus: 164th (Americal Division), 298

damage to, by high-velocity missiles, 200 169th (43d Division), 239, 240, 241

fracture of, 319, 361 172d (43d Division), 239, 240

176th-241

Impact velocity: 182d (Americal Division), 296, 298

effect of missile weight on, 126-127 See also Chinese units; Japanese units.

factor of, in production of casualty, 116- Initial velocity, 115-116

117 See also Muzzle velocity.

Imperial Russia, 4 Inkangatawng, 247

Incendiary ammunition, 18, 26, 53, 95, 96 Intelligence and Reconnaissance Platoon, 3d

India, 245, 246, 249 Battalion, Merrill's Marauders, 279

Indirect fracture, production of, 201, 203 Interior ballistics, 143

Infantry battalion(s) : Intestines, 319

1st (24th Infantry), 296 Intra-abdominal and intrathoracic wounds,

1st (148th Infantry), 237, 240, 241, 242- combined, 481, 483, 501

245, 253 Intra-abdominal wounds, 501

1st (5307th Composite Unit (Provisional)), special studies on, 502-508

237, 245, 248, 251, 253 statistics, 481, 483

2d (148th Infantry), 240, 241, 243 Intracranial hemorrhage, 487

2d (182d Infantry), 296 See also Hemorrhage.

3d (148th Infantry), 240 Intracranial wounds, 499

3d (5307th Composite Unit (Provisional)), statistics, 481, 483

237, 245, 246, 247, 251, 253 Intrathoracic wounds, 500

See also Japanese units. statistics, 481, 483

Infantry Board, 642, 643 Intravertebral wounds, 500

Infantry division(s): Iodobenzene, 206

2d-731 Iodophenylundecylate, 202, 206

3d-731 IRVING, Maj. J. W., 748

7th-731 Italian campaign, 533

25th-240, 242, 246 Italian ordnance materiel, 39

32d-246 Italy, 76, 473

36th-532 Iwo Jima, 18
870 WOUND BALLISTICS

Jamba Bum Pass, 247 Joint Army-Navy Plastic Armor Technical

Japan, 4, 5, 35, 44, 692, 715, 749 Committee, 683

Japanese Army, 4, 5, 33, 288 Jungle warfare, 99, 291, 314, 422, 574

casualties of, in- casualties of:

Bougainville campaign, 298, 303, 304 character of, 110

Burma campaign, 248-249 frequency of head wounds in, 314

New Georgia campaign, 240, 242 effectiveness of machinegun in, 260

design of weapons for, 4, 5 treatment of wounded in, 366-369

standard sidearm in, 6

Japanese body armor, 675 Kachin villages, in Burma, 246

Japanese casualties. See Japanese Army. Kahili-Empress Augusta Bay track, 291

Japanese Navy, 11, 288 Kamaing, 247

Japanese ordnance materiel, 4-34, 78-79, "Key-hole" wounds, 131

289-290, 291-292 See also Wound(s).

ammunition, 18-27 Kidneys, 319

artillery weapons, 15 Killed in action, 6, 238, 253, 264, 267, 275,

bore sizes of, 5, 6 475, 598-603, 645

by caliber, 6, 7, 8, 9, 10, 11, 12, 13, 14, according to combat crew position, 599

15, 78, 79 causative agents of, 259, 260, 264, 330, 446

comparison of, with U.S. weapons, 5 causes of, 599

distribution of, 33-34 criteria of causes of death in, 602-603

edged weapons, 6 definition of, 311, 323

grenade dischargers, 12, 290 incidence of fractures in, 601

mortars, 12-15, 290, 291 missiles causing fatal wounds in, 599

rocket launchers, 17 post mortem examination of, 281, 282

small arms, 6-12 primary wounding agent of, 646

See also specific weapons by name. statistics, 754

Japanese plan, in Battle of the Perimeter, study of:

293-294 in Fifth U.S. Army, 437-471

Japanese units: in Korean War, 448, 720, 736-737, 749-

Battalion (s): 764

lst-288, 293 survey of, 753-754

2d-288, 293 wounds in:

3d-288, 293 anatomic distribution of, 255-256, 314,

Division(s): 315, 754

6th-288, 298 anatomic location of, 448

17th-288 as related to body armor, 760-761

classification of, 443-446

Regiment(s): regional distribution of, 599

4th Heavy (Medium) Artillery, 288 regional frequency of, 448, 599, 720

6th Field Artillery, 288, 293 single and multiple, 601

13th Infantry, 288, 293, 298, 299 See also Aircrew combat casualties; Cas23d Infantry, 288, 293, 298 ualties; Missile casualties; Wounded in

45th Infantry, 288, 293, 304 action.

53d Infantry, 288 Kinetic energy, 91, 92, 93

81st Infantry, 288 at missile velocities, 118, 119

Japanese weapons, 341 criterion of, 107, 111

relative lethal effect of, 345-346 factor of, in production of casualty, 118

types of, used in Bougainville campaign, formula for, 112

289-292 in wound formation, 117-120

See also Japanese ordnance materiel, in wound production, 144

Jaupadu Bum Mountains, 246, 247 "Knee mortar." See Grenade dischargers,

Jeep ambulances, 243, 284 Japanese.

JERGESEN, Maj. F. H., 488 Knife, as casualty-producing agent, 6
INDEX 871

Koaris, 291 Loading points, ambulance, 535

KocHsm, 145 London, 663

Kokorana Island, 243 Long bones, damage to, by high-velocity

Kokura, 749, 753, 754, 759, 762, 763 missiles, 200-204

Kolombangara, 239 LONOMORE, T., 559

Korea, 6, 45, 77, 99, 692, 715, 720, 727, 730, Lorraine, 35

749, 753, 755, 759, 763 Low-velocity missiles, character of wound

body armor studies in, 691-766 from, 144

hostilities in, start of, 691-692 Lower extremity, wounds of, 256, 257, 377,

wound ballistic studies in, 691-766 378, 502, 702, 705, 709

Korean War, 1, 77, 83, 84, 448, 645, 646, 648, case reports, 459-460

654, 666, 680, 691, 692, 697, 761, 765 morbid anatomy of, 372

use of body armor in, 676, 677, 684 percent of casualties due to, 319, 327, 328

wound ballistic studies on casualties- See also Extremities.

killed in action, 749-764 Lower nephron nephrosis. See Pigment

wounded in action, 732-736 nephropathy.

Krag-Jorgesen rifle, 128 Lower torso armor, 764

Kumon Range, 245 See also Body armor.

Kunu-ri, 715 LST's, for evacuation of casualties, 239, 243

Laboratory: LUCKA, B., 525

2d Medical, 437, 438 Luftwaffe, 36, 37

406th Medical General, 692, 718, 727

Aero Medical, 437, 438 MCKOAN, Col. J. W., Jr., 536

Naval Field Medical Research, 506, 507 MCMILLYN, J. H., 108

LA GARDE, L. A., 145 MAcH, E., 143

LAMPORT, H., 576, 578 Mach number, 121

Landmines, 90, 92, 102-103, 119, 422, 446 Machinegun(s), 2, 3, 79, 95

German, 71-73, 103 American, 5

Japanese: ammunition for, 10, 11, 42, 43, 44

Model 93 (1933), 32 as aircraft armament, 12

Model 98 (1938), 32 as tank armament, 11

Model 99-93 British, 38

yardstick, 32 fire of:

relative lethal effect of, 324 casualties caused by, 76, 265, 290, 330

'wounds produced by, 380 cyclic rate of, 10, 11, 42, 43, 44

Laruma River, 304 wounds produced by, 261-263, 325-326,

Leadership, in prevention of casualties, 279 339

Ledo, 245, 246 German:

Ledo Road, 245, 246, 247, 249, 251 MG 15-44

Leg, fracture of bones of, 320, 321, 362 MG 34-42, 43

Leg armor, 661 MG 37 (T) (Brno), 44

"Lehrbuch von Ballistik," 145 MG 42-43

Lethal effect of weapons, 99-127, 323-329 in jungle warfare, 260

LEwis, Col. I. N., 3 Italian, 38

LEwis, Lt. Comdr. J. L., Jr., 727 Japanese, 292

Lewis machinegun, description, 3 Model 01 (1941), 11

See also Machinegun(s). Model 3 (1914), 10

Liana Beach, 239, 240, 242, 243 Model 11 (1922), 10, 79, 290

Light-case bombs, 101, 102, 112 Model 89 (1929), 12

Liner, inner, of M1 helmet, 643-644 Model 92 (1932), 10, 11, 290

LINK, M. M., 656, 633 Model 96 (1936), 10, 79, 290

Litter bearers, 283, 299 Model 97 (1937), 11

Liver, 319 Model 98 (1938), 12, 44

Living wounded. See Wounded in action. Model 99 (1939), 11, 79
872 WOUND BALLISTICS

Machinegun(s)-Continued Mediterranean Allied Air Forces, 618

muzzle velocity of, 10, 11, 42, 43 Mediterranean Theater of Operations, 1, 76

relative lethal effect of, 260, 266, 267, 268, "Merrill's Marauders," 247, 279

323, 324, 338, 339, 340, 342 Methods, in study of wounding, 147-152

Machinegun bullets. See Bullet(s). Metropolitan Museum of Art, 643, 649, 650,

MALLORY, Lt. Col. T. B., 525, 526 654, 661, 666, 670, 673

Manchuria, 5 MICHALSKI, Capt. J. V., 754

Mandible, fracture of, 349 Micronex (Westinghouse), 150

Manganese steel, 642, 643-644, 645, 654, 658, Microsecond roentgenograms, 118

663, 666, 667, 680, 683 in study of wounding, 146

Marine Corps. See U.S. Marine Corps. Mikado, 4

MARTIN, Brig. Gen. J. L 4 4 Military cemeteries. See U.S. military cemMASON, Maj. J. M., 524 eteries.

Mass of missile:

effect of, on impact velocities, 126-127 Military headgear. See Helmet(s).

in wound production, 26, 144, 146 Military Planning Division, Office of the

Maxilla, fracture of, 349 Quartermaster General, 681, 682

Maxillofacial wounds, 500 Millersford, England, 613, 617, 618

MAXIM, H., 3 Mines. See Landmines.

Maxim machinegun, description of, 3 Missile(s):

See also Machineguns. angle of incidence of, 109

Maximum rate of fire, definition of, 3 bone penetrated by, 227-230

Mechanical time fuze, 26 criteria of effectiveness of, 93, 112

Mechanism of wounding, 143-235 formulas for motion of, 120-123

historical note, 143-147 fragments of, 55, 56

study of: fragmentation pattern of, 24, 26

animals used for, 147 frequency distribution of, 22

nonliving models used in, 147 in wound production, 26

underwater ballistics as guide to, 152- from enemy fiighter aircraft, 596, 597

158 kinetic energy of:

Medical and surgical history, of War of Re- for production of casualty, 93

bellion, 558, 559 in wound formation, 117-120

Medical battalion(s): mass of, as related to production of casu13th-251 alties, 26, 231-233

118th-242 momentum of, 117-120

Medical clearing companies, 533 passage of, pressure changes accompanyMedical Department, U.S. Army, 110 ing, 211-223

Medical Field Service School, 762 physical aspects of, 115-132

Medical General Laboratory, 406th-692, retardation of, 223-226

718, 727 secondary, 589-594

Medical installations, in Bougainville cam- shape of:

paign, 282, 286, 288 ballistic, 124-125

Medical Laboratory, 2d-437 random, 123-124

Medical Operational Research Section soft tissue penetrated by, 227-230

ETOUSA, 547, 550, 552, 553, 581, 598, source of, 94-99

599, 613 velocity of, 26, 91, 92, 115-117

Medical Research and Development Board, as related to casualty production, 231-

Office of the Surgeon General, 691 233

"Medical Service, New Georgia Campaign," impact, 116-117

242 increases in, 91, 92

Medical study, of casualties killed in action, initial, 115

749-764 measurement of damage due to, 146

Medicine and Surgery, Bureau of, Depart- residual, 115

ment of the Navy, 683, 727 variations in, 149
INDEX 873

Missile casualty: Motor Torpedo Boat Squadron Number

physical aspects of, 91-114 Twenty Five, 673

probability of, 107-110, 232-233 Mount Bagana, 283, 291

Missile-producing agents, 68-70 Mount Washington, 104

Missile track, 194 MTOUSA MD Form 86f, 475, 476

injury of organs at distance from, 144 Multiple wounds, 364, 377, 446-448, 502,

See also Wound track. 597-598

Missile warfare, steps in development of, 92, case reports, 364-366, 461-469

93 in living wounded, 253

Missing in action, 550, 555 morbid anatomy of, 373

Mogaung Valley, 246, 247 mortality for, 364

Momentum of missile- percent of casualties with, 255, 256, 258,

in wound formation, 117-120 276, 315, 316, 317, 321, 326, 329, 339,

in wound production, 144 340, 371, 375, 563, 564, 573, 574, 600,

Monsanto Chemical Company, 683 722

Monte Beni, 4, Multiplicity of wounds, as index of weapons'

Monte Lungo, 531, 532 effectiveness, 343-344

Monte Trocchio, Mont 532Prohia,532Munda airfield, 239, 240, 241

Morbid anatomy, of wounds, 369-415 Muscle, temporary cavity formed in, 167-

by weapon, 374-380 176

MORRISSEY, Maj. R. A., 478 Muscle fibers, 161

Mortar(s): damage to, 195

ammunition for, 13, 14, 15, 44, 45, 46, Musket, 4, 92

53-57 Muzzle velocity, 115-116

fire of, 238 definition of, 3

casualties due to, 76, 241, 242, 265, 290, of antitank weapons, 115

330 of artillery projectiles, 115

relative lethal effect of, 260-262, 266, of bomb fragments, 115

267, 268, 323, 324, 327, 328 of German weapons, 37, 39, 40, 42, 43, 44,

wounds caused by, 261-262, 325-326, 47, 50, 95

339, 377-279 of Japanese weapons, 7, 8, 9, 10, 11, 95, 96,

German: 292

50 mm., 44 of sidearms, 94, 115

81 mm., 44 of small arms missiles, 115

105 mm., 45 of U.S. weapons, 95

200 mm. spigot, 46 Myitkyina airfield, 247, 248, 249

Japanese, 292 Myitkyina campaign, 247

70 mm., 12 forces involved, 248

81 mm., 13, 290 Myitkyina Valley, 246, 247, 251

90 mm., 13, 14, 290, 291

250 mam. spigot, 15 320 mm. spigot, 15 NAMBU, Col. KIJIRo, 6 320 rum. spigot, 15 NPLO 1,3

relative lethal effect of, 260, 342 NatoliON iII 35 , 

Soviet, 45 Nationalist China, 79

United States, 44, 45 Naval Field Medical Research Laboratory,

60 mm., 5 725, 726, 727

81 mm., 5, 13 Naval Research Laboratory, 681, 682, 683

Mortar shell fragments: Navigators, 572, 596

characteristics of, 56 body armor for, 664, 666

size of, in nonfatal wounds, 584-585 casualty rates for, 557, 558

wounding potential of, 22-26 Navy Department. See U.S. Navy.

6032251'-62--57
874 WOUND BALLISTICS

Neck, wounds of, 321, 572, 573, 757, 758, 761 Office of the Quartermaster General, 681,

case reports, 456 682, 683

death due to, 316 Office of the Surgeon, Far East Command,

frequency of, 562 692

operative mortality for, 348 Office of the Surgeon, South Pacific Area, 242

percentage of body area, 562 Office of the Surgeon, USSTAF, 548, 585,

Nerve(s), damage to, near wound track, 205- 599

211 Office of the Surgeon General, 681

Neural trauma, 487 Medical Research and Development

New Caledonia, 239, 246, 288, 337 Branch of, 691

New Georgia campaign, 239-241 Okinawa, 684

casualties of, 240, 242-245 Oliguria, 515

casualty survey in, 237-245, 675 Operating time, as index of severity of

methods and materials, 237-239 wounds, 521

evacuation policy during, 243 Operational Analysis Section, Mediterranean

forces involved, 239-240 Allied Air Forces, 618

military operation of, 239-240 Operational Research Section:

report on medical and surgical care during, of Eighth Air Force, 553, 554, 595, 620

242 of Office of the Chief Surgeon, ETOUSA,

New Georgia Island, 1, 6, 239, 253 547, 550, 552, 553, 581, 598, 599, 613

arrival of 37th Division on, 242 Operations Research Office, U.S. Army, 647

climate, 239 Operative mortality, in Bougainville camgeography, 239 paign, 369

New World, 35 Ordnance Department, U.S. Army, 642, 644,

Nhpun Ga, 247 649, 650, 651, 653, 657, 662, 663, 666, 669,

Ninth Air Force, 547, 581, 598, 599 673, 675, 679, 680, 681, 682

Nondelay fuse, 99 Ordnance materiel, enemy, 1-90

Normandy, 684 effectiveness of, 76

North Africa, 663 See also specific country of origin.

North African theater, 76 Ordnance Memorandum No. 5-6, USSTAF,

North Burma. See Burma. March 1944-613

North German Confederation, 35 Ordnance Office, USSTAF, 552

North Korea, 78, 79 Ordnance terminology, definition ofNorth Korean Army, 77, 648 blowback operated, 2

North Korean Forces ordnance materiel, 77- cyclic rate of fire, 2

90 effective rate of fire, 2

Nose gunners. See Gunners. gas operated, 2

Nyenbien, 247 hollow charge, 2

Nylon, 691 maximum rate of fire, 3

material for body armor, 725 muzzle velocity, 3

Nylon body armor vest. See Body armor. recoil operated, 3

setback, 3

O'Brien Hill, 241 shaped charge, 4

0DKOLEK, Capt. Baron ADOLPH VON 2 ORR, T. G., 525

Offensive action, casualties of, 110, 278, 419 Oscillograph, cathode ray, 118

Office of the Chief Engineer, 679 Oxygen therapy, 521

Office of the Chief of Information and Education, Department of the Army, 653 Pacific islands, 5, 27

Office of the Chief of Ordnance, 94, 110, 114, Pack Artillery, 98th-246

683 PALMER, Maj. A., 547

Office of the Chief Surgeon, ETOUSA, 613 PALMER, Capt. R. F., 692

Operational Research Section of, 547, 613 Pangsau Pass, 245

Professional Services Division of, 547 Parachute flare, 323, 324
INDEX 875

Parachutist's helmet, MIC, 649 Pistol(s) 4, 78, 323, 422

See also Helmet(s). ammunition for, 7, 37-38

Paratroopers, 94 German:

Paris, 144, 145 Luger (08), 37

Path of bullet. See Missile track. Parabellum, 37

Patients, disposition of, as index of weapons' Walther (P38), 38, 39

effectiveness, 337-343 Japanese:

See also Casualties. Model 14-7

Patrol activity: Model 94-7

casualties of, 278, 419 "Nambu," 6

evacuation of wounded of, 283, 284 muzzle velocity of, 7, 37

in New Georgia campaign, 241 relative lethal effect of, 324

Pearl Habor, 4 Piva airfields, 291, 293, 294

PECK, Maj. C. H., 661 Plasma, 354

Pentothal sodium, 507 administration of, 366, 505, 511, 519

Perimeter defense, Bougainville campaign. use of, 368

See Battle of the Perimeter. Plasrnodium falciparum, 525

Peripheral nerve injuries, 711 Plasticine, 146, 165

Peritoneal cavity, hemorrhage into, 197 Plexiglas, 147, 149, 157, 557

Peritonitis, 319, 488, 489 fragments of, in wound production, 557

Permanent cavity of wound, 133-134 564, 572, 573, 589, 592, 594

excavation coefficient of, 155, 158 Pneumonia, 489

See also Wound track. Point detonating fuze, 26

PERSHING, General, 662 Position:

PERsico, W., 748 of body, in protection from blast effects,

Personnel protective armor, 641-689 105

See also Body armor; Helmet(s). of casualty, as related to wounding, 268,

Pescadores, 4 269, 270

PETERSON, H-1. L., 661 value of, in preventing casualties, 278

Phenomena of wound formation, 133 Post mortem examination, 369-370

Philadelphia Quartermaster Depot, 748, 749 for determining circumstances of woundPhilippine Forces, 731 ing, 313

PHILLIPS, Capt. W. R., 692, 727 Posture, effect of, on wounds, 540

Physical aspects- Potential energy of missile, factor of, in

of missile, 115-132 production of casualty, 118

of missile casualty, 91-114 Power of missile, in wound production, 144

Picric acid, 26, 32, 71 Powder explosion, 323, 324, 422

Piezoelectric tourmaline crystal, for record- Pressure changes:

ing pressure changes, 152, 211, 215 accompanying passage of missiles, 211-223

Pigment nephropathy: gas pockets in tissues in relation to, 221

blood transfusion in, 524 types of, 211

case reports, 526-529 Prisoners of war:

in battle casualties, 515-526 casualty study of, 722

sulfonamide therapy in, 523 interrogation of, 693

treatment, 530 Probability of a missile casualty, 107-110,

Pillboxes, 102, 294, 296, 302, 304 232-233

protection in, 268, 269, 273, 282, 418, 419, Professional Services Division, Office of the

424, 425 Chief Surgeon, ETOUSA, 547, 613

Pilots, body armor for, 664, 667 Projected body surface area, 321, 571-572,

Pine-board penetration, as criterion of mis- 697

sile effectiveness, 93, 110, 112 See also Body surface area. Piper Cub, for evacuation of casualties, 238 Projectile detonation, fuzes for, 98
876 WOUND BALLISTICS

Projectiles: Region of wounds, in battle casualties, 477-

AP (armor-piercing), 26, 50 483

canister,99 Regional distribution of hits, due to flak

HE (high explosive), 26, 50, 98 fragments, 572

hollow charge, 2, 26, 50, 70 Regional distribution of wounds:

shaped charge, 4, 26 as related to body armor, 757

Propellents: in casualties wounded in action:

black powder, 26, 72, 99 armored, 732

smokeless powder, 92, 93, 98, 99 unarmored, 732

See also High explosives. Regional frequency of hits, due to flak

Protection: fragments, 573

as related to wounding, 268-269 Regional frequency of wounds. See Anatomin preventing casualties, 278 ic distribution of wounds.

Protective devices, for body areas. See Body Relative lethal effect of weapons, 259-267,

armor; Helmet(s). 323-329

Protective measures, for prevention of cas- Remington chronoscope, 150

ualties, 424-430 Renal damage. See Pigment nephropathy.

value of, 531 Rendova, 239

Proximity fuze, 26, 99, 101, 114 Republic of Korea troops, 677

Prussia, 35 1st ROK Division, 731

Prussian Army, 35 Research and Development Division, Office

Public Information Division, Office of the of the Quartermaster General, 681, 748

Chief of Information and Education, Research and Engineering Command,

Department of the Army, 653 Chemical Corps, 691

Pusan, 692, 720 Residual velocity, 115, 117

Pyogenic bacteria, 134 See also Velocity.

Pyongyang, 692 Resuscitation, 478

Pyrotechnic grenade, 12 Retardation, of missiles, 107, 120-123, 226

Retardation coefficientQuartermaster Corps, 650, 651, 681, 727 for missiles, 155, 157, 224, 225, 228

Quartermaster Department, U.S. Army, 644 for skin, 226

Quartermaster General, Office of the, 748 Revolvers, 6, 78

Quartermaster Graves Registration Com- Ribs, protection afforded by, against lowpany, 47th-439 velocity fragments, 331

Quartermaster Graves Registration Service, Riddell-type suspension system, in M1

439, 536, 537, 552, 693, 720, 749, 753 helmet, 644

methods employed by, 439 Rifle(s), 78, 79, 92, 93

Quartermaster Pack Troop, 31 st-246 ammunition for, 8, 9, 41, 42

Quartermaster's Department, British, 642 bore sizes of, 5

fire of:

Radio operators, body armor for, 666 casualties caused by, 76, 260-263, 265,

Random fragments, area of presentation of, 290, 330

127 cyclic rate of, 41

Range of missiles, in production of casualties, wounds caused by, 260-263, 325-326,

419, 716-717 339, 374-377

Rapido River, 531, 536, 540 German, 41-42

Ratio, of killed in action to wounded in FG 42-41

action, 254 M35-42

RDX (cyclonite), 26, 69, 70, 102 PzB 38-42

Recoil operated, definition of, 3 PzB 39-42

Recoilless weapons, 50-51 Japanese, 292

Regimental Combat Team, 25th-288 Model 2 (1942), 10

Regiments. See Chinese units; Infantry Model 38 (1905) (Arisaka), 4, 8, 290

regiments; Japanese units. Model 97 (1937), 9
INDEX 877

Rifle (s)--Continued Ships, Bureau of, Department of the Navy,

Japanese-Continued 683

Model 99 (1939), 9, 290 Shock, 319, 353, 354

muzzle velocity of, 8, 9, 42, 95, 96, 115 as contributory cause of death, 507, 508

relative lethal effect of, 260-262, 266, 267, as immediate cause of death, 485-486, 503,

268, 324, 338, 339, 340 504, 506, 511-512

United States: Shock wave:

Browning automatic, 274 movement of, through tissue, 145

M1-41 of missile in air, 149

M1903-4, 8, 128 technique for recording of, 150

Springfield, 78 Shock wave pressures:

Rifle bullets. See Bullet(s). characteristics of, 157

Rifle grenades, 27, 101-102 methods for recording of, 150, 211

Ringer's solution, 211, 212, 217, 221 velocity of, 211

Rocket launchers, 17, 50-51, 83 Shoulder weapons:

Rocket projectiles, fragment distribution of, in wound production, 94, 95

114 muzzle velocities of, 95

Rocket-propelled bombs, 93 Shrapnel, 26, 98, 99, 112, 291

Rockets, 93 vleo,9 as aircraft armament, 17 value of, 93

Roentgenograms, microsecond, in study of

wounding, 146 SHUEY, Lt. Col. H. E., 437

Rome, 531 Siberia, 5

Round-nose bullets, 97 Sidearms, muzzle velocities of, 94, 115

See also Bullet(s). Signal Corps Helmet, 649

Routes of evacuation, 242 See also Helmet(s).

in Bougainville campaign, 283-288 SIMEONE, Lt. Col. F. A., 488

Royal Air Force, 547 Size, ofRoyal Canadian Air Force, 547 wound of entrance, 93, 144, 161

Royal New Zealand Air Force, 288 wound of exit, 93, 144, 161

wound track, 161-163

Scalp, wounds of, 321 Skin:

Scapula, fracture of, 319 elasticity of, 136

SCHUTZ, C. B., 525 elation of, 136

Seagrave Portable Hospital, 251 penetration of, 138-139

Secondary missiles, in wound production, Skull:

106-107 damage to bones of, by high-velocity misSeoul, 731 siles, 200, 204

Self-inflicted wounds, 311, 714 protection afforded by, against lowSemiautomatic weapons. See Carbines; velocity fragments, 331

Pistol(s); Revolver(s). Small arms ammunition, 95

Setback, definition of, 3 AP (armor-piercing), 11, 18

Seven Weeks' War, 35 ball, 8, 9, 10, 11, 18, 37

Shaduzup, 247 bottlenecked semirimless cartridge, 7

Shaduzup campaign, 249 effect of, on targets, 18, 19

Shape of missile, in wound production, 144, explosive, 18

146 German, 51-53

Shaped charge, 26 incendiary, 18

definition of, 4 Japanese, 7-12

Sharp-pointed bullet, 97 metals used in, 18

See also Bullets. reduced-charge (practice) ball, 8, 9, 10

Shell fragments, 483, 557, 614 tracer, 11, 18

Shields, abdominal 661 Small arms fire, casualties due to, 76, 242, 265

See also Body armor, disposition of, 265
878 WOUND BALLISTICS

Small arms weapons, 6-12, 37-44, 94, 446, 483 Statistics-Continued

ammunition for, 7, 8, 9, 10, 11, 37, 38, 39, on effectiveness of weapons, 259-267, 323-

40, 41, 42, 43, 95, 96, 124 329

antitank, 95 on lethal effect ofas casualty-producing agents, 6 bullets, 325

automatic, larger than 8 rmm., 95 grenades, 327

by caliber, 94 high explosives, 325

cyclic rate of fire of, 7, 8, 9, 10, 11, 12, 39, mortars, 327

41, 42, 43, 44 peripheral nerve injuries, 711-712

muzzle velocity of, 7, 8, 9, 10, 11, 37, 39, time lost from flying status, 567-568

40, 41, 42, 43, 95, 115 type of wounding, 702-709

range of, in wounding, 271-273 wounds, 481, 483

relative lethal effect of, 259-267, 323-329 anatomic distribution of, 563

See also specific weapons by name. causative agents, 718-720

Smokeless powder, 92, 93, 98, 99 of the abdomen, 319, 698, 701, 704, 708

SYNDER, Col. II. E., 477 of the extremities, 698, 701-702, 705,

Societ6 Anonyme des Anciens Establisse- 709

ments, Hotchkiss et Cie, 2 of the genitalia, 698, 702, 705, 709, 711,

Sodium bicarbonate, 524 733, 736, 757

Soft-nose bullets, 98 of the head, 316, 698, 703, 707

See also Bullet(s), of the thorax, 318, 698, 701, 703, 704,

Soft tissue(s): 707, 754, 757, 758, 761

water content of, 153 regional distribution of, 562

wounds of, 320, 321 self-inflicted, 714

"Soldiers' Bullet Proof Vest," 660 vascular, 712-714

Solomon Islands, 293 Steel, 691

South Pacific Area, 22-25, 76, 242, 246, 283, as body armor material, 725

290, 310 in small arms ammunition, 18

ammunition tested in, 22-24 Steel spheres, in study of wounding, 147

Southwest Pacific Area, 246, 675 STEVENSON, W. F., 145

Soviet Russia, 36 Stomach, 319

Soviet Union, 78, 83 STOUGHTON, Lt. R. B., 759

SPAATZ, Lt. Gen. C., 663 Strength, of U.S. forces, inSpall, 107 Myitkyina campaign, 248

Spark shadowgraph: New Georgia campaign, 240, 242

for shock wave recording, 150 Strafing, 100-101

in study of wounding, 146 Study, of armored vests used in field test,

Special-purpose bombs, 101 737-741

Spinal cord, transection of, 316, 319 Submachinegun(s):

Spleen, 319 American, 5, 78

Springfield M1903 rifle, 4, 8, 128 ammunition for, 5, 7, 39, 40

See also Rifle(s). British, 39

Statistics: cyclic rate of fire of, 8, 39, 40

amputations, 566, 567 German, 39, 40

casualties, 76, 242, 248-249, 254, 311 Italian, 39

causes of death, 485-502 Japanese, 5, 7

fractures, 565, 710-711 muzzle velocity of, 7, 8, 39, 40

helmets, 649, 657, 658 Sulfanilamide, 523, 524

hits, due to flak fragments, 572, 573 Sulfonamide therapy, 523

hospital battle casualty deaths: Surgeon, Eighth Air Force, 663

by causative agent, 483 Surgeon, Far East Command, 692

by distribution of wounds, 481, 483 Surgeon, Fifth U.S. Army, 437, 540

by region of wounds, 481 Surgeon, USSTAF, 547, 552, 555
INDEX 879

Surgeon General, The, 725 Thoracoabdominal wounds, 353, 500, 501

Surgery, as related to hospital battle casualty case reports, 354-357

deaths, 477, 478, 503, 511 morbid anatomy of, 372

Survey, of Eighth Air Force battle casualties, mortality for, 353-354

547-611 Thorax, 179, 353

collection of data, 548-554 expansion coefficient of, 177

summary and conclusions, 603-611 formation of temporary cavity in, 177-180

Survival time, of casualties, 720 protection of, 664

Suspension system, Riddell-type, in MI structural makeup of, 177

helmet, 644 temporary cavity in, 177-180

Switzerland, 145 wounds of, 255, 350-351, 375-376, 378,

Sydney, 674 446, 701, 704, 707, 754, 757, 758, 761

case reports, 351-353

Tanai Hka River, 246 morbid anatomy of, 371-372

Tank(s), Tiger, 47 mortality for, 350

Tank casualties, 99 percent of casualties due to, 255, 256,

See also Casualties. 258, 276, 315, 316, 317, 318, 327,

Tank crash helmet, 650-653 371, 375, 563, 564, 572, 573, 574,

See also Helmet(s). 600, 722

Target area, of projected body surface, 108 Thrombotic embolism, 489

Temporary cavity: Tibia, chip fracture of, 320

duration of, 167 Tiger Tanks, 47

expansion coefficient of, 155, 157-158 Time fuze, 98, 274, 275

movements following collapse of, 181-189 Tissue(s):

of wound formation, 134-136 damage of, histologic character of, 140

in abdomen, 177-180 destruction of, 117

in head, 177-180 elasticity of, 132, 134, 135

in muscle, 167-176 gas pockets in, 221

in thorax, 177-180 missile penetration of, 227-230

pulsations of, 136-138, 153 passage of high-velocity missile through,

shape of, 164 158

size of, 164 pressures of high-velocity missiles moving

Terminology, ordnance, definition of, 2-4 through, 179

Terrain, of- velocity of shock wave pressures in, 211

Hill 260-295 water content of, 153

Hill 700-299 TNT, 26, 27, 70, 71, 93, 99, 102, 103

North Burma, 246, 247 Toggliers, 557

129th Infantry sector, 304 Tokyo, 692, 727

Textolite, 149 Tokyo Army Hospital, 692, 711, 715, 753

Thigh, 187, 320 Tongnae, 693, 722

Top turret gunners. See Gunners.

wound track in, 189-197 Torokina River, 283, 284, 293, 295

Thiopental sodium, 507 Tourniquet, 319, 366

Third Reich, 36 Tracer ammunition, 8, 10, 11, 18, 26, 53t

Third U.S. Army, 76 96, 100, 292

Thirty Years' War, 35 characteristics of wounds produced by, 96

Thoracic wall, wounds of, 321 Trachea, perforation of, 349

Thoracic wounds: Tracheobronchial obstruction, 489

casualties with: Trajectories, length of, in wound production,

disposition of, 318 716

survival time of, 720 Trauma, neural, 487

effect of body armor on, 736, 737 Traumatic amputations. See Amputations.

statistics, 318, 698, 701, 703, 704, 707, Treatment, of wounded, 347-368

754, 757, 758, 761 comment on, 366-368
880 WOUND BALLISTICS

Treaty of Frankfurt, 35 U.S. Army Quartermaster Department, 644

Treaty of Versailles, 36 U.S. Casualties, caused by U.S. weapons,

Trenches, 105 277-280

THIMBLE, Lt. Col. I. R., 674, 675 methods for prevention of, 277-280

body armor designed by, 685-689 U.S. Marine Corps, 684

Troop acceptability- body armor of, 728-729, 754-756

of body armor, 661 units of, 727, 755

of helmets, 641, 645 U.S. Military cemeteries, inTroop Carrier Command, 2, 581, 598, 599 England:

Troop strength- Cambridge, 552

in Bougainville campaign, 288 Italy:

in Burma campaign, 248 Carano, 437, 438

in New Georgia campaign, 240 Casteiflorentino, 438, 443

Trucks, for evacuation of casualties, 243 Follonica, 438, 443

Tsushima Bay, Battle of, 4 Monte Beni, 437, 438

Turkish brigade, casualty survey of wounded U.S. Navy, body armor program in, 683-684

of, 715-718 U.S. ordnance materiel, 6, 12, 40, 50

Type of wounds, in battle casualties, 477- artillery, 5

483 carbines, 78

machineguns, 12

Unaimed weapons. See Artillery; Grenades; mortars, 5, 13, 14, 44, 45

Mortar(s). rifles, 4, 8, 41, 78, 128, 274

Unarmored aircrew personnel, 587-588, 664 rocket launchers, 50

Underwater ballistics, 146 submachineguns, 44

as guide to wounding mechanism, 152-158 U.S.S.R., ordnance materiel of, 45, 77-90

United Kingdom, 547, 550, 555, 556, 620, U.S. Strategic Air Forces, (USSTAF), 547,

625 548, 585, 599

United Nations forces: Ordnance Memorandum No. 5-6, March

casualties of, 720 1944-613

in Korea, 79 surgeon of, 547, 552, 555, 556

participation of, in body armor test, 731 Surgeono 5

United Nations weapons, effect of, on .. epos American casualties due to, 264, 311, 345

enemy, 693 bore size of, 5

United States Rubber Company, 683 bore se 5of, 

University of Oklahoma, affiliated unit from, relative lethal effect of, 345-347

286

Upper extremity, wounds of, 502, 701, 705, Vascular damage, degree of, at distance from

709 wound track, 197

percent of casualties due to, 319, 327 woundstrack,719 See lseExtrmites.Vascular wounds, 712-714

See also Extremities. survival time of casualties with, 718, 720

Uremia, 354

U.S. Army: Velocity:

First, 76 function of, in missile effectiveness, 92

Third, 76 measurement of, 149-150

Fifth, 473, 532, 540 of air, 104

Eighth, 692, 731, 758, 763 of blast wave, 104

U.S. Army all-nylon vest, 728 of missiles, 115-117

test of, 731-732 in wound production, 114, 146

See also Body Armor variations in, 149

U.S. Army Medical Department, 111 of missile fragments, in wound production,

U.S. Army Medical Service, 1 26, 336, 337

U.S. Army Ordnance Department, 642, 644, of sound, 104

649, 650, 651, 653, 654, 657, 658, 661, 662, Venturi tube, 50

663, 666, 669, 673, 675, 679, 680, 681 Versailles, Treaty of, 36
INDEX 881

Vertebral wounds, survival time of casualties Weapons-Continued

with, 720 See also Causative agents; specific weapons

Vest, armored, in field test, study of, 737-741 by name.

See also Body Armor. WEBSTER, Lt. Comdr. A. P., 683

"Vickers." See Maxim machinegun. Wehrmacht, 37

Vickers Sons and Maxim, Ltd., 3 Weight, ofVisceral lesions, in wounded in action, 319 helmets, 642

Volks Grenadier division, 73 German 88 mm. high explosive antiaircraft

VON BISMARnK, OTTO, 35 shell, 613

VON ODKOLEK, Capt. Baron ADOLPH, 2 military bullets, 112, 119

Vulnerability, of projected body area, 108- missile fragments, in wound production,

110, 585 26, 581, 582, 584

Western Electric 8 mm. camera, 150

Waist gunners. See Gunners. Westinghouse Electric Corporation, 683

Walawbum, 247 Westinghouse X-ray surge generator, 150

Wangabum Mountains, 247 WESTON, Lt. L. E., 279

War(s) : WILHELM I, of Prussia, 35

American Civil, 4, 438, 660, 661 Wilkinson Sword Company, Ltd., London,

Korean, 1, 77, 83, 84, 448, 641, 642, 645, 663

646, 647, 648, 654, 666, 677, 680, 684, WILSON, L. B., 145

691, 692, 697, 76], 765 Winchester smoothbore gun, 149

Seven Weeks', 35 Wind velocities, 104

Thirty Years', 35 Wisbrod Armored Vest, British, 662

World War 1, 3, 39, 94, 98, 100, 102, 103, See also Body Armor.

110, 112, 128, 145, 347, 641, 642, 646, WOOD, Col. J. R., 691, 727

661, 673, 675, 681, 695 World War I, 3, 39, 94, 98, 100, 102, 103,

World War II, 4, 5, 6, 8, 9, 10, 15, 17, 33, 110, 112, 128, 145, 347, 641, 642,

36, 39, 42, 44, 71, 79, 80, 84, 94, 95, 646, 661, 673, 675, 681, 695

99, 100, 101, 103, 111, 114, 314, 559, adoption of helmets during, 641, 642

641, 643, 645, 646, 647, 648, 649, World War II, 1, 4, 5, 6, 8, 9, 10, 15, 17, 33,

652, 653, 655, 656, 658, 662, 663, 666, 36, 39, 42, 44, 71, 79, 80, 84, 94, 95,

673, 679, 681, 683, 684, 691, 695 99, 100, 101, 103, 111, 114, 314, 559,

War of the Rebellion, medical and surgical 641, 642, 643, 645, 646, 647, 648, 649,

history of, 558, 559 652, 653, 655, 656, 658, 662, 663, 666,

Water: 673, 679, 681, 683, 684, 695

as casualty-producing missile, 120 causative agents of battle casualties in, 76

collapse of temporary cavity in, 181 casualty surveys conducted during:

content of, in soft tissues, 153 in Bougainville campaign, 281-436

use of, in study of wounding, 152-158 in Burma campaign, 245-251

shock wave pressures in: in Cassino area, 531-545

characteristics of, 157 in Eighth Air Force, 547-611

velocity of, 211 in Fifth U.S. Army, 437-471

Watertown Arsenal, 691 in New Georgia campaign, 237-245

Weapons: Wound(s):

antimateriel, 92 anatomic distribution of, 109, 255, 256,

antipersonnel, 91, 100 258, 276, 311-321, 327, 371, 375, 722

causing casualties, 259-267, 322-347 as related to body armor, 759

description of, 289-292 as related to causative agent, 260-263,

effectiveness of, 331-336 325-326, 329, 339, 374, 699, 733, 735,

by disposition of patients, 337-343 736, 738, 755

German, 35-76 as physical entity, 132-141

Japanese, 4-34, 78-79, 289-292 case reports, 349, 351, 354, 358, 362, 364,

lethal effect of, 323-329, 345-347 454-471

United States, 5, 94, 264, 3117,345-347 cervical, 500
882 WOUND BALLISTICS

Wound(s)-Continued Wound (s) -Contin ued

character of, 93, 96, 117, 119 of neck, 456, 470

from high-velocity missiles, 92, 101, 102 of thorax, 255, 318, 327, 350-351, 375-376,

from low-velocity missiles, 144 378, 446, 701, 703, 707, 754, 757, 758,

classification of, 443-446 761

decrease in number of, due to body armor, permanent cavity of, 133-134

664-665 regional distribution of, 541-543, 562, 698,

diagnoses of, 451 761

due to- regional frequency of, 563

all missiles, 562-563 self-inflicted, 311, 714

cannon shell fragments, 663 severity of, 267, 323, 336, 521, 567, 575,

flak fragments, 585-588, 663 577, 592, 594

machinegun bullets, 663 criterion of, 567, 575, 576, 592, 594

missiles from enemy fighter aircraft, size of, 576

597, 598 soft-tissue, 320, 321

missiles of low to medium velocity, 661 statistical studies on, 443-446

Plexiglas fragments, 589, 590 survival time of casualties with, 718-720

secondary missiles, 663 thoracoabdominal, 500, 501

effect of body armor, 585-588, 759 type of, 702, 703, 704, 705, 706, 707, 708,

effect of posture on, 540 709, 713, 755

formation of: weapons responsible for, 541

mechanics of, 93 vascular, 712-714

phenomena of, 133 Wound Ballistics Research Team, 692

in armored personnel, 587-588 administrative conduct of, 696-697

in killed in action, criteria for analysis of, conclusions of, 723-725

561 entry of, into Korea, 692

in unarmored personnel, 587-588 findings of, 697-698

in wounded in action, 698-711 observations of, 723-724

incapacitating vulnerability of, 108 recommendations of, 724-725

incidence of, 315, 757 Wound Classification Report, 475

intra-abdominal, 501 Wound distribution, factors of, 109-110

intra-abdominal and intrathoracic, com- Wound of entrance, 131, 158

bined, 481, 483, 501 configuration of, 161

intracranial, 499 size of, 93, 144, 161

intrathoracie, 500 Wound of exit, 158

intravertebral, 500 configuration of, 161

maxillofacial, 500 size of, 93, 144, 161

mechanics of production of, 93 Wound production, mechanics of, 93

method for charting of, 762 Wound-producing missile, criterion for efmorbid anatomy of: fectiveness of, 107, 108

by region, 370-374 Wound track, 133-134

by weapon, 374-380 area of extravasation of, 134

multiple, 502 configuration of, 161-163

of abdomen, 319, 357-358, 376, 378, 446, degree of vascular damage at distance from,

572, 573, 701, 704, 708 181, 185, 197

of abdominal wall, 321, 502 extent of damage around, 189-200

of entrance, 93, 131, 144, 158, 161 features of, 133

of exit, 93, 144, 158, 161 hemorrhage area surrounding, 132, 134

of extremities, 257, 314, 319, 320, 321, 361- in lung tissue, 198

362, 446, 502, 701, 705, 709, 757, 758 in muscle, 158-167

of genitalia, 698, 702, 705, 709, 711, 733, in thigh, 189-197

736, 757 nature of, 189-200

of head, 314, 374, 377, 572, 573, 700, 703, size of, 161-163

707, 754, 757, 761
INDEX 883

Wounded in action, 475, 476, 540, 552, 646, Wounding-Continued

715 mode of, 723

blast injuries in, 543 single versus multiple, 706

definition of, 311 Wounding potential, of missile fragments,

disposition of, 312, 316 22-26

fractures in, 710-711 Wounding power, of bombs, 531

primary wounding agent of, 646 "Wounds in War," 145

single versus multiple wounding in, 706 Wright Field, 654, 666

statistics, 698-711

wound ballistic data on, 698-711, 732-736 Yaw, 93, 96, 100, 127-132, 134

wounds of, 540-543 angular velocity of, 130

anatomic distribution of, 314, 315, 316 degree of, 131-132

See also Casualties. factors in production of, 128

Wounding: Ywangabum Mountains, 246

agents of:

ballistic characteristics of, 91-141 Zanana Beach, 239, 240, 242, 243

degree of damage from, 717 Zinc, in small arms ammunition, 18

circumstances of, 268-273, 416-430 Zone of Interior, 710-711, 730

mechanism of, 143-235 ammunition tests in, 25, 63-67

methods used in study of, 147-152 ZUCKERMAN, S., 108, 146, 559, 697

0