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Chapter II

Contents

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SECTION I

GENERAL SURGERY

CHAPTER II

FIREARMS AND PROJECTILES; THEIR BEARING ON WOUND PRODUCTION

The military surgeon, during the World War, had brought to his attention, in his treatment of wounds, many factors of which the experience of previous wars had furnished few or no data, and to which the experience of civil surgical practice had contributed almost nothing. The effects of direct shock and of secondary missiles from high-explosive shells, of multiple wounds from machine-gun fire, and the exaggerated effects of pointed rifle bullets of very high velocity were the chief factors of which previous military and civil experience had given little or no suggestion. It is true that considerable experimental data, particularly concerning the effects of small-arm missiles, had been accumulated

FIG. 6.- United States 14-inch railway artillery. This type was evolved entirely by the United States Ordnance Department. It is an excellent weapon for coast defense and hurls a 1,200-pound projectile more than 18 miles

which were corroborated by battle-field experience during the war, but unfortunately the experimental data, prior to the war, had been regarded as largely theoretical or at least lacking confirmation either in military experience or in big-game hunting. As a result, the surgeons of all armies, not only those drawn from civil medical practice but also those with previous experience in military surgery, found many conditions in the type and extent of the wounds encountered which they were unprepared to meet and unable to explain. And thus, early in the experience of each nation involved, the lives of many wounded men undoubtedly were sacrificed which might have been saved had the men come under surgical treatment at a period after the attending surgeons had become more familiar with actual wound conditions.


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FIG. 7.- United States 12-inch rifle on sliding type railway mount. It is capable of hurling a 700-pound shell 2.5 miles. This is a modified Schneider type of carriage

FIG. 8.- British 9.2-inch howitzer, model 19l7. This gun shoots a shell weighing 290 pounds 8,690 meters


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It is the purpose of this chapter to summarize the more salient facts, from the standpoints of weapons and missiles used by the several nations in their relation to wound production, and of pathology and physics which were learned from a study of war wounds.

ARTILLERY

The artillery used by the belligerents in the World War underwent various changes subsequent to the beginning of the war in 1914, and in consequence of the varying conditions along the front.1 In the earlier months of the war, when the character of warfare was open. light mobile field guns were used almost exclusively on both sides, with the exception of the large siege guns and mortars used by the Germans to reduce Belgian fortifications.1 The subsequent use of intrenched positions necessitated resorting to additional heavier guns.

The calibers commonly used by the Germans are given in Table 1.

FIG. 9.-United States 240-mm. howitzer, model 1918

TABLE 1.- Some German guns and howitzers a
 
a Sources of information: (1) Data taken from S. S. 356, Handbook of the German Army in War, April, 1918. Issued by the General Staff (British-Ed.), 6/18. (2) Notes on German Artillery Materiel, I, Divisional Artillery, second edition, issued by second section, General Staff, American Expeditionary Forces, Nov. 1, 1918. (3) Ordnance Data, VI, European Artillery, German, memorandum supplied to Gen. J. II. Rice, chief ordnance officer. A. E. F., by Colonel Coles, and forwarded to Chief of Ordnance, Washington, D. C. Received Oct. 30, 1918. On file, Office of Chief of Ordnance, Ordnance Library, U F 520, XOO, Vol. VI


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FIG. 10- United States 155-mm. howitzer, model 1918 (Schneider). This weapon throws shell or shrapnel weighing 95 pounds. Muzzle velocity for shell is 1,420 feet per second

Besides the guns listed in Table 1, various trench mortars were in use by the Germans, the principal ones being given in Table 2.

TABLE 2.- German trench mortars. a

FIG. 11.- United States 7-inch Navy rifle mounted on a pedestal on a railway car. This rifle has a range of about 10 miles and throws a projectile weighing 165 pounds


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FIG. 12.- United States 4.7-inch gun and carriage, model 1906. This gun throws a projectile weighing 45 pounds a distance of about 6 miles

FIG. 13.- United States 75-mm. field gun, model 1917 (British). This gun throws a shell weighing 12.3 pounds a distance of 8,300 meters, with a muzzle velocity of 1,750 foot-seconds, and shrapnel weighing 16 pounds a distance of 8,900 meters, with a muzzle velocity of 1,680 foot-seconds


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The German 7.7-cm., the French 75-minn., and the British 3.3-inch (18-pounder), all of which were relatively light field guns, were the most used by these three armies;2 the American forces used almost entirely the French73-mm.3 field gun. In the later stages of the war, heavy artillery came more and more into use. Of the heavier types the French 90-mm., 105-mm., 120-mm., 155-mm., and the 220-mm.,1 and the British 5-inch gun and 6-inch, 8-inch, and 9.2-inch howitzers,4 together with a considerable number of large caliber naval guns usually mounted for land operations on railway carriages, came into general use.1

FIG. 14.- French 75-mm. fleld gun. This type of gun has been used by the French Army since 1897 and was the gun most used by the Allies in the Great War. This gun throws a shell weighing 12.3 pounds a distance of 8,400 meters, with a muzzle velocity of 1,805 foot-seconds, or shrapnel weighing 16 pounds a distance of 9,000 meters, with a muzzle velocity of 1,.755 foot-seconds

ARTILLERY PROJECTILES

The shape and weight of artillery projectiles are determined largely by ballistic factors which only remotely affect the wounding capacity. The thickness and tensile strength of the wall must be sufficient to prevent destruction or fracture by the firing and rotational stresses. Once this condition is attained the thickness and fracture-index of the walls and the amount and character of the shell contents are designed to produce the greatest destroying effect for which the shell is to be used.

As used during the World War, artillery ammunition consisted of shrapnel, high-explosive shell, armor-piercing shell, or special shell such as gas shell, incendiary shell, smoke shell, and star shell.

SHRAPNEL

Shrapnel shell is usually made as thin-walled as possible and still withstand firing and rotational stresses. 5 The largest number of bullets possible, of sufficient weight to maintain wounding energy, are packed within the shell cavity. 6


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During the war the artillery ammunition of each of the armies showed a considerable variation in the size and weight of the shrapnel bullets used in shells of different calibers. Table 3 will give some idea of the number in the shrapnel shells in the three most used light field guns.

FIG. 15.- Types of shrapnel in modern use

FIG. 16.- A type of the high-explosive shrapnel

TABLE 3.- Shrapnel shell used in light field guns. a

Shrapnel shell is designed primarily for man-killing, although frequently it is employed for destroying obstacles such as wire, billets, and so forth.7


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FIG. 17.- French 75-mm. high-explosive, nose-fuse shell


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In shrapnel fire against men the shell is made to explode in the air so as to discharge in a compact mass. 8 The opening charge somewhat accelerates the velocity of the bullets (about 200 foot-seconds) at the moment of their releases.6

FIG. 18.- Fragmentation of 10-inch common steel shell weighing 221 pounds. Total number of fragments recovered, 4,078

The height and angle of descent of the shell at the moment it is opened determines in large measure the angle at which men are struck and also accounts to some extent for the large proportion of wounds in the upper exposed parts of the body. The chief function of the steel helmet is protection from this overhead shrapnel fire.

Shrapnel shells are generally made of forged steel with high tensile strength, and when used with bursting charges of low energy are not fragmented.5

HIGH-EXPLOSIVE SHELL

The high-explosive shell, as its name implies, contains a large destructive charge of some high explosive.9 It is made in two general types,10 either with

FIG. 19.- Smaller fragments of high-explosive shell (actual size)

thick strong walls and relatively reduced amount of explosive for the production of man-killing splinters, or with relatively thin walls and a very large explosive content for cutting wire entanglements, destroying dugouts, buildings,


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and so forth. The German 77-mm. high-explosive shell had a thick casing and contained at relatively small charge (about 133 gin, of picric acid) 11 On detonation about 300 fragments were produced, varying in weight from 10 to 200 (gm., with an initial velocity of from 300 to 400 meters a second.11 The

FIG. 20.- Actual size of fragment of high-explosive shell removed from lower jaw

French 75-imm. shell had at thinner easing and carried a heavy charge, about 825 gm. of melinite. 11 On detonation this shell burst into about 2,000 small splinters with a very high initial velocity of approximately 1,000 to 1,200 meters a second. 11

FIG. 21 .- Shrapnel and rifle bullets removed from wounds

Small splinters from high-explosive shell. owing to their relatively low specific gravitv as eomparedl with shrapnel hall and the high air resistance due to their irregular shape, rapidly lose their velocity and do not fly far. It is ordinarily estimated that the best man-killing weight of splinters from the


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FIG. 22.- Shell fragments removed from wounds

FIG. 23.- Portion of casing of 210-mm. high-explosive shell, with piece of olive-drab cloth still adherent, removed from wound


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high-explosive shell is about 25 gm., although splinters lighter than 10 gm. may be very effective near the point of explosion.12The German 7.7-cm. high explosive shell weighing about 15 pounds was designed to give 135 splinters of an average weight of 50 gm.12 The French 75-mm. high-explosive shell, weighing about 12 pounds, was designed to give only 50 splinters averaging 100 gm. in weight.12 The effectiveness of this shell depended on the high velocity near the point of explosion of the very large number of small splinters into which it was fragmented. This shell was highly effective over an area of about 25 square meters.12 The German 7.7-cm. shell was less thoroughly effective over a considerably larger area .12

FIG. 24.- Piece of shell (above) and two pieces of cloth (below) removed from a shell wound of the back, having some fibers of cloth still clinging to piece of shell. Actual size

Besides the steel splinters from high-explosive shells, the surgeon some- times encountered other metallic missiles from the same source which he was at a loss to explain. The shell fuses for igniting the bursting charge contained a number of cast or machined metal parts; on the bursting of the shell these frequently caused wounds of unusual type. In addition, when the annealed copper driving rings which surrounded shells were blown apart, they were likely to remain as long strands of metal with terrific wounding power. The Germans employed on their shells, behind the driving rings, various types of decoppering rings.13   These were of aluminum or tough alloys, such as zinc-aluminum or tin-lead, and they acted very much like the copper driving rings as wounding agents, although they were smaller and usually of lower specific
gravity.


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FIG. 25.- Trench mortar, 240-mm. (9.45-inch)

FIG. 26.- Stokes 4-inch trench mortar and ammunition


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The common belief that poisonous gases were generated by the detonation of high-explosive shells was erroneous. Small quantities of carbon dioxide and carbonic oxide were generated. These were quickly dissipated by the terrific air currents following detonation.

FIG. 27.- Trench mortar shell, 240-mm

  Though shrapnel and high-explosive shells were issued in equal proportions to the French artillery early in the war, as the war progressed high-

FIG. 28- Regulation French bracelet bracelet type of hand grenade and a number of extemporized types, such as the “racquet” and “jam-tin”

FIG. 29.- German combination grenade for hand or rifle use

explosive shell was predominant.14 Efforts were made by all of the warring nations to develop a universal " shell which would effectively deliver shrapnel ball and also produce wounding fragments by rupture of the casing.15 One such type of universal shell was so arranged that when the shrapnel balls were


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FIG. 30.- English combination grenade used in the rifle

FIG. 31.- English combination grenade

FIG. 32- Longitudinal section of an English grenade

FIG. 33- United States hand grenades. From left to right, defensive, offensive gas phosphorus


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released in the air the head of the shell, which itself contained a high-explosive charge, was blown off and fragmented by explosion on striking any object.15

The consideration of armor-piercing, gas, incendiary, smoke, star, and other special shells is outside the scope of this chapter, since they were not primarily designed as wounding missiles.

Shells fired from heavy trench mortars--for example, the 240-mm.--were thin-walled, of low velocity and short range. They had large charges of high explosive. Though the detonation of these shells produced serious concussion in their immediate vicinity, and their moral effect was very considerable, the penetration power of secondary missiles from them was small.

HAND GRENADES

Two kinds of hand grenades were used during the war: A defensive grenade, made of stout metal which would fly into fragments when the interior charge exploded; an offensive grenade made of paper, the purpose being to produce a deadly  effect by the flame and concussion of the explosion itself.16 The defensive, or fragmentation, type of grenade was the most commonly used of the grenades, and ordinarily was thrown by men in the trenches, the walls of which protected the throwers from the flying fragments. On the other hand, though the offensive grenade was quite sure to kill any man within three yards of it when it exploded, it was safe to use in the open, there being no pieces of metal to fly back and strike the thrower.16

The wounding effect of grenade fragments, especially at short ranges in trenches, was very considerable;17 however, the fragments rapidly lost their velocity and consequently their wounding energy. Grenade wounds were almost always infected.18

RIFLE GRENADES

The rifle grenade, used both as a defensive and offensive weapon, fits in a holder at the muzzle of an ordinary service rifle.19 When the rifle is fired, the bullet passes through a hole in the middle of the grenade, and the gases of the discharge following the bullet throw the grenade approximately 200 yards.19 The effective area of an exploding rifle grenade is 75 yards.19

AIRPLANE BOMBS

All of the bombs used by our aviators and by the aviators of other nations were of three distinct types: Demolition, fragmentation, and incendiary bombs.20 The demolition bombs were for use in destroying mat riel, and all sorts of heavy structures where a high-explosive charge was desired; consequently they were of light steel, which was filled with some explosive of high destructive power.20 The fragmentation bombs differed from the demolition bombs in having a thick wall and a smaller charge of explosive.21 The shell walls were likely to separate into thin slivers, with very sharp edges, which prodluced lacerated wounds.


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FIG. 34.- Demolition bomb, 25-pound, carrying 125 pounds of explosive, and having heavy cast-steel nose and pressed sheet-steel rear body, for airplane use

FIG. 35.- Fragmentation bomb, 25-pound, carrying 3 pounds of explosive, designed for use by airplanes against troops

FIG. 36.- Incendiary bomb, 40-pound, of the intensive type, with steel nose and fusible zinc rear casing, for airplane use


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FIG. 37.- Italian Mannlicher rifle, model 1891. This rifle with 30.75-in. barrel weighed 8.41 pounds. The carbine shown here, with 18-inch barrel with which Cavalry and Alpine troops were armed weighed barely 6 pounds

FIG. 38.- Austrian straight-pull Mannlicher rifle, model 1895. The bayonet for this rifle had a blade 10 inches in length

FIG. 39.- German Mauser rifle, model 1898. The muzzle of this rifle was fitted with a cover which is not shown in the cut. The bayonet is "D" in Figure 74

FIG. 40.- German short rifle, model 1898. This rifle had the bolt turned down. The muzzle cover is shown in place. The sling passed through a loop on the left of the lower hand and was fastened on the right side of the buttstock after passing through a recess just back of the grip.

FIG. 41.- English short Lee-Enfleld rifle. model 1907. The hump over the receiver is a clip guide. The heavy ears at the sides of the front sight were cumbersome but very useful as sight protectors


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I

FIG. 42.- Canadian Ross magazine rifle, Mark III, model 916. This was a straight-pull clip loader. The action was very fast, but had a tendency to stick under adverse conditions

FIG. 43.- French Lebel rifle, model 1886-93. This rifle, the standard arm of the French Army at the beginning of the war, had a tubular magazine under the barrel

FIG. 44.- French Lebel rifle, model 1907-15. In this model a clip-loading magazine under the receiver was substituted for the cylinder magazine of the 1886-93 model; otherwise the gun was practically the same as the latter. The magazine holds three cartridges loaded in a clip

FIG. 45.- French automatic rifle, model 1917. This weapon closely resembles in its barrel and fore end the model 1886-93. It is gas operated and self-loading in action

FIG. 46.- American Springfield rifle, model 1903


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FIG. 47.- American Enfield, model 1917. This gun was an adaptation of the British Enfoeld model 1914 design. It was substituted for the Springfield in equipping American troops because there was abundant machinery or its manufacture already in existence in the United States in the spring of 1917, while there was not sufficient machinery in existence for the manufacture of a proper supply of the Springfield, model 1903

FIG. 48.- Japanese Arisaka rifle, model 1907, officially known as the "Thirty-eighth year model." Many of these rifles were sold by Japan to both Russia and England during the war and hence were in use in Europe

FIG. 49.- Russian Mouzin rifle, model 1901, officially known as the "3-line Nagant." This was a heavy, clumsy weapon of doubtful accuracy and reliability. It was made in large numbers for Russia by manufacturers in this country. Many of there still remain in the United States

FIG. 50.- Belgian Mauser rifle, model 1889. This model had a metal tube protector covering the barrel


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SMALL-ARMS WEAPONS AND MISSILES

RIFLES

The chief infantry arm of each of the warring nations in the World War was a rifle of a comparatively old model. 22 The French Army of 1918 carried the Lebel model 1886-1893 rifle. 22 The Italian Army carried the Mannlicher-Carcano rifle of the 1891 model. 22 The Austrian Army was armed with the 1895 Mannlicher. 22 The German Army carried the 1898 model Mauser. 22 The Russian 3-line rifle, model 1900, was only a slight modification of their old Nagant model. 22 The American Springfield was of the 1903 model 23; the American 1917 model, modified British Enfield, was the most modern weapon. 22 The British Enfield model 1907 was slightly more recent than the American Springfield, but in 1914 the British Government considered it so obsolete that it had been planned to supersede it with a new model. 24 However, though all of these guns, except perhaps the two American models, were regarded as obsolete before the war began, they all stood the severe test of war service in a most satisfactory manner. 22 The chief characteristics of the principal rifles in use are shown in Table 4.

TABLE 4.- Characteristics of the principal rifles used in the World War a

 a Sources of information: (1) Textbook of Small Arms, 1909, London. Printed for His Majesty's Stationery Office by Harrison & Sons, 250. (2) America's Munitions. (3) Training Regulations No. 320-10, War Department, Washington, Mar. 12, 1919.
 b During the war the Ross was displaced by the British Enfileld in the Canadian forces, principally to have all British forces armed with the same rifle. (Whelen, Townsend: The American Rifle; New York, The Century Co., 1918, 95.)
 c See Figures 44 and 45 for further changes. 
d Increasing from 19¼ to 8¼ inches.


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ANTITANK RIFLE

During 1918, the Germans developed an antitank rifle. This was a single-shot 13-mm. rifle that had been developed pending the construction of a 13-mm. machine gun.22 The weapon was very heavy, weighing 37 pounds, and was nearly 5½ feet in length, so it was necessary to provide it with a bipod for fixed position firing.22 The bullet, weighing 570 gr., was pointed, and fired with an initial velocity of about 2,450 foot-seconds.22 The bullet was of armor-piercing construction, and a penetration of 20 mm. of the best steel was claimed for it at a range of 500 yards.22

AUTOLOADING AUTOMATIC RIFLE
 
Besides those weapons listed in Table 4, a number of special rifles were developed and brought into military use for the first time during the war.23 Of those which were designed to be fired from the shoulder the Mondragon, semiautomatic rifle, the St. Etienne semiautomatic rifle, and the Browning automatic rifle deserve mention.

FIG. 51.- Browning automatic rifle, model 1918, caliber 30

The Mondragon semiautomatic, in use in the Mexican Army before the World War, was adopted by Germany in 1915, chiefly for aviators' use.25 It was of 7-mm. caliber and provided with two types of magazines, one with a capacity of 10 rounds and the other with a capacity of 30 rounds. 25

The French model, 1918, St. Etienne semiautomatic rifle, fired the Lebel 8-mm. cartridge. The magazine had a capacity of five cartridges.23

The American Army had about 5,000 Browning automatic rifles in use during the last two months of the war.26 This gun, although handling the powerful 1906 United States rifle cartridge, had so slight a recoil that it could be fired continuously, without serious discomfort, at the rate of about 100 shots a minute. 22 The magazines held either 20 or 40 cartridges.27

MACHINE GUNS

Besides these autoloading automatic rifles designed to be fired from the shoulder, a number of automatic light machine guns were in use. The French used the Chauchat machine rifle,28 model,1915. This gun, weighing 19 pounds and firing the ordinary 8-mm. Lebel cartridge, had a magazine which held 20cartridges.22 A bipod rest was attached to the fore end for fixed position firing. Hotchkiss light machine rifles firing the Lebel 8-mm. cartridge and weighing about 1812 pounds were also in use by the French Army. 22


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FIG. 52.- Chauchat machine rifle, model 1915, caliber 8 mm.

FIG.53.- Maxim machine gun and tripod (American), model 1904, caliber .30. This was the first automatic machine gun to he developed. It is of heavy type, recoil operated, water cooled, and belt fed. The gun is capable of sustained fire for long periods of time provided its water supply is properly maintained. It is adaptable to indirect barrage fire. It was used by the British and United States forces and in modified form by the Germans


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  The Madsen machine rifle weighing about 16 pounds was used by the Russians.22 The magazine held 40 rounds; when used as an automatic, the rate of fire was about 500 shots a minute.22 The British Army used the light Lewis machine gun, which was of the "ground type," weighing about 26½ pounds.22 In this type the magazine held 47 rounds of the ordinary 0.303caliber rifle ammunition.22 A somewhat heavier model, with the magazine holding 97 rounds, was used in aircraft by both the British and French.22 These guns were capable of firing 690 shots a minute.22

FIG. 54.- German Maxim machine gun on mount

  The Germans used two types of light machine guns.25 Early in the war the Bergmann, weighing 30 pounds, with a bipod mount, was much in use, although it was discontinued before the end of the war. 23 The principal light machine gun used by the Germans in the later years of the war was the Maxim 08-15. 25 This was a modification of the heavy Maxim machine gun with which the German Army was so abundantly supplied. 25


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FIG. 55.- Flat (Italian) machine gun and tripod

FIG. 56.-  Browning heavy machine gun, model 1917


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FIG. 57.- Hotchkiss machine gun, model 1914, 8-mm. This is the machine gun adopted by the French Army. It is of heavy type, air cooled, and gas operated. Its rate of fire is about 500 rounds per minute

FIG. 58.- Vickers machine gun, model 1915, caliber .30


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FIG. 59.- Vickers aircraft machine gun, model 1918, caliber .30

FIG. 60.- Lewis machine gun, model 1917. caliber .30, ground type

FIG. 61.- Lewis aircraft machine gun, model 1917, caliber .30


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FIG. 62.- Marlin tank machine gun

FIG. 63.- Marlin aircraft machine gun, type 8 M. G.

FIG. 64.- German 08/15 (Spandau) machine gun

MACHINE CARBINE PISTOLS

In 1918 the Germans brought into use a “snail" magazine holding 32 cartridges for the Luger service pistol, thus bringing this weapon into a class related to the light machine rifle.29 This type of magazine, handling the 9-mm. cartridge, was used in the Luger with a long barrel and with a wooden buttstock attached to the hand grip as a shoulder piece.29 When the gun was fired from the shoulder the magazine served as a fore-end, hip-elbow rest, thus giving unusual stability and accuracy to the very light weapon.22

The Bergmann pistol gun (officially pistol 18 I) which was in reality a carbine, fired the 9-mm. Luger pistol cartridge from a "snail" magazine holding:32 shots 29 at the rate of about 540 shots a minute.22 This carbine was heavy, weighing about 91, pounds without the magazine it was sighted to 200 m. 22


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FIG. 65.- Colt .45 automatic pistol used by the American Army and, whenever obtainable, by other armies also

FIG. 66.- Colt double-action revolver, model 1917, caliber .45, with adapting clip to take rimless cartridges


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FIG. 67.- Smith & Wesson double-action revolver, model 1917, caliber .45, with adapting clip to take rimless cartridges

FIG.68.- German Luger automatic pistol, caliber 7.65 mm. with "snail" magazine in place. The bridge from the receiver to the buttstock for mounting  a Lyman sight is an American addition

FIG 69.- German Mauser automatic pistol, caliber 7.65 mm. The wooden buttstock is hollow and serves as a holster for the pistol


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PISTOLS

 The autoloading military pistol, with calibers ranging from 0.30 to 0.45inch, was used in practically all combat branches of the service of all armies not armed with rifles.30 Table 5 gives the principal ballistic factors of these auto-loading pistols and their cartridges.

TABLE 5.-Automatic pistols and their cartridges a
 
The German Luger (Parabellum) was the standard German side arm,30 but owing to the great shortage of these weapons as many as 28 different models of pistols and revolvers were in use in the Germany Army.31 The Colt automatic pistol, caliber 0.45, was in use by the American Army.32 The regular magazine held seven cartridges. It proved to be the most effective side arm in use during the war; however, because it could not be produced in sufficient number to arm completely the American forces, Colt and Smith & Wesson revolvers of 0.45 caliber were adapted to use the rimless cartridge of the Colt pistol.32 They were as reliable, accurate, and effective as the pistol, but of course slower in functioning.

FIG. 70.- Photographs of various dissected rifle cartridges. A. Italian Mannlicher (Carcano) (6.5 mm.); B. Austrian Mannlicher (8 mm.); C. German (Mondragon (7 mm.); D. German Mauser (8 mm.); E. British Lee-Enfleld (.303 in.); F. French Lebel (8 mm.); G. Russian Nagant (.300 in.); H. U. S. .06 (.300 in.)

SMALL-ARMS MISSILES

RIFLE MISSILES

 In Table 6, data are given concerning various rifle missiles. It will be noted that, with the exception of the Italian and Japanese rifle cartridges, the bullets of the others were practically 0.3 of an inch in diameter (30 caliber, or 8 mm.); also, with the exception of the Austrian, the bullets were of approximately the same weight, namely, from 150 to 198 gr. Likewise, their initial velocity did not vary greatly, running from 2,121 feet a second to 2,866 feet


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a second. The initial muzzle energies of translation were also fairly close. being, except the Italian, from 2,216 to 2,685 foot-pounds.

TABLE 6.-Various dissected rifle cartridges and their ballistic data a

While all of these bullets possessed sufficient energy to be mankilling in the limits of all ranges at which they could be purposively directed, yet their shape, composition, and maintained energy varied so greatly as to produce widely different effects. It is therefore necessary to analyze each cartridge in detail.

The .30-caliber United States Springfield bullet as fired from the 1906 model cartridge during the war weighed 150 gr.33 It was composed of a solid lead core surrounded by a cupro-nickel jacket of very high tensile strength. Its remaining velocity at 500-yard range was 1,668 foot-seconds and its remaining energy 932 foot-pounds.34 At the 1,000-yard range its remaining velocity was 1,068 foot-seconds and its remaining energy 382 foot-pounds.34 At the 1,500-yard range its remaining velocity was 853 foot-seconds and its remaining energy was 244 foot-pounds.34

The bullet of the .303-caliber British Lee-Enfield cartridge left the muzzle of the gun with 2,440 foot-seconds velocity and a muzzle energy of 2,300 foot-pounds.35 This bullet, however, Weighed 174 gr.35 and therefore maintained its velocity and energy better than the lighter Springfield bullet. Its extreme effective ranges were practically the same as those of the Springfield. The base and body of the core of the bullet was composed of solid lead, but the point
consisted of a small cap of lighter material, either aluminum or stalbite (hardened paper pulp).36

The bullet of the Russian cartridge, as made in America, was practically identical with that of the Springfield bullet, and had practically the same muzzle velocity and muzzle energy.


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The bullet from the 8-mm. German Mauser cartridge weighed a triflemore than the Springfield bullet. It possessed about 200 foot-seconds more muzzle velocity and 200 foot-pounds more muzzle energy. Its range was longer and its maintained energy slightly higher at long ranges than that of the Springfield bullet. The core was of solid lead, the jacket of low carbonsteel, nickel or copper plated.35

The French 8-mm. bullet was nearly one-third heavier and one-third longer than the Springfield bullet. Its muzzle velocity was much less than that of the Springfield, and its muzzle energy considerably less. Its maintained energies were greater at extreme ranges than those of the Springfield bullet. 22 This was due not only to its superior weight but also much to its superior shape. The bullet was reduced in diameter from 0.320 inch at its middle to 0.270 inch at its base; its forward part (shoulder) was very sloping. Owing to these factors it encountered less resistance to the air than did any other military bullet. The French bullet was of solid bronze, containing neither core nor jacket to separate or split.7 Because of these factors when flying head-on this bullet produced clean-cut wounds.7

The Austrian Mannlicher rifle, model 1895, fired a bullet 0.323 inch in diameter (8 mm.) and 1.25 inches in length, weighing 241 gr., with a muzzle velocity of about 2,121 foot-seconds. Because of its relatively heavy weight, this bullet had a relatively high muzzle energy. However, since it had an ogival head, rather than a pointed one, the resistance of the air to its passage was relatively high,37 and its velocity and energy were both rapidly reduced. This bullet consisted of a solid lead core with a low carbon steel envelope similar to that of the German Mauser bullet.37

The Italian Mannlicher-Carcano rifle, 1891 model, fired a bullet 0.267 inch in diameter (6.5 mm.), 1.2 inches long, and weighing 162 gr. It had a velocity of about 2,400 foot-seconds and approximately 2,000 foot-pounds muzzle energy. The bullet consisted of a lead core surrounded by a cupro-nickel envelope.37 This bullet had an ogival head with consequently high air resistance which caused it to fall off rapidly in velocity and energy.37

SPECIAL RIFLE BULLETS

Besides rifle bullets referred to above, various special bullets for small arms (rifle and machine guns) were made. Practically all of these may be classified as armor-piercing, tracer, incendiary, wire-cutting, or explosive.

Armor-piercing small-arms bullets consisted essentially of a hard steel core surrounded by a jacket composed of cupro-nickel alone or of a thin coating of lead covered with a cupro-nickel jacket of ordinary thickness.38 Bullets of this type not previously mutiliated by striking armor or other metal objects were likely to penetrate the human body, including bones, without deformation. On coming in contact with even fairly thick steel armor the relatively soft cupro-nickel jacket was split, permitting the passage of the steel core through the metal.38 These bullets were used by the Germans, chiefly against tanks and occasionally against armored adversary machine-gun operatives and airplanes.39


42

Tracer bullets contained in a small cavity in the base a slow-burning compound which produced smoke, or more often a small speck of bright light visible even in the daytime.40 The forward part of the bullet consisted of a lead core and the whole was encased in a cupro-nickel or low-carbon steel jacket.40 During the later stages of the war the Germans devised an armor-piercing tracer bullet.39 However, in this the steel core was rather too small to be very effective. Tracer bullets were used almost entirely by airplanes.40

Incendiary bullets contained, within a chamber in the fore end, phosphorus, access to which was provided by a hole drilled on one side of the missile through the jacket and the lea core of the base.40 The passage of the bullet through the gun barrel melted the solder with which the hole was closed and ignited the phosphorus within the chamber. 40 The rotation of the bullet whirled the burning phosphorus out through the open hole.40 This bullet had an effective range of about 350 yards, beyond which the flame was extinguished.40 The smoke from the burning phosphorus served to make this bullet also of tracer character.40 These tracer incendiary bullets were produced by the French and the Americans in 11 mm.,41 as well as in the ordinary 8 mm. and .30 caliber. The flame from these large caliber bullets continued up to 1,200 yards range.42

Numerous attempts were made to improve the wire-cutting qualities of rifle and machine-gun bullets, either by cutting off the head of the ordinary pointed bullet with wire clippers or other wise mutilating them.43 These efforts were not successful. The Germans developed a cylindrical steel bullet for the same purpose, but it also was not satisfactory.43

An explosive rifle bullet was made by the Germans which contained at the point pared with the United States Springfield model within cupro-nickel and lead jackets a complicated firing mechanism consisting of a percussion cap, a suspension coil spring, and a striker.43 This mechanism was contained within a brass collar and was designed to explode a relativelylarge compressed bursting charge in the rear of the bullet to which theflame from the cap gained access by way of a channel through a brass

FIG. 71.– German antitank rifle cartridge with the United States Springfield model 1906 cartridge. Full size


43

container in the middle portion of the bullet.43 This container was filled with a composition of potassium chloride and antimony sulphide.43 Experiments by the Allies with captured bullets of this variety showed that they had considerable penetrative power before explosion and that they must have been designed for their explosive effects only, since they were valueless as tracers or for incendiary purposes,43 although the Germans stated that they were intended for ranging purposes.39

In the early years of the war many accusations were made by each of the warring nations that the enemy was using explosive and "dum-dum" bullets.36 While any bullet might be made into "dum-dum" pattern by mutilating its forward end in any way, the only "dum-dum" "mushrooming" bullets which had evidently been manufactured in soft-point form which came under the writer's observation were those in cartridges removed from the pockets of a German sharpshooter in the Chateau-Thierry operation.36 These were American-made 0.256 Newton (6.5 mm.) bullets with soft-lead points, each with a small steel tack embedded therein. They were of pre-war manufacture (about 1912),36 loaded in German-made cartridge cases which had evidently been necked down from the ordinary 8-mm. size, and were being fired from a Mauser rifle of 6.5-mm. caliber. They probably represented a personal experiment of the sharpshooter on whose body they were found.

The fact that "explosive," "dum-dum," and "mutilated" bullets were not more frequently used was probably due more to the difficulties of their manufacture, their inaccuracy, and their ineffectiveness. The ordinary bullets from rifle and machine gun were found to be sufficiently effective to satisfy military necessity.

PISTOL BULLETS

TABLE 7.- Various dissected pistol cartridges and their ballistic data a

Figure 72 and Table 7 show the shell, powder, and bullet, together with the ballistic data of several of the more important cartridges used in automatic pistols during the World War.

The bullet fired by the .45 Colt automatic pistol was the heaviest used except that of the Webley automatic pistol in use in the British Navy. The Colt bullet weighed 230 grains and had a muzzle velocity of 802 foot-seconds and a puzzle


44

energy of 329 foot-pounds.44 Because of their heavy weight and large cross section this bullet and that of the .45 Webley possessed greater man-stopping power than that of any other bullet used in pistols.45

The bullet of the .38 Colt and Bayard automatic pistols weighed 130 grains and was fired with a muzzle velocity of 1,146 foot-seconds and a muzzle energy of 379 foot-pounds.31 At close quarters this bullet was more likely to pass through the body than was the .45 Colt. Thus, although it possessed more muzzle energy than the .45,31 it did not have as much man-stopping power. 46

The bullet of the .30 Luger automatic pistol (7.65 mm.) weighed 93 grains and was fired with a muzzle velocity of 1,173 foot-seconds and a muzzle energy of 284 foot-pounds.31 Its head was a truncated cone which served to reduce the air resistance to it but also reduced its man-stopping power.46

FIG. 72.- Photographs of sundry dissected automatic pistol cartridges. A. .38 Colt; B. .45 Colt; C. 30 (7.63 mm.) Mauser; D. .30 (7.65 mm.) Luger

 
The bullet of the .30 Mauser automatic pistol (7.63 mm.) weighed 86 grains and was fired with a muzzle velocity of 1,397 foot-seconds and a muzzle energy of 373 foot-pounds.31 This bullet had an ogival head similar to that of the .45 and .38 Colt bullets.31 Its velocity and energy were well retained at relatively long ranges, but its small caliber and relatively high velocity contributed to reduce its man-stopping power. 46

As a whole the experience of the World War bore out the previous experience of the United States Army in the Philippines, that a pistol bullet of large size (.45 caliber), heavy weight (230) grains), and relatively low velocity was much more effective as a "man stopper" at close quarters than any other vet devised of smaller caliber.47

BOAT-TAIL BULLETS

The most recent development of rifle bullet designing has been in so modifying the base of the missile as to reduce the negative pressure set up by its passage through the air.48 Double-pointed bullets of all sorts have been experimented with, but, in general, nations now are apparently settling down to the so-called "boat" shape; that is, with a long pointed front, a cylindricalcenter, and a base which is a truncated cone. This boat-shaped bullet, first tried out by the French and later perfected by the Swiss, was adopted early


45

in the war by the French, and later by the British, Germans, and Americans.49 Properly designed these bullets are said to have less than one-half the resistance to the air that is offered by missiles with ogival heads of 1½ diameters.50
 
GENERAL CHARACTER OF WOUNDS FROM VARIOUS CAUSATIVE AGENTS

Relatively large, smooth missiles of low velocity, such as shrapnel balls near the end of their flight, produce wounds of little depth, with but slight tearing, and with considerable contusion of the tissues. Large missiles of irregular shape and low velocity, such as large shell fragments near the end of their flight, produce ragged wounds with considerable bruising and little penetration. Large or small missiles of very high velocity, such as fragments from high-explosive shells in the first portion of their flight, and modern rifle missiles in the first mile of range, produce "explosive" wounds, with the wound of exit larger than the wound of entrance. Shape and velocity remaining the same, doubling the weight of the missile doubles its wounding power. Shape and weight remaining the same, doubling the velocity quadruples its wounding power, since it quadruples its energy. When weight and velocity remain the same, increase in sectional area either regularly or irregularly, as in a bullet with flattened point or one with the deformity of a split jacket, produces additional wounding capacity, and especially its "shock" effect, which can not be stated mathematically since it will vary so greatly with the character of the tissue affected.

With these general principles in mind, though all of them are subject to innumerable modifications, some general conception of the types of the wounds produced from various missiles may more readily be understood. The effects of shrapnel bullets and shell fragments from the older types of explosive missiles have been so well described by LaGarde,51 Stevenson,52 and others that there is no need of repeating them here. It was supposed that the very greatly increased velocity and the very much greater comminution of shell fragments, due to the use of much higher explosives in the shells during the recent war, would eliminate in large measure the type of wound from shrapnel and shell fragments so common in previous wars. This has not proved to be the case. Very many wounds from shrapnel ball and shell fragments were of the old type, namely, with slight penetration, much contusion, and incidentally much infection with foreign matter. A large number of the shrapnel and shell-fragment wounds among the American Expeditionary Forces must have been produced by relatively low velocity missiles. This explains why the surgeons with the American Expeditionary Forces so seldom stated the causative agent as from high-explosive shell. 53

On the other hand, in close quarters, as in trench fighting, where men were struck by missiles from exploding bombs and grenades, the character of the wounds often indicated that the missiles were of relatively high velocity.

In general it may be said that shell fragments and shrapnel bullets, whatever their primary velocity, rapidly become slow and depend less for their wounding effect on velocity than on their weight and shape.54 Thus they have but small power of penetration and frequently lodge in the body. They are likely to carry clothing and other foreign matter into the wound. On the other


46

hand, rifle missiles and secondary missiles of all kinds from high-explosive charges, striking the body while still having a high velocity, produce effects from their kinetic energy in penetration, "explosive" exits and injury at relatively large distances from the tract of the missile, which are quite different from all low-velocity missiles; also they are less likely to carry foreign matter into the wound.

WOUNDS FROM EXPLOSIVE MISSILES

Sufficient has been said above to indicate to the surgeon the very great variety, both in extent and character, of the effects on human tissue of shrapnel and shell fragments from exploding artillery missiles. Occasionally steel shell splinters of needlelike fineness were hurled with such tremendous velocity that striking end-on they penetrated the body wall either from the back, the front, or the sides and caused ultimately fatal hemorrhages by injuring large arteries, or the heart itself. In some instances the wound of entrance of these missiles was almost imperceptible. On the other hand, large masses of metal, weighing as much as 2 or 3 pounds, had frequently so little remaining velocity when they struck the body that they did not rupture the skin or at most barely buried themselves in the flesh. It was surprising, however, what large masses of metal were found occasionally lodged in the human body. Between these two extremes of light weight with high velocity and heavy weight with low velocity every conceivable variety of weight and velocity of missile existed and likewise every conceivable variety of wound effects.

If the missile lodged in the body, study of its shape and size, together with consideration of the tissues met with, gave some indication of its remaining velocity at the point of entrance. If the wounding missile had passed out of the body, unless both wound of entrance and wound of exit were small, it was impossible even to estimate the ballistic data. To these uncertainties was added the possibility that the wound might not have been produced by artillery fire but by a rifle or machine-gun bullet of unusual shape or flight, a subject which will be discussed below.

WOUND PRODUCTION BY SMALL-ARMS MISSILES

The World War afforded uprecedented opportunity to study the effects of high-velocity rifle bullets in human wound production. Leaving aside for the moment the unusual wound effects produced by deformed bullets and by bullets of irregular flight, the causes and effects of which have already been hinted at in the preceding analysis of the various types of bullets, we may examine the causes of the wound conditions produced by the normal-shaped bullet which struck human tissues while it was in normal flight.

The wounding effects of a bullet depend on (a) the amount of energy it transmits to the tissues, (b) the velocity of the transmission, (c) the direction of the transmitted energy, and (d) the density of the tissues. The first three of these factors depend almost entirely on the energy, velocity, and shape ofthe bullet.

All rifle bullets used in the World War were several (three to five) times longer than they were thick. (See Table 6.) All except the Austrian and Italian


47

had very sharp-pointed forward ends and cylindrical bodies. Their surfaces were smooth except for the spiral longitudinal grooves, about 0.004 inch deep, cut by the lands of the rifle barrel through which they were fired. They left the gun muzzle with a velocity usually somewhat more than twice that of the velocity of sound (from 2,200 to 2,800 feet a second) and they were rotating on their long axes in most instances more than 3,000 times a second, with a surface speed of about 260 feet a second. The muzzle energy of their forward motion (translation) was about 2,400 foot-pounds and that of their motion of rotation was about one two-hundredths as much, or 12 foot-pounds. The different bullets used varied greatly in the rates in which their velocities of translation were reduced. The rate of reduction of the velocity of rotation is almost

FIG. 73.- Various deformed rifle bullets removed from wounds

impossible of calculation, but it is not as great as the rate of reduction of velocity of translation, since we know that a bullet will continue to spin after it has ceased to move forward.

The amount of energy transmitted to the animal body by a bullet is the amount with which the bullet enters less that with which it leaves the body. If the bullet does not pass out of the body it transmits to it all of its energy. If it does pass out, it obviously does not transmit to the body the energy it retains after exit. The proportion of energy transmitted depends on the sectional area of the bullet, the shape of its head, the character of its surface, and the relative densities of the tissues struck. This is why a blunt-pointed, large-caliber revolver bullet, like the Colt .45, lodging in the body, may cause more tissue destruction and more shock than a sharp-pointed small caliber


48

bullet carrying much more energy but passing through and out of fleshy structures with but slight loss of energy.

When the modern high-velocity, sharp-pointed military rifle bullet enters the human body it may produce terrific destruction of tissue at very considerable distance from its line of passage. It may do this without being in anyway deformed in shape or flying erratically. The cause of the so-called explosive effects of the modern rifle bullet has been the subject of prolonged discussion and experimentation by many careful students. It can not be said that the solution of the problem is yet entirely clear. However, from long experimentation and consideration of the laws of physics the following consideration derived from observations of wounds in man and animals would appear to be of most weight in the explanation of the phenomena:

When the sharp-pointed rifle bullet enters the body point-on and passes through it without tumbling, its wound production is the result of the transmission of energy from the bullet's two motions, first, of translation, and second, of rotation. If the bullet were a cylinder it would act much like a punch, but though the body of the bullet is a cylinder the forward end has long, sloping shoulders which act as wedges. As a consequence of this, the energy of the bullet is transmitted not directly forward but at oblique angles with that of the path of the bullet. The energy is thus transmitted through an area of tissue which is represented roughly by a broad-base cone having its apex at the point of entrance and its base surrounding the point of exit. Besides the motion of translation, a small amount of force is no doubt exerted by the motion of rotation. The energy of the bullet from its motion of rotation is transmitted centrifugally at right angles to the track of the missile. It is probable that the energy of rotation is reduced less in proportion than the energy of translation by the passage of the bullet through the tissues; thus the energy of rotation of the bullet may be a relatively greater factor in the resultants representing the total transmitted energy of the bullet at the exit than at the entrance point.

This transmission to the tissue of the energy of the bullet at decided angles to its path explains the dissemination of foreign bodies, and incidentally bacteria along with them, to points in the tissues at considerable distances from the path of the projectile. Dense particles, as, for example, charcoal used experimentally on the skin at the point of entrance of the bullet, are not driven into the tissues but are scattered widely through the tissues along the track of the missile. This is a most important point for the surgeon to remember in his primary treatment of wounds made by high-velocity bullets.

 But the physics of dense particles driven through soft tissues will not explain the phenomena encountered in "explosive" wounds of soft tissues. When the particles of a plastic body are set in motion by being struck by a missile the distance to which the motion is transmitted is determined by the freedom with which the particles move. Experimentally the energy of a high-velocity rifle bullet is transmitted approximately four times as far in 5 percent gelatin as in 10 percent gelatin and approximately nine times as far in 5 percent gelatin as in 15 percent gelatin. In other words, in plastic bodies the distance to which the energy is transmitted by a rapidly moving bullet is approximately


49

inversely proportional to the squares of the densities of the masses penetrated.36 On the other hand, the velocity with which tissues of greatly differing densities move when set in motion by transmitted bullet energy is apparently, though roughly, in direct proportion to their densities, and may result in shattered parts of a more dense tissue, as bone, being driven through a less dense tissue, as muscle. Apparently when tissues approximate each other in densities, none of which are sufficiently great to permit of angular fragmentation, as, for example, the several coats of the wall of an artery, particles of the one are not driven through the other by transmitted bullet energy. Probably both are moved but at somewhat different velocities. It may be assumed that these different velocities may produce unequal stresses. This possibly may be the cause of the frequently observed ruptures of the intima of large arteries by the passage near, but not in contact with them, of high velocity bullets.

On the whole, then, it seems reasonable to assume that the "explosive" effects produced by high velocity rifle bullets, either experimentally or in war wounds, in their passage through liquid or plastic substances may be due to their angular and lateral transmission of the energy of the bullet to the mass as a whole, thus setting up violent motion in the particles of the mass which are transmitted throughout the whole mass from particle to particle. In homogeneous fluids and plastic structures of low density all particles move together wavelike. In composite tissues of varying densities irregular stresses are developed which tear or even comminute the tissues.

IRREGULAR MOVEMENTS OF BULLETS IN TISSUES

There is a great tendency for the modern pointed bullet to tip on striking tissue of any considerable density. This is most noticeable, of course, with bullets of reduced velocity. These sometimes follow most eccentric paths in the body. Not infrequently they follow the curve of a rib for considerable distance without puncturing it.

The amount of actual tumbling within the body which a bullet is capable of making is a question of considerable dispute. It is doubtful, however, if any bullet turns completely over more than once or twice in passing through the human body. Of course, even this amount of tumbling would transmit an enormously increased amount of energy to the tissues.

At all except extreme ranges the straight-flying modern military bullet should pass completely through the human body. However, a great many bullets fired at comparatively short ranges were known to have remained in the body. It is probable that some bullets remaining in the body after wounding j at short range may have previously encountered other obstacles which reduced their energy. Others may have been fired from worn-out rifle barrels.

SITE AND CHARACTER OF INJURY IN THE BATTLE DEAD

The military surgeon is concerned only with the wounded soldier. The military pathologist is concerned also with the dead soldier; the site and character of injury of men killed in action involve problems in which the military pathologist is much concerned.


50

The number of men killed in action constitutes a very appreciable share ofthe total casualties. Prior to the World War, it was generally accepted that the ratio of those killed or found dead on the field to the number wounded was 1 to 4.65 This ratio, of course, is very much influenced by the mode of attack. In the American Army during the World War, this ratio was slightly less. The total number killed or missing on battle fields in the American Expeditionary Forces was 36,780.56 The total number of wounded was 153,537,53 comprising only those wounded by military destructive agents, excluding poisonous gases.Thus the ratio was about 1 to 4.2.
I
Information is not available as to the total number of men killed in action in the French Army during the war. The total number of dead and missing was computed to be 1,357,800.57 The total number of wounded from 1914 to1918 was 2,052,984.58 Although it is impossible from these figures to determine the ratio of killed in action to the total number wounded in the French Army, the general statement has been made that in the trench fighting on the western front. during the earlier years of the war, the ratio of killed to wounded was as1 to 3; also, in the Battle of the Marne the ratio of killed to wounded was approximately 1 to 4.5.59

The total number of men in the British Army killed in action has been reported to be 464,049;57 the number of missing (including prisoners) was 320,944.57 The total number of wounded from August, 1914, to November,1918. was 2,036,750.57 Allowing 100,000 for the "presumed dead," the ratio of killed to wounded in the British armies was thus about 1 to 2.9.

In that part of the German Army opposite the French-Belgian-British front the total number killed in action was 789,400 and the number missing inaction 968,197.57 The number of wounded was 3,088,743.57 Thus, assuming two-thirds of the missing were prisoners, the ratio of those reported killed to the total wounded was 1 to 2.8.

It would seem that the preponderance of trench warfare, especially on the western front in the World War, tended to increase the ratio of killed to wounded, while the preponderance of shell and other explosive missiles tended to decrease it. That these two factors did not offset each other-for in the war in France and Belgium as a whole the general ratio of killed to wounded was greater than that of previous recent wars, namely, about 1 to 3 or even more-is accounted for by the deadliness of the pointed rifle missile with which most of the contending armies were equipped. This deadliness had already been determined in the Turko-Balkan War of 1912-13, during which, though but 20 percent of wounds were attributed to shrapnel, the ratio of killed to wounded was1 to 2.5.60

The careful hunter of big game learns from a study of the effects of his bullets on the relatively few animals which fall to his fire more than he can possibly learn from years of experimental work on the rifle range. From a purely military standpoint it is greatly to be regretted that the military pathologist has hitherto been unable to make a similar adequate study of the siteand type of the injury and the character of the missile in the bodies of men killed on the battle field. So far as the writer is aware, this phase of military pathologic research, which it may readily be seen would probably have a most important


51

bearing not only on military medical problems but also on the planning of body armor and the revising of weapons and missiles, was scarcely if at all touched on by any of the nations involved in the World War. In only relatively isolated instances did physicians, usually in first-aid service, have opportunities to make such examinations. These physicians were seldom trained pathologists, nor were they interested in the problems which might have been solved by careful study of the dead. Most of all, their duties to the living did not permit time to be given to such study.

Although, because of lack of observation and lack of records, most of our conclusions concerning the character of injury and the probable missile causing it in the battle dead have been drawn from inferences chiefly on conditions in the badly wounded, yet some of these inferences are worth recording. While no accurate figures of the proportion of deaths on the battle field from primary hemorrhage are available, we are probably safe in estimating that from 80 to 85 percent of such deaths were due to this cause. Relatively few wounded with central chest injuries or with injuries involving the abdominal aorta ever reached first-aid stations.

Immediate fatalities from head injuries, chiefly from snipers' fire, were very common in the early stages of trench warfare. These fatalities, however, were rapidly reduced to a minimum as men learned "to keep their heads down." Long-range sniping was largely at men whose entire bodies were exposed Here the sharpshooter aimed at the chest.

The total number of men reported as "missing," who were not captured and who were not deserters, but whose bodies had been blown into unidentifiable fragments, was relatively very much larger than in any previous wars. This was due to the great increase in number and size of high-explosive missiles.

Compared with previous wars, a relatively large number of instantaneous deaths occurred in action, particularly in trench warfare, without any sign of external injury to the body. In a few such bodies examined by pathologists many minute and occasionally large hemorrhages were found, usually in the central nervous system or lungs. Crile's experiments at Rouen, in 1917, on animals showed the lungs to be the seat of massive hemorrhages.61 Crile found the central nervous system also involved. Durante and Mairet,62 in similar experiments, found the central nervous system most affected. The exact physical condition producing these lesions has been much discussed. The most plausible hypothesis is that the very great instantaneous reduction of air pressure immediately following its very great increase from the gases of explosion causes such rapid displacement of gases and fluids inside the body as to rupture blood vessels with weak support, as in the lungs, and probably also to disintegrate cell membranes, particularly of the central nervous system.

RATIO OF WOUNDS FROM MISSILES FROM SMALL ARMS

In the open wars of the last 75 years prior to the Turko-Balkan war, approximately 90 percent of the wounds were reported as having been caused from the fire of small arms, with approximately 10 percent of the wounds


52

from bursting missiles from heavy gunfire.63 The proportion of wounds from bayonets, sabers, and other piercing instruments has never been large and is rapidly decreasing, though the bayonet has been and still remains the cause of a considerable number of battle-field fatalities.

FIG. 74.- Sundry bayonets. A, United States; B, Great Britain; C, France; D, E, and F, Germany; G, United States Springfield, 1886 model

In the American Army during the World War the causative agent of wounds was either not designated or designated as "gunshot missile," with the kind not specified in approximately one-half of the battle wounds, by military destructive agents (76,076 of the 153,537 total admissions).53 Of the remaining admissions the causative agent was stated as small-arms missile (rifle, machine gun, or


53

FIG. 75.- United States trench knives, models 1917 and 1918

FIG.76.- German coup stick or trench club

FIG.77.-  French steel darts which were dropped in showers from airplanes.


54

pistol ball) in 20,662 admissions.53 Missiles from shell, shrapnel, bombs, hand grenades, exploding mines, etc., were noted as the causative agent in 53,183admissions.53

 Thus, secondary missiles from exploding projectiles in the World War effected a much greater proportion of wound injury than in any previous war, while injury by direct missiles from the fire of small arms was proportionately greatly reduced. Taken as a whole, the percentage of wounds from exploding missiles probably varied, from 50 to 80 per cent being highest when battle conditions were most stabilized, as in trench warfare, thus resembling those of a siege, and lowest when the action became one of movement.

 The great increase in the proportion of wounds from fragments of exploding missiles was due to the fact that not only in the barrage accompanying major engagements was there an unprecedented number of large-caliber weapons, each firing an unprecedented amount of high-explosive ammunition, but also under the daily siegelike conditions of trench warfare, long-range artillery fire was supplemented as never before by trench mortars, hand grenades, and rifle grenades and by aircraft bombs, almost all of which were charged with high explosives. Although the missiles from these soon dropped to relatively low velocities as compared with the velocities of missiles of small arms, their wounding energies were most effective. The American military surgeons' refusal to hazard a guess as to the character of the causative agent of approximately half of all wounds needs no word of apology. The character of the wounds in a large share of instances was such as not to permit of even a reasonable guess as to the causative agent. Indeed, it is probable, on theoretic grounds, that many of the wounds of which the causa- tive agent was described as secondary from an explosive missile may have been due to deformed direct missiles from small arms.

REFERENCES

(1) Fauntleroy, A. M.: Report on the Medico-Military Aspects of the European War. Washington, Government Printing Office, 1915, 17.
(2) Dickinson, W. N.: The Story of the 75 (75 Millimeter Field Gun). Washington, Government Printing Office, 1920, 5.
(3) America's Munitions, Report of Benedict Crowell, the Assistant Secretary of War. Washington, Government Printing Office, 1919, 69.
(4) Ordnance Data, VI, European Artillery, British, table "British Gun Data." On file, Ordnance Bureau, Reference Library, UF 520, X00.
(5) Bethel, H. A., Brevet, Col., R. F. A.: Modern Guns and Gunnery, 1910. Woolwich, F. J. Cattermole, 1910, 76.
(6) Ibid., 154.
(7) La Garde, Louis A., Col. U. S. Army Medical Corps (Retired): Gunshot Injuries, How They are Inflicted, Their Complications and Treatment. New York, William Wood and Company, 1916, 33.
(8) Bethel, Op. cit., 201.
(9) Ibid., 159.
(10) America's Munitions, 120.
(11) History of the Great War Based on Official Documents, Medical Services, Surgery of the War. London, His Majesty's Stationery Office, 1922, I, 31, 32.
(12) The Encyclopedia Britannica, new volumes, 1922, xxx, 263.
(13) Ibid., 119-122.
(14) Fauntleroy, Op. cit., 25.
(15) Ibid., 24.
(16) America's Munitions, 202.
(17) Snow, Chester R., Maj., Trench Art.: Ordnance and its Effects. The Military Surgeon, Washington, 1919, xlv, No. 1, 23.
(18) Fauntleroy, Op. cit., 15.
(19) America's Munitions, 208.
(20) Ibid., 303.
(21) Ibid., 305.
(22) The Encyclopedia Britannica, xxxii, 277-285.
(23) America's Munitions, 178.
(24) Ibid., 180.
(25) Handbook of the German Army in War, April, 1918. Issued by the General Staff (British), 57, 60, 61. On file, Library, Army War College, General Staff, D 609, G 3, G 71 (1918) 48,628.
(26) Ayres, Leonard P., Col., G. S., Chief of the Statistics Branch of the General Staff: The War with Germany, a Statistical Summary. Washington, Government Printing Office, 1919, 68.
(27) The Encyclopedia Britannica, xxxi, 819.
(28) America's Munitions, 162.
(29) Pollard, H. B. C., Capt., The London Regt.: Automatic Pistols. London, Sir Isaac Pitman and Sons, Ltd., 1920, 94, 95.
(30) Ibid., 17-27.
(31) The Encyclopedia Britannica, xxxii, 105-107.
(32) America's Munitions, 188.
(33) Training Regulations No. 320-10, War Department, Washington, March 12, 1924, 44.
(34) Description and Rules for the Management of the United States Rifle, Caliber .30, Model of 1917, October 8, 1917, Revised January 16, 1918, Revised May 7, 1918. Washington, Government Printing Office, 1918, 65.
(35) British and German Small Arms Ammunition, memorandum communicated by the War Office respecting British and German ammunition. British Medical Journal, London, 1914, ii, 895.
(36) Wilson, Louis B., Col., M. R. C., U. S. Army: Dispersion of Bullet Energy. The Military Surgeon, Washington, 1921, xlix, No. 3, 241.
(37) La Garde, Op. cit., Table I.
(38) America's Munitions, 197.
(39) Handbook of the German Army, 50.
(40) America's Munitions, 196.
(41) Ibid., 198.
(42) The Encyclopedia Britannica, xxx, 136.
(43) History of the Great War, 10-12.
(44) Training Regulations No. 320-15, War Department, Washington, March 3, 1924, 5.
(45) La Garde, Op. cit., 75.
(46) Ibid., 74.
(47) Ibid., 69.
(48) Textbook of Small Arms, 1909, printed for His Majesty's Stationery Office. London, Harrison and Sons, 187.
(49) Wilhelm, Glenn P.: Long Range Small Arms Firing. Army Ordnance, Washington, 1922, ii, 299-303.
(50) Bethel, Op. cit., 14.
(51) La Garde, Op. cit., 96-115.
(52) Stevenson, W. F., Surgeon-Colonel, Army Medical Staff: Wounds in War, the Mechan- ism of Their Production and Their Treatment. New York, William Wood and Company, 1898, 77-85.
(53) Based on Sick and Wounded Reports made to the Surgeon General, U. S. Army.56
(54) Bethel, Op. cit., 29.
(55) La Garde, Op. cit., 412.
(56) Based on reports made to The Adjutant General of the Army.
(57) Special Report No. 178, Statistics Branch, General Staff, W. D., February 25. 1924. Copy on file, Historical Division, S. G. O.
(58) Ministère de la Guerre, Direction du Service de Santé, Étude de Statisque Chirurgicale, Guerre de 1914-1918. Paris, Imprimerie Nationale, 1924, Tome Premier.
(59) La Garde, Op. cit., 422.
(60) Ibid., 61.
(61) History of the Great War, Op. cit., 46.
(62) Mairet, A., and Durante, G.: Étude Expérimentale du Syndrome Commotionnel. Paris, Presse médicale 1917, xxv, No. 46, 478.
(63) La Garde, Op. cit., 414.