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Chapter XII

Contents

CHAPTER 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

Wound ballistic and body armor studies during 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. III, Herget, C. M., and Odell, F. A.: Preliminary Study on Body Armor Protection From Wounding. CmlC Medical Division Report No. 165, October 1948. (2) Tillett, C. W. III, Banfield, W. G. Jr., and Herget, 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. III, Banfield, W. G. Jr., and Herget, C. M.: The Effect of a Non-Perforating Projectile on the Animal Body Protected by Steel Armor. CmlC Medical Division Report No. 228, December 1949. (4) Tillett, C. W. III, 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., Michalski, 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.


692

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


693

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

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 human 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 method, time, and distance of evacuation in relation to primary wound treatment, wound contamination, and all other 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 maximum 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.

2Trained personnel of a battle casualty survey unit and indoctrination of medical personnel during peacetime maneuvers would facilitate the gathering of accurate data.-J. C. B.


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?

3Unfortunately, no serious attempt has 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.-J. C. B.


696

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


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 findings4 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 Zuckerman5 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

FIGURE 338.-Anatomic location of body regions.

4Wound 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.
5Burns, 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 ballistic data on 4,600 WIA casualties6 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 wounds

Percent of total wounds

Head and neck

1,275

16.4

Thorax

613

7.9

Abdomen

481

6.2

Extemities:

Upper

1,948

25.0

Lower

3,394

43.7

Genitalia

62

.8

Total

7,773

100.0

6The 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.


699

TABLE 253.-Regional distribution of 7,773 wounds in 4,600 WIA casualties, by wounding agent

Wounding agent

Head

Thorax

Abdomen

Extemities

Genitalia

Total wounds

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

1

1

---

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

TABLE 254.-Area distribution of 1,275 head wounds in 4,600 WIA casualties, by wounding agent

Wounding agent

Region of skull

Brain

Scalp

Face

Maxilla

Mandible

Nose

Ear

Eyelid

Eyeball

Neck

Cervical vertebra

Total wounds

Frontal

Temporal

Occipital

Parietal

Fragment

56

46

25

66

46

52

163

54

83

21

35

39

254

138

13

1,091

Mortar

4

---

2

2

1

2

13

2

8

1

3

3

20

7

---

68

Grenade

1

---

---

---

---

1

6

1

1

---

1

3

12

3

---

29

Landmine

---

---

---

---

---

---

5

---

---

---

---

2

7

4

---

18

Machinegun

---

---

---

---

---

1

---

---

---

1

---

---

1

4

---

7

Rifle

2

2

3

6

4

---

1

3

9

---

---

---

5

5

---

40

Pistol

---

---

---

---

---

---

---

---

---

---

---

---

1

---

---

1

Burn

---

---

---

---

---

---

4

---

---

---

---

---

1

---

---

5

Phosphorus

1

---

---

---

---

---

1

---

---

---

---

---

---

---

---

2

Secondary

---

---

---

---

---

1

2

1

---

---

---

---

10

---

---

14

Total

64

48

30

74

51

57

195

61

101

23

39

47

311

161

13

1,275


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 wounds

Wounding agent

Number of 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

Abdomen1

Stomach

Liver

Spleen

Small intestine

Colon

Rectum

Anus

Kidney

Bladder

Total 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

1Specific 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

Head

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

---

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

---

2

---

1

4

---

9

Total

424

14

620

89

279

387

135

1,948


702

TABLE 258.-Area distribution of 3,394 wounds of the lower extremities in 4,600 WIA casualties, by wounding agent

Wounding agent

Buttocks

Hip

Thigh

Knee

Leg

Foot

Toes

Total 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 wounds

Percent of total 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


703

TABLE 261.-Area distribution of 1,275 head wounds in 4,600 WIA casualties, by type of wound

Area

Penetration

Perforation

Superficial

Laceration

Contusion

Avulsion

Concussion

Total 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

---

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

1,017

80

24

98

15

12

29

1,275

TABLE 262.-Distribution of 613 wounds of the thorax in 4,600 WIA casualties, by type of wound

Type of wound

Rib cage

Thoracic vertebra

Back1

Total 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

1Specific site not specified.


704

TABLE 263.-Area distribution of 481 wounds of the abdomen in 4,600 WIA casualties, by type of wound

Type of wound

Abdominal wall

Inguinal region

Lumbar region

Sacral region

Stomach

Spleen

Liver

Kidney

Bladder

Small intestine

Colon

Rectum

Anus

Posterior

Total wounds

Penetration

140

4

28

1

3

7

11

3

6

12

15

4

1

74

309

Perforation

38

1

3

1

5

3

14

4

3

24

27

5

---

10

138

Superficial

4

---

---

1

---

---

---

---

---

1

2

1

---

3

12

Laceration

4

---

---

---

---

1

2

1

---

1

1

---

---

3

13

Contusion

1

---

---

---

---

---

---

1

---

1

---

---

---

3

6

Avulsion

1

---

1

---

---

---

---

---

---

---

---

---

---

1

3

Total

188

5

32

3

8

11

27

9

9

39

45

10

1

94

481


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

Buttocks

Hip

Thigh

Knee

Leg

Foot

Toes

Total 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

---

5

Avulsion

1

---

---

1

Total

39

20

3

62


706

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 wounds

Percent of 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

Multiple 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 enough 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.


707

TABLE 268.-Area distribution of 1,189 wounds of the head in 4,600 WIA casualties, by type of wounding

Type of wounding

Region of skull

Brain

Scalp

Ear

Face

Maxilla

Mandible

Eye

Nose

Neck

Cervical vertebra

Total wounds

Frontal

Temporal

Occipital

Parietal

Single local

19

13

10

39

10

23

10

21

12

37

64

2

41

4

305

Single local, single elsewhere

23

25

12

24

36

24

23

69

32

46

140

15

53

6

528

Single local, multiple elsewhere

4

3

1

3

2

---

1

8

2

1

40

3

15

---

83

Multiple local

2

1

2

2

2

1

---

7

---

2

24

---

1

2

46

Multiple local, single elsewhere

1

1

---

---

---

---

---

13

---

2

1

---

6

---

24

Multiple local, multiple elsewhere

8

4

1

5

---

3

4

74

9

7

68

2

18

---

203

Total

57

47

26

73

50

51

38

192

55

95

337

22

134

12

1,189

TABLE 269.- Area distribution of 594 wounds of the thorax in 4,600 WIA casualties, by type of wounding

Type of wounding

Pulmonary

Rib cage

Heart

Thoracic vertebra

Back

Total wounds

Single local

1

179

---

9

26

215

Single local, single elsewhere

2

221

---

12

47

282

Single local, multiple elsewhere

---

12

1

---

3

16

Multiple local

---

10

---

---

2

12

Multiple local, single elsewhere

---

6

---

1

4

11

Multiple local, multiple elsewhere

---

42

---

1

15

58

Total

3

470

1

23

97

594


708

TABLE 270.- Area distribution of 466 wounds of the abdomen in 4,600 WIA casualties, by type of wounding

Type of wound

Abdominal wall

Posterior

Stomach

Liver

Spleen

Small intestine

Colon

Rectum

Anus

Kidney

Bladder

Lumbar vertebra

Sacral vertebra

Total wounds

Single local

59

27

2

5

1

4

7

3

1

---

1

14

1

125

Single local, single elsewhere

102

46

5

14

8

29

28

8

---

7

8

13

---

268

Single local, multiple elsewhere

8

3

---

2

---

---

3

---

---

---

---

1

---

17

Multiple local

5

3

---

2

---

1

2

---

---

---

---

2

---

15

Multiple local, single elsewhere

3

3

---

---

---

---

---

---

---

---

---

---

---

6

Multiple local, multiple elsewhere

11

15

1

2

---

3

1

---

---

---

---

2

---

35

Total

188

97

8

25

9

37

41

11

1

7

9

32

1

466


709

TABLE 272.- Area distribution of 3,252 wounds of the lower extremities in 4,600 WIA casualties, by type of wounding

Type of wounding

Buttocks

Hip

Thigh

Knee

Leg

Foot

Toe

Total
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

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 WIA casualties, by site of fracture

Site of fracture

Number of
fractures

Percent for body
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

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


711

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 remaining 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 WIA casualties, by region wounded

Region wounded

Returned to duty

Evacuated to the Zone of Interior

Total casualties

Number

Number

Number

Extremities:

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

TABLE 276.-Distribution of 200 cases with peripheral nerve wounds, by causative agent and anatomic location of nerves

Anatomic location of nerve

Missile unknown

Gunshot

Mortar

Shell fragment, caliber unknown

Hand grenade

Artillery shell

Landmine

Machine gun

Total cases

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

---

---

---

---

23

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

3

1

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.


713

TABLE 277.- Distribution of 100 cases of vascular damage, by type of wound

 

Type of wound

Artery

Artery and
vein

Vein

Total
wounds

Penetrating

42

12

1

55

Perforating

39

3

1

43

Lacerating

1

--- ---

1

Contused

1

--- ---

1

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

Vein

Total
wounds

 

Fracture

5

3

---

8

 

Nerve damage

19

--- ---

19

 

Fracture and nerve damage

39

--- ---

39

 

Fracture, nerve and vascular to be determined1

7

--- ---

7

 

Aneurysm

3

11

---

14

 

Vascular damage alone 

10

1

2

13

Total

83

15


2

100

1In 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

Vein

Total
wounds

 

Missile, unknown

58

13

2

73

 

Shell fragment, unknown

3

---

---

3

 

Shell arms

11

2

---

13

 

Machinegun

3

---

---

3

 

Mortar

8

---

---

8

 

Total

83


15


2


100


714

The regional and area frequency of the vascular damage in the 100 cases was as follows:

Number of cases

Head and neck:

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 wounds

Percent of total wounds

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


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 November 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

Body region

Hits on-

Total hits

Percent of total body area

Anterior surface

Posterior surface

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

FIGURE 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 from the site of origin to the man hit. No attempt was made to discard any data (such as mortar shell fragment hits alleged to have occurred at a 200-400 meter range). The reported mean ranges were given to establish orders of magnitude, as follows:

Type of missile:

Mean estimated length of trajectories 
(in meters)

Rifle

112.5101.0

Machinegun

70.783.1

Mortar fragments

9.718.8

Hand grenade fragments

5.14.6


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 gun1

1

.1

Grand total

950

100.0

1Not considered a small arms hit nor a fragment hit.

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 causing 
perforating wounds

Missiles causing 
penetrating wounds

Type of missile:

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

TABLE 283.-Distribution of 233 determinations of the degree of damage caused by each type of missile

Type of missile

Degree of damage1

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 from-

 

Mortar

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

1Degree 1.-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 cm. in their greatest dimension.
Degree 4.-Same as degree 3 for defects measuring 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


719

TABLE 284.- Distribution of 250 casualties (152 sustaining hits during the day and 98 during the night), by type of missile

Type of missile

Day of casualties

Night casualties

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 of estimated number of enemy casualties caused by the indicated number of Turkish soldiers, by weapon used

Weapon

Enemy killed or wounded

Turkish soldiers involved


Number

Number

M1 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

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

Body region

Unknown missile

Gunshot

Shell fragment

Mortar

Grenade

Mine

Bayonet

Crushing

Chemical burns

Total casualties (number)

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.


721

TABLE 287. -Anatomic cause of death and body region wounded in 125 DOW casualties

Anatomic cause of death

Head

Vertebra

Thorax

Abdomen

Thorax, abdomen

Extremity

Abdomen, extremity

Thorax, vertebra

Thorax, abdomen, vertebra

Head, extremity

Abdomen, vertebra

Miscel- laneous

Total

Brain damage

14

---

---

---

---

---

---

---

---

---

---

---

14

Cerebellar hemorrhage

---

---

1

---

---

---

---

---

---

---

---

1

2

Brain abscess

5

---

---

---

---

---

---

---

---

---

---

---

5

Meningitis

5

---

---

---

---

---

---

---

---

---

---

---

5

Japanese B encephalitis

7

---

---

---

---

1

---

---

---

---

---

---

8

Japanese B encephalitis and peritonitis

---

---

---

---

---

---

1

---

---

---

---

---

1

Poliomyelitis

---

---

---

---

---

1

---

---

---

---

---

---

1

Pneumonia

---

4

---

---

---

---

1

---

1

1

---

1

8

Other pulmonary

4

2

3

---

---

---

---

3

---

---

---

---

12

Myocarditis

---

1

---

---

---

---

---

---

---

---

---

---

1

Mediastinal hemorrhage

---

---

---

---

1

---

---

---

---

---

---

---

1

Peritonitis

---

---

---

7

4

---

1

---

2

---

1

1

16

Fat embolization

---

---

---

---

---

2

---

---

---

1

---

---

3

Shock

---

---

---

---

---

---

1

---

---

---

---

---

1

Anesthetic

---

---

---

---

---

1

---

---

---

---

---

---

1

Lower nephron nephrosis

1

---

---

2

3

5

1

---

---

---

---

---

12

Lower nephron nephrosis with peritonitis

---

---

---

10

3

---

4

---

---

---

1

1

19

Lower nephron nephrosis and fat embolization

---

---

---

---

---

3

---

---

---

---

---

1

4

Lower nephron nephrosis and shock

---

---

---

---

---

2

---

---

---

1

---

---

3

Lower nephron nephrosis and gas infection

---

---

---

---

---

1

---

---

---

---

---

---

1

Lower nephon nephrosis and meningitis

---

1

---

---

---

---

---

---

---

---

---

---

1

Lower nephron nephrosis and transverse myelitis

---

---

---

---

---

---

---

---

---

---

---

1

1

Lower nephron nephrosis and pulmonary

---

---

---

---

1

---

---

---

---

---

---

1

2

Tetanus

---

---

---

---

---

1

---

---

---

---

---

---

1

Arteriovenous fistula

---

---

---

---

---

1

---

---

---

---

---

---

1

Laryngeal obstruction

---

---

---

---

---

---

---

---

---

---

---

1

1

Source: Autopsy reports from the 406th Medical General Laboratory, Tokyo, Japan.


722

TABLE 288.- Regional frequency of fatal wounds in 1,500 KIA casualties, by anatomic location

Anatomic location

Number of casualties

Percent of 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:


723

Number of cases

Number of 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

 

Total

150

Buttocks

61

Upper extremities:

Hip

46

Arm

220

 

Total

1,326

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 cases

Number of cases

Casualty-producing agent:

In air action-Continued

In ground action:

 

Rocket

30

 

Gunshot

430

 

Napalm

44

 

Shell fragment

235

Total

277

 

Grenade

12

Nonbattle casualties

46

 
Total

677

Total

46

In air action:

 

Bomb

109

 Grand total

1,000

 

Aircraft machinegun

94

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

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 KIA 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 KIA 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.


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 thoraco-abdominal 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

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.

7Medical Project-Body Armor, Korea, 14 June to 13 October 1951, issued by Joint Army-Navy Mission, Medical Research and Development.


727

FIGURE 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 Army-Navy 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

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 as 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 common 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 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


729

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

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 in the Zone of Interior and accompanied the test team to Korea. These items

FIGURE 343.-Map showing disposition of Body Armor Test Team, March-July 1952.

8Additional 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 H. Bailey, MC, HQ, Army Chemical Center, Md.; Capt. William L. Camper, Inf., 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, HQ, Army Chemical Center.
Detailed from Eighth U.S. Army units in Korea: Maj. Rodney O. Capps, QMC, 23d QM Group; Capt. William Barber, QMC, 23d QM Group; Capt. Robert H. Bessey, Jr., Inf., 15th Infantry; Capt. Henry E. Davis, QMC, 23d QM Group; Capt. Gene P. Eardley, MC, 25th Evacuation Hospital; Capt. Richard W. J. 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; 1st Lt. William B. Gillett, Inf., 233d Infantry; and 2d Lt. Rodney M. Brigg, Inf., 160th Infantry.


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.

Conduct 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

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

Mar. 26

200

Apr. 10

200

Apr. 13

200

Apr. 21

200

Apr. 24

200

May 4

200

May 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 had 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.


733

TABLE 29l.-Regional distribution of 1,474 wounds in 908 WIA casualties not wearing body armor

Body region

Number of wounds

Percent of total 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

Body region

Number of wounds

Percent of total 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

FIGURE 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.


735

FIGURE 344.-Continued.

 

TABLE 293.-Distribution of 1,460 armored and unarmored WIA casualties, by causative agent

Causative agent


Armored casualties

Unarmored casualties

Total casualties

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

Type of wounding

Armored casualties

Unarmored casualties

Total casualties

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

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 casualties

Percent of 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 KIA casualties, by anatomic location

Anatomic location

Lethal wounds

Associated wounds

Regional total

Percent regional wounds fatal

 Number

Percent

Number

Percent

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



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

FIGURE 345.-Typical missiles removed from vest, armor, T52-1, in Korea.


738

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

Disposition

Wound through vest

Wound not through vest

Total casualties

Number

Percent1

Number

Percent1

Number

Percent1

Small arms

Wounded in action:

Returned to duty

---

---

---

---

7

13.5

Evacuated

15

42.9

16

17.2

31

24.2

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

1Percent 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


739

casualty was collected in 235 cases. These latter cases were studied and broken down in the following categories:

Number of cases

Percent of 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

Causative agent

Vests hit

Penetrating hits1

Perforating hits2

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

1Missiles were defeated by vest, and no wound was produced.
2Missiles 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

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, who 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.


741

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 reported9 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

9Cox, W. W., Irving, J. W., Breezley, H. F., and Camper, W. L.: Report on the Use of Body Armor in Combat-Korea, February 1952-July 1952. Issued by the Office of the Assistant Chief of Staff, G-4 Logistics, September 1952.


742

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 90 F. When soldiers were under enemy fire, they did not complain of the excessive perspiration


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

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 he 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).

FIGURE 349.-World War II M12 vest with aluminum plates and a nylon cloth backing. Korea, 25 May 1952. A. Front view. B. Back view.


745

FIGURE 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.


746

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,


747

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 making 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

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,


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

FIGURE 355.-Reflection of light from surface of body armor, T52-1.

FIGURE 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.


751

FIGURE 357.-Recommended protection and side closure, in body armor

FIGURE 358.-Armor, vest, nylon, T52-2. This vest is made of 12 layers of spot-laminated 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

FIGURE 359.-Armor, vest, nylon, T52-3. Note new covering material, redesigned pockets, grenade and shoulder straps and side closure. (The trousers are not protective armor.) A. Front view. B. Front view showing closure. C. Side view. D. Rear view.


753

The initial survey of KIA casualties10 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 plan11 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 in Action, Korea, 12 November 1952-1 March 1953, vol. III. CmlC Medical Laboratories Research Report No. 221, October 1953.
11Cook, J. C.: Graves Registration in the Korean War. The Quartermaster Rev., pp. 18 and 131-144, March-April 1953.


754

TABLE 299.-Regional distribution of 1,346 wounds in 346 KIA casualties

Region

Number of wounds

Percent of 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 (M1951) (fig. 360) was standardized by 16 November 1951, and by 14 July 1952 approximately 9,772


755

TABLE 300.-Distribution of 1,346 wounds in 346 KIA casualties, 24 April-1 July 1952, by causative agent

Causative agent

Number of wounds

Percent of 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 wounds

Percent of wounds

Penetrating1

952

70.7

Perforating2

244

18.1

Avulsion3

133

9.9

Decapitation

17

1.3

Total

1,346

100.0

1Wounds of entrance but no exit; missile retained.
2Wounds of entrance and exit.
3Traumatic 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


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TABLE 302.-Entrance location of 128 lethal wounds in 103 KIA casualties, 24 April-1 July 1952, by body region

Body region

Number of lethal wounds

Percent of 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

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


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 Army1 and 2,308 wounds in 355 Marine Corps personnel2 killed in action

Body region

Army personnel, without armor

Marine Corps personnel, with armor

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

1Surveyed from 15 June to 1 September 1952.
2Surveyed 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.


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TABLE 304.-Regional distribution of lethal wounds in 354 Army1 and 355 Marine Corps2 personnel killed in action

Region wounded

Army personnel, without armor


Marine Corps personnel, with armor

Number

Percent

Number

Percent

Head

155

31.6

178

32.1

Face

30

6.1

52

9.4

Neck

28

5.7

47

8.5

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

1Surveyed from 15 June to 1 September 1952.
2Surveyed from 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.

TABLE 305.-Status of armor vests, available to major Army units,131 December 1952

Unit

Type of body armor vest

Marine2

Army nylon3

M124

Total


Number

Number

Number

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

4,977

5th RCT

1,454

91

---

1,545

Army troops

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

1Data derived from Staff Report, Quartermaster Section, Headquarters, Eighth U.S. Army, November and December 1952.
2Constructed of doron plates and nylon cloth.
3T52-l and -2 all-nylon body armor. This was the type used during the Army body armor test period.
4Army World War II body armor; aluminum plates with nylon cloth.


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TABLE 306.-Status of armor vests, available to major Army units,129 February 19532

Unit

Type of body armor vest available


M12 and Marine standard issue

Standard Army issue

Total


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

---

3,470

1st BCW Division

1,900

---

1,900

United Nations units

2,755

---

2,755

Total

46,625

22,768

69,393

1Data derived from Staff Report, Quartermaster Section, Headquarters, Eighth U.S. Army, February 1953.
2In 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.12 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.

12See footnote 10 (3), p. 753.


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TABLE 307.-Entrance location of lethal wounds in 2061casualties not wearing armor and in 5002 wearing armor

Entrance location

Without armor

With armor

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

1Survey 20 March to 1 July 1952; 154 KIA casualties with 206 lethal wounds.
2Survey 15 November 1952 to 1 March 1953; 500 KIA casualties with 500 lethal wounds.
3The 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 period. 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 percent13 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

13Other surveys would indicate a reduction of only approximately 12 percent.-J. C. B.


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TABLE 308.-Regional distribution of 3,510 wounds in 500 KIA casualties wearing body armor,November 1952-March 1953

Region

Number of wounds

Percent of 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

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 regions14 which is advocated 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.

FIGURE 361.-Demarcation of anatomic surface regions. Skeletal views. A. Anterior view. B. Posterior view. C. Lateral view.

14Holmes, R. H., Enos, W. F., and Beyer, J. C.: Demarcation of Body Regions. U.S. Armed Forces M. J. 5:1610-1618, November 1954.


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.15 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:


Number

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:


Number

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

15Coe, G. B.: Battlefield Performance of the M-1 Steel Helmet. CmlC Medical Laboratories Research Report No. 248, February 1954.


764

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 head.

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.


765

IMPROVISED ARMOR FOR SPECIAL PURPOSES

In addition to these experimental and standard items of issue, a considerable number of armored "suits" were devised by the personnel in Korea in an attempt to provide protection to individuals engaged in minefield clearance. Some of these models were produced from the ballistic materials in the World War II M12 vest and portions of the World War II flyer's armor (fig. 363). Others were developed from either the Army or Marine Corps upper torso armor in conjunction with overlapping plates of doron applied to the abdomen and upper and lower extremities (fig. 364).

FIGURE 362.-All-nylon lower torso armor. A. Closeup of armor. B. Lower torso armor worn in conjunction with vest, T52-3.

It is difficult to summarize quantitatively the effects of body armor in the Korean War; however, certain tentative conclusions are permitted by the battlefield studies and by the impressions gained by the team members.

1. There was a decrease in the number of personnel killed in action.

2. There was a decrease in the number of personnel wounded in action.

3. There was a decrease in the severity of wounds in those areas protected by the vest.

4. There was a decrease in the convalescence time of many of the wounded in action.

5. There was a decrease in the workload of medical personnel.

6. There was an increase in the percentage of wounded in action who returned to frontline duty.


766

FIGURE 363.-Armored suit for use by mine clearance personnel, World War II M12 vest components and World War II 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.

Many 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.


767

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.

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