CHAPTER VI
Examination of 1,000 American Casualties Killed in Italy
William W. Tribby, M.D.1
PURPOSE OF STUDY
The purpose of this study was to provide accurate sourcematerial on the distribution of wounds in the bodies of American soldiers killedin action. The project was conceived and initiated by Brig. Gen. (later Maj.Gen.) Joseph I. Martin, Surgeon, Fifth U.S. Army, who requested that it be doneby personnel of the 2d Medical Laboratory. Fieldwork, restricted to the bodiesof those who died before reaching field or evacuation hospitals, was begun on 29April 1944 at the U.S. Military Cemetery, Carano, Italy, under the supervisionof Col. Kenneth F. Ernest, MC, then commanding officer of the 2d MedicalLaboratory. It was completed on 6 November 1944 at the U.S. Military Cemetery,Monte Beni, Italy, with the very helpful advice and direction of Lt. Col. (laterCol.) Harold E. Shuey, MC, who became commanding officer of the laboratory inJuly 1944. Results of the study were presented in a six-volume report,2for which General Martin prepared the following foreword:
It is quite apparent to anyone who has seenthe human wastage in war that provisions for the best possible protection of thesoldier from enemy fire on the battlefield have not been achieved, nor has theproblem received the study it deserves. If the Medical Department is to carryout its mission fully, we should do our part in furthering improvement in thisfield. This study was conceived in that light and as a necessary step in theprocess of final solution of the problem.
The extent of the effort required to completethis study should be apparent on the face of the data presented. It is only whenit is known that this work was done as an additional
1The suggestions and assistance of Col. Charles G. Bruce, MC, Executive Officer, Office of the Surgeon, Headquarters, Fifth U.S. Army, facilitated the preparation of the original six-volume report. The author wishes to acknowledge his indebtedness to the following enlisted men of the 2d Medical Laboratory whose assistance made possible the work presented in the report: Sgt. Warren G. Dougherty, T4g. William E. McHale, T5g. Edward S. Werner, and Pfc. Ruben J. Anderson for their technical help in examining the bodies; and T4g. Arthur F. Labrado for the laborious task of typing the text, tables, and case descriptions. Special credit is due to Sergeant Dougherty for his invaluable assistance in assembling the data and for his faithful reproduction of the diagrams of the wounds. The well-executed outline form of the body, upon which the wounds were reproduced, was drawn by S. Sgt. John M. Watson, Office of the Surgeon, Headquarters, Fifth U.S. Army. The author wishes to thank the 47th Quartermaster Graves Registration Company for their willing and cheerful cooperation and the Fifth U. S. Army branch of the Army Pictorial Service for the use of one of their cameras and for their expert processing of the films and prints. The author is also indebted to Maj. Alfred G. Karlson for his suggestions and assistance in editing.
2This six-volume report, other than the part which serves as the basis for this chapter, consists of case reports on the 1,000 casualties examined. Since lack of space precludes inclusion of all 1,000 cases, representative case reports have been chosen for inclusion in this chapter (p. 454).
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duty by hard pressed personnel of a very active fieldlaboratory that the monumental scope of the undertaking is realized. The authorhas amply justified his right to ask that others, less actively engaged than hein the pursuit of the present conflict, develop the data presented here intoterms of usefulness.
On several occasions it seemed that lack oftime, obstinate weather of all kinds, the need for secrecy, the difficulty ofworking under battlefield conditions and the constantly changing militarysituation would contrive to halt this work. The reader is asked to considerthese factors before becoming too critical. The completion of this uniqueproject in its present form is a tribute to the indomitable desire forscientific investigation and [to the] * * * adherence to a high standard ofscientific endeavor.
During the organization of the survey, it appeared that astudy of this scope and character had not been done previously in the U.S. Army.Other casualty surveys were in progress (pp. 237-280 and pp. 281-436), but thedetails of the surveys were not available nor were either of them confinedsolely to the study of the killed in action. In the Bulletin of the U.S. ArmyMedical Department, No. 74, March 1944, a footnote to an article entitled"Need for Data on the Distribution of Missile Wounds" states:"The only data available in the Office of the Surgeon General are thosefrom 1,175 Union soldiers who were killed in action during the Civil War. Thisfootnote refers to the following statement:
The records in this office [Surgeon General ofthe U.S. Army] show the seat of injury in only one thousand one hundred andseventy-three cases of soldiers killed on the battlefield. Of these, fourhundred and eighty-seven (487) were of the head and neck, six hundred and three(603) of the trunk, thirty (30) of the upper extremities, and fifty-three (53)of the lower extremities.3
It is evident that a thorough study of these cases was notmade.
It was believed that the contemplated survey would partiallysatisfy the need for data on the distribution of missile wounds. Morespecifically, it was hoped that the material would be useful in helping todevise one or more forms of body armor which could be used in some of thevarying conditions encountered in battle. The data should also be useful toballisticians although much of the material required by this group wasunobtainable, as explained later.
METHODS OF STUDY
It was decided that this work should be done in the U.S.military cemeteries because it is here that bodies become available in groupslarge enough to make possible the study of a thousand cases within a reasonableperiod of time. Information regarding the circumstances attending death couldnot be augmented by working farther forward. Furthermore, the removal ofclothing from bodies cannot be permitted before they have been searched foridentification tags and personal effects by personnel of the Graves RegistrationService in preparation for burial. This latter function was performed in theceme-
3Medical and Surgical History of the War of the Rebellion. Surgical History. Washington: Government Printing Office, 1883, pt. III, vol. II, pp. 691-692.
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teries. The data for this study, therefore, were collected inthe U.S. military cemeteries at Carano, Follonica, Castelfiorentino, and MonteBeni, Italy. The periods of time and numbers of cases studied in each locationare shown in table 111.
TABLE 111.-Period oftime, location of cemetery, and number of cases studied at each cemetery
Date | Location | Cases studies |
| 1944 | Number | |
29 April-27 May | Carano | 250 |
4-20 July | Follonica | 240 |
6-21 October | Castelfiorentino | 328 |
27 October-6 November | Monte Beni | 182 |
Quartermaster Graves Registration Service
The methods employed by the Quartermaster Graves RegistrationService for collection and delivery of bodies to the cemeteries are related tocertain aspects of this study, and they merit brief description. The divisionquartermaster is responsible for evacuation of bodies to the Graves RegistrationService. He, or his appointed representative, may act as the divisional gravesregistration officer. Each regiment has a graves registration officer whoorganizes collecting teams. These teams are composed of enlisted men who collectthe dead and write the EMT'S (emergency medical tags). One platoon of a gravesregistration company is capable of operating a cemetery provided the number ofburials is not too great. In Italy, it was usually possible for the 47thQuartermaster Graves Registration Company to have one of its platoons operatefour collecting points so spread out behind the front as to cooperate with thedivisional collecting teams. It was intended that regimental collecting teamswould evacuate their dead to Graves Registration Service collecting pointswhence they were evacuated to the cemetery. This plan was not always followedbecause at times the regimental collection point was closer to the cemetery thanit was to a Graves Registration Service collecting point. In static situations,the divisional collecting and evacuation system usually functioned without delayin cooperation with the Graves Registration Service. Most bodies were recoveredpromptly. However, when the army was advancing rapidly and actions occurred inwidespread areas, it was more difficult to find bodies, and frequently they didnot reach the cemetery for many days after death. When the divisional collectingsystem was forced to leave bodies behind, the task of finding and collectingthem fell to the Graves Registration Service.
Examinations
Bodies were examined as received in the cemeteries, withoutselection but with the requirement that they be in a condition fit forexamination; that is,
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FIGURE 229.-Worksheet with anatomic views ofbody and location of wounds.
not so decomposed nor so heavily infested with fly larvae asto make the location or extent of the wounds uncertain. In practice, the bodieswere stripped of all clothing after having first been searched by gravesregistration personnel. The wounds were then described and recorded promptly soas not to delay interment. Every wound was probed and its extent determined asexactly as possible from external examination.
All data were recorded on mimeographed sheets on one side ofwhich were outline forms of front and rear views of the body with three views ofthe head. Rough sketches of the wounds were made (fig. 229). On the reverse ofthe sheet was entered identifying information to include, when available, name,rank, Army serial number, organization, army branch of service, type of missile,type of action, position at time of injury, treatment, and description of woundand wound track. This information is essentially the same as that suggested
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in the article in the March 1944 Medical Department bulletin.The worksheets were saved as a permanent record.
Certain difficulties were encountered in attempting to obtainthe items of information just cited. All of these items, except descriptions ofwounds and names and serial numbers, had to be obtained from EMT's or fromGraves Registration forms. Names and serial numbers were usually copied fromidentification tags. When the latter were missing, other means of identificationwere sought, such as AGO cards, letters, and membership cards. Ranks,organizations, and serial numbers could not always be recorded at the time whenthe bodies were examined. After 1,000 cases had finally been studied, it wasfound that information on approximately one-third was incomplete. The missingdata were obtained from the office of the Fifth U.S. Army Graves RegistrationOfficer and the Adjutant General Casualty Section.
Causative Agents
Efforts to ascertain and tabulate the missiles in this seriesmet with almost insurmountable difficulties. A man killed in battle will be seento fall only by his comrades who cannot know with certainty what type of missilecaused a man's death. They may know that a man was hit by machinegun or riflefire or that he encountered a mine, but they cannot state with accuracy thecaliber of a high explosive shell which has been fired at them. In any event,even if accurate information regarding missiles is known to a man's comrades,it does not often find its way to the EMT's which are filled in by companyaidmen or other medical personnel who arrive on the scene after the action hasoccurred. Those who actually see the death occur are seldom present when thebody is tagged. Ballistic data on EMT's cannot therefore be depended uponsince it is not known which ones are accurate. The best method of obtainingaccurate information of this type is to perform an autopsy to locate andidentify missiles4 (fig. 230) and to determinethe extent of tissue damage. Early in this study, it became evident that theperformance of an autopsy in every case was impracticable because of the timerequired for such a procedure. The first body autopsied in this project wasthoroughly dissected in search of the missile. After a period of 3 hours, themissile had still not been found, and the search for it was abandoned. Even whenfragments of metals are found, their small size usually precludes determinationof their origin. Frequently, missiles were discovered near the surface of thebody, in wounds, or in the clothing adjacent to wounds. The size and shape ofall such pieces of metal were incorporated in
4This information should be supplemented by interviews with soldiers present at the time the man was wounded. They can identify the causative agent with a surprising degree of accuracy and can also furnish invaluable data pertaining to type of activity, position of soldier, terrain and protective cover, and approximate range. Therefore, surveys on killed-in-action casualties should be conducted by two teams working simultaneously but in widely separated locations. One team should be available for interrogation of eyewitnesses in the forward area where the body is recovered. This team can be composed of nonmedical personnel. The second team, composed of medical and certain essential nonmedical personnel, should be located at the main collecting point for the bodies (interment site or current death embalming area) where a complete wound ballistics examination can be conducted. Ideally, the latter should entail a complete external examination of the wounds with their location and description, adequate color photographs of the wounds, X-ray examination, autopsy examination of the major wounds, recovery of missiles, photographs and preservation of gross organs, preparation of tissue blocks, and determination of cause of death.-J. C. B.
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the descriptions of each case. The data concerning missileswere copied from the EMT's with the important exception that the term"high explosive" did not occur on the tags. Under this heading wereplaced all casualties who obviously died as the result of having been hit byhigh explosive missiles but whose EMT's did not indicate a missile. Alsoincluded in this category were all cases for which there was definite evidencethat the missile was erroneously stated on the EMT but which were manifestly hitby high explosive missiles. It was believed that the data as finally recorded onthe case report were in general accurate with regard to gross categories ofcausative agents.
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Problems Encountered
In warm weather, the condition of most of the bodies received inthe cemeteries was so unsatisfactory that even external examinations were notdone. During the months of August and September, the work was discontinuedbecause too few bodies in fresh condition were received at the cemeteries tomake an effort worth while. For this reason, the proportion between the numberof cases included in this series and the number of interments variedconsiderably from one cemetery to another. For example, the sample of battledeaths included in this study was larger at Castelfiorentino in October than itwas at Follonica in July.
The 1,000 casualties of the survey though not representativeof casualties from all types of action during different seasons were notsignificantly different from those observed in areas other than where the surveywas conducted. There was also no apparent difference in the types of casesreceived when the front was static as compared with those received during anoffensive.
The exact type of action in which these battle casualtiesoccurred could not be determined at the cemeteries. The available informationconsisted of the location where bodies were recovered, which was indicated on amajority of the emergency medical tags. The usual statement consisted of"Vic [victim] of," followed by the name of the nearest landmark orinhabited locality, often misspelled. Coordinates were usually not given. Toobtain accurate type-of-action data, it would be necessary to study the historyof each organization.
The position of the body at the time of injury could not bedetermined because it was impossible to make contact with anyone able to givethis information.
As it was impossible to obtain the services of a photographerfor an extended period of time, a camera was borrowed from the Army PictorialService. Photographs of 82 representative cases were made by the author andprocessed by the Army Pictorial Service (fig. 231). The photographs were madeunder an agreement with the Fifth U.S. Army Graves Registration Officer that nonames would be associated with them.
STATISTICAL STUDIES
At the beginning of the description of each case in thecomplete report is a statement which classifies the wounds as single or multipleand lists the various parts of the body which are involved. Tables 112, 113,114, 115, and 116 are presentations of these data in tabular form. Each wound ismentioned separately in most of the cases except in instances where multiplewounds were present. In the latter cases, each wound is not describedseparately.
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Classification
A compilation of the cases, arranged according to parts ofthe body which were affected and according to probable missiles, is presented intable 112. Emphasis must be placed upon the word "probable" whenreference is made to missiles. It must not be forgotten that the placing of themajority of the cases in any particular group, with respect to missiles, isbased upon the appearance of wounds and EMT data rather than upon actual findingof missiles. The columns labeled "Upper half of the body" and"Lower half of the body" list the cases which had wounds confined tothe areas above and below the diaphragm, respectively, but with more than oneregion involved. The column labeled "Upper and lower halves of thebody" lists the cases in which the wounds were distributed above and belowthe diaphragm. It will be seen that some of the cases in these three columnshave single wounds. This means that from external examination it was determinedthat more than one region was affected. For example, a single wound in thechest, with intestine herniated through it, is of the thoracoabdominal type, andthe case belongs in the group of cases with wounds both above and below thediaphragm. Undoubtedly, many of the cases with wounds which were too small to beprobed would have been
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found to have parts affected other than those listed had itbeen possible to perform autopsies in all such instances. The data, however,were uniformly recorded from the standpoint of external examination.
TABLE 112.-Distribution of 983 KIA casualties,1according to body areas andprobable causative agents
Probable causative agent2 | Head | Neck | Thorax | Abdo- | Upper extremity | Lower extremity | Upper half of body | Lower half of body | Upper and lower halves of body | Pelvis | Total | |
| Casualties with single wounds | ||||||||||||
High explosive | 61 | 1 | 31 | 6 | 3 | 7 | 4 | 5 | 9 | 2 | 129 | |
Shell fragments | 39 | 5 | 26 | 7 | 4 | 8 | 6 | --- | 4 | --- | 99 | |
Small arms | 24 | 7 | 27 | 3 | 3 | 2 | 7 | 3 | 2 | 3 | 81 | |
| 124 | 13 | 84 | 16 | 311 | 17 | 17 | 8 | 15 | 5 | 3310 | |
| Casualties with multiple wounds | ||||||||||||
High explosive | 7 | 1 | 16 | 1 | --- | 14 | 87 | 14 | 202 | --- | 342 | |
Shell fragments | 1 | --- | 9 | --- | 1 | 8 | 55 | 8 | 201 | --- | 283 | |
Small arms | 1 | --- | 4 | --- | --- | 1 | 9 | --- | 11 | --- | 26 | |
| 9 | 1 | 29 | 1 | 1 | 23 | 4154 | 22 | 5433 | --- | 4,5673 | |
| 133 | 14 | 113 | 17 | 12 | 40 | 171 | 30 | 448 | 5 | 983 | |
1Does not include 4 casualties cremated in a tankand 13 casualties due to blast injury. See text, p. 446.
2Identified from appearance of the wound and from information onEMT's rather than by recovery of the actual missile.
3Includes a wound caused by a landmine.
4Includes 3 wounds caused by landmines.
5Includes 19 additional wounds-3 caused by hand grenades, 15 bylandmines, and 1 by aerial bombs.
Some difficulty was encountered in attempting to classifywounds located in marginal areas; for instance, deciding whether axillary woundsshould be listed as upper extremity wounds or as chest wounds. Axillary andshoulder girdle wounds were classified as chest wounds except in cases wherethey extended into or were distal to the head of the humerus. The same criteriawere applied to wounds in the inguinal and buttock areas where they wereclassified as pelvic unless they extended into or were distal to the head of thefemur. The terms "back" and "lumbar area" were not includedin the classifications. Wounds located in the back above the level of the firstlumbar vertebra were listed as "chest." Similarly, posterior wounds inthe lumbar region above the iliac crests were classified as abdominal.
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Four cases5 were classified as cremation in a tank, andthirteen cases were designated as blast injury. (These 17 cases are not includedin table 112.) The latter cases were those with nonpenetrating wounds with blastinjury the probable cause of death. Autopsies were performed upon four of thesebodies and diffuse pulmonary hemorrhage was found in all four cases andpulmonary edema in three of them. Microscopic tissue studies were done in onlyone of the cases, the others having been decomposed to such an extent thattissues were not saved for this purpose. All cases in this group, except one,showed the presence of blood either in the nose or mouth or in body places. Thisfinding, in the absence of penetrating wounds, was presumed to indicatepulmonary hemorrhage probably due to blast. Several other cases, withoutpenetrating wounds sufficient to explain death, may have died of blast injury.
Even though the actual missiles were not recovered, thegeneral breakdown of the causative agents was comparable to that determined inother ground force casualty surveys where witnesses were interrogated andautopsies were performed. Small arms accounted for 107 (10.9 percent) of the 983missile-wounded casualties. Fragment-producing weapons were tentativelyidentified in the remaining 876 (89.1 percent) of these casualties. Shellfragments were identified with certainty in 382 (38.9 percent) of thecasualties. However, the noncommittal term "high explosive" was usedfor 471 (47.9 percent) of the cases, and it was presumed that most of themissiles were derived from mortar and artillery shells. Hand grenades werepositively identified in 3 (0.1 percent) of the casualties, landmines in 19 (1.9percent), and aerial bombs in 1 (0.1 percent). If the exact identification ofthe missiles could have been made, the proportion of hand grenade and landminecasualties might have increased.
Multiple Wounds
From the group of cases with wounds involving the upper halfof the body, the lower half of the body, and the combined upper and lower halvesof the body, data were compiled on regional incidence (number of times ananatomic region was involved). These data are presented in tables 113, 114, and115. Table 116 is a compilation of all the data on actual distribution of woundsin the whole series and also lists the regional frequency of the probablelethal wounds. The thorax was most frequently involved, followed, in order, bythe head, the upper and lower extremities, and the abdomen.
5The author had originally included these cases with thecasualties receiving missile-inflicted injuries (upper and lower halves of thebody). Since only a few pounds of charred body remains were recovered, it isfelt that they should be considered in a separate category.-J. C. B.
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Anatomic location | Number of wounds | Percent of cases |
Head | 88 | 51.5 |
Neck | 67 | 39.2 |
Thorax | 120 | 70.2 |
Upper extremity | 121 | 70.8 |
Anatomic location | Number of wounds | Percent of cases |
Abdomen | 20 | 66.6 |
Pelvis | 24 | 80.0 |
Genitalia | 2 | 6.6 |
Lower extremity | 21 | 70.0 |
Anatomic location | Number of wounds | Percent of cases |
Head | 210 | 46.5 |
Neck | 97 | 21.5 |
Thorax | 339 | 75.0 |
Abdomen | 232 | 51.3 |
Pelvis | 146 | 32.3 |
Extremities: | ||
| Upper | 276 | 61.1 |
| Lower | 327 | 72.3 |
Genitalia | 21 | 4.6 |
1Includes 4 cases cremated in atank not included in table 112.
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With a view to determining the approximate total number ofwounds and their regional distribution, the author's original case reportswere reexamined.6 The total number of cases (983, table 112) remained thesame, but a slight change was made in the distribution of the single andmultiple regional involvements (missile wounds), as follows:
Single region involved: | Number of cases |
| Head | 138 |
| Neck | 21 |
| Thorax | 126 |
| Abdomen | 25 |
| Extremities: | |
Upper | 18 |
Lower | 72 |
90 | |
| 400 |
Multiple regions involved | 583 |
| 983 |
No change in classification was made for the 4 cases crematedin a tank and the 13 casualties which were due to blast injury, and they werenot included in any of the tabulations.
Reevaluation
In the original tabulation, a number of cases withperforating wounds had a missile track involving several body regions and wereclassified as multiple-region-type cases. It was decided that these should beconsidered as a single-region involvement of the entrance site regardless of thelocation of the exit wound. The demarcation of the anatomic regions was alsobased upon slightly different criteria7 and accounts for some of the changes inthe regional frequency of wounds (table 117, compare with table 116). Thebuttocks, though considered as a portion of the lower extremity, were listedseparately because of interest in this region in the development of lower torsobody armor. Table 118 lists the regional distribution of the estimated 7,006wounds in the 983 casualties. Of the total wounds, 55.4 percent (more than ahalf) occurred in the extremities and 25.7 percent were located in the thorax.Approximately 6,130 (87.5 percent) were penetrating8 type of wounds and 876(12.5 percent) were perforating9 type of wounds. The wound incidence percasualty was approximately 7.1 percent, and this is very similar to that foundin the study of KIA in the Korean War.
6By the editor (J. C. B.).
7Holmes, R. H., Enos, W. F., and Beyer, J. C.: Demarcationof Body Regions and Battle Casualty Analysis. U.S. Armed Forces M. J. 5: 1610-1618,November 1954.
8Wound of entrance only and major portion of missileretained within the body.-J. C. B.
9Wounds of entrance and exit and major portion of missilenot retained within the body.-J. C. B.
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Anatomic location | Regional involvement in groups with wounds of- | Total wounds | Probable fatal wounds2 | |||||
Upper half of body (171 cases) | Lower half of body (30 cases) | Upper and lower halves of body (452 cases) | Single region (334 cases) | Number | Percent | Number | Percent | |
Head | 88 | --- | 210 | 133 | 431 | 17.6 | 401 | 28.1 |
Neck | 67 | --- | 97 | 14 | 178 | 7.3 | 121 | 8.5 |
Thorax | 120 | --- | 339 | 113 | 572 | 23.4 | 422 | 29.6 |
Abdomen | --- | 20 | 232 | 17 | 269 | 11.0 | 167 | 11.7 |
Pelvis | --- | 24 | 146 | 5 | 175 | 7.2 | 79 | 5.5 |
Extremities: | ||||||||
| Upper | 121 | --- | 276 | 12 | 409 | 16.7 | 98 | 6.9 |
| Lower | --- | 21 | 327 | 40 | 388 | 15.9 | 138 | 9.7 |
Genitalia | --- | 2 | 21 | --- | 23 | .9 | --- | --- |
| 396 | 67 | 1,648 | 334 | 2,445 | 100.0 | 1,426 | 100.0 |
1Includes 4 casualties cremated in a tank and not included intable 112.
2Included in total wounds but probably responsible for mortality.
Anatomic location | Regional involvement | Total regional involvement | Regional frequency in 983 cases | ||
Single wound | Multiple wounds (583 cases) | Number | Percent | ||
| Percent | |||||
Head | 138 | 258 | 396 | 18.1 | 40.3 |
Neck | 21 | 128 | 149 | 6.8 | 15.1 |
Thorax | 126 | 390 | 516 | 23.6 | 52.5 |
Abdomen | 25 | 192 | 217 | 10.0 | 22.1 |
Extremities: | |||||
| Upper | 18 | 358 | 376 | 17.2 | 38.2 |
| Lower | 68 | 342 | 410 | 18.8 | 41.7 |
Buttocks | 4 | 115 | 119 | 5.5 | 12.1 |
| 400 | 1,783 | 2,183 | 100.0 | |
1Indicates frequency of anatomicregional incidence of wounds per casualty but not total number of wounds.
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Anatomic location | Regional distribution of wounds | Total wounds | ||
Single wound | Multiple wounds | Number | Percent | |
Head | 156 | 458 | 614 | 8.8 |
Neck | 21 | 238 | 259 | 3.7 |
Thorax | 186 | 1,616 | 1,802 | 25.7 |
Abdomen | 26 | 420 | 446 | 6.4 |
Extremities: | ||||
| Upper | 21 | 1,439 | 1,460 | 20.8 |
| Lower | 275 | 1,806 | 2,081 | 29.7 |
| Buttocks | 10 | 334 | 344 | 4.9 |
| 695 | 6,311 | 7,006 | 100.0 |
Rank and Type of Duty
The rank and type of duty of the 1,000 killed in actionexamined are listed in the following tabulations:
| Rank: | Number | Rank-Continued | Number |
| Private | 454 | Technical sergeant | 18 |
| Private, first class | 277 | Sergeant, first class | 4 |
| Technician, fifth grade | 33 | 2d lieutenant | 31 |
| Corporal | 34 | 1st lieutenant | 15 |
| Technician, fourth grade | 12 | Captain | 10 |
| Sergeant | 67 | Major | 2 |
| Staff sergeant | 42 | Lieutenant colonel | 1 |
Type of duty: | Number | Type of duty-Continued | Number |
| Infantry and armored infantry | 875 | Reconnaissance | 7 |
| Field artillery | 27 | Antiaircraft artillery | 5 |
| Tank | 27 | Signal | 4 |
| Engineer | 21 | Division headquarters | 1 |
| Infantry medical detachment | 13 | Division headquarters, Military police | 1 |
| Tank destroyer | 9 | Division band | 1 |
| Chemical | 8 | Medical battalion | 1 |
Emergency Medical Tag
Of the EMT's attached to the bodies examined, 119 gave indication that thecasualties had been seen alive after having been hit. Data collectedpartly by examination of the bodies and partly from EMT's showed that109 of the cases had received the following types of treatment:
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Number | Number | ||
Sulfonamide, local | 80 | Tourniquets | 9 |
Dressings | 89 | Sulfonamide, tablets | 2 |
Plasma | 27 | Oxygen | 1 |
Splints | 16 | Shock therapy | 2 |
Medicine (for example, morphine) | 9 |
For the remaining 10 cases listed as "WIA" onGraves Registration Burial Forms (GRS No. 1), no treatment was noted.
At the time this study was being done, diagnoses from the EMT'swere not copied on the worksheets. The diagnoses on the tags were not changed orinfluenced by this study except in six cases which were autopsied. Itbecame evident as the study progressed that diagnoses on EMT's were oftenerroneous. Since EMT's were frequently the only source of information onbattlefield deaths available to the Medical Department, an effort was made todetermine the accuracy of the diagnoses contained thereon. The EMT diagnosis wasobtained for each case in this study from the Graves Registration Burial FormNo. 1. A comparison of the diagnoses is presented in table 119. It isseen, for example, that 15.3 percent of the EMT's for these 1,000 cases haderroneous diagnoses for wounds of the head and 13.9 percent were in error forwounds of the neck. For the abdomen and pelvis, the errors were 20.2 percent and16.3 percent, respectively. This deficiency was only partially the fault ofthose who wrote the EMT's for battlefield deaths. Accurate diagnoses are notto be expected unless the body is stripped of all clothing and examined by amedical officer.10
TABLE 119.- Comparison of regions actually involved and regions recordedon EMT's
Body region | (1) | (2) | (3) | (4) | (5) |
Head | 431 | 327 | 49 | 153 | 15.3 |
Neck | 178 | 58 | 19 | 139 | 13.9 |
Thorax | 572 | 338 | 42 | 276 | 27.6 |
Abdomen | 269 | 114 | 47 | 202 | 20.2 |
Pelvis | 175 | 26 | 14 | 163 | 16.3 |
Extremities: | |||||
| Upper | 409 | 113 | 42 | 338 | 33.8 |
| Lower | 88 | 190 | 34 | 232 | 23.2 |
Genitalia | 23 | 3 | 3 | 23 | 2.3 |
| 2,445 | 1,169 | 250 | 1,526 | 100.0 |
1Figures in column 1 minus figures in column 2 plusfigures in column 3.
10In addition, the EMT could be designed to containseveral small anatomic outlines so that the exact location of all wounds couldbe quickly but accurately located.-J.C.B.
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Indication for Body Armor
The following 198 cases with severe multiple mutilating wounds (figs. 232 and233) are grouped according to the regions affected:
Group with- | Number of cases |
Severe wounds involving the head, including decapitations and crushing and mutilating wounds (20 of this group are included in one or more of the other groups listed) | 103 |
| Traumatic amputation of all or part of one lower extremity (10 of this group are included in one or more of the other groups listed) | 33 |
| Traumatic amputation of all or part of both lower extremities (12 of this group are included in one or more of the other groups listed) | 23 |
| Traumatic amputation of all or part of one upper extremity (18 of this group are included in one or more of the other groups listed) | 33 |
| Traumatic amputation of all or part of both upper extremities (10 of this group are included in one or more of the other groups listed) | 12 |
| Other mutilating or dismembering wounds (29 of this group are included in one or more of the other groups listed) | 54 |
453
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These 198 cases plus 4 which were cremated represent 20percent of the total number examined which could not have been saved from deathby any type of body armor.
In many cases with multiple wounds, it is difficult todetermine which wound is the immediate cause of death. Undoubtedly, some of thetraumatic amputations of extremities would not have resulted in death had theybeen the only wounds. Wounds of the head were considered as more likely to havebeen fatal than wounds of other regions. Of 432 head wounds, only 31 were eithernonpenetrating or not serious enough to have been fatal. Although no study hasbeen made to determine the percentage of head wounds involving the areas notprotected by the helmet, the impression was obtained that a helmet could bedesigned to cover more of the head and neck and reduce the number of seriouswounds of these regions. Other sites which would be difficult to protect byarmor are the attachments of the extremities to the trunk, of which no studieswere made in this report. About 20 percent of the cases could not have beenprotected by any type of body armor. Possibly some type of body armor could bedesigned to protect vital areas most often involved, such as the head and trunk.The data in the original report are source materials which can be studiedfurther in an attempt to clarify this problem.
CASE REPORTS
The case reports which are included in this section wereselected from the original report as illustrative of the types of woundsinflicted on the various anatomic regions of the casualties studied in thissurvey. In all instances, the case numbers assigned in the original report havebeen used.
HEAD
Case No. 633.-Pfc., 168th Infantry, 14 Oct. 1944; missile:high explosive; single wound in the head (fig. 234). There was athrough-and-through wound in the head with the wound of entrance, 2 x 4 cm., inthe left cheek area and the wound of exit, 3.5 x 5 cm., in the right temporaland zygomatic area, passing through the external ear. The right temporal boneand bones of the face were severely crushed.
Case No. 641.-Pvt., 338th Infantry, 15 Oct. 1944; missile:shell fragments; multiple wounds in the head (fig. 235); treatment: plasma, 2units local sulfonamide and dressing. Three deep lacerations were present in theright posterior half of the head. The right temporal bone was penetratedimmediately behind the external ear in an area which measures 3 cm. in diameter.
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FIGURE 234.-Single head wound. A. Wound of entrance. B. Wound of exit.
FIGURE 235.-Multiple wounds of the head.
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NECK
Case No. 501.-Pfc., 362d Infantry, 7 Oct. 1944; missile: shell fragment;single wound in the neck (fig. 236). A large mutilating wound was present in theleft anterior and lateral sides of the neck. There was exposure andfragmentation of several cervical vertebras.
FIGURE 236.-Single neck wound.
Case No. 970.-Pfc., 362d Infantry, 5 Nov. 1944; missile: shell fragment;single wound in the neck (fig. 237). A wound, 1.3 x 2.5 cm., penetrated theanterior side of the neck immediately to the right of the midline andimmediately inferior to the larynx. The trachea was perforated and the body ofthe C7 vertebra was crushed. The wound bled profusely.
FIGURE 237.-Single neck wound.
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CHEST
Case No. 760.-Pvt., 338th Infantry, 19 Oct.1944; missile: high explosive; single wound track in the chest (fig. 238). Thisthrough-and-through wound had its entrance, 1 x 2.5 cm., in the posterior leftside of the chest at the level of the T5 vertebra, 10 cm. from the midline. Thewound of exit, 4 x 6 cm., was located in the anterior left side of the chest atthe level of the second and third ribs. There was a large opening into thethoracic cavity through the second, third, and fourth ribs.
FIGURE 238.-Single chest wound. A. Wound of entrance. B. Wound of exit.
Case No. 824.-Pfc., 936th Field Artillery, 27 Oct. 1944;missile: shell fragments; multiple wounds in the chest (fig. 239). There was athrough-and-through wound in the chest with the entrance, 2 x 2.5 cm., in theleft anterior axillary line. The wound track traversed the thoracic cavity in aslightly posterior and medial direction through compound comminuted fractures inthe fourth and fifth ribs. The wound of exit, 3.5 x 4 cm., was located in theanterior lateral right side of the chest, where it passed through a compoundcomminuted fracture in the fifth rib. A superficial through-and-throughlacerated wound was present in the posterior left side of the chest in themidscapular area. Another laceration was found near the medial angle of theright scapula.
FIGURE 239.-Multiple wounds of the chest.
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Case No. 908.-Sgt., 755th Tank Battalion, 1 Nov.1944;missile: high explosive; single wound track in the chest (fig. 240). Thisthrough-and-through wound in the chest had its entrance, 2 x 2.5 cm., throughthe body of the left pectoralis muscle group, near the axilla. The trackproceeded downward and posteriorly through the fractured third rib. The wound ofexit, 2.5 cm. in diameter, was found in the posterior side of the chest,immediately to the left of the midline at the level of the T4 vertebra. Thewound opened into the spinal canal through the T4 and T5 vertebras and extendedto the left of the spinal column into the thorax. The left fourth rib wasfractured transversely at the site of exit..
FIGURE 240.-Single thoracic wound. A. Wound of entrance. B. Wound of exit.
ABDOMEN
Case No. 986.-Pvt., 363d Infantry, 5 Nov. 1944; missile: high explosive;single wound in the abdomen (fig. 241); treatment: local sulfonamide anddressings. A penetrating wound, 6.5 cm. in diameter, was located in the midlineof the abdomen in the epigastrium. There was evisceration of numerous loops ofsmall intestine through the wound.
FIGURE 241.-Single abdominal wound.
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LOWER EXTREMITY
Case No. 644.-Pfc., 338th Infantry, 14 Oct. 1944; missile: high explosive; multiplewounds in both lower extremities(fig. 242). There was traumatic amputationof both legs immediately distal to the knee joints. Lacerations extended into the distal medial third of the left thigh.
FIGURE 242.-Multiple wounds of lower extremities.
Case No. 759.-Cpl., 337th Infantry, 19 Oct. 1944; missile:high explosive; multiple wounds in both lower extremities (fig. 243). Numerouspenetrating wounds were found in the left leg between the knee and the ankle.They varied in diameter from 1 cm. to 2.5 cm. There was traumatic amputation ofthe right leg through the middle third. The distal portion was attached bymuscle and was completely mutilated. Two lacerated penetrating wounds werepresent in the lateral and anterior sides of the right knee. There was acompound comminuted fracture in the right patella. A laceration, 3 x 5 cm., waslocated in the anterior side of the right knee and leg. Maggots, visible infigure 243, were contaminants from another body.
Case No. 966.-Pfc., 339th Infantry, 4 Nov. 1944, missile:high explosive; multiple wounds in both lower extremities (fig. 244); treatment:local sulfonamide and dressings. There was traumatic amputation of the left legthrough the proximal third of the tibia and fibula, with lacerations extendinginto and above the knee joint for a distance of 10 cm. There was essentialtraumatic amputation of the right foot through the ankle joint with severemutilation of the entire foot; lacerations extended 12 cm. above the distal endof the tibia and fibula. Two intercommunicating lacerations in the right medialthigh were 6 cm. apart; the lower opening measured 1.5 x 2.5 cm. and the upperopening, 4 x 5 cm. A superficial laceration, 3.5 cm. in diameter, was found inthe anterior proximal aspect of
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the right thigh. There was a comminuted fracture in the middle third of theright femur, with a penetrating wound over the fractured area in the middle ofthe thigh, anteriorly. A laceration, 2 x 4 cm., in the medial side of the rightleg exposed the periosteum of the tibia.
FIGURE 243.-Multiple wounds of the lower extremities.
FIGURE 244.-Multiple wounds of the lowerextremities.
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MULTIPLE WOUNDS
Case No. 80.-T5g., 338th Infantry, 15 May 1944; missile:shell fragments; multiple wounds in the head, neck, chest, and both upperextremities (fig. 245). A penetrating wound, 1 x 2 cm., was present in thevertex of the skull in the midline; the point of exit, 4 cm. in diameter, waslocated in the right parietal region; there was avulsion of brain tissue andextensive lacerations of the scalp. A through-and-through wound was noted in theright side of the neck: The point of entry, to right of the larynx anteriorly,was 1 cm. in diameter; the point of exit, 4 cm. in diameter, was at the anteriorborder of the trapezius muscle; two other small penetrating wounds were seen inthe right side of the neck posteriorly. A penetrating wound, 3.5 cm. indiameter, was found in the left shoulder over the upper portion of the scapula;there were many other small penetrating wounds of both shoulders, posteriorly,and of the right arm and shoulder, anteriorly. A penetrating wound was presentin the base of the left thumb. There was traumatic amputation of the right handimmediately distal to the wrist joint.
Case No. 631.-Pvt., 133d Infantry, 14 Oct. 1944;missile: high explosive; multiple wounds (two) in the chest and left upperextremity (fig. 246). There was traumatic amputation of the left arm through theproximal end of the humerus. The joint cavity was not involved. The arm remainedattached by a small segment of skin. The wound extended into the left upperanterior side of the chest where the skin and muscles were extensivelymutilated. A laceration, 4 x 6 cm., was located in the left lateral aspect ofthe thorax.
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FIGURE 246.-Multiple wounds of the chest and the left upper extremity.
Case No. 678.-T. Sgt., 361st Infantry, 15 Oct. 1944;missile: shell fragments; multiple wounds in the head, neck, chest, and bothupper extremities (fig. 247). Many penetrating wounds were found in the face,anterior neck, chest, left arm and shoulder. They varied in diameter from a fewmillimeters to 1.5 centimeters. The largest wound entered the chest anteriorly,at the level of the sixth intercostal space 6 cm. from the midline through
FIGURE 247.-Multiple wounds of the head, neck, chest, and upperextremities.
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compound comminuted fractures of the secondand third ribs.Another penetrating wound in the right anterior side of the chest at the levelof the fourth intercostal space adjacent to the sternum extended downward intothe thoracic cavity. Three penetrating wounds in the posterior left side of thechest measured 1 cm. in diameter, 3 x 5 cm. and 1 x .3 cm. A laceration, 2 x 5cm., was present in the top of the right shoulder. The track passed throughcomminuted fractures of the proximal end of the humerus and lateral angle of thescapula.
FIGURE 248.-Multiple wounds of head, chest, and right upper extremity.
Case No. 907.-T. Sgt., 755th Tank Battalion, 31 Oct. 1944;missile: high explosive; multiple wounds in the head, chest, and right upperextremity (fig. 248). There was a through-and-through wound in the vault of theskull with the entrance, 2 x 3 cm., in the left posterior parietal area and thewound of exit, 5 cm. in diameter, in the right posterior parietal area near the midline. The frontal, both parietal,and occipital bones were fragmented and the brain was partially eviscerated. Athrough-and-through wound in the lower jaw had its entrance, 1 x 2 cm., in theleft cheek anterior to the angle of the mandible and its wound of exit, 1.5 x4.5 cm., in the right side immediately anterior to the angle of the mandible.The entire mandible was fragmented. A laceration, 3.5 x 7 cm., was present inthe anterior left side of the chest, with an irregular steel fragment, 2.3 x 1.2x 0.6 cm., embedded in one end of it. Another laceration, 2 x 5 cm., was foundin the right anterior side of the chest at the same level. A lacerated wound, 8x 11 cm., was seen in the middle of the right arm, anteriorly. A penetratingwound, 3 x 5.5 cm., located proximal to the right wrist in the ventral surface,exposed a compound comminuted fracture in the distal end of the ulna.
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Case No. 254.-Pvt., 437th Antiaircraft Artillery (AirWarning) Battalion, 4 July 1944; missile: landmine; multiple wounds in the head,chest, abdomen, right upper extremity, and both lower extremities (fig. 249).Many large severe penetrating wounds were found in the ventral surface of thebody. There was complete mutilation of the head with total loss of the brain. Alarge opening in the left side of the chest revealed multiple fractures of theribs. A large penetrating wound in the right upper quadrant of the abdomen hadintestine eviscerated through it. The right arm was mutilated. Numerous smalland large penetrating wounds were present in both thighs and legs and there wasa compound comminuted fracture of the left femur in the distal third.
Case No. 655.-Pfc., 19th Engineer Battalion, 15 Oct. 1944; missile: shell fragments; multiple wounds in the chest, abdomen, left upper and both lower extremities (fig. 250 A and B). A penetrating wound, 1 cm. in diameter, was present in the anterior right side of the chest at the level of the second rib. Three other penetrating wounds were found in the anterior aspect of the chest, each 5 mm. in diameter. A laceration, 10 x 13 cm., was located in the lateral left side of the chest without penetration of the thorax. A penetrating wound, 2 x 3 cm., entered the abdominal cavity in the mid epigastrium. A mutilating wound, 10 x 20 cm., in the left ventral arm revealed a compound comminuted fracture through the middle third of the humerus. A through-and-through wound in the left proximal forearm had a ventral opening, 5 x 8 cm., and a dorsal opening, 6 x 12 cm. There was laceration of the muscles and a compound comminuted fracture of the radius in the track.
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FIGURE 250 A and B.-Multiple wounds of chest, abdomen, and upper and lower extremities.
Three other penetrating wounds in the left arm and forearmvaried from 5 mm. to 5 cm. in diameter. A penetrating laceration, 20 x 30 cm.,was located in the left anterior and medial thigh; a comminuted fracture of thefemur was visible in this wound. Mutilating penetrating wounds were present inboth knees, with compound comminuted fractures of the tibia, fibula, patella,and femur in the left leg and compound comminuted fractures of the same bones,except the patella, in the right leg.
Case No. 663.-Pfc., 351st Infantry, 15 Oct. 1944; missile:shell fragments; multiple wounds in the neck and chest (fig. 251) and left lowerextremity. A mutilating wound,
FIGURE 251.-Multiple wounds of neck and chest.
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11 x 21 cm., was present in the superior anterior side of the chest and the lower portion of the neck. There were compound comminuted fractures of both clavicles and of the first and second ribs on both sides in the wound. The right lung was visible through the opening. A superficial through-and-through wound in the left anterior distal thigh had a lateral opening, 1.5 x 2 cm., and a medial opening, 1.7 x 2 cm.
FIGURE 252 A and B.-Multiple wounds of head, neck, chest, and upper and lower extremities.
Case No. 731.-2d Lt., 755th Tank Battalion, 18 Oct. 1944;missile: high explosive; multiple wounds in the head, neck, chest, and bothupper and left lower extremities (fig. 252 A and B). A penetrating wound, 1.5cm. in diameter, entered the skull in the midline through the coronal suture.There was slight evisceration of the brain through this opening. A laceratedpenetrating wound, 2.5 x 7 cm., in the left cheek involved the lower and upperlips. Compound comminuted fractures of the mandible and maxilla were visible inthis wound. A penetrating wound, 1.5 x 2 cm., entered the right cheek inferiorto the zygomatic arch. A penetrating wound, 1 cm. in diameter, entered the baseof the right side of the neck. A mutilating wound, 9 x 11 cm., was found in theposterior side of the right shoulder; there were fractures in the head of thehumerus, the scapula, clavicle and first four ribs, and an opening into thethoracic cavity. A mutilating wound, 11 x 23 cm., in the anterior left side ofthe chest extended from the second intercostal space to the lateral leftthoracic margin, accompanied with fractures of the fourth, fifth, and sixthcostal cartilages and exposure of the pericardium but no penetration of thepericardial sac. A superficial laceration, 3 x 6 cm., was located in the leftantecubital space. A lacerated wound in the left thumb and left fourth and fifthdigits exposed compound comminuted fractures in the metacarpals and the firstand second phalanges of the fourth and fifth digits. A deep laceration, 17 x 35cm., in the left posterior and medial thigh extended from the popliteal space tothe crease of the buttock. The left femur was not fractured. A penetratingwound, 1.5 cm. in diameter, entered the left anterior superior thigh. Fourpenetrating wounds were present in the left anterior leg and thigh. They variedfrom 1 cm. to 1.5 cm. in diameter.
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FIGURE 253.-Multiplewounds of head, neck, chest, abdomen,and right upper extremity.
Case No. 780.-Pfc., 760th Tank Battalion, 20 Oct. 1944;missile: shell fragments; multiple wounds in the head, neck, chest, abdomen,right upper extremity (fig. 253), and both lower extremities. A laceratedpenetrating wound, 3 x 10 cm., in the face involved the right cheek, upper andlower lips, and part of the chin. It opened into the right maxillary sinus andpassed through the right lower jaw. The right ear was lacerated adjacent to apenetrating wound, 2 x 3 cm., in the right mastoid process. The track extendeddownward and medially behind the sternomastoid muscle. A wound, 1 cm. indiameter, penetrated the neck above the middle third of the right clavicle. Thetrack passed downward and medially and entered the thorax above the first rib. Awound, 4 cm. in diameter, entered the thoracic cavity in the anterior right sideof the chest at the level of the first and second ribs, through compoundcomminuted fracture in the second and third ribs. The track penetrated in adownward medial direction. Six wounds in all four quadrants of the abdomenvaried from 1 x 2 cm. to 2.5 x 3.5 cm. None of these wounds entered theabdominal cavity. A mutilating laceration in the right lateral distal forearmwas located adjacent to the wrist. A compound comminuted fracture in the distalend of the radius was seen in this wound. A wound, 2 cm. in diameter, penetratedthe left anterior superior thigh. An irregular steel fragment, 2 x .8 cm., wasembedded in this wound. A laceration, 3 x 5 cm., was present in the medial sideand dorsum of the right foot. Compound comminuted fractures were visible in thefirst and second matatarsal bones.
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FIGURE 254.-Multiple wounds of pelvis, lower extremities, and genitalia.
Case No. 831.-Pfc., 401st Antiaircraft Artillery, 27 Oct.1944; missile: shell fragments; multiple wounds in the head, chest, pelvis, bothupper and both lower extremities, and genitalia (fig. 254). There was athrough-and-through wound in the head. The probable wound of entrance was anopening, 1.3 x 2.5 cm., in the left temple and the point of exit, a wound insidethe mouth which perforated the left maxilla. The left superior canine tooth,both premolars, and the first molar were avulsed. A penetrating wound, 2.5 x 3.5cm., entered the posterior left side of the chest through a compound comminutedfracture in the 11th rib. The left leg was amputated through the pelvis, theperineum, genitalia, and medial side of the right thigh as far down as the knee.The bones of the left side of the pelvis were severely crushed and displaced.The right femur was also fragmented in its lower third. Three penetrating woundsentered the lateral proximal side of the left arm. They measured from 1 x 1.5cm. to 2.5 cm. There was a comminuted fracture in the middle third of thehumerus. Three lacerated open wounds were present in the left mid forearmrevealing compound comminuted fractures in both bones. The left hand and wristwas severely mutilated. Several small wounds entered the right wrist. Numerouspenetrating lacerations were found in both buttocks.
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FIGURE 255.-Multiple wounds of the head, neck, chest,abdomen, and upper extremities.
Case No. 882.-Sgt., 351st Infantry, 30 Oct.1944; missile: shell fragments; multiple wounds (fig. 255) in the head, neck,chest, abdomen, pelvis, and both upper and both lower extremities. A superficiallaceration, 1 x 5 cm., was present in the right side of the forehead. A wound, 3x 3 cm., entered the anterior side of the neck in the midline, severing thetrachea inferior to the larynx. A through-and-through wound in the abdomen hadthe wound of entrance, 6 x 12 cm., located in the left posterior flank and thewound of exit, 20 x 20 cm., in the left upper quadrant. There was partialevisceration of the intestine through the larger wound, which extendedsuperficially into the left lower thorax. Other penetrating wounds were locatedin the left superior axillary margin, anterior left shoulder, left inguinalarea, left anterior forearm adjacent to the elbow, where all three bones of thearm were comminuted in the wound, right antecubital space, where a compoundcomminuted fracture was visible in the distal end of the humerus, right anteriorsuperior thigh, left anterior mid thigh and both anterior mid-legs, withcompound comminuted fractures in both bones of both legs. The distal end of theleft femur was also comminuted.
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FIGURE 256.-Single wound of neck. A. Wound of entrance. B. Wound of exit.
Case No. 904.-S. Sgt., 361st Infantry, 31 Oct. 1944;missile: high explosives; multiple wounds (two) in the neck (fig. 256) and leftlower extremity. There was a through-and-through wound in the neck with thewound of entrance, 3 x 4 cm., in the left anterior side, where it passed throughthe body of the sternomastoid muscle. The wound of exit, 3 x 6.5 cm., was foundin the midline posteriorly at the base of the skull. Fractures, at the site ofexit, extended into the spinal canal through the third and fourth cervicalvertebras. A lacerated wound, 1 x 1.5 cm., in the medial side of the left kneehad an irregular steel fragment, 2 x 1.6 x .5 cm., embedded in it.
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FIGURE 257.-Multiple wounds of abdomen, pelvis, and upper and lower extremities.
Case No. 929.-T5g., 532d Antiaircraft Artillery (AirWarning) Battalion, 3 Nov. 1944; missile: shell fragments; multiple wounds (fig.257) in the head, neck, chest, abdomen, pelvis, and both upper and lowerextremities. There were many lacerated penetrating wounds present on theanterior surface of the body, including both arms and both thighs, the chest,abdomen, face, and neck; the wounds varied in size up to 4 x 6 cm., which wasthe measurement of a wound located in the anterior superior margin of the leftaxilla. There was an avulsive wound in the right lower quadrant of the abdomenwhich extended from a point midway between the symphysis pubis and the thoracicmargin into the right anterior mid thigh. Numerous loops of small intestine wereeviscerated through the upper extremity of the wound. There was a compoundcomminuted fracture in the proximal third of the shaft of the right femur. Thepelvis was not definitely fractured. The right leg was amputated through themiddle third. The distal portion was attached by strips of skin. There wasessential traumatic amputation of the left leg through the knee joint. Thedistal end of the femur was shattered; the severely mutilated distal portion ofthe leg was attached by a segment of skin; lacerations extended into the medialmid thigh. A lacerated wound, 6 x 10 cm., was present in the dorsum of the leftwrist, with mutilation of the third, fourth, and fifth digits of the left handand fragmentation on the proximal phalanges of all three digits. Compoundcomminuted fractures were found in both bones of the left forearm in theirdistal thirds.
