Preface
Medical interest in the battle casualty as to the type andanatomic location of his wounds, the correlated visceral damage, and thecausative missiles has been in evidence since the earliest days of organizedcombat. The founding of the Army Medical Museum during the Civil War and theresultant collection of case histories, drawings, anatomic specimens, andrecovered missiles was a major milestone in the accurate documentation ofwartime medical history. Notwithstanding its seeming antiquity in the light ofpresent-day standards, the collection is of unique and unparalleled value, andits complete exploitation has never been fully realized. Near the close of the19th century, Col. Louis A. La Garde of the U.S. Army Medical Corps, inconjunction with the Ordnance Department, conducted numerous experiments inbasic wound ballistics and later extended his observations to the casualties ofthe Spanish-American War.
During World War I, there were numerous small casualtysurveys conducted by medical personnel of great vision and foresight, but therewere no formal directives governing such activities. Col. Louis B. Wilson of theU.S. Army Medical Reserve Corps made a rather extensive study of the wounds incasualties of World War I, and this, coupled with his interest in the subject ofballistics, enabled him to reach a number of basic conclusions regarding thewounding effect of a bullet. In later years, Colonel Wilson was active indirecting the ballistic research of Col. (later Brig. Gen.) George R. Callender,MC, and M. Sgt. (later Major, SnC) Ralph W. French. Much of this work was anattempt to carry out on a scientific basis experiments which would prove,disprove, or modify statements Colonel Wilson had made regarding the woundingpotentials of small arms missiles.
Unfortunately, the excellent collection of pathologicspecimens by the British Army Medical Service from World War I was partiallydestroyed during the bombing of London in World War II. This collection at theRoyal College of Surgeons resulted from the activity of the British MedicalHistory Committee which from its origin had a duty "to collect examples ofthe wounds and diseases suffered by soldiers in the present war [World War I];to dissect and examine such specimens in order to fully understand their extentand nature so that the best means for their treatment might be adopted; and topreserve instructive examples so that they might be examined and studied notonly by Army surgeons of today but also by medical men for many generations tocome." According to Sir Alfred Keogh, Director-General of the Army MedicalService (20 Oct. 1917): "Such specimens are original documents, theyconstitute an original and reliable source of knowledge for all time, and supplythe most valuable basis possible for present and future medical and
surgical treatment of the diseases and injuries of war."Such sentiments are still applicable in the elucidation of the value andfunction of a battle casualty survey unit. The collected information andspecimens can be channeled into various fields for instruction, training, anddevelopmental purposes, both within the medical service and within the othertechnical services, and for permanent display and historical storage.
In addition to determining the location and types of woundsin battle casualties, it is also essential that the members of a survey team befamiliar with enemy ordnance materiel. One must learn to recognize thecharacteristics of the external wound and the permanent wound track and, inaddition, attempt an identification of the causative missile, of its approximatemass, and of its striking velocity. In small arms missiles, it is desirable tobe aware of the effective rate of fire and range of the weapon and the types andmakeup of the ammunition. With fragment-producing weapons, it is essential todetermine the types of shells and the mass distribution and initial velocity ofthe fragments. By means of such information, a more adequate and intelligentanalysis can be made of wounds and their causative agents, and valuable data canbe made available for dissemination to other technical services for weapons'evaluation and development of personnel armor. This leads to an excellentliaison and interchange of ideas, test results, interpretations, and guidancebetween the interested technical services.
Chapter I of this volume deals with the enemy ordnancemateriel of World War II and Korea insofar as it had a bearing on casualtysurveys. An attempt was made to make it as informative and readable as possiblewhile still maintaining the security of information classified in the interestof national defense. Maj. James K. Arima, MSC, and Mrs. Doris Johnson (neeWalther) of The Historical Unit, U.S. Army Medical Service, were responsible forthe collection and compilation of much of the information, and this was possibleonly after a review of a large number of publications, principally ordnance, andcorrelating the various weapon specifications which in many cases had a greatvariability. In addition, members of the various sections of the OrdnanceTechnical Intelligence Service, U.S. Army, were very helpful in reviewing thematerial for accuracy and security. The wholehearted cooperation of variousmembers of the Ordnance Department in compiling the material and in its finalreview for publication has been most encouraging.
During the interim between World Wars I and II, activeresearch on a probable mechanism of wound production by high-velocity missileswas conducted by General Callender. Most of this pioneer work was done incollaboration with Major French. In chapter II, they have utilized some of theiroriginal material to elaborate upon the correlation between a missile, its massand velocity, and its wounding potential. Both authors are to be commended forthe quality and originality of their research and for the particular correlationwhich has existed between their laboratory experiments and later fieldwork.
In September 1943, Mr. R. H. Kent, physicist at the AberdeenProving Ground, Md., contacted Dr. Lewis H. Weed, chairman of the Division of
Medical Sciences of the National Research Council, regardingthe establishment of a research project designed to test the casualty-producingeffectiveness of U.S. weapons. As a result of this request, a meeting of thenewly created Conference on Wound Ballistics, later called the Conference onMissile Casualties, was held on 25 September 1943. General Callender presidedand Dr. John F. Fulton was secretary of the meeting. After accepting the generaltenets of Mr. Kent's proposal, the Conference granted contracts for researchprojects to several groups of investigators. One of these contracts led to themonumental work reported by E. Newton Harvey, Ph. D., and his associates(chapter III). Much of this material has been published in separate medicaljournal articles, but this volume would be grossly deficient if it were notpresent. Many of the original conclusions of this work have been the basis forcontinuing ballistic research after World War II. Floyd A. Odell, Ph. D.,Technical Director of Research, U.S. Army Medical Research Laboratory, FortKnox, Ky., and formerly of the Biophysics Division, Medical Laboratories, ArmyChemical Center, Md., kindly furnished a copy of the original manuscript and acomplete set of negatives for illustrations. The excellence of the illustrationsin chapter III is due solely to the availability of these negatives.
The natural extension of basic wound ballistic laboratoryresearch into field surveys and the increasing awareness of the need for data onbattle wounds was recognized by the Conference on Missile Casualties, and inearly October 1943, a general recommendation was made that special teams beappointed to conduct battle casualty surveys and that some attention be given tothe training of personnel qualified to conduct these field activities. On 14October 1943, the Conference prepared a formal proposal directed to The SurgeonGeneral of the Army concerning the formation of a special survey unit whichcould receive its initial indoctrination in the United States and its subsequenttraining with Prof. Solly Zuckerman's group at Princes Risborough in England.It was felt that such a team should consist of approximately six to eightpersons, including medical personnel qualified in pathology and surgery andother technical service personnel having training in physics, interior andexterior ballistics, and other ordnance specialties.
Subsequent to this proposal, General Callender informed theConference on 5 November 1943 that The Surgeon General and Brig. Gen. Fred W.Rankin, Director, Surgical Consultants Division, were in agreement concerningthe need for data on wounds in battle casualties but felt that the immediateshortage of trained men precluded the appointment of any special team. Instead,it was recommended that theater commanders be advised of the need for theinformation and that they then assign medical officers under their command tocollect wound ballistic data for transmittal to the Conference on MissileCasualties. General Callender prepared an article in which he described thestartling lack of available information and outlined the overall scope andorganization of a casualty team and the type of data which was needed. Thisarticle was published in the March 1944 issue of the Bulletin of the U.S.Army Medical
Department. Before general publication, copies of thearticle were sent to all theaters of operations.
As a result of General Callender's article, a survey teamwas organized under Col. Ashley W. Oughterson, MC, to cover a phase of theBougainville Island campaign from February to April 1944. Because of his tragicand untimely death near Cali, Colombia, in November 1956, Dr. Oughterson wasnever able to review the revision of his original report as it was prepared forchapter V of this volume. However, this manuscript was recovered through thegracious cooperation of his widow, the late Dr. Marion E. Howard, and wasreviewed by another member of the original survey team, Dr. (then Colonel, MC)Harry C. Hull. The Bougainville survey team performed an outstanding and pioneereffort, and their organization and report served as the basis for thedevelopment and efforts of later casualty survey units. It is most regrettablethat the death of Dr. Oughterson prevented him from seeing his report reach thefinal publication and public recognition which it so justly deserves.
Even before the dissemination of the directive prepared byGeneral Callender, another young Army Medical Corps officer was actively engagedin the study of battle casualties. This officer was Capt. James E. T. Hopkins,MC, whose work in the New Georgia and Burma campaigns is reported in chapter IV.Because of his own innate interest and ambition, Captain Hopkins undertook astudy of casualties in the New Georgia campaign for the period, July to August1943. Following this, he was stationed in Burma and studied casualties there inthe period, February through May 1944. Both of these surveys have producedunusual and valuable information regarding the type of casualty and causativeagent in jungle warfare. Since case reports from this survey are unique in thatthey describe the battlefield duty and anatomic position of the soldier at thetime he was wounded, they have been included in their entirety in appendixes A,B, and C. Some of the conclusions which were reached by the author regarding thetraining of infantrymen and their use and conduct in the field were highlypertinent and valuable at the time the original material was prepared and wouldundoubtedly prove of equal importance in the event of similar jungle-typewarfare.
Simultaneous with the conduct of casualty surveys in thevarious areas in and about the Pacific, additional survey teams were beingorganized in Europe. Brig. Gen. (later Maj. Gen.) Joseph I. Martin, Surgeon,Fifth U.S. Army, Mediterranean theater, arranged for and obtained authority tostudy the killed in action, and Capt. (later Lt. Col.) William W. Tribby, MC,was assigned to this duty.
Captain Tribby worked in association with Quartermastergraves registration units at U.S. military cemeteries in Italy and studied athousand Americans killed in action in the Fifth U.S. Army from April toNovember 1944. This survey probably represents the largest single study ofkilled-in-action casualties conducted during World War II, and its scope was notsurpassed until the Korean War. The survey was concerned primarily with theaccurate anatomic location of wounds, their probable causative agents, and thecause of
death. The original report contains an outline figure of thebody for each case with exact location and extent of all wounds. Limitations ofspace precluded the inclusion of these anatomic drawings in chapter VI of thisvolume, but the original work is still available as an invaluable reference.
In addition to the survey of Fifth U.S. Army killed inaction, another survey was conducted by Col. Howard E. Snyder, MC, and Capt.James W. Culbertson, MC, on battle casualty deaths in hospitals of the FifthU.S. Army (chapter VII). A statistical analysis was made of case reports fromfield and evacuation hospitals on 1,450 fatally wounded American soldiers duringthe period from April through September 1945. Only a small fraction of theoriginal material is contained in the present chapter. The authors concernedthemselves not only with the anatomic location of wounds, the probable causativeagent, and cause of death of the casualties but thoroughly investigated all thepossible surgical avenues which might have had a bearing upon the fatal outcomeof the soldier. Therefore, they investigated a wide variety of subjects rangingfrom time lapse between wounding and entrance into a medical facility and earlysurgery, possible effect of anesthesia, use of blood transfusions, and a widevariety of other topics all of which are immensely important to the militarysurgeon of any war.
Next, there are three chapters (VIII, IX, and X) andappendixes G and H all prepared and written by Maj. (later Lt. Col.) AllanPalmer, MC. Perhaps no other author in this volume has waited so long and sopatiently for the publication of his works. Nevertheless, he was still able tomaintain a wholesome interest in his original work and a genuine desire tocooperate in its final review. In April 1943, Major Palmer became associatedwith Professor Zuckerman for the purpose of studying field casualty surveymethods. The first survey conducted by Major Palmer was with the Fifth U.S. Armyduring the Rapido River conflict south of Cassino in January 1944 (chapterVIII). Notwithstanding the small number of casualties in the survey, it stillserves as a model for future field casualty survey studies. In addition, certainvaluable information can be gathered concerning the type of casualties to beexpected under certain specific forms of ground combat.
Major Palmer's major effort was concerned with a survey ofall Eighth Air Force heavy bomber battle casualties returning to the UnitedKingdom during June, July, and August 1944. At this time, Major Palmer was chiefof the Medical Operational Research Section, Office of the Chief Surgeon,European Theater of Operations, U.S. Army. The section had been organized underthe direction of Maj. Gen. Paul R. Hawley, Chief Surgeon, and Col. (later Brig.Gen.) Elliott C. Cutler, MC. In addition to making a study of casualties(chapter IX), an exhaustive survey was made of the effects of flak strikingaircraft and their correlation with the associated casualties among crew members(chapter X). Appendix G relates the accidental discharge of an aerial bomb at anairfield in England. Again, this survey can serve as a model for future studiesof accidental discharges of weapons during wartime or during trainingprocedures. Unfortunate as these accidents are, they can still serve as
a source of some valuable information concerning thepotential and possible lethal effects of our own weapons.
After the work with the Eighth Air Force, the MedicalOperational Research Section was reconstituted as a survey unit and moved intothe Third U.S. Army area on the European Continent. The unit finally becamefully operational just 2 days before V-E Day. Major Palmer prepared a veryinteresting and informative diary of the experience of this unit from the timeit left England until the cessation of the war. It is of great interest foranyone who has been associated with a field casualty survey unit to read thediary and see the many pitfalls and complications which developed in the unit'sattempt to become operational.
Owing to his field experience, Major Palmer was able to studythe various casualty surveys from World War II and to correlate all the surveysin regard to anatomic location of wounds and to the possible causative agent(appendix H). Even though there is a mixture of casualty surveys conducted underdifferent collecting criteria and composed of aircrew and ground forcecasualties, many interesting correlations can be obtained.
Despite the fact that this volume was originally intended toinclude only the work of World War II, the casualty surveys and subsequentdevelopment of personnel armor during the Korean War was such a naturaloutgrowth of the World War II experience that the Korean material couldlogically be included in this volume. Numerous investigators during World War IIhad advocated the development and use of some form of body armor for groundtroops. Through the untiring efforts of Brig. Gen. Malcolm C. Grow of the U.S.Army Air Forces, personnel armor was provided for members of bomber crews andwas of undenied success in reducing the number of overall wounds and the numberof lethal wounds. Numerous prototypes had been developed for ground forces, anda test model was ready for field testing at the time of the conclusion of thewar with Japan. Therefore, it would seem that body armor should have been astandard item of equipment at the onset of the Korean War. However, it wastragic to see the effect that peacetime had had on the thinking of thoseindividuals who could have been responsible for the use of body armor at theimmediate onset of the conflict. It was only due to the administrative abilityand guidance of Col. (later Brig. Gen.) John R. Wood, MC, and several fieldsurveys conducted under the leadership of Lt. Col. (later Col.) Robert H.Holmes, MC, that the responsible agencies would consent to the development ofprototypes and the field testing of models. New statistics had to be compiledfrom field surveys, and old arguments had to be refought and won before anymodels were developed for field usage. Initially, Colonel Holmes laid the basicgroundwork for the development and successful acceptance of personnel body armorfor Army ground troops. Later, Lt. Col. (later Col.) William W. Cox, MC, andMaj. William F. Enos, MC, were instrumental in the final testing andstandardization of the present all-nylon model. Numerous other medical officersas well as Quartermaster, Ordnance, and infantry officers
were also concerned with the gathering and interpretation ofvaluable field statistics.
It is perhaps a natural consequence of the Americanphilosophy not to maintain a constant interest in certain military matters inpeacetime. However, it is costly both from the usual sense of time and moneylost and from the even more fundamental and irreplaceable point of view of humanlives being lost when certain fundamental suggestions and conclusions reached inone war are completely lost in intervening times, and the points have to beregained in subsequent wars.
Chapter XI is concerned with the development of personnelarmor for ground troops as seen in World War II. The major portion of thischapter must of necessity be concerned with various forms of helmet design andprotection which were developed in response to varying needs of specific formsof combat duties. Most of the source material for this chapter was obtained fromthe historical files of the Ordnance Department. It was only due to theunlimited cooperation of historians in the office of the Chief of Ordnance, inoffering all the available materials in their files to the authors, that thischapter is possible. Major Enos was one of the medical officers on the surveyteams testing one of the prototypes of the Army personnel armor in Korea, anddespite his resignation from the service he has still maintained an activeinterest in the field and has always been available to the Office of the SurgeonGeneral for invaluable consultation and advice.
Development of personnel armor in the Korean War was sointimately associated with and a direct consequence of casualty surveysconducted in that conflict that both aspects have been combined in chapter XII.There is also a natural association of authors in this chapter for Carl M.Herget, Ph. D., is perhaps the foremost leader in laboratory investigations onbasic wound ballistics and testing of personnel armor and Capt. George B. Coe,Ordnance Corps, was one of the foremost leaders in Korean casualty surveys. Dr.Herget and his able associates in the Biophysics Division, Medical Laboratory,Army Chemical Center, were instrumental in directing many of the Korean casualtysurvey units, since laboratory experiments had disclosed fields in whichknowledge was vitally needed, and conversely much of the information that couldbe gained by field units was of utmost value to laboratory workers in directingtheir own research programs and in interpretation of some of their results.Captain Coe, then 1st Lieutenant, Medical Service Corps, made numerous trips toKorea as a member or as a leader of missions conducted for the field testing ofbody armor and the gathering of information concerning various types of battlecasualties. In addition to this immense amount of fieldwork, he was also vitallyconcerned with and instrumental in the development of various prototypes of Armybody armor, and before his transfer from the Army Chemical Center he was amainstay in the development and the testing of newer models.
Many of the contributors to this volume have been mostpatient in awaiting publication of their World War II battle casualty surveys orresults of research
in basic wound ballistics. Those whose work was done underthe rigors and expediencies of combat conditions are to be commended for theirdevotion and zeal to the immediate treatment of the wounded soldier and,additionally, for their great desire to study the factors which were importantin producing the casualty. Many of these contributors came into considerableconflict with their immediate superiors, who at the moment did not see thepossible value or application of their investigations. Undismayed, theycontinued their vital studies while performing outstandingly their prescribedduties.
One of the most valuable lessons to be gathered from much ofthe reported work is the relative constancy of warfare up to the Korean War.Anatomic location of wounds, causative agents, ratio between the wounded and thekilled in action have all remained relatively constant since the various studiesoriginated during the Civil War. In addition, the importance of close liaisonbetween the Army Medical Service and the other technical services is shown to beof utmost importance in the gathering and dissemination of fundamentalinformation which can be utilized by all services in the greater fulfillment oftheir primary duty and in the development of future lines of endeavor. Theeditor is firmly convinced that there should be a small group of readilyavailable and highly trained medical personnel who could be utilized for theconduct of battle casualty surveys or the investigation of peacetime trainingaccidents on very short notice.
Because of the limited and technical nature of much of theoriginal source material, the sole responsibility for the final preparation andinterpretation of all the chapters is assumed by the editor.
A great many individuals other than the authors themselveswere responsible for the final preparation and publication of this volume.Foremost among those who have patiently awaited its publication and have alwaysbeen available for consultation and invaluable advice is General Callender. Col.Calvin H. Goddard, MC, was originally scheduled to be a coeditor, but hisuntimely death cut short an association which had always been most stimulatingand enlightening to the present editor and had held great promise of futuretraining and guidance for him. Colonel Goddard was one of those uniqueindividuals who was most proficient and efficient in performing a number ofvaried tasks. Firstly, he was a medical officer, but he was also a notedhistorian and writer and a pioneer investigator and world-renowned authority onballistics, small arms missiles, and weapon identification. His absence will bevery evident in certain portions of this volume, but it was fortunate that thebasic plan of the book had been formulated before his death. All thecontributors have been most generous in consenting to review their materialwhich, after a lapse of a number of years, must have seemed relatively foreign.Numerous members of various casualty surveys conducted during the Korean Warhave all been available for consultation and criticism of the manuscript.
A major vote of thanks must be tendered to Col. John BoydCoates, Jr., MC, Director of The Historical Unit, USAMEDS, and to the members ofthe
various branches of that unit who were most cooperative andmore than patient in waiting for the final delivery of the entire manuscriptfrom the editor.
Special appreciation is tendered to Col. Charles A.Pendlyshok, MSC, former chief of the Special Projects Branch, for hisnever-failing interest in the progress of this volume; to Miss Elizabeth P.Mason, cartographic compilation aid in the Special Projects Branch, for herpreparation of the maps; to Mrs. Josephine P. Kyle, former chief of the Researchand Archives Branch, who, with her staff, provided much of the archival materialand corroborated data obtained from other sources; and to members of the MedicalIllustration Service, Armed Forces Institute of Pathology, who, under thedirection of Mr. Herman Van Cott, chief of that service, prepared the excellentlayouts for the illustrations and mounted them for printing.
Finally, the editor gratefully acknowledges the assistance ofMiss Rebecca L. Duberstein, publications editor of the Editorial Branch, whoperformed the final publications editing and prepared the index for this volume.
JAMES C. BEYER,
Major, Medical Corps.
