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PRIVATE FRANK NOLAN EXTRAORDINARY JOURNEY THE GREAT WAR MEDICAL SERVICES 1 MEDICAL SERVICES 2 AMBULANCE TRAIN MILITARY HOSPITALS
WAR AND MEDICINE WHEN THEY SOUND THE LAST ALL CLEAR GROUP CAPTAIN DOUGLAS BADER GROUP CAPTAIN DOUGLAS BADER CBE DSO '
THE MEDICAL MEMORIES ROADSHOW
‘To understand where we are today
We have to know where we have come from’
Countless books have been written over the years about 'THE GREAT WAR' - too many to list here! I have been fortunate to have made the acquaintance of a number of Researchers and/or Authors on this topic.
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One such person is Major General Sir William Grant Macpherson, K.C.M.G, CB
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He has written several books relating to 'THE GREAT WAR' and I would like to begin this section with the first chapter of his book
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STORY OF THE GREAT WAR - BASED ON OFFICIAL DOCUMENTS
MEDICAL SERVICES - SURGERY OF THE WAR
VOL. I
PROJECTILES.
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INTERNATIONAL AGREEMENTS.
ENEMY PROJECTILES.
MODE OF ACTION OF PROJECTILES.
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IN an account of the wounds of any particular campaign with special reference to the missiles causing them, it is necessary to consider first the nature of the missiles used ; secondly, their mode of action, that is, the intentions of their designers as to the effects they should produce and their actual behaviour in flight ; and thirdly, their experimental effects upon animal tissues, and the observed results of their action in the field and in the various areas covered by the medical department from front to base. Under these headings then the subject of projectiles will be considered, but before dealing with them there is a point of interest which naturally arises. In every campaign of late it has been usual to find accusations by one or other belligerent that the enemy was employing "unlawful" missiles. In view of this fact and because the war was no exception to the rule, it may be worth while to note the agreements which limited the use of certain kinds of instruments of violence in European warfare.
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Four important international documents provide a fairly complete code for the guidance of combatants in land warfare —the unratified Declaration of Brussels of 1874, the Second Convention of the Peace Conference of 1899, the Fourth Convention of the Peace Conference of 1907, and the Geneva Convention of 1906. The United States had led the way by drawing up a series of rules in 1863, which were adopted, except in so far as they dealt with the question of levies en masse, by Germany in 1870; and the Conference of the Powers at Brussels in 1874 drew up a Declaration in that year, which was, however, never ratified, Great Britain and Germany in particular declining to accept it at the time, though it subsequently became the basis of the Conventions agreed upon at the Hague. But even in 1899 and 1907 there was no unanimity, chiefly owing to the difficulties arising on the question of the conditions under which combatants may be recognized and treated as belligerents, and the result was that the actual Regulations were set out as annexes to the Conventions, the contracting parties only agreeing to issue instructions to their forces in conformity with these Regulations without expressly binding themselves to accept them in their entirety. They are "general rules of conduct for belligerents in their relations with each other and with populations," though it is to be noted that a certain binding force is recognized in them by the provision of the Convention of 1907, which supersedes that of 1899, that belligerent parties violating the Regulations shall make compensation "if the case demands." In the preambles to both Conventions (1899 and 1907) it was laid down that
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"it could not be intended by the high contracting parties that the cases not provided for should, for want of a written provision, be left to the arbitrary judgment of military commanders. Until a more complete code of the laws of war can be issued, the high contracting parties think it expedient to declare that in cases not included in the Regulations adopted by them, populations and belligerents remain under the protection and the rule of the principles of the law of nations, as they
result from the usages established between civilized nations, from the laws of humanity and the requirements of the public conscience."
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Not every mode nor instrument of violence is permitted by the laws of war. The general principle must always be observed that only such violence is permissible as is reasonably proportionate to the object to be obtained, namely, the breaking down of the armed resistance of the enemy. The preamble of the Declaration of St. Petersburg in 1868 recognized that "the only legitimate end which States should aim at in war is the weakening of the military forces of the enemy, and to this end it is sufficient to put out of action the largest possible number of men, and that this end would be exceeded by the use of arms which would uselessly aggravate the sufferings of men put out of action, or would render their death inevitable. "The rules on this point, as at present agreed in principle, are set out in Articles 22 to 28 of the Annexe to Convention IV. of 1907, which expanded and amended the provisions of the Declaration of Brussels, and of the Convention of 1899, ratified on behalf of Great Britain in November 1909. After laying down that the choice of means of injuring the enemy is not unlimited, the rules particularly forbid the use of poison or poisoned weapons, and the use of arms, projectiles or substances likely to cause unnecessary suffering.
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The permissibility of the use of the Dum Dum bullet, Mark IV pattern, which has a small cylindrical cavity in the head over which the hard metal envelope is turned down, was much discussed at the Hague in 1899. Explosive bullets have been discontinued since the Declaration of St. Petersburg, 1868, but the representatives of Great Britain in 1899 refused to concur in an agreement which would have required all bullets to be cased in hard envelopes. The Conference drew up a Declaration in favour of abstension from the use of bullets " which expand or flatten easily in the human body, such as bullets with hard envelope which does not entirely cover the case or is pierced with incisions." But Lord Lansdowne instructed Sir Julian Paunceforte to inform the Conference that the Chitral campaign of 1895 had demonstrated the insufficiency of a hard envelope for stopping a rush in savage warfare. On this ground, and contending that the Dum Dum bullet did not inflict unnecessary suffering, the British Government, and with it the United States, refused to sign this Declaration ; but the objection was, so far as Great Britain was concerned, based only on the argument from savage warfare, as the bullet was not used by the British in the South African War, and its use occasionally by their adversaries formed the subject of strong protests. However, in 1907, Great Britain and Portugal intimated their accession to the Declaration, and of the larger Powers only the United States has not yet assented to it, though willing to agree to the prohibition of bullets inflicting unnecessarily cruel wounds or exceeding the limit necessary for placing a man hors de combat. The above is a summary of what has been attempted by civilized Europe to mitigate the severities of warfare. It will be seen that these agreements fall into two parts. There is on the one hand an acceptance of the fact that all and any methods of destroying life are not permissible to civilized peoples, and on the other an attempt to eliminate the unlawful methods by name. These latter are set forth in Annexes to the Convention, but the assent which is given to them can only be described as unwilling. The Powers will "issue instructions in conformity with the regulations," but they will not expressly bind themselves" to accept them in their entirety," a reservation which goes far to sterilize the agreements.
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Germany, by word and deed and with outspoken frankness, declared its reliance upon absolutely ruthless warfare, and it may be inferred that in any case the Regulations would be interpreted according to such factors as racial characteristics, political pressure, standards of civilization, national sense of danger or assurance of immunity from punishment. This is no more than might have been expected. And in fact one by one in the course of the war the Regulations were broken until not one was left. Again, on a retrospective view of the fighting in the war it must be seen that hampering restrictions as to the use of poison gases, explosive bullets, bombs from aircraft, and expanding bullets, even if they had been respected, would by no means have prevented all the
" unnecessary suffering." Humanitarianism, in fact, in nations wealthy and industrially efficient cannot keep pace with the inventiveness of destructive science. It was not even foreseen that an alteration of or an improvement in the tactical use of even such weapons as were allowed might be responsible for a vast increase of suffering. The Hague diplomatists excluded the explosive bullet but were not in a position to know the severity of wounds caused by concentrated machine gun fire, or by a barrage of six inch shells charged with high explosive. And yet nothing is more certain than that multiple wounds due to machine gun fire are among the severest injuries recorded in military surgery.
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Moreover, when statistics of the present war are completed it will certainly be found that shell and shrapnel wounds are in a very much higher proportion to bullet wounds than in any previous war. And of the two there can be little doubt that the shell wound, if it lacks in many cases the penetrative severity of the bullet wound, is as often immediately fatal and carries a fourfold danger of infection and septic after-effects. No international agreement, however, limits the artillery barrage or the use of as large a field gun as road or rail will carry. But even if some measure of international police had been found effective to compel the observance of agreements, it is questionable if the Powers took the best means of informing themselves as to the terms in which agreements should be drawn up. To find means of "weakening the military forces of the enemy, which would not uselessly aggravate the sufferings of men put out of action, nor render their death inevitable" obviously demands the co-operation of those who are specially engaged in dealing with wounds inflicted by the missiles of war, and of these individuals the military surgeon and the big game hunter are the most conspicuously expert. Clean healing is as much the object of the one as clean killing is the object of the other, but on the question of unnecessary suffering the military surgeon stands alone. And on the subject of wounding by artillery projectiles, bombs, and the like, he is clearly an authority. There is a large body of surgical literature dealing with wounds in warfare and covering the period of the most recent campaigns, waged with the most modern weapons. Military surgeons have experimented with modern rifles and ammunition with a view to informing their professional brethren as to the kind of injuries they may have to deal with in warfare. But it does not seem that this work was even noticed by the diplomatists at the Hague, or that it has had very much influence upon military practice. Thus the publication of Fessler's work in 1905 upon the effects of the pointed bullet, the typical small arms missile in the war, did not prejudice its adoption by practically all the great Powers, though the more humane type of wound caused by the bluntnosed small bore cylindrical bullet was well shown in the records of the South African War. The evidence of the big game hunter is of secondary importance from a humanitarian point of view, but as far as the killing effectiveness of any particular make of rifle goes it is of great value. Indeed, from the standpoint of the designer of small arms the big game hunter's word is the decisive one, so that it is not wonderful that the military rifle tends to approach the clean killing rather than the clean healing ideal. The dilemma raised by these almost irreconcilable ideals has led to one curious situation. When the blunt-tipped small bore
bullet was introduced it was found to lack "stopping power" against determined enemies or charging wild beasts. Experience with the pointed bullet, however, showed that the difficulty had been overcome. But in the interregnum a bullet of the forbidden type was used against savage foes, by which it will be seen that the trend of military opinion was towards the big game hunter's results and away from the more humane type of bullet.
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The Germans introduced the pointed bullet .into military use ; they experimented with it and were fully informed of its superior powers of injury, and characteristically enough they were the first to complain of it. In December 1914, Professor Kershner of Konigsberg suggested that by removing the tip the British bullet could be converted into a Dum Dum bullet, and some of his colleagues stated their belief that the British bullet was intended to be used as an expanding one, and alleged that a device for removing the tip was provided on the rifle. Professor Stargardt of Hamburg went somewhat further and complained that the composite character of the British bullet was such that it broke up easily in the tissues and so approximated in its effects to an explosive bullet. While there is no need to assert our innocence of both these charges, they are a testimony to the enhanced severity of the wounds by pointed bullets, a fact which even some German observers realized. At a meeting of German army surgeons at Lille in January 1915, Dr. Braun stated that wounds by the British bullet differed in no essential point from those inflicted by ordinary rifle bullets. He had attempted to convert the ordinary bullet into a Dum Dum by the methods supposed to have been adopted by British soldiers in the trenches, but had found that such "doctoring " interfered with the automatic loading of the rifle and with the range and penetrative power of the bullet. He found that the "Dum Dum bullets of the English are mainly the products of fantasy." These comments appeared early in the war, and subsequently, as will be seen below in dealing with enemy ammunition, the enemy used both "doctored" and actual explosive bullets. To sum up then, one is forced to the reluctant conclusion that in the absence of power to enforce them, international agreements are of small value in restraining the severities of warfare, and one is almost tempted to sympathize with those who affirm that warfare governed by prize ring rules can never be truly and in fact the ultima ratio of nations. But it cannot be denied that a great deal of the uninformed outcry about so called illegal weapons is due to the fact that their critics have not made themselves familiar with the actual text of the Hague Conventions and Regulations.
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Enemy Projectiles.
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Of the weapons actually used in the war it is not necessary to give all the details. Only those facts are chosen which have some interest or importance for the surgeon. Nor is it possible in all cases to follow up the many changes which were made during the campaign. Here again it is proposed only to note developments which have had some effect upon wounding power.
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Rifles.—The rifles used by enemy forces were very similar to each other in make and calibre. On the accompanying table are given some details of their make. It will be observed that in the case of the German Mauser, since the length of the barrel is nearly 30 inches, the length of complete twist of the rifling over nine inches, and the muzzle velocity 2,882 feet per second, the actual spin imparted to the bullet is more than 3,000 turns per second.
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As regards rapidity of fire, it has been found that with this class of rifle twenty aimed shots can be fired per minute used as a single loader, and forty shots per minute using magazine fire from the hip without aim. The nature and quantity of the propelling charge is a factor of extreme importance from the point of view of its effect upon the rifling of the barrel, upon which the accuracy of shooting depends. In large-bore rifles firing black powder, pressures in the barrel were not high and the metal was not injuriously affected. If carefully cleaned, a rifle could be used for years and could fire many thousands of rounds without loss of accuracy. It is quite otherwise with the small calibre rifle firing cordite or ballistite. Not only is the very high temperature at which these propellants bum a great cause of erosion, but the pressures are extremely high and the effects, especially towards the breach end, tend to the enlargement of the bore even after a couple of hundred rounds have been fired. Erosion also takes place at the muzzle, but not so rapidly. Experimentally it has been proved that after 12,000 rounds a rifle was "quite unfit for further use." When the bore enlarges in this manner it fails to give the requisite spin and gyroscopic steadiness to the bullet, and the muzzle velocity also falls off to a large extent. It is probable therefore that, with worn rifles, bullets, especially of the pointed type, will be more unsteady, as, for example the German "wire cutting" bullet which is described below.
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The machine gun and the various types of automatic rifle are, in all essentials which concern surgery, rifled arms with special arrangements for rapid fire. Their action is automatic and they can fire from 400 to 500 shots per minute, using the service rifle cartridges which are fed to the gun in belts carrying about 250 cartridges. The barrel of the machine gun has a controlled movement in firing both vertically and horizontally, and thus it came about that multiple wounds of the severest type were inflicted by these weapons which were used in immense numbers in the war. The bullet employed by Germany and her allies in the war was of the type used in the small calibre magazine rifle of the present day. It was composite, consisting of a core either of soft lead or more generally of lead hardened with antimony and a casing or envelope of some harder metal, soft steel or iron, or an alloy of copper and nickel. The core was inserted in the rear end of the envelope which was afterwards turned in over the base of the core. The envelope itself was solid drawn, and consequently had a solid point somewhat thicker than the sides. But the feature which gave the bullet its chief ballistic and wounding qualities was its shape. Fig. 1 gives the resistance to air pressure offered by bullets whose points are shaped by making them the intersection of two circles with radii of one, two, three or more times the diameter of the bullet. The first form is hemispherical, the third is the shape of the standard bullet's point, the air resistance of which may be considered as unity
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It will be seen that at 1,000 yards, in spite of its superior initial velocity, the German bullet enjoys no great advantage over the Mark VII, an effect no doubt of its weighing some 20 grains less. From a ballistic point of view then the pointed shape is evidently a great advantage. Moreover, as the whole cartridge now weighs less, the infantryman can carry some 150 on his person and can thus meet the more rapid expenditure of the magazine rifle. And finally, as will be shown later, both experimentally and from actual battle experience, the wounds inflicted by the pointed bullet were found to be more severe than those due to the oval tipped bullet. Besides the ordinary bullet above described the enemy used a number of special bullets ; some for use against tanks, some of the so-called "tracer" kind, and so on. Three of these may be mentioned—one which was used for the machine guns on his aeroplanes, and the others in the trenches.
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(1) An explosive bullet, a sectional diagram of which is shown in Fig. 2, was composed of the following parts :—
(a) A case of thin rolled iron, 3 mm. thick at the sides and 6 mm. at the head.
(b) A lining of lead 6 mm. thick at the base which it closes, and extending almost up to the curve of the head.
(c) In the head, a cylindrical brass pellet carrying a flat striker point.
(d) A percussion cap moving freely in the pellet, but held away from the striker by a spring.
(e) Another cylindrical brass pellet below the first one, containing black powder, slow burning.
(f) A cupro nickel tube extending to the lead base and containing a mixture of potassium chlorate 56 8 per cent, and antimony sulphide 42- 1 per cent.
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Experiments were made by the French by firing these bullets from a German rifle at a range of 8 metres against a target composed of eleven half-inch pine planks with four cases filled with bran behind them, each about ten inches thick. One of these bullets penetrated the eleven planks and the first two cases and burst in the middle of the third. The French authorities concluded that these bullets were intended to be explosive and would be valueless either as tracers or smoke producers for observation purposes.
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(2) A bullet for wire cutting was a drawn steel cylinder of 7-8 to 7-83 mm. in diameter and 77 to 77-1 mm. in length weighing 28-65 to 28-80 grammes. The steel of which it was composed was very mild and could not be tempered. Experiments were made in France with these bullets which suggest
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that they were used principally for cutting wire at short ranges. The diameter of the bullet being less than that of the bore, they do not take the rifling, and, when fired through paper screens at varying distances from the muzzles, made holes in many of the screens equal in length to the bullet itself.
The experiments showed that the bullets turned over in the air within 10 metres of the muzzle. Such a bullet would no doubt be useful for cutting wire, but it is also calculated to inflict terrible wounds at short ranges.
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(3) A perforating bullet, which was intended to perforate the light steel plates protecting the machinery of aeroplanes, consisted of an exterior shell of mild steel lined with lead and containing a central pointed core of hard steel. According to a captured German document this ball, which was known as "SMK," would penetrate a plate of 4-5 mm. in thickness made of nickle chrome steel at 1,400 metres when fired at its normal, and at 900 metres when fired at an angle of 70°. These bullets, though giving much greater penetration, gave less accurate firing at long ranges. The " K " bullets, in spite of their inferior initial velocity, owing to their greater weight and their stream line form, preserve their velocity longer, and their trajectories would cut those of the " S " bullets again at about 600 metres. The following table gives the comparative weights, charges, and muzzle velocities of these and the ordinary " S " bullet.
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During the first period of the Somme offensive, he reported his average daily expenditure to have been :—
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This long list of artillery projectiles is by no means exhaustive. Trench warfare produced projecting machines of many kinds for throwing parcels of high explosive for short distances. The catapult was represented among these. No mention has been made of the many types of gun which threw gas shells, as it is thought that the resulting type of injury interests the medical side more than the surgical. As a commentary on this amazing range and amount of artillery armament, it may be remarked that the multiplicity of types shows that there was, so to speak, a gun for every emergency, that is, an immense increase in the total number of guns used ; that the expenditure of ammunition was beyond all precedent; and that the bulk of the common shell had high explosive as a bursting
charge.
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Bombs.—The aircraft bombs were relatively thin-walled missiles loaded with a large charge of high explosive, and their wounding effects were due partly to the mere disruptive effect of their explosion, partly to the secondary missiles, splinters of wood or stone set in motion by their explosion, and partly to the razor-edged slices of metal, composed as a rule of shell steel of which their bodies are composed.
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Grenades.—Numerous rifle and hand grenades were used in trench warfare and acted partly by the direct effects of their explosion or by the action of the fragments into which the tin or iron casing was blown. These were often very small and had little power of penetration. Fragments of the "serrated" varieties were larger and more dangerous. But the direct effect of the explosion was the main danger. Rifle grenades were disused owing to want of accuracy. Of hand grenades in common use,
the cylindrical grenade with handle {Stielhandgranate,sometimes known as the "jampot and stick grenade "), the "ball hand grenade" {Kugelhandgranate) , both of the time variety, and the "disc percussion grenade" (Diskushandgranate) , were retained. A new hand grenade, the "egg" (Eierhandgranate) , made its appearance and was used in considerable quantities.
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This was a small grenade of the shape and about the size of a pullet's egg. It weighed only 1 1 oz. and could be thrown about 50 yards ; but its effect, as it was only filled with powder and fired without a detonator, was very small.
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The Germans did not seem very satisfied with their disc percussion grenade, which was in fact somewhat dangerous to handle and very dangerous to pick up, if blind. Attempts were made to convert the time cylindrical grenade with handle into a percussion pattern.
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Mode of Action of Projectiles
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In dealing with the mode of action of projectiles it is at once evident that the rifle bullet is in a class by itself. No greater contrast could be presented than the more or less haphazard open-air explosion of a high explosive or shrapnel shell or bomb, and the ordered and controlled deadliness of a rifle bullet. Moral effect has always been an important factor with the artillery arm, and it is only when used in immense and crushing concentration that its action is as killing as that of well-aimed rifle fire. The circumstances of the war, the stabilization of battle so as to resemble siege conditions, gave an entirely unaccustomed predominance to the artillery arm, both in number and weight. Under the
usual conditions of open warfare this would be impossible, and the rifle and machine gun would regain their proper value.
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Rifle bullets.—It is of importance therefore for the surgeon to have some acquaintance with those characteristics of the rifle bullet which mainly influence its wounding powers, and are due to its make and behaviour in flight. Of the actual movements of a bullet as determined experimentally it will be possible to give only a summary. The dynamics of a smooth elongated body of this nature moving in the line of its long axis with an initial velocity of 2,600 to 2,800 feet per second, rotating between 3,000 and 4,000 times per second on its long axis, and of a length nearly four times its diameter, may be mathematically investigated and its characteristic flight foretold, but the results could only be true while conditions remained constant. The propellant charge must be correct to a grain, the material of the metal so nearly homogeneous that the centre of gravity and centre of form lie in the long axial line, no alteration of form must take place on discharge, and the bore of the rifle must undergo no change.
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Whereas in practice every one of these conditions is found to vary, it results that most bullets do, from imperfections of manufacture and other causes, show irregularities of flight which have been the subject of investigation by many workers. In the well-known work of Dr. F. W. Mann of America, it is stated that of the following movements not every bullet shows them all but some bullets do and all bullets will show a majority of them :—
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(1) Movement of translation, due to gas pressure from exploding powder.
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(2) Spin, due to spirally grooved rifle bore. The spin is a factor of such importance that it has been found experimentally that every kind of propellant, every bore of rifle, every weight and shape of bullet requires a definite pitch of rifling to obtain the best results.
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(3) Trajectory movement, due to the effect of gravity and air resistance, which cause the path of the projectile to be a modified parabola.
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(4) Gyration produced in the spinning bullet by the application of a constant force continually acting at right angles to the movement of gyration. This force is the air pressure at or near the bullet's point.
Most bullets being more or less unbalanced begin to develop a "tip" immediately upon their exit from the muzzle and the deflected point is at once acted upon by the air pressure due to the movement of translation, and so develops a gyration, each phase of which is complete in about 50 feet.
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(5) Oscillation, produced in a spinning bullet by a tertiary force which has been suddenly applied and then removed. This temporary force arises as follows. In the rifle barrel the centre of gravity of an unbalanced bullet (that is, a bullet in which the centre of gravity is outside the axis of rotation) must take a spiral path round its axis of rotation, but the moment it is released from the muzzle the centre of gravity flies off, like a stone released from a sling, in a line which is the tangent to the bore spiral, and thus a sudden motion is imparted to the hinder end of the axis of rotation of the bullet, and at right angles to it. This produces an oscillation each phase of which is completed in about 9-10 feet.
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(6) Point deflection. Since the bullet with a "tip" is not flying in the direction of its long axis, it has a motion which may be properly termed point deflection, due to the glancing of the bullet as a whole on the air pressure, this pressure being more pronounced on one side than the other.
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(7) Centre of gravity spiral, in rifle bore. If the centre of gravity is not in the axial line it describes a spiral round the the axial line in passing along the barrel. The importance of this movement appears under oscillation.
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(8) Centre of form spiral in the air. The centre of form of an unbalanced bullet, which is obliged to make a straight flight in the rifle bore, begins to make a circle round the centre of gravity and consequently a spiral flight immediately upon its exit from the muzzle. This movement is identical with that which causes the hum of a spinning top.
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(9) Gyratory or air spiral. Because of the gyratory movement of the bullet, the direction of its long axis continually changes round the line of the bullet's flight, and because the deflected point must follow in the direction towards which it is pointing or towards the direction of the bullet's axis due to air pressure, it causes the tipping bullet to make a spiral flight. Since the tipping bullet due to point deflection flies as a whole in a spiral after leaving the muzzle, there is this spiral joining itself on to the smaller spiral made by the centre of gravity in the bore within a few feet of its muzzle exit, which may still further increase the deflection from the line of fire.
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(10) Wind drift. A change of direction due to the bullet being carried along by the wind.
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(11) Wind deflection. Wind drift cannot take place without some pressure on the bullet which will not only move the bullet as a whole but will cause a slight deflection, deflection being due to rotation, i.e., the bullet rolls on the side of increased pressure.
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(12) Trajectory deflection, improperly called drift. Because of gravitation the bullet has a trajectory, and this motion combined with air pressure causes deflection of the bullet to the left if the twist of the rifling grooves be left-handed. It is a motion, one element of which is skin friction due to partial rolling and slipping of the bullet upon increased air pressure on its under side, or that side which is presented towards the centre of the earth. This increased air pressure, according to present works on ballistics, is partly due to falling of the bullet through the air in making its trajectory curve, but more largely to its axis not being in the line of this curve or line of flight but standing above it. For example, when a bullet is fired in a horizontal plane its axis of spin remains horizontal, while its trajectory almost at once begins to make a curve below the horizontal plane. Thus the bullet becomes a tipper and like all tipping bullets begins to gyrate, due to air pressure ton its point. The axis of gyration tries to keep itself in line ('with the curve of the trajectory but fails because this latter is ' constantly becoming more curved. Thus the bullet receives greater pressure on the side presenting downwards. This raises the bullet in its flight and allows it to roll on the increasing air pressure below.
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(13) Tumble. If a bullet does not "tip" sufficiently to tumble it tends to follow its point, thus making a spiral flight. If it tips more than six degrees, according to some authorities it is liable to tumble and be lost.
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Dr. Mann's results, which are rather difficult to summarize intelligibly, have been accepted generally as correct and go to show that the majority of bullets do not take an absolutely straight course in their flight, but it has to be remembered that all these deviations from the line of flight are^ very small. For example, the "bore spiral" has a diameter varying from two or three thousandths of an inch to a fraction of a thousandth in diameter, and a pitch of 12 inches, and the "air spiral"
has a diameter of five-sixteenths of an inch and a pitch of 45 feet. Nevertheless, in certain cases it must be admitted that the bullet may not be mathematically point-on when it strikes. Speaking of the pointed bullet. Dr. Mann says that it " has practically lost its tip when the 100 yard screen is reached," but not until it has developed "the same error and in the same direction as all other bullets that we have recorded." Now the significance of any form of irregular flight is that with an elongated bullet, if on striking it changes from a small to a large striking surface, if instead of proceeding end-on through the body, it turns sideways, the destructive effects produced are likely to be very much greater. The so-called "expanding" bullet owes its efficiency to this property of changing from a small to a large striking surface. When smallbore bullets were first introduced they were made with a blunt
tip and a long cylindrical body as compared to the length of the conical tip. These bullets were found to penetrate the body, both soft parts and in many cases even bone itself, with clean punctures and little destruction, and it was only at short ranges that the disruptive effects at the exit, which were incorrectly called "explosive," were noted. With the pointed bullet, on the other hand, experience showed that clean perforations were relatively uncommon, and, on the contrary, disruptive effects were common up to the greatly increased ranges. And the question arose as to what caused this difference. Can irregular flight in a rifle bullet suffice to produce the increase of area on impact, which is the essence of the expanding bullet's action, or is the destructive effect due to some other factor ? Those who would explain the action of the pointed bullet by its unsteady flight draw attention to the fact that the centre of gravity of the bullet lies some distance behind the centre of its long axis, so that the arm of the couple which tends to turn it on its short axis on impact is much longer than it would be if the centre of gravity were nearer the centre of the long axis (Fig. 5) ; that clean perforations might naturally be expected to be rare, since the clean perforation could only occur at those rare moments when the long axis of the oscillating, gyrating bullet happened to be for a small fraction of a time in the line of flight, whereas explosive exits would be the rule at medium ranges ; and, finally, that in cases of multiple wounds by single bullets the extent of the damage and the key-holing of the cutaneous structures afford abundant evidence that the pointed bullet actually does turn on impact. Turning, however, does not explain all the facts. If instability alone accounted for explosive wounds, signs of disruption would be visible in all wounds in which the bullet has sufficient remaining velocity to tear up the tissues at all, at much greater ranges in fact than those at which they are actually seen. And in the view of some small arm experts the normal bullet, to use the words of one expert, "does not wobble appreciably."
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He also says " No doctor in the absence of direct experimental evidence is entitled to say that the gravity of a wound is due to the pointed bullet turning over and over in the cadaver. It is a physical impossibility, I believe. So that I think you may take it as an established experimental fact that the pointed bullet goes to sleep like a top in its flight, at any rate for the first mile. In long range barrage work the bullet, however, may be flying asleep but with its long axis 20° to 30° out of its trajectory, and so makes an oval hole on hitting. We actually have fired all the bullets used in this war through Mann screens and they are normally quite steady. But if a very worn barrel is used we get what is known as B.S.O. (bullet side on). The bullet never takes the rifling but floats down the bore in a stream of gas and emerges with no spin.
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It travels point first a few yards, perhaps 10 to 20, and then goes head over heels. It loses velocity rapidly and probably has an extreme range of half a mile or so." In the opinion of this expert the normal bullet (that is, the ordinary jacketed bullet as manufactured) is not sufficiently unsteady to add to the gravity of a wound from that cause alone. It is only when it is abnormal in make or when the circumstances in which it is fired are abnormal that it is unsteady enough for mischief. There is then another factor which must be considered to explain explosive wounds, and here again expert opinion may be quoted :— " Explosive wounds are due to unsteadiness.
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I feel sure that a ' burst ' rabbit, or ' brains all over the wall ' are effects due solely to velocity. Sir Samuel Baker never, I believe, records an instance, and the normal muzzle velocity of black powder rifles was about 1,400 foot seconds. With double powder charge, perhaps, 1,800 foot seconds was the high limit, and all these ball rifles lost velocity at the rate of 500 foot seconds per 100 yards of range. Explosive effects (burst rabbits) were first observed, I understand, in England when the Roumanian Mannlicher was introduced for stalking. Men shot at deer and rabbits and ' burst ' them to their intense surprise. The muzzle velocity was 2,300 foot seconds, falling 100 foot seconds per 100 yards. Many men had the Mark VI "303, muzzle velocity 2,000 foot seconds, for stalking and had not burst their game. The ' bursts ' occurred with solid nosed bullets and were not peculiar to soft-nosed bullets. The horrible wound of a soft-nosed bullet can be best accounted for by the mushrooming and break-up of the bullet itself. In the Boer War explosive wounds were noticed, I believe, when the head was hit at short range by a Boer rifle, but not with the -303 Mark VI.* In this war both the German and the -303 Mark VII bullet gave explosive effects at 200 yards when the brain was hit and other parts also." In this expert's opinion it is the velocity which counts in wounding powers of the higher order. And this is what might be expected when the striking energy of the missile is considered. This is expressed by the formula ^|- by which it is clear that of the two factors, weight and velocity, the latter is the more important, and that a large diminution of weight can be more than made up for by suitable increase in muzzle velocity. It would seem, too, that the critical velocity to produce explosive effect is somewhere in the neighbourhood of 2,100 foot seconds, and it has been suggested that the rush of air which follows in the wake of a bullet with a velocity which has been likened to "cavitation" velocity in air—that is, the velocity with which air rushes in to fill a vacuum—may help to produce disruptive effects. One may go further indeed and speculate whether, at any rate in some of the gas and fluid containing structures of the body, there may not be a commotion of the tissues in the wake of a bullet comparable to “cavitation" effects in air, generated in the rear of a projectile moving at the rate of over 2,000 foot seconds and competent to produce a blowing out effect at the exit.
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* There are no records confirming this observation, but it may be true.
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Professor A. M. Worthington, in his "Study of Splashes," gives some ^remarkable information as to visible physical results when a missile is dropped into a fluid medium, using the term in its widest sense. He used fluids of such varying viscosity as petroleum, water, milk and glycerin. He shows how a rough sphere dropped from a low altitude into a fluid throws the fluid with which it comes into contact upwards in the form of a circular crater which subsequently closes over and forms an air bubble, how a column of air follows the sphere downwards, and subsequently breaks up into bubbles some of which follow the sphere, and how the general level of the liquid surface is slightly raised even at a great distance from the place of the splash. When the height from which the
sphere is dropped is increased and its velocity is greater, a downward jet of fluid is formed which shoots down behind the sphere in pursuit of it.
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The sphere in fact acts as a sort of piston, sucking in the bubble formed by the closing of the crater produced at the impact of the sphere on the fluid surface, which is driven down by the greater atmospheric pressure above. The jet may pass down through the air tube in the wake of the sphere and even strike the top of the descending sphere. When a projectile hits an iron plate, there appears the same slight upheaval of the neighbouring surface and the same crater, from which it is inferred that under immense and suddenly applied pressure the steel has behaved like a liquid. Professor Worthington's projectiles moved with a velocity of from 24 to 36 feet per second on impact. What results might have been observed at higher velocities it is impossible to say. Nor is it fair to press too far the analogy of his results with those of bullet impact. But at least it may be inferred from them that a war missile does something more than merely perforate the tissues like a trocar, that there is a commotion of the tissues pierced which may be exceedingly destructive, the tissues tearing themselves, as it were, in their endeavour to follow the bullet, and that these effects are not confined to the parts struck but radiate far beyond them.
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Expert opinion then seems to have decided that velocity is the main cause of the acknowledged severity of wounds by the light pointed bullet, but at the same time it is difficult to believe that instability has nothing to do with it, especially after any considerable experience of wounds in warfare. It is possible that the results observed are due to a combination of the two factors in many instances. During the trench warfare period of fighting the ranges at which wounds were inflicted by rifle bullets were short, and it is probable that ricochet shots were extremely common. Delorme in his " War Surgery" " says, we rely on the effects of ricochetted bullets, a ricochet occurring in the proportion of 1 to 3 bullets discharged." At short ranges a ricochetting bullet passing through sand or loose earth would not necessarily lose a great deal of velocity, but would almost certainly develop "wobble." So that if Delorme's estimate can be taken as approximately correct, both factors of instability and velocity are in constant action. With the pointed bullet the effect of shape as a wounding factor is very important. The pointed bullet most certainly can and does glance at any obstruction, and in a very curious way. A clean puncture is the usual hole made in wood or any artificial stopbutt used for the recovery of the bullet, when the impact is at a right angle. When the impact is at an angle there is a great chance of the bullet bending or breaking up, or glancing in the most unexpected manner. The sharper the point the greater are the chances of an extraordinary hole. Artillery projectiles of a pointed shape show the same liability to deflection. It has been said that no gunner will fire a non-deformable pointed projectile at an earth bank if he knows his business, unless he is a mile or so behind the bank. It may "turn turtle" in the bank and come out right backwards. A flat-headed shot always lodges in the bank.
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The holes which the pointed shots make in the bank show that they keep their noses fairly well in line with their direction. One of the objections to the light pointed bullet in big game shooting is that it is very liable to be deflected by any dense bone and so miss vital structures. On the other hand, as has already been shown, the shape is of great importance as a factor in overcoming air resistance, and so enabling the bullet to start with a high muzzle velocity and maintain a high velocity over useful military ranges. The clean perforation and the explosive exit are at opposite poles as regards severity in rifle bullet wounds, and what has been said above, while perhaps it cannot make clear the exact mechanism of their causation, at any rate suggests a fairly satisfactory explanation of their occurrence. But the explosive exit is not always due to one and the same cause. Among other hypotheses which have been put forward to explain its appearance there is one which supposes that the pad of air in front of the nose of the bullet, which is clearly seen in Professor Boys' photographs of flying bullets, expands in some fashion in the tissues and blows them out. Another takes the view that the high rotation of the bullet is an important factor in causing disruption of the tissues. But there are two theories which better deserve mention because they are based upon normal physical phenomena and may in many cases explain disruptive effects. The "hydraulic" theory supposes
that when body structures containing water or other fluid are struck by a bullet the same effect is produced as when a lead pot containing water is fired at. The lead pot is burst completely, since the fluid conveys to all parts of its interior surface the multiplied effect of the bullet's stroke upon one small area. There is no doubt that effects of a similar kind have been observed in a full stomach and bladder and even in the brain, but bursts of this kind are by no means invariably the result of perforation as ought to be the case if the hydraulic theory were true. Still it is impossible altogether to rule them out as a type of disruptive effects. The other theory is based upon the observed fact that when a large bone is hit at short range the bone fragments become secondary missiles and, endowed with communicated energy from the bullet, plough up the tissues and even blow away large areas of skin. It is supposed that this energizing of tissue particles may even extend to the soft parts and so cause bursting of solid viscera like the liver and spleen. This is perhaps to push the analogy rather beyond probability. It will be seen later that those who have studied wounds of large solid viscera adopt the view that the laceration is the result of high velocity.
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Professor Shattock says :—" From the more strictly pathological standpoint the new factor introduced into gunshot injuries, as injuries, is the velocity of the missile." Two other physical characteristics of bullets have to be mentioned. The heating of the bullet is natural enough. It is exposed to the super-heated gases which arise from nitrocellulose and nitro-glycerine compounds on explosion ; it is scraped along 30 in, of barrel with sufficient friction to engrave its sides ; it is fired from a barrel which is often hot from previous shots, and a part or the whole of its kinetic energy becomes transformed into heat upon impact. Many stories are heard from wounded soldiers of bullets which singed their clothes and blistered their skin. Moreover, examination of many bullets after firing shows a ring of minute beads of lead at the base where the jacket turns over the lead. Friction has evidently caused heat enough to melt the superficial layers of lead, though it is questionable if it sets up enough heat to warm the whole mass of the bullet appreciably. At any rate bullets fired into sawdust do not cause any charring. According to La Garde they do not melt butter or ignite gunpowder, nor is the development of heat sufficient to sterilize the bullet. When a bullet is really hot to handle it is almost certainly a ricochet, part of whose kinetic energy has been transformed into heat.
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The sterility of the bullet has been the subject of much experimentation. The base and cylindrical sides are almost certainly sterile after firing, but the pointed bullet has a large area in front of its cylindrical portion which cannot be surgically clean. Punctured wounds by the blunt-nosed bullet are only relatively non-infective. Their reputation as clean healing wounds was due to the power of the tissues to destroy a mild infection. It would probably be true to say that no bullet is bacteriologically clean, even when it reaches the skin directly. When it is remembered that it passes through muddy and body-soiled clothing and finally through the unwashed skin, all debate as to its sterility must be abandoned. Delorme remarks, however, that in passing through the skin and superficial tissues this bullet apparently rapidly wipes itself clean. The same observation was made by Dr. Mann when firing bullets through a series of screens. The first screen wiped off the major part of the blackening from the bullet. And as rifle bullets show a remarkable power of penetrating clothing without carrying portions into the wound, infection in their case is not so deeply implanted as is the case with shell fragments and shrapnel bullets, but is more superficial and, therefore, amenable to surgical treatment. Artillery projectiles, bombs and grenade fragments.—
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Turning next to shell fragments, shrapnel bullets and fragments of aircraft bombs and hand grenades, it is to be noted that they differ in their effects more from the rifle bullet than they do from each other. They are all of the same class, haphazard in action, and, as compared with rifle bullets, lacking in velocity, that is, in penetrative power. It is true that in the case of large shell or bomb fragments the striking energy ^' is sometimes very great owing to the weight of the fragments, and that the resulting wounds are very severe, but the average size of missiles due to fragmentation of field gun shells or of hand grenades is seldom large enough to cause fatal injury except in the immediate neighbourhood of the explosion, or unless they strike a vital part,* and their chief danger is that they almost invariably carry in with them fragments of clothing and thus render wounds septic. This class of wound assumed an importance in the war which was misleading. The usual proportion of shell to rifle bullet wound in the wars of the last 50 years has been about 10 per cent.
In the Russo-Japanese War at the battles of Liao Yang, Sha Ho and Mukden taken together, there were 10 per cent, of wounded by shell out of over 29,000 wounded by all arms. It is acknowledged that this proportion rises in sieges, and in the war where the stabilized line of battle approximated to siege work this proportion was certainly surpassed, putting aside the fact that the numerical increase of gun power was unusually great and that aircraft bombs and hand grenades were used in large numbers. The following table gives the regional incidence in trench warfare of wounds received into the casualty clearing stations of three armies in a fortnight, and the nature of the missiles
causing them. It is often so difficult, however, to be certain of the missile that the table cannot be considered quite correct. The higher degrees of injury will nearly always in the absence of the missile be put down to shell fragments. But taking this table for what it is worth, and remembering the siege-like conditions which the front line had assumed at that time in Flanders and Picardy, it is seen that rather over 27 per cent, of all wounds were due to bullets, and rather less than 73 per cent, to shells, trench mortars, bombs and grenades. Moreover, of the 897 bullet wounds, about half are classed as severe, whereas in the case of the shell wounds the proportion of severe to slight is roughly as 3 to 4. In this remarkable and unusual phase of warfare, therefore, shell wounds, being nearly three to one wound by rifle bullets, necessarily take rank as type wounds. In open warfare, however, the fact still remains that the rifle bullet does nearly as much wounding as the artillery projectile, and there is no doubt that from the point of view of septic infection the rifle bullet is far less dangerous than the shell fragment.
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* See illustration of fragmentation patterns, facing pp. 30 and 31.
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The surgical literature of previous wars recorded this fact, but its real importance only appeared when shell wounds became as frequent as or more frequent than rifle bullet wounds. The septic shell wound soon assumed an importance which made surgeons forget the possibility of a relatively clean bullet wound and assume that all missile wounds were equally septic. So, no doubt, they were, under the circumstances in France and Flanders, but the results noted in Manchuria in the Russo-Japanese War and in Egypt and Palestine recently were by no means the same, and it is notorious that the observations of the South African War were misleading because based upon wounds caused by bullets in very aseptic surroundings.
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Generally speaking, it may be said that wounds of the shrapnel and shell fragment class lack penetration, and owe their effects, when they do show conspicuous severity, more to their weight element than to their velocity element ; that fragments frequently lodge and carry in with them to their site of impaction portions of clothing and other foreign bodies ; that they are almost invariably septic ; that they are frequently multiple ; and that they do not show "explosive" results. As regards the mechanism of their flight, the following facts concerning artillery projectiles are of interest.* The shrapnel bullet has a maximum effective flight of little more than 150 metres (162 yards). It starts from the bursting point of the shell, so that its velocity is that of the shell. It is thus free from the influence of rifling. The initial velocity of the shrapnel shell is 500 to 580 metres per second, decreasing from 420 metres per second to 250 metres per second as the range increases from 1 to 4 kilometres. A certain velocity is imparted by the explosion of the charge in the shell, the resultant velocity of the bullets being 350-520 metres per second. Bullets at the farthest limits of the "cone of dispersion" have a velocity of 180 metres per second at a distance of 150 to 200 metres from the bursting point. They also have a striking force of 15 kilograms per square centimetre, sufficient to place a man hors de combat. Double that amount is required for a horse.
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* Translated from the Revue Militaire Suisse of January 1917 by Captain G. de L. Landon, R.F.A.
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The following table gives the principal ballistic data of three modern types of shrapnel shell, and the average opening of the "cone of dispersion."
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With regard to shell, bomb and grenade fragments there are two types of high explosive shell. One has a thin casing and carries a heavy charge {e.g., 825 grms. of melinite). A dense fragmentation takes place on detonation into about 2,000 small splinters with an initial velocity of 1,200 metres per second The other has a thick casing and a small charge (g.g'., 135 grms. Of picric acid). On detonation about 500 fragments are produced of varying weight (10 to 200 grms.) with relatively small initial velocity (300 to 400 metres per second). The French 75 mm. shell is an example of the first, and the German 77 mm. shell of the second.
Some photographs are given to illustrate the degree of fragmentation of a high explosive shell
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The English 18-pounder shell is taken and the effect is shown of complete detonation (Fig. 6) and of explosion only (Fig. 7), and the manner in which complete detonation alters the shape of the fragments, leaving them with edges which are ragged and sharp cutting (Figs. 8 and 9), whereas incomplete detonation or explosion leaves them blunt and more regular. A description is given in Appendix C of the size and shape of fragments of aeroplane bombs. They are usually large and ragged, but the chief effect is due to the local effect of the detonation of high explosive with which they are filled. In the case of hand and rifle grenades of all kinds the effect again is chiefly due to their explosion and not so much to the size or penetration of the fragments into which they break up. The latter lose velocity very rapidly and often do no more than penetrate the skin, causing very numerous wounds of a characteristic kind. In an enclosed space like a trench, the effect is severe, but the interposition of a traverse renders their action more or less nugatory. From what has been said above, it is clear that in the case of shrapnel the effect of the shell burst depends to a large
extent on the range and the height of the shell at the point of detonation. The bullets have the remaining velocity of the shell at the point of detonation, plus a certain impulse due to the bursting charge in the shell. The longer the range, therefore, the less the remaining velocity. Similarly, the greater the height of the shell burst, the less will be the striking velocity of the bullets, though owing to the opening out of the "cone of dispersion" they will cover a greater extent of ground. The nosepiece of the shell containing the fuze, the base and sides of the shell, which attain a thickness of about 5 to 15 mm. and which usually also undergo fragmentation by the force of the explosion, provide additional missiles of some importance. The danger area surrounding the detonation of high explosive shell is dependent on many factors, such as :—
(1) Whether fired by time or percussion fuze. If the former, the effects depend on the height of the point of explosion ; if the latter, upon the angle of impact and the nature of the object struck, whether hard or soft.
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A shell impinging on soft earth forms an excavation in which its fragments are retained, but when it strikes a hard object such as a rock or concrete, it may add to its own fragments many pieces broken off.
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(2) Whether the shell bursts close to its objective.
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The effect of high explosive is very localized and shell fragments rapidly lose their initial velocity. In the immediate vicinity of the explosion the effects of the shell fragments are altogether lost in the disruption caused by the explosion itself. This applies to all forms of high explosive, and is seen particularly when explosion takes place in a confined space. Photographs of a 12-inch wire-wound gun burst by a charge of cordite show the gun cut completely in two, the muzzle and breech piece
being practically intact. Again, "within a German dugout which was entered after being bombed, all that could be found in the way of human remains were pieces of flesh, hair and brain plastered on the dug-out wall, while pieces of bone with thoracic and abdominal contents were strewn about the floor." Many instances could be quoted of the disruptive effect of high explosive at close quarters. The chief effect of the Minenwerfer and the hand grenade was due to this disruptive effect, and not to their fragmentation. At a slightly greater distance this concussion effect was seen also in such injuries as fracture of the base of the skull, and all that train of nervous affections summed up under the head of shell shock. But that missile fragments soon lose velocity is sufficiently demonstrated by the fact that the steel helmet, and in some cases body armour, were found to be an efficient protection against their impact, whereas no protection worn upon the body was found capable of stopping a rifle bullet. The contrast between the rifle or machine gun bullet and the shrapnel bullet or fragment of shell, bomb or grenade may be summarized as follows:—
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Rifle or machine gun bullet. Shrapnel bullet or fragment of shell, etc.
1 . Has a fixed weight and shape. 1 . Variable in both these particulars.
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2. Has a high initial velocity which it 2. Has a lower initial velocity and
loses slowly. rapidly loses it.
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3. Is purposive in action and depends 3. Is haphazard in action and for its effects upon velocity of depends for effect less upon impact. velocity than upon size and weight.
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4. Has great power of penetration and 4. Has small power of penetration
infrequently lodges in the body. and often lodges in the body.
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5. Does not tend to carry clothing into 5. Frequently carries clothing into
the wound. the wound.
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6. Explosive exits at short ranges 6. Explosive exits rare.
almost invariable.
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7, Except when inflicted by machine 7. Multiple wounds very common,
gun bullets, or when several parts of
the body are traversed by the same
bullet, multiple wounds are not
common.
8. The effect of the explosive itself is at least as destructive as the fragmentation.
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As regards mode of action, therefore, the rifle or machine gun bullet presents a strong contrast to the shrapnel bullet, and to fragments of shells, bombs and hand and rifle grenades.
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