Battering someone about the head with a bottle, a golf club or a garden spade is a messy business. Blood, brains and bits of bone and teeth go everywhere. The face is often smashed beyond recognition with all the bones crushed. Conversely, the thorax is the usual target for knife attacks, particularly the belly; the knife is associated with premeditation and malice. Knife attacks where the head is stabbed or cut occur in only about a quarter of all murders committed with knives. Stabbings often involve multiple wounds rather than a single injury since most attackers have no particular skill with their weapon of choice and attack with great ferocity. Stab is the key word here. The blade is plunged in repeatedly, often up to the hilt. The blade frequently bends or breaks. Major organs are usually lacerated. Hardly anyone slashes, partly because the stab is more instinctive than a slash. And to be effective against someone wearing clothes, slashing and cutting require more skill and a very sharp knife. This is converse of what happens with swords; with swords, the untutored bash wildly.
In the sixteenth and seventeenth centuries when men went about armed with swords, some fencing masters of the time reckoned an untutored man armed with a knife was more dangerous than a skilled swordsman armed with a sword. Such an assailant was to be treated with extreme caution. The untutored man lashed out unpredictably. To strike with a knife, the assailant had to get in very close, so close that the sword was of little use once the attacker was inside the blade’s length. In November 2010, a British policeman was stabbed several times in the neck and back with a screwdriver while apprehending a man. This was despite the policeman using CS spray and his baton to protect himself. Neither was effective against his determined attacker. Fortunately, the officer was not fatally injured and his man was caught. In October 2012, a former Gurkha, a black belt in karate and taekwondo, was attacked as he withdrew money from an ATM by a man wielding a knife. He managed to deflect and break the 5-inch blade, then overpower his assailant. He only realised the broken blade was embedded in his arm, such was the violence of the attack, after the police used a metal detector on him.
‘Stab wounds of the brain’ a paper published in The Western Journal of Medicine in 1977, showed that the majority of stab wounds to the head, although traumatic for the victims, were not necessarily fatal, at least as far as Europe and North America in the present era were concerned. Victims of the more distant past did not have the benefit of CT scanners and modern surgical techniques to save them so that their prognoses were generally less promising. Stabs to the head in medieval times were intended to kill, a killing strike on the battlefield. And in South Africa, fatal stab wounds to the brain were much more common than in Europe or North America, which highlights the regional variations in modes of attack. In South Africa, the head was the primary target while in Europe the thorax was. There is no question that being stabbed in the face is distressing. In the First World War, Sir John Macdonald, a former soldier and trench knife enthusiast, advocated stabs to the face for that very reason. Indeed, so-called punch daggers were designed specifically for that purpose (made by a iron-mongery firm, Robbins of Dudley in the English Midlands).
Serious head wounds were not necessarily fatal in the distant past. Phillip II of Macedon (382–336 bce), father of Alexander the Great, survived the loss of an eye to an arrow during a siege in 355–354 bce. Medieval surgeons were capable of removing arrows from heads and other parts of the body as illustrated in a manuscript dating from c.1170. But in case anyone imagines being shot with an arrow was an ancient or medieval hazard, in 2001, a man in Vermont, USA, was accidentally shot in the back of the head with a hunting arrow which pierced his brain. He survived although he suffered some physical impairment due to slight brain damage. Generally, depth of penetration determines the fate of the victim; the deeper the projectile goes into the brain, the greater the risk of immediate death or serious physical impairment if the victim survives. But not always.
Phineas Gage was an exceptionally lucky man. He survived having an iron rod fired through his head in a blasting accident in 1848. Gage was part of a gang cutting a pass through rock for a new railway track. His job was to tamp the gunpowder which had been poured into holes bored into the rock. As he tamped one hole, a spark ignited the powder and the 3 cm diameter iron rod was blasted through his left cheek. It went up behind his eye and came out through the top of his head, destroying the left frontal lobe of his brain. The rod landed some 25 metres away. Yet, the accident did not kill him. Inevitably, he was severely impaired by the damage to his brain which evidently affected his personality. Nevertheless, after many months of recuperation, he was well enough to work again, although not in railway construction. The injury eventually led to him suffering convulsions and he died aged thirty about eleven years after the accident.
Similar head injuries caused by gunshots have also proved to be survivable. In January 2011, US Senator Gabrielle Giffords was shot in the head at point blank range with a 9 mm Glock semiautomatic pistol by a man intent on killing her. The bullet entered her forehead, went through one side of her brain without crossing the midline, taking with it fragments of her skull, and exited from the back of her head. Prompt first-aid by her intern saved her life. After the surgical removal of part of her skull to relieve pressure on her swollen brain, and an induced coma, she eventually recovered sufficiently to make a public appearance eight months later. But she suffered considerable brain damage which affected the right side of her body although not her cognitive abilities. In the past, such an injury would most probably have been fatal in the first few minutes. It is entirely likely that had her attacker used a larger calibre gun, Giffords would have died at the scene because of the greater amount of damage a bigger calibre bullet would have inflicted.
Gunshot wounds to any part of the body are far more destructive than implied in Crane in The Red Badge of Courage and certainly more so than is portrayed in the cinema. The nature of such a wound depends on a wide range of factors including the sort of projectile involved. There is a significant difference between wounds caused by bullets from handguns and those from rifles, largely because of the different velocities of the projectiles; muzzle velocities for handguns are typically 180–300 metres per second (subsonic), while those for rifles are typically 700–900 metres per second (supersonic).
Before the mid-nineteenth century, pistols and muskets were mostly smooth-bored and fired large-calibre lead balls 0.5–0.8 inches in diameter. These were relatively low-velocity missiles – typically 320 metres per second for a musket with an effective range of about 200 metres. But they were very inaccurate, making the chances of hitting a man-sized target at 75 metres a matter of luck. This was one reason why troops fired by ranks at a similarly arrayed enemy. These men were not aiming, merely directing their fire in the direction of the enemy.
The low velocity of the balls meant that when they struck, the victim often remained standing. At Waterloo, there were instances when two men were talking and the face of one of them suddenly ‘opened up’ as a musket ball struck but without felling the injured soldier. Lead is soft, so the balls tended to flatten on impact making entry wounds very much larger than the calibre of the bullet. Getting shot could mean you had a largish hole in some part of your body. If the bullet hit a major organ, it could cause a lot of damage. Perforations of the abdominal cavity and especially of the stomach and bowel were mostly fatal even when the victim survived the initial injury because of peritonitis. Moreover, a musket ball could shatter bone so that arms or legs could be mangled. Amputation was sometimes the only remedy in such circumstances. Nevertheless, a musket ball could go right through a man if it was fired from close enough, about 30 metres, a not unlikely battle range.
So-called flesh wounds are not necessarily minor. Bullets could graze along the skin, splitting it open into a gutter wound. The elongated ogival bullet (i.e. pointed) of the modern era can slice open soft tissues very effectively, sometimes to the bone, without actually entering the body. Similar wounds can be caused by shell fragments and these are generally more serious as they can effectively unzip flesh, such as a thigh, a buttock or the abdomen. The term ‘graze’ is a misleading term, as no shape of projectile inflicts an injury similar to that caused by scraping the skin against a rough surface.
The problem with high-velocity ogival rifle bullets, available to the military since about the 1880s with the advent of powerful smokeless propellants, is the gyroscopic effect of spin. Such bullets are much longer than their calibre, with a point at the front and a square tail. Spin is imparted to them by the rifling in the barrel to give them flight stability and, hence, range and accuracy; otherwise, they would be less accurate than a musket ball. The gyroscopic effect forces the axis of the bullet to stay parallel with that of the gun rather than with the axis of the trajectory which is always slightly curved due to gravity. Deviation of the bullet’s axis from the axis of the trajectory is known as yaw and increases with range. The consequence of yaw is that bullets tend not to strike point first, especially at longer ranges. Hence, a bullet may strike obliquely, sometimes making a keyhole-shaped entry wound. Other factors affect the stability of the bullet in flight so that it may also rotate about its axis like an aircraft performing a barrel roll, or it may wobble; these instabilities are caused by minor imperfections in the bullets during the manufacturing process.
A ricocheting bullet becomes highly unstable and may windmill erratically, increasing the damage it causes when it strikes flesh and bone. The instability of any bullet is amplified when it strikes a human target because of the retardation effect of entering a medium denser than air. On impact, yaw is magnified by up to 800 times which causes complex and rapid bullet movements. This is known as tumbling. If the bullet strikes a bone, it will be deflected and may disintegrate along with the bone, resulting in multiple wound tracks. It is possible for a bullet to strike the upper body and exit the lower leg. Moreover, the retardation effects of body tissues helps the transfer of kinetic energy from the bullet to the target and, hence, production of the wound. This means that the damage inflicted by high-velocity bullets is greater than that caused by lower velocity projectiles such as musket balls or bullets from handguns despite their larger calibre.
Compared to musket balls (spherical) and to the Minié bullet (short and pointed) of the mid-nineteenth century which replaced them, ogival bullets (which replaced the Minié) fired by smokeless propellants (much more powerful than gunpowder) are heavier while their calibre is smaller. The lead core is jacketed in copper alloy. Muzzle velocities increased with these sorts of bullets: about 600–700 metres per second for rifles from c.1880–1900 to about 800–900 meters per second for rifles and machine-guns of the late twentieth and early twenty-first centuries. Such bullets travel a very long way. They are capable of travelling more than 2,000 metres and striking a man with sufficient energy to kill him. During the Boer War (1900–01), Boer marksman could hit a British soldier and kill him at 1,000 metres. On the Western Front, medium machine-guns such as the British Vickers were used for interdiction, shooting at distances of up to 3,500 yards (3,200 metres) behind the German front line trenches. Even at that range, the bullets could still kill.
According to data collected during the First World War,
The zones of action of bullets have been classified as follows:
1. Explosive Zone, up to 547 yards [500 metres].
2. Perforation Zone, ranging from 547 to 2,188 yards [500–2000 metres].
3. Contusion Zone, beyond 2,188 yards [2,000 metres].
In other words, when a bullet strikes at a range of up to about 500 metres (547 yards), the damage it causes is severe. A high-velocity bullet strike to the head often has an explosive effect on brain tissue as happened to President Kennedy, shot at a range of 81 metres in November 1963. While entry wounds are small, exit wounds are large, irrespective of which part of the body the bullet strikes. When such injuries were seen in the First World War, the British mistook exit wounds for entry wounds and feared the Germans were using explosive bullets (the science of wound ballistics did not emerge until the 1940s). If the bullet strikes within a few metres of the muzzle, however, when the bullet has the most stable flight characteristics, the bullet is likely to go straight through the body, provided it avoids bone, leaving a localised wound track with small entry and exit wounds.
The explosive effect is due to the very large temporary cavity the bullet makes because of its high kinetic energy, amplified by tumbling. In certain types of soft tissue, including the brain, the bladder, intestines, stomach and gallbladder, the cavity is not temporary. Indeed, the effect is akin to hitting a bag of porridge with a bat. Yet, while a bullet may tumble inside the body, the entry and exit wounds may be of similar size and little bigger than the calibre of the bullet, disguising the massive amount of internal damage it has caused. Indeed, surgeons only learned this lesson during the First World War after men died when they had appeared to have been only slightly injured.
With the arrival of the machine-gun on the battlefield, multiple bullet strikes on a single individual were not untypical. During the Battle of Passchendaele in 1917, Reg Le Brun of the 16th Canadian Machine-Gun Company saw several rounds hit a fellow Canadian in the head.
His blood and brains, pieces of skull and lumps of hair, spattered all over the front of my greatcoat and gas-mask. I stood there trying to wipe the bits off.
At ranges greater than 500 metres, the injuries tend to be less explosive so that the damage is more localised to the bullet track. The effect of a bullet striking the body is complex, however. When a bullet enters the body, irrespective of its velocity, all fluids in the vicinity of the wound track are effectively pushed outwards, thereby suddenly raising blood pressure in those areas. This hydrostatic shock can have serious consequences for the internal organs as well for surrounding tissues as it causes them to haemorrhage. Pressure pulse effects similar to those created by an explosion can damage the spine even though it is not actually hit. Nerves can be similarly damaged. Even being shot in the thigh can have an effect on the brain because of the transmission of a pressure pulse. These effects are directly related to the ability of the projectile to transfer its kinetic energy to the surrounding tissues.
Rifle and machine-gun bullets striking from very long ranges may not exit the body because their kinetic energy has significantly diminished. A bullet strike may knock a man down but what it will not do is lift him off his feet as though a bomb has exploded under him, no matter the range at which he is shot, including point blank. When a bullet hits, it makes a distinctive thwack sound. When a fragment of shell hits the body, the sound this makes is louder and more disturbing, rather like smacking a bag of wet sand with a spade.
Before the widespread use of high-explosive shells, solid roundshot, grapeshot and shrapnel were fired by cannon at infantry which, from the sixteenth to nineteenth centuries, usually formed up into squares on the battlefield which made them good targets for artillery. Solid shot, usually of iron from the seventeenth century onwards (dressed stone before that), was aimed to bounce once or twice on the ground and strike the ranks of infantry. Having gone through the first ranks, the shot would continue into the opposite side of the square and cause more casualties. If the shot hit the head or the body, death was immediate as it would decapitate, disembowel, even cut a man in half. If it hit an arm or a leg, it would smash the limb or tear it off leaving splintered bone and ripped flesh. Yet, at Waterloo, one British soldier was struck on the knee by a cannonball which did not take off his leg. His knee became horribly swollen, however.
Grapeshot, so called because each load was tied together in a canvas bag and resembled a bunch of grapes, was devastating against infantry, especially at short range. Smaller calibre than solid shot but larger than a musket ball, grape caused severe injuries as each one was large enough to smash a limb or disembowel a man. At Waterloo, Lieutenant Doherty of the 13th Light Dragoons suffered
a grape-shot contusion in his groin, which only missed killing him owing to his watch. The watch, a double-cased one, was flattened. He was also severely wounded in the head by a musket-shot.
Yet, neither injury killed him and, although it took him more than three months to recover, he lived for another twenty years.
Canister was similar to grapeshot but the shot was of smaller calibre and contained in a tin or brass cylinder rather than a bag. It had a shotgun effect at short range. The shrapnel shell, invented in 1784 by Henry Shrapnel of the Royal Artillery, was taken into British service in 1803 and proved to be a very effective antipersonnel weapon, rendering grape and canister largely redundant. The shell was designed to detonate above and in front of enemy troops and blast balls of musket calibre into them. Although their design changed, such shells continued to be used until the end of the First World War. The sort of injuries they inflicted were similar to those inflicted by musket balls as the shrapnel balls travelled at similar speeds.
After the Great War, the shrapnel shell was superseded by the thin-walled high-explosive shell which produced a large number of lethal fragments when the shell exploded. An exploding shell or bomb kills and injuries by several methods, principal among them being blast and fragmentation. An explosion can obliterate a man so completely that little of him remains. At Passchendaele, a shell landed in a crater where a group of Canadians were sheltering, including Corporal Baker of the 28th North-West Battalion and his friend Tom. Baker survived. Tom did not. ‘Bits of Tom’s body came showering down on top of me.’
Sometimes, men close by can be wounded by body parts from someone else killed or injured by the explosion. William Manchester of the 5th US Marines who fought in the Argonne during the First World War was injured during shelling when another man about ten feet away was hit by a shell.
One piece [of the other man’s leg] went through my shoulder, just missing the shoulder blade. Another piece went in about 41/2 inches below the other but by some miracle missed my lung. The two wounds together are about eight inches long. [My] bones were missed but the cords and nerves were cut connecting with my hand.
His arm was useless afterwards and his fingers perpetually clawed.
Men may be literally blown up as witnessed during a bombardment in 1916 when
two men suddenly rose into the air vertically, 15 feet perhaps, amid a spout of soil … and fell … [with the] graceful poise of acrobats
But they can be shredded by shell fragments. And yet, while one man may be killed by a shell, another standing next to him may escape injury. This occurs because explosions are directional, particularly in the case of artillery shells. Most of the explosive effect is directed forwards or sideways but artillery shells also expend a great deal of their explosive energy downwards and, hence, make craters. Mortar bombs come down at a higher angle and expend more of their explosive energy outwards; less of it goes into making a crater. The lethal area of a shell tends to be two symmetrical plumes angled slightly forwards from the point of impact, whereas that of a mortar bomb is more oval with no ‘safe’ zone in its immediate vicinity. The shape of the lethal zone is determined by angle of impact as well as the shape, construction and size of the munition. Moreover, shells from different eras have different characteristics when they explode due to the sort of explosive they contained and the sorts of steel used to make the casings.
When a device explodes, the detonation produces a fast moving pulse of high pressure. The difference between atmospheric pressure and the pressure of the pulse is termed the overpressure. In air, for a person standing in its path, an overpressure of about 690 kPa (100 psi or 68 times atmospheric pressure) lasting for 0.2 milliseconds is lethal, while an overpressure a tenth of this value is lethal if the pulse lasts for about 10 milliseconds. Overpressure rapidly diminishes with distance from the centre of the explosion. The bigger the explosive yield, the higher the overpressure, the greater the duration of the pulse, the further it will travel and the greater its lethality.
Overpressure severely damages all gas-containing organs of the body as well as the brain. In effect, the organs swell and bleed. Sometimes, the effect of blast does not become apparent until some hours afterwards so that, even when the victim survives the initial explosion, they may still suffer fatal injuries and die. Blast can also cause non-fatal internal injuries, burst eardrums and lead to memory loss. Long-term problems associated with brain injury due to blast, especially repeated exposure to it, can lead to serious health problems typically associated with shell shock.
The high-pressure pulse displaces air as it advances and this blast wind can knock someone down so that they may be injured by being thrown against hard or sharp objects. Typically, such injuries include fractures and penetration wounds. These, too, may be fatal. In addition, a victim may suffer flash burns from the explosion if they are close enough to it. Eyes are especially vulnerable to damage from tiny fragments thrown by the blast, typically from glass, brick and stone; even soil and dust are dangerous.
The size and shape, mass and velocity of the fragments produced when a device explodes vary considerably. The larger the fragment, the greater its velocity, the further it will travel and the more damage it will do. Some of the most lethal fragments are some of the smallest, however. A fragment of between 0.1 g and 1 g is capable of killing, provided it is travelling at a high enough velocity. Modern shell casings and grenade bodies produce many fragments in this size range. The casing of the British Mills bomb, used in both world wars, produced more than 770 fragments when it exploded and two-thirds of them were 0.1–1.0 g in size. Its base plug, a large piece of metal used to retain the fuze assembly inside the grenade, remained intact and was, in effect, fired outwards like a projectile for up to 180 metres. The lethal radius of most other Mills grenade fragments was 68 metres. That made it one of the most lethal hand grenades ever produced.
Fragments do not fly out uniformly from an explosion. They tend to be grouped in clusters radiating from the axis of the munition. A man may be struck by several splinters from an explosion so that he is literally peppered. It was not uncommon for a man to be struck by a large number of non-lethal fragments in the same area of his body. When these fragments are a few centimetres across, however, they rip up flesh. Even when they do not kill, the victim likely to be torn open. If a major artery is severed, they will bleed to death in minutes. If the abdomen is sliced open, the organs will spill out and their chances of survival are poor without prompt medical attention. Otherwise, they will die from shock (that is, loss of blood and other fluids) within a relatively short time. Larger fragments will slice a man in half or split his torso vertically. In the fighting for Mount Challenger during the Falklands War of 1982, one Royal Marine was hit by a fragment from an Argentinian 155 mm shell which split him ‘open from pelvis to collar-bone’. Such fragments can also sever limbs, decapitate, take out chunks of flesh and remove faces and jaws.
Traumatic injuries like these are not confined to the conventional battlefield. Terrorist bombs and IEDs can do the same thing as artillery shells and bombs dropped from aircraft. And even when people survive being struck by the splinters, they are likely to retain some of them in their bodies because surgeons treating them often consider it safer to leave the pieces in situ rather than risk causing greater damage in the process of removing them. It was not uncommon for war veterans to live for decades with shell or bullet fragments lodged in their soft tissues.