Survival of battlefield injuries

Factual Questions
1

I recently watched a documentary on WWI. In this, it discussed some of the grotesque and horrific injuries suffered, and survived by, some of the combatants.

For example, many had literally half of their faces torn off by shrapnel, leaving nothing but a gaping hole. Similarly horrific injuries were suffered in other body areas as well.

According to the documentary, many soldiers not only survived the immediate effects of these horrific injuries, but lived on for many years after. It was these grotesquely wounded soldiers who gave rise to the expression “basket cases”.

As any soldier knows, there is nothing unusual about this type of battlefield injury. However, the difference is that in post WWI wars proportionately fewer people suffering this type of injury survive the initial injury, let alone any time after that.

Apparently, this decline in the survival rate has something to do with the munitions employed.

Assuming that the documentary is correct in its assertions, I find this difficult to understand. Why would the munitions employed have any bearing on the survivability of the wound?

2

Well it’s obviously not true because the munitions didn’t change to any appreciable extent between WWI and WWII.

If we exclude aerial bombs then pretty much all the weapons used by major powers in WWII were first fielded in WWI. Same artillery, same rifle, same grenades. These were often literally the same weapons and same ammunition in the opening years of the war, being WWI surplus). The only significant exceptions I can think of were the general purpose machine guns like the mg42, that were short in supply in WWI, and the submachine guns, that weren’t widely fielded in WWI.

So blaming it on munitions seems like a stretch.

In reality, the wounds of WWI were bad for two reasons: good surgeons an

3

Well it’s obviously not true because the munitions didn’t change to any appreciable extent between WWI and WWII.

If we exclude aerial bombs then pretty much all the weapons used by major powers in WWII were first fielded in WWI. Same artillery, same rifle, same grenades. These were often literally the same weapons and same ammunition in the opening years of the war, being WWI surplus). The only significant exceptions I can think of were the general purpose machine guns like the MG42, that were short in supply in WWI, and the sub-machine guns, that weren’t widely fielded in WWI. But even those weapons used standard WWI ammo

So blaming it on munitions seems like a stretch.

The idea that fewer people survived horrific injuries post WWI is also provably untrue. The percentage of soldiers surviving *any *type of injury has risen steadily since WWI

In reality, the wounds of WWI were bad for the combination of several reasons: good surgeons, no antibiotics but great antiseptics, and no reconstructive surgery. Those things combined to produce a lot of badly mutilated survivors.

Prior to the Great War, someone with a bad wound probably died. The medical knowledge to save someone simply did not exist. Even in the US Civil War, surgery largely consisted of amputation and bandaging. If an area could not be amputated, either infection usually set in or blood got out and the patient died. As a result patients with “half of their faces torn off by shrapnel” died of blood loss within a few hours and patients with abdominal wounds died within days of infection. In most cases these patients weren’t even taken to a hospital. They were given morphine and placed in a comfortable place to die.

By WWI the medical world had discovered antiseptic and aseptic surgery. That not only gave them a chance to treat more wounds, it meant that surgeons had been practicing on civilian wounds for decades. Surgery had advanced beyond all recognition. Now a surgeon could treat abdominal and facial wounds. He could ligature blood vessels and stop bleeding and he could sew the guts back up.

However they still had no antibiotics, so infection was still major problem. So the solution was to clean the wound up and remove all the jagged edges. For a bullet wound to the face, that meant that removing a large chunk of tissue, including any parts of the jaws that had been broken and exposed to thee air or mud. The patient was going to survive, but half the face had been removed.

By the time WWII rolled around surgeons had the luxury of antibiotics. They didn’t need to hack out large chunks of tissue to avoid infection. A bullet wound to the face resulted in stopping the blood flow and basic rearrangement of bone fragments followed by weeks of IV penicillin.

WWII also saw the rise of plastic surgery, where surgeons started replacing missing bone fragments with animal bone or metal and stretching and transplanting skin. So even in cases where bone was shattered beyond repair, the face could be reconstructed so it looked, if not pretty, at least not horrific. I saw a brilliant documentary years ago on the pioneering work of English and (mostly) Scottish plastic surgeons in WWII and the tricks they used to reconstruct the faces of even the most severe head wounds. Quite amazing really, considering they were tarting from nothing. In that documentary one airman had lost 3/4 of his bottom jaw and half his top jaw on one side. His teeth were exposed and his tongue just dropped down from the hole. Very distressing, but he had survived his wound for several months, so presumably in WWI he would have been a “basket case”. When the surgeons had finished he looked odd, like a bad burns victim, but he could talk, and he wasn’t all that distressing to look at. He went on to marry and run a small store somewhere for decades, so obviously the surgery was a success.

WWI was just a bad time for horrific survivors because the surgery was advanced enough to save lives, but not quite advanced enough to allow a neat repeair job.

4

Umm, how did half a post get submitted?

5

Messageboard injuries, dude. Half your post got blown off.

6

:smiley:

7

Yes, from a medical viewpoint you are probably correct, but I think there may be more to it than that.

In thinking about the issue, and taking into account the historical context, the following is my logic:

During WWI there was an ongoing scandal regarding the quality of explosives, particularly in artillery shells. Apparently, due to the poor quality of the filling explosive, a high percentage of them were either duds or “fizzlers”.

This was manifest in reduced explosive power, and the consequent reduction in the force exerted on, and velocity of, shrapnel.

If this were the case, then maybe the reduced velocity of shrapnel has bearing on the issue.

Specifically, I am thinking that maybe the current trend in small bore, high velocity rifle ammunition has some bearing on the question.

In these munitions, the most damage is caused by the shock wave surrounding the bullet as it impacts tissue at high velocity.

So, maybe this is relevant to the WWI injuries: because the shrapnel was traveling at a relatively slow velocity, it would have sufficient energy to slice through tissue, but didn’t have an accompanying highly damaging shock wave.

In contrast, with better quality control, post WWI munitions are more consistent in the production of high velocity shrapnel and the accompanying shock wave produces the higher kill rate???

8

But his reconstruction work was, if not pretty, at least not horrific! :wink:

9

Firstly I’m not sure if what you say is true. Mass production technology was still a work in progress in WWI, but I’ve never seen any evidence that a significant fraction of shells partially.

Secondly, velocity of shrapnel degrades over time. It doesn’t matter how fast it starts out, at some point all shrapnel will be going at the same speed. So even if WWII shells were more powerful, there would still be exactly the same amount of shrapnel travelling at the same speed as WWI shells.

I assume you are talking about the hydrostatic shock hypothesis. While it is still debated, I gather it has largely been dismissied by ballistics experts.

OK, so where did the shrapnel go? It had to land somewhere right? And when it landed its velocity must have been reduced, right?

10

Yes, all true; I don’t have a response to that. But these things are all part and parcel of my question.

Maybe the changes in field tactics have some bearing on the effective battlefield kill/injury radius of shrapnel?

I did, however, make a quick phone around of some of my buddies.

Each of us has seen numerous of these kind of injuries on the battlefield. However, in our experience, the person who sustained them was invariably dead on the field.

In addition, none of us has even heard of anyone sustaining this kind of injury and surviving long enough to require a dust off, let alone see the inside of an aid post.

Granted, this is a small sample size and we are talking Vietnam era, but the consistency of the responses is significant. And munitions are only getting “better”.

So, the question remains: why did people survive these kind of injuries in WWI, but do not seem to do so now?

11

I think Blake answered the question. Wounds haven’t changed- reconstructive surgery has advanced more than most people can imagine.

12

I don’t think this is correct. If anything the chances of surviving a serious wound has improved through each war since WWI.

13

Hard to see how.

Maybe you don’t realise it, but the NVA and Viet Cong had almost no artillery at all. The artillery pieces they did have were almost all light weapons that could be moved by manpower alone.

So of course there weren’t many artillery injuries suffered by American/Australian forces in Viet Nam.

Had you and your friends been on the other side, I suspect you would have had a much different picture of the number and nature of wounds inflicted by artillery.

And as noted, they demonstrably do survive them now.

Maybe you missed it.

Survival of any type of injury has been increasing since WWI.
Survival of all injuries has been increasing since WWI
Regardless of the type or source of injury, far, far more people survive it now than survived it in WWI.

Bloody comedians.

14

I acknowledge the advances in battlefield medicine; but I don’t think they are relevant to the question. In current wars, if the soldier survives the initial injury and makes it to an aid station, no doubt his survival chances are greatly improved over those in previous wars. That is not the issue.

The question is why in WW1 they survived the initial injury, horrific though it was, when it is contended that today they are less likely to do so. (This contention having been put forward by the documentary.)

Further discussion of this amongst a few of us with direct experience with somewhat more recent battlefield injuries suggests that battlefield tactics and practices may be of some relevance.

In WW1 artillery was often used as a barrage over a largeish area. Many of the shells were fitted with contact fuses. Consequently, many would bury themselves some distance into the ground before exploding.

This meant that the blast effect profile of these individual shells was reduced somewhat, and the the kill cone was directed upwards; soldiers very close to the blast would have been killed either by the immediate blast effect or by fast shrapnel within the cone.

However, if he was somewhat distant from the point of impact, he may be struck by a piece of slow shrapnel which had already dissipated a lot of its initial kinetic energy. And this slow shrapnel was responsible for the non fatal gouging type wounds we are talking about.

So it is possible that due to the density of shelling, and the considerations noted above, proportionately more WW1 soldiers were struck by slow shrapnel. Therefore, the proportion receiving, and surviving, these kind of horrific injuries was higher.

On the other hand, our experience in Vietnam was that when used against exposed infantry, it was most common to use air bursts with proximity fuses. Tactically, it was most common that the target infantry was concentrated within a relatively small area, and the barrage was similarly concentrated.

Therefore, the exposed infantry would have received the full explosive force of the shell and shrapnel.

Therefore, they would have received not only blast effects but also fast shredding shrapnel. So they would have received multiple injuries, in addition to the kind of injuries we have been discussing. So, overall, their survival probability would have been low.

All of this is consistent with our observations in the field; we observed very few survivors of a barrage on exposed infantry, and the bodies were pretty severely mutilated.

Similarly, with entrenched infantry, they were usually concentrated within a very small area; most shells were fused to bury themselves before exploding. This resulted in concentrated blast effects within the entrenchments in addition to fast shrapnel; the survival probability of these individuals was not high.

Our observation of entrenched infantry casualties under these conditions was that the bodies suffered fewer shrapnel type injuries; most of the dead were due to blast effects.

Given these considerations, this may explain the contention that fewer people survive the kind of injuries observed during WW1.

It is not that these type of injuries are not being inflicted, but the general context mitigates against survival.

15

Until I see some evidence, I do not believe the assertion that grievous battlefield injuries were survived at a higher rate in the First World War than since.

I suspect there may be a perception that terrible injuries were often survived because so many such injuries were sustained that even a tiny survival rate left enough of these guys walking about, or being rolled, to be seen and to leave impressions.

16

Good point.

17

As mentioned above, don’t forget that you are judging the horror of the injury by how disfigured the survivor is, which is not a great metric. Given the surgical techniques available, a large percentage of eminently survivable wounds would leave survivors badly disfigured. Identical wounds today and ninety-odd years ago would have extremely different outcomes wrt cosmesis and function. And I’m not talking about fancy reconstructive procedures, either - just basic trauma surgical techniques.

The wounds that killed guys outright in Vietnam would have killed guys outright in WWI, too. But a wound in Vietnam that might leave you with a plate in your cheek and a crooked grin would have left you massively disfigured at the Somme if you were among the small percentage who survived. Don’t mistake the amount of flesh blown off by immediate trauma for the amount that dies and sloughs off later because of problems with blood supply, infection, contraction of scar tissue, lack of rehab, etc.

18

One possible reason…My dad was an army veteran of WW2, Pacific Theater. I’ve often heard him grumble about a common problem faced by soldiers in that area; that the European Theater for political reasons got all the best equipment, supplies, rations etc. while soldiers in the Pacific had to make do with the leftovers. One common complaint was that the ETO got scarce “soft point” rifle ammo while fighting men in the Pacific were issued armor piercing bullets which were less in demand and more plentiful. Armor piercing ammo is noted for passing cleanly through a body while doing relatively little damage…it wounds, but frequently does not kill.

I don’t know how common this situation was, but it is quite possible that a soldier hit with an armor-piercing shell would have a very “survivable” wound, and might even be able to continue the fight.

It was extremely frustrating for the American forces to be forced to face an enemy with ammo that had relatively little stopping power. According to veterans, this screw-up by their own government was responsible for many American casualties in the Pacific. But it might help to explain why there were so many survivable wounds in some cases.
SS

19

That was a common complaint of soldiers in the Pacific*, but it was not actually true. Roosevelt did agree with Churchill & Stalin to target Germany first, but the majority of American resources (about 60%) went to the Pacific theater. But the other Allies were not contributing much in the Pacific at all; Britain did some through Australia, but Russia wasn’t even in the Pacific war except for the last 2 days.

  • It was actually a common complaint of servicemen everywhere. Relatives who were in the invasion of Italy complained that they were short of material because it was being stockpiled for the invasion of France. An English friend reported that his uncle serving in Egypt/North Africa complained that they were often short of materials when fighting Rommel.
20

^
Burma?