WOUND BALLISTICS 
REPORT 
BOUGAINVILLE 
CAMPAIGN 
1944  HTljY OF SOUFJ S,U-LISTICS 
Report on Casualties at Bougainville 
from 15 February to 22 April 1944 
TABLE OF CONTENTS 
1. IKTRODUCTION 
a. Organization or lean. 
Jb. Scope of Study. 
£. Hethod of Study 
2. FACTORS PECULIAR TO CAMPAIGN 4 
a. Geography >,. 
b. i.edical Installations and Routes 6T evacuation 
jc. Allied and Japanese forces 
d. Japanese /eapons 
3. NARRATIVE OH THS CAMPAIGN 21 
4. BETTIS OF IFS PERH/HSTER 22 
/#|NsN; (****«# iMifjr •?* f#>?i frimi rf 
a « Hill 260 f *• WW Sfetw wtthin tte Ttnltf of the E?p!'r * U, 5fl U a 
]). Hill 700 81 and 32 at . mM, iis : 
jc. 129th Infantry Sector w*ri«u*wi«k«* 
il&aitluVi IfciU Iff | ,* 
d. Japanese Casualties 
5. STUDY OF BATTLE CASUALTIES 41 
a. iaialysis of the Dead ana Living 
Jb. disposition of Patients according to Hegion V/ounded 
£. anatomical distribution of bounds. 
d. The different v’eapons: (1) Relative Lethal effect 
(2j effect on disposition 
of Patients 
(3] U*3. Weapons f 
6. 0Y TLj. WOUHoAj 
• 
a. hounds of Head 
b. Wounds of Thorax 
c. hounds of Thorax and abdomen 
]T. hounds of abdomen 
£. hounds of .extremities 
Tm. multiple hounds 
£. 'Comment on Treatment of hounded 
86 
7. M0R3IJ mh.TQMY 
a, Morbid .matomy of bounds by Region 
b. Morbid Rnato:ay of hounds by ,’eapon 
£. autopsy Protocols 
112 
to r*TTT' i c?rp - r/~i ("i-r-i i/mt*" n r" tj r50rP ,r,rPTi7' ’ ■%T'TT?1?v 
198 
9. JUMMARY 213 
10, COKCLUSIOMC 219 
APPENDIX 1 Care of hounded on latrol 221 
UnSUITTl Ordnance Intelligence Report 228 
APPJMDIX III Illustration of fragrant s and their Affect 23h 1. INTRODUCTION 
a. Organization of Team. 
In accordance with instruct/ions irom the ourgeon 
General, <1 January 194h, a team was organized for the pur- 
pose of conducting a study on wound ballistics. This team 
included tne following personnel: 
(1) Colonel X Cughterson, 0-403362, k.C. 
burgeon. 
i2) Lt.Colonel Harry G. hull, 0-4043o6, m.C., 
burgeon. 
(3) i-ajor Francis A. Sutherland-, 0-4o3029, L.C., 
Surgeon. 
(4) major Daniel J. Greiner, 0-317179, L.C., 
Pathologist. 
(5) ogt. need X. Pitch, 33145016, Clerk. 
(o) T/4 Charles J. berzenyi, 32201974, Clerk. 
(7) T 5 varies H. x.estifo, 12063356, Photographer. 
This team was organized to participate in the 
contemplated hew Ireland operation and was ordered to Guadal- 
canal for preparation* The hew Ireland operation was can- 
celled and tne tea:,, wt s then ordered, on detached service 
with the XIV Corps on rougainville ana report earth ere on 
22 Larch 1944. 
.6 • Scope of btudy . 
In order to obtain information on the relative 
effects of enemy weapons all casualties occurring in uhe 
ij.ri.iy ground forces, both living and dead, were studied. 
The enemy had attached our perimeter s^n-^caugalnviiltr-on 
-^y-iv.arcn. This battle was still in progress and arrange- 
ment s ..ere immediately made for the poet mortem examination 
of those killed in action. ~t the same time a t>lan was 
inauger at ed for ti.it study of all battle casualties wnich 
occurred alter 15 lebi'uary . On chat date 
at ion mospital was opened ana all Array- casualties from 1 0 
oeugainvxile were thereafter evacuated through this hos- 
pital. oince records were readily available at this hos- 
pital, ail battle casualties from a 5 February 19n4 to 22 
•iipri.1 1944 were included. 
During this period there were a small number of 
casualties among Xavy personnel killed or wounded, mostly 
by bombs or artillery lire. These were not ix.cludsd. adequate information could not be obtained regarding a 
small air corps casualties whose ta-eed 
on or removed 19 -other islahas. reason 
were deluded. The study was, 
limited to the Ground Forces. 
V/hile it was possible to obtain information on 
all casualties living and deaa for the entire period from 
15 February to 22 April, post mortem examinations were lim- 
ited to the interval extending from 22 Larcn to 22 April. 
The number of autopsies was further curtailed because the 
bodies of some of those killed in action curing this period 
were not obtained before decomposition was far advanced. 
It was also hoped to study the effect of our own weapons 
on the enemy dead. however, the cnaracter of the fighting 
resulting in multiple wounds by rifle, machine gun, grenaae, 
mortar and artillery fire made it next to impossible to de- 
termine what weapon was responsible for death. Furthermore, 
because of delay in obtaining the Japanese dead, the state 
of deterioration frequently precluded postmortem examination. 
Also during this period it often required all the available 
personnel to perform post mortem examinations on our own 
troops Killed in action. 
Since the effect of weapons may be observed on 
the living as well as the dead, a clinical appraisal espec- 
ially as regards end results was needed. Furthermore the 
relative effect of weapons may be greatly influenced oy t 
quality of medical care. ror this reason ti e ballistics 
team after completing the study 0^Bougainville followed v 
the patients through the hospitals of the rear echelon. 
_c. lethod of Study. 
The battle casualties studied may be divided 
into two large groups; those killed in action and those 
wounded in action. 
(1) Killed in action. Those killed in action 
prior to 23 larch were recorded in graves registration. 
While some of these records were excellent, many were in- 
adequate. The circumstances attending such as type 
of missile, distance from burst, terrain, time, type of 
protection, etc. were supplemented by personal interviews 
with the Ledleal Officers and aid men, or comrades present 
during the action who had seen the soldier Killed or nad 
seen him before he expired'. This informal ion is oetter ob- 
tained by personal interview than by questioniiaire because 
the circumstances attending death are so varied. mi oraer 
to obtain reasonably accurate data, evaluation 01 the situ- 
ation by trained and interested personnel is necessary at 
the time of interview. Subsequent to 23/,&rch 
the dead were Drought to the-cist- evacuation hospital v.hrch 
was located near the cemetery. } ere excellent lacixities 
and assistance for post mortem examinations were avaiiac-Lt. 
This work was carried on bylhajor Greiner, .no was assisted 
by a clerxv and a photographer. when the number of autop- 
sies exceeded ten or twelve per lay, additional assistance 
was provided by the surgeons, A few additional post l 01 ten examinations were obtained on those wounded in action, who 
died later in hospitals of the rear echelon • A card index 
was kept on all mounded and this was checked for death 
against the records of the hospitals in the rear echelon. 
This check was made at a later date ana for the majority of 
patients a period of one to four months had elapsed since 
they were wounded, hence there is reason to believe that 
all or nearly all of the dead are recorded in this study. 
(2) Wounded in action. The wounded in action 
fell into three groups: (IT] the more seriously wounded in 
action who were evacuated from the Island; (b) the relative- 
ly minor wounds created and returned to duty from the clear- 
ing stations or hospitals usually in one to three weexs; 
(c) the very minor wounds and aorasions returned to immediate 
duty from the battalion aid ana collecting station. This 
latter group was not studied. The second group, oi minor 
wounds treated ana returned to duty from the clearing stations 
ana hospitals were studied in detail, as were also those 
evacuated from the Island. Factors relating to ballistics 
in the wounded in action were ootained by questionnaire and 
by personal interview. The personal interview was undoubt- 
edly superior but since these troops were stiul in cattle it 
was sometimes impossible to obtain an interview with an eye 
witness. ./hen emergency medical tags and hospital records * 
were checked with eye witness accounts, many discrepancies 
were found as to the weapon, the distance, what the soldier 
was doing, ana the exact circumstances surrounding his in- 
jury. Officers, platoon sergeants and privates were ques- 
tioned regarding effectiveness of enemy weapons and tactics, 
as well as our own. questions were also asmed regarding 
the construction of pill-boxes, ana the use of camouflage 
with reference to their effectiveness as a means of protection. 2. FACTOR3 TC ThT-, C.u.Jn.lGh 
a. Geography 
Bougainville Island is the northern most of the 
nolomon group lying between 1; titudes 5C"2£f 3 and 5' 51f 3. 
It is approximately 130 miles long with an average width or 
thirty miles. It is a tropical island of vulcanic origin 
with a bach bone of rug ;ed mountain ranges. Behind the 
impress Bay sector the drown Irince rante rises to 
a height of 6$o0 feet v.ith an active volcano, ht.Bogana. 
The -impress Augusta Bay and Torckina roint sector 
a low sandy shore line with heavy surf. The soutn shore 
of this island has very little coral mid behind the shore 
line a sandy alluvial plain rises gently to the 
of the Crown Irince range about 4000 yards inland. . ear 
the shore are some lagoons and In the region of the Toro- 
kina sliver extensive swamps. The subsoil of the plain is 
blacK volcanic sand crovidin- ; ood drainage. The rainfall 
which is fairly uniform throughout too year aval ages approx- 
imately eleven inches per monti . eavy tropical showers 
are characteristic which is sh the hillsides and mane con- 
stant road maintenance a necessity. 
Fig,1: due vegetation -s a dense tropical rain 
‘ ~~ forest ml tiic iieavy foliage of the large 
trees or: an almost continuous canopy- 
over *a 1. The depress Augusta auy beach-head was virgin 
jungle except for e small coconut plantation on iorokina 
Point. The elaborate system >f roc di I 3 .. 11. the accom- 
panying terrain mar had all been built since the initial 
landing curing the first week of I.ovember 1943* At the 
time of the enemy attack on 8 Larch 1944 this syste_ of 
roads was nearly completed except for a sectlo: of the peri- 
meter road connecting the .erica 1 ana 37tn division sector. 
The perimeter at its greatest depth was carriea the 
high ridges of the foothills and this extremely rugged ter- 
rain presented a major problem in evacuation ,nere roeas 
were not present or were under fire. This roaa system 
alone played an important role ir saving the 11 /cs c: many 
casualties which .aight otherwise cave oeen lost. however, 
the problem of evacuation of .oundea within the perimeter 
was simple when compared to the difricuities encounterea 
in evacuating men wounded on patrol. a description of 
such difficulties given by hajor .William T. holladay, regi- 
men tai surgeon of the 129t n Ini ‘entry , 37th division, is 
incluaed in Appendix I, I-atrols constantly covered this 
rugged terrain beyond the perimeter for distances of 10op- 
to BGGO yards. -ven a 1GGG yard carry over these ridges 
and draws was exhausting to both the litter bearers and 
the patient. 
ng.*;: View soutx 1‘roi4 midge, footaiii or the 
Croirh . ri;. ; can , local ' , . 3 rd :r 
the Bougainville perlxneter• e ridg« . 
used by Japs Tor- artillery positions In their 
attacx on Hill 700• m the distance is Lake 
Kathleen. the air 1‘leld :.n> i-uruata Isiand• Reproduced by Engineer Section, Hq. S.O.S. 1225 
ii'ig.3: Aerial view of approximately half oi the perimeter 
sector held by 37th division left ana 
Division right. b. Medical Installations and Koutes of Evacuation 
The medical installations and routes 'of evacuation 
were better developed on Hougainville at the time of the 
attack than for any other Island campaign in the South Paci- 
fic. This was due to the fact that the beachhead had been 
developed steadily over a period of four months before the 
of the trimeter be^an. 
fig 4: One of the routes of evacuation between the 
Clearing station of the Division 
and the 21st evacuation hospital. 
Two way all weather roads made all parts of the 
perimeter easily accessible wi$h one exception. This one 
sector lay near the boundary line between the Americal and 
37th .divisions, where the perimeter road had not been com- 
pleted. furthermore, the roads were kept open throughout 
t:.e battle except on Hill 700. Here the one way all 
weather road over very rugged terrain leading to the hill 
was for a time under enemy fire ana as a result a difficult 
litter carry of 1200 yards was necessary during the attack, 
later at this point and at others where sporadic fire was 
encountered, half tracks were used for evacuation, patients 
then being transferred to jeep ambulances ana taken to the 
hospital. The greatest distance from the front line to 
a clearing station was found on the xdiierical sector at the 
mouth of the Torokina Hiver which was approximately 10,000 
yards over a good road. Fig $: A section of the perimeter roau behind the 
145th Infantry, 37th Division. 
Fig 6: Perimeter road near junction' of 
and 37th Divisions. good route of evacu- 
ation over difficult terrain built by the 
117th engineers. Owing to this excellent system of gooa roaas, 
the majority of patients arriveu at the hospitals within 
three hours, and frequently within an hour. a sample of 
142 patients showed that 87 per cent were on the operating 
table within three hours. Patrol missions presented the 
most difficult problems of evacuation. omall petrols, 
frequently no larger than a platoon, were so numerous that 
it was impractical to send a medical officer with each one. 
Larger combat patrols were usually accompanied by a medical 
officer. On only one occasion was a patrol large enough 
to warrant the use of a portable surgical hospital. a 
consequence some patients who were wounded on patrol did 
not reach the hospital until twenty four to forty eight 
hours had elapsed. however, every effort was made to re-‘ 
duce d'elay to the minimum, and to provide surgery at the 
earliest possible moment. 
Fig 7: headway along the Laruma ..iver. This was 
outside the perimeter. 
The medical installations for this 
campaign were than adequate. The clearing stations 
of both the Americal and 37th divisions had been augmented 
with additional surgical equipment before the hospitals 
were established on the. beachhead. The 31st Portable 
Jurgical hospital had been assigned to the **merical div- 
ision and the 33rd Portable ourgical to the 37th division. 
Owing to the fact that more adquate medical facilities be- 
came available later, the portable surgical hospitals were 
not necessary although they were both utilized. ...ap 
Pig.11). The 52nd Field hospital was utilized for the Fig 8: Ward area of the 21st Evacuation Hospital 
on Bougainville. 
care of service troops and functioned chieflj as a station 
hospital for the Island. The 21st evacuation hospital, 
an affiliated unit from the University of Oklahoma, had an 
exceptionally well qualified staff including the various 
specialists. The construction of this hospital was com- 
pleted on 8 llarch 1944, although it had been functioning 
for a limited number of patients since the 1$ February. 
Its normal capacity was 750 beds with facilities available 
for an additional 250 beds. Casualties from all combat 
troops were cared for at this hospital.- Since the 21st 
evacuation Hospital was situated only 4,000 yards from the 
front lines at the nearest point of attach (forward of some 
artillery batteries), the majority of the seriously wounded 
patients were sent directly t® the hospital to avoid aelay 
at the clearing stations. 
*1.11 patients from the Island were evacuated 
through the 21st evacuation Hospital. heariy ail patients 
evacuated to the rear ’were sent by air transport to Guadal- 
canal and were cared for there in one ol three 500 oed 
station hospitals. latients requiring a long period of 
convalescence were evacuated from this Island by snip or 
air transport to Espiritu oanto and to New Caledonia. Big 9: Underground operating room of the 21st Evac- 
uation Hospital on Bougainville. There was 
another similar operating roora above ground 
providing space for eight tables. 
Big 10; Interior of underground ward, 21st Evac- 
uation Hospital on Bougainville. * npace 
was provided for 120 litter patients under 
, . round. This would have been inadequate 
if shelling haa been heavy. ~ Fig 11: mu underground operating room of the type 
used by the portable surgical hospitals. L£G-CHO *QOAO Her 
■ 0~* -.A- wr»/L,~ 
’ /'■•// g. Allied and Japanese Forces 
(1) Allied Forces on Bougainville were concen- 
trated in the impress Augusta Bay beachhead. The peri- 
meter line of defense had been extended previously in three 
phases until by the time of the Japanese attach on 8 March 
1944, it enclosed about twenty square miles and was approx- 
imately 22,000 yards in length. 
The total strength within this perimeter as 
of 31 March 1944 was 60,583. Included were 11,220 Navy 
personnel, Marines and civilians. The casualties from 
these groups are not included in this study although they 
were few and due mostly to shelling and bombing. The casu- 
alties included in this study were derived, therefore, from 
a total strength of 49,3o3. Of this number 40,404 were U. 
3. Army ground force combat troops of which 27,831 constit- 
uted the 37th and Americal Divisions. Thesremainder of the 
ground force combat troops were attached to the aIV Corps 
and the 25th Regiment Combat Team. Allied forces other 
than U.S.troops, chiefly Royal New Dealand Air Force and 
Fijian Infantry I numbered 3,424. 
it should be noted that of the above forces, 
the number involved in combat was comparatively few. The 
number involved could not De ascertained except 
for certain specific engagements to be described later. 
The perimeter?line of defense was divided between the 37th 
and Americal/Divisions although other forces were used in 
the line at various times. The Fijian troops, among whom 
there were a considerable number of casualties recorded in 
this report, were used chiefly on patrol missions. 
(2) Japanese Forces. 
Immediately prior to the attack, the effect- 
ive strength of the Japanese Army and Navy forces on Bougain- 
ville numbered about 27,000. Of these about 16,000 were be- 
lieved to be Army combat troops. The remaining strength 
consisted of Army and Navy antiaircraft, base, service, and 
labor troops. No surface ships had been observed in the 
Bougainville area since mid-November 1943, and whatever sup- 
plies were brought in were carried by submarine or barge. 
There is evidence that the enemy was short of supplies ex- 
cept small arms ammunition. 
Although elements of the 17th division (one 
battalion each from the 81st and 53rd Infantry Regiments] 
were identified in the Torokina area, the brunt of the 
attack was borne by the Japanese 6th Division. The back- 
bone of the enemy’s strength was the 13th, 23rd, and 45th 
Infantry Regiments. These units were supported by the 
6th Field ■tO’tillery Regiment (2nd battalion; elements ol 
the 4th Heavy (medium] artillery Regiment, as well as mis- 
cellaneous mortar, artillery, engineer and roan construction 
units. (Bee Fig.13). The first Battalion, 13th Infantry 
(-1 co.) was to be the division reserve. The total strength 
of these units actually in combat in the battle ol the peri- 
meter was believed to be only slightly more than ib,UoU. ♦ 
The enemy forces faced great difficulties 
of transportation on the Island in maneuvering various units, 
especially heavy artillery, into positions favorable for 
attack. This had to be accomplished over the most rugged 
type of terrain at great expenditure of man power. i’inally 
they attacked with almost no air support. MAP NO.I 
EMPRESS AUGUSTA BAY 
BOUGAINVILLE ISLAND 
SOLOMON ISLANDS GROUP 
AC.OPS 0-2 
HO USAPItPA 
CARTOGRAPHIC UNIT 
MARCH 26,1944 A - 1O66 
’ DISPOSITION- 26/FEB/1944 
PLANNED MOVEMENT 
LEGEND 
TWO WAY ALL WIATHCR ROAOS 
J€CP ROAOS 
one WAT ROAOS 
trails 
DISPOSITION OF PRINCIPAL ENEMY UNITS. 29/FEB/I944 WAP NO 2 
EMPRESS AUGUSTA BAY 
BOUGAINVILLE ISLAND 
SOLOMON ISLANDS GROUP 
A C. OE S 0-2 
MO USAEI9PA 
CARTOGRAPHIC UNIT 
MARCH 28,1944 A-IO86 
legend 
TWO WAY AU. WEATHER ROAOS 
Jf£P AO AOS 
OWE WAY ROAOS 
TRAILS 
— ~~ T9i d. a Description of the ./eayons Commonly j&ployed 
by the Japanese at Bougainville. 
In the period under study Japanese weapons ac- 
counted for 1569 casualties. Six hundred and fifty nine 
(42.0 per cent] of these were produced by mortar fire. 
There were 393 (25.1 per cent) who were killed or wounded 
by rifle fire. Of the remaining casualties the grenade 
was responsible for 205 (13-1 per cent), machine gun for 
151 (9.0 per cent], artillery for 151 (9-6 per cent) and 
miscellaneous weapons for ten (0.6 per cent). 
(1) xiifles 
estimates based upon captured weapons indi- 
cate that the ratio of the 6.5 mm to the 7.7 mm rifle was 
approximately four to one. furthermore, of the smaller 
caliber (6.5 mm) weapon, roughly 90 per cent were "long", 
7 per cent "short" and 3 per cent "medium” types. 
Designed by Arisaka the model 38 (1905) 
6.5 mm rifle, listed by the Japanese as "Sampachi Bhiki 
Hoheiju" is commonly called by them the "Arisama oampachi". 
Patterned after the mauser type, this weapon possesses an 
action resembling the U.3.caliber .303 M 1903 (Springfield) 
rifle. Loading is accomplished by a five round clip. The 
muzzle velocity is 2,410 feet per second, the effective 
range 400 yards, and maximum range 2,600 yards. This weapon 
without sling and bayonet weighs 9t lbs. The almost com- 
plete absence of muzzle flash is a characteristic commented 
upon favorably by our soldiers. bince the latest Japanese 
rifle, model 99 described below, does not possess this feature 
it is apparently considered unimportant by the enemy. 
The later but less common model 99 (1939) 
7.7 mm rifle is designated by the Japanese "kyukyu Shiki 
Tanshoju". Like the previous m lei 38, this weapon has a 
manually operated bolt action ana a magazine capacity of 
five rounds. Unloaded and with sling this rifle weighs 
lbs. The muzzle velocity of this weapon is 2,300 feet 
per second, the effective range 600 yards and the maximum 
range 3000 yards. 
(2) Machine Puns 
Most commonly employed by the enemy at Bougain- 
ville, in a ratio of approximately four to one, were the model 
96 (1936) 6.5 mm light and tne model 92 (1932) 7.7 mm heavy' 
machine guns. -.xtremely rare was model 11 (1922) b.5 mm 
light {"nambu Keiki") among the 2o0 captured machine guns. 
Closely resemblint the British Bren light .303 
caliber model, the model 96 (193&) 6.5 mm light iobchine gun 
is considered an excellent weapon by our officers. ("I have 
never heard it jam".) The Japanese name for this weapon is 
"kyuroku Shixci heikikanju". Weighing only 20 lbs., it is 
easily handled and may be fired from the hip. It is a gas 
operated, air cooled weapon, fed by curved-box magazine con- 
taining thirty rounds. The cyclic rate of fire is 550 rounds 
per minute. Its muzzle velocity Is 2,410 feet per second, 
effective range 1,640, ana maximum range 4,374 yards. Model 92 (1932) 7.7 mm heavy machine gun is 
officially designated by the Japanese ”kyuni Shiki Jukikanju”, 
but commonly called by them "Juki”. Its slow rate of fire 
(effective 200, cyclic 450 rounds per minute) almost en- 
tirely eliminates overheating. It weighs with tripod 122 
lbs. A modified Hotchkiss-type weapon, it is gas operated, 
air cooled, and fed by brass strips containing thirty rounds. 
Three telescopic sights are available. The effective range 
is 1,500 yards, and the maximum range is 4,587 yards. The 
muzzle velocity is 2,400 feet per second. 
(3) Mortars* 
Wounds ascribed to the mortar at Bougainville 
in many instances were actually produced by the grenade dis- 
charger. Mistakenly called the "Knee Mortar”, this weapon, 
because of its accuracy and efficiency has earned the res- 
pect of the American combat troops, and is more feared than 
any other Japanese weapon. If the ”Knee Mortar” is grouped 
with the other types of captured mortars it is found to con- 
stitute approximately 90 per cent of the total. The ratio 
of the 81 mm to the 90 mm mortar (both models) was about 
three to two. a total of 96 mortars were captured, only 
one of which was the 90 mm model 97 (1937)* 
There are two types of the 50 mm grenade dis- 
charger; the smaller model 10 (1921), and the larger model 
89 (1929). Model 10 has a smooth bore barrel, nine and one 
half inches long, an overall length of twenty inches, and 
weighs 5i lbs. Using the model 91 grenade its range is 
65 to 175 yards. The barrel of model 89 is rifled and 
measures ten inches in length. The overall length is twenty 
four inches and the weight 10£ lbs. Maximum range for this 
weapon is 770 yards with the model 89 shell, and 175 yards 
with the model 91 grenade. The range of this weapon depends 
upon the distance travelled by the projectile through the 
barrel. This distance is regulated by increasing or de- 
creasing the length of the trigger housing extending inside 
the barrel of the discharger. The weapon is thought to op- 
erate most efficiently at an angle of 45°, its base resting 
on the ground or some solid structure. 7ith model 89 pro- 
jectile, the effective range of burst probably is five to 
ten yards, and the danger zone about forty yards. 
Both 81 ram and 90 mm mortars were in common 
use at Bougainville. Very little information is available 
regarding model 97 (1937) 81 mm mortar. It closely resembles 
the U.S. 81 ram mortar Ml, and it is said that shells for the 
two weapons can probably be used interchangeably. The Jap- 
anese name for this mortar is ”Kyunaua Shiki Kyokusha". 
The effect of the shell is that of blast and fragmentation 
with an estimated effective range from the Durst if fifteen 
to twenty yards, and a surrounding danger zone of 200 yards. 
Model 94 (1934) 90 mm mortar (marked ”xyuyon 
Shiki Keihakugekiho”) fires both chemical and high explosive 
* See. Appendix II Frequency Distribution of Shell Fragments 
from Japanese Mortar Shells. shells. It is a smooth bore, muzzle loading weapon with 
a maximum range of 4,150 yards. It weighs 340 lbs. From 
point of burst the shell has a probable effective range of 
twenty yards and a danger zone of 300 yards. 
(4) Grenades 
Because it can be thrown by hand, fired from 
a grenade discharger, or used as a rifle grenade, model 91 
(1931) hand grenade, "nyuichi Bhiki Bhuryudau" is a useful, 
versatile and frequently employed weapon. Lade of cast 
iron and painted black, it is distinguished by the serrated 
surface, brass safety cover and perforated propellant con- 
tainer screwed into the base. When used as rifle grenade, 
a tubular tail fin is substituted for this propellant con- 
tainer. The grenade weighs 18.8 ounces, is 3*75 inches 
long without the propellant container, and measures 1.97 
inches in diameter. When used as a hand grenade, the pro- 
pellant container is, of course, unscrewed and removed. 
Lodel 97 (1937) hand grenade is similar to model 91 except 
that it has no propelling charge, and cannot be fired from 
a grenade discharger. It is carried by all Japanese front 
line troops. This grenade is loaded with TOT and weighs 
one pound. It may be used as a booby trap. It is said 
to have poor fragmentation, the fragments being small and 
of short range. The effective range from the burst is 
estimated at five yards and the danger zone thirty yards. 
(5) Artillery 
.artillery support in the plan to neutralize 
and seize the three ToroKino airfields was the most exten- 
sive yet employed by the enemy in the South Pacific. 
Through dense jungle and over exceedingly rough terrain 
to positions overlooking our perimeter, the Japanese were 
able to transport a considerable number of heavy weapons. 
Assuming all units at full strength, an order of battle 
indicates that the maximum number of weapons available to 
them was 136. actual observation suggested the presence 
of approximately forty or fifty pieces. 
Vith the exception of the 10 and 15 cm pieces 
all weapons were of pack type and were undoubtedly carried 
by hand. Possibly the 150 mm howitzers may have been dis- 
mantled also, as some of these were reported on Lt.Bagana. 
These weapons were brought by water to Koaris and thence by 
road to the vicinity of hills and 501. Limited.use of 
horses was reported on the Kahili-Empress Bay track. 
Apparently there was no serious shortage of ammunition by 
Japanese standards, fire having continued intermitently 
from some positions for three weeks. Considerable quanti- 
ties of ammunition were generally found with the captured 
weapons. 
Principal targets were the air strips, supply, 
and CP areas, road junctions and the tank area. Lassing 
of fire was not utilized, gun fire seemed independent. The 
heaviest concentration occurred in the early morning and 
evening. On 23 Larch in less than two hours, seventy rounds fell on the Fiva Airfields. Alter the first two aays of 
attack, curing which some parked planes ..ere destroyed, 
rarely in a single day did more than five in six shells 
fall on these same airfields. 
Difficulties inherent in jungle warfare pre- 
cluded the use of artillery in close support of attacking 
Japanese infantry. For this purpose they relied princi - 
ally upon 90 mm mortar fire. 
The Japanese employed at least thirty five 
75 mm guns model 41 (1908) and model 94 (1934t , the former 
predominating. These pieces were situated north and north- 
east of the perimeter. Four 150 mm howitzers .ere 1ocatea 
on the northeast and east, and two 105 mm howitzers on tie 
east near hill 501. Mortar fire received was principally 
from the north and northwest sections. The greatest con- 
centration of fire in any one day was 200 rounds. I: con- 
trast to the experience during the weeks after the landing 
in November, the proportion of ’’duds" was remarkably low. 
Observers were able to identify by type of burst or by "ouds" 
about 1300 rounds received. Of these 885 ware 75 mm shel-s 
and 130 were 150 mm shells. Many of artillery wea- 
pons were captured. The five most common moods will oe 
described briefly. 
model 94 (1934) 37 mm gun is desi gnated 
"Kyuyon Shiki Sanjunana kiri Ho", and commonly called "oan- 
junana kiri Ho". It can be used both as an anti-tank and 
anti-personnel weapon, employing armor-piercing, high ex- 
plosive and shrapnel ammunition. This gun has a long 
slender barrel measuring 66.5 inches in length, Tneef- 
fective range is 2,500 yarns, ana the maximum range 5,ooo 
yards. The total weight of the weapon in action is 714 Ids. 
The effective burst of the high explosive shell is said to 
be ten yards with a zone of danger extending about seventy 
five yards. Fragmentation tests have shown that the 500 
grams of metal in the shell broke into 49o fragments. Only 
143 of these fragments were classified as lethal (average 
weight of lethal fragment being 3*1 grams). ..ssuring that 
all fragments passed within a mans height standing at sevei - 
ty five yards, it is estimated that his chance of being hit 
would be 50/50. This assumption is incorrect, however, the 
actual chance being 1 in ICO. Nevertheless, thi : 
could be fatal. 
The model 92 (1932) 70 mm howitzer (battalion 
gun), "Kyuni Shiki Loheiho" is a horse drawn iufs itry ~UV~ 
port howitzer. It weighs 468 lbs. arm. can be handled by 
ten men section. It has an effective range of yards 
and a maximum range of 3»000 yards. The estimated^ell act- 
ive range of burst is twenty yards and the area ci ranger 
is 200 to 300 yards. 
Now issued for use as an infantry regi iental 
gun, the model 41 (1908) 75 mm mountain (infantry ) gun was 
originally used as a field artillery pack gun. m.e ell act- 
ive range of this weapon is 2,100 yards and it fires beta 
high explosive and armor-piercing shells. .ith the pong 
pointed shell its maximum range is 7,675 yards, ana with the ordinary shell 6,575 The total weight is 1,200 
lbs. Its muzzle velocity is listed as 1,200 feet per sec- 
ond. The effect is produced both by blast and fragmentation. 
The shell has a probable effective burst of twenty yards with 
a danger zone of 300 yards. 
The model 96 (1936) 150 mm mobile field how- 
itzer has a range of 13,200 yards. The effective range of • 
the shell burst is said to be fifty yards with an area of 
danger of 500 yards. The effect produced is that of blast 
and fragmentation. 
The model 98 (1938) 20 mm anti-aircraft anti- 
tank machine cannon is an all purpose weapon. It is gas 
operated and semi or full automatic. The ammunition for 
this weapon is high explosive, tracer and armor-piercing, 
and is fed by a 20 round box magazine. This weapon is very 
maneuverable, weighing without wheels 836 lbs. The rate of 
fire is 120 rounds per minute. The muzzle velocity is 
2,720 feet per second, and the maximum ranges, horizontal 
5,450 and vertical 12,000 feet. 
A list of Japanese weapons captured on Bougain- 
ville follows: 
RIFLES 
♦Model 38 (1905) 6.5 nira Rifle (Long) 
Iodel 38 (1905) 6.5 mm Rifle (Short) 
Model 97 (1937) 6.5 mm Snipers Rifle 
Model 38 (1905) 6.5 Rifle (Medium) 
Model 44 (1911) 6.5 Cavalry Carbine 
♦Model 99 (1939) 7.7 mm Rifle 
(Caliber Equivalents 6.5 mm - .256 inch, 7.7 mm - «3o3 inch) 
MACHINE GUNS 
Model 11 (1922) 6.5 mm Light Machine Gun ("Kambu") 
♦Model 96 (1936) 6.5 mm Light Machine Gun 
Model 99 (1939) 7.7 mm Light Machine Gun 
’•'Model 92 (1932) 7.7 mm Heavy Machine Gun 
MORTARS 
♦Model 97 (1937) 81 mm Mortar 
♦Model 94 (1934) 90 mm Mortar 
Model 97 (1937) 90 mm Mortar 
♦Model 89 (1929) 50 mm Grenade Discharger ("Knee Mortar") 
GRENADES 
♦Model 97 (1937) 
♦Model 91 (1931) 
Model 23 (1923) Booby Trap Grenade ARTILLERY 
'Model 94 (1934) 37 mm Gun 
Model 1 (1941) 47 mm Gun 
'Model 92 (1932) 70 mm Howitzer (Battalion Gun) 
'Model 41 (1908) 73 mm Mountain (Infantry) Gun 
(or Regimental Gun) 
Model 94 (1934) 75 mm Mountain Gun 
Model 91 (1931) 105 mm Light Field Howitzer 
Model 96 (1936) 150 mm Mobile Field Howitzer 
Model 97 (1937) 20 mm Anti-Tank Rifle 
‘Model 98 (1938) 20 mm Anti-Aircraft-Anti-Tank Machine 
Cannon. 
Asterisk indicates models most frequently employed. 
In this section free reference has seen made to 
”Japanese Infantry Weapons", special series iio.19, 
prepared by Military Intelligence division, War 
Department. 3. BRIEF NARRATIVE OF TJ i BOUaAXKVILLE OA.VTAIGK 
DURli'G Tiff frj&lc-j GoTiffff 't.T~ !L. 
TO 22 ABRIL l$u. 
a. The beachhead was established during the first 
week of November 1943* The period prior to the battle of 
the perimeter was characterized by consolidation of the de- 
fenses of the airfields which were being used in attacKing 
enemy installations in the Bismarck Archipelago and on Bou- 
gainville. By 15 February the air strips were completed and 
the perimeter established with the 37th"Division on the left 
flank and the Americal Division on the right flank. From 
15 February to 8 March the perimeter defense was strengthen- 
ed, and an extensive system of roads was further developed 
within the perimeter. During this period patrols made con- 
tact with enemy forces moving into position north and east 
of the perimeter. Some artillery installations were dis- 
covered and strong enemy positions were noted on Hills 1000, 
1100, and 600 east of the Torokino River mouth. However, 
during this period contact with the enemy was limited to 
patrol skirmishes and an occasional bombing raid at night. 
b. The battle of the perimeter extended from 8 
March to 24 March. The Japanese laid plans for this off- 
ensive sometime around the turn of the year. Cur intell- 
igence obtained information that the enemy attack was to 
be launched on the 8 or 9 March, thereby permitting ample 
preparation for defense of the perimeter. 
(1) Bnemy Flan. The three infantry regiments 
were to leave their respective lines of departure (see map 
Fig. 13) following an artillery barrage. This barrage was 
to commence at 0430 Y day from the main strength of the 6th 
Artillery Regiment located near Blue Ridge (Mountain Guns) 
and the Medium Field Artillery (10 and 15 cm field pieces) 
deployed near Hill 500. It appears that the 45th Infantry 
was to constitute the main thrust and were to strike our 
forces near the point where the Fiva-Huma-Huma road enters 
the perimeter. (129th Infantry Sector). Simultaneously 
the-23rd Infantry was to launch its attack from approxi- 
mately 1000 yards N.3. Hill 700 with tie 3rd Battalion on 
the left and the 2nd Battalion on the right and the 1st 
Battalion in reserve. By the end of Y day the 3rd Batt- 
alion was to have captured Hill 700 and the 2nd Battalion 
was to have occupied Cannon Hill. These heights over- 
looked the Piva air strip and the main strength of the 23rd 
Infantry was to have attacked the strip from the ~.ast while 
the 45th attacked from the .Vest. The 13th Infantry was to 
attack Hill 260 and then join with elements of the 2}rd In- 
fantry to proceed in the general direction of the strip, 
These three main thrusts are shown on the map (Fig.14) end 
on the aerial photograph (Fig.3)- 
(2) Results. The enemy’s Torokina operation 
began on 8 March with preliminary artillery fire directed 
mostly on the Piva air strips. Blue counter fire against 
hostile positions located in the general areas of hills 
1111 and 501 began immediately. The main Japanese drives 
began under the cover of darkness during the night of 8 and 
morning of 9 Larch at the three points on the perimeter indicated on the map (Fig.3). In the hast sector patrol 
contacts and fire fights took place in the vicinity of Hill 
260. To the North on Hill 700 the Japanese infiltrated 
through our lines and occupied the northwest slope of the 
hill. £>lue counter attack reduced the Japanese positions 
and the perimeter was reestablished. In the Northwest 
sector several fire fights occurred. The Japanese had oc- 
cupied strong points on Hill 260 and severe fighting resulted 
in retaking these points but by 11 March two Blue companies 
occupied Hill 260 with the exception of strong points on the 
southeast slope. Another attack on the Northern sector was 
repulsed. Meanwhile preparations for an enemy drive from 
the Northwest continued. On the 12 March three major attacks 
from the Northwest near the Numa Numa Trail placed the Japan- 
ese within our perimeter. Our tank-infantry teams reestab- 
lished the lines the next day. The same'Blue forces on 
Hill 700 received and repelled the third attack on that pos- 
ition. On 1$ March another attempt was made by the Japanese 
to break through the sector held by the 129th Infantry. 
Tank-infantry counter-attack again restored the perimeter. 
The next strike by the enemy was again from the northwest 
near the Piva-Numa-Numa Trail on 17 March. Although a sev- 
enty five yard penetration was made for the third time, 
tanks and infantry drove the enemy bacx. For a week the 
Japanese remained relatively quiet regrouping their forces 
opposite the northwest sector of the perimeter. Smaller * 
holding forces which were dug in were contacted on the other 
sectors. On 24 March after a feeble attempt at laying an 
artillery barrage, the Japanese strucx toward the Piva air 
strips once more, penetrated the 129th Infantry lines and 
again were driven back, losing 300 men and a field gun. On 
each occasion when penetration was made the enemy succeeded 
in occupying pill-boxes within our perimeter only to be dis- 
lodged with heavy losses. 
q. The Japanese did not again attacx in force after 
the repulse on 24 March and began a general withdrawal. How- 
ever, Hill 260 was not evacuated by the enemy until 28 March. 
From 28 March to 22 April when this study was completed, con- 
tact with the enemy was limited to a few fire fights, patrol 
skirmishes and occasional shelling of the air strips. There 
were 5322 Japanese dead counted between 8 March and 22 April. 
However, this did not include all areas subjected to our ar- 
tillery fire. 
4. BATTLE OF THE PERIMETER 
(Description of three major attacks). 
a. Operations on Hill 260 * 
(1) The original garrison on Hill 26u - a rein- 
forced platoon from Company C was attacked by a Japanese 
force of undetermined size at dawn on 10 March. int: i 
generally occupied the area south of the OP tree and ironi 
this date until the termination of the battle, the 
tried to increase their garrison and improve their posi 
on that side of the hill in order to secure observation loi an 
all-out attack on the main line of resistance. 
Extracted from report by Lt. Col. Mm. J.Mahoney, executive 
officer, H.1.182nd Infantry, Americal Division. Fig.15: Jungle growth on Hill 260 showing pro- 
tection afforded by trees. 
(2) Forces engaged; American: B, E, F, G, and K 
Companies plus one platoon of K, 182na infantry, and Co. G, 
164th Infantry, actively took part in the action on the hill. 
All other companies in the regiment were in general support 
plus A and 3 Companies, 57th Engineers; 246th and 247th FA 
Battalions; 82nd Chemical Battalion. Total 1350 men. 
Japanese: Elements of the 
13th and 23rd Infantry regiment s, both part of the 6th Div- 
ision, have been identified as taking part in the battle for 
Kill 260. It is estimated that 1400 Japanese were involved 
in this action. 4 
(3) After the initial attack, the Japanese held 
the south end of Hill 260. They greatly increased the 
force which made the original attach because they beat back 
our every attempt to storm the northwest, southwest and south- 
east ridges of the hill during the period 11-17 March. ap- 
parently their main route of supply and evacuation was down 
the steep east side of the hill, then north clinging to the 
east side of the west bank bluff overlooking the Torokina 
River. This route was well-concealed and in defilade and 
difficult to reach by fire. After the initial engagement 
reinforcements were sent to secure the north side of Hill 260. 
The establishing of a perimeter there and the continual pres- 
■ sure on the Japanese positions completely neutralized the 
effect of the offensive action taken by the Japanese. The 
possession of Hill 260 by the enemy would have Jeopardized 
a considerable portion of our main line of resistance. Fig. lo: rnese trees ar© common ±n tne jangle ou 
Bougainville and offer excellent protection. 
The CP tree on Hill 260 was of this variety. 
(4) From the outset, the problem on Hill 260 
was one of ejecting the Japanese from the south end of the 
hill. Their positions were well dug in ana defended and 
various American assaults to take the hill were turned 
back with heavy casualties. artillery and mortars were 
useful in blasting Japanese positions in the general area 
but due to the proximity of our own troops, prepared fires 
could not be used on the Japanese positions just outside 
our perimeter. artillery was effective on the exposed 
southwest slope and after a week’s fighting, the Japanese 
were pretty well removed from that area. But tnose in 
defilade on the southeast slope dug in ana countered our 
every move. Various means were used to force the Japanese 
from their dugouts during the closing ten days of the 
battle. It was obvious that at tnat time the Japanese 
garrison was considerably reduced in numbers although there 
was not a corresponding lessening of fire power. Flame- ' 
throwers and gasoline ignited with thermite grenades re- 
duced a few pill-boxes. as late as the morning of ...arch 
Japanese were seen near pill-boxes on the southeast slope. 
Cn the morning of 28 I,larch, three patrols were sent around 
the base of the hill to fire on the Japanese. When there 
was no fire, our patrols investigated and found that the 
Japanese had evacuated. At 1246, 28 Liarch, Kill 260 was 
secured. On the morning of 30 March, the 2nd Battalion, 
182nd Infantry, was replaced on the hill by 1st Battalion 
24th Infantry. 
(3) estimates of Japanese Killed and wounaed 
were difficult to make because of their practice of carry- 
ing away and burying their own dead. x. total of 212 Japan- 
ese bodies were found by our troops on Hill 260 and the 
Amerlcal Division G-2 listed 541 Japanese as the total killed. 
A Fig.17: Focal point of entire Hill 260 
battle. Banyan tree used as an 
iiirierical Division Artillery spot- 
ting post. $41 Japanese were 
killed in the 20 day fight for 
the hill. This tree is similar 
to those in Fig.16 and withstood 
artillery shelling and fire. 
In addition many wounded were seen going to the rear and it 
is believed an entire battalion plus a number of supporting 
troops were virtually wiped out. The heaviest fighting 
occurred during the period 10-14 March and as indicated later 
by POW reports, this engagement broke up the initial attack 
of the entire Japanese 13th Infantry Regiment on the Bougain- 
ville Island perimeter. 
(6) The terrain was that of an elongated hill with 
moderately steep sides covered by rain jungle. The OP tree 
(Fig. 17), around which the heaviest fighting occurred, was one 
of a common variety of trees on Bougainville, the roots of 
which plus excavation make a very strong defensive position. Fig.18: Hill 260 on March 19 being blasted by 
Americal Division artillery fire. The 
firing continued for several hours at 
the end of which time it was believed 
that all enemy resistance had been neu- 
tralized. Partial destruction of 
jungle growth may be seen. 
In comparison to the other two main thrusts by the enemy 
on the perimeter there was more offensive action by our 
troops on Hill 260. The enemy in the initial attack had 
captured and managed to defend the OP tree which was the 
focal point on the hill. Furthermore, the character of 
the terrain lent itself readily to defense and prevented 
the effective use of tanks. 
(7) During this engagement our casualties were 
as follows: 
KIA SERIOUS NCR-SERIOUS L.lA TOTAL AGGREGATE 
0 EM 0 El.: 0 EM C EM 0 EM 0 5c EL. • 
3 rr 9 204 37 370 4 58 655 TH 
There were approximately 1350 of our troops involved or 
52.8 per cent casualties with 5.3 per cent killed in action. 
Ratio of Japanese to our troops killed was 7.6 to 1. 
The heaviest casualties were in the 182nd 
-26- Fig.19: Knemy pillbox on Hill 260. The dense 
jungle growth has been entirely cleared 
away by artillery fire. 
Infantry with 800 troops involved: 
Killed in Action 63 or 7.9 per cent 
Seriously Wounded 106 or 13*3 per cent 
Slightly Wounded 256 or 32.0 per cent 
Self-inflicted Wound 1 or 0.1 per cent 
Total Casualties 53.2 per cent 
b. Operation on Hill 700* 
(1) The terrain here was mountainous but mostly 
- second growth rather than virgin jungle. The sides of 
the ridges were very steep and at one point of the assault 
was almost precipitous. The action by our troops was 
largely defensive involving, however, the recapture of cer- 
tain positions into which the Japanese had infiltrated, A 
one way road leading along behind our lines for a time was 
under enemy fire, necessitating a difficult carry lor the 
litter bearers of more than a thousand yards. 
(2) On the morning of 8 larch the Japanese 
attack began with some artillery and spasmodic small arms 
fire which continued throughout the day. juring the night' 
of 9 Karch booby traps warned of attack followed by hostile 
fire from mortars and rifles. «.t dawn it was found that 
* Extract from G-3 Periodic Report, H. w. 37th Infantry 
Division. A 
-27- Fig.20: Jungle growth partially cleared on Hill 
700. Through*this draw the Japanese made 
their approach to the Hill. 
at least one company of Japanese had occupied the north 
slope and crest of Hill 700 and had penetrated our line 
to a depth of 75 yards over a 100 yard front. Luring 
the day a counter attach by the 1st and 2nd Battalions 
of the 145th Infantry regained several pillboxes on the 
south slope of the hill. One tank was used with fair 
success along the road which was unaer fire. On 10 larch 
the enemy retained possession of the crest of the hill in 
spite of continued ground action. Efforts to reach the 
Japanese positions on Kill 700 by engineer ’"polecharges", 
bangalore torpedoes and bazookas were without avail and 
resulted in numerous casualties due to the excellent Jap- 
anese field of fife. 
At 1700 hours 10 Larch a determined attack 
was made by our forces and, in spite of intense enemy light 
and heavy mortar and artillery fire, succeeded in driving 
the enemy from the crest of Hill 700. Japanese concen- 
trations coming up to reinforce this area were subjected 
to heavy bombing and_artillery fire which was very effective 
On 11 Larch at daylight the enemy made a general assault on 
Cannon Hill held by the 3rd Battalion of the 145th Infantry. 
The attack was repulsed with the exception of one pillbox 
gained by the enemy on Hill 700. Japanese losses were re- 
ported as enormous with the enemy assault wave attacking 
over piles of their own dead. On 1< Larch after severe 
lighting our forces succeeded in driving the enemy from 
Hill 700. Three hundred and ninety nine Japanese dead 
were counted within the wire on the crest and on the forward 
slope of the hill. On the night of 13 Larch the enemy Fig.21: Precipitous hillside off the perimeter 
road. - Grenades were rolled down this 
bank causing many casualties. 
again attacked in the draw west of Hill 700. Searchlights 
were used successfully to reflect light from the overhanging 
clouds and the attack was repulsed. After this date only 
intermittent contact was made with the enemy in this area. 
Pig.22: oundea soldier being helped down the side 
of Hill 700 by two medical corps men. Fig.23' 'founded transferred from half-track to 
Jeep. Half-tracx was used because road 
was under fire. 
Fig.24: dlneny dead who were blasted to bits while 
defending their position in a pillbox on 
Kill 700. Fig.25: Interior view of Jap 75i&w gun emplacement 
on Blue Ridge that was used in their 
attack on Hill 700. Rote the large win- 
dow. 
(3) U.S.forces involved 2600 
hilled in Action 45 
Wounded in action 
and Jied later 16 
jead 61 - 2.4# 
'..•bunded in action 
,(to duty) 215 
Wounded in action 
(hospitalized] 243 45$ - 17.6fo 
Total wasualties 519 ~ 20.Oft 
Japanese hilled in 
..ction (Oounted)’ 719 
Japanese hilled in 
xi.ction (estimated) 1500 
Japanese Total (x>ead) 2219 
natio of U.j.jead to 
Japanese Jead 1 to 36 
The large number estimated rather than counted is due to 
tie enery custori of burying several bodies in one grave, 
v.WW-—' and also to the large number killed by our bombing and 
artillery fire behind the lines, making it impossible to 
obtain an immediate count. 
c. Operations on 129th Infantry sector* 
— *•'■'' 1 ■ .. ■ * «i — -■ 
* 
(1) The terrain here was fairly flat covered with 
second growth and provided fair ground for tanx maneuvers. 
The action here was characterized by temporary withdrawals 
from forward positions under the pressure of Japanese attacKS 
followed by highly effective tanx supported counter attacks. 
Jig. 2b: Action on 12911* Infantry sector snowing 
cleared area of jungle in front of peri- 
meter. 
12j On b there were numerous patrol con- 
tacts and clashes with superior Japanese forces advancing 
along the Laruraa hiver and our outposts were forced back:. 
The main attack by the /»3th Japanese Infantry was launched 
on the morning of li march' which succeeded in penetrating 
our wire and occupying several pillboxes, some of which 
were retaken by counterattack. j-vgain, in the early morn- 
ing of 13 march the enemy attacked taking six more pillboxes 
Jxtracted from Cr-3 - eriodic Report, 37th Infantry 
Division. Fig.2?: Firing at the enemy with concentrated rifle 
BAh and grenade fire. Soldier at right- 
center has just tossed a grenade. «.ction is 
at last pillbox on left flank of the peri- 
meter of Co F, 129th Infant 1*3 , 37th division. 
if ig. 281 xict/ton during Jsj... ini ol 2nd 3xi», 
129tli Inf. 37th iJiv. Scene here is- at area 
cl* CP’, xveinforcing troops of -Go .re in 
prone position as an enemy machine pun 
the area. Tanks in background were called 
upon to knock out enemj positions. Burning 
jeep is the result of a Jap grenade. Pig.29: Soldiers of Co P, 129th Infantry, 37th 
Jivision crawling up to barbed wire. 
Japanese were just in front and to left 
of wire and occupied one of our pillboxes 
to the left and one to the right of pic- 
ture. Our troops were surrounded until 
tanks were called upon to knock out the 
enemy. 
and again counter attacks supported by tanks succeeded in 
retaking all but two pillboxes. The Japanese were attack- 
ing very strong positions in relatively open terrain and 
their losses were heavy, estimated at 350-500 dead on this 
day, compared with two killed and ten wounded in the 129th 
Infantry sector. 14 March was a relatively quiet day 
during which our wire was repaired under cover of the tanks. 
On 15 March at 0400 hours the Japanese again attacked and, 
after heavy fighting, penetrated to a depth of 100 yarns 
over a 1000 yard front. A tank-supported counter attack 
failed to dislodge the enemy who had now brought in at 
least one 77 mm Field gun. A second counter attack, sup- 
ported by tanks and a heavy concentration of artillery, re- 
established our line. 16 March spasmodic fire occurred 
but on 17 March at 0400 hours the enemy again attacked, 
breaching our wire to a depth of 75 yards where the attacks 
stopped and the enemy dug in. Prisoners statements in- 
dicated that our artillery had’ taken a huge toll in the 
support and reserve units. Our artillery continued a 
heavy harassing fire and except for sporadic fire fights 
the sector was relatively quiet until 24 March when shortly 
after* midnight the Japanese began to infiltrate. By day- 
light the enemy had penetrated 300 yards, ouring the day 
there was heavy hole to hole fighting and tank-supported Fig.30; light tank of the 754th Tank Battalion in 
action against the Japanese at bo G, 129th 
Infantry, 37th Division The 
cleared area in front of perimeter greatly 
facilitated the use of tanks. 
counterattacks which regained control of the high ground. 
The Japanese losses were large, 310 dead were counted \vitbin 
our wire compared to our losses of 16 killed and 42 wou'nded. 
The artillery placed an extremely heavy concentration ir\ 
front of our lines following which only sporadic attempts! 
to cenetrate our wire occurred. 
(3) Casualties: 
U.o.Forces engaged 1850 
Killed in action 64 
hounded in action 
(died later) 14 
78 4.2ft Dead 78 4.2% 
Wounded in action 
(duty) 160 
Wounded in action 
(hospital) 212 372 20.1% 
Total Casualties 450 24.3% 
Japanese Forces engaged on 129th 
Sector up to 16-17 harch when 
600 more were added: *1 3^0 
hilled in Action (Counted) 2373 
Ratio U.S. to Japanese dead 1:30 
Fig.31: General Sherman medium Tan* and Infantrymen 
attack Japanese positions along the peri- 
meter of 129th Infantry, 37th Division. iTig.32: Japanese killed on the perimeter of Co IT, 
129th Infantry, 37th Division. The enemy 
dead were hit by so many missiles it was 
impossible to determine cause of death. 
*'ig«33: Hass burial for Japanese killed on the 
perimeter of Co F, 129th Infantry, 
neat and flies made early burial imperative. Hig.34: Hunting out any remaining Japanese that 
may have survived U.3.artillery fire con- 
centrated on this area. 
Fig.35: Japanese foxholes under bank of draw in 
129th Infantry Sector. Note how jungle 
is cleared by artillery fire. Fig.36: An area devastated by artillery shell 
fire during advance on Japanese pillboxes 
near Torokino Kiver. 
d. Comment on Relative Large Numbed of Japanese 
Casualties 
(1) Since one of the purposes of this study was 
to make observations on the relative lethal effects of 
weapons, the great disproportion between enemy casualties 
and our own deserves some comment. It is estimated that 
the enemy had 8,52? killed in action out of 10,000 troops 
involved in combat, as contrasted to 210 killed in action 
out of 5,80u U.S. troops involved. This is a ratio %f 
24.6 Japanese for each one of our forces killed. 
(2) The approximate time,for the Japanese attadk 
was known as well as the most likely points of attack. Con- 
sequently the enemy attacked against extremely well prepared 
positions. Our supplies of ammunition were abundant and 
easily accessible to the front by an excellent system of 
roads. Our concentration of fire especially artillery and 
mortar was intensive. Cur artillery concentration on Japan- 
ese reinforcements moving over restricted jungle tracks was 
particularly effective. \re had complete control of the air 
making observation easy as well as bombing of enemy troop . 
concentrations. The limited supply of enemy artillery and 
ammunition had to be transported by them under great dif- 
ficulties over the most rugged terrain. Furthermore, as in 
other campaigns in the South Pacific, their artillery was 
never used in concentration as judged by our standards. 
Whenever the Japanese broke through our lines, which they 
did repeatedly, they never appeared to have reserves suffic- 
ient to follow up the advantage. There is evidence that the concentration of our artillery fire on their reinforcements 
prevented the eccumulation of any effective body of troops. 
(3) On Hill 2bC the ratio of Japanese dead to 
U.b. was 8 to 1. This was the most favorable ratio for the 
Japanese in any of the three sectors. The enemy had taken 
the hill very early and acquired the advantage of the terrain. 
Consequently the action of our troops was mostly offensive 
under the disadvantage of retaking a hill in which the enemy 
occupied well dug in positions. The terrain prevented the 
use of tanks and the proximity of the lines limited the use 
of our artillery. 
(4) On Hill 700 the ratio of Japanese dead was 
36.3 to 1. ,'ftiile it was necessary here also to retake 
the crest of the hill, nevertheless the major part of our 
action was defensive in well prepared positions. The enemy 
approach to this sector was limited because of the terrain 
making artillery concentrations on their reinforcements 
highly effective and accounting for the greater number of 
enemy dead. On reaching the vicinity of our lines the 
enemy attacked up steeo slopes in great concentration (see 
Fig.20) 
(3) On the 129th Sector the ratio of Japanese 
dead to U.S.deaa was 30 to 1. Here the approach for the 
enemy via the Huma I.'uma trail was easier and the terrain 
permitted attach on a wider front. However, the tei*rain 
was also favorable to the use of tanks; these were highly 
effective in retaking positions lost after the enemy had 
exhausted the force of their initial impact ana their re- 
serves had been disrupted by our artillery. On this sector 
also the enemy attacked in great concentration on a narrow 
front against strongly prepared positions. Our use of 
Dali Canister was also highly effective against these con- 
centrated attacks. 
Control of the air, the use of tanks, and 
superior fire power in defensive positions, in audition to 
the greater and more effective concentrations of artillery 
fire, were the chief factors accounting for the large number 
of the enemy dead. 
(6) oummary 
Battle of tne Perimeter 
Japanese i i ed 
Total Forces Involved 24,CC0 $63 
Totau Forces Under Fire 20,u00 6u,3o3£ 
Total Combat Troops 13,000 40,4c4j( 
Total in three L.ajor battles (est imatea] lu,C00 3,buu^ 
Total Killed in 3 battles (estimatea) 21o 
Katio dead 3 I ajor battles 24-0 1 
A .ill Allied forces within the ierimeter were uncer enerr^ 
artillery fire. 
B Total allied Ground forces. 
C joes not include arti-lery and air iurce. 
-40- 5. A STUDY OF ZSATTL., J^SlAJ/TISo 
Total battle Casualties and Jisposition. 
• 
The term "battle casualty" in this report is 
used to designate those combatants who -were killed or 
wounded by weapons only. deaths or injuries produced 
by other agencies, such as falling trees, motor vehicle 
accidents etc., have been The total number of 
casualties includes all those woutided both by our own and 
enemy weapons. Zounds caused by Japanese weapons and 
those resulting from U.5. weapons have been separated, and 
are discussed under separate sections. It was impossible 
to ascertain which of the self-inflicted rounds were ciue 
to the soldiers wilful misconduct, ana which were accidental. 
These wounds are included arm aiscussea in the section on 
Li.o.weapons. It is known that 12.1 per cent of tne total 
casualties were produced by our weapons; however, the act- 
ual percent1.: e may be slightly greater, for it is nnownthat 
the enemy aiu use some of our captured weapons, particularly 
rifles ana grenades. 
There were 2,335 battle casualties. Of these 
547 (23.4 per cent} were lightly woundeu ana were returned 
to duty immediately from the battalion aiu posts, or col- 
lecting stations. These £7-5 casualties are included in 
the initial total for the sake of completeness, for it is 
assumed that reports of clinical studies in other Arnies 
are based on computations which also include this group of 
minor wounds. However, in the remainder of the study 
these patients have been excluded, because of tne insignif- 
icant disability entailed by tneir injuries. Therefore, 
this study is based actually on 1,786 casualties who were 
killed in action, or who sustained wounds which necessit- 
ated hospital* treatment. 
Since no exact definition for the terra "killed 
in action" has been established, an arbitary standard was 
selected. In this study "killed in action" includes only 
those killed instantly, those founa deaa, and those who 
were mortally wounded and died shortly thereafter. Aeports 
from division surgeons invariably contained a greater number 
of "killed in action" than are found in this study. ex- 
planation for this discrepancy is apparent, ana lies in the 
fact that the battalion surgeon ofttines included among 
these, patients who were seen alive, but who were known to 
him to have died later. In this particular campaign, be- 
cause of the close proximity of hospitals to the front, a 
large number of casualties are included under "wounded in 
action", who perforce less favorable circumstances, 
would have been classified as "killed iu action". 
The "first echelon" referi to the/ island; of X 
mougainville, and Hrear echelon" to the islands of Guadal- 
canal, -.spiritu santo, anu hew Caledonia, Tiji Islands, 
* the term "hospital" includes two augmented clearing stations. 
The majority of patients returned to uuty in the first ech- 
elon were treated in tnese clearing stations. 
-41-  /MBrk&rXl. Tith few exceptions all patients who 
were returned to duty in the first echelon left the hospital 
within thirty days. Patients in a hospital of the rear 
echelon who were not evacuated to the United states were 
usually returned to duty within 120 days. 
TOTAL CASUALTIES AT BOUGAINVILLE, 8.1. 
IS FEBRUARY TO El APRIL. 
1944 
KILLED IN ACTION 320 
W.I.A. AND DIED LATEN 79 
DOTY FROM AID POST 947 
DOTY FROM HOSPITAL,FIRST ECHELON 700 
DOTY FROM HOSPITAL,REAR ECHELON 379 
Pi r.-y? 
i K 
The total number of our casualties on gougglfi- 
are shown in Fig. It may be seen tnat the dead 
(395) constitute lo.9 per cent of the total casualties 
(2,335). Thus, approximately one out of every six wounded 
were Killed.. Nearly seventy per cent of all casuaxties 
were returned to duty anu of the living wounded (194o), 
1,022 or 83.6 par cent were returned to auty. However, 
547 of tnese were returned to duty from a first aia post 
and did not re.uire hospitalization. These soldiers hau 
very minor wounas and were not lost to battle. Since the 
incapacitating effect of weapons on this group was negli- 
gible, they were eliminated from the remainder of this 
study, leaving 1,768 casualties who wer« Killed or whose 
wounds were of such severe degree that'they were lost to 
the battle. Using this criterion one cut of every four 
and a half men wounded vvere Killed. Those who died and 
those who were evacuated to tie United states were classed 
as "lost to service"couth xacific Theater and 
-42- comprised 30*5 per cent or the total casualties 
b. ./ounds by Revlon and Jispositiun of the Wounded 
The remainder of this stuay is based on 1T788 
battle casualties who were admit'tecTTo 'hospitals or hilled 
in action. The disposition of patients according to the 
region wounded is shown in Fig. -all casualties were 
classified under anatomical regions according to the location 
of the wound. In many instances a major wound was accom- 
panied by one or more minor wounds. In this event the 
anatomical location of the major wound alone determined 
the classification. Furthermore, if a single wound among 
others was responsible for death or disability, the anatom- 
ical location of that wound determined the classification. 
Only under the circumstance that two or more wounds in one 
individual may have resulted in death or disability, was 
the classification "multiple Wounds" utilized. Because of 
the difficulty in analysis of the Multiple Wounded" every 
effort was made to keep to a minimum the number so classi- 
fied. Nevertheless, the "multiple Wounded" constituted 
18.6 per cent of the casualties. 
HEAD WOUNDS 
KILLED IN ACTION 194 
NLI.A , DIED LATEK 10 
DUTY FIRST ECHELON 157 
DUTY REAR ECHELON 4t 
EVACUATED TO U.S. 41 
Fig.>£ 
-43- (1) Jiead VJounds. 
head wounds alone constituted 21.4/per cent 
of all battle casualties. Of the 134 soldiers in this 
group killed in action, death resulted from brain injury 
in 125 and from wounds of the face and neck in nine. In 
the ten patients who were wounded in action and died 
nine sustained brain injuries, and one a transect 
cervical spinal cord. A more detailed these 
ten patients will be found under ”Treatmejat^tfrthe /founded” 
(Section 6). (Two hundred and far^j^rperfients survived, and 
of this number more than half cent) were returned, 
to duty in the first of the living 
-according to wound is shown oelow. 
race and 
Brain 'Keck iSye Scalp Concussion 
Duty 3*irst Dchelon 6 Wl 10 50 2b 
Duty Hear Bchelon 4 /18 6 11 1 
Evacuated to l).o. 12 ,■ 1$ 12 2 0 
HEAD WOUNDS 
( INCLUDING THE MULTIPLE WOUNDED) 
KILLED IN ACTION 100 
NLUL DIED LATER It 
DUTY FIRST ECHELON 100 
DUTY REAR EONELON 70 
EVACUATED TO U.S. It 
-44“ In/Fig. 39^the head wounds previously sum- 
marized (in Fig. are combined with those head wounds 
which are described later under Multiple rounds", making 
a total of 505* It is evident by comparison of the two 
charts that the ratio of the dead to those evacuated to 
the United States, and to those, returned to cut} , remains 
relatively unchanged. (The inclusion of multiple wounds 
with those classified under single anatomical regions may 
lead to duplication and confusion. For this reason mul- 
tiple wounds have not been included in an) charts except 
those devoted to the analysis of head wounds). 
THORACIC WOUNDS 
KILLED IN ACTION •• 
W.UL.DIED LATER 21 
DUTY FIRST ECHELON S3 
DUTY REAR ECHELON 47 
EVACUATED TO OS. 94 
(2j .'ounds of Thorax. 
Thoracic wounds accounted for 12.9 per cent. 
of all battle casualties. _>ixty-six of tnt dead were 
Killed in action. Cf the twenty one who were wounded in 
action and died later, fifteen died curing or following 
operation. Perforating'wounds of the thorax were present 
in all those who were killed or died later. Sixty three 
patients wer* returned to duty in the first echelon. Of 
these only three had wounds which penetrated the pleural 
cavity. All othera had wounds of the chest wall only. 
-45'- In the group of forty seven patients returned to duty from 
# the rear echelon, thirty thr*e sustained chest wail wounds 
only. Among the remaining fourteen with lesions involving 
' the lung or pleura, six underwent lung operation. Thirty 
four patients were evacuated to the United states. Twenty 
four of these had Injuries of the lung, nineteen of this 
group were treated by surgical operation, and five by con- 
servative measures. The remaining ten patients had wounds 
of the chest wall whicji *did not communicate with the pleural 
cavity. 
ABDOMINAL WOUNDS 
KILLED IN NOTION NO 
WLA.% DIED LATCH 80 
DUTY FIRST ECHELON IS 
DUTY REAR ECHELON £3 
EVACUATED TO OS. C4 
ilzJd 
(3) Wounds of Abdomen 
4 One hundred and fourteen patients sustained 
abdominal wounds. The abdomen was struck less frequently 
than any other anatomical region end these wounded con- 
stituted the smallest number (6.Jr per cent, of all casual- 
ties. In ten patients, wounds involving both the abdomen 
and thorax with perforation of the diaphragm were present. 
(->ee -Section 6 c, for a more detailed description of thorac- 
ico-abdominal Wounds]. Twenty patients were killed in 
action, one of whom sustained a transection 01 the spinal 
-V'~ cord. relatively greater number (24.5 per cent) of 
patients were wounded in action and died later in this group 
than any other. Of these twenty eight patients only'three 
died without operation. In most instances death resulted 
either from shock and hemorrhage or from peritonitis. The 
entire group of nineteen patients returned to duty in the 
first echelon had wounds r#of the abdominal wall only. Twenty 
three patients were returned to duty from the rear echelon, 
thirteen of whom had abdominal wall wounds, one a combined 
thoracico-abdominal wound, and the remainder visceral lesions 
distributed as follows: liver four, colon two, spleen, kidney, 
and bladder one each. — pat 1 tints in the abd-omen 
'(3b.9 per cent/ were able to- return to duty-,- than-were--thoae - 
wounded Tn any other region; Nineteen-of the twenty four 
patients evacuated to the United States had injuries of the 
abdominal viscera, five had abdominal wall wounds and one a 
transection of the cauda equina. The visceral lesions among 
these patients were distributed as follows: small intestine 
six, small intestine ahd colon four, colon three,' spleen and 
diaphragm two, stomach and liver, colon and diaphragm, and 
bladder one each. 
UPPER EXTREMITY WOUNDS 
KILLED IN ACTION I 
DUTY FIR6T ECHELON 175 
DUTY NEAR ECHELON M 
EVACUATED TO US. 76 
gig.fra 
(4) bounds of the Upper .pxt remits^ 
Wounds of the upper extremity' alone const it 
uted .17.9 per cent of all battle casualties, yet wounds of 
47- this region carry a death risk of only 0.3 per cent. No 
patients died who received treatment. ' The number of patients 
returned to duty in the first echelon is greater among those 
receiving upper extremity wounds than among those wounded in 
any other region. Of these 175 patients, four had fractures 
of the hand, and two incomplete fractures oi the arm. In 
the sixty eight patients returned to duty from the rear 
echelon there were twelve fractures as follows*, six of the 
bones of the hand, and two each of the scapula, humerus, and 
forearm. Fifty eight compound fractures and five amputations 
were found in the sixty six patients evacuated to the United 
States. These fractures were distributed as follows; humerus 
twenty three, bones of the forearm nineteen, bones of the hand 
twelve, and‘scapula four. The percentage of patients evacu- 
ated to the United States was highei in upper extremity wounds 
than in wounds of any other anatomical region. 
LOWER EXTREMITY WOUNDS 
(QLtKo m AonoN • 
tttA DKO LATCH 0 
WTY riWT IONIUM 100 
DUTY MAR ECHCLON ttt 
EVACUATED TO US. 00 
Fig.fr?- 
($) Wounds of the Lower AXtremitjtiO 
/founds of the lower extremity were the most 
numerous of all battle wounds, (22.7 per cent) H(l.hi—— 
48 2 f 
rnr nnrt tn tlir Inurnnt innptnTTt]~ ~nf uny mpimi (1 i‘i ~rTT^r3TTtr) 
There were six casualties classed as killed in action al- 
though with one exception all were alive when first seen. 
These soldiers either could not be reached or else died be- 
fore adequate medical aid could be given. (See case histor- 
ies in Section 6 £.). There were eight patients who were 
wounded in action and died later. Seven of these died in 
the first echelon and one in the second echelon. Of the 
seven deaths in the first echelon, two resulted from gas 
gangrene, and five from shock and hemorrhage. Two deaths 
in the latter group might have been avoided by the use of 
a tourniquet. One hundred and ninety five patients were 
returned to duty from the first echelon. *Vith the excep- 
tion of one patient who had a chip fracture of the tibia, 
all of these patients had soft tissue wounds only. From 
the rear echelon one hundred and thirteen patients were re- 
turned to duty, eight of whom had fractures of the bones of 
the leg and four of the bones of the foot. Eighty five 
patients were evacuated to the United states. In this 
group fifty nine compound fractures were present and dis- 
tributed as follows: bones of the leg thirty one, femur 
eighteen, and bones of the foot nine. In addition there 
were ten amputations of the thigh or leg. 
INCIDENCE OF FRACTURE 
UPPER EXTREMITY 
LOWER EXTREMITY 
FRACTURE 
| NON FRACTURE 
1 
49- (6) Incidence of • 
Ttfe risk of death in wounds of the extremities 
is lowm In 72?jfsvounds of the upper and lower extremities 
there were fifteen deaths (2.0 per cent). On the other 
hand, wounds of the extremities constituted half of all pat- 
ients evacuated.to the United States. The majority of 
patients with wounds of the extremities who ’were lost to 
the service by evacuation had fractures as shown in Fig.-W- 7 
Fractures emonar upper extremity wounds are more common 
(29.5 per centy then among the lower extremity lesions 
(18.3 per cent). The greater relative volume of soft 
tissue to bone in the lower extremity may explain the lower 
incidence of fracture. On the other hand the exxilanation 
may lie in the fact that the percentage of high velocity 
missile wounds are slightly greater in the upper than in the 
lower extremity. Bullets produced 36.9 par cent of all 
wounds of the upper extremity and 2?.9 per cent of the 
wounds of the lower extremity. Patients who returned to 
duty in the first and second echelons usually had fractures 
of small bones, chip and perforating fractures and other 
1 fractures with minimal hone damage. It should be rioted in 
I Fig.>4 that 89.5 per cent of the patients with wounus of the 
upper extremity and 68.2 per cent of those with wounds of 
the lower extremity were evacuated to the United states be- 
cause of fractures. The cause of fractures is discussed 
further in a later section devoted to the relative effect 
MULTIPLE WOUNDS 
KILLED IN ACTION 99 
W LA , DIED LATER 8 
DUTY, FIRST ECHELON 91 
DUTY. REAR ECHELON 82 
EVACUATED TO US. 88 
■50- (7) Multiple Hounds 
Hounds were classed as "multiple” only if 
two or more wounds of different regions could have caused 
death or disability. -ouch wounds caused 18. o per cent of 
all cattle casualties. in wounds of the nead whan death 
occurred, it was usually instantaneous. Cn the other hand 
a relatively high percentage of patients with multiple 
wounds were returned to duty . x.inety one patients were 
returned to duty from the first echelon in which group there 
were two hundred and three soft tissue wounds distributed as 
follows: upper extremity seventy three, lower extremity sixty 
one, thoracic wall twenty two, face and neck twenty, scalp 
fourteen, abdominal wall eight, and eye five. Present also 
were chip fractures of the clavicle, finger and leg. Prom 
the rear echelon eighty two patients were returned to duty 
with one hundred end eighty six soft tissue wounds distribu- 
ted as follows: upper extremity sixty two, lower extremity 
sixty one, thoracic wall twenty four, face and neck seventeen, 
scalp ten, abdominal wall eight, abdominal perforations two, 
(spleen and rectum), eye one and lung perforation one. 
There were eight chip fractures, six of the upper and two of 
the lower extremity, and also two perforating fractures of 
the pelvis. . In addition there were two finger amputations. 
Fifty eight patients having a total of one hundred and fifty 
three soft tissue wounds and fractures were evacuated to the 
United states. The thirty eight fractures were distributed 
as follows: upper extremity twenty, lower .extremity sixteen 
and jaw two. The following soft tissue wounds were present; 
upper extremity thirty six, lower extremity thirty four, 
thoracic wall sixteen, face and neck twelve, eye five, ampu- 
tations five, scalp three, brain one, ana abdominal wall one. 
Among these patients with multiple wounds, fractures were the 
chief cause for evacuation to the United dtates. 
£. The Anatomical distribution of Wounds 
A study of both the living and the dead is essential 
in order to gain an accurate and complete picture of the ana- 
tomical distribution of wounds produced by various weapons. 
Although many wound studies have been made on tx.e living, 
few records are available which analyze the effect of weapons 
on toth the dead and living. In this investigation data con- 
cerning all those who were killed in action as well as those 
who were wounded in action and died later have been collected 
and combined with the records of the living wounded. 
Information regarding the circumstances of wounaing 
in the living is relatively easy to obtain,frequently the 
facts may be elicited by an interview with tne person wounded. 
However the information will be still more accurate if check- 
ed with an eye witness. To secure accurate details concer- 
ning the dead, however, is much more difficult. Post mortem 
examinations should be done of course when ever possible, 
autopsies, however, were limited by the fact tnat all bodies 
could not be recovered, and also by the fact that seme were 
decomposed when recovered. Unfortunately rapid deterioration 
-51- occurs in the tropical climate of Bougainville, and for 
sanitary reasons the dead must be buried as soon as possible. 
The dead, when recovered, frequently exhibit wounds other 
tlian those which produced death. Wounds inflicted after 
death were especially common in areas subjected to concen- 
trated artillery or mortar fire.( Furthermore, it was often 
difficult and frequently impossible to identify the lethal 
weapon from the appearance of the wound or missiles recov- 
ered at autopsy. In many instances discrepancies were 
found, when the emergency medical tag, hospital record and 
post-mortem findings were compared. It became apparent, 
therefore, that the true sequence of events leading to death 
could be secured only by careful personal questioning of 
witnesses who saw the soldier killed, or who knew personally 
of the circumstances surrounding his death. By adhering to 
this method of investigation, a relatively high degree of 
accuracy was achieved, not only in the records of the dead 
but also of the living. 
In the classificetion of the wounded, it became 
necessary to add to the conventional division by anatomical 
regions, an additional group which was designated "Lultiple 
Wounds". The term "multiple wounds" is used for those casu- 
alties sustaining two or more wounds, either one of which * 
might have been responsible for the soldiers death, or for 
rendering him unfit for action. It was difficult or im- 
possible to classify accurately all casualties who received 
more than one wound. In many instances the dead were struck 
by other missiles after death, under which circumstances it 
was not possible to decide which of several wounds produced 
death. In other instances decomposition of the body made 
examination unsatisfactory. for these and other reasons 
some patients were placed in the "multiple wound" classifi- 
cation, who probably should nave been included properly with 
those grouped under single anatomical regions. 
It is desirable in a study of this Kind if possible 
to evaluate the influence of various factors on the anatomical 
distribution of wounds. Particular consideration should be 
given to the type of action, whether defensive or offensive, 
available cover or protection, armor, terrain ana type of 
weapon and projectile employed. furthermore, if a true re- 
presentation of the distribution of wounds is to be establish- 
ed, the data should be derived from a study of the dead as well 
as the living. 
O&MU V 
In P±gv46'the anatomical distribution of wounds in 
the living and dead in Bougainville is compared with similar 
wound distributions in the living in past and present wars. 
It will be observed that head wounds were more frequent at 
Bougainville than elsewhere. Perhaps this was due to the 
relatively close range of rifle fire in jungle warfare, 
another discrepancy is observed by comparing the percentage 
of wounds of the head, chest and upper extremities in the 
living. for example, wounds of these regions on Bougainville 
attained a total of 60.5 per cent, whereas the Russians in 
'’/orId Var II report only per cent. 
-52- DISTRIBUTION OF WOUNDS 
REGION 
LIVING 
DEAD < 
American 
Civil War 
World War I 
World War H 
Bougain- 
vllle 
Bougain- 
ville 
as. 
Britain 
US. 
Russia 
Heod, Foes, Neck 
9.1 
1 1.4 
16.8 
16.1 
9.1 
20.7 
4 9.0 
Upptr Extremities 
36.6 
36.2 
30.4 
28.2 
28.0 
27 .4 
0.3 
Chest 
1 1 .7 
3.6 
7.8 
9.8 
1 1 4 
12.4 
29 6 
Abdomen 
6 0 
34 
4.7 
5 6 
62 
5 7 
16.3 
Lower Extremities 
36 6 
45.4 
40.3 
40.3 
45.3 
33.8 
4.8 
Totol 
100 0 
10 0.0 
-100.0 
100 0 
100.0 
100.0 
fOO.O 
ANATOMICAL DISTRIBUTION OF WOUNDS 
IN 
1788 BATTLE CASUALTIES 
&CAO 395 
JVtNO |393 A rrnr rrA 
THE DEAD (990) 
ANATOMICAL DISTRIBUTION 
OF WOUNDS 
KILLED IN ACTION 
DIED LATER 
210 
Vith the exception of head wounds the anatomical 
distribution of wounds in jungle.warfare does not appear to 
differ greatly from the distribution of wounds reported for 
other types of warfare. In the absence of available data 
on other types of warfare it is difficult to derive an ade- 
quate explanation for this high frequency of mead wounds. 
The mortar followed closely by the rifle was the most fre- 
quent cause of wounds of the head. Since rifles are used 
frequently, and at close range, in jungle warfare, it is 
suggested that the greater number and accuracy of bullets 
might account for the high incidence of head wounds. How- 
ever, we can offer no proof of this hypothesis. The factor 
of exposure appears to offer no better explanation, since 
the head is apparently exposed to the same degree in the 
jungle, as in other types of warfare. The predominance of 
lower extremity and multiple wounds is accounted for by the 
high incidence of mortar hits. 
\$ The anatomical distribution of wounds in the aead 
(Fig.ipS.) is in striking contrast to the distribution of 
wounds in the living. The low incidence of extremity wound 
amon ; the aeaa is a rough index of the effectiveness of mod- 
ern surgery, when dealing with wounds which do not involve a 
vital organ. multiple wounds hold second place among the 
deed. Bullets, mostly at close range, caused 5°.,9 per cent 
-54- of all deaths, v.hi/le high explosives caused P<=r cent. 
A consideration or, those who were wounded in action and 
died later (Fig.-4o) indicates that the major problem is en- 
countered in wounds of the abdomen and thorax. These two 
regions accounted for 63.3 per cent of all those who were 
wounded in action and died later. 
TNI UVINS CIS98) 
ANATOMICAL DISTRIBUTION M WOUNDS 
WTY 1078 
TO 08 818 
Ail index of the degree of the residual disability 
may be obtained by a consideration of the number of patients 
returned to duty or returned to the United States (Fig.• 1| 
It should be noted that while the total number of patients 
in the anatomical divisions varies considerably, the percen- 
tage of patients returned to duty in each anatomical region 
remains remarkably constant. 
The anatomical distribution of wounds may vary 
according to the type of weapon causing the wound, the de- 
gree of exposure of different parts of the body, the pro- 
tection afforded by various means, and the direction of fire. 
If the body were unprotected in an atmosphere of flying mis- 
siles of egual distribution, wounding shou_d occur in direct 
proportion to the eAposed surface area. however, such a 
theoretical condition never exists. On the contrary missile 
-55- MEAN PROJECTED BODY AREA 
V and 
y WOUND DISTRIBUTION 
• m—mmmmmmmam • 
MEAN PROJECTED 
BODY AREA 
TOTAL HITS ALL 
WEAPONS 
RIFLE 
MORTAR 
i 
usually move in one direction at a riven time. The projected 
area of ...jthe body if completely exposed, therefore, offers a 
better, measure for the study of the provable hits., The mean 
projected body area is obtained from pro jecth&i, iff’three 
positions, standing, tatting and kneeling. with 
all weapons are compared with the mean projected bod;/ area 
(PigrJfe4.W I’he bead is the only region in which the percentage 
of wounds appreciably exceeded the percentage of the projected 
area for that region. # The percentage of hits in the abdominal, 
area is considerably le'ss than the percentage of its projected 
area. The question may be raised as‘to why wounds of the head 
so far exceed the projected head area. Vvas this due to good 
marksmanship or exposure*. Obviously the head must be exposed 
for marksmanship to be effective. .since wounds caused by 
rifie bullets ana mortar shell fragments were found in signif- 
icant numbers and the circumstances were xoiown with reasonable- 
accuracy, they may be compared. The directed fire of the 
rifle and the undirected hits with mortar fragments were found 
to approximate closely the total hits by all weapons. This 
is evidence that exposure is one of the chief factors in ac- 
counting for the high incidence of head wounds. nevertheless, 
* U.ean Projected body Area) from- h. O.xio. 350 of the research 
and Experiments Department of The Hlnistry of Home Security. 
"The wounding power of small bomb anu shell fragments” by 
a. Delish burns and b.Huckerman, Bulletin of the Con- 
ference on Pound Ballistics, Page 5. 
-56- the number of wounds caused by rifle fire does exceed 
the number caused by mortar fragments in the head, upper 
extremity and thorax. This may be interpreted as evidence 
that marksmanship does play a small but important part in 
the high incidence of Lead wounds. This observation is 
further substantiated by the fact that the lower extremity 
presents the reverse of these findings. 
d. The Different Weapons Causing prattle Casualties 
It is obvious that the number of battle casualties 
produced by various weapons will depend upon the type of war- 
fare, the number of weapons employed ana. the training end 
tactics of the opposing forces. Thus, the measure of effect- 
iveness of a given weapon must vary necessarily according to 
the circumstances under which it is used. The effectiveness 
of a weapon depends not only upon the totar number of casu- 
alties it produces, but also upon the ratio of the Killed to 
wounded and upon the severity of the wound. In a certain 
local situation the most effective weapon might be one which 
temporarily disabled the greatest number of the enemy and 
hence allowed the capture of a particular objective or the 
winning of a single battle. If the effectiveness of a 
weapon is to be measured by this latter criterion, it would 
be necessary to set up an arbitrary definition of "temporary 
disability”. In this event a solution of the problem would 
be found in classifying the wounded on the basis of "ability 
to continue combat if life depended upon it". 
The ratio of the killed to wounded is subject to 
various interpretations and must be clarified. As previously 
stated the term "killed in action” in this study indicates 
those killed instantly and those who were mortally wounded 
end died within a relatively short time. Because of the 
proximity of medical installations at Bougainville, many mor- 
tally wounded patients lived to reach the hospital and were 
classified among those who were wounded in action and died 
later. Joubtiess under other less propitious circumstances, 
many of these casualties would have been classified with 
those who were killed in action. The term "dead” refers to 
the total number of those killed in action and those who were 
wounded and died later. 
Since the severity of a wound is an abstract 
quality, open to individual interpretation and judgement and 
hence to consequent error, it was necessary to establish 
another criterion by which to judge the degree of disability 
sustained. The ultimate disposition of the patient seemed 
to offer b more reasonable basis for this estimation end was 
selected. All wounded, therefore, were separated into three 
groups depending upon whether the nature of the wound allowed 
the patient to be returned to duty from the first or from the 
rear echelon, or whether it necessitated his return to the 
United States. It is recognized that this is an arbitrary 
standard and open to the criticism tnat it is also an index 
of medical care, nevertheless, it is*a factual and objective 
measure of the relative effect of weapons in the living 
wounded. The following charts are designed to illustrate 
the relative effectiveness of various weapons, as judged by 
these different standards. 
-57- xv fairly comprehensive description of the common 
types of enemy weapons used on Bougainville will be found 
under the section entitled "Japanese Weapons" (Beetion 4 d). 
From wound examination alone it was never possible to dis- 
tinguish the caliber of rifle or machine gun bullets nor 
the size of explosive shells. It was frequently impossible 
to judge with any accuracy whether the wound haa oeen pro- 
duced by grenade, shell fragment, bomb, or bullet. esti- 
mations based on captured weapons show that the ratio of the 
6.5 mm (.25b inch) to the 7*7 mm (.303 inch) caliber rifle 
was approximately four to one. Similarly the 6.5 nun machine 
gun bore the same ratio (four to one) to the 7.7 mm model. 
If the "knee mortar" (grenade discharger) is included with 
all other captured mortars, it constitutes approximately 90 
per cent of the total. The ratio of the 81 ram mortar to the 
90 mm was about three to two. The most commonly used ar- 
tillery weapons were the 37 mm and the 75 mm guns, and the 
70 mm and 150 mm howitzers. among these the 75 mm gun 
predominated. Aerial bombing by the enemy did not occur 
during the battle of the perimeter. Wounds by miscellan- 
eous weanons were produced by the bomb (U.3.aerial 
pistol thirteen, bangalore torpedo nine, powder 
explosion five, bayonet two, bazooka one and parachute flare 
one. 
(1) The Relative Lethal Effect of Weapons 
The phrase "relative lethal effect” of a 
weapon refers to the percentage of deaths among the total 
number of casualties.(dead and wounded) caused by that par- 
ticular weapon. as previously stated, the ratio of the 
number of deaths to the number of casualties produced by any 
given weapon depends upon such variable factors as the type 
of action (offensive or defensive), number of weapons em- 
ployed, terrain exposure and available protection. These 
factors primarily determine the necessary degree of exposure 
of the soldier and consequently the number of hits, other 
factors being equal. The type and number of the particular 
weapon employed is then of prime importance in determining 
"the relative lethal effect". For example a small number 
of machine guns may produce few casualties but a "high lethal 
effect", whereas, a great many casualties may result from 
heavy mortar fire yet the "lethal effect" will remain re- 
latively low. 
* A comparison of the incidence of casualties 
caused by different weapons (Figshows that the mortar 
wounded more men (38.7 per cent) than any other weapon. 
This is the weapon most feared by our troops. However, the 
relative lethal effect of the mortar is low (11.8 per cent) 
rating next to the grenade which has the lowest (6.3 per cent) 
relative lethal effect. There were 1,741 casualties caused 
by high explosive shells, grenades, land mines and bullets . 
(not including the small group of casualties produced by mis- 
cellaneous weapons). Excluding bullets; high explosive 
shells, grenades and mines caused wounds in 1,144 men (65./ 
per cent), however, in this group only 152 deaths (39.7 per 
cent) occurred. In contrast bullets wounded 597 men (34.3 
per, cent) , but they accountea for 2 31 deaths (60.3 Pe** centj . 
-58- The rifle was responsible for wounds in 445 casualties 
with a lethal effect of 32.2 per cent. The machine gun, 
while causing fewer casualties (152), had the highest 
lethal effect of 56 per cent. The very low lethal effect 
of the grenade (6.3 per cent) is a characteristic probably 
peculiar to the Japanese hand grenade. Thirty three of 
the thirty four land mine casualties were produced by our 
own mines. The forty seven casualties listed under mis-, 
cellaneous weapons were caused by pistols, bangalore 
does, bazookas, flares, powder explosions and bayonet wounds 
RELATIVE LETHAL EFFECT OF WEAPONS 
IN i 
I7SS RATTLE CASUALTIES 
DCAD 395 
UVWt 1393 
TOTAL 1788 
(a) bounds of the Head 
There were 364 casualties (21.4 per 
cent of the total number) due to wounds of the head alone, 
moreover wounds of the head accounted for 36.4 per cent 
of all dead (144). excluding the five wounded by mis- 
cellaneous weapons, 20B head casualties (55 per cent) 
were produced by high explosives and 171 (45 per cent) by 
bullets. however,* high explosives accounted for only 
27.1 per cent of the dead, whereas, bullets were responsible 
-59- for 72.9 per cent. Thus while high explosives caused 
more casualties, the lethal effect produced was relatively 
low. This may be explained by the average lower velocity 
of shell fragments and the relative greater protection af- 
forded against them by the helmet and skull. This is 
further substantiatea by the fact that in 92.3 par cent of 
the deaths due to head wounds, the skull had, been penetrated 
WEAPONS CAUSING HEAD WOUNDS 
SHOWING 
RELATIVE LETHAL EFFECT 
144 " OCAO 
240 ~ UVW8 
384 - TOTAL 
Fig.52 
(b) Wounds of the Thorax 
V/ounds of the thorax accounted for 12.9 
per cent of all casualties and for 22.0 per cent of all 
deaths. excluding five wounded by miscellaneous weapons, 
high explosives produced 135 casualties (60 per cent;, ana 
bullets 91 (40 per pent). However, again contrasting re- 
lative lethal effects, bullets accounted for 59*7 per cent 
of the deaths, and high explosives for 40.3 per cent. In 
thoracic wounds the contrast between the lethal effect of 
wounds due to high explosives and bullets is not as pro- 
nounced as in wounds of the head. possibly this is due to 
the fact that the thoracic cage offers less protection to 
the vital organs than does the skull ana helmet. This hy- 
pothesis seems to be substantiated further by the fact that 
-60- WEAPONS CAUSING THORACIC WOUNDS 
SHOWING 
RELATIVE LETHAL EFFECT 
KAO §7 
LIV*M 144 
TOTAL Ml 
gig-?? 
while the lethal effect of both mortar and artillery fragments 
is increased in the thorax, the lethal effect of the grenade 
is increased four fold. Bullet wounds were limited to the 
chest wall in only eighteen instances, while high explosives 
caused eighty five wounds which did the thoracic 
cavity. The relatively lower velo&t$*§T the high explosive 
shell fragments would appear to account for its frequent failure 
to penetrate the thorax. 
(c) .Younds of Abdomen 
Casualties occasioned by wounds or the ab- 
domen had the lowest incidence arid accounted Tor only 6.6 per 
cent of the total wounded and 12.2 per cent of the dead. Where- 
as, high explosives caused 56.2 per cent of the casualties due to 
abdominal wounds, bullets accounted for 62.5 per cent of the 
deaths from these wounds. This ratio may represent a distor- 
ted picture when compared to findings in other theaters, since 
it is based on such a small number (8) of wounds of the abdomen 
caused by artillery shells. However, the mortar and the gren- 
ade show" almost twice the relative lethal effect in wounds of 
the abdomen as they did in wounds of the thorax. This is fur- 
ther evidence that the bony structures of the body wall may 
offer considerable effective protection against these low 
-61- WEAPONS CAU8INS ABDOMINAL WOUNDS 
SHOWINS 
RELATIVE LETHAL EFFECT 
DEAD 48 
LiYtNt 66 
TOTAL 114 
Fig.54 
velocity fragments. High explosive fragments caused thirty 
of the fifty three wounds perforating the abdominal cavity, 
which would appear to indicate a relatively high index of 
penetration. Nevertheless, the relative protection afforded 
uy uhe aouuiuinaj. wan to mow velocity fragments should also 
be mentioned. Thirty of the thirty eight wounds limited to 
the abdominal wall were caused by high explosive fragments. 
(d) Wounds of Upper extremity 
Zounds of the upper extremity (Fig.55) 
account for 17.9 per cent of all casualties and for only 0.3 
per cent of tne dead. High explosive fragments caused 62.5 
per cent of these wounds.' Hore than half of all wounds 
caused by high explosives were due to mortar shells. The 
relative effectiveness of bullets and high explosive frag- 
ments may be judged from the severity oT the wound as indi- 
cated by the disposition of the patients shown in the follow- 
ing table; 
Younded by Bullets 
,'ounded by High 
explosives 
Number IPer Gent 
Humber Per Cent 
uuty 1st Echelon 
Duty Hear Jchelon 
evacuated to the U.S. 
44 
33 
46 
35.7 
26.8 
37.5 
131 
35 
30 
66.8 
17.8 
15.4 
-62- WEAPONS CAUSING UPPER EXTREMITY WOUNDS 
SHOWING 
RELATIVE LETHAL EFFECT 
DC AO I 
UVtWt 319 
TOTAL 320 
Pig-55 
The one death among the upper extremity 
casualties was caused by a mortar shell. Since the lethal 
effect of wounds of the upper extremity was negligible, it 
deserves no discussion. 
(e) .founds of Lower extremity 
'•founds of the lower extremity (Big.56) 
caused the highest number of casualties (22.7 per cent). 
However, lower extremity wounds were responsible-lor only 
3.3 per cent of all deaths. High explosives caused 72.5 
per cent of lower extremity casualties, of these mortar 
shells alone were responsible for more than half. Bullets, 
however, caused eight of the fourteen deaths. The severity 
of wounds caused by bullets and high explosives may be judged 
hy the following table showing the disposition of casualties: 
•founded by Bullets 
1.umber 1 er lent 
founded by high 
explosives 
TTuHTBer rer lent 
I'uty 1st echelon 44 
itear 3^ 
evacuated to the U. S. 36 
. u 
27.3 
32.7 
131 
83 
49 
33-4 
29. " 
17.3 
-63- WEAPONS CAU8INS LOWER EXTREMITY WOUNDS 
SHOWINS 
RELATIVE LETHAL EFFECT 
DCAO 14 
UVINt 303 
TOTAL 407 
gif;. 56 
Of the entire number of casualties with lower extremity 
lesions lost to the service in the South Pacific by evacu- 
ation to the United States, 32.7 per cent were produced by 
bullets and 17*3 per cent bj high explosives. 
(f) junctures 
Vounds of the extremities constitute the 
largest group of battle casualties and account for per 
cent of all wounds. These wounds, however, account for the 
smallest number of dead, only per cent. Since relative- 
ly few deaths result from wounds of this region the effect- 
iveness of weapons on the extremities must be judged by the 
duration of the soldiers incapacity anct by the number of casu- 
alties lost to the service- by evacuation to the rear echelon 
and to the United States. In view or the fact that fractures 
are the chief cause of evacuation to the United States, the 
relative effect of weapons on the extremities may also be 
judged by the number of fractures they cause. The rifle 
caused the greatest number of fractures in both the upper anu 
lower extremities (gig.57). In the upper extremity the rifle 
leads not only in the number but also in the percentage chance 
of fracture. In general the chance of fracture appears to 
parallel the velocity of the missile. Bullets caused only 
37.5 per cent of upper extremity and 26.3 per cent of lower 
extremity wounds, whereas these missiles caused 66 per cent 
of upper extremitj?’ and 60 per cent of lower extremity fracture 
-64- WEAPONS CAUSING FRACTURE 
I FRACTURE 
1 NON FRACTURE 
UPPER EXTREMITY (319) 
LOWER EXTREMITY (393) 
37 
This graph shows the distribution oT 
fractures according to weapon. There were 319 living 
patients with wounds of the upper extremity and 393 witi 
wounds of the extremity. The printed column at 
the left shows the percentage of wounds caused by each 
weapon. 
v-' ✓ WEAPONS CAUSINS MULTIPLE WOUNDS 
S HO WINS 
RELATIVE LETHAL EFFECT 
dead ioi 
UVIIW 231 
TOTAL 332 
Sl&JS. 
(g) I ultiple bounds 
• Casualties due to multiple rounds rate 
third in incidence and constitute 18.6 per cent of the total 
number. High explosives caused 63-4 per cent oi these 
wounds and 61.4 per cent of the resultant deaths, however, 
the machine gun .and rifle showed the highest relative lethal 
effect. The ; rt played by high explosives in the production 
of multiple wounds is further demonstrated in the following 
table: 
Wounded 
by Bullets 
Wounded 
by High 
explosives 
Number 
Per Cent 
Numbe r 
Per Gent 
Duty 1st Ncbelon 2 
12.5 
89 
41.4 . 
Duty Hear Jchelon 8 
50.8 
74 
34-4 
.vacuated to tie U.S. 6 
37.5 
52 
24.2 
To 
TfrTCT 
n? 
T3U7S THE DEAD (899) 
WEAPONS CAUSING WOUNDS 
aeo - 
78 - 
KIUIO IN ACTION 
DICO LATER 
gig-’*? 
(h) The Dead 
Fig.>9 shows the distribution of the 
dead according to the causative weapon. There were 395 
dead of whom 231 or per cent were killed by bullets. 
Seventy five (19 per cent) of these 395 dead were wounded 
in action and died later. Fifty of the seventy five 
patients died within 24 hours; of these fifty, forty were 
classed as mortally wounded. Had medical facilities been 
further removed from the front line or transportation pro- 
blems more difficult, no doubt a large number of those who 
were wounded and died later would have been classed as 
"killed in action”. Bullet wounds tended to produce more 
immediate fatalities than did wounds produced by mortar an* 
artillery shells. Among those who were wounded and died 
later, wounds were produced by the mortar in 2|>?per cent, 
by artillery in 28 per cent, and by the rifle in 14.5TPer 
cent. 
-67- RELATIVE EFFECT OF WEAPONS 
CHANCE OF DEATH 
HEAD 
THORAX 
ABDOMEN 
EXTREMITIES 
Fig. 60 
(i) Chance of ueath 
The percentage chance of death when hit 
by various weapons is shown in J?‘ig..6c. The order of these 
weapons suggests that the chance of being killed is a function 
of the velocity of the missile. The risk of death when hit 
by a machine gun in the head, chest, or'abdomen is approxi- 
mately equal. Casualties produced by/more than twojfcounds 
either one of might have produced death are not in- 
cluded in but are discussed under "Multiple 7/ounds". 
nevertheless many of these casualties did have more than one 
wound. The contrast in death risK between the machine gun 
$55 per cent) and the rif cent) is not entirely 
due to multiplicity of hitsr, since multiple hits were found 
not infrequently with rifle fire. On the average machine 
run fire originated at a closer range than rifle fire, 61 per 
cent of the hits being from less than fifty yards. (A con- 
siderable number of this latter group of hits w at much 
longer ranges). The chance of death when hit by a- grenade 
9 percent) is approximately half that when hit by the 
Per cent). The risk of death when hit in the 
abdomen by mortar or grenade is relatively greater than when 
hit in the head or thorax. This suggests that the helmet 
and skull as well as the ribs may offer considerable pro- 
tection against many of*these relatively low velocity frag- 
ment s. 
-68- (2) The Relative effect of Weapons on the Disposition 
of Patients. 
An evaluation of the effectiveness of each weapon 
may be obtained by considering both the number‘killed and 
the severity of the wound as determined by the disposition 
of the patient. 
There were 6?6 casualties returned to dut> from 
the first echelon (defined as the beachhead perimeter on 
Bougainville Island). These patients spent an average of 
12.5 days in the hospital,■{Fig.6l~tr-ffiwever, the majority 
if required would have been available for emergency combat 
duty in a shorter time. hevertheless, the problem of the 
lightly wounded, treated in the first echelon, is of con- 
siderable importance, both because of days lost to the ser- 
vice and because these casualties occupy beds which might 
be needed for the more seriously wounded. Wounds caused by 
high explosive shell fragments constituted the major problem 
in the first echelon. 4-Fig. Wounds of the extremities 
and multiple wounds comprised a majority of these lesions. 
PATIENTS IN HOSPITALS AND RETURNED TO DUTY IN FIRST ECHELON 
Fir:.61 
-69- PATIENTS 
Fig.62 
The rear echelon included hospitals on Guadalcanal, 
Espiritu Santo, and New Caledonia, 400 to 1,500 miles from 
Bougainville. Consequently patients evacuated to these hos- 
pitals were lost to the service in so far as this batt|€. was 
concerned. Subsequently, however, some of these patients 
were returned to duty from the rear echelon and performed 
service in combat units, hence, were not lost to the South 
Pacific theater. The severity of the wounds in these casu- 
alties usually Justified their removal to a rear echelon for 
convalescence. Only a very few were evacuated because of 
the need for additional vacant hospital beds on Bougainville. 
Hence, transfer to the rear echelon may be taken as a fair 
measure of the severity of a soldier1s wound from the stand- 
point of his ability to undergo combat. The wounded were 
usually returned to duty from the rear echelon or evacuated 
to the United States within 120 days. However, the average 
elapsed time before return to duty was considerably less than 
this. 
While many patients evacuated to the United States 
may return to duty eventually, they must be considered as lost 
to the service for a long period. 
-70- MORTAR 
BATTLE CASUALTIES 
DM) tt 
DUTY FUST MLON 3*8 
DUTY REAR ECHELON 170 
EWOUftTEO TO US. IIP > 
?lK:§2 
(a) kortar 
) The mortar caused more wounds than any other 
weapon and accounted for 38.7 per cent of all battle casu- 
However, its relative lethal effect was only 11.8 
PeLJh0|n3if The °nly weapon having a loWplethal effect was 
the grenade. , Furthermore 71.5 per cent of the living 
wounded were returned to duty, a higher percentage than for 
any other weapon except the grenade. The dead and evacuated 
to the United States ("lost to the service") totalled 28.3 
per cen\. The percentage of casualties produced by the 
mortar by region wounded in order of frequency follows: 
lower extremity (24.7 per cent), multiple {22.7 per cent), 
head (18.4 per cent) and upper extremity (17.2 per cent). 
The highest relative lethal effect (30.8 per cent) is obser- 
ved in wounds of the abdomen, whereas, the greatest number 
of deaths occurred in "multiple wounds". 
(b) Rifle 
In number of founds produced the rifle was 
exceeded only by the mprtar 4nd was responsible for 24.8 per 
cent of all battle However, the rifle ranked 
first as a lethal agent accounting for 36.7 per cent of all 
dead. Moreover, it was second in percentage relative lethal 
effect, being exceeded only by the machine gun. The rifle 
-71- RIFLE 
BATTLE CASUALTIES 
KAD |«1 
DUTY PMST mtitwnt 
DUTY NEAR KONCUM M 
ftMOUATSD TO UA. H 
Fig.64 
produced wounding in 53*? per cent of all casualties lost 
to the service by death and evacuation to the United ctates. 
The rifle caused more head wounds than any other weapon and 
was second only to the machine gun in relative lethal effect 
in head wounds. It ranked third in relative lethal effect 
in thoracic wounds being exceeded by the machine gun and 
artillery shell and second in abdominal wounds. V/hile the 
rifle was second to the mortar in causing wounds of both the 
upper and lower extremities, it produced more fractures than 
any other weapon. 
(c) Grenade 
/ The grenade ranked third in wound production 
and accounted for 12.5 per cent of all battle casualties 
(l1ig.'o^7. However, its relative lethal effect was the low- 
est of all weapons, 6.2 per cent. Furthermore the majority 
of the wounds were of a minor nature. The grenade was first 
among all weapons as gauged by the percentage of wounded re- 
turned to duty, 77.J per cent, and three fourths of these 
patients were returned to duty from the first echelon. The 
grenade was responsible for the lowest number of casualties 
(22.7 per cent) among those who were lost to the service by 
death and evacuation to the United States. Of all wounds 
produced by the grenade, 68.7 per cent were classified as 
extremity wounds and multiple wounds. 
72- GRENADE 
BATTLE CASUALTIES 
DEAD 14 
DUTY FIRST ECHELON 199 
DUTY REAR ECHELON 40 
EVACUATED TO OS. 97 
. ig,. lo 
ARTILLERY 
BATTLE CASUALTIES 
DEAD 49 
DUTY FIRST ECHELON 84 
DUTY REAR ECHELON 99 
EVACUATED TO US. E7 
Fis.66 
-73- (d) artillery 
The use of artillery by the enemy in this 
campaign was relatively limited. Wounds caused by artillery • 
shells, however, accounted fbr 10.8 per cent of the casualties 
and were fourth in artillery raniced fourth in 
cause of death and third in percentage lethal effect, 21.J*per 
cent. ~mong casualties evacuated to the United States^artil- 
lery produced the lowest nurxber of wounds, 14.1 per cent. 
However, the percentage of those lost to the service by death 
and evacuation to the United dtates per cent. While 
wounds of the extremities were frequent, only one death occur- 
red. This death was produced by a lower extremity wound. 
Lethal wounds in order of frequency by regions were: thorax, 
head, multiple and. abdomen. 
MACHINE CUN 
BATTLE CASUALTIES 
[dead ar 
I DUTY msr ECHELON *C 
I DUTY NEAR ECHELON II 
IrWCUATBP TOW. W 
Fir- 67 
(e) Lachine Gun 
The nachine gun caused fewer casualties than 
any other weapon, 8.5 per cent. However, its percentage 
relative lethal effect was the highest of all weapons, 57.9 
per cent. It'v/as not possible to separate the casualties 
74 produced by the 6.5 mm weapon from those produced by the 
7.7-mm machine gun. The percentage lost to the service 
by death and evacuation to the United states was also the 
highest of any weapon, 78.3 per cent. Measured by'the 
number of patients lost to the service machine gun wounds 
were the most severe among those produced by any weapon. 
This high degree of effectiveness of the machine gun bullet 
may be explained partially by close range fire in this cam- 
paign and also by the multiplicity of wounds. The percen 
tage relative lethal effect was uniformly high for all re- 
gions of the body with the excention of the extremities. 
(f) Multiple Wounds 
The question has been frequently asked, do 
multifile missiles causing multiple wounds result in more 
serious casualties, because of the number of wounds per se? 
The data available dos* not answer this question satisfac- 
torily. Multiple wounds were analyzed according to the 
number of different anatomical regions involved, rather thar 
by the total number of wounds. Thus a patient with ten 
wounds of the leg and five of the hand was classified under 
multiple wounds in two anatomical regions, as an upper and 
a lower extremity casualty without regard to the number of 
lesions nresent. 
Using the criterion of the number of differ 
ent anatomical regions involved, the following tables were 
derived: 
MULTIPLE WOUNDS SHOWING RELATION BETWEEN 
NUMBER OF MEN, NUMBER OF ANATOMICAL RE- 
GIONS HIT AND SEVERITY OF WOUNDS 
(AS JUDGED BY DISPOSITION) 
Number of Patients 
Number of Anatomical 
Regi 
ons Hit 
let 
Echelon 
Rear 
Echelon 
To 
U.S. 
Total 
1st 
Echelon 
Rear 
Echelon 
To 
U.S. 
Total 
Mortar 
53 
41 
33 
127 
117 
99 
85 
301 
Granada 
29 
16 
11 
56 
70 
40 
29 
139 
Land Mina 
2 
7 
5 
14 
4 
20 
16 
40 
Art.Shell 
4 
6 
3 
13 
9 
12 
8 
29 
Rifle 
2 
7 
3 
12 
4 
17 
7 
28 
Mach.Gun 
0 
1 
3 
4 
0 
3 
8 
11 
Total 
90 
78 
58 
226 
204 
191 
153 
548 
75 RATIO OF NUMBER OF ANATOMICAL 
REGIONS HIT PER PATIENT EVACUATED IN 
EACH ECHELON ACCORDING TO WEAPON 
Duty 
1st Lchelon 
Duty 
Hear Echelon 
evacuated 
To U.S. 
Total 
Mortar 
2.21 
2.41 
2.58 
2.37 
Grenade 
2.41 
2.50 
2.64 
2.48 
Land Mine 
2.00 
2.86 
3.20 • 
2.86 
-art. Shell 
2.25 
2.00 
2.67 
2.23 
Kifle 
2.00 
2.43 
2.33 
2.33 
Mach.Gun 
— 
3.00 
2.67 
2.75 
Total 
2.27 
2.45 
2.64 
2.44 
The disposition of the patient was used to deter- 
mine the severity of the wounds. The number of the multiple 
wounded casualties discharged in each echelon is tabulated by 
weapon* The corresponding number of anatomical regions hit 
is also recorded by weapon. Thus there were fifty three 
patients with mortar wounds in one hundred and seventeen dif- 
ferent anatomical regions, returned to duty in the first eche- 
lon. Therefore, among the patients returned to duty in this 
echelon there were mortar wounds 2:21 of the various anatom- 
ical regions per patient. The ratio of anatomical regions 
wounded per patient is slightly higher for each weapon among . 
the casualties evacuated to the United States. However, the 
difference is so slight as to suggest that multiplicity of 
wounds alone is not a factor of great importance. The re- 
latively low mortality of 3*3 per cent for all patients with 
multiple wounds seen alive suggests that the multiple wounds 
per se add little to the risk. It is likely that the actual 
severity of the wound is the more important factor in deter- 
mining death and disability. It would be desirable, however, 
to have data which a count of the actual number of 
wounds by anatomical region in troth the living and the dead. 
(g) Effectiveness of V/eapons 
To measure the effectiveness of a weapon by 
the number of casualties it produces may lead to erroneous 
conclusions. To reiterate, the number of casualties depends 
on such factors as, the necessary exposure of the soldier, 
the concentration of troops, the number of weapons employed 
and the effect of the missile. It is seldom that all these 
varying conditions of battle can be duplicated. Cn the other 
hand the percentage chance of death, and the length of dis- 
ability when hit by a given weapon should remain relatively 
•76- rftTIVE EFFECT OF WEAPONS 
0 HA NOE OF LNHT WOUND 
I EXTREMITIES 
I HEAD 
I THORAX 
I ABDOMEN 
TOTAL MT98JVM8) 
P4ACHINE 8UN 
36.7% 
RIFLE 
37.9% 
ARTILLERY 
08.8% 
MORTAR 
66.t% 
6RENADE 
67.6% 
Fig.68 
RELATIVE EFFECT OF WEAPONS 
—„OMANOC OF MWOO« WQund _ 
MEAD 
THORAX 
ABDOMEN 
EXTREMITIES 
> if.-69 
I I constant, and, therefore, should offer a fairly accurate 
index of the effectiveness of various missiles. 
The relative effect of weapons may be judged 
by the percentage chance of a light woufid or of a Severe 
wound. (i’igs.68 and 69). (These charts are based on 
living wounded only. A light wound was defined as one 
which allowed return to duty in the first echelon, and a 
severe wound as one which necessitated evacuation to the 
rear echelon or to the United States). The average per- 
centage chance is given below each weapon. There appears 
to be considerable difference in the severity of a wound 
according to the anatomical region hit, as well as to the 
weapon causing it. In general high explosives tend toward 
light wounds, while bullets tend toward more severe wounds. 
RELATIVE EFFECT OF WEAPONS 
"LOST TO THE tBRVIOKM 
HEAD 
THORAX 
ABDOMEN 
EXTREMITIES 
gig.70 
The relative effectiveness of weapons may 
also be evaluated by a consideration of the total dead 
plus the total evacuated to the United otates. Together 
these may be considered as "lost to the service”, (Fig.7b} 
although some who were returned to the United otates may 
serve in future campaigns. It should be noted that by 
this criterion wounds of the extremities and abdomen assume 
a far greater relative importance than ..hen death alone is 
utilized as an index of weapon effectiveness 
7* RELATIVE EFFECT OF WEAPONS 
DUTY FROM FRET COHKLON 
Fig.71 
The upper section of the graph shows the 
number of patients returned to duty from the first echelon 
(Bougainville). The bottom section shows the percentage 
of patients hit by each weapon who were returned to duty 
from the'first echelon. The total number of casualties 
hit by the different missiles are shown on the bottom line 
79' RELATIVE EFFECT OF WEAPONS 
DEAD AND BVAOUATBO TO REAR EOMELON AND TO ILS. 
Fig.72 
The total number of casualties dead, evacuated 
to the rear echelon and to the United States are shown in 
the top section of the graph. These were ”lost to the Boug- 
ainville Campaign”. The bottom section shows the percentage 
of casualties caused by the different weapons who were killed 
evacuated to the rear echelon, and to the United States. Uot 
that the percentage effectiveness of each weapon suggests a 
possible correlation with the average velocity of hits. 
80 RELATIVE EFFECT OF WEAPONS 
LOST TO COMBAT 
11k-7 3 
Conditions of battle may be such that the 
effectiveness of a weapon can be best measured by whether 
the wounded soldier is able to continue fighting. lienee, 
the number of casualties per se is not a sufficient criterion 
since many of them may continue to fight and hold off the 
enemy at least temporarily. It was, therefore, desirable 
to know the number who are put out of action immediately and 
the number who could continue combat for a period of Lours, if 
life depended on it. A questionnaire to determine whether 
an individual did or did not continue combat was found to be 
misleading, since conditions of battle were frequently such 
as to permit the soldier to seek immediate treatment. This 
he usually did when possible, since he had been so instructed- 
by the medical Corps. However, there were numerous instances 
of soldiers who were severely wounded and yet who continued 
to hold their position in the line until relieved. (e.g. Two 
soldiers were holding a pillbox at night under Japanese at- 
tack. Avantually each had a hand blown off, but with two 
hands between them, they cared for their wounds, manned their 
guns and held off the attack until relieved at daybreak). 
81 arbitrary criterion based on the serious- 
ness of the wound seemed justified in order to determine whether 
a soldier will be able to continue in battle for a number of 
hours, if his life were at stake. i'or this purpose an ar- 
bitrary schedule was derived and the following wounded were 
classed as "Lost to Combat". 
1. hounds of the head ana GLTJ producing uncon- 
sciousness or naralysis. 
2, hounds of intrathoracic structures producing 
hemorrhage and shock. 
2- Woundb of intraperitoneal structures pro- 
ucing hemorrhage and shock. 
2. hounds of the extremities producing fractures 
of long bones, severance of major blood vessels or major trau- 
matic amputations. 
£. Extensive wounds of soft tissue producing 
shock. 
The wounded were classified according to the 
above criteria and added to the dead to determine the total 
,flost to combat" (Tig.73)* The lower section of this graph 
again suggests that the percentage effectiveness of the wea- 
pon is a function of the average velocity of the hits. 
Callender end others have shown that the 
wounding power of a missile is in proportion to the cube of 
the velocity, the mass and other factors being equal. In 
this report the percentage effectiveness of weapons as judged 
by the chance of death, and the severity of the wound, appears 
to be in accord with the observation that the wounding power 
of a missile is chiefly a function of velocity. When hits 
occur the weapons in order of effectiveness are (1) machine 
gun, (2) rifle, (3) artillery, (4) mortar, and (3) grenade. 
(3) Wounds Caused by U.d.Weapons 
It had been the intention of the ballistic 
team to study the effect of U.S. weapons on the enemy deaa. 
Unfortunately this plan was found impracticable because of 
difficulty in obtaining the enemy dead -oefore decomposition 
had occurred and also because of the paucity of team person- 
nel. Certain local conditions prevailed which circumvented 
accuracy in such a study. In the first place, due to the 
character of the fighting ana our extensive use of artillery 
and mortar fire, the enemy dead were frequently struck by 
many different missiles oefore the bodies coula be recovered 
furthermore, it was impossible to obtain any detailed infor- 
mation regarding the circumstances surrounding death. 
It was possible, however, to investigate the 
effect of U.3, weapons on a limited number of our soldiers 
who were wounded. There were 219 casualties (12.3 per cent 
of the total; due to our weapons in the Lands of our own 
troops. ./bile the Japanese used some of our weapons par- 
ticularly rifles and grenades, as a rule it was impossible 
-82- to know when this occurred. ’ Among our forces there were 
sixty three deaths (16.0 per cent of the total dead) pro- 
duced by U.S.weapons. 
Lortar and artillery fire accounted for fifty- 
five of the wounded and twenty one of the dead. Among these, 
thirteen were killed and forty wounded by mortar and artillery 
"shorts”. -iight died among the sixteen casualties who were 
wounded on patrol by our artillery. 
There were fifty two casualties caused by the 
rifle, sixteen of whom died. Nineteen were wounded by the 
accidental discharge of a rifle by a fellow soldier. Listaken 
identity resulted in thirteen deaths and the wounding of six 
others. Night of these deaths were occasioned by the soldier 
seeding to relieve himself at the toilet during the night. 
Self-inflicted wounds, accidental or intentional, were respon- 
sible for ten casualties, three of whom died. The accidental 
tripping of land mines and booby traps produced fourteen 
deaths in a total of forty wounded. Night soldiers were killed 
and four wounded by hand grenades other than those used in 
booby traps. Miscellaneous weapons including bangalore tor- 
pedoes, bombs, pistols, knives and powder explosions accounted 
for thirty eight these seven were fatal. 
WOUNDS BYJUS. WEAPONS 
KILLED IN ACTION 48 
MUL.DICD LATER 18 
DUTY FRST ECHELON 80 
DUTY NEAR ECHELON 48 
EVACUATED TO U-& E5 
Fift.74 The disposition of/bll casualties produced 
by our weapons is shown in .tfhile the number of 
these casualties is too small to allov; adequate comparison 
between -the effect of Japanese and U.S.weapons, nevertheless, 
it is utilized, being the only availaole data. (Jigs.75 and 
76). It is evident that the relative lethal effects of the 
Japanese mortar and rifle are essentially similar to the leth- 
al effects of these same U.3. weapons. however, the relat- 
ive lethal effect of U.S.artillery isper cent, while 
that of the Japanese artillery is only 17.2 per cent. A 
possible explanation for this discrepancy may lie in the pro- 
portion of different weapons employed by the opposing forces. 
The predominant Japanese artillery piece was the 75 mm gun, 
whereas, most of our artillery weapons were 105 mm or larger 
caliber. In relative lethal effects a sharp contrast is ob- 
served between the U.3.grenade, per cent, and the Japan- 
ese grenade, 4.4 per cent. This finding is in accord with 
the generally observed ineffectiveness of the Japanese grenade. 
SHOWING 
RELATIVE LETHAL EFFECT 
MEAD ' 95 
UVMt 156 
TOTAL 219 
ng.75 
su WOUNDS CAUSED BY JAPANESE WEAPONS 
AND 
RELATIVE LETHAL EFFECT 
CAD 392 
JVIMG 1237 
rOTAL 1569 
-85- 6. ThSATI -J7T OF Tita 'CURDED 
A. detailed clinical study would ue out of place in 
a report on V/ound ballistics. On the other Land a resume 
of end results in ale treated wounded is essential to ahe 
proper evaluation of the effect of weapons. This is well 
illustrated by the results obtained in the treatment of com- 
pound fractures of the femur early in ,'or.ld .ar I, when the 
mortality at first was 5u per cent. ouch a mortality would 
materially change the evaluation of the effect of weapons 
causing wounds in the lower extremities 
The purpose of this report on the treatment of the 
wounaod is to indicate tne quality of the treatment, good 
or bad; to account for all of those wounded in action and 
who died later; to record the amount or disability as in- 
dicated by the disposition of txie patients and 10 give a 
very brief classification of the types of wounds encountered 
in the various anatomical regions. a recording of the cir- 
cumstances as to how each- wound was acquired ana even a brief 
description of the w und would make this report far too len- 
gthy. On the other hand such descriptions are helpful in 
giving the reaaer on appreciation of the type of warfare en- 
countered. Tor this reason a brief description is given of 
the circumstances associated with the wounding of each pat- 
ient who was wounded in action and uieu. later. 
a. .ounas of the hoaa and keen 
There were 250 patients with wounds of the head 
and neck alone who were seen alive*. Ten of this number 
4 per cent) died. These ten patients were considered as 
mortally wounded and seven died without operation (Cases 1 
to 7)• Three patients died following operation making an 
operative mortality for all head end neck wounas of 1.2 per 
cent. (Cases 8, 9 ana lu). 
Of these 250 patients, 198 haa wounds of the 
scalp, face and neck. Only one patient died (Oase 5) giving 
an operative mortality of 0.5 per cent. There were fifty 
five patients who had injuries of the eye, nineteen of whom 
per cent) were returned to the United States, because 
of permanent visual impairment. The most serious wounds en- 
countered in the group o: face and neck injuries were four 
perforations of the trachea, nine compound fractures of the 
mandible, and four of the maxilla. 1he majority of face 
and neck wounds were not serious, ana 86.0 per cent of the 
patients who received ouch wounds were returned to duty with- 
in four months. There were fifty two patients who sustameu 
brain injury. Twenty seven of these naa concussion and 
three were evacuated to the Unitea states. 
* in ere ..ere ninety patients listed under rpie wounas who 
also luu wounds ol“ the Lean and neck. mowever, these 
wounas aid not constitute major problems or tne Lena and 
necK, ana in order t ) avoid duplication, such patients were 
considered only under multiple wounas. *af the plaining twenty f.i.ve patients who Lea 
brain injury, nine were nortally wounaeu. nineteen of 
these patients underwent operation ana tnree aiea, *^anin0 
a of 15.7 par cent. tnree 01 these patients 
;.iay ue considered as havinr ueen mortally wounded (Gases 6, 
9, and 10). -v.onL’ the nineteen cases having operation, 
the Jura was open and the brain lacerated in fourteen, ana 
in five there were depressed fractures without openIn * of 
the dura. 
(in .iCt j.O' i <• in jl -untun) 
'-'k^Q 1 • hrxi (Jbijian) , while on 
patrol was wounded by a fragment of a 9G 
shell which exploded at 20 yards distance at 1700 Lours, 
30 harch 1944- the 21st hvacuatio.i Hospital La was 
found .o have a penetrating wound of the skull thru the 
right frontal bone with extensive laceration of tne brain 
ana severe intracranial hemorrhage. he died shortly after 
arrival at 20u0 hours, 30 harch 1944, of respiratory ihilurt 
ana extensive brain damage. (bee autopsy r>rotocols Case 3. 
>rd i In (hi. iaa, , while 
on patrol //as struct by a U.o. 90 xum shell frag- 
ment 25 yards from the ourst at 1700 hours, 3o Larch 1944. 
he received a penetrating wound of the head in the right tem- 
poral region anu. was taxon directly to the 21st.evacuation 
hospital. The patient was in extremis ann aied at 1855 
hours, 30 -..aron 1944 (oee autopsy protocols Case 12; . 
Dase 3. HBHHHHIHHPHMHHflPHMHfc , , 
Division, was strucxi. in the hean a tia'ranese 
machine gun build hired from a distance of 3D yarns at 
hours, 9 -.arch 1914. he was given first aid including plas- 
ma, but never regained consciousness ana aied in the battaiioi 
aid station 2 hours later. 
Casa 4■ ) 1st (Fijian; 
mistaken for the enemy ana shot in the heaa and ab- 
domen by a U.3. .303 caliber rifle at a distance of 13 yards, 
he was wounded at 1810 hours, 23 harch 19h4, and taken direct - 
ly to the 21st evacuation hospital. There a severe gutter 
wound of the right side of the head with extensive Drain 
damage and a wound of the abdomen were disclosed. He was 
given 1 unit of plasma, but being in extremis died at 2055 
hours, 23 x-arch 1944. (Jae autopsy protocol Case 22). 
'Je.se 3. 182nu 
withdrawing 1'roin enemj fire was hit in the bacK of 
the neck by a ,25 caliber Japanese bullet fired by a sniper 
from a distance of 35 yards. lie was wounded at OoOO hours, 
15 karcli 1944, kept in the battalion aid station about 2 hours 
end then taken to the 21st evacuation hospital. he was para- 
lyzed and in shock ana no operation was done. His death was 
associated with hyperthermia and occurred at 1300 hours, 15 
harch 1944. The clinical impression was transection of the 
cervical cord at C-5, hut postmortem that the cord 
-87 had not been penetrated. (Dee autopsy protocol Case 21). 
Hote: This was the only instance of trauma to the spinal 
cord in which the dura was intact. 
Case 6. , 145th inf., 
37th Division, was struck by fragments of a mor- 
tar shell which exploded in a tree 15 feet overhead. He 
sustained multiple wounds of the head and shoulder and a 
partial avulsion of the leg. tourniquet was applied to 
the leg plasma given and the patient was removed from the 
lines within an hour. He died on the way to the hospital. 
Death was thought to have been due to head injury. 
37th Division, was wounded by a .23 caliber bullet 
fired by a Japanese sniper from a distance of 75 yards. The 
bullet passed thru the helmet producing a severe gutter wound 
of the right parieto-ocoipital region. The injury occurred 
at 1430 hours, 24 Larch 1944. The patient received aid 
promptly and was given 9 units of plasma before arriving at 
the 21st evacuation Hospital. He was mortally wounded, how- 
ever, and died at 1920 hours, 24 Larch 1944, without operation 
(Dee autopsy protocol Case 25). 
37th Division, was struck by a Japanese machine 
gun bullet fired from a distance of yards on hill 700. 
Because the road was under enemy fire, a 1000 yard litter 
carry was necessary over very rough terrain. He was given 
plasma at the aid station but arrived at the hospital in a 
semiconscious condition. He had a gutter wound of the left 
fronto-temporal region and a severe laceration of the brain. 
The wound was debrided and shock treated, but the patient 
died 24 hours later. Death was due to extensive brain dam- 
age. 
37th Division, was struck by a fragment of a Japan- 
ese mortar shell (90 mm) which burst 20 feet distant at 0630 
hours, 17 March 1944. The shell fragments destroyed one 
corner of the pillbox, killed one soldier and wounded Dher- 
vinsky. He was removed to the aid station at 0830 hours, 
and thence to the 21st evacuation Hospital. He had a gutter 
wound of the right temporal region which measured 4x2 inches 
and a deep laceration of the brain measuring 2x2x2 inches. 
V/hile the patient appeared to be mortally wounded, a sanguine 
attempt was made to control hemorrhage. In spite of sup- 
portive treatment, the patient died at 2o00 hours, 17 Larch 
1944 with hyperthermia. (Dee autopsy protocol Case 26). 
37th Division, was struck by a fragment of a Japan- 
ese mortar shell which burst 3 yards distant at 1800 hours, 
10 Larch 1944. He was evacuated promptly to the 21st Evac- 
uation Hospital and found to have a severe wound penetrating 
the right eye and base of the skull with intracranial hem- 
orrhage. In spite of supportive treatment he died at 2400 
hours, 10 Larch 1944. (Dee autopsy protocol Case 23.) 
88 b. punas of the Thorax 
A discussion of wounds of the thorax is compli- 
cated by the fact that oftimes these missiles pass thru 
the diaphragm causing wounds of abdominal organs which in 
turn nxay be responsible for the death of the patient. For 
this reason wounds involving both the thorax and abdomen 
are discussed in a separate section. Multiple wounds pre- 
sent a problem, since they incluae many -wounds of 
the thorax and they also are discussed in a separate section. 
Included under multiple wounds were sixty two wounds of the 
thoracic wall alone and three wounds perforating the lung. 
None of these patients died and the tnree perforating wounds 
were treated conservatively. 
excluding the groups previously mentioned, there 
were 156 patients with wounds of the thorax who were seen 
alive. Thirteen of these patients diea giving a mortality 
of 8.3 per cent; the operative mortality for the entire 
group, however, was much lower since seven of these patients 
died of shock and hemorrhage without operation (Cases 1 to 7) 
Wounds of the thorax may be divided into two gen- 
eral groups, those involving the chest wall only and those 
perforating the thoracic cage. There were 102 patients 
(65.4 per cent) who had wounds limited to the thoracic wall. 
Lone of these patients died. The majority of these had 
penetrating wounds caused by small fragments from high ex- 
plosive shells. Only ten or these patients (9.8 pel- cent) 
were evacuated to the Unitea states, and the remainder re- 
turned to duty. 
There were fifty four patients with perforating 
or lacerating wounds of the lung who were seen alive. All 
of the thirteen deaths occurred in this group, making a 
mortality of 24.1 per cent. eighteen of these patients 
were known to have had sucking wounds. There were twenty 
nine open operations on the chest with six deaths, an oper- 
ative mortality of 20.7 per cent. (Cases 8 to 13). 
eighteen patients with penetrating or perforating wounds 
were treated conservatively with debridement only. There 
were no deaths in this group. The total operative mortal- 
ity for perforating or lacerating wounds of the lung was 
12.7 per cent, forty seven patients underwent operation and 
six died. 
(Wounded in action and Died Later) 
Case 1. Service 3try., 
246th Jivis ion, was riding in 
the back of an uncovered truck when a Japanese 105 mm shell 
exploded at a distance of 5 yards to the rear at 0730 hours 
8 March 1944. He was struck by a shell fragment which 
caused a large wound of the left posterior chest. He was 
taken immediately to a battalion aid station, a dressing 
applied and plasma given. He did not recover from shock, 
however, and died at 1120 hours, 8 March 1944. 
89- Case 2. 
Infantr:, , 37th division, was lying prone on the 
ground when a mortar shell exploded at a distance of 2 feet 
at 0800 hours, 12 Larch 1944. On arrival at the 21st evac- 
uation Hospital 50 minutes later, he was in extremis with 
multiple wounds of the left jaw, upper right arm, and pro- 
fuse hemorrhage from a large perforating wound which extendea 
thru the right shoulder into the chest cavity. He was mor- 
tally wounded and died without treatment at the hospital at 
0910 hours, 12 Larch 1944. 
Case 3. 
Infantry, .americal Division, was manning a machine 
gun in a foxhole on Hill 260. 3 others haa been wounded in 
this same position by a heavy barrage of Japanese knee mortar 
shells. This soldier slipped out to look for the enemy 
position and was struck by a fragment of a Japanese mortar 
shell which burst at a distance of 40 yards. He received 
multiple severe wounds of the left chest and arm, and did not 
regain consciousness. He died from hemorrhage in the bat- 
talion aid station at 1300 hours 11 Larch 1944. 
Case 4. , 162na Infantry, 
Americal Division, was advancing in an upright 
position in a skirmish line on Hill 260 when struck by Japan- 
ese .25 caliber maci-ine gun bullets at Lours, lo ...arch 
1944. He received multiple wounds of the chest and arm, was 
given first aid which included plasma but died at the Collect- 
ing Company at 1530 hours, lo Larch 1944. 
In- 
fantry, 37th Division, was standing in a covered 
foxhole by a machine gun when hit by a Japanese mortar frag- 
ment at a distance of 5 yards from the burst. 3 others in 
the foxhole were uninjured. The shell fragment penetrated 
the left shoulder and entered the chest. He received im- 
mediate first aid including plasma at the aid station. The 
wounding occurred at 0545, 12 Larch 1944 and the patient died 
in the aid station of pulmonary hemorrhage 3 hours later. 
129th In- 
fantry, 37th Division, was advancing behind a tank 
when wounded by a Japanese .25 caliber machine gun bullet 
fired from a distance of 25 yards at 1245 hours, 24 Larch 
19*4.4. The bullet entered the chest ana transectea tx.e spinal 
cord. His death at tne 21st evacuation Hospital 24 hours 
later was accompanied by shock and hyperthermia. (Dee autop- 
sy protocol Ho.52). 
Case 7. > 
fantry, Americal Jivision, was wounded by a shell 
fragment from a U.3.artillery "short” at 0815 hours, 7 April 
1944. The distance from the burst was unknown. *». large 
sucking wound of the left chest and multiple penetrating 
wounds of the left thigh were evident. He died in the clear- 
ing station at 1145 hours, 7 npria 1944, as a result of sev- 
ere hemorrhage from the chest wound. 
90. 11 I\Mdr, FJLK uijianj , was 
on patrol when strucm by a .25 caliber 
Japanese sniper bullet fired from a distance of 15 yards. 
An extensive wound of the left lower cnest was accompanied 
by profuse hemorrhage. On arrival at the 21st Evacuation 
Hospital it was evident that fatal exsanguinatioh was immin- 
ent, accordingly an immediate but futile attempt was made to 
relieve intrathoracic pressure end to control hemorrhage. 
During operation the patient was given 1500 cc of whole blood 
and 6 units of plasma, but he died on the operating table. 
Postmortem examination revealed a dilated heart. It was the 
opinion of the surgeon that in the presence of pulmonary dam- 
age occasioned by tne wound plus manipuiation of the lung, 
the rapid administration of large volumes of blood and plasma 
may have resulted in overloading the pulmonary circulation 
and thus produced dilation of the right neart. (dee autopsy 
protocol Ho.56). 
Case 182nd 
fantry, Airierical Division, was lying prone on Hill 
260 operating a machine gun when hit by a .25 caliber Japan- 
ese machine gun bullet fired from a distance of 50 yards at 
1200 hours, 12 ...arch 1944. He sustained a sucking wound of 
the lower right chest accompanied by multiple fractured ribs 
posteriorly and disruption of the rib cartilages anteriorly, 
i-vt the 31st lortable ->urgical iospital 2000 cc jf plasma and 
1200 cc of whole bload were administered and the skin rapidly 
closed over the sucking wound. After transfer to the 21st 
evacuation hospital the patient continued to have severe res- 
piratory difficulty because of the crushing chest wound. An 
attempt was maae to reconstruct the posterior thoracic cage 
by wiring the 4th, 5th, 6th, 7th, anu 8th ribs to their para- 
vertebral stumps. At operation the lung was stated to have 
the appearance of "blast injury" (consolidation). There 
were several rents in the lung but no bleeding. On lh i..arch 
1944 it was apparent that the patient haa pneumonia, his tem- 
perature had risen to 106 degrees F. and his respiratory rate 
to 50. accordingly 100,000 units of penicillin were given. 
The paradoxical breathing due to the disrupted anterior car- 
tileges became worse anu the patient died of respiratory 
failure at 2300 hours, 14 march 1944. 
Case 1U. 129th 
Infantry, 37th Division, was prone on the crest 
of a ridge behind a tank attack when hit by a .25 caliber 
Japanese rifle bullet fired from a distance of 100 yards, 
lie received a severe wound of the left posterior thorax at 
1100 hours, 24 mar of 1944, and was removed at once to the 
21st -Evacuation Hospital. operation the lacerated lung 
was repaired and the wound closed tightly. On the following 
day, because of tne development of pneumonia, penicillin 
therapy was instituted using 25,000 units every four hours. 
a severe right pneumothorax was aspirated. On 26 march the 
patient's temperature was 105 an- His condition poor. 
improvement occurred, but on 28 .viarch the patient suddenly 
cried out, ceased breathing, and died at O73o hours. The 
radial pulse was perceptible for a brief interval after res- 
piration ceased. diagnosis of juliaonarj embolism was made 
(Jee autopsy protocol Case wo.50j. 
29th 
-91- Case 11. i ComHrools, 
: Aid , accidentally shot himself with a .30 cal- 
iber carbine at 0100, 4 a. ril 194*. The bullet perforated 
tie left chest. lie was taKen immediately to the 52nd Held 
Hospital and given 3 units of plasma. At operation 2 hours 
later, the patient died on the table. The cause of death 
was not entirely clear, although a large intrapleural hemorr- 
hage may have been sufficient to account for the fatal ter- 
mination. a contusion of the heart muscle was found at 
postmortem. (jee autopsy protocol Case No.53)* 
Case 12. ■SJpSBW, 129th 
?th division, was standing by his fox- 
hole when strucx by a fragment of a 4.2 U.o.mortar shell which 
fell short and burst at a distance of 7 feet. at the 33rd 
Portable hurgical hospital a sucking wound of the right chest 
was sutured. oince this hospital had no thoracic surgeon, 
the patient was transferred to the 21st Evacuation Hospital, 
-.nroute, severe bleeding was initiated by dehiscence of the 
recently sutured thoracic wound. While 1500 cc of blood ana 
10 units of plasma were administered a second operation 
was done. a rib fragment was removed from the lung and 
active bleeding of the intercostal arteries controlled. The 
wound was closed tightly with thru ana thru sutures. At the 
termination of the operation the blood pressure was 80/50. a 
penicillin solution containing 17,500 units was left in the 
pleural cavity. The patient did not recover consciousness 
and died at 1500 hours, 30 Larch Autopsy showed acute 
dilatation of the heart, blast injury of the right lung and 
hemorrhage in the right pleural cavity. (Note: Interhospital 
transfer of this patient was obviously inadvisable). 
Case 13. g162nd Infantry 
America! division, was moving up a hill when struck 
by a .25 caliber Japanese bullet fired from a distance of 30 
yards, at 1130 hours, 2o march 1944. The bullet fractured the 
posterior 9th rib, perforated the upper lobe of the right lung 
and made its exit in the right supraclavicular fossa. mucking 
wounds were present on the posterior ana anterior aspects of 
the chest, with free bleeding fro... the posterior wound. .At 
the 31st Portable Jurgical hospital plasma was given and the 
sucking wounds were debriaed and closed. The lung appeared 
consolidated from intrapulmonary hemorrhage. The patient uied 
of shock and hemorrhage shortly after operation. 
_c. ,Zounds 01 Thorax and abdomen, 
rhe anatomical divisions of tnorax ana abdomen are 
satisfactory for e consideration of wounds or entrance. how- 
ever, from a clinical standpoint, those wounds which are caused 
by missiles which pass from one cavity into the other present 
special problems of sufficient importance to warrant placing 
them in a separate category. 
There were twenty Tour patients with wounds in 
which the missile penetrated both the thoracic and abdominal 
cavities. . ore than half of* these wounds were caused by bul- 
lets entering the chest. The various missiles entered thru 
• 92 the tnorax in seventeen cases, through the abdomen in four, 
and through both the abdomen ana chest in three. Bullets 
caused sixteen of these wounds, mortar fragments five, and 
artillery shell fragments three. 
The mortality" of these wounds is higher than for 
wounds of the thorax or abdomen alone. Of the twenty four 
cases, eighteen died resulting in a mortality of 75*0 per 
cent. Three of these patients died of hemorrhage and shock 
without operation. T.verity one patients underwent operation. 
Of these, fifteen died, giving an operative mortality of 71.4 
per cent. Brief case histories are given for all patients 
who w’ere wounded in action and died later. 
The high operative mortality requires this further 
explanation. If medical installations had not been so easily 
available some of these patients probably’- would have been 
classed as killed in action. Bhock from hemorrhage was 
usually severe and occasionally when bleeding continued it 
was necessary to attempt "heroic surgery" (Case 3) in an effort 
to control it. bleeding into both the thorax and abdomen re- 
sulting from explosive wounds of the liver, spleen, and kid- 
ney frequently contributed to the shock. On the whole anes- 
thesia appeared to have been well uone but occasionally left 
something to be desired. more whole blood would have been 
beneficial in some instances, since Diooa loss was frequently* 
great and couid be replaced by plasma only within limits. 
Hemorrhage and shocx oere the chief causes of death as seen 
in Cases 3, 6, 8, 10, 11, 14, 16, 17, and 18. Case 15 was 
moved immediately after operation. This 'may have contributed 
to the chock. Case 4 illustrates the sequelae which may be 
encountered from the blast effect due to high velocity bullets. 
Case 12 died with uremia associated with a high sulfathiazole 
blood level. (This patient also had an explosive wound of 
one kidney.) -xtensive liver damage appeared to account for 1 
death, Case 7. Two patients who were evacuated to the rear 
echelon died; one from sepsis and empyema (Case 9), and the 
other from secondary hemorrhage (Case 13)* The strain of 
evacuation may’’ have contributed to death in these cases. 
(hounded in action and Jied Later] 
Case 1. HlK 132nd 
Infantry, Americal Jivision, was running between 
foxholes cn Hill 260 when shot by a .23 caliber rifle at 46 
yards. The bullet enterea the thorax at the level of the 
left 7th rib in the anterior axillary line. he was wounded 
at 133t hours, 14 march 19b4. .ithin 13 minutes after re- 
ceiving first aia he was taken to the aid station and from 
there transferred directly to the 31st lortable Surgical 
hospital. The wound was extensive as the bullet had passes 
tangentally from the thorax into the abdomen, ana had lace-r- 
ot ed the left lung, perforated the diaphragm and hau produced 
a massive hemothorax. The spleen was shattered, gastro- 
splenic artery and renal vein divided and "entire descending 
colon avulsed”. Because he was mortally wounded the patient 
was given supportive treatment only. he died at 0315 hours, 
13 larch 1944. Case 2. oerb. 
145th Infantry, 37th division, was souvenir hunt- 
ing when hit by a .25 caliber Japanese rifle buxlet fired 
from a distance of 70 yards. He was in severe shock when 
first seen at 1420 hours, 12 March 1944. At the aid station 
he was given 3 units of plasma and then transferred to the 
clearing station. The bullet had enterea the left posterior 
chest and had produced a large wound of exit in the left up- 
per quadrant of the abdomen from which omentum protruded. He 
aid not respond to therapy and died in the shock tent at 1700 
hours, 12 March 1944. 
82nd Chemical 
Bn., 37th division, was standing in a pit beside 
his mortar when a Japanese 7.7 mm mortar shell exploded 4 
yards distant at 193C hours, 6 march 1944. He was taken 
directly to the 21st Evacuation Hospital and on arrival was 
found to be in profound shock from multiple wounds of the 
thorax and abdomen and both lower extremities. n. severe 
compound fracture of the left femur was present. He aid not 
respond to shock therapy and died without operation at C53C 
hours, 9 March 1944. death resulted from hemorrhage, shock, 
and respiratory failure. Cursory costmorteru examination re- 
vealed multiple penetrating wounds of left chest and abdomen 
involving the large bowel. 
129th 
Infantry, 37th division, was prone on the ground 
in front of the tanks when shot by a .30 caliber Japanese 
machine gun at 35 yards distance. He was struck by 2 bul- 
lets in the back at 0830 hours, and taxen directly to the 
21st evacuation Hospital. he haa an obvious left hemo- 
thorax, a sucking wound of the chest and questionable ab- 
dominal involvement. After preliminary shock treatment the 
explosive wound of the chest was aebridea and closed. The 
abdomen was then opened, but no lesion was founu. He res- 
ponded well to operation, but developed increasing respira- 
tory difficulty (blast effect) requiring frequent aspiration 
and died at 0645 hours, 26 March 1944. (dee autopsy proto- 
col Case 34). 
Bn., U5th Infantry,37th Division, was a.iong a 
group of men preparing to climb into a trucix whan 4 shells 
struck within a radius of 13 yards at 0730 hours, IB March 
1944. 12 men were killed. Lawson received first aid^im- 
mediately and arrived at the 21st Evacuation Hospital within 
an hour. He had a large sucking wound of the posterior 
chest with a laceration of tne left lower lobe of the lung, 
perforation of the diaphragm, and laceration oi the spleen 
and cardia of the stomach. He received 2U00 cc of blooa 
and 8 units of plasma within 6 hours, but neither regained 
consciousness nor recovered from shock. Thoractomy was 
necessitated because of continued inorathoracic bleeding 
which produced a shift of the mediastinum. nt operation 
3000 cc of blood were removed from the pleural cavity an 
lacerations in the lunp and dome of the diaphragm were re~ 
paired. In spite of continuous shocK therapy recovery was 
not sufficient to allow repair of the abdominal defects, ne 
died at 0345 hours, 19 Larch 1944. Uee autopsy protocol 
Case 74). . ->ase 6. 24th 
Infantry, 93ru division, was on a combat patrol 
prone on the ground when shot by a .30 caliber Japanese 
machine gun, distance unknown. he received multiple 
wounus at 1000 hours, 19 April 194n, was given first aid 
and arrived at the 32nd hield xxospital at 1400 hours. In 
order to combat severe shoex he -as given 1000 cc blood and 
1230 cc of plasma. Because of suspected lung hemorrhage, 
thoracotomy was performed. A bone fragment was removed 
from the lung and the pleura ana diaphragm were sutured. 
He did not responu to shock therapy and died at 2123 hours, 
19 April 1944. (cee autopsy protocol Do.73 Tor description 
of multiple wounds). 
143th 
Infantry, 37th division, was climbing a hill when 
hit by a .25 caliber Japanese sniper bullet fired from a 
distance of 36 yaras. He was wounaed at 17*+3 hours, 11 
Larch 1944, given first aid, and taken directly to the 21st 
evacuation Hospital. dter adequate shock therapy thoracot- 
omy was performed. The lower lobe of the right lung was 
lacerated and showed consolidation (blast), the Sth amd 9th 
ribs were shattered, and in addition a rent in the diaphragm 
and a severe explosive wound of the liver were discovered. 
The lung was sutured, the diaphragm transplanted and tne 
liver packed. Death occurred at 1600 hours, 13 x-.arch 1944, 
prior to which time recovery had seemed satisfactory. xost- 
mortem examination showed no cause or death other than ex- 
tensive damage. 
lase 8. 57th 
Clerical Division, v/as accidentally shot by a .30 
caliber III rifle at I30O hours, February 194m- at 1 foot 
distance. receiving immediate first aid and plasma 
he was taken to the 32nd i'ield hospital. ~ large sucking 
wound pf the rxght chest was present. Because of continued 
hemorrhage plasma and 1000 cc of blood were administered 
during operation. Thoracotomy revealed a perl oration of 
the diaphragm, an explosive wound of the liver and large hemo- 
thorax. An attempt was made to control deeding from the 
liver by packing it with muscle. The patient died of shock 
and hemorrhage one half hour after the conclusion of the op- 
eration at 1615 hours*, 22 /ebruary 1944. 
Jase 9* T43tn In- 
fantry, 37tL Division was kneeling, when shot by 
a .30 caliber Japanese rifle at 40 feet on 16 Idarch 19*+4. 
a sucking wound of the right lower chest resulted. 
blood and plasma transfusions the thorax was explored at 
the 21st evacuation Hospital. It was found that the bullet 
had perforated tne lower lobe of the left lung, guttered a 
large wound in the diaphragm, and transected the spinal cord 
at the level of tne 12th dorsal vertebra. ~ right lower 
lobectomy was done and the diaphragm repaired. he was evac- 
uated to the rear echelon in good condition on the Sth post- 
operative day. he developed empyema and in spite of 
adequate drainage and penicillin therapy, died on 23 .v-ril 
1944. (See autopsy protocol ho.35)* 
■95 , 3ra on., x 1H (. i j mn y 
was mistaken for the enemy and shot by a .30 caliber 
machine gun at 3o yarns distance. He was wounded ct 15oo hour- 
1 April 1944, and was evacuated im..ediatd} to the 21st evac- 
uation Hospital. x*fter sLock treatment, thoracotomy was dx»ne 
because of suspected hemorrhage. nt operation a right lower 
lobectomy was performed and an extensive wound in the liver 
packed. He did not recover from this operation, ana aied at 
2030 hours, 1 April 1944. (Bee autopsy protocol Ho.72.) 
Case 11. 37tn lien. 
Tr., 37th Jivision, was on a combat patrol which 
was ambushed. He was shot by a .25 caliber Japanese rilLe 
at 25 yards distance, at 1815 Lours, 4 ..arch He re- 
ceived first aid treatment but aid not arrive at the hospital 
until OSuO hours, 5 -arci 1944. The bullet enterea tie ab- 
domen through the left flank and made its exit thr the 
right anterior chest wall. .-.fter shocn therapy perforations 
of the small and large bowel were sutured. The patient did 
not recover from .sheen ana aied at lo!5 hours, 5 Larch 1944. 
(Bee autopsy protocol Ho.71). 
3rd Bn. 
i32nd Infantry, Americal division, while on oomoat 
patrol was shot with a Japanese rifle as he entered an enemy 
pillbox, at 1700 hours, 29 -larch 1944. After a long can*} 
he arrived at the 121st Hearing otatiom at 2e0u hours, 3d 
Larch 1944. Tne buinet had enterea the chest in the 6th in- 
terspace in the posterior axillary line ana naa perforated the 
diaphragm, large bowel and kidney. operation a laceration 
of the diaphragm was repaired, the large perforation 
sutured, a transverse colostomy performed, ana sulfonamide 
therapy institutea. On tne third day, tne urinar} output 
having aecreased to 2u0 cc., a aiagnosis of uremia was msae. 
The sulfonamide levd was then 24. .after transfer to the 
21st evacuation Hospital he died at ubUO hours, 4 April 1944. 
(Bee autopsy protocol Ho.68). 
Case 13. ■■■■■■■■■■■■■■■■■' 1st 129th 
Infantry, 37th division, was snot tnrough the arc 
and chest by a .25 caliber Japanese rifle oullet on 13 Larch 
1944. After receiving plasma he was taken airectly to the 
21st evacuation Hospital. The bullet had fracturea the left 
humerus, penetrated the chest, perforated the diaphragm, ana 
produced a hemothorax. The wound was aebrided anu the pleura 
closed. The patient was evacuatea by air on 15 march 1944. 
He died on 21 Larch 1944 of secondary hemorrhage. (oee auto - 
sy protocol Ho.69). 
division, ms in a foxhole on Kill 260, 
when hit by a .25 caliber Japanese machine gun bullet Tired 
from a distance of 40 yaras. he was .vounaed at 12u0 hours, 
11 ...arch 194w. At the 31st Portable Hospital it 
was found that the bullet had entered the left chest in the 
7th interspace posterior axillary line ana haa coursed down- 
ward and forward into the abdomen. sucking 'wound of the 
chest was closea arm the abdomen openea. The builet haa 
perforated the diaphragm, stomach, and liver, ana had shat- 
tered the spleen. The various perforations were closed and the spleen removed. The patient did not rally and died at 
0700, 12 Larch 1944. autopsy revealea that a perforation 
of the jejunum had been overlooked at operation. oeath wa 
attributed to peritonitis although shock was also a factor. 
Case 15. 
182nd Infantry, was advancing on a combat patrol 
when shot by a machine gun at close range on 6 Larch 1944- 
He continued to command for 2C minutes, but was then evacu- 
ated to the 31st Portable Surgical Hospital. The bullet had 
entered just medial to the anterior axillary line in the 5th 
interspace and made exit near the 12th rib posterior. In 
its course it had perforated the lung, diaphragm, stomach, 
and spleen. Lt operation the diaphragm ana stomach were re- 
paired. The patient was transferred to the 21st Svacuation 
hospital on 9 Larch 1944, ana died the following day at 1845 
hours. (note: The transfer‘of this patient on the first aay 
after operation was inadvisable.) 
Case 16. 145th Infantry, 
37th Jivision, was struck by a fragment of a 
Japanese knee mortar shell on Hill 700. He was approximate- 
ly 25 yards from the burst. Having received plasma and im- 
mediate first aid dressings, he was taken to the 21st Svacu- 
ation Hospital. Because of multiple perforating wounds of 
the chest and abdomen, laparotomy was done. mxcensive lac- 
eration of the liver and several perforations of the jejunum 
and duodenum were repaired. He died of shock and Hemorrhage 
on the day of operation at 2240 hours, 11 Larch 1944. 
was approximate- 
Case 17. 920th xx • jL> • O • j S 
riding on a truck when a Japanese artillery shell 
exploded 5 feet behina his vehicle at OoOO hours, 24 march 
1944. He was directly to the 52nd Field hospital and 
treated for shock. There were 2 wounds, one traversed the 
4th and 5th ribs in the mid-axillar> line, perforated the 
left lower lobe and entered the posterior mediastinum. The 
second fragment entered the left ilial region and perforated 
the sigmoid colon. .massive hemothorax was present. At 
operation the perforation of the lung was sutured and the 
sigmoid colon was ej&riorized. The patient was given 40C0 
cc. of plasma and 1000 cc. of whole blood. die did not res- 
pond, however, and died eight hours after the operation. 
(See autopsy protocol No.57i. 
lb. 1st Bn., 
crawling on a combat patrol, when 
a Japanese mortar shell exploded at a distance of 2o yards, 
on 29 larch I9h4. On arrival at the 21st evacuation hospital 
he received treatment for shock. Perforating wounds invol- 
ved the lung, diaphragm, colon, spleen, pancreas, and left 
kidney, and the patient also had a fracture or the left hum- 
erus. The spleen was removed, the colon exteriorized and 
the diaphragm repaired. He died at 2215 hours, 30 Larch 
1944. (Bee autopsy protocol ho.70.) 
-97- d. ..ounds of the Abdomen 
This anatomical division is used to designate 
not only the abdominal cavity and contents but also the 
various structures surrounding it, including the muscles 
of the abdominal wall, the vertebral column and the ilia, 
tfounas involving both the thorax and abdomen are consider 
ed in a separate section. 
There were eighty six patients who had wounds 
of the abdomen, in forty nine the wounds were limited to 
the abdominal wall and in thirty seven they penetrated the 
abdominal cavity. The majority of wounds limited to the 
abdominal wall were caused by high explosive missiles, 
chiefly mortar fragments. There were five deaths among 
the forty nine patients who received wounds of the abdom- 
inal wall only (Cases 1 and 2) died before operation. Cne 
death followed a negative abdominal exr>loration. ( Case 18). 
Penetration of the abdominal cavity was found 
in thirty seven patients. There were twelve deaths among 
thirty six pat.lents undergoing operation making a total 
operative mortality of 33.3 per cent. It must be borne 
in mind, however, that this high operative mortality is ac- 
counted for in part by many mortally wounded patients who 
died of shock, on whom operation was undertaken with little 
hope of success (Oases 3, 7, 10, 11, 12, 13, 14). One 
patient died of shock before operation, (Case 3), two died 
of peritonitis (Cases 6, 6) , and one of unexplained uremia 
(Case 17). ho deaths occurreu because of failure to ex- 
plore the abuomen but in two patients (Cases 4, 9) death 
resulted from visceral perforations which were overlooked 
at operation. The very early evacuation of patients from 
the portable surgical hospitals undoubtedly contributed to 
shock and was the factor which may have precipitated death 
in a f6w instances. (See Cases 4, 3, 7, 17). It is also 
known that patients do not tolerate air transportation well 
soon after abaominal operations, this type of evacuation nay 
have contributed to the death of one patient (Case lb). 
The large bowel was perforated in fifteen pat- 
ients among whom there were five deaths, making an operative 
mortality of 33*3 par cent (jCe oases 4, 3, b, 7, 6). .among 
these fifteen patients, the colon alona was perforated in 
five, the colon and spleen in one, and the colon and small 
intestine in nine. hour of the five deaths occurred in 
this latter group. The small intestine alone was perfor- 
ated in six patients, the liver in four, the stomach in one 
and the bladder in one. **.11 of these patients recovered. 
In addition three patients recovered who had wounds perfor- 
ating the abdominal cavity in which the injury was limited 
to the peritoneum and .esenteric vessels. 
-98- (Wounded in Action and Died Later) 
Case 1. 145 th 
Infantry, 37th Division, having returned from patrol 
was preparing to get into a truck when 4 Japanese artillery 
shells landed within a radius of 15 yards. (At the same 
time there were 12 others killed and 37 wounded). He was 
wounded at 1930 hours 18 March 1944 and taken directly to 
tne 21st Evacuation Hospital, Multiple wounds were present 
which Included spinal cord injury and an extensive avulsion 
of the tissues of the lumbar region exposing the vertebrae, 
spinal canal and both kidneys. The patient was treated for 
shock but died without operation at 1300 hours 19 March 1944. 
case 2. 145th 
Infantry, 37th Division, while crawling in attack 
on Hill 700 was hit by a Japanese machine gun bullet fired 
from a distance of 30 yards. He was wounded at 0700 hours 
10 March 1944 and arrived at 21st Evacuation Hospital at 1500 
hours on the same day. Extensive compound fractures invol- 
ving the sacrum, fourth and fifth lumbar vertebrae and the 
ilium were found. There was apparently no intra-abdominal 
injury, nevertheless the patient failed to recover from pro- 
found shock and died at 2330 hours 11 March 1944. 
Case 5. Infantry, 
“Americal Division, returning from patrol was shot 
with a .25 caliber Japanese machine gun at 1600 hours 6 April 
1944. He received first aid and remained in the command 
post overnight. After receiving plasma he was evacuated to 
the clearing station. Multiple wounds involving the lower 
thorax, abdomen and sacrum were found. There was no response 
to shock therapy and death occurred 0 April 1944. Postmortem 
examination showed peritonitis, resulting from multiple per- 
forations of the colon end terminal ileum, destruction of 
vertebrae L5 to S2 and retroperitoneal hemorrhage. 
/3X 
Case 4. 152nd In- 
fantry, Americal Division, while walking along a 
trail on Hill 260 was wounded by a 90 mm Japanese mortar 
shell burst 25 yards distant at 1530 hours 13 March 1944. 
After immediate first aid treatment he was taken to the 31st 
Portable Surgical Hospital. Multiple wounds were present 
involving the right knee, thigh, right chest and abdomen. 
A shell fragment entered the abdomen through the left flank, 
passed transversely and perforated the large and small bowel. 
At operation the ileum, colon and mesocolon were repaired. 
On 15 March 1944 the patient was transferred to the 21st Evac- 
uation Hospital. After the adminlstration of 1000 cc of blood 
and 4 units of plasma, a transverse colostomy was done under 
local anesthesia because of severe abdominal distention. 
The patient died at 1115 hours 16 March 1944. postmortem 
examination revealed peritonitis resulting from the two per- 
forations of the jejunum which had been overlooked at oper- 
ation. (See autopsy protocol 83). (Note: Interhospital 
transfer was inadvisable in this case). Ca3e 5. Cav.Hcn.Tr., 
37th Division, was running along a ruad carrying 
a box of ammunition when struck by a .25 caliber bullet 
fired by a Japanese tree sniper from a distance of 75 yards. 
He was wounded in the abdomen at 0739 hours 10 March 1944, 
and transported immediately to the 33rd Portable Surgical 
Hospital. In preparation for laparotomy he was given 4 
units of plasma. At operation resection of 18 inches of 
lower ileum with a side to side anastomosis was done and a 
transverse laceration of the sigmoid colon was sutured. On 
11 March he was transferred to the 21st Evacuation Hospital 
and died there of shock at 0700 hours, 12 March 1944. * (Note 
It was inadvisable to have transferred this patient before 
recovery). 
Case 6. 82nd Chemical 
Bn., 37th was standing in the gunpit of 
a mortar battery when struck 'by a fragment of a 77 mm Japan- 
ese mortar shell which burst at a distance of 10 yards. 
Following wounding at 1930 hours, 8 March 1944, he was re- 
moved immediately to the 21st Evacuation Hospital. Severe 
wounds of the left flank and abdomen involving the sigmoid 
colon and retroperitoneal tissues were found at operation. 
The sigmoid colon was exteriorized, but the patient died of 
peritonitis at 1700 hours 13 March 1944. 
case 7. 25th In- 
fantry, 93rd Division, was returning from a patrol 
when wounded by a hand grenade which exploded in his pocket 
at 1700 hours, 9 April 1944. At the 31st Portable Surgical 
Hospital, 5 penetrating wounds of the right side of the ab- 
domen and a compound fracture of the right hand ware discov- 
ered. Because of the presence of shock he received 8 units 
of plasma, 1000 cc of blood and cc of glucose solution. 
The wounds were debrided. 8 inches of jejunum were resected 
and 8 perforations of the jejunum were sutured. Perforations 
of the descending colon, sigmoid colon and cecum were also re- 
paired and a transverse colostomy done. The patient was 
transferred to the 21st Evacuation Hospital on 10 1944, 
and died at 2355 hours 11 April 1944. (See autopsy protocol 
No.85). (Note: It was inadvisable to have transferred this 
patient on the first postoperative day). 
Case 8. 2nd Bn. , 
129th Infantry, 37th Division, while operating a 
machine gun was hit by a .25 caliber Japanese sniper bullet, 
distance unknown, at 1130 hours 13 March 1944. He received 
first aid within twenty minutes, was evacuated from the line 
within 1 hour and arrived at the 21st Evacuation Hospital 
shortly thereafter. After appropriate measures to combat 
shock laparotomy was done. The bullet, coursing upward 
after entering the abdomen on the left side, had produced 2 
perforations of the descending colon, severed the right mid- 
dle colic artery, perforated the jejunum in 3 places and then 
made its exit through the right rectus muscle. The visceral 
perforations were closed, and after resection of 4 inches of 
jejunum a catheter was placed in the bowel for decompression. 
-100- After a few days severe abdominal distention developed and 
it became obvious that the enterostomy was unsatisfactory. 
He died at 1400 hours 20 March 1944. At autopsy it was 
found that the catheter had slipped out of the bowel, pro- 
bably because the bowel had not been sutured to the abdominal 
wall, "Bile peritonitis" produced by leakage was stated to 
have caused death. 
Case 9. 82nd Chem- 
ical Battalion, while walking along a column of 
vehicles which were moving into new positions was shot with- 
out challenge with an Ml rifle at a distance of 10 feet. He 
received first aid dressings and plasma immediately, and 2 
hours later was taken to the 21st Evacuation Hospital. A 
severe wound of the abdomen was present and the sigmoid colon 
was perforated in 3 places. a bladder wound having been over 
looked at the first operation was discovered on the following 
day. A suprapubic cystomy was done at once and at the same 
operation the left external iliac artery was ligated because 
of a contused area which had weakened its wall. The patient 
did not rally, appeared to be in shock and died at 0344 hours 
16 March 1944. 
Case 10. BBSS 143th 
Infantry, 37th Division, was carrying ammunition to 
a gun position when a Japanese knee mortar snell burst 10 
yards away. he was wounded in the lumbar region at 1330 
hours 10 March 1944 and immediately transported to the 21st 
evacuation Hospital. The shell fragment haa passed through 
the left kidney, spleen, transverse colon and jejunum. The 
operation consisted of splenectomy, exteriorization of the 
transverse colon lesion and resection of a 3 inch segment of 
jejunum. Because of the patient's poor condition nephrec- 
tomy was not done. He did not recover completely from shock 
and died on 14 March 1944. 
Case 11. 62nd Chemical Bn., 
37th Division, while standing in a gun pit of a mor- 
tar battery was hit by a fragment of a 77 mm Japanese mortar 
shell which burst at 5 yards distance. He received his wounds 
at 1930 hours 8 March 1944, and was taken immediately to the 
21st Evacuation Hospital. Hollowing treatment for shock lap- 
arotomy was done. One shell fragment passing laterally had 
perforated the transverse colon in 3 places, lacerated the 
right lobe of the liver and made an exit wound 4 inches in 
diameter in the lateral abdominal wall. Iresent also was a 
compound fracture of the left ulna and a large wounu of the 
right ankle. There were other smaller wounds of the legs, 
thighs, buttocks, back and face. At operation the wounds 
were debrided, the perforations of the transverse colon sutur- 
ed, and the defect in the liver repaireu. The patient did 
not recover from shock and died on the following day at 2330 
hours 9 March 1944. 
-101- Case 12. , 132nd 
Infantry, Americal Division, while advancing 
on Hill 260 was struck by a fragment of a 90 mm Japanese 
mortar shell, distance unknown. He was wounded at 0900 
hours, 13 Larch 1944, given immediate first aid ana then 
transported directly to the 21st evacuation Hospital. 
The left arm was avulsed, an extensive wound of the right 
leg was present and the great vessels of this extremity 
were severed. There were multiple wounas of the abdomen 
and the ileum was perforated. Because of severe shock, 
the perforations of the ileum only were sutured at the in- 
itial operation. On the following day because of an ex- 
tension of gangrene of the leg, amputation was aone. The 
patient died at 2112 hours 15 Larch 1944. Postmortem ex- 
amination showed no leakage from the repaired bowel. In 
this case death was attributed to "traumatic shoex" despite 
the fact that there had been adequate blood replacement. 
(The surgeon expressed the opinion that "the operation 
should have been postponed and the limb packed in ice.) 
Case 13. 24th In- 
fantry ,'37th Division, while on patrol was struck 
by a Japanese .25 caliber bullet fired from a distance of 
25 yards. While being moved he was shot again by the same 
rifleman. This second wound resulted in evisceration. He 
was wounded at 1030 hours 16 Larch 19 and taken directly 
to the 21st evacuation Hospital. There he received 1000 cc 
of blood and 3 units of plasma. The first bullet entered 
2 inches below the right costal margin, passed downward alon 
the rectus muscle into the flank, then through the wing of 
the ileum and made its exit in the right buttocks. The 
bullet causing the evisceration entered 2 inches below the 
left costal margin, travelled downward, destroying the rec- 
tus muscle, perforated the jejunum ana ileum and passed unae 
the inginal ligament into the thigh. Loderate shoex was 
present. operation the eviscerated intestine was en- 
closed in a pack while the rents in the jejunum and ileum 
were resected. Irofound shock developed from which the 
patient did not recover ana he died at 1515 hours 16 ...arch 
1944. 
Case 14* 135th 
F.A. , 37th division, accompaniea a party burying 
the Japanese dead in front of the 129th perimeter. He 'wan- 
dered away and was shot by a Japanese .23 caliber rifle at 
1545 hours, 2? Larch 1944. He was taxen immedlately to the 
hospital. The bullet entering the lumbar region iiad shat- 
tered the 12th rib driving bone fragments into the kiuney 
and had then passed through the right lobe of the liver, 
causing an extensive laceration. Following appropriate 
shock therapy the abdomen was explored and the liver packed. 
Due to the poor condition of the patient only the loose frag 
ments of kidney were removed. He did not recover from shoe 
and died at 1836 hours, 27 March (dee autopsy pro- 
tocol 81) . Case 15. mPMW, 140th 
37th Division, while on patrol looking for the 
enemy who had infiltrated the lines, was shot by a .25 Japan- 
ese rifle at 10 yards distance. He was wounded at 1605 hours 
14 Parch 1944, received immediate first aid ana arrived at 
the hospital within an hour. A wound was present in the 
left axilla and the axillary vein was severed. Tne major 
lesions consisted of compound fractures of the femur and ileum 
with an extensive wound penetrating the right hip joint. Sev 
ere shock was present. The axillary vein was ligated. Be- 
cause of the presence of abdominal symptoms laparotomy was 
done but no lesion found. During this operation the urinary 
bladder was explored and closed. Because of the poor con- 
dition of the patient only a simple debridement of the hip 
wound was done. The patient showed a severe toxic reaction, 
developed gas gangrene of the hip and died on the second post 
operative day, at 1450 hours, 16 March 1944. (See autopsy 
protocol 103)• 
Case 16. 145th 
Infantr^^2n^Bn., 37th Division, while attacking 
on Hill 700 was shot by a Japanese machine gun at 30 yards. 
He was wounded at 1630 hours, 9 1-arch 1944, and taken im- 
mediately to the battalion aid station. After he had re- 
ceived 3 units of plasma he was evacuated by half track be- 
cause the road was under fire. At the hospital, in order to 
combat severe shock, he was given 12 units of plasma and 500 
cc. of blood. The bullet had entered the right iliac crest 
and passing downward haa shattered the entire right wing of 
the pelvis. Exploration of the abdomen through a McBurney 
incision was negative. The hip wound was debrided and pack- 
ed. He failed to recover from shock and died at 2300 hours, 
10 March 1944. 
Case 17* '129th In- 
fantry, 37th Division, was standing oy a foxhole 
when a 4.2 U.3.mortar shell fell short and burst 7 feet away, 
on 27 liar oh 1944. He received treatment for shock at the 
33rd Portable Surgical Hospital. One shell fragment pro- 
duced a large wound over the region of the right iliac crest, 
it also fractured the fifth lumbar vertebra and shattered the 
lower pole of the right kidney. -another fragment caused a 
wound of the right shoulder and arm. Shock therapy was con- 
tinued while the wounds were debrided. The development of 
severe abdominal distention necessitated ileostomy. On 31 
March he was transferred to the 21st Evacuation Hospital and 
died there on 1 April 1944 with unexplained uremia. (oee 
autopsy protocol 84). 
Case 182nd 
Division 1 was standing in the 
open when a Japanese hand grenade 3 a^ay. He 
was wounded at 1345 hours, 13 March 1944* Hfter arrival 
at the 31st Portable Surgical Hospital examination disclosed 
many wounds over the left side of the trunA and extremities. 
Following transfer to the Clearing Station abdominal explor- 
ation was done with negative results. He was evacuated y 
-103- air on 18 March 1944. On arrival at the 137th Station 
Hospital on Guadalcanal on the same day, evisceration was 
discovered. A secondary wound closure was done but the 
patient developed peritonitis and died on 23 Larch 1944. 
(See autopsy protocol 82) . (2Tote: Air evacuation might 
have caused evisceration although planes transporting cas 
ualties usually fly at low altitudes.) 
e. Wounds of the extremities 
Wounds of the extremities are of great importance 
because of their frequency. Wounds of the upper and lower 
extremities together (excluding multiple wounds) account for 
40.6 per cent of all casualties (Fig.47). As a surgical 
problem, these wounds are of major significance since they 
comprise more than half of all the living wounded (Fig.49). 
Three hundred and twenty patients had wounds of 
the upper extremities only one of whom was killed in action. 
This patient had a traumatic amputation. There was not a 
single death in the 319 treated wounds of the upper extrem- 
ities. Gas gangrene infection aid not occur. In this 
group there were 119 compound fractures of which 44 were in 
the humerus, thirty three in the bones of the forearm end 
forty two in the bones of the Land. There were ten ampu- 
tations, two through the humerus because of extensive de- 
struction of tissue and impairment of blood supply, one 
traumatic amputation of the hand and seven of the fingers. 
There were 401 patients with wounds of the lower 
extremity (not including multiple wounds) eight of whom died. 
One patient died of unexplained cause (Case 1), two died be- 
cause of shock and hemorrhage (Cases 2 and 3)» one died in 
the rear echelon of uremia associated with a probable "crush 
syndrome nephrosis" (Case 4), two who were not seen by a 
medical officer died of shock and hemorrhage following trau- 
matic amputations of the feet (Cases 3 and 6), and two died 
because of gas gangrene (Gases 7 and 8). Therefore, the 
total mortality for the wounded who were seen alive was 2 per 
cent. 
There were ninety compound fractures of tne lower 
extremities distributed as follows; femur twenty three, bones 
of the leg fifty one, and bones of the feet sixteen. All 
fractures were treated with plaster. There were no deaths 
due directly to compound fracture (See Case 4). There were 
eighteen amputations of the lower extremity of which seven 
were "traumatic" and eleven "elective". Of the seven trau- 
matic amputations three died (Cases 3» 5, and 6). Of the 
eleven elective amputations, eight were none because of ex- 
tensive tissue destruction and blood vessel injury. The 
one death in this group occurred in the rear echelon (Case 4) 
The remaining three amputations were necessary because of 
gas gangrene infection, although in two of these patients im- 
pending circulatory gangrene was also present. One of this 
group died. (Case 8). All amputations were of the guillo- 
tine type. , 
-104- (Wounded in Action and Died Later) 
Case 1. 132nd In- 
fantry, 37th Division, was lying prone in. open 
jungle when struck by a .25 caliber Japanese machine gun 
bullet fired from a distance of 30 yards at 1800 hours, 2 
April 1944. He was taken immediately to the battalion aid 
station and found to have a severe perforating wound of the 
right knee joint. While receiving first aid treatment he 
became hysterical and died suddenly at 1900 hours, 2 April 
1944. While some hemorrhage had occurred, he had not lost 
enough blood to cause severe shock. Death was unexplained. 
Case 2. 132nd Infantry, 
37th Division, leaving the trail to the observation 
post to try a "short cut", tripped the wire of a U.3.land 
mine which exploded a few feet away. He was wounded at 0715 
hours, 22 Larch 1944. Plasma ana morphine were administered 
by a medical officer within 10 minutes and the patient was im- 
mediately evacuated. At the clearing station examination ais 
closed an extensive wound of the dorsal aspect of the left 
thigh. Because of severe hemorrhage from the larger vessels 
3 blood transfusions were given. Following debridement of 
the wound and ligation of the profunda artery, the patient 
did not recover from shock and died at 15c0 hours, 22 Larch 
1944. 
Case 3> 129th In* 
fantry, 37th Division, was firing a machine gun 
when a Japanese knee mortar shell burst between his legs. 
He was wounded at loOO hours, 12 March 1944, and taken im- 
mediately to the 33rd Portable Surgical Hospital. ii. trau- 
matic amputation at the upper third of the right femur was 
completed by guillotine amputation under sodium pentothol 
anesthesia, and several small wounds of the posterior aspect 
of the left leg were dressed. Following operation, during 
which he received 4 units of plasma, the patient was trans- 
ferred immediately to the 21st Evacuation hospital. On 
arrival there the systolic blood pressure could not be ob- 
tained. While awaiting blood transfusion he was given one 
unit of plasma, but died before this could be completed at 
1450 hours, 12 March 1944. Cause of death was shock and 
hemorrhage. (Note: This, patient should not have been trans- 
ferred to another hospital). 
Infantry, 37th Division, was lying prone in the 
open when struck by a fragment of a Japanese knee mortar 
shell which burst nearby. He was wounded on 15 Larch 1944 
and taken to the 21st Evacuation Hospital. He had a severe 
wound of the right leg involving the vessels and nerves and 
a compound fracture of the tibia, Tnis wound was debrided. 
The next day because of destruction of the blood supply a 
guillotine amputation was done 2 inches proximalto the knee 
joint. He was evacuated to a station hospital in the rear 
echelon on 19 Larch 1944. On 23 Larch ne developed anuria 
and died with uremia at 0645 hours, 25 March 1944. xost- 
mortem examination revealed nephroses which was thought to 
have been due to "crush syndrome". (See autopsy protocol 93) 
-105- Ca£e 3. iSSHO 132nd Infantry, 
37th Division, while on a combat patrol lying in an 
open foxhole, sustained a direct hit by a Japanese knee mortar 
shell. He was wounded at I80O hours, 4 April 1944, was taken 
to the command post, given 2 units of plasma and morphine, and 
kept there over night. He had a traumatic amputation of the 
right foot. On the following day an attempt was made to 
transport this soldier to the hospital but he died enroute 
while crossing a river coming into our lines at 1300 hours, 
5 April 1944. The wound was not bleeding when inspected prior 
to the journey hence a tourniquet was not applied. However, 
during the long carry bleeding occurred and death was apparent- 
ly due to shock from hemorrhage. This might have been pre- 
vented by the use of a tourniquet. (See autopsy protocol 93). 
Case b. 182nd Infantry 
Jivision» .was digging a foxhole on Hill 260 
when ricocnet .25* caliber Japanese bullet firea 
from an unknown distance. Ke was woundea at I80O hours, 11 
March 1944 and received immediate first aid. "There was 
practically no bleeding when bandaged. It was aark. Jlfe put 
him on a litter and started down the hill". The patient com- 
plained of feeling cold and when the bottom of the hill was 
reached he was found dead. Profuse hemorrhage haa occurred. 
The rough journey down the hill in ■ohe absence of a tourniquet 
had apparently dislodged a blood clot thus initiating a fatal 
hemorrhage. 
Case 7. 2nd 
talion, 182nd InfantryTAmerical division, was patrol 
ling on Hill 260 a short distance beyond the perimeter when he 
tripped the wire of a U.S.grenade booby trap at 1200 hours, 28 
march 1944. (These booby traps had been set previously and 
no one knew where they were). He threw himself on the ground 
but was struck in the left buttock by a fragment at a distance 
of 3 yards from the burst. He was evacuated immediately to 
the clearing station and found to have a penetrating wound of 
the buttocks extending upward 7 inches into the soft tissues 
of the lumbar region. The point of entrance was 1 inch in 
diameter. Through a 3 inch incision the fragment was removed 
and the wound closed without arainage. The wound of entrance 
was debrided but not sutured. The tract was not debrided, 
but the wound was irrigated and dusted with sulfanilamide pow- 
der. «.fter transfer to the 21st evacuation Hospital on 3 
March 1944, a diagnosis of gas gangrene was made. Despite 
the administration of 2o,000 units of gas gangrene anti-toxin 
and 1000 cc. of blood, death occurred 4 hours later as a re- 
sult of the very virulent Clostridium V/eichii infection. 
Case 6. 37th Gab Kecon Trp. , 
37th hill '/CO prone behind a tree 
when a Japanese knee mortar shell burst within a fe»v feet, Ke 
was wounded at 0430 hours, 11 March 1944, ana taken immediately 
to the battalion aid station. After receiving plasma he was 
transferred airectly to the 21st evacuation hospital. He had 
multiple severe wounds of both legs, thighs, buttocks, scrotum, 
and back. hollowing the administration of an additional 3 
units of plasma and 1000 cc. of blood, wound debridement was 
done under ether anesthesia. On 13 March 194k he developed 
signs of gas gangrene of the right leg and was given 60,000 
units of gas gangrene anti-toxin. Cn 14 March a guillotine 
amputation of the lower third of the thigh was done following 
which the patient became rapidly more toxic and died at 1415 
hours, 15 March 1944. ' - * \ . -j: 
106- f. Multiple Wounds 
Only those .patients who had two or more wounds in 
different anatomical regions either one of which might have * 
produced death or disability are included in the classifi- 
cation "Multiple V/ounds". When a single wound was considered 
responsible for the disability, even though several addition- 
al minor wounds were present, that patient was classified ac- 
cording to the anatomical location of tue major wound. Many 
factors are involved when multiple wounds occur simultaneous- 
ly in different parts of the body. For this reason endeavor 
was made to limit to a minimum the number of casualties in- 
cluded under the division designated "Multiple Wounds". 
Nevertheless, despite this effort there were 239 patients 
seen alive who were so classified. 
In this group of 239 patients who received multiple 
wounds there were eight deaths, making a mortality of 3*3 per 
cent. With one exception (Case 3) > those who died underwent 
surgical operation. These operations were usually sanguine 
procedures, and in most instances death resulted from shock 
and hemorrhage (Cases 1, 2, 4, 5, 6, 7). In one patient 
(Case 8) death was caused by gas gangrene infection. 
In these 239 patients, 569 anatomical regions were 
hit with wounds distributed as follows: Upper extremity 202, 
(35»5 par cent); lower extremity 161 (32.0 per cent); head 92 
(16.1 per cent); thorax 69 (12.2 per cent); and abdomen 25i 
(4.4 par cent). The number of wounas was actually in excess 
of these figures because several wounds frequently occurred 
in one anatomical region. There were 2.8 anatomical regions 
wounded per patient or well in excess of three wounds per 
patient, since many minor wounds from small fragments were 
not even tabulated. 
(Wounded in Action and Died Later) 
which burst near him in the mess hall, at 0730 hours, 11 
March 1944. He reached the operating room of the clearing 
station within 15 minutes and although shock did not appear 
to be severe, was given 2 units of plasma. He had sustain- 
ed a large perforating wound of the left leg, a compound 
fracture of the bones of the left foot, a wound of the left 
forearm, a severed temporal artery', and many small penetrat- 
ing wounds. Following wound debridement shock supervened, 
and despite the administration of 15D0 cc of blood and 2 units 
of plasma, the patient died at 1450 hours, 11 March 1944. 
Death was attributed to irreversible shock, although brain 
injury may have been a factor since bleeding from the ears 
was present. / 
Artillery, was riding in the back of a truck when 
a Japanese 105 mm shell burst 5 yards to the rear at 0730 
hours, 8 March 1944. (Three others were wounded). Because 
10 7- hemorrhage was profuse, a tourniquet was applied to the leg 
immediately and plasma administered. At the nearby 36th 
Naval hospital shock was evident associated with a severe 
wound of the left thigh and right forearm, and an extensive 
wound of the back accompanied by compound fractured of the 
third and fourth lumbar vertebrae. The wounds were cleaned 
but the patient did not recover from shock ana died at 0120 
hours, 9 March 1944. 
Case 3» mngr.Bn. , 
14th Corps, leaving his foxhole to rescue a friend 
was struck by fragments of a Japanese 90 mm mortar shell which 
burst 6 feet away at 0$00 hours, 24 March 1944. He was taken 
directly to the hospital. It was apparent that the patient 
was mortally wounded, a blood pressure reading could not be 
obtained and profound shock was present. a severe wound in- 
volving the brain was found in the temporal region and a pene- 
trating abdominal wound in the region of tne right flanm. He 
died without operation at 0830 hours, 24 March 1944. At 
postmortem extensive lacerations of the liver and kidney were 
discovered. (See autopsy protocol 99). 
Case 4. , 132nd 
Infantry, Americal Division, was investigating a 
mine field when an H3 anti-personnel mine exploded within a 
few feet at 0830 hours, 27 March 1944. He received immedi- 
ate first aid including 3 units of plasma, following which 
he was removed to the clearing station. A traumatic ampu- 
tation of the left foot and extensive lacerated wounds of 
both buttocks and the right forearm were found. Operation 
under ether anesthesia was started at 1000 hours and completed 
at 1115 hours. During the operation $00 cc of blood ana 1 
unit of plasma were given, but at the conclusion of the pro- 
cedure the blood pressure was only 90/60. While recovering 
from ether the patient struggled violently and died suddenly 
at 14$$ hours, 27 March 1944. (See autopsy protocol 104j. 
Case 148th 
Infantry, 37th Division, was running across a 
jungle trail when a U.3. 81 mm mortar shell fell short and 
burst "right between his legs". He was wounded at 0945 
hours, 1 April 1944, and was taken directly to the 33rd Por- 
table Surgical Hospital. A traumatic amputation of the 
right foot, an incomplete traumatic amputation of the left 
leg ana lacerated wounds of the right elbow ana hand were 
evident. After the administration of 2000 cc of blood and 
1 unit of plasma, the traumatic amputation of the left leg 
was completed at operation. The patient died on the operat- 
ing table at 1$U0 hours, 1 April 1944. (See autopsy protocol 
94). f '{ 
Case 6. 182na In~ 
fantry, Americal Division, was in a slit trench 
covering a bazooka man in front when a Japanese Knee mortar 
shell burst in the trench at 0830 hours, ,11 March 194*+. 
Both legs were blown off below the knees as well as the left 
arm ana a portion of the right buttocks. He received 2 
units of plasma, remained rational and reached the 31st port- 
able Surgical hospital with comparatively little bleeding. 
-108- At operation the partial amputation of the arm was completed 
and the other wounds were debrided. He died at 1300 hours, 
11 March 1944 of shock and hemorrhage. 
Case 7. 162nd Infantry, 
Americal Division, while in a foxhole on Hill 260, 
was wounded by a Japanese knee mortar shell which burst in 
the foxhole. The aid men had difficulty in reaching him and 
5 hours elapsed before he could be removed. At the 31st Por- 
table Surgical Hospital shock was apparent ana resulted from 
compound fractures of the right femur and leg, and severe 
wounds of the right arm, chest, and pelvis. After a plasma 
transfusion a Steinmann pin was inserted in the distal end 
of the femur and the lower leg amputated. The patient did 
not survive the operation, however, and died at 135o hours, 
13 March 1944. autopsy showed multiple perforating wounds 
of the right thigh and a compound fracture of the femur. The 
right lower leg had been amputated at the junction of the 
upper and middle thirds, and a compound fracture of the bones 
of the left foot and deep lacerations of the scrotum, chest 
wall and medial aspect of the thigh were present. The ab- 
dominal and thoracic cavities were negative. Death was at- 
tributed to shock and hemorrhage. 
Case 8. 117th Engr., 
37th Division, while driving a vehicle along a jungle 
trail was struck by fragments of a Japanese mortar shell which 
burst in a tree at a distance of 25 feet. lie was wounded at 
103D hours, 9 march 1944, and taxen at once to the 21st Evac- 
uation Hospital. Severe multiple wounds of the right thigh 
and buttocks involving the perineum and scrotum were discover- 
ed, The sciatic nerve had been transected. .vftar appropri- 
ate shock therapy the wounds were debrided and the patient was 
given a prophylactic injection of 5000 units of gas gangrene 
anti-toxin. Immediately after a diagnosis of gas gangrene 
had been established, multiple incisions were made in affect- 
ed areas in the right groin and thigh. The patient expired 
at 2045 hours, 10 ivlarch 1944, approximately 30 minutes after 
the termination of the operation. Death was ascribed to gas 
gangrene infection. 
£. Comment on Treatment of the Pounded 
Perhaps never in the history of Jungle warfare • 
were professional talent and medical facilities so excellent 
and routes of evacuation so favorable as in this campaign. 
Hence, the care of the wounded did achieve a very high standard 
That this was accomplished is evidenced by the foregoing des- 
cription of the treatment of all those who were wounded in 
action and died later. 
The first aid treatment was prompt and efficient. 
Great credit should be given to the aid men who fearlessly 
exposed themselves, ana high approbation to the many who were 
killed in order that their comrades might live. Plasma was 
given promptly and in large quantities. hemorrhage was ef- 
ficiently controlled in all patients with only two exceptions 
Botn of tnese patients bled to death from traumatic amputa- 
tions of the foot. Bleeding had ceasea while the patient 
was at rest, but began anew during transportation. These 
patients might have been saved by the use of a tourniquet. 
Considerable criticism was heard, because sucnin wounds of 
the chest were not tightly sealed by the adequate use of ad- 
hesive. however, no patient was Known to have died because 
of this. 
109 me division medical services were adequately 
staffed to care for the type of surgery they were expected 
to do. Host of the major surgery was done at the 21st 
evacuation Hospital, because of its proximity to the front. 
The clearing stations and portable surgical hospitals were 
usually passed by in order to save time in the case of tne 
seriously wounded. inor surgery was done in the clearing 
stations. One clearing station sutured approximately fifty 
superficial wounds and ootained primary healing in all. 
This was done as a trial and no untoward'results ensued as 
the procedure was limited strictly to superficial fresh 
wounds. While two portable surgical hospitals were avail- 
able, they were not necessary in this campaign. A few 
patients who underwent operation at these hospitals were 
transferred immediately or shortly after operation before 
recovering from shock. This factor may have contributed 
to a fatal termination in some instances. Rapid evacuation 
of patients to the hospitals was possible, because of excel- 
lent roads and more than 60 per cent of all patients reached 
the hospital within three hours. 
The 21st -.vacuation Hospital was staffed with well 
qualified specialists and no patient here failed to achieve 
adequate specialized care. The value of a neurosurgeon at 
the front is frequently a disputed point. In island war- 
fare, unless a competent surgeon is assigned locally the pat- 
ient may have to be evacuated for a distance of hundreds of 
miles. Hence, the various specialists should be available 
if possible on the island where combat occurs. Especially 
is the thoracic surgeon of great value at the front, if the 
lives of these patients are to be saved. The chief defic- 
iency in ranxs of the specialists is the lack of adequate- 
ly qualified anesthetists. One such anesthetist was available 
at the 21st evacuation Hospital, but when faced with the pro- 
blem of anesthetizing eight patients simultaneously, his 
problem was insurmountable. xxs is the case so frequently it 
was impossible to determine which deaths to attribute to im- 
proper anesthesia. Good anesthesia is of first importance 
in dealing with wounds which require major surgical procedures 
in the presence of impending shock. 
Plasma was used in large quantities in the hospitals 
as well as in the forward areas. Blood transfusions were 
more liberally used in this campaign than in any other in tte 
South Pacific. Over 400 transfusions were given in the 21st 
evacuation Hospital with only three reactions. Blood loss 
was usually great ana very large quantities of blood.were re- 
quired to restore blood volume. Blood counts and hemoglobin 
determinations revealed these huge blood deficits ana further 
confirmation was frequently obtained at postmortem. All 
blood was donated by troops on the island and furnished from 
a blood bank maintained at the hospital. 
Professional cere of the wounded was excellent 
and even the unavoidable errors of judgment incident to war 
surgery were at a minimum. ’ There were four patients who 
died of gas gangrene infections, but only one*death could be 
attributed to an error of surgical judgment. In this in- 
stance closure of the wound by suture was responsible. There 
were no deaths due directly to compound fractures of the ex- 
tremities. Only three patients died in the rear echelon. 
-llu- The total mortality among 2,015 treated woundea was 3»7 per 
cent. The total mortality among 1,788 treated in hospitals 
was 5*1 per cent. The total operative mortality was 3*5 pel 
cent. 
y ip:. 77 
A screened operating room in a clearing station. 
Note excellent sterile technique. 
-Ill- Fig.77 (a): The j'eep ambulance carrying three litters 
is well adapted for use over jungle 
Fig.77 (b); Long and difficult litter carries con 
tribute! to some deaths. 7. MORBID ANATOMY 
The study of morbid anatomy in battle casualties is 
limited by the facilities* and the personnel available as 
well as the circumstances of battle. In the tropics it is 
still further limited by the number of’dead which must be 
studied before decomposition, which occurs early. 
This report includes 395 dead on which 104 post- 
mortem examinations were performed. Explanation for the 
relative small number of autopsies is two-fold. First, 
the assigned pathologist was on detached service at Bougain- 
ville for less tnan one-half of the period covered in this 
study. Second, many deaths occurred on patrol or in areas 
which remained unaer enemy fire, and the bodies were not re- 
covered until decomposition had ensued ana consequently ex- 
aminations were omitted. 
All autopsies were performed at Bougainville except 
in three instances in which death occurred in hospitals in 
the rear echelon. Allied dead numbered ninety nine of 
which nineteen were Fijian Scouts and their New Zealand Of- 
ficers. Five Japanese bodies were examined to the 
total of 104. 
The completeness of the postmortem examinations was 
determined by the circumstances, such as the condition of 
the body, whether the cause of death was obvious and the num- 
ber of bodies awaiting autopsy (largest number was 2b on one 
afternoon). Every effort was made to determine the cause 
of death and to record the gross effects of the missile, its 
wounds of entrance and exit and its effects on tissues and 
organs. 
The wounds of entrance responsible for death are 
shown in Figs. 78 and 79. In the case of multiple wounds, 
whenever it was possible to decide which of two or more were 
responsible for death, the wound which caused instantaneous 
death, was recorded. Missiles entering the body in the 
lateral plane are indicated at the extreme edge of the pro- 
file diagram. Although the number of wounds is small, this 
* Facilities for postmortem examination were courteously pro- 
vided by the 21st Evacuation Hospital. The morgue, a screen- 
ed storage tent with a concrete floor, running water and elec- 
tric lights exceeded expectations for a combat zone. The. 
tent was surrounded by a six foot canvas wall which helped to 
isolate it from the hospital wards. Vehicles could reach 
the area without driving past the ward installations. Tech- 
nicians to assist with the work were detailed by the 21st 
Evacuation and the 52nd Field Hospitals. A stenographer and 
photographer recorded all significant wounds and photographed 
all recovered missiles, fragments, or foreign bodies. When 
identification of fragments was difficult, they were taken to 
the Ordaance Section of the XIV Corps for expert opinion. 
The Cemetery and Graves Registration Office were conveniently 
located near the hospital and all dead as they were received 
at the cemetery were transferred to the morgue for examination. 
112 diagram may give some indication of the number of lives 
which might possibly be saved by protective armour. A 
recently devised armour chest plate* (9” x 8") covers a 
square outlined by the sternal notch above, the xiphoid 
process below and the nipples laterally. Such a plate 
could possibly have prevented perforations of the chest 
cavity in sixteen of these chest wounds (39 per cent) 
illustrated in the anterior view. A central abdominal 
armour plate (8" x 6”) could possibly have prevented 4 of 
the seven fatal perforations of the peritoneal cavity. 
* A review of body armour as a protection against missiles 
Bull. W.B., Page 81. 
-113- MORTAL WOUNDS OF ENTRANCE 
IN 104 AUTOPSIES 
4UIZBWR 
Flfi. 78 MORTAL WOUNDS OF ENTRANCE 
IN 104 AUTOPSIES 
pnsrjE/uofi 
Fig. n ANATOMICAL DISTRIBUTION Of WOUNDS 
AUTOPSIES 
DIED LATER 56 
KILLED MSTANTLY 66 
TOTAL 104 
Fig.80 
WEAPONS CAUSINQ WOUNDS 
AUTOPSIES 
DIED LATCH 56 
KILLED INSTANTLY 66 
TOTAL 104 
Fir.81 a. Morbid Anatomy of Wounds by Region 
The autopsied dead were classified under anatomica 
regions according to the location of the wound considered re- 
sponsible for death. In many instances multiple wounds were 
present. Tor this reason it was necessary to reserve the 
classification "Multiple Wounds" for those cases in which two 
or more wounds could Lave been responsible for death. There 
were 1C4 postmortem examinations, sixty eight of these dead 
were killed instantly and thirty six were wounded in action 
and died later. 
(1) Head. in this study twenty six (23 per cent) 
of the autopsied aead sustained fatal head wounds,*twenty of 
these were killed instantly anu six were wounded and died 
later. Characteristic ol this group was the extent and mag- 
nitude of the fragmentation of the skull found at autopsy, 
extensive comminution of the vault with rauiating basal frac- 
ture lines was almost invariably present in these compound 
fractures. Indriven bone splinters were common. The ac- 
companying severe laceration, herniation or avulsion of the 
brain was obviously the cause of death in all head cases, 
hone of the four patients on whom operation was undertaken 
survived longer than forty eight hours. In three of these 
an apparently hopeless prognosis existed from the time of 
injury. 
later 
fracture 
(2) Thorax. There were thirty two (3C.8 per cent) 
deaths from thoracic wounds, ana of this number twenty three 
died instantly. almost half (4o.2 per cent) of all deaths 
resulted from a combination of thoracic and thoracico-abdom- 
inal wounds. Remarkable to note was the widespread des- 
truction produced by high velocity bullets. Gross damage 
or "blast effect" in the opposite lung by such missiles was 
clearly demonstrated in six instances and later confirmed by 
microscopic sections. In two such cases death was attri- 
buted to cardiac failure and in these right ventricular dila- 
tation was found. It was suggested that the blast injury * 
may have produced a partial obstruction of tne pulmonary cir- 
culation.' The rapid administration of intravenous fluids 
may have contributed to the cardiac dilatation. 
Laceration of the lung by perforating or pene- 
trating missiles was present in all cases. The left lung 
was involved in fifteen cases, the right in nine and in eight 
instances bilateral lesions were present. Injury to the lung 
alone resulting in massive unilateral hemothorax caused death 
in thirteen cases. It was not uncommon to find three to four 
liters of blood in the pleural cavity. Seven of these 
patients survived to undergo operation, the others died in- 
stantly. The size of the various external chest wall wounds 
bore no relation to the amount of underlying damage. Partic- 
ularly striking were the small external wounds of the high 
velocity bullet which were so frequently accompanied by ex- 
tensive laceration and destruction of intrathoracic structures 
The lower velocity fragments of explosive shells and bombs as 
a rule produced more extensive external defects. Indriven 
bone (rib; fragments were common. With the exception of Case 
36, in which a metal button was removed, no foreign material 
was recovered. 
115- In order of frequency, perforation or lacer- 
ation of the intrathoracic structures occurred as follows: 
heart, eight; aorta, five; pulmonary artery, four; and trachea 
and esophagus two. The thoracic cord was transected in 
three cases, and the cervical cord in one. Wounds of the 
heart and great vessels were found in approximately 50 per 
cent of these cases. Hemorrhage was the cause of death in 
65 per cent of thorax wounds. 
(3) Thoracico-xibdominal Wounds: multiple lesions 
of the abdominal and thoracic cavities in the same individual 
accounted for sixteen (15*4 per cent) deaths. Only those 
cases in which one missile was responsible for the combined 
injury are included in this group. The wound of entry was 
through the thoracic wall in twelve of t-he sixteen cases. 
Nine were killed instantly and the remaining seven underwent 
operation and died later/ Four patients naa thoracotomy, two 
laparotomy, and one had both laparotomy and thoracotomy. Five 
of these patients died within twenty four hours from hemorr- 
hage and shock, one after eight days from secondary hemorrhage 
and one (Case 66) after six days from cardio-respiratory 
failure. 
The cause of death in fifteen of the sixteen 
cases was hemorrhage and shock, hemothorax and hemoperitoneum 
being Sequently combined. The lung was injured in all cases, 
the heart perforated in one, the thoracic aorta in one and the 
abdominal aorta in another. The abdominal organs injured in 
order of frequency were liver, spleen, hollow viscus, kidney 
and nancreas. 
(4) abdomen. There were twelve (11.5 per cent) 
fatal abdominal wounds. Death resulted from hemorrhage in 
five of the six patients who died instantly, anu in the sixth 
patient was due to shock from evisceration. Of the six 
patients who had laparotomy none lived longer than four days 
following'operation. In these cases death was attributed to 
hemorrhage in one, to paralylic ileus ana uremia in one (dase 
64), and to peritonitis in four. 
Multiple lesions were usually present. In 
order of frequency the abdominal organs injured were as lollows 
jejunum, ileum, transverse colon, and rectum, eleven; major 
vessels, five; kidneys, four; liver,two; pancreas, two; and 
spleen, one. fractures of the vertepral bodies were found in 
four instances. damage to the spinal cord occurred in one 
case and to the cauda equina in another. 
(5) Lower extremities. Wounds of the lower ex- 
tremities were responsible for ten (9.C per cent) deaths. 
Hemorrhage from the femoral artery accounted for death in the 
four soldiers who died instantly. -in the others, both Japan 
ese and about whom little is known, death apparently resulted 
from shock associated with severe compound fractures of the 
femur. 6ix patients were wounded and died later; lour of 
this group underwent operation. Cas gangrene accounted for 
death in three (two Japanese and one American) patients, hem- 
orrhage in two, and uremia in one. 
116- (6) Multiple Wounds. Under this heading are 
classified those cases in which two or more wounds could 
have been the cause of death. In the six who died instan 
ly, the following wound distribution was present: head and 
abdomen, two; head, thorax, and abdomen, one; thorax and 
multiple fractures of the femur, and extensive multiple 
wounds, one; and head with multiple fractures of the femur 
and tibia and fibula, one. In all cases, the immediate 
cause of death was hemorrhage, extensive Drain damage or 
shock or a combination of these three. 
There were two patients who had undergone 
operative procedures. One who sustained a traumatic anpu 
tat ion of the leg and multiple wounds and fractures, died 
from shock within ten hours. The second patient died fro 
gas gangrene after forty eight hours following fracture of 
the femur and other extensive wounds. 
(7) Bummary 
(a) jl. Hemorrhage frequently occult, is the 
most common cause of death. 
2. Extensive brain damage is the second 
most common cause of death. 
it is impossible to determine with 
accuracy the causative missile :rom the appearance of a wound. 
it. The extent of the underlying structur 
damage bears no constant relationship to the size of the 
wound of entrance or exit. 
j>. Foreign material, except for the woun 
ing missile is seldom found. 
6. Contralateral Drain and lung damage 
from high velocity missiles is a frequent finding. Blast 
effect on the contralateral lung may result in sequelae fur 
ther impairing the pulmonary circulation. 
' 7. High velocity missiles striking larg 
blood vessels or solid organs usually produces an explosiv 
effect rather than a perforation. 
(b) Causes of in lc4 autopsies. 
Hemorrhage 
57 
54. S,o 
Brain or Jpinal Cora Bandage 
27 
26.0 
Bhock not due to hemorrhage 
5 
4.9 
Peritonitis 
U' 
3.9 
Gas Gangrene 
4 
3.9 
Cardiac Failure 
2 
1.9 
Uremia 
2 
1.9 
Pulmonary 
1 
.9 
Pulmonary .embolus 
1 
.9 
hmpyema with oepsis 
i 
ikit 
.9 
100.0 '/o 
-117 b. Ilorbid anatomy of .Vounds by V.'eapon 
(1) /founds Caused by Rifle 
The rifle was the weapon responsible for 
death in slightly less than half (42.3 per cent) of the 
autopsied cases. Table I shows the anatomical distribution 
of wounds among those killed by rifle fire. 
TABLE I 
Killed 
Instantly 
Jicd 
Later 
Japanese 
Weapons 
U.3. 
Weapons 
Total 
Head 
12 
3 
13 
2 
15 
Abdomen Thorax 
1 
3 
4 
0 
4 
Thorax 
12 
5 
15 
2 
17 
Abdomen 
2 
1 
3 
0 
3 
Lower extremity 
3 
0 
1 
2 
3 
Multiple 
1 
1 
2 
0 
2 
31 
2E 
44 
(a) Head, head wounds produced by rifle fire 
were characterized without exception by extensive destruction 
of the brain and skull. Laceration, massive herniation or 
total absence of large portions of the brain were the usual 
findings. Large areas of honey skull and scalp were fre- 
quently avulsed with shattering or widespread comminution of 
the residual portions of the skull. Oftimes bone fragments 
were driven deep into the brain tissue. Perforating skull 
wounds were more common than gutter wounds. Frequently long 
stellate fracture lines radiated across the base of the skull. 
Extensive damage was sometimes observed in one hemisphere of 
the brain, when the traversing missile tract lay entirely in 
the opposite hemisphere. All these findings were interpre- 
ted as additional evidence in support of the modern hypotheses* 
of wound production by high velocity missiles. 
There are no features present to distin- 
guish the wounas produced by the Japanese rifle from those 
produced by our own rifle, nor are there any dissimilar find- 
ings in the wounds of those killed instantly and those who 
were wounded and died later. Perforating wounds completely" 
traversing the skull are recorded frequently by the Japanese 
.25 caliber bullet at varying distances from ten feet to 1$C 
yards. 
* That a high velocity bullet produces terrific destruction 
of tissue at a considerable distance from its tract is an old 
observation. Kecent photographic evidence suggests tiat such 
a missile produces a centrifugal motion to the soft material 
through which it passes, producing an effect similar to an 
internal explosion. It is now believed that the rate 
which energy is delivered or the power expended in producing 
a wound is the important factor and that "wounding ability” 
is actually a function of the cube of the velocity o 1 the mis- 
sile. 
-118- Perforation of the U.S.helmet by enemy 
rifle fire was found in six instances. The maximum re- 
corded distance at which this occurred was 100 yards. A 
sample of the sizes of the entrance and exit wounds of the 
head produced by the Japanese rifle at various distances 
follows: 0.6 and 1.2 cm. at 150 yards, f2.5 and 3 cm. at 
100 yards, 0.5 and 1.2 cm. at 20 yards, and 3*7 and 8.7 cm. 
at 15 yards. 
(b) Thorax. Fairly typical of extensive 
thoracic damage caused by the .25 caliber Japanese rifle 
bullet is Case 40. This soldier was struck in the chest 
at moderately close range. The entrance wound was situ- 
ated in the seventh posterior intercostal space, and the 
exit wound over the clavicle. All ribs from fourth to 
eighth inclusive were fractured in addition to the clavicle 
The upper and lower lobes were severely lacerated and a 
massive hemothorax was present. 
Passive intrathoracic hemorrhage was the 
immediate cause of death in all those killed instantly, and 
in two patients who were wounded and died a lew hours later 
Transection of the spinal cord with fracture of vertebra 
was present in four instances. In two of these death oc- 
curred immediately, and in both cases massive hemothorax 
was found. In one of the other two cases, death occurred 
in twenty four hours associated with terminal hyperthermia, 
and in the other after on month following an extensive em- 
pyema complicated by a broncho-pleural fistula. 
All rifle wounds of the chest were with 
two exceptions complete perforating through and through 
wounds. In both of these instances the enemy .25 caliber 
bullet failed to perforate the thorax at a distance of 
twenty five yards. 
Sizes of known wounds of entrance and 
exit at various ranges are shown in Table II. 
TABLE II 
RIFLE WOUNDS 
Distance 
(Ids) 
-1 
5 
5 
20 
20 
25 30 
LTN 
O 
c"\ 
O 
Entrance 
Wound (cm.) 
0.6 
0.5 
1.8 
0.5 
3x1 
0.5 0.6 
0.6 0.5 0.5 
Exit 
Wound {cm-) 
2.5 
1.2 
3.8 
3.7 
3.8x 
2.5 
1.5 4.3 
x 1 
2.5 2.5 
-119- (c) Thorax and Abdomen. The terrific force 
of the .25 caliber Japanese- rifle bullet fired at moderately 
close range (twenty five yards or less) is well demonstrated 
by the great number of structures ana organs injured when 
the thorax and abdomen is traversed by the same missile. 
Structures perforated in each of four illustrative cases are 
listed here: Case 67, anterior chest wall, upper left lobe, 
left ventricle, right ventricle, right lower lobe, diaphragm 
liver, lateral chest wall; Case 71, abdominal wall, jejunum, 
ileum, transverse colon, liver, diaphragm, lower right lobe, 
chest wall; Case 68, chest wall, lung, diaphragm, colon, 
spleen, kidney; Case 69, left elbow (fracture of humerus), 
chest wall, both lobes of left lung, diaphragm, spleen, kid- 
ney, chest wall. The latter patient lived eight days and 
died of secondary hemorrhage from lung and spleen. Death 
in the third case occurred on the following day and resulted 
from cardio-respiratory failure. In the first two cases 
massive hemothorax and hemoperitoneum were present at autopsy 
(d) Abdomen. The powerful disruptive effect 
of the rifle bullet on various abdominal structures can be 
appreciated best by enumerating its destructive effects in 
the individual case. Three patients were struck in the ab- 
domen by Japanese rifle bullets at distances of twenty yards, 
seventy five yards and at an unknown distance. Respective- 
ly, their important injuries were; in Case 77, fracture of 
the ileum and sacrum, perforation of the rectum, and massive 
hemoperitoneum; in Case 78, fracture of the rib and vertebra, 
extensive lacerations of the liver, kidney, and transverse 
colon and hemoperitoneum; in Case 61, extensive lacerations 
of the kidney and liver with hemoperitoneum. Common to all 
these cases and characteristic in the wounds of the solid 
organs in the kidney, liver, and spleen was the widespread 
"shattering” and fragmentation produced by the explosive 
effect of the missile in its passage. 
(e) Lower hxtremity. a Fijian soldier (Case 
87) was struck in the groin by an enemy rifle bullet which 
severed the femoral artery ana vein. He died within a few 
minutes from exsanguination. A Japanese soldier (Case 89) 
sustained a severe compound comminuted fracture of the mid- 
dle third of the femur and died .from shock several hours 
later despite therapy. Cursory examination of the decom- 
posed body of another Japanese soldier (Case 90) revealed 
an extensive comminuted compound fracture of the femur with 
a very large wound of exit (16.6 x 13.9 cm.), but with in- 
tact femoral vessels. In these last two cases, death ap- 
parently resulted from severe shock without significant 
concomitant hemorrhage. 
(f) multiple. Two patients sustained mul- 
tiple rifle wounds. One of these (Case 101) died instantly, 
the other (Case 103) died two days later from peritonitis 
and gas gangrene. 
(2) Mortars end Grenade Discharges. 
kort&r fire accounted for death in approxi 
lately one fourth (23.1 per cent) of the autopsied cases. 
-120- The anatomical distribution of wounds among those hilled 
by this weapon is shown in Table III. 
TABUS III 
Tiled 
Instantly 
l)ied 
Later 
Japanese U.S. 
Weapons Weapons 
Total 
Head 
4 
2 
3 
3 
6 
Abdomen Thorax 
2 
2 
4 
0 
4 
Thorax 
5 
1 
4 
2 
6 
Abdomen 
1 
2 
2 
1 
3 
Lower Extremity 
0 
4 
2 
2 
4 
Multiple 
1 
0 
1 
0 
1 
Total 
13 
11 
16 
8 
24 
It is interesting to observe that the im- 
mediate lethal effect of the low velocity mortar fragment 
is appreciably less than that of the high velocity rifle 
bullet. Only slightly more than half of the autopsied 
dead, wounded by the mortar, died instantly; whereas, two- 
thirds of all autopsied cases struck by rifle bullets were 
killed instantly. 
In cases in which perforation of the skull 
occurred, the size of the skull wounds and distance from 
the burst are known in three. At twenty five yards a 
fragment (3 x 1 x 0.8 cm.) of a U.S. 90 mm. shell perfor- 
ated the skull and resulted in death two hours later from 
the extensive brain damage (Case 12). -‘•he entrance wound 
in this case measured 2.5 cm. in diameter. U.S. 90 mm. 
shell exploding at a distance of twenty yards produced a 
large gutter wound in the skull measuring 6.2 x 1.8 cm. 
(Case 3). heath followed in three hours. small metal 
fragment (20 x 4 x 1 mm.) was recovered from the. inner table 
of the skull. In the third instance (Case 26) a soldier . 
was struck by a fragment from a Japanese 90 mm. shell at a 
distance of seven yards. An entrance wound of 2.5 x 0.5 
cm. was produced. This soldier expired after twelve hours 
from the cerebral injury. 
A fairly characteristic feature of mortar 
wounds of the thorax was the extraordinary extent of the 
defect identified as the wound of entrance. For example, 
a Fijian soldier (Case 29) was killed instantly by a U.3. 
90 mm. shell which burst twenty yards away. mven from 
that distance the fragment completely traversed the thorax 
and produced a wound of entrance 8.2 x o.8 cm., and a wound 
of exit 20 x 12.5 cm. In another instance (Case 46) an en- 
trance wound defect over the region of the scapula measuring 
20 x 10 cm., was produced by a fragment of a 90 mm. Japanese 
■a't 1 ilej-h shell bursting at a distance of twenty yards. On 
the other hand a mortar "fragment in its greatest dimension 
measuring a little more than 1.0 cm. , caused death from in- 
trathoracic hemorrhage (Case 48). This fragment originated 
from an enemy 90 mm. shell burst at ten yards. The wound 
121 of entrance in this case measured only 1.5 cm. One 
patient (Case 51) survived for a period of three days 
following severe chest injuries resulting from the ex- 
plosion of a C.S.4.2 mortar shell at a distance of three 
yards. 
In the abdomen extensive laceration of mul- 
tiple orgsns and structures was frequently observed. 
Death in these if immediate, resulted from hemorrhage and 
shock. Two patients surviving for three and five days 
respectively after laparotomy died of peritonitis. The 
first patient (Case 83) was struck in the abdomen by a frag- 
ment of an enemy 90 mm. mortar shell at a distance of twenty 
five yards. multiple perforations of the jejunum and colon 
resulted but unfortunately the jejunal lacerations were over 
looked at operation. The second patient (Case 84) was 
wounded by the burst of a 4.2 U.3. mortar shell at a dis- 
tance of three yards. The largest external defect in this 
case was an entrance wound measuring 1) x 5 cm. over the re- 
gion of the right iliac crest. Laceration of the right 
kidney and cauda equina, and a large retroperitoneal hema- 
toma were found at operation. 
There were four autopsied dead who haa sus- 
tained lower extremity wounds only. One of these deaths 
might have been prevented. In this case a soldiers foot 
was blown off by the point-blank burst of an enemy shell 
(Case 91). evacuation of this patient was effected at 
night twenty four hours later. In the process of trans- 
portation by litter and unknown to the aid men, delayed 
hemorrhage occurred and the soldier expired. In another 
case (Case 93) amputation was performed one uay after in- 
jury, because of damaged blood supply to the extremity. 
This patient died five days later with uremia, the cause 
of which was unknown. A U.3. 81 mm. "short" exploded be- 
tween the legs of a soldier (Case 94) who lived thereafter 
for six hours. Traumatic amputations of both lower ex- 
tremities resulted, the left thigh and right leg at the 
level of their upper thirds. A Japanese soldier (Case 96) 
died of gas gangrene four days after being wounded. The 
femoral vessels were intact but thrombosed and the femur was 
not fractured. In this instance the wound on the medial 
surface of the thigh measured 17 k 16.2 cm. 
Two small external wounds resulted from the 
explosion of a 9C mm. Japanese mortar shell at a distance 
of two yards in a patient (Case 99) who survived only a few 
hours. One wound over the parietal region measuring only 
1.5 cm. in diameter had resulted in extensive intracranial 
injury and hemorrhage. The liver and right kidney were 
extensively lacerated and a massive hemoperitoneum was pre- 
sent. This was the only case listed under "Multiple 
’/Zounds” by mortar fire. 
(3) Machine Gun. The only distinguishing 
feature between rifle and machine gun wounds is that the 
latter are more often multiple. In all other respects 
wounds produced by rifle and machine gun bullets of liKe 
caliber and muzzle velocity are identical. There were 
twenty six separate wounds in these thirteen dead. 
-122 Grouped anatomically the wounds responsible for death were 
divided as follows: head two, thorax four, thorax-abdomen 
five, and abdomen four. eleven were killed by enemy wea- 
pons and two by our own weapons. light of the thirteen 
autopsied were killed instantly, with one exception the re- 
maining wounded died within a few hours. Two of the dead 
were struck by .25 caliber bullets at distances of 150 yards, 
this being the maximum range recorded. In one of these 
(Case 27) a perforation of the thorax resulted, the entrance 
wound of which measured 2 cm. and the exit wound 3 x 1.5 cm. 
In the other (Case 5) a larger gutter wound of tne skull was 
found measuring 6.5 x 2.5 cm. 
(4) Grenades. The grenade produced death in seven 
(6.1 per centj of the autopsied cases. lour of these deaths 
resulted from the*U.3.Grenade, ana three from the Japanese. 
The anatomical distribution of fatal wounds among the autop- 
sied dead was; abdomen and thorax, two; thorax, one; abdomen, 
two; lower extremity, one; and multiple, one. With one ex- 
ception all patients wounded by grenades had multiple wounds. 
This soldier (Case 92) while on guard tripped the wire of a 
U.S.grenade booby trap and was struck in the buttock by a 
single fragment. he died six days later from gas gangrene. 
A U.S. grenade exploded in the hand of an American soldier 
(Case 65) returning from patrol. kultiple abdominal organs 
and intestinal loops were perforated. Despite laparotomy 
and supportive treatment, this patient died on the following 
day. Multiple wounds and massive hemorrhage 
were found in two soldiers whose deaths resulted from point- 
blank bursts of our own grenades. In one instance (Case 
a soldier returning to his own foxhole was mistaken for the 
enemy and in the other (Case 64) an unexplained explosion 
occurred in the pocket of a soldier returning from patrol. 
Three deaths resulted from point-blank explosions of Japan- 
ese hand grenades, and in all instances multiple wounding 
was present. The cause of death was intrathoracic hemorr- 
hage in the two cases in which death was instantaneous. In 
the other case the patient died after twelve days from gen- 
eralized suppurative peritonitis due to evisceration follow- 
ing laparotomy. The grenade fragments did not perforate 
the abdominal cavity. No conclusions can be drawn from 
these dead as to different effects ol the Japanese and U.S. 
grenades. 
(5) artillery. Of the six autopsied dead by 
artillery fire, four were killed instantly bj our own wea- 
pons. Two of these dead (Cases 9 and 16) sustained sever 
head wounds from 75 mm. shell bursts at distances ox live 
and twelve yards respectively. In the other two cases 
death resulted from extensive thoracic /vounus, produced in 
one (Case 34) by a 37 mm. enemy shell burst at three yards 
and in the other (Case 42j by a U.S. sheii ol unknown call 
ber at a distance of five yards. One patient (aase 13) 
was killed instantly and anotrrer (Case 5.7) lived for only 
a few hours following the explosion of a Japanese shell 
(probably 15 cm.) at distances of less than two yards. 
-123- (6) Lana Pines. That the U.3. land mine is a 
most deadly weapon is convincingly demonstrated by the autop- 
sy findings in seven cases. of these dead had many 
wounds, and all were killed instantly except two. One of 
the two who survived the initial blast was a Japanese sol- 
dier (Case 95). His death later in an ijuerican hospital 
was due to gas gangrene. The other was an American soldier 
(Jase 1U+J who lived a little more than six hours and aied 
from £.iOC 1c. The postmortem findings in tnis instance well 
illustrate the multiplicity of wounds found. The solaier 
sustained a traumatic amputation of the foot ana thirteen 
penetrating wounds. Present also were compound comminutea 
fractures of the patella, internal malleolus of the tiuia, 
sacrum and ulna. 
Other examples of the extreme aegree of 
trauma caused by these land mines is seen in the cases of 
five soldiers who were xilled instantly. strixing il- 
lustration is that of a soldier (Case lo2) in whom avulsion 
of the right and left 1 rental lobes and part of the right 
parietal lobe occurred with destruction of the orbit, fron- 
tal bone and an area of skull measuring lo x o cm. In 
addition compound fractures of the tibia (bilateral)#, fib- 
ula, femur, ulna, and mandible were present. altogether 
there were eighteen, widely distributed, perforating and 
penetrating wounds. One other case will suffice to il- 
lustrate the lethal effect of this weapon. Postmortem 
examination showed seven penetrating and perforating wounds 
(Case 100). n fragment passed thru the sxull fracturing 
the maxilla, zygoma, and temporal bones, and then made its 
exit through the fronto-temporal region. In its course 
the missile-destroyed the right frontal lobe. Another 
fragment entered the abdomen, severed or perforated the 
pyrlorus, duodenum, jejunum, and small intestine mesentery, 
and finally louged in the bifurcation of the aorta. The 
peritoneal cavity was filled with blood, the brachial 
plexus was severed and there were numerous other wounds 
of the thoracic and abdominal walls and' thigh. 
In all these instances it is assumed that 
the victim either stepped directly on the mine or was in- 
jured at close range by having tripped a mine wire. £. Protocols 
INDEX 
Case Lio. 
Name 
./ouLds By region 
Weapon 
1 9 
Head 
Rifle* 
2 M 
Head 
Aiii i e 
3 M 
Head 
mortar* 
4 m 
• 
Head 
it if le 
5 9 
Head 
Machine Gun 
6 A 
T «ri 
xaS&Q 
Lortar 
7 ■ 
heaa 
Rifle 
8 9 
Head 
Rif le 
9 m 
# 
Heaa 
artillery* 
io 9 
Head 
Rifle 
ii m 
Head 
Rifle 
12 9 
Heaa 
Mortar* 
13 m 
■hhhhhb • 
Head 
Artillery 
u m 
Head 
Lortar 
15 ■ 
Head 
Rifle 
16 fi 
Head 
artillery* 
17 9 
1,'j? 
'H^d 
Rifle 
18 9 
HeacT''^. 
Rifle 
19 9 
li&CiU 
Rifle 
20 9 
Head 
iiif le 
21 9 
Head 
i\if le 
22 ■ 
Head 
N Rifle* 
23 m 
Head 
Lortar 
24 9 
Heaa 
Lachine Gun 
25 9 
Head 
Rifle 
26 9 
■9^^^99B|99[M 
Head 
Lortar 
27 ■ 
Thorax 
Lachine Gun 
2 a ji 
Thorax 
machine Gun 
29 9 
Thorax 
Lortar* 
30 9 
Thorax 
Rifle 
31 9 
Thorax 
Rifle 
32 9 
Thorax 
Rifle 
33 9 
Thorax 
Land *..ine* 
34 9 
Tnorax \ 
Artillery* 
'35 9 
Thorax \ 
Lortar 
36 9 
Tnorax \ 
iv.ortar 
37 9 
Thorax \ 
Rifle* 
38 9 
Thorax 
a i f 1 e 
39 K 
Thorax 
.Grenaae 
40 IB 
Thorax 
Rifle 
41 9 
Thorax 
Rifle 
42 9 
Thorax 
Artillery* 
43 9 
Tnorax 
Rifle 
44 ■ 
Thorax 
Rifle 
45 9 
Thorax 
Rifle 
46 9 
Thorax 
Lortar 
47 9 
HH lllllllll H ip* 39 
Thorax 
Rifle 
48 ' 9 
Thorax 
Lortar 
49 9 
‘c* 
Thorax 
Rifle 
-lo- Case No. 
Name 
Wounds by Region 
.Veapon 
50 
BUI Thorax 
.Rifle 
51 
mam Thorax 
mortar* 
52 
■H Thorax 
Rifle 
53 
■■B Thorax 
Rifle3" 
54 
Thorax 
Lachine dun 
55 
Thorax 
Rifle 
56 
■V;?B1 Tiiorax 
xin 16 
57 
mm Tnorax 
.artillery 
58 
' >. ■§. Thorax 
la chine Gun 
59 
mm Thorax-Abdomen 
hachine Gun 
60 
■■■ Thorax-Abdomen 
hachine Gun 
61 
mm Thorax-Abdomen 
hortar 
62 
vhH Thorax-Abdomen 
Grenade 
63 
Thorax-Abdomen 
Lana hine’ 
64 
W/0 Thorax-Abdomen 
Grenade5" 
65 
Thorax-Abdomen 
hortar’ 
56 
Thorax-Abdomen 
hachine Gun 
67 
mmf Thorax-Aba omen 
Rif le 
68 
mam Tharax-Abaomen 
Rifle 
69 
Wm Thor ax-Abdomen 
Rifle 
70 
|m Thorax-Abdomen 
hortar 
71 
$m Thorax-Abdomen 
Rifle 
72 
ma Thorax-Abdomen 
hachine Gun5" 
73 
m• Thorax-Abdomen 
hachine Gun 
74 
aatm Thorax-Abdomen 
** *0 x Ck X* 
75 
mm Abdomen - 
45 cal.li-toi* 
76 
Abdomen 
hortar 
77 
m Abd amen 
mi fie 
78 
|pH Abdomen 
mif le 
79 
mm Abdomen 
machine Gun5,1 
80 
$am Abdomen 
hachine Gun 
81 
HP -Abdomen 
Rifle 
82 
mm- Abdomen 
Grenaae 
83 
mm a.ba omen 
hortar 
84 
B Abdomen 
hortar’ 
85 
BB abdomen 
Grenade’*' 
86 
IHF Abdomen 
Aerial Bomb’ 
87 
mam Lower Extremity 
mifle 
£8 
-m Lower Extremity 
Bayonet5" 
89 
mm* Lower extremity 
Rifle* 
90 
■p Lower Extremity 
Rifle* 
91 
BBBV Lower extremity 
hortar 
9*- 
mmm Lower extremity 
Grenaae’ 
93 
mmm Lov;er extremity 
hortar 
94 
am0 Low er mxt r em 11 y 
hortar’ 
95 
■H Lower Extremity 
Lana hine’ 
96 
PPB axtremitp- 
hortar’ 
97 
BB .uitiple 
land i..ine* 
98 
mama multiple 
Grenaae* 
99 
Lultiple 
hortar 
100 
* I.uitiple 
I ine’ 
101 
'■': ..uitiple 
Rifle 
102 
hultij le 
rand hine’ 
103 
w ..uitiple 
Rifle 
104 
Bi Multiple 
manu ...inc* 
* U.i. .'eepon 1 
CAlil 
pern g n 11 KSHI lc>4th Inf. , while . alking 
thick jungl^towards our lines returning from patrol, 
was mistaken for the enemy’and shot through tne head with an 
L'-i rifle at a distance of 30 yards by a fellow soldier. Ke 
was wearing a helmet when struck ana this was perforated in 
the front and back. HHHV waS Q instantly at 1700 hours 
1 rii 1944. 
examination revealed a perforating wound of tne skull. The 
bullet produced a wound of entrance (3 cm. in diameter) through 
the left orbit and a wound of exit (2.5 cm. in diameter; at 
tne Junction of the parietal and occipital bones. Comminution 
of tne cranial vault with diffuse disruption of the brain was 
present. 
The photograph demonstrates tue widespread destruction of tne 
cranial vault ana Drain. (scalp retracted). 
CA3E 2 
j^|Bn., FIR (Fijian), 
a tree when struck by a .25 
caliber Japanese bullet fired from a distance of 20 yards. 
I e was killed instantly on 3i March 1944. 
-ixamination revealed a perforating wound of the head. The 
entrance wound (0.5 cm. in diameter) was situated over 
lateral border of the right supra-orbital riage and the exit 
wound (1.2 cm. in diameter) over the occipital bone.  
itellate fractures of the frontal and occipital tones radi- 
ated ftoil both perforations. The frontal and parietal lobes 
cf the brain were perforated, ana the cerebellum was grooved. 
In the photograph the wounds of entrance and exit are demon- 
strated by the insertion of instruments. 
3 r* *, o 
Ca32 3 
3rd Bn. FIB (Fijian, while on patrol 
was standing digging a foxhole when strucx. by a iragment Irom 
a U.0.9O mm shell. The shell exploded on the ground at 2o 
yards distance. He was wounded at l?0o hours, 34 ..arch 1944» 
ana died 3 hours later in the hospital. heath was attribu- 
ted to severe brain damage. 
Examination revealed a gutter wound (b.2 x 1.8 cm.] in the 
right frontal region. « stellate fracture involved the vault 
of the skull. The fragment coursed obliquely through the 
right cerebral hemisphere to the posterior aspect of the left 
parietal lobe. metallic fragment (2o x 4 x 4 mm.) was re- 
covered at this point and was found to be partially imbedded 
in the inner table. 
The photographs illustrate tne extensive fracture of the sxux. 
and the recovered fragment. 
CASE 4 
129th Inf., crouching 
behind a tree stump stood to throw a hand grenade anp. was 
struck: in the head by a .25 caliber Japanese bullet fired 
from a distance of lu feet; he was wearing a helmet which wat 
perforated un tne left side. hilled instantly 
at J>30 hours, 24 l arch 1944. 
Cursor} exaiiiination* revealed a perforating wound of the left 
* On this afternoon twenty six bonier were received ana since 
time did not permit a complete examination of all esses, some 
of these in which the cause of heath was obvious received only 
cursory examinations. side of the skull. The entrance wound involved the left 
orbit. The exit wound was found over the left parieto- 
occipital region. . Brain tissue exuded from both openings. 
The cranial vault was severely comminuted ana the left cere- 
bral hemisphere destroyed. 
CASS 5 
CASE 3 
FIR (Fijian), while on patrol peered 
over a ridge ana was struck in the head by a .25 caliber 
Japanese machine gun bullet fired from a distance of 150 
yards. He was silled instantly at 1000 hours, 26 March 
1944. After death from the head wound, he was struck 
again in the chest by a fragment from an artillery shell. 
Examination revealed a gutter wound (6.5 x 2.5 cm.) in the 
center of the forehead, a portion of the frontal bone had 
been blown away. Fracture lines radiated through the 
temporal, parietal, and occipital bones. Both frentals 
and the right temporal lobes were lacerated. A bullet was 
recovered from the right temporal fossa. The chest was 
penetrated by a shell fragment entering through a wound 
(10 x 5.0 cm.) in the left 7th and 8th intercostal spaces 
in the anterior axillary line. In its course the frag- 
ment fractured the 8, 9, 10, and 11th ribs, lacerated the 
left lower lobe, the upper and lower right lobes, fractured 
and perforated the bodies of the 7th and 8th dorsal verte- 
brae, transected the spinal cord and fractured the 3rd, 4th 5th and 6th ribs at the costovertebral junctions. The 
fragment was lodged in the subcutaneous tissue of the right 
posterior chest wall. 
The photograph shows the two recovered fragments. 
Giujig fe 
CA3h 6 CASS 6 
CASS 6 
117th jMgx., while lying in 
'an open foxhole in a cleared area of the jungle was struck 
by fragments of a Japanese mortar shell. * The shell exploded 
on the ground at a distance of 1 yard. He was killed instant- 
ly at 2015 hours, 24 Larch 1944. 
Examination revealed a penetrating wound of the head. The 
entrance wound (2.5 cm. in diameter) perforated the left oc- 
cipital bone. There were severe comminution of the cranial 
vault and several fracture lines continued inferiorly through 
the base of the skull traversing the foramen ovale and cribi- 
form plpte. The left occipital and temporal lobes were 
severely lacerated and small indriven bone fragments were re- 
moved from these lobes. Two metal fragments v/ere recovered 
from the depth of an irregular laceration of the left cere- 
bellar hemisphere. The fragments measured 15 x $ x 1 mm. 
and 15 x 10 x 2 mm. 
Photographs show the extensive skull fractures ana the re- 
covered fragments. 
CASH 7 _ 
129th Inf., was lying be- 
hind a tree root and was! struck by a Japanese .25 caliber 
bullet fired from a distance of 10 yards. He was killed in- 
stantly at 1000 hours, 24 t'arch 1944. 
Cursory examination revealed a perforating wound of the 
skull. The entry wound traversed the right orbit and the exit ;<uuna was found over the parieto-occipital region. 
TLe cranial vault was extensively fractured, and marked 
destruction of the right cerebral hemisphere was evxaent. 
Photograph shows the large wound of exit with brain tissue 
exuding. 
GA3h 7 
CA3JS  8. 
CUSii 6 
129th Inf., 37th division, 
was standing on his bunm in an open tent in battalion head- 
quarters firing at the enemy, when strucx by a .23 caliber 
Japanese bullet lined from a distance of 25 yarns. He was 
killed instantly at 0630 hours, 24 l.arcn 1944. 
examination revealed a gutter wound cm.) of the 
left parietal region. brain tissue exuded through the per- 
foration in his helmet. Lacerated brain tissue, portions 
of the frontal and parietal lobes, was nerniateu through the 
wound. Larked subgaleal hemorrhage was present. The cra- 
nial vault was comminuted by sterlate fractures. Loth hemi 
spheres of fhe brain were extensively lacejeiteu. mush- 
roomed .25 caliber buLlet was found in the right anterior 
fossa. 
photographs show the severe comminution of the sxuil (scalp 
retracted). The missile was identified as a flattened .25 
caliber bullet. 
case 9 
_ . _ _ 164th Inf*., while on patrol in 
cleared Jungle lying in an open foxhole, was struck by a 
fragment of U.3. 75 . shell which fell short. The shell 
exploded on the ground at a distance of 5 yards. He was 
killed instantly at IbUO hours on 2b march 194h. Exanination revealed an extensive {.utter uound traversing the 
left side of the shuxl. lie occipital, parietal ana temporal 
bones .vere almost entirely destroyed. Only fragmentary por- 
tions of tne left cerebral hemisphere remained. 
J.. .. la 
CaSE 1C 
FIH, peering over the edge ol an 
open foxl*ole to lire at the enemy was struct by a .13 calioer 
Japanese bullet fired from a distance of 15 yards. Le was 
killed instantly at 14uo hours, 1 April 19*+*+. r7ne body wc s 
not recovered immediately ana re-ceivtd other wounas from nigh 
explosive fragments after death. 
examination revealed a perforating v/ouna oi tut real am mul- 
tiple wounds or the extremities. The heau wound oi niir;. 
(3*7 cm. in diameter; locate i at tne inn».r cantnus oi 
the left eye ana the exit wound (d.7 on., in uiamter] at the 
vertex of the skull. Ihe skull was conminutea ana tnere was 
a Laost complete destruction of the left half of the train, 
iresent in addition were: a perforates ... una of the right 
elbow associated with compound comminuted fracture of tne 
radius, a perforated wound of the soft parts ox* the right 
calf, ana an extensive gutter wound of tne left hand. 
The photograph shows the shell fragment removed from the left 
hand. CASE 11 
Anti-Tank Co.., 129th Inf., was 
crouching and moving forward in a skirmish line when struck 
by a Japanese .25 caliber bullet fired from a distance of 2u 
yards. He was killed instantly at 1300 hours, 24 March 19^4. 
Cursory examination revealed an extensive gutter wound 15 x 
10 cm. involving the left temporal, occipital ana parietal 
regions. Large portions of these bones and unuerlying, ora in 
were absent. extensive comminution of the remaining cranial 
vault was present. 
The photograph shows the destructive effect of the missile. 
CxiSS 11 
Cjioii 12 
FIR (.Fijian), while on patrol 
was standing digging a foxhole when struck by a fragment of 
a U.3. 90 mm shell. The shell exploded on the ground 25 
yards distant, Ke was wounded at 1700 hours, 30 March 1944» 
and died 2 hours later. Death was caused by extensive brain 
damage. 
The wound of entry (2.1 cm. in diameter) in the head was 
located 2 cm. above the right tragus. Brain tissue exudea 
from this wound. The fragment perforated the temporal bone 
producing stellate fractures of the temporal and frontal 
bones. The wound tract traversed the right temporal, 12 
12 frontal and left frontal lobes. a fragment (3 x 1 x 0.6 cm) 
was found in the left frontal lobe. examination revealed 
additional wounds; traumatic amputation of the left thumo, 
extensive laceration of the dorsum of the left hand and wrist 
and perforating wounds of the soft tissue of the anterior, 
right and left mid-thighs. 
One photograph shows a metal probe inserted into the wound 
of entry in the head, evident also is the extensive hand 
wound . The metal sliver recovered from the Drain is shown 
in the other photograph 
CnJj. 13 
182nd Infantry, 
while in a covered pillbox on top of a hill was strucx by 
fragments from a 150 mm Japanese shell which exploded on 
the ground 1 yard from the hole. He was billed instantly 
at 1400 hours, 26 Ivlarch" 1944. 
examination revealed a gutter wound (15 x 5.5 cm.) of the 
left side of the neclo with extensive soft tissue damage ana 
transection of tne external jugular vein. another gutter 
wound {10 x 3-7 cm.) extended obliquely across the 5th and 
6th cervical vertebrae. The vertebrae were shattered. nt 
autopsy the dura was opened, the cord exposed and 
found intact. Ho foreign bodies were found. 
CA33 14. CASE 14 
1129th Infantry, was 
found dead in the 129th sector on the 24 Llarch 1944. He 
was struck in the left arm and leg by a Japanese .25 caliber 
bullet. The head wound is believed to have been caused by 
a Japanese mortar fragment. 
Cursory examination revealed perforating wounds of the soft 
parts of the left thigh and arm. A severe penetrating wound 
through the left orbit was present as illustrated in the 
photograph. marked comminution of the cranial vault was 
found with brain tissue exuding from the head wound. 
CASE 14 
casa 15 
132nd Infantry, 
was on patrol duty and had bivouaced in the open for the 
night. during the middle of the night he stood up to void 
and was shot by an apprehensive fellow soldier with an M-l 
rifle at a distance of 10 yards. He was killed instantly 
at 2350 hours, 21 .vprix 1944. 
examination revealed a perforating wound of the neck. The 
entrance wound (1.2 cm. in diameterj penetrated the left 
submental triangle and the exit wound {12.3 x 7.3 cm,) oc- 
cupied the posterior cervical region from the 3rd to the 6th 
vertebrae. The 4th and 3th vertebrae were shattered, the 
cord was exposed and was partially severed at the same level CAjE 16 
CASE 16 
164th Inf., while on patrol 
in the jungle was lying oh a slope under a tree when struck 
by a fragment of a U.S. 75 mm. shell which fell short. The 
shell exploded in a tree 12 yards above the soldier. He 
was killed instantly at 1600 hours 26 March 1944. 
examination revealed a penetrating wound of the left occipital 
region 3*7 cm. in diameter. Brain tissue exuded through this 
wound. The fragment pierced the left occipital bone, left 
occipital lobe and left cerebellar hemisphere. A shall frag- 
ment was found on the inferior surface of the cerebellum. A 
linear fracture line extended across the left occipital, pari- 
etal and temporal bones. 
The fragment recovered, which is shown in the photograph measured 
6x5x4 mm. 
CASE 17 
, 129th Inf., while walking 
up a jungle trail was struck by a Japanese .25 caliber bullet 
fired from a distance of ICO yards. he was killed instantly 
132u hours 24 Larch 1944. 
Examination revealed a perforating wound of the Lead. The 
wound of entrance (2.5 cm. in diameter) traversed the right 
infraorbital ridge, the exit wound (3 cm. in diameter; was 
located in the left parieto-occipital region. lien the body 
was received the helmet had not been removed ana brain tissue 
was extruded over its surface. 
The photograph shows an instrument in the wound of entrance 
and exit .N The perforation in the helmet is eviuent. C.n.33 17 
CASA IS 18 
_ was standing 
in a cleared area digging a foxhole when struck in the head 
by a . 2t> caliber bullet. The shot was fired by a Japanese 
sniper at a distance of over 150 yards. He was billed in- 
stantly at 15o0 hours 2b March 19**a. 
examination revealed a perforating wound of the head, the 
entrance wound (o.o cm. in diameter) was posterior to the 
left mastoid process and the exit wound (1.2 cm. in diameter) 
at the outer canthus of the right eye. The bullet coursed in 
a superior ana anterior direction ana perforatea the atlas, 
it then crossed the foramen magnum ana severed the- brain stem 
at the lower level of the pons. The tract continued through 
the base of the skull, right ethmoid and right orbit to tne 
point of exit. 
rlhe photograph shows a catheter in txje wound tract. 
19 
flUwh on 
as a sniper in the Jungle, peered ever a protecting log and 
was struck In the head by c .23 caliber bullet. The shot 
was hired by a Japanese sniper Tro:n an unknown distance, 
he was Killed instantly on 24 h'arch 1944. Cursory examination revealed a penetrating wound of the 
skull, with the wound of entrance in the left orbit. A 
compound comminuted fracture of the skull with marxed 
brain destruction was present. The large number of dead 
received on this day prevented a more complete examination. 
The photograph showg the extent of the wound of entry. 
CASS 2C 
CASL 20 
> 129th inf., was sitting 
on a log holding a flame thrower when struct in the head by 
a .25 caliber Japanese bullet fired from a distance of 75 
jrards. Lis perforated helmet was found lying on the ground, 
was hilled instantly at hours, 27 Larch 194h. 
examination rtvealea a gutter wound 17.5 x 4 cm. involving 
the left temporal ana frontal regions. There were aeep 
lacerations of the frontal parietal ana temporal lobes, 
disorganized brain tissue fillea the wound. extensive 
comminution of the cranial vault was found. 
The photograph illustrates the extent of the wound.  182nd Inf., while crouched, 
withdrawing from enemy fire was struck in the bacK-of the 
neck by a .25 caliber Japanese bullet firea by a sniper from 
a distance of 35 yards. He was wounded at 0600 hours on 
15 Larch 1944. His death 8 hours later was accompanied by 
a terminal hyperthermia. 
Examination revealed a perforating wound of tne posterior 
cervical region. The entrance wound (o,5 cm. in diameter) 
was located to the right of the spinous process of the 5th 
cervical vertebra and the exit wound (5 cm. in diameter) over 
the vertebral border of the left scapula. a fracture of the 
transverse process ana lamina of the 5th cervical was dis- 
covered. The dura and the cord were intact, but the cord 
was bulbous and hemorrhagic for a distance of 2 cm. Be- 
cause of the patient’s profound shock no operative interfer- 
ence was attempted. 
CASE 22 
Fi i ian) while walking 
towards his own lines returning from patrol was mistaken for 
the enemy and shot. He was strucK in the right side of the 
head and abdomen by .303 caliber bullets fired from a Lee- 
mnfield rifle at a distance of 13 yards. He was wounded at 
1810 hours on 23 Larch 1944 and died 2055 hours. The sol- 
dier died on the operating table, while an’attempt was being 
made to stop bleeding from the brain. 
Postmortem examination revealed a gutter wound of the right 
side of the head extending from the inner canthus of the 
right eye to the occipital bone. The diffusely lacerated 
right cerebral hemisphere was herniated tnrough the wound. 
Bone fragments had been driven into the Drain ana extensive 
hemorrhage was present. The abdominal cavity was filled 
with blood from severe lacerations of the right Kidney and 
liver. 
GA3E 23 
open observing 
mortar fire was struck by a fragment of a Japanese mortar 
shell. The snell burst on a pillbox 3 yards distant from 
the soldier. rafter injury the patient walked to the bottom 
of the hill, he was then placed in an ambulance and taken 
directly to the -vacuation hospital. he was wounded at 
1800 hours, lo Larch 1944. Craniotomy was performed but 
the patient died 6 hours later. Death was attributed to 
severe intracranial hemorrhage. 
iou tit autopsy revealed a penetrating wound of the 
right orbit with destruction ol the globe-. Craniotomy in- 
cision was present. A stellate fracture of the right fron- 
tal bone with laceration ol the frontal lobe and narked in- 
tracranial hemorrhage was found. CASE 24 
» walking 
through the jungle on patrol was struct by a Japanese machine 
gun bullet. He was wounded at 1800 hours, 3C April 1944, 
and arrived at the hospital three hours later. gutter 
wound of the left frontoparietal region was debrided and 
closure of the wound attempted. His death at 1210 hours, 
2 Lay 1944 was accompanied by terminal hyperthermia. 
Examination revealed a gutter wound 8.7 x 5 cm. in the left 
frontoparietal region through which an infected fungus pro- 
truded. Closure of the wound at the time of operation had 
not been complete. Portions of the frontal and parietal 
bones were absent. 3one edges had been rongeured. irom 
the bone margins stellate fracture lines radiated over the 
cranial vault. The remnants of the frontal and parietal 
lobes were grossly infected. 
' OT? O S 
CA3E25 
129th Inf. , standing 
a .23 caliber Japanese 
builet fired by a sniper distance 01 /3 yarns. nis 
helmet was perforated. jHBBBwas wounaed in action at 
1430 hour.;, 24 I. arch 1944 ana aied 3 hours later, aespite 
shocK therapy. examination revealed a gutter wound (15 a 7* cm.) occupying 
the right parieto-occipital region. Portions of these 
bones as well as the underlying cerebral hemisphere were 
absent. small metal -fragment was recovered from the re- 
maining brain tissue. The right lateral ventricle was 
filled with blood. Petechial hemorrhages were present in 
the left half of the brain. otellate fracture lines coursed 
through the bones of the vault. 
The missile in the photograph is part of the jacket of a 
.25 caliber Japanese bullet which was found in the brain below 
the wound tract. 
CAPS 26 
129th Inf. , standing in a 
covered pillbox when a Japanese 90 inn. artillery shell ex- 
ploded on the ground 7 yerus distant destroying one corner of 
the box. A fragment of the shell struck the soldier pene- 
trating his skull. He was wounued at O63O hours, 17 Larch 
Supportive treatment was given and debridement per- 
formed. Terminal hyperthermia was present at death 12 hours 
later. 
Postmortem examination limited to the head revealed compound 
linear fractures of the right parietal ana temporal bones. 
Present also were uarge extra and subuural hemorrhages. 
laceration 2.5 x .5 cm. with a surrounding area of contusion 
was present in the right temporal lobe. destruction of the 
areoptic area was noted. 27 
CASH 27 
Fijian a tree 
directing his platoon on patrol when struck oy a .23 caliber 
Japanese machine gun bullet fired from a distance of 150 
yards. He was willed instantly at 1200 hours, 23 ..arch lyi±. 
The wound of entrance (2 cm. in diameter] was round over 
the right 3th intercostal space in the post-axil xine, 
ana the exit wound (3 x 1.3 cm.) at the right sterno-davic- 
ular articulation. The bullet fractured tne wtn, 3th and 
6th ribs, lacerated the middle and upper lobes of the right 
lung, ana fractured the 1st rib, clavicle ana sternum at its 
exit. a right hemotnorax cc,] was resent. 
In one photogr; ph-the path of the bullet is demonstrated by 
a catheter lying in the wound tract. Tne otner photograph 
shows tne extensive damage of the thoracic wall, viewed from 
inner aspect. • 
CASS 28 — 
. ? n.< rlif. , hilt 
running in open terrain toward ffs foxhoie was strucn by a 
.23 caliber Japanese machine gun bullet fired from a distance 
of 3t yards. He was willed instantly at hours, 24 
...arch 194W. 
The entrance wound (1.0 cm. in diameter) was located en the 
right side of the suprasternal notch. The wound of exit was 
found in the 3th left intercostal space at the costosterutl 
Junction. In its course the bullet fractured the sternum and 1st rib, severed the aortic arch and trachea, grooved 
the esophagus and perforated the left lower lobe. Passive 
bilateral hemothorax and mediastinal emphysema were present. 
CASE 29 
CASE 29 ______ 
Hr> FIK (Fijian), while on patrol 
standinganddigging a hole was struck in the chest by a 
fragment of a 90 mm U.S. shell which burst on the ground 
20 yards He was killed instantly at 1700 hours, 
30 March 1944. 
The wound of entry (8.2 x 6.8 cm.) in the posterior left 
chest extended from the level of the 3rd to the 7th rib. 
The wound of exit (20 x 12.5 cm.) destroyed the anterior 
chest wall above the nipple. In its course the fragment 
fractured the left scapula, destroyed all but a small 
portion of the left lung and lacerated or severed the 
heart, thoracic aorta, and vena cava. 
The photograph shows the enormous wound of exit. 
CASS 30 
when struck by a .25 caliber Japanese rifle bullet fired from a distance of 20 yards. 
He was killed instantly at 1000 hours, 24 March 1944. 
Examination revealed the wound of entry (3x1 cm.) in the , 
4th right intercostal space in the mid-axillary line, and 
the wound of exit (3*8 x 2.3 cm.) in the 3rd left inter- 
costal space in the anterior axillary line*. In its course 
the bullet fractured the 4th rib, and lacerated the left 
auricle and ventricle. Marked extravasation of blood in 
both lungs was* produced by the concussion. Massive bi- 
lateral hemothorax was present. 
CASS 31 
IMHHMMHBIIHBHBBHMHBB C-F, while walking through 
the jungle on patrol was struck by a .25 caliber Japanese 
bullet fired from a distance of 30 yards. He was killed in- 
stantly at 1145 hours, 8 April 1944. 
Examination revealed the wound of entry (0.6 cm. in diameter) 
in the anterior left 2nd intercostal space in the mid-clavic- 
ular line, and the wound of exit (2.5 cm. in diameter] in the 
posterior right 5th intercostal space in the posterior ax- 
illary line. The bullet in its course perforated the upper 
left lobe, pericardium, pulmonary artery, the upper right 
lobe and fractured the right 3th rib in its exit. Hemo- 
thorax, (left 400 cc.‘, right 1300cc.) and hemopericardium were 
present. 
CASE 32 17th Sngrs., while walking 
and covering the eval?uatid(!H)f a casualty was struck by a 
.25 caliber Japanese bulleWaired from a distance of 35 
yards. He was killed instantly 1300 hours, 24 liafrch i944. 
Examination revealed a perforating wound oC the chest. The 
wound of entry (0.5 cm. in diameter) was located in the an- 
terior axillary line in the 4th left intercostal space, and 
the wound of exit in the 7th intercostal space in the right 
mid-axillary line. In its course the bullet grooved the 
anterior medial border of the left lower lobe, pierced the 
pericardial sac, right ventricle, and right middle and lower 
lobes. Bilateral hemothorax (2500 cc.) and hemopericardkim 
was present. 
In the photograph a catheter has been passed through the 
wound tract. 
the 
CASE 33 
CASE 3 3 • 
129th inf., 37th du. , 
while walking beyond the perimeter stepped on U.o. land 
mine and was killed instantly at 1015 hours, 12 April 1944. 
examination revealed 7 penetrating and perforating wounds. 
A chest wound was responsible for instantaneous death. CASS 33 
Cne fragment entered the left chest through the second 
rib in the mid-clavicular line and made its exit through 
the right 6th intercostal space in the mid-axillary line. 
In its course the fragment fractured the 2nd rib, lacer- 
ated the upper left lobe, avulseu the anterior wall of 
the ascending aorta, perforated the middle right lobe, 
lacerated the lower right lobe and fractured the 6th and 
7th ribs at its exit. There were 2000 cc. of blood in 
each pleural cavity. A compound comminuted fracture of 
the mandible was present. In addition wounds of the 
right forearm and arm, left frontal region and left thigh 
were found. 
One photograph shows the wounds of the chin, thorax and 
arm with a catheter threaded through the chest wound, 
and a probe traversing tne perforation of the forearm. 
Small metal fragments removed from the right arm are 
shown in the other photograph. 
CASS 34 . 
182nd Inf. , was 
ai^operW^xhol^wiTi^i^^buddy", when struck by frag- 
ments of a U.S.37 ram shell which burst on the ground 3 
yards distant. The other occupant was not injured, 
he was killed instantly at 0710 hours, 24 March 1944. 
examination revealeu a perforating wound oi tne chest, 
i'he entrance wound (7.3 x 3 cm.) was in the right 3rd 
intercostal space at the costosternal junction, and the exit wound (6.5 x 4 cm.) in the left 4th intercostal space 
in the mid-axillary line. The fragment severed the left 
intercostal and the internal mammary arteries. The left 
lower and right middle lobes were contused and massive hemo- 
pericardium and left hemothorax were present. The right 
ventricle and auricle were lacerated, but,, the pericardial 
sac was intact. 
CASA 35 
CASS 35 - 
in a covered pillbox when struck by a fragment of a Japanese 
mortar shell which came through the peep slit. The shell 
burst on the ground at 25 yards distance. he was killed in- 
stantly at 2000 hours, 23 March 1944. 
examination revealed a penetrating wound of entry (2.5 cms. 
in diameter) in the right chest in the 2nd intercostal space, 
anterior axillary line. The fragment in its course fractured 
the 2nd rib, perforated the right upper lobe, partially sev- 
ered the thoracic aorta, perforated the lower lobe, fractured 
the 8th rib and lodged in the subcutaneous tissues over the 
9th rib in the right mid scapular line. Massive hemothorax 
was present. 
The photograph shows the recovered fragment. CixSZ! 36 
. S 6 CASE 36 
129th inf., 37th 
killed in action in the 129th sector at 2140 hours, 25 March 
1944. He was strucK by fragments of a Japanese mortar. 
Other circumstances are not known. 
examination revealed a large entrance wound (12.5 x 10 cm.) 
on the left extending from the nipple to the mid-axillary 
line and from the level of the 3rd to the 6th rib. The 
fragments shattered the 5th and 6th ribs creating an opening 
(4 cm. in diameter) into the left pleural cavity. Bone 
fragments were driven into the left lower lobe producing 
an irregular laceration. A small metal fragment.penetrated 
the left dome of .the diaphragm, and a button from the sol- 
dier’s jacket was found in the omentum. A lacerated wound 
3.2 x 3 cm. was found in the left ventricle. The 7th and 
9th ribs posteriorly were fractured, and in the subcutaneous 
tissue in this region 5 metal fragments were found. mas- 
sive left hemothorax was present. 
The photographs show the extensive chest wound and the re- 
covered metal fragments. 
CASE 37 _ 
148th , 4MHHHK on 
1944 having been struck in the arm by a Japanese .25 caliber 
bullet fired from a distance of 7 yards, walked oack toward 
the first aid station. -.nroute he was mistaken for the 
enemy and was strucK in the chest with a .30 caliber bullet 
fired from a U.S. Ivl-1 rifle from a distance of 30 yards, 
he was killed instantly. 
Examination revealed a perforating wound of the right thorax 
ana a wouna of the right shoulder. The entrance wound in 
the chest (0.5 cm. in aiameter) was located in the first 
intercostal space in the mid clavicular line, ana the exit 
wound (2.5 cm. in diameter) at the level of the 12th rib in 
the mid scapular line. The bullet perforated the ana 
lower lobes of the right lung and fractured the tenth and 
eleventh ribs. massive hemothorax was present. The pene- 
trating wound of the left shoulder (.5 cm. in diameter) in- 
volved only the left deltoid muscle. No foreign body was 
found. 
CASE 38 
lst Bn., FIR (Fijian), while on 
ind a rotten log, when struct by a 
.25 caliber Japanese bullet fired from a distance of 5 yards. 
He was Rilled instantly at 1545, on 31 larch 1944. 
The entrance wound (.5 cm. in diameter) was found over the 
sternum at the junction of the manubrium with the body and 
the exit wound (l.i cm. in diameter!in the left 6th inter- 
costal s]ace in the anterior axillary line. In its course 
the bullet fractured the sternum, perforated the aorta, pul- 
monary artery and left lower lobe, and fractured the 6th rib 
in making its exit. Hassive bilateral hemothorax was pre- 
sent . 0133 38 
rhotograph shows the laceration of the pulmonary artery. 
CAS3 39 CASE 39 
BHHHlMHBOT 129th Inf. , while attacking 
a Japanese pillbox was killed instantly by the point blank 
explosion of a Japanese hand grenade at 0800 hoursf 24 Larch 
1944. 
examination revealed multiple penetrating wuunas of the 
head, face and abdomen. One fragment entering the thorax 
through the 3rd right intercostal space in the nipple line, 
had lacerated and lodged in the right upper lobe. massive 
hemothorax was present. The 12th dorsal vertebra, the man- 
dible and temporal bones were fractured. 
The recovered fragments are shown in the photograph. 
C.. - , 4o 
casj: 40 
was struck by .25 
caliber Japanese bullets f irea from a distance of 5 yards, 
he was killed instantly at 113o hours, 29 larch 1944. 
examination of the chest revealed an entrance ’wound (1.6 cm. 
in diameter) in the posterior left crest in the 7th inter- 
costal space end an exit, wuunu (3»8 cm. in diameter) in the 
left mid-clavicle.. In its course the bullet had fractured 
the 4th, 5th, 6th, 7th, and 8th ribs in the axillary^line, 
severely lacerated both lobes ana fractured tne clavicle at its exit. Massive left hemothorax was present. another 
bullet had penetrated the soft tissues of the left thigh, 
making its entrance through the lateral side of the upper third. 
It was found in the vastus medialls. A third bullet perfor- 
ated the left foot through the first metatarso-phalangeal 
joint. 
In one photograph the tract of the missile is demonstrated by 
a catheter. The other photograph shows the bullet recovered 
from the thigh. 
H- - 
irst aid to a casualty was struck 
by a .25 caliber bullet fired by a sniper from a distance of 
35 yards. lie was killed instantly at 1300 hours, 24 March 
1944. 
examination revealed a perforating wound of the left chest. 
The entrance wound (0.5 cm. in diameter; lay over the 3rd 
rib anteriorly 4 cns. from the mid line, and the exit wound 
(1.5 x 1 cm.] over the angle of the left scapula. In its 
course the missile fractured the 3rd rib and lacerated the 
hi luxe of the left lung severing a large branch of the pul- 
monary artery and 0 secondary bronchus. The upper left 
lobe was severely lacerated. hemothorax (1500 cc.) was 
present on the left. Blood exuded iron the mouth. CASg__42 . 
129th Inf., flHHI while squatting in 
a shallow hole on patrol was struck by a fragment of a U.3. 
artillery shell which burst on the ground 5 yards distant. 
He was killed instantly, 1230 hours 29 March 1944. 
hxaminaticn revealed a penetrating wound of the right chest. 
The wound of entrance (3.7 cm. in diameter) was situated in 
the 3rd right intercostal space in the mid axillary line. 
The fragment fractured the 4th rib, perforated the right 
middle lobe, the right auricle, the right ventricle and lodged 
in the left lower lobe. Kemopericardium and massive right 
hemothorax were present. 
The photograph shows the only fragment recovered. 
CA3L 42 
CA334J 
P129th Inf. , was killed in 
he was struck by .25 caliber 
Japanese bullets and killed instantly at 1345 hours, 24 March 
1944. 
The thoracic entrance wound (0.5 cm. in diameter) was round 
in the 6th right intercostal space in the posterior axillary 
line, and the exit wound in the 8th left intercostal space 
in the mid scapular line. The bullet produced fractures of CASS 43 
the right 6th, 7th and 8th ribs, severe lacerations of the 
posterior surface of the middle and posterior right lobes, 
fractures of the bodies of the 7th and 8th vertebrae, trans- 
ection of the spinal cord, perforation of the left lower 
lobe and fracture of the left 8th rib in the posterior ax- 
illary line. a metal fragment 1.2 x 1 x 0.2 cms. was re- 
covered in this region. Passive bilateral hemothorax was 
present. a severe comminuted fracture of the middle third 
of the right femur hau resulted from another bullet. The 
wound of entrance on the thigh was very small. 
The photograph shows the flattened oullet which was recov- 
ered from the thoracic wall. 
case 44 
-•••• - -*3 FIH (Fijian; , while on 
patrol, Kneeling behind a tree and firing at the eaeny, was 
struck by a .25 caliber Japanese bullet fired from a distance 
of 20 yards. he was killed instantly on 31 larch 1944. 
The wound of entrance (.5 cm. in diameter) was located in 
the left 4th intercostal space in the parasternal line, and 
the exit wound (3*7 cm. in diameter) in the left 6th inter- 
costal space in the mid-axillary line. The bullet produced 
irregular lacerations of the right and left ventricles and 
perforated the upper lobe of the left lung. ...assive hemo- 
thorax and hemopericard!urn were present. 
In the photograph the perforations in the heart are demon- 
strated by a catheter lying in the wound tract. CASE 44 
CASE 45 129th Inf. , stepped out of 
his pillbox and was struck by a .25 caliber Japanese sniper 
bullet from a distance of 25 yards. He fell back into the 
pillbox ana died instantly at 0730 hours, 25 karch 1944. 
examination revealed a penetrating wound of the left anterior 
chest wall. The entrance wound (1 cm. in diameter) was 
found in the 4th intercostal space at the costochondral junc- 
tion. -demonstrated at autopsy were: a fracture of the 4th 
rib and sternum, right hemothorax (3000 cc), perforation of 
the right auricle and ventricle and a laceration of the hilus 
of the right lung. 
The photograph shows the flattened .25 caliber bullet which 
was found lying free in the right pleural cavity. 
o— 
CAJ.j 46 
129th Inf., flBBBBF, While sitting 
in ti e clearer open jungle was struck by fragments of a 90 mm 
Japanese shell which exploded on the ground at a distance of 
20 yards. He was killed instantly at 1425 hours, 25 karch 
1944. 
Examination disclosed an exit wound (2 cm. in diameter} on 
the left arm 6 cns, below the acromion process and an entrance r* a O - i 
l+b CASS 46 
wound (20 x 10 cms.) over the left scapula. The head of 
the left humerus shattered and the tract widened by an ex- 
plosive force which fractured the 3rd, 4th, 3th, 6th, 7th 
and 8th ribs in the mid axillary line, and the 5th, 6th and 
7th ribs in the anterior axillary line. The parietal 
pleura was tom, both lobes of the left lung were severely 
lacerated, and the left scapula was extensively comminuted. 
A hemothorax (3500 cc.) was present. 
Photographs show the large wound of entry, and a small wound 
of exit of one of the fragments. The extensive damage to 
the left thoracic cage is evident. Several small metal frag- 
ments recovered from the scapular area are shown. 
CASS 47 
Hew eal£ind, while walking 
through the jungleonpatrolwas struck by a .23 caliber 
Japanese sniper bullet fired from a distance of yards. 
He was killed instantly at 0930 hours on 14 March 1944. 
Examination revealed a perforating wound of the neck with 
the entrance (0.6 cm. in diameter) situated below the tip 
of the left mastoid and the exit (4.3 cm. in -diameter) be- 
low the right acromioclavicular articulation. In its 
oblique course the bullet perforated the 3rd cervical ver- 
tebra, severed the spinal cord, fractured the 1st, 2nd, and 
3rd ribs at their costovertebral junctions, entered the 
pleural cavity, perforated the upper lobe of the right lung 
and made its exit between the clavicle and scapula. Present 
on the right was a hemothorax of 2000 cc. CASS 43 
CASE 48 _ 
FIR,(Fijian) , while moving forward on 
patrol in a crouched position was struck by a fragment of 
a 90 mm. Japanese mortar shell, which burst on the ground 
10 yards away. Ee died enroute to the hospital at 1000 
hours, 26 i/Iarch 1944. 
Examination revealed a penetrating wound of the right pos- 
terior chest. The fragment entered 8 cm. from the mid-line 
at the level of the 6th dorsal vertebra through a wound 1.5 
cm. in diameter. It coursed under the skin to enter the 
left chest in the 6th intercostal space 5 cm. from the mid- 
'line. The 7th rib was fractured at this point. The pos- 
terior surface of the .left lower lobe was severely lacerated. 
A metal fragment was recovered from the pleural cavity. A 
left hemothorax (2000 cc.) was present. 
Photograph shows the recovered missile. 
CASS 49 
129th , 
walking behind a tank was struck twice by .25 caliber 
Japanese bullets fired from a distance of 40 yards. he 
was killed instantly at 1030 hours, 24 Aarch 1944* 
Examination revealed two penetrating \;ounds of entry (4 x 
2.4 cm. and 3.5 x 2 cm. ip diameter) one through the right, 
the other through the left second costosternai junction. 
Postmortem examination showed: compound comminuted fractures 
of the second ribs (right and left) ana sternum, severance of the right intercostal and* internal mannary arteries, 
bilateral hemothorax, complete transection of the aortic 
arch and right pulmonary artery and vein, perforation of 
the left auricle, laceration of the right upper lobe, incom- 
plete division of the esophagus and trachea at the level of 
bifurcation and perforation of the body of the 7th thoracic 
vertebra. 
CASE 50 _____ 
» MB was 
prone in the open behind a tank assault when struck by a 
.25 caliber Japanese bullet fired from a distance of 100 
yards. He was wounded at 1100 hours 24 1-arch 1944. Sev- 
eral hours later thoracotomy was performed at the 21st Evac- 
uation Hospital and a lacerated left lung was sutured. He 
received penicillin daily and seemed to improve. Death 
from pulmonary embolus occurred suddenly at 0730 hours, 
28 March 1944. 
Examination revealed a curved incision (22.5 cm. in length) 
in the left posterior chest wall extending from 5th aorsal 
vertebra to the axillary line. A left fibrinous pleuritis 
with effusion (500 cc.) was present. A laceration of the 
left lower lobe had been closed by suture. The lung was 
congested and a thrombus was found lodged in the pulmonary 
artery. 
CASE 51 ‘ 
129th Inf., BBBM, while 
standing in anopenToxnole received a mortal wound at 
1500 hours 2? March 1944 from a fragment of a U.S. 4.2 
mortar shell which burst on the ground 3 yards away. At 
the portable surgical hospital the sucking wound of the 
chest was closed. The following day he was transferred 
to the 21st Evacuation Hospital. Upon admission to the 
ward dehiscence of the wound was present. a second oper- 
ation was done at which time bone fragments were removed 
from the lung and bleeding was controlled. The patient 
never regained consciousness and died at 1700 hours 30 Aarch 
1944. 
autopsy revealed an oblique operative incisicn 17.5 cm. long, 
extending from the 3rd dorsal spine to the 9th rib, in the 
right posterior chest. The right scapula, 7th and bth ribs 
were fractured. A right hemothorax was found and sutures 
were preseftt in the right middle and lower lobes. The lungs 
were emphysematous, and there was marked dilatation of the 
right ventricle. Death was attributed to heart failure. 
In this case death may have been precipitated by the rapid 
administration of necessary intravenous fluids in the pre- 
sence of some pulmonary obstruction. 129th Inf . , walking 
in a crouched position following a tank assault, was struck 
by a .25 caliber Japanese bullet fired from a distance of 
25 yards. He was wounded at 1245 hours, 24 March 1944, 
and died 24 hours later. Death resulted from transection 
of the thoracic spinal cord and was associated with terminal 
hyperthermia. 
The wound of entrance (3 cm. in diameter) was located in tne 
center of the left supraclavicular region. The bullet en- 
tered the cnest through the first intercostal space, fractured 
the first and second ribs and produced a gutter wound in tne 
left upper lobe. The body of the second dorsal vertebra was 
fractured and the spinal cord severed at the same level. a 
massive left hemothorax was found. The bullet was not re- 
covered . 
GaSE 53 
> i3tn AAF, 
with a .3d caliber carbine at 1300 hours, 4 April 1944. lie 
arrived at the hospital in ten minutes, was given 3 unit: of 
plasma and underwent immediate thoracotomy. An attempt was 
made to suture the lacerations of the lung but the patient 
died on the table from shock due to hemorrhage. 
Postmortem examination revealed a perforating entry wound omm. 
in diameter in the anterior left chest, 10 cm. from the mid 
line in the 7th intercostal space. The wound of exit, loca- 
ted posteriorly in the 3rd intercostal space 5 cm. from the 
mid line, was 2.5 cm. in diameter. The bullet in its course 
lacerated the left lower lobe. contusion of the left ven- 
tricle and a hemothorax (lOuO cc.) were found. 
CASE 54 
while prone firing at the enemy was. hit twice by .25 caliber 
bullets lirea' from a Japanese machine gun from a distance of 
35 yards. he was wounded at 0830 hours on the 24 March 1944 
and taken to the hospital immediately. .after adequate shook 
therapy the chest wound was debrided and closed and laporotomy 
performed. uleu at 0930 hours, 28 March 1944 of 
pulmonary edema. 
Postmortem examination revealed two wound tracts. One bullet 
produced an entry wound (3.2 * 2.5 cm.; lateral to the spin- 
ous process of the first lumbar vertebra, this missile coursed 
superiorly and laterally, fractured the 12th rib, perforated 
the diaphragm, and was found lodged under the 11th rib in the 
mid axillary line. The other wound was perforating in type 
with its entrance (1.2 cm. in diameter) located 1 cm. below 
the right clavicle at the outer third and exit (17-9 cm. in 
length) located 9 cm. to the left of the 11th dorsal verte- 
bra. In its course this bullet produced a blast injury of 
the right lung, perforated the left lower lobe and fractured 
the 9th rib. hdema of the left lower lobe, fibrinous pleur- 
ite ana hemo-uneumothor&x were present. The right lung was diffusely discolored from blast injury. The abdominal ex- 
amination was negative, as the bullet had traversed the 
retroperitoneal space. 
CASE 55 
145th 
kneeling in the open firing at the enemy was struck by a 
.25 caliber Japanese bullet fired from a distance of 15 
yards. He was wounded on 16 Larch 1944. Thoracotomy was 
performed at the 21st evacuation hospital several hours later. 
The right lower lobe was removed, the diaphragm closed and 
bleeding from the perforation in the body of the 12th dorsal 
vertebra was controlled by electrocoagulation. The spinal 
cord was severed at the level of 12th dorsal. The patient 
was evacuated from the island on the 8th postoperative day. 
he developed an empyema at the 31st General Hospital. Sur- 
gical drainage of the empyema was established. In spite of 
adequate drainage, penicillin and supportive therapy, the 
patient died from the infection on 25 April 1944. 
Postmortem examination revealed grosa infection of the right 
pleural cavity. The remaining upper and middle lobes were 
shrunken and adherent and the pleura markedly thickened. 
The right lower bronchus communicated with the pleural cavity. 
The spinal cord was transected at the level of the fracture 
of the 12th dorsal vertebra. The diaphragm had been repaired. 
Generalized intestinal distension and focal necrosis of the 
liver were, present. 
145th Inf., while 
3ASE 36 
1st Bn. , FIR, while crouching and ad- 
vancing on patrol was shot through the left chest by a .25 
caliber Japanese bullet from a distance of 30 yards. He was 
wounded in the morning, 30 Larch 1944. Upon arrival at the 
Hospital immediate thoracotomy was performed in an attempt to 
control pulmonary bleeding. The patient died several hours 
later (1420 hours, 30 Larch 1944) of acute cardiac dilatation 
and hemorrhage. The cardiac dilatation was thought to be 
secondary to obstruction of the pulmonary circulation (See 
Case 51)• 
• 
Postmortem examination showed a wound of entry (1.2 cm. in 
diameter) through the 2nd left intercostal space above the 
costosternal junction. The wound of exit had been closed at 
the time of operation. curved anterio-lateral incision 
from the 2nd to 6th rib was noted. Lacerations of the upper 
and lower lobes had been sutured. The right heart was mar- 
kedly dilated. federate left hemothorax was present.' 
CASS 57 
HHBtaHHHMi 920th ABS, while stepping out of a 
truck was hit by fragments of a Japanese artillery shell 
which burst on the ground 2 yards away. He was wounded at 
0600 hours, 24 Larch 1944. At operation within an hour at 
the field hospital the left chest wound was excised, the 
lung sutured and the chest closed. In audition a loop CASS 57 
colostomy of the sigmoid was done because of a perforation 
of the colon. The patient died several hours later from 
massive pulmonary hemorrhage. 
Examination revealed penetrating wounds of the chest and 
left gluteal region. The entry wound in the anterior left 
chest through the 5th interspace had been excised and closed. 
The 5th and 6th ribs were fractured. Passive hemothorax 
was present. large mattress suture partially closed the 
laceration in the left lower lobe. The abdominal cavity 
had been entered by a fragment which perforated the left wing 
of the ilium leaving a wound of entrance 7.5 cm. in diameter. 
Fragments of bone had been dispersed extensively lacerating 
the gluteal muscles. stated above the perforation of 
the sigmoid colon had been treated by exteriorization through 
a left rectus incision. 
Photograph shows metal fragments removed from the chest wall. 
5 B 
crawling patrol was struck by .25 cali- 
ber Japanese machine gun bullets. He was woundec at 210o 
hours, 2 .'ay 1944, and reached the hospital within three 
hours. Thoracotomy was decided upon because ol iijtrathor- 
acic bleedin, . ■■■■■■died on the operating tabxe auring 
induction of the anesthetic at 0515 hours, 3 May 1944. 
Examination revealed a perforating wound of the left cnest 
anj a penetrating wound of the right axilla. One entrance 
wound (1.2 cm. in diameter) into the chest was situated in 
the left midscjapular region and the exit wound (5x2 cm.) 
in the left supraclavicular fossa. In its course the bullet 
fractured the scapula, and the 2nd, 3rd and 4th ribs. The broken ribs had severely lacerated the pleura and the upper 
left lobe. The bullet had not entered the pleural cavity. 
massive left hemothorax was present. ..mother bullet pene- 
trated the apex of the right axilla through a wound 3.7 cm. 
in diameter, and in its course severed the radial and median 
nerves and fractured the upper third of thehimerus. The 
bullet was found in the belly of the triceps muscle. 
CASE 59 
CASE 59 
24th , 
forward in a was struck by .25 caliber Japanese 
machine gun bullets fired from a distance of 75 yards. He 
was killed instantly at 1100 hours, 14 April 1944. 
Examination revealed multiple wounds. A missile which pro- 
duced a penetrating wound of the right side of the abdomen 
and traversed the right thorax was responsible for rapid 
death. This bullet entered the right kidney region opposite 
the process of the 2nd lumbar vertebra. In its 
course it lacerated the lower pole of the right kidney, per- 
forated the hepatic flexure of the colon, right lobe of the 
liver and diaphragm, lacerated the lower right lobe of the 
lung and fractured the dtn, 9th, 10th, 11th and 12th ribs 
in the posterior axillary line. Hemoperitoneum and a right 
hemothorax (1000 cc.) were present. The bullet was recover- 
ed in the subcutaneous tissue. Another bullet peri orating 
the neck entered the right side in the posterior cervical Case 39 
triangle and made its exit below the tip of the left mastoid 
process. The trachea was severed at the level of the cri- 
coid cartilege. Another bullet struck the left side of the 
face producing a gutter wound 12.5 x 3.7 x .25 cm., which 
destroyed the left temporomandibular joint. Present also 
was a perforating wound in the right infraclavicular space 
with fracture of the right clavicle. 
One photograph reveals the gutter wound of the face below 
which is the wound of exit. The other photograph shows the 
distorted bullet and a part of the jacket removed from the 
right chest wall. 
CASE 60 - 
flHPBSI 129th Inf. , while crouching 
following a tank assault was shot by a .25 caliber Japanese 
machine gun bullet from a distance of 25 yards. He was 
killed instantly at 0800 hours, 13 March 1944. 
Examination showed an entrance wound {O.b cm. in diameter) 
through the right anterior chest 2nd intercostal space in 
the nipple line, and an exit wound (7.5 cm. in diameter) 
through the left loin above the wing of the ilium. In its 
oblique course the bullet perforated or severed the right 
middle lobe oi the lung, the diaphragm, the right lobe of 
the liver, the pancreas at the junction of the head and body, 
the transverse duodenum, the jejunum, ana the left colon at 
the sigmoid junction. Moderate hemothorax and hemoperiton- 
eum were present. CASE 61 
CASS 61 
129th Inf. , while standing in a 
foxhole covere^b^^ngn^roOfing was killed instantly by 
the direct burst of a Japanese mortar shell. 4 other men 
were woundea. MHHfcvas killed at 0530 hours, 24 Aarch 194*f. 
Multiple penetrating wounds of the back, chest and abdomen 
were sustained. A large chest wound caused death. The 
wound of entrance was 9 cm. in diameter ana situatea in the 
posterior left chest 2.5 cm. from the spinous processes of 
T-ll and T-12. In its course this fragment fractured the 
5th, 6th ribs anteriorly, and the 8th, 9th ana loth ribs 
posteriorly, fragmented the left lower lobe of the lung, 
perforated the diaphragm, disrupted the spleen, and transec- 
ted the descending colon. The bodies of the 11th and 12th 
dorsal vertebrae were badly comminuted. Passive left hemo- 
thorax and hemoperitoneum were present. 
The photograph shows metal fragments identified as parts of 
a first aid box which were recovered. 
129th , in 
pillbox was surrounded b\ Japanese. lie was killed by frag- 
ments of a Japanese hand grenade which exploded at point 
blank range. 2 other men in the pillbox were wounded. 
Harmon died instantly at 0800 hours, 24 I.arch, 1944. CASE 62 
Examination revealed multiple penetrating wounds of the 
chest, right thigh, right leg and right arm. The wounds 
of the thorax were fatal. There were multiple small pene- 
trating wounds through the right posterior axillary line 
from the 7th to 12th rib. The largest was 1.2 cm. in dia- 
meter. Small fragments perforated the lower lobe of the 
right lung and diaphragm, and produced a laceration (7x3 
x 1.3 cm.) in the dome of the liver 7 x 3 x 1.3 cm. Passive 
right hemothorax and moderate hemoperitoneum were present. 
The remaining wounds were not extensive. 
Photograph shows the recovered grenade fragments. 
CASE63 
1st Bn., ?1ii, while running on 
patrol stepped on a mine ana was Killed instantly 
at 1100 hours, 26 Parch 1944. 
examination revealed 9 penetrating wounds. 3 fragments en- 
tered the left chest anteriorly in the 1st intercostal space 
in the nipple line and perforated or severed the upper left 
lobe, pulmonary arter , aortic arch, trachea, right lower 
lobe, diaphragm ana liver. 2 metallic.fragments were found 
in the liver. Hemothorax (left 2300 cc. ana right 230 cc.) 
was present. In audition there were wounds of the left el- 
bow, thigh, cheeK, chin and eye, and an extensive gutter wound 
of the left buttock. 
Photograph shows metal fragments removed from the liver. CASE 63 
CASE 64 CASS 64 
21st Rcn.Tr. , was killed by a U.S. 
hand grenade which exploded in his pocket while returning 
from patrol. He was killed instantly at 0920 hours, 25 
April 1944. 
Examination revealed 12 penetrating wounds, 4 of which 
penetrated the thorax. These fragments entered the left 
chest in the mid-axillary line at the levels of the 4th, 
6th and 9th ribs. The left 4th, 5th and 6tn ribs were 
fractured, the diaphragm, spleen, and pancreas were lacer- 
ated, and the stomach was perforated in 2 places. hassive 
left hemothorax and hemoperitoneum were present. 1 gren- 
ade fragment was recovered from the pleural cavity and 2 
fragments from the lumen of the stomach. The remaining 
wounds were in the upper extremities. 
The photograph shows the recovered fragments, the largest 
of which was removed from the thorax. 
CASE 6 
CASS 65 * 
(UAhhdWH JAPANESE SOLDIER). This soldier was hilled 22 
Kerch 1944 by fragments from a high explosive shell. 
examination revealed an entrance wound (2 cm. in diameter) 
in the 11th left intercostal space. The fragments in their course lacerated the lower lobe of the left lung, 
diaphragm and spleen, and were found in the subcutaneous 
tissue at the exit wound. Present also was a bilateral 
hemothorax and a hemoperitoneum cc.) 
The photograph shows the small metal fragments recovered 
from the wound tract. 
CASH 6b 
, 21st Hen. , while crouching and 
moving forward in a ckirmish line was struck 3 times by 
.25 caliber Japanese machine gun bullets fired from a dis- 
tance of 20 yards. Le was killed instantly at 1600 hours, 
27 Parch 1944. 
An abdominal wound was responsible for death. The wound 
of entrance (.5 cm. in diameter) was placed in the mid line 
7.5 cm. above the umbilicus. This bullet severed the ab- 
dominal aorta and fractured the first lumbar vertebra, 
another bullet jjerforated the right deltoid muscle and en- 
tered the right thoracic cavity through the 4th intercostal 
space in the anterior axillary line. The 5th, 6th and 7th 
ribs were fractured, the lower lobe of the lung acid the dome 
of the diaphragm were lacerated, the liver was perforated, % 
and the right kidney was fragmented. There were also super- 
ficial wounds of the left hip and left forearm. 
OtxSa 67 
129th inf., oy 
a .25 caliber Japanese bullet fired by a sniper from a dis- 
tance of 25 yards. His position when hit was not known. 
He was killed instantly at 1300 hours, 24 march 1944. 
The bullet entered the left thorax through a wound (.5 cm. in 
diameter) in the anterior 4th intercostal space in the an- 
terior axillary line, and made its exit through a wound (2.5 
x 1.5 cm.l in the right 6th intercostal space in the mid- 
axillary line. The bullet in its course perforated the 
upper left lobe, left ventricle, right ventricle, right lower 
lobe, the diaphragm, and produced an irregular laceration in 
the vertex of the .Tver 7.5 cm. in length before making its 
exit. Passive bilateral hemothorax and hematoperitoneum 
were found. 
-CUSS 68 
patrol entering a Japanese nillbox was struck by a .25 caliber 
Japanese bullet fired at close range. He was wounded at 
hours, 29 inarch 1944. Laporotomy was performed several hours 
later at the clearing station. At operation the left dia- 
phragm was repaired and a transverse colostomy was performed 
after suture of a perforation in the splenic flexure of the 
coion.- The patient died at 0600 hours, 4 April with 
sigtfs of cardio-respiratory failure. ♦ 
Examination revealed a penetrating bullet wound of the left 
chest entering the 6th intercostal space in the posterior 
axillary line. Transverse colostomy had been performed 
through an upper left rectus incision. The 7th, 8th and 
9th ribs were fractured, and moderate left hemothorax was 
present. The left lower lobe was discolored from blast in- 
jury. The pericardial sac contained a'small amount of blood 
although it had not been perforated. An area of epicardial 
ecchymosis was found on the left ventricle. Present also 
was a laceration of the spleen and an explosive wound of the 
left kidney with a large hematoma. A perforation in the 
splenic flexure of the colon had been sutured. The repair 
of the diaphragm was unsuccessful. 
Z ASE 69 . 
» 129tn Inf., while leading 
his platoon against the enemy was struck by a .25 caliber 
bullet fired from a short distance. He was wounded at 
0900 hours, 13 march 1944. an hour later debridement and 
closure of the chest wound was done at the 21st evacuation 
Hospital. He was evacuated oy air on 15 larch-and died on 
21 Kerch 1944 at the 9th Station hospital of secondary hem- 
orrhages from the left lung and spleen. 
Postmortem examination revealed a perforated wound of the 
left elbow and a compound fracture of the humerus. The 
same bullet had entered the left chest in the 6th inter- 
costal space in the posterior axillary line ana made its 
exit in the left 7th intercostal space. The thoracotomy 
incision was well healed. The left pleural cavity con- 
tained a liter of blood. Both lobes of .the left lung were 
lacerated and the diaphragm, spleen, and kidney were perfor- 
ated. Old and fresh blood were present in the peritoneal 
cavity. a retroperitoneal hematoma was well organized. 
!ASE 70 
IIHMHflHMI 1st Bn., PIR, while crouching in a 
skirmish line on patrol was struck by fragments of a Japan- 
ese mortar shell which burst on the ground 20 yards distant. 
He was wounded on 29 March 1944. Splenectomy, exteriori- 
zation of the colon, closure of a chest wound and debride- 
ment of an arm wound were performed the same day. Ke died 
at 2215 hours, 30 march 1944 of shock and hemorrhage. 
Examination revealed wounds of the chest, abdomen and left 
arm. A linear incision extended in the 9th, left inter- 
costal space from the nipple to the axillary■line. The 
pleural cavity contained 3600 cc. of blood. Eibrinous 
pleuritis, congestion of the lung and dilatation of the 
right heart were found. The rent in the left diaphragm 
was incompletely closed. a left rectus incision was pre- 
sent through which protruded the exteriorized loop of the 
perforated transverse colon. a small amount of free blood 
was present in the abdominal cavity. The spleen had been 
removed. The body and tail of the pancreas were lacerated. 
An explosive wound of the left kidney and a large retro- 
peritoneal hematoma were found. Present also in the lower 
third of the left arm was the wound of a severe compound 
comminuted fracture of the humerus. lrt.SE 71 
37th Hen. Tr. while 
position through thick jungle on patrol was 
struck in the left lumbar region by a Japanese .25 caliber 
bullet fired from a distance of 25 yards. he was wounded 
at 1700 hours, 4 March 1944. Laporotomy was performed at 
the 21st Evacuation Hospital several hours later. Perfor- 
ations in the bowel were sutured and an attempt was made 
to arrest hemorrhage from a laceration in the liver. He 
died 1015 hours, 5 March from shoex and Hemorrhage. 
Examination revealed a wound of entry (0.5 cm. in diameter) 
in the left lumbar region directly below the 12th rib and 
an exit wound (1 cm. in diameter) through the right mid- 
axilaary line in the 8th intercostal space. In its course, 
the bullet perforated jejunum, ileum, transverse colon, liver, 
diaphragm and the lower right lobb of tne lung ana fractured 
the right 9th rib. Moderate hemoperitoneum and hemothorax 
(right) were present. 
72 
CA3E 72 J 
ffjgggPHP 3rd Bn., FIH (.Fijian), while standing in 
the jungle was mistaken for the enemy ana shot by a fellow 
soldier 30 yards distant with a Bren machine gun. He was 
wounded at 1530 hours, 1 194s-. -Ot the 21st evacuation 
hospital after shock therapy right pulmonary lobectomy was 
performed, and a wound in the liver was tamponaded. he died 
of hemorrhage at 2030 hours, 1 1944. There were two perforating wounds of the right chest. The 
wounds of entry (each .5 cm. in diameter) were both situated 
in the 6th intercostal spaces 2.5 and 3.7 cm. respectively 
from the mid-line, and the exit wounds were in the Sth in- 
tercostal space in the mid-axillary line. The 9th rib was 
fractured. recent anterio-lateral 6tn intercostal space 
incision was present. The lower right pulmonary lobe had 
been removed and the rent in the diaphragm incompletely 
closed. a large explosive wound occupied the dome of the 
right lobe of the liver. 
Photograph shows the extensive liver wound. 
CASE 73 
24th 
prone in the jungle on patrox was strucK by Japanese .30 
caliber machine gun bullets fired from a distance of 30 yards. 
At 1000 hours, 19 received shock treatment followed by 
right thoracotomy. ivt operation a bullet and a bone frag- 
ment were removed from the right lung and the diaphragm and 
lung werv. sutured. This soldier dia not recover from shocK 
and died at 2150 hours, 19 April 1944. 
Examinetion revealed 2 major wounds. One bullet produced a 
perforating wound of the right thigh and a compound fracture 
of tae femur. The other bullet penetrated the left buttock 
and coursed superioraly to the right, terminating in the right 
pleural cavity. This bullet fractured the 5th lumbar ver- 
tebra, severed the cauda equina, lacerated the right Kidney, 
perforated the diaphragm and lower lobe of the right lung. 
In addition there were superficial gutter wounds of the right 
and left forearms. 
CASS 74 
HHHIIHHV > 
waging aiong was struct by a fragment of a 
Japanese mortar shell, which burst on the ground 15 yards 
away. He was wounded at 1930 hours on 18 March 1944* 
rtf ter arriving at the hospital within one hour continuous 
shook therapy was instituteu. Thoracotomy was performed 
at 02u0, 19 march 1944, in an attempt to arrest hemorrhage. 
The patient died 2 hours later of shock from hemorrhage. 
examination revealed a sutured wound over the posterior 
lower left chest 10 cm. in length. ii laceration in the 
left lower pulmonary lobe had been sutured. The diaphragm, 
stomach, and spleen were lacerated. moderate left hemo- 
thorax and heraoperitoneum (2500 cc.) were present. 
CASE 75 A 
;j!t i-TsnK, 2236 
foxhole to void. Cn return 
was shot through che abdlMen by an apprehensive bunk mate 
with a U.S. 45 caliber Jwolver from a distance of 2 yards. 
He died within an hour. T Examination revealed a penetrating wound (1.5 cm. in diameter) 
in'the upper right quadrant of the abdomen. The peritoneal 
cavity was filled with blood from a perforation of the vena 
cava. In addition several loops of jejunum had been perfor- 
ated . 
HHBBMHHHMIIIHHMMBHV> 145th Inf. , while standing 
the open was /struck of a Japanese 90 mm. mortar 
shell which burst on the ground 2 yards distant. He was 
killed instantly 18 1 arch 1944. 
apparently a fragment had strucK the abdominal wall tangen- 
tially in the midline, .5 cm. above the symphysis. loop 
of ileum was protruding. Only remnants of the urinary 
bladder remained. The right ilium, right pubic ramus, and 
sacrum were severely cornminuted. The peritoneal cavity con- 
tained two liters of blood. 
CASE 77 
while crouching on patrol was 
strucK in the right lumbar region by a .25 caliber Japanese 
bullet fired from a 'distance of .20 yards. He was shot at 
10 30 hours, 29 march 1944 and died one hour later in the aia 
station from internal hemorrhage. 
examination revealed a perforating wound of the right lumbar 
region. The entrance wound (0.5 cm, in diameter) was loca- 
ted in the right lumbar region 3 cm. above the posterior 
superior spine of ilium and the exit wound (0.6 cm. in dia- 
meter) on the left buttock on a level with the greater tro- 
chanter of the femur. The bullet in its course fractured 
the wing of the right ilium, severed the right spermatic and 
pudendal arteries and rectum and fractured the sacrum. Pas- 
sive hemoperitoneum was present. 
CA3E 78 
Led.^ept., 
while lying prone beside his radical officer, was struck b} 
a .25 caliber Japanese bullet fired from the rear at a dis- 
tance of 75 yards. Hq spoke a few words, had several con- 
vulsive seizures, and died at 1100 hours, 24 march 1944. 
examination revealed a perforating wound of entrance (.5 cm. 
in diameter; over the right 12th rib in the posterior axillary 
line and an exit wound (10 x 0.5 cm.} through the left lumbar 
region at the level of the 5th spinous process, 15 cm. from 
the mid line. In its oblique course the bullet fractured 
the 12tn rib, exploded the right kidney, lacerated the right 
lobe of the liver and mesenteric border of the mid portion 
of the transverse colon, end fractured the body of the first 
lumbar vertebra. Hassive hemoperitoneum was present. CaSH 79 
BHBHHHHHRHHm25th Inf. , left his foxhole at night 
to defecate. While returning to his hole he was shot by a 
fellow soldier with a .30 caliber U.J. machine gun from a 
distance of 30 yards. He was Kixled instantly 1200 hours, 
16 April 194h. 
One of the two wounds had its entrance (.6 cm. in diameter) 
over the right scapula and exit (1.2 cm. in diameter) through 
the left side of the nectc. The bullet producing this wound 
fractured the 3rd cervical vertebra and severed the spinal 
cord. The other bullet produced a long (32.5 cm.) gutter 
wound of the right side of the abdomen which resulted in 
evisceration. This missile pierced the ascending and trans- 
verse colon, ileum and liver. 
The photograph shows the extent of the gutter wound and the 
eviscerated bowel. 
p-q 7Q 
CaSH sc ___ 
129th 
while running forward over open terrain was shot by a .25 
caliber Japanese machine gun from a distance of % yards, 
he was killed instantly 0830 hours, 24 larch 1944. 
Of the two bullet wounds, one (1 cm. in diameter) was 
classified as penetrating and was situated 7 cm. superior 
to the umbilicus in the mid line, the other was a perfor- 
ating wound with the entry wound (1 cm. in diameter) throur 
the right lower quadrant and the exit wound {i+ x 2 cm.) through the right transverse process of the 4th lumbar 
vertebra. of the abdominal cavity revealed 
a massive hemoperitoneum, severance of the middle colic 
artery, linear laceration of the mid portion of the trans- 
verse colon, division of the right common iliac vein and 
artery and a compound fracture of the 4th and 5th lumbar 
vertebrae. 
CASS 81 
Hicld Artillery, while assigned 
to a detail burying the Japanese dead in front of the peri- 
meter wandered away from the main party. He was struck by 
a .25 caliber bullet which was thought to have been fired 
by a sniper. He was wounded 15,30 hours, 27 March, -and 
arrived at the hospital within 2 hours. Laporotomy was 
performed and an extensive wound of the liver was found. He 
died 1830 hours, 2? March 1944, of shock from hemorrhage. 
examination revealed a penetrating wound (.5 cm. in diameter) 
in the 11th right intercostal space in the anterior axillary 
line. A recent T-incision was present in the right upper 
quadrant of the abdomen. The abdominal cavity contained 2 
liters of blood. An extensive laceration of the right lobe 
of the liver had been filled with transplanted muscle. The 
12th rib was fractured. Approximately one third of the 
snatterea right Kidney remained ana bone fragments were found 
in the remnant of this kidney. There was no wound of exit, 
ho foreign body was recovered. 
CASS 62 _ 
182nd Inf. , while standing 
in the open was struck by multiple fragments of a Japanese 
hand grenade which exploded 1 yard away. He was wounded at 
1345 hours, 13 March 1944. Abdominal exploration which was 
performed at the Clearing Station several hours later was re- 
ported negative. Multiple penetrating wounds of the left 
chest wall were uebriued at the same time. he was evacuated 
by air from the island 18 March 1944. Upon arrival at a 
hospital in the rear echelon on the same day, evisceration was 
discovered. Secondary wound closure and ileostomy were done. 
He received penicillin and general supportive treatment, but 
died at 0833 hours, 25 March 1944 of peritonitis. (It is 
suggested that air evacuation resulted in evisceration). 
Postmortem examination revealed multiple healed wounds in- 
volving the left side of the body from the axilla to the 
knee in a band between the anterior and posterior axillary M 
lilies. The abdomen was distended. Incomplete visceral 
herniation was present below the Ileostomy in the partially 
closed incision. Advanced diffuse suppurative peritonitis 
was present. CASE 83 _ 
13211a 
following a jungle trail was struck by fragments of a 901.1111. 
Japanese mortar shell which burst on the ground 25 yards 
distance away. He was wounded at hours, 13 Larch 
1944. Laporotomy was performed at the portable surgical 
hospital and a rent in the colon sutured. After transfer 
to the 21st evacuation hospital 2 days later, because of 
severe distension a colostomy was none. he aied at 1115 
hours, 16 march 1944. JeatL was attributed to peritonitis. 
'ilie wound responsible for death had its entrance at the 
lower right costal margin and its exit just ±eft of the urn- 
bill us. Jiffuse peritonitis resulting from leakage from 
two perforations in the jejunum had been missed at the time 
of operations, was discovered. In addition penetrating 
wounds of the left and right thigh ana right knee were pre- 
sent. 
L/iiDij84 
84 ‘ 
129th Inf. , while standing 
outside his foxhole was struck by a fragment of a 4.2 U.S. 
mortar shell. The shell fell short and burst on the ground 
at 3 yards distance. lie was wounded, 27 Larch 1944. One 
fragment struck the right hip and coursed retroperitoneally. On 31 Larch 1944 an ileostomy was performed because of 
abdominal distention. He died 1 April 194h* i->eath was 
attributed to paralytic ileus and unexplained uremia. 
The major wound nad its entrance (10 x 5 cm.j at the level 
of the right iliac crest. The fragment producing this 
wound fractured the ilium and 5th lumbar vertebra, severed 
the cauda equina, entered the right retroperitoneal space 
and shattered the lo..er pole of the right kidney. metal 
fragment was recovered in this area. An ileostomy had been 
performed through a right paramedian incision. The peri- 
toneal cavity contained a small amount of free serous fluid, 
nil coils of intestine were markedly distended. A large 
hematoma was present in the right Kidney area. pene- 
trating wound of the right shoulder ana a perforating wound 
through the soft tissues of the right arm were observed. 
Photograph shows the shell fragment removed .from the right 
renal area. 
c..,. - -: 
HHHIV 25th 
was carrying a grenade in the right hand .-hen it expxodec 
lie was wounded at 150U hours, 1 Laparotomy was 
performed at the 31st -ortable Juii icei ..ospital at wnich 
tine several loo s of intestine were resected. On the 
hollowing day he was transferred to the 2o.sc -vacuation Hospital and died at 2335> hours, 11 April 1944. 
-.xamination revealed 3 penetrating wounds of the anterior 
left side of the abdomen, varying from 1.8 to 3 cm. in 
diameter. The peritoneal cavity contained a moderate 
amount of sanguino-purulent fluid. -lid to end anastomosis 
of the upper jejunum and the left splenic flexure of the 
colon had been performed. -ariy gangrenous changes were . 
noted in the descending colon. 3mall multiple lacerations 
of the spleen, pancreas and left kidney were present. One 
grenade fragment was recovered from the splenic fossa, another 
from the lumen of the transverse colon. Present also was a 
penetrating wound of the right hand with fracture of the 4th 
metacarpal and 4th proximal phalanx. 
Photograph shows the recovered grenade fragments. 
143th 
was struck by a fr* gment of a 
50C lb U.o. aerial bomb, which exploded in a tree 3 yards 
above. The bomb was dropped accidentally by a U.3. plane 
leaving on a bombing mission on 19 March 1944. The wound 
was debrided at the po -table hospital shortly thereafter- 
wards. he was transferred to tne evacuation hospital on 
the following day, and died at 083u hours, 23 i«.ai ch 1944* 
jjeath was attributed to peritonitis. 
examination revealed a large penetrating wound (21.4 x 13 x 
7.$ cm.; over the crest and wing or tne right ilium. This 
wound was grossly infected. The lamina ana spinal process 
of the 3th lumbar vertebra were destroyed. The retroperi- 
toneal space was filled with purulent exudate. diffuse 
fibrino purulent peritonitis had resulted from direct ex- 
tension mf infection from the wound. small perforating 
wound of tne right shoulder was clean and granulating.. 3A3E 87 
Hfl • mmm i ' I! fftf. FIR (Fijian), while 
patrol was struck in the left groin by a .25 caliber 
Japanese bullet fired from a distance of 25 yards. Though 
aid reached him immediately, he died in several minutes at 
1515 hours, 29 Larch 1944. 
Examination revealed a penetrating wound of the left groin. 
Ine wound or entrance *(3.1 cm. in diameter) was located 
1 cm. below the middle third of the left inguinal ligament. 
The femoral artery and vein were severed. The bullet was 
Imbedded in the pubis. 
Photograph shows the bullet removed from the ospubis. 
-184- CASE 88 
25th left 
foxhole at night to void, on returning was mistaken for the 
enemy and in the resulting confusion was stabbed to death 
by fellow soldiers. He died within an hour of hemorrhage, 
on 17 April 1944. 
Examination revealed 10 stab wounds in the upper and lower 
extremities. The right femoral artery was severed in its 
upper third and the left radial artery was divided. Ho 
other important structures were injured. 
CASE 89 _ 
■■■■■■■■■■' . 
was brought by American soldiers to the aid post and treated 
for shock. Respite treatment he died in several hours. 
Examination revealed a perforating bullet wound of the right 
thigh. The entrance wound (2.5 cm. in diameter) was found 
on the lateral surface and the exit wound (2,3 cm. in dia- 
meter) on the medial aspect. The right femur was shattered 
in its middle third. Present also was a perforating bullet 
wound of the abdominal wall in the right lumbar region with 
wounds of entrance and exit both 2.3 cm. in diameter. This 
bullet did not enter the peritoneal cavity. 
CASE 90 
(unucv/i: JAPANESE) The body of this soldier was partially 
decomposed when received. It appeared that the soldier 
had been wounded by bullets. heath was attributed to shock 
associated with a severe fracture of the left femur. 
examination revealed a perforating wound of the lower third 
of the left thigh. The wound of entrance (.3 cm. in dia- 
meter) was medial and the explosive wound of exit (lb.6 x 
13.9 cm.) was located on the lateral Aspect of the thigh. 
The lower third of the femur had oeen shattered' but the great 
vessel were intact. Present also was a perforating wound 
of the right buttock. 
CASE 91, 
132nd Inf., on patrol 
lying in an open foxhold was wounded by the direct burst of 
a^Japanese mortar shell. His right foot was blown away. 
He was taken to the command post and remained there 
night. On the following aay he oled to death, while being 
carried to the rear on a litter. This was a preventable 
death. The aid man, when questioned, stated that he did 
not apply a tourniquet before beginning the litter carry be- 
cause the stump was not bleeding at that time. He was 
wounded at 1800 hours, 4 npril 1944, and died at 1300 hours 
on 3 April. 
The photograph reveals the traumatic amputation stump. CASE 91 
CASE 92 CASE 92 
CASE 92 
182nd while on 
-guard beyond the perimeter tripped the wire to a U.S. Booby 
Trap (Grenade). He heard a noise and hit the dirt, but 
was struck in the left buttock by a fragment from a distance 
of 3 yards. He was wounded in the morning 29 March 1944. 
At the clearing station the wound was debrided and another 
incision made to remove the fragment. This incision was 
sutured. Sulfanilamide powder was insufflated into the 
entrance wound and it was left open. The patient died at 
1100 hours 4 April 1944, of the gas gangrene which was diag- 
nosed on the same day. 
Postmortem examination revealed necrosis and infection of 
the wound and blood stream infection due to B.Yelchii. 
Photographs show both wounds with forcep grasping one of 
the sutures which were still in place. 
CASS 93 
BUgmmHHHMBHW, 129th Inf., while lying 
prone in the open Tiring at the enemy was struck by frag- 
ments from a Japanese mortar shell which burst on the ground 
nearby. He was wounded on 15 March 1944. On the following 
day a guillotine amputation was performed through the lower 
third of the right thigh because of impairment of blood sup- 
ply. -a shattered 4th left toe was removed and small wounds 
of the right 'buttook, lumbar region, right shoulder, and arm 
were debrided. tHHi was evacuated on 19 March to a 
Station Hospital. He developed anuria 23 March and died at 
0845, 25 March 1944. Death was attributed to uremia and 
cardio-respiratory failure. The uremia was thought to have 
been associated with "crush syndrome nephrosis". 
At postmortem examination the various wounds were healing CASE 94 
Ca32 94 
running along a jungle trail, was struck by fragments of 
a "short” U.3. 81 mm mortar shell which exploded between 
hi«B legs. He was wounded at 0945, 1 April 1944. -r.t a 
portable hospital surgical disarticulation of the left hip 
was done for an incomplete high traumatic amputation of 
the left thigh. ‘hole blood'(2000 oo.) was administered 
before and during the operation. He died of o hours 
later. 
ion revealed traumatic amputation ol the right leg 
in the upper one third, surgical disarticulatipn of the left 
hip, and"mutilation of the right hand with multiple fractures. 
The photograph shows the extent of the wounds. 
CASH 95 
( ) , was wounded in action on an 
unknown date. he sustained multiple penetrating wounds of 
the right lower extremity and a superficial wound of the 
scalp from fragments of a U.5. land mine. :.e was treated 
at the Evacuation hospital developed gas gangrene of tne 
right leg and died at 1530 hours, 12 march 194^. 
examination revealed the characteristic odor and edmatous 
discoloration of gas infection. The right tibia and fibula 
were fractured in the middle third. The largest of'the 
penetrating wounds measured 2.5 cm. 
ruotogrupii snows t-ne iueuax iragiaentb rocuVereu. irum ouo 
"astrocnemius muscle. CASE 93 
IHHHBiHIHHV (Txm , was Abounded in action on 24 
i-afch’and died at 2000 hours, 28 karch 1944. was 
caused by gas gangrene of the left thigh. 
* 
examination revealed a large wound '(17 *x 16.2 cm.) involving 
the mediaj. surface of the thigh. The wound apparently had 
been caused by a high explosive shell fragment. The femoral 
vessels were intact but thrombosed. The femur was intact. 
The wound exhibited characteristic features of gas bacillus 
infection. 
CASS 97 
129th , 
beyond the perimeter hunting souvenirs, stepped on 
a U.S. land mine and was killed instantly on 30 ..larch 1944. 
Examination revealed multiple wounds of the head, chest and 
abdomen. One missile destroyed the antral, orbital and 
frontal areas of the skull. Only remnants of brain tissue 
remained. another fragment entering the right thorax had 
resulted in perforation of the right ventricle and almost 
total destruction of the right lung. Two fragments were 
recovered, one from the pericardial sac, the other from the 
pleural cavity. a fragment penetrating the abdominal cavity 
had completely severed the right lobe of the liver. 
Photographs show the extensive wounds of the head and thorax 
and the recovered metal fragments. CASE 97 
CASE 97 CASE 98 
was jrie 01 ** soldiers 
assigned to a pillbox. They became alarmed thinking they were 
being surrounaed by Japanese and left the box and separated to 
seek other cover. 3 of the men took cover in another foxhole, 
-ttfter a time HBHi came to join them. Le was met with rifle 
fire and hand grenades from his apprehensive companions as he 
walked down the trench to enter the hole. He was killed in- 
stantly at 2130 hours, 20 April 1944. 
Examination revealed 7 wounds of the chest, scalp, back and 
lower extremities. These wounds were all produced by grenade 
fra*gments, no bullet wounds were found. Instantaneous death 
resulted from the thoracic injury: One fragment traversed 
the left supraclavicular fossa and the posterior first right 
intercostal space. The entrance wound was 2.5 cm. in dia- 
meter. This missile fractured the first rib, lacerated the 
left upper lobe and in crossing the mid line, fractured the 
bodies of the 4th, 5th, 6th and 7th dorsal vertebrae. Mas- 
sive hemothorax was found. Bilateral fractures of the tibia 
and fibula and fracture of the left femur were present. 
0*33 99 
IBB 131st Engrs. , left his foxhole to 
rescue a friend who had been wounded. vhile running he 
was struck by fragments of a Japanese 90 Him. mortar shell 
which burst on the ground 2 yards away. He died in the 
hospital several hours later at 0830 hours, 24 March 1944. Examination revealed penetrating wounds of the left parietal 
and right kidney regions. The wound of entrance (1.3 cm. in 
uiameterj in the left parietax region was filled with brain 
tissue. Stellate fracture.lines coursed the cranial vault. 
The parietal lobe was lacerated and intracranial hemorrhage 
was marked. A siiiall fragment of metal was removed from the 
brain tissue. .mother fragment pierced the *12th rib right 
to enter the abdominal cavity, fragmented the right kidney and 
lacerated the right lobe of the liver. kassive hemoperito- 
neum was present. 
Ihotograph shows the small fragment recovered from the brain. 
GA33 ICu 
CASE 100 _____ 
1st Fiji Commando, while on patrol 
U.S. land mine. He was killed instantly 1360 
hours, 26 karch 1944. 
Ex{*mination revealed 7 wounds. A fragment entering the 
head produoea an entrance wound (1.2 era. in diameter) through 
the right, fronto-temporal region. In its course this irag- 
ment fractured the maxilla, zygoma, frontal and temporal 
bones and destroyed the right frontal lobe of the brain. x. 
penetrating wound (2 cm. in diameter) of the abdomen was 
located 6 cm. above the umbilicus. The fragment producing 
this wound severed or perforated the pylorus, duodenum, je- 
junum. and mesentery of the small bowel and was found lodged CiiS2 100 
in the soft tissue at the aortic bifurcation. The peri- 
toneal cavity was filled with blood. Another missile which 
produced a penetrating wound (2.2 cm. in diameter) in the 
left pectoral region severed the brachial plexus. This 
fragment was found in the subcutaneous tissue over the 6th 
rib in the posterior axillary line. In eydaition 2 pene- 
trating wounds of the chest wall, 1 of the abdominal'wall 
and 1 of the left thigh were discovered. 
Photographs show wounds of the head and chest and metal 
fragments recovered from the wall and peritoneal 
cavity. /v: 
CASE 101 . • 
164th Inf.*, while crouch- 
ing and advancing on patrol was struck by several .25 
caliber Japanese bullets fired by a sniper from a distance 
of 50 to 75 yards. He was killed instantly at 1620 hours, 
29 larch 1944. 
.examination revealed 6 perforating wounds. The thorax was 
perforated by a bullet entering posteriorally. The entrance 
wound (1.5 cm. in diameter) was found in the left 3rd inter- 
costal space at the costovertebral junction and the exit 
wound (6.2 cm.) over the right deltoid prominence. In its 
course this missile fractured the 3rd rib, perforated the 
left and right upper pulmonary lobes and fractured ttie 
right clavicle and scapula. Passive bilateral hemothorax 
resulted. 
164th Inf;, while crouch CASA 1CX 
CAS., 101 The entrance wound (2.5 cm. in diameter) in the abdominal 
wall was situated in the left lower quadrant and the exit 
wound (5 cm. in diameter) on the right side of the scrotum. 
The missile producing these wounds lacerated the sigmoid 
colon, fractured the symphysis pubis, and avulsed the 
right testicle. The left femur was fractured in its lower 
third by a bullet which produced an oblique perforating 
wound. This bullet traversed the thigh from the lateral 
aspect of the upper third to the medial aspect of the lower 
third. In addition wounds of the left buttock, 
left shoulder and left ear were present. 
The wound tract traversing the abdomen and scrotum is de- 
monstrated in one photograph by the inserted catheter. 
bullet found in the clothing is shown in the other photo- 
graph. 
CASE 102 
102 __ 
mmbmwhile in front of the 
improve line of fir© 
stenned on a U.S. land mine ana was killed instantly at 
195 CASE 102 
1015 hours, 1 *».pril 1944 • 
Examination revealed 16 widely distributed wounds. The 
head wound was obviously responsible for immediate death. 
The fragment which produced the extensive head wound 
(10 x 6 cm.j destroyed the right orbit, right frontal bone 
and avulsed both frontal lobes ana part of the right pari- 
etal lobe of the brain. In addition there were numerous 
penetrating and perforating wounds of the upper and lower 
extremities and abdominal and chest walls. The following 
compound fractures were found: right tibia, left tibia and 
fibula, right femur, right ulna and mandible. 
Photographs show the wound of the head and some of the re- 
covered metal fragments. 
CASE 103 
140th E.A. , while walking 
through thick jungle on patrol was shot by .25 caliber Jap- 
anese bullets fired from a distance of 10 yards. lie was 
wounded at 1600 hours, 14 Aarch 1944 end reached the hos- 
pital 1 hour later. The wounds sustained necessitated 
multiple operations. The severed left axillary vein was 
ligated and the wound left open. exploratory cystotomy 
revealed no perforation of the urinary bladder making supra- 
pubic drainage unnecessary. Compound comminuted fractures 
of the"right femur and ilium were accompanied by extensive wounds of soft, tissue about the right hip joint and buttocks. 
These wounds were debrided. _ The patient died at 1450 hours, 
16 Inarch 1944. His death was attributed to gas gangrene and 
peritonitis. 
Examination revealed a foul, edematous, discolored crepitant 
wound of tne right hip. A sinus tract containing a sero- 
sanginous exudate led to the' fractured head and neck of the 
femur. The edema and discoloration extended above to the 
wound into the right buttock. An operative incision was 
present in the low mia line. The terminal ilium was gan- 
grenous as a result of an unexplained thrombosis of the mes- 
enteric vessels. Gangrene of the ilium accounted for the 
presence of a diffuse sero-purulent peritonitis. 
flHIHIHlHBHlBMHPHHBP 132nd Inf., on a 
mine while on an authorized mission in front of the peri- 
meter arming U.3. land mines at G83G hours, 27 1944. 
he was taken immediately to the Clearing Station. There 
his numerous wounds, inducting the wound of a traumatic am- 
putation of the left foot, were debrided. He died of shock 
at 144$ hours, 27 Karch 1944. 
Examination revealed 13 wounds. The 4 wounds of the left 
lower extremity were: the wound of an amputation stump in 
the lower third of the leg, a linear wound 12.5 x 6.2 cm. 
over the knee accompanying a compound comminuted fracture 
of the patella, an irregular wound 10 cm. in length on the 
medial aspect of the knee and a superficial wound on the 
medial surface of the thigh. 3 wounds of the right leg 
were seen, a gutter wound 7.5 cm. long on the dorsum of 
the foot, a small penetrating-wound of the ankle accompany- 
ing a fracture of the internal malleolus, and a superficial 
wound of the calf. A large wound (12.5 x 7.5 cm.) of the 
right buttock was associated with a compound fracture of 
the sacrum. Present also was a compound comminuted frac- 
ture of the right ulna. In addition wounds of the back (2), 
right forearm (2), and left buttock (1), were found. 8. JHiCUI/.STAKGS3 AHL) PRCTFCi IVm I.IHASURFS 
study of the circumstdnces uiider which wounds occur 
may yield information regarding the effectiveness or weapons 
under battle conditions, the results of training enc. the need 
lor protective measures. Zounds occur unaer a variety of 
conditions which maKe calssification difficult. However, 
an attempt was made to determine the position and occupation 
of the soldier when wounded, the type of cover and the dis- 
tance from the shell burst or weapon. This information was 
obtained from the wounded man or from his comrades or from 
both. The circumstances under which the soldier was wounded 
usually could be obtained in considerable detail. However, 
the caliber and. exact type of v/eapon frequently could not be 
identified other than as belonging to the general classifi- 
cation used in these tables. 
Fig.82: Photograph illustrates necessary exposure 
of head and upper extremities. 
’■Then the subject of "cover” is viewed broadly, 
casualties fall naturally into three general groups depen- 
ding upon the relative degree of protection available at 
the time of wounding. In the first group are placed 
these who had the best protection, usually a well construct- 
ed pillbox covered by fairli neavy logs. In the second group are those who had no overhead "cover", but were pro- 
tected on all sides by well dufe-in holes or trenches. The 
third group comprised those with the least protection, and 
is subdivided into those who had no protection whatsoever, 
and those who had partial protection. A soldier in a 
shallow foxhole or behind a tree or log would be considered 
one with "partial protection". Eighty one casualties pro- 
duced by miscellaneous weapons whose position at the time of 
wounding was not considered significant are excluded, but 
will be discussed later in this section. In 150 instances 
the "position" was not stated. Data regarding "protection 
and position" was available therefore in 1,557 cases, and is 
summarized in Table 1. Those who were erect, standing, 
walking or running were included under the classification 
"standing". 
i?1ig.83: Showing "necessary" and "unnecessary" ex- 
posure in a position on Hill 700. 
Those who had considerably less body area exposed, whether 
they were sitting, crouching or kneeling, are placed in 
the* group designated "sitting". The term "prone" does not 
require explanation. By weapon these casualties were dis- 
tributed as follows: mortar 39.6 per cent, rifle 26.8 per 
cent, grenade 13*5 per cent, artillery 11.4 per cent and 
machine gun 8.7 per cent. TaRLE I 
Rifle 
Itech.G-un 
Grenade 
Mortar 
*rty. 
Totals 
No. % 
Standing 
open 
184 
57 
' 49 
189 
88 
567 
36.3 
cover 
4 
1 
l 
5 
2 
13 
0.8 
Sitting 
open 
92 
25 
39 
114 
15 
263 
18.4 
cover 
10 
0 
1 
15 
2 
28 
1.8 
Prone 
open 
72 
30 
62 
122 
26 
312 
20.1 
cover 
13 
3 
5 
12 
2 
35 
2.3 
Pillbox 
11 
0 
33 
64 
26 
140 
9.1 
Trench-hole 
29 
12 
19 
9! 
26 
177 
11.0 
Totals 
415 
m 
209 
612 
167 
-1552 
100.0 
a. Influence of position on number of casualties. 
It is obvious that the body surface exposed de- 
pends upon the '’position” of the soldier when wounded and 
should bear some correlation with the number of hits. It 
is important to know whether the number of hits depends 
solely upon the body surface exposed, or whether it is great 
er for aimed weapons. Data relating to this problem was ob 
tained by examining the least protected group (standing, sit 
ting and prone) which constitutes 79*9 per cent of the total 
(1,557). 
Fig.84: Little protection is afforced by this 
type of machine gun emplacement. Fig.85: A shallow 81 mm. mortar emplacement which 
afforus moderate protection. 
TABLE II 
("covered and uncovered") 
Aimed 
Weapons 
Unaimed 
/eapons 
Totals 
Position 
No. 
/* 
No. 
No. 
/O 
Standing 
246 
50.2 
33^ 
44.6 
580 
46. B 
Sitting 
127 
25.8 
186 
24-9 
313 
25.2 
Prone 
118 
24.0 
229 
30.5 
347 
28.0 
Totals 
491 
100.0 
749 
100.0 
1240 
100.0 
By reference to Table II it is apparent that tnere 
are twice as many casualties among the "standing" as there 
are among either the "sitting" or the "prone". Furthermore, 
the number of casualties is approximately equally divided be- 
tween the two latter groups. V/hen the factor of "cover" is 
excluded by omitting the small number who had slight pro- 
tection, the relative rroportion of casualties in the three 
subdivisions remains unchanged. This is what might be ex- 
oected were all missiles unaimed and travel]ing at random. Fig.86: A cleared Field of fire in front of tn* ,.a« 
the 129th sector, where the terrain was also 
favorable for the use of tanks. 
Table hi 
("covered'’ omitted} 
lifted 
,'eapons 
" 1 ■ 1 
Unaimed 
Weapons 
T 
otals 
Posit ion 
No. 
% 
No. 
7o 
No. 
P 
Jtanding 
241 
52.4 
326 
46.2 
5t>7 
48.7 
Jitting 
117 
25.4 
166 
23-9 
285 
24.5 
Prone 
102 
22.2 
210 
29.9 
312 
26.7 
Totals 
460 
100.0 
704 
100.0 
1164 
99.9 
In this event tne number or wounds received wouxu ue in approx- 
imate proportion to the projected body area exposed. On the 
basis of the foregoing finding it appears that in this partic- 
ular jungle c.-Ainpaign, the number of casualties depended upon 
random unaimed hits which were roughly in proportion to the 
body area exposed. b. The Relatively V/ell Protected 
In the total group (1,557), 317 or 20.1 per cent 
were wounded in well covered pillboxes or well dug in, but 
uncovered holes or trenches. These casualties were nearly 
equally divided between the pillbox (44.8 per cent) and the 
open trench (55.2 per cent)/ Many more of this group were 
wounded by aimed weapons (81.9 per cent) than by unaimad 
weapons (18.1 per cent). However, the aimed weapons pro- 
duced 70.7 oer cent of the casualties ii the open trend., 
but only 29.3 per cent in the pillbox. Casualties from 
unaimed weapons were approximately equally distributed be- 
tween the pillbox (48.1 per cent) and the open trench (51.9 
per cent). One may, therefore, conclude that the covered 
pillbox offers relatively greeter protection against aimei 
weapons. 
Tig.87: showing typical Jungle terrain. Members 
of a netrol crossing the . iva silver on 
•way bscK to front lines. 
c. Ty: of action 
The number wounded on patrol, or defensive end 
offensive action is shown in Table IV. TABLE IV 
Rifle 
Ivia ch. Gun 
Orenade 
I'ortar 
artillery 
Totals 
Patrol 105 
34 
25 
35 
29 
228 
Defensive 253 
78 
152 
588 
136 
1207 
Offensive 58 
36 
38 
50 
3 
185 
Total 416 
148 
215 
673 
168 
1620 
Table V shows the relative percentage distribution 
of these casualties according to the aimed (34.6 per cent) and 
unaimed weapons (65.2 per centj. A much higher percentage, 
however, were wounded on both patrol and offensive action by 
the aimed weapons. On defensive action the reverse obtains. 
TABUS V 
Type of * action 
Weapons 
Unaimed Weapons 
# 
Total 
Patrol 
24.6$ 
8.4/e 
14.1* 
Defensive 
58.8 
83.0 
74.5 
Offensive 
16.6 
8.6 
11.4 
Totals 
100.0 
100.0 
100.0 
. ig.88: .1 • Luma tr.- •. 1 * perlmetei 
yti - f( • v cuatlon of -ties fvc 
out od ■ :: i natrols. d. Hange and Distance from Burst 
The approximate range was known in 339 casualties 
produced by the rifle and in 121 casualties resulting from 
machine gun fire. In Table VI this group is tabulLtea in 
percentages according to range and disposition. The higher 
lethal effect of bullets at close range Should be noted. 
.sb longer range it wouxd appear that the casualties received 
either minor or vital wounas since none received wounds of 
sufficient severitjr to cause evacuation to the U.b. The 
distance from the shell burst or weapon was estimated in 
most instances and is, therefore, open to considerable error. 
It is likely that the actual distance from a shell burst was 
greater than the estimated distance. In future studies 
suitable samples might be used to check on this error. fur- 
thermore, indoctrination of troops, before combat, regarding 
the importance of such data i. ipht lea' to more accurate ob- 
servation . 
ITlBLI VI 
Dead 
Duty 
Evacuated to 
Total 
Average 
U.S. 
Yards 
Rifle 
Mach.Gun 
Rifle 
Mach.Gun 
Rifle 
Mach.Gun 
Rifle 
Mach.Gun 
0-23 
34-72 
40.3* 
17.92 
3-255 
37.755 
28.6^ 
33- 95! 
28.15S 
23-30 
27.3 
43.1 
8.3 
6.4 
19.3 
33.7 
16.6 
33.1 
30-73 
8.3 
6.4 
37.2 
31.6 
42-9 
33.7 
29.3 
24.8 
754- 
9.4 
8.1 
36.5 
38.7 
0.0 
0.0 
19.8 
14.0 
Totals 
99.9 
99.9 
99.9 
99.9 
99.9 
100.0 
100.0 
100.0 
Approximate distance? from shell bursts (including 
"knee" mortars) were known in 623 casualties produced b; the 
mortar and in 176 caused by artillery. The percentage^dis- 
tribution of these casualties according to the disposition 
of the patient is shown in Table VII. In the Jungle the 
effect of a shell burst should be more limited than in open 
terrain. approximately 60 per cent of tne casualties were 
under ten i ards from the burst. TAELS VIJ 
Ranges 
Dead 
Duty 
Evacuated 
to U.S. 
Total Average 
Yards 
Mortar 
Art. 
Mortar 
Art. 
Mortar 
Art. 
Mortar 
Art. 
0-10 
79.43 
66.02 
64.52 
50.52 
66.6% 
53-82 
66.72 
59-6* 
10-20 
6.2 
9*3 
19.1 
21.3 
22.0 
19.2 
I8.3 
18.2 
20-30 
11.0 
4.7 
12.1 
15.9 
7.6 
11.3 
11.2 
12.3 
30+ 
1.4 
0.0 
4.3 
12.1 
3.8 
15.4 
3.6 
9.7 
Totals 
100.0 
100.0 
100.0 
100.0 
100.0 
99.9 
100.0 
100.0 
Similar results are tabulated for the grenade in 
Table VIII. It is rather surprising to find that the effect- 
iveness of the Japanese hand grenade extends beyond five yards, 
as evidenced by the fact that 25.1 per cent were wounded at 
this distance. However, it is possible that some of these 
casualties were produced by U.3.grenades. 
7111 
liange Yards 
Jead 
Outy 
Evacuated to U.^. 
Total 
0-3 
100.0/o 
6?. yjo 
56.7^ 
67.6 
3-5 
0.0 
6.4 
13.5’ 
7.2 
5+- 
0.0 
26.3 
29.7 
25.1 
Totals 
100.0 
100.0 
99.9 
99.9 
e_. Tire rhass 
In Table I-* casualties ere separated according to 
the period of time in which they occurred. Tne first phase 
extends to uhe beginning of the battle of the perimeter (15 
February to 7 Larch), the second phase covers the intensive 
period of activity of (8 Larch to 28 ..arch) anu the last phase, 
the subsequent relatively inactive period (29 I..arch to 21 
1944). eighty per cent of the casualties occurred during the 
cattle of the perimeter. 
TA3LH IX 
nifle 
1 Inch Gun 
Grenade 
liortar 
.j11. 
Totals 
ho. 
i:o. 
ho. 
ho. 
*>i C/ • 
I e. 
First Phase 
35 
7 
11 
39 
35 
127 
Second Phase 
308 
111 
184 
622 
140 
1365 
Third Phase 
102 
34 
29 
32 
18 
215 
Totals 
445 
152 
224 • 
693 
193 
1707 Table A summarizes the distribution of casu- 
alties in percentages according to their mode of production. 
Eixty five per cent were wounded by unaimed and the remain- 
der by aimed weapons. 
TABLE A 
Aimed V/eapons 
Unaimed eapons 
Totals 
First Phase 
7.1/0 
7.7/0 
12.6>i 
Second Phase 
70.1 
85.2 
6u .0 
Third Phase 
22.8 
7.1 
7.4 
Totals 
100.0 
100.0 
100.0 
f. .miscellaneous .'eapons ana Circumstances 
eighty one casualties (4*5 cent of 1,768} re- 
sulted from the following miscellaneous weapons, land mine 
(excluding grenade booby traps) 34, aerial bomb 14, .45 cal- 
iber pistol 14, powder explosions and flares 6, bangalore % 
torpedoes 9, bazooka 2 and bayonet one. Enumeration of the 
very varied circumstances surrounding the wounding of these 
patients serves no purpose since no general conclusion can 
be derived. 
V/hen all casualties are considered, however, (in- 
cluding those produced by miscellaneous weapons) several cir- 
cumstances deserve mention and are quoted from the section on 
U.3.weapons. ’’Nineteen were wounded by the accidental dis 
chaige of a rifle by a fellow soldier. mistaken, identity 
resulted in thirteen deaths and the wounding oi six others. 
~.ight of these deaths were occasioned by the soldier seeking 
to relieve himself at the toilet during the night. 
inflicted wounds, accidental or intentional were responsible 
for ten casualties, three of whom died. The accidental 
tripping of land mines ana booby traps produced fourteen 
deaths in a total of forty wounded. hour soldiers were 
killed while souvenir hunting, two by the rifle and two by 
land cines.” 
In jungle warfare a fair number of casualties 
result from the overhead explosion of mortar or artillery 
shells, or aerial bombs overhead, as a result ol detonation 
on impact with a tree or its branches. Juch explosions 
are designated ’’tree bursts” as distinguished from "ground 
bursts”. In 900 instances there were 93 Per cent) 
’’tree bursts”. mortar shells constituted $6.1 per cent 
of all ’’tree bursts”, artillery shells 34.4 per cent and 
aerial bombs 7.5 per cent. Ground bursts were divided as 
follows: mortar shells 79.1 per cent, artillery shells 
per cent and aerial bombs 0.9 per cent. ✓ 
Pig.t-9: a mortar shell oursts In front of two mien 
on a patrol. Pany casualties were caused 
by our own mortar and artillery"shorts". 
Irotective measures and recommendations 
(1) Pillboxes. Opinion has been expressed that 
the large size of the firing slit resulted in casualties 
which might have been avoided by & smaller opening. In some 
instances, nearby tree snipers were able to direct Tire 
through the firing slit. Because of this fact it has been 
suggested that an eave overhanging the firing slit might be 
a useful additional means of protection. Our findings in- 
dicate that gun fire directed through the slit is of little 
importance. ’‘founding through the firing slit did occur in 
104 (6.7 per cent; instances in 1,557 casualties. however, 
in this group the aimed weapons (rifle and machine gun) were 
responsible for only 9 (8.6 per cent) of those so wounded. 
In view of this small number the advisability of the over- 
hanging eave is doubtful. However, a considerable number 
of casualties (95) are caused by shell fragments passing 
through the firing slit. This would indicate the need for 
keeping the size of the firing slit as small as is consistent 
with observation and maneuverability of weapons within the 
pillbox. 
Protection against the hand grenade was afford- 
ed by the use of wire ("chicken") net at night to cover peep 
slit openings, and was favorably recommended. Home type of 
rubber net might serve to "bounce off" the unexpected grenade 
even better than the wire net. The earth should be sloped 
from the slit opening so that grenades will roll away. Fig.90: View of entering a well constructed pillbox 
showing size of firing slit. 
Fig.91: ire netting to cover firing slits w<aS used 
successfully to ’’bounce oil” enemy"grenades. The construction of pillboxes might be im- 
proved by the use of heavier (12 Anch) logs. Lard wood 
is recommended if obtainable as termites destroy soft 
timber quickly. Some concrete could be used to advantage. 
Since the location of the pillbox is usually known to the 
enemy, camouflage should be sacrificed for sturdy con- 
struction. The earth floor in a square log pillbox should 
not be excavated cut to the edges of the logs. On the con- 
trary a stronger pillbox results if the central excavation 
is made circular in shape, thus leaving more earth in the 
corners. 
Fig.92: Photograph reveals unnecessary exposure 
and concentration of men. 
(2) Combat Training. The majority opinion held 
that the Japanese soldier made oetter use ol cover than did 
our troops, and were better trained at "digging in" Quickly. 
They utilized all natural cover. They crawled close to the 
ground and their foxholes were small, efficient and well 
suited to the purpose intended. On tha contrary our troops 
were frequently careless in exposing tnemsolves unnecessarily 
and oftimes were content with foxholes which were entirely 
too shallow, hany wounds were. received oecause soldiers 
crawled with buttocks elevated, making a large silhouette. 
In training anu staging areas more time devoted to "digging 
in" would serve not only to stress the importance 01 adeQuate 
cover, but would also develop the necessary muscle. Fig.93: Infantry advancing behind tanks. I.any 
casualties occurred when the Japanese 
withheld fire until the tanxs had passed. 
.nen under fire the importance of dispersion 
should be repeatedly emphasized. Fur example in one in- 
stance thirteen men preparing to enter a trucx were killed 
or wounded by a single shexl. Neglect of this rinciple 
resulted in 600 enemy killed by our artillery fire in one 
area. 
(3) fried!cal Suggestions. Aid men should re- 
ceive more preliminary training in vena puncture. Lack 
of familiarity ana practice in this technique frequently 
delayed the administration of plasma. Jince patients can- 
not be evacuated at night frgm front line positions, every 
soldier should know the orinciples of first aid. Under 
combat conditions similar to these at Bougainville, it is 
felt that the oral administration of sulfanilamide medi- 
cation should be discontinued in the field unless on patrol 
far from medical installations. It was often difficult to 
know later in the hospital wl ether a man had received this 
medication and,if so, in what amounts. It was estimated 
that less than 10 per cent took the drug by mouth after 
wounded. This uncertainty as to dose frequently de- 
layed adequate sulfonamide therapy. Finally the practice 
of sending aid men forward to remove the dead under fire is 
very demoralizing and should be condemned. 
(4) Body Armor. The subject of protection would 
not be complete without some expression oi opinion regarding Fig.94: natural jungle growth provided excellent 
camouflage. The soldier is examining an 
abandoned Japanese gun position. 
the advisability or body armor. Lany line officers believed 
that under certain tactical situations the judicious employ- 
ment of some type of body armor would be definitely advanta- 
geous. Its routine use is not recommended. Tne objections 
most frequently raised are, that the infantry foot soldier 
is already burdened with a maximum amount of weight, that any 
further equipment and would interfere 
with fighting efficiency ana finally that too much protection 
induces an "oyster complex". These objections could be over- 
come if the use of armor were restricted to a special circum- 
stance. .then the tactical situation demanded body armor, it 
could be transported to that point, issued ana later collect- 
ed when the objective had been attained. In the type of 
combat at Bougainville the .soldier aid not carry a "full pack", 
obviously for brief intervals all unessential equipment could 
be discarded in favor of armor. 9. SUMMARY 
The primary purpose of this report is to evaluate 
the relative effectiveness of the different weapons as casu- 
alty producing agents. In order to achieve this aim it 
was necessary to determine and to correlate the varied cir- 
cumstances surrounding wound production in each individual 
case. It was essential to know what weapon caused the 
wound, the anatomical region wounded, the range and distance 
from the burst, the available protection, the degree of dis- 
ability, the treatment ana disposition of the patient and 
all details relating to death. This report comprises a 
study of all battle .casualties (living ana deaa] occurring 
in the Army Ground Forces on Bougainville Island from 15 
February to 21 April 1944. 
a. History 
The Bougainville campaign possesses certain 
features which are not found in jungle warfare. 
a beachhead was made in virgin jungle for the purpose of 
establishing airfields. Not until four months later did 
the enemy engage in the major large scale attack referred 
to as the "Battle of the Perimeter”. In t* is interval the 
perimeter was extended and strongly fortified and an excel- * 
lent system of roads was constructed within the defended 
area. V/hen attack came, we possessed superior force both 
in numbers and equipment. '.Ve had gained control of the 
air and ii addition had the advantage of overwhelming ar- 
tillery s. . Ample vehicular transportation and 
smooth a lx weather roaas facilitated supply and evacuation, 
i.edical installations had been completed which were easily 
accessable and adequate to meet all exigencies. Conse- 
quently a high standard of i.edical care was maintained. 
The Japanese on the contrary were handicapped by the nec- 
essity of taking offensive action against a well established 
perimeter defended by a greater number of better equipped 
troops. furthermore, their supply problem was very dif- 
ficult. They were compelled to transport supplies chiefly 
by pack through dense jungle and over narrow ruggea mountain 
trails. However, with the exception of artillery weapons 
and shells, the enern^, by logged effort were able to keep 
adequate supply of arms artd ammunition. 
b. Casue It leg 
T: e United Jt&tes forces at Bougainville sustained 
2,335 casualties troa 15 F~br 21♦April 1944, of these 
16.9 per cent died, 69,3 per cent were returned to duty and 
13*6 per cent were evacuated to the United States. In the 
totao. group there /ere -f ? who were so lightly wounded that 
t/iey were returned directly to duty from the battalion aid 
posts or collecting stations. iince the effect of weapons 
on this group was roinlmal and since these soldiers were not 
actually "lost to combat", they were e/cluded from the re- 
mainder of the study. Therefore, all subsequent percentage 
figures are based on 1,7&6 battle casualties who were admitted to hospitals, or were killed in action. Using the 1,788 
casualties as a basis we find that one of four men wounded 
died, making a mortality of 22.1 per cent. The living 
wounded numbered 1,393, of these 77.2 per cent were returned * 
to duty and the remainder evacuated to the United States. 
* 
The majority of casualties (78.6 per cent) occur- 
red during the "Battle of the Perimeter", a period arbitrarily 
defined as extending from 8 Larch to 28 Larch 1944. Most 
of these casualties occurred within our lines. Because of 
the fortuitous circumstance of hospital aocessebility, these 
wounded obtained adequate medical care, usually within one 
hour, but in most instances in much less time. Patrol 
activity was chiefly responsible for the small number of 
casualties which occurred before and after this battle. 
These casualties constituted the major problem in the evac- 
uation of the wounded. During the "Battle of the Perimeter" 
the .Americans loss was 210 killed in action as contrasted 
to 8,527 Japanese dead, a ratio of 1 to 24.6. 
£. anatomical Distribution of Vounds 
A striking contrast is observed in the percentage 
distribution of wounds in the dead, in the living and in both 
groups combined, when classified according to the anatomical 
region involved. (Bee Table I). 
TABLE I 
Relative 
Order 1 
2 
3 
4 
5 
6 
Total 
...end 
Multiple 
Upper Lxt 
. Thorax 
Abdome 
Casual- 
ties 
22.7,; 
21.4$ 
18.6,0 
17.9* 
12.9/0 
6.670 
Lead 
Only 
Head I. 
36.4^ 
-ult Iple Thorax 
25.6/0 22. 
1 
..bdomen 
12.2,i 
3.3,0 
. Upper 
-xt. 
' 0.3$ 
Living 
Lower . 
Upper 
Head 
Multiple 
Thorax 
Abdome 
Only 
28.2/j 
-•Xt . 
22.7/0 
17.3, i 
16.7/o 
10. k% 
4. l°/o d. ./guild Distribution 
It was found that the distribution of v/ounds is 
dependent largely upon exposure to the random missile and 
not upon directed fire. This is demonstrated clearly by 
comparing the actual with the expected number of hits in 
each anatomical region. This was done by superimposing the 
percentage of hits over the percentage mean of the projected 
body area. In this way the directed fire (rifle) was com- 
pared to the undirected fire (mortar) and to the total hits 
by all weapons. A close correlation exists between the 
expected number of hits and the mean projected body area ex- 
cept in the cane of a single region, the head. In the head 
the number of hits exceeded the expectancy by more than 100 
per cent. This would indicate that in combat exposure of 
the head exceeds that of any other anatomical region. How- 
ever, the fact that percentage of rifle hits exceeded the 
percentage of unaimed mortar hits by a perceptible margin 
would tend to indicate that the factor of marksmanship does 
account for a moderate number of head wounds. 
om. Effectiveness of weapons 
In Table II the number of battle casualties pro- 
duced by the different weapons is shown in relation to the 
"relative lethal effect" of each weapon. A clear distinction 
exists. The total number of casualties produced by a given 
weapon reflects not only the extent of its .use by the enemy, 
but also the effectiveness of that weapon when employed under 
the particular circumstances of that battle. On the other 
hand the "relative lethal effect" of a weapon is defined as 
the percentage killed by all hits and is a measure of the 
effectiveness of that weapon under all conditions (providing 
facilities for medical care are comparable and constant), 
itor example, while the mortar produced more casualties in 
this campaign, the machine gun Laa the highest lethal effect. 
TABLE II 
Relative 
Order 
1 
2 
3 
4 
5 
Humber of 
£.foj*tar 
Rifle 
Grenade 
Mach Gun 
Casualties 
38.7/. 
24.856 
12.5$» 
10.856 
8.556 
Relative 
Lethal 
Mach Gun 
Rifle 
artillery 
Llortar 
Grenade 
Effect 
58.056 
32.25b 
22.3,0 
11.856 
6. 
Total 
Rifle 
I'ach Gun 
JJortar 
artillery 
Grenade 
Dead 
36.7% 
22.2% 
2b. 7 
10.9, a 
3-5^ A true measure of tne effectiveness of a weaoon 
cannot be obtained by a consideration of the total number of 
casualties and the relative lethal effect alone. third 
factor must be considered, namely, the severity of the wound 
in the living. An estimate of the severity of the wound 
may be obtained by classifying the living casualties accord- 
ing to the ultimate disposition of the patient, whether he 
was returned to duty from the first or second echelon, or 
evacuated to the United Jtates. still more important 
criterion of the effectiveness of a weapon from the stand- 
point of winning a battle is the ability of the wounded 
so±dier to continue combat. This was determined by class- 
ifying the wounded according to arbitrary criteria based on 
whether the soldier could have continued combat for a few 
hours if his life were at stake. /hen measured by both of 
these standards the relative effectiveness of the different 
weapons was found to be of the same order as follows: (1} 
machine gun, (2) rifle, (3> artillery, (4) mortar, (5) gren- 
ade. 
Sufficient ballistics data is not available in 
this theatre to determine the average velocity of shell 
fragments producing casualties. The exact size of the 
shell causing these casualties is also unknown. Further- 
more, there is insufficient clinical data to determine the * 
size ana mass of the fragments causing casualties. however, 
if one assumes the average velocity of bullets is greater 
than that of shell fragments at the point of impact, these 
findings suggest that the effectiveness of a weapon is a 
function of the velocity of the missile. 
TA3LL III 
Relative 
Order 
1 
2 
3 
4 
3 
Lost 
to 
1 la) 
distribution 
by 
« .'eapon 
'■Qi’tar 
35.6^ 
Rifle 
3?. 3$ 
l.acL Gun 
12.6 fa 
. 
10.5% 
Grenade 
8,6/3 
Battle 
nvr 
effective- 
L.ach Gun 
Rifle 
.jrty. 
Grenade 
ness of 
Weapon 
85.5% 
IkM 
56-5^ 
53-d 
40. 6% 
Lost 
Jistribut ior 
by 
Weapon 
Rifle 
l.ach Gun 
Artj . 
Grenade 
to 
37. 
27.0% 
18.0% 
9.3% 
6.3/0 
Combat 
effective- 
ness of 
. eapon 
Rach Gun 
75... 
it if le 
52-3^ 
Rrty. 
30 . 6% 
I .ortar 
24.5% 
Grenaue 
18. H 
"Lost to Battle"-dasualties dead evacuated to trie rear ecnelon 
and to the United states. 
"Lost to Combat"-Casuaities dead or unable to continue to fight 
"if life were at staxe". 
(a) Percentage of casualties wounded by each weapon. 
(b) Percentage effect of the weapon per se. f. Comparison of Japanese and U.3.Weapons 
A comparison of the effects of Japanese and U.3. 
weapons shows a lower lethal effect for both the enemy ar- 
tillery and the grenade. The fact that our artillery was 
predominately heavier than that of the Japanese may explain 
its greater relative effectiveness. The low lethal effect 
of the enemy grenade appears to be characteristic of that 
weapon. (a comparison of weapons was possible in only a 
relatively small number of instances, since records were 
available for only 219 casualties produced by U.S.weapons.) 
£. Circumstances 
On the basis of the study of a large group 
(79.9 per cent} who haa relatively little or no protection 
when wounded, it was found that the number of casualties 
depended upon random unaimed hits which were distributed 
roughly in proportion to the body area exposed. The re- 
maining casualties which occurred unuer the circumstance 
of relatively good protection were equally distributed be- 
tween the pillbox and the uncovered foxhole or trench, 
mimed weapons were responsible for 81.9 per cent of the 
casualties in the uncovered trench or foxhole ana for only 
29.3 per cent in the pillbox. On patrol and offensive 
action the majority were wounded by the aimed weapons, 
whereas, on defensive action, the reverse obtained. mighty 
per cent of the casualties in this study occurred during the 
"Battle of the Perimeter". 
A number of casualties resulted from careless ex- 
posure, failure to aig-in and failure to take advantage of 
natural cover. a large number of casualties (219) resulted 
from our own weapons. These findings indicate the need for 
even greater emphasis on the importance of "cover". The 
training program should also stress the avoidable circum- 
stances under which troops are killed or wounded by care- 
less behavior. 
h. Ledical Treatment 
Exceedingly advantageous circumstances surrounded 
the treatment of the wounded at Bougainville. In the treat- 
ment of 2,015 casualties the low mortality of 3-7 per cent 
was obtained. experience In this campaign indicates a need 
for portable blood banks. ehock and hemorrhage were well 
treated by the liberal use or plasma. Vhole blood trans- 
fusions were used more extensively than in an3? previous cam- 
paign in the Bouth Pacific. Nevertheless, a wider utili- 
zation of blood transfusions would have been beneficial, be- 
cause of large blood volume replacement needed. fractures 
were well treated by plaster immobilization. There were no 
deaths due to compound fractures oi the extremities. first 
aid treatment was excellent, and in only two instances did a 
death occur which might have been attributed to an aid mans 
error of judgment. Inadvisable evacuation of patients be- 
fore recovering from shocK possibly contributed to a fatal 
outcome in a few instances. _i. Postmortem examinations 
Hemorrhage was the most common cause of death in 
104 autopsies. frequently four or more liters of blooa were 
found in the pleural or cavities. -extensive 
brain damage ranked second in reducing death. Accurate 
determination of the causative missile by the appearance of 
the wound was not possible in either the dead or the living. 
There was no constant relations}, ip between the size of the 
wound of entrance and exit and the underlying structural 
damage. "Blast Effect” of high velocity missiles was fre- 
quently noted in the more solid organs as well as in the lung 
and brain. 
NOTE: This report hs been written without the benefit of 
adequate ballistics data. Hence some of the assumptions 
regarding the velocity of missiles may be erroneous. 10. CONCLUSIONS 
a. The Objective 
The ultimate aim in the study of wound ballistics 
is to provide data which will allow the machinery of war to 
produce more casualties among the enemy. These data may en- 
able an army to devise more efficient weapons, develop better 
protective measures and will eventually reflect in improving 
the care of the wounded. 
b. The Data Required 
Field studies should yield information which per- 
mits the proper evaluation of weapons as casualty producing 
agents. The effectiveness of a weapon may be measured by 
the number of casualties it produces, and by the severity of 
the wound. Wound severity in turn must be gauged not by 
local appearance, but by the ultimate disposition or length 
of disability of the patient. The following factors, there- 
fore, must be considered: 
(1) Weapons. Type and proportion of weapons 
employ'd, the range or distance from the shell burst, and the 
mass or velocity of the missile should be determined. 
* 
(2) Local Circumstances. The number and char- 
acter of casualties reflect battle condition; hence, local 
conditions must be ascertained. It is desirable to know 
the position and occupation of the soldier when wounded, the 
available cover, terrain and the tactical situation. 
(3) Medical Care. A detailed study of the 
patients medical record is essential nnd should include a 
description of the wound, with the exact location of the 
point of entry, evaluation of the treatment and postmortem 
findings in case of death. The degree of disability measured 
in time lost from combat must be ascertained end evaluated, 
together with the mortality rates for each weapon. 
£. The Lethods and Results 
Lata in this report were obtained by personal inter- 
view and by questionnaire. Because the wounded man frequently 
knew less about the circumstances of wounding than his unin- 
jured companion, witnesses were interviewed at the Iront as 
soon as possible after the action. nospitaj. staff officers 
were not trained in the study of wound ballistics and when 
casualties were heavy they were fully occupied with the care 
of the wounded. For this reason it was found desirable to 
have an officer of the ballistics team assemble clinical data 
at tire various hospitals. hince the action was confined to 
a small geographical area and transportation facilities were 
excellent, the collection of essential information was rela- 
tively easy. Under these rather ideal circumstances the re- 
port falls short of attaining the full advantage of the op- 
portunity presented for the study of wound ballistics. ts 
merit, if such there be, lies in the fact that it presents 
data on all who were killed and wounded in one battle. ' d. The Lessons Learned 
(1) The personal interview is preferable to 
the Questionnaire. The questionnaire may be utilized as 
an adjunct, if its use is supervised by a ballistics in- 
vestigator and its accuracy repeatedly checked. 
(2) There is need for the definition and stan- 
dardization of terms used in the study of wound ballistics. 
To obtain comparable reports it is necessary to adhere to 
some uniform plan of collecting and recording data. 
(3) The number of the wound ballistics team 
personnel was inadequate. For a comparable volume of work 
the number should be doubled. 
(4) A wound ballistics team should be assigned 
to the combat unit one month prior to D-day. This will 
allow for indoctrination of medical officers, aid men and 
troops. In this interval experienced team members may fur- 
nish valuable instruction by outlining the avoidable circum- 
stances under which troops are killed or wounded. 
(3) Surgeons in hospitals along the line of 
evacuation should be instructed regarding the clinical data 
desired. They should understand the general objectives 
of the study in order to enable them subsequently to furnish 
the desired information. 
(6) The study of wound ballistics in the field 
requires special training and aptitude. It necessitates 
an attention to detail which an overloaded hospital staff 
does not have the time to devote during battle. Information 
collected in the routine manner without the aid of trained 
investigators lacks uniformity ana accuracy. In order to 
collect adequate and accurate data it is essential that a 
full time wound, ballistics team be assigned for that purpose. APPENDIX I 
iCSDICAI ACTIVITIES IK HECSKT SNGAGBJEST 
The following is an account of the activities of 
officers and enlisted men of the Ledical Detachment, 129th 
Infantry, in with the enemy during the period 
14 February, 1944, to 16 February, 1944, in a sector to the 
front of OP //7, 129th Infantry. 
A reinforced platoon composed of personnel from the 1st 
Battalion, assigned the mission of organizing and manning a 
new outpost approximately 10,000 yards to the front of OP #7, 
left the bivouac area of the 1st Battalion at approximately 
0700L, 14 February via vehicle to the CP of the 3rd 
Battalion, 145th Infantry, and thence proceeded by foot. The 
patrol was accompanied by one officer and four enlisted men 
of the 1st Battalion Medical Section, per instructions issued 
by headquarters 129th Infantry. 
The patrol proceeded without incident to OP /7, approx- 
imately 4,000 yards to the front of our lines. Thence it 
marched in route column up the Laruma River and, at a point 
approximately 5,200 yards forward, scouts of the patrol re- 
ported the discovery of enemy emplacements. plan of action 
was mapped by the patrol leaders, but before the plan could 
be carried out the patrol was attacked from the front and 
flank by the enemy. Personnel of the patrol withdrew to 
covered positions and, during the process of the withdrawal, 
enemy mortar and rifle fire caused 10 casualties, four of 
which were fatal. Cne of the four dead was buried during 
the initial phase of the engagement. This casualty had been 
killed near the enemy position, and inasmuch as heavy fire 
prevented the evacuation of his body, he was buried there to 
prevent his capture by the enemy. heavy'- enemy fire prevent- 
ed the recovery of the three other bodies. Of the six wound- 
ed men, five were removed to covered positions during the 
withdrawal and three of the five were taken to CP ,f?. They 
were treated there by medical personnel attached to the OP. 
The other wounded were taken to the point where the patrol 
set up an overnight bivouac and were given all possible 
first aid and treatment. 
Communication with the patrol had been severed and as a 
result no report of the engagement was received at tne CP, 
129th Infantry, until approximately 1800L. The Regimental 
Surgeon, upon being informed of the developments, immedlately 
made arrangements to take care of the evacuation of the casu- 
alties. The Assistant Regimental Surgeon, Capt. Mark '7.Dick, 
and the non-commissioned officer in charge of the Medical De- 
tachments transportation section, T/4 Vincent J. Walter, 
were ordered to proceed immediately by vehicle to OP //7 for 
this purpose. Within five minutes after receipt of the orders Capt. Dick and T/4 /alter were enroute. iit the C-t , 145th 
Infantry, they were joined by fjur armed guards from the 
1st Battalion, 129th Infantry, who accompanied them to the 
OP. The trip, over a poor trail, was made more difficult 
by the torrential rain which had fallen continuously since 
early afternoon. They reached the OP at approximately 20u0L. 
Three wounded men had already arrived by then at the OP and 
Capt. DicK administered blood plasma and morphine to the 
wounded. Thereupon, he instructed T/4 /alter to bring the 
three wounded men back to the Division Clearing Company. 
Driving at night through the jungle over the mud-ridden trail, 
T/4 ’/alter, accompanied by four armed guards, accomplished 
this mission by approximately 2400L. Because of the con- 
dition of the wounded, it was necessary to drive slowly and 
carefully during the trip. 
meanwhile, Capt. Dick, having been informed that there 
were additional casualties at the point of the engagement, 
transmitted a request to the Regimental Burgeon for four 
litter squads. The Regimental Surgeon contacted the Burgeon, 
1st Battalion, Capt. Carl C. -.rnst, and advised him of this 
request. Capt. mrnst ordered 18 enlisted men, under the 
leadership of S/3gt Glenn J. Siewenie, to proceed immedlately 
to OP These men joined the forward elements of the re- 
inforcements sent out from the 1st Battalion, 129th Infantry, 
and left their bivouac area at approximately 0245L. 
The going over the muddy road and through the dense 
undergrowth was slow and difficult and after continuous 
marching the medical personnel reached the 01 at approxi- 
mately 0430L. Upon arrival there, it was possible for the 
aid men to obtain some rest before accompanying the rein- 
forcements to the point where the remnant of the original 
patrol had taken utj positions. Capt. Dick took over com- 
mand of the medical personnel and, at approximately 0700L, 
departed from the 01*with 16 aid men. Three aid men, under 
T/4 Charles T. Tsakonas, were ordered to remain at the 01, 
set up an aid station and handle the forwarding of supplies. 
Capt.Dick, prior to leaving the.01, contacted the Regimental 
iurgeon aiftl requested that auditional supplies and personnel 
be dispatched to set up and man a more complete aid station. 
The Regimental ourgeon left the Regimental cl for the 01 with 
ei, ht aiu at approximately 0730L, 15 lebruary 194*+, ar- 
riving there at approximateiy 093^1. 
Capt. Dicrv, Laving departed from OP jfl with tne forward 
element of the reinforcements, proceeded toward the point of 
the engagement. four men were encountered bringing 
in a wounded man on a makeshift litter. Capt. Dick dropped 
out from the column to treat the wounded man. He aaminister- 
eC two units of plasma, dressed the wounds and gave him a 
blaryiet. The aid men made the litter as comfortable as poss- 
ible ana the litter-bearers proceeded with the wounded men to 
the CP. Capt. oick instructed the litter-bearers to request 
that additional supplies, particularly plasma, blankets and 
litters, be sent to him as soon as possible. Bhortly after- 
wards, another group of litter-bearers carrying a wounded man was met on the trt ii by Gai t. .Jick. This wounded man was 
also given two units of plasma, had his wounds dressed, was 
given a blanket and made comfortable before oaing ~ent on 
to the 01. This accounted for five of the six mounded 
in the engagement of the previous day. 
laving completed the treatment of the v*ounued on the 
trail, Cant. Dick and his medical personnel proceeded to re- 
join the forward element of the reinforcements. They joned 
the reinforcements just after contact haa been i.iade with the 
original patrol. There Japt. Dick informed that the 
sixth wounded man was on a cliff near the point of the attack 
of the previous day. ..bout this time, two members of the 
regimental ..edical Section, T>5 Henry Searcy ana T/5 Aichard 
if. Jaeger, arrived at the scene with four lifters, five units 
of plasma, morphine surette arid other supplies. They attempt- 
ed to contact Capt. mien but before Deing able to do so learn- 
ed of the whereabouts of the wounded man on trie cliff. The 
two took a' litter and a morphine surette and, despite enemy- 
fire in the vicinity, crawled to the side of the wounded man. 
They administered morphine to the wounded man, examined his 
wounds, carefully placeu him on the litter ana moved him to a 
spot which officered more concealment. Here the two men at- 
tempted to administer a unit of plasma, but at this point they 
were fired upon and were forced to move the wounded man farther 
to the rear. The men could not return to ti e main body via 
ohe trail which they had come, due to the fact that tac trail 
was too narrow for the litter. Thereupon, the two men decided 
to return by way of a stream at the foot of the cliff. They 
had gone about half-way across the stream wnen again vi/ere fired 
upon. The shots caused no damage and tue men, carrying the 
litter through the rain-swollen, swift water, finally reached 
cover on the other ban*. They then turned over the wounaed 
man to Capt. oick, who gave the patient four units of plasma, 
dressed his wounds, placed him in a blanket and made him as 
comfortable as possible. 
It should be noted that this soldier had been wounded by 
enemy machine gun fire the day before. He could not be located 
during the withdrawal and, being unable to move, laid in the 
position where he had fallen overnight. The following morn- 
ing, at approximately 0900L, he was discovered by a party of 
Jans. They gave him a butt stroke on the left side of the 
head, splitting his scalp open, and then bayoneted him twice, 
once in each side of the chest above t .e nippl* line, 
of these wounds extended completely through the chest and out 
of the back. -In spite of these multiple wounds, the-soldier 
was alive when recovered. Upon tr nt by Dick, he 
was taken back to the 01 by members of an anti-tank company 
patrol, accompanied by T/5’s Jearcy and Jaeger and ifc. Clyde 
Hackett, of the Regimental medical Section. 
..t the OP aid station, the three wounded men were checked, 
p-iven further .treat ment and ti on Were taken In a vehicle by 
ifc. Vert is R. Conn, of the 1st Battalion Ledical lection, to 
the Division Jlearin: :tati >n to further ascertain tie con- 
dition of the six wounded. He left the aid station at 0. „7 
under the command of Japt. .rnst, who had arrived there early 
that day. ihe bodies of the men killed the first aay were re- 
covered and buried near the point of the original attack. 
The coordinates of the graves was recorded on the emergency 
i.eaical Tags. 
Capt. Dick, along with the medical personnel assigned 
to him, remained with the main body of our troops which had 
made preparations to continue the original mission on the 
morrow, 16 February 1944. -an overnight bivouac was set up 
and the men retired for tie night. artillery barrage 
commenced during the night and at a roximately 030CL a’ 
shell fell short and wounded several men in the area occupied 
by men of Company ”0", 129th Infantry. Because of the dark- 
ness and lack of communication, it was impossible to report 
this incident to the area where Capt. Diek and his medical 
personnel were stationed. However, an aid man attached to 
Company nBM, Pfc.Frank V. Cudaitis, courageously crawled 
through the darkness from foxhole to foxhole in the sector 
where the shell hit, ad: inistering morphine to the wounded 
and dressing their wounds as best he c^ulu. 
approximately 06201, four artillery shells fell, 
short and exploded in the area where the command personnel 
of our forces had bivouaced. One shell hit within 25 feet 
of Capt. Dick and his medical personnel. The shell killed 
three men outright and wounded approximately 20 others, the 
majority of them seriously. Capt. dIck reached the three 
slain men just after the shells hit and found a fourth man 
very seriously wounded. He administered several units of 
plasma to the fatally injured soldier, but, despite all 
efforts, the patient died 45 minutes later. 
.ith lirited supplies and insufficient personnel to 
take care of so many wounded, Cent. Dick and his men for 
hours without a break treated the casualties. During that 
period, six wounded were given plasma, the wounds of all 
were dressed and the aid men carried the wounded to a point 
along the trail so that evacuation would thus be facilitated. 
A request had been dispatched by Capt. JiCK to the DP for 
litters, supplies, litter-bearers and personnel to take care 
of the evacuation. These arrived under Capt. Drnst, who 
brought with him two aid men, T/4 Tsakonas and Pfc,Verde1 L. 
Blair, and more than 100 enlisted Lien (to carry litters] from 
Company 129th Infantry. They arrived after all but 
three of the wounded had been carried to the trail and plans 
for the evacuation were made immediately. 
Just before the evacuation of the casualties got under- 
way, Capt. -rnst examined the wounded ana found one man whose 
wounds were of such severity that it was necessary to ampu- 
tate his left leg immediately. The wounded man ha_ been 
given five units of plasma prior to the amputation and two 
morphine sureties. Then, using a \ocKet knife—the only in- 
strument available—Cai t. -„rnst amputated the leg. Later, 
on the trail enroute to the Cl the man was given two more 
units of plasma. 
Transports of the wounded to the aid station at the 0-1 
then bewail. There were 1? litter cases end these were arranged in a convoy, the least seriously wounded in front 
and the most seriously wounded at the rear. There were 
approximately eight men to carry a litter, four men alter- 
nating per litter all along the slow, hazardous route. 
Security was provided by infantry personnel placed at the 
point, rear and flanks. -Along the route, Capt. krnst and 
T/4 Tsakonas continually administered aid ana treatment to 
the wounded. Virtually everyone of the litter cases, as 
well as the walking wounded, were at one time or other during 
the trip treated. The convoy stopped at intervals where 
good cover was afforded and on these occasions the wounded 
were washed with cola water from the adjacent stream. The 
going was difficult throughout. a.t one point, on a steep 
precipice, it was necessary to line some 40 men on both sides 
and hand the litter down in chain fashion. Finally, after 
five long and arduous hours, the convoy of wounded reached 
the vicinity of the 0?. 
Approximately 250 yards ahead of the OP, the convoy came 
to the Laruma diver. To reach tne OP it was necessary to 
cross the stream. dwelled by the torrential rains which had 
fallen for two consecutive days, the current-whipped stream 
at some points was five feet deep. A rope had been stretched 
across the river and T/4 Tsakonas, with one walking wounded man, 
attempted to cross. -ibout 10 feet out, the rushing water 
swept the wounded man clear of the rope and it was necessary 
for the men on the bank to pull him out. T/4 Tsakonas, with' 
great difficulty, finally got to the other side, reached OP Ifl 
and informed the Regimental Surgeon, in charge of the forward 
aid station, of the hazards entailed in crossing the river. 
A reconnaissance was made along the river at a point about 75 
yards- from the original crossing a large tree was felled in 
such a manner that it provided the convoy with a bridge. Two 
ropes were strung parallel three feet above the tree as rails 
of support. The convoy then began to move over the make- 
shift bridge. Straps were placed on the ends of the litters, 
and, with one man in*front and another in the rear, the wound- 
ed were thus carried across. Construction of the bridge re- 
quired approximately two hours, but the actual transport of 
the over it took less than half an hour. 
Having reached the other side of the. Laruma River, the 
convoy moved down the stream about 250 yards. From this 
point it was necessary to scale a steep hill to reach the 
aid station. .i human chain, made up of at least 100 men, 
was formed on the hill and through this means the litters one 
by one were carried up. i.t the aid station, the men were 
checked and hot coffee, dough-nuts and cake were served to 
the patients and bearers by the medical personnel. Darkness 
had set in even before half the patients were assembled at the 
aid station and this further impeded the evacuation. 
• From the aid station at the OP, arrangements were made 
to evacuate the wounded as soon as possible to the Division 
Clearing Station. Previous to arrival of the convoy at the 
OP, 10 peeps with racks and two ambulances had been ordered 
to Xransport the wounded. Because of the rain-soaked c°nditi°n of the trail leading to the division road, the 
oth lield Artillery Battalion was requested to send a 
tractor to the 01 to assist in the transport of the wound- 
ed. The request was immediately granted and a tractor 
was at the 01 lone before the convoy arrived. The actual 
movement to the .division Clearing station was brought about * 
by hooking a peep to each of the ambulances--both of which 
were able to negotiate the muddy going--and chaining four 
other peeps to tractor which pulled them to the division 
hoad. Thus all the patients were removed to the hospital 
the last arriving by 2100L. 
In summary, cognizance should be taken of the obstac- 
les faced by the medical officers and personnel in treating 
and evacuating the casualties. The tireless, efficient, 
and courageous efforts of the medical officers on the scene, 
Capt. Dick and Gapt. -rnst, was typical of the high tra- 
ditions of the Army Medical Corps. Outstanding, too, was 
the work of the enlisted men of the Medical detachment, un- 
der the capable leadership of Technical Sergeant Julius C. 
fieezorek. Heavy enemy fire had to be braved several times 
to remove patients to safet3'. Wounded were administered 
morphine and blood plasma,-brought up despite adverse and 
hazardous conditions to the scene of action. The convoy 
of litters had to accomplish the return to the aid station 
over a narrow, vine-crossed and muddy trail, made treacher- 
ously slippery by incessant rain, and over a distance of 
three miles--a feat in itself in jungle warfare. The cross- 
ing of the stream was made possible by well-planned, 
hard work and, considering the obstacles, was completed in 
exceptionally fast time. 
The problem of supply was exceptionally great. It was 
necessary to request and obtain numerous items over and a- 
bove T/lA--such as heavy rope, musette bags, heavy wire, 
machetes, axes and shovels--in order to successfully com- 
plete the evacuation. Units of bioou plasma, morphine sur- 
ettes, first-aid dressings, blankets and litters a.iu sulfa- 
diazine had to be constantly brought up from the rear. The 
actual transportation of tie patients by vehicles was made, 
in almost all cases, at night and care had to be exercised 
at all times to prevent unnecessary trauma to the patients. 
Manpower, while available in large numbers, had to be 
utilized advantageously because of the hazards. Alterna- 
tion of litter-bearers and the providing of security, in 
addition to the medical personnel, required at least 400 
men for the entire evacuation. Tireless efforts by' all 
concerned was necessary throughout. 
Of great importance was the excellent cooperation by 
all units concerned in the evacuation. Personnel of Com- 
pany "B”, 112th medical Battalion, ably assisted in all 
phases of the evacuation from the point of the river cross- 
ing. approximately twenty enlisted men of Company "B”, 
under the leadership of 2nd Lt. Javia T. Andrews, toom part. 
Two ambulances and three jeeps with racks ana an additional supply of litters ana blankets were dispatched by the Com- 
manding Officer, Company WB", immediately upon request. 
Important, too, was the assistance of the 6th yield ,«Ttillery 
Battalion. .Without the tractor furnished by that unit, it 
would have oeen virtually impossible to get the jeeps with 
the patients over the trail from the CP to the jivision koad. 
finally, it cannot be too greatly emphasized how inval- 
uable was the assistance rendered throughout the evacuation 
by the line officers and enlisted men of the 129th Infantry, 
men assigned the arduous, slow task of carrying the litters 
of wounded did their job without complaint or slack. Officers 
who organized and led the convoy back through the jungles un- 
der conditions fraught with hazards performed their auty ef- 
ficiently and courageously. the river-crossing near OP 
fr7, the incessant labors of all officers and men—notably 
major Ohan I. Coulter, executive Officer, 129th Infantry; 
Captain John A. Brailsford, Commanding Officer, Company A; 1st 
Lt. ',/illiam C. Beaty, Commanding Officer, Company D; and 1st 
Lt. 'Jilbur I . .:ilkin, Company n-v/as the major factor in pav- 
ing the way for the speedy and thorough execution or this 
treacherous phase of the evacuation mission. 
YILLIAK T. HOLLADAY 
L'ajor, K.C., 
Burgeon, 129th Infantry HEADQUARTERS USAPISPA 
OFFICE OP AC OP S,0-2 
ORDNANCE INTELLIGENCE UNIT 
ORDNANCE INTELLIGENCE REPORT #48. 
APPENDIX II 
FREQUENCY DISTRIBUTION OF SHELL FRAGMENTS PROM JAPANESE MORTAR 
SHELLS 
The following tests were made In order to determine 
the approximate frequency distribution of fragments from 
exploded Japanese mortar shells. 
a. Disposition: 
All tests were made on level ground (sand beach). 
The shells were detonated statically In vertical position 
with nose of shell pointing downward, the nose being slight- 
ly burled In the ground (ca.l Inch). Panels of cellotex 
were equally distributed In circles of 5, 10, 20, 26 and 30 
yards radius, around the shell as centre. The panels were 
4 feet high, 8 feet long and inch thick. The distribut- 
ion was such that In each circle the same fraction (1/6) of 
the same circumference was covered with panels. The outer- 
most circle (radius 30 yards) had 12 panels, the next (rad- 
ius 25 yds) 10 panels and so on. The Innermost circle (ra- 
dius 5 yds) had 4 half-size panels (4* x 41). No one panel 
was covered by other panels with respect to the shell. 
b. Detonation; 
The shells were statically detonated by means of 
No. 8 commercial blasting cap and miners' safety time fuse. 
All detonations occurred without fall and were high order. 
£. Shells: 
The types and numbers of shells examined were as 
follows; 
Type 89 60 nan. heavy grenade (knee mortar shell) 
5 rounds 
81 mm. mortar shell (Type 100, light, similar to 
U.S. M 43) 5 rounds 
90 ram. mortar shell 4 rounds 
All shells were of mild steel charged with high 
explosive fyellow bend). The type 89 grenade was detonat- 
ed Including propellant case and propellant, the 81 mm and 
90 mm shells without propellant but with fin assemblies. d. Recording: 
The effect of each single round on each target 
was recorded separately. The relative position of the 
tests were drawn in rectangles representing the targets. 
Fragment holes larger than 1 cm in any one direction were 
marked especially with indication of size. 
e. Fragments: 
Very few fragments could be recovered. Their size 
was generally small 1/8 tol/16 of an Inch. Two larger frag- 
ments were approximately 1" x x 1/16" in size, showing 
irregular leaf-shape with very sharp edges. 
f. Results; 
The blast had no marked effect on the panels and 
the same panels were used for all tests. Almost all frag- 
ments hitting a panel made a complete penetration through 
the board. Generally the cross section of the holes pro- 
duced by fragments were larger in the rear than in front. 
Holes with front cross section of 1 to 2 cmd were observed 
in all whereas pinholes as well as larger holes 
(over 2 cm2 cross section) were relatively more frequent 
in the inner circles than in the outer. The distribution 
with respect to distance from bursting shell (radius) is 
different for the different types of shells. For the type 
89 heavy grenade the relative frequency of shell fragments 
hitting a specific target appears to be inversely proport- 
ional to the square of the distance. For the 81 mm. and 
90 mm. mortar shells it seems to be nearly Inversely pro- 
portional to the cube of the distance. These results are 
shown in the following table; 1 
2 
3 
4 
5 
6 
7 
8 
r - 
9 
■ 
10 
Distance 
Counted hits on i 
panels 
Number of hits calculated 
Values 
Values 
Values 
of pan*Is 
from burst 
(panels cover 1/6 of 
eaoh oirole) 
for full 
circles. 
coverage 
of 
of col 5 
x (r/5) 
of col 6 
x (r/5)2 
of col 7 
x (r/6)2 
(radius of 
circle in yds•) 
89 Grd. 
5 rds. 
81mm M. 
5 rds. 
90mm U. 
4 rds. 
89 Grd. 
1 rd. 
81mm M. 
1 rd. 
90mm M. 
1 rd. 
89 Grd. 
81am M. 
90am M. 
r - 5 
132 
327 
276 
158 
392 
414 
158 
392 
414 
10 
48 
19 
104 
58 
95 
156 
116 
380 
624 
15 
37 
42 
65 
44 
50 
98 
132 
450 
882 
20 
26 
22 
20 
31 
26 
30 
124 
416 
480 
25 
21 
17 
21 
25 
20 
32 
125 
500 
800 
30 
10 
8 
14 
22 
10 
21 
132 
360 
766 
T A B L E I TABLE 2. 
HIT PROBABILITY FOR HUMAN TARGETS. 
DISTANCE IN YARDS PROBABLE NUMBER OP HITS FOR TYPE OF SHELL. 
89 Grfd. 81 mm M. 90 mm M. 
5 1.56 4.4 5.7 
10 0.39 0.55 0.7 
15 0.17 0.16 0.21 
20 0.10 0.07 0.09 
25 0.06 0.04 0.05 
30 0.04 0.02 0.03 
DISTANCE FOR ONE 
PROBABLE HIT. 
6.25 1 
8.2 1 
8.93 1 
It is to be noted that the hit probability has been 
calculated on the basis of the mean projected area of a sold- 
ier, This is correct, because the directions of fragments 
from bursting shells are random. The values thus obtained do 
not show however, the probability for wounding or disabling a 
human target. They merely show the probability that a man 
will be hit by a fragment. The wounding probability could 
not be computed although the effective vulnerable area of a 
soldier to small fragments is known. The missing factors 
are the frequency distribution with respect to mass and vel- 
ocity of the fragments and the wounding potentiality of a 
fragment of given mass and velocity. According to reports 
from the National Research Council, the frequency distribut- 
ion can bo calculated for the types of shells in question, 
because it is known for other types. The wounding potential- 
ities of fragments, however, is almost unknown. It is this 
which forms the main subject in the program for investigat- 
ion on wound ballistics. 
This distribution is different from the distrib- 
ution for the type 89 grenade and must be due to the differ- 
ence in shape of the mortar shells as compared with the gren- 
ade, The grenade has approximately the shape of a little 
cylinder 2\ inches high and 2 Inches in diameter. The mor- 
tar shells are approximately truncated cones with 81 mm (90 
mm) base diameter, 21 mm (21 mm) diameter on top and 15 cm 
(23 cm) altitude. Therefore it is to be expected that a 
great part of the fragments are projected upward rather than 
horizontally. This behavior, however, will be partially off- 
set when the shell detonates on Impact In actual firing. The 
fragments will then have an additional velocity due to the 
motion of the shell along its trajectory. This velocity is 
pointing downward, whence the different trajectories of the 
fragments will be lowered proportionally. 
£. Probability: 
By using the data in Table 1 it is of interest to 
figure out the probability that a man, at a distance of 0 to 
30 yards from a bursting shell, will be hit by a fragment. This probability Is a function of the distance and equals 
the number of hits which are expected at a given distance 
within the mean projected area of a soldier. The data In 
following Table are calculated by using the values In Table 
1 (with certain adjustments) and setting the mean projected 
area of a soldier equal to 4.2 square feet. For each type 
of shell, the first six lines Indicate the probable number 
of hits which a soldier would receive at the Indicated dis- 
tance. The last three lines give the distance at which the 
probability Is one, that Is the distance at which each bur- 
sting shell (of the same type) would score an average of one 
hit on a human target. This distance may be called the dis- 
tance for one probable hit. A soldier who is at a closer 
range than this distance will more likely be hit by several 
fragments, whereas at a greater distance the probability of 
getting hit at all is smaller than one and decreasing rapid- 
ly with increasing distance. For the type 89 grenade the 
decrease Is proportional to the square of the distance. For 
the two mortar shells the decrease Is proportional to the 
cube of the distance. The probability decreases therefore 
more rapidly for the 81 mm and 90 mm mortar shells than for 
the type 89 grenade. Each line represents the group of 
panels belonging to the circle whose radius is given In 
Column 1. Ther numerals In Colums 2, 3 and 4, equal the 
total number of hits counted on each of the groups of pan- 
els. These hits were produced by the number of rounds for 
each type of shell as Indicated In the heading. The same 
Is true for Columns 5, 6 and 7 except that the totals are 
calculated as if circles were completely covered with pan- 
els and on the basis of one round. It Is to be noted that 
these numerals do not represent the relative ratio of prob- 
able hits per unit of area for the different circles, but 
the number of hits expected on each full circle of panels. 
The total areas of all panels of any one circle Is of course 
different for different circles and proportional to their 
respective radii. 
Column 8 shows on each line the product of the 
values given In Column 6 with the corresponding r (in Col- 
umn 1) divided by the common denominator 5. The numerals 
in Column 8 represent therefore relative values which can 
be obtained by multiplying the probable number of hits per 
unit of area for each particular circles with the square 
of the respective radii. 
The values obtained do not show a marked tenden- 
cy for Increase or decrease for increasing values of r. 
They are all fairly close to an average constant. If this 
behavior can be confirmed by further tests It means that 
the frequency distribution for shell fragments from the 
type 89 heavy grenade Is Inversely proportional to the 
square of the distance from the bursting shell. The type 
89 grenade would spray Its fragments equally distributed 
In space, at least within the zone examined. 
Columns 9 and 10 are obtained from Columns 6 and 
7, as Column 8 Is obtained from Column 5, with exception 
that the square of r/6 Is used. If r/6 were to be used In- 
stead of the square, values would be obtained in Columns 9 
and 10, which would show a marked decrease for Increasing values of r. The values, however, obtained by using (r/5) 
do not show a typical tendency either for decrease or for 
Increase. They are all of the sane order of magnltude,al- 
though not very close to an average constant. It seems 
therefore and for the reasons given above that the frequen- 
cy distribution for shell fragments from the 81 mm or 90 mm 
mortar shell Is Inversely proportional to the cube of the 
distance from the bursting shell. in 
fhe following photographs illustrate some of the 
produced by different missiles from Japanese 
weanons. 
tovmrtj xJ 
Compound oonuninuted fracture of the humerus caused 
by a Japanese .25 caliber rifle bullet fired, from a distance 
of seventy five yards. This is a typical example of the 
explosive effect of the .25 caliber rifle bullet when It 
strikes bone or a solid organ. .any pf these bullets 
caused similar damage to the arm and then passed through 
the chest.  ents knife handle and .25 caliber bullet 
removed from the chest wal]. The soldier was prone and the 
bullet fired from seventy five yards distant struck his knife 
resuming in & severe gutter wound of the pectoral muscle 
and nicking the pleura. lie was evacuated to the U.h. 
LOGIN BROS. 
BIGGEST MEDICAL BOOK BARGAIN HOUSF 
-Talent of a $0 mn. Japanese mortar shell with 
attached piece of clothing'removed from infected pleural 
cavity. The shell burst in .a tree twenty feet over head. HtrH Cx a detonator cap of a Japanese % mm. mortar 
shell removed from the chest wall. He was also wounded 
in the hand. The patient was prone and forty five feet 
from the burst but the fragment did not penetrate the pleura. 
Juse cap of e Japanese hand grenade removed from the 
neck of a soldier who was standing in a pillbox when the 
grenade exploded three feet from his head. He sustained 
multiple small penetrating wounds of the necK, shoulders 
and lower lip witha fracture of the mandible by the frag- 
ment shown. • This X-Ray shows the characteristic small fragments 
of the Japanese hand grenade. This soldier was prone in 
a foxhole when the grenade exploded at a distance of not 
more than one foot from the chest wall. host of the 
fragments were stopped by the chest wall but some of them 
penetrated the pleura. The fragmentation of this grenade 
is irregular but usually very small. This patient was prone on the ground when a mortar 
shell of unknown size exploded one yard distant. He was 
also wounded in the arm, thigh and both ankles. He had 
an open operation and the numerous lacerations in the lung 
caused by the small fragments were sutured and the inter- 
costal vessels ligated. He made a good recovery. U.S. Hand Grenade 
Japanese Hand Grenade 
The photograph on the left is that of a wound caused by 
a U.S. hand grenade thrown by a Japanese. The grenade ex- 
ploded three yards from the leg. The typical large frag- 
ment is shown. 
The photograph on the right shows an explosive type 
fracture of the ulna and the usual small fragments character- 
istic of the Japanese hand grenade. The soldier was lying in 
a foxhole and the grenade exploded almost in contact with the 
arm. Under these circumstances there may be considerable 
blast affect on the soft tissues. This soldier was standing in the company area when a 
Japanese artillery shell exploded at a distance of 
100 yards. The fragment penetrated through the outer 
wall of the antrum and lodged within the sinus cavity. It 
is e good example of the relative protection afforded by 
bony structures of low velocity fragments, even of large 
size.