CHAPTER V

RATIOS OF WOUNDS IN PARTICULAR BODILY REGIONS IN WARFARE

Variations in the regional distribution of wounds in warfare. As previously stated, it is not to be expected that the regional proportions of wounds resulting from war will correspond numerically with the percentages of areal exposure of the body mentioned in the preceding chapter. The numbers of wounds inflicted in battle in particular regions of the body are caused to vary by a great number of circumstances. The nature of the military operations-whether they consist of sieges and assaults, of battles on open plains, over rugged and broken ground, in a mountainous country, in forest or bush-will always exert an important influence in this regard. In siege operations the parapets of the trenches screen the lower parts of the body, and the number of wounds in these situations will usually be proportionably lessened; in engagements in the open field, on the other hand, it may be expected that the wounds inflicted will be distributed in more even numbers over both the upper and the lower parts of the body.

If firing should commence when infantry troops are very far apart from each other, the bullets fall at the end of a very long trajectory, and the upper parts of the body are more exposed to be struck by them. If the troops are within point-blank range, the shot may be expected to be distributed evenly over the body, for the line of fire under such circumstances will almost certainly be a directly forward one, notwithstanding aim in some particular direction may have been ordered.

The more level the surface of the ground on which the opposing troops are placed, the nearer may be expected to be the approach to the average regional distribution named in the preceding chapter; the more broken and uneven, the more that average will be disturbed. Variations in hardness and softness of the ground affect the proportion. When the ground is rocky or frozen, many bullets, on striking it, glance upwards with considerable force. The legs and thighs of soldiers are not unfrequently wounded by projectiles which have rebounded from hard ground or stones, and the number of wounds in the lower extremities thus becomes increased. When the ground is soft, as when the troops are marching over ploughed fields, this source of additional wounds is in great measure avoided.

On the other hand, the lower limbs are not unfrequently protected from the effects of fire, both direct and indirect, by objects in front of them, and by the practice of soldiers to take advantage

of any cover they can obtain-in ditches, holes, behind trees, walls, and other obstructions-whenever circumstances admit of their doing so. The higher parts of the body can rarely have the advantage of any such protection. The upper extremities, and the hands especially, are exposed to injury in action. They are necessarily left uncovered in carrying and handling the firearms; and are constantly advanced in aiming and firing, as well as in a variety of work requiring manual exertion and dexterity. As a consequence of this constant exposure, although the target area of the upper extremities is so much less than that of the lower extremities, quite as many, and often more, wounds of the arms and hands will be met with among hospital admissions than wounds of the lower limbs.

Wounds of the hand in warfare.-The disproportionate number of wounds of the hands and fingers has frequently attracted attention in campaigns. One reason given for their frequency on the occasion when the celebrated inquiry by order of the first Napoleon was instituted, under the presidency of Baron Larrey, after the battles of Bautzen and Wurschen,+2 was the nature of the ground over which the French troops fought. The infantry charges were chiefly made up the slopes of hills. The soldiers had their hands raised on their firelocks in front of them as they ascended, aiming at the enemy on the summits above, and thus their hands were frequently struck because they were the parts most advanced, and therefore first exposed to be hit. The same effect was said to have been observed on another occasion in the campaign of Poland, where also, from the relatively large number of wounds of the hand, the men were accused of having intentionally mutilated themselves. But there can be no doubt that other shots, besides those of the enemy, have sometimes assisted in increasing the number of wounds of this particular part of the upper extremity. The awkwardness of young soldiers, not well habituated to the use of fire-arms, has led to accidental wounds in many instances. The fact of rear-rank men, when troops have been standing in double file, or, as often happened in Continental armies, in triple file, incautiously pointing their weapons in the direction of the hands of the front-rank men, has doubtless led to many more such injuries. The nature of the wounds pointed to these accidental causes in some of the instances examined by Baron Larrey, and they were mentioned in his report. During the Italian war of 1859, out of 15,383 wounds by projectiles shown in the hospital returns, there were more than one-seventh, viz., 2300, wounds of the hand and fingers. The proportion was higher, by nearly two-thirds, than the wounds of each of the other sections of the upper extremity. This large relative number of wounds of the hand is not attributed by Dr. Chenu to the causes which have just been mentioned, but to the nature of the fighting. Dr. Chenu

remarks that the sheltered defence of the Austrians in houses, farms, cemeteries, behind walls and entrenchments, necessitated, on the part of the assailants, escalades, manual exertion in breaking open doors, and, in short, a constant use of the hands in a direction toward the enemy, so that they were unavoidably exposed to the action of projectiles more than other parts of the body. As might be expected, the right hand is more frequently wounded than the left, being the more constantly exposed of the two. The proportion of shot wounds of the hands and fingers was also very large during the American war of the rebellion. The History states that out of 33,064 cases of fracture and contusion of the upper extremities, 11,369 were in the hands and fingers, and that over one-fourth of 54,729 shot flesh wounds of the upper extremities were flesh wounds of the hand.

Regional distribution of wounds among soldiers admitted into hospital. It has been already mentioned that the only records of wounds usually kept are those which enumerate the number and nature of the wounds of men admitted into the hospitals for treatment. The relative proportions of these wounds, even if other conditions were alike, could not be expected to coincide with the numbers calculated according to the areal exposure of the regions concerned, nor with the distribution of the wounds inflicted in a given battle, when those directly fatal and those not directly fatal are calculated together. Many of the wounds inflicted in the regions of the head, neck, and trunk will have been attended with speedily fatal results; while most of the men wounded in the extremities will have survived to be admitted into the hospitals.

Experience in the French hospitals in 1859.-Dr. Chenu has given approximately the regional percentages of the wounds of 17,000 French soldiers who were admitted under hospital treatment for wounds and contusions of all descriptions during the Italian war of 1859. These percentages are shown in the table which follows. The relative numbers of the different kinds of projectiles by which the injuries were caused are also tabulated side by side with the bodily regions in which the wounds were inflicted.

This furnishes the following regional distribution, when all the projectiles above named are included in one column, and the regional distribution is confined to the principal divisions to which Dr. Chenu found himself compelled to limit the wounds by grape and shell:

The proportionate numbers of wounds by projectiles in the four divisions of the body just named accord more nearly than might have been expected with the areal measurements of the same regions previously given, considering the many sources of disturbance of the calculated numbers which occur in actual warfare. When brought to a similar standard of one hundred parts, the areas of these regions, according to the ratios given in the preceding chapter, are—

Regional distribution of wounds in military hospitals in other wars. I have calculated the proportions of wounds in these four great divisions of the body in some other wars, the histories of which contain materials, more or less perfect, available for the purpose. In all but two of these instances, not excepting the Crimean war, in which siege operations took so large a part, the wounds of the lower extremities are in excess of those of the upper extremities. The number of wounds in the upper extremities was highest in the wars in New Zealand and on the Gold Coast. In these wars there was scarcely any fighting in clear, open ground. In New Zealand the larger number of the wounds were inflicted either by shot discharged from pits like rifle-pits, from stockades and pahs, after the British troops had got into close proximity to them, or in high and dense fern; and all these conditions would necessarily lead to the upper parts of the body being chiefly struck. On inquiring of my friend Sir Anthony Home, V.C., who took an active part in both these wars, whether his views on the cause of the higher proportion of wounds of the upper limbs in them coincided with what I have expressed above, he replied in the affirmative, and added : In the New Zealand war the wounds were nearly always received at close quarters. The Maoris had no powder to spare, and absolutely not a cap to throw away; they hardly ever fired except the shot appeared certain to take effect. Lying perdus either in the trench of their pah or in a hole, they waited until our men were on them-had, in fact, flushed them-and they then fired at the first part of their opponent visible, which would be the head or upper part of the body. Again, our men marched to attack through heavy fern, up to their middles or necks in it, and from this cause the lower half of the body was partly protected; for owing to the Maoris using bad powder and bad projectiles, the fern would occasionally suffice to turn the bullets."

Very similar conditions existed in the war on the Gold Coast. Nearly all the fighting took place in the midst of tropical bush, in which the troops were able to protect the greater part of their bodies behind trees; while, in aiming and firing, the head, neck, and upper extremities would be necessarily exposed to the fire of their adversaries. Moreover, these were the parts which the enemy would naturally aim at, from the lower parts of the body being so much concealed. The large proportion of wounds of the head, face, and neck, compared with those of the trunk, in the Ashanti war, is notable from its contrast with the experience of other wars. The wounds of the head were 13:31 per cent. of the total number, of the face 12.23 per cent., neck 5:43 per cent.; or, together, 30.97 per cent., as shown in the table; while those of the chest were only 6.25 per cent., abdomen 4.62 per cent., back and spine 3.53, and perineum 0.82 per cent.; or, together,