Findings of Ronald F. Bellamy regarding indirect ballistic injuries
Between 1987 and 1989, wound ballistics researchers working for the Swedish Defense Forces published four papers in the Journal of Trauma which laid the foundation for modern understanding of remote effects of ballistic impacts on the central nervous system. Martin Fackler published a letter to the editor in which he disputed the findings of distant injuries. He wrote: A review of 1400 rifle wounds from Vietnam (Wound Data and Munitions Effectiveness Team) should lay to rest the myth of “distant” injuries. In that study, there were no cases of bones being broken, or major vessels torn, that were not hit by the penetrating bullet. In only two cases, an organ that was not hit (but was within a few cm of the projectile path), suffered some disruption (personal communication, Bellamy, R.F., 1989).
In contrast to Dr. Fackler’s claims regarding Bellamy’s findings as supposedly communicated privately, Bellamy’s published analysis of the data the following year (Textbook of Military Medicine) describes a number of cases of distant injuries including broken bones (pp. 153-154), five instances of abdominal wounding in cases where the bullet did not penetrate the abdominal cavity (pp. 149-152), a case of lung contusion resulting from a bullet hit to the shoulder (pp. 146-149), and a case of distant effects on the central nervous system (p. 155). See: Bellamy RF, Zajtchuk R. The physics and biophysics of wound ballistics. In: Textbook of Military Medicine, Part I: Warfare, Weaponry, and the Casualty, Vol. 5, Conventional Warfare: Ballistic, Blast, and Burn Injuries. Washington, DC: Office of the Surgeon General, Department of the Army, United States of America; 1990: 107-162.
At the time of publication, Colonel Ronald F. Bellamy served as the acting chief of Department of Surgery at the Walter Reed Army Medical Center and as Associate Professor of Military Medicine and Associate Professor of Surgery at the Uniformed Services University of the Health Sciences. His co-author, Colonel Russ Zajtchuk, served as the Deputy Commander of the WalterReedArmyMedicalCenter and as Professor of Surgery at the UniformedServicesUniversity of the Health Sciences.
In addition to documenting a number of cases of indirect ballistic injuries,
Bellamy and Zajtchuk wrote favorably of findings relating wounding effects to energy transfer:
Quote:
Total energy transfer, however, gives only part of the available information about the projectile-target interaction. Energy transfer plotted as a function of depth of penetration gives a much clearer picture. The concept is further illuminated when the magnitude of debrided tissue is seen as a function of energy transfer and both are plotted along the wound tract. Figures 4-32 and 4-33 show the results of especially elegant experiments that were designed to relate tissue damage in skeletal muscle to energy transfer along the wound tract.
The last 25 years of modern wound ballistic research has demonstrated yet again what historical reports have always indicated--that there are only two valid methods of incapacitation: one based on psychological factors and the other physiological damage. People are often rapidly psychologically incapacitated by minor wounds that are not immediately physiologically incapacitating. Psychological factors are also the reason people can receive severe, even non-survivable wounds and continue functioning for short periods of time. Up to fifty percent of those individuals rapidly incapacitated by bullet wounds are probably incapacitated for psychological rather than physiological reasons. Psychological incapacitation is an extremely erratic, highly variable, and completely unpredictable human response, independent of any inherent characteristics of a particular projectile.
The degree and rapidity of any physiological incapacitation is determined by the anatomic structures the projectile disrupts and the severity of the tissue damage caused by the bullet. Physiologically, immediate incapacitation or death can only occur when the brain or upper spinal cord is damaged or destroyed. The tactical reality is that in combat, opportunities for military personnel to take precisely aimed shots at the CNS of enemy combatants is rare due to high stress unexpected contact marked by rapid fleeting movements, along with frequent poor visibility on the battlefield including use of cover and concealment. Thus the reduced likelihood of frequent planned CNS targeting in combat conditions. Absent CNS damage, circulatory system collapse from severe disruption of the vital organs and blood vessels in the torso is the only other reliable method of physiological incapacitation from small arms. If the CNS is uninjured, physiological incapacitation is delayed until blood loss is sufficient to deprive the brain of oxygen. Multiple hits may be needed before an individual is physiologically incapacitated. An individual wounded in any area of the body other than the CNS may physiologically be able to continue their actions for a short period of time, even with non-survivable injuries. In a 1992 IWBA Journal paper, Dr. Ken Newgard wrote the following about how blood loss effects incapacitation:
“A 70 kg male has a cardiac output of around 5.5 liters per minute. His blood volume is about 4200 cc. Assuming that his cardiac output can double under stress, his aortic blood flow can reach 11 Liters per minute. If this male had his thoracic aorta totally severed, it would take him 4.6 seconds to lose 20% of his total blood volume. This is the minimum amount of time in which a person could lose 20% of his blood volume from one point of injury. A marginally trained person can fire at a rate of two shots per second. In 4.6 seconds there could easily be 9 shots of return fire before the assailant’s activity is neutralized. Note this analysis does not account for oxygen contained in the blood already perusing the brain that will keep the brain functioning for an even longer period of time.”
Military and LE (law enforcement) personnel are generally trained to shoot at the center of mass, usually the torso, of an aggressive opponent who must be stopped through the use of lethal force. Physiological incapacitation with wounds to the torso is usually the result of circulatory system collapse. More rapid incapacitation may occur with greater tissue disruption. Tissue is damaged through two wounding mechanisms: the tissue in the projectile’s path is permanently crushed and the tissue surrounding the projectile’s path is temporarily stretched. A penetrating projectile physically crushes and destroys tissue as it cuts its path through the body. The space occupied by this pulped and disintegrated tissue is referred to as the permanent cavity. The permanent cavity, or wound track, is quite simply the hole bored by the projectile's passage. Obviously, bullets of greater diameter crush more tissue, forming a larger permanent cavity. The formation of this permanent cavity is consistent and reliable.
The tissue surrounding the permanent cavity is briefly pushed laterally aside as it is centrifugally driven radially outward by the projectile's passage. The empty space normally occupied by the momentarily displaced tissue surrounding the wound track, is called the temporary cavity. The temporary cavity quickly subsides as the elastic recoil of the stretched tissue returns it towards the wound track. The tissue that was stretched by the temporary cavity may be injured and is analogous to an area of blunt trauma surrounding the permanent crush cavity. The degree of injury produced by temporary cavitation is quite variable, erratic, and highly dependent on anatomic and physiologic considerations. Many flexible, elastic soft tissues such as muscle, bowel wall, skin, blood vessels, and empty hollow organs are good energy absorbers and are highly resistant to the blunt trauma and contusion caused by the stretch of temporary cavitation. Inelastic tissues such as the liver, kidney, spleen, pancreas, brain, and completely full fluid or gas filled hollow organs, such as the bladder, are highly susceptible to severe permanent splitting, tearing, and rupture due to temporary cavitation insults. Projectiles are traveling at their maximum velocity when they initially strike and then slow as they travel through tissue. In spite of this, the maximum temporary cavity is not always found at the surface where the projectile is at its highest velocity, but often deeper in the tissue after it has slowed considerably. The maximum temporary cavitation is usually coincidental with that of maximum bullet yaw, deformation, or fragmentation, but not necessarily maximum projectile velocity.
All projectiles that penetrate the body can only disrupt tissue by these two wounding mechanisms: the localized crushing of tissue in the bullet's path and the transient stretching of tissue adjacent to the wound track. Projectile wounds differ in the amount and location of crushed and stretched tissue. The relative contribution by each of these mechanisms to any wound depends on the physical characteristics of the projectile, its size, weight, shape, construction, and velocity, penetration depth and the type of tissue with which the projectile interacts. Unlike rifle bullets, handgun bullets, regardless of whether they are fired from pistols or SMG’s, generally only disrupt tissue by the crush mechanism. In addition, temporary cavitation from most handgun bullets does not reliably damage tissue and is not usually a significant mechanism of wounding.
Bullets that may be required to incapacitate aggressors must reliably penetrate a minimum of approximately 10 to 12 inches of tissue in order to ensure disruption of the major organs and blood vessels in the torso from any angle and through excessive adipose tissue, hypertrophied muscle, or intervening anatomic structures, such as a raised arm.
Tissue is a denser medium than air; as the bullets strikes tissue, the increased drag on the projectile overcomes its rotational stabilization and the bullet can yaw. If the bullet yaws, more surface area is in contact with tissue, so it crushes more tissue, creating a larger permanent cavity. When a bullet yaws, it also displaces more of the surrounding tissue, increasing the temporary cavity size. Both the largest permanent and temporary cavities are produced when the bullet is traveling sideways at 90 degrees of yaw, allowing the maximum lateral cross sectional area of the bullet to strike tissue and displace the greatest amount of tissue. Longer and wider bullets have a greater lateral cross sectional area and thus create a larger permanent cavity when they yaw.
Aerodynamic projectiles, such as bullets, cause minimal tissue disturbance when passing point forward through tissue. Deformation destroys the aerodynamic shape of the bullet, shortening its length and increasing its diameter by expanding and flattening the bullet tip in the classic "mushroom" pattern exhibited by deforming jacketed hollow point and jacketed soft point bullets. The larger frontal area of deformed bullets can crush more tissue to increase permanent cavity size and also displace more tissue to increase temporary cavity size. (Note: The Hague Declaration of 1899 prohibits the use of bullets that expand or flatten easily in the human body against combatants in international armed conflict; the Hague Declaration does not prohibit the military use of bullets that fragment or because of their design, yaw upon entry into tissue.)
Projectile fragmentation in tissue can also greatly increase the permanent cavity size. When a bullet fragments in tissue, each of the multiple fragments spreads out radially from the main wound track, cutting its own path through tissue. This fragmentation acts synergistically with the stretch of temporary cavitation. The multiply perforated tissue loses its elasticity and is unable to absorb stretching that would ordinarily be tolerated by intact tissue. The temporary cavitation displacement of tissue, which occurs following the passage of the projectile, stretches this weakened tissue and can grossly disrupt its integrity, tearing and detaching pieces of tissue. Note that handgun bullets, regardless of whether they are fired from pistols or SMG’s, do not generally exhibit the fragmentation effects produced by rifle bullets. If handgun bullets do fragment, the bullet fragments are usually found within 1 cm of the permanent cavity; wound severity is usually decreased by the fragmentation since the bullet mass is reduced, causing a smaller permanent crush cavity.
Thank you for all the nice citations. Sadly, many of them are quite old and offer suspect information--unfortunately most do not appear to be clinically relevant or even valid. Taking a few of the newest ones, for example in the 2008 article by Miller in the AmJEMed, where the 19 y/o kid was goofing around and let his friend shoot him while wearing his father’s police CBA; the kid sustained no significant injury other than a bruise…big deal, the ER docs told him to not be so stupid in the future. The 2007 article by Gryth was so poorly designed, and had results so at odds with what is seen in actual combat shooting saves with rifle shots against SAPI, eSAPI, and SPEAR/BALCS plates as to render it irrelevant. Likewise, the 2007 JOT article by Drobin using a similar protocol to Gryth was not much better— after being shot at close range by 7.62 x 51 mm FMJ ammo while wearing Swedish Army ceramic armor plates of unstated protective ability and no underlying soft armor, half the piggies had bruised and broken ribs, all had lung contusions around the strike zone; there were no hemothorax, no pneumothorax, no macroscopic injuries to heart, contralateral lung, liver, bowels, and no pigs died as a result of being shot—color me unimpressed.
The most important current citation you offered is the “War Surgery in Afghanistan and Iraq: A Series of Cases, 2003-2007”http://www.bordeninstitute.army.mil/...r_surgery.html, as it contains numerous actual combat injury cases from the current conflict. Unfortunately, with the sole exception of the brief theoretical mention of potential BABT effects on page 146, and the two accompanying photos of someone with apparent blast induced BABT bruising and contusion on the lateral chest—absolutely NONE of the actual combat injury cases described in the 464 page text present any GSW caused BABT injuries. Even more profoundly, none of the numerous rifle GSW’s depicted to the limbs, chest, neck, and face of various casualties showed any clinical signs or symptoms of remote pressure wave induced CNS injuries…nice theory, too bad it does not match reality. While there are always bizarre outlying injuries that crop-up, as I stated before, over the past 7 years, the vast majority of folks hit in their SAPI, eSAPI, and SPEAR/BALCS plates by projectiles fired from AK47's and PKM's have had minimal significant, life threatening, "Behind Armor Blunt Trauma" damage; NONE that I am aware of have had any clinically detectable remote neurological effects... As shown by a couple cases discussed in the text, rifle caused TSC can absolutely cause substantial damage to non-elastic tissues, including FX of bones and disruption of spinal cord function—these facts were discussed in the IWBA Journal and in previous comments I have made. FWIW, as is frequently found in the medical literature, much of the general wound ballistic information and theory discussed in the text is rather off base and inaccurate. Too bad the editors didn’t consult with the JSWB-IPT or FBI BRF before writing the tome.
DocGKR and I--as well as many other learned persons with experience in scientific research--have independently spent hours and hours looking up Courtney's citations to be sure we're not missing something important, and we have independently come to the conclusion that his work is junk science at best. Feel free to keep researching and arguing with Courtney, if you like, but in the end you may feel you've wasted a lot of time and energy that could have been used more productively in other pursuits.
Arguing with Courtney is like trying to teach a pig to sing...
The modus operandi of Courtney & Courtney has been to "overwhelm" the readers of their papers with quotes to lots and lots of papers. Suneson seems to be one of their favorites.
The problem is that few - very few - actually read the supporting papers to determine if they are scientifically relevant. Thankfully, you and Dr. Roberts have taken the time out to follow up the claims.
Between 1987 and 1989, wound ballistics researchers working for the Swedish Defense Forces published four papers in the Journal of Trauma which laid the foundation for modern understanding of remote effects of ballistic impacts on the central nervous system. Martin Fackler published a letter to the editor in which he disputed the findings of distant injuries. He wrote: A review of 1400 rifle wounds from Vietnam (Wound Data and Munitions Effectiveness Team) should lay to rest the myth of “distant” injuries. In that study, there were no cases of bones being broken, or major vessels torn, that were not hit by the penetrating bullet. In only two cases, an organ that was not hit (but was within a few cm of the projectile path), suffered some disruption (personal communication, Bellamy, R.F., 1989).
In contrast to Dr. Fackler’s claims regarding Bellamy’s findings as supposedly communicated privately, Bellamy’s published analysis of the data the following year (Textbook of Military Medicine) describes a number of cases of distant injuries including broken bones (pp. 153-154), five instances of abdominal wounding in cases where the bullet did not penetrate the abdominal cavity (pp. 149-152), a case of lung contusion resulting from a bullet hit to the shoulder (pp. 146-149), and a case of distant effects on the central nervous system (p. 155). See: Bellamy RF, Zajtchuk R. The physics and biophysics of wound ballistics. In: Textbook of Military Medicine, Part I: Warfare, Weaponry, and the Casualty, Vol. 5, Conventional Warfare: Ballistic, Blast, and Burn Injuries. Washington, DC: Office of the Surgeon General, Department of the Army, United States of America; 1990: 107-162.
At the time of publication, Colonel Ronald F. Bellamy served as the acting chief of Department of Surgery at the Walter Reed Army Medical Center and as Associate Professor of Military Medicine and Associate Professor of Surgery at the Uniformed Services University of the Health Sciences. His co-author, Colonel Russ Zajtchuk, served as the Deputy Commander of the WalterReedArmyMedicalCenter and as Professor of Surgery at the UniformedServicesUniversity of the Health Sciences.
In addition to documenting a number of cases of indirect ballistic injuries,
Bellamy and Zajtchuk wrote favorably of findings relating wounding effects to energy transfer:
I smell desperation.
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All projectiles that penetrate the body can only disrupt tissue by these two wounding mechanisms: the localized crushing of tissue in the bullet's path and the transient stretching of tissue adjacent to the wound track.
Evidence showing that this assertion is false has been published by such a number of reliable journals and respected institutions that it is surprising that some continue to claim it as fact. Over the last decade, those publishing in wound ballistics have largely abandoned this position, and the minority of those continuing to hold this view would no longer dare publish it in a mainstream peer-reviewed journal, because they would easily be embarrassed by the weight of the contrary evidence. As demonstrated above, Bellamy and Zajtchuk present evidence supporting distant injuries, and many other researchers have also published evidence supporting distant injuries.
Let’s consider the work sponsored by the Swedish Defense Forces carried out by doctors in the departments of Neurosurgery, Histology, and Surgery at the University of Gothenburg and published in the Journal of Trauma (Vol. 27 No. 7, pp. 782ff): The kinetic energy from a high velocity projectile which strikes the body and moves through it, is to some extent transferred to the adjacent tissue as a pressure wave which moves radially out from the trajectory with a velocity of sound in tissue (3,4,8). These pressure waves have been recorded, e.g., in the stomach of cats (3), in the aortic arch of dogs (1), and in the abdominal cavity of pigs (15) after the animals have been hit in the thigh by high-velocity missiles. We attempted to test the hypothesis (1,10) that pressure waves may induce damage to the nervous system. To test this hypothesis, pressure waves were recorded in the abdomen and in the brain of pigs injured by a high-energy missile hitting a hind leg. Circulatory and respiratory parameters were simultaneously recorded. Evaluations of the blood-brain and blood-nerve barriers were carried out. . . The blood-brain damage demonstratable in small vessels was noticed primarily in the brainstem and basal ganglia . . . The blood-brain barrier damage may be a parallel sign to a direct neuron damage and not the primary reason for the disturbance in nervous function.
Yes, some of the papers supporting distant injuries are 20 years old or more. However, these findings have continued to be favorably cited and confirmed with corroborating data right up to the present year. In contrast, there has been no data published during this period giving cause to doubt the veracity of the numerous studies supporting distant ballistic injuries.
The point of the human autopsy study is that there were no known confounding factors in the available medical histories and the reports of the events. One can always hypothesize that all 33 out of the 33 cases had unknown confounding factors that produced the brain injuries in spite of a reasonable amount of due diligence reported in the study AND that the control group just as miraculously happened to be free of such unknown confounding factors.
The autopsy study confirms the prediction of remote brain injury that was made in a published paper on links between ballistic pressure waves and traumatic brain injury. This prediction was built upon earlier work documenting indirect ballistic injuries and correlation between pressure wave magnitude and rapid incapacitation. The autopsy study reports nothing about rapid incapacitation in the case studies. However, it does give more concrete evidence for a remote cerebral injury mechanism that was suggested in earlier studies more directly correlating ballistic pressure wave magnitude with observed rapid incapacitation (or EEG suppression.)
A number of studies relate pressure wave magnitude with rapid incapacitation. A number of studies demonstrate remote wounding effects of pressure waves. A subset of these studies report BOTH rapid incapacitation AND central nervous system injury in the same cases. The scientific issues are not completely settled, but much progress has been made since Gary Roberts published the claim “A thorough review of the scientific literature relating to wound ballistics has failed to identify any valid research papers which demonstrate that projectiles can exert a remote effect on the CNS.” Now, there are a lot of published papers demonstrating that projectiles can exert remote effects on the CNS. Precise mechanisms and thresholds remain an open question, but remote wounding effects on the CNS well supported.
Papers supporting remote CNS effects have been published by a variety of well-credentialed scientists in a number of peer-reviewed venues including the highly regarded Journal of Trauma, Brain Injury, Military Medicine, and the Textbook of Military Medicine and representing US Army trauma surgeons, researchers with the Swedish Defense Forces, California Institute of Technology, The Third Military Medical Institute (China), and the United States Military Academy (West Point).
Even if we omit papers from Courtney and Courtney that support remote wounding/incapacitation of ballistic pressure waves. There is published evidence for:
1) Pressure pulses inducing incapacitation and brain injury in laboratory animals.
2) Ballistic pressure waves originating remotely from the brain causing measurable brain injury in pigs and dogs.
3) Remote ballistic impacts producing rapid EEG suppression in animal experiments where the probability of EEG suppression and death increases with pressure magnitude.
4) Experiments in animals showing the probability of rapid incapacitation increases with peak pressure wave magnitude.
5) A variety of remote injuries attributed to stress/pressure waves in ballistic injuries in the Vietnam War.
6) Brain damage occurring without a penetrating brain injury in human case studies.
7) Ballistic pressure waves causing spinal cord injuries in human and animal studies.
In the past, proponents of the “sole wounding mechanisms” viewpoint published scathing criticisms of other researchers for failing to publish all their data and failing to cite published sources in support of their claims. Now that the published research convincingly supports remote wounding mechanisms, "sole wounding mechanisms" adherents are claiming that they’ve got unpublished data that contradicts data that has been published, peer-reviewed, and favorably cited by journals and institutions of considerable reputation and credibility.
The modus operandi of Courtney & Courtney has been to "overwhelm" the readers of their papers with quotes to lots and lots of papers. Suneson seems to be one of their favorites.
The problem is that few - very few - actually read the supporting papers to determine if they are scientifically relevant. Thankfully, you and Dr. Roberts have taken the time out to follow up the claims.
Who is Dr. Williams?
The only one who had replied to this thread up to this point is DocKWL which is you.
I'm confused.
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If your plan is for ten years, plant trees.
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I wish I had the money to buy some pigs to test this out with once and for all. Shoot them one by one in the belly, diagonally so as to purposefully NOT hit the heart or spine. Time how long it takes them to fall.
I even have some good calibers to test with... 30 06, 10mm, and 9mm. Pasteur, want to pony up some cash and have some fun?
How would we be able to pull something like that off without going to jail for animal cruelty, knowing that... even if BPW is true, the "low impact" bullets are going to take a long time to incapacitate them?
I wish I had the money to buy some pigs to test this out with once and for all. Shoot them one by one in the belly, diagonally so as to purposefully NOT hit the heart or spine. Time how long it takes them to fall.
I even have some good calibers to test with... 30 06, 10mm, and 9mm. Pasteur, want to pony up some cash and have some fun?
How would we be able to pull something like that off without going to jail for animal cruelty, knowing that... even if BPW is true, the "low impact" bullets are going to take a long time to incapacitate them?
These kinds of experiments have a long history, dating back to the 1940's in the Princeton laboratory of Harvey et al., who wrote:
It is not generally recognized that when a high velocity missile strikes the body and moves through soft tissues, pressures develop which are measured in thousands of atmospheres. Actually, three different types of pressure change appear: (1) shock wave pressures or sharp, high pressure pulses, formed when the missile hits the body surface; (2) very high pressure regions immediately in front and to each side of the moving missile; (3) relatively slow, low pressure changes connected with the behavior of the large explosive temporary cavity, formed behind the missile. Such pressure changes appear to be responsible for what is known to hunters as hydraulic shock--a hydraulic transmission of energy which is believed to cause instant death of animals hit by high velocity bullets (Powell (1)). The magnitude and time relations of these pressures have recently been recorded by the Princeton Biology Group, using tourmaline piezoelectric crystal gauges (Harvey et al. (2)). The part they play in wounding has also been analyzed (Harvey et al. (3)).
and the smell of decay.
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