Broken Bodies, Shattered Minds: A Medical Odyssey From Vietnam to Afghanistan

by Ronald Glasser M. D.

  But these are still women. That is always there. Erin Solaro, in her book, Women in the Line of Fire, mentions a female sergeant who, after a particularly vicious fire-fight, looks around at the marines policing up their gear and says with real affection “The marines are like little kids who need Ritalin.” She paused, and flashing a small but satisfied maternal smile, clarified her comment, “The young ones anyway,” she added, “ those on their first combat tour …”

  19.

  BULLETS OF GRIEF/A PRESCRIPTION FOR PREVENTION

  “We need a bigger bullet.” What the young marine, just returned from Afghanistan, meant was a heavier bullet with more velocity, a longer range, and better terminal ballistics. More than one military surgeon had heard something like that during their own deployments, a few had heard it within weeks of the Iraq invasion in 2003.

  The concern is no small thing. In our new kind of wars, the size of the bullet matters. During the battle for Telafar in 2005, General H.R. McMaster, then Regimental Commander of the 3rd Armored Cavalry, had issued M-14s, the successor to the Second World War’s M-1 Garand rifle, to some squad members in each platoon.

  The M-14 fires a much larger and heavier. 308-caliber round that can reach out to ranges simply unreachable by the 22-caliber round fired from the standard-issue military M-4. In addition, a full .308-caliber round is able to penetrate cover that would deflect the M-4’s smaller and lighter bullets. Anyone reading the After Battle Report would have guessed that, given the opportunity, the commander of the 3rd Armored Cavalry would have issued M-14s to all his troopers.

  At the beginning of the war in Iraq, the Marines made the fight at Fallujah using the M-4. They would often hit insurgents with the smaller bullet but could not kill them or were unable to drop them. The insurgents kept attacking, at times bringing the fire-fights down to meters, and in a few places actually breaking through the Marine’s forward positions. As one corporal put it, “They had to be hyped up on something. We’d hit them and they’d just keep coming.”

  This was something that hadn’t happened to American Marines since they fought in the Philippines during the native uprisings in the late 1890s. At the start of the insurrection against American rule, the 38-caliber revolver, the standard-issue side arm for the Marines, was found to be unsuitable for the rigors of jungle warfare due to its unsatisfactory stopping power.

  The weapon was upgraded to an automatic handgun firing a 45-caliber round. The heavier bullet was more effective against charging tribesmen who had high battlefield morale and used amphetamine-like drugs to inhibit sensations of pain. Yet, the message that bigger is better had gotten lost or was ignored as our armies moved into 1950s, 60s, and 70s.

  Indeed, heavy-caliber rifle rounds had been standard issue since before the First World War. During the trench warfare of World War I, with most opposing forces well over 300 yards apart, if a soldier stood up or lifted his head out of the trench for a few seconds, he would be dead. Sergeant York, using a bolt-action M1903 Springfield rifle, firing a large caliber 30-06 round from over a third of a mile, single-handedly picked off a column of German soldiers one at a time, using a technique he had learned as a small boy hunting turkeys in the woods of Tennessee. He killed the Germans, as he had killed the birds, back to front to avoid alerting the German’s at the front of the column.

  It was a simple time, though I doubt that there was a physician in the U.S. Army units deployed to France who did not appreciate that degree of marksmanship.

  Still, the ethical issues facing physicians in the military have not changed since medicine came to the battlefield. It is basically the result of that conflict between the Hippocratic Oath to heal the sick and relieve suffering, and General Patton’s universal and timeless speech to troops that they were not there to die for their country but to make sure that the enemy died for theirs. What has added a modern edge to the reality of that tension is what a marine said to me some forty years ago at Zama and what they are still saying today, “We’re the tip of the spear. Believe me, there isn’t anyone out there trying to turn us into plowshares or pounding us into pruning hooks.”

  Whatever you may think, war is death and destruction and universally painful. Just as there are no atheists in a foxhole, there are no jingoists in a battalion aid station or a military triage area. What troubled physicians and surgeons in Vietnam who treated everyone brought into their hospital whether American, South Vietnamese, Viet Cong or NVA, is the same that troubles military physicians and surgeons in Iraq and Afghanistan today. With the escalations in deaths and casualties as troop numbers are increased, the same realization comes into play, if anyone is going to have to be killed or wounded, better it be them than us. It is a desperate Hobson’s choice with no clear cut or acceptable default position.

  How to hold both the Hippocratic Oath and the reality of war in the same breath, not to mention the same mind, is at best a difficult and perhaps impossible task. Ultimately, you have to pick a side or you just have to stay clear of the whole thing. That is the choice. Still, like any reasonable medical or therapeutic decision, the facts help.

  Regarding the bullets, those facts and that history are as simple as they are clear. You either have the right bullet or you don’t, and if you don’t the whole ethical issue quickly morphs into something decidedly less slippery than ethics—responsibility. And that anyone can understand and hopefully appreciate. We simply need to give our troops a bigger bullet.

  Whatever else might be said about World War I, it was a war where marksmanship, accuracy, the hitting power of largecaliber bullets, as well as the operational range of the rifle, mattered as it had in every war since the invention of firearms. At Gallipoli in 1916, the average life span of an Australian or New Zealand soldier moving about outside of the trenches was somewhere in the neighborhood of one to two minutes. That in itself, after six months, ended the campaign, with the Allied Forces simply giving up and going home. But things were changing. Technology was taking over, not only within civilian industry, but within militaries themselves.

  The last years of the First World War saw the development of a number of fully-automatic weapons, including the 1919 Browning automatic rifle, the Thompson submachine gun, the German machine pistol, and the British Vickers machine gun. The industrial revolution had been in place for some sixty years when World War I began and so it was time for slaughter on an industrial scale.

  These automatic weapons fired a shorter and slightly lighter bullet than the standard 30-caliber rifle round. The lighter bullets allowed these automatic weapons to fire a large number of rounds, without substantial recoil, over a very short period of time. The soldiers using these weapons, however, had to carry the increased numbers of cartridges needed to fire these weapons. The arguments then are the arguments used today to justify the use of the lighter, less kinetic, rounds in both Iraq and Afghanistan.

  What is not arguable is that the “lighter” ammunition combined with the automatic fire did away with aiming, and the issue of marksmanship quickly morphed into a new military doctrine of “Spray and Pray.” Enamored by the numbers of rounds that could be fired per minute, this new doctrine replaced individual expertise and personal battlefield skills with sheer volume. Like so much that has happened with industrialization, the machine replaced craftsmanship.

  Still, that idea of not aiming was a potential problem which the military did understand, and dealt with by taking the full auto-setting off the upgraded M-16s and M-4 to allow for single shot or 3-round bursts. Yet, the development of the assault rifle by virtually every major military in the world was the modern battlefield answer to the balance between a rifle that, if aimed properly, was able to fire long distances and still drop whoever was hit, with the sustained rapid fire of the automatic weapon used at close quarters.

  All the assault rifles used the smaller reduced 30-caliber cartridge, universally called the 5.56 round, that contained less powder than the original larger and heftier 30-caliber rifle cartridge. T
he German assault rifles developed for use on the Eastern Front at the close of the Second World War used a larger 30/08 or 7.92-mm round based on the full powder, older 30-caliber cartridge. Yet, only a few hundred thousand of these assault rifles were ever issued to German forces. Consequently, the only units of the German Army to successfully fight their way out of the encircling Red Armies throughout 1944 and early ’45 were those units that had been issued the assault weapons firing these larger rounds. The German units firing assault rifles using the more powerful cartridges were able to kill more Russians, at a farther distance, than the Russians were able to kill Germans at those same distances, using automatic weapons with the lighter cartridges.

  Despite all the technology, there are still times out on the battlefield—and more often than has been or is currently being admitted—when surviving the life and death struggles of modern warfare may mean no more than using a bullet a few hundred grams heavier, with greater terminal ballistics, than the bullet your enemy is using. That was a message that somehow has gotten lost. It made a difference in World War I and World War II and once again today can mean the difference between living and dying.

  In the early 1940s, the U.S. military believed there was a need for a light carbine to be used by personnel not in direct combat, that offered more personal defense than the standard issue 1911 / 45-caliber Colt pistol developed in the Philippines during the native insurrection and used throughout World War I.

  The carbine worked well for close-in defense and limited assaults against lightly fortified positions. In these limited encounters the carbine, firing little more than a slightly more powerful handgun cartridge, was definitely better than using a pistol. But in Korea, the carbine proved a deadly nightmare for U.S. troops.

  The Chinese, attacking in winter across the frozen Yalu River at the Chosin Reservoir, wore padded winter uniforms. More than one marine was killed, who after putting a few rounds from a carbine into a Chinese soldier who did not drop, kept up the attack. Faced with these lighter rounds, the Chinese in their padded winter uniforms might just as well have been wearing Kevlar vests. There were instances during the Korean War of our troops simply throwing away their carbines and looking for an M-1 Garand or a Browning automatic rifle or even an M-14, in order to stay alive.

  It would not have been unreasonable for the physicians in the MASH Units—and there was a script that had been in the works for the TV show MASH—to make the point to their more senior officers that if they didn’t want their soldiers and marines killed and wounded they would have to dump the carbines and distribute weapons that would work. Preventive medicine is still a part of medicine in general and it is certainly a part of military medicine, whether issuing tablets to fight off malaria or adding iodine tablets to make contaminated water potable. Unfortunately, history was doomed to repeat itself.

  In the middle 1950s, the U.S. Army established a program to develop weapon systems based on the combat statistics of World War II for what was called the “Battlefields of the Future.” The data showed that the greatest number of kills from small arms had occurred at less than 300 yards, with the majority to be within 100 yards of enemy combatants. It was determined that the military should consider very light-weight, high-capacity weapons that would be effective at close ranges, especially less than 100 yards. Once again, it was explained that the use of lighter rounds would allow soldiers to carry more ammunition, while firing a less kinetic bullet would provide controllability to the weapons, even under full automatic fire.

  U.S. military doctrine now called for being able to carry enough rounds so that a soldier could keep firing until he finally hit someone or something. Long standing factors such as aiming and distances were disregarded. The analysts were now in charge. “Spray and Pray” had become Pentagon policy, but with even more spraying and more praying, at the time, no suitable cartridge was available for that proposed new small-caliber assault rifle.

  But Eugene Stoner, while working at the Armlite Corporation on just such a weapon, looked at the then available 22-caliber cartridges and based on the slightly heavier Remington Magnum 22-caliber round, developed the lightweight but more powerful, NATO-designated 5.56-mm rifle cartridge for his new rapid fire AR 15 assault rifle. Virtually overnight a star was born. The production of the AR 15 Stoner rifle was leased to the Colt Company and produced by the millions as the Military M-16.

  Rushed into production in the middle 1960s for the Vietnam War, the physics of initial velocity and end-point ballistics soon caught up with the new weapon and the new round. Even though the 5.56 cartridge was lightweight, had low recoil, and met the absolute military specifications of being able to penetrate a steel helmet at 300 yards, the round did not have the reach of the other older and heavier military cartridges. Additionally, there was the problem of knockdown power. The 5.56, which despite its increasing powder load, was still a 22-caliber round and lacked the energy to reliably knock down a determined or crazed attacker past 100 yards.

  The Soviet Bloc countries, as well as their allies and surrogates, had also drifted to fully automatic weapons, but used a much heavier 30-caliber round. The famous AK 47 was the product of this type of assault rifle.

  But across the world, updated versions of the old-fashioned bolt-action World War I rifles were used by snipers, commandoes, and Special Forces, as well as nuclear weapon guards. These are considered critical military specialties where the target has to be killed. These are weapons to be used in situations where there was not the luxury of a second chance. That should have told our military something about the realities of combat. More times then anyone is willing to admit, there is never that luxury of a second chance.

  Nowhere are the limitations and dangers of the Stoner 5.56 round more clearly or more dramatically described than in Kent Anderson’s book on the Special Forces, Sympathy For The Devil, where two special forces officers getting drunk at a bar in Da Nang during the beginning of the Vietnam War discuss the differences between their M-16 cartridge and the AK rounds they are up against.

  Hanson was standing next to the bar. “You know,” he said, holding a bullet in each hand between thumb and forefinger, “you can get an idea of a country’s national character by the bullets their armies use.”

  “Oh, yeah,” Quinn said, turning on the bar stool to look at Hanson. “I guess you’re going to tell me about it.”

  “Now you see,” Hanson said, “here’s the standard American small-arms round,” and held up the bright bullet toward Quinn. “It’s slim, lightweight, and fast, but unstable. Look at it,” he said, shaking the pencil-thin round. “It’s the bullet equivalent of a fashion model—sexy-looking, thin, glittering. But if it gets dirty or damp or overheated, it’s liable to jam on you. Temperamental, a prima donna.

  “Now here’s the Russian bullet,” he said, holding out the dull AK-47 round. “Short, thick around the middle. The peasant woman of bullets. Sturdy and slow, not easily deflected by brush, dependable at long range. You can stick it in the mud, put it in the gun, and still shoot it.”

  “We’re shooting our fashion models at them and they’re firing back with peasant women,” he said, holding out the bullets, grinning.

  A battalion surgeon with the 9th Division in the Delta or a medic up in the Central Highlands could not have said it better. Erin Solaro, in a recent interview about women in combat, gave a clearer view while adding a bit of feminine testosterone to the controversy:

  The cartridges used in the M-16 in Vietnam and the same 5.56 round used in the M-4s in Iraq and Afghanistan are a bunch of shit.

  A soldier having spent two tours in Iraq and recently one in Afghanistan said much the same thing:

  We’re using varmint rifles and they’re using real guns. We try to get assigned to the .50 Cals that way we can kill ‘em and don’t have to worry about having to hit them with three rounds before they drop. Believe me, we complained but no one listened.

  Yet, even while Stoner was willing to give away distance based
on the Army’s own data on most kills being at less than 300 yards with the majority of those under 100 yards, he clearly understood the physics of bringing a smaller bullet to what were surely to be deadly gunfights. He understood that the low kinetic energy of his 22-caliber round would become a real survival issue once they were used in actual combat.

  In the military, a soldier or marine should be able to drop anyone he or she hits. There is no place in a battle for a fair fight. In any combat situation, a soldier doesn’t want to give the enemy a break and he certainly doesn’t want anyone he shoots to keep moving—much less be able to shoot back.

  So Stoner did the obvious. A physicist at heart, he started to fiddle. He increased the hitting power of his new bullet by actually decreasing the rifling of the M-16 barrel so that the bullet was spinning at a slower rate when it left the barrel of the gun, making the bullet barely stable in flight almost from the moment that it left the barrel. Most middle or long-distance weapons have a ten or eight twist to length rifling of the barrel in order to keep the bullet spinning fast enough to maintain a stable trajectory. That twist to length rifling allows the round to reach out accurately and predictably to considerable distances without fluttering off course, being deflected by windage, or losing significant terminal energy as it hits the target.

  The degree of spin acts like a gyroscope, keeping the bullet on line and stable in flight. Stoner’s reducing of the twists in the barrel of the M-16 allowed the bullets to quickly tumble and a tumbling bullet, even with losing energy, can still cause terrible wounds that become the classic “small hole in/big hole out” wounds.

  But tumbling bullets are also easily deflected. It is the reason that soldiers in ’Nam out on patrol were relieved to have someone on point with a sawed off shotgun or a cut down M-60 machine gun that could fire rounds through tangled jungle growth and kill anyone off the trial waiting in ambush.