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A commenter claiming to be Steve Silberman, the writer of The Painful Truth in Wired, checked in on my post noting the aritcle.

A bit of a debate had started in the comments section with another reader about whether combat injuries are more “excruciating” today than in wars past, and the writer was kind enough to stop by and leave a message:

What Chuck said [about the article being about more injured soldiers surviving and needing long-term pain care] was exactly what I intended to say, with apologies for my probably muddled syntax. And the doctors at Walter Reed — who, you know, have a lot of experience in dealing with combat injuries — told me that because the bullets from the latest generation of weapons are designed to fly faster than the ones employed in previous wars, they shatter bones more extensively and create a form of injury known as “massive soft-tissue derangement” which is indeed particularly painful if you survive.

First off, I am flattered that the writer (assuming it’s really him–but I’m giving him the benefit of the doubt) took the time to read and comment on MO.

Second of all, I’m certainly not saying that more soldiers aren’t surviving and needing long-term medical care. Not at all, and I tried to make that clear in my original post and in the comments. I agree that this is certainly a problem that deserves more attention, and I support anything that can help our wounded veterans in any way.

Thirdly, the article is very interesting and informative. Certainly beyond my real comprehension, which is why I merely pointed it out rather than dug into it.

Lastly, however, is the issue of wound from today’s wars being more “excruciating” than those of previous conflicts. I don’t doubt for one minute the pain that today’s wounded suffer (despite the fact that “massive soft tissue derangement” returns exactly zero google hits). Add to that the facts that I’ve never been wounded in battle and that I have no experience as a medic or doctor and I’m demonstrably un-equipped to share my opinion.

I’d just like to point out that the primary small-arms used in the current war are the exact same ones (with only minor incremental improvements) used in wars going back to Vietnam, as are the RPGs. As for so-called, IEDs, they’re by their very nature “mundane” in a military and technological sense. So I fail to see the differences between these injuries and those.

Maybe I’m just splitting hairs. After all, I don’t disagree with the subject of the article at all. And I certainly mean no disrespect to the doctors and the patients of today’s wars. There just seems to be a fair amount of writing out there that tries to make what’s going on today seem like some strange new, terrible world when it’s not. It’s the same old, terrible world.

In any event, I commend the doctors and researchers who are working hard to make our wounded vets more comfortable and I thank Mr. Silberman for his excellent article (besides that one part) and for taking the time to contact me.


  1. The small arms used in the current Iraqi conflct are little different than those used 30-40 years ago. Indeed, most of the standard weapons now are merely improvements of those issued to US and ComBloc forces back then. Even so, the basic premise that velocities are higher today than before is quite simply false. The current US issue 5.56mm NATO M855 cartridge is slightly slower than the 5.56mm M193 issued in the Vietnam-era. The Soviet 7.62x39mm cartridge used in the various AK47 and AKM clones has not effectively changed since it was designed in 1943. It velocity is significantly lower than the 5.56mm NATO and is even slower than most of the standard rifle cartridges used during both World Wars. And while we are on that topic, the Russian 7.62x54mmR cartridge used in insurgents’ PK-type machinguns and SVD-type sniper rifles has not changed much since 1908 or 1930 (depending upon which of the two standard bullet weights is issued).

  2. Murdoc, it’s definitely me, brought to you by the magic of RSS. Thanks so much for your generous comments regarding my article. Daniel, thanks for that contradicting info about weaponry. I’ll admit that I didn’t check that statement about bullet velocities by the doctors too closely — I assumed they knew, being Army doctors, and one of my sources for that statement was from an article of Dr. Buckenmaier’s that will appear in a peer-reviewed medical journal, so I figured it was kosher. But we may be in danger of losing the forest for the trees here. One of the reasons the IED wounds are so painful is because of this, another paragraph from my article: When a bomb detonates under a Humvee, septic muck from the chassis and road surface – carrying native strains of bacteria for which US troops have no resistance – is blown deep into the ravaged tissue. In other words, the injuries are being aggravated not by the pure firepower of the admittedly ‘mundane’ IEDs, but by how they’re used, and by the strains of a nasty bug called actinobacter that lives in the soil of Iraq. Frankly, at Walter Reed, many of the doctors and nurses have started jokingly calling that bacteria ‘iraqibacter,’ and the ubiquitous presence of it on the bodies of soldiers coming back necessitates all kinds of precautions at Walter Reed, like the scene with John McCain and Don Imus that I describe in my article. As far as ‘massive soft-tissue derangement’ being as yet unGooglable — I went to Walter Reed to see the front lines of Army medicine. ‘Iraqibacter’ isn’t in Google yet either. Someday, both terms probably will be. But the larger point of the article stands, as Chuck put it in the very first response: the main reason why pain is a bigger problem in this war than before is because more profoundly wounded soldiers are surviving their combat injuries, which is a tribute to the amazing improvements made to the Air Force’s evacuation chain, for which they deserve much credit. And thanks again for the link, Murdoc. This is a very lively site — keep up the good work!

  3. One *bad* thing about RSS though, is that I do have a lot of other responses to make elsewhere — I will probably not be able to become a regular respondant here. But I certainly appreciate the warm welcome.

  4. Steve: No prob. Your article is quite interesting and informative, and I appreciate your willingness to discuss the nit I decided to pick. Stop by anytime.

  5. massive soft-tissue derangement’ is like turning your guts into hamburger. Up there a poster mentioned the weights of the 5.56 rounds used today and back in the 60s, saying that today’s was heavier than the vietnam era’s bullet, however, the rifling of the barrel changed, a 1:7 twist, meaning one turn every 7 inches, which would be faster than the original 1:12 rifling of the vietnam era rifles which used the older cartriges. So with a faster twist, the bullet spins faster and that’s where the ‘massive soft-tissue derangement’ comes from, which is extremely nasty. P.S. I’m pretty sure this is common knowledge but here’s a source:

  6. I am basing this on big game hunting, but isn’t it energy that does the damage? I had learned that the energy causes tissues and fluid to send shock waves which magnify the damage and that high energy will also start plowing fragments of bone forward to multiply the damage. I have never heard of rate of twist affect velocity, but accuracy based on projectile type. I have never heard of twist and damage being related. I will check out the link later though. AFA as bacteria, we haven’t fought a war at home since the Civil War (and even then not for everyone). Is there actual basis for saying Iraqi Bacteria is worse than Guadalcanal Bacteria or French Bacteria etc. etc. Interesting, but unless I am way off on my ballistics (could be) and microbes (could be), I don’t see the reason for extra painfulness on a wide scale. I am not doubting there is plenty of pain, just trying to see why there would be ‘extra.’ Thanks for stopping by Steve. Great post Murdoc

  7. John the twist doesn’t affect the forward movement, the projectile spins faster, and that’s what sends the shockwaves through soft tissue that do so much damage. I’ve seen tests done with a gelatin block, and the 5.56×39 round from a AK-74 will tear large holes in muscle tissue, which is also in part as a result of the rifling. I think the bacteria is a problem mostly because the bombs are buried in bacteria laden soil and when the bomb explodes the shrapnel and the bacteria soil are launched at the target together, and it gets stuffed into wounds. Combine that with the fact that it’s a third world country and americans have never been exposed to these kinds of bacteria before, and people get wounded and seriously ill at the same time. Also, injuries don’t cause more pain, but the probability of survival has increased. Soldiers today are surviving wounds that would have killed men generations ago thanks to modern technology. Consider this, in the civil war, a man who had his knee shot would probably die in the field, in world war 1, a man shot in the stomach would in most cases die, and in world war 2 men with serious wounds wouldn’t be able to be evacuated fast enough to properly treat them. With helecopters, you can quickly take a wounded man back to an army hospital and then have a better chance of saving his life, but instead of being in pain for an hour or so and dying, he gets to live through it and be in pain for several months.

  8. Hate to be repetitive here, but I’ve heard other discussion of this issue over the last year-or-so. The pain issue is 100% based on survival of wounds . . . the wounds themselves are little different than before. People got blown up by all kinds of things in WWI, WWII, Korea, Vietnam, etc. The difference is that the explosive that blew your leg off in Vietnam was more likely to kill you. The better body armor and medical care we have today means you have a better chance of surviving that explosion. As far as small-arm balistics, if anything we are faced with less-lethal balistics coming our way. The Germans used a 7.92 mm cartridge in WWII. The Vietnamese used 7.62 mm. Iraqi insurgents use the 7.62 mm (AK-47) or the smaller 5.45 mm (AK-74). Of course, the rate of accurate fire is drastically increased with the newer weapons, but if you are hit, it is actually a lower energy bullet. Also, we aren’t really facing a lot of heavy machine guns, the way we did in previous wars. Those could really pack a whallop. Another point on the pain issue is that it is a statistical problem, not an individual problem. What I mean is this: Every war has some soldiers who survive some extremely painful wounds, where the pain sticks around through (and even beyond) the recovery period. The difference here is not the amount of this pain, but the number of casualties who have experienced extreme levels of pain.

  9. Well, this started as Chuck and I fencing over terms and now it’s evolved into Chuck and I totally on the same side. The example and link given earlier about increased twisting in M-16 barrels is good and right on. But how many US soldiers treated at Walter Reed have been shot by M-16s? It’s AK-47 country. The bacteria in the ground in Iraq and the fact that it gets into wounds is no doubt an issue. But as also pointed out, Iraq isn’t the first foreign soil our troops have been wounded on. The total point of that story was that due to better armor, more speedy evac, and better medical capability many of our troops are living who would have died earlier. This creates a large problem with intermediate and long-term pain management that hasn’t been encountered on this scale before since so many more troops would have died of the same wounds that troops now regularly survive. That is all well and good and I said so. What I took issue with is the suggestion (well, plain and clear statement) that today’s weapons are more painful than the weapons of previous wars. This sounds like total bunk. Men have had their muscle turned into hamburger for centuries. Bombs, artillery shells, and mines have put dirty shrapnel into wounds for centuries. This is nothing new. The exact bacteria in the ground of Iraq probably hasn’t been encountered before, but then the malaria problems or the trenchfoot problems of previous wars aren’t really a factor this time around. Never mind that the enemy’s weapons in this war are virtually unchanged from previous wars. I don’t care what we’ve done to the M-16, and I don’t care if the Special Forces are using plasma guns. The enemy is using the AK-47, and much of the ammo they’re firing might actually be from 1960s stockpiles. Yes, new weapons are fearful. But no one is laying in bed groaning about getting shot by a 12-twist rifle instead of a 7-twist rifle.

  10. I don’t know anything about modern weapons, but I have always felt that it would be particularly unpleasant to be hit by a cannon ball. The poor sod at the receiving end is going to feel quite bad no matter what the weapon used to injure him.

  11. Murdoc, You’re on the money. Rounds used in WWII-era weapons were typically bigger and faster than those used by the AK-series. The M-1 fired a 174 grain bullet at 2800 fps. At muzzle, the M-1 delivered 2903 ft-lbs of energy. The standard Japanese firearm in WWII fired a 181-grain bullet at 2400 fps. The Lee-Enfield fired a 174 or 215 grain bullet at 2060-2440 fps. The 7.62×39 AK round typically weighs 120-125 grains and has a muzzle velocity of approximately 2400 fps. It averages around 1500 foot-pounds of energy…quite a step backward from the large caliber rounds used in WWII and Korea. Take a look at this report: To simply state ‘faster rounds are creating larger wound channels’ is just plain wrong. That’s not what’s happening.

  12. Shock waves are created when the material or fluid has something pass through it that is travelling at a speed faster than it’s relative speed of sound. Shockwaves spread out in a conical way, the angle of this cone to the bullet is dependent on how sharp or blunt the object is. Therefore technically speaking a shockwave will do more damage if it can create a larger angle with the bullet, although this type of bullet would have to be very flat at the end. Also we have to take into consideration the loss of velocity of this bullet as it penetrates, which is dependant, not only on the shape and material, but also on its mass. Therefore, as with the lighter bullet of the m-16, it may hit the target at a high velocity but unless it retains the energy for a long time past impact, the bullet will have a small shockwave and thus create less damage. [For more info on shockwaves, read an aerodynamics book about compressible flow] To say how much damage purely depends on circumstance ie. the distance from shooter and what kind of material the bullet has to pass through to reach vital organs/arteries, but it does not depend on new guns and ammo, they have simply been made more accurate. (Possibly excluded from being more deadly is the M-82, which is a new type of weapon to war, but this topic is about US injuries, therefore I shall exclude it.)