shells loaded with rubber or plastic pellets Wounds are designed for self-defense or for police riot-control purposes [1]. The cylindrical barrel may be slightly tapered toward the muzzle end (choke bore) in order Introduction to keep the discharged shot in a tighter spread over a longer distance. injuries are regarded as a special form of blunt trauma. The damage to the organism is caused by the impact of a single projectile (or a multitude Caliber of pellets) propelled from a barrel by high-pressure On the one hand, the term caliber represents the combustion gases and striking the body at a high diameter of the bore, and, on the other hand, the velocity. Gunshot wounds, in a broader sense, are bullet diameter. For metric calibers, the caliber spec- also lesions caused by - weapons as ifications are nominal values usually based on the well as injuries due to livestock stunners, stud guns diameter of the lands (maximum diametrical distance used in the construction industry, and similar devices. between the lands in the barrel). Most projectiles have a somewhat larger diameter. Example: The caliber Weapons and Ammunition 7.65 mm Browning has a land diameter of 7.63 mm, whereas the bullet diameter is 7.85 mm. The Anglo- Weapon Types American caliber specifications (in inches with 1 in. corresponding to 25.4 mm) are based rather on the enable the user to hit a target from a dis- tance. Depending on the weapon type (see Firearms: bullet diameter. Overview), a distinction is made between handguns In pistols, the predominant calibers are 6.35 mm, (short-barreled firearms for use with one hand: pis- 7.65 mm, 9 mm, and .45 in, whereas in revolvers the tols, revolvers) and long arms (portable long-barreled main calibers are .32, .357, .38, and .44 in. firearms for use with both hands: rifles, submachine Cartridges for .22 caliber rimfire weapons can be guns, machine guns, and ). fired not only from handguns but also from long Modern pistols carry a magazine in the handle; rifles (LRs). after firing a cartridge, its case is ejected as the bolt In cartridges designed for hunting rifles, it is usual is sliding back. Revolvers have a rotating cylinder to indicate not only the caliber but also the length of × × holding the cartridges; after firing the shot, the case the case in millimeters (e.g., 7 64 mm, 8 57 mm). remains in the chamber. The same applies to the cartridges of military rifles × × Weapons intended to be fired from the shoulder (e.g., 5.56 45 mm, 7.62 51 mm). have either a rifled barrel (see below), e.g., hunting The caliber of shotgun barrels is not identical with rifles (firing single projectiles) and military assault its internal diameter. It indicates the number of spher- rifles, or they have a smooth barrel such as shotguns ical lead balls collectively making up one English = (firing lead pellets, shotgun slugs, or rubber/plastic pound (1 lb 453.6 g) in weight; the diameter of pellets). these lead balls corresponds to the internal diame- ter of the barrel (e.g., 18.2 mm for shot caliber 12 and 16.8 mm for shot caliber 16). An exception to Rifled and Smooth Barrels this rule is the .410 shotgun, which is named after The inside surface of a rifled barrel has a spiral the barrel diameter in inches. pattern of elevations (lands) and grooves in between. As the bullet passes through the barrel, the lands cut Cartridges into the cylindrical part of the projectile, thus causing it to rotate around its longitudinal axis (“twist”). This The cartridges of handguns and rifles consist of a case gyroscopic spin stabilizes the bullet on its trajectory with a primer in its base, the propellant (gunpowder) and improves the accuracy of the shot. above, and a bullet (projectile). Shotguns have smooth-bore barrels without The case is usually made of brass. Cartridges for grooves and lands. They are designed for firing autoloading pistols have a groove just above the base shells containing mostly lead pellets or shotgun slugs. so that the fired case can be extracted and ejected by 2 Gunshot Wounds the recoiling slide. Revolver cartridges have a base 400 ms−1, whereas in hunting and military rifles it is plate that is wider than the cartridge case. considerably higher (approximately 700–1000 ms−1). The explosive compound is located in the base Generally, ammunition designed for autoloading of the cartridge case. When the trigger is pulled, the pistols and military rifles has full-jacketed bullets firing pin strikes the base of the case, causing the with a lead core and a jacket made of steel or a primer compound to detonate and initiate the burn of copper alloy covering the front and lateral parts of the gunpowder. the projectile but not its base. The primer consists of an explosive compound For hunting, most cartridges are equipped with a sensitive to percussion. Initially, the primer was semijacketed bullet. As the jacket is open at the tip, made of mercury fulminate, which was later replaced the projectile with its soft-point or hollow-point lead by a combination of chemical compounds typically core deforms more readily, thus transferring more containing the elements lead, barium, and antimony. energy to the animal body. Therefore, these elements play an important role in Standard .22 caliber rimfire ammunition usually the detection of gunshot residues (GSR). On the other has unjacketed lead bullets. Revolvers mostly fire hand, nowadays, lead-free primers are also available lead bullets, but also semijacketed projectiles. (e.g., “Sintox” with the main elements zinc and According to the bullet’s head configuration, there titanium). are different shape categories: round nosed, flat Above the primer, the case is filled with gunpow- nosed, pointed, cylindrical, and truncated cone. der (propellant), which does not detonate, but burns Apart from the shape and the design of the pro- rapidly. “Black powder”, which has been known for jectile, its mass and velocity are also of importance centuries and is a mixture of 75% potassium nitrate, for its potential effect. From the mass (m) and the 15% charcoal, and 10% sulfur, is rarely used as a pro- velocity (v), the kinetic energy Ek can be calculated (E = 1/2mv2); it is indicated in Joule (J). As exam- pellant nowadays (for historical or reproduced muzzle k ples, we may mention the mass of a .22 LR projectile loaders or some blank-cartridge weapons). Because of (2.55 g) and a 9 mm Parabellum projectile (8.0 g); in the high amount of solid combustion residues, a lot the first instance (.22 LR), the bullet energy is about of dense smoke is produced [2, 3]. 140 J, and, in the second instance (9 mm Para), about Currently, mostly smokeless powder is used as 430 J. The bullet energy of military and hunting car- propellant because of its higher efficiency of com- tridges is many times higher. Note that the energy bustion compared to that of black powder. It either increases exponentially with the velocity of the pro- consists of nitrocellulose (NC) alone (“single-base jectile. powder”) or of NC dissolved in nitroglycerine (“double-base powder”). The powder grains are of pale green color or have a shiny silver-black appear- Shotgun Ammunition ance (if coated with graphite). The powder particles Conventional shotgun shells are fired from smooth- resemble thin platelets (flake or disk powder), small bore shotgun barrels. Instead of a single projectile, spheres (ball powder), cylinders, or short tubes (tubu- they mostly contain numerous spherical pellets made lar powder). The individual powder particles have a from hard lead. The pellet diameter of birdshot varies diameter ranging from several tenths of a millimeter between 2 and 4.5 mm, and the pellet velocity on up to more than 1 mm. In Flobert cartridges (caliber leaving the barrel is about 300 ms−1. The larger the 6 or 9 mm), the primer also serves as propellant. pellet, the greater is its range, given the same velocity. The deflagration of the propellant produces an In addition to birdshot, cartridges with especially ample amount of gases (CO2,CO,H2,N2, nitrous large pellets (“buckshot”) are also available, with gases, water vapor), which are under high pressure single shotgun slugs (e.g., Brenneke type, Foster, and accelerate the projectile on its way through the Smith & Wesson sabot) and with rubber/plastic barrel. The processes inside the weapon itself are pellets. called interior (see Firearm Examination: The cartridge cases are made of cardboard or Ballistics). plastic and the floor (mostly consisting of brass) In handguns and .22 caliber rimfire rifles, the contains the primer. The space above it is filled with muzzle velocity typically ranges from 250 to a (smokeless) nitro powder, which is separated from Gunshot Wounds 3 the lead shot by intermediate layers (felt or plastic By firing test shots at “simulants” such as gelatin wad). Nowadays, the cardboard and felt wads have or glycerin soap, the transfer of kinetic energy in been largely replaced by plastic wads in connection biological soft tissue can be visualized, as the density with shot cups for the pellets. of these materials is similar to that of muscle. In contrast to elastic gelatin, soap shows an almost Wound Ballistics plastic deformation. The bullet path and the volume of the cavitation remaining after firing the shot is Exterior ballistics deals with the behavior of the pro- proportionate to the energy transferred [4]. jectile after leaving the barrel (trajectory, velocity A stable bullet with a low deformation potential etc.), whereas terminal ballistics covers the inter- (full-jacketed projectile, as used in military ammu- action between the projectile and the target (see nition) produces a “narrow channel” in the simulant Firearm Examination: Ballistics). If the target is at first, which then opens into the larger temporary a human or animal body, one speaks of wound bal- cavity as the projectile moves in a sideways posi- listics. tion (when tumbling) and imparts more energy to the surrounding tissue. An expanding deformation of the projectile also increases the effect of radial Fundamentals of the Wounding Capacity displacement and thus the volume of cavitation. In The wounding capacity of a projectile is partly due deformation projectiles (e.g., semijacketed hollow- to the direct destruction of anatomical structures point bullets as used in civilian hunting ammunition), along the bullet track by crushing, punching, and the cavity starts forming immediately after penetra- tearing. Another type of lesion is caused by changes tion. A fragmentation of the projectile results in a in pressure and displacement of tissue (with stretch- multitude of wound tracks. ing and shearing) around the permanent wound chan- When projectiles of identical design, head config- nel. The extent of mechanical damage depends on the uration, and mass are fired, the transfer of energy in amount of kinetic energy (Ek) released in the tissue. a dense medium and thus the extent of the tempo- When a projectile penetrates the tissue, this is rary cavity essentially depend on the velocity of the displaced laterally (radially) – i.e., at right angles to bullet. the bullet path – thus forming a temporary wound cavity, whose diameter can be considerably larger Wound Track than the bullet. The radially displaced tissue then moves back in the opposite direction toward the In gunshot injuries, the bullet may remain lodged in geometric bullet path. the body, or perforate it completely (through-and- The process just described is especially marked through shot), or hit only the surface tangentially with high-energy projectiles such as those fired from (graze wounds). In the first-mentioned type of gun- military and hunting rifles. In fluid-filled organs shot wound, there is an entrance, but no exit wound. (heart, urinary bladder) or in the skull, the radial Rather often, projectiles traveling at a low velocity expansion may lead to a “hydrodynamic explosive remain lodged under the tough and resilient skin on effect” with bursting of the encasing structures. Cases the side of the body opposite to the entrance wound, in which the brain is completely flung out of the where their final position can be recognized by a cranial cavity are referred to as exenteration shots. hematoma and/or a palpable resistance (Figure 1). Even a shot with a smaller transfer of kinetic energy Radiological examination is advisable in any case to may cause indirect lesions away from the wound determine and document the localization of bullets track, e.g., skull fractures, cerebral contusions, and and bullet fragments retained in the body. stretch-mark-like tears of the facial skin. For the determination of the angle of fire (in The “permanent” wound channel represents the relation to the horizontal, sagittal, and frontal plane destructive passage of the bullet itself. The path is of the body), it is imperative that the length of the filled with blood and is surrounded by a more or wound track and the localization of the entry and less wide zone in which the tissue was temporarily exit wound or, in shots with the projectile retained stretched, thus suffering structural damage (“zone of inside the body, the final position of the bullet extravasation”). are exactly measured and recorded (height from the 4 Gunshot Wounds

(a) (b)

Figure 1 Nonperforating gunshot injury to the chest (.22 caliber rimfire rifle, homicide). The spent lead bullet got stuck in the subcutaneous tissue of the back where a hematoma indicates its position (a). The projectile could be exposed by carefully incising the overlying skin (b) plantar plane and the lateral distance from the median pass along the inner surface of the skull producing plane). Statements as to the bullet’s trajectory before a curved wound track in the underlying brain. entering the individual are possible only if additional The latter type of ricochet not only occurs on the facts (such as the position of the victim and/or the concave side of the cranium but also on other inner shooter) are known; in the presence of a through- surfaces (e.g., ribs) if a concave boundary surface and-through gunshot wound, it is essential to know continuously changes the direction of the bullet. any secondary sites of impact or penetration (on the In a perforating shot, the projectile produces an floor or the walls, in the furniture etc.) to reconstruct exit wound as it leaves the body. Bullets with a the trajectory. low residual energy are sometimes no longer capable In most cases, the wound track in the body is lin- of perforating the clothing covering the exit wound. ear. Full-jacketed rifle bullets, however, may produce After having passed through one part of the body a curved bullet path if its length in the body is longer (e.g., the upper arm), the bullet may reenter in another than 20–30 cm. The deviation from the straight line part (e.g., the thorax). begins when the projectile first moves into a lateral Graze shots produce groovelike lesions on the position, i.e., in the region of the first cavitation, as body surface, occasionally accompanied by short the pressure gradient along the projectile becomes tears along the wound edges. If a projectile strikes the asymmetrical, thus creating a force component lateral body with low residual energy, but does not penetrate, to the direction of the movement. the affected skin may show an excoriation and/or Nonlinear bullet paths are often caused by internal a hematoma. ricochet. Inside the cranial cavity, such ricochets are seen in 10–25% of the cases and occur if the Intermediate Targets, Deflection of the Projectile projectile is deflected from the internal table of the skull with a low residual energy. Bullets either For the interpretation of a gunshot wound, it may ricochet back into the brain at an acute angle or be essential to know if the projectile struck the Gunshot Wounds 5 human body primarily or if it interacted with an In gunshot injuries with a fatal outcome, the intermediate object before. For example, if the bullet direct lethal effect may be due to various causes. A passes through an intermediate target such as a door special case is the gunshot-related “exenteration” of first, the typical “ring of dirt” on the site where the brain from the skull [3]. When the shot strikes it entered the clothing or body is missing, because the nape of the neck or the occipital region, it the grayish-black depositions adhering to the bullet may directly destroy vital centers of the brain stem. surface were already wiped off at the primary target. More often, it is not the cerebral lesion as such, but When a bullet passes through the dense medium of the subsequent increase in the intracranial pressure an intermediate target, it loses its gyroscopic stability, (due to intracerebral, subarachnoidal, and subdural resulting in a rotation around a lateral axis. If such bleeding, sometimes associated with cerebral edema) a bullet then hits the body in an oblique or sideways that is responsible for the lethal outcome. position, the entrance wound is elongated and there Gunshot fractures of the bony skull base are often is a higher loss of energy in the initial section of the followed by a hemorrhage into the nasopharynx; wound track. Analogous effects may be seen when if the victim is unconscious, fatal aspiration of the bullet was already deformed at the primary target. blood will result. Gunshot-related lacerations of the If a projectile is deflected by an intermediary target venous sinuses may act as entrance sites for air instead of penetrating it, one speaks of a ricochet. bubbles, possibly leading to death from venous air A change of direction may happen, for example, if embolism. the bullet strikes stone, concrete, or asphalt. In such Injuries to the heart, great vessels, or parenchy- cases, the bullet often shows a flattened, mirrorlike matous organs cause massive internal bleeding with surface. The deformation and/or fragmentation of the consecutive hemorrhagic shock. to the lung ricochet bullet may cause an atypical entrance wound with traumatic pneumothorax are an acute threat with no, or an incomplete ring of dirt. Owing to the because of the impaired respiration – especially if loss of velocity and the instability of the ricochetting both sides are involved. Inflammatory complications projectile, its depth of penetration is less than in are potential causes of delayed death. primary hits after an undisturbed trajectory [5]. Ability to Act

Lethal Gunshot Injuries It is often wrongly believed that a gunshot to the head or the trunk always incapacitates the victim According to statistical investigations, about 20% of immediately. This opinion is disproved by a multitude gunshot injuries are primarily lethal, i.e., the victims of well-documented cases in which gunshot victims die before receiving medical care. performed surprisingly differentiated actions even Generally, fatal consequences of a gunshot wound after severe traumatization of vital organs [7]. also have to be expected if weapons are used, If a victim becomes unable to act, this is usu- which lay people would not consider very dangerous ally due to functional impairment of the central ner- (e.g., air guns, blank-cartridge weapons, and .22 vous system caused either by tissue lesions directly caliber rimfire rifles). For example, bullets fired or indirectly by insufficient oxygen supply. Imme- from conventional air guns (with a common barrel diate incapacitation is to be expected if the bullet diameter of .22 or .177 in, that is, 5.6 and 4.5 mm, destroyed parts of the brain essential for physical respectively) may perforate the thin temporal squama activity – with exenteration of the entire organ in or penetrate into the cranium via the orbital cavity extreme cases. Targets of immediate incapacitation (eye socket). The gas jet of blank-cartridge guns are the upper cervical spinal cord, the brain stem, has repeatedly caused penetrating skin lesions, bone the cerebellum, the basal ganglia, the motor areas of fractures, and lethal injuries of vessels or organs, the cerebral cortex, and the large motor nerve tracts when fired from a very short distance [6]. Of course, [8]. The bullet need not necessarily pass through projectiles with a low energy fired from .22 caliber these cerebral regions directly, as the gunshot-related rimfire weapons may also produce fatal injuries if pressure and shearing forces can also damage nerve major organs or great vessels are hit along the bullet structures and impair functions away from the bullet track. path. 6 Gunshot Wounds

Cerebral hypoxia with consecutive unconscious- Embolism of Projectiles ness following gunshots to the chest is mostly due to massive loss of blood. However, even if the bullet The rarely seen transport of bullets or shot pellets strikes the heart, the aorta, or other large arteries, within the vascular system is called embolization. blood circulation will hardly cease immediately and Most of the embolized projectiles are of smaller even then the oxygen reserves left in the brain may caliber and low velocity, which is sufficient only be sufficient for simple and short actions. Conse- to penetrate the artery or vein, but not to exit the quently, rapid but not immediate incapacitation is to vessel again, so that the foreign body, which is now be expected after gunshot injuries of the heart, the localized inside the vessel, may be moved to a region aorta, and the pulmonary artery. On the other hand, of the body away from the bullet path where it can victims go down immediately if struck in the spinal be easily visualized by radiography [9]. cord. Bullet and pellet embolization is mostly seen in The pathophysiological considerations just de- the arterial system (entry via the heart or the aorta scribed have significant implications for the and transport, e.g., to the leg arteries). In rare cases, assessment of suicides in which several shots were a projectile may enter a vein and travel from there fired. Continued ability to act after a cerebral to the (right) ventricle or to the branches of the gunshot injury is observed especially if low-energy pulmonary artery [10, 11]. ammunition was used and/or the bullet track did not involve the above-mentioned structures of immediate Delayed Effects incapacitation (upper cerebral spinal cord, brain stem, motor cortex areas, and large motor pathways). In In survived gunshot injuries with retained bullets or most suicides with more than one shot to the head, pellets, the question arises, if this may cause chronic only the frontal lobe(s) or one of the temporal lobes of lead poisoning. Generally, the risk is assessed as the brain is involved. Multiple gunshots to the cardiac being very low. Most cases reported in the literature region are seen more often than multiple suicidal refer to patients with projectiles lodged in the joints shots to the cerebral cranium. or bones. The latency period until an intoxication becomes manifest ranges from a few months to several decades. Stopping Power Criminalistic Aspects The term stopping power is used to characterize the potential biological effect of a projectile, in particular, The purpose of clinical examination or autopsy its capacity to prevent a person from moving or of persons with gunshot injuries is to answer the attacking [4]. Actually, the idea conveyed by movies following questions [3]: and TV films that the impact of a bullet stops or even knocks down the affected person is not true • Do the findings confirm the assumption of a in real situations. Bullets do not have the potential gunshot injury? to throw people off their feet. Otherwise, the person • Number of hits? who shoots the gun would be knocked over, as action • Did a striking projectile pass through the body or and reaction are equal and opposite. is it lodged in the body or did it produce a graze In fact, the effectiveness of the projectile depends wound? on the amount of energy transferred to the body, • What was the direction and angle of fire (trajec- leading to local displacement and destruction of tory)? tissue. In this context, the shape of the bullet is • Are there any clues as to the type of weapon and essential for its effectiveness: If the bullet head is ammunition used? blunt, deceleration and energy transfer are larger. • From what distance was the shot fired (contact However, in real cases, the effect of a bullet not only shot, close-range shot, distant shot)? results from its effectiveness but also to a large extent • Do the wound characteristics in connection with from the point of impact, i.e., from the affected region the traces at the scene suggest self-infliction or and the relevant anatomical structures. involvement of another party? Gunshot Wounds 7

• Did the gunshot injury result in immediate inca- particles are flung back against the direction of fire pacitation? [12, 15, 16].

Abrasion Collar (Abrasion Ring/Margin/Rim) Entrance and Exit Wounds The central entrance hole is usually surrounded by In order to determine the direction of fire, it is imper- a circumferential loss of epidermis (and its natural ative that entrance and exit wounds are interpreted pigmentation [17]), forming a moist, reddish margin correctly. when fresh and later assuming a brownish color due to the drying of the unprotected corium (Figures 2, Characteristics of Entrance Wounds 5a and 5b). With the help of high-speed photography, Sellier Typical features of an entrance wound in the skin are was able to prove already in 1967 that the epidermis- free margin of the entrance wound is not caused by • punched-out hole (i.e., a central tissue substance any major indenting with consecutive overstretching defect that cannot be closed by approximation of and local friction [12, 18]. When the bullet head its edges); strikes the skin, backspatter of marginal tissue parti- • marginal zone without epidermis (abrasion ring); cles is induced by the pressure exerted on the entrance • grayish-black ring of dirt (provided the projectile site. The former idea that the bullet head indents did not pass through another target first). the skin before penetration, thus causing marginal abrasion, is not correct. It also neither results from When the shot was fired either with the muzzle in the bullet being hot nor from its rotating move- contact or at close/intermediate range, the respective ment. signs can be regarded as further evidence of a bullet In the peripheral parts of the abrasion collar, the entry wound. epidermis is often torn and detached like wallpaper, so that parching can progress beyond the epidermis- Entrance Hole free zone after prolonged exposure to air. When the bullet strikes at an oblique angle, the abrasion ring is The central entrance defect is roundish (if the projec- elliptic and eccentric, being wider on the side from tile strikes at a right angle) or oval (if it strikes at an which the shot was fired. A unilateral widening of oblique angle). The diameter is usually smaller than the abrasion collar thus gives an indication of the that of the bullet. direction in which the bullet was traveling. The discrepancy between the caliber of the projec- If the skin of the entrance region is under water, no tile and the diameter of the permanent entrance hole abrasion ring is formed. The same is true for shots to can be explained by the elastic behavior of the skin: palms and soles [9, 18]. Entrance wounds from high- On impact of the bullet head, the edges of the defect velocity centerfire rifles may lack a typical abrasion temporarily move centrifugally due to radial forces collar, but show small splits radiating from the edges causing a reversible widening of the bullet entrance (so-called microtears). hole [12]. When the deformation forces cease, the elastic skin resumes its former shape so that the per- Bullet Wipe-off (“Ring of Dirt”, “Grease Ring”) manent entrance defect may be much smaller than the diameter of the bullet (this discrepancy is particularly The criminalistic importance of the bullet wipe is marked on the palms of the hands and soles of the due to the fact that – at least on the primary tar- feet [9, 13, 14]). The size of the skin wound therefore get – this finding is a reliable sign of a bullet does not allow to draw accurate conclusions as to the entrance. caliber of the projectile. The term bullet wipe refers to the mechanism The reason for the skin defect remaining at the of formation: when the projectile hits a skin region entrance site is essentially that the projectile trans- not covered by clothing, sooty remnants and other ports tissue particles into the depth of the wound residues deposited on the bullet’s head are transferred track. Moreover, at the moment of impact, small skin to the wound margin, so that a grayish–blackish 8 Gunshot Wounds

mm 1 2 3 1 2 3

(a) (b)

Figure 2 (a) Entrance wound (from a .22 LR projectile) in the epigastric region, which was covered only by a thin T-shirt. A vague grayish-black ring of dirt partly overlies the dried abrasion collar. (b) Entrance wound (from a 7.62 mm pistol bullet). The skin was covered by several layers of clothing. Therefore, the central defect is surrounded by a characteristic circumferential abrasion ring, but no bullet wipe-off ring (partly) overlies the abrasion collar. More often, Thus, contact shots fired to the head may show this “ring of dirt” is seen on the uppermost textile “stellate entrance wounds” with long radial tears; in layer, but not (or only vaguely) on the margin of such cases, the exit wound may be much smaller the entrance wound. In oblique gunshots, the bullet (Figure 4). In cases of splinter injuries (e.g., by frag- wipe is eccentrically enlarged on the side from which ments of explosive weapons), the entry wound is the shot was fired. The bullet wipe is not a sign of always larger than the corresponding exit. The dif- a close-range or a contact shot, as it also occurs in ferentiation between entrance and exit should never distant shots. be made on the basis of simply comparing the wound dimensions. Exit Wounds The size of the exit wound mainly depends on the The exit wound presents as a slitlike or stellate diameter of the temporary cavity at the site where the severance of tissue (Figure 3a, b). In typical cases, bullet leaves the body. In some cases, bone splinters there is – contrary to the entry wound – no real hole, carried along may also contribute to a larger exit hole. i.e., no tissue defect. This means that the wound Many projectiles leave the body deformed and/or usually can be closed by bringing the edges into tumbling, which may also influence the shape of the apposition. An exit wound produced by a bullet exit wound. passing sideways through the skin may be slitlike It goes without saying that exit wounds cannot and therefore mistaken for a stab wound. have a bullet wipe. Occasionally, the margins of Often, though not always, the size of the exit the exit wound are abraded (shored) when a firm wound is larger than that of the entry wound. In object (e.g., tight-fitting clothes, floor, wall or back practice, the uncritical application of this unreli- of a chair) is pressed against the body at the site able “rule” often leads to misinterpretations [5, 19]. of the exiting projectile (Figures 3c and 5c). Under Gunshot Wounds 9

(a) (b) (c)

Figure 3 (a) Slitlike bullet exit wound in the buccal region resembling a stab (.22 caliber revolver, homicide). (b) Stellate exit wound in the scalp, which was partly shaved before autopsy (7.65 caliber pistol, suicide). (c) Shored exit wound on the back. In the moment of discharge, a heavy backpack pressed against the bullet exit site (7 mm caliber hunting rifle, suicide)

(a) (b)

Figure 4 (a) Suicidal contact shot to the right temple with a revolver (caliber .357 magnum). The entrance wound shows a central defect with partially blackened edges (→) and radial lacerations of different length. Note the superficial stretch tear at the inner angle of the right eye, which is located several centimeters away from the wound channel (hyperextension of the facial skin by the expanding gases). (b) Irregularly shaped exit wound close to the left ear. The maximum diameter of the exit wound is much smaller than the large split at the entry site such circumstances, the skin around the exit is “shored” or “supported” exits the area of abrasion abraded by the supporting surface. In contrast to the is not concentric, but irregular or lopsided and often “original” abrasion ring around the entry wound, in disproportionately large [17]. 10 Gunshot Wounds

(a) (b) (c)

Figure 5 (a) Five gunshot entrance wounds in the anterior thoracic region, which was originally covered by clothing. (b) Roundish entrance holes with circular abrasion rings (after removing the body hair). (c) Corresponding exit wounds on the back, which was in contact with the ground (“supported exits”). A 7.62 mm caliber pistol, homicide

Classification of Entrance Wounds in partly burned powder grains expelled along with the Relation to the Range from Muzzle to projectile. The cloud of powder soot rapidly decel- Target erates so that smoke soiling is to be expected only relatively close to the muzzle. The larger powder grains (having a diameter of at least several tenths To understand the different features of gunshot entry of a millimeter) can also reach more distant targets. wounds, it is necessary to be familiar with the major The diameter of the spread and the density of processes occurring when a firearm is discharged. soot and/or powder particles on a target are not As the trigger is pulled, the firing pin is released only dependent on the range of fire but also on the and strikes the primer at the base of the cartridge cartridge type and the weapon (length of the barrel). case. The detonating primer ignites the propellant. Consequently, the range of discharge can only be The subsequent burning (deflagration) of the gun- evaluated by firing test shots with the respective powder generates a large amount of expanding gas, weapon and ammunition [5]. which is under high pressure and propels the pro- In handguns, macroscopically visible traces of jectile down the barrel. The gas is composed of gunsmoke are to be expected up to a range of carbon monoxide, carbon dioxide, oxides of nitro- several centimeters. Depending on the weapon and gen, and other compounds. A small percentage of ammunition, gunpowder grains may reach targets the powder grains remains unburned or only partly several decimeters away (in rifles even more than burned. 1 m). The use of silencers strongly reduces the Already, before the projectile leaves the barrel, deposition of soot and powder particles, thus creating a cloud of gunsmoke exits the muzzle. The term the false impression of a larger range of fire [20]. gunsmoke refers to the grayish-black combustion When a gun is discharged, two different light products of the powder that has not fully converted phenomena can be observed: first, the flame – a to gases. Essentially, gunsmoke consists of carbon in short, mostly dark red jet of fire caused by the not the form of soot. yet completely finished combustion of the powder Apart from the combustion gases and the finely particles; second, the muzzle flash – a glaring fire ball dispersed soot, there are always unburned and some distance away from the barrel end caused by Gunshot Wounds 11 the reaction of the incompletely oxidized combustion gases with the oxygen in the air. With nitro powder, the extremely short impact of the muzzle flame is usually not sufficient to cause substantial burns on the clothing or skin. Sometimes, frizzing may be seen on the hair near the entry wound. Thermal damage is possible in shots with nitro ammunition fired from a very short distance (near contact) if textiles made of thermolabile synthetic fibers melt on the underlying skin [14, 15, 21]. If black powder ammunition is used, close-range shots may cause impressively large burns. In forensic medicine, three ranges of fire are distinguished according to morphological criteria (see Shooting Distance: Estimation of): Figure 6 Near/loose-contact shot to the left zygomatic region (.22 caliber revolver, homicide). The entrance hole • contact range is surrounded by a wide zone of intense powder soot • short/close and medium/intermediate range blackening • long/distant range. • The weapon was in contact with the skin at the instant of discharge. Contact Shots • The configuration of the imprint mark corre- sponds with the constructional elements being in The term contact shot means that the muzzle was line with the muzzle or just behind. Therefore, the held against the body surface at the time of discharge. imprint mark can characterize the type of weapon In contact shots, soot-containing combustion gases used (e.g., revolver or pistol) or even a specific are propelled into the depth of the entry wound. make or model. They expand beneath the skin and blacken the initial • The imprint configuration may provide informa- section of the wound track (pocketlike undermining, tion as to the way in which the weapon was “powder cavity” containing soot and gunpowder par- held at the moment of discharge. For example, an ticles). As the combustion gases have a high content imprint of the front sight below the bullet entrance of carbon monoxide (up to 50%), the surrounding tis- means that the weapon had been held upside sue often assumes a bright cherry-red color. In tight down (i.e., with the handle pointing upward). (hard) contact shots, all the combustion products enter the wound, whereas in loose, angled, or incomplete If the entrance wound is above a bony support contacts some soot may escape between the muzzle (e.g., in the frontal and temporal region), the sub- and skin so that the adjacent surface is blackened cutaneous expansion of the penetrating combustion (Figure 6). gases may cause radial skin tears due to overstretch- The entrance region is bloated by the inrush- ing, resulting in a stellate wound of entrance. This ing powder gases and balloons backward against the additional sign of a contact shot is facultative: Shots muzzle end of the weapon, which is imprinted on fired with low-energy ammunition such as .22 LR do the skin, causing a “muzzle abrasion” (“barrel mark- not necessarily cause stellate lacerations even at the ing”, “muzzle contusion”). Mechanically, the muzzle sites having a bony support. Away from the entrance imprint is a patterned pressure abrasion with a ten- wound stretch-mark-like tears of the facial skin may dency to parching after exposure to air [18]. Apart occur, especially in shots to the forehead and the sub- from the barrel end (or its contours), other construc- mental region (cf. Figure 4a, [22]). tional parts situated near the muzzle, such as the front sight and/or the recoil spring guide, may also Close and Intermediate-Range Shots be imprinted (Figure 7). The muzzle contusion allows to draw significant In close-/intermediate-range shots, GSR (soot and/or conclusions: powder particles) are deposited around the entry 12 Gunshot Wounds

(a) (b)

Figure 7 Hard-contact gunshot wounds to the right temple in two suicide cases with imprint marks mirroring the front end of the recoil spring guide and its position in relation to the muzzle. (a) “Normal” position (with the recoil spring guide being below the barrel and the grip pointing downward). The muzzle became blocked by soil when the pistol fell down after discharge. Brain substance protrudes through the bullet entrance wound. (b) The weapon is turned around the barrel’s longitudinal axis so that the imprint is lateral to the bullet entrance hole wound. Usually a distinction is made between L-shaped mark if the skin or a fabric is in close close-range shots and medium (intermediate)-range proximity at the time of discharge [9, 24]. shots. The term medium-range shot is used if no zone Close-range shots are defined by the presence of of powder soot blackening is discernible around the a zone of powder soot soiling surrounding the bullet entry wound any more, but there are unburned or entrance (often associated with additional powder tat- partially burned gunpowder grains deposited on, or tooing). The grayish-black soot leads to skin or textile forced into, the skin or clothing. The penetrating discoloration of a cloudy structure, whose intensity capacity of the powder grains depends on the propel- decreases with growing firing distance. Shots fired lant (flake or ball powder, grain size), the weapon, at an oblique angle result in an asymmetrical soot the range of fire, and the surface properties of the pattern with unilateral extension on the side of the target. At short shooting distances, grains may be shooter or away from it (depending on the angle driven through thin textiles and cause stippling on at which the shot was fired and the range of fire). the underlying skin [9, 17]. Interfering objects such as clothing or body parts On the skin, the powder particles cause either (hand) may partially filter out the gunsmoke. Flash superficial epidermal lesions (with subsequent dry- suppressors, which are often used in military rifles, ing) or – if deposited beneath the epithelium – have lateral smoke outlets, which may produce a petechial dermal hemorrhages (Figure 8). According flowerlike pattern of soot with several radial petals to some authors, the term tattooing should be used corresponding to the number of slits [9, 23]. In to describe forceful in-driving, whereas the term stip- revolvers, there is a gap between the cylinder and the pling means the mere presence of impact markings. barrel, which allows the combustion gases to emerge The distribution pattern of powder tattooing/stip- sideward. The soot and the powder grains escaping pling varies according to the angle of fire: only from the gap may produce a characteristic linear or perpendicular shots produce a radially symmetrical Gunshot Wounds 13

(a) (b)

Figure 8 (a, b) Close-range shot to the left preauricular region (7.62 mm caliber pistol, homicide). The entrance wound (arrow) is surrounded by a dense dispersal pattern of unburned/partly burned powder grains associated with a small amount of soot around the bullet hole picture; in most other cases, the affected skin area is elliptic in shape. The entry wound may be local- ized outside the tattooing if the powder grains were partly filtered out by clothing or other primary tar- gets (Figure 9, [17]). Pseudo tattoo marks can be due to fragments of an intermediate target such as the window of a car. In such cases, fragments of glass may produce irregular stippling lesions on the person seated behind the perforated win- dow [9, 15, 21].

Distant-range Shots

In forensic usage, the term distant shot means that the weapon was discharged from such a distance that Figure 9 Two intermediate-range shots to the sternal no soot and no powder grains could reach the body region. As the victim was clothed, the most of the unburned surface (skin or clothing in covered body regions). powder particles were filtered by the textile layers. Only The minimum range for this type of gunshot wounds some peripheral powder grains produced stippling of the varies not only depending on the weapon and ammu- uncovered neck. 7.62 mm caliber pistol, homicide [Repro- nition but also on the sensibility of the investigation duced from Ref. 17.  Hodder Arnold, 2000.] method used. The special methods of determining the range of fire cannot be discussed here. For securing and ade- on the clothing or in the vicinity of entry wounds, quately preserving any GSR that may be present close cooperation with the responsible experts is 14 Gunshot Wounds necessary (see Firearm Discharge Residue: Anal- shotgun discharges. Shot pellets are made from lead, ysis of; Shooting Distance: Estimation of). In any which is easily deformed when striking dense tissue. case, the relevant findings should be documented A shotgun contact wound is produced when the by photographs and also by X rays, whenever muzzle is placed tightly against the body surface. The possible. entrance wound roughly corresponds to the gauge and is of circular shape in most body regions, but stellate over the bone (due to the expansion of the inrushing Shotgun Injuries gases with consecutive backward ballooning of the Shotguns are hunting or sporting weapons intended to skin). Sometimes, there is a clear imprint abrasion be fired from the shoulder (see Firearms: Overview). mark, e.g., from the front sight or–in double-barreled They are either single- or double-barreled, the latter weapons – from the nonfiring muzzle. The wound ones being arranged either side by side or “up and edges may be blackened, but most of the soot enters under”. A so-called pump gun has a pipe magazine the body and is deposited in the depth of the wound under the barrel, which can take up several cartridges. (Figure 10). The surrounding muscle is often colored Usual shotgun shells with birdshot or buckshot con- cherry-red due to carbon monoxide. An intraoral tain a multitude of pellets, which first travel together discharge (Figures 11 and 12a) or a contact wound for a short distance and then separate more and more. to the head (forehead, temple, under the jaw) leads The increasing dispersal of shot improves the hunter’s to massive destruction of the skull (“bursting of the chance of striking a moving target such as a hare or a head”, “shooting off the face”) and is occasionally flying duck. The criminal use of shotguns on humans associated with evisceration of the brain [3, 9, 14]. is common, and improvisations, such as sawn-off bar- Even in cases with extreme splitting of the rels, facilitate the handling and hiding of the weapon face and the scalp, careful approximation of the [11, 14]. Shortening the barrel results in an increased wound edges helps in finding the entrance site spread of the pellets in midrange and distant-range (Figure 12b). Loose-contact discharge allows the

(a) (b)

Figure 10 Contact-range discharge to the left side of the neck (12 G shotgun, homicide). (a) Entrance wound with longitudinal splitting laceration toward the angle of jaw and soot staining in the depth. (b) Exit site on the right lateral neck Gunshot Wounds 15

escape of sooty combustion gases, staining the skin around the entrance hole (Figure 13). Intermediate- range shots are characterized by the presence of stippling/tattooing from unburned propellant (up to 1 m, depending on the type of powder). In close-distance discharges, additional smoke soiling is seen. The injury pattern of shot ammunition is mainly influenced by the distance between the muzzle and the target: As the range increases, the initially circu- lar entrance hole shows scalloping of the wound edge (“nibbling”, “crenation”); from a distance of approx- imately 2 m, peripheral pellets produce satellitelike holes outside the central entry defect. Ranges of sev- eral meters are characterized by a sievelike wound pattern [3, 5, 9, 14, 21, 24, 25]. If shots are fired from short distances, wads or plastic cups may either penetrate the body together with shot (cf. Figure 11) or cause excoriations of characteristic shape on the victim’s skin (“wad abrasion”) [3, 5, 9, 14, 24, 25]. Shotgun slugs are large, single lead projectiles destined for smooth-bore shotguns and also for those having a choke at the end of the barrel. The hitting Figure 11 Intraoral discharge of a 12-gauge shotgun, accuracy of shotgun slugs is considerably lower than resulting in facial disruption (suicide). The spent plastic that of rifle projectiles; as a consequence, they should piston and the lead pellets were recovered from the depth not be used for distances beyond 35–50 m in hunting. of the wound

(c)

(a) (b) (d)

Figure 12 (a) Intraoral shotgun wound with extreme facial splitting (suicidal discharge of a 12-gauge shotgun). (b) Reconstruction by reapproximating and sewing together the originally gaping lacerations. Note the superficial tears from overstretching along the nose. (c) Fragment of the skullcap (inner aspect) with shallow imprints (arrow) and one deformed pellet still adhering to the inner table of the bone. (d) Shotgun shell of the type used in the suicide case 16 Gunshot Wounds

from the shooter. So the manner in which the bone breaks may indicate the inclination of the bullet path. Beveling is not restricted to the skullcap, as it is seen likewise in other flat bones such as the sternum, the pelvis, and the ribs. In contact shots to the cerebral cranium (frontal, temporal, parietal, and occipital region), soot deposits are found not only under the skin but also around the bone defect and on the underside of the lifted- off periosteum (Figure 14), often even on the outer surface of the dura mater [14, 24, 26]. Frequently, radial fractures may extend from gun- shot holes of the skull. According to Puppe’s rule, a secondary fracture line ceases when it meets a pre- existing fracture line, which may help in determining the sequence of the shots. In soft tissue, the wound track collapses and/or is filled with blood. Postmortem probing of the bullet path involves the risk of causing artifacts and should therefore be avoided. Parenchymatous organs such as the liver, the kidneys, and the spleen may show large stellate wounds at the sites of entry and exit. Whole projectiles or bullet fragments removed from the body by surgical intervention or dur- ing autopsy must be preserved for further labora- Figure 13 Near contact-range discharge beneath the chin tory investigation, including ballistic comparison. A with intense soot deposition around the entrance hole recovered projectile provides information regarding (12-gauge pump-action shotgun, suicide)

Some shotgun slugs are designed according to the arrow principle (heavy front part, light rear part).

Internal Findings

The gunshot lesions of the inner organs can only be briefly discussed here. Special mention should be made, however, of bullet holes in the flat bones of the skull. On the entrance side, the bone defect in the outer table is sharp edged and its minimum diameter roughly corresponds to the caliber of the projectile, whereas the inner table is beveled out in a conelike manner [1, 3, 5, 9, 14, 17, 21, 24]. This characteris- tic widening on the exit side allows to determine the direction of fire even in an isolated bone. For gun- shot exit holes of the skull, the opposite is true: The outer table shows a craterlike defect (“outward bevel- Figure 14 External surface of the skull (right temporal ing”). Projectiles striking at an acute angle produce region) showing a roundish bone defect with soot deposited keyhole-shaped entrance defects in flat bones with on the margin. The periosteum is detached and reflected. partial cratering of the outer table at the side away Suicidal contact shot, 6 mm caliber single-shot pistol Gunshot Wounds 17 the caliber, twist direction, number and width of lands pertinent professional experience (farmers, slaughter- and grooves, as well as of individual characteris- house workers, butchers). tics imparted by the inner surface of the barrel (see The steel bolt has a diameter of about 10–12 mm Firearms: Bullet and Cartridge Case Identifica- and a conically grooved distal end with a sharp edge tion). and thus produces a punch injury (Figure 15a, b and c). As the bolt returns into the instrument, no pro- Livestock Stunners (“Humane Killers”, jectile, but only punched-out material (skin, bone) “Slaughterer’s Guns”), Stud Guns, is left in the depth of the wound track (Figure 15d). Because of the limited forward movement of the bolt, Blank-Cartridge Guns no exit wound is to be expected in shots to the head. Stunning devices are guns firing a cylindrical steel Some types of livestock stunners have gas outlets bolt about 10 cm deep into the brain of animals in the muzzle plane. Corresponding to the openings intended for slaughter, which usually results in of the smoke conduits, the entrance wound may be immediate unconsciousness [27]. Humane killers are accompanied by two or, less often, four small zones loaded with a blank cartridge. After the captive bolt of powder soot blackening located in pairs opposite has been fired, a recoil spring brings it back into its each other (Figure 15a). initial position. Cartridge-operated stud guns and nail guns are In forensic practice, injuries from livestock stun- used to shoot fasteners into walls, wood, concrete ners are seen primarily in suicide cases; homicides etc. [3, 14]. In contrast to livestock stunners, the and accidents with a fatal outcome are very rare. fasteners leave the device and may fly freely, thus Suicides are mostly committed by persons with a causing an accident. For safety reasons, a shot can

(b)

(c)

(a) (d)

Figure 15 Suicidal captive-bolt injury to the parietal region from a livestock stunner (type Kerner). (a) Circular, sharply defined punch lesion of the skin. On both sides of the skin defect, roundish zones of powder soot blackening (corresponding to the opposite openings of the two smoke conduits in the muzzle end, arrows). (b) Circular entrance defect in the outer table of the skullcap, approximately corresponding to the diameter of the steel bolt. (c) Inner aspect of the skullcap with cone-shaped widening of the hole in the direction of the shot. (d) Punched-out bone fragment recovered from the depth of the wound channel 18 Gunshot Wounds be fired only when the front plate of the instrument Radiographs are also a valuable tool to find pro- is pressed firmly to the object fired at. jectiles lodged in body regions, which are hardly Blank firing pistols and revolvers are detailed accessible during autopsy (e.g., within the vertebral facsimiles of “real” handguns. The blank cartridges column). In addition, X rays provide evidence that a destined for these weapons contain gunpowder, but bullet might have been deflected or embolized [30]. no projectile. If the muzzle is held in close proximity All wounds have to be described exactly with to the body surface or even in contact with it, the gas regard to their location using fixed landmarks such as jet from the blank gun is capable of penetrating the the base of the heels, the midline, the height above the skin and causing potentially fatal injuries [6, 28]. buttocks, and the distance from the top of the head. The documentation should also mention the size and shape of each wound, the features of the wound mar- gins and their surroundings, the presence or absence Forensic Examination and Documentation of GSR such as soot or stippling on the clothing and/or skin, the total length of the wound tracks, and, In all firearm fatalities, careful documentation is of of course, the injuries to the internal organs. utmost importance [3, 5, 29]. This includes tak- It is important to recover any bullets or major ing photographs and close-up views of each wound parts thereof from the body of the victim. Subsequent using a scale. The clothing must be preserved, as laboratory investigation may help in identifying the the uppermost layer may exhibit the bullet wipe bullet type and to assign the fired bullet to a specific around entrance holes and depositions of soot and/or weapon (see Firearms: Bullet and Cartridge Case powder particles in close- and medium-range shots, Identification). respectively. Whenever possible, X rays should be taken before autopsy in two planes (anteroposterior as well as Manner of Death lateral views). They are not only a useful means of permanent and objective documentation but also To classify a gunshot wound as suicidal, homicidal, or help in exactly locating and characterizing all bullets accidental, a synoptic evaluation of the scene and the and any metal fragments including separated jackets. circumstances of the case, the evidence obtained from

(a) (b)

Figure 16 Intraoral shot from a .22 caliber rimfire rifle (suicide). (a) Near contact entrance wound in the palate with eccentric soot deposition around the bullet hole. (b) Exit wound on the top of the head after reapproximation of the edges Gunshot Wounds 19 the injuries, the victim’s clothing, and the laboratory Firearm Discharge Residue: Analysis of). These investigations concerning the weapon, ammunition, residues mainly escape from the cylinder–barrel gap and range of fire has to be made [9, 30]. An easy (in revolvers) or from the ejection port (in automatic access to weapons due to a permissive legislation is pistols) and come to rest on the skin and/or clothing associated with increased rates of firearm homicide where they can be collected for subsequent chemical and suicide. analysis. The presence of GSR is detected by flame- From the medicolegal point of view, the question less atomic absorption spectroscopy (FAAS) or by has to be answered whether the entry wound is scanning electron microscope-energy dispersive X- localized in a region typical for suicides [9, 31, 32]: ray spectrometry (SEM-EDX) [19, 35]. temple (cf. Figures 4, 7 and 14), mouth (Figure 16; Sometimes, clues suggesting suicide are found on cf. Figures 11 and 12), cardiac region, forehead, and examination with the naked eye only (Figure 17), submental region (cf. Figure 13). In almost all cases e.g., spray of blood or tissue deposits on the firing of suicide, the muzzle is held against the body or hand (“backspatter” from the entry wound [9, 36, inserted into the oral cavity. In shots to the chest, the 37]), traces of soot on thumb and index finger (if the skin is seldom bared before [33]. In more than 20% muzzle end was held against the entrance site with of the suicides committed with pistols or revolvers, one hand), or injuries from the edges of the recoiling the weapon is found clutched in the firing hand slide. Direct and prolonged contact of the skin with [9, 34]. steel parts of the weapon in a moist environment The examination of hands to detect GSR, espe- promotes the formation of brownish rust stains [9]. cially lead, antimony, and barium originating from This phenomenon is found especially in suicides, the primer, can only be briefly mentioned here (see although it is no proof that the shot was self-inflicted.

(a) (b)

Figure 17 Suicidal shot to the right temple with a .38 caliber revolver. The left hand (a) was used to steady the barrel. Corresponding to the position of the cylinder–barrel gap, black soot is deposited on the palm (arrow). The trigger was operated with the right hand (b). The radial aspects and the back of both hands were spattered with a spray of blood 20 Gunshot Wounds

Injuries Caused by Explosives [9] Di Maio, V.J.M. (1999). Gunshot Wounds: Practical Aspects of Firearms, Ballistics, and Forensic Techniques, In peacetime, injuries and fatalities due to the det- 2nd Edition, CRC Press, Boca Raton. onation of explosives are mostly seen in connection [10] Yoshioka, H., Seibel, R.W., Pilhai, K. & Luchette, F.A. (1995). Shotgun wounds and pellet emboli: case reports with politically motivated or terrorist attacks against and review of the literature, Journal of Trauma 39(3), persons (letter or parcel bombs), vehicles, and build- 596–601. ings (see Explosions: Scene Investigation; Explo- [11] Pollak, S., Ropohl, D. & Bohnert, M. (1999). Pellet sion Debris: Laboratory Analysis of). Accidents are embolization to the right atrium following double shot- mostly due to natural gas ignitions, chemical explo- gun injury, Forensic Science International 99(1), 61–69. sions or improper handling of explosives, fireworks, [12] Sellier, K. (1969). Bullet entry studies of the skin, etc. In countries without terrorist activities, suicides Beitr¨age zur Gerichtlichen Medizin 25, 265–270. using explosives are rare and usually restricted to per- [13] Pollak, S. (1980). Morphology of bullet entrance wounds in palms and plantae, Zeitschrift fur Rechtsmedizin. sons with a pertinent professional experience. Journal of Legal Medicine 86(1), 41–47. The injury pattern is often characterized by a [14] Spitz, W.U. (2006). Injury by gunfire, in W.U. Spitz, ed, complex combination of different lesions [1, 38, Spitz and Fisher’s Medicolegal Investigation of Death, 39]. Mechanical tissue destruction up to traumatic 4th Edition, Thomas, Springfield, pp. 607–746. amputation and evisceration is caused by blunt force [15] Pollak, S. (1982). Macro- and micromorphology of (exploding device and other objects impacting the bullet wounds caused by handguns, Beitr¨age zur body, pressure wave), often associated with pen- Gerichtlichen Medizin 40, 493–520. etrating injuries from splinters, burning, and soot [16] Grosse Perdekamp, M., Vennemann, B., Mattern, D., Serr, A. & Pollak, S. (2005). Tissue defect at the gunshot blackening of the skin. The internal examination entrance wound: what happens to the skin? International may reveal organ and vascular damage, skeletal Journal of Legal Medicine 119(4), 217–222. fractures, ruptured tympanic membranes, and acute [17] Besant-Matthews, P.E. (2000). Examinations and inter- pulmonary emphysema. Complete body X-ray exam- pretation of rifled firearm injuries, in J.K. Mason & ination should be performed whenever possible. B.N. Purdue, eds, The Pathology of Trauma, 3rd Edition, Arnold, London, pp. 47–60. [18] Pollak, S. & Rothschild, M.A. (2004). Gunshot injuries References as a topic of medicolegal research in the German- speaking countries from the beginning of the 20th century up to the present time, Forensic Science Inter- [1] Saukko, P. & Knight, B. (2004). Knight’s Forensic national 144(2–3), 201–210. Pathology, 3rd Edition, Arnold, London, pp. 245–280. [19] Smock, W.S. (2000). Evaluation of gunshot wounds, [2] Karger, B. & Teige, K. (1998). Fatalities from black in J.A. Siegel, P.J. Saukko & G.C. Knupfer, eds, powder percussion handguns, Forensic Science Interna- Encyclopedia of Forensic Sciences, Vol. 1, Academic tional 98(3), 143–149. Press, London, pp. 378–384. [3] Dodd, M.J. (2006). Terminal Ballistics: A Text and Atlas of Gunshot Wounds, CRC Press, Boca Raton. [20] Missliwetz, J., Denk, W. & Wieser, I. (1991). Shots [4] Sellier, K.G. & Kneubuehl, B.P. (1994). Wound Ballis- fired with silencers – a report of four cases and exper- tics and the Scientific Background, Elsevier, Amsterdam. imental testing, Journal of Forensic Sciences 36(5), [5] Lew, E., Dolinak, D. & Matshes, E. (2005). Firearm 1387–1394. injuries, in D. Dolinak, E.W. Matshes & E.O. Lew, eds, [21] Pollak, S. & Saukko, P. (2003). Atlas of Forensic Forensic Pathology: Principles and Practice, Elsevier Medicine (CD-ROM), Elsevier, Amsterdam. Academic Press, Burlington, pp. 163–200. [22] Faller-Marquardt, M. & Pollak, S. (2002). Skin tears [6] Rothschild, M.A. & Vendura, K. (1999). Fatal neck away from the entrance wound in gunshots to the injuries caused by blank cartridges, Forensic Science head, International Journal of Legal Medicine 116(5), International 101(2), 151–159. 262–266. [7] Karger, B. (1995). Penetrating gunshots to the head and [23] Grosse Perdekamp, M., Braunwarth, R., Schmidt, U., lack of immediate incapacitation. II. Review of case Schmidt, W. & Pollak, S. (2003). Contact shots from reports, International Journal of Legal Medicine 108(3), infantry weapons fitted with a flash-suppressor, Archiv 117–126. f¨ur Kriminologie 212(1–2), 10–18. [8] Karger, B. (1995). Penetrating gunshots to the head and [24] Dana, S.E. & Di Maio, V.J.M. (2003). Gunshot trauma, lack of immediate incapacitation. I. Wound ballistics and in J. Payne-James, A. Busuttil & W. Smock, eds, mechanisms of incapacitation, International Journal of Forensic Medicine: Clinical and Pathological Aspects, Legal Medicine 108(2), 53–61. Greenwich Medical Media, London, pp. 149–168. Gunshot Wounds 21

[25] Cassidy, M. (2000). Smooth-bore firearm injuries, in J.K. [35] Heard, B.J. (1997). Handbook of Firearms and Bal- Mason & B.N. Purdue, eds, The Pathology of Trauma, listics: Examining and Interpreting Forensic Evidence, Arnold, London, pp. 61–74. Wiley, Chichester, pp. 179–200. [26] Faller-Marquardt, M., Bohnert, M. & Pollak, S. (2004). [36] Karger, B., Nusse,¨ R., Schroeder, G., Wustenbecker,¨ S. Detachment of the periosteum and soot staining of its & Brinkmann, B. (1996). Backspatter from experimen- underside in contact shots to the cerebral cranium, Inter- tal close-range shots to the head. I. Macrobackspat- national Journal of Legal Medicine 118(6), 343–347. ter, International Journal of Legal Medicine 109(2), [27] Pollak, S. & Saukko, P.J. (2000). Humane killing 66–74. tools, in J.A. Siegel, P.J. Saukko & G.C. Knupfer, [37] Betz, P., Peschel, O., Stiefel, D. & Eisenmenger, W. eds, Encyclopedia of Forensic Sciences, Academic Press, (1995). Frequency of blood spatters on the shooting hand London, Vol. 2, pp. 939–944. and of conjunctival petechiae following suicidal gunshot [28] Grosse Perdekamp, M., Peuten, M., Sequenc, A., wounds to the head, Forensic Science International Schmidt, U. & Pollak, S. (2001). Fracture of the lower 76(1), 47–53. jaw by a contact shot with a blank cartridge weapon [38] Crane, J. (2005). Explosive injury, in J. Payne- (starter’s pistol), Archiv f¨ur Kriminologie 208(3–4), James, R.W. Byard, T.S. Corey & C. Henderson, eds, 88–95. Encyclopedia of Forensic and Legal Medicine, Elsevier, [29] Kirk, G.M. (2005). Firearm injuries, in J. Payne- Oxford, Vol. 3, pp. 98–100. James, R.W. Byard, T.S. Corey & C. Henderson, eds, [39] Spitz, W.U. (2006). Medicolegal considerations of bomb Encyclopedia of Forensic and Legal Medicine, Elsevier, explosions, in W.U. Spitz, ed, Spitz and Fisher’s Medi- Oxford, Vol. 3, pp. 110–118. colegal Investigation of Death, 4th Edition, Thomas, [30] Naidoo, S.R. (2005). Ballistic trauma, overview and Springfield, pp. 777–782. statistics, in J. Payne-James, R.W. Byard, T.S. Corey & C. Henderson, eds, Encyclopedia of Forensic and Legal Medicine, Elsevier, Oxford, Vol. 1, pp. 271–283. Related Articles [31] Sellier, K. (1986). Death: accident or suicide by use of firearm, in A. Maehly & R.L. Williams, eds, Foren- Explosions: Scene Investigation sic Science Progress, Springer, Heidelberg New York Explosion Debris: Laboratory Analysis of Tokyo, Vol. 1, pp. 91–115. [32] Karger, B., Billeb, E., Koops, E. & Brinkmann, B. Firearm Examination: Ballistics (2002). Autopsy features relevant for discrimination Firearms: Bullet and Cartridge Case Identification between suicidal and homicidal gunshot injuries, Inter- national Journal of Legal Medicine 116(5), 273–278. Firearm Discharge Residue: Analysis of [33] Karger, B., Kersting, C. & Brinkmann, B. (1997). Prior Firearms: Overview exposure of the entrance wound region from clothing is uncommon in firearm suicides, International Journal of Shooting Distance: Estimation of Legal Medicine 110(2), 79–81. [34] Krauland, W. (1984). Evaluation of fatal gunshot injuries STEFAN POLLAK AND PEKKA J. SAUKKO (the weapon in the hand), Archiv f¨ur Kriminologie 174(1–2), 1–22.