Mais, plus ça change, plus c’est la meme chose. (The more things

change, the more they seem to remain the same.) Remarkable

as the enormous changes in surgical diagnostics and

therapeutics have been in the 16 years since the last edition of

the Handbook, as noteworthy – and humbling – are what

have not changed. Wound ballistics are the same and often

injuries are due to the same projectiles used 35 years ago in

Vietnam. The ghastly penetrating wounds, blast trauma, and

burns produced by present day conventional and improvised

weapons are essentially unchanged from those produced in

the last half of the 20th Century. The automatic rifle, rocketpropelled

grenade, mortar, and improvised explosive are

widely available, easy to obtain, simple to use, ferociously

lethal, and not confined to the arsenals of disciplined soldiers.

Bearers of these arms today include suicidal fanatics, women,

and children.