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Blast Effects on Buildings
Third edition

David Cormie
Arup

Geoff Mays
Retired from Cranfield University

Peter Smith
Retired from Cranfield University
Published by ICE Publishing, One Great George Street,
Westminster, London SW1P 3AA
Full details of ICE Publishing representatives and distributors can be
found at: www.icebookshop.com/bookshop_contact.asp
Other titles by ICE Publishing:
Progressive Collapse of Structures, Second edition
Uwe Starossek. ISBN 978-0-7277-6168-2
Seismic Design of Foundations: Concepts and applications
Subhamoy Bhattacharya, Rolando P Orense and
Domenico Lombardi. ISBN 978-0-7277-6166-8
Application of Codes, Design and Regulations
Ravindra K. Dhir (ed). ISBN 978-0-7277-3403-7
www.icebookshop.com
A catalogue record for this book is available from the British Library.
ISBN 978-0-7277-6147-7
# Thomas Telford Limited 2020
# Arup for Chapter 10
# Centre for the Protection of National Infrastructure/Arup for
Chapter 12
ICE Publishing is a division of Thomas Telford Ltd, a wholly-owned
subsidiary of the Institution of Civil Engineers (ICE).
The Authors assert their moral right to be identified as the Authors
of the work.
All rights, including translation, reserved. Except as permitted by the
Copyright, Designs and Patents Act 1988, no part of this publication
may be reproduced, stored in a retrieval system or transmitted in any
form or by any means, electronic, mechanical, photocopying or
otherwise, without the prior written permission of the Publisher,
ICE Publishing, One Great George Street, Westminster,
London SW1P 3AA.
This book is published on the understanding that the author is solely
responsible for the statements made and opinions expressed in it
and that its publication does not necessarily imply that such
statements and/or opinions are or reflect the views or opinions of the
publisher. While every effort has been made to ensure that the
statements made and the opinions expressed in this publication
provide a safe and accurate guide, no liability or responsibility can be
accepted in this respect by the author or publisher.
While every reasonable effort has been undertaken by the author
and the publisher to acknowledge copyright on material
reproduced, if there has been an oversight please contact the
publisher and we will endeavour to correct this upon a reprint.
Cover photo: Sheikh Zayed Road in sunset time, Dubai, UAE

Commissioning Editor: James Hobbs

Production Editor: Madhubanti Bhattacharyya
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Typeset by Academic + Technical, Bristol
Index created by Matthew Gale
Printed and bound in Great Britain by Bell and Bain, Glasgow
Dedication
To Emma and Martha,
who make the impossible possible.
Acknowledgements It is 25 years since this book was first published by my
co-authors, Professor Geoff Mays and Dr Peter Smith,
and almost 20 years since my first forays into the field of
protective design which were in part inspired by their
efforts. The first edition of this book was prepared at a
time when the UK faced an Irish Republican terrorist
threat on the UK mainland, and intended to provide
guidance to the structural engineer making their own first
forays into the field in response to this threat. It achieved
this with an accessible style and content that has been the
hallmark of the book over the years and is maintained in
this new edition.
I am indebted to Geoff and Peter for their generosity in
having allowed me to pick up the baton and update their
book for the second edition, and again with this third
edition. I have benefitted enormously from the guidance
they have given me over the years, as I have done from
my colleagues at Arup, past and present, where I have
had the good fortune to spend much of the past 15 years
working in an area which fascinates me. A particular
debt of thanks is owed to David Hadden and to his wife
Sue. It was David who took Arup’s first steps in the field
of protective design in the mid-1990s, around the time of
the publication of the first edition. It was also David,
and specifically the faith he showed in me, that allowed
me to follow him along the path he had first trodden.
From his confidence in me and his warm, patient and
unwavering style, I have had the tremendous good
fortune to work on some of the world’s most exciting and
ground-breaking projects, and it is from the wealth of
knowledge that I gained through David and these
projects that enabled me to contribute to the field of blast
and protective design through this book.
I am especially grateful to those who have contributed as
co-authors of previous editions and whose valuable input
remains in this book. I am also grateful for the
meticulous eye for detail of all of those who have read,
used and taken the time to comment on the earlier
editions, without which a great number of errors would
have made it into print. Any that remain are mine alone.
Finally, without the strength and encouragement I draw
from my wife Emma and my daughter Martha, none of
this would have been possible. Thank you.
David Cormie
London, June 2019

xiii
About the David Cormie is the leader of blast and protective
design in Arup. He has spent his career to date in the
authors design of buildings and structures against extreme loads,
and since 2005 has specialised in blast engineering and
protective design against terrorist attack. He has led the
design of a wide range of landmark and high-profile/
high-threat buildings and other structures across the
world against security and terrorist threats, including
airports, mass transit infrastructure, commercial
buildings, international sporting venues, event and
leisure venues, government and diplomatic buildings,
critical infrastructure and strategic assets. He has
published widely in the field of blast engineering,
collaborating with many world-leading academic centres
on research in different aspects of the field, and has
been invited to speak at conferences and other forums
throughout the world on the design of buildings and
other structures to be resilient against terrorism. He is
currently the nominated UK expert on structural
robustness working on the update to the Eurocodes.
He is a Fellow of the Institution of Civil Engineers and
of the Institution of Structural Engineers and is a
Principal of the Register of Security Engineers and
Specialists, and is Visiting Professor of high strain rate
mechanics and blast engineering at Imperial College
London.
Geoff Mays is Professor Emeritus of Civil Engineering
for Cranfield University. He was formerly Head of
Cranfield Defence and Security at the Defence
Academy of the United Kingdom, where he conducted
research and consultancy and lectures on postgraduate
courses in the fields of structural resilience to blast
loading and the strengthening of concrete structures.
An author of over 90 papers for refereed journals and
conference proceedings, he has also written books on
the durability of concrete structures and adhesives in
civil engineering. He was the convenor of the CEN
Committee which led the development of European
Standards for the protection and repair of concrete
structures and chair of its working group concerned
with structural bonding.
Peter Smith was formerly Reader in Protective Structures
with Cranfield University at the Defence Academy of the
United Kingdom at Shrivenham. He lectured on masters
programmes and shorter courses in the UK and
worldwide on blast loading, structural response and
design. He has supervised research contracts and

xv
 undertaken consultancy in this general area for both
commercial and government organisations. He is the
author of over 100 journal and conference papers and
technical reports as well as books in the blast area and
was a member of a European working group concerned
with explosion effects on urban buildings.

xvi
Preface Terrorism, and the expectation that buildings and
infrastructure will be designed to protect users and
occupants against terrorist attack, have both evolved
substantially over the 25 years since this book was first
published. The terrorist threat has become more
pervasive yet at the same time more diverse in its forms,
some of which are less sophisticated. Whereas when this
book was first published, the terrorist threat from
explosions typically took the form of a charge either
hand-emplaced or in a parked vehicle, the threat
background is now more complex and more uncertain.
Explosive threats may still take the form of a placed
charge or a parked vehicle using relatively sophisticated
home-made explosives. They may also now take the form
of low-grade, highly improvised, explosives, or liquid
explosives which require particular expertise to
manufacture. Explosives may have fragments packed
around the charge specifically to increase the lethality,
or there may be no explosive at all and the vehicle itself
is used as the weapon with which to engage in terrorism.
We recognise that as engineers we have a duty of care to
evaluate the risk from terrorist attack in the design of
buildings for which we are responsible, and, except where
the risk is negligible, to take steps through the design and
operation of the building to mitigate this risk so far as
reasonably practicable. There are also practical and
commercial reasons for doing so. The expectations of
developers, funders, insurers and tenants follow a
generally upward trend over time, meaning that whereas
once a lesser standard of design was acceptable, now a
higher quality is the norm – this is true across the design
spectrum, whether concerning thermal performance,
material usage, health and safety risks during
construction, maintenance and operation of the building,
speed of construction or capital and lifecycle costs.
The same holds for consideration of terrorist risks in
design – whereas once it was acceptable to neglect
terrorism from consideration, it is now expected that
terrorism will be considered, where there is a recognisable
terrorist threat. Our increasing demands in relation to
quality of design are also associated with investment
decisions and the service life of our buildings. Investment
decisions generally become bigger over time, and greater
scrutiny is placed on the decision: developers, funders
and insurers want to be confident that their investment
is sound and the risks are well-managed. Similarly,
we expect more from less, placing greater dependence on
buildings and infrastructure in the function they are to

xi
 provide, combined with ‘sweating’ often ageing assets to
wring more value from them without the cost of
replacement. All this leads to a certain brittleness in our
physical infrastructure and therefore a greater need to
evaluate and reduce the risks arising from the hazards
that could materialise.
This book attempts to help practising engineers respond
to some of these challenges.

xii
Contents Preface
Acknowledgements
xi
xiii
About the authors xv

01 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction 1
Objective 1
Legal obligations 4
Purpose 5
Scope 6
Modern terrorism 7
Risk 8
The special effects of catastrophic loss 8
Partial factors in blast design 9
A design philosophy: planning for protection 9
References 10

02 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Basic guidelines for enhancing blast resilience 11

The requirements of the client 11
Design features 12
Blast loading and stand-off 14
Response of a building to blast load 18
Protected spaces 26
References 29

03 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Blast loading 31
Notation 31
Introduction 33
Explosions 33
Explosion classification 34
Explosives classification 34
Blast waves in air from high explosives 35
Blast waves in air from vapour cloud explosions 35
Blast wave interactions 37
Basic blast wavefront parameters in air 37
Blast wave parameters for loading on structures 39
Blast wave scaling laws 41
Reflection coefficients 44
Regular and Mach reflection 45
Groundshock 47
Underwater explosions 52
External blast wave loading of structures 61
Internal blast loading of structures 65
Conclusions 70
References 70

04 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prediction of blast loads 73

Notation 73

v
 Introduction 73
Categorisation of techniques 74
Empirical methods 74
Phenomenological methods 78
First-principle methods for blast loads from high
explosives and deflagrative events 79
References 87

05 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Structural response to blast loading 89

Notation 89
Introduction 90
Elastic SDOF structure 90
Evaluation of the limits of response 93
Iso-damage (or pressure–impulse) diagrams 95
Energy solutions for specific structural components 100
Lumped mass equivalent SDOF systems 102
Resistance functions for specific structural forms 105
Limitations of SDOF methods for blast analysis 107
Advanced SDOF methods for blast analysis 107
Response of blast-loaded structures in the near field 109
Behaviour of structural materials in response to
blast loading 109
Discussion 111
References 111

06 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Design of elements in structural steel 113

Notation 113
Introduction 114
Objectives 114
Design loads 114
Design strengths 115
Deformation limits 116
Behaviour of structural steelwork subjected to
blast loading 118
Flexural design of structural steel elements to resist
blast loading – quasi-static/dynamic response 119
Flexural design of structural steel elements to resist
blast loading – impulsive response 121
Dynamic reactions 121
Design example: structural steel beam subject to
quasi-static/dynamic load 122
Design of connections in structural steelwork 124
Steelwork detailing for steel structures subjected to
blast loading 125
References 126

vi
07 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Design of elements in reinforced concrete 129
Notation 129
Introduction 131
Objectives 131
Design loads 131
Design strengths 133
Deformation limits 134
Behaviour of reinforced concrete subjected to
blast loading 136
Flexural design of reinforced concrete elements to
resist blast loading 138
Flexural design of reinforced concrete – impulsive
response 139
Flexural design of reinforced concrete – quasi-static/
dynamic response 141
Design of reinforced concrete elements for shear
under blast loading 144
Dynamic reactions 147
Design example 1: reinforced concrete cantilever
subject to impulsive load 147
Design example 2: reinforced concrete wall panel
subject to quasi-static/dynamic load 150
Spalling and breaching of reinforced concrete
under blast loading 154
Design of connections 156
References 157

08 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Design of elements in masonry 159

Notation 159
Introduction 159
Design loads 160
Design strengths 160
Deformation limits 160
Behaviour of reinforced masonry walls subjected to
blast loading 160
Behaviour of unreinforced masonry walls subjected
to blast loading 161
References 163

09 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Design of elements in steel–concrete sandwich

composite materials 165
Notation 165
Introduction 166
Objectives 167
Design loads 167
Design strengths 167

vii
 Deformation limits and design cross-sections 168
Behaviour of steel–concrete–steel composite
elements subject to blast loading 169
Stiffness 173
Shear design 174
Design of SCS elements to resist blast loading 175
Design example 1: SCS cantilever subject to
impulsive load 176
Comparison of SCS and reinforced concrete 182
Detailing of SCS structures 183
References 184

10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Design of glazing 185

Notation 185
Introduction 185
Types of glazing and behaviour under blast loading 188
Levels of blast enhancement 191
Framing systems 193
Design of laminated glass for blast loads 196
Derivation of the resistance function for a laminated
glass pane 199
Design example 1: single-glazed laminated glass
pane subject to blast load 207
Design example 2: single-glazed laminated glass
pane subject to increased blast load 212
Iso-damage analysis 212
Calculation of edge reaction forces 214
Framing design 214
Glazing hazard classification 216
References 219

11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Whole-building response to blast damage 221

Notation 221
Introduction 221
Disproportionate versus progressive collapse 222
Protection and disproportionate collapse 223
Development of robustness requirements in
national standards 223
Tolerability of risk 223
Methods of design for structural robustness 230
Tie-force design methods 231
Alternate loadpath methods 233
Alternate loadpath analysis procedures 240
Key element design methods 247
Discussion 247
References 248

viii
12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vehicle-borne threats and the principles of
hostile vehicle mitigation 251
Introduction 251
Development of a design basis for protecting
against hostile vehicles 252
Types of vehicle-borne threat 253
Practical site assessment for vehicle-borne threats 255
Vehicle dynamics assessment (VDA) 257
Principles of hostile vehicle mitigation 257
Principles of design of vehicle security barriers for
high-energy impact 270
Operational requirements 272
References 273

13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Designing for operational resilience 275

Introduction 275
Effects of explosions on building services 275
Principles of design 276
Design of services to support life safety 277
Design of services to aid escape and evacuation 281
Design for service continuity 282
Design for ease of recovery 286
Business continuity and incident emergency
management 287
The threat assessment 287
Pre-event contingency planning 288
Post-event contingency planning 289
Useful publications 290
References 291

Appendix A . . . . . . . . . . . . . . . . . . . . . Equivalent single degree of freedom properties

for beams and slabs 293

Appendix B . . . . . . . . . . . . . . . . . . . . . Maximum deflection and response time for

elasto-plastic single degree of freedom systems 303

Appendix C . . . . . . . . . . . . . . . . . . . . . Design flowchart 313

Appendix D . . . . . . . . . . . . . . . . . . . . . Conversion factors 317

Index 319

ix
Blast Effects on Buildings

Cormie, David, Mays, Geoff and Smith, Peter

ISBN 978-0-7277-6147-7
https://doi.org/10.1680/beob.61477.001
ICE Publishing: All rights reserved

Chapter 1
Introduction

Objective
Society expects that buildings will protect their occupants against events such as heat,
cold, snow, ice, wind and rain. Society also expects that buildings will protect their
occupants against more extreme events such as tornado, hurricane and earthquake. In
general, the more extreme the event, the rarer its occurrence. This raises a question: how
rare does an event have to be before we no longer expect buildings to protect against it?
The answer to this question is typically very rare indeed: we generally design buildings for
1 in 100 year loads, that is, in any given year there is less than one per cent chance that
the load will be exceeded. Even if it is, buildings are designed so that the onset of collapse
is not sudden – there is residual capacity, in the design of the structure and it is designed
to show signs of structural distress and exhibit post-elastic behaviour so there is a
residual structural capacity, rather than it undergoing a sudden, catastrophic failure.
Collapse sometimes results from earthquakes or from heavy snow, and buildings are
sometimes washed away in floods; however, societal response to the failure is generally
to ask: why did it happen? The load may have been larger than we decided it should be
designed to withstand, but this is set aside and we ask ourselves: shouldn’t it have been
foreseen? Shouldn’t we have predicted it and designed against it? What was missed and
why? What went wrong for there to be such a catastrophic failure?

This reveals an intrinsic expectation in our approach to the design of buildings. If a

hazard is foreseeable, protection should be taken against it. Only when the hazard
becomes so remote, so unexpected that it starts to be dismissed as a freak event, do
we find it acceptable for the structure to fail. Indeed, this trend is well-proven: we take
everyday risks that lead to far greater numbers of fatalities, each involving maybe only
one or two deaths than are killed in earthquakes and terrorist attacks. In 2017, there were
more than 40 000 fatalities on US roads (NSC, 2019), which is more than 400 times the
number killed in terrorist attacks in the same year (Global Terrorism Database, 2018).

So why do we worry about rare events? Well, research shows that the threshold that
defines tolerability of risk tends to be skewed so that consequence is assigned greater
weight as the likelihood reduces, up to the point where the event can be dismissed as
being so unlikely that it could not possibly have been foreseen (Ale, 1992). A significant
part of this is due to an acceptance of a certain degree of risk – a certain quantum of
losses – in return for the achievement of some gain: we get to our destination quicker,
more easily, more cheaply, and we do so even though we know it involves more risk.
Part of this appears to be the old adage that familiarity breeds contempt: we cross a road

1
Blast Effects on Buildings

and nothing happens, so we do it again and again, and might become careless. On the
other hand, it appears that there is an instinctive aversion to risk when large numbers
of casualties are involved: we are revulsed and find it unacceptable. There is an
inclination to find someone to blame, a scapegoat, because we are convinced that
someone must be held responsible and someone must be made to pay. Such a large number
of deaths cannot go unanswered: it is socially unacceptable if we pay no attention to, or
take no action as a result of, what has happened.

Thus, perception is often markedly different with the benefit of hindsight. There is a
rational, mathematical calculation of risk in which we weigh likelihood and consequence.
In such a model, a highly likely event with small consequences and a low-likelihood event
with significantly larger consequences would be judged the same, and we would invest
similar amounts in reducing the risk arising from them. But then, when a low-likelihood
event occurs, the weight ascribed to likelihood tends to be set aside and the consequences
are viewed through a lens independent of any consideration of how rare the event that has
just occurred actually was.

The final factor in how we weigh risk, and our attitude to risk, is the gain mentioned
earlier. There is no gain that is being sought when people are caught in an earthquake
or terrorist attack. People are simply going about their everyday business, trying to make
the best they can of their lives and are, as is often said, simply in the wrong place at the
wrong time. In relation to terrorism it may be that, viewed through the perspective of
others, people are trying to enrich themselves unduly, pursuing misplaced religious
beliefs or enjoying an overly liberal existence. The values that put certain sections of
society at risk, however, are the same values that we consider dear to the society in which
those people have chosen to make their homes and livelihoods, and are not gains so
much as values which the societal belief is that people have the right to enjoy. Thus,
in the absence of a gain, there is nothing against which the loss is offset, and so we find
the event intolerable.

Since the first edition of this book was published in 1995, the threat of terrorism has
evolved in scope and scale, particularly with the emergence of suicide bombers prepared
to die in the act of delivery. It is an unfortunate fact that terrorism is a foreseeable event
in many parts of the world, and it shows no sign of abating for a long while yet. So
normal has it become that counter-terrorist measures are now considered usual in most
commercial and recreational activities; protection is now commonplace and there is
heightened curiosity about what can be achieved in this area. This has helped the
engineer very considerably in attracting attention to the benefits of sensible protective
design.

The field of protective design, as an area in which serious effort has been invested, may
be said to have begun in earnest in the late 1980s and early 1990s in the wake of the IRA
bombing campaign in the UK. Other countries have also suffered at the hands of
terrorists, both before and since the bombings in the UK, but following these attacks
and particularly the large vehicle bombings in London in 1992 and 1993, it began to
be recognised that buildings could play a part in protecting occupants in the event of

2
 1 Introduction

an attack. Of course, during wartime, Morrison shelters and civic air-raid shelters played
a major part in limiting casualties, but these were purpose-built structures designed for
escaping the hazard in conventional buildings or the open air, and designing the fabric
and structure of conventional civilian buildings to offer a protective benefit to occupants
in the event of an explosive attack in supposed peacetime was a relatively new field until
the late 1980s and early 1990s. It began to be recognised that glazing may be designed
not only to not fragment – thereby avoiding the generation of additional hazard – but
to reduce the airblast hazard from the explosion, and that certain forms of construction
and details had significant advantages in ensuring that the structure was inherently
robust and could withstand damage local to the blast.

The simultaneous attacks on the World Trade Center and the Pentagon in 2001 left a
deep imprint on perceptions: the ambition of the terrorists involved; the innovation and
novelty of their method of attack; the complexity of their preparations; the callous and
casual murder of thousands of innocent civilians; the initial disruption to a highly inter-
connected commercial world (and also the surprising resilience achieved through that
interconnectivity); the insult delivered to national self esteem with consequences far
beyond the attack itself.

Yet the twin towers of the World Trade Center performed remarkably well under what
was an ‘unscripted’ attack for them, for they remained standing long enough for almost
all those below the location of the impact to escape. Much of this was due to an inher-
ently robust structure and to a sensible review of evacuation procedures by the owners
following the 1993 detonation of a vehicle-borne device in the basement car park. The
rules for response to fire and other hazards were ‘stay put’ and were firmly established,
but through the experience learnt in 1993, the rules for events which could challenge the
structural integrity of the building were changed from ‘stay put’ to ‘evacuate with best
speed’.

These principles go to the heart of the philosophy laid out in this book: protection
should be intelligent, thoughtful and holistic in approach, not blind and expensive hard-
ening against the greatest explosive charge weight that a terrorist might be theoretically
able to deliver. It is a fact that too much is not done that could be done, because of
conflict of interest with planning and financial areas or lack of imagination. An
underlying purpose of this book is to give engineers the arguments that will sway the
debate in favour of sensible, practical, economic measures being adopted, not discarded.

As architects and engineers, we cannot do anything about the fact that terrorism will
occur – that is the job of politicians and the security services. So we must instead look
at the buildings we are designing and ensure that they will protect people living and
working in them – at least to a reasonable degree. The intent is neither to over-engineer
nor under-engineer the protective measures designed into the structure and fabric of a
building; but instead to do what is reasonable. What is reasonable is of course subjective,
but it depends on the significance of the building and how likely it is to become a terrorist
target. If a building will be attractive to terrorist attack, perhaps because of its scale,
prominence, iconic status and so on, people will be exposed to a higher level of risk

3
Blast Effects on Buildings

by virtue of being in that building. It is therefore reasonable that greater steps be taken to
protect them than those in a building that is of no particular significance.

There are three strong business reasons why the owner/occupier should plan to deter acts
of terrorism or at least to minimise their impact:

g corporate and legal obligations

g business continuity
g loss of reputation.

As a minimum, we should aim to design a building that does no harm. The building
design should not exacerbate conditions for occupants through generation of additional
hazards to occupants – for example by additional fatalities being caused as a result of
structural collapse or routes of escape being blocked. Rarely can this ambition be
achieved in the purest sense as set out here, but we can but identify what is likely to occur
in the form of the threat and what is likely to result in terms of building damage if the
threat materialises, and then design out the most harmful aspects. Beyond this relatively
limited ambition of the building being at worst neutral in terms of the hazard to its
occupants, it is preferable that the building offers a protective benefit to occupants,
improving conditions by protecting them from the effects of blast pressure, the fireball
or fragmentation. It is possible to design structures to withstand the effects of blast,
to withstand local damage that might otherwise lead to progressive collapse, and to
design façades, and to exclude blast pressures and avoid fragmentation. In doing so,
we can design buildings that provide a distinct protective benefit to their occupants,
providing a reasonable level of protection against terrorist attack in an unfortunately
uncertain world.

Legal obligations
In England and Wales, a number of statutes and statutory instruments define duties on
employers, designers, organisations and those involved with managing a building during
its life.

The Health and Safety at Work Act 1974 places a duty on employers to identify all
reasonably foreseeable hazards to which employees and other people who might be
affected by their business might be exposed and to reduce the risks arising so far as is
reasonably practicable. The Management of Health and Safety at Work Regulations
1999 further oblige an employer to establish and, where necessary, give effect to
appropriate procedures to be followed in the event of serious and imminent danger to
persons at work in their undertaking. Current legal opinion implies that this legislation
may be interpreted to include the safety of employees when there is a threat of a terrorist
act or other violent act perpetrated by, for example, a disgruntled employee.

The Construction (Design and Management) Regulations 2015 (the CDM Regulations)
form the principal piece of legislation giving duties to designers in the design, construc-
tion, operation and maintenance of a building. The CDM Regulations make explicit the

4
 1 Introduction

duties of a designer under section 3 of the Health and Safety at Work Act, and require
designers to identify all reasonably foreseeable hazards to which those affected by the
design might be exposed and, so far as reasonably practicable, to eliminate hazards that
may give rise to risks, and then to reduce risks from any hazards that remain. Duties are
placed on those involved with the management of risks arising from buildings and struc-
tures throughout their life.

Further, the Construction Products Regulation (EU) No. 305/201 contains, within
Annex 1, essential requirements to ensure that products are fit for their intended use.
This includes safety in use, paragraph 4, and in particular it specifies that ‘the
construction work must be designed and built in such a way that it does not present
unacceptable risks of accidents in service or in operation’.

Finally, the Corporate Manslaughter and Corporate Homicide Act 2007 introduced a
new offence of corporate manslaughter where the way in which the activities of
a company or organisation are managed and organised across its management causes
a person’s death and amounts to a gross breach of duty of care owed to the deceased.
The Act considers the relevant duties of care established under the law of negligence and
builds upon the responsibilities of the organisation to address health and safety risks that
can reasonably be foreseen. There are few instances where the duty of care owed by the
employer and occupier towards persons affected by their actions have been tested in the
courts in the context of terrorism, although it is the view of the UK government that
these principles extend to terrorist bomb threats. In the United States, the New York
Supreme Court found the New York Port Authority negligent in not taking adequate
countermeasures (New York Times, 2005, 2008) to safeguard the World Trade Center
twin towers before the 1993 bombing after receiving advice from security advisers to the
UK and US authorities that the underground car park was vulnerable to terrorist attack
and should be closed to public parking.

Clearly the above principles do not amount to being required to ensure that every
occupant will be unharmed under all circumstances. The threshold is generally one of
either negligence, or gross negligence: it is inherent in the uncertainties of the severity and
timing of a terrorist attack that there can be no guarantee that no injuries will be sustained.
However, the legislation is clear in placing the responsibility upon building owners
and occupiers to ensure that all steps have been taken to minimise so far as reasonably
practicable the risk to human life. One component of this will be the design of building
services to provide resilience in the event of a blast, particularly where required for safe
evacuation from a building or where a strategy of sheltering in place is proposed. Another
will be the establishment of well-defined and practised business contingency and incident
emergency management procedures. These are described in Chapter 13.

Purpose
The purpose of this book is to give engineers and architects a better understanding of the
opportunities (and of their own and their clients’ responsibilities) to provide buildings
that minimise damage to people and property in the event of an explosion. It is not a
design manual, requiring compliance, but a design handbook, giving guidance and

5
Blast Effects on Buildings

practical advice. The focus is on the damaging effects of terrorist attacks, but the
principles can be extended to all explosive events.

All this underlines the thesis of the earlier editions: that protective measures were not solely
about hardening and blast protection, but offer a much more inclusive consideration about
the balance between protection and continuing normal life. Since the first edition, the field
of blast engineering has expanded greatly and a great deal of effort has been invested
around the world in research and development of protective design, from the development
of better methods of analysis to manufacturers bringing new products to the market for
improving the counter-terrorist resilience of buildings. Much work has been done to
improve the way in which we manage and respond to incidents, in terms of evacuation
and sheltering strategies, emergency response and coordination, and recovery after an
incident.

In parallel, significant advances have been made in other fields. Computational fluid
dynamics and computational structural mechanics continue to undergo significant
advances, improving our understanding both of blast wave phenomena and of structural
behaviour. Research into structural collapse and achieving robustness in design has also
been a very active field, continuing apace since the collapse of the World Trade Center on
9/11. Façade blast design has also moved on very significantly since the publication of
the earlier editions. Our understanding of the behaviour of glass, glazing systems and
façade framing systems under blast load has benefitted from wide-ranging programmes
of research and development, while façade technologies also continue to evolve rapidly.

Scope
The chapters of this book have been thoroughly revised to reflect advances in the field.
Basic guidelines for enhancing building resilience are set out in Chapter 2. The theory of
blast loading is covered in Chapter 3, followed by a separate chapter on the calculation
of blast loads, which covers the range of semi-empirical and more advanced methods for
the prediction of blast loads and the advantages and limitations of each. A section on
human injury and fatality is included so that the reader can better understand when blast
loads become hazardous to occupants.

The previous chapter on the structural response to blast loading has been retained in
Chapter 5, but has been expanded to include a new section on structural response to
near-field blast loading, which is an increasingly common design requirement. Chapters
6 to 9 outline methods for design of structural steel, reinforced concrete, masonry and
steel–concrete composite materials against blast loading, including new content on
detailing for blast loading in each material. Chapter 10 discusses the design of glazing
and was the subject of radical revision in the second edition. The field of design of
glazing systems against blast loads continues to evolve rapidly and the material has been
revised to reflect recent developments, with a new section covering the design of façade
framing members for the first time.

Chapter 11 discusses the whole-building response to blast damage and the design of
structures against progressive and disproportionate collapse. Material is presented on

6
 1 Introduction

the issues of robustness as they apply to blast effects on buildings. The chapter gives the
practising engineer an insight into the theory and modern approach to the fundamental
analysis of collapse following sudden structural damage, providing an understanding of
the phenomenon, its characteristics and the preparation of a logical and coherent assess-
ment of the vulnerability of a building to collapse under blast loading. Where specific
vulnerabilities are identified in a structure, the engineer may choose to provide
protection to or enhance the robustness of a local structural element, or to enhance the
ability of the structure to redistribute load after damage. Practical mitigation measures are
presented for both these approaches. Structural robustness and design against collapse
has continued to be an area of intensive research since the second edition was published
and the chapter reflects advances and revisions in design standards in this area.

Chapter 12 has been rewritten to reflect the significant advances made in the design of
vehicle barriers to protect against hostile attack since the publication of second edition,
which was the first time such material appeared in the open literature. With penetrative
vehicle attacks on buildings being a common threat around the world, the engineer is
now frequently required to consider the design of vehicle protection for high-energy
impact. The principles of design of vehicle restraint measures to protect buildings against
high-energy impact are presented, enabling the engineer to approach the problem
competently and to understand the requirements and constraints typically associated
with the design of vehicle barriers. A more comprehensive treatment of the different
types of vehicle barriers is presented together with discussion of when and where they
should be used and what protection they offer, which makes this chapter still one of the
only authoritative references on design of vehicle barriers against hostile attack.

Chapter 13 expands the previous chapter on the design of building services to be resilient
under blast loading. The emergency response to terrorist threat has changed, as we have
built greater resilience into the design of buildings such that sheltering in place is now the
most appropriate response for buildings in which the blast resilience is known. Refuge
in hardened or adequately protected areas of the building raises the need for due
consideration to be given to life safety and other building services during a blast event.
The design of building operation is intrinsic both to the prevention of an attack and to
the response should an attack take place. In turn, this is linked to the blast resilience
which has been achieved in the design of the building and places demands on the design
of building services to withstand a terrorist attack and to provide continued safe
operation through and after a terrorist attack. This chapter recognises the interlinking
of these areas and replaces the previously separate chapters on design of building services
and implications for building operation.

Modern terrorism
Terrorism is the deliberate use of violence to create a sense of shock, fear and outrage in
the minds of a target population. Several factors in the way we now live make that easy to
achieve.

First, terrorists are able to make use of the media as never before to carry a sense of
terror to their target population, and television in particular gives terrorists a political

7
Blast Effects on Buildings

leverage out of all proportion to their other powers. Second, developed societies have
become very dependent on complex, ‘brittle’ systems and networks – for example rail
networks, key transport infrastructure (e.g. major bridges), aviation, utility networks,
large shopping centres and business districts, which are both vulnerable and critical to
society’s function, and allow the terrorist many suitable targets. Third, terrorists hide
behind the camouflage of normal daily life. This means that almost all effective measures
to combat terrorism also carry considerable constraints on individual freedoms, which
governments are rightly reluctant to impose, and often will not.

This leads to several conclusions: terrorism today is much easier to contain than to
eliminate; there are few completely acceptable antidotes to it; and prudent design will
allow for its effects wherever it is possible and affordable.

Risk
Protection is not an absolute concept and there is a level of protection where the cost of
protection provided with respect to the cost of the potential loss is in balance. Protection
can never offer a guarantee of safety; conversely, too much protection is a waste of
resources with regard to what is being saved.

Furthermore, the consequences of loss vary: some loss is incremental, but certain losses,
such as human life, essential functions or specialist equipment, are catastrophic. For
these reasons the approach to design against terrorism must be risk-based, assessing a
combination of the type, the likelihood and the consequences of an attack. Some risks
will have to be accepted, while others must be deflected at all costs. Advice on how to
conduct a terrorist threat assessment can be found in Chapter 13.

The special effects of catastrophic loss

The special effects of catastrophic failure or large numbers of casualties on public
perceptions need special attention. As discussed earlier, the societal aversion to risk
increases as the consequences of the hazard increase. Put simply, the greater the number
of casualties the less tolerant society is of the causation – but tolerance diminishes at a
faster rate than mathematical models suggest is rational. This relationship is well-proven
and the mathematical models are wrong – this is simply a humanogenic response.

In terrorist attacks, the number of casualties is most influenced by whether or not a

warning is given before a terrorist device is detonated: a warning allows emergency
action to be taken to reduce casualties. Today the stated aim of many terrorist groups
is mass casualties. Therefore, even though the likelihood of terrorist attack on any given
building is extremely small, what is deemed an appropriate level of protection will
usually be higher than these mathematical models will imply.

Further important factors in such situations are the public perception of terrorism and
the likelihood that an attack will take place with warning being given and the potential
reluctance to work in unprotected buildings while the potential for an attack remains.
There are no firm metrics for these arguments, but they are important nonetheless when
trying to decide the cost/benefit of protective measures.

8
 1 Introduction

Partial factors in blast design

When designing structural elements in accordance with limit state principles, partial
factors are applied to loads and the strengths of materials. In designing against blast
loading, the following special conditions will usually apply:

(a) The incident will be an unusual event.

(b) The threat will be specified in terms of an explosive charge weight at a stand-off,
which can only be an estimate and is already subject to a risk assessment.
(c) The strengths of in situ materials often exceed the characteristic values.
(d ) The strengths of materials will be enhanced because of the high rate of strain to
which they will be subjected.
(e) Some plastic deformation is normally acceptable and indeed for economic design
is favourable. The level of damage is specified in terms of the limiting member
deflection or support rotations.

For these reasons, the design initially should be carried out at the ultimate limit state, with
partial factors for both load and materials usually set at unity. Superimposed loads such
as superimposed dead and live load should normally be given partial factors equivalent to
those for an accidental limit state. In addition to these provisions, special enhancement
factors may be applied to material strengths, accounting for material strengths typically
being greater than specified as well as for strain rate effects. These are considered in further
detail in Chapters 6 to 9. Design is undertaken to a limit placed on the allowable
deformation of members to ensure some functionality after the event.

A design philosophy: planning for protection

A starting point for the design of a building that resists blast loading is to consider the
building layout and arrangements. The aim here is: to decide what needs protection
(the contents or the structure itself ); to imagine how damage or injury will be caused;
and to consider how the building or structure can be arranged to give the best inherent
protection. Specifically for protection against terrorist attacks, the building design
should achieve one or all of the following:

(a) Deflect a terrorist attack by showing, through layout, security and defences, that
the chance of success for the terrorist is small; targets that are otherwise attractive
to terrorists should be made anonymous.
(b) Disguise the valuable parts of a potential target, so that the energy of attack is
wasted on the wrong area and the attack, although completed, fails to make the
impact the terrorist seeks; it is reduced to an acceptable annoyance.
(c) Disperse a potential target, so that an attack could never cover a large enough
area to cause significant destruction, and thereby impact; this is suitable for a
rural industrial installation but probably unachievable for any inner-city
building.
(d) Stop an attack reaching a potential target by erecting a physical barrier to the
method of attack; this covers a range of measures from vehicle bollards and
barriers to pedestrian entry controls. Against a very large car bomb, in particular,
this is the only defence that will be successful.

9
Blast Effects on Buildings

(e) Blunt the attack once it reaches its target, by hardening the structure to absorb
the energy of the attack and to protect valuable assets.

The first three of these objectives can often be met at no cost, while the last two require
extra funds or special detailing. These last two objectives, to stop and blunt the attack,
are the subject of the remainder of this book.

REFERENCES
Ale BJM (1992) The use of risk information in the Netherlands. 7th Annual European
Summer School on Major Hazards, Christ College, Cambridge.
EU Council Directive 305/2011 of the European Parliament and of the Council of 9 March
2011 on the Harmonised Conditions for the Marketing of Construction Products (The
Construction Products Regulation). Official Journal of the European Union L88.
Global Terrorism Database (2018) https://ourworldindata.org/terrorism (accessed 28/05/
2019).
Health and Safety at Work etc. Act 1974. The Stationery Office, London, UK.
The Management of Health and Safety at Work Regulations 1999. SI 1999/3042. The
Stationery Office, London, UK.
The Corporate Manslaughter and Corporate Homicide Act 2007. The Stationery Office,
London, UK.
The Construction (Design and Management) Regulations 2015. SI 2015/51. The Stationery
Office, London, UK.
National Safety Council (2019) https://injuryfacts.nsc.org/motor-vehicle/overview/introduction/
(accessed 28/05/2019).
New York Times, 27 October 2005.
New York Times, 30 April 2008.

10
Blast Effects on Buildings

Cormie, David, Mays, Geoff and Smith, Peter

ISBN 978-0-7277-6147-7
https://doi.org/10.1680/beob.61477.011
ICE Publishing: All rights reserved

Chapter 2
Basic guidelines for enhancing blast
resilience

The requirements of the client

The type of building being considered in this chapter is a typical commercial multi-storey
building, assumed to be a new structure with a new (i.e. not retained) façade. The client,
engineer and architect have a number of choices to make regarding the fundamental
aspects of the building design. The designers can advise the client regarding these
choices, based on the points made in this chapter. It should be noted however that while
the guidelines set out below will provide a sound basis for a resilient building, they will
not automatically ensure that all the client’s requirements are met.

The level of protection provided will inevitably be influenced by the cost associated with
the enhancements. While extensive blast hardening to glazing, cladding, building services
and the structural frame are possible, the fundamental requirement is the safety of the
building’s occupants. Design of the cladding to mitigate blast hazards and the structure
to survive an explosion without gross collapse can save the lives of occupants and aid
rescue, without requiring excessively costly protection measures or allowing blast
mitigation to dominate the design intent to the detriment of other design considerations.
This philosophy is pertinent for high-consequence, low-likelihood risks such as terrorist
attack, where a large device may cause substantial damage if detonated close to the
structure, but the blast hardening measures implemented in the design are balanced
against the low likelihood of the occurrence of such an event. Buildings may not remain
undamaged or ensure that all injuries or fatalities are avoided, but the measures adopted
should limit the effects of an attack so far as is reasonably practicable.

The designer will have to define the size of a device to be used as a basis for design, and to
help the client define limits on the extent of damage associated with these design threats.
The former is referred to as the design basis threat, and the latter the performance criteria
to be met under this particular threat. Just as a performance criterion on its own is
meaningless, to state a particular charge weight to be used as a design basis threat without
giving the performance criterion to be met is equally meaningless. The two components
together form a design basis, in the same way as a structural engineer might understand
that the allowable deflection under wind load is span over 360, or the allowable
inter-storey drift is 0.5%.

The design basis threat is not necessarily the worst-case, largest conceivable threat.
Indeed, it is not normally such, because this threat is the most unlikely and there can

11
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size and occur in multiple form. The contained fluid is naturally milky
and corresponds to that seen in chylous ascites and hydrocele.
These lesions are only recognized after exploration. When found
they are to be extirpated, on general principles, usually by
enucleation, with ligature of the connecting lacteals and avoidance of
all unnecessary disturbance of blood supply.
 Fig. 631

Cyst of the mesentery, containing clear fluid. The hour-glass constriction passes
through the layers of the mesentery. (From a case occurring in Richardson’s
practice.)

THE SPLEEN.
 The spleen is often an object of surgical interest, not alone
because of the frequency with which it is enlarged in the course of
the acute surgical infections, but because it is something more than
a reservoir for blood. Thus it seems to enlarge to accommodate
blood forced in from the exterior under conditions of extreme
exercise, etc., and in the higher vertebrates it seems to be a place
where blood corpuscles are destroyed, especially those which are
already disintegrating, rather than one in which they are
manufactured. It is claimed by Ehrlich that the splenic enlargement
of the infectious diseases is produced mainly by the products of
disintegrating leukocytes which are allowed to accumulate.

ANOMALIES OF THE SPLEEN.

Of the congenital anomalies or defects the surgeon is mainly
interested in the fact that supernumerary spleens are common, being
found perhaps in one out of four bodies varying in number up to
thirty or forty, located near the hilus in the gastrosplenic omentum, in
the great omentum, or even in the pancreas. Doubtless after some
splenectomies no peculiar symptoms are produced, which is due to
the fact that some of the supernumerary organs have taken up the
splenic function. The spleen varies in shape to such an extent that
the notch upon which so much stress is often laid in diagnosis will
not always be found along the anterior border. In cases of
transposition of the viscera the spleen may be found on the right
side. It has been found in the sacs of large umbilical hernias and in
the left thorax after defects of the diaphragm.

INJURIES TO THE SPLEEN.

The spleen may be injured by itself or along with other viscera.
The most common injury is from contusion, which produces more or
less disintegration or rupture and hemorrhage. The organ is so
friable that it may literally burst under a comparatively slight force,
other conditions being favorable. Doubtless minor degrees of these
injuries pass unnoticed or are followed by some local peritonitis and
adhesions. On the other hand the spleen may be actually
fragmented, with necessarily fatal consequences unless promptly
operated. Rupture is especially likely to occur after those infectious
diseases which cause its enlargement—e. g., typhoid.
In case of injury there is, in addition to the history, a prompt
location of pain in the region of the spleen, with signs of intra-
abdominal hemorrhage, but without blood in the urine; perhaps with
tumor or dulness on percussion, and always with abdominal rigidity,
all of which point to the serious nature of the injury and demand
exploratory section. Should this reveal a slight injury it may be
repaired with ligatures or sutures. More serious tears or perforations
are treated by gauze packing through a sufficiently open wound,
while the most serious cases of pulpifaction call for complete
extirpation. When the blood supply of the spleen is left in doubt its
total removal will be far the safer course to adopt. Obviously such an
operation should include examination of all the viscera and a careful
toilet of the peritoneum.

ABSCESS OF THE SPLEEN; SUPPURATIVE SPLENITIS.

Pus may form within the spleen in consequence of septic infarcts
or thrombosis, or it may be due to the extension of trouble from
adjoining foci, or to pyemic metastasis. Splenic abscesses are
usually localized, but the pyemic forms are always multiple, miliary at
first, but coalescing into larger collections, and practically destroying
the organ if the patient live long enough. The infectious fevers may
be followed by suppuration of the spleen, which is also known to
occur rarely in malaria.
Symptoms.—The symptoms of splenic abscess are indeterminate
until the capsule is involved and a perisplenitis—i. e.,
a local peritonitis—results, after which pain becomes severe. These
collections occasionally discharge spontaneously into the colon or
even into the stomach.
On general principles any abscess which can be located, even
somewhat vaguely, should be attacked. After the abdomen is
opened, preferably through the left semilunar line, the exploring
needle may be used, especially if adhesions be present.
 GANGRENE OF THE SPLEEN.
Gangrene of the spleen is the result of a still more rapid, otherwise
similarly septic or thrombotic process, or of severe injury, by which
circulation is practically cut off. It is a condition which rarely permits
of any surgical help, though if it could be foreseen it might be
prevented by an early splenectomy.

HYPERTROPHIES OF THE SPLEEN.

Enlargement of the spleen occurs during numerous acute and
chronic infections—e. g., typhoid, malaria—in connection with certain
affections of the liver; in consequence of interstitial or gummatous
forms of syphilis, with or without similar lesions in the liver; in acute
peritoneal infections; in general septic and pyemic disturbances; in
rickets and the status lymphaticus; in the various forms of leukemia,
Hodgkin’s disease, and pseudoleukemia, and in that somewhat
peculiar type known as Banti’s disease, or splenomegaly. In fact the
spleen enlarges under so many conditions that its hypertrophy is an
expression of a general infection rather than of any pronounced or
particular type of the same. Minor degrees of enlargement have
often passed unnoticed or given little or no trouble. When seriously
overgrown its principal features are its inconvenience, weight, and
size. The condition is recognized by its characteristic shape and
notch (See above.) By its extension upward it can be usually
distinguished from a tumor, of the kidney.
Every splenic enlargement, especially chronic, should lead to a
careful blood examination, by which, among other things, malaria
may be recognized or excluded, while the degree and form of
leukemia, if present, may be estimated. The lymph nodes throughout
the body should also be carefully examined. Splenomyelogenous
leukemia, for example, is progressive, severe, and marked by
cachexia and anemia of peculiar type. In many of these cases there
is a tendency to hemorrhage, both from surfaces and into the
tissues. The hemoglobin is much reduced and prognosis after any
operation is unfavorable. (See chapters on the Blood and the
Lymphatic System.)
 Banti’s disease, or splenomegaly, seems also a somewhat
peculiar type of lesion which is probably due to an infection
proceeding from the intestinal canal, and involving the liver in its later
course. In its last stage there is a tendency to hepatic cirrhosis, with
ascites, and hemorrhages in any part of the body are frequent.
Removal of the spleen for any of these conditions is usually a
precarious procedure. It has been more successful when performed
for malarial hypertrophy than for other conditions, the patient’s
chances being then about three out of four; but here, too, the lesion
is usually amenable to other treatment. If done in the early stages of
Banti’s disease it would seem to be strongly indicated, but not in the
later stages, when the liver is involved and the abdomen full of fluid.
In the leukemias it has succeeded in a few instances. It is mostly
indicated in those cases where hemorrhages occur early.
The Röntgen rays have recently been shown to have an excellent
effect in many of these cases and are worthy of trial. Especially in
the leukemic forms, in connection with arsenic internally, they offer
probably the best prospects.

SPLENIC DISPLACEMENTS.
While, under ordinary circumstances, the supports of the spleen
may seem equal to ordinary needs they prove insufficient in many
cases of marked enlargement. Hence results displacement, or the
so-called “wandering spleen,” which may be due to the results of
injury, to tight lacing, possibly to congenital relaxation of ligaments,
but mainly to hypertrophy, with increase in size and weight. When
the spleen enlarges it descends toward the umbilicus, but it has even
been found in the pelvis. As it prolapses it brings down with it the
stomach and the pancreas, thus interfering with the circulation of all
three organs and producing a train of distressing secondary
consequences. A long-drawn-out splenic ligament may be much
stretched and may even become finally twisted, thus causing
gangrene of the spleen from torsion of its support. Moderate
displacement and stretching produce discomfort, pain, and
disturbance of function. Such a displaced spleen is to be recognized
by its shape, size, and notch, and is occasionally to be distinguished
from a wandering kidney. When displaced its normal location will not
be dull upon percussion.
Treatment.—Palliative treatment, which may be tried first, calls for
whatever drugs may be needed to unload the bowels,
but especially for rest in bed and support by suitable abdominal
binder, with or without a pad. If the spleen itself be much enlarged it
may also be subjected with a judicious frequency to the x-rays.
Operative help, which is the only measure when other treatment
fails, should come either through a splenopexy or splenectomy,
preferably the former, save in the presence of serious disease which
may call for its extirpation. Nevertheless splenopexy, which seems
so simple and so promising, is often unsatisfactory because of the
friability of the spleen itself and the weakness of its capsule. Here, as
in hepatopexy, the intent is to produce adhesions, by scarification of
the external peritoneal surroundings, which is made through a
suitable incision, directed usually along the left costal border; after
thus intentionally provoking adhesions, sutures may be used if there
be any prospect of their being serviceable.
 PLATE LVI

Upper Abdominal Viscera, showing their Normal

Relations. (Sobotta.)

NEOPLASMS OF THE SPLEEN.

Splenic cysts of the serous or blood type are seldom seen. Even
hydatids here are uncommon. Sarcoma of the spleen may be
primary; carcinoma is due to extension or metastasis. In proportion
as splenic tumors develop they may be recognized as involving this
particular organ. While a careful blood examination may permit the
exclusion of certain conditions, exact early diagnosis will scarcely be
made without exploration, which is justifiable whenever the blood
count would indicate it. After exposing the lesion the surgeon is for
the first time in a position to judge whether to drain or extirpate a
cyst, or remove part or the whole of the spleen itself.

OPERATIONS UPON THE SPLEEN.

Besides those operations addressed toward fixation of a more or
less enlarged or wandering spleen a splenotomy can be made—i. e.,
incision and drainage at any suitable point, anterior or posterior,
which can be satisfactorily exposed; and evacuation of fluid may be
followed, with or without suture of the deep to the external wound, by
gauze packing or tubage, combined, if necessary, with
counteropening or posterior drainage.
Splenectomy.—Total removal of the spleen is performed through
an incision which should be made ample for the
purpose, either along the costal border or the left semilunar line or by
combination of both. A median incision may be also utilized if it will
permit better access. Splenectomy, under ordinary circumstances,
would not be a difficult operation, but with the organ enormously
enlarged and the vessels dilated, as they may be, it becomes usually
a formidable procedure. The most serious difficulty and danger arise
from the numerous adventitious vessels which may connect the
spleen with the diaphragm or with some of its other surroundings,
and whose location is to be made out before an attempt is made to
remove it. Thus, in one instance, I have seen an adventitious vein,
the size of the little finger, between the upper splenic surface and the
diaphragm. Through such large vessels torrents of blood will pour
unless they be first secured. All such connections then with the
stomach and the diaphragm have to be ligated and separated with
great care, while gentleness of manipulation is requisite throughout
the operation. The spleen may be reached and adhesions be located
with great speed of manipulation, but in the depths of such a wound
valuable time may be consumed and much blood lost, all at a time
when the patient can least tolerate them. Oozing from vessels which
cannot be secured should be checked by gauze packing.

THE PANCREAS.
The anatomical features of the pancreas which have most interest
for the surgeon are the facts that its head is in contact with the
duodenum, and lies usually so closely against the second portion of
the former as to surround from one-fourth to one-third of its lumen.
Becoming adherent at this point it may then produce obstruction high
up in the intestine. In rare instances it may even completely surround
the duodenum, and thus may, when swollen, cause tight constriction
of the latter. Should this condition be met with a gastro-enterostomy
would be the proper measure for relief. These intimate relationships
account for the spread of disease from the pancreas to the intestine,
rarely in the reverse direction. The pancreas lies also in contact with
the stomach along its anterior peritoneum-covered surface, and
malignant disease travels easily from one to the other. Ulcers of the
stomach, favorably situated, may also be followed by adhesion and
inflammatory infiltration of the pancreas, by which the viscera are
cemented together, the same result following duodenal ulcer, as well
as serious disease about the biliary passages. Thus under a variety
of circumstances the operator may find these parts so cemented as
to be separated only with the greatest difficulty, or perhaps not at all,
without causing laceration or rupture of one or more of them, with
escape of contents which are often septic. Therefore when there is
reason to fear this accident it will usually be safer to simply make a
gastro-enterostomy. (See Plate LVI.)
The relations of the biliary ducts to the pancreas are most
important, the association of the common duct with that of Wirsung
having the greatest bearing upon a variety of conditions, which are
nearly all essentially surgical. The former, descending along the
head of the pancreas, comes in contact with the duct of the latter,
and passes alongside of it for a short distance before entering the
intestinal wall. In about two-thirds of individuals it is completely
enclosed by the pancreas. In the other third it lies in a deep groove
upon it. Resting here, as it were like Siamese twins, it will be easily
seen how disturbance in one duct or its source may be reflected to
the other. When the common duct lies in a groove it is less likely to
be seriously compressed by pancreatic engorgement than when
actually embedded in pancreatic tissue. The degree of resulting
jaundice may thus be dependent upon anatomical conditions not
determinable before exploration. Such pressure doubtless accounts
for many cases of so-called catarrhal jaundice. When the condition
becomes constant, or nearly so, a chronic interstitial pancreatitis
may be assumed, which really warrants an operation—i. e.,
cholecystostomy with drainage. When a gallstone is passing through
the common duct, especially when lingering or impacted, it may have
in turn reversed this condition, and, by obstructing the pancreatic
duct, set up as a consequence pancreatic stagnation and
consequent digestive disturbance, and such other internal conditions
as invite infection from the duodenal cavity, with a more or less lively
pancreatitis, perhaps even of fulminating type, by which life may be
jeopardized.
The pancreas, however, being usually provided with two ducts, the
second (that of Santorini) is often represented as an additional
safeguard, since it usually has a separate opening into the
duodenum below the ampulla. Opie carefully studied 100 cadavers
and found that in more than 50 of them the accessory duct could be
of no use or relief, and that in only 10 instances did two independent
ducts enter the intestine, while in the other 90 they were united, and
in 21 of the latter the accessory duct had become obliterated.
Moreover, in only 6 of the 100 instances was it larger than the duct of
Wirsung. This will show, then, how little reliance may be placed upon
the duct of Santorini. Moreover, no matter which duct is opened, or
whether both are, so long as pancreatic fluid can escape there is an
open channel for infection, and when it cannot escape it may be
seen that infection has already occurred and is manifesting its
pressure consequences. Chemosis of mucous membrane may be
the first mechanical result of such infection, but this is sure to be
followed by interstitial sclerosing and compressing effects.
The normal duct opening in the duodenum is also a matter of
surgical interest. The ampulla of Vater, within the second portion of
the duodenum, is usually described as a conical protrusion or
papilla, having an average length of 4 Mm., with an opening 2.5 Mm.
in diameter, this being the narrowest portion of the common duct, but
from this arrangement there are many variations. The ducts may join
at some distance from the intestine, or they may open independently
into a depression or into a protrusion, and the ampulla be thus totally
wanting, all of which has the greatest possible bearing upon what
may happen during the passage of gallstones, for instance, or by
infection and according to its direction; and may account for the
difficulty met in certain cases, as when, for example, it becomes
necessary to incise the duodenum and open the ampulla for the
removal of a pancreatic or biliary calculus. It will emphasize, too, the
necessity for always exploring the common duct by opening the
biliary passage and thus making sure of its patency.

ANOMALIES OF THE PANCREAS.

Congenital anomalies include not only those of the ducts above
mentioned, but the presence of accessory masses, like the
accessory thyroids, which may occasionally lead to confusion and
perplexity. Furthermore, accessory nodules of pancreatic tissue may
be found alongside the ducts, or even in the walls of the stomach
and intestine, where they are probably present more often than is
generally appreciated, and are to be explained by the embryology of
the parts, since the pancreas is known to take origin from a cluster of
cells in the wall of the upper end of the developing intestinal canal.
They have been seen also along the line of a persistent vitelline
duct. Such small accessories, when present, usually empty by
minute independent ducts into the intestine. On the same embryonal
grounds are to be explained other anomalies occasionally met, such
as separation into detached portions. The existence of accessory
pancreatic glands is also held to account for the absence of
glycosuria in certain cases where the principal portion of the
pancreas is itself extensively diseased.

GLYCOSURIA.
 Glycosuria is so associated with the popular conception of
pancreatic disease that it seems imperative to state what importance
should be attached to it. It is now clearly established that the so-
called “islands of Langerhans” have to do with the elaboration of a
certain glycolytic ferment, and that the failure in its supply to the
blood (it being regarded as an internal secretion) is followed by the
appearance of sugar in the urine. These islands are not connected
with the ducts, at least not in the vertebrates, and usually escape
pressure effects in chronic interstitial pancreatitis of the interacinous
as well as of the interlobular form. This explains the accompaniment
of diabetes in some instances of pancreatic disease and its absence
in others. Again, if only part of the pancreas be affected, as in
cancer, the remaining healthy portion may still afford a sufficient
amount of this ferment to supply the body needs.
The uncertain symptomatology of the slower forms of pancreatic
disease is to be accounted for by the fact that, with the exception of
its glycogenic function just mentioned, all its other functions may be
vicariously assumed by other organs of the body. Thus as a
compound racemose gland it furnishes—
1. Trypsin, a proteolytic ferment;
2. Amylopsin, a starch-splitting ferment;
3. Steapsin, a fat-digesting ferment; and
4. A milk-curdling ferment.
The first of these functions may to some extent at least be
assumed by the stomach and the others by the bile and intestinal
juices. (Mayo Robson.)

INJURIES TO THE PANCREAS.

Injuries to the pancreas may occur with or without external
traumatisms. By any kind of injury which affects the gland it is
probable that its glandular structure may be so disrupted as to set
free an autodestructive secretion, which, by softening and
weakening vascular walls, may lead to hemorrhage and to the
accumulation of a collection of inflammable material, which is a good
culture medium, and which needs only the spark of infection to be
easily aroused into a conflagration. That possibility of infection is
imminent is apparent from the relations of the adjoining viscera and
their ducts, as already outlined. However, the same is true of even a
first and spontaneous hemorrhage, as of the clot, however produced.
It has been held that the manipulations to which the pancreas has
been unavoidably submitted during many operations may lead to its
acute inflammation or destruction. On the other hand, there seems
no doubt but that it is sometimes much relieved or benefited by a
mild massage as a part of the operative procedure. Mayo Robson
has suggested that concretions may thus be pushed along or
adhesions removed, or, as it seems to me, circulatory equilibrium
restored and autonutrition improved.
Aside from the injuries which the pancreas may receive during
operations it is unquestionably the site of hemorrhages produced by
contusions of the abdomen, although these are rare, and of injuries
produced by deeply penetrating wounds, especially those caused by
a stab or gunshot. The immediate result of a serious wound might be
hemorrhage, perhaps even a large escape of blood filling the lesser
cavity of the peritoneum. Such injuries are always to be treated
surgically, as any external contusion followed by serious collapse
and evidences of internal hemorrhage should be promptly explored,
and, even more so, every case of penetrating wound. Should blood
be found to be escaping from the pancreas the bleeding vessel may
be sought and secured, or, if necessary, a portion of the organ
extirpated, since no danger can be greater than that of uncontrolled
bleeding. It is on record that through an extensive gash in the
abdomen the pancreas has not only been exposed, but has partially
escaped, and one case report, apparently authentic, details its
subsequent sloughing and spontaneous separation.
Any wound of the pancreas which needs no further attention may
at least be sutured if it can be exposed. Nearly all surgical attacks
upon this viscus will require extensive incision and more or less
emptying of the upper abdominal cavity. It may now be of great
assistance to place the patient in the semi-upright position in order
that the viscera may gravitate toward the lower part of the abdomen
—i. e., to reverse the ordinary Trendelenburg position.

NON-TRAUMATIC SURGICAL DISEASES OF THE PANCREAS.

 These diseases include especially the acute infections, the chronic
lesions, and the occurrence of neoplasms or calculi.
Certain local and general conditions predispose to pancreatic
disease of any type. Among them are to be reckoned—
1. Injury, either by accident in the ordinary course of events,
as by contusions or penetrating wounds, or bruising during
the manipulations of operation;
2. Anatomical anomalies;
3. Hemorrhages into the substance of the gland, whether from
vascular changes or other causes;
4. Obstruction along either the biliary or pancreatic ducts,
whether due to catarrh, calculi, adhesions or stricture,
parasites (worms) or cancer;
5. General toxemias: typhoid syphilis, influenza, mumps, and
the like.
The principal exciting causes are the various infections which may
proceed from the blood, as in pyemia or syphilis, or from the
alimentary canal, which is never free from bacteria, either by
adhesions and continuity, as from gastric ulcer and cancer, or by
those natural passage-ways, the ducts.
When summed up the most common of all the causes of
pancreatic disease, acute or chronic, will be found to be
cholelithiasis, with some of its variant consequences or
complications. This will help to make clear the reason for operating
on the biliary passages in most cases of pancreatic disease,
especially the more chronic forms. A stone impacted in any portion
of the common duct, especially in its terminal portion, after it has
come into relation with the duct of Wirsung, may cause an amount of
disturbance disproportionate to its size. Moreover, a stone impacted
at the orifice of the duct will permit the entrance of bile into the
pancreatic canal, where it does not belong, and where of itself it may
cause trouble.

ACUTE AFFECTIONS OF THE PANCREAS.

These include—
1. Hemorrhagic pancreatitis.
 (a) Ultra-acute, where hemorrhage precedes infection,
and bleeding occurs outside as well as inside the
gland.
(b) Acute, where inflammation precedes hemorrhage, the
latter being less profuse and occurring in patches.
2. Gangrenous pancreatitis.
3. Suppurative pancreatitis.
(a) Diffuse, destructive.
(b) Subacute, localized, with abscess formation.
Acute Pancreatitis.—Acute pancreatitis is a distinct form of
disease, like appendicitis, with an etiology and
symptomatology of its own, which has been recognized only within
the past twenty-five years. This statement will account for the fact
that so little reference to it is made in any but the recent text-books.
In fact it is to the writings of Fitz, of some fifteen years ago, that the
world owes its first keen interest in the subject. By no means a
frequent disease, it nevertheless occurs with frequency sufficient to
make it inexcusable for the practitioner to fail to take it into
consideration, although he may waver in diagnosis.
The predisposition to infection which previous injuries, especially
minute hemorrhages or previous pathological conditions, seem to
afford has been already mentioned, and a history of previous injury
or digestive disturbances will aid in diagnosis. The exciting cause is,
however, in nearly every case when not distinctly traumatic,
connected with previous disease in the biliary tract, either
cholelithiasis or cholangitis. Reference to what has been said above,
and a consideration of the anatomical relations, will show how
readily an infectious process can travel upward from the duodenum
into the pancreatic duct, as well as into the common duct; or how,
passing down the latter, it may speedily find its way up the former.
The previous condition of the tissues, and the activity or virulence of
the infective organisms, have to do with the degree of acuteness of
the resulting pancreatitis. This is sometimes of such overwhelming
toxicity that the entire gland dies almost as does the appendix, within
a few hours, the result being an acute necrotic condition that of itself
is necessarily fatal.
Symptoms.
—Acute pancreatitis gives rise to symptoms which, in general,
assume the clinical form of an acute peritonitis of the upper
abdomen. It commences with sharp pain in the epigastrium,
accompanied by faintness, nausea, vomiting, and collapse, while
tenderness over the pancreas is an early symptom, and swelling or
enlargement can sometimes be detected. Constipation is so
frequently a feature that the diagnosis of acute bowel obstruction is
sometimes made, but it will be found that obstruction is not
complete, for flatus may pass and enemas may be successful. The
pain becomes paroxysmal, is increased by movement and pressure,
while the tenderness becomes more localized. Meteorism may so
quickly succeed the other symptoms as to make physical signs
uncertain, while rigidity of the abdominal muscles makes them still
more vague, yet affording in itself a sign of value. Vomiting
intensifies the pain and the vomitus changes from food to bile, and
then to blood, which is dark and altered. Hence jaundice may be an
early feature, in which case it becomes more marked as the disease
progresses, and may become intense. This is likely to be the case if
the exciting cause prove to be a stone impacted at the ampulla. The
face indicates profound distress and disturbance. The temperature
affords no certain indication, save that in the most serious cases it
may be subnormal. On the other hand, as the case progresses, the
pulse becomes small and rapid. Every expression of overwhelming
toxemia is added, and delirium usually precedes death. In fact death
may follow the first expression of pain, in unrelieved cases, in from
two to three days. Other less acute expressions of the same general
character are met with in the so-called subacute forms of
pancreatitis.
While the postmortem findings differ in various instances the
symptoms above noted do not vary conspicuously. They differ rather
in intensity only, in accordance with the gravity of the case.
The pathologists have described various forms of pancreatitis as
the hemorrhagic, the gangrenous, the suppurative, and those
distinguished by fat necrosis, as well of the omentum as of the
pancreas itself. These distinctions have the greatest interest for
those engaged in minute research and are not to be regarded lightly.
They have no small interest for the clinician, since prognosis is in
some measure dependent upon them. Nevertheless the symptoms
of the condition are but slightly modified, whether the destructive
process assume one or the other of these types, and the therapeutic
indication is the same for all—namely, the earliest possible
operation.
If pathologists were better agreed on their pathology it might be
worth while to give more space here to this aspect of the subject. It
is, however, not yet certain, for instance, whether in a given case
inflammation precedes hemorrhage, or whether hemorrhage occurs
first and the outpour of blood is suddenly invaded by bacteria. In fact
it is probable that sometimes one thing occurs and sometimes the
other. Certain it is that the pancreas is not only loosely held together,
and consequently disrupts easily, but that it quickly succumbs both to
its own digestive juices and the disintegrating effect of bacteria, so
that putrefaction quickly occurs hours before life is extinct. The
morbid excitement quickly spreads to the adjoining peritoneum, and
along it, so that a more or less generalized peritonitis soon
complicates the case. Mayo Robson inclines to the view that in the
most fulminating cases the hemorrhage is the prior lesion.
Diagnosis.—The diagnosis should be made mainly from perforating
gastric or duodenal ulcer; phlegmonous or gangrenous cholecystitis
or cholangitis; rupture of the biliary tract, with escape of contents;
fulminating appendicitis; acute intestinal obstruction, including
internal hernias, and acute mesenteric thrombosis or embolism.
Fortunately in every one of these conditions prompt operative
intervention is alike demanded, save possibly in the last named;
while even in the latter diagnosis cannot be made without it, and it
may still be possible to accomplish something if the occlusion be not
too widespread. A history of previous “dyspepsia” or “indigestion”
may point to the stomach or the biliary channels; repeated
hemorrhages to gastric ulcer, and repeated attacks of pain to
gallstone trouble. General tympanitis would indicate intestinal
obstruction, especially if no flatus were passed, while when limited to
the upper abdomen it would be more suggestive of pancreatic
disease. This would be corroborated by vomiting of blood, while fecal
vomiting would indicate obstruction. Tenderness and tumor located
in the region of the gall-bladder would point rather to it as the source
of trouble, while in pancreatitis something distinctive may be perhaps
made out by palpation and percussion, and the tenderness will be
complained of alike on each side of the middle line. Abdominal
rigidity, while general, is usually most pronounced near the site of the
most important lesion. Much importance is attached by Halsted to
excessive pain, and to cyanosis of both the face and the abdomen.
The latter may be helpful as a corroborative indication, but is
certainly not always present, and, on the other hand, is seen in many
cases of general peritonitis. Glycosuria is rarely a feature of the
acute cases.
Treatment.—This is of necessity not only surgical, but, to be
effective, should be prompt, every added hour of delay causing
increased danger. While arranging for this it is possibly justifiable to
allay pain by giving morphine hypodermically. The colon should be
emptied by a copious enema. Collapse is to be combated by the
usual means, including hypodermoclysis or infusion, perhaps with
the addition of a little adrenalin to the saline solution. The
preparation of the patient, both before and during anesthesia, should
include the same scrubbing of and attention to the skin of the back
as that of the abdomen, as there is much probability in any such
case that posterior drainage will be needed.
The operation is begun as an exploration, through a median
incision above the umbilicus, some three inches in length, through
which the operator may inform himself as to the state of affairs within
the abdomen. Should fat necrosis be revealed, and first noticed in
the omentum, no doubt need be felt as to diagnosis. Any tumefaction
by which the stomach or colon is displaced, or the gastrocolic
omentum placed upon the stretch, calls for further and deeper
exploration. The upper abdomen should next be walled off with
gauze and a small rent made through the gastrocolic omentum; or it
may in rare instances prove wiser to push down an already
depressed stomach, or more likely to lift up the greater omentum and
enter the lesser peritoneal cavity through the mesocolon. In the
majority of instances the condition can be best appreciated and
relieved by separating the stomach from the colon.
The condition may be one of extensive fat necrosis, disseminated,
but with its most abundant expressions in the neighborhood of the
pancreas, or there may be found evidence of extensive gangrene,
the pancreas itself sloughing and involved past any possibility of
repair, surrounded by disintegrating clot and debris; or there may be
found a more or less localized abscess, and perhaps evidences of
putrefaction. In at least two instances reported by Muspratt and
Porter the pancreas itself was not yet dead, but was so darkly
discolored and swollen, as well as so dense, that it was freely
incised, the bleeding vessels being tied and the clot removed. Both
of these cases recovered. Such incisions, if made in the gland,
should always run parallel with the duct and not across it. Whether
pus be found or not will depend in large degree upon the time that
has elapsed since trouble began. It is most desirable to expose the
focus before pus has had time to form, just as it is in acute
appendicular disease.
The further operative treatment consists essentially in checking
and preventing hemorrhage, in removing all sloughing tissue which
can be safely taken away (and this may involve the greater part of
the entire gland), in disinfection of the cavity and general toilet of the
upper abdomen, with ample provision for drainage. This may be
anterior or posterior, and in bad cases should be both, unless
procedure is hastened by collapse. Posterior drainage is effected by
having the patient turned upon the right side, then making an incision
3 or 4 Cm. long at the left costospinal angle, where, if the advice
above given have been followed, the skin will have already been
prepared. Here the outer border of the erector spinæ group of
muscles is quickly exposed and the blades of a pair of stout forceps
entered and pushed toward the inner cavity, within which the
operator’s left hand is acting as a guide. In this way it is possible to
quickly insinuate the blades so that the large vessels and the upper
end of the kidney are preserved from harm. A suitably prepared
drain, preferably tubular, may then be introduced deeply enough
through the anterior wound to be seized by the forceps and pulled
through the tunnel made by their introduction. It is thus drawn
backward and outward to such an extent that its inner end shall rest
just where it is desired in the cavity of the lesser peritoneum, the
unnecessary external part of the drain being now cut away. The