Gunshot wounds

Gunshot Wounds

‘Wounds made by Gun-shot are the most complicate sort of Wounds that can be inflicted: For they are not only Solution of continuity, but have joined with them Contusion, Attrition, and Dilaceration, in a high and vehement kind’.

                        Richard Wiseman, Several Chirurgical Treatises (London, 1686), p. 409.

 Ambroise Paré, Les oeuures d’Ambroise Paré … (Lyons, 1685), p. 263.

The introduction of a musket ball to a wound was catastrophic as it encouraged the development of fast-growing, gangrenous tissue. In an effort to combat this, hot oil was often poured into the wound – thus causing yet more tissue damage. The sixteenth-century French surgeon, Ambroise Paré (1510-90) challenged this approach, advocating instead a mixture of egg yolk, rose oil and turpentine.[1] A military surgeon who had witnessed a lot of wound damage on battlefields, Paré shared his insights, publishing his first work, La Méthode de Traicter les Playes Faictes par Harquebutes et Aultres Bason de Feu (The Method of Treating Wounds made by Arqubuses and other Firearms), in 1545. Rightly called ‘the most celebrated surgeon of the Renaissance’, editions of Paré’s collected works became best-sellers.[2] Worth owned the thirteenth edition, printed at Lyon in 1685.

Paré’s “Ten Books of Surgery” begins with a detailed account of the treatment of wounds made by various weapons. Book One describes wounds made by arquebuses. He argued that they should be treated by first removing the foreign bodies from the affected area, from the position in which the patient was wounded. This way, the lacerated muscles and flesh stay in their current state, for allowing them to move around can make removal more difficult. He advocated searching for foreign bodies by using one’s finger because this was the most accurate way to pinpoint the location of the debris. If it was too deep in the wound, however, the surgeon was instructed to use tools to extract it out.

In this image, Paré illustrates two of these instruments: the ‘Parrot’s Beak’ was for ‘drawing out pieces of harness inserted in the depth of the extremities, even within the bones’.[3] The letters in the image refer to the following: A: The tail of the screw; B: The barrel; C: The slide, which by means of a screw is raised and lowered; D: The chase’. [4] The ‘Swan’s Beak’ was used to dilate the wound, allowing the foreign object to be removed by the accompanying pincer.

Ambroise Paré, Les oeuures d’Ambroise Paré … (Lyons, 1685), p. 261.

In this image we see two more instruments. Paré provides illustrations of many instruments designed for gunshot extraction for, as he said, ‘The surgeon must have some of many and different types, some larger, others smaller, in each of these forms, in order to accommodate them to the bodies and to the wounds, and not the bodies or the wounds to these instruments’.[5] This particular type was known as the ‘Bent Crane’s Beak’ and was useful for extracting ‘small shot, links of mail, splinters of fractured bones, and other things’.[6]

Alfonso Ferri et al., De curandis vulneribus sclopetorum tractatus singulares, Alphonsi Ferrii Neapolitani, Joh. Francisci Rotae Bononiensis, Leonardi Botalli Astensis. Additus est ejusdem Alphonsi Ferrii libellus, De callo, sive caruncula quae cervici vesicaeinnascitur (Antwerp, 1583), p. 21.

This is an image of an ‘Alfonsine’, an instrument specifically designed to take bullets out of wounds. Johannes Scultetus (1595-1645) (whose illustration below shows three different types of alfonsines in use in the seventeenth century), explains how they operated:

‘Fig. I, II, and III. is an instrument called an Alphonsiae, made fit to take out bullets out of wounds; which Alphonsus Terrius, a Physitian of Naples, Lib. 2. De vulner sclopet. Cap. 3. describes in these words. Yet that instrument which men call the Cranes bill, must not be forgotten, for that it is also an excellent instrument to draw forth anything, and commended by all both old and new Chryurgians; wherewith not only small bullets are taken out of the most difficult places, but also pieces of Armour, and many other things. To this we (that it may be more commodiously and firmly held in the hand, and so bullets and other strange things in wounds may be found out more certainly) have added rings for pincers, after this fashion. The ring of A of the first Figure, thrust to the former part of it, shuts the instrument; the ring of B of the second Figure being drawn back to the handle, the instrument is opened. The third Figure is the instrument which now holds the bullet’.[7]

The remaining items are various pincers and piercers which aid bullet extraction.

Johannes Scultetus, Armamentarium chirurgicum olim auctum triginta novem tabulis … (Leiden, 1693), plate XV.

Sources

Ellis, Harold, The Cambridge Illustrated History of Surgery (Cambridge, 2009).

Paré, Ambroise, Ten Books of Surgery translated by Robert White Linker and Nathan Womack (Athens, Georgia, 2010).

Scultetus, Johannes, Armamentarium chirurgicum olim auctum triginta novem tabulis … (Leiden, 1693). All English translations are from The Chyrurgeons Store-House … (London, 1674).

Wiseman, Richard, Several Chirurgical Treatises (London, 1686)

Zimmerman, Leo, and Ilza Veith, Great Ideas in the History of Surgery (Baltimore, 1961).

Text: Ms Paige Blancett (third year student of Museum Studies, Arizona State University) and Dr Elizabethanne Boran, Librarian, The Edward Worth Library, Dublin.

[1] Ellis, Harold, The Cambridge Illustrated History of Surgery (Cambridge, 2009), p. 128.

[2] Zimmerman, Leo, and Ilza Veith, Great Ideas in the History of Surgery (Baltimore, 1961), p. 179.

[3] Paré, Ambroise, Ten Books of Surgery translated by Robert White Linker and Nathan Womack (Athens, Georgia, 2010), p. 27.

[4] Ibid.

[5] Ibid., p. 23.

[6] Ibid.

[7] Scultetus, Johannes, The Chyrurgeons Store-House … (London, 1674), p. 39.