Wounds made by Gunshot

Today’s fragments come from a late 16th century book (originally published in French) on the treatment of gunshot wounds. Designed primarily to be used by surgeons on the battlefield, its advice would also be useful to soldiers, physicians, and any victim of a firearm. Imagine being prodded and poked on the battlefield by some of the surgical instruments below (without any form of anaesthetic!)

All wounds made by Gunshot on the body of man, whether they be simple, or compounded with dilaceration, contusion, distemperature, and tumor, are made some in the noble parts, others in the ignoble parts; some in the fleshie parts, and others in the Nervous and bony parts; sometimes with ruption and dilaceration of the great vessels, as of the Veines and Arteries, and sometimes without ruption of them. Such kinde of wounds are also sometimes superficiall, but most commonly profound and deepe, even to the penetrating through the body & members of them that receive them.

Another diversity is taken according to the differences of the Bullets: amongest the which, some are great, some in a meane substance, and some are small as Haile shot: whereof the matter (which is ordinarily but of Lead) is somtimes turned into Steele, Iron, or Tin, rarely into Silver, but never into Gold. According to the which differences, the Chirurgian ought to take divers Indications to operate, and according to them to diuersifie the remedies. I have found those Woundes heeretofore to bee as little rebellious in their curations, and as easie to handle as those which are made by anie Instrument of that kinde; I meane such which make a round and contused wound, or of such a figure which the shot maketh: and therefore it is most necessary that there bee a greater regard had to the symptomes or accidents of the contusion, dilaceration, fracture of the bones and evill quality of the incompassing aire, than to the combustion which is thought to proceed from the Bullet, or venenosity of the powder. This I thought good to publish to the world to aide young and new Practitioners in Chirurgery, in the same manner & Method which I have my selfe experimented in following the warres.

In the beginning of the Curation, you ought first to know whether the wounds was made by Gun-shot or no; which is easie to be seene if the figure of the wound be round and livid in colour, and the naturall colour of the part is changed, that is to say, yellow, azure, livid, or blacke.  Also at the same instant that the patient received the blow, if he say that he felt an aggravating pain, as if he had beene strooke with a great stone, or with a club, or as if a great burthen had falne upon the wounded part. In like manner, if the wound happened not uppon any great vessell, if there have issued but little blood from the wounded partes, which happeneth because they are contused, and greatly crushed, and therefore they tumifie presently after the blowe received;  thereby it cometh to passe, that the flux of blood is suppressed, which otherwise would flow at their Orifices. Also the Patient therein feeleth a great heate, which happeneth because of the impetuositie proceeding both from the violent motion of the Bullet, and the vehement impulsion of the ayre, with the ruption of the flesh and nervous partes.  Also, because of the great contusion the Bullet maketh there followeth Spasme, Faintings, Palsie, Gangrene, Mortification, and finally death.

First, it is convenient that the Chirurgian should amplifie the wound to give ample passage unto all such strange bodies which might have been conveyed in with the shot, and to draw them forth (if any there be) as any portion of the apparrell, wad, paper, peeces of Harnesse, Maile, Bullets, Shot, Splinters of bones, dilacerated flesh, and other things that shall bee found therein; and this to bee done at the first dressing if it be possible. For the accidents of pain and sensibility are not so great in the beginning, as they are afterwards.

Now for the better extraction of the aforesaid things, you ought to place the Patient in the same situation that he was at the time when he was first shot, because that the Muscles and other parts being otherwaies situate, may stop and hinder the way; and for the better finding of the saide Bullets, and other things, it is fitting that search bee made with the finger (if it be possible) rather then with any Instrument, because that the sense of feeling is more certaine then any Probe, or other insensible thing. But if the bullet have pierced farre into the body, there it may be reached with a Probe, round in the end thereof, for feare of causing paine: neverthelesse it happeneth somtimes that the Bullet cannot be found by the Probe. Wherefore it is very convenient to search for the Bullet not onely with the Probe, but (as I saide before) with the fingers, by handling and feeling the part and places about the same where you may conjecture the Bullet to have penetrated

As for the strange bodies which may be infixed in the wound, they may bee extracted by such Instruments heereafter described, which are different both in figure and greatnesse according as neede shall require; whereof some are toothed, & others not. And it is fit the Chirurgian should have of many and diuers fashions: some greater, and some smaller of every kind to accommodate them to the bodies and wounds, and not the bodies and wounds to his Instruments.

This following is called the Cranes bill, because of the similitude it hath thereunto; the which in like manner ought to bee toothed; and it is proper to extract any thing from the bottom of the wound both shot, maile, splinters of fractured bones, & other things. The other Instrument is called the Duckes Bill, having a Cavity in the extreamity or end thereof large and round, & toothed, the better to holde the Bullet; and it is proper principally when the Bullets happeneth in the fleshy parts.

Another Instrument called the Parrats Bill, and it is proper to draw foorth any peeces of Harnesse which may be inserted into the bottome of the Member, or also into the bones.

* A. sheweth the stalke of the Vice.
* B. The Scrue.
* C. The runner, which by the meanes of a Vice, is scrued higher or lower.
* DD The other part which is fixed with a Cavitie in the middest thereof, wherein the Runner is placed.

An Instrument called the Tire-fond, the which is turned by a Scrue within a pipe or hollow Instrument;  it is very convenient to extract forth the aforesaid Bullets when they are penetrated or are infixed in the bones:

The Dilatorie (above right) may be used to open and dilate the wounds
The Instruments which follow are Probes for the Seton, and are very convenient when as you would passe in a Seton to keepe the wound & the way of the Bullet open, untill you haue drawne forth all the strange bodies which might yet remaine therein. You must understand that those Probes which are used to search the bullet ought to be of a mean greatnesse.
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