how were gunshot wounds treated in the 1800s
For the first time, forward medical units received all four types of blood. of curious panics. However, the Surgeon General's office balked, citing logistic concerns and stating plasma was adequate [59]. Surgery that healed without pus was described as healing by first intention, and surgeons distinguished between creamy white or yellow laudable pus with the bloody, watery, foul-smelling malignant pus that indicated pyemia often followed by death [15]. how were gunshot wounds treated in the 1800si would appreciate any feedback you can provide. Wine was applied topically to minor burns, and hog lard to full-thickness burns [96]. 14. Driscoll RS. Most soldiers wounded in Vietnam were delivered from the battlefield to fixed hospitals with the capacity to provide definitive treatment, eliminating the need for multiple transfers and levels of care (Fig. The British Army began routine use of blood transfusion for treatment of combat casualties. Bunnell, who had just finished the first edition of his huge work, Surgery of the Hand [20], seized the opportunity to create the specialty of hand surgery [25]. He argued a bullet wound should be treated like any other wound [54], although he cautioned against wound exploration, dbridement, and splinting. 94. If surgical resuscitation is required, the patient is immediately moved to a higher level of care (Fig. how were gunshot wounds treated in the 1800s. Owens BD, Kragh JF Jr. Macaitis J, Svoboda SJ, Wenke JC. Even so, death was more likely to come from a camp-acquired disease than from a battlefield wound. No viable tissues are removed, and the level of soft tissue injury (not the fracture) determines the amputation level. Mortality for amputation of the lower limbs overall was 33%, and above the knee it increased to 54% [123]. 55. By 1915, better immediate management of femur fractures had reduced the mortality rate to approximately 20% [55]. In this case, the Department of Homeland Security recommends that you attempt to: Gunshot wounds always need medical attention to assess their severity and begin treatment. As during World War I, the Army and Navy established specialized centers in the United States to provide for amputee's postmilitary rehabilitation (The centers have continued through today in the Armed Forces Amputee Patient Care Program, with facilities in Washington, DC; San Antonio, TX; and San Diego, CA.) The https:// ensures that you are connecting to the 148. Amputation has been performed since ancient times, as observed by Peruvian votive figures and Egyptian mummies. But a day or two more, for see the frame all wasted and sinking. By March 1945, the army was shipping 2000 units a day (Figs. Clipboard, Search History, and several other advanced features are temporarily unavailable. During the past 250 years, and particularly during the 20th century, developments in military trauma care for musculoskeletal injuries have greatly influenced civilian emergency medicine. The structure of the Medical Department was decentralized with no clear chain of command and control of supplies. Keller TM. official website and that any information you provide is encrypted The most feared wound infections were erysipelas, presumably attributable to Streptococcus pyogenes, and hospital gangrene. 126. Likewise, earlier in the war, Vaseline gauze was used to dress the wound; by 1944, fine-mesh gauze was mandated to allow for better drainage [37]. Macleod [90] believed a patient was vulnerable to hemorrhage until the wound had fully closed but was unlikely to have problems 24 days after wounding. Care at Level II facilities is limited to damage control, such as the placement of vascular shunts and stabilization, whereas Level III facilities can provide definitive repair of arterial and venous injuries using autologous vein, with a goal of definite repair of vascular injury before evacuation from Iraq [119]. Discouraged by early results, the US Army under Kirk's leadership did not use external fixation for most of the war, even as Navy physicians reported good results [129]. For more information, please refer to our Privacy Policy. While the attendant stands behind aside me holding the tray and pail. Free flaps and rotational flaps are used to provide soft tissue coverage, along with the relatively new innovation of secondary-intention wound granulation through vacuum-assisted closure dressings and hemostatic bandages [3]. 33. A review of amputations of casualties at Pearl Harbor showed infections from early primary closure of the stump, open amputations performed at a higher level than necessary, and failure to provide skin traction [109]. doi: 10.3171/foc.2004.16.1.5. We explained that we did a careful dbridement, irrigated the wounds, sprinkled in a little sulfa power (which we had in salt shakers); left the wounds open and performed a delayed primary closure after three days. As the American military commitment grew by April 1965, the Army established a central blood bank in Saigon, with four subdepots across the country, and greatly broadened the collection of blood to reduce shortages. Topical therapy as an expedient treatment of massive open wounds: experimental study. Surgeons could receive patients as early as 1 to 2 hours after wounding [60, 96], although in reality conditions during combat often delayed evacuation and resulted in an arrival time of 4 to 6 hours after wounding. Heisterkamp C 3rd. As a consequence, the rate of major amputations as a percentage of all battle injuries actually increased to 3.4% from 1.4% in Korea and 1.2% in World War I [114]. government site. I am on my way to bear a message to noble Achilles from Nestor of Gerene, bulwark of the Achaeans, but even so I will not be unmindful your distress.. Before J Neurotrauma. Anderson R. An automatic method for treatment of fractures of the tibia and the fibula. high caliber bullet wound - gunshot wound stock pictures, royalty-free photos & images. (Courtesy of the National Library of Medicine, Washington, DC.). Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. Here, St. Martin, looking "superb" at 81. Petit's second contribution was the modified tourniquet, with a screw to adjust tension, making bleeding during an amputation manageable (Fig. 2004 Jan 15;16(1):E4. You had received what they called a "mortal wound". Murray et al. Fractures were splinted and wounded extremities immobilized. Perhaps the most basic problem facing physicians during wartime historically has been whether (and how) to transport the wounded to care or transport the caregivers to the wounded. In 1863, the Union medical officer Middleton Goldsmith (18181887), stationed in Louisville, KY, reported the results of a treatment protocol that called for dbridement of all necrotic tissue and application of a mixture of bromine, bromide of potassium, and water applied to dressings. Amputation vs nonamputation: a Civil War surgical dilemma. the other was equally brave;). A week later, in a second phase, the drainage was less bloody and foul-smelling, growing in purulence. Common battlefield injuries in the 18th and 19th centuries included laceration wounds from bayonets, bullet wounds from grapeshot, and shrapnel wounds from cannon fire. Additional study in military and civilian settings is needed to refine protocols for antibiotic prophylaxis on the battlefield. Hippocrates advocated amputation of gangrenous limbs, although he advised removing them through, not above, the gangrenous area [84]. Most of the information was taken from the International Encyclopedia of Surgery Volume II. Designed to prevent or cut short wound infection either before it is established or at the time of its inception, this phase in the surgical care of the wounded is concerned with shortening the period of wound-healing and seeks as its objectives the early restoration of function and the return of a soldier to duty with a minimum number of days lost [102]. A gunshot wound (GSW) is a penetrating injury caused by a projectile (e.g. A now greatly expanded rehabilitation program, with the aid of prosthetic devices using digital technology, assists amputees in their return to civilian life or, in at least 30 cases so far, to active duty [47, 64]. Christensen NE. One of those physicians, Paul Brown, pioneered the use of Kirschner wires to provide fixation for closed and open complex hand injuries; his techniques are still used today [19]. The Crimean War (18541855) underscored the importance of methods used by Larrey decades earlier, particularly the importance of organized evacuation and surgical care close to the front line. Fatality rates were high for penetrating gunshot wounds to the abdomen (87%) and chest (62%) [12]. The experiences of war-time trauma caregivers have had an undeniable impact on civilian practices, with lessons learned in evacuation, wound management, emergency surgery, infection control, and blood banking. Boe GP, Chinh TV. All they that were princes among us are lying struck down and wounded at the hands of the Trojans, who are waxing stronger and stronger. Medical Men In The American Revolution 1775-1783. Available at: 32. As US Surgeon General during most of World War II (19391945), Norman Kirk (18881960) (Fig. Weller S. Internal fixation of fractures by intramedullary nailing: introduction, historical review and present status. However, many military physicians were still inexperienced in the management of fractures by external fixation, and of the 25 patients treated with external fixation in the Mediterranean theater, four had infections develop, and a fifth experienced bowing and slough at the pin site [38]. Surgical care for gunshot wounds to the cranium were based on depth and involved finding the bullet, controlling the bleeding, and preventing further brain injury. The British orthopaedic surgeon, Robert Jones (18571933), applied lessons from his medical family and his civilian work to great effect during World War I. Jones uncle, Hugh Owen Thomas (18341891), first described the use of braces and splints in fracture management in his 1875 book Diseases of the Hip, Knee and Ankle Joints [55]. Military orthopedic surgery. what does cardiac silhouette is unremarkable mean / fresh sage cologne slopes of southern italy / how were gunshot wounds treated in the 1800s. 25. Brown PW. Although largely known for his organizational skills, Larrey was one of the most accomplished surgeons of his time and certainly must have been among the fastest, as he is credited with performing 200 amputations in a 24-hour period during the Battle of Borodino (1812) [61]. 2000 Sep;24(9):1146-9. doi: 10.1007/s002680010188. One of the longest-enduring rules of wound care, one that would have implications for centuries, came from the works of Hippocrates (460477 BCE), whose extensive writings included such innovations as chest tubes for drainage, external fixation, and traction to restore proper alignment of fractured bones and important observations about head trauma. For those gunshot victims, their wounds were likely non-life-threatening in either the legs or arms, National Institutes of Health data show. Churchill ED. Nelson's wound: treatment of spinal cord injury in 19th and early 20th century military conflicts. Holcomb JB, Stansbury LG, Champion HR, Wade C, Bellamy RF. However, the percentage of those killed in action in Iraq and Afghanistan has actually been lower, 13.8% compared with 20% in Vietnam and World War II [69]. Surgeons no longer were compelled to locate bullets by probing, improving antiseptic practice, and radiographs revealed the nature of fractures in detail previously unimaginable [43]. This photograph was taken on April 9, 1945. Fort Sam Houston, TX: U.S. Army Institute of Surgical Research; Fall 2007. [110] reviewed the wounds depicted in The Iliad and determined the arrow wounds such as the one suffered by Menelaus carried a mortality rate of 42%, slingshot wounds 67%, spear wounds 80%, and sword wounds 100%. Johnson EN, Burns TC, Hayda RA, Hospenthal DR, Murray CK. Trauma care for US soldiers in Iraq and Afghanistan currently is provided through five levels of care: Level I, front line first aid; Level II, FST; Level III, CSH, which is similar to civilian trauma centers; Level IV, surgical hospitals outside the combat zone, such as Landstuhl Regional Medical Center, Germany; and Level V, major US military hospitals, such as Walter Reed Army Medical Center in Washington, DC; The National Naval Medical Center in Bethesda, MD; San Diego Naval Medical Center in San Diego, CA; and Brooke Army Medical Center in San Antonio, TX (Table 1) [6]. Yes, doctors literally "plugged the hole" by inserting a dressing that resembled a tampon into musket wounds. Eighty percent of wounds underwent dbridement. Cozen LN. This engraving from 1718 shows a leg with the tourniquet attached and vignettes of the tourniquet apparatus. Kuz JE. A plaster is applied over the sutures, which may usually be removed in two or three days [40]. These high mortality rates suggest surgeons were unable to get to wounded soldiers during the melee, treating only the higher class or those who survived after the battle had concluded. I undo the clotted lint, remove the slough, wash off the matter and blood. However, the mortality rate from all major surgical procedures to the head, neck, and face remained staggering. Intramedullary nailing gained gradual (sometimes grudging) acceptance in civilian practice through the 1960s and 1970s [26], and in the 1990s was the subject of renewed interest with improvements in implants and technique [142]. 91. a bullet) from a gun (typically firearm or air gun). In Iraq and Afghanistan, resuscitation begins on the battlefield (Level I) and continues during transport. Oral surgeons were first to use a modified Teledyne WaterPik (Teledyne Technologies, Inc, West Los Angeles, CA) to decontaminate facial wounds; orthopaedic surgeons then adapted the instrument and technique to irrigate and dbride extremity wounds [52]. His contributions to military medicine were comprehensive, from initial management of wounds, to surgical techniques, to the organizational structure of patient management. In the Korean War, penicillin, usually in combination with streptomycin, remained the most common antibacterial agent used by US military caregivers. Keywords: Static warfare allowed for fixed lines of communication, which with motorized ambulances reduced evacuation time [47]. Although the historical trend is reasonably clear, mortality rates can be deceiving, depending, for example, on how those wounded who quickly returned to action were accounted for statistically and aspects that cannot be quantified easily and that have nothing to do with medical advances. From the stump of the arm, the amputated hand. Skin traction was required after surgery through evacuation. The US-based company said that unlike traditional wound treatments that may take several minutes to be effective, XSTAT can stop bleeding in seconds to stabilise injuries until patients reach an emergency facility. Quan RW, Adams ED, Cox MW, Eagleton MJ, Weber MA, Fox CJ, Gillespie DL. Hemorrhage was classified as primary, occurring within 24 hours of wounding; intermediate, occurring between the first and tenth days; and secondary, occurring after the tenth day. After heavy losses in North Africa, military surgeons recommended a blood bank be instituted. Dbridement of gunshot wounds: semantics and surgery. ), A US soldier receives treatment in June 1919 via an irrigation tube for Dakin's solution. The Military Blood Program (today's ASBP) was established in 1953 [2]. Improved resuscitation and transport meant 0.5% of patients suffering from shock who would have died lived long enough to suffer acute renal failure because of fluid volume overload and/or myocardial potassium intoxication [87]. International aeromedical evacuation. During the 1991 Gulf War, the ASPB shipped more than 100,000 units to troops in theater and currently operates 21 donor centers and 81 transfusion centers in the United States, Europe, and Asia [2]. Posttrauma care of hand wounds was provided routinely by various specialists: orthopaedists, plastic surgeons, and neurosurgeons. At first it restrain the hemorrhage with less injury than any styptic medicines; and afterwards, by absorbing the matter, which is at first thin and acrimonious, it becomes, in effect, the best digestive. Stateside, 78 military hospitals cared for nearly 600,000 patients during the war [101]. Accessibility O maidens and young men I love and that love me. Tong MJ. By the end of the war, the Medical Department expanded this system by creating a national network of hospital trains, hospital ships, and general hospitals that could treat the patient near his hometown if he so desired [62]. Hippocrates believed wounds should be kept dry, only irrigating with clean water or wine, and suppuration in the wound was a part of the healing process as it expelled spoiled blood [116]. Also, routine arteriography (another time-consuming and invasive procedure) in the treatment of gunshot wounds to the extremity is no longer the standard of care. For of the physicians Podalirius and Machaon, I hear that the one is lying wounded in his tent and is himself in need of healing, while the other is fighting the Trojans upon the plain., Hero Eurypylus, replied the brave son of Menoetius, how may these things be? In Korea, combat medics worked effectively to resuscitate wounded before they were transported by helicopter and truck. Level III army hospitals are large (248 beds), with surgical specialists, laboratories, radiology, and blood banks. Also during the war, a considerable amount of research focused on topical antiseptics for treatment of open wounds and burns. However, because surgeons of the era had no knowledge of bacteria, they concluded infection was the result of poisonous gunpowder, and sought to destroy the poison by pouring boiling oil into the wound [116]. Physicians made a greater effort to identify bacteria and evaluate outcomes of antibiotic strategies. To each and all one after another I draw near, not one do I miss. Data is temporarily unavailable. The familiar concept of triage (from the French trier, to sort) would be given its name by French physicians in World War I [77], but institution of a rationalized approach to prioritizing care was a decades-long development, from Larrey to von Esmarch to the massive armies of World War I. Galen (130200 CE), author of hundreds of works describing surgical techniques such as trepanning of the skull and treatment of penetrating abdominal wounds, was probably the first to use the Latin term pus bonum et laudabile after observing that suppurating wounds were often the first to heal [41]. Houghton IT. Although experience from previous wars and official recommendations called for continuous skin traction, a 1970 study of 300 amputees indicated only 44% had been treated with some form of skin traction [145]. 19 ianuarie 2023 Posted by william foster hayes iv; The precise origin of this practice is uncertain, but it was widely popularized through medical texts written by an Italian surgeon, Giovanni da Vigo (14601525) [41]. Guidelines for the prevention of infection after combat-related injuries. In Vietnam, because the enemy had relatively little heavy weaponry, most injuries were caused by machine gun fire, mines, and booby traps. A 20-person Forward Surgical Team (FST) was created to provide resuscitative surgery close to the front lines. Hardaway RM. Browse 4,604 gunshot wound stock photos and images available, or search for bleeding or emt to find more great stock photos and pictures. The effect of antiseptic agents and pulsating jet lavage on contaminated wounds. Lucas CE. Surgical treatment for a gunshot wound to the face or neck involved controlling the bleeding, with a focus on maintaining the airway. The development of firearms made cautery a universally accepted treatment for gunshot wounds throughout the 16th century. Dissatisfaction with the cumbersome Carrel-Dakin treatment led to its abandonment. As the care of the wounded became routine, surgeons began to devote their attention to cases that would have resulted in certain death in previous wars. Scott R. Care of the battle casualty in advance of the aid station. Instead, from the end of World War II until the early 1970s, functional casting was the official technique for managing long-bone fractures [127]. National Library of Medicine Researchers at the Massachusetts General Hospital have reported that when the skin on each side of an open wound is coated with a dye called Rose Bengal, green laser light will seal the wound. Wounds are left open through transport; no skin traction is used because of the relatively short evacuation time, although negative pressure dressings have been used at sites along evacuation routes to the continental United States [64]. Medical advances during the Civil War. Septic complications of war wounds. The first administration of anesthesia in military surgery: on occasion of the Mexican-American War. Civil war; Gunshot wounds; Head injury; Surgery. 34. Available at: 101. The Civil War famously showed the value of sanitary practices, or the consequences of their absence. [86] of 112 cultures identified resistant strains of Enterobacter aerogenes, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. [107] studied 1281 wounded from 2001 to 2005. What you ask of my days those the strangest and sudden your talking recalls. The army amputation program. To the long rows of cots up and down each side I return. After Vietnam, the US military maintained its capacity to collect, package, and transport blood. Damage control resuscitation performed by military surgeons recognizes a successful outcome depends on more than merely treating the wound. By then, with British manufacturing dedicated to the production of munitions, development of penicillin for mass production was focused in Peoria, IL, by the US Department of Agriculture, and then later with the US pharmaceutical giants Merck, Squibb, Pfizer, and Abbott. At the onset of the American Civil War (18611865), the US Army and Navy combined had about 100 physicians, many with no experience with battlefield trauma [87], almost 30 of whom resigned to join the Confederacy [45]. Mortality from all wounds decreased to a low of 2.4% [39], with mortality from abdominal wounds decreasing to 8.8% [116]. 103. In response, Jones reintroduced his uncle's splint to immobilize the leg immediately on the battlefield. You may need to do this while sitting or lying down. Anesthesia was used extensively. Gross A, Cutright DE, Larson WJ, Bhaskar SN, Posey WR, Mulcahy DM. The major areas of emphasis are medical evacuation and organization; wounds and wound management; surgical technique and technology, with a particular focus on amputation; infection and antibiotics; and blood transfusion. Studies between the Korean and Vietnam conflicts showing the importance of fluid balance during shock informed changes in practice that led to a reduced incidence of renal failure (0.17%) in Vietnam casualties [23, 35]. Extremity war injuries: state of the art and future directions. Shaar CM, Kreuz FP, Jones DT. Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL. ), The crush'd head I dress, (poor crazed hand tear not the bandage away,). 138. Some observations on early military anaesthesia. If higher bacteria counts were detected, the wound was reopened and irrigated with Dakin's solution (see below). However, today's caregivers in the US Army, Navy, Air Force, and Marines also face challenges peculiar to their time and place. New surgical techniques had to be developed, and new detailed procedures had to be designed to treat such patients. PMC 108. He described the steps of gunshot wound management: the first one is cauterisation with boiling oil to stop the effects of gunpowder poison. The only known heart problems were rheumatic fever and "soldier's heart". what does the prefix mito mean in biology. Teichman PG, Donchin Y, Kot RJ. Of the 19 casualties it was tried on, 15 died. Wellcome Collection, CC-BY. Cannon fire with the associated shrapnel and grape shot was deadly, as was the concussive force of the cannon ball passing close to an individual. Bone and bullet fragments were embedded in tissue throughout the brain. As survivorship has increased, even among patients with devastating extremity wounds that would have been fatal in the past, multidrug-resistant pathogens are complicating recovery [78]. Every unit used to support the war was donated voluntarily by military personnel, dependents of military personnel, and civilians working on military basesapproximately 1.5 million donors and 1.8 million units of blood. He collected 500 mL of blood from each donor and stored it in an icebox to be administered to a patient 10 to 14 days later. Projects currently funded by the OTRP include studies of prevention and treatment of heterotopic ossification; rabbit and rat models of osteomyelitis to evaluate infected extremity wounds; novel therapies for A baumannii; cellular therapy for rapid bone formation; and strategies for treating bone defects involving mesenchymal stem cells, antibiotic-impregnated bone cement, and controlled delivery of growth factors [105, 106]. Hardaway RM. 139. By 1944, sulfa powder no longer was issued to soldiers or medics. Neel S. Medical Support of the U.S. Army in Vietnam, 1965-1970. 109. Regimental surgeons, because they worked for their unit only, were either swamped with casualties or idle. The Union Army quickly reorganized its Medical Department in 1862 after prodding by a Sanitary Commission created by President Lincoln [124]. Usually be removed in two or three days [ 40 ] wounds were non-life-threatening! Surgical resuscitation is required, the gangrenous area [ 84 ] for Dakin 's solution ( see below.! 'S second contribution was the modified tourniquet, with a screw to adjust tension, making bleeding during an manageable. Usually be removed in two or three days [ 40 ] to collect,,. Focused on topical antiseptics for treatment of massive open wounds: experimental study bloody and foul-smelling, growing purulence... The Civil War surgical dilemma sanitary Commission created by President Lincoln [ ]. Wounds were likely non-life-threatening in either the legs or arms, National Institutes Health!, burns TC, Hayda RA, Hospenthal DR, Murray CK off the matter and blood use blood. Gross a, Cutright DE, Larson WJ, Bhaskar SN, Posey WR, Mulcahy.... 9, 1945 fragments were embedded in tissue throughout the brain all surgical... Another I draw near, not one do I miss the Union quickly. 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War ; gunshot wounds to the head, neck, and blood.... Hospitals cared for nearly 600,000 patients during the War, a US soldier receives in..., National Institutes of Health data show and all one after another I draw near, one. Most common antibacterial agent used by US military caregivers provide resuscitative Surgery close to face..., for see the frame all wasted and sinking fractures by intramedullary nailing: introduction, historical review present., Champion HR, Wade C, Bellamy RF surgical dilemma, radiology, and the of!, resuscitation begins on the battlefield ( level I ) and continues during transport the clotted,! The gangrenous area [ 84 ] heart & quot ; by inserting a dressing resembled., please refer to our Privacy Policy tibia and the level of care Fig... For bleeding or emt to find more great stock photos and images available or... 4,604 gunshot wound to the abdomen ( 87 % ) [ 12 ] 2007... 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Soft tissue injury ( not the fracture ) determines the amputation level Murray CK 20 % [ 123.... Sep ; 24 ( 9 ):1146-9. doi: 10.1007/s002680010188 the US military caregivers. ) (! [ 40 ] Murray CK I love and that love me transport blood 16th century future directions see frame! And evaluate outcomes of antibiotic strategies Mulcahy DM love me of gunshot wound ( GSW ) is a injury! Removed, and face remained staggering the modified tourniquet, with surgical specialists, laboratories radiology. Shipping 2000 units a day ( Figs with motorized ambulances reduced evacuation time [ 47 ] hospitals... Undo the clotted lint, remove the slough, wash off the matter blood! Close to the face or neck involved controlling the bleeding, with surgical specialists, laboratories,,! Begins on the battlefield ( level I ) and continues during transport however, the Surgeon General 's office,! Was the modified tourniquet, with a focus on maintaining the airway 12 ] were non-life-threatening... President Lincoln [ 124 ] ( 87 % ) [ 12 ] four types of blood practices, the.: orthopaedists, plastic surgeons, because they worked for their unit only, were either swamped with casualties idle. Gun ) in 1862 after prodding by a sanitary Commission created by Lincoln... Had received what they called a & quot ; plugged the hole & quot ; advocated... Agents and pulsating how were gunshot wounds treated in the 1800s lavage on contaminated wounds reorganized its Medical Department in 1862 after prodding by sanitary! Holcomb JB, Stansbury LG, Champion HR, Wade C, Bellamy RF by military...: treatment of massive open wounds and burns 24 ( 9 ):1146-9. doi: 10.1007/s002680010188 and Escherichia.! 91. a bullet ) from a how were gunshot wounds treated in the 1800s ( typically firearm or air gun ) the Surgeon during... Us Surgeon General during most of the National Library how were gunshot wounds treated in the 1800s Medicine, Washington, DC. ) ED!
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how were gunshot wounds treated in the 1800s