Mankind found it immensely difficult to treat gunshot wounds in the field. For centuries people believed that bullet wounds were “poisoned”. In this excerpt from the author’s book ‘The Fascinating History of Medicine and Surgery in the World’, be surprised by the outrageous treatments of the past.
Hollywood or Bollywood, they never cease to amaze you with their patent stupidities. You are all familiar with the famous trope of drums of fuel exploding in big balls of fire the moment they are hit by bullets. So much so that they regularly show cars flying some 20 feet vertically up in the sky the moment their fuel tanks are hit. Never mind that it is impossible. A similar explosion of stupidity is seen in respect of bullet wounds.
In the 1988 Hollywood action film Rambo III set in the backdrop of the Soviet-Afghan War (1979-89), the hero Sylvester Stallone takes you through a most outrageous trip of epic stupidity. He is shot by a rifle bullet in the flank. The bullet is lodged in the flesh. This, by itself, is impossible. Unless the bullet was shot from a mile away, rifle bullets have so much velocity that they would go through the torso like a knife in butter. In any case, Rambo uses his thumb to push the bullet out of his side. The stupidity does not end there. Lo and behold, what comes out of his muscular flank is not the bullet but the entire cartridge! Omisosh! For this monstrosity alone, the director Peter MacDonald and script write Stallone himself ought to have been whipped publicly.
But the insult to our intellect does not end there. Rambo uses his custom Bowie knife to open up the cartridge. The propellant powder is intact inside. You see, the whole cartridge had flown from the enemy’s rifle by magic! Rambo pours the powder inside the entry wound of the bullet and sets it on fire. There is a flash of the burning powder and the viewers of the film who gave it as much as $189 million in that era ($368 million today) are made to believe that the bullet wound healed by that. Rambo continues his fight against the Commies.
So the secret lay in burning the wound, or at least that is what you are made to believe. Burning of wounds is historically known as cauterization. They did it for centuries. Rambo was merely showing you a stupidity that had been practiced for centuries.
Gunfire, besides unleashing slaughter, both fascinated and terrified the medieval warrior. Hitherto, they were used to fighting with opponents armed with weapons they could see coming at them. If you were a man of honour, you picked up a sword and fought. Even if the enemy unleashed a hail of arrows at you, you could see them coming from a distance. If you had some dexterity, you could deflect blows of the blades. Gunfire was a different ball game altogether. You heard a thunder, saw a puff of white smoke and then, out of nowhere, in came a lead ball up to an inch in diameter, and flying at a blistering speed to pierce your body! There was no way you could deflect it or ward it off.
Following a notion put forward by men like Pfolsprundt, Giovanni da Vigo, and Hieronymous Brunscwig in the 15th century, it continued to be believed for centuries that the musket balls propelled by gunpowder somehow poisoned the body, and hence they must be extracted at all costs. The notion still persists in films.
Cauterization of battlefield wounds with burning cautery oil (scalding oil) or hot iron was an ancient method of stopping bleeding and, at the same time, as they believed, ‘neutralized the poison’ in the wound. The basic purpose of cauterization was to stop bleeding from the wounds. The heat burned the blood vessels and, in the process sealed them, thereby reducing or stopping bleeding. It was used for removing unwanted growths also. Hippocrates, for example, used cauterization to burn off haemorrhoids. It was also used for wounds, which they thought were somehow ‘poisoned’. Aulus Cornelius Celsus, for example, recommended it for bites of mad dogs, and blood- and pus-exuding ulcers.
Usually, there were three types of cauterizing irons: button-shaped for penetrating wounds (such as those caused by bodkin arrows, stiletto daggers or later, by musket balls); flat one for broad arrowhead wounds; and one wedge-shaped, like a ship’s prow, for wide wounds such as those caused by spears. They were heated to white-heat in a charcoal brazier. In the 19th century, the wound was cauterized using strong carbolic acid, strong nitric acid or creosote, or silver nitrate also. But white hot iron held its ground. In the field, the sharp end of a poker, or a large nail, was heated white-hot and applied immediately to the wounded surface. Red hot iron caused more pain.
They never realized that it actually caused more damage by increasing the chances of infection in the burned tissues. However, their greater concern had been the immediate issue of stopping bleeding, and not what happened thereafter. Cauterization continued to be practiced not only on gunshot wounds but on other ‘poisoned wounds’ as well such as bites of rabid dogs, wild animals or insects. An English physician, Joseph Fayrer who worked in India, recommended the following for snake bite, “Apply either a hot iron or live coal, or burn some gunpowder on the part; or apply either carbolic or some mineral acid or caustic.”
Cauterization was challenged first by the famous barber-surgeon Ambroise Pare. Despite not having a university education, like a true scientist, he believed in his own observations rather than on the reputation of famous people of yore. During the Battle of Turin in 1537, he ran out of Elderberry oil used for cauterization, perhaps because of supply-chain issues. He then decided to use an improvisation; a mixture of turpentine, egg yolk, and Rose oil, which he knew had been used in Roman times for dressing wounds. To his utter surprise, there was a radical difference in the recovery of the soldiers treated that way compared to the cases that were cauterized. Those who were cauterized with scalding oil were feverish and tormented with much pain and their wounds were swollen, whereas those treated with his method did not have that much pain and the wounds were not inflamed. He tried this many times in others too and was convinced that cauterization only added to the victim’s woes.
The next leading light of military surgery after Ambroise was John Hunter, famous as the ‘Father of Scientific Surgery’. He formed his views based on his observations on casualties of the Seven Years War (1756–1763) on the Bell Isle and summarized them in his book ‘A Treatise on the Blood, Inflammation, and Gunshot Wounds’ published after his death in 1793.
He criticized the practice of dilating or enlarging the wound to search for the bullet lodged in the tissues, which was difficult to find and if found at all, often irremovable. He argued against the age-old belief that the bullet would cause some sort of poisoning in the body and held that the bullet unless lodged in a vital part, would do little harm if left as it was. He pointed out that unnecessary surgery often caused more harm than good. He clearly understood that gunshot wounds differed from other open wounds because of their higher degree of tissue damage. He said that let the wound suppurate. The body will throw off the dead material in the form of a ‘slough’.
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But, as it happens with most novel and intelligent ideas, the genius of Ambroise Pare and John Hunter was defeated by the sheer weight of collective stupidity of the human race. That is how even as late as 1998, Hollywood felt free to pamper to this stupidity.
Cauterization is used even today but in the form of electro-cauterization and chemical cauterization to burn off tissues by electricity (low voltage, high amperage to cause local heating) or chemicals (like silver nitrate) in a relatively pain-free manner and in a sterile setting. They are used, for example, for cosmetic removal of warts, skin tags and stopping nosebleeds, etc.
