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Bullet and Splinter Wound Care in the Golden Age of Piracy, Page 2

Bullet and Splinter Wound Theory

Since Bullet and Splinter wounds were a combination of broken and unbroken skin wounds, much of the theory of their cure was similar to that used for curing simple wounds. However, there were some differences. Surgeons during this time pointed out a variety of factors including the shape and color of the skin around the wound. Such wounds also proved to be more difficult to cure than simple wounds.

Much was made of the discoloration of the bruised skin surrounding bullet and splinter wounds. Surgeons from this time noted that this skin looked black¹, livid², deadly³, "like Flesh long hang’d in the Air"⁴, evil⁵, decayed⁶,
Bullet Wound to Leg
"greenish, violet or other colour"⁷. It was due in large part to this discoloration that gunshot wounds had previously thought to be poisoned and gangrenous as discussed in detail in the next section. However, such discoloration could also be used in combination with the wound shape to identify such wounds.

Several surgeons pointed out the challenging shape of gunshot wounds, which was often round⁸ like the shot fired from guns during this period. The wounds could also be long⁹, probably as a result of the bullet going into the body at an angle. Sea surgeon John Woodall noted that gunshot wounds could be "triangular, quadrangular, fistulous &c. [etc.]"¹⁰ although such shapes would have been far less likely in gunshot wounds; no other surgeon mentions such shapes.

Round wounds presented a particular healing challenge for a surgeon. French surgeon Ambroise Paré explains, "Wounds which are round and circular are so much the worse [to try and cure]; for there can be no unity [of the skin] unlesse by an angle, that is, a meeting together of two lines, which can have no place in round wounds, because a circular figure consists of one oblique line."¹¹

Perhaps the most salient feature of splinter and bullet wounds was difficulty encountered in curing them. Richard Wiseman said they were "the most complicate[d] sort of Wounds that can be inflicted" because they combined a broken skin wound with "Contusion, Attrition [wearing away], and Dilaceration [torn skin], in a high and vehement kind."¹²

There were a couple different ways of classifying gunshot wounds. John Woodall said "Wounds made by Gunshot are alwaies compound, never simple". 'Compound' wounds normally referred to broken skin wound combined with broken bones.
Photo: US Institute of Health
Bullet Wound Through Femur
Woodall appears to have a different meaning in mind, however. He later explains that such wounds produced "fraction of many sinewy fibres, veynes, Arteries, membranes and bones, yea often shivered [slivered] into divers peeces"¹³. Ambroise Paré is not so limiting, noting that bullet wounds could be both simple and compound, although, similar to Wiseman, he says they "are accompanied with contusion, dilacerations, distemper, and swelling"¹⁴. It was due to this complex nature that these wounds were so difficult for surgeons of this time to cure.

Several surgeons also comment on the lack of bleeding present in forced projectile wounds, which was contrary to their usual experience with simple wounds.¹⁵ Paré suggests that this lack of bleeding was caused "when the parts contused, within some small while after the stroak they swell up, so that they will scarse admit a Tent, whence it is that the blood is stopped, which otherwise would flow forth of the orifice of the Wound"¹⁶. He elsewhere states that "there usually flows no great store of blood from wounds of this nature; for that by the greatness of the contusion and vehemency of the moved air, the spirits are forced in"¹⁷.

Richard Wiseman presents a different theory, suggesting that "Though the Veins and Arteries be wounded, they commonly lie quasht in the contused flesh", which prevented them from bleeding.¹⁸

Woodall thought that such wounds had a particular humoral quality. (Humors were believed to be health-controlling fluids in the body.) He explained that these wounds were "the more difficult of cure by reason of a certaine humor without the veynes found neere them inclining to corruption, the qualitie thereof being changed by the sodaine violence of the blow."¹⁹ Wounds were generally thought to be sites of corruption for the body's humors. It was felt that these corrupted humors produced infection, pain, fevers and even gangrene. However, Woodall's identification of a humor particular to gunshot wounds is most likely related to the idea that bullet wounds were inclined to be poisonous, which is discussed in the next section.

Ambroise Paré also mentions how the particular humoral qualities of certain people wounded by bullets
The Four Humoral Body Types, From
Physiognomische Fagmente,
By J.C. Lavaters (1792) contributed to a more challenging cure. He says "the violence of the blow ...causeth many and grievous symptoms, which are stubborne and difficult, and oft times impossible to cure especially in bodies replete with ill humours... which therefore is subject to putrefaction"²⁰. While this shares certain similarities to Woodall's idea, Paré does not suggest that a unique humor was the cause of the problem. Instead, he says the patient's body type could be inclined towards unwanted humors. Medicine at this time recognized four different body types and Paré linked challenges in healing for certain types in his discussion of simple wounds. For more information on this, see the discussion of diet as it relates to bodily humors.

Period surgeons also identified bullet wounds as being "sinuous" and deep.²¹ This refers to the fact that, unlike other through skin wounds, bullets made destructive trails into, and sometimes even through, the body, leaving a trail of damage. Unlike simple wounds, a bullet wound could destroy 'sinewy fibres, veynes, Arteries, membranes and bones' as Woodall so aptly stated. Such wounds were to be healed from the depths outward. Many large splinter wounds and other types of forceful weapon puncture wounds also required such treatment, although gunshot wounds presented a particular challenge because they were so narrow.

¹ Richard Wiseman, Several Chirurgicall Treatises, 1686, p. 428 & Ambroise Paré, The Workes of that Famous Chirurgion Ambrose Parey, 1649, p. 312; ² John Atkins, The Navy Surgeon, 1742, p. 150 & Paré, p. 315; ³ Wiseman, p. 407; ⁴ Wiseman, p. 428; ⁵ Wiseman, p. 412; ^6,7 Paré, p. 315; ⁸ See Matthias Gottfried Purmann, Chirugia Curiousa: or, the newest and most curious observations and operations in the whole art of chirurgery, 1706, p. 184, John Woodall, the surgions mate, 1617, p. 140 & Paré, p. 315; ⁹ Purmann, p. 184; ¹⁰ Woodall, p. 140; ¹¹ Paré, p. 253; ¹² Wiseman, p. 409; ¹³ Woodall, p, 140; ¹⁴ Paré, p. 315 & 321; ¹⁵ John Atkins, The Navy Surgeon, 1742, p. 148, Paré, p. 315, Woodall, p, 140, Wiseman, p. 409; ¹⁶ Paré, p. 315; ¹⁷ Paré, p. 321; ¹⁸ Wiseman, p. 409; ¹⁹ Woodall, p. 140; ²⁰ Paré, p. 310; ²¹ See for example Paré, p. 319 & Wiseman, p. 415

Bullet and Splinter Wound Disproved Theories

There were two theories related to gunshot wounds that held sway in the medical community before they were disproved by French surgeon Ambroise Paré in the late 16th century. These were that bullets caused poisoning of the wound and that they burnt the skin when they entered
Photo: Lee Hutchinson - Musket Balls From Naseby Battlefield (1645)
the body. This led to a particularly unpleasant form of treatment for such wounds.

German military surgeon Matthias Gottfriend Purman explained, "The Ancients were of the opinion that a Bullet conveyed into the Wound both a burning Heat and a sort of Poyson, and therefore [they] used to cure such Wounds with burning Oils, and such like Medicines, made very hot, which put their Patients to intolerable Pain"¹. They basically cauterized the wound with burning oil. 'The Ancients' refers to books written by important surgeons and physicians of the past. Significant weight was given by surgeons before, during and after the golden age of pirates.

This created an interesting problem for surgeons whose experiences differed from what the revered ancients had written. While explaining why gunshot wounds were not poisoned or burnt, Ambroise Paré said that physicians and surgeons must not "invent new remedies, for these new kinds of wounds [bullet wounds]; the lawes of the sacred and divine Art of Physick ....are established with immutable necessity, which constancy neither consuming time, nor age, nor tyranny can pervert."² However, he also said,

For I shall make it evident by the most strong reasons drawn out of the writings of the Ancients both Philosophers and Physitians, and also by certain experiments of my own, and other Chirurgeons, that the malignancy and contumacy [swelling] which we frequently meet withal in curing wounds made by Gunshot, is not to be attributed either to the poyson carried into the body by the Gunpowder or Bullet, nor to burning imprinted in the wounded part by the Gunpowder.³

Here, Paré may have been down playing his experimental role and couching it in the writings of the ancients in an effort to make it more palatable to a medical community which was invested in learning, teaching and employing the methods of the celebrated past physicians and surgeons. However, his account presents the evidence in a rather straightforward and unapologetic fashion.

Artist: William Holl - Ambroise Paré (19th c.)

Now I had read in John de Vigo [Giovanni da Vigo, a 15th/16th century Italian surgeon], in the first booke of wounds in generall, the eighth chapter, that wounds made by weapons of fire did participate of Venenosity [were poisoned], by reason of the [gun] pouder, and for their cure commands to cauterize [burn] them with oyle of Elders scalding hot, in which should be mingled a little Treackle [Venice theriac - an antidote to poison]; and not to faile, before I would apply of sayd oyle, knowing that such a thing might bring to the Patient great paine...

I was willing to know first, before I applied it, how the other Chirurgions did for the first dressing, which was to apply the sayd oyle the hottest that was possible into the wounds, with tents [rolls of absorbent material, often medicated and used to keep a wound open] and setons [a type of fontanel used to create a wound which allowed pus to escape]; insomuch that I tooke courage to doe as they did.

At last I wanted oyle, and was constrained in steed thereof, to apply a digestive [substance to promote healthy flesh formation in a wound] of yolkes of egges, oyle of Roses, and Turpentine. In the night I could not sleepe in quiet, fearing some default in not cauterizing, that I should finde those to whom I had not used the burning oyle dead imposysoned; which made me rise very early to visit them, where beyond my expectation I found those to whom I had applied my digestive medicine, to feele little paine, and their wounds without inflammation or tumor, having rested reasonable well in the night: the others to whom was used the sayd burning oyle, I found them feverish, with great paine and tumour about the edges of their wounds. And then I resolved with my selfe never so cruelly, to burne poore men wounded with gunshot.⁴

The idea that
Photo: Dr. Andreas Settje - A Gangrened Wound
gunshot wounds were burnt appears to have been largely due to the discoloration of the skin around the wound, as pointed out by several of the surgical authors under study from this period. This coloration also caused some surgeons to suggest the wounds were already gangrened. Richard Wiseman noted that wounds by gunshot, chain-shot and splinters "look black, and do often deceive the unexperienced Chirurgeon, he taking them by their aspect to be gangrened⁵. Sea surgeon John Atkins similar says that such wounds "by their livid Colour, were taken to be gangrened or poisoned"⁶.

However, each of these authors explained why such wounds weren't gangrened or poisoned. Wiseman explains that unlike regular contused wounds, such wounds go "through Flesh and all, as far as the Bullet or Splinter went, extinguishing the natural Heat [where they impact]: So no wonder if it hath the colour of a gangrened or poisoned Wound."⁷

Yet Wiseman elsewhere explains that these wounds "have warmth", something dead, gangrened skin would not.⁸ Atkins explains that "in these Wounds (though large) there is no Danger on account of Colour or Extinction of Heat, unless a very ill Habit [of body - overweight or badly nourished being examples of ill habits of body] and preposterous Method of treating them induce it."⁹ Paré himself said that although the wounds were black, "it is not from the effect of the heat brought thither by the bullet, but the force of the contusion."¹⁰ From this notion the theory of treating bullet wounds as both broken and unbroken skin wounds was built.

In proving his point, Paré examined the notion of how a bullet
Making Black Powder, From Les Travaux de Mars,
By Allain Manesson Mallet,. p. 97 (1672) could come to be poisoned in the first place. He looked at both poison from the bullet and from the gunpowder. With regard to the bullet, he discussed the theory that poisoning and/or burning was due to the heat the bullet had when it struck the body. Paré observed that bullets "cannot conceive such heate, as to become causticke. For if you shoot them out of a Gun against a hard stone, yet you may presently take them up without any harme in your hands, though by striking up on the stone, they should become more hot."¹⁰

With regard to the gunpowder residue poisoning the bullet, he explained gunpowder was composed of a few simple elements: "Charcoals of Sallow or Willow, or of Hemp stalks, Brimstone, and Salt-peter, and sometimes a little aqua vitæ. You shall find each of these, if considered in particular, void of all poyson and venenate [poisonous] quality."¹¹ Purmann actually pointed out that the gun powder worked against the idea of poisoning the bullet, explaining that there was nothing that could be done "to make a Bullet so Poysonous that the subtil Fire of the Gun-Powder [exploding behind and around the bullet] would not spoil the Effects of it"¹².

Mithridate Jar from the Wellcome Collection
Even with all this proof, Richard Wisman noted in the late 17th century that "although they [practicing surgeons] do not call them venomous, yet is it a difficult thing to disswade many of our Chirugeons from dressing these [gunshot] Wounds with Tinctures of Myrrh and Honey of Roses [to prevent decay of the flesh]"¹³. Sea surgeon John Woodall, who usually incorporated a little bit of everything into his remedies, used such medicines to prevent poison in gunshot wounds..

Woodall suggested that if the surgeon was treating a gunshot wound and he feared "venomous vapors may be gathered, give him of good Mithridate, Venice Trekell [medicines thought to be antidotes to poison] {half dram}"¹⁴. He later recommends that "a good Alexiphrmacon or Preservative against poyson be given the sicke, if you see cause, namely a little Venice Trekle or other Treckle on the point of a knife... where unto adde certaine drops of Oyle of Vitriole, for it exceedingly resisteth putrefaction [decomposition]."¹⁵ Still, this was a far cry for cauterizing the wound with hot oils which was the standard practice before Paré. In fairness, Woodall was writing in the early 17th century while many of the other authors under study here were writing after him.

¹ See Matthias Gottfried Purmann, Chirugia Curiousa: or, the newest and most curious observations and operations in the whole art of chirurgery, 1706, p. 184, ² Ambroise Paré, The Workes of that Famous Chirurgion Ambrose Parey, 1649, p. 324; ³ Paré, p. 311; ⁴ Paré, p. 767; ⁵ Richard Wiseman, Several Chirurgicall Treatises, 1686, p. 428; ⁶ John Atkins, The Navy Surgeon, 1742, p. 150; ⁷ Wiseman, p. 428; ⁸ Wiseman, p. 412; ⁹ Atkins, p. 150; ¹⁰ Paré, p. 310; ¹¹ Paré, p. 311; ¹² Purmann, p. 184; ¹³ Wiseman, p. 407; ¹⁴ John Woodall, the surgions mate, 1617, p. 141; ¹⁵ Woodall, p. 141-2

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