Acute Care Surgery and Trauma


Conventional practice dictated that army surgeons open up a gunshot wound—a technique known as “dilatation”— prize out the musket ball or shot with their fingers or forceps prior to cleaning away any debris and dressing the wound. The principle of dilatation stemmed from the belief that gunpowder was poisonous, dating back to its first use in European warfare in the thirteenth century. This doctrine almost certainly increased death and suffering. The acts of incising flesh within a wound were exceedingly painful before the advent of anaesthetic agents and often lead to tremendous loss of blood. In addition, dilatation frequently introduced fatal infection as military surgeons often treated their casualties on muddy, manure-ridden battlefields. 

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