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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