Muskets, musket balls and the wounds they made

Death on a Napoleonic battlefield - Peri-mortem trauma in soldiers from the Battle of Aspern 1809

On the 21^st-22^nd of May1809 Napoleon Bonaparte saw his first major defeat on land at the Battle of Aspern, just north-east of Vienna. Of the 167,000 soldiers who fought for the French and Austrian armies, a total of 55,000 died on the battlefield. Salvage excavations prior to the construction of large urban development project (2008-2016) have revealed several burial sites related to the Battle of Aspern. The skeletal remains of 30 soldiers were excavated and underwent a detailed bioarchaeological study to elucidate both the impact of 19th-century military conditions on soldiers in life, as well as how they died on the battlefield. This paper presents the analysis of peri-mortem trauma observed in 21 of the 30 skeletons (70.0%) excavated from the battlefield of Aspern. Following standard criteria in forensic and palaeopathological trauma studies, this study revealed a predominance of ballistic trauma (20 cases in 17 individuals), while only nine individuals (eleven cases) displayed evidence of blunt force trauma. By contrast, no evidence of sharp force trauma was identified in the skeletal remains. These results are discussed within the historic context of the Napoleonic Wars to reconstruct causes of injury and circumstances of death.

Selective non-operative management of civilian gunshot wounds to the abdomen: a systematic review of the evidence

BACKGROUND

Selective non-operative management (SNOM) of penetrating abdominal wounds has become increasingly common in the past two or three decades and is now accepted as routine management for stab wounds. Gunshot wounds are more frequently managed with mandatory laparotomy but recently SNOM has been successfully applied. This review systematically appraises the evidence behind SNOM for civilian abdominal gunshot wounds.

METHODS

A Medline search from 1990 to present identified civilian studies examining success rates for SNOM of abdominal gunshot wounds. Case reports, editorials and abstracts were excluded. All other studies meeting the inclusion criteria of reporting the success rate of non-operative management of abdominal gunshot wounds were analysed.

RESULTS

Sixteen prospective and six retrospective studies met the inclusion criteria, including 18,602 patients with abdominal gunshot wounds. 32.2% (n=6072) of patients were initially managed non-operatively and 15.5% (n=943) required a delayed laparotomy. The presence of haemodynamic instability, peritonitis, GI bleeding or any co-existing pathology that prevented frequent serial examination of the abdomen from being performed were indications for immediate laparotomy in all studies. Delayed laparotomy results in similar outcomes to those in patients subjected to immediate laparotomy. Implementation of SNOM reduces the rates of negative and non-therapeutic laparotomies and reduces overall length of stay.

CONCLUSIONS

SNOM can be safely applied to some civilian patients with abdominal gunshot wounds and reduces the rates of negative or non-therapeutic laparotomy. Patients who require delayed laparotomy have similar rates of morbidity and mortality and similar length of stay to those patients who undergo immediate laparotomy.

Gunpowder, the Prince of Wales's feathers and the origins of modern military surgery

BACKGROUND

The history of military surgery claims many forebears. The first surgeon-soldiers were Homer's Machaon and Podalirius, followed a thousand years later by the Roman surgeons-general, Antonius Musa and Euphorbus; and later, e.g. Ambrose Paré, John Hunter and Sir John Pringle; and the 19th century innovators, Dominique-Jean Larrey (France), Friedrich von Esmarch (Prussia) and the Russian, Nikolai Pirogoff. The singular feature that distinguished modern military surgery from its earlier practice was the use of gunpowder. It was one of two inventions (the other was printing) that by the empowerment of individuals, lifted Western humankind from the medieval to the modern era.

METHODS

Research of primary and secondary archives.

RESULTS AND CONCLUSION

Gunpowder was first used in European warfare at Algeceras (1344-1368). Hitherto, the destruction of tissue had been the result of (relative) low-energy wounding with tissue damage caused by incisional or crushing wounds. The founder of modern surgery, Master John of Arderne (1307-1380), wrote of his experience gained as a military surgeon on the battlefield at Crecy (1346). Following Crecy, Arderne was the only chronicler who described the origins of the Prince of Wales's feathers as a royal and later commercial symbol, and the motto 'Ich Dien', 'I serve', as that of hospitals in the Western World. Later advances in military surgery incorporated both clinical experimentation and the innovation of new systems of pre-hospital battlefield care.

Communicating with the family: the risks of medical radiation to conceptuses in victims of major blunt-force torso trauma

BACKGROUND

Trauma surgeons must balance the risk and benefits of diagnostic radiographic procedures on potentially pregnant patients and should know the range and likelihood of effects that radiation might have on pregnancy.

METHODS

We present guidelines for assessing such radiation risks. Knowledge of a patient's pregnancy status and an estimate of radiation dose to the conceptus (low, < 10 mGy [milligray]; intermediate, 10-250 mGy; high, > 250 mGy) allow provisional assessment of radiation-induced risks.

RESULTS

Dose estimates may be estimated at 2 mGy per exposure (radiographs), 5 mGy per slice (computed tomography), and 10 mGy per minute of fluoroscopy, when the conceptus is within the x-ray field. A formal radiation exposure assessment is appropriate when provisional estimates exceed 10 mGy.

CONCLUSION

A simple qualitative dose assessment can inform clinical decisions and guide appropriate triage to more formal quantitative assessment.