Modern toxic antipersonnel projectiles.

In the spring of 1944, Kurt von Gottberg, the SS police chief in Minsk, was shot and injured by 2 Soviet agents. Although he was only slightly injured, he died 6 hours later. The bullets were hollow and contained a crystalline white powder. They were 4-g bullets, semi-jacketed in cupronickel, containing 28 mg of aconitine. They were later known as akonitinnitratgeschosse. The Sipo (the Nazi security police) then ordered a trial with a 9-mm Parabellum cartridge containing Ditran, an anticholinergic drug with hallucinogenic properties causing intense mental confusion. In later years, QNB was used and given the NATO code BZ (3-quinuclidinyl-benzylate). It was proven that Saddam Hussein had this weapon (agent 15) manufactured and used it against the Kurds. Serbian forces used the same type of weapon in the Bosnian conflict, particularly in Srebrenica.The authors go on to list the Cold War toxic weapons developed by the KGB and the Warsaw pact countries for the discreet elimination of dissidents and proindependence leaders who had taken refuge in the West. These weapons include PSZh-13 launchers, the Troika electronic sequential pistol, and the ingenious 4-S110T captive piston system designed by the engineer Stechkin. Disguised as a cigarette case, it could fire a silent charge of potassium cyanide. This rogues gallery also includes the umbrella rigged to inject a pellet of ricin (or another phytalbumin of similar toxicity, such as abrin or crotin) that was used to assassinate the Bulgarian writer and journalist Georgi Markov on September 7, 1978, in London.During the autopsy, the discovery of a bullet burst into 4 or 5 parts has to make at once suspecting the use of a toxic substance. Toxicological analysis has to look for first and foremost aconitine, cyanide, suxamethonium, Ditran, BZ, or one of the toxic phytalbumins. The use of such complex weapons has to make suspect a powerful organization: army, secret service, terrorism. The existence of the Russian UDAR spray gun in the present day, however, shows that these weapons are still present. The possibility that one might be used to spray a charge of cyanide is still very real, especially as it would not be very difficult for an informed amateur to produce homemade toxic ammunition by adapting existing civil or military cartridges.

[The death of Goffredo Mameli in 1849]. / La morte di Goffredo Mameli a Roma nel 1849.

After the introduction of firearms, which became increasingly efficient over time, the number of seriously injured soldiers increased considerably during the nineteenth century. As a consequence, surgeons were called upon to broaden their activity, performing operations which had hitherto been considered too hazardous, since they were deemed to be too extensive, or were contraindicated by the risk of complications during surgery (haemorrhage, heart and circulatory failure). From 1846 onwards, the introduction of anaesthetic techniques carried out with ether had expanded surgical perspectives in anatomical districts like the abdomen, which were previously considered a sort of taboo, such that few surgeons ventured into the realm of this internal surgery. In the mid nineteenth century the possibility of suffering from severe infections, as an immediate complication after a firearm injury or after surgical intervention, was very high, ranging between 23% in London, up to 80% in Munich, according to the available records; in Zurich a 46% mortality is reported, and a similar 43% rate came from Edinburgh. The situation worsened during war time, since injured soldiers were recovered in extremely precarious conditions, ad hoc hospitals were located in dilapidated old buildings, and the physicians and health care providers were unaware of the minimum hygiene conditions required, and performed both operations and medications without taking sterility measures into consideration. The author reports and comments on the most significant parts on the documents written by Agostino Bertani, who described in full detail the clinical evolution of the wound suffered by Goffredo Mameli, the poet and patriot of the Italian Risorgimento who wrote the Italian national anthem. The clinical evolution of Mameli's disease was unfavourable: he underwent amputation of the left lower limb after the firearm injury suffered during the defence of the Roman Republic, since a gangrenous complication had become apparent. The poet died of septicaemia on July 6, 1849, 17 days after the surgical operation.

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.

In the line of fire--21st-century approach to an ancient war injury.

Authentic black-powder muzzle-loader weapons or replicas are used today primarily for re-enactments of historic battles. A lay actor playing the role of a Prussian infantryman sustained life-threatening gunshot injuries during a recent re-enactment of a historic battle of the Sixth Coalition. As only blank historic muzzle-loading weaponry was used, the origin of the missile causing the wounding was initially unclear. Further investigation revealed a ramrod that had been propelled out of the barrel of another gunner's smooth-bore gun as cause of injury. The ramrod was hurled on a trajectory of more than 20 m, breaking the victim's shouldered barrel and hitting the victim resulting in severe abdominal, thoracic, and upper limb injuries. The critical incidents while handling muzzle-loading weaponry leading to premature discharge are elucidated. Furthermore, this report demonstrates how actual diagnostics and subsequent surgical treatment enabled this infantryman to survive an injury to which his comrades-in-arms would have succumbed 200 years ago.

General Shrapnel and the "unfortunate" Dr. H. J. Shrapnell.

Several aspects of Shrapnell's career are still little known or erroneously typed. 1. Some historians of Medicine profess that Dr. Shrapnell was the inventor of a shell which bears his name. 2. Others neglect the negative points of Shrapnell's paper published in 1832 on the pars flaccida. To be able to comment on these different aspects of Shrapnell's life and work we compared the biographies of the anatomist and of the artillery officer. We noticed the positive and also the negative points of his paper. We conclude that: 1. Dr. Shrapnell was not an artillery officer, but the two men were present in the British Army; their surnames, their names and the period when they lived were about the same. 2. Errors in Shrapnell's paper were due to the philosophy and lack of anatomical and pathological knowledge of the time. 3. Otologists' reception was better than that of the Anatomists because for the Otologists, Shrapnell's membrane was recognized as an important original area of cholesteatoma, whereas for the Anatomists it was just a detail.

Cómo recompensaba el CZar al dentista / How the CZar rewarded the dentist

Un prestigioso odontólogo norteamericano, el Dr. Edward Maynard, célebre fabricante de la carabina que llevó su nombre, tuvo el privilegio de atender al CZar de todas las Rusias y recibir honores y favores de la familia Real. El autor describe las interesantes alternativas del breve paso del Dr. Maynard en San Petersburgo

Duels, doctors and death.

Duelling as a method of settling disputes between gentlemen was practised in the British Isles and on the Continent from the 16th to the beginning of the 20th century. In early duels the victory would go to the better swordsman, but the use of pistols not only made the contest more deadly, but also more democratic. The social aspects, the indications for a challenge, the material and methods and the mortality and morbidity of the contest are considered. Mention is made of a case in which John Hunter was consulted. Its management, progress and autopsy findings are described together with Hunter's thoughts about it and the management of similar wounds.

Muskets, musket balls and the wounds they made.

Gunshot wounds are a common occurrence today in both military and civilian situations. This paper discusses the development of the weapons, their capabilities, the type of wounds produced and their management in earlier times. A brief comparison is made with the wounds produced by modern firearms. It may be concluded that the earlier wounds were simpler due to the lower velocity of the projectile and therefore a more conservative approach to treatment was acceptable.

Principles of management of shotgun wounds.

As an instrument of close range combat, the shotgun has no parallel. At short distances, its destructive capacity parallels that seen from high velocity missile injury. In this study, the history of the shotgun, wound ballistics, principles of initial therapy and special management problems related to shotgun wounds of specific sites are reviewed. An analysis of pooled data on abdominal shotgun wounds is presented. A subset of patients who do not require abdominal exploration exists. Specific problems encountered in defining this subset are enumerated. Three algorithms are presented that summarize our current management approach to shotgun wounds of the torso and extremities.