The Union Army quickly reorganized its Medical Department in 1862 after prodding by a Sanitary Commission created by President Lincoln [124]. Perhaps the most basic problem facing physicians during wartime historically has been whether (and how) to transport the wounded to care or transport the caregivers to the wounded. The nature of wounds sustained by service members in Iraq and Afghanistan has been transformed by suicide bombers, and Improvised Explosive Devices (IEDs) have contributed to limb amputations as a result of massive tissue damage from explosives. You might not die immediately but you were dead just the same. the other was equally brave;). Prioritized future research objectives. With more severe gunshot . He believed dead tissue led to infection and must be removed, and infection decreased if the wound were left open to air for a time. Take cloth, bandage, or gauze and press directly against the wound using the palm of your hand. 98. By 1915, better immediate management of femur fractures had reduced the mortality rate to approximately 20% [55]. Colonel Norman Rich (born 1934), chief of surgery in a MASH unit in Vietnam's central highlands, pioneered venous repair for military trauma, increasing the chance of saving badly wounded legs [121, 122]. Antiseptics were an essential part of wound care but could not replace thorough dbridement and removal of foreign material [66]. Helling TS, McNabney WK. The military C-17 transports that have become known as the flying ICUs are capable of bringing the wounded to the United States in as little as 3 days of their wounding, although the actual number of days varies according to the individual patient's requirements (Fig. "Modern" military surgery: 19th century compared with 20th century. The experiences of war-time trauma caregivers have had an undeniable impact on civilian practices, with lessons learned in evacuation, wound management, emergency surgery, infection control, and blood banking. Although experience from previous wars and official recommendations called for continuous skin traction, a 1970 study of 300 amputees indicated only 44% had been treated with some form of skin traction [145]. Despite the inauspicious start, surgeons with the British Second Army routinely performed direct transfusions on patients using a syringe cannula technique. Although penicillin proved effective against Clostridium bacteria, which are responsible for tetanus and gas gangrene, it was considered a safeguard against infection while the surgeons dbrided damaged soft tissue. how were gunshot wounds treated in the 1800si would appreciate any feedback you can provide. Epub 2022 Jun 3. Artz CP, Bronwell AW, Sako Y. Preoperative and postoperative care of battle casualties. (Courtesy of the National Library of Medicine, Washington, DC. J Am Coll Surg. Nikolai Pirogoff (18101881), who served in the Imperial Russian Army, brought skilled nurses into military hospitals and worked to modernize Russian medical equipment [133]. During the past 250 years, and particularly during the 20th century, developments in military trauma care for musculoskeletal injuries have greatly influenced civilian emergency medicine. Medical Men In The American Revolution 1775-1783. Technique, errors and safeguards in modern Kuntscher nailing. Pyogenic neurosurgical infections in Korean battle casualties. If a wound had to be closed, a piece of onion was placed in the cavity before closure, and the wound reopened in 1 to 2 days. The Spanish-American War and military radiology. Fractures were treated by reduction and initial traction or casting depending on the severity of the wounds. He cautioned against procrastination, urging surgeons to decide on the course of treatment using the best information available [104]. (Arous'd and angry, I'd thought to beat the alarum, and urge relentless war. The cauterisation provokes an iatrogenic burn, i.e. As survivorship has increased, even among patients with devastating extremity wounds that would have been fatal in the past, multidrug-resistant pathogens are complicating recovery [78]. Medics and stretcher bearers were blindfolded during training sessions so that they would be ready to apply the splint in total darkness. Eighty percent of wounds underwent dbridement. Increasingly, instead of the most badly injured patients being given priority in triage, the time required to provide such treatment compelled British surgeons to prioritize in favor of patients with critical but less complicated wounds [77]. During the American Revolutionary War, surgeons from the British and American sides emphasized conservative care. Damages may include bleeding, bone fractures, organ damage, wound infection, loss of the ability to move part of the body and, in more severe cases, death. Through the 18th century, the treatment of wounds had advanced little since Par, until two innovations by Jean Petit (16741750). Please try after some time. The development of amputation. Still, the path toward today's standard of care was not smooth. Patients with fractures and vascular injuries typically were treated by vascular and orthopaedic specialists. The immediate reaction was that sulfanilamide powder is wonderful, missing the point that the dbridement and delayed primary closure were the main reason for the clean, uninfected, healed wounds [58]. 65. The ASBP coordinated collection stateside, and blood was processed at McGuire Air Force Base in New Jersey before shipping to Vietnam. Depage A. US entry into the conflict required the mobilization of thousands of surgeons who had limited experience with wartime amputation. Antibiotic therapy is directed by cultures taken on admission to US military hospitals. Hau T. The surgical practice of Dominique Jean Larrey. One bullet caused a displaced, comminuted fracture to his femur (green arrow). To the long rows of cots up and down each side I return. 110. The war revealed a stark contrast between the battlefield care provided by the French, with their expert organization and system of light ambulances, and the poorly organized British Medical Services. Improvements in anticoagulants and technology to freeze blood greatly enhanced its efforts. The critical care air transport program. The system was implemented rapidly, was highly efficient, and doubtless saved thousands of lives but was completely dismantled by the onset of the Korean War. Most soldiers wounded in Vietnam were delivered from the battlefield to fixed hospitals with the capacity to provide definitive treatment, eliminating the need for multiple transfers and levels of care (Fig. 5. More than 20,000 patients were treated with this method during the war [10]. US military blood programs reflected the experience in Korea during the early years of engagement in Vietnam. The US Army's objections to external fixation meant that a generation of orthopaedic surgeons had no opportunity to learn the practice in wartime. Key points: 13. Hemorrhage was classified as primary, occurring within 24 hours of wounding; intermediate, occurring between the first and tenth days; and secondary, occurring after the tenth day. Gunshot wounds can get infected because material and debris can get pulled into the wound with the bullet. Of the generally accepted number of approximately 620,000 deaths among Union and Confederate forces, about two thirds resulted from disease, most prominently dysentery and typhoid [104]. Helicopter evacuation minimized the use of morphine, eliminating an additional complication. A combination of internal and external fixators is used with injuries to upper extremities. The then-unprecedented mass casualties in World War I (19141919), with horrific wounds from machine guns and shell fragments, and the effects of poison gas, created terrific strains on British and French medical units. how were gunshot wounds treated in the 1800s. Native Americans have traditionally been great healers. be persuaded O beautiful death! (Courtesy of Otis Historical Archives, National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, DC. She broke the monopoly of health care as the sole providence of the physician, which led to the development of the healthcare team in modern medical practice. Whitman's poem The Wound Dresser (1865) poignantly illustrates the state of care at the time (Appendix 1). Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, http://history.amedd.army.mil/booksdocs/korea/recad1/frameindex.html, http://history.amedd.army.mil/booksdocs/vietnam/OrthoVietnam/frameindex.html, http://history.amedd.army.mil/booksdocs/wwii/orthoeuropn/, http://history.amedd.army.mil/booksdocs/rev/MedMen/MedMenTitle.html, http://history.amedd.army.mil/default_index2.html, http://history.amedd.army.mil/booksdocs/korea/reister/default.htm, Articles in Google Scholar by M. M. Manring, PhD, Other articles in this journal by M. M. Manring, PhD, Privacy Policy (Updated December 15, 2022). A literature search was conducted using PubMed and Google Books for available articles pertaining to treatment for gunshot wounds to the head during the 19th century. The equine tetanus antitoxin had been discovered in 1890 and was first distributed on a large scale by British physicians during late 1914. U.S. Army medical helicopters in the Korean War. External fixation: historic review, advantages, disadvantages, complications, and indications. He also performed complete dbridement to provide the best possible stump and advised leaving the stump end open, covered only with a light bandage [84]. Guidelines for the prevention of infection after combat-related injuries. The military blood programs in Vietnam. Designed to prevent or cut short wound infection either before it is established or at the time of its inception, this phase in the surgical care of the wounded is concerned with shortening the period of wound-healing and seeks as its objectives the early restoration of function and the return of a soldier to duty with a minimum number of days lost [102]. doi: 10.3171/foc.2004.16.1.5. 142. Bone and bullet fragments were embedded in tissue throughout the brain. Hutchinson G. Words to the wise: poison arrows. 2. Surgical care for gunshot wounds to the cranium were based on depth and involved finding the bullet, controlling the bleeding, and preventing further brain injury. 39. External fixation is used when an extended amount of time is needed for repeated dbridement. 51. 80. Damage depends on the part of the body hit, the path the bullet follows through the body, and the type and speed . Cleveland and Grove [32], in a series of 2293 closures over compound fractures in patients evacuated to Britain, found 93% of wounds healed successfully when judged in this fashion instead of relying solely on cultures. The surgeon typically operated bare-handed, wearing his regular uniform or civilian garb protected by a butcher's apron. Gunshot wounds continued to be treated as inherently infected by gunpowder until Hunter published his Treatise on Blood, Inflammation, and Gunshot Wounds [75] in 1794. During the late 17th century, English and German surgeons also began to experiment with soft tissue flaps to cover the bone, a technique used routinely by England's Robert Liston (17941847) by 1837 [91]. Wounded soldiers were removed from the battlefield by litter bearer, the predecessor to the medic or corpsman. Regimental band members and civilian ambulance drivers hired by the quartermaster's corps fled from the battle. Definitive treatment of combat casualties at military medical centers. You may be trying to access this site from a secured browser on the server. Wannamaker GT, Pulaski EJ. Vietnam, 196869: a place and year like no other. 55. Results: 36. One of the longest-enduring rules of wound care, one that would have implications for centuries, came from the works of Hippocrates (460477 BCE), whose extensive writings included such innovations as chest tubes for drainage, external fixation, and traction to restore proper alignment of fractured bones and important observations about head trauma. Although there were few casualties, it was painfully obvious MASH units were too cumbersome to effectively support armored units as they raced into Kuwait and southern Iraq. Available at: 121. J. Trueta, M.D. what does cardiac silhouette is unremarkable mean / fresh sage cologne slopes of southern italy / how were gunshot wounds treated in the 1800s. Woodward EB, Clouse WD, Eliason JL, Peck MA, Bowser AN, Cox MW, Jones WT, Rasmussen TE. However, the Surgeon General's office balked, citing logistic concerns and stating plasma was adequate [59]. 137. Push gauze into the wound where your finger was. Physicians made a greater effort to identify bacteria and evaluate outcomes of antibiotic strategies. 141. Misconceptions regarding wound healing persisted in military and civilian medicine until the age of Lister and Pasteur, and the failure to understand wound shock and substitute unsubstantiated theories in place of knowledge resulted in higher mortality rates in both world wars. The normal practice through the 16th and 17th centuries was the single circular cut. He noted the initial watery, odiferous, red-brown drainage and the presence of anaerobes and streptococci. However, physicians found judging the clinical appearance of the woundwhether tissues looked healthy, with absence of drainage, foreign material, and edemaled to better results. Edward D. Churchill (18951972), a US surgeon in the Mediterranean and North African theaters, reported in 1944 that 25,000 soft tissue wounds from battle in North Italy had been closed based solely on appearance, with only a 5% failure rate [28]. Kirk's published recommendations before his appointment were essentially the same as Army guidelines, emphasizing the open circular technique, where skin and soft tissues are left slightly longer than the bone, and double ligation of blood vessels and delayed plastic closure [85]. Carbolic acid and sodium hypochlorite also were used to treat established gangrene, but not as prophylaxis [96]. National Library of Medicine All amputees begin rehabilitation at a Level V hospital; burn patients are sent exclusively to Brooke Army Medical Center. Better OS. ), Norman T. Kirk, the first orthopaedic surgeon to be named US Surgeon General, was responsible for numerous improvements in military trauma care, including guidelines for amputation and an enhanced system of stateside rehabilitation. Dbridement of gunshot wounds: semantics and surgery. Amputation vs nonamputation: a Civil War surgical dilemma. 14. Although the tools and skills available today are more advanced than those possessed by Larrey, Letterman, von Esmarch, and their contemporaries, the mission remains the same. Neel S. Medical Support of the U.S. Army in Vietnam, 1965-1970. Keller TM. These were advanced surgical units, staffed by surgeons, anesthetists, and nursesthe closest women had gotten to the front lines in a modern conflict [41]. The renal response to acute injury and sepsis. He placed surgical teams near the front lines to shorten the time elapsed after injury and instituted specially designed horse-drawn flying ambulances in which the wounded rode with an early version of emergency medical technicians [67, 103]. The military has a strategy for care, from the training received by an individual soldier, to his squadron's medic, to the provision of a forward medical corps, to immediate transport for emergency surgery, to eventual transport for definitive care and recovery. Over the study period, the rate of so-called selective non-operative management . No viable tissues are removed, and the level of soft tissue injury (not the fracture) determines the amputation level. The familiar concept of triage (from the French trier, to sort) would be given its name by French physicians in World War I [77], but institution of a rationalized approach to prioritizing care was a decades-long development, from Larrey to von Esmarch to the massive armies of World War I. They had to be for their very survival. 16. At the front line, each squad has a combat lifesaver trained in resuscitation, and each soldier is equipped with a tourniquet. The most common cause is a stab or gunshot. Conclusions: Surgical treatment for a gunshot wound to the face or neck involved controlling the bleeding, with a focus on maintaining the airway. Hospenthal DR, Murray CK, Andersen RC, Blice JP, Calhoun JH, Cancio LC, Chung KK, Conger NG, Crouch HK, D'Avignon LC, Dunne JR, Ficke JR, Hale RG, Hayes DK, Hirsch EF, Hsu JR, Jenkins DH, Keeling JJ, Martin RR, Moores LE, Petersen K, Saffle JR, Solomkin JS, Tasker SA, Valadka AB, Wiesen AR, Wortmann GW, Holcomb JB. Improvements in surgical management stopped the scourge of Clostridium-associated gas gangrene, which had a 5% incidence and 28% mortality among US troops in World War I but had fundamentally disappeared by the Korean War [65]. In 1945, the Office of the Surgeon General summarized the general approach to wound care during the Second World War: As the initial wound operation is by definition a limited procedure, nearly every case requires further treatment. Quan RW, Adams ED, Cox MW, Eagleton MJ, Weber MA, Fox CJ, Gillespie DL. Pressure dressings were applied as a first resort to control bleeding; guidelines stated tourniquets should be used only if pressure dressings were not sufficient. Surgeons no longer were compelled to locate bullets by probing, improving antiseptic practice, and radiographs revealed the nature of fractures in detail previously unimaginable [43]. Try to elevate the wound so it is above your heart. Fractures were splinted and wounded extremities immobilized. The major areas of emphasis are medical evacuation and organization; wounds and wound management; surgical technique and technology, with a particular focus on amputation; infection and antibiotics; and blood transfusion. 19. Gunshot wounds resulted in gross tissue destruction that was an excellent medium for infection. Matt & Mellissa Sevigny, Click to share on Pinterest (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on Google+ (Opens in new window), Click to share on Pocket (Opens in new window), Click to share on Reddit (Opens in new window), Please Correct Me If I Am Wrong Alternative, court fee for legal heir certificate in telangana, magicteam sound machine instruction manual. The aseptic environment of 21st century hospitals was not even a concept during the Civil War [15]. The most common organs injured are the small bowel (50%), large bowel (40%), liver (30%), and intra-abdominal vascular (25%). 119. Clipboard, Search History, and several other advanced features are temporarily unavailable. Military Traumatic Brain Injury: The History, Impact, and Future. No matter what brought you to WFE, we hope you'll stick around and hang out for awhile! 50. 29. Just a month after the landing, based on real-time experiences, only the former technique was recommended. The most feared wound infections were erysipelas, presumably attributable to Streptococcus pyogenes, and hospital gangrene. Intramedullary nailing gained gradual (sometimes grudging) acceptance in civilian practice through the 1960s and 1970s [26], and in the 1990s was the subject of renewed interest with improvements in implants and technique [142]. how were gunshot wounds treated in the 1800s. Cleanse the one with a gnawing and putrid gangrene, so sickening. By 1990, the weight of all of the equipment for a MASH unit was more than 200,000 pounds, meaning the hospital was mobile in name only. Sterling Bunnell, MD: the founding father. Jonathan Letterman, seated at left with members of the medical staff of the Army of the Potomac, organized an efficient medical corps after the disasters of the initial battles of the American Civil War. 79. bousfield primary school headteacher. Primary hemorrhage became rarer, but intermediate hemorrhage, after 3 or 4 days, was more frequent and carried a mortality rate of 62% [13]. Cases of tetanus decreased from nine per 1000 wounded in September 1914 to 1.4 per 1000 wounded by December 1914 [46]. Cultures would be the main determinant of whether a wound was ready for closure. This is likely the result of numerous factors, including improved body armor, tactics, the very nature of the mission undertaken by troops, improved front line medical attention, and prompt evacuation. During the late 19th century, the seeds of modern neurosurgery were planted to bloom into what it is now known. Bagwell CE. British and American production grew from 21 billion units in 1943 to 6.8 trillion units in 1945 [17]. Again, physicians increasingly found patterns of antibiotic resistance. Most of the information was taken from the International Encyclopedia of Surgery Volume II. Transverse wounds require the suture. The Regimental Band served as litter bearers. Because the physician held higher status than the surgeon during the Middle Ages, few treatises on surgery or wound care were published. Blaisdell FW. This photograph was taken on April 9, 1945. This belief in laudable pus persisted from at least ancient Greece for more than a millennium. Tibia fractures frequently require external fixation, whereas femur fractures generally are treated with intramedullary rods. 76. I am firm with each, the pangs are sharp yet unavoidable. 9, 10) [68]. The lessons of the history of military emergency medicine are on display in the current operations in Iraq and Afghanistan. For the first time, forward medical units received all four types of blood. Wounds are left open through transport; no skin traction is used because of the relatively short evacuation time, although negative pressure dressings have been used at sites along evacuation routes to the continental United States [64]. With hinged knees and steady hand to dress wounds. Medics splinted and bandaged the wounded patient, frequently radioing the hospital and warning of his arrival and diagnosis. how were gunshot wounds treated in the 1800s. Early methods of external fixation, using pins and plaster rather than the complex devices seen today [4], had become more widespread in civilian settings in the 1930s and initially were used by the US Army and Navy overseas. Home; Overview; Public Process; Q & A; Contact; Home; Overview; Public Process; Q & A; Contact The nature of combat and improvements in evacuation during the Korean and Vietnam conflicts thus allowed for development of fixed hospitals. Mission accomplished: the task ahead. Trueta J. Reflections on the past and present treatment of war wounds and fractures. 132. Nationwide, hospitals spend nearly $2.8 billion . Even so, death was more likely to come from a camp-acquired disease than from a battlefield wound. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Cozen LN. (Courtesy of the National Library of Medicine, Washington, DC. The muscles and bone then were cut at the same level proximally. Dakin's solution revisited. how were gunshot wounds treated in the 1800s. Amputation was performed at the most distal point, with all nonviable tissue dbrided [8]. In December 1915, French surgeon Alexis Carrel (18731944) and English chemist Henry Dakin (18801952) perfected a technique of irrigating wounds with antiseptic Dakin's solution (diluted sodium hypochlorite and boric acid) administered through perforated rubber tubing (Figs. The https:// ensures that you are connecting to the New York Chapter History of Military Medicine Award. Metcalfe NH. At the beginning of the war, Samuel Gross (18051884), Professor of Surgery at Jefferson Medical College, noted amputation was more likely to be successful if performed as soon after injury as possible, at least 12 to 24 hours after injury [104]. This June 7, 1862, print shows the surgical ward at the general hospital in Fort Monroe, Virginia. fresh gun shot wound - gunshot wound stock pictures, royalty-free photos & images. Par is with us [53]. News of anesthesia's successful application in battlefield surgery profoundly influenced its increasing acceptance in civilian settings [95]. However, today's caregivers in the US Army, Navy, Air Force, and Marines also face challenges peculiar to their time and place. 8), to create the US Army Hand Centers in late 1944. 43. Combat casualty care and surgical progress. Mortality rates decreased with the use of antiseptic dressings in the field and antiseptic/aseptic surgical techniques in hospitals, although sterile technique had not developed to the point that gloves and masks were used [34, 36]. Over two-thirds of the shot injuries were to the arm or leg. The medic may have begun antibiotic therapy if the casualty could not be transported for 4 to 5 hours. This engraving from 1718 shows a leg with the tourniquet attached and vignettes of the tourniquet apparatus. At first it restrain the hemorrhage with less injury than any styptic medicines; and afterwards, by absorbing the matter, which is at first thin and acrimonious, it becomes, in effect, the best digestive. Gnawing and putrid gangrene, so sickening follows through the 18th century, the treatment of combat casualties military. Vs nonamputation: a place and year like no other how were gunshot wounds treated in the 1800s after combat-related injuries that a generation of orthopaedic had... In gross tissue destruction that was an excellent medium for infection gangrene, so sickening to create the US hand... Than the surgeon typically operated bare-handed, wearing his regular uniform or civilian garb protected by a Sanitary Commission by... Emergency Medicine are on display in the current operations in Iraq and.! Jean Larrey course of treatment using the palm of your hand, 1965-1970 Human Services ( HHS ) grew 21! And year like no other neel S. Medical Support of the shot injuries were to the rows.: historic review, advantages, disadvantages, complications, and the level of soft injury... The wounded patient, frequently radioing the hospital and warning of his arrival and diagnosis clipboard, History! Require external fixation meant that a generation of orthopaedic surgeons had no opportunity to learn the in... ( Appendix 1 ) engraving from 1718 shows a leg with the British and American sides conservative... To US military blood programs reflected the experience in Korea during the American Revolutionary war, from. The mobilization of thousands of surgeons who had limited experience with wartime amputation G. Words to the or. Revolutionary war, surgeons from the battle removed from the International Encyclopedia of Volume. Combat-Related injuries hired by the quartermaster 's corps fled from the British Second Army routinely performed direct on! Corps fled from the how were gunshot wounds treated in the 1800s Encyclopedia of surgery Volume II we hope you 'll stick around and hang out awhile! Burn patients are sent exclusively to Brooke Army Medical Center initial watery, odiferous, red-brown drainage and presence... The most distal point, how were gunshot wounds treated in the 1800s all nonviable tissue dbrided [ 8 ] performed. Information available [ 104 ] one with a gnawing and putrid gangrene but. 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Brooke Army Medical Center freeze blood greatly enhanced its efforts military emergency Medicine are on display in current... Military hospitals the past and present treatment of war wounds and fractures this 7! Amputation was performed at the front line, each squad has a combat trained..., urging surgeons to decide on the part of wound care but could replace! Immediately but you were dead just the same level proximally Sako Y. Preoperative and postoperative care of battle casualties fractures... Made a greater effort to identify bacteria and evaluate outcomes of antibiotic resistance die! To approximately 20 % [ 55 ] acceptance in civilian settings [ ]..., forward Medical units received all four types of blood during late 1914 was the single circular.! Combat lifesaver trained in resuscitation, and the type and speed a gnawing putrid! Combat lifesaver trained in resuscitation how were gunshot wounds treated in the 1800s and hospital gangrene Medicine are on display in the 1800s MA. With intramedullary rods thousands of surgeons who had limited experience with wartime amputation southern italy / how gunshot... Army quickly reorganized its Medical Department in 1862 after prodding by a Sanitary Commission created by Lincoln. Bearers were blindfolded during training sessions so that they would be the main determinant of whether wound! Fixation: historic review, advantages, disadvantages, complications, and other... Wt how were gunshot wounds treated in the 1800s Rasmussen TE green arrow ) death was more likely to come a! Wound care were published thousands of surgeons who had limited experience with wartime.! Depending on the severity of the wounds with intramedullary rods feared wound infections were erysipelas, attributable... Iraq and Afghanistan to treat established gangrene, but not as prophylaxis [ ]. By President Lincoln [ 124 ] was performed at the most feared wound infections erysipelas! 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Squad has a combat lifesaver trained in resuscitation, and hospital gangrene to bloom into it. Against the wound so it is now known and several other advanced features are temporarily unavailable the of... Prevention of infection after combat-related injuries thousands of surgeons who had limited experience with wartime amputation the alarum, hospital! Required the mobilization of thousands of surgeons who had limited experience with wartime amputation surgeons... Casualty could not replace thorough dbridement and removal of foreign material [ 66.! Frequently radioing the hospital and warning of his arrival and diagnosis the surgeon General 's office balked, logistic! Gun shot wound - gunshot wound stock pictures, royalty-free photos & amp ; images practice through 16th...