Gun Baby Gun: A Bloody Journey Into the World of the Gun (8 page)

War and violence have been the engines of creativity for many things that we take for granted. A material called Cellucotton, for instance,
first used in the First World War to patch up gun wounds, was so absorbent that it caught the nurses’ eyes, and the sanitary towel was invented. The Great War also saw the creation of, or at least popularised, the tea bag, the wristwatch, the zip and stainless steel. But war, most pointedly, has been a constant driver of medicine.

As guns have evolved through the centuries, so too have medical responses to the injuries sustained from them. And the injuries have been terrible. In the fourteenth century, gunpowder’s arrival onto the battlefield made the treatment of trauma wounds far more complex. No longer the splice of a sword or the pierce of an arrow. Rather, embedded bullets, gunpowder burns and gaping holes in flesh changed forever the nature of wounds.

The early modern doctor was ill equipped to deal with such complex trauma. For a time gunpowder’s ability to take life so easily was even put down to the belief it was poisonous and that bullets were contaminants. This led to the medieval practice of burning the wound to rid the body of poison.
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Of course, such treatment probably took more lives than it saved, but it was not until the mid sixteenth century, when the French military surgeon Ambroise Paré, in the thick of battle, ran short of hot oil to cauterise wounds, that anyone challenged this practice and, more importantly, wrote about it. Paré improvised: egg yolk, rose oil and turpentine were used instead, and the benefits were marked. Many more survived under his care.
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But innovation takes time to find roots, and the technique of pouring boiling oil into wounds continued for another 200 years.

Bloody death after bloody death, though, has a horror that cannot be ignored, and the impulse for doctors to learn and to understand remained. Clearly much of that was by trial and error. So the American War of Independence in 1775 saw the surgeon John Hunter suggesting that, if a gunshot wound was to be sewn up, a piece of onion was best put inside, and then the wound reopened after two days. But during the Crimean War in the 1850s, a connection between mortality rates and sanitation was to become firmly established. There Florence Nightingale ‘was to thoroughly scrub the hospital, provide clean bedding, improve ventilation and sewage disposal’, with notable impact on patient mortality – it dropped almost immediately from
52 per cent to 20 per cent.
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This vicious war also saw the widespread use of chloroform to alleviate pain, and plaster of Paris to treat bones shattered by grapeshot.

But, just when it was thought medical discovery was catching up with weapons technology, the Minié ball came along. The round balls used before this tended to remain lodged in the flesh and muscle. The Minié ball, on the other hand, cut straight through, leaving a gaping, haemorrhaging exit wound; the metal rarely remained in the body. If a Minié ball was to strike your bone, it often caused it to shatter, causing damage severe enough to require amputation. It turned mass infantry assaults into mass slaughter.
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Fatality rates shot up; penetrating gunshot wounds to the abdomen reached a mortality rate of 87 per cent. There were over 50,000 amputations in the American Civil War, and infections followed, the spectre of death hard on their tail.
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Tetanus had a mortality rate of 89 per cent and pyaemia, a type of septicaemia, killed 97 per cent of those who developed it.
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So devastating were these odds that, by the Spanish-American War of 1898, the medical profession recognised the urgent need for antisepsis. After reading findings by Louis Pasteur, Joseph Lister carried out experiments using carbolic acid and found it helped massively reduce the patient’s chances of dying if applied following amputations.
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Antiseptic dressings on the battlefield and saline solutions to hydrate patients were also brought into play – innovations conceived on the bloody, ragged fields of war.

Roentgen’s discovery of the X-ray in 1895 further revolutionised trauma medicine. In previous wars, unwashed fingers and metal probes were shoved into screaming men to locate bullets and metal shards. Lost pieces of cloth could be lethally dangerous, suppurating and causing gangrene to topple a man, but the use of X-rays in the field helped pinpoint fabric, bullets and bone fragments. The need for amputation and the subsequent risk of infection were greatly reduced – so much so that what happened to the mortality rates of the US wounded in the Spanish-American War was nothing short of revolutionary: 95 per cent of wounded men recovered.
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It was a far cry from the carnage that had defined the American Civil or Crimean Wars.

Then came the First World War. Those fixed lines of carnage brought their own rat- and slime-filled horror, but they also meant that those who were not caught dying upon rusting barbed wire had a fighting chance of survival. The rapid evacuation of casualties from the front line massively improved a wounded soldier’s chances of living. There was a mortality rate of 10 per cent if those hurt were casevaced within the hour. If you were out in no man’s land for eight hours, your chances of death rose to 75 per cent.
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The Great War also saw the wide-scale use of the tetanus antitoxin, and deaths from lockjaw dropped from 9 per 1,000 wounded to 1.4 per 1,000.
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But perhaps the most significant medical innovation was the first blood bank, established by Captain Oswald Robertson in 1917.
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The Second World War added to this: the development of blood banks continued through the early 1940s, as well as the rapid evacuation of the wounded and the production of penicillin on an industrial scale.
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By the time the Korean War began, things had improved beyond recognition. Casualties were being evacuated by helicopter, and plastic bags had been introduced to replace the glass bottles used to transport blood for transfusions. The conflict also saw the development of mobile army surgical hospital (MASH) units, which brought surgeons to the front lines. They were literally life-changing. A wounded soldier who arrived at a MASH unit had a 97 per cent chance of survival.
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Medicine and surgical techniques have continued to keep up with modern warfare, and their benefits have been passed on to civilians. In 2013 a trauma centre at St Mary’s Hospital in London launched a new medical process based on a protocol developed at the British Army’s Camp Bastion in Afghanistan. It was a triage system to treat gunshot patients as quickly as possible, taking casualties straight to theatre to stem the bleeding.
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Other recent medical innovations in gunshot trauma include the drug Tranexamic acid. In 2010 a study into this drug, originally used to ease heavy menstrual flow, showed it could save the lives of haemorrhaging patients.
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The drug was quickly adopted by the British and US armies and is now seen in many American emergency
departments. There has even been the development of syringes containing tiny sponges that can seal a gunshot wound in seconds.
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The reality of gunshot victims being placed in suspended animation, or ‘emergency preservation and resuscitation’, is also upon us. This involves replacing all of a patient’s blood with a cold saline solution, which rapidly cools the body and stops the majority of cellular activity, giving doctors time to treat the wounds methodically, without the tick-tock urgency of a dying patient on the table.
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But what all of these medical advances mean is that we cannot view the impact of guns solely in terms of the numbers killed by them. Given so many people are now being dragged back from the edges of death by the medic’s steady hand, we have to factor in the numbers wounded by them as well if we are truly to understand the gun’s impact.

The BBC foyer was filled with day-trippers. A coachload of excited, heavy-set tourists were down from the North, full of laughter, teasing each other gently. Some were having a go at being newsreaders in an ‘Interactive Newsroom’ corner. A huge poster of Annie Lennox dressed as an angel looked down. I sat down on a puce kidney-shaped sofa and thought about the person I was to meet: Frank Gardner, the broadcaster’s diplomatic correspondent.

Ten years earlier, Frank had been gunned down by six Al Qaeda thugs in Saudi Arabia. He had been shot a number of times – in the shoulder, leg and, at point-blank range, four times in the lower back. His colleague, the Irish cameraman Simon Cumbers, was killed beside him. Frank had lain there, in a spreading pool of blood, for the better part of an hour until he had been delivered, as minute seeped into agonised minute, into the capable care of a surgeon who had worked in the very South African hospital where I had seen those trauma victims. The training had, clearly, been of use, and Frank survived. Just. The bullets had missed his major organs. But one had clipped his spine and left him partly paralysed in the legs
and dependent on a wheelchair. That was why I was there: because of his pain.

We are seduced by the idea of the wounded poet. The warrior hurt beyond hurt, yet a hero who, against the odds, rises through agony, overturns death and emerges, filled with knowledge, into the light. Perhaps I imagined Frank like this. After all, since the shooting, he had been given a medal by the Queen and written two bestselling books. Following fourteen operations, over half a year in hospital and months of rehabilitation he had also returned to reporting for the BBC. He was probably the most famous person alive who had been severely disabled by a bullet. It struck me that if I was to find a wounded poet, I’d find one in Frank.

The crush of excited tourists meant his approach was obscured by a line of standing figures. But he wheeled through the crowd and was apologetic for being late, shaking my hand firmly. Frank is one of those Englishmen who, in another era, would have been sent off to India to run a colonial province. He had a patrician kindness about him, with lean features and a keen mind. The way he took command of our meeting was fluid and understated – a lesson in leadership and diplomacy. He was, quite simply, charming.

I had hoped for something darker; the journalist in me wanted to paint a picture of arrogance or bitterness or something that would show ugly humanity. But Frank was none of these things.

We went into the building and, over coffee, he made one thing very clear. ‘The BBC have been unfailingly generous,’ he said. ‘And the NHS have been brilliant. I quickly learned that when you are really badly shot up, with multiple injuries, you need the care of a major NHS hospital. There, some of the treatment I had was pretty pricey, like the nutrients they had to feed me through a tube in my chest to keep me alive.’

His rehabilitation treatment was extensive. And that was an important thing to say, because the treatment of the wounded in a developed nation is not cheap. One US review estimated the care costs for regular gunshots victims at $18,000.
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This financial breakdown did not include complicated plastic or neuro-surgery, and other reviews have quoted much higher figures: $48,000 for treating
people shot in the hand;
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over $100,000 for those shot in the face.
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Around the time Frank was shot, the daily cost of care for a spinal-cord gunshot victim in a US hospital was estimated at about $2,000 a day.
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It all adds up. The Pacific Institute for Research and Evaluation calculated that, in 2010, the financial burden of firearm injuries in the US came to $174 billion. They included things like work loss, medical care, mental-health fees, emergency transport provision, police time and insurance claims,
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a bill that was estimated to cost every American $564 a year.
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Just as the long-term pain that guns can bring is hidden, so too is the financial impact caused by them.

In some ways, if one is to see lightness where there is only dark, Frank was lucky. Sixty-two countries in the world do not have gun rehabilitation services of any kind; a shot to the spine would be the end for most.
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In 1994 it was estimated that gun-wound rehabilitation services in developing nations reached, at most, 3 per cent of victims.
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And today it’s only about 15 per cent of people with disabilities in such developing countries who can get devices like wheelchairs.
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The cost is huge, too – one report estimated that treating a gunshot wound in Kenya was twenty-seven times a person’s average monthly salary.
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But these are comparative statistics and figures that offer no comfort to a Westerner who, like Frank, still has to live their days in a wheelchair and in pain. For him the agony of nerves was constant. Some days . . . and his voice trailed off, and you know he’ll always be reminded that the past is real. That scar on his spine will always pull him back to a blood-soaked road and the roaring in his head.