J. Oliver
1915 BMJ (Clinical Research Edition)  
LPit, -r7, iix pucilmothorax in the absenice of anyi signs of sctive intrapulmlonary dlisease oni that si(le -would hiave beeni to lave run aii entirely u1n juLstifiable lrisk of excitillg an effuIsion of uluid -with its accomipal ying discowforts anid dlangers. I milay add ihlat I saw thie patienit, whlose case I qtioted, last weele, two itionitlis after lher disclarge. Sle had been cntirely ftce fieoii aniy reciintence of paiin alnd was in excelleint healtl. ---f anii, ete.. Bliauclhory,
more » ... 1001. GE(wreI1 v LuCAS. SHOULD ALIL BULLETS AND PIECES OF SIIELL! BE IREMOVED? Sirt,-Ilu view of occasional staterments that these slhould be renmo-vcd only if anAd whleln tlhey cause trouible, tlle 'requenicy of readmission of suichl cases as tlhe folloWing in a morning's woek show is instinctive: 1. 2,577; woulldedI on March 20tl. X ray-ed at Havre aind a 'ifle bullet lccated dleep in neck. No paiii from presence of bullet at that timne. Advised to leavo things alone. Selnt home with wouind quite lheale(l. On admission htere (from d6p6t wvlere he reporte(d sick) some paiti oiriotation and exteinsion of thie neck, an(l botlh movements limnited. Againi x rayed, and rifle l)ullet seen (leep on left side, one inchI from second anid third cervical spines and lying wvith its stharp poinlt vertically uipwar(ds. Bullet easily remove(d from pocket of sterile fluidl und(ler local aniaestlhesia. 2. 8,427; 'bullet enitered left thligh above hea(l of femur on November 5thl, 1914. X rayed in a general hiospital and bullet lecate(l. Again .r rayed at local hospital oni returni to depot. At 6ot0t lplaces advised that nio operatioln be done, owing to depth of bullet andi a mini-imutmi of pain. Admitted here oni certificate of reglimental doctor, wvlo refused to send( himil to France unless tile btillet, which was inow givinig some trouble, was remove(d. Againi .r ray-ed and shirapnel bullet located at base of bladder. iSeevere paini oni sittinig an(I when micturatilng. BuLllet remove rer rectuLmii undler spinal anaesthiesia. 3. 7,592; vounadedI October 25thi. X rayed( in a genieral lhospital. Piece of metal in back. said to be too deep for removal withotit grave riskI. No -local l)ain at that timile. X rayed on niflnssion here. Piece bf shlell A in. squiare lying behind lower *(1nd of right kiidniey. 2~in.to-right of first ltulmibar spine and(1 2J in. deep. Paini referr'ed to left kidney, as well as some (liscomiifort on right side of pressuire. Removed under local anaesthesia. 4. 10,094; wounded November 7th. N raved in a general lhospital and sktull trephined over riight froiital bone. Piece of skull wantinig. Admitted hiere for severe headaches and dizziness, dlue, he said, to piece of slhell inbrain. X rayed, and piece of metal seeni inside and close to skull near trephimie opening Operation delayed for exact localization. The piece of shrapnel' has since been removed. Many cases stichi as above lhave come uinder my notice recently, vWhere the reason for non-rew.oval lhas been the (ianger to the patient owing to tlhe deptlh of the bullet or piece of slhell. Surely the dianaer of removal depends as muhelo oln the skill of the surgeon as on tlhe depth of the btullet. Tlhere are few piaces in tlhe body that cannot be reaclhed with safety nowadays by muany surgeons, and the services of suclh are at present available to tlle soldier in general hlospitals throughbout the country. These cases slhould not be senit fromlii sach lbospita's witlh an equivocal opinioni as both timne and 'money are wasted, besides the loss of manii trained soldiers urgently needed at the present mom-ent. Removal ultimately will be insisted on before the soldier is deemed fit for expeditionary worlk. Finally, it is as easy to malinger with a baitlless (?) bullet, as witl a harmless varicocele for all excuise; abd whlatprice his pension wvlhen war is over, no miiatter howinoffensive these
doi:10.1136/bmj.1.2833.698-c fatcat:faei4yaf7vdpvj2tgd7tzajcwe