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SHOULD A BULLET BE REMOVED?

SHOULD A BULLET BE REMOVED? To the Editor:— Please inform me why the physicians attending Colonel Roosevelt thought it advisable to leave the bullet undisturbed. In my opinion, since the bullet is a foreign body, which may travel and cause destructive changes, and since in this instance the bullet is so superficially located that it is easily accessible, I think that it would have been best to remove it. M. A. BERNSTEIN, M.D., Kenosha, Wis. ANSWER.—An idea once fixed in the human mind is exceedingly difficult to eradicate and often descends from generation to generation long after the fallacy underlying the idea has been exposed. That all bullet-wounds should be probed and the bullet removed as soon as possible is one of these erroneous ideas. This idea seems to be fixed not only in the layman's mind, but unfortunately also in the minds of many physicians, notwithstanding the fact that ever since the Franco-Prussian war surgery has diligently taught that bullet-wounds should not be probed and that bullets after they are once lodged are harmless. Not only is probing useless; it may be actually dangerous. It is a common belief that a bullet imbedded in the soft parts is a dangerous thing and likely to cause trouble, but this is not the case. When a bullet is once lodged its power for evil is lost, except in a very small percentage of cases in which the bullet is lodged against the spinal cord, the brain or some equally important or delicate organ. The location of a bullet, therefore, is seldom of immediate importance, but it is very necessary to know what damage has been done by the bullet in transit. . . . A probe cannot give one the information desired but may cause much damage by introducing infection into the wound, by distributing it over a wider area or by reopening injured blood-vessels, etc., all of which, taken with the fact that it is almost always impossible to locate the bullet with the probe anyway, has long since placed a ban on the use of a probe in bullet-wounds. If it is desired to know the location of a bullet that has lodged in the body it can be readily determined by the use of the x -ray. . . . Fortunately, bullets do not, as a rule, carry in infection. Hence, it is unnecessary to pay any attention to them for the time being; in fact, it is better to let them alone until it is determined whether or not there is infection. Much tissue in the track of the bullet has been devitalized and complete rest should be given the part until this has been taken care of, and any meddling with it only increases the chances of infection. After the dangers of infection have passed, if the bullet is in an accessible location, it may be removed or not. It then becomes purely an operation of election. Bullets do not travel in the soft parts and do not cause destructive changes, other than those due to infection which have been mentioned. JAMA. 1912;59(18):1641 Back to top Article Information Editor's Note: JAMA 100 Years Ago is transcribed verbatim from articles published a century ago, unless otherwise noted. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

SHOULD A BULLET BE REMOVED?

JAMA , Volume 308 (7) – Aug 15, 2012

SHOULD A BULLET BE REMOVED?

Abstract

To the Editor:— Please inform me why the physicians attending Colonel Roosevelt thought it advisable to leave the bullet undisturbed. In my opinion, since the bullet is a foreign body, which may travel and cause destructive changes, and since in this instance the bullet is so superficially located that it is easily accessible, I think that it would have been best to remove it. M. A. BERNSTEIN, M.D., Kenosha, Wis. ANSWER.—An idea once fixed in the human mind is exceedingly...
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Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2012.8959
Publisher site
See Article on Publisher Site

Abstract

To the Editor:— Please inform me why the physicians attending Colonel Roosevelt thought it advisable to leave the bullet undisturbed. In my opinion, since the bullet is a foreign body, which may travel and cause destructive changes, and since in this instance the bullet is so superficially located that it is easily accessible, I think that it would have been best to remove it. M. A. BERNSTEIN, M.D., Kenosha, Wis. ANSWER.—An idea once fixed in the human mind is exceedingly difficult to eradicate and often descends from generation to generation long after the fallacy underlying the idea has been exposed. That all bullet-wounds should be probed and the bullet removed as soon as possible is one of these erroneous ideas. This idea seems to be fixed not only in the layman's mind, but unfortunately also in the minds of many physicians, notwithstanding the fact that ever since the Franco-Prussian war surgery has diligently taught that bullet-wounds should not be probed and that bullets after they are once lodged are harmless. Not only is probing useless; it may be actually dangerous. It is a common belief that a bullet imbedded in the soft parts is a dangerous thing and likely to cause trouble, but this is not the case. When a bullet is once lodged its power for evil is lost, except in a very small percentage of cases in which the bullet is lodged against the spinal cord, the brain or some equally important or delicate organ. The location of a bullet, therefore, is seldom of immediate importance, but it is very necessary to know what damage has been done by the bullet in transit. . . . A probe cannot give one the information desired but may cause much damage by introducing infection into the wound, by distributing it over a wider area or by reopening injured blood-vessels, etc., all of which, taken with the fact that it is almost always impossible to locate the bullet with the probe anyway, has long since placed a ban on the use of a probe in bullet-wounds. If it is desired to know the location of a bullet that has lodged in the body it can be readily determined by the use of the x -ray. . . . Fortunately, bullets do not, as a rule, carry in infection. Hence, it is unnecessary to pay any attention to them for the time being; in fact, it is better to let them alone until it is determined whether or not there is infection. Much tissue in the track of the bullet has been devitalized and complete rest should be given the part until this has been taken care of, and any meddling with it only increases the chances of infection. After the dangers of infection have passed, if the bullet is in an accessible location, it may be removed or not. It then becomes purely an operation of election. Bullets do not travel in the soft parts and do not cause destructive changes, other than those due to infection which have been mentioned. JAMA. 1912;59(18):1641 Back to top Article Information Editor's Note: JAMA 100 Years Ago is transcribed verbatim from articles published a century ago, unless otherwise noted.

Journal

JAMAAmerican Medical Association

Published: Aug 15, 2012

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