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The Great War (1914-1918) Forum

Remembered Today:

War Wounds


RMF

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Could any of the contributors to the forum comment on the circumstances surrounding medical decisions during the Great War to leave shrapnel or bullets in place rather than attempt to remove them from the wounded. Was the decision to leave bullets or shrapnel in place common or rare? The son of a Great War veteran once told me that his father died many years after the war ended when a piece of shrapnel in his father's neck shifted, causing him to bleed to death in his sleep.

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The decision to remove or leave a piece of shrapnel or a bullet will have depended on a number of factors. Henry Sessions Soutar, a British surgeon who worked in Belgian hospitals during the war, wrote:

'Amongst all the cases which came to us, certainly the most awkward were the fractured thighs. It was not a question of a broken leg in the ordinary sense of the term. In every case there was a large infected wound to deal with, and as a rule several inches of bone had been blown clean away. After some hesitation we attempted the method of fixation by means of steel plates... The missing portion of bone was replaced by a long steel plate, screwed by means of small steel screws to the portions [of the bone] which remain... The result was a brilliant success. We were told... that the patient would come to a bad end through the violent sepsis induced by the presence of a "foreign body" in the shape of the steel plate. But none of these disasters happened, the cases did extremely well.

And this brings me to a subject on which I feel very strongly, the folly of removing bullets. If a bullet is doing any harm, pressing on some nerve, interfering with a joint, or in any way causing pain or inconvenience, by all means let it be removed, though even then it should in most cases never be touched until the wound is completely healed. But the mere presence of a bullet inside the body will of itself do no harm at all. The old idea that it will cause infection died long ago. It may have bought infection with it; but the removal of the bullet will not remove the infection, but rather in most cases make it fire up. It may be mark of a Scotch ancestry, but if I ever get a bullet in my own anatomy, I shall keep it'.

Souttar gives quite a nice list of indications to remove a foreign body. Other factors influencing the choice will include the surgeon's preference and, possibly most important of all, whether there was actually the time and equipment to do it. There are definite occasions when you would not attempt to remove a bullet or piece of shrapnel; where the nature of the procedure needed to get it would actually place the person's life at risk.

Without knowing the exact details of the specific case you mentioned, I think it highly unlikely that this was the cause of death. To die in one's sleep suggests that the death was painless and did not waken the person. Bleeding into the neck in sufficient quantity that the person dies would not be painless! The pain of an expanding mass of blood would quickly become extreme, not to mention the likelihood of the person waking as the haematoma (collection of blood under the skin) began to press on the windpipe. Having said which, however, nothing would surprise me. The only other point to make is that fiddling around in the neck to extract a piece of shrapnel is not something I would have been keen to do if at all possible. There would be quite a high likelihood of bleeding to death or other serious complications at the time of the procedure, especially if it had penetrated to an awkward place in the neck.

Robert

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RMF,

You may find these articles interesting - they are a superb resource (click on 'Surgery'):

http://www.ku.edu/carrie/specoll/medical/medindex.htm

Although 'shrapnel' has now become a generic word for any piece of ordanance fragment it should technically only apply to the projectile of a shrapnel shell ie a lead ball. Pieces of shell casing are really fragments or shards. However, these days everyone just calls it shrapnel. :D

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Many years ago a local ex-soldier achieved some fame (newspapers, TV) when he had to see his doctor about a painful lump on his shoulder. An x-ray showed that it was a bullet which had been deliberately left in a hip wound during the Great War (probably just as Robert describes.) Over the next 50 years the bullet had moved through the man's muscle tissue where it had been no trouble at all until it found its way to just below the surface of the skin.

Tom

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Different War but a gentleman I knew had to go for a stomach X-Ray in the 1980's.

When the plates were exposed he was asked if he had ever been wounded.Yes,he replied "suffered grenade wounds whilst serving with the 8TH Army in the Desert but they assured me they had extracted all the pieces!".

He had great delight showing copies of the plates bearing testimont to the fact that he still carried pieces of German Metal in his body after over 40 years!

George

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My grandfather carried a small piece of shell fragment in the back of neck until he died. It was apparently only discovered in the 1950's when he went to hospital for a check up on an unrelated matter. The doctors decided to leave it there as it was not causing him any trouble.

Terry Reeves

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And another war again.

I served with (and still good friend) with a fellow who was wounded in Vietnam. "Shrapnel" from a round that had hit the bipod of the GPMG that by coincidence was in front of his face at the time (he was "changing his arcs" while patrolling) entered his eye. They had "bumped" a bunker system that they were unaware was there.

Apparently the round was aimed at his face.......

Anyway, by the early 1980's when I ran into him and to the present day, he occasionally rubs his eye from irritation, to find a small shard of metal (lead) on the tip of his finger…..

(He was also the strangest person I had ever to wake for his turn at “stag”. Only ever approach from the feet end – good practice anyway coz you cannot charge a man who takes a swing at you when you grab him on the shoulder to wake him! He would sit up and look around and then you could see him wake up. Comes from 2 tours in Vietnam as a section machine gunner including some very “hairy” fights like FSB Coral)

Cheers

Edward

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I would like to thank those who provided their comments on this subject thus far. My father was wounded in the right arm, the bullet lodging between elbow and wrist, by machine gun fire in the Great War as a result of which he received a partial disability pension. The bullet was never removed.

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My grandfather was shot throught the chest in September 1918 with the bullet lodging in the left side of his back. I never met him, he died before I was born, however my father remembers him offerring people a feel of the lump as a bit of a party trick.

Rgds

Tim D

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  • 2 weeks later...

I spoke to a Great War veteran in Scotland during the 1970s and he told me that a piece of shrapnel( shell splinter) had worked its way up his body and into his throat and he had eventually coughed it up. He calimed that it had stillbeen shiny! I always wondered whetehr that would have been possible presumably in an anaerobic environment so difficult to rust but would body fluids have caused corrosion?

Greg

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I have a 1918 book by an American surgeon (Dr. Penhallow) who worked during the war at the American Women's War Hospital. The book reviews all his cases and discusses any new developments and treatments particular to war wounds.

His advice was to remove all foreign objects if possible because they carried in items such as much, uniform, etc. that could become infected. He analyzed bullet wounds and shell wounds and compared them, concluding that usually bullet wounds were "cleaner". So, the focus should be on removing shell fragments. His cases are illustrated with original x-rays showing the placement of the bullets and shell fragments.

The Carrel-Dakin treatment helped ease infections, but it was not ideal, and treatment needed to commence early on.

Dr. Penhallow left the wounds open with drainage tubes before closing them to ensure all the infection had cleared.

He didn't discuss leaving anything in place, but I would suspect that the reason would be similar to today's medicine. For example, recently in my community a boy was shot by a pellet gun in the brain and they have had to leave the pellet in place because moving it would cause problems.

Article attached - Oct. 23, 1916

post-3-1108848462.jpg

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He calimed that it had stillbeen shiny! I always wondered whetehr that would have been possible presumably in an anaerobic environment so difficult to rust but would body fluids have caused corrosion?

There are very few places inside the body that have fluids as such. In theory, you can regard the intestines, and the contents thereof, as being 'outside' the body. The intestines are an internal extension of the outside world that is fully enclosed. Here you do get the corrosive fluids produced by the stomach. The lining of the stomach is heavily protected with a mucous/slime barrier to prevent tissue corrosion, something that occurs with stomach ulcers. Apart from blood, urine, and the fluid that surrounds the brain and spinal cord, the rest of the body is pretty much 'solid' ie not fluid. Though the body is made up mostly of water, the water is contained in tissues, such as muscle and liver to mention the two largest. When you make a cut in tissues you get blood from the cut blood vessels but you do not (usually) see fluid weeping from the cut surface. Then you get things like bone and fat. Thus a foreign body would not be subjected to corrosion (otherwise tissues would be corroded as well). It might well have been shiny because the body would have recognised any foreign organic matter on the metal as being a source of infection and the specialised white cells would have set about cleaning debris off it. It is possible for objects to work their way through the body tissues.

Robert

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Guest Simon Bull

My Grandfather was in Great War tanks. My mother recalls my grandmother removing from his skin (using tweezers) small pieces of metal that had worked their way to the surface. My Mum was not born until 1934, so this would have been in the 30's or 40's. The pieces of metal appear to have been tiny splinters, possibly of "splash" from inside the tank. These had obviously taken years to work to the surface.

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Evening all.

I used to know a Parachute Veteran from Arnhem,who took a load of shrapnel from a mortar blast.

Every now and then,a splinter would work it's way to the surface,and depending on where it was,and how big it was,decided if the Doc could do it,or whether he had to go into hospital.

The strangest thing i have ever read about bullets in the body,was another WW2 story,in one of Richard Ambrose's books.

A doctor looks at an X-ray,and sees a bullet bouncing up and down in a blokes heart!.

Seems it hit him near a main blood vessel,worked it's way up into his heart,went through one ventricle,and was left in the other,with no way out.

Doesn't say if they left that one where it was,but i can't see that they would have had much choice.

Scary.

All the best.

Simon.

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A doctor looks at an X-ray,and sees a bullet bouncing up and down in a blokes heart!.

Seems it hit him near a main blood vessel,worked it's way up into his heart,went through one ventricle,and was left in the other,with no way out.

Simon

Not sure it would be inside the heart. It could well have lodged in the tough membrane that surrounds the outside of the heart, which would make it look as it were inside the heart on some x-ray views.

To go from one ventricle to another would have caused a hole-in-the-heart - a very serious one. Blood would bypass the lungs, shunting from the right heart into the left, with extremely serious consequences. This type of hole-in-the-heart is not the same as the one that you often hear about, for example with Kanu the Nigerian footballer. A ventricular septal defect (a hole in the wall between R and L ventricles) can occur as a congenital problem; occasionally after a heart attack. If it is small enough (ie pinhole) then you can get away with it till surgery. But anything bullet-size would be potentially life-threatening, and would certainly make the person very unwell.

Robert

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Interestingly enough, well relatively interesting anyway, the grandfather of one of my brother's colleagues received a bullet wound to the head in 1918, which although not fatal immediately was deemed to be so serious that it would kill him within months. So much so in fact, that he was discharged from the army with a full pension for life, which I presume the War Office assumed, would be about 3 months. However he lived until he was 90 odd and never needed to work again!

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