Two papers were devoted to it, one by Dr. H. Billet, military physician, on wounds made by war projectiles, the other by Dr. A. Demoulin, surgeon of the hospitals of Paris, who considered only the wounds of civil life.
In war the indication for operation is hemorrhage, or signs of cortical irritation. In uncomplicated perforation in which the projectile lodges in the head, the general rule is to refrain from operation, but it is necessary to watch over the patient carefully, for often an operation is warranted later. Tangential wounds, on the other hand, imperatively demand active and early operation, even in the frequent cases in which the symptoms are not alarming, for secondary infection here is the rule. In fact, statistics prove that the mortality is 20 per cent. if operation is not performed. Operation ought to be performed only when facilities for operation with perfect asepsis are obtainable. Secondary operation is necessary under three circumstances: (1) to ward off infection (the ordinary case); (2) to extract a projectile or foreign body; (3) to treat one of the late complications which darken the prognosis.
Treatment of Head Wounds Made by Small ProjectilesParis Letter—The Twenty-Sixth Annual Meeting of French Surgeons. JAMA. 2013;310(5):540. doi:10.1001/jama.2013.5237