The Case of the Rotating Bullet

A bullet lies at the apex of the heart

heart vascular health line art

Dr. Lower with his surgical team

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The year was 1915. Europe was at war. Cleveland physicians William E. Lower, MD [known as Ed by close friends and family], and George Crile, Sr., MD, were in France, studying military surgery. The two physicians would go on to share in the founding of Cleveland Clinic in 1921. But at this point, they were partners in a smaller medical practice.

At one point 1915, Dr. Crile had to go back to Cleveland, leaving Dr. Lower at the battlefront hospital. Years later, Dr. Crile wrote — “Soon after my return, I received a letter from Ed Lower in which he said: ‘We have an interesting case of a bullet lying at the apex of the heart and embedded in its outer covering. Fluoroscopic examination shows that the bullet moves in a rotary manner with each heart beat. While it is causing no discomfort, it may later, so I am going to attempt to remove it. Besides who would want to carry the bullet of his enemy in his heart the rest of his life?’

Dr. Lower in operating room (1915)

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“It proved to be a rare case in medical history – one of the first, if not the first recorded case of such an operation upon the heart. Under nitrous-oxygen and novocaine the bullet was removed, Dr. Sherry and Dr. Kieger [two American colleagues] assisting Dr. Lower. I have often heart Eddie Kieger relate the thrill he experience when holding the beating heart in his hand while Dr. Lower extracted the bullet. After a stormy convalescence this Frenchman made a complete recovery and entered the service again. I have always been proud that this unusual case came up in our group.” (George Crile, an Autobiography, edited, with sidelights, by Grace Crile, vol. 1, p. 264.)

This is the first recorded instance of cardiac surgery by a Cleveland Clinic physician – albeit seven years before Cleveland Clinic even existed. Cardiac operations were rare in 1915 and restricted to the great vessels and superficial areas of the heart. It was only with the development of the heart-lung machine in the 1950s that surgeons were able to stop blood flow to the heart and attempt more ambitious repairs. Cleveland Clinic surgeon Donald Effler, MD and his team performed a pioneering stopped-heart surgery in 1956, using a heart-lung machine devised by Willem Kolff, MD, PhD. The patient, a seventeen-month old baby, was described by Time magazine as “the first human subject of the heart-stopping technique.” (Time, April 30, 1956.)

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