From the Confederate States Medical and Surgical Journal, Vol. I, No. 2
(Feb. 1864). Richmond: J. B. McCaw, Ed., pp. 22-23
2.—Letter to the Editor front Surgeon A. Y. P.
GARNETT, on the Use of Nelaton's Probe.
DEAR SIR,—In compliance with your request, I herewith
furnish you with a brief statement embracing the results of my experience with
the use of Nelaton's probes. These highly useful, but simple and ingenious
little instruments, I am informed, were invented by this eminent French surgeon
for the purpose of exploring a gun-shot wound received by the notorious
Garibaldi at the time of his capture. The ball having buried itself in some
portion of the foot, it was found impossible, by any of the ordinary methods of
exploration, to distinguish it from the bony structure into which it had
penetrated.
In this condition the patient was conveyed to Paris and
placed under the professional care of Nelaton, whose operative skill and
brilliant genius has achieved for him so wide-spread and distinguished a
reputation.
Through the instrumentality of these probes, which he
devised for the occasion, he was enabled to discover the exact locality of the
ball and succeeded in removing it from the foot. My attention was first called
to these instruments by Surgeon James Bolton, who had procured them from the
office of the Surgeon-General, with the view of exploring a gun-shot wound of
the thigh of long standing and involving the femur. All preceding investigations
having failed to discover the exact position of the ball and the extent of
injury to the bony structure implicated, I assisted in the examination of the
case, and was surprised, as well as gratified, at the accuracy with which we
detected the ball deeply imbedded in the cancellated structure of the external
condyle. The reliability of the instruments was put to a rigid test in this case
by the mutually corroborative evidence of each, the porcelain bulb exhibiting
clearly the metallic impression, and the canulated nippers unmistakably
confirming the diagnosis by bringing away small portions of the metal.
The details of this case, I believe, have been already
presented to you by Surgeon Bolton, who had immediate charge of the patient.
Case No. 2 was that of Lieutenant R., who, whilst
practising at a pistol gallery in firing with a duelling pistol, accidentally
shot himself through the metatarsal bones of the right foot. I was called to
this case a short time subsequent to the receipt of the wound, but was unable to
discover the position of the ball by the use of the ordinary silver probe or my
finger. There was very slight hemorrhage and the patient was put to bed; a full
anodyne exhibited and cold cloths applied to the wound. He was soon after
conveyed to the residence of Professor Gibson, who was at the time absent from
the city. Some three weeks after, at the request of Dr. Gibson, I was present
and assisted in a thorough examination of the wound, with the determination, if
practicable, of finding and extracting the ball. In passing the probe down the
track of the ball, it soon came in contact with a hard sub-stance, which the
doctor seemed inclined to believe might be the ball, but which we had no way of
distinguishing from the bony structure, unless by cutting down through the soft
parts to the point in doubt. My own impression was that the ball had passed
through the bony arch of the foot, but, as neither of us had found it
practicable to pass the probe through to the soft parts beneath, I was forced to
acknowledge the probable fallibility of such a conclusion. It was finally
determined to submit the case to the diagnostic elucidation of Nelaton's probes.
These having been procured, we first passed down upon the solid body, previously
alluded to, the porcelain bulb probe, and making pressure, whilst giving it a
rotary motion for several seconds, we removed it, and found that no metallic
impression had been left upon it. This operation was repeated with this probe
several times and with similar results in each instance. We next tried the
nippers, and discovered that they contained, when removed, a small piece of
bone. Taking the results of these two examinations in connexion, the one
substantiating or verifying the negative evidence of the other, we were forced
to adopt the opinion, that there was no ball at that point, but that it had
passed through the bony arch of the foot and lodged somewhere in the subjacent
tissues. Acting upon this conclusion, although the most careful manipulation had
failed to indicate the existence of a foreign body at all, an incision was made
through the soft parts beneath and immediately opposite the wound upon the
dorsum of the foot, sufficiently large to admit the introduction of the
index-finger, with which the ball was readily felt lying beneath and in contact
with the metatarsal bones. It is scarcely necessary to add that the ball was
removed and that the patient recovered the entire use of the foot.
Case No. 3 exhibits in perhaps a still more gratifying
manner the important and useful agency of these instruments. On the 18th of
December, 1863, Mr. C. was brought to the Robertson Hospital of this city
suffering with a gun-shot wound of the right thigh, received some six or more
months prior to his admission; the ball having entered the external part of the
thigh, about the junction of the upper with the middle third, and ranged
obliquely inwards and upwards. He stated that he had suffered with severe
constitutional symptoms, his general health having undergone a gradual and
almost uninterrupted decadence since the receipt of the wound; that the wound
had been repeatedly examined by different medical officers, but that on no
occasion had any one of them been able to ascertain the existence or position of
the ball, which still remained somewhere concealed in the limb At the time of
his entrance into the hospital, his general health had somewhat improved,
although he presented a pallid and feeble appearance; he was unable to use the
wounded extremity at all, and was scarcely able to get along with the aid of
crutches. The wound was still discharging slightly, but presented a small red
spot not much larger than a garden pea. There was also an indurated condition of
the tissues along the anterior aspect of the limb and somewhat circumscribed,
which, though not painful to the touch, had given rise to the suspicion that a
large abscess was about to develope itself at that point.
Having procured a long gun-shot probe, I passed it along
the track of the ball until it impinged against the upper surface or periphery
of the thigh bone. With some difficulty and perseverance I finally succeeded in
passing the probe beyond this obstruction, obliquely inwards and upwards,
to-wards the adductor muscles, until it came in contact with a hard, rough body,
which seemed to be lying immediately contiguous to the femoral artery. Taking
into consideration the history of this case, I was somewhat puzzled to determine
whether this body was the ball or a fragment of bone which had been chipped off
at the time the wound was inflicted, when it occurred to me that this important
problem might at once be solved by the unerring test of Nelaton's probes. I was
not disappointed in my anticipated triumph; for, not-withstanding some
difficulty experienced in consequence of the insufficient length of the
porcelain bulb, I succeeded in obtaining the metallic mark at several different
exploratory operations with it. A few days after, assisted by Surgeon Bolton,
the patient, having previously been placed under the influence of chloroform, an
incision was made, about three inches long, through the external wound, down to
the bone, and the track of the ball beyond enlarged with a blunt-pointed
bistoury, to avoid the possibility of wounding the femoral artery. Through this,
an ordinary pair of bullet forceps was introduced and the ball extracted. The
patient had no bad symptoms whatever; the wound healed almost entirely at the
expiration of three weeks, when he was permitted to return to his home on
furlough.
The above embraces the only cases in which I have had an
opportunity of employing these probes; but, limited as my experience has been,
it has demonstrated conclusively to my mind the important advantages secured to
the military surgeon by this useful invention, and I take pleasure, as an humble
member of our profession, in expressing my high appreciation of its merits, and,
at the same time, in acknowledging the obligations under which the profession
has been placed to the distinguished inventor.
It is, perhaps, as well that I should state in this
connexion, that I have experienced great difficulty in removing from the
porcelain bulb the particles of metal, in order that it may be fit for future
use—having failed with warm water, soap and brush, acids and other agents. It
seems that it will be necessary to subject these metallic particles to some
chemical process, by which the metal may be oxidized and formed by the agency
of an acid into some of the soluble salts of lead. Of this, however, you are far
more competent to judge than I am.
[Nitric acid in excess, or acetic acid will cause oxydation
of the metal and the formation of a soluble salt.—ED.]
