Object of the Month: July 2019

Kugelzieher after Garengeot, 18 century, NML Medical Museum, N 199. Photograph by Veronika Löblová.

Bullet-drawer (Kugelzieher) after Garengeot, first half of the 18 century

The velocity and force of missiles launched from long-distance weapons grew over the centuries. Fingers, mouth and smith’s tongs served well to pull a simple arrowhead out of the body, one that penetrated bone could be loosened by a drill or a chisel. Medical writers of the Antiquity and the Middle Ages describe special instruments and methods to remove deeply embedded barbed arrowheads; dental extraction instruments were deemed useful as well. In the 7 century, Paul of Aegina recommended using bronze sounds to locate a projectile and determine its shape, metal shafts had been clearly employed both before and later.

Surgeons of the 16 – 18 centuries, the era of expansion of firearms, developed many diverse instruments for locating and extracting bullets. For removing shallowly embedded projectile, the surgeon used tweezers or forceps. Ambroise Paré (1510-1550) depicted various bullet forceps under the name of “beaks” (rostrum). Paré identified the various types by bird names: the short “crow beak” and the curved “crane beak” with crosswise grooved jaws or the straight “duck beak” encircled by a ring that drew the jaws together when the bullet was seized. The Bologna surgeon Bartholomeo Maggi (1516-1552) devised the „ goose beak” with short, circular jaws fitting around a round projectile. In the important 18 century surgical handbook of Lorenz Heister (1673-1758) we still find engravings of these instruments.

Early guns launched bullets relatively slowly (around 300 m/s muzzle velocity): the projectiles ricocheted and changed direction, taking along scraps of clothing or armor and other debris. First, the surgeon had to find the bullet – blindly, without X-ray and attempting to minimize the cut – and then attempted to remove it. If the soft lead bullet pierced bone, the surgeon could drill a hole into it and dislodge it. B. Maggi developed an early drill for finding, drilling and pulling out projectiles. The surgical instrument textbook of Giovanni Brambilla shows both the original Maggi drill and its later version improved by Wilhelm Fabry (1560-1634). The „acological cabinet,“ the NML Medical Museum old surgical collection, includes two of these instruments as well.

The three-pronged bullet drawer (tire-balle, Kugelzieher), introduced by the Breton surgeon René-Jacques Croissant de Garengeot (1688-1759) ends, instead of a drill, with a cage of steel springs (Stahlfederkorb). Three curved, elastic blades are linked with a staff and a screw to a handle and enclosed in a metal tube. By turning the handle and the screw back the „cage“ is closed and drawn inside the tube, turning it in the opposite direction opens it and pushes it forward. First, the closed cage functions as a sound. When the foreign object is found, its blades stretch out around it and close again, preventing it from slipping.

During the 18 and 19 centuries many other instruments for bullet removal and their modifications appeared. Pierre Francois Percy’s (1754- 1825) tribulcon, a 19 century war surgeon’s “Swiss army knife,” combines the functions of a spoon, a forceps and a drill. The branches of the forceps, held together with a peg, are hollow and round on one end to grasp the bullet. On the other end, one branch ends with a larger scoop, while a slim drill with a ring handle is embedded inside the other. The Coxeter scoop, with a smooth round spoon at the end and a sharp forked shaft to hold the bullet, was a standard British Army surgical instrument until the 1900s. In the 19 century, porcelain sounds marked black by the lead of the bullet, magnets and electrical detectors were employed as well.

The design of bullet-removing instruments inspired also the tools of early 19 century urology. Were a bullet embedded deep in the body, encasing the drill or the blades inside a metal tube prevented damage to surrounding tissue. An analogous tube allowed accessing and removing or crushing stones in the urinary bladder via the urethra, a much safer intervention than “cutting for the stone” through the perineum. Lithotriptors for crumbling bladder stones sheathed both the blades and a sharp, forked staff inside the same tube.

In the 20 century, the era of the bullet drill ended. During World War One, the character and the measure of gun wounds changed drastically, with most wounds caused by shrapnel shells, bomb and grenade fragments or land mines. Extensive, open and often infected wounds required tissue removal, not searching for bullets; X-rays rather than metal sounds were used to find an elusive projectile. Seeing the location of the projectile allows a surgeon using modern imaging technology to remove it using a scalpel and forceps. The ingenuity of artifice shown by ingenious instruments of centuries past continue to command our interest and admiration.