the stems to which the blades are attached work with a cross action, and thus distension of the bullet track is avoided as much as possible. After a foreign body is grasped the two stems of the instrument can be pinned together near the rings or handle by suitable movements of the operator's thumb and finger within the rings, and then the foreign body remains fixed in the grasp of the blades, independently of the operator's hand. This forceps is well designed, strong, and handy, for the extraction of missiles of moderate dimensions.

It

FIG. 49.

Tieman's mouse-toothed bullet forceps. An extractor belonging to the class of forceps instruments, but different in design from the kinds previously described, was manufactured by Messrs. Tieman of New York, and was greatly praised during the war of the rebellion in the United States. was similar to the sharp-pointed bullet forceps previously made by Luer of Paris; the only difference being that in Luer's instrument an additional provision was made for fixing the arms together after the teeth had been imbedded in the bullet. The arms of this forceps are straight, slender, and joined by an ordinary hinge; but instead of terminating in hollow blades, they are furnished with two pointed extremities, long and stout teeth,' which, when closed, overlie each other in such a way as to present a smooth and blunt surface to any object with which they may be brought into contact. When the curved points are separated, they are adapted for biting into any relatively soft substance, such as lead, which may be placed between them. They cannot fix their teeth in a fragment of iron shell, or into a steel-mantled bullet, but can penetrate the cupro-nickel cover of a Lee-Metford bullet sufficiently to get a firm hold This compound metal, though not so soft as lead, is nevertheless softer than the steel points of the forceps. But from the slenderness of the arms of which the teeth are the terminal points, the arms are apt to twist and to loosen their hold, unless they are drawn carefully and in a straight direction

French Army Bullet Forceps.

from the place where the bullet has been grasped. This tendency to twist can be avoided by strengthening the arms, and causing them each to end in two points instead of a single one. Forceps have been made for extracting foreign bodies on this plan, so that they form a sort of vulsellum, and even more teeth have been added behind the front teeth. But the great objection to all such sharppointed forceps is that they are hardly safe instruments, particularly in the hands of novices, when foreign bodies are lodged among important bodily tissues.

FIG. 50.

Although when the forceps is inserted into a wound with its teeth closed it may push aside any bloodvessel or nerve which presents itself, and so may ensure these structures against injury from its points, this offers no security against their being pierced after the claws have been opened and the sharp points are brought towards each other again, or as the instrument is moved about, in the efforts to fix them into the supposed foreign body; nor even, when the points are imbedded in a bullet, against tissues being at the same time hooked inwards and held within the space included between the bullet and the short arms of the instrument. Repeated observations made with such instruments for practising the extraction of bullets from the dead body have shown that, on efforts being made to grasp bullets, the teeth of the instruments have bitten into tissues which have come in their way, and that, too, without conveying any perceptible sensation to the hands of the operators that they have done so. The penetration of the tissues is only made known, indeed, when traction is made upon them in the process of withdrawing the instrument from the wound or by subsequent inspection. Moreover, frequent mistakes were found to be made in the conclusions arrived at respecting a foreign body having been grasped between the teeth, especially when the position of the object sought for was one of much depth and out of sight.

Tieman's Bullet Forceps.

The penetrating power and firm tenacity of grasp of such pointed instruments, when they are applied to substances capable of being penetrated by them, is undoubtedly very great. No forceps, however, depending upon sharp points for its grasp can be employed without causing unnecessary hazard to a wounded man whenever the foreign body to be removed is not in view, for injury can be so much more readily inflicted by a pointed instrument, and so much more unconsciously to the operator, than can happen with extracting instruments which terminate in blunt, smoothly rounded blades, when they are properly used.

FIG. 51.

Forceps for modern small-bore bullets.-The holding power of the varieties of bullet forceps hitherto described partly depends on their capacity for biting into a metal such as lead, a power which they no longer possess when the projectile is protected by a steel or other cover nearly as hard or harder than themselves. In order to get a secure hold of such an armoured projectile, supposing it to preserve its original form, the hollow parts of the two blades should correspond closely with its shape when it has been seized lengthwise, so that it may not slip away from the forceps in the efforts at extraction, or it must be held in suitable depressions when it is caught crosswise. By this latter contrivance it will be grasped securely until it can be adjusted into the position of its long diameter in the forceps by the aid of the surgeon's finger prior to extraction.

ARNOLD & SONS LONDON

PATENT NO4688.

Messrs. Arnold of London, under direction of Professor Stevenson of Netley, have contrived a bullet extractor on the above-named principles. They have modified the dimensions of the ordinary bullet forceps, so as to adapt it for securely holding the armoured bullets of 303-inch diameter used with the Lee-Metford rifle, as well as for other smallbore rifle bullets. The blades are scooped, and each scoop presents a concavity of about 1 inch in length, and inch in width. Two transverse grooves are added for securing the grasp of a narrow bullet if one should chance to be laid hold of athwart the blades. The scoops are not roughened on their inner surfaces as the hold is sufficiently firm without this addition, owing to the manner in which the edges of the scoops are made to overlap and enclose any narrow bullet which may be

Forceps for Small-bore
Bullets.

caught and held between them. The hold of the bullet by the forceps is not so absolute as it would be if the forceps were pronged, and the prongs were hooked into its surface; but it is so securely held that none of the natural tissues through which the forceps would have to pass when being withdrawn from a wound could displace the projectile, while the objections to the addition of teeth which have already been mentioned are avoided. Externally the blades are smooth and polished, and sufficiently narrow when closed to pass without difficulty along any narrow bullet track which is not tortuous in direction. The whole instrument is 9 inches long. The projections of the ridge-and-furrow contrivance near the handles by which the blades are locked when a bullet is held between them, are so inclined that a simple sliding pressure of the surgeon's thumb and finger readily serves to fix or unfix them, and the arms of the forceps do not require one of them to be tilted upwards, as is necessary in the French and some other instruments, for fixing the two arms together.

Delorme's bullet extractor. A similar modification of the bullet forceps hitherto used in the French army, but differing in some of its details from the English extractor, has been designed by Professor Delorme of Paris, for withdrawing compound rifle bullets of 8 mm. diameter from wounds. A figure of this instrument, drawn by Professor Delorme, appears as one of the illustrations in the second volume, recently published, of his work on Military Surgery.26 The excavations of the blades are cylindrical, and equal in length to that of the 8 mm. bullet, viz., 1.25 inch. Their extremities are rounded and smooth externally, and their lip-like terminations are fully open, so that one of the 8 mm. bullets when placed longitudinally can lie between them and the hollows of the blades, as in a bed fitted to receive it. The concave surfaces have a series of rather deep transverse grooves to assist in maintaining the grasp of a bullet when lying between the blades. The sides of the blades have an opening for receiving a bullet in case one should be laid hold of transversely.

Three-bladed forceps.-Grasping instruments have been constructed with three instead of two claws. Some of them are of ancient, some of modern invention. The Alphonsinum,' invented by Alphonse Ferrius early in the sixteenth century, was an instrument of this character; and several others with triple claws are figured in old works.

Ruspini's bullet extractor.-In 1813 Mr. Ruspini published an account of his three-bladed instrument for extracting balls from gunshot wounds.27 It was estimated so highly at the time that a large sum of money was awarded by the Government to its designer for inventing it. The object of the instrument was stated to be in the first place to act as a probe, and secondly, to do away with the necessity of enlarging the openings of wounds either by incision

or dilatation. It consisted of a silver tube, to the extremity of which three claws, each 2 inches in length, were attached by hinges. The claws, when closed together, formed a smooth conical end to the instrument. The claws were capable of being separated from each other by three short springs, which were acted upon by a screw near the handle and a rod passing through the tube of the instrument. The same rod, on a foreign body being grasped by the claws, could cause them to close together upon it.

Ruspini's bullet extractor was issued in army supplies for many years, but has long been abandoned from practical experience of its inefficiency. The idea, however, has been frequently repeated by inventors. It was complicated in construction, liable to get out of order, and was not strong enough to withdraw a projectile, even though it had succeeded in grasping it, when much opposition was offered to its removal by the surrounding tissues. The levers by means of which the blades were opened were very short and weak, and no further power could be brought to act upon the blades than what these levers supplied.

Goodchild's bullet extractor. This is a steel three-bladed forceps, invented by Dr. Goodchild when surgeon of the 1st Warwick Militia Regiment. It resembles Ruspini's forceps in several respects, but differs in the mechanism by which the blades are opened and closed. The opening of the blades is produced by the action of a central rod and screw, together with the elasticity of the blades themselves; while their closure is effected by the action of the screw in the opposite direction. The blades or claws are 2 inches in length when fully expanded, and can be drawn 1 inch into a canula by the screw action. The grasping power of Goodchild's instrument is much superior to Ruspini's, and the construction being simpler, it is less likely to get out of order.

(b.) Bullet extractors of the scoop class.-Scoops are employed with a view to remove bullets by lifting them out from their place of lodgment, and then exerting traction. The position of the bullet having been ascertained, the scoop is passed behind it, and on the instrument being carefully withdrawn from the wound, the bullet is brought away in front of the scoop. Some surgeons consider the scoop a safer appliance than instruments which act by grasping; and also that, when once in front of a scoop, a bullet is less liable to slip away during the extraction than if it were held by pressure between the blades of a forceps.

Ingenious mechanical contrivances have been applied to bullet scoops with a view to facilitate the passage of the instrument along a wound by keeping the scoop, or spoon part of the instrument, in line with the handle until the bullet is reached, and then arranging for the scoop to turn behind it. Weiss's and Tufnell's bullet scoops are examples of different contrivances for this purpose.

Simple scoops.-Ordinary bullet scoops consist of slender