THE NÉLATON PROBE: GARIBALDI’S
ANKLE AND OTHER TALES
In 1862, Guiseppi Garibaldi, the Italian patriot intent on uniting Italy, crossed from Sicily to Italy’s boot, beginning a march toward Rome. In the town of Aspromonte, Garibaldi met soldiers sent to 
Giuseppe Garibaldi (Wikipedia)
oppose him. Recognizing them as fellow Italians and reluctant to fire, he ventured forward to arrange a truce. Three bullets caught him, two of no consequence and one that ricocheted off a rock into his right ankle. After his capture, at least six doctors examined him and all but one felt that the bullet was no longer in his ankle. Before the
availability of X-rays, locating a bullet in a wound was a challenge for military surgeons. The stakes were high as a retained missile could lead to infection and death.
In faraway England, Garibaldi’s campaign was highly popular and his backers raised money to send a surgeon, Richard Partridge, to assist. Partridge agreed that the bullet was no longer present. Inflammation increased substantially, however, and the Italian doctors invited a French surgeon, Auguste Nélaton, to see Garibaldi. After probing the 
Auguste Nélaton (Wikipedia)
wound, Nélaton opined that the bullet was still in place. But, he wondered, was it bone, and not bullet, that halted his probe? On return to France, he developed a porcelain probe that was unglazed at the tip, which, if rubbed against a bullet, would show traces of lead. He sent the probe to one of Garibaldi’s surgeons, Zanetti, who confirmed that the bullet was still in place.
Partridge heard of this and returned to Italy, this time accompanied by Nicolai Pirogov, the famous Russian surgeon (see essay of Dec. 2016). Partridge reversed his opinion, agreeing with Pirogov that the bullet was present. Zanetti enlarged the wound and extracted the bullet fragment (fragmented because of the ricochet), allowing the wound to slowly heal.
Nélaton probe with unglazed porcelain tip
(National Museum of American History)
On return to England, Partridge’s reputation fell. The medical
Richard Partridge (Wikipedia)
profession accused him of “stealing a patient,” since he saw Garibaldi without an invitation, and the public disparaged him for his error in diagnosis. His practice dwindled and he died poor.
Auguste Nélaton, conversely, enjoyed increased renown. Aged 56 at the time, he had spent six years as an intern and extern under the famous surgeon Guillaume Dupuytren at the Saint Louis Hospital in Paris, rising later to a surgical professorship. In 1867, Emperor Napoleon III appointed him as his personal surgeon, and he attained membership in the French Academy of Sciences. He made contributions to pelvic surgery, lithotomy, and especially to surgery on the maxilla and mandible. He invented the flexible urinary catheter still in use today, a much-appreciated advance over the stiff ones in use at the time. He wrote a large text on surgical pathology and several other works. He accumulated a large fortune but lived modestly.
The prominent Harvard professor of surgery, J. Collins Warren, during study in Europe in 1866 had met both men and wrote that Partridge “was never regarded by his colleagues as an exceptionally brilliant exponent of surgical art.” Nélaton, by contrast, he found refined and highly regarded in surgical circles. Nélaton probes became standard equipment in the military surgeon’s tool kit. Parenthetically, Warren, on his trip had also watched Joseph Lister apply his new antibacterial techniques for preventing wound infections, work as yet unpublished.
The Nélaton probe later found a use on two American presidents. Three years after Garibaldi’s episode, John Wilkes Booth shot Abraham Lincoln in the back of the head in Ford’s Theater, Washington. Dr. Charles Leale, in a nearby box, heard the fatal shot and rushed to help. Leale, a recent graduate of the Bellevue Hospital Medical College in New York, was a young surgeon in the U.S. Army
Hospital in Washington. He found Lincoln slumped forward, unconscious. A clot over part of the occiput showed the wound, which Dr. Leale probed with his finger. Volunteers carried Lincoln across the road to a private home where Dr. R.K. Stone, Lincoln’s personal physician, the Surgeon General, Dr. Joseph K. Barnes, and other volunteer physicians arrived to help. Barnes sent for a Nélaton probe while keeping the wound open with a silver probe (to reduce intracranial pressure). At about 2 AM, as the President was dying, Barnes inserted the Nélaton probe into the wound, twice, and on the second try he claimed to have encountered the bullet, though it was of no help. Five hours later, after a period of loud and “stertorous” breathing, the President expired at 7:20 AM.
Dr. Charles Leale (Wikipedia)
On July 2, 1881, the mentally deranged Charles J. Guiteau shot President Garfield in the back while in a railroad station. Dr. Doctor Willard Bliss (Doctor was his first name), one of the first physicians to examine Garfield, in addition to inserting his unwashed finger into the bullet wound,
inserted a Nélaton probe. The probe encountered only a fractured rib and the bulb on the end, entrapped in the bone fragments, could only be released by pressing on the President’s chest, a painful maneuver. A rib had deflected the bullet so that a straight, rigid probe, such as the Nélaton probe, would not reach the bullet in any case. .png)
Doctor Willard Bliss (Wikipedia)
Another attempt to find the bullet was made by Alexander Graham Bell. He created a device based on magnetic induction that would produce sound when metal entered the circuit. It failed in Garfield's case, Bell surmising that the metal bedsprings interfered with the detection.
Alexander Graham Bell applying his metal detector to President Garfield. Man on the right is
listening for sounds if metal found. (From Frank Leslie's Illustrated Newspaper, courtesy Library
of Congress)
Garfield lingered on for three months, undergoing repeated probes with unclean fingers, until he expired from secondary infection. By this time, the role of germs in wound infections was well known to many in the medical profession, though most of those caring for President Garfield were not believers.
The advent of X-rays, discovered in 1895, soon made the Nélaton probe obsolete. Until then, it was a standard instrument in a military surgeon’s kit.
SOURCES:
Rutkow, Ira, James A. Garfield. 2006; Times Books, Henry Holt & Co.
Dobson, J, “A Surgical Problem of the Last Century.” Ann Roy Coll Surg Engl, 1953; 13: 266-69.
Moscucci, O, “Garibaldi and the Surgeons.” J Roy Soc Med 2002; 94: 248-52.
Sabbatani, S, “Garibaldi’s Wounds.” Le Infezioni nella storia della Medicina. 2010; 18(4): 274-87. (Translated by Google)
Curca, F P and Patrascu, T, “Historical Landmarks of the Use of Nélaton’s Probe in the Surgical Diagnosis of Gunshot Wounds and Two Famous Applications: Garibaldi’s and Lincoln’s Cases.” Roman J Legal Med, 2019; 27: 388-94.
Warren, J Collins, “The Nélaton Probe.” Boston Med Surg J 1919; 181 (8): 235-6.
Mylonis, A I, “Glances in the History of Medicine: Auguste Nélaton.” Hellenic Arch Oral Maxillofacial Surg 2021; 3: 207-12.
Papaioannou, H I and Stowell, D W, “Dr. Charles A. Leale’s Report on the Assassination of Abraham Lincoln.” Accessed at: https://quod.lib.umich.edu/j/jala/2629860.0034.105/--dr-charles-a-leales-report-on-the-assassination-of-abraham?rgn=main;view=fulltext
A full index of past essays is available at: https://museumofmedicalhistory.org/j-gordon-frierson%2C-md
