THE 
AMERICAN 
■JWMIN 
GEORGE TIEMANN & GO 
NEW YORK. Entered according to Act of Congress, in the year 1889, by 
GEORGE TIEMANN & CO. 
in the Office of the Librarian of Congress, at Washington. 
CHARLES H. LUDWIG, PRINTER, 10 4 12 READE STREET. PREFACE. 
In surgical works many of the instruments for performing operations 
are not illustrated. In illustrated catalogues, on the other hand, a de- 
scription of the modus operandi is wanting. A good drawing of an in- 
strument imparts an accurate conception of its form and construction. 
A description of the application added to this gives a clearer idea of 
its suitableness to the end proposed. 
These facts have induced the publication of the present volume, in 
which we attempt to explain the use of the instruments and appliances 
by accompanying the illustrations with pertinent quotations from the 
writings of inventors and authors, as published in medical periodicals, 
recent works on surgery, and from other sources ; as far as possible pro- 
per credit being given. By consulting the following pages and comparing 
the observations and experiments of the various authors, practitioners of 
surgery may form their own opinions, and be assisted in the choice of the 
most approved instruments and apparatus for the accomplishment of their 
purposes. 
GEO. TIEMANN & CO. ©wo Silver CQedaes 
AWARDED BY THE 
PARIS EXPOSITION OF 1867. 
Being the only Silver Medals granted to American Exhibitors of Surgical Instruments. 
One Bronze CQedal 
AT 
International Exhibition, 
PARIS, 1867. 
©wo Hu^sni CQedabs and F)onoi^able CQention 
AT 
SANTIAGO, CHILI, 1875. INTRODUCTION. 
SURGERY, OR CHIRURGERY. 
"Gr. %8tp, the hand, and epy'OV, labor: that department of the art of healing which appertains to the diagnosis, 
prognosis and treatment of the class of diseases which require manual or instrumental measures for their cure. The 
sphere of surgery is more limited and at the same time more accurately defined than that of medicine. Surgery divides 
tissues or parts improperly united, and unites those which have been divided when they should remain in unison; 
separates whatever has become dangerous or inconvenient to the patient; removes foreign bodies, or parts of the 
body which from disease or loss of vitality have become foreign, whenever they exert a hurtful influence on the animal 
economy ; restores to their activity or replaces in their natural position portions of the body which have become dis- 
placed ; checks the loss of blood from wounded or divided bloodvessels ; reduces inflammations, or removes puru- 
lent or phlegmonous matter which may have been deposited by them ; repairs and corrects deformities and distortions, 
and effects the replacement of lost tissues. Its means of accomplishing these results are the hand, lint, bandages and 
apparatus of various kinds, cutting, crushing, and probing instruments, catheters, bougies, sounds, forceps, specula, 
&c., and the various forms of cauteries, direct and indirect, liquid and solid. 
" The earliest surgeons of whom there is any record were the Egyptian priests. According to Herodotus, we owe 
to them the use of the moxa and the adaptation of artificial limbs. Among the ancient Hebrews there is but little 
evidence of surgical skill, and that little was confined to the priests. In Greece, surgery is as ancient as the mythic 
period of its history. Chiron the centaur, born in Thessaly, and skilful in the application of soothing herbs to wounds 
and bruises, is the legendary father of Greek surgery. But ^Esculapius, the son of Apollo, said by some to have 
been the pupil of Chiron, though others call him his predecessor and superior, won the highest fame in that early time 
for surgical skill. He is said to have been deified, on account of his wonderful success, about fifty years before the 
Trojan war. Temples were reared for his worship, which became the repositories of surgical knowledge, at Epidau- 
rus, Rhodes, Cnidus, Cos, and Pergamus. Homer has immortalized his two sons, Podalirius and Machaon, the com- 
panions of Agamemnon in the Trojan war, where they rendered essential service in healing the wounds of the Grecian 
heroes. The Asclepiades, or reputed descendants of Hisculapius, retained the monopoly of surgery as well as medi- 
cine in their family. They had established in this period three schools of medicine, at Rhodes, Cnidus, and Cos. 
" Pythagoras, in the sixth century B. C., established at Crotona a new school of medicine, in which his peculiar 
philosophy was probably applied to the art of healing ; among its early pupils was Democedes, eminent as a surgeon, 
who when taken captive by the Persians reduced the dislocated ankle of Darius and removed or in some way cured 
the cancerous breast of his queen Atossa, after the Egyptian physicians had failed. The want of anatomical know- 
ledge, no dissections being allowed, was a fatal bar to any considerable progress in surgery. Hippocrates (about 400 
B. C.) more than any of his predecessors advanced surgical treatment; he reduced dislocations and adjusted fractures, 
used the trephine, applied the forceps in accouchment, made incisions into the kidney for the removal of calculi, per- 
formed amputations, and perforated the cavity of the ribs in empyema and hydrothorax. Interdicted from human dis- 
section, he practised the dissection of the ape tribe, as nearest to man in anatomical structure, and thus obtained much 
knowledge. For a century after the death of Hippocrates we meet few names of note in surgery. The founding of 
the Alexandrian school under Ptolemy Soter, about 300 B. C., was another important epoch in the advance of the art. 
Herophilus and Erasistratus, the two great leaders of the medical school of that university, if it may be so called, were 
eminent both as physicians and surgeons ; with them commenced the practice of human dissections. The extirpation 
of the spleen, and the application of remedies direct to scirrhosities and tumors of that viscus and of the liver, were 
among the bold operations of Erasistratus. To him also belongs the invention and application of the catheter in cases 
of retention of urine. The pupils of these eminent surgeons invented bandages of peculiar forms, and introduced the 
tourniquet and contrivances for reducing dislocations of the femur. One of them, Ammonius, employed an instrument 
for lithontriptic purposes, anticipating Civiale's process. 
" Rome, in the first seven hundred years of its history, produced no surgeons of note. Celsus, who flourished about 
the beginning of the Christian era, was the greatest of the surgeons of ancient Rome, and his observations on injuries 
of the head, on cataract, on the ligature of wounded arteries, hernia, lithotomy, fractures and dislocations, amputations 
and carbuncle, show considerable knowledge. Aretseus, the first to use the cantharides blister, Heliodorus, Rufus the 
Ephesian, all of whom flourished between A. D. 50 and 120, and after them Antyllus, added to the surgical knowledge 
of the time new views of the treatment of injuries of the head, the resort to arteriotomy instead of venesection in 
sudden emergencies of inflammatory action, bronchotomy in some acute diseases of the throat, the radical cure of hy- 
drocele by free incision of the parts, and a more thorough investigation of diseases of the kidneys and the Wadder. 
Galen devoted more attention to medicine than surgery, but his observations on hernia, on luxation of the femur back- 
ward, and on the application of the trephine on the sternum in empyema, are of importance. In the early period of 
Christianity surgery languished ; the early Christians opposed dissection as strongly as the pagans, and by attributing 
V VI 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SURGERY, OR CHIRURGERY. 
the power of healing wounds to martyrs and their relics, discouraged all efforts at improvement in surgical science. 
The first eminent name among the surgeons of the dark ages is Aetius (500 to 550), whose surgical writings are nu- 
merous and valuable. He practised scarification of the extremities in anasarca, operated for aneurism, endeavored to 
dissolve urinary calculi by internal remedies, discussed hernia with great ability, and wrote on encysted tumors, in- 
juries to nerves and tendons, diseases of the eyes, &<;. Alexander of Tralles, a younger contemporary of Aetius, wrote 
treatises, now lost, on diseases of the eye and on fractures, which were highly commended for their originality by 
some of his successors. 
" Paulus yEgineta, in the seventh century, was a surgeon of eminence and considerable originality. His sixth book 
has been considered by many as the best body of surgical knowledge prior to the revival of letters. He recommended 
topical, in preference to general bleeding, as more effective in reducing local inflammation ; resorted to copious vene- 
section to accelerate the painful descent of calculi through the ureters ; opened internal abscesses with caustics ; defined 
the points for performing paracentesis in ascites ; made his incision in lithotomy on one side of the raphe instead of 
the centre, as Celsus had recommended ; practised both laryngotomy and tracheotomy, the latter as a means of carry- 
ing on respiration during occlusion of the larynx ; treated of fracturd of the uatella, and was the originator of the ob- 
stetric operation of embryotomy. 
" The Arabian physicians, who rose into distinction as those of the West declined in reputation, did little for sur- 
gery. Rhazes (about 900) described for the first time spina ventosa and spina bifida, cauterized the wounds from the 
bites of rabid animals, opposed the use of the knife in cancer except when limited and when the whole tumor could be 
removed, and gave a clear and satisfactory description of the treatment of hernia. Avicenna (died about 1036) intro- 
duced the flexible catheter. Albucasis (died about 1106) introduced an instrument for the cure of fistula lachrymalis, 
invented the probang, and in wounds of the intestine practised union of the divided parts by suture with success. 
" In Catholic Europe medical practice and what of surgery remained was mostly in the hands of the clergy until, 
by the edict of the Council of Tours, in 1163, they were interdicted from all surgical practice. The Jews were at this 
period and for a century or two later in high repute as physicians, but they seem to have had a dislike to surgery. 
Guy de Chauliac, a priest, compiled from the Greek and Arabian authors the earliest work of modern times on surgery, 
but with very little judgment of what was worth retaining. For two centuries and more surgery was mainly in the 
hands of illiterate barber surgeons. The revival of surgical science dates from the appearance of Vesalius (died 1564) 
as a teacher of anatomy in Italy, followed soon after by Fallopius and Eustachius. Surgery was then for the first time 
put upon a sound and scientific basis, that of careful dissection, and Ambroise Pare, a French army surgeon who had 
educated himself in anatomical science, was the first of its great lights. He was surgeon successively to four Kings 
of France, and was attached to the French armies as surgeon-general down to 1569. To him we owe the revival and 
improvement of the practice of tying the arteries after operations and wounds, instead of cauterizing them with hot 
iron or boiling oil. The pupils of Pare added little lustre to their master's name ; but in Italy, at the close of the 16th 
century, Fabricius ab Aquapendente flourished at Padua, and his Opera Chirurgica, the first really valuable treatise 
on surgery of modern times, passed through seventeen editions. He was the preceptor of Harvey. Wiseman, ser- 
geant-surgeon to Charles II., was the first eminent surgical writer and practitioner in England. His recommendation 
of immediate amputation in military practice, when the preservation of the limb was impossible, has been followed 
from that time to the present. He left eight treatises on surgery, which are not without value even at the present day. 
" The flap operation in amputation is claimed for James Young, an English surgeon contemporary with Wiseman, 
and also for two French surgeons, Verduin and Sabaurin, of the same period. In Germany, during this century, Hil- 
danus, Scultetus, Purmann, and Heister were the principal surgical writers and practitioners. In Italy the principal 
names of note toward the close of the sixteenth and in the seventeenth century were Taliacotius, the originator of the 
restorative surgery in Europe : Caesar Magatus, who greatly simplified the treatment of wounds • and M. A. Severinus, 
who banished the salves and plasters which in Italy had usurped the place of operations. 
" The eighteenth century witnessed a still greater advance in the science. In England, Percival Pott, well known 
for his investigation of that form of caries of the vertebra known by his name, and the most judicious writer of modern 
times on fractures, amputations, injuries of the head, and diseases of the spine ; John and William Hunter, the 
former the great master of the principles of surgery in the profession ; Cheselden and Douglas, both famous as litho- 
tomists ; and the two Monros, father and son, are among the great names of the surgical profession. 
" In France flourished La Peyronie, at whose instance Louis XV., in 1731, founded the academy of surgery ; Jean 
Louis Petit, the greatest French surgeon of the eighteenth century ; Ledran, Garangeot, and the illustrious Desault, 
the originator of clinical surgical instruction and the inventor of numerous admirable apparatus for the treatment of 
fracture. Among the celebrated surgeons of other European countries were Molinelli, Morgagni, Scarpa, Bertrandi 
and Moscati in Italy ; Deventer, Albinus and Camper in Holland ; and Plainer, Roderer, Brambilla, Theden and 
Richter in Germany. 
" During the eighteenth century the ligature of aneurismal arteries of large size, the treatment of hernia and fis- 
tula in ano, the cure of fistula lachrymalis, and the skilful management of dangerous and difficult parturitions, were 
the most important branches of surgery in which there was a material advance from the preceding century ; the proper 
construction of instruments also received great attention. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
VII 
SURGERY, OR CHIRURGERY, 
" The nineteenth century has, however, done more for the improvement of this science than all the centuries 
which have preceded it. In England, Abernethy, Sir Astley Cooper, Liston, and others of the highest reputation have 
passed away, and others hardly less eminent remain ; in France, Depuytren, Roux, Lisfranc and Larrey have had no 
superiors, either before or after them. • 
" The following may with propriety be particularized as among the improvements of the age in surgery : the in- 
troduction of anaesthesia; resection of the bones at the joints ; the preservation of the periosteum and consequent 
development of new bone; partial amputations of' the foot, as instanced in the operation of Lisfranc for the removal 
of the metatarsus, and of Chopart, Symes, Malgaigne and Pirogoff for disarticulation of tarsal bones; the amputa- 
tions at the thigh and shoulder joints ; the ligature of arteries within the trunk and immediately at their departure 
from it; the resection and removal of portions or even the whole of the upper or lower jaw ; the operation for cleft 
or deficient velum palati or palatine vault; the opening by longitudinal section of the air passages at different points 
to avoid asphyxia ; the resection and extirpation of the uterus, of the ovaries, and of the lower portion of the rectum ; 
the introduction of the silver suture, especially in operations on the viscera, as for recto-vaginal and vesico-vaginal 
fistulse ; the adoption of the immovable apparatus for fractures ; the process for remedying ununited fracture; the 
substitution of milder means for the trephine in all except the most serious cases; the improved treatment of ulcers 
and abscesses; the cure of the most formidable aneurisms by the ligature of the carotid, subclavian, axillary, humeral 
and external and internal iliacs ; the treatment of varicose veins ; the successful treatment of calculus by lithotrity, in 
consequence of the great improvements made in the processes and instruments ; the diagnosis and treatment of tumors, 
whether encysted, fatty, vascular or malignant; the cure of strabismus, and the generally improved treatment of dis- 
eases of the eye, including the invention of the ophthalmoscope by Helmholtz, in 1851, and the reformation of oph- 
thalmic medicine and surgery carried on by Von Graefe, Donders, Bowman, Toynbee, Wilde, Von Troltsch, Politzer, 
and others ; the restorative processes, by which the nose, lip and other parts are reformed from adjacent tissues ; the 
treatment of hareiip and club-foot; and the notable advance consequent upon the conservative treatment of gunshot 
and other wounds of the brain. Modern conservative surgery is marked by the care that is taken for saving blood in 
operations (Esmarch). Excision of diseased joints in cases where the whole limb would formerly have been removed, 
arm or leg can be preserved with a degree of impairment of movement that makes it only less useful than the limb 
before it was diseased. 
" The adoption of the antiseptic system has made it possible to counteract the noxious qualities of ' infected' air in 
hospitals, and with the aid of the new method operations are carried on with diminished mortality and almost assured 
safety, and are made to confer life and health upon thousands who must otherwise have suffered for years or have 
miserably perished. Among the most striking operations of this kind may be named the extirpation of deep-seated 
and important organs, such as the pancreas, spleen, kidney and thyroid gland, the removal of a part of the stomach 
and pylorus (Billroth), and of a part of the small intestine, both with perfect recovery.* Intubation of the larynx, re- 
moval of the larynx and substitution by an artificial voice-organ, has been performed ; the use of the laryngoscope has 
made the easy removal of morbid growths and foreign bodies an every day proceeding. The invention of improved 
ligatures made of various kinds of animal tissue and their application with antiseptic precautions. Wounded joints 
are freely opened and successfully treated. Among the new operations in plastic surgery may be named skin-grafting 
and the transplantation of the cornea, &c.,&c."-"American Cyclopaedia." 
The Past and Present Methods of Operating. 
" Long after anaesthetics came into general use surgeons dwelt with much emphasis upon the necessity of cultivat- 
ing a habit of operating rapidly. Now, while every surgeon aims to diminish the period of anaesthesia, mere haste 
at an operation is only mentioned to be condemned. No part of the elaborate preparations are designed to render the 
operation simply more rapid. One thought and purpose occupy the mind of the surgeon, and that is recovery without 
suppuration. To this end all his preparations are made, and the entire precedure is subordinated. 
"Formerly the surgeon prepared his instruments only by keeping them free from rust, and giving them a fine edge. 
When he operated the instruments were taken from the case, and, without any cleansing, were so placed that he could 
most readily select the one required. During the operation he laid them down, or dropped them, and without clean- 
ing applied them again to the wound. 
"Now instruments are not only protected from rust and all soiling and kept sharp, but long before the operation they 
are placed in a carbolic solution, in order that any possible septic matter on them or their handles may be destroyed. 
Dqring the operation one assistant devotes himself entirely to the duty of handing the instruments to the operator, 
and of receiving them from him and at once submerging them in the disinfectant liquid. To avoid the possibility 
of laying an instrument down on an unclean surface, and then putting it in the wound soiled, towels wrung out of the 
antiseptic fluid are spread around the wound. In preparing a part for an operation, as amputation, the surgeon used 
to do nothing further than, perhaps, to have superfluous hair shaved off, and that, too, often without soap and water. 
Patients brought directly from the street or shop, with limbs begrimed with dirt and filth, were subjected to operations 
without bathing. Even when there was ample time for preparation little or no thought was given to the immediate VIII 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SURGERY, OR CHIRURGERY. 
condition of the part about to be incised. The accumulated secretions of the skin, and the dead epidermis, charged 
with poisonous animal matters, became part of the wound and its immediate surroundings. Through this layer of filth 
the surgeon passed his knife into the living tissues beneath, conveying to the deepest parts of the wound matters of 
untold septic virulence. In this simple failure to secure ordinary cleanliness of the surface, more wounds were poisoned 
and induced to suppurate than from any other cause. In the closure of the wound the filthy margins were often 
brought in direct contact with the cut surfaces, and thus the propagation of the germs of fermentation or putrefaction 
were implanted in a fertile soil. 
"Now, the greatest pains are taken to cleanse the part about to be operated upon. In addition to a general bath, 
the entire limb, including the hand or foot, is washed with soap and water, with a flesh-brush, and all the hairs are 
shaved clean from the part. This washing is followed by a douche of an antiseptic solution, and then all the parts ad- 
jacent to the wound are covered with towels, wrung out of bichloride solution. 
"Formerly the personal preparation of the surgeon and his assistants for the operation was limited to self-protec- 
tion against soiling their clothes or persons. Now the surgeon and his assistants take infinite pains with their hands. 
Soap and water and the flesh-brush are brought into active use, to be followed by a douche of bichloride solution. 
The nails are rendered scrupulously clean. 
" The sponges of former times were universally believed to be the carriers of filth to the wounds, and yet little 
was done to purify them exept to cleanse them in water. 
"Now, the process of purification of sponges is elaborate in the extreme, and is so exact in details as to render them 
perfectly harmless in wounds. 
" The ordinary silk ligatures were formerly regarded as necessarily foreign bodies in wounds, and no care was taken 
of them to improve their condition. They were carried about in any convenient pocket, and at the operation the silk 
was cut of proper lengths, waxed, and then drawn through a button-hole of an assistant, or laid on any convenient 
surface. 
"Now, the ligature undergoes a long process of cleansing and disinfection at the hands of a chemist, and is then 
applied to a reel enclosed in a corked bottle filled with antiseptic fluid. From this bottle it is removed only as it is 
drawn out at the moment of using it. Considering the well recognized fact that the ligature, as formerly used, was an 
intense irritant to wounds, it is not surprising that surgeons applied as few as possible. From time to time they resorted 
to other methods of closing arteries, as by torsion, or metallic wires, to avoid the use of silk. But all these devices 
bore no comparison to the simple and efficient antiseptic ligature of to-day. Reeled off from the bottle, clean, strong 
and supple, the surgeon applies them without other limit than the complete suppression of haemorrhage. 
"Formerly, the operation being completed in the shortest possible time, the operator concluded by exploring all 
parts of the wound with his unwashed fingers. It was a common occurrence, also, for the surgeon to invite any by- 
stander to examine the wound with his fingers, and sometimes several persons would avail themselves of the opportu- 
nity to improve their tactual sensibilities. 
"Now, the most scrupulous care is taken to protect the wound from injury, either at the hands of the surgeon or 
his assistants. No one is now allowed, invited by courtesy or to obtain an opinion, to examine the wound by digital 
exploration unless they have made due preparation for the act. 
" In closing an ordinary wound the surgeon formerly took great pains to provide for the drainage of pus. The 
most dependent part of the wound was left open, and all the ligatures were drawn out at that point. The edges of 
the skin were brought into apposition by the interrupted suture, at intervals of half an inch, and the intervening skin 
was approximated by adhesive plaster. The suture and adhesive plaster were alike unprepared by any process that 
would relieve them of filth, and too often both contained the germs of putrefaction. 
"Now, the surgeon employs sutures that, like the ligatures, have been relieved of all possible elements of poison- 
ing, both in their preparation and in the method of preserving them. Wherever there is a liability of the collection of 
fluid he inserts a drainage tube, to prevent distention of the wound and possible putrefaction. 
"The final dressing of the wound formerly was the adhesive plaster and the bandage for support and retention. 
The plaster was never rendered aseptic, and by its close relations to the wound was dangerous. The bandage was 
usually of unbleached muslin, and had no special cleansing or preparation for the wound. It may not have been 
harmful, but it added to the risks of infection. 
"Now, the wound once closed, is protected from external infection by dusting the surfaces with iodoform. Then 
pads of disinfected materials, with iodoform sprinkled between the layers, are applied; sometimes over a large area 
around the wound, and in considerable numbers. The whole is retained by bandages of disinfected materials, care- 
fully preserved in a disinfected atmosphere. The addition of these external dressings, prepared with so much care, 
and adjusted with so much painstaking, has been very much criticised. It is possible that they are often unduly mul- 
tiplied, but the results justify the faith which so many surgeons have in them. 
" In speaking of the closure of wounds, it should be stated that, while the older surgeons did not close many 
wounds, as those of exsection, surgeons now close all such wounds. The difference in treatment is one of the most 
striking features in the comparison of the surgery of the present time and that of the decade past. The former sur- GEORGE TIEMANN CO.'S SURGICAL INSTRUMENTS. 
IX 
SURGERY, OR CHIRURGERY. 
geon prepared the wound for suppuration, the later surgeon dressed it as for union without suppuration. Both uni- 
formly realized their expectations. 
"If we follow the wounds treated by these two methods, from the first to the last dressings, the contrast is remark- 
able. If the wound were large, on the second or third day the fever formerly began, announcing suppuration, and 
from this date, for weeks after, the dressings were changed daily, one, two or three times. The pus-basin, the irrigator 
and the dressing forceps were in constant demand. In many wounds the suppuration was so profuse that vessels 
were placed under them which received the continuous discharge. The fever generally ran high, with consequent ex- 
haustion and depression of the patient. Septicaemia, as we now understand it, was the intermediary fever of that day, 
and was regarded as a usual, if not a necessary sequel of all considerable operations. Following this fever, or rather 
insidiously engrafted upon it, were chills, fever and profuse sweatings, now recognized as pyaemia, but then regarded 
as only another stage of surgical fever. Few indeed survived this fever; and in the diffused or metastatic abscesses 
revealed at the autopsy the surgeon discovered a cause of death quite beyond his power to prevent, control, or even 
comprehend. The vast change in the progress of operated cases during the past ten years can scarcely be realized. 
The wound is now dressed with no expectation that fever will rise, or that suppuration will occur, or that the dressing 
will require renewal on account of the presence of pus. The patient sleeps and eats well from the first, and the 
surgeon removes the dressing, often only to find the wound united. This remark is true, not only of incised wounds, 
but equally of wounds of amputation, excision, ligation of arteries, &c. 
" In reviewing the surgical practice of Bellevue, it is not difficult to determine the essential feature of the present 
methods as compared with those of the past. Cleanliness is the one great object sought to be attained in all opera- 
tions. Whatever may be the final conclusion of scientific students as to the cause of putrefaction in wounds, practi- 
cally it is determined that the surgeon may, with the most absolute certainty, protect an ordinary open wound from 
suppuration. To effect this object he finds that he has simply to resort to those measures which are known to secure 
perfect cleanliness of the wound. The agents now relied upon and found efficient are : I. Soap and water to the 
external parts ; 2. Carbolic solutions for the instruments ; 3. Bichloride solutions to all surfaces and tissues; 4. Iodo- 
form for external dressings. We may summarize the conditions regarded as essential to success as follows, viz.: a clean 
operator ; clean assistants ; a clean patient; clean instruments ; clean dressings."-Stephen Smith, M.D., Surgeon to 
Bellevue Hospital. Medical Record, November 17th, 1885. 
THE SURGEON'S OUTFIT, OR ARMAMENTARIUM CHIRURGICUM. 
" The surgeon cannot employ rude articles, as a butcher's knife or a carpenter's saw, in amputation, unless he is 
placed under circumstances which prevent his obtaining suitable instruments. And he is required to employ the more 
recently devised instruments which have been recommended by the best authorities as preferable to those formerly in 
use, provided they are reasonably accessible to him. They should be so constructed as to be readily made aseptic and 
maintained in that condition. For this purpose the handle should be, as far as practicable, smooth, and made from 
non-absorbent material, and the setting of the blade should have no recesses for filth. They must be kept in good 
order, as dull knives, broken forceps and imperfect saws seriously complicate operations. They must, finally, be kept 
in a state of scrupulous cleanliness, as blood and pus may convey contagion to the person next operated, and rust and 
filth may fatally poison a wound."-Stephen Smith, M. D. 
The case of instruments which the surgeon must provide depends upon the variety of operations which he under- 
takes. To aid him in selecting his armamentarium is the object of this present catalogue.-G. T. & Co. Extract from General Report of the Judges of Group XXIV. 
Centennial International Exhibition, 1876. 
" The largest collection of instruments was exhibited by Messrs. Tiemann & Co., of New York. It embraced 
almost every instrument used by the surgeon in general or special practice, and some entirely new. In material, 
workmanship, and exquisite finish, they could not be excelled. They were complete in minute detail so essential to 
the formation of a perfect instrument, and gave evidence of scrupulous care and nice appreciation of the wants of the 
surgeon." 
Judges Report on Thermometers and Galvano-Caustic Apparatus. 
"Commended for excellent construction, workmanship and applicability of Clinical Thermometers and Dawson's 
Galvano-Caustic Apparatus." 
" The most complete Battery presented for competition was one exhibited by Tiemann X Co., invented by Di. 
Dawson." 
THE HIGHEST AWARD, GOLD MEDAL, 
AT THE 
Worlds Exposition, New Orleans, 1885. ORDER OF CONTENTS. 
PAGE 
Diagnostic. 
Urinary Examinations 1 
Clinical Thermometers 4 
Mediate Auscultation 5 
Mediate Percussion 7 
Cyrtometric 8 
Cardiometric 8 
Dynamometric 9 
Stethometric 9 
^Esthesiometric 10 
Pulsometric 11 
Microscopical 12 
Post Mortem. 
Embalming 14 
Dissecting 15 
Physiological Experiments 18 
Medicine Cases 19 
Electro-Therapeutic 23 
Electro-Surgery 37 
Thermo-Cautery 39 
Actual Cautery 39 
Dry Cold and Heat 40 
Hot Water in Surgery 41 
Anaesthetic 43 
Antiseptic 49 
Operating Furniture 51 
General Operating. 
Sets of Instruments in Cases 56 
Military Surgery. 
Sets of Instruments in Cases 61 
Major Surgery. 
Sets of Instruments in Cases 63 
Major and Minor Surgery. 
Sets of Instruments in Cases 64 
Minor Surgery. 
Sets of Instruments in Cases 65 
Pocket Instruments. 
Sets of Instruments in Cases 66 
Dressing of Wounds. 
Materials for Antiseptic Dressing of Wounds. 74 
Cleansing Wounds 75 
Drainage 75 
Dressing Instruments 76 
Sutures and Ligatures. 
Sutures, Ligatures, Wire, Whale Tendon .... 78 
Suture Needles 79 
Needle Holders 80 
Probes and Directors 81 
Arrow and Bullet Extracting 82 
Fasciotomy, Miotomy, Tenotomy, Dry Dis- 
secting 84 
Pocket Instruments 86 
Arterial . 88 
Amputating 95 
PAGE 
Amputating. 
Aseptic Knives 96 
Bone Saws 97 
Trepanning 98 
Osteological 99 
Skeletons 99 
Osteotomy 99 
Osteoclasis 114 
Phlebotomy 115 
Cupping, Wet 115 
Cupping, Dry 116 
Leeching 116 
Transfusion 117 
Vaccinating 120 
Dermic 120 
Mercurial Fumigation 122 
Hypodermic 123 
Paracentesis 126 
Aspiration 129 
Ophthalmic. 
Ophthalmoscopes and Accessories 134 
Trial Glasses and Accessories 143 
Palpebral 145 
Lachrymal 147 
Syringes, Douches 149 
Foreign Body 150 
Specula and Lid Holders 151 
Fixators, for the Globe 152 
Strabotomy 153 
Anatomy of the Muscles 153 
Advancement of the Rectus 157 
Anatomy of the Globe 158 
Pterygium and Pannus 159 
Paracentecis Cornese 159 
Artificial Pupil 160 
Keratomy 162 
Iridotomy, Iridectomy, Iridodialysis, Corec- 
topy 163 
Cataract 165 
Cystotomy, Capsulotomy 168 
Expulsion of the Lens 168 
Extraction of Cataract 168 
Extraction of Soft Cataract 173 
The Needle Operations for Cataract 174 
Capsular and Secondary Cataract 174 
Tattooing the Cornea 175 
Extirpation and Enucleation 175 
Electro-magnet in Ophthalmic Surgery 176 
Artificial Eyes 177 
Ophthalmic Sundries 178 
Ophthalmic Operating Cases 179 
Aural. 
Perforating the Lobe 182 
Wounds of the Auricle 182 
XI XII 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PAGE 
Aural. 
Absence of the Canal 182 
Diagnostic 183 
Microcoustic, Ear Trumpets 187 
Foreign Bodies and Polypi 190 
Douches and Syringes 194 
Pus Basins and Spouts. 195 
Applicators 195 
Membrana Tympani and Inner Ear 196 
Mastoid Process 197 
Eustachian Canal 199 
Auscultating the Middle Ear 199 
Politzer's Inflation 200 
Sets of Aural Instruments in Cases 202 
Artificial Ear 203 
Nasal. 
Rhinoplasty .... 203 
Artificial Noses 203 
Simple Obstruction 204 
Rhinoscopic, Anterior 205 
Posterior Rhinoscopy 207 
Douches, Irrigators 209 
Syringes, Applicators, Brushes 211 
Epistaxis 212 
Polypi, Foreign Bodies 213 
Removing Polypi and Hypertrophied Nasal 
Tissue 214 
Ecraseurs, &c 214 
Turbinated Bones 216 
Nasal Septum, deviated 217 
Naso-Pharyngeal 220 
Mouth and Throat 221 
Dental. 
Extraction of Teeth 221 
Tooth Forceps 222 
Turn Keys 228 
Root Extractors, Gum Lancets 229 
Antrum, Abscess of 230 
Harelip 230 
Staphylorrhaphy 232 
Uranoniscoplasty 236 
Specula Oris. 
Cheek Retractors 236 
Mouth Gags 237 
Tongue Depressors. 238 
Tonsillar. 
Anatomy and Physiology of the Tonsils, Uvula 
and Soft Palate 240 
Nature of, and Changes produced in the Ton- 
sils and Uvula 241 
Scarification of Enlarged Tonsils 241 
Tonsilotomy 242 
Removal of Enlarged Tonsils 243 
Uvular. 
Excision of the Uvula 246 
Pharyngeal. 
Pharynx 247 
Pharyngoscopy 247 
Pharyngotomy 247 
Vault of Pharynx 248 
PAGE 
Pharyngeal. 
Cleansing the Nasal Passages 248 
Laryngeal. 
Direct Medication, Spray Apparatus 251 
Application of Medicated Powders 254 
Larynx, Organ of Voice 255 
Examination of the Pharynx and Larynx 256 
Sets of Instruments in Cases 256 
Laryngoscope, Use of 257 
Laryngoscopes and Accessories 257 
Laryngeal Applicators, Probes, Sponge-Hold- 
ers, Drop Tubes, Syringes, Powder Blowers 264 
Porte-caustics 264 
Knives and Scissors, for Operating 267 
Laryngeal Electrodes and Foreign Body In- 
struments 269 
Laryngo-Tracheal. 
Surgical Anatomy 271 
Infra-Glottic Laryngoscopy 271 
Instruments 271 
Stenosis Dilators 271 
Intubation of the Larynx (O'Dwyer's Method) 274 
Extirpation of the Larynx 275 
Artificial Larynx 275 
Tracheotomy, Bronchotomy 277 
Respiratory Apparatus 280 
Inhalers. 
Pneumatic Apparatus, Spirometers 281 
Hot Air, Steam, Vapors and Fumes 283 
Injuries and Diseases of the Chest. 
Abscesses, Empyema, Hydrothorax, Hydro- 
pericardium 288 
Alimentary Canal 289 
(Esophageal. 
Surgical Anatomy of the CEsophagus 290 
Stenosis 290 
Stricture 291 
Removal of Foreign Bodies 292 
Stomachal. 
The Artificial Introduction of Food into, and 
Lavage of the Stomach 293 
Anal and Rectal. 
Rectum and Anus 297 
Examination 298 
Specula and Dilators 298 
Sounds and Bougies 301 
Alimentation by the Rectum, Infusion, Injec- 
tion 303 
Stricture and Fissure, Knives, Directors, &c.. 306 
Dressing, Removal of Foreign Bodies and the 
Application of Remedies 307 
Haemorrhoidal 308 
Pile Bougies and Supporters 312 
Artificial Anus 313 
Hernial. 
Abdominal Hernia, Treatment and Cure .... 315 
Herniotomy, for the Relief of Strangulated 
Hernia 816 
Radical Cure Operations 817 
Taxis, Reduction of Hernia 321 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
XIII 
PAGE 
Hernial. 
Trusses, for Retention of Hernia (Inguinal, 
Femoral, Umbilical) 321 
Abdominal Supporters 328 
Varix. 
Stockings and Belts 330 
Varicocele. 
Suspensories 331 
Operation 334 
Hernia Humoralis 333 
Hydrocele. 
Keyes' Method of Subcutaneous Ligation .... 334 
Phimosis , 335 
Urethral. 
Normal Male Urethra 338 
Scales or Guages, for Grading the Sizes of Ure- 
thral Instruments 339 
Proper Curves for Male Urethral Instruments 342 
Proper Conicity of Sounds 342 
Ocular Inspection 343 
Urethral Stricture. 
Exploring 345 
Treatment 349 
Injecting the Urethra 349 
Application of Cold 352 
Dilators, Bougies and Sounds 353 
Over-distention 356 
Rapid Dilatation and Divulsion 357 
Internal Urethrotomy 360 
Dilating Urethrotomy 364 
Otis' Method 365 
Haemostatic 373 
External Perineal Urethrotomy 374 
Prostatic 378 
Prostatotomy, Prostatectomy 379 
Prostatic Dilators 380 
Tunnelling the Prostate 381 
Urethral and Uro-Cystic. 
Bladder, Anatomy and Physiology 382 
Extrophy. Incontinence of Urine 383 
Urinals for Incontinence 383 
Retention of Urine, Catheters 384 
Irrigation of the Bladder 388 
Dilatation of the Bladder 390 
ParacentesisVesicae, Cystotomy; Rectal, Peri- 
neal and Supra-Pubic Puncture 390 
Digital Exploration of the Bladder (Sir Henry 
Thompson's Method) 394 
Operating Cases, Uro-Cystic 396 
Operating Cases, Stone, Lithotomy 397 
Foreign Body Extractors 398 
Cysto-Lithic, Stone, Lithiasis Cystica, Vesical or 
Urinary Calculus. 
Stone Searchers 400 
Methods of Removal 401 
Lithotrity, Lithotrites 402 
Evacuation of Debris 405' 
Litholapaxy, Rapid Lithotrity with Evacuation 406 
The Ancient Stone Operations 413 
The Modern Lithotomy Operations 414 
PAGE 
Cysto-Lithic. 
The Lateral Lithotomy Operation 416 
The Bilateral Lithotomy Operation 418 
The Median Lithotomy Operation •. 420 
The High Lithotomy Operation 420 
Lithotomy, Apparatus for Securing in Position 415 
Lithotomy Staffs, Directors, Knives, Forceps 417 
Supra-Pubic Lithotomy 420 
High Operation Instruments 423 
Perineal Lithotrity (Dolbeau's Operation) .... 424 
Lithoclasty 425 
Washing out Debris 428 
Arresting Haemorrhage after Lithotomy 428 
Renal Lithotomy, Nephrotomy and Nephrec- 
tomy 429 
Gynaecological. 
Female Organs of Generation 430 
Specula Vaginae 431 
Vesico-Vaginal Fistula 448 
Vesico-Vaginal Operating Cases 462 
Stone in the Female Bladder 463 
Kolpo-Cystotomy 464 
Urethral and Uro-Cystic 466 
Urethral Tumors 467 
Vesico-Urethral Fissure 469 
Douching the Urethra 469 
Stricture of the Urethra 469 
Gynaecological Operating and Dressing Cases. 470 
Uterine Diagnosis, Probes and Sounds 473 
Uterine Dressing, Forceps, Applicators ...... 475 
Uterine Irrigation, Douching 479 
Uterine Malpositions, Displacements 483 
Repositors, Elevators, Redressors 483 
Inversion of Uterus 485 
Supports, Pessaries, Hysterophores 486 
Uterine Fixators, Tenacula, Forceps 497 
Uterine Dilators 498 
Uterine Stenosis, Hysterotomes, Metrotomes, 
Uterotomes 505 
Uterine Plethora, Scarifying, Leeching, Cup- 
ping 506 
Uterine Tumors and Polypi, Galvanism, Elec- 
trolysis 507 
Curettes, Forceps, Ligators, Ecraseurs 510 
Hysterectomy, Uterine Malignant Disease, 
Hysterectomy per Vaginam 516 
Hysterectomy per Abdominal Section 519 
Abdominal Section, Laparotomy 520 
Ovariotomy 522 
T rocars 524 
Sac Forceps 525 
Pedicle Forceps, Clamps 526 
Drainage Tubes 531 
Closing Wound 532 
Application of Cold and Heat 533 
Obstetrical 534 
Labor or Parturition 534 
Operations 535 
Forceps 536 
Obstructed Labor 546 XIV 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PAGE 
Gynaecological, Obstetrical. 
Placenta Praevia 547 
Vectes, Levers, Cord Carriers 548 
Embryotomy 548 
Craniotomy 549 
Sets of Instruments, in Cases 553 
Hystero-Trachelorrhaphy 553 
Perineorrhaphy 559 
Closure of the Vagina, Episiorrhaphy, Kolpo- 
kleisis 562 
Wounds and Injuries. 
Litters for Carrying Wounded Persons 563 
Wounds 563 
General Rules for the Treatment of 563 
Covering of 563 
Cleansing of 564 
Reduction of Heat 564 
Hermetical Sealing of 565 
Lister's Antiseptic Dressing of 566 
Union of, Sutures 568 
Bandaging 569 
Hardening Bandages 571 
Application of Plaster of Paris Dressings. 573 
Removing Plaster of Paris Bandages .... 574 
Fracture, Simple, Compound, Comminuted .. 576 
Apparatus, Splints, Adhesive Plaster .... 576 
Suspension Apparatus 577 
Adaptable Porous Felt Splints 577 
Levis' Metallic Splints 580 
Extension and Counter-Extension 582 
Treatment of Simple 585 
Passive Motion 586 
Inferior Maxilla 586 
Ribs 586 
Clavicle 587 
Shoulder, Humerus 589 
Elbow 589 
Forearm and Wrist 591 
Lower Extremities 593 
Femur, Thigh-Bone 593 
Leg, Tibia and Fibula 599 
Leg, Patella - 602 
Compound 605 
Shot 607 
Joints 610 
Dislocation and Luxation 610 
Resection and Excision 616 
Splints and Brackets for Securing Immo- 
bility 617 
Transfixion of Bones 619 
Wiring Bones (Fluhrer) 621 
Nerves 623 
Suture, Neurotomy, Neurectomy, Stretch- 
ing 624 
Emergency Operating Sets 625 
Restraints 631 
Care of the Insane 631 
Orthopaedic. 
Orthopaedic Surgery 633 
General Remarks on Orthopaedic Therapeutics 633 
PAGE 
Orthopaedic. 
Diseases of the Joints 635 
Morbus Coxarius 637 
Anatomy of the Hip Joint 637 
Pathology, Etiology, Symptoms 637 
Treatment, Mechanical Apparatus 638 
Treatment after Exsection 650 
Knee Joint, Treatment, Apparatus 653 
Ankle Joint, Treatment, Apparatus 663 
Shoulder Joint, Treatment, Apparatus ... 668 
Elbow and Wrist, Apparatus 669 
After-Treatment, Massage, Passive Motion 670 
Anchylosis, Complete 671 
Fibrous 672 
Apparatus for Breaking-up Fibrous 674 
Spinal Diseases and Deformities 678 
The Spinal Column, Vertebrae, Curvature. 677 
Caries, Spondylitis, Angular Curvature or 
Pott's Disease 678 
Braces 678 
Plaster Jaeket 682 
Suspension Apparatus 683 
Nil Desperanduin in Spinal Caries 685 
Cyphosis, Posterior Curvature 689 
Cyphosis Braces 687 
Lordosis, Anterior Curvature 692 
Lordosis Braces 692 
Scoliosis, Lateral Curvature 693 
Scoliosis Braces, Suspension 694 
Torticollis, Wry-Neck .... 700 
Torticollis Braces 701 
Accidents to the Vertebral Column 703 
Paralytic Deformities 704 
Diseases of the Spinal Cord 704 
Affections of Nerves and Muscles 704 
Progressive Locomotor Ataxia 705 
Paralytic and Spastic Deformities 706 
Paralysis, Palsy, Hemiplegia, Paraplegia, 706 
General Treatment, Apparatus 706 
Valgus Ankle 709 
Short Leg 710 
Arm, Forearm and Wrist 710 
Wrist Drop 711 
Fingers 711 
Writer's Cramp 712 
Genu Valgum or Knock Knee 713 
Genu Varum or Bow Leg 718 
Bowed Tibia 720 
Deformities of the Feet 724 
The Normal Human Foot 725 
The Morbid Alterations in the Form of 
the Foot, Kyllosis, Club-Foot, Talipes. 725 
Talipes Equinus 726 
Talipes Calcaneus 726 
Talipes Varus 727 
Talipes Valgus 727 
Talipes, Causes of 728 
Talipes, Treatment 728 
Talipes, Methods of Dressing 731 
Shoes, Apparatus 732 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
XV 
PAGE 
Orthopaedic, Deformities of the Feet. 
Talipes Varus et Valgus 734 
Equinus 740 
Calcaneus 741 
Pes Planus 741 
Abnormal Eversion and Inversion 742 
Bunions, Hammer-Toes, Nailsand Corns, 745 
PAGE 
Prosthetic. 
Compensative Appliances, Pseudarthrosis .... 747 
Dangle Limbs 750 
Artificial Limbs 751 
Miscellaneous 754 
Index and Price-List 773 OAf^E OF INSTRUMENTS 
TEST DRUM, TO TRY THE EDGES OF EYE INSTRUMENTS AND LANCETS. 
Every practitioner, after having selected, should know how to take proper care of his armamentarium. In order 
to do this intelligently he should understand something of the mechanism of instruments. 
The materials of which the blades of general operating instruments are made are steel, silver, platinum, gold and 
aluminum. German steel is used for forceps and blunt instruments, owing to its tenacity ; English cast-steel for edge- 
tools, as it receives a high temper, a fine polish, and retains its edge. Silver, when pure, is very flexible, and is use- 
ful for catheters which require frequent change of curve ; when mixed with other metals, as the silver coin, it makes 
firm catheters, caustic holders and canulated work ; seamless silver instruments are least liable to corrode. Platinum 
resists the action of acids and ordinary heat and is useful for caustic holders, actual cauteries and the electrodes of the 
galvano-cautery. Gold, owing to its ductility, is adapted for fine tubes, as eye syringes, &c. Aluminum is, by its 
extreme lightness, suitable for probes, styles, pessaries and tracheotomy tubes. German silver and brass-plated instru- 
ments are used extensively, owing to their cheapness. 
The handles may be made of ebony, ivory, hard rubber or shell. Ebony is more generally used for larger instru- 
ments. Ivory is more expensive, but makes a durable and beautiful handle-especially adapted for scalpels and eye 
instruments. Shell is more used for light instruments-as those of the pocket case. Hard rubber makes an excellent 
handle, combining neatness, lightness and durability, and may be baked on to the blades when desirable-as for anti- 
septic knives, &c. 
Next to the materials, the making of the instrument determines its quality. If the steel is overheated in the forge 
the knife will be brittle or rotten; in shaping it with the file the form may be destroyed ; in hardening and tempering 
the steel may be spoiled ; in grinding and glazing the instrument may be rendered worthless. In every stage of the 
manufacture, therefore, the value of the instrument depends upon the personal skill of the workman. The last act of 
the maker is to polish and sharpen the instrument, and thus adapt it for use. 
The tests of the quality of instruments are as follows: Draw the cutting edge of an instrument from heel to point 
slowly and lightly across the border of the nail, and it will catch or stop at every "nick draw it across the flat of the 
nail, and if at any point the edge is seen to be wiry or smooth, it is soft, and must be re-applied to the hone. For 
pointed instruments, stretch upon a " test drum" a very thin piece of gold-beater's skin, and push the point through. 
If it enter smoothly and easily, the point is good; but if a slight cracking noise is heard, it is defective. If a lancet is 
tested, see-saw the edge in the opening, and if it glides over without cutting or cuts roughly the edge is imperfect. 
The preservation of instruments in good condition requires careful attention in the following details: Select a place 
always free from moisture and dirt for their safe keeping. Polished instruments should be suspended or placed in 
cases lined with oil-dyed velvet. After being used every instrument should be thoroughly cleaned with warm water, 
and perfectly dried with chamois, or the fire, before it is returned to the case. 
Silver instruments tarnish when they are exposed to the air, or brought in contact with hard or soft rubber, caustics 
or acids. To preserve the edge and polish of instruments, the surgeon requires two or three small hones, some fine emery 
paper, two or three screw-drivers, small files, rouge, crocus or other polishing powder, chamois and gold-beater's or kid skin. 
Cutting instruments should have their blades kept in perfect order by a judicious use of the hone. Occasionally 
the blade must be ground by a competent workman. 
Blunt instruments, which are designed to enter natural or other passages, should be frequently polished with rouge 
and chamois skin, in order to maintain smooth and unblemished surfaces. Very fine emery paper will remove rust 
spots ; but it is best to prevent their formation by the rubbing with rouge. 
Saws are sharpened with three-cornered files, applied lightly in the direction of the original cut of the teeth. 
Rust spots on capital saws, especially when on or near the teeth, should be carefully scraped off with a sharp 
pocket knife ; for, if emory paper be used by an inexperienced hand, the wire edge of the teeth may be polished off 
and the saw deprived of its cutting power. After the saw has been thus sharpened once or twice, the set of the teeth 
must be renewed by a competent workman. Metacarpal and other small bone saws have double teeth and require very 
careful filing, as each tooth must have a wire edge raised on its exterior-this allows the blade, which ought to be 
thinned a little on the back, to follow easily in the kerf. Chain saws are rather delicate instruments, which none but 
an experienced workman should attempt to sharpen. 
XVI the 
^meficaq Cl]iiluiIgicum, 
DIAGNOSTIC. 
APPARATUS FOR URINARY EXAMINATIONS. 
Fig. 1000.-Flint's Apparatus. 
Black Walnut Case, with rings, clamps, &c $25.00 
12 Small and 3 larger labelled bottles 14.50 
3 Small plain bottles, not labelled 48 
Flint's Apparatus for Urinary Examinations. 
To hold the following Reagents, which we can furnish if desired, at 
2 oz. Nitric acid $0.25 
2^oz. Hydrochloric acid ' 23 
2 oz. Acetic acid 20 
2 oz. Nitroso-nitric acid 20 
2 oz. Nitrate of silver in solution (9.58 gr. in an 
ounce) 50 
2 oz. Sulphate of copper in solution (90.5 gr. in 
an ounce) 35 
2 oz. Neutral tartrate of potash in solution (364 
gr. in an ounce) 50 
1 lb. Solution of soda (specific grav. I.I2) 65 
2 cz. Liquor potassae 20 
2^oz. Liquor ammoniae 20 
2 oz. Ether 25 
1 lb. Mercury (pure) 1.50 
1 lb. Solution of hydrochlorite of soda 1.00 
I lb. Solution of chloride of sodium (saturated). .35 
Litmus paper, red and blue . . ) 
Turmeric paper ) 3 
German yeast, in cake 20 
Contents of the Large Drawer. 
1 Urinometer $1.25 
1 Thermometer 1.50 
4 Porcelain evaporating dishes 1.50 
2 Watch glasses, 2 inches diameter $0.20 
2 " . " 3 " " 50 
2 " "4 " " SO 
I Alcohol lamp 75 
I Burette graduated in grains 1.98 
1 Plain blowpipe .50 
Contents of the Small Drawer. 
3 Stirring rods ; $0.45 
3 Drop tubes 15 
2 Long swabs to clean out the Urea tube 50 
2 Brushes 44 
I Six ounce graduated glass 75 
1 One " " " 50 
1 One drachm " " .50 
4 Conical glasses with porcelain covers 2.00 
6 Test tubes and stand (a commoner article less). 3.38 
3 Funnels and filtering paper 1.50 
3 Flasks and wire gauze 1.50 
1 Two hundred grain measure 60 
1 Tube graduated in cubic inches 2.00 
1 Vessel in which the graduated tube can be in- 
verted 60 
Amount for the Case and contents. .$70.45 2 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
DIAGNOSTIC. 
FOR. URINARY EXAMINATIONS. 
1 Hydrometer of Baume for liquids heavier than 
water $1.00 
1 One thousand grain specific gravity bottle .... 3.00 
1 Five hundred " " " .... 2.75 
1 One " " " " .... 2.50 
1 Water bath 2.50 
1 Water oven for drying filters, brass 8.00 
1 " " " tin 3.25 
2 Wash bottles 2.00 
1 Delicate balance to turn of a grain n .00 
1 Blowpipe, platinum point 3.00 
1 Platinum spoon for calculi 4.00 
12 Test tubes and stand 3-38 
I Book of colored papers, gummed, for recording 
the color of specimens 1.50 
1 Bunsen burner and 6 feet rubber tubing 3.00 
Flint's Extra Apparatus. 
Graduated solution of chloride of barium (36.6 
grains in 6 fluid ounces of water) for quantita- 
tive analysis of the sulphates $0.80 
Three separate solutions for quantitative analysis 
for phosphoric acid : 
1st. Sesquichloride of iron: 9.33 grains of 
iron by hydrogen dissolved in hydrochloric 
in a little nitric acid, evaporated to dryness, 
and dissolved in 6 fluid ounces of water, 
in bottle 80 
2d. 400 grains of acetate of soda and 800 
grains of acetic acid, dissolved in 6 fluid 
ounces of water, and bottle 50 
3d. 12 grains of ferrocyanide of potassium, 
dissolved in 6 fluid ounces of water, and 
bottle 50 
Full directions for the use of this and other apparatus are given in Professor Flint's work, " Manual of Chemical 
Examination of the Urine in Disease," by Austin Flint, Jr., M. D., Professor of Physiology and Microscopy in the 
Bellevue Hospital Medical College, &c., &c. Also in "A Guide to Urinary Analysis, for the Use of Physicians and 
Students," by Henry G. Piffard, A. M., M. D., Physician to the Charity Hospital, to the New York Dispensary for 
Diseases of the Skin, &c., &c. Also in " Lessons in Physical Diagnosis," by Alfred M. Loomis, M. D., Professor 
of the Institutes and Practice of Medicine in the Medical Department of the University of New York, Physician to 
Bellevue and Charity Hospitals, &c., &c. 
Fig. iooi.-Roberts' Urine Test Apparatus. 
On a revolving black walnut Etagere, . . $25. 
Fig. 1002.-Vance's Urine Test. 
In a neat Morocco Case, 
Contents: 
2 Test tubes and holder. 
I Urinometer. 
I Acid bottle. 
I Axilla thermometer. 
I Pair brass forceps. 
Red and blue litmus paper. 
Roberts' Urine Test Apparatus, improved by Lewis, consists of the following parts 
I Set Neubaur's urinometers with 
two test glasses. 
4 Urine glasses ; 6 Test tubes. 
I Alcohol lamp. 
5 Bottles with pure reagents, 
1 Burette with holder. 
3 Pipettes and 3 stirring rods. 
1 Graduate. 
I Flask with ring support for same. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
3 
DIAQJMOSTie. 
FOR URINARY EXAMINATIONS. . 
Fig. 1005.-Fehlich's Flask, 
Bunsen Burner and Burette. 
Fig. 1006. 
Urea Tube. 
Fig. 1004. 
Urinometer. 
Fig. 1003. 
Graduated 
Measure Glass. 
Fig. 1007. 
Rapid Filtration Apparatus. 
Fig. 1008 
Fig. 1009. 
Piffard's Measuring Pipette. 
b. Arrangement for Fer- 
mentation Test. 
Graduated Tube 
for Approximate 
Analysis. 
Fig. ioii.-a. Retort Stand ; e. Bunsen Burner; 
b. Water Bath, and c, d. Piffard's Water Oven. 
Fig. ioio.-a. Mohr's Burette; 
b. Stand; c. Beaker. 
See Price List 
for enumeration of 
Loomis' and Piffard's 
Apparatus, 
as perpage 188, "Loomis' 
Physical Diagnosis." 4 
GEORGE TIEMANN «fc CO.'S SURGICAL INSTRUMENTS. 
DIAGNOSTIC. 
CLINICAL THERMOMETERS. 
Fig. 1012.-Straight Self-registering Thermometer. 
Fig. 1013.-Straight Self-registering Thermometer, with Constriction. 
Fig. 1014.-Ivory Scale Axilla Thermometer. 
Fig. 1015.-George Tiemann & Co.'s Patent Bent Thermometer. 
Fig. 1016.-Surface Thermometer, Fahrenheit Scale. 
Fig. 1017.-Seguin's Surface Thermometer, Self-registering; Zero at Normal Temperature. 
Fig. 1018.-Patent Twisted Stem Thermometer. 
Fig. 1019.-Hick's Patent Lens Thermometer. 
Directions for Using' Thermometers. 
Before making an observation of the temperature of the body, the thermometer should first be examined to ascer- 
tain the position of its index. The index is a detached portion of the column of mercury in the tube, separated by a 
very minute portion of air. If the bulb is warmed, the ascending column of mercury will be seen to push before, but 
not to touch the index ; upon cooling the bulb, the column withdraws and leaves the index at the maximum temperature 
attained. The index being a portion of the column of mercury, that end of it most distant from the bulb indicates 
the temperature. If the index is found to be above 98 degrees Fahrenheit it should be shaken down until it is 2 or 3 
degrees below that point, say 95 degrees. This may be done by holding the instrument between the thumb and index 
finger, about the upper fourth of its length in a line continuous with the arm ; then raise the forearm until the thermo- 
meter is as high as the shoulder, and bring it down with a swing in a line with the body. This motion will have the 
effect of propelling the index toward the bulb at the rate of two or more degrees for each movement; this should be 
repeated until the index points below 98 degrees. 
Care should be taken in all cases that the part selected for ascertaining the temperature of the body has not been 
recently subjected to influences likely to lower its temperature. If used beneath the tongue, it must be learned 
•whether the patient has taken any cold drink within the last fifteen minutes, as the local temperature is often reduced 
some degrees thereby, and if in the axilla, whether it has been exposed by extending the arm, or in any way uncovered. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
5 
DIAGNOSTIC. 
FOR MEDIATE AUSCULTATION. 
Fig. 1020.-Flexible Stethoscope. 
Fig. 1021.-Barclay's Stethoscope. 
Fig. 1022.-Hawksley's Stethoscope. 
Fig. 1024.-Elliottson's Stethoscope. 
Ivory Ear Piece and Pleximeter. 
Fig. 1025.-Dobell's Ebony Stethoscope. 
Fig. 1023.-Martin's Combination Stethoscope, 
Percussor and Pleximeter. 
Fig. 1026.-Loomis' Stethoscope (with Rubber Ring, 
used as Pleximeter). 
Fig. 102g.-Walsh's Stethoscope. (Dogwood.) 
Fig. 1027-Burrows' Stethoscope. 
Vulcanite Ear Piece. 
Fig. 1030.-Clark's Stethoscope. 
Fig. 1028.-Short Cedar 
Stethoscope. 
FlG. 1034.-Quain's Telescopic Stethoscope. 
Fig. 1035.-Arnold's Flexible Stethoscope. 
FlG. 1031.-Stokes' Stethoscope. 
Fig. 1032.-Cedar Stethoscope. 
Hard rubber Ear Piece. 
Fig. 1033.-Ferguson's Stethoscope. 6 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
DIAGNOSTIC. 
FOR MEDIATE AUSCULTATION. 
Fig. 1037.-Cammann's Intra-Costal 
Auscultator. 
Fig. 1036.-Cammann's Stethoscope with Snelling's Rubber Bell. 
Fig. 1040.-Allison's Differential Stethoscope. 
Fig. 1038. 
Cammann's Cylindrical Auscultator. 
, Solid Cedar. 
Fig. 1039.-Cedar Stethoscope. 
Vulcanite Ear Piece. 
Fig. 1042.-Bartlett's Stethoscope. 
Fig. 1041.-Davis' Stethoscope. 
Fig. 1043.-Knight's Stethoscope. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
7 
DIAGNOSTIC. 
FOR MEDIATE AUSCULTATION, 
Many other modifications of Cammann's Binaural Stethoscope have been sug- 
gested, of which that of Mr. Irvin Palmer deserves special notice. This instrument is 
adapted for use as calipers and the elastic band of Cammann's is replaced by a cir- 
cular box spring at the hinge. Attached to the joint is a dial plate, which registers 
the divergence of the two metal arms-thus at once enabling diametric and other 
measurements to be accurately and readily made without the addition of a separate 
instrument. It will recommend itself to the profession for the facility with which it 
permits anatomical measurements to be registered: as, for example, in estimating the 
relative expanding power of the two sides of the chest, in lung disease, &c. 
London Medical Record, May 15, 1881. 
Fig. 1044.-Ware's Stethoscope. 
Fig. 1045.-Holden's Resonator. 
FOR MEDIATE PERCUSSION. 
Fig. 1047.-Hoffmann's Pleximeter. 
Fig. 1046.-Flint's Pleximeter. 
Fig. 1048.-Glass Pleximeter. 
Fig. 1050.-Flint's Percussor. 
Fig. 1051.-Gerne's 
Pleximeter. 
Fig. 1049.-Ivory 
Pleximeter. 
Fig. 1052.-Percussor 
with Whalebone Stem. 
Fig. 1053.-Winterich's 
Percussion Hammer. 
Fig. 1054.-Speir's Echoscope (to intensify sounds produced by percussion). 8 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
DIAGNOSTIC. 
Fig. 1055.-Flint's Cyrtometer, 
CYRTOMETRIC. 
Instruments for taking the shape of the chest, with 
short arms-compasses-holding narrow strips of alum- 
inium or lead, long enough to encircle the chest. An 
indicator may be set at any point by a thumb-screw. 
The strips of lead are easily moulded so as to fit any 
depression or elevation of the chest ; the thumb-screw 
is then loosened and the instrument removed ; after re- 
moval the arms of the compass are brought together at 
the same point of the indicator as when applied, fastened, 
and when placed on paper the exact shape of the chest 
can be traced by a pencil. 
Fig. 1056.-Wood's Cyrtometer. 
Fig. 1057.-Warren's Conformator. 
Warren's Conformator consists of two hard rubber or metal 
braces, grooved to receive a number of blunt-pointed needles ; 
these needles move easily in the grooves, and when applied to 
an undulated surface will take the exact shape of the depressions 
or elevations. 
CARDIOMETRIC 
Fig. 1058.-Cammann's Cardiometer, 
To determine the distance of the apex beat from 
the median line, one point of the instrument is placed 
on the median line and that of the other bar to a 
point corresponding to the apex beat; by reading the 
figure marked by the indicator, you determine the 
number of inches the apex beat is distant from the 
median line. 
The instrument is very small, and when closed 
presents rounded ends, and may be conveniently car- 
ried in the pocket. 
For the following special mechanical aids to diagnosis: i. e., Endoscopes, Laryngoscopes, Otoscopes, Oph- 
thalmoscopes, Probes, Sounds ; and Aural, Nasal, Oral, Ophthalmic, Uterine. Vaginal and Anal Spe- 
cula, see Index. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
9 
DIAGNOSTIC 
DYNAMOMETRIC. 
To measure accurately the strength of paralyzed muscles of the upper extremities, to determine the slightest dif- 
ference in muscular power of the two hands, as well as any changes that may occur, from time to time, in the course 
of paralysis.-" Physical Diagnosis," Loomis. 
Fig. 1060.-A. McLane Hamilton's Dynamometer, 
Fig. 1059.-Dynamometer. 
Fig. 1061.-Dynamograph. 
For the same purpose as the Dynamometer, with additional 
contrivance for recording observations. 
For measuring the extent of movement of the walls of the chest. 
STETHOMETRIC, 
Fig. 1062.-Quain's Stethometer. 
Fig. 1063.-Carroll's Stethometer. 
Carroll's Stethometer consists of an outer case, marked with a scale of three inches, 
a b, within which moves a slide, c d, bearing a gnomon or indicator, d. To the end of 
this slide is attached an ordinary measuring tape, the first three inches being cut off, so 
as to render the scale continuous, which is passed around the chest and drawn through 
the catch at the opposite end of the instrument. As the lungs are inflated, the slide 
is drawn out and the indicator shows the exact amount of expansion. A hard rubber ring, f, sliding easily over the 
scale, may be used to render the stethometer self-registering ; and Messrs. Tiemann & Co. have added also an elastic 
band, e e, to draw the two portions of the instrument together. This elastic band, if used at all, must be very slight, 
as I have found that even the thin envelope rings prevent the full expansion of the chest. I therefore remove the 
band before applying the stethometer, which thus registers itself without the hard rubber slides. 10 
GEORGE TIEMANN *fe CO.'S SURGICAL INSTRUMENTS. 
DIAGNOSTIC. 
2ESTHESI0METRIC. 
For investigating the condition of the tactile sensibility of patients suspected of having brain disease. The earliest 
attempt in this direction was made by Dr. Sieveking, of London, who, in 1878, described an instrument for this pur- 
pose, which he called an aesthesiometer. This was simply a modification of the common beam-compass employed by 
carpenters, and is yet in common use among physicians interested in the pathology of the cerebro-spinal organs. 
The class of cases in which it is useful were thus enumerated by Dr. Sieveking: 
1. "In actual paralysis, to determine the amount and extent of sensational impairment. 
2. " As a means of diagnosis between actual paralysis of sensation and mere subjective anaesthesia, in which the 
tactile powers are unaltered. 
3. "Asa means of determining the progress of a given case of paralysis for better or for worse. 
The diagnostic value of an instrument of this nature, in cases where sensibility is affected, depends upon the fact 
Fig. 1064.-Sieveking's .Esthesiometer. 
that the capability of distinguishing two impressions 
made simultaneously varies in different regions of the 
body, according to the distance they are apart. 
"For instance, the two points of a pair of compasses 
can be distinguished at about the sixth of an inch apart 
when applied to the end of the finger, while on the back 
of the hand only one point is felt, though they are an 
inch apart." 
Fig. 1065.-Carroll's /Esthesiometer. 
Fig. 1066.-Hammond's /Esthesiometer. 
Fig. 1067.-Vance's Pocket /Esthesiometer. 
Carroll's /Esthesiometer has each free extremity divided into two points-one blunt, the other sharp. This enables 
the observer to determine the comparative sensibility to contact and pain at different distances by simply substituting 
the one pair of points for the other. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
11 
DIAGNOSTIC. 
JESTHESIOMETRIC. 
Fig. 1068.-Elsberg's ^Esthesiometer (for the Throat). 
Fig. 1069.-Beard's Piesmeter, for measuring the sense of pressure. 
The sense of pressure is strongest on the forehead, tongue and cheek ; next in order come the fingers, back of hand, 
forearm and arm ; then the anterior portion of the thigh and leg,-back of foot and toes. The least sensitive portions 
are the back of thigh and leg. 
On comparison, the relative sensitiveness of different parts of the body to farradization, with the relative acuteness of 
the sense of pressure, exhibits a remarkable coincidence. 
PULSOMETRIC. 
Instruments to ascertain and record the quickness, strength, uniformity or irregularity of the pulse. Used for purposes 
of diagnosis and various physiological investigations. 
Fig. 1070.-Dudgeon's Sphygmograph. 
Fig. 1071.-White's Haemarumascope. 
In order to prepare the haemarumascope for an. observation, 
a fraction of a drop of filtered solution of rose aniline in alcohol, 
with some essential spirit, must be introduced. The essential 
spirit is thus employed in combination with a view to its quality 
to diminish friction within the bore of the tube. 
When this instrument is made to rest firmly and steadily upon 
the trunk of a superficial vein of sufficient dimensions, the peculiar 
movement of the stream of blood beneath the bowl of the instru- 
ment sets the sensitive fluid column within the tube into sympa- 
thetic motion, clearly demonstrating that the blood within the 
vein receives the shock and experiences augmentation of contents 
nearly isochronous with the arterial throb. 
Fig. 1072.-Marey's Sphygmograph. 12 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
DIAGNOSTIC. 
Fig. 1073. 
Transplantation Scissors. 
For obtaining minute sections of 
fresh tissue for transplanta- 
tion or for examination. 
MICROSCOPICAL. 
For obtaining minute pieces of 
muscle for examination. 
Fig. 1074.-Microscope. 
Fig. 1076.-Duchenne's Exploring Trocar (Ivory Handle). 
Fig. 1075.-Duchenne's Exploring Trocar. 
Fig. 1077.-Noeggerath's Exploring Trocar. 
Fig. 1078.-Tiemann & Co.'s Exploring Trocar. 
Fig. 1079.-Exploring Trocar. 
Fig. 1080.-Jewett's Improved Section Cutter. 
Fig. 1081.-Curtis' Section Knife and Frame. 
Fig. 1082. 
Valentine's Section Knife. 
(Tiemann's Model.) GEORGE TIEMANN CO.'S SURGICAL INSTRUMENTS. 
13 
DI/rGNOSTie. 
MICROSCOPICAL. 
For obtaining thin sections of morbid integument for microscopical examination. 
Fig. 1083.-Piffard's Cutisector. 
Fig. 1090.-Valentine's Knife (Charriere's Model). 
Fig. 1084.-Microscopic Section Knife. 
Fig. 1089.-Microscopic Section Razor, 
Fig. 1085.-Microscopic Scalpel. 
Fig. 1086.-Probe-Pointed Microscopic Bistoury. 
Fig. 10S7.-Sharp-Pointed Microscopic Bistouiy. 
Fig. 1088.-Microscopic Pocket Scalpel. 
Fig. 1092.-Microscopic Needle (Straight or Curved). 
Fig. 1095.-Straight Microscopic Forceps. 
Fig. 1094.-Spear-Pointed Microscopic Knife. 
Fig. 1098.-Brass Microscopic Syringe. 
Fig. 1091.-Microscopic Needle Holder. 
Fig. 1093.-Small Microscopic Knife. 
Fig. 1096.-Curved Microscopic Forceps. 
Fig. 1097.-Hard Rubber Microscopic Syringe. 
To obtain fluid contained in pleural, pericar- 
dial or abdominal cavity, &c., for examination, 
the Aspirators are useful. 14 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
f>OST JVIORTEM. 
Fig. 1099.-Embalming Pump. 
EMBALMING. 
The art of embalming originated in Egypt over 3000 years ago. 
The invention was ascribed by the Egyptians to Anubis the son of Osiris, 
who is said to have performed the office for his father. In recent times, 
considerable attention has been devoted to the subject and various pro- 
cesses and compounds have been devised. 
Gaural injected the veins with sulphate of alumina. Falconi injected 
into the body sulphate of zinc. Chloride of zinc and sulphate of soda are 
also sometimes used. 
Dr. Wywodzoff, of St. Petersburg, Russia, recommends thymol diluted 
with water and glycerine. 
R. Thymolis sc. ij. 
Glycerine, lbs. iv. 
Aq lbs. ij. 
German Process.-The dead bodies of human beings and animals 
are said to fully retain their form, color, and flexibility by this process. 
Even after a period of years such dead bodies may be dissected for 
purposes of science and clinical jurisprudence. Decay and the offensive 
smell of decay are completely prevented. Upon incision the muscular 
flesh shows the same appearance as in the case of a fresh dead body. 
Preparations made of the several parts, such as natural skeletons, lungs, 
entrails, &c., retain their softness and pliability. 
The liquid used is prepared as follows : in 3000 grams of boiling water 
are dissolved 100 grams of alum, 25 grams of cooking salt, 12 grams salt- 
petre, 60 grams potash, and 10 grams arsenious acid. This solution is 
then allowed to cool and filter; to 10 litres of this neutral, colorless, odor- 
less liquid, 4 litres glycerine and one litre methylic alcohol are to be 
added. The process of preserving or embalming dead bodies by means 
of this liquid consists as a rule in saturating and impregnating the bodies 
with it. From to 5 litres of liquid are used for a body, according to 
its size. 
Anatomical preparations that are to be preserved dry are immersed in the fluid from six to twelve days, according to 
their size ; then taken out and dried in the open air. Hollow organs, such as the lungs, &c., must be filled with the 
preserving liquid, then laid in a vessel containing the same fluid, and afterwards distended with air and dried. Small 
animals, such as crabs, beetles, lizards, frogs, &c., if the natural colors are to be preserved, are not to be dried, but 
put immediately into the preparation. 
The Embalming Pump (fig. 1099) is made of brass, nickel-plated and put up in a black walnut case, lined 
with velvet $22.00 
Fig. i too.-Anatomical Syringe. 
Brass Syringe. 
1 Double injection Pipe. 
3 Different sizes single Pipes. 
I Stop-cock. 
i Key Wrench to fasten and detach the stop-cock. 
i Mahogany Case lined with velvet $35 00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
15 
POST MORTEM AND DISSECTING 
Fig. iioi.-Darling's Dissecting Scalpel. 
Fig. 1105. 
Dissecting 
Scissors. 
Fig. 1107.-Enterotome. 
Fig. 1104.-Dissecting Hook (Steel Handle). 
Fig. fio8.-Coxeter's Dissecting Forceps. 
Fig. 1102.-Dissecting Forceps. 
Fig. 1103.-Steel-Handle Cartilage Knife. 
Fig. 1106.-Blowpipe. 
Fig. 1109.--Finnell's Knife, Saw and Handle. 
Fig. i i 13.-1 Post-mortem saw, I Knife and 1 Handle. 
Fig. 1112.-Warren's Demonstrating Knife. 
Fig. i i io.-Brain Knife. 
Fig. 1111.-Reamer. 16 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
POST JV1ORTEM AND DISSECTING 
Fig. 1116. 
Post Mortem 
Hammer. 
Fig. 1114.-Darling's Chain Hook. 
Fig. 1118.-Satterthwaite's 
Rachitome. 
Fig. 1115.-Rachitome, Chisel. 
Fig. 1117.-Costotome, Chisel. 
Fig. 1119.-Chisel. 
Fig. 1120.-Calvarian Hook. 
Fig. 1121.-Dissecting 
Double Hook. 
Fig. 1122.-Double Rachitome. 
Fig. 1123.-Grappling Hook. 
Fig. 1125. 
Satterthwaite's Calvarian Clamn. 
Fig. 1126.-Chain Hook. 
Fig. 1124.-Tripod Head-Rest. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
17 
POST JVIORTEM ^ND DISSECTING. 
AUTOPSIC OR POST MORTEM EXAMINATION SETS. 
No. 1 Post Mortem Set. 
Price, $28.00. 
1 Hammer. 
1 Costotome (Rib Shears). 
1 Ebony Handle Cartilage Knife. 
2 Ebony Handle Scalpels, assorted. 
1 Steel Handle Dissecting Hook. 
1 pair of Coxeter's Dissecting Forceps. 
1 Enterotome. 
1 set of Heavy Chain Hooks. 
1 pair of Straight Scissors. 
1 Saw. 
1 Amputating Knife. 
1 Handle to fit the Saw and Knife. 
1 Chisel. 
1 Reamer. 
2 Needles, Thread and Wax. 
1 Mahogony Case, with a slide or 
lock, lined with velvet. 
1 Chisel. 
1 pair of Straight Dissecting Scissors. 
1 set of Chain Hooks. 
1 pair of Dissecting Forceps. 
I Aneurism Needle. 
1 Metacarpal Saw. 
3 Ebony Handle Scalpels, assorted. 
1 Steel Director. 
1 Probe-pointed Bistoury. 
1 Hammer. 
1 Steel Handle Dissecting Hook. 
1 Ebony Handle Cartilage Knife. 
1 German Silver Blowpipe. 
2 Needles, Silk and Wax. 
1 Rosewood Case, with lock and key, 
lined with velvet. 
1 German Silver Blowpipe. 
1 Plain Chisel. 
1 pair of Straight Dissecting Scissors. 
1 Amputating Knife. 
1 Saw. 
1 Handle to fit the Knife and Saw. 
2 Needles, Thread and Wax. 
Mahogany Case, with a slide or lock, 
lined with velvet. 
Finnel's Post Mortem Set. 
Price, $12.50. 
1 Amputating Knife. 
I Saw. 
1 Handle to fit the above. • 
3 Ebony Handle Scalpels, assorted. 
I Steel Handle Cartilage Knife. 
1 pair of Straight Dissecting Scissors. 
1 Ebony or Steel Handle Tenaculum. 
1 set of Heavy Chain Hooks. 
1 German Silver Blowpipe. 
1 pair of Dissecting Forceps. 
2 Needles and Thread. 
1 Chisel. 
1 Rosewood Case, with lock and key, 
lined with velvet. 
No. 3 Post Mortem Set. 
Price, $22.00. 
1 Hammer. 
1 Costotome Chisel. 
1 Steel Handle Cartilage Knife. 
3 Ebony Handle Scalpels, assorted. 
1 Steel Handle Dissecting Hook. 
1 pair of Plain Dissecting Forceps. 
1 Enterotome. 
1 set of Heavy Chain Hooks. 
No. 2 (Hutchison's) Post Mor- 
tem Set. 
Trice, $24.00. 
1 Amputating Knife. 
1 Saw. 
1 Handle to fit the above. 
STUDENTS' DISSECTING SETS. 
No. 1 Dissecting Set. 
Price, $8.00. 
1 Steel Handle Cartilage Knife. 
4 Ebony Handle Scalpels, assorted. 
1 Steel Handle Dissecting Hook. 
1 German Silver Blowpipe. 
1 pair of Straight Dissecting Scissors. 
1 pair of Dissecting Forceps. 
1 set of Chain Hooks. 
1 Chisel. 
1 Mahogany or Rosewood Case, with 
lock and key, neatly arranged, 
lined with velvet. 
No. 4 Dissecting Set. 
Price, $6.00. 
1 Steel Handle Cartilage Knife. 
3 Ebony Handle Scalpels, assorted. 
1 Steel Handle Dissecting Hook. 
1 set of Wire Chain Hooks. 
1 pair of Dissecting Forceps. 
1 pair of Straight Dissecting Scissors. 
1 Mahogany Case, lined with velvet. 
1 set of Adjustible Chain Hooks. 
1 pair of Coxeter's Dissecting Forceps. 
I pair of Curved up Dissecting Scissors. 
1 Mahogany Case, lined with velvet. 
Microscopic Dissecting Set. 
Price, $15.00. 
1 Needle Holder. 
6 Needle Points. 
1 Section Knife. 
1 Fine Lacerating Needle. 
1 Heavy Lacerating Needle. 
3 Ebony Handle Microscopic Scalpels, 
assorted. 
1 pair of Straight and Delicate Micro- 
scopic Dissecting Forceps. 
1 pair of Curved, Delicate Microscopic 
Dissecting Forceps. 
1 pair of Straight, Delicate Scissors. 
1 pair of Delicate Scissors, curved on 
the flat. 
1 Neat Rosewood Case, lined with silk 
velvet. 
No. 5 Dissecting Set. 
Price, $5.50. 
1 German Silver Blowpipe. 
2 Ebony Handle Scalpels. 
1 Steel Handle Dissecting Hook. 
1 Steel Handle Cartilage Knife. 
1 pair of Dissecting Forceps. 
1 pair of Straight Dissecting Scissors. 
1 set of Wire Chain Hooks. 
1 Mahogany Case, lined with velvet. 
No. 2 Dissecting Set. 
Price, $7.00. 
1 Steel Handle Dissecting Hook. 
4 Ebony Handle Scalpels, assorted. 
1 Steel Handle Cartilage Knife. 
1 set of Wire Chain Hooks. 
1 pair of Dissecting Forceps. 
1 pair of Straight Dissecting Scissors. 
1 German Silver Blowpipe, 
1 Mahogany Case, lined with velvet. 
No. 6 Dissecting Set. 
Price, $5.25. 
2 Ebony Handle Scalpels. 
1 Steel Handle Dissecting Hook. 
1 Steel Handle Cartilage Knife. 
1 pair Dissecting Forceps. 
1 pair of Straight Scissors. 
1 set of Wire Chain Hooks. 
1 Mahogany Case, lined with velvet. 
Our Patent Dissecting Case. 
Price, $3.50. 
1 Steel Handle Cartilage Knife. 
3 Ebony Handle Scalpels. 
1 Steel Handle Dissecting Hook. 
1 set of Wire Chain Hooks. 
1 pair of Dissecting Forceps. 
1 pair of Straight Dissecting Scissors. 
1 Blowpipe. 
1 Strap to sharpen the scalpels. 
I Black Walnut Case. 
No. 3 Dissecting Set. 
Price, $6.25. 
1 Steel Handle Dissecting Hook. 
3 Ebony Handle Scalpels, assorted. 
1 Steel Handle Cartilage Knife. 
1 set of Wire Chain Hooks. 
1 pair of Dissecting Forceps. 
1 pair of Straight Dissecting Scissors. 
1 German Silver Blowpipe. 
1 Mahogany Case, lined with velvet. 
Darling's Dissecting Set. 
Price, $5.75. 
3 Darling's Scalpels, ebony handles, 
assorted. 18 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PHYSIOLOGICAL EXPERIMENTS. 
Flint's Armamentarium. 
Complete set, $70.00 
1 Portal Vein Ligator. 
1 pair Bone Forceps, for opening spinal canal. 
1 Hey's Saw, for opening spinal canal. 
1 pair Forceps, for extirpating the spinal accessory nerve. 
1 Drill, for breaking up medulla oblongata. 
1 pair Bone Forceps, shear handles. 
2 Blunt Hooks, for hooking up roots or spinal nerves. 
2 Knives, for intra-cranial division of the root of the 
fifth nerve. 
2 Piques, for irritation of the floor of the fourth ventricle. 
1 Bull-dog Forceps, for drawing out the stomach in 
making a gastric fistula. 
2 Gastric Fistula Tubes. 
1 Catheter, for catheterizing the right side of the heart. 
2 Dissecting Tenacula, steel handles. 
1 pair long-pointed Dissecting Forceps. 
1 pair medium Dissecting Forceps. 
1 pair short Dissecting Forceps. 
1 Enterotome. 
1 Blowpipe, with mouth-piece, stop-cock and 2 points. 
1 Lifting-Back Saw, 9 inches long. 
1 Lifting-Back Saw, 7| inches long. 
1 pair Scissors-one probe-point, the other sharp. 
2 pair Pointed Scissors. 
3 Langenbeck's Steel Serresfines. 
1 Heavy Cartilage Knife. 
3 Scalpels, assorted sizes. 
1 Probe-pointed Bistoury. 
3 Microscopic Needles, each in handle. 
1 Tenotome. 
1 Artery Needle. 
1 Mahogony Case, lined with oil-dyed velvet. 
Flint's Armamentarium for Physiological Experiments 
Fig. 1127.-Portal Vein Ligator. 
Fig. 1130.-Forceps, for extirpating the spinal accessory nerve 
Fig. 1128.-Hey's Saw. 
Fig. 1132. 
Bone Forceps, for 
opening spinal canal. 
Fig. 1133. 
Bone Forceps. 
Fig. 112g.-Drill, for breaking up medulla oblongata. 
Fig. 1131. 
Gastric Fistula Tubes. 
Fig. 1134.-Bull-dog. Forceps, for drawing out the 
stomach in making a gastric fistula. 
Fig. 1135.-Probe-pointed Scissors. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
19 
PHYSIOLOGICAL EXPERIMENTS. 
Flint's Armamentarium foi' Physiological Experiments (continued). 
Fig. 1136. Cartilage Knife (stout). 
Fig, 1138.-Blunt Hooks, for hooking up roots 
of spinal nerves. 
Fig. 1137.-Catheter, for catheterizing the right side of the heart. 
Fig. 1142.-Medium Dissecting Forceps. 
Fig. 1144.-Blowpipe: 2 points, Mouth-piece and Stop-cock. 
Fig. 1143.-Long-pointed Dissecting Forceps. 
Fig. 1139.-Knives, for intra-cranial division of the 
root of the fifth nerve. 
Fig. 1140.-Piques, for irritation of the floor of the 
fourth ventricle. 
Fig. 1141.-Short Dissecting Forceps, 
Fig. 1145.-Lifting-back Saw. 
Robert M. Fuller, M. D., of New York, on Pocket Medicine Cases. 
"The frequent need which physicians experience of having at hand, in night calls and emergencies, the necessary 
means of affording prompt relief, has suggested the designing of a pocket case which shall possess the following 
important features essential to render it of practical utility at the bedside, viz.: accuracy in dispensing, the ready and 
proper labeling of the medicines dispensed, as well as of the vials in the pocket case, and lastly, compactness and 
durability of case. 
Accuracy in Dispensing. 
For Standard Liquid Preparations, such as those manufactured by E. R. Squibb, M. D., of Brooklyn, N. Y., 
accurate dispensing can be secured by the use of a minim pipette or minim measure. The former may prove more 
convenient when dispensing 5, 10 or 15 minims, and the latter when dispensing 20, 30 or 40 minims. 20 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
JVIEDICINE e/fSES 
Robert M. Fuller, M. D., of New York, on Pocket Medicine Cases (continued). 
When it is desirable to dispense powders, it will be found that the so-called compressed pills (or compressed powders), 
such as Pil: Calomel, gr. V., or Pil: Morphias sulphatis, gr. manufactured by Wyeth & Bro., of Philadelphia, can 
be easily reduced to powder by gentle pressure and subdivided if desired. 
When pills are used, medium-sized ones will be best suited to the vials. 
Ready and Proper Labeling of Medicines Dispensed, as well as of the Vials in the Pocket Case. 
By writing the date and directions plainly upon an adhesive label-which may also be inscribed with the number 
and name of the patient-the latter can readily be attached to the covered glass containing the medicine dispensed, 
thus preventing errors by supplying a complete prescription. 
Physicians who preserve a copy of their prescriptions, can also retain copies of those thus given. 
The envelopes for powders or pills being also printed with number, date and directions, copies of them can be 
preserved with equal facility. 
A double sheet of adhesive labels, eighty-eight of which are printed and twenty-two blank, should accompany each 
case. 
Compactness and Durability of Case. 
The style, size and finish of a pocket case is a matter of convenience or taste. In this instance, the " box" case 
has been selected, and its thickness reduced to the minimum, so that it is not only neat in appearance, but also con- 
venient to carry on all occasions. From its construction it would seem to be the most durable, the easiest opened and 
closed, and best calculated to protect its contents from injury. It is encased in durable leather and provided with 
the finest kind of spring-catch. 
Lastly, the size of the vial selected, a medium 3ij, renders it well adapted for liquids, pills, or powders, and of 
sufficient size for ordinary occasions. If, however, larger sizes are required, duplicate vials might prove preferable to 
some of double size. 
Any number of vials being once labelled, selection can be made from them as desired, and the case re-arranged at 
pleasure." 
Adhesive Vial Labels for Fuller's Pocket Medicine Cases. 
The sheet of labels previously referred to, embraces the appended list of Squibb's Preparations, from which each 
physician can readily select those medicines which would prove most useful in cases of emergency. 
Fluid Extract of 
Aconite Root. 
American Hellebore, or Veratrum Viride. 
Aromatic Powder. 
Belladonna Leaf. 
Belladonna Root. 
Buckthorn Bark. 
Digitalis. 
Ergot. 
Gelsemium. 
Indian Hemp. 
Ipecacuanha. 
Nux Vomica. 
Podophyllum. 
Rhatany. 
Rhubarb. 
Senna Compound. 
Valerian. 
(1 minim of each of above represents 1 grain.) 
Solution of 
Chloral, I grain to the minim. 
Sulphate of Morphia, Magendie's, grain to the 
minim. 
Sulphate of Atropia, 4 grains to the fluid ounce. 
Sulphate of Quinia, | grain to the minim. 
Sulphate of Zinc, io grains to 30 minims. 
Subsulphate of Iron. 
Compound Tincture of Ipecacuanha, each minim equal 
to 1 grain of Dover's Powder. 
Deodorized Tincture of Opium. 
Compound Solution of Opium. 
Compound Tincture of Opium, or Diarrhoea Mixture. 
Compound Spirit of Ether, or Hoffman's Anodyne. 
Purified Chloroform. 
Tincture of Chloride of Iron. 
Pills of Aloes and Mastic, Lady Webster's Dinner Pills. 
Pills of Arsenious Acid, grain in each pill. 
Pills of Opium, 1 grain each. 
Pills of Sulphate of Quinia, 3 grains each. 
Pills of Sulphate of Quinia, 2 grains each. 
Pills of Sulphate of Quinia, 1 grain each. 
Compound Cathartic Pills. 
Mercurial, or Blue Pills. 
Podophyllum Pills. 
Compound Pills of Scammony, or Triplex Pills. 
Nitrite of Amyl. 
Calomel. 
Mercury with Chalk. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
21 
JV1EDICIJME CASES 
Fig. 1146.-Fuller's Pocket Medicine Cases, designed for Squibb's Standard 
Pharmaceutical Preparations. 
Pocket Medicine Case. 
Style 4. 
No. 2.-Minim Measure. 
No. 3.-Pocket Case Vial. 
Pocket Medicine Case. 
Style 3. 
No. 4.-Pocket Case Vial, for Tablets. 
No. I.-Minim Pipette. 
Pocket Medicine Case, 
Style 2. 
Pocket Medicine Case. 
Style I. 22 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS 
JV1EDICINE CASES. 
Fig. 1147.-Medicine Chest, 
Fig. 1148.-Medicine Chest. 
No. 1 contains 2 Jars and 20 Vials. 
"2 " 3 " " 28 " 
Made of the best Russet Leather. 
No. 3 contains 4 Jars and 35 Vials. 
" 4 " 12 1 oz Vials, glass stoppers. 
Fig. 1149.-Saddle Bag. 
MEDICAL SADDLE BAGS. 
Fig. 1150.-Saddle Bag, 
Made of the best Russet Leather, Patent Leather 
Covers, space for Instruments under the Cover, Walnut 
Drawers in lower part. 
Flat Pattern. 
16 if oz. Vials, Glass Stoppers. 
20 if " " " " 
24 li 
16 oz. Vials, Glass Stoppers, Russet Leather, Patent 
Leather Flaps. 
20 oz. Vials, Glass Stoppers, Russet Leather, Patent 
Leather Flaps. 
24 i| oz. Vials, Glass Stoppers, Russet Leather, Patent 
Leather Flaps. 
PHYSICIANS' HAND BAG. 
Fig. 1151.-Saddle Bag. 
Fig. 1152. 
Box Pattern, with Trays to lift out. 
16 1 oz. Ground Stop Bottles. 
20 1 " " 
24 1 " GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
23 
ELECT^O-TfdERAfEUTIC. 
Fig. 1153.-Stoehrer's Galvanic Battery (Constant Current). 
(Abridgedfrom Beard & Rockwell's work on Medical 
and Surgical Electricity.) 
How the Battery is Constructed and Used.- 
This battery is composed of plates of zinc and carbon in a 
solution of bichromate of potass, sulphuric acid and water. 
The solution is contained in glass jars that are raised up 
to the plates of zinc and carbon by the keys at the ends of 
the box. When the jars are raised by the keys to the top of 
the box, turn the keys at right angles and the jars will stay 
in position. The battery is now ready for use, if the jars are 
properly filled with the solution. By means of the slide on 
the top, the current can be increased two cells at a time, as 
indicated by the graduated plane at the side. 
When the battery is not in use the jars should be let 
down from the plates by means of the keys. If allowed to 
remain immersed day after day the battery will rapidly lose 
its strength. 
How TO Charge the Battery.-The solution is made in about the following proportions: sulphuric acid, I 
oz.; bichromate potass, i£oz.; water, io oz. The best way to make the solution is to dissolve the bichromate of 
potass in cold water and then add the sulphuric acid. The mingling of the water and sulphuric acid causes great 
heat. Do not use the solution until it is cool. 
Lift out the plates by the middle piece to which they are attached, lift up the jars by the keys and fill each jar 
with two, or three, or three and a half ounces of the solution. They should be filled pretty uniformly, and care 
taken that no more is put in than the jar will hold after the plates are immersed. 
How to Clean the Battery and Amalgamate the Zincs.-Every few weeks or months, according to the 
extent to which the battery is used, it will be necessary to wash the plates and scrape off the incrustations and renew 
the solution, or, at least, to add more acid or water, and amalgamate the zincs. A good way to amalgamate the zincs 
is, take a strip of zinc, dip it in a solution of sulphuric acid and water, then dip it in mercury; the mercury will 
adhere to and run over it; then rub it up over the surface of the zincs of the battery until all are well covered with 
mercury. During the process of amalgamation the zincs should be kept well moistened with a solution of sulphuric 
acid and water. The brass work of the battery should be kept clean and bright, so that the current may flow readily. 
How to Tell the Strength of the Current.-Those who have no galvanometer can tell whether the 
current is running and how strong it is by putting one pole in the hollow of the hand and the other between the 
thumb and forefinger. The poles should be of sponge, wet with salt-water or simple warm water. Those who have 
been accustomed only to the noisy and violent faradic (induced) current, will be disappointed to find that this 
galvanic current causes only a slight burning sensation, with no shocks, except when interrupted. A current that is 
scarcely felt when applied in the hand, may be too strong to apply to the head, or face, or neck. The greatest 
mistakes are made by using the galvanic current too strong. 
How to Distinguish the Poles.-The current is felt strongest at the negative pole. When both poles are 
dipped in a solution of iodide of potassium, the brown color of the iodine appears at the positive pole. 
Flexible, self-acting, comfortable, vitalizing and durable. 
Fig. 1154.-Garratt's Electric Disk. 
Long Disk, 4 x 12 inches, and strap to go around the body, $3.50. 
Extra Long Disk, 4x8 inches, and strap with buckle for larger 
body, $5.00. 
A constant medico-electric relief for local pains and weakness, for old rheumatic and neuralgic pains, coldness and 
stiffness, weak lungs, heart, stomach, kidneys, sluggish liver, lame back and other ailments. 24 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
EbECTRO-TJHERAPEUTie. 
Fig. 1155.-Gaiffe's Battery (Farradic Current). 
Accessories to the battery: i Pair of sponge holders ; I Olive-shaped excitor ; I Spherical excitor ; i Metallic brush. 
It gives: The primary current ; The secondary current; The current of the two first, combined in intensity ; and, 
Shocks, slow or fast, according to the use either of the contact breaker or the lever. 
Admitting that the three currents produce the same physiological effects, they give a series of results increasing in 
intensity. 
The battery working this instrument consists of a small rectangular cell of hard rubber divided in the middle, each 
part containing a carbon plate and also one of zinc. Each is charged with bi-sulphate of mercury and water, produc- 
ing no fumes or smell whatever. 
To prepare the apparatus for use: remove the zincs, a a, from the gutta percha reservoir, b b, place a few grains of 
bi-sulphate of mercury on the carbon plates contained in same reservoir, and mix with a little water. Replace the 
zincs, a a. Should the apparatus refuse to work, give the vibrator, c, an impulse with your finger. 
The power of the apparatus is regulated by pulling out the tube, d, more or less, and increased by adding to the 
dose of bi-sulphate of mercury. 
By placing the conducting wires in their sockets, A B, we have the primary, in A C the extra, and in A D the 
primary and secondary currents. 
To produce shocks press on the button, e. 
After use, clean out the reservoirs, wash and dry them. 
To keep the apparatus in repair: 
a. Oxide often forms on the platina of the vibrator, c, clean it by rubbing it softly with a small smooth file. 
b. The same may happen to the springs, f f, which touch the platinum wires emerging from the reservoir ; clean 
them in like manner, and as they serve the double purpose of holding in place the reservoirs and forming the 
connection with the instrument, it is necessary to rebend them, should they cease to touch the wires. 
c. The ends of the conducting wires and their sockets, ABC D, should also be kept clean, which may be done 
with powdered pumice stone and a rag, the holes cleaned out with pumice stone and a piece of wood. 
An electro-magnetic remedy for nervous diseases, 
Fig. 1156.-The Voltaic Armadillo. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
25 
ELECTRO-THERAPEUTIC. 
Fig. 1157.-Eighteen-cell Galvanic Battery. 
Price, $40.00. 
In a polished black walnut case, 12 inches long, 8| inches wide, 7i inches high, with lock and handle, metal work 
all nickel-plated, and first-class sponge electrodes and cable conducting cords. This is a convenient size for physicians 
use, as it gives a powerful current and weighs but a little over 14 pounds. 
Fig. 1158.-Eighteen-cell Combined Galvanic and Faradic Battery. 
Price, $52.50. 
In a polished black walnut case, 17 inches long, 8 J inches wide, 7 inches high, with first-class faradic coil, polished 
hard-rubber ends and cover, extra large cell to run the coil, sponge electrodes and cable conducting cords. This is 
the most convenient battery for a physician's use, as it gives a very intense galvanic current and a faradic current of 
sufficient strength to treat any case. It weighs only 18 pounds, and is perfectly portable. 26 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
ELECTRO-TJHERAf>EUTIC. 
Fig. 1159.-Twenty-four-cell Galvanic Battery 
Price, $55.00. 
Same style of case, finish, electrodes and cords as the eighteen-cell battery. Case is 15 inches long, 9 inches wide, 
- inches high, with lock and handle. Weighs less than 20 pounds. 
This battery gives galvanic current of great intensity, sufficient to treat any case where it is indicated. 
Fig. 1160.-Twenty-four-cell Combined Galvanic and Faradic Battery. 
Price, $67.50. 
Same style of case and finish as the above (but two inches longer), with first-class faradic coil, polished hard-rubber 
ends and cover, extra large cell to run the coil, sponge electrodes and cable conducting cords. 
This battery gives same intensity of galvanic current as the above, and a faradic current of sufficient strength ot 
treat any case. It weighs only 22 pounds, and is perfectly portable. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
27 
ELECTRO-TJHERAPEUTI6 
Fig. 1161.-McIntosh Physicians' Faradic Battery. 
This battery is put up in a neat 
polished black walnut case, 6 inches in 
width, 9 inches in length and 7 inches 
in height, and weighs less than 6 
pounds charged. All the metal work 
is nickel-plated. 
It has a hard-rubber cell and drip- 
cup. First-class induction coil, with 
polished hard-rubber ends and cover. 
The coil, binding posts and rheotome 
are placed on the upper surface of a 
polished- hard-rubber plate, the under 
surface of which is covered with soft 
rubber, and also holds the zinc and 
carbons. When the elements are re- 
moved from the cells and placed in the 
drip-cup, this plate is securely clamped 
over them and makes them water-tight. 
The connections of the coil with the 
zinc and carbons are permanent. 
To use this battery, it is only necessary to loosen the thumb-screws and raise the elements from the drip-cup and 
place them in the cell, and the battery will commence to work at once ; connect one end of the conducting cords with 
the binding posts, and the others with the sponge electrodes, and it is ready for use. 
It is very convenient for a physician's visiting battery, or family use, as it is light and perfectly portable, and gives 
sufficient strength to treat any case where the faradic or induced current is needed. 
Price, $18.00. 
Fig. 1162.-Twelve-cell Combined Galvanic and Faradic Battery. 
Price, $40.00. 
In a polished black walnut case, 13I inches long, 8J inches wide, 7J inches high, with first-class faradic coil, pol- 
ished hard-rubber ends and cover, extra large cell to run the coil, electrodes and our new cable conducting cords. 
This battery gives a galvanic current same as above described, and a faradic current of sufficient strength to treat any 
case. 28 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ELECTRO-THERAPEUTIC. 
Fig. 1163.-McIntosh Physicians' Faradic Battery, No. 3. 
Price, $30.00. 
This instrument is intended for a physician's visiting battery. It is put up in a finely polished black walnut case, 
8 inches long, 8 inches wide and inches high. All the metal work is finely nickel-plated. 
It has several new features, whidh we believe make it the most complete and elegant (aradic battery ever offered to 
the profession. It has a large rubber cell and drip-cup, composed of one piece of hard vulcanized rubber. It has a fine 
induction coil with polished hard-rubber spool and cover. The coil, rheotome, binding posts, pole changer indicator, 
and switch to connect primary or secondary current with the binding posts, are attached to a polished hard-rubber 
plate, 5x7 inches. Under this plate is a space for electrodes. The pole changer is so arranged that when moved to 
the left it uncovers a button marked positive, on which is an index pointing to the positive post on the right. (Post 
on the left is now negative.) When turned to the right, a button on the left is uncovered and the index points to the 
positive post on the left. (Post on the right is now negative.) It is not necessary to remove the conducting cords 
when connected with the binding posts to obtain the primary or secondary current, as this is accomplished by means 
of a switch. The elements are securely clamped to a hard-rubber plate, the under side of which is covered with a 
thick sheet of pure soft rubber. By simply closing the cover of the case, this plate is firmly pressed over the cell and 
drip-cup, so that it is impossible for the fluid to be spilled. When the battery is to be used, open the box, raise and 
reverse the plate holding the elements, which immerse in the cell and connect the coil by means of the two bars, which 
should be pressed into the slots in the two posts opposite them. This makes a very simple, perfect connection. 
The handle on the plate holding the elements serves the purpose of a spring, which gives firm and even pressure 
over the cell and drip-cup when the case is closed. 
Another new and very important improvement in this battery is the perfect connections of the elements. The ends 
of the zinc and carbon plates which are fastened to the rubber plate are covered with hard rubber, which is put on in 
a soft state, then vulcanized. This covers them so perfectly that no fluid can get between them and the rubber, or 
the screws which clamp them. 
This is the only connection ever made with zinc and carbon elements where the metal work and screws are perfectly 
protected from the battery fluid. 
It is a very convenient and elegantly finished battery,,.and gives a smooth, even current of great strength. The 
force can be graduated, from a current so mild as to be scarcely perceptible, to one so strong as to be painful. 
With sponge electrodes and cable conducting cord. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
29 
EIdESTF^O-THERAPEUTICS 
Fig. 1164.-McIntosh Family Faradic Battery. 
Price, $10.00. 
It is made on the same principle as higher 
priced faradic batteries, and is portable. It is not 
intended to take the place of the Physicians' Battery, 
but is for domestic use. Will give a smooth even 
current. 
It is put up in a neat black walnut case, 6^- inches 
long, 6 inches high and 5 inches wide, with lock and 
handle, and furnished with electrodes and conduct- 
ing cords. All the metal work is finely nickel-plated. 
Fig. 1165'.-Davis & Kidder's Magneto-Electric Machine. 
Price, $10. 
For Nervous Diseases. 
Instructions for use, in the English, German, and Spanish 
languages, accompany each apparatus. 
Directions for Operating the McIntosh Faradic Battery. 
To make the battery fluid : B-Sulphuric acid (commercial), 3 fluid ounces ; powdered bichromate of potass, 2 
ounces ; water, 16 fluid ounces; bisulphate of mercury, 2 drachms Dissolve the bisulphate of mercury in the 
water, then add the bichromate of potass. When dissolved, pour in the sulphuric acid and allow the liquid to cool, 
as the mingling of the acid and water produces heat, and if the mixture is used when warm it injures the battery. 
The bisulphate of mercury keeps the zincs well amalgamated. 
To charge the battery: Loosen the thumb-screws that hold the rubber plates over the cell and drip-cup, and fill 
the large cell one-half full of the battery fluid. Wherf the battery is to be used, immerse the zinc and carbon plates 
in this cell, and the battery will commence to work at once ; if it does not, touch the spring on the coil and set it 
vibrating. A buzzing sound is produced, which shows that it is in action. The screw-heads on each side of primary 
give the weak current. The screw-heads on each side of secondary give the stronger current. Either of the currents 
can be made stronger by drawing out the tube from the coil. 
To use the electric current: Connect the conducting cords wit'h either the primary or secondary current, and hold 
the sponge electrodes, or place on any part of the body to be treated. The sponges should be thoroughly wet, or the 
current will not pass. When through using the battery, remove the zinc and carbon plates from the fluid and place 
in drip-cup, and fasten with the thumb-screws so the soft rubber on the other side of the hard-rubber plate presses 
evenly over the cell and drip-cup. 
In no instance should they be left in the fluid. After using the battery a few times, rinse the zinc and carbon 
plates ; this keeps them clean. After using for some time, the battery fluid should be changed, as it grows weak, and 
the battery will not act. 30 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ELECTRO-THERAPEUTIC, 
Instruments for localized electrization may be used in connection with any galvanic or faradic apparatus. 
To affect the tissues beneath the epidermis, electrodes covered with sponge, chamois or flannel moistened with 
salt-water are most efficient. 
Duchenne used the faradic current making applications to muscles. Remak applied the galvanic current to motor 
nerves. 
Niemeyer says: " In the constant current we have the means more powerful than any other of modifying the 
nutritive conditions of parts that are deeply situated." 
ELECTRODES. 
Fig. 1166.-Beard's Adjustable Electrode, 
with Band. 
These are made of different sizes. They can 
be kept in contact with any part of the body by 
means of a single cloth band. They may be covered 
with sponge or with electrode covers made of 
flannel, provided with elastic in their edges to keep 
them in position and allow of slipping them on 
and off easily. 
Fig. 1167.-Beard's Current Changer. 
It differs mainly in this feature from other devices to accomplish the same purposes, viz.: that the current is 
reversed by simple and slight pressure of the thumb, without the intervention of a slide or any complex arrangement 
whatever. The letter D represents the button of the spring, by pressing which the current is interrupted or reversed. 
Pressing it lightly, interrupts the current, pressing it firmly reverses it. In the vertical section of the hard-rubber 
handle, A A is represented as springing up against a metallic plate on the upper and inner surface of the handle. 
Pressing it slightly down, the metallic connection is broken and the current is interrupted ; pressing it firmly down, 
the connection is made and reversed at BB, the metallic plate on the lower surface of the handle. 
C represents the wires that connect with the battery, enclosed in a rubber tubing, E. 
/'and G are flexible wire electrodes armed with sponges ; they can be separated several inches and kept there, or 
put close together, as represented in the cut. The advantages of this are these: I. In many of the applications of 
localized electrization this neat and simple arrangement saves considerable expenditure of muscle on the part of the 
operator. One hand can be perfectly free, while the other holds and guides the electrode. In electrizing the muscles 
of the hand and arm, and of the face especially, it is far more convenient than to use separate electrodes. 2. In cases 
of paralysis of motion and of sensation, where voltaic alternatives are sometimes indicated, this is the easiest conceiv- 
able method of reversing the current. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
31 
ELEGT^O -TJHERAPEUTI© 
ELECTRODES IN CASES. 
Fig. 1168.-Tiemann & Co.'s Set of Electrodes. 
Price, in Morocco Case, $12.00. 
i Sponge Holder. 
I Tongue. 
I Needle Holder. 
I Universal Handle. 
I Rectal and Vaginal. 
I Wire Brush. 
i Uterine. 
I Vesical Electrode. 
Electrode Case, No. 1. 
i Wheel Electrode, with universal handle of polished 
hard rubber, wheel of the same material, set with 
metallic points, for muscular faradization. 
i Holder for large sponge (nickel-plated). 
I Rectal Electrode, insulated with polished hard 
rubber. 
i Vaginal Electrode. 
I Tongue Electrode. 
i Cup-shaped Uterine Electrode. 
i Metallic Brush. 
Price, $30.00. 
i Uterine or Urethral Electrode, insulated with polished 
hard rubber. 
I Spiral Flexible Uterine or Urethral Electrode, in- 
sulated. 
i Laryngeal Electrode, with sponge tip, insulated with 
polished hard rubber 
i Ear Electrode, insulated with polished hard rubber. 
I Eye Cup Electrode, new style. 
I Hair Brush Electrode. 
I Needle Holder for Electrolysis, with two needles. 
Electrode Case, No. 2. 
Price, $15.00. 
1 Universal Sponge Holder, nickel-plated. 
1 Rectal Electrode, nickel-plated. 
I Vaginal Electrode, nickel-plated. 
1 Nasal Electrode, insulated with polished hard 
rubber. 
1 Cup-shaped Uterine Electrode, insulated with pol- 
ished hard rubber. 
I Spiral Flexible Uterine or Urethral Electrode, in- 
sulated. 
2 Duchenne's Points, nickel-plated. 
I Ball Electrode, nickel-plated. 
i Metallic Brush. 
i Disk Electrode. 
i Needle Holder for Electrolysis with one needle. 
The manner of introducing a hypodermic syringe is the best method of introducing needles for electrolysis. One 
or more gold-plated needles (according to size of tumor), connected with the negative pole of the galvanic battery, 
should be inserted in the base of the tumor, and a sponge electrode connected with the positive pole should be placed 
on the skin near the tumor. At the commencement of the operation connect from 4 to 6 cells and-increase the num- 
ber until decided electrolysis of the fluids of the tumor take place, which may be known by the escape of a frothy 
fluid and loosening of the needles-care should be taken that the electrolysis is not carried too far. In tumors the size 
of a chestnut the passage of a galvanic current from 6 to 10 cells for 5 to 10 minutes is usually sufficient. If more 
extensive and rapid electrolysis is desired, introduce two or more needles, and connect by means of a needle holder 
connected with the negative pole of the battery. If electrolysis of the skin is not wanted insulate the needle or nee- 
dles by coating them with shellac varnish (gum shellac dissolved in alcohol) within 1 to an inch from the point; this 
will depend on the size of the tumor, as the insulation is to prevent the action of the galvanic current on the skin 
where the needle passes through it. The pain attendant on the introduction of the needles in large tumors situated in 
sensitive parts of the body is, of course, best combatted by full anaesthesia, or by ether spray, but in a majority of 
cases anaesthetics are hardly required. 
To Produce Electrolysis of Tumors, Warts, N.evi, Hair Bulbs, &c. 
Connect the small platinum needle with the negative pole of the galvanic battery and introduce it into the hair 
sack, using the hair as a guide. The point of the needle should be carried to the bottom of the sack. The positive 
pole of the battery should be connected vpth a sponge electrode, which can be placed on the surface of the skin near 
the hairs to be removed ; when electrolysis has been carried far enough the hair bulb can be easily pulled out. Use 
from 4 to 6 cells of the battery. After the operator has had a little experience he will know the time required and 
number of cells to use. 
To Remove Hair by Electrolysis, 32 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ELECTRO-THERAPEUTIC. 
Fig. 1169.-Murray's Electrolysis Needle. 
(magnified view.) 
Fig. 1170.-Beard's Long Cutting Needles for Electrolysis of the Base. 
Fig. 1171. 
Post's Electro-Massage 
Roller. 
Fig. 1172.-Butler's Electro-Massage Instrument 
Fig. 1173.-Intra-Uterine 
Galvanic Pessary. 
Fig. 1174.-Post's Warm Water Electrode. 
Fig. 1175.-Hank's Galvanic Pessary. 
Fig. 1176.-Nunn's Catheter Electrode. 
Fig. 1177.-Electro Magnet. 
This instrument is for removing bits of iron or steel from the cornea and chambers of the eye. To use the 
magnet the conducting cords are connected with the poles of a battery cell (a cell with zinc-carbon element is the 
best), and the small stylet brought near or in contact with the particle, which adheres to the magnet and is removed. 
If the particle of iron is imbedded in the cornea, it may be necessary to loosen it and then remove it with the magnet, 
which can be done without contact with the eye. If iron or steel has penetrated either chamber, it is then necessary 
to introduce the small stylet of the magnet, which attracts the particle, and is easily removed. The connections are 
made so that it can be joined to the cell of any faradic battery, but its magnetic force is greatly increased by add- 
ing several cells. GEORGE TIEMANN <t CO.'S SURGICAL INSTRUMENTS. 
33 
ELECTRO-THERAPEUTIC 
[■ XG. 1178. AN heel Electrode of Hard Rubber, set with metallic points for muscular 
Faradization ; universal hard rubber handle, 
with current interrupter. 
Fig. 1180. 
Sponge-covered Electrode, Insulated with 
Soft Rubber for general application 
with the hand. 
Fig. 1182.-Sponge-covered Electrode, with long handle, 
Fig. 1179.-Universal Handles, with Sponge- 
covered Disks. 
Fig. 1181.-Flannel-covered Foot Plate. 
Fig. 1186.-Holder for large 
sponge Electrodes for 
universal handle. 
Fig. 1185.-Rectal Electrode, Insulated with Polished Hard Rubber. 
Fig. 1190.-Vaginal Electrode, Insulated with Polished Hard Rubber. 
Fig. 1183.-Ball Rectal Electrode (insulated). 
Fig. 1184.-Rectal Electrode, nickel plated. 
Fig. 1188.-Rectal Electrode, large, nickel plated. 
I* IG. 1189.-Vaginal Electrode, nickel plated. 
Fig. 1187.-Sponge-Cup. 34 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ELECTRO -THERAPEUTIC. 
Fig. 1191.-Nasal Electrode, nickel plated 
Fig. 1192.-Small Aural and Nasal Electrode. 
Fig. 1195.-Comb Electrode, nickel plated. 
Fig. 1196.-Metallic Brush. 
Fig. 1197.-Cup-shaped Electrode, for Uterus, 
three sizes, Insulated. 
Fig. 1193.-Tonsil Electrode, nickel plated. 
Fig. 1194.-Tongue Plate, Insulated. 
Fig, 1198.-Olives, different sizes, which may be attached to Fin. iiqq. 
Fig. 1201.-Uterine or Urethral Electrode, insulated with hard rubber 
Fig. 1204.-Laryngeal Electrode, nickel plated, insulated. 
Fig. 1206.-Small Sponge Electrode, for 
external application to the larynx. 
Fig. 1200.-Elastic Electrode, for conveying both Currents 
to the Uterus or Urethra. 
Fig. 1199.-Spiral Flexible Uterine or Urethral 
Electrode, Insulated. 
Fig. 1207.-Laryngeal Electrode, with sponge tip. 
Fig. 1203.-Metallic Catherer (silver). 
Fig. 1205.-Duchenne's Metallic Points, for muscular 
Faradization, gold plated. 
Fig. 1202.-Metallic Catheter (silver). GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
35 
ELECTRO-THER/vPEUTI© 
Fig. 1213.-Disk Electrodes, 
three sizes. 
Fig. 1208. 
Neck and Arm Electrode. 
Fig. 1210. 
Ball Electrode. 
Fig. 1209.-Ear Electrode. 
Fig. 1214. 
Eye Cup Electrode. 
Fig. 1211. 
Metallic Scourge, nickel plated. 
Fig. 1212.-Small Eye Electrode. 
Fig. 1215.-Metallic 
Points for Faradization. 
Fig. 1217.-Dental Electrode. 
Fig. 1218.-Metallic Handles. 
Fig. 1223.-Vaginal Electrode, for both currents, insulated in halves 
Fig. 1221.-Bole Changer (handle of hard rubber) 
Fig. 1222.-Vaginal Electrode, for both currents, insulated 
in the centre, nickel plated. 
T 
Fig. 1224.-Sponge Holder and Current Breaker. 
Fig. 1216.-Hair Brush Electrode. 
Fig. 1219. 
Disk Electrode, 
insulated points. 
Fig. 1220. 
Sponge Cup, nickel plated. 36 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ELECTRO-THEf^APEUTie 
Fig. 1225.-Double Ear Electrode, insulated. 
Fig. 1226.-Metallic Sound, nickel plated. 
Fig. 1227.-Needles for Electrolysis. 
Straight, half-curved, full-curved, flattened 
needles (shown in cut full size). 
Fig. 1230. 
Rectal Electrode, insulated. 
Fig. 1228.-Uterine Electrode, with cup and stem (insulated). 
Fig. 1229.-Needle Holders, with cord and tips to hold I, 2, 3, 
4. e or 6 needles of any size. 
Fig. 1231.-Metallic Foot Plate. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
37 
ELECTRO "SURGERY. 
GALVANO-CAUTERY. 
Galvano-Cautery is employed for removing cancerous, vascular and other tumors, for cauterizing hemorrhoids, 
fistulous openings and ulcers, for performing tracheotomy, amputations of the tongue and neck of the uterus, and for 
destroying neuralgic nerves, &c., and has the following advantages over other modes of operating: absence of the 
hemorrhage usual with cutting instruments, the cauterizing effects can be localized to parts that are not easily acces- 
sible to other instruments, and freedom from pain after the operation. The instruments employed are based on the 
principle of heating a resisting wire by the galvanic current. Platinum is the material best adapted to construct the 
electrodes, as it offers a greater resistance to the passage of the 
electric current than other metals, and cannot easily be burnt. 
For Galvano-Cautery electrical intensity and quantity is re- 
quired, to accomplish which the batteries made heretofore were 
bulky, inconvenient and expensive. 
The adjoining woodcut represents a galvanic battery, made on 
a principle devised by Dr. B. F. Dawson, of New York city. It 
is entirely novel in construction, more perfectly reliable, durable 
and powerful than any other battery of similar size and cost, and 
for simplicity of construction, facility in working, and for con- 
tinuance, uniformity and intensity of its power, has no superior. 
These advantages over other batteries lie in the principle of con- 
struction, and the means for preventing and overcoming what is 
known as "polarization" of the battery, the occurrence of which 
in all small batteries has heretofore rendered them unreliable and 
useless. The battery is composed of but two cells, in each of 
which are two positive (zincs) and one negative (platinum) plate, 
all measuring but 4^ by 6 inches. The zincs, A, are perforated, 
and adjusted but half an inch apart, and between them a platinum 
plate is placed and held in position by uprights, B. On each side 
of the platinum plates are hard rubber or celluloid pumps or 
agitators (C), worked by means of a small knob. D and E are the 
connecting screws, and F a knob for lifting the battery out of the 
cells. The entire battery requires but 2| pints of fluid, with 
which amount it will keep up a most powerful action, long enough 
for the most prolonged operation, by the moving up and down of 
the pumps, C, which, according to the intensity of the heat 
desired are moved more or less quickly. By this action, the old 
and exhausted fluid between the plates is thrown out through the 
perforations, and fresh fluid is made to take its place ; thus keep- 
ing up a uniform power, equal in intensity and constancy to that obtained from the large imported batteries. In con- 
sequence of its power it has been found necessary to make special platinum cautery instruments of heavier metal to 
accompany this battery. Batteries have already been ordered by many of the most eminent surgeons and physicians, 
in place of others of foreign and domestic manufacture, which latter they pronounce inferior to this in portability, 
simplicity, reliability, power and compactness. The entire battery, with polished wood case, measures 8$ inches in 
height, 6 inches in width and 4 inches in depth from front to back. Each battery will be fully guaranteed to prove 
all that is claimed for it. Directions, &c., accompany each. In ordering platinum cautery knives and wire, it will 
be best to state for what class of operations it is designated to use them, for thus satisfaction will be more perfectly 
secured. The principle upon which this battery is constructed being applicable to all galvanic batteries, for whatever 
use, was patented Sept, 7 th, 1875, No. 167510. 
Fig. 1232.-Dawson's Galvano-Caustic Battery 
Fig. 1233.-Galvano-Cautery Sling and Platina Wire. 
The loop is formed of flexible platinum wire, and may be of any size. By turning the wheel on the handle, the 
loop is contracted, and, being heated by the battery, cuts the tumor off gradually. The instrument is applied cold; 
it becomes heated instantly at the moment the circuit is completed, which is done by attaching the wires in the socket 
at the extremity of the handle. 38 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
EbE6T^O-SUR(SE^Y. 
Fig. 1234.-Dawson's Universal Cautery Electrode 
The woodcut represents a universal electrode for galvanic-cautery operations. Of the simplest mechanism, it also 
combines strength, lightenss, durability and perfect reliability, either as a galvanic-cautery ecraseur, or cautery knife, 
needle or applicator. 
A is a solid hard rubber handle, through which pass the conducting rods, C C, connected with the conducting 
wires at B. The rods, C C, being hollow half their length, admit of the rods running from the ivory tip, E, to slide 
in and out like a telescope, which they are made to do by turning the small wheel, E. This telescoping of the rods 
keeps up perfect current connection, and at the same time causes a slow contraction of the wire cautery loop at E, the 
ends of the wire being secured in the ivory clamps, G, on the rods, C C. The current is regulated or cut off and on 
from the battery by the screw, £). 
The small illustrations show three of the cautery instruments accompanying the handle, and which are used by 
withdrawing the tip, E, with its rods and adjusting the individual cautery instruments that may be requisite into the 
open ends of the rods, C C. 
Fig. 1235.-Schroetter's Laryngeal Cautery Electrodes, 
Fig. 1236.-Lincoln's Laryngeal Cautery Electrode. 
I. Snare of platinum. 
2. Lancet. 
3. Porcelain burner. 
4. Knife. 
5. Voltolini's knife. 
6. Blunt's cautery. 
on account of the patient being able to avoid contraction of the palate during the operation, or when it can be con- 
It consists of an electrode fitted to Schroetter's handle. In some cases the shield may be dispensed with, either 
trolled by some retractor. 
i. Schroetter's universal handle; 2. Electrode, on which is fixed a spiral spring terminating in a shield of bone, 
concealing a platina disk, which terminates the electrode; 3. The same, with the disk disclosed by the recession of 
the shield when pressed against the tissue in the act of cauterization. The shield serves to protect the surrounding 
parts in case the instrument is grasped by them during an operation ; 4. The disk in its relation with the shield. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
39 
TJHERMO-CAUTE^Y. 
Fig. 1237.-Paquelin's Thermo-Cautery 
The apparatus consists of a hollow handle, insulated with wood, to protect the hands from the heat. It is fur- 
nished with two movable hollow platinum cauteries ; into these, after they have been heated to blackness in a flame 
of a spirit lamp, a blast of benzine vapor is introduced by means of a Richardson's spray bellows, which at once rises 
to and maintains them at a state of vivid incandescence. 1 he heat thus produced can be kept up for an indefinite 
time by slightly compressing the bellows occasionally. 
The apparatus, in a morocco case, direct from the manufacturer. 
/rCTUAb CAUTERY. 
Fig. 1238.-Naevus Needle. 
Fig. 1239.-Wight's Blowpipe. 
Fig. 1241.-Cautery Irons. 
Fig. 1240.-Blowpipe for Heating Irons. 
Fig. 1243.-Cautery Irons. 40 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
D^Y ©OLD AND JHEAT 
Fig. 1244. 
Spinal Ice Bag, 
for the application of dry 
heat and dry cold. 
Directions for Preparing and Applying. 
Put ice (broken into pieces about the size of a nut) into the opening of the bag, on 
the side nearest to the loops, until the contents of the lowest cell reach up to the bottom 
of the second cell; then into the middle opening until it reaches up to the bottom of the 
third cell; and, finally, fill the top cell. Then close the bag with the clamp, placing it on 
the thickened, band-like part around the mouth, and letting the screws be on the same side 
as the loops of the bag. When the clamp is properly applied, a very moderate pressure by 
its screws is needful to make the bag water-tight. Care must be taken that each cell is 
not so filled as to cause it to become round, otherwise only a small portion of the bag will 
touch the back. It is also expedient that the contents of the several cells should only 
slightly overlap each other. 
In applying the bag, place the smooth side of it in apposition with the back, the side 
bearing the loops being turned outwards. The bag may be kept in its position in various 
ways. If it is intended to be used for only a short time, or if the patient be in bed, the 
best plan is to lie upon it, taking care that it is exactly along the centre of the back. If 
the patient should wish to move about, pass the elastic band around the head, in order that 
it may hold the upper cell close to the back of the neck, and sustain the bag by fastening 
the clothes tightly outside of it; or pass a long tape through the lower loop, carrying each 
half of this tape over the shoulders, crossing one over the other in front of the chest, carry- 
ing them backwards around the waist, in order to clasp the bag closely into the small of 
the back, and then, bringing them forward, tie them in front. 
As ice contains a considerable amount of air, this air, as the ice melts, accumulates at 
the top of the bag, and being a bad conductor of heat, prevents the still unmelted ice 
which it surrounds from exerting its intended influence: it is therefore necessary to unscrew the clamp occasionally, 
in order to let the air escape, and, if the bag is to be worn for a considerable time, to replace the air by a little fresh ice. 
Fig. 1245.-Dr. Allan McLane Hamilton's Revulsor. 
For patients with dysaesthesiae, spinal irritation, and a few other maladies, confined chiefly to women, and depend- 
ent upon uterine diseases, I found the alternate use of heat and cold to be followed by the most desirable effects, par- 
ticularly in spinal irritation. Of twenty-six cases of this kind I have cured fifteen, and have greatly improved all the 
others. I at first directed the patients to employ icebags, and hot flat-irons covered by flannel, but subsequently made 
use of the instrument I will presently describe. In hysterical affections this mode of treatment was of great use, 
particularly those forms characterized by lividity of the surface and unconsciousness, with rigidity. The surface be- 
came warmer and the circulation much more equable after ten or fifteen minutes' use of the revulsor. 
It consists of two chambers of brass, two and a half inches in diameter by one and a half inches deep. These 
have screw plugs inserted so that they may be removed and the chambers filled, one with cold water and salt, the 
other with hot water. These chambers are fixed on a rod, and separated by an insulating or non-conducting sub- 
stance. The rod terminates in a handle. The flat surface covered by thin flannel is placed against the bare back, 
on either side of the spinous processes of the vertebras, and the instrument is passed up and down quite rapidly. As 
the heated surface moves instantaneously to where the cold one was an instant before, the effect is quite marked. 
Dry heat and dry cold are much better as therapeutical agents than moist heat or moist cold. The effect is ener- 
getic ; the skin is influenced more quickly, as there is no fluid between to act as a non-conductor. 
In paralytic conditions, local applications of the revulsor to the muscles themselves seemed to increase the circulation 
in the tissues much more vigorously and successfully than did the faradic current. 
Heat and cold, I am convinced, are valuable remedies that have not been thoroughly made use of 
Dr. Winternitz, of Vienna, uses a new instrument for treating pollutions, spermatorrhoea and chronic gonorrhoea, 
which he names Psychrophor. It is a double current catheter without eyes, the two canals communicating near the 
point of the instrument. It is introduced into the urethra until its point has passed the pars prostatica, and it is then 
attached by rubber tubing to a reservoir containing water of the desired temperature. On turning the stopcock, the GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
41 
DF^Y ©OIdD AND JHEAT 
water flows into one canal and out through the other. In this way the caput callinaginis and the entire mucous mem- 
brane are exposed to the mechanical action of pressure and the sedative action of cold. 
Other instruments for the application of dry heat or cold have been devised, as : for the penis and scrotum, by 
Dr. Otis ; for the head, neck, breast, abdomen, anus, &c., by Leiter. 
They may be readily made of lead or rubber pipe-preferably lead, on account of being a superior conductor of 
heat or cold. The lead pipe is molded in coils to the part of the body to be treated : one of its ends is connected by 
rubber tubing to any form of reservoir containing water of the desired temperature which, circulating through the 
coils, finds its exit at the other end into some convenient receptacle. 
JHOT W/tTER 
USE OF WARM AND HOT WATER IN SURGERY, 
Professor Frank Hastings Hamilton, M. D., of New York City, 
No treatment hitherto adopted, under our observation, has been attended with equally favorable results. 
Under this plan the area of acute inflammation is exceedingly limited ; erysipelatous inflammation has been almost 
uniformly arrested or restrained when it has actually commenced, and it has never originated after submersion ; gan- 
grene has in no instance extended beyond the parts originally injured, and when progressing it has in most cases been 
speedily arrested (in gangrene hot water, or water at a temperature of from ioo° to no° Fahrenheit, is to be preferred). 
Septicaemia and pyaemia have not ensued in any case in which submersion has been practised from the first day of the 
accident. Purulent infiltration and consecutive abscesses have been infrequent, and always limited to the neighbor- 
hood of the parts injured, and of small extent. Traumatic fever, usually present after grave accidents, when other 
plans of treatment have been pursued, as early as the third or fourth day, has seldom been present when this plan has 
been adopted, and in no case has the fever been intense or alarming. 
The phenomena usually observed in cases of recent lacerated or incised wounds, when submerged, are, a sense 
of comfort, yet not absolute relief from pain ; on the second or third day the parts adjacent are swollen, but not much 
reddened ; the integument generally assumes a white and sodden appearance, and with only slight tenderness. On 
the fifth, sixth or seventh day the swelling is greater than usually accompanies other plans of treatment; and, with 
the inexperienced, is likely to excite alarm, but is found not to be attended with increased tenderness, and it pits 
under pressure, showing that it is a condition of oedema chiefly. At this time the granulations are generally covered 
with lymph, or some exudate of a whitish color, and which might easily be mistaken for a diphtheritic deposit. At the 
end of fourteen days, or thereabouts (the period at which, in most cases, we substitute fomentation for submersion), 
the limb is still oedematous, the granulations are abundant, sometimes presenting a fresh red appearance, and at 
others covered with the white exudate. 
(Extracted from the New York Medical Record, May 15th, 1874.) 
To what Class of Cases Submersion is especially Applicable. 
Position of injury.-The lower extremities can only be completely and permanently submerged to a point 
three or four inches below the knee, and the upper extremities to a point a few inches above the elbow: consequently, 
submersion is limited to those portions of the extremities which are below the points mentioned. 
Character of injury.-Submersion in warm water demonstrates its superiority over other plans, especially in 
the case of a laceration or contusion of the hand or of the foot, when the integument and flesh are extensively torn- 
provided the limb is submerged without closing the wound-that is, without sutures or bandages; indeed, sutures are 
inadmissible when this plan is adopted, since the cedema which almost inevitably ensues would break away the sutures, 
Mere contusions, without external lesions, have been treated almost constantly at St. Francis'by this method; 
and the results have been in all cases satisfactory, and occasionally they have progressed toward recovery in a manner 
to excite surprise. 
Simple incised ivounds have seldom been subjected to immersion, since it inevitably defeats union by first 
intention. Nor have wounds caused by amputation been treated in this manner, partly for the reason just given, 
and partly because of certain apprehensions that the depending position might expose the patient to the dangers of a 
secondary hemorrhage where large arteries have been severed and are exposed in the wound. 42 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
jHOT W/vTER 
Value of Hot Water in Traumatic Gangrene. 
The power of hot-water baths, or water at or above the normal temperature of the blood, to arrest traumatic 
gangrene is remarkable ; and the writer entertains a hope that its efficiency may not be limited to traumatic gangrene 
alone, yet this remains to be proved. 
For the arm and hand we have an oblong zinc bath, 23 inches long by 8 inches wide and 8 in depth, with some- 
what flaring margins where the arm is to enter, supplied with a movable cover, which leaves an opening for the arm, and 
provided with a stop-cock to enable us to draw off and renew the water. Along the upper and outer margin of the 
bath are arranged small wire-pins, upon which pieces of cloth may be fastened for the purpose of suspending the 
limb. Care must be taken not to allow the limb to rest against the edge of the bath, so as to interfere with the 
circulation, and it must be carefully adjusted upon a shelf, be- 
side the bed, in such a position as will be most comfortable to 
the patient. 
For the lower extremity a zinc bath is used also, somewhat 
larger, the floor being in the form of an inverted roof, the apex 
of which is below ; the base being represented by the open top 
of the bath ; this latter is provided also with a movable cover. 
The apex is supported by a wooden frame and horizontal 
board. This bath is, like the arm-bath, provided with pins 
for suspension of the limb, and a stop-cock. 
In the case of the foot-bath, when it is found uncomfortable 
to project the foot from the side of the bed, the portion of the 
bed upon which the body reposes is elevated by mattresses, 
and the bath is placed on the floor of the bedstead. 
We have not thought it necessary to keep the water at an 
absolute uniform temperature, so that its management is left very much to the judgment of the patient or his attend- 
ant ; but usually it has been kept at such a temperature as to feel warm to the hand of the attendant-and this is 
found to be about 950 Fahrenheit. Sufficient uniformity has been attained generally by changing the water three 
times daily. 
In case of a recent wound, where secondary hemorrhage is at all liable to occur, the limb is dressed for a few hours 
with either warm or cold fomentations, and is left reposing in bed ; but neither sutures, adhesive plasters, nor bandages 
are applied. At the expiration of this time either the bath or the warm-water fomentations are commenced, and there- 
after employed systematically. The patient is at 
liberty at any time to lift the limb from the bath, and 
he generally does this pretty often, to see how it is 
progressing. 
Warm-water fomentations are regarded by us as 
always second in value to submersion in the prevent- 
ing and cure of inflammation, and they are reserved, 
therefore, for those examples in which submersion for 
one or another reason cannot properly be employed. 
Fomentations are employed by us after the four- 
teenth day in all those cases in which we employ 
submersion at first-occasionally, when the patient is 
weary of the confinement of the bath, the limb is 
taken out and fomented during the night. 
We employ fomentations in amputations and other 
incised wounds when union by first intent is desired ; 
in lacerated and contused wounds which cannot be 
subjected to immersion ; in most examples of ulcers ; in many syphilitic and cancerous sores ; in some simple con- 
tusions and sprains. In short, to repeat what has been already intimated, with warm water, either in the form of 
the bath or fomentation, we treat nearly all surgical accidents. Carbolic acid, the chlorinate of soda or lime, and other 
antiseptics being reserved for very rare and exceptional cases. 
In using the fomentations we envelop the wound and limb in several folds of sheet lint or soft old muslin, saturated 
with warm water, the whole being enclosed in oiled silk or vulcanized rubber. This is changed about once in four or 
six hours. 
Method of Using the Warm-Water Bath. 
Fig. 1246.-Bath for Arm, Forearm and Hand. 
Fig. 1247.-Bath for the Lower Extremity. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
43 
/rN/ESTMETIC 
Fig. 1248.-Lente's Modified Ether Inhaler. 
A person thoroughly conversant with the use of ether can succeed quite well, though with a waste of the drug and 
greater annoyance to the operator and assistants, with an extemporized apparatus, a towel and stiff paper formed into 
a cone, or a cup sponge enveloped in some impervious material. The great objection, however, to a soft apparatus is 
that its air space is liable to be, and almost invariably is, much contracted during the struggles of the patient by the 
pressure exerted upon it either by the administrator or the patient who frequently 
clutches it and gets it out of shape, and by losing its stiffness from other causes, so 
that, as the writer has not unfrequently seen, the patient's struggles are mainly 
caused by having but little chance to breathe either air or ether. The writer formerly 
contended that, in using the inhaler, the admixture of air should be prevented as 
far as possible. This was owing to the imperfect fitting of the different parts of 
the instrument, and of the cushion to the face, more air than necessary being thus 
admitted. With the present apparatus, however, its improved shape and better fit- 
ting cushion, all entrance of air may be prevented, which was never considered 
desirable. An arrangement is, therefore, made for the admission of more or less 
air at the apex of the cone. But at the same time, the writer adheres to his original 
idea that but little air should be admitted after the patient is able to breathe with 
tolerable facility-that is, if we desire rapid etherization, which is not desirable if 
the operation is to be a protracted one. 
The present instrument resembles very much the face-piece of Waldenburg's 
apparatus for condensing and rarifying air ; and the idea of using sheet brass and 
the india-rubber u/r-cushion was indeed taken from it. But the air-cushion is a 
failure, as almost all inflated things are, without an improvement suggested by the writer, the stuffing of the tube first 
with hair, so that, when the air leaks out, the cushion will still retain sufficient of its rotundity to fit the face air-tight. 
When it is to be used, a handkerchief, or piece of sheet lint, &c., is stuffed into the cone, a wire or whalebone arrange- 
ment slipped in to keep it off the face, and it is ready. There is a hole in the stopper to admit air, and if more air is 
needed the stopper can be removed. The ether can be poured in the opening at the apex, in case it is undesirable to 
remove the cone from the face, or throw it on the cloth. Its cleanliness is perfect, as a different piece of cloth 
may be used each time. 
Fig. 1249.-Allis' Ether Inhaler. 
The apparatus consists of a wire frame-work, sufficiently large to cover the lower part of the face. The wires are 
parallel, and about an eighth of an inch apart. Between the wires, from side to side, a strip of bandage two and one 
half inches wide is passed. The instrument is only about four inches long and three inches at its greatest width, and 
yet it consumes more than three yards of bandage when passed between all the 
wires. By further reference to the figure it will be seen that each section of the 
bandage is separate from the adjoining one, thus permitting the air to pass freely to 
both sides of it. 
Its advantages are these: The ether being very thoroughly mixed with air, the 
patient does not suffer from the suffocation usually felt at first inhaling; there is a 
large evaporating surface. A very much smaller quantity of ether is used, and less 
escapes into the room than with the usual mode of giving this ancesthetic ; the ether 
can be dropped from a bottle on the distal end of the inhaler, without removing it 
from the face ; the mask is soft and pliable, fitting accurately to the nose and mouth ; 
and, lastly, it is of very simple construction, and cannot get out of order. 
Over this frame is drawn a piece of stout sheet india-rubber, or patent leather, 
which has been stitched together at the edges, so as to make a covering for the frame, 
projecting over one end two inches, to form the mask, and at the other one inch. 
The ether is poured on the bandage, which forms a close, well-made artificial sponge. 
My mode of using it is as follows: Placing it over the face, I sprinkle on a few 
drops of ether-I mean literally but a few drops. In a few seconds I add a few 
more drops ; and usually in from half a minute to a minute I find that I can drop it more constantly. As soon as I 
notice the deep inspirations, I pour on a small stream, watching carefully lest I irritate the larynx ; and as soon as I 
find the patient tolerant of its vapor, I add it in larger quantities, and as rapidly as can be evaporated, and am usually 
gratified by seeing my patient pass quietly under its influence in from three to ten minutes. 
The instrument is especially serviceable when a prolonged use of ether is required. A slight dripping will suffice to 
prolong the effect, and economy of ether, though not a great desideratum, is still worthy of consideration. 44 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/cN/eSTJHETIC 
Fig. 1250.-Squibb's Ether Inhaler. 
The apparatus consists of an hour-glass shaped muslin bag, which, when laid flat, is about twenty inches long by 
nine inches wide at the widest part, one end of which is cut off so as to be funnel-shaped, and open to receive the lower 
part of the face. This funnel-shaped mouth of the bag is of such a size as to admit the nose, mouth, chin and beard 
of an adult male, and may be adapted to any smaller 
face by turning it back like a cuff. The muslin of this 
end of the bag is double, to afford additional obstruc- 
tion here to the passage of air and ether vapor. The 
narrow part of the bag is made elongated, so as to re- 
ceive a tin tube about seven inches long and two inches 
in diameter. And the bottom of the bag or round end 
is made of such a size that, when moderately distended, 
it holds say forty or fifty cubic inches, or more than is 
necessary for a full inspiration. 
When about to be used, this bag is thoroughly wetted 
in water, and squeezed so that it does not drip, for the purpose of rendering it only partially pervious to air and ether 
vapor. It is not certain that an impervious bag would not answer as well, but it would be more difficult to obtain, 
more expensive, less cleanly, and, perhaps, less safe. The sole object of the tin tube is to keep the narrow portion of 
the bag distended while in use. A piece of flannel about six and a half inches wide and eighteen inches long, and a 
piece of thick blotting paper or blotting card of the same size as the flannel, completes the apparatus. The flannel is 
laid upon the blotting board, and the two are rolled up together into a roll or spiral which will slip into the tin tube, 
and when there spring out sufficiently to retain its place loosely. A two-ounce graduated measure, and a can or bottle 
of ether, are all that are now required for the anaesthesia. 
The patient to be anaesthetized - fasting, takes, about fifteen minutes before the time set for the operation, a 
fluid ounce or a fluid ounce and a half of brandy or whiskey, if an adult male, or two fluid ounces of wine, if a female. 
This, upon an empty stomach, will produce slight intoxication in about ten minutes, and the anaesthetic has only to 
supplement this in order to get quickly through the stage of excitement in many cases. It also renders retching less 
likely to occur. The patient is then placed quietly on the table, and is advised in a slow, quiet tone, to be composed 
and perfectly still. He is told that he will soon begin to feel intoxicated, or excited and restless ; that this is very much 
under his control, and that the more he resists it the sooner he will be asleep. If this advice be given with tact and 
skill, it will be well received, and be of service in a majority of cases. The manipulator is then to wet the bag 
thoroughly, squeeze out the water until it no longer drips, slip the empty tin tube into its place in the narrow part 
of the wet bag, and then prepare the charge of ether. This may be done in several ways ; but perhaps the 
best way is to pour the measured quantity of ether into a tumbler, and having allowed the roll of flannel and 
blotting board to expand itself to nearly the size for the tin tube, dip first one end and 
then the other into the ether until the ether is all taken up, and then at once slip the 
charged roll into its place in the tin tube, the latter being already in its place in the 
wet bag. Then fold, first one end of the wet bag and then the other, up over the part 
which holds the tin tube, so that both ends of the tin tube may be closed up by the 
wet muslin to prevent loss of ether, and then lay it aside, ready for use at any moment. 
The loss of ether, while thus laying ready, is very small, not over a fluid drachm in 
half an hour. The quantity of ether for the first charge should vary with the estimated 
sensibility of the patient. For an adult man one and a half to two fluid ounces, and 
for females and sensitive males one to one and a half fluid ounce is sufficient, if the 
ether be good ; for children, a half to one fluid ounce. In the anaesthesia of children, 
and in many exceptional cases, no general rule can be laid down ; and, indeed, the 
circumstances of each case must always modify each application. 
Fig. 1251.-Chisolm's Pocket Ether Inhaler. 
Chisolm's Pocket Ether Inhaler is in the shape of a lancet case, made of german 
silver or nickel-plated brass. It is stuffed with washed sheep's wool or sponge. The 
wire gauze or perforated circle is for the reception of the ether and for the admission 
of air. On the cover are two nozzles for introduction into the nostrils. When the 
instrument is not in use this cover is reversed, and it may then be carried in the pocket 
like the common lancet case. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
45 
/?N/ESTJHETIC. 
Fig. 1252.-Cheatham's Ether Inhaler. 
It operates by Lente's method of replenishing the evaporating surface without removing it from the face. 
A patient cannot be anaesthetized as quickly with it as with a common cone, but with much less ether. It econo- 
mizes by not having to remove it from the face to replenish it, and by this you avoid the disagreeable effect of having 
the ether that would otherwise escape permeating every part of the house in which 
it is used. Its convenience of application is also quite obvious. The ease with 
which the face-piece (being paper) can be removed immediately after use and thrown 
away is, I think, a strong recommendation in its favor. 
This apparatus consists of a tin cup (A\ holding in the inside a sponge as an 
evaporating surface, and connected from the top by rubber tubing with the bottle 
that contains the antesthetic. This tube has attached to its distal end a cap {D) 
that will fit over the neck of almost any bottle. 
Make a cone of paper, cut the top off, so that when tin cup {A) is slipped inside, 
the top of the cup will protrude a line or two from the top of cone. 
Place tin cup (A) over both cup and cone, screw it down tightly by means of 
nut (0, and you have the cone held tightly. Attach tube to top of cup, and the 
apparatus is complete. The smaller the cone the quicker you can get the patient 
under the influence of the anaesthetic. I would suggest, after the cone is in posi- 
tion, the bottom should be trimmed, leaving a part of it-we shall call it the back 
part-that is intended to go over the chin, three inches longer than the cup, and 
sloping forwards and upwards, leaving the front part, intended to go over the nose, 
about an inch longer than the cup. E gives an inside view of cup (J). 
Fig. 1253.-Hutchison's Ether Inhaler, 
Dr. J. C. Hutchison recently presented to the Medical Society 
of the County of Kings (Proceedings of the Society) an ether inhaler, 
which he describes as follows: 
A tin tube for holding a sponge for the ether, three and a quarter 
inches long and two and a quarter inches in diameter; one end is left 
open, to be covered by a muslin bag, the other is closed, with the ex- 
ception of an opening at its upper part, one inch in diameter, into which 
is inverted a tube for attaching a rubber hood. This tube projects 
backward three-fourths of an inch, and is then carried downward, at a right angle, to a level with the lower margin 
of the sponge tube. This arrangement prevents the liquid ether from running down upon the patient's face or mouth. 
There is an opening in the centre of the top of the large tube, one inch in diameter, having a neck half an inch long, 
which is closed by a cork; through this opening the ether is poured upon the sponge without removing the mask from 
the patient's face. A rubber hood, such as is used in giving nitrous oxide gas, fits accurately over the mouth and 
nose, and may be so adapted to any face as to completely exclude the air. The neck of a muslin bag, pear-shaped, 
eleven inches long, and eight or nine inches wide at its widest part, fits closely over the open end of the sponge tube, 
and has a slit an inch and a half long at its mouth, to the corners of which tapes are attached, for the purpose of tying 
it tightly around the opening through which the ether is poured, so as to prevent the entrance of air at this place. 
The bag should be made of close material, and when it is wet with water, it is impervious, or nearly so, to air 
or ether vapor. 
Mode of Using the Inhaler.-When about to be used, the large tube is filled with a piece of coarse sponge, of 
proper size and shape, which has been previously wet with water and thoroughly squeezed. The bag is then wet and 
squeezed, so that it does not drip, and secured over the mouth of the tube. The sponge will hold two ounces of ether, 
which should be poured upon it through the opening on the top of the tube containing the sponge. In most operations 
the first charge of ether is all that is required, and in many, half the quantity mentioned is quite sufficient. The 
rubber hood is applied accurately over the mouth and nose, but the opening through which the anaesthetic is poured is 
left uncorked until tolerance or partial anaesthesia of the mucous membrane of the air passages is established, as in- 
dicated by deep inspirations. Free dilution of the ether vapor with atmospheric air when its administration is 
first begun, prevents in a measure the coughing and strangling that is liable to occur from the sudden application o/ 
the concentrated vapor. 
The bag ordinarily lies upon the upper part of the chest, but in operations about the neck and upper part of the 
body, it may be placed to one side or the other, or upward over the face, by turning the sponge-holder on the rubber 
hoed, the latter retaining its position. 46 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
/vN/ESTHETIC 
Hutchison's Ether Inhaler (concluded). 
The Advantages of the Inhaler.-The advantages which the writer believes this apparatus possesses are: 
1st. The mechanical act of respiration is entirely free-"the lower end of the bag rises and falls with the respira- 
tion, without offering any practical obstruction to the mechanical process" (Squibb), and the breathing can be closely 
watched. 
2d. No part of the instrument is liable to become soiled by expectoration or vomited matters, except the rubber 
hood, and this is easily cleaned-an advantage of no small importance for the antiseptic days. But it is better to 
throw the whole apparatus into a basin of water after each inhalation, to free the products of respiration. No inhaler 
should be used a second time without being thoroughly cleansed. 
3d. The apparatus economizes ether, the first charge (two ounces) being usually sufficient for a long operation ; it 
prevents, in a great measure, the vapor from permeating the apartment, and affecting the comfort of the operator and 
his assistants, and especially the anaesthetizer who often suffers from inhaling a large quantity of the vapor himself. 
4th. It is simple in its construction, having no valves, and is inexpensive and portable. 
The apparatus, together' with a bottle or tin can containing four or six ounces of ether, may be carried in a tin 
case nine inches long and three and one-half inches in diameter, divided by a diaphragm in the middle-one side 
of the case for the ether bottle and rubber hood, and the other for the tin tube (the sponge being placed inside of it) 
and the bag. 
The instrument consists of an oblong conical cylinder, which iolds upon itself. Within the cylinder and near the 
top of the instrument, when extended, is a pocket, in which rests the flannel or sponge to receive the anaesthetic used. 
The pocket is so constructed that a continuous column of air can pass between it 
and the sides of the inhaler proper. The top and sides of the inhaler contain slides, 
by means of which more or less air can be admitted or excluded as required during 
the administration of any anaesthetic. The top of the pocket is concave and per- 
forated. The preparation used can be poured through the top, and the anaesthetic 
agent, falling upon the concave surface of the instrument, passes through the per- 
forations alluded to, and is taken up by the sponge or flannel within the apparatus; 
thus enabling the practitioner to replenish the instrument, when required, without 
removing it from the face of the patient. 
The interior of the instrument, when closed (which looks like a cup), contains 
a bottle, which can be kept filled with chloroform, ready for immediate use as 
required-as in cases of convulsions, diagnosis, obstetric practice, &c. Within the 
box containing the apparatus, is a flannel sack. This can be pulled over the in- 
strument to keep it warm, when from long and continued use, and consequent 
evaporation of the anaesthetic, it becomes cold. Whenever desired, the instrument 
can be instantly removed from the face of the patient ; and, when not in immediate 
use, the slides can be closed and the apparatus placed upon a pillow. The pillow, 
being soft, conforms to the bottom of the instrument, retaining the vapor within, to 
be again used from time to time as required. 
Fig. 1254.-Speirs George's Inhaler. 
Fig. 1255.-Mitchell's Ether Inhaler. 
The accompanying wood-cut so clearly represents the instrument 
that an explanation of it is hardly necessary. This inhaler is made of 
tin. It is divided by a diaphragm of wire gauze into two nearly equal 
parts. The letter a shows the mouth-piece with the wire gauze inside 
and openings for the admission of air. The cover, b, opens by a hinge 
on the side, and allows the introduction of cotton cloth or other 
material, which lies on the top of the wire diaphragm, and receives 
the ether. There is a sliding button, c, which goes between the fingers, 
and facilitates the handling of the instrument. When not in use, this 
button slides in. 
This inhaler has been thoroughly tested, and is recommended to 
the profession on the grounds of: I. Durability; 2. Cleanliness; 3. 
Cheapness; 4. Economy of ether, the amount being far less than that 
consumed by other inhalers. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
47 
/cN/EST^ETIC. 
Fig. 1256.-Heuel's Ether Inhaler. 
In apparatus for ether inhalation, the objects to be attained are, first, that it be more convenient, durable 
and economical, though just as simple, easily managed, safe, and cleanly as the towel cone ; second, that it pre- 
sent no possible difficulty to free respiration, either by the inadequate diameter of its respiratory passages or by 
inhaling or exhaling valves, which are apt to get out of order; third, that it be self supplying, with the anaes- 
thetic under perfect control, thereby avoiding the necessity of 
removing the instrument from the face to replenish with ether; 
fourth, that it present the air as nearly as possible saturated with 
ether, at the same time preventing its general diffusion outside of 
the body without impeding the patient's respiration ; and, lastly, 
that it be inexpensive, and not bulky or cumbersome. 
I have devised an inhaler, constructed for me by Messrs. Tie- 
mann & Co. of this city, which overcomes in a satisfactory manner 
all of the difficulties enumerated above. I have used it in hospital 
and private practice for the last nine months, and have found that 
it practically fulfils the theoretical requirements of a perfect in- 
haler. 
It is constructed of thin nickel-plated brass, with a rubber face- 
piece, and is, when closed for transportation, a cylinder six inches 
long by three inches in diameter, being of convenient size to carry 
in the pocket, and consists, as shown in the accompanying wood- 
cut, of three parts, viz.: An ether reservoir, ay a respiratory chamber, 
b; and a face-piece, c; one placed below the other. 
The ether reservoir' is cylindrical in shape, holding about twelve 
fluid ounces. It has at the top, near the side, an opening, d, 
closed by a screw-cap and rubber washer for filling the reservoir. 
The screw-cap has drilled through its side, below the washer, a 
small opening, so that when unscrewed, before using the apparatus, 
by a few turns it will permit air to enter the ether reservoir to sup- 
ply the vacuum left by the exit of ether through the stop-cock at 
the bottom. 
At the bottom of the ether reservoir, near the side, is an opening closed by a metal stop-cock, e, continuous with 
which, and in a plane parallel to and one-half inch below the bottom, is a spiral coil, /, of small copper tubing, having 
perforations about one inch apart on the top or side nearest the reservoir. This pipe runs from the stop-cock on the 
side straight to the centre, and then spirally straight toward the periphery. To steady it, it is soldered at its outer 
margins to a ring, projecting from the bottom of the reservoir. The stop-cock has attached to it an index hand 
and chequered button, h, which moves on the outside of the reservoir, and indicates when parallel to the long axis 
of the reservoir that it is closed, s; when moved away from this axis toward o, that it is being opened. The ring, g, 
projecting from the bottom of the reservoir, fits, by an accurate bayonet joint, into the top of the next cylinder, b, 
which is the respiratory chamber. Both the ring, g, and the top of the respiratory chamber are pierced with corre- 
sponding holes five-sixteenths of an inch in diameter and about three-eighths of an inch apart. These I will designate 
as the respiratory openings. The bottom of the respiratory chamber is slightly turned in, forming a shoulder upon 
which is fitted a disk of wire gauze, k, to retain the evaporating medium and protect it from expectorated and vomited 
matter. Around the outside of the respiratory chamber, and one half inch from the bottom, is soldered a piece of 
brass wire, I, to act as a shoulder to the top of the rubber face-piece, c, which fits over the bottom of the respiratory 
cylinder. Within the respiratory chamber and upon the wire gauze is packed washed sheep's wool, which I have 
found the best medium of evaporation for the ether, which drops upon it from the spiral coil above. Now it will 
be seen why the perforations in the copper coil are placed in the upper side, as the ether, when the inhaler is placed 
in the vertical position for use, must fill the entire coil before it can escape from the openings, thereby ensuring an 
equal distribution of the anaesthetic fluid. For the same reason the coil is first run straight from the stop-cock to 
the centre of the ether reservoir, and then spirally to its periphery, as the inhaler, when in use, cannot always be kept 
in a strictly vertical position. 
The face-piece, c, is made of soft vulcanized rubber, shaped like a truncated cone, with notches for the chin, w, 
and nose, n, to more accurately fit it to the face. Being made of soft rubber, it adapts itself equally well to a round, 
thin, large or small face, a prominent or a flat nose. It will answer as well for a child as for an adult. In the 
former the chin must be placed within the face-piece, the rubber then covering the nostrils, mouth, and entire chin. 
In the latter a notch, m, in the rubber fits on the chin. At the top, and within the face-piece, a metal ring, p, is 
baked on, which firmly fits over the bottom, q, of the respiratory chamber. 48 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/vN/EST^ETIC. 
Fig. 1257.-Morton's Ether Inhaler, 
It is a simple cylinder of leather, of which A repre- 
sents the face-piece, with thinned and pliable edges to 
admit of close adjustment. 7? is an inlet valve, per- 
mitting of inspiration through the ether-chamber, but 
closing against expiration. D is the entrance orifice of 
a metal tube leading through the wool-packed ether- 
chamber to E, the exit valve, which closes with inspira- 
tion-opening with expiration ; this tube is for the 
purpose of collecting the heat of the exhaled breath and 
communicating it to the surrounding wool, thus favoring 
rapid evaporation of the ether with which the wool is saturated. C is the opening for introducing the ether, one-half 
a drachm, or even less, of which is sufficient to begin with. 
The inhaler may be withdrawn from time to time, to avoid irritating the larynx, until the patient gets accustomed to the 
vapor ; then ether may be added, as the case requires, and the patient will be found to pass quietly under its influence. 
Fig. 1258.-Junker's Methylene Inhaler, 
The apparatus for using methylene 
as an anaesthetic consists of a face-piece 
to cover the nose and mouth, having 
an arrangement to admit more or less 
air at the apex. This connects by 
means of rubber hose to one end of a 
double branched metal tube running 
through a rubber stopper: the other 
branch of the metal tube connects by 
rubber hose to a set of air bags with 
valves, such as are used for Richardson's 
ether-spray. The stopper fits tightly 
a glass graduated bottle of fifteen 
drachms capacity. This has a hook 
attached to its neck by which it may 
be held in a button-hole of the operator's coat or vest. To guard against being easily broken, as well as for protect- 
ing the methylene against the action of light, it is covered with leather, preferably of yellow or light blue color, 
leaving only the graduated scale free for observation. When the air-bag is worked, the methylene in the bottle is 
agitated and vapor formed, which may be inhaled by the patient in the same way as usual with other inhalers. It 
has been used by Drs. Junker, Richardson and others with more or less success. 
Fig. 1259.-Richardson's Atomizer, for local anaesthesia. 
After filling the bottle two-thirds full with the 
solution, operate the end ball briskly ; this will ex- 
tend the netted ball and force a current of air into 
the cavity of the silver tube. This column of air, 
being disproportionately large compared with the 
aperture of the tube, becomes compressed and exerts, 
frst; an influence upon the surface of the fluid (which 
is forced by it into the capillary tube ; secondly: a 
pressure upwards, escaping through the orifice at its 
tip. This continued upward current of air divides 
into spray the drops collected at the extremity of the 
capillary tube. The force with which this spray can 
be thrown is surprising. The jet is steady, there being pretty uniform pressure kept up by the regulating power of 
the netted bag, which, by virtue of its elasticity, compresses the air in it during the intervals of manipulation upon 
the hand ball. Our tubes, being made of silver, do not form verdigris (a serious objection to instruments made of 
inferior metals). This atomizer is also the best douche for bathing sensitive eyes, inflamed sores, &c. Suitable forms 
made for the eustachian tubes, uterus, urethra, posterior nares, or any part of the body accessible to instruments. 
If the capillary tube should become obstructed, clear it with fine soft wire. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
49 
y^NTisEf>Tie 
Fig. 1260.-Hank's Antiseptic Spray, 
The stand, boiler and lamp correspond in design to the com- 
mon atomizer, now so generally used for inhalation purposes, but 
are much larger. The open glass vessel for holding the antiseptic 
fluid has a capacity of one pint, and is held in position over the 
boiler in a shallow metal cup. The latter is made to move for- 
ward and backward by means of a thumb-screw, which is attached 
to an erect rod, fastened at the base of the apparatus. The rod in 
the cut is necessarily concealed from view. There is a small stop- 
cock arrangement low down at the side of the glass vessel, thus 
regulating the amount of antiseptic fluid which flows downward to 
the atomizing points. The long metal arm, into which is fastened 
in the usual manner the glass or metal spray-producer, is attached 
to the boilers by a kind of elbow-joint, thus enabling the spray to be 
projected forward at any angle. The alcohol lamp has a large tube 
for the wick, and over this is a second tube which slides up and 
down by means of a ratchet. The handle of the ratchet is seen in 
the cut. It readily controls the size of the blaze, the degree of heat, 
and the amount of steam produced. Great care should be exer- 
cised in selecting a suitable atomizing point. With a proper point 
a coarse or fine spray may be produced, according to the amount 
of antiseptic fluid admitted through the stop-cock. The force of 
the spray will depend upon the blaze, and the consequent amount 
of steam ; and the angle of the arm will regulate its direction. 
The apparatus thus constructed will supply a suitable spray for 
two hours' operation, as the antiseptic fluid can be replenished as required. I claim for it its portability, small size, 
safety, durability and cheapness. It contrasts favorably in every way with the Lister or Sass apparatus. 
Fig. 1261.-Weir's Antiseptic Spray. 
" The best spray-producer is that devised by 
Lister himself. It is, however, quite costly, 
ranging in price from fifty to seventy-five dollars, 
and it was to meet this objection that the one 
before you has been constructed. With its dimin- 
ished cost some of the improvements of Mr. 
Lister's lamp have been sacrificed. It is, how- 
ever, essentially the same. Its hollow wick, 
readily raised or lowered, affords a great and con- 
trollable heat. The spray-tube is in this apparatus 
fixed, an objection which in the majority of cases 
is of no moment. It will supply spray for over 
two hours. It therefore requires only that the 
boiler-containing twenty-two ounce-should be, 
as well as the lamp, full at the beginning of the 
operation ; and, with this precaution, it has been 
found practicable to dispense with the expensive 
and tell-tale windows of glass belonging to the original imported instrument. The accompanying wood-cut gives 
a good representation of this lamp." 
Further directions for its use have been supplied us by Dr. Weir, viz.: 
" The lamp should be filled with alcohol at the beginning of an operation and the stopper removed from the side 
opening when the wick is lighted. Prior to filling the boiler with water (preferably hot) it is desirable to ascertain 
that the spray-tube is free by sucking or blowing through it, and also that the escape valve works properly. If the 
latter is stiff, a drop of oil or glycerine should be introduced from above. When the boiler is yet quite full, the spray- 
tube should not be depressed very much, in order to avoid the exit of hot water. If the spray-tube is too coarse, 
the end of the rubber tubing immersed in the carbolic acid solution may be plugged with cotton or sponge, or the 
tubing itself may be narrowed by a thread loosely tied around it. Should the spray-tube become choked during an 
operation, a small wire, such as comes with a hypodermic syringe, can be resorted to, to clear it. 50 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
/cNTISEpTie. 
Fig. 1262.-Little's Antiseptic Spray. 
This is Tiemann's Steam Inhaler, altered at my suggestion, so as 
to give a good spray. It answers well for dressing wounds. For large 
operations, it is necessary to use the large spray apparatus, this small 
one answering well for subsequent dressings. Mr. Lister uses a still 
smaller one for this purpose, which he carries in the pocket. This 
small one will work for over an hour. The best instrument is the one 
which makes the finest spray, it wetting and numbing the hands but 
little, and causing the fluid to last longer, while producing as good an 
effect upon the tissues. The spray-tube, in order to accomplish this, 
should be of small calibre. Always be careful to see that the safety- 
valve is right before you use it. 
1263.-Heuel's Antiseptic Spray 
1 he apparatus represented in the accompa- 
nying cut is a modified apparatus for use in an- 
tiseptic surgery. The modification consists in 
the addition of two flexible rubber tubes and a 
steam-chest to the ordinary atomizing apparatus 
used for inhalation purposes, and may be readily 
attached by the physician himself to any of the 
atomizers now used. In the annexed figure, 4 is 
a steam-chest, to the upper part of which is 
soldered, at 3, the ordinary metal atomizing 
tubes, and at the side a tube, I, to which is to be 
attached a piece of flexible rubber steam tubing, 
for carrying steam from a boiler: opposite 3 is a 
wooden handle, 7, for holding the apparatus, and 
at the lowest part of the chest is a stop-cock, 5. 
The rubber tube, 2, delivering the medicated 
fluid, is also furnished with a stop-cock, 6, so that the amount of fluid atomized maybe varied at pleasure. The steam 
water tubes, I and 2, are held together bv a figure-of-eight piece of wire, so that they may be handled as if they were 
but one tube. 
As is readily seen, the length of these tubes may be varied to suit the occasion, only remembering that the longer 
the tubes, the greater the pressure of steam required, and the higher must the vessel containing the medicated fluid 
be placed, in order to deliver it at the opening of the tube, 2. The steam, which condenses in the tubing and steam- 
chest, is allowed to escape, when necessary, through the stop-cock, 5, so that the patient is not scalded by a jet of 
hot water. 
The use of long flexible tubes, combined with the steam-chest, permits the boiler of this apparatus to be placed 
at such a distance that all danger of explosion, when ether is used, is avoided, as well as all interference with the 
operator. The force, amount and direction of the spray can also be varied at pleasure. In the ordinary atomizers 
the whole apparatus must be placed unpleasantly close to the patient ; in this a very light portion is readily supoorted 
and directed by the hand without fatigue. 
ANTISEPTIC KNIVES. 
Esmarch has devised Antiseptic Knives made of one piece of steel, so as to afford no lodgment for septic germs, 
which might possibly adhere to ordinary knives. One objection to these is, that the handles become quite slippery 
if wet with blood ; in order to obviate this, we have made, at the suggestion of Dr. Weir, antiseptic knives of which 
the handles are baked on, of hard rubber, but containing no crevices whatever. Any instrument constructed in this 
way is as if made of one piece, and affords the perfect customary hold. 
COUSIN'S ANTISEPTIC TROCAR AND KNIFE. 
After the existence of fluid has been determined by the trocar, the inner tube, or stillet, can be removed and a 
proper pointed knife, fitting the tube exactly and made so as to leave a cutting edge one and one-quarter inches 
in length, can be introduced. The direction of the knife is shown by a mark on the handle. 
This instrument may prove useful in cases of deep-seated abscesses and empyema. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
51 
Of>ERATIJ\IG fUF^NITU^E 
Fig. 1264.-Bozeman's Operating Chair. 
For placing and securing the patient in the knee-elbow position for the operation of Vesico-Vaginal Fistula, 
Vaginal Ovariotomy, &c. 
This apparatus not only completely secures the patient in this position, by straps and braces, but insures perfect 
comfort for any length of time, and also favors the administration of an anaesthetic. 
Fig. 1265.-Foster's Combined Gynaecological Table and Instrument Case, 
For the past two or three years I have used with great satisfaction an examining table, the chief features of which 
may be described as follows: when not in use it forms a close case three feet long, two feet wide and about three feet 
in height-forming rather a handsome article of furniture, not at all suggestive of the purposes for which it is chiefly 
meant. The greater portion of it serves to hold instruments and other appliances-one-half of this portion being taken 
up by a series of drawers, and the other half forming a closet. 
The upper part of the table consists of a couch, folded together somewhat after the manner of a bagatelle table. 
The central section of this couch extends the whole length of the closed case-three feet. To either end of this por- 52 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OJ^ER/cTINQ fURJ^ITU^E 
Foster's Combined Gynaecological Table and Instrument Case (continued). 
tion is hinged a lid one foot wide, making the couch, when opened for use, five feet long, furnished with hair cushions 
covered with leather. In this state it is a simple horizontal couch, of convenient height and dimensions for examining 
patients of either sex in the reclining posture. The patient's head may rest upon a small separate cushion, which 
cushion, when the table is not in use, is contained in a third lid, which serves to fill up the space between the two 
hinged lids above referred to. At the rear of the table is a hinged step, resting, when in use, on swinging brackets. 
Partial pronation of the body is thus facilitated, without the unpleasant effects sometimes produced by a table having 
a lateral pitch throughout its whole length. Moreover, from the hips resting at a higher level than the trunk, a slight 
lateral bending of the spine is caused, bringing the vagina more nearly parallel with the rays of light which are 
depended on for illumination-reaching the room, as they generally do, from a point somewhat higher than the table. 
In an examination of this sort, the stirrup for the right foot projects from the side of the table-the one for the left 
foot, diagonally from the corner. 
Fig. 1266. 
For an examination with the patient lying on the back, the central portion of the couch may be raised to any con- 
venient pitch, as shown in Fig. 1266. The stirrups, or foot supports, are simply' inserted into sockets in the frame of 
the couch, so situated that the distance between the feet may be varied according to circumstances. The shape of the 
stirrups is correctly shown. 
For an examination in Sims' posture, one end of the cushion upon which the hips rest (the end corresponding to 
the operator's left hand, as he faces the patient), is raised, so that that portion of the couch slopes towards the right. 
For the knee-elbow posture, the patient's knees may rest upon the step, the middle lid, with its cushion, being 
interposed, as shown in Fig. 1265. For the knee-chest posture, the table is arranged in the main as shown in Fig. 
1266, but the middle lid, with its cushion, is placed at B. The patient's knees rest upon this, and the trunk upon the 
declivity formed by the central portion of the couch. 
The deep drawer may be conveniently partitioned into compartments for bottles, jars, cotton wads, a vessel of 
warm water, &c. ; the others are for instruments. From the fact that the end of the couch overhangs the body of the 
table, these drawers may be opened without obliging the operator to retreat from the patient. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
53 
OPERATING FURNITURE. 
Fig. 1267.-Comstock's Gynapod. 
Explanation.-The cushioned bands slide on the 
rectangular rods, and are fastened by screws. They 
may be adjusted so as to fit any female who is ex- 
amined, and will support her limbs and make her 
position one of perfect ease, so that the uterus, vagi- 
nal walls and perineum are all placed directly in 
front of the operator. The leg braces may be elevated 
or depressed in their sockets, to suit the operator, for 
the minor operations upon the vagina, 
uterus and urethra, and, especially, 
for the more important operations, 
such as laceration of the cervix, 
vesico-vaginal fistula, fistula in ano, 
cystocele, rectocele, &c. It will also 
be found veiy practical in the lateral 
operations for lithotomy. We will 
suppose a patient to be placed upon 
her back (ano-dorsal position); the 
leg-braces, that are represented in 
the cut, are rectangular rods, dropped 
into the two upright standards which 
are made of gas pipe, and may be 
fastened to a table, or to any gynae- 
cological chair, by means of simple 
clamps screwed to the table or chair; 
the rectangular rods are provided 
with cushioned bands for the limbs to rest in. The 
rods may be raised or lowered, and turn outwards or 
inwards to suit the convenience of the operator. 
When the patient is placed in this position, a 
Simon's adjustable gutter speculum may be intro- 
duced, and is held in position by a small clamp, also 
screwed to the table ; this speculum is a perineal re- 
tractor, the same as Sims'; or the speculum of Boze- 
man may be used, one of the best vaginal retractors 
that I have ever tried. It is self-retaining and may 
be conveniently introduced, so that the screw is 
placed upwards, and rests upon the mons veneris. 
If some minor operative proceeding is required, such 
as an intra-uterine application or the removal of a 
polypus, an ordinary bivalve speculum may be used, 
e. g.. Brewer's, Hale's or Higbee's. In secondary 
operations upon the perineum, the leg braces will 
be found very practical; in vesico-vaginal fistula, 
when using the gynapod, the anterior wall of the 
vagina will be situated directly opposite to the ope- 
rator, and he can freshen easily and completely the 
fistulous margins of the rent, and then insert the 
sutures with much greater facility and accuracy than 
when the patient is placed, as is usual, in the lateral 
position or upon her hands and knees. 
Fig. 1268.-Foster's Speculum Holder. 
Foster's Speculum Holder consists of a round 
rod, bent at right angles, which may be secured by 
means of clamps to any operating table, the free end 
extending up perpendicularly. On one end of another straight rod is adjustably secured by a set screw, a Sims' Specu- 
lum. The free ends of both rods move through a double socket, and set screws permit the speculum to be fixed in 
any position desired by the operator. 54 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPERATING fURNITURE. 
Fig. 126g.-Knapp's Oculists' Operating Chair. 
Designed by Prof. II. Knapp. 
It will put the head in any position. 
It will, by means of two jaws, hold the head steady. 
The back will rise to suit the height. 
It will lower down the back or place at any incline. 
The seat will rise and the back will lower to operate on a child. 
Foot-piece rises up and draws out to support the limbs. 
Upholstered in Leather, Irons Nickel Plated. 
Fig. 1270.-Little's Operating Lounge. 
Black Walnut Frame, Upholstered in Leather. 
The appearance and proportions of the Operating Lounge and Table, designed by Dr. Little, are those of the usual 
style of lounge, and it may be used as such in the office. It is very handy for examination and reduction of ruptures, 
the convenient application of trusses, and for performing an operation on any part of the body. The seat or bed may 
be raised by taking hold of the loop-handle near the cushion and pulling it up, when a stay will fall in place and secure 
the bed in an elevated position, in the usual height convenient for operations. The illustration represents the bed or 
seat of the lounge raised. If it is to be used for gynaecological examinations, or for operations and applications to 
vagina or uterus, &c., the two foot rests concealed on the lower extremity may be pulled out, against which the feet 
of the patient are placed, as usual in such cases. By lifting the lower end of the stay, the bed is put back in its 
position, indicated by the dotted lines. There are no racks, pinions or windlasses, nothing to get out of order, and 
when not in use for an operation it forms as neat a piece of office furniture as any that has not the additional advantages 
of this lounge. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
55 
OfERATIN® FU^NITU^E. 
Fig. 1271.-The "Clark" Physicians' Office Chair, for the Practice of Gynaecology, Surgery, 
and all office purposes. 
The chair is very simple in its adjustments, absolutely noiseless, and can be placed at any angle, with the patient 
in or out of it. The design is simple, unique and beautiful. It is the proper height, does not have to be raised or 
lowered by ratchet in the presence of nervous patients, and does away with all embarrassments to both physician and 
patient, on account of its ready adaptability in all cases of emergency. 
The chair has a side table, quilted back and seat double stitched before the leather or plush is put on. All irons, 
except under drawer and rod on back chair, are nickel plated. 
Dimensions: Length, 6 feet; height, 28 inches; width, inside of arms, 21 inches. 
Fig. 1272.-The Crosby Invalid Bedstead. (Patented.) 
It affords easy access to the body-permitting the bed-clothes to be changed, and the bed made up, securing perfect 
cleanliness, without fatigue or annoyance, and allowing defecation to be performed without moving the patient. 
One person can perform all the necessary duties to a sick person, make up the bed, wash and ventilate the body, 
dress bed-sores, and use the bed-pan, without assistance or disturbing the patient. 56 
GEORGE TIEMANN * CO.'S SURGICAL INSTRUMENTS. 
GENERAL OPERATING. 
Buck's General Operating Set. 
$190. 
1 Liston's long Knife, Hip and Thigh. 
1 Liston's medium Knife, Leg and Arm. 
1 Metacarpal Knife, large. 
1 Straight Bistoury, ferruled handle. 
1 Curved Bistoury, sharp point. 
I Curved Bistoury, probe point. 
1 Hernia Bistoury. 
1 Tenotome. 
4 Scalpels, assorted sizes. 
1 Tenaculum. 
1 pair Crampton's Artery Needles. 
1 Double-pronged Hook. 
1 Beer's Cataract Knife. 
1 Desmarre's Scarifying Knife. 
1 Straight Eye Needle. 
1 Curved Eye Needle. 
1 Gouge and Spud for removing foreign bodies from 
the eye. 
1 Folding Probang with silver Bucket. 
1 Long Bullet Probe, German silver. 
1 Nelaton's Bullet Probe. 
1 pair German silver Retractors. 
1 Double silver Trachea Tube. 
1 Curved Rongeur, with spring. 
1 Ferguson's Bone-Holding Forceps, lion jaw. 
1 pair Liston's Bone Forceps. 
I pair Sequestra or Toe-nail Forceps. 
I Small Straight Trocar and Canula. 
1 Ferguson's Bone-holding Forceps, crow-bill. 
1 Rectum Trocar and Canula, curved. 
2 Gouges. 
2 Chisels. 
1 Straight Trocar and Canula, large size. 
1 pair Lithotomy Forceps. 
I Glass Ear Speculum. 
I Tourniquet. 
4 Silver Catheters, Nos. 3, 6, 9, 12. 
I Tiemann & Co.'s Bullet Forceps. 
1 Steel Director. 
1 pair Coxeter's Forceps. 
2 Vulsellum Forceps. 
1 pair Eye Scissors, curved on the flat. 
1 pair heavy Scissors, angular curve. 
1 Lithotomy Bistoury. 
1 Wire Ecraseur. 
1 pair Spring-catch Artery Forceps, fenestrated. 
1 pair Buck's Throat Forceps. 
1 pair Polypus Forceps. 
1 pair Strabismus Forceps. 
1 Peters' Hernia Director. 
1 Capital Saw. 
1 Chain Saw, best. 
1 Trephine and handle. 
I Metacarpal Saw, movable back. 
I Finger Saw, narrow blade. 
3 Lithotomy Staffs. 
3 Steel Bougies. 
i Syme's Staff. 
I Buck's Sponge Holder. 
i German-silver Eye Speculum. 
I Odema Glottis Instrument. 
2 Needles, Silk, Wax, Plastic Pins. 
2 coils Silver Suture Wire and 4 coils Iron Wire. 
3 Silver Probes. 
6 Serrefines. 
1 Mahogany or Rosewood Case, brass bound, good 
French lock, lined with silk velvet. 
1 Patent-leather Cover, water-proof. 
Wood's General Operating Set. 
$74-55- 
i pair Silver Probes. 
2 Steel Sounds. 
I Long Amputating Knife. 
i Circular Knife. 
I Catling. 
i Trepanning Scalpel with Raspatory. 
I Spiral Tourniquet. 
2 Needles, Silk, Wax, Plastic Pins. 
I Trepanning Brush. 
I Metacarpal Saw. 
I Tiemann & Co.'s Bullet Forceps. 
i pair Straight Dressing Scissors. 
i pair Curved Eye Scissors. 
i Hey's Saw. 
I Silver-plated Catheter. 
I Gum-elastic Catheter. 
2 Gum-elastic Bougies. 
I Capital Saw. 
I pair Liston's Bone Forceps. 
i Trephine and Handle, Galt's. 
I pair Spring-catch Artery Forceps, plain. 
I Trepanning Elevator. 
I Director, steel. 
I Beer's Cataract Knife. 
I Curved Sharp-pointed Bistoury. 
I Curved Probe-pointed Bistoury. 
2 Scalpels. 
i Plain Aneurism Needle. 
I Tenaculum. 
I Strabismus Blunt Hook. 
I Straight Eye Needle. 
I Curved Eye Needle. 
I Curved Eye Forceps, Strabismus. 
I Rosewood, brass-bound Case, lined with oil-dyed 
patent velvet. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
57 
GENERAL OPERATING 
Post's General Operating Set. 
$150.95. 
1 Granger's Sponge-Holder, gilt. 
1 pair Dressing Forceps. 
I pair Polypus Forceps. 
I pair Strabismus Scissors. 
I pair Strabismus Forceps. 
1 set Mott's Aneurism Needles. 
1 pair Angular Scissors, heavy. 
I Kramer's Ear Speculum. 
I pair Liston's Bone Forceps, larger than usual. 
1 Silver Female Catheter. 
1 Metacarpal Saw. 
6 English Gum Elastic Catheters 
1 Medium-sized Trocar and Canula. 
1 Probang, with Silver Bucket. 
1 Nelaton's Probe. 
I pair Cilia Forceps. 
1 Sharp-pointed curved Bistoury, with ferule. 
1 Finger Bistoury. 
3 Scalpels, assorted sizes. 
1 Tenaculum. 
1 Trepanning Scalpel and Raspatory. 
1 Long Amputating Knife. 
I Blunt Hook. 
2 coils Silver Wire and Silk. 
1 Metal Bullet Probe. 
1 Uvula Scissors, with claws. 
I Galt's Trephine. 
I Bone Trephine. 
1 Trephine Handle. 
1 Ebony Gorget. 
1 pair Coxeter's Forceps. 
1 pair Dressing Scissors. 
1 Trepanning Elevator. 
1 pair Spring-catch Artery Forceps, plain. 
1 Rongeur. 
1 Double Trachea Tube, silver. 
I pair Entropium Forceps. 
I Silver Catheter, No. 9. 
1 Hey's Saw. 
1 pair Mott's Retractors. 
1 Japanned Tongue Depressor. 
1 Rectum Trocar. 
1 pair Sequestrum Forceps. 
1 Wire Eye Speculum. 
1 Tiemann & Co.'s Bullet Forceps. 
1 Lachrymal Needle.' 
1 Tenotome. 
1 Probe-pointed Bistoury. 
1 Straight and 1 Curved Eye Needle. 
1 Beer's Cataract Knife. 
1 Medium-size Amputating Knife. 
12 Suture Needles, Silk, Wax, Plastic Pins. 
2 Silver Probes. 
1 Director. 
1 pair Vulsellum Forceps. 
1 Capital Saw. 
1 Rosewood brass-bound Case, lined with silk velvet. 
1 Patent-leather Cover, water-proof. 
Blackman's General Operating Set. 
$i36-75- 
1 Liston's long Knife, handle to unscrew. 
1 Liston's medium Knife. 
I Catling. 
1 Straight Finger Knife. 
I Capital Saw. 
1 Aneurism Needle. 
1 Tenaculum. 
1 Narrow Finger Saw. 
1 Lead Mallet. 
1 Lithotomy Staff. 
1 Chisel. 
1 Gouge. 
1 Rongeur with Spring. 
1 pair Liston's Bone Forceps, large, with spring. 
1 Elevator and Raspatory. 
1 Sequestrum Forceps. 
1 Lion-jaw Bone-holding Forceps. 
1 Tiemann & Co.'s Bullet Forceps. 
1 Universal Forceps, crossing. 
1 Double Silver Trachea Tube. 
1 Lead Bullet Probe. 
2 Scalpels, with Ferules. 
1 Curved Sharp-pointed Bistoury. 
1 Curved Probe-pointed Bistoury. 
1 Hernia Knife. 
2 Blackman's Retractors. 
18 Needles, Silk, Wax, Plastic Pins, Silver Wire, Iron 
Wire. 
2 Silver Catheters. 
1 Gum Elastic Catheter. 
I Straight Trocar. 
1 Chain Saw, best. 
1 Galt's Trephine and Handle. 
1 Spiral Tourniquet. 
I Steel Director. 2 Silver Probes. 
1 Eye Needle and Scoop on one handle. 
I pair Strabismus Forceps. 
1 pair Dressing Scissors. 
1 pair Dressing Forceps. 
1 Wire Eye Speculum. 
1 Double-current Catheter, silver. 
1 Nelaton's Probe. 
1 Horn Screw, to open jaw. 
1 pair Artery Forceps, slide catch. 
I Rosewood Case, brass bound, lined with oil-dyed 
patent velvet. 
1 Patent-leather Cover, water-proof. 58 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GENERAL OPERATING. 
Little's General Operating Set. 
$100. 
Patent-leather Pouch for the Case, $4.00. 
2 Amputating Knives, one handle. 
1 Bow Saw. 
3 Scalpels, assorted. 
1 Finger Bistoury. 
1 Curved Bistoury, sharp-pointed. 
1 Curved Bistoury, probe-pointed. 
1 Hernia Bistoury. 
2 Retractors. 
1 Tenaculum. 
1 Mouse-tooth Forceps. 
1 Aneurism Needle. 
1 Artery Forceps, fenestrated. 
1 Artery Forceps, plain. 
1 Torsion Forceps, Phelps'. 
1 Sands' Needle Forceps. 
1 Liston's Bone Forceps. 
1 Tiemann's Bullet Forceps. 
1 Nelaton's Probe (Tiemann's Spiral). 
1 Spiral Tourniquet. 
1 Director and Tongue-Tie. 
1 Peters' Hernia Director. 
1 Trocar and Silver Canula. 
1 Polypus Forceps, curved. 
1 Scissors, straight. 
1 Scissors,curved on the flat. 
1 Throat Forceps, Cusco's. 
1 Trepanning Elevator. 
1 Curved Rongeur. 
1 Van Buren's Sequestrum Forceps. 
1 Chisel. 1 Gouge. 
1 Sayre's Periosteotome. 
1 Galt's Trephine. 
3 Steel Sounds, Nos. 10, 12, 14, one handle. 
3 Plated Catheters. 
1 Fine Silver Probe. I pair Silver Probes. 
Needles, Silk, Silver Wire, Plastic Pins, &c. 
In a Rosewood, Brass-bound Case, lined with oil- 
dyed silk velvet. 
1 Trocar, straight. 
1 Tongue Depressor, japanned. 
1 pair Liston's Bone Forceps. 
1 Galt's Trephine and Handle. 
1 Steel Director. 
1 Straight Bistoury. 
1 Curved Bistoury, probe-pointed. 
1 Curved Bistoury, sharp-pointed. 
3 Scalpels, assorted sizes. 
1 Tenotomy Knife. 
1 Aneurism Needle. 
1 pair Polypus Forceps. 
I Hey's Saw. 
1 Metacarpal Saw. 
1 pair Dissecting Scissors. 
1 Double Hook. 
1 Green's Tonsil Bistoury. 
12 Needles, Silk, Wax, Plastic Pins. 
1 Probang. 
1 Catheter, German silver, plated. 
1 Metal Bougie. 
1 pair Tiemann & Co.'s Bullet Forceps. 
1 Mahogany Case, lined with oil-dyed velvet. 
Markoe's General Operating Set. 
$67.45. 
1 Liston's Knife, long. 
1 Liston's Knife, medium. 
1 French Finger Knife, long. 
1 Straight Bistoury, sharp-pointed. 
1 Curved Bistoury, sharp-pointed. 
1 Curved Bistoury, probe-pointed. 
1 Cooper's Hernia Knife. 
2 Scalpels, assorted. 
1 Tenotome. 
1 Tenaculum. 
1 Aneurism Needle. 
12 Needles, Silk, Wax, Plastic Pins. 
1 Tourniquet. 
1 Chisel. 
1 Metacarpal Saw. 1 Hey's Saw. 
1 Trepanning Elevator and Raspatory. 
1 pair Artery Forceps, plain. 
1 pair Artery Forceps, spring-catch, fenestrated. 
1 pair Vulsellum Forceps, long. 
1 pair Toe-nail Forceps. 
1 Capital Saw. 
1 Galt's Trephine and Handle. 
I pair Parker's Retractors. 
1 pair Liston's Bone Forceps. 
1 Gouge. 
1 Silver Catheter, male. 
1 Steel Sound. 
1 Rosewood Case, lined with oil-dyed patent velvet. 
California General Operating Set. 
$69.30. 
I Capital Saw. 
1 Amputating Knife, long. 
1 Amputating Knife, medium. 
1 Small Catling. 
1 Scalpel. 
1 Elevator and Raspatory. 
1 pair Artery Forceps, spring-catch, plain. 
1 pair Artery Forceps, slide-catch, bulbous points. 
1 Tourniquet. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
59 
SEVERAL OPERATING 
Seymour's General Operating Set. 
$176.70. 
1 pair Tiemann & Co.'s Bullet Forceps. 
1 pair Polypus Forceps. 
1 Trepanning Elevator and Raspatory 
1 Exploring Trocar. 
1 pair Artery Forceps, plain 
1 Steel Director. 
1 Metacarpal Saw. 
1 Bow Saw, 2 blades. 
1 Hey's Saw. 
1 Trepanning Brush. 
2 Blackman's Retractors. 
1 Double Trachea Tube, silver. 
3 skeins Silk, Iron Wire. 
6 Double Bougies, s. s., Nos. 1 to 12, nickel-plated 
3 Silver Catheters, Nos. 3, 6, 9. 
3 Gum Elastic Catheters, best English. 
1 Lithotomy Staff. 
1 pair Harelip Scissors, straight, heavy 
1 pair Scissors, curved on the flat. 
1 set Mott's Artery Needles. 
4 Scrrcfines. 
2 coils Silver Wire, Plastic Pins 
1 Liston's Knife, long. 
1 Long Catling. 
1 Screw Handle, for both. 
1 Liston's Knife, medium. 
1 Catling, narrow. 
I Finger Knife, long, narrow. 
I Cartilage Knife, heavy, ebony handle. 
1 Tenaculum. 
1 pair Artery Forceps. 
1 pair Artery Forceps, self-closing, bull dog. 
1 Chain Saw, best. 
2 Silver Probes. 
1 Bullet Probe, lead. 
1 Bullet Probe, whalebone. 
1 Nelaton's Bullet Probe. 
3 Scalpels, assorted. 
I Curved Bistoury, sharp-pointed. 
1 Curved Bistoury, probe-pointed. 
1 Hernia Knife. 
1 Spud and Gouge, for removing foreign bodies from 
the eye. 
1 pair Gullet Forceps. 
1 Galt's Trephine. 
1 Bone Trephine. 
1 Trephine Handle. 
1 Trocar and Canula, straight. 
1 Rectum Trocar and Canula. 
1 Lead Mallet. 
1 Chisel. 
1 Gouge. 
1 set Brainard's Bone Drills. 
2 Ear Specula, porcelain. 
1 pair Liston's Bone Forceps, with spring, extra large. 
1 pair Sequestrum Forceps, with spring. 
1 Rongeur, with spring. 
1 pair Satterlee's Bone Forceps, small. 
I Tourniquet. 
1 Horn Jaw Screw. , 
1 Rosewood Case, lined with oil-dyed velvet. 
1 Patent-leather Cover, water-proof. 
Parker's General Operating Set. 
$104.90. 
1 Liston's Amputating Knife, screw handle. 
1 Liston's Amputating Knife, medium size. 
1 Small Catling. 
1 Capital Saw. 
1 Metacarpal Saw. 
1 German-silver Wire Eye Speculum. 
1 Hey's Saw. 
1 Trepanning Elevator and Raspatory. 
1 Galt's Trephine and Handle. 
1 Finger Knife. 
1 Curved Probe-pointed Bistoury. 
1 Curved Sharp-pointed Bistoury. 
1 Cooper's Hernia Knife. 
3 Scalpels, assorted. 
1 Cataract Knife. 
1 Parker's Lachrymal Needle. 
1 Exploring Trocar. 
1 Director, steel. 
1 pair Probes, silver. 
1 Tiemann & Co.'s Bullet Forceps. 
1 Tenotome. 
1 pair Parker's Retractors. 
12 Needles, Silk, Silver Wire, Plastic Pins. 
1 Small Trocar, straight. 
1 Rectum Trocar, curved. 
1 pair Artery Forceps, plain. 
1 pair Polypus Forceps. 
1 Steel Sound. 
2 Lithotomy Staffs. 
1 Lithotomy Bistoury. 
1 pair Lithotomy Forceps. 
1 pair Liston's Bone Forceps. 
1 pair Eye Scissors, curved on the flat. 
2 Silver Catheters. 
1 Spiral Tourniquet. 
1 Eye Needle, curved. 
1 set Parker's Aneurism Needles. 
1 pair Strabismus Forceps. 
1 pair Artery Forceps, spring-catch, plain. 
I Rosewood Case, brass bound, lined with silk velvet. 
1 Patent-leather Cover, water-proof. 60 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GENERAL OPERATING 
Hamilton's General Operating Set. 
$101.85. 
I Long Catling, Hip, 16 inches long. 
1 Long Catling, Thigh, 13 inches long. 
1 Liston's Knife, Leg and Arm, 13 inches long. 
1 Broad French Bistoury. 
1 Narrow French Bistoury. 
1 Probe-pointed Bistoury, ferule handle. 
I pair Liston's Bone Forceps. 
1 Capital Saw. 
1 Narrow Metacarpal Saw. 
1 Tenaculum. 
1 pair Slide-catch Artery Forceps, Torsion. 
1 pair Spring-catch Artery Forceps, fenestrated. 
1 pair Dressing Scissors, straight. 
1 pair Strong Harelip Scissors. 
1 pair Dressing Forceps. 
r pair Tiemann & Co.'s Bullet Forceps. 
1 U. S. A. Bullet Forceps. 
1 German-silver or Whalebone Bullet Probe. 
6 Serrefines. 
12 Needles, Silk, Wax, Plastic Pins. 
I Spiral Tourniquet. 
I Field Tourniquet. 
1 Long Director and Ear Spoon. 
1 Conical Trephine. 
1 Bone Trephine. 
I Trephine Handle. 
1 Trepanning Elevator with Raspatory. 
1 Hey's Saw. 
1 Tirefond. 
1 Hard-rubber Dental Syringe. 
1 set Mott's Aneurism Needles. 
1 pair Plain Artery Forceps. 
1 pair Mott's Retractors. 
1 pair Long Cotton Forceps (bird stuffing). 
3 Acupressure Needles. 
1 Metal Bougie. 
2 Silver Catheters. 
1 Mahogany Case, brass bound, lined with oil-dyed 
patent velvet. 
1 Patent-leather Cover, water-proof. 
1 Liston's Bone Forceps. 
12 Needles, Silk, Wax, Plastic Pins. 
1 Galt's Trephine and Handle. 
1 Trepanning Elevator and Raspatory. 
1 Tenotome. 
1 Curved Bistoury., sharp-point. 
1 Curved Bistoury, probe-point. 
1 Steel Director. 1 pair Polypus Forceps. 
2 Silver Probes. 1 pair Scissors, straight. 
I pair Scissors, angular curve. 
2 Mott's Retractors. 1 Double Hook. 
1 Finger Knife. 1 Hey's Saw. 
3 Scalpels. 1 Trocar and Canula. 
I Rosewood Case, lined with oil-dyed velvet. 
J. W. Wright's General Operating Set. 
$140. 
In Tiemann & Co.'s Patent Folding Rosewood Case, 
compact, lined with oil-dyed silk velvet. 
1 Amputating Knife, medium. 
I Satterlee's Amputating Saw. 
1 Bistoury, sharp-point. 1 Straight Finger Knife. 
I Bistoury, probe-point. 1 Cooper's Hernia Bistoury. 
2 Scalpels, large and small. 
2 Tenotomes, straight, sharp and blunt-point. 
I Tenaculum. 
1 set Mott's Aneurism Needles. 
1 Straight Scissors, large. 
1 Coxeter's Thumb Forceps. 
1 Fenestrated Artery Forceps, spring-catch. 
3 Wright's Artery Compressing Forceps. 
1 Grooved Director and Tongue-Tie. 
1 Galt's Trephine. I Wright's Bone Trephine. 
I Curved Rongeur. I Elevator and Raspatory. 
2 Silver Probes. 1 Liston's Bone Forceps. 
1 Ferguson's Sequestrum Forceps. 
1 Detmold's Metacarpal Saw, narrow blad? 
1 Tiemann's Bullet Forceps (American). 
1 nest (4) Trocars, silver canulas. 
1 Double-end Bone Scoop, all metal. 
1 Little's Bone Chisel, to use with hand or mallet. 
1 Little's Bone Gouge, to use with hand or mallet. 
2 Szymanowsky's Bone Gouges. 
1 set Brainard's Drills, short. 
1 Prostatic Catheter, No. 10, Plated. 
1 Tiemann's Tourniquet. 
2 Hard Rubber Trachea Tubes. 
I Curved Polypus Forceps. 
1 pair Parker's Retractors. 
I Russian Needle Forceps, small. 
1 Vulcellum Forceps, long. 
1 Henry's Circumcision Clamp. 
1 Levis' Hernia Director. 
Needles, Silk, Silver Wire, Plastic Pins, &c- 
Mott's General Operating Set. 
$72.85. 
1 Mott's Knife, large. 
1 Mott's Knife, medium. 
1 Small Catling. 
I Capital Saw. 1 Metacarpal Saw. 
1 Tourniquet. I Tenaculum. 
1 pair Artery Forceps, plain. 
1 pair Artery Forceps, spring-catch, plain. 
1 Tiemann & Co.'s Bullet Forceps. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
61 
JVII LITANY SUF(GEI^Y. 
Otis' U. S. A. Compact Field Set. 
$160. 
1 Strong Cartilage Knife. 
1 Small Amputating Knife. 
1 Catling, medium. 
1 Amputating Knife, medium. 
1 Catling, large. 
1 Major Amputating Knife. 
1 Bistoury, straight, sharp-pointed. 
1 Bistoury, curved, sharp-pointed. 
1 Bistoury, curved, probe-pointed. 
1 Bistoury, long, straight, probe-pointed. 
1 Tenaculum. 
1 Scalpel, large. 
1 Small and 1 very small Knife for Dissections. 
1 Hey's Saw. 
1 Torsion Forceps. 
1 Needle Forceps. 
1 Artery Needle Holder, with 4 points and 1 key. 
1 Tourniquet. 
1 Liston's Bone Forceps, large. 
1 Rongeur. 
1 Sequestrum Forceps. 
1 Lion Forceps. 
1 Conical Trephine. 
1 Trephine Brush. 
2 Retractors, German silver. 
I Osteotome, handle with 4 points. 
1 Tirefond. 
1 Oliver's Curved Osteotome and Chain-saw Conductor. 
1 Scissors. 
1 Dissecting Forceps. 
1 Artery Forceps. 
1 Silver Grooved Director. 
1 Major Saw, with two extra narrower blades. 
1 Movable Back Saw. 
1 English No. 6 Gum-elastic Catheter. 
1 Elevator. 
1 Bullet Forceps (Gross'). 
1 Tiemann & Co.'s Bullet Forceps. 
1 Long Articulated Probe, or sonde de poitrine, with 2 
Nelaton or porcelain tips. 
I Burrheaded Ball-searcher. 
1 Chain Saw, rotating handles and needle. 
10 Large Serrefines. 
2 coils of Annealed Iron Wire under the Movable 
Back-saw, Silk, Linen and Catgut Ligatures, Wax, 
Silver Suture Wire, Surgeons' Curved Needles, 
Acupressure Pins. 
2 Silver Probes. 
1 Mahogany Brass-bound Case, lined with oil-dyed 
velvet. 
Fig. 1273. 62 
GEORGE TIEMANN CO.'S SURGICAL INSTRUMENTS. 
JVIILITARY SURGERY 
U. S. A. Staff Surgeons' Capital Operating Set. 
$i37-io. 
1 Amputating Knife, long. 
1 Amputating Knife, medium. 
1 Catling, long. 
1 Catling, small. 
1 Cartilage Knife, heavy, ebony handle. 
I Straight Bistoury. 
3 Scalpels. 
1 Bow Saw, two blades. 
1 Chain Saw, best. 
1 Metacarpal Saw, lifting back. 
1 Hey's Saw. 
2 Trephines and Handle. 
1 Razor. 
1 Raspatory, ebony handle. 
1 Elevator, strong. 
1 Brush. 
1 pair Liston's Bone Forceps, 9 inches long. 
1 Rongeur, curved, with spring. 
1 Rongeur, straight, with spring. 
1 pair Sequestrum Forceps. 
1 pair Lithotomy Forceps. 
1 pair Liston's Artery Forceps, slide-catch. 
1 set Mott's Artery Needles. 
12 Surgeon's and 6 Wire Needles. 
1 Tourniquet. I Tenaculum. 
1 pair Scissors. 
1 Chisel and one Gouge, ebony handles. 
1 Trocar and Canula, straight. 
1 set Brainard's Bone Drills. 
1 pair Mott's Retractors. 
12 yards Silver Wire. 
1 Mahogany Case, lined with red chamois. 
1 Leather Pouch, heavy. 
12 Surgeon's Needles. 
I Tourniquet. 
I Tenaculum. 
I pair Scissors, straight, heavy. 
I Chisel and i Gouge. 
I Lead Mallet. 
i set Brainard's Bone Drills. 
I pair Mott's Retractors. 
I Elevator and Raspatory. 
i Brush, 12 yards Iron Wire, Silk, Plastic Pins. 
I Mahogany Case, lined with oil-dyed velvet or chamois. 
I Leather Pouch. 
U. S. A. Staff Surgeons' Minor Operating Set. 
Regulation Style of October, 1867. 
$136. 
1 Amputating Knife. 
1 Long Finger Knife. 
1 Hernia Knife. 
1 Straight Sharp-pointed Bistoury. 
1 Curved Sharp-pointed Bistoury. 
1 Curved Probe-pointed Bistoury. 
2 Scalpels, large and small. 
1 pair Slide-catch Artery Forceps. 
1 pair Tiemann & Co.'s Bullet Forceps. 
1 pair Dressing Forceps. 
1 pair Coxeter's Dissecting Forceps, small. 
1 pair (.Esophageal Forceps, French joint. 
1 set Mott's Aneurism Needles. 
12 Surgeon's and 6 Wire Suture Needles. 
1 pair Straight Scissors, French joint. 
1 pair Angular Scissors, French joint. 
1 pair Scissors, curved on the flat, French joint. 
1 Tenaculum. 
1 Rectum Trocar and Canula. 
2 Double Trachea Tubes, sterling silver. 
1 Belocq's Canula for Epistaxis, sterling silver. 
1 Nelaton's Bullet Probe. 
1 Director and Porte Meche. 
1 pair Flat and Cutting Pliers. 
1 Wire Ecraseur, with two points. 
2 Grooved Staffs. I Syme's Staff. 
1 Plain Sound. 
6 Silver-plated, Double-curved Bougies. 
3 Silver Catheters. 
3 Gum Elastic Catheters, English. 
1 Prostate Gland Catheter, sterling silver. 
6 Serrefines. 
24 Suture Pins. 6 yards Silver Sutures. 
1 CEsophageal Probang, silver crochet. 
1 Tonsilotome. 
1 pair Trousseau's Tracheal Forceps. 
1 Mahogany Case, brass-bound. 
1 Leather Pouch. 
U. S. A. Capital Operating Set. 
$102.50. 
1 Amputating Knife, long. 
1 Amputating Knife, medium. 
1 Catling, long. 1 Catling, small. 
1 Cartilage Knife, heavy, ebony handle. 
1 Bow Saw, two blades. 
1 Metacarpal Saw. 1 Chain Saw, best. 
1 Hey's Saw. 
1 Galt's Trephine. 1 Crown Trephine. 
1 Trephine Handle. 
1 pair Liston's Bone Forceps, with spring. 
1 pair Liston's Bone Forceps, slightly curved. 
1 pair Gouge Forceps or Rongeur. 
1 pair Sequestrum Forceps. 
1 pair Artery Forceps, plain. 
1 set Mott's Aneurism Needles. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS, 
63 
JMAJOR SURGERY 
Tiemann & Co.'s 
No. 1 Set of Amputating Instruments. 
$25. 
1 Liston's Knife, Hip and Thigh. 
1 Liston's Knife, Leg and Arm. 
1 Catling, small, Hand and Foot. 
1 Scalpel. I Tenaculum. 
1 pair Artery Forceps. 
1 Metacarpal Saw. I Capital Saw. 
1 Tourniquet. 
12 Needles, Silk, Wax and Plastic Pins. 
1 pair Bone Forceps. 
1 Mahogany Case, lined with oil-dyed velvet. 
1 Scalpel. 
1 Tenaculum. 
1 Amputating Saw, lifting back. 
1 Metacarpal Saw. 
1 Liston's Bone Forceps, best. 
1 pair of Fenestrated Spring-catch Artery Forceps. 
1 Tourniquet. 
12 Needles, Silk, Wax, Plastic Pins. 
1 Rosewood Case, lined with oil-dyed velvet. 
Tiemann & Co.'s 
Amputating and Trepanning Set. 
$44-25. 
1 Liston's long Knife, Hip and Thigh. 
1 Liston's medium Knife, Leg and Arm. 
1 Catling, Foot and Hand. 
1 T enaculum. 
1 Scalpel. 
1 Elevator and Raspatory. 
1 Hey's Saw. 1 Brush. 
1 Metacarpal Saw. 1 Capital Saw. 
1 Galt's Conical Trephine and Handle. 
1 pair Spring-catch Fenestrated Artery Forceps. 
1 Tourniquet. 
1 pair Liston's Bone Forceps. 
12 Needles, Silk, Wax, Plastic Pins. 
1 Mahogany or Rosewood Case, lined with oil-dyed 
velvet. 
Tiemann & Co.'s 
No. 2 Set of Amputating Instruments. 
$30. 
1 Liston's long Knife, Hip and Thigh. 
1 Liston's medium Knife, Leg and Arm. 
1 Catling. 
1 Scalpel, checkered handle. 
1 Tenaculum. 
1 Metacarpal Saw. 1 Capital Saw. 
1 pair Spring-catch Artery Forceps, fenestrated. 
1 Tourniquet. 
12 Needles, Silk, Wax and Plastic Pins. 
I pair Liston's Bone Forceps.- 
1 Mahogany Case, lined with oil-dyed velvet. 
Tiemann & Co.'s 
No. 3 Set of Amputating Instruments. 
$35- 
1 Liston's long Knife, Hip and Thigh. 
1 Liston's medium Knife, Leg and Arm. 
1 Catling, medium. 1 Scalpel, feruled. 
1 Tenaculum, feruled. 1 Capital Saw. 
1 Metacarpal Saw, lifting back. 
1 pair Slide-catch Artery Forceps, fenestrated. 
I Tourniquet. 
12 Needles, Silk, Wax and Plastic Pins. 
1 pair Liston's Bone Forceps, best. 
1 fine Rosewood Case, lined with oil-dyed velvet. 
Capital Operating Set. 
$52. 
1 Capital Saw. 
1 Liston's long Knife or Catling, Hip and Thigh. 
1 Liston's medium Knife or Catling, Leg and Arm. 
1 Short Catling or Breast Knife. 
1 Scalpel, checkered handle. 
1 Tenaculum. 
1 pair Fenestrated spring-catch Artery Forceps. 
1 pair Liston's Bone Forceps. 
1 Elevator with Raspatory. 
1 Brush. 
1 Hey's Saw. 
1 Galt's Conical Trephine and Handle. 
1 Tourniquet. 
12 Needles, Silk, Wax, Plastic Pins. 
2 Small Scalpels. 
1 Bistoury, sharp-pointed. 
1 Bistoury, probe-pointed. 
1 Bistoury, Finger. 1 Tenotome. 
1 Trocar and Canula. 1 Aneurism Needle. 
1 Mahogany Case, lined with oil-dyed velvet. 
Tiemann & Co.'s Compact Amputating Set. 
$33-5°- 
1 Parker's Knife. 
1 Catling, medium size. 
1 Finger Knife, French. 64 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
JVIAJO^ AND JVIINO^ SU^GEF^Y 
Conant's Capital and Minor Operating Set. 
$53-95- 
1 Amputating Knife, long. 
x Amputating Knife, small. 
1 Amputating Saw, small. 
1 Handle, to fit the above. 
I pair Satterlee's Bone P'orceps, small. 
1 Double Hook. 
1 Bistoury, probe-pointed. 1 Hernia Knife. 
1 Bistoury, sharp-pointed. 2 Scalpels, assorted. 
1 Tenotome. 2 Parker's Retractors. 
1 Nelaton's Bullet Probe. 1 Director, steel. 
1 pair Scissors, straight. 1 Caustic Holder. 
1 pair Scissors, curved on the flat. 
1 pair Tiemann & Co.'s Bullet Forceps. 
1 pair Polypus Forceps, curved, small. 
1 Compound Catheter, Male and Female,German silver. 
2 Silver Probes. 
12 Needles, Silk, Wax, Plastic Pins. 
1 pair Artery P'orceps, spring-catch, fenestrated. 
I Tourniquet. 
1 Rosewood Case, lined with oil-dyed velvet. 
1 Tenaculum. 
1 set Fletcher's Aneurism Needles. 
1 pair Straight Scissors. 
1 pair Angular Scissors. 
1 pair Dressing Forceps. 
1 pair Fine Thumb Forceps. 
1 pair Fenestrated Artery Forceps. 
1 pair Prout's Needle Forceps. 
1 Hydrocele Trocar. 
1 Exploring Trocar. 
1 German-silver Director. 
I pair Silver Probes. 
Needles, Silk, Silver Wire. 
I Mahogany or Rosewood Case, lined with oil-dyed 
silk velvet. 
Seneca D. Powell's Operating Case. 
$85. 
3 Scalpels. 
1 Curved Bistoury, sharp-pointed. 
1 Curved Bistoury, probe-pointed. 
I Straight Bistoury. 
1 Cooper's Hernia Knife. 
1 Tenotome. 
1 Aneurism Needle. 
1 Tenaculum. 
1 Director, silver. 
1 Peters' Hernia Director. 
2 Retractors. 
1 Angular Scissors. 
1 Flat-curved Scissors. 
1 Straight Scissors. 
1 Dressing Forceps 
1 Artery Forceps, fenestrate!. 
1 Phelps' Torsion Forceps. 
2 Silver Probes. 
1 Nelaton's Probe, 3 pieces. 
1 Rongeur and Pin-Cutter. 
1 Van Buren's Sequestrum Forceps. 
1 Hebras' Bone Scoop. 
1 Thumb Forceps. 
1 Sands' Needle Forceps. 
1 Trocar and Silver Canula. 
1 Ashton's Ligature Carrier. 
1 Galt's Trephine. 
1 Bone Elevator. 
1 Post's Pile Forceps. 
1 Powell's Phymosis Forceps. 
1 T rousseau's Trachea Dilator. 
1 Sayre's Pereosteotome. 
1 Buck's Pin Conductor. 
1 Exploring Needle. 
1 Detmold's Metacarpal Saw. 
1 Rosewood Case, lined with oil-dyed silk velvet. 
Little's Minor Operating Set. 
Instruments with Hard-rubber Handles, in highly fin- 
ished Hard-rubber Case, $40. 
Ivory Handle Instruments, $45. 
3 Scalpels, assorted sizes. 
1 Finger Knife. 
1 Curved Bistoury, probe-pointed. 
1 Curved Bistoury, sharp-pointed. 
1 Hernia Knife. 
1 Tenaculum. 
1 Aneurism Needle. 
2 Retractors. 
1 Phelps' Artery Forceps. 
1 Thumb (Dressing) Forceps. 
1 Trocar and Silver Canula. 1 Director. 
1 Peters' Hernia Director. 
1 Scissors, angular. 
1 Curved Rongeur and Pin Cutter. 
2 Silver Probes. 
6 Needles and Silk. 
Mason's Minor Operating Set 
$44- 
1 Metacarpal Saw. 
4 Bistouries. 
4 Scalpels. 
I Tenotome. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
65 
MINOF^ SU^GEF^Y 
Plain Miner Operating Set. 
$18. 
I Straight Finger Knife. 
1 Curved Probe-pointed Bistoury. 
1 Curved Sharp-pointed Bistoury. 
1 Cooper's Hernia Knife. 
3 Scalpels, assorted. 1 Tenotome. 
1 Aneurism Needle. 1 Tenaculum. 
6 Needles, Silk, Iron Wire and Plastic Pins. 
1 pair Straight Scissors. 
1 pair Dressing Forceps. 
1 pair Plain Artery Forceps. 
1 Steel Director. 
1 Rosewood Case, lined with oil-dyed velvet. 
Enos' Minor Operating Set. 
$33- 
1 Double Hook. 
1 Curved Sharp-pointed Bistoury. 
1 Curved Probe-pointed Bistoury. 
1 Cooper's Hernia Knife. 
4 Scalpels, assorted. 1 pair Small Polypus Forceps. 
1 Tenotome. 1 Tenaculum. 
I Aneurism Needle 1 Narrow Metacarpal Saw. 
1 Small Trocar. 1 pair Plain Artery Forceps. 
1 pair Angular-curved Scissors. 
1 pair Slide-catch Artery Forceps. 
6 Needles, Silk, Iron and Silver Wire. 
1 Steel Director. 
2 Silver Probes. 
1 Rosewood Case, lined with oil-dyed velvet. 
Tiemann's Minor Operating Set. 
$25. 
1 Straight Finger Knife. 
1 Curved Probe-pointed Bistoury. 
1 Curved Sharp-pointed Bistoury. 
1 Cooper's Hernia Knife. 
3 Scalpels, assorted. 1 Tenotome. 
1 Aneurism Needle. I Tenaculum. 
6 Needles, Silk, Iron Wire and Plastic Pins. 
1 pair Straight Scissors. 
1 pair Dressing Forceps. 
1 pair Plain Artery Forceps. 
1 Steel Director. 
1 Compound Catheter, male and female, plated. 
I pair Spring-catch Artery Forceps, fenestrated. 
2 Silver Probes. 
1 Hard-rubber Caustic Holder. 
1 Rosewood Case, lined with oil-dyed velvet. 
Hospital Minor Operating Set. 
$74.80. 
2 Finger Knives. 
2 Straight Probe-pointed Bistouries. 
1 Straight Hernia Knife. 
2 Curved Sharp-pointed Bistouries. 
2 Curved Probe-pointed Bistouries. 
I Curved Hernia Knife. 
1 Abscess Knife. 1 Short Straight Bistoury. 
1 Tenaculum. 4 Tenotomes, various shapes. 
1 pair Nichol's Needle Forceps. 
1 pair Parker's Retractors. 
18 Assorted Needles, Silk, Silver Wire. 
12 yards Annealed Iron Wire. 
3 Serrefines. 
1 Straight and 1 Curved Tonsil Knife. 
7 Scalpels, assorted sizes and shapes. 
1 Green's Double Hook, plain. 
1 pair Spring-catch Fenestrated Artery Forceps. 
1 pair Coxeter's Plain Artery Forceps, small. 
1 pair Strabismus Forceps. 
1 pair Tiemann & Co.'s Bullet Forceps. 
I Whalebone Bullet Probe. 
1 Nelaton's Bullet Probe. 
1 pair Polypus Forceps. 
1 pair Vulsellum Forceps. 
1 pair Straight Heavy Scissors. 
1 pair Scissors, curved on the flat. 
1 pair Scissors, angular curve. 
1 Trocar and Canula. 
I German-silver Ear Speculum. 
1 Belocq's Sound, for epistaxis, sterling silver. 
1 Steel Director. 
1 Rosewood Case, brass-bound, and lined with oil-dyed 
velvet 
Eves' Minor Operating Set, 
$33-5°. 
1 Double Hook. 
1 Curved Sharp-pointed Bistoury. 
1 Curved Probe-pointed Bistoury. 
1 Cooper's Hernia Knife. 
4 Scalpels, assorted. 1 Tenotome. 
1 Tenaculum. 1 Aneurism Needle. 
1 Narrow Metacarpal Saw. 
1 pair Plain Artery Forceps. 
1 Small Trocar. 1 pair Angular Scissors. 
1 pair Polypus Forceps. 
I pair Slide-catch Torsion Forceps. 
6 Needles, Silk and Silver Wire. 
I Steel Director. 2 Silver Probes. 
1 Rosewood Case, lined with oil-dyed velvet. 66 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
POCKET C/vSES 
Two-fold Pocket Set. 
$10. 
Two-fold Morocco Case, single-bladed Instruments, 
with Tortoise-shell Handles; containing: 
1 Scalpel. 1 Probe-pointed Bistoury. 
1 Tenaculum. 1 pair Straight Scissors. 
1 pair Artery Forceps. 1 Spatula. 
1 Compound (male and female) Catheter. 
1 Director. 
1 pair Silver Probes. 
6 Needles and Silk. 
1 Exploring Needle. 
1 Director and Aneurism Needle. 
1 Probe-pointed Bistoury. 
1 pair Dressing Polypus Forceps. 
1 Scalpel. 1 Sharp-pointed Bistoury. 
1 pair Straight Scissors. 1 pair Curved Scissors. 
1 Thumb Lancet. 1 Spatula. 
1 pair Dissecting Forceps. 
1 Straight Finger Bistoury. 
1 Seton Needle. 
6 Needles and Ligature Silk. 
The Instruments have Tortoise-shell Handles and are 
single bladed. 
Same contents, all of extra fine finish, spring or slide 
catch, Catheters and Probes of sterling silver, neat 
Turkey-Morocco Case, silver lock $36. 
Two-fold Pocket Set. 
$12. 
Two-fold Morocco Case, Single-bladed Instruments, 
with Tortoise-shell Handles, containing: 
1 Scalpel. 1 Probe-pointed Bistoury. 
1 Tenaculum. 1 pair Straight Scissors. 
1 pair Artery Forceps. 1 pair Dressing Forceps. 
I Hard Rubber and Silver Caustic Case. 
1 Compound (male and female) Catheter. 
1 Director. 
I pair Silver Probes. 
6 Needles and Silk. 
Hospital Pocket Set. 
$18. 
Three-fold Russia-leather or Morocco Case, single-bladed 
Instruments, with Tortoise-shell Handles, con- 
taining : 
I Sharp-pointed Bistoury. 
I Probe-pointed Bistoury. 
1 Scalpel. 
1 Tenaculum. 
1 Abscess Lancet. 
1 Compound Catheter. 
1 pair Straight Scissors. 
1 pair Angular Scissors. 
1 pair Dressing Polypus Forceps. 
1 pair Plain Artery Forceps. 
1 Spatula. 
1 Steel Director. 
2 Silver Probes. 
6 Needles and Ligature Silk. 
Three-fold Pocket Set. 
$15. 
Three-iold Morocco Case, Single-bladed Instruments, 
with Tortoise-shell Handles; containing: 
1 Scalpel. 1 Probe-pointed Bistoury. 
1 Tenaculum. 1 pair Straight Scissors. 
1 pair Artery Forceps. 1 pair Dressing Forceps. 
1 Spatula. 1 Sharp-pointed Bistoury. 
1 Hard Rubber and Silver Caustic Case. 
1 Gum Lancet. 
1 Compound (male and female) Catheter. 
1 Director. 
1 pair Silver Probes. 
6 Needles and Silk. 
Sayre's Pocket Set. 
$23.50. 
Two-fold morocco Case. 
1 Sharp and 1 Blunt-pointed Tenotome. 
1 Tenaculum and Sharp-pointed Bistoury. 
1 Scalpel and Probe-pointed Bistoury. 
1 Finger Knife. 1 pair Plain Artery Forceps. 
1 pair Straight Scissors. 1 Director and Tongue-tie. 
1 pair Silver Probes. 
1 Compound Catheter, silver. 
1 Silver Caustic Case, seamless. 
6 Needles, Silk and Wax. 
Four-fold Pocket Case. 
$21. 
Leather Case. Contents: 
1 Male and Female Catheter. 
1 Tenaculum. 
1 Hard-rubber Caustic Case. 
2 Silver Probes. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
67 
POCKET C/vSES. 
Little's Pocket Set. 
$25. 
Instruments slide catch, Tortoise-shell Handles, enclosed 
in fine morocco Case, lined with silk-velvet. 
1 Scalpel and Sharp-pointed Bistoury. 
1 Tenaculum and Probe-pointed Bistoury. 
1 Gum Lancet and Tenotome. 
1 Hernia Bistoury and Finger Knife. 
1 pair Angular Scissors. 
1 pair Polypus Dressing Forceps. 
1 pair Fine Thumb Forceps. 
1 Weir's Vaccinating Lancet. 
1 Exploring Needle. 
1 Spatula and Tongue-tie. 
1 Director and Aneurism Needle. 
1 Parker's Silver Catheter and Caustic Case. 
2 Silver Probes. 
6 Needles, Silk and Wax. 
With Thermometer, $28. 
Andrews' Pocket Case. 
$28. 
Black hard rubber Case, with nickel-plated mountings, 
the instruments placed on metallic rests, so as to 
dispense with velvet lining. 
1 Scalpel. 
1 Curved Sharp-pointed Bistoury. 
1 Curved Blunt-pointed Bistoury. 
1 Tenotome. 
1 Tenaculum. 
1 Grooved Exploring Needle. 
1 Abscess Lancet. 
1 pair Scissors. 
1 pair Dressing Forceps. 
1 pair Artery Forceps, toothed. 
1 pair Andrews' Toothed Bull-dog Forceps. 
1 Combined Catheter. 
1 Andrews' Pocket-Case Saw. 
1 Ivory Card for Ligature. 
1 Grooved Director. 
1 Probe. 
6 Needles, kept in a little compartment with a metallic, 
nickeled lid. 
The first seven instruments each in a thin ivory handle, 
the length not to exceed 5 inches, these are set up 
edgewise in the Case. 
Weir's Pocket Set. 
$30. 
Either two or three-fold morocco Case. 
1 Aneurism Needle and Sharp-pointed Bistoury. 
1 Gum Lancet and Probe-pointed Bistoury. 
1 Hernia Knife and Tenaculum. 
1 Thermometer in silver Case. 
1 Tenotome and Scalpel. 1 pair Scissors. 
1 Director. 2 Probes. 
1 pair Thumb Forceps. 1 pair Dressing Forceps. 
1 Weir's Vaccinating Lancet. 
1 Silver Female Catheter and Caustic Holder. 
1 Stimson's Hypodermic Syringe. 
6 Needles, Silk, Wax, Wire. 
Parker's Pocket Set. 
$18. 
Two-fold Morocco Case, plain double-bladed Instruments, 
with Tortoise-shell Handles ; containing: 
I Scalpel and Probe-pointed Bistoury. 
i Tenotome and Sharp-pointed Bistoury. 
I Tenaculum and Gum Lancet. 
I pair Dressing Forceps. I pair Artery Forceps. 
i pair Scissors. i Lancet. 
2 Silver Probes. i Steel Spatula. 
I Steel Director. 
x Plated Compound Catheter and Caustic-holder. 
6 Needles and Silk. 
Van Buren's Pocket Set. 
$22. 
Turkey morocco Case, silk-velvet lining, silver lock. 
Instruments double-bladed, Tortoise-shell Handles 
with slide or spring-catch ; contents: 
1 Sharp-pointed Bistoury and Tenotome. 
1 Scalpel and Probe-pointed Bistoury. 
1 Gum Lancet and Tenaculum. 
1 pair Straight Scissors. 
1 pair Bull-dog Artery Forceps. 
1 Steel Director. 2 Silver Probes. 
1 Silver Catheter (male and female) of sterling silver 
and Caustic Case, sterling silver, seamless. 
6 Needles and Ligature Silk. 
Parker's Fine Pocket Set. 
$25. 
Contents the same as in the one previous,but Tortoise-shell 
Handle Instruments, either slide or spring-catch, 
extra fine finished, the Compound Catheter (male 
and female) is made of sterling silver, the Caustic- 
holder seamless,w'M. last much longer than a soldered 
one. The Case is made of genuine Turkey mo- 
rocco, with a silver lock, very neat and compact. 68 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
fOSKET CASES. 
J. R. Wood's Pocket Set. 
$27.50. 
Morocco Case lined with silk-velvet. Instruments double 
bladed, Tortoise-shell Handles with spring or slide 
catches ; contents: 
1 Scalpel and Gum Lancet. 
1 Scalpel and Tenotome. 
1 Sharp and I Probe-pointed Bistoury. 
1 Aneurism and 1 Exploring Needle. 
1 Compound Male and Female Catheter and Caustic 
Case. 
1 pair Straight Scissors. 
1 pair of Dressing Polypus Forceps. 
1 pair Hamilton's Artery Forceps. 
1 pair Plain Artery Forceps. 
1 Grooved Silver Probe and Nelaton's Porcelain Head, 
in three parts united by screw. 
1 Lancet. 
2 Plain Silver Probes. 
1 Coil Silver Suture Wire. 
6 Needles and Ligature Silk. 
Multum in Parvo Pocket Set. 
$19. 
Turkey morocco Case, silk-velvet lining, silver lock. 
Instruments Tortoise-shell Handles with spring or 
slide-catch, double-bladed ; containing: 
1 Scalpel and Probe-pointed Bistoury. 
1 Sharp-pointed Bistoury and Tenotome. 
1 Gum Lancet and Tenaculum. 
1 pair Straight Scissors. 
1 pair Fenestrated Spring-catch Artery Forceps. 
1 Female Catheter and Caustic Case, sterling silver. 
1 Steel Director. 2 Silver Probes. 
6 Needles and Silk. 
Gunn's Pocket Set. 
$20. 
Turkey morocco Case, silk-velvet lining, silver lock. 
Instruments double-bladed, Tortoise-shell Handles 
with slide or spring-catch ; contents: 
1 Scalpel and Exploring Needle. 
1 Sharp-pointed Bistoury and Tenotome. 
1 Probe-pointed Bistoury and Scalpel. 
1 Seton Needle. 
1 Tenaculum. 1 pair Scissors. 
1 Screw Probe Directoi. 
1 pair Torsion Forceps with slide-catch and a long 
groove, answers also for holding Suture Needles. 
4 Suture Needles. 
1 Sharp and 2 Blunt Aneurism Needles. 
1 skein Ligature Silk. 
Gross's Pocket Set. 
$22. 
Russia-leather or morocco Case, German silver lock. 
Instruments double and single-bladed, Tortoise- 
shell Handles with slide or spring-catch ; contents: 
I pair Mouse-teeth Artery Forceps, delicate. 
1 Scalpel. 
1 pair Dressing Polypus Forceps. 
I Probe-pointed Bistoury and Tenaculum. 
1 Sharp-pointed Bistoury and Tenotome. 
1 pair Straight Scissors. 
1 Finger Bistoury. 
1 Caustic-holder, plated. 
I pair Vulsellum Forceps. I Exploring Needle. 
1 Gross' Ear Spoon. 1 Steel Director. 
6 Needles and Ligature Silk. 
2 Silver Probes. 
1 Male and Female Catheter. 
Hamilton's Pocket Set. 
$32. 
Turkey morocco Case, lined with silk-velvet, silver lock. 
Instruments double-bladed, Tortoise-shell Handles 
with spring-catch ; contents : 
1 Large Scalpel and Exploring Needle. 
1 Medium and 1 Small Scalpel. 
1 Tenaculum and Aneurism Needle. 
1 Sharp and 1 Blunt-pointed Tenotome. 
1 Metacarpal Saw. 
1 pair Bull-dog Artery Forceps with spring-catch. 
1 pair Slide-catch Torsion Forceps. 
1 pair Straight Scissors. I Thumb Lancet. 
1 set Silver Probes and Nelaton's Bullet Probe. 
1 Male and Female Catheter and Caustic Holder of 
Sterling Silver. 
6 Needles and Ligature Silk. 
The same,without the Catheter and Caustic Case.. .$27. 
Gross's Fine Pocket Set. 
$26. 
Two-fold Turkey morocco Case, lined with silk-velvet, 
silver lock. Contents the same as in the one previ- 
ous. The Caustic Case is made of sterling silver, 
seamless, lasting much longer than a soldered one. 
The Male and Female Catheter are of sterling silver 
and the whole of extra fine finish and quality. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
69 
POCKET C/vSES 
Exhibition Pocket Set, extra size. 
$100. 
Five-fold Turkey morocco Case, with one inner and one 
outside silver lock ; containing: Our patent-catch 
Instruments. 
2 Large and 2 Small Tortoise-shell Patent-catch 
Handles. 
1 Movable Back Saw and 1 Amputating Knife, both five 
inch blades. 
1 Amputating Scalpel. 2 Assorted Scalpels. 
1 Tenotome. 1 Gum Lancet. 
1 Blunt-pointed Straight Bistoury. 
1 Curved Probe-pointed Bistoury. 
1 Curved Sharp-pointed Bistoury. 
1 Post's Wire Needle. 
1 Cataract Needle. 
1 Cooper's Hernia Knife. 
1 Tenaculum. 
1 Exploring Lancet. 
1 Aneurism Needle. 
1 Belocq's Sound for Epistaxis (silver). 
1 Silver Male and Female Catheter with Caustic Case. 
1 Abscess Lancet. 1 Thumb Lancet. 
1 Weir's Vaccinating Lancet. 1 Seton Needle. 
1 pair Angular Scissors. 1 pair Straight Scissors. 
1 Fenestrated Spring-catch Artery Forceps. 
1 Torsion Forceps. 
1 Prout's Needle Forceps, with slide-catch. 
1 pair Polypus and Dressing Forceps, combined with 
Tiemann & Co.'s Bullet Extractor. 
Uterine, CEsophagus and Vulsellum Forceps. 
Ligature, Suture Needles, Plastic Pins, Silver and 
Iron Wire, Serrefines. 
1 pair Fine Curved-up Scissors. 
1 Thumb Forceps for extracting Splinters, &c. 
1 Exploring Trocar. 
1 Trocar for Hydrocele and Ascites. 
1 set Silver Probes with Nelaton's Bullet Probe. 
1 Director. 1 Porte Meche. 
1 Whalebone Probe. 1 Artery Constrictor. 
1 Ear Scoop and Hook to remove foreign bodies. 
1 Spatula with Elevator. 
Wight's Pocket Set. 
$37- 
Two-fold Frame Case. 
I Scalpel and Finger Knife. 
1 Tenotome and Sharp-pointed Bistoury 
1 Scalpel and Probe-pointed Bistoury. 
1 Tenaculum and Gum Lancet. 
1 pair Wight's Artery Forceps. 
1 pair Thumb Forceps. 
x Sand's Needle Holder. I Exploring Needle. 
1 pair Straight Scissors. 1 pair Curved Scissors 
1 Thermometer in Hard-rubber Case. 
1 Parker's Catheter and Caustic Case. 
I Director and Aneurism Needle. 
2 Silver Probes 
I Metacarpal Saw. 
6 Needles, Silk, Wax. 
Gay's Pocket Set. 
$22. 
Morocco Case, four inches long by two wide, silver lock. 
I Tiemann & Co.'s Bent Thermometer. 
1 Patent Hypodermic Syringe. 
I Scalpel and Probe-pointed Bistoury. 
I Gum Lancet and Tenotome. 
I Female Catheter and Caustic Case 
I Gay's Scissors, both rings open. 
I pair Artery Forceps, plain. 
I Spatula and Grooved Director Probe, steel. 
1 Silver Director Probe. 
1 Silver Probe. 
6 Straight Needles, Silk, Wax. 
Brown's Pocket Set. 
$30. 
1 Amputating Knife, shell handle. 
1 Scalpel and Newman's Needle. 
x Gum Lancet and Tenotome. 
1 Probe and 1 Sharp-pointed Bistoury. 
1 Brown's Subcutaneous Syringe. 
1 Dressing Ear and Bullet Forceps. 
1 Slide-catch Artery Forceps. 
1 Combined Porte Caustique with Eye Curette. 
1 Open Ring Scissors, rounded points. 
1 Tiemann's Flexible Joint Catheter. 
1 Aneurism Needle and Director. 
2 Silver Probes. 
1 Nelaton's Probe, porcelain head 
1 Vaccinating Lancet. 
Ishiguro or Whale-tendon Ligature, Silk and Needles. 
Crosby's Pocket Set. 
$15. 
One-fold morocco Case. 
1 Scalpel and Probe-pointed Bistoury. 
1 Tenotome and Sharp-pointed Bistoury. 
1 Tenaculum and Exploring Needle. 
1 pair Artery Forceps. 1 pair Scissors. 
1 Director and Aneurism Needle. 
2 Probes. 
6 Needles, Silk, Wax. 70 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS, 
POSKET C^SES 
Fig. 1274.-Tiemann & Co.'s Patent Pocket Set. A. 
Tiemann & Co.'s Patent Catch Pocket Set. 
$33- 
This Pocket Set contains, in a very neat and compact 
Case of Turkey morocco, with silver lock: 
2 Patent-catch Handles. 
I Post's Exploring Needle. 
I Tenaculum. 
i Gum Lancet. 
i Sharp-pointed Bistoury. 
I Probe-pointed Bistoury. 
i Tenotomy Knife. 
I Large Scalpel. I Small Scalpel. 
I Finger Knife. 
I Metacarpal Saw. 
i Lancet. 
i pair Straight Scissors. 
I pair Dressing Forceps. 
I pair Spring-catch Fenestrated Artery Forceps. 
I Spatula. 
I Grooved Director and Aneurism Needle. 
2 Silver Probes. 
i Compound Catheter of sterling silver. 
i Caustic Case of sterling silver, made seamless. 
6 Needles and Suture Silk. 
2 coils Silver Suture Wire. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
71 
P06KET C/cSES. 
Fig. 1275.-Woodworth's Pocket Set. 
Woodworth's Pocket Set. 
$22. 
(By Dr. Woodworth, Surgeon-General Marine 
Hospital Service, U. S.) 
Two-fold red morocco Case, with metal hinge and lock, 
very flat. 
1 Male and Female Catheter, silver. 
1 Vaccinating and 1 Exploring Lancet, concealed inside 
of the Catheter. 
1 pair Scissors with 1 open ring. 
1 Open Ring Dressing Forceps, answers for holding 
needles also. 
1 Tenotome and Scalpel, white handle, spring back. 
1 Sharp-pointed and 1 Probe-pointed Bistoury, white 
handle, spring back. 
1 Abscess Lancet. 
1 Silver Ear Spoon and Probe. 
1 Steel Tenaculum and Delicate Ear Hook. 
1 Director and Sims' Adjuster. 
6 Needles, Silk and Wax. 
Fig. 1276.-Tiemann & Co.'s Patent-Catch Pocket Instruments. B. 
Tiemann. & Co.'s Patent Pocket Set. B. 
$28. 
In morocco, velvet-lined Case. 
2 Patent Handles (B), hard rubber, for following blades: 
1 Exploring Needle. 
1 Tenaculum. 
1 Gum Lancet. 
1 Curved Sharp-pointed Bistoury. 
1 Curved Probe-pointed Bistoury. 
1 Tenotomy Knife. 
1 Large Scalpel. 
1 Finger Knife. 
1 Metacarpal Saw. 
1 pair Straight Scissors. 
1 Weir's Vaccinating Lancet and Comb. 
1 Spatula and Elevator. 
1 pair Silver Probes. 
1 Parker's Sterling Silver Male and Female Catheter 
and seamless Caustic Case. 
1 Dressing or Polypus Forceps, double crossing. 
1 Spring-catch Fenestrated Bull-dog Artery Forceps 
and Needle Forceps, combined. 
1 Director and Aneurism Needle. 
Needles and Silk. 
Minor's Pocket Set. 
$22.50. 
Two-fold morocco Case. 
1 pair Spring-catch Forceps. 
1 pair Hamilton's Artery Forceps. 
I Tenaculum and Aneurism Needle. 
1 Sharp and 1 Blunt-pointed Tenotome. 
1 Sharp-pointed Bistoury and Scalpel. 
1 Silver Probe and Director. 
1 pair Scissors. 
6 Needles, Silk. 
1 Silver Catheter and Caustic Case. 72 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
POCKET C/rSES 
Helmuth's Pocket Set. 
$32. 
Either two or three-fold morocco Case. 
I Tenaculum and Hernia Knife. 
I Scalpel and Tenotome. 
1 Sharp and Probe-pointed Bistoury. 
1 Prout's Needle Forceps. 
1 pair Fenestrated Artery Forceps. 
1 pair Plain Artery Forceps. 
1 pair Dressing Forceps. 
1 pair Scissors. 
1 Uterine Sound, to screw apart. 
1 Thermometer. 
1 Compound Catheter and Caustic Case, plated. 
1 Steel Director. 
2 Probes. 
1 Exploring Trocar. 
I Hook and Adjuster. 
6 Needles, Silk, Wax. 
Regimental Surgeons' Pocket Set. 
$23. 
Russia leather Case, with strong German silver lock. 
Instruments plain, single-bladed, Tortoise-shell 
Handles; contents: 
1 Scalpel. 
1 Sharp-pointed Bistoury. 
1 Probe-pointed Bistoury. 
1 Finger Bistoury. 
1 Gum Lancet. 1 Thumb Lancet. 
1 Small Razor. 
1 pair Dressing Forceps. 
1 Artery Needle. 
6 Surgeon's Needles. 
I Exploring Needle. 
1 Tenaculum. 1 pair Scissors. 
1 Steel Director. 
3 Silver Probes. 
1 Silver Gilt Caustic Holder. 
1 Compound Catheter. 
3 yards Iron Wire for Sutures. 
1 pair Plain Artery Forceps. 
1 Tenotome. 
Ligature Silk and Wax. 
Dugas' Pocket Set. 
$56. 
Turkey morocco Case lined with silk-velvet, silver lock, 
and chamois - leather pouch. Instruments have 
Tortoise-shell Handles with a very firm slide-catch ; 
two strong blades in one handle ; contents: 
1 Jointed Porte Caustic, for nitrate of silver and sul- 
phate of copper 
1 Cataract Needle. 
1 Male and Female Catheter, made of sterling silver. 
1 pair Dissecting, Artery and Needle Forceps. 
1 Thumb Lancet. 
1 pair Delicate Artery Forceps. 
I Spatula and Elevator. 
1 Belocq's Sound, of sterling silver. 
I pair Curved Scissors. 
1 Ear Spoon and Tumor Hook. 
1 Grooved Director, of sterling silver. 
2 Eye Probes. 
2 Probes and Director Probe, of sterling silver. 
1 Porte M6che. 
1 pair Polypus and Shot Forceps. 
1 Dupuytren's Probang, with three silver joints and 
silver basket. 
1 Large and 1 Small French Finger Knife. 
1 Large and 1 Small Straight Bistoury. 
I Straight Probe-pointed Bistoury and Tenotome. 
1 Gum Lancet and Exploring Needle. 
I Tenaculum and Artery Needle. 
6 Curved and 6 Straight Needles. 
Silver Wire and Silk Sutures. 
Trepanning Set. 
$16. 
i Galt's Trephine. 
I Crown Trephine. 
i Trephine Handle. 
I Trepanning Scalpel and Raspatory. 
I Trepanning Elevator. 
I Hey's Skull Saw. 
I Brush for cleaning Trephine and Saw. 
i Mahogany Case. 
Dugas' Dressing Case. 
$18. 
One morocco Case lined with silk velvet, silver lock 
contents: 
i Silver Caustic Case. 
I Dissecting Artery and Needle Forceps. 
i Thumb Lancet. 
I pair Straight Scissors. 
i Grooved Director. 
i Silver Director with an eye. 
I Silver Grooved Probe. 
i Large and i Small Straight Bistoury. 
I Tenaculum and Gum Lancet. 
6 Needles and Suture Silk. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS, 
73 
POCKET CASES 
J. Williston Wright's Pocket Set, No. 1. 
$28. 
Instruments with Spring Catch, Tortoise Shell Handles, 
enclosed in fine Morocco Case lined with silk 
velvet. 
1 Scalpel and Probe-pointed Bistoury. 
1 Tenotome and Sharp-pointed Bistoury. 
i Tenaculum and Gum Lancet. 
1 Narrow Finger Bistoury and Aneurism Needle. 
1 Fenestrated Artery Forceps and Needle Holder, 
slide catch. 
I Wood's Artery Forceps. 
1 Thumb Forceps. 
1 Thumb Lancet. 
1 Straight Scissors, with one sharp and one blunt point. 
1 Grooved Director and Ear Scoop. 
1 Parker's Silver Compound Catheter and Caustic Case. 
2 Silver Probes. 
6 Needles and Silk. 
Roswell Park's Antiseptic Pocket Set 
$28. 
Compact two-fold Case of Morocco Leather lined with 
silk velvet. 
1 Park's Artery and Needle Forceps. 
I. Gross' Ear Curette and Spoon. 
1 Park's Articulated Angular Scissprs, with open rings. 
1 Self-registering Fever Thermometer, in sterling sil- 
ver case. 
1 Silver Director. 
1 Silver Probe. 
1 Silver Eyed Probe. 
I Nelaton's Bullet Probe. 
1 Articulated Haemostatic Forceps, with ratchet catch 
and open rings. 
1 Sterling Silver Caustic Case. 
1 Elastic Silk Catheter. 
2 Tiemann & Co.'s Patent Hard Rubber Handles (Fig. 
1275, page 71), terminating in bevelled ends 
for separating tissues. To these handles the 
following Tiemann's Patent Blades are easily 
and firmly attached by turning up the button 
on the handle. 
I Sharp-pointed Bistoury. 
1 Probe-pointed Bistoury. 
1 Tenaculum. 
I Exploring Needle. 
I Tenotome. 
1 Park's Straight Bistoury. 
1 Scalpel. 
1 Metacarpel Saw. 
6 Assorted Needles, Silk for Sutures, and Plastic Pins. 
All the steel instruments are nickel-plated, includ- 
ing the knife blades, &c. ; while all fittings are so made 
that they can be easily cleaned to prevent rusting. 
J. Williston Wright's Antiseptic Pocket 
Set, No. 2. 
$38. 
George Tiemann & Co.'s Patent Catch Instruments 
(Fig. 1275, page 71), adopted by Dr. J. Williston 
Wright for his Pocket Set, No. 2. In fine Russia 
Leather Case, lined with silk velvet. 
2 Tiemann & Co.'s Patent (B) Catch, Hard Rubber 
Handles for the following blades : 
2 Scalpels. 
1 Finger Knife. 
I Finger Knife, very narrow. 
1 Tenotome, blunt-pointed. 
I Tenotome, sharp-pointed. 
I Curved Bistoury, sharp-pointed 
1 Curved Bistoury, blunt-pointed. 
1 Tenaculum. 
1 Aneurism Needle. 
1 Gum Lancet, short. 
1 Post's Canulated Needle. 
1 Metacarpel Saw. 
1 Fenestrated Artery Forceps. 
1 Open Ring French Jointed Scissors, one sharp and 
one blunt point. 
1 Dressing Forceps, open ring. 
1 Parker's Silver Compound Catheter and Caustic 
Case. 
1 Director and Ear Scoop. 
1 Thumb Forceps. 
1 Prout's Needle Forceps. 
1 Thumb Lancet. 
1 Heuel's Vulcellum Forceps, slide catch. 
2 Silver Probes. 
6 Needles, Silk and Wax. 
J. W. Hayward's Antiseptic Pocket Set 
$21. 
I Compact Case, Morocco, lined with silk velvet. 
2 Tiemann & Co.'s Patent Handles (Fig. 1275) 
1 Finger Saw. 
1 Narrow Straight Bistoury. 
1 Curved Sharp-pointed Bistoury. 
I Curved Probe-pointed Bistoury. 
1 Small Gum Scarifying Lancet. 
1 Short Tenaculum. 
1 Delicate Exploring Needle. 
1 Small Scalpel. 
I Large Scalpel. 
1 set Jointed Silver Probes. 
1 Eye Probe. 1 Nelaton's Bullet Probe. 
1 Director. I Plain Probe. 
1 Haemostatic Forceps, articulated. 
1 Scissors. 
1 Artery Forceps, with Silver, Needles and Silk 74 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
DF^ESSIN® 
" Let the dressing be destitute of any irritating quality, and so arranged that the surfaces of the wound may be 
kept in gentle apposition throughout if closed, and free from all irritants if open, while free escape of discharge is 
maintained."-Dr. Stephen Smith. 
MATERIALS FOR THE ANTISEPTIC DRESSING OF WOUNDS. 
Lister's Antiseptic Gauze, in 6 yard pieces. 
Uster's Silk Protective, by the yard. 
McIntosh Waterproof Cloth, by the yard. 
Oiled Muslin, by the yard. 
Jaconet, Carbolized. 
Lister's Carbolized Catgut, in bottles. 
Carbolized Cotton. 
Borated Cotton. 
Van Brun's Wound-Dressing Cotton. 
Dennison's Absorbent Cotton. 
Animal Ligature, Carbolized, Dry. 
Fig. 1277.-Roller Bandage. 
BANDAGES 
Fig. 1278. 
Martin's Solid Rubber Bandage. 
For the Treatment of Ulcers, Eczema, 
Varicose Veins, &c. 
Dr. Martin himself inspects the process of manufacture at every stage, and is personally responsible for the excel- 
lence of every bandage thus manufactured. Every bandage is stamped with a fac simile of his autograph signature in 
carmine ink. No bandage without this stamp is guaranteed by him. 
We have been appointed by Dr. Martin agents for the wholesale and retail sale of his bandages. To fulfill every 
possible requirement they are made in twenty (20) numbers, of different lengths and widths, and of four degrees of 
thickness, as follows: 
SIZES AND PRICES. 
Feet. 
Inches. 
Stub's Wire. 
Guage. 
No. i 
Length, io| 
Width, 3 
Thickness, 22 
Price, $2.00 
Postage, $0.08 
" IA 
" IO$ 
" 3 
" 24 
" 1-75 
" .07 
" IB 
" IO| 
" 3 
" 28 
" 1.50 
" .06 
" 2 
" 21 
" 31 
" 22 
" 450 
" .20 
" 2A 
" 21 
" 31 
24 
" 4.00 
" .15 
" 2B 
" 21 
" 31 
" 28 
" 3-00 
" .12 
" 3 
" 6 
" 21 
" 22 
" -75 
" .05 
" 3A 
" 6 
" 2| 
" 24 
" .60 
" .05 
" 4 
" 15 
" 31 
" 20 
" 4.00 
" -15 
" 5 
" 5 
" 31 
" 20 
" 1.30 
" .08 
" 6 
71 
" 31 
" 20 
" 2.00 
" .10 
" 7 
" 14 
" 3 
" 24 
" 2.00 
" .08 
" 8 
" 14 
" 3 
" 28 
" i-75 
" .08 
" 9 
" 21 
" 3 
" 22 
" 4.00 
" .16 
" 9A 
" 21 
3 
24 
" 300 
• 14 
" 9B 
" 21 
" 3 
" 28 
" 2.50 
" .12 
" IO 
" 12 
" 2 
" 22 
" 1-75 
" .08 
" II 
" 15 
" 21 
" 22 
" 2.25 
" .10 
" 12 
" 2 
" 22 
" .50 
" .03 
" 13 
" 2 
" 3 
" 22 
" .60 
" .04 
Adhesive Plaster per yd. $0.75 
Moleskin Adhesive Plaster, on twilled goods, " 1.50 
Roller Bandage per lb. $1.50 
Marine Lint, in a tin box, about 1 lb 1.00 
Hot Water Dressing, see page 41 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
75 
D^ESSIJMG 
FOR CLEANSING WOUNDS. 
Pus Basins, Wound Syringes, of Hard Rubber and Metal, and Surgical Syringes. 
Fig. 1279.-Tiemann & Co.'s Universal Douche (constant current), 
Fig. 1280 
Warren's Soft Rubber Pus Basin. 
Fig. 1281.-Triangular Pus Basin. 
Hard Rubber. 
Fig. 1282.-Ellis' Drainage Spiral. 
DRAINAGE. 
Fig. 1283.-Hamilton's Drainage Tube Carrier. 
Fig. 1287.-Callender's Drainage Canula. 
Fig. 1284.-Chassaignac's Drainage Trocar. 
Fig. 1286.-Ileuel's Punch, for 
cutting drainage openings. 
Fig. 1285.-Black Rubber Drainage Tubing (any size of gauge.) 
Tiemann & Co.'s Velvet Eye Drainage Tubes. Neubert's Bone Drainage Tubes. 
Chicken Bone Drainage Tubes, 
The tibia and femora of chickens, cooked, form the materials. The bones are not injured by cooking. They are 
taken, scraped, and put in a solution of hydrochloric acid and water (1 to 5) until soft. Their articular extremities 
are then snipped off with a pair of scissors; the endosteum is raised at one end and pushed through to the other 
extremity, along with its contents. The bones are then reintroduced into the acid solution until they are rendered a 
little more pliable and softer than what is ultimately required (as they afterwards harden a little by steeping in the 
carbolized solution). When thus prepared they are placed in a solution of carbolic acid and glycerine (1 to 10). At 
the end of a fortnight they are ready for use. Before introduction into the wound they are threaded with horsehair, 
which are pulled out in a few days, leaving the tubes perfectly open. The tubes gradually become absorbed in the 
tissues ; the average time required being eight days. 76 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
DRESSING. 
Instruments for the Application and Removal of Lint and Cotton Wool Dressing, for Removing 
Plaster of Paris Dressing and Spatulas for Spreading Plasters. 
Fig. 1288.-Dressing Forceps. 
Fig. 1289.-Dressing Scissors. 
Fig. 1292.-Porte Meche. 
Fig. 1290.-Polypus Dressing Forceps, double crossing. 
Fig. 1291. Gay's Open Ring Scissors. 
FlG. 1293.-Spring Dressing Forceps. 
Fig. 1298.-Esmarch's Knife and Wedge. 
No. 1294. 
Wackerhagen's Plaster Shears. 
Fig. 1295. 
Old's Dressing Forceps and Scissors. 
Fig. 1296.-Spatula, made of Steel or Hard Rubber. 
Fig. 1297.-Spatula and Elevator. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
77 
Df^ESSI^G. 
Caustic Cases and Sponge Holders for Carrying and Applying Escharotics, Pocket-case Catheters 
for Relieving the Male and Female Bladder of Urine, Blood or Pus, 
and Exploring Needles. 
Fig. 1299.-Caustic Case, Silver. 
Fig. 1301.-Dugas' Caustic Case. 
Fig. 1300.-Parker's Compound Catheter and Caustic Holder. 
Fig. 1302.-Dugas' Caustic Case. 
Fig. 1303.-Child's Brush and Caustic Holder 
Fig. 1304.-Porte Caustique and Eye Curette. 
Fig. 1305.-Compound Catheter. 
Fig. 1308.-Caustic Case, Hard Rubber and Silver. 
Fig. 1309.-Exploring Director. 
Fig. 1306.-Tiemann & Co.'s Flexible Joint Catheter. 
Fig. 1307.-Exploring Needle. 78 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SUTURES AND LIGATURES. 
Various materials are used for sutures, as catgut, horsehair, silkworm gut, salmon gut, silk, hemp, silver, iron and 
lead. Carbolized catgut is unirritating; so is horsehair, but not very flexible. Silk must be free from poisonous color- 
ing material: braided silk is best. Hemp resembles silk, but is much harsher. Dr. C. J. Cleborne, U. S. N., recom- 
mends "hard-ash" three-ply manilia. Silver wire for sutures should be pure ; iron wire must be annealed, to make it 
soft. 
Fig. 1310.-Satin Sewing Silk, for surgical purposes-will not kink or curl during the operation of sewing. 
Fig. 1311.-Black Iron-Dyed Silk. 
The Plaited 
Satin Sewing Silk. 
The 
Ordinary Twisted Silk. 
Dittel's Elastic Ligature 
(i yard long) exerts a constant elastic 
pressure upon the parts ligated with it. 
Chinese Bead Silk, 
very fine, white or black, for 
ophthalmic operations. 
GEO. TIEMANN & CO., 
New York. 
Fig. 1312.-Closely Twisted Silk. 3 sizes. 
The whale tendon ligature is imported by us from Japan and is the invention of Dr. Ishiguro, the Chief Surgeon of 
the Imperial Japanese Army. In its preparation a whale tendon is teased out until the fibres look very much like 
those of hemp. Then the longest and finest fibres are selected and spun together as ordinary silk thread. According 
to the reports of the Japanese surgeons who have tested them-some of whom, having been connected with the Japanese 
army in active service, have had excellent opportunity to test them-the results have been eminently satisfactory. Dr. 
Skene used them. (See " Transactions of the Obstetrical Society of Philadelphia," stated meeting, Thursday, Sep- 
tember I, 1S81.) " My experience with this kind of suture is as follows : I first used two of six sutures in restoring 
the cervix, one on each side. The other sutures used were silk. At the end of a week, when I came to remove the 
sutures, I found the ends of the Japanese sutures in the vagina-the portion included in the tissue had all disappeared. 
In my next case (in which the cervix and perineum were both operated upon at the same sitting) I had only two silk 
sutures, and all the rest Japanese. The sutures were removed from the perineum at the end of a week, and at the 
end of three weeks the cervix was examined and the two silk sutures were found in place, but there was not a trace to 
be found of the Japanese sutures. In my next case, in which the two operations were performed together, Japanese 
sutures were used exclusively in the cervix. At the end of the third week the cervix was healed completely and the 
sutures had all disappeared. 
Ishiguro Whale Tendon Ligature GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
79 
SUTURES AND LIGATURES. 
Ox Aorta Ligature. 
In the "Transactions of the Royal Medical and Chirurgical Society," (British Medical Journal, March 19, 
1881), will be found the report of a discussion on the ox aorta ligature, by Dr. R. Barwell. In it he claims supe- 
riority for this ligature over catgut, in that it needs no preparation, being simply cut from the fresh aorta and dried 
for use ; like all soft connective tissues, also, it is gradually absorbed, and in this respect it has the advantage over 
the catgut. The latter, judging by the action of sutures, is absorbed in from forty-eight hours to two weeks. The 
ox aorta furnishes a flat ligature, by which any amount of pressure can be applied to the artery without injury to the 
coats. Dr. Barwell considers this an advantage. Several specimens were shown in which the arteries were occluded. 
Mr. Lister, however, states that the catgut prepared by his new method is fully equal to the aorta, and regards the 
division of the walls of the vessel as desirable. 
SUTURE NEEDLES. 
Fig. 1313.-Full Curve Suture Needles. 
Fig. 1314.-Ligature 
and Ruptured Perineum Needle. 
Fig. 1315.-Half Curve Suture Needles. 
Fig. 1316. 
Wire Suture Needles. 
Fig. 1319.-Tiemann & Co.'s Hollow Needle for Wire Sutures. 
Fig. 1322.-Van Brun's Needle. 
Fig. 1320.-Needles for Vesico-Vaginal Fistula. 
Fig. 1321.-Open-Eyed Needle. 
Fig. 1318. 
Buck's Pin Conductor. 80 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SUTURE NEEDLES AND JHOUDERS 
Fig. 1323.-Allis' Suture Forceps 
Fig. 1326.-Post's Pin Conductor. 
Fig. 1327.-Heuel's Pin Conductor. 
Fig. 1324.-Goetz's Suture Instrument, with Endless Thread. 
Fig. 1325.-Cleborne's Tenaculum Needle and Wire Twister. 
Fig. 1328.-Mathis' Needle Holder. 
Fig. 1329.-Needle Forceps, 
Fig. 1330.-Wyeth's Needle Forceps. 
Fig. 1332. 
Reiner's Needle 
Forceps. 
Fig. 1331. 
Heuel's Needle 
Forceps. 
Fig. 1333.-Hoff's Automatic Suture. 
Nig. 1334.-Roux's Needle Holder. 
Fig. 1335.--Parker's Needle Holder. 
Fig. 1336.-DeGaine's Russian Needle Holder. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS, 
81 
JMEEDLE JHOLDEF^S 
Fig. 1337.-Sims' Needle Forceps. 
Fig. 1340.-Prout's Needle Forceps. 
Fig. 1341.-Sand's Needle Forceps. 
Fig. 1338.-Stimson's Needle Holder and Cutting Forceps. 
Fig. 1339.-Kiister's Swan Needle Holder. 
Illustrations of other Needles and Holders, for special operations, will be found in their proper places, 
PROBES AND DIRECTORS, 
FOR EXPLORING WOUNDS AND GUIDING OPERATING KNIVES. 
Fig. 1342.-Delicate Probe Director and Tongue Tie. 
Fig. 1346.-Hamilton's Set of Director Probes. 
Fig. 1343.-Silver Probes. 
Fig. 1347.-Hunter's Director. 
Fig. 1344.-Director and Tongue Tie. 
Fig. 1345.-Director and Aneurism Needle'. 82 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ARROW AND BULLET EXTRACTING. 
Fig. 1348.-Bill's Arrow Forceps. 
Fig. 1355.-Tiemann & Co.'s Bullet Probe, with Eye for introducing Lint into Wounds. 
BUhbET. 
Fig. 1354.-Long Silver Bullet Probes. 
Fig. 1349.-Bullet Seeker, Burr Head. 
Fig. 1350.-Nelaton's Bullet Probe, Porcelain Head. 
Fig. 1351.-Eldridge's Bullet Probe. 
Fig. 1352.-Sayre's Vertebrated Bullet Probe, Nelaton Point. 
Fig. 1353.-Hamilton's Director Probes, Nelaton Point. 
When it is difficult to determine the presence of a bullet in a wound by means of the common probe, the burr-head 
seeker or Nelaton's porcelain-head probe, if rotated against the suspected ball, will show fragments or traces of color 
of lead. 
Forceps and other bullet extractors should be light and slender, but strong enough to allow of the application of 
considerable force. Various patterns are in use of more or less antiquity and usefulness. Tiemann's bullet forceps differ 
from others in principle. The good quality of this instrument consists mainly in that it has only one point on each 
lever, admitting of the seizure of any part of a ball or other foreign body, and by then pulling on the instrument it will 
revolve between the points and follow in the track of the wound, presenting its long axis to the line of the wound. 
Tiemann & Co.'s Bullet Forceps have been introduced into the European Armies during the late Franco-German 
War , it is highly recommended by the Army Surgeons, and styled by them " the American Bullet Forceps." It is 
also of material service in the removal of portions of necrosed bone. 
When the course of a ball is circuitous, or when it is imbedded among swollen and infiltrated tissues, the flexible 
bullet forceps may be used with advantage. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
83 
BULLET EXTRACTING. 
Fig. 1357.-Tiemann & Co.'s Flexible Bullet Forceps. 
Fig. 1360.-Hamilton's Bullet Forceps. 
Fig. 1356.-Thomasin's Bullet Forceps. 
Fig. 1359.-Bullet Scoop. 
Fig. 1358.-Weisse's 
Fig. 1365.-Tiemann & Co.'s (American) Bullet Forceps. 
Fig. 1363.-U. S. A. Bullet Forceps. 
Fig. 1364.-Mose's Bullet Extractor. 
Fig. 1361.-Gross' Bullet Forceps. 
Fig. 1362.-Bullet Screw. 84 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
fASCIOTOMY, JVIIOTOMY, TENOTOMY AND 
Df^Y DISSECTING. 
Fig. 1366.-Feruled Operating Scalpels. 
Fig. 1377.-Feruled Tenaculum. 
Fig. 1378.-Aneurism Needle. 
Fig. 1376.-Little's Retractor. 
Fig. 1379.-Little's Small Scalpel. 
Fig. 1367.-Finger Knife. 
Fig. 1380.-Little's Medium Scalpel. 
Fig. 1368.-Straight Blunt-pointed Bistoury. 
Fig. 1381.-Little's Large Scalpel. 
Fig. 1369.-Sharp-pointed Bistoury. 
Fig. 1382.-Little's Straight Bistoury. 
Fig. 1370.-Probe-pointed Bistoury. 
Fig. 1383.-Little's Probe-pointed Bistoury. 
Fig. I371--Cooper's Hernia Knife. 
Fig. 1384.-Little's Hernia Knife. 
1" ig. 1372.-Concave Edged Tenotome. 
Fig. 1385.-Little's Sharp-pointed Bistoury. 
Fig. 1373.-Convex Edged Tenotome. 
Fig. 1386.-Little's Aneurism Needle. 
Pig. 1374.-Blunt-pointed Tenotome. 
Fig. 1387.-Little's Tenaculum. 
FlG. 1375.-Sharp-pointed Tenotome. 
Fig. 1391.-White's Graduated Surgical Knife. 
Fig. 1388.-Hamilton's Dry Dissector. 
Fig. 1389.-Hamilton's Dry Dissector. 
Fig. 1393.-Hamilton's Dry Dissector. 
Fig. 1394.-Hamilton's Dry Dissector. 
Fig. 1392.-Post's Tissue Separator. 
Fig. 1390.-Double Hook. GEORGE TIEMANN A' CO.'S SURGICAL INSTRUMENTS 
85 
fASCIOTOJVIY, JVIIOTOJVIY, TEJMOTOJV1Y 
Fig. 1395.-Tenaculum. 
Fig. 1396.-Straight Finger Knife. 
Fig. 1399.-Curved Sharp-pointed Bistoury. 
Fig. 1397.-Cooper's Hernia Knife. 
Fig. 1400.-Medium Scalpel. 
Fig. 1398.-Curved Probe-pointed Bistoury. 
Fig. 1401,-Small Scalpel 
Fig. 1402.-Large Scalpel. 
Fig. 1403.-Artery Scissors, or for opening other small Canals. 
Fig. 1404.-Angular Operating Scissors. 
Fig. 1405.-Operating Scissors, curved on the flat. 
Fig. 1406.-Straight Operating Scissors. 86 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
FASCIOTOJVIY, JVIIOTOMY, TE^OTOJVIY 
POCKET INSTRUMENTS. 
Fig. 1408.-Scalpel. 
Fig. 1407.-Tenotome, slide-catch. 
Fig. 1410.-Tenaculum. 
Fig. 1409.-Curved Sharp-pointed Bistoury. 
Fig. 1412.-Gum Lancet. 
Fig. 1411.-Curved Probe-Pointed Bistoury. 
Fig. 1413.-Cooper's Hernia Knife. 
Fig. 1414.-Double Bladed Pocket Instrument, 
Tenaculum and Gum Lancet. 
Fig. 1415.-Scalpel and Probe-pointed Bistoury. 
Fig. 1416. 
Sharp-pointed Bistoury and Tenotome. 
Fig. 1417.-Post's and Buck's Needles. GEORGE TIEMANN * CO.'S SURGICAL INSTRUMENTS. 
87 
fASCIOTOMY, JVIIOTOJV1Y, TE^IOTOJVIY. 
POCKET INSTRUMENTS. 
Fig. 1418.-Spring-catch Gum Lancet 
and Tenaculum. 
Fig. 1419. 
Abscess Lancet. 
Fig. 1420.-Syme's Abscess 
Knife and Scalpel. 
Fig. 1421.-Four-bladed Spring- 
catch Pocket Instrument. 
Fig. 1422.-Plain Single-bladed Pocket Instrument. 
Fig. 1424.-Plain Double-bladed Pocket Instrument. 
Fig. 1423.-Seton Needle. 88 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/vRTE^IAL 
For Suspending the Circulation and Preventing Loss of Blood during Capital Operations ; for 
Arresting Arterial Haemorrhage in Wounds and for Local Treatment of Aneurisms. 
Fig. 1425.-May's Tourniquet, for the Treatment of Aneurism. 
Fig. 1426.-Skey's Arterial Compressor. 
Fig. 1427.-Briddon's Artery Compressor. 
Fig. 1428.-Buck's Arterial Compressor. 
Fig. 1429.-Field Tourniquets. 
Fig. 1430.-Petit's Spiral Tourniquet. 
Fig. 1431.-Charriere's Tourniquet. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
89 
/rRTEF^IAlD 
For Suspending the Circulation and Preventing Loss of Blood during Capital Operations ; for 
Arresting Arterial Haemorrhage in Wounds and for Local Treatment of Aneurisms. 
Fig. 1433.-Erichson's Arterial Compressor. 
Fig. 1432.-Esmarch's Bandage Clamp. 
Fig. 1434. 
Langenbeck's Bandage Clamps, for 
Esmarch's Bloodless Method. 
Fig. 1435.-Aorta Compressor. 
Fig. 1436. 
Valentine Mott's Tourniquet. 
Fig. 1437. 
Gross' Tourniquet. 
Fig. 1439.-Spohn's 
Rubber Ring Tourniquet. 
Fig. 1438.-Tiemann & Co.'s 
Direct Pressure Tourniquet. 90 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
jARTE^IAL. 
For Suspending the Circulation and Preventing Loss of Blood during Capital Operations. 
"ESMARCH'S BLOODLESS METHOD." 
Fig. 1440.-Esmarch's Tourniquet. 
(Extracted from Sammlung Klinischer Vortrcrge. No. 58, Leipzig, 1873.) 
"I shall perform an operation (necrotomy, both legs) which would cause a much more 
profuse haemorrhage than that of yesterday, did I not adopt a method which will enable us to completely control the 
bleeding. 
" While the anaesthetic is being administered, we envelop the lower portion of the limb in oil silk, to prevent soil- 
ing the bandage ; then we bandage the legs tightly from the toes to above the knees with this elastic rubber bandage 
(A), which, by gradual compression, forces the blood out of the vessels of the limb. Immediately above the knee, 
where the bandage terminates, we wind the rubber cord or tubing (B) four or five times around the thigh, and join the 
one extremity by means of the attached hook to the chain at the other end. The rubber tubing or cord compresses all 
the soft parts, including the arteries, in such a perfect manner that not a drop of blood can enter the bandaged portion 
of the limb. 
" This tourniquet possesses the advantage over all others, viz.: it can be adjusted to any portion of the limb, and 
the location of the principal arteries need not be considered. 
" We now remove the elastic bandaging and the oil silk, and you will notice that both legs, below the tourniquet, 
present the appearance of the limbs of a corpse, the pallor of the same forming a remarkable contrast to the rosy hue 
of the skin above. You will also notice that we will operate exactly as though on a cadaver. * * * 
" After the operation, the rubber cord is slowly removed, the circulation restored, and those arteries which have 
previously remained unnoticed, tied. * * * 
" The slumbering patient presents the same appearance as before the operation, his pulse is full and strong, and 
convalescence will no doubt follow much more rapidly and surely than if we had performed the operation in the 
customary manner. 
* ' The tourniquet can be used with more or less complete success in nearly all operations on the extremities. In 
extirpation of tumors, in the removal of scrofulous sores or caries, and resections of small bones or joints, you can 
proceed in the manner I have just demonstrated, viz. : you need not loosen the tourniquet until the wound has been 
dressed." 
Esmarch's Bandage Clamp, see Fig. 1432. 
Langenbeck's Bandage Clamp for Esmarch's Bloodless Method, see Fig. 1434. 
Fig. 1441.-Emmett's Uterine Tourniquet, for controlling Haemorrhage during Operations on the Uterus. 
The instrument has a portion of a watch spring passed through a canula, and in the handle a ratchet to tighten the 
loop about the cervix. Just before constricting the neck with the instrument, sufficient vaginal tissue is drawn through 
the loop with a tenaculum ; the folds thus formed render the instrument less liable to slip over the cervix when it has 
become reduced in size from the escape of blood. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
91 
/rRTEF^IAk 
For Seizing and Holding Divided Vessels after an Operation, and for Closure by Ligature, 
or by Torsion. 
Fig. 1442.-Prince's Tenaculum Forceps. 
Fig. 1443.-Coxeter's Artery Forceps. 
Fig. 1444.-Spring-catch Artery Forceps.( 
Fig. 1445.-Plain Artery Forceps. 
Fig. 1446.-Torsion Forceps. 
Fig. 1447.-Andrews' Artery Forceps. 
Fig. 1448.-Hamilton's Spring-catch Artery Forceps. 
Fig. 1449.-Old's Artery and Needle Forceps. 
Fig. 1450.-Wheeler's Torsion Forceps. 
Fig. 1451.-Phelps' Artery and Torsion Forceps. 
Fig. 1453.-Esmarch's Fenestrated Artery Forceps. 
Fig. 1452.-Spring-catch Fenestrated Artery Forceps. 
Fig. 1454.-Esmarch's Bulbous Artery Forceps, Slide-catch. 
Fig. 1456.-Hunter's Artery and Needle Forceps. 
Fig. 1455.-Esmarch's Torsion Forceps, Slide-catch. 
Fig. 1457.-Hewson's Torsion Forceps. 92 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
A^TEf^lAL. 
Fig. 1459.-Bigelowe's Artery Forceps. 
FOR APPLYING LIGATURES. 
Fig. 1458.-Carroll's Knot Tyer. 
Fig. 1460.-Mott's Set of Aneurism Needles. 
Fig. 1462.-Fletcher's Aneurism Needle. 
Fig. 1461. 
Crampton's Artery Needles. 
Fig. 1463.-Plain Aneurism Needle. 
Fig. 1464.-Helical Needle for Sutures and Ligatures. 
Fig. 1465.-Wight's Artery and Ligature Forceps. 
Fig. 1466.-Ostrom's Drainage Tube and Ligature Carrier. 
Fig. 1467.-Helmuth's Ligature Carrier. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
93 
/cRTERI^L, 
For Arresting Haemorrhage during or after Operations by means of Acupressure 
and Compression. 
Fig. 1468.-Stearn's Artery Claw-Forceps. 
Fig. 1469. 
Acupressure Pins, 
for arresting 
Surgical Haemorrhage. 
Fig. 1470.-Bilroth's Artery Clamps. 
Fig. 1471. 
Mattock's Key-Ring 
Artery Clamp. 
Fig. 1472.-Gross' Artery Compressor. 
Fig. 1473. 
Allis' Acupressure Forceps 
Fig. 1474. 
Allis' Acupressure Forceps. 
Fig. 1475. 
Allis' Acupressure Foreeps. 
Fig. 1477. 
b. Vidal's Serrefin, Straight. 
c. Vidal's Serrefin, Angular. 
d. Langenbeck's Serrefin. 
Fig. 1478.-Milne's Artery 
Compression Forceps. 
Fig. 1479.-Allis' Acupressure Forceps. 
Fig. 1480.-Allis' Acupressure Forceps. 94 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS, 
/rRTEF^IA 
For Closing Divided Vessels by Clamping, Constriction and Arteri vers ion. 
Fig. 1481.-Nott's Artery Clamp Forceps. 
Fig. i486. 
Pean's (Wood's) Artery Clamp Forceps. 
Fig. 1483. 
Sabine's Clamp Forceps. 
Fig. 1484. 
Little's Artery Clamp Forceps. 
Fig. 1485. 
Lawson Tait's Clamp Forceps. 
Fig. 1488. 
Weber's Tenaculum, 
for Arteriversion. 
This method is designed 
to reinforce the cut extremi- 
ty of the artery by duplica- 
ture of its walls, and thus 
secure such an amount of 
muscular structure around 
the cut end as will effectually 
close its calibre against the 
impulse of the heart's action. 
The point of the tenaculum 
is introduced within the ar- 
tery, and, holding the mar- 
gin with the forceps, traction 
on the hooks inverts the 
coats, as the cuff of a sleeve 
is rolled backward. 
Fig. 1482. 
Wyeth's Clamp Forceps. 
Fig. 1487.-Speir's Artery Constrictor. 
A substitute for the ligature acupressure and torsion-designed for the instantaneous hermetic closure of arteries, 
without the use of ligatures or other foreign substance to be left in the wound. 1 he application of the constrictor is 
very simple. The artery is to be caught up by a pair of forceps and the tongue of the constrictor placed around the 
vessel, the tongue is then drawn tightly upon the artery by means of the vice arrangement at the upper end of the in- 
strument. As soon as the screw turns with a considerable degree of resistance, or the internal and middle coats are 
seen to be invaginated sufficiently, by noticing their movements in the end of the artery, the instrument is to be de- 
tached from the artery and the operation is completed. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
95 
/vMPUTATI^G. 
Knives, Catlings, Scalpels, Tenaculums-for Division of the Soft Parts. 
An/estiietic Apparatus, page 43. 
Find on page 
97, Saws. 
103, Bone Forceps. 
91, Artery Forceps. 
79, Needles. 
78, Ligature. 
88, Tourniquets. 
74, Elastic Bandages. 
102, Pereosteotomes. 
49, Antiseptic Spray. 
96, Antiseptic Knives. 
Amputating Sets, page 63, 
Fig. 1494.-Amputating Tenaculum. 
Fig. 1489.-Amputating Tenaculum. 
Fig. 1490.-Amputating Scalpel. 
Fig. 1493.-Amputating Scalpel. 
Fig. 1491.-Cartilage Knife. 
Fig. 1492.-Cartilage Knife. 
Fig. 1498.-Parker's Knife. 
Fig. 1499.-Liston's Long Knife. 
Fig. 1501.-Conant's Amputating Knives and Saw. 
Fig. 1496.-Wood's Circular Knife. 
Fig. 1497.-Liston's Small Knife. 
Fig. 1500.-Wight's Folding Knife. 
Fig. 1495.-Small Catling. 96 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
AMPUT/rTIJMG 
ANTISEPTIC KNIVES. 
For Division of the Soft Parts in Major and Minor Operations 
Esmarch has devised Antiseptic Knives made of one piece of steel, so as to afford no lodgment for septic germs, 
which might possibly adhere to ordinary knives. One objection to these is, that the handles become quite slippery if 
wet with blood ; in order to obviate this, we have made antiseptic knives of which the handles are baked on, of hard 
rubber, but contain no crevices whatever. Any instrument constructed in this way is as if made of one piece, and 
affords the perfect customary hold. 
Liston's Amputating Knives. 
Fig. 1502.-Long. 
Fig. 1503.-Medium. 
Fig. 1504.-Small. 
Catlings. 
Fig. 1505.-Long. 
Fig. 1506.-Medium. 
Figs. 1507, 1508.-French Finger Knives. 
Scalpels 
Bistouries. 
Tenotomes. 
Figs. 1512, 1513, 1514, 1515, 1516. 
Figs. 1517, 1518, 1519, 1520. 
Figs. 1509, 1510, 1511. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
97 
/cMPUTATI^IG 
BONE SAWS. 
Saws should be kept in a state of scrupulous cleanliness, as the teeth afford organic matter great opportunity of 
becoming adherent; this may convey contagion to the next person operated on. Rust and other matter may poison 
the wound. Clean the teeth, after and before use, with warm water and a stiff tooth-brush, then dry with chamois. 
Fig. 1521.-Metacarpal Saw. 
Fig. 1522.-Lifting-back Metacarpal Saw. 
Fig. 1525.-Lifting-back Saw. 
Fig. 1526.-Tiemann & Co.'s Capital Saw. 
Fig. 1523.-Lente's Interosseous Saw. 
Fig. 1524.-Detmold's Metacarpal Saw. 
Fig. 1527.-Satterlee's Capital Saw. 
Fig. 1530. 
Lewis' Folding Saw. 
Fig. 1528.-Parker's Capital Saw. 
Fig. 1529.-Tiemann & Co.'s Bow Saw, with two blades. 98 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
TREPANNING. 
Trepanning Set, page 72. 
Fig. 1531. 
Brace Trephine and Guarded Crown. 
Fig. 1535.-Raspatory. 
Fig. 1532.-Crown Trephine. 
Fig. 1537--Van Buren's Trepanning and Sequestrum Forceps. 
Fig. 1538.-Trepanning Scalpel. 
Fig. 1533.-Galt's Trephine. 
Fig. 1536.-Pope's Antrum Drill. 
Fig. 1534.-Trephine Handle. 
Fig. 1539.-Hey's Saw. 
Fig. 1540.-Tirefond. 
Fig. 1541.-Hand Trepan. 
Fig. 1545.-Trepanning Elevator and Lenticular Knife. 
Fig. 1542.-U. S. A. Raspatory. 
Fig. 1543.-Hey's Saw. 
Fig. 1544.-Plain Trepanning Elevator. 
Fig. 1546.-Lenticular Knife. 
Fig. 1547.-Trepanning Elevator and Rasps. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
99 
OSTEOLOQICALs 
Fig. 1548.-Human Skeleton. 
SKELETONS. 
FEET. 
Articulated by means of brass 
screws. 
Grades I, 2, 3. 
Strung on catgut 
SKULLS. 
HANDS. 
Plain and disarticulated 
Strung on catgut. 
FEMALE PELVES. 
Without ligaments 
With ligaments. 
BRASS SCREWS AND 
HINGES. 
OSTEOTOMY. 
Fig. 1549.-Costotome, or Rib Shears. 100 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
0STE0T0JV1Y. 
Retractors for drawing back the Soft Parts to Protect them against Injury by Saws or Knives 
during Operations on Bones. 
Fig. 1550.-Parker's Retractor. 
Fig. 1553.-Blackman's Retractor. 
Fig. 1551.-Prince's Bone Staff. 
Fig. 1554.-Mott's Retractor. 
Fig. 1552.-Blandin's Bone Staff. 
Fig. 1555.-Durham's Retractor. 
Fig. 1556.-Lange's Retractor. 
fig- 1557- 
Robert's Retractor. 
Fig. 1558.-Bilroth's Three-pronged Retractor. 
Fig. 1559.-Bilroth's Two-pronged Retractor. 
Fig. 1560.-Langenbeck's Blunt Retractor. 
Fig. 1561.-Langenbeck's Sharp Retractor. 
Fig. 1562.-Stout Tenaculum, Single. 
Fig. 1563.-Stout Tenaculum, Double. 
Fig. 1564.-Stout Tenaculum, Triple. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
101 
OSTEOTOJVIY. 
Forceps for Holding Bone during an Operation and for the Removal of Dead Bone (Sequestrum). 
Fig. 1565.-Ferguson's Lion-jaw Bone-holding Forceps 
Fig. 1571.-Markoe's Curved Sequestrum Forceps. 
Fig. 1566.-Hamilton's Serrated Bone Cutter. 
Fig. 1567.-Ferguson's Lion-jaw Bone-holding Forceps. 
Van Buren's 
Sequestrum Forceps, 
see Fig. 1537, page 98. 
Fig. 1568.-Ferguson's Sequestrum Forcep: 
Fig. 1572.-Hamilton's Sequestrum Forceps. 
Fig. 1569.-Farabeufs Osteophor. 
Fig. 1570.-Hamilton's Osteophor. 102 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OSTEOTOMY. 
MALLETS, CHISELS, GOUGES AND LEVATORS. 
For Hounding Sharp Edges of Bones, Removing Spiculae, Clearing out Carious Cavities and 
Dividing and Raising the Pereosteum. 
Fig. 1577.-Darby's Chisel 
Gouges and Levator. 
Fig. 1573.-Szymanowsky's Gouge. 
Fig. 1578.-Linhardt's Knife Chisel. 
Fig. 1576.-Lead Mallet. 
Fig. 1574.-Gouge. 
Fig. 1575.-Chisel. 
Fig. 1579.-Curved Hand Gouge. 
Other forms of Chisels and 
Gouges made to order, to 
suit the fancy of operators. 
Fig. 1581.-Goodwillie's Curved Levator. 
Fig. 1582.-Goodwillie's Half-curved Levator. 
Fig. 1583.-Sayre's Periosteotome. 
Fig. 1584.-Sands' Periosteotome. 
Fig. 1580.-Hamilton's Levatcr. 
Fig. 1585.-Scalpel and Raspatory. 
Fig. 1586.-Whitehead's Hoe, 
for Dividing Muco-Periosteal Membrane. 
Fig. 1587.-Hebra's Bone Scoop. 
Fig. 1588.-Langenbeck's Bone Hook and Levator, GEORGE TIEMANN * CO.'S SURGICAL INSTRUMENTS. 
103 
OSTEOTOMY. 
FORCEPS AND RONGEURS. 
For Section of Small Bones, for Rounding the Edges in Amputations and Gnawing off Projecting 
Parts, not accessible to other instruments, in Resection. 
Fig. 1590.-Hoffman's Gouge Forceps. 
Fig. 1589.-Liston's Bone Forceps, Straight. 
Fig. 1594.-Liston's Bone Forceps, Large. 
Fig. 1591.-Liston's Bone Forceps, 
curved on the flat. 
Fig. 1592.-Liston's Bone Forceps, 
Knee Curve. 
Tig. 1599--Curved Rongeur. 
Fig. 1593. 
Satterlee's Straight Bone Forceps. 
Fig. 1595.-Isaac's Bayonet-shaped Bone Forceps. 
Fig. 1600.-Velpeau's Curved Bone Forceps. 
Fig. 1597--Darby's Rongeur and Bone Holder. 
Fig. 1596.-Heuel's Bone Forceps. 
Fig. 1598.-Straight Rongeur. 104 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OSTEOTOJVIY 
FOR RESECTION AND EXSECTION. 
Fig. 1601. 
Maxillae Saw, Right. 
Fig. 1603. 
Maxillae Saw, Left 
Fig. 1602.-Goodwillie's Oral Saw'. 
Fig. 1604.-Butcher's Bow Saw, with two Blades. 
Fig. 1605.-Stohlmann's Rotating Saw. 
Fig. 1606.-Szymanowski's Bone Exsecting Saw, improved by Tiemann & Co. 
The blade of any of the above Bow Saws may be taken from its position, and passed under the bone, if required, 
and the ends, being re-attached in the frame, the bone is as readily divided from beneath as from above; the saw may 
be turned laterally also, or may be made to cut in a curve; especially with the saw, Fig. 1605, the blade of which is 
made to rotate at will, the thumb of the hand turning the cogs while sawing. The tension of the saws, Figs. 1604 and 
1605, is regulated by a screw ; that of Fig. 1606 by a spring in the handle and screw. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS, 
105 
OSTEOTOJVIY. 
FOR RESECTION AND EXSECTION. 
Fig. 1607.-Heine's Osteotome. 
Heine s Osteotome is composed of the articulated saw, the saw-carrier, the case with 
motive wheel and crank, the adjustable guards, the handle, the hand-rest and meter. 
The saw is in form of gearing chain ; it has, besides the cutting-teeth on the exte- 
rior, grooves on the inside corresponding to spurs on the motive wheel. 
The saw-carrier is a thin knife-like plate (deeply grooved longitudinally), over 
which, and the motive wheel, the saw is extended. By means of a set screw, the 
milled head of which is seen in the case in front of the motive wheel, the saw-carrier is 
made to move ; this regulates the tension of the saw. 
The case is composed of two plates, between which the motive wheel is held. To 
the axle of this is fitted a crank with ball and socket joint; by this the saw is operated. 
The adjustable saw-guards are two bars with hooked extremities; they move in 
frames attached to the saw-carrier, and may be fixed in any desired position by set 
screws. They are intended to grasp and hold the bone to be sawed, to protect the 
soft parts, and to guide and approximate the saw to the bone. 
The handle consists of a plate of steel covered with two concaved tortoise shell 
scales. Underneath the scales is a spring, for the purpose of gradually retracting the 
guards when the saw is operated. 
The hand-rest, composed of three articulations and a cross-plate, is fastened 
on to the left side of the instrument by means of a bolt, and is movable in all 
directions. The hand-rest and frame of the saw may be likened to the legs of 
compasses, so that when the point with screw is fixed, the other, with the saw, 
can be directed to describe any figure on deep-seated bone. 
The meter is situated on the right side of the instrument. It moves back- 
wards, forwards and laterally, and is for the purpose of predetermining the 
depth to which the saw shall be permitted to enter when used on the skull. 
It is so constructed that the blade, instead of being fixed in its position to the. 
handle, works up and down in a slot, which is adjusted by a screw in the handle. By 
this means the length of the blade can be regulated to the thickness of the bone to be 
sawn through, making it impossible for the blade to slip through and injure the brain. 
The blade can be lengthened as well as shortened, of course. This makes it a very 
convenient instrument for working in deep cavities in resection, and also in removing 
sequestra. 
Fig. 1608.-Cowgill's Iley's Saw. 106 
GEORGE TIEMANN A CO.'S SURGICAL. INSTRUMENTS. 
OSTEOTOMY. 
FOR RESECTION AND EXSECTION. 
Fig. 160g.-Chain Saw 
To use this saw, one end is removed from the hooked handle, B, and the 
needle, C, armed with a strong thread, is attached to this end ; the needle is 
passed under the bone, and the saw drawn into position, with the cutting edge 
upwards, and the handle re-attached. The operator, grasping the handles, draws 
the saw alternately from side to side until the bone is divided. Thefe is great 
danger of breaking a chain saw if it be worked carelessly ; it should be drawn 
from side to side steadily, at an angle of 450 to the long axis of the bone. 
The handle of this saw is an improvement on the old style. It rotates around 
the socket, A. This socket is made in two halves, held together by a ring. Into 
one of the halves, depressions, corresponding to a link of the chain saw, are cut, 
so that if the saw should break during an operation the first sound link n ay be 
grasped into this socket, and the operation proceed. 
Fig. 1610.-Buck's 
Chain Saw Conductor 
Fig. 1611.-Post's 
Ligature and Chain Saw Carrier. 
Fig. 1612. 
Chain Saw Carrier. 
Fig. 1613. 
Prince's Retractor and 
Chain Saw Carrier. 
Bone Exsecting Set. 
$65.60. 
1 Chain Saw, best. 
2 Chisels, different sizes. 
2 Gouges, different sizes. 
1 Curved Rongeur or Gouge Forceps, with spring. 
1 pair Liston's Bone Forceps, large. 
1 set Brainard's Bone Drills. 
1 Bone Trephine and Handle. 
1 Elevator and Raspatory. 
I pair Sequestrum Forceps. 
I pair Mott's Retractors. 
3 Coils Silver Wire. 
6 Wire Needles, Silk, Iron Wire 
I pair Bone Forceps, angular. 
I pair Ferguson's Lion-jaw Bone-holding Forceps 
I Lead Mallet. 
i Metacarpal and Interosseous Saw, narrow. 
I Pope's Antrum Drill 
I Mahogany Case, lined with oil-dyed velvet GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
107 
OSTEOTOJVIY. 
FOR RESECTION AND EXSECTION. 
(Extract from a description by John A. Wyeth, M. D., Medical Record, March 29, 1884.) 
Fig. 1614.-Gowan's Exsector. 
The handle is hollowed out for the passage of a steel bar, b, which runs the entire length of 
the apparatus to act on the jaw of the forceps. On a portion of its inferior edge, at about its 
middle, cogs are cut in which the teeth of the lever, a, catch, and the degree of pressure of 
the jaws, c, on the bone to be held is regulated by the pressure of the fingers of the operator 
upon the lever, a. The saw, e, 
works into a shield, d. 
Method of using.-The bone 
to be exsected having been 
exposed, with its periosteum 
peeled off in common with all 
the circumjacent tissues, the 
operator, holding the handle of 
the instrument in his left hand (the saw being entirely removed), depresses the lever, a, draws 
back the bar, b, and opens the jaws, c, wide enough to insinuate them upon the bone. As 
soon as this is accomplished, the bar, b, is pushed forward against the heel of the jaw and the 
lever, a, is pressed toward the handle. With the right hand the saw is passed into the shield, 
d, down until the teeth engage against the bone. A slight oscillation of the handle of the saw 
with the requisite pressure carries it through the bone with remarkable rapidity, and without 
wounding or bruising the contiguous soft tissues. The shield, d, not only rotates, but is revers- 
ible, and can be changed from one side to the other. 
My modification is simpler as to mechanism than Gowan's. I have had constructed a nar- 
rower saw and shield, so that it may be used in exsections of small bones closely related to 
each other, as the metacarpal bones. The handles work with a double-jointed motion, and 
have a fixation clamp, f, like the Rus- 
sian needle-holder. By opening or 
closing the handles, the jaws, g, are 
separated or closed. The action of the 
rotating shield, and the savz, Z ar*, 
the same as in Gowan's. 
Fig. 1615.-Wyeth's Exsector. 
Fig. 1616. 
Stohlmann's Bead Saw (Patent). 
Fig. 1617.-Tiemann & Co.'s Circular Saw. 
This saw has two blades that move in opposite ways when the 
lever is worked ; this makes it stay on the spot and cut. A circular 
saw, with but one blade, will not stay on the place where it is 
intended to cut, but will run, unless driven with great velocity or 
provided with fixators. 
The sections consist of metallic 
beads strung on a wire with handles; 
it acts in whatever direction it is held, 108 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OSTEOTOMY. 
Fig. 1618.-V. Graefe's Circular Saw. 
The circular saw is fitted and secured, by means of a screw, to the extremity of a steel 
rod about sixteen inches long, the other end of which is headed by a wheel gearing. A 
second wheel, to be turned by means of the crank, also provided with corresponding teeth, 
is fastened to a short rod. The rods and gearing are concealed by a brass casing, conical 
as to length, oval in diameter ; the small end of the cone serving as a bed in which the 
long rod moves. An iron plate is soldered into the casing, about half an inch from the 
larger extremity ; this is pierced with two holes which serve as layers for one end of each 
of the spindles. 7 he broadest extremity of the casing is closed by means of a cap fastened 
with screws ; through this the end of the short spindle projects, to which the crank is fitted. 
The crank or motive wheel has seven teeth, the one for the saw spindle twenty-one, 
so that the crank has to be turned three times to effect one revolution of the saw. 
This arrangement can be reversed by exchanging the position of the cogs, so that three 
revolutions of the saw are obtained by turning the crank once. 
'Die operator has to hold the saw with both hands. It is very difficult to keep applied, 
it having a tendency to divert from the intended direction. 
An assistant must turn the crank. 
For Perforating the Mastoid Process, 
Fig. 1619.-Buck's Drills. 
Fig. 1620.-Post's Rongeur. 
Fig. 1621-Hand Gouge. 
Fig. 1622.-Drill with Guard, for Perforating the Mastoid Process. 
Fig. 1623.-Burnett's Knife, for Mastoid Process. 
Fig. 1624.-Drill. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
109 
OSTEOTOMY. 
DRILLS. 
For Un-united and Oblique Fractures, for passing Silver Sutures, clearing out Carious Cavities 
and letting out Pus. 
Fig. 1625.-Brainard's Bone Drills. 
Fig. 1626.-Howard's Bone Drills. 
Fig. 1627.-Gaillard's Bone Drill for Un-united and Oblique Fractures. 
Fig. 1628-Tiemann & Co.'s Drill Stock. 
Fig. 1629.-Hamilton's Improved Bone Drills. 
Fig 1630.-Buck's Drills for the Mastoid Process. 
Fig. 1631.-Marshall's Osteotrite. 110 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OSTEOTOMY 
FOR CORRECTION OF DEFORMITIES. 
For Subcutaneous Section of the Neck of the Thigh Bone. To rectify Malposition in case of 
Osseous Anchylosis of the Hip Joint. 
Fig. 1632.-Adam's Subcutaneous Section Knife. 
It is three-eighths of an inch wide, with a cutting edge one inch and half in length, at the end of a slender shank 
three inches long. This is for making an incision down to the trochanter major, dividing the muscles and opening the 
capsular ligament. 
Fig. 1633.-Adam's Large Saw 
This saw has a large curved handle by which a good hold is obtained. It is three-eighths of an inch wide, with a 
cutting edge an inch and a half in length, at the end of a slender shank three inches long. The saw has a round, blunt 
end, in order not to injure the tissues behind the bone. The saw is carried along the track of the knife, and the neck 
of the bone is then divided. 
Fig. 1634.-Adam's Small Saw, 
Fig. 1635.-Shrady's Subcutaneous Saw and Knife. 
The instrument consists of a trocar and canula, i, of the same size as the saw. The canula has a fenestra corre- 
sponding in position to the teeth of the saw. The trocar and canula are thrust down by the side of the bone to be 
divided, the instrument being held in such a position that the fenestrated portion of the canula shall rest upon the bone 
at the point of desired section, the trocar is then withdrawn from the canula and is replaced by the saw, 2. After the 
bone has been sufficiently divided, both saw and canala, 3, are removed. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
111 
OSTEOTOMY. 
FOR CORRECTION OF DEFORMITIES. 
For Subcutaneous Section of the Thigh Bone. To Rectify Malposition in case of Osseous An 
chylosis of the Hip Joint. 
Fig. 1636.-Shrady's Subcutaneous Section Saw, Angular Handle Canula 
Fig. 1637.-Shrady's Improved Subcutaneous Saw and Knife. 
The subcutaneous saw (Fig. 1637) is believed to be an improvement on the one presented by me to the profession 
some time ago. The principle is essentially the same, but its application as compared with the former instrument much 
wider and its construction much less complicated. It is now made in three parts : 1, a long, strong, blunt-pointed in- 
strument, with limited saw-edge and fixed handle ; 2, a trocar and handle ; and 3, a canula or sheath, open on one 
side throughout its entire length, and made to fit both saw and trocar. The trocar and canula are used as guides for 
the saw. They are first introduced to the bone to be divided by thrusting them through the skin and intermediate soft 
parts. The trocar is then withdrawn, and in its place the saw is introduced, guided by the canula. The canula is then 
in its turn withdrawn, leaving only the saw with its teeth in contact with the bone. The bayonet-bend of the saw near 
its handle allows the canula or sheath to slide back and forth over the saw-blade and past the deflected handle with the 
greatest ease. After the saw has done its work, and while it is still in the wound, the canula is slipped over its blade 
and the latter withdrawn in its turn. Finally, the canula itself is removed, leaving only the wound caused by the ori- 
ginal track of trocar and canula. 
By these means it will be seen that the introduction and withdrawal of the saw are effected without the possibility 
of any tearing of the soft parts by the teeth of the saw. 
Fig. 1638.-Wyeth's Subcutaneous Section Saws. 112 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
OSTEOTOMY. 
For Correction of Deformities, of Badly United Fractures ; for Correcting Malposition of Limbs 
affected with Osseous Anchylosis and Rachitic Deformities. 
Dr. Wm. Macewen (" Osteotomy") says: The instruments used by me are of two different kinds, the chisel and the 
osteotome. The former being of the same form as the carpenters'-though different in temper, the latter being sharpened 
like an attenuated double inclined plane. 
Trie chisel is used for paring, shaving and cutting out of bone, such as a cuneiform portion of the tibia in anterior 
curvature. 
The osteotome is used only for making simple incisions or wedge-shaped openings, without removal of bone. 
Fig. 1639.-Macewen's Chisel. 
The blade of the r^tWhas two parallel sides extending as far as the cutting edge. The cutting surface has one side 
straight, the other beveled. It ought not to be too thick, otherwise the bone will splinter. For most purposes an 
eighth of an inch at the base of the bevel is suitable. The breadth of the instrument varies according to the size of 
the bone. Half an inch broad is found, very suitable in the majority of cases; but for narrow fibulas a quarter of an 
inch is better. The breadth ought always to be less than that of the bone to be divided, otherwise the soft tissues on 
either side would be cut. Though the form of the instrument is similar to many employed by the carpeijter, yet the 
temper and quality are quite different. A chisel tempered so as to cut wood, such as a carpenter's, would not be suit- 
able to cut bone. On the other hand, the instrument employed by the iron cutter (dresser) would be equally faulty in 
thickness and temper. The bone would be apt to turn the edge of the former, while the latter would be apt to splinter 
it. The nearest approach of the requisite temper will be found in the tools of the hard-wood or ivory turner ; but it is 
best to get the chisel tempered to suit bone, and its quality may be easily tested on the thighbone of an ox. The quality 
of the steel used, and the exact temper, are the same as required for the osteotome. The edge of the chisel ought to 
be kept very keen, so as to catch the bone when brought in contact with it, and to take away fine shavings when re- 
quired. The osseous surface left by a sharp chisel ought to be quite smooth. This instrument is used for cutting a 
wedge and removing it out of the bone. For the purpose of making a simple osteotomy, or in order to have a wedge- 
shaped opening in the bone, without removal of any osseous substance, an osteotome is employed. 
Fig. 1640.-Macewen's Osteotome. 
The osteotome is an instrument of the chisel order, bevelled on both sides, so as to resemble a very slender wedge. 
The handle and blade form one piece. The handle is octagonal, which is preferable to the oval or cylindrical, as it 
affords a better grip, and enables the operator to readily detect any deviation which the instrument might assume while 
in the wound. The top of the instrument is furnished with a round projecting head, against which the thumb of the 
operator rests as he steadies the instrument; it also serves as a support whereby the osteotome may be gently levered 
out of the section. 
One of the borders of the blade is marked with half inches, the figures being extremely delicate. The thickness of 
the bone can be ascertained in many cases, and thus the distance to be penetrated can be predetermined. The figures 
on the border of the instrument indicate the depth to which it has penetrated, and thus they serve as a guide. It is 
finely polished-not for appearance, but because the finer the surface the less opportunity will organic matter have 
of becoming adherent and of afterwards decomposing. 
It has sharp cutting edges, which grip the bone when they are pressed in contact with it. The sharpness may be 
tested by seeing whether they will easily pare the finger-nail. The attenuated double-inclined plane has its apex at the 
cutting edge and its base where the blade joins the handle. 
The instrument ought to be made to suit the material upon which it is to act, not only in respect to its form, but 
also to its temper and the "stuff" of which it is made. It ought to be made of very fine steel, tempered so as to pre- 
vent brittleness or too great softness. If it is brittle it may snap and leave a portion of the metal in the tissues; if too 
soft it will curl and turn up on the edge. 
They are best made from Stubb's finest steel, f8, forged at a low heat; tempered by raising the instrument to a 
cherry-red heat, dipping it into oil, and then plunging it into water until cold ; next polished, and about an inch of the 
chisel, measuring from its cutting edge, having its temper drawn back to a copper yellow color with purple spots; so GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
113 
OSTEOTOMY. 
FOR CORRECTION OF DEFORMITIES. 
that only a small portion of the blade, embracing its cutting edge, is raised to a great degree of hardness, the remainder 
of the blade is comparatively soft, so as to avoid the possibility of snapping. Though this particular is applicable to 
all osteotomes, it is especially so to the most slender of them, when used where the bone is thick and the instrument 
has to be deeply inserted. A good material for testing the instrument is the "hough" bone of an ox. If one finds 
that the instrument will neither turn nor chip in penetrating such a bone, it may be concluded that it is well suited for 
cutting any human bone. 
Macewen employs the term osteotome to this instrument in order to distinguish it from the ordinary chisel. The 
instrument maker will be obliged to term it " Macewen's Osteotome," to further distinguish it from other instruments 
known by the same appellation. 
The set of instruments are made as nearly of the same weight as possible, so that the hand, accustomed to the 
sensations communicated through one of these instruments, may not be thrown out of reckoning by having a heavier or 
a lighter instrument turn by turn. Even the chisel is made of the same weight for similar reasons. It is also of some 
moment to use the small mallet, as the impelling force may then be nicely balanced. Being all in one highly-polished 
piece, with few or no crevices in which foreign matter may lodge and decompose, these instruments are easily cleaned 
and the surgeon ought himself to see that they are clean, as scrupulous cleanliness is a very important element of 
success. If they are not clean before being used, they will probably clean themselves in the wound, leaving in the 
soft parts or on the osseous tissue the foreign substances, and so probably inoculate the tissues with decomposing matter. 
Fig. 1641.-Rawhide Mallet 
The mallet used by Dr. Macewen is of 
hard wood (lignum vitse) with a hard wood 
handle, and the only other instruments, an 
ordinary sharp-pointed scalpel, suitable for 
penetrating at once to the bone, and a couple 
of blunt hooks which ought to be used very 
gently and sparingly. 
The mallet of rawhide is a more durable 
instrument than the one of lignum vitae 
Fig. 1642.-Hutchison's Osteotome 
Dr. Hutchison says: " For the purpose of protecting the hands from the irritating effects of carbolic acid spray I 
cover them with carbolic vasaline, one part to ten, this makes the hands slippery and the hold upon the handle of 
Macewen's osteotome and chisel uncertain. In order to obviate this I now have their handles covered with hard 
rubber, which is baked on and creased in various directions." 
Fig. 1643.-Poore's Osteotomes. 
Dr. Poore's osteotomes are longer in the handle and not quite so heavy in the blades as Macewen's. The Doctor 
describes them in his work, " Osteotomy and Osteoclasis : " "* * * The cutting edge should be very sharp. 
It should be marked on the flat surface every half-inch from the edge, in order that the distance that the instrument 
has penetrated the bone may be known. A large handle is also of advantage, as it can be grasped more easily. The 
best width is half an inch. It is well to be provided with three osteotomes of the same width, but of different thick- 114 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OSTEOTOJVIY 
FOR CORRECTION OF DEFORMITIES. 
ness, in order that, if the largest gets wedged, it may be withdrawn and replaced by the next smaller-to be again 
replaced by the third if it be found necessary. 
" I also have an osteotome of the same shape, but only one-quarter of an inch wide, for section of the fibula or any 
small bone. Most of the osteotomes found in instrument stores are not made properly. They have a bulge just above 
the cutting edge, like a post-mortem chisel. In some trials made upon the cadaver with such an instrument, it was 
found that the bone was invariably splintered at right angles to the line of desired section, the fracture extending 
several inches above or below the instrument. This was due to the thickness of the chisel, just above its cutting edge, 
acting too much like a wedge. An instrument properly made can be driven into the bone without turning from its 
direction. The mallet should be made heavier than those placed in necrosis cases. The chisel for performing a cunei- 
form osteotomy should be shaped much like a carpenter's ; half an inch in width is sufficient. The beveled portion 
should not be too large." 
OSTEOCLASIS. 
For Correction of Deformities after Fractures; for Straightening Anchylosed Joints; for the 
Correction of Rachitic Deformities. 
The object of osteoclasis is to produce a simple fracture and then to keep the limb in a fixed bandage, in a corrected 
position, until firm union has been established. 
Fig. 1644.-Rizzoli's Osteoclast 
Osteoclasis, by means of an apparatus by which considerable power can be applied, has been advocated by all 
writers upon surgery, and many instruments have been devised for this purpose. The earlier operations were re- 
stricted to the correction of fractures of the long bone united at an angle, but later surgeons have extended the operation 
to deformities of the limbs due to other causes. Bush, Louvier, Maisonneuve, and others, have invented instruments 
for this purpose. In 1846 Rizzoli devised the osteoclast, which is figured above, with the modification of Dr. Poore, 
who has had three threads cut upon the upright bar which forms the screw, in order to increase the rapidity with which 
the force can be applied. 
It consists of a heavy bar, fifteen inches long, one inch wide and three-eighths of an inch thick ; being much thicker 
in the centre, which is pierced for the female portion of a screw. Into this is fitted a round steel bar, one-half 
an inch in diameter, on which is cut a thread corresponding to the nut on the long bar, and furnished at its upper 
portion with a handle ; at its lower extremity is a strong, well-padded steel plate or crutch, forming a segment of a 
circle. The portion of steel forming the male part of the screw turns in a socket on the upper side of this crutch. 
Two steel rings, five inches in diameter, one inch wide and one-fourth of an inch thick, having at their upper portion 
a slot into which the large bar slides, and to which they are fixed in any desired position by binding screws. The 
lower segments of these rings are well padded with flannel and covered with chamois. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS, 
115 
PHLEBOTOMY 
Fig. 1645.-Spear-pointed 
Thumb Lancet. 
Fig. 1646.-Broad-pointed 
Thumb Lancet. 
Fig. 1647. 
Tiemann & Co.'s 
Spring Lancet. 
Fig. 1648. 
Button Trigger 
Spring Lancet. 
cupping. 
Fig. 1650.-Tiemann & Co.'s Patent Scarificator, 
Fig. 164g. 
Plain Spring Lancet. 
Fig. 1653. 
Tiemann & Co.'s Soft 
Rubber Cupping Cup. 
Fig. 1651. 
Ten-Bladed Scarificator. 
Fig. 1652. 
Twelve-Bladed Scarificator. 
Fig. 1654. 
Glass and Rubber 
Cup. 
Fig. 1655.-Cupping Pump, Stop-cock and Cup. 
No. 1 Cupping Set. 
$13. 
Contains : 
I Brass Cupping Pump. 
3 Stop-cocks. 
3 Glass Cups. 
1 Ten-bladed Scarificator. 
1 Mahogany or Black-walnut Case, lined with velvet. 
No. 1. Without Scarificator.... $9.00 
Also, Breast Pumps. 
No. 2 Cupping Set. 
$15. 
Contains : 
1 Brass Cupping Pump. 
3 Stop-cocks. 
6 Glass Cups. 
1 Twelve-bladed Scarificator. 
1 Mahogany or Black-walnut Case, lined with velvet. 
No. 2. Without Scarificator.... $10.50 116 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
DRY 6UPPIN®. 
Fig. 1656.-Junod's Boot. 
Dry cupping was suggested about thirty-five years ago by Junod, 
of Paris, for the relief of rheumatic pains, paralysis, and atrophy of 
the muscles. It is an excellent counter-irritant, producing no painful 
sores, and is frequently more effective than blisters. 
It increases the circulation when, from any cause, there has been 
an obstruction-thus aiding and assisting nature in her efforts to con- 
vey a healthy current of blood to the different parts of the system. 
Fig. 1656 represents a metallic receiver for the leg with a rubber 
band on the upper border, which, when fastened to the leg by a strap 
and buckle, renders the boot air-tight. 
In front of the boot is a stop-cock ; this has a rubber tube attached, 
connecting it to an air pump, which, when worked, exhausts all the 
air from the boot. 
Fig. 1657 represents Junod's Arm, which is analogous to the boot 
and will readily be understood by the drawing. 
Cups for other parts of the body adapted to order. 
Fig. 1658.-Thomas' Dry Cupper. 
Dr. Thomas, on " Diseases of Women," says : " The cervix uteri may, by the application of an exhauster or dry 
cup, have a marked hyperaemia excited within it, which extends to the uterine body and replaces that which should have 
occurred from physiological causes. A very simple method for producing it is to enclose the cervix within the mouth 
of the cylinder of hard rubber represented in Fig. 1658, and then to exhaust the air by withdrawing the piston. Before 
the introduction of this instrument the uterus should be exposed by means of the speculum. 
LEECJHINC. 
.Fig. 1659.-Tiemann & Co.'s Patent Artificial Leech. 
1 he principal feature is the employ- 
ment of light glass tubes, from which 
the air is expelled by the vapor of ether, 
and which imitate very closely the suc- 
tion of the natural leech as the vapor 
within them condenses. 
To expel the air from a tube, a few 
drops of ether are poured into it, and 
it is then immersed as far as the mouth 
in hot water until the ether boils briskly. 
The mouth of the tube is then applied 
to the skin, and held for an instant, 
when it will be found to be firmly at- 
, tached and can be left to itself. Each 
tube will draw about two drachms of blood. For uterine practice they are made long enough to be applied through a 
speculum. 
The scarifier is simply a tube one-eighth of an inch in diameter, straight or curved, having a cutting edge at one 
extremity. By a simple device this is made to rotate rapidly, making, when applied to the skin, a circular incision, the 
depth of which is regulated by a gauge. 
In the cut, a represents the button, by turning which the instrument is wound up ; d, the trigger, by which the 
spring is released ; c, the cutting edge, and A, the gauge for regulating the depth of the incision. 
The tubes for general use have the mouth on the side, but some are made straight, as more convenient of applica- 
tion in certain cases. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
117 
LEECHING. 
Fig. 1660.-Heurteloup's Artificial Leech 
One Glass Pump and Cutter, contained in a neat Morocco Case, $8, 
The instrument is of great service in the abstraction of blood 
in deep-seated intra ocular diseases, &c. 
The scarifier has a circular cutter, passing through the cen- 
tre of the shaft ; the depth of the cut is regulated and set by a 
thumb-screw. The motive power is a watch spring, which after 
having been wound up, is set off by a trigger. After making 
the incision the blood is drawn by the pump, consisting of a 
glass barrel and a piston, with a screw arrangement to fix it 
when drawn up. The glass cylinder, which holds about one 
ounce of blood, should be filled in from three to four min- 
utes. The piston should be soaked in warm water previous 
to the operation, so that it may swell up and fit the tube tightly, 
and the edge of the latter, which is applied to the skin, should be greased or soaped, in order that it may fit closely to 
the skin and prevent the entrance of air. 
Fig. 1661.-Reese's Uterine Leech. 
TRANSfUSIOJT 
Fig. 1662.-Aveling's Apparatus for Immediate Transfusion. 
Mode of Operation.-First place the 
apparatus in a basin of tepid water, and, 
while completely under the water, to fdl 
it and ensure its cleanliness, compress 
the bulb until the air is expelled. 
The patient having been brought to 
the side of the bed, and the arm bared, a 
fold of skin over a vein, at the bend of 
the arm, should be raised, transfixed and 
divided. The flattened vein now brought 
into view, should be seized with a pair of 
fine forceps, raised while an incision is 
made in it, and the bevel-pointed silver tube inserted. In taking this tube out of the basin, it should be kept full of 
water, by placing the tip of the thumb over its larger opening. While the operator is doing this an assistant should 
prepare the arm of the blood-donor, as in ordinary bleeding, making an incision direct into the vein, and passing the 
round-pointed tube into it, with its point toward the fingers. This person should then be brought to the bedside of the 
patient, and seated in a chair. It is better not to secure the tubes in the veins by ligatures. B represents the hand of 
an assistant holding the efferent tube and the lips of the small wound together, and A shows the afferent tube secured 
in the same manner. The india-rubber portion of the apparatus, filled with water, and kept so by turning the cock at 
each end of it, is now fitted into the two tubes. The cocks are then turned straight, and the operation commenced by 
compressing the india-rubber tube on the efferent side, D, and squeezing the bulb C ; this forces two drachms of water 
into the afferent vein. Next shift the hand D to E, and compress the tube on the afferent side, then allow the tube to 
expand slowly, when blood will be drawn into it from the efferent vein. By repeating this process any quantity of 
blood can, at any rate, be transmitted, the amount being measured by counting the number of times the bulb is emptied. 
The advantages of this method of transfusing blood are: 
1st. The chances of coagulation are small, because thy blood is removed from the action of the living vessels for 
only a few seconds, and glides smoothly through the india-rubber pipe without being exposed to the air. 
2d. The apparatus is effective, simple, portable, inexpensive and not likely to get out of order. 
3d. The operation is safe, easy, uninterrupted, and a close imitation of nature. 118 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
TRANSfUSION. 
Fig. 1663.-Fryer's Transfusion Apparatus. 
The instruments for transfusion are, as is well known, quite numerous, and while many of them are very good, we 
believe that of Aveling, for immediate transfusion, to be probably the simplest, safest, and most easy of application. 
We have lately modified it by adding another bulb to the tube, and by having both tube and bulbs cast of the rubber 
into one piece. By the additional bulb we can save time in doing the operation, and can keep the blood moving alo»g 
the tube almost continuously. In having the tube and bulbs in one, we do away with the metal portion which couples 
them in Aveling's apparatus, and we thereby diminish the risk of blood lodging and coagulating; while we can, if 
necessary, compress the whole apparatus more completely. As in Aveling's instrument, there are no valves. The inner 
wall of the whole apparatus is perfectly smooth, and we have had the opening from tube to bulbs made a gradual slope, 
thus altogether doing away with corners in which the blood might be arrested and form a clot. 
The manner of using the instrument is 
very similar to Aveling's. The canula 
marked B is placed in the giver's vein, that 
marked C in the vein of the receiver. The 
tube and bulbs having been filled with 
warm water, or better with Mr. Little's 
saline solution (also warm), are now ad- 
justed to the canulae and the blood allowed 
to flow into the apparatus. The canula 
being steadied by an assistant, the tube is 
to be nipped tightly between the fingers, 
close to the giver's or efferent end, and 
then the bulb marked I is to be compressed, 
and the blood of course forced on towards 
the receiver. While this bulb is still held 
compressed, the tube at the giver's side 
is to be relaxed, and that portion of. it between the bulbs is to be nipped ; bulb I is relaxed, and No. 2 compressed 
and held ; then the tube at the receiver's side is to be seized and held to prevent regurgitation, and the whole apparatus 
allowed to refill. The same operation to be repeated till sufficient blood is transfused. As suggested by Dr. Aveling, 
a few drops of ammonia solution may be injected into the bulbs now and then, by a fine-pointed hypodermic syringe, in 
order to more effectually prevent coagulation. It will be found that considerable force is necessary' in sending blood or 
other fluids into the veins. This we discovered while doing transfusion twice in a case after haemorrhage from gunshot 
injury, and we have also found it in our experiments on the lower animals. It is a fact that we have not seen noted 
in connection with transfusion, and one worth remembering. 
In order to use the apparatus as a mediate transfuser, the vessel marked A in the cut receives the blood, the tube 
is to be applied, and the instrument used as before directed. If the blood is not defibrinated and strained, three or 
four drops of ammonia solution to each ounce is added, in order to avoid coagulation. 
Draw eight or ten ounces of blood from a healthy person 
into a clean vessel, whilst it is accumulating whip it with a silver 
fork, a stick of wood or a bunch of straw, then strain it through 
a piece of cleanly washed linen into a vessel placed within an- 
other containing warm water (about 105 C.) Warm the syringe, 
put the suction end A mto the blood, compress the bulb, and 
when it flows through the canula, turn the stopcock C. 
Having bared the patient's arm, raise a fold of skin over a 
vein at the bend of the elbow, divide it and pass a probe or 
thread under the vein thus brought into view. This is now held 
with a pair of forceps or tenaculum and an incision made with a 
lancet or pair of fine-pointed scissors, carefully avoiding to wound its posterior wall. Now introduce the canula D, 
open the stopcock and inject slowly. 
The bulb contains about three fluid drachms, but by moderate compression about two only are expelled. In most 
cases it suffices to inject from four to six ounces. If resistance not due to external pressure be felt, or dyspnoea, or 
any other untoward symptom appear, the operation has to be interrupted or ended. Dress the wound as after phle- 
botomy. 
After use, the instrument must be thoroughly cleansed, which is best done by separating all the parts and washing 
them in warm water. 
Fig. 1664.-Garrigue's Transfusion Apparatus GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
119 
TRANSfUSION 
Fig. 1665.-Hutchison's Transfusion Apparatus. 
The apparatus consists of a cylindrical glass receiver, graduated into 
inches, ten and three-quarter inches long and three-quarters of an inch in 
diameter, of a capacity of twelve ounces ; or it may be made larger if 
desirable. A metal cap is attached to its lower end, with a perforated nipple- 
shaped termination, to which a rubber tube four feet long is attached, in 
order to convey the liquid from the receiver to the canula which enters the 
blood vessel. The mouth of the receiver is closed by a rubber stopper, 
which prevents the escape of heat, and is perforated in the centre to admit a 
thermometer, which fits the opening tightly. The canula has a nipple- 
shaped end, which is slipped into the distal end of the rubber tube, and is 
furnished with a stop-cock. The receiver is surrounded by double jacket of 
india rubber, the walls of which are separated by a half inch space for hold- 
ing hot water. The water is introduced into the jacket through a tube 
projecting from the top, fitted with a nipple stop-cock end. An opening at 
the top of the jacket admits the receiver, and a smaller one at the bottom 
allows the metal cap to protrude ; it has also a narrow opening, extending 
two-thirds of its length, to allow the operator to see the graduated marks on 
the receiver, and a loop at the top for suspending the apparatus when in use. 
Method of Using the Apparatus.-Drop the end of the rubber tube, 
to which the nipple belonging to the lower end of the receiver has been 
attached, into a vessel of hot water (150 to 2000 F.) placed three or four feet 
above the patient, and attach the other end of the tube to the stop-cock at the 
top of the jacket, the receiver having been previously put inside the jacket, 
because it cannot be introduced after the jacket has been filled. Now com- 
press the jacket with the hands to expel the air, which will be seen to rise 
in bubbles through the water; then reverse the compression, and, placing the 
jacket lower than the surface of the water, a syphon is established, which 
fills it almost immediately. The jacket when distended holds ten ounces 
and hugs the receiver closely. This method of filling the jacket is most 
convenient and rapid, and a larger amount of water can be introduced than 
by pouring in the opening at the top. 
The rubber tube is now attached to the lower end of the receiver, and 
both are warmed by filling them with hot water, which is allowed to run off 
before they are filled with the fluid to be injected. The receiver is closed with the rubber stopper carrying the 
thermometer, and the apparatus is suspended, or held by an assistant, three or four feet above the vein which is to be 
opened. The vein is to be exposed by lifting a fold of skin transversely across it and dividing it with scissors or a 
bistoury, making the incision about three-fourths of an inch long. A probe is carried behind the vein ; it is then 
picked up with forceps and opened, by a V incision, with a delicate pair of scissors. Before doing this, the stop-cock 
of the canula should be opened and a small quantity of fluid allowed to escape, for the purpose of carrying off bubbles 
of air which may have adhered to the walls of the tube. After the canula is introduced, it is fixed in position by the 
finger laid over the opening in the vein ; no ligature is necessary to retain it in position. 
A vein at the bend of the arm is usually selected for the operation, a bandage having been previously applied 
above the elbow, as in phlebotomy, to distend the veins ; but where there is difficulty of finding a vein in this locality, 
a saphena near the outer ankle may be selected, or the fluid may be introduced into the radial artery. The central end 
should be selected, as recommended by Hueter and recently practiced by Halstead.* 
Transfusion of blood from the veins of one person into those of another is imperatively demanded when a patient 
is rapidly sinking from haemorrhage, whether the result of disease, accident or operation. It has hitherto been more 
particularly employed in profuse and exhausting flooding, and there are many cases on record where it was thus 
instrumental in saving life. In such an event it is the last recourse of the obstetrician, and no one should hesitate to 
perform it, even although the woman should literally be in the act of dying, or when, to borrow the language of an 
eminent writer, "the vital spirit is fluttering with tremulous delay upon the lips."-"System of Surgery," Gross. 
Vol. I., p. 457. 1882. 
* See Medical Record, January 5, 1884. 120 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
VACCINATING. 
Fig. 1672.-Tiemann & Co.'s Vaccinating Trocar. 
FlG. 1673.-Tiemann & Co.'s Vaccinating Scarificator. 
Fig. 1670.-Weir's Vaccinating Lancet and Comb. 
Fig. 1666.-Vaccinating Lancet. 
Fig. 1667.-Dawson's Vaccinator. 
Fig. 1668.-Carroll's Vaccinator. 
Fig. 1671.-Wier's Vaccinating Lancet. 
Fig. 1669.-Teller's Vaccinator. 
DERMIC 
Fig. 1674. 
Piffard's Comedone Extractor. 
Fig. 1675.-Piffard's Acne Lancet and 
Comedone Extractor. 
Fig. 1676. 
Hess' Glass Pleximeter. 
For observing the skin under 
pressure. 
Fig. 1677.-Skin Grafling Scissors. 
Fig. 1678.-Piffard's Grappling Forceps. 
Fig. 1679.-Piffard's Scarifying Spud, 
Fig. 1680.-Piffard's Milium Needle. 
Fig. 1681.-Piffard's Cutisector. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
121 
DERJVlie 
Fig. 1682.-Auspitz's Scoop. 
Fig. 1683.-Henry's Depilating Forceps. 
Fig. 1685.-Piffard's Epilating Forceps. 
Fig. 1686.-Piffard's Irido-Platinum Needle. 
Fig. 1687.-Duhring's Galvano-Depilator. 
Fig. 1688.-Fox's Needle, for Removing Superfluous Hair 
by Electrolysis. 
Fig. 1691.-Piffard's Sharp Spoon, or Dermal Curette. 
Fig. 1690.-Nsevus Needle. 
Fig. 1689.-Sherwell's Cutipuncture. 
SKIN GRAFTING. 
Professor Frank H. Hamilton published an account of an operation, en- 
titled "Old Ulcers Treated by Skin Grafting," in the New York Journal of 
Medicine for 1854. His patient had a large wound, caused by a fall of a heavy 
stone some fifteen months previously, and attended by so much loss of skin as to 
render nature unable to effect a cure. To cover this gap Hamilton transplanted 
a portion of integument from the opposite limb, not sufficient, however, to 
cover the whole surface. In three months the cicatrization was complete, the new piece of skin having grown from its 
periphery in every direction, and in the end acquired nearly twice the original size. By this operation, which fore- 
shadowed the whole principle involved in skin-grafting, the New York surgeon hoped to establish, as he expressed it, 
' ' a new centre of life on an oasis, from whose outer verge a true and healthy vegetation shall advance in every direction 
over the exhausted soil."-"System of Surgery," Gross. Vol. I., p. 447. 1882. 
To a French surgeon, Dr. J. L. Reverdin of Paris, is given the credit of generalizing skin-grafting by taking 
minute pieces from healthy parts of the body and transplanting them to large ulcerated surfaces. He called attention 
to it in 1869. 122 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
DERMIC. 
COUNTER IRRITATION. 
Martin's Rubber Bandages, for the treatment 
of Ulcers, Eczema, Varicose Veins, &c page 74 
Microscopic Instruments " 12 
Galvano-Cautery Instruments " 37 
Thermo-Cautery Instruments " 39 
Actual Cautery " 39 
Dry Cupping " 116 
Fig. 1692.-Lente's Platina Cup, for Smelting Caustic. 
Fine Scalpels page 84 
Seton Needle " 87 
Electricity " 23 
Revulsor . " 40 
Fig. 1693.-Baunscheidt's Lebenswecker. Baunscheidt's Oil. 
The needles of this instrument are connected to a spiral spring concealed in the case ; they are propelled by draw- 
ing the spring back with the right hand, whilst holding the instrument applied with the left, then suddenly letting it 
go. After this a drop or two of the oil is applied. 
FOR MERCURIAL FUMIGATIONS. 
The patient, completely stripped and surrounded by a 
cloak of gum cloth or a blanket, is seated on a cane chair, 
beneath which the fumigating apparatus is placed. 
Fig. 1694.-Van Buren's Lamp. 
Fig. 1696.-Maury's Apparatus. 
Fig. 1695.-Lee's Lamp, modified by Bumstead. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
123 
JHYPODERJVIIC 
Fig. 1697.-Hypodermic Syringe. No. 0. 
Nickel-plated, in a neat Morocco Case, $3 
Has a graduated glass barrel, fenestrated 
metal guard, 2 steel needles, attachable by 
screw or slide, a G. T. & Co.'s patent vial and 
wires for cleaning the needles. 
Fig. 1698.-Hypodermic Syringe. No. 1. 
Nickel-plated, in a fine Morocco Case, $4. 
Graduated glass barrel, bi-fenestrated 
metal guard ; 2 needles, attachable by a slide 
or screw, made of tempered cast steel, nickel- 
plated and much finer than those usually em- 
ployed-an advantage in lessening pain on the 
introduction of the same ; G. T. Co.'s patent 
vial and wires. 
Fig. 1699.-Hypodermic Syringe. No. 2. 
In a neat Morocco Case, $3. 
Hard rubber barrel, grad- 
uated piston, 2 steel nickel- 
plated needles, attachable by 
screw or slide, with vial and 
wires for cleaning the ne«» 
dies. 
Fig. 1700.-Hypodermic Syringe. No. 3. 
Graduated piston, glass barrel, 
• 2 steel nickel-plated needles attachable by screw or slide, with 
vial and wires for cleaning the needles. 
In a neat Morocco Case, $2.50. 
Hypodermic Syringe. No. 4. In a neat Morocco Case, $2.50. 
Graduated glass barrel, smooth piston rod, 2 fine steel nickel-plated needles attachable by screw or slide, with vial 
and wires for cleaning the needles. 
Fig. 1701.-Hypodermic Syringe. No. 5. 
In a neat Morocco Case, $3. 
Graduated glass barrel, 2 fine steel 
nickel-plated needles, attachable by 
screw or slide, with vial and wires for 
cleaning the needles. 
Fig. 1702.-Stimson's Hypodermic Syringe. No. 6 
The accompanying cut represents a convenient form of 
hypodermic syringe to be carried in the pocket case. The 
point, inclosing the wire cleaner, fits into a hollow gradu- 
ated piston. The barrel is an ordinary silver tube, the size 
of a Number 10 catheter, and is about three inches long. 
Price, $3. 
Hypodermic Syringe. No, 9. In Morocco Case, $3 
Metal barrel of true bore, seamless, nickel plated, graduated on piston-rod, 2 steel needles and patent vial. 124 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
JHYP0DERMI6 
Fig. 1703.-Geo. Tiemann & Co.'s Hypodermic Syringe. No. 10. 
Price, $5. 
Contains in a metal, nickel-plated, spring top, seamless case: 
Hypodermic syringe, double fenestrated guard and graduated glass 
barrel; 2 hypodermic points, best tempered cast steel, nickel-plated 
and much finer than those usually sold; I vial with rubber stopper. 
Fig. 1704.-Tyndale's Intra-Pulmonary Syringe. 
Tyndale's syringe is made to hold forty- 
five minims, and is used for both intrapul- 
monary and hypodermic injection of anti- 
septics, the packing being of a kind not 
readily affected by them. Curved finger 
bearings are attached to the syringe. The hypodermic needles are of ordinary size and calibre used for the injection of 
antiseptics into the abdominal wall and thighs. 
For intrapulmonary injection, puncture through the thoracic walls direct: the needle used is two and three-quarter 
inches (seven centimetres) in length, stronger and with a somewhat larger bore than the ordinary hypodermic needle. 
Fig. 1705.-Nunn's Hypodermic Syringe and Pellet Holder. 
Greene's Hypodermic Case. Price, $10. 
It contains four four-drachm vials, and five two-drachm vials, which each physician can fill to suit his fancy or 
requirements ; a double fenestrated hypodermic syringe and three points or needles, all of the most improved pattern. 
They are of different sizes: one, the smallest and most delicate ever manufactured : another, a size larger, and a third 
one of the ordinary size and make. Wires for keeping them clean and open, a small hone or stone of the finest quality 
for sharpening the points, a twenty-four minim glass measure perfectly exact, a self-registering pocket thermometer, 
very superior, contained in a neat vulcanized rubber case ; and last, but not least, a thumb-lancet, also of the best 
manufacture. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
125 
HYPODERMIC. 
Fig. 1706.-George Tiemann & Co.'s Hypodermic Syringe Bottle. 
(Patented October 9th, 1877.) 
Great inconvenience is often experienced in filling a hypodermic syringe from 
the ordinary bottle, because of its narrow neck and its liability to upset. 
The narrow neck prevents the insertion of the end of the syringe, or, if the 
syringe is screwed upon the bottle, a partial vacuum is liable to be formed, so that 
the piston returns when released and often some of the fluid re-enters the bottle. 
The liability to spill the contents of the bottle is increased by the fact that it has 
to be removed from the case and stood upright. 
All these difficulties are overcome by the above improvement, the bottle having 
the mouth at a right angle to its body and made sufficiently large to admit the 
nozzle end of the syringe. It need not be removed from the 
case for the purpose of charging the syringe. You merely turn 
the neck upward, remove the stopper, insert the syringe into 
the fluid, and draw upon the piston until the desired quantity 
of medicine has entered the barrel. The case is made to hold 
the bottle tightly in any position, so that both may be left on the 
table durins the operation, without fearing for the safety of the 
glass or its contents. 
After having operated and replaced the needle 
and syringe in the case, the bottle is corked and 
turned back to its former position. 
Brown's Syringe is of hard rubber, of same 
length and two millimetres greater circumference 
than the common stylographic pen. The barrel 
is of uniform calibre throughout. The canulated 
needle is protected by a sheath, so that the in- 
strument can be safely carried in the pocket case 
or loose in the pocket. At the upper end of the 
piston a cap fits air-tight to the syringe ; the caps 
at the two ends hermetically seal the instrument, 
and thus keep the piston at all times moist and 
in working order; the danger is also avoided of 
rusting the instruments associated with the sy- 
ringe in the case. At the lower end is a recep- 
tacle capable of containing a dozen or so com- 
pressed subcutaneous pellets. The piston is of 
metal, graduated and with screw adjustment, and 
works easily in a bearing in the upper cap. 
Fig. 1707.-Tiemann & Co.'s Pocket Case 
Hypodermic Syringe. 
Fig. 1708.-Brown's Pocket Case Hypodermic Syringe. 
Fig. 1709.-Extra Needles for Hypodermic Syringes. 
Gold, .... $1.00 
Steel, .... .50 
Steel, gilt, . . . $0.75 
Steel, nickel-plated, .65 
When ordering needles please state how the attach' 
ment to the syringe is to be effected, i. e., screw or slide? 
If you desire needles for syringes not of our manufacture, it is necessary to send your syringe to fit them. 
Repairing Hypodermic Syringes. 
If your glass cylinder is broken, and you want a new one, always send us your fittings. 
If any other part of the syringe is wanted, send what you have left, and it will be easy to supply the missing portions. 
To prevent confusion and loss, parties sending parcels to us are requested to enclose their card in the same, as 
otherwise they cannot be identified. 126 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PARACENTESIS. 
Fig. 1710.-Set of four Trocars, for Ascites, Hydrocele, &c. 
Fig. 1711.-Flint's Trocar and Aspirator, for Paracentesis Thoracis. 
Fig. 1712.-Rubber Bag and 
Stop-cock for Injecting (Hydrocele) 
Fig. 1714.-Wood's and Harris' Trocars for Ascites. 
Fig. 1713.-Robert's Pericardial Trocar. 
Fig. 1715.-Exploring Trocar and Case. 
Fig. 1716.-Little's Trocar. 
Fig. 1718.-Set of three Trocars. 
F1G. 1719.-Trocar and Canula. 
Fig. 1717.-Warren's Trocar. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
127 
PARASEJMTESIS 
Fig. 1720.-Spencer Welles' Ovarian Trocar. 
Fig. 1721.-Thomas' Ovarian Trocar, 
Fig. 1722.-Fitch's Ovarian Dome Trocar (1, 2, 3). Aspirator Needles (4, 5). Clamp Forceps (6). 
Fiy J 
Fig. 1723.-Emmet's Ovarian Trocar. 
Fig. 1724.-Warren's Ovarian Trocar. 
Fig- 1725.-Dunster's Ovarian Trocar. 128 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PARACENTESIS 
Fig. 1726.-Lawson Tait's Ovariotomy Trocar. 
Fig. 1727.-Spencer Welles' Ovariotomy Trocar (latest). 
FlG. 1728.-Rectum Trocar, for Rectal Puncture of the Bladder. 
Fig. 1729.-Parker's Guarded Rectum Trocar. 
Fig. 1730.-Buck's Rectum Trocar. 
Fig. 1731.-Van Buren's Double Silver Tube. 
For Supra-Pubic Puncture of the Bladder, see ' ' Dieulafoy's" and other Aspirators. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
129 
^SPI^ATIOJ< 
PNEUMATIC ASPIRATORS. 
For evacuation by powerful suction of the fluid, contents of tumors, serous and synovial 
effusions, collections of blood, pus, &c., for relieving retention of urine (supra-pubic 
puncture of the bladder) and the withdrawing of accumulated gases from the 
intestines by means of capillary tubes, so as not to leave an open 
wound nor admit air to the cavity. 
This instrument consists of a glass cylinder, H, about seven 
inches in height and two in diameter, with a tight-fitting piston. 
The cylinder is partly covered with a brass casing, nickel- 
plated. In front is a graduated scale, showing the amount of 
contained fluid in grammes. 
The piston, B, is raised or lowered by turning the handle 
A. Near the bottom of the cylinder are two taps with stop- 
cocks, D and E. To these are fitted two rubber tubes, as seen 
in the cut. 
To the extremity of the one, connected with D, a capillary 
trocar may be attached. About four inches from this end of 
the tube is inserted a piece of glass tubing about three inches 
in length, so as to allow the fluid to be seen passing to the 
cylinder. 
The contents of the cylinder are discharged through the 
rubber tube attached to the tap, E. 
The capillary tubes, or trocars as they are called, repre- 
sented below the instrument, are six in number, sharp-pointed, 
and of different sizes, the smallest being about the calibre of 
the tube of the hypodermic syringe, or one-third of a milli- 
metre in diameter ; the largest one and a half millimetre, all of 
them about four inches in length. 
The manner of using the pneumatic aspirator is as follows: 
The instrument is first prepared by attaching the rubber 
tubes to the taps, D and E. After selecting the capillary tro- 
car, it is to be connected to the tube attached to the tap D, as 
represented in the cut. The extremity of the tube, G, should 
be placed in a basin, to receive the contents of the cylinder. 
Closing the stop-cocks, D and E, the piston is raised by 
turning the handle, A, and is retained in position by the spring, 
C. In this way nearly a perfect vacuum is obtained. The 
capillary trocar is then introduced with a rotary motion into the 
part from which the fluid is to be drawn. The stop-cock, D, 
is then opened, and the fluid rushes into the cylinder, which, when full, is emptied by closing stop-cock D and 
opening E, pulling out spring C, and lowering the piston. When this is done, both stop-cocks are again closed and 
another aspiration made in the same manner. 
The following practical points should be attended to in using this and other similar instruments: 
i. Be sure that your instrument is in perfect order-that the trocars and tubes are pervious, that the stop-cocks 
and piston work easily and without leakage. 
2. Oil the needles or trocars before using. 
3. Combine rotation with pressure in introducing the trocar, holding it between the index-finger and the thumb, 
and introduce slowly, so as to injure the tissues as little as possible. 
Local anaesthesia may be used at the point of puncture if desired. A small nick in the integument, made with the 
scalpel, will facilitate the introduction of the trocar. 
4. Remove the trocar slowly, and keep up the aspiration during its removal. This prevents the escape of any of 
the fluid which may remain in the trocar. This is always to be borne in mind whenever the peritoneum is perforated. 
5. After using, carefully wash out the instrument and tubes, and insert fine wire into the sharp-pointed trocar or 
canula before putting it away. 
6. It is well occasionally to unscrew the top of the cylinder carefully and pour in about half an ounce of sweet-oil. 
This will keep the piston in good order.-Dr. Little, in New York Medical Record, November, 1872. 
Fig. 1732.-Dieulafoy's Aspirator. 130 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/cSPI^ATIO^. 
PNEUMATIC ASPIRATORS. 
For removing fluids from the pleural cavity in cases of hydrothorax or empyema; from the 
cranial cavity in cases of hydrocephalus; from the knee-joint in cases of synovitis : for remov- 
ing pus from abscesses ; for removing gas and the fluid contents of the intestines in cases 
of strangulated hernia, and thus allowing the gut to be reduced by taxis; also in 
diagnosticating hydatids and abscesses of the liver and tumors of the abdomen; 
and for puncturing the bladder above the pubes to relieve retention of urine 
caused by stricture, enlarged prostate or injuries of the urethra, &c. 
Fig. 1733.-Hospital Aspirator. 
Fig. 1734.-Steurer's Aspirator. 
The Hospital Aspirator is the largest Dieulafoy's aspi- 
rator in general use. Its arrangement is such as to leave 
both hands of the operator free to perform any manipula- 
tion which may be found necessary. 
The rack and pinion movement admits of the piston 
being tightly packed, and hence a nearly perfect vacuum 
is obtained for exhausting. There are three stop-cocks at 
the lower cap, so that all the trocars and voiding tubes may 
be attached, this enables to wash out a cyst without the 
necessity for removing the needle. The syringes and 
needles are exquisitely fitted and finished. 
The manner of using and keeping the instrument in 
order is the same as described on page 129 for the upright 
aspirator. 
Steurer s Aspirator (r ig. 1734). 
This aspirator proper is identical in construction with 
Dieulafoy's, and is worked in the same manner ; but it is 
of smaller size, and, having no stand, it must be held with 
the hand. 
Instead of the capillary tubes with sharp points, as 
Dieulafoy's, we have trocars provided with three-cornered 
stilets, as in the ordinary trocar. The shaft of the stilet is piston-like, working through an air-tight chamber at I. 
After the trocar has been introduced, the stilet is drawn back until it stops at I-the point being then at F. This 
opens the canula, L, and tube, A', for the influx of matter. Now, if the barrel, A, is filled, the stop-cock, G, on the 
lower end shut, and the other one on the side of the barrel opened, the contents maybe voided by pushing the piston, 
F, either directly or by means of the key, D, down into the barrel. New aspirations, ad libitum, may now be made 
without being necessitated to remove the trocar from the wound. 
The trocar is a modification of Bilroth's instrument for performing aspiration without permitting the entrance of 
air into the punctured cavity. The instrument can be used for injecting as well; but, for obvious reasons, when so 
used, it ought to be well cleansed by passing warm water through it. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
131 
/vSPI^ATIO^I. 
PNEUMATIC ASPIRATORS. 
For removing fluids from the pleural cavity in cases of hydrothorax or empyema ; from the cranial 
cavity in cases of hydrocephalus ; from the knee-joint in cases of synovitis ; for removing pus 
from abscesses ; for removing gas and the fluid contents of the intestines in cases of 
strangulated hernia, and thus allowing the gut to be reduced by taxis ; also in diag- 
nosticating hydatids and abscesses of the liver and tumors of the abdomen; 
and for puncturing the bladder above the pubes to relieve retention of urine 
caused by stricture, enlarged prostate or injuries of the urethra, &c. 
Fig. 1735.-Tiemann & Co's Aspirator. 
This instrument consists of a clear glass bottle, z, with a 
graduated scale showing the amount of fluid contained. It 
is closed by a rubber stopper, through the centre of which a 
double current tube, 2, passes. This is attached to, 3, an elastic 
hose with, y, an exhausting pump and, 3, another elastic hose 
with, 6, a stop-cock, on the top of this a capillary tube or tro- 
car, 7, is attached. Three sizes of trocars or tubes go with the 
instrument. It is reliable in action and of simple construction. 
The Manner of Using' the Instrument. 
1st. Select the capillary tube or trocar, see that it is per- 
vious, and attach it to the stop-cock, 6. 
2d. Close the bottle tightly with the stopper, 2 ; screw the 
air pump well home to its fitting, j>, and shut the stop-cock, 6. 
3d. A vacuum is now formed in the glass bottle by giving 
from thirty to fifty strokes of the air pump, and the instrumen 
is ready for use. 
4th. Local anaesthesia maybe used at the point of puncture 
and a small nick made in the integument with a scalpel, ta 
facilitate the introduction of the trocar. 
6th. The trocar should be oiled and introduced slowly. 
combining rotation with pressure, so as to injure the tissues as 
little as possible. 
6th. The stop-cock, 6, is then opened. 
The fluid, if thin and clear, will now rush into the glass 
bottle quite fast; if it is thickish, it will drop down slower. 
The flow can be stopped at any time by closing the stop-cock. 
If more than one quart or bottle full is to be drawn, the stop 
cock, 6, must first be closed, the stopper, 2, removed from the 
bottle, which is then emptied, and the operation repeated as 
above described. 
Should the fluid cease to run, a few strokes of the air pump 
will make it flow again, unless the trocar be obstructed by fibrinous matter. In this event it must be withdrawn, 
cleaned out with the wire stilet, and re-introduced; or better, one of a larger size instead. 
When the operation is completed: Remove the trocar slowly, keeping up the aspiration during its removal, to 
prevent the escape of any fluid which may remain therein. This is especially to be borne in mind whenever the 
peritoneum is perforated. 
How to Keep the Instrument in Order. 
1st. If the instrument is not used, often, the valves may become sticky and adhere to the brass , run a fine needle 
under and separate them carefully ; or, 
2d. Renew the valves in the following manner: pass a strip of our valve material or of oil-silk, one-eighth of an 
inch wide, over the perforation in the valve-cone, 
and tie it to its neck with a waxed silken thread. 
3d. Oil the leather piston before use. 
4th. After use, wash out with warm water, dry 
and oil the trocars and put them away with the wires 
inserted. 
If these rules are observed, the instrument will 
always be in order. 132 
GEORGE TIEMANN <fc CO.'S SURGICAL INSTRUMENTS. 
/cSPIRATIOJM. 
PNEUMATIC ASPIRATORS, 
Fig. 1736.-Higgins' Aspirator and Injector. 
This instrument is similar to Tiemann & Co.'s, with the fol- 
lowing additions: through the rubber stopper for the glass bottle 
is passed a triple current tube. Behind the bottle is seen the 
case in which the instrument is kept when not in use. The top 
of the case has a slot into which a vacuum-gauge is fitted. 
The needle or trocar, A, connects with the stop-cock, B ; this 
to a short piece of rubber tubing, this is followed by a short 
glass tube, C, to allow the fluid to be seen passing to the bottle; 
the rubber tube, D, connects with one of the outlets of the triple 
current tube passed through the stopper. The second arm of 
the outlet, E, connects the bottle with the vacuum gauge by 
means of rubber tubing, E. To the third outlet of the triple 
tube through the stopper is connected, also by means of stout 
rubber tubing, G, the brass air pump, II. When this pump is 
worked the vacuum gauge, F, indicates.how near to perfection a 
vacuum is obtained. 
The manner of using the instrument is the same as given for 
Fig- 1735, page 131- 
The syringe, J, is attachable directly to the points, needles or 
trocars, that are to be used for injecting cavities. This is in- 
tended to avoid the danger of poisoning a patient, which may 
occur when injections are made by means of an instrument that 
has previously been used for aspiring septic matter, or that may 
not have been properly cleaned. 
Fig. 1737.-Aspirator and Injector, 
Directions for Using as an 
Aspirator. 
Insert the stopper firmly into a strong 
bottle (a clear glass one preferred), then 
attach the short elastic hose to the stop- 
cock, B, of the tube projecting from stop- 
per, attach the other end of same elastic 
hose to the exhausting or inward flowing 
chamber of the pump. 
Next attach one end of the longer 
elastic hose to the stop-cock, A, projecting 
from stopper, and the other end to the 
needle. Care should be taken that all the 
fittings or attachments are placed firmly 
into their respective places. Now close 
the stop-cock, A, and open stop-cock, B, 
and by giving from thirty-five to fifty 
strokes of the pump you can produce 
sufficient vacuum to fill a bottle holding from one pint to a quart. After having formed the vacuum, close the stop- 
cock, B, and the instrument is ready for use. 
To Inject with same Instrument. 
Connect the air-tube with the outward flow chamber of the pump as directed by the arrows; put the desired liquid 
in the bottle, then fasten or tie the stopper securely to the bottle, and while holding the receiver in a reverse position 
inject air into it. After having obtained the desired pressure, close the air-cock, B, and open the fluid-cock, A, and 
with it control the flow of liquid. Care should be taken to close the fluid-^ock in time to prevent the escape of air. 
The pump should never be worked while the fluid-cock is open, as an air bubble might pass with the out-flowing fluid. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
133 
/tSPIRATIOJE 
Fig. 1738.-Emmet's Aspirator. 
It has a glass graduated cylinder; the piston consists of double cups of leather, making it perfectly air tight to the 
up or down stroke. The stop-cock works by a lever, as in a stomach pump. It can be used for either injection or 
aspiration 
Fig. 1739.-Warren's Aspirator Needle, 
Fig. 1740.-Miller's Aspirator. 
1. Pump with stop-cock ; 2. Flexible exhaust tube with short 
glass tube inserted ; 3. Needle. 
. To use the instrument, attach one end of the tube, 2, to the 
needle and the other to the pump, and then, after introducing 
the needle, turn the lever and draw the piston. When the pump 
is filled turn the lever and shove down the piston. This action 
may be repeated as often as necessary. By reversing the action, 
the instrument can be used to inject a cavity as well. 
Fig. 1741.-Fitch's Handy Aspirator 
Fitch's Handy Aspirator (Fig. 1741). 
A represents the dome aspirator needle, with the cutting point 
projected, ready for puncture ; G, a magnified diagram of the same, 
after insertion, with the dome advanced so as to protect the inte- 
rior of the cavity during aspiration ; E, bulb in upright position, 
to insure the best action of valves ; C C, valves ; D, entrance tube; 
E exit tube ; E E, bits of glass tubing, through which to observe 
the presence or absence of fluid. 134 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
Of>HTHALJVlie. 
OPHTHALMOSCOPES. 
Fig. 1742.-Liebreich's Ophthalmoscopes. 
Fig. 1744.-Dudley's Ophthalmoscope. 
Fig. 1743.-Knapp's 
Single Disk Ophthalmoscope. 
Fig. 1745. 
Loring's Student Ophthalmoscope. 
ON THE USE OF THE OPHTHALMOSCOPE. 
Some of the simplest applications of optics to the observation of the eye, and detection of diseased conditions, 
depend upon the fact that the transparent structures still reflect some light, and more when diseased than when 
healthy. Thus: 
Firstly.-We examine the reflecting efficiency of the surface of the cornea, in order to determine its transparency. 
In cases in which there is no large opacity, but simply a general steaminess caused by an uneven surface, it may be 
difficult to detect it by direct inspection, but if we expose the eye to the light, and look at the image of the window- 
frame produced, we shall see distinctly that this image is blurred and indistinct, like that from a greasy mirror. 
Secondly.-We use what is called the catoptric test to determine the presence or absence of the lens. This depends 
upon the fact that the surfaces of the lens reflect images. Dilate the pupil well with atropia. Hold a small taper in 
front of the pupil in a dark room. You will observe, if the lens be present, three images : an anterior one, bright, 
distinct and erect-from the front surface of the cornea ; a middle one, inverted, small, fairly distinct-from the con- 
cave posterior surface of the lens capsule ; a posterior one, erect, indistinct-from the anterior surface of the lens cap- 
sule. 
Thirdly.-Again, the surfaces of the crystalline lens easily become visible, by the light which they reflect, whenever 
we can see them obliquely. When the lens is in its normal position it is difficult, unless by oblique illumination, to see GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
135 
OPHTHALoMie. 
OPHTHALMOSCOPES. (Continued.) 
its surface ; but if it is malplaced, as we sometimes find it, by congenital imperfection, or from injuries, then its surfaces, 
being oblique, become easily visible. Any one not aware of this fact would at once declare that the malplaced lens was 
also slightly opaque, and erroneous observations to that effect are to be found in some records of such cases. 
In former days the catoptric test used to be much employed to determine the transparency, or otherwise, of the 
crystalline lens. Now, however, it has been wholly superseded by another discovery, which in its every-day usefulness 
is second only to that of the opthalmoscope itself. I allude to oblique illumination. To accomplish this is the easiest 
matter possible, and by its aid any one of the slightest skill can, in almost all cases, 
determine at a glance the condition of the patient's pupil and of his crystalline lens. 
The smallest dots of pigment on the capsule, the least possible streaks of an inci- 
pient cataract, become by its aid conspicuously definite. We have no longer any 
need for the curious, but very disappointing, catoptric test which fails us just 
when most needed, i. e., in slight cases ; for the discovery of cataract, in any stage 
whatever, is now perfectly easy. For oblique illumination you need only a candle 
and a convex lens, say a two-inch. The pupil should be dilated with atropia, and 
the candle having been placed to one side of the patient's head, the lens is held so 
as to receive its light, and concentrate it to a pencil, which is thrown upon the pa- 
tient's eye. All the superficial parts, i. e., the cornea, the iris, the pupil, and the 
lens, may thus be brilliantly lighted up. In addition to the illumination, we may 
also, with another lens, employ magnifying power, and thus inspect the state of 
things yet more accurately. 
Oblique illumination is applicable to all morbid conditions of the cornea, iris, 
or lens, and to blood-clots in the anterior part of the vitreous or new growths 
which bulge forwards into the anterior half of the globe. You cannot, however, 
by its aid, see the fundus of the eye. To do this we must employ another in- 
strument. Here let us ask the important question, Why is an ophthalmoscope 
necessary? Why can we not, by simply looking into the little round box, one inch 
deep, which constitutes an eyeball, see what is at its bottom ? The answer is, that the eyeball is not simply a box, 
it is an optical instrument, and it is from its lens apparatus that the difficulty comes. The rays of light received by 
the eye are brought to a focus on the retina; back again from the retina they are reflected, and pass out of the eye, 
destined to depict somewhere an image of the retina itself. The lens apparatus, however, not only brings the rays 
passing in to a certain and definite focus on the retina, but it acts on those which pass back, and brings these also to a 
focus at a certain and definite place. There is no difficulty whatever in illuminating the fundus, any light held in front 
of the eye will do that, nor have the structures of the fundus any difficulty in reflecting light by which they themselves 
ought in turn to become visible. The difficulty is in bringing the eye of the observer into the line of the reflected rays ; 
this without artificial aid is impossible, and hence the necessity for the ophthalmoscope. 
I have said that every lens has a principal focus, or spot at which parallel rays which impinge upon it are made to 
meet by the convergence induced. Now, suppose that from this focus the rays are reflected back again, they must pass 
through the lens in the reverse direction, and will again become parallel. If, however, divergent rays be used, they 
will in returning be converged and made to meet at another focus in front of it. Inasmuch as the rays were at first 
not parallel but divergent, the focus at which, after passing through the lens, they meet, will not be at the same 
distance as that for parallel rays, but at a greater one. The distance will always be in exact proportion to the degree 
of divergence, and thus the two foci will always bear mutual relations to each other. If one be brought nearer to the 
lens the other will be further off, and vice versa. Let us call them from this fact, that they maintain mutual relation, 
"conjugate foci." You may observe, if you like, that although conjugate, they keep each other at a distance. It is 
absolutely necessary that you should observe that all the rays of light passing out from the eye take a direction towards 
this conjugate focus, and that thus an observer who would make use of them to see the fundus must bring his eye into 
their line. This line, however, is the same that the rays took in passing into the eye. and if you try to intercept those 
coming out, you will intercept those going in and cut off the source of illumination. 
Thus if we hold a candle two feet in front of the observed eye, its rays, divergent, will be refracted in entering the 
eye, and will depict an image on the retina-they will then be reflected and again refracted in such a manner that an 
image of the fundus will be found at the position of the candle flame, that being the position of the conjugate focus. 
If the observer puts his head in the direction of these rays between the candle and the observed eye, of course he stops 
the rays which should have entered from the candle, he illuminates only the outside of his own head, and the eye of 
his patient is left in shadow. If he tries to see by looking from beyond the candle, then the flame of the latter intercepts 
his view and dazzles his eye. What is wanted is some contrivance to enable the observer to bring his head into his 
own light. Now the mirror of the ophthalmoscope does this, a reflecting surface with a small hole in the middle, it 
Fig. 1746. 
Noyes' Lens Holder. 136 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPHTHALMIC. 
OPHTHALMOSCOPES. (Continued.) 
practically makes the observer's eye the source of illumination, and brings it into the direction which the rays of light 
returning to their conjugate focus must take. Foreshadowed by Cumming, invented by Helmholtz, improved by Coc- 
cius, Reute, Liebreich, and many others, this little instrument, which has worked such a revolution in ophthalmic 
science, is thus simple in its essential principle. 
The ophthalmoscope, as in daily use, consists of two parts, a mirror and an object lens, and to these is often added 
an eye-piece as well. The mirror, however, is the essential, the other parts are accessories intended for different 
special purposes. Without troubling you with details respecting the various modifications of the instrument, I will 
now describe the use of the simplest of them, a reflecting mirror slightly concave, and with a perforation in its centre. 
Having placed the patient's head in such a manner that the light (a lamp, candle, or gas-light) is on a level with his 
temple, and slightly behind it, and his face, as a consequence, in shadow, the observer sits in front and applies the 
back of the ophthalmoscope mirror to his own eye. He should keep both eyes open that he may see where the light 
falls, and then move the mirror until the light falls full on the pupil of his patient. In a moment he will perceive the 
first fact which this instrument reveals, that the fundus is not black, as it has always appeared to be before, but that it 
is of a brilliant fire-red. He will, however, see nothing of the fundus distinctly, only a general red reflex. Now at 
this point the student must stop awhile and use his mirror, to inspect, first, the transparency of the cornea, and next, 
that of the lens and vitreous, and to do this he must make the patient move his eye in various directions. After a little 
practice he will be able to manage his light well, and to throw it with precision wherever he may wish, and to keep it 
steadily on any given part. At a first lesson he may even, with advantage, practice for awhile by illuminating the 
second button of the patient's waistcoat. Tact in directing the light having been obtained, we may now proceed 
further. Instruct the patient to look, not full in your face, but over one shoulder ; if you are inspecting his right eye, 
over your left shoulder. You will, when he does this, notice at once that the tint of the light reflected from his fundus 
is changed, that it is no longer fire-red, but canary-yellow. The reason of this is that a different part of the fundus is 
exposed to view-that, namely, of the optic disc itself, which is much lighter in color than the rest. The area of yellow 
is very large-occupies, indeed, the whole of the field, while we know that the disc itself is very small. This proves 
that the objects thus indistinctly seen are immensely magnified. Magnified by what? By the patient's own eye, 
which, as we have said, is equivalent to a lens of one-inch focus. 
Hitherto, we have seen nothing distinctly, but if the observer now brings his head very close to his patient's face, 
he will be able with more or less facility to observe the details at the bottom of the eye, the trunks of vessels of the 
retina, the optic disc, &c., &c. All these will be seen very large indeed, being still magnified by the patient's eye. 
What he sees now is equivalent to type looked at through a one-inch lens, placed exactly one inch in front of it. 
[It is plain, then, that we cannot see the fundus of the eye without optical aid. Of such aid, we have our choice 
of the inverted and of the erect. Both are seen much magnified, the latter much more so than the former. For ordi- 
nary purposes the inverted image is used. It is seen very easily, and it brings a large field into view at once, so 
rendering the observer much less liable to inconvenience from slight motions of the patient's head. The examination 
of the erect image is chiefly useful for the inspection of detail, and even for these it requires great practice.] 
Next I will attempt a few suggestions by which beginners, and those who use the instrument but seldom, may best 
hope to avoid mistakes. 
I. Always indulge yourself in the use of atropine, and by its aid both enlarge the patient's pupil and paralyze his 
accommodation. Experts can manage without, and may sometimes smile at those who are obliged to use it, but the 
increased facility which it gives is such that no beginner should neglect it. The objection that it causes the patient 
inconvenience is a very trivial one. What the patient wants before all things is, that a correct opinion should be 
formed, and to this end he is quite prepared to make a little sacrifice of convenience. For want of the use of atropine 
I think I have known even experts overlook things which would have been apparent at a glance had it been used. 
2. Always proceed on system. Examine the eye first without the object-lens and ascertain the state of the cornea, 
lens, and vitreous. No mistake is easier to make, or more frequently made, than by the immediate employment of 
the inverted image to overlook the fact that the media are not perfectly transparent. With strong illumination you 
can look right through a slight opacity in the cornea, lens, or vitreous, and observe only that the retina and choroid 
are seen indistinctly. Many a diagnosis of " hazy retina" ought to have been " opaque vitreous." It is like criticising 
the beauty of a prospect, and declaring that it looks dull, when you have forgotten to observe that the window wanted 
cleaning. If you have any doubt as to the state of the cornea or lens, examine them by oblique illumination before 
going further. Many opacities in the cornea are so slight that you overlook them on naked-eye inspection, and also 
with the ophthalmoscope mirror, but find them directly by oblique illumination. Need I add that you must be very 
particular that your object-lens, when you use it, is quite clean. Any stains on it will be seen as if on the patient's 
retina. 
3. Having completed your examination of the media, still proceed on system. The next duty is to estimate the 
length of the eyeball. A patient may come complaining that he is rapidly losing his sight, and you may find that it GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
137 
OPHTHALMIC. 
OPHTHALMOSCOPES. (Continued.) 
really has become so defective that he cannot read the largest ordinary print. You hastily assume that he must have 
some disease of the deep parts, some form of amaurosis. You proceed to ophthalmoscopic examination, and again 
hastily employ both mirror and object-lens, and it is quite possible that you may overlook altogether the fact that the 
eyeball is much too short and the patient hypermetropic. In high degrees of hypermetropia, if sudden failure of 
accommodation happen to occur, the defect in sight may often be so great as to draw the attention quite away from the 
right scent. I have already described the method by which we ascertain whether an eye is abnormal as to length. For 
the benefit of the mere novice, I may, however, here add, that whenever, 
without the object-lens, any of the details of the fundus-vessels, disc, 
patches, &c.-are easily seen, he may be quite sure that the globe is 
either too long or too short, or that the lens is wanting. If these objects 
are seen very easily, and the image very bright and beautiful, then, in all 
probability, it is an inverted image, and the eye is myopic. If only large 
trunks of vessels have been seen, and these not easily kept in view, then 
probably it is the erect image, and the eye hypermetropic. 
4. Still proceed on system. Having ascertained that the media are 
clear, and that the eyeball does not materially deviate from its normal 
length in either direction, you may now examine in succession the optic 
disc and its vessels, the retina, and choroid near to it, the yellow spot, and 
lastly, the outlying districts. I must mention each of these separately. 
5. The Optic Disc. Note its shape, its margins, whether definite or 
otherwise, its color, and its level. Observe whether the vessels upon it 
are seen sharply or not, and look particularly as to how they conduct 
themselves at its margin. Distinguish between artery and vein, and note 
the size of each. It is a common mistake with young observers to pay 
attention to the vein only. In the healthy state the disc should be round, 
and its choroidal ring distinct and sharp ; the vessels on its surface should 
be seen with beautiful clearness, and the difference between vein and ar- 
tery, as to size and color, should be readily distinguished. In the centre, 
or near it, and close to where the trunks of the vessels dip back, there 
will be seen a bright white patch. This white patch may be large and 
very conspicuous in some eyes, and small in others, whilst still the eye is 
not in the least diseased. As regards the vessels, you must distinguish 
between the large branches of those destined to supply the retina, and the 
minute ones which give a general pink tint to the nerve itself. The latter 
may be much diminished, whilst the former retain their size. 
Amongst the more common peculiarities displayed by the disc in a 
state of disease, we have- 
1st. The formation of crescents by its side, or of irregular circles 
around it in myopia. 
2d. A jagged condition of the choroidal rim, indicating either the 
commencement of crescents, or the previous occurrence of inflammation 
(neuritis). 
3d. A hazy semi-opaque appearance of the structures in which the retinal vessels run, by which the latter are in 
part concealed and rendered indistinct. In this state the margins of the choroidal rim are concealed, and the disc 
appears to be much increased in size, and to be limited by a shaded, indistinct edge. This "woolly" condition implies 
neuritis. 
4th. The disc may be too red or too pale. The pallor sometimes amounts to absolute whiteness, sometimes it is 
blue-white, and sometimes it is a dirty gray tint. Sometimes the pallor affects the whole disc surface, and at others 
only a part. If only a part, the third next to the yellow spot is that usually affected, and in commencing cases this is 
always the first to suffer. The pallor may indicate mere anaemia, with, perhaps, primary atrophy, or it may indicate 
an anaemia and atrophy which are secondary to inflammation. It requires much experience to decide this point. 
5th. The disc, instead of being on the same level as the rest of the retina, may be pushed backwards, or cupped as 
it is called. This cupping will be recognized by carefully tracing the main trunks of vessels and observing whether 
they curve On passing over the choroidal margin. If the cup is well marked, the vessels will bend so much that they 
are lost sight of at the edge of the disc, to be found again on its surface, looking much smaller and paler than those in 
the retina, and requiring a little movement of the object-lens to bring them well out. Cups of this kind imply intra- 
Fig* 1 
Loring's 7 Lens Ophthalmoscope. 138 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPHTJHALMIC. 
OPHTHALMOSCOPES. (Continued.) 
ocular pressure, the characteristic of the disease known as glaucoma. With them pulsation of the vessels may often be 
observed. 
Having carefully studied the disc, your attention will next be directed to the retina and its vessels. The retina 
ought to be almost perfectly transparent, but in dark eyes-and particularly in members of the dark races-a delicate 
haze, or bloom-of-plum appearance, may be observed in it, especially near to the yellow spot. You ought to be able 
to trace the retinal vessels with the greatest ease. If this cannot be done, then inflammation of some kind or degree is 
present. The grand characteristic of inflammation, as far as the retina 
is concerned, is opacity. This opacity may vary from the merest haze to 
that of the dense white or gray pellicle. By this haze the trunks of the 
vessels will probably be more or less concealed, but if the deeper layers 
of the retina are affected, their concealment may not be much. You will 
remember that the retina consists of three principal layers-that of rods 
and bulbs, which is close to the choroid, and probably fed by it, that of 
nerve cells, granular matter, &c., in the middle, and that of nerve-tubes 
(derived from the optic), &c., which is innermost. It is in the latter layer 
only that the arteria and vena centralis run: these vessels have nothing to 
do with the deeper or outer layers. The inflammation may affect chiefly 
the inner or outer layer, being in the one case a neuro-retinitis, in the 
other a choroido-retinitis. 
In some cases of retinitis, as in that which attends Bright's disease, 
haemorrhages are very common. 
The yellow spot is recognized almost as much by its negative features 
as by any distinctive peculiarities. It is situate a little to apparent nasal 
side (inverted image) of the optic disc, and is exactly opposite the observer 
when the patient looks at the ophthalmoscope mirror. No large vessels 
cross it. It is more highly pigmented than the neighboring parts, and 
also often looks rather hazy and indistinct. It is here that the deposits 
characteristic of Bright's disease are earliest seen. 
The choroid is the tissue which gives color and glow to the fundus. It 
may vary exceedingly within the limits of health, and its variations will 
cause apparent haze, or otherwise, in the retina. Before trusting yourself 
to any ophthalmoscopic descriptions whatever, examine carefully the dif- 
ferences in the eyes of fair and of dark persons. In the latter you will 
find the choroidal epithelium full of pigment, and showing dark mapped- 
out areas, which might easily be supposed to be morbid, whilst the ves- 
sels of the choroid are concealed. In the fair-complexioned eye the 
leashes of vessels will be seen with marvelous brilliancy and beauty, and 
the suspicion of atrophy will be suggested. 
It is much more common to see the results of inflammation in the 
choroid than to trace the early stages of such. The results are perma- 
nent, and very conspicuous. The epithelium may be absorbed in large 
patches, usually with masses of black pigment remaining. The absorp- 
tion may implicate deeper layers, and be attended by atrophy of the vas- 
cular rete and exposure of the sclerotic. The patchy condition in a case of choroiditis disseminata may be compared 
to that of a piece of well-marked tortoise-shell. 
Inflammation of the choroid in patches is usually of syphilitic origin. Atrophy of the choroid, independent of 
inflammation, is frequent in advanced states of myopia. 
Inspection of the outlying districts of the fundus is easily done, by making the patient look upwards, downwards, 
&c., strongly. It should never be omitted ; for not unfrequently changes may here be discovered which will be the 
key to the case. It is here that the dots of pigment, characteristic of retinitis pigmentosa, will be first found. Here 
also, in syphilitic inflammation of limited degree, patches may be sometimes found when there are none in the central 
parts of the fundus. 
Having mentioned some of the chief morbid conditions to be expected, I will now specify some of the errors into 
which novices with the instrument are likely to fall. Like all other instrumental aids-and the stethoscope is a prom- 
inent example-the ophthalmoscope must be expected to lead to many mistakes. It is difficult to use, and requires long 
experience before the observer can trust his own interpretation of what he has seen. Want of familiarity with the 
Fig. 1748. 
Lorings 12 Lens Ophthalmoscope. 
" 1 r GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
139 
OPHTHALMIC 
OPHTHALMOSCOPES. (Continued.) 
varying conditions which may be met in health, is a main cause of error. Thus a well-pigmented choroid in a dark- 
complexioned person may be easily apprehended. A very large physiological cup may be taken for " white atrophy," 
or for a glaucoma cup ; a margin of black pigment at the edge of the disc may be attributed to disease ; and alterations 
in size of vessels, which are peculiar to the individual, may be supposed to imply anaemia or congestion. It is possible, 
also, in a highly pigmented eye, to mistake the yellow spot itself for the remains of a blood clot. As to the common 
error of fancying the retina hazy when the appearances are due to opacity in one or other of the media, I have, I think, 
already said enough. 
Degrees of vascularity are especially difficult of satisfactory comparison. You will hear one authority assert that the 
disc or retina is congested, when another will declare that they are quite normal. Let me warn you against the diagno- 
sis of "congested retina." In four out of five of the cases in which the words "hyperaemic retina" are used, they are 
probably employed in error. Both in the optic disc and in the retina, the size of the vessels may differ widely and be 
still within the bounds of health. Just as one person may have a florid cheek and red ears, and another pale ones, yet 
both be in good health, so may the color of the optic disc and the size of the retinal vessels differ. The conditions 
of the circulation in the retina are such as to make any condition analogous to erythema of the skin simply impossible. 
If you find the retina visibly reddened, be sure that it is not simply "congested," but stained by effusion, in fact, 
inflamed. The individual arteries are too far apart to give any general red color to the whole. The interpretation of 
congestion must rest on the enlargement of their trunks only; and this, which is a comparative question, is very diffi- 
cult to estimate. The old notions as to active congestions preceding inflammation, must be abandoned for the retina, 
as elsewhere. We now know that cell changes are the essential factors in inflammation, and that it is these that induce 
vascular changes. I do not by any means deny that the optic disc and retina may in some cases contain too much 
blood, and yet show no trace of inflammation : but I feel sure that these conditions are far less frequent than they are 
thought, and I warn the beginner against the fatal facility of explaining amblyopia by discovering congestion. 
[Jonathan Hutchinson, Esq., Surgeon to the London Hospital, in "Clinical Reports of London Hospital," 
1S67-8, p. 182.] 
Knapp's Single Disk Ophthalmoscope (Fig. 1743). 
It has a series of auxiliary lenses as extensive as any ophthalmoscope, with the exception of Dr. Knapp's double 
disk instrument. It is sufficient for all the purposes of the student and practitioner in ophthalmic surgery. When the 
instrument is held 20 millimetres from the patient's eye, the accompanying table will indicate, in millimetres, the 
shortening and elongation of the optical axis as determined with this (and other) instruments in the erect image and by 
relaxed accommodation. 
For a full description of the instrument, see "Archives of Ophthalmology and Otology," Vol. IV., No. 1. 
Table indicating, in millimetres, the shortening and elongation of the optical axis, as determined with this (and other) 
instruments in the erect image and by relaxed accommodation. The instrument to be held 20 millimetres from 
the patient's eye. 
Number of Glass. 
OPTICAL AXIS. 
Number of Glass. 
OPTICAL AXIS. 
Shortened. 
Elongated. 
Shortened. 
Elongated. 
2 
6.12 
5.08 
8 
I.42 
I.36 
3 
3-95 
3-49 
10 
I.I3 
I.09 
4 
2.9I 
2.65 
12 
0-94 
O.9I 
5 
2.31 
2.14 
16 
0.70 
O.6o 
6 
I.9I 
1.80 
24 
0-47 
O.46 
7 
I.63 
i-55 
48 
0.23 
O.23 
Knapp's Double Disk Ophthalmoscope (Fig. 1749). 
Two disks are placed behind the mirror, the upper containing one empty aperture and thirteen concave glasses, 
the lower one empty aperture and thirteen convex glasses. Each disk is fastened like the one in the Single Disk 
Ophthalmoscope, and is moved separately, the superior one on the upper edge of the instrument, the inferior *one on 
either side of its lower end. The edges of the two disks overlap behind the opening in the mirror in such a way that 
by combination of concave and convex glasses, as great a variety of auxiliary lenses can be obtained as the most minute 
physiological and pathological examination ever will require. 140 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPHTHALMIC 
OPHTHALMOSCOPES. (Continued.) 
Fig. 1749.-Knapp's Double Disk Ophthalmoscope. 
a. Front View (Mirror). 
l>. Lens, Disks and Cover (removed). 
'1 h's jn»hvment offers a complete series of correcting glasses to the expert ophthalmoscopist if he wants accurately to 
ascertain the dioptric condition of an eye independently of the statements of the patient, or to determine the relief of 
the background of the eye, and follow its changes in the course of exudations, tumors, excavations, &c. A full 
description of this instrument, with many practical remarks, maybe found in the "Archives of Ophthalmology and 
Otology," 1874, Vol. Iff., No. 2, pp. 1-25. A convenient series of glasses, their combinations and optical effects, is 
seen in the following table. 
Table indicating the ophthalmoscopic determination of the shortening, resp. elongation of the ocular axis by means 
of positive, resp. negative auxiliary lenses. The instrument to be held 20 millimetres from the patient's eye. 
Number of 
Glass. 
Obtained by Combina- 
tion of. 
Shortening 
Elongation. 
Number of 
Glass. 
± 6 
± 62 
± 8 
± 10 
± 12 
± 14 
± 17 
± 20 
± 24 
± 33 
± 48 
Obtained by Combina- 
tion of. 
Shortening. 
Elongation. 
± 2 
± 21V 
± 2$ 
± 2| 
± 3 
± 3s 
± 3i9t 
± 3i9t 
± 4 , 
± 4U 
± 5 
± 5f 
± 2 T i; 
± 2 T IO 
± 2 T 8 
i 3 T 48 
± 3 T 20 
± 3 T 14 
± 4 T 33 
± 4 ± 20 
.± 4 T 14 
6.12 
4-93 
4.80 
4-27 
3-95 
3-68 
3-32 
3-05 
2.91 
2.63 
2.31 
2.05 
5-o8 
4-23 
4.14 
3-9° 
3-49 
3-28 
2-99 
2.78 
2.65 
2.42 
2.14 
1.92 
£ 6 T 48 
I.9I 
1.62 
1.42 
1.13 
O.94 
0.80 
0.66 
0.56 
0,467 
0.339 
0.232 
I.80 
1.56 
1.36 
I.09 
O.9I 
O.78 
O.65 
0-55 
0-459 
0-335 
O.23O GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
141 
OpHTHAbJVIIC 
OPHTHALMOSCOPES. (Continued.) 
Fig. 1750.-Loring's 
Single Disk Upright Image 
Ophthalmoscope. 
Fig. 1751.-Loring's 
Double Disk Upright Image 
Ophthalmoscope. 
The latest modification of the ophthalmoscope, adopted by Dr. Loring, is a successful attempt 
to combine two essential points, viz. : first, that the glass should have a diameter of not less than six millimetres ; and, 
secondly, to have a sufficiently large number of glasses. This is done by a single disk and the segment of a disk, the 
latter being the quadrant of a circle. 
The single disk contains sixteen glasses, on the metric system, the plus being numbered in white, and the minus in 
red. The first row of numbers, or that just beneath the glass, shows the real value of the glass ; the second, or inner 
row, shows the results of the combination when the quadrant is in position. The quadrant rotates immediately over 
the disk and around the same centre, and contains four glasses - .5 - 16. and + .5 + 16. 
When not in use, the quadrant is beneath the cover. The instrument then represents a simple ophthalmoscope 
with sixteen perforations, the series running with an interval of I. D, and extending from 1. to 7. plus, and from 1. 
to 8. minus. 
This is ample for all ordinary work, as the interval of 1. D is as close as even an expert usually desires, and can, 
with a little experience, be used for even very minute discrepancies. For if, in a given case, the fundus is seen 
distinctly with I. D, and a little to spare, while 2. D blurs the picture, we know at once that the refraction must be 
between the two, or 1.5 D. If, however, for any reason we wish to prove this conclusion, we can bring up 0.5 D. 
From this grass we get successive half-dioptrics from 1. to 8. plus and from 1. to 9. minus. In this way we have, so 
to speak, a fine and a coarse adjustment, as in the microscope. 
If the higher numbers are desired, these are obtained by combination with those of the quadrant. These progress 
regularly up to 16. D, every dioptric being marked upon the disk ; above this, up to + 23. D and - 24. D, we have 
to simply add the glass which comes beneath the 16. D, turning always in the same direction. 
By the various combinations a total series of sixty-five glasses can be obtained. 142 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
OPHTJHALdMIC. 
OPHTHALMOSCOPES. (Continued.) 
Beginning with o, and revolving always from 
left to right, we obtain : 
PLUS. 
o 
1 
2 
3 
4 
5 
6 
7 Bring up 4- 16 
+ 16 - 8- 8 
" - 7- 9 
" - 6 = 10 
" - 5 - 11 
" - 4 - 12 
" -3- 13 
" - 2 - 14 
" - 1 - 15 
" - o - 16 
" + I - 17 
"4-2- 18 
" +3- 19 
" 4- 4 - 20 
" 4- 5 - 21 
" 4- 6 - 22 
" 4- 7 - 23 
Beginning with o, and revolving always froto 
right to left, we obtain : 
MINUS. 
I 
2 
3 
4 
5 
6 
7 
8 Bring up - 16 
- 16 4- 7 - 9 
" 4- 6 - io 
" 4- 5 = • n 
" 4- 4 " 12 
" +3- 13 
" 4- 2 - 14 
" 4- I - 15 
" 4- o - 16 
" - I - 17 
" -2- 18 
" -3~ 19 
" - 4 - 20 
" - 5 - 21 
" - 6 - 22 
" - 7 - 23 
" - 8 - 24 
Thus, with the superposition of a single glass (4- 16. or - 16.), and with an uninterrupted rotation, a series is ob- 
tained of successive Dioptrics from I. to 23. plus, and from 1. to 24. minus. 
With the use of the 0.5 we can obtain, in addition, the following series, with an interval of half a dioptric: 
4- o. 
4-0.5 
4- I. 
+ 1-5 
4- 2. 
4- 2.5 
4- 3- 
4- 3-5 
4- 4- 
- 0.5 
- 1. 
- 1-5 
- 2. 
- 2-5 
- 3- 
- 3-5 
- 4- 
- 4-5 
By a simple displacement of the quadrant the instrument becomes a single disk ophthalmoscope.-See "Trans. 
Fifth Intern. Ophthal. Congress," 1876, and "Trans. Amer. Ophth. Soc." 1878. 
Dr. II. T. Noyes has described, in his own "Treatise on Diseases of the Eye," 1881, pp. 28-29, an ophthalmo- 
scope with certain modifications, based upon Loring's latest model, devised for the purpose of putting at command, in 
rapid succession, the full series of glasses which may be required. The mechanism by which this is effected is by cog 
wheels, and there are two disks carrying lenses. The mirror, besides swinging in the trunnions, may be rotated in a 
circular direction, and thus assume any angle. The front disk is moved by the lowest wheel, and the back disk by the 
upper and exposed wheel. There is a spring clip on the back of the instrument, which will carry a cylindrical glass. 
It gives command of a complete set of spherical glasses, both positive and negative, seventy-six in number.-" Soelberg 
Wells' Diseases of the Eye." Bull's Am. ed., 1883, pp. 738-740. 
Knapp's Metric System Ophthalmoscope (Fig. 1752). 
It contains thirty-two glasses, running from 0.5 Dioptric to 18 Dioptrics, positive and negative. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
143 
OPJHTHALJVlie. 
OPHTHALMOSCOPES AND ACCESSORIES. 
Fig. 1752.-Knapp's Metric System Ophthalmoscope. 
Ophthalmo-Phantome 
Fig. 1753.-Nachet's Trial Set. 
Fig. 1755. 
Thompson's Optometer. 144 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPJHTHALJVIIC. 
PERIMETERS, PUPILLOMETERS, STRABISMOMETERS, TEST TYPES. 
Fig. 1756.-Carmalt's Perimeter. 
This instrument, described fully 
in the " Transactions of the Fifteenth 
Annual Meeting of the American 
Ophthalmological Society," 1879, is 
a modification of Foerster's, but at a 
very much less cost. It consists of a 
brass arc B, cast accurately upon a 
circle of 35.5 cm. (14 in.) radius, re- 
volving smoothly about the axis c. 
A portion of the long arm unships 
and fits on the short arm for the ex- 
amination of each eye. The short 
lines across the face of the arc, Fig. 
2, represent, as the arc is revolved, 
concentric circles situated at IO° 
apart up to 900, and the radiating 
lines shown in Fig. 2, represent the 
meridians of the globe of the eye at 
intervals of 300. Both are numbered 
to correspond with a diagramatic chart 
of the visual field (which may be pro- 
cured with the instrument) drawn to 
a scale of 1 mm. to each degree of the 
visual field. The centre of the chart 
corresponds to the macula lutea. 
Description. 
, Fig. i.-A, upright shaft upon which the brass arc slides ; B, arc 35.5 cm. radius, embracing 1400 of a circle; C, 
chin-rest, sliding up and down in horizontal brace, D, with thumb-screw for fixation at F. The horizontal brace, D, 
is arranged with slide to be just 35.5 cm. long, so that the eye is exactly at the centre of the arc, A ; E, string-clamp 
for attachment of whole to table or bracket against the wall ; c, axis about which arc, A, levoIves, nickel-plated for 
fixation of eye. 
Fig. 2.- Reverse end of axis, showing radiating lines for meridian of eve. as indicated on chart to acconmanv in- 
strument. 
Fig. 1759. 
Lawrence's 
Strabismometer. 
Fig. 1757.-Pupillometer. 
Fig. 1758. 
Galezowsky's Binocular Strabismometer. 
Snellen's, Jaeger's, &c., Test Types. 
Test Types for Color Blindness. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
145 
OPJHTHALJVlie 
PALPEBRAL. 
For Tumors, Versions, and other Affections of the Lids. Entropium, Ectropium, 
Ptosis and Trichiasis Ciliorum. 
Fig. 1763.-Tiemann & Co.'s Entropium Forceps. 
Fig. 1764.-Desmarre's Entropium Forceps. 
Fig. 1765.-Laurence's Eyelid Tourniquet. 
Fig. 1761.-Snellen's Entropium Forceps. 
Fig. 1762.-Roehrich's Entropium Forceps. 
Fig. 1760.-Knapp's Entropium Forceps. 
Fig. 1766.-Cross-Bar Entropium Forceps. 
Fig. 1768.-Prout's Entropium Forceps. 
Fig. 1767.-Tiemann & Co.'s Entropium Forceps. 
Fig. 1770.-Jaeger's Plate Lid-Holder. 
Fig. 1771.-Carron de Villard's Lid Forceps. 
Fig. 1769. 
Stoke's Eyelid 
Compressor. 146 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
OPJHTHALJVI IC 
PALPEBRAL. 
For Tumors, Versions, and other Affections of the Lids. 
Fig. 1772.-Ratti's Trichiasis Forceps 
Fig. 1777.-Scalpel for Operating upon the Lids. 
Fig. 1778.-Small Size Scalpel 
Fig. 1779.-Medium Size Scalpel. 
Fig. 1780.-Desmarre's Scarificator. 
Fig. 1773.-Cilia Forceps. 
Fig. 1774.-Piffard's Epilating Forceps. 
Fig. 1775.-Gruening's Epilating Forceps. 
Fig. 1776.-Henry's Depilating Forceps. 
Pig. 1784.-Fine Curved and 
Half-Curved Needles. 
Fig. 1781.-Knapp's Needle-Holder, 
See Piffard's Milium Needle and Irido-Platinum Needle, page 121. 
Fox's Needle-Holder, for removing Hair by Electrolysis, see page 121 
Fig. 1782.-Sand's Needle Forceps. 
Fig. 1785. 
Turnbull's Ice Bag, for the application of cold to 
the eye, to subdue inflammation. 
Fig. 1783.-Prout's Needle Forceps. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
147 
OPJHTJHALMIC 
LACHRYMAL. 
Probes, Dilators, Catheters, Styles, for Strictures of the Lachrymal Passages. 
Fig. 1786.-Anel's Probes. 
Fig. 1792.-Styles and Lachry- 
mal Canula. 
Fig. 1787.-Bowman's Set of Nos. 1, 2, 3, 4, 5, 6, 7, 8, Probes. 
Styles made of gold, silver, 
aluminium, hard rubber and 
lead, solid and canulated ; also 
lead wire. 
Fig. 1793. 
Galezowskv's Canalicula Dilator. 
Fig. 1788.-Weber's Graduated Dilator. 
Fig. 1794. 
Werber's Lachrymal Canula. 
Fig. 1789.-Williams' Set of Lachrymal Probes. 
a, b. Probes. 
c. Dilator. 
d, e. Styles. 
Fig. 1790.-Brewster's Lachrymal Cupped Sound. 
Fig. 1795.-Levi's Probe. 
S 
o 
o 
*c3 
g 
q 
►J 
cc 
<u 
I 
\6 
o 
11 
o 
£ 
By Samuel Theobald, M. D. 
Transactions of the Medical and Chirurgical Faculty of Maryland, Baltimore, 1877. 
Fig. 1791.-Probes for the treatment of Strictures of the Nasal Duct. 
No. 1.- 34 m'm' 
2.- % m.m. 
3.- % m.m. 
4.-1 m.m. 
5.-lJ4 m.m. 
No. 6.-1^ m.m. 
7.-1% m.m. 
8.-2 m.m. 
9.-2^ m.m. 
10.-2^ m.m. 
11.-2% m.m. 
No. 12.-3 m.m. 
I3-~3/4 w-w- 
I4--3/4 m-m- 
I5--3/4 
16.-4 m.m. 148 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS, 
OPHTHALMIC. 
LACHRYMAL. 
Probes, Directors and Knives, for Division of Strictures of the Lachrymal 
Passages and for Fistula Lachrymalis. 
Fig. 1797.-Weber's Hall Curved Canalicula Knife. 
Fig. 1798.-Weber's Curved Canalicula Knife. 
Fig. 1799.-Beaumont's Concealed Canalicula Knife. 
Fig. 1800.-Jaeger's Bistoury Cache for the Canalicula. 
Fig. 1801.-Greenslade's Concealed Canalicula Knife. 
]■ IG. 1803.-Stilling s Knife for stricture in the lachrymal passages. 
Fig. 1804.-Noyes-Stilling's Knife. 
I"IG. 1802.-Girard Teulon's Canalicula Instrument. 
IG. 1806.-Noyes' Movable Blade Canalicula Knife. 
FlG. 1813.-Parker's Fistula Lachrymalis Knife. 
Fig. 1805.-Noyes' Plain Canalicula Knife, 
Fig. 1811.-Liebreich's Probe and Fistula Knife. 
Fig. 1808.-Bowman's Canalicula Knife. 
Fig. 1809.-Agnew's Canalicula Knife. 
Fig. 1810.-Prout's Lachrymal Knife. 
Fig. 1812.-Petit's Fistula Lachrymalis Knife. 
Fig. 1807.-Bowman's Director. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
149 
OPHTHALMIC. 
LACHRYMAL. 
For Cauterizing the Nasal Duct and Obliterating the Sac. 
Fig. 1815.-Gensoul's Canula for Cauterizing the Nasal Duct. 
Fig. 1814.-Noyes' Lachrymal Gougi 
See Galvano Cautery, page 37. 
Thermo Cautery, page 39. 
Fig. 1816.-Manfredi's Speculum. 
Fig. 1817.-Knapp's Caustic Holder. 
Figs. 1818 and 1819.-Desmarre's Cautery Iron and Many-Pronged Hook, 
for Obliterating the Sac. 
Fig. 1820.-Anel's Silver Eye Syringe-Gold and Silver Points. 
LACHRYMAL SYRINGES, EYE DOUCHES AND BATHS. 
Fig. 1824.-Agnew's Eye Douche. 
Fig. 1821. 
McFarlan's Lachrymal Syringe. 
Fig. 1825. 
Stopcock for Eye Douche. 
Fig. 1826.-Knapp's Lachrymal Syringe. 
Fig. 1822. 
Liebold's Subpalpebral Syringe. 
Fig. 1823.-Agnew's Lachrymal Syringe. 
See also Drop Glass, and Eye Bath, page 150. 150 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
OPHTHAGMie. 
FOR REMOVING FOREIGN BODIES. 
Fig. 1827.-Drop Glass for the Eye. 
Fig. 1828. 
Eye-Bath Glass. 
Fig. 1830.-Pocket Gouge and Spatula. 
Fig. 1838.-Knapp's Foreign Body Hook. 
Fig. 1829.-Knapp's Foreign Body Hook. 
Fig. 1835.-Carron de Villard's Needle. 
Fig. 1832.-Daviel's Curette. 
Fig. 1836.-Couching Needle. 
Fig. 1837.-Hard Rubber Spoon. 
Fig. 1831.-Spatula 
Fig. 1833.-Dix's Spud. 
Fig. 1834.-Gouge. 
See 
Richardson's Spray, 
Fig. 1259, l)age 48. 
Fig. 183g.-Pocket Spud and Needle. 
Dr. Gruening's Magnet. 
Fig. 1840.-Gruening's Magnet. 
For Removing Particles of Steel or Iron from the Eye. 
It consists of a series of bar magnets, 
united at one end by an armature of mal- 
leable iron, on which is mounted a needle 
of soft iron, 32 mm. in length and 1 m. in 
width. This magnet will easily sustain a 
weight of 15 grammes and will promptly 
extract splinters and particles of iron 
weighing from 1 to 50 centigrammes from 
the vitreous. Should it be inexpedient to 
extract the foreign substance through the 
wound already existing in the sclerotic, 
Dr. Gruening would draw the splinter to 
a favorable site and extract through an 
incision in the sclera. A splinter brought 
to the original wound might present trans- 
versely, and so render its extraction diffi- 
cult. With some dexterity in manipula- 
tion, one end of the splinter could be 
attached to the magnetic needle and the 
foreign body could then be removed with 
facility.-A7. K Med. Journal, Sept. 1S80. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
151 
OpHTHALJVI IC. 
SPECULA AND LID HOLDERS. 
For controlling and keeping the Lids apart and exposing the Ball for an operation. 
Fig. 1841.-Plain Wire Eye Speculum 
Fig. 1842.-Graefe's Eye Speculum. 
Fig. 1843. 
Noyes' 
Plain Eye 
Speculum. 
Fig. 1844. 
Noyes' Improved Eye Speculum. 
Fig. 1845.-Galante's 
Eye Speculum. 
Fig. 1846.-Landolt's Eye Speculum. 
Fig. 1847.-Schwatka's Eye Speculum. 
Fig. 1848.-Liebold's Eye Speculum. 
Fig. 1849.-Noyes' Eyelid Retractor. 
Fig. 1850.-Liebreich's 
Eye Speculum. 
Fig. 1851.-Critchett's Eye Speculum 
Over the nose. 
Fig. 1852.-Critchett's Eye Speculum. 
Over the temple. 
Fig. 1853. 
Hart's Eye Speculum 
Fig. 1854 and 1855.-Desmarre's Eyelid Retractors, 152 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPJHTJHALJVlie. 
SPECULA, FIXATORS AND OPHTHALMOSTATES. 
To Steady the Eyeball for an Operation. 
Fig. 1856.-Bowman's Eye Speculum. 
FlG. 1858.-Carron de Villard's Fixation Forceps. 
Fig. 185g.-Fixation and Tumor Forceps. 
Fig. i8f>o.-De la Roza's Fixation Forceps. 
Fig. 1857.-Dudley's Fixation Forceps. 
Fig. 1861.-Noyes' 
Fixation Forceps. 
Fig. 1866.-Pamard's Pique, for Fixation. 
FlG. 1864.-Jaeger's Ophthalmostate. 
Fig. 1865.-Noyes' Ophthalmostate. 
Fig. 1867.-Three-Pointed Ophthalmoscope, 
Fig 1868.-Double Hook, for Fixation 
Fig. 1862.-Graefe's Fixation Forceps. 
Fig. 1863.-Curved Fixation Forceps. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
153 
OPjdTHALJVlie. 
SURGICAL ANATOMY OF THE MUSCLES OF THE EYE. 
In reference to Operations performed and the Instruments employed for the Relief of Strabismus. 
* * * The movements of the globe of the eye are performed around three axes, an antero-posterior, a 
transverse and a vertical. These motions are effected by six muscles, four straight and two oblique. The four 
straight muscles arise around the foramen opticum behind the globe, and, enveloping it, pass forward and are inserted 
into its anterior hemisphere, about one or two lines from the circumferance of the cornea, a favorable arrangement for 
the movements of rotation, which they are destined to effect. These four muscles are: 
1st. The superior rectus, situated at the upper part of the orbit, beneath the levator palpebrae superioris, it raises 
the pupil by turning the eye upon its transverse axis. 
2d. The inferior rectzis, diametrically opposed to the preceding, also turns the eye upon its transverse axis, by draw- 
ing down the pupil. It passes between the globe and the inferior oblique which is inserted above its external border. 
3d. The internal rectzis, lying along the internal wall of the orbit, turns the eye on its vertical axis, and draws the 
pupil inwards. 
4th. The external rectus, lying along the external wall of the orbit, is the antagonistic of the preceding; its 
insertion into the sclerotica is a little nearer the cornea than that of either of the other recti muscles. 
The two oblique muscles turn the eye around its antero-posterior axis : 
1st. The superior oblique arises around the optic foramen, from thence it passes forwards and inwards to the 
internal orbitar process of the frontal bone, where it passes through a fibrous ring, which forms a species of pulley. 
After leaving this ring it passes from within outwards beneath the superior rectus, and is inserted into the posterior 
hemisphere of the globe; when it contracts, it draws the pupil downwards and upwards. 
2d. The inferior oblique arises along the inner edge of the border of the orbit; it passes beneath the globe from 
within outwards, and is inserted by a large tendon into the posterior hemisphere of the eyeball, below the insertion of 
the superior oblique, to which action its muscle is opposed. 
Three different nerves supply these muscles: the motores oculorum, or third pair, give branches to the superior, 
internal and inferior recti, and the inferior oblique; the pathetici, or fourth pair, supply the superior oblique alone; 
and the abducentes, or sixth pair, the external rectus. 
Orbitar aponeurosis.-The eyeball is retained in the middle of the orbit by the orbitar aponeurosis. Suspended in 
this fibrous capsule, it executes with rapidity its movements of rotation, without sustaining any general displacement, 
which would destroy in the two globes that simultaneousness of motion so necessary to distinctness of vision. This 
aponeurosis, after lining the orbit and supplying the palpebral ligaments, is reflected upon the globe, envelopes its 
two posterior thirds, furnishes sheaths for its muscles, and finally terminates posteriorly upon the neurilemma of the 
optic nerve. 
It is adherent anteriorly to the muscles at the point where they leave it to be inserted into the sclerotica. This 
arrangement does not always allow each muscle to act independently; it accounts for those movements which still 
continue after the section of the muscle itself, the movements of the eyeball depending in these cases upon those of the 
orbitar aponeurosis. 
Strabismus consists of a loss of paralellism between the two axes of vision. 
The indications for and against an operation are derived from the causes which produce the disease, the most 
frequent of which is, perhaps, contraction of the muscle corresponding to the direction of the squint. 
STRABOTOMY. 
Earlier Modes of Operating. Miotomy. 
Strohmeyer's method, ■which he recommended in 182g. * * * The sound eye being closed, the 
patient is directed to carry the affected eye as far as possible in the direction opposite to that which it usually retains. 
If the strabismus is inwards, a fine double hook is inserted into the inner margin of the ocular conjunctiva, and con- 
fined to an assistant, who draws the eye outwards; the conjunctiva being raised up with forceps, is divided with a 
cataract knife, the incision being directed towards the inner angle of the eye ; the traction outwards is then increased 
until the internal rectus muscle appears ; a fine probe is then passed beneath the latter, and it is divided with the curved 
scissors or with the knife with which the conjunctiva was opened. 
Sedillot's Method.-In converging strabismus, to turn the eye outwards, we take up the conjunctiva with a hook (Fig. 
1873); another hook is then introduced along the border of the sclerotica, and a little within the cornea; an assistant 
takes charge of this last hook while the surgeon withdraws the first. Raising up a fold of the conjunctiva a little to the 
inner side of the hook with an ordinary pair of forceps, we divide it with a single cut of the scissors, and then cutting 
one after another the fibro-cellular filaments which present themselves, we soon come to the muscle, whose reddish 
color contrasts strongly with the sclerotica. After carefully isolating the muscle, we slip a blunt hook beneath it, and 
raising it slightly, divide it with the scissors. In slight cases of strabismus, we have intentionally left a portion of the 154 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPfHTHALJVlie. 
STRABOTOMY. 
For Operating on the Ocular Muscles and their Tendons, to Correct 
Diplopia and the Deformity of Squint. 
Fig. 1873.-Sedillot's Double Hook, for Fixing the Eye. 
Fig. 1869.-Wecker's Double Strabismus Hook. 
Fig. 1870.-Theobald's Crochet Strabismus Hook. 
Fig. 1871.-Graefe's Large Strabismus Hook. 
Fig. 1872.-Graefe's Small Strabismus Hook. 
Fig. 1874.-Wecker's Strabismus Hook. 
Fig. 1875.-Critchett's Strabismus Hook. 
Fig. 1876.-Strabismus Hook-Bistoury. 
Fig. 1877.-Curved Strabismus Forceps. 
Agnew's 
Tenaculum 
is like Fig. 1871, 
with an eye near the 
point for ligature. 
Fig. 1880.-Angular Strabismus Scissors. 
Fig. 1878.-Probe-Pointed Curved 
Strabismus Scissors. 
Fig. 1881.-Straight Strabismus Forceps, Delicate. 
Fig. 1879.- Blunt-Pointed Curved 
Strabismus Scissors. GEORGE TIEMANN CO.'S SURGICAL INSTRUMENTS. 
155 
OpHTHAhJVIIC 
STRABOTOMY. 
Earlier Modes of Operating. Miotomy. (Continued.) 
muscular fibres undivided, and yet obtained a successful result by covering the sound eye for four or five days, and 
forcing the patient to turn the operated eye outwards, to see the objects through a circular opening in a piece of plaster. 
Subconjunctival Operation.-Guerin's Method : Take up with the hooks a fold of conjunctiva, and entering a 
Z-shaped tenotome (Fig. 1876) at its base, introduce it between the muscle and the sclerotica; turn the cutting edge 
of the knife from behind forward and divide the muscle with a slight sawing motion. 
By this method Guerin proposed to prevent the contact of the air with the wound, and to procure for it, as for all 
subcutaneous wounds, the benefits of an immediate and rapid reparation.-From "Bernhard and Huette's Manual of 
Operative Surgery." Am. Ed., by Van Buren and Isaacs. 
Tenotomy. The New Operations. 
* * * The principle of Von Graefe's new operation consists in a very careful division of the tendon 
close to its insertion, with the smallest possible amount of laceration of the subconjunctival tissue, and the tendinous 
processes of the capsule of Tenon. We diminish the power of the muscle by giving it a more backward insertion, 
but we, at the same time, preserve its length intact. Our object is only to weaken the muscle, and not to render it 
more or less impotent. 
Before proceeding to consider this method of operating we will, however, dwell for a moment upon the anatomi- 
cal relations of the muscles of the eye with the ocular sheath. Commencing at the optic foramen, and loosely em- 
bracing the optic nerve, the sheath expands and passes on to the eyeball, which it encloses like a capsule. It is 
loosely connected with the sclerotic with connective tissue-so loosely as to allow of the free rotation of the globe 
within it. At the equator of the eyeball it is pierced by the tendons of the oblique muscles, and more anteriorly by 
the tendons of the four recti muscles, with which it becomes blended ; being finally on, rather than inserted into, the 
sclerotic, close to the cornea. The posterior portion of the sheath, up to the passage of the tendons, has been called 
the "capsule of Bonnet ;" the anterior portion, from the passage of the tendons to its insertion in the sclerotic, having 
been designated the " capsule of Tenon." On piercing the capsule the tendons of the recti muscles become connected 
with it by slight cellular processes, sent forth from the capsule. These processes prevent the too great retraction of 
the muscle after the division of its tendon, which would be followed by a great loss of power. It is, therefore, of 
much consequence that these connecting processes should not be severed by the tendon being divided too far back, or 
be lacerated by rude and careless manipulations with the strabismus hook. Von Graefe has, moreover, pointed out 
that the result may be unfavorable, even although the tendon has been divided anterior to these fibres, as the sheath 
of the tendon becomes thickened from the point at which it passes through the capsule, and this thickening extends 
nearly up to its insertion. If the tendon is, therefore, not divided sufficiently close to its insertion, it is apt to retract 
within this thickened sheath, and this retraction will, in many cases, prevent its reunion with the sclerotic. 
In the old operation the muscle was divided far back-frequently even posterior to its passage through the cap- 
sule-and it was, consequently, rendered so powerless that the eyeball could not be moved in this direction; its 
opponent acquired a corresponding preponderance of power, giving, but too frequently, rise to a secondary squint in the 
opposite direction. Hence, the popular dread of the operation, " lest the eye should go the other way." But such an 
unfortunate result is not to be feared if the surgeon performs the operation with care and circumspection, and is 
thoroughly conversant with the theoretical part of the subject. 
Von Graefe's Method.-Patient under an anaesthetic. The eyelids kept apart by a spring speculum (page 151), or, if 
this proves not sufficiently strong, by the retractors (Figs. 1854, 1855). An assistant everts the eye with a pair of forceps, 
taking care to do so in the horizontal direction, without rotating the eyeball on its axis, otherwise the horizontal posi- 
tion of the internal rectus will be changed. The operator then seizes, with a pair of finely-pointed forceps (Figs. 1877 
or 1881), a small but deep fold of the conjunctiva and subconjunctival tissue close to the edge of the cornea, and about 
midway between the centre and lower edge of the cornea, and about midway between the centre and lower edge of the 
insertion of the internal rectus. He next snips this fold with the scissors, which should be bent on the flat and blunt- 
pointed (Figs. 1878, 1879), and, burrowing beneath the subconjunctival tissue in a downward and inward direction, 
makes a funnel-shaped opening beneath the subconjunctival tissue-this being, however, done very carefully-so as not 
to divide it to too great an extent. If the subconjunctival tissue is thick and strong it will be better, first, to take up a 
small fold of the conjunctiva only, to open this, and then seizing the subconjunctival tissue, to divide the latter. The 
squint-hook, which should be bent at a right angle, and have a slightly bulbous point (Figs. 1871, 1772), is then to be 
passed through the opening to the lower edge of the tendon. Its point being pressed somewhat firmly against the scler- 
otic, the hook is to be turned on the point and slid upwards beneath the tendon, as close to its insertion as possible, and 
the whole of the expanse of the tendon caught up. The operator must be careful not to direct the point of the hook 
upwards and outwards, otherwise it may perforate the fibres of the tendon, and only a portion of the latter be caught 
up. When the tendon has been secured on the hook, the conjunctiva, which covers its upper portion, may be gently 156 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPHTHALMIC 
STBABOTOMY. 
Tenotomy. The New Operations. (Continued.) 
pushed off with the points of the scissors, so as to expose the tendon, which is then to be carefully snipped through 
with the scissors as closely as possible to its insertion. When it has been completely cut through the conjunctiva it is 
to be slightly elevated on the point of the hook and a smaller hook passed upwards and downwards to ascertain whether 
the lateral expansions of the tendon have been divided. Should a few fibres remain they must be divided, and the 
surgeon should again ascertain whether any others are still present, for if a few fibres only remain, they would suffice 
to spoil the effect of the operation.-" Soelberg Wells' Diseases of the Eye," p. 708. Am. Ed., 1883. 
Critchett's Subconjunctival Operation.-The patient having been placed under the influence of an anaesthetic, and 
the eyelids kept apart by the stop speculum, he seizes a small fold of the conjunctiva and subconjunctival tissue at the 
lower edge of the insertion of the rectus muscle, and with a pair of blunt-pointed, straight scissors, makes a small 
incision at this point through these structures. The lower edge of the tendon, close to its insertion, is now exposed. 
A blunt hook (Fig. 1875) is next to be passed through the opening in the subconjunctival tissue beneath the tendon, so 
as to catch up the latter and render it tense. The points of the scissors, but slightly opened, are then to be intro- 
duced into the aperture, and one point passed along the hook, behind the tendon, the other in front of the tendon, 
between it and the conjunctiva, and the tendon is then to be divided close to its insertion by successive snips of the 
scissors. A small counterpuncture may be made at the upper edge of the tendon, to permit of the escape of any 
effused blood, and thus prevent its diffusion beneath the conjunctiva.-Bowman. 
In this operation the tendon, owing to the cutting action of the scissors, is apt to slip off the hook before it has been 
completely divided. To remedy this Dr. Theobald has devised the "crochet hook" (Fig. 1870), which Dr. Noyes modified. 
* * * Liebreich's Method, based upon a different view of the anatomical relations of the conjunctiva, 
subconjunctival tissue, and the capsule of Tenon to the muscles of the eye. He considers the capsule of Tenon as 
divided into two portions-an anterior and a posterior-the division being formed at the point where the recti muscles 
pierce it from without inwards: the capsule being at this point so closely connected with the muscles as to render any 
displacement between the two impossible. The posterior half of the capsule, with its smooth, firm, inner surface, 
forms a cup, in which the eyeball moves as freely as the head of a joint in the socket. The close connection between 
the muscles and the posterior half of the capsule is increased by sheath-like processes, which run backwards from the 
outer surface of the capsule towards the orbit, and which are, for a certain distance, closely connected with the muscles. 
But there are no sheath-like processes between the inner portion of the posterior capsule and the sclerotic. The 
anterior half of the capsule of Tenon adheres to the upper surface of the muscle and is intimately connected with it. 
But Liebreich denies the presence of sheath-like processes derived from the capsule, where they pierce the latter, and 
accompanying the muscles as far as their insertion. He states, moreover, that the "caruncle," together with the semi- 
lunar fold, rests upon the band-like ligament, which passes from the capsule of Tenon towards the edge of the orbit. 
Now, when the internal rectus is contracted, and the eye rolled inwards, this band is rendered tense, and the caruncle, 
which is fixed to it, is consequently drawn towards the inner edge of the orbit. But the outer edge of the caruncle, 
together with the semilunar fold, and an adjoining portion of the conjunctiva, are drawn backwards into a furrow. 
This intimate connection between the muscle, capsule and caruncle is the reason of the sinking of the caruncle and 
semilunar fold, which is occasionally observed after an extensive division of the internal rectus. To obviate these 
disadvantages, and yet to obtain a considerable effect, Liebreich operates in the following manner: "If the internal 
rectus is to be divided, I raise with a pair of forceps a fold of conjunctiva at the lower edge of the insertion of the 
muscle, and, incising this with scissors, enter the points of the latter at the opening between the conjunctiva and the 
capsule of Tenon. I then carefully separate these two tissues from each other as far as the semilunar fold, also sepa- 
rating the latter, as well as the caruncle, from the parts lying behind. When this portion of the capsule, which is of 
much importance in the tenotomy, has been completely separated from the conjunctiva, I divide the insertion of the 
tendon from the sclerotic in the usual manner, and extend the vertical cut, which is made simultaneously with the 
tenotomy, upwards and downwards-the more so if a considerable effect is desired. The wound in the conjunctiva is 
then closed with a suture. The following are the advantages of my proceeding : 
"First.-It affords the operator a greater scope in apportioning and dividing the effect of the operation between 
the two eyes. 
" Second.-The sinking back of the caruncle is avoided, as well as ever)' trace of a cicatrix, which not uncommonly 
occurs in the common tenotomy. 
"Third.-There is no need for more than two operations on the same individual, and therefore of more than one 
on the same eye." 
Noyes, of Detroit, operates by making the tenotomy on the elongated tendon. The shortening necessary to correct 
the squint is made by lapping the ends of the divided tendon, and maintaining them in position by two sutures passed 
through the conjunctiva and lapped ends of the tendon, above and below, and tied lightly.-" Transactions Am. Ophth. 
Soc." "Soelberg Wells' Diseases of the Eye," p. 714. Am. Ed., 1883. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
157 
OPHTHALMIC 
The Advancement of the Rectus and Limiting Strabismus Operation 
of Dr. A. E. Prince, of Jacksonville, Ill., improved since publication in the St. Louis Medical and Surgical Journal, 
1881, and first edition of " Diseases of the Eye," by H. D. Noyes, will be elucidated by the following brief description : 
1st. Patient being cocainized,* medium 
sized antiseptic silk suture (a. a') is intro- 
duced, with very sharp needle, into dense 
episcleral tissue two mm. from corneal 
margin. 
2d. Conjunctiva and Tenon's capsule 
are opened in the usual manner,one branch 
of the advancement forceps is introduced 
and the remaining branch closed down, 
grasping conjunctiva and tendon of the 
rectus, now to be separated from the scle- 
rotic with strabismus scissors. 
3d. The muscle now being elevated by 
the forceps,both needles of the double loop 
suture (b b') are introduced from beneath 
through Tenon's capsule and conjunctiva, 
including the middle portion of the rectus, 
sufficiently far back to allow for the portion 
to be excised. 
4th. The forceps, still being elevated, 
the belly of the muscle is divided by the 
scissors at least two mm. on the corneal 
side of the suture (b b'). 
5th. The needles being cut away, four 
independent sutures are formed, viz.: a, 
a', b and b'. Ignoring, for the present, 
a' and b', one branch of suture, b, is 
crossed over suture, a, both branches of which are now tied down enclosing, b, in a loop or pulley. 
6th. Both branches of b, are now taken up and tied, when it will become apparent that, in proportion as they are 
tightened over the loop (formed by a), will the free end of the rectus be approximated to the insertion of the tendon 
simultaneously closing the conjunctival gap. A bow knot is now applied, by loosening which the effect may be modi- 
fied, and, after several hours, if satisfactory, sutures a' and b' (which are reserve sutures to be used in case of entangle- 
ment) are withdrawn. The eye is washed out and kept moistened with absorbent cotton compresses, frequently soaked 
in one-half per cent, aqueous solution of acid, carbol, purum, with ten per cent, of glycerine. 
For considerable effect and to diminish the tension on the loop suture the tendon of the opposite rectus is divided 
as a preliminary step, and, in case of paralysis, as much as possible of the anterior portion of the opposite rectus should 
be exsected or divided, back of the capsule. 
Fig. 1882.-Prince's Advancement Forceps. 
Limiting Strabismus Suture. 
As a limiting suture this method is employed by the author to afford security against over correction following or- 
dinary section of the rectus : first, in those cases where one desires to produce an extreme effect by extensive division of 
the capsule, and, second, in the correction of minimum degrees of deviation which compromise comfortable binocular 
vision. In these cases a and b are introduced single and further forward, previous to section of the tendon, simply 
dipping into and out of the muscle with a single sharply-curved needle (care being exercised to exert no traction on the 
hook, thus avoiding temporary paresis and diminishing the consequent dangers of subsequent deviations). Both con- 
junctiva and capsule are now divided together with the tendon, after which the effect is limited by the completion of 
stitch as in the advancement operation. For further details apply to author for reprint of publication. 
Fig. 1883.-Prince's Needle for Advancement and Canthoplasty. 
* Cocaine, as a local anaesthetic, was first used by Dr. Koller, of Vienna, on the eye ; he also suggested its use on the 
throat. In America surgeons apply cocaine successfully in many other operations. (See reports in New York Me di- 
cal Record, of Nov. 22, Dec. 13 and 27, 1884, and other medical literature of this period.) 158 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
OfHTHALJ^ie 
SURGICAL ANATOMY OF THE GLOBE OF THE EYE. 
A concise description of those parts of the globe of the eye which are important in reference to 
the operations performed on this organ and the instruments employed. (For Pterygium, 
Pannus, Hypopyon, Phlegmon, Hydrophthalmia, Artificial Pupil, Cataract, Spots 
on the Cornea, Extirpation of the Eye, Insertion of an Artificial Eye.) 
Proceeding from the periphery toward the centre of the eye, we meet with : 
The conjunctiva, a delicate and vascular membrane, which, after lining the inner aspect of the eyelids, is reflected 
over the globe of the eye, and covers all the visible portion of the sclerotica and cornea. At the internal angle of the 
eye it forms a cul-de-sac of some depth before it is reflected upon the sclerotica. The conjunctiva is tough and resist- 
ing, and the instruments which are used for cutting it should be of very superior quality. 
The transparent cornea is intimately united to the sclerotica. It is composed of laminae laid one upon the other, 
between which the points of instruments may become engaged when they are not plunged at once through the cornea. 
The sclerotica extends from the optic nerve to the cornea. This envelope is of a pearly white color ; it is elastic and 
dense, so much so that in penetrating it the point of the instrument should be introduced with a sudden and vigorous 
thrust, and at right angles with the membrane. The muscles of the eye are inserted into the sclerotica. 
The choroid lines the internal aspect of sclerotica, to which it slightly adheres. This membrane is composed of 
two distinct laminae; one, internal, consists entirely of the coloring matter; the other, external, is essentially vascular. 
The ciliary vessels and nerves ramify between the choroid and sclerotica.. 
The long ciliary arteries which supply the iris are two in number-one internal and the other external. They are 
found between the choroid and sclerotica, in the plane of the transverse diameter of the globe, and take their course 
horizontally from behind forwards. To avoid injuring them the sclerotica should be punctured below or above the 
transverse diameter of the eye. Between the choroid, sclerotica, and iris, and directly opposite to the circumference of 
the cornea is situated the ciliary circle or ligament, presenting the appearance of a greyish colored ring. It is essentially 
vascular and interwoven with nervous filaments anastomosing with each other. In performing operations upon the eye, 
it should be carefully avoided. 
The ciliary processes, folds formed by the internal lamina of the choroid, float behind the iris and surround the cir- 
cumference of the crystalline lens, without possessing any intimate adhesions with it. 
The iris, a diaphragm situated between the transparent cornea and the crystalline lens, separates this anterior portion 
of the globe of the eye into two chambers-, one, the anterior, between the cornea and the iris; the other, the posterior, 
between the iris and the crystalline lens. The distance between the cornea and the iris is, at the centre, between a line 
and a line and a half. The distance between the iris and the lens is half a line, and not unfrequently they are in 
contact, which renders the passage of instruments between these two organs very dangerous for both. 
The two chambers communicate with each other by the pupil, a circular opening in the centre of the iris. The 
greater circumference of the iris is in connection with the ciliary ligament, from which it can be easily separated. This 
anatomical arrangement is made use of in the operation for artificial pupil. 
The iris floats freely in the middle of the eye as soon as instruments by their presence have destroyed the equilibrium 
of the pressure of the fluid by which it is maintained in its place. It is very necessary to avoid injuring this membrane, 
and to penetrate the anterior chamber very cautiously when operating for cataract by extraction. 
The movements of the pupil have been variously explained by means of theoretical ideas concerning the structure 
of the iris. We refer to those theories which have originated particular methods for the operation of artificial pupil. 
The action of light and belladonna upon the iris is well known. 
The crystalline lens, situated behind the iris, is a double convex lens, formed by concentric layers of unequal 
density, but which increase in solidity as we approach its centre. The most external layer is almost liquid and has 
received the name of liquor Morgagni, The most concentric layer, or the nucleus, is of a gummy consistence, and 
easily crushed with the finger. On pressure the lens easily separates into triangular segments, with their apices towards 
its centre. Each of these segments may be opaque of itself, or as a whole they may present different degrees of opacity, 
which gives to certain varieties of cataract their stellated or marbled appearance. The facility with which the crystal- 
line lens is divided increases the difficulties in the operation by depression. 
The crystalline lens is enveloped by a membrane or capsule, which, by its connections with the hyaloid membrane, 
and its contact with the ciliary processes, maintains the lens in its place. These relations often render the depression 
in mass of the crystalline apparatus very difficult in cases of general cataract. In milky or lenticular cataract it suffices 
to lacerate the capsule and permit its contents to escape. 
Behind the crystalline lens is placed the vitreous humor, a gelatinous mass which fills the four posterior fifths of the 
globe of the eye. A very delicate membrane, the hyaloid, envelopes the vitreous humor, and by its numerous processes 
divides it into isolated cells of variable forms. To facilitate the operation for cataract by depression, it is frequently 
necessary to rupture with the needle some ot these hyaloid cells.-"Bernhard and Huette's Manual of Operative 
Surgery." Van Buren and Isaac's Am. ed., 1857, p. 146. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
159 
OPHTHALMIC. 
PTERYGIUM AND PANNUS. 
Fig. 1884.-Chadwick's 
Pterygium Scissors. 
Pterygium is a species of fleshy excrescence which attacks the cornea, and is usually 
triangular in form ; its position is commonly towards the inner angle of the eye. 
Pannus, less regular in its form, may attack any portion of the cornea. The same 
modes of operating are applicable to both. 
The small excrescence is seized with a double hook (Fig. 1873) or a pair of mouse- 
toothed forceps, and excised with a small scalpel or a pair of scissors curved upon their 
flat surface ; it should then be cauterized with nitrate of silver. These diseases fre- 
quently return and are apt to leave an opacity of the cornea after them.-" Bernhard 
''.nd Huette's Operative Surgery." Van Buren and Isaac's Am. Ed. 1857. 
Fig. 1885.-Knapp's Caustic Holder. 
See Child's Brush and Caustic Holder, Fig. 1303, p. 77. 
Io explain big. 1886, reference is made to the publication 
of Dr. A. E. Prince, of Jacksonville, Ill., in the "Archives of 
Ophthalmology," March, 1885, where a case is reported which 
originated a new and valuable procedure, particularly adapted 
to the separating of the pterygium from the underlying cornea, 
with the preservation of its transparency. By accident, while 
lifting the growth with a strabismus hook, in place of the for- 
ceps, in a case of extensive pterygium covering the pupil, an un- 
skillful movement of the assistant tore the pterygium from the 
cornea. " Inspection converted solicitude into satisfaction, for the 
removal had been accomplished with the least possible injury to 
the parts, leaving at the same time so transparent a surface that 
the iris and pupil were distinctly seen." The uneventful recovery 
of this case, without opacity of the cornea, led Dr. Prince to em- 
ploy no other method in the separation of the corneal portion of the growth, and after two years of favorable experi- 
ence, he has considered it worthy of publication. 
To facilitate the operation we have made, at his suggestion, the enucleation or divulsion hook, with a cutting point 
to favor its introduction under the growth at the corneal margin, and wedge-shaped, so that the separation from Bow- 
man's membrane may be more easily accomplished than with the ordinary strabismus hook. Experience has shown that 
the inevitable remnants of opaque material, which follow the usual dissection with scissors, and the facets and opacities 
from wounds of the cornea, which too often occur from the use of the knife, are largely avoided when the usually 
feeble union between the cornea and pterygium is severed by the sliding motion of the hook, counter-traction being 
exercised with forceps. 
Fig. 1886. 
Prince's Pterygium Divulsion Hook. 
PARACENTESIS CORNEJE. 
Hypopyon, Phlegmon, Hydrophthalmia. 
Purulent accumulations in the anterior chamber (hypopyon) are easily absorbed in the great majority of cases, so 
that puncture is rarely necessary; but, when required, it may be performed by introducing an ordinary broad cataract 
needle into the most dependent part of the transparent cornea. 
In cases of acute phlegmon of the eye, when the pain caused by the purulent accumulation has become intolerable, 
an exit must be given to the fluid. This may be done by opening the cornea at its most inferior portion by a simple 
incision with a cataract knife. 
Hydrophthalmia, when it greatly distends the globe, or when it is accompanied by intense inflammatory action, 
also requires paracentesis. According to the case, the liquid may be entirely or only partially evacuated by a puncture 
made either in the cornea or sclerotica. 
Desmarres, for puncturing the sclerotica, uses a lancet-shaped needle, having two shoulders a short distance from 
its point, to prevent it from penetrating too far. 
See Paracentesis Needles and Keratomes, for Incision and Section of the Cornea, on p. 162. 160 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPJHTHALJVI16 
ARTIFICIAL PUPIL. 
The operation for artificial pupil is performed to open a new path for rays of light to the retina, the natural pas- 
sages being obstructed (Bryant). It was performed for the first time by Cheselden, A. D. 1728, and has since that 
period undergone an infinite number of modifications. 
Four principal methods include all the modes of operating : 
1st. The incision of the iris Iridotomy. 
2d. Excision of the iris Iridectomy. 
3d. Detachment of the iris Iridodyalysis or Coredialysis. 
4th. Displacement of the natural pupil, . Corectopy. 
1st Method. Incision of the Iris-Iridotomy, Iridotomia or Coretomiao 
Cheselden's Method.-Cheselden introduced a small sickle-shaped needle through the sclerotica, as in the operation 
for cataract by depression ; the needle being freely entered into the posterior chamber. He turned the point towards the 
iris, and with a slight sawing motion made a horizontal incision of this membrane from behind forwards from a line 
and a half to two lines and a half in length. 
Sharp introduced the needle through the cornea. 
Reichenbach, Odhelius and Richter incised the cornea and divided the iris from before backwards. 
Jurine introduced a needle through the sclerotica, and perforated the iris from behind forwards, and again from 
before backwards. These two punctures are then united by a single incision made by disengaging the needle down- 
wards and backwards. 
Janin, having noticed that the horizontal incision of the fibres of the iris was almost constantly followed by reunion 
of the lips of the wound, determined to divide them across ; to effect this, he introduced a small knife, or a pair of 
delicate scissors, through the cornea, and made his incision vertical, and on the inner side of the natural pupil. 
Guerin's Method.-To unite the advantages of the methods of Cheselden and Janin, Guerin first opened the cornea, 
and then made a crucial incision of the iris, which divides its radiating fibres vertically as well as transversely. 
Maunoir^o incises the cornea, and then, with delicate bent scissors, cuts a triangular flap from the iris, whose apex 
is at the centre and base at the circumference of that membrane. 
Carron du Villars operates in the same way as Maunoir, but uses scissors without rings, and which are kept open by 
a spring. 
Velpeau used an elongated double-edged knife, resembling very much the serpent-tongued lancet. The instrument 
transfixes the cornea ; the point passes first through the iris from before backwards and penetrates the posterior 
chamber ; it is then brought from behind forward through the iris in the anterior chamber, about a line and a half or 
two lines from the first incision. The point is now carried anew through the cornea, and thus with a single thrust a 
flap is cut from the iris and the cornea. The small flap in the iris contracts upon itself, and soon disappears, leaving a 
triangular-shaped artificial pupil. * * * 
Wenzel's Method.-This operation is the same as that of Velpeau, described above, with the exception that Wenzel 
removed the little flap of the iris with scissors, while Velpeau leaves it to itself. 
Sabatier opens the cornea as in the operation for cataract, turns up the corneal flap, draws the iris outwards with 
forceps, and excises it with scissors curved upon their flat surface. 
Mulder, after making a crucial incision of the iris, removed one by one the small triangular flaps resulting from the 
incision. 
Physick used a pair of cutting forceps ; one of the jaws is introduced behind, the other in front of the iris. These 
jaws being brought together remove a circular portion of the iris. Furnari uses an instrument similar to that of 
Physick. 
Leroy d' Etioles operates upon the iris in situ, with an instrument similar in shape to a tonsil cutter. A small turn- 
ing hook catches the iris and draws it between two rings, which, sliding one upon the other, excise the portion caught 
by the hook. 
Beer makes a small incision in the cornea, through which he introduces a small hook which catches the iris and 
draws it through the wound in the cornea ; with delicate scissors he excises the portion of the iris. 
Desmarres incises the cornea with eye forceps, seizes a fold of the iris, draws it out through the wound and 
excises it. * * * 
2d Method. Excision of the Iris-Iridectomy, Iridectomia. 
3d Method. Detachment of the Iris-Iridodialysis, Coredialysis. 
The facility with which the iris detaches itself from the ciliary ligament was taken advantage of for the first time by 
Assalini and Buzzi, in the operation for artificial pupil. Scarpa systematized the method, and introduced it into prac- GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
161 
OPJHTHALJVl I© 
ARTIFICIAL PUPIL. 
3d Method. Detachment of the Iris-Iridodialysis, Coredialysis. (Continued.) 
Scarpa's Method.-A needle is plunged into the eye through the scelerotica, as in the operation for cataract by 
depression ; the point of the needle is carried to the superior and internal border of the iris, passed through this mem- 
brane from behind forwards, and, with a see-saw motion, one-third of its circumference is detached by depressing it 
from within outwards. 
Leveille's, method differs from the preceding only in the previous depression of the lens to avoid injuring it during 
the operation. 
The methods of Himly, Flajani and Beer consist in introducing the needle through the cornea, which facilitates the 
operation and allows the pupil to be made at any point of the iris. Assalini makes a large opening in the cornea, and 
detaches the iris with eye forceps. Bonzel detaches the iris with a small hook. 
Langenbeck's Method.-Impaction is united with detachment. An opening of a line or two is made in the cornea 
with an ordinary keratotome ; through this opening a small hook enclosed in a cylindrical sheath is introduced ; the hook, 
slipped from its sheath, catches the iris and draws the detached flap into the wound in the cornea, where it contracts 
adhesions which prevent it from closing up the newly formed pupil. 
Luzardi's Method.-Luzardi invented a hooked needle consisting of two branches sliding one upon the other, but 
held together by a spiral spring. The needle is easily introduced into the eye, either through the cornea or the sclero- 
tica, without any previous incision ; when it is fully entered, one of the branches is slid backwards, which exposes a 
small hook with which a flap of the iris is seized; the spring, left to itself, forces the movable branch against the hook, 
which thus grasping the detached flap, easily serves to draw it out through the wound. 
Donegana's Method.-Donegana unites incision with detachment. A sickle-shaped needle, having a cutting edge on 
its concave aspect, is introduced through the cornea or sclerotica; the iris is detached with the convex border of the 
instrument, while with the concave cutting edge it is divided from its circumference towards its centre. 
Huguir, remarking that, when the iris is detached from the ciliary ligament, it folds before the instrument and is 
incised with difficulty, begins by dividing it from the centre to the circumference, and afterwards detaching each lip of 
the wound. 
4th. Method. Displacement of the Natural Pupil-Corectopy, Corectopia. 
This displacement is applicable in cases where the natural pupil is marked by a spot upon the centre of the cornea. 
The object of the operation is to place the pupil behind a portion of the cornea which is not opaque. 
Adams' Method.-Adams made a small incision in the cornea, into which he drew the iris, to change the position 
of the natural pupil. When cicatrising, the wound of the cornea created adhesions, which retained the iris and the 
pupil in their new position. 
Himly, like Adams, makes an incision through the cornea, and draws the iris outwards with a small hook caught in 
the circumference of the natural pupil. 
Guepin and Desmarres invented a punch-like knife with which a small portion of the cornea is removed, and into 
which opening the iris falls ; when the iris does not fall into this opening of its own accord, it is easily forced into it by 
making a slight pressure upon the eyeball. The cicatrisation of the cornea creates an impaction of the iris. * * * 
("Bernhard's and Huette's Manual of Operative Surgery," Van Buren and Isaacs' Am. Ed. 1857. p. 158.) 
IRIDECTOMY. 
Wecker's Method.-An incision of eight millimetres is made with a Von Graefe's knife through the cornea and iris, 
about two milimetres from the lower margin of the cornea. The forcep scissors are then introduced, one blade passing 
behind the iris and exudation masses, the other along the posterior surface of the cornea, with two incisions which meet 
at the apex, a triangular portion of the iris is excised. The forcep scissors are bent at an angle, and can be passed 
through a small corneal opening, and yet be widely opened in the anterior chamber (Fig. 1928). 
Bowman's Method : Excision of the Pupil.-The puncture and counterpuncture are made with Graefe's Linear 
Knife, the blades of a pair of fine scissors-one point blunt, the other sharp-are then introduced through the first in- 
cision ; the blunt point is passed in front of the iris, the sharp point pierces the iris and anterior capsule of the lens, 
and running down in front of the nucleus a cut is made diagonally downwards as far as the centre of the lower part of 
the iris. The scissors are then withdrawn and next introduced through the counterpuncture and a similar incision made 
on this side so that the two incisions meet at the lower part of the iris, including between them a triangular piece of the 
iris as well as the constrictor pupillae. Finally, the base of the triangle is divided by cutting through the upper portion 
of the iris lying between the puncture and counterpuncture, and the whole triangular piece is then removed, as well as 
any false membrane attached to it, with a pair of forceps.-" Soelberg Wells on the Diseases of the Eyeball." Am. 
Ed. 1883. p. 326. 
As a preliminary step in the operations for the extraction of Cataracts. 162 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPJHTJHALMIC. 
KERATOMY. (CERATOTOMIA.) 
For Paracentesis Cornese, to give exit to Pus in case of Hypopyon, and for Section of the 
Cornea in certain methods of operating for the formation of Artificial Pupil 
and the Extraction of Cataracts. 
Fig. 1889.-Desmarre's Paracentesis Trocar. 
Fig. 1890.-Broad Paracentesis Needle. 
Fig. 1887.-Jaeger's Angular Keratome, 
Fig. 1891.-Extra Broad Paracentesis Needle. 
Fig. 1888.-Jaeger's Straight Keratome, 
or Artificial Pupil Knife. 
Fig. 1892.-Beer's Keratome. 
Fig. 1893.-Beer's Keratome. 
Fig. 1894.-Beer's Keratome. 
Fig. 1895.-Straight Knife, for enlarging the Section. 
Fig. 1896.-Angular Knife, for enlarging the Section. 
Fig. 1897.-Agnew's Iridectomy Knife. 
Fig. 1898.-Graefe's Linear Knife. 
1 
Fig. 1899.-Liebreich's Linear Knife 
Fig. 1902.-Baader's Linear Knife, 
Fig. 1903.-Baader's Linear Knife, 
curved to the right. 
Fig. 1900.-Noyes' Linear Knife. 
curved to the left. 
Fig. 1901.-Test Drum, to try the edges of Eye Instruments. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
163 
OPHTJHALMIC. 
IRID0T0MY, IRIDECTOMY, IRIDODIALYSIS, C0RECT0PY. 
For operating on the Iris for the formation of Artificial Pupil, per se, and as a preliminary 
step in the Extraction of Cataract, 
Fig. 1907.-Beer's Straight Needle. 
Fig. 1908.-Narrow Straight Needle. 
Fig. 1909.-Scarpa's Curved Needle. 
Fig. 1904.-Sichel's Iris Knife. 
Fig. 1905.-Hayes' Knife Needle. 
Fig. 1906.-Sickle-shaped Iris Knife. 
Fig. 1910.-Critchet's Hooked Needle. 
Fig. 1911.-Luzardi's Hooked Needle. 
Fig. 1912.-Levi's Needle, with an Eye. 
Fig. 1913.-Iris Knife. 
Fig. 1914.-Double-Edged Iris Knife. 
Fig. 1915.-Iris Knife, with a Stop. 
Fig. 1916.-Knife Needle. 
Fig. 1917.-Wilde's Canulated Needle. 
Fig. 1922.-Tyrrell's Sharp Hook. 
Fig. 1920.-Adams' Iris Knife. 
Fig. 1921.-Tyrrell's Blunt Hook. 
Fig. 1918. Wilde's Canulated Forceps, Scissors and Forceps Needle, in one Handle 
Fig. 1919.-Wilde's Canulated Forceps (Lithotriptor-like). 164 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OfHTHALJVI IC. 
IRIDOTOMY, IRIDECTOMY, IRIDODIALYSIS, CORECTOPY, 
For operating on the Iris for the formation of Artificial Pupil, per se, and as a preliminary 
step in the Extraction of Cataract. 
Fig. 1923.-Curved Iris Scissors. 
Fig. 1925.-Althof's Iridectomy Scissors. 
Fig. 1926.-Straight Iris Scissors. 
Fig. 1924.-Maunoir's Scissors, 
probe on upper or lower blade. 
Fig. 1927.-Noyes' Iris Scissors. 
Fig. 1928.-Wecker's Iridotomy Scissors. 
Fig. 1933.-Lanne's Forceps Needle, for False Membranes. 
Fig. 1931.-Welker's Iridectomy Instrument. 
Fig. 1929.-Strawbridge's Keratome Scissors. 
Fig. 1934.-Culbertson's Iris Hook. 
Fig. 1932.-Hall's Iris Scissors. 
Fig. 1930.-Culbertson's Iricystome. 
The object of this instrument is to cut a triangular portion of 
the iris and lens capsule, or of either, and thus form an artificial 
pupil in a certain class of eye cases. The front blade is solid, the 
back blade a little larger and fenestrated, so as to cut out an equi- 
lateral triangle of the included membrane. But it does not cut 
the base of the triangle. Hence an incision is needed of the iris 
or capsule, or both, before using the instrument.-SeeJournal of 
Ophthalmology. Oct. 15, 1884. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
165 
OPHTHALMIC. 
IRODOTOMY, IRIDECTOMY, IRIDODIALYSIS, CORECTOPY. 
For operating on the Iris for the formation of Artificial Pupil, per se, and as a preliminary 
step in the Extraction of Cataract. 
Fig. 1935.-Graefe's Angular Iris Forceps. 
Fig. 1936.-Straight Iris Forceps. 
Fig. 1938.-Liebreich's Iris Forceps (latest). 
Fig. 1939.-Walton's Self-Holding Iris Forceps. 
Fig. 1940.-Fischer's Tris Forceps, 
CATARACT. 
Cataract is a partial or total opacity of the crystalline apparatus. The opacity may affect: 1st. The crystalline 
membrane, causing capsular ox membranous cataract; 2d. The liquor Morgagni, giving rise to milky cataract; 3d. The 
crystalline lens, lenticular cataract; 4th. The lens and its capsule, capsulo-lenticular cataract.-Cataracts may be 
either hard, soft or liquid. Lenticular cataracts are usually hard and dark ; they are common in old persons. Cap- 
sular cataracts are softer and clearer than the former. Milky cataracts are liquid and less opaque in the superior than 
in the inferior half of the capsule, their opaque particles obeying the laws of gravity."-Bernhard and Huette's 
" Manual of Operative Surgery'." p. 149. Van Buren and Isaacs' Am. Ed. 1857. 
The Operations for Cataract. 
" The different operations for this purpose have for their common object the removal of the opaque body from 
behind the pupil, so that the rays of light may be again allowed to pass on to the retina. This object is sought to be 
effected in one or other of three different ways, according to the circumstances of the case, viz.: 
1st. By at once extracting the cataract from the eye. 
2d. By simply displacing it to below the level of the pupil. 
3d. By lacerating the capsule and dividing the lens, in order that the latter, being exposed to the action of the 
aqueous humor, may be gradually dissolved and absorbed, and thus eventually removed from the eye. Of these three 
different ways again, there are different modifications."-Jones' "Ophthalmic Medicine and Surgery." p. 221. Am. 
Ed. 1863. 
Extraction of Cataract. 
Extraction of cataract may be effected by the flap or linear methods, which consist in opening, with suitable in- 
struments, the transparent cornea and the anterior portion of the capsule of the crystalline, and causing the lens to 
issue through the aperture. Soft cataracts may also be removed by the stiction operation. 
Operative Indications. 
The general conditions of success are the following: Satisfactory general health ; healthy condition of the eye; 
absence of even slight inflammation of any of its tissues ; cornea unblemished ; movable pupil; non-adherent iris ; 
sensible retina; maturity of the cataract, proved by the entire loss of sight; existence of cataracts on both eyes, in 
order that the second eye may not be endangered by the unforeseen and frequently unfavorable consequences of the 
operation when performed upon the diseased eye ; operate upon children in infancy ; a moderate atmospheric temper- 
ature ; excessive heat or extreme cold are frequently prejudicial.-Bernhard and Huette's " Manual of Operative 
Surgery." Van Buren and Isaacs' Am. Ed., p. 149. 1857. 166 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OP^THALJVlie. 
EXTRACTION OF CATARACT. 
Fig. 1941.-Superior Flap-Beer's Keratome. 
Corneal or Flap Operation. 
The cornea may be cut on its inferior or superior half, or obliquely 
on its external and lower portion, each of which methods has its spe- 
cial advocates. 
The corneal or flap operation is performed in three periods or steps: 
J st Step. Incision of the Cornea (with Beers' or similarly shaped 
knives). 
2d Step. Division of the Capsule (with needle or cystotome). 
3d Step. Expulsion of the Cataract (with Daviel's or other 
spoons). 
Mackenzie gives the following description of the operation : 
ist Step.-The point of the knife is entered on the temporal side 
of the cornea, at the distance of one-twentieth of an inch from the 
scelerotic, the blade being kept strictly in a plane with that of the iris. 
The point, in first puncturing the cornea, must do this perpendicularly 
to that structure ; otherwise it might pass between its lamellae, instead 
of entering the anterior chamber. The point of the knife is directed 
towards the point of exit at the cornea, opposite to, and correspond- 
ing with, the point of puncturation. The knife is simply pushed 
slowly and cautiously onwards, so as to cut its way out by its purely 
progressive motion, no sawing or dragging of the edge against the 
cornea being permissible. Many operators leave the last small por- 
tion of the cornea undivided by Beer's knife before proceeding to the 
next step of the operation. 
2d Step.-This consists in lacerating the capsule of the lens sufficiently with the crystotome to permit of the exit of 
the cataract. If a small bridge of cornea has been left undivided, this may then be severed by a blunt-pointed knife 
or scissors. The upper eyelid may now be allowed to drop. 
3d Step.-After a minute's pause, the eye is again opened, when a little gentle pressure and manipulation on it 
with the finger, or the back of the curette, will usually suffice to determine the exit of the lens through the coVneal 
wound.-" Ophthalmic Surgery," Laurence and Moon. Am. Ed. 1866. m pp. 
Fig. 1942.-Inferior Flap-Beer's Keratome. 
This operation, devised by Gibson in 1811, modified soon after by Travers, and lately revived in Germany, con- 
sists in making a small incision through the outer and lower part of the cornea from the eighth to the sixth of an 
inch in extent, in freely dividing the capsule and lens with a fine cutting needle, and in removing the fragments, 
after they have been brought into the anterior chamber, with a scoop. If thorough cominution has been effected, 
most of the fragments will probably be washed away by the aqueous humor, as it gushes through the wound ; if not, 
they should be carefully extracted, unless they are very small, when they may be left in the hope of being speedily 
absorbed. Linear extraction is, of course, applicable only to soft cataracts.-" System of Surgery," Gross. Vol. II., 
p. 194. 1882. 
Linear Extraction. 
The Modified Linear or Spoon Operations. 
* * * In those cases in which there was a somewhat firm nucleus, Ton Graefe was led to modify the linear 
extraction, and to excise a portion of the iris prior to the laceration of the capsule, and then to remove the lens with a 
broad flat scoop. The stages of this operation were as follows: 1st. The incision was made at the edge of the cornea 
(temporal side) and embraced about a quarter of its circumference. 2d. A portion of iris was removed, the size of 
which did not, however, quite equal the extent of the incision. 3d. The capsule was freely divided quite up to the 
margin of the lens. 4th. A scoop was then introduced at the free edge of the lens and gently inserted between the 
posterior cortical substance and the nucleus, and the cataract lifted into the anterior chamber and extracted. The scoop 
which he employed for that purpose was shallower, broader, and sharper at the extremity than Daviel's Curette. Thus 
originated the "modified linear" or "scoop" extraction-an operation which afterwards assumed so important a position 
in ophthalmic surgery. By this operation Von Graefe greatly extended the applicability of the linear extraction, for he 
was now able to remove through a linear incision cataracts whose cortex was of a pulpy consistence, and the nucleus 
moderately large and hard-a form of cataract which would otherwise have necessitated the flap extraction. To Von 
Graefe belongs the credit of having first suggested, in some cases, the combination of an iridectomy with flap extrac- 
tion, and also of having introduced the modified linear or scoop extraction.-" Soelberg Wells on Diseases of the 
Eye." Bull's Am. Ed., p. 456. 1883. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
167 
OpHTHALoJVl IC. 
EXTRACTION OF CATARACT. 
The Modified Linear or Spoon Operations. (Continued.) 
In i860 Waldau proposed the following operation for cataract: An incision with a lance-headed keratome is made 
into the cornea, half a line from its junction with the sclerotic, and embracing one-fourth of its circumference ; a por- 
tion of iris is excised; the capsule of the lens lacerated freely with a cystotome; a silver spoon inserted into the cor- 
neal incision, and glided along the posterior surface of the lens, between this and its capsule ; the lens, when fairly re- 
ceived into the bowl of the spoon, is then removed from the eye, as the spoon is withdrawn by the operator. * * 
Critchet did away with the high rising edges of Waldau's spoon, and replaced its terminal one by an inverted edge 
(Fig. 1957), so fashioned as to glide easily along the posterior surface of the lens, but to seize the distal margin of the 
lens firmly in its grasp as soon as the operator attempts to withdraw the spoon from the eye. * * * A 
second improvement was to enlarge the corneal incision from one-fourth to one-third of the cornea. * * * In 
Waldau's original operation the lens is spooned or scooped out; in the modified one, it is drawn out. Hence this 
latter operation has been appropriately termed "traction-operation."-" Ophthalmic Surgery." Laurence and Moon. 
Am. Ed. 1866. p. 114.) 
* * * Adolph Weber's mode of extracting hard cataracts through a linear incision made with a lance-shaped 
knife, -withotit any excision of the iris or the employment of a traction instrument. He employs a large lance-shaped 
knife, which is ten and twenty-five one-hundredth millimetres in length, and ten millimetres broad at a distance of six 
and five-tenths millimetres from its point; and this width it retains for a distance of two millimetres, in order that the 
internal and external wound may be exactly the same size; thence it becomes narrower to pass over into the stem. 
Fig. 1943.-Weber's Keratome. 
The back of the blade is not flat, but hollowed out. The blade is bent at an angle of about 120 °, in order that it 
may be readily used from above or the nasal side. The pupil is kept dilated with atropine for a day or two before the 
operation. The eyeball fixed below the centre of the lower margin of the cornea with broad fixation forceps, and gently 
drawn down, the point of the knife is to be entered in the centre of the upper margin of the cornea, just in the sclero- 
corneal junction. If the diameter of the cornea is less than twelve millimetres, the incision is to lie a little further 
away from the edge of the cornea. The blade is to be carried slowly and steadily forward across the anterior chamber 
as far as the base of the instrument; its point will then have nearly reached the opposite (lower) margin of the cornea. 
The knife is then to be very slowly withdrawn. This will prevent the sudden escape of the aqueous humor, which, from 
its stimulating the constrictor pupillse, would cause the pupil to contract. Moreover, during the slow and gradual with- 
drawal of the knife we can press the back of the blade somewhat against the edge of the section, and thus prevent pro- 
lapse of the iris. The capsule is then to be very freely lacerated, for which purpose Weber used a very minute double hook 
Fig. 1944.-Weber's Double Hook. 
(Fig. 1944), the stem being bent at an angle, so as to permit of its being readily turned. The capsule is to be divided in the 
following way, the lines of incision lying somewhat below the iris, as shown in Fig. 1945, where 
the dotted line indicates the pupil. The hook having been passed down to a, the capsule is to 
be divided from a to b, and thence to c ; then the instrument is to be again passed to a, and the 
capsule divided from a to d, and thence to c, the last incision lying, of course, along the inner 
margin of the section. If, on the withdrawal of the hook, the capsule does not present in the sec- 
tion, the instrument is to be reintroduced, passed down to e, and the square tom portion of cap- 
sule drawn out in the direction of f; or it may be extracted with a small pair of iridectomy for- 
ceps. The anterior thin lip of a peculiarly constructed curette is then to be placed on the exter- 
nal lip of the wound, so as to press this back a little, and thus facilitate the presentation of the 
equator of the lens in the incision, the exit of the cataract being assisted by a slight simultaneous 
pressure of the fixation forceps below the cornea. During the exit of the lens, the iris generally protrudes a little into 
the wound, and if it does' not retract at once when the cataract has escaped, it should be replaced by applying Von 
Graefe's vulcanite curette, and gently moving this from the angles towards the centre of the section. This will soon 
cause the iris to retract and the pupil to resume its normal position, a point which should be always carefully at- 
tended to before the operation is considered as finished.-" Soelberg Wells on Diseases of the Eye." Bull's Am. 
Ed., p. 457. 1883. 
Fig. 1945. 168 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPHTJHALMIC. 
CYSTOTOMY, CAPSULOTOMY. 
For the Laceration or Division of the Capsule in Operating for the Extraction of Cataracts. 
Fig. 1946.-Knapp's Cystotome. 
Fig. 1947.-Cystotome, for Lacerating the Capsule. 
Fig. 1948.-Graefe's Cystotome. 
Fig. 1949.-Cystotome and Daviel's Spoon. 
For Removal, Expulsion or Withdrawal of the Cataracteous Lens. Final step in the Operation 
for the Extraction of Cataracts. 
Fig. 1951.-Tortoise Shell Lens Spoon. 
Fig. 1952.-Hard Rubber Lens Spoon. 
Fig. 1958.-Silver Lens Spoon and Cystotome. 
Fig. 1959.-Levi's Fenestrated Lens Spoon. 
Fig. 1950.-Graefe's Lens Tractor. 
Fig. 1953.-Bowman's Flat Lens Spoon. 
Fig. 1954.-Noves' Lens Spoon. 
Fig. 1955.-Bowman's Concave Lens Spoon. 
Fig. 1956.-Critchet's Flat Lens Spoon. 
Fig. 1957.-Crichet's Concave Lens Spoon. 
Fig. i960.-Lens and Foreign Body Forceps. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
169 
OPHTHALMIC. 
EXTRACTION OF CATARACT. 
Graefe's Peripheric Linear Extraction. 
* * * An operation which combines all the merits of the flap extraction and the linear method with trac- 
tion, together with superior advantages of its own, devised by Von Graefe, and termed by him the "peripheric linear 
extraction" method. 
His extended clinical experience enabled him to render each step of his operation so perfect that it is accepted 
by ophthalmic surgeons universally as the best now known. It is most readily described by dividing it into four 
stages: 1st. Incision; 2d. Iridectomy; 3d. Laceration of the Capszile ; 4th. Removal of the lens. The instru- 
ments required are the stop speculum, fixation forceps, iris forceps, and scissors, described under the head of iridec- 
tomy ; added to which are the capsule tearer, or cystotome, a caoutchouc spoon, and a narrow knife. 
As the pain of the operation is not severe, and as it is very desirable that the patient should give some assistance in 
moving the ball, if it should be found requisite, an anaesthetic should not be given if it can be avoided. 
The patient having been placed in the recumbent position, the surgeon, if limited to the use of his right hand for 
his incision, must place himself behind the patient for his right eye, and at his left side for the 
operation on the left eye. Having secured the eyelids by means of the speculum, the surgeon 
seizes the conjunctiva, beneath the cornea, with the fixation forceps, and thus gains control of 
the ball ; or, what is better, he grasps, as is the practice of Dr. Levis, the inferior straight 
muscle. Holding the knife with its cutting edge upwards, he then introduces it at a point half 
a line behind the corneal border and half a line below an ideal tangent to the cornea at its apex, 
as designated in Fig. 1961. 
The point of the knife should be directed towards c, until three or four lines of it have entered 
the anterior chamber, when its point is elevated by depressing the handle; it is then carried to the point b, and a 
counterpuncture made through the sclerotica. The edge of the blade is now turned forwards, and the knife carried 
onwards until its length is exhausted, when the section is to be finished by drawing it backwards until all the tissues 
have been divided except the conjunctiva, which should be cut so as to leave a flap of not more than a line or a line 
and a half in extent. 
If these steps have been exactly followed, the anterior chamber will have been opened at its periphery by an in- 
cision which shows little tendency to gape, and which will be from four and one-half to five lines in extent, and, 
although not strictly linear, yet giving a flap of half a line in height. 
Confiding the fixation of the ball to an assistant, the surgeon, with the iris forceps, seizes the iris about one line 
from the temporal extremity of the cut, draws a portion of it out, and, with successive clips of the scissors, divides it 
at the ciliary attachment, and gradually making the traction towards the nasal end of the incision, finally excises it 
there as close as possible to the ball. 
The fixation forceps being resumed by the operator, the anterior capsule is lacerated with the cystotome, which 
should be carefully passed to the lower border of the pupil, when its sharp point should be turned against the 
capsule, which should be incised in a direction upwards and outwards ; the point should be again passed to the 
same spot, and an incision upwards and inwards effected ; these two should then be united by a transverse cut across 
the capsule, when the lens will probably be freed and will be seen to advance. 
The surgeon still retains control of the ball, while, with the caoutchouc spoon, applied with its convex surface 
to the lower border of the cornea, he makes a pressure which has for its object the tilting of the upper margin of 
the lens towards the corneal incision. When this has been accomplished, a gentle upwards motion of the spoon 
will cause the cataractous lens to emerge more and more, and finally to escape entirely from the wound. When this 
manipulation does not succeed, the lens must be withdrawn by one of the traction instruments, one of the best of 
which is a delicate wire loop devised by Dr. Levis. 
If any cortical matter or blood remains, it should be removed by gentle pressure upon the cornea with the 
spoon, or, after the withdrawal of the speculum and a little delay, by pressure and counterpressure with the finger 
tips upon the closed lids.-" System of Surgery," Gross. Vol. II., p. 194. 1882. 
Fig. 1961. 
Graefe's Corneal 
Incision. 
Liebreich's Method. 
Dr. Liebreich found that, without actual formation of a flap, mechanism can be brought about, by means of which 
the advancing equator of the lens overcomes the obstacles of the iris and of the sphincter papillae in order to enter 
the wound. Avoiding iridectomy, he found he could do without elevators and forceps, " and thus change the whole 
operation into a less violent and almost painless one." He says : In my method the incision is situated entirely 
within the cornea, with the exception of the points of puncture and counterpuncture, which are placed about one 
millimetre beyond it in the sclerotic-the whole remaining incision passing with a very slight curve through the cornea, 
so that the centre of it is about one and one-half or two millimetres within the margin of the cornea. Alb the instru- 
ments required are two, namely, a very small Von Graefe's knife, and a cystotome which has a common Daviel s spoon 
at the other end. 170 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OpHTHALJVIIC 
EXTRACTION OF CATARACT. 
Liebreich's Method. (Continued.) 
ist Step. Supposing the right eye is to be operated upon, the operator, standing behind the patient, takes hold of 
the upper eyelid with the index finger of his left hand, whilst he slightly presses the middle finger against the inner 
canthus of the eye. The knife, held in the right hand with its back horizontal and backwards, the plane of the blade 
making with the horizontal meridian of the eye an angle of about forty-five degrees, enters the sclerotic at the point indi- 
cated. Without altering the direction, the knife passes through the anterior chamber in order to make the counter- 
puncture on the opposite side so that the point of the knife becomes visible in the sclerotic about one millimetre (or 
less) distant from the cornea. The knife is now pushed forwards, so that its retraction finishes the incision. As soon 
as the incision is made the eyelid is dropped. 
2d Step. The second part of the operation consists in the careful opening of the capsule. 
yd Step. In the third part, Daviel's spoon is slightly pressed against the inferior margin of the cornea, and the 
index finger of the left hand, which holds the upper eyelid, through it exerts a very slight pressure on the highest 
point of the cornea. Thus the lens is made to rotate a little, its lower margin presses, in the manner already de- 
scribed, against the posterior surface of the iris, pushes the iris forward, passes along it to the margin of the pupil, 
overcomes the obstacle and places itself freely in the wound, which is made to gape by Daviel's spoon pressing against 
it. A slight pressing movement of the index finger of the left hand, by means of which the upper eyelid is shifted 
from above downwards over the cornea, serves to expel the lens. Similar movements of the lids are employed for the 
purpose of forcing out wy debris of the cortical substance, after pushing them from behind the iris towards the pupil, 
by gently rubbing the shut eyelids. Should the pupil then not appear round, but its margin drawn towards the wound, 
it regains its normal position by an outward shifting of the lower lid ; or, if that be not sufficient, by the introduction 
of Daviel's spoon. Immediately afterwards I put some atropia into the eye and close it by my compressive bandage. 
-" Soelberg Wells, on the Diseases of the Eye.'' Bull's Am. Ed., p. 467. 1883. 
Lebrun's operation closely resembles Liebreich's, except that the puncture and counterpuncture lie at the edge of 
the cornea ; that the section forms somewhat more of a flap, and lies in the upper half of the cornea. 
The operation is to be performed as follows : The lids being kept apart by the speculum and the eyeball fixed, 
Von Graefe's knife is introduced one or two millimeters below the external extremity of the transverse diameter of 
the cornea, the cutting edge being turned upwards and slightly forwards, so that the plane of the blade forms an 
angle of about thirty degrees with that of the iris. The anterior chamber is to be traversed rapidly and the counter- 
puncture made at a corresponding point of the opposite side of the cornea. The incision is then to be continued up- 
wards in such a manner that it describes a circular curve, the summit of which lies slightly below the upper edge of 
the pupil when in a medium state of dilatation. Dr. Lebrun terms this "extraction by a small medium flap."-"Soel- 
berg Wells on the Diseases of the Eye." Bull's Am. Ed., p. 468. 1883. 
Knapp's Modification of Graefe's Peripheric-linear and Wecker's Flap-section, with Capsulotomy 
and subsequent Discission of the Capsule. 
Both observation and experience induce us to recommend what is known as " Knapp's modification " of the oper- 
ation for the extraction of cataract,* and as we consider his method of sufficient interest and importance we quote his 
own words and describe the details of the operation somewhat at length, in the hope of tempting the more progressive 
and especially the younger members of the profession, to give this method a fair trial, with the full assurance that it 
offers more advantages and less disadvantages than any other, and, on the basis of statistical data, claims a peculiar 
influence on the final object of all operations for cataract-the restoration of sight. 
In a recent lecturef Knapp makes a synopsis of thirty extractions, which serve as a basis for the following re- 
marks, in the course of which he describes in detail the steps of his operation ; and we refer to cuts of most of the 
instruments he employs: 
" The youngest patient was a servant girl aged thirty-two years, whose cataract I would, under ordinary circum- 
stances, have operated on by division ; but as she was blind in both eyes, had only recently come to this country, and 
was without support, I preferred that operative procedure which restored her sight in the shortest time. There were 
three patients between forty and forty-eight years of age ; the remainder were over fifty. The oldest was eighty- 
two. 
" The method was a more or less linear or low-jlap section, ivithabroad iridectomy, and peripheric opening of the cap- 
♦ Knapp's previous report of a hundred cases of extraction (the sixth hundred), published in the July number, 1879, of the Archives 
of Ophthalmol., refers to sixty-six successive cases of extraction with peripheric capsulotomy, and together with the preliminary commu- 
nication tn Vol. VI., and later in Vol. X., No. 3 contains the substance of his views and experience on this subject, also historical and critical 
remarks on the peripheral opening of the capsule. 
+ On the Extraction of Cataract, by Herman Knapp, M.D. The Medical Record, New York, Feb. 18, 1882. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
171 
Of>HTHALJVIie. 
EXTRACTION OF CATARACT. 
Knapp's Method. (Continued.) 
sule. In the first operations (Fig. 1962), Graefe's section begins and terminates one millimeter in the corneo-scleral 
junction, its apex being at the transparent margin of the cornea, or even one or two 
millimetres below it. Gradually I shifted into the flap-section (Fig. 1963), which De 
Wecker, of Paris, recommends as the best, namely, a section with a Graefe's knife, 
situated exactly in the transparent margin of the cornea, extending over its upper 
third. For full-sized cataracts, I made it somewhat larger. Both sections-the linear 
and the flap-have their advantages and their disadvantages ; the linear does not 
incline to tilting, and shows a very accurate co-aptation, but as its ends are nearer to 
the insertion of the iris, it is more liable than the flap to adhesions and incarcerations 
of the iris and to cyclitic processes. With regard to firm closure of the wound, one of the most important factors in 
the whole operation, the flap, though easily gaping during the whole operation and soon after it, has one redeeming 
quality-it cuts the lamellae of the cornea obliquely, not at right angles, as the linear section does. This principle of 
oblique piercing is frequently made use of, and with admirable ingenuity, in the animal organism. Let me only men- 
tion the ductus choledochus piercing the wall of the duodenum obliquely, by which contrivance the bile can, without 
obstacle, flow into the gut, but the food, while passing from the pylorus onward, will press the inner wall of the valve- 
like opening of the bile duct against the outer, and thus completely closes the aperture. Somewhat in the same 
manner the inner lip of the flap-section is pressed against the outer by the contents of the globe, whereby a firm 
and lasting closure may be established. Theorizing is a fine thing in its way, but worthless without the test of expe- 
rience, because in complicated problems we commonly fail to know and appreciate the quality and quantity of the co- 
operating factors. Wecker's section has thus far shown us very kind healings, encouraging to further trial." 
The most approved form of speculum, i. e. Graefe's modified, is shown (Fig. 1842, page 151). The arms are 
curved so that the loop of spring and adjusting screw are out of the operator's way. There is a right and left specu- 
lum. Fixation forceps (Fig. 1862, page 152), and a typical Graefe's cataract knife (Fig. 1898, page 162). 
" The iridectomy in almost all of our operations was large. The coloboma varies from one-sixth to one-quarter of 
the corneal circumference. When the corneal section and the opening of the capsule are peripheric, it must be large, or 
the columns of the coloboma will be an obstacle to the exit of the lens, which, if overcome by force, entails bruising and 
incarceration of the iris. When the iris is being cut, it ought not to be dragged with the iris forceps (Fig. 1935, page 165) 
into the corners of the section, since there the lips of the wound act like clamps, holding the iris-tissue tight between 
them. It is good practice to seize the iris in the centre of the section, draw it straight up and cut it off close to the 
cornea-carefully avoiding the corneal tissue itself-in one, two, or three strokes of the iris scissors (page 164, Fig. 
1923), as may prove convenient, and afterward, according to the sufficient or insufficient size of the coloboma, either 
reduce or exsect iris tissue which may still lie in the corners. Such tissue, even after a clean and apparently satisfac- 
tory iridectomy, remains hidden in the wound more frequently than we imagine. Proofs : I. The anatomical exam- 
ination of eyes on which iridectomy had been made for glaucoma, or combined with cataract extraction, commonly 
found the stump of the iris or its adjacent tissue united with the corneal scar, even if no outward inspection could 
discover such a condition. 2. Many times, when passing the cystotome from the corners of an apparently unob- 
structed corneal section toward the centre, I drew iris-tissue along, which was either the periphery of the adjacent 
iris, or the stump of the part that had been removed. Such portions, of course, have to be grasped with the forceps 
and cut off. This observation has taught me not to rest satisfied with an apparently correct coloboma, even if its 
sphincter edges are in the anterior chamber, but, before opening the capsule, to clear the whole extent of the corneal 
section, especially the corners, of iris tissue, which, with a delicate probe or spatula, may be stroked back into the 
anterior chamber." 
Fig. 1962. 
Fig. 1963. 
Fig. 1964.-Knapp's Needle Cystotome. 
"When the wound is clean the operator takes the fixing-forceps in his own hand, presses gently with it on the globe, 
so as to make the corneal section slightly gape, and passes the needle cystotome (see Fig. 1964) from the inner corner 
of the section to the outer, through the anterior capsule of the lens. This manoeuvre has to be closely watched; a far- 
sighted operator should make himself near-sighted by convex spectacles, and either daylight or artificial light ought to 
be thrown on the eye by a large convex hand lens, so that the point of the cystotome can be accurately followed in its 
course through the capsule. An insufficient capsulotomy is commonly without consequences, as the cataract on its way 
out enlarges the opening ; only in tough capsules is an obstacle to the expulsion of the lens, and may lead to prolapse 
of vitreous. When I had practiced this mode of opening the capsule in about two hundred cases, I varied it, not 
because I was dissatisfied with its results, but in order not to get wedded to one particular procedure. There is no 172 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
OPHTJHALdMI© 
EXTRACTION OF CATARACT. 
Knapp's Method. (Continued.) 
conceivable way of opening the capsule that has not here and there been tried. The one just described is the sim- 
plest in execution, and the least injurious to the eye, but it has the disadvantage of necessitating, in the majority of 
cases, an after-operation, viz.: the subsequent central splitting of the capsule. In order to avoid that, I have lately 
joined to the horizontal division a larger vertical one than I made a few years ago while practicing a T-shaped open- 
ing. A bent needle cystotome (Fig. 1948), is introduced into the anterior chamber, and the capsule slit open from the 
lower edge of a middle-wide pupil up to the centre of the corneal section. In order not to let the outcoming lens 
enlarge the upper end of the capsular wound irregularly, I made the horizontal incision in one case with a delicate, 
sharp-pointed scalpel, the point of which was inserted into the upper end of the vertical incision of the capsule at the 
centre of the corneal section, pushed forward toward one corner of the wound, and then, by raising the hilt, one-half 
of the upper margin of the capsule was ripped open. In the same way the other half was dealt with. In another 
case I made the horizontal incision of the capsule with the needle cystotome, which was passed first from one, then 
from the other corner of the corneal section through the capsule, so as to meet the upper end of the vertical capsular 
section. If the cystotome were passed from one end of the section to the other, it would split the first half of the 
capsule, but most likely not the second, for when fallen into the vertical section it would enlarge this by dragging the 
capsule before it rather than cut it. 
" The expulsion of the lens is effected by pressing with a hard rubber spoon (Fig. 1952, page 168) on the lower part 
of the cornea. 
" The after-operation, the subsequent central division of the capsule, is an essential feature in this mode of oper- 
ating for cataract. Without it the method could not stand, as it has also virtually been abandoned by the operator who 
first, in 1873, tried it on a larger scale, namely, Professor Gayent, of Lyons. He made no after-operations, and was 
dissatisfied with the imperfect visual results. The empty capsule will wrinkle and opacify, requiring subsequent split- 
ting, in the majority of cases. But then the visual results are permanently good, and better than by any other 
method, except the removal of the lens within the capsule, which, according to its warmest advocate, Dr. Herman 
Pagenstecher, is indicated in thirty per cent, of the patients only. But do the methods with central opening of the 
capsule, even in their successful cases, yield good vision permanently ? By no means. With them, too, the capsule 
will wrinkle and opacify, and vision be reduced to a surprising degree. 
" The subsequent division of the capsule comprises not only its anterior, but also its posterior half, and, therefore, 
gives a perfectly unobstructed pupil. The imperfect visual results, after the primary central division of the anterior 
capsule, have always been felt by the profession, and given the incentive to different attempts at obviating this disad- 
vantage, among which I will mention the puncture of the vitreous, immediately after the expulsion of the lens, 
which Professor Hasner, of Prague, has made for many years, and which, as I saw last summer, has been adopted, on 
trial at least, by Schweigger. Both gentlemen assert that this procedure is not dangerous, but neither has, as yet, pub- 
lished statistics to convincingly support their assertion. The subsequent division of both capsules is an innocent 
operation ; I have done it more than a hundred times. Only in a few cases the reaction from it lasted longer than a 
few days, and never was the vision made worse. The technique of the operation, however, is peculiar and has to be 
learned. The operation requires, above all, two things, without which nobody should undertake it; first, good arti- 
ficial light, thrown on the eye with a large lens, so that during the operation every wrinkle, dot and stria of the cap- 
sule can be seen, as well as the course and effect of the needle ; second, a sharp, "well-proportioned scalpel needle, with 
Fig. 1965.-Knapp's Scalpel Needle, for Capsulotomy. 
which the capsule can be cut without tearing. I first make a horizontal incision, then a vertical one, varying them, 
however, according to the conditions of the capsule. No aqueous should, none need escape. I have described it in 
the Archives of Ophthalmology, Vol. VIII., No. 2, p. 200, Vol. X., No. 3, p. 295."-Charles S. Turnbull, M. D., 
Medical and Surgical Reporter, May 8, 18S2. 
Fig. 1966.-Bradford's Twin Cataract Needle. 
The object in having the needles move laterally is that they will be of such a width as to puncture and hold any 
capsule, according to the size of its pupil, without injuring the iris. When in that position a crochet needle, the size 
of a stop needle, can be inserted and the capsule torn without losing any aqueous and without any pulling upon the 
ciliary region, as all strain must come between these three points and is exerted from the centre outwards. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
173 
OPJHTHALJVlie. 
FOR THE EXTRACTION OF SOFT CATARACT. 
Fig. 1969. -Wecker's Canulated Needle. 
Fig. 1970.-Blanchet's Instrument for Exhausting Soft Cataract. 
Fig. 1968.-Walton's Grooved Needle, for Soft Cataract. 
Fig. 1967.-Levi's Needle, with an Eye. 
Fig. 1971.-Teale's Instrument for Exhausting Soft Cataract,, 
Fig. 1972.-Bowman's Instrument for Exhausting Soft Cataract. 
This method is applicable to soft cataracts only. Tangier plunged into the cataract a hollow needle with an open- 
ing near its point. This needle is attached to a small syringe, whose piston, being put in action, sucks the opaque 
humor from the cataract. Blanchet operated by means of suction upon liquid cataracts, but he introduced his needle 
through the cornea, and instead of a syringe to draw out the cataract, used a small india-rubber bag, which being 
compressed and left to its own elasticity, sucks out the opaque liquid with more or less rapidity.-"Bernhard and 
Huette's Manual of Operative Surgery." Van Buren and 
Isaacs' Am. Ed., p. 153. 1857. 
* * * Mr. Teale makes a puncture in the cornea 
with a broad needle, at a point opposite the margin of the fully 
dilated pupil, and, passing obliquely through the substance of 
the cornea, the instrument should enter the anterior chamber at 
a point opposite the margin of the pupil when of medium size. 
Such a valvular opening will prevent any scar in front of the 
pupil and diminish the risk of prolapse or an anterior synechia. 
The capsule having been freely divided, the curette should be 
carefully introduced through the corneal wound and its end (the 
opening looking towards the cornea) held steadily in the area of 
the pupil and gently buried in the opaque matter, the convex 
surface being pressed somewhat back towards the posterior cap- 
sule. The suction power should then be carefully applied and 
continued in gentle inspirations as long as any opaque matter 
comes forward into the pupil, and, when the latter is quite clear, 
the instrument is withdrawn.-" Soelberg Wells on Diseases of 
the Eye." Bull's Am. Ed., p. 477. 1883. 
Suction. 
Fig. 1973. 
Teale's Instrument for Soft Cararact, in Case. 174 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPHTHAlsMie. 
THE NEEDLE OPERATIONS FOR CATARACT. 
Keratonyxis, Scleronyxsis. Couching, Depression, Reclination (Abaissement ou Deplacement 
de la Cataracte.) 
This consists in passing a cataract needle 
through the sclerotica and subjacent membranes, 
a little above the transverse diameter of the eye, 
and at about two lines distance from the circum- 
ference of the transparent cornea, until the point 
arrives in the posterior chamber of the eye. With 
this the crystalline is depressed to the outer and 
lower part of the globe of the eye, where it is 
left. This operation is, however, mainly of his- 
torical interest, being now almost abandoned.- 
Dunglison. 
A certain modification of depression, when 
the needle is made to carry the lens from before 
backwards into the vitreous humor and then de- 
presses it, so that its anterior aspect becomes its 
superior, is called reclination. 
Division, Discission, Solution of Cataract. 
The object of this operation is to lacerate the 
anterior capsule with a fine needle, so as slightly 
to break up the surface of the lens and to permit 
the aqueous humor to come into contact with the 
lens substance, which, imbibing the fluid, softens 
and becomes gradually absorbed. * * * 
There are two operations for division: 1st. 
Through the cornea, Keratonyxis, or the ante- 
rior operation for absorption ; and, 2d. Through 
the sclerotica, Scleratonyxis, or posterior opera- 
tion for absorption. 
Keratonyxis.-A fine needle-Bowman's Stop-is introduced through the cornea, at a point lying well within the 
field of the dilated pupil, so that the iris may not be touched by the stem of the needle, with the point of which the 
lens is then broken up. 
Scleronyxis.-Is applicable to partially absorbed cataracts, lying deeply behind the iris. The instrument used for 
this purpose is the Hays' (or other) Knife-needle, with which the division of the lens of considerable hardness can be 
accomplished. 
Cataract Needles. 
Fig. 1975.-Walton's Round-Pointed Reclination Needle. 
Fig. 1976.-Beer's Straight Cataract Needle. 
Fig. 1977.-Narrow Straight Cataract Needle. 
Fig. 1978.-Bowman's Stop Needle. 
Fig. 1979.-Curved Cataract Needle. 
Fig. 1974.-Couching Needle. 
Capsular and Secondary Cataracts. 
If, in an operation for senile cataract, the capsule is found too hard and tough for the cystotome, it is torn across 
with a sharp hook (Fig. 1922), and then, after extraction of the lens, the capsule is removed by the hook, or by a pair of 
forceps. If the connection between the capsule and the hyaloid is loosened, the lens may often be readily extracted in 
its capsule by the hook. Some operators divide the capsule across with a knife. 
Dr. Agnew, of New York, passes a stop needle through the centre of the membrane, thus fixing both the eye and 
the latter; he then makes a linear incision on the temporal side of the cornea, through which he passes a sharp pointed 
hook, the point of which is passed into the same opening in the membrane as the needle. He now tears the mem- 
brane, and by a rotary movement of the hook rolls it up around the latter, and then either draws it out altogether, or, 
if this cannot be done, he tears it widely open. 
For cases in which severe and protracted inflammation has followed the removal of cataract, giving rise to a dense 
secondary cataract, Dr. Noyes, of New York, has devised the following operation : He makes a puncture at the centre 
of the outer margin of the cornea with Von Graefe's cataract knife, carries it across the anterior chamber, and makes 
the counter-puncture at a corresponding point on the opposite side ; he then partially withdraws the knife until its point 
arrives opposite the middle of the iris, when he plunges it backwards through the false membrane into the vitreous, 
making the wound as large as possible. After withdrawal of the knife, a small blunt hook is to be passed through each 
corneal wound and caught in the wound made in the false membrane and traction made in opposite directions, so as to 
drag out a portion of tissue at each corneal wound, where it is to be snipped off. Thus a large central pupil will be 
made.-"Soelberg Wells, Diseases of the Eye." Bull's Am. Ed. p. 482. 1883. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
175 
OPJHTHALJVlie. 
For the Coloring of White Spots in the Cornea. 
Fig. 1981.-Grooved Tattooing Needle. 
6 
o 
d 
H 
to 
C/2 
vs 
S 
to 
I 
d 
'o' 
0 
Ph 
Fig. 1982.-Baader's Tattooing Needle. 
Fig. 1983.-Agnew's Tattooing Needle. 
The substance which De Wecker recommends is india ink ; Mr. Taylor has also em- 
ployed with advantage, sepia, ultramarine and other colors, and, when an immediate and 
deeply-colored effect has been desired, a combination of lampblack with india ink or a 
solution of nitrate of silver. The needles are dipped into the pigment solution, which 
should be made as thick as possible, and, the eye being steadied, the superficial layers of 
the cicatrix are rapidly punctured in an oblique direction and layers of the solution ap- 
plied, just as in the ordinary tattooing.-American Journal of Medical Sciences, October, 
1872, p. 561. 
* * * or, use the grooved needle, rub up the india ink to a thick solution, and cover the leucomatous spot 
thickly with it; then fill the groove of the needle with the pigment, and puncture the cornea obliquely in various di- 
rections.-" Soelberg Wells, Diseases of the Eye." Bull's Am. Ed., p. 245. 1883. 
For Enucleation or Extirpation of the Eyeball. 
Fig. 1985.-Ball's Double Hook, for Extirpation. 
Fig. 1984.-Blitz's Extirpation Forceps. 
Fig. 1986.-Enucleation Scissors. 
Scalpels and Bistouries, - - - - see page 84. 
Dissecting Forceps, - "15, 19. 
Needles and Ligature, - - - - " 78, 79. 
Dressing, - - - - - "74. 
Fig. 1987.-Bulldog Forceps, for drawing out the Eye. 
Fig. 1988.-Wells' Enucleation Spoon. 176 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
OPJHTHALJVlie. 
THE ELECTRO MAGNET IN OPHTHALMIC SURGERY. 
I he rapidly extending use of the 
electro magnet for the purpose of 
removing fragments of iron and 
steel from the interior of the eye, 
the slight attention previously be- 
stowed on this method of proced- 
ure, and the imperfect knowledge 
of the subject displayed in many of 
the published articles, have induced 
me to bring forward the following 
views. They are the result of seve- 
ral years' practical study. And their 
main object is to demonstrate that 
in the application of a properly con- 
structed magnet we possess an effi- 
cient means of treating cases for 
which enucleation has hitherto been 
practically considered the sole re- 
sort. 
Magnetism may be applied to the eye from either a permanent or an intermittent source ; that is, either from a so- 
called permanent magnet, which, once excited, retains its magnetic power indefinitely, or from a magnet which 
becomes such only when excited by the electric current. And the superiority of the latter is incontestible. It ex- 
ceeds its rival by many times in power, when of less weight and smaller size. The permanent magnet is, moreover, 
open to the objection of being liable to a constant dissipation of its energy upon receiving any sudden shock or blow, 
upon moving across the magnetic meridian of the earth, and even when at rest, unless guarded by an armature whose 
weight nearly equals its suspensive power. 
The electro-magnet must then be the one employed for the purposes of ophthalmic surgery. And in modeling such 
an instrument for use about the eye, it is evident that we must combine the minimum of size with the maximum of 
power. To this may be added, for the sake of convenience, with the smallest and most compact battery that proves 
itself available. * * * 
The core is composed of soft Norway iron, one-third of an inch in diameter, and two and one-half inches in 
length; to one end of this solid cylinder is riveted a flat circular disk of the same material, one inch in diameter, and 
one-sixteenth inch thick. 
The surrounding helix is composed of insulated copper wires, weighing twenty-nine grains to the foot, making 
eight convolutions of one and three-quarters inch in length. 
The polar extensions are respectively five, four and three thirty-seconds of an inch in diameter, and one-half inch 
in length ; their suspensive power equals twenty, sixteen and eleven ounces each, when an armature of soft iron, one 
inch by one-tenth in diameter is used, which is within two ounces of the saturation point. These points can be made 
of any size or shape to suit. 
The battery used is a single bichromate of potash cell, having eight square inches of negative surface. The mag- 
net weighs about five ounces, and the intensity of its field by the addition of another cell is made as great as that of a 
magnet capable of lifting a ton. 
* * * the larger the fragment the more probable its removal, and, conversely, the smaller the 
fragment the more difficult its extraction. Finally, a point may be reached where the resistance to be over- 
come exceeds the amount of polarity capable of being induced. This is illustrated in the case of minute foreign 
bodies in the cornea, where the magnet is of no avail. All incisions for removal of foreign bodies anterior to 
the plane of the lens should be marginal incisions of the cornea, those that concern the vitreous should be scleral, 
and made posterior to the ciliary border ; in both cases, by so doing, the ciliary body is avoided, and in the latter case 
the surrounding tissues form the best support for the wound. 
One important point in regard to all incisions made for the entrance of the magnet, and the removal of a foreign 
body from the eye, is that the cut should be not one with parallel edges, but T-shaped, as in the former case, when the 
extraction of the foreign body takes place, it is invariably stripped off the end of the magnet, and is retained at the 
site of the wound, or drops into the interior of the eye. This is a foregone conclusion unless the lips of the wound 
be held apart, and no amount of skill or carefulness upon the part of the operator can guard against it, unless the 
incision is of the above-mentioned shape.-Henry W. Bradford, M.D. Extract from Boston Medical and Sur- 
gical Journal, March 31, 1881. 
Fig. 1989.-Bradford's Electro Magnet GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
177 
OPHTHALMIC. 
ARTIFICIAL EYES. 
An artificial eye is a shell of enamel, representing the front of the eyeball, 
the loss of which it is intended to conceal. It should be of such shape as to 
admit of being introduced behind the eyelids, and of fitting, by its hollow 
posterior surface, over, but without touching or at least pressing on, the 
stump-like remains of the eye, and, by its margins, into the folds formed by 
the reflection of the palpebral and ocular portions of the conjunctiva into 
each other. 
The cases best adapted for the wearing of an artificial eye are those in which the eye, at the same time that it has 
been destroyed as an organ of vision, has been reduced in size, viz.; 
1st. Those cases in which the cornea is destroyed by purulent ophthalmia, whether in adults or new-born infants, 
by gonorrhoeal ophthalmia, various ophthalmia, &c., and in which staphyloma has not resulted, but the cicatrice 
formed in the place of the cornea is flat. 
2d. Those cases in which the eye is intentionally reduced to the state just described, by the operation for staphy- 
loma, common or sclerotic. 
When the remains of the eye are of a very small size, as after the loss of much or all of the vitreous humor, as 
may happen from the bursting of the eye in purulent ophthalmia, or in ocular phlegmon, or during the operation for 
staphyloma, there is not a good support for an artificial eye. After extirpation of the eyeball there is no support at 
all. Cases of atrophy of the eyeball do not, in general, bear the wearing of an artificial eye. 
Of course, before the use of an artificial eye is thought of, the remains of the eye must be perfectly cicatrized, and 
the conjunctiva free from inflammation and morbid sensibility. 
An artificial eye, besides resembling the opposite sound eye in prominence and in the color and appearance of 
the iris, ought, if the stump be good, to move in concert with it; this it does by following the movements communi- 
cated to the conjunctival folds, into which its margins are fitted, by the movements of the stump. It ought, at the 
same time, to cause no pains or uneasiness. 
Introduction of an Artificial Eye.-Raise the upper eyelid and slide the artificial eye, previously dipped in cold 
water, up behind it by the end which is to correspond to the temporal angle. Then, turning this end towards the 
temporal angle, and letting the upper eyelid fall, depress forcibly the lower, and make the lower edge of the 
artificial eye slip into the lower palpebral sinus. This being done, and the lower eyelid allowed to rise, the intro- 
duction of the artificial eye is accomplished. 
Removal of an Artificial Eye.-This is done by an opposite procedure, viz.: by depressing the lower eyelid, and 
with a large pin, or a bit of wire bent like a hook, or even with the thumb nail, hooking the lower edge of the eye out 
from the lower palpebral sinus, whereupon the eye will glide down from behind the upper eyelid and fall into the hand 
ready to receive it. In doing this himself, the patient should lean his face over a soft cushion, or the like, in order 
that if the eye should slip out of his fingers it may not be broken in the fall. The artificial eye is withdrawn on 
going to bed. Immediately on being withdrawn, it is to be put into water in order to cleanse it from the mucus 
which may be adherent to it. Both before putting in the artificial eye, and after withdrawing it, the person should 
bathe his eye with water, tepid or cold. The artificial eye in the course of a few months becomes rough, from the 
slow corrosive action of the humors which come into contact with it, and requires to be exchanged for a new one. As 
it is also liable to be broken by accident, several should always be kept on hand.-"Jones's Ophthalmic Medicine 
and Surgery.'' Am. Ed., p. 188. 1863. 
Fig. 1990.-Artificial Eyes. 
We have on hand a large assortment of all colors, forms and sizes, for the right and left eye, from which personal 
selections may be made, or we can send them by mail; but as the success of being well matched depends on the 
exactness of the description and the minuteness of adaptation and accommodation of the artificial eye to the remains 
of the natural one, we advise patients to apply to their physician and have him send us the following particulars: 
I. Right or left eye ? 
2. Diameter of the iris of the well eye. 
3. Normal diameter of the pupil. 
4. Degree of atrophy of globe in comparison to well eye. 
5. Form of anterior of stump, flat, round or conical. 
6 Partial or entire presence or absence of cornea remaining transparent. 
7. Depth of furrow behind the lower lid. 
8. Sex and age of patient. 
9. A drawing (natural size) representing accurately the eye region of both eyes, the color of the iris and sclerotica 
(or a minute description). 178 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPHTHALMIC 
SUNDRIES. 
The peculiarity of this lachrymal syringe is that 
the canula or nozzle is closed at its extremity with a 
solid olive-shaped bulb, just above which there are a 
number of small openings which pass directly through 
the canula, permitting the liquid-when the piston is 
pressed-to pass out laterally in a number of jets. 
The bulbous point permits of an easy introduc- 
tion and a passage through the canal with the least 
traumatism to its walls ; having been passed directly 
through and into the nasal cavity, the canula is drawn 
upwards, until the bulb closes the lower opening of 
the canal; then, if the piston is pressed, the liquid 
passes into the cavity, and applying itself to every 
part of the canal and sack, it escapes from the inner 
canthus-being prevented from passing downwards 
by the closure of the lower opening-and is caught by a napkin held to the eye for that purpose. If one syringe 
full is not sufficient, the cylinder may be unscrewed from the canula, filled and emptied again, as before described. 
The canal and sack can thus be perfectly washed, or an application be perfectly made without a drop of the liquid 
used passing into the nose or throat of the patient. 
Fig. 1991.-Tansley's Lachrymal Syringe. 
Fig. 1993.-Prince's 
Lachrymal Syringe. 
Prince's Medicating and Drainage Canula is de- 
signed to facilitate the treatment of lachrymal stenosis, 
purulent dachryocystisis and fistula. The accompany- 
ing syringe, which fits the visible end of the canula, 
enables the patient to irrigate with warm salt water or 
peroxide of hydrogen, thus absolutely removing all pus 
or mucus. The medicating fluid, similarly applied, es- 
caping from the apertures of the canula, comes in con- 
tact with the entire surface of the sac and duct. 
By using the accompanying lachrymal cocaine pi- 
pette (ten per cent, solution), the surgeon is enabled, 
without an anaesthetic, to slit, probe and introduce the 
canula, which is worn until the discharge shall have 
ceased or the tendency to constrict shall have been 
overcome. 
Fig. 1992. 
Prince's Medicating and 
Drainage Canula. 
Fig. 1994.-Bradford's Eye Speculum 
Natchet's Complete Set of Trial Glasses. 
Fig- *753- Fine rosewood Case ,-contains: 
30 .pairs each of Spherical, Convex and Concave Lenses, 
from if to 148 inches focus. 
18 pairs each of Cylindrical,Concave and Convex Lenses, 
from 6 to 148 inches focus. 
10 Prisms of angles from 2 to 20 degrees. 
4 Plane .Glasses of assorted colors. 
1 Plane White Glass. 1 Half-ground Glass. 
2 Metal Disks with slits of assorted widths. 
1 each Metal Disks, solid and with central perforation. 
All mounted in gilt and silver-plated metal rims, 
with handles. 
1 Adjustable Spectacle Frame for the various Lenses, 
graduated for reading the astigmatic axis of the eye. 
1 Horn Lens Holder. 
The use of this speculum is in cataract and glaucoma 
operations, when the pressure of the lids upon the globe 
is very liable to force the vitreous out, and as the lids 
are raised entirely clear from the globe with this instru- 
ment, the more force the patient uses to contract the 
lids the higher the lids are carried from the globe. I 
think it will come in common use, as it is the only 
speculum that does this.-II. W. Bradford, M. D. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
179 
OPHTHALMIC. 
OPERATING CASES. 
Set of Strabismus Instruments. 
$9.50. 
1 Plain Wire Speculum. 
2 Strabismus Hooks. 
1 Double Hook, Sedillot's. 
1 Strabismus Forceps. 
1 Strabismus Scissors. 
1 Morocco-covered Case. 
Ayres' Large Set of Eye Instruments. 
$84.65. 
2 Graefe's Cataract Knives. 
2 Bistouries for Lid Operations. 
1 Cystotome, flexible shank, and Daviel's Curette. 
2 Angular Iridectomy Knives, medium and small. 
I Weber's Curved Canaliculus Knife. 
1 Bowman's Stop Needle. 
1 Discission Needle, curved. 
1 Tyrrell's Blunt Hook. 
2 Strabismus Hooks. 
1 Cystotome, flexible shank, and Hard Rubber or Shell 
Spoon. 
1 Knapp's Foreign Body Hook. 
I Spud. 
1 Spatula for the Iris. 
2 Lid Elevators, large and small. 
2 Graefe's Eye Specula, right and left. 
1 Fixation Forceps, medium. 
1 Fixation Forceps, broad. 
1 Iris Forceps, curved. 
1 Iris Scissors, curved on the flat. 
1 Strabismus Scissors, straight. 
1 Enucleation Scissors. 
1 Canaliculus Scissors. 
4 Probes, Ayres' modification of Bowman's. 
I Sands' Needle Holder. 
6 Needles and Silk. 
I Anel's Probe. 
1 Dressing Probe. 
1 Knapp's Entropium Forceps. 
1 Canalicula Syringe, one straight and one curved point. 
1 Cilia Forceps. 
2 Serrefines. 
1 Jaeger's Lid Holder and Spatula. 
1 Test Drum. 
1 Rosewood Case, not lined, except the tray that 
contains the scissors and the bridges for the 
cutting instruments. 
Compact Set of Eye Instruments. 
$28. 
1 Plain Wire Speculum. . 
1 Strabismus Hook. 
1 Beer's or Graefe's Cataract Knife. 
1 Angular Iridectomy Knife. 
1 Straight Cataract Needle. 
I Curved Cataract Needle. 
1 Desmarre's Lid Holder. 
1 Cystotome and Daviel's Spoon. 
I Straight Scissors. 1 Curved Scissors. 
1 Plain Fixation Forceps. 1 Straight Iris Forceps. 
1 Cilia Forceps. 
1 set Bowman's Probes. 
6 Suture Needles and Silk. 
1 Rosewood Case, lined with silk velvet. 
Ayres' Small Set of Eye Instruments. 
$49-25- 
1 Graefe's Cataract Knife. 
1 Bistoury for Lid Operations. 
1 Cystotome, flexible shank, and Daviel's Curette. 
1 Angular Iridectomy Knife, medium. 
1 Weber's Curved Canaliculus Knife. 
1 Discission Needle. 
1 Strabismus Hook. 
1 Desmarre's Paracentesis Needle. 
1 Dix's Spud. 
I Desmarre's Lid Elevator. 
1 Jaeger's Elevator and Spatula combined. 
1 Graefe's Eye Speculum, reversible. 
1 Fixation Forceps, spring catch. 
I Iris Forceps, curved. 
1 Iris Scissors, curved on the flat. 
1 Strabismus Scissors, straight. 
1 Enucleation Scissors. 
4 Probes for Nasal Duct (Ayres' modification of Bow- 
man's). 
1 Entropium Forceps, reversible. 
1 Cilia Forceps. 
6 Suture Needles and Silk. 
1 Sand's Needle Holder. 
I Rosewood Case, not lined, except the tray that 
contains the scissors and the bridges for the 
cutting instruments. 
Agnew's Set of Eye Instruments. 
$66.50. 
2 Graefe's Eye Specula. 
1 Graefe's Fixation Forceps, spring catch. 
1 Desmarre's Double Lid Retractor. 
1 Agnew's Lachrymal Syringe, with two pliable silver 
points. 
1 set Theobald's Lachrymal Probes. 
1 Bowman's Lachrymal Director, gilt. 
1 Weber's Probe. 
1 Agnew's Lachrymal Knife, with long pliable shank. 
1 Prout's Needle Holder. 
1 Strabismus Scissors, straight small blunt points. 
1 Large Straight Scissors. 
(over.) 180 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OPJHTHALJVlie. 
OPERATING CASES. 
Agnew's Set of Eye Instruments (continued). 
1 Delicate Scissors, curved on the flat, sharp points. 
I Agnew's Strabismus Hook, with eye. 
1 Plain Strabismus Hook. 
1 Agnew's Tattooing Needle. 
1 Beer's Cataract Knife. 
1 Graefe's Linear Cataract Knife. 
1 Liebreich's Linear Cataract Knife. 
1 Cystotome and Daviel's Curette. 
1 Small Cataract Needle. 
1 Ivory-handle Shell Spoon. 
2 Bowman's Stop Needles. 
1 Delicate Curved Iris Forceps. 
1 Tyrrell's Sharp Hook. 
1 Iridectomy Knife, angular. 
1 Desmarre's Paracentesis Needle. 
1 Large Enucleation Scissors, curved on the flat. 
12 Suture Needles and Silk. 
1 Rosewood, brass-bound Case, lined with silk velvet. 
Graefe's Set of Eye Instruments. 
$46. 
1 Beer's Cataract Knife. 
1 Graefe's Cataract Knife. 
1 Lance-shaped Iridectomy Knife, straight. 
1 Iridectomy Knife, angular. 
1 Desmarre's Scarifyer. 
1 Weber's Fistula-Lachrymalis Knife. 
1 Discission Needle. 
1 Paracentesis Needle. 
1 Cystotome, with Daviel's Spoon. 
1 Curved Eye Scissors. 
1 Straight Eye Scissors. 
2 Desmarre's Lid Holders. 
1 Fixation Forceps, Graefe's. 
1 Iris Forceps. 
1 Cilia Forceps. 
2 Strabismus Hooks. 
1 Jaeger's Lid Plate. 
1 set Bowman's Probes. 
1 Anel's Probe. 
1 Desmarre's Entropium Forceps. 
1 Graefe's Eye Speculum. 
6 Suture Needles and Silk. 
1 Rosewood Case, lined with silk velvet. 
Gruening's Set of Eye Instruments. 
$71. 
2 Scalpels, 2 sizes. 
2 Cataract Knives, Graefe's. 
1 Lance-shaped Iridectomy Knife. 
1 Hard Rubber Cataract Spoon. 
I Wire Spoon. 
1 Cystotome with Daviel's Spoon. 
1 Knapp's Needle-Knife. 
1 Gouge, for foreign bodies. 
1 Weber's Canaliculus Knife. 
1 Discission Needle. 
2 Lid Retractors. 
2 Strabismus Hooks, 2 sizes. 
1 set Theobald's Lachrymal Probes. 
2 Landolt's Specula. 
6 Small Curved Suture Needles. 
6 Larger Curved Suture Needles. 
1 skein China Bead Silk. 
1 Sands' Improved Needle Forceps. 
I Gruening's Epilating Forceps. 
1 Curved Iridectomy Forceps. 
1 Straight Iridectomy Forceps. 
1 Curved Iridectomy Scissors. 
1 Straight Strabismus Scissors. 
I Jaeger's Hard Rubber Plate. 
1 Fixation Forceps, with spring catch. 
I Plain Fixation Forceps. 
1 Knapp's Entropium Forceps. 
1 Slide-catch Artery Forceps. 
1 Cocaine Case, with dropper. 
1 Atropine Case, with dropper. 
1 Platinum Cautery Probe. I Test Drum. 
1 Morocco Case, lined with silk velvet. 
Knapp's Set of Eye Instruments. 
$73-75- 
2 Desmarre's Lid Holders. 
i Fixation Forceps. 
i Artery and Needle Forceps. 
i Porte Caustic. 
2 Bistouries. 
i Knapp's Lid Clamp. 
I Strabismus Scissors. 
2 Strabismus Hooks. 
I set Bowman's Probes. 
2 Graefe's Knives. 
i Himley's Blunt Hook. 
i Needle Cystotome, with Daviel's Spoon. 
i Canalicula Knife. 
2 Knapp's Discission Needles. 
I Beer's Cataract Knife. 
I Iris Forceps. 
I Iris Scissors. 
i Foreign Body Needle. 
I Grooved Foreign Body Hook. 
I Anel's Syringe, with Meyer's Nozzle. 
I Sharp Spoon. 
I Cilia Forceps. 
i Wire Speculum (neutral), made to fit both eyes. 
i Sulphate of Copper Crystal, mounted in a camel's 
hair brush. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
181 
OPJHTJHALMIC. 
OPERATING CASES. 
Knapp's Set of Eye Instruments (continued). 
3 Curved Suture Needles. 
I Cane Pin. 
1 Small Anatomical Forceps. 
1 Large Curved Hook, for Cataract Extractions. 
1 Large Curved Scissors, for Enucleation. 
1 Canalicula Probe, fine point, and Weber's Cone. 
1 Horn Plate. 
1 Scarpa's Style. 
3 Perforated Silver Drainage Tubes. 
1 Morocco Case, lined with silk velvet. 
Noyes' Set of Eye Instruments (continued). 
1 Spatula. 
1 Straight Iridectomy Knife. 
1 Angular Iridectomy Knife. 
1 Short Iris Forceps. 
1 Large Curved Iris Forceps. 
1 Tyrrell's Blunt Hook. 
2 Straight Discission Needles. 
1 Graefe's Linear Cataract Knife, wide pattern. 
2 Graefe's Linear Cataract Knives, narrow pattern. 
1 Small Sharp Iris Hook. 
1 Prout's Entropium Forceps. 
1 Cystotome and Curette. 
1 Sands' Needle Forceps. 
6 Small Curved and 3 Straight Suture Needles, and 
fine Silk. 
1 Hard Rubber Spoon. 
1 Noyes' Lens Spoon. 
1 Rosewood brass-bound Case, lined with silk velvet. 
Mittendorf's Set of Eye Instruments. 
$50. 
1 Mittendorfs Plain Wire Speculum. 
2 Noyes' Mod. Graefe's Knives. 
1 Iridectomy Knife. 
1 Agnew's Canaliculus Knife. 
1 Cystotome and Scoop. 
1 Cataract Scoop (Shell). 
1 Bowman's Stop Needle. 
I Straight Cataract Needle. 
2 Strabismus Hooks. 
1 Lid Retractor. 
1 Prout's Reversible Entropium Forceps. 
1 Small Scalpel. 
1 Curved Iris Scissors. 
1 Curved Strabismus Scissors. 
1 Fixation Forceps, spring catch. 
1 Cilia Forceps. 
1 Curved Iris Forceps. 
1 Prout's Needle Forceps. 
1 set Bowman's Probes, 1 to 8. 
3 Small Curved Suture Needles. 
1 Heurteloup's Artificial Leech Cylinder. 
Webster's New York Polyclinic Eye Set. 
$72. 
2 Graefe's Long Eye Specula. 
2 Angular Iridectomy Knives. 
1 Graefe's Linear Cataract Knife. 
1 Liebreich's Linear Cataract Knife. 
1 Knapp's Knife-Needle. 
1 Daviel's Curette and Broad Paracentesis Needle. 
1 Tyrrell's Sharp Hook. 
1 Agnew's Lachrymal Knife, long pliable shank. 
1 Small Cataract Needle. 
1 Scalpel. 
1 Gouge. 
1 Bowman's Stop Needle. 
1 Knapp's Cystotome. 
1 Beer's Knife. 
1 Ivory Handle Shell Lens Spoon. 
1 Agnew's Lachrymal Syringe. 
1 set Theobald's Lachrymal Probes. 
1 Weber's Probe. 
1 Test Drum, for testing the edges of instruments. 
1 Curved Strabismus Scissors. 
1 Straight Strabismus Scissors. 
1 Curved Iris Scissors. 
1 Straight Iris Scissors. 
1 Straight Strabismus Forceps. 
1 Cilia Forceps. 
1 Delicate Curved Iris Forceps. 
1 Large Scissors, curved on the flat, for Enucleation. 
1 Sands' Needle Holder. 
1 Graefe's Fixation Forceps. 
1 Large Straight Scissors. 
12 Suture Needles and Silk. 
1 Morocco Case, lined with silk velvet. 
Noyes' Set of Eye Instruments. 
$70. 
2 Desmarre's Lid Retractors. 
1 Plain Wire Speculum. 
1 Noyes' Plain Canaliculus Knife. 
1 set Theobald's Probes. 
Some Lead Wire, Nos. 4 to 8. 
1 Small Scalpel. 
1 Hard Rubber Lachrymal Syringe. 
2 Strabismus Hooks, large and small. 
t Strabismus Scissors. 
1 Enucleation Scissors. 
1 Straight Iris Scissors. 
1 Curved Iris Scissors. 
1 Fixation Forceps. 
1 Plain Dissecting Forceps. 
1 Dix's Foreign Body Spud. (over.) 182 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
AU^AL 
" The practice of Otology in this country was, a few years since, almost exclusively confined to charlatans ; but it is 
now cultivated by a class of men who are the equals of any in the profession. Ten years ago, in most parts of the 
country, those who wished advice upon a disease of the ear were forced to seek aid outside of the medical profession. 
At the present time, there can be found those in the large cities who are constantly and successfully treating aural 
diseases ; and all over the land the old and familiar advice-' not to meddle with the ear'-is growing far less frequent. 
The day will soon arrive-if, indeed, it be not already upon us-when Otology will take equal rank with Ophthal- 
mology, to which department it has so long been a mere appendage, and when some knowledge of the diseases of the 
ear and of their treatment will be required of every practitioner."-" Treatise on the Diseases of the Ear." St. John 
Roosa. 1873. 
Perforating the Lobe of the Ear. 
Fig. 1995.-Ear Trocar. 
This operation, the object of which is the insertion of ear-rings, is performed w'ith a small trocar (Eig. 1995), whose 
canula has a removable point. A cork is placed behind the ear as a support for the lobe. The point of the trocar, after 
passing through the lobe, is buried in the cork, with which it is removed from the canula. The latter is left in situ to 
aid in the introduction of a leaden w ire or silken cord, which is tied in the form of a ring and allow'ed to remain until 
the wound is cicatrized and become converted into a permanent opening suitable for the reception of earrings. 
" Even those wounds which include the cartilagenous portion of the ear close very speedily when brought together 
by numerous fine sutures."-" The Principles and Practice of Surgery." Hamilton, p. 583. 1872. 
Wounds of the Auricle. 
Absence and Obstruction of the Auditory Canal. 
" The congenital absence of the meatus auditorius, caused by consolidation of its bony parieties, is beyond the re- 
sources of art; but when a membrane, more or less thick, situated deeply or otherwise, obliterates the canal, puncture, 
incision and cauterization have been successfully employed. 
" It is always prudent to begin w ith an exploring puncture, to determine the existence of a cavity behind the mem- 
brane ; if, by this puncture, the hearing is improved, a crucial incision of the membrane may be made and the flaps 
exsected. Some dilating substance should be introduced into the artificial opening to keep it patent and prevent its 
obliteration during the healing of the w'ound (such as catgut, tupelo, prepared sponge), which may afterwards be re- 
placed by a canula of gold or ivory (or hard rubber), to keep up the dilation. 
" Whatever method is adopted, the surgeon should proceed carefully and be wary of creating lesions in the internal 
ear."-" Bernhard and Huette's Manual of Operative Surgery." Van Buren and Isaac's Am. Ed. 1857. 
The experience of the profession is against the attemps to open the canal to an organ which will probably be found 
so imperfect that sound cannot be perceived by it. 
* ' By means of the tuning fork we may always determine, in the case of persons of sufficient age, whether the central 
apparatus be or be not unimpaired. If the canal be closed, while the labyrinth is intact, the vibrations of a tuning 
fork whose handle is placed on the teeth or forehead will be heard more distinctly in the affected than in the sound 
ear. The reflection of the sound waves is diminished by the stoppage of the auditory passage, just as in cases of in- 
spissated cerumen and thickening of the mucous membrane of the cavity of the tympanum and the eustachian tube, 
or perhaps there is no nervous apparatus on that side to receive the sound waves.-" Treatise on the Diseases of the 
Ear. St. John Roosa, p. 105." 1873. 
Auro-Nasal. 
"That the nasal and post-nasal regions are inseparably associated with the ear, both anatomically and physiologi- 
cally, is a trite fact in otology. It is not so clearly realized, however, that diseases of these cavities implicate the audi- 
tory apparatus in such a manner that the latter can only be successfully treated by theurapetic measures, directed in 
the first place to the nose and its adjacent structures. The recognition of this fact is a comparatively new department 
>n aural practice. Its importance in this relation cannot be over-estimated."-"Post-nasal Catarrh." Woakes. 1884. 
DIAGNOSTIC. 
" It is by no means necessary that every aural patient should be examined with the so-called rhinoscope, nor will 
the most accomplished manipulator be liable to see the mouth of the eustachian tubes in every case ; but, every one 
who attempts to treat the disease of the organ of hearing will find his diagnosis is very often facilitated by an inspection 
of these parts ; for example, when any unusual difficulty is experienced in entering the mouth of the eustachian tube." 
--"Treatise on the Diseases of the Ear." St.John Roosa, p. 90. 1873. (See " Rhinoscopic.") GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
183 
AUF^AL. 
DIAGNOSTIC. 
Otoscopes, Specula Auris. For Inspection of the External Meatus and Membrana Tympani. 
Fig. 1996. 
Gruber's Specula of Hard Rubber. 
Fig. 1997. 
Troeltsch's Ear Mirror. 
Fig. 1998. 
Wilde's Tubular Specula and Case. 
Fig. 1999. 
Speir's Self-retaining Ear Speculum. 
Fig. 2000. 
Simrock's Otoscope, with Lens 
Roosa's, Schroetter's, 
Tiemann & Co.'s 
and other Head-Rests, 
see "Laryngoscopes." 
Fig. 2001. 
Millikin's Self-retaining 
Ear Speculum. 
Fig. 2002.-Toynbee's Ear Specula. 
Fig. 2003.-Knapp's Ear Specula. 
Fig, 2004. 
Hassenstein's Otoscope, with Lens. 184 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
jAURAk 
DIAGNOSTIC. 
Otoscopes, Specula Auris. For Inspection of the External Meatus and Membrana Tympani. 
Fig. 2005.-Clarke's Otoscope, with Reflector and Lens. 
Fig. 2006.-Wilde's Gorgeret. 
Fig. 2008.-Brunton's Otoscope, with Lens and Reflector. 
Fig. 2007.-Kramer's Ear Speculum. 
Fig. 2009.-Bivalve Ear Speculum. 
Fig. 2011.-Rumbold's Acou-Otoscope. 
Fig. 2010.-Speir's Ear Speculum. 
Fig. 2012. 
Park's Electric Otoscope, with Lens and Reflector. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
185 
AURAL. 
DIAGNOSTIC 
r IG. 2013 -Ear Probe. Steel, Angular. 
Fig. 2014.-Bucks Silver Probe- 
Fig. 2014 b.-Buck's Silver Probe. 
Fig. 2015.-Toynbee's Diagnostic Tube. 
Fig. 2016. 
Politzer's 
Ear Manometer. 
Fig. 2017.-Toynbee's Explorer 
Fig. 2018.-Blake's Inner-Ear Mirror. 
Fig. 2020.-Ely's Modification of Siegle's Otoscope. 
Fig. 2019.-Siegle's Otoscope. 
Siegle's Otoscope enables us to form pretty accurate notions of the mobility of the membrane. The air is exhausted 
by means of the lips, while the membrane is carefully watched through the glass for its movements. 
In Ely's modification of Siegle's Otoscope, the syringe is employed (instead of the lips for exhausting the air) by 
an assistant, while the surgeon examines the movements of the drum-head. 186 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/vURAL 
DIAGNOSTIC. 
Fig. 2021.-Politzer's Acoumeter, for 
testing perception for bone conduction. 
"If the windows of the labyrinth were filled up with bone, then the 
ear, according to Knapp, would be in the condition of an eye with a 
closed pupil ; the sound waves would be irregularly transmitted to the 
cochlea, not producing the sensation of a sound image, but an indefinite, 
quantitative perception of sound. Knapp thinks direct bone conduction 
does exist, but it produces only quantitative perception of sound, not use- 
ful hearing. He has never met with a patient who could hear his watch 
(H. D. - 24") from the mastoid process, temple, or other parts, if he 
could not hear it when applied to the ear. He has had patients with 
acute and chronic disease of the middle ear that could not hear his watch 
at all, or only when applied to the auricle ; but when he had punctured 
the drum-head and inflated the ear by Politzer's method, his watch was 
distinctly heard, not only when applied to the auricle, but also from the 
mastoid or temple. This he regarded as conclusive that the immediate 
bone conduction was of little or no account. As another proof of the latter point, he has never found a patient who 
was benefitted more by the audiphone than by a trumpet.-New York Medical Journal, January, 1881. 
Bone Conduction. 
The pitch of the tuning fork used by Politzer is 
C, vibrating 512 times in the second. On striking 
it we notice two distinct tones, one the key-note. 
C, the other the musical fifth, g. Either one or 
the other predominates, according to the force with 
which and the tensity of the substance against 
which it is struck. As the predominance of the upper tone is confusing, the fork should not be struck too hard, 
so that the key note, C, may be distinctly heard. 
Fig. 2022.-Politzer's Tuning Fork (Diapason) C. 
The Tuning Fork in Diagnosis of Nervous Deafness. 
"Certain tests can be applied to the hearing by means of a tuning fork placed on the head, which will sometimes 
give almost or quite decisive information. Little value can be attached to the mere fact that a tuning fork of any par- 
ticular pitch is heard badly, or even not at all, through the cranial bones, since not only do various diseases of the 
tympanum produce this effect, but I have known at least one person, with healthy ears and perfect hearing for the 
voice, entirely unable to hear a tuning fork upon the head. But since this peculiarity is rare, an inability to hear vibra- 
tions thus imparted to the cranial bones may be fairly held as a suspicious circumstance, and at least the converse may 
be held valid that, if the tuning fork be well heard, the deafness is not likely to be nervous. But the chief use of the 
tuning fork in diagnosis rests on the simple fact that its vibrations, when imparted to the bones, pass outward freely 
through the tympanum and external meatus, and are therefore reinforced by reflection when either the tympanum or 
the meatus is rendered impervious to sound. If the meatus of a healthy ear be closed by the finger, the sound of a 
tuning fork placed on the head becomes louder, and the same is the case with sounds produced by our own vocal 
organs when the mouth is closed-the escaping vibrations being thrown back upon the labyrinth. 
" If the meatus be obstructed by wax, the ear being otherwise healthy, the effect is the same ; or, again, if the pas- 
sage of vibrations through the tympanum be hindered by closure of the Eustachian tube. It may, indeed, be laid 
down as fairly ascertained that whatever diminishes the permeability of the tympanum or meatus for sonorous vibra- 
tions, causes the bone-conducted sounds to be, caterisparibus, better heard. If, therefore, a patient comes to us deaf 
on one side only, we have at hand an immediate means of determining, with an extreme degree of probability, the 
seat of the disease. We place a tuning fork upon his head, and inquire on which side it is best heard, of course being 
careful not to accept a hasty answer. Generally it will be found loudest on the deafer side, the conducting media 
being most often in fault. If it is heard best, or only, by the better ear, the nervous system is in some way concerned 
in the deafness. 
" It often happens, however, that no decisive information can be obtained in this way, the tuning fork not being 
heard unequally on the two sides, although the condition of the ears may be very different. This may be accounted for 
in many ways, such as inaptness of the patient to discern, or a balancing of morbid conditions producing opposite 
effects in the ear itself. 
" Of course, when both ears are pretty equally involved, this method is not applicable. But in all cases the effect 
of closing the meatus by the finger, while the tuning fork is placed upon the head, gives important information. If 
the conducting media are healthy, the sound is rendered louder by the closure ; if they are impermeable to vibrations, 
no effect is produced."-"Hinton, Surgeon-Aurist, Guy's Hospital Reports," Third Series, Vol. XIII., 1868, and 
"Diseases of the Ear," Turnbull, 1872, p. 337. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
187 
AU^AL. 
MICROCOUSTIC. 
Ear trumpets are intended to aid the hearing of persons partially deaf, although sometimes used by ordinary per- 
sons to intensify distant sounds. We have no means of ascertaining at what period or by whom ear trumpets were 
invented. The practice of putting the hand to the ear in a trumpet shape probably first suggested it, and from occa- 
sional allusions to the use of the trumpet in old writers it would seem to have been of very early origin. The earliest 
form of which we have any knowledge was a rude imitation, on an exaggerated scale, of the form of the external ear; 
but as this was found inconvenient from the difficulty of retaining it in place, a form more nearly resembling a speak- 
ing trumpet was substituted. This was modified by bending the tube and applying the mouth, turned forward and 
given an elliptical form, close against the ear. Another modification was a flat tube passing over the head and ap- 
plied to each ear, while in front immediately over the forehead was an opening to receive the sound. 
One inventor, having observed that in listening intently people opened their mouths, contrived a sort of plectrum 
or vibrating body to be held between the teeth, and thus to convey sounds by the eustachian tube. After the intro- 
duction of caoutchouc and gutta percha into the arts, a long tube of one or the other of these materials, with a bell- 
shaped trumpet at the end, took a place along with the metallic trumpet, and for many purposes is very convenient. 
In England, in some of the churches, pews are constructed with tubes to conduct the sound, opening in 
convenient positions for the ear of the listener. Among the most recent inventions for facilitating hearing are the 
auricles and small tubes of silver with semi-globular expansions, intended to be inserted into the meatus of the ear; 
and the tympanum, a small thin disk of rubber, having a silver wire passing through it, to transmit the sound. In a 
few cases the latter has been of considerable service. In total deafness, such means are of no advantage.-"American 
Cyclopaedia." 
Ear trumpets are to the ears what spectacles are to the eyes, but the aid which they render is neither as perfect nor 
as complete. Yet with all their defects they could not be dispensed with, as they are the only means by which par- 
tially deaf personshave intercourse with their friends, or are enabled to listen to a lecture or sermon. Each individual 
generally has his or her favorite instrument, and would not part with it on any consideration. 
" Ear trumpets are bent, so as to cause the sound to be deflected from a straight line in passing into the ear, and by 
making the portion which receives the sound like a funnel, a much larger volume is received for the impression on the 
impaired auditory nerve. We must have a variety of these useful instruments, so as to allow the patient to choose the 
most suitable."-Turnbull, " Diseases of the Ear." 1872. 
Ear Trumpets. 
Fig. 2023. 
Toynbee's Artificial Tympanum. 
Fig. 2025. 
Apparitor Auris. 
Fig. 2026.-Auricles. 
Adapted to be worn on the head. 
Fig. 2024.-Compact Ear Trumpet. 
Fig. 2027.-German Silver Ear Trumpet 
Fig. 2028.-Japanned Conical Ear Trumpet, 188 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
AUf^AL. 
MICROCOUSTIC 
Ear Trumpets. 
The Martineau Hearing Horn, or Dipper Trumpet (Figs. 2029 and 2030) (paraboloid), is a powerful instrument, 
suitable to hear public lectures or sermons, and is often efficient where the smaller-sized trumpets fail. 
Fig. 2029.-Dipper Trumpet 
Fig. 2030.-Martineau Hearing Horn. 
Fig. 2031.-Ear of Dionisius (Paraboloid). 
Fig. 2033.-Long Japanned Ear Trumpet. 
Fig. 2032. 
London Hearing Horn. 
(Paraboloid.) 
Fig. 2034.-Corrugated Ear Trumpet 
Fig. 2035.-Telescopic Ear Trumpet. 
Fig. 2037.-Dome Trumpet. 
(Paraboloid.) 
Fig. 2036.-Conversation Tube, to make whispers audible. 
Fig. 2038.-Walking Cane Trumpets. 
Fig. 2039.-Silver Comets. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
189 
AUF^AL. 
MICROCOUSTIC. 
Ear Trumpets. 
Fig. 2040.-Currier's Duplex Conversation Tube, for Educating Deaf Mutes. 
Currier's Duplex Ear-Piece, in 
conjunction with the Conical Con- 
versation Tubes, has been found to 
possess the greatest practical value 
of all the "aids to hearing" in the 
instruction of the deaf. The instru- 
ment, as shown in the picture, is the 
result of a series of experiments 
made by Prof. E. H. Currier, in the 
direction of developing speech and 
hearing in a class of partially deaf, 
and consequently mute children, in 
one of the largest institutions for the 
instruction of the deaf and dumb in 
America. It is not sufficient for the 
pupil to hear what is said to him, he 
must also hear himself say the same 
thing. In class-room instruction, 
after adjusting the instrument, the 
teacher first speaks through one of 
the tubes, and requires the pupil to 
repeat the words or sounds that have 
been uttered to him through the 
other tube. This enables him to 
compare his own enunciation with 
that of his instructor, and, after re- 
peated trials, to obtain such control 
over his vocal organs as to secure the reproduction with clearness and precision. Without this aid, a deaf person is 
wholly dependent upon the ear of his teacher, of whom he is obliged to inquire as to whether he has spoken correctly 
or not. But with it, he can depend, to a great extent, upon his own ear, only asking that the words shall be repeated 
a sufficient number of times to enable him to make the necessary comparisons. By means of such an education of the 
ear and of the voice, the partially deaf will be able to take their place in the society of the hearing, and also to con- 
verse with all who may address them through the mouth-piece of the tube. 
Currier's Conico - Cylindrical Con- 
versation Tube was designed to extend 
the benefits of hearing to a large class 
whose deafness is so great as to render 
of no avail the American Conical Con- 
versation Tube. 
It is the most powerful conductor of 
the human voice yet perfected. It en- 
ables the voice to penetrate a greater 
degree of deafness than any other in- 
strument, and is, therefore, of incalcu- 
lable value to such persons as may be 
found to possess even the lowest degree 
of hearing. The attention of all who 
are engaged in the work of ameliorating 
the condition of the deaf is called to these new instruments, in the belief that they will be found, in the highest degree, 
useful in training the ear, when the power of hearing is not totally extinct, and in bringing its invaluable aid to assist 
in the development of the voice. 
Fig. 2041.-Currier's Large Conical Conversation Tube. 
Also on hand: 
All the varieties of Audiphones and Dentiphones in the market. 190 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
AU^AL 
Foreign Bodies in the External Meatus. 
" It would be difficult to enumerate the foreign bodies which might accidentally obstruct the auditory canal. They 
may be divided into two classes: 1st. Bodies forming in the ear itself, wax more or less hardened, pus, coagulated 
blood, &c. ; 2d. Bodies introduced from without. 
" The extraction of these foreign bodies may be effected either with scoops or forceps, whose curves and dimen- 
sions are appropriate to the direction of the external auditory canal. The forms of these bodies, their solidity, 
softness, &c., will furnish indications to the surgeon, which will direct him in the choice of the proper method of 
operating for their removal. By drawing with the left hand the pinna of the ear upwards and outwards, we 
straighten a little the curves of the canal and thus facilitate the introduction of instruments. By lubricating the 
canal with oil, the expulsion of the foreign body is more easily effected. It must be remembered, as an anatomical 
fact, that in adults the vertical diameter of the canal is greater than its transverse diameter. Instruments, there- 
fore, should be carried along the inferior wall of the canal, in order that they may be insinuated more easily between 
it and the foreign body. In infants, on the contrary, the transverse is greater than the vertical diameter. In the 
second place, the membrana tympani, being inclined from above downwards and from without inwards, this arrange- 
ment should be recollected that the membrane may not be wounded, nor the foreign body be forced into the angle 
which is formed at the internal extremity of the canal. 
" Hardened wax and analogous substances may be softened and removed by the use of injections of warm water. 
Surgeons have also successfully used forcible injections for the expulsion of solid bodies, which the reflux of the 
liquid force outwards. If all these means fail, we may have recourse to the method of Paul, of Egina, who advises 
the surgeon to make a small incision behind the pinna, on a level with the canal, through which a probe can be intro- 
duced behind the foreign body and used to force it from within outwards." 
Polypi of the Auditory Canal 
" May be removed, or destroyed in situ, by ligature, excision, avulsion, and cauterization. The ligature may be 
applied directly, or with the aid of knot-tyers or snares. Avulsion of the polypus is effected with steel forceps. 
" The blood, which frequently flows in abundance after the operation, can be stopped by cauterization. 
"The action of the caustic should be carefully watched, and it would be prudent to introduce a small wad of 
cotton into the auditory canal to preserve the membrana tympani."-"Bernhard and Huette's Operative Surgery." 
Van Buren and Isaac's Am. Ed., p. 168. 1857. 
The whole series of forceps, from the crude instruments of the earliest surgeons to those of the present day, are 
manifestly unfit for securing a firm grip on a foreign body which presents but a small part of its surface, and that a 
convex one, to their grasp. To this remark I make the one exception of the Tiemann bullet forceps, so successfully 
used in the late War of the Rebellion, and its smaller form, which finds a place in some of the pocket cases of the 
present day (Fig. 2057). In this instrument the teeth are set in such a manner that, even when only a small part of 
the foreign body can be reached, they can be firmly engaged in it and a considerable extractive force can be employed. 
It will be remembered that a trifle more space is obtained and the ease of extraction increased in the case of a tightly 
fitting body, if the patient is caused to open his mouth during the process, an experiment which any one can try by 
putting his little finger in his ear.-F. H. Brown, M. D., in American Journal of Otology, January, 1881. 
Quire's Nasal and Ear Curette (Fig. 2051, page 191) is introduced with short bar straight, and, after its introduc- 
tion beyond the foreign body to be removed, the short bar is brought to the angle required by the action of the index 
finger and thumb on the spring.-Medical and Surgical Reporter, July 3, 1880. 
For the Removal of Foreign Bodies and Polypi. 
The principle involved in 
the ecraseur is that the pedicle 
is embraced and severed by 
ecrasement. In this procedure 
the whole growth is removed, 
and, at the same time, some of 
the connective tissue fibres are 
drawn out from the mucous 
membrane : thus no polyp tis- 
sue remains from which a new 
growth may develop. The in- 
strument shown is a combination of the ecraseur principle with that of the snare : a modification of Jarvis' and Wilde's 
instruments, in which the manipulation of the loop is entirely under ocular inspection during the operation.-Medical 
News. February 24, 1883. 
See Snare-Ecraseurs for Nasal and Pharyngeal Polypi. 
Fig. 2042.-Bosworth's Snare Ecraseur, for Aural and Nasal Polypi. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
191 
AUf^Ah. 
For the Removal of Foreign Bodies, Flakes of Epidermis, Wax, Hair and Fluid Secretions, 
and for Dressing. 
Fig. 2043.-McKay's Ear Forceps. 
Fig. 2044.-Buck's Ear Curette. 
Fig. 2048.-Speir's Ear Curette. 
Fig. 2049.-Fenestrated Ear Scoop. 
Fig. 2045.-Politzer's Hard Rubber Ear Spoon. 
Fig. 2046.-Gross' Ear Spoon and Hook. 
Fig. 2047.-Elsberg's Angular Screw-Hook. 
Fig. 2050.-Angular Ear Hook. 
Fig. 2053.-Devil's Screw-Hooks. 
Fig. 2051.-Quire's Nasal and Ear Curette, 
Fig. 2054.-Sexton's Ear Dressing Forceps. 
Fig. 2052.-Politzer's Cotton-wool Forceps. 192 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/vURAId 
For the Removal of Foreign Bodies and Polypi. 
Fig. 2055. 
Pomeroy's Ear Forceps, 
Fig. 2056.-Avery's Ear Forceps. 
Fig. 2057.-Tiemann & Co.'s Foreign Body Forceps. 
Fig. 2059.-Politzer's Polypus Forceps. 
Fig. 2058.-Tiemann & Co.'s Ear Forceps and Reflector. 
Fig. 2060.-Hinton's Polypus Forceps. 
Fig. 2061.-Hinton's Double- 
jointed Polypus Forceps. 
I* IG. 2062.-Bumstead's Canulated Forceps. 
Fig. 2063.-Wilde's Polypus Snare. 
Fig. 2064.-Blake's Polypus Snare. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
193 
AUF<AL 
For the Removal of Foreign Bodies, Polypi, &c, 
Fig. 2065.-Tiemann & Co.'s Universal Ear Forceps, 
Fig. 2066.-Allen's Polypus Forceps, and for 
Removing Solid Bodies. 
Fig. 2069.-Sexton's Folding Tongue-Depressor. 
Fig. 2070.-Vulcanite Cotton-wool Carrier. 
Fig. 2067.-Bacon's Blunt 
Curette Ear Forceps. 
Fig. 2068.-Sexton's Double Curette. 
Fig. 2073.-Sexton's Handle, with Polypus Snare, Myringotome, Sharp-pointed Knife, 
Probe-pointed Knife, Stout Silver Probe, Hoe-shaped Scraper. 
Fig. 2071.-Sexton's Foreign Body Forceps. 
Fig. 2072.-Noyes' Ear Forceps. 194 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
AUf^AL. 
DOUCHES AND SYRINGES. 
For Removing Foreign Bodies and Cleansing the Ear after Operations, and in Chronic 
Suppurations of the Middle Ear, and for Alleviating Pain. 
Fig. 2074.-Lucae's Reflux Ear Douche. 
Fig. 2075.-Hard Rubber Ear Syringe. 
Fig. 2078.-Soft 
Rubber Ear Syringe. 
Fig. 2076. 
Bag Ear Syringe, 
Fig. 2077.--Kramer's Ear Syringe. 
Fig. 2080. 
Buck's Ear Nozzle. 
Fig. 2079.-Sexton's Ear Douche. 
Fig. 2081.-A. II. Smith's Ear Syringe. 
Fig. 2082.-Pomeroy's Ear Syringe. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
195 
AUF^AL. 
DOUCHES, PUS BASINS AND SPOUTS. 
" The warm douche is very valuable in the treatment of chronic eczema of the canal. It allays itching sensa- 
tions, and is usually very grateful to the patient. The use of the douche may be entrusted to the patient himself. It 
is well to use it very often in the early periods of treatment-say once an hour. The warm water is a direct 
antiphlogistic ; I have seen its use alone cure most obstinate cases of inflammations of the canal that have existed 
for years."-"Treatise on Diseases of the Ear." St. John Roosa, p. 118. 1873. 
Fig. 2083.-Ear Spout 
and Hose. 
Fig. 2085. 
Up de Graff's Ear Basin. 
Fig. 2084.-Hosner's Ear 
Spout. 
Fig. 2087.-Eiterbecken (Pus Basin), Brass 
Fig. 2086.-Bonder's Ear Spout. 
Fig. 2089.-Triangular Pus Basin. 
Fig. 2088.-Pus Basin, Hard Rubber or Tin. 
Fig. 2090.-Elastic Caustic-Holder, for the Application of Powders and Caustics. 
Fig. 2091.-Buck's Cotton Probe. 
Fig. 2093.-Buck's Port Acid Glass. 
Fig. 2092.-Sexton's Powder-Blower. 
Fig. 2094.-Knapp's Powder-Blower. 196 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/vURAk 
FOR THE MEMBRANA TYMPANI AND THE INNER EAR. 
Fig. 2095. 
Weber's Tensor Tympani Instrument. 
Bistouries, Myringotomes, 
Furuncle Knives, 
Scissors for the Ossicula 
Auditus. 
Fig. 2096. 
Gruber's Tensor Tympani Instrument. 
Fig. 2097.-Gruber's Scissors. 
Fig. 2098.-Simrock's Scissors, 
for Operating on the Tympanum and Small Bones of the Ear. 
Fig. 2099.-Politzer's Tympanum Perforator, Angular Myringotome. 
Fig. 2100.-Blake's Inner Ear Syringe. 
Fig. 2105.-Politzer's Tympanum Perforator, Straight Myringotome. 
Fig. 2104.-Prout's Myringotome. 
Fig. 2to6.-Buck's Sharp-Pointed Bistoury. 
FlG. 2107.-Buck's Probe-Pointed Bistoury. 
Fig. 2101.-Politzer's Forceps, 
for Introducing Eyelets into the Perforated Tympanum. 
Fig. 2102.-Buck's Furuncle Knife. 
Fig. 2103.-Buck's Myringotome. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
197 
/cURAk 
FOR PERFORATING THE MASTOID PROCESS AND THE REMOVAL OF NECROSED BONE. 
Fig. 2108.-Buck's Mastoid Process Knife. 
Fig. 2110.-Buck's Pereosteotome. 
Fig. 2109.-Burnett's Knife, for Mastoid Process. 
Fig. 2111.-Hand Gouge. 
Figs. 2112 and 2113.-Buck's Chisels. 
eSchwarze's Chisels and Gouges. 
2114 2115 2116 2117 2118 2119 2120 2121 
Fig. 2123.-Post's Rongeur, 
for Removing Necrosed Bone. 
Fig. 2126. 
Gruening's Mastoid 
Drainage Tube. 
Fig. 2124, 2125. 
Knapp's Mastoid 
Drainage Tubes. 
Fig. 2127.-Buck's Drills. 
Fig. 2129.-Politzer's Mastoid Scoop, 
Fig. 2128.-Politzer's Mastoid Knife, 
See "Mallets," pp. 102-13. 
Perforation of the Mastoid. 
The conditions under which the mastoid may be properly operated upon, either in periostitis or caries, may be for- 
mulated as follows: 
1. The integument and periosteum should be freely divided over the mastoid in all cases in which there is pain, 
tenderness and swelling in the part.-Wilde. 
2. Such an incision should also be made whenever severe pain, referred to the middle ear, exists, and is not re- 
lieved by the usual means, i. e. leeches, warm water, &c. 
3. An explorative incision should be made when we have good reason to suspect the existence of caries and 
retained pus in this part. 
4. The mastoid bone should be perforated after such an incision whenever the bone is found diseased, or a small 
fistulous opening should be enlarged. It should also be perforated when we have good reason to believe that there is 
pus in the middle ear or mastoid cells which cannot find an exit by the external auditory canal. 198 
GEORGE TIEMANN CO.'S SURGICAL INSTRUMENTS. 
AU^AL. 
Perforation of the Mastoid. (Continued.) 
5. The mastoid should be perforated in the case of a suppuration of 1< ng standing, with frequent and painful 
exacerbations. 
The operation may now be sure to be fairly established, and is frequently undertaken, it having been performed 
by Follin, Schwartze, Pagenstecher, Hinton (London), Jacoby, Agnew (New York), Colles (Dublin), and by myself 
since 1859.-Dr. St. John Roosa. 
Dr. A. H. Buck has appended to his articles on mastoid disease (from which I have quoted), a table containing 
thirty-four cases of opening of the mastoid, beginning with Arneman. Drs. Weir, Laight and Buck of this city, 
Drs. Newton, of Brooklyn, and North, of Waterbury, Conn., are among the surgeons who have operated since 1870, 
and this second surgical procedure may be said to be fairly established in the profession. Twenty-six cases reported 
by Buck resulted in lecovery.-" Treatise on the Diseases of the Ear." St. John Roosa, M. D., p. 424. 1873. 
Peroxide of Hydrogen in Mastoid Abscess. 
Dr. Prince, having learned of the peculiar property of peroxide of hydrogen, as applied by dentists, that upon 
coming into contact with the pus in the foetid cavity of a tooth, the liberated gas permeates it throughout, and by the 
continued evolution of the gas the cavity is emptied of its contents, which boil out at the fistulous opening so thor- 
oughly mixed that the appearance is that of foam or froth ; while the remnant not thus removed is rendered so thor- 
oughly antiseptic that the healing process proceeds uninterruptedly, he was led to apply it in mastoid abscess, and re- 
ports a case in the St. Louis Medical and Surgical Journal, March, 1884: 
" Julia, eight months old. Suppuration following scarlatina had existed about ten weeks, when the mastoid be- 
came invaded and continued to grow worse, until it assumed a serious aspect with marked symptoms of septic poison. 
When it came under observation the child had become much emaciated with continued fever and loss of appetite. 
Examination revealed absence of the drum membrane, exceedingly offensive pus, granulations in the tympanic cavity, 
with swelling, redness and heat over the mastoid. These symptoms established the presumption, if not the certainty, 
that the disturbance was caused by a quantity of confined and foetid pus, somewhere among the mastoid cells. Act- 
ing on this conception of the case, a drill was passed through the mastoid directly into the tympanic cavity. A fenes- 
trated cataract spoon was then placed into the drum cavity, with the opening in the line of the direction of the drill, 
which was then withdrawn, and a flexible lead wire passed along its track until the end reached the fenestrum of the 
spoon, by the removal of which its extremity was directed into the meatus. By the aid of the angular forceps it was 
then drawn out and turned down on the cheek. It was now possible, through the cutaneous opening in the mastoid, 
to inject antiseptic solutions which escaped from the external meatus. This usually successful monoeuvre failed. The 
capacity of my hypodermic syringe was injected by the side of the lead wire, the finger of the remaining hand being 
held over the external meatus. Upon withdrawing the syringe, and preventing the escape of the liquid, the liberated 
oxygen must have penetrated every accessible recess of the mastoid cells, with the same force that caused it to boil out 
of the external openings, baffling all efforts to restrain it. The conduct of the agent was in every respect satisfactory, 
and the quantity of pus dislodged by this tumultuous effervescence proved it to have reached the seat of trouble, and 
the intimate mixture of gas and pus, which appeared as a yellow froth at the points of escape, reminds us of its be- 
havior under the microscope, where it is seen that no cell escapes its disturbing action. By repeated injections, so long 
as any pus remains, the oxygen will continue to be liberated ; hence, by the absence of the evolution of gas, an evi- 
dence exists that the cavity is completely empty and the surface freed from the presence of pus. 
Eustachian Catheters. 
From the date of the promulgation of the use of the eustachian catheter by the postmaster of Versailles, Guyot, 
until Toynbee's time, the views of the profession as regards the use of this instrument have varied exceedingly. At 
one time it was almost utterly rejected by the greater number of respectable practitioners, and at another time has 
been considered by them as a panacea in the treatment of aural disease. The text-books of Wilde and Toynbee, 
which attached very little importance to the use of the eustachian catheter, and which bear intrinsic evidence that the 
authors did not choose to be very familiar with the details of the proper employment of the instrument, probably did 
more than anything else to cause the profession in our own country to settle down, until a few years since, into the 
belief that the eustachian catheter was always a useless and sometimes a dangerous instrument. * * * In 
regard to the change in sentiment I only need to say that nearly every American surgeon who now treats aural dis- 
ease, attaches much importance to the use of this instrument. 
The material of which the instrument should be made, may be either alloyed silver or hard rubber. For diagnosis 
the silver catheter is to be preferred. For the injection of warm vapors, the india-rubber instrument is the only one to 
be used, because the heat will very soon make it impossible for a patient to bear the metal instrument in the nostril.- 
" Treatise on the Diseases of the Ear." St. John Roosa, p. 93. 1873. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
199 
AUF^AL. 
FOR THE EUSTACHIAN CANAL. 
Fig. 2130.-Eustachian Catheter, Hard Rubber or Silver. 
Fig. 2131.-Wire Nose Clamps, 
for Holding the Eustachian Catheter. 
Fig. 2133. 
Pomeroy's Kramer's 
Eustachian Catheter Holder. 
Fig. 2132.-Sexton's Eustachian Catheter. 
Fig. 2135.-Noyes' Eustachian Catheter. 
Fig. 2138.'-Dr. Ferguson's Eustachian Catheter, soft rubber, velvet-eyed 
point, flat metal spiral inside. 
Fig. 2136.-Fitzgerald's Eustachian Catheter. 
Point of spiral wire, covered with rubber. 
Fig. 2137.-Woakes' Eustachian Catheter. 
Fig. 2134.-Bonafont's 
Eustachian Catheter Holder. 
"Dr. Noyes has modified the eustachian catheter by giving the beak a double curve of extra 
length. The cut exhibits the manner in which the second curve is made to point exactly in the 
direction of the eustachian tube. When introducing the catheter, it is needful to keep the front 
close to the septum, as well as to the floor of the nostril. Arrived at the posterior edge of the sep- 
tum, the beak should wind closely around it, curving obliquely across, and turning upwards, so as 
to point towards the eustachian orifice."-" Transactions of the Otological Society." 1870. 
Dr. Sexton's eustachian catheter is made partly of German silver, point of rubber, for painless 
introduction.-Medical Record, N. Y., July 16, 1881. 
Auscultating the Middle Ear, by Catheterization of the Eustachian Tube. 
"For this purpose the patient should be seated with his back and head firmly supported in the erect position. The 
operator places one end of the otoscope (Fig. 2015) in the external ear of the patient corresponding to the tube to be 
examined, the other end being similarly placed in his own ear. It will facilitate the accommodation of the instrument 
if its hard tips be covered with a short length of soft rubber tube, which enables them to be tolerated by the external 
meatus of each, without that annoyance which is apt to occur if this precaution be omitted. 
" The surgeon takes the short silver eustachian catheter (Fig. 2137) between the forefinger and thumb of his right 
hand and introduces it into the nostril of the patient on the side that already supports the diagnostic tube. In doing 200 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
AUF^AL 
Auscultating the Middle Ear. (Continued.) 
this, care must be taken to prevent the beak of the catheter striking against the margin of the nostril, or, beyond this, 
the contents of the nasal fossa; to aid this step, it may be convenient to tilt up the end of the nose with the forefinger 
of the operator's left hand. When the beak has thus freely passed the vestibule, it should be depressed until it is felt 
to rest on the floor of the nose; it is then passed onward, being held all the while so lightly that any check which may 
be encountered is appreciated by the operator before pressure has been applied to the obstruction and pain thereby 
elicited. 
"When, by the cessation of the resistance afforded by contact with the nasal floor, the operator becomes aware 
that the instrument has entered the post-nasal space, he should give it a quarter turn inward, and gently withdraw it 
until the curve of the catheter touches the septum. The patient having all this time been directed to breathe entirely 
through the nose and to keep his mouth closely shut, the veil of the palate should not be encountered ; the surgeon is 
now, therefore, free to make a firm but gentle turn of the instrument over half a circle outward, following the depend- 
ent surface of the palate as his guide, until the ring of the instrument corresponding to its curve lies horizontally 
outward and a little upward. If this proceeding has been successfully accomplished, the back of the catheter will 
be now resting in the orifice of the eustachian tube. * * * When the catheter is introduced in this 
manner the surgeon need not concern himself about the posterior wall of the pharynx, as his instrument does not 
approach it. * * * 
" It is necessary to have some guide to the situation of the orifice of the eustachian tube, and this is afforded by 
the straight posterior border of the septum nasi (vomer), with which the curve of the catheter is brought into contact by 
means of the quarter turn inward given to it as it leaves the cavity of the nose. When the concluding step of the 
operation is accomplished by the half turn outward, the mouth of the tube will be entered by the catheter. This latter 
step cannot be executed at all unless the conditions of breathing above indicated be followed ; for, if the patient breathe 
through his mouth, the veil of the palate will be drawn upward and fix the catheter as in a vice, at the same time 
causing much pain to the patient. The various details of the mode of catheterization above described have been con- 
tributed by several otologisis, but especially by Loewenberg, of Paris."-" Post-Nasal Catarrh." Woakes. 
An improved form of Eustachian Catheter. (Fig. 2138.) 
In order to overcome the difficulty of passing an eustachian catheter in cases where the inferior turbinated bone 
or a displaced septum encroach on the nasal passage, and to avoid giving pain to the patient when the nasal mucous 
membrane is much swollen and sensitive, it occurred to me that a soft rubber catheter might be used, fitted with a 
straight style, on withdrawal of which the catheter would resume its curve. My idea has been very carefully carried 
out by Messrs. Tiemann, and the instrument has given very satisfactory results so far as I have yet been able to try it. 
The catheter is of the ordinary shape, and is of soft red rubber, having inside the stem, and extending nearly to the 
point, a spiral of fine wire, which prevents the lumen of the instrument being lessened by pressure when in position. 
There is a straight style of the same length as the catheter, which, when it is introduced, obliterates the curve at the 
beak. The catheter on the style is introduced like a straight probe along the floor of the nostril, with the side to which 
the beak tends to curve outward. When the back of the pharynx is felt, the style is withdrawn and the beak curls 
around to the mouth of the eustachian tube. In several cases I have not had to draw it forward at all, for the curve 
of the beak withdraws the point about the right distance. The instrument passes through very much obstructed nostrils 
and gives no pain in cases in which the hard rubber catheter cannot be tolerated.-11. Lindo Ferguson, F. R.C. S. J., 
Dunedin, N. Z., Archives of Otology, Vol XIII., Nos. 3 and 4. 
Inflation of the Cavity of the Tympanum through the Eustachian Tube. 
The purposes for which inflation is practised are: First, diagnosis ; in order that the permeability of the tube 
maybe determined ; and in order that, by the diagnosis tube applied at the same time to the external ear, or by inspec- 
tion with the reflector, the condition of the middle ear may be ascertained through the medium of the various rales, 
and also the movements of the ossicula and of the tympanum. 
Second, treatment; that is, for the purpose of removing secretions from the tube and middle ear, overcoming 
slight adhesions of the tube, and preparing the way for the introduction of medicated fluids, or vapors, &c. 
Politzer, of Vienna, introduces the nozzle of a gum-elastic bag into the nares, and compressing the ala? with his 
thumb and fingers, directs the patient at the same moment to swallow. The act of deglutition lifts the velum palati, 
and opens the mouth of the eustachian tube, thus enabling the current of air, or of fluid, to pass more directly into 
the ear. In children, the orifice of the eustachian tube being much larger than in adults, it is not necessary to direct 
them to swallow while the air is being injected. Gruber has modified the practice of Politzer, by directing a current 
of water into one nostril, while the other is closed, and the head bent forwards ; when, in the case of children, some 
of the fluid will generally find its way into the corresponding eustachian tube. In adults, it is recommended to close 
both nostrils and the mouth, and to direct the patient to make a moderate attempt to blow while the current is passing 
in.-" The Principles and Practice of Surgery." Hamilton, p. 590. 1872. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
201 
AU^Ah. 
FOR THE EUSTACHIAN CANAL. 
Fig. 2139.-Politzer's Air-Bag, for Inflating the Eustachian Canal 
Fig. 2141.-Hardy's Chloroform Douche. 
Fig. 2140.-Roosa's Attachment and Politzer's Air-Bag, for Treating Diseases 
of the Middle Ear. 
" The bulb contains a moist sponge, on which are placed a few drops of tincture of 
iodine. The combined apparatus is then used in the same manner as the ordinary air- 
bag, which constitutes Politzer's apparatus."-St. John Roosa, M. D., " Trbltsch on 
the Ear," p. 248. 1869. 
Fig. 2143.-Hackley's Instrument for Spraying the 
Eustachian Canal. 
Fig. 2142.-Sexton's Insufflator. 
Fig. 2144.-Buttle's Inhaler, and for Forcing Medicated 
Vapors into the Eustachian Canal. 
Fig. 2145.-Sexton's 
India-Rubber Nozzle for 
Politzer's Air-Bag. 202 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/vURAb 
Roosa's Set of Ear Instruments. 
$43-40. 
I Troeltsch's Ear Mirror, with handle, and Roosa's 
Head-band, 
1 set of three Wilde's Tubular Specula. 
1 pair of Wilde's Angular Forceps. 
1 Scalpel and David's Curette. 1 Cotton Probe. 
1 Eustachian Catheter, silver. 
1 Eustachian Catheter, hard rubber. 
1 Posterior Nares Syringe, hard rubber. 
1 Roosa's Iodine Apparatus. 
6 Toynbee's Artificial Tympana. 
1 Diagnostic Tube and Explorer. 
I Siegle's Pneumatic Otoscope. 1 Tuning Fork (C). 
I Small Powder-Blower, hard rubber. 
1 Blake's Ear Snare and Paracentesis Needle. 
1 Morocco-covered Case, lined with velvet. And, 
1 Politzer's Apparatus, in a separate paper box, $2. 
Politzer's Set of Ear Instruments. 
$22. 
1 Troeltsch's Mirror, with handle. 
3 Hard Rubber Ear Specula. 
1 Hard Rubber Curette. 1 Curette and Hook, steel. 
1 Polypus Knife, steel. 1 pair of Angular Forceps. 
1 Wilde's Polypus Snare. 1 Hard Rubber Syringe. 
2 Hard Rubber Eustachian Catheters. 
1 Diagnostic Tube and Explorer. 
1 Morocco-covered Case, lined with velvet. 
Toynbee's Set of Ear Instruments. 
$23.20. 
3 Silver Ear Specula (Toynbee's). 
1 pair of Rectangular Forceps. 
1 Metallic or Hard Rubber Syringe. 
1 Ear Spout. 1 Wilde's Polypus Snare. 
1 pair of Ring Polypus Forceps. 
4 Artificial Tympana. 
1 Otoscope (Diagnostic Tube) and Explorer. 
1 Eustachian Catheter, hard rubber. 
1 Morocco-covered Case, lined with velvet. 
Buck's Set of Ear Instruments. 
$35. 
2 Curettes. 1 Mastoid Process Knife. 
4 Cotton Holders. 1 Port Acid Glass. 
1 Silver Probe. 1 Silver Probe. 
1 Blunt-pointed Curved Bistoury. 
2 Myringotomes. I Furuncle Knife. 
1 Sharp-pointed Curved Bistoury. 
2 Drills for Mastoid Process. 
1 Mirror, 2J inch diameter, and Head-Band. 
1 Wild's Ear Forceps, very delicate. 
1 Blake's Snare, silver canula, only one hole, to receive 
No. 37 wire doubled. 
1 set of (4) Wild's Ear Specula, silver. 
1 Fine Morocco Case, silk velvet lining. 
Turnbull's Set of Ear Instruments. 
$68. 
I Troeltsch's Ear Mirror, with handle and headband. 
I set of (3) Rhinoscopic Mirrors, to fit one handle. 
I set of (3) Gruber's Tubular Specula, German silver, in 
a case, to be carried in the vest pocket. 
1 Tuning Fork (C), to test the condition of the audi- 
tory nerve. 
1 Explorer and Diagnostic Tube, pair. 
I Eustachian Catheter, hard rubber, small size. 
1 Politzer's Apparatus, attachable to. 
1 Capillary Spray, for injecting the middle ear. 
1 Ear Syringe, hard rubber. 
1 Turnbull's Curette, soft silver. 
1 Turnbull's Angular Forceps, for removing foreign 
bodies. 
1 Turnbull's Sickle-shape Knife and Curette, for open- 
ing furunculous abscess in the external meatus. 
I Ear Spout. 
I Clarke's Douche, for the ear and eye. 
I Wilde's Polypus Snare. 
1 Probe. 
I pair of Polypus Forceps, Politzer's. 
I Gruber's Tenotome (3 blades). 
1 Politzer's Tympanum Perforator. 
I Catarrhal Syringe, posterior nares. 
1 pair Thudichum's Nasal Specula, right and left. 
1 Powder Blower. 
1 Drill, for perforating mastoid cells. 
1 Morocco-covered case, lined with velvet. 
Sexton's Set of Ear Instruments. 
$35- 
1 Handle, into which are fitted : 
1 Polypus Snare. 1 Sharp-pointed Ear Knife. 
1 Myringotome. 1 Probe-pointed Ear Knife. 
1 Stout Silver Probe. 1 Hoe-shaped Scraper. 
1 Foreign Body Forceps. 
1 Small Dressing Forceps. 
1 3 inch Head Mirror and Band. 
1 set of German Silver Ear Specula. 
1 Sexton's Folding Tongue Depressor. 
1 Sexton's Double Curette. 
1 Vulcanite Cotton-Wool Carrier. 
1 Aluminium Cotton-Wool Carrier. 
1 Silver Probe, 6| inches long. 
1 Scalpel and Tenotome, in slide-catch tortoise-shell 
handle. 
1 Case, covered with morocco, lined with silk velvet. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
203 
/cURAL. 
ARTIFICIAL EAR. 
An auricle, having the shape of the natural external ear, of gutta-percha or soft rubber, colored to resemble nature 
and attached by clasps or otherwise to the remnants of the ear lost by disease or accident. It is made in the following 
manner: first, a plaster of paris cast of the other, sound ear, is taken, then the model is reversed and a metal mold 
formed, into which plastic india rubber is cast and, finally, baked by the regular vulcanizing process ; it is then colored 
by an artist to match the complexion of the wearer. The process is a slow one, requires from two to four weeks time 
and the presence of the patient for part of the time. Full particulars will be given on application. 
JMAS/rL>. 
RHINOPLASTY. 
The object of this operation is to restore the nose in cases where it has been partially or entirely lost. Three chief 
methods have been described : 
" I. The method of Celstis, which consists in bringing forward the skin of the cheeks, and forming the septum, if 
necessary, from the upper lip. 
" 2. The Italian or Taliacotian, called also the German method, on account of the application of it made by Von 
Graefe, which consists in paring the edges of the nostrils and uniting them to a graft taken from the arm, but left 
attached to it until union has taken place. 
"3. The Indian method, practiced for ages in the East Indies, where cutting off the nose has been a common 
punishment for criminals, in which the graft is taken from the forehead."-Dunglison. 
" Rhinoplasty is always an important operation. It rarely effects as much as it promises, and the noses thus made 
frequently shrink and diminish in size, forming tubercles whose appearence is sometimes more hideous than the original 
deformity. At the present time, when the manufacture of noses of wax, pasteboard or silver, attached to spectacles, 
has reached such great perfection, rhinoplasty is performed only in extreme cases."-" Bernhard and Huette." 
After much experimenting, an artificial nose, made of thin silver, shaped to conform to the rules of beauty and, at 
the same time, to resemble the lost member as nearly as possible, has been found the most satisfactory. It is accu- 
rately fitted to the skin, covering the remaining part of the nose as well as the opening. It is held in place by a 
spectacle frame superiorly, while a pair of springs, attached to its base, enter the fossae and secure its position below. 
It can be worn with ease, is very light and, if nicely fitted, will hardly show points of attachment, being painted to 
correspond to the tint of the face. 
ARTIFICIAL NOSES. 
Fig. 2146.-Loss of Nose. 
Fig. 2147.-Artificial Nose 
Full particulars will be given on application 204 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
J^ASjAL 
" The nasal cavities are liable to malformations and to various accidents and diseases, of which the most impor- 
tant are: haemorrhage, ulceration, polypus, hypertrophy of the mucous membrane and foreign bodies."-"System of 
Surgery." Gross, Vol. II., p. 279. 1882. 
Instruments are employed for freeing and enlarging the inferior nasal channel. 
Rhinoscopy.-Examining or inspection of the anterior and posterior nares. 
Medicating and Cleansing.-Douches, insufflators. 
Epistaxis.-Stopping haemorrhage. 
Polypi and Foreign Bodies.-Removal of by forceps, snares, scoops, and destruction of polypi by hypodermic 
injections. 
Hypertrophy of the mucous membrane and the erectile tissue covering the lower turbinated bones.-Wire 
snares, ecraseurs, galvano-cautery. 
Deformity of the Nasal Bones, correction of ; and 
Deviation of the Septum.-Forceps, gouges, scissors, scalpels, clamps, &c. 
Nasal Stenosis.-Exostosis, Enchondrosis. 
SIMPLE OBSTRUCTIONS OF THE NOSE. 
" There are few who have not at some time or other experienced the discomfort and inconvenience of inability to 
breathe through the nose. A much greater amount of evil arises from such a condition than has hitherto been imagined. 
The obstruction depends on chronic inflammation or thickening of the mucous surface, which, throughout the windings 
of the nasal cavities and passages, goes by the name of the pituitary, Schneiderian, or olfactory membrane. It often 
exists to such an extent as to block up the passage of the nose entirely, and thus obstructs the principal channel through 
which respiration is, or ought to be, performed, as well as impedes the performance of various other functions. Besides 
the unpleasant effects on the expression of the face of persons who are thus obliged at all times to keep their lips apart 
or their mouths open to enable them to breathe, the respiration, the voice, and the sense of smell, there is one other 
circumstance to which less importance has been attached than it deserves, namely, the connexion of nasal obstruction 
with defective hearing. A free state of the nasal passages is of great importance to the acuteness and preservation of 
hearing * * * without it the function of the eustachian canal could not be properly performed." 
Nasal Probes and Dilators. 
Fig. 2148.-Yearsley's Elastic Dilator (or Naso-Gutteral Probe). 
" The effects of this instrument have answered my most sanguine expectations. It has relieved a large number of 
cases to which other kinds of treatment would have been ill-suited and inefficacious. The majority of them were 
cases of simple obstructions; but it has also proved of essential service in cases of deafness, complicated with the 
thickening of the mucous membranes. The passing of the probe (dilator) once or twice a day soon dilates the canal to 
such a size as to permit the passage of air to and fro; and, in addition to this, it appears to exert a salutary influence 
on the tract of mucous membrane extending to the ear." 
Mode of Using the Naso-Guttural Probe (Fig. 2148). 
Until expertness is acquired, the patient should place himself before a glass, holding the instrument between the 
finger and thumb. He then introduces it into the nasal opening, in an horizontal direction. Being once inserted, 
the slightest force will cause it to glide along the floor of the nostril uninterruptedly, until its extremity strikes the 
back of the throat, the sensation of which is instantly distinguished by the patient. Here it should be allowed to re- 
main a few seconds, and then gradually withdrawn, to be introduced in a similar manner along the opposite nostril. 
The operation should be followed by blowing the nose until the passages are free to admit the ingress and egress of air 
to and from the lungs. 
When it is recollected how many thousands of cases of deafness, proved to be irremediable by ordinary means, are 
rapidly approaching by almost imperceptible gradations toward total deafness, the importance of any remedy which 
affords even a chance of arresting the disorder, still more of ameliorating or curing it altogether, will be duly estimated. 
One or the other of these results will very frequently follow the employment of the instrument. This is not its only 
advantage, as it proves of much service in removing the obstruction to the voice, smell, and respiration, and is beneficial 
in other minor points.-From " Yearsley on Obstructions of the Nose." GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
205 
JMASAL 
Fig. 2149.-Woakes' Dilator, for Widening the Inferior Nasal Channel. 
"To overcome certain malformations of the lower spongy bone which tend to occlude the auditory channel of the 
nose and are especially opposed to the introduction of a eustachian catheter. The dilator is similar in principle to 
instruments adapted for stretching the rectum, &c. It is of the size of an ordinary silver eustachian catheter, and, be- 
ing nearly straight, can, when closed, be insinuated beneath the spongy bone without occasioning a breach of tissue. 
" By acting on the screw a gentle upward leverage is exerted upon the bone ; the amount of pressure so exerted 
being increased with each application." 
RHINOSCOPIC. 
Specula for the Inspection, and Examination of the Anterior Portion of the Nasal Cavities. 
Fig. 2150.-Bonafont's 
Nasal Speculum. 
Fig. 2151.-Bivalve Nasal Speculum. 
Fig. 2152. 
Simrock's Nasal 
Speculum. 
Fig. 2153.-Elsberg's 
Nasal Speculum. 
Fig. 2155.-Fraenkel's 
Nasal Speculum. 
Fig. 2154.-Shurley's Nasal Speculum, with 
Ivory Slide, right and left. 
Fig. 2156.-Robert and 
Collins' Nasal Speculum. 
Fig. 2157.-Collins' Nasal Speculum. 
Fig. 2158.-Goodwillie's 
Nasal Speculum. 206 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
NASAL,. 
RHINOSCOPIC 
Specula, Rhinoscopes, for Inspection and Examination of the Anterior and Posterior Nares. 
Fig. 2161.-Jarvis' Operating Nasal Speculum. 
By compressing the lower portion of this instrument, after the blades 
have been introduced into the nose, the ring near the joint will slip down- 
ward and make the blades self-retaining. 
Fig. 2160. 
Bosworth's Nasal 
Speculum. 
Fig. 2159.-Zaufal's Trichter Specula. 
Fig. 2162.-Jarvis' 
Nasal Speculum. 
Fig. 2163.-Andrew II. Smith's Nasal Speculum. 
Fig. 2166.-Folsom's Nasal 
Speculum. 
Fig. 2165.-Sexton's 
Nasal Speculum. 
Fig. 2164.-Thudichum's Nasal 
Speculum. 
The instruments required for careful and thorough examination in the ordinary treatment of diseases of the nose are: 
The Head Mirror.-The mirror is the same as is used in laryngoscopy ; the focus power should be from ten to 
twelve inches. It is a matter of individual choice whether it is perforated through the centre or not. 
Nasal Specula.-Framckel's (Thudichum's, or Goodwillie's). 
Tongue Depressor.-Turek's. 
Rhinoscope.-A very small mirror, at right angles to the shaft. A larger one may be used if tolerated by the 
patient. • 
Nasal Probe.-Silver, heavy, flat and probe-pointed-for ascertaining the presence of necrosed or denuded bone, 
or a foreign body ; its flat shape enables one to pass it easily through the meati for the purpose of ascertain- 
ing whether or not stenosis or stricture exists. 
Wagner's Rhinoscopic Set. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
207 
J^ASAL. 
Wagner's Rhinoscopic Set. (Continued.) 
Cotton-Holder.-For making topical applications of solutions to any part of the anterior or posterior nares. 
Nasal Brush.-Soft camel's hair brush on a rod bent at an angle of 450, fitted into either a permanent or shift- 
ing handle. It can be introduced behind the velum without coming into contact with the posterior wall 
of the pharynx, by which retching, gagging and nausea are avoided. By means of it solutions can be 
thoroughly applied to the posterior surfaces of the turbinated bones, septum and spaces between the septum 
and the bones. The posterior surface of the velum can also be touched, as well as the vault of the 
pharynx and the orifices of the eustachian tubes. 
Insufflators.-Constructed of hard rubber, one straight and one turned to the angle of the nasal brush, for the 
posterior nares, but in the majority of cases the straight one will suffice. The hand-ball may be used, or 
the compressed air from a large receiver, for expelling the powder. 
Sass' Spray Tube.-For cleansing and washing.-From " Diseases of the Nose." Clinton Wagner, M. D. 1884. 
POSTERIOR RHINOSCOPY. 
It is necessary to premise that all persons are not at once amenable to posterior rhinoscopy. For instance, where 
there is paresis of the palate, or hypertrophy of the fauces, or an excessively irritable faucial region, a preparatory 
course of treatment, directed to subdue the several obstacles, must be adopted before a satisfactory examination of the 
naso-pharynx can be accomplished. Various accessory measures have been recommended by authors, with the object 
of facilitating this inspection. Such are : catching the uvula in a loop of silk or wire, and by its means drawing for- 
ward the soft palate ; passing a curved spatula behind the velum, and so making forward traction upon it, &c. * * 
" Wales' method consists in passing a piece of soft string, previously stiffened at one end by saturation with mucilage 
(a useful addition suggested by Bosworth to facilate its introduction), through the anterior nasal meatus, until it appears 
below the soft palate, when it is caught in a long pair of forceps and drawn out of the mouth. A similar process is 
then gone through with regard to the other nostril. The two ends of each piece of string are respectively tied together 
outside the mouth, firm traction being made while doing so upon the velum. The latter is thus held forward in a 
manner best tolerated by the stretched tissues, and space afforded through which to observe the exposed region. * * 
The patient and surgeon should be arranged as for laryngoscopic observation, the former being directed to hold 
his head slightly forward, and to breathe through his nose while holding his mouth wide open. The observance of 
these details is essential to secure a flaccid and advanced position of the velum, which will otherwise tend to be drawn 
backward against the pharyngeal wall as soon as the tongue is depressed, thus rendering the proceeding an abortive 
one. It is just these preliminary steps that the patient can practice by himself, and, if ordinarily intelligent, will soon 
bring the region in question under control. 
The surgeon now lightly depresses the tongue with a small tongue spatula, held firmly in his left hand, taking care 
not to place this too far backward. 
With the right hand he introduces the small rhinoscopic mirror, previously warmed, into the pharynx behind the 
root of the tongue, taking care not to touch its sensitive posterior wall, and in such a way that its stem rests in the 
left commissure of the patient's mouth. By gently pressing the trigger with which the handle of the instrument (Fig. 
2171) is furnished with his right thumb, the observer can change the angle of the mirror from the horizontal plane to a 
right angle, and can maintain it at any angle he may desire. The light reflected from the forehead mirror is now 
thrown upon the smaller one located in the pharynx, whence it is directed upward, illuminating the space above the 
velum, while the image of the part upon which the rays of light fall becomes visible in the glass of the rhinoscope. In 
this way the posterior wall of the pharynx, with the pharyngeal tonsil, the vault and the choanae or posterior openings 
of the nares, with the corresponding aspect of the septum-nasi and the posterior surface of the velum palati, come 
successively into view, when the mirror is moved as above directed. To see the lateral walls of the pharynx and the 
orifices of the eustachian tubes and Rosenmuller's fossae, it is necessary to turn the mirror slightly toward the side it 
is intended to view. The reversal of the image in the mirror, as in laryngoscopy, is a source of confusion at first, 
indeed, much practice is required to overcome it, owing to the complicated outline of the parts brought into view and 
the varying depths at which these are seated. It must not therefor be expected that the entire region will be seen in 
the mirror at one glance."-" Post-Nasal Catarrh." Woakes. 1884. 
Fig. 2167.-Plain Rhinoscopic Mirror. 
See "Laryngeal," "Pharyngeal," 
"Naso-Pharyngeal, ''"Tongue Depressors," 
"Tonsil and Uvula Instruments." 208 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
NAS/cL. 
POSTERIOR RHINOSCOPY. 
Fig. 2168.-Jarvis' Rhinoscopic Mirror and Tongue Depressor. 
A stout wire, after being made to divide and assume the form of a tongue depressor, is crossed upon itself and 
then shaped into a pincette. Mirrors of different sizes are received between the pincette's blades, and are held at any 
desirable angle for viewing the posterior nares, and at the same time facili- 
tate depression of the tongue. 
" The tape-holders are intended to take the place of the unsatisfactory and 
disagreeable procedure of tying the ends of the tape, which passes around the 
palate. (See " Wales' method.") They are two small V-shaped spring clips, 
so arranged that the tape, passing through apertures in its blades, is caught 
by a tooth-like projection and firmly held. Pressure on the spring releases 
the catch and sets the tape free. One of the clips is provided with a rest 
for the ecraseur."-"Archives of Laryngology." Vol. II. April, 1881. 
Fig. 2169.-Jarvis' Tape Holders. 
Fig. 2170.-Duplay's Rhinoscope 
Fig. 2171.-Fraenkel's Rhinoscope. 
Fig. 2172.-Simrock's Rhinoscope. 
Fig. 2173.-Voltolini's Uvula Hook 
Fig. 2174.-Fraenkel's Uvula Hook. 
Fig. 2175.-Czermack's Uvula Hook. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
209 
^ASAb. 
Cleansing and Medicating the Nasal Passages. Douches and Irrigators. 
Dr. Gruber believes that harmful effects of the nasal douche are due to the entrance of fluid into the middle ear, 
and that, however proper it may be to intentionally inject fluid in small quantities into a diseased cavity of the tympa- 
num, it is manifestly incorrect to force it into an ear that was previously healthy, with no restriction as to quantity, as 
is done in the use of the nasal douche. 
Dr. Elsberg prescribed the nasal douche for more than 1600 cases, and has experienced no ill results. 
Dr. St. John Roosa does not believe that the nasal douche will necessarily cause aural disease, but that it is a 
dangerous means of treatment, which should be watched by the practitioner, and he hopes that the method of anterior 
syringing and the use of the posterior nares syringe may finally supplant the nasal douche."-" Treatise on the Dis- 
eases of the Ear." St. John Roosa. 
There can be but little doubt that the nasal douche, as a cleansing apparatus, is tolerably effective, although not 
nearly so thorough in its action as has been generally admitted. Being familiar with the frequent inflammatory diseases 
of the ear occasioned by its use, I am convinced it ought not to be used.-" Nasal Catarrh," p. 20. Robinson. 1880. 
If certain precautions in the use of the nasal douche are closely observed, not only will there be no unpleasant effects 
following its employment, but, on the contrary, the patient being pleased with its action, is not willing* to do without 
it. In the first place, the bottom of the vessel should, under no circumstances, be elevated more than an inch or so 
above the eyebrows of the patient, as otherwise the pressure is so great as to force the water into the frontal sinuses or 
the eustachian tubes, giving rise in the first instance to intense frontal headache, and in the second to an inflammation 
of the mucous membrane of the middle ear. (Here follow directions as to temperature, density or specific gravity of 
the liquid to be used, and the proper selection of cases.) " Diseases of the Throat," p. 207. Seiler. 1883. 
It is through the nose that normal respiration takes place, the post-nasal space being so located as to occupy an 
intermediate position between the nasal meati, which are the gateways of the respired current and the larynx, which 
admits the latter to the lungs through the trachea. It cannot be too strongly insisted upon that the mouth is only 
subsidiary to its function, and is used for this purpose only when obstruction exists in the naso-pharynx, by which the 
ingress of air through it is rendered difficult or impossible, or when very hurried respiration is excited by any cause, and 
then only as supplementary to the normal channel.-" Post-Nasal Catarrh," p. 108. Woakes. 1884. 
Fig. 2177. 
Thudichum's Nasal Douche 
Fig. 2178. 
Weir's Sniff Glass. 
Fig. 2176.-Clark's Nasal and 
Aural Douche. 
Fig. 2179.-Woakes' Nasal Irrigator. 
A glass tube for holding the fluid, with curved up arms ; one, 
tipped with a soft rubber nozzle, closes the nostrils when intro- 
duced. The bulbous portion is then raised until the fluid is felt 
by the patient in the nose ; the patient then forcibly inspires, 
when the contents are drawn inward, passing into the pharynx, 
and are readily expelled through the mouth. 210 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
J^ASAL. 
Cleansing and Medicating the Nasal Passages. Syringes, Douches and Sprays. 
Fig. 2180.-Fiillgraff's Nasal Douche. 
Fig. 2181.-Chapman's Nasal 
Spray. 
Fig. 2182.-Hard Rubber Laryngeal and Posterior Nares Syringe. 
Fig. 2183.-Warner's 
Catarrhal Douche. 
Fig. 2184.-Bennett's Posterior Nares Syringe. 
Fig. 2185.-Yearsley's Naso-Pharyngeal Syringe. 
For the purpose of washing the back part of the nares, the upper part of the throat and 
the mouths of the eustachian tubes. 
The apparatus is composed of a cautchouc bottle for the reception of the gargling fluid, and an elastic tube to con- 
vey the fluid across the floor of the nostril. The tube is introduced along the nostrils, in the same way as the elastic 
nasal dilator (Fig. 2148). Before pressure is exercised on the previously filled bottle, withdraw slightly the extremity 
of the tube from the back of the throat, to admit of the fluid being expelled; or the contents of the bottle may be 
squeezed out during the act of withdrawing the instrument, whereby not only the throat and adjacent parts, but the 
nasal passages also, become well washed by the injection. 
If the facility of washing the throat through the nose were known, it would not be long before it would become a 
general practice ; for it is very certain that gargling the throat through the mouth, though so frequently recommended, 
is but rarely accomplished. Owing to the action of the veil of the palate, the gargling fluid is confined to the cavity 
of the mouth, and rarely enters the throat at all.-" Yearsley on the Throat," p. 74. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
211 
J^ASAL. 
Cleansing and Medicating the Nasal Passages. Douches, Applicators, Brushes, Insufflators. 
Fig. 2186. 
Fiillgraff's Laryngeal and Posterior 
Nares Douche. 
Fig. 2187.-Powder-Blowing Tubes, for the Posterior Nares. 
Fig. 2188.-Robinson's Powder Blower. 
Fig. 2189.-Bosworth's Applicator. 
Fig. 2190.-Wagner's Post-Nasal Brush. 
2 Stems, 12 Brushes. 
Fig. 2191.-A. H. Smith's Nasal Applicator, for Nitric Acid. 
Fig. 2193. 
Bridge's Auto-Insufflator. 
Fig. 2192.-Bridge's Nasal Douche. 
See " Roosa's 
Iodine Apparatus," 
page 201. 212 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
J^ASAL 
EPISTAXIS 
Clamps, Tampons, Canulas, to arrest Haemorrhage. 
Fig. 2194.-Caro's Nasal Clamp. 
Fig. 2196.-Belocq's Canula for Epistaxis. 
Fig. 2195.-Rubber Tampon for Epistaxis. 
N ose-Bleeding. 
"A common case of epistaxis requires but little treatment, especially if in a young person. Light diet and a dose 
or two of the sulphate of magnesia will be sufficient. The flow of blood has been arrested by directing the patient to 
stand up with his head elevated, compressing the nostril with the finger, raising the corresponding arm perpendicularly, 
and holding it in this position for about two minutes. In more severe attacks cold and astringent washes of alum, sul- 
phate of zinc, weak sulphuric acid, or creosote, may be used, and the nostrils be plugged anteriorily; but if the bleed- 
ing goes on posteriorily, choanorrhagia, the posterior nares must be plugged likewise-the patient being kept with the 
head elevated, and on dry diet."-Dunglison. 
" A roll of lint (or styptic cotton) to stop the posterior opening of the nasal fossa is made, and to this a very strong 
silk thread is tied, whose extremities are long enough to reach from behind forward through the nostril. Belocq's 
sound, or a very flexible gum-elastic catheter, is introduced by the nostril; when the extremity of the instrument is in 
the pharynx, the button of Belocq's sound is sprung-or, if a gum-elastic catheter is used, its end is drawn out through 
the mouth ; to this the threads of the plug are attached, and by withdrawing the catheter they are brought from behind 
forward through the nostril. By pulling upon the threads the plug is introduced into the posterior nasal opening, which 
it stops as completely as possible. A second plug, slid between the two threads, should be tied into the nostril in front 
and allowed to remain for two or three days. 
" To withdraw the plugs, the thread in front of the nostrils must be cut; the posterior plug can be seized through 
the mouth by a pair of forceps, or pushed backward into the pharynx by means of a catheter carried through the 
nostrils. * * * It is more surgical to attach a ligature to the posterior plug, before its introduction, which 
is brought out at the mouth and attached temporarily in front; by drawing on this the posterior plug can be more 
readily removed. Without this precaution the withdrawal of the posterior plug is sometimes a troublesome and very 
painful process. Sponge is a good substitute for lint as a material for plugs."-" Bernhard and Huette's Manual of 
Operative Surgery." Am. Ed., p. 193. 1857. 
The rubber tampon (Fig. 2195) is introduced into the nasal fossa by means of a sound ; air or water is then thrown 
in, and the end, outside of the nostril, firmly secured. 
Ordinary Method of Plugging the Nose. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
213 
fJASAh. 
POLYPI AND FOREIGN BODIES. 
Removal by Forceps, Snares, Scoops, Probes, Torsion, Strangulation, Ecrasement 
and Galvano-Caustic. 
Fig. 2197.-Gross' Polypus Forceps. 
Fig. 2198.-Polypus Forceps, 
Crossing Blades. 
Fig. 2199.-Nasal Polypus Forceps. 
Fig. 2200.-Foreign Body Hook. 
Fig. 2201.-Buck's Nasal and Ear Curette. 
Fig. 2203.-Nasal Polypus Canula. 
Fig. 2202.-Simrock's Polypus Forceps. 
See "Batteries and Slings," page 38. 
See "Ear Instruments for Foreign Bodies," page 191. 
Fig. 2204.-Upson's Syringe, for Hypodermic Injections of various 
substances for the Destruction of Polypi. 
" It consists of an ordinary hypodermic syringe, provided with a long, hollow needle, which is passed through a silver 
canula properly curved at its extremity. The outer surface of the needle, for a short distance from its attachment to the 
syringe, has cut upon its surface a screw-thread, which is fitted with a traverse-nut, to regulate the depth of puncture of 
the growth. Two shanks, with finger-rests at one end, are passed through rings on the side of the syringe and attached 
at their other extremity, by means of set-screws, to the canula, to enable the surgeon to operate the instrument with 
one hand. The flat wings at the end of the syringe serve as thumb-rests. The tip of the canula is made to unscrew, 
and in its place can be fitted the fine spray-jet which accompanies the instrument. * * * 214 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
JMASAL. 
Destruction of Polypi by Hypodermic Injection. Use of Upson's Syringe (Fig. 2204.) 
" First charge the syringe with the desired quantity of the solution to be injected-I generally prefer acetic acid, 
gtt. x.-xv. ; then place the patient in a good light-either direct or reflected-draw forward and depress the tongue 
with a proper instrument, which may be entrusted to the patient to hold, or the tip of the tongue may be covered with 
a napkin, drawn forward and held out of the way by the patient. After cautioning the patient to breathe quietly 
through the nose, introduce the rhinoscopic mirror below and a little back of the palate, and, as soon as you secure a 
good image in the mirror of the growth, introduce the canula with the free hand, project the needle the desired depth 
into the growth, move the thumb back from its rest to the piston, and slowly inject the contents of the syringe into the 
tumor."-Ch. R. Upson, M. D., Surgeon to the Department of Nose, Throat and Lung Diseases, Atlanta Hospital, 
Atlanta, Ga., Medical Record, May 14, 1881. 
For Removing Polypi and Hypertrophied Nasal Tissue. 
Fig. 2205.-Jarvis' Wire Snare Ecraseur. 
The ecraseur consists of a long and short canula, the latter of which glides over a screw-thread, cut on the 
former. A milled nut, fitting this thread, is intended to push the outer canula before it. Fine steel wire is drawn- 
through the long canula and its ends are attached to retention pins on the short one. As the outer canula cannot 
turn, there is no twisting of the wire loops formed. A graduated scale may or may not be cut upon the smooth surface 
of the screw-thread, to give the dimensions of a growth and indicate the moment of its complete division by the wire. 
In using the ecraseur, pass the two ends of the wire through the main canula, entering them at its distal extremity, 
and twist them around the retention-pins. A loop is formed, whose size, of course, depends upon that of the growth. 
This loop should be flattened against the orifice of the canula, at the wire's two points of exit, so as to form a point 
of resistance for its fixation, when traction is made. It can now be placed in any desired position, and firmly held 
there by making a few turns of the nut. So we have an elastic ring formed, not to be permanently moved from its 
position; on account of its elasticity, it can be made to accommodate itself to the narrowest and most tortuous pas- 
sages. Giving the wire loop a twist toward the side of the nose occupied by the growth, it is fixed by a turn of the 
nut and passed into the nostril. Holding the rhinoscopic mirror (Fig. 2168) in one hand, the position of the wire loop 
in the posterior nares is carefully watched, while it is steadily advanced with the other hand, until seen to encircle the 
growth. The tip of the wire loop has already, by excurvation, been made to assume a point considerably to one side 
of the axis of the main canula ; hence, firm pressure is exercised upon the anterior part of the base of the growth, by 
the end of the canula, and, at the same time, the apex of the wire Joop is pressing firmly on its posterior border. On 
drawing the wire home, the tissue is cleanly divided, and, if not too large to pass through the nares, it will generally 
be drawn out clinging to the snare. Make traction very slowly, stopping at short intervals, in order to cause the 
slightest amount of haemorrhage. 
Fig. 2206.-Transfixion Needle. 
" The transfixion needles have small metal handles, and are of various shapes and sizes. 
"Extensive posterior hypertrophies (especially the inferior turbinated variety), and soft sessile anterior hyper- 
trophies, can be removed with the small snare. Firm non-pedunculated anterior hypertrophies, and small and hard 
anterior hypertrophies, require both ecraseur and transfixion needles. In using the transfixion needle, the amount of 
tissue requiring removal is carefully determined and the point of the needle directed accordingly. The loop will be 
caught by the point of the needle, projecting into the nostril, and a few turns of the milled nut causes the wire to 
sever the transfixed tissue. In transfixing posterior hypertrophies, the position of the needle's point can be determined 
by the rhinoscopic mirror (Fig. 2168). Curved needles should be used in transfixing anterior hypertrophies, in order 
to bring the needle's point into view. Whole lengths turbinated hypertrophies should be removed in the same manner, 
either in whole, or, when very extensive, in sections. Nasal hypertrophies of every size and description can be per- 
manently got rid of by this simple method."-" Transactions of the American Medical Association." Vol. 32. 1881. 
See ''Jarvis' Tape Holders," Fig. 2169. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
215 
JMASAL. 
For Removing Polypi and Hypertrophied Nasal Tissue by Ecrasement. 
Fig. 2207.-Bosworth's Jarvis' Snare Ecraseur. 
" I have had constructed an ordinary snare with a distal tube six inches in length ; the end of this is curved in a quad- 
rant of a circle whose radius is one and one-fourth inches. This is now mounted with a No. 5 piano wire, which I re- 
gard as by far the most useful number, as combining elasticity, strength and resistance. Having observed the growth 
and carefully estimated its size, a loop is formed which will embrace it, and is then bent forward over the end of the 
instrument, in order to give it a decided kink. The wire is now played out of the snare about an eighth of an inch, 
and the whole loop is now thrown backward toward the handle of the instrument, giving it another bend. As will be 
seen, it is in a position for easy introduction behind the palate, without touching the part, and may be passed imme- 
diately to the base of the growth. The palate of course is now immediately retracted by reflex irritation, but only 
embraces the tube of the snare, without in any degree hampering the manipulation. 
" The instrument is now held firmly in place, while the loop is rapidly drawn in by turning the screw. As the 
wire is drawn in, the loop is thrown backward with considerable vigor, and embraces and severs the growtlu In this 
manner even a broadly sessile growth is easily seized and extirpated. There is but trivial haemorrhage, but little pain 
or retching, and the whole manipulation is accomplished very easily, simply and speedily. After the withdrawal of 
the instrument, the tumor is expelled through the nose by blowing. Occasionally it drops into the pharynx below, but 
this is very rare. In no case has any patient experienced the slightest annoyance from the growth dropping too far 
down in the air-passage, nor do I regard this as an accident that is liable to happen. The operation by this method 
has never required an anaesthetic."-The Medical Record. January 13, 1883. 
Fig. 2208.-Bettman's Jarvis' Snare Ecraseur. 
" Jarvis' wire ecraseur, modified by Dr. Jefferson Bettman, shown at the International Medical Congress, was de- 
vised specially for the removal of nasal polypi and hypertrophic tissue covering the turbinated bones. Its action is 
simple and efficient, and, when properly used, it should occasion but little pain and loss of blood. In the original 
instrument, the sliding or outer canula was propelled by a milled nut or wheel, which has now been replaced by a 
flattened bar ; this, for mechanical reasons, entails less expenditure of force, and can be manipulated with greater ease 
and comfort. One of the chief points in the modified ecraseur consists in the clamp-screw to fasten the free ends of 
the wire loop. In Jarvis' instrument these were wound around small retention pins, and, if the case required, had to 
be undone and rewound. This is obviated in the modification ; a simple turn of the screw releasing or clamping the 
wire. Another point hereby gained is the impossibility of a fracture ; the wire, except at its looped extremity, remain- 
ing straight throughout its entire length. The straight tube, which is used for operations in the nasal cavity, can be 
unscrewed from the handle and replaced by a long tube with the post-nasal curve, so that tumors or redundant tissue, 
growing from the posterior nares or the naso-pharyngeal space, can be operated upon through the mouth. The wire 
used is pianoforte strings, Nos. 5 and 6."-London Medical Record, p. 480. Nov. 15, 1883. 
Fig. 2209.-Dr. A. H. Smith's Canula Scissors, for the Removal of Neoplasms. 
Cut by rotating the screw. 216 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
JMASAb. 
The Surgical Treatment of Hypertrophied Mucous Membrane. (Evulsion.) 
" In excessive hypertrophy of the mucous membrane covering the turbinated bones, especially the middle and 
inferior, closing the ineati, and thus interfering with nasal respiration ; when presenting in the rhinoscope a baggy 
oedematous condition, somewhat like a gelatinous polypus ; and upon inspection of the anterior nares frequently pre- 
senting the same appearance. Several methods are practiced for the removal of the superflous tissue. Nelaton per- 
formed it with scissors. Gross has treated these cases by tearing away the redundant tissue, and in some cases the 
middle turbinated bone. 
" Beverly Robinson urges caution in its adoption, as several cases in which he operated were followed by pain and 
swelling cf the face and abundant discharges from the nasal fossae ; he subsequently devised a pair of forceps with 
grooved and serrated edges, which he has used with satisfactory results."-" Diseases of the Nose," p. 75. Wagner. 
Fig. 2210.-Robinson's Evulsion Forceps. 
For the Turbinated Bones, 
Fig. 2211.-Woakes' Scissors, for Excising a portion of the Middle 
Turbinated Bone. 
Fig. 2212.-Woakes' Nasal Plough-Guide. 
Fig. 2213.-Woakes' Nasal Plough. 
" Woakes' nasal plough guide (Fig. 2212), for removing lymphoid vegetations or hypertrophic proliferations, along 
with a strip of the inferior turbinatad bone, and for exostosis. 
" A pair of forceps, with thin but strong blades, so shaped that every other part is out of the way of the surgeon 
and does not interfere with his vision. These are fitted with a catch near the bows. The free end of the spongy bone 
is grasped by the blades of the forceps at the line where it is intended to divide the bone, and, the catch being closed, 
it now serves as a guide for the nasal plough, with which the severance of the bone is effected. The latter is a kind 
of gouge, a portion of the cutting surface of which is curved upon itself, while the rest projects forward keel-wise, and 
ends in a blunt point. The blunt point of the plough is now passed beneath the turbinated bone and outside the 
forceps (as regards the middle line of the body), to which it readily adapts itself. It is now pushed freely along the 
nostril, keeping it close to the forceps, until the post-nasal space is entered. It is then withdrawn, followed by the 
forceps, when the latter will retain the growth, with a narrow strip of the spongy bone attached. By this method it 
is possible to regulate exactly the width of the slice which is to be removed from the spongy bone, besides which the 
difficulty of the operation is reduced to a minimum."-" Post-Nasal Catarrh." Woakes. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
217 
J^ASAL. 
SEPTUM. 
The typical septum nasi is a straight, flat wall or partition, running through and separating the nasal cavities. 
Though constituted posteriorily of bone and anteriorly of cartilage, it is not usual for any line of demarcation to exist 
indicative of this division. The covering of muco-perichondrium in front passes backwards into the muco-periosteum 
by quite insensible gradations ; nevertheless, the existence of this duplex formation must not be lost sight of, because 
it will assist to differentiate the character of any neoplasm which may be present, to note whether it grows from the 
osseous or cartilaginous section. It is not common, however, to see the septum so architecturally proportioned as 
the above intimation implies, many degrees of deviation occurring which are quite consistent with a normal breath-way. 
The lateral divergencies are most frequent into the left nostril, and have a corresponding depression on the opposite 
side. What the observer has to note is, whether they be sufficiently marked to obstruct the channel, and whether any 
adventitious thickening is present, with or without such deviation, and also to observe the lining membrane for con- 
gestion, ulcers, &c. Note should also be taken whether dislocation of the anterior aspect of the septum from the 
maxillary spine exists, for, though not a common occurrence, this displacement is occasionally met with, either alone 
or in combination with other abnormalities.-" Post Nasal Catarrh." Woakes. 
For measuring the thickness of the nasal septum, and by 
means of which a differential diagnosis between the local thick- 
ening, as exostosis and deviation of the septum, can be made 
more readily and accurately than by inspection of the nasal 
cavities alone. 
The septometer is held by a wooden handle, screwed at 
an angle into the lower blade, so that the hand is below the 
patients' nose and does not obstruct the view of the points, and 
also in order to prevent any embarrassment of the delicate 
motion of the blades. The index hand will point out position 
and variations of thickness as the instrument is passed up ordown.-Carl Seiler, M. D., in Medical News, Dec. 2, 1882. 
Fig. 2214.-Seiler's Septometer. 
For Operations on the Distorted and Depressed Fractured Nasal Bones. 
Fig. 2215.-Adam's Rhinoplastos. 
Mr. William Adams, of London, E., classed all 
cases of broken noses under two heads : 
I. Injury limited to anterior or cartilaginous por- 
tion, in which the deformity consists of depression 
and lateral bending with partial displacement from 
its bony attachment. 
2. Fracture of the nasal bones, with more or less 
depression and lateral displacement, together with 
crushing and bending of the cartilaginous septum. 
He recommends forcible straightening of the sep- 
tum by forceps (Fig. 2215), one blade of which is 
introduced into each nostril, and, if a depressed frac- 
ture of the bones be also present, that these two be 
fractured by crowding at the same time the forceps 
strongly upward, assisting the manoeuvre with power- 
ful pressure with the thumb and fingers outside. 
After the deformity of the septum has been thus 
overcome, the wearing for several days of a mildly 
pressing screw clamp, to keep it straight, and, in 
case of refracturing the bones, their reposition to be 
assisted by a nose truss, so arranged that pressure 
by a screw pad could be made at the point of great- 
est convexity ; after which he introduced ivory plugs 
(Fig. 2226), which the patient can remove and re-in- 
troduce at pleasure. 
Fig. 2216.-Weir's Rhinoplastos. 
Fig. 2217.-Bosworth's Rhinoplastos. 
Fig. 2218.-Bosworth's Nasal Clamp. 
Fig. 2219.-Gouley's Nasal Clamp. 218 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
J^AS/cL. 
For the Treatment of the Deviated Septum Narium. 
I shall discuss the treatment of the deviated septum, as a most common cause of catarrh. As with a button in the 
nostril, so that thorn in the flesh, a deviated septum, must be removed to cure catarrh. 
Since several instruments will be presented to your notice, I trust you will not interpret them as indicating dis- 
satisfaction with any one method and recourse at random to another, but as providing against certain possible contin- 
gencies. The very structure and shape of the septum warrants this assertion. We may meet bone, cartilage or mucous 
membrane. The bone will break or dull our knives, the rongeur forceps may strip off or mutilate unnecessarily the 
mucous membrane, and either may unfortunately perforate the deviated cartilage. For opening the field of operation 
I employ my ring-drop nasal speculum (Fig. 2161), since in my hands it has proved the best for painlessly and per- 
sistently dilating the nostrils. In the treatment of cartilaginous and soft structural deviations of the septum, 
I have for several years employed nothing more than my ecraseur with transfixion needles. Instead of using No. 5 
piano wire, originally recommended and introduced by me for the removal of turbinated hypertrophies, I employ Nos. 
o and 00 piano wires. The exclusion of the question of haemorrhage in operations by ecrasement is an additional re- 
commendation for the employment of fine wires, acting like knives. The employment of the ecraseur for this purpose 
must be invariably combined with the use of my transfixion needles (Fig. 2206). 
The removal of cartilaginous and soft deviated tissues by ecrasement has been followed by most excellent results 
in my hands, and it is to be preferred for this purpose. 
It is often desirable to economize time, and, in order to do so, I have devised a fenestrated cartilage forceps and trim- 
ming scissors. Their blades are made almost at a right angle, to enable the operator to obtain a clear view of the field. 
The cutting edges of the fenestrated forceps resemble somewhat, in shape and action, the ordinary ticket-punch. 
A ring on the fixed blade is intended to slip over the middle finger, and a knob on the free one is manipulated with the 
thumb. This arrangement enables one to seize 
and divide the cartilage with great facility. 
The trimming scissors are convenient for 
removing asperities remaining after the other 
instruments have been employed. The instru- 
ment is grasped like a pistol, firm pressure 
being exercised against its lateral margin by 
the index finger. 
Thus far the instruments shown have ap- 
plied only to cartilage and hypertrophied 
mucous membrane. Bone blunts or breaks 
their keen edges, and we may have to treat an 
osseo-cartilaginous deviation of the septum. 
This little instrument, essentially a rongeur 
forceps, has, in my hands, most satisfactorily 
accomplished this result. Its two blades are 
hollowed to cut like the teeth of a rodent. 
The instrument has the proper nasal curve. 
A great advantage possessed by this bone 
forceps is the control exercised over it by the 
operator. Each osseous projection can be 
distinguished over the edge of the upper blade 
and deliberately crushed away by the keen- 
edged cutting surfaces, and by a kind of gnaw- 
ing process large sections of the bone are re- 
moved with rapidity and precision. All the 
methods thus far mentioned accomplish their 
purpose by removing the superfluous or devi- 
ated tissues or the turbinated structures op- 
posite the deviated point. 
[From "The Etiology and Treatment of 
Nasal Catarrh, with Special Reference to the 
Deviated Septum." By William Chapman 
Jarvis, M. D., Lecturer on Laryngology and 
Diseases of the Throat in the New York 
University Medical College, in The Medical 
Record, March 14, 1885.] 
Fig. 2220.-Jarvis' Fenestrated Cartilage Forceps. 
Fig. 2221.-Jarvis' Trimming Scissors. 
Fig. 2222.-Jarvis' Nasal Rongeur. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
219 
^IAS/cId. 
Excision of Cartilage in Nasal Occlusions due to Deviated Septum. 
Dr. John B. Roberts septum cutting forceps, 
with fenestrated cutting edge, for punching out 
sections of the septum, to make its replacement 
more stable. The opening becomes smaller on 
cicatrizing and frequently completely closes.- 
Medical and Surgical Reporter, May 20, 1880. 
When the deviated septum causes, as is fre- 
quently encountered, an almost complete occlu- 
sion at or near the external orifice of the nose, 
the remedy is readily applied. It is to cut off, 
with a sharp knife or scissors, the projecting por- 
tion of the cartilage. This little operation I 
have found to be facilitated by using a small 
double gouge forceps, mounted like a dressing 
forceps. The same instrument will serve to cut 
away a turbinated bone, or those not very rare 
exostoses from the vomer that sometimes shut up 
the middle and inferior meatuses.-From "On 
the Relief of the Deformity of a Broken Nose 
by some New Methods." By Robert F. Weir, 
M. D., New York Medical Record, March, 1880. 
Steel's septum forceps has inserted into one 
of its blades a number of knives, at right angles 
to the surface and arranged in the shape of a 
star, the septum is punched at its greatest curva- 
ture once, or, if the bend extends far back, twice, 
by introducing the blade carrying the knives into the open nostril 
and the unarmed blade into the closed one, and then compressing 
the handles. The punch is then removed, and, with a pair of 
forceps with flat blades (Adams', Weir's or Bosworth's, page 217), 
the septum is forcibly straightened, which becomes possible since 
the triangular pieces produced by the cut made with the punch lap, 
and thus the distance from the base to the top of the septum be- 
comes diminished. Having accomplished this the forceps is re- 
moved and a wooden, hard-rubber or ivory plug (Fig. 2226), shaped to fit the cavity, is inserted into the formerly 
obstructed nostril, and is kept there for about forty-eight hours, when it is replaced by a plug of cotton, which must 
be removed daily until the cuts in the septum have firmly united and the septum remains straight without support.- 
" Diseases of the Throat, Nose and Naso-Pharynx." Carl Seiler, M. D. 1883. 
Fig. 2223.-Roberts' Septum Punching Forceps. 
Fig. 2224.-Weir's Double Gouge Forceps. 
Fig. 2225.-Steel's Septum Forceps. 
Fig. 2226.-Nasal Plug. 
Fig. 2227. 
Jarvis' Modification of Steel's Septum Forceps. 
Fig. 2228.-Jarvis' Excisor. 
For successively excising small pieces 
of deviated cartilaginous or hyper- 
trophied tissue until the desired ef- 
fect is obtained. 
In order to prevent sloughing away of the flaps, for lack of nutrition-due to close cutting of the 
star-shaped knives of Steel's ordinary instrument-Dr. Jarvis' has fenestrated the star, so as to 
leave the centre of the portion to be operated upon uncut. The blades of the forceps are curved, 
to facilitate vision. The lock of the forceps, almost straight, is made so as to allow the introduction 
of its blades, separately, into the nostrils. The knives, removable, fit either blade, so that they 
may be suitably fixed for introduction into the open nostril. 220 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
fJASO-jaH/vRYJMGEAU. 
Fig. 2229.-Jarvis Rhinometer, 
used for measuring the size of normal and diseased nares. 
Fig. 2230.-Wilkerson's Revolving Trocar. 
Fig. 2231.-Woake's Nasal Saw, 
Exostosis of the Septum and Congenital Malformations. 
Exostosis of the septum proper, originating in the vomer and extending towards 
the outer wall of the nose, requires to be perforated with a drill (see p. 109). Through 
the orifice thus obtained a small saw may be worked and a sufficient portion of the 
mass removed to re-establish the breath-way. This operation may be performed 
most safely with the finger in the post-nasal space, the patient being gagged and 
anaesthetized. Should the new orifice have a tendency to close up, it may be re- 
opened by galvano-cautery. 
It is quite practicable with one of these saws to remove small exostoses of the 
septum, where sufficient room exists for working it, without prior recourse to drill- 
ing.-" Post Nasal Catarrh." Woakes. 
Although it is possible to effect some slight subsidence in the enlargement of the 
pharyngeal tonsil by the repeated application of such styptics as nitrate of silver, 
solution of chloride of zinc, &c., this method of treatment gives only a partial result, and requires a long period to 
accomplish even this. Evulsion of the mass is the only measure in which confidence can be placed. The choice of 
methods for accomplishing this object lies between the cutting forceps, the galvano-cautery and the wire snare.- 
"Post-Nasal Catarrh." Woakes. 
A gouge forceps, by means of 
which one is enabled to seize readi- 
ly such of the vegetations as grow 
on the posterior and lateral walls of 
the pharynx. In using this pharyn- 
gotome, the index finger of the left 
hand should be introduced into the 
space through the mouth, which 
must be kept open by a gag, to di- 
rect the blades of the instrument to 
the exact spot where they are to be closed upon the mass. In this way, also, the operator can detect, and so secure 
the removal of all remaining exuberant tissue. If, upon examination of the choanal orifices, the villous fringe exists 
(spoken of elsewhere), it should be scraped off with the fingernail. If attention to this point be neglected, an apparently 
successful operation, which has yielded a large aggregate mass of tissue, will prove abortive as regards results, because 
the fringe of itself constitutes a complete obstacle to nasal respiration. 
It is necessary to repeat that deafness, asso- 
ciated with hypertrophic catarrh of the pharynx, 
can only be relieved by securing the normal action 
of the eustachian tubes, and that, in nine cases out 
of ten, the cause of their defective functioning is 
in the naso-pharynx. Direct treatment of the 
middle ear by catheterization, &c., can therefore 
accomplish little until the hyperplasias which 
block the approach to the tubal orifices have been 
got rid of or have been greatly reduced in sub- 
stance.-" Post-Nasal Catarrh." Woakes. 1884. 
Evulsion of the Pharyngeal or Luschka's Tonsil. 
Fig. 2232.-Loewenberg's Pharyngotome. 
Fig. 2233.-Wagner's Post-Nasal Forceps. 
See " Pharyngeal," p. 247. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
221 
JVIOUTH AND THROAT. 
Mouth.-" The opening in the face or forepart of the head through which food is received and the voice uttered ; 
the aperture between the lips ; also, the cavity within the lips, containing the jaw, teeth and tongue."-Webster. 
Throat.-" The portion of the neck anterior to the spinal column, with its cavities and passages."-Webster. 
Also, " the pharynx, the common origin for the digestive and respiratory passages."-Dunglison. 
Classification of Mouth and Throat Instruments. 
For Operations on the Jaws and Lips, in the Oral Cavity, and for the Surgical and Therapeutic 
Treatment of Throat Ailments. 
Spacium Oris. 
Extraction of Teeth, Dental. 
Antrum. 
Harelip. 
Staphyloraphy. 
Uraniscoplasty. 
Specula Oris. 
Cheek Retractors. 
Tongue Depressors and Holders. 
Isthmus Faucium. 
Tonsils, Uvula and Soft Palate. 
Excision of Tonsil. 
Excision of Uvula. 
Pharynx. 
Pharyngeal. 
Pharyngoscopic. 
Rhinoscopic, Posterior. 
N aso-Pharyngeal. 
Pharyngeal-Laryngeal. 
Larynx, Voice. 
Laryngoscopic. 
Laryngeal Operating. 
Laryngo-Tracheal. 
Tracheotomy, Bronchotomy. 
Respiratory. 
Inhaling. 
Alimentary Canal. 
CEsophageal. 
DENTAL. 
The extraction of teeth, though not strictly belonging to the province of the medical practitioner, must frequently 
be performed by him. It is surprising that the operation should receive so little attention ; this neglect can only be 
accounted for by the too prevailing belief that little or no skill is required for its performance ; but it is the duty of 
every physician, residing where the services of a skillful dentist cannot always be commanded, to provide himself with 
proper instruments and become acquainted with the manner of performing this operation. 
The forceps are to be preferred to the key, for in a majority of cases they can be used with greater ease and much 
less pain. Though there are a great variety of forms, but four are required for general use. These are arranged in two 
sets: one adapted for the incisors, below and above, and the other for the molars and bicuspids, below and above. 
(See Nos. 36, 46, 3, 23, 42.) 
Operate as follows: detach the gum from the neck of the tooth, unless the claw of the forceps is sharp and suffi- 
ciently separates it; grasp the tooth firmly at the alveolar edge, but do not compress the handles of the forceps too 
tightly; move the tooth outwards and inwards, in quick succession, until it is loosened, and then draw it from its socket 
in a line with its normal axis. 
For the incisors, strong, straight forceps may be used, and a slight rotary motion should be given to the tooth; the 
cuspids require greater force, due to the length of their roots ; very little rotary motion can be given to the bicuspids ; 
the upper molars have three roots, are very firm, and must be grasped as high up as possible and pressed out and in 
until it yields; the superior dentes sapientise are usually less firmly articulated and are easily removed with the bicuspid 
forceps; the inferior molars have two roots, but are very firm, and the decayed tooth is liable to be overlapped by the 
crowns of the adjoining teeth, which may require filing off to admit of removal; the dentes sapientiae of the lower jaw, 
when situated far back, are oftentimes exceedingly difficult to extract, especially when the roots are turned toward the 
coronoid process ; in this case the loosened tooth should be pushed backward, describing the segment of a circle when 
it is raised.-"Operative Surgery." Stephen Smith. 1880. 
The "key" is now very rarely used. Forceps are constructed of various forms and sizes to adapt them for the ex- 
traction of the different teeth ; indeed most dentists employ a special instrument for almost every tooth ; but in general 
it is sufficient to be furnished with several sizes and forms of straight instruments for extracting the incisors and the 
cuspids-indeed the same instrument will usually answer for the bicuspids also-and with two or three slightly curved 
instruments for the molars. (See Nos. 63, 55, 62, 56.)-"Principles and Practice of Surgery." Hamilton. 
The Extraction of Teeth. 222 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
DENTAL. 
EXTRACTION OF TEETH. 
Tooth. Forceps. 
Fig. 2234. 
Wisdom. 
Fig. 2235. 
Lower Wisdom. 
Fig. 2236. 
Stump. 
Fig. 2237. 
Upper Bicuspid. 
Fig. 2238. 
Upper Molar. 
Fig. 2239. 
Upper Molar. 
Fig. 2243. 
Upper Molar. 
R. or L. 
Figs. 2240, 2241, 2242.-Upper Molars, Cowhorn. 
Either side GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
223 
DENTAL. 
EXTRACTION OF TEETH. 
Tooth Forceps. 
Fig. 2244. Fig. 2245 
Bayonet Upper Molars. 
Fig. 2246. Fig. 2247. 
Harris' Upper Molars. 
Fig. 2248. Fig. 2249. 
Harris' Lower Molars. 
Fig. 2250. 
Harris' Lower Molar. 
Either Side. 
Fig. 2251. Fig. 2252. 
Cowhorn Lower Molars. 224 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
DENTAL. 
EXTRACTION OF TEETH 
Tooth. Forceps. 
Fig. 2253. 
Cowhorn Molar. 
Either Side. 
Fig. 2254. 
Fig. 2255. 
Harris' Lower Molars, 
Fig. 2256. 
Fig. 2257. 
Wolverton's Lower Molar 
Either Side. 
Either Side. 
Fig. 2258. 
Wolverton's 
Upper Bicuspids. 
Fig. 2259. 
Wolverton's 
Lower Bicuspids 
Fig. 2260. 
Wolverton's 
R. 
Fig. 2261. 
Lower Roots. 
L. 
Fig. 2262. 
Universal Root. 
Fig. 2262. 
Universal Root. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
225 
DE^T/L. 
EXTRACTION OF TEETH 
Tooth. Forceps. 
Fig. 2263. 
Straight Root. 
Fig. 2264. 
Lower Root. 
Fig. 2265. 
Straight Root 
Fig. 2266. 
Half Curved Root 
Fig. 2267. 
Full Curved Root. 
Fig. 2272. 
Bayonet Narrow 
Beak Root. 
Fig. 2268. 
Narrow Beak 
Root. 
Fig. 2269. 
Straight Narrow 
Beak Root. 
Fig. 2270. 
Half Curved Narrow 
Beak Root. 
Fig. 2271. 
Full Curved Narrow 
Beak Root. 226 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
DENTAL. 
EXTRACTION OF TEETH. 
Tooth Forceps. 
Fig. 2273. 
Narrow 
Fig. 2274. 
Beak Roots. 
Fig. 2275. 
Universal. 
Fig. 2276. 
Universal Root 
Fig. 2277. 
Family's Straight 
Fig. 2278. 
Half Curved. 
Family's. Fig. 2279. 
Full Curved, 
Fig. 2280. 
Family's Bayonet 
Fig. 2281, 2282 
1'armly's. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
227 
DENTAL. 
EXTRACTION OF TEETH. 
Fig. 2283. 
Straight. 
Excising. Fig. 2284 
Curved. 
Tooth. Forceps 
Fig. 2285. 
Splitting. 
Fig. 2286. 
Elevating. 
Fig. 2287. 
Single Jointed 
Fig. 2288. 
Goodwillie's Upper Molar. 
Fig. 2289. 
Goodwillie's Spicula, 
Fig. 2290. 
Goodwillie's Root and Children, 
Fig. 2291. 
Goodwillie's Splitting. 228 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
DENTAL. 
EXTRACTION OF TEETH 
Tooth Forceps. 
Fig. 2292. 
Plain Curved. 
Fig. 2293. 
Goodwillie's Bicuspid 
Fig. 2294. 
Plain Straight 
Fig. 2295. 
Goodwillie's 
Straight. 
Fig. 2296. 
Goodwillie's 
Half Curved. 
Fig. 2297. 
Spring Bolt (double). 
Turn Keys. 
Fig. 2298. 
Spring Bolt. 
Fig. 2299. 
Removable Fulcrum. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
229 
DEJMTAk 
EXTRACTION OF TEETH. 
Turn Keys. 
Fig. 2300.-Rotating Fulcrum. 
Root Extractors and Gum Lancets. 
Fig. 2301.-Stag-foot Elevator. 
Fig. 2302. 
Screw Elevator. 
Fig. 2303 
Root Extractor. 
Fig. 23P4. 
Root Extractor. 
Fig. 2305. 
Gum Lancet. 
Fig. 2306. 
Curved 
Root Extractor. 
Fig. 2307. 
Angular 
Root Extractor. 
Fig. 2308.-Gum Lancet. 230 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/?NTRUM 
ABSCESS OF THE ANTRUM. 
The antrum, maxillary sinus, is a large cavity in the body of the superior maxilla, lying above the molar teeth and 
below the orbital plate, lined in the fresh state by mucous membrane, and communicating with the middle meatus of 
the nose. The relations of the antrum to the teeth vary extremely ; it may extend so as to be in immediate relation to 
all the teeth of the true maxilla, or may be so contracted as to correspond with only two or three of the central ones. 
Occasionally a root or roots of the first molar extend into the cavity, free of any bony covering, and merely overlaid 
by the mucous membrane lining the sinus. 
" Before an abscess has formed, and when as yet it is only imminent, remove any carious tooth or teeth in the neigh- 
borhood and apply leeches and fomentations. When pus has formed, extract all the carious teeth from the maxilla in- 
volved, and, if the pus is discharged from the cavity of either, enlarge the opening sufficiently to give free exit to the pus 
in the antrum. If there is no carious tooth, proceed as follows: Perforate the antrum by extracting the first perma- 
nent molar tooth, and passing a trocar (or trephine, see Pope's Antrum Drill, page 98, Bone Drills, page 109) into 
the cavity through its socket; the forefinger should be extended on the shaft of the trocar as guard, and the instrument 
pressed forward with an even rotating motion ; avoid the sudden giving away of the wall of the antrum and the plunge 
of the trocar through the wall of the orbit. If the teeth of the affected side have been long removed, the antrum is 
more readily perforated at the base of the molar process of the maxillary bone, over the region formerly occupied by 
the second or third molar tooth, by dividing the mucous membrane and employing a large trocar or a strong pair of 
scissors. When the antrum is opened wash it out thoroughly with warm water, followed by carbolic acid solutions. 
The entrance of food must be prevented by plugs of hard rubber, or by a plate fitted to the opening and closed by a 
cork. It is sometimes practicable to open the passage from the cavity of the antrum to the nasal fossae with a probe 
properly directed."-" Operative Surgery." Stephen Smith. 
"This entrance is situated above the inferior turbinated bone, almost in the centre of the middle meatus; the 
sound ox probe should be directed upward, backward and outward ; about one and a quarter inches from the entrance 
of the nostril the orifice will be found; slight force may be require^ to rupture the mucous membrane which covers it. 
If the natural orifice cannot be found, an artificial one may be made with the knife."-" Diseases of the Nose." 
Wagner. 1884. 
HARELIP. 
" Harelip, a congenital fissure of the upper lip, on one or both sides, giving to the mouth very much the appear- 
ance presented by the cleft upper lip of the hare. It is sometimes accompanied by a fissure of the hard and soft 
palate, in which the cavities of the mouth and nose communicate. When the teeth and the gums project through the 
fissure the deformity is much increased. In the infant it interferes with the process of sucking, and in the adult 
renders speech imperfect; when fissure of the palate co-exists, not only is articulation indistinct and nasal, but the 
passage of food and drink from the mouth to the nose, and of the nasal secretions into the mouth, is a source of great 
annoyance and mortification. This deformity is in most cases capable of removal by a very simple surgical operation, 
which has been practised successfully upon infants a few weeks old. The 
operation consists merely in paring the edges of the fissure with a knife 
or scissors, and keeping the cut surfaces in apposition by needles and 
sutures, strengthened by sticking plaster or collodion. When the harelip 
is double, both sides are generally operated on at the same time. It is 
usual to extract projecting teeth, or to remove any too prominent portion 
of the jaw by cutting forceps. Bleeding is generally slight, and restrained 
by pressure or simple contact of the cut surfaces. In infants, adhesive 
straps are often necessary to prevent the edges being drawn asunder by 
crying or sucking; in adults, strict silence and liquid food are enjoined 
for four or five days. 
" Fissure of the soft palate is remedied on the same principle of paring 
the edges and keeping them in contact by various kinds of sutures and 
needles; this operation, called staphyloraphy, can only be performed on 
a patient old enough to aid the proceedings of the surgeon."-"Ameri- 
can Cyclopedia." 
" When the chasm is uncommonly large, as when the intervening sub- 
stance has been removed, the tension of the parts may be so great as to re- 
quire support. A most admirable contrivance for this purpose, sketched in 
Fig. 2309, has been devised by Mr. Hainsby, and is so arranged as to press 
each cheek over toward the middle line."-" System of Surgery." Gross. 
Fig. 2309. 
Hainsby's Cheek Compressor or Truss. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
231 
JHAREIdIP. 
Clamps and Forceps for holding the Lips, Scalpels and Scissors for paring the Edges of the 
Cleft, and Pins to preserve them in contact in order to cause adhesion. 
Fig. 2310. 
Hutchison's Harelip Forceps. 
Fig. 2311.-Parallel Harelip Forceps. 
Fig. 2312. 
Whitson's Harelip 
Clamp. 
Fig. 2313. 
Prince's Harelip Clamp. 
Fig. 2314.-Smith's Harelip Forceps. 
See " Hainsby's Cheek Compressor." 
Fig. 2315.-Scalpel. 
Fig. 2320.-Hamilton's Harelip Scissors, Heavy. 
Fig. 2316.-Buck's Pin Conductor. 
Fig. 2321.-Harelip Scissors Angular. 
Fig. 2317.-Post's Pin Conductor. 
Fig. 2318.-Plastic Pin. 
Fig. 2319.-Silver Harelip Pin, 
with Removable Steel Point. 232 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
ST/tPHYLORApHY. 
The Operation for Uniting a Cleft Palate. 
It consists in paring the edges of the cleft, passing ligatures through them and bringing them together.-Dunglison 
Fig. 2322.-Whitehead's Mouth Gag (in situ). 
Fig. 2322 represents a mouth speculum used by Dr. White- 
head. It is serviceable in many operations about the mouth and 
throat, but particularly well suited to the operation for cleft palate, 
while the patient is under the influence of ether. This speculum 
is provided with a sliding tongue depressor, which adapts it to dif- 
ferent patients, and has two stout ratchets, kept in position by a 
spiral spring or slightly curved piece of steel, which presses on the 
upper end of the ratchet. It is sometimes necessary to wrap a 
piece of soft yarn around the part of the wire which presses on the 
gum. The speculum or gag is nickel plated, to protect it from 
rust and injury by acids. 
Fig. 2323 shows a later improvement, by which the tongue de- 
pressor can be not only depressed or elevated, lengthened or short- 
ened, but it can also be made narrower or wider, at will, by means 
of a peculiar adjustment shown in the figure. 
Figs. 2324 to 2327 illustrate forceps with which the palato- 
pharyngeus and palato-glossus muscles may be seized, previous to 
their division, with long curved scissors, such as represented by 
Fig. 2328. These forceps embrace the muscle and do not permit 
it to escape. 
Fig. 2329 represents knives useful for cutting the levator palati 
muscles and for dividing, at the same time, the rather thick muco- 
periosteal membrane lining the lower part of the internal pterygoid 
plate. These knives are also used for paring the edges of a cleft 
palate. 
Fig. 2330 shows Sims' tenaculum, which is useful for pulling 
the velum aside, holding the edges of the flaps, catching the thread 
used for passing silver wire, also for holding the wire in approxi- 
mating the edges and for other purposes. 
Richardson's Spray Instrument, with an ex- 
tra tube, and half a dozen sponge holders with 
small pieces of sponge securely fastened to 
them, are necessary to clear the throat of blood. 
Fig. 2323.-Whitehead's Mouth Gag. 
Fig. 2324.-Whitehead's Seizing Forceps. 
Fig. 2325.-Seizing Forceps. 
Fig. 2330.-Tenaculum for Pulling the Velum aside, Holding 
the Edges of Flaps, &c. 
FiG. 2329.-Whitehead's Knives, for Paring the Edges. 
Fig. 2326.-Langenbeck's Seizing Forceps. 
Fig. 2327.-Durham's Seizing Forceps. 
Fig. 2328.-Curved Scissors, for Dividing the Muscles. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
233 
STAPHYLORAPHY. 
UNITING CLEFT PALATE. 
The instrument shown in Fig. 2331 is designed for making 
deep cuts through the muco-periosteal tissue of the gum and 
along the side of the teeth. When it is necessary to close a cleft 
of the hard palate at the same time that staphyloraphy is re- 
quired, and such is most frequently the case, it would be well to 
recall to mind the peculiar distribution ot the arteries of the roof of the mouth: At the junction of the horizontal 
plates of the maxilla and palate bones with the alveolar process, there is a groove in which courses the superior pala- 
tine artery. This artery, which is of considerable size, emerges from the orifice of the posterior palatine canal, and 
after running along the groove ascends through the anterior palatine canal, anastomosing with its congener and the 
naso-palatine. Some small branches, which emerge from the accessory palatine canals, contribute to nourish the 
velum. The proper distribution of the incisions, and the protection of the arteries from injury, insure the nutrition of 
the muco-periosteal tissues, with which a cleft in the hard palate is closed by sliding them together at the middle line. 
By closing the cleft in the hard palate, there is, below the age of twenty, a fair prospect of having a formation of new 
bone which closes the deformity in the palatine vault. This has been observed in some of Dr. Whitehead's cases. 
This instrument (Fig. 2332), shaped like a hoe and having a 
cutting edge, is useful in dividing the muco-periosteal membrane 
along the edges of a cleft of the hard palate, and also for dividing 
the tendinous insertion of the palate muscles along the posterior 
border of the cleft palate bones. 
Fig. 2333 represents Dr. L. A. Sayre's instru- 
ment for detaching the periosteum in operations 
about the hip-joint and elsewhere, and is a capital 
instrument for detaching the muco-periosteal mem- 
brane in an operation for cleft palate. This is a 
heavy, solid steel instrument, resembling somewhat 
an oyster knife, and is represented half size. 
The needle holder which Roux used for staphyloraphy was a good instrument, but, as attention began to be 
directed to cleft palate, one of the apparently most difficult steps of the operation was the passage of the sutures. 
Numerous instruments were devised, and the instrument of Depierris was probably the most ingenious ever conceived. 
It is said to have given the idea of the sewing machine, and indeed one can readily believe such to have been the case 
on inspecting the instrument. The difficulties of passing the sutures are not so great as some might suppose, and so 
complicated an instrument as that used by Depierris is not required. Standing in front of the patient is not the 
easiest way to pass the sutures. 
There are a number of little simple details which make up the success of many operations generally considered 
difficult; the position of the patient and the attitude of the operator, the substitution of a simple instrument for a 
comolicated niece of mechanism and a simple manner of using it. 
Fig. 2331.-Whitehead's Gum Knife. 
Fig. 2332.-Whitehead's Hoe, 
for Dividing Muco-Periosteal Membrane. 
Fig. 2333.-Sayre's Periosteotome 
Fig- 2334 represents an excellent 
needle. It is spiral and has an eye 
near the point, and when used the 
operator should stand behind the pa- 
tient, and bending over him pass the 
sutures from right to left, the thread 
being looped and the two free ends 
hanging out of the eye on the convex 
side. When the point of the needle 
has transpierced the left flap, Dr. 
Sims' tenaculum, represented in Fig. 
2336, is used to pull out the two free 
ends of the thread. The needle is then disengaged, and silver 
wire drawn through on the looped thread. A spiral canulated 
needle of the same shape may be used by those who prefer it, 
with either silver wire or horse hair. But Fig. 2334 is stronger 
and preferred by Dr. Whitehead, who uses three different 
sizes. 
Figs. 2335, 2337 and 2338 are instruments used by Dr. 
Sims, for twisting silver wire in the operation for vesico-vaginal 
fistula, and are useful in the operation for cleft palate. 
Fig. 2334.-Whitehead's Spiral Needle, for Sutures. 
Fig. 2335.-Sims' Adjuster. (For Wire Sutures.) 
Fig. 2336.-Sims' Tenaculum. 
Figs. 2337, 2338.-Sims' Adjuster and Pulley. 234 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
STAPHYLORAPHY. 
UNITING CLEFT PALATE. 
A whalebone probe is required for stuffing into the side cuts bits of cotton, which keep them from healing too 
soon, and press the edges of the flaps together. A small pair of forceps for removing the cotton from the side cuts 
will also be found serviceable. 
Buck's needle, for passing harelip pins (Fig. 2316), on account of the frequency of harelip attending cleft palate, 
will appropriately find a place in this case. A pair of stout straight scissors, about the size of those generally con- 
tained in a pocket case, might be added. 
They will be found useful in cutting thread 
and wire, and in the operation for harelip in 
thoroughly detaching the lip from the gum. 
This is a precaution that the late Dr. Buck 
insisted upon in operations on the lips ; and 
it is an excellent rule to use soft cotton yarn for twisting around the pins, instead of thread. The yarn soaks up the 
water readily and may be renewed each day, and thus relieve a certain degree of strangulation of the parts, which 
otherwise would be too long continued. A narrow sharp-pointed bistoury, for paring the edges of a cleft lip, should 
be contained in this case.-Whitehead. 
Fig. 2339.-Sims' Wire-Twisting Forceps. 
Fig. 2340.-Curved Bistoury. 
Fig. 2341.-Curved Needle. 
Fig. 2342.-Blunt Hook. 
Fig. 2343.-Bent Needle. 
Up de Graff's Staphyloraphy Set.-The edges of the cleft are freshened with the bistoury (Fig. 2340). The 
curved needle (Fig. 2341) is threaded with waxed Chinese silk and thrust through one edge of cleft, then slightly with- 
drawn, so as to form a loop underneath. The blunt hook (Fig. 2342) is passed through this loop, by means of which 
the thread is withdrawn outside the mouth, and the needle is also withdrawn. The bent needle (Fig. 2343) is then 
threaded with the same thread and pushed from the rear (of the opposite side of cleft) to the front ; a loop is formed 
in same manner as with curved needle, and thread withdrawn with the blunt hook. The process is repeated until as 
many sutures are introduced as seem necessary, all of which are tied. 
Fig. 2344.-Double-edged Staphyloraphy Knife. 
Fig. 2345.-Staphyloraphy Knife, Curved Right or Left. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
235 
STAPHYLORAPHY. 
UNITING CLEFT PALATE. 
Fig. 2346.-Good- 
willie's Canulated 
Staphyloraphy 
Needle, 
for Silkworm Gut. 
Fig. 2347.-Goodwillie's Mouth Gag. 
Figs. 
2349> 235o, 2351. 
Goodwillie's 
Staphyloraphy 
Knives. 
Fig. 2348.-Prince's Staphyloraphy Needle. 
A A. Shaft and handle. 
B. Foot-piece of the shaft, curved. Its extreme point has an orifice, 
the place of which is indicated by the dotted line. The orifice is entered 
by the needle, C, carrying the thread, EE. 
C. Needle with a thumb-piece. 
DD. Pick-up pin, with a thumb-piece above its sliding shaft and its 
fine point above the B. As the shaft (upper D) goes down, the pin (lower 
D) moves horizontally and at a right angle to its shaft, and picks up the 
thread carried by the needle, C. 
EE. Thread carried by the needle, C, and picked by the stiletto or pin indicated by D. This is retained while 
the needle is withdrawn, so that, on displacing the shaft, AA, with its foot-piece, B, the thread is exposed and can be 
seized by a tenaculum or by the fingers. 
"A needle in the form of a tenaculum (the eye being near the point), to which 
Black's pick-up attachment is applied, greatly facilitates the introduction of sutures. 
The tenaculum is placed in the mouth, and the pick-up shaft in the nose, striding 
the alveolar and labial tissues in front, and picking up the stiches in the dark. 
"a a. shaft and handle of the needle, b, the finger end of the pick-up shaft, 
which terminates at d. c, thumb-piece of the pick-up stilette, the point of which is 
in d. d, the terminal end of the pick-up shaft, which receives the point of the 
needle, e, thread, which is seen passing through the eye of the needle, then hid- 
den beneath the tissue engraved dark, and again emerging to be connected with 
the pick-up mechanism. The view is taken at the time when the pick-up stilette is 
ready to let go its hold, f, point of the 
needle perforated for the passage of 
the suture thread, g, slot in the pick- 
up shaft to enable it to be drawn out 
of the way and detached."-" Palato- 
Plasty. David Prince, M.D. Ameri- 
can Practitioner, March, 1876." 
Fig. 2352.-Prince's 
Tenaculum Needle. 
See Goodwillie's Periosteum Levators, page 102 ; Goodwillie's Oral Saw, page 104. 236 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
STAPHYLORAPHY. 
URANISCOPLASTY. 
The operation of engrafting in case of deficiency of the soft palate.-Dunglison. 
Clefts in the hard palate are treated upon the same principles as those of the soft palate, by a process originally 
suggested by Von Langenbeck and since variously modified by different surgeons. It consists in dividing the maxil- 
lary and palate bones on each side close to the alveolar border, so as to form two osseous flaps, which are then pressed 
over to the middle line, where they are united in the usual manner-the edges having been previously pared, along 
with those of the soft palate, from behind forward, so as to admit of the operation being finished at one sitting.- 
" System of Surgery." S. D. Gross. 
Fig. 2353. 
Langenbeck's 
Retractor. 
Figs. 2354, 2355, 2356. 
Langenbeck's Double 
Edge Knives. 
Figs. 2357, 2358, 2359, 2360. 
Langenbeck's Convex and Con- 
cave Knives and Tenaculum. 
FiG. 2361. 
Langenbeck's 
Suture Holder. 
SPECULA ORIS 
CHEEK RETRACTORS. 
For holding back and protecting the Cheeks against injury in Operations on the Upper and 
Lower Jaws. 
Fig. 2362.-Cheek Retractor. 
Fig. 2363. 
Right Cheek Retractor. 
Fig. 2364.-Luer's Cheek Retractor. 
Fig. 2365. 
Left Cheek Retractor. 
Fig. 2366. 
Roe's Mouth Gag and Cheek Retractor. 
See Osteotomy Instruments, page 102, &c., and 
Antrum Drill, page 98. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
237 
SpECUhA ORIS. 
MOUTH GAGS. 
Gags for keeping the Jaws apart during Operations in the Mouth, Pharynx, Larynx, Trachea 
and (Esophagus, and Specula Oris for breaking up Morbid Adhesions and Lockjaw. 
Fig. 2367. 
Allingham's Annandales' Mouth Gag. 
Fig. 2368.-Goodwillie's Speculum Oris, 
for Reducing Lockjaw. 
Fig. 2369.-Mussey's Mouth Gag. 
Fig. 2370.-Parker's Mouth Gag. 
Fig. 2371.-Weir's Mouth Gag. 
Fig. 2372. 
Goodwillie's 
Elastic Mouth Gag. 
Fig. 2375. 
Westmoreland's Speculum Oris, 
for Reducing Lockjaw. 
Fig. 2373.-Mott's Heister's Speculum Oris. 
Fig. 2376.-Gross' Speculum Oris. 
Fig. 2374. 
Clover's 
Mouth Gag. 238 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SPECUL/v Of<IS 
TONGUE DEPRESSORS. 
For increasing the space between the Tongue and the Velum, for the passage and manipulation 
of Pharyngeal and Laryngeal Instruments. 
Fig. 2377. 
Rumbold's 
Tongue Depressor. 
Fig. 2378.-Green's Folding Tongue Depressor. 
Fig. 2379.-Goodwillie's Tongue Depressor. 
Fig. 2380.-Sass' Tongue Depressor. 
Fig. 2383. 
Steel Folding Tongue Depressor. 
Fig. 2381. 
Bosworth's Tongue Depressor. 
Fig. 2382.-Hard Rubber Tongue Depressor. 
Fig. 2384.-Folding Tongue Depressor. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
239 
SPECUL/r ORIS. 
TONGUE DEPRESSORS. 
For increasing the space between the Tongue and the Velum, for the passage and manipulation 
of Pharyngeal and Laryngeal Instruments. 
Fig. 2385. 
Pocket Tongue Depressor. 
Fig. 2386.-Elsberg's Tongue Depressor. 
Fig. 2387. 
Turk's Tongue Depressor, 
(3 blades). 
Fig. 2388.-Church's Tongue Depressor. 
Fig. 2389.-Dobell's 
Tongue-holding 
Forceps. 
Fig. 2390.-Cusco's Tongue-Holding Forceps. 
Figs. 2389 and 2390 
are used to steady the tongue 
when operating 
for tumors, excision, &c. 
Tongue Depressors, 
" Take care that the blade of the instrument be not introduced beyond two-thirds of the length of the dorsum of 
the tongue, as otherwise retching will ensue. No more pressure should be exerted with it than suffices to expose the 
pharyngeal wall. In this way the whole region will be much more satisfactorily exposed than will be the case if the 
patient be allowed to 'show his throat' by his own intuitive method, which implies strain on all the muscles of the 
part."-" Examination through the Mouth." " Woakes on Post-Nasal Catarrh," page 94. 1884. 240 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
TONSILLAR. 
Anatomy and Physiology of the Tonsils, Uvula and Soft Palate. 
On looking into the mouth, we observe, at its posterior part, the contraction which, under the name of the isthmus 
faucium, constitutes the line of division between the oral cavity and the bag of the pharynx and posterior nares. It 
is formed, above, by the uvula and edge of the soft palate ; below, by the base of the tongue; and laterally, by the 
two arches of the palate, each of which arises from the base of the uvula and passes downwards and outwards-the 
anterior diverging from the posterior in the descent, so that when they are seen at the side of the fauces on a level with 
the dorsum of the tongue they are about three-fourths of an inch asunder. Below this point they proceed, one to be 
inserted into the side of the tongue, the other into the pharynx at about its middle. In the sulcus formed by the di- 
vergence of the anterior and posterior arches, is situated the tonsil, which, when the parts are in a state of rest, is 
scarcely to be seen, the substance of the gland being hidden by the anterior arch ; but, when this is not too strongly 
developed, the convex surface of the gland sometimes becomes visible. 
The tonsils, or, as they are not unusually called, the amigdala, from their resemblance to the almond shape and 
size, are glandular bodies, secreting a mucous fluid from a considerable number of openings on their external surface, 
which is pressed out in great abundance upon the food, on its passage through the isthmus faucium into the throat. 
This process is effected by the joint action of the various muscles, more especially by the palato-glossus and palato- 
pharyngeus, which form the arches between which the tonsils are situated. The openings upon the surface of the 
tonsil are sometimes so large as to give it a cellular appearance ; occasionally, also, it presents a lobulated or tubercu- 
lated exterior, especially when enlarged by disease. 
The uvula is the conically-shaped body which hangs from the centre of the loose edge of the palate into the 
pharynx. At its origin it is broad and rather flattened, becoming rounded in its descent, until it terminates in an 
obtuse point. It varies considerably in length ; sometimes it may be seen, to all appearance, inconveniently long, 
and sometimes so little developed as to leave it doubtful whether an uvula exists. In its natural state it is said to 
point to the foramen caecum of the tongue; but this is giving it credit for an independent muscular development which 
it does not in reality possess. The uvula must be considered as little more than a prolongation of the mucous membrane 
which lines the whole of the throat, mouth, nose, &c. It is only found in man and the monkey tribe. In other animals 
the loose edge of the palate, instead of being formed into arches by this central appendage, is found almost straight. 
The soft palate, velum pendulum palati, ox, palatum molle, is described as a movable and flexible curtain, extend- 
ing from the back of the palatine arch into the pharynx, of nearly a quadrangular figure, with an anterior and posterior 
surface and four margins-one superior, one inferior and two lateral; the anterior surface concave, presenting down- 
wards and forwards and studded with numerous mucous ducts ; the posterior surface directed upwards and backwards 
and elevated at its sides. At the lateral margins of the soft palate commence the muscular folds, which constitute the 
palato-glossus and palato-pharyngeus muscles. The superior margin is attached to the posterior edge of the ossa-palati, 
and the inferior hangs loosely into the pharynx, formed into arches by the pendulous uvula which arises from its centre. 
The arches, velum palati, and uvula are chiefly composed of muscular fibres, covered by mucous membrane, which 
is everywhere studded with follicles; the dorsum of the tongue also, at its posterior part, is furnished with numerous 
mucous glands, which give it the rough and tuberculated appearance it presents on looking into the mouth. 
The muscles of the soft palate are: the levator palati, the circumflexus palati and the azygos uvulae. The palato- 
glossus, passing down from the uvula to the side of the tongue, and constituting the anterior arch, assists above to 
form the soft palate. In like manner the palato-pharyngeus, passing from the uvula to the side of the pharynx, also 
contributes above to form the soft palate. These two last-mentioned muscles embrace the tonsil between them in the 
irregular triangular space or sulcus, in the manner already mentioned. The pain in deglutition which is experienced 
by persons with inflamed tonsils, arises from the pressure of the palato-glossus and palato-pharyngeus muscles on 
these glands. 
These various parts are supplied with blood from the following sources: the soft palate and uvula chiefly from the 
inferior palatine branch of the facial artery ; the tonsils from a twig of the facial, called, therefore, the tonsilary branch, 
and from another arising from the pharyngeal branch of the ascending pharyngeal. The carotid artery is situated 
considerably behind the tonsil, and, when the gland is drawn out by a tenaculum from its place between the arches, the 
artery will be more than an inch distant. The nutrient vessels of the tonsils and adjacent mucous membrane are all of 
them exceedingly minute ; when cut they speedily contract, so that no haemorrhage of consequence ever ensues on their 
division. The nervous ramusculi which supply the soft palate and the tonsils are : one of the small terminal branches 
of the glosso-pharyngeal nerve ; a minute filament of the great palatine nerve, which passes through an osseous foramen 
in the nasal plate of the palate bone and enters the tonsil; and, lastly, the middle palatine nerve, which penetrates the 
soft palate by the canal in front of the pterygoid hook, and is distributed to the soft palate and the amygdalae. The 
various filaments thus derived form an interlacement around the tonsil, termed the plexus tonsilaris; their ultimate 
distribution is chiefly to the neighboring mucous surfaces ; so few fibres enter the tonsil itself that it possesses a very 
low degree of sensibility. 
Use of the Tonsils.-The tonsils have been supposed most erroneously to give tone to the voice. There can be no 
doubt that the principal use of the tonsils is to facilitate deglutition by the lubrication of the morsel of food with their GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
241 
TONSILLAR. 
Anatomy and Physiology of the Tonsils, Uvula and Soft Palate. (Continued.) 
abundant mucous secretion in its passage into the throat. The mucous follicles, or lacunas of the tonsils, retain their 
secretion till the act of deglutition takes place ; it is then squeezed out by the approximation of the arches on each side 
of the throat and received by the piorsel of food with which this action brings them in contact. This appears to be 
the only function of the tonsilary secretion ; it possesses no other properties than those of ordinary mucus, and cannot, 
therefore, like the salivary, be supposed to have any share in the process of digestion. The food is still further lubri- 
cated in its passage into the pharynx by a supply of mucus from the small glands with which the surrounding parts 
are studded, including the palate, the uvula and the base of the tongue. 
Use of the Soft Palate and Uvzda.-During the act of deglutition, vomiting or holding the breath, it has been 
shown by Dzondi that, by the approximation of the posterior arches from side to side, the lower parts of the pharynx 
and the cavity of the mouth may be almost entirely cut off from the posterior nares. It is this action, and not the mere 
raising of the palate, which enables us to swallow without regurgitation into the nose, or to vomit without allowing the 
matter to escape by the nose, or to perform the act of breathing through the mouth alone, when we wish to defend the 
olfactory organ from unpleasant odors. When the palatine arches thus act, the uvula lies passive between them, and 
contributes in some degree to complete the division between the nares and the pharynx. It cannot, however, be of 
any great importance in this particular, as this appendage is only present in man and the quadrumana. In singing, 
the uvula and palate are raised during the production of the higher notes, and it is a singular fact that, when the uvula 
is removed and the soft palate in consequence more easily raised, the voice, in singing, can attain a greater altitude; 
oftentimes two full notes in the musical scale are gained, without any deterioration or loss of the lower notes. That 
the uvula is of no importance in the production of the voice or speech is proved by the fact that many cases are re- 
corded in which it had been destroyed by disease, or when there had been congenital deficiency ; in none of these cases, 
when the soft palate had been left intact, had anything abnormal been observed in the voice. Neither does the loss of 
the uvula, as far as my experience goes, interfere in the least with deglutition ; the contraction of the palatine arches 
and guidance of the food into the pharynx take place with as much precision as before. 
This brief sketch of the anatomy and physiology of the tonsils, uvula and soft palate would be very incomplete 
without adverting more particularly to the important membrane by which these and all the surrounding parts are 
covered. Commencing at the mouth, at the junction of the skin with the red tissue of the lips, it passes inwards to 
line the mouth and enters into all the salivary glands, giving off delicate prolongations to the different nasal cavities, 
the cells and sinuses in the upper jaw, os frontis, and the other bones of the cranium and face which are subservient 
to the senses of hearing and smell. In the pharynx it becomes continuous with the mucous lining of the eustachian 
tubes, and through them enters the tympanum as its investing membrane, covering the small membranes which close 
the inner ear, and also the external membrane of the drum ; finally, this part of the membrane spreads itself out on the 
surface of the mastoid cells, behind the organ of hearing. Passing downwards from the throat, its track admits of two 
important divisions ; the one, entering at the glottis, runs down the trachea and bronchial tubes, dividing and sub- 
dividing to an infinite extent, to line these innumerable cells in which the vital properties of the air become imparted 
to the blood as it flows through the lungs; the other division, or the intestinal mucous membrane, continues down the 
gullet to the stomach, contributing greatly to the rugae of that organ, and becomes the seat of the secretion of the 
gastric juice, the bile, pancreatic fluid and the multitude of minor glands with which the intestinal tube is everywhere 
studded ; finally, it terminates at the anus, where it again becomes identified with common integument. 
On considering the immense extent of this continuous mucous surface, its ramifications throughout cells, tubes, ca- 
nals, reduplications and convolutions in an almost infinite variety of arrangement and form, the principle of sympathy 
between one organ and another may be readily understood ; and a valuable guide this principle is to us in the treatment 
of disease.-"Yearsleyon the Throat." London. 7th edition. 185g. 
Nature of the Changes produced in the Tonsils and Uvula. 
The chronic disease of the tonsils usually met with cannot be strictly termed hypertrophy, which signifies an 
increased nutrition of the parts, inasmuch as the augmented size does not consist of the proper glandular substance, but 
of deposits of fibrin, which are gradually thrown out during the inflammation or irritation to which they are subject, 
and in process of time become organized. This organization takes place only to a limited extent, as they never possess 
much sensibility, when of the largest size, unless acutely inflamed ; and they receive so small a supply of blood in their 
enlarged state that, even when cut into, little or no haemorrhage takes place.-Yearsley. 
When enlarged tonsils are in the first stage of active inflammation, nothing is so immediately efficacious as scarifi- 
cation freely performed, so as to disengage the tumefied surface of the glands. If this should fail to check the in- 
flammatory action, leeches must be applied to the tonsils themselves, or throat externally, or both; and, if suppuration 
cannot be prevented, it should at all events be kept within as small a limit as possible. When matter has formed, 
Scarification of Enlarged. Tonsils in a state of active inflammation. 242 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
TONSILLAR. 
Scarification of Enlarged Tonsils in a state of active inflammation. Continued.) 
which is indicated with tolerable correctness by fits of shivering, it should be evacuated as soon as possible. The touch 
will guide the surgeon as to the spot which must be entered by the lancet. This will sometimes be through the 
anterior arch of the palate, which becomes thin from being stretched out upon the enlarged tonsil, and at others the 
surface of the tonsils themselves. When the inflammation is extensive, the cellular tissue around becomes implicated 
and the tonsil itself is lost in the surrounding tumefaction. In these cases, which are supposed to render puncture 
dangerous, as some parts more immediately in contact with the internal carotid than the tonsil may be wounded, and 
possibly this vessel itself. To obviate this risk, the rule should be in all cases to make the puncture as nearly as possible 
in the situation of the tonsil, which is free from danger. If practicable, the tonsil to be operated on should be seized 
by forceps, and drawn out towards the median line of the throat. After judicious puncture all the alarming symptoms 
.usually subside.-"Yearsley on the Throat." 
Fig. 2391.-Buck's Throat Lancet. 
See Tobold's 
Concealed Tonsil Lancet 
Mackenzie's 
Laryngeal Knives, 
&c., &c. 
TONSILOTOMY. 
Notwithstanding all that has been written, a difference of opinion still exists as to the propriety of excision of en- 
larged tonsils, merely from misapprehension of what the operation really consists. The phraseology which is adopted 
in speaking of it, such as "excision of the tonsils," "tonsil cutting," "cutting away the tonsils," is calculated to mis- 
lead, and it is asked, with some show of reason, how an operation can be justified which removes an important part of 
the animal economy? Now, in point of fact, nothing of the kind is done ; it cannot be too often repeated, that the 
tonsils in a healthy state are never interfered with, but only when enlarged, that is to say, diseased, and then only to 
the extent of the enlargement, sufficient of the gland being always left to perform its function-the secretion of mucus. 
The operation can be performed without the slightest risk, and, incredible as it may appear, frequently without the 
slightest pain. My own experience now extends to more than three thousand cases, each unattended by accident or 
subsequent inconvenience, whilst the great majority had been followed by relief of the particular malady, whether 
defect of speech, deafness, obstruction to respiration or swallowing, cough, or impaired health, which singly or con- 
jointly, may have necessitated the operation.-"Yearsley on the Throat," p. 57. 
Operation.-I place my patient opposite a good light, and having requested that the mouth be opened to the 
greatest possible extent, I introduce the tenaculum (held in the right hand, if about to excise the left tonsil; in the 
left, if the right) over the tongue, and include within its grasp as much of the morbid growth as possible. I then draw 
out the diseased tonsil from between the pillars of the fauces diagonally across the throat, and over the bridge thus 
formed I introduce the knife, held like a pen. As I cut forward towards myself, I keep slightly dragging at the 
tenaculum, so that when the excisor is completed, the portion of the enlarged gland grasped by the tenaculum and the 
knife are withdrawn at the same moment.-Yearsley, page 62. 
When hypertrophy is accompanied by 
induration, whether this condition co-exists 
with follicular disease or is the effect of 
chronic tonsilitis, excision of the enlarged 
gland is almost the only method of treat- 
ment by which permanent and effectual relief can be obtained.-"On Diseases of the Air Passages." Dr. Horace 
Green, New York. 
The President asked the indulgence of the Academy, while he referred to certain points in 
connection with chronic hypertrophy of the tonsils and its treatment. Inasmuch as no allusion had been made to one 
whose experience and extraordinary dexterity in manipulation had, perhaps, never been equalled, whatever may have 
been thought of his pathological views or practice, he would refer to the method of operating adopted by Dr. Horace 
Green, because he thought that all that could be should be known relative to the operation for removal of the tonsils." 
-Proceedings of the New York Academy of Medicine. April I, 1880. 
" The best and most satisfactory method of treating hypertrophied tonsils is to cut them off as close to the pillars 
of the fauces as possible. This may be done in adults by means of a pair of forceps and a bistoury-the operation 
being, however, rather tedious and bloody, but, strange to say, not at all painful. A better, quicker and more safe 
mode of operating is by means of an instrument called the ' tonsilotome.' "-" Diseases of the Throat." Seiler. 1883. 
Fig. 2392.-Yearsley's Tonsil Knife. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
243 
TOJMSILOTOJVIY. 
For Removing Portions of the Enlarged Tonsils. 
Dr. Green, after trying various methods, finally settled upon the following, alluded to by Dr. Hamilton. Ilis 
method was to seize the tonsil with a single hook, bring it forward, and then, with a bistoury, cut away the exact 
amount he wished to remove. He always operated upon the left tonsil first, standing in front of the patient, and cut 
from above downward. When the right tonsil was removed, he stood behind the patient, seized the gland, and cut 
from below upward. Scarcely ten seconds were required to perform the operation.-2V. Y, Med. Record* May i, 1880. 
Fig. 2393.-Tonsil Scissors, Curved on the Flat. 
Fig. 2394.-Musseux's Forceps, for Seizing (Vulsellum). 
Fig. 2397.-Green's Tonsil Bistoury. 
Fig. 2400.-Green's Tonsil Hook. 
Fig. 2395.-Green's Double Hook. 
Fig. 2396.-Tenaculum Forceps, for Seizing (Vullsellum). 
Fig. 2398.-Durham's Seizing Forceps. 
Fig. 2399.-Langenbeck's Seizing Forceps. 244 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
TOJMSILOTOJVIY. 
For Removing Portions of the Enlarged Tonsil. 
Fig. 2401.-Fahnestock's Tonsilotome. 
Fahnestock's tonsilotome is an annular knife, moving in a split ring. The tonsil is encircled by this ring, and a 
stout needle on the exterior of the instrument is pushed through the gland for transfixing it. When thus secured, the 
parts that protrude are cut by pulling on the handle of the blade. To use this instrument both hands are needed. 
Fig. 2402.-Mathieu's Tonsilotome. 
The use of Mathieu's tonsilotome requires but one hand and one motion. The middle and index fingers are 
passed into the double rings, the thumb into the other. After the fork has been pushed through the tonsil, it rises and 
draws the gland through the ring, then a catch is lifted and the knife is drawn down, cutting the protruding mass with 
the same motion of the hand that drove the fork forward. 
Fig. 2403.-Billing's (U. S. A.) Tonsilotome. 
The use of Billing's tonsilotome requires but one hand. The middle and index fingers are placed into the double 
rings of the lower shank, the thumb into the ring of the blade. The blade moves and is guided in grooves. It cuts 
like a chisel. 
Modus Operandi.-The blade is drawn back, to open the aperture for the reception of the tonsil and the seizing 
forceps. After taking hold of the instrument as stated above and applying the ring over the tonsil, the blade is 
pushed home by the thumb, this cuts the tonsil whilst the forceps hold the excised part. The closing movement of the 
forceps is automatic. 
The instrument may be fixed in 
position by the thumb-screw to suit 
the right or left tonsil. Its use re- 
quires but one hand and one motion, 
leaving the other hand free. It is 
not automatic - every part of the 
operation is done and watched by the 
intelligence of the operator. When 
once applied to the tonsil, only the 
closure of the scissor-handles is re- 
quired ; this will first seize and then 
cut the gland. The opening of the 
handles releases the grasp on the ex- 
cised portion of the tonsil, when the 
instrument is withdrawn after use. 
It may be taken apart and cleaned 
without the aid of a screw-driver. 
Different size blades can be fitted 
into the same handles. 
Dr. Tost had been in the habit 
of using a guillotine made by Tie- 
mann, and it seemed to him to be as perfect as could be.-Medical Gazette, May I, 1S80. 
Fig. 2404.-Tiemann & Co.'s Tonsilotome. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
245 
TOJMSIbOTOJVIY 
For Removing Portions of the Enlarged Tonsils. 
Owen's original instrument I have considerably modified, and it is this modified 
instrument which I now present to you, and nearly in the form I have used it 
hundreds of times. The handle is sufficiently large to be felt in the grasp, and it is 
not smooth and slippery. It is placed at an angle, so as to remove the hand from the 
front of the mouth. The shaft is composed of two firm plates, which, including the 
ring or fenestra, are about inches long and J of an inch wide, except the ring, 
which, in its outer circumference, is ij inch wide, and in its inner circumference J 
of an inch wide by l| inch in length. The plates are jointed together by movable 
hooks instead of screws, as was the case in Owens' original instrument. The forceps 
in the original instrument had simply straight bone for handles. I have curved 
them, as you see, and added rings as in scissors, into which the thumb and forefinger 
may be inserted for the purpose of giving a secure hold. 
These forceps can be moved laterally as well as upwards, and thus by oscillation 
draw the larger tonsils through; and I have provided braces for them to limit the 
extent of their motion. The cutting portion of the instrument is camerated, or 
lance-shaped, and cuts by entering its point first and then penetrating the gland, 
moving from before back. 
Mode of Using the Instrument.-The tonsils having been previously thoroughly 
examined (I do not find it necessary to look into the mouth while operating, 
although it is always easy to do so, when the instrument is in place). The patient 
being seated, with the head thrown back, the instrument being held in the right hand 
in the case of the left tonsil-is carried in flat-wise, with its dorsal surface, or the 
surface supporting the forceps, below; it is then turned upon its axis about one- 
quarter, and carried to the tonsil, and it is pressed against the tonsil from below up 
and out, as the tonsil generally or often hangs down a little and is more easily 
looped from below. Now the forefinger of the left hand is carried along the dorsal 
surface of the instrument, under the protection of the broad plates of the shaft, until 
the tonsil is felt, and its presence in the ring is assured. The forefinger is then with- 
drawn and the same finger, ■with the corresponding thumb placed in the rings of the forceps, the tonsil is seized and 
drawn through; and now the thumb of the right hand, which holds the handle of the instrument, is placed upon the 
projecting end of the cutting shaft and the knife is projected firmly through the gland. The tonsil is held by the 
forceps and safely removed with the instrument. In removing the right tonsil, the employment of the hands is 
reversed.-Dr. F. II. Hamilton, Medical Gazette, May I, 1880. 
The guillotine which I employ is the same as 
that of Physick, slightly modified, so that the 
handle can be applied to either side of the shank. 
This arrangement enables the operator to use one 
instrument with his right hand for amputating 
either tonsil, the free surface of the blade in each 
case being directed towards the centre of the 
mouth. The instrument being ready for use, the 
hilt is grasped in the right hand, and the aperture 
in the shank is placed over the tonsil. The sur- 
geon, with the thumb or index finger of the left 
hand placed under the angle of the patient's jaw, 
then presses the tonsil inward, whilst at the same 
moment, with the thumb of the right hand, he drives 
home the blade of the tonsilotome.-" Diseases of 
the Pharynx, Larynx and Trachea." Mackenzie. 
Take sponges fitting the bowls, wet to softness; then 
squeeze out dry and replace in the bowls; pour on their 
centres a little melted caustic potash. It hardens imme- 
diately and is ready for application. It takes hold of the 
sponge fibre, but leaves room for the passage on its sides of 
tonsil discharge, which the sponge absorbs-thus prevent- 
ing any outflow of caustic on contiguous parts whilst ap- 
plied or on removal of the instrument. 
Fig. 240c.-Hamilton's Tonsilotome. 
Fig. 2406.-Mackenzie's Tonsilotome. 
Fig. 2407.-Clendinnen's Tonsil Haemostatic 246 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
UVUbAR. 
EXCISION OF THE UVULA. 
In regard to the uvula, also, nothing could justify the removal of that appendage to the palate in the healthy state, 
however unimportant a part it may play in the functions of the throat; but when in an elongated condition, giving rise 
to most distressing symptoms, and even threatening suffocation, the propriety of reducing it to at least its natural di- 
mensions cannot be questioned.-" Yearsley on the Throat." 
In numerous cases in which I have resorted to excision of the uvula, I have never seen any ill consequences, but, 
on the contrary, the most striking relief from the removal. I have often known the injury to the voice and the re- 
spiration, the harassing cough of years, removed in a moment by the loss of the uvula. The operation, moreover, 
renders the voice clearer than before, and increases its compass. In some professional singers I have proved that the 
excision of the uvula has gained for the patient one, two, or even'three notes in the voice, and this not in the falsetto, 
but in the natural register. 
In treating of enlongation of the uvula, Dr. Horace Green says: " In simple enlongation of the uvula, depend- 
ant upon relaxation of the parts, the use of stimulant or astringent gargles may, in some slight and recent cases, be 
sufficient to overcome the difficulty. But where hypertrophy actually exists, and the uvula itself is both thickened 
and elongated, excision will prove the only effectual remedy. So simple is this operation, and so entirely unattended 
with subsequent danger or inconvenience, that the removal of the uvula should not be omitted or delayed in cases of 
follicular disease, where its elongation serves to increase and prolong the irritation."-"Yearsley on the Throat," p. 61. 
7 he uvula is occasionally productive of disagreeable effects from mere relaxation of the soft palate, independently of 
any particular disease of its own substance. The palate, thus affected, hangs down into the fauces, and thereby permits 
the organ to encroach upon the larynx and root of the tongue in the same manner as in actual elongation. Such a 
condition is very common in dyspeptic and consumptive subjects, in whom it often constitutes a source of great 
annoyance. 1 he only reliable remedy for this affection is excision of the uvula. The patient being seated upon a 
chair opposite a good light, the surgeon depresses the tongue, and, with a polypus forceps, seizes the apex of the 
uvula, which is then cut off with a pair of probe-pointed scissors, slightly curved on the flat. An instrument which 
combines both forceps and scissors (hig. 240g) will be found convenient for this little operation. * * * If I were 
obliged to operate upon a professional singer, I should limit myself to the removal of a comparatively small portion of 
the elongated organ.-" System of Surgery." Gross. Vol. II., p. 483. Sixth edition. 1884. 
Fig. 2408.-Uvula Scissors. 
Fig. 2413.-Mackenzie's Uvulatome, for Seizing and Excision. 
Fig. 2412.-Tiemann & Co.'s Universal Forceps. 
Fig. 2409.-Uvula Scissors with Claws, 
for Seizing and Excision. 
Fig. 2410.-Vulsellum Forceps. 
Fig. 2411.-Knox's Uvulatome, for Seizing and Excision. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
247 
PHARYNGEAL,. 
PHARYNX. 
Pharynx.-That part of the alimentary canal situated behind and below the mouth and above the cesophagus, with 
which it is continuous. It is a muscular membranous sac, conical or pyriform, with its base upward, and extends from the 
base of the skull to the cricoid cartilage in front and the fifth cervical vertebra behind, being about four and one-half 
inches long in the adult human subject. Its transverse is greater than its antero-posterior diameter. It is connected be- 
hind by loose areolar tissues with the cervical portion of the vertebral column, and some of the muscles of the neck situ- 
ated there. Seven openings communicate with it; the two posterior nares, the two eustachian tubes, the mouth, the 
larynx, and the oesophagus. The pharynx is placed behind the larynx, as the oesophagus is placed behind the trachea or 
windpipe ; and the glottis, or opening into the larynx, which in swallowing is closed by the vascular epiglottis, is in 
the front side of the pharynx, and looks backward into its cavity. It is divided from the cavity of the mouth by the 
velum palati, or soft palate. The pharynx has three coats: a mucous or lining coat, next to it a middle or fibrous 
coat, and beneath this the muscular coat. The mucous coat is continuous with that of the mouth and adjacent pas- 
sages. The fibrous coat, called the pharyngeal aponeurosis, is thick above, where the muscular fibres are wanting, and 
is firmly connected with the occipital and temporal bones of the skull. As it descends it gradually diminishes in 
thickness until it disappears. The muscular coat is composed of five pairs of muscles, viz.: three constrictors and two 
elevators. The constrictors, called superior, middle, and inferior, have their fibres directed transversely downward 
around the pharynx, being mostly united in a continuous raphe or suture behind, but attached to different and separ- 
ated points in front, most of the fibres of the superior constrictor being inserted into the palate and sphenoid bones, 
the lower jaw bone, the root of the tongue, and some other muscles and ligaments. The middle constrictor is prin- 
cipally inserted into the hyoid bone, at the root of the tongue. The fibres of the inferior constrictor are mostly 
united in front to the thryroid and cricoid cartilages. The elevator muscles rise from points at the base of the skull, 
and passing nearly vertically downward, have most of their fibres inserted into the posterior border of the thyroid 
cartilage. From this description the action of the muscles, as far as the pharynx is connected with the function of 
deglutition or swallowing, will be apparent. When a portion of food is about to be swallowed, the pharynx is drawn 
upward and dilated to receive it, the elevator muscles drawing the sides outward as well as upward. As soon as the 
food is thrown into the cavity by the action of the tongue, the elevators relax, and the constrictors, beginning above, 
contract successively and propel the food downward into the cesophagus, which transmits it to the stomach. Besides 
its action in deglutition, the pharynx exerts an important influence in modulating the voice by the different dimensions 
it is capable of assuming. It is well supplied with mucous glands. Follicular glands are spread over its whole extent 
beneath the mucous membrane, and across the upper part is a thick layer of rasemose glands, all of which, especially 
during mastication and deglutition, pour out an abundant secretion of lubricating mucus. The pharynx is liable to 
be attacked by inflammation (pharyngitis), and is one of the common seats of exudation in diphtheria. Its mucous 
membrane is often the seat of common catarrh, like that which lines the respiratory passages. In scarlet fever, measles, 
and other exanthematous diseases, it has a specific inflammation.-"American Cyclopaedia." 
'XiiZ pnaryngo-nasal space is continuous anteriorly with the nasal cavities, and laterally communicates, by means of 
the eustachian tube, with the middle ear. The upper wall of the roof is rich in gland tissue, and shows numerous 
depressions and crypts. In some subjects there is a cavity of considerable depth situated posteriorly and in the centre 
of the roof, in which are found openings of numerous follicles. This collection of follicles has been described by 
Luschka {"Der Schlundkopf des Menschen." Tubingen, 1868, p. no) as an acinous gland, named the "pharyngeal 
tonsil" (called also "Luschka's tonsil," see page 220), in contradistinction to the analogous glands in the fauces. 
This tonsil is about a centimetre in thickness, and is situated near the vault of the pharynx, between the orifices of 
the two eustachian tubes.-"Pharynx, Larynx and Trachea." Mackenzie. 1880. 
The pharyngo-oral cavity may be said to be limited superiorly by the level of the base of the uvula, and below by a 
plane passing through the posterior extremities of the greater curve of the hyoid bone. The posterior surface of the 
uvula must be regarded as its incomplete anterior wall, the pillars of the fauces its lateral walls, and the base of the 
tongue, together with the folds of mucous membrane enclosing some muscular tissue and known as the pharyngo- 
epiglottic folds, its lower margin.-" Pharynx, Larynx and Trachea." Mackenzie. 1880. 
PHARYNGOSCOPY. 
Pharyngoscopy (see page 207), or posterior rhinoscopy, is accomplished by means of the same appliances as used in 
laryngoscopy, i. e., a small plane mirror for introduction and one of the various instruments for illuminating. (See 
"On the Use of the Laryngoscope.") Special rhinoscopes are invented by Duplay, Simrock, Fraenkel, Jarvis, and 
others. (See page 208.) 
PHARYNGOTOMY. 
Pharyngotomy.-" Some authors have used this word synonymously with oesophagotomy. It means, also, scarifica- 
tion of the tonsils (page 242), or an incision made for opening abscesses there, &c."-Dunglison. 248 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
f>HARYJ\l®EAL. 
VAULT OF THE PHARYNX. 
The post-nasal forceps here shown are of the pattern recommended by Prof. Lefferts, in his " Pharmacopoeia for 
the Treatment of Diseases of the Larynx, Pharynx and Nasal Passages." Putnam. New York: 1884. 
They were devised by Lowenberg of Paris. Their peculiar shape renders them easy of introduction into the vault 
of the pharynx even in children, and as 
a practical and efficient instrument for 
the safe removal of adenoid vegetations 
from the pharyngeal vault they may be 
confidently advised. 
When the hypertrophy of the tissues 
extends broadly, in the shape of small, 
slightly elevated, nodular masses, over the 
entire pharyngeal vault, a sharp curette, 
such as is used in uterine operations, with 
copper shank that can be suitably curved 
to pass behind the velum into the upper 
pharynx, will answer a better purpose in 
scraping away the vegetations than the 
forceps, which would here be difficult of 
exact application.-Lefferts. 
Fig. 2414.-Post-Nasal Forceps. 
Fig. 2415.-Lefferts' Post-Nasal Curette. 
Fig. 2416.-Holbrook Curtis' Post-Nasal Forceps, 
The forceps are made on the principle of Thomas' double uterine curette, the sharp edges continuing all around the 
opening, the blades approximating as the instrument is closed. The forceps are introduced by aid of the rhinoscopic 
mirror, and the growth, or a portion of it, seized. As the blades are brought together, the cut material passes through 
the fenestrated openings, which enables the operator to incorporate a much greater portion of the growth at one cut- 
ting than when the ordinary cup forceps are applied.-"Medical Record," October 7, 1885. 
FOR CLEANSING THE NASAL PASSAGES. 
The nasal spray apparatus (see Fig. 2417) was devised some years since by Dr. George M. Lefferts, Professor of 
Laryngoscopy and Diseases of the Throat in the College of Physicians and Surgeons, New York, to supersede the use 
of the nasal douche as a means of effectively and harmlessly cleansing the nasal passages. It is an apparatus arranged 
to throw a very coarse spray, with some force and in the proper direction, into the anterior nares. The conical tip of 
the instrument closes the nostril completely, the medicated fluid spray then enters one nasal passage and passes out by 
the other. Power is obtained by means of a double hand-ball tube. 
With this apparatus and a suitable medicated fluid, the nasal passages and upper pharynx may, except in rare 
instances, be thoroughly cleansed of secretions and crusts by the use of less than one ounce of the medicated fluid 
contained in its bottle or reservoir. Here at once is an immense advantage gained over the pint or even quart of fluid 
commonly used in the nasal douche. Being a coarse spray it washes up, loosens and dislodges the secretions-unless, 
as in rare instances, they are impacted firmly-in which case the anterior or posterior nasal syringe must be employed 
(see Fig. 2418), by the constant commotion of the fluid in the nasal passages, and this very readily and quickly. 
Explicit directions should be given to the patient in every case, as to the proper use of the apparatus. They should 
accompany every box in which that instrument is sold. 
The medicated fluid used in the apparatus is always a warm alkaline one (borate of soda, bicarbonate of soda, or 
"Listerine"); a saline solution (chloride of sodium) is never used.-" The Diagnosis and Treatment of Chronic Nasal 
Catarrh." Lefferts. St. Louis; Lambert and Co., 1884. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
249 
PHARYNGEAL. 
CLEANSING THE NASAL PASSAGES. 
Fig. 2417.-Lefferts' Nasal Spray Apparatus. 
Directions for Use. 
" I. Warm the medicated fluid in the bottle before using by hold- 
ing the filled bottle for a few moments in hot water. 
" 2. Hold the body erect and incline the head very slightly forward 
over the toilet basin. 
" 3. Introduce the conical nozzle of the apparatus into the nostril 
(first on the side most occluded), far enough to close it perfectly, hold- 
ing at the same time the horizontal tube of the apparatus directly out- 
wards from the face ; do not turn it from side to side or downwards, 
and make a trial of the spray by compressing the hand-ball once, to 
prove that the opening in the nozzle is not occluded in the nostril; 
then, 
"4. Open the mouth widely and breathe gently but quickly through 
it in a snoring manner ; avoid carefully all attempts at speaking, swal- 
lowing, or coughing. At the moment that the fluid passes in the 
upper part of the throat from the nostril being operated on, a desire 
to swallow will be experienced-resist it, and the next second the fluid 
passes forward through the opposite nostril. 
" 5. Hold the end-ball of the apparatus firmly in the right hand (the left holds the bottle), and operate it briskly, until 
the spray of the medicated fluid, which should be felt at once to enter the nasal passage, has passed around it and 
appears at the opposite nostril-at this moment, stop. 
" 6. Remove the nozzle from the nostril, allow the surplus fluid to run out of the latter ; then blow the nose gently, 
never vigorously. 
" 7. Repeat the operation upon the opposite nostril." 
Arrangement and Care of the Apparatus.* 
"After filling the bottle two-thirds full with the medicated solution, place the thinnest end of the hard rubber tube 
into the bottle, securing the entire tube into the neck of the same by a turn. Attach the double bulbs by slipping the 
rubber hose over the tube (see cut); operate the end ball briskly, when a continuous spray will be produced, issuing 
from the nozzle. 
" Should the fine opening in the nozzle or inner capillary tube become obstructed, clear it with a fine wire that 
accompanies this instrument. Never use a pin, needle or hard wire for this purpose. To facilitate the cleaning of the 
inner capillary tube, remove the oval nozzle by carefully and slightly rotating the same to and fro, making traction at 
the same time. Should the apparatus still not work satisfactorily-especially after it has been used some time-the 
instrument maker will repair the valves in the rubber hose. Every few days, when the instrument is in use, fill the 
bottle with warm water and force it through the tubes, to cleanse them."-" Pharmacopoeia for Diseases of the Throat 
and Nose." Lefferts. New York and London: Putnam. 1884. 
" In certain cases, i. e.\ atrophic 
nasal catarrh and syphilitic or stru- 
mous ozaena, the ordinary means 
for cleansing the nasal passages of 
hard crusts and impacted secretions 
will fail, and some more powerful 
method, short of direct instrumen- 
tal interference, must be employed ; 
this is preferably the use of the 
anterior and posterior nasal syringe, with a warm alkaline solution (' Listerine '). 
" The instrument here shown (Fig. 2418), and which has been devised by Professor Lefferts for the purpose, presents 
certain advantages over the many other forms of apparatus that are used to attain the same end. They may thus be 
briefly stated: 1. The instrument is of hard rubber ; 2. It is of a sufficient size to contain a quantity of the cleansing 
fluid ; 3. It is a syringe of some power ; 4. The two attachments that are furnished with the one instrument convert 
it, in a moment, into either an anterior or posterior nasal syringe ; 5. The form of these nozzles or attachments is new 
and novel, and is specially adapted to fulfill their purpose ; 6. The syringe is well and carefully made, therefore durable." 
Fig. 2418.-Lefferts' Anterior and Posterior Nasal Syringe. 
* These directions are applicable to keeping in working order all similar apparatus.-G. T. & Co. 250 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PH/vRYNQEAL- LARYJ^QEALd. 
FOR DIRECT MEDICATION. 
In the work already alluded to Prof. Lefferts' says : 
" Having shown you how the parts may be cleansed, if this may be necessary, I turn to the question of direct medi- 
cation of the disease which affects them. 
" The treatment of catarrhal conditions of the nares is based practically either upon the employment of various 
medicated fluids, used in spray by means of some form of atomizer, or upon the use of medicated powders, applied with 
the anterior or posterior nasal powder insufflator, in one of its various forms. Both methods have their warm advocates." 
Medicated Sprays. 
" My own experience prejudices me strongly in favor of the medicated spray as a means of making a thorough and 
efficient application to a diseased laryngeal mucous membrane. There is, I think, no question as to its superiority 
over other methods, in applications to the upper pharyngeal space and posterior nares, as well as anteriorly, through 
the nasal passages. I believe, that with a proper spray tube and a pressure of compressed air of about forty pounds 
to the square inch-which is obtainable by means of the "Compressed Air Spray Apparatus" (Fig. 2420)-no 
more perfect application can be made to the parts." 
" I prefer this high pressure of compressed air to the lower pressure so often recommended. I have never done 
harm to the mucous membrane with it, and the increased power of propulsion in the cloud of spray renders it possible 
to reach instantly, before any spasmodic action of the larynx takes place, its entire mucous surface. In the nasal pas- 
sages the same pressure causes the spray to enter and thoroughly bathe all the many irregularities and recesses that 
here abound." 
Spraying the Nasal Passages. 
"The patient depressing his tongue by means of a spatula, the velum palati must be drawn forward-that is, away 
from the posterior pharyngeal wall-by means of a suitable palate hook made of strong metal wire, of the proper form 
and size and covered with bougie mate- 
rial ; the contact of the latter with the 
throat being much better borne than 
that of metal. This procedure can be 
readily accomplished in all cases after 
a little practice, and is one that I re- 
gard as absolutely essential to the thorough success of the spray application, as it is the only way in which a practic- 
able degree of space can be gained through which to throw a spray upwards and forwards through the nasal passages. 
To attempt an application with the velum drawn upwards and backwards-closely approximated to the pharyngeal 
wall-is useless ; in this position it will be found the moment the operator introduces the spray tube into the patient's 
mouth, in nine cases out of ten. 
" The palate hook will overcome this difficulty. It is held in the operator's left hand and is quickly introduced into 
the mouth and turned so as to pass under the edge of the velum ; then drawn forwards, carrying the velum with it, and 
thus opening up a space between the posterior pharyngeal wall and velum, into which the end of the spray tube (the 
latter held and controlled by the operator's right hand) is passed, and the spray thrown upwards into the vault of the 
pharynx and forwards through the nasal passages, so that it appears, at both nostrils, in a fine cloud. 
" Such applications as are here described are thorough and complete, not painful, nor even very disagreeable to the 
patient, and that the results, obtained by a series of such, far exceed those obtained by any other method of local 
application, ample experience has shown." 
Fig. 2419.-Lefferts' Palate Hook. 
Spraying the Pharynx. 
"A spray application to the middle pharynx is made at the moment that the operator, with his left hand holding the 
spatula, depresses the patient's tongue well down into the floor of the mouth, and while the latter is breathing quietly, 
in order that the parts, viz.: the faucial pillars, soft palate, and constrictor muscles of the pharynx, may be relaxed, 
not contracted." 
"A spray application to the larynx should always be made, as is that with the laryngeal brush, under the guidance 
afforded by the laryngeal mirror. The concave forehead mirror and artificial illumination being used, the patient 
holding his own tongue and phonating the vowel sound * e,' in order to elevate the epiglottis and bring the vocal cords 
together at the instant before the volume of spray is discharged into the larynx ; the operator holds the spray tube in his 
right hand and the laryngoscopic mirror in his left." 
Spraying the Larynx. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
251 
PHARYNGEAL- LARYJMQEAL, 
FOR DIRECT MEDICATION. 
For the Production and Application of Medicated Spray. 
Fig. 2420.-Lefferts' Compressed Air Spray Apparatus, Complete. 
Fig. 2423.-Air Receiver. 
Fig. 2421.-Air Receiver. 
Component Parts of the Compressed 
Air Spray Apparatus. 
The cylinder or condensed air receiver, of 
which four (i, 2, 3, 4) different patterns are 
shown, is a necessary part of the compressed 
air spray apparatus. They are made of heavy 
copper, with strong hard-soldered joints, and 
burnished to a high degree of finish, and nickel- 
plated. A steam guage, to indicate the amount 
of air pressure, is a convenient adjunct to it, 
but not an absolute necessity. The stop-cocks, 
to control the entrance and exit of air, are made 
of brass, and especially ground true and air tight. 
In the complete apparatus shown, Fig. 2420, the 
cylinder or receiver is connected with the air- 
pump by means of hydraulic rubber tubing, 
and in turn with the glass, rubber or metal 
spray tube, Figs. 2426, 2427, 2428, by rubber 
tubing of small calibre-which should be over- 
spun with silk or mohair, in order that it 
may possess strength combined wtth flexibil- 
ity. These tubes are firmly secured to the 
connecting fittings (i. e. air receiver, &c.) by 
means of close air-tight, metal collars. 
" There are various patterns of pumps for 
the purpose of obtaining a given degree of air 
pressure in the cylinder or air receiver. They 
differ in size, mechanism, and degree of power. 
Figs. 2420-29 represent those employed by 
Prof. Lefferts. 
Fig. 2422.-Air Receiver. 
*IG' 2424- Air Receiver, 252 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PHARYNGEAL- LARYNGEAL. 
FOR DIRECT MEDICATION. 
For the Production and Application of Medicated Spray. 
Fig. 2425.-Attachments for the End of Spray Tubes. 
Fig. 2426.-Spray Tube, with Bayonet and Cut Off. 
The " automatic cut off" (1) is attached to the end of the 
spray tube for the purpose of controlling the air current. An- 
other method is to attach the spray tube by means of a metal 
bayonet joint (2), or the connecting tube from the air receiver 
may be simply slipped on (3) and the current controlled by press- 
ure with the thumb against the end of the spray tube. 
Fig. 2429.-Double Acting Air Compressor. 
Fig. 2427.--Spray Tube, with Bayonet End. 
Fig. 2428.-Plain End Spray Tube. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
253 
fHARY^QEAL- LAF^YNGEjALd. 
FOR DIRECT MEDICATION. 
For the Production, and Application of Medicated Spray. 
Prof. Lefferts says : "If the general practitioner has not, or can not obtain the above instruments-viz.: the com- 
pressed air spray apparatus with air pump and spray tubes-he is necessarily obliged to depend upon some form of 
hand atomizer constructed upon either the principle of Richardson or Bergson, in which the propelling power is de- 
veloped by the use of the hand ball bulbs and tubes." 
"In any of these forms of atomizers the hand 
balls should be double, in order that a continu- 
ous spray maybe produced ; and each instrument 
must be provided with three separate tips (occa- 
sionally only two are furnished, one of which is 
reversible), which screw or fasten on the horizon- 
tal hard rubber bar of the spray tube : one throws 
the spray downward to the larynx, one upwards 
into the naso-pharynx and the third directly back- 
ward into the pharynx. 
"Such an apparatus is shown in Fig. 2430. 
Finally the cheapest and simplest form of atom- 
izer is found in Fig. 2431. In default of all other 
spray apparatus it not unfrequently answers a 
good remedial purpose. Its use with proper medicated solution is certainly more effective in both pharyngeal and 
laryngeal affections than the old time-honored prescription of a gargle. 
For the use of hand ball atomizers the following directions are given by Prof. Lefferts : 
Fig. 2430. 
Hard Rubber Hand Atomizer, 
Continuous Spray. 
Hand Ball Atomizers. 
Fig. 2431.-Atomizer, 
Throwing a Coarse Spray. 
To make an Application to the Larynx with the Hand Atomizer. 
" The patient must stand or sit facing the operator, so that a good light is thrown into the widely opened mouth ; or, 
still better, the operator should use the concave forehead reflector, with artificial light. The patient draws his tongue 
well out of the mouth, and holds it between two fingers of the right hand, the tongue having first been covered by a 
small clean napkin. The operator now carefully passes the horizontal bar of the atomizer, on which is placed the 
tips which throw the spray, downward, well back into the pharynx, without, however, touching the posterior pharyn- 
geal wall, and holds it steadily with the left hand in a position which his anatomical knowledge tells him is such that 
the point of the instrument is directly above the mouth of the larynx (the laryngoscope cannot, of course, be used during 
this procedure, as both of the operator's hands are occupied). The patient now takes a deep, full and quick inspiration, 
at the same moment that the operator begins to compress the air bulbs of the apparatus vigorously. A short, sharp, 
laryngeal cough will be the evidence that the spray has entered the larynx." 
To make an Application to the Pharynx. 
" The application to the posterior pharyngeal wall is an easy matter, for the parts are directly before the operator and 
under his vision. The patient depresses his tongue by means of a spatula, and breathes quietly. The proper tip is, 
of course, to be placed on the spray tube." 
To make an Application to the Nasal Passages. 
"A proper application with the "hand ball spray" to the posterior nasal passages and upper pharynx is the most diffi- 
cult. A patient is rarely found with a throat tolerant enough to allow of the spray being thrown with this instrument up 
behind the velum into the vault of the pharynx and posterior nares. Both of the operator's hands being again occupied 
with the atomizer, he cannot use the palate hook to draw the velum forward, and, as a rule, therefore, he had better 
confine himself to applications made through the anterior nares, and forced well and quickly back through them into 
the pharynx, if he employs this form of instrument.-" Pharmacopoeia for Diseases of the Throat and Nose." Lefferts. 
Putnam : New York and London, 1884. 
For local medication, see also "Laryngeal Brushes, Sponge Holders, Insufflators and Caustic Carriers," 
page 264. 
For other forms of "Apparatus for the Atomization or Nebulization of Medicated Fluids, for Inhal- 
ation in Affections of the Air Passages, see page 284. 254 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PHARYNGEAL- LApYNGE/vL. 
FOR DIRECT MEDICATION. 
For the Application of Medicated Powders. 
In cases where medicated spray applications are not well 
borne bythe nasal mucous membrane, causing pain and irri- 
tation, or perhaps, in any case, in accordance with the special 
views of the physician, a medicated powder may be substi- 
tuted. Powders are particularly adapted to the treatment 
of simple chronic rhinitis, where the secretions are readily 
removable, and the parts soft and absorptive. 
The powder insufflator adapted for the treatment of 
diseases of the nasal passages is shown in the wood-cut. 
It is arranged to deliver, by means of the air pressure 
developed by the hand ball, a charge of powder contained 
in the bottle into the anterior nares, by means of the short 
nozzle. The long curved tube, which should be introduced 
with care behind the velum of the patient, performs the 
same operation in the posterior nares and the vault of the 
pharynx.-" Pharmacopoeia for Diseases of the Throat and Nose." Lefferts. Putnam : New York and London, 1884. 
In the New York Medical Record of Nov. 17, 1873, Prof. Lefferts describes his modification of the Rauchfuss 
insufflator, and speaks in addition of its advantages over the ordinary powder insufflator for the larynx, in which the 
propelling power is the breath of the operator-a detail which may be objected to by a fastidious patient; moreover, 
those who use it are not free from the danger of receiving into their own mouth a portion of the powder with which the 
instrument is charged, should the patient suddenly cough while the insufflator is in position in his throat. The foetid 
breath of a patient with cancer, syphilis or phthisis of the throat may in a like manner reach the mouth of the operator. 
All of these disadvantages are obviated by Prof. 
Lefferts' modification of the laryngeal insufflator. 
Its advantages over the Rauchfuss instrument 
are, that its form, size and curve admit of its ac- 
curate and skillful introduction into the larynx, 
and allow of its remaining steady in the hand 
during compression of the ball, thereby insuring 
an accurate application of the powder. 
The tube is held by the right hand in the 
position of a writing pen, the index finger resting 
lightly upon the rubber ball. At the moment of compressing this with the finger, in order to 
expel the medicated powder from the tube, there is no sudden movement, as is the case with the 
Rauchfuss insufflator, in which an impulse forwards is given to the instrument, thus altering the position of its point 
in the larynx and throwing the powder wide of its mark. 
Fig. 2432.-Lefferts' Nasal Powder Insufflator. 
Fig. 2433.-Lefferts' Laryngeal Insufflator. 
For "Nasal Douches, Syringes, Sprays, Insufflators, Brushes and Applicators," see pages 209, 210, 211 
See list of "Lefferts' Examination Case for Laryngoscopy and Rhinoscopy," page 256. Illustration of 
the same (Fig. 2450). 
Fig. 2434.-Penn's Catgut Ecraseur, for the Removal of Polypi 
" Southern Practitioner, Nashville, October, 1885." GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
255 
PHARYNGEAL- LARYNGEAL. 
LARYNX, THE ORGAN OF VOICE. 
The larynx is the organ of voice, placed at the upper part of the air passages. It is situated between the trachea 
and base of the tongue, at the upper and fore part of the neck, where it forms a considerable projection in the middle 
line. On either side of it lie the great vessels of the neck ; behind, it forms part of the boundary of the pharynx, and 
is covered by the mucous membrane lining that cavity. 
The larynx is narrow and cylindrical below, but broad above, where it presents the form of a triangular box, flat- 
tened behind and at the sides, whilst in front it is bounded by a prominent vertical ridge. It is composed of cartilages, 
which are connected together by ligaments and moved by numerous muscles; the interior is lined by mucous mem- 
brane, and supplied with vessels and nerves, &c.-"Gray's Anatomy." 
The epiglottis, consisting of a single leaf-shaped cartilage, is attached to the front of the larynx. It is elastic, 
easily moved, and fits accurately over the entrance to the air passages below it. Its office is to guard these delicate 
passages and the lungs against the intrusion of food and other foreign articles when the act of swallowing takes place. 
It also assists in modifying the voice.-" Hutchinson's Physiology and Hygiene." 
The voice.-The sound produced in the larynx by the vibration of the column of air passing through the rima glot- 
tidis. The rima glottidis is the narrow elongated slit or chink situated in the larynx and forming the entrance to the 
trachea and the lungs. Its boundaries on either side are formed posteriorly by the movable arytenoid cartilages; and in 
its middle and anterior portions by the so-called "vocal cords "-two nearly parallel bands of elastic tissue, the anterior 
extremities of which are attached side by side to the inner surface of the thyroid cartilage, their- posterior extremities 
being attached to the points of the arytenoid cartilage. As the anterior extremities of these bands, therefore, are fixed 
in position, while their posterior portions are capable of being separated from or approximated to each other, accord- 
ing to the movements of the arytenoid cartilages, the rima glottidis may thus change alternately its form and size- 
being expanded into a comparatively wide triangular opening when the arytenoid cartilages and vocal cords are separ- 
ated from each other, and reduced to the form of a narrow, almost linear slit, when they are closely approximated. By 
the varying movements of the arytenoid cartilages, the tension of the vocal cords may at the same time be increased 
or diminished. It is upon these variations in the width of the rima glottidis, and the position and tension of the vocal 
cords, that the production and modifications of the voice mainly depends. The first condition of the formation of a 
vocal sound is the forcible expulsion of air through the larynx. The voice may also be formed imperfectly in inspira- 
tion, but only for a short time and with a certain degree of difficulty. The natural time for the continuous produc- 
tion of a vocal sound is during expiration. The chest is first filled with air, and then, by its prolonged and steady 
expulsion, accompanied by the simultaneous action of the laryngeal muscles and the vocal cords, the vocal sound 
becomes audible. The second condition is that the vocal cords be approximated to a certain extent and thrown into 
a state of appropriate tension. Even with a forcible expulsion of air, if the rima glottidis be widely open and the 
cords relaxed, no vocal sound is produced, or at best nothing more than a hoarse whisper, audible only a short distance. 
But when the cords are closely approximated and at the same time rendered tense by the action of the laryngeal 
muscles, their edges are thrown into a state of rapid vibration by the passage of the air, and a vocal sound at once 
becomes audible. But the vocal sound is not directly produced by the vibration of the vocal cords. These cords are 
not, like the strings of a guitar or violin, simply extended between two opposite points and capable of vibrating freely 
in the interval. On the contrary, they are bands of elastic tissue attached throughout by their external surface, as well 
as at both ends, to the surrounding tissues, and only projecting inward as more or less flattened or rounded ridges at 
the level of the rima glottidis. In the opinion of some physiologists, it is the thin fold of mucous membrane on the 
internal surface of the vocal cords which forms the real vibrating edge in the vocal effort, while the cords themselves 
only constitute the necessary elastic basis for its attachment. Still it is evident that the approximation and elastic 
tension of the cords supply the primary and essential physical condition for the formation of the voice. The im- 
mediate cause of the production of the vocal sound is the vibration of the column of air itself, while passing out 
through the rima glottidis. The mechanism of the larynx as a vocal organ, therefore, seems to be analogous to that 
of a reed instrument, in which a column of air, passing forcibly through a narrow slit, bounded on one or both sides by 
a thin elastic plate of wood or metal, first causes the edge of the plate to vibrate with a sufficient rapidity, and is thus 
itself thrown into a state of sonorous vibration. In instruments of this kind, the tone or pitch of the sound produced 
varies with the length and width of the opening, the size of the vibrating plate, the force of the column of air, and 
the rapidity of the vibrations. With a wide opening, a large vibrating surface, and a moderately rapid passage of air, 
the vibrations will be comparatively slow and the sound produced of a deep or grave tone. With a narrow opening 
and a more rapid current of air the vibrations will be increased in frequency and the note produced will be acute or 
high-pitched. The same thing takes place in the formation of vocal sounds in the larynx. When the vocal cords 
are only partly approximated, their tension is incomplete and the vibrations allowed to take place along their whole 
extent, the voice has a grave sound ; when they are closely approximated, reducing the rima glottidis to a comparatively 
short and linear slit and thrown into a high degree of tension, the voice becomes acute. Every variation between 
the two extremes of high and low notes is produced in this way, by alterations in the width of the rima glottidis and 
the length and tension of its vibrating edges. These variations are also aided by changes in the position of the entire 256 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PJHA^YNQEAL- LARYJMGEAL. 
LARYNX, THE ORGAN OF VOICE. (Continued.) 
larynx; the organ being usually carried downward toward the chest in the production of the lower notes and upward 
toward the head in forming the more acute sounds. The character or quality of the voice is also considerably modi- 
fied by the conditions of tension or relaxation, moisture or dryness of the mucous membrane of the larynx, mouth, 
and fauces, and the variation in form of the cavities both above and below the glottis; but the actual production of 
the vocal sound invariably takes place in the larynx, its modifications from the above causes being always secondary. 
From what has been said, it is evident that the formation of the voice depends upon the action of the laryngeal 
muscles, which move the arytenoid cartilages upon their articulations, and thus increase or diminish the width of the 
rima glottidis and the tension of the vocal cords. These muscles are animated by the recurrent laryngeal nerves, 
branches of the pneumogastric nerves, which come off from their parent trunks after these have entered the cavity of 
the chest, and then retrace their course from below upward through the deeper parts of the neck until they reach the 
level of the larynx. Hence their name of " recurrent " laryngeal nerves. If these nerves be divided by an operation, 
or compressed by an abscess, aneurism or tumor, so as to interrupt the nervous communication, the voice is enfeebled 
or lost, according to the degree of injury to the nerve and the consequent paralysis of the laryngeal muscles. The 
same effect is produced by injury or compression of the pneumogastric nerves of the neck, above the point where their 
recurrent laryngeal branches are given off. The voice is also affected by inflammation, thickening, ulceration, or sub- 
mucous infiltration of the tissues of the larynx ; all these causes interfering with the necessary action of the laryngeal 
muscles and the formation of a vibrating fold of mucous membrane at the rima glottidis. There is only a form of 
hysterical affection in which the power of forming a vocal sound is temporarily lost, owing to a functional disturbance 
of innervation, and consequent failure of action in the laryngeal muscles. Loss of voice from any of these causes is 
termed aphonia, and is to be distinguished from aphasia, an affection of different origin, in which the patient retains 
the power of making a vocal sound, but is unable to remember the appropriate words or phrases necessary to com- 
municate his ideas.-"American Cyclopaedia." 
FOR EXAMINATION OF THE LARYNX AND PHARYNX. 
(Rhinoscopy, see p. 207. 
Laryngoscopic Set, No. 1. 
$12. 
1 Reflector, with Tiemann & Co.'s Head-band. 
2 Laryngeal Mirrors. 
1 Lente's Probe, silver. 
1 Morocco Case, lined with velvet. 
Laryngoscopic Set, No. 4. 
$26. 
1 Reflector, with Head-band. 
1 Church's Tongue Depressor, self-holding. 
3 Laryngeal Mirrors, assorted sizes. 
1 Simrock's Laryngeal Forceps. 
1 Uvula Hook, hard rubber. 
1 Laryngeal Probe, silver or aluminium. 
1 Morocco Case, lined with velvet. 
Laryngoscopic Set, No. 2. 
$18. 
1 Reflector, with Tiemann & Co.'s Head-band. 
1 Tongue Depressor, steel handle, japanned. 
3 Laryngeal Mirrors, assorted sizes. 
1 Sponge Holder, delicate. 
1 Lente's Probe, silver. 
1 Morocco Case, lined with velvet. 
Lefferts' Examination Case, 
for Laryngoscopy and Rhinoscopy. 
$26. 
1 Forehead Reflector, 3I inch diameter, with Kramer's 
Head Band. 
1 Laryngoscopic Mirror, No. 1. 
1 Laryngoscopic Mirror, No. 5. 
1 Tongue Spatula, folding. 
2 Universal Handles, to fit the Laryngoscopic Mirrors 
and the Brush Holders. 
1 Laryngeal Brush Holder and 6 Brushes. 
1 Hard RubberPowderlnsufflator,with Rubber Tubing 
and Mouth Piece. 
1 Neat compact Morocco Case. 
Laryngoscopic Set, No. 3. 
$23. 
1 Reflector, with Tiemann & Co.'s Head-band. 
2 Laryngeal Mirrors. 
1 Church's Tongue Depressor, self-holding. 
1 Uvula Hook, hard rubber. 
1 Laryngeal Probe, silver or aluminium. 
1 Sponge Holder. 
I Morocco Case, lined with velvet. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
257 
PJHARYNGE/vL- bA^YNGEAb. 
LARYNGOSCOPES AND ACCESSORIES.* 
On the Use of the Laryngoscope. 
Fig. 2435.-Laryngoscope, with Head-Band. 
Before speaking of laryngeal pathology as exhibited 
by the laryngoscope, let me say a few words anent the ap- 
paratus to be employed, the method of using it and the 
points to be observed. 
What do you want to do? In plain English, you 
want to look around a corner into a dark hole. This 
sounds paradoxical, but the paradox is solved by the 
laryngoscope. 
The light, either of the sun or of a lamp, is received on 
a mirror attached to the observer's forehead, from which 
it is reflected on to a small mirror which is introduced into 
the fauces of the patient, and from this mirror again the 
light is thrown down upon and into the larynx. The 
angle of incidence being equal to the 
angle of reflection, you have merely to 
place your mirrors in such a relation to 
one another as to secure the proper 
direction of the rays of light, and a per- 
fect and distinct image of the parts illu- 
minated will be visible on the small 
mirror. 
The sun cannot be relied upon at any 
hour of the day; and patients would 
not, even if the sun were always shin- 
ing, present themselves when his rays 
penetrated a given locality. We there- 
fore find it much more convenient to 
trust to artificial light altogether, and 
accordingly have recourse to a gas mode- 
rator or a paraffine oil lamp, which 
are not amenable to the caprices of the 
weather. 
It is well to darken the room in 
which you make your examination ; but 
even this is not absolutely necessary if 
the light is protected by a convex mirror 
on one side, and concentrated by one or 
more lenses on the other. Various ap- 
paratuses have been devised for the pur- 
pose of intensifying the light. The lamp 
should be placed close to the patient's 
head, on either side most convenient to 
the observer, and so that the lamp and 
the patient's and observer's heads are in 
the same horizontal plane. The patient, 
sitting erect, should push his head back 
so as to straighten the neck, and facilitate 
the introduction of the small mirror. 
Before attempting to do this, the 
observer should first ascertain that the 
reflector is properly adjusted. If he 
finds that the mouth is fully illuminated, 
he may fairly conclude that he will be 
able to throw the light upon the fauces. 
Beginners generally find a little difficulty 
Fig. 2436.-Application of the Laryngoscope. 
Fig. 2437.-Tobold's Large Laryngoscope and Student's Lamp. 
* Speculum Laryngis : also called Pharyngoscope, according to its employment. 258 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PHARYNGEAL- LARYNGEAL 
LARYNGOSCOPES AND ACCESSORIES. 
On the Use of the Laryngoscope. (Continued.) 
in adjusting the reflector, but this is speedily surmounted. 
Whether you place your mirror on your forehead,or whether 
you prefer to use it fixed to a lamp, is a matter of little 
moment. Try both ways, and adopt the one you like best. 
The mirror I employ has a central uncovered spot. It is an 
improvement upon the original mirror employed by the 
father of laryngoscopy, Professor Czennak. I admit that 
with Professor Czermak's instrument I had a difficulty in 
seeing through the central orifice, but with this modifica- 
tion I find it advantageous first to adjust the reflector so 
that I am enabled to see the fauces through the opening, 
with the eye covered with the reflector, and then I am 
certain to have the proper axis for both eyes. After you 
have satisfied yourselves that the lamp and the reflector 
(which is fixed on the head by an elastic band passing 
over the forehead) are in the right position, tell your patient to open his mouth widely, to protrude the tongue, and to 
breathe freely. Some patients will permit you to see into their larynx without in any way fixing the tongue, but this 
is the exception. As a rule, it is necessary that the patient, or the observer, should take hold of the tip of the tongue 
with a handkerchief or towel, or to use a tongue depressor, to prevent this "unruly organ" from slipping back. With- 
out this precaution, you very often fail in your endeavors to see below the epiglottis. Your next step, after having got 
your patient in the proper position, is to warm the laryngeal mirror. This is necessary to prevent the vapor of respira- 
tion being precipitated on, and dimming the mirror; but take care not to overheat it. As a precaution, it is well to 
test the temperature by applying the back of the mirror to your own cheek. 
Fig. 2438.-Schroetter's Laryngoscope, 
with Nasal Rest. 
Figs. 2439.-Laryngoscopic Mirrors. 
Take hold of the stem of the mirror as if you were holding a pen; introduce it into the mouth without touching 
the tongue, teeth, or lips, sinking the hand at first, and then raising it gradually, so as to allow the mirror to form a 
curve until it reaches the uvula. Almost the whole secret of the manipulation in laryngoscopy consists in this. If you 
touch the lips or teeth, you tease the patient, but if you touch the tongue, you are certain to excite reflex action, and 
the root of the tongue will arch up to impede your view. A udacem fortuna juvat. Push your mirror, after having 
passed the janitors, well against the uvula, and you will rarely meet with any serious impediment in getting a proper 
view of the larynx. An unsteady hand creates difficulties which need not exist, by bringing the mirror into contact 
with other parts than the uvula and soft palate. These are not very sensitive, but if you tease the root of the tongue, 
or the arches of the palate, you infallibly excite reflex action, which will necessitate the withdrawal of the instrument. 
Having placed your mirror at an angle of about 450 with the horizon, it is well to rest the little finger of the right 
hand against the patient's cheek, by which means you will steady the instrument. You then secure a proper illumina- 
tion of the laryngeal mirror, and by the necessary manipulation, which practice alone can teach, you successively 
examine all the parts exposed to view. 
In making the examination and recording the facts observed, you must remember that you are looking into a mirror, 
which represents the parts in a different relation from their real position. The epiglottis, which in nature is turned from 
the observer, is represented as opening towards him; the base of the tongue, which is in front of the epiglottis, appears 
in the mirror behind it; and the vocal cords equally occupy in the mirror a reversed position from that which they really 
possess. As laryngoscopic illustrations represent the appearances as seen in the mirror, it is necessary to remember the 
true relation, in order to understand the drawing correctly. The lateral relations will cause less difficulty than the antero- 
posterior relations. What ordinarily appears to be the left or right, in the subject of observation placed before us, still 
continues so. We readily make the necessary allowances here from the habit engendered by custom ; but it is different GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
259 
PHARYNGEAL- LARYNGEAL. 
LARYNGOSCOPES AND ACCESSORIES. 
On. the Use of the Laryngoscope. (Continued.) 
in regard to objects placed in front of each other, and reflected in a 
mirror, because for this our daily life offers us fewer precedents. Per- 
haps the easiest way to realize the position of the parts as seen in the 
mirror, is to imagine yourselves looking at the epiglottis and vocal 
cords through a hole in the Cervical portion of the vertebral column. 
To the beginner I would say, make your first experiment upon a case 
in which you are informed there is no special difficulty; remember 
the rules laid down ; bear in mind the anatomy of the parts, and the 
direction in which you wish to carry the light; and, with a light and 
steady hand, you will scarcely fail, after one or two attempts, to see 
that which is ordinarily visible by the aid of this instrument. 
Now, what are you to look for? The first point that always 
attracts the attention of the observer, after having got the light and 
the mirror duly placed, is the epiglottis. It is the Cape of Good 
Hope of the laryngoscopists, and it is at times a difficult matter, 
a very difficult matter, to round the Cape. You will find that it varies 
as much in form as the nose, and its position not unfrequently is so 
prone as to render a good view of the subjacent parts almost an im- 
possibility. Then, too, in irritable persons, it undergoes a variety of 
contortions and contractions, which give it character for muscularity 
greater than anatomists show it to possess. Still, as a rule, it serves 
merely as a land-mark anatomically and pathologically; 
anatomically, because its well-known relations tell you in 
what direction to look for more important organs ; patholo- 
gically, because the appearance of the mucous membrape 
covering the epiglottis is often a valuable indication as to 
the state of the subjacent parts. Examine the epiglottis 
carefully, the form, the color, the attachments. It should 
be perfectly smooth, of a pale, yellowish rose hue, and 
symmetrical. Look at the fossa formed by the front of the 
epiglottis with the base of the tongue, and note the state of 
any secretions upon or near the epiglottis. In disease you 
will see its color varying from the dull white of anaemia 
to every shade of uniform, or streaky and patchy redness. 
It may present ulcers of varying size and depth ; it may be 
deformed by old cicatrices or congenital malformation; tumefaction from inflammatory 
or oedematous thickening of the mucous and submucous layers may present itself ; and it 
may exhibit extravasations of blood, or be more or less bathed in pus, or covered with a 
mucous secretion. Similar conditions may be discovered in the glotto-epiglottid fossa, or 
on the glotto-epiglottid folds. In order to see the parts subjacent to the epiglottis, you 
will have to depress the handle of your mirror somewhat, so as successively to illuminate 
the posterior surface of the epiglottis ; the arytenoid cartilages, with the corpuscula Santor- 
ini and Wrisbergii; the superior thyro-arytenoid folds, or the false vocal cords, as they are 
also called ; and, by turning the mirror laterally, you will examine the right and left sides 
of the introitus laryngis, and especially the state of the ventricles of the larynx. These 
are cul-de-sacs intervening between the vocal cords proper, and the superior thyro-arytenoid 
folds. The state of the ventricles has an important bearing on the production of the voice, 
inasmuch as their patulousness is essential to the free vibration of the vocal cords and the 
due production of the voice. If the mucous membrane of the ventricles is swollen, the 
pitch and sonorousness of the voice is interfered with, and, the more the pouch is obliterated, 
the greater will be the interference with phonation. It is here that various secretions form 
and accumulate, and you will readily understand why these should more or less affect the 
voice, as they present obstacles to the passage of the air, or diminish the vibrations of the 
aereal pulse. If the secretions are viscid, you may at times be puzzled by strings of 
mucus extending across the entrance of the larynx, closely simulating the vocal cords 
Fig. 2440.-Mackenzie's Light Concentrator. 
Fig. 2441.-Simrock's Laryngoscope 
Fig. 2442. 
Cresswell-Baber's 
Pocket Laryngoscope. 260 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PJHARYNGEAL- IdARY^GE/cL. 
LARYNGOSCOPES AND ACCESSORIES. 
On the Use of the Laryngoscope. (Continued.) 
Fig. 2443.-Henry's Bull's-Eye 
Illuminator. 
themselves. Little patches of secretion may also simulate ulcers. The sponge 
or brush will readily remove such secretions, and show the condition of the sub- 
jacent membrane. The ventricles, moreover, are the frequent seat of morbid 
growths. All these points having been noted, you seek the vocal cords them- 
selves. 
In a healthy larynx the vocal cords stand out, with a clear pearly sheen which 
is peculiarly characteristic. Once seen, the appearance is not to be forgotten ; 
and you will often, in doubtful cases of laryngeal disease, rejoice at recognizing 
this striking feature, because it will prove that the most important part involved 
in phonation (so far as the larynx is concerned) is healthy. The vocal cords, or 
inferior thyro-arytenoid ligaments, are mainly composed of yellow elastic tissue, 
but are endowed with the most marvelous capability of minute vibratile adjust- 
ment, subject to the controlling power of the will, exercised through the arytenoid, 
thyro-arytenoid, crico-arytenoid, and other muscles. It has been calculated that 
no less than one hundred muscles are brought into action in the ordinary modu- 
lation of the voice, but the note which is uttered depends upon the exact degree 
of tension of two ligaments, at the utmost seven lines in length, which is mainly 
determined by the two sets of muscles mentioned. You will have 
a measure of the minuteness of this adjustment when you reflect, 
that a practiced singer is capable of uttering three hundred different 
notes at will, for each of which, on 
this minute vibrating cord, a differ- 
ent stop must be applied. 
The vocal cords are covered with 
mucous membrane, distinguished 
from the mucous membrane of the 
rest of the larynx, which is ciliated, 
by being squamous. The mucous 
membrane overlies the elastic tissue 
of the cords, and is liable-though 
to a much less extent than the 
mucous membrane in the vicinity- 
to congestion, and the various mor- 
bid changes which are seen in this 
tissue elsewhere. An accurate 
knowledge of the anatomy and phy 
siology of the parts will enable you 
more fully to appreciate the import- 
ance of minute shades of difference 
in the appearance of the parts. A 
roughness of the surface or a dis- 
coloration, which would lead to no 
palpable results elsewhere, here affects the comfort, the occupation, the life of the 
patient, and is therefore well deserving the study of the practitioner by any additional 
physical means that may be placed at our disposal. Here, too, we have a good illus- 
tration of the difference between vital morbid conditions and the condition of the same 
parts as seen after death ; a difference that you should always bear in mind, as you may 
otherwise easily be misled into a wrong interpretation of the phenomena presented on 
the post-mortem table. If you had merely seen the interior of a larynx, removed from 
the body, you would scarcely anticipate the marked contrast that exists in life between 
the vocal cords and the adjacent parts, nor would it be possible satisfactorily to determine the mode in which the 
variations of sound are produced by the vocal cords. You will find that there was much uncertainty as to the theory 
to be adopted regarding vocalization, even in Muller's time; and it was not until after the practical introduction of the 
laryngoscope by Czermak, that the study became satisfactory and the conclusions definite. If I name Czermak, it is 
not because I do not appreciate the labors of others in this field; but whatever others have done, he certainly has 
Fig. 2444.-Pomeroy's Reflector and Holder. 
Fig. 2445.-Elsberg's 
Pocket Laryngoscope. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
261 
pHAf^YNGE/cL- LARYNGEAL 
LARYNGOSCOPES AND ACCESSORIES. 
On the Use of the Laryngoscope. (Continued.) 
compelled us all, by the demonstration of the comparative facility of laryngoscopic examination, to make it a part of 
our medical studies. 
It would be an injustice, in speaking of the subject, not to mention the name of M. Garcia, a well known singer 
and amateur physiologist, who established by laryngoscopic examination much that is now known as to the physiology 
of the larynx before Czermak had made known his method; 
but the pearl that M. Garcia discovered was not appreciated 
by our profession, and therefore, so far as the medical world 
are concerned, laryngoscope remained an unknown quantity 
until the appearance of Czermak's monograph. 
It is not my object, for the present, to do more than to 
interest you in the practical employment of the laryngoscope 
in the recognition and treatment of disease ; therefore I do 
not attempt to lay before you an account of laryngeal phy- 
siology-a branch of science which is capable of further 
development, and which some of you may feel called upon 
to promote. Allow me yet to revert to a few points con- 
nected with the pathology of the larynx, to which I would 
draw your attention, as illustrating the value of this mode 
of investigating disease. The practical examination of the 
numerous cases that present themselves in our hospital, will 
serve to impress upon your memory and comprehension 
more vividly what I now merely show you veluti in speculo. 
I have spoken of various morbid changes seen in or near the vocal cords, showing 
increased or diminished vascularity, congestive or oedematous swelling, ulceration, cica- 
trices, growths, all of which I have myself seen. If you consider the muscular and 
the nervous functions of the parts, you will expect to see these also materially affected by 
disease. The phis-evinced by spasm-is not likely to be very visible, because it will not 
leave you time for anything but immediate action to relieve your patient: but the minus 
of paralytic conditions is frequently observable in the irregular action, or want of action, 
of one or both vocal cords. It is here that stimulation, and notably the direct application 
of galvanism, is often of palpable benefit. And you will not examine many larynges 
before you will satisfy yourselves of the perfect facility with which you may direct 
the galvanic current, as well as any other medicinal application, to any given part of 
the larynx. 
I have not, however, quite done yet. You may see further than the vocal cords. 
Their under surface can at present only be examined when there is a hole in the trachea, 
and at least one instructive instance is on record where this mode of exploration was 
practiced with much benefit to the patient. But these are refinements of practice upon 
which it is unnecessary to dwell. I now merely speak of the ordinary employment of the 
laryngoscope, and I wish to remind you, that having explored the entrance to the larynx 
and the vocal cords, you should examine, as far as may be, the trachea. It is generally 
easy to recognize several rings of this tube, and you may, when the larynx is capacious 
and the patient steady, penetrate to the very bifurcation of the trachea. The only morbid 
conditions that I have definitely recognized in the trachea, have been scattered ulcers; 
but it is manifest that, especially in those cases in which foreign bodies have slipped 
through the glottis, the discovery of their exact site by the laryngoscope may, as it already 
has been, prove of great practical value to the surgeon. 
There is no better mode of initiating yourself into the practice of laryngoscopy than 
to examine your own larynges, or those of your fellow-students. By this kind of exer- 
citation, you will familiarize yourself with the use of the instrument, no less than the healthy condition of the parts. 
M. Garcia's interesting observations were entirely the result of examination made upon his own vocal cords, and as 
there is room for a further cultivation of this field of physiology, each of you may be enabled to advance science in 
this direction. But apart from this, the mere dexterity of manipulation will be increased by the practice recommended, 
and if you know from experience in your own persons how to behave, you will more readily advise your patients what 
to do, and sympathize with their difficulties. Not every one, however, is a suitable subject for autolaryngoscopy ; the 
Fig. 2446.-Pocket Illuminator. 
Fig. 2447.-Collins' Lamp 262 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PHARYNGEAL- LARYNGEAL. 
LARYNGOSCOPES AND ACCESSORIES. 
On the Use of the Laryngoscope. (Continued.) 
Fig. 2448.-Seeger's Modification of Tobold's Laryngoscope, 
for Gaslight. 
narrowness of the introitus laryngis and the prone 
condition of the epiglottis, no less than an unusual 
irritability of the parts, frequently render the pro- 
cess extremely difficult. Various methods have been 
suggested for the removal of undue irritability, such 
as the inhalation of small quantities of chloroform, 
the application of bromide of potassium, or the use 
of astringent gargles. Every now and then, even 
after you have acquired sufficient dexterity in the 
use of the instrument, you will meet with cases 
which present insuperable difficulties. You are then 
no worse off than your predecessors were without 
the laryngoscope. You will have to fall back upon 
those other symptoms which your knowledge of 
physiology and pathology will teach you to appre- 
ciate, and which this instrument is not intended to 
supersede."-By Dr. E. H. Sieveking, Physician 
in Ordinary to the Prince of Wales, and to St. 
Mary's Hospital. Lancet, April 8,1865, page 360. 
Fig. 2449. 
Laryngeal Mirrors and 
Universal Handle. 
Fig. 2450.-Lefferts' Examination Case, for Laryngoscopy 
and Rhinoscopy. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
263 
PH/RYNGEAL- LARYNGEAL. 
LARYNGOSCOPES AND ACCESSORIES. 
Fig. 2451 -Roe's Modification of Tobold's Laryngoscope. 
Uvula or Palate Hooks: 
Voltolini's, p. 208. 
Fraenkel's, p. 208. 
Czermack's, p. 208. 
Jarvis', p. 208. 
Lefferts', p. 250. 
Tongue Depressors, p. 238. 
Fig. 2452.-Roe's Uvula Hook 
Fig. 2453.-Rumboldt's Laryngeal Mirror. 
Fig. 2454.-Rumboldt's Uvula Retractor. 
For raising the uvula and drawing it slightly forward, in order to 
obtain a more extended view of the cavity above. A tube six inches 
long and one-eighth of an inch in diameter, having at one end an en- 
largement three-sixteenths of an inch transversely, and cup-shaped, for the purpose of receiving the uvula. The other 
extremity is trumpet-shaped, and one inch in diameter, and covered by sheet india rubber. The smaller extremity is 
applied gently to the uvula, whilst the air is expelled from the tube by slight pressure on the rubber extremity. 
Relieving the pressure draws the uvula into the tube about one-quarter of an inch. Only slight traction is now ne- 
cessary to lift the uvula and draw the soft palate forward. If carefully handled, patients hardly feel the application. 
The instrument re- 
sembles the ordinary pal- 
ate-hook, split longitud- 
inally. The surface of 
each hook that comes in 
contact with the soft pal- 
ate is made convex by 
binding the blades. The 
arms are separated by a 
lever (/I) on the handle, and are maintained in this expanded condition by a retainer or wedge-connected with another 
lever (C) having a spring under it-which insinuates itself between them. The uvula is prevented from dropping into 
the operator's way by a small piece of india rubber tubing {B) slipped on the arms over the hooks, which also answers 
to close the hooks on raising the wedge (C). Equal retraction of the velum palati-with both relaxation and tension 
at will-can be effected by the instrument held in the left hand, while the right is engaged in operating. 
Fig. 2455.-Rumboldt's Spreading Soft-Palate Retractor. 264 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
pHARYNGEAh- LARYNGEjAL. 
PROBES, 
For Making Exploration by the Sense of Touch, 
For Local Application of Remedies in Solution to the Mucous Membrane of the Throat. 
SPONGE HOLDERS AND BRUSHES, 
Fig. 2456.-Mackenzies Laryngeal Probes. 
See "Elsberg's 
/Esthesiometer," 
page 11. 
Fig. 2457.-Finger Sponge Holder. 
Fig. 2460.-Granger's Sponge Holder. 
Fig. 2458.-Mackenzie's Laryngeal Brushes. 
Fig. 2459.-Child's Brush and Caustic Holder. 
Fig. 2461.-Buck's Sponge Holder. 
Fig. 2462.-Seeger's Brush Holder. 
Fig. 2467.-Lefferts' Laryngeal Brush Holder. 
Fig. 2466.-Ruppaner's Brush Holder. 
Fig. 2463.-Noyes' Laryngeal Brush Holder 
Fig. 2464.-California Sponge Holder. 
Fig. 2465.-Wagner's Brush Holder, with twelve Brushes. 
Sponge holders are preferable to probangs, because the 
same piece of sponge need not be used twice. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
265 
PHARYNGEAL- LARYNGEAL. 
SPONGE HOLDERS, DROP TUBES, SYRINGES, INSUFFLATORS. 
For Local Application of Solutions and Pulverized Remedies in Diseases of the Throat. 
Fig. 2468.-Mackenzie's Sponge Holder, with 
Safety Wedge. 
Fig. 2469.-Elsberg's Sponge Holder and Throat Forceps. 
Fig. 2470.-Hard Rubber Laryngeal and Posterior Nares Syringe. 
Fig. 2471.-Hartwell's (Staerk's) Drop Tube. 
Fig. 2472.-Tobold's Laryngeal Syringe. 
rlG. 2477.-Gibb's Spray. 
Fig. 2476.-Laryngeal Powder Blower, Hard Rubber. 
Fig. 2473.-Lefferts' Powder Blower. 
Fig. 2474.-Elsberg's Insufflator or Powder Blower. 
Fig. 2475.-Rauchfuss' Powder Blower, with Mouth-piece. 
The pistons of all syringes used for the application of solutions should be kept in proper order, by frequent oiling, 
and by renewing the leather packing whenever it becomes too loose. 266 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
J^HARY^GEAh- LARYNGEAL. 
For the Local Application of Pulverized Remedies and Solid Escharotics, in Diseases of the Throat. 
Fig. 2478.-Clay's Powder Insufflator. 
The method of using solid nitrate of silver in a forte caustique is dangerous, because the piece of caustic is apt to 
break and drop into the larynx or trachea. 
Solid nitrate of silver is best applied by means of Lente's or other probes. The manner of charging the probe 
is to melt the nitrate over a spirit lamp in the platinum cup, then, after having well cleaned the bulb of the probe, to 
dip it in and out of the nitrate until a sufficient coating for the application has adhered to it. It then clings so closely 
that a blow from a hard instrument is required to detach it-making the application perfectly safe. 
Fig. 2479.-Lente's Platina Cup, 
for Fusing Nitrate of Silver. 
Fig. 2480.-Laryngeal Caustic Carrier, Concealed. 
Fig. 2481.-Lente's Probe, for Caustic. 
See " Galvano Cautery,''page 38 
Fig. 2482.-Jarvis' Laryngeal Applicator. 
To apply chromic acid in small quantities at short intervals for the removal of laryngeal growths. 
This is accomplished by means of a probe upon the point of which a tiny crystal of the salt has been 
fused, and facilitated by a device to act as a guide, protector and regulator. 
The instrument consists of a canula, containing a movable metallic rod, the latter being continued 
in the form of a spiral spring at the curved portion of the tube. A probe-pointed piece of wire is 
rivetted to the extremity of this spiral, to preclude the accidental displacement and lodgment of the 
caustic-carrier in the larynx. The spring also serves as buffer to deaden the force of the probe's im- 
pact against the growth. 
The handle of the applicator is excavated to receive a spiral spring, acting upon the movable rod. A detent drops 
between the teeth and sets the spring. The nut serves to regulate the tension of the spring. When not in use, the 
stylet projects beyond the hood, thus permitting fusion of the chromium crystals upon it as with the ordinary probe. 
When ready for use the probe's point is drawn within the tube by traction upon the milled nut, its return being 
prevented by the catch. The applicator can now be introduced without risking the loss of the application upon 
accidental points of contact. 
It is not necessary to carry the end of the instrument directly upon the growth, since the probe-point is propelled 
some distance beyond the end of the tube, thus bridging over the interval of alarm. 
A special feature of the instrument is the trigger device. This contributes the utmost steadiness, and therefore 
precision in manipulation, by securing instantaneous action with the smallest expenditure of force. The extremity of 
the probe is made of flexible metal, to permit its fixation at any angle."-From a paper read at the Sixth Annual Ses- 
sion of the American Laryngological Association, May 13, 1884. By Dr. William Chapman Jarvis. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
267 
PJHARYNGEAL- LARYNGEAL. 
For Scarifying the Mucous Membrane in (Edema, the Evacuation of Cysts and the Removal of 
Pharyngeal and Laryngeal Growths. 
Fig. 2483.-Mackenzie's Laryngeal Lancet, with Three Blades. 
Fig. 2484.-Schroetter's Laryngeal Lancet and Forceps. 
Fig. 2485.-Mackenzie's Laryngeal Lancet, Two Blades. 
Fig. 2486.-Mackenzie's Laryngeal Forceps, Scissors and Ecraseur. 
Fig. 2489.-Tobold's Polypus Scissors (Vocal Cord). 
Fig. 2487.-Tobold's Concealed Laryngeal Lancet. 
Fig. 2488.-Tiemann & Co.'s Scissors, Movable Points. 268 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PHA^YNGEjAL- LARYNGEAL. 
For Scarifying the Mucous Membrane in (Edema, Dilating the Larynx and for the Removal of 
. Pharyngeal and Laryngeal Growths. 
Figs. 2490, 2491, 2492.-Tobold's Laryngeal Knives. 
See Snares, 
"Jarvis'," page 214. 
" Bosworth's," page 215. 
" Bettman's," page 215. 
" Galvano-Cautery," 
page 38. 
Fig. 2493.-Grant's 
CF.dema Glottis InUnimFnt 
Fig. 2494.-RumboM's Laryngeal Forceps and Scissors, 
for Removing Laryngeal Tumors. 
Fig. 2497.-Gibbs' Laryngeal Ecraseur. 
Fig. 2495.-Whistler's Cutting Laryngeal Dilator 
A. Bougie, with blade concealed ; B. Blade protruding; 
C. Lever by which the blade is projected. 
The instrument is used for dividing webs, cicatricial tissue 
or membranous formations. When passed into the larynx any 
existing web is put upon the stretch, and thus rendered tense 
for division. 
Fig. 2496.-Haywood Smith's Scissors, Movable Points. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
269 
PHARYNGEAL- LARYNGEAL 
For Paralysis of the Vocal Cords and for the Removal of Foreign Bodies and Neoplasms from 
the Pharynx, Larynx, Trachea and Gullet. 
This is so constructed that the 
current does not pass till the metal 
point or sponge is in contact with the 
vocal cords. The instrument is held 
in the hand between the thumb and 
second finger, and when the point 
has been placed in the desired posi- 
tion, the operator, with his index 
finger, presses on the key in the 
handle, when the electric current 
passes tnrougn tne larynx to tne sKin externally. At tne same time the patient has to wear a necklet, Fig. 1166, with 
which the other wire of the battery is connected. See also page 34. 
Fig. 2498.-Mackenzie's Laryngeal Electrode, for Paralysis of the 
Vocal Cords. 
Fig. 2499.-Brun's Epiglottis Pincette, for holding a too large or pendant Epiglottis forward while the Laryngeal 
Mirror is in position, to get a view of the interior of the larynx. 
Fig. 2500.-Noyes' Throat Forceps. 
Fig. 2501.-Simrock's Laryngeal Forceps, for Extracting Polypi and Foreign Bodies 
and for holding Sponge and Camel's-hair Brushes. 
Fig. 2502.-Laryngeal Curette, with Copper Flexible Stem that allows of 
bending to suit the operator. 
Fig. 2503.-Fauvel's Laryngeal Polypus Forceps 
Fig. 2504.-Tiemann & Co.'s Flexible Throat Forceps. 
Fig. 2505.-Tiemann & Co.'s Laryngeal Scoop. 270 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PJHARYNGEAL- UARYNGEAL. 
For the Removal of Foreign Bodies and Neoplasms from the Pharynx, Larynx, Trachea and Gullet. 
Fig. 2506.-Fauvel's Throat Forceps. 
Fig. 2507.-Mathieu's Throat Forceps. 
Fig. 2508.-Burge's Throat Forceps. 
Fig. 2511.-Mackenzie's Antero-Posterior Throat Forceps. 
Fig. 2509.-Mackenzie's Lateral Throat Forceps. 
Fig. 2510.-Buck's Throat Forceps. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
271 
LARYNGO -TR^CH EAL. 
Surgical Anatomy of the Laryngo-Tracheal Region. 
" The space may be regarded as bounded on each side in the upper part by the sterno-hyoid muscles, and in the 
lower part by the sterno-thyroid muscles, whilst the superior border of the thyroid cartilage above and the upper edge 
of the sternum below may be considered as the possible limits of the region within which the air tube can be opened. 
Owing to the directions of the sterno-thyroid muscles, the space is slightly narrower below than above. It is true that 
an opening can be made at a higher level, i. e., through the thyro-hyoid membrane ; but in that case it is the pharynx 
which is laid bare. Division of the thyroid cartilage may also be practiced, but this operation is veiy rarely performed, 
except for the removal of a body impacted in the larynx or for the extirpation of a neoplasm which cannot be got rid 
of by an endolaryngeal method. Even when a foreign body is firmly fixed, however, it can almost always be dis- 
lodged through an opening in the air-passage below the level of the thyroid cartilage ; and the great importance (in 
relation to the vocal function) of maintaining the absolute integrity of this portion of the larynx cannot be too strongly 
insisted on."-" Diseases of Pharynx, Larynx and Trachea." Mackenzie. American edition. 1880. 
Infra-Glottic Laryngoscopy. 
" Where tracheotomy has been performed, and a fenestrated canula is worn, a very minute mirror may be introduced 
through the tube, with its face directed upward ; or the canula may be removed and the mirror passed into the wound. 
In this way the observer obtains a view of the larynx from below. * * * This mode of examining the larynx, 
though of very limited application, is valuable, because it generally happens-in cases where a canula is worn, and air 
is inspired mainly through the trachea-that the epiglottis does not rise up, but remains pendent in inspiration. In 
post-tracheotomy cases, also, it often happens that the epiglottis is bound down over the larynx by old cicatrices, and 
consequently ordinary laryngoscopy is useless. It is well to remark that the vocal cords, when observed from below, 
have a reddish color, and do not present the peculiar white appearance which is seen when the laryngeal mirror is 
placed on the uvula."-" Diseases of the Pharynx, Larynx and Trachea." Mackenzie. 1880. 
Laryngo-Tracheal Instruments, Brushes, Forceps, &c. 
" The various laryngeal instruments can be employed in treating disease of the trachea, but the brushes and sponge 
holders, if used, require to be longer below the angle. In tracheal affections insufflators are of great service, the same 
instruments being applicable for the purpose as those for the larynx, as inhalations and sprays. The common laryn- 
geal forceps, however, can seldom be introduced into the windpipe, though the tube-forceps will be found useful in 
extracting foreign bodies-especially through an opening in the trachea."-Mackenzie. 
LARYNGO-TRACHEAL STENOSIS. 
Fig. 2512.-Mackenzie's Laryngeal Dilator. 
"For dilating the larynx when it has 
become blocked up by organized mem- 
brane or by cicatricial tissue, various di- 
lators have been invented. In most cases 
the use of these instruments is facilitated 
by the previous performance of tracheo- 
tomy, which is almost certain to have be- 
come necessary. 
"The screw dilator is an instrument 
which I have occasionally used for the last 
fourteen years. It consists of three blades, 
which, when united together, form a solid 
instrument easily introduced into the 
larynx. When it has passed into the con- 
stricted larynx, a screw at its proximal 
extremity enables the operator to open the 
blades and thus effect distention, the de- 
gree of which is shown on a dial placed 
over the screw."-" Pharynx, Larynx and 
Trachea." Mackenzie. 1880. 
Fig. 2513.-Mackenzie's Laryngeal Dilator. 
See "Whistler's Cutting Dilator," Fig. 2495. 272 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
bARY^I GO-TRAC HEAL. 
STENOSIS, DILATORS, CATHETERS. 
Fig. 2514.-Navratil's Laryngeal Dilator. 
" Professor Navratil, of Pesth, has in- 
vented an instrument very much on the 
principle of my dilator, but much more 
perfect in its details, and consisting of four 
segments instead of three. Moreover, the 
dilating action in his instrument is confined 
to its laryngeal portion, while in mine it 
extends a little above its angle. The only 
objection to Professor Navratil's instru- 
ment is its extremely complicated construc- 
tion, which renders it liable to get out of 
order and difficult to clean."-"Pharynx, 
Larynx and Trachea." Mackenzie. 1880. 
A, extra cylinder ; B, flange and metal 
pins, designed as position indicators, and 
also for securing a firm grasp of the instru- 
ment ; C, commencement of triangular por- 
tion, which extends thence to the beak ; 
D, beak of catheter, showing its four 
openings. 
Catheterization for the cure of laryn- 
go-tracheal stenosis is practiced either in- 
dependently of or after tracheotomy has 
been performed, and the patient is able 
to breathe for a short time without the 
canula. While the catheter is in position it will conduct the profuse flow of saliva and mucus, which may best be 
caught by a moderately large sponge, previously squeezed dry. 
Fig. 2515.-Schrotter's Hard Rubber Laryngeal Catheter, 
for Treating Laryngo-Tracheal Stenosis. 
ON LARYNGEAL STENOSIS. 
" To prevent death from gradual suffocation, local treatment must be primarily and immediately undertaken, al- 
ways with the object of overcoming the constriction in such a manner as to allow the lungs to receive again the normal 
amount of oxygenated air which has for a time been cut off from them. It has long been the custom in this emer- 
gency to obviate this trouble by the creation of a second one (treacheotomy), which is but little better than the first, 
and by which-although air is certainly allowed to pass to the lungs-the original trouble is in no wise benefitted nor 
its progress stopped. 
" In some cases of imminent death this treatment is not only justifiable, but is most judicious. Before being under- 
taken, however, a most careful laryngoscopic examination should be made ; for sometimes, when the permanent con- 
striction is not very great, the breathing may be temporarily obstructed, either by a slight oedema glottidis or a collec- 
tion of mucus in the larynx, in which case the trouble can be treated through the natural passage, either by scarification 
of the cedematous membrane with the laryngeal lancet (see " Whistler's Cutting Laryngeal Dilator, Fig. 2495), or by 
tubage of the glottis, without any necessity for an external opening being made in the throat. 
"Catheterization or tubage of the larynx was advocated by Dessault as far back as 1793, and afterwards by Bouchut, 
Trousseau, Weinlechner and Horace Green, for some cases of urgent dyspnoea ; but in all these instances it was only 
intended to give temporary relief. To Schrotter is due the credit of introducing the use of tubes for the systematic 
dilatation and permanent cure of laryngeal strictures (see Fig. 2515). 
" These tubes are of gradually increasing diameters, and are about ten inches long, have perforations at the end, 
and are hollow throughout their calibre. They have a long curve of about one-third their length, for introduction into 
the larynx ; and at the oral end of the instrument a curved cylinder about two inches long is inserted, to prevent its 
slipping and to protect the face of the operator from mucus, &c. The introduction of the tubes is effected in this way: 
Having slightly warmed and well oiled one, it is passed behind the epiglottis and placed over the orifice of the glot- 
tis ; then, by keeping up constant and steady pressure it will, if it be of proper size, presently glide through the open- 
ing into the trachea, and the breathing through it will be instantly apparent by the tubular sound, and may be felt by GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
273 
LA^YNGO-TRAC|HEAL. 
ON LARYNGEAL STENOSIS. (Continued.) 
placing the hand over the end of the tube. The length of time the patient will allow the tube to remain in the larynx 
varies. At first it can only be retained a few seconds, but after each introduction it is better tolerated, and sometimes 
may be worn for one or two hours or longer. 
' Of the cases treated by me, some retained the tube about fifteen minutes without much discomfort; others never 
allowed it to remain longer than three or four minutes ; so I introduced it several times at each sitting, which proved 
sufficient to break the adhesions and dilate the glottis to quite a sufficient extent for easy respiration. The sensation 
or irritability of the larynx is usually very much diminished in chronic laryngitis." 
TRACHEOTOMY TUBES AND DILATORS. 
"The method that Schrbtter 
makes use of for those cases in 
which tracheotomy had been per- 
formed either through necessity or 
otherwise, and where the tracheal 
canula had become a vade mecum 
that they were doomed to bear 
silently to the grave, was like 
the tubage foreshadowed and sug- 
gested by the experiments that 
preceded it. The most remark- 
able cases in ante-laryngoscopic 
times are those of Mr. Liston. 
One was a laryngeal stenosis, 
treated and cured by him, in 1827. 
by passing bougies of increasing 
sizes into the larynx through a tracheal fistula that had been made in 
an attempt at suicide. The other, a tracheal constriction, is still more 
noticeable. Here he passed bougies of different sizes through an 
opening in the trachea, up through the larynx and out of the mouth ; 
when one was passed he grasped it there, and then pushed the other 
end down into the trachea, and finally allowed one the size of an 
oesophageal bougie to remain fifteen days in the trachea-and this 
case was also cured. 
"After the invention of the laryngoscope we have records of this 
trouble being treated by Czermak, Busch, Semeleder, 
Trendelenburg, Gerhardt, and later by a number of 
others. In most of these cases dilators were passed 
through a tracheal opening and upwards into the 
larynx ; in none of them, however, was the method 
employed considered satisfactory ; but I believe that 
an instrument invented by Stoerk, in 1874, for dilat- 
ation from below, altered so as to have three dilating 
blades instead of two, which would open antero-pos- 
teriorly as well as laterally, will be found most useful, 
and is one which, as modified by myself, I shall in 
future employ where tracheotomy has been performed. 
The dilators can have blades of different lengths to 
suit the necessities of the case ; and after being introduced into the stricture the dilatation can be gradu- 
ally increased day by day by turning the nut on the screw outside of the plate of the canula. 
" My instrument shows the extent of dilatation by markings in millimetres on the screw ; and it also 
has a flange or rim on the inner canula, so that when the dilator is in position the canula can be corked and 
the breathing be carried on entirely through the larynx, which assists very materially the dilatation. 
" In all my cases the difficulty was relieved by the treatment, and one patient who was for months 
absolutely dependent on a tracheal opening for respiration, after wearing the tracheotomy tube for one year, was then 
able to breathe with perfect comfort entirely through the natural passage."-H. Clinton McSherry, M.D., Baltimore, Md. 
Fig. 2516.-McSherry's Tracheotomy Tubes 
Fig. 2517.-McSherry's Laryngeal Dilator. 
McSherry's Laryngea^Dilator in Position. 274 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
b/r R Y N G 0 - T R AC H E^ L 
INTUBATION OF THE LARYNX. 
Dr. Joseph O'Dwyer's Method in Croup and Kindred Diseases. 
Fig. 2519.-O'Dwyer's Mouth Gag. 
Fig. 2522.-O'Dwyer's Larynx Tube Extractor. 
Fig. 2520.-O'Dwyer's Larynx Tube and Introductor. 
Fig. 2521.-Scale of Lengths for O'Dwyer's Larynx Tubes. 
The Complete Set of O'Dwyer's Instruments for Tubing the Larynx. 
1 Mouth Gag. 
1 Introductor. 
6 Larynx Tubes. 
1 Extractor. 
1 Scale. 
1 Morocco, Velvet-lined Case. 
" The numbers on the scale (Fig. 2521) indicate the years for which the corresponding tubes are suitable. For in- 
stance, the smallest tube when applied to the scale will reach to the first line, marked I, and is intended to be used up 
to the age of twelve or fifteen months ; the size marked 2 is suitable for the next year ; 3 and 4 for these years, and so on. 
"When the proper tube is selected for the case to be operated on, a fine thread is passed through the small hole 
near its anterior angle, and left long enough to hang out of the mouth-its object being to remove the tube should it 
be found to have passed into the oesophagus instead of the larynx. The obturator is then screwed tightly to the in- 
troductor, to prevent the possibility of its rotating while being inserted and passed into the tube. 
" The following is the method of introducing the tube, which is done without the use of an anaesthetic: The child 
is held upright in the arms of a nurse, and the gag (Fig. 2519) inserted in the left angle of the mouth, well back between 
the teeth, and opened widely ; an assistant holds the head, thrown somewhat backward, while the operator inserts the 
index finger of the left hand to elevate the epiglottis and direct the tube into the larynx. The handle of the intro- 
ductor (Fig. 2520) is held close to the patient's chest in the beginning of the operation, and rapidly elevated as the 
canula approaches the glottis. The tube is then pushed downwards, without using much force. It is then detached. 
The joint in the shank of obturator is for the purpose of facilitating this part of the operation. As soon as the obtura- 
tor is removed, and it is ascertained that the tube is in the larynx, the thread is withdrawn, but at the same time the 
finger is kept in contact with the tube to prevent its being also withdrawn. 
" It is important that the attempt at introduction be made quickly, as respiration is practically suspended from the 
time that the finger enters the larynx until the obturator is removed. It is therefore, under the circumstances, much 
safer to make several abortive attempts than one prolonged effort, even if successful. 
" For the purpose of removal the patient is held in a similar position, except that the head is not inclined back- 
ward, or very slightly so, and the extractor passed into the tube guided by the index finger of the left hand, which also 
fixes the epiglottis, and is brought in contact with the head of the canula. Firm pressure with the thumb is then made 
on the lever above the handle while the tube is being withdrawn. If secondary dyspnoea supervenes at any time the 
tube should be removed and a larger one substituted. To avoid accidents it is very essential to have some preliminary 
practice on the cadaver, particularly in extracting, which is the more difficult operation, owing to the aperture of the 
tube being so much smaller than that of the larynx. These tubes will also prove valuable as dilators in chronic steno- 
sis of the larynx or trachea. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
275 
bARYJ^GO -TRjACH eal. 
TOTAL EXTIRPATION OF THE LARYNX AND AN ARTIFICIAL SUBSTITUTE. 
(Extract of an acccount of the operation as performed Dr. Roswell Park, Professor of Surgery, Medical Depart- 
ment, University of Buffalo, &c., on June 25, 1885.) 
Patient anaesthetized. 
" It was necessary to make a long incision in the middle line, which ran from a little in front of the body of the 
hyoid to one inch below the upper end of the sternum ; this made it about six inches long. Careful dissection was then 
made down on either side of the larynx and trachea, the muscles attached to the sides of the larynx were peeled back 
with a sharp periosteum levator. This separation of soft parts on either side was carried as high as the hyoid bone 
and as low as the second or third rings of the trachea. Vessels were caught in haemostatic forceps as fast as they bled, 
and tied later with catgut; a few larger veins were tied twice and cut between ligatures ; about twenty-five haemostatic 
forceps were employed, once or twice all being in use at one time. Up to this period patient had breathed his chloro- 
formized air by the mouth. After the deep parts had been well exposed, and the lateral portions held aside with re- 
tractors, and after the operator's fingers had pretty completely separated the trachea from the oesophagus, the thyroid 
cartilage was opened for exploratory purposes. This was no easy task, and sharp-cutting bone forceps were necessary 
before it could be accomplished, so firmly was it calcified. The trachea was divided, first, longitudinally through its 
upper three rings, and then transversely between the first and second ring. A Trendelenburg tampon tracheal canula 
was then inserted, and, as its rubber balloon proved faulty, sponge was packed around its main tube; the tube and 
funnel for the anaesthetic connected with it were utilized during a part of the remaining time. The larynx and upper 
tracheal ring were now rapidly separated from the oesophagus, and, after this separation was complete from below, the 
thyro-hyoid membrane was divided, 
and then the remainder of the lateral 
walls of the lower pharynx; the con- 
strictors were dissected off from their 
insertions into the larynx, and the 
whole removed in one piece. Haem- 
orrhage was checked, and then the parts 
explored for evidences of any extra-lar- 
yngeal suspicious tissue. None was 
found. The uvula, which had been for 
some time very sensitive, and in which 
a little firm nodule was felt, was ex- 
cised. The upper part of the epiglottis, 
withits glossal and lateral connections, 
was left in position. 
"After all the bleeding points had 
been attended to, the tracheal tube was 
removed, and a strong silk suture intro- 
duced on either side through the skin 
and the upper tracheal ring, which, it 
will be remembered, had been split 
vertically. These were the only sutures 
used, and were for the purpose, not of 
trying to pull the trachea up in the neck, 
but simply of holding it well to the 
front. A large single trachea tube of 
aluminium, made for the purpose, was 
then introduced and held by tapes 
around the neck. Over its upper sur- 
face fell the anterior-cut margin of the 
oesophagus. Iodoform was dusted spar- 
ingly throughout the wound and the 
whole cavity carefully packed with iodoform gauze, so arranged that a pathway to the oesophagus was left, this latter 
being lightly plugged with the same material. This ended the operation, which lasted about one hour. 
" Fourteen weeks after the operation, an opening barely admitting a finger tip, and which has had its present size 
for eight weeks, remains. Through this small opening are introduced the various portions of the most ingenious 
mechanism, known as " Gussenbauer's Artificial Larynx" (which has been modified by Dr. Parks to suit the case. 
G. T. & Co.) 
Fig. 2523.-Park's Modification of Gussenbauer's Artificial Larynx. 276 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
LARY^IGO -TRACHEAL,. 
Total Extirpation of the Larynx and an Artificial Substitute. (Continued.) 
" It consists of a tracheal tube of large size, A, with rings at its lower end permitting a slight motion, corresponding 
to the natural flexibility of the trachea. Through its front plate and through an opening on its upper curvature passes 
a second pharyngeal tube, B, made also flexible, with an opening on its lower curved surface, so placed that a stream 
of air may play freely through both tubes, even though the external outlet be closed. The upper end of the pharyn- 
geal tube lodges behind and below the epiglottis, if this has been left in situ, or behind and below the base of the 
tongue, as the case may be. Around it the oesophagus granulates and closes, so that, after the healing process is com- 
plete, the only passage from the pharynx into the larynx is by way of the metal tube. In order that fluids and solids 
may not pass through this, an obturator, C, is provided, which is passed through the external opening and up through 
the tube, so that its rounded upper end plugs the upper end of the pharyngeal opening, thus preventing passage of 
anything into the trachea. But since this would also shut off air, the obturator is attached below, not to a solid plug, 
but to a ring, as seen, which fits accurately into the external opening of the instrument, through which, then, the patient 
breathes so long as this plug is worn, i. e. while taking his meals. After a time the patientswearing these instruments 
learn to swallow readily without the assistance of the obturator. Except at meals the simple stopper, E, is worn, so 
that, at all other times, the patient breathes through the nose and mouth. 
" Now the feature of greatest interest about this apparatus is the vocal part. The vocal cords do nothing in articulate 
speech but furnish the tone or sound, articulation is carried on by the parts above the larynx. With only the simple 
stopper in place, by aid of which the air current is directed toward the mouth, the patient will speak in a loud or 
"stage" whisper, which is distinctly audible, and his articulation is perfect. Now we can understand how we get a 
distinct speaking voice, providing we can introduce some substitute for the vocal cords, something which, by vibrating 
in the air current, may produce a distinct tone. And in the simple mechanism, D-only a free metalic reed, like a 
melodeon reed, playing freely in a movable slotted bar, and fitted inside of a stopper like 
the other one-we have such a substitute. The movable bar carrying the reed has an exter- 
nal lever, by means of which the wearer is enabled, with a touch of his finger, to throw it 
in or out of the air current, and thus, as it were, to voluntarily open or close his glottis. 
Placing this part of the instrument in situ, and throwing the reed into the air current, the 
metal strip vibrates as it does in the jews-harp, and the sound thus produced is converted, 
by the articulating parts above, into something more than a whisper-into distinct speech. 
To be sure this voice is now monotone, but it is nevertheless a voice, and the wearer of this 
apparatus is capable of carrvine on a conversation." 
Fig. 2524.-Dr. Foulis' 
Modification of 
Gussenbauer's Artificial 
Vocal Apparatus. 
Fig. 2525.-Trousseau's Forceps, for Removing Clots of Blood 
or Mucus from the Canula while in situ. 
Fig. 2526.-Mop, for Cleansing Canulas in situ. 
Fig. 2528.-Tiemann & Co.'s Tracheal Forceps, 
for Removing Foreign Bodies. 
Fig. 2527.-Tiemann's Tracheal Aspirator. 
For clearing the trachea of blood-clods or mucus, after the insertion of the 
trachea tube. It is simply a hard rubber syringe terminating into a soft rubber 
cup ; this is easy of application over the inserted canula. If the thumb be 
placed on the air-hole of the barrel, the soft rubber cup applied, the piston drawn, 
mucus or clods of blood will enter the barrel. By taking the thumb off the air- 
hole the instrument detaches easily, may be cleansed and used again if necessary. 
One of the simplest of these is made on the principle of a dry cup with a 
rubber ball (see Fig. 1653, page 115). GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
277 
TRACHEOTOMY- BROJMCHOTOMY 
Cutting an Opening into the Trachea or Larynx for the Extraction of Foreign Bodies, or to 
permit the Passage of Air to the Lungs. 
Fig. 2529.-Finger Protector. 
Fig. 2530.-Tiemann & Co.'s 
Tracheotome and Dilator. 
Fig. 2535.-Tracheotomy Scalpel, Sharp Point. 
Fig. 2531.-Tracheotomy Scalpel, Probe Poini 
Fig. 2533.-Buck's 
Tracheotomy Guide. 
Fig. 2532.-Well's Retractor. 
Fig. 2534.-Rose's Retractor. 
Fig. 2536.-Tardieu's Trachea Scissors. 
Fig. 2541.-Langenbeck's Tracheotomy Double-Hook. 
Fig. 2537.-Pilcher's Supra-Sternal Retractor. 
Fig. 2542.-Langenbeck's Tracheotome.. 
Fig. 2538.-Pitha's Tracheotome and Dilator. 
Fig. 2539.-Tracheotomy Blunt Hook. 
Fig. 2540.-Pilcher's Retractor. 278 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
T F^AC H EOTOJVIY- B F^O N C H OTO JVIY. 
Cutting an Opening into the Trachea or Larynx for the Extraction of Foreign Bodies, or to 
permit the Passage of Air to the Lungs. 
Fig. 2544.-Hank's Tracheotome. 
Fig. 2543.-Pilcher's Bronchotome, 
for Removing Pieces from the Trachea. 
Fig. 2545.-Delaborde's Tracheal Dilator. 
Fig. 2546.-Trousseau's Dilator, to Facilitate the 
Introduction of Canulas. 
Fig. 2548. 
Chassaignac's Tracheal Dilator. 
Fig. 2547.-Double TracheaTube, 
Silver Plain. 
Fig. 2549. 
Elsberg's Trachea Tube, with Valve. 
Fig. 2551.-Gendron's Split Canula, Silver. 
Fig. 2550.-Double Trachea Tube, 
Movable Plate, Silver. 
Fig. 2552. 
Little's Aluminium Trachea Tube. 
Fig. 2554.-Trachea Canula, Hard Rubber. 
Fig. 2553.-Silver Trachea Canula. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
279 
T R ACJd EOTO M Y- B RO N C JH OTO MY. 
Cutting an Opening into the Trachea or Larynx for the Extraction of Foreign Bodies, or to 
permit the Passage of Air to the Lungs. 
Fig. 2555.-Minor's Trachea Retractors. 
Fig. 2556.-Johnson's Double Canula and 
Obdurator. Modification of Durham's. 
A substitute for the tracheotomy tube, designed to hold 
open a wound in the trachea, so that the air can pass in and 
out of the windpipe through the same. A is a hollow rod, 
slightly curved, having a screw at each extremity, B, B, to 
set the retractors, D, D, which are then secured in the desired 
position by tapes adjusted at C, C. 
Fig. 2557.-Gerster's Tracheal Tampon Canula. 
Fig. 2558. \ 
W. W. Keene's Trachea Tube. 
A number of delicate steel springs are placed longitudinally 
around the lower end of a stout tracheal tube, so that, by turning a 
thumb-screw attached to the upper extremity of the oblique flange, 
they become diametrically dilated. A piece of rubber membrane, 
somewhat stouter than that used by Trendelenburg, is drawn over 
the steel springs, and on being equally dilated will insure perfect 
closure. A rubber tube is fitted into the distal opening of the 
canula, and bears at its end a funnel-shaped apparatus for the ad- 
ministration of the anaesthetic.-Medical Record, May 19, 1881. 
The trachea tube, a (Fig. 2559), is made 
of silver. A soft rubber sheath is drawn 
over the front part of it. A small canula, 
b, to which a rubber hose and bulb attaches, 
admits of blowing air between the rubber 
sheath and the silver tube, inflating the rub- 
ber so as to completely fill the trachea ; a 
clamp prevents it from collapsing. The ob- 
ject of this is to keep the blood from enter- 
ing the trachea or lungs whilst the surgeon 
is operating in the throat above the instru- 
ment, at the same time the lungs are sup- 
plied with fresh air through the larger open- 
ing of the silver tube. An anaesthetic may 
be administered by connecting the inhal- 
ing apparatus, c, with it. 
In using the apparatus please observe the following: I. Before drawing a tampon over the canula moisten both parts 
with water. 2. Before inflation warm the tampon a little. 3. Do not inflate the tampon except within the trachea or 
within a tube of like dimensions, say a speculum or other glass cylinder. 4. The tampon should not be too old. 
Fig. 255g.-Trendelenburg's Trachea Tampon. 280 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
RESPIRATORY-INHALERS. 
RESPIRATORY APPARATUS. 
" In man the respiratory apparatus commences at the larynx, which communicates by the opening of the glottis with 
the pharynx. The larynx is continuous below with the trachea, a cylindrical tube, four inches in length and nearly 
one inch in width, running down the anterior part of the neck, on the median line, to the top of the chest. It is com- 
posed of a fibrous membrane, strengthened by a series of cartilaginous rings, complete in front, but open posteriorly, 
which serve to maintain the cylindrical form of the trachea and to keep its cavity open for the free passage of air. It 
is lined with a mucous membrane covered with ciliated epithelium. At the upper part of the chest the trachea divides 
into two main branches, of a structure similar to its own-the right and left bronchi; each of which passes to the root 
of its corresponding lung. Here the bronchi begin to divide, subdivide and ramify, radiating in smaller and more 
numerous divisions to every part of the lungs, and becoming constantly more delicate and membranous in their texture. 
They are now called the bronchial tubes ; and their smaller ramifications lose together their cartilaginous element, and 
consist only of a fibro-elastic tubular membrane. Each terminal bronchial tube finally goes to a special division of the 
pulmonary tissue, termed a lobule. This is an air sac of more or less conical form, the bronchial tube opening into it 
at its apex, while its base is turned in the opposite direction. The interior of the lobule, like the entire lung of the 
frog, is imperfectly divided by membranous partitions into secondary cavities of a cup-like form, all of which, though 
separated from each other, communicate with the central cavity of the lobule. These terminal cavities, into which 
the air finally penetrates, are called the air vesicles. The air vesicles are rounded cavities, about of an inch in dia- 
meter, lined with a single layer of pavement epithelium. They are surrounded by a tissue containing a large pro- 
portion of elastic fibres, in which also ramify the capillary blood-vessels. Owing to the small size and excessive multi- 
plication of these air vesicles, the entire extent of respiratory membrane in the human lung is very great. It has been 
estimated by Lieberkuhn at not less than 1,400 square feet, and there is reason to believe that this estimate is not an 
exaggeration. The tissue of the lungs is thus of a spongy nature ; that is, it contains a multitude of minute cavities, 
filled with air, disseminated through a soft, moist, fibrous and vascular texture. Acccordingly, unlike any of the other 
internal organs, the lungs are lighter than water, and float upon its surface when separated from the body. They also 
retain the air entangled in their substance with such obstinacy that it cannot be expelled by any compression or violence 
short of absolutely disintegrating the pulmonary substance ; and the lungs, if healthy, will still float upon the surface of 
water, even after they have been bruised and mutilated to an excessive degree. This has given rise to the "hydrostatic 
test" for determining whether a newly-born infant found dead has been born alive. The lung which has never breathed 
sinks in water like any other solid organ ; but, if respiration has been once completely established, the lung floats, and can- 
not be made to sink by any ordinary method of manipulation. The application of this test, however, requires several pre- 
cautions in particular cases, which are usually fully discussed in works on medical jurisprudence. The lungs are sup- 
plied with blood from two sources. First, the pulmonary artery brings the venous blood from the right ventricle of the 
heart and distributes it to the pulmonary capillaries, when it is returned to the left auricle by the pulmonary veins. 
This blood, which is in great quantity as compared with the amount of solid substance in the pulmonary tissue, is 
brought to the lungs, not for the nutrition of these organs, but for its own aeration. Secondly, the bronchial arteries, 
a number of small vessels which come off from the thoracic aorta, and follow the ramifications of the bronchi and 
bronchial tubes, supply these tissues with arterial blood for the purpose of their own nutrition. It is returned to 
the right side of the heart by the bronchial veins. The nerves of the lungs consist of the pulmonary branches of the 
pneumogastric nerve, and the pulmonary plexuses of the sympathetic. They are also provided with an abundant 
supply of lymphatic vessels; and the lymphatic glands belonging to them, known as the "bronchial glands," often 
become very conspicuous at the root of the lungs, from the deposit in adult life of a dark pigmentary matter in their 
substance. The lungs are liable to a variety of acute and chronic diseases, the most important of which are pneumonia, 
or inflammation of the lungs, and pulmonary phthisis, or wasting of the lungs owing to a tuberculous deposit in their 
substance. They are also liable to be compressed by serous effusions into the cavity of the pleura, to be wounded by 
the extremity of a fractured rib, or to be the seat of haemoptysis or of pulmonary apoplexy."-"American Cyclopaedia." 
INHALATION. 
Inhalatio Pulmonalis.-" The act of drawing air or vapor into the lungs."-DUNGLISON 
" The utilization of the normal act of inspiration for conveying air impregnated with remedial agents to the diseased 
structures themselves, in the treatment of disorders of the lungs and air passages, has attracted the attention of physi- 
cians from the remotest period ; inhalation is at least as advantageous a mode, in many instances, for the administration 
of appropriate remedies as the skin or connective tissue. The material inhaled comes directly in close juxtaposition to 
the blood while it is in its most vital state, and is thus more promptly and more thoroughly absorbed into the tide of 
the circulation than when it traverses part of the venous circuit before exposure to the inspiratory effort. It is often 
advantageous, too, that nothing shall interfere directly with the digestive functions."-"Inhalation; its Therapeutics 
and Practice." Cohen. 1876. 
For Inhalation of Airs, Gases, Vapors, and Fumes. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
281 
IJMHALE^S. 
Pneumatic Apparatus, for Inhalation of Condensed and Rarefied Air. 
" In compressed and rarefied air we have powerful means of physically impressing the respiratory and circulatory 
systems, and thus of acting therapeutically upon them in diseases in which their functions are abnormally executed. 
Inspiration of compressed air increases the pressure on the lungs, and thus augments the vital capacity ; the chest 
becoming expanded to greater extent than can be accomplished by the most powerful voluntary inspiration of normal 
air. * * * Expiration into compressed air diminishes the quantity of expired air in proportion to the density of 
the compressed air."-" Inhalation in the Treatment of Disease : its Therapeutics and Practice." J. Solis Cohen, M.D. 
Fig. 2561.-Waldenburg's 
Pneumatic Apparatus. 
Fig. 2562.-Brown's Spirometer. 
Fig. 2560.-Franckel's 
Pneumatic Apparatus. 
By drawing the accordeon apart, the 
air contained in it will be rarefied ; if 
it be compressed, the air will be con- 
densed. 
See "Chloroform and Ether 
Inhalers," pp. 43 to 48. 
" Roosa's," " Hardy's," "But- 
tle's" Inhalers," p. 201. 
Fig. 2563. 
Hutchinson's Spirometer. 
Fig. 2564. 
Tobold's Pneumatic Apparatus. 282 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
INjdALEF^S. 
Spirometers, for Measuring the Capacity of the Lungs. 
Respirators, for Medicating and Tempering the Air before it reaches the Lungs in Inhalation. 
Fig. 2566.-Richardson's Instrument to Reestablish Respiration 
in Asphyxia, by alternately working the Balls. 
Fig. 2567.-Barnes' Spirometer. 
Fig. 2568.-Jeffrey's Respirator 
for the Mouth 
find XT mi th nnd 
Fig. 2570.-Dobell's Residual Air Pump. 
Fig. 2569.-Ramage's Inhaler. 
Fig. 2571. 
Tyndale's Antiseptic Oro-Nasal Respirator, 
Fig. 2572.-Nitz's Respirator. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
283 
I^HALE^S. 
For the Production of Steam of Hot Water, Vapors and Fumes of Ether, Chloroform, Iodine, &c., 
and for Inhalation in Affections of the Air Passages. 
Fig. 2573.-Hot Air Bath. 
Fig. 2574.-Gedding's Respirator. 
Fig. 2575.-Nichols' Inhaler. 
See 
"Chloroform and Ether Inhalers," 
pp. 43 to 48. 
" Bumstead's," p. 122. 
"Roosa's," "Hardy's," "Buttle's," 
p. 201. 
Fig. 2576.-Mackenzie's Eclectic 
Inhaler. 
Fig. 2577.-Porter's Croup Kettle. 
Fig. 2578.-Roe's Inhaler. 
The employment of hot moist air (steam), charged with a volatile matter, which latter should possess a decided and 
remedial action, is of the greatest value in the treatment of all acute and subacute inflammatory diseases of the larynx, 
and especially of those of the tonsils and pharynx. The inhalations can very properly be entrusted to the patient, 
and thus form an adjuvant to the local and direct treatment adopted by the surgeon.-" Pharmacopoeia for Diseases of 
the Throat and Nose." Lefferts. Putnam : New York and London. 1884. 284 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
INHALERS. 
For the Production of Steam of Hot Water, Vapors and Fumes of Ether, Chloroform, Iodine, &c., 
and the Atomization or Nebulization of Medicated Fluids, for Inhalation 
in Affections of the Air Passages. 
Fig. 2579.-Hunter's Inhaler. 
Fig. 2580.-Clinton's Atomizer. 
Fig. 2581.-Tiemann & Co.'s Steam Atomizer. 
For making medicinal applications to the mucous surfaces of the 
nares, pharynx and larynx. 
Fig. 2583.-Edson's Spray Producer. 
Fig. 2582.-Seeger's Steam Nebulizer. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
285 
INHALERS. 
For the Atomization or Nebulization of Medicated Fluids, for Inhalation in Affections of the 
Air Passages and for Local Application. 
Fig. 2584.-Sass' Spray Producer, with Receiver and Air Pump 
Fig. 2585. 
Novelty Air Pump. 
" The glass spray tubes of Sass, attached by means of india rubber tubing to a cylinder of compressed air, in which 
the amount of pressure is regulated by a guage at the top and the air let in or cut off at any moment by stop-cocks 
placed both on the cylinder near the tubing attachment and upon the tubing itself near the atomizing tubes-have 
been used by me with much satisfaction. The rubber tubing from the cylinder may be made to fit that on the glass 
atomizers by means of a bayonet joint. This arrangement makes their adaptation ready and secure. The cut off 
(Fig. 2425, z) may be conveniently and securely attached to the air supplying tube and to any of the atomizing tubes 
in ordinary use."-"Nasal Catarrh." Robinson. 1880. 
Fig. 2586. 
Wile's Compressed Air Spray Apparatus 
The pump is attached to a bracket and 
worked by an ash lever. The receiver 
stands on a swinging shelf and may 
be detached from the pump in a mo- 
ment. The spray 
tubes are modified 
after the pattern of 
Sass, but instead of 
being made of two 
glass tubes cement- 
ed together, they 
are made of one 
solid piece of hard 
rubber and the tops 
are screwed in and 
made interchange- 
able. By means of 
a small wrench they 
are readily un- 
screwed and taken 
out for purposes of 
cleansing. 
Fig. 2587.-Burge's 
Double-Acting Air Compressor. 286 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
1^1 HALEPS. 
For the Atomization or Nebulization of Medicated Fluids, for Inhalation in Affections of the 
Air Passages and for Local Application. 
Fig. 2588.-Sass' Spray Tube and Bottle. ; 
Fig. 2589.-Chapin's Laryngo-Tracheal Spray, for Solution 
of Trypsin in Croup. 
Fig. 2590.-Fullgrafs Laryngo-Tracheal Douche. 
Fig. 2591.-Fluhrer's Spray Tube. 
Fig. 2593.-Hank's Spray Tubes. 
Fig. 2592.-Newman's Atomizer. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
287 
INHALERS. 
For the Atomization or Nebulization of Medicated Fluids, for Inhalation in Affections of the 
Air Passages and for Local Application. 
Fig. 2594.-Cleborne's Tongue Spatula and 
Atomizer, combined. 
Fig. 2595.-Cleborne's Tongue Depressor, with Insufflator and 
Vaporizer, for all cavities of the body.^-«||i»»^ 
Fig. 2596.-Sass' Hand-Ball Spray Producer. 
Fig. 2597.-Fullgraf's Flat-bill Laryngeal Spray. 
Fig. 2599.-Wight's Continuous Spray Apparatus. 
Fig. 2598.-Spray Tubes and Stand. 288 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
INJHAbE^S 
For the Atomization or Nebulization of Medicated Fluids, for Inhalation in Affections of the 
Air Passages and for Local Application. 
Fig. 2600.-Bun-all's Atomizer. 
Fig. 2601.-Tiemann & Co.'s Universal Syringe. 
Fig. 2602.-Richardson's Spray Producer. 
For Applying Heat to the Chest in the Treatment of Diseases of the Lungs 
With the object of bringing to greater perfection this im- 
portant auxiliary (heat) in the treatment of diseases of the 
lungs, I designed a rubber apparatus, represented in the cut, 
manufactured by Messrs. Tiemann & Co.: a, stop-cock and 
exhaust tubes ; b, three-quarter inch calibre steam tubing, which 
conducts the steam from a boiler through feeding tubes, c, c, to 
the jacket; d, d, d, buckles and straps. The boiler is cylindri- 
cal, composed of tin, eight inches in diameter, six inches high, 
holds two gallons of water (two-thirds of which quantity is ne- 
cessary only for steaming purposes), and fits the top opening of 
a range, cooking stove, or portable kerosene stove. Its top 
converges into a three-quarter inch tube, to which the rubber 
tubing is attached. 
The rubber steam jacket strictly fulfills all the essential re- 
quirements of a strong and powerful, yet moderate external 
stimulant, and possesses the following prominent advantages 
over poultices and other appliances : It envelopes the whole 
chest completely ; it is light and readily applied ; it retains 
its position on the chest without difficulty ; it is easily managed 
and operated ; it is capable of maintaining a constant and uni- 
form temperature ; it requires no renewal ; and patients, if 
strong enough, can sit up in a chair, or, if too weak, lie in bed 
while using it. 
Before this jacket is applied it is necessary, in order to pro- 
tect the skin from any undue effects of heat, to envelope the 
whole chest with a vest composed of spongiopilin, or of several 
thicknesses of heavy flannel, which may be either wet or dry, according to the condition and indication of the patient. 
From a limited experience in the use of this steam jacket, I believe it to be a most valuable and important adjunct to 
the therapeutics of protracted and obstinate diseases of the lungs, such as interstitial pneumonia, chronic bronchitis, 
and even pulmonary consumption.-New York Medical Journal, October, 1879. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
289 
INJURIES AND DISEASES OF THE CJHEST. 
ABSCESSES, EMPYEMA, HYDROTHORAX, HYDROPERICARDIUM. 
Fig. 2604.-Westbrook's Curettes for Pleural Cavity. 
See "Pneumatic Aspirators," page 130; " Drainage," page 75 ; "Trocars for Paracentesis Thoracis" 
and "Roberts' Pericardial Trocar," page 126. 
ALIMENTARY C/tNAb. 
SURGICAL ANATOMY OF THE ALIMENTARY CANAL. 
" The principal portions into which the canal is divided in the human subject are known as the mouth, the oesopha- 
gus, the stomach, the small intestine, and the large intestine. The mouth is the cavity included between the opening 
of the lips in front and the fauces behind. In it are the teeth, intended for the mastication and comminution of the 
food ; the tongue, a muscular and sensitive organ, which subserves both the sense of taste and the proper movement 
and admixture of the food in mastication ; and a lining membrane which contains mucous glandules destined to supply 
a viscid secretion forming part of the saliva. There are also the parotid, submaxillary, and sublingual glands, situated 
in the immediate vicinity of the mouth, which pour their secretions into its cavity, and thus complete the formation 
and supply of saliva, which is mingled with the food in mastication and reduces it to the condition of a soft pasty 
mass. Immediately behind the fauces is pharynx, a short, funnel-shaped passage, leading directly to the oesopha- 
gus. The latter is a nearly straight tube of uniform size, about nine inches long and rather less than an inch in diam- 
eter. It passes through the neck and posterior region of the chest to the upper part of the abdomen, where it termi- 
nates in the stomach. It has a double layer of transverse and longitudinal muscular fibres,'by whose peristaltic or 
wave-like contractions the masticated food is rapidly carried from above downward. Its lining membrane is of a 
simple structure, and produces only a small quantity of mucus, destined, by its lubricating qualities, to facilitate the 
passage of the food. The oesophagus, in fact, is simply an organ of transmission, by which the food is transferred 
from the mouth to the stomach, where the more important digestive actions are to begin. The stomach is a dilatation 
of the alimentary canal, lying transversely across the upper part of the abdomen. Toward the left side it expands 
into a wide hemispherical sac or pouch ; towards the right side it becomes narrowed to a smaller diameter, where it 
unites with the upper extremity of the intestine. The orifice by which the stomach communicates with the oesopha- 
gus is called the cardia (Gr. Kapdta, the heart), because it is situated near the heart ; that by which it communi- 
cates with the intestine is called the pylorus (Gr. irv^G)pop, a gatekeeper). Both are provided with a special cir- 
cular bundle of muscular fibres, by which the food, once in the stomach, is retained there for a time, to allow of the 
secretion and operation of the gastric juice. The gastric juice is secreted by the mucous membrane of the stomach, 
which is soft, glandular, and vascular in texture, and, when stimulated by the contact of the food, pours out the gastric 
juice in considerable abundance, as the perspiration is exuded by the skin. Next the stomach follows the small 
intestine. This is a tubular canal, of about twenty-five feet in length and between one and two inches in diameter. 
It is thrown into numberless folds and convolutions, by which, notwithstanding its great length, it occupies a compar- 
atively moderate space in the abdomen. It is attached to the abdominal portion of the spinal column by a thin 
flexible membranous sheet, termed the mesentery, which, while retaining it in its proper position, allows of the neces- 
sary movement of its different convolutions upon each other. Its muscular layers are well developed and active, and 
by their contractions continually urge the semi-fluid ingredients of the food through the tortuous windings of its 
internal cavity, Its mucous membrane is provided, first, with a great number of glandular follicles which'secrete the 
intestinal juice, one of the active agents in digestion ; and secondly, with minute filimentous vascular prominences or 
villi, which are so abundant and thickly set as to give its internal surface a velvety texture, and which, by their ab- 
sorbent action, take up from the intestine the nutritious elements of the digested food. Into the upper part of the 
small intestine, a few inches below the stomach, there are also discharged two accessory secretions, namely, the bile 
from the liver and the pancreatic juice from the pancreas. The small intestine terminates in the lower part of the 
abdomen on the right side, by a junction at right angles with the large intestine. The large intestine, so called from its 
greater capacity as indicated by a transverse measurement, is about five feet long and from one and a half to two and 290 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
jA^IMENT/vRY CjANAk 
SURGICAL ANATOMY OF THE ALIMENTARY CANAL. (Continued.) 
a half inches in diameter. It extends from its commencement in the right iliac region upwards on the right side of the 
abdomen, then transversely across to the left side, then downward upon the left side, then through an S-like convolu- 
tion to the top of the pelvis, and finally through the cavity of the pelvis to the anus. At the point of junction of 
the small with the large intestine there are two parallel folds of mucous membrane, with their edges turned toward 
the cavity of the large intestine, which act as a double valve (called the ileo-cacal valve), allowing the passage of 
material in this direction, but preventing their regurgitation from the large into the small intestine. The mucous 
membrane of the large intestine has no villi, but is provided with simple glandular follicles, which secrete various 
excrementitious materials. This portion of the alimentary canal contains, also, the refuse portions of the food, which, 
together with the excrementitious matters supplied by its lining membrane, assume a faecal consistency and appear- 
ance from the situation of the ileo-caecal valve downward, and are finally discharged from the lower extremity of the 
large intestine."*-"American Cyclopaedia." 
CESOPJHAGEAk 
"The relations of the oesophagus are of considerable practical interest to the surgeon, as he is frequently required 
in cases of stricture of this tube to dilate the canal by a bougie, when it becomes of importance that the direction of 
the oesophagus and its relations to the surrounding parts should be remembered. In cases of malignant disease of the 
oesophagus, where its tissues have become softened from infiltration of the morbid deposit, the greatest care is requi- 
site in directing the bougie through the strictured part, as a false passage may easily be made and the instrument 
may pass into the mediastinum or into one or the other pleural cavity, or even into the pericardium. 
" The student should also remember that contraction of the oesophagus, and consequent symptoms of stricture, 
are occasionally produced by an aneurism of some part of the aorta pressing upon this tube. In such a case, the 
passage of a bougie could only hasten the fatal issue. 
" It occasionally happens that a foreign body becomes impacted in the oesophagus, which can neither be brought 
upwards nor moved downwards. When all ordinary means for its removal have failed, excision is the only resource. 
This, of course, can only be performed when it is not very low down. If the foreign body is allowed to remain, ex- 
tensive inflammation and ulceration of the oesophagus may ensue. In one case with which I am acquainted, the 
foreign body ultimately penetrated the intervertebral substance, and destroyed life by inflammation of the membranes 
and substance of the cord. 
" The operation of oesophagotomy is thus performed: The patient being placed upon his back, with his head and 
shoulders slightly elevated, an incision about four inches in length should be made on the left side of the trachea, 
from the thyroid cartilage downwards, dividing rfhe skin and platysma. The edges of the wound being separated, the 
omo-hyoid muscle and the fibres of the sterno-hyoid and sterno-thyroid muscles must be drawn inwards; the sheath 
of the carotid vessels being exposed, should be drawn outwards and retained in that position by retractors ; the oesoph- 
agus will then be exposed, and should be divided over the foreign body, which should then be removed. Great care 
is necessary to avoid wounding the thyroid vessels, the thyroid gland and the laryngeal nerves."-"Gray's Anatomy." 
SURGICAL ANATOMY OF THE (ESOPHAGUS. 
STENOSIS. 
Fig. 2605.-Dilators for (Esophageal Stricture. 
(Hard rubber handle and bulb, whalebone stems.) 
♦ " The large intestine is usually divided into three portions, the ceecum, colon and rectum."-Dunglison. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
291 
CESOPJHAGEAL. 
STRICTURE. 
Fig. 2606.-CEsophageal Dilator. (Hard rubber handle and bulb, whalebone stem.) 
Fig. 2607.-Roe's CEsophageal Dilators, 
on whalebone stems. 
Fig. 2608.-Roe's CEsophagotome. 
Roe's (Esophageal Dilators can be held in the stricture for a 
time at each introduction, giving the benefit of pressure, an ad- 
vantage well known in overcoming stricture.-Medical Record, 
Nov. ix, 1882. 
Fig. 2609.-Crawcour's CEsophageal Dilator. 
" They are fifteen inches long, and have a broad, flat handle. They terminate in an acorn-shaped bulb, and are 
made of four sizes: Nos. 15 to 17, 17 to 19, 19 to 21, and 21 to 24; and are perfectly flexible."-Medical Record, 
August 6, 1880. 
Fig. 2610.-Mackenzie's Internal CEsophagotome. 
" The shaft is fifteen inches long, made of gum elastic, and flexible. Through the centre runs a stem which is 
attached to the blade. When the instrument is introduced the blade is concealed in the metallic shield, which is firmly 
attached to the lower end of the shaft. The distance to which the blade may be thrown out is regulated by a screw 
in the handle."-Medical Record, Nov. 11, 1882. 
Fig. 2611.-Sands' CEsophagotome. 
" * * * The shank of the instrument, which is fifteen and a half inches in length and four millimetres 
in diameter, is a flexible tube made of narrow, spiral steel plate, secured within by two pieces of fine wire in order to 
prevent separation of the spiral coil. The instrument is provided with a variable number of steel bulbs, each bulb 
being furnished with a corresponding knife-blade. The bulb is firmly fastened by a screw to the distal end of the 
shank, and the knife is attached to an inner flexible steel rod, manipulated by a thumb-screw at the proximate end of 
the instrument. By turning this screw, the knife is drawn out from its concealed position within the bulb, the back of 
the blade sliding over a firm inclined plane. An index on a dial-plate indicates the amount of projection of the blade, 
the maximum projection being two and a half millimetres. A sliding ring on the spiral tube is used to indicate the 
distance of a stricture from the incisor teeth. I selected the metallic spiral tube for the shank of the instrument 
because it combines flexibility with strength. The bulb being conical, the operator can readily perceive when it 
comes in contact with the stricture before he projects the blade. In operating, a bulb must be employed which exactly 
fits the stricture ; the depth of the incision will then just equal the distance to which the blade is projected by the 
action of the screw in the handle."-" Internal CEsophagotomy in the Treatment of Cicatricial Stricture." By Henry 
B. Sands, M. D. Medical Record, Feb. 9, 1884. 292 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
CESOPHAGEAL. 
For the Removal of Foreign Bodies. 
See also page 270, "Throat Forceps," for Pharynx, Larynx, Trachea, and Gullet. 
Fig. 2612.-Probang, with Silver Bucket, in three parts. 
Fig. 2613.-Bristle Probang, for Removing Foreign Bodies. 
Fig. 2614.-Stanford's Bristle Probang. 
Fig. 2615.-Schaffer's Throat (and Uterine) Scoop, 
Fig. 2616.-Tiemann & Co.'s Oesophageal Forceps. 
Fig. 2617.-Dawson's Oesophageal Forceps. 
See also page 200, " Laryngeal Forceps." GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
293 
STOMACHAL 
For the Artificial Introduction of Food into the Stomach when Deglutition is Impracticable; 
for the Evacuation of its Contents in case of Poisoning, &c., and for Lavage. 
Fig. 2618.-Lever Stomach Pump. 
Lavage of the Stomach. 
Washing out the stomach, and the aspira- 
tion of liquids secreted by it, is more and 
more practiced in Germany since Kussmaul 
highly praised this method. Dr. Schliep uses 
it in nearly all affections of the stomach, es- 
pecially in chronic gastritis, with or without 
dilatation. The cure of chronic catarrh, ac- 
cording to his account in the Deutsche Klinik, 
Vol. XIV., would require a limited number of 
applications ; in simple catarrh five would suf- 
fice on an average. He uses this method even 
in dyspepsia of consumptive patients. In di- 
latation of the stomach he empties that organ 
with the pump every day. He performs the 
washing out, even in cancer, with pure water; 
or adds bicarbonate of soda to the water if 
the liquids be very acid ; or permanganate of 
potash if these liquids show signs of ferment- 
ation ; carbolic acid when they contain vege- 
table parasites; boracic acid as a disinfect- 
ant, and tincture of myrrh in atonic dyspepsia 
with abundant secretion of mucus.-Medical 
and Surgical Reporter, May 15, 1875. 
Directions for Using the Stomach 
Pump. 
Attach the stomach tube, A, firmly on to 
the lower tap, B, of the pump, and affix the 
hose, C, on to the side tap, D. Place the 
mouth-gag, F, between the jaws of the pa- 
tient, and introduce the stomach tube through 
the aperture. This mouth-gag serves the two- 
fold purpose of keeping the mouth open and 
of protecting the stomach tube against possible 
injury from the patient's teeth. After press- 
ing the lever, F, down, which opens the in- 
strument for aspiration, the piston is drawn out by the handle, G ; this fills the barrel of the pump with part of the 
contents of the stomach, which are then ejected through the hose, C, by first letting the lever, F, loose and then push- 
ing the piston down. A few repetitions of this operation will relieve the stomach of its fluid or masticated contents. 
The hand, 5, connected with the lever, F, indicates that passage of the instrument shut towards which its point is 
turned. Before attempting to discharge the stomach of its contents a quantity of warm water should be pumped into 
it, as this will facilitate the operation very much. To charge the stomach merely reverse the action of the pump, 
having immersed the hose, C, into the fluid prepared for this purpose, which should be held in a narrow, deep bowl. 
The hard rubber screw, H, is used for reducing lockjaw or for forcing the mouth open, which is done by screwing it 
between the jaws. 
N. B.-In affixing the tubes to and detaching them from the pump, their metal fittings only should be handled. 
After the use of gruel, or any thick fluid, wash out the instrument by pumping water through it. If the piston gets 
hard, and allows water to pass over it, it should 'be oiled and a little worsted evenly wound around it under the leather, 
which will render it as perfect as at first. 
" To feed a patient in spasmodic closure of the jaw, it is well to know that there is behind the last molar teeth a 
space sufficient for the passage of a small tube into the mouth."-" Medical and Surgical Landmarks." Luther Holden. 
Dr. Bowditch has used the lever stomach pump, in connection with trocars, as an aspirator. It may also be used 
as an injector in severe constipation of the bowels. See "Anal" and "Rectal" instruments. 294 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
STOJVIACHAh. 
For the Artificial Introduction of Food into the Stomach when Deglutition is Impracticable; 
for the Evacuation of its Contents in case of Poisoning, &c., and for Lavage. 
Fig. 2619.-Tiemann & Co.'s Hollow 
Piston Stomach Pump. 
This stomach pump is made of hard rubber. The piston rod is hollow. 
When the piston is drawn up, a valve, a, opens and admits the fluid into 
the barrel. Pushing the piston down closes the valve, a, at the same time 
opening a second valve, b, through which the contents of the barrel are 
ejected. 
There are two tubes, one for the stomach ; the other, with a plunger, 
for the fluid. These tubes fit on either end of the pump by means of a 
simple bayonet slide. 
When the contents of the stomach are to be evacuated, the tubes are 
fixed as represented in the drawing. They must be reversed if fluid is to 
be pumped into the stomach. 
It is a plainer and cheaper instrument than Fig. 2618, but not so dur- 
able nor as efficient. 
Fig. 2620.-Paine's Nasal Feeding Tube. 
For feeding maniacs or persons who are unable or unwilling to open 
the mouth. This tube is made of soft rubber, with our patent velvet eye. 
Its advantages are: That the introduction causes no pain; there is no 
struggling to weary the patient; all the food enters the stomach, and none 
is thrown about the room ; respiration proceeds regularly, and even con- 
versation may continue without hindrance. The objections to it are those 
against the much-used stomach tube ; while, over that instrument, from the 
non-necessity of forcing open tightly clenched jaws, and because of the 
inability of the patient to prevent its passage, it holds a true and deserved 
supremacy. Its adaptability is not confined to cases of melancholia. It 
may be used in choking paretics or in paralysis of the throat from any cause ; it might be used in fractures of the jaw, 
when teeth would otherwise be sacrificed, and in cancer of the mouth, or where food cannot be taken readily and 
naturally. 
Fig. 2621.-Tiemann & Co.'s Patent Velvet-Eyed Stomach Tube. 
A soft red rubber tube for introduction into the stomach. They are made of various sizes, from one-quarter to 
three-quarters of an inch in diameter, and from twenty-six to thirty-six inches long. Although very flexible, they are 
of sufficient firmness to be easily introduced-indeed they may be swallowed. 
For feeding, a glass or tin funnel may be attached to the open or top end, into which the liquid is poured (see Fig. 
2625). At the bottom it has two fenestras or eyes, very nicely rounded off (countersunk, beveled edges), making it im- 
possible to injure the mucous membrane either in entering or withdrawal. 
This beautifully contrived tube cannot be too highly spoken of. It may also be used in connection with any 
stomach pump for rinsing the stomach (lavage.) 
Fig. 2622.-Funneled Feeding Tube (English). 
All of the above tubes may be used with funnels, or may have an attachment for the stomach pump. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
295 
STOMACHAL. 
For the Artificial Introduction of Food into the Stomach when Deglutition is Impracticable ; 
and for the Evacuation of its Contents in case of Poisoning, &c., and for Lavage. 
The instrument consists of an india rubber tube, about half an inch in diameter 
and some four feet in length, provided with a ball of the same material, which 
is two or three inches in diameter, and situated about eighteen inches from one 
end of it. In fact, it is almost a facsimile of an enema syringe, but without a 
valve. To the other end a Tiemann & Co.'s patent velvet-eyed stomach tube is 
attached. Let us suppose the instrument to be used in a case of poisoning where it 
is desired to wash out the stomach as speedily as possible. The patient being seated 
in a chair, or reclining on a couch, the stomach tube is oiled and then passed back 
in the mouth in the usual way until it has reached the upper part of the pharynx. 
Its passage down the oesophagus, as in the case of a catheter in the urethra, is ef- 
fected by twisting it round and round in the hand until it has reached the stomach. 
We need scarcely point out how much less pain this soft flexible tube must cause 
than the hard somewhat inelastic tube generally used. The rest of the instrument 
is now adjusted to the stomach tube (the work of a second), and then a jug of water 
being obtained, the end of the tube beyond the ball is introduced into it. The 
operator with one hand pinching the india rubber tube somewhere between the 
ball and the patient's mouth, with the other hand compresses the elastic ball, and 
thus forces out some of the air contained in it, which bubbles up through the 
water into the jug. When this has been repeated two or three times, all the air 
is forced out, and the ball becomes filled with water. If the jug be now raised 
a foot or two above the patient's stomach, and pinching of the tube discontinued, 
the instrument acts at once as a siphon, and the water flows from the jug in a 
continuous stream into the patient's stomach. When enough has been intro- 
duced, the tube is pinched somewhere between the ball and the patient's mouth, 
and the flow of water into the stomach is at once stopped, the water being re- 
tained in the ball by atmospheric pressure. If the end of the tube be now 
taken out of the jug and put into a basin below the level of the patient's 
stomach, upon the pinching of the tube being discontinued the contents of the 
stomach will at once flow out into the basin in a continuous stream, the in- 
strument acting of course again as a syphon, only in the reverse way to that previously. When it is believed that 
the stomach is nearly empty, the tube is pinched between the ball and the basin, the end of the tube put back into 
the jug, and the whole thing repeated over again. The object of pinching the tube when the end of it is being shifted 
from the jug to the basin, and vice versa, is of course to retain the water in it by means of the atmospheric pressure, 
thus enabling it to act as a syphon. In case the holes at the end of the stomach tube become clogged with food, they 
can be easily freed by pinching the tube between the ball and the jug; com- 
pression of the ball will then force out the fluid contained in it, and thus 
clear the holes. In conclusion we would draw special attention to the low 
price at which this instrument can be obtained. The great majority of gene- 
ral practitioners do not possess a stomach pump. This is chiefly due to 
the high price of the instrument hitherto used. This objection being now 
removed, there can no longer be any excuse for any practitioner being un- 
provided with an instrument, the want of which may materially tend to lessen 
the chances of recovery in a case of poisoning. 
The gastro-mundator is a very convenient instrument for lavage or 
simply cleansing of the stomach, for drawing off poison, and for artificial 
or forcible feeding. 
The end with the plunger, B, is always the external one. The patent 
velvet-eyed oesophageal tube enters the stomach by the mouth or nose. 
The ball is worked like the common well-known injecting apparatus-by 
turning the ball below the hard rubber neck, the valves are made to change 
position; so that, without being obliged to disconnect the tubes as in other 
apparatus, we can first fill the stomach and then, by merely turning the ball 
to the opposite arrow, empty it again, and so on ad infinitum. 
The instrument can be safely placed in the hands of patients who are 
treated for affections of the stomach. 
Fig. 2623. 
Toswill's Syphon Stomach Pump, 
with Tiemann & Co.'s 
Patent 
Velvet-Eyed Stomach Tube. 
Fig. 2624.-Tiemann & Co.'s 
Patent Gastro-Mundator. 296 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
STOM/cCHAb. 
For Artificial or Instrumental Introduction of Food into the Stomach, and the Evacuation of its 
Contents, in case of Poisoning, and for Rectal Infusion. 
Fig. 2625. 
Hegar's Infusor. 
Fig.2626. Fig.2627. 
Stomach Tubes. 
French. English. 
Over the nozzle of a glass, metal or hard rubber 
funnel the end of a soft rubber tube of convenient 
length is slipped, the other extremity of which is at- 
tached in like manner to a stomach or rectal tube. 
For Lavage of the Stomach. 
"The introduction of the stomach tube is easy in 
most cases. You stand in front of the patient, make 
him open his mouth and protrude the tongue. You then 
introduce the tube into the pharynx. When it reaches 
the base of the tongue you ask your patient to swallow, 
and, during the movements caused by the effort, you ad- 
vance the tube into the oesophagus ; when the first part 
of the oesophagus is freely entered, you can push the 
tube easily and with more rapidity down into the stom- 
ach. For facilitating the descent of the tube, it has 
been advised to make them slippery by application of 
oil, vaseline or glycerine ; but, as fatty substances often 
leave a disagreeable taste, it is better to immerse the 
tube in Vichy water or milk. 
" The tolerance of the pharynx, oesophagus and stom- 
ach becomes easily established; after three or four seances 
patients never object to the presence of the tube ; they 
are soon able themselves to introduce the tube and con- 
duct the washing. As to the quantity of the liquid to 
be employed, it varies and depends on the degree of 
dilatation and tolerance of the stomach ; some patients 
will allow two, three, four and even five litres to enter, 
with others five hundred grammes excite efforts to 
vomit. Those who are capable should continue the 
lavage of the stomach until the liquid runs out as lim- 
pid as when it entered the tube. The return jet of 
liquid will sometimes cease to run on account of pre- 
sence of particles of food closing the eyes of the tube; 
it suffices to let a little water run into the stomach to 
displace the obstacle. 
"To completely empty the stomach of the liquid 
that has been introduced, bring into play the abdominal 
muscles and the diaphragm, and assist the careful efforts 
of these by pressure of the hands on the abdomen. If, in 
cases of greatly dilated stomachs, when the tube has 
been introduced too deeply, the extremity thereof curv- 
ing up, the eyes rising to the superior part of the stom- 
ach the syphon ceases to act, you may correct by with- 
drawing the tube a little occasionally. 
" During the first introduction of the tube, certain phenomena are ob- 
served, the most important of which is dyspnoea. The patient's eyes become 
injected, his face reddens and he claims he cannot breathe. I cannot re- 
commend too strongly to encourage your patient to breathe during the in- 
troduction of the tube, as well as during the time it remains in the stomach. 
" Besides dyspnoea, nausea and vomiting are sometimes caused by the 
introduction of the tube. As soon as the first portion of the oesophagus 
or the stomach of certain sensitive patients is entered, a discharge is ex- 
cited. By administering bromide of potassium internally, and making 
local pharyngeal applications of the salt during the three or four days 
preceding the first 'lavage' of the stomach, this accident is avoided.''- 
From a lecture by Dr. Dujardin Beaumetz. O. Doin. Paris: 1883. 
Fig. 2628.-Korup's Infusor. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
297 
STOMACHAL. 
For Artificial or Instrumental Introduction of Food into the Stomach, and the Evacuation of its 
Contents, in case of Poisoning, Lavage, &c. 
Fig. 2629. 
Stomach Tube, with Aspirator Attachment. 
Fig. 2630.-Hard Rubber Oral Screw, 
to aid in Forcible 
Introduction of Stomach Tubes. 
Fig. 2631.-Masticator. 
"According to Debove there is no relation between 
the appetite of patients and their digestive faculties. 
The food introduced into the stomach artificially may be 
tolerated and digested, no matter how sensitive the 
pharynx may be. 
" If carefully studied and employed, I believe ali- 
mentation with Debove's stomach tube will be found 
efficacious in some cases of vomiting of pregnancy where 
all other means fail."-Medical Record, January 2,1886. 
H. B. Millard, M. D. 
See also Alimentation by the Rectum, p. 303. 
For mincing meats. Useful to persons who 
have lost their teeth, or who are unable to mas- 
ticate by reason of accident, disease or old age. 
Also for preparing the food to be conveyed by 
means of the stomach pump. 
^NAL AND RECTAL. 
RECTUM AND ANUS. 
"Rectum, from rectus, 'straightso called from a notion that it is straight, which it is not. Intestinum rectum, 
apeuthysmenos, euthyen-teron, longaon, longas, longanon, archos, cyssaros, princeps, monocolon, bumgut (prov.), 
jotgut. The third and last portion of the great intestine. It forms the continuation of the sigmoid flexure of 
the colon, occupies the posterior part of the pelvis, and extends from the left side of the sacro-vertebral articulation 
to the coccyx, before which it opens outwards by the opening called the anus. It is cylindrical, but saccated as it 
were, at its inferior portion, where it is consequently larger, and is attached to the sacrum by the mesorectum. Like 
the other portions of the canal, it is formed of three membranes. Towards the lower extremity some parallel and 
longitudinal wrinkles are observable on its inner surface: these are the columns, columnce carnea of the rectum or of 
morgagni. They are merely folds of the mucous membrane, between which are a number of lacunce. The arteries 
of the rectum are numerous. They proceed from the inferior mesenteric, hypogastric and internal pudic, and are 
called hcemorrhoidal. The veins open partly into the hypogastric vein, partly into the inferior mesenteric. The nerves 
proceed from the sciatic and hypogastric plexuses. The rectum receives the faecal matters, as they pass from the colon, 
which serves as a reservoir for them."-Dunglison. 
"Anus.-One of the most important landmarks which guide a surgeon in his operations about the anus, is a white 
line at the junction of the skin and mucous membrane. It is easily recognized and is of especial interest, because it 
marks with great precision the linear interval between the external and internal sphincter muscles. From this line 
the internal sphincter extends upwards, beneath the mucous membrane, for about an inch, becoming gradually more 
and more attenuated. The wrinkled appearance of the anus is caused by the contraction of the external sphincter. 
At the bottom of these cutaneous folds, especially toward the coccyx, we look for fissure of the anus."-"Gray's 
Anatomy. " 298 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/vNAL a^id rectal. 
EXAMINATION. 
" For making a rectal examination, which shall be at the same time thorough and as free from pain as possible, two 
things are necessary above all others: a good bed or table and a good light. For a table, a strong four-legged one, 
upholstered with hair and leather, answers every purpose ; it should be hard, without springs, and about thirty inches 
in height. In place of this any of the examining tables of the gynaecologist may be used (see pages 51 to 55). Either 
natural or artificial light may be used, but the latter is on some accounts preferable, being always at command and 
easily thrown up the bowel or concentrated upon a particular point. The lamp which I have found most convenient 
is a modification of Tobold's laryngoscope (see page 257). 
" The instruments necessary are: specula of various forms, bougies, a Davidson syringe, ointment, cotton, sponge- 
holders, brushes, a cup for fusing nitrate of silver, an applicator of some metal easily bent, around the end of which 
cotton may be twisted, towels, basins, &c., and these should all be placed within easy reach of the hand. In the matter 
of probes almost every variety is useful, from the hard rubber uterine probe to the finest wire of pure silver; and di- 
rectors also should be of many sizes." See " Diseases of the Rectum and Anus." Kelsey. 1884. 
SPECULA. 
For Presenting the Parts to View, Facilitating Examination, Exploration, Applications and 
Operations. 
Fig. 2632.-Tiemann & Co.'s 
Trivalve Speculum Ani. 
Fig. 2633.-Trivalve Trellis 
Speculum Ani. 
Fig. 2634.-Bodenhamer's Reflector 
and Lens. 
Fig. 2635. 
Ferguson's Tubular Speculum 
Fig. 2636.-Ashton's Fenestrated Speculum Ani. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
299 
jANAb AND RECTjAL. 
SPECULA. 
For Presenting the Parts to View, Facilitating Examination, Exploration, Applications and. 
Operations. 
Fig. 2637.-Van Buren's 
Rectal Speculum. 
Fig. 2638.-Kelsey's Rectal Speculum. 
Fig. 2639.-Helmuth's 
Rectal Speculum. 
Fig. 2640.-Gorget-Formed Anal Speculum. 
Fig. 2641.-Van Buren's Rectal Depressor. 
A useful addition to 
any speculum. 
Fig. 2642.-Bivalve Speculum Ani. 
Fig. 2643.-William's Rectal Speculum. 
Fig. 2644.-O'Reily's Rectal Speculum. 
Fig. 2645.-O'Neil's Rectal Speculum, 
employed while Injecting for cure of Haemorrhoids. 300 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
jANALo AND REST/cL. 
SPECULA, DILATORS AND RECTO-COLONIC ENDOSCOPE. 
For Facilitating Examination, Exploration, Applications and Operations. 
Fig. 2646.-Rectal Dilator. 
Fig. 2647.-Anal Dilator. 
Fig. 2648. 
Sims' Rectal Speculum. 
Fig. 2649.-Small Bivalve 
Anal Speculum, 
for Children. 
Fig. 2650.-Sims' Anal Dilator. 
Fig. 2652. 
Thebaud's Sphincter-Ani Dilator. 
Fig. 2651.-Bodenhamer's Recto-Colonic Endoscope. GEORGE TIEMANN & CO'S. SURGICAL INSTRUMENTS. 
301 
^NAb AND RECT/vL 
SOUNDS AND BOUGIES. 
For Examination by the Sense of Touch above the reach of the Finger and for Dilatation of 
Strictures. 
Fig. 2653.-Vertebrated Recto-Colonic Exploring Sound. 
Fig. 2655.-English Rectal Bougie, Conical Point. 12 sizes. 
Fig. 2654.-English Rectal Bougie, Cylindrical. 12 sizes. 
Fig. 2657.-Kelsey's Soft Rubber Rectum Bougie. 
"For examination by the sense of touch, above the reach of the 
finger, recourse may be had to bougies. These are of all forms, sizes 
and materials, and, in general words, the softer the instrument the better 
it is for examination. These instruments are made of twelve different 
sizes and for the purpose of diagnosis the medium sized is the best. The 
old-fashioned red English hard-rubber bougie is unnecessarily stiff and 
dangerous, and should be discarded, having no advantages over the 
softer ones, either for the purpose of diagnosis or for that of treatment. 
The bougie a boule, made of hard rubber with a flexible stem, is a favor- 
ite instrument with many. Formyownusel have had a kind of bougie 
made by Messrs. Stohlmann, Pfarre & Co. (branch of Geo. Tiemann 
& Co.) which I prefer to all others, for the simple reason that it is 
softer and more flexible than any in the market. It is made of the 
same material as their red soft rubber catheters and differs from them 
only in size and in the thickness of its walls ; with such an instrument 
one is pretty certain not to perforate the bowel, and for diagnosis it 
answers every purpose as well as the harder instruments. The better 
fitted a bougie is for pushing its way through a stricture, the worse it 
is for rectal exploration. Every bougie intended for exploration should 
be perforated, so that a stream of water may be injected through it."- 
"Diseases of the Rectum and Anus." Kelsey. 1884. 
Fig. 2656. Bodenhamer s Rectal Exploring 302 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
^NAh AND RECTAL 
STRICTURE BOUGIES. 
For Examination by the Sense of Touch above the reach of the Finger and for Dilatation 
of Strictures. 
Fig. 2658.-Whitehead's Improved Instrument for Dilatation of Stricture 
of the Rectum by Elastic Pressure. 
Wales' Set of Rectal Bougies, Sheath and Syringe. 
Fig. 2659(6).-Wales'Soft Rubber Recto-Colonic Bougie. 
Fig. 2660 (<?). 
Wales' Rectal 
Bougie and Sheath. 
Fig. 2661 (7). 
Wales' 
Rectal Bougie 
Fig. 2662.-Gum Sheath. 
Fig. 2663. 
Sizes of Rectal Bougies. 
Fig. 2664.-Rubber Bag Syringe. 
The Application of Wales' Bougies for Dilatation of Rectal Strictures. 
" * * * With the view of obviating all possible objections to mechanical dilatation, I devised, for the first 
time, in 1876, rectal bougies made of pure gum (not, as heretofore, of gummed cloth webbing or other materials) of 
exceeding flexibility, smoothness, and varying in size. 
"A conduit runs through the centre and terminates in the point of the bougie, for the purpose of commanding a 
stream of water that might be required at any moment to facilitate the introduction of the instrument. The points of 
the bougies are made in various shapes, spherical, conical and olivary, with the view of meeting the necessities of 
special cases. The surface is perfectly polished, which, by reducing friction, increases the facility of introduction and 
eliminates the unpleasant sensation of dragging caused by a rough instrument. 
" The method of introducing the bougie is simple. The patient, after the bowels have been cleaned out by injec- 
tion, is placed, reclining on his left side, upon an ordinary operating table, the thighs flexed, and the buttocks just 
overhanging its lower edge. The smallest sized instrument likely to pass the stricture is smeared with grease, its point 
inserted into the anus and gently pushed onward in the following manner: The right hand grasping the bougie close 
to the anus, the whole perineum is pressed upwards, which will advance the point of the instrument; the left hand 
now steadies it while the right is slid downwards for a lower hold, the perineum, of course, settling with it; the bougie 
is again pushed forward in the same manner until the obstruction is passed. I have occasionally found that this 
manoeuvre may be greatly facilitated by sinking the fingers of the left hand deep into the left iliac region and drawing GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
303 
jANAId and rectal 
STRICTURE BOUGIES. 
The Application of Wales' Bougies for Dilatation of Rectal Strictures. (Continued.) 
upwards, as though an effort was being made, so to speak, to stretch out the sigmoid flexure, while pressure is made at 
the same time upon the bougie in the manner described. Another practical point of prime importance is to employ 
a stream of water, as warm as can be comfortably borne, propelling it through the conduit of the instrument, whenever 
its point is arrested for any cause. The water, flowing from the distal aperture, will distend the bowel, efface its 
folds, and break down any hardened fasces which may exist, obstructing the ascent of the bougie. An assistant may 
manage the syringe (Fig. 2664), throwing in the water in such quantities as may be needed, while the operator is en- 
gaged with the bougie. It must be borne in mind, however, that no great volume should be used at once, otherwise 
the bowel will be excited to energetic contraction, and compel the instrument to be withdrawn before it has been 
properly lodged. In preliminary trials, the bougie may be permitted to remain two or three minutes, and afterwards, 
when greater tolerance is established, a longer stay may be allowed. I rarely exceed five minutes in any case, even 
when the patient makes no complaint of irritation or pain. After several introductions of one size of the bougie, say 
number seven or eight, the next largest may be taken, and so on until the stricture has been sufficiently dilated. 
" The application of the instrument may be repeated twice or thrice a week, according to circumstances, such as 
the irritability of the rectum, temperament of the individual, and intercurrent attacks of diarrhoea or other trouble. 
Twice a week, in my experience, suffices in most cases ; a fortunate issue, if attainable, can only be brought about by 
patient and prolonged treatment. 
" Rudeness or violence inflicted with the view of hastening the case can effect nothing but harm, and may jeopard- 
ize the life of the patient. If the instruments be hastily thrust into the bowel it may be perforated, especially in those 
cases in which inflammatory softening or ulceration exists ; or, if it be too large, the rectal mucous membrane may be 
ruptured, giving rise to smart haemorrhage ; or the entire wall of the bowel may be ruptured into the peritoneum, an ac- 
cident that,is pretty sure to be followed by peritonitis, with all of its attendant dangers. But these funest consequences 
are infinitely less liable to follow the use of india rubber bougies than of any other sort, for certainly, a priori, nothing 
could furnish a milder, more equable and less dangerous force than these; and experience shows this to be the fact. 
" It often happens that, after the most patient devotion to this method of treatment, the bowels do not regain 
their functions, even after the largest sized bougie has been passed with ease. This result is due in part to long con- 
tinuance of the expanded condition of the bowel above the stricture, by which its muscular walls have been more or 
less paralyzed. 
"Avery gentle pressure can also be obtained by converting the bougie into a dilator. For this purpose I had each 
bougie provided with a gum sheath (Fig. 2662) which accurately fitted it. Thus prepared, by adjusting a rubber bag 
or an ordinary syringe to the butt of the bougie, air or water may be thrown into the sheath its whole length, or into 
any section of it, by tying a silken ligature about the instrument at the point to which it is desired to restrict the dila- 
tation. It is not desirable to distend the sheath largely, not more than will represent the diameter of a bougie two sizes 
larger than the one in actual use. The sheaths, under this degree of pressure, will expand uniformly or cylindrically, 
while a greater degree will cause it to bulge irregularly, or burst it. In the latter case, however, there is no danger, 
as a low thud and a peculiar sensation felt by the patient at the moment announce the accident, and may alarm nerv- 
ous persons. The amount of pressure above stated is all-sufficient, and, therefore, those instruments, of which there 
are numerous forms, specially contrived to gain great mechanical power, are both unnecessary and dangerous. Since 
I first brought to the notice of the profession rectal bougies made of pure gum, I have used them many hundred times, 
and they are employed now, I believe, to the exclusion of all others. I have neither myself seen any inconvenience or 
dangerous results follow, nor have I heard of any accident occurring in other hands. Some of my friends had, how- 
ever, expressed a suspicion that, being so soft and flexible, they were likely to deceive by doubling in the intestines 
instead of slipping along the mucous membrane ; but in all cases, except in very adipose subjects, when the bougie is 
properly lodged, it can be felt through the abdominal walls lying straight along the lumen of the bowel. * * *"- 
" Stricture of the Rectum." By Philip S. Wales, M. D. The Medical Chronicle, Baltimore, January, 1883. 
ALIMENTATION BY THE RECTUM. INFUSION, INJECTION. 
Fig. 2665.-Tiemann & Co.'s Patent Rectal Feeding Tube (Soft Rubber, Velvet Eye). 
May be used with funnels (see page 296), or may have an attachment for the stomach pump (page 293). 
^JEWANN-CO. 
"Alimentation by the rectum is required in diseases of the oesophagus preventing swallowing and in diseases of the 
stomach which prevent the retention or ingestion of food ; in this manner life may be maintained for long periods. 
The nutritive injection should be composed of materials which need no digestion, as milk, eggs, mutton and chicken 
broths."-" Operative Surgery." Stephen Smith. 1880, 304 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/vNAL RECTAL. 
ALIMENTATION BY THE RECTUM. INFUSION, INJECTION. 
" Pancreatic meat emulsion should be made as follows : To five to ten ounces of finely-chopped meat add one-third 
that weight of the fresh pancreas of the ox ; remove the fat and mix with about five ounces of water, and reduce the 
whole to the consistence of a thick soup. Or, the following preparation may be used : Crush or grind a pound of beef 
muscle fine, add one pint of cold water, allow it to macerate three-fourths of an hour; now raise it to the boiling point 
and let it boil two minutes and stand. The quantity used should be three or four ounces every four hours, and it 
should be tepid. 1 he bowels should first be moved by a laxative or enema. The injection should be very gently 
thrown into the rectum."-"Operative Surgery." Stephen Smith. 1880. 
a. Tape attached to the ob- 
turator, for withdrawing it after its 
collapse. The tape or thread may 
also be passed through the central 
opening and around over the cir- 
cumference, and then be tied so as 
not to be lost. 
" b. Funnel attached to the 
pipe, arranged for filling the obtu- 
rator. This can be replaced by a 
syringe. In using a syringe the 
amount of water (measured by the bulb of the syringe) necessary to 
fill the obturator, should be previously ascertained, in order not to 
run the risk of bursting the obturator by over pressure. 
"c. Syringe for injecting fluids into the rectum. 
"d. Wales' bougie. 
The obturator expanded with water. This, in the collapsed 
state, should be placed just within the anus. A piece of dentist's 
elastic rubber dam slipped upon the bougie down to the position of 
the obturator facilitates its entrance through the anus. The greater ap- 
proach to a wedge shape enables the obturator to pass the sphincter 
more easily." 
"i. For enabling the alimentary canal to hold two or three gallons of water in cases of obstinate constipation, in 
cases of obstipation and of strangulation ; or, for the speedy and complete washing out of the alimentary canal on any 
account. 
"2. For the holding in the alimentary canal of comparatively large amounts of nutritious fluids in cases in which 
the introduction of food by the mouth is impracticable. 
"3. For the holding in the large intestine of an adequate quantity of alcoholic liquids introduced for anaesthesia in 
surgical operations or injuries, or for the alleviation of shock or terror from any cause, or in all conditions in which 
alcoholic anaesthesia is desirable. 
"4. For the speedy dilution of the blood through the absorption of water from the intestinal surfaces in order to 
stimulate the kidneys to filter out any poisonous constituents of the blood, whether these impurities have been introduced 
by accident or design, or whether they have developed in the blood and in the glands by the chemical process incident 
to disease. 
" 5. For the reduction of temperature in fever and inflammation by the more ready discharge, through the various 
emunctories, of irritating material by the thinning of the blood through the introduction of water. 
The obturator is to be filled with air or water, and is intended to be of such a size as to fill the lower part of the 
anus and act as a valve, so that the greater the pressure is above, the tighter it will fit. It should be placed upon the 
bougie previous to its introduction. The bougie is then worked up as far as convenient and the obturator pushed in 
through the sphincter, and after being inside the sphincter it should be injected with warm water or blown up with air. 
It is probably better to use water because it is not so likely to leak away as air; you then fasten to the tube some kind 
of syringe and fill the large intestine. The practicability of securing a disentanglement of a strangulated intestine (the 
obstruction being occasioned by a loop of intestine caught under a bridge, which maybe the result of a previous inflam- 
mation, or occasioned by intussusception, in which the upper portion of the intestine is drawn into the lower) has been 
established by many successes. Where the obstruction is below the ileo-coecal valve, there can be no doubt of the 
ability, with the obturator, to fill the large intestine below the obstruction and exert an influence to disentangle it. It 
is not to be supposed that all the attempts will be successful, for there may be such adhesions as to make it imprac- 
ticable."-David Prince, M. D. St. Louis Medical and Surgical Journal, February, 1883. 
Fig. 2666.-Prince's Rectal Obturator. 
Anal or Rectal Stopper in position 
upon a Wales' Bougie. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
305 
jANAb AND F^EOTAL. 
IRRIGATORS. 
Fig. 2667.-Maw's Enema Pump. 
Fig. 2668.-Syphon Syringe. 
Fig. 2669.-Recto-Colonic Enema Apparatus, 
consisting of a Force-Pump with a Colonic Tube attached, for Injecting 
or Forcing Fluids both into the Rectum and Colon. 
Fig. 2670.-Clendinen's Rectal Irrigator. 
Fig. 2671.-Parker's Vaginal and Rectal Syringe, 
with Tiemann & Co.'s Patent Velvet-Eye Soft Rubber Tubes. 
Parker's syringe is made entirely of rubber, and the 
vaginal and rectal tubes are perfectly flexible. There 
is no terminal orifice, but the sides are perforated 
with "velvet eyes " for a distance of nearly two inches 
from the end. These rubber syringe points do not 
lacerate the mucous membrane, nor produce the in- 
jury so often caused by hard metallic tubes. The 
bulb and tubes are large, and insure a copious supply 
of water. 
Fig. 2672.-Munde's Rectal Irrigator. 
Fig. 2673.-Bodenhamer's Rectal Irrigator. 
On hand all sizes of metal and hard rubber syringes of universally-known styles, also Davidson's and other bag syringes 306 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ANAL AJMD RECTAL. 
STRICTURE. 
Fissure and Fistula Knives, Directors, Scarifyers, &c. 
Fig. 2674.-Bodenhamer's Blandin's Knife, 
for making the Sub-mucous and Sub-cutaneous Sec- 
tion of the Sphinctores Ani muscles, in Anal Fissure. 
Fig. 2675.-Bodenhamer's Anal Fissure Knife. 
(See Wales " Rectotome and Herniatome," 
Fig. 2761, page 316.) 
Fig. 2676.-Bodenhamer's Bistoury Cache, for Fistula en Ano. 
Fig. 2681.-Kelsey's Proctotomy Knife. 
Fig. 2680.-Rectal Scarificator. 
Fig. 2677.-Small Blunt-Pointed Curved Bistoury, for Incising Preternatural 
Pouches or Sacculi of the Rectum. 
Fig. 2678.-Kelsey's Knife, for Fistula en Ano. 
Fig. 2679.-Bistoury Cache, for Rectal Stricture. 
Fig. 2682.-Bistoury Cache, for Fistula 
Fig. 2690.-Allingham's Scissors and Director, for Fistula en Ano. 
Fig. 2689.-Flexible Silver Director, grooved and probe-pointed. 
Fig. 2688.-Elastic Probe. 
Fig. 2683.-Sharp-pointed Straight Bistoury. 
Fig. 2684.-Round-pointed Straight Bistoury. 
Fig. 2685.-Probe-pointed Curved Bistoury. 
Fig. 2686.-Sharp-pointed Curved Bistoury. 
Fig. 2687.-Cooper's Hernia Knife. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
307 
^NAh AJ\ID RECT/cL. 
DRESSING. 
For Removal of Foreign Bodies and the Application of Remedies. 
Fig. 2691.-Kelsey's Scoop, for removing Impacted Faeces. 
Fig. 2692.-Rectal Curette, for scooping out the Rectum in Atony or Paralysis 
of that organ, and also for removing Ascarides of the Rectum. 
Fig. 2693.-Forceps, for extracting Concretions and 
other Foreign Substances from the Rectum. 
Fig. 2702.-Rectal Sponge-Mop Holder. 
Fig. 2700.-Lente's Platina Cup, 
for fusing Nitrate of Silver. 
Fig. 2701.-Suppository (Hard Rubber). 
Fig. 2694.-Kelsey's Applicator (flexible metal, around the 
end of which cotton may be twisted). 
Fig. 2695.-Silver Probe. 
Fig. 2696.-Silver Probe. 
Fig. 2697.-Rectal Brush Holder (stem of flexible wire). 
Fig. 2703.-Small Trocar and Acupuncture, or Exploring 
Needle (for testing the character of ambiguous swellings or fluid 
collections of the Rectum). 
Fig. 2698.-Hutchinson's Improved Breech-loading Syringe, for ad- 
ministering semi-solid substances into the Rectum, &c. 
Fig. 2704.-Rectal Insufflator 
(for blowing powdered substances into the Rectum, 
when well opened by the speculum). 
Fig. 2699.-Rectal Porte Caustique. 308 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
/NAL AND RECTAL 
HEMORRHOIDAL. 
Fig. 2705.-Kelsey's Hypodermic Syringe, 
for Injecting Haemorrhoids. 
Fig. 2706.-Adams' Haemorrhoidal Syringe. 
The Treatment of Haemorrhoids 
by Injection. 
Dr. Kelsey, of New York, again urges 
the treatment of htemorrhoids by injection 
of carbolic acid. After an ample experi- 
ence this has become his routine practice, 
and in all his cases he has never known a 
patient to abandon the treatment after it 
was begun, and he has never failed to ef- 
fect a perfectly satisfactory cure 
by it, and he has never had an 
accident of serious nature with 
it. He uses three solutions, one 
of fifteen percent., one of thirty- 
three per cent., one of fifty per 
cent., and sometimes he uses the 
pure acid.-American Journal 
of the Medical Sciences. 
Fig. 2707.-Syringe for Injecting Haemorrhoidal Tumors, as used by Dr. O'Neal. 
Fig. 2708.-Angular Pile Scissors. 
Fig. 2711.-Byrne's 
Double Spring Tenaculum, for 
Pulling Down the Rectum. 
Fig. 2709.-Bush's Pile Scissors, 
curved on the flat. 
Fig. 2710.-Skene's Haemorrhoidal Clamp. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
309 
/vNAL A^D RECTAL. 
HEMORRHOIDAL. 
Fig. 2712.-Sims' Needle Forceps. 
Fig. 2713.-Bush's Pile Needlesand Holder. 
Fig. 2716.-Helical Needle for Piles, Ruptured Perineum, and 
for Colotomy. 
Fig. 2714.-Suture Needles. 
Fig. 2715.-Ruptured Perineum Needle. 
Fig. 2717.-Angular Pile Needle 
g. tiemann & 
Fig. 2718.-Lente's Ligature Carrier. 
Fig. 2722.-Skeene's Needle for Ruptured Perineum. 
Fig. 2719.-Hutchinson's Needle, for the Subcutaneous Ligation of External 
Hsemorrhoidal Tumors. 
Fig. 2720.-Slide-Catch Artery and Needle Forceps. 
Fig. 2721.-Carroll's Knot Tier. 310 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ANAL jAND RECTAL). 
HEMORRHOIDAL. 
Fig. 2723.-Verona's Winch, 
for Ligating Haemorrhoidal Tumors. 
Fig. 2724.-Bodenhamer's Curvilinear Forceps, 
for Facilitating the Ligation of Haemorrhoidal Tumors. 
Fig. 2727.-Bodenhamer's Spring Forceps, for Seizing and Ligating Bleeding Vessels, 
as well as Polypoid Tumors of the Rectum when high up. 
Fig. 2725.-Gibson's Instrument for the Introduction 
of the Ligature in Anal Fistula. 
Fig. 2726.-Rectal Porte Meche and Tampon. 
Fig. 2731.-Gooche's Canula for Ligating Haemorrhoidal Tumors. 
Fig. 2728.-Van Buren's Ligator. 
Fig. 2729.-Pin for Transfixing Haemorrhoidal Tumors. 
Fig. 2730.-Allingham's Ligature Carrier. 
For facilitating the introduction of the elastic ligature. A double ligature can be readily drawn through a fistula 
or under a tumor. It is not necessary, in fistula, to see the hook, for if the finger with a loop of india rubber around 
it be passed up the rectum, the loop can, with great facility, be directed over the end of the probe and caught in the 
notch, quite unassisted by vision. C shows the sharp-pointed instrument adapted to the canula, so that only one 
handle and one canula are required to complete the double instrument. Many other simple surgical operations may 
be advantageously performed by means of the elastic ligature. 
Dittel's Elastic Ligature (i yard long, 25 cents) exerts a constant and almost painless constriction upon the 
parts ligated with it. 
See also "Ecraseurs," "Helmuth's Ligature Carrier," page 92. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
311 
^NAL AJ\ID RECTAL 
HEMORRHOIDAL. 
Fig. 2732.-Smith's Serrated and Cutting Cauteries. 
Fig. 2734.-Smith's Pile Clamp. 
Fig. 2733.-Kelsey's Pile Clamp. 
Fig. 2735.-Tiemann's Hsemorrhoidal Clamp, Ivory Plated. 
Fig. 2736.-Luer's Polypus Forceps. 
Fig. 2740.-Amussat's Hsemorrhoidal Clamp and 
Cautery combined. 
Fig. 2737.-Ashton's Pile Clamp. 
Fig. 2738.-Kelsey's Tumor Forceps. 
Fig. 2739.-Smith's Wire Ecraseur. 
"For removing pieces of cancerous mass, after per- 
forming double proctotomy."-" Diseases of the Rectum 
and Anus." Kelsey, page 362. 1884. 
See "Kelsey's Proctotomy Knife," Fig. 2681. 
Fig. 2741.-Siemon's Sharp Scoop, for Removing 
Soft Growths. 312 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ANAL> AJMD RECTA 
H^EMORRHOIDAL. 
Fig. 2742.-Set of three Cautery Irons 
to fit one handle. 
Fig. 2743.-Rectal Cauteries 
(en roseau, en haricot). 
See "Actual 
Cautery Irons ane 
Blow-Pipe," p. 39. 
Pile Bougies and Supporters. 
Fig. 2749.-Prolapsis Ani and Pile Supporter. 
Fig. 2746.-Trosseau's Pile Supporter, 
and for treating Spermatorrhoea. 
Fig. 2744.-Swift's Pile Bougie. 
Fig. 2745.-Pile Bougie and 
Prolapsus Ani Supporter. 
Fig. 2747.-Bolton's Pile Bougie. 
Fig. 2750.-Matthieu's Prolapsus Ani Supporter. 
Fig. 2751.-Abdominal Pad, for Application of 
Heat or Cold. 
See pages 40 and 41, 
Dry Cold and Heat 
Fig. 2748.-Reed's Pile Bougie. 
This appliance is most efficacious 
in subduing inflammation and lower- 
ing fever. It is especially useful in 
peritonitis following operations with- 
in the abdominal cavity. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
313 
jANAL AND REST/cL. 
HEMORRHOIDAL. 
"Among the most numerous cases requiring surgical treatment which come before the practitioner are those suffer- 
ing from piles, and for these, especially when of long standing and accompanied by more or less prolapse of the rec- 
tum, surgery offers us many means of relief: extirpation by the knife, ligature or galvano-cautery, absorption by 
hypodermic injections, &c. But it seems to me that the main point of treatment-absorption by support and pressure 
-is overlooked ; and this is especially adapted to cure forty cases out of fifty, as the disease is caused by a relaxation 
of the parts about the anus, due to prolonged constipation, to irregular and prolonged defecation, and any other con- 
dition which admits of a filled and heavy rectum bearing down too strongly upon its supports. 
" Of course, the less advanced cases can be treated by regulating the bowels with a tonic laxative ; the occasional 
use of a T bandage, when unusual exercise is expected; insisting upon a regular time for defecation ; the use of 
astringent injections, &c., varying for each case. But when the patient exhibits piles of sufficient extent to be out more 
or less most of the time, and attended or not with prolapse or haemorrhage, the method of procedure I am about to 
detail will be found especially useful. 
" Place your patient in the knee-chest position, and, after anointing the parts with some lubricator, gently exercise 
traction, as in a hernia reduction, and the force of the atmospheric pressure will cause the piles to return. Follow 
them with your finger until each pile is in place. This reduction cannot be effected in severe cases unless the patient 
is placed in this position, and all cases of piles should be reduced in this manner. 
" So much for the method of reduction, for which I was indebted, during my hospital work, to Dr. Joseph W. Howe. 
"But, in practice, I found that the moment the patient assumed an erect position, the piles came down, because 
of the lack of support, and in looking about to find something which would supply the deficiency, the supporters shown 
in the engravings (Figs. 2744 and 2747) were brought to my notice. They are manufactured by Geo. Tiemann & Co., 
of rubber, semi-solid and very flexible, and of the correct shape for introduction and retention in the rectum. 
" Flaving been well lubricated, they are passed into the rectum on the withdrawal of the finger, and kept in place 
there by a T bandage and compress. One napkin is passed around the waist and the two ends fastened with a safety- 
pin, and a second napkin having a folded one fastened to its centre for a compress over the anus, is passed between 
the legs and secured to the other napkin in front and behind with safety-pins, being drawn up as tightly as is consistent 
with the comfort of the patient. 
" The support produced by the combination of the rubber pessary and the T bandage is both external and internal, 
producing rapid absorption and cure without pain, and affords great relief to the patient. 
" I usually place a mirror at such an angle that the patient can see the whole procedure, and I have yet to find one 
that cannot practice it upon himself, as he is directed to do each morning on rising, each night on retiring, and after 
each defecation, although in most cases the latter only will be necessary. Combine with this the use of a laxative 
pill."-Medical Record, February, 14, 1880. Chas. F. Stillman, M.D. 
Stillman's Method for the Radical Cure of Haemorrhoids without an Operation. 
" If (in gunshot wounds) the wounded intestine becomes attached to the external wound, an artificial anus is 
formed, and the contents of the bowels are discharged externally at this opening."-"Operative Surgery." Stephen 
Smith. 
" One of the various accidents which are liable to result from a strangulated hernia is that it may terminate in gan- 
grene of the intestine, producing ulceration of the tumor, and giving passage externally to fecal matters through a fis- 
tulous opening in the groin. This opening, becoming permanent, and permitting constantly the passage of the fecal 
matter, forms the variety of disease to which the name of artificial anus has been given." 
ARTIFICIAL ANUS. 
" The condition of the intestine, both above and be- 
low the opening, should be thoroughly ascertained, for 
upon it the curability of the disease depends. Some- 
times the artificial anus consists of a number of small 
external openings, at a variable distance from the intes- 
tine ; in other cases the walls of the upper and lower end of the gut lie in contact and parallel to each other, and 
open externally by two distinct openings. These walls form a species of valvular system, which prevents the 
free passage of the fecal matter from the upper into the lower end of the gut. This septum is called by the French 
Peperon, or the spur."-Bernhard and Huette's " Manual of Operative Surgery." Van Buren & Isaacs' 
American edition. 1857. 
" To restore the passage by the removal of the septum, or the two opposed walls of the intestine ; If the septum 
is prominent aud unyielding, it must be destroyed by the enterotome, an instrument with serrated edges (Fig. 2752), 
worked by a screw. Place the patient on the back, and distinguish the upper and lower end of the bowel; now 
Fig. 2752.-Depuytren's Enterotome. 
Cure of Artificial Anus, 314 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ANAL A^D RECTjAL. 
ARTIFICIAL ANUS. 
Cure of Artificial Anus. (Continued.) 
take one branch of the enterotome in the right hand and pass it carefully along the track of the bowel one to three 
inches, according to the depth of the septum ; while an assistant retains the branch, introduce the other with the same 
care along the other bowel; now join the blades and tighten them sufficiently to compress the opposed serous surfaces 
firmly together, and finally to destroy the septum by strangulation ; after a few days the instrument becomes loose and 
finally falls. The after treatment requires compress and truss until the wound heals."-"Operative Surgery." 
Stephen Smith. 
Creation of Artificial Anus. 
" The creation of artificial anus constitutes a regular operation, by which the surgeon proposes to make an orifice 
in the intestine and in the corresponding portion of the abdominal wall, through which the feces can escape, when, in 
certain pathological conditions, their passage by the natural anus is prevented. 
"According to Amussat the following conditions may require the performance of the operation : I. Accumulation 
of feces in consequence of an obstruction of the rectum, or any other portion of the large intestine, when the ob- 
stacle cannot be removed through the natural passage below, and life is thereby in danger ; 2. For cancerous diseases 
of the rectum and large intestine, when they occasion difficulty in defecation ; 3. When the rectum is congenitally 
imperforate, or rather when a portion of this intestine is wanting, and the passage cannot be established from below. 
" There are but two methods now adopted by surgeons. The first is Littre's (1710), who, having seen an oblitera- 
tion of the rectum in a child who died on the sixth day, pointed out the possibility of making an artificial anus through 
the abdominal parietes and the sigmoid flexure of the colon. The second method was proposed by Callisen, of Co- 
penhagen, and consists in making an opening in the descending colon in the lumbar region. Callisen's operation 
was, however, rejected by the great majority of surgeons. In 1839 Amussat directed attention to its feasibility, and 
proposed a modification."-Bernhard and Huette. 
"Amussat's Operation.-The instrumental apparatus consists of straight and convex bistouries, scissors, ligature 
forceps, ligatures and suture needles. 
" The operation, which ought to be preferred in the adult, is that first made by Amussat in 1839, and which has to- 
day been repeated many times with what has been regarded as encouraging success. The following is his method : A 
transverse incision is made upon the left side parallel to, and about two finger's breadth above the crest of the ileum, 
and four inches in length, the centre of which will correspond to the centre of the crest. Continuing to divide the tis- 
sues in this direction, portions of the fibres of the latissimus dorsi, quadratus lumborum, obliquus externus and inter- 
nus, and the transversalis will be successively exposed and cut; or the line of the incision may be kept to the outer 
side of the quadratus lumborum, so that its sheath only will be exposed, and its muscular fibres not cut. Cellulo- 
adipose tissue of more or less abundance will now be brought into view, beneath which lies the colon ; which last may 
be recognized by its hardness and by its bulging, if filled with fasces, and by its greenish color. The intestine being 
well exposed, is seized by a tenaculum or with a strong ligature, and held until it is opened by a knife or large trocar 
and canula. If the wound is deep care must be taken in emptying the gut that its contents do not escape among the 
adjacent tissues, or along the track of the wound. The operation is now completed by stitching the margins of the 
intestinal wound to the integument, and for this purpose it must be drawn well out. After the operation the patient 
should repose upon the wounded side, to facilitate the escape of the contents of the bowels. If it is desired to render 
the canal fistulous and permanent, a large silver, ivory or flexible tube may be subsequently introduced, furnished with 
a shield to prevent its escape inwards, and a stop-cock to control the faecal evacuations, or the open mouth of the tube 
may be kept closed with cork or india rubber pad, supported by a bandage. 
" In operating upon infants with congenital occlusion of the rectum, it will be remembered that the kidneys are, 
at this period of life, large, and extend outwards to near the line of incision ; that they are covered with very little fat, 
and that the meso-colon descends lower upon the colon than in adult life. Some have, for these and other reasons, 
preferred in such cases Littre's operation, which consists in cutting from the left iliac region directly through the per- 
itoneum and upon the sigmoid flexure. This method was adopted by Dr. Pooley. The operation was completely 
successful, and at the end of a year the child was in good health."-Pooley. American Journal of Obstetrics, &c.. 
May, 1870. 
" The vessels liable to be cut in this operation, whether made according to Amussat's or Littre's method, are small, 
and will be easily secured by the forceps and ligature. 
" It seems necessary to state further, in regard to the operation of colotomy, in whatever manner performed, that 
although nearly one-half of the patients upon whom it is made have survived a sufficient length of time to render it 
certain that it is a proper surgical expedient, where the purpose is solely to prolong life, yet it cannot be denied that 
it seldom, if ever, results in a permanent cure by the restoration of the natural or original channel."-" The Principles 
and Practice of Surgery." H. A. Hamilton. 1872. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
315 
JHER^IAL. 
ABDOMINAL HERNIA. 
"Abdominal hernia are remarkable for their frequency, variety and the danger attending them. They are pro- 
duced by the protrusion of the viscera contained in the abdomen through the natural or accidental apertures in the 
parietes of that cavity. The organs which form them most frequently are the intestines and the epiploon. These 
hernise have been divided, according to the apertures by which they escape, into: 
" i. Inguinal or suprapubian hernia. These issue by the inguinal canal: they are called bubonocele when small, 
and scrotal hernia or orcheocele, in man, when they descend into the scrotum : vulvar hernia, pudental or labial 
hernia, episiocele, in woman, when they extend to the labia majora. Direct inguinal hernia, ventro inguinal hernia, 
when the protruding parts, in place of entering the internal ring and descending along the inguinal canal, make a 
direct passage through the parietes of the abdomen opposite the external ring. 
" 2. Crtiral or femoral hernia, merocele, when they issue by the crural canal. 
" 3. Infra ptibian or sub-pubic hernia, oodeocele, opeocele, opodeocele, hernia foraminis ovalis seu obturatoria, when 
the viscera escape through the opening, which gives passage to the infra pubian vessels. 
" 4. Ischiatic or sciatic hernia, when it takes place through the sacro-sciatic notch. 
"5. Umbilical hernia, hernia umbilicalis, exomphalos, omphalocele, when it occurs at the umbilicus or near it. 
" 6. Epigastric hernia, occurring through the linea alba above the umbilicus. 
" 7. Hypogastric or infra-umbilical hernia, cceliocele, hypogastrocele, when it occurs through the linea alba below 
the umbilicus. 
" 8. Perineal hernia, mesocleocele, herniaperincei seu perinealis, perinaocele, perineocele, when it takes place through 
the levator ani and appears at the perineum. 
' ' g. Vaginal hernia, colpocele, coleocele, seu elytrocele, through the parietes of the vagina. 
"10. Diaphragmatic hernia, diaphragmatocele, when it passes through the diaphragm. 
" The prolongation of the hernial sac in various directions within the abdominal walls is called intraparietal or 
intramuscular hernia. Hernia are likewise distinguished, according to the viscera forming them, into enterocele, epip- 
locele, entero-epiplocele, gastrocele, cystocele, hepatocele, splenocele, &c. 
" When a hernia can be restored to its natural cavity, by the aid of pressure, &c., properly applied, it is said to 
be reducible. It is, on the contrary, irreducible when adhesion, bulk, &c., oppose its return. When the aperture 
which has given passage to the hernia occasions more or less constriction of the protruded portion, the hernia is said 
to be incarcerated, hernia obstructa-or strangulated, hernia strangulata ; and, if the constriction be not removed, 
constipation, hiccough, vomiting, and all signs of inflammation, followed by gangrene, supervene, with alterations of 
the features, small pulse, cold extremities, and death." 
The Treatment of Herniae. 
" The therapeutical indications are: I. As regards reducible hernia-to replace the viscera in the abdomen by the 
taxis, and to retain them there by the use of a truss, which, if properly adapted, may effect a radical cure ; 2. As 
regards irreducible hernia-to support the tumor by an appropriate suspensory bandage ; 3. As regards strangulated 
hernia-to have recourse to the taxis, bloodletting, warm bath, tobacco clysters, ice to the tumor, and, if these should 
not succeed, to perform an operation, which consists in dividing the covering of the hernia and cutting the aponeurotic 
ring, which causes the strangulation ; reducing the displaced viscera, unless their diseased condition should require 
them to be retained without; dressing the wound appropriately ; restoring the course of the faeces by means of gentle 
clysters; preventing or combating inflammation of the abdominal viscera ; conducting the wound to cicatrization by 
appropriate means, and afterwards supporting the cicatrix by a bandage."-Dunglison. 
" By the application of trusses which maintain for a considerable time a thorough reduction of hernise, a permanent 
cure is occasionally effected ; especially may this happen in cases of oblique inguinal hernise. If a hernia is reduced 
immediately, or very soon after its occurrence, the sac itself will often be found to be replaced, and there are many 
chances that if a truss is applied at once and kept in place steadily, the hernia will never again descend. The same 
is true of the congenital hernise of infants; for, although we do not in these cases return the sac, a few weeks of re- 
tention is often, indeed generally, sufficient to secure an obliteration of the canal. There is, however, a large class 
of old hernise in which nothing can be expected from a truss, except to maintain their reduction while the instrument 
is applied."-" The Principles and Practice of Surgery." Hamilton. 
"The radical cure of hernia would be too important a triumph for surgery and a resource too deeply interesting 
to humanity to permit that we should not endeavor to improve it still more and to modify its processes and to make 
renewed efforts for the purpose of attaining this result. For myself I cannot cease to entertain the idea that in the 
experimental spirit of our age we may succeed in obtaining a remedy of this description which shall be of real effi- 
cacy."-"Operative Surgery." Velpeau. 
Radical Cure of Herniae. 316 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
JHE^NI^L 
HERNIOTOMY. 
For the Relief of Strangulated Hernia. 
Fig. 2753.-Peter's Hernia Director. 
Fig. 2754.-Hunter's Director. 
Fig. 2755.-Hernia Director. 
Fig. 2756.-Hinge Hernia Director. 
Fig. 2762.-Allis' Herniotome. 
Fig. 2757.-Levis' Hernia Director. 
Fig. 2761.-Wales' Herniotome and Rectotome. 
Fig. 2758.-Cooper's Hernia Knife. 
Fig. 2759.-Stewart's Hernia Knife, 
Fig. 2763.-Hernia Saw. 
Fig. 2760.-Warren's Herniotome. 
" The operation only requires the cutting or severing of a few fibres of Poupart's ligament, and it is astonishing 
how very small an amount of this ligament, on becoming divided, will release a strangulated sac or intestine, so as to 
be readily reduced into the abdominal cavity. But bear in mind, while dividing the ligament, to cut as little as pos- 
sible, for too much cutting here leaves our patient in a much worse condition for the descent of his rupture than before 
strangulation, and more liable to become again strangulated by a too free division of these ligaments."-"Practical 
Treatise on Hernia." J. H. Warren, M. D. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
317 
HERNIAL. 
FOR THE RADICAL CURE OPERATIONS. 
The methods employed to accomplish this by plugging the mouth of the sac with its invaginated fundus and 
securing it to the surrounding tissues by sutures, and to produce such an inflammation of the parts as will provoke 
adhesions, and hence closure or contraction of the enlarged opening. 
Fig. 2764.-Dowell's Hernia Needles. 
Dowell's operation.-The double spear-pointed needle being 
threaded with silver wire at one end, a portion of the skin and 
cellular tissue is pinched up over the hernia and the needle in- 
serted and pulled through until the threaded point reaches the 
superior tendon of the external ring. The sac is now invagi- 
nated and the needle passed through both superior and inferior 
tendons of the ring. A second ligature is applied in the same 
way, and both tied over a piece of cork, drawing the edges of 
the two tendons together. 
Octavius White's method, by ligature.-The point, 
A, is invaginated into the ring. The needles are then 
pushed out through the integument and a ligature tied 
over the two handles and knobs, C and D, these 
handles being turned over, as shown by the dotted 
lines. The needles are then withdrawn and the 
instrument, weighing less than an ounce, is left in 
place for some days. 
Fig. 2765.-White's Hernia Ligator. 
Wutzer's instrument consists of three pieces, a 
cylinder, a needle, and a cover to produce adhesions. 
The cylinder is a hollow oval, and its end is nicely 
rounded. A curved needle runs through the cylin- 
der, emerging a short distance from the rounded 
point. The hernia having been returned, the in- 
tegument is pushed up the canal with the forefinger 
of the left hand, the cylinder is introduced into the 
cul-de-sac thus made, the finger at the same time 
being withdrawn. When the end of the cylinder is 
in the internal ring, the cover is made to compress 
the integument ; the needle is then pushed through 
the sac, canal and integument. The handle is then 
unscrewed and the rest of the instrument is allowed 
to remain in position for six or eight days. The 
puncture made by the needle suppurates by the 
fourth day; the bowels are not allowed to move, 
rest is enforced, with a plain diet, and then a truss 
is worn for six months or more. 
Fig. 2766.-Wutzer's Hernia Instruments. 
"It is proper to say of these 
operations, that, by their 
most earnest advocates, they 
have been considered applicable 
especially to the smallest, most re- 
cent and least troublesome herniae, 
and their value has been denied or 
seriously questioned in all those 
large, ancient and inveterate cases 
which alone demand resources be- 
yond what the truss, skillfully ap- 
plied, can supply."-"Principles and 
Practice of Surgery." Hamilton. 
Fig. 2767.-Redfern Davis' Hernia Instruments. 318 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
HERNIAL. 
FOR THE RADICAL CURE OPERATIONS. 
"For plugging up the orifice with the surrounding tissues and securing them by suture, to produce such an inflam- 
ation of the parts as will provoke adhesions of the enlarged opening, &c. 
" The operation of 
Wutzer has been materi- 
ally simplified by Agnew. 
The apparatus required 
for its performance con- 
sists, first, of a steel in- 
strument, closely resem- 
bling a bivalve speculum, 
the blades, of which one 
has two longitudinal 
grooves, being three 
inches in length and con- 
nected by a hinge near the handle, which is itself controlled by a screw ; secondly, of a very long, slender needle, 
mounted upon a wooden handle, and terminating in a curved point, pierced by an orifice ; and, thirdly, of a common 
stout suture needle, two inches and a half in length. The parts being well shaved, and a portion of the scrotal integu- 
ment pushed into the ring, the instrument, with its grooved blade looking towards the abdomen, is employed to carry, 
by gentle but steady pressure, the invaginated plug to the upper extremity of the inguinal canal. Holding the parts 
in these relations, the surgeon inserts the point of the long needle, armed with a silver wire, into one of the canals of 
the inner blade, widely separated from the other, and, passing it on, perforates the superimposed structures. The 
needle being withdrawn, is then carried along the other gutter, and thence, in like manner, across the tissues, the two 
punctures being about half an inch apart. In this way the base of the plug is thoroughly embraced by the loop of 
the wire, the ends of which are next twisted over a roll of lint upon the surface of the abdomen. The instrument 
being kept steady in position, the sides of the inguinal canal are next approximated by three horizontal sutures, about 
half an inch apart, the needle, armed with a stout silk thread, being passed between the blades of the cylinder. In 
this way all danger of including the spermatic cord and the peritoneum is effectually avoided."-" System of Surgery." 
Gross. 1882. 
" I have now a record of over sixty cases, all of whom have recovered. The patients 
varied in age from five months to thirty-four years, and the herniae differed in size from small 
tense ones to enormous lax ones. All were of the inguinal kind, some oblique, others direct, 
and a considerable proportion were congenital. An incision is made, large enough to admit the 
forefinger, through the skin of the scrotum at the fundus of the hernial sac, an inch and a half 
or two inches below the pubic spine. The sac, with the fascial tissue covering it, is then 
separated from the skin by passing the knife or the handle freely around the internal surface 
of the wound, until a sufficient extent has been separated to permit the finger easily to invagi- 
nate the sac into the hernial canal, which is readily accomplished by pushing the sac with the 
left forefinger up into the internal ring. After carefully examining the condition of the parts 
within reach of his finger, especially with regard to the position of the blood-vessels and 
the bounderies of the aperture, the operator retains his forefinger in the inguinal canal, 
thereby protecting the spermatic cord, which lies below his finger, and at the same time closing 
the internal ring so as to prevent any protrusion of the bowel. Sometimes, with a very potent 
ring, it is necessary for an assistant to place his finger externally on the groin to make perfectly sure of this, especially 
if there is any cough or struggling. It is, however, wiser to wait a few moments and to let the patient become quiescent 
before proceeding further. Then, holding the strephotome firmly in the right h^nd, the surgeon thrusts the point 
through the skin of the groin at that part of the surface which corresponds to the outer pillar of the internal ring, 
which is also pierced by the point which now comes in contact with the left forefinger. Having given the screw a 
turn, the point is made to pierce the invaginated sac, and pushed on through the internal pillar (conjointed tendon) 
as high up as can be safely reached, the left forefinger carefully guarding the point of the instrument throughout. 
Another turn is now made, causing the screw to pass through the invaginated tissues and across the pillars of the ex- 
ternal ring as many times as the length of the canal and the nature of the case will permit. The left finger is grad- 
ually withdrawn as the point passes downward and outward through the opening in the scrotum, the spermatic cord 
lying behind, and slightly compressed by the gradual tightening of the hernial canal. The point of the screw is then 
protected by a small india rubber ball, and the handle lies flat on the outer surface of the abdomen. The scrotal 
wound is closed by a single wire or hair suture. In from seven to ten days the screw can be removed, and a compress 
used to keep the parts in position."-"Annals of Anatomy and Surgery," by Dr. William Dunnet Spanton, of Eng- 
land. Medical and Surgical Reporter, Nov. 25, 1882. British Medical Journal, Dec. 11, 25, 1880, and Jan. 8, 1881. 
FlG. 2768.-Agnew's Hernia Instruments. 
Fig 2769 Span- 
ton's Strephotome. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
319 
JHERNIAL. 
FOR THE RADICAL CURE OPERATIONS, 
The Heatonian Method. 
" The pathology of it, according to the author, consists in developing, by the action of an irritant which is also an 
astringent, a tendinous irritation, causing a contraction of the fibrous tissues and rings which the circular arrangement 
of fibres makes possible, and the formation of a strongly plastic lymph. Recognizing that the fibrous structures and 
rings are primarily and principally in fault, to these alone is the remedy addressed. The mild character of the irritant, 
the operation being subcutaneous, the parts so slightly vascular being nourished by nutritive juices, are the reasons 
given for the irritation exceeding no further bounds, while the permanency of the effect produced is due to the inter- 
stitial and hyperplastic changes and the disposition of fibrous tissues generally to recover slowly-analogy being drawn 
to the duration of changes in similar structures elsewhere, as around joints and the heart valves. 
"The irritant used is the fluid extract of quercus alba prepared in vacuo, to which is added the solid extract in the 
proportion of fourteen grains to half an ounce, and a little morphia to lessen pain ; this is triturated with heat until a 
very perfect solution is obtained. The instrument with which the operation can be most satisfactorily done is 
De Garmo's syringe. 
Fig. 2770.-Heaton's Hernia Syringe. 
' The operation consists in locating the exact position of the external abdominal ring, by invaginating a finger of 
the right hand in the scrotum and fixing its position on the exterior by a finger of the other hand, which is made to 
press directly down upon it, or, if possible, in it. The instrument (Fig. 2771), already prepared, is carried with a 
sharp thrust quickly through the integument, just passing the external pillar ; the needle, then guarded, is carried on 
into the canal, care being exercised not to injure the cord or penetrate into the peritoneal cavity. The position of 
the beak of the instrument should at this stage be confirmed by a finger again invaginated through the scrotum, and 
the irritant deposited as it is withdrawn, all the fibrous strictures being wet. A bandage and compress, previously 
applied, are then carefully adjusted into position, and so arranged as to press with considerable firmness downwards 
and upwards in the direction of the canal, with somewhat less pressure over the internal than the external ring. This 
procedure is not accompanied with much pain, and that which follows is of short duration and but moderate intensity. 
Tenderness exists in a degree for some little time, but not enough to require the compress to be removed or to produce 
any inconvenience. 
" The recumbent position for a week or so, and no movement from the bowels, are to be insisted on, for the protru- 
sion must not be allowed to descend after its reduction and the irritant deposited. The bandage, or a light truss, 
should be worn for a month or more, as a precaution, but after that it may be discontinued and the case considered 
cured. In a certain number of cases the operation has to be repeated, more especially where the apertures are large 
and patulous or the cause has been violent tearing of the fibrous rings, and in congested hernia where they apparently 
are deficient in fibrous structure. 
" Simple as all this appears, it requires considerable care and dexterity ; the cord, which must be pushed aside, may 
be displaced in part and overlie the sac which may itself be irreducible. The direction of the canal and position of 
the internal ring being changed, the possibility of transfixing one of the pillars, wounding the cord or entering the ab- 
dominal cavity, are all to be remembered and avoided. The attention to every detail in operating, adjusting the com- 
press and bandage, and the after care, are so important as to largely determine the result in most cases. An hour or 
so, therefore, in the dissecting room, with a long needle, would not be misspent, but would aid to familiarize a be- 
ginner with the points most important to find, or as far as possible to avoid."-W. S. Heath, M.D., Assistant Surgeon 
U. S. Marine Hospital Service. Buffalo Medical and Surgical Jotirnal, April, 1881. 
" Having experienced some difficulties in the use of Dr. Heaton's syringe, and especially in being unable to de- 
posit the irritant gradually, owing to the unsteady action of the piston of the syringe, I had constructed by Messrs. 
Stohlmann, Pfarre & Co. one similar to that shown in 
the cut (Fig. 2771). 
" My first modification was in the addition of a screw 
piston, with a crescent-shaped bar at the end of the 
same, and in having the exterior of the barrel furrowed, 
A to B, instead of smooth. 
"In order, however, to deprive the operation of its 
only remaining dangers, I have added the trocar needle 
shown in the cut, C. The principle involved in the con- 
struction of this needle is the design of Dr. Simon 
Fig. 2771.-De Garmo's Hernia Syringe. 320 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
HERNIAL. 
FOR THE RADICAL CURE OPERATIONS, 
The Heatonian Method. (Continued). 
Fitch, who first introduced it as the 'dome trocar.' D represents the cutting point of the needle exposed ; E shows 
it with the point protected in such a manner that no injury can be done to the canal or vessels. 
"The hernial syringe is used in the following manner: It should be charged by removing the needle from the 
barrel and filling the latter two-thirds full; the central part of the needle is then replaced ; then, with beak elevated, 
sufficient of the irritant should be ejected to leave the barrel about half full. By this means all air is expelled and 
the perfect action of the syringe is secured. The sheath is now slipped on and it is ready for use. After penetrating 
the tissues with the cutting point of the sheath, it is drawn back so that it is perfectly protected, and the beak is then 
carried well into the canal without fear of injury to its tissue or to the vessels and nerves which are in close proximity 
to it. The crescent of the piston is now held firmly in the palm of the hand, and the barrel of the syringe is revolved 
between the thumb and finger of the same hand. In this manner the needle is revolved and at the same time is grad- 
ually withdrawn, thereby traversing the entire length of the canal and distributing the irritant over its interior surface. 
The after treatment corresponds in every particular with that given by Dr. Heaton."-W. B. De Garmo, M.D. Medi- 
cal Record, February 7, 1880. 
The irritant used is composed of 
R. Ext. quercus alba, gr. xxviij. 
Ext. quercus alba, fl. f i. 
Morphia sulphas, gr. i. 
M. 
Fig. 2772.-Warren's Hernia Syringe, No. 1 
" The needles are flatish, oval in shape and twisted throughout their entire length. They are of three sizes. No. i 
is twisted to revolve once in penetrating one-fourth of an inch ; No. 2, once every half inch ; No. 3, once in penetrat- 
ing three-fourths of an inch. I use No. 1 in operations on umbilical hernia and other herniae where the tissues are 
thin. It is, therefore, small, and has a quick twist, because it is necessary that the needle in penetrating should make a 
full revolution, so as to distribute the fluid on the parts to be irritated by the injection. No. 2 is for use in operating 
on the majority of small and recent herniae. No. 3 is for use on large and long-standing ruptures, where the needle 
must traverse tissue generally much thicker than in the other cases mentioned and often surrounded by adipose deposit. 
" The method of using the instrument is as follows: With the valve, G, closed, the needle is inserted in the fluid 
to be used. The valve is now opened by slight pressure on the spring, C. The pressure being continued, the piston 
can be retracted and the barrel will be consequently filled with the fluid. The valve is then allowed to close and the 
instrument is charged for use. We now thrust the needle slowly and gently, but at the same time firmly, through the 
integuments. During this act the needle revolves because of its twisted form. As soon as it has passed through the 
integuments, pressure is made upon the spring, C, which opens the valve, G, and allows the fluid in the barrel to 
flow as slowly and in such quantity as the operator may in any given case think necessary."-Joseph H. Warren, M. D. 
Medical Record, January 10, 1880. 
Fig. 2773.-Warren's Hernia Syringe, No. 2. 
The No. 2 syringe (Fig. 2773) is equally effective as No. I, and not as expensive. It has a valve by which we can 
control the fluid; the head of the needle revolves upon a ruby, and a spiral spring upon the piston within the barrel 
forces the plunger down upon the fluid, ejecting it through the valve. A screw on the piston, similar to that seen on 
the common hypodermic syringe, regulates, with great certainty, the number of drops of fluid we wish to use. It is 
more fully under control of the operator than the previous instrument. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
321 
J-IERJ\IIAL> 
TAXIS. REDUCTION OF HERNIA. 
"Taxis.-The name of taxis is given to the various manoeuvres by which surgeons effect the return of the pro- 
truded organs into the abdomen. Taxis is performed by means of the hands applied directly upon the tumor. 
"Position of the patient.-This should be such that the abdominal muscles will be in a state of complete relaxation. 
The patient should lie upon his back, with the head and shoulders slightly raised by means of pillows. The pelvis 
should also be elevated, so that the back will be in the most depending position and the tumor somewhat raised as 
regards the abdominal cavity. The patient lying in this position, no pressure will be made by the intestine upon the 
ring through which the hernia is expected to pass. The thighs should then be flexed upon the pelvis and the legs 
flexed upon the thighs. 
"General rules.-Before describing the special manoeuvres required for the reduction of either variety of hernia, 
we will quote from Malgaigne the following general rules which are applicable to the great majority of cases: 1st. 
Evacuate the bladder, to augment as much as possible the capacity of the belly. 2d. Advise the patient to breathe 
freely, without crying out or moving the head, in fact to keep as quiet as possible. 3d. Make but slight pressure at 
the commencement, in order that you may be able to increase it by degrees and continue it longer without bruising the 
hernia. 4th. Return first the parts that last protruded. 5th. Return them in the same direction as they came out: for 
instance, in recent inguinal hernia, push the intestine directly backward until the external ring is passed, then backward, 
upward, and especially outwards along the course of the canal, and lastly from before backward, when you have 
reason to think that you have reached the internal ring. In congenital and long standing hernia it usually suffices to 
push the parts backwards and slightly upwards to effect their reduction. 6th. Finally, in certain exceptional cases, 
these general rules fail, and the patients themselves have some peculiar method which they are in the habit of employ- 
ing which it is advisable for the surgeon to adopt. 
"Mode of operating.-The surgeon takes his position at the right of the patient, and embracing with one hand the 
base of the tumor, squeezes it gently with the other, with a view of distributing equally throughout the hernia the 
solid matter or gas which it may contain ; this manoeuvre, exercising a general pressure towards the abdominal ring, 
would force the whole of the hernial contents towards the point of strangulation, and thus render the reduction im- 
possible, if the surgeon did not take care at the same time to compress the pedicle of the hernia in order to concentrate 
and contract the contents in them toward the ring; this last measure prevents the bearing down of the whole of the 
hernia at once upon the ring, but allows it to be drawn outwards and gradually forced along in the direction of the 
canal through which it is to pass. Compression may also be made upon the whole of the tumor, by applying the 
fingers over its entire surface. In some cases, those portions which lie next to the ring are returned in succession. 
To aid in the reduction, the patient may be requested not to breathe, that in this way the action of the diaphragm 
upon the intestinal mass may be prevented. The application of large cupping glasses upon the abdomen has also 
been recommended. 
"It is very difficult, in an operation of this nature, for the surgeon to confine himself to one manoeuvre exclusively. 
For the successful reduction of hernia, he should try, simultaneously or successively, the various methods which have 
been described by authors for this purpose. The essential point is, to return the hernia in the same direction which 
it took when coming out. During the performance of reduction the volume and hardness of the tumor may regu- 
larly diminish and then suddenly return into the abdomen ; this sudden reduction, which is accompanied by a gurgling 
sound, is the sign of an intestinal hernia. Omental hernia usually returns gradually and without noise. 
"Continuance of the taxis.-The taxis, when continued too long, may impair the chances of success of the opera- 
tion by the knife, which is required after the failure of the various means which have been tried to effect reduction. 
Amussat, however, recommends the continuance of the taxis for a long time, and presents a number of successful 
cases in support of his opinion. This question should not absolutely be decided a priori. The surgeon, therefore, 
taking into consideration the various circumstances connected with the accident, must regulate his proceedings accord- 
ingly."-Bernard and Huette's " Manual of Operative Surgery. Van Buren and Isaac's American Edition. 1857. 
"A truss is an instrument employed for the purpose of preventing the descent of a hernia. Any truss that will 
keep up the hernia under all circumstances, and does not cause pain or lasting discomfort, is probably beneficial. 
Every truss that fails to carry out that object should be condemned. An instrument with too feeble a spring is a 
delusion and a snare ; but one that is too powerful may tend to do more essential harm than present good by causing 
absorption of the abdominal parietes upon which it presses, and, as a consequence, enlargement of the opening 
through which the hernia descends. For the same reason a pad that is unduly convex is also to be condemned. A 
truss that will keep one hernia may fail in the case of another. Every hernia, in fact, requires a special adaptation 
of the pad as well as a carefully regulated spring. Every subject of hernia, young or old, male or female, should wear 
a truss, and in a good proportion of cases, particularly of the young, a cure may take place ; that is, the neck of the 
sac may close. But even after a cure or apparent cure has taken place, it is well, for the sake of safety, to wear the 
instrument."-Bryant's " Practice of Surgery." Roberts. 1881. 
TRUSSES. RETENTION OF HERNIA. 322 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
JHERJBAL. 
TRUSSES. 
Trusses for Inguinal and Femoral Hernia. 
Fig. 2774.-French Truss. Single, Soft Pad, Right. 
"A retentive bandage or truss, properly 
applied, keeps the parts accurately and 
perfectly reduced, and thus prevents the 
occurrence of accidents which might com- 
plicate the hernia, such as unreducibility, 
obstruction, strangulation, &c. Trusses, 
also, when properly applied, may, under 
certain conditions regarding the age of the 
patient and the state of the disease, effect 
a radical cure of the hernia. It is therefore 
important that the surgeon should be 
thoroughly acquainted with their proper 
form and dimensions, in order to be able 
to use them with the greatest possible ad- 
vantage. 
" The trusses in use at the present 
time are such as are made of a narrow 
strip of well padded elastic steel, which 
is covered with leather and terminated 
by a pad, either fixed or movable, and of 
a shape which is varied to suit the case. 
Formerly soft bandages were used, made 
of leather, linen, or some other non-me- 
tallic substance. These bandages were 
fixed in their proper position by means of 
a belt made of some soft material, and the 
pressure required for keeping up the hernia 
was effected by means of a spring inserted 
into the pad. 
"The pads of spring trusses may be 
more or less soft. They are sometimes 
made of wood, ivory, india rubber, &c. 
The union of the spring to the body of 
the truss is called the neck. Buttons are 
affixed to the plate to which the pad is 
attached, and are used to fasten the leather 
strap which extends beyond the steel spring 
carried around the body. Another strap, 
not illustrated on the figures, and not 
wanted in every case, made either of leather 
or cloth, may be looped to the posterior 
part of truss and brought from behind 
forward around the thigh, and attached to 
one of the buttons upon the pad plate. 
This last strap keeps the truss in place 
and prevents it from slipping up. There 
are also various kinds of trusses for double 
hernia. The requisites of a good truss are: 
that it be appropriate to size and contour 
of the patient ; and that it maintains a 
moderate and continuous pressure upon 
the tendinous ring, without giving annoy- 
ance." 
Fig. 2775.-French Adjustable Truss. Soft Pad, Right. 
Fig. 2776.-German Truss. Soft Pad, Right. 
Fig. 2777.-Self-Adjusting or Ball and Socket Pad, either side GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
323 
JHEf^NI/tL 
TRUSSES. 
For Inguinal and Femoral Hernia. 
Fig. 2778.-Bow Truss. Single, Wooden Pad, Right. 
" The patient is laid down upon his back 
and the truss carried around the pelvis ; 
then, after reducing the hernia, the surgeon 
keeps it in this condition by placing one 
hand over the inguinal or femoral ring, and 
now applying the pad directly over that 
point, he retains it in this position by but- 
toning the leather belt to the back of the 
pad ; he then carries the other strap around 
the thigh and also fastens it to the back of 
the pad. The patient then rises, and, by 
walking about and making various move- 
ments of the limbs, enables the surgeon to 
see if the truss keeps the hernia firmly and 
properly in place. ' 
"When a truss is applied to a femoral 
hernia, the pad should be carried below 
Poupart's ligament. Malgaigne thinks that 
in some cases movable pads are decidedly 
better than those which are fixed ; that, in 
oblique inguinal hernia, the pad should 
press on the course of the canal and on the 
internal ring and resting upon the pubis but 
slightly, if at all; that, in direct hernia, the 
pad ought to be larger, fixed, and resting 
upon the pubes ; that hard pads are in gene- 
ral better suited for compressing the canal 
and soft ones for direct hernia."-"Bern- 
hard and Huette's Operative Surgery." 
Van Buren and Isaac's American edition. 
Application of a Truss. 
Fig. 2779.-Ratchet Truss. Hard or Soft Pad, either side. 
Fig. 2780.-Hull's Truss. Soft Pads, either side. 
Fig. 2782.-Wood's Horse-Shoe Pad 
Truss. Left. 
Fig. 2781.-Moc. Main Truss, for night wear. 
Fig. 2783.-Tiemann & Co.'s Finger-Pad 
Truss. 324 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
JHERNIAL. 
TRUSSES. 
For Inguinal and Femoral Hernia, 
Fig. 2784.-Chase's Truss. Cedar Pad. 
Please order a Truss by letter, as follows : 
Messrs. Geo. Tiemann & Co. 
Send to , a leather-covered 
(or celluloid) Truss, of the style illustrated 
by Fig. , for right, left or double. 
Inguinal ) Reducible Hernia. 
Scrotal - See Fig. , page , and 
Femoral ' describe accordingly. 
Patient : male or female. 
Circumference: Crest of ileum, 
inches. 
Pad: large, small. 
Perineal Strap : inches long. 
Fig. 2785.-Schuppert's Galvanic Truss. 
Trusses carefully fitted, according to phy- 
sician's directions, by competent and experi- 
enced persons. 
A lady will wait on lady customers, at 
the Branch Store : 
Stohlmann, Pfarre & Co., 
107 East 28th Street, 
New York. 
Large and commodious private parlors. 
Surgeons who wish to personally superintend 
the fitting are invited to call with their pa- 
tients. 
Fig. 2786.-Folsom's Truss. 
" This instrument consists of a back-plate 
of metal, which rests upon the flat surface at 
the upper part of the sacrum. To this are 
hinged two arms of steel, which curve around 
the pelvis just below the crest of the ileum, 
to avoid the action of the glutei muscles, but 
fitting very accurately to the shape of the 
body. To their extremities are attached the 
pads, upon which they exert such moderate 
pressure as will ensure safety in each particular case, without aggravating the condition intended to be relieved. The 
necessary adjustment of curve is, therefore, given in each case by the hand of the surgeon, before tempering and fin- 
ishing the instrument. In no other way can the same degree of firmness and efficiency be obtained. The two pads 
are connected by a single strap, buttoning on studs at their upper part. A double truss is used in every case of hernia. 
" The truss is plated with nickel, and, instead of being covered with any absorptive material, is worn over a silk 
handkerchief or flannel bandage."-Medical Record. 
All styles and sizes of Celluloid Trusses on hand. 
The celluloid truss is composed of a steel spring, finely tempered and covered, or encased with this compound 
forced on under immense pressure, without any seam and quite as smooth as the finest polished ivory. This material 
being entirely impervious to moisture or perspiration, the spring is completely protected and preserved from rust, thus 
rendering it perfectly indestructible. The pad is made of the same material and in different forms, and, being hollow 
and perfectly smooth, is rendered light, comfortable and pleasant to the person. This coating is not liable to crack in 
cold weather, nor does it emit any sulphurous or unpleasant odor. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS- 
325 
HERNIAL. 
TRUSSES. 
Fig. 2787.-Plain Double Truss. Soft Pads. 
For Inguinal and. Femoral Herniae. 
"The symptoms and appearance of in- 
guinal hernia are generally sufficiently char- 
acteristic, but even in the most marked case 
it is important, by a formal inquiry and the 
recognized tests, to distinguish it from differ- 
ent affections which occur in these organs 
and tissues. 
" The more noticeable are hydrocele ; en- 
cysted spermatocele, connected with the epi- 
didymis ; varicocele of the spermatic veins ; 
inflammation of an old hernial sac and its 
results; inflammatory affections and other 
diseases of the testis, cord and their cover- 
ings, of inguinal and lymphatic glands ; hse- 
matocele ; malpositions of the testis; growth 
of fat in the connective tissue of the ingui- 
nal canal and upon the spermatic cord; dis- 
eases of the integuments of the scrotum, 
especially growths. 
" The truss selected for the early treat- 
ment of this hernia must be preventive and 
curative. It is of great importance to pro- 
tect those who, from hereditary tendency or 
weakness of the abdominal walls, are predis- 
posed to rupture. 
"For this purpose a broad band, with a 
suitable pad (Fig. 2781) may be worn. It 
should consist of stout elastic web, which 
passes around the body and is attached to 
the pad by studs on the pad; elastic bands 
pass from the body band, under the limbs, to 
studs upon the rupture pads. If the patient 
is corpulent two pads should be used, to give 
more extended support to the abdomen. 
" If hernia exists and is reducible, a truss 
must be selected according to the size of the 
aperture. It should not press in the tissues, 
nor invaginate them into the canal, between 
the pillars of the external abdominal ring, 
and thus stretch, fray and weaken the inter- 
columnar fascia. * * * * 
" To prevent undue pressure upon the 
cord, which may be so great and long con- 
tinued as to cause atrophy of the testicle, a 
pad has been advised with a slit or chink 
(Fig. 2782), which gives a horse-shoe shape, 
the shorter end lying upon Poupart's liga- 
ment, immediately outside and above the 
spine of the pelvis, the longer end lying on 
the inner pillar ; the inner border of the pad 
being parallel to the outer edge of the rectus 
muscle, while the round part presses upon 
the internal ring, and the movable cord slips 
into the chink between the two points of the 
pad and escapes all injury."-"Operative 
Surgery." Stephen Smith. 
Fig. 2788.-Self Adjusting Double Truss. Ball and Socket. 
Fig. 2789.-Best French Double Truss. Soft Pads. 
Fig. 2790.-French Adjustable Double Truss. Soft Pads. 326 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
HERNIAL. 
TRUSSES. 
Warren's Trusses, for Abdominal Hernia. 
" Ever $ince I began to operate for hernia by 
the method of subcutaneous injection, I have been 
troubled to obtain a suitable truss to be worn by 
the patient. * * * I have devised a truss 
which, I think, will meet all demands. The pad 
is composed of a rim of hollow tubing, in sizes 
from No. 12 to No. 21, over which very fine wire 
gauze is tightly drawn and soldered neatly and 
securely. The plane of the pad is slightly con- 
cave, in order to accommodate it to all the ana- 
tomical relations, and can be still further adjusted 
by the surgeon to any individual case. The gauze 
being drawn tightly over this rim gives us a flat 
pad which presses upon the body like a human 
hand, the best of all trusses. The pad is Soldered 
at its neck to the spring, and is so shaped that it 
will not press upon the spermatic cord in scrotal 
hernia, nor too hard upon Poupart's ligament in 
femoral. Neither will it glide over the ligament 
and slip into the grove of the groin, as does the 
common pad. There is a bridge of tubing over 
the pad, which serves to strengthen it, and may 
also assist in retaining in apposition to the body 
a sponge, either medicated or moistened simply 
with cold water, for the purpose of reducing in- 
flammations. The pressure of the pad can be 
applied in any desired direction, for there are 
three knobs for the attachment of the strap. 
Between the pad and the integuments a layer 
of cotton flannel, either single or double, should 
be placed ; this can be renewed by the patient as 
often as desired. The perineal band consists of 
a small gum rubber tubing or a coarsely braided 
silken cord. 
" It will be evident to all that this is a very 
light and comfortable truss. It is hygienic, and 
is accurately fitted to the parts. It is anatomical, 
because it tends to draw the pillars of the rings 
together rather than to separate them. Hence, 
even if used without the operation of injection, 
such a truss is better fitted to effect a cure than 
any convex pad in use. 
" The springs are of two degrees.of stiffness. 
One is very soft and gentle in its action, and is 
adapted for use after the operation of subcuta- 
neous injection. It can be applied in eight or ten 
days after the operation. The other is stronger, 
and is better adapted for all those forms of her- 
niae where a truss is to be worn. It can be worn 
with perfect ease night and day without removal, 
as it is non-corroding and covered with the best grained morocco or russia leather. I call the attention of the pro- 
fession to this truss as the most practical one I have ever seen. It is the truss I should recommend to those who are 
adopting the method of subcutaneous injection in their practice. It is, of course, free from all patent or trade-mark. 
"A Practical Treatise on Hernia." J. H. Warren. 1882. 
Fig. 2791.-Warren's Umbilical Truss. 
To be worn after operations. 
Fig. 2792.-Warren's Double Truss. 
Fig. 2793.-Warren's Single Truss. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
327 
HERJ^IAId. 
TRUSSES AND BANDAGES. 
For Umbilical Hernia. 
Fig. 2794.-Chase's Umbilical Truss. 
Fig. 2797.-Children's Umbilical Truss 
with crescent spring, hard or soft pads. 
Has a hard wooden pad, and is a com- 
fortable appliance for corpulent persons, 
as well as for children. Being light and 
cool, it is very agreeable for summer wear. 
Fig. 2795.-Bow Spring Umbilical Truss. 
Fig. 2798.-Children's Bow Spring 
Umbilical Truss. 
The spring of this truss is made in 
form of a bow, the convex side of which, 
supporting the pad, is applied to the rup- 
ture. It is forced to conform to the shape 
of the body by drawing it tight. 
Fig. 2799.-Umbilical Bandage. 
Fig. 2796.-Walker's Combination Supporter, for Umbilical and 
Abdominal Hernia. 
. These bandages are made of linen, 
satin-jean, or canvas, with hard pads 
of wood, cork, lead, &c., and with soft 
pads made of sponge, horse-hair, or of 
india rubber inflated with air. 
Fig. 2800.-Elastic Umbilical Truss, 
with transparent celluloid pad. 
The order for an zimbilical bandage or truss, for patients who can 
not call on us for adjustment, should be accompanied by the follow- 
ing measurements: I. Diameter of the protuberance; 2. Circumfer- 
ence of the body at the umbilicus. 328 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
HEF^NIALd. 
ABDOMINAL SUPPORTERS. 
For Hypogastric, Perineal, Vaginal and Diaphramatic Hernia. 
Fig. 2801.-Bow-Spring Abdominal Supporter. 
Fig. 2805.-Elastic Belt. 
Fig. 2802.-Eugene Abdominal Supporter. 
Cotton Elastic Abdominal Belt. 
Braun's Abdominal Supporters. 
Phelp's Abdominal Supporter. 
Dugas' Abdominal Supporter. 
Boston Abdominal Supporter. 
Riding Belts, with stays, lined 
with chamois. 
Canvas Abdominal Belts. 
Satin-jean Abdominal Belt. 
Fig. 2803.-Fitch's Abdominal Supporter. 
Fig. 2806.-Thomas' Supporter. 
Fig. 2804.-London Abdominal Supporter. 
Fig. 2807.-Noeggerath's Supporter. 
The order for an abdominal supporter should be accompanied with the measure around the pelvis, GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
329 
JHERJMIAk 
ABDOMINAL SUPPORTERS. 
FiG. 2808.-Abdominal Bandage 
Fig. 280g.-Hofmann's Adjustable 
Abdominal Supporter. 
We have on hand cotton elastic abdominal belts, canvas riding 
belts, satin-jean, abdominal belts, &c.; also Brauns', Phelps', Dugas' 
Scanzoni's, the Boston, and a variety of other supporters, and make to 
order any other pattern desired. With the order for any of the above 
please send measure around the pelvis. 
Supporters and Trusses carefully fitted, according to physi- 
cian's directions, by competent and experienced persons. 
A lady will wait on lady customers at the Branch Store, Stohl- 
mann, Pfarre & Co., 107 East 28th Street. Large and commodious 
private parlors. 
Surgeons wishing to personally superintend the fitting are invited 
to call with their patients. 
See "Prolapsus Ani and Pile 
Supporters," page 312. 330 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
V/vRIX 
DILATATION OF A VEIN. VARICOSITAS, VARICOSITY. 
"Varices are owing to local retardation of the venous circulation ; and, in some cases, to relaxation of the parietes 
of the veins. They are very common in the superficial veins of the lower limbs, especially of pregnant females. 
The tumor or tumors formed by varices are soft, knotty, unequal, indolent and livid ; without pulsation, and yielding 
readily to the impression of the finger, but returning as soon as the compression is discontinued. Sometimes the vein 
bursts and gives rise to haemorrhage. The treatment is usually palliative, and consists in exerting a uniform and con- 
stant pressure upon the parts by means of an appropriate bandage. The radical cure has, also, been obtained by ex- 
tirpation, division of the vein, or ligature. The second course is apt to be followed by phlebitis."-Dunglison. 
"Varicose veins are not confined to the lower extremities. They are found in other parts of the body wherever 
obstruction to venous circulation exists, The mechanical means required for their treatment consist in the application 
of elastic support, formed of rubber cord covered with silk or cotton and worked into the form of stockings or arm and 
iviistlets for the extremities. For the trunk it takes the shape of a belt, or the surgeon may apply Martin s rubber 
bandage (see page 74), which, is however, inconvenient for the patient's own management. 
Fig. 2810. 
Silk and Cotton Elastic 
Hose. 
Directions for Measuring. 
Indicate the exact measure around the limb, in inches, opposite the dotted lines on the 
cut (we allow for pressure). Also give the length of stocking from floor or plane upon 
which the foot rests. 
For Thigh Hose, to cover the entire limb, measure at A, B, C, D, E, G, H. 
Length from floor to E, inches. 
Length from floor to ZZ, inches. 
For Half Thigh Hose, to reach to G, measure at A, B, C, D, E, G. 
Length from floor to E, inches. 
Length from floor to G, inches. 
For Knee Hose, to reach to F, measure at A, B, C, 1), E, F. 
Length from floor to E, inches. 
T.pnath from flnnr tn A' 
For Three-quarter Hose, to reach to D, measure at A, B, C, D. 
Length from floor to D, inches. 
For Knee Cap, measure at D, E, F. 
Length from D to E, inches. 
Length from D to F, inches. 
For Anklet, measure at -4, B. 
Length from floor to B, inches. 
We have constantly in stock a large assortment of best qualities of Silk and Thread Elastic Hose, for the treat- 
ment of varicose veins, sprains, weak joints, &c. 
Elastic Abdominal Belts, Stockings, Wristlets and Armlets made to order. 
EACH. 
Silk Elastic Leg and Thigh Hose to H, best, . $12.00 
Silk Elastic Half Thigh Hose to G, best, . . 10.00 
Silk Elastic Knee Hose to F, best .... 8.00 
Silk Elastic Three-quarter Hose to D, best, . 4.50 
Fine Silk Elastic Knee Hose to F, .... 6.00 
Fine Silk Elastic Three-quarters Hose to £), . 3.50 
Cotton Elastic Leg and Thigh Hose to H, . . 6.50 
EACH. 
Cotton Elastic Half Thigh Hose to G, . . . $5.50 
Cotton Elastic Knee Hose to F, 3.50 
Cotton Elastic Three-quarter Hose to D, . 2.00 
Knee Cap, Best Silk Elastic, 3.50 
Knee Cap, Fine Silk Elastic, 3.00 
Knee Cap, Cotton Elastic, . 1.75 
Anklets, 1.75 to 3.00 
Wristlets and Armlets made to order. 
Silk Elastic Abdominal Belt, $12.00 
Silk Elastic Abdominal Belt, with Stays, . . $14.00 
Cotton Elastic Abdominal Belt, . . . $8.00 GEORGE TIEMANN & CO'S. SURGICAL INSTRUMENTS. 
331 
V/cRieOCEhE. 
OSCHEOCELE VARICOSA, HERNIA VARICOSA, RAMEX VARICOSUS, SPERMATOCELE, 
CIRSOCELE. 
"A varicose dilatation of the veins of the scrotum and spermatic cord ; usually by English and American writers 
restricted to the latter, like circocele. This latter variety of the disease is more common on the left side than the 
right; it appears under the form of a soft, doughy, unequal, knotty, compressible and indolent tumor, situate in the 
course of the cord, and increasing from below upwards, It is less when the individual is in the recumbent posture, 
and increases when he is erect. It is, ordinarily, an affection of no moment, and is very common, requiring merely 
the use of a proper suspensory bandage. It has been advised, in bad cases, to tie the enlarged vein, but the operation 
is not free from danger induced by phlebitis. Sir A. Cooper has proposed the removal of a portion of the scrotum, 
so as to render the remainder of it a natural bandage. This plan has been found effectual."-Dunglison. 
Fig. 2811.-Miliano's Compressor, for Varicocele, 
Swelling, &c., of the Testes. 
The first step in applying the apparatus is to secure 
for it close apposition to the scrotal organs. This is 
begun by taking the two ends of the upper lacings on 
either side (marked A), and by pulling uniformly on 
each, the diameter of the upper part of the appliance is 
contracted and closed around the spermatic cord, above 
the testes, so as to prevent the latter escaping. The 
bandage being shirred snugly, is held in position by 
tying the lacings in a bow-knot under the penis. The 
next step is to similarly shirr and tie the lowest set of 
lacings, which closes and shortens the bandage below the 
testicle (marked C). This produces counter-action and 
compression against the upper set of lacings, care being 
taken to exclude any fold of the scrotum. 
The next lacings above the lowest set (marked B), 
which encircle the middle of the scrotal organs, not to 
constrict as shown at A and C, but be shirred only snugly 
enough to be comfortable. In a few hours, or sooner, 
according to the nature of the disease (as in the reduc- 
tion of varicocele) the compression acts upon the absorb- 
ents, and the enlargement of the scrotal organs begins 
to abate. As this reduction of the scrotal contents pro- 
gresses, the sets of lacings (marked A and B) are to be 
tightened in order to maintain equable compression. 
Fig. 2813.-Double Front Suspensory. 
Made with and without Strings. 
Fig. 2814. 
Doisneau's Compress for 
the Seminal Cords. 
Fig. 2812.-Single Front Suspensory. 
Fig. 2815.-Henry's Depilating Forceps, 
We keep in store a large assortment 
of Suspensory Bandages of all kinds 
and patterns, made of silk, linen, cotton 
an£l leather. 332 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
VARICOCELE. 
VARICOCELE, OSCHEOCELE VARICOSA, HERNIA VARICOSA, RAMEX VARICOSUS, 
SPERMATOCELE, CIRSOCELE. 
Fig. 2817.-Williams' Varicocele Clamp. 
Fig. 2816.-Lewis' Varicocele Clamp. 
Fig. 2818.-Williams' Varicocele Clamp. 
This instrument and the method of applying 
it are represented in the cut. It is made of a 
soft flexible metal, so that, after being applied, 
the two bars can, if necessary, be pressed a little 
closer together. The method of applying it is as 
follows : the clasp, being tightly closed, is slipped 
upon the scrotum sufficiently high up to support 
the testicles in their proper position ; it will 
generally be retained there without any trouble, 
but if inclined to slip off, the bar may be pressed 
a little closer together. 
This instrument has two double- 
curved blades, made of steel, it em- 
braces, when placed in front of the 
scrotum, the entire and exact portion 
which it is desired to remove. The 
coapting surfaces are evenly notched 
to prevent the tissues from slipping. 
The screws are not adjusted until the 
operator is perfectly satisfied that he 
has embraced the exact portion to be 
removed in front of the blades. The extra blade is easily inserted with a little pressure, and removed as easily by 
pressing downward and forward ; it is then dislodged by slightly raising the extreme end. When in position it leaves 
a fenestra to afford the surgeon the facility of inserting all his ligatures, should he prefer it, before dividing the parts. 
The thickness or amount of the tissue left in front of the main blade and between that and the extra blade, which is 
the guide for the part to be removed, is ample to assist union, and if the division be a clean one, and the stitches are 
close and evenly inserted, the pressure and tension is so slight, or rather divided, over the entire cut surfaces, that 
there is little probability of ulceration through the stitches before union has taken place. 
When the part has been removed the extra blade is displaced, leaving a free border exposed in front of the main 
blade about a quarter of an inch in thickness. In a few minutes the whole wound can be stitched without any incon- 
venience. The clamp is, of course, not removed until this is accomplished. 
Besides the clamp, the only instruments necessary are the scissors or scalpel, needles, with either silk or fine silver 
wire for sutures, a few acupressure needles, a few serres-fines, silver pins, and some adhesive plaster. 
Fig. 2819.-Henry's Scrotal Clamp. 
Fig. 2820.-Henry's Cartilage Scissors. 
"To ensure an easy and clean removal of the part, I use a cutting instrument which I have named cartilage-scissors. 
These can be grasped and handled with the utmost ease, and, by the aid of springs, are self opening. They are curved 
on the flat side."-M. II. Henry, M. A., M. D., &c. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
333 
JHERNIA HUMO^ALIS. 
EMPRESMA ORCHITIS, DIDYMITIS, ORCHITIS, ORCHIDITIS, TESTITIS, INFLAMMA- 
TIO TESTIUM, INFLAMMATION OF THE TESTICLE, SWELLED TESTICLE, 
HERNIA VENERIS, ORCHIOCELE, ORCHIDOCELE, ORCHIDON- 
CUS, (F.) INFLAMMATION DU TESTICULE, ORCHITE. 
Fig. 2821.-Hawes' Orchitis Compressor. 
" Swelling and inflammation of the testicle is a common symptom 
of gonorrhoea, (F.) Chaudepisse tombee dans les Bozirses ; but it may 
arise from external injuries or from other causes. It is a disease which 
cannot be mistaken, and the treatment must obviously be strongly anti- 
phlogistic, supporting the testicle during the treatment and for some 
time afterwards ; methodical compression has also been found useful. 
The disease is not generally of a serious character, going off as sudden- 
ly as it comes on. As it effects the epididymis more especially, when 
supervening on gonorrhoea or blennorrhoea, it is sometimes termed 
blennorrhagic epididymitis or gonorrhceal orchitis."-Dunglison. 
Hawes' Orchitis Compressor is composed of two rubber bags, the 
inner one easily distensible, and united so as to form an air-tight com- 
partment between the outer and inner layers. A small rubber tube 
perforates the outer layer. Placing the swollen testicle within the bag, 
its mouth completely encircling the cord, it is carefully closed by 
lacing; air is then blown from the mouth or by a syringe through the 
rubber tube into the air-tight space, and prevented from escaping by 
simply tying the tube. Instead of air, hot water may be used. 
Fig. 2822. 
White's Elastic Scrotal Compressor. 
" White's Elastic Scrotal Compressor is shell-shaped, very 
light and symmetrically molded to receive and accommodate 
within its cavity a swollen testicle, surrounded by its scrotal 
integuments. The material of which it is composed is hardened 
rubber, special care being taken to render the walls as thin and 
light as possible. The peculiar shape selected has been found 
by experience to afford the very best mechanical support to the 
pendulous organ. The cleft, running down the front of the 
shield, is intended to admit of free overlapping of the two 
thin edges. By this means ample provision is made for all necessary 
reinforcement of compression which is to be practiced during the man- 
agement of the case."-Boston Medical and Surgical Journal, Jan- 
uary 29, 1880. 
Fig. 2823.-Carroll's 
Orchitis Compressor. 
"Carroll's Orchitis Compressor is a bag of webbing like that of the common sus- 
pensory, open at one side, is bound at its mouth with a strip of flexible metal, which 
can be wrapped above, and thus made to isolate and control the affected testicle. 
The side opening is then laced from below upwards with elastic cord, which main- 
tains its elastic tension as the testis decreases in size, or may be loosened or tight- 
ened as occasion may demand. Not the least advantage of this appliance is that the 
patient can remove and readjust it for purposes of cleanliness."-Medical Record, 
March 19, 1881. 334 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
V/vRICOSELE. 
SUBCUTANEOUS LIGATION OF THE DILATED VEINS. 
Fig. 2824.-Keyes' Varicocele Needles. 
" I have two varieties of needles, both straight, in handles ; one has a lance-shaped point, the other a point like 
a hypodermic needle. The former I prefer when any of the thickened tissues of the cords have to be pierced, the 
latter when a single large vein can be isolated from all the other tissues, as is sometimes the case. Both needles, have 
a long eye. The needle is threaded with a loop of silk, or a thin whale tendon (carbolized), and a piece of carbolized 
catgut. The scrotum is to be thoroughly washed out with a solution of bichloride of mercury, one in one thousand, 
and all instruments, ligatures and the operator's hands to be soaked constantly in the same solution. Ether is not 
admissible, as the patient must stand up. A few drops of four per cent, solution of cocaine, thrown under the skin 
near the point of proposed puncture, will nullify the pain in the case of exceptionally nervous patients. 
"After the first puncture, faintness on the part of the patient is no bar to a successful completion of the operation, 
for the patient may then be placed on his back and the operation finished, with a certainty that the dilated veins are 
included in the ligature, if only the first puncture has been successfully made. 
" The patient stands near the bed, in a good light. The veins which it is proposed to occlude are separated in the 
usual manner from the rest of the spermatic cord, at a point rather high up, where the separate dilated trunks may 
be made out as straight and not convoluted dilated channels. The big veins are pushed out toward the thigh of the 
affected side, and the scrotal tissues between the veins and the rest of the cord are tightly pinched by the thumb and 
finger of the operator's left hand, placed behind and in front of the scrotum. 
" Now the needle, properly armed, is boldly thrust through the scrotal tissues from before backward at the point 
pinched, leaving the veins on the outer side of the needle toward the thigh. The eye of the needle is made to emerge 
at the back of the scrotum. A tenaculum seizes the catgut ligature and pulls it out of the eye of the needle, leaving 
it sticking out freely from the posterior wound alongside of the shaft of the needle. Now the point of the needle is 
withdrawn within the scrotum, leaving the catgut end outside. The veins are allowed to join the rest of the sper- 
matic cord. The point of the needle is not to be withdrawn outside the anterior point of puncture in the scrotum. 
When the veins have passed internally to the point of the needle, the latter, still charged with its loop of silk or 
whale tendon, is manipulated around externally to the veins under the scrotal integument, and is made to emerge 
accurately at the posterior hole, the original point of puncture in the scrotum. This is the most important step in 
the operation, and the only one at all difficult to execute nicely. When the eye of the needle has emerged posteriorly, 
charged with its loop of silk, the tenaculum again is called into play to loosen the loop and to draw through it the free 
end of the catgut which was left at the first puncture protruding posteriorly from the scrotum. The parts are again 
dashed with the antiseptic bichloride solution, and the needle and loop (containing the catgut) are rapidly withdrawn. 
Now it will be found that a few filaments of the dartos (or other tissue), just within the posterior wound in the scrotum, 
are included in the catgut loop. These are torn away by simply holding the free ends of the catgut in front and 
pulling upon the scrotum behind. The thin tissues will be felt to tear, and the patient will complain of little pain. 
" Finally, the few hairs about the anterior wound are to be seized with the thumb and finger and pulled out-else 
they certainly will be tied into the knot and cause trouble-and the catgut (again drenched with bichloride solution) is 
tied tightly to a triple knot, cut off short, and the scrotum pulled away. The knot sinks out of sight, and the operation 
is terminated by placing small pieces of plaster over the minute points of puncture, if any blood exudes. If the 
operation is well done, in twenty-four hours it is difficult to detect the points of puncture."-E. L. Keyes, M. D. 
Medical Record, February 20, 1886. 
JHYD^OeEEE. 
"A term generally applied to a collection of serous fluid in the areolar texture of the scrotum, or in some of the 
coverings, either of the testicle or spermatic cord. To the first of these varieties the names external hydrocele 
(h. oedemotodes) have been given ; and, to the second, those of hydrocele interna {h. tunica vaginalis testis). When 
the collection occurs in the envelope of the testicle it is called h. of the tunica vaginalis; and the epithet, congenital, is 
added; hydrocele congenita, when the interior of the membrane in which it is situate still communicates freely with the 
cavity of the abdomen. When it exists in the spermatic cord it is called encysted or diffused hydrocele of the sper- 
matic cord, hydrocele cystica, hydrocele funiculi seminalis, as the case may be. The tumor of the distended scrotum is 
oblong ; greater below than above ; indolent and semi-transparent. When it becomes inconveniently large, the fluid GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
335 
JHYD^OCEhE. 
HYDROCELE. (Continued.) 
may be evacuated by puncturing with a trocar ; but, as it collects again, this operation can only be considered pallia- 
tive. The radical cure consists, usually, in injecting some irritating fluid through the canula of the trocar, which has 
been left in after puncturing. This is kept in the tunica vaginalis for a few minutes and then withdrawn. The coat 
inflames, adhesion takes place, and the cavity is obliterated."-Dunglison. 
See "Paracentesis, Trocars," page 126; "Rubber Bag for Hydrocele," Fig. 1712. 
" The apparatus I employ is a glass syringe, holding one hundred minims, having for its nozzle an ordinary hypo- 
dermic point, not the very smallest size. If the cyst is small this point is thrust into it and the clear contents drawn 
out with the syringe. Then the latter is unscrewed from its point, rapidly and thoroughly washed, and promptly filled 
with pure carbolic acid, deliquesced with a little glycerine. The syringe is now screwed again upon the point, which 
has been left sticking in the cyst, and from thirty to sixty minims of the deliquesced acid thrown in. The point is 
now withdrawn and the whole operation terminated, with not much more trouble than it takes to give a hypodermic 
injection. 
" When the hydrocele is large I modify the operative method as follows: I first insert the hypodermic point and 
see that a drop of clear serum oozes from it. I now puncture the cyst at another point with a fine aspirating needle, 
empty the contents, and withdraw the aspirating needle. I then screw the glass syringe upon the hypodermic point 
first introduced, and throw in the drachm of deliquesced acid, which appears to be all that is required to accomplish 
the cure. Nothing is easier; no operation of minor surgery in my hands has been more satisfactory in its results."- 
Medical Record, February 20, 1886. 
See " Hypodermic Syringes," page 123, and "Aspirators," page 131. 
Method of E. L. Keyes, M. D. 
H IJVI O S I S. 
"Phimosis, improperly "phymosis" I bind tight'), a disease which consists in a preternatural narrowness 
of the opening of the prepuce, so that it cannot be carried behind the corona glandis. This affection is most commonly 
congenital. Sometimes it is accidental, and dependant upon tumefaction of the glans, or of the prepuce, as it occurs 
in syphilis. To remedy this state, the prepuce may be divided by means of a bistoury and director, or circumcision 
may be practiced."-Dunglison. 
" In performing this operation it is important to seize the orifice of the prepuce for the purpose of making suitable 
traction on the mucous membrane, which is but slightly elastic compared with the skin. First insert a well-oiled probe 
under the prepuce and sweep the surface of the glans to break up adhesions, seize the orifice of the prepuce at opposite 
points, with sharp-toothed forceps, drawing the whole forwards until the mucous membrane is put well upon the stretch; 
grasp the prepuce firmly just in front of the glans with a clamp or forceps, with a bistoury cut away any portion ante- 
rior to the forceps ; if the prepuce readily retracts, the angles may be cut away, and the mucous and skin flaps united 
by a number of fine sutures ; if the prepuce is not free, all tightness must be relieved by an incision on the dorsum, or, 
in infants, by tearing the tissues. The cut mucous membrane must be attached to the skin by sutures."-" Operative 
Surgery." Stephen Smith. 
Fig. 2825.-Probe and Spatula for the Frsenum. 
Fig. 2826.-Ross' 
Circumcision Ring. 
" It is a light flat ring, made of hard rubber, with two ridges upon its outer surface, 
the posterior one, b, continuous, the anterior one, a, interrupted or notched. It is to 
encircle the penis in the cul-de-sac under the prepuce, the latter being drawn forward 
over the instrument and compressed against it, in the groove between the two ridges, by 
a small cord wound around its integumentary surface. The foreskin is then to be severed 
just in front of the anterior or notched ridge by a circular sweep of the knife, the angle 
formed by the ridge and the horizontal surface serving as a director. The notches in 
the anterior ridge are to facilitate introduction of the sutures."-Surgeon J. W. Ross, 
U. S. N. Medical Record, September 26, 1885. 336 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PHIJ^OSIS. 
Fig. 2827.-Hutchinson's Forceps, 
for Rupturing the Mucous Membrane 
of the Prepuce. 
Fig. 2828.-Baruch's Circumcision 
Scissors. 
Fig. 2829.-Nelaton's 
Phimosis Forceps. 
Fig. 2830.-Fisher's Phimosis Forceps. 
Fig. 2831.-Roger's Phimosis Forceps 
Fig. 2834.-Knox's Phimosis Forceps. 
Fig. 2835.-Skillern's Phimosis Forceps. 
Fig. 2832.-Henry's Phimosis Forceps. 
Fig. 2833.-Levis' Phimosis Forceps. 
With backward set teeth, for holding the inner inelastic mucous 
membrane without the risk of slipping whilst it is put upon the 
stretch. The blades are separated by the screw. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
337 
pHIJVIOSIS. 
Fig. 2836.-Girdner's Phimosis Forceps. 
Fig. 2838.-Scissors, curved on the flat, for cutting the 
Prepuce on any of the Forceps. 
Fig. 2839.-Taylor's Phimosis Scissors. 
It is introduced into the preputial opening 
closed ; then, relaxing the spring, causes the 
the barbs to transfix, first, the mucous mem- 
brane, and then the skin. 
Fig. 2837.-Cohn's Phimosis Forceps. 
Dr. R. W. Taylor's procedure consists in making two incisions, one on either side, exactly in the middle of the 
lateral portion of the prepuce with a pair of strong scissors (Fig. 2839). The result of this operation is that the prepuce 
is converted into two flaps-an upper and a lower-with the glans penis between them, and the upper flap can be 
elevated and the lower one depressed with the greatest ease, so as to expose the whole surface. Then, after the acute 
disease has subsided and the edges of the incisions have healed, these flaps may be snipped off without confining the 
patient to the house or taking him away from business. But, it will be objected, you thus have double the amount 
of raw surface exposed to contagion. Very true, but the advantage gained is more than a counterbalance, and, more- 
over, if the incision be properly cauterized and dressed, contagion will in most cases be avoided. The caustic pre- 
ferred by Dr. Taylor is pure carbolic acid, rendered fluid by a small quantity of water. Four pieces of lint are to be 
cut-two to fit the glans, the one above and the other below-and two strips to place between the cut surfaces. These 
pieces of lint are soaked in the acid and put in their places ; the flaps are then brought together and a bandage wound 
around the penis, allowing the meatus to be free. The whole should be kept wet with cold water, and the dressing 
repeated daily until the parts are healed. 
"If, from any cause, an operation 
be impracticable, the subject of con- 
genital phimosis should be directed 
at each act of micturition to expose 
the meatus as fully as possible, in 
order to prevent the entrance of the 
urine beneath the prepuce, and intra-preputial injections should be resorted to if sebacious matter accumulates or any 
signs of inflammation appear. The best syringe for this purpose is one with a broad flattened nozzle, to facilitate its 
introduction between the prepuce and glans, as proposed by Dr. Taylor."-"Venereal Diseases." Bumstead and 
Taylor. 1879. 
According to the chronology of the Bible circumcision was instituted as a religious rite by Abraham, in the year of 
the world 2059-nineteen hundred and forty-nine years before Christ. Several of the Eastern nations still practice it 
as a hygienic measure. 
Fig. 2840.-Taylor's Syringe, for Sub-preputial Injections. 338 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETJHRAL. 
NORMAL MALE URETHRA. 
" The urethra extends from the neck of the bladder to the meatus urinarius. It presents a double curve in the 
flaccid state of the penis, but in the erect state it forms only a single curve, the concavity of which is directed upwards. 
Its length varies from eight to nine inches ; and it is divided into three portions, the prostatic, membranous and spongy, 
the structure and relations of which are essentially different. 
" The prostatic portion is the widest and most dilatable part of the canal. It passes through the prostate gland, 
from its base to the apex, lying nearer its upper than its lower surface. It is about an inch and a quarter in length ; 
the form of the canal is spindle-shaped, being wider in the middle than at either extremity and narrowest in front, 
where it joins the membranous portion. A transverse section of the canal in this situation is triangular, the apex 
directed downwards. Upon the floor of the canal is a narrow longitudinal ridge, the verumontanum, ar caput gallin- 
aginis, formed by an elevation of the mucous membrane and its subjacent tissue. It is eight or nine lines in length, 
and a line and a half in height ; and contains, according to Kobelt, muscular and erectile tissues. 
"When distended it may serve to prevent the passage of the semen backwards into the bladder. On each side of 
the verumontanum is a slightly depressed fossa, the prostatic sinus, the floor of which is perforated by numerous 
apertures, the orifices of the prostatic ducts, the ducts of the middle lobe opening behind the crest. At the forepart 
of the verumontanum, in the middle line, is a depression, the sinuspocularis (vesicula prostatica); and upon or within 
its margins are the slit-like openings of the ejaculatory ducts. The sinus pocularis forms a cul-de-sac about a quarter 
of an inch in length, which runs upwards and backwards in the substance of the prostate beneath the middle lobe ; its 
prominent upper wall partly forms the verumontanum. Its walls are composed of fibrous tissue, muscular fibres and 
mucous membrane; and numerous small glands open on its inner surface. It has been called by Weber, who dis- 
covered it, the uterus masculinum, from its supposed homology with the female organ. 
" The membranous portion of the urethra extends between the apex of the prostate and the bulb of the corpus 
spongiosum. It is the narrowest part of the canal (excepting the orifice), and measures three-quarters of an inch along 
its upper and half an inch along its lower surface, in consequence of the bulb projecting backwards beneath it below. 
Its upper concave surface is placed about an inch beneath the pubic arch, from which it is separated by the dorsal 
vessels and nerves of the penis and some muscular fibres. Its lower convex surface is separated from the rectum by a 
triangular space, which constitutes the perinseum. The membranous portion of the urethra perforates the deep peri- 
neal fascia; and two layers from this membrane are prolonged around it-the one forwards, the other backwards ; it is 
also surrounded by the compressor urethrae muscle. Its coverings are mucous membrane, elastic fibrous tissue, a thin 
layer of erectile tissue, muscular fibres, and a prolongation from the deep perineal fascia. 
The spongy portion is the longest part of the urethra, and is contained in the corpus spongiosum. It is about six 
inches in length, and extends from the termination of the membranous portion to the meatus urinarius. Commencing 
below the symphysis pubis, it ascends for a short distance, and then curves downwards. It is narrow and of uniform 
size in the body of the penis, measuring about a quarter of an inch in diameter ; being dilated behind, within the 
bulb, and again anteriorly within the glans penis, forming the fossa navicularis. A cross section of this canal in the 
body of the penis has its long diameter transverse ; but, in the glans, that diameter is directed vertically. 
"The bulbous portion is a name given, in some descriptions of the urethra, to the posterior dilated part of the 
spongy portion contained within the bulb. 
" The meatus urinarius is the most contracted part of the urethra ; it is a vertical slit, about three lines in length, 
bounded on each side by two small labia. The inner surface of the lining membrane of the urethra, especially on the 
floor of the spongy portion, presents the orifices of numerous mucous glands and follicles, situated in the submucous 
tissue and named glands of Littre. They vary in size, and their orifices are directed forwards, so that they may 
easily intercept the point of a catheter in its passage along this canal. One of these lacunse, larger than the rest, is 
situated on the upper surface of the fossa navicularis, about an inch and a half from the orifice ; it is called the lacuna 
magna. Into the bulbous portion are found opening the ducts of Cowper's glands. 
"Structure.-The urethra is composed of three coats : a mucous, muscular and erectile. 
" The mucous coat forms part of the genito-urinary mucous membrane. It is continuous with the mucous mem- 
brane of the bladder, uretersand kidneys ; externally, with the integument covering the glans penis ; and is prolonged 
into the ducts of the glands which open into the urethra, viz.: Cowper's glands, the prostate gland, and the vas defer- 
entia and vesiculae seminales, through the ejaculatory ducts. In the spongy and membranous portions the mucous 
membrane is arranged in longitudinal folds when the organ is contracted. Small papillse are found upon it, near the 
■orifice ; and its epithelial lining is of the columnar variety, excepting near the meatus, where it is laminated. 
"The muscular coat consists of two layers of plain muscular fibres, an external longitudinal layer and an internal 
circular. The muscular tissue is most abundant in the prostatic portion of the canal. A thin layer of erectile tissue 
is continued from the corpus spongiosum around the membranous and prostatic portion of the urethra to the neck of the 
bladder."-"Gray's Anatomy." 
" In the female the urethra is only about an inch long. It is wider than in man and susceptible of great dilatation." 
See " Gynaecological Urethra. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
339 
U l<ETH^AL 
SCALES OR GUAGES. 
For Grading the Sizes of Urethral Instruments. 
Fig. 2841.-French or Metric Scale. 
Comparison by Dr. Bumstead. 
The French scale advances one-third of a millimetre in diameter for each size, commencing with No. 1=^ mm. 
The numbers above the openings express French standard, those below them approximately English sizes. 
Fig. 2842.-English Numbers. 
Fig. 2843.-Metrical Diameter. 
Modified by Dr. Gouley 
1866. 
English. Scale. 
Originally the English scale ran from 
No. 1 to No. 12 only ; measurement in- 
definite. 
Dr. Gouley has extended it two sizes 
below No. 1, i. e., No. -J-and No. and 
six sizes above No. 12, i. e., Nos. 13, 
14, 15, 16, 17, 18 ; making the extremes 
correspond to those of the French or 
metric scale. 
This guage, then, consists of twenty 
numbers, the smallest one millimetre 
and the largest ten and one-half milli- 
metres in diameter, with a difference be- 
tween each two numbers of half a mil- 
limetre instead of one-third, as in the 
French scale. 
On one side of this guage is stamped 
the diameter of each aperture in milli- 
metres, and on the reverse side the num- 
bers of the English scale, which are by 
this method made definite. 
Upon the handle of each Gouley's 
sound both the English number and the 
metrical diameter are stamped. 340 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL>. 
SCALES OR GUAGES. 
For Grading the Sizes of Urethral Instruments. 
Fig. 2844. 
American Scale. 
Fig. 2845.-Approx- 
imate French Numbers. 
The American scale, introduced by Drs. Van 
Buren and Keyes, advances also by diameters of 
one-half of a millimetre. The smallest size is half 
a millimetre in diameter, and is designated No. i, 
No. 2 equals one millimetre, No. 3 equal to one 
and one-half millimetre in diameter, &c. 
The American numbers and metrical diam- 
eter are stamped upon one side of this scale, the 
approximate French numbers on the other. 
Dr. H. E. Handerson, of New York, has de- 
vised a gauge which consists of a plate with a 
wedge-shaped slot. The instrument to be mea- 
sured is simply to be inserted in the base of the 
opening and slid towards the apex as far as it will 
go, when the parallel lines on either side will in- 
dicate its size according to the French, American 
and English scales. 
Dr. C. H. Thomas' Gauge, for measuring the 
circumference of oval or cylindrical urethral in- 
struments, consists of a graduated tape, into a 
loop of which the instrument to be measured is 
placed; when this is drawn tight two arrows in- 
dicate the circumference. 
Fig. 2847.-Handerson's Guage. 
Fig. 2846.-Thomas' Guage. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
341 
U F^ETH F^Ab. 
SCALES OR GUAGES. 
Fig. 2848. 
Metric Scale. 
For Grading the Sizes of Urethral Instruments. 
Fig. 2849. 
Approximate English Numbers 
The Metric Scale. 
Enlarged from No. 30 to No. 40, 
and sizes compared 
to the 
numbers of the English Gauge 
by Dr. Otis. 
Dr. Otis claims, as an outcome of 
many experiments, that the human 
urethra varies much in its calibre in 
different persons. Hence an instru- 
ment that is of full size for one man 
may be either much too great or too 
small for another, and that the urethra 
is really much wider than is generally 
taught. 
Dr. Otis has demonstrated, by a 
large number of measurements, that 
there is a proportionate relation be- 
tween the circumference of the flaccid 
penis and the urethra of about I to 3^. 
" In a penis of 3 inches circumfer- 
ence the urethra would be 30 mm.; 3J 
in., 32 mm.; 3$ in., 34 mm.; 3$ in., 
36 mm.; 4 in., 38 mm.; 4^ to 4I in., 
40 mm.; and that an estimate of ca- 
libre made on this basis is a valuable 
guide when the urethrameter is not 
available."-" Stricture of the Urethra: 
its Radical Cure." Fessenden N. Otis, 
M.D. 1878. 
"Authorities concur, as a rule, in asserting that the meatus is the narrowest portion of the urethral canal, and yet 
this is usually accepted as a test of its calibre. This opening is subject to great natural variations in organs of about 
the same general proportions. The well-developed penis, in a dozen cases, may vary in regard to the size of the con- 
genital meatus, from the calibre of No. 8 (or nine millimetres in circumference) to Nos. 32 or 34. It is important to 
recognize the fact that the meatus bears, necessarily, no proportion to the actual size of the urethra. If symptoms of 
stricture are present, such as persistent urethral discharge, &c., or if any chronic irritations of the genito-urinary appa- 
ratus present, the meatus should be freely incised and a thorough examination of the canal with the bulbous sound 
should be made."-" Stricture of the Urethra : its Radical Cure." Fessenden N. Otis, M. D. 1878. 342 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL. 
Proper Curves for Male Urethral Instruments. 
Fig. 2850.-Showing the Proper Curve for Unyielding Male Urethral Instruments. 
Curve as recommended by Sir Henry Thompson, A. B. E. ; Dr. Van Buren, A. B. E. ; Dr. Gouley, A. B. E. ; 
Dr. Benique, C. B. D. ; Dr. Otis, F. B. E. ; Dr. Bumstead, F. B. E. See the works of these authors for particulars. 
Prostatic catheters are now usually made with this curve, but with a longer beak. 
" To Professor Van Buren is due the credit of having popularized, in New York, the excellent sounds curved after 
Thompson's model."-" Diseases of the Urinary Organs." Gouley. 1873. 
Proper Conicity of Sounds. 
Fig. 2851.-Gouley's Conical Steel Sound. 
" * * * The principle, though an old one, and recommended more recently by Mr. Liston and other mas- 
ters, does not seem to have been much applied ; neither do I know of any methodical or definite conicity being adapted 
for steel sounds before 1864, when I had mine made at Tiemann's. Ever since the year 1864 I have been using such 
sounds, made of smoothly polished steel. The point in each is three or four numbers (rarely more) smaller than the 
shaft, and the conicity occupies about one inch and a half. The length of the instrument, from the point to the junc- 
tion of the shaft and handle, is nine inches. The handle, like the shaft, is smooth, and its edges have no angular 
projections, but all curved lines.-"Diseases of the Urinary Organs,"page 27. Gouley. 1873. 
All sounds are now nicely nickel-plated. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
343 
UF^ETH^AId. 
OCULAR INSPECTION. 
Meatoscopes, Endoscopes, Urethroscopes, Specula, Dilators. 
Fig. 2852.-Glass Meatoscope. 
Fig. 2853.-Weir's Meatoscope. 
Fig. 2854.-Skene's Urethral Speculum 
Fig. 2855.-Laveur's Endoscope. 
The endoscope is an instrument for ocular 
inspection of the urethra. Desormeaux's endo- 
scope and the various modifications of it consists 
of a series of metallic tubes, equal in calibre to 
Nos. io, 12 and 14, about nine inches in length 
and open at both extremities, and of an illuminat- 
ing apparatus. Being too expensive an instru- 
ment for general use it may well be replaced by 
the more simple urethroscopes. One of these 
was devised by Dr. Otis. This instrument, made 
of hard rubber, is very light, easily handled and 
causes little if any pain when in position; light 
reflected by means of a concave mirror from the 
sun, or from a modified student's lamp, being 
used for illumination (see page 257). 
"For examining the deep urethra, however, 
the large instruments are decidedly preferable. 
To make a thorough inspection, the tube should 
be introduced well into the membranous urethra, 
the obturator withdrawn, the oil and mucus wiped 
away from the membrane presenting at the bot- 
tom of the tube, and then, the illumination being 
brought to bear, each successive portion of mem- 
brane may be inspected as the tube is withdrawn. 
The healthy mucous membrane has a pale pink 
color, and contrasts strongly with congested spots, 
which are of a vinous red without polish. Such 
spots can be plainly seen as they come across the 
end of the tube, and any granulations upon them 
are readily recognized by the practical eye.- 
" Genito-Urinary Diseases with Syphilis." Van 
Buren and Keyes. 
Fig. 2856.-Desormeaux's Endoscope. 
Fig. 2857.-Otis' Endoscopic Tube. 344 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
U^ETH^AId. 
OCULAR INSPECTION 
Meatoscopes, Endoscopes, Urethroscopes, Specula, Dilators. 
Fig. 2858.-Auspitz's Urethroscope. 
Fig. 2859.-Smith's Urethroscope. 
Fig. 2860.-Endoscope, with Plain Glass in front. 
Fig. 2861.-Skene's Urethral Endoscope, 
for Inspecting the Female Urethra and Bladder. 
Fig. 2862. 
Skene's Folsom's Speculum. 
Fig. 2863. 
Otis' Dilator. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
345 
URETJdRAh STRICTURE. 
EXPLORING. 
Gum Elastic Bougies. 
Fig. 286'4.-Olivary Whalebone Bougie. 
Fig. 2865.-Bougie olivaire a ventre. 
Fig. 2866.-Bougie conique a ventre. 
Fig. 2867.-Bougie olivaire. 
Fig. 2868.-Bougie conique. 
Fig. 2869.-Bougie a boule. Dick's. 
Fig. 2870.-Bougie a boule. Mallez's. 
Fig. 2871.-Bougie a trois nceuds. 
Fig. 2872.-Knotted Bougie (a nceuds). 
Fig. 2873.-Bell's Ball Urethral Sound. 
Fig. 2874.-Bulbous Bougie (A boule). 
Fig. 2875. 
Thompson's Leaden Stileted Olivary Bougie. 
Fig. 2876.-Leroy d'Etiolle's Gum Filiform Bougies, Nos. o. 1, 2. 
Fig. 2877.-Olivary Gum Elastic Catheter. 
" The treatment of stricture, as well as its exact diagnosis, is, in the great majority of cases, carried on by the aid 
of instruments introduced into the urethra. All instruments of this exploring nature were, by the ancients, denomi- 
nated catheters-, the name is retained by the moderns, though with more restricted significations. In the United 
States and Great Britain the term is confined to the hollow evacuating instrument; the solid instrument is termed 
sound. The French word bougie, meaning, literally, a wax candle, has been adopted to coverall the varieties of 
flexible instruments. 
"The bougie a boule, for diagnosing stricture, is used in the following manner: The penis is grasped by the left 
middle and ring fingers, while the thumb and index serve to retract the prepuce and separate the lips of the meatus ; 
then an instrument as large as the orifice will easily admit, having been oiled, is slowly and gently introduced into the 
canal until it meets an obstacle which presents a positive hindrance to its further progress; the stem of the bougie 
should then be marked by the thumb-nail exactly at the meatus, and withdrawn and measured to ascertain the location 
of the stricture. The length of the stricture can be determined by using an instrument sufficiently small to pass 
through and beyond the obstacle. This bougie should then be pushed onward in search of other impediments, until 
it has reached the bladder, where it may be retained a moment, and then slowly withdrawn till the base of the olive 
presents at the vesical extremity of the constriction. If the measuring above directed be now repeated, and the first 
measurement, phis the length of the smaller bulb, be deducted from the second measurement, there will remain the 
length of the stricture."-"Diseases of the Urinary Organs." Gouley. 346 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL. STRICTURE. 
EXPLORING. 
Fig. 2878. 
Points of Gouley's 
Whalebone Guides. 
"Though the soft filiform bougie of Leroy d'Etiolles answers well in many cases, I have 
often verified the fact that the instrument coiled in front of a stricture and sometimes doubled 
itself, so that the point appeared at the meatus when it was believed to have passed into the 
bladder. For these reasons I have for many years used in their stead slender, probe-pointed 
shafts of whalebone, which are less liable to coil in the urethra, adapt themselves admirably to 
the inflections of the canal, can be made as thin as a horse-hair, and will still retain sufficient 
strength to enter the narrowest stricture."-"Diseases of the Urinary Organs." Gouley. 1873. 
Gouley's Whalebone Guides are especially designated to be used with his Tunnelated In- 
struments, of which they form a sine qua non ; see next page. 
Fig. 2879.-Hunter's Filamentous Wedge. 
FiG. 2880.-Bank's Whalebone Bougies. 
Fig. 2881.-Eldridge's Pathfinder. 
A bougie-like instrument having five passages extending through its entire length ; 
it is introduced into the urethra up to the stricture. Filiform bougies are then passed 
through any of the holes, and may be withdrawn any number of times or introduced 
through different holes until one of them enters the bladder, when the others are with- 
drawn and the instrument advanced upon the one in situ. 
Fig. 2885.-Warren's Exploring Sound. 
Fig. 2882.-Tiemann's Eldridge's Pathfinder. 
Fig. 2883.-Gross' Urethrometer. 
Fig. 2884.-Weir's Urethrometer. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
347 
URETHRAL STRICTURE. 
EXPLORING. 
Fig. 2886.-Otis' Metallic Bougie a boule. (Nos. 8 to 40 constitute a full set.) 
Fig. 2887.-Civiale's Bistoury Cache. 
<15 
£ 
c 
o 
a 
<u 
s 
tn 
£ 
Ph 
oi 
O' 
oo 
01 
0 
£ 
Fig. 2891.-Otis' Meatotome. 
Fig. 2888.-Gouley's Meatotome. 
Fig. 2889.-Mitchell's Meatotome. 
Fig. 2893.-Piffard's Fossal Bougie a bouie. 
Fig. 2894.-Piffard' 
Fig. 2890.-Piffard's Fossal Stricture Knife. 
Strictures at or near the meatus may be divided by any of the above 
instruments. According to authors the cut is always to be made down- 
wards, or on the floor of the urethra, and the enlarged opening subse- 
quently tested with a bougie a boule, to ascertain if it be of sufficient 
size. 348 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRICTURE 
EXPLORING. 
Fig. 2895.-Gouley's Tunnelled Catheter. 
It is three millimetres in diameter, conical, its 
point being two millimetres. A groove on its con- 
vex side extends a distance of four inches, and is 
bridged over in its last twelfth of an inch, so as 
to form a tunnel for the reception of a whalebone 
guide. The catheter eye is on the concave side of the instrument, about three-fourths of an 
inch from its point, and is kept closed by a well fitted stylet. 
The whalebone guides or probe-pointed conductors are of the length of the ordinary 
gum bougies, and half a millimetre in diameter. Some are straight, some spiral and some 
angular pointed (as indicated by Fig. 2896); a dozen of these should be in your case of 
instruments. One of these is introduced into the urethra; if it enters a false passage, it is 
retained in situ by the left hand, while another is passed by its side. If this second guide 
makes its way into the false passage, it is to be treated precisely as was the first, and the ope- 
ration repeated till one guide can be made to pass the obstruction and enter the bladder; the 
others are then removed. Now, if the free end of the guide bougie, which occupies the whole 
length of the urethra, be passed through the tunnel or canal of the catheter and the instru- 
ment made to advance, it must follow the guide. When its point comes in contact with the 
face of the stricture it will be held there firmly, but no force must be used; in a few moments 
it will probably pass the stricture and enter the bladder. 
Fig. 2896. 
Points of Gouley's 
Whalebone Guides 
Fig. 2897.-Thompson's Retention Catheter, with Malleable Silver Probe Points, 
Fig. 2898.-Otis' Dilating Catheter and Syringe. 
" With the view of affording aid in the preparatory dilatation of strictures too small to admit the necessary instru- 
ment for immediate operation I have designed the accompanying modification of Sir Henry Thompson's probe-pointed 
catheter. It consists simply of a fine probe-pointed silver tube, eleven inches in length and three millimetres in cir- 
cumference at its point, gradually increasing in size, so that at six inches it is six millimetres. The tube is traversed 
by a steel stylet throughout its length. Carefully insinuated through close stricture, by the aid of a finger in the rec- 
tum, until its point may be supposed to have reached the bladder, the stylet is removed and a small syringe is applied 
to its proximal opening. If the instrument has passed the sphincter vesica, on a withdrawal of the piston, the urine 
will appear in the barrel of the syringe. The instrument may then be confidently pressed onward until the stricture 
is dilated to the largest capacity of the tube ; a second tube, of corresponding form, but with dimensions ranging from 
four millimetres at the point to eight millimetres, may then be similarly used. In cases where, on account of the ex- 
treme closeness of the stricture or from its divergent or tortuous course, a difficulty in passing the instrument occurs, 
Dr. Gouley's whalebone guide bougies will prove serviceable. These are used as in his grooved canulated staff, viz.: 
by the previous introduction of the guide-bougie into the bladder, threading the dilating catheter upon it and following 
it down through the stricture. Succeeding in this manoeuvre, the guide-bougie may be removed, the presence of the 
dilating catheter in the bladder tested by the aid of the syringe, the stylet introduced and the stricture dilated, as 
previously described. The whalebone guide-bougies, to be used in this manner, require to be from sixteen to eighteen 
inches in length. They are easily made of any desired length and fineness, and, by passing them through the flame of 
an alcohol lamp, may be moulded at the extremity to any curve or angle deemed most likely to adapt itself to the 
eccentricity of the stricture."-" Stricture of the Urethra : Its Radical Cure." Fessenden N. Otis, M. D. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
349 
URETHRAL stricture 
EXPLORING. 
Fig. 2899.-Otis' Retention Cathether. 
Fig. 2900.-Bumstead's Modification of Thompson's Catheter. 
METHODS OF TREATMENT. 
The surgical methods of treating stricture are : Direct applications to the diseased surface, pressure and overdisten- 
tion by swoate-dilatation, forcible rwpX.vxe-divulsion, and internal urethrotomy and external perineal urethrotomy. 
" Pressure and over-distention by large sounds, and direct applications of various chemical agents (see " Syringes 
and Applicators ") to the diseased surface, are used in the formative period. In fully developed stricture, dilatation 
is usually tried first; if it fails, divulsion is employed, except in obstinate constrictions of the pendulous portion and 
those near the external orifice, in which internal urethrotomy should be performed. External perineal urethrotomy is 
demanded in severe contusions of the perinseum, where the urethra is torn across; in narrow unyielding traumatic 
strictures ; in narrow resilient and in impassable strictures with retention of urine ; and also for the relief of bad cases 
complicated with obstinate urinary fistulae."-" Diseases of the Urinary Organs." Gouley. 
" The instruments which it is necessary for the surgeon to possess in order to be able to meet the requirements of 
all cases of stricture are: different varieties of bougies, sounds, catheters, a catheter guage ; instruments for divulsion, 
internal and external urethrotomy: trocars, canulae and an aspirator."-"Genito-Urinary Diseases." Van Buren 
and Keyes. 
Injecting the Urethra, 
"A very general impression exists in the profession that 
fluids are with difficulty injected into the deeper parts of 
the urethra by an ordinary syringe, and that to force them 
into the bladder by that means is a physical impossibility. 
Within the past two years I have had three patients who 
were able to inject their respective bladders by means of an 
ordinary Davidson syringe, one of them throwing in a pint of water in my presence, then emptying the viscus, refill- 
ing and discharging it in succession. I am therefore convinced that it is judicious to limit the distance we desire to 
medicate by pressure on the canal at a given point; and I also believe that the whole diseased surface can usually be 
reached by a properly constructed syringe of ordinary size. After directing the patient to pass his water (for the pur- 
pose of cleansing the canal), the medicated fluid should be thrown in quickly, to avoid spasmodic resistance, filling the 
urethra to the desired limit, and allowing it to remain for from one to three or four minutes. This procedure I am 
accustomed to have repeated three or four times in the twenty-four hours. If, notwithstanding the use of injections 
administered after the manner I have indicated, the discharge still continues, though in decreased quantity, no other 
cause of failure appearing prominent, I am led to infer that the medicating fluid does not reach all points of the 
diseased surface ; that, from insufficient distention of the canal, portions between the folds of the membrane, or in the 
sulci of some of the numerous follicles with which the urethral lining is studded, have escaped the topical application. 
For security against failure, I am accustomed to introduce the injection through a modification of the ordinary syringe, 
as represented in the cut. By means of this instrument the urethra is penetrated to the farthermost point of disease, 
distended to its full capacity and thoroughly bathed with the contained fluid."-"Stricture of the Male Urethra." 
F. N. Otis, M. D. 1878. 
Fig. 2901.-Otis' Syringe Nozzle. 350 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRICTURE. 
SYRINGES AND APPLICATORS. 
Fig. 2902.-Buttle's Gonorrhoea Syringe. 
Fig. 2905.-Hard Rubber P. P. Syringe. 
Fig. 2907.-Long Pipe Urethral Syringe. 
Fig. 2906.-Bumstead's P. P. Syringe. 
Fig. 2903.-Wheelock's Reverse-Flow Syringe. 
Fig. 2904.-Sigismund's P. P. Syringe. 
Fig. 2908.-Brown's (F. Tilden) Syringe and Applicator. 
rlG. 2911.-Hutchinson's Catheter, for applying Ointments 
to the Urethra. 
Fig. 2909.-Ultzmann's Deep Urethral Syringe. 
Fig. 2910.-Bumstead's Urethral Syringe. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
351 
URETHRAL STRICTURE 
SYRINGES AND APPLICATORS. 
Fig. 2912.-Lallemand's Porte Caustique. 
Fig. 2913.-Reginald Harrison's Pessary Catheter. 
Fig. 2918.-Caspar's Ointment Bougie, modified by Tiemann & Co. 
Fig. 2914.-Dick's Caustic Syringe. 
Fig. 2915.-Van Buren's Cupped Sound. 
Fig. 2917.-Bryce's Urethral Applicator, for Ointment. 
Fig. 2916.-Ointment Bougie. 
Fig. 2919.-Mallez's Powder Insufflator. 
Fig. 2920.-Bigelow's Catheter Syringe 352 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL ST^ICTU^E. 
SYRINGES AND APPLICATORS. 
Fig. 2921.-Harrison's 
Urethral Irrigator. 
" The catheter should be six inches in length, and be completely passed into the 
urethra, merely allowing room for the connection with the syringe pipe. The cathe- 
ter should not be larger than a No. 6, English gauge, so as to allow plenty of room 
between it and the walls of the urethra, in which the injected fluid can circulate. 
The eye in the catheter should not be too near the end, nor too large, and its edge 
should be beveled so as not to scrape the urethra. For smoothness in introduc- 
tion, Tiemann's (of New York) velvet-eyed india rubber catheters are a great im- 
provement on the English make, where the eye of the instrument is punched out 
without being beveled."-Reginald Harrison, F. R. C. S., Surgeon to the Liverpool 
Royal Infirmary. 
Fig. 2922.-Thornton Parker's Urethral Tube. 
To remove some of the difficulties encountered at present in the treatment of 
urethral inflammation, and to facilitate the injection of the urethra without pain, 
Messrs. George Tiemann & Co., of New York, have made some "soft rubber, 
velvet-eyed tubes with bulbs, for making the injection painless." 
The accompanying woodcut gives a very good idea of the tubes. 
fhey are about two and a half inches long, of three sizes, the bulbs corresponding with Nos. 13, 15 and 17, Ameri- 
caa scale. They are made of pure rubber, soft and pliable. They fit easily on the nozzle of almost any syringe. 
Fig. 2923.-Mitchell's Reflux Catheter, with Tiemann & Co.'s Soft Rubber Velvet Eye. 
Application of Cold. 
Fig. 2924. 
Spermatorrhoea Ring, 
Fig. 2925.-Winternitz's Psychrophor (Cooling Sound). 
For Treating Pollutions, Spermatorrhoea and Chronic Gonorrhoea. 
"A double current catheter without eyes, the two canals communicating near the point of the instrument. It is 
introduced into the urethra until its point has passed the pars prostatica, and it is then attached by rubber tubing to a 
reservoir containing water of the desired temperature. On turning the stopcock, the water flows into one canal and 
out through the other. In this way the caput callinaginis and the entire mucous membrane are exposed to the me- 
chanical action of pressure and the sedative action of cold. 
Fig. 2924 is for the purpose of preventing nocturnal involuntary emissions of semen-the teeth of the ring causing 
pain as soon as an erection occurs and awakening the patient. See " Electrodes for the Urethra," page 34. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
353 
URETHRAL stricture. 
GRADUAL DILATATION, PRESSURE AND OVER-DISTENTION. 
Dilators. 
Dilators have been made of various substances, susceptible of considerable expansion by moisture, such as catgut,, 
slippery-elm bark, laminaria digitata, &c. These instruments, when introduced into the urethra and left in situ, would 
be expanded by the secretions. They were sometimes painful, and their withdrawal endangered the urethra. They 
are now rarely used. 
Bougies and Sounds. 
The French word bougie, meaning literally a wax candle, has been adopted to cover all varieties of flexible dilators ; 
those made of metal are termed sounds. (See page 345 for other forms of bougies.) 
Of the modern flexible gum bougies Dr. 
Gouley says: "Their great advantage is, that 
anybody can introduce them ; there is ordinarily 
no great skill needed and no danger to be ap- 
prehended of lacerating the mucous membrane. 
They are the safest instruments in the hands of 
beginners. In my own practice I use the gum 
bougies almost exclusively up to No. 7. I have 
no ordinary steel sounds smaller than No. 7; 
but, having reached that number, I usually set 
aside the elastic instruments to use the smooth- 
ly polished conical steel sounds. " 
Fig. 2926.-Cylindrical Gum Bougie. 
Fig. 2927.-Olivary Gum Bougie. 
Fig. 2928.-Van Derveer's Bougie. 
" Having had such excellent results from the use of the instrument illustrated by the accompanying cut, I feel it 
proper to call the attention of the profession to it. In the treatment of urethral stricture by gradual dilatation, and 
in those cases where it became necessary to maintain the calibre of the urethra after internal urethrotomy, or rapid di- 
vulsion, I have realized for a long time that the fixed curve of the steel sound gave unnecessary pain, and that the soft, 
olive-pointed bougie, by passing some two or more inches further into the bladder than was required, gave to that 
organ a shock and an irritation which, in addition to being very disagreeable to the patient, incurred also the dangers of 
possible cystitis, with its complications. 
"Acting upon the knowledge of the fact that we seldom, if ever, meet with a stricture in the prostatic portion of 
the urethra, I had made, some two years ago, by Messrs. Tiemann & Co., light metal urethral dilators, of the average 
length of the spongy and membranous portion of the urethra-about eight inches-and in size ranging from Nos. 10 
to 42 of the French scale. These were found very serviceable, being used by patients with safety and success. Later, 
as an improvement on the above described instrument, I had made, in different sizes, the solid rubber urethral bougie, 
which gives the least possible pain on passing. These bougies were also made by Tiemann & Co., who are now pre- 
pared to furnish them singly or in sets. Believing them to be the safest of all bougies, and knowing from actual use 
that they are the most serviceable, I present them with confidence to those of my brethren who have these cases, in 
the treatment of which such an instrument is indicated."-A. Van Derveer, M. D., in Medical Record, Dec. 3, 1881. 
Fig. 292g.-Straight Conical Steel Sound. 
"Stricture in the pendulous part of the urethra may be kept dilated with a straight steel sound of proper size, 
very little conical, and not over five inches long."-Van Buren. 
" In order to insure success the dilatation should be continued until the size of No. 12 or 14 is found to pass with- 
out resistance. The patient may then be considered cured, so far as a cure is possible in these cases, for it must be 
understood that in whatever manner the relief of the stricture has been effected, whether by dilatation or by rupture, 
by caustic or incision, the result is the same-the stricture will inevitably return unless the use of instruments is con- 
tinued."-" Principles and Practice of Surgery." Hamilton. 354 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRICTURE. 
GRADUAL DILATATION. 
Conical Steel Sound. 
" If patients applied for relief in the earlier stages of the disease 
cutting operations would seldom be required. It is best to begin 
with the systematic use of conical steel sounds, gradually increas- 
ing the number to the full capacity of the meatus ; introducing 
but one instrument every second or third day-never sooner than 
the second day-and then allowing it to remain in situ for a single minute to make 
pressure upon the granular surface. Ever since the year 1864, when I had mine 
made by Tiemann &Co., I have been using such sounds, made of smoothly polished steel. 
The point in each is three or four numbers (rarely more) smaller than the shaft, and the 
conicity occupies about one inch and a half. The length of the instrument, from the point 
to the junction of the shaft and handle, is nine inches. The handle, like the shaft, is 
smooth, and its edges have no angular projections, but all curved lines. The smallest 
instrument constructed on this plan is five millimetres in diameter at the shaft-about 
No. 7 English-the largest No. 20. Upon one side of the handle the number is stamped, 
the diameter upon the other."-" Diseases of the Urinary Organs." Gouley. 1873. 
" The most necessary instrument for the treatment of stricture is the steel sound ; for, 
whatever means be used to cure the stricture, rarely can the cure be maintained without 
the help of the sound. The short curved steel instruments, at first made blunt, I had 
subsequently finished with slightly conical extremities. The old instruments which they 
replaced were made of heavy wire with long rediculus curves, constantly varying, so awk- 
ward that they were rarely employed, bougies being generally preferred. These are 
numbered according to American and French scales."-"Genito-Urinary Diseases with 
Syphilis." Van Buren and Keyes. 1874. 
"All other modes of enlarging the canal are only preliminary steps to the application 
of proper dilators-which are bougies and sounds ; for, after divulsion and the urethroto- 
mies, the dilators must always be used to ensure calibration and permanent relief."-" Dis- 
eases of the Urinary Organs," p. 47. Gouley. 1873. 
Fig. 2030.-Conical Steel Sound, 
Fig. 2931.-Teft's Sound, for Strictures exteriorly to the triangular ligament. 
See Medical Record, 
Jan. 23, 1886. 
Fig. 2932.-Burge's Curved Stricture Dilator, Metal 
Fig. 2933.-Burge's Straight Dilator. 
Dr. Burge's dilators (Figs. 2932, 2933) consist of four different sizes of tubes, all 
telescoping on the smaller. Modus operandi: The tubes are all drawn in, so that the 
point of the instrument appears rounded like the ordinary sound. It is then well oiled 
and introduced into the urethra until it meets with the obstruction ; the inner or smallest 
of the tubes is then pushed forward. After it has entered the orifice of the stricture 
the tubes next in size are forwarded progressively. * GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
355 
URETHRAL, STRICTURE 
GRADUAL DILATATION. 
Fig. 2934.-Weisse's Bougie a Boule, with non-flexible, ruled staff. 
Fig. 2935.-Weisse's Urethral Sound, for treating strictures of the male urethra exteriorly to the triangular ligament. 
Fig. 2934. 
Fig. 2935. 
" The sound portion at either end is two inches in length; the middle, for an inch, represents the full circum- 
ference, or size of the sound, in millimetres ; the ends, for half an inch each, taper through several sizes. The staff 
portion has much less circumference and is four and a quarter inches in length ; it is flattened on two sides (one for 
each of the end sounds), which are ruled in inches, with quarter inch divisions."-Faneuil D. Weisse, M. D., Medical 
Record, December 20, 1884. 
Fig. 2936.-Minor's Dilators. 
"Minor's dilators (Fig. 2936) consist of metallic catheters or tubes, open at both ends, the one at the vesical 
extremity well rounded. They are introduced over a filiform gum bougie, which serves as a guide for them. They 
may be used as stricture dilators, and also for evacuating the bladder of urine. 
Fig. 2937-38.-Gouley's Whalebone Bougies, for Catheterism of Eccentric and Tortuous Strictures 
"I have, for many years, used slender probe-pointed shafts of whalebone, which possess great advantage over 
both the French and English capillary gum bougies, being more elastic than either of the latter, and less liable to coil 
in the urethra, while they adapt themselves admirably to the inflections of the canal, and can be made so small as to 
enter the narrowest constrictions. The size mostly in use is two-thirds of a millimetre in the shaft, the next is half a 
millimetre ; they can, however, be reduced to the size of a horsehair, and still be sufficiently strong. They are ordi- 
narily twelve inches long, but I have had some made of double that length. 
"Mode of using them.-Being very slender, they cannot be properly oiled ; it is therefore better to fill the urethra 
with warm benzoated olive oil; then, if the stricture be eccentric, an angular bougie is to be introduced, with the point 
directed towards the floor of the canal in order to avoid its entering the lacuna magna. The direction of the point 
may be changed as soon as it has gone beyond the lacuna, but should it then enter another lacuna it must be slightly 
withdrawn, turned aside, and carried onward until it meets the final obstruction. From this moment it becomes an 
explorer in search of the orifice of the stricture, to find which is not, as has been asserted, "a mere matter of chance," 
but a procedure requiring very light fingers with great delicacy of touch, and much experience and skill. To be sure 
of entering the mouth of a narrow eccentric stricture, the point of the bougie should be kept in contact with the 
urethral wall, while a slight to and fro movement is given the instrument until the stricture is entered or the whole 
circumference of the canal is explored. The instrument is bent at both ends in exactly opposite directions, that the 
distal may indicate the position of the vesical extremity, and consequently the situation of the orifice of the stricture. 
"After the bougie has been passed through the stricture it should be movable back and forth ; otherwise it is 
almost certain that the point is caught in one of Cowper's ducts, in one of the many enlarged lacunae in the ampulla 
behind the stricture in the utriculus, or in one of the ejaculatory ducts. At this stage of the proceeding it is neces- 
sary to exercise much caution and gentleness in disengaging the instrument from its faulty position, as an undue 
force will give rise to a false passage, or excite inflammatory action which may extend to Cowper's gland or to the 
testicle. By withdrawing the instrument a quarter of an inch, or even less, and giving it a slight rotary movement 356 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STF^ISTURE 
GRADUAL DILATATION AND OVER-DISTENTION. (Continued.) 
to change the direction of the point, and then pushing it gently onward, the obstacle will be surmounted and the 
bladder entered. Having reached the bladder, the bougie (Fig. 2937-38) serves as a conductor upon which a peculiarly 
constructed sound is made to glide and dilate the canal, and also straighten it if the stricture happens to be tortuous. 
Fig, 2939.-Gouley's Tunnelled Sound (and Guide). 
" This last-named instrument was suggested by me in 1864, and I have since used it very much 
and with great success. It is a grooved conical steel sound with a canal one-eighth of an inch in 
length at the vesical extremity, and with a curve equal to one-fifth the circumference of a circle three 
and a quarter inches in diameter. The smallest (No. 3) is one and a half millimetres at the point. 
I have had larger ones made (to No. 15), to fully dilate strictures complicated with false passages, and 
have named them tunnelled sounds."-" Diseases of the Urinary Organs." Gouley. 
" When a capillary whalebone guide has passed through a tortuous or an eccentric stricture and has entered the 
bladder, the free end is slipped through the tunnel of the smallest sound, which is carried down to the obstacle, held 
in firm contact with it-precaution being taken to keep the guide in the groove of the staff-and in a few moments 
the instrument will pass, but no force or undue pressure should be used. It is desirable, after having accomplished 
this much, to carry on dilatation rapidly, at the same sitting, to four or five higher numbers, to guard against 
the possibility of retention of urine from too great inflammatory swelling. The stricture should then be treated by 
gradual dilatation, and no other method thought of, unless dilatation fails after a thorough trial."-" Diseases of the 
Urinary Organs." Gouley. 
Extent to which a Stricture should be Dilated. 
"It is often said that if a No. io or 12 instrument is passed into a man's bladder he cannot have stricture; this is 
a very common error into which too many intelligent practitioners have fallen. * * * The introduction of a 
No. 12 may cause extreme over-distention in some cases,while in others it may not make the slightest impression upon 
the urethra, which may require distention to No. 20 or 22 at the seat of disease. 
"The normal average in the narrowest part of the urethra, i. e., the meatus, is equal to No. 14; but, even then, 
a stricture in its formative period may exist in the canal, and still admit No. 14, and escape detection unless proper 
means be taken for its discovery. Another man's urethra may admit No. 16, 17, or even 18, and be constricted. The 
extent, then, to which dilatation is to be carried should depend upon the normal calibre of the canal in each individual 
case."-" Diseases of the Urinary Organs." Gouley. 1873. 
Fig. 2940.-Gouley's Instrument for Over-Distending the Urethra. 
" If the meatus will admit no larger sound than No. 16, the two-bladed dilator, which I have devised for the pur- 
pose of greatly over-distending the canal at the diseased point, in such cases, does good service. Its two blades are 
not joined at the vesical end, and are, at that point, so thin and yielding that they cannot act injuriously upon the 
parts behind the diseased portion of the urethra. The calibre of the shaft is equal to No. io, and the instrument is 
really a curved hollow conical sound, split longitudinally so that the two blades are separated laterally by a lever attached 
to a rod, which is moved by a screw in the handle, and when fully expanded the widest part more then equals in cir- 
cumference the sound No. 20. It is graduated in inches, so that the part susceptible of greatest expansion can be 
made to act on the urethra exactly where it needs to be over-distended. This dilator may be used to distend the canal 
very gradually, or may be made to act as a divulsor by rapidly turning the screw and opening the blades to their 
greatest extent."-" Diseases of the Urinary Organs." Gouley. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
357 
URETHRAL STRICTURE. 
RAPID DILATATION AND DIVULSION 
Fig. 2941.-Voillemier's Stricture 
Divulsor. 
" To treat a stricture by divulsion is to make a longitudinal rent of the con- 
stricted portion of the urethra. This may be accomplished by the successive 
introduction of conical sounds-which act on the principle of the wedge-be- 
ginning with small ones, or by any of the various divulsors, improperly called 
dilators, which are now in use. These are Perrere's instrument, and its modifi- 
cations by Holt, Richardson, Voillemier, Michelena and Sir Henry Thompson's 
and their modifications. The method of treatment by divulsion is more thor- 
oughly understood and appreciated in our time than when the early "dilators" 
were brought into notice. 
" In 1847 appeared Dr. Michelena's thesis on stricture, with a description and 
engraving of a " dilator," consisting of two blades, free at the extremity and 
acted upon by a series of levers. In 1849 Mr. Rigaud published, in the Gazette 
Medicate de Strasbourg, a description of a similar instrument, and the two are 
sometimes confounded. In Mr. Rigaud's dilator the blades slide upon each 
other while they are being opened, but in that of Dr. Michelena they preserve 
their parallelism."-" Diseases of the Urinary Organs." Gouley. 
Vollemier's instrument consists of two slender blades, between which rods of 
different sizes are introduced, according to the degree of dilatation the operator 
intends to make. The rods are grooved in such a manner that they are re- 
tained in position and cannot travel off the blades. Either the cap may be screwed 
on to the point or the long delicate conducting gum filiform bougie attached, 
which is intended to penetrate very close strictures complicated with false routes. 
" When one of these filiform bougies has been made to penetrate a stricture, 
some other instrument, which it is desirable to use for rupturing or incising the 
stricture, or drawing the urine, may be screwed on to it and then pushed for- 
ward, following its guide through the stricture into the bladder. The filiform 
bougie coils up in the bladder, doing no harm there, and is withdrawn with the 
larger instrument. The device is due to Maisonneuve ; it has been largely ap- 
plied by others. 
" Cazition.-The metallic cap upon the bougie should always be examined 
before it is used, to make sure that it is firmly attached to the bougie. They 
become loosened by time, and, if a defective instrument be used, there is danger 
of leaving the bougie behind in the bladder."-" Genito-Urinary Diseases." 
Van Buren and Keyes. 
Fig. 2942.-Holt's Divulsors. 
Holt's instrument consists of two blades, joined at the vesical extremity. Each blade has a handle, these are kept in 
place by a brace provided with a set-screw. A conducting rod runs from the point-inside of the blades-and projects 
one-quarter inch out of the handles. Four different sizes of tubes fit upon the rod between the handles, and are thus 
prevented from leaving their position when pushed onward. The degree of dilatation is determined by the size of the 
tube employed. 
Bumstead says: " It was evident to others, as well as to myself, that the expansive power of the instrument was 
insufficient; that even when the largest tube of the set was employed, there were some strictures which would merely 
stretch as it passed, without being ruptured, and which afterwards show the marked tendency to recontraction which 
always follows rapid dilatation. The remedy for this was: to allow wider separation of the blades and to be supplied 
with larger tubes. Another change has been the addition of the filiform bougie as in Voillemier's instrument." See 
Fig. 2943 (Holt's Divulsor, modified by Bumstead). 358 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRICTURE. 
RAPID DILATATION AND DIVULSION. 
Fig. 2943.-Holt's Divulsor, 
modified by Bumstead. 
Fig. 2944.-Thompson's Divulsor. 
For the treatment of stricture by gradual distension at a single sitting, even beyond 
the natural calibre of the canal. By means of a single lever the two parallel rods are 
made to "separate so as to form a long oval or spindle-shaped figure," the greater 
diameter of which will correspond to the seat of the stricture to be " dilated," and equal 
in circumference to No. 18 of the English catheter scale, or even more. In the third 
edition of his treatise on stricture, Sir Henry Thompson speaks of the instrument as 
suitable for the performance of divulsion. 
Fig. 2945.-Gouley's Divulsor. 
Dr. Gouley, believing the above dilator too large for the treatment of very narrow 
strictures, has had it reduced in size, and modified it so that it can be used with a 
whalebone guide. The dimensions of the instrument, represented in Fig. 2945, are 
two millimetres at the extremity, and three and one-half millimetres at the part suscept- 
ible of greatest expansion. Another important modification he has made is in the 
blades, which instead of being flat or guttered on their inner surface for the first two 
inches from the point, are cylindrical, so that the urethral mucous membrane cannot be 
pinched and torn in withdrawing the divulsor. The curve of the instrument should not 
exceed one-fifth of the circumference of a circle three inches and a quarter in diameter. 
Those who have a preference for any of the other divulsors, may have them modi- 
fied so that they can be used with a conductor. 
Fig. 2946.-Gross' Urethral Dilator. 
" I have arrived at the conclusion that enlargement of the meatus is uncalled for when the 
relation between its size and that of the spongy urethra is normal. With this instrument, after 
divulsion or internal incision, the severed parts alone can be stretched during the healing process, 
without detriment to the remainder of the urethra. It consists of a No. 16 steel sound, the terminal two-thirds of 
which are split into two halves to form the blades. These are united at the vesical extremity, where they are care- 
fully bevelled, and can be separated laterally, so as to form a spindle-shaped body, by a flattened cone attached to 
a rod, which is acted upon by a wheel at the proximal end of the handle. The extent to which the blades can be 
parted is indicated by a register, marked in milimetres, attached to the handle. 
" The instrument may be used as an explorer to define the anterior face of the stricture ; it may be employed for 
ordinary dilatation by gradually and progressively expanding the blades, or it may be utilized as a divulsor by rapidly 
turning the wheel."-Samuel S. Gross, M.D. Medical Record, June 15, 1878. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
359 
URETERAL STRICTURE. 
RAPID DILATATION AND DIVDLSION. 
Fig. 2947.-Stearns' Dilator. 
Fig. 2948.-Powell's Dilator. 
Fig. 2951.-Thebeaud's Stricture Dilator. (Divulsor.) 
Fig. 2949.-Schweig's Dilator. 
" The exact location of the stricture having been determined, the dilator is introduced a dis- 
tance to make the centre of the dilating wedge to correspond with the stricture. One hand then 
steadies the instrument by means of the ring handles, while the other slowly turns the screw- 
wheel until the desired degree of dilatation is obtained. The index gives accurate information in 
this respect, and will serve to keep dilatation within safe limits, as defined by the calibre of the 
individual urethrae. When the patient complains of pain desist, or wait a few minutes, when 
usually the pain subsides, and one or two more numbers may be advanced. 
" Where resiliency is so prominent a feature that slow and gradual dilatation proves unavailing, 
the instrument will be found a perfect divzilsor, by simply turning the screw-wheel rapidly. Be- 
fore withdrawing the instrument, the screw must be turned all the way back, to allow the wedge 
to sink back within the shaft. The instrument is so constructed that, after use, the wedge can 
be removed entirely, and both it and the shaft thoroughly cleaned."-Medical Record, May 3, 
1870. 
Fig. 2950.-Steurer's Dilator. 
" The instrument is composed of a hollow canula (A) with a bulb at the end (C); the portion between b and c is 
composed of pure copper, which allows to make any fixed curve, or of a spiral, which makes it very flexible. Over 
b and c is a membranous tube fastened at both ends. The canula is perforated within the membrane to allow free 
passage of water. B is a hard rubber syringe, with a graduated piston, and worked with a rack and pinion, the latter 
being removable. There is also a rubber band attached to the head of the syringe and passing through the ring of the 
piston, so that by its own elasticity it draws the latter down, thus making the instrument also work automatically, and 
in proportion as the membrane becomes distended by the water the stricture is dilated. D shows the tube dilated. 
" The manner of using the instrument is as follows: The membrane is soaked in carbolized water until it becomes 
very flexible ; all the air is driven out of the tube by compressing the membrane, which is then greased. The syringe, 
being filled with carbolized water, is screwed on the canula, which is then introduced through the stricture. The 
water being forced out of the syringe, gradually distends the membrane and thereby the stricture."-Medical Record, 
New York, September 22, 1877. 360 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRICTURE 
INTERNAL URETHROTOMY. 
" Introducing into the urethra a knife (urethrotome), with which the strictured part is incised, together with a little 
uncontracted tissue in front and behind. The design is to obtain union by granulation, and with the aid of dilating 
instruments to insure the formation of a wide cicatricial splice."-" Diseases of the Urinary Organs." Gouley. *873. 
Instruments Cutting from Before Backwards. 
Fig. 2952.-Maisonneuve's Urethrotome. 
It consists of a deeply grooved sound, with a small ring near its distal extremity as handle, a long stem with trian- 
gular knife attached and a gum elastic filiform conducting bougie. 
1 he steps of the operation, according to Maisonneuve, are as follows: 
i. The gum elastic conducting bougie is introduced past the stricture. 
2. 1 he vesical end of the sound is screwed to it, and the instrument is slowly and gently pushed onward until 
it has gone beyond the obstruction and can be moved back and forth without impediment. (The con- 
ducting bougie may coil up in the bladder.) 
3. 1 he blade is made to glide into the groove of the sound until it has reached the part to be divided ; the penis 
is then drawn forward, the sound steadied and the cutting blade pushed onward. 
4. The instrument is slowly and cautiously withdrawn and the operation is thus terminated. 
Fig. 2953.-Voillemier's Urethotome. 
"After many experiments with this instrument it was found that the healthy mucous membrane did not usually escape 
injury. On this account Voillemier made a modification in which the blade is guarded by a plate of the same size 
and shape, and the summit is sharp, not blunted as in the original. 
1 he operative procedure with Voillemier's urethrotome, and the many other modifications, differ but slightly from 
the foregoing."-" Diseases of the Urinary Organs." Gouley. 1873. 
Fig. 2954.-Bumstead's Maisonneuve's Urethrotome. 
Among other urethrotomes used by American surgeons are those of Banks, Bates, Gouley, Gross, Hunter, Kin- 
loch, Mastin, Milnes, Nall, Otis, Peters, Pritchett, Rogers, Smith, Stearn, Westmoreland, Wyeth, &c., &c. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
361 
URETHRAL. STRICTURE. 
INTERNAL URETHROTOMY. 
For Operating from Before Backwards. 
Fig. 2955.-Gouley's Tunnelled Urethrotome. 
" The first and really difficult step of Maisonneuve's operation is to pass the gum conductor. I have often wit- 
nessed bending of the bougie in front of the obstruction, so that its point would appear at the external orifice. My 
success with capillary whalebone bougies induced me to employ them as conductors in urethrotomy, and I had but 
to adopt Maisonneuve's blade to the vesical end of my smallest tunnelled sound and I had a urethrotome of the 
simplest construction for cutting from before backward. The blade being sharp, both in front and behind the blunted 
summit, could also be used to cut from behind forward. 
"Fig. 2955 represents the instrument, which is nearly straight, and I have experienced no trouble in using it, 
either in the sub-pubic curve, or in the pendulous portion of the urethra. 
" The operative procedure is as follows : 
" 1. The capillary whalebone conductor is passed into the bladder. 
" 2. Its distal end is slipped through the smallest tunnelled sound, and a little dilatation made, to facilitate 
the entrance of the point of the urethrotome, and the sound is withdrawn. 
" 3. The tunnelled urethrotome is introduced in a similar manner as is the tunnelled sound. The penis is 
steadied with the left forefinger and thumb, and the stricture divided by sliding the instrument gently 
upon the conductor until all resistance to its passage ceases. 
" 4. The instrument is withdrawn, but the conductor left in position, that a large tunnelled catheter may be in- 
troduced, in order to ascertain if the incision has been sufficiently free, and at the same time to draw off 
the urine."-" Diseases of the Urinary Organs." Gouley. 
Fig. 2956.-Gouley's Improved Tunnelled Urethrotome. 
" The same objections made to Maisonneuve s urethrotome have been urged against mine. I have, therefore, fol- 
lowed Voillemier's example and placed a guard on one side of the blade. The improved tunnelled urethrotome is 
straight and designed for operations in the pendulous portion of the urethra."-"Diseases of the Urinary Organs." 
Gouley. 
Fig. 2957.-Pritchett's Rotating Urethrotome. 
" It may be called a modification of Maisonneuve's, and consists of the following parts: First, we have a plain 
cylindrical rod or staff, fifteen inches long, two millimetres in diameter, and with the short curve of Bumstead. The 
external extremity has attached on its under surface a ring to serve as a handle, while the internal extremity termi- 
nates in a screw for the attachment of filiforms. A tunneled screw-head (Gouley's attachment) is also provided to 
screw on for using the finest whalebone guides. Next, and in this consists the peculiarity of the instrument, we have 
three tubes, each seven inches long, and fitting the rod closely, and with a slit down its entire length so as to pass the 
ring-handle of the staff. At the external extremity of each tube are attached laterally two rings for handles; while 
each internal extremity is beveled so as to pass strictures more readily. One tube carries at its internal extremity, at- 
tached superiorly, a triangular, probe-pointed blade, nine millimetres in size, also attached superiorly ; while the third 
tube carries two similar blades, each four millimetres in size, attached laterally. 
" The staff is made so long (fifteen inches) in order that the entire tube may pass the ring-handle before the blade 
enters the meatus.'"-New York Medical Journal. July, 1878. 362 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL, STRICTURE. 
INTERNAL URETHROTOMY. 
For Operating from Before Backwards. 
Fig. 2958.-Teevan's Stricture Cutter, with Guide and Tunnel 
Fig. 2962.-Westmoreland's Stricture Instrument. 
Fig. 2960.-Trelat's Urethrotome, both ways. 
Fig. 2961.-Gross' Urethrotome. 
Fig. 2959.-Mastin's Stricture Cutter. 
Fig. 2963.-Mastin's Maisonneuve's Urethrotome. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
363 
URETHRAL STRICTURE 
INTERNAL URETHROTOMY. 
For Retrograde Operation. 
Fig. 2964.-Civiale's Urethrotome. 
The terminal olivary extremity is used as an explorer, and serves also to guard the blade, which can be opened to 
the degree required. 
Fig. 2965.-Charriere's Stricture Cutter. 
This is a modification of Civiale's urethrotome, with Maissonneuve's gum conductor. When the instrument has 
been carried down to the stricture, the concealed blade is pushed forward so as to incise the constriction ; it is then 
carried beyond, the blade projected as much more as the operator deems necessary, and the stricture more fully 
divided in withdrawing the instrument a little. 
A plain metallic sound, marked 
in quarter inches, by which the 
depth of its introduction is noted, 
and grooved for the reception of a 
urethrotome, consisting of a round 
steel rod, with a metallic button to 
serve as handle, and terminating in a 
thin spring cutting blade. The edge 
of the blade is entirely concealed in the groove of the sound, except at a point about one-half or three-quarters of an 
inch from the point, where it is made to ride over an elevation in the groove, thus displaying the blade for the length 
of about half an inch, and again dropping into concealment. The instrument is introduced beyond the stricture, 
the cutting done by pulling on the knife and withdrawing the instrument a little. 
Fig. 2966.-Peters' Urethrotome. 
Fig. 2967.-Bumstead's Urethrotome (modification of Peters'). 
Fig. 2968.-Kinloch's Urethrotome. 
A. Instrument entire, with small bulb attachment. B. Section, showing the blade projected and ready for use. 
C. Tunnelled end attachment, with whalebone guide. D. Probed end or short elastic guide. E. Bulbous attachments, 
of different sizes. F. Blade, detached to show formation, shoulder, &c. G. Long elastic bougie guide attachment. 
Fig. 2969.-Bates' Urethrotome. 364 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRICTURE. 
INTERNAL URETHROTOMY. 
For Retrograde Operation. 
Fig. 2970.-S. W. Gross' Exploratory Urethrotome. 
" Of the two modes of inserting a soft pliable splice in the contracted part, and in the sound tissues of its imme- 
diate vicinity, I give decided preference to internal urethrotomy from behind forwards. In forcible rupture, short 
oblique rents are liable to be made in the healthy mucous membrane, which, after the healing process is completed, 
may form partial traumatic strictures. In internal urethrotomy, on the other hand, the contracted part can be di- 
vided with the utmost precision, while the sound portions of the urethra are free from injury. The instrument which, 
from the simplicity of its construction, perfection and action, accurate definition of the stricture, and moderate cost, I 
prefer for retrograde division, is the one devised by myself three years ago (Fig. 2970). It is nothing more than a 
metallic exploratory bougie, the slender shaft being provided with a handle, and grooved for the reception of a steel 
rod, to one end of which is attached the blade and to the other a button, through the retraction of which the former 
is thrown out of the under surface of the bulb, so that the incision may be made along the floor of the urethra. The 
extent to which the blade can be projected is regulated by a lateral screw near the handle. The length of the con- 
trivance is 11 inches, of which three are taken up by the handle, button and screw. In actual practice I have found 
two such instruments to be all that are required. In one, which is intended for strictures of moderate calibre, the 
bulb is equal to No. 15 of the French catheter scale, while, in the other, the bulb corresponds to No. 23, which suf- 
fices to define coarctations of much larger size. 
" To use the exploratory urethrotome : The stricture having been passed, and its posterior face having been ac- 
curately defined by the projecting shoulder of the bulb, the latter is carried at least half an inch towards the bladder- 
as the object is to cut, along with the coarctation, the sound tissues to that extent behind and in front of it-when the 
blade is protruded by sliding the button, and the parts divided as the instrument is withdrawn, the penis being put 
upon the stretch to render the urethra tense. Should the tissues be thick or resistant, the section may be materially 
aided by counterpressure with the fingers of the left hand along the median line. The bulb is then used as an ex- 
plorer to detect any undivided bands, which, if discovered, should next be severed, since thorough section of all con- 
stricting bands is essential to success."-Samuel W. Gross, M. D. Medical Record, June 15, 1878. 
Fig. 2971.-Banks' Urethrotome. 
INTERNAL DILATING URETHROTOMY. 
Fig. 2972.-Gouley's Dilating Urethrotome. 
" I have had a small dilating urethrotome made with Dr. Peters' cutting blade, but with two lateral dilating springs, 
so arranged that only the constricted portion of the urethra is stretched. The point is tunnelled so that a capillary 
conductor may be used in cases of false routes. It is introduced closed into the urethra until the central portion of 
the dilating springs correspond to the stricture to be stretched. The screw near the handle is turned until the springs 
are sufficiently expanded to make the strictured portion tense, then the blade is protruded and the stricture divided. 
Further dilatation may be made, the blade pushed back-this time cutting from before backwards-and dilatation re- 
peated perhaps a third time, when the stricture tissue is cut through completely. The urethra is afterwards explored 
with a full-sized bulbous bougie, to be sure that there is no hindrance to the passage of a large sound. The after- 
treatment is the same as in ordinary urethrotomy, namely periodical catheterism with large instruments during, and 
for some months after, cicatrization."-" Diseases of the Urinary Organs." Gouley. 1873. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
365 
URETHRAL STRICTURE. 
INTERNAL. DILATING URETHROTOMY. 
Stricture of the Urethra: Its Radical Cure. Chapter XVII. 
Fessenden N. Otis, M. D, 
"The points which are claimed to have been established by observations are: 
" I. That the urethra is an individuality, and hence, to obtain the true normal calibre of any urethra, it must 
be measured, or estimated, independently of any other. 
" 2. That the meatus urinarius is worthless as a guide to the normal urethral calibre, and that its normal con- 
traction is the cause of the pouch-like dilatation of the urethra behind it, known as the fossa naviculatis. 
"3. That stricture is a relative term ; hence its extent must always be estimated by comparison with the pre- 
viously ascertained normal calibre of the urethra under consideration. 
" 4. That the slightest abnormal contraction of the urethra, at any point, constitutes a stricture. 
"5- That a stricture, in this sense, is always a point of friction, the legitimate tendency of which is to produce 
inflammation ; and hence the slightest appreciable stricture becomes worthy of consideration. That 
serious trouble often results from strictures which but slightly contract the calibre of the urethra and 
which do not markedly interfere with the passage of urine ; and that, among such troubles, spasmodic 
stricture, simulating true organic stricture in every respect, is often caused by such slight contractions. 
"6. That stricture is a cause, though not the only cause of gleet; and is, when present, always a cause of its 
persistence. 
" 7. That stricture always embraces the entire circumference of the urethra at some point. 
" 8. That complete division of stricture at any point results in immediate disappearance of the stricture. 
" 9. That separation of the sundered ends of the stricture, suitably maintained, until the healing of the wound, 
prevents the return of the stricture and finally results in the complete absorption of the stricture tissue. 
" 10. That stricture is, strictly speaking, an inflammatory product, and that any acute or chronic inflammation 
may produce it. 
"11. That stricture is often present as a result of inflammation caused by lithiasis, masttirbation, or urethral 
laceration (by gravel, &c.), though usually the sequel of gonorrhoea. 
" 12. That stricture occurs most frequently in the anterior portion of the canal; and with increasing frequency 
when approaching the meatus where a gonorrhoeal inflammation begins the earliest, rages the hottest and 
lasts the longest. 
"From authorities and their followers, who have hitherto denied the possibility of radical cure of urethral stricture, 
I anticipate continued denial, until they shall have conscientiously and exactly carried out the plans and procedures 
through which my success has been attained, and have had the opportunity of testing the results by years of observa- 
tion, as I have done. In the meantime other independent, honest and capable observers will aid me in educating the 
general profession up to the point of departing so far from established doctrines as to give the rational treatment of 
stricture a fair trial. This effected, I believe the day will not be far distant when close stricture will be deemed a 
surgical opprobrium, and the continuous treatment by dilatation, except under rare and peculiar circumstances, will 
be relegated to physicians or to the patient, and this only as a temporary expedient to be practiced until competent 
surgical aid is attainable. 
" I am prepared to assert that such results as I have recorded are not exceptional and may be attained by any sur- 
geon who will provide himself with the necessary instruments for the performance of dilating urethrotomy, and use 
them in accordance with the plans and principles previously enforced and with the exercise of such judgment and skill 
as are considered essential to success in any other operation of like importance."-New York, July I, 1878. 
Diagnosis of Stricture. 
Fig. 2973.-Otis' Bulbous Sound. (Improved.) 
"In explorations of the urethra with this instrument, I am accustomed to accept the meatus, if apparently of 
normal size, as a guage of the urethral calibre ; that is to say, any instrument which will pass that orifice will easily 
traverse the entire canal if no abnormal condition is present. It should be borne in mind, however, that both con- 
genital and pathological contractions of the meatus are not infrequent. 
See also Fig. 2886. 366 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRICTURE. 
INTERNAL DILATING URETHROTOMY. 
Diagnosis of Stricture. (Continued.) 
"A bulb, with its shaft bent to correspond with the curve of an ordinary sound, is accurately fitted to the urethral 
orifice, then slowly inserted and pushed gently back until some resistance is recognized. Muscular contraction may 
arrest the instrument at any point along the spongy urethra, but, with a little delay, this will subside. As the bulb ad- 
vances it may impinge upon the triangular ligament; tilting the shaft upward will clear this point. Muscular con- 
traction will also usually occur at the commencement of the membranous portion at the posterior part of the prostatic, 
gently overcoming which, the bulb slips into the bladder. This is the usual course of the proceeding when no con- 
traction has been recognized. After allowing the bulb to remain in the bladder for three or four minutes, it is slowly 
withdrawn ; if contractions are present at any point, slight clinging or want of suppleness will indicate their locality, 
and, in moving the bulb back and forth, where resistance is appreciated, a diagnostic ridgy feel may be recognized. 
Should this proceeding fail in locating a constriction, I am then accustomed to slit up the meatus freely,* and repeat 
the operation with the largest bulb that will enter the spongy portion. Failing with this, a full sized meatoscope, 
without the entering shaft, is introduced under the light, and slowly pressed back along the passage, carefully noting 
any paling or lack of flexibility of the membrane at any point. Should this last effort yield no evidence of undue 
condensation of tissue, I am forced to conclude that no contraction is present."-"Stricture of the Male Urethra." 
F. N. Otis, M. D. 1878. 
Otis' Table; showing the Relative Circumference of the Penis and. Urethra. 
PENIS. 
URETHRA. 
3 inches . 
. . . or 75 millimetres, . 
. . 30 millimetres. 
3i " 
. . . or 8i " . . 
. . 32 
3i " 
. . . or 87 " . . 
• • 34 
3f " 
. . . or 92 " . . 
. • 36 
4 " 
. . . or 100 " . . 
. . 38 
4| to 4| in., 
or 106 to 112 " . . 
. . 40 
The estimate of the size of the urethra from its proportionate relation to the size of the penis is but approximate, 
and intended only to serve as a guide where the urethrameter is not available. Examined by the rule laid down, ex- 
perience has shown that the estimate will never exceed the normal calibre, though it often falls short of it several 
millimetres circumference. The flaccid penis is subject to variation from heat, cold, &c., but, practically, it will be 
found that the relative conditions will always be the same when the patient presents to the surgeon. Measurements 
should always be made at about midway of the body of the penis. 
Fig. 2974.-Otis' Urethrometer. 
" In order to gain a definite knowledge of the calibre of the urethral canal, in cases with or without contraction 
of the meatus, I have devised an instrument which I term the urethrameter, or dilating bulbous sound. It consists 
of a small, straight canula, size No. 8, Fr., terminating in a series of short metallic arms, hinged upon the ca- 
nula and upon each other. At the distal extremity, where they unite, a fine rod, running through the canula, is in- 
serted. This rod (which is worked by a stationary screw at the handle of the instrument), when retracted, expands the 
arms into a bulb-like shape, ten millimetres in circumference when closed, and capable of expansion up to forty milli- 
metres. A thin rubber stall, C, drawn over the end of the closed instrument, protects the urethra from injury, and 
prevents the access of the urethral secretions to the interior of the instrument. When introduced into the urethra and 
expanded to a point which is recognized by the patient as filling it completely-and yet easily moving back and forth- 
the index at the handle then shows the normal circumference of the urethra under examination. In withdrawing the 
instrument, contractions at any point may be exactly measured, and any want of correspondence between the calibre 
of the canal and the external orifice be readily appreciated. Among the advantages claimed for this instrument are : 
1. Its capacity to measure the size of the urethra, and to ascertain the locality and size of any strictures present, with- 
out reference to the size of the meatus; 2. It enables the surgeon to complete the examination of several strictures by 
a single introduction of the instrument, and by reduction of its size to avoid the irritation which usually attends the 
withdrawal of the ordinary bougie a boule or bulbous sound."-" Stricture of the Male Urethra." F. N. Otis, M.D., 
&c., &c., 1878. 
See Meatotome, page 347. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
367 
URETHRAL STRICTURE. 
INTERNAL DILATING URETHROTOMY. 
For the preparatory Dilatation of Strictures too small to admit the necessary instruments for 
immediate operation.* 
The normal calibre once obtained by means of the urethrameter, or by measurement of the flaccid penis, the 
method by which the sundering of the stricture at some one point is accomplished may vary, and rest in the judgment 
of the operator. If dilatation or divulsion be selected as the medium through which to effect this result, the procedure 
must be carried far enough to completely rupture every fibre of the contraction ; if division, every fibre must be com- 
pletely severed, or subsequent recontraction is certain. 
Otis' dilating urethrotomes are known as Nos. I, 2, 3, 4, in the order of their invention; Nos. 1 and 2 dilating 
and cutting at a single predetermined point, while Nos. 3 and 4 dilate the entire canal. Each has advantages which 
cannot be combined in the other, but neither one will answer in all cases of single stricture. When several strictures 
are present, especially if close together, the latter numbers are to be preferred. No. 4 has the advantage of being 
adapted to any stricture in the straight urethra without distending the curved portion of the canal. 
Dr. Otis asserts that strictures divided by one of these, or any other instrument, in accordance with the irrevocable 
law of complete division of every fibre, followed by the daily use of sounds of the full capacity of the canal, until all 
bleeding ceases, will accomplish a speedy cure. 
Fig. 2975.-Otis' Dilating Urethrotome, No. I, for Dividing Strictures of Large 'Calibre. 
(Presented to the profession Nov. 24, 1871.) 
" The dilating urethrotome (No. i) consists of a pair of steel shafts connected together by short pivotal bars 
shown at 2. Its expansion or contraction is effected by means of a screw which traverses the handle connected with 
the lower shaft at C. The extent of the dilatation is indicated on one side of the instrument in numbers according to 
the American, on the other with those of the French scale. Upon the inferior shaft (B) is engraved a scale of 
inches and quarter inches, by which the depth of its introduction into the urethral canal may be noted. Up to this 
point the instrument is simply a divulsor, and may thus be used by introducing it beyond the supposed point of 
stricture ; the screw (C) is now turned, dilating the instrument, until, if considered desirable, the stricture is com- 
pletely ruptured. 
" The upper bar of the instrument, which is hollowed out, is traversed by a urethrotome (3), the distal extremity of 
which terminates in a little metallic knob {F, 3) ; by the metallic handle of the urethrotome it is moved at will along 
through the entire length of the shaft {A} of the dilator; a small button screw (H) secures the canula at any point. 
Running through the canula and attached to a handle (Z) is the staff terminating in a thin narrow spring knife, which, 
when at the extremity of the canula, is concealed in a deep groove which extends on its superior aspect through its 
entire length. On withdrawing the handle of the urethrotome (Z) the spring knife rises out of the groove by means 
of a little elevation on its floor, rides over it, displaying the full width of the blade for half an inch, when it again 
drops down and is concealed in the groove of the canula. 
" Use : The instrument, with its contained urethrotome, having been passed down beyond the stricture, and dilated 
until the stricture is made tense, the button screw (ZZ) is turned, releasing the canula, which may then be drawn care- 
fully outward until the knob at its extremity is arrested by the stricture. The canula is then advanced about half an 
inch and secured by the screw A rapid movement of the handle (Z) of the urethrotome, outward, brings its blade 
up through the stricture, from behind it forward, incising it almost instantaneously, and passing down again into its 
concealment. The dilator is then sufficiently expanded to ascertain whether or not the stricture is completely divided ; 
if not, the knife may be passed from before backward, completing the operation."-" Remarks on Strictures of the 
Urethra of Extreme Calibre, &c." F. N. Otis, M.D., &c., in New York Medical Journal, February, 1872. 
* See " Otis' Dilating Catheter," Fig. 2898, and " Otis' Divulsing Urethrotome," Fig. 2981, also Fig. 2978. 368 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRICTURE. 
INTERNAL DILATING URETHROTOMY. 
Fig. 2976.-Otis' Small Dilating Urethrotome, No. 2. 
" This specimen, devised by me and constructed by Tiemann & Co., is equal in size to thirteen millimetres, or 5 J 
English scale. Its mechanism is exceedingly simple. The principle of its action being that of the parallel ruler, ex- 
panding by means of a screw at the handle, is the same upon which my original instrument (Fig. 2975) is constructed. 
" The cutting apparatus is also virtually the same. An independent rod, terminating in a blunt elevation, plays 
the part of a bougie a boule for the detection and location of the stricture points. In order that it may readily be 
passed down into the curved portion of the urethra, its shaft, which terminates in a copper probe point, may be easily 
adapted to the curves of the deeper portions of the canal, and also enables the operator to arrange it for cutting at will 
upon either the superior or inferior aspect of the urethra, and, when straightened, can be used as well for operation 
upon strictures in the straight portion of the canal ; a movable hard rubber slide marks the required depth of insertion. 
Its efficiency was demonstrated at my office, January 29, 1873. The instrument has an expanding power up to 40, F.- 
" Strictures of the Male Urethra." F. N. Otis, M.D., &c., &c., 1878. 
Fig. 2977.-Otis' Dilating Urethrotome. 
" Incurvation of the penis during erection is an occasional sequel of urethrotomy, being caused by an inflammatory 
thickening along the superior surface of the urethra at the point of operation, where more or less discomfort may be 
experienced, as during erection this part becomes tense and salient. Taking advantage of the knowledge gained by 
M. Reybard in his experiments on dogs (i. e., that transverse sections of the urethral tissues resulted in stricture, while 
longitudinal incisions were not open to that objection), I devised an instrument or, rather, I modified my first dilating 
urethrotome (Fig. 2975), so that, while distending and fixing the urethral tissues firmly, I might divide them in a di- 
agonal line across the superior aspect of the canal. The above cut gives an idea of the modified instrument. With 
this I succeeded in dividing the cord completely, giving immediate and perfect relief. It may be interesting to note 
here that the diagonal incision was not followed by stricture."-" Stricture of the Male Urethra: Its Radical Cure." 
F. N. Otis, M. D. 1878. 
Fig. 2978.-Otis' Bulbous Urethrotome 
" This urethrotome was first used in 1874, and presented to the profession in my pamphlet on ' Instruments and 
Apparatus,' May, 1875. This in shape is like the bulbous sound, so constructed that, after passage through a 
stricture, a broad blade two to three millimetres in breadth, concealed in the bulb, is drawn forward through the con- 
tracted point, by means of a handle which traverses the hollow shaft of the instrument. The blade is then pushed 
back through the stricture into its place of concealment, and the instrument is withdrawn. If the bulb has been of 
sufficient size to make firm resistance on attempted withdrawal before, and meets with none after incision, it is probable 
that the test by a bulbous sound of the size of the normal canal will show that the division has been complete. The 
bulbs of this urethrotome are readily changed, and range in size from 20 F. to 40 F. 
"For the division of narrow and dense strictures in the deep urethra, this instrument is often efficient, but it lacks 
the certainty of action which characterizes the dilating urethrotome. Where, however, it is employed, the incisions 
are confined more completely to the cicatricial tissue, and consequently are less often followed by troublesome haemor- 
rhage."-" Stricture of the Male Urethra: Its Radical Cure." Fessenden N. Otis, M.D., &c., &c. 1878. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
369 
UF<ETHRAk> STRICTURE. 
INTERNAL DILATING URETHROTOMY. 
" Between the years 1874 and 1876 I made various changes in minor 
points about my dilating urethrotome, with a view of increasing its ease of 
application and the safety of its use. The chief alteration from the 
original was the attachment of a guard to the summit of the blade, in 
order, after the plan of M. Maisonneuve, to divide only stricture tissue. 
After a time, however, it was found that slight and resilient stric- 
tures often escaped complete division, and always unless the overdis- 
tention was very great. I therefore removed the 
guard and concealed the blade in a slit at the end 
of the shaft. I likewise had the instrument made 
straight and short, for more convenient use in the 
straight portion of the canal where, fortunately, 
according to my observations, much the 
greater proportion of strictures are to be 
found. 
" Heretofore all operations by internal 
urethrotomy have been performed as a last 
resort, after failure to obtain relief by other 
methods. It thus happens that a very large pro- 
portion of such cases have been the subject of ad- 
vanced disease of the bladder and kidneys. The 
simple introduction of a sound or catheter where 
such organic disease is present has not unfre- 
quently caused urethral fever, suppression of 
urine and death. It has therefore come to pass 
that the operation of internal urethrotomy, neces- 
sitated in these desperate cases, has been held re- 
sponsible for fatal issues which were likely to re- 
sult from any mode of interference. I am able to 
state with confidence, that complete division of all 
strictures anterior to the bulbous urethra (i.e., from 
five to six inches), by dilating urethrotomy pro- 
perly performed, is one of the simplest and safest 
of all surgical operations ; that in the very large 
proportion of cases it is uncomplicated by a simple 
accompaniment which can be termed an acci- 
dent, and that the recovery is, as a rule, practi- 
cally complete in from three days to a fortnight 
after theoparation-the variation depending upon 
the number, depth and calibre of the strictures.-• 
F. N. Otis, M.D. 1878. 
Fig. 2979.-Otis' Dilating Urethrotome, No. 3 
Fig. 2980.-Otis Dilating Urethrotome, No. 4. 
Fig. 2981.-Otis' Divulsing Urethrotome. 
"When strictures of small calibre are situated in the penile urethra, where the greatest proportions of stricture are 
found, there need be but little apprehension of danger from the use of immediate measures. Divulsion may be made 
with the instrument of Thompson, Holt, Voillemier, and myself. Division by the urethrotome of Maissonneuve has, 
in my hands, often proved serviceable. In all diseases, however, where there is no necessity for immediate operation, 
I have preferred to use gradual dilatation by means of soft French bougies to bring them at once up to the size requi- 
site for the passage of the dilating urethrotome." 370 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
URETHRAL STRICTURE. 
INTERNAL DILATING URETHROTOMY 
Fig. 2982.-Milne's Dilating Urethrotome 
" The dilator is brought into action by the screw at the handle, producing traction upon a flexible rod attached to 
the terminal extremity, being lifted from a curve to bridge over the concavity. Upon the convex side slides a guarded 
knife for dividing the stricture tissue."-N. Y. Medical Record. Feb. 19, 1876. 
Fig. 2983.-Stearns' Dilating Urethrotome. 
Fig. 2984.-Geo. K. Smith's Urethrotome. 
Fig. 2985.-Wyeth's Urethrotome. 
" Dr. Wyeth also exhibited a modification of Dr. Otis' Urethrotome. The modification consisted in the attach- 
ment of a cogwheel arrangement, by means of which the movements of the knife could be regulated and arrested at 
any desired point."-New York Pathological Society. Stated meeting, November 26, 1884. Medical Record, 
January 3, 1885. 
Fig. 2986.-R. B. Nall's Urethrotome 
The instrument itself defines the diseased tissue. The incision is confined to the stricture. It subserves the pur- 
pose of a urethrameter. It possesses the power of adaptability from 26 French scale to 50. The functions of the 
bulbous sound, urethrameter and urethrotome are all blended into one single instrument. 
Manner of using this instrument: The bulbous portion is well oiled and passed into the penis beyond the 
stricture in a closed condition, the upper half bulb in which the knife is concealed always against the superior wall; 
when the bulb is a little beyond the stricture the instrument is then to be separated by means of the thumb-button as 
desired to the already calculated width. Now withdraw the instrument in this open condition, when the shoulders of 
the half-bulbs will come in contact with the posterior surface of the stricture ; then the knife may be withdrawn, 
severing the band. When this one is cut, the knife is returned to its place of concealment in the upper half bulb, and 
then the instrument becomes a urethrameter. Continue to withdraw it steadily in this open state, and. when other 
bands are defined, withdraw the knife and treat them similarly. GEORGE TIEMANN * CO.'S SURGICAL INSTRUMENTS. 
371 
URETHRAE STRICTURE. 
INTERNAL DILATING URETHROTOMY. 
Fig. 2987.-Hunter's Divulsor and Urethrotome. 
Hunter's Divulsor and Urethrotome. 
" The curved bars dilate but three and one-half inches at a 
time of the urethra, and therefore the operator can address his 
efforts to the deeper portions of the canal, without enlarging 
the meatus. It enables the operator to make tense, longitudin- 
ally, any portion of the canal he may desire to incise. Dilata- 
tion or incision may be made also in the curved portion of the 
urethra. 
" The blade (A) traverses the convexity of the curve from be- 
hind forward. It is sharpened on either end, but blunt on its 
most projecting part, and, therefore, while it will readily cut the 
resisting bands, it will crowd away without incising the looser 
tissues. 
" A scale of inches, commencing at a point where the knife 
rises out of the fenestrum which conceals it, extends to the 
handle, and enables the operator to locate the blade just be- 
hind the stricture. 
" A similar scale to locate the divulsor is on the other side, 
and commences at the end of the convex bar. The amount of 
dilatation is indicated on the handle by sliding scales, in 
French and American numbers. It is equipped for the dilatation 
or divulsion of strictures, in all locations, from No. 20, French, 
up to the normal size of the urethra in its spongy portion, by 
simply placing the bar (7?) in the groove prepared for the 
knife, which it accurately fills, and into which it is securely re- 
tained by a hook on one end and a hook and sliding catch on 
the other. 
" Having carried the dilatation up to the normal size of the 
spongy portion, the steel bar (B'), on which there is rivetted a 
glove one and one-half inches long, may be substituted for the 
bar {B). By this means the dilatation can not only be con- 
fined to shorter limits, but the stricture can be over-distended 
without interfering with the normal calibre of the canal else- 
where."-Alexander S. Hunter, M. D., in N. F. Medical 
Record. Nov. 9, 1879. 
Dr. F. Tilden Brown, of New York, has given the name 
of Urethrametome to the instrument (Fig 2989), in which the 
functions of the bulbous sound, urethrameter and urethratome 
are all combined in a single instrument. It is passed beyond 
the stricture closed, the blades are then separated by means of 
the thumb-screw to the desired width ; by now drawing the 
blade out of its concealment the stricture is cut, the instru- 
ment slowly withdrawn, and if any more stricture bands are 
encountered they are dealt with in like manner. 
Fig. 2988 -Young's Dilating Urethrotome. 
Fig. 2989.-Brown's Urethrametome. 372 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRIGTU^E. 
INTERNAL URETHROTOMY. 
For Locating, Measuring, Dilating and Incising during Withdrawal. 
Fig. 2990.-Rogers'Dilating Urethrotome and Urethrameter. 
" Fig. A shows the instrument with its points and guides ; Fig. B shows its passage along the urethra to the 
bladder ; Fig. C shows it during withdrawal, the bulb which was formed in the bladder, detects the stricture at S', 
while R is the blade for incising the stricture. 
" Returning to A, the instrument will be seen to consist of a shaft, IH, a curve, HD G, and a curved point, M. 
This point, M, maybe unscrewed just in advance of G, and replaced by the straight point, O, to which is attached the 
soft catgut guide; or, the point, J/, may be replaced by the short point, tunnelled for the whalebone guide, X-after 
Gouley. The shaft, IH, is seven inches long, cylindrical, with a uniform diameter equalling that of No. 4, English 
scale, while the curve gradually diminishes in diameter to the size of No. 3. The point, 0, tapers to the filiform 
guide. Thus we form an instrument which can be safely pressed to the bladder, through any stricture whose opening 
can be passed by the guide. 
" The shaft, I H, consists of two cylinders, a solid one with ring handle, E, inclosed by hollow one with ring 
handle, F. Along the curve the two cylinders become solid half cylinders, with their flat surfaces opposed, thus 
forming a solid whole cylinder. At G the hollow cylinder of the shaft receives the solid one. The instrument having 
been passed well into the bladder, by means of the ring handle, F, the hollow cylinder of the shaft is rotated, causing 
a separation of the two half cylinders of the curve, thus forming (in the bladder) a skeleton bulb of any desirable diame- 
ter up to that of the full size male urethra. The diameter of the bulb at any stage of its formation can be seen as the 
arrow point plays over the meter plate opposite ring handle, F. It will be seen in Fig. C that, as the instrument is 
withdrawn, we approach the stricture at .S' with the point of a wedge whose base corresponds to the greatest diameter 
of the bulb. With this wedge we keep the stricture well on the stretch. At R is seen the blade for incising, and 
whose handle is at K. The blade lies concealed and sheathed between the two half cylinders of the curve, and can 
be made to protrude and cut to the depth of one line or less. This incising may be performed with a bulb of any size, 
and at one razor-like sweep, or by nicking, then dilating and repeating. The latter is preferable, since by this method 
we cut only through the depth of the cicatrix when the bulb glides on. That it does incise the healthy (?) urethra, both 
behind and in front of the stricture, may be urged as an objection, which, however, is more theoretical than real, since 
longitudinal incisions are not followed by contraction of the canal. 
" It is not claimed that a cure must necessarily follow simple incision with this urethrotome, but it is claimed that 
the instrument can be safely passed through any urethra admitting the filiform guide ; that it detects and locates the 
stricture during withdrawal; that it stretches or dilates steadily while the blade nicks fibre after fibre of the stricture 
through its entire thickness. That besides being a urethrometer, it can take the place of a series of conical sounds or 
dilators, and thus be used in the after treatment.-W. B. Rogers, M.D., in St. Louis Medical Journal. April, 1884. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
373 
URETHRAL STRICTURE. 
INTERNAL URETHROTOMY. 
Haemostatic. 
Fig. 2991.-Bates' Urethral Haemostat, for the Application of Cold 
by Means of Ice Water. 
" Haemorrhage is not unfrequently an unpleasant accident following operations upon strictures, especially those of 
rupture and internal urethrotomy. It is not so much to be feared at the time of the operation as at some subsequent 
period, more particularly after the passage of urine, or on the occurrence of an erection at night. It shows itself 
usually within three or four days after the operation ; but the patient, especially after 
internal urethrotomy, is not free from this danger for ten days or a fortnight-instances 
of its occurrence at this late period being now and then met with. Knowing the site 
of the stricture operated upon, the surgeon will be able to determine very nearly the 
situation of the bleeding point; moreover, if the latter be in the penile portion of the 
canal, the blood will flow continuously from the meatus, or, if in the portion of the 
canal posterior to the bulb, the blood may flow backwards and even distend the 
bladder with clots. 
" The liability to this accident emphasizes the necessity of keeping the patient quiet, 
and preferably in the horizontal posture for some days after the operation, and also ot 
his having a faithful attendant. Should haemorrhage occur it may be controlled by the 
application of ice to the penis and the perinaeum. If obstinate, and the bleeding point 
be situated in the pendulous portion of the canal, a moderate sized catheter should be 
introduced and pressure exercised by a bandage encircling the penis. When the 
source of the bleeding is more deeply seated, pressure may be most conveniently exer- 
cised upon the perinaeum in the following manner: Place upon the perinaeum a pad of 
sufficient thickness ; tie a bandage firmly around the waist; finally, pass an elastic bandage by a number of turns from 
behind forwards, and from before backwards, between the buttocks and over the pad, from the waist-bandage behind 
to the same in front. Dr. Otis has invented the above tourniquet (Fig. 2992) for the purpose and recommends that 
it should be applied loosely directly after the operation, so as to be tightened in a moment if necessary."-"Venereal 
Diseases." Bumstead and Taylor. 1879. 
Fig. 2992.-Otis' Perineal 
Tourniquet. 
Fig. 2993.-Otis' Urethral Haemostatic Tube. 
"In a small proportion of cases haemorrhage has been quite profuse; not during or immediately following the 
operative procedure, but coming on after urination, or, more commonly, during erection. Especially from the latter 
cause, it is sometimes sudden and copious, but readily controlled. The fact that haemorrhage, of any moment, ever 
occurs, leads me to use and to advise such precautionary measures, in all cases, as will give complete security against 
harm from this accident. My usual plan is to have an intelligent attendant instructed to watch the patient during sleep 
(when erections are most likely to occur), and to make prompt pressure of the penis at the incised locality. This is 
usually sufficient to arrest the flow. Applications of ice are also of value for the same purpose. In some cases I have 
found it necessary to introduce a tube into the urethra, making pressure upon it by means of a light bandage, and to 
have it retained until the haemorrhagic tendency has passed. When an attendant is not available a soft rubber tube, 
one or two sizes smaller than the normal calibre of the canal, may be inserted and retained by a light bandage for one, 
two or three days, according to the necessities in any given case. If the tube is not worn from the first it may be in- 
troduced to protect the surface of the wound during urination, for a day or two. In very sensitive persons I have had 
the bladder habitually emptied by means of a small soft rubber catheter. An admirable method of arresting haemor- 
rhage in the pendulous urethra, and especially at or near the meatus urinarius, has been devised by Dr. Geo. K. 
Smith, Professor of Genito-Urinary Diseases in the Long Island Hospital Medical College. This consists of pressure 
applied to the sides of the penis by two thin pasteboard splints, an inch or so in width, padded with cotton and en- 
circled, when in position, by half a dozen narrow india-rubber bands. Small notches in the splints keep the bands 
from slipping and the amount of pressure may be easily regulated by the number or size of the bands. Simple separa- 
tion of the splints is sufficient to permit urination without removing them."-" Stricture of the Male Urethra." F. N. 
Otis, M. D. 1878. 374 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRICTURE. 
INTERNAL URETHROTOMY. 
Haemostatic. 
Fig. 2994.-Hunter's Urethral Tourniquet. 
" To lessen the chief dangers of urethrotomy-haemorrhage, urinary infiltration and urethral fever. It consists of two 
curved bars, nine and a quarter inches long, connected on their distal end by a third bar, half an inch in length. They are 
separated by a screw. When the instrument is closed it measures No. 20, French scale. Its pressure can be limited to 
the exact extent of the incision. The convex bar is larger than its fellow and nearly round. This rounded surface, when 
buried in the incision, prevents not only the loss of blood, but also haemorrhagic infiltration about the edges of the 
wound. A fenestrum is provided in the short bar, through which the urine may be voided. A septum divides the 
bore of the large bar-ice water from a fountain syringe may be made to flow in one of the tunnels and return 
through the other-and, by attaching a rubber tube, it may be conducted into a receptacle. If the instrument be left 
with the patient, with instructions how to insert it, and how often, he will be able himself to not only thoroughly keep 
apart the edges of the wound while healing, but will also himself be able to arrest a possible secondary haemorrhage."- 
Alexander S. Hunter, M.D. Medical Record, November 9, 1878. 
EXTERNAL PERINEAL URETHROTOMY. 
The operation consists in cutting the urethra from without inward in the perineal portion, to relieve retention of 
urine, in case of failure of catheterism and for the cure of stricture. 
" External urethrotomy is a valuable operation in selected cases and includes three very different measures; one, 
in which the stricture is divided through the perinaeum upon a grooved director passed through the stricture : external 
division, or Syme's operation ; the second, in which the urethra is opened in front of the stricture and a grooved 
probe passed through it into the bladder previous to its division: Wheelhouse's operation and Gouley's method ; and, 
a third, in which the perinaeum is laid open without a urethral guide-the stricture being imperious: Cock's operation. 
Syme's Operation.. 
Fig. 2995.-Syme's Staff. 
" Syme's operation is valuable in the highly irritable, as well as contractile stricture, in cases which Syme described 
as strictures that ' continue to present symptoms after being dilated,' and that ' are indomitable by the ordinary means 
of treatment.' A grooved staff as large as can be passed through the stricture is first introduced, the patient having 
been placed upon his back as if about to be cut for stone. The surgeon should then, with perfect precision, intro- 
duce his knife into the centre of the perinaeum and, at one stroke, cut down upon the groove situated at the lower 
border of the staff ; and, using this as his guide, the perineal portion of the urethra in which the stricture is situated 
can be readily and freely divided. There are but two important points to be observed in this, the second step of the 
operation ; the first is to be certain that the knife touches the groove of the staff, and, secondly, that the whole of the 
diseased or strictured portion of the urethra is freely divided. Having succeeded in this, the essential part of the 
operation, and after a grooved probe or director has been introduced into the bladder through the perineal wound, the 
sound may be removed, when a full sized elastic catheter can be readily introduced through the penis into the bladder 
and fixed in ; but, if the bladder resents its presence, it may be removed. After the wound has closed, the occasional 
introduction of a catheter is essential, and ' prudence requires that every patient should learn to introduce bougies to 
maintain the potency of the urethra.' "-" Bryant's Practice of Surgery." Third Am. Ed. Roberts. 1881. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
375 
URETHRAL STRICTURE. 
EXTERNAL PERINEAL URETHROTOMY WITH CONDUCTOR. 
Wheelhouse's Operation, 
" The instruments required are : A special staff (Fig. 2996), fully grooved through the greater part, except the last 
half inch, where it stops abruptly and terminates in a rounded button-like end ; an ordinary scalpel; two pair of straight- 
Fig. 2996.-Wheelhouse's Staff. 
bladed forceps, nibbed at the points, ordinary artery forceps and ligatures ; lithotomy bandages, sponge, a well grooved 
and finely probe-pointed director; a straight probe-pointed bistoury; Teale's probe gorget (Fig. 2997), a short silver 
catheter (No. 10 or 11 gauge) with elastic tube attached. 
" Operation.-The patient is placed in the lithotomy position, with the pelvis a little elevated, so as to permit the 
light to fall well upon it and into the wound to be 
made. The staff is to be introduced with the groove 
looking towards the surface, and brought gently into 
contact with the stricture, for fear of tearing the 
tissues of the urethra and causing it to leave the 
canal, which would mar the whole after-proceedings, 
which depend upon the urethra being opened a 
quarter of an inch in front of the stricttire. Whilst 
an assistant holds the staff in this position, an in- 
cision is made into the perinaeum, extending from 
opposite the point of reflection of the superficial perineal fascia to the outer edge of the sphincter ani. The tissues of 
the perinaeum are to be steadily divided until the urethra is reached. This is now to be opened in the groove of the 
staff, not upon its point, so as certainly to secure a quarter of an inch healthy tube immediately in front of the stricture. 
As soon as the urethra is opened, and the groove in the staff fully exposed, the edges of the healthy urethra are to be 
seized on each side by the straight-bladed nibbed forceps and held apart. The staff is then gently withdrawn, until 
the button-point appears in the wound. It is then to be turned around, so that the groove may look to the pubes, and 
the button may be hooked into the upper angle of the opened urethra, which is thus held stretched open at three 
points-at two by the forceps, and at the third by the hook of the staff. The operator looks into it immediately in 
front of the stricture, inserts the director into the urethra, and, if he cannot see the opening of the stricture, which is 
often possible, generally succeeds in very quickly finding it, and passes the point onwards through the stricture to- 
wards the bladder. The stricture is sometimes hidden among a crop of granulations or warty growths, in the midst of 
which the probe-point easily finds the true passage. The director having been passed on into the bladder (its entrance 
into which is clearly demonstrated by the freedom of its movements), its groove is turned downwards, the whole 
length of the stricture is carefully and deliberately divided on its under surface and the passage is thus cleared. The 
director is still held in the same position and the straight probe-pointed bistoury is run along the groove, to insure 
complete division of all bands or other obstructions. These being thoroughly cleared, the old difficulty of directing 
the point of a catheter through the divided stricture is to be overcome. To effect this, the point of the probe-gorget 
is introduced into the groove of the director, and, guided by it, is passed onwards into the bladder, dilating the 
divided stricture and forming a metallic floor, along which the point of the catheter cannot fail to pass securely into 
the bladder. The short catheter is now passed from the meatus down into the wound ; is made to pass once or twice 
through the divided urethra, where it can be seen in the wound, to render certain that no obstructing bands have been 
left undivided, and is then, guided by the probe dilator, passed easily and certainly along the posterior part of the 
urethra into the bladder. The gorget is now withdrawn, the catheter fastened in the urethra and allowed to remain 
for three or four days, the elastic tube conveying the urine to a vessel under or by the side of the bed. After three or 
four days the catheter is removed, and is then passed daily, or every second or third day, according to circumstances, 
until the wound in the perinaeum is healed, and, after the parts have become consolidated, it requires to be passed still 
from time to time to prevent recontraction."-C. G. Wheelhouse, Senior Surgeon to the Infirmary at Leeds. 1869-70. 
Fig. 2997.-Teale's Probe Gorget. 
Gouley's Method, 
The following description of Prof. Gouley's improved method of external division of the urethra in peringeo, for 
the relief of obstinate stricture, is extracted from the New York Medical Journal for August, 1869. 
Operation : The perinaeum having been shaved, the patient is etherized. The urethra is explored with a flexible 
bulbous bougie, of proper size, to ascertain the exact seat of the obstruction. The canal is then filled with olive oil 
and a capillary probe-pointed whalebone bougie is introduced into the urethra. If its point becomes engaged in a 376 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRICTURE. 
EXTERNAL PERINEAL URETHROTOMY WITH CONDUCTOR. 
Gouley's Method. (Continued.) 
lacuna, it is withdrawn a little, and again carried onward with a rotary movement. If it enters a false passage it is 
retained in situ by the left hand, while another is passed by its side. If this second guide makes its way into a false 
passage it is to be treated precisely as was the first, and the operation repeated till one guide can be made to pass the 
obstruction and enter the bladder. Sometimes five or six guides are thus caught before the false passage is filled up 
and the natural route opened. As soon as a guide enters the bladder-which 
may be known by the ease with which the instrument may be moved in and 
out-the other guides are withdrawn. 
(Teevan calls it ' A conductor which tells the surgeon where it has 
gone to, so that external urethrotomy can now be performed with a certainty 
hitherto unattainable, and also extended to desperate cases which were 
formerly beyond reach.'-London Lancet, August, 1874.) 
The next step is to introduce a No. 8 grooved metallic catheter staff, with a 
quarter of an inch of its extremity bridged over, so as to convert the groove into a 
canal, the bridged portion itself being also grooved. Its introduction is accom- 
plished by passing the tunnelled point over the free end of the retained guide, then 
holding the latter steadily between the thumb and index finger of the left hand, and 
pushing the catheter staff gently into the urethra until its point comes in contact 
with the face of the stricture. The staff and guide are then kept in position by an 
assistant, who at the same time supports the scrotum. The patient is placed in the 
lithotomy position, and held by two assistants, or, better, by Pritchard's anklets 
and wristlets. 
" The surgeon, seated on a low chair, first makes a digital exploration per rectum, 
to ascertain, as far as practicable, the condition of the membranous and prostatic 
divisions of the urethra; then he makes a free incision in the median line of the 
perinseum, extending from the base of the scrotum to within half an inch of the 
margin of the anus, involving only the skin and superficial fascia. A few well 
directed cuts having brought into view the urethra, the operator, with his finger- 
nail, feels for the groove on the bridged portion of the staff, and opens the canal 
upon this groove longitudinally, in the median line, exposing to sight the instrument. 
A loop of silk is then passed through each edge of the incised urethra, close to the face of the stricture, and held by 
the assistant in charge of the corresponding limb. When the urethra is opened, and the loops are secured, the catheter 
staff is withdrawn a little, so as to bring into view the black guide ; then the stricture, with about half an inch of the 
uncontracted canal behind it, is divided. This is best accomplished by means of the Beaked Bistoury, Fig. 3000. 
Fig. 2998.-Gouley's Catheter Staff. 
Fig. 2999.-Gouley's Tenaculum (useful in the operation). 
Fig. 3000.-Gouley's Beaked Bistoury. 
" It is a very narrow, beaked, straight bistoury, about the size of a small probe, and is made to enter the stricture 
alongside of the guide, as if it were a probe, and the incision is done by directing the edge downward. The last step 
is to pass the catheter staff, guided by the whalebone bougie, into the bladder ; but, should it be arrested in its course, 
the knife must be reintroduced and the incision extended further back. The operation is thus completed without un- 
necessary delay ; the bladder is entered with the greatest gentleness, and, by the free flow of urine through the 
catheter, the surgeon is certain that the instrument has gone in the right direction, that he has divided the stricture 
thoroughly, and that he has not simply enlarged a false passage. 
" Where the initial introduction of the whalebone guide is impossible, it may be passed through the perineal 
wound into the bladder, and the stricture divided as before ; or Fig. 3001 may be used as a guide for the incision and 
the whalebone bougie then passed along its groove. In either case, with the 
guide in the bladder after the incision, the point of the catheter staff may be 
protruded from the wound, the free end of the guide carried through the 
terminal canal and the bladder entered as before described."-" Diseases of 
the Urinary Organs." Gouley. 1873. 
Fig. 3001.-Arnott's Grooved Probe. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
377 
URETHRAL stricture. 
EXTERNAL PERINEAL URETHROTOMY WITHOUT A GUIDE. 
Cock's Operation. 
" Cock's operation, tapping the urethra at the apex of the prostate, unassisted by a guide. The only instruments 
required are a broad double-edged knife with a very sharp point, a large silver probe-pointed director with a handle, 
and a canula or female catheter, modified so that it can be retained in the bladder. 
" The patient is to be placed in the usual position for lithotomy ; and it is of the utmost importance that the body 
and pelvis should be straight, so that the median line may be accurately preserved. The left forefinger of the operator 
is then introduced into the rectum, the bearings of the prostate are carefully examined and ascertained, and the tip of 
the finger is lodged on the apex of the gland; the knife is then plunged steadily but boldly into the median line of the 
peringeum and carried on in a direction towards the tip of the left forefinger, which lies in the rectum. At the same 
time, by an upward and downward movement, the vertical incision may be carried in the median line to any extent 
that is considered desirable. The lower extremity of the wound should come to within half an inch of the anus. 
" The knife should never be withdrawn in its progress towards the apex of the prostate ; but its onward course 
must be steadily maintained until its point can be felt in close proximity to the tip of the left forefinger. When the 
operator has fully assured himself as to the relative position of his finger, the apex of the prostate and the point of the 
knife, the latter is to be advanced with a motion somewhat obliquely, either to the right or left, and it can hardly fail 
to pierce the urethra. If, in this step of the operation, the anterior extremity of the prostate should be somewhat in- 
cised, it is a matter of no consequence. 
" The knife is now withdrawn, but the left forefinger is still retained in the rectum. The probe-pointed director 
is carried through the wound, and, guided by the left forefinger, enters the urethra and is passed into the bladder. 
The finger is now withdrawn from the rectum, the left hand grasps the director, and along the groove of this instru- 
ment the canula is slid until it enters the bladder. 
" The operation is now complete, and it only remains to secure the canula in its place with four pieces of tape, 
which are fastened to a girth around the loins. A direct communication with the bladder has now been obtained and 
the relief of the patient will be immediate ; unless the kidneys have become irremediably disorganized, we may confi- 
dently anticipate a favorable result and the restoration of the urinary organs will be more or less complete, in propor- 
tion as the obstructed portion of the urethra is more or less amenable to the ordinary judicious treatment of stricture. 
The canula may generally be retained in the bladder for a few days, and, if the state of the urine renders ablution 
necessary, the viscus may be frequently washed out. The canula may then be removed, cleansed and reintroduced. 
A flexible catheter is sometimes more desirable and congenial to the feelings of the patient than a metallic canula. 
" If the previous destruction has not been very great, and if the case progresses favorably, the swelling of the 
perinseum and scrotum gradually subsides, the induration disappears and the urinary sinuses become obliterated. The 
urethra may be examined in the ordinary way, to test its permeability, and one may be agreeably surprised to find that 
the sound or catheter readily passes through the former stricture until it strikes against the canula. An attempt may 
then be made to introduce a flexible catheter into the bladder, and its passage may, if necessary, be facilitated by pass- 
ing a director through the perinseum into the bladder, and guiding the catheter along its groove. The urethra once 
restored to its normal condition and calibre, the artificial opening through the perinseum soon heals up, and, barring 
the liability of stricture to return if not attended to, the cure may be said to be complete."-" Guy's Hospital Re- 
ports." 1866. 
"Few operations in surgery are more formidable than this one of perineal urethrotomy ■without a guide. The 
surgeon who approaches it should be thoroughly at home in the anatomy of the perinseum, and even then should be 
prepared for possible failure. The patient is tied and held in the lithotomy position, after he has been anaesthetized. 
The scrotum is held out of the way by the assistant. The perinseum having been shaved, an external incision should 
be made directly in the median line, from two and a half to three inches long. It should be carried down, layer after 
layer, until the urethra has been opened into upon the end of the blunt staff previously introduced up to the front face 
of the stricture. The perinseum should be turned toward a window, and a couple of hours of daylight always allowed, 
in order to have an abundance of time if the operation proves complicated. Haste, in this operation, is bad surgery. 
After the urethra has been laid open the subsequent steps of the operation are greatly simplified by adopting Avery's 
suggestion for getting room and light. It consists in transfixing each flap of the wound with a stout ligature about 
three feet long. The ends of each ligature are knotted, thus forming a long loop on either side, which may be held 
by assistants. By means of these loops the wound is kept open to the bottom without the necessity of thrusting 
fingers or spatulae into the small space, where the fingers of the operator alone are necessary."-" Genito-Urinary 
Diseases with Syphilis." Van Buren and Keyes. 1874. 
Puncture of the bladder, paracentesis vesica, is an operation of very ancient date, and has been practiced in va- 
rious ways to fulfill either temporary or permanent purposes. A history of the proceeding would show that, from 
time to time, there has been considerable fluctuation in opinion as to the best way of performing it. See " Paracen- 
tesis," p. 128, "Aspiration," p. 129, "Tunnelling the Prostate," p, 381, "Cystotomy," page 390, &c. 378 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRI6TURE. 
PROSTATIC. 
"Prostate.-A glandular, cordiform body, of the size of a chestnut, situate before the neck of the bladder, behind 
the symphisis pubis and surrounding the first portion of the urethra. Its excretory outlets, to the number of ten or 
twelve, open into the part of the urethra that traverses it, and pours into it a whitish viscid humor (liquor prostaticus) 
intended to lubricate the interior of the urethra and to serve as a vehicle for the sperm in its ejaculation. It is usually 
described as consisting of three lobes-two lateral and one middle,* fitted in between them on the under side and lying 
beneath the neck of the bladder and the immediately adjacent parts of the urethra."-Dunglison. 
HYPERTROPHIED PROSTATE. 
" By digital examination per rectum some estimate of the size and consistency of the prostate can be formed, and 
it is possible to ascertain if this body is harder or softer than normal, if one lobe is larger than the other, if it is nodu- 
lated or smooth and uniformly enlarged, if its apex is obtuse instead of being lost in the membranous portion of the 
urethra, or if there is longitudinal increase. 
" The next step in the physical examination of a case of suspected prostatic hypertrophy is to ask the patient to stand 
up and urinate ; if he can urinate spontaneously, the character of the jet of urine will aid to a certain extent in the 
diagnosis; but it is to be borne in mind that a man who has no prostatic hypertrophy, but contracture of the vesico- 
urethral sphincter, urinates precisely in the same way as he with enlarged prostate, i. e., in a small, weak and per- 
pendicular stream, suddenly interrupted and soon followed by a succession of drops, perhaps twenty or thirty, to begin 
again, and to be again followed by the dribbling, or even slobbering, until two or three ounces of urine may be collected 
in a vessel, without which the patient surely soils his garments or wets his shoes. When the patient has passed all the 
urine he can void spontaneously, a soft catheter is introduced, and the residual urine drawn off, measured and inspected. 
It may be clear or turbid. The turbidity may be owing to the presence of gravelly substance, of pus, or of both. 
Such purulent urine indicates cystitis; ammoniacal slimy urine, decomposition of the pus, which proves that the 
urine has been stagnant for a considerable time. Fetid, slimy, chocolate-colored urine indicates that haemorrhage has 
occurred and that the cystitis is in an advanced stage. Residual or stagnant urine in the bladder is then another link 
in the chain of evidence of prostatic obstruction. 
" The physical exploration is further carried on by the use of certain rectangular metallic catheters and sounds, with 
a view of determining the situation, size or form of the obstruction. To Dr. Mercier belongs the credit of suggesting 
and first employing the short-beaked, rectangular catheters and sounds for ex- 
ploring the prostate and bladder, as well as for evacuative catheterism in reten- 
tion of urine. The advantages of the rectangular beak over all others for the 
uses to which it is applied are: I. The extremity of the short beak (| inch 
long) is constantly in contact with the upper urethral wall in the prostatic por- 
tion. 2. The blunted heel comes in contact with the obstruction and overrides 
it easily, while in the case of a long curved instrument the point is presented to the obstacle. 3. The beak can be 
rotated with the greatest facility when it has entered the bladder, and serves at the same time as a stone searcher and 
as the means of detecting induration and hypertrophy of the bladder. Thus, by the aid of the rectangular sound, it is 
possible to diagnosticate intra-urethral hypertrophy of either lobe of the prostate-the deflection of the handle of the 
instrument indicating the affected side-longitudinal hypertrophy, intra-vesical hypertrophy of one or both lobes, 
supra-montanal hypertrophy, whether as a crescentic valvule, as a bar, or as a sessile pedunculated tumor or tumors. 
A few years ago it occurred to me 
that an instrument of still greater pre- 
cision might be constructed. I ac- 
cordingly devised the cysto-pylometer, 
by the aid of which I have been able 
to measure accurately the thickness of 
crescentic valvules and of urethro- 
vesical bars. The beak of this instru- 
ment is nearly rectangular and one inch in length. The shaft is in two longitudinal segments, the male segment 
sliding over the female, and being flat at its vesical end to come in contact with a correspondingly flat surface on the 
inner side of the beak, and designed to grasp the valvule or the bar. The reverse of the flattened, hollow and quadri- 
lateral handle is graded in centimetres and millimetres, and an indicator is screwed to the male blade. 
" Surgical Treatment.-The surgical treatment of hypertrophy and its consequences may, with propriety, be divided 
into two distinct parts. First, that which relates to the mechanical means of relief of obstructed urination and its first 
consequence, cystitis ;f second, that which relates to the removal of the obstruction by operation {prostatotomy, prosta- 
tectomy). 
Fig. 3002. 
Mercier's Rectangular 
Sound. 
Fig. 3003.-Gouley's Cysto-Pylometer. 
* Some authors allude only to the two lateral lobes. 
t See " Retention of Urine, Catheters," page 384, &c. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
379 
URETHRAL STRICTURE. 
PROSTATOTOMY AND PROSTATECTOMY 
'After a careful study and analysis of the various attempts to relieve 
prostatic obstruction that had been made by the surgeons who preceded 
him, Mercier was led to devise instruments to excise a portion of the ob- 
struction and thus make a channel through which the urine could be 
more freely expelled from the bladder. 
Mercier gave no names to his instruments, except that of incisor and 
excisor, and to his operations that of incision and excision of urethro- 
vesical valvules. I have named the instrumentsprostatotome and prosta- 
tectome, and the operations prostatotoniy and prostatectomy. 
"Internal prostatotoniy and 
prostatectomy are executed by 
means of special instruments, 
not unlike lithotribes in appear- 
ance, and introduced in a simi- 
lar way. 
"Externalprostatotoniy and 
prostatectomy are preceded by 
external perineal urethrotomy 
of the membranous portion. 
The former is done with a 
special prostatotome; or, simply 
with a straight probe-pointed 
bistoury or a concealed cysto- 
tome ; the latter with a special 
prostatectome, or, as in the case 
of pedunculated tumor, with a 
small wire ecraseur, or in an iso- 
lated intra-mural tumor, by in- 
cision and enucleation. 
" On account of the difficulty 
which I have experienced with 
forward the urethro-vesical obstruction with the 
following is a brief description. 
Fig. 3004. 
Mercier's First Excisor. 
Fig.' 3005.-Mercier's Last Incisor and Ecraseur Combined. 
Fig. 3006.-Mercier's Last Excisor. 
Mercier's prostatectome, in surmounting from behind 
male blade, I devised a prostatectome, of which the 
Fig. 3007.-Gouley's Prostatectome. 
" This instrument resembles an ordinary modern lithotribe, and its mechanism is very simple. It consists of a male 
and a female blade, the one sliding into the other. The male blade is hollow, its sides are vertical and its superior 
portion a little rounded. It is welded to a tubular shaft, in the centre of which is a long needle worked by a button, 
at the proximal extremity of the handle. The object of this needle is to transfix the prostatic valvule or tumor and 
hold it in position from the moment it is seized till it is cut and extracted, the cavities in the two blades rendering ex- 
traction certain. The inclination of the male blade is such that it will ride quite easily over the valvule as a pre- 
paratory step to prehension, whereas in Mercier's instrument the same blade is bent so abruptly that it is with the 
greatest difficulty carried over the valvule, and I have found it impossible in some instances. Again, what in Mercier's 
exciseur a hame^on is a cutting edge, in mine is a flat edge, so that it really acts as an ecraseur. This instrument will 
cut or punch out a segment of the valvule, three by nine millimetres. The beak is hollow to receive the piece of 
valvule, in part at least, and has a small orifice at its extremity, which serves the double purpose of allowing a little 
water to escape and making sure that the bladder has been reached, and of forcing out any blood oozing from the cut, 
which might otherwise soon coagulate, fill the cavity and interfere with the proper lodgment of the segment of valvule. 380 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL STRICTURE. 
PROSTATOTOMY AND PROSTATECTOMY. (Continued.) 
The shaft of the female blade is cut sloping for four centimetres to its junction with the beak, so as to give more 
depth to the male blade. The handle is copied from Colins' lithotribe handle. The instrument is easily dismounted 
for cleansing by first unscrewing the button which serves to work the needle. Marks, one centimetre apart, on both 
surfaces of the screw apparatus, indicate the extent of separation of the blades during seizure of the valvule, and con- 
sequently its thickness. 
" To seize and punch out a piece of the valvule, the instrument is introduced locked, the beak is reversed as soon as 
it has entered the bladder, and the screw turned from right to left, so as to open the blades or jaws, when the male 
blade will pass over the valvule and drop in front of it into the prostatic sinus. The instrument, still locked, is moved 
to and fro, that the operator may know that it is in the proper position ; then the needle is thrust through the valvule 
until its point has entered a shallow pit in the posterior wall within the female blade. The screw is now turned from 
right to left until there is a slight resistance. The operator, casting his eye upon the handle, at once ascertains the 
thickness of the valvule which he is about to cut. A few slow turns of the screw which drives the male blade home will 
complete the section or ecrasement, with a peculiar crunching sensation, such as is never experienced in any other ope- 
ration. The instrument, holding the segment in its closed jaws, is pushed into the bladder, and then slowly with- 
drawn, and a full dose of quinine is given. In the course of half an hour the patient is asked to urinate ; failing, his 
bladder is emptied by means of a catheter. Contrary to Dr. Mercier's injunctions, I have retained a catheter in the 
bladder for twenty-four hours in some of my cases. 
The after treatment consists in the introduction of an instrument to make dilatation and depression of the urethro- 
vesical orifice once every five days to retard the process of cicatrization. 
Fig. 3008.-Mercier's Prostatic Gland Dilator. 
Fig. 3009.-Gouley's Prostatic Gland Dilator. 
Indications and Contra-Indications. 
" Prostatotomy and prostatectomy, in my belief, should be reserved for cases of crescentic valvular obstructions and 
bars of not more than a centimetre in thickness. I would give my preference to external prostatotomy over the in- 
ternal operation in these cases, although I have had recourse to external prostatotomy and prostatectomy in only four 
of nine cases. As a general rule it is best to perform the operation in the early period of the existence of obstruction to 
urination ; but, under certain circumstances, it is justifiable to operate upon cases where the obstruction has been of long 
standing, for instance when ordinary catheterism becomes very difficult or impossible. Advanced renal disease is a 
contra indication. Dr. Mercier has operated successfully upon cases where stagnation of urine had existed seven and 
nine years. The co-existence of stone is not a contra indication, nor is age ; some of Mercier's patients were 74, 76 
and 78, one of mine was 76. 
" Pedunculated tumors (which are rare) should be removed by external operation, and, if large, with the aid of a small 
wire ecraseur; if small by clamping them with Mercier's last prostatotome and cutting through the pedicle. Intra- 
mural tumors also require external section, followed by enucleation. This method has been eminently successful. 
" I doubt if anything can be gained by excising a portion of a large sessile supra-montanal growth, and am dis- 
posed to think that a very free central incision would be more serviceable."-"Some Points in the Surgery of the 
Hypertrophied Prostate." By John W. S. Gouley, M. D., Surgeon to Bellevue Hospital, New York, &c., &c. 
Gaillard's Medical Journal, New York, July, 1885. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
381 
URETHRAL STRICTURE. 
PROSTATIC, DILATORS, 
Fig. 3010.-Walker's Prostate Gland Dilator. 
" On the earliest manifestations of prostatic obstruction, mechanical treatment should be resorted to with the same 
diligence that is required in the treatment of other forms of urethral obstruction. If this be not done, it is only post- 
poning the day until the necessity 
is greater and the difficulty more ap- 
parent. There are at least two con- 
ditions of the enlarged prostate which 
are unattended with obstructed mic- 
turition, where either channels are 
formed between the masses of the 
growth, or the line of the urethra re- 
mains unaltered. These conditions 
may be artificially produced to an 
extent capable of being useful. For 
this purpose I have recently devised 
some specially adapted bougies which 
I use. They are gum elastic, from 
two to four inches longer in the stem 
than the ordinary instruments, and have an expanded portion, an inch from the tip, which is made to enter the 
bladder. If dilatation be not too rapidly proceeded with, no irritation will be aroused; on the contrary, irritability 
will subside by reason of the completeness with which the bladder is emptied. Where there is residual urine, catheters 
of a similar shape may be substituted, thus allowing any water to be drawn off, whilst at the same time the prostate is 
subjected to dilatation."-" International Cyclopaedia of Surgery." Reginald Harrison, F. R. C. S., Ashhurst. Vol. 
VI., 1886. 
Fig. 3011.-Harrison's Prostatic Dilators. 
Fig. 3012.-Fitch's Dome Trocar Catheter. 
" To Tunnel the Prostate.-The instrument, with the dome fully protruded, as in 3, and fixed by the thumb- 
screw (m), is introduced by the urethra till the dome (<7) is stopped by the enlarged prostate, where it is to be firmly 
held while the forefinger of the left hand steadies the prostate ; then the thumb-screw (m) is loosened, and the tips of 
the fingers and the thumb of the right hand grasp the outer canula (b), 3, and press it quickly forward. If now the 
instrument does not promptly advance, let the right thumb-nail catch the end of the outer canula at i, and push it 
onward while the inner side of the right middle finger makes counter-pressure on the distal edge of the thumb-screw 
(m), or an assistant may pull out the disk (£) so as to retract the dome, especially taking care that while the inner tube 
is being retracted the outer tube is to be pushed boldly onward, when the cutting point (r) 1, of the outer tube will 
pass easily through the prostate into the bladder, and urine escaping at i will show that the bladder is entered and the 
operation completed. Then, the dome being protruded by pressing home the disk (k) and fixed by tightening the 
screw (m), the instrument again becomes a harmless catheter, giving full flow to the urine through the fenestra (/), and 
may be retained in the bladder twenty-four hours, or until the perforation is sufficiently patulous, shown by the in- 
strument moving easily in it ; then it may be withdrawn, and a full-sized metal catheter introduced twice a day till the 
new channel is permanently established. It may also be used for supra-pubic puncture, rectal puncture of the bladder, 
and for tapping ovarian cysts/^r vaginam."-The New York Medical Journal and Obstetrical Review, February, 1882. 382 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL AjMD UR0-6YSTIC. 
BLADDER, VESICA URINARIA, CYSTIS, UROCYSTIS. 
Anatomy and Physiology. 
" Bladder, a musculo membranous bag, cyst or pouch, which serves as a reservoir for the urine secreted in the 
kidneys. It is called vesica urinaria. The bladder is situated in the pelvis, immediately behind the symphysis 
pubis and in front of the rectum in the male; in front of the uterus and vagina in the female. Thus placed in the 
lowest portion of the trunk in front, it communicates by means of two long tubes, called ureters, with the two kidneys, 
placed high up in the back, just above the lumbar region, on each side of the vertebral column. It communicates 
with the exterior by means of a single tube called the urethra, through which the urine is voided. In infancy it is of 
a pyriform shape, and situated almost entirely in the abdomen ; it undergoes a change of form in the adult, and sinks 
deeper in the pelvic cavity. It then assumes the shape of a short oval, compressed in its anterior and posterior walls ; 
its lower surface expands on the rectum and forms what is termed by anatomists the has fond of the bladder. In the 
female its transverse diameter is greater than it is in the male, owing to the position of the uterus and vagina between 
the bladder and the rectum. It increases in dimensions with advancing age, and is larger in females than in males, 
probably from habitual distention, arising from constraint. The direction of the bladder is oblique, being inclined 
forward and upward. It is retained in position by ligaments. Anatomists have divided it into six regions or surfaces, 
for the facility of description and surgical operation ; these are named anterior, posterior, superior, inferior and left 
and right lateral. The anterior surface lies behind the symphysis pubis, with which it is connected by loose connective 
tissue. When distended the bladder rises, and its anterior surface comes in contact with the recti muscles of the 
abdomen. The posterior surface is covered by the peritoneum, which is reflected upon it from the rectum in the 
male and from the uterus and vagina in the female. The lateral and superior regions are partially covered by the 
peritoneum. The inferior region, or bas fond, is the most important in a surgical point of view. It is bounded be- 
fore by the prostate gland and behind by the peritoneum. Attached to it in the male we find the vesiculce seminalis 
and the vasa deferentia, which converge to the prostate gland, leaving a triangular space, where the bladder is only 
separated from the rectum by a quantity of fatty connective tissue surrounding numerous small vessels, chiefly veins. 
In the female this region rests on the vagina, which separates it from the rectum. The anterior and inferior regions 
of the bladder being left uncovered by folds of the peritoneum, the surgeon is able to perform operations on those 
parts without injuring that membrane, which is so liable to dangerous inflammation from wounds. The walls of the 
bladder are composed of three layers or coats, united by connective tissue : an internal or mucous membrane, a middle 
or muscular coat, and an external or serous coat, formed by folds of the peritoneum. The muscular coat is composed 
of pale fibres interlacing in all directions, and enabling the bladder to contract so perfectly as to expel every drop of 
its contents. The neck of the bladder differs in structure from the rest of the organ, being composed of a somewhat 
fibrous whitish substance, and forming a connecting medium between the bladder and the urethra. Its posterior part 
rests upon the rectum ; its anterior is surrounded below and at the sides by the prostate gland, which is peculiar to the 
male. This gland is composed of an aggregation of mucous follicles, forming three lobes, one on each side of the 
neck of the bladder and one below, communicating by means of small ducts with the urethra. The inner coat or 
lining of the bladder, being a portion of the genito-urinary mucous membrane, not only lines the bladder, but is pro- 
longed upward through the ureters into the kidneys, and downward along the urethra. It is of a pale rose color, with 
a smooth surface when the bladder is distended, and corrugated when empty. This membrane secretes a viscid fluid 
termed mucus, which protects it from the acrimony of the urine with which it would otherwise be in contact. The 
secretion of the urine is performed by the kidneys, which are constantly active, without any apparent alteration of ac- 
tion and repose, although within a given period they do more work at one time than another. The urine thus secreted 
dribbles incessantly along the ureters, and drops into the bladder, where it accumulates until the walls are distended 
and a general uneasy sensation is produced, which calls for an evacuation of the contents. Congenital malformations 
of the bladder are not unfrequent. Sometimes it is altogether wanting, and in such cases the ureters empty into the 
rectum, as into the cloaca of birds, or at the pubes, or directly into the urethra. A still more frequent malformation 
is that in which, the lower portions of the recti muscles being imperfect, and the anterior wall of the bladder deficient, 
the posterior wall is protruded (extrophy) and forms a red fungus-like tumor above the pubes. The tumor presents 
two orifices, which are the mouths of the ureters, from which the urine constantly dribbles. Blasius describes a case 
in which the bladder was double. Molinetti, it is said, found in a female subject five kidneys, five ureters and five 
bladders. Inflammation may affect the coats of the bladder singly or together. When the mucous membrane is in- 
flamed there is a sense of irritation and a constant desire to discharge the contents. Ulcers, gangrenous spots and 
indurations of various kinds may be produced by inflammation. The secretion of the mucous membrane may be in- 
creased or altered, constituting what is termed catarrh of the bladder. The mucous membrane is sometimes found in 
a varicose state. In other cases it gives origin to cysts of different kinds, and fungous growths ; the latter occur 
mostly in old people. Various accidents and diseases may prevent the bladder from evacuating its contents, in which 
case it becomes excessively distended, and unless relieved inflammation ensues, a portion mortifies, through which the 
urine escapes into the abdomen, and speedy death is the result. After three days' retention the bladder usually at- GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
383 
URETHRAL AJMD URO-CYSTIS. 
BLADDER, VESICA URINARIA, CYSTIS, UROCYSTIS. 
Anatomy and Physiology. (Continued.) 
tains its utmost limit of distention, and if not relieved the contents are evacuated in small quantities, as they would be 
in a case of mere incontinence of urine ; and it is of great importance, therefore, not to mistake retention for incontinence 
where there is this point of similarity in their respective symptoms. When there is danger in delay, and a catheter 
cannot be introduced, the bladder must be punctzired, either through the perinaeum or the rectum, or above the pubes, 
as it is not covered by the peritoneum in these regions. Where urinary calculi exist in the bladder they are removed 
by surgical operations."-"American Cyclopaedia." 
Extrophy. Incontinence of Urine. 
Fig. 3013. 
Tiemann's Instrument for 
Extrophy of Bladder. 
Urinals for Incontinence 
Fig. 3014. 
Fig. 3015. 
Fig. 3016. 
Tiemann's instrument for 
everted (extrophy of) bladder 
consists of a metallic or hard 
rubber shield, to the lower 
extremity of which is attached 
an elastic tube, leading to a 
soft rubber pouch, to collect 
the urine. This is buckled to 
the thigh, or may be carried 
down to the boot. 
We have various other patterns, for 
males and females, of English, F rench 
and American make. 
" When cystitis, accompanying enlarged prostate, be- 
comes considerable enough to require the use of anodynes, 
the recumbent position should be insisted upon. The pa- 
tient should lie upon his back with a hair pillow under his 
hips, so that they may be raised higher than his shoulders, 
in this way relieving the bladder from some of the intestinal 
pressure, and favoring a drainage of venous blood from the 
pelvis. The head may be raised, but the shoulders must be 
low. The skin of the hypogastrium should be kept slightly 
reddened by the application of a hot, light poultice, con- 
taining a sprinkling of mustard, or more neatly by the use 
of moistened mustard paper, and a flat rubber bag, contain- 
ing hot water, which may be laid upon it. Heat, applied 
also to the perineum, is agreeable to the patient. To meet 
the demand of heating the perineum and hypogastrium at 
once, there has been constructed a rubber bag with a long 
hollow prolongation to pass between the thighs, the whole 
to be fastened on by suitable straps and to be filled with 
hot water. These bags afford great comfort. The rectum 
should be kept empty by the daily use of a hot enema. 
Water, as warm as can be borne in the rectum, often ex- 
ercises a decidedly soothing effect upon the inflamed 
bladder."-" Genito-Urinaiy Diseases with Syphilis." Van 
Buren and Keyes. 1874. 
Fig. 3017.-Van Buren and Keyes' Hot Water 
Bag, for Diseased Prostate. 384 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL A^ID U^O-SYSTIC 
RETENTION OF URINE. 
Fig. 3018. 
I arkers Compound Catheter 
and Caustic Holder. 
" A disease in which the urine accumulated in 
the bladder cannot be evacuated, or, at least, can- 
not be passed without extreme difficulty. In the 
former case the retention is said to be complete; 
in the latter, incomplete. Many writers have dis- 
tinguished three degrees of this affection, to which 
they have given the names dysury, strangury and 
ischury. Retention of urine may depend upon loss of 
contractibility, paralysis of the bladder, &c., or on some 
obstacle to the passing of the urine, as in cases of pres- 
sure of the womb on the bladder, of tumors in its 
vicinity, foreign bodies in its cavity, inflammation of 
the urethra, swelling of the prostate, stricture, &c. The 
pain is extremely violent, and the bladder may be found 
distended above the pubis. The treatment consists in 
introducing the catheter or puncturing the bladder, and 
in combating the cause which has produced the retention 
by particular- means adapted to each case."-Dunglison. 
Fig. 3019. 
Male and Female Catheter. 
" Triangular Ligament.-In a thin perinaeum we 
can feel the lower border of the deep perineal fascia or 
the so-called triangular ligament of the urethra. The 
urethra passes through it about one inch below the 
lower part of the symphysis pubis, and about three- 
quarters of an inch higher than the central tendon of the 
perinaeum. It is important to bear in mind these land- 
marks in introducing a catheter. If the catheter be de- 
pressed too soon, its passage will be resisted by the 
triangular ligament; if too late, it will be likely to make 
a false passage by running through the bulb. 
"Introduction of Catheters.-Keep the point of the instrument well applied against the upper surface of the 
urethra ; depress the handle at the right moment; keep the umbilicus in view ; in cases of difficulty feel the urethra 
through the rectum, to ascertain whether the instrument be in the right direction. Attention to these rules diminishes 
the risk of making a false passage, an injury which under great delicacy in manipulation ought never to happen."- 
" Gray's Anatomy." 
"Retention in a child is generally from stone impacted in the urethra ; in an adult from stricture; and in an old 
man from prostatic disease."-" Bryant's Practice of Surgery." Roberts. 1881. 
" The most common form of obstruction of the bladder, productive of retention of urine, is hypertrophy of the 
prostate gland. The enlargement may involve the entire organ, or it may be limited to one of its lateral lobes, or 
even to its mammillary process. 
" Great obstacle to micturition, and even retention of urine, may be caused by centric enlargement of the prostate, 
without any material increase of weight or bulk of the lateral lobes. The tendency of such a development is to en- 
croach upon and diminish the calibre of the corresponding portion of the urethra, and, consequently, to interfere more 
or less with the evacuation of the urine and the passage of instruments. 
" Ths treatment is by the catheter, and one of silver is generally far preferable to one of gum elastic. It should be 
at least twelve inches in length, and with a curve forming an arc equal to one-third of the circumference of a circle 
five inches and a half in diameter, otherwise it may fail to reach the distended reservoir."-''System of Surgery." 
Gross. 1882. 
In regard to mechanical means of relief of obstructed urination and its first consequence, cystitis, Dr. Gouley says: 
" Permit me to say a word about cartheters, and first let me urge that all rigid catheters be discarded, except in cases 
of false routes. The promiscuous and careless use of rigid instruments, whether metallic or non-metallic, is almost 
certain to lead to the infliction of wounds in the urethra, either at the bulbo-membranous region or in the prostatic 
sinus, and these rents soon after may be converted into troublesome false routes, which often render further catheter- 
ism of the bladder impossible and place the patient's life in great jeopardy. Even when used with the greatest caution, 
rigid catheters do much mischief."-" Some Points in the Surgery of the Hypertrophied Prostate," Gaillard's Medical 
fournal. New York: July, 1885. 
Evacuative Catheterism. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
385 
URETHRAL AJMD U^O-eYSTiC. 
RETENTION OF URINE 
Catheters for Evacuating. 
Fig. 3020.-Hutchinson's Prostatic Catheter. 
A silver prostatic catheter, with a large eye in its concavity, permitting of the introduction of a portion of india 
rubber tube through it. After introducing the tubing into the bladder, the catheter is withdrawn, and a small nozzle, 
with rings, is introduced into the end of the india rubber tube to allow of its being fixed to the penis. A stiletted 
plug for the nozzle, intended in the first place to plug its orifice, and in the second to stiffen the first three inches of 
the tube, will prevent its being bent and expelled. The nozzle, having been passed into the meatus, is fastened firmly 
to the penis by means of tapes and plaster. 
Fig. 3021.-French Gum. Prostatic Catheter. 
" French gum elastic catheters with a conical and 
bulbous joint are often of value on account of the 
ease and safety of their introduction. They are ad- 
mirably fitted for a patient's own use, since their 
flexibility renders it almost impossible for him to do 
himself harm."-"Venereal Diseases," Bumstead 
and Taylor, page 284. 1879. 
" Mercier's elbowed catheters (single 
or double curves) have fixed angles so as 
to override obstructions in the floor of the 
urethra, such as posterior median hyper- 
trophy. The point follows the roof of the 
canal or strikes any obstacle upon its in- 
clined surface, and at an angle which allows 
the instrument to ride over the obstruc- 
tion. For difficult cases these catheters 
are invaluable."-" Genito-Urinary Dis- 
eases." Van Buren and Keyes. 
" The patient should be cautioned against using 
gum catheters w'hich are at all worn or cracked, or 
whose eyes are deformed by use, as the slightest in- 
equality in the instrument causes pain and irritation 
and even erosion of the urethral mucous membrane. 
Orchitis, which is by no means an infrequent conse- 
quence of often repeated catheterism, is also traceable 
to the use of defective or worn out catheters."- 
" Diseases of the Urinary Organs." Gouley. Page 
287. 1873. 
The English yellow elastic catheters are stiffer than 
the French-black-more durable and easier to keep. 
The French will stick together in hot weather unless 
freely powdered with soap-stone dust and kept in a 
cool place. 
Fig. 3022.-Olivary Gum Catheter. 
Fig. 3023.-French Olivary Gum Catheter. 
Fig. 3024.-Mercier's 
Elbowed Catheter. 
Fig. 3025.-Mercier's 
Double Elbowed 
Catheter. 
Fig. 3026.-Curved 
Gum Catheter. 
Figs. 3027, 3028, 302g. 
English Silk Webb Catheters. 386 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL A^ID URO-CYSTIC. 
RETENTION OF URINE. 
Catheters for Evacuating. 
Fig. 3030. 
Vulcanized India Rubber Catheter, for old men affected 
with retention of urine without stricture. 
This flexible instrument, even in cases where there exists 
considerable enlargement of the prostate, seems to find its 
own way in the urethra with the utmost facility. It causes 
less irritation than others when left in the urethra. The 
latest improvement is Tiemann & Co.'s Velvet Eye Catheter. 
"Sir Henry Thompson says: 'If, after twenty-four 
hours of agony, relief follows your dextrous use of the 
catheter, and the two or three pints which the patient was 
unable to void are withdrawn by your hand, he tells you 
that he is in heaven-a common expression with such patients ; and he will never doubt for a moment 
that you were the author of his translations.' I have repeatedly been more warmly and gratefully 
thanked by the patient and family for relieving, by the use of soft catheters, the retention of urine 
than for any other professional service. 
" These catheters are especially suited to the wants of country practitioners, where in sparsely 
settled sections they are frequently unable to see the patient suffering with retention from prostatic 
obstruction, and atony from over distention or paralysis of bladder, more than once in twenty-four hours, when in 
that length of time the operation should have been repeated three or four times. You can easily instruct these 
patients to relieve themselves with 
one of them. Thus the great ad- 
vantage to that class of practitioners 
is evident."-Joseph W. Thomp- 
son, M.D., Paducah, Ky. Ameri- 
can Practitioner, August, 1877. 
" When catheterism is to be in- 
trusted to inexperienced persons, to 
nurses, or to the patients them- 
selves, the soft india rubber in- 
struments are unquestionably the 
safest. One of the prime requisites 
of a good catheter is an eye as 
small as practicable, with perfectly 
smooth, rounded edges. It should 
never have two eyes. Nearly all 
those who practice auto-catheterism 
have a predilection for small cath- 
eters, such as Nos. 4, 5, 6, English. This is a grave error. The catheter should seldom be under No. 9, which, 
though it may be pliable, retains a certain degree of firmness and can be much better managed."-Gouley. 
Fig. 3031.-Vulcanized India Rubber Catheters. 
Fig. 3032.-Keyes' Catheter Guide. 
Fig. 3033.-Otis' Prostatic Guide for Soft Rubber Catheters. 
To impart increased firmness to, without impairing the elasticity of soft rubber catheters. 
It is made of flat bands 
of rubber; where the bands 
cross over the meatus they 
are perforated by a minute 
hole, this being very elastic 
holds the instrument 
passed through it, while 
the strap of the muzzle is 
passed around the body of 
the penis. 
Fig. 3034.-Catheter Holder. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
387 
URETHRAL A^ID URO-CYSTIC. 
RETENTION OF URINE 
Catheters for Evacuating. 
Fig. 3035.-Squire's Vertebrated Catheter. 
Fig. 3036.-Cowan's Vertebrated Catheter. 
Fig. 3040.-Huter's Flat Catheter. 
Fig. 3041.-Gross' Flexible Catheter. 
Fig. 3037.-Rubber Bag and Stopcock for Injecting. 
See Tiemann & Co.'s "Flexible Joint 
Catheter," Fig. 1306, page 77. 
Fig. 3038. 
Warren's Door Catheter, for Evacuating the Bladder. 
Fig. 3039.-Warren's Vermicular Catheter. 388 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
U^ETHRAb /rND U^O-CYSTIC 
RETENTION OF URINE. 
Catheters for Evacuating. 
Fig. 3042. 
Mercier's Invaginated Catheter. 
" In cases where ordinary catheterism has been impracticable, owing to very 
large supra-montanal tumors, or false routes, the invaginated catheter of 
Mercier is almost certain to be successful. On five or six occasions, having 
entered the bladder with the male part of the invaginated catheter, I gradually 
and cautiously pushed together onward into the bladder both the male and the 
female portions of the catheter and thus made free and complete divulsion of the 
false route. 
"Evacuative Catheterism cannot be employed too soon in the management 
of prostatic obstruction. But there are cases where it would be most unwise in 
the surgeon and often fatal to the patient to withdraw all the urine retained in the bladder at one 
sitting, without taking certain steps which I shall presently describe. 
" Let us suppose a case in which the bladder is distended so that its fundus rises above the level 
of the umbilicus. A catheter is introduced and one pint of urine is slowly drawn off. Immediately 
half a pint of warm borax solution-two grains to the ounce, with five minims of wintergreen essence 
and ten minims of glycerine to the ounce-is thrown in, then another pint of urine is allowed to 
escape through the catheter, and half a pint more of the borax solution is injected. There is already 
one pint less of fluid in this bladder, and what remains is mixed with a disinfectant. After this, for 
every half pint of diluted urine drawn off, half a pint of borax solution is injected until the fluid that 
escapes from the catheter is perfectly clear. Once every four hours afterwards half a pint or a little 
more of the clearer contents is removed, until the bladder is entirely empty, which may take several 
days or more than a week."-John W. S. Gouley, M.D., Surgeon to Bellevue Hospital, New York. 
Gaillard's Medical Journal. New York: July, 1885. 
" In order to empty the bladder entirely, it is necessary, as the point of the catheter can not reach 
the cavity behind the gland, to raise the patient's hips, or to turn him on his belly, so as to force the 
urine out of its hiding place; or instead of this a Squire's vertebrated catheter or the coiled silver catheter of Dr. S. 
W. Gross (page 387) may be used."-" System of Surgery." Gross. 
IRRIGATION OF THE BLADDER. 
" The washing out of an hypertrophied and dilated bladder, where the mucous membrane is habitually congested 
and secreting an over-supply of mucus, is a point of treatment of cardinal importance. By this means the last drops 
of residual urine, with the pus and stringy mucus which they contain, are diluted and drained away, and no ferment is 
left behind to decompose the healthy fluid as it comes down the ureters. The formation of stone is prevented, and 
the congestion existing around the neck of the bladder is soothed and kept from any aggravation which would increase 
the irritability, that distressing symptom so closely linked with the pathological changes incident to enlarged prostate. 
The best method of washing out the bladder is as follows : The soft catheter through which the residuum has been 
drawn off is used. A double current catheter is not advisable, for with such an instrument no distention is brought to 
bear upon the bladder-walls, and the whole mucous surface is not brought into contact with the cleansing fluid. Warm 
water should be used, since it is soothing as well as cleansing, and does not excite the bladder to speedy contraction 
upon being thrown into its cavity. A temperature of about blood heat should be aimed at-a little below ioo° Fahr. 
The best style of syringe is a rubber bag holding about four ounces, provided with a nozzle tapering to a fine point 
(Fig. 3037), so that it may readily enter the calibre of any catheter, and with a stop-cock which works smoothly for 
convenience of manipulation. The bag is filled by exhausting the air and inverting it into the vessel containing the 
water. By removing the nozzle from the water and slightly compressing the bag, with the nozzle held uppermost, 
whatever air remained within it will be first expelled and then the water will get out. Now the stop-cock is to be 
turned and the nozzle once more submerged, the stop-cock being again turned on. The bag will now fill itself com- 
pletely and there is a certainty of no air being present in it. Finally, the stop-cock is turned off, the nozzle being 
still under water, and the bag is ready for use. At this stage of the operation the patient (or surgeon) introduces his 
soft cathater and drains off the residual urine. As soon as the last drops have been evacuated, the nozzle of the bag 
is gently inserted into the catheter and the stop-cock once more turned on, while gentle continued pressure with the 
hand is applied to the bag, forcing its contents in a steady stream into the vesical cavity. As soon as a slight feeling 
of distention is experienced by the patient, the bag is removed and the injected fluid allowed to drain off. A second 
washing is executed in the same manner, and perhaps a third, until the water which flows out is nearly or quite clean. 
These simple manipulations are easily learned by a patient and often constitute the only treatment which his case re- 
quires."-" Genito-Urinary Diseases with Syphilis." Van Buren and Keyes. 1874. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
389 
URETHRAL, jAND UF^O-CYSTIC 
IRRIGATION OF THE BLADDER. 
Fig. 3043.-Keyes' Irrigator. 
To the fountain-syringe bag holding a pint, and 
tube of variable length, so as to allow, if desirable, 
considerable pressure by elevating the bag, is at- 
tached a two-way stop-cock. Upon the tube is 
another stop-cock only useful when it is desired, 
having thrown a medicated solution into the blad- 
der, to retain it there for a certain length of time, 
without either allowing the bladder to become over 
full or its contents to escape. The nozzle of the 
nickeled stop-cock is very large, nearly a quarter 
of an inch in diameter, and fits snugly into the ex- 
panded conical (also nickeled) mouthpiece. It is 
so large, and fits so easily, that the most clumsy 
fingers can readily adjust it almost unaided by sight. 
Upon this conical catheter mouthpiece is fitted a thin 
piece of rubber tubing covering its upper two-thirds. 
This allows the mouthpiece to be used with any 
metallic or other hard catheter, and prevents leak- 
age. The fine conical point of the mouthpiece is to 
be screwed into any soft catheter before introducing 
the latter. The other branch of the two-way stop- 
cock is fitted into a short piece of rubber tubing 
which conveys the urine and the washings into some 
convenient receptacle. 
Fig. 3044.-Soft Rubber Double Current Catheter. 
" Tiemann & Co., of New York, have improved the smaller varieties of these tubes (those numbers suitable for use 
in the male bladder) by furnishing a probe point and the ' velvet eye ' peculiar to their excellent catheters. This en- 
ables the instrument to be made smaller, since the direct current requires only a small stream. The efferent tube is 
relatively larger, and thus overstrain upon the bladder is prevented. At my suggestion, attachments have been made 
so that the tubes may be lengthened at will. As now made and sold by Messrs. Tiemann & Co., these tubes appear 
verv nearly perfection."-The New York Medical journal. H. O. Marcy, M. D., Boston. 
Fig. 3045.-Double Current Catheter. 
Fig. 3046.-Nott's Double Current Catheter. 
Vesical injections are used for the purpose of simply cleansing the bladder, of decomposing phosphatic concretions, 
of dilating contractured bladders, or of applying certain agents to stimulate, modify, or soothe the mucous membrane. 
Double current catheters of silver or other metals are also used for washing out detritus after lithotrity. 390 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL AJMD Uf^O-CYSTI©. 
DILATATION OF THE BLADDER. 
"Contracture of the bladder -wMx diminution of its capacity is a rare complication of cystitis in prostatic hyper- 
trophy, but when this occurs measures must be promptly taken to dilitate the viscus to its normal capacity, otherwise 
the life of the sufferer is rendered intolerable by the almost constant desire to urinate. A very excellent method by 
which this desired end may be obtained, is slow, gradual hydraulic dilatation. This is accomplished by injecting 
warm water to the point of tolerance, then, a few seconds after, by adding a very small quantity, perhaps not more 
than a drachm. The amount is slightly increased from day to day until, from half an ounce, which may have been 
the maximum quantity retained at first, in two or three weeks the capacity of the bladder is increased to eight, ten, or 
twelve ounces. 
"To render catheterism less painful in cases of great irritability of the urethra and bladder, solutions of sundry 
substances are thereinto injected, or introduced into the rectum, such as morphia, atropia, hyoscyamus and more re- 
cently cocaine hydrochlorate. Harrison, of Liverpool, has suggested the use of some of these alkaloids, in small 
pessaries or suppositories, made of cacao butter, to be placed in the urethra or bladder by means of a specially con- 
structed catheter (see Fig. 3047).-Gaillard's Medical Journal. John W. S. Gouley, M.D., Surgeon to Bellevue 
Hospital, &c. New York, July, 1885. 
Fig. 3047.-Reginald Harrison's Pessary Catheter. 
" A metallic catheter, open at the end, into which is received a cocoa-butter pessary (ci) containing the requisite 
drug. After the urine has been allowed to run off, by pressing the stylet the pessary is projected into the bladder, 
when the instrument is removed. The treatment of many bladder affections is only to be effectually carried out by 
local measures, and, in addition to those we are already provided with, I believe this instrument will be of service. 
In this way I have frequently given a patient a good night by a morphia pessary, where rectum suppositories and 
other means have failed."-Lancet. Reginald Harrison, F. R. C. S., Surgeon to the Liverpool Royal Infirmary. 
Feb. 9, 1878. 
PARACENTESIS VESICA, CYSTOTOMY. 
" When the catheter, bougie or other means have failed to procure relief, the only thing that remains to be done 
is to puncture the bladder."-Gross. 
" In opening the bladder advantage is taken of the partial manner in which it is invested by the peritoneum to 
effect this object without detriment to its covering. Having regard to this object, the bladder may be opened as fol- 
lows : 1. From the perinaeum ; 2. From the rectum ; 3. Above the pubes ; 4. By the subpubic operation of M. Voille- 
mier ; 5. Through the symphisis pubis." 
Puncture of the Bladder. 
Tapping the Bladder from the Perinaeum. 
" Recognizing the necessity for establishing a permanent opening through which the urine could escape, I deter- 
mined to tap the bladder from the perinaeum. Taking the trocar (Fig. 3048) especially made for the purpose, I in- 
troduced it in the median line of the perinaeum, three-quarters of an inch in front of the anus, and pushed it steadily 
through the prostate into the bladder, at the same time retaining my left forefinger in the rectum as a guide. On with- 
drawing the trocar a large quantity of ammoniacal urine escaped. The canula, being provided with a shield, was se- 
cured in place by tapes, much in the same way as a tracheotomy tube. A piece of india rubber tubing was attached 
to the portion of the canula which projected beyond the shield, and conveyed the urine into a vessel placed at the 
side of the bed. Through this tubing the urine continued to dribble. The patient was at once made comfortable 
by this arrangement, and in forty-eight hours he was up and sitting in an easy chair. To permit of this the rubber 
tubing was shortened during the daytime, its end being tucked through a light abdominal belt, where it was com- 
pressed by a small pair of bull-dog forceps, which were removed when the patient desired to pass water. For about 
six weeks my patient passed urine through the prostatic canula. Then it was noticed that urine in gradually increasing 
quantities began to flow through the natural passage, so much so as to lead me to infer that, for some reason or other, 
the prostate was ceasing to obstruct micturition. After removal of the canula, the puncture healed in the course 
of a few days, and with this the bladder gradually proceeded to recover its natural function and power."-Reginald 
Harrison, F. R. C. S., Lecturer on Clinical Surgery in the Victoria University, Surgeon to the Royal Infirmary, Liver- 
pool. " International Cyclopaedia of Surgery," Ashhurst. Vol. VI. 1886. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
391 
URETHRAL AJMD U^O-CYSTI© 
PARACENTESIS VESICiE, CYSTOTOMY. 
Tapping the Bladder from the Perinaeum. 
Fig. 3048.-Harrison's Trocar. 
" I he operation of tunnelling the enlarged prostate from the perineum, 
which I introduced nearly five years ago, has been so favorably received in 
this country and in America, as a means of relieving the more urgent symp- 
toms sometimes attending this complaint, as well as of permanently reducing 
the size of the gland, that I am induced to again draw attention to this treat- 
ment and to notice some modifications which tend to simplify the performance 
of the operation. 
"The operation consists in puncturing the bladder with a special trocar 
and canula (made for this purpose for me by Messrs. Tiemann & Co., of 
New York), one inch in front of the anus. The trocar is made to pass through 
the large prostate at a lower level than that of the normal canal, the object 
being to make a 'low-level' urethra, and thus to favor a thorough drainage 
of the viscus. Where the bladder is largely distended with urine the pro- 
cess is simple enough ; when this is not the case, and the operation is under- 
taken with another object, I advise the following procedure: The patient 
being placed in the lithotomy position under an anaesthetic, a catheter is 
passed and the bladder distended with tepid water; the beak of the cathe- 
ter should then be reversed so as to lie in the dip above the large gland. 
A temporary ligature being placed around the penis and the escape of any 
fluid through the catheter being prevented, the trocar is then plunged from 
t(ie perineum into the distended viscus ; as the point of the trocar enters 
the bladder it will be found to strike against the end of the catheter, towards 
which it should be directed. 
" The trocar is hollow, with an opening by the side of the point. Imme- 
diately the instrument penetrates the prostate, fluid escapes at the handle. 
The trocar is then withdrawn, and the canula is left behind. The latter is 
fitted with a movable collar, perforated at the sides for fixing with a T bandage. The collar is 
movable, so that by means of a screw it can be nicely adapted to the thickness of the tissues through 
which the canula may have to pass, as it is undesirable to have too much of the tube projecting into 
the bladder cavity. The canula being thus adjusted and fixed with an ordinary perineal bandage, a 
piece of tubing is attached to the end of it, by means of which urine is conducted to a vessel by the 
patient's bedside. After a few days in bed the patient gets up, and then tucks the end of his tube 
into a belt around his waist. A pair of bull-dog forceps will be found to act as a convenient com- 
pressor. When the patient requires to pass water, all he has to do is to take off the compressor and 
let the tubing fall between his legs ; urine then flows by gravity and without any expulsive effort on 
the part of the patient. After six, eight or ten weeks wear, according to circumstances, the patient 
will now and then be conscious that slight gushes of urine along the natural passage will involuntarily 
take place. Like as when urine passes along the urethra for the first time after lithotomy, I have 
known its first occurrence, after prostatic puncture, followed by slight indications of reflex action, in 
the form of a rigor, and some elevation of temperature. Where these involuntary gushes take place 
they may be regarded as indications that the gland has undergone such an amount of atrophy as to 
cause the urine to prefer the natural to the artificial channel for its exit. The canula can then be re- 
moved, when the wound speedily closes. One benefit the patient derives from catheterism being un- 
necessary, the easy way the bladder is washed out, the non-confinement to bed, and undisturbed repose, is obvious. 
"After the repeated use of the aspirator both micturition and catheterism may again become permanently passive, 
this seems to point to some diminution of the gland having, in the interval, taken place. In conclusion, I would urge 
the adoption of tunnelling the prostate from the perineum as the best method of tapping the bladder in all cases of 
emergency where retention of urine from an enlarged prostate occurs and catheterism is found to be impossible ; and, 
secondly, this operation may be undertaken with the view of inducing atrophy of the gland in cases where the func- 
tions of the bladder are so disturbed as to render life almost unbearable. In the observation of a considerable num- 
ber of cases of difficult catheterism and large prostates, I have often thought that, in some instances, far less damage 
would have been done, and the patient's chances improved, had the practitioner, on recognizing his difficulty, used a 
trocar in a suitable position, rather than persevere with the catheter.' -Reginald Harrison, F. R. C. S., Surgeon to the 
Liverpool Royal Infirmary and Lecturer on Clinical Surgery in the Victoria University. Gaillard's Medical Journal, 
March, 1886. 392 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
URETHRAL jAND UF^O-CYSTIC. 
PARACENTESIS VESICA, CYSTOTOMY. 
Tapping the Bladder per Rectum. 
Fig. 3049.-Cock's Instrument for Tapping the Bladder per Rectum. 
" I consider, writes Cock, that the benefit of the operation consists, not merely in the immediate relief given to 
the patient, but also in the opportunity which it affords, by the retention of the canula in the bladder through an in- 
definite period, of diverting the flow of urine from its ordinary channel, and thus giving quiet, freedom from pain and 
the natural means of restoration to the maimed, irritable or diseased urethra. I conceive, also, that the bladder might 
be tapped with advantage in cases of obstinate stricture in which retention of urine does not actually exist. 
" Cock's instruments consist of a canula (j>) six and a half inches long, a blunt pilot trocar (2) and a sharp trocar 
(z); a second tube with an expanding end (/) to keep the canula in position ; and a third (5) to maintain the second 
in position. 
"Operation.-The patient should be placed and held in position for lithotomy and brought well to the edge of the 
bed. The operator must then introduce the index finger of the left hand into the rectum, with the palm upwards, to 
feel for the prostate, and, if possible, for the bulging base of the tense bladder beyond. Some little pressure above the 
pubes may help in this attempt. The pulpy point of the index finger is then to be held in the median line just below 
the spot at which the puncture is to be made. The surgeon then, with his right hand, is to take from his assistant the 
canula, well oiled and fitted with the bitint pilot trocar, and to introduce it into the rectum upon his left index finger, 
passing it well up to the point selected for the puncture. He should then steady the canula and hold it firmly in po- 
sition with the thumb and three outer fingers of his left hand, and withdraw the blunt trocar. The sharp trocar can 
then be introduced through the canula, and, having reached its end, the handle with the canula is to be depressed and 
driven home, in a direction upwards and forwards, in a line towards the umbilicus. The bladder in this way will be 
entered, the free end of the instrument moving freely, and all resistance ceasing. The trocar should then be with- 
drawn and the canula pressed well home. Before the bladder is completely emptied it is well to insert the two inner 
canulae, and fasten the whole in by means of tapes, two passed in front and two behind the thighs to a girth around the 
waist. The canulae may then be plugged with a peg to retain the urine, or with a hollow plug inserted into a piece of 
india rubber tubing, through which the water may drain away. 
"As soon as the urethral passage has become pervious to the catheter, but not before, the canulae should be with- 
drawn ; this condition taking place usually within a week from the introduction of the catheter. The stricture may 
then be treated on rational principles by dilatation. It is very remarkable how, at times, a stricture, which has thus 
been left alone and unirritated by catheterism or ineffectual natural efforts at micturition, gives way under such treat- 
ment, and a thoroughly impervious indurated urethra becomes pervious and amenable to simple measures. 
" The wound into the bladder closes rapidly after the removal of the canula, even after many weeks ; and in a case 
of my own no urinary fistula followed the presence of the canula for seven weeks. The surgeon then may perform 
this operation without fear in all cases of retention where any difficulty in catheterism exists. I know of no opera- 
tion attended with equal good that is so safe, satisfactory or free from danger."-"Bryant's Practice of Surgery." 
Roberts. Am. Ed. 1881 GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
393 
URETHRAL jAND UF<O-CYSTIC. 
PARACENTESIS VESICLE, CYSTOTOMY. 
Tapping the Bladder above the Pubes. 
Tapping the bladder above the pubis.-There is a space immediately above the pubic bone, where the anterior sur- 
face of the bladder may be reached with a trocar, or even the end of the finger, without wounding the peritoneum. 
Though this interval varies much in extent and is increased by the degree to which the bladder is distended, it is a 
condition of this operation, when undertaken from this point, that the puncture shall be made immediately above the 
pubis. Instances have occurred in which, this rule having been disregarded, the cavity of the peritoneum has been 
opened. The supra-pubic operation is probably the safest and most convenient one in cases in which it is tolerably 
obvious that it will only be required for temporary purposes until the bladder can be reached by the natural passage. 
For fulfilling such an object the aspirator (page 129, &c.,) will be found a most useful instrument. Aspiration of the 
bladder above the pubis has now been so extensively practiced and with such good results, that no one would be at 
all likely to question its utility as a temporary expedient. If, in using the instrument, the finger be for a moment 
pressed firmly above the pubis, the passage of the needle is rendered almost painless. In this respect it strongly con- 
trasts with the distress occasioned by attempts at catheterization, where the difficulty is increased by the tension thrown 
on the stricture by the largely distended bladder. The bladder may also be tapped in this situation with an ordinary 
trocar (a small incision being previously made with the knife), the canula being left in and retained by tapes, or an 
india rubber catheter introduced through the canula. For permanent wear, a shield of rubber or vulcanite may be at- 
tached, with a belt around the abdomen. 
A modification of the supra-pubic puncture was some years since introduced by Sir Henry Thompson for treatment 
of certain advanced cases of prostatic disease, attended with much vesical irritability. Here the operator cuts down, 
immediately above the pubis, on the end of a sound (Fig. 3050) passed into the bladder by the urethra and by means 
of this introduces an elastic tube, which is then permanently fixed within the viscus. Provision is in this way made 
for reaching the bladder which might not present any prominence above the pubis, and when, consequently, tapping 
with the trocar and canula, as previously described, could not be undertaken with safety. 
Fig. 3050.-Thompson's Prostate Sound and Tube. 
A. Hollow sound, the end of which, when stopped with the stylet, A, forms the point which guides the operator 
in finding the bladder in the last incision. Size about 12 or 13 Eng. 
B. Bulbous-ended flexible metal stylet. 
C. Suprapubic tube of elastic gum, about 2| in. long, with silver plate, introduced in its whole length into the 
sound when the stylet is removed. The withdrawal of the sound leaves the tube in the bladder. 
Subpubic operation of M. Voillemier.-This consists in plunging a trocar into the bladder through the anterior 
wall, entering it above the penis, after having drawn that organ downwards and backwards. The suspensory liga- 
ment is thus put upon the stretch and perforated, the instrument entering the viscus in the median line and beneath 
the arch of the pubis. This proceeding does not seem to have recommended itself to surgeons. 
'Puncture through the symphysis pubis.- This was first proposed by Dr. Brander, of Jersey, in 1825, but although 
it has been successfully performed on several occasions, it is not a proceeding which has found general favor."-" In- 
ternational Cyclopaedia of Surgery," Ashhurst. Vol. VI. 1886. 394 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL AJ\ID U^O-SYSTIC. 
DIGITAL EXPLORATION OF THE BLADDER IN OBSCURE VESICAL DISEASE. 
"No one who has had much experience in the treatment of maladies affecting the urinary organs will deny that he 
occasionally meets with a case, the nature of which, however closely it is studied, is not determined by the ordinary 
methods of investigation. These methods comprise palpation and percussion externally, the use of the sound and 
catheter internally, and an examination of the characteristic secretion, the urine, physically, chemically and micro- 
scopically. Extensive as these resources are, a certain proportion of patients, larger, perhaps, than is generally 
supposed, receive treatment for long periods of time without any satisfactory diagnosis having been made of their cases. 
" Some five or six years ago I came to the conclusion that, keen and careful as we might be, the cases of urinary 
disease which defy analysis are so numerous and so important as to demand a further method of investigation than 
they had hitherto received ; and I resolved to make a bold experiment for the purpose of accomplishing it. I deter- 
mined on searching the bladder, if possible, with the finger itself, when the sound and other means had failed to in- 
form me, and when the symptoms were so grave as to demand a knowledge of their source, and probably some effi- 
cient surgical action, in order to give a chance of life to the patient. 
" The first question naturally arising was, Will it be possible to accomplish this completely in many, or, indeed, in 
a moderate proportion of these obscure cases ? There proved to be no difficulty in the dead body ; and, with anaesthesia, 
I thought there ought to be none in the living. And having well considered both the supra-pubic and the perineal 
routes, I adopted the latter, introducing my finger as far as to the internal meatus, by means of a limited perineal 
urethrotomy, without section of the prostatic urethra, finding that this afforded me an unexpected facility in obtaining 
that intimate knowledge of the interior of the bladder which I sought. 
"It is the object and the achievement of the proceeding which are new, and not the incisions by which they are 
attained. Further, even the incision would not alone accomplish what is necessary, and could not do so until the dis- 
covery of anaesthetic agents enabled us to induce complete relaxation of the abdominal muscles, and thus to prosecute 
an enquiry not otherwise possible. 
"I will now describe the method which my present experience has led me to adopt, and point out some of those 
details in prosecuting it which are the most important. The patient having been secured in the usual position for 
lithotomy and rendered insensible, a rather short median-grooved staff is carried into the bladder and held by an 
assistant. The knife to be employed should be straight, the blade very narrow and about two and three-fourth inches 
long. With this the operator makes a vertical incision 
of the skin in the line of the raphe, an inch and a 
quarter long, and terminating below about a half or 
three-quarters of an inch above the anus. Placing his 
left index finger, palmar surface upwards, in the rectum, 
so as to inform himself of the upper limit of the bowel, 
he introduces the knife with the cutting edge upwards, 
horizontally into the wound, until he reaches the groove of the staff, which should thus be struck about the junction 
of the membranous with the bulbous portion of the urethra. When contact is verified, the puncture of the canal is 
lengthened a little with the point of the knife, which is then withdrawn, incising in the act perhaps some of the 
tissues, so as to enlarge the wound towards the external orifice, but avoiding as far as possible injury to the bulb. 
A director, resembling a small gorget with blunt edges, 
is passed into the groove of the staff and serves as a 
guide to the left index finger, which is insinuated into 
the prostatic urethra and gently pressed onwards until 
the tip, slowly dilating it, enters the neck of the blad- 
der. Arrived at this point, the operator should stand 
up, demanding the full effect at this movement of the 
anaesthetic agent, and with his right hand press very firmly above and behind the pubic sym- 
physis. By concerted movements between the left index finger and the right hand he may 
now bring seriatim every part of the interior of the bladder over the point of the index and 
scrutinize the lining membrane, so as to learn its physical condition to the minutest particular. 
If there is the smallest growth, recess or inequality of any kind, or even roughness, an 
adhering scale, or small calculus, it is recognized with ease and certainty. Occasionally, when the subject is very fat 
and the prostate large, considerable pressure is necessary to make the exploration complete, and now and then it may 
be impossible to reach the whole interior, as I have found in one case ; but, if the relaxation of the abdominal walls 
is absolute, it is surprising how far the contents of the pelvis, with the aid of an assistant, maybe, by continued forcible 
pressure, brought down towards the peringeum, and thus within reach of the operator's finger. 
If, in examination of the bladder, a growth is encountered, the surgeon should devote two or three minutes to 
Sir Henry Thompson's Method and Instruments. 
Fig. 3051.-Thompson's Urethral Knife. 
Fig. 3052.-Thompson's Vesical Director GEORGE TIEMANN CO.'S SURGICAL INSTRUMENTS. 
395 
URETHRAL A^D U^O-eYSTIC. 
DIGITAL EXPLORATION OF THE BLADDER IN OBSCURE VESICAL DISEASE. 
Sir Henry Thompson's Method and Instruments. (Continued.) 
deliberately estimating its exact size, form and density ; its position in the bladder, and whether others are present 
also. He should do this again after he has reseated himself, with and without supra-pubic pressure by his assistant, 
so as to be thoroughly acquainted with the situation of the growth. Then, withdrawing his finger, he introduces 
slowly a pair of forceps, 
straight or curved accord- 
ing to his judgment, to the 
spot, holding lightly a handle 
in each hand, when he will 
almost certainly seize the 
growth if he be careful and 
deliberate in his movements; 
much in the same way as he 
would in seeking a nasal 
polypus. Having assured 
himself that he has a fair 
hold , he is not to drag or 
tear out the body, or even much 
twist the forceps, especially if 
the material is tense, or he may 
injure the bladder itself. I find 
it better to "jamb " or "mash" 
together the rough margins of 
the forceps before I endeavor to 
withdraw and effec.t separation 
thus if I can. If this is not 
easily accomplished, I introduce 
the left index and complete the 
operation with the finger nail if 
possible, which is sometimes a 
very efficient instrument. Pro- 
ceeding thus, partly by forceps, 
of which I have employed vari- 
ous forms (see Figs. 3053, 3054, 
3055), partly by the finger, the 
removal of the mass may be safe- 
ly accomplished, entirely so if the growth or growths be simple and pedunculated ; less completely when the base is wider, 
employing the forceps several times, carefully removing as much as possible, piece by piece ; and but very imperfectly 
if the tumor is mammilated and not at all pyriform in character. In the female I have sometimes slowly brought it 
within view and have put on a ligature. A small ecraseur, threaded with wire, may be useful in some cases. 
" There is one source of danger which I would point out and which must be carefully guarded against. It may 
happen during the operation that the assistant is required to press very firmly above the pubes, so as to bring the 
growth nearer to the operator. By doing so at this stage, it is quite possible that the upper part of the bladder may be 
inverted and pushed downwards in a fold, presenting itself toward the operator as an eminence and be mistaken for a 
large polypus or growth, an error which might be fatal. The possibility of the occurrence should not be lost sight of ; 
hence my admonition to examine the bladder, not only with, but without the influence of pressure, and so as to ascer- 
tain precisely what is to be removed before any attempt to do so is commenced. After the removal, whatever the re- 
sult may be, a stout India rubber tube, about five or six inches long and the diameter of a little finger, is secured in 
the wound to wash out the debris and to serve as a channel from the bladder to some vessel placed for the purpose. 
Haemorrhage is usually free fora few hours and gradually subsides. If the tube causes irritation it may be removed 
soon ; if not, it may remain a day or two." 
After stating experience Sir Henry Thompson closes the article as follows : 
" And I trust my brethren will agree with me, that the proceeding described will enable us to prolong life in many 
cases, and to avert disease completely in some, where, without such aid, it must inevitably prove fatal."--Medical 
News, January 5, 1884. 
Figs. 3053, 3054, 3055.-Thompson's Vesical Forceps, for Removing Growths 
in Bladder. For Growths close to the Neck of the Bladder, with 
Separation of Blades to avoid Nipping Neck of Bladder. 396 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL A^ID URO-CYSTIC. 
OPERATING CASES. 
Van Buren and Keyes' Compact Set of Urethral 
Instruments. 
$76.21. 
1 Grooved Staff. 
3 Whalebone Guides, one long and two short. 
4 Tunneled Sounds. 
1 Thompson's Probe-pointed Catheter, modified by 
Otis. 
I Silver Catheter, No. 12, short curve. 
1 Thompson's Tunnelled Divulsor. 
1 Civiale's Bistoury Cache. 
1 Civiale's or Maisonneuve's Urethrotome. 
1 Gouley's Catheter Staff. 
1 Silver Probe. 
I Small Scalpel. 
1 Silver Director-Probe. 
1 Curved Trocar. 
1 Double Silver Tube. 
1 Morocco Case, with extra spaces, lined with oil-dyed 
cotton velvet. 
Van. Buren and Keyes' Set of Urethral 
Instruments. 
$121.55. 
1 American Guage. 
12 Conical Steel Sounds, nick el-plated, 2d. 
3 Whalebone Guides, one long and two short. 
1 Otis' Catheter. 
1 Silver-plated Catheter, No. 12. 
2 Silver-plated Prostatic Catheters. 
1 Thompson's Tunnelled Divulsor. 
1 Civiale's Bistoury Cache. 
1 Civiale's Urethrotome. 
1 Gouley's Catheter Staff. 
1 pair of Urethral Forceps. 
1 Cupped Sound, No. 12, nickel-plated. 
4 English G. E. Catheters. 
12 French G. E. Conical Bougies. 
6 French G. E. Olivary Catheters. 
4 Mercier's Elbowed Catheters. 
17 Bougies a Boule. 
1 Mahogany Case, lined with oil-dyed cotton velvet. 
Gouley's Complete Stricture Set 
(superior finish.) 
$109. 
6 Steel Sounds, conical. 
1 Gouley's Divulsor, nickel-plated. 
1 Gouley's Retention Catheter. 
1 Gouley's Catheter Staff. 
6 Gouley's Tunnelled Sounds. 
1 Gouley's Meatotome. 
1 Director Probe,, silver 
1 Beaked Bistoury. 
5 English Bougies a Boule. 
12 English olive-pointed Bougies. 
6 English Gum Catheters. 
6 Whalebone Guides. 
2 English Tunnelled Catheters. 
1 Metrical Sound Guage, German silver. 
1 Gouley's Dilating Urethrotome, two points. 
1 English and French Rule. 
1 Rosewood Case, lined with silk velvet. 
Skene's Uro-Cystic and Urethral Set. 
$63.35. 
2 Skene's Urethral Specula. 
1 Folsom's Speculum (modification). 
1 Skene's Reflux Catheter for Bladder. 
1 Skene's Reflux Catheter for Urethra. 
2 Silver Probes. 
1 Sponge Holder, steel wire. 
1 Knife, wire. 
1 Blake's Polypus Snare (Ear). 
1 Allen's Polypus Forceps (Ear). 
2 Glass Pipettes, six inches long. 
2 Head Mirrors, on same strap, 3^ and inches. 
1 Lente's Caustic Cup. 
2 Skene's Self-retaining Catheters. 
2 Rectal Endoscopes, long and short, with fenestrated 
Rubber Specula. 
3 Urethral Endoscopes (Nos. 13, 15, 17, American), 
with Bevelled Rubber Specula. 
2 Bevelled Urethral Endoscopes (Nos. 19, 21, Ameri- 
can), with Fenestrated Rubber Specula. 
1 Brush, for cleaning Endoscopes. 
1 Rosewood or Mahogany Case, lined with oil-dyed 
velvet. 
Gouley's Compact Stricture Set. 
$50. 
4 Conical Steel sounds, nickel-plated. 
3 Gouley's Tunnelled Sounds. 
1 Gouley's Retention Catheter. 
1 Gouley's Dilating Urethrotome, two points. 
1 Gouley's Meatotome. 
1 Gouley's Catheter Staff. 
1 Beaked Bistoury. 
1 Grooved Director Probe, silver. 
1 Mahogany Case, with extra spaces, lined with oil- 
dyed cotton velvet. 
Set of Silver Catheters. 
$25. 
12 Silver Catheters. 
1 Bottle for Oil. 
1 Guage. 
1 Mahogany Case, lined with fine velvet. 
*** Special selections of instruments cased to order. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
397 
URETHRAL A^D URO-CYSTIC. 
OPERATING CASES. 
IT. S. A. Genito-Urethral Set, No. 1. 
$75- 
1 Gouley's Dilating Urethrotome, with two points. 
1 Gouley's Tenaculum. 
1 Gouley's Beaked Knife. 
1 Gouley's Silver Director. 
3 Gouley's Tunnelled Sounds. 
1 Double Current Catheter, silver. 
1 Gouley's Grooved and Tunnelled Catheter Staff. 
1 Gouley's Tunnelled Catheter. 
6 Otis' Bougies a Boule. 
1 Thompson's Urethral Forceps. 
1 set (4) Sounds, fitting one handle 
12 Gouley's Whalebone Guides. 
1 Mercier's Gum Catheter. 
1 Steel Guage, French and American. 
2 Pasteboard Guages, French and American. 
1 Otis' Whalebone Guide. 
4 Velvet-eye Catheters (Tiemann & Co.'s patent). 
6 Olive-pointed Bougies, English. 
1 Crin de Florence. 
1 Thompson's Dilator, modified by Gouley. 
1 Rubber Yoke (Catheter Holder). 
1 Rosewood Case, lined with French rouge skin 
(chamois). 
Van Buren and Keyes' Set of Instruments 
for Stone. 
$134-75- 
1 Thompson's Searcher. 
1 Thompson's Lithotrite, heavy. 
1 Thompson's Lithotrite, light. 
1 Evacuating Catheter, Nott's. 
1 pair Urethral Forceps, Thompson's. 
2 Lithotomy Staffs, lateral. 
1 Median Lithotomy Staff. 
1 Lithotomy Scalpel. 
1 Lithotomy Bistoury, straight, sharp-pointed. 
1 Blizard's Knife. 
1 Blunt Gorget. 
1 Little's Director. 
1 Scoop. 
1 pair of Lithotomy Forceps, with crossed handles. 
1 pair of Lithotomy Forceps, with curved blades. 
1 pair of Crushing Forceps. 
1 Tube, with globular head, for Washing the Bladder. 
1 Shirted Canula (a chemise). 
1 Keith's Tenaculum. 
1 Mahogany or Rosewood Case, lined with oil-dyed 
velvet. 
$134-75. 
1 Crin de Florence. 
Little's Median Lithotomy Set. 
$54- 
4 Little's Staffs, Nos. 7, 9, 10, 12. 
1 Straight Sharp-pointed Bistoury. 
1 Little's Director. 
1 pair Dressing Forceps. 
2 pairs Lithotomy Forceps. 
1 Thompson's Searcher. 
1 Small Sound, for children. 
1 Canula (A chemise). 
1 Hard Rubber Syringe, No. 5, Nozzle to fit Catheters. 
1 Dolbeau's Stone Crusher. 
1 Lithotomy Scoop, ebony handle. 
1 Mahogany Case, lined with oil-dyed velvet. 
U. S. A. Genite-Urethral Set, No. 2. 
$140. 
21 Otis' Short-beaked Steel Sounds, Nos. 20 to 40, in- 
clusive. 
33 Otis' Bougies a Boule, metal, nickel plated, Nos. 8 
to 40, inclusive. 
1 Otis' Dilating Urethrotome, straight. 
1 Maisonneuve's Urethrotome: No. 8 Otis' Guage, 
with two blades, 1 Tunnelled Tip for Whalebone 
Guides and 2 Tips with Filliform Bougies. 
2 Otis' Whalebone Guides. 
1 Otis' Urethrameter. 
12 Rubber Cones for Urethrameter. 
3 Otis' Endoscopes, hard rubber, Nos. 22, 26, 32. 
1 Otis' Meatus Bistoury. 
1 Otis' Steel Guage. 
1 Mahogany Case, lined with French rouge skin 
(chamois) and secured with two bolts and lock. 
May's Lithotomy Set. 
$39- 
x pair of Lithotomy Forceps, large. 
I pair of Lithotomy Forceps, medium. 
I pair of Lithotomy Forceps, small. 
3 Plain Steel Sounds. 
2 Lithotomy Staffs. 
i Canula (a chemise). 
2 English G. E. Catheters. 
i Sharp-pointed Lithotomy Scalpel. 
i Probe-pointed Lithotomy Scalpel. 
I Probe-pointed Lithotomy Bistoury. 
I Hard Rubber Syringe, No. 5, the nozzle to fit the 
Catheter. 
I Mahogany Case, lined with oil-dyed velvet. 
Lithotomy Set. 
$47- 
1 Liston's Bistoury. 1 Scoop and Conductor. 
2 Steel Sounds. 1 Blizard's Bistoury. 
3 Lithotomy Staffs. 1 Lithotomy Scalpel. 
2 Lithotomy Forceps, medium and small. 
1 Double Current Catheter, silver. 
I Hard Rubber Syringe, with a Stopcock to fit the 
Catheter 
I Mahogany or Rosewood Case. 398 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
URETHRAL AJ\ID U^O-eYSTIC. 
FOREIGN BODIES. 
Extractors. 
" Besides the foreign bodies 
which find their way into the 
bladder through wounds, or 
come down the ureters (renal 
calculi), a host of substances 
have been encountered in the 
bladder, introduced through the urethra. All imagin- 
able articles, such as pins, beads, stones, pieces of straw, 
heads of rye, heads of wheat, portions of glass, tubing, 
pipe stems, lead and slate 
pencils, portions of chalk, 
wax, &c., have been found 
in the male bladder, intro- 
duced there through the 
urethra under the influence 
of morbid erotic fancies. 
The patient's shame will 
often prevent him from seek- 
ing relief ; a small smooth 
foreign body in a healthy 
bladder may create no dis- 
turbance at first, and so the 
patient goes on, supposing 
that everything has arranged 
itself, until, in after years, 
he gets bladder symptoms, 
is cut for stone and the lat- 
ter is found to have formed 
upon a nucleus introduced 
from without. Not unfrequently, however, a foreign body comes legitimately, as it were, into the bladder ; dermoid 
cysts, containing bones, teeth and hair, may discharge into the cavity ; the broken end of a metallic, or more com- 
monly a gum elastic catheter, may constitute the foreign body. A catheter is most apt to break at the eye. The 
old-fashioned gutta percha instrument is particularly dangerous, on account of its liability to become brittle when old. 
Again, substances of all sorts, bone, seeds, &c., may enter the bladder through ulceration into the rectum, while 
splinters, bullets and bone may be lodged there during injuries of the bladder. 
" When the nature of the substance in the bladder has been learned, an attempt should be made to extract it, to 
prevent it from becoming a nucleus for stone. Anything which will go into the urethra would come out of it if it 
could be correctly seized, with its point turned backward, and be drawn upon in a correct line. Consequently an at- 
tempt should be made to reach all long bodies, and all small bodies, by using a small lithotrite, or other forceps de- 
signed for this special purpose, of which there are several varieties (see page 399). If the object be seized in a faulty 
diameter, it may be released and caught again. This rule applies to portions of metallic catheters as well. It is ex- 
ceedingly difficult to catch them correctly; soft catheters, however, are very easy to extract ; they should be doubled 
up, and may be withdrawn, however caught. Care must be exercised, of course, not to catch a fold of the bladder. 
"For all foreign bodies of wax or glass, and for all such as cannot be extracted after patient gentle effort with 
the lithotrite or forceps, the median operation for stone should be performed, and this as early as possible, before the 
foreign body has had time to become incrusted with urinary salts. If, for any reason, it should be advisable to post- 
pone the operation, it would be wise towash out the bladder daily, with a view of retarding calculous deposit upon 
the nucleus. Dr. Douglas, of Rondout, N. Y., in cutting a patient to extract a piece of glass, fearing that pressure 
with his forceps might splinter it in the bladder during extraction, devised the ingenious expedient of covering the 
blades of his forceps with soft molasses candy, knowing that, if any of this substance was left in the bladder, it would 
melt and pass away. The device was fully successful."-" Genito-Urinary Diseases with Syphilis." Van Buren and 
Keyes. 1874. 
Mercier's duplicator (Fig. 3063) resembles a lithotrite in general shape ; it differs from it only in the arrangement of 
the blades. The female blade is pierced and its edges are very prominent; the male scoop, which is hook-shaped at the 
lower concavity, terminates at the angle of junction with the shank of the instrument in a rounded projection. If a soft 
Fig. 3056.-Reliquet's Urethral Stone Crusher. 
Fig. 3057.-Nelaton's Urethral Foreign Body Instruments. 
Fig. 3058.-Mathieu's Urethral Lithotrite. GEORGE TIEMANN * CO.'S SURGICAL INSTRUMENTS. 
399 
URETHRAL A^ID URO-CYSTIC. 
FOREIGN BODIES. 
Extraction. (Continued.) 
and flexible foreign body like a catheter is seized between the two blades, and the male blade is pushed on until it meets 
the other, the foreign body, being pushed back by the " pigeon's beak" of the male blade, slides along as far as the 
hook, where it is fixed against the female blade. The instrument is withdrawn at the same time and the foreign body 
is bent. The fenestra of the female blade is intended to permit the convex portion of the male blade to become en- 
gaged in it. Experience has shown that Mercier's instrument is very useful in practice, and that it is preferable to 
others in cases of catheters. Collins' foreign body instrument (Fig. 3064) is of the shape of an ordinary lithotrite. At 
the side of the handle is a thumb-screw for fixing the blade at will. The female blade is rather large, presenting on 
one side a projecting ridge, very high at the elbow and diminishing more and more up to the end of the blade, where 
it no longer projects. The border of the other side of the female blade is much lower than the opposite, but has a 
sudden projection at the tip. The male blade is narrower than the female and of a rounded, triangular form, present- 
ing the apex to the scoop of the female blade. As the two blades are approached, the foreign body, if grasped trans- 
versely, slides toward the end of the scoop, where, coming in contact with the projection, it is revolved in a plane, and 
thus places itself in the axis of the instrument, where it is firmly held by the union of the two blades. Upon withdraw- 
ing the instrument, we must assure ourselves that it is well in the axis. If this is not so it has been seized too far 
from the end, and must be brought nearer. 
Fig. 3061.-Curved Urethral Forceps (Alligator). 
Fig. 3060.-Straight Urethral Forceps (Alligator). 
Fig. 3059.-Thompson's Urethral Forceps. 
Fig. 3062.-Leroy d'Etiolles Articular Urethral Curette. 
Fig. 3063.-Mercier's Duplicator. 
Fig. 3064.-Collin's Foreign Body Instrument. 400 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
6YST0-LITJHie 
STONE, LITHIASIS CYSTICA, VESICAL OR URINARY CALCULUS. 
Stone Searchers, Sounds, Lithophone. 
Stone, the common name of calculus in the urinary bladder, is formed by a precipitation of the urinary salts either 
in the kidney, passing thence to the bladder, or primarily in the bladder. In the latter case a foreign body may be 
the nucleus. The prominent symptoms are irritability of the bladder with frequent irresistible desire to pass water, 
and occasional stoppage of the stream, with pain in various parts of the urinary system and sometimes the presence of 
blood, mucus and pus in the urine. None of these, however, can be depended on, the only sure 
diagnosis resting on making the stone perceptible to the ear and fingers by means of a metallic 
sound introduced through the urethra and brought into direct contact with the foreign body. 
Fig. 3065.-Steel Sound. 
Fig. 3066.-Gouley's Searcher. 
Fig. 3072.-Thompson's Searcher. 
Fig. 3067.-Little's Searcher. 
Fig. 3068.-Thompson's Searcher. 
Fig. 3069.-Otis' Exploring Sound (is also used for exploring strictures). 
Fig. 3070.-Andrew's Searcher. 
Fig. 3073,-Thompson's Measure. 
Fig. 3071.-Steel Sound and Billroth's Sounding Board. 
Langlebert's "lithophone" is a small cylindro-conical 
drum of glazed pasteboard, to the extremity of which an 
exploring sound is attached. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
401 
CYSTO-IdITHIC. 
METHODS OF REMOVAL OF STONE FROM THE BLADDER. 
1. Solution; 2. Extraction as a whole through the Urethra; 3. Lithotrity; 4. Lithotomy. 
" I. Solution has been attempted by remedies taken by the mouth, or injected into the bladder. Uric acid calculi 
have been treated by the administration of alkalies and the phosphatic by the injection of a solution of nitric acid. 
These methods have, from their inefficiency, fallen into disuse. 
" 2. Extraction by the zirethra is done in females ; in them the canal is so short and dilatable that a stone of con- 
siderable size can be removed by this method. 
" 3. Lithotrity.-Crushing into fragments of such size that they can pass through the urethra is indicated, in patients 
beyond puberty, when the stone is single and not large, and when the urethra is not strictured and the bladder and 
kidneys are not much diseased. The early instruments used for this purpose were very rude and dangerous, the stone 
being grasped by branches made to protrude from a straight catheter and then bored by a drill extending through the 
instrument and worked by a watchmaker's bow ; after it was bored it was crushed by another complicated instrument. 
To Civiale (1817-24) is unquestionably due the credit of having introduced the operation by improving the instruments 
and the manner of their use. The instruments now used are composed of two sliding blades, introduced in the shape 
and after the manner of a sound, between which the stone is seized and then crushed by the gradual pressure of a 
screw ; the fragments may then be washed out by injections or by the urine, large pieces being again broken by the 
same or another instrument. 
"4. Lithotomy.-Extraction through an opening artificially made into the bladder is indicated in all males under 
puberty, and in others when the stone is large or there are several; when the urethra is strictured ; when the bladder 
is in such a condition as to be unable to bear the repeated introduction of lithotrity instruments and the irritation 
caused by the fragments resulting from lithotrity. Lithotomy was practiced twenty-five centuries ago ; Hippocrates 
bound his pupils by oath not to practice it, but it came into use again in the time of Celsus, in whose writings are found 
the first indications of the bilateral operation ; the lateral operation was first practiced toward the end of the seven- 
teenth century; the supra pubic method was first employed by Franco in the sixteenth century and the recto-vesical 
by Sanson in the nineteenth."-"American Cyclopaedia." 
"Perineal lithotrity.-The combination of external urethrotomy in the membranous region, dilatation of the pros- 
tate and neck of the bladder, with fragmentation of the stone and immediate removal of debris, proposed and per- 
formed by Dolbeau in 1862, as an additional resource of surgery, to rid patients of stone with a minimum amount of 
cutting."-Gouley. 
LITHOTRITY, LITHOTRITES. 
Lithotrity.-The operation of breaking or crushing vesical calculi into fragments of such size that they may be 
passed with the urine through the urethra. The instruments employed for this purpose are called lithotrites, litho- 
tritors, lithotriptors, lithoclasts. 
" The lithotrite is the perfected result of many trials and of the correction of faults, as found out by experience, 
in instruments previously invented, modified and thrown aside. Amusat and Key had established the fact that straight 
instruments could be passed through the urethra into the bladder with a certain degree of facility, and for this reason, 
apparently, the earlier efforts to bring a perforating, grinding or triturating power to bear upon the stone were made 
by Civiale and his followers with straight instruments. This surgeon made his first great success with his * litholabe '- 
a straight instrument-and for ten years no other than straight instruments were used for lithotrity." 
Fig. 3074.-Jacobson's Lithotrite, closed for Introduction. 
Fig. 3075.-Jacobson's Lithotrite, open, for Seizure of the Stone. 402 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
©YSTO-LITHie 
LITHOTRITES. 
For Breaking or Crushing Vesical Calculi into Fragments of such size that they may be passed, 
through the Urethra. 
Fig. 3076.-Hunter's Trilabe. 
" Hunter's trilabe is still occasionally employed to catch lost fragments and in case of impaction of a fragment in 
the urethra. About the year 1834 the articulated lithotrite of Jacobson and the curved lithotrite with jaws to open and 
shut, devised by Weiss, of London, began to be substituted for the ' trilabe,' and Ileurteloup so modified this latter in- 
vention that percussion, by means of a hammer applied to the extremity of the male blade, causes fragmentation of the 
stone. This instrument has been gradually superseded by the varieties in use at the present time, i. e., those worked 
either by lever power, with rack and pinion, or screw. Sir Wm. Fergusson's instrument is worked by rack and pinion. 
Its crushing power is regulated by the strength of the operator's hand, and may be increased by exercising a certain 
jerking impulse, resembling that of the percussion hammer, or by using the hammer itself."-" Genito-Urinary 
Diseases with Syphilis." Van Buren and Keyes. 
Fig. 3077.-Lever Lithotrite. 
Fig. 3078.-Fergusson's Lithotrite. 
Fig. 3079.-Heurteloup's Lithotrite and Mallet (Percuteur) GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
403 
©YSTO-LITHIC 
LITHOTRITES. 
For Breaking or Crushing Vesical Calculi into Fragments of such size that they may be passed. 
. through the Urethra. 
Fig. 3080.-Handle of Thompson's Lithotrite. 
1 ne greater efficiency of tne screw as a 
power, and the ease and smoothness with 
which it acts, have led to its very general 
adoption for lithotrites. Civiale's (Fig. 3083), 
Thompson's (Fig. 3080) and Teevan's (Fig. 
3082) instruments are worked in this way. 
The motive power of these instruments re- 
sides in the handles and may be applied or 
detached at will, so that the male blade can 
be withdrawn to the required 
extent and then brought into 
connection with the screw, 
by simply sliding the button 
on the handle of Thompson's 
instrument (Fig. 3080), or 
by moving the vertical slide 
/, on the handle of Teevan's 
(Fie. 3082). 
Fig. 3081.-Thompson's Lithotrite 
Fig. 3082.-Handle of Teevan's Lithotriptor. 
Fig. 3083.-Civiale's Lithotriptor. 
In Civiale's lithotriptor the screw-power is thrown in and out of gear by a quarter turn of a movable disk attached 
to the handle of the female blade (Fig. 3083). 
Considering a lithotrite as composed of parts, we speak of the female blade and the male blade. The female blade 
is the one continuous and fixed to the handle (Fig. 3084), it is deeply grooved for the reception of the male blade or 
sliding rod (Fig. 3085). 
Fig. 3084.-Female Blade of Thompson's Lithotrite. 
Fig. 3085.-Male Blade of Thompson's Lithotrite. 404 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
CYSTO-LITHIC 
LITHOTRITES. 
For Breaking or Crushing Vesical Calculi into Fragments of such size that they may be passed 
through the Urethra. 
When the male blade is pushed home as far as it will go, we say the lithotrite is closed-and then call the curved 
extremity the beak, the other, by which we take hold of the instrument, the handle and the part between handle and 
beak the shaft. When the male blade is drawn out, the beak separates, or opens, and we now speak of the halves as 
jaws (Figs. 3086, 3087). 
The jaws of lithotriptors vary in strength and structure, in 
accordance with the work required of them. For reducing 
stones, of large size and considerable hardness, to fragments, 
the male blade is narrow, with deep and sharp angular teeth, 
while the female blade is broad, heavy and fenestrated (Fig. 
3086). In closing the jaws, fragments and detritus are forced 
through this fenestrum, so that no clogging or impaction can 
take place. 
For crushing small or soft calculi, or for pulverizing frag- 
ments, the jaws of the lithotriptor are shorter, less heavy and 
their opposing surfaces are simply roughened, so that detritus 
produced may pass off with the urine. 
Mercier has made valuable improvements in the 
jaws of lithotriptors, in Fig. 3087 will be observed a 
slit at the base of the female blade, T, through which 
accumulated detritus is ejected by means of a plough- 
share or spur, T, which, at the same time, adds 
enormously to the strength of the instrument. This 
spur fits into the eye of the female blade, so that, if 
the finger be passed over the hole when the blades 
are closed, no inequality will be felt. The spur is 
also made as seen in Fig. iA, which may be regarded 
as a model instrument. It is not easy to exaggerate 
the value of the spur, T, for it enables us to use a 
very slender instrument in cases where it would 
otherwise not have been safe, and thus extends lithotrity to a field from whence it was previously excluded, for there 
are many patients whose urinary tract is in such a state of irritation that repeated manipulations with heavy lithotrites 
could not be borne. 
Our lithotrites are forged out of the best English steel. The groove in the female blade is cut with a machine 
made for this special purpose. When finished, they are tested, by breaking with them pieces of soft grindstones. We 
should advise surgeons to test their instruments in this manner, before attempting to use them in the bladder ; it will 
exercise their tact and judgment. When a stone is between the jaws of a lithotrite and the screw turned, the operator 
will distinctly recognize a certain recoil and spring of the instrument before the stone is crushed. This sensation re- 
quires to be studied in order to know how far the instrument may be taxed (when used unassisted by eyesight), on a 
bladder calculus. 
Fig. 3086.-Fenestrated Jaws of Lithotrite, 
Fig. 3087.-Closed Jaws of Lithotrite 
Fig. 3088.-Gouley's Lithotrite. 
Lithotrity. 
"To within a few years ago, Civiale's method of operating had been practiced with a considerable amount of 
success. The proceeding consisted in the breaking up of the calculus by the lithotrite, at one or more sittings, 
according to circumstances, the fragments being either partially removed by appliances, such as Clover's instrument, 
or allowed to escape spontaneously with the urine. Each sitting, or rather breaking of the calculus, was limited to a 
few minutes-there being a general agreement that anything like a prolonged use of the lithotrite was hazardous. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
405 
6YST0 - LITH IC. 
LITHOTRITY. (Continued.) 
This practice was attended, with few exceptions-where the stones were so small or so friable as to be crushed with 
one or two grips of the lithotrite-with the retention in the bladder, for varying periods, of pieces of rough and broken 
stone, which had no means of escape other than those mentioned. Here, then, was a fruitful cause of cystitis, which 
necessarily became a serious complication. Though this method has now been largely superseded by litholapaxy, some 
surgeons consider that there are cases to which the older method still remains applicable."-"Observations on Lithoto- 
my, Lithotrity," &c. 1883. R. Harrison, F. R. C. S. 
Evacuation, of Debris, 
Fig. 3089.-Van Buren's Evacuating Catheter and Bag. 
Fig. 3093.-Clover's Evacuating Apparatus. 
Fig. 3090.-Nelaton's Evacuating Apparatus. 
Fig. 3091.-Cornay's Washing Bottle (Litheretie). 
Fig. 3092.-Mercier's Washing Bottle. 
"Various inventors, from time to time, devised evacuating tubes, to which syringes, rubber balls or evacuating 
pumps were attached. Among the most prominent names are those of Leroy d'Etiolles, Cornay, Mercier, Nelaton, 
Maisonneuve, Clover and Coxeter. Cornay's litheretie was described in 1845, one year before Crampton's bottle, 
which it resembled in many respects, differing in that it combined the possibility of injecting the bladder through a 
double current catheter (Fig. 3045) with the principle of pneumatic aspiration. Mercier, in 1871, published a descrip- 
tion of a washing bottle (Fig. 3092) made of rubber, oval in shape, with a glass receiver for fragments below. It very 
closely resembles in principle, and, indeed, in appearance, some of the first washers used by Thompson and Bigelow, 
and was worked without valves by alternate compression and relaxation of the rubber bulb filled with water, while the 
fragments collected below in the glass receiver. But Mercier did not dream of litholapaxy. He states distinctly that 
he had devised the washer for use, ' quand la retention devient complete'-in other words, to help the bladder out when 
it should prove inadequate to the task of expelling the urine and the debris. Clover's evacuating apparatus, having 
a glass receiver and a metallic catheter with large eye, or open at the end, is one of the best of the old type of instru- 
ments. The same tube, with a metallic pump above the receiver, is known as Nelaton's evacuating apparatus."-• 
" Urinary Calculus," by E. L. Keyes, A.M., M.D. " International Cyclopaedia of Surgery," Ashhurst. Vol. VI. 1886. 406 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
eYSTO-LITHIC 
LITHOLAPAXY. 
Rapid Lithotrity with Evacuation. 
"The following are the chief points connected with the modification in lithotrity which I have described, and for 
which I propose the above name. 
" I. The calculus, although not necessarily pulverized, is crushed as rapidly and completely as is practicable. The 
dust and fragments are immediately evacuated, and a serious source of irritation is thus removed. 
" 2. This can be effected in a single operation. 
" 3. The operation-performed of course under ether-may be, if necessary, of one or two hours duration, or even 
longer. 
" 4. The method applies to larger stones than have been hitherto considered to lie within the province of the litho- 
tritist. It also applies to small stones, nuclei, phosphatic deposits and foreign substances. 
" 5. Evacuation is best accomplished by a large tube, preferably straight with a distal orifice, the extremity of which 
is shaped to facilitate its introduction, and, during suction, to repel the bladder wall-and by an elastic exhausting 
bulb, which acts partly as a siphon. Below the latter is a glass receptacle for debris. 
" 6. The best size for the tube is the largest the urethra will admit. 
" 7. Such a tube is usually introduced with facility, if passed vertically as far as it will go toward the anus before 
changing its direction, and afterward directed almost horizontally, and passed by rotation through the triangular liga 
ment. The first part of this rule applies also to the introduction of a lithotrite, and even a curved catheter. A free 
injection of oil is important. 
"8. A small meatus should be enlarged, or a stricture divulsed, to allow the passage of a large tube. 
"9. If the bladder be not small, a large and powerful lithotrite is always better than a small one. 
" 10. That this may haveroom for action, the escaping water should be replaced occasionally, through a tube inserted 
a few inches into the urethra by the side of the lithotrite. But the bladder should not be over distended. 
" II. To save time, and also to prevent undue dilatation of the vesical neck, a non-impacting lithotrite is desirable. 
The jaws of a non-fenestrated instrument will not impact, if the male blade is furnished with alternate triangular 
notches by which the debris is discharged laterally, and also with a long thin spur at the heel fitted to a corresponding 
slot in the female blade-provided the floor of the female blade, especially at the heel, be made nearly on a level with 
its rim. To repel the bladder, the female blade should be longerand a little wider than is usual. It should have also 
low sides easily accessible to fragments-relying for strength less upon these than upon a central ridge below the heel. 
In the male blade of such a lithotrite the apices of the triangles should be a little blunted. Lastly, a non-fenestrated 
female blade protects the floor of the bladder, during a long sitting. A fenestrated instrument directs sharp splinters 
against it. The latter also delays the process of disintegration, by delivering through its opening the same fragments 
many times. 
" 12. In locking and unlocking a lithotrite repeatedly in a long operation, it takes less time and is easier to turn the 
right wrist, as in my instrument, than to displace the thumb of either hand in search of a button or a lever, as in pre- 
vious instruments."-Henry J. Bigelow, M.D. Boston, May 25th, 1878. 
Fig. 3094.-Bigelow's Lithotrite. 
Fig. 3095.-Beak of Bigelow's Lithotrites 
(closed). 
Fig. 3096.-Beak of Bigelow's Lithotrite 
(open). 
The female blade of 
Bigelow's lithotrite has 
a long blunted toe to fa- 
cilitate its passage 
through the urethra, 
while the male blade is 
deeply notched, and pro- 
vided with a spur to drive 
out the debris and pre- 
vent impaction. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
407 
©YSTO-blTHiC 
LITHOLAP AXY. 
Rapid Lithotrity with Evacuation. 
Fig. 3097.-Handle of Bigelow's Lithorite (closed). 
The lithotrite of Bigelow is pro- 
vided with an elongated vulcanite 
handle, shaped to fit the hand, 
the lock, represented open in Fig. 
3098, is readily closed by a quar- 
ter revolution of the cover held 
between the thumb and index fin- 
ger of the right hand, without 
compelling the operator to relax 
his hold upon the stone until it is 
well between the blades. It is 
represented closed in Fig. 3097. 
Fig. 3098.-Handle of Bigelow's Lithotrite (open). 
Evacuation, 
"The large evacuating tube (3, 4,5) being the essential instrument 
in the new operation, a vacuum produced by almost any apparatus will 
draw fragments through it. 
"An apparatus I early employed consisted of a stiff bulb (z) and 
Clover's trap, attached to the large catheter by a short elastic tube (2). 
The combination was a good one; for the elastic tube allowed the bulb, 
when in use, to be bent down to the level of the bladder. The bulb 
could also be laid on its side, and, by further depression, reversed; which 
brought the catheter tube to the top. It then remained only to open a 
trap at its lowest point and the fragments staid where they fell. This 
arrangement, placed on a stand, is practically the evacuator I still use. 
"A strong bulb or bottle is here a very desirable substitute for the 
former slender one. In the glass trap (6) at the bottom of the instrument, 
the fragments are kept out of the current at a point distant from the 
catheter. After entering at the top of the bulb, they settle at once to 
the bottom and remain there undisturbed. 
" If fragments are drawn through the tube with the force and rapid- 
ity that are given to the current by a strong elastic bottle, a few inches 
added to the length of the route are of no consequence. A short and 
curved elastic tube (here five inches long, but which I have varied from 
two inches to two feet) between the bottle and the catheter makes it 
possible to move one without the other. It relieves the surgeon and pro- 
tects the patient. The surgeon can explore the bladder in search of frag- 
ments, without having to move the bulb, while the jar of pumping does 
not reach the bladder. The discomfort to the unetherized patient resulting 
from this jar is a serious objection to the rapid attachment of the bulb of 
water to the catheter. It should have a support of its own, placed upon 
the table or bed between the patient's legs, which may be separated a 
little, as in the case of the introduction of a catheter or lithotrite. The 
bulb, when thus near the level of the bladder, acts as a siphon. This is 
desirable. By experiments you will find that the difficulty of suction in- 
creases as the bulb is held higher than the evacuating tube. There is 
great advantage in keeping the bulb low, near the level of the bladder."-• 
Henry I. Bigelow, M. D., Medical and Surgical Journal, Jan. 1, 1880. 
"After trying several modifications of it, I must express my satisfac- 
tion, so far, with the original instrument. Exception has been taken 
to it on the grounds: 1. That the trapping of fragments is imperfect; 
2. That the apparatus permits air to enter the bladder. Admitting the 
truth of these objections to some extent, I am not disposed to think that 
the utility of the instrument is thereby seriously impaired."-" Lithotomy, 
Lithotrity," &c. R. Harrison, F. R. C. S. London. 1883. 
Fig. 3099.--Bigelow's Original Evacuating Apparatus. 408 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
6YST0-LITHIC 
LITHOLAPAXY. 
Rapid Lithotrity with Evacuation. 
Fig. 3101.-Thompson's Evacuator. 
"The principle pursued by those who at an early period adopted the 
operation of crushing the stone, instead of cutting for it, was to proceed, 
little by little, to feel their way cautiously with the new proceeding, and ac- 
complish as much progress as they could, but always subject to one impor- 
tant condition-namely, that the operator should do no mischief to the organs 
by any undue manipulation on his part. This was the practice long before 
anaesthesia was allied with surgery, and the lithotritist made it part of his 
business to watch the patient closely during the proceeding to ascertain 
whether he was distressed by it, and to modify it according to his sensibility 
and power of endurance. So much had this become a natural condition of 
the operation that, long after the use of ether and chloroform had become 
indispensable in all operations, lithotrity was performed by many without an 
anaesthetic agent. Hence it was the aim of the operator to cultivate a light 
and gentle, but quick hand ; to do as much as possible in a short space of 
time, but also as gently and delicately as he could. Thus several sittings, 
varying in number from three to four, or to ten or twelve, were commonly 
necessary, according to the size of the stone. 
" In time, however, anaesthesia became adopted also for lithotrity, and 
since employing it myself I have gradually diminished the number of sittings, 
and removed more debris on each occasion, so that from one sitting to four 
or five became at length as productive as the numbers before named. This 
progress was naturally in part the result of familiarity with the instruments 
and their use, acquired by many years of practice. I also employed more 
and more, during the last six or seven years, for the same purpose, and especi- 
ally when the presence of irritation or inflammation made the removal of all 
fragments particularly desirable, the aspirator of Clover. 
"About this time Mr. Bigelow, of Harvard, U. S., proposed, as a general 
rule, that the stone should, if possible, be crushed at one sitting, and removed entirely by a large aspirator and evac- 
uating catheters, no matter how prolonged the time which might be necessary in order to accomplish the task. He 
believed that less damage would really accrue to the bladder and associated organs by a long, and even somewhat 
hazardous sitting, provided the viscus was emptied of the debris, than by the old process of taking away a little and 
often, but leaving always hard and broken fragments in the cavity, to produce continued and sometimes serious irri- 
tation there during much of the period necessary for repeated sittings. 
" This was a bold, but I believe it was also a happy idea. My mind was already prepared by past experience to 
receive it favorably, although the means Bigelow employed in the shape of instruments, especially the lithotrites he 
proposed to use for the purpose, it was impossible for me to approve; and I at once tried the plan, and have to a very 
great extent carried it out during the past twelve months. I am bound to say, as far as I can judge, as far as now 
thirty-one consecutive cases thus managed enable me to determine, I think the principle a decided step of progress for 
lithotrity. Let the stone as to size be within the limit of the surgeon's powers, and let all be removed, or at all events 
the greater part of it, at the first trial. In attempting this, he should commence by crushing freely with a light but 
strong lithotrite, removing debris by the aspirator current afterwards. This done, the lithotrite is again introduced, 
if necessary, to deal with the remainder, and is again followed by the aspirator. If the rattle of fragments in the 
bladder against the end of the evacuating catheter still exists after its use, the lithotrite is to be again introduced to 
break them down, and another employment of the aspirator will perhaps complete the task. If only a few small 
pieces still remain, it is better perhaps to leave them than to subject the parts to repeated manipulations in order to 
remove some tiny portion. Such will do no harm, and may be removed at a second sitting. For the purpose of this 
mode of operating, I have modified my instruments somewhat. I have used one lithotrite, when necessary, slightly 
stronger than before, making the male blade more wedge-shaped, or rather like the prow of a ship-in part angular, 
in part more bluff or obtuse ; this male blade protrudes through a small opening at the bottom of the female blade, 
so as to make blocking up impossible. And the original aspirator of Clover, the principle of which is maintained in 
its entirety, I have considerably modified, in a manner so that my new form of it offers three advantageous conditions: 
first, there is no possibility of air entering it; secondly, it ensures the shortest possible route into it from the bladder; 
and, thirdly, it has a globular trap at the bottom, into which the fragments enter, but which they cannot leave. 
" Thompson's evacuator (Fig. 3101) consists of a stout india rubber bottle. On the upper part is a tap and above 
it a small funnel through which to fill the bottle. At the lower end is a tube with a tap attached, and a spherical 
glass receiver of about two and a quarter inches in diameter. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
409 
©YSTO-IdITHIC. 
LITHOLAPAXY. 
Rapid Lithotrity with Evacuation. 
The apparatus acts thus: The evacuating catheter being in the bladder, it is attached to the tube. If the tap 
is now turned communication is established between the bladder and the apparatus, or cut off, as the case may require. 
To fill the instrument, the upper tap is opened, the lower one closed and water poured in by the funnel at the 
top. The water fills it directly and drives the air completely out; the upper tap is then closed and the instrument is 
then ready for use. 
" The change in the situation and form of the lower tap shortens the distance many inches for the fragments to 
traverse, which thus reach the glass receiver by the shortest possible route. The current having less distance to travel, 
has a more powerful action on the fragments, consequently the aspiration is more perfectly made than it has hitherto 
been. The entry of air into the bladder is impossible, since the current leaves the lower part of the apparatus, and 
the air bubbles, if any, must rise to the upper part. In consequence, also, of its small size and portability, this instru- 
ment can be very easily adapted to an evacuating catheter, without necessitating any change in the position of the 
patient to be operated on. Lastly, for those who prefer a portion of flexible tube between the aspirator and the evacu- 
ating catheter, a portion is provided ; two inches thus interposed will insure freedom from any jar to the bladder in 
using the instrument, and will only lengthen the route pro tanto. For myself, I prefer the absolutely direct and shortest 
route ; having no more fear of hurting the bladder with the inflexible evacuating catheter than I have with the in- 
flexible lithotrite."-Sir Henry Thomp- 
son on " Lithotrity at a Single Sitting." 
Lancet. June, 1880. 
" This evacuator is more simple in 
construction and aspirates more per- 
fectly than any I have used. It is a 
compact modification of one formerly 
published in Lancet, Sept. 24, 1881, 
as a ' simplified evacuator,' but without 
the stand of that instrument, which is 
not essential, and has been omitted be- 
cause operators seem to prefer to do 
without it. It has an elastic bulb, glass 
receiver and stop-cocks. Below there is 
a metal brace between the collar of the 
glass receiver and that of the catheter 
to steady the latter. Within the bulb, 
and open at the end, is a tube strainer 
to prevent the return of debris. The 
bulb forms a concentric handle to the 
catheter. The tunnel and hose both 
fit on the top of the bulb ; they belong 
to the apparatus, but are not essential 
to it."-London Aledical Record, Aug. 
15, 1883. 
Fig. 3102.-Bigelow's Latest Evacuator. (1883) 
" The facility and safety of removing the debris from the bladder, in litholapaxy, depends, in a very important de- 
gree, on the size and shape of the evacuating tube or catheter. Professor Bigelow recommends that the size shall not 
be below 25 millimetres in circumference, nor above 31 millimetres. For my own part I have never yet met with a 
normal adult urethra of less than 28 millimetres in circumference. He uses, and recommends, the straight evacuating 
tube, in preference to the curved. The calculous debris finds its way through it much more directly and easily, and, 
while less liable to become clogged, it is more readily cleared. The only objection appears to be the somewhat greater 
difficulty of introducing it into the bladder, especially in cases of enlargement of the prostate. I have modified the 
straight instrument of Professor Bigelow by adding a small curved projection, CL (Fig. 3103), which, with all the 
advantages of the former, I have found more easy of introduction, and preventing, in greater degree, the closure of 
the opening in the tube, from engagement of mucous membrane in it, during the process of evacuation."-F. N. 
Otis, M. D. Medical Record, November 3, 1883. 
Otis' Evacuating Catheters. 410 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
eYSTO-biTfdie 
LITHOLAPAXY. 
Rapid. Lithotrity with. Evacuation. 
Fig. 3103.-Otis' Evacuator. 
" Notwithstanding their excellence in other respects, the weight and size of the different evacuators had often oc- 
curred to me as an objection. Aftercareful experimental study of the matter, bearing in mind the excellent points of all 
the instruments in use for this purpose, the plan of a new instrument was evolved by me, and elaborated by the surgical 
cutlers, Geo. Tiemann & Co. It consists of an annealed glass bulb, A, two inches in diameter, the reservoir, into one 
side of which a metal tube, B, forty millimetres in circumference, curving down to its lowest part, is inserted. This is 
connected to an evacuating catheter, C, by a short india rubber tube. Attached to the floor of the reservoir by a bayonet 
joint, E, is a short, strong glass bottle, F, the receiver. On the side of the bulb, opposite the tube connecting with the 
evacuating catheter, is another metal tube (at G), curving upwards to near the top of the bulb, A. This is connected 
by another flexible tube, 17, with a strong india rubber bulb, I, constituting an independent air-chamber. A stopcock 
at the extremity of the flexible tube, B, permits the removal of the catheter without leakage from the reservoir, A. The 
capacity of the reservoir, A, is just four fluid ounces; that of the receiver, F, one and one-half ounce. The instrument, 
in the position shown, may be emptied of the contained air by firm compression of the bulb, I, and the evacuating 
catheter placed in a vessel containing sufficient water, when, by removing the pressure, the instrument fills instantly 
and is then ready for use. 
"Directions for Operating.-The evacuating catheter having been well oiled and carefully introduced into the 
bladder, the contained urine is evacuated, and six to eight ounces of tepid water are introduced into the bladder. The 
evacuating catheter is then attached to the evacuator. Gentle pressure of the bulb-sufficient to displace one-third to 
one-half of its contained air-drives a current of water into the bladder and produces the necessary vacuum. The re- 
turning current from the bladder brings a portion of its contained water, and with it the calculous debris. This is 
quietly, quickly and certainly deposited into the receiver, from which there is no possibility of return into the bladder. 
Repeating the pressure on the bulb at intervals of two or three seconds, as long as fragments are seen to fall into the 
receiver, the catheter, the point of which has been in contact with the most dependent portion of the bladder, is then 
withdrawn a little and gently moved about, in order that floating or reluctant fragments may find access to it, and the 
rhythmic pressure of the bulb is continued, until no more debris is seen to fall into the receiver. If, then, there are 
evidences that calculous material still remains in the bladder after removal of the evacuating catheter, the crushing is 
renewed, after which the same operation for removal of debris is repeated, and so on, until the stone is completely 
removed."-F. N. Otis, M. D., &c. Medical Record, Novembers, 1883. 
N. B.-" The readiest and best way of filling the instrument is to plunge the evacuating end into a vessel of water, 
of a temperature of 98°, and, by one or two firm compressions of the rubber bulb, the filling is complete and the 
evacuator is ready for use. If, during the operation, it is found desirable to introduce additional water into the bladder, 
this is done with great ease, by attaching the discharge pipe of a Davidson's syringe to the stop-cock (at K), while the 
supply end is immersed in a vessel (preferably a large glass graduate), filled with water of a proper temperature. The 
easy attachment and detachment of the Davidson's syringe, allows any desired amount of fluid to be introduced into 
the bladder without delay or inconvenience."-F. N. O., Feb. 4th, 1885. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
411 
©YSTO-LITjHie 
LITHOLAP AXY. 
Rapid Lithotrity with. Evacuation. 
"This," says Sir Henry Thompson, "is identical with Fig. 3101 in 
every particular, except that the cylindrical receiver, which is (in Fig. 3101) 
directly under the bottle and may be influenced by currents, is removed 
to the front of it, and is perhaps less disturbed by the current which 
passes over the mouth of the receiver." In neither of these is any stand 
required, and the connection with the bladder is the shortest and simplest 
possible. The connection of the aspirator with the bladder is also cut off 
by the taps. 
"Cocoaine in Litholaj>axy.-Professor Bruns reports a case in which 
he obtained local anaesthesia of the bladder and urethra by injecting a 
cocaine solution, with the most gratifying results. The patient, a young 
man, had suffered for four years from stone in the bladder. Chronic cys- 
titis was present, and evening feverishness. The injection of one gramme 
mostly into the bladder itself, in a two per cent, solution, but also a little 
into the urethra, produced complete local anaesthesia for half an hour, 
during which time a very hard oxalate of lime calculus was thoroughly 
crushed, and removed without pain. After the injection, the patient 
assumed a different position, to bring the fluid into contact with the whole 
inside of the bladder ; and, after the operation, a little of a ten per cent, 
of iodoform-glycerine emulsion was injected. The recovery was uninter- 
rupted."-British Medical Journal. 
" The instrument consists 
of a six-ounce wide - mouthed 
glass bottle, fitted with a rubber 
stopper having two openings 
through it for the introduction 
of two metal tubes; one short, 
extending down about half an 
inch below the stopper, and the 
other long, extending to within 
an inch of the bottom of the 
bottle, with an oval (side) open- 
ing. These are held in place 
by a steel flange over the stop- 
per, and fastened by a screw. 
" The metal tubes are curved 
at their upper extremities, both having for a medium of connection a short piece of rubber tubing. To the short one 
is attached a rubber bulb, and to the long one the evacuating-tube, with stop-cock and bayonet connections. The 
evacuating catheters vary in size and are of the usual shape. For use the bottle is to be filled with warm antiseptic 
water just to clear the opening of the short tube. After the introduction of the evacuating catheter into the bladder, 
it will be well, before making the connection with the long tube, to exclude the air. This can be done by forcing 
water into it by slight pressure upon the bulb and then closing the stopcock. Everything being in readiness, the con- 
nection is made, the stop-cock opened and gentle pressure made upon the bulb, so as to force out from the bottle 
about an ounce and a half of water, when, by a sudden relief of pressure upon the bulb a return current takes place, 
bringing with it broken calculus. The repetition of this manoeuvre is kept up until the operation is completed."- 
H. O. Walker, M. D., &c., Detroit, Mich. Medical News, January, 1885. 
Fig. 3104.-Sir Henry Thompson's 
Latest Evacuator, modified by Weiss. 
Fig. 3105.-Walker's Evacuator. 
Keyes' Evacuating Tubes. 
Fig. 3106.-Keyes'Straight Evacuating Tube, with Obturator. 412 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
CYSTO-LITJHI6 
LITHOLAP AXY. 
Rapid Lithotrity with Evacuation. 
Dr. Keyes has advocated, under certain circumstances (Medical Record, November n, 1882), a straight evacuating 
tube, open at both ends. This is shown as now used by Dr. Keyes in Fig. 3106. 
Dr. Keyes' curved evacuating tube-a short curved sound for purposes of introduction, a straight tube in all the 
essentials for washing-is shown in Fig. 3107. Both tubes have leather packing on the rod carrying the obturator, 
and, being furnished with stop-cocks, may be used without wetting the bed. 
Fig. 3107.-Keyes' Curved Evacuating Tube, with Obturator. 
Fig. 3108.-Keyes' Lithotrite. 
Dr. Keyes employs 
three sizes of lithotrites. 
Fig. 3108, m, in, i, shows 
the handle of the instru- 
ment. The pattern of 
the jaws, d,p, is the same 
in all. The three sizes are 
to accommodate varia- 
tions in the size and hard- 
ness of the stone. He 
says : " I prefer the Re- 
liquet pattern of rough- 
ening the male blade. 
The instrument is narrow, but exceedingly strong. It 
grasps well, and cannot clog. With any reasonable care it 
is unlikely to catch a fold of the bladder in its bite. In the 
handle of my larger lithotrite I have placed two buttons, m, 
in, so that any finger of either hand, in any position, may 
strike a button easily and promptly connect the screw. Either 
button works alone, or they work together. They are saddle- 
shaped, high and much easier to work than those of the 
older patterns. The larger instrument will lock upon a 
stone two and a half inches in diameter." 
Fig. 3109.-Jaws of 
Keyes' Large Lithotrite. 
Fig. 3110.-Chismore's Evacuating Lithotrite. 
"It is a lithotrite and evacuating tube combined, and so made as to be readily connected with Bigelow's, Otis', 
Sir Henry Thompson's, or any other form of aspirator. The screw power and lock usually found on lithotrites 
have been omitted, as it is not intended for use in the beginning of operations on stones of considerable size or 
unusual hardness ; in such cases the first crushing and aspiration should be made with the usual instruments, after 
this it will be found that the hands of the operator are quite powerful enough to crush even large fragments with- 
out difficulty." GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
413 
©YSTO-LITJHIC 
LITHOLAP AXY. 
Rapid Lithotrity with. Evacuation. Chismore's Evacuating Lithotrite. (Continued.) 
" Modus operandi.-First draw the urine and then inject an ounce of a four percent, solution of muriate of cocaine 
into the bladder through a silver catheter. Then soap the tube of the male blade of the instrument to make the joint 
air-tight, put it together and introduce into the bladder. When in situ the jaws are opened an inch or more, an aspir- 
ator coupled on, and about four ounces of a warm solution of biborate of soda injected into the bladder, in addition to 
the solution of cocaine already there. The solution of cocaine remaining, mixed with the other fluid, passes in and 
out of the aspirator and bladder as the bulb is compressed and relaxed, agitating the fragments of stone in all 
directions, while the outflowing current sucks them between the open jaws of the instrument, where they are ground 
down to the proper size to be drawn out."-From a paper by George Chismore, M.D. Read before the Medical 
Society of the State of California, April, 1886. 
THE ANCIENT STONE OPERATIONS. 
Lith.otom.ia, Cystotomia, Urolithotomia, Sectio Vesicalis, Lithocystotomy. 
" i. The Method of Celsus.-This consisted in cutting upon the stone after having made it to project at the 
perinseum by means of the fingers introduced into the rectum. The method was attended with several inconveniences ; 
such as the difficulty of dividing the parts neatly, injury done to the bladder, as well as the impossibility of drawing 
down the stone in many persons. It is sometimes called methodus Guytoniania; from Guy de Chauliac having en- 
deavored to remove from it the discredit into which it had fallen in his time. It was termed apparatus minor, from 
the small number of instruments required in it. 
" 2. Apparatus Major.-This method was invented in 1520, by John de Romani, a surgeon of Cremona, and com- 
municated by him to Mariano Santo di Barletta, whence it was long called Mariano's method, sectio Mariano. It 
was called, also, apparatus major, and cystotomia seu methodus cum apparata magno, from the number of instruments 
required in it. An incision was made on the median line ; but the neck of the bladder was not comprehended in it. 
It was merely dilated. The greater apparatus was liable to many inconveniences: such as ecchymosis, contusion, 
inflammation of the neck of the bladder, abscesses, urinary fistulse, incontinence of urine, impotence, &c. A modi- 
fication of this method, by Mr. John Allarton of England, has been called the median or Allartoris operation. It con- 
sists in dividing the perinseum and the membranous portion of the urethra, passing a probe down to the staff and into 
the bladder, as a guide for the finger through the prostatic portion of the urethra into the bladder, thus dilating the 
passage so as to allow of the introduction of the forceps. 
" 3- The High or Suprapubic Operation, apparatus altus, cystotomia cum apparatu alto, cystotomia hypogastrica, 
lithotomia suprapubem, epicystolomia, laparocystotomia, sectio seu methodus Franconiana.-It was first practiced by Peter 
Franco, about the middle of the sixteenth century. It consisted in pushing the stone above the pubis by the fingers 
introduced into the rectum. Rousset afterwards proposed to make the bladder rise above the pubis by injecting it. 
The method had fallen into discredit, when Frere Come revived it. It is used when the calculus is very large. It was 
practiced by opening first the membranous part of the urethra upon the catheter passed into the canal. Through this 
incision the sonde a dard-a species of catheter, having a spear-pointed stilet-was introduced into the bladder. An 
incision was then made into the linea alba, above the symphysis pubis, of about four or five fingers breadth, and the 
peritoneum detached to avoid wounding it. The stilet was pushed through the bladder and used as a director for the 
knife, with which the bladder was divided anteriorly, as far as the neck, and the stone extracted. It was performed 
in England by Douglass, in 1719, and since by others with various modifications. 
"4- The Lateral Operations, hypocysteotomia, cystotomia lateralis, cystauchenotomia, cystotrachelotomia, urethro- 
cystauchenotomia, urethrocysteotrachelotomia, sectio lateralis, apparatus lateralis.-So named from the prostate gland and 
neck of the bladder being cut laterally, was probably invented by Peter Franco. It was introduced into France by Frere 
Jaques de Beaulieu. He performed it with rude instruments invented by himself, and improved by the suggestions of 
some of the Parisian surgeons. In England it received its earliest and most important improvements from the celebrated 
Cheselden. It is the method practiced in the present day, according to different modes of procedure. In this method the 
patient is placed upon a table ; his legs and thighs are bent and separated ; the hands being tied to the feet. The perinaeum 
is then shaved and a staff introduced into the bladder, the handle being turned towards the right groin of the patient. 
An oblique incision is then made from the raphe to the middle of a line drawn from the anus to the tuberosity of the 
ischium of the left side ; and, taking the staff for a guide, the integuments, areolar tissue of the perinseum, membranous 414 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
©YSTO-LITHIC. 
THE ANCIENT STONE OPERATIONS. 
Lithotomia, Cystotomia, Urolithotomia, Sectio Vesicalis, Lithocystotomy. (Continued.) 
portion of the urethra, transversus perinaei muscle, bulbo-cavernosus, some fibres of the levator ani, the prostate and 
neck of the bladder, are successively divided. For this latter part of the operation, the knife, the beaked bistoury, 
bistoury ou lithotome cache, cutting gorget, &c., is used, according to the particular preference. The forceps are now 
introduced into the bladder and the stone extracted. In the operation care must be taken not to injure the rectum or 
the great arterial vessels distributed to the perinaeum. The method of Le Cat and of Pajola-urethrocysteoaneurys- 
matotomia-consists of dividing the prostate in part only-the enlargement of the wound being effected by a peculiar 
dilator. 
"5. Lithotomy by the Rectum-recto-vesical-lithotomy, proctocystotomia, sectio rectovesicalis.-This was pro- 
posed by Vegetius in the sixteenth century ; but it was never noticed until M. Sanson, in the year 1817, attracted atten- 
tion to it; since which time it has been successfully performed in many instances. It consists in penetrating the 
bladder through the paries corresponding with the rectum by first cutting the sphincter ani and rectum about the root 
of the penis, and penetrating the bladder by the neck of that organ, dividing the prostate, or by its bas-fond."- 
Dunglison. 
Practically the surgeon requires but three operations to meet the necessities of all cases ; they are: 
The lateral, the median, and the high operation for stone. 
The condition of the stone calling for lithotomy are four : 
Size, number, composition, position. 
" 1. Size.-If a stone is decidedly over medium (one inch diameter) size and, at the same time, composed of any- 
thing except the phosphates. 
" 2. Number.-Most cases of multiple stone do better if cut. 
" 3. Composition.-If the stone is small, its composition is a matter of not much importance ; if much over an inch, 
it is all important. The constant appearance in the urine of uric acid, oxalate of lime, or the mixed phosphates, or the 
examination of the gravel or small stones previously passed by the urethra (if any), will often throw great light on this 
subject, as will also the click when the exploring instrument strikes the stone, the sound being sharp and clear for hard, 
dull for soft stones. 
"4. Situation.-Encysted stones, if molested at all, require the knife. Severe general or local disease (especially 
cancer or Bright's disease), unnatural size of stone, advanced age, and debility, make it often advisable to palliate rather 
than assume the risk of any operation, especially among the wealthy, who can command every comfort. 
THE MODERN LITHOTOMY OPERATIONS. 
" Choice of Operation.-Having now decided what cases of stone require lithotomy, it remains to discuss the cir- 
cumstances calling for one or the other operation. Young children do well by any operation, but the lateral is 
undoubtedly the best, as the incision is not liable to injure the seminal ducts, and a free outlet is afforded for the ex- 
traction of the stone. If the latter is quite small, the medium operation is, perhaps, as good ; but, where it is large, 
the violence done in dilating the vesical neck is objectionable. It is exceedingly rare for children to have infiltration 
of urine, although the limits of the prostate are undoubtedly often surpassed by the incision in the lateral operation. 
Peritonitis from violence is what is to be feared in children, and there is little danger of this (even with large stones) 
from the lateral operation. The median section, however, in children, has the advantage of being generally attended 
with less haemorrhage, and is useful for small stones ; the older the child, the less objectionable the operation. 
" With the adult, the same rule holds good-the median operation for small stones, the lateral for large. But small 
stones in the adult are preferably dealt with by lithotrity; hence the application of the median method is rarely advis- 
able, except under two circumstances, namely, where there are many stones, all small, and where, with a single small 
stone (less than one inch in diameter), the patient's irritability is such that chill or constitutional disturbance follows 
every attempt to use instruments in the bladder. Where the stone is small or large, but the bladder more than ordina- 
rily irritable and inflamed, the lateral operation, with free incision of the prostate and vesical neck, is to be preferred. 
In the case of very large stones and, indeed, as a matter of prudence for all stones over one and a half inches in dia- 
meter, a modification of the lateral operation is called for, namely, bilateral section of the prostate to make more room 
for extraction ; or, if the stone shows exceptional proportions, the combination of crushing with cutting (perineal litho- 
trity) and extraction of the stone in fragments, or the supra-pubic operation."-" Genito-Urinary Diseases with Syphilis." 
Van Buren and Keyes. 1874. 
Choice of Operations. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS, 
415 
6YST0-LITHIC 
LITHOTOMY. 
Apparatus for Securing a Patient in the Position for Lithotomy. 
Pritchard's anklets and wristlets are made of stout 
leather and padded. The wristlet is furnished with a 
strong hook, and on either side of the anklet is a 
ring of metal. The pieces are put on separately and 
hooked up after anaesthesia is complete. 
"Peter's substitute for the wrist and ankle band 
consists of an iron rod sliding within a hollow one, 
for the purpose of rendering it longer or shorter. At 
each end of the rod is a padded, leather strap, which 
is to be buckled around the leg just below the knee; 
a long padded strap is then fastened to one of the 
buckles near the end of the connecting rod, carried 
behind the patient's neck and fastened to the buckle 
at the other end of the rod. It enables one to dis- 
pense with one or two assistants, as the one giving 
ether can also keep the patient 
from rolling to either side, by 
simply grasping the connecting 
bar with one hand, leaving the 
other free. It also secures a 
thorough stretching of the peri- 
neum, lifts the legs and feet com- 
pletely out of the way, and en- 
ables you to fetch the nates well 
down beyond the edge of the 
table, which is often very desir- 
able."-New York Medical Re- 
cord, December 9, 1882. 
" The high operation for stone, 
designed by Franco in 1561, has 
still a respectable advocacy. It 
is applicable only to large stone, 
where the choice must otherwise 
be a perineal operation, with the 
additional danger of crushing in 
situ; or, recto-vesical section, 
with its possible resulting fistula ; 
and, finally, in cases of deformed 
pelvis. Humphrey,* who speaks 
with authority upon the subject, and is quoted by Thompson, states that the dangers in the high operation do not 
increase in so great a ratio with the size of the stone as they do in the lateral operation.' -" Genito-Urinary Diseases 
with Syphilis." Van Buren and Keyes. 1874. 
" The Bilateral Operation is founded on that of Celsus. It consists in making an incision posterior to the bulb of 
the urethra, and anterior to the anus, involving both sides of the perimeum by crossing the raphe at right angles: an 
incision is then made through the membranous part of the urethra, and the prostate may be cut bilaterally, either with 
the double lithotome of Dupuytren, or a prostatic bisector. * * * 
" Buchanan's Operation.-Dr. Buchanan, of Glasgow, suggested the use of a rectangular staff (Fig. 3122), the angle 
being placed about three inches from the point, the portion beyond the angle being deeply grooved at the side. V hen 
introduced, the angle of the staff is made to correspond to the apex of the prostate. The surgeon, introducing his finger 
into the rectum, inserts a bistoury in front of the anus, with the blade horizontal and its edge turning to the left, push- 
ing it straight into and along the groove to the stop at its extremity. While slowly withdrawing the bistoury, he makes 
a curved incision through the soft parts, about an inch and a half long, around the upper and left side of the rectum. 
" The Quadrilateral Operation, proposed by Vidal de Cassis, was a modification of the bilateral operation, to be em- 
ployed when the calculus was unusually large ; but it was quadrilateral only so far as the number of prostatic incisions 
was concerned, the external incision being bilateral."-Dunglison. 
Fig. 3111.-Pritchard's Anklets and Wristlets. 
Fig. 3112.-Peter's Substitute for the Wrist and Ankle Band. 
* " Transactions of the Providence Medical Association.'' 1850. 416 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
6YST0-LITHIC 
LITHOTOMY. 
1. The Lateral Operation. 
" The lateral operation dates back to Pierre Franco, of Provence, about the middle ot the sixteenth century, and 
claims the names of Jaques in the seventeenth century, and Rau, his pupil, in the eighteenth. It was popularized 
and practiced with great success in England, by Cheselden, in the last century, and it is his operation which is still 
performed. 
" Instruments employed.-The instruments necessary for the operation are the searcher (ff. 3065), a staff of proper 
size with a long curve deeply grooved on its convexity (Fig. 3119), the groove encroaching on the right lateral aspect of 
the staff toward the point. The handle of the staff should be broad, heavy, and marked with deep crossed lines, so 
that it may be held firmly with ease. The groove should not run off at the beak, but stop abruptly, leaving the last 
quarter of an inch blunt and round. The scalpel should be firm, seven or eight inches long, with a stout shank and 
solid back, the blade about three inches long (Fig. 3123), the cutting edge about one and a quarter inch. Blizardsprobe- 
pointed knife (Fig. 3120, English pattern), long, straight, with a stiff back, and (Fig. 3121, American pattern), stout 
plain or ribbed handle. The blunt gorget, possibly useful where the patient is fat and the perinaeum deep (Fig. 3134). 
The scoop (Fig. 3136). Several forceps of different sizes, with extremities roughened in the inside to hold the stone 
firmly, one with crossed handles (Fig. 3141), so as to be opened sufficiently in a deep perinaeum without stretching the 
wound unduly; another with its blades sharply curved (Fig. 3139), so as to catch stones behind the pubes or in the bas 
fond. A lithoclast, or heavy pair of forceps with a central raised ridge of heavy teeth pointing backward (Fig. 3152) 
in each blade, to catch and break stones which are found too large to extract safely, with an extra screw for attaching 
to the handles to draw the jaws together ; or, for the same purpose, an instrument known as Maisonneuve s (Fig. 3155). 
A metallic debris tube (Fig. 3165) with an open end, and a large eye-furnished with an obdurator for easy introduction- 
through which to wash out debris. A debris syringe with a tube, one-sixth inch diameter, provided with a globular 
head, having holes pointing backward. A shirted canula for haemorrhage (Fig. 3170). A tenaculum (Fig. 3142). 
Pritchard's anklets and zmistlets. A soft French olivary catheter, brandy, hot and cold water, sponges, towels, liga- 
tures, ether, &c. These make up the list of instruments. At least five assistants are necessary: one for the ether ; one 
to steady each knee; one-the post of honor-to hold the staff; one to sponge and act as general assistant. 
" The Operation.-The patient is prepared beforehand as for any capital operation, and, in addition, has the peri- 
neum shaved, and receives a full enema about two hours before the operation, to clear the rectum, after which he 
abstains, if possible, from again passing water. He should be etherized in bed, and then carried to a small, firm table, 
and comfortably arranged on an old blanket. The anklets and wristlets are adjusted (or the hands and feet bound to- 
gether with bandage). The pelvis is now drawn to the lower edge of the table, facing the light, a piece of old carpet 
and a pan with saw-dust placed beneath to catch the blood and urine. The operator passes the staff, feels the stone with 
it, and then entrusts it to his assistant of honor, and, taking his seat on a low stool, facing the patient's pelvis, with all 
his instruments systematically arranged within easy reach of his right hand, is in readiness to commence. Should the 
staff fail to strike the stone, it may be withdrawn and the searcher introduced. Should this also fail to detect it, after 
a careful and prolonged sounding, the operation should be deferred. Some of the best operators have been deceived in 
their diagnosis, and have cut patients in whom no stone existed ; so that it has become a cardinal rule nevbr to cut a 
patient in whom the stone cannot be felt after he is upon the table. The sound may fail to detect it, if it lies in a deep 
bas fond, but not so the searcher. The holder of the staff usually satisfies himself that the sound strikes the stone. It 
is not essential that the end of the staff should rest against the stone. As long as it is certainly in the bladder, nothing 
more is required. The chief assistant stands at the patient's left, holds the staff vertically, steadily, and firmly hooked 
up under the symphysis, with its long curve a little bellied out in the median line of the perinaeum, and keeps the inte- 
gument of the latter taut by pulling the scrotum up around the staff. The assistants steady the knees, while the ope- 
rator impresses his mind firmly with the shape and size of the long outlet of the pelvis by running his finger down the 
rami of the ischium, touching their tuberosities, feeling the symphysis pubis and the coccyx. The surgeon should 
picture to himself a pelvis lying before him, in position, denuded of soft parts, and recall the general inverted heart- 
shape of its outlet. The operator now introduces the left index finger into the rectum, assures himself that the sound 
enters the apex of the prostate and passes centrally through its canal, and that the rectum is empty and collapsed. Then, 
withdrawing his finger, he searches with the thumb or finger of his left hand upon the raphe of the perinaeum, for the 
groove in the staff, which, in a thin person, can always be obscurely felt. If he cannot feel it, he takes the handle of 
the staff from his assistant and, by depressing it several times, while he makes pressure upon the perinaeum, he satisfies 
himself of the position of the groove and returns the staff to his assistant. 
" The scalpel is now entered a little to the (patient's) left of the raphe, from one and a quarter to one and a half 
inch in front of the anus, the point of the knife, guided by the nail, being made to enter the groove of the sound and 
open the urethra at the first cut. If the point enters the groove, it is to be pushed along for a quarter to half an inch; 
if it fails to strike the groove it is made to pierce more or less deeply-and then, with a single bold stroke, the first 
incision is made laterally to the right, about three and a half inches long, terminating exactly midway between the tuber GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
417 
CYSTO-IsITJH IC 
LITHOTOMY. 
Staffs, Directors and Knives. 
Fig. 3113.-Little's Director for Median Lithotomy. 
Fig. 3114.-Little's Lithotomy Bistoury. 
Fig. 3115.-Little's Lithotomy Staff. 
Fig. 3116.-Sharp-pointed Lithotomy Scalpel. 
Fig. 3117.-Markoe's Lithotomy Staff. 
Fig. 3118.-Probe-pointed Lithotomy Scalpel. 
Fig. 3119.-Steel Staff. 
Fig. 3120.-Blizard's Probe-pointed Knife (English). 
Gross' Lithotomy 
Knife 
is like Fig. 3121, 
but sharp pointed 
Fig. 3121.-Blizard's Probe-pointed Knife (American). 
Fig. 3122.-Buchanan's Rectangular Staff. 
Fig. 3123.-Lithotomy Scalpel (Depruyten's). 418 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
e YSTO - LI TH IC. 
LITHOTOMY. 
1. The Lateral Operation. (Continued.) 
ischii and the anus. The scalpel is again entered into the groove, and the urethra amply opened. The practiced litho- 
tornist sometimes uses the same knife to complete the operation, but, as a rule, it is better at this stage to change the 
scalpel for Blizard's knife. The probe point of the latter, following the guiding index finger, is passed into the groove, 
and the surgeon takes the handle of the staff, depresses it somewhat, and, following the groove, pushes his knife along 
until its point is arrested by the abrupt termination of the groove at the end of the staff. He now increases the angle 
between his knife and the staff, by depressing the handle of the former, and, remembering the position and shape of 
the prostate, he cuts his way out, his incision through the prostate being at about an angle of 300 with the horizon, 
the external incision at an angle of about 500. A gush of urine usually follows this incision. If the external incision 
has not been bold enough, it may now be enlarged with a few strokes of the scalpel. Having now completed the in- 
cisions, the index finger of the left hand should be gently introduced into the bladder, and the sound withdrawn. The 
finger usually comes at once in contact with the stone. The bladder's neck is now to be dilated slowly but thoroughly 
with the finger-if the perinaeum be deep with fat, with the blunt gorget, carried in along the groove of the staff. If 
the stone has been previously measured, and is less than one inch in diameter, or if there are many small stones, the 
surgeon should proceed to extract at once. If, however, the stone is above one inch in diameter, Blizard's knife should 
be re-introduced on the finger and the prostate cut on the (patient's) right side. After being satisfied that the neck of 
the bladder is nicked, the prostate sufficiently cut, the whole wound dilated and dilatable, the forceps is passed into 
the bladder as the finger is withdrawn. One blade is depressed into the floor of the bladder, the other is widely opened, 
and usually, on closing them, the stone will be caught. Failing in this, search laterally and further back in the bladder 
must be made, the direction of the blades being changed, until the stone is seized. In cases of deep perinaeum the 
small end of the scoop is introduced, until it touches the stone, and then the forceps is followed along upon the scoop 
as a guide until it enters the bladder and strikes the stone. It should never be forgotten during these manoeuvres 
that the bladder, usually already much inflamed, is often nearly empty, clasping the stone, and that any roughness 
or force may inflict serious (perhaps fatal) injury upon the patient. The utmost gentleness, deliberation and care are 
necessary during this stage of the operation ; indeed, the catching and skillful extraction of the stone are often a 
more delicate proceeding than any other part of the operation. If it is found that the stone has been seized in a 
faulty diameter, it should be dropped or pushed out of the jaws of the forceps, perhaps rolled over with the finger, 
and another attempt made to catch it correctly. Extraction should be slow, the traction being made in the line of the 
external incision, downward and outward. Lateral motions should be given to the forceps during extraction, the force 
being about two-thirds lateral, one third extractive. It must be remembered that the most fatal source of danger in 
lithotomy is bruising and lacerating the neck of the bladder in forcible efforts at removing the stone ; and if, after the 
exercise of a sufficient amount of force-the amount to be learned only by experience-the stone will not engage in the 
outlet of the bladder, it is far more brilliant morally, and better surgery, to break the stone and carefully extract the 
pieces than to remove by force a handsome specimen to show, with the risk of having to attach to its history, " Result 
fatal." 
" After one stone has been extracted, if it is found to be smoothly rounded and presenting no facets, there is pro- 
bably no other present; if it has facets, the reverse is almost, if not quite certain to be the case. Phosphatic calculi are 
often multiple, uric acid less commonly so, oxalate of lime often single. In any case, after extracting one stone, careful 
search should be made for another with the searcher and the small end of the scoop through the perineal wound. Should 
any stone break during extraction, and in those very rare cases where a quantity of debris is found in the bladder, partly 
adherent to ulcerated patches of mucous membrane, the large end of the scoop is to be used to spoon out the earthy 
matter, and then copious injections of tepid water are to be thrown into the bladder with the bulbous headed irrigator 
(Fig. 3164) until the bladder is clean. When the stone is found to be encysted, or fixed in position by some faulty 
contraction of the bladder behind the pubis, or in the fundus, the dexterity of the operator may be taxed to seize it with 
the forceps, but intelligent efforts, gently and carefully prolonged, will usually overcome the difficulty. If the stone 
is deeply encysted, it may be impossible to liberate it. The neck of the cyst may be nicked in several places, efforts 
made to gnaw off any projecting portions of the stone, and gradually to insinuate the narrow blades of a small curved 
forceps to extract it. Each case must be coolly studied out at the time ; no definite rules, covering all contingencies, 
can be given."-" Genito-Urinary Diseases with Syphilis." Van Buren and Keyes. 1874. 
" The bilateral operation of Depuytren, suitable for the extraction of large stones by the perinaeum, is performed as 
follows: The patient is fixed in the ordinary lithotomy position, and the staff, having a median groove, is held cen- 
trally. A semi-lunar incision is made crossing the raphe, about one inch (from twenty-two to twenty-four millimetres) 
in front of the anus. The integument, cellular tissue, and interior fibres of the sphincter are cut. The left index-finger 
16. The Bilateral Operation. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
419 
CYSTO-LITHIC. 
LITHOTOMY. 
Staffs, Directors, Knives and Lithotomes. (Continued.) 
Fig. 3124.-Wyeth's Lithotomy Bistoury, 
Fig. 3125.-Lateral Lithotomy Staff. 
Fig. 3126.-Mason's Catheter Staff. 
Fig. 3127.-Depuytren's Double Bistoury Cache. 
Fig. 3128.-Smith's Lithotome. 
Fig. 3130.-Brigg's Lithotome. 
Fig. 3129.-Hutchison's Lithotome. 420 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
CYSTO-LITHIC 
LITHOTOMY. 
1&. The Bilateral Operation. (Continued.) 
is now introduced into the wound and made to depress the rectum, while with short strokes of the knife the surgeon 
endeavors to free those muscular fibres, a part of the sphincter, which hold the bulb of the urethra attached to the anus. 
The bulb is now turned up and the finger seeks the membranous urethra far back in the wound. This is to be opened 
upon the nail, the knife being held transversely, to insure safety to the rectum. The operator now takes the double 
lithotome cache (Fig. 3127), enters its point in the groove of the staff, holding the instrument's convexity upwards. As 
soon as the lithotome is in the bladder the staff is removed, the blades of the lithotome are protruded, and the instru- 
ment is withdrawn, at first horizontally, and then with the handle slightly lowered, so as to spare the rectum. As soon 
as the prostate has been cut through, the blades are returned to their sheaths and the lithotome is withdrawn. 
" The operation of the late James R. Wood, of New York, is essentially a pre-rectal, bilateral operation. After the 
incision is made across the perinaeum in front of the rectum, and the urethra opened, the cutting part of the operation 
is terminated by placing the button of the bisector (Fig. 3137) in the central groove of the staff (Fig. 3138). This button is 
so arranged that the bisector cannot escape after its button has once entered the groove. It is pushed directly onwards 
into the bladder, cutting the prostate and the vesical neck to a moderate extent transversely. Dilatation does the rest. 
The stone is extracted in the manner described when speaking of the lateral operation."-" Urinary Calculus." By E. 
L. Keyes, A. M., M. D. " International Cyclopaedia of Surgery." Amhurst. Vol. VI. 1886. 
2. The Median Operation. 
" The median is known classically as the Marian operation, devised in the sixteenth century, and afterwards largely 
adopted and improved in Italy. Allarton has been its apostle in England, and the modern operation is known by his 
name. In this country Markoe first brought it into particular prominence, and the names of Little and Walter are 
also connected with it. Each of these surgeons has enjoyed remarkable success with this operation. 
"Instruments required.-The only instruments necessary, differing from those employed in the lateral operation, are 
three: a staff, director and knife. The staff, of appropriate size, has a central groove with a broad flare. Markoe 
(Fig. 3117) and Little (Fig. 3115) have each adopted a staff. A ball-pointed director, known as Little's (Fig. 3113) is 
generally employed, and a straight, stout, sharp-pointed bistoury (Fig. 3114). 
"Operation.-The patient bound in the lithotomy position, and the staff introduced in contact with the stone, the 
operator passes the index-finger of the left hand intp the rectum, familiarizes himself with the feel of the parts, and 
accurately locates the apex of the prostate, just where the staff enters it. He now transfixes the perinaeum about half an 
inch above the anus with the sharp-pointed bistoury, the cutting edge upward, entering the point of the same, guided 
by the finger in the rectum, into the central groove of the staff, at the apex of the prostate. The double-edged point 
is now advanced very slightly into the groove, so as certainly to enter the urethra, and barely nick the apex of the pros- 
tate. Finally, the knife is made to cut forward and divide the membranous urethra, within, and, the handle being 
elevated in the vertical plane, the blade is swept so as (theoretically, at least) to avoid the bulb, and cut its way out along 
the raphe, the external incision being from one and a quarter to one and a half inches long. Thompson prefers making 
the incision from without centrally inward. The director is now passed along the staff into the bladder, and, these 
two being separated in an angular way, the neck of the bladder is dilated, some urine flowing out during the process. 
The staff is now withdrawn, and a finger introduced through the wound, with which the dilatation is completed, without 
cutting the prostate or the neck of the bladder. The stone-necessarily not very large-is withdrawn, as in lateral 
lithotomy, and the general after-care of the patient is the same. 
"The operation yields excellent results; the patient sometimes retains control over his urine from the first. The 
wound generally heals rapidly. The objections to the operation are: its general inapplicability except for stones which 
lithotrity is more capable of managing, and the temptation to use violence during the extraction of too large a stone. 
It is eminently applicable for small stones, in a bladder which will not tolerate the use of instruments without chill or 
other disturbance, for multiple small stones in the adult, and for oldish boys too young for lithotrity, who by reason 
of budding and advancing puberty are not very good subjects for the lateral operation. Where rather large stones are 
extracted by this method, incontinence, sometimes lasting several years, may occasionally ensue. The median operation 
has been variously modified, as by being combined with single or double prostatic incision, but mainly in relation to the 
means resorted to to dilate the prostate."-" Genito-Urinary Diseases with Syphilis." Van Buren and Keyes. 1874. 
3. The High Operation. 
"Mode of Performing the High Operation, described by Villeneuve.-All hair is to be shaved from the pubis, the 
parts are to be washed in an antiseptic solution (carbolic acid I in 20, or bichloride of mercury 1 in 1000), and all the 
details of antiseptic surgery are to be carried out. Anaesthesia is pushed to complete relaxation. A silver catheter with 
stop-cock is introduced. The bladder is emptied and washed clean with a four per cent, solution of boracic acid. When GEORGE TIEMAW & CO.'S SURGICAL INSTRUMENTS. 
421 
eYSTO-wTjdie 
LITHOTOMY. 
Stafis, Gorgets, Bisectors, Scoops, Conductors and Forceps. 
Fig. 3131.-Dowell's Gorget and Staff. 
Fig. 3132.-Physick's Gorget (two blades). 
Fig. 3135.-Keyes' Blunt Gorget. 
Fig. 3136.-Scoop and Conductor. 
Fig. 3137.-Wood's Bisector. 
Fig. 3138.-Wood's Staff. 
Fig. 3133.-Bush's Gorget. 
Fig. 3134.-Blunt Gorget. 
Fig. 3139.-Curved Lithotomy Forceps. 
Fig. 3140.-Little's Lithotomy Forceps. 
Fig. 3141.-Lithotomy Forceps. 422 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYSTO- LITJHIC. 
LITHOLAP AXY. 
3. The High Operation (Continued). 
the wash returns clean, the bladder is slowly distended with the same solution and the stopcock turned ; meantime the 
penis has been tied over the silver catheter with a rubber tube, the tension of which is maintained by a forcipressure 
forceps (Fig. 3148). 
" The amount of fluid varies with the receptivity and the degree of irritability and resistance of the bladder. If too 
much be thrown in, there is danger of rupturing the organ, an accident which has occurred in able hands (Monod, 
Cheselden, Verneul). Two hundred grammes (between six and seven ounces) is considered a moderate amount, and 
six hundred grammes the limit. A piston syringe is used, and a guide to the amount to be thrown in is stated to be the 
resistance offered by the pressure within the bladder to the surgeon's hand as he depresses the piston-a degree of re- 
sistance to be learned by experience. It is undoubtedly wiser here to err on the side of safety. Guyon believes that an 
irritable condition of the bladder, not tolerating distention, contraindicates the operation. 
" The rubber ball (Fig. 3147) is next to be greased and inserted into the rectum, and through its tube from twelve 
to twenty ounces of warm water are to be injected. Six hundred grammes is said to be about the proper amount, but 
undoubtedly this quantity must vary in different cases. The distention of the rectum brings the bladder plainly into 
view above the pubis. An incision is now made exactly in the median line, three or four inches long, stopping at the 
pubic symphysis. The deep fascia is incised upon a director over the entire length of the superficial cut, and the sul- 
cus between the recti muscles is sought. If the pyramidales are in the way, the muscular fibres are to be cut directly 
through in the middle line. No tearing or pulling asunder is allowable, such separation of the elements of the muscle 
favoring infiltration. The incision must be as clean as possible. 
"After getting through the muscle, a yellow layer of fat is exposed, covered by the transversalis fascia. This thin 
fascia is seized with forceps in the middle line, near the lower angle of the wound, a button-hole incision is made, and 
the left forefinger is introduced, bulb upwards. The forefinger thus placed now pushes upwards the yellow layer of 
fat, carrying before it the perineal cul-de-sac. This is Guyon's manoeuvre. He says that by practicing it the perito- 
neum is never seen. The cellulo-adipose layer, between the bladder and pubis, is not to be disturbed at all, and no 
effort is made to reach the neck of the bladder low down in front. Such unnecessary burrowing with the finger behind 
the bone invites infiltration. The finger which has pushed up the fat and the peritoneum is maintained in position in 
the upper angle, and serves as a guide to the point of the bistoury, which is made to puncture the bladder at this point, 
and to continue the incision downwards in the middle line from one and a quarter to one and three-quarter inches, ac- 
cording to the size of the calculus. A tenaculum, or the hooked gorget, or any suitable blunt hook, might be used here 
to hold up the upper angle of the wound in the bladder, or the lips of the wound may be held apart by loops of silk 
inserted on either side. 
" In making the incision into the distended bladder, no attention is to be paid to a plexus of prominent veins which 
are seen over the front wall of the organ, and which may lie directly in the line of the proposed incision. It tears the 
tissues to attempt to ligate them. They are to be cleanly cut through. The haemorrhage, sometimes considerable at first, 
becomes arrested as the bladder collapses. If no veins are seen, Petersen's manoeuvre may be adopted, cutting slowly 
into the muscular layers of the bladder until the mucous membrane projects through the lips of the vesical wound, then 
seizing the latter and incising it. 
" The liquid having run out, the next step is to untie the penis and remove the catheter. As this is being done, the 
finger of the surgeon follows the bistoury into the bladder, detects the stone and places it in a position favorable for re- 
moval. The forceps follow the finger, seize the stone and extract it slowly and with care not to bruise the sides of the 
vesical incision. If the latter be too small, it should be enlarged toward the neck of the bladder with a probe-pointed 
bistoury, as the stone is held in the forceps. All the stones having been extracted, and the debris or clot removed, the 
bladder is to be carefully washed with the boracic acid solution and the rectal tampon withdrawn. 
" Two large parallel tubes of soft red rubber, fenestrated only at their extremity, are now to be introduced upon 
the finger to the bottom of the bladder near the vesical neck. These tubes must be long enough to mount over the 
pubes and enter a urinal placed in the bed between the patient's thighs. The tubes are united together by silver wire, 
passed through their walls, but not into their cavity, and are attached superficially to the lips of the wound by a point 
of superficial suture on either side.* The wound itself is closed in its upper third, the sutures being passed through the 
skin, superficial fascia and borders of the recti muscles, without touching the bladder or the peritoneum. A few points 
of superficial suture are required, and a Lister dressing, or a bichloride or iodoform antiseptic pad is applied, the dress- 
ing being performed for the passage of the tubes. 
" During the period of after-treatment, the dressing is removed two or three times and reapplied. The tubes are 
taken out at the end of a week, and intermittent catheterization by the urethra is then resorted to. Drainage by this 
method is said to be admirable, and the cure is said to be complete by the twentieth day."-"Urinary Calculus." By E. 
L. Keyes, A. M., M.D. "International Cyclopaedia of Surgery." Amhurst. Vol. VI. 1886. 
* We make double current tubes, especially adapted for the purpose,-G, T. & Co. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
423 
CYSTO-LITHIC. 
LITHOTOMY. 
The High Operation. 
Fig. 3142.-Keith's Tenaculum. 
Fig. 3143.-Sonde a Dard. 
Fig. 3144.-Helmuth's Sonde a Dard. 
Fig. 3145.-Aponeurotome. 
Fig. 3148.-Forcipressure Forceps. 
Fig. 3147.-Peterson's Rectal Colpeurynter, modified by 
Guyon. For use in the Modern Operation of 
Supra Pubic Cystotomy (made of thick stiff rubber). 
" I am glad to find that Petersen's method of raising 
the bladder by distending the rectum with an india-rub- 
ber bag filled with fluid, as practiced by Sir Henry 
Thompson, is giving an impulse to the high operation 
of lithotomy; it has always appeared to me that it is 
the operation best suited for the removal of large stones, 
and I have been surprised that it has not been more fre- 
quently practised." - Prof. Humphry, in the London 
Lancet. July 25, 1885, page 146. 424 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
CYSTO - bITHIC. 
PERINEAL LITHOTRITY 
Dolbeau's Operation, 
" The name of perineal lithotrity was given, in 1862, by Professor Dolbeau, of Paris, to an operation completed 
in one sitting, by which the membranous portion of the urethra is opened, the prostate and neck of the bladder dilated 
instead of being cut (as in lithotomy), and a large stone crushed and the fragments immediately extracted. * * * 
" The instruments necessary to perform perineal lithotrity are : a broad, deep and centrally grooved staff ; a strong, 
straight, lancet-pointed bistoury, such as that used in median lithotomy ; a six-branched (Dolbeau's) prostatic dilator; 
three or four lithoclasts of different shapes and strength ; two or three pairs of small, straight and curved forceps; 
a scoop, and a long nozzled rubber syringe. Mr. Dolbeau advises that, in addition to the above-named instruments, 
the following should be within reach in case unforeseen difficulties should occur during the operation : A beaked 
bistoury, a single or double lithotome, a blunt gorget, strong forceps, and a canula a chemise. 
"Operation.-The description Professor Dolbeau gives of his operation is substantially as follows: It comprises 
three principal steps: 1st. The opening of the bladder; 2d. Lithoclasty, or fragmentation of the stone ; 3d. The ex- 
traction of the debris. 
" I. Opening of the Bladder.-The patient, having been properly prepared, is etherized and placed in the litho- 
tomy position. The staff is introduced and confided to the principal assistant, who holds it firmly and perpendicularly 
in the median line and well hooked under the pubic arch. An incision, two centimetres (about thirteen-sixteenths of 
an inch) in length, is made in the median raphe, extending to the anal margin and involving the skin and superficial 
fascia. The deep fascia is next incised ; the left index finger-nail is then pressed into the groove of the staff, and the 
membranous portion of the urethra is punctured with the knife, care being taken to avoid the bulb on one side and the 
rectum on the other. The urethral incision is only five or six millimetres in length. I see no reason why the knife 
should not be plunged into the urethra through the skin, as in Allarton's operation. 
"Dilatation.-In most cases the dilator can be introduced into the bladder at once ; but Mr. Dolbeau prefers, for 
safety's sake, to make dilatation in three steps, the first of which consists in inserting the point of the dilator into the 
groove of the staff, and fixing it in a direction perpendicular to the plane of the perinseum. The staff is held firmly 
in position, that there may not be the slightest deviation of either instrument, and that it may serve as a fulcrum for 
the dilator; and, during dilatation, the assistant should constantly resist the strain arising therefrom. The dilators 
should be opened very slowly, although during this step scarcely any obstacle is encountered, as the tissues yield 
readily and the passage is made immediately. Methodical divulsion of the urethra and the crowding back of the 
tissues from the skin to the urethral rent being thus secured, there is an artificial canal large enough to allow the 
instrument, after it is closed, to enter the prostatic urethra. Then begins the second step of the dilatation, in which the 
surgeon, holding in his right hand the dilator, in contact with the groove of the staff, takes the handle of the latter in 
his left hand and depresses it to an angle of about one hundred and thirty degrees. This depression of the staff 
causes the point of the dilator to be carried nearer the vesical neck. In this new position of the instruments the peri- 
neal wound is again slowly dilated. * * * 
" At the termination of the second step, the dilator is closed and the staff removed ; but the former is left in posi- 
tion, that the third and last step of dilatation may be accomplished. The dilator may have to be employed two or 
three times, in order to make the perineal wound sufficiently patent. 
" In the third step, also, the introduction of the dilator and its opening must be very slow. Often only its conical 
extremity can be engaged in the neck of the bladder; when this happens, no violence or haste must be used. It is 
sufficient to dilate very slowly, then to close the instrument, when it will be comparatively easy to introduce it into the 
bladder. The dilatation of the vesical neck is then proceeded with, always slowly, stopping each time there is any 
great resistance. After the dilator is developed to its fullest extent (twenty millimetres), it is gently withdrawn- 
its six branches remaining open. At the conclusion of the last step of dilatation, Mr. Dolbeau is in the habit of 
introducing a small straight lithotomy forceps, to ascertain the size and hardness of the stone. If the calculus does 
not exceed two centimetres in diameter, he extracts it entire, otherwise he proceeds to lithoclasty. In some cases he 
has been able to reduce to fragments, with this forceps, large phosphatic stones. 
" 2. Lithoclasty.-This step of perineal lithotrity has, according to Mr. Dolbeau, for its principal and essential 
basis the following proposition : The great danger in the operation of perineal lithotomy is the extraction of a calculus 
too large, considering the restricted dimensions of the neck of the bladder. Security then resides in fragmentation of 
the stone. In this manner the fragments extracted are proportioned to the canal by which they pass, and it may be 
said that, as a rule, calculi which exceed two centimetres should be broken up. 
" The manner of breaking up the stone with Mr. Dolbeau's forceps (Fig. 3152) is as follows : After having ascer- 
tained the volume of the stone with the small lithotomy forceps, this instrument is removed and the lithoclast, pre- 
viously oiled, is introduced slowly and cautiously through the artificial canal into the bladder ; the stone, if very hard and 
large, is gnawed by the teeth at the extremity of the lithoclast, so that it is destroyed from the circumference toward 
the centre, and, when it is sufficiently reduced in size, it is caught between the jaws and broken up, considerable force GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
425 
CYSTO-LdITHIC. 
PERINEAL LITHOTRITY. 
Dolbeau's Operation. (Continued.) 
being sometimes required to fracture it. Then fragment after fragment is seized and broken into portions sufficiently 
small to be extracted without injury to the vesical neck. When the calculus is not very hard and does not exceed an 
inch in diameter, it may be at once seized and crushed. Mr. Dolbeau was once able to reduce, at one crushing, such 
a stone to fifty-three fragments, all of which were small enough to be successfully extracted. (Fragmentation with 
my lithoclasts is done in the same manner.) 
" 3. Extraction is made partly with the lithoclast and small forceps and partly with the scoop. The rules that 
apply to extraction after lithotomy should here be observed. It is, says Mr. Dolbeau, by a series of fragmentations 
and explorations followed by extractions that the bladder is finally relieved of the calculous matter. He advises the 
injection of cold water into the bladder from time to time during the explorations, not for the purpose of washing away 
calculous debris, which would be impossible, but to control bleeding and to render certain fragments more accessible. 
He insists that the patient must not be left until it is certain that there is nothing in the bladder, that therefore several 
explorations should be made with the small forceps through the wound, and also with a metallic sound of short curve 
introduced by the urethra. 
" The advantages claimed for the operation are: That the situation of the small wound exposes the patient to very 
little risk of haemorrhage ; there is less suppuration, and the patient is less exposed to its bad effects, and in fact that 
it possesses all the advantages of median lithotomy without its disadvantages. Mr. Dolbeau urges that perineal litho- 
trityhas not been with him an operation of choice, but of necessity ; that he has resorted to it only when lithotripsy by 
the natural route has been contraindicated, and where the larger incision in perineal lithotomy might prove serious."- 
"Diseases of the Urinary Organs." John W. Gouley, M. D., &c. 
Fig. 3149.-Dolbeau's Dilator. 
Fig. 3150.-Cuyon Duplay's Dilator. 
Fig. 3151.-Dolbeau's 
Guide for the Lithoclast. 
Lithoclasts. 
Fig. 3152.-Dolbeau's Lithoclast. 
Fig. 3153.-Gouley's Lithoclast (double lever). 426 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
eYSTO-LITJHie 
LITHOCLASTY. 
Lithoclasts, for Breaking Stones which are found to be too large to extract safely through the 
wound made in any of the Lithotomies. 
Fig. 3154.-Gouley's Lithoclast (plain). 
Fig. 3155.-Maisonneuve's Stone Crusher. 
The female blade of Maisonneuve's stone crusher terminates in a deep scoop. The scoop, a, is introduced care- 
fully through the perineal wound until it has entered the bladder, after which, by a lateral motion, it is insinuated 
under the large stone. Now the male blade, c, b, with its inner shaft, e, e, withdrawn, is gradually pushed down 
against the stone, and screwed firmly by the wheel, d, until it holds the calculus fixed. Finally, the inner sharp 
"bit" at the end of the central shaft, e, is, by rotating the handle, driven through the stone, e, thus perforating it, 
and, by the assistance of the wheel, d, splitting it into fragments-which may then be removed by the lithotomy forceps. 
Fig. 3156.-De Rigal's Stone-Holder, Perforator and Breaker. 
(Tennette avec cassepierre et perforateur de Rigal.) 
The forceps or holder is introduced through the wound and the stone fixed between its blades by means of the 
set-screw. The stone is then perforated, the drill being turned by the crank-gearing. After this the drilling appara- 
tus is withdrawn, and the breaker, shown at the top of figure, passed into the opening by a rotating motion. When 
in, the winged screw is turned once or twice, this draws the head of the trocar within the slit of the tube, which thus 
expands and breaks the stone. 
Fig. 3157.-Luer's Lithotomy Scoop, for Removing Fragments. GEORGE TIEMANN .fc CO.'S SURGICAL INSTRUMENTS. 
427 
CYSTO - LITHIC. 
PERINEAL (SECTION) LITHOTRITY. 
Fig. 3158.-Whitehead's Staff 
and Knife. 
Fig. 3159.-Hewitt's Staff and Knife. 
Fig. 3160.-Walker's Prostatic 
Divulsor. 
Fig. 3161.-Walker's External Urethrotome. 
Fig. 3162.-Walker's Urethrotomy Staff. 
Prostatic Calculi. 
At a recent meeting of the Surgical Society of Paris, M. Reclus reported the following case 
{Revue Medicale, October 24, 1885). A patient who had just had an attack of renal colic, passed 
fourteen small stones by the urethra. Upon the introduction of a sound an obstruction was 
found at the level of the prostate, and as the instrument passed there was a sensation as if it 
were going over a number of roughened bodies. There was no stone in the bladder. Rectal 
examination revealed the presence of a hard swelling in the prostatic region. A perineal incis- 
ion was then made on a guide, and thirty-two calculi, weighing seven hundred and thirty grains, 
were extracted ; two of these were adherent, and were removed with difficulty. 428 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
GYSTO-LITHIC. 
WASHING OUT DEBRIS, AND ARRESTING HAEMORRHAGE AFTER LITHOTOMY. 
Fig. 3163.-Mussey's Bladder Curette, 
Fig. 3164.-Van Buren's Debris Syringe. 
Fig. 3165.-Debris Tube and Obdurator. 
For Arresting Haemorrhage after Lithotomy. 
Fig. 3166.-Gouley's Hydro-IIajmostat. 
Fig. 3167.-Campbell's Canula, with Cotton Introducer. 
Fig. 3168.-Brown's Air 
Tampon, for Haemorrhage. 
Fig. 3169.-Gross' Artery Compressor. 
* The haemorrhage after perineal lithotomy is usually very slight, 
not exceeding two or three ounces. It may be arterial or venous, pri- 
mary or secondary. Its principal sources are the artery of the bulb and 
the superficial artery of the perinaeum. In old subjects a copious flow of 
blood occasionally proceeds from the veins of the neck of the bladder and of the prostate gland. The pudic artery, 
in its natural course, can hardly be wounded posteriorly ; anteriorly, however, it is more exposed, and, therefore, in 
danger of being injured. The accident is most likely to happen when the prostate is divided with the gorget or the. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
429 
eYSTO-biTfdie. 
FOR ARRESTING HAEMORRHAGE AFTER LITHOTOMY. (Continued.) 
Fig. 3170. 
Canula a Chemise. 
lithotome cache. The artery of the bulb sometimes bleeds profusely; and from its deep 
position, and the readiness with which it reacts, is always secured with difficulty. A 
tremendous gush of blood sometimes proceeds from the transverse perineal artery. The 
bleeding generally follows the first incision, and should immediately be arrested with 
the ligature. When the artery is situated very far back, at the neck of the bladder, or 
by the side of the prostate gland, it may be extremely difficult, if not impossible, to 
ligate it. To meet this contingency I devised a pair of forceps (Fig. 3169) which, after 
having grasped the artery, may be permanently retained, by unscrewing its handle, 
until all danger from haemorrhage is over. 
'''Compression may be resorted to when it is impossible to use the ligature or torsion. 
A canula(Fig. 3170) consisting of metal or hard rubber, four inches and a half long by 
four lines in diameter, open at the vesical extremity, or provided with large eyelets 
and surrounded with a chemise, is inserted into the bladder, previously emptied of 
clots, when the chemise is tightly plugged with charpie, tow or cotton. The instru- 
ment is then secured by means of pieces of tape to a double T bandage, and answers 
the twofold purpose of conducting off urine and compressing the bleeding vessels. 
It should be retained for several days, or until there is reason to believe that all danger 
of haemorrhage is over. Professor Campbell, of Georgia, prefers a slightly curved to a 
straight canula (Fig. 3167)."-" System of Surgery." Gross. 
" The number of cases in which surgeon's have cut into the kidneys, or have taken out the kidney, is now very con- 
siderable, while a few years ago the operation was a rarity. The kidney is subject to many incurable diseases, and 
especially to the formation of stone in its substance. Such a stone can be reached in no way except by the knife. 
An incision is made through the loin down to the diseased organ, and it is laid open. If the disease be calculus, this 
may be removed and the kidney left in its place ; or, if the kidney be found extensively diseased, it may itself be re- 
moved."-"Appleton's Annual Cyclopaedia." 1883. 
"Jane J., age 42, married, was the mother of ten children. On July 2d, 1884, a fortnight after my first visit, I had 
her placed under ether by my son, and, assisted by Mr. Thompson and Mr. Freshney, performed the following opera- 
tion under full antiseptic precautions. I made an incision parallel with the last rib, as for lumbar colotomy, and, on 
arriving at the peritoneum, which was easily pushed aside, I could feel the lower and outer convex border of the kid- 
ney. I then passed a very fine aspirating needle into it. At the first insertion no stone was felt, nor did anything 
come into the cylinder of the aspirator. I made a second insertion, somewhat more upwards, when I struck the stone, 
and the cylinder filled with pus. I then carefully cut down on the needle, using it as a director, following the knife 
with my finger, and making the wound in the kidney large enough to introduce two fingers after which there was 
not much difficulty, with the aid of a lithotomy scoop, in removing a large branched stone, in shape rather like a piece 
of ginger-root. It is composed of the triple phosphates, and weighs three drachms and fourteen grains. There was 
only one small vessel which required tying; and during the operation there was a slight oozing from the kidney, which 
soon ceased. After removal of the stone I thoroughly explored the dilated kidney, both with my fingers and with a 
pair of curved forceps. A small stone, weighing six grains, was the result (this stone had a facet on it). There were 
eight ounces of foetid pus emptied out; before closing the wound, we thoroughly sponged it our. 
" I requested Mr. Thompson to examine the interior of the dilated kidney and, then, inserting a large drainage- 
tube, stitched the outer wound with silver sutures, and dressed with a pad of salicylic silk. The patient rallied very 
well, and the same evening the thermometer went down to 99, and only once rose higher. She gradually pro- 
gressed toward convalescence, the pus slowly decreasing. Then again, during four months, she passed a rather large 
number of small calculi, the size of peas, and they were accompanied with a small quantity of pus. She has had no 
more haematuria, and is gradually gaining flesh ; the wound is entirely healed, only a small fistulous opening remaining, 
which requires a pad of lint once or twice a week." * * * 
"Nephrectomy for other causes has been performed successfully on individuals as old as fifty-three."-R. H. 
Bouchier Nicholson, M. R. C. S., Assistant Surgeon to the Royal Infirmary, Hull, Eng., in British Medical Journal, 
Sept. 5, 1885. 
Renal Lithotomy, or Nephrotomy, and Nephrectomy. 430 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
FEMALE ORGANS OF GENERATION. 
External. 
" The external organs of generation in the female are the mons veneris, the labia majora and minora, the clitoris, 
the meatus urinarius, and the orifice of the vagina. The term "vulva" or "pudendum," as generally applied, includes 
all these parts. 
"The mons veneris is the rounded eminence in front of the pubes, formed by a collection of fatty tissue beneath 
the integument. It surmounts the vulva, and is covered with hair at the time of puberty. 
" The labia majora are two prominent longitudinal cutaneous folds, extending downwards from the mons veneris 
to the anterior boundary of the perinaeum, and enclosing an eliptical fissure, the common urino-sexual opening. Each 
labium is formed externally of integument covered with hair; internally, of mucous membrane, which is continuous 
with the genito-urinary mucous tract; and, between the two, of a considerable quantity of areolar tissue, fat and a tissue 
resembling the dartos of the scrotum, besides vessels, nerves and glands. The labia are thicker in front than behind, 
and joined together at each extremity, forming the anterior and posterior commissures. The interval left between the 
posterior commissure and the margin of the anus is about an inch in length, and constitutes the perinaeum. Just within 
the posterior commissure is a small transverse fold, the frenulum pudendi, or fourchette, which is commonly ruptured 
in the first parturition, and the space between it and the commissure is called the fossa navicularis. The labia are 
analogous to the scrotum in the male. 
" The labia minora, or nymphce, are two small folds of mucous membrane situated within the labia majora, extend- 
ing from the clitoris obliquely dowwards and outwards for about an inch and a half on each side of the orifice of the 
vagina, on the sides of which they are lost. They are continuous externally with the labia majora, internally with the 
inner surface of the vagina. As they converge towards the clitoris in front, each labium divides into two folds, which 
surround the glans clitoridis, the superior folds uniting to form the prceputium clitoridis, the inferior folds being at- 
tached to the glans, and forming the franum. The nymphae are composed of mucous membrane, covered by a thin 
epithelial layer. They contain a plexus of vessels in their interior, and are provided with numerous large mucous 
crypts, which secrete abundance of sebaceous matter. 
" The clitoris is an erectile structure, analogous to the corpora cavernosa of the penis. It is situated beneath the 
anterior commissure, partially hidden between the anterior extremities of the labia minora. It is an elongated organ, 
connected to the rami of the pubes and ischia on each side by two crura; the body is short and concealed beneath the 
labia; the free extremity, or glans clitoridis, is a small rounded tubercle, consisting of spongy erectile tissue, and 
highly sensitive. The clitoris consists of two corpora cavernosa, composed of erectile tissue enclosed in a dense layer of 
fibrous membrane, united together along their inner surfaces by an incomplete fibrous pectiniform septum. It is pro- 
vided, like the penis, with a suspensory ligament, and with two small muscles, the erectores clitoridis, which are in- 
serted into the crura of the corpora cavernosa. Between the clitoris and the entrance of the vagina is a triangular 
smooth surface, bounded on each side by the nymphae: this is the vestibule. 
" The orifice of the urethra (meatus urinarius') is situated at the back part of the vestibule, about an inch below 
the clitoris, and near the margin of the vagina, surrounded by a prominent elevation of the mucous membrane. Below 
the meatus urinarius is the orifice of the vagina, an eliptical aperture, more or less closed in the virgin by a membran- 
ous fold-the hymen. The hymen is a thin semilunar fold of mucous membrane, stretched across the lower part of the 
orifice of the vagina ; its concave margin being turned upwards towards the pubes. Sometimes this membrane forms a 
complete septum across the orifice of the vagina ; a condition known as imperforate hymen. Occasionally it forms a cir- 
cular septum, perforated in the centre by a round opening; sometimes it is cribriform, or its free margin forms a mem- 
branous fringe, or it may be entirely absent. It may also persist after copulation. The hymen cannot, consequently, 
be considered as a test of virginity. Its rupture, or the rudimentary condition of the membrane above referred to, gives 
rise to those small rounded elevations which surround the opening of the vagina, the carunculce mirtiformes. 
" Glands of Bartholine.-On each side of the commencement of the vagina is a round or oblong body, of a reddish- 
yellow color, and of the size of a horse-bean, analogous to Cowper's gland in the male. It is called the gland of Bar- 
tholine. Each gland opens by means of a long single duct, upon the inner side of the nymphae, external to the hymen. 
Extending from the clitoris, along either side of the vestibule, and lying a little behind the nymphae, are two large 
oblong masses, about an inch in length, consisting of a plexus of veins inclosed in a thin layer of fibrous membrane. 
These bodies are narrow in front, rounded below, and are connected with the crura of the clitoris and rami of the 
pubes ; they are termed by Kobelt the bulbi vestibuli, and he considers them analogous to the bulb of the corpus 
spongiosum in the male. Immediately in front of these bodies is a smaller venous plexus, continuous with the bulbi 
vestibuli behind and the glans clitoridis in front; it is called by Kobelt the pars intermedia, and is considered by him 
as analogous to that part of the corpus spongiosum which immediately succeeds the bulb. 
"The bladder is situated at the anterior part of the pelvis. It is in relation, in front, with the os pubis ; behind, 
with the uterus-some convolutions of the small intestine being interposed ; its base lies in contact with the neck of the 
Bladder. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
431 
@Y^I/Eeo LOGICAL. 
SPECULA VAGINAE. 
For Facilitating Inspection, Exploration, Applications and Operations. 
Fig. 3171.-Ferguson's Tubular Speculum. 
Fig. 3172. 
Dome Top Speculum. 
Fig. 3173. 
Thomas' Telescopic 
Speculum. 
Fig. 3174.-Ferguson's Mirror Speculum 
Fig. 3175.-Ashton's Fenestrated Speculum. 
Fig. 3176.-Thomas' Tubular Speculum. 
Fig. 3177.-Bivalve Vaginal Speculum. 
Fig. 3178.-Weber's Speculum. 
Fig. 3179.-Segala's Speculum. 
( " There are various forms 
of specula for examining the 
vagina, and each has its ad- 
vocates, the favorite instru- 
ment being the one to which 
the operator has become ac- 
customed. " ' ' Principles and 
Practice of Gynaecology." 
Emmet. " The Speculum." 432 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
FEMALE ORGANS OF GENERATION. 
Bladder. (Continued.) 
uterus, and with the anterior wall of the vagina. The bladder is said to be larger in the female than in the male, and 
is very broad in its transverse diameter. 
Urethra. 
" The urethra is a narrow membranous canal, about an inch and a half in length, extending from the neck of the 
bladder to the meatus urinarius. It is placed beneath the symphisis pubis, embedded in the anterior wall of the vagina; 
and its direction is obliquely downwards and forwards, its course being slightly curved, the concavity directed for- 
wards and upwards. Its diameter, when undilated, is about a quarter of an inch. The urethra perforates the triangu- 
lar ligament precisely as in the male, and is surrounded by the muscular fibres of the compressor urethrae. 
"Structure.-The urethra consists of three coats: muscular, erectile and mucous. The muscular coat is continuous 
with that of the bladder; it extends the whole length of the tube, and consists of a thick stratum of circular fibres. 
A thin layer of spongy, erectile tissue, intermixed with much elastic tissue, lies immediately beneath the mucous coat. 
The mucous coat is pale, continuous, externally, with that of the vulva, and internally with that of the bladder. It is 
thrown into longitudinal folds, one of which, placed along the floor of the canal, resembles the verumontanum in the 
male urethra. It is lined by laminated epithelium, which becomes spheroidal at the bladder. Its external orifice is 
surrounded by a few mucous follicles. The urethra, from not being surrounded by dense resisting structures, as in the 
male, admits of considerable dilatation, which often enables the surgeon to remove calculi, or other foreign bodies, 
from the cavity of the bladder. 
" The rectum is more capacious and less curved in the female than in the male. 
"The first portion extends from the left sacro-iliac symphisis to the middle of the sacrum. Its connections are 
similar to those in the male. % 
" The second portion extends to the tip of the coccyx. It is covered in front by the peritoneum, but only for a 
short distance, at its upper part: it is in relation with the posterior wall of the vagina. 
" The third portion curves backwards from the vagina to the anus, leaving a space which corresponds on the sur- 
face of the body to the perinaeum. Its extremity is surrounded by the sphincter muscles, and its sides are supported 
by the levatores ani. 
Rectum. 
The Vagina. 
" The vagina is a membranous canal, extending from the vulva to the uterus. It is situated in the cavity of the 
pelvis, behind the bladder, and in front of the rectum. Its direction is curved forwards and downwards, following 
at first the line of the axis of the cavity of the pelvis, and afterwards that of the outlet. It is cylindrical in shape, 
flattened from before backwards, and its walls are ordinarily in contact with each other. Its length is about four inches 
along its anterior wall, and between five and six inches along its posterior wall. It is constricted at its commencement 
and becomes dilated near its uterine extremity; it surrounds the vaginal portion of the cervix uteri, a short distance 
from the os, and its attachment extends higher up on the posterior than on the anterior wall of the uterus. 
"Relations.-Its anterior surface is concave, and in relation with the base of the bladder and with the urethra. 
Itsposterior surf 'ace is convex and connected to the anterior wall of the rectum, for the lower three-fourths of its ex- 
tent, the upper fourth being separated from that tube by the recto-uterine fold of peritoneum, which forms a cul-de-sac 
between the vagina and rectum. Its sides give attachment superiorly to the broad ligaments, and inferiorly to the leva- 
tores ani muscles and recto-vesical fascia. 
"Structure.-The vagina consists of an external, or muscular coat, a layer of erectile tissue, and an internal 
mucous lining. 
" The muscular coat consists of longitudinal fibres, which surround the vagina, and are continuous with the super- 
ficial muscular fibres of the uterus. The strongest fasciculi are those attached to the recto-vesical fascia on each side. 
" The erectile tissue is inclosed between two layers of fibrous membrane ; it is more abundant at the lower than at 
the upper part of the vagina. 
" The mucous membrane is continuous, above, with that lining of the uterus, and below with the integument cover- 
ing the labia majora. Its inner surface presents, along the anterior and posterior walls, a longitudinal ridge, or raphe, 
called the columns of the vagina, and numerous transverse ridges, or rugae, extending outwards from the raphe, on 
each side. These rugae are most distinct near the orifice of the vagina, especially in females before parturition. They 
indicate its adaptation for dilatation, and are calculated to facilitate its enlargement during parturition. The mucous 
membrane is covered with conical and filiform papillae, and provided with mucous glands and follicles, which are 
especially numerous in its upper part and around the cervix uteri. The epithelium is of the squamous variety. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
433 
GYN/EGOLOGIGAb. 
SPECULA VAGIN2E. 
For Facilitating' Inspection, Exploration, Applications and OporationSe 
Fig. 3180.-Labia Speculum. 
Fig. 3181.-French's Speculum. 
Fig. 3182. 
Greensville Dowell's Speculum. 
Fig. 3183.-Blakeley's Resilient Speculum. 
Fig. 3184.-Bath Speculum. 
" There is one property, in a high degree characteristic of the instruments employed in the investigation of the 
diseases of women, of such singular value that it ought to completely silence the objections at one time so passionately 
urged against them. It is this: the instruments have therapeutical as well as a diagnostic application ; the speculum, 
for instance, revealing a lesion of the cervix uteri, enables the surgeon at once to apply his remedy. Thus treatment 
follows upon the track of diagnosis, one sitting and one operation serving for both."-Barnes, " On Diseases of Women." 434 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
®YN/ECOLOGI©AL. 
FEMALE ORGANS OF GENERATION. (Continued.) 
The Uterus. 
" The uterus is the organ of gestation, receiving the fecundated ovum in its cavity, retaining and supporting it 
during the development of the foetus, and becoming the principal agent in its expulsion at the time of parturition. 
In the virgin state it is pear-shaped, flattened from before backwards, and situated in the cavity of the pelvis, be- 
tween the bladder and the rectum ; it is retained in position by the round and broad ligaments on each side, and pro- 
jects into the upper end of the vagina below. Its upper end, or base, is directed upwards and forwards ; its lower end, 
or apex, downwards and backwards, in the line of the axis of the inlet of the pelvis. It, therefore, forms an angle with 
the vagina, since the direction of the vagina corresponds to the axis of the cavity and outlet of the pelvis. The uterus 
measures about three inches in length, two in breadth at its upper part, and an inch in thickness, and it weighs from 
an ounce to an ounce and a half. 
" The fundus is the upper broad extremity of the organ ; it is convex, covered by peritoneum, and placed on a line 
below the level of the brim of the pelvis. 
" The body gradually narrows from the fundus to the neck. Its anterior surface is flattened, covered by peritoneum 
in the upper three-fourths of its extent, and separated from the bladder by some convolutions of the small intestine ; 
the lower fourth is connected with the bladder. Its posterior surface is convex, covered by peritoneum throughout, 
and separated from the rectum by some convolutions of the intestine. Its lateral margins are concave, and give attach- 
ment to the Fallopian tube above, the round ligament below and in front of this, and the ligament of the ovary behind 
and below both of these structures. 
" The cervix is the lower rounded and constricted portion of the uterus ; around its circumference is attached the 
upper part of the vagina, which extends upwards a greater distance behind than in front. 
"At the vaginal extremity of the uterus is a transverse aperture, the os uteri, bounded by two lips, the anterior of 
which is thick, the posterior narrow and long. 
"Ligaments.-The ligaments of the uterus are six in number: two anterior, two posterior, and two lateral. They 
are formed of peritoneum. 
" The two anterior ligaments (vesico-uterine) are two semilunar folds, which pass between the neck of the uterus 
and the posterior surface of the bladder. 
" The two posterior ligaments (recto-uterine) pass between the sides of the uterus and rectum. 
" The two lateral or broad ligaments pass from the sides of the uterus to the lateral walls of the pelvis, forming a 
septum across the pelvis, which divides that cavity into two portions. In the anterior part are contained the bladder, 
urethra and vagina ; in the posterior part the rectum. 
" The cavity of the uterus is small in comparison with the size of the organ : that portion of the cavity which cor- 
responds to the body is triangular, flattened from before backwards, so that its walls are closely approximated, and 
having its base directed upwards towards the fundus. At ea:h superior angle is a funnel-shaped cavity, which consti- 
tutes the remains of the division of the body of the uterus into two cornua ; and at the bottom of each cavity is the 
minute orifice of the Fallopian tube. At the inferior angle of the uterine cavity is a small constricted opening, the in- 
ternal orifice {ostium internum), which leads into the cavity of the cervix. The cavity of the cervix is somewhat cylin- 
drical, flattened from before backwards, broader at the middle than at either extremity, and communicates, below, with 
the vagina. Each wall of the canal presents a longitudinal column, from which proceed a number of small oblique 
columns, giving the appearance of branches from the stem of a tree, and hence the name arbor vitce uterinus applied 
to it. These folds usually become very indistinct after the first labor. 
"Structure.-The uterus is composed of three coats: an external serous coat, a middle or muscular layer, and an 
internal mucous coat. 
" The serous coat is derived from the peritoneum ; it invests the fundus and the whole of the posterior surface of the 
body of the uterus, but only the upper three-fourths of its anterior surface. 
" The muscular coat forms the chief bulk of the substance of the uterus. In the unimpregnated state it is dense, 
firm, of a grayish color, and cuts almost like cartilage. It is thick opposite the middle of the body and fundus, and 
thin at the orifice of the Fallopian tubes. It consists of bundles of unstriped muscular fibres, disposed in layers, inter- 
mixed with areolar tissue, bloodvessels, lymphatic vessels and nerves. In the impregnated state, the muscular tissue 
becomes more prominently developed, and is disposed in three layers: external, middle and internal. The external 
layer is placed beneath the peritoneum, disposed as a thin plane on the anterior and posterior surfaces. It consists of 
fibres, which pass traversely across the fundus, and, converging at each superior angle of the uterus, are continued on 
the Fallopian tubes, the round ligament and ligament of the ovary-some passing at each side into the broad ligament 
and others running backwards from the cervix into the recto-uterine ligaments. The middle layer of fibres presents no 
regularity in its arrangement, being disposed longitudinally, obliquely and transversely. The internal, or deep layer, 
consists of circular fibres arranged in the form of two hollow cones, the apices of which surround the orifices of the 
Fallopian tubes, their bases intermingling with one another on the middle of the body of the uterus. At the cervix 
these fibres are disposed transversely. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
435 
GYNECOLOGICAL. 
SPECULA VAGIN2E. 
For Facilitating Inspection, Exploration, Applications and Operations. 
Fig. 3185.-Ball's Speculum. 
Fig. 3186.-Meadow's Trivalve Speculum. 
Fig. 3187.-Weiss' Speculum. 
Fig. 3188.-Tiemann's & Co.'s 
Trivalve Steel Speculum. 
Fig. 318g.-Stohlmann's Speculum. 
Fig. 3191.-Nelson's Speculum Vaginae. 
Fig. 3190.-Brewer's Speculum. 436 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
@YN/EeOLO@l(BAL. 
FEMALE ORGANS OF GENERATION. 
The Uterus. (Continued.) 
" The mucous membrane is thin, smooth, soft, of a reddish color, lined by columnar-ciliated epithelium, and pre- 
sents, when viewed with a lens, the orifices of numerous tubular follicles arranged perpendicularly to the surface. They 
are of small size in the unimpregnated uterus, but shortly after impregnation they are enlarged, elongated, presenting 
a contorted or waved appearance towards their closed extremities, which occasionally dilate into two or three saccu- 
lated extremities. The circular orifices of these glands may be seen on the inner surface of the mucous membrane, 
many of which during the early period of pregnancy are surrounded by a whitish ring, formed of epithelium which lines 
the follicles. In the impregnated uterus the epithelium loses its ciliated character. In the cervix the mucous mem- 
brane, between the rugae and around the os uteri, is provided with numerous mucous follicles and glands. The small, 
transparent, vesicular elevations, so often found with the os and cervix uteri, are due to closure of the mouths of these 
follicles, and their distention with their proper secretion. They are called the ovula of Naboth. The mucous membrane 
covering the lower half of the cervix presents numerous papillae. 
" Vessels and nerves.-The arteries of the uterus are the uterine, from the internal iliac ; and the ovarian, from the 
aorta. They are remarkable for their tortuous course in the substance of the organ, and for their frequent anastomoses. 
The veins are of large size and correspond with the arteries. In the impregnated uterus these vessels are termed 
uterine sinuses, consisting of the lining membrane of the veins adhering to the walls of canals channelled through the 
substance of the uterus. They terminate in the uterine plexuses. The lymphatics are of large size in the impregnated 
uterus, and terminate in the pelvic and lumbar glands. 1 he nerves are derived from the inferior hypogastric and 
spermatic plexuses, and from the third and fourth sacral nerves 
" The form, size and situation of the uterus vary at different periods of life and under different circumstances: In 
the foetus the uterus is contained in the abdominal cavity, projecting beyond the brim of the pelvis. The cervix is con- 
siderably larger than the body. At puberty the uterus is pyriform in shape, and weighs from eight to ten drachms. It 
has descended into the pelvis, the fundus being just below the level of the brim of this cavity. The arbor vitae is dis- 
tinct, and extends to the upper part of the cavity of the organ. During and after menstruation the organ is enlarged 
and more vascular, its surfaces rounder ; the os externum is rounded, its labia swollen, and the lining membrane of the 
body thickened, softer and of a darker color. During pregnancy the uterus increases as toweight from one pound and 
a half to three pounds. It becomes enormously enlarged, and projects into the hypogastric and lower part of the umbi- 
lical regions. This enlargement, which continues up to the sixth month of gestation, is partially due to increased develop- 
ment of pre-existing and new-formed muscular tissue. The round ligaments are enlarged, and the broad ligaments be- 
come encroached upon by the uterus making its way between their laminae. The mucous membrane becomes more 
vascular, its mucous follicles and glands enlarged ; the rugae and folds in the canal of the cervix become obliterated ; the 
blood and lymphatic vessels, as well as the nerves, according to the researches of Dr. Lee, greatly enla-ged. After 
parturition the uterus nearly regains its usual size, weighing from two to three ounces ; but the cavity is larger than in 
the virgin state ; the external orifice is more marked and assumes a transverse direction ; its edges present a fissured 
surface ; its vessels are tortuous, and its muscular layers are more defined. In old age the uterus becomes atrophied, and 
paler and denser in texture ; a more distant constriction separates the body and cervix. The ostium internum and, oc- 
casionally, the vaginal orifice, often become obliterated, and its labia almost entirely disappear. 
Appendages of the Uterus. 
" The appendages of the uterus are: the Fallopian tubes, the ovaries and their ligaments, and the round ligaments. 
These structures, together with their nutrient vessels and nerves, and some scattered muscular fibres, are inclosed be- 
tween the two folds of peritoneum, which constitute the broad ligament; they are placed in the following order: in 
front is the broad ligament; the Fallopian tube occupies the free margin of the broad ligament; the ovary and its liga- 
ment are behind and below the latter. 
" The Fallopian tubes, or oviducts, convey the ova from the ovaries to the cavity of the uterus. They are two in 
number, one on each side, situated in the free margin of the broad ligament, extending from each superior angle of the 
uterus to the sides of the pelvis. Each tube is about four inches in length ; its canal is exceedingly minute, and com- 
mences at the superior angle of the uterus by a minute orifice, the ostium internum, which will hardly admit a fine 
bristle ; it continues narrow along the inner half of the tube, and then gradually widens into a trumpet-shaped extremity, 
which becomes contracted at its termination. This orifice is called the ostium abdominale, and communicates with 
the peritoneal cavity. Its margins are surrounded by a series of fringe-like processes, termed fimbria, and one of 
these processes is connected with the outer end of the ovary. To this part of the tube the name fimbriated extremity 
ts applied ; it is also called morsus diaboli, from the peculiar manner in which it embraces the surface of the ovary 
during sexual excitement. In connection with the fimbriae of the Fallopian tube, or with the broad ligament close to 
them, there is frequently a small vesicle, or hydatid, floating on a long stalk of peritoneum. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
437 
GYNAECOLOGICAL. 
SPECULA VAGINA. 
For Facilitating Inspection, Exploration, Applications and Operations. 
Fig. 3192.-Tiemann & Co.'s Quatrivalve Speculum. 
rIG. 3193. 
Schlotterbeck's Speculum. 
Fig. 3194.-Meadow's Quatrivalve Speculum. 
Open. Closed. 
Fig. 3195.-Jenks' Speculum. 
Fig. 3196.-Bivalve Speculum. 
Fig. 3197.-Blake White's Speculum. 438 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
(SY^I/ECObOGie/L. 
FEMALE ORGANS OF GENERATION 
Appendages of the Uterus. (Continued.) 
" Structure.-The Fallopian tube consists of three coats: serous, muscular and mucous. The external or serous coat 
is derived from the peritoneum. The middle muscular coat consists of an external longitudinal and an internal or cir- 
cular layer of muscular fibres continuous with those of the uterus. The internal or mucous coat is continuous with 
the mucous lining of the uterus, and at the free extremity of the tube with the peritoneum. It is thrown into 
longitudinal folds in the outer part of the tube, which indicate its adaptation for dilatation, and is covered by columnar 
ciliated epithelium. This form of epithelium is also found on the inner and outer surfaces of the fimbriae. 
The Ovaries. 
" The ovaries {testes muliebres, Galen) are analogous to the testes in the male. They are oval-shaped bodies, of 
an elongated fcrm, flattened from above downwards, situated one on each side of the uterus, in the posterior part of 
the broad ligament behind and below the Fallopian tubes. Each ovary is connected, by its anterior margin, to the 
broad ligaments ; by its inner extremity to the uterus by a proper ligament, the ligament of the ovary ; and by its 
outer end to the fimbriated extremity of the Fallopian tube by a short ligamentous cord. The ovaries are of a whitish 
color, and present either a smooth or puckered uneven surface. They are each about an inch and a half in length, 
three-quarters of an inch in width, and about a third of an inch thick ; and weigh from one to two drachms. The 
surface and posterior convex border are free, the anterior straight border being attached to the broad ligament. 
" Structure.-The ovary is invested by peritoneum, excepting along its anterior attached margin ; beneath this is 
the proper fibrous covering of the organ, the tunica albuginea, which is extremely dense and firm in structure, and 
incloses a peculiar soft fibrous tissue, or stroma, abundantly supplied with bloodvessels. Imbedded in the meshes of 
this tissue are numerous small, round, transparent vesicles, in various stages of development ; they are the Graafian 
vesicles, the ovisacs containing the ova. In women who have not borne children, they vary in number from ten to 
fifteen or twenty; and in size from a pin's head to a pea ; but Dr. Martin Barry has shown that a large number of 
microscopic ovisacs exist in the parenchyma of the organ, few of which produce ova. These vesicles have thin, 
transparent walls, and are filled with a clear, colorless, albuminous fluid. 
" The Graafian vesicles are, during their early development, small and deeply seated in the substance of the ovary; 
as they enlarge, they approach the surface, and, when mature, form small projections on the exterior of the ovary 
beneath the peritoneum. Each vesicle consists of an external fibro-vascular coat connected with the surrounding 
stroma of the ovary by a network of bloodvessels, and an internal coat, named ovicapsule, which is lined by a layer 
of nucleated cells, called the membrana granulosa. The fluid contained in the interior of the vesicles is transparent 
and albuminous, and in it is suspended the ovum. The formation, development and maturation of the Graafian 
vesicles and ova continue uninterruptedly from infancy to the end of the fruitful period of woman's life. Before 
puberty, the ovaries are small, the Graafian vesicles contained in them minute and few in number ; and few, probably, 
ever attain full development, but shrink and disappear, their ova being incapable of impregnation. At puberty the 
ovaries enlarge, are more vascular, the Graafian vesicles are developed in greater abundance and their ova are capable 
of fecundation. 
" Discharge of the Ovum.-The Graafian vesicles, after gradually approaching the surface of the ovary, burst; 
the ovum and fluid contents of the vesicles are liberated and escape on the exterior of the ovary, passing from thence 
into the Fallopian tube, the fimbriated processes of which are supposed to grasp the ovary, the aperture of the tube 
being to the part corresponding to the matured and bursting vesicle. In the human subject, and most mammalia, the 
maturation and discharge of the ova occur at regular periods only, and are indicated, in the mammalia, by the phe- 
nomenon of heat or rut, and, in the human female, by menstruation. Sexual desire is more intense in females at this 
period, and if the union of the sexes takes place, the ovum may be fecundated. 
" Corpus Luteum.-Immediately after the rupture of a Graafian vesicle and the escape of its ovum, the vesicle is 
filled with blood-tinged fluid ; and in a short time the circumference of the vesicle is occupied by a firm, yellow sub- 
stance, which is probably formed from plasma exuded from its walls. Dr. Lee believes that this yellow matter is 
deposited outside both the membranes of the follicle ; Montgomery regards it as placed between the layers; while 
Kolliker considers it as a thickening of the inner layer of the outer coat of the follicle. The exudation is at first of a 
dark brown or I rownish-red color, but it soon becomes palerand its consistence more dense'. For every follicle in 
the ovary from which an ovum is discharged, a corpus luteum will be found. But the character it exhibits and the 
changes produced in it will be determined by the circumstance of the ovum being impregnated or not. 
" Although there is little doubt that corpora lutea exist in the ovaries after the escape of the ova, independent of 
coitus or impregnation, it appears that the corpus luteum of pregnancy (true corpus luteum) possesses characters by 
which it may be distinguished from one formed in a follicle, from which an ovum has been discharged without subse- 
quent impregnation (false corpus luteum). GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
439 
GYNAECOLOGICAL. 
SPECULA VAGINA. 
For Facilitating Inspection, Exploration, Applications and Operations., 
Fig. 3198.-Steel Bivalve Speculum. 
Fig. 3199.-Hale's Speculum. 
Fig. 3200.-Leonard's Speculum 
Fig. 3201.-Hunter's Speculum. 
Fig. 3202.-Howard's Speculum. 
Fig. 3203.-Thomas' Cusco's Speculum. 
Fig. 3204.-Dicken's Speculum. 440 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
(§Y^I?EeOLOGie/vL 
FEMALE ORGANS OF GENERATION. 
The Ovaries. (Continued.) 
" The true corpora lutea are of large size, often as large as a mulberry ; of a rounded form and project from the sur- 
face of the ovary ; the summit of the projection presenting a triangular depression or cicatrix, where the peritoneum 
appears to have been torn. They contain a small cavity in their centre during the early period of their formation, 
which becomes contracted and exhibits a stellate cicatrix during the latter stages of pregnancy. Their vascularity, 
tabulated or puckered appearance, firm consistence and yellow color are also characteristic marks of true corpora lutea. 
" False corpora lutea are of small size, do not project from the surface of the ovary, are angular in form, seldom 
present any cicatrix, contain no cavity in their centre : the material composing them is not tabulated, its consistence 
is usually soft, often resembling coagulated blood ; the yellow matter exist in the form of a very thin layer, or more 
commonly is entirely wanting. False corpora lutea most frequently result from the effusion into the cavities of the 
Graafian vesicles of serum or blood, which subsequently undergoes various changes and is ultimately removed. 
Dr. Lee states that, in the false corpora lutea, the yellow substance is contained within, or attached to, the inner sur- 
face of the Graafian vesicle and does not surround it, as in the case of true corpora lutea. 
" In the foetus, the ovaries are situated, like the testes, in the lumbar region near the kidneys. They may be dis- 
tinguished from those bodies at an early period by their elongated and flattened form and by their position, which is 
at first oblique and then nearly transverse. They generally descend into the pelvis. Lying above the ovary, in the 
broad ligament between it and the Fallopian tube, is the organ of Rosenmuller, called also parovarium or epoophoson. 
This is the remnant of a foetal structure, the development of which has been described in the introduction. In the 
adult it consists of a few closed convoluted tubes lined with epithelium, some of them atrophied, and one usually dis- 
tinguishable from the rest by ending in a bulbous or hydatid swelling. The parovarium is connected at its uterine 
extremity with the remains of the Wolffian duct, the duct of Gaertner. 
" The ligament of the ovary is a rounded cord, which extends from each superior angle of the uterus to the inner 
extremity of the ovary; it consists of fibrous tissue and a few muscular fibres derived from the uterus. 
" The round ligaments are two rounded cords, between four and five inches in length, situated between the layers 
of the broad ligament in front of and below the Fallopian tube. Commencing on each side, at the superior angle of 
the uterus, this ligament passes forwards and outwards through the internal abdominal ring, along the inguinal canal 
to the labia majora, in which it becomes lost. The round ligament consists of areolar tissue, vessels and nerves, besides 
a dense bundle of fibrous tissue, and muscular fibres prolonged from the uterus, inclosed in a duplicature of peritoneum, 
which, in the foetus, is prolonged in the form of a tubular process for a short distance into the inguinal canal. This 
process is called the canal of Nuck. It is generally obliterated in the adult, but sometimes remains pervious even in 
advanced life. It is analogous to the peritoneal pouch which accompanies the descent of the testes. 
" Vessels and Nerves.-The arteries of the ovaries and Fallopian tubes are the ovarian from the aorta. They 
anastomose with the termination of the uterine arteries, and enter the attached border of the ovary. The veins follow 
the course of the arteries ; they form a plexus near the ovary, the pampiniform plexus. The nerves are derived from 
the inferior hypogastric, or pelvic plexus and from the ovarian plexus, the Fallopian tube receiving a branch from one 
of the uterine nerves."-" Gray's Anatomy." 
Care in the Application of Instruments in Operating on the Female Genitalia. 
" 1st. Before and after every operation wash all instruments in very hot carbolized water, and during every opera- 
tion keep all instruments immersed in carbolized water. This should especially be observed in regard to needles and 
sutures. 
" 2d. In all laparatomy operations pursue Lister's antiseptic method fully. 
"3d. Where the spray is not employed, always bathe denuded surfaces, both before and after apposition by 
suture, with carbolized water. 
"4th. Always destroy sponges used in an operation which admits of the possibility of these being contaminated by 
septic fluids ; when they are employed a second time always have them immersed previously in boiling carbolized water. 
" 5th. After all operations upon the uterus bathe or spray the vaginal portion of the organ with carbolized water, 
and tampon lightly for twenty-four hours with antiseptic cotton. This being removed, syringe the vagina with car- 
bolized water at short intervals. 
" 6th. After all operations on the pelvic organs syringe the vagina with carbolized water as often as once in every 
eight hours. 
"8th. Before every operation let the operator and his assistants cleanse and disinfect their hands as if they felt 
sure that septic material attached to them. 
" 9th. Avoid even trivial operations, unless good reason for doing otherwise exist, for a few days before and after 
menstruation."-Thomas, " On the Diseases of Women." 1880. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
441 
GYNAECOLOGICAL. 
SPECULA VAGINA. 
For Facilitating Inspection, Exploration, Applications and Operations. 
Fig. 3205.-Storer's Speculum, when used as Cusco's. 
Fig. 3206.-Keene's Speculum Vaginae, at Rest 
Fig. 3207.-Storer's Speculum, 
when used as Sims'. 
Fig. 3208-Byrne's Speculum. 
Fig. 3209.-Wackerhagen's Speculum. 
Fig. 3210.-Graves' Speculum, 
can be used as Sims'. 
Fig. 3211.-Nott's Speculum (plain). 442 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYN/EGOLOGIGAh. 
SPECULA VAGINA. 
For Facilitating Inspection, Exploration, Applications and Operations. 
Fig. 3212.-Sims' Speculum. 
Fig. 3213.-Sims' Vaginal Dilator. 
Fig. 3215.-Baxter's Speculum. 
Fig. 3214.-Bozeman's Duck-Bill Speculum. 
Fig. 3216.-Dawson's Sims' Speculum 
Fig. 3217.-Dawson's Sims' Dilating Speculum. 
Fig. 3218.-Barnes' Neugebauer's 
"Sims' speculum elevates the posterior vaginal wall, which allows the entrance of air to distend the 
whole passage, the woman lying on her side in such a manner that the cavity can be probed with the most 
perfect ease and applications made to the fundus. Its use requires the aid of an assistant."-" Thomas on 
Diseases of Woman." GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
443 
GYNAECOLOGICAL. 
SPECULA VAGINAE 
For Facilitating Inspection, Exploration, Applications and Operations. 
Fig. 321g.-Sims' Bivalve Speculum. 
Fig. 3220.-Cracour's Mirror Speculum. 
Fig. 3221.-Taliaferro's Speculum 
(Perineal Elevator). 
Fig. 3222.-Thomas' 
Sims' Speculum. 
Fig. 3223.-Yarrow's Speculum. 
Fig. 3224.-Thomas' 
Self-Retaining Speculum. 
Fig. 3226.-Bozeman's Speculum. 
Fig. 3225.-Thomas' Speculum. 444 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
®YN/ECOL>OGICAL>. 
SPECULA VAGINAS. 
For Facilitating Inspection, Exploration, Applications and Operations. 
Fig. 3227.-King's Pelvimeter. 
Fig. 3228.-Hank's Speculum. 
Fig. 3229.-Blake White's Sims' Speculum. 
Fig. 3230.-Darrow's Self-Retaining 
Sims' Speculum. 
Fig. 3231.-Fryer's Speculum. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
445 
®YN/EeOLOGieAb. 
SPECULA VAGINAE. 
For Facilitating Inspection, Exploration, Applications and Operations. 
Fig. 3232.-Schuyler's 
Combination Specula. 
Fig. 3233.-Fryer's Self-Retaining Speculum. 
Fig. 3234.-Nott's Depressor 
Fig. 3235.-Garrigue's 
Vaginal Deoressor. 
Fig. 3236.-Emmet's Self-Retaining 
Speculum (Perineal Retractor), Single Blade. 446 
GEORGE TIEMANN * CO.'S SURGICAL INSTRUMENTS. 
GYN/ECOLOGICAL. 
SPECULA VAGINA. 
For Facilitating Inspection, Exploration, Applications and Operations. 
Fig. 3237.-Dawson's Modification of Erich's Speculum. 
Fig. 3238.-Taylor's Speculum. 
Fig. 3239.-Biart's Self-Retaining Speculum. 
Fig. 3240.-Reid's Speculum. 
Fig. 3241.-Bozeman's Vaginal Dilator. 
Fig. 3242-Bozeman's Vaginal Dilator. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
447 
SYN/EeOLOQieAk 
SPECULA VAGINAE. 
For Facilitating1 Inspection, Exploration, Applications and Operations. 
Fig. 3243.-Nunn's Speculum. 
Fig. 3244. 
Bozeman's Set of 3 Columning Specula. 
Fig. 3245.-Hunter's Speculum. 
Fig. 3246.-Munde's Speculum. 448 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
@YN/ECOLO@ICAL. 
VESICO AND RECTO-VAGINAL FISTULA. 
Depressors for the Anterior Walls of the Vagina, to clear the field of operation 
Fig. 3249.-Notts Depressoi 
Fig. 3250.-Sims' Depressor 
Fig. 3248.-Bozeman's Double-hooked Depressor. 
Fig. 3247.-Bozeman's Depressor. 
Fig. 3251.-Sims' Double Depressor. 
Fig. 3252.-Hunter's Depressor. 
Fig. 3253.-Bozeman's Urethral and Perineal Depressor. 
" To J. Marion Sims the world is indebted for suggesting and perfecting the measures 
by which this formerly intractable condition is rendered one of the most certain of relief 
within the field of surgery. It is true that, in every particular feature of the operation on 
which his success depended, Dr. Sims had been anticipated. In our own country, Dr. H. 
S. Levert, of Mobile, Alabama, had published {American Journal of the Medical Sciences, 
May, 1829) his experiments in the use of silver wire. Mr. A. Gosset, in a letter to the 
Lancet, November 21, 1834, gave an account of his method and success in closing a 
vesico-vaginal fistula which had been produced by the cutting through of a stone in the 
bladder. He used interrupted sutures of gilded silver wire, which were twisted, and as 
clearly defines the advantages of the metallic sutures as if given in the words of Dr. Sims 
himself. The method of Metzler was published in Germany in 1846, and in the article 
not only is Sims' Speculum essentially described, but also the use of clamp sutures and 
the mode of denuding the edges of the fistula with scissors, the patient being in the knee- 
chest position. In this country Hayward, of Boston, had been successful, between 1836 
and 1840, with the silk suture ; while Dr. Mettauer, of Virginia, in 1847, had used the 
lead suture, and in the account of his operation expressed his conviction that every case 
of vesico-vaginal fistula could be cured. Yet, withal, were we assured of the fact that 
Dr. Sims was as familiar as we are at the present time with what had been accomplished 
before his day, it should not lessen the credit due him. What had been done fell on 
barren soil, bore no fruit, was not appreciated, and was destined to be forgotten. From 
Dr. Sims' hand the operation was accepted by the profession ; it was immediately put 
into successful practice and to the present day it has not been materially modified. His 
first article on the subject was published in the American Journal of the Medical Sciences, 
in 1852, and this, with his address before the New York Academy of Medicine, in 1857, 
on "Silver Sutures in Surgery," may be regarded as a summary of his experience, for 
since the latter date he has given nothing to the profession on the subject. Within the 
period between the two papers he materially modified the mode of securing the edges of 
the fistula. At first he employed the clamp or shot suture. Finally he adopted the simple 
interrupted metallic suture secured by twisting, as Mettauer and Gosset had dcre before 
him."-" Principles and Practice of Gynaecology." Emmet. 1884. 
Fig. 3254.-Sponge-Holder, Iron, Ebony Handle 
Fig. 3255.-Sponge-Holder, German Silver. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
449 
6 Y N /ECO bO@ I C A b. 
VESICO-VAGINAL FISTULA. 
Tenacula and Forceps for Seizing and Holding. 
Fig. 3256.-Sims' Tenaculum. 
Fig. 3257.-Emmet's Tenaculum 
Fig. 3258.-Emmet's Tenaculum 
Fig. 3270.-Long Angular Tenaculum. 
Fig. 3271.-Long Stout Tenaculum. 
Fig. 3259.-Emmet's Heavy Shank Tenaculum. 
Fig. 3260.-Perry's Barbed Tenaculum. 
Fig. 3261.-Emmet's Tenaculum. 
Fig. 3262.-Double Hook. 
Fig. 3263.-Bozeman's Tenaculum. 
Fig. 3264.-Sims' Tenaculum. 
Fig. 3265.-Emmet's Tenaculum. 
Fig. 3272.-Self-Closing Seizing Forceps. 
Fig. 3266.-Bozeman's Long Tenaculum. 
Fig. 3267.-Skene's Seizing Forceps. 
Fig. 3273.-Sims' Seizing Forceps. 
Fig. 3268.-Skene's Seizing Forceps, with Lock. 
Fig. 326g.-Thomas' Tissue Forceps. 450 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
VESICO-VAGINAL FISTULA. 
Sims' Operation. 
" This operation may be divided into three parts : 1st. Paring the edges; 2d. Passing sutures through them; 3d. 
Approximating them and securing the sutures. The patient, being placed upon a table,* two and a half by four feet, 
which is covered by folded blankets, is brought under the influence of an anaesthetic and placed in the following 
position. She is made to lie on the left side, with the thighs bent at about right angles with the pelvis, the right a 
little more flexed than the left. The left arm is placed behind her back and the chest brought flat down upon the 
table so that the sternum may touch it. The assistant who is to hold the speculum, which is then introduced, does so 
with the right hand, while with the left he elevates the right side of the nates. The table should be so arranged that a 
bright and steady light may fall into the vagina, which, being then fully distended, will be seen throughout its extent, 
except where it is obscured by the speculum. The operator, having near him all the instruments, &c. (Sims' set), 
which he will require, places his assistants thus : one holds the speculum, another administers the anaesthetic, and a 
third stands ready at his right hand to remove the blood accumulating in the vagina, by means of sponges in the 
Fig. 3274.-Sims' Sponge-Holder. 
sponge-holders, which are rapidly washed in a basin of water that stands by his side, to be used again. A fourth 
assistant, if attainable, may be well employed in handing the instruments as they are required. All being ready, he 
proceeds with the first step of the operation. 
" I. Paring the Edges of the Fistula.-The edge of the fistula, at the point which is deemed most difficult of 
access and manipulation, is caught by a tenaculum, or with, what I much prefer, the tooth (tissue) forceps (page 449) 
and held up. Then, with a pair of long handled scissors, or a knife (page 452), a strip is cut, extending from the 
mucous membrane of the bladder to that of the vagina, care being taken not to wound the former. Another portion 
of the edge is then seized and removed like the first. The wound thus left should be one beveled from the vesical 
surface outwards and great care should be observed to remove the entire border, for upon this success depends. * * 
The abraded surface, from the edge of the fistula to the point of vaginal section, should measure at least four lines, 
one-third of an inch, while above, it should just touch the vesical border, not invading its mucous membrane. During 
this part of the operation the sponges, held in the long handled sponge-holders (Fig. 3274), will have to be freely 
resorted to, but the bleeding generally soon ceases and the operator may proceed to the second step. 
" 2. Passing the Sutures.-The sutures are passed by means of slightly curved needles, held in a pair of strong 
forceps (Figs. 3303, 3305) made for the purpose. In some cases the metallic thread, made of annealed silver, which 
is employed, may be passed at once, but usually silk threads are first passed and the silver sutures are attached and 
drawn through. * * * The needles which we employ in the Woman's Hospital are about three-quarters of 
an inch long, round, slightly curved and without cutting edges anywhere (Fig. 1320). The needle, held in the grasp 
of the needle-holder, should be passed at the angle of the wound which is most difficult of access, half an inch from the 
edge of the incision and brought out at the vesical surface, but not involving its mucous lining. The point of the 
needle having passed out, it is engaged by the small blunt hook (Fig. 3275) until it can be seized and drawn through 
Fig. 3275.-Sims' Blunt Hook. 
by the needle forceps. Then it is plunged into the other lip and drawn out half an inch from the edge of the incision. 
The ends of the silk sutures are then given into the charge of the assistant holding the speculum, and another is passed 
in the same way at the distance of one-sixth of an inch from the first. In this way a sufficient number are passed to 
close the fistula. During this procedure the edge of the fistula is to be fixed by the tenaculum, and, should firm 
opposing force be needed to make the needle pass, it may be given by the blunt hook. When the needle is seized by 
the forceps and pulled so as to make the thread follow it, some opposing force is needed, or the thread might cut 
Fig. 3276.-Sims' Pulley or Fork. 
through the tissues. This force is offered in the species of fork represented, which is put as a fulcrum under the thread 
at its point of exit, and made to sustain and draw it through. A bit of silver wire about twelve inches long is attached by 
bending its extremity to the first silk suture, and, by the use of the fork just mentioned, the silk thread is drawn through 
so as to make the wire replace it. The silk is then cut off, the silver suture put aside, and the operator proceeds to 
♦ See " Operating Furniture," page 51. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
451 
@Y^I/ECOhOGie/< 
VESICO-VAGIN AL FISTULA. 
Sims' Operation. (Continued.) 
replace each silk thread in the same way. This being accomplished, the instruments are then changed, in order to 
effect the twisting of the sutures. 
" 3. Twisting of the Sutures.-The ends of the silver sutures being drawn together by the fingers, the adjuster 
(Fig. 3277) is slipped down over the wires and pressed against the wound, after carefully approximating the edges, 
each thread is slightly twisted, 
so as to keep the whole in ap- 
position. Then the ends of 
the first suture are seized in 
the bite of the twisting forceps 
and torsion is made, so as to close the wound completely 
at this point. In this way the sutures are twisted one 
after the other, care being taken not to carry the tension 
so far as to strangulate the tissues engaged in the con- 
stricting loop. Each suture is then clipped by a pair of 
scissors, about half an inch from the edge of the fistula, 
and by means of forceps pressed flat against the vaginal 
wall, so as not to wound the opposite surface. The 
bladder should then be syringed out, to remove all blood 
which may have accumulated there ; for, if a large clot 
should be retained in this viscus, it may cause severe vesical 
tenesmus, and smaller ones may block up the mouth of the 
catheter, which is to be kept in place permanently, and call 
for its repeated removal. 
Fig. 3277.-Sims' Wire Adjuster or Fulcrum. 
Fig. 3278. 
Twisting Forceps and Scissors, for Cutting the Wire. 
Fig. 3279.-Sims' Sigmoid Catheter. 
" The patient is then placed in bed by the assistant, an 
opiate is administered, and a Sim's sigmoid catheter is 
passed into the bladder and left there. The mouth of this 
instrument projects beyond the vulva, so that under it a 
small china dish may be placed, which will receive the urine 
as it passes through."-" Treatise on the Diseases of Wo- 
men." Gaillard Thomas, M. D. 
" To Sims' sigmoid or self-retaining catheter (Fig. 3279) I am satisfied that we are greatly indebted for success in 
this operation, as well as for much comfort which it affords the patient. It should be made of block-tin, that the 
curve may be altered to suit each individual case. * * * 
" The catheter must be removed several times a day, for the purpose of cleaning it; this is done by forcing a stream 
of water through it from a large syringe, and with a wire brush to remove the phophatic deposit. The patient should be 
instructed to notice carefully that the urine escapes freely at all times. It is well to have two catheters, so that one may 
be introduced immediately on the removal of the other."-" Principles and Practice of Gynaecology." Emmet. 1884. 
" The use of the catheter is by no means as needful after the operation as it was at one time supposed to be. The 
late Dr. Simon dispensed with it altogether ; but there is a golden mean better than dogmatism. In small openings 
there is no need for it. In larger ones the water should be drawn off every four hours, or a good self-retaining 
catheter be used. The best one is the Skene-Goodman. Whenever the self- 
retaining catheter teases the bladder into tormina, it does more harm than good, 
and should be at once removed. Sometimes it provokes a haemorrhage. A 
medical friend of mine operated four times, and I once, on the same woman, 
unsuccessfully. Each time Sims' self-retaining catheter was used, and each 
time an abundant haemorrhage took place into the bladder. At the sixth time, 
by withholding the catheter, I saved my patient from having a haemorrhage, 
and cured her."-" Lessons in Gynaecology." Goodell. 
Fig. 3280.-Skene's Self-Retaining 
Catheter, modification of Goodman's. 452 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
6 YN/ECO LOG I ©A L 
VESICO-VAGINAL FISTULA. 
Scissors and Knives for Paring or Vivifying the Edges, 
Fig. 3281.-Sims' Curved Scissors, Sharp Points. 
Fig. 3285.-Bozeman's Double Curved Scissors. 
Fig. 3286.-Bozeman's Curved Scissors. 
Fig. 3284.-Bozeman's Angular Scalpel, 
one curved right and one left. 
Fig. 3282.-Sims' Rotating Knife. 
Fig. 3283.-Bozeman's Straight Scalpel. 
Fig. 3288.-Sims' Scalpel. 
Fig. 3289.-Scalpel, Right and Left. 
Fig. 3290.-Nott's Knife. 
Fig. 3287.-Sims' Holder and four Knives. 
Fig. 3291.-Nott's Angular Knife, 
Fig. 3292.-Scott's Knife. 
Fig. 3293.-Sims' Probe-Pointed Knife. 
Fig. 3294.-Bozeman's Knife. 
Figs. 3282, 3287 and 33°° are useful at points inaccessible to fixed knives or scissors-the 
joint permitting the blades to be placed and fixed at any angle. GEORGE TIEMANN CO.'S SURGICAL INSTRUMENTS. 
453 
GYNAECOLOGICAL. 
VESICO-VAGINAL FISTULA. 
Scissors for Paring or Vivifying the Edges. 
Fig. 3295.-Sims' Curved Scissors. 
Fig. 3296.-Sims' Straight Scissors. 
Fig. 3301.-Heywood Smith's Scissors 
Fig. 3297.-Emmet's Knee-bent Scissors. 
Fig. 3298.-Emmet's Slightly Curved Scissors. 
Fig. 3299.-Emmet's Double-curve Scissors. 
Fig. 3302.-Thomas' Dilating Forceps, 
for Separating the Bladder and Vagina. 
Fig. 3300.-Emmet's Ball and Socket Knife. 454 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
®YN/EeOkO@ieAk. 
VESICO-VAGIN AL FISTULA. 
For Passing the Sutures. 
Fig. 3303.-Sims' Needle Forceps, 
Fig. 3305.-Sims' Needle Forceps, with Catch. 
Fig. 3304.-Tiemann & Co.'s New Needle Forceps 
(adapted for Hagedorn's Needles). 
Fig. 3306.-Currie's Canulated Needle, 
for Wire Sutures in Staphylorrhaphy, Vesico-Vaginal 
Fig. 3309.-Abbott's Silver Wire Cutter, 
for Removing the Sutures. 
Fig. 3307.-Emmet's Needle Forceps. 
Fig. 3308.-Dawson's Needle Forceps. 
Emmet's Needles, see Fig. 1320. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
455 
@YN/ECOLO@ICAL. 
VESICO-VAGIN AL FISTULA. 
For Passing the Sutures. 
The advantages claimed by this new kind of needle are: 
I. Being curved on the edge, they are more resistant, and the 
point follows without deviation the intended direction of the 
puncture. 
2. The eye, perforating the flat side, can be made larger and 
tapering at the terminal end ; in consequence of which, even a 
stout double thread will pass without difficulty through the punc- 
ture, which no surgeon will fail to appreciate. 
3. The needle, owing to its equal thickness, can be firmly and 
safely taken hold of at any point, whereby its direction will be 
much facilitated. 
4. The cutting edge being on the convex side, cannot be in- 
jured or blunted by the needle-holder and may be easily re-sharp- 
ened by the surgeon himself. 
5. The incision of the old cross- 
edged needles (a d) spreads, while the 
incision made by the new needle is in 
aright angle to the edge of the wound, 
similar to a buttonhole. The two 
edges of the stitch-wound, on tying 
the sutures, are drawn into close ap- 
position, whereby their union is fa- 
vored (c d). 
6. The flat needles cause less in- 
jury, which is of high importance, 
especially in sutures of nerves and 
tendons. 
Hagedorn's holder differs entirely 
from the usual kinds. It is so con- 
structed that it is made to hold the 
needle at the flat side ; its jaws open 
and close parallel to each other, and 
every size of needle, of whatever 
curve, is held with equal firmness. 
The breaking of a needle is rendered 
impossible, even when the strongest 
pressure is applied. A needle held 
with the holder is grasped as firmly 
as if both would bodily form but one 
single instrument. Moreover, the 
needle can be disengaged with equal 
readiness. It holds the needle as 
firmly at the edge as near or at the 
point, even if the latter emerges ever so little, which is of great importance to the gynaecologist when applying 'Sutures 
in narrow and deeply situated regions. The point of the needle, after having passed through the tissues, can be seized 
without injury to itself or to the surrounding soft parts, being guarded by the jaws of the needle-holder. The needle- 
holder consists of a steel-rod, ending in a handle, upon which a similar shorter rod is made to glide up and down. Both 
rods form at a right-angle with their anterior termination, the jaw, which is lined with copper. The up and down 
movement of the rods is effected by a lever-handle, held in position by a movable screw. A ratchet on the lower part 
of the handle serves for fixing the needle. The first tooth on the ratchet will fix a stout needle, the second and the 
following third tooth, finer needles. A slight pressure with the little finger on the ratchet will easily release the stop 
and set the needle free. In using it, the needle-holder is held in such a position that the little finger is near the ratchet, 
ready for releasing its hold by slightly pressing against it. Attention must be paid that the needle is placed in the 
longest diameter of the jaw with the inner curve close to the stem of the fixed rod. Only when the needle has been 
grasped in this manner, will its perfectly firm position be secured. 
Fig. 3310.-Dr. Hagedorn's Needles. 
Fig. 3311. 
Fig. 3312.-Hagedorn's Needle-Holder. 456 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
®Y]M/Ee0L0GI6AL. 
VESICO-VAGIN AL FISTULA. 
For Passing the Sutures. (Continued.) 
Hagedorn's needle-holders (Fig. 3312) are made of several sizes and strengths, to meet the various requirements. 
Two kinds are especially made for gynaecologists, one with a rectangular and another with an oblique jaw. 
*. A strong holder, 16 centimetres (6| inches) in length, with a jaw of 8.0 mm. in width, and 7.0 mm. in thick- 
dess, will serve for all ordinary surgical purposes and may be used for many years. 
2. The smallest holder, 13 centimetres (5 inches) long, with a jaw 5.8 mm. by 5.0 mm. will prove the most useful 
vne for ophthalmic and plastic operations and for intestinal sutures. 
3. General practitioners, requiring an instrument combining the advantages of both kinds of needle-holders, will 
find a middle-sized instrument, 15 centimetres (sf inches) long, with a jaw 7 mm. by 6 mm., very handy. 
Fig. 3313.-Parrott's Needle Forceps. 
Counterpressure and Wire Twisters. 
J?IG. 3314.-Nott's Needle and Twisting Forceps. 
Fig. 3319.-Nilsen's Counter-pressure Fork and Tyer. 
Fig. 3320.-Hank's Counter-pressure Tenaculum. 
Fig. 3316.-Fitch's Wire Twister. 
Fig. 3317.-Emmet's Counter-pressure Hook. 
Fig. 3315.-Emmet's Twisting Forceps. 
Fig. 3318.-Bozeman's Blunt Hook. 
Fig. 3321.-Dawson's Wire Twister. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
457 
GYN/ECOLOGICAL. 
VESICO-VAGIN AL FISTULA. 
Bozeman's Button Suture, &c. 
Fig. 3322.-Bozeman's Needle Carrier. 
Fig. 3325. 
Arranging the Button 
or Shot Suture. 
Fig. 3324. 
Bozeman's Buttons. 
Fig. 3323.-Bozeman's Button Shaper. 
Since 1855, Dr. Bozeman 
has continued to use what he 
terms the "button suture." 
This is a perforated disk of 
metal,made slightly concave, 
and fitted accurately to the 
vaginal surface about the edges of the fistula. Through one of the 
holes in the row down the centre, the two ends of the sutures are 
passed together, and over these a perforated shot, which is then com- 
pressed at the point needed to secure the sutures. 
Fig. 3326. 
Bozeman's Buttons Applied. 
Other instruments for Bozeman's method are 
Bozeman's Chair, Fig. 1264 ; Bozeman's Specula, Figs. 3214, 3226 ; Bozeman's 
Depressors, Figs. 3247, 3248, 3253 ; Bozeman's Knives, Figs. 3283, 3284; 
Bozeman's Scissors, Figs. 3285, 3286 ; Bozeman's Vaginal Dilators, Figs. 
3241, 3242. 
Fig. 332g.-Bozeman's Button Adjuster. 
Fig. 3328.-Bozeman's Wire Adjuster. 
Fig. 3327. 
Bozeman's Perineal Elevato 458 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
VESICO-VAGINAL FISTULA. 
Bozeman's Button Suture. 
" The button suture may be usefully employed in vesico-vaginal fistulse, as it serves to support the edges of the 
fissure and prevent undue traction. The first suture should be introduced at the centre of the fistula, the distance 
at which the needle is entered from its anterior edge being not less than one-third of an inch, as the object is to obtain 
a very firm hold. The needle, pushed steadily on, is brought out of the sub-mucous connective tissue of the bladder 
(counterpressure being made against its advancing point with a pair of forceps, or the hook represented by Fig. 3318). 
It is then carried across the fissure, and entered at the posterior edge, which it traverses in a similar manner as the 
anterior. Thus suture after suture is introduced, until the number is completed, the interval between each two being 
about three-sixteenths of an inch, as exhibited in Fig. 3325. 
" The closure of the fistula and the arrangement of the wire suture is done with the aid of the wire adjuster, 
Fig. 3328. This consists of a strong rod, curved in the shaft and set into a handle, its distal extremity being perfo- 
rated and somewhat bulbous. 
"Modus Operandi.-The opposite ends of each wire are passed through the opening in the adjuster, and firmly 
held between the forefinger and thumb of the left hand, when the instrument is carefully slipped down and well 
pressed against the parts in order to approximate the edges of the opening; when this is accomplished the adjuster 
is withdrawn. A button of suitable size and shape having been selected, is now passed over the wires, its concave 
surface corresponding to the vesico-vaginal septum, with which it is brought in close contact by means of the instru- 
ment represented in Fig. 3329, the angular and scalloped extremity of which admirably adapts it for that object. A 
perforated shot or a small piece of lead is then slipped down over the approximated ends of each suture and pressed 
firmly against the convex surface of the button by means of a pair of forceps. Finally, the operation is completed 
by clipping off the wires close to the crochet (or shot) and turning down their short ends ; this keeps the button in place 
and the edges of the wound thoroughly united. Certain modifications of this operation are frequently necessary, 
growing out of the peculiar situation of the fistule or the condition of the parts. Thus, as Dr. Bozeman has pointed 
out, in the urethro-vaginal lesion the button must be rather long in the antero-posterior direction, very concave, 
and extended well forward in front of the urinary meatus, so as to support the catheter, its extremity being some- 
what notched. The edges of the opening are brought together transversely; and the catheter, a gum elastic one, is 
introduced before the sutures are adjusted, retention being maintained, if possible, until the cure is completed. In 
fistules involving the vesical trigone and the root of the urethra, or of the trigone and bas-fond, or of all these parts 
together, in which the anterior border of the opening is immovably fixed to the pubic arch, with the concavity pre- 
senting backwards, the button requires to be bent upon its convexity."-" System of Surgery." Gross. 1882. 
" The proper time for removing the sutures is between the seventh and tenth days. They are removed by gently 
elevating each one in turn 
with the forceps and clipping 
the nearest side of the loop, 
so that, as they are with- 
drawn, they will continue 
to bind the parts until 
cleared."-Emmet's " Prin- 
ciples and Practice of Gy- 
naecology." 
"In from eight to four- 
teen days the sutures should 
be removed. To accomplish 
the removal of the sutures, 
the twisted end of one of 
them should be seized by a 
pair of forceps and drawn 
upon gently until the edge 
of the loop emerges bom 
the tissue in which it has 
been embedded. Then the 
blade of a pair of scissors 
should be inserted into, the loop and one side cut, after which a little traction will remove the suture."-" Thomas, 
on the "Diseases of Women." 1880. 
Removal of the Wire Sutures after Cure of Fistulse. 
Fig. 3330.-Tucker's Wire Cutter. 
Fig. 3331.-Perry's Abbott's Wire Cutter. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
459 
GYNAECOLOGICAL. 
VESICO-VAGINAL FISTULA. 
Simon's Operation. 
"No one, with the exception of Marion Sims, has labored more earnestly or achieved more for this operation than 
Prof. Gustav Simon of Heidelberg. Succeeding Dieffenbach, Wutzer and Metzler, who had themselves accomplished 
a great deal in advancing the interests of the operation by suture, he steadily labored with the means at his command, 
and, even before he became acquainted with the improvements made by Sims, had acquired a great degree of skill in 
treating vesico-vaginal fistulae. To regard him as an imitator would be unjust; he was, without question, a coincident 
discoverer. The chief features in Simon's operation are these: 
" I. He repudiates silver wire as a suture superior to silk. 
" 2. He employs an exaggerated lithotomy position in place of the left lateral position. 
" 3. Instead of avoiding the mucous membrane of the bladder, he intentionally involves it in his abrasion. ' 
"4. He uses no stationary catheter, and has the urine drawn only during the first twenty-four hours, and this not 
always. 
" 5. He allows the bowels to be evacuated whenever nature prompts it, and does not diet the patient nor confine 
her to bed. At times he even permits out-door exercise in twenty-four hours after the operation in favorable cases."- 
Thomas, "On Diseases of Women." 1880. 
" There are three positions in general use for the patient in operations for vesico-vaginal fistula: I. The back, as 
in operation for stone ; 2. The knee-elbow ; and, 3. Sims' position, which is a modification of the latter. I use neither 
of these, but prefer the breech-back position (Steiss-Ruckenlage), which has all the advantages of those mentioned, 
without their disadvantages. It consists in this, that the patient, lying on her back, is put in a position which is 
almost exactly similar to the knee-elbow position. The breech is so elevated that it is somewhat above the level of 
the abdomen and breast. The thighs are bent back towards the belly and the sides of the chest, so that the breech 
is the most projecting part. The legs are either flexed at the knee or extended over the sides of the chest. The 
vulva is above and to the front. The head is supported by a pillow. If the fistula is seated very high in the vagina 
the thigh must be drawn as far as possible upwards ; if the fistula is, however, very near the vaginal outlet, we are 
not obliged to elevate the breech so much, and have no need, therefore, of flexing the thigh so forcibly. I have called 
this, in distinction to the ordinary back position, the ' Steiss-Ruckenlage ; ' because in it the breech (Steiss) is the 
most projecting part, and presents itself in a manner very similar to the breech presentation of the foetus. The ad- 
vantages are: 
" I. The field of operation is clear ; we are not obliged to operate between the thighs. 
" 2. The assistance can be all given from the side, without hindering the operator. 
" 3. It allows the use of several specula and the side retractors, to expand the vagina on every side. 
"4. It is quite as well borne as the ordinary back position. 
"5. It admits of chloroform narcosis. 
" If the fistula can be brought down entirely with perfect ease, I bring it directly to light. If, however, there is 
the least difficulty in moving it (as in the majority of cases), I operate with the specula and retractors, with the fistula 
in situ. I always prove this by seizing the uterus with a hooked forceps (Museux) and pulling it gently down, before 
I operate with the specula and levers. I have improved Jobert's method of seizing the cervix with the forceps by 
passing two threads through the cervix, thus getting rid of an instrument which is very much in the way. 
" Sims has constructed a gutter-shaped speculum for expanding the fistula, which has left all other specula in the 
background. He used four sizes. 
" I have found the use of this speculum in many difficult cases absolutely insufficient, and, in the majority of cases, 
it only answers the purpose by the aid of other instruments to expand the vagina. I use, therefore, not this specu- 
lum alone, but also a flat-shaped speculum to hold up the other vaginal wall and also side levers (shaped like retrac- 
tors), to hold back the labia and sides of the vagina. All these instruments are fixed in long handles, curved at the 
end, in order to get them out of the way and to give the assistant a firm grasp. Always use the widest specula possible ; 
Sims are not wide enough. I have had two sizes more made. 
" In addition to these I often use long-handled hooks to seize the edges of the fistula. I always cut the cord-like 
contractions of the vagina, and have even cut vaginal folds which were in the way. 
Position of Patient. 
"All operators have tried to give a large surface for union without enlarging the wound. They have done this by 
cutting at the expense of the vagina, leaving the edges of the bladder intact. According to my observations and ex- 
perience, I give the preference to a deep funnel-shaped incision of the edges of the fistula, similar to the incision in 
plastic operations in any other part of the body. The incision must be carried to the healthy tissue and all the cica- 
tricial tissue extirpated. It extends quite through the walls of the septum to the vaginal mucous membrane, and 
sometimes through it. 
Vivifying the Edges. 460 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYN/ECOLdOGICALd. 
VESICO-VAGINAL FISTULA. 
Simon's Operation. (Continued.) 
" In this way is formed a steep, funnel-shaped wound, with its point in the bladder and its base in the vagina, and 
its edges from six to eight millimetres thick. Although other authors wish to avoid as much as possible the enlarging 
of this defect, it is exactly here only, where union can take place by first intention, that I strive to have the edges as 
free from cicatricial substance and as prone to union as possible ; and, even in the largest fistula, I do not refrain from 
this repeated paring off the edges, even to making the defect very much larger, until the union is accomplished. And, 
even if with the best preparation of the edges, the union does not take place, and we meet with entire want of success, 
the woman loses no more urine than before. 
" Sometimes I cut the vesical mucous membrane and sometimes avoid it, but place little weight on that. 
" The advantages claimed are : 
" I. By the deep funnel-shaped incision all cicatricial substance will be certainly cleared away. 
" 2. The edges are more prone to union, as they unite in a natural manner, edge to edge, and not with a flat surface 
on the same ; the nerves, vessels, &c., thus continue on in the normal direction. 
" 3. The very wide edge is unnecessary, as only the upper edges unite in any case. 
"4. If union does not take place the first time, a second attempt is more likely to succeed with the thick edges 
than where, with already thin edges, these must be bevelled off still more and made thinner. 
" 5. The idea that catarrh is more likely to follow this form of incision is unfounded. 
" Method of Uniting.-There have been a great number of methods of bringing the edges together; all of which 
accomplish their purpose, but are more complicated than the method I published in 1854, which, with some modifica- 
tion, I have used ever since. In order to meet the indication for uniting, I use either one or two rows of fine silk 
sutures tied in the ordinary manner. In large fistulae, where a great degree of relaxation is necessary in order to bring 
the edges into exact union, I use my so-called double suture, consisting of two rows, one the ' relaxing,' the other the 
'uniting.' In small or slit-shaped fistulae I use only one, the uniting row. In the double suture, one row, placed 
very deep and wide, approaches the tissues surrounding the fistula, to the line of union, thus relaxing the edges ; while 
the other, placed between the stitches of the first, holds firmly the edges and thus promotes the most exact union. 
When only one is used it is the uniting row, and placed in the same manner as here described. Of course, each row 
of sutures supplements the other in its action. 
" Both rows are placed very deep, even, in many cases, through the vesical mucous membrane. They thus bring 
the edges of the wound, in their whole thickness, in the closest union, and withstand greater traction than if they 
only seized a part of the edges. The sutures are one and one-half lines apart. The point of entrance of the threads 
is, in the relaxing suture, some distance from the edge ; in the uniting, quite near. I consider it of little importance 
whether the suture goes through the vesical mucous membrane or not. It is only necessary to be careful that this 
membrane does not get between the edges of the wound. 
Uniting the Edges of the Wound. 
" I. From a series of observations I conclude that neither on the wound nor on the new cicatrix does the urine 
have any injurious influence, and neither hinders the union by primary intention nor loosens a once formed cicatrix. 
" 2. From another series of observations I have learned that the healing is not interfered with by a degree of dis- 
tention, which could come in a normal filling of the bladder, provided, only, that the wound is perfectly freshened 
and united. In most cases the permanent retention of the catheter only does harm. Each of these deductions is 
drawn from a number of appropriate cases. 
"Upon these conclusions, then, is based my after treatment, which, up to the removal of the stitches, is entirely 
unimportant. Those minute directions, the carrying out of which is so tedious both for the patient and physician, are 
all laid aside. The patient is permitted to take any position she chooses. She passes her water as soon as she feels 
the need, either in a bed-pan, or, if she objects to that, in the sitting or knee-elbow position. Only in a few cases, 
where the patient is not in a condition to pass water spontaneously, is the catheter used every three or four hours. On 
the fourth or fifth day an attempt is made to remove the stitches, and this is repeated on the following days. On the 
eighth day, the patient is allowed to leave her bed, even if all the stitches are not out. 
"To avoid passages from the bowels, with straining, on the first eight days, a fluid discharge is recommended. 
If irritation of the bladder ensue, morphine, one-eighth grain per dose, should be given, and daily warm injections 
into the vagina, but not into the bladder, should be employed."* 
After Treatment. 
* This resume has been prepared from Prof. Simon's work, published in 1862 by Dr. M. D. Mann. Copied from " Practical Treatise 
on the Diseases of Women," by F. Gaillard Thomas, M. D. 1880. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
461 
@YN/ECOIdO®ICA1d. 
VESICO-VAGINAL FISTULA 
Simon's Specula and Retractors. 
Fig. 3332.-4 Simon-Bozeman's Specula. 
4 Simon-Sims' Gutter-shaped Specula. 
2 Simon's Socket Handles. 
Fig. 3334.-Simon's 
Serrated Retractors ol 
Side Levers. 
Fig- 3335--Simon's 
Plain Retractor or Side 
Lever. 
Fig. 3333.-8 Simon's Flat-shaped Specula, 
2 Simon's Socket Handles. 462 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
(SYN/EeOLOGISAb. 
VESICO-VAGINAL FISTULA OPERATING CASES. 
Sims' Set of Instruments for Vesico-Vaginal 
Fistula. 
$55' 
2 Silver Sigmoid Catheters. 
2 Metal Sigmoid Catheters. 
I Sims' Speculum, plated. 
I pair of Sims' Needle Forceps. 
i pair of Straight Long-Handled Scissors. 
i pair of Curved Long-Handled Scissors. 
i pair of Small Smooth-pointed Scissors. 
i pair of Twisting Forceps, slide-catch. 
I pair of Seizing Forceps. 
2 Sims' Scalpels. 
2 Sims' Tenacula. 
i Sims' Blunt Hook. 
I Sims' Suture Carrier. 
i Sims' Wire Adjuster. 
6 Sims' Needles. 
i Coil Silver Wire. 
2 Sponge Holders. 
Some Lead Wire. 
I Mahogany, Rosewood or Morocco - covered Case, 
lined with oil-dyed velvet. 
Sims' Set of Instruments for Vesico-Vaginal 
Fistula and Uterine Operations. 
$75- 
i Sims' Speculum. 
i Depressor. 
I Silver Caustic Probe. 
I Simpson's Sound. 
2 Sponge Holders. 
i pair of Sims' Twisting Forceps. 
I pair of Sims' Seizing Forceps. 
i pair of Scissors, curved to the right side. 
i pair of Scissors, curved to the left side. 
i pair of Sims' Needle Forceps. 
i pair of Straight Scissors. 
i Sims' Revolving Knife. 
i Sims' Wire Adjuster. 
i Sims' Suture Carrier. 
I Sims' Uterine Repositor. 
2 Sims' Scalpels. 
2 Sims' Tenacula. 
i Sims' Blunt Hook. 
I Sims' Silver Sigmoid Catheter. 
4 Metal Sigmoid Catheters. 
4 Coils Silver Wire. 
12 Sims' Needles. 
I Mahogany, Rosewood or Morocco - covered Case, 
lined with oil-dyed velvet. 
Bozeman's Set of Instruments for Vesico- 
vaginal Fistula. 
$ioo. 
2 pairs of Bozeman's Scissors, right and left. 
i pair of Stout Straight Scissors. 
I pair of Scissors, curved on the flat. 
I pair of Shot-smashing Forceps. 
I Perforating Awl. 
I pair of Self-Closing Seizing Forceps. 
i pair of Curved Forceps, lined with copper on the 
points, for holding and drawing wire sutures. 
i Bozeman's Clamp or Button Adjuster. 
i Bozeman's Wire Adjuster. 
i Fork Pulley. 
I Long Steel Probe in Ebony Handle. 
i Blunt Hook. 
2 Tenacula. 
2 Straight Scalpels. 
2 Angular Scalpels, right and left. 
i Urethra Depressor. 
I Curved and I Straight Needle-Holder, both to fit 
one handle. 
I pair of Shot-Perforating Forceps. 
I pair of Plain Forceps, with i extra point. 
3 Metal Sigmoid Catheters (Bozeman's). 
5 Sizes of Silver Buttons. 
2 Swan-Bill Speculums, four sizes. 
3 Coils of Silver Suture Wire and some Silk 
I Common Probang. 
2 Sponge Holders. 
12 Assorted Needles (Bozeman's). 
I Rosewood Case, lined with oil-dyed velvet. 
Emmet's Set of Instruments for Vesico- 
vaginal Fistula. 
$80. 
i Sims' Hospital Speculum. 
i Sims' Virgin Speculum. 
i Emmet's Depressor. 
i Emmet's Sponge Holder. 
I Sims' Catheter, soft metal. 
I Emmet's Uterotome. 
2 Emmet's Tenacula. 
i Perry's Tenaculum. 
6 Emmet's Scissors. 
1 Emmet's Wire Pressing Forceps. 
2 Bistouries. 
i Scalpel. 
i Emmet's Needle Forceps. 
i Emmet's Dressing Forceps. 
I Emmet's Wire Twisting Forceps. 
i Sims' Blunt Hook. 
i Sims' Shield. 
i Sims' Wire Carrier. 
i Coil Silver Wire. 
i doz. Emmet's Needles. 
In a three-fold Morocco-case, lined with chamois- 
red or drab. In the middle compartment are placed the 
scissors and other instruments which would be injured 
by being twisted in the rolling or folding of the case. 
Beneath these is space for the speculum and sponge 
holders. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
463 
GYN/E©OLOGIGAL>. 
STONE IN THE FEMALE BLADDER. 
Formation and Methods of Removal. 
" Calculi have formed after a vesico-vaginal fistula had been closed-and more frequently after some operation 
about the neck of the uterus, and generally when laceration had occurred through the anterior lip into the base of the 
bladder. I have, in several instances, found the nucleus to be a small portion of wire which had dropped into the 
bladder as the end of some suture had been clipped. But, as a rule, I believe the nucleus is furnished by some denuded 
surface which has been turned into the bladder, or left there through a careless adjusting of the edges of the fistula. 
" Dr. Henry F. Campbell, of Augusta, Ga., has offered a different explanation of the origin of calculi after the 
operation for vesico-vaginal fistula :* ' Reasoning then, from my own case, and from others in which calculi of con- 
siderable size have been found to exist in the bladder shortly after closing the fistula by operation, I conclude: 1st. That 
in such cases the stone exists previous to the fistula, perhaps causing the slough during the labor in which it occurs; 
2d. That they are grasped by the empty bladder and remain imbedded during the entire period of the existence of the 
fistula ; and, 3d. That when the fistula has been closed by operation and the collection of urine in the bladder becomes 
again possible, the consequent distention releases the stone. The calculus is not, therefore, in process of formation in 
the bladder at that time, but is only discovered after the close of the fistula.' 
" The explanation is original, and I have no doubt is a correct one for a number of cases. I can recall several in- 
stances in my own experience where I was unable to offer to myself any explanation for so rapid a development of 
stone within a few weeks after closing the fistula. But, on the other hand, I have known of several cases where the 
loss of tissue had been too great, and too large a portion of the bladder had been constantly inverted, for a stone to 
have any lodgment. I acknowledge the importance of Dr. Campbell's explanation, and the consequent necessity for 
passing the finger into the interior of every bladder before closing it. But I am equally certain that an undenuded 
surface left in the bladder will furnish a starting-point and that a stone may be developed within a short time after 
closing the fistula. 
Stone Searchers, Sounds. 
" The symptoms of stone resemble closely those of cystitis, and, unless a steel sound is passed into the bladder, 
the differentiation will not be easy. This is best done while the patient lies on the back, with her limbs flexed on the 
abdomen and held by an assistant on each side. The administration of ether is generally necessary, and it is well to 
moderately distend the bladder with tepid water before attempting the examination. (See page 400.) 
" There are two methods by which a stone may be removed from the bladder : through the urethra, or through an 
opening made in the base of the bladder from the vagina. When the stone is soft and of moderate size, it may be 
readily crushed by a lithotrite, and, if it is thoroughly broken up, the debris will readily pass through the urethra. 
As a woman, in comparison with a man, is little liable to inflammation, the stone should be repeatedly and thoroughly 
crushed and it should be accomplished at a single sitting. * * * Dr. Henry J. Bigelow, of Boston, has 
devised an excellent method for crushing stone in the male bladder and for removing the fragments, which it appears 
is even more applicable in the female." 
See " Litholapaxy," page 406. 
Lithotrity. 
" When the coats of the bladder have become thickened and marked cystitis exists, the proper course is to extract 
the stone through an artificial opening in the vesico-vaginal septum. A stone by this means can be safely removed 
by one who may not possess the dexterity to crush it properly. It is the operation par excellence when the bladder has 
become so diseased that absolute rest is required, and rest is to be obtained only by allowing the urine to escape as 
rapidly as it enters the bladder. The operation does not differ essentially from that described for the relief of cystitis 
by opening the base of the bladder.f After the stone has been removed the patient should be turned on the back, 
placed over a bed-pan, the nozzle of the syringe introduced through the urethra and the bladder thoroughly washed 
out, while the sides of the fistula are kept apart by the index finger in the vagina. After removal of the stone, the 
opening is closed in the same manner as for vesico-vaginal fistula generally, and it should be done immediately, un- 
less the mucous membrane is found to be in a diseased condition. In this event, the case must be treated as if it were 
one of cystitis and the opening left for the free escape of urine until the parts, by rest, gradually recover their tone."- 
" Principles and Practice of Gynaecology." Emmet. 1884. 
" Vesica -Vaginal Lithotomy.-Rousset, who first performed this operation, made an incision some thirteen or 
fourteen lines in length, in the septum which lies between the vagina and the bladder."-" Bernhard and Huette's 
Manual of Operative Surgery." Van Buren and Isaacs. Am. Ed. 1857. 
Lithotomy. 
* " Origin and History of Calculi found in the Bladder, after the Cure of Vesico-vaginal Fistula by Operation." "American Gynae- 
cological Transactions." Vol. I. 1876. t See " Kolpo-Cystotomy," page 464. 464 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
®YN/EG01d0@I6ALd 
KOLPO - CYSTOTOMY. 
Artificial Vesico-Vaginal Fistula for the Cure of Cystitis. 
Emmet's Method.-" The operation is in itself a simple one, and, if resorted to before the disease has advanced 
so far as to involve the kidneys, is as free from risk as any other in minor surgery. Even under the most unfavorable 
circumstances the risk of the operation is justifiable, for by it life may be prolonged and a great degree of comfort 
obtained in allaying the persistent efforts to empty the bladder. 
" The operation is to be performed under the influence of an anaesthetic when possible, with the patient on the left 
side and the anterior wall of the vagina fully exposed by means of a large-sized Sims' speculum. A sound, somewhat 
abruptly curved an inch and a half from its extremity, must be introduced into the bladder and held by an assistant. 
While the point of this instrument is firmly pressed in the median line against the base of the bladder, a little behind 
the neck, the projecting tissue on the vaginal surface must be seized with a tenaculum and divided by a pair of scissors 
directly on the point of the sound until it can be passed through into the vagina. With the sound remaining in the 
opening as a guide, one blade of a pair of scissors should be passed into the bladder, and the vesico-vaginal septum 
be divided backwards in the median line. By this mode, especially where the vagina is of a natural size, the operation 
is extremely simple, and is completed in a few moments. The object in cutting on the point of the sound is, to be 
sure that the bladder and vaginal surface are divided in corresponding incisions, for there is so much mobility of one 
surface over the other that it is exceedingly difficult to enter the bladder unless the parts are transfixed. 
Fig. 3336.-Harris' Counter-pressure Staff. 
"Dr. P. A. Harris, of Paterson, N. J., has devised an instrument for entering the bladder, which renders the 
operation safe and easy of execution. His description is as follows: ' A fenestrated staff, shaped as shown in the 
illustration (Fig. 3336), is passed through the urethra into the bladder. The convex surface of the fenestrated portion 
of the staff is then pressed firmly against that point in the median line which may be selected for the opening. While 
the vesico-vaginal tissues are thus stretched with a degree of tension, a tenaculum is thrust through all into the bladder. 
The tenaculum is then rotated half-way round, and its point brought out at a distance of about one-quarter of an inch 
directly posterior to that of its introduction. The staff having served its purpose, that of counterpressure, while trans- 
fixing the tissues with the tenaculum, is now withdrawn. The point for the opening, being still firmly held by the 
tenaculum in the left hand, is divided by one sweep of the heavy curved scissors in the right hand. A little practice 
will enable the operator to quickly make either a round or oval opening at will.' "-"An Improved Method of Cutting 
die Vesico-Vaginal Fistula for the Cure of Chronic Cystisis." American Journal of Obstetrics. New York, March, 
1883. 
"The mode of operating, as described, can be but little improved upon as to simplicity. The median line has 
been preferred for the location of the incisions, since it is not likely to include any large blood-vessels, unless the 
opening is extended too near to the cervix uteri or to the neck of the bladder. In theory there is no necessity for 
an opening larger than that equal to the area of the two ureters ; in practice, however, it is found that it must be 
greater at first than this, from the fact that, in spite of all the care that can be taken to prevent it, a large portion of 
it will close too soon. Moreover, at first, it is a great advantage to have an ample opening through which the accu- 
mulated mucus in the bladder may be easily washed out. It is very seldom that much bleeding follows this operation 
unless, as just stated, the incision is extended too far in either direction. When a large vessel 
has been divided, it will either be a branch of the circular artery of the cervix uteri or one given 
off from the sub-pubic artery. Bleeding in either direction is readily arrested by introducing a 
silver suture, so as to include a fair amount of tissue beyond, the angle of the wound, and twisting 
it sufficiently tight. The suture must, of course, be bent flat, so that it shall not be an additional 
source of irritation. 
" Formerly, it was necessary to force the finger through the articial opening once or twice a 
day, to keep if open, and even with the greatest care it would sometimes close if the edges were 
kept in a healthy condition by the hot water injection. I devised a hollow glass stud or eyelet 
(Fig. 3337), which was buttoned into the incision, and this answered reasonably well under the 
circumstances. But the different devices for retarding the healing, and the daily use of the finger 
to break up the union, added greatly to the suffering of the patient, and very often this additional irritation, for the 
Fig. 3337. 
Emmet's 
Cystitis Eyelet. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
465 
®Y^^EeOLOGie/vL. 
KOLPO - CYSTOTOMY. 
Artificial Vesico-Vaginal Fistula for the Cure of Cystitis. (Continued.) 
time, at least, greatly increased the cystitis. The suffering of the patient was aggravated by the phosphatic deposit 
which took place from the urine over the raw surfaces. This arrested cicatrization of the sides of the fistula, so 
that it was necessary to pick it off, and this was a slow and painful process, to be followed by the application of a 
solution of nitrate of silver to protect the surfaces. After making the buttonhole opening into the urethra, where the 
necessity for uniting the two mucous surfaces was at once made evi- 
dent, I applied the same plan to the opening for cystitis, using in the 
same manner interrupted carbolized silk sutures. The lining mem- 
brane of the bladder is as loosely attached as that of the urethra, and 
can be as readily drawn out. By uniting these mucous surfaces the 
bladder membrane is rolled out into the vagina, so that the raw edges 
of the fistula become perfectly protected from the action of the urine. 
These surfaces soon unite, and the artificial opening remains patu- 
lous afterwards. By this simple method the fistula can now be kept 
open indefinitely and it has rendered the operation now perfect."-"Principles and Practice of Gymecology." 
Emmet. 
Bozeman's Method.-" Dr. Bozeman recommends the cutting out of a circular piece, and the plan is a good one, 
for the opening could then never entirely close of itself. But the size of the piece as recommended by him is too large 
for any but an expert to remove. The general operator must bear in recollection the anatomy of the parts and remove 
but a moderate sized portion, or he will be apt to include the mouths of both ureters and the neck of the bladder, and 
to open laterally into the large bloodvessels running along the vagina, outside of the bladder."-"Principles and 
Practice of Gynaecology." Emmet. 1884. 
Fallen's Method.-Prof. Fallen recommends opening into the bladder with the Paquelin thermo-cautery (page 39) 
as follows: " The main difficulty hitherto has been to keep the incision open after the use of the scissors or knife. 
Artificial means must be resorted to, such as an india-rubber tube passed from the urethra through the opening, which 
is annoying and painful, or a glass button introduced, which is difficult to retain, and when retained is apt to beget 
vesical tenesmus. I believe the use of the actual cautery at a red heat will be found to answer all purposes. If the 
platinum tip of the cautery be heated to a white heat, it cuts through as rapidly as the knife, and, therefore, hsemorrhage 
is to be expected. Besides, the thin slough produced by white heat might peel off and union ensue. To avoid both 
bleeding and contraction, the tip should be raised to a red heat only and passed slowly along the site of the proposed 
opening, dividing first the mucous membrane of the vagina, and then held still for a moment or so to allow the adjacent 
vessels to contract and become occluded. The submucous connective tissue is then burned and afterwards the bladder 
itself. Extreme delicacy of manipulation is required upon the part of the surgeon, lest he burn directly into the cavity 
of the bladder, which should be avoided in order to prevent hsemorrhage, contraction and subsequent union."-" Kolpo- 
Cystotomy ; or, Artificial Vesico-Vaginal Fistula." By Montrose A. Fallen, A.M., M.D. American Journal of 
Obstetrics. Vol. XI. April, 1878. 
" The care, after an operation of this kind, consists in daily cleansing the bladder thoroughly with demulcent 
warm fluids, such as starch or flaxseed water. The pain in the bladder, following the burning, is comparatively 
slight, and usually subsides within thirty-six or forty-eight hours." 
"An objection to cystotomy is that, while the patient is relieved 
from pain, she is made distressingly uncomfortable by the constant 
trickling of urine from the fistula. I tried to obviate this trouble to 
some extent by using a hollow globe pessary, made of hard rubber, 
with a tube attached to it. The globe is numerously perforated with 
small holes all around, except for about half an inch from where the 
tube begins. The globe is introduced into the vagina and the tube 
projects through the introitus. The urine collects in the globe and 
escapes through the tube ; and, by attaching a piece of flexible tubing 
to it, the urine can be conveyed into a vessel. When the introitus vulvse is small and the sphincter vaginae perfect, 
this answers very well, especially during the night, when the patient is in the horizontal position. When worn during 
the day, it is necessary to have a rubber bag attached to the leg of the patient, to act as a receptacle. Encouraged by 
my success with the globe pessary, I had another made, shown in Fig. 3339. It is the ordinary Smith's pessary, with 
an oblong cup on the upper anterior portion of it, which fits over the fistula and collects the urine and guides it out to 
a urinal. In artificial fistula, made in the centre of the vagina, this pessary answers a most valuable purpose."- 
" Diseases of the Bladder and Urethra in Women." Alexander J. C. Skene, M. D. 
Fig. 3338.-Bache Emmet's Fistula Tube. 
Fig. 3339.-Skene's Urinal Cup Pessary. 466 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
URETHRAL AND URO-CYSTIC. 
Drainage of the Female Bladder in Cystitis. 
Fig. 3340. 
Skene's Self-Retaining Catheter. 
(Modification of Goodman's.) 
" This catheter, devised originally for treatment in vesico-vaginal fistula, 
is a good one for the purpose of draining the bladder in cystitis. Dr. Skene 
had the point made larger and more rounded, and finds that it answers well and 
is easier to introduce than the original. It is self-retaining in all positions of 
the patient; first, by reason of the bulb at its upper extremity, which passes 
beyond the urethra into the bladder ; secondly, on account of its curved shape ; 
and, thirdly, in consequence of the button being overlapped and grasped, as it 
were, by the vulva. At the lower end there is a slight projection or knob, 
over which an india-rubber tube may be slipped ; this being inserted into a bottle at night, or into a urinal when the 
patient is up, her person may thus be kept perfectly clean."-Skene. 
Fig. 3341.-Skene's Double Perforated Catheter for Irrigation of the Bladder. 
It is made of hard rubber 
and perforated with small open- 
ings at the point, and bifurcated 
at the end. A small tube runs 
from one of the bifurcations to 
the extreme point. This is the 
supply lube, which is connected 
by means of rubber tubing with 
the syringe. The escape tube 
being much larger, a great quantity of fluid can be passed into and through the bladder without distending it. By 
means of rubber tubing attached to the escape nozzle the fluid may be conveyed to a receiving vessel. By compress- 
ing the escape tube with the thumb and finger, a stop-cock effect can be produced, and the fluid retained in the bladder 
for any desired length of time and then permitted to escape fast or slowly, at the will of the operator."-Skene. (See 
also page 388.) 
"My favorite method of making such applications 
(nitrate of silver in solution) to the interior of the bladder 
is by instillation, as it is called. I take a glass tube of 
the size and shape of No. 8 or 9 sound, with a small 
rubber bulb attached to the straight end. The curved 
point is introduced into the solution to be used ; the bulb is compressed by the thumb and finger and then relaxed, 
which draws up the desired amount. The tube is then carried into the bladder, and, by again compressing the bulb, 
the fluid is easily deposited in the organ."-"Diseases of the Bladder and Urethra in Women." Alexander J. C. 
Skene, M. D. 
Fig. 3342.-Skene's Instillation Tube 
Local Applications to the Bladder. 
" It is now some six years since I first devised 
the plan of making a buttonhole - like opening 
in the female urethra for the purpose of forming 
a diagnosis, or for facilitating any operative pro- 
cedure. I do not now hesitate to announce the 
fact that the method I shall now describe for 
exploring the female urethra is the only one 
within our knowledge to-day which fulfils every 
indication, is safe, simple, and within the scope 
of any one possessing the least degree of surgical 
dexterity. It is necessary to administer an anaesthetic for the operation and then place the patient on the left side, 
using a moderate-sized Sims' speculum to bring into view the vaginal surface covering the urethral tract. An instru- 
ment has been devised by me for making an opening into the urethra. It is formed somewhat on the principle of the 
scissors used for cutting a buttonhole, with the exception that the portion entering the urethra is made round and like 
the extremity of a large-sized uterine sound. The vaginal blade has a portion removed, so as to begin the incision about 
a quarter of an inch from the urethral entrance, from which point the opening is to be extended, in the median line, 
nearly to the neck of the bladder. This instrument answers the purpose admirably."-" Principles and Practice of 
Gynaecology." Emmet. 1884. 
Fig. 3343.-Emmet's Urethral Buttonhole Scissors. 
For Inspection, Exploration and Dilatation of the Urethra. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
467 
®YN/ECOLdO@ICAId. 
URETHRAL AND URO-CYSTIC 
For Inspection, Exploration and Dilatation of the Urethra. 
Fig. 3344.-Stein's Female Urethral Speculum or Dilator. 
Fig- 3345- 
Sampson's Urethral Speculum. 
See "Instruments 
for the Removal of 
Foreign Bodies," 
page 398- 
Fig. 3346.-Skene's Urethral Endoscope. 
' Rapid dilatation of the urethra is chiefly useful 
for the purpose of allowing the extraction of foreign 
bodies and moderate sized calculi ; for cauterizing the 
mucous membrane ; opening hasmatoceles, allowing 
the introduction of endoscopic tubes of large size, 
and with them diagnosticating cystitis, calculi, ul- 
ceration, vesico-intestinal fistulae, polypi, papilloma, 
&c., and for the local treatment of these."-"Dis- 
eases of the Bladder and Urethra in Women." Skene. 
" Skene's endoscope, for physical exploration of 
the urethra and bladder, is composed of three parts' 
1st. A glass tube (2) in shape like the ordinary test 
tube used by chemists. 2d. A mirror and handle, b, 
which holds it. A piece of very thin silver plate is made to fit nearly the whole length of the inside of the glass tube, and 
about one-third its circumference, to one end of which the mirror is attached, at an angle of about one hundred degrees ; 
the delicate handle at the other end projects at an obtuse angle. This piece is blackened inside, and, when placed in 
position for use, darkens one side of the glass tube. 3d. A fenestrated hard rubber speculum, open and beveled at the 
end. These specula are used in making applications to the urethra and bladder. The method of using this instrument 
is as follows: The tube, with the mirror inside, is introduced into the urethra, and bladder also, if an examination of 
the latter is desired. Light is then thrown into the tube by aid of a concave mirror ; and, by moving the mirror back- 
ward and forward, the whole of the parts to be examined are brought to view in regular succession. With this simple 
instrument I can accomplish all that is to be desired." (See also page 343.) 
URETHRAL TUMORS. 
Cysts, Condylomata, Mucous Polypi and Fibroma. 
" The treatment of these cases is, in most instances, entirely surgical, but when the general system is deranged it 
should receive careful attention. The local treatment recommended by the various authors differs widely, but has the 
same end in view, viz. : the destruction or removal of the abnormal growth. The various methods employed are liga- 
tion, torsion, excision by the knife, scissors, curette, ecraseur, galvano-cautery, caustic and electrolysis. Either of 
these methods may be made to answer in all cases, but a judicious selection, according to the location and the nature 
of the neoplasm, is advisable. A combination of means is best at times : say, excision by the scissors and cauterization 
afterwards. Whatever method you choose, you will first place your patient in the lithotomy position, or in Sims' posi- 
tion, on the left side, which I prefer, and by a speculum expose the part to be removed. 
" There are two instruments which I use for this purpose. 
The first is shown, Fig. 3347. It is made on the principle of 
Sims' speculum vaginae, the ends being of different sizes. An 
elevator is attached at the central portion between the blades, 
and so arranged that when it is closed on one blade it is thrown 
out from the other. The ele.vator is pressed down on the blade 
Fig. 3347.-Skene's Urethral Speculum. 468 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
QYN/ECOLOGieAL. 
URETHRAL TUMORS. 
Cysts, Condylomata, Mucous Polypi and Fibroma. (Continued.) 
and the instrument introduced, and then by pressing on the other end of the elevator the urethra is distended to its 
full natural capacity. When it is necessary to expose one side of the urethra completely, the elevator should be re- 
moved and the instrument used in the same way that we employ Sims' speculum in examining the vagina. The 
other instrument is a modification of Folsom's nasal speculum. By turning the nut 
of the screw the blades are closed and the instrument is introduced; by unscrewing the 
nut the elasticity of the spring coil throws the blades apart. This instrument anwers well 
when the tumor to be removed is small and you are obliged to operate without assistance. 
It is self-retaining. The other speculum is preferable in most cases, but in operating 
through it you require some one to hold it for you. 
" When the tumor is at or near the meatus and has a large base, or if it is vascular and 
you fear troublesome haemorrhage, removal by ligature is preferable. Having exposed the 
part with the speculum, transfix the base of the tumor by passing a needle from without 
inwards, parallel to the axis of the urethra; pass your ligature around, under the needle, 
then grasps the tumor with a forceps and make traction, so as to bring the sides of the 
base within the grasp of your ligature, and then tie it slowly and as tight as you possibly 
can without cutting the tissues. * * If the base of the growth is too large to be in- 
cluded easily in one ligature, you can transfix with a needle armed with a double thread 
and tie its two halves. In choosing the material for a ligature, I would advise the use of 
fine plaited silk, boiled in a mixture of beeswax, carbolic and salicylic acids. This ties 
easily, does not stick and jerk like the ordinary ligature ; and, more than that, it does not slip. If the tumor is within 
easy reach, you can seize the pedicle with a small forceps, and, taking the tumor in a polypus forceps, remove it by torsion; 
or, you can cut it off with the knife or scissors, and if the pedicle inclines to bleed, touch it with caustic. You will 
find Allen's polypus forceps for the ear (Fig. 2066) the most convenient instrument for taking hold of these tumors. 
In cases where there are several small growths high up in the urethra, they can be removed with the curette (page 191), 
and, when the haemorrhage has subsided, the base of each should be cauterized. But little difficulty will be experienced 
in operating in the various ways described when the neoplasms are low down in the urethra, where they can be easily 
seen and handled. When they are high up in the canal, then skill and care are required to remove them. In such 
cases you will succeed best with the ecraseur, or the instrument known as Blakes' polypus snare, used for removing 
polypi from the ear (see Fig. 2064). It is simply a very delicate ecraseur, the chain or wire of which is tightened by 
the finger in place of a screw. You will find that, instead of the wire commonly used, catgut is better; it is more 
pliable, yet stiff'enough to be manageable. My friend, Dr. John W. S. Gouley, was the first to use this instrument for 
removing tumors of the urethra, and I can testify to its great value in such operations. In operating with the snare, 
the tumor is exposed with the urethral speculum ; and, if the growth is pedunculated, the loop of catgut is passed over 
it and removal effected by constriction. When there is a broad base, the whole mass is seized with the polypus forceps 
and the snare is passed over it and tightened until it comesaway. There is one accident that very often occurs in this 
operation, and that is breaking the wire or catgut. This takes place usually just when the tumor is almost cut off, and 
it annoys and hinders the operator, but does not spoil the operation, as a new piece of catgut can be used and the 
operation completed. You can often avoid this accident by taking time. The base of the pedicle of most of these 
growths will give way under long-continued pressure, but the wire or catgut will break if you hurry too much. 
" In order to operate high up in the urethra, it is sometimes necessary to dilate the lower portion of it. A con- 
venient way to do this is the following : Take a piece of fine rubber tubing and draw it over the blades of the Folsom 
speculum, and then introduce the instrument into the urethra. Open the blades and let it distend the urethra as far 
as it can. To produce the extra dilatation, take a series of graduated sounds or dilators and force one of these in 
between the blades of the speculum ; remove that one and use a size larger, and so on until you obtain the requisite 
amount of dilatation. The blades of the speculum and the rubber tubing protect the mucous membrane of the urethra 
from injury in passing in the dilator. The danger of incontinence of urine, which is liable to follow from forcible 
dilatation, can be avoided by distending the lower portion of the urethra only. 
" To obtain sufficient light for operating high up in the urethra, it is necessary to have clear sunlight; or, if that 
is not obtainable, gaslight should be used ; and in either case the concave head mirror (see page 257) should be employed. 
" Of late years the galvano-cautery has been very extensively used in surgery generally and has been recommended 
for the removal of urethral tumors. 
" Caustics have been more extensively used than any other means of removing urethral neoplasms, and I know of 
no better way of destroying small growths. I prefer pure nitric acid, which I use as follows: Exposing the tumor 
with the speculum I wrap a little cotton around a probe and dip it into the acid, and apply it to the part to be de- 
stroyed, taking care not to touch any of the normal tissues. 
Fig. 3348. 
Skene's Folsom's 
Speculum. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
469 
(SYN/ECOlDOGieAb. 
URETHRAL TUMORS. 
Cysts, Condylomata, Mucous Polypi and Fibroma. (Continued.) 
"Electrolysis.-This means of treating abnormal growths has been employed so much lately that I need not detain 
you with any description of the modus operandi, but simply tell you that those tumors that recur, and those that you 
suspect to be malignant, and those also that are so high up in the urethra as to be difficult to remove, should be treated 
by electrolysis. Two long slender needles (page 36) should be insulated by coating them with collodion, except at the 
points. These are attached to the electrodes of a galvanic battery, and their points introduced into the base of the 
tumor and the current passed through until the whole of the abnormal tissue is decomposed. I prefer to use a current 
sufficiently strong to char the tumor and thereby completely destroy it. There is one rule which I would urge you 
to keep in mind in treating tumors of the urethra, and that is, to be sure to remove all the abnormal tissue. What- 
ever method you employ, do not leave any portion of that which ought to be removed. I am confident that much of 
the trouble experienced by these growths returning again and again might be avoided by a careful observance of this rule." 
" I have used with benefit the modified stick of nitrate 
of silver. It consists of one part of nitrate of silver to two 
or three parts of the nitrate of potash. Drawing a fine 
point of this through the fissure causes sharp pain at the 
time, and is often followed by pain, burning, and tenes- 
mus, which, however, soon subside. Incising the fissure 
in the manner that surgeons treat the same disease of the anus, has been followed by great relief. For this operation 
I use the small knife as represented (Fig. 3349). 
Fig. 3349.-Skene's Fissure Probe and Knife. 
Vesico-Urethral Fissure. 
Douching the Urethra. 
" I have seen much benefit 
from douching the urethra with 
water as hot as the patient can 
bear it. For this purpose I use 
a catheter made like a fluted rol- 
ler of a crimping machine. Inside of the catheter is a small supply tube, which conveys the water to the point of the 
instrument to where the grooves terminate, each one of which is perforated to let the water flow out. By this 
arrangement the water, as it flows back through the grooves, is brought in contact with every portion of the mucous 
membrane. The instrument is passed up to the neck of the bladder and a fountain syringe attached to it, and the 
water as it flows away is caught in a cup." 
"Urethrocele; Dilatation of the Middle Third.-Dr. Bozeman has proposed making an opening into the most 
dependent part of the urethra, through the vaginal wall and maintaining it until all inflammation has been relieved, 
and then closing the opening by the usual plastic operation." 
Fig. 3350.-Skene's Reflux Catheter. 
Stricture of the Urethra. 
" The treatment of stricture will depend upon its location and cause. If it is situated at the meatus, it can be 
divided by the urethrotome, or forcibly stretched with the dilator. When due to bands of scar tissue in the vagina 
they should be divided at several points and the urethra dilated by repeatedly passing the sound. When it is owing 
to deposition of the products of inflammation in the submucous tissue, forcible and rapid dilatation, as practiced on 
the male subject (see instruments page 357), will answer well if you select the proper cases for this form of treatment. 
Remember, while operating in this way to make your dilatation carefully, with a view to breaking up the constricting 
tissue without lacerating the miicous membrane. To do this it is not necessary to dilate the urethra to any great extent. 
As soon as you feel that the stricture has given away, suspend your dilatation. 
" Incising the stricture from within outward, according to the method commended by Otis for the cure of stricture 
in the male (see page 365), will no doubt answer a good purpose. 
" In contraction of the whole urethra, arising from disuse in cases of vesico-vaginal fistula, gradual dilatation with 
graduated sounds (see page 353) answers very well. This should be attended to before closing the opening in the 
bladder. In all cases, attention should be given to any inflammation that may accompany the stricture or follow the 
treatment. It is well to keep such patients under observation, and pass the sound from time to time to see if there is 
any tendency for the stricture to return."-"Diseasesof the Bladder and Urethra in Women." Alex. J. C. Skene, M.D. 
See Skene's Urocystic and Urethral Operating Set, page 396. 470 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
OPERATING AND DRESSING CASES. 
Fig. 3351.-Gardner's Uterine Case. 
Gardner's Set of Uterine Instruments. 
$46. 
1 Gardner's Manifold Instrument. 
1 pair of Caustic Forceps, gilt. 
1 Uterine Sound. 
1 Barker's Salve Bougie. 
1 Sponge Holder. 
1 Tiemann & Co.'s Quadri valve Speculum. 
1 Long Pipe Syringe. 
2 Cylindrical Glass Specula. 
2 Bottles for Oil, &c. 
1 Rosewood or Mahogany Case, lined with oil-dyed 
velvet. 
I Porte Tampon. 
I Forked Sound. 
I Vaginal Dilator. 
i Mahogany, Rosewood, or Morocco - covered Case, 
lined with oil-dyed velvet. 
Peaslee's Set of Uterine Instruments. 
$60. 
i Sims' Speculum. 
i pair of Speculum Forceps. 
i Uterine Tenaculum. 
i Peaslee's Sound. 
i Emmet's Applicator. 
I Peaslee's Metrotome. 
i pair of Curved Uterine Scissors. 
i Uterine Scarificator. 
i Tube for Intra-Uterine Applications. 
i Uterine Syringe. 
I Catheter. 
i Peaslee's Curved Needle. 
i Emmet's Needle. 
i pair of Needle Forceps. 
2 Furguson's Glass Specula. 
i Peaslee's Depressor. 
I Simpson's Sound. 
i Whalebone Probe. 
I Rosewood, Mahogany or Morocco - covered Case, 
lined with oil-dyed velvet. 
Sims' Set of Instruments for Uterine Surgery. 
$125. 
1 Sims' Curette. 
2 Sponge Holders. 
1 pair McClintock's Polypus Forceps. 
1 pair Sims' Polypus Forceps. 
1 Sims' Porte-Chain Ecraseur. 
1 Aveling's Polyptrite. 
I Simpson's Hysterotome. 
1 pair of Curved Scissors. 
1 Sims' Movable-Blade Knife. 
1 Priestley's Dilator (or Ferguson's). 
1 pair of Tenaculum Forceps. 
1 Uterine Repositor. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
471 
GYNAECOLOGICAL. 
OPERATING AND DRESSING CASES, 
Fig. 3352. 
Buttles' Set of Uterine Instruments. 
$23. 
2 Glass Specula. 
1 Hard Rubber Syringe. 
1 Handle to fit: 
1 Simpson's Sound. 
1 Flexible Silver Probe. 
1 Sims' Razor-shaped Knife. 
1 Sponge Holder. 
1 Cotton Expeller. 
1 Budd's Whalebone Probe. 
1 Scarifyer and Tenaculum. 
1 Phial to carry Caustic. 
1 Russet Leather Case. 
The same, with Metallic Specula, $26. 
Elliott's Set of Uterine Instruments. 
$25. 
1 Handle to fit: 
1 Simpson's Sound. 
1 Guarded Scarifyer. 
1 Sanger's Porte Caustic. 
1 Ointment Bougie. 
2 Mirror Specula. 
1 Long Pipe Syringe. 
1 Uterine Probe. 
2 Phials, with glass stoppers. 
1 pair Uterine Dressing Forceps. 
1 Rosewood or Mahogany Case, lined with oil-dyed 
velvet. 
Thomas' Set of Uterine Instruments. 
$46. 
1 Thomas' Cusco's Speculum. 
1 Thomas' Sims' Speculum. 
1 Caustic Holder. 
1 pair (Uterine) Dressing Forceps. 
1 Thomas' Cotton Expeller. 
1 Small Uterine Probe. 
2 Whalebone Swabs. 
2 Sponge Holders. 
1 Long Pipe Syringe. 
1 Long-handled Tenaculum. 
1 Small Phial, for holding solid caustic, none for fluid. 
Place for a small roll of cotton batting and small 
sponges. 
12 Sponge Tents. 
1 Uterine Scarificator. 
1 Mahogany, Rosewood or Morocco-covered Case, 
lined with oil-dyed velvet. 
2 Mirror Specula. 
Fig. 3353 
Hunter's Gynaecological Bag. 
Skene's Set of Uterine Instruments. 
$54.25. 
1 Sims' Speculum. 
1 Skene's Needle Forceps. 
1 Skene's Scarifyer and Sound. 
1 Skene's Elevator. 
1 Long Pipe Syringe. 
1 Nott's Depressor. 
1 Uterine Dressing Forceps. 
1 Straight Scissors. 
1 Curved Scissors. 
1 Tenaculum. 
1 Uterine Probe and Slide. 
1 Skene's Curette. 
1 Sponge Holder. 
1 Simpson's Sound, graduated. 
Russet Leather Case, lined with oil-dyed velvet. 472 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
OPERATING AND DRESSING CASES. 
Nott's Set of Uterine Instruments. 
$111.46 
1 Nott's Speculum and Tenaculum. 
1 Nott's Depressor. 
1 Roux's Needle Holder. 
1 Applicator and Expeller. 
1 Sponge Holder. 
1 Lead Sound. 
1 Scarifying Knife. 
1 Simpson's Sound. 
1 Uterine Probe, pure silver. 
1 Nott's Uterine Dilator. 
1 Nott's Uterine Catheter. 
1 Double Spring Tenaculum. 
1 Hard Rubber Syringe, for Cleansing the Vagina and 
Uterus. 
1 Lente's Ointment Syringe. 
1 Lente's Platina Cup. 
1 pair of Uterine Dressing Forceps. 
1 pair of Needle Forceps. 
1 pair of Seizing Forceps. 
1 Straight Scalpel. 
1 Curved Scalpel. 
I pair of Emmet's Scissors. 
1 Sims' Adjuster. 
1 Sims' Wire Pulley. 
1 Sims' Blunt Hook. 
I Sims' Sigmoid Catheter, tin. 
1 Sims' Sigmoid Catheter, hard rubber. 
1 Sims' Sigmoid Catheter, silver. 
1 Buttles' Scarifyer. 
1 Thomas' Dry Cupper and Suppository. 
1 Smith's Wire Ecraseur. 
6 Emmet's Round-pointed Needles. 
6 Needles. 
Silk for Sutures and for Polypi. 
3 Coils of Silver Wire. 
1 Whalebone Cotton Swab. 
2 Glass Bottles, for Caustic, &c. 
12 Seatangle and Carbolized Sponge Tents. 
1 Long Delicate Tenaculum. 
1 pair of Long Straight Scissors. 
1 Curette, for Scooping out the Uterus. 
1 Rosewood Case, lined with oil-dyed velvet. 
Wylie's Office Examining Instruments, 
Polyclinic Set. 
$45- 
1 Long-bladed Sims' Speculum. 
1 Sims' Depressor, double. 
1 Sims' Dressing Forceps. 
2 Tenacula. 
1 Simpson's Uterine Sound, graduated. 
1 Wylie's Sound, pure silver. 
1 Sims' Repositor. 
1 Emmet's Applicator, pure silver. 
1 Wylie's Cervical Protector. 
1 Sims' Curette, small. 
1 Wylie's-Sims' Dilator. 
1 Wylie's Mucus Syringe. 
1 Pouch, to roll up. 
Wylie's Gynaecological Operating Instruments. 
Bellevue Hospital Clinic Set. 
$100. 
1 Sims' Speculum, short bladed. 
1 Sims' Depressor. 
2 Sims' Tenacula. 
12 Sponge Holders. 
2 Scissors, curved flatwise, blunt and sharp pointed. 
2 Knives. 
1 Thumb Forceps. 
6 Haemostatic Pressure Forceps. 
1 Angular Forceps. 
3 Sims' Curettes, assorted. 
12 Sims' Cervix Needles, 1 inch long. 
12 Suture Needles, straight. 
5 coils Silver Wire (Nos. 26 and 27) and Silk. 
2 coils Catgut, Nos. 2 and 3. 
1 Sims' Shield. 
1 Sims' Wire Twister. 
2 Applicators, whalebone. 
1 Applicator, pure silver. 
1 Sims' Rectal Speculum. 
1 Sims' U terotome. 
1 Wylie-Sims' Dilator. 
3 Glass Plugs. 
1 Leather Pouch, to hold most of above instruments. 
Munde's Pocket Case, for Examinations and 
Applications. 
1 Dawson's Double-Hinge Sims' Speculum. 
1 Double Depressor. 
2 Tenacula. 
2 Munde's Hard Rubber Applicators. 
2 Straight Hard Rubber Sticks. 
1 Curved Catch Dressing Forceps. 
Absorbent Cotton, Tampons, Leather Case. 
See Vesico-Vaginal Fistula Sets, . . page 462. 
Operating Furniture " 51. 
Anesthetic Apparatus, . . . . " 43. 
Antiseptic Dressing of Wounds, . " 74. 
Drainage Trocars and Tubes, . . " 75. 
Pus Basins, " 75. 
Paracentesis " 126. 
Ovariotomy Trocars, " 127. 
Aspirators, ... ... . " 129. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
473 
@Y^I/£CObO®ie/L. 
UTERINE DIAGNOSIS. 
Probes and Sounds. 
" The uterine probe, or sound, is a useful instrument in diagnosis of uterine disease and displacement; its use 
gives us information of the presence of stenosis of the uterus, tenderness and flexions of the organ, the size and 
attachments of fibrous polypi, and some information regarding intra-mural fibroids, &c. Caution.-The surgeon 
should always be sure pregnancy does not exist before he attempts the introduction of the uterine 
sound. Cellzilitis also contra-indicates its employment, even for purposes of diagnosis."-Eaton on 
" Diseases of Wnmpn " tRRo 
Fig. 3354.-Thomas' Hard Rubber Probe. 
Fig. 3355.-Leaden Probe. 
Fig. 3360.-Thomas' Whalebone Probe (flat). 
Fig. 3361.-Jenks' Uterine Probe. 
Fig. 3356,-Silver Uterine Probe. 
Fig. 3357.-Chapman's Probe and Sounds. 
Fig. 3358.-Wyeth's Probe, Copper, Nickeled. 
Fig. 3359.-Nott's Uterine Instruments. 
Fig. 3362.-Thomas' Elastic Probe, 
Fig. 3363.-Silver Uterine Probe. 
Fig. 3359--No. i is a modification of Roux needle-holder. It is an excellent needle- 
holder, which may be used in the operations of vesico-vaginal fistula, cleft palate, &c., and it 
is made to serve as a handle to the instruments accompanying it; No. 2 combines the applicator with the 
spopge tent expeller; No. 3 is a sponge holder and ligating forceps; No. 4, a lead sound, which easily 
follows the curve of the uterus ; No. 5 intra-uterine scarifying knife, blunt point; No. 6, Simpson's sound : 
No. 7, uterine probe, of pure silver. 474 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
UTERINE DIAGNOSIS. 
Probes and Sounds. 
Fig. 3374.-Skene's Uterine Sound. 
Fig. 3364.-Simpson's Uterine Sound, Graduated. 
Fig. 3365.-Hunter's Uterine Sound. 
Fig. 3366.-Sliding Uterine Sound. 
Fig. 3367.-Folding Uterine Sound. 
Fig. 3368.-Leonard's Uterometric Sound. 
Fig. 3369.-Fitch's Uterine Sound. 
Fig. 3375.-Gidding's Uterine Sound. 
Fig. 3370.-Leonard's Uterine Sound. 
Fig. 3371.-Jenk's Uterine Sound. 
Fig. 3372.-Wylie's Cervical Speculum, or Protector. 
Fig. 3373.-Wylie's Cervical Applicator. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
475 
GYN/ECObOGICAb. 
UTERINE DRESSING. 
Dressing? Forceps and Applicators. 
Fig. 3376.-Uterine Dressing Forceps (slide catch). 
Fig. 3383.-Uterine Dressing Forceps. 
Fig. 3377.-Nunn's Folding Uterine Forceps 
FiG. 3384.-Bozeman's Dressing Forceps. 
Fig. 3378.-Uterine Dressing Forceps. 
Fig. 3379.-Dressing Forceps, 
Fig. 3385.-Wackerhagen's Applicator. 
Fig. 3380.-Newman's Metrorganon. 
Fig. 3386.-Sims' Tampon Screw. 
Fig. 3381.-Jones' Uterine Dressing Forceps. 
Fig. 3382.-Nunn's Uterine Dressing Forceps and Scissors. 476 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
UTERINE DRESSING. 
Applicators for Solid, Powdered and Fluid Remedies. 
" Medicinal agents may be applied to the mucous membrane of the vagina, intra-vaginal portion of the cervix and 
external os uteri by various methods, as in solution by vaginal injections, through specula, and on wads of cotton ; as 
powders, through specula, on cotton and by insufflation ; as ointments, through specula and by a syringe ; in supposi- 
tories and - through tubes."-Munde. 
Fig. 3387.-Sims' Caustic Forceps. 
Fig. 3388.-Gardner's Caustic Forceps. 
Fig. 3399.-Sponge Holder. 
Fig. 3389.-Gardner's Caustic Holder. 
Fig. 3390.-Turner's Applicator. 
Fig. 3398.-Edward s Caustic Holder. 
Fig. 3391.-Nunn's Applicator. 
Fig. 3392.-Lente's Double Bulb Caustic Probe 
Fig. 3393.-Lente's Platina Cup. 
Fig. 3394.-Emmet's Applicator. 
Fig. 3395.-Skene's Instillation Tube. 
Fig. 3396.-Kelly's Silver Uterine Syringe. 
Fig. 3397--Parker's Uterine Applicator (velvet eye). GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
477 
@YN/ECOLdOGICAId. 
UTERINE DRESSING. 
Applicators for Ointments, Solids and Fluids. 
Fig. 3400.-Braun's Uterine Syringe 
Fig. 3409.-Nott's Hard Rubber Uterine Syringe. 
Fig. 3401.-Barker's Ointment Bougie. 
Fig. 3402.-Hutchison's Ointment Syringe. 
Fig. 3403.-Lente's Ointment Syringe. 
Fig. 3404.-Lawson's Applicator. 
Fig. 3405.-Dick's Caustic Syringe. 
Fig. 3406.-Lallemand's Porte Caustic. 
Fig. 3407.-Lente's Ointment Syringe. 
Fig. 340S.-Nott's Applicator. 
G.TIEMANN&CO. 478 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
(SYN/EeOLOGieAL. 
UTERINE DRESSING. 
Introduction of Cotton Wool Charged with Remedies into the Vagina. 
"To enable the patient herself to carry out this treat- 
ment. It is made of hard rubber and consists of two blades, 
moving on a pivot to come together, forming a hollow 
cylinder in which the pledget of wool is placed, the blades 
being kept in contact by a strong elastic ring outside. 
When charged, the patient, by simply opening the vulva, 
can pass the instrument into the vagina, directing the point 
backwards as far as necessary ; then, by compressing the external diverging blades, the internal ones are opened, and, 
by pushing on the piston or rod, the pledget is deposited in the vagina."-Barnes. 
"The Tampon.-Had Sims' me- 
thod of uterine examination done no- 
thing else than lead to the proper me- 
thod of using the vaginal tampon, it 
would have done by that alone a vast 
deal of good. Before its introduction 
the use of the tampon was a painful, 
uncertain and inefficient haemostatic 
method. Since the use of Sims' spec- 
ulum it has become an easy, painless, 
scientific and most effectual method 
for preventing and checking haemor- 
rhage from the non-pregnant uterus." 
Thomas. 
Fig. 3410.-Barnes' Tampon Speculum. 
Fig. 3411.-Braun's Tampon Expeller. 
Fig. 3412.-Thomas' Tampon Expeller and Dry Cupper. 
UTERINE DRESSING. 
Vaginal Tamponade for Controlling Uterine Haemorrhage. 
" It is impossible to tampon the vagina effectually without the aid of Sims' speculum. The mere stoppage of the 
'.scape of blood from the vaginal outlet is not sufficient, for the accumulation may continue unsuspected in the upper 
part of the vagina. When the uterine haemorrhage is free, we must prevent its escape from the os, as far as possible, 
and for this it may even be necessary to tampon the lower portion of the uterine canal. There is no danger of the 
uterus enlarging from concealed haemorrhage, as after labor, nor do I think there is any probability of the escape of 
blood through the Fallopian tubes into the peritoneal cavity. The formation of a clot within the canal will excite the 
uterus to contraction, by which it will be forced out into the vagina. This is just the condition we wish to bring 
about; for, as the uterus contracts, its vessels are compressed and the flow of blood is checked. 
" The best material for tamponing the vagina is damp cotton. A quantity of it is to be soaked in water and 
squeezed nearly dry. Then it should be thoroughly moistened in a saturated solution of alum, and again squeezed 
out. But, before the cotton has become too dry, it must be separated into portions, of which the edges are to be 
turned over, so that, when compressed between the hands, each shall be about two inches square and half an inch 
thick. If the pieces are then placed one upon the other, they will not become too dry before they can be used. 
Before introducing the tampon, the bladder must be emptied, the patient placed in the proper position on her left side 
and the speculum introduced. All the blood and clots must be first removed from the vagina and the whole passage 
mopped out with a piece of damp sponge held by a long dressing-forceps, or in a sponge-holder. When the bleeding 
is profuse, it may be necessary to make an application of iodine to the uterine cavity, to excite contraction. After a 
pledget of cotton has been properly twisted on the applicator, and the instrument has been bent to the curve of the 
uterine canal, it is to be dipped into the iodine and passed to the fundus. If we wish to leave the cotton behind, it is 
only necessary to loosen it from the applicator, by giving the instrument several turns in the opposite direction to 
that in which it was put on ; and, as it is withdrawn, apply the nail of the index finger against one side of the instru- 
ment, which will cause the cotton to slip off and remain in the canal. Before introducing the tampon it is advisable, 
by means of a sponge-probang, thoroughly to smear the vaginal walls with vaseline or any other greasy substance of a 
proper consistence. 
" The packing of the vagina is begun by placing over the cervix a pledget of cotton, dampened afresh with the solu- 
tion of alum. Then a mass is rolled up and placed in the posterior cul-de-sac, close to the cervix, a similar one on each 
side and in front, and a flat piece over all. The pledgets are next placed around the cervix in a circle and the central 
place filled in. When the mass reaches the vaginal walls, it should be pressed back, with a stout whalebone stick, 
from tha sides towards the centre, and, as room is thus gained, new portions of cotton must be slipped into place with GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
479 
GYN^GOLOGIGAId. 
UTERINE DRESSING. 
Vaginal Tamponade for Controlling Uterine Haemorrhage. (Continued.) 
dressing forceps and pressed backwards as before, the pledgets being packed wherever space is gained. When the 
vagina has been well filled, the tampon is to be pressed firmly back with the stick from the anterior wall of the vagina 
towards the hollow of the sacrum, and, when the speculum has been placed in front of this, the space will extend 
nearly up to the uterus. This is to be filled in the same manner until the whole canal has been firmly packed. No 
force should be used, but, by going around and around the mass, and firmly packing in, with the forceps, one small 
portion after another, we can gradually distend the vagina, if necessary, until the whole basin of the pelvis is filled 
by the tampon. 
"It is always necessary to confine the patient to bed and to give an anodyne if the tampon is a large one, and the 
bladder may have to be emptied by means of a flexible male catheter. It is best, as a rule, to administer the anodyne 
by enema, using for this purpose, as I commonly do, the acetated tincture of opium ; or, if more convenient, a sup- 
pository of morphine and belladonna may be used, but it must be passed high up into the rectum before the tampon 
is introduced. The most distressing effect of a large tampon is due to a pressure on the neck of the bladder. Should 
the anodyne fail to relieve this, the position of the patient must be shifted across the bed, her hips brought near the 
edge, her limbs flexed, and some of the cotton lying near the neck of the bladder be carefully removed. This may be 
done by means of a forceps, or better, by twisting the notched whalebone swab-stick into each piece, using the index 
finger as a guide. In a few hours, the vessels will have had time to contract, under the influence of the pressure, so 
that, as a rule, a sufficient quantity of cotton to give relief may then be removed with safety if the patient continues to 
keep the horizontal position. Notwithstanding the astringent and disinfectant properties of the alum, it will be necessary, 
after twenty-four or thirty-six hours, to remove the tampon, since by that time it will have become offensive from being 
saturated with blood and the secretions. After its removal a large injection of hot water, containing a little impure 
carbolic acid, should be administered, to wash out the vagina thoroughly, after which another tampon may be inserted 
if necessary. As the flow will, in all probability, have been greatly lessened by the pressure of the first tampon, the 
second one will not need to be so large. Before replacing the tampon it is well to encircle the cervix with several 
pledgets of cotton saturated with glycerine. Not only is this a good disinfectant, but it also renders the condition of the 
patient more comfortable, by removing the heat and dryness of the vagina which habitually follow the use of the alum 
and tampon."-" Emmet's Principles and Practice of Gynaecology." 1884. 
"Dr. Frank P. Foster recommends the use of lampwick for tamponing the vagina, as a material always to be 
found. It can be easily saturated while in the ball with an astringent or other medication, and may be introduced 
with the aid of any speculum. It is sometimes desirable to tampon the cervical canal, or to introduce a medicinal 
agent into the uterine canal in such a manner as to insure its prolonged contact with the endometrium. For such pur- 
pose an inch or more of the end of the wicking may be stiffened with gelatine, and then, after having been dipped into 
the liquid to be applied, be introduced into the canal by means of dressing forceps. If care is taken not to coat the 
whole circumference of the wicking with the gelatine the liquid medicament readily permeates and a considerable 
quantity of it may thus be introduced within the uterine canal. Enough more wicking is then inserted into the 
vagina to act as a tampon ; and, when this is removed, the portion originally introduced into the uterus comes out with 
it. When the tampon is to be removed, the patient simply makes traction upon the portion of wicking that was left 
hanging from the vulva, and the mass within the vagina is unwound as the tractioh proceeds ; consequently no large 
wad has to pass the vaginal orifice, and the extraction of the tampon is painless."-" Remarks on Vaginal Tampons." 
W. F. Medical Journal, June, 1880. 
UTERINE IRRIGATION. DOUCHING 
Fig. 3413.-Hospital Bed Pan. 
For Hot or Cold Injections per Vaginam, 
The very general use of hot injections, both for 
purposes of cleanliness and medication, necessitated 
the manufacture of some suitable vessel to receive 
the fluid as it is discharged. Such a receptacle is 
now furnished in the hospital bed pan. Especially 
in the case of applications per vaginam, in which 
heat is an important factor, it is necessary that the 
good effect upon the circulation should not be coun- 
teracted by pressure upon the very parts designed to 
be relieved. It is therefore essential that the patient 
be kept in a recumbent position and that she should 480 
GEORGE TIEMANN CO.'S SURGICAL INSTRUMENTS. 
/ECOLOGICAL. 
UTERINE IRRIGATION. DOUCHING. 
For Hot or Cold Injections per Vaginam. (Continued.) 
not be exposed to cold, either during or after taking the injection. The hospital bed pan meets all these requirements ; it 
is of large capacity, and its form is adapted at once to fit the body while lying down and to prevent any spilling of the 
contents on the bed. The pan holds nearly seven pints, which is sufficient for most purposes. It is emptied through 
the handle C, by unscrewing the cap Z>. When, however, it is to be used in cases requiring a larger volume of liquid, 
the plug B is removed and heavy rubber tubing is attached to the tube A to carry off the outflow ; the quantity of 
water used may then be ad libitum. The hospital bed pan is also used for receiving rectal discharges, either with or 
without injections. For this purpose it is better than the common porcelain bed pan, on account of its capacity 
and form. 
" Dr. R. B. Dixon explained the advantages of a douche pan invented by W. M. Searby. The pan is of large 
size and its shape is such that it can be easily placed in position for use, and the patient can remain undisturbed in a 
recumbent position as long as may be necessary to inject a large volume of water, no discomfort from wet or any other 
cause being experienced. The pan is used largely in hospital practice, and is highly spoken of. One great advantage 
it possesses over other pans exhibited is that it is by far the least expensive of them all."-Boston Medical and 
Surgical Journal. 
" The injection can be better administered to the patient after she is undressed for the night and in bed. She 
should be placed near the edge of the bed, with her hips elevated as much as possible by the bed pan, and a small 
pillow under her back, the lower limbs being flexed. Her body must be covered, to protect her from cold, and her 
position made perfectly comfortable ; when the bed is a soft one, a broad board should be placed under the pan to 
prevent it from sinking down by the weight of the patient, and to keep the hips elevated. The vessel of hot water is 
placed on a chair by the bedside, and the nurse passes the nozzle of the syringe over the perinaeum into the vagina, 
directing it along the recto-vaginal wall until it has reached the posterior cul-de-sac. The water must be thrown in, at 
first, very carefully, until the vagina has become distended. If the nozzle is not properly introduced, the stream of 
water may be thrown directly into the uterine canal. The forcible entrance of any fluid into the undilated uterus 
causes intense pain, and frequently alarming symptoms of nervous prostration or collapse ; and sometimes it is the 
cause of cellulitis. At the completion of the injection, the vagina can be 
emptied by depressing the perinaeum for a few seconds, with the finger 
on the nozzle of the syringe before withdrawing it; and, as the bed pan 
is removed, a napkin should be placed against the vaginal outlet to absorb 
any water which may have been retained. When circumstances prevent 
the injections being thus administered, it is better to use a fountain or 
siphon syringe than that the patient should attempt to give them to her- 
self. This mode, however, can only be regarded as a substitute, for it is 
never so efficacious. In any event the same elevated position of the hips 
is necessary. A steady stream is never so serviceable as the interrupted 
current from a Davidson's syringe. Hence it would seem as if, in addi- 
tion to the heat of the water, the jet from the syringe acted as a stimulus 
to excite the bloodvessels to contraction. 
" Dr. Frank P. Foster has had constructed an arrangement by which 
the bed pan can be dispensed with, and which does not require an 
assistant to administer the injection. A cup or shield is made by de- 
pressing one half of an india rubber bag into the other half and screwing 
the two together. This point is pierced by the pipe of a Davidson's 
syringe, and fixed by a brass cap. On compressing the bulb, the water 
is forced directly through the vaginal portion, or nozzle, of the syringe, 
which is shaped like the letter U, and pierced with one hole near the bow 
of the U, on its inner side. Now, as the soft india rubber cup is held 
over the labia, the only escape for the water is by the outflow tube. The 
nozzle is attached to the cup by a short piece of tubing, so that it may 
turn in various directions without displacing the cup. The patient's hips 
should be elevated, so that the vagina may be kept fully distended, and 
only the surplus water be allowed to flow off by the outflow tube."- 
" Emmet's Principles and Practice of Gynaecology." 1S84. 
Vaginal Injection Apparatus. 
Fig. 3414.-Foster's Vaginal Syringe. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
481 
GYN/EeOkOGieAL. 
UTERINE IRRIGATION. DOUCHING 
For Hot or Cold Injections per Vaginam. 
" The proper administration of therapeutic vaginal injections in the dorsal re- 
cumbent position, with hips elevated, is almost impossible, owing to the discomfort, 
annoyance and expense attending the use of the various contrivances for receiving 
the injection fluid as it leaves the vagina. These are entirely overcome by the sim- 
ple instrument shown in the accompanying woodcut. 
" The instrument consists of a cup made of soft rubber with a flexible ring around 
the top. Through the bottom of the cup pass the afferent tube (D), with hard rub- 
ber nozzle, and the efferent tube (C), to which is attached a waste pipe two feet and 
a half long, for conveying the fluid into a receptacle under the bed or table. These 
tubes are supplied with patent stop-cocks (A and 2?). The nozzle (2?) may be re- 
moved from the cup when desired. The cup is readily introduced into the vagina 
by compressing the flexible ring, which easily passes the sphincter muscles, and, ex- 
panding, produces sufficient pressure on the vaginal walls to prevent the escape of 
the fluid, except through the efferent tube. 
" The nozzle of any style of syringe may be inserted into the efferent tube, and 
any quantity of water may be injected with perfect comfort to the patient. Ihe 
patient lying on the back, with hips slightly elevated, the fluid dilates the upper 
portion of the vagina and comes in contact with the entire surface, while the more 
sensitive portions of the vagina, vulva and peritoneum are completely protected in 
case very hot water is used. 
" In applying to the vagina or cervix, glycerine or glycerole of tannin, or any 
fluid application, the nozzle being removed, close the stop-cock, 2s1, in the efferent 
tube, remove the waste pipe, inject the application, close the stop-cock, A, and leave 
the instrument in situ. Instruct the patient to allow the fluid to escape at a speci- 
fied time and remove the instrument, or allow it to remain in the vagina as a tem- 
porary support to the uterus, thus doing away with cotton and oakum tampons. 
Many ways will suggest themselves to the physician in which this simple instru- 
ment may be made useful."-E. P. Fraser, M. D. Professor of Gynaecology, Medi- 
cal Department of the Willamette University, Portland, Oregon. 
Fig. 3415. 
Fraser's Intra-Vaginal Syringe. 
Fig. 3416.-Frost's 
Vaginal Douche. 
Fig. 3417.-Thornton Parker's Vaginal Syringe. 
"To meet a want in our practice, and remedy defects which detract from the utility of the 
instruments now commonly in use, we have devised a syringe, manufactured by Messrs. 
Tiemann & Co., of New York city. This syringe is made entirely of rubber and the vaginal 
and rectal tubes are perfectly flexible. There is no terminal orifice, but the sides are per- 
forated with "velvet eyes" for a distance of nearly two inches from the end. These rubber 
syringe-points do not lacerate the mucous membrane, nor produce the injury so often caused 
by the hard metallic tubes. The bulb and tubes are large and insure a copious supply of 
water."-Thornton Parker, M. D., of Newport, R. I., in Medical Record, July 5, 1879- 
" Fig. 3416 is intended to be a convenient and efficient instrument for administering the 
prolonged hot water douche, as recommended by Dr. T. A. Emmet. It consists of two por- 
tions : the nozzle and tube through which the injection is to flow, and the bulbous part around 
it, which is introduced into the vagina, acting as a plug to cause the vagina to be filled with 
water, the surplus passing off through the hollow bulb and out through the overflow tube into 
a receptacle placed beside the bed."-L. A. Frost, M.D., in Medical Record, Feb. 28, 1885. 482 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
UTERINE IRRIGATION. DOUCHING 
For Hot or Cold Injection per Vaginam. 
Fig. 3418.-Woodward's Uterine Syphon Douche. 
Fig. 3419.-Byrne's Reflux Catheter and Adjuster. 
Fig. 3420.-Reliquet's Double-Current Catheter. 
Figs. 3421, 3422.-Nott's Double-Current Catheters. 
Fig. 3423.-Bozeman's Intra-Uterine Backflow Tube. 
Fig. 3424.-Hanks' Intra-Uterine Douche Tube. 
' This hard rubber tube (which is represented by Fig. 3424) is about twelve inches in length and one-fifth to one- 
fourth of an inch in diameter. The distal end is bulb-shaped and removable, about one-third to one-fourth of an inch 
in diameter. It should be attached in the usual manner of a screw-cap. The openings in the bulb-shaped end are so 
arranged, as seen in the cut, that the fluid used is forced backward toward the proximal extremity of the tube, thus 
avoiding, as much as may be, the danger of forcing fluid into the Fallopian tubes. When the tube is to be cleansed, 
it is only necessary to remove the bulb-shaped end, and every septic germ can be easily reached and destroyed. The 
proximal end of the tube is arranged, of course, for attaching the rubber tube of whatever syringe it is desired to use. 
It can be easily bent to any angle by oiling and heating over an alcohol lamp or coal fire, or by simply placing the tube 
in a bowl of hot water for a few moments."-H. T. Hanks, M. D., in York Medical Journal, Sept. 18, 1886. 
"Proper Vaginal Syringe Nozzle.-Sometimes, where the cervix is lacerated or the cervical canal dilated, the 
patient will carry the instrument directly into the os externum and project a large amount of fluid into the uterus. 
Such an accident is followed by violent uterine contractions, and the probable passage of the liquid into and perhaps 
through the Fallopian tubes, and this often results in a degree of pain which almost causes collapse and sometimes 
even pelvic peritonitis. This accident can always be prevented by having the nozzle of the syringe made with a reverse 
current."-Thomas, on " Diseases of Women." 1880. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
483 
GYNAECOLOGICAL. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Repositors, Elevators, Redressors. 
Fig. 3425.-Sims' Uterine Elevator, No. I. 
Fig. 3426.-Sims' Uterine Redressor, No. 2 
Fig. 3427.-Emmet's Uterine Elevator. 
Fig. 3428.-Guernsey's Elevator. 
Fig. 3429.-Gardner's Manifold Instrument. 
Fig. 343°--Stowe's Retroversion Elevator. 
Fig. 3433.-Noeggerath's Uterine Elevator. 
Fig. 3431.-Elliott's Uterine Sound. 
By means of a screw in the handle the point of the instrument is moved from side to side, 
or extended in a direct line ; hence making it easy of introduction, and, when introduced, we have 
but to turn the screw in the handle to bend the other end of the elevator in the opposite direction, 
and thereby correct the flexion we wish to rectify. In inversions of the uterus it is equally ser- 
viceable."-Eaton. 
Fig. 3432.-Skene's Elevator and Curette. 484 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
@YN^ECOIdO®ICALd. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Repositors, Elevators, Redressors. 
Fig. 3434.-Porter's Uterine Repositor. 
" It is easy to carry the instrument to place, and the points being of copper, can be curved to any required degree, 
and may be carried along the uterine canal and take any direction necessary. On the lever disc is a mark (/) that shows 
the direction and angle the uterine point has taken. After the point is fully within the uterus, and it ought to reach 
to the fundus, but not press thereon, the forefinger of one hand may be used to assist the instrument by pushing against 
the body of the uterus as felt through the vaginal wall. The forefinger of the hand holding the instrument pressed 
against one lever and the thumb pulling on the other will cause the point to rotate so as to bring the uterus to the 
desired position. You know as you use it how much power or force you are exerting and how much you have moved 
the organ at any time; you can judge of the rigidity or elasticity of the parts moved, because the whole force is in 
your fingers, and not in a screw. After having moved the uterus into place, by letting go the levers, you will be able 
to see if it tends to return back again to its old position. As there has always been a difficulty after replacement of a 
uterus with an instrument in getting the point out again without turning the organ back to its wrong position, I have 
had points made which flex only in one direction. These points enter the uterus with the greatest facility, and, if the 
version is complete after introduction, the instrument will perhaps need to be revolved upon its axis, and then use the 
lever disc. The turning the instrument on its axis is to bring the uterine point into proper relations so as to get its 
rigid action. In taking the instrument out, elevate the handle towards the abdomen, so as to cause the button disc 
to describe an arc of a small circle from the uterus backwards, downwards, and then forwards. By this motion the 
point will slip out without displacing again the replaced organ. A rubber disc is also made to go on the button disc 
for use in cases where the instrument might too easily enter the os, such as in lacerations, gaping os tincae, &c. With 
no other instrument can the uterus be so easily manipulated in examinations made to decide the question of attach- 
ment or non-attachment of tumors to itself within the abdomen. Here the rigid points are best. You can difinitely 
guide the uterus between adhesive bands into its natural position, and as easily return it again if there would seem to 
be any necessity therefor."-J. A. Porter, M.D. Medical News, May 6, 1882. 
Fig. 3435.-Blake White's Metratrep. 
"The metratrep (p/qTpa, the womb, and Tterpetv, to turn) is composed of two parts. The first is a straight tube 
(C). At the larger extremity two rings are attached, by means of which the operator is enabled to steady and guide 
the stem when searching for or operating upon flexions about the womb. At the end of this tube is a highly flexible 
and elastic spiral attachment, terminating in a blunt probe-point. This spiral attachment, being graduated to the depth 
of a normal womb, does not exceed two inches and a half in length and is pliant; it can, with the slightest effort, be 
made to follow the most devious uterine flexion without causing any pain. 
" The second part, which is intended to be combined with or disunited from the first part at will by means of a catch 
at A, consists of a split metallic spring, made to fit the calibre of the tube above described precisely as a sword its 
scabbard. This spring is furnished with a separate handle, upon which is attached a graduated dial-plate with a 
movable index. By means of a governing screw placed at the butt of this handle (5), the point of the spring, which 
is within the spiral inclosure, can be forced to turn upward or downward, the index meantime recording very faithfully 
every change of direction impressed by the will of the operator. 
" Introduced into a retroflexed uterus, the spiral extremity, yielding to the maldirection, turns backward and down- 
ward to the precise degree of flexion existing. To restore the organ to its normal position, it is, therefore, necessary 
only to operate upon the governing screw at B. The combined instrument is held steadily and firmly in place after 
its introduction, and, by simply turning the screw referred to, the body of the organ can be gradually and painlessly 
lifted into its proper place. As soon as this is accomplished, the index will announce the fact, when the instrument 
can be carefully withdrawn, leaving the organ in its redressed condition."-N. V. Medical Journal, April io, 1886. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
485 
®YN/ECOLO®ICAL. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Repositors. 
Fig. 3436.-Leonard's Uterine Repositor. 
Fig. 3437.-Carroll's Uterine Repositor. 
Inversion of the Uterus. White's Method of Reduction. 
" Inversion of the uterus is a condition in which the uterus has become either partially 
or completely turned inside out, so that more or less of the inner surface forming the ute- 
rine canal projects through the dilated os into the vagina. The injury results from child- 
birth or from the growth of some interstitial tumor which had already begun to project into the uterine canal. 
" One hand is introduced into the vagina, for the double purpose of grasping the uterus and, at the same time, 
keeping pressed against the fundus an india rubber cup, from which, projecting outwards, is a short staff, having at 
its other end a stout steel spiral spring. This spring has a pad at its extremity (not shown in the cut) and is intended 
to rest against the body of the operator, so as to maintain a steady pressure. The effect of this is to put the vaginal 
canal on the stretch, so that by traction on the walls the ring at the seat of inversion above may be dilated. The other 
hand is employed to steady the uterus and, at the proper time, to aid by making counter-pressure, with the view of 
rolling out the tissues at the seat of inversion."-" Principles and Practice of Gynaecology." Emmet. 
Fig. i.-a. Uterus in process of re- 
duction. 
b. Anterior lip or wall of the uterus 
with the fingers of the left hand press- 
ing upon it and assisting in pulling 
open the uterine cavity. 
c. Posterior uterine wall semi-re- 
flected. 
d. Anterior vaginal wall. 
e. Wooden or hard rubber stem of 
repositor, its enlarged extremity held 
in contact with the fundus by the intra- 
vaginal hand of the operator. 
f. Distal extremity of stem made 
into a screw, so as to fasten into g, a 
coil of No. ii steel spring wire, re- 
quiring eight or ten pounds pressure 
by the breast of the operator, against 
which it is placed, to bring it down. 
Fig. 2.-h. Uterine extremity of 
stem e, which is terminated with a soft 
india-rubber disc if inch diameter, the 
concavity into which the fundus is re- 
ceived being about one-half inch deep, 
with its terminal margin thin and soft. 
Fig. 3438.-White's Uterine Repositor. 486 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYN/ECOLOGIOAL. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Supports, Pessaries, Hysterophores. 
"Pessary, Pessarium.-An instrument, made of cork, ivory, hard rubber or elastic gum, which is introduced into 
the vagina to support the uterus in cases of prolapsus of the uterus or relaxation of the vagina ; to keep vaginal hernia 
reduced, &c. 1 he ancients made use of medicated pessaries, which they distinguished into emollient, astringent, 
aperient, &c., and they are still used, although generally called vaginal suppositories. An anal pessary is sometimes 
employed for the compression of haemorrhoids. The form of pessary is very variable-round, oval, &c., according to 
fancy and circumstances. Some of them have an external support from astern-the intra-uterine pessary, for example. 
Some forms of pessary are referred to according to their shape, as the ring pessary, the horseshoe pessary, &c., and 
the various modifications of shape are also named after their proposers."-Dunglison. 
Fig. 3439.-Ring Pessary. 
Fig. 3441. 
Bozeman's Vaginal Dilator. 
Fig. 3440. 
Cutter's Cup 
Pessary for Pro- 
lapsus. 
Fig. 3445. 
Inflatable Ball 
Pessary. 
Soft rubber. 
Fig. 3442. 
Inflatable Ring 
Pessary. 
Soft rubber. 
Fig. 3443. 
Inflated Pessary 
Soft rubber. 
FIG. 3444. 
Concave Pessary 
Hard rubber. 
Fig. 3447. 
Tiemann & Co.'s Uterine Supporter, 
Fig. 3446.-Rozer's Pessary, GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
487 
GYNAECOLOGICAL. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Supports, Pessaries, Hysterophores. 
Fig. 3448.-Thomas' Supporter. 
Fig. 3449.-O'Leary's Pessary. 
McIntosh's Uterine Supporters. 
Fig. 3450. Fig. 3451. Fig. 3452. Fig. 3453. 
Fig. 3455. 
Babcock's Pessary. 
Fig. 3456. 
Donaldson's Uterine Supporter, 
Fig. 3454.-Hornby's Pessary. 
Fig. 3457.-Cutter's Ring Pessary. 
Fig. 3458.-Thomas' Cutter's Cup Pessary, 
for Prolapsus. 
See ocher Supporters, page 328. 488 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SY^/ECOlnOQie/L. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Supports, Pessaries, Repositors, Hysterophores. 
"The instrument is made of steel wires. It is elastic and thoroughly 
self-sustaining. It has vesical and rectal branches which are covered with 
thin rubber up to points near the heel of the instrument, where an opening 
is left for the escape of the menstrual and other discharges. Upon the 
vesical branch is set a cushion which is to receive and support the vesico- 
vaginal septum. The covering of the rectal branch is distended with air in 
order that it may adapt itself uniformly to the recto-vaginal septum. The 
two uneven bows are united by a broad elastic apron, which is to receive the 
cervix uteri, and to a certain extent support the weight of the entire organ. 
" Retroflexion and fixation of the uterus in the hollow of the sacrum con- 
stitute the largest class of uterine displacements, and often the most deplor- 
able, which we are called upon to treat. Hitherto, treatment of these cases 
by means of the uterine sound and stem pessary has been 
unsatisfactory, and, according to my experience, a more 
comfortable, safe and effective method is unquestionably a 
great desideratum."-Extract from " Retroversion in Rela- 
tion to Lacerations of the Cervix Uteri." By Nathan 
Bozeman, M. D., New York. 
Fig. 3459. 
Bozeman's Vaginal Support. 
IG- 34^0. 
Campbell's Pneumatic Uterine Repositor, 
r r 
"An efficient stimulus to the unde- 
veloped or atrophic uterus, and at the 
same time to the ovaries, is the in- 
terrupted or faradic electric current. 
This may be applied to the endome- 
trium by means of an insulated steel 
sound, the other electrode being 
placed alternately on the abdomen 
over the fundus uteri and each ova- 
rian region, or over the sacrum ; the 
strength of the current and the length 
of the sitting will depend on the sensi- 
bility of the patient, and should gradu- 
ally be increased until the full strength 
of the battery is applied and the sitting 
lasts thirty minutes. As with a medi- 
cinal application, so should the electricity be applied most thoroughly immediately preceding a menstrual epoch, and 
two or three times a week or oftener in the interval."-" Minor Surgical Gynaecology." Munde. 
See Electrodes, page 34. 
Fig. 3461.-Hofmann's Pelvic Pessary. 
Soft rubber, inflated 
Fig. 3462.-Hurd's Pessary. 
Fig. 3463. 
Fig. 3464. 
Globe Pessaries. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
489 
QYN/ECOLOGISAL. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Supports, Pessaries, Hysterophores. 
Fig. 3465.-Ring Pessary 
Fig. 3466,-Sims' Pessary Introducer. 
Fig. 3467.-Trask's Pessary. 
Fig. 3468.-Nceggerath's Pessary. 
Fig. 3469.-Trask's Pessary. 
Fig. 3470.-Graily Hewitt's Pessary 
Fig. 3471.-Wilhoff's Pessary. 
Fig. 3472.-Hodge's Pessary. 
Fig. 3474.-Zwank's 
Hysterophore. 
Fig. 3475. 
Taliaferro's Universal Pessary. 
Fig. 3473.-Hodge's Pessary. 
Fig. 3476.-Todd's Pessary. 
Fig. 3477. 
Taliaferro's Retro-Displacement Pessary. 490 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYN/ECOLdOGI©AId. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Supports, Pessaries, Hysterophores. 
Fig. 3478.-Chamberlain's Pessary. 
Fig. 3479.-Chamberlain's Pessary. 
Fig. 3480.-Frazer's Pessary. 
Fig. 3481.-Fowler's Pessary. 
Fig. 3482. 
Campbell's Soft Rubber Pessary. 
Fig. 3483.-Hewitt's Pessary. 
Fig. 3484.-Hodge's 
Horseshoe Pessary. 
Fig. 3485.-Sleigh Pessary. 
Fig. 3487.-Coleman's 
Pessary (shaped). 
Fig. 3486-Coleman's Modification of Hodge's 
Open-lever Pessary. 
It is made of copper wire, covered with soft rub- 
ber, and can be bent into this (Fig. 3487) or any de- 
sired shape. 
Fig. 3490.-Hodge's 
Closed Lever Pessary. 
Fig. 3488. 
Graily Hewitt's Pessary. 
Fig. 3489.-Brown's Pessary. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
491 
GYNAECOLOGICAL. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Supports, Pessaries, Hysterophores. 
Fig. 3491.-Thomas' 
Anteversion Pessary. 
Fig. 3492.-Thomas' Hewitt's 
Retroversion Pessary. 
Fig. 3493.-Thomas' 
Anteversion Pessary. 
Fig. 3494.-Fowler's Bow Pessary. 
Fig. 3495.-Hunter's Pessary 
Fig. 3496.-Hitchcock's 
Anteversion Pessary. 
Fig. 3497.-Woodward's Pessary 
Fig. 3498.-Woodward's Pessary. 
Fig. 3499.-Gehrung's 
Anteversion Pessary. 
Fig. 3500.-Skene's Cystocele Pessary. 
Fig. 3501.-Emmet's Smith's Pessary. 492 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
®YN?ECOIdOGICALd. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Fig. 3502. 
Cutter's Pessary. 
Supports, Pessaries, Hysterophores. 
Fig. 3503.-Thomas' Cutter's 
Retroversion Pessary. 
Fig 3504.-Thomas' Cutter's 
Anteversion Pessary. 
Fig. 3505.-Thomas' Cutter's 
Anteversion Pessary, with 
cervical rest. 
3506.-Thomas' Cutter's 
Anteversion Pessary. 
Fig 3507.-Thomas Cutter's 
Retroversion Pessary, with 
cervical rest. 
Fig. 3508.-Smith's Pessary. 
Fig. 3509.-Side view of Smiths Pessary'. 
Fig. 3510. 
Buttles, Pessary. 
Fig. 3511.-Buttles' Pessary 
Fig 3512. 
Thomas' Retroversion Pessary GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS, 
493 
GYN/ECOLoOGIGAL. 
UTERINE. MALPOSITIONS, DISPLACEMENTS 
Supports, Pessaries, Hysterophores. 
Fig. 3513.-Thomas' Anteflexion 
Pessary (open) when in situ. 
Fig. 3514. 
Thomas' Retroflexion Pessary. 
Fig. 3515.-Thomas' Ante- 
flexion Pessary (closed). 
Fig. 3516.-Thomas' Ante- 
version Pessary (open). 
Fig. 3517.-Hanks' Pessary. 
Fig. 3518.-Thomas'Ante- 
version Pessary (closed). 
Fig. 3519. 
Bozeman's Smith's Pessary. 
Fig. 3520.-Von Ramdohr's Pessary. 
Fig. 3521. 
Cole's Retroversion Pessary. 
Fig. 3522.-Cole'sAnteversion Pessary. 
Fig. 3523. 
Carroll's Retroflexion Pessary, 
Fig. 3524.-Thomas' 
Anteversion Pessary. 
Fig. 3525.-Kinloch's Pessary for 
Prolapsus of the Bladder. 
Fig. 3526. 
Kinloch's Anteversion Pessary. 494 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
CYN/ECOLOGieAL. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Stem Pessaries, Repositors, Hysterophores. 
"Intra -Uterine Pessary, Stem Pessary.-An instrument for rectifying uterine displacements-as anteversion and 
retroversion-consisting of a stem which is introduced into the uterus ; this stem is attached to a flattened ovoid bulb 
or ball, on which the cervix uteri rests. Connected with this is sometimes an external part or wire frame, which is 
attached, at one extremity, to a flat tubular portion, passing into the vagina, to be fixed to the intra-uterine portion. 
The wire frame is made to press upon the pubis, so that the pessary can be kept in position in utero."-Dunglison. 
Fig. 3528. 
Conant's Intra-Uterine Stem Pessary. 
Fig. 3529.-Ball's Stem Pessary. 
Fig. 3527.-Stem Pessary. 
Fig. 3531.-Stem Pessaries. 
Fig. 3532.-Stem Pessary. 
Fig. 3533.-Thomas' 
Galvanic Stem Pessary. 
Fig. 3530. 
Cole's Galvanic Pessary. 
Fig. 3535.-Peaslee's Stem Pessary. 
Fig. 3534. 
Coxeter's Stem Pessary. 
Fig. 3536.-Mossman's 
Intra-Uterine Stem Pessary. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
495 
QYN/ECOLoOGICAlo. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Supports, Stem Pessaries, Hysterophores. 
Fig. 3537.-Sims' Stem Pessary. 
Fig. 3538.-Wilhoff's Stem Pessary. 
Fig. 3539.-Donaldson's 
Flexion Pessary. 
Fig. 3540.-Donaldson's Flexion Pessary, 
in nosition for insertion. 
Fiji. 
n3s. 
Fig. 3541.-Chambers' Stem Pessary. 
Fig. 3542. 
Edward's Stem Pessary. 
Fig. 3543.-Kinloch's Retroflexion Pessary. 
Fig. 3544. 
Kinloch's Retroflexion Pessary. 
Fig. 3546. 
Weber's Pessary. 
Fig. 3545.-Thomas' Intra-Uterine 
Stem Pessary, for Anteflexion. 496 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
®Y^^EeOLOGie/vL. 
UTERINE. MALPOSITIONS, DISPLACEMENTS. 
Fig. 3547.-Wallace's Spring Tent. 
Stem Pessaries and Repositors. 
A straight spring is incarcerated in a sponge and compressed so as to 
retain the curved form as long as it is dry. When passed into the flexed 
uterus the sponge softens, the spring erects itself and straightens the uterus. 
Fig. 3548. 
Van de Warker's 
Anteflexion Pessary. 
Fig. 3549. 
Perry's Instrument for Flexion of the Uterus. 
Fig. 3550. 
Van de Warker's 
Retroflexion Pessary. 
Fig. 3551.-H. Marion Sims' Stem Pessary 
Van de Warker s Pessaries.-"An intra-ute- 
rine stem must be made with reference to a few prin- 
ciples which I believe to be unalterable. First, the 
stem must be shorter than the cavity of the uterus, 
and so small in diameter that neither the outer 
nor inner os is stretched or occluded. Secondly, it 
must be supported wholly from within the vagina. 
Thirdly, the retaining part must be of such a size that it will not interfere with the action of the bladder or rectum, or 
with the comfort of the patient; and, lastly, the retaining part must be of such a form and so adjusted to the vagina that 
it will not restrict the normal uterine mobility. In order to comply with the latter condition, we cannot limit ourselves 
to any one form of the retaining part. Anteflexion, like all forward displacements of the uterus, is the most difficult 
to replace and retain comfortably in position. The vaginal part differs materially from that of the retroflexion form. 
F*g- 3548 shows the form of the anteflexion flange. The retroflexion flange has large fenestra cut out of the solid 
portion, which gives the flange superior retaining power and affords ready exit to the secretions of the cervix. This 
form generally converts a retroflexion into a retroversion, but, after years of work with this instrument, I have come to 
the conclusion that this is better than to further complicate the instrument by attachments to correct the resulting 
version. It will happen now and then that the flange and stem will get displaced. The remedy is a very simple one 
-replace them, remembering that if a stem is so securely held in place by the the vaginal attachment that it cannot 
become displaced, it is probably too good a 'fit,' and the patient cannot wear it."-Philadelphia Medical Mews, Febru- 
ary. 21, 1885. Ely Van de Warker, M. D. 
" Dr. H. M. Sims exhibits a hard rubber pessary of his own devising, adapted to cases of retroversion in which the 
cervix uteri is very short. It consists of a straight stem, to the base of which is attached a ring having the shape of the 
posterior half of a Hodge pessary. At the points where the ends of the rings join the base of the stem are two peculiar 
bends, or shoulders, of such a shape that when a downward pressure is exerted upon the stem, the ring is tilted up- 
wards. The instrument is adjusted by exposing the cervix through a Sims' speculum, pulling the anterior lip down- 
wards and forwards, and at the same time slipping the end of the stem into the os. As soon as the weight of the 
uterus rests upon the disk forming the base of the stem, the ring is thrown forwards against the symphisis, where it 
takes its point d'appui, pressing the cervix backwards, and thus everting the uterus."-"Transactions of the Obstetrical 
Society of New York." Stated meeting, April 6th, 1886. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
497 
SYN/EeObOQieAk. 
UTERINE FIXATORS. 
Tenacula, Tenaculum Forceps, for Holding the Uterus Steady during Operations. 
Fig. 3552.-Tenaculum for Nott's Speculum. 
Fig. 3553--Hanks' Tenaculum Forceps. 
Fig. 3555.-Byrne's Uterine Fixator. 
Fig. 3554.-Wylie's Tenaculum Forceps. 
Fig. 3556. 
Byrne's Double Tenaculum Forceps. 
See " Tenacula," page 449. 
Useful for seizing and hold- 
ing steady the'cervix uteri for 
examination, and during opera- 
tions through the speculum. 
Fig. 3557.-Wooster's Tenaculum Forceps. 
Fig. 3558.-Emmet's Double Tenaculum. 498 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GY N/ECO LOGICAL. 
UTERINE DILATORS. 
Fig. 3561. 
Tupelo Dilators (Solid). 
For Gradual Dilatation of the Uterine Canal. 
Fig. 3560. 
Sussdorfs Tupelo Dilators (Hollow). 
Sussdorff's 
Tupelo (Nyssa) Dilators, 
for Dilatation of 
the Os and Cervix Uteri. 
Process of manufacture patented, 
May 17, 1882, 
by George Tiemann & Co. 
Fig. 3562.-Wallace's Spring Tent. 
Fig. 3563.-Sponge Tent Expeller. 
Fig. 3564.-Sponge Tent Expeller. 
Fig. 3565.-Willhoft's Tent Expeller. 
Fig. 3567.-Sponge Tent Expeller, 
Sponge Tent Expeller.-When the tent is in situ the stilet is withdrawn and the 
unsupported tent is left in the uterine canal. 
Fig. 3566.-Campbell's Intra-Uterine Stem. 
"Gradual dilatation is accomplished by porous substances, shaped to fit the uterine canal, which gradually swell 
through imbibition of the fluids from the surrounding tissues. These are called uterine tents. Tents are made of 
sponge, laminaria, tupelo, slippery elm bark, &c. 
" Suss dorff' s tupelo (tenf) dilator absorbs fluids rapidly and expands to at least double its compressed size ; when 
expanded its surface is, although not perfectly smooth, not sufficiently rough to injure the mucous membrane during 
its removal; it does not favor decomposition of fluids-indeed, I have never found a tupelo tent to possess the slight- 
est offensive odor after having been left in utero over twelve hours."-" Minor Surgical Gynaecology." Munde. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
499 
@YN/EeOLOGieAk 
UTERINE DILATORS. 
For Rapid Dilatation of the Uterine Canal, 
"There are two methods of dilating 
the uterine canal without knife or scis- 
sors, and they differ simply in the de- 
gree of rapidity with which the dilata- 
tion is accomplished. 
" Dilatation is effected by means 
of graduated sound-like instruments, 
which are forced through the uterine 
canal one after the other; or by steel 
two- or three - branched instruments, 
which are introduced closed, and then 
expanded by an external mechanism; 
or by tubes or bags of rubber which 
are inserted in a collapsed 
condition, and are then in- 
flated with air or water ; or 
by the finger. 
"Graduated Sounds.- 
The dilators of Simpson 
(Fig. 3568) are twelve in a 
set. They were designed to be left in 
situ for an hour or more, and the 
handle is therefore provided with a 
slide by which the dilator can be de- 
tached when it has been introduced. 
A tampon keeps it in place, and it is 
withdrawn by the string attached to it. 
" In 1870 the late Dr. E. R. Peaslee 
devised a series of graduated metal 
sounds, which are arranged to screw 
into one handle (Fig. 3569). There 
are either three or five in a set. Later 
these are also made of hard rubber. 
" Dr. Horace T. Hanks placed two 
dilators of different sizes on one han- 
dle, making eight sizes to constitute a 
set* (Fig. 3570.) 
"All these dilators are provided with a circular enlargement at a distance 
of about two inches from the point, to prevent their too deep insertion. 
" These sound dilators are introduced through the speculum, the cervix 
is seized with a stout tenaculum (best a double tenaculum), and the uterus is 
slightly drawn down and straightened. The direction of the uterine canal being ascertained by the sound or probe, 
the smallest sized dilator is inserted into the os and forced upward toward the internal os, the cervix being steadily 
held by the tenaculum. As soon as the whole dilator has been introduced, it is allowed to remain a few moments, 
then withdrawn and the next size forced in, and so on until the desired degree or the limit of dilatation has been 
reached. The last dilator may be allowed to remain in utero for fifteen minutes or longer, or, if only temporary di- 
latation is desired, maybe removed at once when the desired degree has been accomplished."-"Minor Surgical 
Gynaecology." Munde. 1885. 
" For the rapid dilatation of an already partly dilated cervical canal, as at the beginning of a miscarriage, or in 
rigidity of the external os during labor term, or for the removal of intra-uterine polypi and fibroids, Dr. Hanks has had 
constructed a series of much larger olive-shaped dilators of hard rubber (Fig. 3571). They are designed to take the 
place of elastic rubber obstetric dilators, which often burst and are liable to spoil. In using these dilators it is abso- 
lutely necessary to have a strong tenaculum-forceps in order to firmly fix the cervix." (See Fig. 3553.) 
Fig. 3568.-Simpson's Uterine Dilators. 
Fig. 3569.-Peaslee's Uterine Dilators. 
Fig. 3570.-Hank's Uterine Dilator. 
Fig. 3571.-Hank's Rapid Uterine Dilators, set of ten. 
* The set may increase in number ad libitum.-G. T. & Co. 500 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
6YN/EC0L0GICAL. 
UTERINE DILATORS. 
Specula for Rapid Dilatation and Ocular Examination. 
Fig. 3572.-Tiemann & Co.'s Intra-Uterine Speculum. 
Fig- 3573--Elliott's Intra-Uterine Speculum. 
Forcible and Rapid Dilatation of the Cervix Uteri; for the Relief of Stricture, Conical Os, 
Flexions, Sterility, &c. 
" Dr. Ball's description of the operation is as follows: First, introduce a metal bougie as large as the canal will 
admit, followed in rapid succession by others of larger size, until a No. 7 is reached, which is the size of Ball's dilator ; 
then introduce the dilator and stretch the cervix in every direction until it is sufficiently enlarged to admit a No. 20 
bougie, or more if necessary ; then introduce a gum elastic uterine pessary of about that size and retain it in position 
by a stem secured outside of the vulva for about eight days, during which time it has done its work and is ready for 
removal. During this time keep the patient perfectly quiet upon her back. 
" By this operation all adhesions are broken and a radical change in the nutrition of the whole organ takes place, 
all abnormal sensibility and pain passing away."-H. H. Tinker, M. D., in New York Medical Times, April, 1882. 
Fig. 3574.-Ball's Original Dilator. 
Fig. 3575.-Ball's Modified Uterine Dilator. 
Fig. 3577.-Ball's Stem Pessary. 
Fig. 3576.-Ball's Stem Pessary. 
See "Ball's Speculum," 
Fig. 3185. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
501 
@YN/ECObO@ICAL>. 
UTERINE DILATORS. 
For Rapid Dilatation of the Uterine Canal. 
Fig. 3578.-Ady's Uterine Dilator. 
Fig. 3579.-Simpson's Uterine Dilator. 
Fig. 3582.-Hunter's Uterine Dilator. 
Fig. 3580.-Thomas' Uterine Dilator. 
Fig. 3581.-Nott's Uterine Dilator. 
Fig. 3583.-Wessinger's Uterine Dilator. 
Fig. 3586.-Atlee's Uterine Dilator. 
Fig. 3584.-White's Uterine Dilator. 
Fig. 3585.-Tiemann & Co.'s Intra-Uterine Speculum, 502 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
UTERINE DILATORS. 
For Rapid Dilatation of the Uterine Canal. 
Fig. 3587.-Sims' Uterine Dilator. 
Fig. 3588.-Long's Uterine Dilator and Injector. 
Fig. 3589.-Etlinger's Uterine Dilator. 
Fig. 3590.-Miller's Uterine Dilator. 
Fig. 3591.-Nelson's Uterine Dilator. 
Fig. 3592.-Howard's Uterine Dilator. 
Fig. 3593.-Vanderveer's Uterine Dilator. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
503 
@YN/ECOLOGieAL. 
UTERINE DILATORS. 
For Rapid Dilatation of the Uterine Canal. 
Fig. 3594.-Palmer's Uterine Dilator. 
Fig. 3597.-McLean's Dilator and Introducer. 
Fig. 3598.-Palmer's Uterine Dilator (latest). 
Fig. 3595.-Ellinger's Uterine Dilator. 
Fig. 3596.-Goodell's Uterine Dilator. 
Dr. Goodell recommends two dilators of different sizes with parallel action of their blades. The smaller of these 
has slender blades, and it pilots the way for the other, which is more powerful. He had the beaks of these dilators 
changed from an obtuse angle to a slight curve, so that it can be reversed within the womb. The light instrument 
needs only a ratchet in the handles, but the stronger one should have a screw with which to bring the handles together. 
Lest the beak should hit the fundus uteri, and seriously injure it when the instrument is opened, the blades are made 
no longer than two inches, and are armed with a shoulder which prevents further penetration. 
Fig. 3599.-Wylie's Uterine Dilator. 504 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
(SYN/ECOLOGISAL. 
UTERINE DILATORS. 
For Rapid Dilatation of the Uterine Canal. 
Fig. 3601.-Climax Uterine Dilator. 
Fig. 3600.-Emmet's Sponge Dilator. 
Fig. 3602.-Ohr's Dilator and Corrector. 
Fig. 3603.-Emmett's Water Dilator. 
Fig. 3604. 
Sponge Tents. 
Fig. 3605.-Barnes' Dilators. 
Fig. 3607.-Cowan's Uterine Dilator. 
r ig. 3000 consists in a duph 
cation of the bag and tube so tha 
one side may be distended inde 
pendently of the other, and re 
quires but one insertion ; the bag 
has no extra pocket on the out- 
side. There need be 
only two sizes used 
and Dr. McLean al- 
ways uses carbol izec 
hot water for filling 
them. The bag is in- 
troduced by doubling 
it upon itself, seizing 
it with the curved 
jaws of a forceps (Fig. 
3597)- 
Fig. 3606.-McLean's Modification of Barnes' Dilator. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
505 
@YN/EC0b0GI6Ab. 
UTERINE, STENOSIS, HYSTEROTOMY, TRACHELOTOMY. 
Hysterotomes, Metrotomes, Uterotomes, Scissors, for Incising the Cervical CanaL 
Fig. 3609.-Simpson's Hysterotome or Metrotome. 
Fig. 3612.-Stohlmann's Hysterotome. 
Fig. 3608.-White's Hysterotome. 
Fig. 3610.-Thomas' Uterine Double Scissors. 
Fig. 3611.-Bozeman's Angular Scissors. 
" The hysterotome is an instrument for incising the interior of the cervical canal. It is occasionally needed in 
stenosis of the cervix ; its use must, in these cases, be followed by the daily introduction of the bougie smeared with 
vasiline, to prevent the adhesion of the cut surfaces and the consequent diminution of the size of the cervical canal."- 
" Diseases of Woman." Eaton. 1880. 
" In 1843 Professor Simpson, of Edinburgh, advocated and practiced cutting through the walls of the cervix and 
thus gaining space without dilatation. He employed a single-bladed hysterotome, represented in Fig. 360g. 
" This instrument is introduced without a speculum, the patient lying on her left side. The hysterotome, with 
its blade concealed, is guided by the index finger up to, and, if necessary, as is very rarely the case, through the 
os internum. If the cervical canal be too small to admit it, previous dilatation should be practiced by tents. Being 
placed in position the blade is thrown out, the force being increased as it is withdrawn to the os externum. By thus 
increasing the pressure upon the handle of the blade, the incision is made wider at the lower than at the upper part of 
the canal. The instrument is then reintroduced and the other side incised in a similar manner, and the surface is 
brushed over with the solution of persulphate of iron. To accomplish the incision of both sides simultaneously, a 
number of double hysterotomes have been devised with two blades instead of one. A very simple one, devised by 
Mr. Stohlmann of this city, is represented by Fig. 3612."-"Diseases of Women." Thomas. 
" Sims' method consists of the following steps : 1st. The patient is placed on the left side and the speculum intro- 
duced ; 2d. The uterus being fixed by a tenaculum, one wall of the cervix is cut with a pair of long scissors, one 
blade of which is passed into the cervical canal until the other reaches nearly to the vaginal junction. In like manner 
the other wall is incised. 
" I have so often found the slit in the posterior wall heal up for a great part of its extent some months after the 
patient has passed out of observation, that I now resort to a different procedure. By means of the double scissors 
(Fig. 3610) I cut by one stroke a strip of tissue one-quarter of an inch wide, and extending from the os externum to 
the vaginal junction. Having removed this I then cut, by the same instrument, a small piece out of the upper ex- 
tremity of the incision. Then a knife should be slid up, so as to make a straight and unobstructed canal."-Thomas, 
Fig. 3613.-Peaslee's Uterotome. 
" Superficial Trachelotomy. (Peaslee's Operation.)-For relieving sterility, Dr. Peaslee devised and practiced an 
operation, which consist in merely cutting through the external or internal os, or both, if constricted, to a depth 
sufficient to make the canal of the average width of a parous woman. According to Peaslee, if the external os does 
not easily admit a sound one-sixth of an inch in diameter, there is stenosis as to conception. 506 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
UTERINE PLETHORA. 
Scarifying, Cupping and Leeching. 
Fig. 3614.-Buttles' Scarifyer and Tenaculum. 
Fig. 3621.-Chapman's Uterine Scarificator. 
Fig. 3615.-Chapman's Uterine Scarificator. 
Fig. 3616.-Probe Pointed Uterine Knife. 
Fig. 3624.-Uterine Knife. 
Fig. 3617.-Lenneker's Uterine Knives. 
Fig. 3618.-Skene's Sound and Scarificator. 
Fig. 3622.-Storer's Uterine Scarificator. 
Fig. 3623.-Buttles' Scarificator. 
Fig. 3619.-Thomas' Dry Cupper. 
Fig. 3620.-Reese's Uterine Leech and Aspirator. 
" Should scarification be employed, a very sharp and narrow bistoury or tenotomy knife may be introduced within 
the os and drawn outward towards the vaginal edges of the cervix, so as to sever all the superficial vessels over which 
it passes. I would recommend, in preference to this plan, the use of Dr. Buttles' spear-pointed scarificator; this, when 
plunged about one-sixteenth of an inch into the cervix and given a rapid half-turn before removal, causes a very free 
flow of blood should congestion exist. If a sufficient flow does not occur from three or four of its punctures, this 
can be caused by dry cupping the cervix by a very simple instrument, made of vulcanite, which is introduced 
through the speculum, the medium size of the cylindrical variety being large enough to admit it. Being passed up to 
the cervix, the piston is retracted, and, so perfect is the working of these instruments, when constructed of vulcanite, 
that a perfect vacuum is produced. By using this for a few minutes, and then puncturing with Buttles' spear, from 
two to four ounces of blood may readily be drawn. The exhauster should not be used after puncturing, but before. 
All that will be necessary afterwards will be to pass a moist sponge, attached to a sponge-holder, over the punctured 
surface, so as to prevent clotting in the mouths of the bleeding vessels."-" Diseases of Women." Thomas. 
See Artificial Leeches, page 116. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
507 
GYN/ECOIdOGICAId. 
UTERINE. TUMORS, POLYPI 
Galvanism. 
" By stimulating the trophic nerves to greater activity, the constant galvanic current has caused retrogressive 
changes in these tumors. I look upon this agent as one yet in its infancy, and as one from which much may in the 
future be expected in the treatment of fibroid tumors."-" Lessons in Gynaecology." Page 300. Goodell. 
The merits of this battery are constancy, durability, portability and general convenience. 
Constancy.-The strength of the current is ab- 
solutely constant. The battery is not weakened by 
work. The power to furnish the required quantity 
of electricity is stored up in the stable and insoluble 
compound, chloride of silver, and so long as the 
smallest portion of this remains upon the silver plate 
the chemical relations of the elements remain un- 
changed, and the electro-motive force of the battery 
is undiminished. 
The quantity and quality of the current which the 
battery will give after six months' or a year's service, 
in fact up to the time when the metallic elements are 
entirely reduced, are found to be the same as when 
the battery is first used. 
Durability.-It is found by actual experience 
that the battery will do all the work of an active 
practitioner, for at least two years, without requiring 
a renewal of the elements. The battery does not 
waste when not used, as the zinc and chloride of 
silver are insoluble in the fluid, and remain un- 
touched by it so long as the battery remains on open 
circuit. When the battery is put to work and a 
current of electricity is drawn from it, certain regular 
and well defined chemical changes take place which 
are in exact proportion to the work done. 
The connections of the battery are entirely free 
from corrosion. The silver wires which are at- 
tached directly to the zinc and silver plates in the 
cells are passed up through the caps and plate, and 
fastened down under nuts which screw upon the 
connecting studs. There are no connections under- 
neath the plates. The nuts and ends of the silver 
wires are on the top of the plate, easy of access, and 
entirely removed from moisture or the fluid of the 
cells. 
Portability.-The battery is the most portable in 
every respect-the lightest, the smallest, the neatest 
and most convenient known for medical purposes, 
or for any other purpose for which such a galvanic ap- 
paratus may be used. A fifty cell battery measures 
7 x 7 x 12^ inches, and weighs, with electrodes, 13 
pounds. The elements remain permanently in the 
fluid, which is non-corrosive, and the cells are her- 
metically sealed. The battery is shipped with per- 
fect safety by express, ready charged with the fluid. 
The battery can be packed in a trunk for traveling, 
or carried in any of the ordinary ways in which bag- 
gage is transported, without danger of spilling or 
damage. 
Convenience.-To use the battery it is necessary 
only to open the cover, connect the electrodes, and 
Fig. 3625.-Barrett's Chloride of Silver Battery. 508 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
QYN/ECOLdOGICAId. 
UTERINE. TUMORS, POLYPI. 
Galvanism. (Continued.) 
select the number of cells desired. A current re- 
versing switch is provided in the cover of the box. A 
handsome tray of electrodes is a part of each com- 
plete battery. The elements are permanently in the 
fluid, and do not require to be raised and lowered as 
in acid batteries. The fluid does not need to be 
changed during the life of the metallic elements, that 
is for two years or more of regular medical work. 
There is no gas or odor about the battery, either when 
in use or idle. The zincs do not require amalgama- 
tion. The parts and connections do not corrode, nor need repairs of any sort. In short, all the annoyances which are 
so familiar to the users of bichromate and acid batteries are entirely absent from this form of battery. 
We ship the battery, charged ready for immediate use, to any address. 
The Care and Use of the Battery.-In using the battery screw the electrodes to the handles, and attach the cords 
to the handles and the posts on the current reverser. The binding posts have no screws, but are in the form of split 
clips, into which the tips of the cords are pinched firmly, always securing good connections. Select the desired 
number of cells by means of the hollow plugs at the ends of the short cords and the numbered connecting studs. It 
is recommended to use the cells as uniformly as is convenient, that is, to count backward from the upper end of the 
battery a part of the time, instead of always using the cells at the lower end. 
The only precaution to be observed is not to put the battery to extra and accidental work, by which the material 
is wasted without doing its regular work. Any moist or metallic article laid upon the connecting studs provides a path 
for the escape of the electricity between all the cells which are thus connected. Also, when the conducting cords are 
connected to the battery, care should be taken not to lay them together so that the current can pass directly through 
them, for a direct contact or, as it is called, a short circuit, of this sort gives the entire battery a large amount of 
wasteful and unprofitable work to do. By observing a little care in these respects, entire satisfaction with the battery 
is guaranteed. 
Renewal of Battery.-After the elements have furnished the full amount of the electricity stored up in them, the 
original composition of silver is reduced to a solid plate of pure metallic silver. This applies towards the cost of new 
plates. The reduced plates may be readily removed and new plates substituted. The cost of a new silver plate is 
thirty-two cents; the value of the worn-out silver plate is twelve cents; the cost of a new zinc is two cents ; the 
actual cost of a pair of new plates is thus twenty-two cents. These plates will be supplied in sets by us on these 
terms. If the batteries are sent to us we will make no charge for the labor of renewing. 
On these terms this battery is very economical, our experience with it enables us to assure satisfaction to every purchaser. 
This instrument is designed to fill a want amongst the medical profession, which 
a closer and more scientific study of the uses of galvanic electricity has made ap- 
parent. The prevalent method of measuring and designating the current applied to 
the body has been by the number of cells of battery employed. This is altogether 
a simple and convenient way, but its uncertainty and indefiniteness render it not 
only misleading to the practitioner, but have obstructed the progressive study of the 
subject, and have kept this department of medicine below the level of accuracy and 
general usefulness to which it is capable of rising. The meter eliminates these ele- 
ments of uncertainty, and puts the application of galvanism upon a basis of exact 
measurement. 
The instrument is of the class of absolute galvanometers, and has its scale 
graduated in units of current strength, so that the movements of the index show in 
these units the absolute strength of current passing through the meter. 
For use in measuring the electricity in medical application, the meter is to be so 
connected in the circuit that all the current which passes through the body of the 
patient goes also through the meter. In this situation the deflection of the index gives 
figures, which are the measure of the current strength which flows freely through 
the body, after having overcome the obstacles to its passage. 
With the use of this meter, then, it being desired to produce a given effect upon a nerve or muscle, the number of 
cells of battery and the sensations of the patient would not be so much consulted, but the required number of units 
of current strength, or milliamperes, would be employed. The milliampere is the fractional unit of current strength 
Fig. 3627.-Electrodes. 
Fig. 3628. 
Absolute-Current Meter. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
509 
QYN/ECOLOQICAL. 
UTERINE. TUMORS, POFYPI. 
Galvanism. (Continued.) 
derived from the primary unit, the ampere. The milliampere is one-thousandth of an ampere. The unit by which the 
meter is graduated is thus a common and universal standard, and is neither arbitrary nor peculiar to the instrument 
itself. The number of milliamperes employed in most cases are from one to twenty, while, by the use of very large 
electrodes, thirty or forty milliamperes may be applied to some parts of the body. 
The instrument is constructed upon established scientific principles, with several devices for increasing its con- 
venience and serviceability. The movable magnet rests upon frictionless, knife-edge bearings, and is provided with 
a vane or wing of mica which checks the otherwise 
oscillations of the needle. The screw on the right hand 
is for fixing the needle when the instrument is not in 
use. To set the needle free give the screw half a turn 
to the left, and push it down to the bottom of the slot 
in which it slides. To fix the needle, raise the screw 
upward as far as it will go, and turn it to the right. 
The needle should always be fixed when not in use, 
to prevent wearing and damage to the knife-edges. 
The screw near the bottom on the left is for levelling 
the instrument. 
The diagram shows the connections for using the 
battery and meter. 
" Galvanization is chiefly applicable to the discussion and removal of certain tumors, diseases of the bloodvessels, 
chronic glandular swellings, from inflammatory exudations in and around joints, serous effusions, the formation of issues, 
and the treatment of rebellious sinuses, fistules and ulcers." 
Electrolysis. 
" The electrolytic treatment of tumors is more universally applicable, although it is far more tedious than other 
methods. The only instruments necessary are fine gold, or gilt steel, or other electrolysis needles and a sponge elec- 
trode. In performing the operation, the needle is passed into the interior of the growth, and attached to the negative 
pole of the battery, while the sponge electrode, previously wet with salt water, is connected with the positive pole and 
placed outside on the skin. When the tumor is small, one needle will suffice ; but when it has acquired considerable 
volume, the serre-fines conductors of Dr. Althaus will prove serviceable, as it permits the introduction of several 
needles in any direction that may appear suitable. They should be insulated to within a short distance of their points 
with vulcanite, so that they may not affect the skin. Although the transmission of the current is not painful, yet, to 
prevent any unpleasant shock, the precaution should be taken of commencing with low power, and gradually increas- 
ing it to the full quantity that it is designed to employ. The duration of the application will vary according to the na- 
ture of the case, two or three minutes being sufficient for small tumors, while larger growths require from fifteen 
minutes to half an hour. The sittings may be repeated every second or third day. The number of cells, or the quan- 
tity of electricity employed, must be proportionate to the consistence of the tumor ; solid goitres and scirrhus, for ex- 
ample, demanding from thirty to forty cells, while other growths will yield to a battery of fifteen pairs of elements. 
"The best results from electrolysis have been obtained in vascular, sebaceous, and goitrous tumors, particularly 
the cystic variety ; in chronic glandular tumors; in hydatid tumors of the liver; in hydrocele, and in stricture of the 
urethra. In the treatment of aneurism it has almost been abandoned ; but it has proved successful in several cases of 
the cirsoid form of the disease that have been subjected to it. Nsevoid, venous, and small sebaceous tumors rarely 
resist the influence of the galvanic current, while the testimony of Dr. Althaus and Dr. Mackenzie is strongly in favor 
of it in the management of goitre, the former observer believing ' that all cases of bronchocele, however large, may be 
cured by electrolysis, if the treatment be persevered in for a sufficient time.' Dr. Fagge and Dr. Durham, some years 
ago, recorded eight cases of hydatid tumors of the liver, in seven of which, one remaining doubtful, a cure was promptly 
effected. Dr. Ruschenberger, of our navy, Scoutetten, and Petrequin have cured obstinate hydroceles by introducing 
both electrodes into the sac ; while other surgeons have successfully employed electrolysis, in similar instances, with 
the cathode only in the sac. The observations of Mallez and Tripier, Brenner, and others, demonstrate that good 
results may occasionally be anticipated from it in the treatment of stricture of the urethra."-" System of Surgery." 
Gross. Vol. I. 1882. 
See page 36, Electrolysis Needles, &c. 510 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
@Y^I/ECOL>O@ie/L. 
UTERINE TUMORS AND POLYPI. 
Curettes for Removing Intra-Uterine Vegetations. 
Vegetations of the En- 
dometrium. 
"The vascularity of the 
womb, its sexual and peri- 
odic congestions, the struc- 
tural energy with which it is 
endowed, and the lesions to 
which it is subjected, make 
it peculiarly liable to be 
invaded by benign and by 
malignant growths. The 
most common are those 
which develop in the endo- 
metrium in the shape of 
vegetations."-Goodell. 
" While some gynaecolo- 
gists treat vegetations of the 
endometrium by application 
of powerful caustics, chiefly 
fuming nitric acid, the ma- 
jority follow the lead of Sims 
and Thomas and remove the 
vegetationswith the curette." 
-MUNDE. 
Fibrous Growths of the 
Uterus. 
"A fibrous growth has its 
origin within the muscular 
tissue of the uterus, and is 
generally of a dense struc- 
ture, but not always, and it 
may or may not undergo cys- 
tic degeneration. Such a tumor may remain as an isolated mass within the uterine tissue, being limited in growth, or 
it may gradually involve the greater portion of the organ, attaining an almost unlimited increase in bulk. A fibrous 
tumor of the uterus has been termed a ' fibro-myoma' by Virchow, a 'fibroid' by Rockitansky, and a 'partial hyper- 
plasia of the uterine parenchyma' by Klebs. While small, such a growth may be designated a fibroid ; when larger, 
and out of the pelvis, it may be called a fibrous tumor, or a fibrous growth of the uterus, without reference to the 
degree of development. As an exceptional circumstance, an accumulation of fluid sometimes occurs within certain 
portions of these growths, and then they are said to have undergone cystic degeneration. But should this process be- 
come so extensive as to involve the whole mass, leaving but little of the fibrous element, it is then termed a fibro- 
cystic tumor."-Emmet. 
" Fibrous Polypi.-Nature often attempts to effect a radical cure of fibrous growths by giving them a polypoid 
shape, and experience has demonstrated that art can supply no safer or more effective method than that suggested by 
nature. The pedicle, or stalk, connecting the tumor to the uterus contains little else than small bloodvessels, a little 
connective tissue, and the lining membrane of the canal which the tumor carried before it. Owing to peculiarity of 
structure a polypus may have so short a pedicle as to remain in close contact with the surface from which it has been 
expelled. Under other circumstances the pedicle will be drawn out to a great length, so that the polyp may remain 
within the uterine canal, or be expelled by the uterus into the vagina without breaking its connection. I have seen 
an instance of a fibrous polypus, as large as a walnut, hanging out of the labia, and connected with the uterine wall by 
an attenuated pedicle. But, as a rule, the little artery by which it is nourished becomes at length so stretched that 
the supply of blood ceases, and the tumor then begins to slough in the vagina. This is a very frequent course of the 
efforts at a spontaneous cure, and the mass may come away as a whole or gradually disintegrate. * * * "-Emmet. 
Fig. 3629.-Thomas' Curettes, three in one handle. 
Fig. 3630.-Thomas' Curette. 
Fig. 3631.-Sims' Curette. 
Fig. 3632.-Sims' Curette. 
Fig. 3633.-Hanks' Curette 
See page 514, Ecraseur. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
511 
/ECO LOGICAL. 
UTERINE. TUMORS AND POLYPI. 
Curettes for Removing Intra-Uterine Vegetations and Fibrous Growths of the Uterus. 
Fig. 3634.-Emmet's Enucleator. 
Fig. 3635.-Emmet's Curette Forceps. 
Fig. 3636.-Thomas' Curette. 
Fig. 3637.-Skene's Curette. 
Fig. 3640.-Siemon's Curette. 
Fig. 3638.-Yarrow's Enucleator. 
Fig. 3642.-Three Curettes. 
Fig. 3641.-Siemon's Curette. 
Fig. 3639.-Richardson's Finger Elongator. 
Fig. 3643.-Thomas' Serrated Scoop, 
for the Detachment of Sessile Uterine Fibroids. 
Fig. 3644.-Bozeman's Curette. 
Fig. 3645.-Reinstetter's Rinse-Curette, for Scraping and Washing the Uterus. 512 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
(aYN/EeOLDOGieAh. 
UTERINE. TUMORS AND POLYPI. 
Forceps, Ligators, Ecraseurs, Enucleators, for Removing Intra-Uterine Vegetations. 
Fig. 3646.-Sims' Vulsellum Hook. 
Fig. 3647.-Nelaton's Pedicle Forceps 
Fig. 3653.-Sims' Enucleator Blunt Hook. 
Fig. 3652.-Sims' Enucleator. 
Fig. 3648.-Up de Graff's Tumor Forcens. 
Fig. 3649.-Van Buren's Ligator. 
Fig. 3654.-Nelaton's Tumor Forceps. 
Fig. 3650.-Aveling's Polyptome. 
Fig. -Penn's Catgut Ecraseur. 
For removing small tumors from the nose, fauces, rectum and 
uterus. Two very small holes through the pin receive the ends of an 
E violin string, which is doubled and passed through from the opposite 
end of the tube. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
513 
@YN/ECOLOGICAL. 
UTERINE. TUMORS AND POLYPI. 
Forceps, Ligators, Ecraseurs for Removing Intra-Uterine Vegetations., 
Fig. 3655.-Byrne's Vulsellum Forceps 
Fig. 3662.-Cushing's Vulsellum Forceps. 
Fig. 3656.-Byrne's Vulsellum Forceps. 
Fig. 3657.-Luer's Polypus Forceps. 
Fig. 3661.-Campbell's Tumor Forceps. 
Fig. 3658.-Wales' Polypus Forceps. 
Fig. 3659.-Greenhalgh's Tumor Forceps. 
Fig. 3660.-McClintock's Polypus Forceps. 514 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
@YN>EC01d0GICAId. 
UTERINE. TUMORS AND POLYPI. 
Fig. 3663.-Chassaignac's Ecraseur. 
Ligators and Ecraseurs. 
"Removing Fibrous Growths of the Uterus.-Formerly the general prac- 
tice was to pass a ligature around the base of a polypus, and day after day 
is was tightened, generally by twisting, until, at length, the cord would cut 
through the mass as it sloughed. Depuytren was the first to remove uterine 
growths by dividing the pedicle with scissors ; but, through fear of haemor- 
rhage, this method has never become general. 
Fig. 3664.-Levret's Double Canula. 
" The removal by ligature or torsion continued to be the practice until 
Chassaignac devised the ecraseur for the removal of haemorrhoids, when this 
instrument was adopted into this branch of surgery. It encircles the mass 
by a chain loop which crushes its way through as it is reduced in size, and 
by lacerating instead of cutting the tissues lessens the liability to haemorrhage. 
Afterwards other instruments were constructed on the same general prin- 
ciple, with a wire substituted for the chain, on account of the difficulty of 
applying the chain, and the greater ease with which a loop of wire can be 
applied around the tumor within the uterus. Sometimes, it is true, the wire 
loop can be managed with more facility, but altogether it possesses no ad- 
vantage over a well-made chain ; and I have found that it is more liable to 
break when subjected to the same degree of strain. 
" To better adapt the ecraseur to this branch of surgery it is sometimes 
given a curve to conform somewhat to the relation of the uterus with the 
vaginal axis. But frequently the tumor within the uterus is so situated that, 
when the chain is tightened, it acts almost at a right angle to the instrument, 
with the effect of rendering the strain greater as the loop is shortened, and the 
instrument has thus often been broken. To obviate this and other difficulties, 
I had an instrument constructed, in 1866, on a plan of my own (see Fig. 3665), 
Fig. 3665.-Emmet's Ecraseur. 
of which an important feature was the placing of two or three joints at the 
end of the instrument, so that it might remain straight or bend upon itself 
at a sharp angle. The instrument in general use, under some circumstances, 
where it cannot adjust itself, cuts off a mass obliquely, which can never hap- 
pen on using one with these joints. Instead of the chain being joined to the 
ratchet portion, as in the original instrument, this is separated into two parts, and between them two flat rods, to which 
the ends of the chain are attached, slide through the handle, where they are secured by a spring catch. The object in 
having the ends of the chain attached to rods which can be separated is to facilitate the passage of the chain around a 
tumor when the latter is beyond the reach of the finger." (For further particulars see Emmet's "Principles and 
Practice of Gynaecology." 1884.) GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
515 
(aYN/EOOLOGieAk 
UTERINE. TUMORS AND POLYPI. 
Ligators and Ecraseurs. 
Fig. 3666.-Cintrat's Ligator. 
Fig. 3673.-Edward's Ecraseur. 
Fig. 3667.-Barnes' Wire Ecraseur. 
Fig. 3668.-Smith's Wire Ecraseur (straight). 
Fig. 3669.-Smith's Wire Ecraseur (curved). 
Fig. 3670.-Braxton Hick's Wire Ecraseur. 
Fig. 3674.-Tiemann's Long Chain Ecraseur. 
Fig. 3671.-Braxton Hick's Ecraseur (modified). 
Fig. 3672.-Thompson's Ecraseur. 516 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYN/ECOGOGIGAL. 
UTERINE. TUMORS AND POLYPI. 
Ligators and Ecraseurs. 
Fig. 3675.-Sajou's Wire Ecraseur. 
Fig. 3676.-Emmet's Uterine Tourniquet. 
Fig. 3677.-Sims' Porte Chain Ecraseur. 
MALIGNANT DISEASE. HYSTERECTOMY. 
Partial or Complete Removal of the Uterus per Vaginam. 
Whenever the cervix becomes the seat of a malignant growth, the common sense indications are, either to 
eradicate the disease, or to check the excessive serous and bloody discharges, to correct the fetor, to allay the pain, and 
to prolong life. Now, the crumbling vegetations and the surface growths cause these serous, bloody and fetid dis- 
charges. The pain comes from progressive infiltration. It stands, then, to reason that whatever restrains these must 
prolong life ; and, of course, if the disease can be eradicated, life may be saved for good. Hence the plan which 
meet these indications is assuredly to take away the whole, or as much as possible, of the diseased structures."- 
" Lessons in Gynaecology." Goodell. 
Fig. 3680. 
Scissors for the Amputation of the Cervix. 
Fig. 3678.-Kuchenmeister's Scissors 
One blade of Kuchenmeister's metrotome scissors is pro- 
vided with a small recurved hook. This buries itself in the 
tissue as soon as the part is seized, and holds it secure whilst 
it is being cut through. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
517 
(SYN/EeOLOGieAL. 
UTERINE. MALIGNANT DISEASE, HYSTERECTOMY. 
Partial or Complete Removal of the Uterus per Vaginam. (Continued.) 
" Varieties of the Operation.-In some cases, as in cancer, for example, it is necessary to remove the entire cervix 
and even as much tissue as possible from that portion of the organ above the vaginal attachment. In others, only 
half of the vaginal portion requires ablation, while, in still another set of cases, only the removal of a thin section of 
the hypertrophied lips is called for. 
" Methods of Performance.-The operation maybe performed by the following methods: I. By the bistoury or 
scissors ; 2. By the ecraseur ; 3. By the galvano-caustic battery. 
''Operation by Bistoury or Scissors.-When performed by the first method, the patient should be placed upon the 
left side and Sims' speculum employed. The cervix being slit bilaterally, one lip is seized and cut off as near the 
vaginal junction as is deemed advisable, and then the other is removed in a similar manner. Formerly the operation 
was completed at this point, but Dr. Sims has introduced the practice of drawing down the mucous membrane and 
stitching it, with silver sutures, so as to cover the stump, as that of the arm or thigh is covered by skin after amputa- 
tion of those parts. When the stump is covered by mucous membrane, after this plan, recovery is much more rapid 
than when granulation is allowed to accomplish the cure. This operation is often a bloody one. 
" Operation by the Ecraseur.-In operating by this method, if the uterus be prolapsed, if the degree of longitudinal 
hypertrophy be so excessive as to cause full protrusion of the cervix, or if such protrusion be attainable by moderate 
traction, the patient may be placed on the back. If the uterus be high up in the pelvis and strong traction be neces- 
sary to depress it, the best position will be found to be that advised when scissors or the bistoury are employed, the 
speculum being used. The passage of the chain will be found to be very simple, and the part should be slowly cut 
through. In using the ecraseur for this purpose, great care should be. observed not to allow too great dragging of the 
chain upon the neck without cutting. If attention be not given to this point, the peritoneum may be opened or the 
bladder involved. I describe the operation by the ecraseur, although I regard it inferior in merit to both the other 
methods. I do this because the operation is often called for far from surgical centres, where it is very difficult to pro- 
cure a battery, and where no operator of sufficient skill can be found to perform the amputation by cutting instruments. 
" Operation by Galvano-Cautery.-The galvano-caustic apparatus consists simply of an instrument which enables 
the operator to engage any part in a loop of wire which, being connected with a powerful galvanic battery, becomes 
red hot and cuts its way through.* In amputating the neck in this way, the patient may be placed upon the back 
and the uterus drawn down between the labia; or, if this depression of it be difficult, she may be placed upon the 
side and Sims' speculum employed. By one of these procedures the part to be amputated is fairly exposed to view 
and manipulation. The wire loop of the galvano-cautery is passed around the neck as high up as is deemed safe, 
and tightened until it is fixed in the tissues so as not to slip. Then the current of electricity is made to pass through 
it, and the loop being slowly tightened, by the turning of the screw by the operator, the cervix is amputated. To 
accomplished the operation completely, I have devised the forceps shown in Fig. 3681. By the long sliding screw 
Fig. 3681.-Thomas' Forceps for Amputating the Cervix. 
between the blades, the cervix is drawn into their grasp and fixed by closing them. Then the screw is withdrawn 
and the cold wire slid over the projecting portions and tightened, and, the electric current passing, a red, and not a 
white, heat being established, the cervix is completely removed. By this method immediate haemorrhage is usually 
controlled, but not so remote haemorrhage. Sometimes on the fifth, sixth, or even the tenth day, a most active flow 
takes place in spite of every precaution. For this reason the tamponf should be used after such an amputation, and the 
patient's convalescence be carefully watched."-"Practical Treatise on the Diseases of Women." T. Gaillard 
Thomas, M. D. 1880. 
* See " Dawson's Galvano-Cautery Battery," page 37. 
+ See page 478. 518 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
UTERINE. MALIGNANT DISEASE, HYSTERECTOMY. 
Partial or Complete Removal of the Uterus per Vaginam. (Continued.) 
" Schroeder's Method of Supra-Vaginal Excision of the Cervix.-Having passed stout ligatures laterally through 
the parametria, the uterus is drawn down, if practicable, so that the os externum presents at the vulva. An incision 
extending into the connective tissue is now made in front of the whole width of the anterior lip, about two centimetres 
distant from the diseased tissue. It is then easy to separate the bladder from the cervix without endangering the ureters, 
provided firm traction on the cervix is kept up. It is quite exceptional to find the tissue so firm as to require the use 
of the scissors. Having freed the cervix in front, he drags the posterior lip forward, so as to bring the posterior 
vaginal vault within reach, and cuts through it in the same way, the two incisions meeting laterally. It does no 
harm to cut into Douglas' pouch, and, when amputation is done very high, it is better to cut into it purposely and 
remove that part of the serous membrane that belongs to the piece of cervix removed. The liberation of the cervix is 
most difficult at the sides, for there the cellular tissue is firmer and larger branches of the uterine artery enter- the 
cervix. Here, therefore, the scissors must often be called into play, and spurting arteries be controlled with forceps 
and tied ; but, as a rule, the bleeding is moderate. When the cervix has been liberated all around, it is cut through at 
the desired point, from before backward, until the canal is opened. Then, before the section is completed, the 
anterior wall of the vagina is united to the anterior part of the stump of the cervix with deep sutures. Traction on 
these sutures gives us command of the stump, even after the posterior wall of the cervix has been divided. The 
posterior cut surface of the uterine wall is then readily stitched to the posterior wall of the vagina. One, if practicable 
two, of the lateral sutures should be passed deep into the uterine tissue, to control haemorrhage ; there is no danger of 
including the ureters so long as the traction on the uterus is kept up. At the extreme sides, the cut edges of the 
vaginal wall are to be stitched to each other and held fast against the sides of the uterus with deep sutures." 
" Dr. W. H. Baker, of Boston, reports the result of his practice by even a more extensive incision.* His mode of 
procedure is essentially Schroeder's method, with the exception that he avoids opening the peritoneal cavity behind, 
when it can be avoided. The chief difference between the two procedures is that Schroeder cuts the cervix square off 
at the line of excision, while Baker begins on a line with the internal os and removes a cone-shaped section with the 
apex extending up the canal as near the fundus as possible. 
" Schroeder's Method of Vaginal Excision of the Entire Uterus.-Having dragged the organ forcibly downward 
with two pairs of Museux's forceps, one grasping each lip, he incises the anterior wall of the vagina, by the method 
already given, and separates the bladder from the cervix thoroughly. This done, the posterior vaginal vault is cut 
through, so that the cervix is freed on all sides, and then Douglas' space is opened. Cutting with scissors, he extends 
the opening to the utero-rectal ligaments and introduces two fingers of the left hand into the abdominal cavity, over 
the uterus and into the utero-vesical pouch. Cutting on these two fingers, he divides the peritonaeum. By combined 
manipulation the uterus is now retroverted, and the attempt is made to bring the fundus through the wound in the 
posterior vaginal vault. This is not a very easy matter, and the difficulty increases with the size of the uterus. It is 
best accomplished by traction with the forceps made to grasp the organ as near as possible to the fundus. When the 
body of the uterus, covered with peritonaeum, has been brought out at the vulva, the ligation of the broad ligament 
must be so managed as to allow of the uterus being cut away without the ligatures slipping. This is quite difficult 
when we undertake the entire removal of the tubes and the ovaries, for then the ligatures have to be applied to the 
tense infundibulo-pelvic ligament, from which they are apt to slip when the ligament retracts after the section is made- 
giving rise to abundant hasmorrhage that is hard to control, on account of the locality. It is much easier w'hen the 
uterus alone is to be removed. He usually ties en masse on each side, and then applies two additional ligatures close 
to the first one, one for the upper and one for the lower part of the broad ligament. * * * A drainage tube is 
placed in the centre of the wound and the lateral portions are brought together without making any attempt to secure 
nice coaptation of the peritonaeum. The vagina is then packed lightly with salicylized wadding, and the free end of 
the drainage tube is filled with the same material. Injections are to be made through this tube if there should be a 
rise of temperature or an offensive discharge escaping. The tube and sutures are left in place for two or three 
weeks."-" Principles and Practice of Gynaecology." Emmet. 1884. 
"No department of surgery has made the same advances within the last thirty years as that of pelvic surgery by 
abdominal section. Ovariotomy, oophorectomy or Battey's operation, the removal of the uterine appendages or Tait's 
operation, obpho-hysterectomy or Porro's operation, gastro-elytrotomy or Thomas' operation, extirpation of the uterus 
or Freund's operation, and hysterectomy or Kimball's operation, by which is meant the removal of the whole body or 
any section of the uterus, with tumors inseparable therefrom. These form a list of surgical achievements, within a 
short period, which every gynecologist is proud to look at to-day."-H. P. C. Wilson, M. D. 1883. 
Abdominal Section. 
* " The Treatment of Cancer of the Uterus." American Journal of Obstetrics^ April, 1882. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
519 
@YN/ECOLOGieAL. 
HYSTERECTOMY. 
Per Abdominal Section. 
"Removal of the whole body, or any section of the uterus, with tumors inseparable therefrom."-Kimball, 
" The extra peritoneal method has met with great success in the hands of Pean, of 
Paris, who has the merit of having elaborated it as a distinct method. He operates as 
follows: The tumor having, if necessary, been reduced by ' morcellement' it is drawn 
out of the abdomen and held perpendicularly by an assistant. The operator, having 
ascertained with a sound the relations of the bladder (which only in rare cases requires 
to be dissected off), transfixes the cervix with two strong wires at right angles to each 
other. Below these wires the curved needle (represented at Fig. 3682) is carried through 
the cervix and drags back a double wire. This wire is divided, and each half is fitted 
into a serre-noeud of Cintrat (Fig. 3683), by means of which it is both tightened and twisted. 
The tumor and uterus are amputated above the wires. The pedicle is placed in the abdominal 
wound, and is kept from retracting into the abdomen by means of the wires and serre-noeuds; 
these are left in position so that they may be tightened in case of haemorrhage." 
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Fig. 3683.-Cintrat's Serre-Noeud. 
" Cintrat's serre-naud (Plegar).-The wire, after having been placed around the neck 01 
the uterus or tumor, is fixed on the knob which travels on the thread of the screw. On turning 
the handle when the middle piece is held firm at the larger loops, we tighten the noose ; when the 
head piece is held at the smaller loops, we twist the wire."-Leblond, " Manual of Gynaeco- 
logy," Vol. II. Hart and Barbour. 
Fig. 3684. 
Kceberle's Serre Nceud, Forceps and Skewer, with Cap. 
Fig. 3685. 
H. Marion Sims' Abdominal Protectors. 
* ' The two rubber plates shown in the cut are for use in the operation of Hysterectomy, where the stump of the 
uterus is drawn outside of the abdominal incision and transfixed by ' skewers.' The tension is sometimes so great, 
especially in stout persons, that the skewers will cut into the flesh and cause deep furrows, which are extremely pain- 
ful to the patient. To obviate this result the ' protectors ' were devised by Dr. H. Marion Sims. The plates are made 
of one piece of hard rubber, are about five inches long, two and one-half wide and one-eighth inch thick. Running 
along the centre in a curved line are locks, for the purpose of firmly holding the four ends of the ' skewers.' These 
plates are an admirable protection to the abdominal walls, besides making the skewers hold the stump more firmly than 
they would do without their aid." 
Fig. 3686.-Wilcox's Hysterectomy Pin. 520 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
ABDOMINAL SECTION. 
Laparotomy. 
"Remarkable advances have lately been made in the surgery of the abdominal cavity. Early in the year Mr. 
Lawson Tait reported a series of a thousand cases in which the abdominal cavity had been opened for the relief of a 
variety of conditions, with a mortality of but 9.3 per cent. In connection with this branch of surgery, the diseases of 
the uterine appendages known as hydro-salpinx and pyo-salpinx (which are essentially an enlargement of the Fallopian 
tubes, the cavity containing fluid, and complicated in may cases with inflammation or its results in the neighboring 
organs) have attracted much notice. Mr. Tait was among the first to direct attention to the frequent existence of this 
condition and to the comparative safety of operations for the removal of diseased organs when performed with proper 
precautions. The number of such cases operated on by Mr. Tait and many other surgeons has already become very 
considerable, and the relief that has been afforded to women whose lives had previously been rendered miserable is so 
great as to warrant the assertion that there has been hardly an operative procedure introduced for many years which 
produced such notable results. 
"Within the year several successful operations have been reported, in which the abdominal cavity has been opened, 
and wounds in the intestines have been closed-a class of cases that have heretofore been regarded as essentially fatal. 
The gall-bladder has been opened for the removal of gall stones, with successful results. Kidneys have been removed 
on account of disease. Cases of chronic and acute peritonitis have been treated by opening the abdomen to secure 
drainage and removal of the causes and products of the disease.''-"Appleton's Annual Cyclopaedia." 7885. 
Fig. 3687.-Thallon's Ether Inhaler. 
''To avoid the various dangers and complications, and to accomplish the even giving of ether, this apparatus was 
devised by Dr. Skene and myself. The apparatus consists essentially of a large tin receiver, a connecting tube fifty- 
three inches long, and a mouth-piece. The receiver is filled with alternate layers of loose sponges and wire gauze, 
thereby affording a large vaporizing surface for the ether. The ether is poured into a funnel-shaped opening in the 
top, and, to prevent any overflow of ether running out at the bottom, the tin flange to which the connecting tube is 
attached projects about three-quarters of an inch into the receiver. The tube is locked to this receiver by a bayonet 
catch. The connecting tube is flexible and precisely similar to those used by dentists in the administration of nitrous- 
oxide gas. At the mouth-piece end of the tube are the same two valves ; one allowing the inspiratory current to pass 
from receiver to mouth, but preventing the expiratory one passing back into the tube; the second allowing the ex- 
piratory current to pass into the surrounding air, but preventing an ingress of air through that opening. And, lastly, 
between these two valves is an opening, beneath which is a movable perforated diaphragm, by which any desired per- 
centage of fresh air can be added to the inspiratory current, so that you can pass from pure air through all inter- 
mediate gradations up to pure ether-vapor, while the rate of that flow can be hastened or retarded by raising or 
lowering the receiver. The mouth-piece is slightly modified from Clover's model; it is locked to the connecting tube 
by a bayonet catch."-Wm. M. Thallon, M. D. New York Medical Journal, January 2, 1886. 
Sec also, page 43. 
Fig. 3688.-Sims' Ovariotomy Director. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
521 
GYN/ECOLOGICAL. 
The Harvard Physicians' and Surgeons' Chair. 
The Harvard is capable of every position desirable in the practice of the surgeon, gynaecologist, the oculist or aurist. 
Fig. 3689. 
A. Normal adjustment. 
C. Full length reclining position. 
B. For operation upon the eye, 
ear or throat. 
G. For- elevating the hips. 
H. Three-quarter length reclining. 
For operations on hand or arm. 
F. Dorsal position. 
D. Reclining with head lowered. 
E. Sims position. 
It is the only surgical chair capable of being rotated. It is the only chair capable of the lateral motion, Sims posi- 
tion, as seen in Fig. E (in this the head may be lowered more than seen in the cut and the step dropped out of the 
way, as in figure H, if desired); the only one capable of the backward inclinations, Figs. B and £>, or of the hip 
elevation, Fig. G, or of the arm support, Fig. I, features recognized by the profession as most important. 
It perfectly balances with or without a patient upon it, and consequently all its various positions are quickly attained 
with ease to the patient and operator. The heaviest patient can be placed in any position with the slightest effort. 
Set upon a large steel screw, it may be raised or lowered or rotated, to get the direct light. When put in the lowest 
reclining position the chair forms an operating table 29^ inches high, and may be so adjusted by means of the screw 
that the elevation shall be anywhere from 29^ inches, the lowest, to 34^ inches, the highest. By means of a set screw 
it maybe rigidly bound to the base when desired, to prevent its turning. The head rest is universal in its movements ; 
may be raised, lowered, extended backwards or forwards, moved to right or left, and rigidly set to any position by 
means of a single set screw. The head rest folds up when thrown back, leaving no projecting iron to be in the way. The 
side arms drop down and back with the patient and form a support for his arms while reclining as well as while sitting. 
Either side arm may be turned out of the way in the use of the speculum. The step is at all times horizontal, and, 
with the rest of the chair, forms a level plain, presenting nothing against which a patient can brace himself or struggle 
while under the influence of anaesthetics. The chair may be fastened at any of the points designated in the cuts, their 
opposites or any intermediate points. It is practically noiseless in its operations. The working parts are under the 
seat, rendering it impossible to catch or tear the garment of the patient or pinch the hands of the patient or operator. 
The system of bracing renders the chair so rigid that it can never, by long or hard usage, sag or get out of shape. The 
base and working parts being made of iron, it is not like wood, liable to get rickety or out of order. The stirrups are 
self-fastening, have no thumb screws, and cannot drop with the foot of the patient in them. Any position may be di- 
rectly attained without a complication of movements. It is always ready for any position ; no extra parts to be brought 
in and hitched on. It has no cogs or cog wheels, no cranks or levers, and no ratchets to rasp the nerves of the patient. 
The Harvard is the most ornamental as well as convenient surgical chair ever offered to the profession. 522 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
ABDOMINAL SECTION. 
Ovariotomy. 
" Oophorectomy, Odriotomy, Oariotomia, Ovariotomia, Excisio Ovarii, Oariosteresis.-The operation for removing 
the ovary was first performed, in 1809, by Dr. Ephraim McDowell, of Kentucky. As now practiced, it includes in- 
cision into the peritoneal cavity, exploration for adhesions, evacuation of the cyst, detachment of the adhesions, extrac- 
tion of the cyst, and the treatment of the pedicle,, the latter including the employment of the ligature, torsion, acu- 
pressure, ecraseur, clamp, &c."-Dunglison. 
"We are indebted to many in this country and abroad for important contributions to our knowledge of ovariotomy; 
but chiefly to Sir Spencer Wells must we acknowledge our obligation for his great service in popularizing the operation 
and making its details so familiar to us. The world is largely indebted to him for his valuable teaching, and his name 
will always be honored wherever ovariotomy is known. To the remarkable success attained by Dr. Charles Clay, of 
Manchester, England, after 1842, we must attribute the acceptance of the operation by the profession, not only in 
England, but in this country. To him is certainly due the impulse given to the development of the operation in this 
country by the Atlee brothers, an impulse so favorable that, according to Dr. Peaslee, eighteen American surgeons 
had performed the operation previous to the year 1850. A more accurate knowledge of the operation was obtained by 
the publication, in 1855, of Dr. Atlee's first thirty cases, and in the following year a prize essay on ovariotomy was 
written by Dr. G. H. Lyman, of Boston, which was the most thorough and exhaustive treatise on the subject which 
had appeared up to that date. After i860 the number of operators increased rapidly."-" Principles and Practice of 
Gynaecology." Emmet. 
Tait's Method.-" The room in which the operation is to be performed should be fairly large, and so arranged that 
ventilation may be possible from window or door to the fireplace without the current crossing the bed of the patient. 
There should be no unnecessary furniture, and as little upholstery as possible. Two small iron couches, with firm hair 
mattresses and a water-pillow, are needed ; and an intelligent woman for nurse, who will do as she is told, and nothing 
more, is absolutely essential. If two such can be got, to act as relays for the first eighty hours after the operation, it 
will be found a great advantage. The patient herself requires a little preparation for the change that is about to be 
made in her alvine actions. For this purpose I direct that her food should be limited to soup and a very little bread 
for forty-eight hours before the operation, and that on the morning of the day previous she shall have a small dose of 
castor-oil. I prefer that the room should have a northern light, that the day should be clear, and I have the patient 
placed on a firm narrow table, with her feet directed against the window. The arms and legs are secured by bands to 
the table, so that only one assistant is required, one person to give the anaesthetic and one nurse to look after the 
sponges. All other bystanders are earnestly requested to do nothing unless specially desired, and above all not to 
speak during the operation. My assistant is duly instructed in his work, and I never, if I possibly can help it, operate 
with any but my usual assistant, for it is quite as important that he should know how to help me as it is that I should 
know how to operate. All the preparations of the instruments and sponges I make myself, and then I am sure nothing 
is forgotten ; or, if anything should be omitted, I have only myself to'blame. As a successful ovariotomy is the 
resultant of a large number of petty details carefully attended to, no amount of care and precision can be too great in 
carrying them out. 
Tait's Set.-"The instruments to be provided are: a perfect sharp scalpel, twelve of Koeberle's artery forceps 
(see Fig. 3148), four handled needles threaded with two thicknesses of silk, two pairs of cyst forceps, a pair of large 
screw bull-dog forceps, a wire clamp, a pair of scissors, a number of pieces of fine silk, about a foot long, for ligatures; 
a number of pieces of somewhat thicker, eighteen inches long, for sutures ; Paquelin's thermo-cautery, an aspirator, two 
sizes of trocars, and twelve good sponges. 
Quality of the Instruments.-"Of this list some of the items require special mention, and the first is the artery 
forceps of Koeberle.* Of the numerous minor improvements in our methods of operating, none deserves to be spoken 
more highly of than the introduction of this instrument. I give an illustration of the pattern I use (see Fig. 1485), 
though I do not know that it has much advantage over M. Koeberle's original form beyond the fact that it is stronger 
and does not break, and that its pointed nose cannot be tied in the ligature. Its method of action will at once be 
seen. As soon as a bleeding point is seen it is seized by one of these instruments and left in its clutches, so that, when 
the operation has advanced as far as the treatment of the pedicle, as many as eight or ten of these forceps may be 
hanging about the wound. More than twelve are rarely required, and if there should be need of more, one or two in 
use must be released by the assistant throwing a ligature around the points held by two or three. I have never more 
nor less than twelve, and I have them always ready to my hand, in a small tray covered with water and ranged carefully 
in order side by side, so that at a glance I can tell how many are in use. In this way I make sure that I never leave 
one inside." * * * 
The Operating Room and Instruments. 
* See Artery Clamp Forceps, page 94. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
523 
GYN/ECObOGICAh. 
OVARIOTOMY. 
The Instruments. (Continued.) 
" These instruments are of great service in saving time, and this is a matter of importance in an operation which 
may extend over an hour. When the time comes for the removal of the forceps, after the pedicle has been dealt with, 
it will generally be found that the mere pressure has stopped most of the bleeding points. These instruments will 
also be found of great service in pulling out cysts and in many other ways which experience will indicate. The 
handled needles, armed with silk, are items of the list upon which I take a great deal of trouble. They must be well 
made and well tempered, so that they will neither break nor bend. They must not have cutting points and must not 
make big holes. The eyes must be perfectly smooth and round, so as not to cut the silk. In fact, like everything 
else in ovariotomy, they must be perfection. The silk with which they are armed is of two thicknesses, for I always tie 
a pedicle or a mass of omentum with the thinnest silk I think capable of securing it. Therefore, for a thin pedicle I 
use thin silk, and for a thick pedicle I use somewhat thicker silk. The silk must be pure Chinese twist, with no cotton 
in it-an adulteration easily detached by liquor potassse. I scald every piece of silk to be used before the operation 
in boiling water, to get rid of the gum, and then I stretch it tightly to test it and to reset the fibres. In this way I 
have secured myself against ever having had a ligature slip, an accident I have heard other surgeons complain of. 
" The form of trocar I use for emptying the cyst is illustrated (see Fig. 1726, on page 128), and I claim for it the ad- 
vantages that, being perfectly solid, it never admits air, and, having no inside mechanism, it never gets out of order. 
The form of its point enables the operator to puncture secondary cysts without any alteration of the mechanism ; it is 
not sharp and therefore can do no harm. Of the sponges to be used it is almost impossible to speak with too great 
emphasis, as I distrust them more than anything else about the operation. I never let them out of my sight and I 
will not permit any one but the nurse in charge of them to touch them. They are prepared for each operation with 
the utmost care, and the number in use is constantly twelve. They are counted before the operation, before the wound 
is closed, and again afterwards, so that by no possibility should one be left inside-an accident which has happened a 
great many times in the history of ovariotomy and which nothing but the greatest care will prevent recurring. 
" Let me further say again that no one should touch the sponges but the nurse responsible for them. In one of 
my early operations, many years ago, a bystander hearing me ask for a small sponge tore one in two, so that there 
were thirteen in use instead of twelve, and both the nurse and myself were ignorant of the fact. The gentleman who 
tore the sponge alone knew of the act, and he left the room before the operation was finished. The result was that 
we found that thirteenth sponge four days after, and the horror of the circumstance is as vividly in my mind now as if 
it happened yesterday. I shall never forget it as long as I live. 
"The sponges used should be of the very best quality, should vary somewhat in size and shape, and should be 
perfectly free from tears or ragged points from which pieces may become detached. When they are new I soak them 
for twenty-four hours in a solution of muriatic acid sufficiently strong to be disagreeably sour to the taste. This dis- 
solves the particles of chalk with which they are infested and loosens the sand, and this must be completely washed 
out of them. After each operation I wash them free from color and then soak them for forty-eight hours in a strong 
solution of washing-soda or ammonia, to dissolve the fibrin. They are washed repeatedly, until the water comes from 
them perfectly clear, and after that they are placed for a week in a five per cent, solution of phenol. Finally, they are 
hung up in a well-made calico bag in a warm place till they are quite dry. It is to Dr. Keith that we are indebted for 
the free and efficient sponging out of the abdomen now always practiced, and in this respect he has again largely con- 
tributed to the advanced success of abdominal surgery."-" Diseases of the Ovaries." Lawson Tait. 
Fig. 3690.-Pilcher's Aseptic Scalpel. 
The Ovariotomy Operation. 
" For ovariotomy I generally have the patient anaesthetized on the bed and then lifted upon the table, the object 
of this being that she is saved the distress of seeing the preparations which have been made for the operation, as the 
instruments and other appliances are not brought into the room until she is unconscious. When upon the table, the 
arms and legs are secured by belts, and two clean towels are arranged so as to leave the abdomen exposed between 
them. The bladder has previously been emptied by the nurse, and I have personally inspected all the arrangements 
of instruments, sponges, &c., to see that nothing has been omitted. I begin the incision midway between the umbili- 
cus and the pubes, and cut downward, going completely through the skin and subcutaneous fat at one cut, for a dis- 
tance of about two and a half inches. I then look for the white line and divide it to an equal extent, and after that I 
cautiously divide the fat and transversalis fascia until the peritoneum is exposed." 524 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYN/ECObOGICAk 
OVARIOTOMY. 
Incision into the Peritoneal Cavity and Exploration for Adhesions. 
* * * "A pause is then made, and every bleeding point is secured by a pair of haemostatic forceps. I 
never, in the first instance, make an incision any longer than two and a half inches, because I am very averse to mak- 
ing the wound any larger than it need be, and, as a rule, three inches is enough. As soon as all the bleeding points 
have been secured, I open the peritoneum so as to admit my forefinger, and with that I make a brief preliminary ex- 
ploration. The peritoneum is then laid open to an extent corresponding with the wound in the other tissues and the 
cyst is exposed, any further bleeding being immediately arrested. In this stage of the operation, indeed through the 
entire proceeding, I never use any other director than my finger, for upon that I can place most reliance. If there 
should be no adhesions between the tumor and the peritoneum in front, this part of the operation is very simple ; but 
if there be adhesions, it is often no easy matter to determine the point of union between the two membranes, and it is 
in such a state of matters that inexperienced operators are apt to commit a grievous error. I have twice known in- 
stances, and I have heard of several others, where the glistening peritoneum has been mistaken for the wall of the cyst, 
and the operators have industriously set to work to separate the former membrane from the transversalis fascia. Some- 
times, even when there is no adhesion, the peritoneum is so greatly altered in appearance, having become so thick, 
leathery and gelatinous, as to deceive any but the most experienced operator." 
" When the point of union between the cyst and peritoneum cannot be discovered, the best way is to cut cautiously 
inward until the cyst be opened, because then it can be emptied, the whole wall carefully taken up and examined and 
the several parts accurately determined. This, however, wants great caution, for it may be that a piece of intestine lies 
in the way and may be opened by mistake ; but the experiences of a few cases will enable an observant surgeon easily to 
determine when he is cutting through muscular fibre. When the cyst is reached, it should be tapped by a large-sized 
syphon trocar (page 128) and emptied as quickly as possible. Sometimes, however, the contents of an ovarian cystoma 
are glairy or even perfectly gelatinous and will not pass through a trocar, and nothing tries the presence of mind of an 
experienced operator more than this. The peculiar adhesive mass which sometimes fills an ovarian cyst will neither 
pass through a trocar, nor be seized by the hand nor lifted up by a sponge, and to remove it from the cyst is often a 
matter of the greatest difficulty. In such a case the walls of the cyst are generally thin and extremely fragile, so that 
they cannot be held by forceps. Such tumors are often very adherent, the adhesions bleeding very freely when broken 
down and many of these cases are lost on account of the mere extension of time required for the removal of the cyst 
contents. In a case like this there is nothing but to enlarge the incision to the extent of four or five inches, or even 
more, and to remove the mass by the hands as rapidly as possible, the assistant aiding in the process by squeezing 
upon the flanks. If, however, the cyst contents are fluid and the tumor consists mainly of one cyst, without adhesions, 
nothing would seem more simple than an ovariotomy, and the removal of a parovarian cyst is usually a proceeding 
which takes a shorter time to perform than to describe." 
Evacuation of the Cyst. 
Trocars for Tapping. 
Spencer Well's, .... Fig. 1720. 
Fitch's, Fig. 1722. 
Warren's . . ... Fig. 1724. 
Tait's, . . Fig. 1726. 
Thomas' Fig. 1721. 
Emmet's, Fig. 1723. 
Dunster's, Fig. 1725. 
Well's, Fig. 1727. 
See, also, Aspirators, page 129. 
Fig. 3691.-Hanks' Modification of Tait's Trocar. 
"When the cyst is emptied, it should be drawn gently out through the wound; and, if non-adherent, no obstacle 
will be met with unless it be the presence of some secondary cysts. The trocar having been maintained in its position 
by means of the spring catches at its sides (Fig. 1726), its points should be made to enter these cysts, and thus empty GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
525 
(SYN/EGOLOGieAb. 
OVARIOTOMY. 
Evacuation of the Cyst. (Continued.) 
them ; but very often the contents of these secondary cysts are much thicker than the fluid contained in the major 
ones, and sometimes they are so numerous and of such small size that they constitute a solid mass at the base of the 
tumor. In such a case I lay open the major cyst, and, passing my hand within it, I break up into its cavity as much 
as I can of the secondary cyst mass, in order to save any further enlargement of the abdominal wound. During the 
whole of these proceedings as much care as possible should be taken to prevent any escape of the cyst contents into the 
abdominal cavity." 
Sac Forceps. 
Fig. 3692. 
Wilcox's Sac Forceps. 
Fig. 3693.-Thomas' Sac Forceps. 
Fig. 3694.-Borck's Cyst Elevator. 
Fig. 3695.-Spencer Wells' Sac Forceps. 
"Adhesions are mediate or intermediate, the former being generally parietal or omental, existing in the shape of 
round or flattened bands of peritoneum. They seem to be found by isolated patches of adhesion, which have dragged 
the peritoneum from the abdominal wall, or by pieces of adherent omentum. They are seldom large, and are only of 
any moment when traversed by an important bloodvessel, which must always be secured by torsion or ligature, or by 
the cautery. The immediate adhesions require great patience to overcome them ; but, even when they unite the tumors 
to the most important organs, they may be separated, or a piece of the cyst may be detached and left. One of the 
dangers of the removal of an ovarian tumor with extensive pelvic adhesions-and still more of an uterine tumor-is 
damage to one or both ureters. It will be remembered that they run down obliquely from the kidney over the brim 
of the pelvis down to the bladder, lying over on each side of the cervix and close to it. I have often laid them bare, 
but have never been unfortunate enough to injure them. Many curious and exceptional forms of adhesion occur, one 
of the most remarkable of which is occasional adhesion of the tip of the vermiform appendix of the caecum to the tumor. 
I have seen this three times, twice in my own practice. The first time I saw it, it was unfortunately divided by the 
scissors of the operating surgeon, with a fatal result; and it was only the discovery of this misfortune at the post- 
mortem which enabled me to recognize a similar condition and avoid a like disaster in my own cases. In dealing with 
pelvic adhesions it must be borne in mind that the large venous trunks in that region lie immediately under the peri- 
toneum, and that they must be carefully avoided. * * * 
" Hsemorrhage from adhesions has always a very strong tendency to arrest itself, and most of the bleeding points 
will stop of their own accord, or can be stopped by simple pressure with a sponge ; each point of importance should be 
seized by a pair of haemostatic forceps (Fig. 1485), or touched with a cautery or with a piece of solid perchloride of iron. 
For the arrest of a general oozing from a large surface, the pressure of two or three dried sponges is generally enough, 
and it is, therefore, my practice always to separate adhesions as rapidly as possible and to follow their separation by the 
immediate application of sponges, leaving these in situ until I have finished the separation and removal of the tumor." 526 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNECOLOGICAL. 
OVARIOTOMY. 
Pedicle Clamps. 
" Suppose the tumor separated and withdrawn, the assistant, stationed opposite the operator, should immediately 
insert one or two sponges to prevent the exit of the intestines, and he should then take possession of the tumor and 
steady it while the surgeon examines the pedicle and determines how it may be best dealt with."-" Diseases of the 
Ovaries." Lawson Tait. 
Securing the Pedicle. 
" 1 his, which constitutes one of the most important steps of the operation, is at times easily and satisfactorily 
accomplished, while at others it is invested with great difficulties. Unless the pedicle be excessively short, the sac 
may be drawn outside of the abdomen and its pedicle grasped by the fingers. When very short it has to be manipu- 
lated in the abdomen. It may be managed after one of the following methods, that one being selected which best 
meets the requirements of the particular case. 
" 1st. The pedicle may be constricted by a clamp and held outside of the abdominal cavity. 
" 2d. The pedicle may be securely ligated and held between the lips of the wound by pins or sutures. 
" 3d. The pedicle maybe transfixed by double ligatures, which, being cut short, is dropped into the pelvic cavity. 
" 4th. The tumor may be enucleated. 
" 5th. The pedicle may be constricted by a temporary clamp and severed by the actual cautery. 
"No rule can be given with reference to a choice between all these methods other than this: when the pedicle 
is long and slender, it does not appear to matter very much which plan is selected, for all have yielded and are daily 
yielding excellent results ; but, when it is very short, the external does not promise nearly so well as the internal method 
of managing the stump. As to the special cases for applying the different plans, the following suggestions, not rules, 
may be of service: 
" a. The clamp is applicable to long pedicles, requiring powerful ligation, and presenting a large amount of tissue 
for suppuration and decay. 
" b. Ligation and return is applicable to tumors with pedicles too short for treatment by the clamp and to slender 
pedicles. 
" c. Enucleation gives a method of removal of tumors which have no pedicles. 
" d. The actual cautery should again be fully tried, for its utility, since the 
experience of Mr. Keith, may now be considered beyond question. Where it 
is employed deep in the pelvis, Storer's clamp-shield (Fig. 3711) is an excellent 
adjuvant for prevention of haemorrhage during its use and a good protection to 
the surrounding parts."-" Thomas, On Diseases of Women." 
Fig. 3696.-Spencer Wells' Pedicle Forceps (Angular). 
Fig. 3697.-Spencer Wells' Pedicle Forceps (Straight). 
Fig. 3698.-Spencer Wells' Pedicle Forceps (T shaped) GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
527 
©YN/ECObOGICAb. 
OVARIOTOMY. 
Pedicle Clamps. 
"At present, we may say, there are only three methods in vogue for the treatment of the pedicle, and of these one- 
that is, the clamp-should be reserved for extremely exceptional instances. Probably not more than two or three cases 
in a hundred require now to be dealt with by the clamp ; certainly I have not met with more than one for the last 
three years. The kind of pedicle requiring the clamp is thick and soft, and so short as to contain, perhaps, a small piece 
of the tumor. With such a pedicle the extra-peritoneal method is admissible, and probably is superior to treatment 
either by the cautery or the ligature; but I am not quite sure that a combination of a drainage-tube with either of these 
latter methods may not yet be found superior to the clamp. If to the pedicle of an ovarian tumor, unusually thick 
and short, or in that of an uterine tumor, it is thought desirable to employ a clamp, then it is evident that what is 
wanted is a form of circular constriction by some means which will completely arrest the haemorrhage, will not cut the 
pedicle, and which will allow the wound to be accurately adjusted around the stump. 
"To meet all the requirements, I have devised a clamp (Fig. 3699) which has served my purpose better than any 
I have seen. After a large number of experiments I selected thick copper wire (No. 12, Birmingham gauge), nickeled, 
and completely softened by being made red hot and allowed slowly to cool, as being the best material to work with. 
For use I bent it into a loop (see right hand Fig. 3699, A), ready for the operation. After it has been placed around 
the pedicle, the collar is run on, close up to the pedicle. The handle with ecraseur mechanism B is then adjusted, 
the ends of the wires run through the holes and the pinch-screws closed tight upon the wires by means of the key, C. 
The handle B is then turned slowly till the loop of wire firmly constricts the pedicle. The tumor is then removed, 
and, if there be any bleeding, a few more turns of the handle B will se- 
cure it. When this is done, the pinch-screws of the collar A are to be 
securely tightened down on the wire and those on the handle B loosened. 
The handle will then come off, leaving the wire clamp with its collar A, 
as seen in the right hand figure. The ends of the wire are then to be 
turned slightly up, and the wound closed and dressed as usual."-"Dis- 
eases of the Ovaries." Lawson Tait. 
Fig. 3700.-Thomas' Clamp. 
Fig. 3699.-Lawson Tait's Clamp. 
Fig. 3701. 
Spencer Wells' Artery Torsion Forceps. 528 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GY^/ECObOGie^L. 
OVARIOTOMY. 
Fig. 3702.-Spencer Wells' Pedicle Clamp. 
Consisting of 3 Clamps, 1 set of Levers for Closing and 1 set for Removing them. 
& J ° 
Pedicle Clamps. 
" The clamp has always been 
the favorite means used by Sir 
Spencer Wells, and the endorse- 
ment of the value of the instru- 
ment by one who has already 
removed more than nine hun- 
dred ovarian tumors demands for 
it more than a passing notice. 
There are two great advantages 
in the use of the instrument - 
bleeding from the pedicle cannot 
take place without being detec- 
ted, and no foreign body in con- 
nection with the pedicle is left 
within the abdominal cavity. 
On the other hand, unless the 
pedicle is a long one, the patient 
suffers in consequence of the 
traction exerted when the ab- 
domen becomes distended by 
flatus. Sir Spencer Wells has 
modified, from time to time, the 
shape of the clamps."-" Prin- 
ciples and Practice of Gynae- 
cology." Emmet. 
Fig. 3703.-Spencer Wells' Clamp Forceps. 
Fig. 3704.-Atlee's Clamp. 
Fig. 3706.-Baker Brown's Clamp. 
Fig. 3705.-Darby's Clamp. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
529 
(aY^I/EeOLOGie/vL 
OVARIOTOMY. 
Pedicle Clamps. 
Fig. 3707. 
Gueride's Clamp. 
Fig. 3708. 
Nott's Rectilinear Ecraseur. 
Fig. 3711.-Storer's Clamp Shield. 
Pig. 3709.-Dawson's Clamp (modified). 
Fig. 3710.-Thomas' Clamp. 
Fig. 3712.-Spencer Wells' Clamp. 
Fig. 3713.-Skene's Ovariotomy Cautery Clamp. 
See page 39, Actual Cautery Irons. 530 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
®YN/EeObO@ieAk 
OVARIOTOMY. 
Pedicle Clamps. 
Fig. 3714.-Forne's Serre-Noeud. 
" This is a loop and knot-constrictor, furnishing continuous tension. Alter the 
wire or cord is applied to the pedicle and crossed-one end above the other and 
pulled in opposite ways, so as to form a single knot-the fag-ends are passed through 
the apertures on the extremity of the forceps, next over the grooved pulleys in the 
middle of the branches, then wound once or twice around the neck of the windlass 
and finally secured to its wings in figure of eight fashion. By now turning the wind- 
lass, the wire becomes tightened. Turning the screw at the handles results in separ- 
ating the branches in front; these, being resilient, are thus influenced to act like 
strong bows, continually endeavoring to straighten, creating a never-ceasing tension 
upon the opposite ends of the wire or cord forming the knot. Docteur Forne, 
Medecin Principal de la Division Navale (France). Verbal explanation by the Doc- 
tor when visiting us. New York, October, 1885. 
Fig. 3715.-Esmarch's Ovariotomy Clamp. 
Fig. 3716.-Keith's Compressing Forceps. 
Fig. 3719.-Keith's Ovariotomy Clamp. 
Fig. 3717.-Skene's Compressing Forceps. 
Fig. 3718.-Byford's Clamps. 
Consisting of 2 Clamps and 1 pair of Lever Forceps. 
"Cleansing the Peritoneum.-The sac having been removed and haemorrhage checked, all fluids contained in the 
peritoneal cavity should be carefully removed by soft sponges, squeezed out of warm carbolized water. Not only the 
intestines and abdominal walls, but especially the pelvis, should be completely and thoroughly cleansed. 1 his is a 
point of great importance, and may decide the issue of the case. Every particle of fluid left may undergo decomposi- 
tion and expose to the great dangers of septicaemia and peiitonitis. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
531 
®YN/Ee0L0GI6Ak 
OVARIOTOMY. 
Drainage. 
"Establishing Drainage.-No one familiar with ovariotomy will to-day doubt the assertion that the two factors 
which prove most fatal after it, septicaemia and peritonitis, are both in great degree due to the retention of putrescent 
materials within the peritoneal cavity. These materials may have escaped from the cyst during or before the opera- 
tion, may consist of blood or serum oozing from the vessels while the operation proceeds or some hours after it has 
ended, or arise from emptying of pus into the peritoneum from inflammatory action. The importance of not only 
preventing the entrance of such elements into the peritoneum and of removing them before closing the abdominal 
opening, but also of giving them free vent during the period of convalescence has attracted the attention of many 
ovariotomists. 
Fig. 3720.-Thomas' Curved Drainage Tube 
Fig. 3721. 
Thomas' Straight Drainage Tube. 
" Peaslee introduced the plan of leaving a cloth tent in the 
lower angle of the wound in order to facilitate drainage in case of 
the development of septicaemia. Kceberle not only inserted chan- 
nels of metal through the abdomen, but even opened the cul-de-sac 
of Douglas and inserted tubes, so as to drain per vaginam, and 
Sims, more recently, has urged this plan as one very greatly calcu- 
lated to diminish the liability to these conditions. 
" The removal of the cloth tent, fixed between 
the lips of the wound by congealed blood, is often 
difficult and painful, and the passage of a catheter 
or other tube down into Douglas' sac, the most 
dependent part of the peritoneum, is not rarely 
impossible after a slight effusion of lymph has 
occurred. 
"For the past fifteen years, whenever, from 
the remaining of a portion of the sac in the pelvis, 
or from escape of fluids into the pelvic peritoneum, 
drainage has seemed advisable, I have, until re- 
cently, employed for this purpose a curved glass 
tube, which entered and rested in Douglas' pouch. This was kept closed by a cork or by a roll of carbolized cotton, 
and through it the pelvis was syringed out with carbolized water, carried in by a catheter if symptoms of septicaemia 
developed. Since the use of antiseptic dressings I have, however, discarded this, and now employ a double tube with 
lateral branches, which pass out through the antiseptic dressings. This renders it unnecessary to disturb it when washing 
out the abdominal cavity, and the rubber tubing with stopcocks arranged at the extremities of the lateral arms enables 
us to exclude air very perfectly. The two halves of the tubes do not communicate. As it is forced in through one 
lateral branch the fluid runs out at its lowest extremity, rises in the cavity, and escapes through the other tube. Ob- 
structing the escape tube will more completely fill the cavity with fluid, if this be considered desirable."-Thomas, on 
" Diseases of Women." 1880. 
Fig. 3722. 
Thomas' Perforated Drainage Tube. 
Fig. 3723.-Thomas' Double Drainage Tube, 
Fig. 3724.-Tait's Drainage Tube 
Fig. 3725.-Keith's Drainage Tube. 
Fig. 3726.-Schapp's Hard Rubber Spiral Drainage Tube. 
Is very pliable, elastic, and admits 
an easy outflow of septic fludis. 532 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
OVARIOTOMY. 
Drainage. 
" It consists of a large and a small tube made of hard rubber. 
The smaller tube is inside of the larger one, running along the 
posterior wall and terminating about an eighth of an inch from 
the bottom. The large tube is perforated on the sides and 
curved at the top, so that, when in the abdominal wound, the 
top of the tube projects nearly over the symphysis pubis. The 
smaller tube is for the purpose of washing out the peritoneal 
cavity, the water being thrown in at the bottom of the cavity 
instead of at the top, as in most drainage tubes. A Davidson's 
syringe is attached to the small tube and a larger rubber hose 
to the other, which conveys the water to a bed-pan or other 
convenient vessel. Where drainage is constant or very profuse, the rubber tube can be long enough to hang over the 
side of the bed into some vessel placed there. By having the smaller, or washing tube, project through the dressing 
on the wound, the pelvic cavity can be washed out without removing the dressing, which will remain dry and clean."- 
H. Marion Sims, M. D. N. Y. Medical Journal, Sept. 20, 1884. 
"A few months ago I devised a 
flexible drainage tube to be used in 
ovariotomy. The implement is long 
enough to reach from the abdominal 
incision to the ostium vaginae, passing 
through the peritoneo-vaginal septum 
on its way. The tube is of rubber and 
pierced with ' velvet-eyed ' apertures 
along its middle third. The diagram 
well represents the implement. After 
an ovarian tumor is removed, and 
soiled parts have been cleaned, a large 
trocar is sent to the vaginal fornix which is proximate to the 
rectum, and there made to transfix the peritoneo-vaginal septum 
the grouped fingers of the left hand, in the abdominal and pelvic 
cavities for that purpose, receiving and guarding the point of the 
instrument. The trocar is then removed, and the smaller end of 
the drainage tube directed through the canula. The fingers of the 
right hand withdraw the canula, leaving the lower end of the drain- 
age tube in the vagina. The upper end of the tube projects from 
the lower angle of the abdominal wound when the incision is closed. 
The object of the flexible tube is to drain the abdominal and 
pelvic spaces of septic fluids exuded directly after ovariotomy and 
hysterectomy. Besides, the flexible conduit offers facilities for 
injecting aseptic fluids within the peritoneal cavity in the event of 
dangerous inflammation. By means of the implement septic sur- 
faces may be frequently bathed with warm water thrown through 
a syringe. The tube is to be removed downwards by pulling upon the part projecting into the vagina."-Extract 
from The Eclectic Medical Journal, January, 1886. 
Fig. 3727.-Sims' Drainage Tube. 
Fig. 3728.-Howe's Soft Rubber Drainage Tube. 
Fig. 3729.-Cushing's Pelvic Abscess Dilating Forceps. 
For opening 
pelvic abscesses 
through the 
roof of the vagina. 
It consists of two blades, which, when closed, form a trocar, and, when introduced and the handles compressed, 
acts as a dilator, tearing the tissues sufficiently to furnish the most ample room for escape of pus and the introduction 
of a drainage tube. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
533 
®YN/ECOLdOQICAId 
OVARIOTOMY. 
Closing the Wound. 
•'Closing the Wound.-This is accomplished by two sets of sutures, the deep and superficial. The first, composed 
of silver, may be passed in the following manner: A thread of silver wire is passed at each of its extremities through a 
long and stout straight needle. One of the needles, being grasped by strong needle-forceps, is passed through the 
peritoneum of one abdominal flap near the edge of the incision and made to emerge through the skin about an inch from 
the edge. Then the other needle is seized and passed through the other side. The suture is then secured by twisting. 
Fig. 3730.-Keith's Needles. 
These deep sutures, placed at the distance of half an inch apart, will bring the whole incision into contact from the 
peritoneum to the skin, and favor healing by first intention. 
"A much better method is to pass through both walls of the abdomen a long needle with fixed handle, and an eye 
near its point armed with a short loop of silk, as recommended by Peaslee. Into this loop or into the eye of the needle 
a bit of metallic wire is fitted and immediately drawn into place. Besides these, superficial •sutures or pins like those 
employed for harelip should be used, which pass through the skin and areolar tissue, but do not involve the peritoneum. 
Around this pin thread is wrapped in ' figure of eight.' 
Fig. 3731.-Abdominal Needle, with Fixed Handle. 
Fig. 3732.-Peaslee's Perineum Needles, Detachable Handle. 
See 
Harelip Pin, 
Fig. 2318. 
Acupressure 
Pin, Fig. 1469 
See Hagedorn's 
Needles 
and Holder, 
page 455. 
" The operation having been performed under Lister's method throughout, the wound is now covered with anti- 
septic dressing, which is secured in place by a heavy covering of carbolized cotton, and this again by a firm bandage. 
Then the patient should be removed from the table to her bed. * * * 
" Hamorrhage, Peritonitis, Nervous Prostration, Septiccemia.-The evils which are chiefly to be feared as sequels 
of the operation are, within the first twenty-four hours, haemorrhage; from second to fourth day, peritonitis; from 
completion of operation to third or fourth day, nervous prostration ; and from fourth to fourteenth day, septiccemia."- 
" Thomas on the Diseases of Women." 
Fig. 3733.-Abdominal Pad, for Application 
of Heat or Cold. 
" Cold Water.-This agent has been more systematic- 
ally employed than formerly in the after-treatment of sur- 
gical cases. An old invention, but one recently reintro- 
duced, is the cold water coil; which consists of coils of 
rubber or metal tubing of all shapes and sizes. These may 
be placed upon the head, spine, abdomen, or around a 
wounded limb, and kept cool by the action of a constant 
stream of ice-water flowing through them. This appliance 
is most efficacious in subduing inflammation and lowering 
fever. It is especially useful in peritonitis following ope- 
rations within the abdominal cavity."-"Appleton's An- 
nual Cyclopaedia." 1884. 
Cold Water. 534 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
®YN/ECOLO@ICAL. 
OBSTETRICS. 
Labor, or Parturition. 
"Obstetrix: Lat., a midwife , the art and science of midwifery.-It has a double mission : I. To render possible, 
easy and regular, exempt from all abnormal suffering and all danger, the accomplishment of the numerous functions 
which directly or indirectly affect generation, from birth to age when the procreative faculty becomes natural to the 
human female ; 2. To direct and defend from all harm the delicate and precarious health of the infant during its early 
period of existence, and particularly during lactation. Labor is a natural function, and happily the intervention of 
art is rarely demanded ; but, to foresee, prevent, or remove all possible danger ; to overcome serious obstacles when 
they exist, to resolve the many difficult and trying questions that may arise, demand skill and judgment. The im- 
portant part which woman takes in generation consists in successive acts which are accomplished in her. One of the 
germs or ova, enclosed in the ovary, receives through impregnation the power to develop itself, and is then trans- 
ported to the uterus. This organ retains the ovum, and furnishes it the materials for its growth. It becomes first an 
embryo, and next a foetus, when it acquires all the necessary powers for exterior life. This succession of phenomena 
constitutes gestation or pregnancy. When these powers are acquired, the new being is expelled by a spontaneous 
action of the same organ which has contained, protected and nourished it; and during this expulsion, known by the 
name of labor or parturition, in order to come to the light, it is obliged to traverse the pelvis, which is not accomplished 
without pain. But after its birth it still requires for some time the aid of the breasts, organs designed only for the 
function, which by the process of lactation furnish the necessary elements for its nutrition. The development of these 
phenomena is preceded and prepared for by particular modifications which the ovarian vesicles undergo. A bloody 
periodical discharge, called menstruation, of which the uterus is the source, ordinarily coincides with this modification 
of the ovarian vesicles. 
" Obstetrics then includes; I. Anatomy, the organs which concur to the execution of the acts above described; 2. 
The physiological phenomena, the mode in which these acts are performed ; and, 3. The pathology of these organs. As 
regards the anatomy, it is sufficient here to say that the female organs subservient to generation are the ovaries, the 
principal function of which is the production of the ovule or germ ; the Fallopian tubes, designed to receive the ovule 
and conduct it into the cavity of the uterus ; the uterus or womb, a kind of receptacle whose office is to contain the 
fecundated germ during its period of development, and to expel it immediately afterward ; and, finally, the vagina, a 
membranous canal extending from the neck of the uterus to the external organs. Most of these organs are situated within 
a large cavity, the walls of which are composed of bones and soft parts ; this is termed the cavity of the pelvis. * * * 
Labor or parturition consists in the spontaneous or artificial expulsion of a viable foetus through the natural parts. 
Previous to the commencement of labor, some precursory phenomena appear-in some cases during the last fortnight 
of pregnancy, in others only five or six days before labor commences. They result from the dilatation of the internal 
orifice of the womb. The uterus, which before extended up to the stomach, sensibly sinks lower, the mechanical ob- 
struction to respiration is removed, the stomach is no longer oppressed, but the bladder and rectum become irritable 
and locomotion is more difficult. The physiological phenomena of labor are divided into three stages: the first stage 
ends with the dilatation of the mouth of the womb, the second with the expulsion of the foetus, and the third with 
the delivery of the placenta or after-birth. The symptoms of the first stage are intermittent pains, resulting from the 
uterine contractions, discharge of a glairy mucus, formation of a bag of waters, and gradual dilatation of the neck of 
the womb. The pains of the first stage are usually borne with more impatience than those of the second. The cries 
which accompany them are sharp, and resemble those of any other species of suffering ; those of the second stage seem 
to be suppressed, like those of a person carrying a heavy burden. The use of the glairy discharge is to moisten and 
lubricate the parts over which the child has to pass, to increase their suppleness and extensibility, and make it more 
easy for the ovum to slide over the surfaces. Where these discharges fail to take place, the dilatation of the mouth 
of the womb is always more painful and slower, and the organs are more disposed to become inflamed. The name 
of a bag of waters is given to a protuberance formed by the membranes in the upper part of the vagina during labor. 
During the presence of pain it is hard, tense and elastic ; after the contraction is over it becomes wrinkled and con- 
tracts or disappears. It eventually breaks, sometimes early in the first stage, and in other cases not until late in the 
second stage, when the contained fluid escapes. The duration of labor is exceedingly variable, even when no obstacle 
opposes its natural course. Some women are delivered in an hour or two, others only after several days ; and between 
these two extremes there is every intermediate grade. In the first confinement, the average length of labor is usually 
from ten to twelve hours ; but, in at least one case out of five, it may not terminate under fifteen, eighteen, or even 
twenty-four hours, and this without any injury whatever resulting either to the mother or child. Women who have had 
children are delivered much sooner, only suffering, in ordinary cases, about six or eight hours. The duration of the 
first stage is to the second as two or even three to one ; but this law is subject to many exceptions. The third stage 
ought to be completed within thirty minutes. To understand the mechanical phenomena of labor it is necessary first 
to define the terms presentation and position. We designate by the term presentation the part of the child that first 
offers at the entrance of the pelvic cavity ; and by the term position, the relations of the presenting part to the differ- GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS, 
535 
GYNAECOLOGICAL. 
OBSTETRICS. 
Difficult and Dangerous Labor. (Continued.) 
ent points of the entrance to the pelvis. The attitude of the child in the uterine cavity is, in a great majority of cases, 
such that the direction of the trunk is parallel with that of the mother, and one extremity forms the most dependent 
part. If the head is flexed, it is called a vertex presentation. If the head is extended back, the chin far removed from 
the breast, it is a face presentation. When the other extremity presents, the legs are usually flexed on the thighs and 
the latter on the abdomen ; the whole breech may therefore offer at the entrance of the pelvis, or one or both feet or 
knees. As the mechanism of labor must be the same in all these cases, they are all included under the term pelvic pre - 
sentations. But it may happen that, instead of one of the extremities offering, some portion of the trunk may offer, 
the child lying transversely in the uterus, and this may be either some point of the right half or of the left half of the 
trunk. We have then five primary presentations, one of the head, one of the face, one for the pelvic extremity, one for 
the right lateral plane, and one for the left lateral plane. The presentation of the head is incomparably more frequent 
than all the others. According to Mme. Boivin, in 20,357 cases it occurred in 19,730. The foetus presents by the face, 
on an average, once in two hundred and fifty labors. The pelvic presentation occurs once in thirty or thirty-five labors. 
The trunk presentations are a little less rare than the face, occurring about once in two hundred cases. As a law, it 
may be said that trunk presentations always demand the interposition of art to accomplish delivery. The other pre- 
sentations generally terminate spontaneously. In order that a labor may terminate without foreign aid, there must be 
on the part of the mother no fault or deformity of the pelvis, no serious affection of the womb, and the organ must 
possess a certain energy ; the general powers of the system must not have been exhausted, either by a profuse haemor- 
rhage or any long continued disease ; there must be no affection making it dangerous for the women to give herself up 
fully to the efforts that she is compelled to make ; and no accident must supervene during the labor. On the part of 
the child, it is important that it should descend with the head, the face, the feet, the knees, or the breech foremost, and 
that it should not be of a size disproportionate to the pelvis. About one case in thirty requires, in some form, artificial 
aid to complete a happy delivery. 
Obstetric Operations. 
" The obstetric operations required for cases of difficult and dangerous labor, either to save the life of the mother 
or child, or both, are : I. Induction of premature labor, an operation of great importance and value in certain cases ; 
2. Version or turning, that manual operation by which one presentation is substituted for another less favorable; 
3. The vectis, to correct malpositions or aid the natural rotations of the head ; 4. Delivery by forceps ; 5. Craniotomy, 
an operation by which the life of the child is sacrificed in order to save the mother ; 6. The Caesarean section, in 
which the child is extracted through an incision in the walls of the abdomen and uterus. The dangerous complications 
which may arise in connection with labor are: Prolapse of the cord or funis, an accident very fatal to the child; 
flooding or haemorrhage ; retention of the placenta ; convulsions ; rupture of the uterus ; lacerations of the vagina or 
perineum, and inversion of the uterus. 
"Among the most striking modern improvements in obstetrical science maybe mentioned the application of 
auscultation to obstetrics ; a more perfect knowledge of the mechanism of labor and of the management of the placenta 
prcevia ; the introduction of anaesthetics ; the induction of premature labor; an increased frequency in the use of the 
forceps and a less frequent resort to craniotomy ; and the substitution of version in cases where either craniotomy or 
the long forceps were formerly employed."-" The American Cyclopaedia." 
Instrumental Labor. 
Instrumental cases of difficult labors are divided by Ramsbotham into two species, he says: " The first, those which 
are accomplished by instruments perfectly compatible both with the life of the child and the safety and continuity of 
the mother's structures ; and the second, those in which either the child's body must be mutilated or a cutting operation 
be performed on the mother's person. 
Delivery Instruments. Forceps, Vectis and Fillet. 
" Four kinds of instruments, differing essentially in their fashion and mode of application, have, been used to over- 
come the lesser degrees of difficulty which we meet with ; by the employment of either of these the labor is reduced to 
the first species of this order: they are the long and short forceps, the vectis and the fillet. 
" The instruments resorted to in the second species of this order of cases are of a cutting character, and they may 
be resolved into two varieties-the first, those which are applied to the child and are necessary for the performance of 
craniotomy, as the perforator or craniotomy scissors, the crotchet, the blunt hook, and the craniotomy forceps ; the 
second, those which are applied to the mother's person, by which the Caesarean section is performed or the symphisis 
pubis is divided, as the scalpel, bistoury and others, which are auxiliary, and sufficiently well known in surgery to re- 
quire no particular mention here."-" Ramsbotham's System of Obstetrics." 
Craniotomy, Caesarean Section. 536 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
OBSTETRICAL. 
Forceps. 
Fig. 3734. - Hodge's Forceps. 
Fig. 3735. 
Tarsitani's Forceps. 
Fig. 3736. 
Brickel's Forceps (1, 2). 
Fig. 3737. 
Robinson's Forceps. 
Fig. 3738.-White's Forceps. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
537 
GYN/ECObOGICAk 
OBSTETRICAL. 
Forceps. 
Fig. 3739. 
Bethel Forceps. 
Fig. 3740. 
Hunter's Forceps. 
Fig. 3741. 
Sawyer's Short Forceps. 
Fig. 3742. 
Comstock's Forceps. 
Fig. 3744.-Sawyer's Long Forceps. 538 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SYN/ECOLOGIGAL. 
OBSTETRICAL. 
Forceps. 
Fig. 3746.-Taylor's Forceps. 
Fig. 3752.-Thomas' Forceps. 
Fig. 3747.-Elliott's Forceps. 
Fig. 3748.-Gillette's Forceps. 
Fig. 3749.-McLean's Forceps. 
Fig. 3753.-Budd's Forceps. 
Fig. 3750.-Osborn's Forceps. 
Fig. 3751.-Denman's Forceps. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
539 
®YN/ECOLOGieAL. 
OBSTETRICAL 
Forceps. 
Fig. 3754. 
Davis' Forceps. 
Fig. 3755. 
Trueheart's Forceps. 
Fig. 3756 
Jenks' Short Forceps. 
Fig. 3757. 
Jenks' Long Forceps. 
Fig. 3759- 
Blake's Forceps. 
Fig. 3760. 
Sawyer's Forceps. 
Fig. 3761. 
Buzzle's Forceps 
Fig. 3758. 
Ives' Forceps. 540 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
GYNAECOLOGICAL. 
OBSTETRICAL. Forceps. 
Fig. 3764.-Draper's Forceps. 
Fig. 3765.-Roller's Forceps. 
J. 
ex 
o 
o 
in 
o 
s 
PQ 
ci 
o 
O 
Ph 
Fig. 3763.-Miller's Jointed Forceps. 
Fig. 3768.-Loewenthal's Forceps, (1, 2). 
Fig. 3766.-Newman's Forceps 
Fig. 3767.-Vedder's Forceps. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
541 
@YN/EeOLOGieAb. 
OBSTETRICAL 
Forceps, 
Fig. 3769. 
Hale's Forceps. 
Fig. 3770. 
Rockwell's Forceps. 
Fig. 3771. 
Mathew's Forceps. 
Fig. 3772. 
Nsegeli's Forceps, 
Fig. 3773. 
Schuyler's Forceps. 
Fig. 3774.-Robertson's Forceps. 
Fig. 3775--Jewett's Forceps. 
" I submit a forceps which is designed to meet the requirements of modern obstet- 
ricians in the matter of cleanliness. The only important new feature is the construction 
of the handles, which are of hard rubber, smoothly polished, and they wholly envelope 
the metal. As the rubber is vulcanized upon the metal there are no crevices for the 
lodgment of filth. With the exception of the handles, the general model of the in- 
strument is similar to the Elliot forceps, but the shanks are stronger and the lock is a 
half Smellie."-" Notes on Hospital Obstetrics." Jewett. New York Medical Journal, 
November 21, 1885. 542 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYN/ECOIdOGISAId. 
OBSTETRICAL. 
Forceps. (Axis-Traction, Continued.) 
"Mr. Tarnier's forceps possesses two ori- 
ginal features; I. The shanks, in place of run- 
ning forward continuous with the pelvic curve, 
are bent backward, so that the handles, when 
placed horizontally, lie about three and a half 
inches above the plane of the posterior curve 
of the blades. This Tarnier curve makes it 
possible to bring the blades well forward in 
the sides of the pelvis without subjecting the 
soft parts above, or the perinasum below, to 
pressure. A transverse screw, crossing the 
handles below the lock, approximates the 
blades to the surfaces of the child's head. 
2. Two movable traction-rods are attached to 
the lower curvature of the blades. These rods 
are curved to correspond to the lower border 
of the shanks, to which, when not in use, they 
are affixed by projecting pegs. When the in- 
strument is adjusted, the outer ends of the 
traction-rods are detached and inserted into a 
socket-joint belonging to a strong steel bar 
with a downward curve, and furnished with a 
transverse handle which can be moved in any 
direction by means of a universal joint. Trac- 
tions are made by means of this transverse 
handle alone. As the head de- 
scends, the handles proper rise up- 
ward and serve as an index to show 
the direction in which the force 
should be exerted. By simply rais- 
ing the traction-rods in a line with 
the curved shanks, the blades of the 
forceps swing always in the trans- 
verse diameter, and the head follows 
as nearly as possible the axis of the 
pelvis. To -one accustomed only to 
the familiar forceps, the facility with which delivery can be accomplished by Tarnier's instrument would seem hardly 
credible."-" The Science and Art of Midwifery." Lusk. 1882. 
" The axis-traction forceps of Tarnier and its modifications offer great advantage in many cases of high operation. 
In these instruments the extracting force is applied in the axis of the forceps blades, and the axis of the blades lies 
constantly parallel with the axis of the passages as the head descends. This can not be accomplished by mere traction 
upon the handles, certainly not with forceps having a marked pelvic curve. It may be done by conjoining with 
traction, applied at the handles by one hand, a downward pressure with the other hand upon the shanks near the lock. 
The operator is often in doubt as to the precise direction of the pelvic axis. I am not sure to whom I am indebted 
for the following useful hints for solving this difficulty and guiding the line of traction. The symphysis pubis is sub- 
stantially parallel with the axis of the brim. The direction of the symphysis may be readily determined by laying the 
finger along its internal surface or by placing the finger-tips externally over the extremities of the symphysis. This 
affords a guide to the line of traction, which deviates but little from the axis of the inlet till the occipital pole ap- 
proaches the pelvic floor. As the head glides along on the floor of the pelvis the forceps handles should sweep for- 
ward rapidly enough to make the anterior margins of the blades hug the ischio-pubic rami as closely as possible 
without crushing the intervening soft parts. These rules serve for general guidance in the use of forceps, but may, of 
course, require modification in individual cases."-" Notes on Hospital Obstetrics." Charles Jewet, M. D. N. Y, 
Medical Journal, Nov. 21, 1885. 
" Of Burge's forceps (Fig. 3778) the blades and handle are made separate, and the lock, being in the end of the 
handle, allows the choice from as many blades as one pleases to carry. The free extremities of the blades, B B, pro- 
Fig. 3776.-Tarnier's Axis-Traction Forceps. 
Fig. 3777.-Corning's Axis-Traction Forceps. 
Fig. 3778.-Burge's Axis-Traction Forceps. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
543 
®Y]M/ECOhO®iey\L. 
OBSTETRICAL. 
Forceps. (Axis-Traction, Continued.) 
jecting on either side of the handle, form levers, by which the blades are separated or approximated at will, being 
acted upon by the slide, C C, which may be fixed at any point by means of the nut, D. The amount of compression 
which the blades shall make upon the foetal head is under perfect control."-J. H. Burge, M. D. 
Dr. Lusk has modified the original Tarnier by making the blades much lighter, somewhat after those of the well- 
known intrument of Wallace. This alteration makes their application, especially in contracted pelves, or through an 
imperfectly dilated os, a much easier matter. In place of the very clumsy socket-joint into which the traction-rods 
are inserted he has substituted the key arrangement, by means of which the handle can be adjusted or removed in a 
few seconds of time. These improvements do away, to a great extent, with the unhandiness of the older model. 
" On the management of breech cases in which both extremities are reflected 
upward parallel to the anterior surface of the child.-In his now famous article 
on the forceps, published in 1872, in the " Dictionaire de medecine et de 
chirurgie " (1872), Tarnier stated that, under exceptional circumstances, neither 
Stoltz nor Dubois feared to apply that instrument to the breech, and added that 
he had several times imitated their practice with success as regarded the mother 
and sometimes as regarded the child. Where the foetus was dead he made the 
autopsy with care, and had assured himself that the forceps had produced no 
lesion, either of the pelvis or of the abdominal viscera. Hiiter, in his excellent 
treatise on "The Obstetrical Operations" (Leipsic, 1874), declares that no 
better instrument exists for the extraction of the breech than the forceps. Dr. 
Henry Fruitnight, of this city, published in the July number of the Virginia 
Medical Monthly, 1877, a successful case where the forceps was used at the 
suggestion of Dr. E. C. Harwood. Dr. I. E. Taylor informs me that he has 
applied the forceps to the breech six times with success. In the same year Dr. 
Agnew reported two successful cases to the London Obstetrical Society. In 
1877, Haake* published five cases, in which, as he says, to the astonishment of 
the physicians present, the extraction with the forceps was easily and quickly 
ended without the slightest detriment to the foetus. Last year I saw, in con- 
sultation with Dr. F. A. Castle, a case of breech presentation in a primipara 
who had passed her thirtieth year. We both of us essayed extraction with the 
fingers, but in vain. The breech was in the pelvic cavity, but had not yet com- 
pleted its descent through the cervical orifice. The foetus occupied an oblique 
diameter, with the back directed to the left and front. In accordance with 
Haake's suggestion, I applied one blade of Simpson's forceps over the posterior 
surface of the thigh, and the other over the sacrum, with the extremity of the 
latter blade just above the crest of the ilium. In spite of the rigidity of the soft 
parts, the child was extracted alive in about fifteen minutes. The pressure 
marks of the forceps were considerable. Dr. Harvey, Professor of Midwifery 
in the Medical College of Bengal, in an essay just received, reports six cases; in 
three out of six the success was complete, in one the forceps was without avail, 
while in the other two the instrument did not slip until it had brought down the 
breech so as to allow him in one case to get his fingers over the groin, and in the other to apply the fillet, which he 
had previously failed to do. Dr. W. H. Van Wyck, of this city, reports to me by letter two cases in which, in the 
years 1865 and 1867, he extracted the children by the breech with the forceps. Both children were born living. 
Since the invention by Tarnier of axis-traction a new impetus has been given to the method advocated. 
"With axis-traction not only is the resistance offered by the pelvic canal diminished, but, as Pinard states, the 
pressure is regulated and is not increased by traction. The foetal portion is therefore seized solidly, and with the least 
risk of harm. Ollivier reports successes with Tarnier's latest model in his own practice and in that of Budin, Thomas, 
Berthaut, Lobat, and Cayla. Thus it will be seen that the weight of experience is favorable to the use of forceps as a 
breech-tractor, while the objections are for the most part theoretical. As regards the rules governing the application 
of the forceps to the breech, it should be stated that the instrument is inadmissible so long as the breech does not 
engage in the pelvis. Haake limited its employment to cases in which the breech was already in the pelvic outlet, and 
after complete rotation had taken place. The history I have related, shows that this rule is not inflexible even with 
the ordinary forceps. 
Fig. 3779.-Lusk's Tarnier's 
Axis-Traction Forceps. 
* Haake, "Ueber den Gebrauch der Kopfzange zur Extraction des Steises." Archiv. f. Gynaek. Vol. XI., p. 558. 544 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNECOLOGICAL 
OBSTETRICAL. 
Axis-Traction. Forceps. (Continued.) 
With the axis-traction forceps the indication is certainly extended, as a rule, to all cases where the breech has 
passed below the pelvic brim, and where the dilatation of the os is well advanced. If rotation has taken place, 
the blades should be applied over the sacrum and the posterior surface of the thigh, as recommended by Haake. If 
the hips occupy a transverse diameter, the blades should be applied to the lateral surfaces of the thighs as suggested by 
Ollivier. The application of the blades over the trochanters, with the extremities overlapping the crests of the ilia, is 
to be deprecated, as the ilia are compressible and allow the forceps to slip (Ollivier). The extraction of the child 
should not be made an exhibition of strength. The rigidity of the maternal structures is rarely to be overcome by any 
justifiable degree of force. The slow descent of the breech, effected by intermittent tractions, insures the physiological 
softening of the tissues in advance of the presenting part. In this respect the rule is the same as in head presentations. 
As the genital canal softens and relaxes, but little force is required to effect the birth of the breech. The tractions are 
most effective if made during the pains. If possible, they should be aided by simultaneous pressure, exerted by an 
assistant, upon the fundus of the uterus. If these rules are observed, the efforts to extract the breech will, in a large 
number of cases, I am sure, be crowned with success. If they fail, at least no injury to either mother or child is likely 
to result from the trial. 
Fig. 3780.-The Fillet. 
" If the forceps fail, or, owing to the non-engagement of the breech, it is contra-indicated, and an extremity can 
not be brought down without the employment of force, a resort to the fillet is admissible. The theoretical objections 
to its use are: I. That the fillet is apt to become twisted, and that, when moistened with the vaginal secretions, it 
forms an uneven band, which, even with care, is capable of cutting deeply into the tissues ; 2. That in some cases it 
causes partial extension of the extremity, and, as a consequence, slips forward upon the thigh, whence a fracture of the 
thigh bone becomes inevitable. The reports from the Lying-in Institution of Munich, where, owing to the advocacy 
of Hecker, the fillet has been assiduously tested, do not confirm these gloomy prognostications. 
"It is hardly necessary to add that, when the fillet is used, it should be passed over the anterior thigh, that only 
moderate tractions should be employed, that these are most effective when made during the pains, and that very 
effective aid can be furnished by conjoint pressure upon the opposite pole of the foetus, exerted during the tractions, 
by a skilled assistant. The main drawback to the popularization of the fillet is the fact that its passage around the 
groin by the finger alone is by no means easy in the very class of cases in which it is principally indicated, viz. : those 
where the breech is high in the pelvis and difficult of access. To be sure, with patience, the knotted end of a hand- 
kerchief can sometimes be pushed around the flexure of the thigh, or, failing in this, an elastic catheter with an 
attached loop may be guided by a finger in the groin between the thighs, to serve as a means of conducting the fillet 
into position. Because of the difficulties, however, attendant upon both these plans, many porte-fillets have been devised. 
" The one I now exhibit (Fig. 3780), which is a modification by Ollivier of an instrument invented by Tarnier for 
carrying a cord around the neck of a child in neglected shoulder presentations, is an ingenious example. It consists 
of a long-handled blunt hook, tunnelled in the centre, and terminating in an olive-shaped bulb. The central canal 
permits the passage of a long piece of whalebone, the extremity of which is furnished with a metallic eye to which a 
loop can be attached. When the whalebone is withdrawn, the eye occupies the hollow space in the olive-shaped ex- 
tremity of the blunt hook. Below the handle the end of the whalebone is supplied with a button to prevent it from 
being accidentally withdrawn into the canal. A screw above the handle serves to fix the whalebone at whatever point 
is deemed desirable. The blunt hook is adjusted by passing it upward along the surface of the child, directed to the 
front to a point above the pelvis, and then directing the curve so as to adjust it to the groin. The whalebone is then 
easily pushed forward until it is felt by the finger of the physician between the thighs of the foetus. The metallic eye 
is next directed outside of the vulva by the fingers, and the attached fillet is easily withdrawn by reversing the process 
described. The fillet employed may be of any material. Every care should be taken to adjust it without forming 
folds or creases. In emergencies the nearest object has to serve the purpose. Ollivier recommends passing a lacing 
through a piece of rubber tubing of the size of the little finger. The lacing should be sewed to the extremities of the 
tube, a projecting portion serving to attach the tube to the eye at the end of the whalebone of the porte-fillet. The 
rubber tubing, in his experiments, admirably answered the purpose of protecting the tissues of the child from injurious 
pressure. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
545 
@YN/ECOLOGICAL. 
OBSTETRICAL. 
Forceps. (Axis-Traction, Continued.) 
"In the absence of other appliances, or should failure attend the measures already described, it is well to remember 
that the blunt hook owes its evil reputation, not so much to its inherent defects, as to lack of proper caution in its 
employment. It will not break the femur if adjusted in the groin. It will not produce serious contusions if the blunt 
end is carefully guarded by the finger. Injuries to the maternal organs can only occur where leverage movements are 
made. The pressure of the curved portion upon the groin is not likely to produce serious lesions. Steady downward 
tractions, made with moderate force, and with a hand in the vagina to guard the point of the instrument and to give 
warning of commencing extension of the thigh, will, as a rule, suffice to prevent the occurrence of serious accident. 
" Finally, it is proper to state that no instrument is capable of furnishing so secure a hold of the breech as the 
cephalotribe. if the child is dead, a fact rarely to be determined with positiveness except in cases where the cord can 
be felt, the cephalotribe should be screwed tightly to the breech, and may be trusted to act as a perfectly reliable 
tractor."-New York Medical Journal, February 14, 1885. William T. Lusk, M. D. 
** In Carl Braun's clinic, the forceps gene- 
rally used is of the Simpson pattern, modified 
in certain particulars by Braun himself. Un- 
der ordinary conditions, this forceps has been 
found to answer every requirement ; but in 
difficult and high forceps cases accompanied 
by more or less pelvic deformity, it has often 
been necessary to terminate labor either by 
version or craniotomy. For a number of 
years Braun has been accustomed to resort in 
the latter class of cases to one or another 
modification of Tarnier's axis-traction forceps, 
and with such favorable results that he has 
himself, by certain alterations, converted the 
typical Simpson into an axis-tractor, and this 
forceps he describes in the present paper. 
Braun has become convinced that through re- 
course to axis-traction living children may be 
brought through deformed pelves in cases 
where, in the absence of an axis-traction in- 
strument, craniotomy would be requisite. 
Braun's tri-form forceps-as he terms it-is 
thirty-six centimetres long, the blades being 
twenty-two centimetres. At the lower angle 
of each fenestra are perforations where the 
handles are attached, making a double axis 
movable joint. The articulation is a perfect 
one, and the screws at the joints easily re- 
movable for cleaning. The hooks at the end 
of the fenestrse handles are for the insertion 
of a stirrup-shaped metallic plate which serves 
to fix the blades. The instrument, when 
used as in No. I, is practically an unaltered 
Simpson, and may be used in typical forceps 
cases. Where high forceps are indicated, owing to the movable joints, the pelvic curve of the instrument may be 
altered from seven to ten centimetres during the adaptation of the instrument, and later, during traction, this curve 
may be reduced at will. The increase in pelvic curvature of the instrument is gained by (No. 3) linking the fenestrse 
handles under the lock. (It is sufficiently suggestive from the cuts how the pelvic curve of the instrument may be 
altered at will by lifting the fenestrse handles above or below the lock.) After use, the instrument may be readily 
taken apart by the removal of the two screws which articulate the fenestrse to the handles, and carefully cleansed. In 
Braun's opinion, this instrument will answer on every possible occasion when forceps are indicated."-" C. Braun, On 
the Manifold Utility of a Tri-form Forceps." Wien. Med. Woch., No. 9, 1886. E. H. G. 
Fig. 3781.-Braun's Tri-form Forceps. 546 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYNAECOLOGICAL. 
OBSTETRICAL. 
Modes of Delivery in Obstructed Labor, 
" I. The Forceps.-From the earliest times in which midwifery was practiced, 
accoucheurs must often have felt the desirability of being able to seize the head of the 
child between the hands in order to hasten its progress in cases of difficult and tedious 
parturition. But the human hands are too thick and large to be thus used as the means 
of seizing and extracting the foetal head when it is arrested in the maternal passages. 
In order to get over this difficulty we use the forceps-which are in reality nothing else 
than a pair of iron hands, thinner and slimmer than our own - and thus capable of 
being pushed past the foetal head so as to embrace and catch it. 
"2. Vectis.-Another operative procedure, by means of which we may often succeed 
in effecting a safe and easy delivery in cases where the foetal head is high up in the 
pelvis, or not yet entered the brim, and when nature is found incompetent to the task, 
is that known as podalic version. * * * What we do in performing this operation 
of turning, is to interfere with the futile attempt of nature to force the child through a 
contracted canal in pushing the head first, by turning it; so that the feet are first brought 
down, and then using these as media by which we may afterwards pull through the 
partially compressible head of the infant. 
" 3. Craniotomy.-By the use of the forceps, and by means of turning, we can bring 
children into the world alive that would have inevitably perished had their birth not been 
hastened by the aid and appliances of art. But there are cases ever and anon occurring 
where the foetal head is too large, or the maternal passages are too small, or the uterus is 
too rigidly contracted to admit of the delivery of the child alive without bringing the life 
of the mother into the most imminent danger. In such instances we can still save the 
mother's life by sacrificing that of her progeny. For by opening the head of the infant 
by means of perforating instruments, we can remove the contents of the cranium, and 
then break down the vault of the skull itself, and bring away the fragments piecemeal, 
until only the base of the cranium and the bones of the face remain to be extracted by 
means of crotchets and other instruments. This frightful operation has been recommended 
and had recourse to alike in cases where the child was living and where it was dead. 
" 4. Cephalotripsy.-About a quarter of a century ago, an instrument was invented 
by the younger Baudeloque, which was intended to supersede all those instruments by 
means of which craniotomy is performed. This formidable instrument is called the cephalotribe, 
and is used for crushing and diminishing, not the presenting portion of the head only, but all the 
bones of the head and face as well. At first, this instrument was used alone for all the purposes of 
diminution and extraction ; but now a preliminary perforation of the head, as in the ordinary operation 
for craniotomy, is always, I believe, first effected."-" Works of Sir James Y. Simpson." Vol. III. 
" Cranioclast.-This is substantially a powerful pair of craniotomy forceps. The larger blade, 
which is intended to be placed upon the outer surface of the head, is fenestrated and grooved. The 
smaller one, for introduction into the perforated skull, is solid and supplied with ridges which fit into 
the grooves upon the opposite blade. The two blades articulate by means of a button lock. By a 
twisting movement, the cranioclast, when applied, can be employed to wrench off the bones of the 
calvarium, different portions of the skull being seized successively with the view of accomplishing 
that result. * * * The cranioclast enables us to extend the limits of safe delivery far beyond 
what would be admissible with the cephalotribe, as with its aid it is possible, after the complete or 
partial removal of the flat bones of the skull, to tilt the chin downward, and draw the base by the 
edge through the conjugate. 
" The Crotchet xi, a steel hook with a sharp-pointed extremity. In craniotomy the instrument is 
often useful in breaking up the brain. It may be inserted into an orbit when it is desired to bring 
the base of the skull end on into the pelvis. In default of either cranioclast or cephalotribe, it may 
be employed to extract the perforated head. 
" The Blunt Hook, though not indispensable, is capable of rendering valuable service in de- 
livering the head after the performance of craniotomy. * * * ln difficult cases, delivery of the 
trunk is sometimes favored by tractions made by a blunt hook inserted under the posterior shoulder. 
" Embryotomy.-In a literal sense, embryotomy includes all the graver operations designed to 
diminish the volume and resistance of the foetus. Custom has, however, restricted the term to those 
operations only which are performed upon the trunk of the child. It is used, therefore, as a rule, in 
Fig. 3782.-Simpson's Forceps. 
Fig. 3783.-White's Vectis. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
547 
GYJM/EeOLOGieAL 
OBSTETRICAL. 
Modes of Delivery in Obstructed Labor. (Continued.) 
contra-distinction to craniotomy, and not in its generic sense. * * * Embryotomy includes two operative 
measures, viz.: exenteration and decapitation."-"The Science and Art of Midwifery." Lusk. 
" 5. Cas are an and Sigaultian Operations.-Where no amount of diminution in the size of the infant would suffice 
for the extraction of it with safety to the mother, accoucheurs sometimes-but fortunately very, very rarely-try to 
save the infant's life by having recourse to one or other of these two operations, by which, however, the mother's life 
is almost inevitably sacrificed. We may either make an incision into the abdominal and uterine walls, and bring the 
child out through that opening; or we may divide the pelvis at the symphysis pubis, and, by separating the two sides 
of the bony pelvis in this way in front, we may produce a dilatation of the passages sufficient to allow of the transit of 
the child. A mighty improvement on all of these form of operation is- 
"6. The Induction of Premature Labor.-By bringing on labor at a period in ptero-gestation when the child is 
still small enough in construction to pass safely through a contracted pelvis, although sufficiently developed to be able 
to maintain an independent extra-uterine existence, we can obviate nearly all the risks to which both mother and child 
are exposed in all of the operative procedures of which I have been speaking. This operation, which represents, 
perhaps, the greatest improvement that has ever been made in the practice of midwifery, was first suggested and per- 
formed in England about the middle of the last century ; and, when we know beforehand of the existence of some 
degree of deformity of the pelvis likely to impede the birth of a full-grown foetus, there is no safer, or speedier, or 
more satisfactory way of solving the problem as to how the dangers of delivery in such a case are to be avoided, than 
by bringing on labor four, six or eight weeks before the normal period of parturition, by simply separating, to some 
extent, the decidual membranes from the interior of the body of the uterus."-" Works of Sir James Y. Simpson." 
Vol. III. 
PLACENTA PRAEVIA. 
"Placenta Previa {prce, "before, and via, "way'), P. obvia sen oblata. Presentation of the placenta; a con- 
dition which gives rise to unavoidable hemorrhage from the uterus. The safety of the female depends upon speedy 
delivery."-Dunglison. 
Barnes' Dilators (see Fig. 3605).-" These bags are inserted into the cervix uteri by means of a sound intro- 
duced into the little pouch, situated on the outside of the bag. The instrument is expanded by injecting water into 
it by means of a Davidson's syringe." 
McLean's-Barnes' Dilator (see Fig. 3606).-" The usual fiddle-shaped bags (Barnes') are inserted by means 
of a sound introduced into the little pouch, which is situated, necessarily, at an awkward point on the surface of the 
bag. This pouch, besides being liable to be punched through in a somewhat dangerous manner, in the attempt at 
introduction, is a convenient receptacle for septic matter. * * * My instrument is a duplication of the bag and 
tube, so that one side may be distended independently of the other, thus requiring but one insertion to get a very 
extensive dilatation. These bags are made as smooth as possible, have no extra pouch, and are easily and quickly 
inserted by means of a pair of somewhat curved forceps, and are held in situ until sufficiently distended to retain 
themselves within the grasp of the cervix." 
McLean's Forceps for Introduction of the Dilator (see Fig. 3597).-"In placenta praevia, time is ex- 
ceedingly valuable, and this instrument renders the operation more valuable by being promptly accomplished. I 
have generally found one size all that is required in dilating the cervix, so that one insertion has sufficed to complete 
the necessary expansion. They are easily cleaned, strongly made, and there need be but two sizes used. I have 
found them also very valuable in the induction of labor for eclampsia, 
and I know of no other means which will accomplish delivery so 
safely and quickly. The largest size I have found useful as a vaginal 
dilator or colpeurynter. For expanding this instrument, I always use 
carbolized hot water. The pressure made by it is very powerful, and 
they should be slowly injected ; one side being fully distended first, and, 
as soon as the grasp of the cervix begins to relax, the other tube is at- 
tached to the syringe and very slowly filled. In this manner continuous 
dilatation with complete occlusion of the bleeding os is accomplished, 
giving us most valuable aid in the management of placenta praevia."- 
American Journal of Obstetrics. March, 1886. 
For dilatation of the os uteri and upper part of the vagina, see 
also Uterine Dilators, page 504. 
Uterine Dilators. 
Fig. 3784.-Braun's Colpeurynter. 548 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
©YN^eObOSICAb. 
OBSTETRICAL. 
Vectes, Levers, Cord Carrier, Insufflators and Placenta and Embryotomy Forceps. 
Fig. 3785.-Wenck's Amniontome, for 
rupturing the membrane during childbirth 
Fig. 3786.-Pulling's Funis Clamp. 
Fig. 379°--Dewey's Hook and Carey's Lever. 
Fig. 3789.-Scholler's Cord Carrier, 
for holding or changing the position of the umbilical cord 
Pulling's funis clamp is made of a single strip of thin steel doubled on itself, by which 
pressure on the cord may be rendered constant under all circumstances for preventing 
haemorrhage. 
Fig. 3787.-Vectis. 
Fig. 3788.-Ryerson's Adjustible Vectis. 
Fig. 3793. 
Bachelder's Embryotomy Forceps. 
G. TIEMANN&C0. 
Fig. 3792>-Lusk's Insufflator, made of an English 
elastic catheter, fitted to a soft rubber air-bag. 
Fig. 3794.-Robinson's Insufflator, 
'or the lungs of infants who are born in a state of semi- 
asphyxia, after prolonged or difficult labor. 
Fig. 3791.- Tiemann & Co.'s Embryotomy Forceps. 
Fig. 3795.-Placenta Forceps. GEORGE TIEMANN * CO.'S SURGICAL INSTRUMENTS. 
549 
©YN/ECO LOGICAL. 
OBSTETRICAL. 
Craniotomy and Embryotomy. 
Fig. 3796.-Batchelder's Perforator. 
Fig. 3802.-Bedford's Perforator. 
Fig. 3797.-Naegeli's Perforator. 
Fig. 3798.-Holme's Perforator. 
Fig. 3799.-White's Perforator. 
Fig. 3803.-Smellie's Perforator. 
Fig. 3800.-Simpson's Perforator. 
Fig. 3801.-Thomas' Perforator. 550 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
©YN/ECOLOGISAL. 
OBSTETRICAL. 
Craniotomy and Embryotomy. 
Fig. 3804.-Blot s Perforator. 
Fig. 3811.-Trueheart's Trephine Perforator. 
Fig. 3805.-Blunt Hook and Crotchet. 
Fig. 3806.-Taylor's Blunt Hook. 
Fig. 3808.-Bedford's Guarded Blunt Hook and Crotchet. 
Fig. 3812.-Braun's Trephine Perforator. 
Fig. 3809.-Decapitating Hook. 
Fig. 3810.-Braun's Decapitating Hook. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
551 
GYNAECOLOGICAL 
OBSTETRICAL. 
Craniotomy and Embryotomy. 
Fig. 3813. 
Tarnier's Basiotribe. 
Fig. 3814.-Thomas' Craniotomy Forceps. 
Fig. 3815.-Meigs' Craniotomy Forceps, straight. 
Fig. 3816.-Meigs' Craniotomy Forceps, angular. 
Fig. 3817.-Meigs' Craniotomy Forceps. 
Fig. 3818.-Van Havel's Forceps Saw. 
For dividing the head from crown to base into half. 552 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
GYN^ECOLOGICA 
OBSTETRICAL. 
Craniotomy and Embryotomy 
Fig. 381g.-Simpson's Cranioclast. 
Fig. 3820.-Braun's Cephalotribe. 
Fig. 3821. 
Simpson's Cephalotribe 
Fig. 3822.-Lusk's Cephalotribe. 
Bags for Obstetrical Instruments. 
Fig. 3823.-Obstetrical Bag. 
We also make Leather " Roll-up" Pouches to hold Obstetrical Instruments, 
and also fit instruments accurately and compactly into Russia Leather or Patent 
Leather velvet-lined Cases. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
553 
@YN/EeOLOGieAk 
OBSTETRICAL. 
Sets. 
Bedford's Set of Obstetrical Instruments. 
$28. 
I pair of Bedford's Forceps 
1 Bedford's Perforator. 
I pair of Placenta Forceps. 
I Blunt Hook and Crotchet, combined. 
1 Leather Pouch, lined with oil-dyed velvet. 
Budd's Set of Obstetrical Instruments. 
$40. 
1 pair of Budd's Forceps. 
1 Blunt Hook and Crotchet. 
I Perforator. 
1 pair of Placenta Forceps. 
1 pair of Craniotomy Forceps. 
1 pair of Simpson's Short Forceps. 
1 Patent-Leather Case, neatly arranged and lined with 
oil-dyed velvet. 
Hodge's Set of Obstetrical Instruments. 
$16. 
1 pair of Hodge's Forceps. 
1 Blunt Hook and Crotchet, combined. 
1 Bedford's Perforator. 
1 Leather Pouch, lined with oil-dyed velvet. 
Thomas' Set of Obstetrical Instruments. 
$66. 
1 pair of Elliott's Forceps, rather heavy. 
1 pair of Davies' Short Forceps. 
1 Trephine, for Perforating. 
1 Blunt Hook and Crotchet. 
1 Simpson's Cranioclast. 
1 Cephalotrite. 
1 Gum Elastic Catheter. 
1 8 oz. Phial for Chloroform. 
1 Case, patent leather. 
Taylor's Set of Obstetrical Instruments. 
$28. 
1 pair of Taylor's Forceps. 
1 Smelley's Perforator. 
1 pair of Craniotomy Forceps. 
1 pair of Placenta Forceps. 
1 Blunt Hook and Crotchet combined. 
1 Leather Pouch, lined with oil-dyed velvet. 
Brickell's Set of Obstetrical Instruments. 
$48. 
1 pair of Brickell's Long Forceps. 
1 pair of Brickell's Short Forceps. 
1 pair of Straight Craniotomy Forceps. 
1 Perforator. 
1 Vectis. 
1 Guarded Blunt Hook. 
1 Guarded Crotchet. 
1 Leather Pouch, lined with oil-dyed velvet. All the 
instruments nickel-plated. 
G. Tiemann & Co.'s Aseptic Obstetrical Case. 
$72. 
1 Braun's-Munde's Cephalotribe. 
1 Blunt Hook. 
1 Vectis. 
1 Jewett's Obstetrical Forceps. 
1 Simpson's Obstetrical Forceps, short. 
1 Placenta Forceps, double crossing. 
1 Blot's Perforator. 
1 Cary's Hook and Lever. 
2 Bottles. 
1 Case, russet leather, velvet lined. 
All handles are of hard rubber and " baked on." 
Elliott's Set of Obstetrical Instruments. 
$35- 
1 pair of Elliott's Forceps. 
1 Ebony-Handled Blunt Hook. 
1 Ebony-Handled Crotchet. 
1 Blots' Perforator. 
1 pair of Plain Placenta Forceps. 
1 pair of Ramsbotham's Craniotomy Forceps. 
1 Roll-up Pouch, lined with oil-dyed velvet. 
TRACHELORRHAPHY, HYSTERO - TRACHELORRHAPHY. 
" In reviewing the field of practice, I have not found it possible to discover any natural line of division between 
obstetrics and gynaecology. No man merits the reputation of a good acoucheur unless he possesses a thorough appre- 
ciation, not only of the immediate dangers, but of the far-reaching consequences of the faulty practice of his art; nor 
can his equipment be looked upon as otherwise than defective unless it include an ability to repair surgical injuries at 
the time of occurrence."-" The Science and Art of Midwifery." Lusk. 1882. 
Emmet's Operation.-"Lacerations through the neck of the uterus are of more frequent occurrence than has been 
supposed. In fact, I doubt if a woman can give birth to her child without some laceration taking place ; but the rule 
is that it should heal rapidly and cause no difficulty afterwards. Even most extensive tears are seldom recognized at 
the time of labor. The tissues are then so soft that, unless the rent has passed beyond the cervix into the vagina and 
Repair of Lacerations of the Cervix Uteri. 554 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYN^ECOLdOGIGAL). 
TRACHELORRHAPHY, HYSTERO - TRACHELORRHAPHY. 
Repair of Lacerations of the Cervix Uteri. 
connective tissue, it can scarcely be detected by a mere digital examination. Indeed, the occurrence of the accident, 
in all probability, will not even be suspected at the time, unless an unusual amount of haemorrhage should take place." 
"After labor, the whole organ being in a state of fatty degeneration, and the tissues of the neck soft, these flaps, in 
a double laceration, flatten against the posterior wall of the vagina, or floor of the pelvis, so that all appearance of 
laceration becomes lost. So perfect is the deception, that it is frequently impossible for any one not familiar with the 
condition to recognize the existence of a laceration by an ocular examination alone." 
" Dr. W. S. Playfair states,* in regard to this difficulty: ' It is. perhaps, somewhat humiliating for us to admit that 
we have all been misunderstanding these cases, and it is not very easy to convince sceptics of the fact, who have not 
accustomed themselves to the only method of examination by which it can be appreciated. So long as we use the or- 
dinary cylindrical speculum only, its extremity impinges upon the everted lips of the lacerated cervix, which are turned 
and rolled outwards, like the head of a piece of celery, and give the impression of an ulcerated surface.' If, however, 
we use a duck-bill speculum and a pair of tenacula we can, with the greatest ease, approximate the surfaces of the torn 
cervix, and at once the apparent abrasion disappears and the cervix seems for the moment to be of its usual shape and 
of an unbroken surface.' In my experience, the same difficulty exists when any other form of speculum is used, with 
this single exception: Sims' speculum is the only instrument in use which will leave the parts unchanged in position. 
My mode of examination is to place the patient on the back, and, by means of the index-finger, the true position can 
be readily appreciated." 
" The usual mode of operating is to place the patient on the left side, and to use Sims' speculum, or some other 
perineal retractor, to bring the parts into view. The operation can sometimes be performed with the patient on the 
back, when the vaginal outlet is large, since the uterus is then so low that it can be readily drawn outside and returned 
after the operation. But the left side has this advantage, that, while the patient is in this position, there will be less 
rolling out of the tissues than in any other, except in the knee-elbow-position. 
" When the uterine tourniquet is to be used, the first step is to bring the flaps together in apposition, and, while 
they are lifted up by means of a double tenaculum in the hands of an assistant, the instrument is to be slipped over 
the cervix below the point of vaginal junction, and tightened." 
Mode of Operating for Closure of a Lacerated Cervix. 
Fig. 3824.-Emmet's Uterine Tourniquet. 
" Its use is to control the haemorrhage during the operation, as it is sometimes excessive. The uterine tourniquet 
has a portion of a watch-spring passed through a canula, and in the handle is the double ratchet of the ecraseur to 
tighten the loop about the cervix. Just before constricting the neck, I take the precaution to draw up with a tenacu- 
lum, through the loop, sufficient vaginal tissue all around the cervix to enable the flaps to be brought together easily. 
The fold thus formed renders the instrument less likely to slip over the cervix, when it has become reduced in size from 
the escape of blood during the operation. 
" Until recently I regarded this uterine tourniquet as essential in every operation for closing a lacerated cervix. I 
now confine its use entirely to operations where the tissues of the cervix are unusually soft, since I have learned from 
experience that the loss of blood is likely, in such cases, to be very great. But, under ordinary circumstances, I have 
found that the administration of a large hot-water vaginal injection, just before the operation, will so far lessen the 
bleeding that the tourniquet can be dispensed with. * * * 
"At the beginning of the operation it is always necessary to open out the flaps, so as to expose fully the lacerated 
surfaces which are to be denuded. The surface is to be removed from one lip to the other, leaving a broad undenuded 
tract in the centre, from before backward, which is to form the continuation of the uterine canal to the os. The un- 
denuded portion on each flap is made to correspond with that on the opposite side, and should widen gradually from 
the outer end of the uterine canal towards the limit of the laceration. Therefore, when the flaps are brought together, 
the new canal through the cervix will be trumpet-shaped. As the uterus gradually returns to the normal size, the new 
canal will become of natural and uniform diameter throughout. To make this canal of a proper size, we must be 
guided by the amount of hypertrophy in the flaps. It must bear some relation to the increased size of the flaps, and 
* " Notes on Trachelorrhaphy, or Emmet's Operation."-" Transactions of the Obstetrical Society of London." 1883. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
555 
GYN/ECOLOGICAL. 
TRACHELORRHAPHY, HYSTERO - TRACHELORRHAPHY. 
Repair of Lacerations of the Cervix Uteri. (Continued.) 
the trumpet-shape is necessary, since the hypertrophy increases in degree from the bottom of the laceration towards the 
outer edge of the flap. * * * 
" Either the scissors or the scalpel may be used to freshen the surfaces, but I prefer the scissors, for the greater ra- 
pidity with which the tissues can be removed with them. It is necessary, when freshening the surfaces, to remove very 
superficially the tissues near the outer angles of the fissure, just at the vaginal junction, unless the laceration should 
have been a very extensive one. The circular artery, owing to its elasticity and its position in loose connective tissue, 
is seldom ruptured when a laceration of ordinary extent takes place. But, as the parts contract after cicatrization, it is 
frequently left just at the termination of the angle of the fissure with the vaginal tissues. When the tissues are dense, 
I sometimes have to use a scalpel to denude the angle at the bottom of the laceration, when confined to one side. We 
frequently meet with cases where nature has attempted to repair the injury and to prevent the gaping of the flaps, in a 
double laceration, by filling in the angle on each side by granulations as the parts have healed. The result is that a 
dense cicatricial plug remains. When this condition exists, there is often much reflex disturbance of the nervous sys- 
tem, and frequently it is the exciting cause of neuralgia in other parts of the body. It is important to draw particular 
attention to this circatricial tissue, that not only its existence may be1 recognized, but the necessity for its removal fully 
appreciated. The presence of a circatricial cord across the cervix may give rise to as much disturbance as the original 
difficulty. 
" The cervix is sometimes lacerated in a bifid form, or in three, and even four, sections. Were we to denude in 
each cleft, and then attempt to bring these flaps together, the result would be, in all probability, a failure-since the 
traction in opposite directions would cause the sutures to cut out. 
"One or more of these flaps is usually hypertrophied and much out of proportion to the rest, so that it would be 
difficult to approximate the surfaces properly without removing a small segment by a V shaped incision, when the 
freshened surfaces may be brought together. When lacerated into four sections, I have removed on each side a seg- 
ment, and then brought the remaining flaps together as in a double laceration. With a knowledge of this principle, 
it will require but little study of any individual case to realize almost at a glance the proper course to pursue. 
" When it is safe to do so, the process of freshening the surfaces is very much facilitated by drawing the uterus 
gently down towards the vaginal outlet, and then having the organ steadied by a strong tenaculum in the hands of an 
assistant. The nearest portion, or that which is the lowest, should be removed first, since, by doing so, the view is 
less obstructed by blood running over the surface. The portion to be removed is to be hooked up with a small tenacu- 
lum, and the strip kept on the stretch while it is being separated, and, if possible, it should be removed by a single 
piece from the side of one flap to the other. This is the best plan to insure the denudation of the whole surface, when 
the oozing of blood is at all free. With the use of either the knife or scissors, the freshened surfaces should be made 
as smooth as possible, and uniform in extent. The best results are obtained when we get union by first intention ; but, 
to gain this, it is necessary that the parts should be approximated with some degree of accuracy, for a projecting edge, 
left to heal by granulation, cicatrizes, and afterwards contracts. The presence of a cicatricial cord across the cervix 
may give rise to as much disturbance as the original difficulty. 
" When the injury has been of long standing, and the tissues have become dense, the chief difficulty in the opera- 
tion is experienced in passing the needles. The short round needle, which I was the first to use for operations about 
the vagina, has the advantage of making only a punctured wound, and, when the suture which it carries is introduced, 
it so fully occupies the tract that there is little danger of oozing of blood, as after the use of the needle with a cutting 
edge. But, the more dense and indurated the tissue, the less vascular will be the parts. Under these circumstances, 
the lance-pointed needle, being easier of introduction, answers best for the purpose ; but, if the tissues are soft, the round 
needle should be used. Four sutures or more are required for each side, if the laceration is extensive or double."- 
" Principles and Practice of Gynaecology." Emmet. 
Skene's Method.-" The treatment consists in reuniting the divided parts by trachelorrhaphy. Preparatory treat- 
ment is necessary when the tissues of the cervix are abnormal. Cysts, if any exist, should be freely laid open. Hyper- 
aemia should be relieved by the free use of hot water injections and applications of iodine. The uterus should be held 
in position by a pessary or tampon, if there is any displacement requiring such treatment. 
" In restoring the cervix I greatly prefer to operate without anaesthetizing the patient. In the record of my last 
sixty-five cases I find that ether was used in two, and nitrous oxide gas in one. The pain of the operation is trivial com- 
pared with the suffering from the after effects of an anaesthetic, and the chances of a good result are increased by 
avoiding the disturbance of the sutures caused by the vomiting which so frequently follows the use of ether or chloro- 
form. 
" The operation is performed as follows: The patient is placed upon the left side, and a Sims' speculum intro- 
duced and held by a trained nurse or assistant. A tenaculum forceps, curved upon the side (Fig. 3825), is fixed in the 556 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
®YN/EC01d0®ICALd. 
TRACHELORRHAPHY, HYSTERO - TRACHELORRHAPHY. 
Repair of Lacerations of the Cervix Uteri. (Continued.) 
Fig. 3825.-Skene's Tenaculum Forceps. 
anterior half of the cervix, at a point which makes the lip of the os externum. The posterior half of the cervix is 
seized in the same way with a similar forceps, and the operator, taking a forceps in each hand, brings the two flaps 
together, in order to see exactly where the parts are to be united. The forceps which holds the anterior flap is then 
given to an assistant, while the one attached to the posterior flap is held in the left hand of the operator, and the sur- 
faces are denuded by the hawk-bill scissors (Fig. 3826). The parts of the scissors are made to seize the angle formed by 
Fig. 3826.-Skene's Hawk-bill Scissors. 
the junction of the two flaps as far as appears necessary. 1 he flaps are brought together by the aid of the forceps on 
each side, so as to bring the tissues more within the grasp of the scissors. The blades of the scissors are then closed, 
and a strip is removed from above downwards on each flap. It frequently happens that a portion of the tissue to be 
so removed escapes from the scissors at the lower portion of the flaps, on one or both sides; but that can be easily 
trimmed off with curved scissors. The most difficult part of the denudation is at the angle formed at the juncture of 
the flaps, if the curved scissors are used ; but with the hawk-bill scissors that portion of the denudation can be accom- 
plished accurately and with facility. Silver wire sutures are generally used, but I prefer silk. It is much more easily 
handled, and, when properly prepared, is as innocuous to the tissue as the metallic suture. 
" Braided silk (No. 7) is prepared by being immersed for several hours in melted beeswax mixed with five per cent, 
each of carbolic and salicylic acid. When thoroughly saturated, the silk is passed through a hole in a piece of card- 
board, or the eye of a needle, to remove the excess of wax. The needles used are triangular, pointed and about three- 
quarters of an inch long. The needle-forceps which I employ is made to obviate two difficulties. First, the tendency 
of the needle to slip when passing the suture on a curve, and, secondly, the danger of spoiling the point of the needle 
in withdrawing it. It is a double forceps composed of two halves, the central portions of which are made of elastic 
steel, which forms the handle. These halves cross at each end and terminate in the jaws of the forceps. At one end 
there are three grooves in the jaws, admitting the needle, and holding it at either an acute, obtuse, or right angle, 
whichever the operator may require. The other end of the forceps has jaws faced with soft copper. This is used to 
grasp the point of the needle in drawing it through. Fig. 3827 will give a correct idea of the mechanism of this instru- 
ment. 
Fig. 3827.-Skene's Needle Forceps. 
" The needle is placed in the groove which will give the desired angle, and is held immovable there, when the ope- 
rator grasps the handle and closes the catch. The needle is then passed into the tissue and left there while the forceps 
is unclasped and withdrawn ; its other end is then applied, to grasp the point of the needle in drawing it through. The 
sutures are tied as follows: One or two turns of the ends are made to form the first half of the knot; the assistant takes 
hold of one end, the other is passed through the loop of a counter-pressure tenaculum (Fig. 3828) and then seized by the GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
557 
GYN/ECOLdOGIGAL. 
TRACHELORRHAPHY, HYSTERO - TRACHELORRHAPHY. 
Repair of Lacerations of the Cervix Uteri. (Continued.) 
Fig. 3828.-Skene's Counterpressor, 
left hand of the operator. Traction is then made on both ends of the suture, and, at the same time, the loop of the 
instrument is pushed down along the thread to make the knot slip to its destination. Repeating this manoeuvre, com- 
pletes the knot. By this method the sutures can be tied about as easily and rapidly in the cavity in the vagina as upon 
a free surface, &c., &c."-" Holmes' Surgery," Vol. II. 1881. Alexander J. C. Skene, M. D. 
Other Instruments for Repair of Lacerations of the Cervix Uteri. 
" The difficulty of clearing out the angles nicely between the flaps in lacerations of the cervix, so as to bring the 
planes of incision to their true line of intersection, is a well-recognized one ; and no apology to the profession is neces- 
sary for inflicting upon its consideration a new instrument in the shape of a tissue-forceps. Everyone who has had to 
operate upon irregularly shaped, unsymmetrical lacerations, filled with tough cicatricial tissue, has experienced the dif- 
ficulty of locating and controlling, with a proper degree of precision and ease the lines of incision with the instruments 
used for cutting, whether they were the curved scissors or scalpel. I have, therefore, had Messrs. George Tiemann & Co. 
construct for my use the tissue-seizing forceps illustrated by the accompanying drawing. 
Fig. 3829.-Cowan's Trachelorrhaphy Forceps. 
" The blades are designed to transfix and than clamp firmly small areas and layers of tissue between their grasp, 
and at the same time to serve as a mechanical guide which limits and directs the scalpel or scissors in any given direction 
of dissection. They nest or spoon together like a pair of silver forks; one of them having small sharp tines or prongs like 
those of a common eating fork, while its companion presents a flat surface to its fellow, and is armed with short, sharp, 
and very small teeth, which interdigitate with the tines or prongs. The method of using it is as follows: the tined 
blade is first thrust in underneath the tissue to be removed, when the clamping blade is pressed down upon it, and its 
hold secured by a catch spring and the small teeth, which bury themselves in the tissues. 
"A scalpel or curved scissors now is made to cut along under the surface of the tined blade, freeing the instrument 
from its position where it has been imbedded in the tissues, and leaving the separated tissue adhering by one end. 
Underneath this detached portion the pronged blade can be reinserted as often as is necessary, and the whole finally 
taken off in one continuous layer; or the whole piece may be left at the point of intersection of the opposite side, to 
be removed by uniting the two planes of dissection at the proper centre. The tissue may in this way be so removed 
as to make any angle at the pleasure of the operator, and clear of all togs and shreddy bits of tissue which the bistoury 
or scissors often leave behind."-Geo. Gowan, M. D., Danville, Ky. Medical Record, August 1st, 1885. 
Fig. 3830.-Skene's Uterine Sector. 
"Theuterine sector, as my friends the instrument makers, George Tiemann & Co., call it, is an instrument which I 
devised for vivifying the tissues in the operation for the restoration of the cervix uteri after laceration. The handle and 
stem is about the shape and size of a uterine sound, only a little shorter in all. At the distal end it is flat and about 
five-sixteenths of an inch broad, and terminates in a number of needle-points, as seen at A, in the figure. To the 
under side of the needle-pointed stem is attached a blade, which is lance-pointed and fits closely under the curved 
portion. The point of this is seen at B. The end of this blade nearest to the handle is held out from the stem by a 
spring at C. The two portions are held together by a scissors joint. 558 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
®YN/ECOLOGIGAL. 
TRACHELORRHAPHY, HYSTERO - TRACHELORRHAPHY. 
Repair of Lacerations of the Cervix Uteri. (Continued.) 
" The instrument is used as follows: holding it by the handle, the needle-points are pushed into the tissues of the 
surface to be pared, and, by pressing in the cutting-blade at C, the lance-point is made to slip to and fro under the 
middle point and divide the tissues. By pressing the point of the instrument forward, and at the same time alternately 
pressing and relaxing at the end of the cutting blade, a strip of a surface can be shaved off with facility. 
" This instrument is not designed to take the place of the scissors or knife, but is intended as an assistant. For 
paring the edges of the divided cervix, when the tissues are so hard as to elude the knife or scissors, this sector is quite 
valuable. In paring the upper angle of a fissure of the cervix that runs up about the vaginal juncture, I have used it 
with more facility than I could the scissors or knife."-Alexander J. C. Skene, M. D., Brooklyn, N. Y., May, 187g. 
Van de Worker's Method.-"As my operation for the repair of the cervical rent is partly peculiar to myself, I think 
it proper to give a few words to the subject. The instrument that I use was figured and described in the Medical Re- 
cord, of New York, January 22d, 1880. It was designed to popularize the operation, but, owing to a misunderstand- 
ing of the method of using it, such has not been the result. To correct this, I again figure the instrument (and the 
manner of using it). 
Fig. 3831.-Van de Warker's Needle Forceps. 
"Fig. 3831, A, represents what I term the male blade. This has two buttons to receive the slot of the female 
blade, B, after the style of a lock of an obstetric forceps. The middle one (see Fig. 3831) for entering the needle, the 
lower one on the arm projecting downwards, is used to receive the slot of the female blade in withdrawing the needle. 
" In preparing the parts, I observe but one rule. I first freshen the opposing surfaces that I wish to unite, and 
then carry my scissors over the outer surfaces of the flaps, so as to remove a scant quarter of an inch of mucous mem- 
brane. Unless this is done, the line of union is apt to show a deep depression after repair, as in twisting the sutures 
the outer margin of the rent inverts, and, unless the inverted edge is freshened, union cannot take place. 
" The parts being prepared, the male blade (A, Fig. 3831) is first taken, and the needle placed at that point on the 
posterior flap, letting its point slightly penetrate so as to hold it where it is desirable to make the first stitch. The slot 
of the female blade B is then adjusted, the tip of the blade resting lightly upon the anterior flap. The lower or pos- 
terior flap is elongated in advance of the anterior, and, in order that the needle may be made to pierce both flaps at op- 
posite points, the anterior one must be drawn down by means of a tenaculum to correspond in length to the posterior 
flap. While the flap is being elongated it may be necessary to slide it laterally, one way or the other, so as to secure 
lateral as well as longitudinal coaptation. When this adjustment is effected, the needle-forceps is closed. No. 30, or 31, 
Fig. 3832.-Van de Warker's Needle Forceps. 
or 32 wire is then passed, looped, into the slot of the needle, which is then ready to be withdrawn. The female blade 
is removed and turned over, its extremity placed under the lower, or left hand, flap, and between it and the extremity 
of the male blade. The slot in the female blade then drops on the button of the extension upon the male blade. If 
the reader will examine Fig. 3832, he will observe that by closing the handles the extremities of the two blades are 
separated, which action must, of course, withdraw the needle. The needle need not be passed as deeply as some ope- 
rators are in the practice of doing. If, in paring the surface of the rent, a greater part of the tissue be removed from 
the outer margins, it follows that, by bringing these margins in contact, apposition is secured through the whole width 
of the denuded surfaces. It is, I think, a very simple manipulation. One great saving in time is in sponging. The 
only part of the operation during which I sponge is in paring. Here you need to see, especially in the final touches. 
But, in passing the suture, once place the needle where you want it, and if it does not transfix the opposite flap just GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
559 
®YN/EC01d0GICAId. 
TRACHELORRHAPHY, HYSTERO - TRACHELORRHAPHY, 
Repair of Lacerations of the Cervix Uteri. (Continued.) 
where you want it, the error lies in the manner you have manipulated the flap by the tenaculum, and not in passing 
the needle. Hence, no sponging in this stage is required, as in the other method with needle and needle-holder. 
Some operators place considerable stress upon the direction in which the needle is passed to secure proper adjustment 
of the flaps. My way in doing this is in shaping the flap. No other way appears practical to me. No matter how 
you pass the needle, so far as it secures apposition of the freshened surfaces, the line of traction of the suture is deter- 
mined by the direction in which its free ends are tied or twisted together."-American Journal of Obstetric j, July, 1883. 
Fig. 3833.-Von Ramdohr's Needle Forceps, 
" They consist of two needle-forceps, which may be united or separated by a pivot and notch-lock at their middle. 
The modus operandi is as follows: A straight needle is clasped at a right angle in the right hand forceps. It is pushed 
through both lips, then the open left hand forceps is hooked on the pivot and its open branches pressed against the cer- 
vix until the point of the needle lies between the branches. They are then closed, grasping the point of the needle, 
which is then withdrawn, having previously released the eye by opening the lock of the right hand forceps."-C. A. 
Von Ramdohr. November 4th, 1882. 
PERINEORRHAPHY. 
" Parturition is the great exciting cause of the accident; it is almost never met with in nulliparous women, except 
after removal of large tumors per vaginam, and then it is usually of little moment. 
" Time for Operation.-Upon this point authorities differ widely-some urging immediate action, some advising 
delay until the effects of parturition have entirely passed away, while others compromise the matter by giving pre- 
ference to the plan of waiting a few days only. To the first class belong Baker Brown, Demarquay, Scanzoni, Simon, 
and others of equal w'eight. Scanzoni thus clearly points out the advantage of early interference: ' The operation 
should be performed just after the delivery, because it is more likely that the bleeding lips of the wound will then unite, 
and because vivification of the edges not being necessary, the procedure is simpler and less dangerous.' The worst 
cases of the accident with which we meet generally follow instrumental or manual delivery, and, when the discovery of 
its occurrence is made, the patient will usually be in a profound anaesthetic sleep. Every operator should be prepared, 
under such circumstances, to attempt repair of the injury: for, if he succeed, the patient will be saved much suffering, 
while failure will not in any wise depreciate her condition. For this reason no case of obstetrical instruments should 
be considered complete which has not in it needles and sutures for performance of this operation. 
" I have commonly resorted to immediate operation, and the result of my experience leads me always to adopt it, 
unless the sphincter ani and recto-vaginal wall be so profoundly implicated in the laceration as to make the operation 
a serious and lengthy one, or necessarily to insure the passage of lochial discharge between the lips of the wound. 
Among those who are opposed to immediate interference are Roux and Velpeau ; while Nelaton, Verneuil and Maison- 
neuve advise delay for a few days, when all haemorrhage will have ceased and the edges of the wound be covered by 
granulations. There are three circumstances which tend to defeat the success of immediate operation: First, it is often 
performed by one not habituated to its performance, and, being practiced upon a woman who, having just been de- 
livered, is exposed to the danger of post-partum haemorrhage and surrounded by anxious friends, it is likely to be 
finished too hastily; second, the lochial discharge, constantly passing over the lips of the wound, is very likely to enter 
and prevent union: third, the operator having been taught to regard the perineum as the superficial layer of tissues 
intervening between the fourchette and anus, closes this by correspondingly superficial sutures, leaves the upper portion 
Repair of Lacerations of the Female Perinaeum. 560 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SYN/EeOLOGieALo 
PERINEORRHAPHY. 
Repair of Lacerations of the Female Perinaeum. (Continued.) 
of the perineal body open, creates a pouch for the accumulation of putrefying materials, and leaves the anterior vaginal 
wall and bladder without support in the future. My advice and practice, with regard to this point, are decidedly to 
give the patient the benefit of the doubt, and to close the rupture at once. If failure follow, however, never, un- 
less there be some special reason for so doing, attempt another operation before the results of parturition have en- 
tirely passed away. This will not be before the lapse of two months from the time of delivery ; just after delivery 
there is reason for operating which has passed away in a fortnight. When immediate operation becomes the rule of 
obstetric practice, the number of cases of disease thus occurring will at once and very decidedly diminish. But the full 
results of immediate operation will never be exhibited until the obstetrician studies the anatomy of this part, and learns 
how to approximate its entire divided surface by sutures carried up to the highest point at which solution of continuity 
has occurred. 
" Treatment of Cases ivhich have Cicatrized.-The operation now generally adopted in these cases, and which has 
received the name of perineorrhaphy, consists in vivification of the edges of the lips of the wound and their approxima- 
tion by sutures. Although the accident for which this procedure is instituted was described by the ancients, no 
surgical means of cure were ever devised for it until the time of Ambrose Pare. He advised the suture, and was fol- 
lowed in its use by his pupil Guillemeau. Subsequently it was employed by Delamotte, Saucerotte, Trainel, Noel, and 
others. Dieffenbach employed it successfully, adding to the operation oblique lateral incisions involving the skin and 
areolar tissue, for the purpose of relieving tension upon the parts brought together by suture. About the year 1832, 
Roux, of Paris, obtained the most brilliant results from the operation, and probably its elevation to the position of a 
reliable surgical procedure was due more to his achievements than to those of any other individual. He employed the 
quilled suture, and cured by it four out of the first five cases operated upon. Of late years great advances have been 
made in the operation by Mr. Brown, in England; Verneuil, Laugier, Demarquay, and others, in France; Langen- 
beck and Simon, in Germany; and Sims, Emmet, Agnew, and others, in the United States. 
"Instruments and Appliances Needed.-These will consist of a long handled curved scissors (Fig. 3295); a bistoury 
with narrow blade ; a toothed forceps (Fig. 3226); a tenaculum (Fig. 3264); twelve sponges fixed in handles ten inches 
long (Fig. 3254); artery forceps ; silk ligatures, and straight darning needles, threaded with silk which is double and 
tied at the eye of the needle by as small a knot as possible. A basin of water should be in readiness to receive the 
bloody sponges, and a pitcher, bucket or other reservoir at hand to supply more when this is to be changed. The 
instruments should be kept immersed in carbolized water, with which the parts should be freely bathed. Let the ope- 
rator keep clearly in mind the shape and dimensions of the body which he is about to restore. It is a triangle with 
apex above and base below. Two surfaces of this shape are to be vivified and held face to face by sutures. That is 
the whole operation."-For further description, see " Thomas, on the Diseases of Women," page 192. 1880. 
Fig. 3834.-Marcy's Perineal Safety Pin. 
"It is made of german silver wire, guage No. 21 or 22. The end is bent in a small loop and turned one-iourth 
of an inch therefrom at a right angle, and the shaft is two to two and a half inches in length, and sharpened like the 
point of the needle of a subcutaneous syringe. The one half is introduced from the vagina, within outward, quite 
deep into the connective tissue laterally-the direction being determined by the finger placed in the rectum, to 
which the pin should be parallel. The other half of the pin, similarly constructed, is introduced from without inward 
upon the opposite side, in the same manner, the point of which is caught in the loop of the first part and adjusted 
without. Thus a kind of 'safety pin' is constructed, and, when fitted to retain properly the enclosed portions, the 
loops are clamped down by the compression forceps, and the ends cut square. This is found to hold sufficiently firm; 
but, at first, fearing it might not be sufficiently secure, I also clamped a perforated shot upon the wire. The shot ren- 
ders the end of the pin less liable to cause irritation. If properly adjusted, the elasticity of the wire compensates for 
the colateral oedema, and does not impair the circulation in the enclosed parts, while complete approximation is ob- 
tained, and no force is exercised in the direction of the long axis of the triangle. Two to four pins are required, as 
the case may demand. The subsequent treatment consists, in most cases, of a daily washing out of the rectum by means 
of a large double rubber tube with a considerable quantity, usually three or four quarts, of water as hot as comfortable to 
bear. Upon the eighth or tenth day, as thought wise, each pin is gently pushed upwards, and the vaginal end exposed. 
Each side is then cut off near the juncture and withdrawn-"-Henry O. Marcy, M. D., Journal of the American 
Medical Association, October 27th, 1883. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
561 
GYN/ECOhOGICAb. 
PERINEORRHAPHY, 
Repair of Lacerations of the Female Perinaeum. 
Fig. 3835.-Agnew's Needle-Holder and Needles. 
Fig. 3836.-Agnew's Forceps, with Adjuster. 
Fig. 3837.-Shot Compressor. 
Fig. 3838.-Helical Needle for Ruptured Perineum. 
Fig. 3839.-Peaslee's Perineum Needles (detachable handle.) 
Fig. 3840. 
Ashton's 
Perineum Needle. 
Fig. 3841.-Peaslee's Perineum Needle (right and left). 
Fig. 3842.-Parker's Perineum Needles (encased in handle.) 
Fig. 3843.-Skene's Needle for Ruptured Perineum. 
Fig. 3844.-Usual Perineum Needle. 562 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
GYJM/ECOEOQie/L. 
PERINEORRHAPHY. 
Repair of Lacerations of the Female Perinaeum. 
Fig. 3845.-Parker's Perinseum Needle and Clamp. 
A Perineal Pin for Lacerations. 
Dr. S. M. Monser's (of San Francisco, Cal.) method of ad- 
justing a lacerated perineum : He uses a number of ordinary 
small safety-pins, either silver or nickel plated. A smooth 
shirt-button is first passed over the point of the pin and carried 
back as far as the spring. Then the pin is inserted at a distance 
of about one-half its length from the rent, and emerges at an 
equal distance on the other side. A second button is then 
slipped over the point and the pin is fastened. The points of 
entrance and exit should be far enough from the line of lacera- 
tion to insure firm coaptation of the wounded surfaces. The 
advantage claimed for this appliance over the ordinary suture is 
that it causes no strangulation of the tissues and little if any 
irritation. Dr. Monser states that he has used it with satisfac- 
tion to himself and comfort to his patient, and has obtained 
better results with it than with any other form of suture. 
Fig. 3846.-Munson's Quill Suture Stay. 
Fig. 3847.-Brickell's Perineal Stay. 
Agnew's Set of Instruments for Ruptured Perineum. 
$24.35. 
1 Scalpel. 1 pair of Agnew's Forceps, with Adjuster. 
I Ashton's Needle. 4 Curved Suture Needles. 
1 Agnew's Needle-holder and 3 Needles. 
1 pair Curved Scissors. 2 coils of Silver Wire. 
I Shot Compressor. 1 Tenaculum. 
2 skeins Silk Ligature. I Probe-pointed Bistoury. 
6 pieces of Cane or Bougie for Quill Sutures. 
i skein of Twine. i piece of Wax. 
i Mahogany or Rosewood Case, lined with oil-dyed 
velvet. 
Closure of the Vagina. 
" The procedure is resorted to in despair of accomplishing the cure of vesico-vaginal fistula, and in the hope of re- 
lieving the patient from the intolerable annoyance attendant upon an involuntary and constant discharge of urine. It 
does not, of course, equal in efficiency closure of the vesical fistula, since it involves the necessity of the urine being 
retained in the vaginal canal, which is injured by its presence, and is proposed only for those cases in which, from ex- 
tensive destruction of tissue, no hope of closure by suture can be entertained. By it the vagina and bladder are ren- 
dered a common receptacle for urine and menstrual blood, the only advantage gained consisting in the fact that they 
may be retained and discharged at will through the urethra, which remains open." 
Episiorrhaphy. 
"Closure of the vagina may be accomplished by two operations, episiorrhaphy and obliteration of the canal. The 
first originated with Vidal de Cassis, and consists in paring the inner surfaces of the labia majora and uniting them by 
sutures, so as to cause their complete adhesion." 
Kolpokleisis. 
" This consists in paring the vaginal walls. Strips of mucous membrane being taken away and the bleeding sur- 
faces brought in contact by suture, the bladder is kept empty by a catheter until union has occurred. This operation 
was first performed by Prof. Simon in 1855, and since that time has been resorted to in Germany, and many cases 
suffering from incontinence of urine, due to great loss at the base of the bladder, have been relieved by it."-" Thomas, 
On Diseases of Women." 1880. 
Dr. Emmet's Objections to Kolpokleisis.-" From my own observation I have learned that it is but a question of a 
few months, a year, or possibly two, before serious consequences must arise after leaving a receptacle, like a portion 
of the vagina, in which the urine may stagnate. To give a retentive power for a short time is not a sufficient compen- 
sation for the suffering and consequences which supervene. As the result of my experience, I would urge that the 
operation should never be resorted to under any circumstances. The maximum has now been reduced to two or three 
per cent, of cases where the resources of the surgeon cannot overcome all the difficulties which may be presented in 
closing a vesico-vaginal fistula. Something more may be accomplished in the future ; but at present these incurable 
cases are better without the retentive power gained by kolpokleisis."-"Emmet's Principles and Practice of Gynae- 
cology." 1884. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
563 
WOUNDS AND INJURIES 
WOUNDS. 
" Wound (Sax. vuna), vulnus (diminutive vulnusculum), volnus, pla'ga, traulma, tro'ma, trdsis, tre sis vul'nus, 
bla'be, tym'ma, (F. plaie, blessure). A solution of continuity in the soft parts, produced by some mechanical agent.- 
Wounds present innumerable differences: as regards their situation, the parts interested, their direction, size, shape, 
the nature of the instrument or agent by which they are produced ; their more or less simple or complex character, 
duration, &c. A wound is called incised (F. coupure, incision), when made by a cutting instrument; punctured, 
nyg'ma (F. piqure'), when made by a pointed instrument ; lacerated (F. dechirure, plaie par arrachemenf), when the 
parts are lacerated or torn by the wounding body ; poisoned, cellulitis venen ata, necu' sia (F. plaie envenimee), when 
some virulent or venomous substance has been introduced ; and contused (F. plaie contuse'), when produced by a blunt 
body. Gun-shot wounds, sclopetoplagee, vul'nera sclopeta' ria, seu a sclope'tis, seu sclopet'ica (F. plaies d? armes a feu 
or d' arquebusade or cCarquebuse, coup de feu), belong to the last division. Lesions produced in battle are classed by 
Dr. Farr under polem'ici (morbi)."-Dunglison. 
Fig. 3849.-Folding Litter for Carrying Wounded Persons. 
Litters of all patterns made to order at various prices, depending upon style and finish. 
" 1, The first and most important principle in the treatment of wounds is to keep at a distance all injurious in- 
fluences which can hinder or retard the healing. Therefore every method of treatment should be rejected which in- 
troduces new noxious influences. 
" 2. Rest is the most important condition for rapid healing. The injured part must be, therefore, placed at rest 
(immobilized, made immovable), and abolute rest in bed must be observed in all severe injuries, at any rate at the 
commencement. Every unnecessary disturbance (touching, examination, probing, squeezing, &c.) of a wound is to be 
avoided. 
" 3. Venous stasis hinders the healing. By elevating the limb care is taken that the escape of venous blood and 
lymph from the injured part is not impeded ; and the removal of any strangulation (such as constricting clothes or 
bandages) must never be omitted. 
"4. The retention of the secretions of the wound tends to suppuration, to traumatic fever, and to other accidental 
complications. A free escape for the. secretions of the wound is, therefore, always to be considered as one of the most 
important principles in the treatment of wounds. There should be no hermetical sealing of wounds, but an escape 
must be provided by the secretions, by introducing rubber tubes (Chassaignac's drainage tubes, page 75) as deeply as 
possible, and by an early removal of the sutures. One suture too tightly drawn may result in the death of the patient. 
" 5. Any contamination of a wound may call forth in it decomposition and putrefaction, and with them the acci- 
dental complications which retard its healing and endanger the life of the patient. Care for the most scrupulous clean- 
liness (of the fingers, instruments, bandages, linen, water and air) is, therefore, the first duty of the surgeon, as well 
as of the attendants. 
General Rules for the Treatment of Wounds and Injuries. 
The Covering of Wounds. 
"For protection against injurious influences from without, for the dressing of wounds, there are used : 
" I. Compresses-pieces of old soft linen, moistened with some fluid or ointment which prevents the hermetical 
closing which would arise from their adhering to the wound. It is best, for this purpose, to make holes through these 
compresses with a punch, or to change them into so-called ' gitter-charpie,' by drawing out the threads. 
" 2. Charpie-plucked from clean old soft linen with clean fingers, and placed beneath the compress, serves to suck 
up all the secretions of the wound and certainly answers for this purpose better than all other substitutes. As it is al- 
ways possible that the charpie contains infectious matter, it should be made harmless before its application by boiling 
and soaking in disinfecting agents (such as carbolic acid, salicylic acid, &c.) Lately too, in its place, many of the fol- 
lowing materials have been brought into use. 
" 3. Cotton Wool.-The common wool serves for wrapping up wounded parts ; this wool, purified and freed from 
grease by boiling in alkalies (charpie wool, Brun's wool dressing) serves for soaking up the secretions of the wound ; 
it is not intended to be applied directly, upon the surface of the wound, because the loose fibres of cotton become 
matted to the granulations. 
"4. Lint-a woven felted cotton, when soaked in oil or water, is a good dressing. 564 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUJMDS AND INJURIES 
WOUNDS, 
The Covering of Wounds. (Continued.) 
5. Oakum plucked from old ship s rope thoroughly soaked with tar, acts as a desinfectant and absorbtive agent, 
but is somewhat too hard for irritable wounds. The same may be said of jute. 
6. Waterproof materials as oil-silk, oil-cloth, gutta-percha tissue, india-rubber material, or varnished silk paper, 
serve for covering and keeping moist the dressings and for the protection of the bed-linen. 
7. Cradles made of bent wire and wood (wire arch), or of barrel hoops, are placed over the injured parts, so as to 
protect them against the accidental contact and pressure of the bed-clothes." 
Fig. 3850.-Esmarch's Irrigator. 
Cleansing of Wounds and their Vicinity. 
For this purpose there are used : 
" i. The Wound Douche (Esmarch's irrigator)-by means of 
which a stream of water (disinfected by the addition of carbolic 
acid, permanganate of potassium, acetate of alumina, salicylic acid, 
&c.) is conducted over the surface of the wound. The force of the 
stream is regulated by the pressure of two fingers holding the pipe, 
by raising or lowering the douche (or by the stop-cock). For wash- 
ing out the cavities of wounds and sinuses a soft point of vulcanized 
india-rubber may be placed on the nozzle. Care is taken not to in- 
ject the sinuses with too strong a pressure, because in this manner 
the fluid may be driven into the cellular tissue and produce a 
violent inflammation. The use of the syringe also is to be dis- 
couraged, because less control is obtained over the action of the 
stream than with the irrigator. 
"2. To catch the water and pus as it runs away, basins* of 
various shapes and sizes are used, made of metal or hard rubber, 
the edges of which fit the various parts of the body. 
3. The surface of the wound itself shonld never, under ordi- 
nary circumstances, be unnecessarily disturbed. For wiping away 
pits in the neighborhood of the wound, charpie-wadding soaked 
in a weak solution of carbolic acid is used, or the antiseptic balls 
(h ig. 3853). Sponges must only be used for cleaning wounds and 
their neighborhood, when all impurities contained in them are re- 
moved or rendered harmless. To thoroughly clean bath sponges 
they must be first repeatedly squeezed out in hot water, then dried, 
and beaten with a wooden stick till they no longer contain any sand. 
Sponges which have been used are freed from grease in a hot concentrated solution of soda. They are then placed for 
twenty-four hours in a solution of permanganate of potash (1: 500), and again washed in clean water ; after that they are 
soaked in a (1 per cent.) solution of the commercial salt of subsulphite of soda, to which is added 8 per cent, of the pure 
concentrated hydrochloric acid, until (in about a quarter of an hour) they have become white ; and, lastly, they are again 
washed in clean water until they are entirely scentless. They must be kept in a strong solution (5 percent.) of carbolic 
acid. Before being used they are laid in a weak solution (2| per cent.) of carbolic acid, and while in use they are 
constantly cleaned in this weak solution. 
"4. For thoroughly cleaning the injured parts of the body, the common baths (with the addition of soap, soda, ace- 
tate of alumina, &c.) are employed, as well as local baths." (Figs. 1246, 1247.) 
" For subduing the inflammation, cold, by the abstraction of heat, is of service, and this is employed in various ways: 
"I. In the form of Cold Wrappings .-They must be very frequently changed, if heat is to be constantly abstracted, 
but this easily disturbs the injured part. If one allows them to remain longer, so that they become hot, they act as 
excitants (Priesnitz's wrappings). 
"2. As Dry Cold-\>y ice in india-rubber bags (see page 40). If the direct application of the ice-bag is too cold, 
some layers of linen are laid between the ice-bag and the part. Glass bottles and tin boxes filled with ice or cold water 
abstract the heat more energetically than india rubber bags, but they are not so well applied to the body. A very ener- 
getic cooling in inflammations of the extremities can be produced by the cooling coil. This is the name given to a long 
The Reduction of Heat. 
* See pages 75 and 195. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
565 
WOUNDS AND INJURIES. 
WOUNDS. 
The Reduction, of Heat. (Continued.) 
Fig. 3851.-Esmarch's Cooling Coil. 
india-rubber tube, which is wound in serpentine turns around 
the inflamed part; one end of this tube, provided with a per- 
forated tin block, is sunk into a pail filled with ice-water, 
whilst the other end hangs down into an empty pail. By 
sucking at the latter a current is produced, which can be 
regulated by the compression of a ligature. When the upper 
pail becomes empty it is refilled by pouring in the water 
which has escaped. 
"3. By Irrigation with cold water.-Out of an irrigator 
(Fig. 3850) hungover the bed, cold water is dropped on the 
injured part, which is covered with linen ; in this the water 
diffuses itself. By inserting a straw into the nozzle of the 
irrigator the rapidity of the falling drops is regulated. In 
place of the irrigator an india-rubber tube can be used, pro- 
vided at one end with a stop-cock, at the other with a per- 
forated block of tin, which is sunk into a bucket filled with 
water. This tube then acts as a syphon, and must be set 
in action by sucking. The effect of irrigation in the reduc- 
tion of heat is very great in consequence of the evaporation 
of the water. It ist not, therefore, necessary to employ 
water of a very low temperature. The water, as it 
runs away, must be caught upon an oblique plain, or 
upon a waterproof (oil-cloth) beneath the limb, and 
guided into a pail standing below. (Fig. 3852.) 
"4. By Immersion in cold water.-To carry out 
this treatment the arm- and leg-baths (see page 42) 
are used : the injured limb being laid upon strips of 
bandages, which are fastened to the buttons on both 
sides of the bath. 
" This method of abstracting heat is especially suit- 
able for recent injuries of the hands and feet. It does 
not require a very low temperature, for the action of 
the permanent bath is very energetic. Water from 16 
to 180 R. (68 to 72|° F.), by a long duration in the 
bath, produces a very perceptible cooling effect. The 
regulation of the temperature, by pouring in cold 
water, can generally be left to the patient himself. 
Fig. 3852.-Syphon 
"For keeping septic matters from the wound, 
dressings for procuring complete closure are em- 
ployed, as well as Lister's antiseptic method. 
" Hermetical sealing aims at producing a dry scab 
upon a recent wound, which remains firmly adherent 
till cicatrization ensues. Open wounds can by this 
treatment heal without suppuration, like subcutaneous 
ones, and, when successful, putrefaction is avoided. 
This method is successful- 
" I. In superficial injuries-scratches, burns, abrasions, &c.-by powdering with flour, charcoal, chalk, potters 
clay, gum arabic; by drying the surface with a stream of air (from a pair of bellows); by slight corrosion with caustic 
or caustic or carbolic acid ; or by covering with cotton wool. 
" 2. In deeper complicated wounds (with fracture, injury to a joint, &c.), by covering the bloody wound with clean 
and disinfected wool, teased charpie, lint or German tinder, which form with the blood a dry crust. Over this a thick 
layer of cotton-wool is laid, and over all a water-proof material is fastened with a moistened gauze-bandage. 
The Hermetical Sealing of Wounds. 566 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND IJMJUF^IES 
WOUNDS. 
Lister's Method of Antiseptic Dressing. 
" This also aims at keeping from the wound all sources of putrefaction (hovering in the air and clinging to every 
object), or at rendering them harmless by antiseptic means, which should not, however, excite the wound to (a septic) 
suppuration. 
" I. For operations, the skin around the seat of operation, and everything which comes in contact with the wound 
(the hands of the operator and of the assistants, the instruments, &c.), after previous careful cleaning with soap and 
brush, is disinfected by washing with a strong (5 per cent.) solution of carbolic acid. 
"2. During the whole operation and at every change of dressing, the air in the neighborhood of the wound is per- 
petually filled with a fine mist of a weak solution (2| per cent.) of carbolic acid. In order to produce this mist the 
carbolic spray is employed.* During lengthy operations and dressings the spray can be momentarily interrupted, if 
the wound is in the meantime guarded by being covered with a linen rag soaked in a weak solution of carbolic acid. 
The sponges which are used at the operations must, after they are thoroughly cleaned and boiled, be kept in the strong 
carbolic solution, and, before as well as during the operation, be squeezed out in the weak solution. In the place of 
the sponges the antiseptic balls can be used. These are balls of salicylic wool, salicylic jute, or salicylic charpie, tied 
up in salicylic gauze. 
" 3. Wounds which have already been exposed to the air, and operation wounds which at the operation have come 
in contact with infectious matter, must before the application of the dressing be disinfected by washing with the strong 
(5 per cent.) solution of carbolic acid ; this does not retard healing by first intention If suppu- 
ration has already set in, a stronger disinfection with 8 per cent, solution of chloride of zinc is 
required for thoroughly washing out the wound. 
" 4. Every bleeding point is to be carefully ligatured with carbolized catgut, and the ends 
of the latter cut off close to the knot. After some time they are completely dissolved in the 
interior of the wound and absorbed. 
"5. The wounds are carefully sewn with silver wire or carbolized silk (uncolored silk 
which has lain for half an hour in a mixture of melted wax and carbolic acid). 
" 6. Draining tubes, well perforated, and carbolized by being kept in a strong solution of 
carbolic acid, are pushed into the deepest parts of the wound : and a careful compression is 
made upon the cavities of the wound by carbolized sponges, or pads of carbolized gauze, wool, 
salicylic wool, or jute. These are the means used to prevent the retention of the secretions of 
the wound. 
" 7. In immediate contact with the wound is laid a piece of protective silk, steeped in a 
weak carbolic solution ; this protects the wound against the direct influence of the carbolic acid, 
and, at the same time, when the dressing is changed, it indicates by an alteration in color (dirty- 
grey sulphuret of lead) whether decomposition has taken place. 
" 8. Over the ' protective' a layer of carbolized gauze in eight folds is laid, which extends beyond the edges of the 
wound more than a hand's breadth ; between the seventh and the eighth fold is placed a piece of mackintosh or varnished 
silk paper, which prevents the secretion from the wound penetrating directly through to the upper surface. The whole 
is fastened on with gauze bandages. 
"9. The dressing must be renewed in the same way as often as the secretions of the wound appear at the edges of 
the dressing ; at first once or twice a day, later on every two or three days, and at last much less frequently. The 
dressing is to be changed as quickly as possible. The neighborhood of the wound is cleansed with the irrigator and 
cotton wadding soaked in the weak carbolic solution. The cavity of the wound is not needlessly washed out. Only 
when the silk has become discolored must it be disinfected afresh with the strong carbolic solution. The drainage 
tubes are changed after some time, or replaced by thinner ones, and as soon as possible left out altogether. 
" to. If it is undesirable or impossible to renew the dressing frequently, the double antiseptic dressing is applied, 
the deeper layer of which consists of the ' protective ' and a compress, soaked in a solution of carbolic acid, which is 
fixed by a gauze bandage ; over this come then the dry layers and the sheet of mackintosh. The deep layer can re- 
main for weeks, and is only moistened at each dressing with the carbolic solution. 
" 11. In default of Lister's dry antiseptic gauze, Bardeleben's moist carbolic dressing can be used. Over the 'pro- 
tective' are laid many folds of gauze which has first lain for twelve hours in a strong carbolic solution, then been 
squeezed out and kept in a fresh 1 per cent, solution of carbolic acid. As soon as the secretion from the wound pene- 
trates anywhere to the surface, new layers of the moist gauze are put on. 
" 12. Boracic acid also acts as an antiseptic and can be used for superficial wounds, burns and granulating surfaces, 
either in the form of a watery solution (1:30) in which is dipped the lint or gauze, or as an ointment (1: 2 lard) 
[Chiene], 
Fig. 3853. 
Antiseptic Ball. 
Page 49, Spray Producers. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
567 
WOUNDS AND INJURIES. 
WOUNDS 
Lister's Method, of Antiseptic Dressing. (Continued.) 
" 13. Salicylic acid, which has been recommended by Thiersch, and lately so much employed, especially in com- 
bination with the carbolic dressing, has a similar effect, although not quite so certain an antiseptic as carbolic acid. It 
can be employed in a watery solution (1: 300), both for the spray and for impregnating the materials for dressing, for 
washing the instruments, hands, &c., but it is especially used for impregnating the materials for dressings, namely 
the wool and jute. Jute (prepared Arrakanian hemp), on account of its permeability, is especially fitted for antiseptic 
dressing.-"The Surgeon's Handbook." Dr. Friedrich Esmarch. 
Solutions. 
"For irrigating wounds, submerging instruments, and disinfecting in general, solutions of corrosive sublimate and 
carbolic acid are necessary, and pure alcohol, iodoform, and chloride of zinc solutions may at times be used. 
' ' Koch has demonstrated that, as a germ-killer, corrosive sublimate excels all known agents. The sublimate solutions 
vary in the proportion of one part of the bichloride to five hundred parts of distilled water by weight, or i to 500, 1 to 
1,000, 1 to 2,000, 1 to 3,000, for use outside of the great cavities, and 1 to 8,000, 1 to 15,000, and 1 to 20,000 within 
the cavities. 
" The sublimate solutions are only used for irrigation and for disinfecting the hands, sponges and gauze. All in- 
struments are submerged in carbolic acid solutions or in alcohol. The stronger solutions, 1 to 500 and 1 to 1,000, are 
rarely employed in irrigation, and then only when the part exposed has been made bloodless by Esmarch's bandage. 
Even when thus employed for the disinfection of an abscess cavity, ulcer, or sinus, the excess of sublimate should be 
immediately washed away by flooding the parts with the 1 to 3,000 solution. In any ordinary operation no stronger 
sublimate than 1 to 3,000 will be required ; a 1 to 10,000 solution may be used in the peritoneal or thoracic cavity where 
the conditions are such that the fluid may run out or be removed at once by sponges. I have filled the entire abdomi- 
nal cavity with warm sublimate, 1 to 18,000, mopping it out with sponges, and repeating the procedure three times 
without any bad symptoms resulting. 
"For convenience, any required solution may be made from the following: Corrosive sublimate, grs. xxx., 
water and glycerine, each f jj. Some add to this about grs. x. of table salt. One teaspoonful of this solution, added 
to a pint of water, approximates 1 to 2,000. Water containing lime should not be used. Tablets of corrosive subli- 
mate are now manufactured and are very convenient for transportation. Each tablet contains enough sublimate to 
make, when dissolved in a pint of water, a 1 to 1,000 solution. It is best to make fresh solutions when needed, for, 
unless kept tightly corked and away from light, they deteriorate in value. 
"Carbolic acid (1 to 20, or a 5 per cent, solution, is employed for the cleansing and submerging of all instruments 
used in a surgical operation. It is not used in irrigating, on account of its irritating properties. 
"The steam and carbolic spray, so much in vogue a few years since, is 
now only used to lay the dust, or as an aid toward the more thorough cleans- 
ing of operating rooms and wards which are especially exposed to infection. 
The spray machine (Fig. 1261) is started one-half hour before the operation is 
to commence, and is allowed to run until that time. The strength of the so- 
lution in the bottle is 1 to 20. As ordinarily sold, carbolic acid is dissolved 
in alcohol, and is about 95 per cent, strong. In this condition an ounce by 
measurement is an ounce by weight. To this quantity add glycerine, S j, 
and water, fxix., which will make a 1 to 20, or 5 percent, solution. All 
instruments are immersed in this solution a half-hour before the operation, 
except the blades of knives, which should be dipped in only a minute or two 
before being used. 
"Pure alcohol is also used for this purpose by some operators who dislike 
the benumbing effects of the acid. 
"Iodoform, one part dissolved in seven parts of ether, is used at times to 
wash the parts where an operative wound is to be made. It is not an uncom- 
mon practice with some of the German surgeons to immerse all the ligatures 
and suture-material in this solution for about twenty minutes before the ope- 
ration is begun. 
" Chloride of zinc solution in water (1 to 12, about 8 per cent.) may be 
used to wash out ulcers or old sinuses which are in the neighborhood of, or communicate with the wound of opera- 
tion. This and the iodoform solutions are not, however, essential, and are now rarely employed."-"Wyeth's Text 
Book on Surgery." 1887. 
Fig. 3854.-Wyeth's Douche 568 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
WOUJMDS AND INJURIES. 
WOUNDS. 
The Union of Wounds. 
"To unite the edges of Wounds, which have no tendency to slough (incisions and incised wounds), we make use of; 
" 1. Strips of adhesive plaster. They are on the whole seldom used, because the plaster easily irritates the skin, 
produces erythema and eczema, and causes the retention of the secretions of the wound. 
"2. Strips of gateze-bandage, which are fastened on both sides of the wound with collodion (gun-cotton dissolved 
in ether) or with gutta-percha dissolved in chloroform. 
"3. Stare h-bandage, dipped in water and applied over the edges of the wound, which are adapted by the fingers, 
presses the edges well together without keeping back the secretions of the wound. In many cases it is better to roll up 
the bandage from both ends, and with it to press the edges of the wound together from both sides. 
Fig. 3855. 
Fig. 3856. 
Fig. 3857. 
Fig. 3858 
Interrupted Suture. 
"4- Sutures.-a. The interrupted suture (Fig, 3855) is applied by more or less curved needles* 
with waxed or carbolized silk, twine, horse-hair, catgut, and silver or iron wire.f It is important to 
finish the stitch with a safe double knot, which does not itself become loose. For this purpose the 
reef knot is used, in which the threads pass respectively beneath and above the corresponding loops, 
while in the false knot or ' granny,' which is not secure, the threads on each side pass one above and the other below the 
loop. When the edges of the wound are considerably strained, it is best, in the first knot, to twist the ends of the 
thread twice around each other (Fig. 3858, surgeon's knot), and on that to tie the second, as in the reef knot. 
"5. The twisted suture is applied by means of insect-needles (Carlsbad needles), whose points are beaten flat and 
sharpened in the form of a lance. When they have been carried through the skin at some distance from the edges of 
the wound, they are wrapped around with thick cotton threads in alternating circles and figures of eight, so that the 
edges of the skin are pressed firmly against each other. The ends of the needles are then nipped off with a pair of 
Fig. 3859.-The Twisted Suture. 
Fig. 3860.-The Fold Suture. 
pliers. To unite the edges of the wound more accurately, a few fine 
interrupted sutures are placed in the intervals between the needles. 
The remains of the needles can be drawn out on the second day, with 
a twisting motion, by means of a pair of pincers, but the pads of thread 
which are generally glued to the skin by the blood, are allowed to re- 
main some days. This suture is especially adapted for large gaping 
wounds of the face, such as commonly occur in plastic operations. 
c. The fold suture (Faltennahf) serves for the union of very thin 
and flaccid edges of skin, which are by this method raised to a fold, 
and the surfaces in contact increased."-Esmarch. 
"Preparation of Catgut.-Select four sizes of the best quality, one dozen each the size of E and A violin strings, six 
D strings and two or three about twice the size of D violin. Remove the small red threads which are tied around each 
bunch, and place the catgut in a glass bottle or jar which contains enough pure oil of juniper berries to completely cover 
them. The vessel should be tightly corked to prevent evaporation. Within twenty-four hours the material is safely 
aseptic and will remain so indefinitely if kept immersed in the fluid. The strength of the catgut is not impaired, while 
its firmness is increased by the oil."-Wyeth. 
" Macewen has introduced a chromic acid catgut ligature, which resists absorption much longer than juniper or al- 
* Pages 79 and 455. 
+ Page 78. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
569 
WOUJMDS AN© INJURIES 
WOUNDS 
The Union of Wounds. (Continued.) 
cohol catgut. His method is: chromic acid, one part, water five parts (by weight). To one part of this solution add 
twenty parts of glycerine, and allow the catgut to remain immersed for seven or eight months. They are then preserved 
in carbolic acid one part, to glycerine ten (I to 10Y Thus orenared catcut will resist absorotion from twentv to sixtv 
days."-"Wyeth's Text Book on Surgery." 
Fig. 3861. 
Fowler's Antiseptic Ligature 
Carrier. 
Fig. 3862. 
Antiseptic Ligature. 
Fig. 3863. 
Spools and Jars. 
" By means of this little 
contrivance the gut can be 
unwound from the spool 
without handling or remov- 
ing it from the fluid in which 
it is immersed. The case can 
be made of sufficient width 
to accommodate as many dif- 
ferent spools as may be de- 
sirable."-"Antiseptic Liga- 
ture Spool and Base." By 
Geo. R. Fowler, M. D. 
Fig. 3865.-Slow Spiral, 
Bandages. 
Fig. 3864. 
Rapid Spiral. 
" To keep the dressings on, to envelope, compress and fix 
the injured part of the body, bandages are used, and these 
are made of the following material: a. of linen-these are 
best made of old soft linen, which has been frequently 
washed, and torn or cut according to the thread (bandages 
of new linen adapt themselves badly, because they are too 
stiff); b. torn from cotton stuff (shirting)-these are cheaper 
than the linen, and especially useful for starch bandages; 
c. from gauze (muslin)-these adapt themselves well, if pre- 
viously moistened, and stick together when dry, because 
they contain starch ; they are especially suitable for the ap- 
plication of plaster of Paris ; d. torn from flannel-these 
are soft and pliable, and consequently accommodate them- 
selves well to the part; they are especially suitable for plac- 
ing beneath starch and plaster of Paris bandages ; e. cut 
out of cotton wool-these are soft and compressible, and 
are, therefore, in like manner suitable for placing beneath 
hardening bandages.-"Surgeon's Handbook." Esmarch. 
The Bandaging. 
" 1 he bandaging must be done with great accuracy and 
care, for a badly applied bandage easily gets out of place, 
and by strangulation may produce considerable mischief. 
A bandage too tightly applied soon produces venous stasis ; 
the parts below the seat of strangulation swell, become painful, blue and cold, and if the 
cause be not soon removed gangrene ensues. If bandages, applied dry, afterwards become 
wet (^. £•., from cold wrappings) they shrink, and frequently produce strangulation. 
" In bandaging one distinguishes the following passes and turns : 
" I. The circular bandage, whose turns are applied on one and the same level (Fig. 3864, infra). 
"2. The rapidly ascending spiral {Schlangentour, dolabra repens') Fig. 3864, supra. 
"3. The slowly ascending spiral (Hobelbinde. dolabra ascendens), whose turns partially overlap each other (Fig. 3865). 
The descending spiral is seldom used, on account of its driving back the venous blood."-Esmarch. 570 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
WOUNDS. 
The Bandaging. (Continued.) 
Fig. 3866. 
"4. Bandaging by reverses (dolabra reversa, renversee'), 
(Fig. 3866, 5867, 3868), must be used when the circumfer- 
ence of the limb increases or diminishes, so as to avoid the 
gaping of the turns (Fig. 3869). 
Fig. 3869.-Gaping Bandage, 
Fig. 3867. 
"5. The figure-of-eight (spica) is employed where the 
bandage passes over a joint (Fig. 3870). 
Fig. 3870.-Spica. 
Fig. 3868. 
"6. The double-headed roller, a bandage which is rolled 
up from both ends, is used especially for the head, and for 
amputation stumps ; it is also employed for drawing to- 
gether the edges of wounds. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
571 
WOUNDS AND INJURIES. 
WOUNDS. 
The Bandaging. (Continued.) 
Fig. 3871.-The Many-Tailed Bandage. 
" 7. The many-tailed bandage, consisting of 
many short strips of bandage which overlap each 
other, is used for compound fractures and some-, 
times for the application of plaster of Paris. 
(Fig- 3871-) 
"8. The T bandage, a strip of bandage, to 
the middle of which another strip is fastened at 
right angles, is used in some dressings for the 
pelvis and head. 
The Handkerchief Bandages. 
" By means of a linen or cotton cloth, trian- 
gular (neck-handkerchief), or square (pocket- 
handkerchief), most of the dressings can be well 
applied ; little or no practice is required for 
their application, and there is little risk of stran- 
gulation. These bandages are, therefore, well 
fitted for military practice, and, before every 
thing else, for the first assistance on the battle- 
field."-"The Surgeon's Handbook."* Dr. 
Friedrich Esmarch, Surgeon-General, Prussian 
Army. 
THE HARDENING BANDAGES. 
I. Starch. Bandage 
was invented by Seutin, in 1840. 
" 1. Preparation of Starch Paste.-Starch 
is stirred with cold water to a uniform, cream- 
like consistence, and then, whilst constantly 
stirring, as much boiling water is added as will 
produce a clear, thick mucilage. 
" 2. Starch Bandages are strips of shirting, which are drawn through the fresh paste and rolled up into bandages. 
"3. Starch Splints are made bf strips of pasteboard, which are drawn once quickly through hot water, and then 
thickly smeared on both sides with the paste. 
"4. Application of the Starch Bandage.-The limb is very carefully bandaged with a moist flannel roller, after 
the recesses about the joints have been padded with cotton wool. A starch bandage is then applied, on which the soft 
starch splints are laid', and these are firmly bandaged on with a starch roller. Finally the whole is enveloped with a 
dry calico, cotton or gauze bandage. 
"5. Strips of paper can be used instead of the bandages. They are drawn through the paste, and applied after 
the method of Scultet's bandage (many-tailed). 
" 6. Burggrceve's Method of cotton wool and pasteboard is very simple and practical. Pasteboard splints are cut 
to the shape of the limb, then covered on one side with paste and on the other with a layer of cotton wool; the splints 
are applied with the cotton wool next the limb, and firmly bandaged on with a dry gauze roller-in doing which one 
begins with the quickly ascending spiral, in order only first to fix the splints to the limb. Over the gauze bandage is 
rubbed with the hands, or a large brush, an abundance of starch paste, and lastly the whole is covered with a dry 
calico bandage. 
" 7. Two or three days elapse before a starch bandage is quite dry and hard. By exposing it to the heat of the 
sun or a stove, its drying can be hastened. 
"8. To render it capable of removal, the bandage is cut open throughout its whole length with a strong pair of 
scissors and the casing bent asunder, while strips of calico bandage are pasted on the edges of the starch. The casing 
is then re-applied and fastened with straps and buckles."-" The Surgeon's Handbook." Esmarch. 
* Having illustrations printed on the triangular handkerchiefs, describing their application for injuries of different parts of the body. 
Vide Esmarch's "The First Dressing on the Battlefield." Translated by Dr. Thomas Guy. Kiel: 1869. 572 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUJMDS AND INJURIES. 
THE HARDENING BANDAGES. (Continued.) 
II. The Silica (Wasserglas) Bandage. 
" 1. Soaked in a concentrated solution of silicate of potassium, which must have a specific gravity of 1.35-1.40 
(Bohm), bandages can be produced which become perfectly firm and hard as soon as the water has evaporated. 
"2. To hasten its stiffening, finely pulverized chalk, or slaked lime and chalk (1.10, Bohm), magnesite (Konig), 
or cement (Mitscherlich), is stirred in the silica till a cream-like fluid is produced, in which the bandages are dipped or 
with which the bandages are smeared, after their application, by means of a large brush. Lastly the whole bandage is 
sprinkled with the dry powder and well rubbed." 
III. The Gutta Percha Bandage. 
" Splints are cut out of gutta percha, two to three millimetres thick, and dipped in hot water at 6o° R. till they 
become quite flexible ; they are then applied to the limb, which has been previously enveloped with a wet flannel roller, 
and firmly bound on with gauze bandages. By pouring cold water over them they quickly become hard." 
was invented by Mathysen, in 1852. It has this advantage over all others, that it becomes hard and firm in the 
shortest time. 
" 1. Mixing the plaster of Paris is best done in a porcelain dish, about so much water being poured upon a suffi- 
cient quantity of plaster, whilst constantly stirring, as to reduce the paste to the consistence of thick cream. It stiffens 
in five to ten minutes to a solid mass. 
" 2. Should it be desirable to delay the setting of the plaster, more water is added, or some starch, size, milk, beer 
or borax is mixed with the water. 
"3. If the setting is to be hastened, less water or hot water is used, or some common salt, alum, silica or cement 
powder is added to it. 
"4. If the plaster has deteriorated by absorption of water from the atmosphere, it can be again made serviceable 
by heating it in an open pan till it no longer gives off steam. 
" 5. The application of the plaster of Paris bandage can be carried out in various ways. 
"6. Strips of bandages are dipped in the plaster cream, and placed after Scultet's method (many-tailed) around 
the limb, which has been previously smeared with oil or lard.-Adelmann. 
" 7. Old clothes (woolen stockings, drawers, vests, &c., or coarse sack-cloth) can be cut up and used instead of 
bandages, as they readily absorb the plaster-cream.-Pirogoff. 
" 8. The Bavarian splint.-Plaster-cream is poured between two pieces of linen or calico, which is stitched 
together down the middle and the limb enveloped in it. As soon as the plaster has set, the two halves, which are 
connected together by the stitching, can be opened and the injured parts exposed {amovo-inamovibel). 
"9. Out of bundles of hemp, flax or jute, which are dipped in plaster of Paris and bandaged to the limb (pre- 
viously oiled) with flannel rollers, removable plaster splints can be quickly produced (Beely) ; they are well fitted for 
fixing compound fractures, which are being treated on the antiseptic method. If it be desirable to suspend the limb 
with such a splint, rings or loops of telegraph wire can be placed in< many places between the bundles of hemp and 
fixed by the plaster. 
" 10. Bandages can be impregnated with dry plaster of Paris, and then soaked in water for a short time before their 
application. The gauze bandages are the most suitable for this treatment. The gauze bandages are impregnated in 
the simplest manner, by putting the end of the bandage through a slit in an upright board, in front of which the 
plaster of Paris is placed ; the bandage is then rolled up with the fingers. 
" 11. The plaster bandages and the powder can be kept together in a tin case, and separated from one another by 
the board mentioned above. 
" 12. The gauze bandages can also be quickly impregnated by means of a machine. 
"13. As an application beneath the plaster of Paris bandages, cotton wool can be suitably employed, as it is the 
best means of averting pressure and strangulation. 
" 14. Moistened gauze bandages (Roser), or dry flannel rollers, can also be employed for the same purpose in com- 
pound fractures, as well as flannel or gauze bandages soaked in carbolic oil (10 per cent.); the latter do not easily 
become impregnated with the secretion from the wound.-Bardeleben. 
" 15. To make the edges of the plaster of Paris bandage smooth and even, the bandage beneath, which projects 
somewhat, can be turned over like a frill and fixed by a turn of the plaster of Paris bandage. 
"16. To make the plaster of Paris bandage stronger, a layer of the plaster-cream can be smeared over the band- 
age. But it will thus become very thick and heavy. 
" 17. To give it greater firmness, it is better to introduce shavings, wooden splints or iron wire, as they last longer 
and can be easily removed. 
IV. The Plaster of Paris Bandage GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
573 
WOUNDS AND INJURIES 
THE HARDENING BANDAGES. 
The Plaster of Paris Bandage. (Continued.) 
"18. Lastly, should it be desirable to give the bandage a neat and smooth surface, some dry plaster is sprinkled 
over and rubbed by the hands moistened with water. 
" 19. Where there are wounds, openings (windows, fenestra) must be made in the plaster, by which the secretion 
from the wound may have a free escape. These are either left open at the time of application of the bandage, or the 
window is afterwards made with the assistance of a short knife and a pair of scissors. 
" 20. In order that the places may be found where the windows have to be cut, a ball of cotton wool is placed upon 
the wound ; this afterwards forms a nut-like prominence, upon which an incision can be made with confidence. 
" 21. To prevent the entrance of pus between the skin and the plaster bandage, the windows must be smeared all 
around their edges with carbolized cement, or filled with cotton wool soaked in collodion. 
" 22. If it is necessary to make the plaster of Paris waterproof it must be saturated with a solution of damar 
resin in ether [(1:4) damar varnish] by means of a brush. 
" 23. For extensive wounds, a plaster of Paris bandage is only applied above and below the injured part, and the 
two united by means of laths, which are placed upon pads of tow soaked in plaster-cream ; these are connected with 
the apparatus by plaster of Paris bandages."-"The Surgeon's Handbook on the Treatment of Wounded in War." 
Dr. Friedrich Esmarch. 
Application of Plaster of Paris Dressings. 
Fig. 3872. 
Stanchion for 
Counter Extension 
"The following is the usual mode of applying this dressing at Bellevue: The patient is 
placed with his nates overhanging one corner of a table, or with his body, shoulders and head 
resting upon a mattress elevated by blankets about one foot from the table, but terminating 
about two feet from its lower end. The perineum is pressed against an iron stanchion, which 
is firmly screwed upon the lower end of the table and wound with heavy flannel cloth. The 
nates are then suspended by a sling which passes under the small of the back, and which is 
supported by a wooden bar projecting horizontally from the top of the stanchion to some point 
of support of equal elevation beyond the head. Compound pulleys are now attached to the 
foot, and the exhibition .of the anaesthetic commenced. In some cases, as is represented in 
Fig. 3873, a plaster of Paris bandage is first applied to the foot and lower portion of the leg an 
hour or two before the fracture is reduced, and when this has become hard the extension is 
applied. The patient being fully under the influence of the anaesthetic, traction is made upon 
the pulleys until the shortening is supposed to be overcome and the fracture reduced. The 
direction of the extension must be in the line of the axis of the body, it having been observed 
that when the plaster is applied with the limb abducted too much pressure is brought upon the 
perineum when the limb is again dropped into line; and if the limb is abducted when the 
plaster is applied, the dressing will be too loose about the groin in the straight position. The 
bandages, saturated with plaster, are applied over the whole limb, from below upwards, includ- 
ing the pelvis. Occasionally the successive turns of the roller are reinforced by broad pieces 
of flannel or of patent lint, dipped in the fluid plaster. The number and thickness of the suc- 
cessive layers must be determined by the apparent necessities of the case, generally four or five 
Fig. 3873. 574 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AJW INJURIES. 
THE HARDENING BANDAGES. 
Plaster of Paris. (Continued.) 
layers of roller being required, at least upon the 
thigh. I have omitted to state that excoriations 
caused by the dressings have been noticed most 
frequently in the groin and gluteal fold ; this 
may, however, be avoided by placing a heavy 
piece of dry flannel over these parts previous to 
the application of the plaster. The dressing 
being completed, the extension is continued fif- 
teen or twenty minutes until the plaster has be- 
come hard. 
"In case the plaster was not applied to the 
foot and lower portion of the leg prior to the 
dressing of the fracture this may now be done, or 
the patient may be laid in bed and permitted to 
recover from the influence of the anaesthetic be- 
fore completing the dressing. On the second or 
third day, after the reduction of the fracture, 
most of our patients have been permitted to go 
about on crutches ; a practice which, although it 
seems to be attended with certain hazards, pos- 
sesses at least this advantage, that it enables the 
patient to preserve his general health. It is not 
improbable, also, that it prevents that atrophy and shrinkage of the limb which would otherwise ensue, and which, 
when it occurs, renders it necessary to open and readjust the dressings."-" Principles and Practice of Surgery." F. 
H. Hamilton. 
Fig. 3874. (As applied at Bellevue.) 
Fig. 3875.-Roller Bandage. 
Fig. 3876.-Tiemann & Co.'s Bandage Roller. 
" 24. The plaster of Paris bandage is most easily removed by cutting a deep groove with a very short thick knife, 
and then dividing the deep layers at the bottom with a strong pair of scissors (Fig. 3878)." 
Fig. 3877.-Esmarch's Bandage Knife. 
Fig, 3878.-Esmarch's Bandage Shears. 
To facilitate the removal 
of Plaster of Paris 
and Starch Bandages. 
" The Surgeon's Hand- 
book on the Treatment of 
Wounded in War." Dr.- 
Friedrich Esmarch. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
575 
WOUNDS AND INJURIES. 
BANDAGE SHEARS. 
To Facilitate the Removal of Plaster of Paris and Starch Bandages. 
Fig. 3879.-Henry's Bandage Shears. 
Fig. 3880. 
Wackerhagen's 
Bandage Shears. 
Fig. 3881.-Szymanowsky's Bandage Shears. 
Fig. 3882. 
Wight's Bandage Shears. 
Fig. 3883.-Brun's Bandage Shears. 
Fig. 3884.-Sayre's Bandage Shears. 576 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURE. 
" Fracture : the breaking of a bone."-Webster. 
"A simple fracture is when the bone is divided. A compound fracture is a division of the bone with a wound of 
the integuments communicating with the bone-the bone, indeed, generally protruding. In a comminuted fracture 
the bone is broken into several pieces; and in a complicated fracture there is, in addition to the injury done to the 
bone, a lesion of some considerable vessel, nervous trunk, &c., according to their direction. The treatment of frac- 
tures consists, in general, in reducing the fragments when displaced ; maintaining them when reduced ; preventing the 
symptoms which may be likely to arise ; and combating them when they occur. The reduction of fractures must be ef- 
fected by extension, counter extension, and coaptation. The parts are kept in apposition by position, rest and an ap- 
propriate apparatus. The position must vary according to the kind of fracture. Commonly the fractured limb is placed 
on a horizontal or slightly inclined plane, in a state of extension ; or rather in a middle state between extension and 
flexion, according to the case."-Dunglison. 
" The reparative power of bone is of the greatest importance in surgery. When a bone is broken, blood is effused, 
with the coagulum of which a semi-transparent lymph is subsequently mingled, covering the surfaces of the wounded 
parts ; in the course of two or three weeks this is gradually condensed by an interstitial change, which converts it into 
substance resembling temporary cartilage ; ossification takes place in this in a nearly uniform manner, and the whole 
is transformed in from four to six weeks into a spongy osseous mass which holds the ends of bone together ; this pro- 
visional callus, as Depuytren called it, is gradually absorbed during the succeeding months, while the permanent cal- 
lus has all the characters of new bone. When this reparative process is interfered with by meddlesome surgery or con- 
stitutional disease, the union takes place merely by ligament, constituting sometimes a false joint."-"American Cy- 
clopaedia." 
FRACTURE APPARATUS. 
" Before an attempt be made to set the fracture, it is necessary to provide the requisite apparatus for effecting its 
maintenance. The means which are employed for the purpose are splints, cushions, bandages and adhesive strips. 
Splints are made of various materials, as wood, trunk-board, leather, felt, gutta percha, tin, wire and iron, according 
to the nature of the fracture, or the fancy, whim or caprice of the practitioner. In fracture of the thigh and leg, espe- 
cially in that form which requires permanent extension and counter extension, the best article is wood. In fracture of 
the superior extremity, particularly of the humerus and of the bones of the forearm, splints made of trunk-board 
generally fulfil every indication, as by a little manipulation, after immersion in hot water, they may easily be moulded 
to the form of the limb. A piece of thick pasteboard affords a good support to a broken jaw or finger. Unoiled sole 
leather and guttapercha make excellent splints. Previously to applying them, they must be softened in hot water, the 
sharp angles and edges having been pared off with a knife. The tin case is employed a great deal, especially in frac- 
ture of the humerus at the elbow and of the tibia at the ankle. Iron splints, in the form of a double inclined plane, are 
sometimes used ; and very good splints may be made of light wire and of perforated zinc. For fractures of the bones 
of the hand and fingers curved splints are very serviceable. 
"Felt splints, adapted to the different regions of the body, and put up in portable cases, have of late years been a 
good deal employed ; they are very light and flexible, are not affected by cold or warm water dressings and are easily 
moulded to every inequality of the surface of the parts to which they are applied." 
Plaster Splints.-See Hardening Bandages, page 571. 
"Adhesive plaster, cut into suitable strips, is now universally employed in this country as a means of making ex- 
tension, in the treatment of fractures of the lower extremity, and nothing, certainly, could generally answer a better 
purpose. * * * 
"Extension and counter extension are always necessary in oblique fractures of the extremities attended with dis- 
placement. By the term extension is understood the force which is required to draw the upper end of the lower frag- 
ment to a level with the lower end of the upper fragment, in order to place them in their natural relations ; by counter 
extension, on the contrary, is implied the resistance which is employed to prevent the limb, or even the body, from 
being dragged along by the extending power. The extension is generally made upon that part of the limb which is 
articulated with the lower piece, and the counter extension upon that which is articulated with the upper. Thus, for 
example, in fracture of the shafts of the bones of the forearm, the extending power acts upon the hand, and the counter 
extending power upon the arm, while in fracture of the body of the humerus the two forces are respectively exerted 
upon the forearm and the chest; and so in regard to fracture of the inferior extremity. When but little muscular re- 
sistance is anticipated, as in a child or feeble person, the extension and counter extension may be applied directly to 
the two fragments, but at as great a distance from the seat of the injury as practicable. On the whole, however, the 
former method is decidedly preferable, as it is much less likely to irritate and worry the muscles."-" System of Sur- 
gery." Gross. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
577 
WOUNDS AND IJMJUF^IES 
FRACTURE APPARATUS. 
Suspension. 
Fig. 3885.-Buck's Suspension Apparatus. 
Buck's apparatus (Fig. 3885), for suspending the upper limbs, is made of iron tubing ; its upright portion is fastener, 
by clamps at the head of the bedstead and its lower portion overhangs the bed and holds suspended at its extremity a 
flattened strip of hard wood, on the upper edge of which a row of screw-heads serves for fastening the ends of the can- 
vas bands that suspend the limb. The strip of wood that supports the limb plays horizontally on a swivel-joint at the 
extremity of the iron tubing. For suspending the lower limbs five-eighth inch iron tubing is bent, in the manner shown 
by the picture. The horizontal portion overhanging the bed is supported by two upright iron rods resting upon the 
mattress astraddle of the thigh. A row of screw-heads inserted along the outer surface of the horizontal portion serves 
for fastening the ends of the canvas bands that suspend the limb. The upright portion of the apparatus is securely 
fastened to the two cross-rods at the foot of the bedstead by clamps, and can be adjusted at any required height. The 
suspending bands are of stout sail-cloth canvas, cut of any required length and width, and buttoned on to the screw- 
heads by slits cut for the purpose. The canvas being very strong does not tear, and will sustain any weight it has to 
bear. 
Adaptable Porous Felt Splints. 
The manufacturer claims: They have been tested extensively in both civil and military practice for a number of 
years, and have been indorsed and recommended in the most unqualified manner by the most distinguished surgeons of 
America. Their porosity allows the free application of cold or warm water dressings; they permit passive motion by 
their flexibility; they are perfectly adapted to the contour of the limb, and hence promptly relieve the pain caused by 
unadjusted fragments ; and as they are also light, soft, odorless, durable, and, finally, the cheapest ever put in the market, 
they seem to fill the ideal of a surgical splint as closely as can be imagined. The splints are made of a tough, flexible 
material, about as thick as heavy binder's board, and are moulded to the perfect form of the limbs, over models. They 
can be adapted, at will, to limbs of various sizes by immersing the splint in boiling water and then fitting it to the part, 
which is protected by muslin cloths saturated with cold water. They are, however, not in the least injured, nor is their 
consistency altered by the continued application of water, as hot or cold as the skin can bear. Their flexibility enables 
them to accommodate themselves to the increase or reduction of the swelling, and by exerting a gentle and equable 
pressure to hasten its disappearance. When once fitted to the limb they are not easily displaced or loosened. The patient 
can move about and change his position without pain or injury, while the muscular structure in the 
fractured limb is maintained in perfect quiet. Hence, they are invaluable when persons with serious 
fractures have to be transported long distances, and also when the general health will suffer from con- 
finement to bed. It is one of the most satisfying proofs (both to physician and patient) of the per- 
fection of these splints, to witness how promptly the pain disappears when the fractured limb is snugly 
encased in them. There is no necessity to wait for hours or days till the inflammation is passed, as 
is sometimes recommended. Nor is the physician exposed to the impertinent interference of officious 
outsiders in loosening bandages and disarranging the fracture on the plea of relieving pain. 
Splint No. I embraces the entire chin and forms a complete support to the fractured part, while 
at the same time it allows, by its flexibility, sufficient motion to open the mouth slightly for food. 
They are more comfortable than the gutta percha splint. Retain it by Barton's bandage. 
Fig. 3886.-Lower 
Maxillary Splints, 
No. 1. 578 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURE APPARATUS. 
Adaptable Porous Felt Splints. 
Fig. 3887. 
I oxs Clavicle Splint. No. 2. 
This frequent injury (fracture of the clavicle) will be most satisfactorily 
treated by Levi's modification of Fox's apparatus, shown by Fig. 3887. 1 his 
consists, in brief, of a trough for the forearm, an auxiliary pad and a broad 
strap over the sound shoulder. We supply the trough, perforated at the proper 
points for the attachment of the necessary straps. The rest of the apparatus 
can be readily improvised. 
Fig. 3888. 
Shoulder Splint. No. 3. 
Any fracture of the humerus can be 
successfully treated by a combination of 
the shoulder and elbow splints. The 
shoulder splint fits over the exterior face 
of the shoulder, and it is to be used with 
the short, slightly curved piece (No. 4), to 
be applied to the opposite surface. 
Fig. 3889. 
Elbow Splint. No. 5, 
No. 5 is for fractures and dislocations of the radius, ulna and humerus at or near the elbow-joint. In combination 
with the inferior and superior forearm splints, it is adapted to all fractures of the ulna and radius, at the middle or 
upper third, or compound comminuted fractures of the same bones. Where both radius and ulna are fractured, 
bring the parts into contact, then apply splints Nos. 3, 4, 5, 6, 7, and bandage over all from the hand to the shoulder. 
If the fracture is comminuted, cut a part or parts out of the splints corresponding to the points of comminution, and 
bandage around them. The wounds can easily be dressed without disturbing the splints or bandages. As the swelling 
is reduced, tighten the bandages, as the splints accommodate themselves to the reduction. The elbow splint is at an 
obtuse angle, to prevent the lapping of soft parts, and as being most natural to sling. 
Fig. 3890. 
Superior Forearm Splint for Radius 
Fig. 3891. 
Inferior Forearm Splint 
for Ulna. No. 7. 
These two splints (Figs. 3890 and 3891) are intended for all 
fractures of the forearm, and also for sprains and dislocations at 
the wrist-joint, complicated or not with fracture. Very often 
actual fractures of the head of the radius or ulna are diagnosed 
as sprains, and result in semi-anchylosis. These cases, even 
when of several months' duration, can be reached with com- 
plete success with these splints. They are also admirably 
adapted to treating Barton's fracture, fulfilling every indication, requiring no pads or compresses, and being less likely 
to be followed by stiffness of the joint; they may be used either in combination or alone. As the radius and ulna are 
more liable to fracture than any other bones, ready made splints are very convenient. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
579 
WOUNDS AND INJURIES. 
FRACTURE APPARATUS. 
Fig. 3892. 
Femoral Splints 
No. 8. 
Adaptable Porous Felt Splints. 
These splints are intended to treat fracture of the lower third and middle of the femur and 
upper third, in combination with anterior and posterior knee-joint splints, as represented in Nos. 
g and io. They encase the fractured limb perfectly. These splints are also intended, and ad- 
mirably suited, for the treatment of fracture of the ribs and hip-joint. 
No. 9 splint is adapted to treat fractures of the tibia, fibula and femur near the joint, and 
also, in connection with the anterior and posterior tibia and fibula splints, to treat all frac- 
tures of those bones. There are two splints to each set-one for the right and one for the left 
knee-joint. 
The No. io splint, in connection with anterior knee-joint splint, treats fractures of the tibia, 
fibula and femur near the knee-joint, and also the upper third of the fibula and tibia, and the 
lower third of the femur; and also, in connection with the anterior and posterior tibia splints, 
treats all fractures of those bones. There are two splints to each set-one for the right and 
one for the left limb. These splints can be used for the tibia and fibula also,when fractured about 
the middle of the shaft. Nos. 9 and 10 are used also for fracture of the patella, and are admirably 
adapted to keep it in position. 
No. 11 splint is intended for fractures of the tibia proper, and 
especially for fractures, either simple or compound, in the vicinity 
of the ankle-joint. It reaches from the knee-joint to the instep 
and embraces the ankle-joint perfectly. Fractures of the malleoli 
will be readily treated by combination of this and the following 
piece. There are two splints of this kind to each set. 
No. 12 splint is suited to treating fractures of the fibula proper, 
and also in the vicinity of the ankle-joints, either simple, compound 
or comminuted. Nos. Il and 12 are combined for a complete appa- 
ratus for treating compound fractures of the tibia and fibula, either 
in the upper, middle, or lower third, and at the ankle-joints. There 
are two splints to each set-one for the left and one for the right 
limb. 
No. 13 splint is intended for treating the 
club-feet of children, after operation or without 
operation,which it does very successfully. There 
are two club-foot splints for each set. If the 
application of these splints be commenced soon 
after birth, where this deformity is present, and 
so adapted (by the foot being bent sidewise, at 
an angle to the leg portion) that they exert a 
constant yet moderate pressure toward the nor- 
mal line of the limb, the deformity may, in 
some cases, be remedied without an operation. 
Fig. 3894. 
Anterior and Posterior 
Fibula Splints. 
Nos. 11 and 12. 
Fig. 3895. 
Club-Foot Splints 
for Children. 
No. 13. 
Fig. 3896.-Levis' Radius Splint, 
for Fracture of the Lower End of the Radius. 
Levis' Radius Splint is made of John- 
stone's Improved Adaptable Porous Felt and 
possesses all the admirable qualities and indi- 
cations of our regular Johnstone's Improved 
Ahl's Splints. They entirely obviate the ne- 
cessity of compresses or pads, and insure ex- 
tension and position. The price of the 
splints is $2 a pair, or $i for a single piece. 580 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURE APPARATUS. 
Levis' Metallic Splints, 
designed by R. Levis, M.D. They are flexible, perforated, nickel-plated, and conformable to every size and con- 
dition of limbs. 
The copper used in the manufacture of these splints, being less than one-eightieth of an inch in thickness, makes 
them very light and readily conformable by bending so as to suit the peculiarities of any limb, and yet the splints when 
applied are as firm as the heaviest wooden appliances. They fit so accurately that but little padding is required ; a 
piece of woven lint, or of cotton or woolen flannel, is all that is necessary for their lining. A slight roughness is left on 
the outside of the splints, by perforations, to prevent the bandage from slipping. They are nickel-plated, to prevent 
oxidation. They are invaluable when the parts are lacerated, as ihe perforations allow ventilation, and secretions are 
not confined and liable to be absorbed, as in many other kind of splints, but readily pass off" through the numerous ori- 
fices. These splints are cooler, lighter in weight, thinner in material, more correct in shape and more perfect in fit than 
any other splints offered to the profession. They are all made in two sizes-one size for adults and one for children-and 
all, except the radius, fit the same on either the right or left limb. The following comprise a complete set, and are ample 
to apply to any fractures that may occur. 
In the treatment of fracture of the 
lower end of the radius it is essential that 
proper allowance be made for the curvature 
of the anterior or palmar surface of this 
part of the bone. This is insured in this 
splint, which follows correctly the radial 
curvature ; and the fixing of the thenar and 
hypothenar eminences of the hand in their 
moulded beds maintains the splint immov- 
ably in its correct position with reference 
to the radial curve. To neglect of complete 
primary reduction of the displacement of the 
lower fragment, and to inefficient restora- 
tion and retention of the normal radial 
curve, are due the frequent unfortunate se- 
quences of this fracture. No dorsal splint 
is needed, but a small pad will, in most cases, be required over the dorsal surface of the lower frag- 
ment. For retention of the splint an ordinary bandage, two inches and a half to three inches wide, is 
all that is necessary. This splint has the merits of being applicable to all cases of fracture of the 
lower end of the radius, and also to manv other injuries involving the forearm and wrist. 
Fig. 3897.-Levis' Radius Splints, Right and Left, 
for Fracture of the Lower End of the Radius. No. 1 
Fig. 3898.-Adjustable Angular Splint. No. 2. 
This splint can be applied either ante- 
riorly or posteriorly, and is conformable 
and adjustable to any angle. The pieces 
are detachable and can be used separately. 
This splint is applicable for all frac- 
tures of the elbow-joint and of the arm and 
forearm, excepting those of the lower end 
of the radius ; also to diseases and to re- 
sections of the elbow-joint. 
Two in each set; price, $1.50 each. 
"Coaptation and dressing, to restore the broken pieces to the original situation or, to use the common expression, 
to set the fracture, may be done aided by extension and counter extension. The former will usually suffice in frac- 
ture of the upper extremity, the jaw and nose, while the latter will generally be required in fracture of the thigh 
and leg" (page 582). GEORGE TIEMANN <fc CO.'S SURGICAL INSTRUMENTS. 
581 
WOUJMDS AND INJURIES 
FRACTURE APPARATUS. 
Levis' Metallic Splints. 
Fig. 3902.-Maxilla Splint. No. 6. 
Fig. 3899. 
Humerus Splint. No. 3. 
Fig. 3900. 
Phalanges Splints. No. 4. 
For fractures of the humerus. 
Two in each set. 
Price, 50 cents each. 
For fractures of the fingers or toes 
Three in each set. 
Price, 15 cents each. 
Fig. 3901.-Clavicle Splint. No. 5 
This splint forms a complete cap or cov- 
ering for the entire chin and lower maxil- 
lary bones, and keeps the fractured parts 
rigidly in the correct position. 
Two in each set. Price, 75 cents each. 
This splint forms a cap for the shoulder, and can 
be applied to fractures of the clavicle and humerus. 
Two in each set. Price, 75 cents each. 
Fig. 3905. 
Tibia and Fibula Splint. No. 9. 
Fig. 3904.-Patella Splint. No. 8. 
This splint can be applied to all fractures from middle of femur to middle of tibia and 
fibula, and is particularly well adapted for fractures of the patella and all other 
fractures occurring near the knee-joint, either above or below it. 
TO Two in each set. Price, $1 each. 
Fig. 3903.-Femur Splint. No. 7. 
For all fractures and other inju- 
ries of the leg below the knee, and 
especially adapted for those at or 
about the ankle joint. 
Two in each set. Price, $3 each. 
For fracture of the femur, 
ribs and hip-joint. 
Two in each set. 
Price, 50 cents each. 
The complete set consists of the twenty-one pieces just described, 
in a neat, compact case. Price, $15 per set. 582 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURE APPATATUS. 
Extension and Counter-Extension. 
Fig. 3906.-Buck's Extension. 
Consists of: 1st. Two bands of heavy adhesive plaster, to which are attached the necessary buckle and elastic web- 
bing. 2d. A perineal band, for counter extension, made of heavy rubber tubing, with straps, buckles and rings. 
3d. Four guttered coaptation splints, leather covered ; three elastic straps with buckles for fastening the same. 4th. One 
pulley, one bag for shot and some strong fishing line. 
Fig. 3908.-Perineal Band. 
Fig. 3907.-Adhesive Plaster and Webbing. 
Fig. 3909. 
This form of upright, made oi 
wood, may be adapted to any or- 
dinary bedstead. A modification 
suited to iron bedsteads is repre- 
sented in Fig. 3911. 
The sooner the limb is put up 
and subjected to this method of 
treatment after the fracture, the 
better. Suffering is prevented, 
and the sufferer made comfortable 
from the outset. The amount of 
weight to be employed must be 
determined by the resistance to 
be overcome and the toleration of 
the patient. 
Fig. 3910.-Coaptation Splints 
Mode of Application of Buck's Extension. 
A roller bandage, commenced at the toes in the usual way, is continued to the ankles, where it is temporarily arrested 
1 he band of adhesive plaster is then applied so that its middle forms a loop below the sole of the foot and its ends 
extend on either side in immediate contact with the limb from the ankles upward. Over this the bandage is continued GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
583 
WOUNDS AND INJURIES. 
FRACTURE APPARATUS. 
Extension and Counter Extension. (Continued.) 
as high up as the plaster, which stops at the seat of fracture. To allow the application of lotions to the thigh during 
the first few days of treatment, the end of the adhesive bands should stop short at the condyles of the femur and be 
turned down. Subsequently they may be replaced, and the bandage continued up on the thigh preparatory to the ap- 
plication of the coaptation splints, which are to be added at this stage of the treatment. 
The wooden block is next to be interposed transversely within the loop below the sole of the foot, the rubber band 
applied around it, and the cord attached as in Fig. 3911. The limb being thus prepared for extension, the perineum 
band may now be adjusted and its ends fastened to the head of the bedstead. The body belt is to be carried around 
the opposite side of the trunk and secured so that the line of counter extension shall correspond to the line of the axis 
of the limb. The limb should be raised upon a hair-cushion sufficiently to clear the heel from pressure. The extending 
cord is to be passed over the pulley, and a weight attached to it. 
Iron Fulcra, Weights and Sundries, for Extension of the Lower Extremities, 
Fig. 3911. 
Buck's Fulcrum and Weights 
Fig. 3912. 
Levis' Apparatus. 
Fig. 3913. 
Sayre's Extension Sundries. 
Levis' apparatus (Fig. 3912) consists of adjustable clamps holding the upright rod which supports the pulley in 
position. Rod and pulley can be adjusted at any elevation required. The amount of weight extension is simply 
effected by a series of one-pound weights suspended upon a rod, bent into the form of a hook at the top, for catching 
in a loop in the extending cord. The upper portion of this rod is flattened or narrowed, the remainder of the rod 
maintaining a uniform diameter. In the centre of the weights a hole is drilled, into which the rounded or lower portion 
of the rod fits very tightly, and from which centre hole a slot is cut that, while it permits the passage of the rod in the 
upper constricted and flattened portion, is too narrow to allow of the weights slipping off the rod, no matter in what 
direction or with what force a blow may be struck or the apparatus displaced. The bag shown in connection with Fig. 
3913, designed to hold sand or shot, answers the same purpose as the sets of weights. 
Fig- 3913 shows Sayre's " extension sundries," consisting of two stout tapes, A, adjusted through button holes to 
the cross-piece, C. The ends of A are attached to the plaster secured to the limb, and C very nearly approaches the 
sole of the foot. To Cis attached a strong cord, to run over the pulley B. To the end of the cord is to be attached a 
bag, as shown in Fig. 3913. 
The following are the prices of these apparatus : 
Buck's Extension Fulcrum, only,. $3.00 
The same, with Sayre's Extension Sundries, . . 4.00 
Sayre's Extension Sundries, A, B, C, . . . . 1.00 
Levis' Extension Fulcrum only $3-5° 
The same, with Series of Weights, . . . . . 5.00 
Series of Weights separate, ....... 2.00 584 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURE APPARATUS. 
Extension and Counter Extension. 
Fig. 3914.-Volkmann's Sliding Rest. 
Fig. 3915.-Volkmann's T Splint. 
Fig. 3916.-Volkman's Sliding Rest (applied). 
" In some instances it may be found 
advantageous to use Volkmann's sliding 
foot-piece. This consists of a posterior 
splint for the leg, to which is attached a 
foot piece having an angle shown in the 
cut (Fig. 3914). This splint should be per- 
forated for the heel, and rest upon two 
cross-bars of wood, which in turn slide up 
and down on a rectangular frame. Upon 
the upper edge of these bars a tongue is 
cut, and a corresponding notch or groove 
in the cross bars."-"Text-Book on Sur- 
gery." Wyeth. 
Fig. 3917.-Fracture Box. 
"To fix the part in the position of least discomfort for from five to six days, or until all danger of swelling is past; 
after this no method is so generally satisfactory as the plaster of Paris dressing. To meet the first indication the fracture 
box (Fig. 3917) is a most useful apparatus. It consists of a bottom, a foot-piece and two movable side-pieces. This may 
be placed upon a pillow or box to give it a slight elevation, or the apparatus may be modified after Petit's box (Fig. 
3918). If any extension is needed, it may be secured by a bandage around the ankle and foot, which is also passed 
through the holes in the foot-piece. In fixing the.leg in this fracture box the sides are turned down, a thick layer of 
cotton or some soft material arranged for the leg to rest upon, and shaped to fit the natural contour of the calf. The 
sides are also packed, turned into position, and fastened. As soon as the first swelling subsides, or as soon as it is evi- 
dent that no marked swelling will occur, the plaster of Paris should be applied."-" Text Book on Surgery." Wyeth. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
585 
WOUNDS AND INJURIES. 
FRACTURE APPARATUS. 
Simple Fracture. 
Fig. 3918.-Petit's Fracture Box 
Treatment. 
" Endeavor, on first approaching a patient suffering from fracture, to inspire him with a confidence that he is not 
to be unnecessarily hurt; sit quietly beside him, and inquire minutely into all the circumstances relating to the acci- 
dent ; remove the clothes from the injured limb with the utmost care ; notice its position, contour, points of abrasion, 
discoloration, or swelling; pass the fingers lightly along the surface of the limb, pressing more firmly at points 
where there are appearances of injury ; finally, to solve all doubts, grasp the limb so as to make traction of the lower 
fragment, rotate to obtain crepitus, and make lateral motions to indicate the false point of motion ; in the application 
of the necessary dressings, let gentleness and a manifest regard for the patient's sufferings characterize every act; and, 
throughout the subsequent treatment of the case, proceed slowly, thoughtfully, and systematically, for rude and awk- 
ward manipulations, by which pain is needlessly inflicted, are frequent sources of inflammation, suppuration, and gan- 
grene. In the simple fracture the bone is broken at a single point, the lesion is subcutaneous, and no other important 
parts are involved; it is, therefore, in the most favorable condition for repair."-F. II. Hamilton. 
" The signs of fracture, on which reliance can be placed, are: I. Crepitus, obtained by rotating the lower fragmant; 
2. Preternatural mobility, produced by lateral movements of the fragments ; 3. Spontaneous displacement, when re- 
duction of the fragments has been effected. The treatment is replacement of the fragments, and maintenance of their 
extremities in apposition. Replacement should be effected as soon as possible after the accident."-F. H. Hamilton. 
" The fragments may usually be placed in coaptation by extension and counter extension with the hands ; but, should 
such means fail, anaesthetics must be used, and even pulleys."-Billlroth. 
" Maintenance is accomplished by side or coaptating splints, by long or extending splints, by the weight and pul- 
ley, by plastic apparatus or by a combination of these methods. Of the several appliances, the plastic apparatus, in 
its various forms, most effectually secures and maintains coaptation ; but used as a bandage, when the fracture is accom- 
panied with such injury to the soft parts as to render subsequent inflammation inevitable or probable, this form of 
dressing exposes to congestion, strangulation and grangrene." 
"As safety in the use of this dressing depends much upon the skill and care of the surgeon, the rule should be 
never to resort to it unless familiar with all its peculiarities, and in a position to give the case necessary care."-A. 
C. Post. "When employed, the provisional callus will always be less, and, hence, firmness will result later, yet the 
formation of definite calius will not be disturbed."-Billroth. "But these objections do not apply to the different 
forms of gypsum splints" (J. Croft) "which can be readily and perfectly adapted to support the limb and not en- 
danger it by strangulation ; these splints should be applied in the first stage of the case ; swelling from contusion and 
subcutaneous laceration, unaccompanied with lesion of the vascular trunks, is not an objection to the immediate appli- 
cation of the apparatus ; on the contrary, the support and enforced rest have a beneficial influence in controlling swell- 
ing and its consequent pain. As a rule, no bandage should at first be applied directly to the skin."-F. H. Hamilton. 
" The dressings adapted to individual fracture must necessarily vary very much ; but it may be stated, as a principle ap- 
plicable to each case, that that apparatus is the best which, -whilst it answers the indications equally well, exacts the 
least amount of skill and attention."-"Operative Surgery." Stephen Smith. 586 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURE APPARATUS. 
Passive Motion. 
As fractures aie constantly liable to be followed by weakness and stiffness of the limb, the rule is to move the joint 
nearest the injury as soon as the union is sufficiently advanced to preclude the possibility of displacing the fragments 
or inteirupting the consolidating process. I his constitutes what is called passive motion, a most important element in 
the management of this class of lesions. It should not be commenced, as a general rule, before the end of the third 
week, after which it should be repeated once a day, or every other day, according to circumstances ; it should be very 
gentle at first, and be gradually increased until the limb has completely regained its normal functions. During its per- 
formance the paits are properly supported by assistants, and the dressings are reapplied the moment it is over. The 
restoiation of lost function will be greatly promoted by frequent ablutions with warm water and soap, followed by 
systematic massage and frictions with some sorbefacient lotion, as spirit of camphor, soap liniment, or weak solutions 
of iodine. As soon as the callus has acquired sufficient firmness to sustain the ends of the broken bone, the splints and 
bandages are either discontinued, or applied more loosely, the object now being merely to keep the parts at rest until 
the union is perfectly consolidated. In fractures of the inferior extremity, some days should usually elapse before the 
patient is allowed to rise, and no weight should be thrown upon the affected limb under a fortnight or three weeks ; 
the new bone is still weak, no definite callus has yet formed, and the individual, awkward from long disuse of his 
joints, is liable to fall from the slightest accident. 1 hese precautions are so extremely important that they should al- 
ways receive the most scrupulous attention."-" System of Surgery." Gross. 
Fracture of the Inferior Maxilla. 
Fig. 3919.-Hamilton's Bandage. 
"The inferior maxilla may be fractured at any point of the body and of 
the rami, or two fractures may occur. Of the variety of apparatus constructed, 
the most convenient and serviceable in general practice is an interdental 
gutta percha splint, moulded to the crowns of the teeth, and an external gutta 
percha or sole-leather cap for the chin, held in position by the four-tailed 
bandage."-Stephen Smith. 
' I have been able to overcome these difficulties, in some measure, by an 
apparatus constructed as follows : 
"A firm leather strap passes under the chin and is buckled over the top of 
the head. It is stayed by two counter-straps of linen webbing. One of these 
is looped upon the maxillary strap at a point just above the ears, and may be 
elevated or depressed to fit different heads. This strap is buckled under the 
occiput posteriorly, and across the forehead anteriorly. A vertical strap, pass- 
ing over the top of the head in the line of the sagittal suture, unites the maxil- 
lary and the occipital strap, T o prevent the maxillary strap being displaced 
backward, a chin-piece is fastened to it."-F. H. Hamilton. 
Fracture of the Ribs. 
"Fracture of the ribs, without complication or displacement, is easily 
managed with the plaster or water-glass dressing, the surface being protected 
with a layer of wadding or an ordinary flannel shirt. The bandage should 
be from two and a half to three inches in width, and drawn so tightly as to 
compel the patient to breathe chiefly with the diaphragm. A thin flat compress, as a small old towel, properly folded, 
to give greater support to the broken bone, may sometimes be advantageously used. In children I know of no better 
dressing for a fractured rib than one made of adhesive strips. Similar dressings will answer in outward displacement 
of the fragments, only that a somewhat thicker compress may be necessary; if, on the contrary, the bone is driven 
inward toward the chest, it is obvious that counter-pressure applied to the extremities of the broken rib can be of no 
avail."-Gross. 
If several ribs are fractured, they may be maintained in very accurate apposition by a broad band of adhesive 
plaster. Cut the plaster of a width to equal one-half the depth of the thorax, and of sufficient length to extend once and 
a half around the body. Place the strip under the patient, while recumbent, so as to inclose the lower half of the thorax, 
the adhesive side internal, and while he is in the act of forced expiration pass one end firmly over the thorax and the 
other in the opposite direction over the first; there is now a sense of suffocation, which is soon followed by relief the 
pain quickly subsides. Do not change the dressing until the cure is complete. 
1 he sternum is occasionally fractured, but more frequently the manubrium is displaced from the gladiolus as a 
luxation. The fragments may be reduced by suitable pressure, and retained as far as possible by adhesive plaster 
fastened during expiration."-"Operative Surgery." Stephen Smith. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
587 
WOUNDS AN0 INJURIES. 
FRACTURES OF THE UPPER EXTREMITIES. 
Clavicle. 
" Clavicle.-The line of the clavicle and the projection of the joint at either end can always be felt, even in the 
fattest persons. Its direction is not perfectly horizontal, but slightly inclined downwards, when the arm hangs quietly 
by the side. When the body lies flat on the back, the shoulder not only falls back, but rises a little, the weight of the 
limb being taken off. Hence the modern practice of treating fractures of the clavicle (in the early stage) by the 
supine position. 
"On the front surface of the clavicle, not far from its acromial end, there is in many persons of mature age a 
spine-like projection of bone. So far as I know, it has not been described. A gentleman, himself a surgeon, showed 
me an instance in his own person. He suspected it was an exostosis. As a rule, the acromio-clavicular joint forms 
an even plane. But there is sometimes a knob of bone at the acromial end of the clavicle; or it may be only a thicken- 
ing of the fibro-cartilage sometimes existing in the joint. In either case this relief might be mistaken for a disloca- 
tion,or even for a fracture. A reference to the other- shoulder might settle the question. Being subcutaneous through- 
out, the clavicle can readily be seized and examined for fracture, &c. If before a glass the arm be swung around, 
raised and lowered, the shoulder be shrugged, &c., we shall appreciate the fact that this is the only bony connection 
the arm has with the body, and to what a very large extent it is movable, the sterno-clavicular joint being the pivot. 
" Tuberosities.-Projecting beyond the acromion-the arm hanging by the side-we can feel, through the fibres of 
the deltoid, the upper part of the humerus. It distinctly moves under the hand when the arm is rotated. It is not 
the head of the bone which is felt, but the tuberosities-the greater externally, the lesser in front. These tuberosities 
form the convexity of the shoulder. When the arm is raised, this convexity disappears ; there is a slight depression in 
its place. The head of the bone can be felt by pressing the fingers high up in the axilla. The absence of this pro- 
minence formed by the upper part of the humerus under the deltoid, and the presence of a prominence low in the hol- 
low of the axilla, or in front, below the coracoid process, or behind, on the ^ack of the scapula, bespeak dislocation of 
the head of the bone. 
" In examining obscure injuries about the shoulder, it is worth remembering that, in the normal relation of the 
bones, and in every position, the great tuberosity faces in the direction of the external condyle. The head of the bone 
faces very much in the direction of the internal condyle. It is worth remembering, also, that the upper epiphysis of 
the humerus includes the tuberosities ; and that it does not unite by bone to the shaft till about the twentieth year. 
" By making deep pressure in front of the shoulder, when the arm is pendent and supine, we can feel the bicipital 
groove (between the two tuberosities). It looks directly forwards and runs in a line drawn vertically downwards 
through the middle of the biceps to its tendon at the elbow. We should be aware of this, lest it be mistaken for a frac- 
ture."-"Landmarks, Medical and Surgical." Luther Holden. 
A is a wedge-shaped pad for the axilla, which is put in place thick 
side up. Two straps fastened to this pad pass directly upwards, and 
buckle to the broad supporting band on the acromion of the afflicted 
arm. This band is then passed across the back and over the shoulder of 
the sound side, and terminates in front of the chest, E. A sling to sup- 
port the arm, elbow flexed, is buckled to the broad band. A strap, D, 
is attached to the back of the sling a short distance above the elbow, and 
passed obliquely across the back and buckled to the supporting band in 
front. The extra buckle comes 
in play when the apparatus is to 
be reversed, in using it for the 
other side. The shoulder is kept 
out by the wedge, up by the sling 
and back by the strap, D. 
These apparatus are made of 
four sizes : two sizes for adults, 
two sizes for children. 
It consists of a padded ring with buckles attached, which fits over the 
sound shoulder, and of a wedge-shaped pad fitting the axilla of the injured 
side. On the top of this pad, pieces of webbing are fastened, one of which 
is to be passed anteriorly over the chest and buckled to the ring over the 
sound arm ; the other over the posterior wall of the thorax, and fitted to 
the posterior portion of the ring, a sling, made of stout linen, in length 
about two-thirds of the forearm, and in depth sufficient to cover it com- 
pletely, is then applied to the elbow and secured tightly to the ring. 
Fig. 3920.-Levi's Clavicle Splint. 
Fig. 3921.-Fox's Clavicle Splint. 588 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURES OF THE UPPER EXTREMITIES. 
Clavicle. 
Fig. 3922.-Richardson's Splint, 
for Fractures of the Clavicle, Scapula 
and Humerus. 
It is composed of three parts, and has three points of attachment, viz.: 
to the side, axilla and arm. The arm and body pieces are semi-cylindrical 
in shape, made of hard rubber, and fastened together by means of rivets, 
with sufficient space left between them to allow the passage of straps of 
adhesive plaster. The crescentic pad is received as a crutch in the axilla. 
For fracture of the clavicle, the crutch is crowded firmly in the axilla, 
and the arm-piece secured to the arm by circles of adhesive strips ; the 
shoulder is then raised, and the arm carried backwards until the fragments 
are brought into position, when the body-splint and crutch are secured 
alike by strips of plaster. If thought desirable, one strap may be passed 
over the opposite shoulder. For fracture of the scapula, the arm is carried 
forward instead of backward, before the splint is secured to the side. For 
fracture of the humerus, the arm is secured in its most natural and easy 
position. In all other respects the splint is adjusted the same as for frac- 
ture of either of the above-mentioned bones. 
After the splint has been applied, the arm may or may not be flexed 
at a right angle on the chest, and supported by a sling from the neck. 
Four sizes of this splint are made: two for adults, and two for children. 
" Velpeau s bandage fixes the hand of the injured side upon the sound shoulder, and the elbow in front of the ensi- 
form cartilage. It is very useful for fractures of the clavicle and for chronic inflammation of the shoulder-joint."- 
Esmarch. 
"After drawing the arm backward and retaining it there by a strip of adhesive plaster, pass another piece of plaster 
from the well shoulder across the back, and by pressing the elbow well forward and inward the first plaster around the 
middle of the arm is made to act as a fulcrum, and the shoulder is necessarily carried upward, outward and backward; 
and the plaster, being carried over the elbow and forearm (which is flexed 
across the chest) to the opposite shoulder, the place of starting, and then 
secured by pins and stitches, permanently retains the parts in position. 
Strong and good adhesive plaster is cut into two strips, three or four inches 
wide (narrower for children); one piece long enough to surround the arm 
and go completely around the body, the other to reach from the sound 
shoulder around the elbow of the fractured side and back to the place of 
starting. The first piece is passed around the arm just below the axillary 
margin and pinned or stitched in the form of a loop sufficiently large to 
prevent strangulation, leaving a large portion on the back of the arm un- 
cased by the plaster. The arm is then drawn downward and backward 
until the clavicular portion of the pectoralis major muscle is put suffi- 
ciently on the stretch to overcome the sterno-cleido-mastoid, and thus pull 
the inner portion of the clavicle down to its level. The plaster is then 
carried smoothly and completely around the body and pinned to itself on 
the back to prevent slipping. This first strip of plaster fulfills a double 
purpose: first, by putting the clavicular portion of the pectoralis major 
muscle on the stretch, it prevents the clavicle from riding upward; and, 
secondly, acting as a fulcrum at the centre of the arm, when the elbow is 
pressed downward, forward and inward, it necessarily forces the other ex- 
tremity of the humerus (and with it the shoulder) upward, outward and 
backward; and it is kept in this position by the second strip of plaster, 
which is applied as follows: commencing on the front of the shoulder of the sound side, drawing it smoothly and 
diagonally across the back to the elbow of the fractured side, where a slit is made in its middle to receive the project- 
ing olecranon. Before applying this plaster an assistant should press the elbow well forward and inward, and retain 
it there, while the plaster is continued over the elbow and forearm (pressing the latter close to the chest, and securing 
the hand near the opposite nipple); crossing the shoulder at the place of beginning, it is there secured by two or three 
pins. When this has been done, the deformity will have entirely disappeared, the fractured bones will be accurately 
adjusted, and as long as the strips of plaster maintain their position no amount of force can displace them."-Ameri- 
can Practitioner. July, 1871. 
Fig. 3923. 
Sayre's Dressing for Fractured Clavicle. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
589 
WOUJJDS AND INJURIES. 
FRACTURES OF THE UPPER EXTREMITIES. 
Shoulder, Humerus. 
" Shoulder (F. epaule).-The most elevated part of the arm. The bones which concur in forming it are the sca- 
pula, head of the humerus, and the clavicle, united together by strong ligaments and covered by numerous muscles. 
"Humerus {os humeri or brachii or adjutorium or brachiale, brachium, lacertus, shoulder-bone, arm-bone, Prov. 
spazit-bone, spazv-bone, shull-bane, F. os du bras'), is the cylindrical irregular bone of the arm ; the upper extremity of 
which has a hemispherical head connected with the scapula and two tuberosities or tubercles, a greater and a lesser 
(F. trochiter and trochin), for the attachment of muscles, between which is the bicipital groove or fossa. At the inferior 
extremity may be remarked: the inner condyle, the outer condyle; the small head {capitulum, F. condyle humeral), 
which is articulated with the radius; the trochlea, articulated with the ulna, &c. The humerus is developed by seven 
points of ossification; one for the body, one for the head, one for the greater tuberosity, one for the trochlea, one fol 
the epicondyle, and another for the lesser head. 
"Humerus surnmus : Top of the humerus, acromion."-Dunglison. 
Fig. 3924.-Dressing for Frac- 
ture of Neck of Humerus. 
"The fragments being reduced as well as possible, a single splint, made of 
leather, felt or gutta-percha, long enough to extend from the acromion process 
to the elbow-joint, must be applied to the outside of the arm, enclosing about one- 
half of the circumference of the limb. This should be moulded and allowed to 
become dry and hard before it is secured to the arm. A second short splint should 
be laid on the inside of the arm ; both of these splints, having previously been 
covered with a sack of woollen cloth, are then to be made fast to the arm by a 
roller; and, finally, the forearm being flexed upon the arm and suspended by a 
sling passing under the wrist, the arm must be secured to the side of the body by a 
separate roller."-" Hamilton's Surgery." 
Fig. 3926.-Bancroft's Arm Splint. 
Fig. 3925. 
Joint Arm Splint. 
Fig. 3928.-Jointed Condyle and Humerus Splint. 
Fig. 3927. 
Condyle and Humerus Splint. 
" It is of great importance to be familiar with the relative positions of the various bony prominences about the elbow. 
We can always feel the internal and external condyles. The internal is the more prominent of the two, and a trifle 
higher. 
" Olecranon.-We can always feel the olecranon. This is somewhat nearer to the inner than to the outer condyle. 
(On strong flexion the groove in the humerus for the olecranon can be readily felt, and even seen.) Between the ole- 
cranon and the internal condyle is a deep depression in which lies the ulnar nerve (vulgarly called the ' funny bone'). 
"On the outer side of the olecranon, just below the external condyle, is a pit in the skin, constant even in fat per- 
sons (when the elbow is extended). This pit is considered one of the beauties of the elbow in a graceful arm, it is seen 
in a child as a pretty little dimple. To the surgeon it is most interesting, as in this valley behind the supinator longus 
Elbow. 590 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURES OF THE UPPER EXTREMITIES. 
Elbow, Olecranon. (Continued.) 
Fig. 3929.-Hamilton's Elbow Splint. 
and the radial extensors of the wrist he can distinctly feel the head of 
the radius rolling in pronation and supination of the forearm. It is, 
therefore, one of the most important landmarks of the elbow, since it 
enables us to say whether the head of the radius is in its right place 
and whether it rotates with the shaft. 
Can the tubercle of the radius be felt ? Yes, but only on the 
back of the forearm in extreme pronation. Its projection is then dis- 
tinctly perceptible just below the head of the bone."-" Landmarks, 
Medical and Surgical." Luther Holden. 
Fig. 3929 is made of gutta percha, moulded to fit the shoulder, 
arm and forearm ; must be well padded, placed upon the limb and 
secured by roller bandage. 
T he forearm should be placed at a right angle with the humerus, 
and maintained in this position by a right-angled splint. The gutta 
percha splint, covered with a woolen or cotton sack, is first secured 
to the forearm by a roller; and then, in a case of fracture of the 
humerus above the condyles, while extension is made, the upper por- 
tion of the splint is secured to the arm in a similar manner. The 
front or bend of the elbow should always be well covered with cot- 
ton batting before enclosing the elbow-joint in the turns of the roller. 
" Passive motion must be commenced very early, by loosening the 
dressing, supporting the parts at the joint, and making flexion and 
extension. If the fiagments are not disturbed, repeat the manoeuvre 
daily."-Stephen Smith. 
Clark's apparatus consists of a band of 
ordinary sole leather, about two inches in 
width, and of sufficient length to surround 
the arm, lined with cloth or chamois and 
well padded with hair or cotton. In order 
to give the band additional firmness, and 
also to secure it around the arm, a strip of 
harness leather is stitched upon the out- 
side, to one end of which two small buckles 
are attached while the other end, which ex- 
tends about three inches beyond the band, is 
split or cut in two straps to correspond with 
and fasten into the buckles. The band is 
fastened around the arm above the fractured 
process, and may be drawn to any degree of 
tightness necessary to bring the broken frag- 
ment down, when traction is made. 
Fig. 3930.-Clark's Splint. 
" Ulna.-The edge of the ulna can be felt subcutaneous from the olecranon to the styloid process (in supination). 
Any irregularity could be easily directed. The styloid process of the ulna does not descend so low as the styloid pro- 
cess of the radius, or it would impede the free abduction of the hand. Its apex is on a level with the radio-carpal 
joint. The head of the ulna is plainly felt and seen projecting at the back of the wrist, especially in pronation of the 
forearm. It then lies between the tendons of the extensor carpi ulnaris and extensor minimi digiti. There is often a 
subcutaneous bursa over it. (In supination it is the styloid process, and not the head of the ulna, which is felt poste- 
riorly.) 
Radius. -The upper half of the shaft of the radius is so covered by muscles that we cannot feel it; the lower 
half is more accessible to the touch, especially just above and just below the part where it is crossed by the extensors of 
the thumb. Its styloid process is readily felt and made all the more manifest by being covered by the first two extensor 
tendons of the thumb. It descends lower, and lies more to the front than the corresponding process of the ulna. The 
Forearm and Wrist. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
591 
WOUNDS AND I^IJUf^lES. 
FRACTURES OF THE UPPER EXTREMITIES. 
Forearm and Wrist. (Continued.) 
relative positions of these styloid processes can be best examined by placing the thumb on one and the forefinger on 
the other. Feel for the little bony pulley on the back of the radius near the wrist, which keeps in place the third ex- 
tensor tendon of the thumb. This and the bone just above it is the place which we examine for a suspected fracture 
(termed Colles') near the lower end of the radius."-" Landmarks, Medical and Surgical." Luther Holden. 
Fig. 3931.-Tiemann & Co.'s Forearm Splint 
Fig. 3932, a, b. 
Coover's Splint for Fractures of the Arm and Hand. 
Fig. a can be used for all fractures of the arm and 
hand, with the fingers fixed upon the hand, and passive 
motion can be directed the first, second or third week, 
as the attending surgeon may direct, thereby keeping 
the tendons loose in their sheaths, and the patient will 
be enabled to secure the use of his limb sooner. 
Fig. b will serve the object better, where the surgeon 
desires to keep the hand and fingers extended. 
With sliding extension for the hand to facilitate pas- 
sive motion of the wrist, without removing the support. 
It is made of wire gauze fastened to a frame. It may 
be used for either arm, and is a very comfortable sling. 
Fig. 3933.-Stillman's Bracket. 
" By encircling the hand (except the fingers) and the 
forearm with plaster, and applying a bracket anteriorly 
and posteriorly, as shown in Fig. 3933, we are enabled 
to retain the wrist in any desired shape and yet keep up 
extension by means of the rachets. In the treatment 
of Colles' fracture they will be found very valuable."- 
Stillman. 
Fig. 3934. 
Right and Left Radius Splints. 
Fig. 3935. 
Fig- 3937- 
Interosseous Splint. 592 
GEORGE TIEMANN «fc CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTUBES OF THE UPPER EXTREMITIES. 
Forearm and Wrist. (Continued.) 
Fig. 3938.-Smith's Arm Splint. 
Fig. 3939. 
"A varied experience, full of disappointments for the more 
severe fractures of the condyles, set me to work to make a 
splint with the following requisites: i. To hold the fragments 
in apposition ; 2. To allow the forearm to be flexed or ex- 
tended, pronated or supinated, with fixation at any point ; 
3. To lengthen or lessen the external lateral angle of the arm 
with fixation ; 4. To leave the entire elbow-joint exposed for 
local treatment during the whole time of wearing the splint, 
without disturbing it. The result of this work was a splint 
that my practice has proved to most happily meet every requi- 
site mentioned. 
" My splint is made with two rods of untempered steel, 
extending from the upper part of the arm to the wrist, with 
a ball and socket joint at the elbow, and screws for fixation; 
the lower ends pass into a sheath-screw on either side of the 
wrist; the upper ends pass through two iron posts set in tin 
and made fast to the arm by plaster of Paris bandages, the 
rods being made firm in the posts by thumb-screws. On each 
side of the wrist is a post through which the sheath-screw 
passes, and made fast to the wrist in the same manner as the 
upper parts, and fastened with fixation screws. By moving 
the sheath-screws the lateral angle of the arm may be con- 
tracted or widened as needed, thus overcoming any tendency 
to loss of the carrying point (or gunstock deformity). A turn 
of the fixation-screws at the elbow and wrist will allow the 
forearm to be flexed, extended, pronated, supinated and fixed 
at any desired point without other interference with the 
splint." - Neiv York Medical Record, December 19, 1885. 
Samuel W. Smith, M. D. 
This apparatus was devised by Dr. Shrady for the purpose of correcting 
extreme deformity in cases of Colles' fracture of the radius. It is to keep the 
hand in the double relation to the forearm of flexion and of deflexion towards 
the ulnar margin. 
Some of these splints are made with a short hand-piece adapting itself to 
the palm proper, or with a long hand-piece extending from the wrist to the 
tips of the fingers. For the employment of either of these forms the surgeon 
must, of course, be governed by the peculiar indications of the case. We also 
make the splints with adjustable flexion and deflexion. 
The fragments being placed as near as possible in apposition, by flexing 
the wrist and deflecting the hand, the splint is applied to the palmer surface 
of the forearm. By means of a strip of adhesive plaster three inches in 
width, which is made to form a sort of lateral sling or loop for the ulnar por- 
tion of the wrist, the tendency to lateral displacement of the ulna is in a 
great measure overcome. This loop, as seen in the cut, embraces the wrist 
and splints (the usual dorsal splint being always used). The ulnar margin 
of the wrist is thus in a sling formed by splints and the plaster, the radial 
margin of the wrist being free. The ulnar margin of the wrist is thus made 
a very efficient fulcrum. In cases of extreme lateral displacement, a suitable 
Fig. 3940.-Shrady's Splint, 
for Colles' Fracture. 
a, a, splints; b, b, b, plaster; 
r, c, c, wrist; d, d, radial margin 
of wrist. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
593 
WOUJMDS AND IJMJURIES. 
FRACTURES OF THE UPPER EXTREMITIES. 
Forearm and Wrist. (Continued.) 
margin of wood is tacked to the ulnar margin of the palmar splint to give additional purchase. The splints are kept 
parallel to each other by suitable strips of plaster, and the hand, by the same means, is secured to the hand-piece. The 
radius and ulna are kept in their proper relations to each other by the usual precaution of directing the palmar surface 
of the forearm and hand upwards and inwards, looking towards the face, the whole apparatus being suspended at a 
right angle with the arm by a sling. In order to prevent undue stiffness of the wrist and fingers by too long confine- 
ment, Dr. Shrady advises that passive motion be resorted to early, and persisted in every two or three days. This is 
done, without disturbing the fragments, by grasping the apparatus firmly at the wrist and freeing the hand. 
This splint is designed, in addition to its 
function as a retentive splint, to promote passive 
motion in the fingers and wrist-joint as well as 
to give support to the hand. It accomplishes 
these objects, as will be seen by the cut, by 
means of the rod connected with the ball 
grasped by the hand, and is joined to the 
sliding-bar on face of the splint by ball and 
socket joint. This joint enables the hand to 
make limited motions of flexion and extension, 
and also of pronation and suppination. The 
natural tendency to relax and contract the 
fingers promotes this intention. 
Fig. 3941.-Hewit's Splint, for Colles' Fracture. 
FRACTURES OF THE LOWER EXTREMITIES. 
Femur, Thigh-bone. 
Trochanter Major.-The trochanter major is the most valuable landmark, to which we are continually appealing 
in injuries and diseases of the lower extremities. There is a natural depression over the hip (in fat persons), where it 
lies very near the surface, and can be plainly felt, especially when the thigh is rotated. Nothing intervenes between 
the bone and the skin except the strong fascia of the gluteus maximus and the great bursa underneath it. 
" The top of the trochanter lies pretty nearly on a level with the spine of the pubes and is about three-fourths of 
an inch lower than the top of the head of the femur. A careful examination of the bearing of the great trochanter to 
the other bony prominences of the pelvis, and a comparison of its relative position with that of the opposite side, are 
the best guides in the diagnosis of injuries about the hip and the position of the head of the femur. 
"Nelaton's Line.-If in the normal state you examine the relations of the great trochanter to the other bony promi- 
nences of the pelvis, you will find that the top of the trochanter corresponds to a line drawn from the anterior superior 
spine of the ilium to the most prominent part of the tuberosity of the ischium, this line also runs through the centre of 
the acetabulum. The extent of displacement in dislocation or fracture is marked by the projection of the trochanter behind 
and above this line. Nelaton's line, as it is termed, theoretically holds good. But in stout persons it is not always easy 
to feel these bony points so as to draw the line with precision. A surgeon must, after all, in many cases trust to 
measurement by his eyes and his flat hands-his best guides. Thus, let the thumbs be placed firmly on the spines of 
the ilia, while the fingers grasp the trochanters on each side. Having the sound side as a standard of comparison, the 
hand will easily detect any displacement on the injured side. Hippocrates bids us compare the sound parts with the 
parts affected (in fractures) and observe the inequalities."-" Landmarks, Medical and Surgical." Luther Holden. 
Femur, Extra Capsular Fractures. 
" Prognosis in Extra Capsular Fractures.-These fractures are almost invariably impacted; the neck being driven 
into the shaft and base of the trochanter, splitting the trochanter and the upper end of the femur into several small 
fragments. The fragments are not, however, completely detached from each other, or even widely separated, owing 
to the strength of the aponeurotic expansion and tendinous attachments which surround them. The impaction con- 
tinuing, bony union takes place with great certainty and rapidity, and without any disappearance of the neck by absorp- 
tion. The trochanteric fragments generally remain perceptibly separated ; but in addition to this there ensues, very 
often, an extraordinary deposit of bone, outside of the capsule, in the form of spindles, called osteophytes, which some- 
times surround the neck like a coronet, and even project upward at points until they reach the pelvic bones. 
" Treatment of Intra and Extra Capsular Fractures.-It was the opinion of Sir Astley Cooper that, considering the 
improbability of bony union in cases of intra-capsular fractures, under any plan of treatment, and the danger of the 594 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
WOUNDS AND INJURIES. 
FRACTURES OF THE LOWER EXTREMITIES. 
Femur, Thigh-bone. (Continued.) 
patient's becoming bedridden, or of sinking under protracted confinement, it would be better in all cases to disregard 
the fracture wholly, leaving the patient for a time in whatever position was found to be most comfortable, and then to get 
him upon crutches as speedily as possible. I cannot entirely agree with this distinguished surgeon in this matter. Sir 
Astley Cooper did not deny the possibility of bony union. He admitted, moreover, the impossibility sometimes of 
establishing a complete diagnosis, since it could not always be affirmed that the fracture was not partly within and 
partly without the capsule. Occupying myself the same position in reference to these two points, I do not see how we 
can properly disregard treatment. On the contrary, we ought, I think, to treat all cases of intra capsular fracture, in- 
cluding even cases of suspected fracture, as if we knew them to be in a condition favorable for bony union : provided 
only that, from day to day, we attentively observe the condition of the patient, and that whenever a failure of strength, 
which can be fairly traced to the confinement, is noticed, we shall lose no time in accepting Sir Astley's advice. 
"A variety of ' fracture' or ' invalid' beds have from time to time been constructed, but in an ordinary case any 
firm bed with a suitable mattrass will serve the purpose."*-Hamilton. 
Fig. 3942.-Skinner's Fracture Bed, 
By referring to the cut, the surgeon will readily comprehend the manner of treating a fracture on this bed. In the 
cut, A represents the bed proper, or the sliding portion thereof, which is six feet long, two and one-half feet wide, six 
inches high at the head and one inch at the foot. It is covered about two-thirds of its length with zinc cut into strips 
and laid longitudinally to the bed. A hole is made through this covering for defecation, which hole is covered with a 
sheet-iron cap that can be withdrawn when required. The side rails of the bed, A, rest on six rolls that run in 
grooved ways on each side of the frame, B, and the arrangement is such that, when the top of the bed is in a hori- 
zontal position, the two legs at the foot of the bed are about six inches higher than the posts at the head, thereby 
causing a strong tendency in the bed to roll in the latter direction-extension being caused by-the weight of the patient's 
own body. 
Fig. 3943.-Burge's Apparatus for Fracture of the Femur. 
♦ See "Buck's Extension," page 582, "Volkmann's Sliding Rest," page 500, and "The Crosby Invalid Bedstead," Fig. 1252. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
595 
WOUNDS AND IJMJURIES. 
FRACTURES OF THE LOWER EXTREMITIES. 
Femur, Thigh-bone. (Continued.) 
" The femur is liable to be fractured through the neck, within and without the capsule, below the trochanter minor, 
in the central portions of the shaft, just above the condyles, through the condyles and at the points of epiphyseal con- 
nections. Fracture of the neck, including even cases of suspected fracture, should be treated as if in a condition 
favorable to bony union, in order both to save the patient from the pain and suffering caused by the irregular contrac- 
tions of the muscles, due to the pressure of the broken fragments against inflamed tissues, and to insure a longer limb 
and less eversion if bony union does not take place. Fractures of the shaft are generally oblique, and the fragments 
over-ride from half an inch to two inches, owing to the contraction of the muscles ; fractures just above the condyles are 
in most cases oblique from above downwards, and frotn behind forwards. All of these forms of fracture can be treated 
more successfully in the straight than in the flexed condition, and in nearly all casesextension is more effectually made 
by the weight and pulley than by any other method. The sooner the limb is put up and subjected to this method of 
treatment after the fracture the better; suffering is prevented, and the sufferer made comfortable from the outset. Pre- 
cisely the same form of apparatus is not suited to all fractures of the femur, but certain modifications are required to 
meet all of the indications present."-Hamilton. 
Fig. 3944--Lente's Hospital Splint. 
" This apparatus is a modification of the splint originated by Desault nearly a century ago, and altered by various 
surgeons from time to time; but especially by Dr. Physic, who introduced it into the Pennsylvania Hospital, and by 
Dr. Gordon Buck, who introduced it into the New York Hospital in 1837. 
" Desault proposed to make the tuberosity of the ischium thepoint d'appui of the counter-extending force. Dr. 
Physic extended the outside splint to the axilla, thus bringing the direction of the counter extension more in a line with 
the axis of the limb, and almost the entire pressure on the groin. Adhesive plaster bands were first proposed by Drs. 
E. Wallace and J. Crosby, and adapted to the New York Hospital apparatus by Dr. Lente, when resident surgeon of 
the establishment, in 1849 or 1850. He reduced the outer splint again to its original length (to the crest of the ilium). 
" From the top of this splint passes, in a curved form, over the abdomen to the median line, a steel brace, padded 
(A, Fig. 3944). To the end of this the pelvic band is buckled, and upon its slides a plate (7'), fixed at any required 
point by a binding screw, to the bottom of which the perineal band is buckled, as seen in the engraving. The iron 
brace is attached to the splint by binding screws, so that it may be shifted, and the splint thus adapted to either side 
of the body. The posterior portion of the perineal band passes under the thigh just below the tuberosity of the ischium, 
and is buttoned to the outer splint at a point about opposite the greater trochanter, or at such a point that, when ex- 
tension is being made, the band shall exactly grasp the tuberosity, and not slip under it. After all the extension has 
been made, by means of the screw, that the patient can bear comfortably, the bands, being elastic, continue the ex- 
tension, and by a very gradual and imperceptible force, a force, however, most difficult to resist-tire out the con- 
tracted muscles of the thigh, and still further enlarge the limb. A spiral spring has also been enclosed in the ferule 
terminating the screw to which the hook for the extending band is fastened. 
" Dr. Lente's remaining modification is a foot-piece {D, Fig. 3944), attached by a slide and thumb-screw to the mor- 
tise in the external splint, and capable of removal at pleasure. This is intended, first, to prevent a usual tendency to 
eversion of the foot; and, secondly, by projecting a little beyond the toes, to take off the pressure of the bed-clothes. 
Application of the Apparatus. 
" Having laid the patient on a firm, unyielding mattress, covered, if you prefer, with one or two folded blankets, 
and measured the respective lengths of the sound and injured limbs, comparing the results of two or more measurements 
(from the anterior superior spinous process to the internal maleolus), shave the leg from the knee to the ankle, apply a 
strip of adhesive plaster, three inches broad, and well warmed, to both sides of the leg, from just below the knee, al- 
lowing them to extend some inches below the sole of the foot. These free ends are to be warmed and smoothly stuck 
to a thin block a trifle wider than the ankle-joint, through holes on either side of which a strong cord is to be passed, 596 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
WOUJMDS AND INJURIES. 
FRACTURES OF THE LOWER EXTREMITIES. 
Femur, Thigh-bone. (Continued.) 
FiG. 3945.-Lente's Hospital Splint, applied. 
to be attached to the hook or ring terminating the screw. A roller bandage is now to be applied from the foot to the 
groin, taking care to make considerable pressure over the adhesive strips. The long splint, having been adjusted to the 
length of the limb, and its cushion secured to it, is to be placed along the outside of the limb, its top just reaching to 
the crest of the ilium ; then, having passed the pelvic band under the body, a guttured splint furnished with a thin 
cushion, long enough to extend from the tuberosity to the popliteal space, is to be passed under the thigh. At the same 
time the perineal band, previously buckled to the iron brace, is to be passed under the thigh and adjusted in its proper 
place. The extending band is now to be secured to the screw, while an assistant is making moderate traction on the 
foot, and at the same time pushing up the long splint; the object of this being to tighten everything before commencing 
extension with the screw, every turn of which will then give an increase of tension. If, after this, the splint is found 
to have been forced up a little higher than the crista ilii, the perineal band must be buckled at either end a little tighter, 
in order to rectify this. The inside splint may now be applied, and the concavity between its cushion and the leg a 
little more than filled up with folds of old blanket or some such elastic material; so that, when the splints come to be 
bound firmly together, the inner condyle of the femur may not be painfully pressed upon, a circumstance which causes 
great discomfort to the patient; a guttered splint, a little longer than the posterior, must now be placed on the anterior 
aspect of the thigh, and then all the splints with the enclosed limb are to be encircled with four strips of strong muslin 
or linen about an inch and a half wide, and long enough to pass twice around the splints and tie in a bow-knot, two 
of these for the thigh and two for the leg. The arrangement of these bands is of considerable importance, as it is thus 
that we are enabled to dispense with the old-fashioned splint-cloth, a very troublesome contrivance, and to keep the 
splints from tilting forward without it. One end is to be placed under the limb, then around it in front, under again, 
and around in front, to be there tied to the other end. In doing this, it is seldom requisite to raise the limb sufficiently 
to disturb the patient. These bands are now to be loosely tied ; and, having made a degree of extension, by means of 
a screw, corresponding to the amount of shortening, the foot-piece is to be screwed on so as to be in apposition with 
the outer surface of the foot. The bands are now to be firmly tightened and tied ; and, if care has been taken to keep 
the inner condyle from undue pressure, they may be tightened to any required degree without any inconvenience to the 
patient. Next, the wedge-shaped cushion is to be placed under the apparatus ; and, finally, the pelvic band is to be 
tightened as firmly as the patient can comfortably bear. A patient under treatment with this apparatus can attend to 
the calls of nature with very little inconvenience. He has only to raise his hips slightly with the aid of the leg and arm 
of the sound side, while the bed-pan is slipped under him without deranging the apparatus in any degree. The pecu- 
liar arrangement of the perineal band secures it from being soiled, as it is removed from the immediate vicinity of 
the anus." GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
597 
WOUNDS AND INJURIES. 
FRACTURES OF THE LOWER EXTREMITY. 
Femur, Thigh-bone. (Continued.) 
Fig. 3946.-Double Incline Plane (Wood). 
Liston's splint is particularly applicable to 
the treatment of fractures of the condyles of the 
femur and of the upper extremity of this bone 
attended with a disposition to displacement of 
the lower end of the upper fragment. It may 
also be advantageously employed in compound 
fractures attended with severe contusion and 
laceration of the integuments, as it affords an 
easy and comfortable position to the injured 
limb. It is applied to the limb by attaching the 
foot to the foot-board and the limb to the splint 
by a roller bandage. The angle of flexion is 
regulated by the screw. The splint is made of 
galvanized iron. 
" The question in relation to the treatment of fractures of the femur, which has given rise to the greatest diversity 
of opinion among surgeons of the present day, is that of position ; and upon this point the testimony of authority may 
be briefly stated as follows: 
" Until Percival Pott wrote his treatise on fractures, about the middle of the last century, nearly 
all surgeons had treated fractures of the thigh in the straight position. From that period up to about 
the close of the first quarter of the present century, probably a majority of surgeons adopted the flexed 
position recommended by Pott. To-day the vast majority of the leading hospital surgeons in Europe 
and in America have returned to the straight position."-Hamilton. 
Fig. 3947.-Liston's-Mclntyre's Splint (Iron). 
Fig. 3949. 
Crutches. 
Fig. 3948.-Extension Bar. 
Crutches. 
Lancewood, rubber bottoms, per pair, . . $12.00 
Maple-wood, rubber bottoms, perpair 11.00 
Plain Maple, per pair, ...... 7.00 
Plain Hickory, per pair 4.00 
Hickory, rubber bottoms, per pair, 5.00 
Children's, per pair, 3.00 to 4.00 
Sockets for Crutches, with rubber, per pair, 4.00 
Crutch Rubbers .45 598 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURES OF THE LOWER EXTREMITIES. 
Femur, Thigh-bone. (Continued.) 
FlG. 3950.-Munger's Splint. 
FF, iron rods three-eighths of an inch in diameter and a foot or more in length, are fitted to the upper or body 
portion of the splint, these rods slide into grooves, G G, in the lower section B, which are covered with tin to prevent 
displacement of the bandages. At the upper end of the lower segment is attached an iron brace, D, through the head 
of which runs a screw, B, ten or twelve inches in length. The end of this screw strikes against a corresponding 
brace, D, attached to the upper segment, and it is by turning this screw that the two portions of the splint are forced 
apart. By this means extension is made and kept up to any desired degree. 
Fig. 3951.-Munger's Splint Applied. 
Application.-Each section should be well padded, and the whole then applied to the limb in the same manner as 
Liston's splint, with rollers and perineal band, except the space between the sections, which is not to be covered by 
the roller but with a light dressing separate from the rest. By this means the wound may be examined and cleaned 
as often as necessary without disturbing any other portion of the apparatus. The surgeon, with a few turns of the 
screw, easily forces the limb to its natural length. 
Fig. 3952.-Apparatus for Gunshot Fractures of the Femur. 
This apparatus is composed of strong iron bars, suitably bent, through which are passed two horizontal sliding rods, 
supporting two pieces of canvas, upon which the limb may be placed. The perpendicular bars are furnished each 
with a clamp and thumb screw, by means of which they may be made fast to the side-rails of an iron bedstead, or, in 
case of necessity, to the side of a stretcher. The clamps enable the surgeon to suspend the limb at any height from 
the bed, and to give to the canvas bottom any degree of inclination desirable. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
599 
WOUNDS AND INJURIES. 
FRACTURES OF THE LOWER EXTREMITIES. 
Leg, Tibia and. Fibula. 
Leg.-The portion of the lower extremity which extends from the knee to the foot. It consists of three bones: 
tibia, fibula and patella. 
" The tubercle of the tibia (for the attachment of the ligamentum patellse), the sharp front edge called the shin, and 
the broad flat subcutaneous surface of the bone can be felt all the way down. The inner edge can be felt too, but not 
so plainly. The lower third is the narrowest part of the bone and the most frequent seat of fracture."-" Landmarks, 
Medical and Surgical." Luther Holden. 
" The head of the fibula is a good landmark on the outer side of the leg, about an inch below the top of the tibia 
and nearly on a level with the tubercle. Observe that it is placed well back, and that it forms no part of the knee-joint 
and takes no share in supporting the weight. 
" The shaft of the fibula arches backwards, the reverse of the shaft of the tibia. The flat of the bones not being on 
the same plane should be remembered in flap amputations. The shaft of the fibula is so buried amongst the muscles 
that the only part to be distinctly felt is the lower fourth. Here there is a flat triangular subcutaneous surface, between 
the peroneus tertius in front and the two peronei (longus and brevis) behind. Here is the most frequent seat of frac- 
ture."-" Landmarks, Medical and Surgical." Luther Holden. 
'''Malleoli.-The shape and relative position of the malleoli should be carefully studied, as the great landmarks of 
the ankle. The inner malleolus does not descend so low as the outer, and advances more to the front; at the same 
time, owing to its greater antero-posterior depth, it is on the same plane as the outer behind. The lower border of the 
inner malleolus is somewhat rounded, and the slight notch in it for the attachment of the lateral ligament can be felt. 
The outer malleolus descends lower than the inner, thus effectually locking the joint on the outer side. Its shape is 
not unlike the head of a serpent. Viewed in profile, it lies just in the middle of the joint. In a well formed leg the 
inner edge of the patella, the inner ankle, and the inner side of the great toe, should be in the same vertical plane. 
Look to these landmarks in adjusting a fracture or dislocation, keeping at the same time an eye upon the conformation 
of the opposite limb. 
" In consequence of violence, usually a sprain, a sliver of the internal surface of the thick malleoli may be broken off, 
seriously implicating the joint, but yet not perceptible by mobility, crepitus, or otherwise, from the exterior. Mr. 
Callender has happily named such ' sprain-fractures.' 
" Into the inter-malleolar space the astragalus is tightly wedged or mortised, and we have here a valuable means of 
diagnosis in case of Pott's fracture of the fibula three or four inches about the external malleolus. In such a fracture 
this inner-malleolar space is widened. If now the leg be seized by one hand above the ankle, and the foot by the 
other, with the palm under the sole, the thumb and the fingers will have the astragalus in their grasp. The astragalus 
can then be pushed sidewise against the outer malleolus and then suddenly towards the firm inner malleolus, against 
which it will come with an easily-perceived impact if there be fracture. If none exist, the astragalus will have no 
lateral play. Motidn at the medio-tarsal joints must not be mistaken for the tibio-tarsal movement."-"Landmarks, 
Medical and Surgical." Luther Holden. 
This apparatus is intended for complicated 
fractures of the lower extremities. It consists of 
a wooden frame, formed of four square bars of 
the length of the lower extremity. These bars 
are united by a crescent-shaped piece of wood 
situated at the back of the knee, and a foot-board 
below, two on either side of the leg. The lower 
two serve the purpose of holding together, and 
giving the apparatus an inclined plane ; the upper 
bars serve as points of attachment for a number 
of linen straps or rollers to suspend the limb. 
They are placed side by side and fastened with 
pins, and constitute a perfect bed, having the advantage of adapting themselves to the differences in the conformation 
of the limb. The foot is retained to the foot-board by long adhesive plaster strips being passed around the foot-board 
and carried upwards and secured to both sides of the leg with roller bandage, leaving a sort of loop beneath the foot- 
board, through which a rope is passed and attached to a little bag weighted with sand, for the purpose of keeping up 
extension. Counter extension is made by a perineal band, the end of which is secured to the head of the bed. A long 
cross-bar under the foot-board, resting on the bed, prevents the apparatus from tilting. Bricks may be placed under 
the inferior legs of the bed, to give the apparatus an inclination towards the pelvis. One of the advantages of this 
instrument is that each of the bands of linen may be removed separately, any wound dressed and the band reapplied 
without displacing the others. 
Fig. 3953.-Hodgen's Splint, 600 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURES OF THE LOWER EXTREMITIES. 
Leg, Tibia and Fibula. (Continued.) 
" Having experienced considerable difficulty in removing plaster of Paris dressings when applied by the roller 
bandage, and especially when obliged to remove them on account of pain caused by an increase of the swelling, I re- 
spectfully submit to the profession a method of application by which these disadvantages may be avoided. 
" Having procured a woollen or cotton stocking sufficiently long 
to reach to the knee-joint, 1 cut from it, as a pattern, six layers of 
coarse red flannel (i), one-quarter of an inch larger to allow for 
shrinkage. The flannel is then soaked in water, pressed and laid 
over the back of a chair ready for use. A one-quarter inch cotton 
rope is now sewed to the posterior median line of the stocking. 
The plaster of Paris being in process of preparation, the stocking 
is cut in the anterior median line, applied to the fractured limb, 
and laced up in front, including the rope (2), extension and counter 
extension being kept up by assistants, and the fracture adjusted. 
Each layer of the flannel is now separately saturated in the plaster 
paste, and applied, three layers to each side of the limb, being 
careful to avoid covering the rope. After this is done, a layer of 
plaster paste is applied to the flannel, and, when this has become 
sufficiently dry, a coating of shellac varnish is applied, which pro- 
duces an elegant finish, and also gives firmness to the splints. The 
varnish will dry in about fifteen minutes. This dressing can be re- 
moved in from three to five minutes by loosening the rope from the 
plaster and cutting the thread which binds it to the stocking. The 
rope having been removed, the plain stocking surface can be cut 
through with an ordinary pair of scissors. The splint is then re- 
moved in two lateral portions, each half of the stocking remaining 
attached to its corresponding splint (3)."-New York Medical 
'Journal, Sept., 1875. G. Wagerhagen, M. D. (See Fig. 3880.) 
Used for fractures of the fibula when they occur about 
two or three inches above the lower end, usually resulting 
from a fall upon the foot, in consequence of which the foot 
is violently twisted outwards, and sometimes the ankle is 
itself dislocated. This modification of Pott's splint con- 
sists in the addition of the screw for extension. 
Pott's original dressing is composed of an outside angu- 
lar splint seven inches in width, constructed of deal board 
with a projection to accommodate the foot ; it is well pad- 
ded, and has a hole with bevelled edges to accommodate the 
external malleolus. It is placed on the outside of the limb, which must be flexed on the abdomen, and the leg kept at 
a right angle with the thigh. On the inside of the leg a padded straight splint of felt, leather or pasteboard, extending 
from the ankle to the knee, is placed, and the two secured by roller bandage. The limb is allowed to rest on its outer 
side. 
Fig. 3954.-Wagerhagen's Splints. 
Fig. 3955.-Raphael's-Pott's Splints. 
Fig. 3956.-Depuytren's Fibula Splint 
Fig, 3957.-Dressing Splints. 
Depuytren's splint is constructed of a single board, about four inches wide, and must extend from the condyle of 
the femur to two or three inches beyond the foot. Upon this a long triangular pad must be laid, the thickest portion 
of the triangle corresponding to a point about an inch above the internal malleolus. The bone is then set, and the 
splint, with the pad resting upon it, lying along the inside of the leg, which is secured by roller bandage-the bandage 
not covering the site of the fracture. 
See "Porous Felt Splints," page 577, and "Levis' Metallic Splints," page 580. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
601 
WOUNDS AND INJURIES. 
FRACTURES OF THE LOWER EXTREMITIES. 
Leg, Tibia and Fibula. 
Fig. 3958.-Salter's Cradle. 
For protecting a fractured limb from the pressure of the 
bed-clothes, and to permit change of position without the 
risk of displacing the bones. It is a frame resting upon the 
bed and having on its central bar a small railway, upon which 
travel two pulleys, suspending by a chain the wounded limb 
(placed in such splinting as the surgeon may select) and pro- 
tecting it from all external pressure. 
Fig. 3959.-Left Ankle Splint. 
Fig. 3961.-Fracture Box, Reversible. By Dr. J. F. Fry. 
Fig. 3960.-Right Ankle Splint. 
See "Volkmann's T Splint," 
Fig. 3915- 
Fig. 3962.-Clark's Splint. 
The attachment for extension is by means of adhesive strips, M, extending to near the knee and passing around a- 
foot-piece, I, to which is attached a small bracket, B, which hooks over the lower end of the main splint. Then the 
limb is suspended by four hooks, DD, which are attached to thimbles that slide back and forth upon the bar, and are 
fixed at the desired point by means of thumb-screws in their outer sides. Extension is made by means of the cord, C, 
attached to the hook in the pulley at S, passing forward between the cords playing over the pulley at O, to drop over 
the pulley, G, fixed in a post at the foot of the bed, and then attached to a sand-bag of sufficient weight to make the ne-< 
cessary amount of extension. The weight ordinarily required for an adult is from ten to fifteen pounds. A uniform 
traction is exerted upon the limb, in whatever position the body of the patient may be placed. 602 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURES OF THE LOWER EXTREMITIES. 
Leg, Patella. 
"Patella (Lat., a small pan, the knee pan, diminutive of patina, patena, a pan or dish ; Fr., patelle."-Webster. 
"A sort of sesamoid, flat, short, thick, rounded bone, situate in front of the knee, and enveloped in the substance 
of the tendon common to the extensor muscles of the leg. The posterior surface of the patella is divided into two 
facettes, united angularly, which are incrusted with cartilages, and each of which is articulated with one of the condyles 
of the femur. The patella is developed by a single point of ossification. When the patella is fractured, it is difficult 
to produce bony union. This can only be accomplished by keeping the fractured extremities closely in apposition."- 
Dunglison. 
"The apparatus consists of thigh and leg-pieces of 
sheet-iron, with two buckled straps attached to each, 
united by two lateral bars and one posterior bar of steel. 
To the posterior bar are two troughs, on a double reversed 
screw; by turning the key in opposite directions, the 
troughs separate or approach each other. The apparatus 
should be applied in simple fractures as soon as possible ; 
but if, in the opinion of the surgeon, it would aggravate 
existing inflammation, thereby jeopardizing the joint, it 
could be applied as a posterior splint, without using the 
coapting appliance, until antiphlogistic measures make 
it safe. 
" In applying the apparatus, it should be well pad- 
ded with flannel or other material, for protecting thigh 
and leg from the splint and straps ; quadriceps femoris 
should be relaxed, the limb held by the thigh portion, 
and buckled ; also buckle the leg portion. 
" First fix the lower fragment, by drawing it up, 
smoothing the integuments down ; this being held by 
an assistant, the surgeon applies a strip of adhesive 
plaster, of sufficient width to hold the fragment, and 
overlaps it sufficiently to prevent any tilting up, passes 
the free ends of the adhesive plaster around the upper 
trough, crosses them and applies them to the skin. 
The upper fragment being coapted, the integuments being smoothed up, a 
similar piece of plaster is applied around the lower trough as around the 
lower fragment. Interpose something where the plasters cross each other, to 
prevent their sticking together. 
"For firmness, use double strips of plaster. Snip the upper edge of the 
upper plaster; thus a rounded edge instead of a cutting edge will be presented 
to the integuments, avoiding in a degree excoriation. The apparatus should 
remain applied thirty or forty days. When new dressings are applied, the 
patella being held, cautious passive motion may be made. After the appara- 
tus is permanently removed, the patient, to favor consolidation, should wear 
something to prevent too much use of the patella, say for four or six months, 
viz., an elastic knee-cap with a ring arrangement over the patella, or posteriorly 
a piece of gutta-percha or leather strapped above or below the joint, either of 
which, being softened by warm water, can be applied and allow of certain 
flexion. Passive motion can be occasionally made, but not extreme, under 
six months."-Medical Record, July 15, 1867. 
This apparatus consists cf a light tin splint, covered with morocco. The coapting 
appliances are a pair of strong webbings or straps, well padded in the middle, which are 
drawn across the fragments obliquely and tightened by means of buckles or hooks. 
Fig. 3963.-Turner's Patella Splint. 
Fig. 3964. 
Hartshorn's Patella Splint. 
I. Length from above ankle to upper third of thigh, .... Inches. 
2. Right or left leg ? " 
3. Circumference of thigh, " 
4. Circumference of calf, " 
Directions for Measurement. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
603 
WOUJMDS AND INJURIES. 
FRACTURES OF THE LOWER EXTREMITIES. 
Leg, Patella. 
Fig. 3966. 
Jointed Patella Splint, with Screw. 4 sizes. 
Fig. 3965. 
Patella Splint. 4 sizes. 
Fig. 3967. 
Levis' Patella Splint. 
I his apparatus consists of a broad pad, resting on the popliteus, to keep the knee extended, 
and a narrow pad, fitting the upper border of the patella. A strap connected with the latter 
one is first passed through a ring attached to the popliteal pad, then continued down the leg 
on each side, being finally buckled to a lined foot-pad. This makes the foot a fixed point for 
extension, and the ring through which the strap passes gives it also a direction backwards, 
maintaining a firm hold of the upper fragment of the patella, whilst the lower fragment is 
readily kept in place by a strip of adhesive plaster. 
Directions for Measurement 
I. Circumference above knee Inches. 
2. Length from sole of foot to knee " 
Fig. 3968.-Denison's Extension Windlass, 
This little instrument is intended to serve 
surgeons in country practice, who, not being 
able to resort to an instrument maker in 
urgent cases, are compelled to depend on their 
own skill to devise means of treating fractures 
or deformities. It is a substitute for the screw 
power or the rack and pinion, and may be 
attached to wooden supports or splints. If 
attached by one screw it will be movable, 
swivel-like, self-adjusting; if fastened by two 
or more screws it is made stationary. 
A, B and C, holes for screws or tacks ; 
II, winding-rod, slotted at G, squared at F, 
for key I, and held in position by ratchet E 
and pinion D, with spring-attachment J. 
Length of the winding-rod, two and one- 
quarter inches ; between the arm of the brackets one and three-quarter inch. 
A A and B B, extension and counter-extension windlasses, each fastened by one screw to wooden posterior splint; 
C C, fan-shaped adhesive plasters, crossing each other at C, and threaded through winding-rods F F, D, padded roller 
over ligamentum patellae, the ends of which are threaded through winding-rods IIH, E, reserve counter-extension to 
relieve D from uncomfortable pressure in front of knee II, point at which splint is bandaged to the limb. 
Many other uses and methods of attachment will suggest themselves to the ingenious surgeon. Our space does 
not allow a fuller description, for which we refer to The New York Medical Record, May, 1875. 604 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
FRACTURES OF THE LOWER EXTREMITIES. 
Leg, Patella. 
Fig. 3969. 
Stillman's Patella Brackets. 
The plaster and brackets being applied as delineated in the cut (Fig. 3969), 
it only remains to hold the fragments together by means of an elastic w eb- 
bing attached to the two bridges, or by strips of adhesive plaster. Thus we 
ensure absolute freedom from motion, are enabled to watch the fragments, 
keep them thoroughly in approximation, at the same time subduing all ten- 
dency to inflammatory action with external applications. 
Fig. 3970.-Boisnot's Patella Splint. 
The splint is concave, to suit the convexity of the limb. The semi-lunar 
pieces are of stout leather, doubled and crimped. The cords pass over 
pulleys to revolving transverse pieces, which are protected from slipping by 
spring and ratchet. 
" The dressing which I have usually em- 
ployed in the treatment of this fracture, con- 
sists of a single inclined plane, of sufficient 
length to support the thigh and leg. about six 
inches wider than the limb at the knee. This 
plane rises from a horizontal floor of the same 
length and breadth, and is supported at its 
distal end by an upright piece of board, which 
serves both to lift the plane and to support 
and steady the foot. The distal end of the 
inclined plane may be elevated from six to 
eighteen inches, according to the length of 
the limb and other circumstances. Upon 
either side, about four inches below the knee, 
is cut a deep notch. The foot-piece stands at right angles with the inclined plane, and not at right angles with the hori- 
zontal floor. It may be perforated with holes for the passage of tapes or bandages to secure the foot. Having covered 
the apparatus with a soft and thick cushion carefully adapted to all the irregularities of the thigh and leg, especial care 
being taken to fill the space under the knee, the whole limb is now laid upon it, and the foot gently secured to the foot- 
board, between which and the foot another cushion is placed. The body of the patient should also be flexed upon the 
thigh, so as the more effectually to relax the quadriceps femoris muscle. A compress made of folded cotton cloth, wide 
enough to cover the whole breadth of the knee, and long enough to extend from a point four inches above the patella to 
the tuberosity of the tibia, and one-quarter of an inch thick, is now placed on the front of and above the knee. While 
an assistant presses down the upper fragment of the patella, the surgeon proceeds to secure it in place with bands of ad- 
hesive plaster. Each band should be two or two and a half inches wide, and sufficiently long to enclose the limb and 
splint obliquely. The centre of the first band is laid upon the compress, partly above and partly upon the upper frag- 
ment, and its extremities are brought down so as to pass through the two notches on the side of th'e splint, and close 
upon each other underneath. The second band, imbricating the first, descends a little lower upon the patella, and is 
secured below in the same manner. The third and so on successively until the whole of the compress and knee is 
covered, is carried more nearly at right angles around the leg and splint, the last band passing obliquely from below 
the ligamentum patellae upwards and backwards. The dressing is now completed by passing a cotton roller lightly 
around the whole length of the splint, commencing at the toes and ending at the groin."-" Hamilton on Fractures 
and Dislocations." 
Fig. 3971.-Hamilton's Patella Splint. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
605 
WOUNDS AND INJURIES. 
FRACTURES OF THE LOWER EXTREMITIES. 
Leg, Patella. 
Fig. 3972. 
Bacon's Patella Support. 
Patients recovering from transverse fracture of the patella, with "aponeurotic union," 
are constantly liable to repeated ruptures of this adventitious tissue, each successive acci- 
dent widening the gap between the fragments of the bone and lessening the power of the 
leg extensors. The frequency with which such patients fracture the opposite patella, in 
their attempts to save the weakened joint from renewed injury, is well known. 
To give efficient support to joints thus impaired, the appliance here shown (Fig. 3972) 
has been devised, and has been worn with satisfaction by several patients, one of whom, 
having an ill-united fracture of each patella, was able to mount a flight of stairs imme- 
diately upon the application of the apparatus, for the first time since the injury was received. 
Authorities on surgery say that great care must be taken not to rupture the ligaments 
of the newly formed union, which so often happens after recovery of the patient from 
fractured patella. For the purpose of guarding against such a recurrence, we make the 
apparatus shown (Fig. 3973). It consists of a knee-cap made of buckskin or satin jean, 
which is adjustable to the knee by buckles or laces. It is provided with a pair of coapta- 
tion pads, to retain the newly united patella in place. These pads are arranged to ap- 
proximate by drawing on laces, as shown in the upper border of the cap, represented in 
illustration (Fig. 3973). It affords the patient exercise of the knee-joint, the best guard 
against the danger of anchylosis, at the same time preventing any undue strain on the 
newly united upper fragment of the patella. 
Fig. 3973.-Tiemann's 
Patella Support. 
Directions for Measurement for Figs. 3972, 3973 
I. Circumference above knee, Inches. 
2. Circumference of knee, " 
3 Circumference below the knee, " 
The Treatment of Fractured Patella. 
" The question of the best treatment for fractured patella has recently been brought 
into prominence. The medical and clinical societies of London at their meetings in 
November made the matter the subject of prolonged and animated debates, during which 
some interesting statistics were brought forward by Mr. G. R. Turner and Mr. Bryant. 
Dr. William Macewen also contributed a paper on the same subject in the Lancet of 
November 17th. The chief point at issue was the adoption of the practice of cutting 
into the knee-joint, drilling the two fragments, and uniting them by a stout silver wire ; 
the whole being done under the strictest antiseptic precautions. The question further 
was, whether, admitting that the operation is justifiable in old and intractable cases where 
the leg is almost useless, it is also justifiable in recent cases. The early operation received 
the qualified endorsement of Mr. Lister, and the unqualified and earnest support of 
Dr. Macewen. 
" The statistics presented by Mr. Turner, however, showed that this operation is not 
without danger to life and limb, while the statistics of Mr. Bryant and the general ex- 
perience of other surgeons showed that the treatment of fractured patella by simpler me- 
thods was attended with just as good results as was the more radical operation. 
" The debates on the whole show, as stated by the Lancet, that the operation was not suitable as a primary mea- 
sure, nor for general employment. That, when performed, the operation should be done with every possible antiseptic 
measure, and that when, as in intractable cases, it is positively indicated, the earlier the operation is performed the 
better."-The Medical Record, December 8, 1883. 
COMPOUND FRACTURES 
"A fracture is compound when it communicates through a wound with the external air. These injuries have al- 
ways been regarded as dangerous, because such wounds commonly inflame and suppurate (Hunter) ; but, when they are 
protected from the action of septic ferments, recovery will occur with slight inflammation and suppuration. The first 
question to determine is as to the possibility of saving the limb, and, as a rule, the attempt should be made if injury 
to the soft parts is not very great; if the bone does not largely protrude and the skin is not extensively lacerated ; if 
the continued warmth of the limb below the fracture indicate the escape of the main artery, and that the nerves are not 606 
GEORGE TIEMANN & SURGICAL CO.'S INSTRUMENTS. 
WOUNDS AND INJURIES. 
COMPOUND FRACTURES. 
Continued. 
implicated (F. C. Skey). The thorough use of disinfectants, by which putrefactive suppuration is now prevented, adds 
largely to our means of saving limbs after compound fractures. 
' The first indication is to convert the compound into a simple fracture when the opening is very slight and readily 
closed ; this may be done with collodion, or with any dressing which hermetically seals the wound. If the bone pro- 
trude, attempt reduction by extension and counter extension ; if this fail, introduce the finger or the spatula into the 
wound and endeavor to stretch the skin over the sharp point of the bone ; if all efforts fail, enlarge the wound suffi- 
ciently to insure return ; if the bone is denuded or very sharp, saw off the projecting end ; ligate the ruptured arte- 
ries, which can be readily found. Anaesthetics may be useful during these efforts (F. H. Hamilton). If the case 
is seen at once, cleanse the wound, disinfect every portion liable to contain septic ferments, secure perfect rest, and 
prevent the entrance of any poisons. Employ the antiseptic dressing, which best meets these indications (J. Lister), 
as follows: Use the spray during the dressing; if the contusion is slight, inject carbolic solution, 1 to 20, into the 
wound, and apply the gauze; if there is much contusion, enlarge the wound and inject the same solution freely and 
forcibly among the injured tissues, and dress as before ; repeat the injection at every dressing when the discharge is 
offensive, opening the wound more freely, if necessary, to reach deeper recesses. If the suppuration has extended very 
deeply, and is offensive, the wound must be still more freely enlarged, and a solution of carbolic acid in wine, 1 to 5, 
injected, and, if necessary, through a tube introduced to the most remote recess. If the gauze is not at hand at each 
dressing, after thoroughly disinfecting all parts of the wound with carbolic solution, fill the cavities and the entire open 
spaces with pledges of lint saturated with carbolic oil. 
" The plastic dressing should next be applied ; if there is danger of too much swelling, it may be applied only to 
the under and lateral surfaces, leaving the upper and injured surface free. As early as possible, however, the gypsum 
dressing should be so employed as to completely envelop the limb, a protective being placed next to the skin, as cotton 
batting, or thick flannel; when completed and nearly dry, a fenestrum, or, if necessary, two or three, should be cut 
out so as to give full access to the wound ; the limb is then suspended."-"Operative Surgery." Stephen Smith. 
SHOT FRACTURES. 
" Projectiles (T. Longmore) cause a variety of partial and complete fractures ; the former are : (i) removal of a por- 
tion of bone, (2) splintering off of fragments of the external cylindrical part of a bone, (3) making a hole throughout 
the entire substance of the bone, (4) driving the external cylinder into the cancellated structure; the latter are: 
(1) simple when the injury is indirect, and (2) compound when the projectile is brought in direct contact with the in- 
jured bone. These fractures are always serious injuries, as they frequently involve the question of a resection and 
amputation, and are always liable to dangerous complications, as haemorrhage, tetanus, septicaemia and pysemia. The 
course of treatment indicated varies with the bone fractured and the nature and extent of the injury."-"Operative 
Surgery." Stephen Smith. 
" I. The superior maxilla has such relations to the structure of the face that every effort should be made to pre- 
serve its symmetry when broken by shot injuries. Unless the fragments are either completely detached or but slightly 
adherent, they should not be taken away, but replaced with care, as in time consolidation may take place, and very 
little permanent deformity be left; after careful adjustment of the movable fragments, close the wound with adhesive 
plaster- and apply cold water dressings ; if fragments subsequently loosen, remove them (J. J. Chisolm). Bony union 
of these fragments usually takes place with great facility (F. H. Hamilton). 
" 2. The inferior maxilla, fractured by projectiles, is with difficulty retained in position ; the fragments should be 
preserved and adjusted, and efforts made to retain them in apposition by the four-tailed bandage, with pasteboard 
cap for the jaw, and interdental splints of gutta percha (Hamilton). 
"3. The clavicle is in such relations with the pleural cavity and the larger vessels of the neck that serious compli- 
cations frequently attend shot fractures of that bone. In the treatment of uncomplicated fractures remove detached 
splinters immediately, and necrosed fragments at the earliest practicable moment (G. A. Otis), then leave the injury 
to nature, with as little operative interference as possible, for the less the wound and bones are manipulated the better 
the result (Beck). 
"4. The humerus should always be subjected to conservative treatment, unless extremely injured by a massive pro- 
jectile, or longitudinal comminution exist to a great extent, or a joint is also involved, or, finally, the patient's health 
is unfavorable (T. Longmore). In cases which admit of conservative treatment, proceed as follows: If the bone is 
much splintered, extend the wound, if necessary, for exploration and operation, at the most depending opening if there 
are two wounds, or make a fresh incision if only one exists and it is not in a favorable position; make an examination 
with the finger for any foreign bodies or detached pieces of bone, and remove them ; remove also such partially de- 
tached portions and fragments as are retained only by very slight and narrow periosteal connections, and saw or cut off 
sharp points of projecting spicula (Longmore). Dress the wound with lint soaked in carbolized oil, and support the GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
607 
WOUNDS AND INJURIES. 
SHOT FRACTURES. 
Continued. 
limb by a fenestrated splint of gypsum, or sole leather, or other material capable of being moulded to it, and which will 
secure rest. Immobility is securely obtained by a triangular cushion and axillary pad interposed between the thorax 
and the arm. 
"5. The radius and ulna, like the humerus, should be conservatively treated, unless there is partial ablation by 
cannon ball, or comminution of both bones with laceration of the bloodvessels and nerves, or extensive comminution 
in the vicinity of joints, with fissures extending into the articulations (F. Schwartz). After extracting loose fragments, 
if no considerable deformity exists, only simple splints and bandages are required ; if there is great tendency to dis- 
placement, the fenestrated gypsum dressing, applied when the arm is midway between pronation and supination, with 
a slightly bent elbow, is most useful (H. Fischer). If a single bone is fractured, the most simple splint dressing is 
required. Suspension of the forearm in the early stages of treatment is very important, and maybe effected by a simple 
apparatus (G. Buck). (See Buck's suspension apparatus, Fig. 3885.) 
"6. The metacarpal and phalangeal bones should, as far as practicable, be preserved, whatever the nature of the in- 
jury, though their functions may subsequently be greatly limited. Their wounds are extremely painful and troublesome 
in management, but are not specially liable to induce tetanus (F. G. Otis). In the treatment, splinters and foreign 
bodies should first be removed ; free incisions through the aponeurotic layers are important in preventing accumulations 
of matter under fasciae and tendons, or relieving tension caused by such collections. Carbolized oil dressings pressed 
into the wounds in ordinary cases, and the hot water in those liable to extensive sloughs, should be early resorted to 
and persistently used; the hand may be supported upon properly adapted splints. 
"7. In shot fractures of the upper third of the femur, especially if it be doubtful whether the hip-joint is implicated 
or not, the question is still open whether excision of the injured portion, or removal of the detached fragments and rely- 
ing on the natural efforts for union, or amputation, which is very dangerous, is best for the safety of the patient. The de- 
cision must depend upon the extent of the injury to the surrounding structures, the condition of the patient, and other 
circumstances in each individual case. As a general rule, in fractures of the middle and lower third of the thigh, am- 
putation is held to be a necessary measure. When it is determined to attempt to save the limb, the wound may be 
enlarged to remove spicula of bone, and occasionally counter openings should be made to prevent the accumulations 
and burrowing of pus; carbolic solutions should be injected into all the recesses, and carbolized oil on lint be in- 
troduced with forceps to avoid creating additional irritation ; cold water or ice dressings may at first be applied, to be 
discontinued if suppuration occurs. The part should finally be perfectly immobilized by apparatus. 
"8. The tibia and fibula, fractured without implication of the knee or ankle joints, are very amenable to conser- 
vative measures, and hence, as a general rule, ordinary fractures below the knee, from rifle balls, should never cause 
primary amputation (T. Longmore). The treatment should consist in freeing the wound of all foreign matters and 
splinters, the local use of carbolized oil on lint, and the application of the gypsum splint noticed in the treatment of 
ordinary compound fractures in this region."-"Operative Surgery." Stephen Smith. 
Fig. 3974.-Fenestrated Plaster of Paris Dressing. 
For Fixation and Through Drainage in Compound Fracture 608 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
SHOT FRACTURES OF THE LOWER EXTREMITIES 
Thigh and Leg. 
Fig. 3975. 
Smith's Anterior Splint. 
Fig. 3976.-Shrimpton's Forceps. 
For bending Smith's Anterior Splint while in situ, to adapt it to the limb. 
" Smith's anterior splint is simply a frame composed or stout wire, which, 
being suspended, allows the limb, fastened to it by rollers, to be suspended 
in turn-the rollers passing around both limb and splint, from the foot to 
the groin. The splint should extend from above the anterior superior spinous 
process of the ilium to a point beyond the toes. The lateral bars of the splint 
are separated about three inches. One of the spring double hooks, fastened 
to the short cord for suspension, ought to be nearly over the seat of fracture, 
the other a little above the middle of the leg. 
Fig. 3977- 
Byrd's Wire Gauze and Smith's Splint. 
' "BBB represents the wire-gauze 
applied. Dr. Smith's anterior splint 
is clearly seen above, at A A A. The 
cords and pulleys are sufficiently well 
defined to be readily recognized. 
"After taking proper dimensions 
of the thigh, popliteal region, leg 
and heel, the gauze is cut so as to 
adapt it to the posterior and lateral 
surface of the limb, and then bound 
around with thin fine leather, with 
buckles and straps attached at suit- 
able intervals. The limb is then made 
nude by the removal of the bandage 
that sustains the splint, and the wire 
gauze, as above prepared, placed in 
position under it. When this is 
accomplished, the "anterior splint," receiving proper shape, is placed over the front of the extremity, the wire gauze 
secured by the buckles and straps to its longitudinal bars, and the hooks for the suspensory apparatus above having 
been passed into the rings or eyelets of the transverse bars of the " splints," the limb is swung from the bed. 
"A wound may be clearly seen and freely syringed or sponged, and receive other local treatment through the wire 
gauze, even when situated on the posterior or lateral aspect of the limb, without disturbing its position. Again, where 
it is desirable to remove, at any point, undue or uncomfortable pressure, it is more easily accomplished, as the leather 
straps and buckles attached to the margin of the wire gauze may be slackened or tightened at such points as may be 
necessary to secure the desired relief. By this management, undue pressure on the muscles may be almost obviated. 
The foot and heel may be turned to most important account, as a lever or weight in certain fractures, by increasing 
or lessening the support which the anterior cord and pulley, or sling attached to the distal end of the gauze, is capable 
of effecting."-Harvey L. Byrd, M. D. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
609 
WOUJMDS AND INJURIES. 
SHOT FRACTURES OF THE LOWER EXTREMITIES. 
Thigh and Leg. 
Fig. 3978.-Suspending Splint. 
Reversible for Right or Left Limb, Extension, Counter Extension, and Fixation of the Knee at any Angle, 
Fig. 3979.-Clendinen's Suspending Splint. 
Fig. 3980. 
Hodgen's Suspending Apparatus. 
The frame is stout wire ; strips of cloth are laid 
across the splint from side to side, and upon these 
the limb is laid. The centre and upper extremity 
of the splint are kept asunder by strong bows of 
iron wire, so arranged that they can be put on or 
taken off without disturbing the dressings. When 
applied, the inside wire must be bent upwards at its 
upper extremity, so as to make room for the pubes. 
Extension is made by adhesive plasters, and the 
whole apparatus is finally suspended to the ceiling or 
to some point above by a rope and pulley. 610 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
OF JOINTS. 
Wounds. 
" Joints are composed of the two ends of bones covered with cartilage ; of a sac, frequently containing many append- 
ages, pockets and bulgings; of a synovial membrane, a fibrous capsule, and the strengthening ligaments (T. Bill- 
roth). It is owing to the intimate relations of these complicated structures that the injuries and diseases of joints are 
peculiarly serious. 
On account of their exposed positions joints are specially liable to wounds of various forms and degrees of severity. 
" i. Contused tvounds may be so severe as to be followed by extravasation of blood into the tissue around it, or 
even into its cavity. Examine first for a fracture, then apply apparatus to secure perfect rest, and the ice-bag to pre- 
vent inflammation ; the gypsum dressing with a suitable fenestrum at the joint is the best apparatus for the injury of 
joints of the lower extremity. 
"2. A punctured wound is dangerous, owing to the tendency to suppurative inflammation and the retention of the 
pus. That the joint is involved is known by the escape of synovia. Pursue the following treatment: Place the patient 
in bed, close the wound with collodion or adhesive plaster, if it is slight, but with sutures accurately applied if it gape ; 
secure perfect rest to the joint by immovable apparatus, and, if any application is made, use cold. In favorable cases 
all excitement about the joint will subside in a few days, and when the dressings are removed, at the end of four to six 
weeks, recovery will be complete (T. Billroth). 
" 3. An incised wound is also recognized as having penetrated the joint by the appearance of synovia. Such a wound 
must be treated and dressed antiseptically; close it accurately with sutures, apply immovable apparatus to the limb, 
and locally use ice-bags; give cooling regimen. If the case proceed favorably, retain antiseptic dressings until union 
is firm, then commence passive motion, but restrict it for at least one month. 
"4. A lacerated wound should be treated as follows: Cleanse the wound of all foreign matters under the spray, 
pare the edges of all contused tissues, and, if possible, close the wound with silver wire sutures and treat it as an in- 
cised wound ; if large, gaping, and if it cannot be closed under the carbolic spray, enlarge the opening wherever it is 
necessary to gain free drainage of the cavity of the joint, inject carbolic solutions (l to 20) to destroy septic ferments 
which may have entered the joint; introduce the drainage tube or a horsehair drain, carbolized ; apply antiseptic dress- 
ings and immobilize the joint by apparatus; renew the dressings within twelve hours, and repeat them as often as ne- 
cessary to prevent accumulation of secretions in the wound (J. Lister). However favorably the case proceeds, the 
joint must be retained in a state of perfect rest for at least two weeks, when passive motion may be begun ; but, if it 
produces any swelling of the joint or tenderness, all motion must cease for several days, when it may be renewed."- 
"Operative Surgery." Stephen Smith. 
Dislocation and Luxation. 
"A joint is dislocated when one bone is displaced from another at its place of natural articulation ; there may be no 
other injury than rupture of the capsule, simple dislocation ; or there may be a wound of the integument entering the 
joint, compound dislocation. The signs of dislocation are: preternatural immobility and tendency, when reduced, to 
remain ; but with free motion without crepitus. The treat- 
ment required is immediate reduction ; anaesthetics must be 
used for relaxation: when reduction is possible by manipu- 
lation this method should always be preferred. If more 
force is necessary, make extension and counter extension 
with the hands, aided with bandages tied in the form of 
the clove-hitch; if more power is required, resort to me- 
chanical contrivances, as the pulley. Compound disloca- 
tions are among the most serious accidents which can 
befall a limb (T. Bryant) ; but it must be borne in mind 
that, by the proper use of antiseptic dressings, these in., 
juries may now be treated without suppuration, and are, 
therefore, far more amenable to conservative measures 
than formerly. The treatment must depend upon the 
amount of injury in each case ; if slight, reduction may be 
effected by suitable enlargement of the wound, followed 
by thorough cleansing and disinfection ; resection should 
be made when the bones are destroyed, the antiseptic 
dressings being employed ; amputation will be necessary 
when the principal artery of the limb is ruptured, or there 
is destruction of the tissue about the joint, or the patient is 
old and feeble."-"Operative Surgery." Stephen Smith. 
Fig. 3981.-Dislocation Pulleys. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
611 
WOUNDS AND INJURIES 
OF JOINTS 
Dislocation, and Luxation. (Continued.) 
" The temporo-maxillary joints are dislocated by the deplacement of the condyles of the lower jaw forwards, one or 
both, the latter being more frequent. Reduce as follows: The patient, seated on the floor, with the head between the 
knees of the operator, place a couple of pieces of cork, gutta percha or pine wood as far back between the molars as pos- 
sible ; now draw the chin steadily upwards, taking care not to draw it forward at the same time ; or, sitting or standing 
in front, depress the condyles by means of the thumbs protected by pieces of leather, placed on the top of the molars ; 
if this method fail, reduce one side at a time, or give an anaesthetic ; after reduction support the jaw with a bandage. 
"The vertebral articulations are rarely displaced without fracture, especially in the lumbar and dorsal regions. 
In the cervical region forward and backward luxations may occur with or without fracture. Reduction should always 
be attempted. If the lumbar or dorsal vertebrae are displaced, make forcible extension with judicious lateral motion 
and direct pressure upon the spine. If a cervical vertebra is displaced, raise the head firmly by the chin and occiput, 
and, if reduction does not follow, add slight rotation in the direction of dislocation to disengage the process, or place 
the patient on the back and make extension in the same manner. 
" The sterno-clavicular joint may be dislocated by the displacement of the end of the clavicle forward, upwards 
or backwards. Reduction is effected by elevating the shoulder in pushing upward at the elbow, or by drawing the 
shoulders backward and upward with the knee pressing against the spine between the scapula. Though frequently it is 
difficult to retain the clavicle in position, the function of the arm is rarely impaired. For the first and second forms, the 
pad in the axilla, the sling for the elbow, and a pad upon the displaced bone, retained by adhesive straps, are most useful; 
for the third form, rest on the back, or such appliance as will retain the shoulder upwards and outwards, are required. 
" The acromio-clavicular joint may be luxated by the upward or downward displacement of the end of the cla- 
vicle ; reduction is effected by drawing the shoulder outward and backward. The retaining apparatus for the upward 
luxation should be applied as follows(W. T. Bull) : Place a compress over the articulation, and retain it by two strips 
of adhesive plaster, the edges being glued to the skin by collodion ; bandage the hand and forearm with a flannel roller; 
apply a loop of elastic bandage (H. A. Martin), five feet long and one inch and a half wide, passed under the elbow 
of the injured side ; draw the ends snugly over the compress, carrying the anterior one around the axilla of the sound 
side, as in a spica of the shoulder, to join the other between the clavicles, where they are fastened with strong pins. 
Complete and permanent restoration rarely follows any treatment (F. H. Hamilton)."-"Operative Surgery." 
Stephen Smith. 
" Dislocation at the shoulder joint may be very conveniently reduced by causing the patient to mount to a conve- 
nient height on some ' steps,' placing his arms across the top step, upon which is placed a pillow. The top step acts as 
a fulcrum, and the weight of the patient'? body answers to a great extent as counter extension."-Dr. G. Hamilton. 
Fig. 3982.-Apparatus for Preventing 
Dislocation of the Shoulder Joint. 
Fig. 3983.-Sir Astley Cooper's Apparatus 
for Dislocated Clavicle. 
This apparatus is to be worn after reduction of a 
dislocated humerus, to guard against a recurrence, and 
also for the purpose of relieving permanent disloca- 
tion arising from a laxity of the ligaments, or from 
paralysis of the deltoid and scapular muscles. It is 
made of satin-jean, with a leather shoulder-cap. 
Directions for Measurement 
I. Right or left shoulder? Inches. 
2. Circumference of the arm, .... " 
3. Circumference axilla to acromion, . . " 
4. Circumference of chest under axilla, . " 612 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
OF JOINTS. 
Dislocation and Luxation. (Continued.) 
Fig. 3984.-Smith's Clavicle Apparatus, 
"This splint is very simple, easily made, and not expensive. It is a gauntlet-shaped piece of leather, laced to 
fit the forearm, running on either side back of the bend of the elbow. To this part is attached a strap and buckle. 
A padded collar with strap, buckle and ring is fitted to -the uninjured shoulder. Through this ring the strap 
from the elbow piece passes, and by tightly drawing this strap the 
arm of the injured shoulder is under sufficient control to bring the 
fragments into perfect apposition. A sling is made to pass from 
the ring of the collar on the uninjured side of the neck for the 
hand of the injured side. I claim that for fracture of the clavicle, 
oblique, downward, and inward, and through the great convexity of 
the bone, my splint has all the advantages of any other as well as 
some (advantages) that no other splints have."-"Original Deductions, 
based on a Study of One Hundred Cases of Fractures of the Upper 
Extremities, excluding the Hand." Samuel W. Smith, M.D. 
Fig. 3985.-Mayor's Apparatus for 
Dislocated Clavicle. 
The outer or acromial end of the clavicle is not unfrequently dis- 
located upwards and more rarely it is driven fairly over the acromion 
process, constituting a dislocation upwards and outwards. This dis- 
location is easily reduced, but the clavicle is with difficulty retained in 
place. The treatment consists in the application of a force over the 
top and outer end of the clavicle, with a counter-force applied below 
the elbow, so as to elevate the humerus and scapula, while the arm 
and forearm are confined by a sling and bandage against the side and 
front of the body. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
613 
WOUNDS AND INJURIES. 
OF JOINTS. 
Dislocation and Luxation. (Continued.) 
" The shoulder-joint dislocations consist of displacement of the head of the humerus: First, downwards into the 
axilla; second, forwards under the caracoid process ; third, backwards under the spine of the scapula. The reliable 
sign of these displacements is the projection of the elbow from the chest when the hand of the dislocated arm is placed 
upon the opposite shoulder. The method of reduction in the first two varieties is the same ; proceed as follows: Flex 
the forearm upon the arm, and while the arm is elevated to a right angle with the trunk, rotate gently forwards by 
depressing the hand and forearm ; or place the knee in the axilla to press the head outward and serve as a fulcrum and 
use the shaft as a lever: or laying the patient down place the heel against a pad in the axilla, and grasping the wrist 
and elbow make steady traction, meanwhile prying the head outward with the heel • failing, give an anaesthetic 
(F. H. Hamilton). 
" Reduction may also be effected by manipulation : Grasp the shoulder with one hand and the flexed elbow with 
the other, make extension at the elbow, drawing it from the side with slight rotary motion outwards; when extension 
is fully made, raise the elbow and with the arm describe a semicircle towards the sternum and face, then suddenly de- 
press the elbow upon the thorax, rotating the head of the humerus inwards, and with the thumb of the right hand 
giving proper direction to the head ; this manoeuvre may be repeated if necessary (H. H. Smith). 
" In the subspinous form make extension towards the joint, or resort to the last method-standing behind the patient 
and drawing the elbow backward and rotating the bone, while the thumb of the right hand guides the head to the 
joint. Or let the operator place the injured arm at right angles to the body, and standing against it, with his side to 
the patient and his hips pressed firmly, but not roughly, into the axilla, fold the arm and hand of the patient closely 
round his pelvis, and fix the hand firmly by pressing it against the crest of his ilium ; reduction is effected merely by 
a rotation or version of the surgeon's body, with a force and rapidity which necessarily vary with the peculiarity of the 
dislocation-some yielding most readily to a sudden and powerful effort, and others to gentle and gradually increasing 
traction (I. E. Kelly). 
" In compound dislocations the question as to reduction or resection should be decided as follows: In a healthy 
patient, without complications, reduction is preferable ; but if the patient is weak or old, or the exposed bone is badly 
injured, or the parts are much lacerated, saw the exposed head of the bone (T. Holmes). Antiseptic dressings 
should be scrunulouslv nnnlied. 
" The elbow joint may be dislocated by displacement 
of the ulna and radius backwards, forwards, inwards, 
outwards, the last two being partial. Examine carefully 
to determine whether there is a transverse fracture of the 
humerus, or of one condyle, or of the olecranon. Re- 
duce the first form thus: the patient seated in a chair, 
press the knee in the bend of the elbow and flex the arm 
forcibly but slowly around it (Sir A. Cooper, F. H. 
Hamilton). Other methods are as follows : the patient 
being seated, carry the arm and forearm directly back- 
wards, the scapula being pressed forwards (R. Liston, 
I. Miller) ; extension of the forearm from the hand or 
wrist downwards (T. C. Skey) ; extension of the fore- 
arm from its middle by an assistant, while the surgeon 
seizes upon the olecranon process with the fingers of one 
hand, and, placing the palm of the other against the front 
and upper part of the forearm, pulls forcibly backwards 
(J. Pirre). The second form may be reduced by forced 
flexion aided by pressure ; the lateral displacements are 
restored by moderate extension combined with lateral pressure (F. H. Hamilton). The head of the radius may be 
displaced separately forwards, outwards and backwards, the first being far the most frequent; reduction is effected in 
all forms by extension aided by pressure upon the head of the radius made in the right direction. In compound dis- 
locations in healthy patients, reduce the bones and close the wound antiseptically, unless there is much comminution, 
when excision of the bones involved should be performed ; in general, a useful limb results from these excisions of 
the joint surfaces. 
" The wrist joint is luxated by displacement of the carpus forwards or backwards; reduction is made by extension 
in a straight line, with slight rocking or lateral motions if necessary."-F. H. Hamilton. 
" The phalangeal joints may be dislocated, and are generally easily reduced. The displacement of the first phalanx 
of the thumb upon its metacarpal bone is an exception ; the difficulty of reduction is due to the escape of the head of 
Fig. 3986. 614 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND I^IJUF<IES 
OF JOINTS 
Dislocation and Luxation. (Continued.) 
the metacarpal bone between the two tendons of the flexor brevis, where it is lodged as in a buttonhole (Fabbri). 
Reduction is effected by first pressing the metacarpal bone firmly to the centre of the palm, to relax the short flexor, 
then putting the displaced phalanx in a state of extreme extension to relax the tissues of the buttonhole and to push 
up those which form its distal part over the projecting head of the metacarpal bone ; this is done by dragging the hyper- 
extended thumb downwards or away from the wrist, and then acute flexion will restore it to its place (T. Holmes). 
If this remedy fail, with a very narrow-bladed tenotome divide the insertions of the flexor tendon and repeat the 
manoeuvre."-"Operative Surgery." Stephen Smith. 
Fig. 3987.-Levis' Splint, for Reducing Dislocation of Phalanges. 
Fig. 3989.-Plain 
Luxation Forceps. 
To apply this instrument: The finger is passed through the loops, and, by drawing on the 
tapes and then winding them around the projecting stem in opposite directions, and finally 
tying them together, a firm grip is obtained. This enables the operator to apply both exten- 
sion and flexion, or leverage in any direction. The proximal end of the phalanx maybe lifted, 
or even rotated, so as to allow one side of the bone to approach the socket before the other. 
It is a simple and cheap instrument, but one that every surgeon ought to possess. Fig. 3988 
represents it applied. 
Fig. 3988.-Levis' Splint applied. 
Fig. 3990.-Luer's Luxation Forceps, for Fingers or Toes. 
This instrument (Fig. 3990) is made in the shape of a pair of forceps, 
the strong jaws of which, in place of being concaved, are bifurcated, and 
carry between their rods straps of strong webbing, doubled and drawn 
over them ; A, the spaces, being filled up by slices of cork or india-rub- 
ber. This construction and the length of the arms of the lever, exercise 
sufficient power to seize and hold the luxated member without contusing 
the soft parts. 
Fig. 3991.-Charriere's Luxation Forceps, for Fingers or Toes, 
This pair of forceps is jointed like a compass. The jaws consist of forks of two stems each, 
equi-distant, to which four leather straps are fastened, intercrossing each other in such a manner 
as to form a double floating knot, A, that opens or shuts as the handles of the forceps are ap- 
proached or separated. The action of this double knot is regulated by a screw and two nuts, 
C, Bt enabling the operator to diminish, augment, or fix the amount of pressure at will. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
615 
WOUNDS AND INJURIES. 
OF JOINTS. 
Dislocation and Luxation. (Continued.) 
Fig. 3992. 
Dislocation Pulley. 
" The hip joint is protected and strengthened by the ilio-femoral, or inverted Y 
ligament, which is inserted above into the front and outside of the inferior spinous 
process of the ilium, and below the anterior inter-trochanteric line ; it has two main 
branches, the outer extending to the trochanter major and the inner to the trochanter 
minor; in regular dislocations this ligament is unbroken and controls largely the 
movements of the head of the femur. The several positions of the head of the 
bone with reference to the socket may be reduced to the following, namely: a. The 
dorsal, including that on the tuberosity, the everted dorsal, the anterior oblique and 
the supra-spinous ; b. The thyroid, including that on the perineum and on 
the thyroid forameii; c. The pubic, the pubic and sub-spinous. Though the 
head of the bone may be primarily luxated in various directions, yet the down- 
ward dislocation is by far the most common, as the capsule is thin and weak 
at this part, and flexion, by which the ligament is relaxed, with adduction or 
abduction, is the habitual attitude of the thigh in action and self-defence. From this 
position the head of the bone readily passes to the dorsal, or thyroid, or pubic regions ; 
thus all regular dislocations may be secondary. These several positions are sufficiently 
well recognized for reduction by the following sign, namely: the head of the femur 
always faces the same way as the internal condyle. As a preliminary to reduction, 
etherize the patient to relaxation, and place him recumbent on the floor. The best 
general rule for reducing a recent dislocation is to get the head of the femur directly 
below the socket by flexing the thigh at about a right angle, and then to lift or jerk it 
forcibly up into its place. This rule applies to all dislocations except the pubic, and 
even to that when secondary from below the socket; the reduction by the lifting method 
is usually instantaneous, and flexion is the basis of its success. If, after one or two 
trials, it appears that the bone cannot be jerked into place, enlarge the rent in the cap- 
sule a little by moving the flexed thigh from one side to the other, so as to sweep the 
head of the femur across below the socket, and again repeat the act of lifting. The 
following rules for reduction of the femur from its several 
positions should be observed : i. In dorsal dislocations, flex 
and forcibly lift ; if this effort fail, flex and lift while ab- 
ducting. If this fail, it will be found that abduction has carried 
the head of the bone from the dorsum nearly or quite to the 
thyroid foramen, and that the capsular rent has been so en- 
larged that the first method may now prove successful; 2. In 
thyroid dislocations, adduction of the flexed thigh reverses the 
movement and carries the head from the thyroid foramen to 
the dorsum, and also enlarges the opening, making the first rule 
effective ; 3. The pubic dislocations may generally be brought 
down without difficulty from above the socket, after flexion, 
especially if they are secondary, and may then be reduced from 
that position like the thyroid. 
"A fulcrum made by rolling one or more sheets into a firm 
band, two or three inches in diameter, may aid the manipu- 
lator. Place the centre of the band in the groin, and, while 
assistants raise the ends by pressure at the knees, the head is 
lifted into the socket. The same result is secured by requiring 
an assistant to lift the head of the bone by means of a stout 
sheet in the groin and over his shoulders."-" Operative Sur- 
gery." Stephen Smith. 
" In reducing a dislocation of the hip by manipulation it is 
important to bear in mind that, in every position, the head of 
the femur faces nearly in the direction of the inner aspect of 
its internal condyle."-" Mechanism of Dislocation and Frac- 
ture of the Hip." Bigelow. 186g. 
Fig. 3993. 
Bigelow's Apparatus, for Reduction of Dislocation 
on the Dorsum Ilii by Vertical Extension. 616 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUJMDS AND INJURIES 
OF JOINTS. 
Dislocation and Luxation. (Continued.) 
" The patella may be displaced outwards, inwards, or on its own axis; reduction is made by laying the patient 
on the floor, lifting the limb with the heel upon the shoulder so as to relax completely the quadriceps muscle, and 
pushing the patella into position ; if this effort fails in the last form, flex the thigh and straighten the leg while pres- 
sure is made on the patella (T. Holmes). 
"The knee joint is dislocated by displacement of the tibia backwards, outwards and inwards, but in general the 
luxation is incomplete. Reduction is generally effected without much difficulty. If backwards, use forced and ex- 
treme flexion ; if forward, reverse the movement; if lateral, make extension and pressure. 
"The ankle joint is luxated by the displacement of the tibia forwards and backwards. Reduction is effected by 
extension and counter extension combined with pressure. Division of the tendo Achillis has been found necessary 
in cases of backward luxation. Dislocation outwards or inwards is a rotation of the astragalus, accompanied usually 
with a fracture of the fibula and rupture of the internal lateral ligament (F. H. Hamilton). Compound dislocations 
are not infrequent at the ankle joint, and always demand the most judicious care; as in other compound dislocations 
the conditions present must determine the course of procedure. By conservative measures in young and healthy per- 
sons, where the vessels have escaped damage, and there are no other serious complications, the limb and joint may 
often be saved. The wound should be cleansed of all foreign matters, carbolic solutions (i to 20) should be injected 
into all its recesses, and antiseptic jute or cotton, soaked in carbolized oil, applied to the opening; the joint must be 
immobilized by the fenestrated gypsum bandage, unless there is great swelling, when the splint must be used. Anchy- 
losis will ensue, but the increased mobility of the transverse tarsal joint will in a great measure compensate for this 
loss (T. Holmes). When there is much comminution, removal of the fragments is necessary, or excision of the joint 
may be required, followed by the dressings already given. In a certain proportion of cases, the injury, or health, or 
age of the patient, renders amputation the only safe course. 
"The tarsal bones may be luxated from their position, but generally the great violence which causes such dis- 
placement does severe injury to the tarsus. Luxations of the astragalus are far the most important ; the dislocations 
of this bone may be forwards, backwards, outwards and inwards, or it may be rotated on its axis. As a rule, if the dis- 
location is simple, attempt immediate reduction ; if the luxation is complete and reduction impossible, resect; if the 
luxation is compound, resect ; if there is severe laceration, or other injuries complicating these conditions, amputate. 
Reduction is effected by extension from the foot, grasped as in removing a boot, and counter extension from the knee, 
with such pressure upon the displaced bone as may be required. If the astragalus is displaced from the scaphoid 
and calcaneus the treatment is the same."-" Operative Surgery." Stephen Smith. 
Resection and Excision. 
" The terms resection and excision are frequently used as synonymous ; but, though the definitions of the two words 
are not unlike, there is a different and distinct meaning attached to each when properly employed. Resection strictly 
implies the removal of the shaft of a long bone, while excision means the removal of the joint ends of bones, or the ex- 
tirpation of a short, flat or irregular bone. The great improvements in the use of antiseptics has enlarged this field of 
useful operations. It is possible now to avoid many of the former dangers of excision (such as excessive suppuration) 
and secure rapid union of bone. The former statistics of the results of these operations before antiseptics were scienti- 
fically employed are now of only historical value. 
" The indications for these operations are in general as follows: a. Resection of bone, in part or whole, is required 
after injuries which have destroyed its vitality, or after diseases which have resulted in caries or necrosis, or in the re- 
moval of tumors ; but the operation is justifiable only when it is evident that resection is preferable to every other re- 
medial measure (T. C. Skey). When undertaken it must be so planned and executed as to become the first step in a pro- 
cess of repair by which a part is restored to more or less complete usefulness that would otherwise have been sacrificed 
(A. Wagner). The operation must be determined by the condition of the patient and of the diseased part. In general 
the operation is indicated only when the general health admits ; for, if the patient is suffering from a progressive wasting 
disease, as tuberculosis or marasmus, which will necessarily prove fatal, resection would be unwise, as repair would not 
follow (T. Billroth). In injuries, as gunshot, only such fragments of bone should be removed as are nearly or quite 
detached from the periosteum. In caries of hollow bone the ulcer may be thoroughly cleaned out with the sponge 
and the cavity be allowed to close by granulation (C. Sedillot) ; but, if the bone is small, extirpation may be necessary 
to arrest the process at once (T. Billroth). If a hollow bone is affected throughout, as with periostitis, external and 
internal caries, partial internal and external necrosis, extirpation of the entire bone may be required as the only alter- 
native of amputation (T. Billroth). Tumors of bone, if not malignant, must be removed from their locality ; but, if 
malignant, extirpation of the bone or wide resection is necessary (Sir J. Paget). 
" b. Excision of a joint is necessary for shot injuries, the comminution of the joint ends of the bones, or the im- GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
617 
WOUNDS AND INJURIES 
OF JOINTS. 
Resection and Excision. (Continued.) 
paction of a ball in the end of the bone in such manner that it cannot be removed without destruction of the bone ; in 
compound dislocation with extensive injury of the soft parts, or complicated with fracture ; in caries which has destroyed 
the articular surface, and continues to progress in spite of well directed efforts to control it. 
"Compound dislocations and fractures involving joints, once so fatal from inflammation, do not always necessitate 
excision, for, when antiseptic methods are rigidly enforced from the first, suppuration does not occur. 
" The time of operating after an injury, as a gunshot, should, if possible, be within twenty-four hours of the accident, 
or primary ; if it is delayed beyond this period, it should not be performed until the intermediary stage of inflammation 
is passed (G. A. Otis). If the bone is necrosed, the invariable rule should be not to attempt removal before complete 
detachment, because the dead bone can rarely be sawed out without removing healthy and newly-formed bone, and 
the new bone is not firm enough before the sequestrum is detached (H. J. Bigelow). 
" The instruments required in resection may be few or many, both in number and variety, according to the nature 
of the case."-"Operative Surgery." Stephen Smith. 
See Osteotomy, page 100; Resection and Excision, page 104; Brackets and Splints, below. 
" Present experience indicates that excision should be had recourse to whenever the injury or disease is of a nature 
to destroy the function of the joint and require anchylosis to render the limb useful. It is generally undertaken for 
chronic affections which cause ulcerative processes within the joint. The antiseptic method has relieved the operation 
of all its former dangers. It is no longer a question of age, or sex, or even physical health; but the decision should 
rest entirely upon the determination of the nature of the disease and its final results upon the usefulness of the limb." 
"Operative Surgery." Stephen Smith. 
Brackets and Splints for Securing Immobility. 
Fig. 3994. 
Esmarch's Interrupted Splint, for Excision of the Wrist. 
" Esmarch's interrupted splint, for excision of 
the wrist (Fig. 3994), consists of a piece of sheet 
iron for the hand and a tin splint for the dorsal 
surface of the forearm, which are connected with 
one another by a strong iron bar, shaped like a 
bow. As the wrist remains exposed for some dis- 
tance, this apparatus is especially suitable for the 
antiseptic treatment of wounds."-" Surgeon's 
Hand-book." Esmarch. 
Fig. 3995.-Esmarch's Interrupted Splint Applied, 
Fig. 3996.-Esmarch's Splint, for Excision of the Elbows. 
' I call it the ' Langensalza' 
splint, because I made it for ex- 
cisions at Langensalza, in 1866, 
when I came from Berlin on a 
visit to Stromeyer. This splint 
is easily made, and is as good 
for the open dressings as it is for 
the antiseptic method."-"Sur- 
geon's Hand-book." Esmarch. 618 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES 
EXCISION OF JOINTS. 
Brackets and Splints for Securing Immobility. (Continued.) 
MG. 3997. 
Stillman's Bracket, for Securing both 
Immobility and Exposure 
after Excision. 
The arm being bent at a right angle with the forearm, 
the plaster is applied from the bases of the fingers to a point 
as near the joint as practicable, and again above the joint 
nearly to the axilla. 
After it has almost solidified the bracket is placed upon 
layers of plaster paste (see Fig. 3997) and bound down by 
the other layers of bandage, which are then smeared over 
with the paste and covered by neat dry bandage. This 
ensures firm support above and below, and yet allows com- 
plete exposure of the surface of the joint. 
Fig. 3998.-Stillman's Wrist Bracket. 
By encircling the hand (except the fingers) and the forearm 
with plaster, and applying a bracket anteriorly and posteriorly, 
as shown in Fig. 3998, we are enabled to retain the wrist in 
any desired shape and yet keep up extension by means of the 
ratchets. In the treatment of Colle's fracture and exsections of the wrist they will be found very valuable."-" Me 
chanical Treatment of Joints. Chas. F. Stillman, M. D. 1878. 
Fig. 3999.-Watson's Plaster of Paris Swing Splint. 
" The excised knee rests 
very comfortably and se- 
curely in Watson's plaster 
of Paris swing splint. The 
leg, enveloped in cotton 
wool, is first placed upon 
a wooden splint which has 
been rubbed with carbolic 
oil or ointment, and then 
bandaged firmly on with 
plaster of Paris rollers, so 
that the knee remains ex- 
posed and is supported 
only by the narrow wooden 
bridge beneath. 
"The suspension bar 
(Fig. 4000) is placed upon 
the anterior surface of the 
limb, beneath the final 
turns of the plaster of 
Paris bandage, and the 
whole leg is suspended to 
a cross bar, placed over the 
bed."-Esmarch. 
Fig. 4000.-The Suspension Bar. 
Fig. 4001.-Steel Spikes, for Transfixion of Bones in Exsections. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
619 
WOUNDS AND INJURIES. 
EXCISION OF JOINTS. 
Transfixion of Bones in Exsections. 
Fig. 4002.-Wyeth's Drills, with Adjustable Handle. 
" Steel spikes, for transfixion of bones in exsections, have been much used in late years in this operation and are 
highly recommended. I prefer the drills, on account of their easier and more accurate adjustment. 
" The drills with adjustable handle, for fixation of the bones in knee-joint exsection, have given perfect satisfac- 
tion in my service. They vary in length from three to five and six inches, are between one-sixteenth and one-eighth 
of an inch in diameter, and with the points smaller than the shaft, so that as they are made to enter and transfix the 
bones they become jammed and are held immovable and secure. Everything being in readiness for the drills, a 
rubber drainage-tube is carried through the wound, so that, when the bones touch each other, the tube is behind these 
with an end projecting on each side of the knee, or two short pieces maybe inserted from either side. The sawn sur- 
faces of the bones are now brought together, and held perfectly steady by a skilled assistant. The operator approximates 
the edges of the wound temporarily, fixes the drill into the handle of the instrument, and at a point about one inch 
or one inch and a half below the end of the tibia, and upon the anterior and lateral aspect of the leg, make a puncture 
in the skin. In this puncture the point of the drill is carried, passing obliquely down to and into the bone as far as its 
periosteum. The handle is now removed and a second drill introduced in the same manner from the opposite side of 
the tibia, crossing the first at about an angle of 900. A third point is next introduced, on the anterior surface of the 
femur, and is made to travel almost directly down into the tibia. The bones are now firmly fastened together, and the 
extremity may be lifted from the foot as if it were anchylosed at the knee. The wound is next closed with catgut 
sutures, and finally irrigated, dressed with sublimate gauze, and, outside of this, a thick layer of borated cotton, with 
protective over all. In order to steady the limb, pieces of tin or hoop iron (or a wooden splint) may be worked in as 
the bandage is being applied, &c."-" Text Book on Surgery." Wyeth. 
" The bones must be maintained in apposition by two or three silver wires which should be introduced into the an- 
terior part of the tibia and femur, and, when sufficiently twisted, cut off, and the ends turned down between the bones. 
Nails have been employed to fix the bones in position, which are removed at the end of two or three weeks. The 
wires are allowed to remain, but nails must be withdrawn after several weeks."-"Operative Surgery." Stephen 
Smith. 
See Fig. 1627, Gaillard's Bone Drill, for Transfixing Bones in Ununited and Oblique Fractures. 
Fig. 4003.-Packard's Splint. 
This splint is made of wood. It is hollowed slightly, 
so as to make a very shallow trough ; at the buttock end it 
is bevelled off, so as not to irritate the skin ; at the lower 
end it is carved out to receive the heel. A slit is mortised 
lengthwise in the middle line, close to the lower end of the 
splint, to receive the tenon of the foot-piece. A piece cor- 
responding to the knee is removed and is made to slide in 
or out. Two strong metal brackets, six to nine inches high, 
connect the thigh and leg pieces : they are made to flare 
out, so as to prevent any pressure against the limb in case 
the latter should swell. Soft leather casings to surround 
the limb may be tacked on to the splint, which, being well 
padded, may be secured by means of laces or buckles. To 
change the dressings, the slide is withdrawn and the leather 
undone, which leaves the knee exposed. When the dress- 
ing is changed the splint is reapplied as above. 
From above. 
From the side (slide removed). 620 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
EXCISION OF JOINTS. 
Brackets and Splints for Securing- Immobility. 
Fig. 4004. 
Esmarch's Splint, for Excision of the Ankle 
Fig. 4005. 
Esmarch's Bracket Splint, for Excision of the Ankle, Applied 
" My bracket consists of a splint for the sole 
of the foot and a narrow dorsal splint for the leg, 
both made of tinned iron and connected with 
one another by a dorsal wire bracket. The foot 
is fastened by strapping and a plaster of Paris 
bandage to the splint for the sole of the foot, and 
the leg in like manner to the dorsal splint. The 
heel can be supported by a triangular handker- 
chief."-Esmarch. 
" Volkmann's dorsal splint is made 
of wood. It is fixed to the foot and leg 
by plaster of Paris bandages, or moist 
gauze bandages. It gives good sup- 
port to the excised joints."-Esmarch 
Fig. 4006.-Volkmann's Dorsal Splint, for Excision of the Ankle. 
Fig. 4007. 
Stillman's Ankle 
Fig. 4008. 
Bracket. 
"It is constructed of two plates of perforated zinc, connected by a 
racheted bridge, one inch in width and one-eighth of an inch in thickness, 
strongly riveted, and bent in the form shown in Fig. 4008. 
"The foot being held at a right angle by an assistant, it is carefully 
wound with plaster from the base of the nail of the great toe as far toward 
the ankle as consistent with the diseased condition, and, beginning at a cor- 
responding point above the ankle, the leg is encased almost to the knee. 
After waiting a sufficient time for the plaster to set, a little plaster paste is 
smeared over the part where the bracket is to be placed, which has previ- 
ously been accurately fitted to both foot and leg. The bracket is now placed 
in position and bound down by repeated turns of the plastered bandage, and 
after smearing the foot and leg with plaster paste, the whole is neatly covered 
with clean fresh bandage. 
" This apparatus maintains the ankle securely, yet leaves the whole sur- 
face open for inspection and dressings."-C. F. STILLMAN, M. D. 
Fig. 4009. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
621 
WOUNDS AND INJURIES. 
EXCISION OF JOINTS 
Fluhrer's Procedure of Wiring Bones. 
Fig. 4010.-a. Crotchet Drill, two-thirds actual size; b. End of Drill, actual size. 
" To overcome the difficulties in the wiring of bones, I devised the instruments, and have practiced the procedure 
described in this paper. 
" The drill, which is shown in Fig. 4010, a and b, is made of one solid piece of steel. Its handle is octagonal, 
one-fourth of an inch in diameter, and four inches long to the shoulder, which tapers quite abruptly to the shank. 
" The shank is one-sixteenth of an inch in diameter, two and three-quarters to four inches long, of fine spring 
temper, and terminates in a flattened head which is a little wider than the diameter of the shank. The peculiar fea- 
ture of this drill is a shallow notch cut into one side of the head and forming the end into a hook. It is important 
that the notch shall not be made too far from the point, that it shall not be too deep, that the side of the head beyond 
it shall have exactly the shape shown in the figure, and that, whatever the other dimensions of the drill, it shall 
always be constructed just as described. Three transverse grooves upon the handle, near the shoulder, are an index 
to mark its position with reference to the circumference of the instrument. 
Fig. 4011.-Fork, two-thirds actual size. 
• • ^phe fork is shown in Fig. 4011. If also made of one solid piece of steel, and is finally annealed. Its flat- 
tened handle, four inches long, is continuous with the shank, also four inches long, which gradually tapers to a diam- 
eter of one-eighth of an inch, and which terminates in a double fork. The prongs of the piimary fork are three-eighths 
of an inch long, and at their ends are notched one-eighth of an inch deep, forming secondary forks. 
Fig 4012.-a. Grooved Retractor, two-thirds actual size ; b. Front View of End, actual siz< 
" The grooved retractor is made of German silver, or other metal, and is shown in Fig. 4012, a, b. 
"The instruments described are made from my own models, by George Tiemann & Co., of 
New York. 
Fig. 4013.-Wire Suture, two-thirds actual size. 
" The wire is of pure silver, annealed. It is used of different thicknesses, and, if practicable, it should be large 
enough to nearly fill the drill hole. A large-sized wire is not apt to cut through the bones, and forms a strong bond 
of union between them. The ends of each length of wire are tapered for about two inches, and bent at an acute 
angle, as shown in Fig. 4013. 
" The procedure is as follows: The bones to be wired are sufficiently bared, but need not be completely denuded. 
The withdrawal of the soft parts for drilling through the smallest possible incision is effected by means of the grooved 622 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
EXCISION OF JOINTS. 
Fluhrer's Procedure of Wiring Bones. (Continued.) 
Fig. 4014. 
Grooved Retractor in use. 
retractor, which not only retracts, but at the same time depresses the obstructing tissues. 
The drill is passed along the channel of the retractor directly to the bone, cutting its 
way through any overlying soft tissues by an incomplete rotary motion. When the 
bone is reached, the drill should never be withdrawn in any degree for fear of fouling, 
but should be urged onward by a rotary motion with continuous and light pressure. 
The drill being made in one piece, and larger at its head than in the shank, its pro- 
gress, like that of a probe, can be nicely felt as it passes through the bone, which would 
not be the case were the mechanism for drilling a complicated one, or were the drill 
driven at high speed. In drilling transversely through a bone, as in the case of the 
upper end of the tibia, the passage of the head of the drill through the proximal 
portion of compact bone, 
through the cancellous 
structure, the striking of 
the distal portion of com- 
pact bone, and its passage 
through it, can be clearly 
discriminated. 
"The emergence of the point of the drill 
having been detected by the finger watching at 
the presumed place of exit, or being known by 
the change in resistance, the next step is to pass 
a loop of silk through the bone to serve as a con- 
ductor for the wire suture. The silk should be 
of a thickness barely large enough to fill the 
notch in the drill. When the end of the drill 
is far below the surface, the fork is needed to de- 
posit the thread in place. When the soft parts 
crowd upon the buried end of the drill, they 
should be pressed back by using the retractor, as 
shown in Fig. 4014 ; then the end of the drill is 
received into the groove of the retractor, and is 
easily accessible to the fork carrying the loop of 
thread. When the silk has been lodged in the 
notch, it is held there by gentle counter-traction, 
while the drill is cautiously withdrawn without 
rotation, leaving the thread in its place. When 
the end of the drill is far below the surface, the 
counter-traction may be exerted through the 
medium of the fork. By a dexterous movement 
the loop may be shifted from the secondary 
forks (Fig. 4015, a) into the crotch of the pri- 
mary fork (^), around which it plays as a pulley 
as it is drawn through the bone. It is essential 
that the closed ends of the loop should lie between the bones to be wired. If, therefore, a loop needs reversing, a 
second thread is passed through the existing loop, by means of which the new loop is pulled through the bone into 
position. The free ends of the thread are then passed through the loop and drawn tightly across the face of the bone, 
as shown in Fig. 4016, thus lining off the broken or sawn surface, and indicating clearly where the drill should be 
passed through the opposing bone. 
" The conducting loops, or guides, for the wire sutures, having been lodged in place, the next step is the drawing 
of the wires into position. The bent end of the wire suture is hooked into the end of a loop of thread which has 
been freed, and under a little counter-traction is fed to the opening, while the operator pulls upon the conducting loop 
and draws one-half the wire through the bone. The end of the remaining half of the wire is then caught into a corre- 
sponding loop through the opposing bone, and is drawn into position. 
" The bones having been brought into close apposition, each wire is imbedded before being twisted. While the 
ends are held in their future position, the scalpel is drawn alongside, cutting the subjacent soft parts and letting the 
To expose the Notch of the Drill in Wiring after an 
Excision of the Knee-joint. 
Fig. 4015. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
623 
WOUNDS AND INJURIES. 
EXCISION OF JOINTS. 
Fluhrer's Procedure of Wiring Bones. (Continued.) 
Fig. 4016.-The Loops of Thread in Position, 
preparatory to Inserting the Wire Sutures, after an 
Excision of the Knee-joint. 
wires sink down to the bone. The tightly drawn ends are 
then twisted and cut short to the twist, which is turned 
down. The slits in the soft parts are closed over the wire, 
which is to remain permanently, by a fine catgut suture. 
" By proceeding in the manner I have detailed, the 
wiring together of bones is a precise, easy and expeditious 
operation. It can be done without extruding the ends of 
the bones through the soft parts, it being only necessary to 
cast the guiding loop of thread over the end of the drill, no 
matter how deeply the latter may be situated. It is easy to 
carry the wire transversely through the whole extent of bone, 
thus securing an effective hold upon it. A suture only dip. 
ping into the cancellous structure, as is the case in the usual 
mode of wiring after an exspction of the knee-joint, maybe 
regarded as a slack wire. It generally cuts partly through 
the soft bone tissue before the surgeon can apply retentive 
apparatus to the limb. On the contrary, when the sutures 
have been passed completely through the bones in the man. 
ner just described, they alone hold the bones firmly in ap 
position, and the grating formed by the wires prevents the 
intrusion of the soft parts. In an excision of the knee- 
joint, in addition to four wires passed antero-posteriorly, 
I also bind the bones together by a wire passed transversely, 
which acts as a substitute for the lateral ligaments. In 
simple fractures of the patella, excisions of the knee-joint and 
compound fractures, I have passed the drill more than thirty 
times, besides being present when others have operated in 
the same manner, and I have never seen a failure or mis- 
carriage in the execution of any step of the procedure."- 
William F. Fluhrer, M. D. November, 1885. 
WOUNDS AND INJURIES OF NERVES. 
" Nerves, like other tissues, are subject to lesions from physical agencies, which may act without breaking the skin, 
simple lesions, or may involve the integument; the latter nerve wound is less grave than the former (S. W. Mitchell). 
" Contusion of nerves (S. W. Mitchell) is a common incident of civil practice ; as a rule, a blow with any blunt 
instrument over the length of a nerve is unlike to be serious; but in the same injury to a nerve at its exit from a bony 
foramen, or where it rests in a furrow of bone or lies superficially on the prominence of a joint, the consequences may 
be much more severe ; a frequent cause of contusion of nerves is the dislocation and reduction of bones, especially at the 
shoulder joint, where the nerves are liable to be bruised by being pressed between the head of the humerus, the first 
rib and the clavicle. When violent contusions do not cause immediate symptoms of loss of function, numbness and 
tingling may succeed the first shock of pain, and only after a time be replaced by grave troubles, due to changes in the 
bruised nerve. When contusion is followed in a few days by slight numbness and prickling, associated with growing 
tenderness over the nerve track, prompt treatment is necessary, as there is a commencing neuritis, or a sclerotic state 
which may or may not be of inflammatory origin ; the nerve may sometimes be felt in thin persons as a firm cord; 
in some cases the evil is most insidious, and may result in large functional losses without any notable pain or tender- 
ness. The proper treatment for a contused nerve is absolute rest, with the use of leeches and cold water when symptoms 
of neuritis are present; apply three or four leeches twice weekly along the nerve, and cold continuously, unless dis- 
agreeable to the patient; inject morphia if the pain is severe; later, opium plaster along the nerve is useful, and, if 
pain is intermittent, give quinine or arsenic. 
" Compression of nerves (S. W. Mitchell) by external and internal causes is frequent, as by cicatrices, callus, 
tumors, parturition, faecal accumulations, malposition during sleep, use of a crutch; the effect of pressure upon a nerve 
is to disturb the contents of the nerve tubes in such manner that impressions are no longer conveyed until the pressure 
is removed and the continuity of the contents of the nerve tube is restored. The symptoms are : 1. Delusive impres- 624 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUJMDS AND INJURIES 
OF AND OPERATIONS ON NERVES. 
Suture, Neurotomy, Neurectomy, Stretching. 
sions, as formication, prickling, sense of warmth ; 2. A seeming return to the normal condition and feelings ; 3. Hyper- 
aesthesia, all the functions exalted, muscular power unchanged ; 4. Anaesthesia and muscular palsy, preceded by a sense 
of roughness of the skin, burning, muscular weariness, vague cramps. When the pressure is removed, recovery takes 
place in a reverse order: 1. There is first pain, tickling, sensibility ; 2. Sudden sense of cold and feeling of enormous 
weight; 3. Awkward motions, with formication ; 4. Regular motions and sense of heat. The treatment consists in re- 
moving the cause, and meeting the inflammatory symptoms with the remedies directed in cases of contusion. 
" Wounds of nerves (S. W. Mitchell) may be incised or punctured. The incised wound is caused by severe cuts, 
as with a knife, or glass. It is of great importance to make out first the extent of injury, and this may be done by 
examining as to the local paralysis. If the nerve is partially divided, cleanse the wound of all foreign matter with 
carbolic solutions ; close it with sutures or adhesive strip ; place the limb in a position to relax the tissues and approxi- 
mate the cut ends : enjoin perfect rest; apply cold. Where it is plain that the nerve trunk has been altogether divided, 
the silver wire suture maybe used to approximate the extremities ; it should be inserted near the cut surfaces, or through 
the loose tissue related to its sheath ; the wound should then be accurately closed ; the restoration of function takes 
place only after long periods. Punctured wounds of small branches are more serious than of large trunks ; they follow 
the use of the lancet, as in venesection and vaccination, or other penetrating instruments. The symptoms are: Acute 
pain in the track of the nerve, immediately or very soon, gradually increasing in severity until spasms or convulsions 
occur; slight injuries of the digital nerves seem especially prone to occasion distressing symptoms and wide-spread 
reflex sympathies. The treatment is complete division if practicable; rest and cold to prevent inflammation ; hypo- 
dermic injections of morphia to relieve pain."-" Operative Surgery." Stephen Smith. 1887. 
" The sutrire of nerves favors cicatrization and regeneration of the peripheral ends; it has proved a harmless 
operation and is indicated in all cases of sections of nerves where the ends cannot be easily maintained in contact by 
position. The elastic bandage may be used. The search for the two ends of the cut nerve is very successful, as these 
structures have little contractility ; if the wound is deep, enlarge it by an incision parallel with the nerve, in order to 
spare manipulation of the wound, which prevents immediate union and facilitates the passing of the threads. If the 
nerve prove to be clean cut and recent, proceed to pass the thread ; but, if crushed or cicatrized, resect a portion and then 
suture. The needle should be fine, and the thread prepared catgut. If the nerve ends can be brought and kept in per- 
fect apposition by a suture involving only the sheath, do not penetrate the nerve tissue, but otherwise pass the needle 
through one end of the nerve to the under side and back through the other, and tie the thread ; cut off both ends closely 
and close the wound accurately with continuous suture and apply gentle compression. If the wound is deep, a drainage 
tube may be required. The nerve ends must be exactly adjusted. Union takes place in about two weeks. Suppura- 
tion must be prevented by antiseptics. If it is impossible to find the corresponding end of the nerve, and another nerve 
is found, two different nerves may be united. 
"Neurotomy, the section of a nerve, is justifiable only as a last resort, all other measures having failed (S. W. Mit- 
chell). It should always be made at a point which will involve as few terminal branches as possible, and yet the di- 
vision must be sufficiently high to include all of the affected trunk ; for, if diseased tissue is left above the line of division, 
the subacute neuritis and sclerosis may continue to ascend the nerve and render the operation useless ; it is important 
that the area of the painful region should be accurately determined and the trunk carefully examined for enlargements 
and hardness by rolling the nerve under the finger; as a rule, the section should be a short distance above the point at 
which the nerve ceases to feel enlarged and hard ; if it is practicable to find a spot, even a little farther up the limb, 
where the nerve is neither swollen nor tender, select that point; when the nerve lies too deep forexamination, especially 
if the neuralgia is of long standing and of traumatic origin, operate as near the body as possible (Von Nussbaum). But 
neurotomy, or simple division of a nerve, is at present scarcely ever practiced, owing to the certainty of prompt reunion. 
'■''Neurectomy, the resection of a nerve, is to be preferred to neurotomy, and not less than two inches of its length 
ought to be removed, the object being to make reunion impossible, or very remote in point of time ; in addition it is 
well to turn the peripheral extremity back, and, if necessary, secure it with a loop of wire, or even interpose muscle or 
fascia to prevent the possibility of union (S. W. Mitchell, W. A. Hammond, E. Brown-Sequard). 
" Stretching of spinal nerves, as a final resort for the relief of spasms (T. Billroth), is now recognized as a justifiable 
operation ; it has been employed also in locomotor ataxia. It originated in the exposure, isolation and rubbing of the 
sciatic nerve from a point below the gluteal fold, through the sciatic foramen, to the sacral foramen, for the purpose 
of relieving epilepsy supposed to be due to some irritating cause affecting the nerve. No such cause was found, but 
the stretching which the nerve received relieved the spasms. It is believed that the manipulation produces a favorable 
change in the position of the nerve fibres in the trunk, whereby their nutrition is improved. The procedure is essen- 
tially the same as that of dissecting a similarly affected nerve out of cicatricial tissue (J. M. Warren), long since suc- 
cessfully practiced. The operation consists in exposing the nerve and stretching it with fingers, forceps or blunt 
hooks, as if attempting to draw it from its connection to the spinal cord."-' ' Operative Surgery." Stephen Smith. 1887. GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
625 
WOUNDS AND INJURIES. 
EMERGENCY OPERATING SETS 
Heuel's Pocket Case. 
Fig. 4017.-Heuel's Pocket Case. 
" My idea of a surgeon's pocket case is that it should be made of 
the best materials, contain the best instruments, and those of the 
most approved design, be a minor operating case, and, in emergencies, 
be suitable for even the larger operations, at the same time not too 
large to be conveniently portable. 
"My case, which I usually carry in a chamois-lined hip-pocket, is 
five inches and a half long by three inches and a quarter wide, and 
one inch in thickness. It is made of alligator, sealskin or morocco 
leather, the latter being thinnest, while it is also very durable. It is 
lined with the best silk velvet, is four-folding, with retaining flaps (see 
a in accompanying figure), and has no pockets, these being liable to 
tear. In opening, it appears like a two-fold case, having the thicker 
instruments as close together as possible, though not crowded on one 
another. Each flap (b, b} may then be opened, revealing (^, c) on one 
side the thinner instruments-such as probes, blunt dissectors, &c.- 
and on the other the needles, pins, &c., neatly arranged in rows upon 
the flap, together with a variety of plaited and black iron-dyed silk, 
horsehair and catgut sutures, ligatures, thin isinglass plasters, &c. 
" The instruments consist of, firstly : 
"Knives.-These are two in number, and, like the one shown in 
Fig. 4018, are four-bladed, having spring catches and tortoise-shell 
handles. 
' ' The first contains a large and a medium-sized scalpel on one side, 
a blunt-curved bistoury and Syme's abscess knife on the other. 
" The second contains a small tenotome and small bistoury, a 
Graefe's linear cataract knife, and a half-curved canalicula knife. 
The gum lancet has been omitted from the case, since either of the 
scalpels, or the tenotome, will meet all of its requirements. The 
various sized scalpels will answer for amputations, 
even up to the shoulder joint, removal of tumors, &c. 
Syme's abscess knife I prefer to the common, thick- 
backed, curved bistoury, as it is double-edged, and 
hence gives less pain in its introduction. Graefe's 
linear knife is very useful for amputating the fingers 
in children, while the half-curved canalicula knife is 
well adapted for opening styes, and for other delicate 
work. 
" Secondly, Fig.4019.-These have closed 
rings, which are preferable to those with open handles, 
as they are much steadier in the fingers. They are 
slightly curved on the flat, thus answering the purpose 
of both curved and straight scissors, which is a great 
desideratum in some cases, having one dull point 
for removing dressings without injuring the skin, 
and one sharp point to easily and painlessly cut 
sutures. They may also have a 
French joint to admit of more thoz 
ough cleaning. 
"Thirdly, Forceps.-These are 
six in number, five of which can be 
used for controlling haemorrhage in 
case of necessity: 
" Fig. 4020 is useful as a fixa- 
tion, torsion,dressing and dissecting 
forceps ; it has an Esmarch's slide- 
Fig. 4018. 
Four-bladed Pocket Instrument. 
Fig. 4019.-Scissors, curved flatwise. 626 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUJMDS AND INJURIES. 
EMERGENCY OPERATING SETS. 
Heuel's Pocket Case. 
(Continued.) 
Fig. 4020.-Esmarch's Artery Forceps. 
catch, which is removable, so that the forceps 
may be thoroughly cleaned. 
" Fig. 4021 is an Andrew's artery forceps 
with Esmarch's slide. 
" Fig 4022 is a compound polypus, dressing 
and artery forceps, with ring handles, ratchet 
clamp, French joint, and longer jaws than those 
shown in cut. 
" Fig. 4023 is a Piffard's grappling forceps 
with Esmarch's slide-catch. This I have found 
a very useful instrument in removing tumors, 
cysts, bullets and foreign bodies. 
" Fig. 4024 is a needle forceps of my own 
design, with duck-bill jaws and a Russian catch, 
a. It will hold with equal firmness a fine 
needle or a coarse instrument, giving a secure 
hold for the hand, and is very useful in removing 
splinters, needles, toe-nails, &c. 
" Fig. 4025 is a small-sized, strong bone-cut- 
ting forceps, made after Liston's pattern, and 
having a reversible spring, a. The cut shows the 
instrument ready for use; when in the case, the 
spring a is reversed to prevent spreading of the 
handles. It is very useful in operating about 
small bones like those of the hand, for cutting 
pins, wire, &c., and can be employed in a very 
small space. 
" Miscellaneous instruments: 
"A thermometer--self-registering, well-sea- 
soned and placed in a thin coin-silver case, 
having cotton in both ends to avoid breakage. 
"An hypodermic syringe (Fig. 4026) with a 
graduated glass barrel, a fenestrated metal 
guard, and graduated piston-rod with screw 
adjustment, b. 
"Nested in the piston-rod are one coarse and 
one fine needle, confined by a screw-cap, a. 
The projection, c, beneath the shoulder of the 
screw-cap, a, is ground to fit tightly the top of 
syringe barrel when the piston is down. This, 
with the additional screw-cap, d, at the bottom, 
hermetically seals the barrel, thereby keeping 
the piston moist and in good working order for 
a long time, which is more than can be said of 
the majority of syringes, whose pistons easily 
become dry and utterly useless if not frequently 
used. In case of necessity the syringe may be 
used as an aspirator, but great care must be ex- 
ercised to thoroughly cleanse it before again 
using it for hypodermic injection. 
"A small loop is left in the pocket-case for 
hypodermic tablets in the original bottle, to 
take the place of the bottle of morphine solution 
or powders, which are usually carried. 
Fig. 4021.-Andrew's Artery Forceps. 
Fig. 4022.-Forcipressure Forceps. 
Fig. 4023.-Piffard's Grappling Forceps. 
Fig. 4024.-Heuel's Needle Forceps. 
Fig. 4025.-Heuel's Bone Forceps. 
Fig. 4026.-Hypodermic Syringe, GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
627 
WOUNDS AND INJURIES. 
EMERGENCY OPERATING SETS. 
Heuel's Pocket Case. (Continued.) 
"A Tiemann & Co.'s new sterling-silver 
male and female catheter (Fig. 4027), with a 
flexible jointed end, made in two sections, one 
nesting within the other, thus economizing space 
and saving the catheter from damage by pressure 
of other instruments. 
"A Weir's vaccinating lancet and comb 
(Fig. 4028). 
"An aluminum caustic holder (Fig. 4029), 
which is non-corrodible by nitrate of silver, and 
which is fitted with an extra male thread to 
screw into the end of the catheter, if a longer 
caustic holder is desired. Within the extra 
male thread is a female thread, into which the 
probes, tenaculum, aneurysm needle and double 
hook in the case can be screwed if a firm handle 
to either is needed. 
"On turning over the left-hand flap, b, of 
pocket-case, it discloses loops for the thinner 
instruments: 
" Probes (Fig. 4030), of which there 
are six varieties, each five inches in length 
and fitting a middle joint, with a female 
screw at each end, to make the probes 
fifteen inches long when desired to explore 
long sinuses, viz.: 
" Two sterling-silver probes, one with 
a large, the other with a small point. The 
large point, suitably bent and lengthened 
by other pieces, makes an excellent searcher for exploring the bladder in children. 
■" One very flexible whalebone probe for tortuous sinuses. 
"One Arnott's grooved probe to act as a fine director in narrow sinuses, and, in case of necessity, for external 
perineal urethrotomy. 
" One combined porte-meche, c, and seton-carrier, b. 
"One flexible steel, extr?.-small Nelaton's porcelain-point (one-sixteenth of inch in diameter) bullet probe, espe- 
cially useful in locating leaden fragments. 
"An aneurysm needle with a large eye. A tenaculum. A volsella, or double hook, each fitting into the caustic 
holder for a firm handle. 
Fig. 4027. 
Tiemann & Co.'s Sterling Silver Male and Female Catheter. 
Fig. 4028.-Weir's Vaccinating Lancet. 
Fig. 4029.-Aluminum Caustic Holder. 
Fig. 4030.-Heuel's Probes and Directors. 
FrG. 4031.-Spatula and Tongue-Tie. 
Fig. 4032.-Heuel's Scoop and Spade. 
"A combined tongue-tie (Fig. 4031) instrument 
and strong spatula, which will act as a large blunt 
dissector or tongue depressor. 
"A combined, strong, spade-shaped dissector, 
b, and sharp medium scoop, a (Fig. 4032). 
"A combined, strong, square, blunt dissector, b 
(useful in raising periosteum), and sharp, fenestrated 
bone scoop, a (Fig. 4033). 
Fig. 4033.-Heuel's Bone Scoop and Levator. 628 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
EMERGENCY OPERATING SETS. 
Heuel's Pocket Case. (Continued.) 
Fig. 4034.-Gross' Ear Spoon and Hook. 
"A Gross' ear spoon and hook 
(Fig. 4034)- 
"A combined, large, grooved 
director and large, dull scoop. 
"A large aspirating needle (Fig. 
4035), five inches long, for exploring 
deep tumors, tapping hydrocele, &c. 
It has a female thread inside the 
shoulder, A for screwing on to the 
hypodermic syringe if suction is 
required. The shoulder at b is for 
attaching rubber tubing if desired. 
Fig. 4035.-Aspirating Needle. 
Fig. 4036.-Heuel's Pin Conductor. 
Fig. 4037.-Heuel's Punch. 
"A combined Post's and Buck's pin conductor (Fig 4036), for readily introducing pins in hare-lip suture. The 
groove of the needle at a, b, is bridged over, forming a canal, which is closed at a. 
"A fenestrated punch (Fig. 4037), fitting into the needle holder for a firm handle for carrying out Neuber's wound 
draining without drainage tube (see article by Dr. A. G. Gerster, N. Y. Medical Journal, vol. xxxix., No. 10)."- 
By Franz Heuel, Jr., M. D., in Medical Record, August 9th, 1884. 
Fig. 4038. 
Dr. Stephen Smith's Compact Aseptic Pocket Case. 
Fig. 4039.-Tiemann & Co.'s Patent Catch Handle 
(furnished for Stephen Smith's Pocket Cases). 
2 Tiemann & Co.'s Patent (B) Catch Hard Rubber 
Handles, for following blades : 
I Scalpel. 
i Probe Bistoury. i Sharp Bistoury. 
i Tenotome. I Tenaculum. 
i Gum Lancet. 
i Scissors. 
i Director and Aneurism Needle. 
i pair Silver Probes. 
i Artery Forceps. 
Needles and Silk. 
Vial for Iodoform. 
Vial for Bi-chloride of Mercury (Fig. 4044). 
1 Morocco Case, 3 J inches long, 2 inches wide. 
Directions.-To secure the blades firmly in the 
handle, slide the shank of the blade into the slot at the 
distal end of the handle, turn down the eccentric bolt 
to a right angle on either side, and the blade is held 
firmly in position. By turning the bolt up, the blade is 
as easily removed. Either side of the blades fits and can 
be adapted so easily without even looking on. These 
instruments are cleaned readily, and there is no danger 
from poisonous matters. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
629 
WOUNDS AND INJURIES. 
EMERGENCY OPERATING SETS. 
Stephen Smith's Antiseptic Surgery Case. 
Fig. 4040.-Dr. Stephen Smith's General Antiseptic 
Operating Case. 
BOTTOM TRAY. 
I Long Bone Forceps, with spring. 
I Large Chisel. 
i Medium Chisel. 
i Stephen Smith's (bone-splitting chisel), Osteotome. 
i Plain Hollow Gouge. 
I Stephen Smith's Bone Knife and Rasp. 
i Hollow Gouging Spoon, for bones. 
I Carbonized Bone Gouging Forceps. 
i pair Double Retractors. 
i Trocar and Canula. 
i Trepanning and Toe-nail Extracting Forceps. 
i Galt's Trephine and Handle. 
i Brush. 
i Handle with 3 Bone Drills. 
1 Antrum Cutting Hook. 
1 Burr Drill. 
1 Aneurism Needle. 
BOTTOM DRAWER, TOP TRAY, 
i Liston's Amputating Knife. 
1 Tonsil Scissors. 
1 Tiemann & Co.'s Bullet Forceps. 
1 Thumb Vulsellum Forceps. 
3 Wyeth's Haemostatic Forceps. 
1 Curved Urethral Forceps, alligator. 
1 Roux's Needle Forceps. 
1 Hypodermic Syringe, extra large, with Aspiratory 
and Exploring Points 
" The general operating case for antiseptic surgery is 
a very strong leather valise, fourteen inches long, ten 
and one-half inches high and seven inches wide. It has 
two drawers to slide out at one end ; these two drawers 
have double trays, each containing all the instruments 
enumerated below. When these drawers are inclosed 
in the bag, a flap below covers up the front tight and 
this is locked inside by the strap passing through the 
aperture in the case. In the bottom of the rear part 
of the case is a partitioned space for four bottles, well 
secured. The upper part of the valise and the drawers 
are entirely separated by a partition. This upper portion 
contains the various articles for antiseptic dressings, as 
given in the list below : 
TOP DRAWER AND TOP TRAY. 
BOTTOM TRAY. 
3 Steel Handle Tenacula. 
3 Assorted Scalpels. 
1 Blunt Tenotome. 1 Probe Tenotome. 
1 Sharp Tenotome. 1 Hernia Bistoury. 
1 Levis' Hernia Director. 
1 Large Scalpel (extra size). 
1 Metacarpel Knife 4-J- inch. 
1 Straight Blunt-pointed Scissors. 
1 Strabismus Forceps. 
1 Dissecting Forceps. 
1 Andrew's Artery Forceps. 
1 Hamilton's Sequestrum and Needle Forceps, with 
catch. 
1 Metacarpel Saw. 
1 Bow-saw, with extra fine blade. 
I Flexible Bullet Probe. 
1 Steel Probe, hard rubber covered. 
I White's Long Fistula in ano Probe. 
3 Serrefines. 1 Long Probe. 
2 Short Probes. Needles, assorted. 
Antiseptic Ligature, on reels. 
Plastic Pins. 
2 coils of Silver Wire. 
8 Langenbeck's Haemostatic Clamp Forceps. 
I Uterine Curette. 
i Sponge Holder. 
i Simpson's Sound. 
I Gouley's Lithotomy Staff. 
i Small Lithotomy Forceps. 
2 Gouley's Catheters for External Urethrotomy 
i Silver Double Trachea Tube. 
I Bozeman's Speculum Vaginae, articulated handle and 
2 blades. 
4 Filiform Guides. 
TOP PART OF VALISE, 
4 Bottles. I Gerster's Iodoform Box. 
i Bristle Probang. I Fitch's Handy Aspirator. 
i Knapp's Ether Inhaler. 2 Aspirator Points. 
i Esmarch's Tourniquet. 
I No. 2 Syphon Syringe with Sprinkler, for washing. 
Borate of Cotton. 
Antiseptic Gauze. 
Bichloride of Mercury. 
Catgut Ligature. Sponge. 
Rubber Drainage Tubing. 
Stomach Tube for Washing out Stomach. 
i Velved-eyed Male Catheter. 
I Female Catheter, &c. 630 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
WOUNDS AND INJURIES. 
EMERGENCY OPERATING SETS 
Tremaine's Antiseptic Surgery Case, 
Fig. 4041.-Tremaine's Operating Bag. 
" For some time it has seemed to me desir- 
able that surgeons, who are liable to be suddenly 
called by day or night, should have an operat- 
ing case, in convenient and portable form, 
supplied with all the instruments likely to be 
used in any operation of emergency, such as 
amputation, kelotomy, tracheotomy, &c.; and, 
moreover, in these days of antiseptic surgery, 
that the case in which the instruments are kept 
should have no absorbent material to become 
contaminated. 
"An ordinary travelling satchel can be fitted 
to contain the instrument case. The sample 
case, which was made by Messrs. George Tie- 
mann & Co., of New York, is shown in the 
accompanying cut. The instruments are contained in a box made 
of spring brass, nickel-plated or gilt, and fitted with metal racks. 
The box contains the following instruments, some of which are 
new in pattern: 
Fig. 4042.-Tray 
1 Amputating Knife. 
1 Sands' Periosteum Knife. 
1 Metacarpal Saw. 
1 Finger Knife. 
I Cooper's Hernia Knife. 
1 Probe-pointed Bistoury. 
1 Aneurism Needle. 
1 Tenaculum. 
1 Large Scalpel. 
3 Smaller Scalpels. 
1 Curved Bistoury. 
1 Sharp-pointed Tenotome. 
1 Blunt Tenotome. 
1 Eye Spud. 
6 Haemostatic Forceps. 
1 Bull-dog Forceps. 
1 Olds' Scissors Forceps. 
2 Tremaine's Hare-lip Clamps 
1 Tremaine's Ratchet Tre- 
phine. 
1 Small Aspirator. 
1 Sequestrum Forceps. 
1 Bone Forceps. 
1 Needle Forceps. 
1 pair Tremaine's Retractors. 
1 Tremaine's Saw (2 blades). 
1 Elevator. 
1 Tracheotomy Tube. 
1 Director. 
3 Silk or Catgut Spool Cases, 
(T remaine's). 
1 Needle Case. 
1 Long Uterine Scissors. 
2 Probes. 
Fig. 4043.-Top view of Satchel, showing bottles, 
" The spool cases of hard rubber will especially 
commend themselves, as also the hare-lip clamps. 
"The interior of the bag is fitted with metal- 
cased bottles, to contain chloroform, antiseptic solu- 
tions, catgut ligature, &c., at the pleasure and prefer- 
ence of the surgeon. It also gives plenty of room 
for additional non-cutting instruments, with a pack- 
age of antiseptic gauze, sponges, Esmarch's ban- 
dage, &c. 
"After many years of experience of the needs of 
the surgeon in military, civil and railroad practice, I 
believe this case will fill every need of the operating 
surgeon in any emergency. As such I present it to 
the profession. Of course the instruments can be 
varied to suit the needs of the surgeon."-Dr. W. 
S. Tremaine, M. D., Surgeon U. S. Army, in New 
York Medical Journal, July 17, 1886. 
Fig. 4044.-Vial for Iodoform or Chloride of Mercury. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
631 
RESTRAINTS. 
CARE OF THE INSANE. 
Most Humane and Approved Forms of Restraints. 
Our muff is of a new design, much superior to all the older styles, and made of heavy russet leather. It is pressed 
into shape and stitched afterward, so that it always retains its form. Permanent wristlets are attached and so fitted 
with buckle as to be adjustable to any size of wrist. These wristlets are turned on the edge and lined with best buck- 
skin, as are also the seams in the muff. The most thorough ventilation is secured by perforation on the under sur- 
face and back. 
Fig. 4045. 
Restraint Buckle. Shoe and Clothing Buckle. 
Fig. 4046.-Lynch's Muff. 
Fig. 4047.-Mitts. 
Fig. 4048.-Wristlets. 
Fig. 4049.-Straight Jacket. 
The wristlet and upper part of palm (Fig. 4048) are made of heavy russet 
leather, and lined with best buckskin. The front and back of hand are of 
calf russet, soft and pliable. Ventilation by perforation in the back. At- 
tachment to waist strap by two brass staples on each wrist, as shown in cut. 
These are made of the best heavy russet stock, pressed into shape and 
afterwards lined with the best buckskin. This secures permanency of form 
and avoids wrinkling of lining. A roll is turned on the side next the hand. 
The wristlet is attached to the waist strap by a brass staple and plate, and is 
adjustable for three sizes of wrists. 
Fig. 4050.-Anklets, with small buckle. 
Fig. 4051. 
Buckles and Key. 
Fig. 4053.-Shoe Buckles, 
with Straps and Loops. 
Fig. 4052.-Anklets, with large buckle. 
Those with small buckles (Fig. 4050) do not become separated 
when detached from the patient, but are always together when re- 
quired for use. They are adjustable to any ankle and are especi- 
ally designed for daily use. 
Those with large buckle (Fig. 4052) may be used separate, and 
are best adapted for night use. Both are made of No. 1 russet lea- 
ther, lined with best buckskin, and rolls are turned on both edges. 
Fig. 4053 shows a very neat small buckle, 
a modification of the larger, for fastening shoes 
and clothing. It is nickel-plated ; can be 
readily attached ; locks and unlocks on the 
same principle as the larger buckle. 632 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
RESTRAINTS. 
CARE OF THE INSANE. 
Most Humane and Approved Forms of Restraints. (Continued.) 
Fig. 4054.-Lynch's Patent Lock Buckles. 
Directions for use of Lynch's Buckle.-To unlock, push 
in the key straight; to lock, press down small pin in end 
of bolt with the forefinger of the right hand, then shove in 
the bolt with thumb of same. The pin is to prevent lock- 
ing till ready. When not in use slip in the bolt. 
Suggestions to Sheriffs, Police Officers, and others having the Insane in charge 
before Commitment. 
" The following suggestions are offered for the benefit of officers called upon to deal with insane patients. 
" I. An insane person is a sick person, and as such should receive every attention and care in the power of the officer. 
" 2. People do not change their natures by becoming insane. Whenever possible, they should be treated as reason- 
able beings. Their feelings and rights should be regarded. No one should be allowed to make them an object of 
ridicule or banter. 
" 3. Harshness is never necessary, and physical force, only occasionally. 
" The use of steel hand-cuffs, leg-irons, chains and ropes is unnecessary severity. In those exceptional cases where 
it is necessary to restrain patients, much suffering will be saved if each sheriff will procure and keep at hand a few 
simple articles of apparatus. The following will suffice: a sole leather muff, to be used in cases where the patient 
tears off the clothing ; a belt with wristlets, to prevent persons from striking, the belt being fastened by lock buckles, 
and the wristlets so arranged as to slide freely on the belt; one or two camisoles, which consist of a jacket buttoning 
behind, made of duck or stout denims, with sleeves extending beyond the hands ten or twelve inches. The sleeves 
can be crossed and secured behind the back. The camisole prevents violent demonstrations and is especially adapted 
to female patients. In the more populous counties it might be desirable to obtain leather anklets which prevent kicking. 
" 4. Do not be afraid of insane patients; usually they are harmless, and, when otherwise, the use of the apparatus 
suggested is a sufficient protection. Gentleness and tact will often render the use of apparatus unnecessary. 
" 5. It is the general practice to confine insane patients in jail, pending examination. This practice is without 
express warrant of law, but is doubtless sometimes necessary to keep the patient safely. There can be no excuse, 
however, for treating an insane patient as a criminal, still less for locking him up in the same apartments with other 
prisoners, as is often done. In many cases, especially where the patient is suffering from an acute attack, the jail is 
not a proper place for him, but he should be kept in a suitable room in charge of a competent person. 
"6. Medical Advice.-In all cases of great excitement or prostration, a physician should be called at once. In 
some cases a sedative or a hypodermic injection is needed to give opportunity for the excitement to pass away; in 
other cases medical advice is needed as to food and treatment. 
" 7. Deception.-Do not tell untruths to insane people ; it is cowardly and very injurious. When a patient is to 
be taken to the hospital, do not tell him that he is to be taken to a hotel or a summer resort, or on a visit. Explain 
quietly and pleasantly, but firmly, that he is to be taken to the hospital for treatment, in order that he may be freed 
from his troubles of mind. 
" 8. Special care is necessary in moving insane patients, particularly in entering or leaving buildings, vehicles and 
cars. Patients often suffer serious bodily injury in these transfers, which might be prevented by care and tact. Ex- 
plain beforehand what you are about to do ; a little deliberation and patience will often obviate the necessity for force. 
When force is used it should be gently applied, but sufficient to overcome resistance easily. 
"9. Treatment of Women.-The greatest care and delicacy should be observed in dealing with female patients. 
No indignity should be offered, nor any violation of their sense of propriety. In some States there is a provision of 
law that female patients shall always be accompanied by a woman en route. This should always be the case, but 
our great distances sometimes render it impracticable. Insane women travelling under the care of a male officer some- 
times suffer great hardships. Women from the country are often unaccustomed to the use of water-closets and other 
conveniences in hotels and railway cars. It is not uncommon for women to be brought to a hospital in a filthy con- 
dition and under great mental excitement, simply because they have not received proper attention. 
" 10. When you visit the hospital ask to be shown how they deal with new-comers. 
" 11. If at all practicable, avoid reaching the hospital in the night. The new patient receives a gloomy and de- 
pressing first impression of the institution, amounting in some cases to positive horror, which it is sometimes impos- 
sible to counteract. Officers and attendants must be roused, and scores of patients are sometimes awakened and dis- 
turbed by the arrival of an excited patient."-Issued by the Superintendents of the Minnesota Insane Hospitals and 
the Minnesota Board of Corrections and Charities. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
633 
ORTHOP/EDIC. 
CORRECTION OF BODILY DEFORMITIES 
Orthopaedic Surgery. 
" Orthopcedics, or orthopcedic surgery, is that branch of practical surgery which deals with the correction of bodily 
deformities, from whatever cause arising (Reeves). Improving the patients' condition and advancing the science of 
this branch of surgical work-the common motive of all conscientious practitioners, however they may differ in the 
selection of their means (Axiom). Pretenders and quacks publish accounts of their wonderful cures and the miracles 
they have performed in the secular press, or in other than scientific and professional journals, never laying down any 
laws or rules to aid another in performing the same cure in similar cases. And this constitutes one of the essential 
differences between an honorable physician and a quack: the one labors to disseminate and diffuse his knowledge for 
the benefit of his whole profession, in order that he may relieve as much of human suffering as is within his power; the 
other endeavors to conceal the little knowledge he may possess for his own particular profit or gain (Sayre)." 
" Outside of large cities, the majority of patients needing attention on account of deformities, or diseases or acci- 
dents that lead to them, must find relief at the hands of the profession in their near vicinity, or not find it at all. The 
proportion of the wealthy, who can be sent a considerable distance to specialists, is so small in relation to the whole 
as to make very little diminution of the number that must be treated at home. This renders it important that there 
should be a general prevalence, in the profession, of a knowledge of prevention and treatment; to bring the means of 
relief within the pecuniary resources of the majority of sufferers. In order to render the advance in knowledge on this 
subject, gained within the last twenty years, accessible to the mass of the profession, it is necessary that the substance 
of many valuable essays and monographs should be sifted and collected into a few pages, within the means of all to 
procure and within the time of all to read."-" Orthopaedics." David Prince. 
General Remarks on Orthopaedic Therapeutics. 
"The principles, few and very intelligible, are these: I. To remove, if possible, the cause of the deformity. 
2. Correction of the deformity through changing the position of the distorted bones, or through extension of contracted 
muscles and ligaments, or by division and subsequent extension of retracted muscles and their tendons. 3. To main- 
tain the improved position and prevent relapse. 
" Under the first head come all these precautions as to correcting bad habits of position in early life, and, after- 
wards, in occupations. Miner's lateral curvature and baker's flat foot are instances of deformity produced by improper 
vocational positions, and by long standing and carrying heavy weights. In the limbs fractures should be so set, and 
diseased joints proceeding to anchylosis so regulated, as to obviate deformity as much as possible, and to allow the limb 
to become fixed in a serviceable position. 
" The details of the second head may be summed up by saying that they consist in: a. Bodily movements, active 
and passive; b. Improvement of the general health; c. Mechanical means, and by operative methods. 
" Under the third head are included the supervision of the case, the continuance of local and general measures used 
in the correction of the deformity, and the regular and judicious exercise, in its normal functions, of the part which has 
been restored to, or near to, its proper shape."-" Practical Orthopaedics." Reeves. 
"Manipulation may be regarded as the natural remedial agent for the care of a deformity. There can be no sub- 
stitute for manipulation by the human hand. There is an intelligent touch that admonishes you of the amount of 
resistance present, the amount of force required to overcome it, and when you should stop its exercise. You are able 
by this means to determine whether you are producing spasmodic contractions and consequent irritation, and can 
arrest your force at any desired point. This is what is generally understood by the term massage, from the word 
/j.doOG), to knead ; the great value of which has not been understood or used by the profession as much as it deserves. 
All such movements are exceedingly beneficial, and very much increase nutrition by stimulating an increased blood 
supply to the parts ; the friction and kneading stimulate the absorbents in the removal of abnormal deposits. In cases 
of paralyzed muscles, massage is frequently combined with whipping or beating of the muscles by the india rubber 
muscle-beater of Klemm, or sometimes by an india rubber hammer in the form of a thimble fastened to an elastic 
handle, with which rapid percussions can be given to the deepest muscles, thus increasing the circulation in these 
parts and tending to an increase of development. The occasional application of electricity may also be of service. 
" Gymnastics.-These are of great service in the treatment of deformities, but they must be used with great caution 
and under wise supervision. 
"Mechanical Appliances.-These are necessary for the purpose of retaining deformed parts in certain positions after 
they have been placed in such positions by manual force; but the more frequently these mechanical appliances are re- 
moved, and the part subjected to manipulation, the greater will be the success that will attend treatment. While 
using any mechanical apparatus, if manipulation be neglected, the patient will be deprived of that stimulus, motion, 
which is so essential for the perfect preservation of the usefulness of the deformed parts. The principal requisites 
of an orthopaedic apparatus are: simplicity, facility of application and lightness, as far as compatible with the object 
to be accomplished by its use. It should never encircle the limb or trunk in such a manner as to interfere with the 634 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORT^OP/EDIC. 
CORRECTION OF BODILY DEFORMITIES. 
General Remarks on Orthopaedic Therapeutics. (Continued.) 
circulation, nerve-currents or natural movements of the parts. It should act in its tractile force gradually and con- 
stantly, and, as the line of deformity is slowly changing its direction ; it becomes very necessary that the apparatus 
be frequently removed and reapplied or adapted to the new line of distortion. The persons in charge of and using 
the apparatus, should thoroughly understand their manner of action, be perfectly acquainted with their mechanism 
and the object to be gained by their application. At the outset the practitioner should adapt the instrument to the de- 
formity, and not the deformity to the instrument, as is too frequently attempted. Proceed in a gentle manner until the 
first difficulty is overcome. The pain experienced in the part soon wears off as the mind becomes more tranquil, and 
then you can, day by day, bring to bear upon it such force as will tend to secure the desired object. In the choice of 
a mechanical apparatus you should be guided, not only by its adaptibility to the member to which it is to be applied, but 
also by your acquaintance with its mechanism and use. 
" There is an important rule which should influence your management of all paralytic deformities, and also many 
other cases, especially those in which it becomes necessary to overcome muscular contraction, or to retain muscles in a 
state of rest for a considerable length of time ; it is this: permit, as far as possible, the natural motion in the parts in- 
volved in the deformity. The joints and muscles of the human body were designed by the Creator of all things for 
active motion ; as far as is practicable the natural movements of the body should be retained, stimulated and strength- 
ened. It is for this reason that all treatment of paralytic deformities by means of fixed apparatus is to be condemned. 
The total, absolute rest which must necessarily occur in a muscle when secured in some fixed apparatus, if too long 
continued, will certainly induce such structural changes as will preclude all possibility of ever overcoming the deform- 
ity by restoring to the muscle its normal power. 
"Adhesive Plaster.-In all cases where it is desirable to maintain long-continued traction by means of adhesive 
plaster, the most reliable article that I have used is that known by the name of * Maw's moleskin plaster.' Plaster 
spread upon Canton flannel may be used, but it is not nearly as good as the 'moleskin plaster.' I receive complaints 
almost daily from doctors in the country that they cannot make the plaster stay on more than a day or two. In 
the first place, they put it on too hot; the heat destroys the vitality of the epidermis, and it peels off the same as from 
a blistered surface, and, of course, carries with it the point of attachment. In the next place, they do not thoroughly 
knead the strips of plaster and mould them uniformly to the limb before subjecting them to the strain of traction. If 
a reliable article is used, and these precautions taken, there need be no trouble with regard to making the plaster ad- 
here firmly to the surface. As an additional precaution, however, it is important that the surface to which the plaster 
is to be applied should be clean and dry. There is another exceedingly important point relating to its reapplication, as 
in a second dressing: when the plaster has been on a limb for a long time, and then removed, there will be found more 
or less dead scarf-skin on the surface ; this must be completely removed before making another application of plaster. 
"Elastic Tension.-Subcutaneous tenotomy was first applied to the relief of deformity in the year 1831, by Stro- 
meyer. That operation marked a new era in orthopaedic surgery, and for many years the operation of tenotomy was 
exclusively relied upon for affording relief of the contracted tendons. Yet, in the progress of time, we have learned 
still more ; and, in my own experience, I have been enabled to test the correctness of the now established principle of 
extending a contracted muscle by the constant application of an elastic force, moderately but persistently applied. This 
will, in the majority of instances, accomplish the object fully as efficiently as tenotomy, where the muscle has not al- 
ready undergone structural changes, or, in other words, become contractured; and it is infinitely better for the future 
usefulness of the limb involved, although sometimes much more tedious in producing the result. 
" Operative Treatment.-Under the head of operative treatment we have tenotomy, myotomy and breaking up of 
bony and fibrous formations. 
" By the term tenotomy we mean section of a tendon. The instrument commonly employed for this purpose is 
called a tenotome. Myotomy means section of a muscle. For the purpose of performing these operations you will re- 
quire knives and tenotomes having a peculiar construction. The handle of the instrument should be so constructed 
that you may always know in which direction the edge of the blade is turned ; this may be indicated by a spot on the 
handle. If the precaution is not taken, when the blade is buried deep beneath the tissues, you will be ignorant of the 
exact direction of the cutting edge, a thing always to be borne in mind. The shank should be strong, and firmly in- 
serted into the handle. The blade should be made very thick at the 'heel,' very narrow in the cutting portion, always 
rounded at the end and sharpened from side to side like a wedge or chisel, so that, when introduced, it splits rather 
than punctures the tissue through which it passes ; the length of the blade should be according to the size of the tendon 
to be divided. The intrument should be made of the finest-tempered steel, otherwise so small a blade as this, in cut- 
ting a permanently contracted tendon or fascia, or any portion of tissue that has undergone structural change, is very 
liable to be broken."*-" Orthopaedic Surgery and Diseases of the Joints." Lewis A. Sayre. 
* See page 84. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
635 
ORTHOP/EDIC. 
DISEASES OF THE JOINTS. 
Inflammation, Caries. 
"It may be stated as a general truth that diseases of a joint commence either in the synovial or osseous tissues, 
and that they originate for the most part in an acute or chronic inflammation; in the progress of any case both tissues 
may become eventually involved ; when they undergo a change it is secondary to some other affection, either of the 
synovial membrane or of the bone. When the disease commences in the synovial membrane or in the bone, and disor- 
ganization of the joint follows, it is in that tissue in which the disease began that the gravest change will be seen."- 
T. Bryant. 
Inflammation. 
" Injury in some form is generally the cause of inflammation of the joints. 
"l. Serous synovitis (T. Billroth) commences with swelling, heat and pain of the joint, but slight fever ; the sy- 
novial membrane is slightly swollen and moderately vascular ; the cavity is full of serum with synovia, and the remain- 
der of the joint is healthy. The symptoms rapidly subside with rest, painting with the tincture of iodine or applying 
compresses of wet bandages or blisters ; the patient soon begins to use the joint without difficulty, the fluid is gradually 
absorbed and function is restored. 
"2. Parenchymatous or purulent synovitis (T. Billroth) begins with a chill, high fever, extreme tenderness of the 
joint, which is fixed, swollen and hot; there is no fluctuation, but the whole limb is cedematous ; the synovial mem- 
brane much swollen, red, and puffy ; there is a little flocculent pus in the cavity, and the cartilage looks cloudy ; the 
difference between the serous and purulent varieties is that in the former the synovial membrane is simply stimulated 
to secretion, while in the latter it is deeply affected. The treatment at this early stage is: fixation of the joint by 
apparatus in the most favorable position for subsequent use if anchylosis occur, anaesthetics being given if neces- 
sary ; the gypsum is generally the most available, the limb being well protected by wadding to avoid strangulation 
(T. Billroth) ; the continued application of ice bags (bladders), so as to effectually cool the entire joint. Before 
applying these dressings, the parts may be thoroughly painted with tincture of iodine. Opium and quinine should be 
given, in such measure as will secure relief from the effects of pain and fever. If the disease subsides months may 
elapse before the inflammation entirely disappears, and great care is necessary to avoid a renewal of the disease by cold 
or injury. If the disease continues to progress, abscesses form, the joint becomes more swollen, the fever is high, and 
inter-current chills occur, emaciation follows, with sleeplessness and prostration ; in the joint there is a collection of 
thick yellow pus, mixed with fibrinous flocculi, the synovial membrane is covered with dense purulent rinds, under 
which it is very red, puffy, partly ulcerated ; the cartilage is partly broken down into pulp, partly necrosed and peels 
off, the bone is very red or infiltrated. The limb being secured in immovable apparatus, with ample fenestrse, open 
the abscesses and the joint antiseptically, thoroughly cleanse with carbolic solutions, secure free drainage, and give 
nourishing diet liberally. The patient may recover under this treatment with anchylosis, or metastatic abscess may 
form in the lungs, liver or other organs, and death may ensue from pyaemia. Occasionally the inflammation extends 
uncontrollably in and around the joint, the suppuration involving the thigh and leg, followed by great exhaustion, fever 
and chills. Recovery is still possible, but openings must be made to evacuate the pus, and strengthening remedies given. 
The antiseptic treatment is most serviceable in such cases (J. Lister) ; every collection of pus must be evacuated ; all 
septic matters removed and cavities cleansed with carbolic solutions, and antiseptic dressings applied. The question 
of exsection or amputation may arise in severe cases and must be determined by the special conditions of each case. 
"3. Chronic synovitis may result from the acute form, or it may be chronic from the start and remain so. The joint 
is much swollen, without heat or pain, and fluctuates all over; the fluid collects chiefly in the mucous bursse adjacent, 
especially at the knee, where the bursae under the tendons of the extensors at both sides of the patella and in the pop- 
liteal space are greatly distended, while the capsule is less distinctly marked than in acute synovitis ; the patient can 
often walk easily, but much exercise is fatiguing and followed by increased effusion (T. Billroth). The cure re- 
quires rest to the joint, and change in the synovial surfaces. Rest may generally be best secured by plastic dressing, 
both in the upper and lower extremity. To effect a change in the synovial membrane apply blisters or iodine ; if it 
still remains filled with fluid, it may be tapped with a fine trocar, and the fluid withdrawn ; or, if the fluid return, to 
tapping add an injection of iodine. The arrest of secretion in the latter case is due to the shrinkage of the serous 
membrane caused by the action of the iodine with the new formation of the endothelium (T. Billroth). Tap the 
joint carefully with a fine trocar, and, after the escape of the fluid, without admitting air, inject by means of a well- 
made syringe officinal tincture of iodine and distilled water, equal parts, or, if it is desired to be more cautious, take 
one of the former to two of the latter ; be careful that no air enter the joint; allow the liquid to remain from three to 
five minutes, according to the pain induced, then let it escape slowly, close the wound and envelope the joint with wet 
bandages ; the operation is not free from danger and may terminate in purulent synovitis (T. Billroth). Or, the joint 
may be irrigated with antiseptics. For the knee use a medium sized trocar and canula, puncture by the inside of the 
patella near its lower end and withdraw the fluid ; then distend the joint with bichloride solution, and let a 
stream flow through the joint for several minutes; close the puncture with suture, and apply iodoform dressings. 636 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC 
DISEASES OF THE JOINTS. 
Caries. 
"Two forms of destructive ulceration occur in the articular extremities of bones, which are liable to seriously com- 
promise joints. 
"l. Simple caries {E. Rindfleisch) attacks the articular ends of bones as a sequel of inflammation of other tissues 
of the joint; it sets in as soon as the cartilage which coats the articular surfaces is finally destroyed, and the bare bone 
is left projecting into the cavity of the joint; by mechanical violence minute portions of bone tissue are successively 
detached with the debris which surrounds them ; the ulcer is invariably superficial, sharply circumscribed, and rela- 
tively smooth ; it is commonly situated where the opposed surfaces are in contact with each other ; though slow in its 
progress it causes extensive losses of substance followed by marked shortening and distortion of the limb. The first 
symptoms may be slight heat, pain and swelling, followed in a few weeks by gnawing pains and starting of the limb 
at night from spasms of the muscles, great pain on rubbing the joint surfaces together, contraction of the limb; finally 
pus forms and abscesses appear with their attendant symptoms (T. Billroth). 
" The indications of treatment are: tonics, as syr. ferri iodid., and cod liver oil; complete relief of the carious bone 
from pressure and friction, by extension with apparatus adapted to the special joint involved. If the caries extends, 
exsection or amputation may be required. 
" 2. Fungating caries, fungous or scrofulous inflammation of a joint, may originate in the synovial membrane, or there 
may be a central or more rarely a periphereal caries in the spongy epiphysis of a hollow bone or in one of the spongy 
bones of the wrist or ankle, which may perforate from within outward and excite synovitis; sometimes in the hip, knee 
and ankle, with the fungous proliferation of the synovial membrane, there is an independent proliferation under the 
cartilage and between it and the bone, which subsequently unites with that above, so that the cartilage lies partly 
movable between the two granular layers (T. Billroth). More commonly the disease commences as a non-suppu- 
rative inflammation of the adjoining epiphyses of two bones where they unite to form a joint; the hyperaemic medulla 
grows towards the joint, the bony tuberculae melt away, the cortical portion becomes thin, the exuberant granulations 
protrude between the cartilage and bone ; meantime, the synovial membrane and its connective tissue, the ligaments, 
and, finally, all of the neighboring connective tissue inflames ; a diffuse congestion occurs in the delicate, overlapping 
fringe of the synovial membrane, from which a membrane of young connective tissue overspreads the cartilage from its 
edges ; the superficial layer of cartilage cells now take part in the inflammation, cells multiply, the capsules open, the 
young connective tissue forces its way in ; finally, the ascending growth meets that which advances downwards, the 
two coalesce, and the cartilage is perforated (E. Rindfleisch). The disease may terminate in resolution, and the parts 
recover, or pus may form in the joint or in the tissues around it, creating abscesses with sinuses ; or the connective 
tissue may enlarge and degenerate into a firm, white fibroid mass of colossal dimensions, stretching the skin all around 
the joint and shining through it with a whitish lustre, causing the so-called white swelling, tumor albus (E. Rindfleisch). 
The external appearances of the affected joint depend upon the extent of participation of the parts around the joint in 
the inflammation ; there may be no suppuration, but a simple proliferation of granulations which shall lead to destruc- 
tion of ligaments and displacement of bones; or suppuration may occur in the granulations or synovial membrane, or 
in the connective tissue; whatever swelling there may be around the joint is due, not to enlargement of the articular 
ends of bones, which never swell in caries, but to the thickening of the soft parts, or to osteophytes (T. Billroth). 
' ' When fungating caries attacks spongy bones, which are largely invested by articulations, as the carpals, tarsals and 
vertebrae, the bone may be entirely dissolved by interstitial granulations growing all through it, without any necessary 
accompaniment of the slightest trace of suppuration (T. Billroth). But, in the great majority of cases, there is a puru- 
lent periostitis, especially of the carpal and tarsal bones, and the disease readily extends to the entire bone and its ar- 
ticular surfaces as it progresses; the sheaths qf the tendons become implicated, the skin ulcerates, giving exit to the 
pus, and the joints swell and lose their shape. The atonic form of inflammation with slight vascularization, which re- 
sults in carious degeneration of the new formation, the so-called scrofulous caries, is essentially a fungating caries. It 
occurs chiefly in the spongy bones, the vertebrae, the calcaneum, and epiphyses of hollow bones, and readily combines 
with partial necrosis. 
" The essential feature of treatment of a carious joint is perfect rest of the part, combined with open air, syr. ferri 
iodid. and cod liver oil. Rest must be obtained either by position or by apparatus. In the upper extremity both 
methods may be usefully resorted to, but in the lower extremity apparatus should be so employed as to prevent all 
injurious movements of the joint, and yet permit of that general exercise essential to the health of the patient. 
"The hip, knee and ankle joints may be placed at rest, and efficiently protected by the gypsum bandage, but 
well-fitted apparatus gives more precision to the efforts to protect them and yet allows free out-of-door exercise. In 
the early stage this course may secure resolution ; later it may be followed by fibrous anchylosis, to be relieved by flexion; 
finally, in the stage of suppuration, it may result in bony anchylosis. At various stages of progress the question of ex- 
section and amputation will be raised and must be determined. The apparatus necessarily varies at each joint, but the 
principle is the same."-"Operative Surgery." Stephen Smith. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
637 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS 
Morbus Coxarius. 
"Anatomy of the Hip-Joint.-The osseous structure of the hip-joint is made up of the os innominatum and head 
of the os femoris, the latter being received into a deep cavity of the former, the acetabulum, by a kind of articulation 
called enarthroidal, or ball-and-socket joint. 
" The head of the femur and the acetabulum are cancellous in structure, quite vascular, and subject to inflamma- 
tion. The acetabulum is lined with cartilage at all parts, except at a circular pit {fundus acetabuli), which occupies 
the lower part of the cavity near the notch, and is cushioned with fat. The head of the femur, which fits into and 
articulates with the acetabulum, is nearly two-thirds of the segment of a sphere, and is entirely covered with cartilage, 
except at the deep pit, which is for the insertion of the ligamentum teres, at its upper and inner face looking toward 
the cavity of the pelvis. 
" The proper ligaments of the hip-joint are the capsular, the ileo-femoral, the ligamentum teres, the cotyloid and 
the transverse. The capsular ligament is the largest and strongest capsule in the body. It is attached above to the 
outer border of the acetabulum and outer face of the cotyloid ligament ; and below to the anterior inter-trochanteric 
line and neck of the femur, which latter it completely surrounds. It is thicker and longer in front than behind, and 
it is more extensively attached at its upper part, where strength and security are required. The strength of the cap- 
sular ligament is further greatly increased by the ileo-femoral ligament, which is accessory to it, and extends from the 
anterior inferior spinous process of the ilium to the anterior inter-trochanteric line. This ligament has been called 
Y ligament by Dr. Bigelow, of Boston. 
" The cotyloid ligament is a thick prismatic ring of fibro-cartilage, mounting and attached to the brim of the 
acetabulum by which the cavity is deepened. 
" The ligamentum teres is attached by a round apex to a pit just below the middle of the head of the femur; it 
divides into two fasciculi, which are inserted into the corners of the notch of the acetabulum, and the cotyloid liga- 
ment, and is covered by synovial membrane. 
" The transverse ligament is continuous with the cotyloid, extending from one point of the notch to the other, and 
completing the circle of the cotyloid ligament, thus converting the notch of the acetabulum into a foramen, through 
which the bloodvessels enter to supply the interior of the joint. 
" The synovial membrane is quite extensive, lining the capsular ligament, the free surface of the cotyloid and 
transverse ligaments and the ligamentum teres, as far as the head of the bone. 
"Pathology.-I. The disease may begin as a synovitis. 
" 2. It may begin in a rupture, partial or complete, of the ligamentum teres, thereby interfering with the nutrition 
of the head of the femur. 
"3. It may begin from rupture of some minute bloodvessels which are situated in the bone just beneath the carti- 
lage of incrustation. This may occur either upon the head of the femur or at some point in the acetabulum, and re- 
sults from blows, jumping, or anything which may produce a sudden concussion of these articular surfaces. * * * 
"Almost all surgical authorities agree that morbus coxarius is invariably the result of a contaminated constitution; 
in other words, that it is essentially strumous in its origin. This has been the universal opinion, and the doctrine has 
descended from teacher to student, and is still extant among the majority of surgical practitioners. It has been so 
often taught and enforced, by frequent repetitions, that nobody considered it worth while to question the truth ; but 
nearly all have taken it for granted that an assertion so positively made and universally accepted must be based upon 
mature investigation. When I first went into the profession I accepted this doctrine taught by our fathers, but must 
confess that I never was fully satisfied with regard to its correctness. Examination of the cases which have presented 
themselves to my notice since that time has convinced me that the cachectic condition so often seen is the result, and 
not the cause of the disease ; for very many of the patients in the earlier stages of the disease have possessed all the 
appearances of robust health, and in all those cases in which the disease has been cured by nature's method, the 
patient, subsequent to the cure, has been hale and hearty. * * * The very fact of his becoming vigorous and 
robust after going through all the exhausting effects of hip-joint disease proves, in my judgment, that the disease is 
not necessarily of constitutional origin. The additional fact that, in so many cases, the joint has been exsected when 
the patients have been, apparently, at the point of death, and after the removal of the dead bone have become strong, 
vigorous persons, is good evidence that the disease is not constitutional. Then there is still a stronger fact that, by 
treating the disease locally, without reference to constitutional taint, we obtain perfect results, so much so that the 
patients recover with perfect motion and without the slightest deformity, which is the best proof in the world that the 
disease is essentially local in character. 
" I regard the disease as one almost invariably due to a traumatic cause, and not dependent upon some constitu- 
tional taint. * * * It generally requires a very close examination to find out the cause, since the disease does not 
usually immediately follow the injury, but often first manifests itself weeks, and even months, after the accident that 
has given rise to it has occurred; so that the patient and his friends naturally enough forget the accident and its con- 
nection with the disease, until especially reminded of it in the investigation. • 638 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS. 
Morbus Coxarius. 
" Ordinarily three stages are described : 
" I. The stage of irritation or of limited motion, before the occurrence of effusion. 
" 2. The stage of 'apparent' lengthening, or of effusion, the capsule of the joint remaining entire. 
" 3. The stage of ' shortening' or of ruptured capsule."-See " Orthopaedic Surgery and Diseases of the Joints." 
Second edition, page 241. Lewis A. Sayre. 
Treatment. Mechanical Apparatus, how applied. 
" The treatment of morbus coxarius may be divided into: 1. Local; 2. General. 
" Many of the general remedies employed have been given to counteract the scrofulous diathesis which was supposed 
to underlie these joint diseases. Of course, if the disease occurs in a patient who happens to be scrofulous, it will be 
necessary to bear in mind the diathesis which complicates the trouble, and employ the proper remedies. But these 
'white swellings' of joints have no necessary connection with scrofula, and occur indifferently in the weak and robust, 
according as the exciting causes, generally traumatic, are brought into action. It would, then, be highly illogical to 
subject every case of joint disease to a course of anti-scrofulous medication. You will, however, generally find that 
these patients are benefited by those remedies, such as tonics, cod-liver oil, and stimulants, which are of value in the 
treatment of any disease of long duration and debilitating tendency. * * * 
"The local treatment, which has grown into favor during the past few years, but which I have advocated since 
1845, is such as to give absolute rest and freedom from pressure of the parts involved in the disease, without materially 
interfering with the mobility of the joint or ordinary exercises of the patient. Bonnet's method-fixation without ex- 
tension-for local treatment has been the plan abroad. In this country, however, fixation with extension has been 
chiefly employed."-"Orthopaedic Surgery and Diseases of the Joints." Lewis A. Sayre. 
Fig. 4055. 
Davis' Splint 
Davis' portable extension apparatus allows mobility of the 
joint, while it diminishes friction of its surfaces. The appara- 
tus is to be worn when the acute stage is passed. Extension is 
made from the foot, counter extension from a two-fold perineal 
band, the outer one of which is rigid, the other elastic, so as to 
allow elastic extension to a certain point only. It is applied to 
the limb by means of adhesive plaster strips, secured with roller 
bandages. It fits either leg. Extension is regulated by a nut 
and screw. 
Fig. 4056. 
Sayres' Original Splint. 
Sayre's original splint consists of two portions, the upper 
one is attached, by means of a universal joint, to a pad fitting 
on the dorsum below the crest of the ilium. The lower por- 
tion slides within the first. On its inferior extremity are bands 
embracing the thigh just above the knee. Extension is made 
by working the splint with key, f. Dr. Sayre now uses the 
apparatus as modified by himself and shown in Fig. 4058. 
Fig. 4057.-Andrew's Splint 
Andrew's splint consists of: 
a. Top pad, applied just below crest of ilium. 
b. Extension screw, sliding in tube, c, and extension regulated by a nut. 
d. Perineal band. 
g. Half band of steel in front of thigh. 
e. Adhesive straps, fastened to lower end of instrument, both sides of the thigh, 
by tapes. 
The extension is regulated by a nut, made hexagonal, so as to be turned by a little 
wrench. The steel semi-circular band, g, goes half around the front of the limb, and 
on the opposite side has a short rod projecting down beside the knee to tie tapes to, like 
the one shown on the hither side in the cut. 
In certain cases it is desirable to use a long splint, coming down to the foot and 
riveted into the heel of the shoe. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
639 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS. 
Morbus Coxarius Apparatus. 
Fig. 4058. 
Sayres Improved Short Splint, 
Dr. Sayre says: " Since that time [when he first devised the instrument for the 
treatment of hip-joint disease, Fig. 4056] I have improved it in many respects, and 
the instrument I now commonly employ is a short thigh splint," as seen in Fig. 4058. 
The following is a description of this instrument, together with the method of 
application: 
It consists of a pelvic band, passing partly around the body under the crest of 
the ilium, well padded on its inner surface, to which usually two perineal straps are 
fastened for counter extension ; its outer surface holds a ball-and-socket joint, from 
which runs a steel bar or rod down the outer side of the thigh to within about two 
inches of the lower end of the femur. This outer bar is divided into two sections, 
one running within the other, and gauged or controlled by a ratchet and key, which 
can make it longer or shorter. At the lower extremity of this outer bar is a pro- 
jecting branch going over to the inner surface of the thigh to receive the attach- 
ments of the plaster, hereafter to be described. Both of the lower extremities 
terminate, as you observe, in a cylindrical roller, over which the tags of the plasters 
are attached to the two buckles placed at the lower ends of the instrument. 
Night or Bed Extension. (Fig. 3913.) 
When the short splint is used, some means must be employed for making exten- 
sion during the night, and also at other times when it is expedient for the patient to 
lie in bed. This is best effected by means of weight and pulley. To apply it, cut 
two strips of strong adhesive plaster, two or three inches wide, according to the size 
of the patient's leg, and long enough to reach from the malleoli to six or seven 
inches above the condyles of the femur. To the lower end of each strip sew a piece 
of strong webbing three or four inches long. 
"After smoothly bandaging the foot and ankle, apply the ends to which the tabs 
are attached, one just above either malleolus, and carry the strips of plaster up the 
inner and outer sides of the leg and thigh, and secure them with a roller, nicking 
the edges of the plasters to make them fit smoothly, and prevent any folding 
or creasing. 
" The proper method of fastening the plasters to the limb is to allow them to hang loose along the sides, and 
bring them in'contact with it by the successive turns of the roller, for in this way you will be much less liable to 
wrinkle them, and that is an important item. This may appear to you like an insignificant matter and hardly worthy 
of special mention ; but it is not, for a single wrinkle in the adhesive plaster may, by the irritation it will produce, 
defeat the whole plan of treatment. 
" The tabs should receive a few extra turns of the roller, over one and under the other, weaving them in, for the 
purpose of making them additionally secure. 
" When the knee is reached by the roller, always cover it1 in with the figure-of-eight turn, for the edge of a reverse 
in the bandage at this place may give rise to serious inconvenience and necessitate its entire removal. 
" When the bandage has been carried two or three inches above the condyles, the remaining portions of the plasters 
are to be reversed, and then a few more turns of the roller will, by the bandages adhering to the plaster, fix the 
dressing so that it will not easily slip. 
" The plaster should be applied cold, but when the bandage has been applied the plaster should be moulded to 
the limb by firmly squeezing it with the hands. It is also very important to secure the plaster above the condyles of 
the femur, in order that extension may be made upon the thigh and not upon the lateral ligaments of the knee-joint. 
The bandage should then be fastened, and with stitches, for it is to remain a long time. If the limb is held in the 
proper position, namely, in the line of deformity, and gentle extension maintained by an assistant, it can be prepared 
for the bed-extension and the splint, without giving the child the slightest pain whatever. 
" Next take a piece of thin board, about three inches long and two or three inches wide, and arrange across it a 
piece of tape or webbing so that it shall project three or four inches upon either side. To the ends of these tabs fasten 
buckles or buttons, that they may be attached to the ends of the tabs upon either side of the limb (Fig. 3913). 
"A simpler and more efficient method is to take a round piece of wood, three or four inches long, and having a 
groove in the centre for the attachment of the cord, and also one on each extremity to hold it in place, where it is 
buttoned into buttonholes made in the lower part of the tabs attached to the strip of adhesive plaster already fastened 640 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORT^OP/EDIC. 
DISEASES OF THE JOINTS. 
Morbus Coxarius Apparatus. Sayre's Night or Bed Extension. (Continued.) 
to the sides of the limb. To the middle of this foot-board or round stick is attached a stout cord. The object of 
the board or stick is simply to prevent the bands from making uncomfortable pressure upon the malleoli. At the foot 
of the bed a pulley is to be arranged in such manner as the ingenuity of the surgeon dictates, the cord from the foot- 
board placed upon it and a weight attached, just sufficient to make such extension as will render the patient comfort- 
able. For a weight, a bag of shot or sand is most convenient, because the amount can be very easily regulated. 
To Apply the Short Splint for Exercising. 
Fig. 4059. 
Fig. 4060. 
Fig. 4061. 
The manner of attaching the plasters for the short or thigh splint is shown above the knee. The manner of attaching 
the plasters for night or bed extension and for the long splint is shown below the knee. 
"To apply the short hip splint for extension while the patient is exercising, the limb should be prepared in the 
following manner: First cut two triangular or fan-shaped pieces of adhesive plaster, the broad extremities of which 
should be wide enough to cover about half the surface of the upper part of the thigh, and are to be slit into strips an 
inch or more in width, for the purpose of permitting a more perfect adjustment, and, also, to be reversed in detail 
over the bandage. They should be of sufficient length to reach from the knee to the groin. To the narrow ends of 
these fan-shaped pieces you will sew a piece of stout tape or webbing, something non-elastic, three or four inches in 
length, and as wide as the cylinder at the lower extremity of the instrument (Fig. 4059). 
"Next, place the instrument upon the thigh, with its jaws about three inches above the condyle, and with the 
thumb and finger grasp the limb at the point upon either side where the instrument comes in contact with it. These 
two points indicate exactly where the tabbed ends of the fan-shaped pieces of adhesive plaster are to be applied. 
" Now, having placed the tabbed extremities over these points, secure them in position with the roller-bandage by 
first making a few extra turns near the tabs, and then carry the bandage snugly and smoothly over the plaster upon 
the thigh, until the perinasum is reached, when the strips of plaster which are now floating loose are every other one 
to be reversed as the bandage goes around the thigh (see Fig. 4060), continuing the bandage at the perinasum until all 
the strips of plaster are reversed, and then the bandage is carried down the thigh until the plasters are entirely covered 
(see Fig. 4061). The effect of all this is to hold the dressing firmly in place. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
641 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS. 
Morbus Coxarius Apparatus. Sayre's Short Splint. (Continued.) 
" The thigh is now ready for the splint, and, after the shaft has been shortened as much as it can be, we will place 
it in position with the pelvic cross-bar, at the upper end, just under the crest of the ilium. 
" Now, fasten the lower extremity of the splint first, and this is done by passing the tabs around the little cylinders 
in the jaw upon either side, buckling them as high as possible, and then buckling the strap that passes behind the thigh. 
Next buckle the perineal bands, drawing them snugly but not too tightly, and see that the smooth side is next to the 
skin. It is well, also, to lay a piece of old linen in the groin, under the bands, to protect the parts from pressure, and 
also to absorb the moisture commonly present in this region. The neglect of these little points often gives the patient 
and the surgeon a good deal of annoyance. 
" The instrument now being in position, the nice adjustment of extension is made by means of the key. In this 
way the exact amount of extension necessary can be applied, and is to be regulated by the following rule: Apply suffi- 
cient extension, so that when a sharp, sudden concussion is made from the knee, or the heel when the limb is straight, 
it will cause no pain whatever; that is all the extension required, and the patient's face is to be our guide in deciding 
when a sufficient amount has been obtained. More extension than this may give rise to an obstruction of the circula- 
tion and do much harm. At night, and at such other times as deemed necessary, the patient is placed in bed and the 
bed-extension adjusted before the splint is removed or shortened. So, also, whenever the patient wishes to get up, we 
apply the instrument and lengthen the shaft, that is, make extension, before the bed-extension is removed. 
" If the patient is a small child, he may be permitted to wear the splint without using crutches. If the patient be 
of much size, crutches will be necessary, for the plaster is only intended to retain the instrument in position and main- 
tain sufficient extension to relieve the joint from all pressure, but not to support the weight of the body if the child is 
heavy. If, after the application of the splint, the patient suffers pain, it is evidence that the splint has not been pro- 
perly adjusted, and it should be carefully examined, for it may be that the plasters have yielded somewhat so as to 
permit pressure upon the joint. If so, it can be easily remedied by giving a little more extension with the key. Now 
the patient is in a condition to receive the constitutional treatment so necessary in his case, which consists of beef, 
milk, bread-and-butter, &c., but, above all, plenty of sunlight and pure air. The apparently trivial points which I wish 
you especially to remember (for they are really important, and neglect to observe them has many times brought the 
instrument into disrepute) are the following: 
"1. Always shorten the shaft before applying or removing the instrument. 2. See that the jaws are tightly buckled, 
so that they will not be crowded down, and press upon the condyles. 3. Do not, as I have seen done, tuck the tab 
between the roller and the buckle. 4. Do not buckle the perineal bands too tightly, for in that manner you may ob- 
struct the femoral vessels ; but make the extension with the key, which tightens the band by crowding it upward, rather 
than by girdling the limb. There is a point with reference to the sound limb that must be mentioned : when the long 
splint is worn, have the sole of the boot or shoe worn upon that side made extra thick, for the purpose of equalizing 
the length of the two limbs. 
" Finally, it will be noticed that the knee is left to move as freely as it may. I can see no propriety whatever in 
restraining the movements of this joint in cases of hip-joint disease in its earlier stages, when the thigh is long enough 
to permit the application of the short splint. There may be other circumstances when it becomes necessary to give 
the knee support, &c., where the long splint should be employed and the movements of the knee-joint restrained. 
But all such considerations being set aside, there is no reason why unrestricted motion at the knee may not be per- 
mitted. It was designed that the motions of the joints should be free, and no harm will attend this freedom of 
motion, unless the joint itself becomes the seat of disease ; but, on the contrary, restraint will give rise to more or 
less anchylosis and deformity. 
" I resort to the use of the short splint as early as possible, in order that the patient may have the benefit of exercise 
in the open air. It sometimes happens that it cannot be applied by reason of abscesses, or some other cause. In such 
cases the bed with extension may be arranged upon some light wagon or wheel-chair, so that the patient can be carried 
out of doors, and placed as far as possible under the influence of good hygienic conditions. In such cases,'however, 
I more commonly employ the long splint, which is a modification of that devised by Dr. C. F. Taylor."-"Ortho- 
paedic Surgery and Diseases of the Joints." Lewis A. Sayre, M. D. 
i. Name of patient. 
2. General appearance of patient. 
3. Circumference of body, between crest of 
ilium and trochanter major, . . . Inches. 
4. Distance from same point to the centre 
of knee-joint, " 
Directions for Ordering Sayre's Short Splints for Morbus Coxarius. 
5. Circumference of thigh, two inches above 
knee-joint, Inches. 
6. Circumference of middle of thigh, . . " 
7. Mention if for right or left hip. 
8. Sayre's improved short splint. 642 
GEORGE TIEMANN & SURGICAL CO.'S INSTRUMENTS. 
O^THOp^DIC. 
DISEASES OF THE JOINTS 
Morbus Coxarius Apparatus. Sayre's Long Splint. 
" This splint differs from the short one in the following particulars : In the first place, it extends the entire length 
of the limb, receives the weight of the body at a cross-bar under the foot, has an iron girdle nearly encircling the pel- 
vis and two perineal straps. The long bar, reaching from the pelvis to the bottom of the foot, is hollow, and has an- 
other running inside of it furnished with a ratchet and key, by which we make extension, and is locked in the same way 
as upon the short splint. The cross-bar at the bottom of the splint is covered with leather, and a strong leather strap 
passes beneath two iron rods, just above the cross-bar, to which are attached the tabs from the adhesive plaster upon the 
leg. This completes the attachments 
at the lower portion of the instrument 
for making extension. There is also a 
knee pad, which is attached to the bar 
running along the outer side of the limb 
in such a manner that it can be moved 
up and down to any point desired. 
"An additional means for applying 
elastic force is attached to the posterior 
part of the instrument, which is to be used 
in cases when the thigh is strongly 
flexed. It consists of an elastic band, 
which is attached above the knee, runs 
along the back of the thigh, and is se- 
cured to the posterior portion of the pelvis-belt. 
This band can be made tighter as occasion may 
require, for the purpose of extending the limb, and 
should be elastic, for the purpose of keeping up a 
constant tractile force, and at the same time al- 
lowing flexion when the patient wishes to sit 
down. A non-elastic strap, as used by Taylor, prevents 
any motion whatever at the hip and simply anchyloses 
the joint. 
" The improvements are: The long rod is attached 
to a round revolving plate, which is fastened to the pel- 
vic band; when this plate is moved upon its axis, the long 
rod moves forward and backward. At the top of this 
plate another joint permits the rod to move from and 
towards the other leg. A screw turns in and out of the 
revolving plate, so that when the key is applied and the screw turned abduction is made. The long rod is divided into 
two parts, the lower holds an endless screw transversely, which is worked by a key, and rotation thus produced. 
"As a matter of comfort to patients, these long splints are also used with joints at the knee, in slight cases of 
disease, or when convalescence has definitely set in. These joints are sometimes made with coiled springs at the knee, 
by which, when the leg is bent backward and the power relaxed, it will spring forward involuntarily. 
"The limb is prepared for the long splint in the following manner: Cut two strips of strong moleskin adhesive 
plaster from two to four inches wide, according to the size of the limb, and long enough to reach its entire length, and 
divide the upper extremity of the plaster into narrow strips for a distance of two or three inches. Pieces of strong 
webbing, one or two inches in length, with buckles attached, are sewed to the lower extremities of the plasters. These 
plasters are then placed on either side of the leg in such a manner as to leave the buckles a little above the ankle-joint, 
and then so secured by a snugly adjusted roller as to leave the tabs with the buckles attached hanging loose. The 
roller is then carried up over the knee, and as far up the thigh as can be done with convenience, when the upper split 
ends of the strips of plaster are reversed and braided in with the roller as it returns down the thigh, securing it 
smoothly. The stocking is then pulled up on the foot, holes having been cut on either side for the buckles to pass 
through and the shoe applied with holes cut through it in the same way. 
" The limb now being prepared, the instrument is placed on its outer side, and the cross-barat the bottom brought 
in front of the heel of the shoe, and securely buckled to the tabs above described. The pelvis belt is next brought 
around the hips and secured by the buckle upon the opposite side, and the perineal bands are next attached as firmly 
as may be. The knee-pad band is then slipped up or down until it is made to rest opposite the knee, when it is passed 
around the leg and buckled. Extension is now made with the key upon the ratchet until free compression is borne 
Fig. 4062. 
Sayre's Long Splint. 
Fig. 4063.-Sayre's Long Splint, with 
socket, to allow shoe to be detached. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
643 
ORTHOp/EDie. 
DISEASES OF THE JOINTS 
Morbus Coxarius Apparatus. Sayre's Long Splint. (Continued.) 
without pain and the patient can walk without cane or crutch. If the limb is adducted the abducting screw can be 
used, daily increasing the tension, for the purpose of abducting the limb. 
" If the limb be strongly inverted, the eversion-screw can be used, the force being gradually applied for the pur- 
pose of rotating the foot outward ; and, if the thigh is strongly flexed, the force exerted by the elastic band upon the 
posterior part of the splint can be applied for the purpose of producing extension. 
" In case you are not able to obtain either a short or a long splint, it is possible to treat the case successfully by 
means of the bed-extension alone. Another method is, in addition to the bed-extension, to make extension by increas- 
ing the weight of the shoe worn upon the foot of the affected limb, and permitting the patient to go about on crutches. 
This can be done by running lead into the sole of the shoe. In such a case you will be obliged to increase the length 
of the sound shoe by making the sole of this shoe considerably thicker than the other. In this manner the patient can 
be up and around a portion of the time-sufficient, at least, to relieve him from the bad influence of continued con- 
finement in bed. These are methods which may be resorted to until proper splints can be obtained."-"Orthopaedic 
Surgery and Diseases of the Joints." Lewis A. Sayre. 
Directions for Ordering Sayre's Long Splint for Morbus Coxarius. 
1. Sayre's Long Splint, Fig. 4062 or 4063? 
2. Patient's name ? 
3. General appearance of patient, estimated weight? 
4. Length from sole of foot to crest of ilium, Inches. 
5. Circumference of pelvis, " 
6. Right or left leg? 
If you wish us to furnish shoes, send the following 
additional measurements: 
a. Length of sole of foot, Inches 
b. Circumference of ball of foot, ... " 
c. Circumference of instep, " 
<7. Circumference above ankle, .... " 
The splint known at the present day by the name of Taylor's splint (as shown 
in Fig. 4064) is a modification of his original model, the improvements having 
been suggested from time to time by various orthopaedists. It is very like to the 
long splint of Sayre, except that with this (Taylor's) rotation cannot be produced. 
" In the Boston Medical and Surgical Journal, for March 6th, 187g, may 
be found a very fair enunciation of this gentleman's (Dr. Taylor's) principles 
concerning the 'mechanical treatment of disease of the hip-joint.' The two 
following propositions form the key-notes to his practice : 
"1st. All organs, while in a state of disease, require rest from the performance 
of their functions in the direct ratio of the amount, quality and intensity of the 
abnormal movements. 2d. What is rest for an organ in one condition is not 
necessarily rest for it in another condition ; that is to say, an organ, in a certain 
degree of progressive inflammation, presents conditions essentially different from 
the same organ in the same relative degree of inflammation in the ^-progressive 
stage. 
"What he understands by the so-called ' mechanical treatment' is the work- 
ing out to practical conclusions the indications which the above propositions 
furnish. He aims, in the first place, to overcome contracted muscles by exten- 
sion and counter-extension. The splint is applied in the line of deformity, and, 
with weight and pulley fastened to the lower end of the splint, the traction is made. 
" The patient, however, is placed on an inclined plane, with conveniences 
for adapting the angle to the amount of relaxation gained. The force exerteji is 
the extending power of the splint, plus that of the weight, and varies according 
to the amount required to bring about relaxation-usually from ten to seventy 
pounds. The recumbent posture is maintained from one to four or five weeks. 
In addition to the improvement in posttie gained, this preliminary treatment, 
he claims, ' relieves nervous depression, gives time for the patient to accom- 
modate himself to the novel situation, enables us to save the amount of his 
weight from the perineal straps, and by that amount increase extension and 
hasten the effects of treatment."-" Diseases of the Hip." Gibney. 1884. 
Measurements requiifod same as for Sayre's Long Splints (Figs. 4062, 4063). 
Fig. 4064. 
Taylor's Long Splint. 644 
GEORGE TIEMANN <fc CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS. 
Fig. 4065. 
Shaffer's Hip Splint. 
Morbus Coxarius Apparatus. 
" With the Taylor-Sayre splint it is easy to produce and maintain extension when 
the patient sits or lies down-but, the moment he commences to walk, the foot approxi- 
mates the foot piece-the lower extension straps become loose, and the patient is able 
to swing the limb backward and forward to a very considerable extent. But when the 
weight is again thrown upon the sound limb, extension again occurs. 
" In this instrument, the usual cylinder and pelvic band are employed. But, instead 
of continuing the extension rod to and below the foot, as in the Taylor-Sayre instrument, 
it is made to terminate at a point about inches above the malleoli, and a band is 
attached which passes half way around the limb, posteriorly. To this band are riveted 
two straps, which are attached to the adhesive plaster buckles. The foot piece has an 
independent rod, which passes upward to a piston arrangement above the point of exit of 
the extension rod. When applied, and the weight of the body is thrown upon the peri- 
neal pads, the instrument shortens, by a compression of the spiral spring. In other 
words, the lower part moves upward and the weight of the body is expended in shorten- 
ing the spring-the straps remaining taut all the while. The same degree of extension 
is exerted upon the diseased hip-joint, whether the patient lies down or walks. Trac- 
tion is constantly maintained, and the joint surfaces are not alternately protected and 
then exposed at every step. The spring, of course, acts automatically, and, so soon as 
the foot piece is removed from the ground the instrument lengthens, and is again ready 
to receive the weight of the patient."-Newton M. Shaffer, M. D. 
I. Right or left leg? 
2. Shaffer's Hip Splint 
3. Length from just below the anterior superior spine of ilium to 
a point 11 inches above the external malleolus, Inches. 
4. Length from the same point to inches below sole of foot, . . " 
5. Circumference of body between crest of ilium and trochanter major, " 
Measurements Required. 
Fig. 4066. 
Washburn's Splint. 
Washburn's splint is a simple, straight bar of steel, jointed to a 
pelvic band. It is intended for poor patients, and has neither racks, 
pinions nor screws. Extension is made, after fastening the lower 
end with adhesive strips, simply by the degree of tensity to which the 
perineal straps are adjusted. A knee-cap assists in keeping the splint 
in place. 
Fig. 4067. 
Bauer's-Andrew's 
Splint. 
Directions for Measurement for Fig. 4066. 
1. Length from ankle to dorsum ili, Inches, 
2. Circumference of pelvis, " 
3. Right or left leg ? 
Bauer's-Andrew's splint affords extension in a vertical line, and 
complete immobility of the joint. By being fastened to the shoe it 
utilizes the foot for extension, the tuber ischii for counter extension, 
and the key rack and pinion for a moving power. No adhesive strips 
are used with this apparatus. 
Directions for Measurement for Fig. 4067. 
i. Right or left leg? Inches. 
2. Length from the sole to the tuber ischii (sound leg), " 
3. Length from the sole to the tuber ischii (diseased leg), " 
4. Circumference of calf, " 
5. Circumference of thigh, " 
6. Measure for shoes as directed on page 643. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
645 
ORTHOPEDIC. 
DISEASES OF THE JOINTS. 
Morbus Coxarius Apparatus. 
Fig. 4068. 
Stephen Smith's 
Hip Splint. 
Hutchisons apparatus is portable, and, being 
fastened to a shoe, needs no adhesive strips. Two rods 
of steel extend from the foot to the upper third of the 
thigh and are secured to the leg with calf and thigh 
bands. The outside rod, longer than the other one, is 
ratched, and slides in a steel tube which is hinged by a 
ball and socket joint to a pelvic band. To this pelvic band is 
attached a perineal strap for counter extension. Extension is 
made by working the splint with a key. The splint is provided 
with joints for the ankle and knee, the latter one is adjustable 
to any degree of flexion and extension, and may be fixed at any 
point, or its motion limited, by an arrangement of a screw and 
two nuts. 
Fig. 4069. 
Hutchison's Hip Splint. 
Directions for Measurement for Hutchison's Hip Splint. 
I. Right or left leg ? 
2. Length from sole of foot to ankle-joint, . . . Inches. 
3. Length from sole of foot to knee-joint, . . . 
4. Length from sole of foot to trochanter major, 
5. Length from sole of foot to crest of ilium, 
6. Circumference of calf, 
7. Circumference of thigh " 
8. Circumference of pelvis " 
Fig. 4070.-Dr. Duncan Eve's (Nashville, Tenn.) Leg Extension Brace, 
with Rotating Joint under the Knee. 
If you wish us to furnish shoes, send the following additional 
measurements: 
a. Length of foot, Inches. 
b. Circumference of ball of foot, 
c. Circumference of instep, " 
d. Circumference of ankle, " 
Stephen Smith's hip splint (Fig. 4068) makes extension by means of adhesive plaster 
applied to the leg and attached by buckles to the two ends of the leather strap fastened 
to the foot-piece ; counter extension is made by means of the two perineal pads, fastened 
to the pelvic band with straps and buckles. At the knee-joint is a movable cross-piece 
for attaching a leather cap to steady and support the knee. At the bottom is a leather 
foot-piece to prevent jar in walking. The splint is applied in the same manner as a 
Sayre splint. Measurements required same as for Fig. 4064. 
Eve's apparatus is portable, and, being fastened to a shoe, needs no adhesive strips. 
The splint is provided with joints for the ankle. Rods of steel extend from the foot on each 
side of the leg, and are reflected back of the knee-joint, connecting by means of a joint 
to other rods running up the internal and external aspect of the thigh ; these are secured 
to the limb with calf and thigh bands. The outside rod is hinged by a ball and socket 
joint to a pelvic band. To this pelvic band are attached two perineal straps for counter 
extension. Extension is made by means of a rack and pinion moved by a key. A knee- 
cap, adjusted to buttons on the lateral shafts, exerts pressure on the patella. An elastic 
strap, buttoned on the semi-circular steel bands covering the thigh and calf bands, con- 
trols the degree of extension of the leg. 646 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS. 
Morbus Coxarius Apparatus. 
Fig. 4071. 
Thomas Posterior Splint. 
" btiff joints are not the result of too long confinement in an immovable apparatus, but 
rather are caused by permitting movement too soon, that is, before all inflammation has 
subsided. It matters not from what causes these affections arise, whether from an injury, 
rheumatic attack, or a constitutional defect, the main thing needful is that the joint be 
mechanically fixed. 
" The patient being placed in the machine, a strap and buckle close the upper circle 
around the chest, and the limb is bound with flannel from the calf upwards beyond the small 
crescent. It is advisable that the sufferer should be confined to bed for a short period at 
the commencement of the treatment, until the night pains and disturbed sleep have ceased. 
This is the first stage of the mechanical treatment. Prescribing for the general health is 
occasionally required ; the surgeon being satisfied that suppuration has been avoided. 
" Now comes the second stage. The patient is allowed to go about with the assistance 
of crutches, the frame continued, and an iron patten placed under the shoe of the sound 
limb. These must be continued until the limb is well atrophied around the great trochanter. 
"We now come to the third stage. The patient takes off the framework in bed and 
replaces it during the day, still using the crutch and patten for a certain period. 
"We now arrive at the fourth stage. The patient discards totally the frame, and uses 
the crutch and patten only. These he sets aside after the surgeon is well satisfied of the 
permanence of the cure. If the case does not progress to the surgeon's satisfaction, some 
of these stages must be prolonged. 
" The weight of the limb is equal to reducing any angular deformity of the lower ex- 
tremity, and capable also, in a slight degree, of diminishing any shortening, should absorb- 
tion of the head of the bone occur-provided a suitable mechanical arrangement is applied. 
" The splint ought to be applied at once, whatever the stage of the disease. Forcible flexion, extension, tenotomy, 
or chloroform, &c., are to be avoided as injurious. Even should the deformity be an extreme one, no violence must 
be attempted ; the limb must be gently persuaded to come back from the erring position, and as the limb assents, the 
bent of the hip instrument should be altered towards the normal lines. 
" The patient (nude) stands on the sound limb ; a book or block is then placed under the sole of the diseased one, 
resting the foot on it. If the spine is then straight, he is ready to have the contour of the sound limb taken. If the 
spine is not of normal line, then add another or several blocks, until the unsound limb is raised sufficiently to allow 
the spine to resume its natural condition. Now take a long flat piece of iron, one inch by a quarter for an adult, and 
three-quarters of an inch by a quarter for children, and long enough to extend from the lower angle of the shoulder 
blade in a perpendicular line downwards over the lumbar region, across the pelvis slightly external to the posterior 
superior spinous process of ilium and the prominence of the buttock, along the course of the sciatic nerve to a point 
slightly internal to the centre of the extremity of the calf of the leg. The iron must be carefully modelled to this 
track to avoid excoriations, which would otherwise trouble the patient during treatment. This iron forms the upright 
portion seen in Fig. 4071. It is also very necessary that this upright should come below the knee, to enable the sur- 
geon to fix this joint, otherwise the patient would flex the knee, and raising the leg as a lever would strain the hip-joint. 
" Then measure around the chest a little below the axilla, deducting, in the case of an adult, three inches from the 
chest circumference. This latter will be the measure for the upper cross-piece, which is made of hoop iron, one and 
a half inch by one-eighth of an inch. The hoop iron is firmly jointed with a rivet to the top of the upright. At one- 
third of its length from the end next to the diseased side-the upper ring is modelled to the outline of the trunk-it is 
oval in shape, which is important, otherwise the machine will rotate from its position behind the body, also inversion 
of the limb will occur. Another strap of hoop iron, five-sixteenths of an inch by one-eighth of an inch, and in length 
half the circumference of the thigh, is fastened to the upright, at a position from one to two inches below the fold of 
the buttock (Fig. 4071), according to the age of the patient; then another piece of metal of like strength equal to half 
the circumference of the leg at the calf is firmly riveted to the lower extremity of the upright. The short portion of 
the top half circle is next to the diseased side, while the long portion must be closely fitted to the sound side. In 
my earlier experience the upper crescent embraced the pelvis instead of the chest, but I found it very inefficient, diffi- 
cult of application, and painful to wear. The instrument is now ready to be phdded and covered. 
" However correctly it may have been modelled, it will often occur that some slight alteration will be demanded 
when it comes to be applied to the patient, either on the first day, or at some period during the progress of the case."- 
"Diseases of the Hip, Knee and Ankle Joints." Hugh Owen Thomas. 
How to make Thomas' Hip Splint. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
647 
ORTHOf/EDIC. 
DISEASES OF THE JOINTS. 
Fig. 4072. 
Hutchison's Extension. 
Morbus Coxarius Apparatus. 
"With this apparatus (Fig. 4072) extension is made 
by the weight of the suspended limb, which is equal 
in weight to one-fifth of the whole body, is greater 
than the weight ordinarily employed for extension, 
and is quite sufficient to subdue the spasm of the 
muscles which crowd the head of the bone into the 
inflamed acetabulum, and is the chief cause of the 
pain which the patient experiences. To the shoe of 
the sound limb a steel plate corresponding to the 
sole of the shoe is attached by upright rods two and 
a half inches in length, so as to raise the foot from 
the ground ; it is the shoe ordinarily used for short- 
ened leg. This elevated shoe and a pair of crutches 
constitute the apparatus. As the patient stands on 
his crutches the diseased limb is suspended."-"Pro- 
ceedings of the Medical Society of the County of 
Kings," April, 1879. J. H. Hutchison, M. D. 
Fig. 4073. 
Wyeth's Combination Method 
Wyeth's Combination Method, 
" Since in all cases some time must elapse be- 
tween the discovery of the lesion and the pre- 
paration of the mechanical apparatus, it is a wise 
practice to put the patient to bed at once, and 
apply the extension as follows : Cut two strips 
of moleskin plaster, from one inch and a half 
to two inches wide, and long enough to extend 
from six inches above the trochanter to below the sole of the foot. Adjust one to the outer and one to the inner 
aspect of the thigh, allowing the upper end, which is to be doubled back upon itself and woven in with the roller, to 
extend four or five inches above the level of the trochanters. Mould them carefully to the contour of the limb, bring- 
ing the strips exactly over the inner and outer condyles of the femur, and hold them by a well-adjusted bandage, 
beginning from above. In order to prevent the plaster from wrinkling, it is necessary to clip it at intervals of an inch 
or two, with scissors, obliquely upwards from each edge. The strips should be made to adhere to the skin to within 
six inches of the malleoli, not so much that traction below the knee is necessary, but because the complete extension 
of the leg and thigh enforces more perfect quiet. The bandage is commenced just at the level of the great trochanter, 
and that portion of the strips which extends above this is to be turned down and worked in with the roller. That part 
of the plaster which is exposed near the foot should be doubled by laying a second strip of equal width on this, the ad- 
hesive surfaces coming together. In this way it is not only strengthened, but is prevented from sticking to the dressing. 
" The extension weight-varying from two to seven or eight pounds-is applied as in Buck's apparatus (page 583). 
The dorsal decubitus should be maintained, for, if the sitting posture is assumed, the iliacus and psoas muscles are not 
materially affected by the extension. To secure this result the long splint of Hamilton should be applied from the 
axilla along the thigh and leg, and firmly secured by a bandage carried around the chest, pelvis and thigh. 
"As soon as the thigh is fully extended a Sayre's long splint (Fig. 4063) should be adjusted, and the high shoe and 
crutches of Hutchison's. The lower end of the rod of Sayre's splint is turned at an angle of 900 to the shaft, and 
fitted with a spring catch into a socket on the sole of the shoe. In applying the instrument, shorten the shaft as much 
as possible, fasten the belt around the pelvis just above the trochanters, and then the perineal bands, one on either 
side. The shoe is put on, the spring-catch fixed in the socket at the sole, and the knee-pad buckled. The shaft of the 
instrument is now lengthened by the key until a fair and comfortable degree of extension is secured. 
" The shoe upon the foot of the sound side should be raised from one inch to one inch and a half, and the patient 
made to walk about on crutches. Upon retiring for the night the extension employed at first should be resumed. 
This, the combination method, is shown in Fig. 4073. The advantages of this plan of treatment are : 1. The patient 
is able to move about and obtain the benefit of out-door life, while the hip is held in extension and practically im- 
movable ; 2. The high shoe and crutches hold the lame foot and leg suspended ; 3. In case of a fall, the splint 
prevents concussion in the joint; 4. The night extension prevents spasmodic contraction of the muscles and pain from 
unguarded movements during sleep."-" Text-Book on Surgery." Wyeth. 648 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
ORTHOP/EDiC. 
DISEASES OF THE JOINTS 
Fig. 4074.-Stillman's Sector Splint. 
Morbus Coxarius Apparatus, 
"The sector may be inserted into any form of brace attachment 
known. But when it is desired that the splint should remain upon 
the limb for any length of time, or, as in acute inflammation of joints, 
where it is used to reduce the contractile antagonism of the muscles, I 
prefer to use it in the form of a bracket, which is to be attached to 
the affected part by some immovable dressing which will be suffi- 
ciently inflexible to prevent unequal pressure upon the soft parts. 
".The sector bracket consists of two terminal plates of thin copper, 
perforated upon the upper side, connected with each other by a bridge 
raised to any desired distance from the surface. This bridge consists of 
two over-riding slotted steel strips, and is connected by three clamps 
which may be either thumb-screws or key-clamps. 
" This splint is capable of the following combination without re- 
moval from the limb : I. Extension at any angle with motion ; 2. Ex- 
tension at any angle with fixation ; 3. Fixation at any angle ; 
4. Motion, complete or limited; constant or occasional; 5. Exposure 
of surface about the joint, admitting compression, applications and 
easy inspection."-Chas. F. Stillman, M. D. 
Fig. 4075 shows a hip brace provided, first, with a back frame ; 
second, with sector at the hip ; third, with a clamp above the sector for 
fixing the angles of abduction and adduction, and one below for fixing 
the angle of rotation. These are changed by the wrench shown in the 
illustration. The sector is operated by thumb-screws, and is provided 
with a removable clamp by which motion in the hip may be limited to 
any given arc. Two pieces of moleskin plaster with webbings attached 
are placed on the thigh, as in applying Sayre's brace. 
To apply the brace, the clamps 
and straps are all loosened and the 
extension ratchets shortened as much 
as possible. The pelvic band is then 
fastened around the pelvis and the 
two perineal bands buckled tightly 
in place. The shoulder straps and 
abdominal band are then buckled, 
so as to secure the back frame tight- 
ly against the back. The thigh is 
next to be attached, the webbing 
tabs are to be passed over the rollers 
at the end of the brace and buckled 
tightly, the girths around the thigh 
having been previously buckled. 
Traction may now be exerted, 
either under chloroform, which is 
the better, or gradually by the hand 
until the limb is in the position de- 
sired, when the clamps are light- 
ened, thus fastening the thigh on 
the pelvis. Extension is now to be 
exerted by the key. The addition 
of the high heeled shoe on the 
sound limb, and a pair of crutches 
(Hutchison's physiological method) 
completes the outfit. 
Fig. 4075. 
Stillman's Hip Brace, No. 1. 
Fig. 4076.-Stillman's Hip Brace, No. 2. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
649 
ORTHOJ^EDIG. 
DISEASES OF THE JOINTS. 
Morbus Coxarius Apparatus. 
" Fig. 4076 illustrates a form of brace which the writer uses to advantage, and in which the posterior pad is a promi- 
nent feature. This affords sufficient leverage behind the joint to overcome flexion and avoid lordosis without the use 
of the back frame. In this brace the extension is produced by an elastic ratchet, in addition to that produced over 
the joint by the sector mechanism. The splint is extended to the ankle and secured by adhesive plaster strips."- 
Chas. F. Stillman, M.D., in Medical Record, June 14, 1884. 
" This instrument consists of a pelvic and a femoral segment. The former is 
made of very thin sheet steel or copper, covered with leather on the outside and 
thoroughly upholstered on the inside. It is broad, and, to secure a good fit, is 
fashioned over a plaster cast of the patient's pelvis. The femoral segment is 
composed of two compound side bars with elastic attachments and a broad 
metallic band which encircles the thigh above the knee. 
" The expanded margins of one of the side bars have been turned over, so as 
to form a shell through which the other bar slides. The upper end of this shell 
is converted into a loop which completely closes over the sliding bar, and upon 
this a brass pin is soldered. The lower end of the other bar (sliding within the 
first) is likewise provided with a pin. Any force which brings these two pins 
nearer together must of necessity lengthen the instrument, and consequently 
exert a tractile force upon the limb to which it is attached. In order to make 
this tractile force elastic (like manual traction) a narrow strip of strong elastic 
webbing is buttoned to the brass pin, at A. To the pin, B, at the opposing end 
of the other bar, a buckle is attached. 
" The instrument having been applied and secured in position by means of 
adhesive plaster and roller bandages, with the brass pins at the greatest possible 
distance apart, we can, by means of the elastic webbing and buckle, exert any 
amount of continuous elastic force. In this way the traction force is graduated. 
The distal ends of the bars with expanded margins are attached to a metallic 
ring which encircles the thigh just above the knee. By means of strips of strong 
adhesive plaster, placed longitudinally around the thigh, the lower ends turned 
up over it, the band is retained in position. It is further secured by a roller ban- 
dage and thus prevented from being pushed down over the knee when traction is 
made as above described. 
"A simple hinge-joint connects the outer side-bar with the pelvic segment. 
Passing over this joint in front is a semi-circular rod .upon which a coiled steel 
spring is placed, the action of which is to oppose flexion of the thigh on the ab- 
domen. An adjustable nut on the curved rod furnishes the surgeon with the means of exercising his discretion as to 
how much motion at the joint shall be permitted. A ball-and-socket joint connects the proximal end of the inner side- 
bar with an upholstered perineal saddle, which latter device is connected with the pelvic segment by means of two 
straps, one passing up anteriorly, the other posteriorly. A perineal strap on the unaffected side passes to the pelvic 
segment in front and behind. These two joints permit of the movements of flexion, and extension at the hip, during 
locomotion, and in changing from the standing to the sitting posture or the reverse." 
Dr. Roberts advises the short splint only in cases where convalescence is in progress ; the patient having a long 
thigh to which the instrument can readily be attached. 
Fig. 4077.-Roberts' Short Splint. 
Roberts' Long Splint (Fig. 4078). 
" The same principles of treatment can be enforced and greater supporting power afforded by the long splint. This 
consists of four segments which respectively correspond to the pelvis, thigh, leg and foot. The pelvic and femoral 
segments are identical in construction with the corresponding parts in the short splint, excepting that a ratchet clamp 
joint, as introduced by Dr. Stillman, permits of rotation. Like the short splint, this instrument is constructed to 
exert elastic linear traction. The segments corresponding to the thigh and leg are both provided with compound or 
sliding side bars, pins and elastic straps. A universal joint connects the inner lateral shaft with the upholstered peri- 
neal saddle. From the lateral bars of the splint, just below the knee, projects anteriorly a semi-circular piece. 
Attached to the middle of this is an adjustable metallic arm projecting downwards in a line with the spine of the 
tibia. From this arm, as a fixed point, there extends a broad elastic band around the leg behind the head of the 
tibia, which serves to keep the instrument constantly in the same relative position to the limb. From the semi- 650 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPEDIC. 
DISEASES OF THE JOINTS. 
Morbus Coxarius Apparatus. 
circular piece on either side, at the points of its attachment to the lateral shaft of the splint, project directly forward 
metallic levers curved upward. To these levers are attached strong strips of elastic webbing which pass upward to the 
pins. These elastic straps are designed to supplement the function of the quadruceps extensor muscle. 
"At the junction of the leg with the foot segment, a French joint permits of their easy 
disarticulation, a matter of convenience in applying the splint. In the application of the 
instrument, long and broad strips of adhesive plaster are used in precisely the same man- 
ner as in the application of a Sayre splint, the lower ends tipped with non-elastic web- 
bing passing through buckles attached to the shoe on either side. The shoes should fit the 
feet well, be made to lace, and should be provided with a low broad heel of soft rubber."- 
"Fundamental Principles of Mechanico-Therapy in Hip Disease." Dr. M. J. Roberts. 
Fig. 4078. 
Roberts' Long Splint. 
" The splint devised by Dr. Willard, of Phila- 
delphia, has a single joint opposite the articulation, 
so that the patient can sit down with comfort. It is 
made of leather, moulded wet over a cast. After it 
has set and thoroughly dried, the pelvic and thigh 
portions are separated, and connected again by a 
joint attached to two spreading steel arms, as seen 
in Fig. 4079. A mortise or slot is made in the thigh 
section, and into this slot fits a bolt with a knob or 
head, by means of which it can be worked through 
one's clothing. It is only a fixed apparatus when the 
patient is standing and when the bolt fits into the 
slot. Dr. Willard says it is applicable to a limited 
number of cases, i. e., those in which the inflamma- 
tory symptoms are not acute. It is always used 
in connection with crutches and a high shoe."- 
"Diseases of the Hip." Gibney. 
Fig. 4079.-Willard's Splint. 
"Sayre's cuirass is an apparatus which will secure absolute rest and a proper position 
for a length of time. It is a modification of Bonnet's grand appareil, and consists of a 
strong wire netting, well padded inside. 
" The cuirass being properly prepared, the patient is laid in it so that the anus is oppo- 
site the opening, and free from any possibility of obstruction, when the well leg is first to be 
dressed. This is to be done by making the leg perfectly straight and screwing up the foot- 
rest until it is brought firmly against the heel of the patient, placing a pad between the foot and the rest to absorb the 
perspiration. The instep is then well padded with cotton or a blanket, and a roller is carried firmly around it and the 
foot-rest, running up over the limb ; but, before going over the knee, a piece of pasteboard or leather or several pieces 
of folded paper, are placed over the leg, knee and thigh, and the roller carried firmly over this extemporized splint 
for the purpose of preventing the slightest bending of the knee, when the roller is carried up the entire length of the 
thigh, around the perinaeum and over the outer arm of the instrument, and several times back through the perineum, 
and then across the pelvis, by which means the well limb is made a firm counter-extending force. 
" Two strips of adhesive plaster, two to four inches in width, according to the size of the patient, are then placed 
upon either side of the operated limb, and secured with a nicely-adjusted roller over the foot and up the leg and thigh, 
as far as the abscesses on it or the wounds will permit, being careful to leave a sufficient length of the plasters at the 
lower extremity free, for the purpose of applying them to the foot-rest where extension is made. The foot-rest is then 
screwed up to meet the heel of the shortened limb, and these strips of adhesive plaster are brought down around the 
foot-rest and securely fastened. The foot-rest is then extended by the screw, slowly and gradually, at times waiting 
a few moments for the muscles to yield, which have been so long contracted, until the limb is brought down to its full 
extent. It sometimes happens that, from long contraction of the adductors and the tensor vaginae femoris, subcuta- 
neous section of those tendons and fascia will be requisite before the limb can be brought to its proper position, even 
after the head of the femur has been removed. After the limb is brought into this position a roller is carried from 
the foot over its entire surface ; a large wad of oakum is placed around the wound to absorb the discharge, and the 
Treatment after Exsection, GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
651 
ORTHOP/EDIC. 
DISEASES OF THE JOINTS. 
Morbus Coxarius Apparatus for Treatment after Exsection. 
roller is carried firmly over the wound, inner surface of the thigh, and around the pelvis. I place great importance 
upon this latter part of the dressing, as we thereby compress the tissues and prevent the burrowing of pus-the oakum, 
which has already been placed in the wound, allowing of free drainage, no matter how tightly the roller may have 
been applied. 
" Immediately after the patient is dressed in this way and has recovered from the anaesthetic, he is capable of 
being stood up against the wall, or of riding out in a carriage or boat, and can take his daily exercise in this way. 
I have, in several instances, had patients removed a long distance, some miles, in fact, within an hour of the opera- 
tion, and without the slightest inconvenience or pain. The dressing will probably not require to be changed for from 
forty-eight to sixty hours, or until secretion has been formed to moisten the dressings, when the oakum plug can be re- 
moved without haemorrhage. If this dressing does not come away easily, warm water injections will readily float it out. 
" The wound, made clean, is again filled with Peruvian balsam and dressed as before. After this it may require 
dressing once or twice a day, according to the amount of discharge ; and the child should be removed from the entire 
instrument as often as is requisite. The well leg should be removed from the wire breeches at least once a week, every 
day is better, and free movements given to all the joints, ankle, knee and hip, otherwise we may anchylose them, 
although they are not diseased. The wire cuirass should be used for from a month to two months, according to neces- 
sity, after which the patient can be put upon the long or short splint and allowed to exercise, thereby increasing his 
prospects of perfect motion in the new joint. 
" The reason for stuffing the periosteum with oakum is because we wish it to retain its proper shape, to mould the 
material thrown out for the formation of the new bone that is subsequently to bear the entire weight of the patient. 
If this precaution is taken we may have a femur nearly as well formed as the original bone, and equally as serviceable. 
" The long and short splints and the modes of their application have already been 
described, and, when the patient has recovered from the operation sufficiently to wear 
one of them, the after treatment of the case is to be continued upon the same general 
plan as that which guides us in the treatment of cases where no operation has been 
performed. 
" The wound should be kept thoroughly cleansed, and every precaution taken to 
secure a free discharge, so as to prevent the formation of abscesses in the surrounding 
tissues. When the discharge begins to cease you may commence passive motions, and 
these should be regularly and systematically resorted to ; slight, at first, but gradually 
increased as recovery goes on. 
" If this treatment is faithfully persisted in you will be able, in the majority of cases, 
to obtain a much more useful limb than nature can ever produce when she is permitted 
to effect a cure according to her own method."-" Lectures on Orthopaedic Surgery and 
Diseases of the Joints." L. A. Sayre, M. D. 
Fig. 4080. 
Sayre's Cuirass. 
I. Patient's name. 
2. Patient's age. 
3. Patient's weight. 
4. Length from sole of foot to axilla, Inches. 
5. Length from sole of foot to perinaeum, " 
6. Circumference of calf, . " 
7. Circumference of knee, " 
8. Circumference of thigh, " 
9. Circumference at the nates, " 
10. Circumference of pelvis at iliac crests, " 
11. Circumference of waist, " 
12. Circumference of chest under axillae, s< 
13. Length from top of skull to vertebra prominens, ... " 
14. Length from vertebra prominens to perinaeum 
15. Circumference of the head, " 
16. Circumference of neck, " 
Directions for Measurement. 652 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS. 
Morbus Coxarius Apparatus for Treatment after Exsection. 
Fig. 4081. 
Bauer's Wire Breeches. 
Bauer s wire breeches are used after excision of the head and neck of the 
femur in necrosis, after the removal of shattered bone, or balls in gunshot frac- 
ture, and in the treatment of chronic inflammation of the hip joint when perfect 
rest and position of the affected parts are desired. It consists of a heavy wire 
frame covered with wire gauze to fit the posterior half of the body from the axil- 
lary cavity to the sole of the foot. 
Proper sized openings may be cut through the gauze to admit of dressing any 
wounds, without being obliged to remove the splints. There is also an opening for 
the anus, so that the patient can pass his faeces by having the lower end of the 
apparatus raised and a bed-pan placed under it. The apparatus may be lined with 
cotton batting, and the patient securely fastened with adhesive plaster strips and 
roller bandages. After the feet are secured to the foot-board, extension can be made 
by turning the thumb-screws, counter extension being from the healthy extremity. 
1. Patient's name. 
2. Patient's age. 
3. Patient's weight. Inches. 
4. Length from sole of foot to axilla, 
5. Length from sole of foot to perinaeum, " 
6. Circumference of calf, " 
7. Circumference of knee, " 
8. Circumference of thigh ' 
9. Circumference at the nates, *' 
10. Circumference of waist, 
11. Circumference under axilla, " 
Directions for Measurement. 
Use of Sayre's Cuirass in cases in which, the Child, is too small for the Hip Splints to be applied. 
" I present to you to-day the case of a little child, eighteen months of age, suffering from hip joint disease in the 
second stage. On account of the small size of the child I deemed it inexpedient to attempt to apply the long hip- 
splint, and therefore directed her to be placed in the wire cuirass. When I first saw her there was an enormous 
abscess at the joint, which I believed, at that time, to be extra capsular. This was aspirated three times, in the hope 
that by this means, and by compression afterwards applied, the walls would become agglutinated and thus all further 
trouble in regard to the abscess be done away with. I gave her the benefit of the doubt in this case, in order, if pos- 
sible, to avoid an incision and the appearance of the resulting cicatrice from this treatment. It, however, was of no 
avail, the abscess still continuing to fill up. I therefore made a free incision down to the lower border of the abscess, 
by this means securing thorough evacuation of its contents ; then washing it out thoroughly and inserting a rubber 
tube I maintained perfect drainage. As I remove this dressing, you observe that the parts are now in a healthy, 
granulating condition and the limb is of normal size; perhaps somewhat smaller than the other, owing to its confine- 
ment. Having removed all dressing from the limb, I carefully lift up the cuirass at the same time that I make a 
slight traction upon it. This you must be careful to do, otherwise you will cause pain by your manipulations. As I 
now hold the leg in this position, with my other hand under the thigh, I can make quite free motion within the joint 
in all directions, without causing pain, as is shown by watching the face of the child. I see no reason, therefore, why 
we should not secure the most satisfactory results in this case and restore this child with perfect strength and motion 
in this now diseased limb. Before a year has expired I hope to be able to apply the long hip splint. 
" In relation to the wire cuirass in cases of very small children suffering from hip disease, in which the long splint 
cannot be applied, I cannot speak too highly. By means of the screws attached to the foot plate you can secure any 
amount of traction you desire, making counter traction, as is done in this case, by passing a roller bandage under the 
perineum and up over the handles of the instrument, which are midway between the thigh and shoulder. In 
this position, the anus being directly over the opening in the back of the instrument, the child can relieve its bowels 
without disturbing its position, and the parts can be cleansed by the mother without soiling the clothing or person of 
the child, the instrument at that point being covered with rubber cloth. She can, thus secured, be placed in the up- 
right position. In this position she can be placed by the window, in order to secure the benefit of the fresh air when 
the mother is not at liberty to take her out."-From a Lecture by Lewis A. Sayre, M. D. Medical News, Aug. 2, 1S84. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
653 
ORTHOP/EDIC. 
DISEASES OF THE JOINTS. 
Morbus Coxarius Apparatus. 
Fig. 4082. 
Hamilton's Splint, Front. 
Fig. 4083. 
Hamilton's Splint, Back. 
This splint consists of an iron wire frame, 
moulded to the outside or back of the pelvis 
and thigh, covered with wire gauze. It is kept 
in place by a pelvic and a broad thigh-band, 
and secured with buckles. Dr. Hamilton ad- 
vises its use whenever it is desirable to secure 
immobility of the joint, together with exercise 
in the open air. 
Directions for Measurement. 
i. Name of patient. 
2. Age of patient. 
3. Weight of patient (estimated). 
4. Right or left side. Inches. 
5. Crest of ilium to the condyles 
of the femur, " 
6. Circumference of pelvis at iliac 
crest, " 
7. Circumference at the nates, . " 
8. Circumference at upper part of 
the thigh, " 
9. Circumference of thigh above 
the knee, " 
" In order to overcome some of the difficulties in 
the management of inflammation at the hip joint, I 
have had an apparatus constructed by which I can 
keep the pelvis and affected joint fixed, and in posi- 
tion, and also apply counter-extension without pro- 
ducing excoriation of the integument at the groin. 
" The bed represented in Fig. 4084 is made of iron 
and constructed for a child six years of age. It con- 
sists of a frame base, measuring twelve inches in its 
antero-posterior-diameterand seventeen inches trans- 
versely - four iron rods are fastened perpendicularly 
to each corner. The surface on which the pelvis is 
fixed is of leather, and is arranged to slide up or 
down on the perpendicular rods, and may be fas- 
tened by the screws. Anteriorly, the leather is slit 
up about five inches, and the under surface is sup- 
plied with straps and buckles. By this contrivance the alvine evacuations may be passed without soiling the apparatus. 
The leather surface having been padded with cotton, the pelvis and affected joint are firmly bandaged thereto. Ex- 
tension is made by weight and pulley after Dr. Buck's method."-G. Wackerhagen, M, D. 
Fig. 4084.-Wackerhagen's Bed Rest, 
Sayre's Method.-" The most important element in the treatment of injuries of the knee, in the earlier stages, is 
absohite rest; no matter whether the ligaments or the synovial membrane is the part chiefly involved, or whether 
there is extravasation of blood beneath the articular cartilages or synovial membrane. You may secure such rest for 
the joint in any manner you see fit. In many instances it is, doubtless, the safer plan to carefully adjust a posterior 
splint, made of sole leather, felt, or other material, according to the convenience of the surgeon, which shall extend 
along the upper portion of the leg and lower portion of the thigh, and hold the articulation and its surroundings per- 
fectly fixed. Place the patient in bed at once and keep him there until recovery is well advanced. 
" If the ligaments are the parts chiefly affected, you will not ordinarily have much difficulty with the case. 
Sometimes simply applying a bandage around the knee will give sufficient support and secure sufficient immobility to 
KNEE JOINT APPARATUS. 654 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS 
Knee Joint Apparatus. 
Fig. 4085.-Sayre's Rubber Compressor, 
for Knee and Ankle Joint. 
meet all the indications. The posterior splint and bandage will certainly 
fulfill every indication. The joint may be kept wet with hot or cold 
water, according to which affords the greater relief to the patient. After 
a few days have elapsed, when probably most of the acute symptoms will 
have subsided, you may write for a liniment, if the patient cannot be in- 
duced in any other way to give the joint a liberal amount of hand-rub- 
bing and passive motion. These cases are usually slow in recovering and 
it may be well to communicate this fact to the patient at the beginning. 
Treatment should continue until pain and tenderness have entirely sub- 
sided. The principles of treatment are, perfect rest, hot or cold applica- 
tions, according to the feelings of the patient, and firm compression. 
Compression can be secured by means of a roller-bandage, sponge and 
bandage, or by means of a double india rubber bag. The latter is the 
best mode, especially for the knee joint. This bag can be partially filled 
with either hot or cold water, as may be indicated, and then, being dis- 
tended with air, you have even compression, with the advantage of a hot 
or cold poultice, as may be desired. 
"When, however, the synovial membrane becomes involved in the injury, either alone or associated with injury to 
the ligaments, a much more serious condition of affairs is present and will (in a majority of cases) require a more 
active plan of treatment. When the injury has been followed by effusion into the joint, next to absolute rest, elastic 
compression is the most essential element in the treatment. Place the patient in bed at once. It may be, and quite 
probably will be necessary, in a majority of cases, to make some local depletion, by means of leeches or wet cups, 
before resorting to any measures for the purpose of promoting absorption of the fluid. The necessity of local deple- 
tion, and its amount, will be decided by the vigor, general health of the patient and the degree of inflammatory action 
present, as manifested by increased heat about the joint, increased frequency of pulse, pain, and general constitutional 
disturbance. After local depletion, hot fomentations and elastic compression, secured either by means of a fine 
india rubber bandage, or by the double india rubber bag before referred to, will be of the greatest possible service. 
If absorption of the fluid does not take place rapidly under this treatment, counter-irritation may be resorted to, 
by applying blisters above and below the joint. Never apply your blisters directly over the knee joint, but apply 
them above the capsular ligament and below the ligamentum patellae. In addition, iodine ointment may be applied 
over the joint and covered with oiled silk. Neveruse iodine locally in the form of tincture. The objection to iodine 
in the form of tincture is, that it renders but little service, except when its effect as an escharotic is desired ; but, used 
in the form of an ointment, scarcely any pain is produced, no exfoliation of the cuticle follows and, therefore, 
absorption can go on, and in this manner the remedy renders continuous service. 
" When the acute symptoms have subsided, great benefit may be derived by freely shampooing the parts, slightly 
lubricated with Cosmoline, vaseline, or any substance which will permit the hand to glide over the surface freely with- 
out producing too much irritation to the skin. Friction should be applied in this manner with very great freedom for 
from twenty minutes to half an hour each sitting ; and, while one hand is made to do rubbing around the joint, the 
other hand should rub up and down upon the limb above the joint, thereby facilitating the absorption of the effused 
fluid. If the case does not yield to this treatment, and the effusion increases, so as to make tension sufficient to para- 
lyze the absorbent vessels, it may be necessary to aspirate the joint and remove all the fluid possible. In many 
instances, if only a small quantity of fluid is removed, the tension upon the absorbent vessels will be relieved to such 
an extent that the remainder may be absorbed by the means already mentioned. Sometimes, however, it happens that 
the fluid contains so much flocculent material that it cannot be removed by the aspirator. Under such circumstances 
no hesitation need be made with regard to opening the joint (with the knife) and giving free discharge to the fluid. 
If you puncture this joint in such a way as to admit air, the consequence will be very serious indeed, because decom- 
positioi} of the contents of the synovial sac will take place and you will have excessive fever and suppuration will be 
set up. I am not afraid of air, but I fear imprisoned air. Therefore, if compelled to make an opening which will 
permit the entrance of air, at once make it large enough, and in such a position, that the air can get out again. I 
wish to be distinctly understood about this matter, and I want to impress it clearly on your minds, that the success of 
the operation depends almost entirely on keeping out the air when you puncture a joint. With this precaution there 
is no danger whatever connected with it. When you have punctured the joint and are about to withdraw the canula, 
no movement whatever of the joint must be allowed to occur until it is, so to speak, hermetically sealed and locked. 
You must have, for this purpose, some plaster of Paris, leather, or starched bandage-^anything on earth, in fact, 
which will, when applied on the posterior aspect of the limb, promptly solidify and prevent the least movement. Let GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
655 
ORTJHOP/EDIC. 
DISEASES OF THE JOINTS. 
Knee Joint Apparatus. 
me also impress upon you not to allow the joint to move until the external opening is perfectly united. If you do, 
the air will be sucked into the synovial sac, in spite of your valvular subcutaneous opening. This precaution is very 
simple, but is most important for the safety of the patient. If, on puncturing the joint, you find the fluid which it 
contains has already begun to change, has become converted into pus, then, instead of leaving it with a simple punc- 
ture, make a free incision, always cutting at the most dependent part of the sac, so that there shall be no possibility 
of secretions being pocketed or otherwise retained. 
" As soon as it is discovered that reflex contractions are taking place, which, if not overcome, will terminate in the 
production of serious deformity, mechanical appliances which afford extension and counter extension must be resorted 
to, and are always required. Such reflex contractions will not only produce deformity, but will greatly aggravate the 
pain, by bringing the diseased articulating surfaces into contact. Extension and counter extension may, therefore, be 
necessary, for the relief of pain incident to muscular contractions. When extravasation of blood has taken place at 
any point beneath the articular cartilages, which can be discovered only by firm compression of the articulating sur- 
faces of the tibia and femur in all possible directions, and also upon the patella, and especially making pressure 
immediately over the insertion of the coronary ligaments,-you should immediately resort to the treatment already 
indicated, perfect rest, and firm compression with the sponge and roller bandage or double india rubber bag, after 
extension and counter extension have been applied. By use of this bag the pressure on the joint is maintained evenly 
and there is no danger of pressing the ecchymosed surfaces of bone against each other. Pressure by this means is to 
be continued until absorption of the effused blood takes place and until the patient can bear concussion of the bones, 
the tibia and femur, against each other. 
"When the disease of the joint, no matter in what particular tissue it originated, has advanced to a condition of 
suppurative disorganization of the structures, it is often attended with grave constitutional symptoms, such as sleep- 
lessness, loss of appetite, great pain and irritative fever. This condition is then generally spoken of as "white 
swelling of the knee joint." Such a condition will require a much more systematic and prolonged course of mechani- 
cal and surgical treatment than has been indicated for the prevention of this advanced stage of the disease. One 
great indication in the case now is, to place the patient in a condition such as will permit him to have all the advan- 
tages of fresh air and sunlight, and at the same time be relieved of all irritation attending the constant attrition of 
the diseased articular surfaces. It is in this particular form of the disease, therefore (inflammation of the articular 
tissues), that extension is of the utmost importance. I regard this principle as one of such moment that, were its 
practical application interfered with by participation of the tissues in the inflammatory action, I should have no hesi- 
tation in cutting them., for the tendons will heal by the time the articular surfaces have resumed a healthy condition. 
Extension is especially important here, for the reason that, even when the tendons are not inflamed, the irritation 
produced by the inflammation within the joint invariably excites reflex action. The muscles contract and thereby 
increase the compression upon the already suffering tissues within the joint, and, if continued, produce serious deformi- 
ties, according to the direction in which the predominating set of muscles are drawing. The result, when the diseased 
surfaces are left in contact, is, the pain is continuous, and the parts pressed upon undergo interstitial absorption. But, 
when you give extension to these limbs, thus locked up by disease, you will give the patient instant relief. Remem- 
ber, then, in the first place, that rest-permanent rest of the tissues involved-is an essential part of the treatment. 
In addition to rest, extension, constantly and persistently employed until the patient is cured. Besides rest and 
extension vou want compression ; but this must be employed after the two former, for compression of the joint, with- 
out first obtaining rest and extension, would aggravate the difficulty. 
" These indications are met by an instrument that I devised several years ago. (See Fig. 
4086.) This instrument should be applied the moment there is any evidence that the dis- 
ease has affected the articular structures, or reflex muscular contractions have been excited, 
which, if permitted to continue, will produce deformity. When the knee joint is filled with 
fluid, and the articular surfaces are sensitive to pressure, we should fix it in an apparatus 
which not only keeps it in a state of absolute rest, but is capable of so extending the parts 
as to remove all pressure from the articular surfaces and thus relieve pain, while it enables 
the patient to exercise in the open air and thus invigorates the general system, rendering ab- 
sorption of the effused fluid possible without resorting to aspiration or incision. As long as 
there is any hope of preserving the joint, this apparatus should be employed. The instru- 
ment consists essentially, as you see (Fig. 4086), of two sheet iron bands or collars, con- 
nected by two bars so constructed that they can be made longer or shorter as required. The 
bands are about an inch in width, have a joint behind, and slots and a pin for fastening in 
front. The hinge-joint at the posterior portion of the band that is to surround the leg is 
Fig. 4086. . 
Sayre's Knee Splint. 656 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPEDIC. 
DISEASES OF THE JOINTS. 
Knee Joint Apparatus. 
made by cutting straight across the band and then fastening the pieces in the proper manner for forming a joint. 
The hinge-joint at the posterior portion of the band that is to surround the thigh is made by cutting out a V-shaped 
piece and then fastening the pieces in the proper manner for forming a joint. This V-shaped piece is removed, for 
the purpose of securing a smaller circle at the lower edge of the band than at the upper, which will better adapt it to 
the natural tapering shape of the thigh. The band which surrounds the leg should be immovably attached to the side 
bars. The band which surrounds the thigh should be attached to the side bars in such a manner (by a single rivet or 
hinge) that it can be tilted about at pleasure, which permits the use of the instrument when the leg is flexed upon the 
thigh at a slight angle. The bars which connect these bands or collars are divided into two pieces, one of which carries 
the cog and the other the ratchet, by means of which extension is to be made. The ratchet is moved by means of a 
key, and in this manner any amount of extension desired can be readily obtained. 
" So much for the description of the instrument, and now we come to the method of its application: In the first 
place, if the limb is much distorted, the leg flexed upon the thigh and perhaps the tibia partially luxated backward, as 
illustrated in Fig. 4087, exten- 
sion must be made, while the 
patient is in bed, until the limb 
is brought to nearly a straight 
position, before the instrument 
is applied. 
" Such extension, previous 
to the application of the in- 
strument, must be made in two 
directions: 1. From the foot 
and lower portion of the tibia, 
by means of weight and pulley, 
with the limb placed in such 
position that the patient can 
endure the extension without 
suffering pain ; and, 2. From 
behind the tibia upward and forward. It is all important that such double 
extension be applied, for more than likely the direct extension from the 
foot will give pain until the second line of extension is brought to bear. 
This double extension can be applied to a limb and continued when the 
limb is placed in the proper position, so that the extending force is brought 
to bear without giving pain. This proper angle must be found, which 
can be easily done by moving the limb about, and the extension should 
not be made until such position has been obtained. When this has been 
done and the extension is properly applied, the pain is immediately re- 
lieved. 
Fig. 4087.-Sayre's Double Extension of the Knee Joint. 
Fig. 4088. Fig. 4089. 
Sayre's Method of Securing the Plasters, 
"When the double extension has brought the limb into nearly the 
straight position, it is ready for the instrument, which is to be applied in 
the following manner: 
" Surround the leg with strips of adhesive plaster, about an inch in 
width, placed lengthwise, and reaching from the top of the tibia down to 
the ankle joint, and secure them with roller bandage from the top of the 
tibia down to the point at which the lower band of the instrument is to 
be applied, leaving four or five inches of the lower extremities of the 
plaster loose, fastening the bandages with stitches. Next, surround the 
thigh with strips of adhesive plaster of about the same width, applied in 
the same manner, and extending lengthwise upon the thigh from the 
lower extremity of the femur nearly its entire length. Secure these 
plasters with a nicely adjusted roller bandage from the knee upward to the point where the upper band of the instru- 
ment is to be applied, leaving the remaining portion of the plasters loose. (See Figs. 4088 and 4089.) 
Manner of Applying- Sayre's Knee Splint. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
657 
ORTHOf/CDie. 
DISEASES OF THE JOINTS. 
Knee Joint Apparatus. 
" The limb is now ready for the application of the instrument. Place the 
instrument on the limb in such a manner as to bring the side bars upon the 
same plane with the condyles of the femur, and place it in the hands of an 
assistant, to be held steadily in that position. The collar embracing the leg 
should be closed, so as to snugly engage the leg, but not sufficiently tight to 
interfere in the least with a free return circulation. Now reverse the loose 
extremities of the pieces of adhesive plaster, bring them snugly over the collar 
and upon the leg, where they are to be secured by a few turns of the roller 
bandage which has just covered the foot and secured the upper portion of the 
plaster. Next press the lower collar down into the plasters which now engage 
it, and then secure the upper band about the thigh. This band, you must re- 
collect, is attached to the side bars in such a manner, like a swivel, that it 
can be tilted sufficiently to come in contact with the thigh and produce seri- 
ous results by pressure, unless it is properly secured. This can be done by 
taking one piece of plaster behind and another in front, at points exactly op- 
posite upon the circumference of the limb and reversing them in such a man- 
ner as to bring equal traction upon the collar posteriorly and anteriorly, which 
will balance it so that its edges will not come in contact with the thigh at any 
point. The band is first closed around the thigh only sufficiently tight to be 
comfortable. When this is done the remaining strips of plaster can be re- 
versed, without causing the edges of the collar to make pressure at any point, 
and all are then secured with a roller bandage. (See Figs. 4090 and 4091.) 
" Now we have the instrument fastened at its lower and upper extremity in a manner which will enable us to make 
extension and counter extension to any degree required; This is done by means of the key and ratchet on the bars 
of the instrument. The amount of extension and counter extension required is that which is sufficient to produce 
perfect relief from all pain, or the possibility of producing pain by making concussion or pressure. This can be ob- 
tained by extending the bars first on one side and then on the other, until the desired amount of extension is reached, 
when the instrument is locked by the slide and retained there. An important point to be remembered is, that you 
can do a good deal of harm by making too much tension upon the lateral ligaments. The point to be aimed at is to 
make just sufficient extension and counter extension to give perfect relief from all pain by pressure upon the articular 
surfaces of the joint, and no more. If too great tension is employed the patient will complain of a sense of dis- 
comfort. In either case, therefore, the countenance and feelings of the patient are to be your guide with reference to 
the amount of extension to be applied. When the dressing is first applied, the plasters and bandages may so yield 
that the patient, soon after their application, again suffers pain. When this happens extension is to be immediately in- 
creased, until the patient gives no response in his face upon the application of concussion or pressure. Now we have 
an apparatus applied to the limb which is competent to remove all pressure from the articulating surfaces of the joint. 
" If there are present any evidences of inflammatory action about the joint, such as may demand active treatment 
by leeches, cold or hot applications, counter irritation, &c., your command of the joint is perfect and such applica- 
tions can be made as may be deemed necessary. If you wish to apply hot or cold, it can be done by means of sponge 
and roller bandage. Just here there is an essential element in practice which must never be lost sight of; for, if we 
would leave the limb with the instrument applied so as to make extension, and do no more for it, it would be ruined. 
The boggy, infiltrated connective tissue which everywhere surrounds the joint, if left without proper support, would 
become more and more engorged by the bandages which have been applied, until strangulation would take place, 
gangrene ensue, and the knee joint and patient go together. Compression, then, is an essential element in the man- 
agement of these cases and must never be neglected, but is never to be applied until the extension is properly 
adjusted. Then you must firmly strap the joint, first filling the popliteal space with cotton, old rags or sponge, and, 
commencing below with the adhesive strips, go upward, shingling the joint, as it were, in such a way as to leave no 
point uncovered. These adhesive strips must also be applied in such a manner as will make uniform pressure over 
the joint. You will not, however, strap the joint after this fashion until your instrument has been applied and exten- 
sion and counter extension have been made; for, if applied before this has been done, the skin will be folded into 
pleats and strangulation and gangrene may result. Again, we wish to continue the double extension which has been 
applied to bring the limb into the present position, and this can be accomplished by carrying the bandage (after cov- 
ering the knee just strapped) between the bars of the instrument and the leg, then over the bars, and under or behind 
the tibia, in such a way as to crowd the head of the tibia forward ; and in the same manner above the knee, applying 
the bandage in front of the femur and under the bars, so as to crowd the lower extremity of the femur backward. 
Fig. 4090. Fig. 4091. 
Sayre's Knee Splints Applied. 658 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS. 
Knee Joint Apparatus. 
Fig. 4092. 
Sayre s Double 
Extension 
" Now, if the patient be an adult, he will probably require the aid of crutches in walking, 
otherwise too great a strain will be brought to bear upon the plasters which hold the instrument 
in place ; but, if a child, he may go about without their assistance. Artificial support for these 
diseased knee joints (which, if properly applied, removes all pressure from the articulating surfaces 
and gives the patient perfect comfort ; which can be worn for months, and, if need be, without 
changing) permits the patient to be out-of-doors, where he can obtain fresh air, the influence of 
sunlight, and, in short, to avail himself of all the hygienic measures which are to contribute 
so largely to his final recovery."-"Orthopaedic Surgery and Diseases of the Joints." Second 
edition, 1885. Lewis A. Sayre, M. D. 
Measurements Required 
I. Circumference of thigh Inches. 
2. Circumference of leg above ankle " 
3. Circumference of knee, *• 
4. Length from above ankle to upper third of thigh, 
"If the knee can still be straightened, I apply the following apparatus. The leather lacer at 
the top, a, spreads its pressure over a wide surface, and also spreads out somewhat upon the bulge 
of the nates, so that hardly a perceptible pressure is exerted upon the veins at any one point ; 
hence there is little tendency to venous congestion and 
swelling of the parts below, yet I think that the practice 
of employing a compression bandage is useful to the 
knee, even if no tendency to swelling exists. 
" The rod, c, is loosely jointed to the steel plate, b. 
The broad perpendicular adhesive strap should termi- 
nate a little above the slot, j. To the lower end a stout 
elastic band is sewn, a few inches long. A leather strap 
is sewn to the elastic. 
"The opposite side of the 
limb is armed in the same way. 
The hip leather being laced on, 
the strap and elastic bands car- 
ried down to the slot, j. The 
strap is drawn through the slot, 
then stretched firmly upward by 
the hand and buckled to the 
knob, d. The elastic, in passing 
under the friction roller, pulls 
strongly downward on the ad- 
hesive plaster and the limb to 
which it is attached. 
' 'Elastic bands are not strictly 
necessary ; but the elastic is con- 
venient, because in any yielding 
or stretching of the dressings its 
contractibility still keeps up the 
tension, without requiring so 
much watchfulness on the part 
of the surgeon. If it is desired 
to remove the apparatus, all that 
is necessary is to unbutton the 
two straps, when the brace can 
be slipped off over the foot."- 
E. Andrews. M. D. 
Andrews' Knee Splint. 
Fig. 4093.-Davis' Knee Joint Splints 
Fig. 4094. 
Andrews Knee Splint. GEORGE TIEMANN & SURGICAL CO.'S INSTRUMENTS 
659 
ORTHOP/EDIC. 
DISEASES OF THE JOINTS. 
Knee Joint Apparatus. 
Fig. 4095. 
Hutchison's 
Knee Joint Splint 
" To secure fixation of the knee-joint, I use splints made of hatters' felt. It consists of seven 
layers of cotton cloth, saturated with shellac and well rolled together while hot. That ordinarily 
sold consists of but five layers of cloth, which, for most cases, is not firm enough. To give effec- 
tual rest to the joint, the splint should be of sufficient length and wide enough to nearly surround 
the limb; it should extend half way up the thigh, and to a corresponding point below the knee. 
A shorter splint, merely wide enough to cover the posterior part of the limb, does not secure the 
complete immobility which I have insisted upon in the treatment of diseases of the joints, where 
absolute rest is demanded. The splint having been cut of the proper length and width with a 
sharp knife, and the limb covered with a stocking, the felt, made pliable by dry heat in an oven 
or before an open fire, or by immersion in very hot water, is applied to the limb and covered 
quickly and firmly with a bandage from below upwards, so as to mould it to all the inequalities 
of the surface. While the splint is being applied, an assistant should make extension from the 
foot, so as to straighten the limb as much as possible, in cases where the joint is flexed ; but no 
violent effort should be made to reduce the malposition. So soon as the splint regains its inflexi- 
bility it may be removed, trimmed up and holes punched an inch or an inch and a half from the 
front edges for lacings. The object in punching the holes a little way back from the edges is to 
permit the splint to be made smaller by cutting off the edges, so that pressure may be kept up as 
the knee diminishes in size. The weight of the body is removed from the diseased joint by the 
use of the elevated shoe and crutches (see Fig. 4072)."-Hutchison. 
Fig. 4096.-Shaffer's Knee Extension Splint, 
In the Archives of Clinical Surgery, for 
June 15th, 1877, Dr. Newton M. Shaffer re- 
marks : " I have attempted to meet the patho- 
logical indications presented in knee-joint 
lesions with an apparatus which I devised 
some time ago. Its design is to apply the 
desired force directly to the head of the tibia, 
throwing the same forward and downward by 
a simple movement. While we thus overcome 
the muscular contraction in a direct line, we 
relieve the joint pressure and overcome the 
deformity simultaneously. The apparatus is 
represented in the accompanying engraving. 
" It consists of three principal parts: the 
thigh, leg and intermediate. The first two 
are secured to the limb by adhesive plasters, 
which are attached at the points, A, A. Extension is made with a key at the extension rod proper, at B. The 
joints, at C and D, move upon pivots, and as the extremities of the apparatus are secured by their adhesive 
straps at A, A, the joint, D, moves forward and downward, describing the arc of a circle, the radius of which is 
the bar, E. Pressure is thus made directly upon the head of the tibia by the band, F, and this can be very greatly 
augmented by using the extension rod at G, which further relieves the joint of pressure by additional extension in the 
position already acquired by the preliminary extension of the rod, B. H is an accommodation-not properly an ex- 
tension rod-which glides forwards as the extension is applied at B. As soon as the leg is thrown sufficiently forward, 
the accommodation rod is secured by a slide, and an extra turn of the key at B and G leaves the joint free from pres- 
sure, and with adequate extension applied directly to the contracted flexors. The thigh and leg bands at 77 and I 
move upon pivots, so that they adjust themselves readily to any position, and at K there is an arrangement by which 
the curved bar, L, may be adjusted to suit the requirements of the extension rod, B. The bars, Af and 0, are secured 
to the thigh and leg parts by double rivets. Through the buckles, at P, P, P, webbing straps (padded) are passed, 
producing counter extension in addition to that secured by means of the adhesive straps." 660 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOf>?EDie. 
DISEASES OF THE JOINTS. 
Knee Joint Apparatus. 
Fig. 4097. 
Roberts' Knee Splint 
with Tibial Rotation. 
Fig. 4098.-Elastic Tension 
Fig. 4099. 
Roberts' Knee Splint, 
applied. 
"The force which keeps up traction, subdues reflex muscular 
<pasm, and overcomes the deformity is elastic tension, and in this 
instrument is developed by means of a spiral spring and rubber straps. 
The instrument permits walking and riding without inconvenience or 
discomfort, and hence deriving all the benefits of fresh air, sunshine, 
and a sufficiency of exercise. During locomotion, limited move- 
ment of the joint takes place, and hence approaches the condition ob- 
tained in the healthy knee. The circulation of blood through the limb 
is facilitated and the maximum amount of nutrition is furnished the 
joint for the purpose of carrying on the repair of the diseased tissues. 
" The extension is effected by means of two steel bars ; one is pro- 
vided with expanded margins, turned over so as to form a groove, in 
which the other slides. The outside bar is attached by one extremity 
to the metallic band which encircles the limb, and the extremity of 
the bar, which slides within the groove, enters into the formation of 
the joint. 
" In order to make elastic extension, a narrow strip of strong elastic webbing is made fast to the loop of the inside 
bar. A buckle is attached to the button at the opposing end of the other bar. By means of this buckle and strap any 
desired amount of elastic force can be exerted. 
" In applying the instrument, the upper and lower metallic bands to encircle the limb are secured in position, in 
the usual way, by strips of strong adhesive plaster and roller bandages. A flat strip of steel is attached to the lower 
metallic band and projects upward so as to rest upon the belly of the tibalis anticus muscle. This strip is encased 
with adhesive plaster, with the adhesive side out. A roller bandage is carried over it, and thus additional leverage 
and fixation of the instrument to the limb is secured. From the lateral bars of the splint projects a semi-circular 
piece directly in front of the head of the tibia. An adjustable metallic arm, attached to the middle of this semi-cir- 
cular piece, projects downward in a line with the spine of the tibia. This arm is at a little distance from the front of 
the leg and serves as a fixed point to which a broad elastic web band is attached, that passes around the leg behind the 
head of the tibia. By means of the buckle any desired tension upon the posterior part of the head of tibia can be 
exerted. The metallic arm is adjustable upon the semi-circular piece, and hence the direction of the elastic tension 
force, applied by means of the webbing to the posterior aspect of the head of the tibia, can be forward, or forward and 
inward, as the necessities of the particular case require. An elastic knee-cap and broad strip of webbing serve to keep 
the upper segment of the instrument in the same relative position to the thigh. From the lateral shaft of the brace 
on each side and below the joint projects directly forward a metallic lever, curved upward. To the ends of this lever 
are attached strong strips of elastic webbing, which pass up to the upper or unattached ends of the bar, and are de- 
signed to supplement the functions of the quadruceps extensor muscle. Finally, by means of a spiral spring, you can, 
with a key applied to the lower or projecting end of the pivot, secure the continuance of any desired amount of elastic 
force tending to rotate the tibia inward on its long axis, and thus, in conjunction with the elastic band which passes 
behind the head of the tibia, overcomes the subluxation and rotation outward of the head of the tibia. 
"Whenever a case of chronic disease of the knee joint comes under treatment, before subluxatjon and rotation 
outward of the head of the tibia has occurred, the tibial rotating mechanism is dispensed with, and a simpler instru- 
ment fulfils all the therapeutic indications. This is represented in Fig. 4100. The lower and upper ends terminate 
in bands about the leg, and the side-bars are constructed, as previously described, for making continuous elastic 
traction. It is applied to the limb in the same manner as Dr. Sayre's knee-splint, by means of strips of strong ad- 
hesive plaster and roller bandages."-From a paper read before the Medical Society of the County of New York, 
January 23, 1882, entitled "Elastic Tension and Articular Motion as Therapeutic Agents in the Mechanical Treat- 
ment of Chronic Inflammations of Joints," by Dr. M. Josiah Roberts. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
661 
ORTHOPEDIC 
DISEASES OF THE JOINTS 
Knee Joint Apparatus 
Fig. 4100.-Roberts' Plain Knee Splint 
Fig. 4101. 
Holthouse's Spiral Spring Extender. 
The apparatus consists of a spiral spring, covered with leather, 
flannel or linen, and having two buckles at one or both extremities. 
When extended, it forms a cylinder closed at the sides but open at 
each end ; and when the coils of the spring are pressed together it 
approaches in form to a discoid ring or closed concertina-it need 
not, however, necessarily be cylindrical, but larger at one end than 
the other in conformity with the tapering shape of the limb. It is 
applied with adhesive plasters, to which tabs are attached for the 
buckles. 
Fig. 4102.-Stillman's Bracket and Sector, 
Fig. 4103. 
Stillman's Knee Extension Brace, 
" The bracket is composed of plates of copper, connected to a compound 
slotted bridge. The plates are so punched that the edges of the perforations 
will be elevated above the surrounding surface, and thus cause them to be 
held firmly in place by the plastered bandage. A steel slotted sector is at- 
tached to the bridge, either before or after the bracket has been secured upon 
the limb, as the case may demand. This splint is simple in construction, and 
its principle is as readily applied to the elbow, hip and intervertebral articula- 
tion as to the knee. 
" In chronic conditions of the knee joint, however, the plaster of Paris 
attachment is always uncomfortable, and can not be removed without dis- 
turbance of the joint. Since the atrophic changes in the soft parts about 
the joint render frequent removal of the dressing desirable, it becomes almost 
a necessity to provide special forms of apparatus which can be removed when- 
ever necessary. In Fig. 4103 such an one is shown. By means of a clamp 
in the slotted arc the joint may be fixed in any desired position, or, by releas- 
ing the clamp slightly, motion may be allowed. 
"An important indication is the employment of traction. To effect this 
four plasters are cut, fan-shape, as shown in Fig. 4104, A, and a long strip of 
webbing is attached to each. 
Stillman's Knee Extension Brace. 662 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
O^THOp/EDIC. 
DISEASES OF THE JOINTS. 
Knee Joint Apparatus. 
"These plasters are placed as shown in Fig. 
4104, B, interlaced for greater security from dis- 
placement, and then covered with roller-bandage, as 
shown in Fig. 4105. The inferior and superior ex- 
tremities of the splint are provided with rollers and 
buckles to which the webbings are to be attached. By 
means of an elastic ratchet, Fig. 4103, D, force may 
be applied upon the thigh portion of the instrument 
to effect elastic extension. This ratchet consists of 
two over-riding slotted strips, which can be fastened 
together by a screw-clamp if the surgeon prefers 
rigid extension. 
"Another indication is the prevention of posterior 
luxation. To meet this I have devised a spring lever 
power which operates without interfering with the ac- 
tion of the remainder of the brace. It is a long, flat 
steel bar, bent to conform to the back of the leg, and 
placed posteriorly. At its upper end is attached a 
semi-girth, which presses on the back of the upper 
part of the leg, and below it is attached to a stirrup 
which is itself fastened to the lower girth of the in- 
strument. This stirrup is provided with a hinge and 
socket, so that it may be opened and shut when the 
brace is in position. The forward pressure of the 
lever can then be adjusted by means of a ratchet at the 
intersection of it with the stirrup. Extension of the 
joint is effected without pain to the patient. 
"After traction has accomplished its purpose and extension is no longer necessary, the splint is so arranged as to 
permit the removal of the rollers and buckles at each extremity and of the traction ratchets-thus converting it into a 
simple fixation splint or knee support during the 
stage of convalescence, when, by the use of resto- 
rative measures, the anterior muscles of the thigh 
have been strengthened so as to hold the tibia 
forward in its proper axis with the femur. 
" Fig. 4107 shows a brace which differs from 
the one just described only in the greater lateral 
support afforded the knee by the use of two larger 
sector movements opposite the joint. There is also 
frequent occasion to force the sides of the brace as 
closely against the joint as possible, in order to af- 
ford protection from lateral displacement; this is 
effected by a metallic band spanning the knee an- 
teriorly, which must be raised sufficiently not to 
touch the surface. 
' ' So far the braces shown are used in connec- 
tion with crutches and a raised shoe ; but in con- 
valescence, when the weight of the body can be 
borne without pain, and yet protection of the joint 
is desired, the side-strips of the brace are fre- 
quently jointed at the ankle and extended below 
the foot, being attached to the shoe underneath 
the arch by a pivot, to allow of the natural move- 
ments of the foot."-Charles F. Stillman, M. D., 
in New York Medical Journal, January Sth, 
1887. 
Fig. 4104. Fig. 4105. 
Application of the Plasters to Effect Traction. 
Fig. 4106.-Stillman's 
Knee Splint, applied. 
Fig. 4107.-Stillman's Knee Splint, 
with large Sectors. GEORGE TIEMANN CO.'S SURGICAL INSTRUMENTS. 
663 
ORTHOP/EDIC. 
DISEASES OF THE JOINTS. 
Ankle Joint. 
"Anatomy.-The bones which enter into the formation of the ankle joint are the lower extremity of the tibia 
with its malleolus, the lower extremity of the fibula, or the external malleolus, and the upper convex surface of the 
astragalus. These articular surfaces, covered with cartilage, are held in place by the internal and external ligaments 
and the anterior ligament of the ankle joint, which are lined with synovial membrane. The important thing to be 
remembered with reference to this joint is, that it is simply a hinge joint, has a to-and-fro movement, and no other. 
The articulation between the astragalus, the lower extremity of the tibia, and the two malleoli, is so complete, close, 
and perfect, that it will admit of no lateral movement whatever. This is one of the statements which I make with 
positiveness. The apparent lateral motion which takes place is not at the astragalo-tibial articulation, but below, at 
the articulation of the astragalus with the os calcis. When the toes are turned out or in, it is in obedience to rotation 
of the leg and thigh at the hip joint; or, if the leg is flexed upon the thigh by the action of the biceps and tensor 
vaginae femoris, giving a revolving motion to the head of the fibula. 
" Pathology.-All lateral movements made at the ankle joint are done at the expense of an injury to the structures 
of that joint; for no lateral movement, external or internal, abduction or adduction, can take place without producing 
undue pressure against the synovial membrane and articular cartilages or the basement membrane beneath them. 
These articular cartilages, like those in other joints, are elastic, non-vascular, and receive their nutriment by imbibi- 
tion from the synovial membrane and from the vessels of the articular lamella. Necrosis of these cartilages takes 
place with the greatest rapidity on account of the low degree of vitality they possess ; hence they are the source of 
great danger when, in any manner, the tissues beneath them become so disturbed as to interfere in the least with their 
nutrition. I do not believe, however, that disease ever commences in the cartilage itself. The malleoli, which stand 
as guards on the side of the joint, are not so well protected, because in the normal movements of the foot they are 
not subject to much pressure and consequently the cartilage covering them is not so thick as that covering the top of 
the astragalus or bottom of the tibia. You have probably all, at some time, twisted your ankle in walking, and you 
cannot have failed to notice how instantly the malposition of the joint is followed by a spasm of the muscles of the 
leg. 
" We may have diseases of the ankle joint which commence either in the ligaments or in the synovial membrane, 
or, which I believe to be far the most frequent, in the articular lamella immediately beneath the articular cartilage. 
In a great majority of instances what we have to deal with is an extravasation of blood beneath the synovial mem- 
brane, or between the cartilage and bone, quite analogous to the 'blood blister' which is formed upon the external 
surface whenever the skin is severely pinched but not broken. This may occur either upon the astragalus, or at the 
lower extremity of the tibia, or, still more commonly, as the result of pressure produced by the astragalus against the 
inner surfaces of the malleoli, which are not sufficiently protected to resist their pressure. Under such circumstances 
no swelling occurs that can be seen ; there is pain, probably, but the cases are very liable to be neglected, their im- 
portance overlooked and thus a slight injury, producing only trifling damage at first, may be permitted to go on and 
develop the most serious condition, ending in inflammation, which goes to softening of the bone, necrosis of the car- 
tilages, and destruction of all the tissues involved in the joint. The inflammation may extend toother bones and you 
may have, as a result, softening and caries of all the bones of the tarsus. 
" These are the cases that are called ' scrofulous disease of the ankle joint.' There is no scrofula about it in the 
vast majority of cases. It is simply inflammatory softening, ending in caries and necrosis of the bones, and ulcerative 
destruction of other tissues entering into the formation of the joint; and instead of being constitutional in its origin, 
dependent upon a constitutional cachexia, it is simply inflammation of the joint dependent upon injury, consequently 
traumatic in its origin. When children who have scrofulous diathesis receive an injury sufficient to lead to serious 
results, such results are usually more rapidly developed and less amenable to treatment than when the injury occurs to 
previously healthy children, or children born of healthy parents. 
" Symptoms.-With this view of the subject you can at once see the very great importance of early recognition of 
the exact nature of these trifling injuries to the structures of the joint, which may lead, if neglected, to such serious 
results. To this end, therefore, I shall endeavor to point out to you in the plainest manner possible the symptoms 
by which you will be able to recognize them in their very earliest stages, so that you may be able to adopt a plan of 
treatment which will prevent such unfavorable results. First, then, if the twist, wrench, sprain or bruise, which the 
patient has received, has produced an injury that involves the synovial membrane chiefly, it will be followed very 
speedily by increased effusion within the joint, giving to the joint a peculiar fullness in front of either malleolus, 
within which swelling an indistinct fluctuation can be recognized. This, in a few hours, is followed by great heat 
and intense pain ; a sense of tension, accompanied by throbbing and great tenderness and pain, will be present when 
the articulating surfaces are crowded together and slightly twisted upon each other. If, on the other hand, the liga- 
ments are involved more than the synovial membrane, the injury will not be attended with so much swelling as when, 
the synovial membrane alone is involved; and the tenderness and pain are not produced by pressing the articular sur- 664 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTJHOP/EDIC. 
DISEASES OF THE JOINTS. 
Ankle Joint 
faces together, but, on the contrary, are relieved, and it is by making extension and rotation, together with pressure 
upon the ligaments over their points of attachment, that pain is produced and tenderness detected. If, however, the 
injury is the result of a blow or concussion, with or without much twisting, but received in such a manner as to pro- 
duce rupture of the bloodvessels underneath the articular cartilage, in the articular lamella, either at the top of the 
astragalus, base of the tibia, or inner surfaces of the malleoli, then there will be but slight pain at first, but afterward 
the suffering will be altogether out of proportion to the appearances presented. At first the extravasation of blood 
into the bone is very light, and, being in a tissue which cannot swell, no apparent enlargement takes place ; nor is 
discoloration observed, because the extravasation is so deep-seated. The ligaments not being specially involved, 
making them tense does not produce pain. All these facts add to the deception and make us very liable to pass over 
the case as one of trifling importance. 
" When this accident has occurred the only manner in which it can be recognized is by direct pressure upon the 
part affected by the extravasation. The seat of the injury may be at any point on the surfaces of the joint, and it 
therefore becomes necessary to make pressure upon all parts of the joint, by moving the bones in every direction and 
also making lateral pressure so as to bring it to bear upon the sides of the malleoli. We are not safe in giving a diag- 
nosis in these cases, until in this manner we have thoroughly explored every portion of the joint. The important thing 
to recollect and always to keep in mind, when called to examine and treat this class of cases, is, that serious injuries 
of joints compel attention and that slight ones are often neglected, and, generally speaking, the slighter the accident 
the more apt to be neglected ; but these are the very ones which are exceedingly dangerous. 
"If an injury be severe, for example, a fracture involving a joint, a dislocation, or even a severe sprain, it can- 
not be overlooked or neglected ; surgical aid is indispensable and is immediately called for, and generally a cure 
results after a reasonable time. When, however, a person receives what is termed ' a slight sprain of the ankle,* the 
amount of mischief from a neglect in recognizing what structures are involved, and instituting a proper method of 
treatment, is often extreme, and may terminate in a sacrifice of the limb as the only remedy for a chronic inflammation 
of the joint involved. Let us, then, next consider how such disastrous results may be brought about. We will take, 
for example, a simple sprain of the ankle, which is very common, and from which all of you, it maybe, have suffered. 
As I have already told you, a 'blood blister,' or extravasation, is first produced. Such a ' blood blister ' is consid- 
ered as insignificant under ordinary circumstances, if it be allowed immediately to heal. If, however, the ' blood 
blister' is constantly irritated by friction an ulcer is formed, which rapidly increases in size and involves the deeper 
tissues. 
" This, I believe, is exactly the morbid process going on in one of these neglected sprained ankles. The small 
quantity of blood effused behind the synovial membrane, or between the cartilage and bone, would be speedily 
absorbed if sufficient rest were allowed to the part; but there is no swelling, and little pain, it may be, to give warn- 
ing of the mischief done and the patient does not stop his usual walks and exercise. The 'blood blister' becomes 
irritated and increases in size, and finally, on account of the disturbance produced, he is obliged to lay by for a short 
time. The trouble apparently disappears and he resumes his avocations ; a slight over-exertion, however, brings back 
the same train of symptoms-namely, exhaustion, stiffness, pain, tenderness, and perhaps swelling. This is repeated 
again and again, as often as rest allays and exertion awakes the morbid process, the attacks becoming more and more 
severe and prolonged, till at last the condition of chronic inflammation is reached. The liquid now contained in the 
joint is abnormally abundant and is changed in consistency ; instead of the clear synovia there is an opaque, viscid 
substance. To this, in part at least, is due that peculiar distention and 'boggy' feel which the joint now presents. 
Ordinarily, suppuration very rapidly supervenes upon this condition of the articulation. The cartilages become 
necrotic and caries of the adjacent surfaces of the bones is set up. The pain now is often excruciating, as is gene- 
rally the case when cartilage is undergoing disintegration. As a result of this process the constitutional disturbance is 
usually quite severe and the pain produces sleeplessness and loss of appetite. The muscles affecting the articulation 
are constantly 'on guard' to fix the joint and prevent any rubbing together of its surfaces. 
" Such constant tension causes an atrophy of the limb both above and below the joint; though in the latter situ- 
ation it may be obscured by swelling. At night, when sleep has become so sound that the muscles relax their tonic 
contraction, motion will take place in the joint and the patient awakes with a sudden, piercing shriek. So quickly do 
the muscles resume their conservative contraction, that, by the time the nurse has reached the bedside, the patient is 
again asleep or is unconscious of the cause of his awakening. This pressure of the joint surfaces, although painful, 
is less so than the motion which would occur if the muscles were not thus contracted ; but it very much increases the 
destruction of the cartilage and bone, and you will find, in post mortem examination of the parts, erosion of the tis- 
sues farthest advanced at those points where the pressure from muscular contraction has been greatest. When the 
joint is thus filled with a liquid which is causing disturbance as a foreign body, one of two terminations is necessary, GEORGE TIEMANN &• CO.'S SURGICAL INSTRUMENTS. 
665 
ORTHOPEDIC. 
DISEASES OF THE JOINTS. 
Ankle Joint. Treatment, Apparatus. 
the absorption, or evacuation, of the liquid. If there is a probability that absorption of the fluid can take place, it is 
best promoted by fixing the joint in such a manner as will relieve the pain and defend it from attrition of the articular 
surfaces, thus allowing our attempts to renovate and invigorate the system really to take effect. 
" If, in addition, we apply some apparatus which will permit the patient to take out-of-door exercise without dis- 
turbing the rests® essential to the articulation, we shall have done the best thing possible, and, fortunately, our effort 
will often be crowned with success. If, however, such precautions are not employed, and often indeed, in spite of 
them, the disease proceeds to ulceration of the bone, and now, if we do not make an exit for the pus, it will eventu- 
ally make one for itself. In the meantime, however, long and tortuous sinuses will have formed, the pus burrowing 
this way and that among the muscles and between fasciae, so that these tissues are involved, while by long-continued 
action of the pus the disease of the bones becomes greatly extended. Much of this trouble is avoided by opening the 
joint when we are convinced that any considerable amount of pus is contained within its cavity. When the disease 
has advanced to this stage, the case is looked upon by the mass of the profession as an unmistakable illustration of 
'scrofulous disease of the joint,' but I believe it to be the result of inflammatory process dependent upon a traumatic 
cause. 
" Treatment.-In all sprains or bruises affecting the ankle joint, involving the ligaments or producing effusion of 
blood, the very best treatment that can be adopted is to immediately immerse the limb in water of as high a temperature 
as can be possibly borne, gradually increasing this temperature until the heat is carried up to the highest point the 
patient can tolerate, and then maintain this for a varying length of time, perhaps several hours, until all pain upon 
pressure and slight movement has entirely subsided. * * * When the pain is relieved by the foot-bath, 
the patient should be placed in an horizontal position, with the limb elevated and firmly bandaged with a flannel roller 
from the toes to the knee and then kept wet, or dry, as maybe more agreeable to the feelings of the patient. Perfect 
rest of the limb in the elevated position, with this even compression, is to be maintained until all tenderness upon firm 
pressure has completely subsided and until the limb can be held in the dependent position without producing any 
unpleasant symptoms. If the synovial membrane has been involved in the injury and effusion and over-distension of 
the joint have ensued, elastic compression is the essential element in the treatment. This can be obtained by surround- 
ing the joint with a large sponge. The sponge should first be thoroughly saturated with warm water, then made as 
dry as possible by squeezing with the hand and finally made to completely surround the joint, being particular to have 
it quite thick over the instep and both malleoli. After it has been properly applied around the joint, bind it firmly in 
place with a bandage that will permit water to pass through its meshes. This bandage should include the foot, ankle 
and leg, and, after the sponge has thus been compressed by the bandage, both sponge and bandage should be thor- 
oughly soaked with water; the sponge, absorbing the water, will increase in size, and, as the bandage prevents it from 
expanding outward, the pressure induced by its enlargement is done at the expense of additional pressure of the parts 
enveloped by the sponge. This method of making elastic pressure is within the reach of every surgeon. 
"A more convenient method of making even pressure over the joint 
is by means of a double india rubber bag, manufactured by Tiemann 
& Co., of this city. It is simply an india rubber sac with double 
walls, which encloses the ankle and foot ; a tube connects with this 
hollow bag, which can have warm water poured into it, and then the 
bag is to be blown up, either by the mouth or a pair of bellows, and 
a stopcock turned which retains the air. (See Fig. 4108.) In this 
manner pressure can be made which will be exceedingly powerful 
and yet so soft and elastic as to be easily borne. Such pressure, con- 
stantly applied, on account of its elastic character, will cause an ab- 
sorption of the fluids within the joint; and also, by this very pressure, 
we have a tendency to separate the articulating surfaces from being 
forced upon each other by muscular contractions. 
Fig. 4108. 
Sayre's Rubber Ankle Compressor, 
Directions for Measurement 
I. Circumference of instep, Inches, 
2. Circumference of ankle, " 
3. Circumference above ankle " 
"'Massage.-After a few days have elapsed, friction with the hand is of the greatest possible advantage; but, to 
afford the best result, it should be much more briskly applied, and continued for a much longer time, than has gene- 
rally been done by the majority of surgeons. In fact, many cases of quite severe injury affecting the ankle joint, or 666 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS. 
Ankle Joint Apparatus. 
any other joint, such as a wrench or a sprain, will yield, in a comparatively short time, to manipulation and friction 
persistently applied for some few hours every day. I have employed this plan of treatment for many years and long 
before the term ' massage' was applied to it. It is, however, sometimes necessary that a method of treatment should 
go across the water and be baptized with a new name before it becomes popular. 
" So much for the treatment to be adopted when the injury is first received. This is the important time for the 
application of measures which are to prevent further development of the disease, and, could such treatment be faith- 
fully carried out in every case from its earliest commencement, there would rarely be need of mechanical appliances 
and surgical interference. Unfortunately, however, very many cases pass unrecognized, or, being recognized, are 
neglected, and gradually arrive at a stage in which surgical aid is sought and then they probably are in a condition 
which will demand some more formidable method of treatment than that which has already been given. When there 
is still hope of preserving the joint intact, which is to be determined by the length of time the condition has existed, 
the amount and character of the fluid in the joint, the degree of constitutional disturbance, and the general condition 
of the joint, I employ an instrument which I have devised for this purpose. 
। " This instrument consists of a firm steel plate, made to fit the sole of the foot; at the 
heel is a hinge joint and attached to it a rod, slightly curved at the bottom and extending 
up the back of the leg to near the knee. Over the instep is an arch like the top of a 
stirrup, with a hinge joint at its summit from which springs another rod, which runs in front 
of the leg, of equal length with the one behind. These rods are made with a male and 
female screw or ratchet and cog, for extension, and connected at the top by a firm band of 
sheet iron, on one side of which is a hinge and a lock on the other, like a dog collar. In 
front of the arch that goes over the instep is a joint in the foot plate which permits flex- 
ion of the toes. 
" The instrument is applied with firm adhesive plaster, cut in strips about one inch in 
width, and long enough to reach from the ankle to a short distance above the knee and 
placed all around the limb, as seen in Fig. 4110. The plaster is secured in its position to 
within a few inches of its upper extremity by a well adjusted roller, as seen in Fig. 4111. 
To prevent its slipping, the ends of the plaster at the top of the instrument are turned 
over the collar, which has been previously locked, just tight enough to be comfortable, 
and secured by a turn or two of the bandage, as seen in Fig. 4111. With the instrument 
accurately adjusted, the extension can be regulated by the key, so as to 
make the patient comfortable. 
" If, however, the symptoms show the system to be suffering from the 
poison of the pus retained in the joint ; or if, the joint being open, the 
patient is sinking under the drain of prolonged suppuration, the diseased 
bone should at once be removed and a perfect drainage established, so 
that no pockets or sinuses can be formed. If this latter accident be 
allowed to occur, the disease of the bone will not be arrested and the 
operation will therefore be useless. Now, you cannot in the ankle exsect 
the bone, as you can at the shoulder or hip, by a straight incision. In 
these orbicular joints the operation is simple : you have but to cut down 
to the bone, open the capsule, throw out the head of the bone through 
the ' buttonhole ' slit, remove it with the chain saw, and finish with the 
rongeur or forceps, if necessary. But in the hinge joints, as a rule, and 
especially such complicated ones as the ankle, you cannot safely operate 
in this way."-See description of operation, "Orthopaedic Surgery and 
Diseases of the Joints." Second edition, page 175. Lewis A. Sayre. 
"The joint being opened, all of the granulation tissue and carious 
bone should be carefully removed with scissors or scoop, carious cavities 
scooped out; all recesses where there is diseased tissue should be cleaned 
and well irrigated. Insert drainage tubes into deep cavities and close the 
wound, or pack it with strips of iodoform gauze and cover with iodoform 
pad and sublimate gauze bandage ; over this place a layer of borated cotton 
and finally apply three layers of gypsum bandage ; cut openings opposite 
the drains and suspend the limb."-"Operative Surgery." Stephen Smith. 
Fig. 4109.-Sayre's 
Ankle Joint Splint. 
Fig. 4110. Fig. 4111 
Application of Sayre's 
Ankle Plasters and Splints. 
Measurements Required 
1. Trace the outlines of the sole on a piece 
of paper. 
2. Length from sole to garter, . Inches. 
3. Circumference at garter, . . " GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
667 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS. 
Ankle Joint Apparatus. 
Fig. 4112. 
Hutchison's Ankle Joint Splint 
" In the treatment of inflammation of the ankle joint and its consequences, 
perfect rest of the parts (mechanical immobilization), and the removal op pressure 
from the diseased articular surfaces, is quite as important, and, I may add, quite as 
satisfactory, as in the diseases of the hip and knee, and the indications may be met 
in the same way. Instead of the felt, I prefer to use, for fixing the ankle, two 
splints made of plaster of Paris, because they adapt themselves better to the in- 
equalities of the surface about this joint ; one is to be applied in front and the other 
behind, extending from the middle of the leg to the ends of the metatarsal bones, 
and wide enough to leave an interval of half an inch between the edges on the inner 
and outer side. The splint should be made of two thicknesses of canton flannel, 
with coarse meshes, or three thicknesses of coarse toweling, cut of the proper length 
and width. One layer of cloth is laid upon a table and covered with liquid plaster, 
of the consistence of cream, and spread smoothly with a table knife. The other 
layers are then immersed in the plaster and applied evenly and smoothly over the 
first; and, when both splints have been prepared, one is applied in front and the 
other behind, with the under surface of the first layer, which is not covered with 
plaster, next to the skin, and a roller bandage is firmly applied over the splints from 
below upwards. The surgeon should now grasp the foot, and, holding it at a right 
angle to the leg, make extension until the plaster hardens, which requires about five 
minutes. The bandage should then be removed, and the splints surrounded by 
three or four strips of adhesive plaster, and the bandage re-applied more loosely. 
Windows may be cut in the plaster, so as to allow any openings that may exist in 
the parts to be uncovered. I have no hesitation in recommending the elevated shoe and crutches (Fig. 4072) as the 
best and simplest method of making extension and removing pressure ; it is just as effectual for the ankle as it is for 
the knee and hip joints. The weight required is not great, and the weight of the foot is sufficient to overcome the mus- 
cular contraction."-Proceedings of the Medical Society of the County of Kings, April, 1879. J. C. Hutchison, M.D. 
Fig. 4113.-Andrew's 
Apparatus for Inflamed 
Ankle Joint. 
" For some years I have used with the greatest satisfaction and excellent results the 
following simple device. The cut gives a correct idea of it. 
" The top of the foot and the lower half of the leg constitute two cones, whose 
apices meet at the ankle. Now if any moderately firm and well-fitting material sur- 
round these parts, and be laced together with some firmness, the two cones will be 
pressed apart and extension of the ankle secured ; or, to put it in different terms, the 
inverted cone laced to the leg is a counter-extending force, while the lacing together of 
the hollow cone embracing the upper surfaces of the foot tend to push that member 
downward, and thus makes extension upon the joint. To construct this, a plaster cast 
should be taken of the foot and leg, with the foot hanging free and pointing somewhat 
downward. This position is found by experience to be much the best. A piece of wet 
russet harness leather is wrapped around the cast and crimped to a perfect fit by wind- 
ing a stout cord or a piece of webbing all over it. The leather laps over itself in front. 
After a few hours drying in an oven, or on a stove, the leather hardens and retains its 
shape. Before applying the leather, a little building out of the malleoli of the cast 
should be done with plaster of Paris, that the leather may be well moulded out, and 
not press painfully on those prominences. Eyelets are set in the overlapping edge, and 
in a strip of leather sewed to the part opposite it, so as to allow of lacing it up to any 
desired tightness. The eyeletted edges of the leather should be-wider apart on the dorsum of the foot than elsewhere, 
as, owing to the yielding part of that member, the edges lace together more than on the leg. The brace is finished by 
pasting in a chamois leather lining. It fits the limb like wax, keeps up a gentle and desirable pressure on the joint, 
maintains immobility and pushes down the foot, so as to make an effective extension of the ankle joint. No screws, 
racks and pinions, nor even adhesive straps are required. The action of the instrument has pleased me beyond 
measure by its simplicity, the ease with which it can be taken off and re-applied, and its efficiency in curing the in- 
flammation. 
" The same principle can be temporarily carried out by means of a dextrine splint, open behind, and compressed 
by an elastic bandage, or even by a common roller."-E. Andrews, M. D. 668 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS 
Ankle Joint Apparatus. 
Fig. 4114. 
Stillman's Ankle Splint. 
Fig. 4115. 
Application of Plasters. 
Fig. 4116. 
Stillman's Ankle Splint Applied. 
i. Trace the outlines of the sole on a piece of paper, and mail to us with 
2. Length from sole to ankle Inches 
3. Length from sole to calf, " 
4. Circumference of calf, " 
Measurements Required: 
Shoulder Joint Apparatus. 
Stillman's Cable Splint. 
Fig. 4117. 
Fig. 4118. 
Fig. 4119 
Fig. 4120. 
Fig. 4121. 
Fig. 4122. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
669 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS. 
Shoulder Joint Apparatus. 
" When the diseased condition requires immobility, without exposure over and about the joint, it is met by the em- 
ployment of the ' cable splint,' Figs. 4117-4122, devised by the writer in March, 1877, and published in the New 
York Medical Record for October 20th, 1877. 
" The arm being at a right angle-the elbow being drawn down and held firmly by an assistant, the shoulders 
being in the same horizontal line, and the body erect and easy-the arm is encased, from the fingers to the axilla, 
with the plaster bandage (Fig. 4117). The next step consists in placing folds of the same bandage around the chest, 
covering the side of the shoulder (Fig. 4118). A shoulder cap of good thickness is then formed of strips of the same, 
bound down occasionally by transverse chest bands (see Fig. 4119). At this stage of the process the cable which 
cements the various parts together is formed. A roller of plastered bandage from three to five inches in width, and 
of good length, is selected. This is laid over the shoulder, as far back as the spine of the scapula, and brought for- 
ward and downward behind the wrist, around which it is wound several times to afford as broad a base as possible, 
and passed anteriorly back over the shoulder to the starting point, where it is bound down by a turn around the chest 
(see Fig. 4120) and again brought forward to the front of the wrist, under which it passes. In returning to the shoul- 
der it is wound lightly around the three slips already passed, thus forming the nucleus of the cable (see Fig. 4121). 
" Upon reaching the chest-band, the bandage is passed around that, until the cable is again reached (see Fig. 4122), 
which is once more wound to the wrist, after passing around which the bandage is returned to the shoulder in the same 
manner and again brought around to the cable, which is once more wound as before. 
" By repeating this winding process a number of times, a plaster cable is produced of great strength, and ultimately 
incorporated with all parts of the apparatus, building and cementing it in a manner which prevents disarrangement of 
the parts covered (see Fig. 4123). 
" The whole splint after the plaster has set becomes one piece ; no part of it can be moved without moving the 
whole, and it absolutely prevents all motion ; and, if neatly applied, with the skin protected by gauze, there is no 
chafing or discomfort experienced by the patient. So entirely is motion prevented that the writer has obtained union in 
five weeks in extra-capsular fracture of the humerus which occurred in a 
patient over sixty years of age. Its advantages are: 
" 1st. Absolute immobility. The cable may be grasped and shaken 
rudely without giving pain to the patient or disturbing the relations of the 
parts beneath. 
" 2d. Ease of application. 
" 3d. It does not constrict the neck, as does the ordinary cloth sling, the 
weight of the arm being borne by the shoulder and upper zone of the neck. 
" 4th. It prevents the leverage outwards of the arm upon the shoulder, 
which is not obviated by any other apparatus now in use. 
" When the diseased condition requires both immobility and exposure of 
the surface, a modification of the ' cable splint' may be used by which the 
arm is held securely and yet the shoulder is left bare. It is constructed 
like the ' cable splint,' but the exterior portion of the shoulder-cap is omit- 
ted, without at all impairing the stability of the apparatus."-Chas. F. 
Stillman, M. D. 
Fig. 4123. 
Fig. 4124. 
Stillman's Modified Cable Splint. 
Elbow and Wrist Splints. 
Fi,g. 4125.-Stillman's Wrist Splint. 
By means of the sector this splint allows the hand to be fixed, at any angle 
with the arm. By means of adhesive strips (shaped and cut like those shown 
on Stillman's ankle splint, Fig. 4115, and Stillman's knee splint, Fig. 4104) 
applied to the hand and arm, traction upon the wrist may be produced. 670 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPEDIC. 
DISEASES OF THE JOINTS. 
Elbow and Wrist Splints. 
"For chronic inflammation of the wrist, I use the following easily-constructed apparatus. A rectangle of thin 
brass or tin is bent into the form of half a cylinder, long enough to extend from the elbow to the tips of the fingers. 
At each side of the elbow is a slot and friction roller. At the other end are two eye-holes in the end of the brass, 
half an inch in diameter. The hand being enveloped in rubber, adhesive plaster, with tapes attached, is secured by 
tying the latter into the eye-holes. Other plasters on the forearm above the wrist have elastic bands attached to their 
upper extremities, terminating in thin leather straps. The latter pass over the friction rollers at the top of the instru- 
ment, turn downward, and are buttoned to knobs on either side. This makes perfect extension. 
" If the elbow requires extension, either in a straight or bent position, the same principle is perfectly available by 
merely varying the form of the tin case. The friction rollers so often referred to are the simplest possible things, they 
consist of simple pieces of strong wire soldered to the brace, so as to cross the desired edge of the slot. A little cylin- 
der of tin or brass loosely surrounds the wire, so as to revolve freely when the elastic band is drawn over it."- • 
E. Andrews, M. D. (See also pages 617, 618.) 
After Treatment. 
"Massage, Passive Motion.-There is no more efficient means for reducing capillary congestion and removing in- 
filtrated material from the tissues than gentle, free, but careful rubbing with the hand. There are those who pretend 
to possess remarkable healing power in their hands, and claim to be able to perform wonderful cures by rubbing, &c. ; 
but no one of any sense believes one individual possesses any special power over another in this direction. There is no 
reason why any surgeon should not possess the same power and afford the same benefit to his patients as any of the 
most successful manipulators. The occasional application of electricity may also be of service. But, in resorting to 
any or all of these measures, the great point to be taken into consideration is to carefully guard against carrying them 
to such an extent as to redevelop inflammation. If at any time you have been a trifle indiscreet, and have carried your 
passive movements too far, or have made your manipulations too freely, so as to cause pain which shall last for more 
than twenty-four hours after the manipulations have ceased, or give rise to the slightest elevation of temperature about 
the joint, place the patient in bed immediately and apply cold and absolute rest until all inflammatory action has sub- 
sided ; after which your passive movements short of exciting inflammation may be made as freely and as often as de- 
sired without danger."-" Orthopaedic Surgery and Diseases of the Joints." Lewis A. Sayre. 
Fig. 4126.-Fluhrer's Swinging Cradle. 
" Fluhrer's swinging 
cradle is for the purpose of 
securing rest of the extre- 
mities in treating inflam- 
mations. If one of the 
extremities is involved, an 
elevated position by means 
of the swinging cradle or 
upon a pillow, will, as a 
rule, give the greatest de- 
gree of comfort, especially 
in cases where, by reason of 
swelling, the circulation in 
the veins beyond the infil- 
trated portion is interfered 
with. In such conditions 
a flannel bandage, proper- 
ly applied from the end of 
the extremity up to the in- 
flamed area, will be advis- 
able."-"A Text Book on 
Surgery." Wyeth. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
671 
Of^THOja/EDIC. 
DISEASES OF THE JOINTS. 
After Treatment. Passive Movements. 
Fig. 4127.-Sayre's 
Knee Support, 
for After Treatment. 
"When the instrument (Fig. 4092) is removed, it is necessary fora time to apply 
some kind of apparatus to protect the joint against accidents, such as falls, trippings, 
&c., and also to prevent too free motion of the joint. For this purpose a piece of 
ordinary sole leather answers very well. 
"Again, firm support may be given to the limb, and at the same time motion of 
the joint allowed within the limits of safety by the use of the following splint. It 
consists of leather rawhide moulds, fitting the back part of the thigh and leg, and 
buckled in front. These are connected by lateral steel bars, jointed at the knee; 
the flexion and extension are made by means of a ratchet-and-cog wheel; at the 
back, there is also a spiral spring on the extending rod which permits limited motion 
when walking. A knee-cap retains the limb in its proper position in the splint 
when motions are made." 
Directions for Measurement. 
I. Circumference at upper third of thigh, Inches. 
2. Circumference above knee, . , " 
3. Circumference at knee, . " 
4. Circumference below knee, " 
5. Circumference above ankle 
6. Length from above ankle to knee " 
7. Length from knee to upper third of thigh " 
" There are some cases of chronic disease of the knee joint, however, in which 
anchylosis is the best possible result that can be obtained. Of course, the question 
whether you permit anchylosis to take place or not must be fully decided, if pos- 
sible, before you resort to passive movements. In some cases it may be impossible 
to decide this question until passive movements have first been tried. 
"If, after the application of the instrument, which shall maintain a constant extending and counter extending 
force, the joint disease goes on favorably and steadily toward a cure, and shows no disposition to recurrent attacks, 
you may reasonably expect that, when the inflammation has entirely subsided, passive movements and any other 
manipulations will restore the use of the joint completely. On the other hand, if there is a lurking tendency to 
the development of inflammatory action, in consequence of nearly every effort made for establishing a cure, whether 
it be in the way of passive movements or the ordinary means for affording extension and counter extension ; or, in 
some cases, apparently independent of any exciting cause ; in short, the diseased joint is frequently taking a new in- 
flammatory action, and behaves badly, you may have grave apprehensions respecting the future mobility of the joint, 
and may reasonably regard anchylosis as a very favorable result."-" Orthopaedic Surgery and Diseases of the Joints." 
Lewis A. Sayre, M. D. 
Anchylosis. 
"Complete or True.-Anchylosis is not a disease of itself, but may be the result of any disease, affection or injury 
which interferes with the normal functions and motions of a joint. Anchylosis may be the most favorable termination 
that can occur in many diseases and accidents of the joints. In such cases it is of the most vital importance that the 
surgeon should select the position most advantageous for the future usefulness of the limb thus involved. As, for in- 
stance, the elbow is more useful when anchylosed at a right angle than if made straight, whereas the knee would be 
entirely useless if anchylosed in the same manner. 
" It has been customary among surgeons, when anchylosis was the best result that could be obtained in any given 
case, to secure it with the leg flexed upon the thigh at an angle of 300 to 450. From this I dissent, and recommend 
to secure anchylosis at the knee joint with the limb in a nearly straight position. If left to anchylose at an angle, the 
anchylosis is very insecure, and sometimes, as the man steps down an unexpected distance, or slips, bringing his weight 
suddenly to bear upon the limb bent at this angle, it may yield sufficiently to give him very serious trouble. If, on 
the contrary, the bones are placed in the straight position as nearly as may be, the large articulating surfaces of the 
tibia and condyles of the femur give such an immense expanse for attachments to be formed as to render that portion 
of the limb even more secure against fracture than any other part of it. The straight position has been objected to, 
on the ground that it places the patient in a very awkward and inconvenient attitude when sitting. That may be 
true, but I regard a secure position which will, perhaps, prevent any accident, as being preferable to insecurity, al- 
though it be accompanied with a greater degree of comeliness. 672 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
DISEASES OF THE JOINTS. 
Anchylosis. 
False, Fibrous or Incomplete.-In chronic or long-continued inflammation of any joint, reflex irritation, producing 
muscular contractions, invariably takes place. This contraction not only aggravates the disease, by causing undue 
pressure on the parts inflamed, but also distorts the limb in accordance with the action of the most powerful muscles 
involved, and the distortion can only be prevented by the proper application of an extending and counter-extending 
force during the treatment of the disease. When this principle has been neglected, the patients frequently recover 
with such seriously distorted and useless limbs as to render surgical interference necessary. 
" In such cases it is of the utmost importance to ascertain whether the anchylosis be complete or incomplete, as 
the plan of treatment depends entirely upon the accuracy of this diagnosis. If fibrous, or incomplete, it can be 
broken up by manual or mechanical force, aided by subcutaneous tenotomy, myotomy, and the section of such fasciae, 
fibrous bands and other adhesions as have prevented its mobility ; whereas, if anchylosis be true or bony, the deform- 
ity can only be relieved by section of the bone itself with the saw or other instrument.* In many cases of simple 
fibrous or incomplete anchylosis, the adhesions are so firm and so short as to allow of no perceptible motion, even 
under a very careful inspection. If any motion whatever has been made, although so slight as not to be observed at 
the time, the parts which have been subjected to the violence necessary for the examination will on the following day 
give evidence, by pain, tenderness and inflammation, that some motion must have been given to the part involved. 
Breaking up Fibrous Anchylosis. 
" Having made our diagnosis that the anchylosis is fibrous, and not osseous, how shall it be broken up? 
" In former times gradual extension, with steaming and friction, was considered all that was necessary ; but the 
length of time demanded and the great pain induced by this method of treatment frequently prevented the patient 
and surgeon from carrying it to the completion of securing perfect motion. The slow and gradual stretching of tissues, 
long contracted, produces reflex contractions in many instances to such a degree as to compel the treatment to be aban- 
doned, and patients prefer to remain with their limbs in the distorted condition rather than undergo the constant pain 
of continued extension. In all such cases it is infinitely better to proceed to the immediate restoration of the joint 
to its normal position, with entire freedom and mobility, by manual force under the influence of an anaesthetic, com- 
bined with tenotomy or myotomy of subcutaneous section of the fascia, if necessary, than to resort to the slow process 
of gradual extension. 
"Brisement Ford.-It is of the utmost importance that manual force should not be resorted to for breaking up fibrous 
anchylosis until all traces of joint disease have subsided. Then we may resort to brisement force, and not until then. 
" How are we to decide whether tenotomy, myotomy, or the section of fascia is requisite ? 
" Put the parts upon extreme tension, and, while thus stretched, if point pressure by the finger or thumb made on 
the fascia thus stretched produces reflex contractions, then that fascia, tendon or tissue must be subcutaneously divided 
or else forcibly ruptured before the limb can be restored to its natural position. If the tissues thus contracted can be 
reached with the knife, without the danger of involving large bloodvessels or nerves, section by the knife is better 
than forcible rupture. If it is necessary to make this subcutaneous section, it is better to do it three or four days pre- 
vious to the breaking up of the joint, so that the external wound made by the tenotome may have healed before the 
latter operation is performed. This tenotomy may be performed under the influence of an anaesthetic or not, as the 
patient chooses ; but, when the brisement proper is performed, an anaesthetic is absolutely essential. In fact, it is due 
to anaesthesia that brisement force has gained its reputation, and to it chiefly owes its success. 
" The patient being thoroughly anaesthetized, the limb is seized by the hands of assistants, holding it with firm- 
ness between the joint involved and the trunk, while the surgeon takes the farther extremity of the limb and forcibly 
flexes it upon itself, which is frequently attended with sharp snaps and cracks that are sometimes quite audible and that 
are distinctly felt by the surgeon's hand while making the rupture. Having flexed it sufficiently to begin to allow of 
moderate movements, he then reverses the movement and forcibly extends it; and in this way, by forcible flexion and 
extension, continues until he has gained perfect and free motion of the joint involved, in all its normal movements. 
If the knee joint is involved, care must be first taken to fracture off the patella from its attachments to the femur,which 
is sometimes the most difficult part of the operation to be performed. Having thus obtained perfect extension and 
flexion, in fact the complete movements of whatever joint involved, these movements are repeated with great freedom 
and frequency until all the adhesions are thoroughly and completely broken up. 
" One of the commonest causes of failure in the treatment of fibrous anchylosis by brisement force is, that the sur- 
geon, succeeding in getting a moderate motion and becoming alarmed at the audible fractures that occur, contents 
himself with that slight motion for the present operation, intending to complete the cure by subsequent operations, 
and thus, by making frequent attempts to increase these slight movements, sets up a new inflammation in the parts 
involved, frequently resulting in a more firm consolidation of the joint than before ; whereas, by breaking up the 
* See Osteotomy, pages no, 616. GEORGE TIEMANN & SURGICAL CO.'S INSTRUMENTS. 
673 
ORTJHOP/EDIC. 
DISEASES OF THE JOINTS. 
Breaking up Fibrous Anchylosis. 
hesions thoroughly and completely at the time of operation, and then by proper dressings of the parts and the preven- 
tion of inflammation, he may confidently expect that he will have a much more satisfactory result. 
" How are these dressings to be applied? and how is this inflammation to be prevented? 
" This I look upon as the most important part in the treatment of an anchylosed joint. For many years past I 
have adopted the following plan. If, for instance, it be the knee which I have broken up for angular fibrous anchy- 
losis, I first strap the toes with strips of adhesive plaster, if it be a small subject, or, if an adult with long toes, pad 
the toes with cotton and bind with bandage, carrying the roller over the foot strongly and firmly, padding the malleoli 
and tendo-achillis with cotton ; the roller is carried snugly over them. Strips of adhesive plaster having been placed 
on either side of the leg for extension, the roller is passed over them, leaving the lower extremity of the adhesive 
plaster exposed for the future attachment of weight and pulley, and is carried up as far as the top of the tibia. The 
popliteal space is then padded and firmly strapped with strips of adhesive plaster, each one shingling over the other 
until the entire knee is covered. The roller is then continued over the knee smoothly and very firmly until we come 
to the junction of the middle and lower third of the femur, when a piece of sponge an inch or two in length, or about 
the size of one's thumb, first being wet in cold water, is placed over the track of the femoral artery, and the roller 
carried on over this sponge for the purpose of making partial compression of this artery, so as to diminish its calibre 
and thus prevent the full supply of blood to the part below. Great caution is necessary, in the application of this 
pressure upon the artery, not to obstruct the circulation so as to produce gangrene-we must here use pressure without 
abusing it. This piece of sponge should be kept soft and elastic by wetting it occasionally with cold water through the 
bandages. If permitted to get dry, it will be like a hard foreign body, and the pressure made upon it will be much 
more liable to cause sloughing. 
" The limb is then secured in absolutely immovable position, either by a wooden splint well padded placed behind 
the leg, gutta-percha, sole leather, plaster of Paris, iron bars on either side of it, or in any way that the surgeon may 
deem best for the purpose of preventing the slightest possible movement. The patient is then placed in bed, the lower 
extremity of which is raised ten or twelve inches higher than the head of the bed (so that the body may act as a coun- 
ter-extending force), and the weight and pulley applied over the foot of the bed to the strips of adhesive plaster at the 
ankle joint before described (Fig. 3913). Ice bags are then placed around the knee, and such constitutional treatment, 
in the way of narcotics, cathartics, &c., as may be required is judiciously used. At the end of six or seven days the 
dressings are removed, the sponge taken from over the femoral artery, the adhesive straps cut from over the knee, and 
the parts carefully examined, and a very slight movement given to the joint for the purpose of preventing solidification, 
when the dressings are reapplied with the sponge left off from over the femoral artery. At this dressing the surgeon 
will often be surprised to find ecchymosis to some extent, both above and below the joint, from extravasated blood 
caused by the rupture of vessels at the time of the operation; but, by following the plan I have here laid down, I have 
never seen a case that went on to suppuration since I have adopted this method of treatment. The extension is still 
continued and the elevated position of the limb is preserved for some days, until all danger of inflammation is past, 
the surgeon exercising his judgment whether the application of ice is still to be kept up or not. At the end of a few 
days the dressings are again removed, and more free motion is given to the part. It may be necessary at the time of 
making this movement, and the three or four subsequent movements, to administer an anaesthetic; these movements 
should be made quite free when an anaesthetic is used, the surgeon being careful not to cany them to the point of 
exciting new inflammation. 
"After some days the passive movements can be made daily, accompanied with friction, and shampooing should 
be very liberally done. These movements may be increased in frequency as the case advances, until, finally, an instru- 
ment can be so adjusted to the limb that the patient can cause the movements many times in the day without the at- 
tendance of his physician (see Fig. 4128). So soon as the parts can be pressed together by bearing the weight of the 
body upon the foot without tenderness, the extension can be omitted, and the movements daily increased. 
" These are the general principles which should guide you in the management of all cases of fibrous anchylosis, 
whether occurring at the hip, knee, elbow, or other joints. 
" When the hip joint is operated upon by brisement force, I usually secure the patient at once in the wire cuirass 
(Fig. 4080). The wire cuirass is also an exceedingly convenient instrument to be used when the knee-joint is broken 
up, especially in children. The circulation of the hip can be controlled by placing a bag of shot over the external 
iliac artery. 
" When the elb^w and wrist joints are operated upon, the sponge is placed over the brachial artery, for partial com- 
pression and control of the circulation, the same as already described when speaking of the femoral artery in reference 
to the prevention of inflammation of the knee. After the roller bandage and arterial compression have been properly 
applied, the joints are to be secured against the possibility of the slightest motion for a few days. After all danger of 674 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOf/EDie. 
DISEASES OF THE JOINTS. 
Breaking up Fibrous Anchylosis. Apparatus. 
producing inflammation has passed, then the same general principles laid down in the treatment of anchylosis of the 
knee joint are to govern us, such as friction, shampooing, passive motion, &c.-being careful never to carry treatment 
to the extent of reexciting inflammation. 
" By the plan of treatment here given I have never had a single case of constitutional fever or suppuration follow- 
ing brisement force of any of the joints ; but cannot urge too strongly the necessity of carrying out all the details of the 
after treatment I have laid down, for I have seen a number of cases in which brisement force has been performed by 
competent surgeons, they neglected to apply extension, and the result was that reflex muscular contraction followed, 
which prevented a successful termination of the operation ; or, they allowed a little time to elapse after the operation 
before the dressings were applied, and a reaction came on which prevented their application, and disastrous inflam- 
mation followed. I regard every detail of the plan of treatment as essential, and cannot urge you too strongly to ob- 
serve them all."-"Orthopaedic Surgery and Diseases of the Joints." Lewis A. Sayre. 
Fig. 4128. 
Long Anchylosis Splint. 
This apparatus is for overcoming muscular contractions of the knee joint and 
for favoring the re-establishment of motion in cases of false anchylosis. 
It consists of metal troughs, 1, 2, 3, for the reception of the thigh and leg, 
united by two lateral shafts, provided with joints at the knee and ankle and attached 
to a shoe. A knee cap, adjusted to buttons on the lateral shafts with strong elastic 
straps, exerts pressure on the patella, whilst the instrument may be flexed and ex- 
tended by means of a key (£■) and ratchet joint, opposite the knee. 
"It is an admirable apparatus for the gradual extension of contracted muscles 
and for favoring the re-establishment of motion in cases of false anchylosis, and of 
remaining stiffness and dryness after treatment of joint disease. By persistent and 
daily passive exercise a flexible and pliable joint may be restored without confining 
the patient to bed or room. The mechanism is powerful and may be moved swiftly, 
adapting it to the forcible breaking up of adhesions as well, should the surgeon pre- 
fer this to gradual extension. If desired, the instrument can be made to detach 
from the shoe, for the greater comfort of patients who are obliged towear the appa- 
ratus continually, but wishing to remove the shoe at night. It is also the best guard 
against malposition, for should it be deemed impossible to effect a cure the limb 
may be placed in a situation (to anchylose) most conducive to its future usefulness. 
Fibrous Anchylosis Apparatus. 
I. Patient's name and age. 
2. Long Anchylosis Splint, Fig. 4128. 
3. Right or left. Inches. 
4. Length from sole of foot to ankle joint (a), " 
5. Length from sole of foot to upper third 
of thigh (/), 
Directions for Measurement. 
Inches. 
6. Length from sole of foot to knee joint (</), " 
7. Circumference above ankle (3), ... " 
8. Circumference of calf (r), " 
9. Circumference of knee (d), . . " 
10. Circumference above knee (<?), ... " 
11. Circumference of thigh (f), . . . " 
I f you wish us to furnish shoes, send the following additional measurements : 
a. Length of sole of foot, Inches. 
b. Circumference of ball of foot, 
c. Circumference of instep, ... 
d. Circumference above ankle, .... 
Fig. 4129. 
Short Anchylosis Splint, for the Knee Joint. 
This is the same in principle as Fig. 4128, but consists of a 
thigh and a calf band only. It does not keep in place as well 
as the long splint, but answers well in slight cases. 
I. Short Anchylosis Splint, Fig. 4129. Inches. 
2. Circumference of calf, 
3. Circumference of knee 
4. Circumference above knee, . . 
5. Circumference of thigh, .... " 
6. Right or left leg? 
Directions for Measurement. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
675 
ORTHOP/EDIC. 
DISEASES OF THE JOINTS. 
Fig. 4130. 
Hooper's Knee Extension Splint, for 
Overcoming Muscular Contractions. 
Fibrous Anchylosis Apparatus. 
It consists of a band encircling the thigh, of another for the calf, and of 
one above the ankle. These are fastened to two lateral shafts provided with 
joints at the knee. Two semi-circular brass tubes, fastened to the lower 
calf shafts, contain each a spiral spring, acting on bows fastened to the thigh 
shaft, thus exerting constant elastic extension, which is sure to overcome 
muscular contraction soon. 
1. Hooper's Knee Extension Splint, Fig. 4130. 
2. Circumference above knee Inches. 
3. Circumference at knee 
4. Circumference below knee, 
5. Circumference above ankle 
6. Length from above ankle to knee, 
7. Length from knee to upper third of thigh, 
Directions for Measurement. 
Stromeyer's knee splint (Fig. 4131) is a simpler and lower-priced appa- 
ratus than those represented in Fig. 4128 and 4I29> but n°t so elegant in 
form nor so comfortable to wear. The cut explains itself. 
Fig. 4131.-Stromeyer's 
Knee Extension Splint. 
Directions for Measurement. 
Fig. 4132. 
Robert's Elastic 
Knee Extension 
Splint. 
I. Stromeyer's Knee Extension Splint, Fig. 4131. 
I. Patient's name. 
3. Patient's age. 
4. Right or left leg? 
5. Length from above ankle to knee joint, . . Inches. 
6. Length from knee joint to upper third of thigh, " 
7. Circumference above ankle, 
8. Circumference of the calf, 
9. Circumference of the knee, 
10. Circumference above the knee, 
11. Circumference of the thigh, 
Roberts' elastic extension apparatus (Fig. 4132), for an- 
chylosis of the knee joint, is exceedingly light. Owing to 
its elastic attachments, there is during locomotion a slight 
yielding of the instrument permitted, which renders it less 
irksome to the wearer than an absolutely rigid apparatus. 
The side bars are simple light strips of steel, fastened above 
to a well padded encasement for the thigh, and below to the 
sole of the shoe. At the knee and ankle are simple hinge joints. A is a semi-circular steel 
band, made fast to the side bars below the knee. Attached to it is an adjustable metallic 
arm, B, extending downward in a line with a spine of the tibia. A broad elastic band, E, passes behind the head 
of the tibia, and over the metallic arm, B, which serves as a fixed point for making elastic traction upon the poste- 
rior part of the head of the tibia. E is an elastic band passing from one side bar to the other in front of the thigh, 
thus keeping the instrument in the same relative position to that part of the limb. C is a short lever projecting for- 
ward and curved upward. To this is attached a strong strip of elastic webbing, C, D, which supplements the action 
of the quadruceps extensor muscle, and by means of which any desired amount of elastic tension can be effected. 
Measurements Required. 
1. Roberts' Elastic Knee Extension Splint, Fig. 4132. 
2. Patient's name and age. 
3. Right or left leg ? Inches. 
4. Length from sole to ankle 
5- Length from knee to upper third of thigh, 
6. Circumference above ankle, Inches. 
7. Circumference of knee 
8. Circumference above the knee, .... 
9. Circumference of the thigh, " 676 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTJHOP/EDIC. 
DISEASES OF THE JOINTS. 
Fibrous Anchylosis Apparatus. 
"a, a. Sheet steel pads, lined with chamois, embracing 
posterior half of leg and thigh ; b. A curved screw, on which 
a nut turns, to make forced extension ; c. Knee cap. 
" Many surgeons still rivet the thigh and leg pieces, 
a, a, fast to the rods that pass to the joint of each knee, thus 
making each arm of the apparatus a rigid lever. The evil 
of this plan is that, in spite of the knee-cap, c, when the 
extension force is applied, the centre of the instrument 
draws back a little, and the entire pressure is made at the 
upper and lower ends, near the hip and the ankle. Here 
the instrument digs painfully into the flesh, in spite of 
all precautions. To avoid this, the armor pieces, a, a, 
should hang by their centres, as a cannon hangs by its 
trunnions, by movable joints, so that they always apply 
themselves painlessly to the surface of the limb, pressing 
equally in all parts. This part of the plan has been in 
use quite a number of years, and seems to have occurred almost simultaneously to seve- 
ral surgeons, while it is still unaccountably neglected by others. Being an old device 
among mechanics, its invention cannot be specially credited to surgeons. The power re- 
quired for the extension has usually been obtained either by a straight brace screw behind 
the knee, or by a small endless screw on the side. The straight brace screw has the incon- 
venience of being in the way when the patient desires to sit in a chair. The endless 
screw-joint is by far the neatest and most compact power that has been used, but it has 
the objection of being expensive ; and, moreover, as it is so close to the centre of motion, 
the pressure of the teeth of the semicircle is immense, and not unfrequently breaks them. Expensiveness is a serious 
objection for great numbers of patients who need treatment ; I have, therefore, sought to combine the economy of 
the screw with the convenience of the endless screw-joint. For this purpose I attach on each side a simple screw, 
bent to a semicircle. The screw' is riveted firmly to the upper arm of the instrument, and runs through a perforated 
projection of the lower arm. A nut, turned by a key, furnishes the requisite pow'er to force the limb to a straight 
Fig. 4133.-Andrews' Instrument, 
for Straightening Bent Knees. 
position."-E. Andrews, M. D. 
Directions for Measurement. 
I. Andrews' instrument for straightening bent 
knees, Fig. 4133. 
2. Circumference at top of thigh Inches. 
3. Circumference above the knee, .... 
4. Circumference at the knee, 
5. Circumference below the knee Inches. 
6. Circumference about the ankle, .... 
7. Distance from centre of knee to perinaeum, " 
8. Distance from knee to above maleolus, . " 
9. Right or left leg ? 
The apparatus here represented is for the gradual extension of contracted 
muscles. By persistent and daily passive and active exercise, a flexible and useful 
joint may be restored. It may also be used for forcible breaking up of false an- 
chylosis, if the surgeon prefers this to gradual extension. It forms also a safeguard 
against malposition, for should it be deemed impossible to effect a cure, the arm 
may be fixed in such a position to anchylose as shall give it the greatest usefulness. 
Fig. 4134. 
Stromeyer's Elbow Splint. 
Directions for Measurement. 
1. Stromeyer's Elbow Splint, Fig. 4134. 
2. Right or left arm ? 
3. Length from wrist to elbow joint {A to C), Inches. 
4. Length from wrist to axilla (J to D) " 
5. Circumference of wrist (A), .... " 
0. Circumference of forearm (2?), " 
7. Circumference of elbow joint (C), " 
8. Circumference of arm (22), " GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
677 
ORTHOPAEDIC. 
THE SPINAL COLUMN. 
Vertebrae. 
" The spine is a hollow bony column, sustaining nearly the entire skeleton, and forming the principal lever of the 
body. Running along the entire length of the trunk, the portions included in the neck, the chest, the loins, and the 
pelvis have been designated respectively cervical, dorsal, lumbar and sacral or pelvic. Omitting the sacral portion, 
the column is formed of twenty-four bones (vertebrae), arranged one above the other. Seven of these vertebrae are 
included in the cervical region, twelve in the dorsal and five in the lumbar. These constitute the true vertebrae. The 
sacral portion is formed of nine vertebrae (five being united together to form one bone, the sacrum ; four being rudi- 
mentary, constituting the coccix); these nine are termed false vertebrae. 
" Viewed sideways the spine presents several alternate curves. These are four in number. The column arches 
forward in the cervical and lumbar regions and backwards to the dorsal and sacral. Thus, looking forwards, the 
column is convex in the neck and loins and concave in the back and pelvis. In the rear the curves are in an oppo- 
site direction to those viewed from the front. The first three curves have a direct dependence the one upon the other. 
For example, if the cervical convexity be more marked than common, the dorsal and lumbar curves will be found also 
to be more convex. The mutual relationship of the curves is such that the least modification of one brings about a 
corresponding modification in the others. Notwithstanding this, it has been found impossible to submit these curves 
in the living subject to a rigid calculation. The varying conditions of the living body set at defiance those exact 
measurements which can be applied to inorganic substance. The mechanism of the spinal column is very wonderful. 
Singularly rigid in structure, it is, nevertheless, exceedingly light and possesses rare elasticity and pliancy-a combination 
of mechanical properties which man has in vain attempted to imitate. The numerous bones of which the column is 
built, while securing mobility, do not, against all human estimates of probability, sacrifice solidity. It happens, 
indeed, as Cruveilhier has shown, that the numerous articulations by which the vertebrae are connected, are all seats of 
force when the spine is subjected to shocks. A portion of the movement impressed upon the column produces slight 
displacement of the articular surfaces, and this portion is entirely lost for the transmission of the shock. If the ver- 
tebral column were formed of one piece, a force impressed, being transmitted without any loss, would be much more 
apt to occasion injury to the structure of the nervous centre which it sheathes. The aptitude to suffer from shock is 
still further diminished, and the mobility of the column increased, by the interposition of a thick elastic cartilage 
between each pair of vertebrae. The canal which traverses the column, for the reception of the spinal marrow, serves 
also the same purpose as the cylinder of the long bones, that is to say, it augments the resistance without increasing 
the weight. The alternate inflections of the column permit much greater variations of its centre of gravity than if the 
vertebrae had been arranged rectilinearly, while at the same time they increase the vertical motion. 
" The different vertebrae are firmly bound together by strong elastic ligaments, and the whole spine is stayed, so to 
speak, by numerous powerful muscles. The ligaments, by their great elasticity, incessantly struggle against those 
causes which tend to throw the column awry. They exercise also an important influence in maintaining the curves. 
But the ligaments and the wonderful articulation and construction of the spine would not, without the aid of the 
powerful muscles which occupy the grooves of the column and are attached to its numerous processes, suffice for the 
maintenance of the erect position. The force of the muscles is exactly proportionate to the weight they have to over- 
come. Hence, in health, the act of standing occurs without perceptible effort. The erect position is not, however, a 
state of repose, as is shown by the sensation of fatigue in the lumbar region after long standing, and the relief afforded 
by resting the body forwards. As an organ of support for the head and trunk, the spine has a solid base of sustenta- 
tion at its junction with the pelvis. In whatever position the body may be placed the spine at this point remains in 
a quiescent state. 
"When the spinal column is in motion, the centre ©f gravity, according to the researches of Weber, is placed 
within the area of junction between the column and the pelvis, and it rarely rises more than a slight space above the 
point of attachment. Hence the equilibrium between the head and the body is left almost undisturbed."-" Ortho, 
praxy." Heather Bigg. 
Spinal Curvature. 
"The spine is subject to various deviations, malformations, or deformities, known by the general appellation of 
curvature. The abnormal deviations of the spine may be arranged under the three heads of lateral, posterior and 
anterior, their respective frequency being in the order here stated. From this list I purposely exclude that form of 
curvature caused by tuberculosis, caries, or Pott's disease of the spine, and generally known as angular czirvatztre. 
These several deformities may exist singly, as the only departure from the natural standard, or, as not infrequently 
happens, they may occur in connection with each other. However this may be, they all are due, as was long ago cor- 
rectly remarked by Cruveilhier, to the following causes : I. The wasting of the vertebrae by caries or softening; 2. 
Want of equilibrium between the strength of the vertebral column and the weight of the body, either alone or when 
oppressed by burdens ; 3. Muscular traction ; 4. The frequent repetition of any attitude in which the column is 
bent."-"System of Surgery." Gross. 678 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPEDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Caries, Spondylitis, Angular Curvature or Pott's Disease. Braces, 
Fig. 4135.-Angular Cur- 
vature of the Spine. 
"Angular curvature, or Pott's disease, is caused by inflammation of the bodies of 
the vertebrae and of the intervertebral substance, usually commencing in the latter. 
It is often accompanied with tubercle, and some hold that it is essentially a scrofulous 
disease. The immediate cause of the curvature is caries, and it most commonly shows 
during the period of bodily development, usually attacking the lower dorsal region. 
Recovery sometimes takes place without pus making its appearance, but ' spinal ab- 
scess ' is a common accompaniment, the pus pointing in the groin and finding its way 
from the dorsal region beneath the fascia of the psoas muscle, under Poupart's liga- 
ment, forming what is known as * psoas abscess.' The pus sometimes burrows beneath 
the muscles and involves the whole thigh. The abscess sometimes appears above Pou- 
part's ligament and sometimes in the loin, forming in the latter case * lumbar abscess.' 
When the cervical vertebrae are affected, the abscess appears in the pharynx. Angular 
curvature is not difficult of diagnosis, as the ill health, suppuration and deformity are 
highly indicative. The initiatory symptoms are also not obscure, the principal being the 
persistent local pain and difficulty in bending the back, accompanied by great general 
disturbance and hectic fever. After curvature has taken place recovery is always accom- 
panied by anchylosis, from union of newly-formed bony tissue. 
" The treatment requires careful attention to the general health, including good diet 
and the employment of tonics and alteratives, such as iron, quinine, iodine and cod- 
liver oil. The local applications of fomentations and leeches and counter-irritants are 
also serviceable. Setons, moxas, and mercury, as tending to exhaust the strength, are 
to be avoided. On getting up, the patient's back should be supported by some kind of me- 
chanical appliance. The abscess should not be opened too hastily, for it may be absorbed ; 
but when it progresses steadily a free opening should be made under a piece of lint satu- 
rated with carbolated oil, to prevent entrance of air."-"American Cyclopaedia." 
" Destructive ostitis of the vertebrae, commonly known as Potts' disease, occurs usually between the third and fif- 
teenth year of life. It is a disease of the growing period, when rapid nutritive changes are taking place in the bones. 
While no portion of the spine is exempt, the disease is much more frequent in the dorsal vertebrae. Judicious medi- 
cation, good food and pure air are the indications in the constitutional treatment. In the mechanical treatment the 
indications are to secure fixation of the spinal column in the position of least discomfort to the patient. The char- 
acter of the mechanism to be used will depend in good part upon the portion of the vertebral column involved."- 
" Text Book on Surgery." John A. Wyeth, M. D. 
"The principles which ought to govern the 
construction and application of mechanical sup- 
ports, in cases of caries of the spine, are the 
greatest degree of lightness compatible with the 
requisite firmness ; accurate adaptation ; pressure 
in opposing directions upon the spinal column, 
sufficient to secure support and steadiness, and to 
transfer, in some degree, the weight of the spinal 
column from the affected'vertebrae to their corre- 
sponding oblique processes, while at the same 
time these vertebrae shall not separate from each 
other in a manner to defeat the end desired, 
namely, their final union and consolidation by 
callus ; the pressure being so applied on either 
side of the spinous processes, and not upon the 
processes themselves, so that it shall cause the 
least pain and not endanger ulceration or excoria- 
tion, giving support to the tumid or pendulous 
belly ; interfering in no way with the free mo- 
tions of the arms or legs. These indications we 
find more or less completely fulfilled in the appa- 
ratus of Davis, Bigg or Taylor."-" Principles 
and Practice of Surgery." Hamilton. 
Fig. 4136.-Davis' Apparatus 
for Caries of the Spine. 
Fig. 4137.-Taylor's Appa- 
ratus for Caries of the Spine. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
679 
ORTHOP/EDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Caries, Spondylitis, Angular Curvature, Pott's Disease. Braces. 
" Some years ago it became necessary for me to have constructed a brace for the 
treatment of angular curvature of the spine, a considerable number of such cases 
having been quite suddenly thrown upon my hands by the resignation of a consulting 
orthopaedist to St. Luke's Hospital, New York. It was my desire to obtain an appa- 
ratus, which, while fulfilling the indications perfectly, should be simple in construc- 
tion and not expensive. 
" In the accompanying figure aa is a steel band, which passes half way around the 
pelvis, just above the trochanters ; bb are two flat bars of steel, parallel to each other, 
and curved upon their flattened sides to the form of the spine to which the apparatus 
is fitted. These bars are curved a little less than the spine, so that, when secured in 
position, their elasticity will constantly operate to rectify the spinal curve. The cross 
bar at the upper ends of the parallel ones is firmly riveted to them, and is to cross the 
back just above the spines of the scapulae. At the ends of this bar are affixed buckles 
to receive the shoulder straps ; cc are two movable pads which slide upon the bars 
to which they are attached-these are best stuffed with chopped cork. These com- 
presses are to be brought one upon each side of the projecting knuckle of spine and 
secured firmly by means of the screws provided for that purpose. Buckles are 
attached to various parts of the brace, by means of which it is secured to the front 
part of the apparatus, which consists, as shown, of a piece of twilled muslin, or other 
strong material, which covers the chest and abdomen and is provided with straps. 
Such parts as are in contact with the body are carefully padded. 
" Success with this apparatus depends entirely upon the faithfulness with which it 
is kept adjusted to the spine of the patient. It is only necessary that a gentle pres- 
sure should be maintained if it is constant. As the spine approaches its normal shape 
the curve of the brace will require to be altered from time to time. The steel has a 
soft temper, so that it will take the form into which it is bent when considerable 
power is applied, but will be sufficiently elastic for the purposes of this apparatus."-Washburn. 
" The downward pressure upon the bodies of the vertebrae and their breaking down, can be in great part obviated 
by backward bending of the spine, in which manoeuvre the pressure is transferred from the bodies and intervertebral 
disks to the articular processes and pedicles. The spinal braces of Drs. Davis, Taylor, Shaffer, Washburn, &c., have 
been constructed with the view to accomplish this. In appropriate cases each of these forms of apparatus, if properly 
adjusted and intelligently worn, will accomplish all that is possible in the mechanical treatment of Pott's disease. 
Much of the discredit which is brought upon particular apparatus, can justly be 
charged to the lack of judgment in the selection of cases, want of skill in the 
adjustment of the instrument and failure on the part of the attendant or patient 
in persisting in its use a sufficient length of time."-"Text-Book on Surgery." 
John A. Wyeth, M. D. 1887. 
Fig. 4138. 
Washburn's Spine Brace. 
Fig. 4139. 
Measurements Required for Figs. 4136, 4137 and 4138. 
I. Davis,' Taylor's or Washburn's Brace. 
2. Patient's age, name (or sex). 
3. Patient's weight (estimated). Inches. 
4. Distance from sacro lumbar articulation to vertebra promi- 
nens (C to D), " 
5. Distance from sacro lumbar articulation to first vertebra in- 
volved C to C), " 
6. Distance from sacro lumbar articulation to the last vertebra 
involved (C to D), " 
7. Distance from crest of ilium to axilla, right side (A to H), . " 
8. Distance from crest of ilium to axilla, left side (A to JE), 
9. Distance from the centre of one scapula to the centre of the 
other {E to E), " 
10. Horizontal (transverse) diameter of the protuberance, . 
11. Circumference of chest under axilla (H) " 
12. Circumference of pelvis one inch below the iliac crests, . 
nens (C to E), 680 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHO^/EDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Caries, Spondylitis, Angular Curvature, Pott's Disease. 
" Pott's Disease.-This name was applied to this disease because Percival Pott first accurately described it in 1783 ; 
but it should be called spondylitis, from arrovdvAOf, a vertebra, as this name gives an accurate idea of its pathology 
and also its location, viz.: an inflammation of the vertebra. This disease may occur at any period of life, but is much 
more likely to occur in childhood, and especially in those children who are reckless and careless and expose themselves 
to all sorts of accidents. It also occurs more frequently among boys than among girls, because they are more exposed 
to accidents. With regard to this affection I have arrived at the conclusion, based upon an accurate and carefully 
recorded experience, that it is produced almost always, if not always, by some injury to the bone or cartilage, and is 
hence traumatic in its origin. 
" By the profession in general, Pott's disease, above all others, has been considered as essentially of strumous ori- 
gin ; as depending upon a tuberculous diathesis, and not occurring unless constitutional dyscrasia is present; but, in 
my own judgment, it much more frequently depends upon some injury than upon any constitutional condition. The 
very fact that hundreds of people are walking about distorted-in many cases to a great degree-and yet remain in 
this condition and enjoy an average degree of health until they have reached a good old age, is evidence that the dis- 
ease which has produced the deformity is not necessarily tubercular in character. The accidents which produce this 
disease are usually concussions and blows. Those children who are generally full of play may, in some of their care- 
less pranks, jump from some height and come down straight without bending the knees or hips, thereby giving a 
sudden and severe concussion to the bodies of the vertebras and their intervetebral disks of cartilage, and in this 
manner disturbing some centre of ossification to such an extent that inflammatory action follows and the case termi- 
nates in inflammatory softening and disintegration of the bone itself. 
"After such disturbance or separation of one or more ossific centres of the vertebrae, several months may elapse 
before attention is drawn to the case, and perhaps by that time the bones have been partially destroyed and the 
distortion developed. Then it is said at once that the exhausted condition which may be present is evidence of con- 
stitutional cachexia, whereas it is simply the result of long-continued suffering from a local disease dependent upon 
some direct injury to the parts involved. Abscesses, commonly known as psoas or lumbar abscess, are quite frequently 
developed in connection with this disease, and the pus formed among the diseased vertebrae becomes imprisoned by 
the fibrous tissue with which it is surrounded, and does not reach the surface, in many cases, as in an ordinary abscess, 
but must travel along under the sheath of the tendons until it reaches the point where psoas abscesses usually show 
themselves. This may require a long time and give rise to serious constitutional disturbances. In some cases these 
abscesses penetrate the tissues and present themselves between the ribs. When the disease has advanced so far that 
inflammatory softening and degeneration of the bone are present, the weight of the body upon the inflamed and 
degenerating parts will cause absorption to take place, which will go on most markedly upon the anterior portion of 
the bodies of the vertebras ; and, as they lose their thickness at this point, the bodies fall together and this causes the 
spinous processes to assume a peculiar shaped prominence, which has given rise to the name, posterior angular curva- 
ture. 
" Symptoms.-The symptoms of this disease vary according to its location in the spinal column. When it has 
advanced far enough to produce a deformity, there is usually no difficulty in diagnosis ; but the disease has existed 
long before the deformity is observed ; and the important point is to diagnosticate the disease before the deformity occurs. 
The symptoms at the beginning are sometimes very obscure ; but the nerves that make their exit from the spinal canal, 
at points opposite to the seat of the disease, becoming more or less involved, will manifest such disturbance by symp- 
toms developed at their distal extremities. For instance, if the disease is situated in the cervical region, long before any 
distortion appears the patient will complain of difficulty in swallowing ; many have a choking sensation, as if there 
were a string around the neck; difficulty about the larynx, producing an irritable and continued cough; pain in the 
thorax, &c. Such symptoms may be the only ones present that will attract attention, but they are sufficient to arouse 
your suspicions, and, if you cannot, by means of the laryngoscope and physical examination of the chest, detect any 
disease of the larynx or lungs, or any of the thoracic organs, sufficient to account for the symptoms present, you should 
at once make a thorough examination of the spine. 
" When the disease is in the dorsal region the patient very often complains of pain in the lower part of the chest 
and upper part of the abdomen ; also a constricting sensation, as if a band were around the body ; complains more or 
less of indigestion and flatulence, and may have been treated for dyspepsia. He may also complain of pain in the 
chest, pain about the heart, and perhaps may have been treated for rheumatism. 
"Again, when the disease is lower down in the spinal column, he may have a sense of constriction about the 
abdomen, may suffer from constipation and flatulence, and perhaps have been treated for worms. When the dis- 
ease is still lower in the spine, the leading symptoms may be referable to the bladder and rectum. The chief symp- 
tom may be frequent desire to pass the urine. The patient may also suffer from radiating pains down the thighs. When 
such symptoms are present and they cannot be explained by the presence of some well-recognized disease, always go back GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
681 
ORTHOP/EDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Caries, Spondylitis, Angular Curvature, Pott's Disease. 
to the point where the nerves distributed to these regions make their exit from the spinal canal, and carefully examine 
the bony structures which surround them. Early in the progress of the disease reflex contractions are excited among 
the muscles, which result in a change in the appearance and action of the child that is worthy of special attention. 
" Every joint of the lower extremities is bent, for the purpose of preventing any concussion from affecting the 
bodies of the vertebrae. The chin is made to project, the shoulders become elevated, and it is impossible for the child 
to stand upright and receive any concussion whatever, which may be communicated to the bodies of the vertebrae, 
without suffering pain. The muscles of the back are held rigid, in order to prevent any movements of the bodies of 
the vertebrae upon each other. The child is unable to stoop down and pick up any object upon the floor, but, if 
asked to do so, he begins by bending his hips, and then his knees, and finally reaches the object by squatting down to 
it. These patients never bend the back forward, for bending it thus presses the bodies of the vertebrae together and 
gives rise to pain ; consequently all the movements of the child are directed in such a manner as to prevent any motion 
in the spinal column. When walking about the room the child will reach with his hands from one article of furni- 
ture to another, making careful calculation that he shall not be deprived of* the support furnished by one object before 
he receives that derived from another. If he cannot obtain any support by catching hold of various articles within 
reach, he will rest his hands upon his thighs, in order to transmit the weight of the head and shoulders through the 
legs to the ground, thereby giving them support without bearing upon the diseased vertebrae. When the child is walk- 
ing about, particularly if the disease is in the dorsal or lower cervical region, he breathes in a short, grunting manner, 
because of the constant effort on the part of the muscles to hold the trunk still. In other words, there is a constant 
effort to put a muscular splint on the child's body to prevent motion in the spinal column, and thus the child by his 
short, grunting breath and muscular rigidity, is trying to teach us doctors what the indications for treatment are in his 
case. The pressure upon the intercostal nerves is sometimes so great as to produce almost spasmodic respiration. 
When, therefore, a case presents .itself in which the patient complains of cough, indigestion, disturbances about the 
bladder or rectum, or constant and persistent pain in the chest or abdomen, and you are not able to detect any disease 
of the lungs, stomach, liver, or other organs, which will account for the development of such symptoms, do not fail to 
examine the spine. The question now arises, How is this to be done? In the first place, put some object upon the 
floor and ask the child to pick it up, and then carefully note the position he assumes while performing the act. If the 
vertebrae are diseased, he will squat down and pick up the object in the manner just described and rise up in the same 
careful way that he went down, keeping the back as nearly straight as possible and allowing no movements in the 
spinal column which he can prevent. He never bends over like a healthy child, but keeps his spinal column as free 
from movement as possible. 
"You will then strip the child naked and lay him across your lap, face down, with the arms over one thigh and 
the legs over the other, and then gradually separate your thighs. When that is done the first thing you will notice, 
probably, will be that the child takes a long breath, a long-drawn sigh of relief, a full inspiration and complete expir- 
ation. As long as the child is held in that manner he will be perfectly comfortable and breathe easily, if you do not 
carry the extension so far as to produce reflex muscular contraction. Then close the thighs again and the muscles are 
at once excited to contract, and the child again begins his short, catching respiration. There may be more or less 
spasmodic muscular action all over the body when the extension is removed ; but, if there is not, it can be very easily 
developed by placing one hand upon the head and the other under the sacrum and crowding the bodies of the vertebrae 
together. The instant this is done you will see a spasm, probably of both legs and arms, and the child will cry out on 
account of the pain ; but, the moment extension is made, he is perfectly easy again. Now, all this can be done when 
the disease is in the anterior part of the bodies of the vertebrae, or in the vertebral disks ; but it may be, in the case 
which you are examining, that the anterior portion of the body and the disks have not yet become involved, and yet 
the child is suffering from spondylitis. For, when the dorsal portion of the spinal column is affected, the disease 
does not always attack the anterior portion of the bodies of the vertebrae at first, but the part most extensively 
involved may be upon the sides of the vertebrae, where they form a junction with the ribs. 
" In these cases the blow or injury is generally received upon the sides of the body, and the heads of the ribs are 
driven against the vertebrae with such force as to give rise to a starting point for an inflammation. Consequently you 
must not be content with examining the spinal column, as far as the bodies of the vertebrae alone are concerned, but 
you must test the sides of the vertebrae by pressing the heads of the ribs against their articulating facets. You may 
be able to press the spine down without producing pain, percuss the spine without producing pain and the spinal 
column may apparently be straight, all of which might lead you to the conclusion that it is not diseased ; but pressure 
upon the ribs, which will bring their heads in contact with the articulating facets, gives the patient pain and at once 
you have evidence of diseased vertebrae. By pressing upon the ribs separately in this manner, the exact location of 
the disease can be determined. 682 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPEDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Caries, Spondylitis, Angular Curvature, Pott's Disease. 
" If the disease be located in the anterior portion of the vertebrae, the child being then placed across the lap, and 
extension made, a moderate downward pressure upon the spinous processes will make him more comfortable. 
The fact that pressure can be made over the spinous processes without causing pain, is regarded by many as 
evidence that no disease of the bones is present. But it is the anterior portion of the body of the vertebrae that is 
affected, and, when these begin to give way, the spinous processes begin to project, and by crowding upon them we 
remove the pressure from the diseased surfaces, and consequently the suffering of the patient is diminished. There are 
some cases in which no definite symptoms can be obtained by examining the patient in the manner described. In 
such cases the application of ice or intense heat may be of service ; for the nerves, made irritable by the disease, will 
receive impressions much quicker than they do normally, so that when a piece of ice, or a vial or thimble containing 
hot water, is passed along the spine, no response is obtained until the point opposite the disease is reached, when there 
will be a sudden movement of the body, as if to get out of the way of the irritant. On the same principle Dr. Rosen- 
thal has advised.the application of a strong faradic current to test the different points of sensibility along the spinal 
column. In this manner you will sometimes be able to spell out cases which cannot be easily examined in any other 
way, and also by the delicate surface thermometer (Fig. 1017) devised by Dr. Seguin, of this city, you will be able to 
detect an elevation of temperature over the inflamed part that you could not otherwise discover. * * * * 
"As to the theory relating to the etiology of the disease I simply wish to make these points: That it is the result of in- 
jury in almost all cases ; this injury is followed by inflammatory action ; it can be diagnosticated by making extension and 
counter extension upon the spine and by pressure upon the sides of the vertebrae ; also by symptoms referable to the 
distal extremities of the nerves involved in the disease, long before the deformity is produced, and, being detected in 
this early staee, can frequently be cured without any deformity occurring. 
" Treatment.-In the earlier stages (and it is dur- 
ing this period that treatment is most important) there 
is nothing which can compare with rest and freedom 
from pressure, absolute and complete. For pressure 
upon the parts diseased causes more rapid softening, 
degeneration and absorption, and in this manner a 
permanent deformity may be very rapidly developed. 
The great object in the direct treatment of spondylitis 
is to maintain rest and freedom from pressure of the 
affected parts, by such means as will not debar the 
patient from the benefits of fresh air, sunlight and 
change of scene. The patient should not be permit- 
ted to assume the upright position before he has been 
fitted with some artificial support capable of remov- 
ing all pressure from the bodies of the diseased ver- 
tebras. This can be done only by an accurately fitting 
apparatus applied to the body itself when extended." 
"This plan of applying a plaster dressing com- 
pletely around the body, from the pelvis to the ax- 
illae, has constituted almost the only treatment which 
I have adopted for spondylitis. I have used it in 
many hundreds of cases, and in each instance with 
great benefit. 
"Preparation of the Bandages.-The bandages 
used in the application of this treatment must con- 
sist of some loosely woven material, such as cross- 
barred muslin, mosquito netting or crinoline. This 
should be torn into strips, three yards long and from 
two and a half to three inches wide, according to the 
size of the patient upon whom it is to be used. Its 
meshes must be completely filled by drawing the 
bandage through very fine and freshly-ground plaster 
of Paris that has not long been exposed to the air- 
this plaster at the same time being thoroughly rubbed 
into the material. Each strip should then be loosely 
Fig. 4140.-Sayre's Plaster of Paris Jacket. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
683 
ORTHOPEDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Caries, Spondylitis, Angular Curvature, Pott's Disease 
rolled up, so as to form an ordinary roller bandage. Several of these band- 
ages thus prepared may be kept ready for use in an air-tight tin vessel. 
When required, they are set on end, one at a time, in a basin containing 
sufficient depth of water to cover them entirely. A free escape of bubbles 
of gas through the water will be observed for a short time ; when this 
has ceased, the bandage is ready for use. 
"Preparation of the Patient.-The surface of the skin should be pro- 
tected by an elastic but closely fitting shirt or vest, without armlets, but 
with tabs to tie over the shoulders, and composed of some soft woven or 
knitted material. 
"For the purpose of suspending the patient during the application of 
the dressing, I make use of a very convenient apparatus, which consists of 
a curved iron cross-beam, to which is attached an adjustable head-and- 
chin collar with straps, and also two axillary bands. To a ring in the centre 
of the bar is hooked a pulley, the other end of which is secured either to a 
hook in the ceiling or to the top of an iron tripod about ten feet in height. 
" The head-and-chin collar and the axillary supports having been care- 
fully adjusted, the patient is gradually drawn up until he feels comfort- 
able. Before applying the plaster bandage, I place over the abdomen, 
between the shirt and the skin, a pad composed of a towel folded up so 
as to form a wedge-shaped mass, the thin edge being directed downward. 
This is intended to leave room, when removed, for the expansion of the 
abdomen after meals, and so I call F the 'dinner pad.' It is important 
to make it thin where it comes under the lower edge of the jacket, or else 
the jacket would fit too loosely about the lower part of the abdomen. It 
should be taken out just before the plaster sets. It is always a good plan to get the patient to eat a hearty meal before 
the jacket is applied, but this precaution of allowing room for meals should never be neglected. 
" If there are any very prominent spinous process which, at the same time, may have become inflamed in con- 
sequence of pressure produced by instruments previously worn, or from lying in bed, such processes should be guarded 
by little pads of cotton or cloth, or little glove fingers filled with wool placed on either side of them. Another detail, 
which I have found to be of practical value in some cases, is the application under the shirt, over each anterior iliac 
spine, of two or three thicknesses of folded cloth three or four inches in length. If these little pads be removed just 
before the plaster has completely set, such bony processes will be left free from pressure. 
" If the patient be a female, and especially if she be developing at the time, it will be necessary to apply a pad under 
the shirt over each breast before the plaster bandage is put on. These pads should be removed just before the plaster 
sets, and at the same time slight pressure should be made over the sternum for the purpose of indenting the central 
portion of the plaster jacket, and of thus giving form to the body, and of removing pressure from the breasts. 
" The skin-fitting shirt having been tied over the shoulders and then pulled down, and kept stretched by means of 
tapes applied, one in front, the other behind, near its lower edge, and tied tightly over a handkerchief placed on the 
perinaeum, the patient is to be gently and slowly drawn up by means of the apparatus until he feels perfectly comfort- 
able, and never beyond that point, and while he is retained in this position the plaster bandage is to be applied. 
"A prepared and saturated roller, which has been gently squeezed to remove all surplus water, is now applied around 
the smallest part of the body, and is carried around and around the trunk downward to the crest of the ilium and a 
little beyond it, and afterward from below upward in a spiral direction, until the entire trunk from the pelvis to the 
axillae has been encased. The bandage should be placed smoothly around the body, not drawn too tight, and especial 
care taken not to have any single turn of the bandage tighter than the rest. Each layer of bandage should be rubbed 
most thoroughly with the hand by an assistant, that the plaster may be closely incorporated in the meshes of the crino- 
line, and bind together the various bandages which make up the jacket, thus making it much stronger than if attention 
is not paid to this particular. If you notice any spot which seems weak or likely to give way, pass the*bandage over it 
and then fold it back on itself, and do this until you have placed several thicknesses of bandage over this point, being 
careful to wet all well together, and then pass a turn completely around the trunk to retain any ends which might 
have a tendency to become detached. 
" In a very short time the plaster sets with sufficient firmness, so that the patient can be removed from the sus- 
pending apparatus and laid upon his face or back on a hair mattress, or-what is preferable, especially when there is 
Fig. 4141.-Suspension Apparatus. 684 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
O^THOp^EDie. 
SPINAL DISEASES AND DEFORMITIES. 
Caries, Spondylitis, Angular Curvature, Pott's Disease. 
much projection of the spinous processes or sternum-an air-bed. Before the plaster has completely set, the dinner 
pad is to be removed and the plaster gently pressed in with the hand in front of each iliac spinous process, for the 
purpose of widening the jacket over the bony projections. In the case of a young child with a small pelvis it may 
happen that the circumference of the body at the umbilicus is as great as around the pelvis, but, as the soft parts in 
the lumbar region allow us to mould the plaster as we choose, you can still obtain a point of support at the pelvis ; if, 
as the jacket hardens, you will press it in at the sides above the ilium and in front and rear gbove the pubes, the 
antero-posterior diameter above will be longer while below it will be the transverse one. 
' If any abscess be present, they must be freely opened antiseptically, at the most dependent part, and their con- 
tents completely abstracted. The surgeon will occasionally find large masses of sloughing connective tissue, having 
the appearance of wads of wet cotton, all of which should be removed. After each abscess has been thoroughly evac- 
uated, fill the cavity with Peruvian balsam, place oakum over the opening and cover it with a piece of oil-silk. Then 
place on this a piece of folded pasteboard somewhat larger than the abscess, carrying a long sharp pin through its 
outer leaf. Now pull down the shirt and the pin will project, indicating the point of the abscess, and each turn of 
the bandage can be carried over the pin without forcing it into the abscess cavity below, and the surgeon is furnished 
with a guide in making an opening which shall lead directly to the diseased surface. When the plaster has nearly 
set, the bandage should be cut away around the pin until the shirt is reached, when the latter should be starred, or cut 
in strips from the pin till an opening has been made of sufficient size to remove the pasteboard. The oil-silk which is 
then exposed should be starred in the same manner from the centre, so that when the strips are reversed they will 
cover the edges in the opening of the plaster, where they can be glued down with gum shellac. In this manner you 
will establish a fenestra for drainage that leads directly to the abscess. 
" There are some cases of spondylitis in which the cervical or upper dorsal vertebrae, or both together, are involved. 
In these cases, treatment by the plaster jacket alone can do but little if any good. It then becomes necessary to treat 
the disease by the use of an instrument which I call the 'jury-mast.' This consists of two pieces of malleable iron, 
bent to fit the curve of the back. To the lower portion are attached two or more strips of tin, long enough to go 
nearly around the body. These strips are roughened like a nutmeg grater, by having holes punched through them in 
both directions, in order to firmly fasten the strips to the jacket. The tins must be 
rough on both sides, else the layer of the jacket on the smooth side will not hold 
the tin, and the jury-mast will slip up and down. 
" From two cross-bars at the upper extremity of the curved iron pieces springs 
a central steel shaft, carried in a curve over the top of the head, and capable of 
being elongated at will. To this is attached at its upper extremity a swivel cross-bar 
with hooks, from which depend straps supporting a head-and-chin collar. This 
cross-bar must be placed above the curved steel arm, or it will be liable to become 
detached, owing to the constant traction on the screw by which it is held in place. 
" The apparatus is thus applied: The patient, having been encased in the usual 
manner in a few thicknesses of plaster roller, the jury-mast is put on over this, care 
being taken that the malleable iron strips are bent so as to conform to the surface 
of the plaster on each side of the spine and that the shaft over the head be kept 
in the same line with the spinous processes. The extremity to which the swivel 
cross-bar is attached should be over the vertex of the head, so that, when the straps 
are applied, the line of traction shall be neither too far forward nor too far back. 
The perforated tins are carried partially around the body. The apparatus having 
been thus carefully adjusted, fresh layers of plaster bandage are applied over it, in 
order to hold the instrument firmly in its place, the assistant being careful to rub the 
bandage into all the inequalities caused by the instrument. 
"After the jacket has thoroughly hardened, the chin-piece is to be applied 
around the patient's neck, so that it supports the chin and occiput comfortably, and 
the straps attached to it are hooked on the cross-bar, the degree of traction made 
upon them being regulated by the feelings of the patient. 
"I wish to give, or rather repeat, a word of caution, fearing that I may not 
have enforced it with sufficient distinctness already. It is this : do not attempt the impossible ! do not try to straighten 
curved spines the result of caries that have become partially or completely consolidated. If nature has already thrown 
out ossific matter and adhesions are beginning to take place, do not break them up by too severe extension, but simply 
extend the patient very slowly, so that the contracted muscles alone will yield, until the patient says he feels com- 
Fig. 4142.-Sayre's Jury-Mast, 
with three strips of tin. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
685 
ORTHOP/EDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Caries, Spondylitis, Angular Curvature, Pott's Disease. 
Fig. 4143.-Sayre's 
Plaster of Paris 
Jacket and Jury- 
Mast, applied. 
fortable, and never beyond that point. If it is a child who cannot talk, watch its counte- 
nance, and as soon as the expression of pain changes to one of pleasure, there stop and se- 
cure your patient by the plaster of Paris bandages, keeping him in that position until the 
plaster has set; he will then retain this sense of comfort so long as the bandage is properly 
adjusted."-"Orthopaedic Surgery and Diseases of the Joints." Lewis A. Sayre, M. D. 
"Nil Desperandum in Spinal Caries. 
"The Doctor said it was never too early to employ mechanical support, and never too late. 
Expectant treatment was a blunder. 
" Diagnosis was easy long before deformity. Sudden cramping pain in the abdomen and 
sides, stiffness in walking in the morning, inability to stoop forward and touch the floor, ' toe- 
ing in,' and holding the shoulders high and stiff. If an infant, it will scream on being moved 
and lifted. There was not generally pain or tenderness in the back, and it was a great mistake 
to pronounce that there is nothing the matter with the spine because that symptom was absent. 
The disease often follows whooping cough, and very often can be traced to a fall or other 
injury. 
" It was never too late, and it is a great error to suppose that strength was necessary to 
bear a surgical apparatus; when local irritation was wasting the vital energies, mechanical 
support was the best tonic, without which medication was vain. The Doctor cited a case 
of a boy, six years of age, with cervical caries following whooping cough two years before ; 
complete paralysis ; wasted to a skeleton ; racking cough. The brace gave immediate relief, 
and in a week he slept and ate well, and could move two fingers ; and in two weeks his toes 
and arms. In five months he could walk alone."-A paper by Dr. Benjamin Lee, of Phila- 
delphia, in The Medical Record, June 6, 1885. 
" The construction of a proper spinal supporter requires the presence of the 
patient. Whenever possible, there should be applied to the case the combined 
skill of the surgeon and of the instrument maker, for the proper adaptation of 
apparatus to the varying needs of spinal disease is a matter of considerable 
difficulty. 
" There are only two principles (i. e., splint and corset} of any real value in 
this class of apparatus. First. The splint principle, which, applying steel splints 
with proper pads along either side of the spine, seeks to lash the body firmly 
back to the splints. This is not merely an attempt mechanically to arrest the 
growth of the deformity ; it is curative of the inflammation. Every vertebra 
rests on three surfaces of support, viz.: the body of the bone in front and the 
two articular processes behind. The body of the bone is alone diseased, and its 
inflammation is perpetuated by the rocking and pressure of the other vertebrae 
upon it. The articular processes are perfectly healthy in most cases. Now, by 
flexing the spine well back against the splint, the pressure is brought upon the 
healthy articular processes, and taken off from the bodies of the vertebrae, 
which, being thus relieved, get well spontaneously. 
"Second. The corset principle, which is best adapted to the adult female form. 
Here the wide spread of the hips makes a rapidly sloping frustum formed by the 
chest, the junction of the two being at the smallest point of the waist. If a 
well-fitted corset, full of whalebone, be applied, and be made so as to lace in 
front, instead of using the ordinary steel locks, the action is as follows : The inverted cone of the waist rests in the 
hollow cone of the upper half of the corset. Now, by drawing upon the strings at the lower cone, the corset tends 
to rise on the slope of the hips and to push up the cone of the chest with it. 
" Now, it is easy to combine both these principles in one instrument, as shown above. The engraving and expla- 
nation (Fig. 4144) will render the plan clear."-E. Andrews, M. D. 
Fig. 4144. 
Andrews' Spine Brace. 686 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOP/EDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Caries, Spondylitis, Angular Curvature, Pott's Disease, 
Fig. 4145. 
Shaffer's Plaster Zone Apparatus. 
Fig. 4146 
" Figs. 4145 and 4146 represent this apparatus. It consists of two perfectly plain uprights of annealed bar steel, 
B, B, riveted to the hip band, A, with cross-pieces, E, E, and shoulder-pieces, D, D. There are no 'pad plates,' 
or 'cork,' or 'hard rubber' pads, no 'hinges' or 'screws,' as in the Taylor spinal brace, from which this apparatus 
is modified. F, F, F, F, represents a zone of plaster of Paris applied around the body and covering the uprights. F 
is opposite the deformity. The pads, C, C, are simple rolls of canton flannel, stitched to the uprights by transverse 
stitches, as shown in the engraving. 
" Fig. 4145 shows the anterior appearance of the apparatus. J is a padded webbing strap, which buckles at G, G, in 
Fig. 4146. F, A1 (Fig. 4145) are two axillary straps, which are buckled to the shoulder pieces, D, D (Fig. 4146). L 
(Fig. 4145) is a padded pelvic strap, which is inserted at either end in the buckles on hip band, A. K (Fig. 4145) shows 
the anterior appearance of the plaster zone which takes the place of the yielding ' apron ' of the Taylor spinal brace. 
"To apply this apparatus, the patient is placed upon two tables of equal height. The tables are then separated so 
that the part that is to receive the plaster zone shall be easily accessible from all sides. The head of the patient being 
grasped by one assistant, and the thighs by another, gentle but steady traction is made, while the operator, using a 
couple of monkey wrenches, bends the straight uprights to correspond with the outline of the transverse processes. 
The canton flannel pads are now sewed on and the apparatus is laid on the back. The pelvic and thoracic straps are 
tightened ; a strip of canton flannel is passed around the body, covering the deformity ; traction is steadily made, and, 
by means of the plaster roller bandage, ordinarily prepared, a zone of plaster is snugly applied, covering only two or 
three vertebrae above and below the diseased bones."-Newton M. Shaffer, M. D. 
1. Shaffer's Spinal Apparatus for Plaster Zone. 
2. Length of uprights, Inches. 
Measurements Required. 
3. Circumference of chest, .... Inches. 
4. Circumference of pelvis, .... " GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
687 
ORTHOPAEDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Posterior Curvature Braces. 
Fig. 4147.-With straps removed. 
Stillman's Improved Lever Brace. 
Fig. 4148.-Anterior view. 
Fig. 4149.-Posterior view. 
Fig. 4150.-Posterior view. 
With Corset. 
Fig. 4151.-Anterior view 
Measurements required 
are the same as 
directed on page 688. 
" The brace is constructed so as to embody a lever with a short and a long arm; the short arm extending from the 
site of the disease to the sacrum, and the long arm from the neck to the sacrum-the two being there connected by an 
adjustable clamp, and together forming a V-shaped lever, which automatically acts to press forward the deformity and 
yet holds the spine firmly in the erect position. The force is so graduated that, if leaning forward is attempted, the 
shorter arms press firmly over the transverse processes adjacent to the kyphos, and exert a forward pressure which pre- 
vents the spine yielding at the seat of disease. 
" Nature's indication for the treatment of Pott's disease is to put a splint on the back of the patient which will 
maintain this erect position ; for, since the tendency of the disease is to curve the affected portion of the spine forward, 
the centre of this curve being anteriorly, our corrective force should be applied to produce exactly an opposite curve to 
the diseased one, the centre of such a corrective curve being posterior to the column. In other words, we must follow 
nature's lead and hold the spine erectly and slightly curved backward."-C. F. Stillman, M. D. 688 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOP/EDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Posterior Curvature Braces. 
Fig. 4152.-Tiemann & Co.'s 
Brace for Posterior Curvature. 
To overcome the objections to all forms of instruments formerly employed 
for the correction of spinal curvature, which were heavy, unyielding, limiting 
muscular motion, and in many cases entirely suspending it, subjecting the patient 
to the greatest inconvenience without compensating results being obtained-we, 
many years ago, constructed braces which possess all the requirements of me- 
chanical aids in the successful treatment of spinal distortions, however induced. 
They are light, airy, easily adjusted, and afford the patient comparative freedom 
of motion along with adequate support. 
The brace (Fig. 4152) is intended to afford an entirely elastic continuous and 
gentle pressure to the parts to which it is applied, giving to the patient, along 
with adequate support, an easy and comfortable feeling. It is made of light 
tempered springs and softly padded wherever it comes in contact with the body. 
The steel belt below passes around the pelvis, and the principal weight is 
thrown upon the gluteal region. The front portion is broad, so as to compress 
the protruding abdomen. Two upright parallel bars pass on each side of the 
posterior elevation having a portion of silk elastic rubber between them, which 
gives a constant pressure upon the protuberance. If the latter is inflamed, a 
portion cut out of the elastic material prevents direct pressure upon the bone. 
Upon these side bars are attached two elliptic and padded springs, yielding to 
every pressure, and adapting themselves to the sides of the spinal column and 
keeping the body in an erect position. These are removed or applied by a very 
simple process. The two padded crutches are elastic and elevate the body by pressing 
mostly under the margin of the scapulae, thus obviating any tendency to pressure upon 
the axillary veins. They are constructed in such a manner that the equilibrium of the 
body can be restored in case one shoulder is depressed. 
The elastic belt shown in Fig. 4153 is for the purpose of giving additional pressure, 
if needed, but mainly to compress the sternum, which generally protrudes. It is also 
designed to be worn at night when the apparatus itself is not applied. The brace was 
first noticed in the New York Medical Record, August 1, 1868, since then very many 
of them have been applied, and have given general satisfaction, as well to the patients 
wearing them as to the physicians by whose orders they were made. 
Fig. 4153. 
Fig. 4154. 
Directions for Measurement, 
I. Tiemann & Co.'s Brace for Posterior Curvature. 
2. Patient's name (or sex). 
3. Patient's age. 
4. Patient's weight (estimated). 
5. Distance from sacro lumbar articulation to vertebra prom- 
inens (C to D), Inches. 
6. Distance from sacro lumbar articulation to first vertebra 
involved (C to G), 
7. Distance from sacro lumbar articulation to last vertebra 
involved (C to D), " 
8. Distance from crest of ilium to axilla, right side {A to 77), " 
9. Distance from crest of ilium to axilla, left side (A to " 
10. Distance from the centre of one scapula to the centre of 
the other (2? to F), " 
II. Horizontal (transverse) diameter of the protuberance (//), " 
12. Circumference of chest under axilla " 
13. Circumference of pelvis one inch below the iliac crests, . " GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
689 
ORTHOp/EDIS. 
SPINAL DISEASES AND DEFORMITIES. 
Cyphosis, Posterior Curvature 
" \V(j>G)Oig, the variety of spinal deviation sometimes de- 
scribed under the name of excurvation, gibbosity or cyphosis- 
terms all more or less expressive of the nature of the deformity- 
is met with chiefly in young and elderly subjects, although it may 
take place at any period of life, as well as in both sexes, and in 
persons of every grade and occupation. The curvature, generally 
situated in the upper portion of the dorsal region, varies in degree 
from the slightest alteration of the natural form of the column to 
the most hideous deformity. Cyphosis of the lumbar and cervi- 
cal regions is infrequent. Occasionally an instance of general 
cyphosis is observed, the whole column presenting an arched ap- 
pearance with marked concavity in front. Among the more com- 
mon and efficient of the causes are rapid growth of the body, 
imperfect assimilation, spanemia, syphilis, rheumatism, scrofula, 
softening of the osseous tissue, and the waste consequent upon 
protracted and exhausting maladies. Certain trades and occupa- 
tions, requiring a stooping posture, belong to the same category. 
Whenever, from these or from any other agencies, the spine is 
materially weakened, the weight of the head and the irregular ac- 
tion of the muscles will readily draw the vertebrae out of their 
normal relations, and thus occasion a corresponding degree of 
distortion. Hence, posterior curvature is very common among 
tailors, shoemakers, engravers, scriveners, and persons of similar 
pursuits. The careless manner of leaning over books, and of sit- 
ting upon backless benches at school, with the shoulders and arms hanging forwards, is a frequent sourse of cyphosis. 
"Treatment.-In the treatment of this affection, three leading indications must steadily be kept in view: I. The 
removal of the exciting cause ; 2. The amendment of the general health ; and, 3. The proper support of the weak- 
ened spine. Dry frictions with the salt towel will be advantageous. Exercise should be taken daily in the open air, 
in pleasant weather, but never carried to fatigue. The patient, when in the house, should recline much of the time 
upon his lounge, being particularly careful to avoid everything like a strain upon the muscles of the spine. 
"Apparatus.-The most important elements in any contrivance for support are, lightness and strength, accurate 
adaptation to the surface of the body, and concentration of pressure at the seat of curvature. The pressure must be 
regulated with the greatest care, and should be as gentle as is consistent with the requisite degree of support. The 
surface of the lounge or bed upon which the patient rests should be soft, elastic and uniform. No pillow should be 
used. The posture may be varied from time to time, from the back to the side, or from the side to the abdomen, as 
may be most agreeable."-" System of Surgery." Gross. 
" Should pressure of .any kind be made, either upon or above the centre of the curve, the deformity would be in- 
creased. But if the support is placed at least two vertebrae beneath the axis of distortion, then expansion of the ex- 
tremities of the curve may be secured, and consequent depression of its arc."-Heather Bigg. 
Fig. 4155.-Cyphosis. 
Round Shoulders. Braces, 
Fig. 4156.-Nyrops' Spring Brace. 
" The most frequent condition is one of general im^ 
pairment of muscular tone, the head and upper spine 
gravitating forward as the muscles yield, until the poste- 
rior ligaments are elongated and the anterior margins 
of the intervertebrated disks narrowed by compression. 
The indications are to correct the deformity by the use 
of braces, and to increase the tone of the muscles, the 
nutrition of which is impaired. To meet the former, in 
mild cases, a double elastic brace, such as shown (Fig. 
4156), will be sufficient. Massage, electricity, tonics, 
and out of door exercise are also essential features of 
treatment."-"Text Book on Surgery." Wyeth. 690 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTfHOP/EDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Cyphosis, Posterior Curvature, Round Shoulders, Braces. 
Unconfined spinal curvature, or " round (stoop) shoulders," in children and youths, brought on by a habit of stoop- 
ing or constant bending forward of the head and neck over books or desk, is amenable to mechanical treatment. 
For slight cases elastic shoulder braces, represented in Figs. 4157 and 4158, are used. These serve as a constant re- 
minder to keep straight. For more advanced curvatures the steel back shoulder brace (Figs. 4159 and 4160) are suit- 
able. 
Fig. 4157 
Elastic Shoulder Braces 
Fig. 4158. 
Fig. 4159.-Steel Back 
Shoulder Brace. 
Fig. 4160. 
Stillman's Cyphosis Brace, back. 
Fig. 4161. 
Stillman's Cyphosis Brace, front. 
Directions for Measurement. 
i. Patient's name (or sex). 
2. Elastic, or Steel Back Brace. 
3. Crest of ilium to axilla. 
4. Circumference of pelvis. 
5. Circumference of chest under 
axilla. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
691 
ORTHOPAEDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Cyphosis, Antero-Posterior Curvature, Braces. 
" Fig. 4!6o is a posterior view of Stillman's cyphosis brace. A rotary clamp is shown just below the antero pos- 
terior clamp ; this is used if any lateral rotation of the vertebrae coexist. Fig. 4161 shows the same brace anteriorly. 
These braces are used for caries of the lower dorsal and upper lumbar region."-" Clinical Lecture on the Mechani- 
cal Treatment of Pott's Disease." Chas. F. Stillman, M. D. 1885. 
"Round Shoulders, or Antero-Posterior Curvature.-The most common 
cause to which this deformity can be ascribed is muscular weakness, the in- 
ability of the back to recover the erect position after it has been relaxed. 
Relaxation of the back is the position of rest assumed by the trunk when 
the superincumbent weight is to be more fully borne upon the bodies of the 
vertebrae, and we then rely upon the ligamentous bands and attachments 
rather than muscular force to keep the body in this less fatiguing position; 
thus relieving the muscles from all necessity of the contraction which is re- 
quired if the trunk be maintained erectly. In this position of rest the spine 
curves backward in the shape of a bow, from the sacrum to the head, the 
centre of the bow being in the middle dorsal region, the bodies of the ver- 
tebrae being crowded together throughout the whole extent of the spine and 
the muscles not exerting their contractile force. 
"When the erect position is again assumed, the muscles should restore 
the normal spinal curves, so that the head and upper portion of the trunk, 
with their appendages, become supported in the proper line of direction. 
But if the muscles lack tone or are fatigued, or the patient is indolent, the 
position of rest becomes habitual and we have production of round shoulders 
as a result."-C. F. Stillman, M.D., in Medical Record, August 25, 1883. 
"Such cases require a brace which will act supplementary to the impaired 
muscles of the back, and in applying one we must remember that this class 
of deformities are unattended by pain, the desire for symmetry bringing the 
patient to us, so that naturally an unsightly apparatus would be objected to. 
" My brace is composed of a light double pair of springs. The under 
springs are somewhat shorter and are provided with a pad at their extremities 
for pressure on the dorsal region when the brace is applied. By means of 
ratchets the power of the springs is regulated. To make the brace effective, 
the curves of the under springs are made the reverse of the curves of the de- 
formity. Thus the curve of the deformity and the curve of the combating 
springs are so placed in contact with each other that, when the brace is ap- 
plied and the springs are drawn tightly towards each other, reduction in the 
exaggerated curves of the spine results. Fig. 4163 shows the adjusting 
straps and belt, also a head-rest which I sometimes add to this brace. These 
braces are a modification of those described in the Medical Record, August 
25, 1883."-C. F. Stillman, M. D. 
Fig. 4162. 
Stillman's Antero-Posterior Brace. 
Fig. 4163. 
Stillman's Antero-Posterior Brace 
with Head Rest. 
i. Sex of patient. 
2. General appearance of patient. 
3. Lay a soft piece of lead wire along the back, moulding it exactly 
to the spine, from the seventh cervical vertebra to the middle 
of the sacrum. With this pattern trace carefully the shape of 
the spine on a sheet of paper, marking the points opposite the 
upper and lower borders of the scapula and the crest of ilium. 
4. Circumference of body between crest of ilium and tro- 
chanter major, Inches. 
5. Circumference of body at waist " 
6. Circumference of body under axillae 
7. Distance between the upper borders of the scapulae, . 
8. Distance between the lower borders of the scapulae, . 
Measurements Required: 692 
GEORGE TIEMANN <fc CO.'S SURGICAL INSTRUMENTS. 
ORTHOP/EDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Lordosis, Anterior Curvature, Braces. 
Fig. 4164.-Lordosis. 
"Another variety of distortion is an abnormal arching forwards of the loins. 
This kind of curvature frequently coexists with a bend of the whole course of the 
spine, the column forming a long arch with a deep hollow in the loins. The tech- 
nical name by which this variety of distortion is known is 'lordosis.' Traction of 
the longissimus dorsi and sacro-lumbalis muscles, or a wasting of the lumbar inter- 
vertebral cartilages on their posterior surfaces, are the principal causes of the condi- 
tion. Each may exist apart from the other, or both may be found combined: the 
latter being the most common occurrence. Patients who suffer from this form of 
spinal distortion find it extremely difficult to walk or stand without throwing the ab- 
domen forward in an unnatural and inelegant manner. The shoulders are generally 
rounded."-"Orthopraxy." Heather Bigg. 
" Anterior curvature, 'lordosis' or 'sway back,' is far less frequent than cypho- 
sis. It occurs almost always in the lumbar region. In the later months of preg- 
nancy it is a common condition, and is met with in individuals with unusual de- 
velopment of the stomach and abdominal viscera, or in cases of chronic abdominal 
tumor (fibroid, &c.)"-Wyeth. 
" The treatment of this variety of spinal distortion must be conducted upon the 
same principles as that of posterior curvature. The pressure must be made to bear 
more particularly upon the abdomen and the lower portion of the chest in front, and 
upon the back and pelvis behind. A piece of elastic webbing will be found of great 
service in equalizing the compression of the abdomen, a matter of no little moment 
in regard to the comfort of the patient, as well as to his ultimate recovery. When 
the curvature involves the cervical region, proper attention must be given to the 
support of the head."-"System of Surgery." Gross. 
Fig. 4165.-Porous 
and Russia Felt Jacket. 
Fig. 4166.-Smith's Corset, 
with Serpentine Springs. 
Fig. 4167.-Delicate Brace 
for Anterior Curvature. 
An order for brace (Fig. 
4166 or 4167) must be ac- 
companied by measures as 
directed on page 688. 
"Felt Jackets are applicable to either lateral, posterior or anterior curvatures. Any portion of the jacket can be made 
quite soft, so as not to press on projecting parts of the spine, hips or breasts. The advantages are lightness, ease, rigidity, 
facility of removal for ablution, exercise,&c., economy-the same jacket being capable of remoulding as the case progresses. 
We need a mould made as follows: A plaster of Paris jacket is applied, and as soon as this hardens, it is split 
down in the median line in front, removed from the body, and the cut edges placed and held in apposition by a band- 
age carried around and over the entire jacket. This shell is greased on its inner surface, placed upon the floor, and 
filled with stiff plaster mortar. When this hardens, the shell is removed, leaving an exact cast of the thorax, upon 
which the jacket is to be built. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
693 
ORTHOPAEDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Scoliosis, Lateral Curvature. 
Fig. 4168.-Scoliosis. 
" In lateral curvature, the scoliosis of the older authors, the deviation of the spine 
is to one side, and is essentially due to irregular muscular contraction, acting upon 
weakened bones, fibro-cartilages and ligaments, and dragging them out of their natural 
position in such a manner as to induce more or less deformity. The side most com- 
monly affected is the right, for the reason, probably, that most persons use the right 
arm much more than the left. Of five hundred and sixty-nine cases of lateral curva- 
ture treated at the Royal Orthopaedic Hospital of London, four hundred and seventy 
were in this situation. 
" The causes which give rise to this irregular action on the part of the muscles may 
be conveniently arranged under the following heads : I. Affections of the muscles, as 
hypertrophy, atrophy, inflammation and spasmodic contraction ; 2. Debility, either 
general or local ; 3. Obliquity of the pelvis from injury, disease, or malformation of 
the inferior extremities ; 4. Altered capacity of one side of the chest, causing increased 
action of the muscles of the opposite side ; 5. Rachitic softening of the bones ; 6. De- 
fective development of the vertebrae. 
"Lateral curvature, in its more aggravated states, is always attended with marked 
rotation of the bodies of the vertebrae, through which the spinous processes are directed 
towards the concavity of the curvature; the vertebral column is diminished in length in 
a degree proportionate to the lateral deviation, and the chest is materially altered in its 
figure-the ribs being flattened, elongated and twisted, and the sternum and costal car- 
tilages tilted prominently forwards and depressed towards the pelvis. The scapula on 
the side corresponding to the convexity of the thoracic curve is unnaturally full and elevated; its upper border is 
directed forwards and inwards while the inferior angle is carried outwards, and hangs off in a very unseemly manner 
from the side of the chest, in consequence either of the elongation of the latissimus muscle, or on account of the bone 
from beneath its surface. 
" Considered as a morbid affection, lateral curvature is most commonly observed in young girls, from the age of 
five to fifteen or eighteen, especially in such as are naturally of a feeble constitution, or whose health has become early 
impaired by want, exposure and imperfect nutrition."-" System of Surgery." Gross. 
" The treatment of rotary lateral curvature must be governed by the cause which has produced the deformity and 
the condition of the patient when first brought under notice. If the distortion be dependent upon obliquity of the 
pelvis, caused by inequality in the length of the lower extremities, or owing to congenital malformation, or to disease 
of the joints, or fracture, thus causing obliquity of the pelvis, the shortened limb must be artificially increased suffi- 
ciently to equalize the length of the two limbs before any other treatment can be effectual."-Sayre. 
" Lateral curvature of the spine, contracted by girls at school and by children at factories, from a vicious habit of 
sitting, standing or reclining, by which the vertebral muscles lose their equilibrium, can only be successfully cured by 
a reference to the nature of the exciting cause. The awkward and constrained position must be promptly rectified and 
means adopted to improve the general health, when this has been suffering, by gentle exercise in the open air, sea- 
bathing, the cold shower-bath, and a properly regulated diet. Great attention must be paid to the gait in walking, 
so as to bring into full play the enfeebled and faulty muscles ; the spine should be well supported while in the erect 
posture by a light and well-adjusted appliance, and the child should lie down frequently during the day, in order to 
afford complete relaxation and rest to the entire system, so conducive to comfort and the restoration of vigor."-Gross. 
"When the lumbar division of the spinal column is the primary seat of the deformity, material benefit may be de- 
rived from the sloping seat of Barwell, which, by lifting the depressed side of the pelvis, tends to throw the curvature 
into the opposite direction. This action is well shown in Fig. 4169, the deformity, represented by the dotted lines, 
having been almost rectified by the seat, which inclines from the convex to the concave side of the curvature. As soon 
as the lumbar muscles in the latter situation have become sufficiently strong, the same principle may be carried out by 
adding a cork sole to the shoe corresponding to the convexity of the curvature. The form of support adopted by Bar- 
well in which gentle elastic force is employed in the direction of the radii of the curves is shown in Figs. 4170 and 4171. 
A band passing around the upper part of the thigh supports a pad of thin sole leather or coutil on the hip, from the two 
upper angles of which a band of webbing, broadest over the most prominent portion of the curve, is carried around 
the loins. In front the band is rendered elastic by the insertion of strong india rubber. In the event of the compensat- 
ing dorsal curve being well marked, or of the support exhibiting a tendency to slip, a second elastic band, indicated 
in the cut by the dotted lines, is passed in front and behind the body to a pad placed opposite the most prominent 
portion of the dorsal curve, and retained in position by a shoulder strap. In primary dorsal scoliosis the best position 
is that which places the great serrated muscle on the side of the curvature at rest, and at the same time renders its in- 694 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
ORTHOPEDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Scoliosis, Lateral Curvature, Braces, Suspension. 
active opponent tense. These objects may be accomplished by directing the patient to carry the arm which corre- 
sponds to the deformity habitually in front of the body, so that the hand shall rest on the opposite side of the waist, 
and the opposite arm behind the waist."-" System of Surgery." Gross. 
Fig, 4169. 
Barwell's Sloping Seat. 
Fig. 4171. 
Harwell's Scoliosis Brace. 
Fig. 4170. 
Barwell's Scoliosis Brace, 
Fig. 4172.-Self Suspension 
" Rotary-lateral curvature of the spine may be corrected before the bones, 
ligaments and ribs become fixed in their abnormal position; but, when that 
has occurred, the deformity will be permanent. It is important, therefore, to 
be able to recognize the deformity in its earliest development. 
" Symptoms.-One of the earliest symptoms is an undue prominence of 
one of the scapulae. If, therefore, this be present, always examine the spine; 
but, even at this stage of the deformity, if a curve is found, if you will re- 
move the weight of the head and shoulders from the spinal column, by placing 
your hands in the axillae and lifting the patient up, the curve will entirely dis- 
appear ; or, if the patient is laid face downward upon a table, the spine will 
be found to be perfectly straight, or can be made so by a trifling amount of 
extension. But, if the patient stands without support under the arms, you 
can, by carefully noting the situation of the spinous processes (which can be 
done conveniently by rubbing the finger over them, thus producing a reddish 
line, or by dotting them with ink), detect a curvature, very trifling it may be, 
in the dorsal region. 
"Now, if the deformity is permitted to go uncorrected, it will gradually 
increase as the spine yields to the muscular contractions assisted by the weight 
of the head and shoulders, until finally, as the body sags over, it is fully de- 
veloped. The deformity does not advance far in the dorsal before a compen- 
sating curve is developed in the lumbar region. 
" Treatment.-The use of all fixed apparatus in the earlier stages of all 
deformities where we wish to restore lost muscular power is positively injur- 
ious. The principle which should guide us is, to place upon the stretch those 
muscles which have been inactive and relaxed, and approximate the origin and 
insertion of the muscles we wish to remain quiescent. * * * Every 
effort should be made to develop the enfeebled muscles by repeated but limit- 
ed exercises, care being taken at all times to avoid over-fatigue, and at the 
same time to limit the action of the over-developed muscles as much as pos- 
sible. Self-suspension, as recommended by Dr. Benjamin Lee, by climbing GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
695 
ORTJHOP/EDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Scoliosis, Lateral Curvature, Suspension, Sayre's Jacket. 
Fig. 4173. 
Self Suspension. 
up a rope which passes over a pulley and is attached to straps passing under the chin and occi- 
put of the patient, is especially to be recommended. Great care should be taken that the 
hands be kept above the head, and the patient should reach one hand slowly over the other, 
until the heels are just raised from the floor ; when the patient has elevated the body to the 
highest point desired, the uppermost hand on the cord should always be the one upon the side 
of the concavity of the dorsal region. While he is in this position, the great thoracic mus- 
cles-the pectoralis major, latissimus dorsi, serratus magnus, &c.-are brought into play, and 
the ligaments of the neck are relieved of the greater part of the strain. If the hands are al- 
lowed to descend below the level of the head while the patient is self-suspended, there will be 
a risk of too much strain being thrown upon the ligaments of the neck, and consequent serious 
damage. During self-suspension some one should always be at hand, especially if the patient 
be a child, to guard against the twisting of the rope and to see that the exercise is properly per- 
formed. The immediate result of self-suspension, produced by the above-described means, 
will be a diminution of the abnormal spinal curves (primarily and secondarily), increase in the 
girth of the chest and a decrease of that in the waist. These exercises should be performed 
twice a day at first, making three full inspirations at each suspension, and repeating these sus- 
pensions three separate times at each seance ; the number and length of time of exercise can be 
increased as the physician thinks requisite."-"Orthopaedic Surgery and Diseases of the 
Joints." Lewis A. Sayre. 
Sayre's Plaster of Paris Jacket for Lateral Curvature. 
*** Knitted Shirts, of all sizes, on hand and made to order. 
"Application of the Plaster of Paris Jacket in Lateral Curvature.-The patient is to be fitted with a knitted 
shirt-the same as in the application for spondylitis-with the exception that it is made twice the length, for the pur- 
pose of being reversed on the outer side of the jacket and made into a corset; in cases where the patient is a female, 
pads of proper size are then placed over the mammae, according to the development of the patient, and the shirt 
then tied tightly over the shoulders. The patient then suspending herself, the shirt is to be pulled down snugly 
by an assistant, the dinner pad not being used in lateral curvation, a full meal being taken before the application of 
the jacket. The plaster bandage then being immersed in water sufficient to cover it when standing on its end, 
is left until all gas has escaped; a second bandage is then placed in the water, and, the first one being removed and 
the surplus water pressed out of it, is then applied snugly around the waist, each turn of the bandage covering two- 
thirds of the one previously applied ; it is carried in this manner down below the crests of the ilia ; then, passing back, 
up toward the thorax and over the mammae ; an assistant rubbing each turn of the bandage into the one previously 
applied, until a sufficient thickness has been secured to give the necessary support to the patient, which varies accord- 
ing to the size of the patient; the adult not requiring more than the thickness of the bookbinder's pasteboard. In a 
few minutes the plaster is sufficiently set to allow of the removal of the jacket; this being effected by a section made 
from the centre of the sternum to the centre of the pubes, using a sharp curved knife for the purpose, dividing both 
shirt and plaster dressing ; the jacket being taken off while the patient still retains the suspended position. In cases 
of persons who are very obese, a small strip is cut out of the centre of the jacket in order that it may be drawn in at 
the waist; but in the majority of cases this is not exquisite. On the removal of the jacket the edges are brought closely 
together, and a roller bandage passed around it in order to retain its shape ; it is then placed before the fire until tho- 
roughly hardened, which occupies generally about twenty-four hours. The following day the patient suspends herself 
as before, but having on at this time a thin under-vest; the jacket is then opened and sprung around her, and fitted into 
the exact position in which it was first applied ; it is then secured by passing a roller bandage around the waist, making 
also a few turns of the bandage above and below the waist. The patient is then removed from the suspending appa- 
ratus, and the jacket cut out under the arms on either side until she is perfectly comfortable, so that no pressure is 
made in the axillae, and the shoulders are not elevated by the jacket; the patient is then allowed to sit down and flex 
the limbs, the lower part of the jacket being trimmed sufficiently to admit of free motion of the limbs. The jacket is 
then removed and sent to the instrument maker, where the shirt is reversed and stitched at the top, cutting off all super- 696 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Scoliosis, Lateral Curvature, Sayre's Jacket. 
Fig. 4174.-Sayre's Plaster Jacket, 
for Lateral Curvature. 
fluous material; strips of leather arranged with eyelet-hooks are then sewed 
down the front of the jacket for the purpose of lacing it ; thus forming a 
complete corset, this being worn during the day and always removed at 
night; the patient taking the gymnastic exercises previous to the application 
of the jacket in the morning and after its removal at night. The patient is 
to be self-suspended in the morning, before the application of the jacket, in 
order that it may be properly adjusted while in the extended position. 
" Many persons are still under the impression that the application of the 
plaster of Paris jacket in lateral curvature is for the purpose of effecting a 
cure, and to be worn as a permanent jacket, as in spondylitis. I wish, how- 
ever, for it to be distinctly understood that the plaster jacket, in the treat- 
ment of lateral curvature, is simply an adjuvant to the gymnastic exercises 
so necessary for the cure of this deformity, and which are for the purpose of 
developing the weakened muscles upon the affected side-the plaster jacket 
being simply applied for the purpose of retaining the body in the improved 
position which self-suspension, &c., give it. Again-and to this I would 
specially draw attention-that the jacket is to be removed at night, and at 
all times when the gymnastic exercises are taken."-"Orthopaedic Surgery 
and Diseases of the Joints." Lewis A. Sayre. 
See Porous Felt Jackets, Fig. 4165 ; see also page 682, Plaster 
Jacket for Spondylitis. 
Fig. 4175.-Squire's Spineyard. 
" This is a new apparatus for producing extension in the treatment of 
spinal disease, by the plaster jacket, or in the fitting of a brace. The plan 
for suspension should be vertical and one that will admit of graduating the 
amount of extending force to the toleration of the patient. I have found 
that my patients can endure a force equal to one-third of their weight, and 
scarcely more than this, without its producing the unpleasant symptoms of 
excitement, fainting, vomiting and cramps, the occurrence of which has too 
often curtailed the time desired for applying a jacket. 
" In order to carry out this principle I use an apparatus which consists of 
a horizontal bar supported at its centre from the ceiling. At the extremities 
of this bar are loops or attachments for the hands of the patient, and pulleys 
for the cords which support the seat. In the seat at each end is a pulley, 
also for the cords to play over. These cords, two in number, are attached by 
one end to the horizontal bar, and, after including the system of pulleys, are 
fastened by the other end to the usual head gear, as may be better undei - 
stood by referring to the accompanying illustration. 
" In the use of this swing, the patient must be able to reach the handles 
with his hands while his arms are at right angles with his body. The head 
gear must be adjusted about the chin and occiput; then, by lifting himself 
clear from the floor by his hold on the handles, he can seat himself in the 
swing; removing his grasp now from the handles, one-third of the weight 
comes upon the chin and occiput, while the remaining two-thirds, which 
practically is found to have been a dead weight, is supported by the seat of 
the swing. 
" I may add that by this process the spine will be simply straightened and 
not stretched. Measurements taken before and after treatment by this mode 
of extension and the application of the plaster jacket have shown an increase 
in height for the patient of over an inch in a recent case. Every time a jacket is applied it is attended with a little 
increase in height over the former measurement, while the extending force is every time the same, but a far greater 
advantage is obtained in the length of time the patient can remain suspended, which may be, as some have expressed 
it, for an hour at a time."-C. L. Squire, M. D., in the Albany Medical Annals. 
Squire's Spineyard. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
697 
O^THOp/EDIS. 
SPINAL DISEASES AND DEFORMITIES. 
Scoliosis, Lateral Curvature, Braces. 
Fig. 4176.-Tiemann & Co.'s 
Scoliosis Brace. 
These braces are constructed on the same principle as those shown on page 688. 
We have applied many of them since they were first noticed in the Medical Record, 
August I, 1869, and they have given general satisfaction. They are made as follows: 
To a pelvic band are attached laterally two elastic crutches to relieve the spine of 
the weight of the trunk. By means of lateral straps the crutches can be elongated, so 
that by raising the one on the concave side higher than the one on the opposite, the re- 
storation of the equilibrium of the body is aided. Posteriorly a single strong upright 
bar is riveted to the pelvic band. This bar it provided with a couple of adjustable pads 
for the scapulae, and, below these, with a number of buttons, to which is attached a 
strong belt of proper formation, made partly elastic. This belt is passed around the 
protuberance obliquely forward, over the compensatory curve on the other side, and 
buckled to the pelvic band behind. It will be found to exercise a gentle but continu- 
ous elastic pressure, at the same time rotating the ribs around their vertebral axes, thus 
unfolding the helical curve. 
" Treatment.- Now it needs no argument to show that when a curve is the result of 
a disturbed equilibrium, from a too great superincumbent weight, relative or actual, or 
from imperfectly antagonized muscular action, a primary object should be to remove 
the superincumbent weight and antagonize the exaggerated muscular action. It is clear 
also, that, in whatever manner this object can be obtained, it will offer the most rational 
means for obviating the absorption of material arising from improperly distributed 
pressure and the retraction of ligaments and muscles. The removal of superincumbent 
weight and the antagonizing of exaggerated muscular traction are obviously mechanical 
questions ; hence the treatment of spinal curvature forms in an especial manner a 
branch of orthopraxy. 
' Experience has abundantly taught that medicine is all but powerless in distor- 
tions of the spine without mechanical aid. The most ably conducted treatment of 
the peculiar form of debility which may be at the foundation of the deformity is of 
no avail unless the mechanical requirements of the case are first attended to. Physic, 
change of climate, and, although in a less degree, gymnastics, are alike unavailing to 
unfold a confirmed curve or restore the elasticity of an impaired ligament or lengthen 
a retracted muscle. But if the pressure be removed from a defective vertebra and 
the tendency to retraction of ligaments and muscles be counteracted mechanically, 
then medicine, change of climate and gymnastics, by invigorating the debilitated 
parts, may induce in them a healthier nutrition and enable them best to resist the 
tendency to distortion."-" Orthopraxy." Heather Bigg. 
Fig. 4177.-Tiemann & Co.'s 
Scoliosis Brace, extra fine. 
Measurements Required. 
Fig. 4178. 
I. Patient's name (or sex). 
2. Patient's age. 
3. Patient's weight (estimated). 
4. Distance from sacro lumbar articulation to vertebra promi- 
nens (C to 22), ■ Inches. 
5. Distance from sacro lumbar articulation to first vertebra in- 
volved (C to G), 
6. Distance from sacro lumbar articulation to last vertebra " 
involved (C to Z?), 
7. Distance from crest of ilium to axilla, right side (A to H), 
8. Distance from crest of ilium to axilla, left side (A to ZZ), 
g. Distance from the centre of one scapula to the centre of 
the other (E to F) 
10. Horizontal (transverse) diameter of the protuberance, . 
11. Circumference of chest under axilla (ZZ) 
12. Circumference of pelvis one inch below the iliac crests, 
In addition to the above measures please state if the convexity of the curve 
is to the right or left side. In the diagram of skeleton it is to the right. 698 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
O^THOf>/EQIC. 
SPINAL DISEASES AND DEFORMITIES. 
Scoliosis, Lateral Curvature, Braces. 
Fig. 4179.-Illustrating Curvature 
when Patient has no Support. 
Fig. 4181.-Showing Principal 
Features of Stillman's Brace. 
Fig. 4180.-Stillman's 
V-Lever Brace, combined 
with Corset (posterior view), 
"The brace is constructed in three parts-dorsal, pelvic and cervical. The first, or dorsal, consists of abroad 
pad placed high up across the shoulders, and from this descend two metallic strips, terminating in pads in the lumbar 
region. From these strips the stiff metallic semi-girths (b, b) pass practically around the body, the upper one being over 
its protuberant scapula, and the lower one carried around to press upon the protuberant ribs anteriorly. From each 
side of the transverse pad (a) pass axillary crutches (c, c), terminating anteriorly in large pads which lift and press the 
shoulders backward without impinging or pressing upon the infra-clavicular spaces. 
" The material of which these crutches are constructed is of sufficient firmness not to yield to the twisting efforts 
of the patient, although they may be bent into any position by the orthopaedist's hands, and they serve a very im- 
portant purpose in regulating the position of the shoulders and upper extremities. The dorsal portion of the brace 
may be incorporated into a corset if desired (see Fig. 4180), several of the straps which are used to fasten it firmly to 
the body being omitted in the drawing, as they might tend to confuse the reader in understanding the construction of 
the brace. 
" The pelvic portion of the brace consists of a padded pelvic girth,which locks in front, is very stiff, and is attached 
to the dorsal portion by a long bar {d}, which terminates superiorly in my compound clamp (e). This clamp has been 
described before in various journals, and permits the pelvic portion to be fixed at three different angles with the dorsal, 
to which it is attached. By it we may exercise a rotary active force, an antero-posterior force, and a lateral force- 
thus bringing a compound twisting force to bear upon the spine. If the dorsal portion of the brace be first securely 
fastened to the body and the clamp regulated properly, when the pelvic portion is secured we have the body held 
hypererectly, the protruding scapulae and ribs pressed upon, and the shoulders squared by an active backward latero- 
oblique force from which the patient cannot escape. • 
" The cervical portion is only necessary when the curvature is high, and then a chin-piece is used, attached to the 
dorsal portion by a bar provided with the compound clamp already described; but this portion of the brace is not 
shown in the drawing. In applying this brace the patient is first suspended so that the abnormal curves may be re- 
duced as much as possible before its application. It will then tend to retain the favorable position produced by the 
suspension, and, indeed, improve it by means of the active twisting force it brings to bear. 
" In conclusion, it is my opinion, based upon many cases of this deformity, that the best results are obtained by 
the conjoined use of an active brace and proper exercise upon curved frames. 
"A brace alone is of but little use, serving merely to hold the body erectly; but to exert any curative power it 
should be made to fit the patient accurately and be readjusted often, so as to exert its active effects through all the 
stages of improvement; and, in addition, the patient should be obliged to take systematic exercise, and, if necessary, 
should receive the benefit of massage, electricity and other tonics. The diet and habits of life should be regulated 
carefully, and all work avoided which tends to increase the deformity."-The Medical Record, May 21, 1887. 
Measurements required, same as directed on page 697 for Fig. 4178. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
699 
ORTHOP/EDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Fig. 4182.-Still- 
man's Vertical Exten- 
sion Brace, for Rotary- 
Lateral Curvature. 
Scoliosis, Lateral Curvature Apparatus. 
" But the use of a brace alone is but a small por- 
tion of the treatment of this curvature. We must 
also aim to strengthen the deficient muscles during 
such time as traction is being exerted upon the spine 
itself, and for this purpose the writer has recently de- 
vised two frames, which are unique and accomplish 
the purpose admirably with but little fatigue to the pa- 
tient. The first, or vertical, frame (Fig. 4183) produ- 
ces suspension on the curved board or curved traction, 
and while thus suspended, either partially or wholly, 
the patient takes arm exercises by means of the weights 
and pulleys with which the apparatus is provided. 
Fig. 4183.-Stillman's Vertical Frame, 
for Backward Curved Traction during 
Exercise. 
Fig. 4184.-Stillman's Horizontal Frame, 
for Backward Curved Traction during Exercise. 
" The second, or horizontal, curved frame (Fig. 4184), produces the same results, but perhaps not to the same de- 
gree ; and their conjoined use not only increases the vitality of the patient by expanding the chest and strengthening 
the muscles, but tends to diminish the curvature very materially. The horizontal frame is also used by phthisical pa- 
tients with good effect, and also in cases of persistent backache, with or without spinal irritation."-C. F. Still- 
man, M. D., in Medical Record, May 21, 1887. 
Fig. 4186. 
Roberts' Spinal Extension Jacket. 
Fig. 4185.-Wolff's Spinal Cradle. 
" In reclining, the body should be placed in such a position that the offend- 
ing muscles are put upon the stretch. The deformity is temporarily overcome 
by the employment of Wolff's cradle (Fig. 4185). The belt passes over the pro- 
jecting ribs and shoulder-blade, thus bringing the weight of the trunk upon these 
parts, while gravity aids in overcoming the curvature in the lumbar region. 
" To make the segments of my jacket (Fig. 4186) removable, metallic clasps are attached to them. The clasps of 
the upper segment are secured in position by strong bands of elastic webbing. This arrangement permits of the neces- 
sary expansion of the thorax with each inspiration, and at the same time does not invalidate the efficiency of the 
support. Should there be any spinal rotation, the further advance of which it is desirable to prevent, or even over- 
come, this may be readily accomplished by means of one or more rubber guys passing from the summit of one steel 
rod to the base of another."-M. Josiah Roberts, M. D., in Medical News, October 14, 1882. 700 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOP/EDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Torticollis, Wry Neck. 
''Torticollis (torquere, torturn, to twist, and collum, the neck), torticolis, caput sen collum obstipum, obstipa cervix, 
cervix rigida, obstipitas capitis seu colli, trachelagra, entasia loxia, loxias, cephaloloxia, anchylodere., anchylodens, 
rhccbocrania, rhcebauchen, rhcebodere, anchenorrheuma, rheumatismus colli seu cervicis, stiff neck, wry neck, (prov.) 
slab, (F.) obstipite.-A variety of rheumatism, seated in the muscles of the neck, which prevents the motion of the 
head, and causes the patient to hold it inclined to the side affected. It is, commonly, of short duration ; usually dis- 
appearing in a few days. Rubefacients are the best topical applications. The term is applied to permanent contrac- 
tion of the muscles of the neck, which causes the head to be held on one side. The remedy is the division of the 
contracted muscles."-Dunglison. 
Fig. 4187. 
Post's Torticollis Flelmet. 
"A case of torticollis cured by division of the sterno-cleido-mastoid 
muscle, followed by elastic traction of the head. Patient was affected with 
torticollis in a very marked degree, and has been so from his earliest recollec- 
tion. His face was strongly turned towards the right side, and his left ear 
was approximated to the corresponding shoulder. The left sterno-cleido- 
mastoideus was firmly contracted, and offered strong resistance to the move- 
ment of the head in the opposite direction. Its sternal and clavicular origins 
were very hard and prominent. 
"On the 9th of April, the patient being etherized, I performed the 
following operation : I made a horizontal incision, six centimetres in length, 
along the upper border of the sternum and clavicle, exposing the prominent 
tendons of the sternal and clavicular portions of the sterno-cleido-mastoid 
muscle. I then passed a director under each of these tendons successively, 
and divided them with a sharp-pointed bistoury. The division of these ten- 
dons scarcely produced any perceptible effect in liberating the movements of 
the neck. On careful examination, I found that there were other and deeper 
bands of muscular fibres, which kept the muscle in a state of tension, and 
which restrained the free rotary motions of the head. These bands were 
successively divided upon the director, and then the head could be freely 
moved in all directions. A few carbolized horsehairs were then laid within 
the wound, which had previously been washed with a carbolized lotion, 1 to 
40. The edges of the incision were brought together with fine sutures. 
"Before the operation the house surgeon, Dr. John A. Wells, had applied a plaster of Paris jacket around the 
chest, and over the right shoulder, with blunt metallic hooks over the sternum and over the right shoulder. A helmet 
had been constructed (Fig. 4187) under my direction, by Messrs. Tiemann & Co., consisting of a horizontal band of 
iron encircling the head above the ears, a vertical band of iron passing over the sagittal suture and riveted to the hori- 
zontal band in the frontal and occipital regions, and a leather strap passing transversely over the top of the head, and 
buckled beneath the chin. To the horizontal band of iron was attached a hook over the mastoid region, and two 
others, one a little before and the other a little behind that point, to vary the direction of traction, if it should be 
deemed necessary. This helmet was applied to the head of the patient and an india-rubber muscle, provided with a 
ring at the upper end and a chain at the lower, was then applied as nearly as possible in the direction of the right 
sterno-cleido-mastoid muscle, the ring above being hooked over the right mastoid process, and the chain below being 
hooked over the sternum. This was found to accomplish the object for which it was designed in a very satisfactory 
manner. It turned the face to the left side, and it approximated the right ear to the right shoulder. 
" Two days after the operation about half of the horsehairs were withdrawn from the wound, and the remainder 
on the following day. There was scarcely any perceptible irritation about the wound, and union took place by first 
intention. The india-rubber muscle was daily removed and reapplied with such a degree of tension as seemed to be 
required. Passive motion of the head was also freely made in all directions. Occasionally a supplementary india- 
rubber muscle was applied, extending from the right shoulder to the corresponding side of the head. The patient 
left the hospital on the 26th of April, seventeen days after the operation, having perfect freedom of motion/'-Alfred 
C. Post, M. D., LL. D., in " Transactions of the American Medical Association for 1880." 
Directions for Measurement. 
i. Post's Torticollis Helmet. 
2. Circumference of Head, chin and top Inches 
3. Circumference of Plead, front and back, " GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
701 
ORTHOPAEDIC. 
SPINAL DISEASES AND DEFORMITIES, 
Torticollis, Wry Neck. 
Fig. 4188.-Shaffer's Ball and Socket Pivot, 
This apparatus for the treatment of 
malpositions of the head, shown in the en- 
gravings, consists of a pivot, F, which may 
be placed at any desired angle, either 
lateral or antero-posterior, and held there 
by a clamp which is controlled by a screw 
operating at X. The pivot fits into the 
chin-piece (Taylor's) at the point C, and, 
by means of the occipital uprights, E, E, 
and the chin-cup, II, any position of the 
head may be maintained and changed at 
will, without removing the apparatus from 
the patient. The key, D, loosens the ball 
of the pivot, and, the head being placed 
by the hand in the desired position, the 
key again is used to tighten the clamp. The whole apparatus may be made to 
surmount the two uprights of Taylor's spinal brace or any other form of support 
which furnishes a reliable pedestal. The chin-piece opens at F on a hinge, and 
the slide at G secures the apparatus after it is applied to the head. It is an ex- 
tremely useful instrument, both in Pott's disease, requiring a head support, and 
in torticollis. 
See Sayre's Jury-mast for Cervical Distortions, pages 684, 685. 
Fig. 4189. 
Wood's Torticollis Head-Rest. 
Directions for Measurement (Fig. 4189). 
I. Head leans to right or left side? 
2. Circumference of the neck, Inches. 
3. Length of the neck at sides, from clavicle to mastoid 
process, ... 
Fig. 4191.-Richter's Torticollis Brace 
Fig. 4190.-Stillman's Lever Brace 
with Attachment for 
Cervical Caries. 702 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOfbEDie. 
SPINAL DISEASES AND DEFORMITIES. 
Torticollis, Wry Neck. 
Fig. 4192. 
Markoe s 1 orticollis Brace. 
" This apparatus is constructed in the following manner: An upright steel bar is 
fastened to a pelvic band, and carried along the spine to a little below the level of the 
shoulders, secured in position by straps passing forward over the shoulders, backward 
under the axillae, and fastened to buttons or pads situated over the scapulae. 
"A steel lever for extension of the neck is provided inferiorly with a slot, to admit 
of adjustment, and connected with the upright bar by means of two screws ; the top of 
this lever is made to form a powerful clamp, for the purpose of holding the head-band 
and of securing the head in position. The head-band is formed of a steel-spring, car- 
ried half around the back of the head, softly padded, and the covering extended to the 
front and buckled there. A strap may also be passed across the top of the head from 
ear to ear. 
"A bandage, the size and shape of the patient's chin, is buttoned to this head-band 
laterally with four straps. Fastened to the steel spring of the head-band is a steel 
stem about one inch or less in length, terminating in a ball; this is held within the 
grasp of a clamp, thus forming a universal joint, moving freely in all directions. By 
turning the thumb-screw with which the clamp is provided, the movement of the joint 
is arrested and the head of the patient may thus be fixed in any position."-Thomas 
M. Markoe, M. D. 
Measurements Required. 
I. Patient's name (or sex). 
2. Patient's age. 
3. Patient's weight. 
4. Circumference of body under axilla, Inches 
5. Distance from sacro-lumbar articulation of the spine to the vertebra prominens, 
6. Distance from the same point to the base of the skull, 
7. Distance from crest of ilium to axilla, each side, 
8. Circumference of the head at the base of the skull over the ears and upper line of the forehead, 
Fig. 4193.-Torticollis Brace. 
This apparatus is principally the same as the one above. It consists 
of a well padded pelvic band, a, to which an upright steel bar is attached 
at I, passing upwards along the spine to the upper dorsal region. A cross- 
bar, c, is attached to its upper end, passing from one axillae to the other 
and fastened to two crutches, £, fitting well under the arm. These are 
connected to the pelvic band by two lateral bars, m, which by means of a 
slot and screw can be raised and lowered somewhat, at will. The part of 
the apparatus so far described is applied firmly to the trunk by means of 
straps passing over the shoulder and fastened to the axillary cross-bar at 
cc. A firm hold of the head is secured by a pad, sheet steel inside, reach- 
ing almost from eye to eye backwards around the skull, with apertures 
for the ears and fastened to the head by straps over the forehead and 
under the chin. To its back part a steel bar is riveted, d, which connects 
the upper part of the apparatus with that applied to the trunk. The 
lower end of this steel bar is ratched and adjusted in a slide at the upper 
end of the steel rod, passing up along the spine and held in position by a 
thumb-screw shown near the letter h. This connecting bar is intercepted 
by three different joints, e, /"and g, by which flexion can be made in any 
direction when worked with the key. At the joint g, flexion can be made 
to the right or left, at /"forward and backward and at e rotation. 
The advantage of this apparatus over many others is, that firstly a firm 
hold is effected to the head and trunk, and that then the head can be 
brought in a proper position by a true and irresistable mechanism. The 
apparatus when worn is almost entirely hidden under the clothing, and 
patients cannot very easily withdraw themselves from its action. 
Measurements required, same as for apparatus Fig. 4192. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
703 
ORTHOPAEDIC. 
SPINAL DISEASES AND DEFORMITIES. 
Torticollis, Wry-Neck. 
Fig. 4194. 
Roberts' Torticollis Brace. 
" This brace is for the purpose of securing, at the seat of disease, continuous elastic 
vertebral extension and voluntary articular motion, together with the avoidance of 
inter-articular pressure and friction. It consists essentially of two encasements, an 
upper or cervico-cephalic, and a lower or cervico-trunkal segment. The superior one 
has a clasp under the chin, which can be opened or closed by means of a key, thus per- 
mitting of easy removal or reapplication. The inferior one is provided with a hinge 
posteriorly, and a clasp anteriorly. The surfaces pressed upon by these two enveloping 
segments serve as points for counter-pressure. Elastic linear extension of the cervical 
spine is effected by means of two strong spiral springs playing upon upright steel rods, 
which are placed on either side of the neck. The degree of elastic traction force which 
is exerted can be regulated by the thumb-screws, which support the spiral springs on 
the steel rods. The upright rods are provided with a ball-and-socket joint at their 
lower end, thus permitting of all the normal movements of the head to be 
made, while at the same time elastic extension is enforced. 
" This appliance leaves all the healthy vertebrae, as well as the muscles of 
the trunk, unrestricted. Muscular debility and retardation of growth of healthy 
vertebrae are thus avoided."-M. Josiah Roberts, M. D., in Medical News, 
October 14, 1882. 
Fig. 4195.-Roberts' Jury-Mast 
" This is an instrument which, while not extending over the head, will exert 
continuous elastic traction upon the diseased vertebrae, and permit of volun- 
tary articular motion. It permits of all the normal movements of the head 
being made at the pleasure of the patient, or controlled and directed by the 
surgeon. 
"The lower part of the instrument, like that of the jury-mast, is held 
between the layers of the gypsum bandage, the shafts being curved forward 
under the arms, so as to bring its base beneath the part supported."-M. Jo- 
siah Roberts, M. D., in The New York Medical Journal and Obstetrical Re- 
view, October, 1882. 
Accidents to the Vertebral Column. 
"Accidents to the vertebral column derive their chief importance from the resulting injury to the spinal cord ; certain 
portions are more frequently the seat of injury than others, namely, the dorsi-lumbar, the cervico-dorsal, and the atlo- 
axial."-A. Shaw. 
" Concussion of the spine often develops symptoms of the most serious, progressive and persistent character, not 
only after apparently slight injuries, but frequently where there is no sign whatever of external injuries (J. E. Erich- 
son). It occurs usually as the result of a fall on the nates or back ; the shock is generally not severe, even when the 
paraplegic condition is well marked; the effects may be immediate, or may not supervene for some time (F. Le G. 
Clark). In direct severe injury the primary symptoms vary with the place of injury, the force, and the amount of 
organic lesion of the cord produced ; a blow on the upper cervical region may cause instant death, and on the dorsal 
region complete paraplegia; or there maybe paralysis of motion, less of power over the sphincters, alkaline urine, 
lowering of temperature of paralyzed parts. The secondary symptoms are usually those of development of inflam- 
mation in the meninges ; namely, pain in some part or parts of the spine, increased by pressure and motion, and ex- 
tending around the body, or down the limbs (J. E. Erichsen). In the severest forms there are lesions which give rise 
to haemorrhage within the canal, and consequent paralysis ; usually the blood proceeds from lacerations of the venous 
plexuses, and collects on the outside of the cord and its membranes, and in largest quantities behind and at the sides; 
in lesion of the cord itself the haemorrhage is slight, owing to the small size of its vessels. 
"The only treatment must be complete and absolute rest on a couch, in a prone position, rather than the supine, 
to avoid pressure on the back and relieve passive venous congestion, with dry cupping on either side of the vertebral 
column, and ice-bags, if comfortable ; the secondary symptoms must be treated by continued rest and such counter 
irritants as mustard poultices, stimulating embrocations, and, finally, setons and issues ; when subacute meningitis be- 
gins, bichloride of mercury, in tincture of cinchona, is most beneficial; at advanced periods the iodide and bromide of 
potassium, in full doses, are useful; when inflammation has subsided and paralysis remains, strychnine, galvanism and 
Warm salt-water douches are required (J. E. Erichsen)."-"Operative Surgery." Stephen Smith. 704 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
PARALYTIC DEFORMITIES 
Diseases of the Spinal Cord. 
" The principal diseases of the spinal cord, that is, the pathological conditions to which it is subject, are spinal me- 
ningitis, myelitis, and spinal apoplexy. These conditions give rise to or aid in developing a variety of symptoms, 
which in turn are classed as diseases, such as paralysis (including paraplegia and spinal hemiplegia), general spinal 
paralysis, and locomotor ataxia. The diseases known as progressive muscular atrophy and infantile paralysis, although 
their causes are not clearly made out, are generally considered to be connected with affections of the spinal cord. 
Moderate exercise and a well-regulated nutritious diet, to promote, as much as possible, the healthy assimilation of 
tissue, should be regarded as a main indication. Galvanism promises to be a powerful adjunct, but time is still re- 
quired to measure its importance."-"American Cyclopaedia." 
Affections of Nerves and Muscles. 
"Muscle (Lat. musculus'), the fibrous contractile tissue forming the flesh of man and animals, by which locomotion 
and the various functions of life requiring voluntary or involuntary movements are performed. Whether elongated or 
enclosing a cavity, this tissue is arranged in the form of fibres, usually in bundles connected by areolar tissue, sur- 
rounded by a vascular network, and supplied with nervous filaments. Muscles are so arranged as to produce great 
velocity, extent of motion, and strength, without injuring the beauty of proportions by the obliquity of their fibres to 
the tendons and of the last to the bones on which they act, and by the proximity of their points of insertion to the axis 
of motion of the joints. Muscles are attached to bone by means of tendons, rounded or flattened fibrous cords, white 
and shining, inelastic and very resisting; aponeurosis or fasciae are firm, shining fibrous membranes, enveloping the 
muscles, giving attachment to their fibres, and often fixed to bones like the tendons. Muscles occupy the whole dis- 
tance between the skin and the bones, and take an elongated, broad or thin form, according to the necessities of the 
several parts of the body ; their strength is in proportion to their length and thickness, and may be rapidly exhausted 
by continuous exertion. Muscles are called voluntary or involuntary, according as they are or are not under the control 
of the will; the division is not strictly accurate, as all of the former at times contract independently of the will, and 
some of the. latter are to a certain extent under the influence of volition. The former are generally solid, as in the 
muscles of the trunk and limbs ; and the latter hollow, as in the heart or the muscular layers surrounding cavities and 
canals. The voluntary and involuntary muscles are also distinguished by their structure; the former consisting of 
striped, the latter of unstriped fibres. The fibres of voluntary muscles are generally cylindrical, though more or less 
prismatic or many-sided, being somewhat flattened against each other. They vary in length in different muscles, and 
in the human subject average of an inch in diameter. Their color in man and the higher animals is ruddy, and 
they are elegantly marked by transverse or circular striations, giving them a very characteristic appearance, which has 
led to their being distinguished by the name of striped fibres. They consist of a cylindrical or prismatic mass of con- 
tractile substance, marked with the above-mentioned striations throughout its entire thickness, and containing also 
minute elongated or oval bodies, termed nuclei. Each fibre is invested by a delicate, transparent, structureless and color- 
less membrane, the sarcolemma, which supports the contractile material and limits its lateral expansion. The fibres 
are arranged side by side, parallel with each other, and united in small groups or bundles of one hundred to two 
hundred each. The bundles are again united into larger secondary bundles, connected with each other by areolar tissue, 
and so on ; the entire muscle being invested with an external fibrous expansion of condensed areolar tissue, and abund- 
antly supplied with, bloodvessels and nerves. The unstriped or involuntary muscular fibres are soft, pale, flattened 
bands, apparently homogenous or finely granular, about 77^ inch in diameter, with an elongated nucleus in'the cen- 
tral part of each one. 
"The contractility of muscle depends on an inherent property, independent of, though capable of modification 
by, nervous influence. The stimuli which induce contraction are volition, emotion, impressions conveyed to the nerv- 
ous centres and involuntarily reflected thence and various physical and chemical agents applied to any portion of the 
course of a motor nerve or to the muscular fibres. A muscle in action becomes shorter and thicker, changing its re- 
lative proportions without any actual change in bulk. After death muscles become fixed and rigid, a condition con- 
stituting the rigor mortis. In the active contractions which characterize muscles on the application of stimulus, force 
is exerted against some opposing power; this is attended with exhaustion or fatigue, and requires intervals of rest. 
Sustained contraction consists of an infinite number of partial momentary contractions acting in succession. Matteuccj 
and Du Bois-Reymond have investigated the electric currents for muscles. The combination of the muscular move- 
ment is in most cases so far independent of the will, that we are apt to lose sight of their perfection ; but let paralysis 
affect one side of the body, or contraction draw up a muscle, and the fact becomes at once evident, as may be seen 
every day in palsy of one side of the face, or strabismus with the turning in or out of the eye. The simple process of 
walking, performed it may be unconsciously, with its nice adjustments executed by the automatic guidance of the senses 
rather than by any act of the will, is what the most ingenious mechanician can never effect in an automaton, from the 
impossibility of harmonizing the many acts which constitute walking. . GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
705 
ORTJHOP/EDIC. 
PARALYTIC DEFORMITIES. 
Affections of the Nerves and Muscles. 
" Muscle may be hypertrophied from excess of nutrition arising from abundance of formative material, from increased 
supply of blood, but principally from preternatural formative capacity ; the opposite conditions lead to atrophy of muscle. 
" Muscles which move a limb in opposite directions are called antagonist muscles. The flexor muscles of the arm, 
for instance, bend the limb at the elbow-joint, and the extensor muscles draw it back, or extend the arm in a direct 
line ; thus these muscles antagonize each other. There is a sort of passive action in the different muscles of the body, 
constituting what is termed the natural tone of the system, and when this is lost or partially enfeebled in one set of 
muscles, their natural antagonists have an undue action on the parts, and cause disfigurement by destruction of the 
natural balance. The form and position of the face, for instance, keep up a balance of feature in the natural expres- 
sion of immobility or stillness; those of one side antagonize those of the other. In paralysis of one side of the face, 
the musclesof that side are deprived of their natural tone and power of action, while those of the other side retain their 
tone and power as before; the consequence of which is that the latter draw the mouth to their side of the face, while 
the others are unable to counterbalance this action from want of power to act in the opposite direction. Certain muscles 
are antagonized by the natural elasticity of the parts to which they are attached ; the elasticity of the ribs and that of 
elastic ligaments of the spinal column may be considered as antagonistic to the natural tone and power of the muscles 
attached to them, or acting in a contrary direction."-"American Cyclopaedia." 
Progressive Locomotor Ataxia. 
" (Gr. dra^La, want of order.) This name has been given to a form of paralysis characterized by disorderly mus- 
cular movements in consequence of loss of coordinating power, which has been recognized only within the present cen- 
tury. Duchenne described it in 1858-59 more fully than any previous author, and gave it its name. Its pathology 
and location has been pointed out by Dr. Todd, but its causes were more fully investigated by Duchenne. Romberg 
called the disease tabes dorsalis, and it has also been called myelo-phthisis. There is not much loss of muscular power, 
except as general debility advances, but the diminution of sensation is more marked. The patient has a peculiar gait 
in walking, throwing the legs out in a jerking and uncertain manner, and, when the disease is pretty well advanced, 
throws his arms out like a man balancing on a tight rope. He seems to be somewhat in the condition of one who is 
walking in the dark over uneven ground. That which has been termed the ' muscular sense' is impaired. The harmony 
of the reflex impressions by which muscular contractions are regulated and the limbs moved and adjusted is so far 
disordered that either too much or too little contraction is produced at each step. The foot will be thrown out and not 
properly brought to the ground, and, as if to relieve this deficiency, the patient by an effort of will brings the foot 
down at the next step with too much force. A chief characteristic is the inability to walk or stand with the eyes closed. 
It needs the assistance of sight to keep the body erect; the walk is uncertain and reeling even with the eyes open, 
but, if the patient shut them, he will fall. As the disease progresses, the upper extremities become affected^ and it is 
difficult for the patient to tie his cravat or button his coat, or perform any motions requiring coordination of muscular 
movements. There are certain premonitory symptoms which have been relied upon, such as fugitive shooting pains in 
different parts of the body, of a neuralgic character; but they are often found unconnected with the disease, and often 
absent when the disease is present. One of the early symptoms is incontinence of urine consequent upon relaxation of 
the sphincter muscle, and an irritable state of the mucous membrane of the bladder; and there is often increased 
sexual activity, which, however, declines in the progress of the complaint, and at last ends in impotence. A characteris- 
tic feature of the disease is transient localized paralysis, such as that of the sixth pair of cranial nerves, which supply 
the external straight muscle of the eyeball, or the third pair, which supply the' elevators of the eyelid, and the con- 
strictor of the iris, so that there is dropping of the lid and dilatation of the pupil, one eye being usually affected more 
than the other, and vision is sometimes impaired or lost. In some cases these paralytic affections are permanent. 
When the paralysis of the limbs begins on one side, which it frequently does, it is much oftener upon the left than the 
right side. Before the disease is much advanced, although the gait is irregular and jerking, the patient retains the 
power to walk considerable distances. 
"After a time the power of locomotion is lost, the patient is confined to his bed, he becomes unable to feed him 
self, and speech is difficult, sometimes impossible. The disease is distinguished from ordinary paraplegia, or anterior 
spinal paralysis, by the careful and. circumspect gait of the latter; although it has some symptoms in common with 
general paralysis of the insane, the totality of them will enable a diagnosis to be made. The prognosis is extremely 
unfavorable ; very few cases ever cease progressing, and fewer still recover. The most that can be hoped for is that 
the disease will remain stationary or progress slowly. Sometimes it develops rapidly, but generally years elapse before 
the fatal termination, and in most cases death is produced by some intercurrent affection. * * * 
" Males are more often affected than females. It is especially a disease of middle life, between the ages of thirty 
and fifty, although it sometimes occurs before thirty, and Trousseau reports a case in a patient eighty years old. The 706 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOp/EDI©. 
PARALYTIC DEFORMITIES 
Progressive Locomotor Ataxia. 
disease is sometimes associated with general paralysis of the insane, sometimes one and sometimes the other disease ap- 
pearing first. 
" There is no particular plan of treatment established. In Europe and in this country success has seemed to at- 
tend the employment of the interrupted galvanic current (farradization), and cases are reported as having been bene- 
fitted by the continuous current of a strong battery. Long-continued and well-regulated gymnastic exercises were suc- 
cessfully employed by Eisenmann in two out of six cases. The iodide and bromide of potassium are beneficial. Counter- 
irritation with blisters, issues and cautery has been found of no avail. Moderate exercise and a well-regulated nutri- 
tious diet, to promote as much as possible the healthy assimilation of tissue, should be regarded as a main indication. 
Galvanism promises to be a powerful adjunct, but time is still required to measure its importance."-"American Cy- 
clopaedia." 
PARALYTIC AND SPASTIC DEFORMITIES. 
"Paralysis.-Abolition or great diminution of voluntary motions, myoparalysis, and sometimes of sensation in one 
or more parts of the body. 
"Palsy is said to be local when it affects only a few muscles. When it extends to half the body, vertically or 
horizontally, it is called hemiplegia or paraplegia. It is commonly symptomatic of disease of the brain orof the nerves 
themselves, and is a frequent accompaniment, precursor, or successor of apoplexy-phrenoparalysis. The immediate 
cause is generally pressure, either by blood effused or by serum, or by vascular turgescence. At its onset, therefore, 
bloodletting may be advisable, but afterwards the disease becomes one of nervous debility, and requires stimulants to 
the paralyzed parts, or to the mucous membranes-frictions, sinapisms, blisters, the moxa, baths, electricity, galva- 
nism, purgatives and the nux vomica, which last has the property of exciting movements where the will has no longer 
power."-Dunglison. 
"Spasm, spasmus, spasma, spasis, sparagmus, synolce, spado, spadon (F. spasme), OTTaopog, from G7Ta(i) ("I 
draw").-The Greeks gave this name to all kinds of convulsions. It is now usually applied to involuntary mus- 
cular contractions, and these again have been divided into tonic spasm, paratonia, which consists in permanent rigid- 
ity and immobility of the muscles that are the seat of it (tetanus'); and clonic spasm, which consists in alternate com 
tractions and relaxations (convulsions)."-Dunglison. 
"Paralysis gives rise to deformities in the following manner: The joints lose their support and bend outward or 
inward, according to the inclination of the joint surfaces in cases of general paralysis of the muscles, or bend toward 
the contracting muscles in cases of partial paralysis. When paralysis of motion and sensation is complete, or very ex- 
tensively developed, it greatly interferes with the nutrition of the part."-Lewis A. Sayre, M. D. 
Paralysis, Palsy, Hemiplegia, Paraplegia. 
" Much benefit may be derived from the use of dry heat. It is especially adapted to the treatment of paralytic de- 
formities, and is beneficial from the fact that it solicits more blood to the part to which it is applied. Clay tubes of 
proper shape and size may be heated to any degree bearable, and then the limb may be placed within them."-Lewis 
A. Sayre, M. D. 
" The bath is another item of general treatment, the value of which can hardly be over estimated. The tempera- 
ture is to be varied according to the constitution of the patient and the character of the deformity. In the treatment 
of paralytic deformities the bath is one of the most useful adjuvants to other treatment that can be employed. In such 
affections it should always be warm and should be continued for a long time. Instead of being applied to the whole 
body, it should be applied to the part affected. In such cases the object of the bath is to increase the circulation of 
blood through the paralyzed parts for the purpose of increasing their nutrition."-Lewis A. Sayre, M. D. 
"Inunction.-Oil-particularly petroleum-may be of benefit; as a general rule, however, all greasy substances 
are of very little value in this connection. The laity all have great faith in ointments, liniments and various kinds of 
oil, for the cure of paralyzed limbs, contracted tendons, &c. My belief is that the chief-and I may say the sole-be- 
nefit arising from their employment is due to the friction and manipulation which necessarily accompany their use, 
and not to any virtue possessed by the grease employed, unless it be that the small quantity of phosphorus sometimes 
found in the combination may be a source of benefit. 
"Strychnia is a remedy so constantly employed in the treatment of paralyzed muscles that a brief reference should 
here be made to its use. It should be administered in doses sufficient only to produce slight twitchings of the muscle. 
The administration of one-fiftieth grain doses three times a day, and the subcutaneous injection of one-sixtieth of a 
General Treatment. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
707 
ORTJHOP/EDIC. 
PARALYTIC AND SPASTIC DEFORMITIES. 
General Treatment. 
grain into the muscle, once in eight or ten days, will ordinarily be sufficient to produce the desired results, and will 
also, as a rule, be of much service. Over-fatigue of muscles can be brought about by exciting undue contractions with 
this remedy, as well as by application of electricity, or by excessive manipulation. Such fatigue is to be carefully 
avoided. 
"Electricity.-Its apparent value as a means for restoring vitality to paralyzed muscles is indisputable. There are 
a few rules which should regulate its application. 
" 1. When applying electricity for the restoration of paralyzed muscles, do not apply it too long. Three or five 
minutes every day, or every other day, is sufficient in a majority of cases. 
"2. Do not apply it too strong. A strong current is very likely to give rise to over-fatigue of the muscles, which 
will be as positively injurious as that induced by any other means, and over-exertion must, therefore, be carefully 
avoided. 
"3. Always restore the muscle as nearly as possible to its normal position, by means of some artificial support, 
and retain it there, approximating its origin and insertion before the battery is applied. * * * Muscles that 
have entirely lost their excitability upon application of the electric current, are incapable of contraction. The production 
of even a few contractions will indicate that treatment persistently applied will finally greatly increase the power of 
the muscles. But if the contractions are forced, as is exceedingly apt to be the case unless great care is exercised, it 
will be found that, perhaps, the next day no contractions can be obtained. The slight power of contraction which some 
muscles may have is, doubtless, many times entirely destroyed by the excessive use of the electric current, the muscles 
being over-fatigued by the stimulus the same as they would be by over-work. 
" For the purpose of determining whether a muscle has undergone fatty degeneration, it is only necessary to remove 
a small portion by instruments especially devised for that purpose (see page 12), and then submit it to microscopical 
examination. One precaution, however, is to be taken, namely, to examine the muscle suspected at different points 
from one end to the other. When this has been done, the prognosis can be established relative to the restoration of 
lost muscular power by means of the electric current."-(See page 24), "Orthopaedic Surgery and Diseases of the 
Joints." Lewis A. Sayre, M. D. 
Apparatus for Paralysis, Palsy, Hemiplegia, Paraplegia. 
" The various forms of paralysis affecting the extremities may be relieved by appara- 
tus."-Stephen Smith. 
The apparatus represented by Fig. 4196 is for hemiplegia, affecting the limb to the 
hip joint. We have often had occasion to make it, and found it to answer a good purpose, 
both as a support and in aiding the restoration of the mobility of the muscles. It answers 
to the same description as Fig. 4198, but is carried up to the pelvis. On to a broad steel 
pelvic band we fasten the artificial muscles for flexion or extension, as the case may require. 
Fig. 4196.-Apparatus 
for Hemiplegia. 
I. Patient's name and description of the case. 
2. Patient's age. 
3. Right or left leg. 
4. Length from sole of foot to ankle joint, Inches. 
5. Length from sole of foot to knee joint, " 
6. Length from sole of foot to trochanter major, " 
7. Length from sole of foot to crest of ilium, " 
8. Circumference of calf, ' 
9. Circumference of knee, ' 
10. Circumference above knee, . , " 
11. Circumference of thigh " 
12. Circumference of pelvis one inch below iliac crests, " 
Patients will furnish their own laced shoes or send the following additional measure- 
ments if they wish us to send them : 
a. Length of sole of foot, Inches. 
b. Circumference of ball of foot, " 
c. Circumference of instep, . . " 
d. Circumference above ankle, " 
Measurements Required. 708 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
PARALYTIC AND SPASTIC. 
Apparatus for Paralysis, Palsy, Hemiplegia, Paraplegia. 
" The thigh may suffer from paralysis of various muscles, but the most important is the quadriceps femoris-inabil- 
ity to extend the leg upon the thigh results from its paralysis or rupture, and the patient is no longer able to walk. The 
condition may be relieved by apparatus having strong elastics attached, working upon eccentric leverages, leaving the 
knee entirely free from all pressure, and, after the leg is bent by the flexors, extension of the leg upon the thigh 
promptly occurs."-Stephen Smith. 
Fig. 4197. 
Apparatus for Paraplegia. 
The apparatus for paraplegia answers to the same description as the one for hemi- 
plegia, except that it is double. It is used when both the lower extremities are affected. 
A general description of the case is necessary to guide us in placing the artificial 
muscles in the right spot. The directions for measurements are the same as for the 
apparatus for hemiplegia, Fig. 4196. 
Fig. 4198. 
Apparatus for 
Partial Paralysis 
of Leg or Thigh. 
In cases of wasting palsy, or when certain groups of muscles 
become atrophied, losing the power to perform their functions, an 
apparatus as shown (Fig. 4198), suited to the case, should be worn. 
The muscles are excited into action, and aided by artificial substi- 
tutes made of elastic rubber or steel, placed on the instrument so 
as to gently exercise the affected parts. This will often recall them 
to a sense of their duty. 
i. Patient's name. 
2. Patient's age. 
3. Right or left leg. 
4. Length from sole of foot to ankle joint, . . Inches. 
5. Length from sole of foot to knee joint, . . 
6. Length from sole of foot to upper third of thigh, " 
7. Circumference of calf, 
8. Circumference of knee, " 
9. Circumference above knee, 
10. Circumference of thigh " 
Directions for Measurement. 
Fig. 4199. 
Stephen Smith's 
Paralysis Apparatus. 
" In cases of infantile paralysis, with atrophy and shortening of the limb, it is very difficult 
to supplement the loss by any ordinary means. The limb not only has to be strengthened, but 
also to be lengthened, in order to restore its function. This may be effected by the following 
apparatus, namely, two upright steel bars, K, attached to the shoe, pass up either side of the 
leg nearly to the knee ; they are then curved backward to the middle of the popliteal space, 
where they unite into a stop joint, A, which allows partial bending of the knee ; from this 
point two lateral steel bars, K, diverge and pass up on either side of the thigh, the external as 
high as the trochanter major, G, and the internal nearly to the groin; to the upper ends of 
these bars two bands are attached, the posterior being thickly padded and resting under the 
tuber ischii, and the anterior, D, of lighter material; a knee-cap, M, maintains the leg in posi- 
tion by means of lateral straps; two light bands pass around the leg, C, and the thigh, B; the 
shoe has an inside elevated sole to which the foot is attached, and which permits support on 
the foot in the act of walking. The effect of the apparatus is to render the defective limb of 
the same length as the well limb: the spine being thereby straightened and the steps made 
equal ; the body is carried on the posterior band. This apparatus is adapted to cases of hip- 
joint disease in the stage of recovery, for slight traction may constantly be made."-" Opera- 
tive Surgery." Stephen Smith, M. D. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
709 
ORTHOP/EDIC. 
PARALYTIC AND SPASTIC DEFORMITIES. 
Apparatus for Paralysis, Palsy, Hemiplegia, Paraplegia. 
Fig. 4200. 
Apparatus for the Sup- 
port of Weak Legs. 
This apparatus is for the support of weak legs when, by reason of relaxed joints, 
softening of the osseous structure or partial paralysis, they cannot quite bear the weight 
of the body, but where the muscles still retain some power to perform their respective 
functions. Very light steel springs are secured to shoes, and carried up the sides of the 
legs and to the pelvis. They are provided with joints corresponding to the natural ones, 
and secured to calf, thigh and pelvis by well-padded bands and buckles. 
Measurements Required. 
1. Patient's name. 
2. Patient's age. 
3. Length from sole of foot to ankle joint, Inches. 
4. Length from sole of foot to knee joint, 
5. Length from sole of foot to hip joint, 
6. Length from sole of foot to iliac crests, . , 
7. Circumference of pelvis one inch below iliac crests 
8. Circumference of thigh, 
9. Circumference of calf, 
" This condition, known popularly as weak ankles, is not alluded to in surgical works, and consists in a laxity of 
the internal lateral ligament and consequent bulging of the internal malleolus, with a tendency to the formation of 
valgus. It may exist quite independently of the latter, and is not uncommon in infantile paralysis of the lower 
limbs, and in cases where the arch of the foot is increased and the plantar fascia tense. In some cases the internal 
malleolus is overgrown laterally, and a condition somewhat similar to the projection of the inner condyle in atonic 
genu valgum results. I have seen small bony spicules in the neighborhood of the inner ankle, reminding me of those 
met with in the tibia, and occasionally on the internal tuberosity of the femur. If unchecked, some of these cases 
may pass, mechanically, into valgus. 
"Symptoms.-The deformity is obvious, and occurs usually in quickly growing children or adolescents with lax 
fibre. The ankles knock together in walking, and this, with the wearing away of the boots where the ankles rub each 
other in walking, are noticed and complained of. The patient is very apt to tread or slip over to the inner side of the 
foot, and sometimes this gives rise to severe sprains and, in two or three cases I know of, a Pott's fracture was thus 
produced. 
"Treatment.-This consists in giving firm support to the joint by good elastic anklets, and by the wearing of a 
boot and support with a properly adjusted T-strap (see Fig. 4202). All prolonged efforts of standing and walking 
must be avoided, and the joint strengthened by massage, frictions, &c."-"Practical Orthopaedics." Reeves. 
Valgus Ankle. 
Fig. 4201. 
Detmold's Ankle Spring. 
This brace is for weak ankle and after-treatment of club-foot. It consists of a 
well-tempered steel spring, forged at one end into a wide flange, by which it is 
rivetted to the sole of the shoe. By a well-padded band, secured to its top, it is 
fastened with a strap and buckle to the leg below the knee. It has no joint at the 
ankle. The tendency of the spring being forward and outward, it will, when brought 
to the leg by securing its padded band at the garter, lift the toes and evert the foot 
so as to bring the sole of the latter flat to the floor. 
The lace shoe, an ordinary one as usually found, freely made, is narrowed across 
the instep by the removal of a wedge-shaped piece from its upper ; the eyelets being 
replaced, this enables the tighter lacing of the shoe at the instep, firmly securing 
the heel of the foot to its place in the shoe. 
Measurements Required. 
I. Send well fitting shoe or shoes to lace and of a size larger than usually 
worn, so as to admit of a steel insole that we secure into the same. 
2. Length from sole to garter (below the knee), . . . . . . Inches. 
3. Circumference at garter, " 710 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
OF<THOp/EDie. 
PARALYTIC AND SPASTIC DEFORMITIES. 
Apparatus for Weak Ankle and Short Leg. 
The ankle is often weak from paralysis of the muscles attached to the bones of the foot. 
The joint is easily strengthened by apparatus with lateral steel braces fastened to the shoe, 
and a T-strap. 
Fig. 4202. 
Weak Ankle Brace. 
Fig. 4203.-Patten, 
to Elevate a Short Leg. 
For a short leg, the result of infantile paralysis, 
when the bones have not kept pace in growth with 
those of the corresponding extremity, we make an 
extension to correct the patient's limp and to guard 
against the danger of spinal curvature. The appa- 
ratus consists of a steel frame of proper height, se- 
curely fastened under a plain shoe. The steel base 
has a leather sole attached, to avoid noise when walk- 
ing on pavements, stone or wooden floors, and to prevent falling on slippery 
ground. These extensions are light and comfortable. 
Directions for Measurement. 
I. Have the patient (both feet bare) stand up ; place books or blocks of 
wood under the short foot until the shoulders and pelvis are in a 
horizontal plane, then measure these books or blocks, which will be 
the height required for extension. 
2. Send us a well-fitting shoe. 
3. Right or left leg? 
Fig. 4204.-Extension for 
Short Leg and Brace for 
Weak Ankle, combined. 
If shortness of a leg is accompanied with weak ankle and consequent inability to 
bear the weight of the body, the muscles being too weak to keep the ankles straight, 
the simple contrivance described (Fig. 4203) is not sufficient, and the apparatus, as 
shown by Fig. 4204, will be required to support the joint. This is in reality the appa- 
ratus Figs. 4203 and 4204 combined. 
Directions for Measurement. 
I. Height of the extension as directed for Fig. 4203. 
2. Right or left leg? 
3. Distance from sole to ankle joint, Inches. 
4. Distance from sole to calf, " 
5. Circumference of calf, *' 
6. Send us a well-fitting laced shoe. 
If we are to furnish shoes, send the following measurements: 
a. Length of sole of foot, Inches. 
b. Circumference of instep, " 
c. Circumference of ball of foot " 
d. Circumference above the ankle, " 
Fig. 4205.-Apparatus for Contracted Wrist 
Apparatus for the Arm, Forearm and Wrist. 
" The forearm and arm affected by paralysis require the appli- 
ances recommended for un-united fracture. The wrist may fall into 
the position of flexion, wrist-drop, from paralysis of the extensors 
of the carpus. This malposition is readily rectified by a simple 
instrument, which makes elastic pressure on the thenar and hy- 
pothenar eminences."-Stephen Smith. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
711 
ORTHOP/EDIC. 
PARALYTIC AND SPASTIC DEFORMITIES. 
Wrist Drop. Apparatus. 
" Wrist Drop.-This deformity consists, as its name implies, in a dropping of the hand, which is an undue flexion 
consequent upon paralysis of the extensor muscles of the forearm. The most common cause is lead poisoning. When 
the lead palsy, as it is sometimes called, has continued for some time, atrophy of the muscles is a common result, and 
in many cases it is very marked. 
" The opinion is quite common that the lead manifests its poisonous effects alone upon these extensor muscles, but 
that is not true. The lead affects the entire system, and the patient has not only wrist-drop, but he has diminished 
muscular power in all the muscles of the body. The more common manifestations, however, of lead poisoning is pa- 
ralysis of the extensor muscles of the hand and fingers, and the patient is unable to extend the hand and fingers. The 
use of cosmetics is a very fruitful source of lead poisoning among women. 
" The indications in the treatment are to eliminate the poison from the system, to restore lost or impaired muscular 
power, and to assist the muscles in the performance of their functions. The means to be used for restoring lost or im- 
paired muscular power (in addition to internal treatment) are galvanism, hypodermic injections of strychnine, fric- 
tion, &c. These measures must not be employed, however, in such a manner as to produce over-fatigue of the 
muscles. Galvanism should be used only when the muscles are properly supported, so that they will not be obliged to 
lift any weight when stimulated to contract. 
" Of the value of Hudson's apparatus in cases of this kind, I cannot speak in too high terms. It is very light 
and beautiful, is worn without inconvenience, enables the patient to exercise the muscles of the hands and fingers 
constantly, and thus materially facilitates nutrition and development."-"Orthopaedic Surgery and Diseases of the 
Joints." Lewis A. Sayre. 
Fig. 4206.-Hudson's Wrist Drop Apparatus. 
Fig. 4207.-Hudson's Apparatus, applied 
Fingers, 
" The fingers occasionally suffer paralysis of the extensor muscles, giving only flexion of the fingers. This con- 
dition may be greatly relieved by a light apparatus which constantly extends the fingers and wrist (see Fig. 4208). 
Stephen Smith. 
This apparatus, made of strong yet 
pliable material, reaches about two 
inches above the wrist, and is arranged 
to lace snugly, to prevent displacement. 
Five india-rubber cords, acting as 
artificial extensors, are distributed along 
the back of the fingers and thumb. The 
ends of these cords are provided with 
hooks which take hold of loops at the 
extremities of the fingers and thumb, 
and of chains connected to straps at the 
wrist. These artificial muscles act in- 
dependently one of the other, and their strength can be regulated by hooking them to the chains so as to make them 
more or less tense. They are passed through loops to prevent their slipping out of place. 
Fig. 4208.-Glove for Paralysis. 712 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
PARALYTIC AND SPASTIC DEFORMITIES. 
Writer's Cramp Apparatus. 
''Writer's cramp, graphospasmus, mogigraphia, chore'a scriptdrum, paral'ysis, notaridrum, scrivener's cramp or 
paral'ysis, scribe pal'sy, pen pal'sy, functional spasm, stammering of the fingers, (F.) crampe des ecrivains.-A con- 
dition of the fingers in which they are unable to hold a pen, or in which one or more of the muscles of the fingers 
are irregularly and irresistibly contracted. A similar condition of the nerves and muscles concerned is seen in the 
shoemaker's cramp, milking cramp, musician's cramp, compositors' and seamstresses' cramp."-Dunglison. 
Fig. 4209.-Velpeau's Writer's Cramp Apparatus. 
There are many devices for the relief of this malady, the 
above is one of the simplest and most effective. It consists of 
an oblong ball, made of wood or hard rubber, to be grasped by 
the hand, keeping it in a proper position. To this are attached 
a couple of half-rings, serving as rests for the index and middle 
fingers. A penholder passes through the neck of the ball at a 
convenient place near the extremity, which can be adjusted and 
made firm by a thumb-screw. Thus a person affected with 
writers' cramp may be effectually treated without being necessi- 
tated to leave off writing. 
Prof. v. Nussbaum, of Munich, deems writers cramp to be 
caused by the pathologically changed antagonism of the muscles 
in which there is always present spastic contraction of the flex- 
ors and adductors along with debility of the extensors and ab- 
ductors. He constructed a penholder which is to be conducted 
by means of the extensors and abductors, instead of the flexors 
and adductors. In this manner cramp is not only avoided, but 
the very act of writing becomes the remedy for the removal of 
the evil. The bracelet consists of an obliquely oval ring, to 
which a penholder is fastened in such a position that the pen 
will easily touch the writing paper when the hand is rested 
upon the desk. The thumb and first three fingers are put into 
the ring, the thumb but little, the third finger to near the metacarpal bone-the fourth finger is left out. By extending 
and spreading the fingers inside of the ring it is held fast, but drops off as soon as the fingers are flexed. By means 
of these bracelets the proper gymnastic exercises are performed to overcome the debility and to restore the antagonism 
of the muscles. The apparatus not oniy enables the patient to do his usual writing, but, according to v. Nussbaum, 
the more he writes the sooner will a cure of his case be brought about. The rings are made of hard rubber and are 
of four different sizes. 
Fig. 4210.-Nussbaum's Bracelet. 
Fig. 4211.-Charcot and Cazenave's Apparatus for Writer's Cramp. 
Fig. 4212.-Mathieu's Writer's 
Cramp Apparatus, for Thumb 
and Index Finger. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
713 
ORTHOPAEDIC. 
PARALYTIC AND SPASTIC DEFORMITIES. 
Writer's Cramp Apparatus. 
Fig. 4213.-Charriere's Writer's Cramp Apparatus. 
Fig. 4214.-Writer's Cramp Apparatus 
Pince Porte-plume. 
Fig. 4215.-Mathieu's Writer's Cramp 
Apparatus, for Three Fingers. 
Fig. 4216. 
Writer's Cramp Apparatus 
Fig. 4217.-Writer's Cramp 
Apparatus, for Index and 
Middle Finger. 
PARALYTIC, SPASTIC AND RACHITIC DEFORMITIES. 
Genu Valgum. 
"Genu valgum is a deformity in which, on standing with the knees extended and touching, one or both knees are 
directed inwards and the malleoli separated. Genu vartim is the opposite deformity, i. e., when standing with the 
malleoli touching, the knees are more or less separated. 
" Varieties.-It may be single or double, whatever its cause, the double forms being commonest, but the traumatic 
forms are usually unilateral. It may be congenital or acquired, and there may be valgum of one side and consecutive 
accommodative varum of the other, or vice versa. 
"Causes.-Any of these deformities may be either congenital, rachitic, atonic, statical, spastic, paralytic, trauma- 
tic, arthritic, senile, or inherited ; and their nomenclature and classification may be arranged according to their teti- 
ology. Another setiological classification is into pathological and traumatic ; the former includes all those above given, 
with the exception of the traumatic cases. Predisposing causes are to be found in bad hygienic surroundings, insuffi- 
cient food as regards quantity and quality, rickets, muscular and ligamentous debility, &c. Exciting causes are to be 
sought in errors in the mode of standing, unequally distributed pressure, the carrying of weights on the head or back, 
producing flat-foot and secondary genu valgum, or vice versa. Miculicz considers the hyper-extension of the legs on 
the thighs, which occurs in rickety subjects at the end of extension, and permits increased rotation of the tibia out- 
wards, as a pathological result rather than a cause. Young bricklayers, and especially bakers, who carry heavy loads 
of bread and also work for hours in a warm moist atmosphere, which is relaxing to the tissues, often are affected by it. 
" The atonic cases are due to muscular and ligamentous debility, and possibly to some nerve debility also, by which 
the muscles are not kept in a sufficiently tonic condition ; the rachitic are due to changes chiefly in the direction of 714 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC 
PARALYTIC, SPASTIC AND RACHITIC DEFORMITIES. 
Genu Valgum. 
overgrowth in a downward or inward sense, or both, of the internal femoral condyle, with or without curvature of the 
shaft, and in several cases changes are also found in the head of the tibia. In well marked rachitic cases the joint 
will frequently be found loose and the tibia rotated on the femur. In other cases there will be an appearance of ro- 
tation, on account of the tibial diaphysis being united to its upper extremity at an angle which is open externally, and 
also because the tibial shaft is twisted inwards so that its crest is directed somewhat inwards. A bony spiculum or 
process is often present at the upper and inner part of the tibia near the insertion of the internal lateral ligament. 
" 'The pathogenesis of most of the other forms of genu valgum and varum, as well as those just given, has been the 
caqse of considerable difference of opinion among surgeons of late years. These various views may be arranged under 
three heads, viz.: I. The ligamentous theory ; 2. The muscular ; 3. The osseous. 
" The ligamentous theory was supported by Stromeyer, Guerin, Blasius, &c.; but two opposite views were held by 
its supporters. Some considered that the internal lateral ligament was relaxed primarily, so that there was a loose- 
ness on the inner side of the joint, allowing the inner condyle to overgrow laterally and also downwards, because of 
the gap permitted between it and its corresponding tibial surface. Others thought that the external lateral ligament 
was primarily at fault, being shortened, and the pressure thus produced on the outer condyle and corresponding arti- 
cular surface of the tibia, caused their atrophy, or rather deficiency of normal growth, while the inner portions of the 
joint had more play to develop. Atrophy of the outer section of the joint is also the result of relaxation of the in- 
ternal lateral ligament. To the former view it has been objected that the relaxation of the internal lateral ligament 
is secondary to the changes in the bones ; and, to the latter, that the external lateral ligament retracts to accommodate 
itself to the altered position of the articular surfaces on the outer side of the joint, and, therefore, this shortening is 
also secondary, and, moreover, that there are cases in which no shortening of the ligament can be made out. 
" The muscular theory is also divisible into two opposing views. The one attributes genu valgum to shortening of 
the biceps, popliteus and tensor fasciae latae ; the other considers the deformity to be due to relaxation of these struc- 
tures. Duchenne, Bonnet, Verneuil, Guerin, Little, Adams, Brodhurst, and others, have supported one or other of 
these views but not, so far as I am aware, to the exclusion of osseous changes, whether primary or secondary. The 
supporters of this theory maintain that there is a primary contraction ; then a retraction of the muscles on the outer 
side of the joint, and that the bone changes, if present, are secondary. The objections to this view are that, in many 
cases, no shortening or tension of the external muscles can be made out, and that in those cases in which it exists it is 
secondary. Paralytic cases are of course explainable by this theory, i. e., lack of supporting power in the muscles and 
of tone in the ligaments, and not by the antagonist theory. In these cases, and they are common in infantile paraly- 
sis, nearly all the muscles are paralyzed, so that there are no active antagonists to produce the distortion. Verneuil 
admits another set of muscular cases, occurring about the age of puberty until the age of twenty, in which he says 
that the muscles of the inner side of the thigh are atrophied, while the biceps is contracted. 
'•The osseous theory attributes genu valgum and varum to primary changes in the lower epiphyses of the femur, 
or to the lower portion of its diaphisis, including in some cases the upper end of the tibia. These bony changes may 
be due to rickets, whether infantile, adolescentium or senile, or to other local inflammatory or general osseous changes 
leading to hypertrophy of the inner part of the joint. In these, as in other cases, there may be atrophy of the outer 
portion of the joint, or this may be normal. Of recent years Annandale, Ogston, Chiene, McEwen, Barwell, and other 
surgeons, have acted chiefly on the belief that the main change-whether primary or secondary-was in the bones, and 
mostly at the lower end of the femur. 
" I think all will agree that any of the theories mentioned are too exclusive to explain the varying phenomena met 
with in studying a large number of cases of these deformities. Genu valgum is not, as a rule, the result of but one 
cause, originating invariably in only one set of structures ; but is frequently due to a series of causes, some of which 
are primary and of more importance than the rest, and of these my experience has taught me that the bony cases are of 
more frequent occurrence than the atonic, or those due to muscular and ligamentous weakness. 
" In atonic statical cases (i. e., those caused through long standing, walking and wrongly directed pressure in deli- 
cate subjects) there are commonly three stages and grades of the deformity. In the first stage there is stretching of the 
internal lateral ligament through the altered direction of the axis of pressure towards the inner side of the joint; and 
Mickulicz has found this internal ligament tense and hypertrophied, instead of relaxed, and Owen and Linhart have 
made similar observations. The last named observer found the external lateral ligament lengthened, but this is quite 
exceptional. Probably the crucial ligaments, especially the posterior portion attached to the internal condyle, is also 
stretched. Lannelongue has found the posterior crucial rudimentary and anterior absent. If the patient now comes 
under observation the case would be considered a mild one. 
" In the second stage the tendon of the biceps, the external lateral ligament and the ilio-tibial band of the fascia 
lata, all on the outer side of the joint, become contracted, and this serves to increase the deformity. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
715 
ORTHOP/EDIC 
PARALYTIC, SPASTIC AND RACHITIC DEFORMITIES. 
Genu Valgum or Knock-Knee. Apparatus. 
" In the third stage bony changes become more noticeable. The internal condyle becomes enlarged laterally, also 
elongated and separated from the tibia ; and if the ligaments on the inner side be very lax a depression can be dis- 
tinctly felt between the femur and the tibia ; but as a rule the enlargement of the inner condyle fills up the gap that 
would otherwise exist between the bones, or the internal tibial tuberosity enlarges and fills the gap, but this is excep- 
tional in my experience. The external condyle and outer tuberosity of the tibia, having to bear the body weight, be- 
come pressed together and either atrophy or cease to grow, and thus serve to accentuate the deformity. 
" Treatment.-This must vary according to the severity of the case, and, to some extent, according to the cause. 
The object being to bring the limb into a normal position, the only question is as to the best mode of doing it. Until 
about the last dozen years, no rapid methods were known to or generally adopted by surgeons, and treatment was con- 
fined to splinting and tenotomy. Reduction may, now-a-days, be accomplished gradually or at once; and even in 
forcible manual or instrumental straightening, complete reduction need not be attempted at once, but may be done 
piecemeal at several sittings. The surgical treatment consists in the use of splints, instruments and in operative pro- 
cedures. The instruments are divisible into two kinds, according to the nature of the case, i..e., those allowing the 
patient to walk, and those for use only when the patient is in a recumbent posture. The operative procedures may be 
divided into five, viz. : i. Tenotomy and gradual reduction ; 2. Forcible reduction ; 3, Osteotomy; 4. Osteoclasy ; 
5. Epiphysial chrondrotomy. There is external wound only in tenotomy, osteotomy and chrondrotomy, but the first 
is subcutaneous and the second practically so. 
" In slight cases, relieving the limbs of the body weight, and the application of well-padded splints to the outer or 
inner side of the limb, will often suffice. Some surgeons prefer to act on the inner side, using the internal condyle as 
a fulcrum and taking leverage from the malleoli, thus gradually drawing the leg or legs inward. Others prefer ap- 
plying the splints on the outer side, taking the fixed points at the trochanter and external malleolus and slowly forcing 
the knee outwards, and yet others apply splints to both sides of the limb."-" Practical Orthopaedics." Reeves. 
" The deformity consists in a bending of the knee inward. It results from weakening of muscular support, the 
joint being unable to properly sustain the body, and with this there is stretching of the internal lateral ligament. 
Sometimes the support is so feeble and the relaxation of these ligaments so great as almost to permit luxation. 
" The pain which is sometimes produced by walking, when the patient is fully grown, will excite reflex contrac- 
tions in certain muscles, and the biceps may become so firmly contracted that it is impossible to bring the limb into 
its normal position without an operation. If you see these cases before reflex contractions have been excited, the 
limbs can be easily restored to a straight position, but will as readily return to the abnormal position when the retain- 
ing force is removed. When, however, adult life has been reached and contracture of the biceps muscle has occurred, 
it will be necessary to divide it before the deformity can be corrected. It also becomes necessary in some cases to di- 
vide the fascia as well as the muscle before proper relief can be obtained. When the necessary sections of contracted 
tissues have been made, you must make extension from the foot, and at the same 
time at right angles to the side of the leg at the knee. 
This can be done by placing the patient upon a bed, the foot of which is 
elevated, and making extension upon each leg from below the knee by the adhesive 
plaster and weight-pulley, applied in the usual way (page 5S3). 
"An upright is placed on either side of the bed opposite each knee, and a 
broad band, passed around the inside of the knee, terminates in a cord which 
runs over pulleys in the upright, and to which is attached a weight which can be 
increased or diminished according to the patient's comfort. These two constant 
tractile forces are continued until the wounds made in performing tenotomy have 
entirely healed, by which time, in many cases, the legs will have become com- 
paratively straight. But, in the majority of instances, the patients will be com- 
pelled to wear an artificial support to keep them in this position for many months 
before perfect restoration will have taken place. 
" The instrument for this purpose consists of a circular belt of steel around the 
pelvis, to either side of which, opposite the femur, a rod passes down, jointed at 
the hip and also at the knee, terminating in a circular band, which half surrounds 
the leg just above each ankle, or in the outer side of the shoe at a. These two 
rods are made of spring steel and bowed outward. Opposite the knee joint an 
elastic band passes around the inside of the knee and is secured to these flexible 
rods above and below the knee, e is a circular band around the thigh."-" Ortho- 
paedic Surgery and Diseases of the Joints." Lewis A. Sayre. 
Fig. 4218.-Genu Valgum Brace. 
The same measurements are required as for Fig. 4219, 716 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTJHOP/EDIC 
PARALYTIC, SPASTIC AND RACHITIC DEFORMITIES. 
Genu Valgum or Knock-Knee. Apparatus. 
Fig. 4219. 
Truehart's Genu Valgum Brace 
"The accompanying cut well illustrates a modification of brace for the 
treatment of knock-knees and similar deformities of the legs, which presents, 
I think, a new and valuable improvement and posesses decided advantages over 
the forms of brace now generally in use. The springs, j, j, J, J, the bearing of 
which can be delicately adjusted by shifting the slides, d, d, d, d, up or down, 
are the characteristic feature of this apparatus. The brace being attached at 
the site of deformity on either side by means of springs, which fit closely and 
firmly to the limbs, perfect coincidence and harmony of movement between leg 
and brace is secured, which is sadly wanting where the attachment is effected by 
means of the long straps of the ordinary brace. The corrective force exerted 
is continuous, and in all positions the wearer may assume is decided and equable, 
while, at the same time, the articulations of the limbs have such a normal free- 
dom of excursion, laterally as well as antero-posteriorly, that no disfiguring habit 
of gait is liable to be contracted by the patient, and there is no tendency to trip 
or fall; even the child of only a few years can wear the brace with little or no 
annoyance, and, on first trial, walk or even run with surpassing ease and pre- 
cision."-New York Medical Record, August, 1878. 
Directions for Measurement. 
1. Patient's name and age. 
2. Length from sole to ankle joint Inches. 
3. Length from sole to knee joint " 
4. Length from sole to hip joint " 
5. Length from sole to iliac crest, " 
6. Circumference of pelvis " 
7. Circumference of thigh at j, " 
8. Circumference of leg at J " 
9. Circumference of ankles at D, " 
"A brace to overcome this deformity should be provided, with facilities for 
twisting the foot into a normal angle with the leg, and for twisting the leg into 
better relations with the thigh, at the same time acting laterally at the knee 
joint to overcome the angular obliquity which constitutes the most prominent 
feature of the deformity. The brace (shown in Fig. 4220) possesses these ad- 
vantages and also permits the normal degree of motion in the knee and ankle 
joints during treatment. It can be worn under the clothing with very little dis- 
comfort and is not especially noticeable. The figure explains its action, but 
should show another girth just above the ankle, and also another on the thigh, 
since it is necessary to have firm fixation on the leg and thigh, if one is to be 
rotated upon the other. 
" In severe cases this fixation may be assisted by nooses of strong moleskin 
plaster, encircling the limb opposite the girths, and fastened to the girths by 
tongues, which protrude through slits in the stockings."-C. F. Stillman, M. D. 
Fig. 4220.-Stillman's 
Knock-Knee Apparatus. 
I. Length from sole to ankle joint, . . Inches. 
2. Length from sole to garter (below knee), 
3. Length from sole to centre of knee joint, 
4. Length from sole to perineum, 
5. Circumference above ankle joint, " 
6. Circumference at garter (below knee) 
7. Circumference at middle of thigh, '* 
8. Circumference of thigh at perineum, . 
9. Send us a pair of well-fitting lace shoes. 
Directions for Measurement. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
717 
ORTHOPAEDIC 
PARALYTIC, SPASTIC AND RACHITIC DEFORMITIES. 
Genu Valgum or Knock Knee. Apparatus, 
Fig. 4221. 
Wilcox's Genu Valgum Brace. 
" The method of applying pressure to the knee is the peculiar feature of this 
brace. In most braces the pressure is made by means of straps which pass around 
the knee and are attached to the outside bar, for the purpose of drawing the 
knee outward. The trouble is, however, that these straps, passing around the leg, 
make pressure on the vessels and nerves in the popliteal space, which pressure 
cannot be endured to a sufficient degree by the patient to make the strap accom- 
plish the purpose for which it was designed. The attempt has been made to 
obviate this difficulty by making the straps cross on the inner side of the joint where the 
pressure is desired, and the straps run diagonally above and below the popliteal space 
to be attached to the outer bar. The brace which I offer makes only a pushing pressure 
from the inside bar and has no constricting bands whatever running around the limb. The 
pressure is made by a concave pad, placed opposite the inner side of the joint and attached 
to the inner bar by means of a very stiff steel spring. The connection between the pad 
and the spring is a ball and socket, so that the pad always accommodates itself to the knee. 
The spring is attached to the inner bar of the brace, working in a slot, so that the pad can 
lie close up against the bar or projected to some distance from it, as more or less pressure 
is desired. The pressure is regulated by means of a small screw which, being passed 
through the bar and spring at a higher or lower hole, increases or decreases the angle of 
the spring with the bar."-Sidney F. Wilcox, M. D. 
Directions for Measurement. 
1. Patient's name and age. Inches. 
2. Length from sole of foot to ankle joint, " 
3. Length from sole of foot to knee joint, " 
4. Length from sole of foot to hip joint, " 
5. Length from sole of foot to iliac crests, " 
6. Circumference of pelvis, Inches. 
7. Circumference of thigh, . " 
8. Circumference of leg, . " 
9. Right, left, both feet. 
" Strips of strong adhesive plaster are cut about two inches wide and of sufficient length to 
reach from the external malleolus to the top of the great trochanter. To add to their strength, 
these are backed by strips of non-elastic webbing, about an inch in width, which are sewed 
fast to them throughout their entire length. One of these strips is applied to the skin, begin- 
ning on the outer aspect of the leg, about midway between the ankle and knee joints. It is 
passed obliquely forward, upward and to the inner aspect of the knee joint. From thence it 
is passed over the prominent internal condyle of the femur obliquely backward, upward, and 
to the outer aspect of the thigh to a point midway between the knee and the hip joints. The 
application of the second strip is begun at the last-named point on the outer aspect of the 
thigh, and is passed obliquely forward, downward and to the inner aspect of the knee joint. 
Here it passes over the prominent internal condyle of the femur and directly across the strip 
which was first applied. From thence it is passed obliquely downward, backward and to the 
outer aspect of the leg, the starting-point for the first strip. The ends of the two strips, 
which meet and cross each other on the outer aspect of the thigh, are sewed together; like- 
wise the ends of the two strips meeting and crossing on the outer aspect of the leg are sewed 
together. A strip of adhesive plaster, passed directly around the thigh, holds the upper ends 
of webbing in position, while a similar strip about the leg maintains the lower ends in place. 
At each of the points on the outer aspects of the thigh and leg a piece of sheet metal, perfo- 
rated with small holes, is sewed to the ends of the strips of adhesive plaster and webbing. The 
mechanism for continuously exerting force in opposite directions is the same as described on 
page 660, for Fig. 4097. The ends of the sliding rods are now passed into the staples on the 
square metal plates and by means of the elastic webbing tension is kept up, and a corrective 
force continuously exerted to overcome the in-knee deformity. A bandage is placed over all 
the strips which have been applied to the limb, or instead light silk elastic stockings. A broad 
piece of webbing, provided with a buckle, is passed around the limb and through a perforated 
flange attached to one of the bars at a point opposite the knee joint. This completes the 
dressing. The other leg is treated in the same manner."-M. J. Roberts.. M. D., in New 
York Medical Monthly, June, 1886. 
Fig. 4222.-Roberts' 
Genu Valgum Brace. 718 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS 
ORTpOP/EDIC 
PARALYTIC, SPASTIC AND RACHITIC DEFORMITIES. 
Genu Varum, or Bow Leg. Apparatus. 
'Genu Varum or Bow Legs.-This deformity consists in a bending of the legs outward. In these cases the ex- 
ternal lateral ligaments give way. The deformity is almost always dependent upon softening of the bones ; hence 
bow-legged children are usually those who have some constitutional disease. The deformity is really dependent upon 
some cachexia or diathesis ; and the disease chiefly productive of the condition is rachitis. The treatment, therefore, 
which is necessary in such cases is both local and constitutional. Locally, some kind of mechanical apparatus will be 
necessary to bring the legs into the proper position and hold them there. Constitutionally you are to resort to such 
remedies as give support to the system, such as cod-liver oil, &c., but the lactate and phospates of lime are the most 
important."-" Orthopaedic Surgery and Diseases of the Joints. Lewis A. Sayre. 
The chief cause of this deformity is thought to be an insufficient supply of food, or the 
supply of improper food - impaired nutrition. The mechanical treatment is very simple. 
I. The bones in a softened condition, yielding under the weight of the body, must be assisted 
by extraneous help ; 2. The arched bones must be restored to their normal condition. The 
instrument illustrated by the cut answers the purpose admirably. 
The support is given by double stems of steel (secured to a shoe) carried up as high as the 
thigh-jointed at the ankle and knee to allow the patient perfect freedom of motion. They 
are kept in place by calf (a) and thigh bands {b}. The bow is corrected by pads (r) and (<7) 
being placed respectively against the ankle and knee on the concave side of the limb, whilst 
an elastic strap (e), passed around on the highest point of the arc, inside of the outer stem, 
tightly buttoned to the steel bar on the concave side, gradually compels the leg to become 
parallel with it. 
In slight cases, or when the bow is greatest below the calf, an instrument carried up to d 
is sufficient. To insure a good fit, in ordering the apparatus, send the following description 
and measurements: 
Fig 4223. 
Bow Leg Braces, 
with 7 high Band. 
Directions for Measurement 
i. Patient s name or sex. 
2. Patient's age. 
3. Length from sole of foot to ankle joint (c) Inches. 
4. Length from sole of foot to knee joint, inner side (d), " 
5. Length from sole of foot to knee joint, convex or outer side (d), . . " 
6. Length from sole of foot to upper third of thigh, inner side of leg (^), " 
7. Length from sole of foot to to highest point of the arc (<?), " 
8. Circumference of calf (a), " 
9. Circumference of thigh (b), " 
This apparatus has only one upright bar, having a joint at the ankle 
and pads at the knee- and ankle-joints. This steel bar is fastened to the 
shoe and placed on the inner side of the leg, where it is secured by a well 
padded band passing around the garter. A wide bifurcated band passes 
around the curved part of the leg and is fastened from two sides on buttons 
placed on the steel bar for this purpose. Measurements required are the 
same as for Fig. 4223. 
Fig. 4224. 
Short Bow Leg Brace. 
Fig. 4225.-Bigg's 
Bow Leg Brace. 
Bigg's bow leg brace "is the simplest, and consists of a padded piece of 
wood, placed on the inner side of the leg, and extending from the inter- 
nal malleolus to a point just above the internal femoral condyle; it is, there- 
fore, a base opposed to the convexity of the curve. A long strap webbing is 
passed several times around the leg, so as to embrace both splint and tibia, 
which, by compression, tends to diminish the arc of curvature. This splint 
acts imperfectly unless secured to the heel of the patient's foot by a metal 
socket, which has the effect of preventing the splint sliding around the leg 
-a thing which will happen in spite of the greatest care, unless the shoe 
and splint are mutually connected. For this purpose a small piece of 
metal is fixed to the lower edge of the splint, which is inserted by a tu- 
bular socket into the heel of the shoe."-Heather Bigg. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
719 
ORTHOPAEDIC 
PARALYTIC, SPASTIC AND RACHITIC DEFORMITIES. 
Genu Varum, Bow Leg. Apparatus. 
Fig. 4226.-Gross' 
Bow Leg Brace. 
" The immediate cause of bowed leg is softening of the osseous tissue, from defect of 
earthy matter. This may depend either upon rachitis or upon some other vice of the consti- 
tution, the precise nature of which cannot always be determined. The existing circumstances 
are two : contraction of the muscles pulling the affected bones out of shape, and the weight of 
the body compelling them to bend under the superimposed pressure. In rachitis the curvature 
is frequently attended with actual shortening; the latter defect, however, often exists without 
the former, the pieces in which it is most marked being perfectly straight. 
" The treatment must be early and decided. If it be postponed until the completion of 
the ossific process, it will be in vain to hope for relief. The general health, if at fault, must 
be amended by appropriate remedies; walking and standing must be interdicted, and the 
limbs must be supported by suitable apparatus, applied in such a manner as to make effi- 
cient counter-pressure opposite the seat of the excurvation. The more simple forms of the 
lateral variety will generally yield to a light, well-padded wooden splint (Fig. 4225), stretched 
along the inside of the leg and inserted by a tubular socket into the heel of a laced shoe. In 
the more severe grades of the affection nothing will be found to be more efficient than the 
apparatus delineated in the above cut."-" System of Surgery." Gross. 
The measurements required for Fig. 4226 are the same as directed for Fig. 4223. 
Fig. 4227.-Stillman's Bow Leg Brace, long. 
Fig. 4228.-Stillman's 
Bow Leg Brace, short. 
These braces exert a constant spring force, which tends to overcome the deformity gradually. It is adjustable by 
?.\eans of a ratchet and key, and is very effective, for not only does it support the limb while the deformity is being re- 
duced, but the ratchets at the lower extremity of the instrument allow the surgeon to control the position of the feet 
at the same time. Sometimes, when the curve is below the knee, the short brace only (Fig. 4228) is needed."- 
Chas. F. Stillman, M. D. 
The measurements required for Figs. 4227 and 4228 are the same as directed for Fig. 4223. 720 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
ORTHOP/EDIC 
PARALYTIC, SPASTIC AND RACHITIC DEFORMITIES. 
Genu Varum, Bow Leg, Bowed Tibia. Apparatus. 
This apparatus consists of: I, a cap made of gutta percha, 
to fit the leg at the apex of the bow ; 2, a bowed spring, the 
size and strength of which must be suited to each individual 
case. 
Application.-The apex of the curve of the spring (rest- 
ing on the gutta-percha cap) is applied to the apex of the de- 
formity, and the spring then bound down with roller bandage. 
As the inclination of the spring is to return to its original 
shape, it tends to straighten the bow of the bone. These 
springs must be reapplied as often as they get loose. 
Fig. 4229.-Harris' Bow Leg Spring 
" This apparatus consists 
of three pieces, with joints 
corresponding to the ankle 
and knee, and is placed 
upon the inner aspect of the 
limb. It is made of very 
light pieces of steel. The 
first segment of the instru- 
ment extends from the sole 
of the shoe to the ankle 
joint, and is riveted directly 
to the sole of the shoe in front of the heel. The second segment of the instru- 
ment is a narrow strip of stiff steel, having a curvature in the opposite direction 
of the deformity. The third segment extends a short distance above the knee 
joint, and is provided with a curved piece, riveted at right angles to the shaft 
of the instrument. A roller-bandage is carried about the leg and over the in- 
strument, the latter being drawn up close to the limb, as shown. 
" The curved shaft of the instrument being made of spring steel, and tem- 
pered, when straightened out and drawn close to the limb gently tends to return 
to its former curved form. The pads attached to the instrument opposite the 
ankle and knee joint serve as points of counter-pressure. This apparatus is to be 
worn day and night, but should be removed each day in order to manipulate the 
muscles, as the prolonged wearing of bandages, even though the patient exercises 
considerably, is likely to cause more or less muscular atrophy."-From a Clinical 
Lecture, December 18, 1886, by M. J. Roberts, M. D. 
The same measurements are required as for Fig. 4231. 
Fig. 4230. 
Bruce's Bow Leg Apparatus. 
Anterior Curvature of the Tibia. Apparatus. 
Fig. 4231.-Brace for 
Correcting Anterior 
Curvature of the Tibia. 
This cut is a fair representation of the instrument. It consists of two upright steel 
stems, fastened below to a shoe and terminating above in the calf-band. The deformity 
is corrected, either by passing a leather bandage around the stems and tightly lacing it in 
front over the arc of the curvature, a (Heather Bigg), or by a strap passed over the arc 
of the curvature and fastened to a spur suspended from the calf band behind, c (Tie- 
mann). The points of resistance being in either case the heel of the shoe, b and the 
posterior trough of the calf-band, c. In ordering the apparatus, send a shoe and the fol- 
lowing particulars and measurements: 
i. Brace for Anterior Curvature of the Tibia, Fig. 4231. 
2. Patient's name (or sex). 
3. Which foot ? 
4. Length from sole to ankle joint, . Inches. 
5. Length from sole to calf (r) 
6. Circumference of calf 
7. Length from sole to knee joint, GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
721 
ORTHOf/EDie 
PARALYTIC, SPASTIC AND RACHITIC DEFORMITIES. 
Genu Valgum, Varum, Bowed Tibia, &c. Treatment. 
" Knock knee and bow leg, for the most part, are due to rickets, and, therefore, considerable is to be expected from 
medicinal measures toward effecting a cure. Dr. Gibney then spoke of climatic influences and the use of phosphates 
of lime and soda in the treatment of rickets, and expressed the opinion that the latter were satisfactory only as they 
improved digestion and general nutrition. 
" In what cases should manual force and retentive splints be resorted to? In the first place, in those patients whose 
parents are unable to buy an apparatus or too improvident to give any attention to the correction and cure of the deformity. 
Second, when one has but little time to effect a cure. Third, where the bones will yield readily to such force, the other 
conditions being present. Dr. Gibney quoted upon this poinj the conditions reached by McEwen, that it may be safely 
concluded that brisement force has served its time, and cannot be practised in the presence of the more exact methods 
of the present day. From his own experience and from the drift of sentiment, he felt well assured that McEwen's con- 
clusions would be more strongly supported at the close of 1884 than they were at the end of 1883 in the treatment of 
genu valgum. 
"With reference to apparatus, Little, of London, was an advocate of mechanical appliances, while McEwen, of 
Glasgow, was opposed to their use. 
" So far as bow-legs are concerned, Dr. Gibney had been guided in their treatment by the principle that, if the 
bones could be sprung into position by the use of a moderate amount of force, a retentive apparatus, consisting of 
springs, could be applied with benefit. If the femur is curved and the inner condyle unusually long in a case of knock- 
knee, he tests with his hands the ligaments of the knee and the femoral curve, and is guided by the result in his selec- 
tion of cases for apparatus. The age beyond which he found this test failing was four and five years. 
"All springs now in use are constructed upon one principle, namely, force brought to bear against the convexity oi 
the curve at its apex. Dr. Little, of London, applies continuous pressure; Dr. Shaffer, of New York, employs mo- 
mentary pressure; Dr. Poore, of New York, reports that about thirty per cent, of the cases of genu valgum are cured 
by mechanical appliances."-Medical Record, November 29, 1884. 
"When the deformity has been neglected and cannot be overcome by appropriate apparatus, and the person is 
badly crippled ormnable to walk, the only resource is osteotomy. The division of the tibia may be effected subcuta- 
neously with the chisel, saw, trephine, or the dentists' drill, the point of greatest convexity of the bone being selected 
for the purpose, and care taken not to interfere with any important bloodvessel. The fibula may be divided in a simi- 
lar manner, or broken by forcible flexion. The limb is at once placed in a suitable apparatus, or, what is generally 
preferable, plaster dressing. The statistics of this operation, published within the last ten years, are of an eminently 
gratifying nature. Occasionally serious symptoms follow, and instances have been recorded in which death ensued 
from erysipelas, pyemia or diffuse abscess."-" System of Surgery." Gross. 
" The operative procedures may be divided into five, viz.: 1, tenotomy and gradual reduction ; 2, forcible reduc- 
tion ; 3, osteotomy ; 4, osteoclasy ; 5, epiphysial chrondrotomy. There is external wound only in tenotomy, osteotomy 
and chrondrotomy ; but the first is subcutaneous and the second practically so."-" Practical Orthopaedics." Reeves. 
" For the relief of genu valgum, Ogston, in May, 1876, made section of the internal condyle by passing an Adam's 
saw from its upper border down into the joint, and then gliding the inner condyle up on a level with the external con- 
dyle. This operation, under the antiseptic precautions, has been repeatedly performed with marked success. Dr. 
McEwen, on May 10th, 1878, modified the operation by removing a wedge-shaped piece of bone from the internal 
condyle, the apex of which did not quite reach the encrusting cartilage of the joint, while its base lay at the upper 
part of the internal surface of the condyle. On its removal with the chisel the leg was forcibly brought into a straight 
line, and the two surfaces of the gap brought into approximation with each other, thus raising the internal condyle to 
a level with the outer condyle. He also made section of the femur, transversely, with a chisel, to the extent of two- 
thirds of its diameter, about half an inch above the epiphysial cartilage, then forcibly bringing the limb straight. Mr. 
Reeves of London Hospital, modified the operation by driving a chisel into the internal condyle in the line of Ogston's 
operation, but not quite down to the cartilage of incrustation, and then forcibly straightening the limb, fractured off 
the condyle withortt opening the joint. 
"All these operations are attended with more or less danger, and should be avoided, if possible ; and, in my own 
experience, I have always been able to secure entirely satisfactory results by the various simple methods already de- 
scribed."-"Orthopaedic Surgery and Diseases of the Joints." Lewis A. Sayre. 
" In cases in which the deformity is severe or of long standing, and especially in rachitic and severe statical cases-• 
always granting that the eburnating stage has occurred, or is taking place-we must resort to more radical measures, 
after giving fair trial to the means already mentioned."-" Practical Orthopaedics." Reeves. 
"The instruments requisite for an osteotomy are few. It maybe performed with a saw, chisel or osteotome. 
Osteoclasy consists in breaking the bone or bones (without external wound) with an osteoclast."-" Osteotomy and 
Osteoclasis." Poore. (See pp. no to 114.) 722 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPEDIC 
PARALYTIC, SPASTIC AND RACHITIC DEFORMITIES 
Genu Valgum, Varum, Bowed Tibiae, &c. Operative Plans. 
" Osteotomy may be linear, cuneiform, rounded, &c.; the former plan only deserves the name of osteotomy, for the 
latter are really osteectomies, as a portion of bone is removed. Osteotomy may be complete, as when the whole thick- 
ness of the bone is cut through, or partial, as when only three-quarters or four-fifths of it are severed and the rest 
broken. This is the usual method in operating for genu-valgum, varum and in curved tibia and fibula. The other 
methods of osteotomy have been used for mal-union of fractures, bony anchylosis of hip, knee, elbow, &c. 
" There are thirteen different operative plans for genu valgum and varum, which may be tabulated thus: 
Osteotomy of Femur. 
1. Condylotomy with saw (linear, complete), Ogston. 
2. Condylotomy with chisel (linear, incomplete), . Reeves. 
3. Supra-condylar (linear internal, incomplete), McEwen. 
4. Supra-condylar (linear external, incomplete) . . . . Reeves. 
5. Diaphysial (linear external, incomplete), Reeves. 
6. Epiphysial chrondrotomy (may be done) Ollier. 
7. Bicondyloid (really a partial excision), Annandale. 
8. Cuneiform of internal condyle, Chiene. 
9. Cuneiform of internal condyle, McEwen. 
Osteectomy of Femur. 
Osteotomy of Tibia. 
10. Linear (incomplete), Billroth. 
Osteectomy of Tibia. 
11. Cuneiform, Me'yer. 
12. Osteectomy (cuneiform) of tibia, and linear complex osteotomy of fibia, . . Schede. 
On Tibia and Fibula, 
13. Linear osteotomy incomplete), , . . Barwell 
On Femur and Tibia 
" Osteotomy is an old operation, for Hippocrates recommends it for badly united fractures, and it was practiced in 
the time of Paul of Egina. Albucasis, a little later, wrote in favor of the use of the saw in preference to refracturing 
badly united bones. Cucherilli* says he also recommended osteotomy in anchylosis consecutive to juxta-articular frac- 
tures. Many centuries elapsed before the question was revived, but this is not the place to write a history of osteo- 
tomy in general, therefore I will refer those interested in this matter to the work of McEwen, and especially of Cam- 
penon, on Osteotomy. Some historical references of more recent date will be found in Dr. Little's work on in-knee 
distortion. 
' ' I will only briefly refer to the history of those methods which have application to orthopcedic practice. Des- 
champs used cutting forceps for correcting a badly united fracture. In 1815 Lemercier excised the ends of the 
tibia for vicious callus. In 1816 Wasserfiihr did the first linear osteotomy with open wound for badly united fracture 
of the femur in a child ; in 1826 Riecke and Rhea Barton performed osteotomy in the femoral neck and trochanter 
for anchylosed hip ; and in 1835 he did cuneiform osteotomy for anchylosis of the knee, and was speedily followed by 
Kearney Rodgers. In 1834, Clemont.f of Rochefort, instituted cuneiform excision of vicious callus,, and was followed, 
probably quite independently, by Rhea Barton. These operations were all by open wound, and the saw or forceps, 
or both, were used. 
" In 1840, Jobert de Lamballe performed the first osteotomy for rachitic curvature, and in 1847 Maisonneuve did 
the first osteotomy (in France) for anchylosis of the hip. In 1854 subcutaneous osteotomy was first practiced by Meyer 
and Langenbeck for mal-union of fractures and rachitic curves (first suggested by Malgaigne in his work on fractures 
and dislocations, 1847). The operation was done in America by Brainard, 1854, and by Pancoast, 1859, and became 
popular for a time. In 1850 to 1851, Meyer, of Wurzburg, performed the first osteotomy for genu valgum. 
* "Lo Sperimentali," May, 1878. 
+ Gazette Medicate de Paris. 1834, page 347. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
723 
ORTjHOP/EDIC 
PARALYTIC. SPASTIC AND RACHITIC DEFORMITIES. 
Genu Valgum, Varum, Bowed Tibiae, &c. Operative Plans. 
" In 1852 Langenbeck proposed osteotomy in two cases of anchylosed knee. His plan was to perforate the bone 
in two places with a drill and to pass a fine saw into one of the holes and saw through the intervening part of bone, 
then to break the bone. In 1859 Pancoast perforated the femur in six places through a single subcutaneous opening, 
just above the knee, for anchylosis, and Brainard repeated the operation in i860. In 1862 Sayre operated for anchy- 
losed hip ; in 1868, Stromeyer Little operated with a chisel for anchylosed knee ; Brodhurst, in 1865, performed sub- 
cutaneous osteotomy ; and, in 1869 and 1871, Adams did subcutaneous section of the femoral neck for bony anchylosis 
of the hip, and was soon followed by Gant, Maunder and Reeve. It was not till 1875, encouraged by the antiseptic 
method, that Annandale excised a portion of the femoral condyles for genu valgum. Ogston operated in May, 1876, 
by a small wound, using a saw; he was followed by Schede in September of the same year. In this method the 
joint was opened under strict antiseptic precautions ; but antiseptic osteotomy was introduced by Volkmann, of Halle, 
for anchylosis of knee in 1875, and the first operation of this kind in Great Britain was by McEwen, of Glasgow. 
Billroth introduced the use of the chisel in 1870, and in 1873 did non-antiseptic linear osteotomy of the tibia; in 1872 
for genu varum, and in 1873 for genu valgum. 
" Schede, of Berlin, did cuneiform osteectomy of the tibia and osteotomy of the fibula for knock-knee in 1876. In 
1877 Chiene, of Edinburgh, did cuneiform osteectomy of part of the internal condyle, and in 1878 McEwen chiselled 
out a wedge of the inner condyle along Ogston's line. Ogston's, Chiene's and McEwen's cuneiform operations have 
been termed osteo-arthrotomy, ox inter-articular osteotomy. In the same year Barwell performed 'simultaneous mul- 
tiple osteotomy' for knock-knee ; and in 1879 Reeve introduced an operation in which he used a chisel, and termed it 
extra-articular osteotomy or condylotomy, the object of which was to avoid entering or doing serious damage to the joint, 
and at the same time to loosen and properly replace the displaced condyle."-" Practical Orthopaedics." Reeves. 
Cuneiform Osteotomy for Anterior Curvature of Tibia and Fibula. 
" Knock-knee, bow-leg and anterior-tibial curvature have of late years been the subject of much study by Euro- 
pean surgeons ; and renewed interest has been awakened in all parts of the world on account of the operative proce- 
dures which have been instituted for the correction of these deformities. 
" My instrument consists of a small electro-motor, sup- 
plied with electricity through insulated wires from a power- 
ful primary zinc carbon battery, and carrying a circular saw 
that revolves in a plane parallel with that of the central 
shaft. A hollow cylinder is firmly screwed to the end plate 
of the motor. Upon this a soft rubber hand-piece, fash- 
ioned like that of a carpenter's chisel, is slipped and fas- 
tened in position, forming the handle of the instrument. 
The central shaft of the motor is continuous through the 
hollow cylinder. At its distal end a right-angle miter-gear- 
ing connects it with the saw-bearing point. A metal shield 
guards the proximal aspect of the serrated blade. Upon the 
outer end of the motor to which the hand-piece is attached 
are two binding-posts, which receive the insulated wires 
connecting the instrument with the battery. 
"When using the electro-osteotome it is suspended by 
a solid rubber cord, six or seven millimetres in diameter, 
from the cross-bar of an adjustable crane screwed to the 
edge of the operating table. In this way all weight is re- 
moved from the hand of the surgeon, leaving the instru- 
ment as thoroughly at his command as if it were a delicate 
probe. A switch is attached on the top of the motor, so that 
it can be opened and closed at pleasure. This increases the 
independence of the operator, for the instrument is not set 
in motion until the desired moment, when, by the use of 
his free hand, the operator closes the circuit by means of 
this switch. Upon completing a section of bone, the opera- 
tor can open the circuit by means of the switch and stop the 
instrument. 
Fig. 4232.-Roberts' Electro Osteotome. 724 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTJHOP/EDIC 
PARALYTIC, SPASTIC AND RACHITIC DEFORMITIES. 
Genu Valgum, Varum, Bowed Tibiae, &c. Operative Plans. 
" It makes no difference which side of the bone you approach, as with the osteotome you can cut out a wedge- 
shaped segment commencing at the base, at the side, or at the apex of the wedge. Therefore, in operating, you have 
only to take into consideration the most direct and safest route to the bone. As the fibula lies on the outer aspect of 
the tibia and would be in the way of reaching the latter bone from this side, the incision is made on the inner and an- 
terior aspect of the tibia. Having made a clean cut incision down to the bone, the soft parts on either side of the in- 
cision are picked up with a pair of dressing forceps, and the cellular tissue between them and the bone is divided with 
a scalpel so as to admit, without the use of undue force, the end of a protecting retractor (Fig. 4233), which is placed 
between the soft parts and the bone. 
" The first two retractors illustrated are in pairs, 
while the others are single and are provided with 
much longer blades, which are curved up so as to 
serve the same purpose as a pair of retractors with 
shorter curves. The single retractors are much more 
difficult of introduction on account of the increased 
length of curvature. These retractors are placed in 
position by passing them in around the bone, be- 
tween it and the soft parts, so that when they are in 
position the bone lies directly upon them and the 
soft parts are behind them. In this way the soft 
parts are absolutely protected from all danger of 
being cut while using the circular saw of the electro- 
osteotome. 
" The battery cells are so connected that they 
can be brought into the circuit fordriving the motor. 
Two of the cells, however, are connected indepen- 
dently, and are designed to be used for lighting pur- 
poses. By means of the switch, however, which is 
connected with the motor circuit, these two cells can 
be cut out of the lamp circuit and brought into play 
for driving the motor. The switch-board is provided 
with two levers, by means of which in case a single 
cell in the battery is at fault it can be readily picked 
out from the others."-" The Electro-Osteotome ; a new instrument for the performance of the operation of osteo- 
tomy, and a New Form of Retractor;" New York Medical Record, October 27, 1883. Also " Electro-Osteotomy in 
Knock-Knee, Bow-Leg, and Anterior-Tibial Deformities;" Virginia Medical Monthly, Richmond, March, 1887. 
M. J. Roberts, M.D. 
Fig. 4233.-Roberts' Protecting Retractors. 
DEFORMITIES OF THE FEET. 
" The human foot, in its natural state, is one of the most beautiful examples of a complicated machine, combining 
great strength with graceful mobility: consisting as it does of twelve bones (in addition to those of the toes), jointed 
to each other by regularly constructed articulations, admitting of motion to a greater or less degree of each individual 
bone-so that no restraint can be put upon these slight movements between the various bones without destroying the 
harmony of their combined action in the foot as a whole-and at the same time being so firmly bound together by liga- 
ments, and sustained in position by tendons attached to strong muscles, as to give it an abundant security to bear the 
superincumbent weight of the body, while it allows of sufficient expansion and extension for ease and elasticity in loco- 
motion. It is connected with the leg at the astragalo-tibial articulation, and prevented from any lateral movement by 
the projecting malleoli on either side, which fit so closely to the sides of the astragalus as to permit of no motion at 
this joint except that of flexion and extension, or that of pointing the toes up or down. Turning the toes out or in is 
produced by rotation of the thigh and leg at the hip joint, or by the revolving motion of the fibula produced by the 
contraction of Ihe biceps and tensor vaginae femoris when the knee is flexed. 
" Having stated that no motion can occur at the tibio-tarsal or ankle joint, except flexion and extension, and that 
the pointing of the toes out or in is done by the muscles of the hip, it follows, as a matter of course, that all the other 
motions of the foot, such as twisting the sole inward or outward, raising or depressing the arch, &c., must occur be- 
tween the joints of the other eleven bones of the foot. The toes, being merely attachments, are not considered as 
having any influence in these motions. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
725 
O^THOja/EDIC. 
DEFORMITIES OF THE FEET. 
The Normal Human Foot. 
Fig. 4234.-The Bones of the Foot. 
a, b. The medio-tarsal articulation. 
c. The astragalus. 
d. The os calcis. 
e. The scaphoid. 
f. Middle cuneiform. 
g. External cuneiform. 
Cuboid. 
i. The metatarsal bones. 
" If we carefully examine the foot, as seen in the figure, we shall observe that, between the os calcis and astra- 
galus behind, and the cuboid and scaphoid in front, is the medio-tarsal joint, a, b, going completely across the foot, 
dividing it into an anterior and posterior portion, admitting in a limited degree of every variety of motion-flexion, 
extension, abduction and adduction, as well as rotation inward and outward upon the long axis of the foot. I desire 
to call particular attention to this compound articulation in the tarsus, because, by a most remarkable oversight of sur- 
geons, the very important part which it plays in deformities of the feet has, until very recently, been entirely unnoticed. 
" The foot, as a means of support, rests upon three buttresses: the heel behind, which is stationary; and the first 
and fifth metatarso-phalangeal articulations in front, which are slightly movable, capable both of expanding and ex- 
tending, thereby increasing the base of support which adds to the security of the body, and by this very expansion and 
extension of the anterior pillars or buttresses, gives elasticity in locomotion. Between these three pillars, or points of 
base, spring two arches; one from the heel, reaching to the anterior two pillars, narrow behind and wider in front, 
called the antero-posterior arch ; and one from the two pillars arching across the foot, called the transverse arch. 
The antero-posterior arch is higher on the inner than on the outer side, and cannot be brought to the ground in the 
normal condition ; whereas, the outer line of the arch is always brought to the ground whenever the weight of the 
body is borne upon it. 
' Let anyone dip his naked foot in a pail of water, and then, while wet, stand with it upon a dry 
board or piece of brown paper, and he will get an exact impression of the parts of the foot which 
will come in contact with the earth in supporting the weight of the body. In Fig. 4235 it will be 
seen that the outer line of the arch touches its entire length, which thus gives it a firm and extensive 
base of support, whereas the inner line only touches the ground at its two extremities, the central 
part of the arch on the inner side being retained in position by the tibialis-anticus muscle, which is 
inserted into the inner and under surface of the internal cuneiform and base of the first metatarsal 
bones. It will, therefore, be seen that the strength and perfection of this arch are greatly dependent 
upon the condition of the anterior-tibial muscle. The importance of understanding the construction 
and retention of this arch will be more fully seen when we come to study the deformities of the foot, 
more particularly talipes valgus, or flat-foot."-"Orthopaedic Surgery and Diseases of the Joints." 
Lewis A. Sayre. 
Fig. 4235 
The Morbid Alterations in the Form of the Foot. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
"Kyllosis (KVAZof, crooked, lame), cyllosis, kyllopodia. Professor Chaussier so calls congenital distortion of the 
feet, club-foot, polt-foot, stump-foot; (Prov.)pommel-foot, pummel-foot; talipes ; (F.)pied-bot-Dunglison. 
"Under the term talipes (Latin, talus, ankle, and pes, foot) are included all deformities in which there is a perma- 
nent deviation from the normal relations of the foot to the leg, or of the parts composing the arch of the foot to each 
other, whether this deviation consists in flexion, extension, inversion or eversion. Talipes is usually described under 
four distinct heads, namely: talipes eqtrinus, talipes calcaneus, talipes varus and talipes valgus. 
" Typical examples of any of these varieties are rare, for nearly always the deformity is a combination of two va- 
rieties. When we wish to designate such a deformity the names of the two component distortions are combined, the 
more important always being placed first. Thus, when we have a combination of equinus and varus, it is styled 
equino-varus or varo-equinus, according as the equinus or varus is the more prominent, and the same principle of no- 
menclature is used for calcano-varus and valgus. 
" In addition to the above-mentioned varieties, there is one known as talipes cavus or plantaris. This is a very 
frequent complication of other varieties of talipes. When it is present as a complication it does not, as a rule, enter 726 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOP/EDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
The Morbid Alterations in the Form of the Foot. 
the name of the deformity. When, however, as occasionally happens, the case presents no other deformity than that 
caused by the contraction of the plantar fascia, the name talipes cavus or plantaris is used. The deformity known 
as flat-foot, I think, should be considered as a variety of valgus, as the peculiar breaking down of the arch is the same 
in both, and the two affections are very generally associated."-Sayre. 
Talipes Equinus. 
Fig. 4236.-Talipes Equinus. 
•* Talipes equinus receives its name from the position of the foot, simulating the 
hoof of a horse. The deformity consists in the raising of the heel and dropping of the 
anterior portion of the foot, so that the weight of the body is borne upon the meta- 
tarso-phalangeal articulation alone, instead of upon the three points above spoken of. 
The convexity of the arch of the foot is generally very much increased ; and the con- 
cavity of the arch becomes more and more angular in proportion to the degree of the 
deformity. The toes are extended upon the foot, and the foot is extended upon the 
leg. Sometimes the foot is so much extended as to make almost a straight line upon 
the tibia. The peculiarity in the deformity is usually associated with a paralyzed con- 
dition of the extensor muscles of the toes. Ordinarily, however, if these muscles 
possess the power of contraction, they voluntarily contract and elevate the toes suffi- 
ciently to enable the patient to walk upon the base of the metatarsal bone of the great 
toe, as seen in Fig. 4236. When the paralyzed condition referred to is present, there 
is absence of power for lifting the toes, which necessitates the use of crutches when the 
patient walks. 
"Talipes equinus may be either congenital or acquired. The deformity much 
more frequently occurs under the form of equino-varus or varo-equinus. Talipes 
equinus may be paralytic or spastic ; or the spastic condition may be developed upon 
the paralytic. The latter condition may be developed by long-continued walking upon 
the deformed parts, thereby exciting inflammatory action, and when present will re- 
quire tenotomy before a cure can be effected. If the deformity is purely paralytic it 
can be overcome by the application of mechanical means and elastic force, which shall 
take the place of the paralyzed muscles, until, by the use of electricity, friction, strych- 
nia, &c., they have been restored to the power of proper contraction. The paralytic 
variety is easily recognized, from the fact that the foot can be easily restored to its normal 
condition ; but, when the force which has restored it is removed, the deformity imme- 
diately returns. The muscles chiefly affected in the paralytic variety are those upon 
the anterior aspect of the leg. On the contrary, when the equinus is spastic, it is due 
to abnormal contraction of the muscles upon the posterior aspect of the leg."-"Ortho- 
psedic Surgery and Diseases of the Joints." Lewis A. Sayre, M. D. 
Fig. 4237.-Talipes Equinus, 
Fig. 4238. 
Talipes Calcaneus. 
" Talipes calcaneus is that variety of deformity where the anterior portion of the foot 
is elevated and the heel is depressed. It is frequently seen as a congenital deformity, and 
all cases which have fallen under my observation have been of a paralytic nature. This 
deformity is much more liable to occur complicated with varus or valgus than to present 
itself uncomplicated. When paralytic, the muscles chiefly affected are the gastrocnemius 
and soleus ; and in the treatment to be adopted the application of artificial muscles to take 
the place of the paralyzed gastrocnemius and soleus forms an essential element. 
" Talipes calcaneus is very often acquired. It may result from jumping, wrestling or 
the application of any force sufficient to rupture or cut the tendo-achillis. It occurs again 
as the result of injuries received upon the anterior portion of the foot. A very common 
cause in this connection is a cicatricial contraction following burns. The gradual contrac- 
tion of the cicatricial tissue overcomes the action of the gastrocnemius and soleus muscles, 
and, as a consequence, the anterior portion of the foot becomes elevated and the heel de- 
pressed. In all such cases, therefore, it is an exceedingly important point in their manage- 
ment to prevent this contraction during cicatrization, and thus prevent the deformity. It is 
important to keep the foot as forcibly extended as possible. By this measure you materially 
delay the cicatrization, but you promote the ultimate usefulness of the limb very essentially. 
Talipes Calcaneus. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
727 
ORTHOPEDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
The Morbid. Alterations in the Form of the Foot. 
" Extend the ulcerated surface as far as you can, and let it heal as slowly as possible. This is one method of 
management, and the one ordinarily employed, until another step had been taken. By the old method cicatrization 
was allowed to go on from circumference to centre until the whole granulating surface had been closed in, which was 
usually an exceedingly tedious process. Now the surgeon transplants a number of little islands of skin to the granu- 
lating surface, and from each of these little islands new skin grows and spreads. The wound heals by cicatrization, 
as before, but it is from the new bloodvessels formed, giving us a far different cicatrix from that obtained by the pro- 
cess of granulation. The cicatrix is much more yielding, is softer, and less liable to contract. The same principle is 
applicable in the treatment of extensive burns about any of the joints, or involving the palmar fascia. * * * If you 
succeed in restoring the deformed parts to their normal position, some artificial apparatus must be applied and the ap- 
plication must be kept up until the patient can voluntarily flex and extend the foot in the normal manner. 
''Prevention of deformity is, therefore, an essential part in the management of all injuries affecting the anterior 
portion of the foot, but especially burns. When the tendo-achilles becomes ruptured from any cause, or is accidentally 
cut, the foot should be dressed in the position of talipes equinus, and the leg flexed upon the thigh. This position is 
to be maintained until the tendon is fully healed, when passive movements should be resorted to for the purpose of 
bringing the foot into its normal position."-"Orthopsedic Surgery and Diseases of the Joints." Lewis A. Sayre, M.D. 
Talipes Varus. 
Fig. 4239. 
Talipes Varus. 
" Talipes varus is that variety in which the foot is inverted and more or less rotated 
in such a manner as to bring its inner surface upward and the outer edge to a greater or 
less degree upon the ground. The muscles chiefly affected in the paralytic variety are 
the peroneals. 
"This variety of talipes may be congenital, and, when combined with equinus, 
usually is of such origin. Combined with equinus it is one of the most common forms 
of deformity of the foot. When congenital it is usually of a paralytic nature, but it may 
be spastic as the result of some influence exerted upon the foetus. When the deformity 
is acquired it is also most frequently of a paralytic nature. The most common cause, 
probably, is that form of paralysis known as ' infantile.' "-SAYRE. 
Talipes Valgus. 
"Talipes valgus presents the converse of talipes 
varus, the inner border of the foot being downward. 
This deformity* is much more likely to arise from 
traumatic causes than any other deformity of the 
foot. It frequently results from inflammation of the 
ankle joint. It may result from a pull or wrench of the foot, causing inflammation 
of the peronei muscles and subsequent spastic contraction. Talipes valgus may be 
combined with equinus or calcaneus, making valgo-equinus or valgo-calcaneous. 
" In some cases this deformity is of purely paralytic origin. This cause being 
unappreciated, the projecting bones which make their appearance at the front por- 
tion of the foot are very liable to be mistaken for ' diseased bones,' ' periosteal in- 
flammation dependent upon scrofula,' &c., and are treated accordingly. These 
cases I regard as worthy'- of special consideration, and shall dwell upon them suffi- 
ciently, I trust, to make them perfectly clear. In the severer cases the deformity is so conspicuous as to be readily 
recognized, but the less marked cases are very liable to be overlooked. In the majority of cases this kind of trouble 
occurs in persons who are obliged to stand or walk for many hours in succession, thereby giving constant exercise and 
strain to the tibialis-anticus muscle, which supports the arch of the foot. Finally, from overwork, this muscle becomes 
partially paralyzed, the arch of the foot settles and valgus begins to be developed ; and, as it increases in consequence 
of the loss of the arch of the foot, the head of the scaphoid bone begins to project, undue pressure is produced on a 
part of the foot not intended by nature to receive it, and inflammatory action is excited which affects the scaphoid on 
the inner border and also the articulations between the two cuneiform, cuboid, and the fourth and fifth metatarsal 
bones, and gives the patient the most exquisite and torturing pain. 
"When the arch of the foot is properly supported by a healthy tibialis-anticus muscle, the articulating facets of 
the bones composing it press upon each other, so as to sustain the weight of the body without producing pain. The 
articular cartilages, having no bloodvessels or nerves of their own, are insensible to pressure ; but, when the arch of 
Fig. 4240.-Talipes Valgus. 728 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTJHOP/EDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
The Morbid Alterations in the Form of the Foot. 
the foot loses its proper support in consequence of a complete or partial paralysis affecting the tibialis-anticus muscle, 
these articulating facets no longer press upon each other equally, but are made to tilt a little, and the pressure is 
brought to bear upon the edges of the articular surfaces, where the supply of bloodvessels and nerves is most abun- 
dant, which gives rise to indescribable pain and suffering with every step that is taken. 
" The pathology of these cases is, first, paralysis of the anterior tibial muscle ; second, settling of the arch of the 
foot ; third, abnormal pressure upon the edges of the cuneiform and scaphoid bones. The pressure in this abnormal 
position produces periosteal, it may be osteal or synovial, inflammation, and then it is that the case is so often re- 
garded as one dependent upon constitutional disease. 
" Now, having arrived at the true pathology, let us study their symptoms. The paralysis of the tibialis-anticus 
muscle can be detected by its wasted and flabby condition when compared with the same muscle upon the sound leg, 
or with a normal muscle when both the anticus muscles are affected. The spine of the tibia will be much more promi- 
nent than normal, the foot will be slightly abducted, and any increase of the abduction, either by traction or by bring- 
ing the weight of the body to bear upon it, causes pain at the points heretofore mentioned. Pressure with the thumb 
over the borders of the articulating surfaces of the cuneiform and scaphoid bones, when in the abnormal position, 
produces extreme pain ; but when the pressure upon these borders is removed, which may be done by rotating the foot 
inward and raising the arch, the foot will be able to bear the weight of the body without producing pain. Usually 
there is but very slight deformity in these cases, hence they require the manipulation indicated in order to detect the 
precise nature of the difficulty."-"Orthopsedic Surgery and Diseases of the Joints." Lewis A. Sayre, M. D. 
Talipes. Causes of, Treatment. 
" The congenital forms are all due to some interference, general or local, with the normal innervation of the part. 
So much has been generally accepted, but the real nature of this nervous disturbance has been for the most part mis- 
understood. 
" The prevailing treatment of talipes is based upon the theory that the pathological condition is a spastic muscular 
contraction. The muscles at fault, in any given case, have been considered to be those that by contraction would draw 
the foot into the position which it occupies. Talipes equinus is attributed to a spastic contraction of the gastrocne- 
mius and soleus muscles; talipes calcaneus to the same condition of the anterior muscles of the leg. So, in varus, the 
tibial muscles, and,'in valgus, the peroneals and the extensor longus digitorum, have been considered to be the seat of 
disease. The natural therapeutical inference from such a pathological theory was tenotomy, and it accordingly has be- 
come a sine qua non of treatment. 
" Now, experiment and observation have fully demonstrated that, in the immense majority of cases, the pathological 
change is precisely contrary to that which has been believed to exist. Spastic contraction is the exception, paralysis 
the rule. The muscles supposed to be in a state of spasm are really contracting with only their normal degree of force, 
which produces an excessive effect, simply because paralysis of the opposing muscles has destroyed the natural harmony 
of action existing between the tractile forces which govern the motions of the foot. 
"If any one doubts the paralytic nature of these congenital deformities, let him examine the first case he may meet 
within a few days after the birth of the child, and he cannot fail to mark the great ease with which the deformity can 
be reduced and the foot restored nearly or quite to its normal position, if he does not excite reflex contraction by too 
rapid and violent attempts at reduction. 
'■'Acquired talipes very generally is due to the various kinds of 'infantile paralysis,' which are frequent sequelae of 
scarlatina, diphtheria, dentition and many other diseases in which a blood-poisoning exists, or which are attended with 
great exhaustion. Very many of the cases of this sort give a history of paralysis that originally involved the whole of 
the lower extremities, and frequently the upper. Some cases of acquired talipes, however, are not paralytic in their 
character: these are occasional cases dependent upon diseases of the spinal cord, in which treatment can be of little 
use while the originating disease is uncured; cases following direct injury, which has caused inflammation and sub- 
sequent shortening and rigidity of muscles and fasciae; and certain cases in which acquired spastic deformities are 
added to the paralytic ones previously existing. This last is a very common condition of things, and doubtl^s has 
been the chief cause in prolonging the belief in the spastic origin of most of these deformities. To apply these prin- 
ciples to special varieties of talipes, we must look for the disease, not in the muscles on that side of the leg toward which, 
but on that from which, the foot is distorted. In equinus, instead of the gastrocnemius and soleus being spastically 
contracted, the anterior muscles of the leg are paralyzed. The paralysis is often so extensive that the only retaining 
contractility is the extensor proprius pollicis, which, acting alone, at length produces a sub-luxation of the great toe. 
(See Fig. 4236.) In calcaneus, the gastrocnemius and soleus are paralyzed ; in varus, the peroneals chiefly; in val- 
gus, the tibials, and, perhaps, the long flexor. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
729 
O^THOf/EDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Causes of, Treatment. 
" The seat of talipes has always, till recently, been supposed to be at the ankle joint. If the ideas expressed in our 
former lecture, when describing the ankle joint, concerning the motion possible at the astragalo-tibial articulation, are 
correct, then the only forms of talipes that could concern the ankle joint are those where the heel is raised or dropped- 
equinus and calcaneus. Examination of so-called equinus will satisfy any one that in them (with the exception of a 
few acquired cases having their origin in a traumatic contraction of the soleus and gastrocnemius) the heel is little, if at 
all, removed from, and can easily be restored to, its normal relation to the axis of the limb, there being really a drop- 
ping of the anterior portion of fhe foot; and that, as in varus and valgus, the deformity takes place at the medio-tarsal 
junction. The deformity of calcaneus, which is dependent upon paralysis of the above-named muscles, does occur at 
the ankle joint, and this I believe is the only variety of which this is true. A further anatomical reason for the truth 
of this statement regarding the seat of deformity is this : Of the twelve muscles of the leg which move the foot, nine, 
namely, the tibialis anticus, extensor proprius pollicis, extensor longus digitorum, peroneus tertius, flexor longus pollicis, 
flexor longus digitorum, tibialis posticus, peroneus longus and peroneus brevis, have their insertion anterior to the 
medio-tarsal junction, and but three-the gastrocnemius, soleus and plantaris-posterior to this articulation, these 
three muscles having a common insertion, by means of the tendo achillis into the os calcis. It follows, as a matter of 
course, that any deformity dependent upon an abnormal condition of these three muscles must have its seat at the arti- 
culation moved by them, namely the ankle and the calcaneo-astragaloid-articulation ; and that, if any of the other nine 
muscles be affected, the resulting distortion will be anterior to the medio-tarsal junction. 
" The resultant complications of talipes are : the effects of inflammation or irritation, defective nutrition of the foot 
and leg and the effects of pressure in changing the bony structure. 
"Inflammatory action is sometimes set up in the muscles as the result of direct injury ; this is very frequently the 
case with the fasciae and integuments in the sole of the foot. The result in either case is a permanent shortening of these 
tissues, which become then one of the first obstacles to be overcome in the treatment. But contracture is produced in 
another way. The muscles that have remained sound, if unirritated, contract only with a normal degree of force ; but 
a constant source of irritation is found in the malposition of the foot. Pressure being made in abnormal directions and 
upon surfaces not prepared for its reception, especially if inflammation has heightened the sensibility, causes frequent 
reflex contractions of the muscles. Contracture is the physiological result of this prolonged contraction. 
" The effect of talipes, in preventingproper nutrition, is seen in the atrophy of the leg, or entire limb, the smaller 
size of the foot as compared with its fellow, as well as its lowered temperature and livid color. The atrophy of the 
leg is due to the paralysis of one set of muscles, and the gradual wasting of the sound ones, from want of exercise ne- 
cessary to keep them in proper condition. The same want of exercise will partly account for the arrest of growth in the 
foot, but mainly it depends upon the diminution of the supply of arterial blood sent to the part and the obstruction of 
the return of the venous blood, caused by the malposition of the vessels of the foot. * * * 
" When the disease is allowed to continue till adult life, an actual deformity of the bones of the tarsus occurs. Not 
only is the normal relative position of the bones changed, but the long-continued pressure in the new position brings 
about eventually a change in their articular facets. The weight of the body upon these deformed feet aggravates the 
deformity till the foot becomes a misshapen mass, covered with callosities, and is sometimes quite inadequate to sustain 
the body without artificial assistance. Locomotion becomes laborious, painful, or even impossible. 
" Treatment.-From the characteristics of talipes above given-namely, the malposition and defective nutrition of 
the foot-it follows that the prime indications for treatment will be: I. To restore the foot to its natural position ; 
2. To assist the nutrition by all means within our reach, such as heat, friction, motion, galvanism, injection of strych- 
nine, &c. Treatment of congenital club-foot should begin at birth. In cases of acquired talipes, treatment should be 
commenced immediately upon the receipt of the injury. Everyday, week or month that treatment is neglected di- 
minishes the chances of its success when finally resorted to. * * * In a large majority of cases, if proper 
attention is paid to the correction of the deformity, from the birth of the child onward, the foot can be made to main- 
tain the normal position without the aid of tenotomy. The importance of this rule and its observance can be seen at 
once, if for a moment we refer to the most serious obstacles which stand in the way of successful treatment of talipes. 
The most serious difficulties are those which arise from the following conditions: I. Advanced stage of fatty degenera- 
tion in paralyzed muscles, due to prolonged neglect of the performance of their normal function ; and, 2. Effects of in- 
flammation produced in the muscles and fasciae by the irritation from walking with the feet in the abnormal position. 
Both of these difficulties could be avoided, or greatly diminished, by early attention to the case. This principle of 
early treatment appears to have been recognized by Hippocrates, who applied proper bandages immediately afterbirth, 
in cases of congenital talipes. Why this sound practice should ever have fallen into disuse it is impossible to say, but 
certain it is that it was neglected to such an extent that, in the surgical text-books of fifty years ago, the subject is 
hardly referred to ; and, in practice, so little was done for the cure of club-foot that, within a quarter of a century, it 730 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
O^THOf>/EDie 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Treatment. 
was extremely common to meet persons who had all their lives endured this deformity, without ever having undergone 
any treatment for its relief. 
" How can the deformity be cured without the aid of tenotomy? The best means of cure would be constant mani- 
pulation, and the retention of the foot in a proper position by the hand of an attendant. This, however, is unfortun- 
ately an impossible plan of treatment, although I have known cases in which a faithful nurse has very considerably 
diminished the deformity by constant handling. As no instrument can ever have the delicate adjustment, the nice appli- 
cation of power, which the human hand possesses, the degree to which any apparatus approximates the hand in these 
respects, is the measure of its excellence. Much can be done by the hand before the dressing, or instrument which 
may be selected, is applied, or during the intervals when it is removed for readjustment. The manipulation should be 
made in the following manner: Take the foot in the hands and rub it gently with a shampooing motion. Hold it firmly 
in the hands, and gradually press it as nearly as possible into its normal position. While this is being done, the foot 
becomes quite white. When the limit of the patient's endurance is reached, the foot should be allowed to fall back as 
it was before and to rest for a few minutes. The operation should then be repeated, and, after several repetitions, it 
will be found that, with very little discomfort to the patient, the foot can be brought nearly, or quite, to its normal po- 
sition. The manipulations should not be continued so long, or used with so much force, as to excite inflammation or 
reflex contraction. Again, the foot should never be retained, by any dressing, any nearer to a normal position than can 
be done without endangering free circulation. At the second dressing the foot can be restored still nearer to its normal 
position, and so on, step by step, until complete restoration has been obtained. If the foot is restored at once to its 
normal position and held there by some apparatus, regardless of a free circulation (indicated by the color of the toes), 
sloughing will probably supervene and treatment will be delayed for a considerable time. The shampooing friction 
of the muscles should be very thoroughly applied, and, in addition, they should be lightly whipped with the fingers 
transversely to their fibres. If a muscle be struck so that the blows fall in the direction of the fibres, the contraction 
produced is far less than if the blow be received transversely; the object being to awaken the paralyzed muscles to 
action, the latter method is far preferable. These manipulations, by drawing a large supply of blood to the part, very 
much increase its nutrition. They should be repeated daily if possible, and I consider them of so much importance 
that I greatly prefer those forms of dressings which do not interfere with this and other kinds of accessory treatment." 
-"Orthopaedic Surgery and Diseases of the Joints." Lewis A. Sayre, M. D. 
Fig. 4241.-Barwell's Attachments of Artificial Muscles 
for Adjusting Club-Feet. 
The ordinary cause of deformity of the 
foot is not contraction of certain tendons, 
but paralysis of the muscles connected 
with the uncontracted ones. Hence divis- 
ion of tendons which retain their normal 
power is not the way to cure the deform- 
ity. The author's mode of treatment is to 
supply the place of the paralyzed muscles 
by means of elastic cords. By a light 
and simple contrivance, these cords are 
fastened to points as near the origin and 
insertion of the paralyzed muscles as pos- 
sible, and the patient is encouraged to use 
his limb, while at the same time constitu- 
tional remedies are prescribed, and local 
means, such as friction, galvanism, &c., are 
employed. This treatment proceeds on 
the principle that our aim ought to be to 
strengthen weak parts and not to weaken 
strong ones. The author has adapted his 
method to the treatment of knock knees 
and crooked shins, and he has devised 
means by which spring force may be 
brought to bear upon these deformities in 
such a way as to draw the bones into a 
more natural position. (Mr. R. Barwell.) GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
731 
ORTHOP/EDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Methods of Dressing. 
" The simplest dressing is the ordinary roller bandage. If the patient be taken while the case is yet recent, by 
bringing the foot as near its proper position as possible and carefully bandaging it to retain it there, by constant ob- 
servation and readjustment a cure may sometimes be effected. There are very considerable objections to this plan of 
treatment, viz.: it is applicable to a very limited number of cases ; it is very liable to get out of order, and therefore 
demands constant care ; it has, moreover, an objection in common with all which permanently cover the limbs by 
bandages or splints, that it interferes with the necessary application of friction. 
" The gypsum bandage possesses the advantage over the last plan that it does not change its form ; the limb is as 
securely locked as in a vice. In the details of its application quite a considerable variety exists-some preferring to 
first bandage the limb and then to cover the bandage with the gypsum mixed with water; others, to fill the meshes of 
a loosely-woven cotton roller bandage with the dry powder, and to moisten it after it has been applied ; and others, 
again, to make from woolen or cotton cloth a covering to fit the leg, and to apply to this the plaster. These varieties 
are, however, immaterial; the property which gypsum has of ' setting ' when wetted is the essential one to bring into 
operation. The objections to this plan are, the weight of the dressing, the impossibility of inspecting the limb and 
of applying to it friction, electricity, &c. 
"Again, splints of sole leather and gutta-perc ha have been recommended as a plan of treatment. Another article 
which I have employed with great satisfaction is Ahl's felt-splint (see Fig. 3895). 
" Before applying any of the bandages or dressings above described, the limb should be enveloped in cotton, or, 
what is better, wool ; this prevents the permanent dressing from excoriating or unduly constricting the limb at any 
point. Great care should be taken that no foreign matter be entangled in the fibres of the cotton or bandages, as very 
severe excoriations and ulcerations may be produced by them. * * * 
" Cases do occur in which the muscular rigidity is too great to yield to 
manipulation, unless continued for a longer time than can be generally 
given. A constant tractile force then becomes necessary, and the plan 
suggested by Dr. Richard Barwell, of London, is by far the best. 
" This consists in cutting from stout adhesive plaster spread on canton 
flannel, or the ' moleskin-plaster,' a fan-shaped piece. In this are cut 
several slips, converging toward the apex of the piece, for its better adap- 
tation to the part (Fig. 4242-46). The apex of the triangle is passed 
through a wire loop with a ring in the top (a, b), brought back upon itself, 
and secured by sewing. The plaster is firmly secured to the foot in such 
a manner that the wire eye shall be at a point where we wish to imitate 
the insertion of the muscle, and that it shall draw evenly on all parts of 
the foot when the traction is applied. Secure this by other adhesive 
straps and a smoothly adjusted roller. 
" The artificial origin of the muscle is made as follows: Cut a strip 
of tin or zinc plate, in length about two-thirds that of the tibia, and in 
width one-quarter of the circumference of the limb. This is shaped to 
fit the limb as well as can be done conveniently. About an inch from the 
upper end fasten an eye of wire. Care should be taken not to have this 
too large, as it would confine the rubber to a fixed point. The tin is se- 
cured upon the limb in the following manner: From a stout (moleskin) 
plaster cut two strips long enough to encircle the limb, and in the middle of each 
make two slits just long enough to admit the tin, which will prevent any lateral 
motion ; then cut a strip of plaster, rather more than twice as long as the tin, and 
a little wider; apply this smoothly to the side of the leg on which the traction is to 
be made, beginning as high up as the tuberosity of the tibia. Lay upon it the tin, 
placing the upper end level with that of the plaster. Secure this (Fig. 4243) by 
passing the two strips above mentioned around the limb ; then turn the vertical strip 
of plaster upward upon the tin. A slit should be made in the plaster where it 
passes over the eye, in order that the latter may protrude. The roller should then 
be continued smoothly up the limb to the top of the tin. The plaster is again re- 
versed and brought down over the bandage, another slit being made for the eye, and 
the whole secured by a few turns of the roller. 
"A large majority of congenital deformities, if taken immediately after birth, can 
be restored to, and retained in, their normal position by adhesive plaster. 
Fig. 4242.-Sayre's Method of Attach- 
ing Barwell's Artificial Muscles for 
Adjusting Club-Feet. 732 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES, 
Methods of Dressing. 
A small chain, a lew inches in 
length, containing a dozen or twenty 
links for graduating the adjustment, is 
then secured to the eye in the tin. Into 
either end of a piece of india rubber 
tubing, about one-quarter of an inch in 
diameter and two to six inches in 
length, hooks of a pattern shown in 
Fig. 4242, c, d, are fastened by a wire 
or other strong ligature. A hook is 
fastened to the wire loop on the plaster 
on the foot, and the other to the chain 
above mentioned, the various links mak- 
ing the necessary changes in the adjust- 
ment. 
" The advantage of this plan of 
treatment is that it causes movements 
in imitation of the natural movements 
of the parts ; permitting and promot. 
ing the constant movements of the 
muscles and joints, thereby increasing 
the circulation in the same and neces- 
sarily improving their development and 
power. 
" The exact amount of force applied can be regulated at will by means of the chain attached to the tubing. The 
change of the hook from one link to another increases or decreases the power, according as the length of the chain 
and tubing is diminished or increased. The only objection that can be urged against this plan of treatment is that 
the adhesive plaster will sometimes slide and change its position ; will soon become worn out and require frequent ad- 
justments ; and, what is most annoying, will often-particularly in young children and in hot weather-so irritate and 
excoriate the skin as to compel, for a while, the abandonment of its application. 
"To permanently overcome or remedy this defect, I constructed a club-foot shoe (Fig. 4246), on the plan of 
' Scarpa's shoe,' with a lateral hinge in the sole, for cases of valgus and varus ; the only difference being that the motive 
power was the rubber tubing in place of the ordinary different kinds of springs which had formerly been used for this 
Duroose."-"Orthopaedic Sureerv and Diseases of the Joints." Lewis A. Savre. M. D. 
Fig. 4244 
Fig. 4245. 
Fig. 4246. 
Sayre's Talipes Shoes. 
Fig. 4247. 
Fig. 4248. 
" These deformities are rarely accidental. They are almost always congenital and may be rectified at an early period 
by proper mechanical means to strengthen the foot gradually and restore it to its proper shape and direction ; and, if 
these means fail, the tendons and muscles concerned in the deformity may be divided."-Dunglison. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
733 
ORTHOp/EDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Talipes. Shoes, Apparatus. 
Fig. 4249. 
Sayre's Talipes Shoe. 
" In January, of 1868, I improved my shoe by putting in the sole, opposite the 
medio-tarsal articulation, a ball and socket, or universal joint, instead of the hinge 
joint, which permitted only lateral movements. This sole and part embracing the heel 
consists of strong sheet-steel, covered with leather on both sides. Two lateral up- 
right bars, B, jointed at the ankle, are fastened near the heel and to the collar-band; 
G, H and I are points for the attachments of artificial muscles, made of rubber tub- 
ing, with hooks and chains at their ends. To the inside walls of the shoe, near A, 
two flaps of chamois-leather are attached to lace together, which, passing over the 
front of the ankle joint, keep the heel firmly in the back part of the shoe. The 
accompanying figure shows the result of the last effort to make this shoe resemble 
an ordinary one as much as possible. In addition, the shoe has been made more 
comfortable and convenient by a slight heel, and by making the anterior part of the 
sole like that of an ordinary shoe, and not so clumsy as that of most club-foot shoes. 
The upper leather laces neatly over the foot, adapting itself more perfectly than if 
arranged with straps and buckles. The shoe is arranged for valgus or varus. There 
is really no essential difference; only observe the principle to apply the artificial 
muscles in such position as shall best supply the place of those paralyzed."-" Or- 
thopaedic Surgery and Diseases of the Joints." Lewis A. Sayre, M. D. 
Measurements Required. 
1. Trace the outlines of the affected foot on a piece of paper. 
2. Length of foot, Inches. 
3. Length from sole to calf, .... " 
4. Circumference of calf, " 
5. Circumference of instep, .... Inches. 
6. Circumference above ankle, ... " 
7. Circumference of ball of foot, . . " 
"Different kinds of apparatus are in vogue for the cure of club-foot, and it is, therefore, not always easy for the 
practitioner to determine which is the best, or which should be employed to the exclusion of others. Every orthopaedic 
surgeon, almost, has some peculiar notions upon the subject, which induce him to adopt such measures as whim, fancy 
or experience may dictate. This very circumstance, however, goes to show that the same end may be attained by dif- 
ferent means. Whatever plan be adopted, the great caution to be observed, on the part of the surgeon, is that the 
extension be made in a slow and gradual manner, that the skin be protected from friction and unequal pressure, that the 
dressing be. worn day and night, and, finally, that the limb be frequently washed and immediately afterwards rubbed 
with some sorbefacient lotion. During the first few days, the apparatus should be applied rather loosely, until the 
limb has become accustomed to its presence, when it must' be gradually tightened. If the skin becomes chafed, hot and 
tender, measures must immediately be adopted to moderate or shift the pressure, or the apparatus must be left off al- 
together for a few days."-" System of Surgery." Gross. 
Fig. 4250. 
Wyeth's 
Talipes Shoes. 
" When the patient is able to walk, the club-foot shoe (Sayre s, Fig. 4249) will give the great- 
est satisfaction. The rubber muscles should be applied and regulated in such a way that they will 
imitate, as nearly as possible, the normal action of the muscles they are intended to assist. A less 
expensive instrument, one which yields good results in the milder forms of talipes equino-varus, is 
shown in Fig. 4250. It consists of a sole-piece of sheet iron, which is rivetted to a heel-piece of 
the same material, and is roomy enough to hold the heel of the patient without chafing. It should 
be nicely padded, to prevent the danger of excoriations. To this heel-piece is attached, by a 
hinge-joint with limited forward and backward motion, an iron bar which extends to the padded 
iron collar around the leg, near the knee. The foot of the patient is secured to the sole-piece by 
adhesive plaster, with the aid of the instep-strap, and a flannel roller (these are not shown in the 
cut) is carried over all. As the perpendicular bar is now carried parallel with the leg, and held 
in this position by buckling the collar around the leg, the foot is turned outward and held in its 
normal position. An ordinary lacing shoe should be worn over the brace."-"Text Book on 
Surgery." Wyeth. 
1. Trace outline of affected foot on paper. 
1. Length of foot Inches. 
Measurements Required. 
3. Length from sole to calf, . Inches. 
4. Circumference of calf, . . " 734 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPEDIC 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Talipes Varus et Valgus. Apparatus. 
Reeve's Universal Talipes Shoe. 
Fig. 4251.-Outer View. Fig. 4252.-Inner View. 
Fig. 4253. 
Reeve's Scarpa Shoe, for Severe Cases. 
" When the deformity has been sufficiently corrected by tenotomy, splints and proper manipulations, a suitable ta- 
lipes shoe must be worn for some time. The form which I have found extremely serviceable in private practice is 
shown in the above drawing (Fig. 4251). In severe cases an outside toe-spring is attached, so that the anterior part 
of the foot can be still further everted. A ball and socket joint, or rack arrangement worked by a key, is adapted above 
the ankle on the outer side. Seeing that it answers for all forms of ordinary talipes, I called it the ' universal talipes 
shoe.'"-"Practical Orthopaedics." Reeves. 
Fig. 4255.-Sole of Harwell's Shoe. 
Fig. 4254.-Harwell's Talipes Shoes, 
" I found that the ball of the joint in the Sayre 
shoe, being somewhat bulky, was apt to wear out on 
the lower part, and the entire separation of the heel 
from the front of the foot permits water to enter and 
keep the stocking wet. To obviate the former incon- 
venience, I proposed to resolve the compound move- 
ment of ball and socket joint into its three elements, 
and have carried out that idea in the manner repre- 
sented in Fig. 4254-55. 
"The shoe thus modified-and I must beg my friend Dr. Sayre to pardon my making any change in his admirable 
inventions-answers every purpose extremely well, especially while a tolerably marked deformity, though not a severe 
one, still exists. It is especially adapted to the middle phase of club-foot."-" Infantile Paralysis and its Resulting 
Deformities," in the London Lancet, February, 1874. Richard Barwell, M. D. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
735 
ORTHOfyEDie 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Talipes Varus et Valgus. Apparatus. 
Fig. 4256. 
Tiemann & Co.'s Talipes Shoe. 
" The sole of this strong leather shoe is of metal, with a joint near the heel, 
allowing lateral motion. A durable spiral spring, a, draws the foot outward 
by a constant, elastic and easy traction. This pressure is increased or de- 
creased at will by fastening the spring in a series of sockets, c. 
" The single outside upright steel bar, with joints at the ankle, is fastened 
around the limb below the knee joint, and so constructed that the screw at the 
ankle joint forces the foot flat upon the floor ; the foot in almost all cases 
being turned under as indicated by the sketch. The spiral spring, d, attached 
to a catgut cord and fastened near the toes upon the outside of the foot, ele- 
vates the toes and stretches the tendo Achilles, thus drawing the foot to its 
natural position. 
" The shoe is well padded, and as there is no metal in the heel-cap, no 
excoriation is occasioned. The contraction of the leather above the heel pre- 
vents the shoe, always so difficult to retain in fleshy infants, from slipping 
off. The straps around the instep depress any undue prominence of the arch 
of the foot, and within the shoe a broad and well-padded tongue keeps the 
toes flat upon the sole of the shoe. This apparatus resembles much the regu- 
lar shoe, and shows no deformed appearance. 
"A very simple and light night shoe, to keep the foot in the same posi- 
tion gained by the above shoe during the daytime, is of much service. 
"For talipes valgus the same principle, but with reversed action, is ap- 
plied."-Medical Record, August 16, 1869. 
In ordering the above shoes please send the following 
Directions for Measurements, 
i. Tiemann & Co.'s shoes. 
2. Length of sole of foot, Inches. 
3. Circumference of calf, d, .... " 
4. Circumference of instep, c, ... " 
5. Circumference of ball of foot, a, . . " 
6. Circumference above ankle, b, . . . Inches, 
7. Length from sole to upper part of calf, d, 
8. Right or left foot, or both? 
9. Talipes, varus or valgus? 
Fig. 4257. 
Tiemann's Weak 
Ankle Brace. 
These braces are used to maintain the position of the foot after the relief of valgus or 
varus by the regular club-foot shoe, and also for correcting simple lateral inversion or eversion of 
the ankle joint, resembling varus or valgus, commonly called weak ankle. 
We attach, by means of three rivets, to the sole of a common laced shoe, a lateral stem, jointed 
at the ankle, a, passing as high as the centre of the calf, and here fixed to a band, b. 
The ankle is supported and kept in its corrected posture by a triangular V shaped leather 
strap, c, acting against and buttoned to the steel stem on the opposite side. 
The best direction for selecting the side on which the instrument should be applied is that, if 
the outer ankle has a tendency to eversion, the apparatus should invariably be placed to the inner 
side, and vice versa. 
In obstinate cases it is made with double stems, in order to give greater security 
and keep the sole in a strictly horizontal plane ; the ankle may be further protected 
by a small round soft pad, to prevent chafing against the steel. 
Measurements Required. 
v. Tiemann's brace for weak ankle, 
2. Resembling-varus or valgus ? 
3. Send us a well-fitting shoe or shoes to lace. 
4. Length from sole to ankle joint, . . Inches. 
5. Length from sole to garter (below knee), " 
6. Circumference at garter (below knee), Inches. 
7. Circumference above ankle joint, . 
8. Mention if for right, left or both ankles. 
If you wish us to furnish shoes, send additional measurements as directed on page 741. 736 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOf/EDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Talipes Varus et Valgus. Apparatus. 
Fig. 4258.-Stillman's Ankle Brace, 
with Clamps. 
"This apparatus is for weak ankles when associated with inverted feet, 
for the less severe forms of talipes varus, especially when due to infantile 
paralysis, and for the after-treatment of such cases as have been subjected to 
operation. It consists of a single bar placed on the outer side of the leg, 
jointed at the ankle, riveted to the shoe under the heel and buckled to the 
leg by two girths, one just below the knee and the other above the ankle. 
"It is fitted with two ratchets and an elastic webbing. One ratchet is 
placed just below the ankle for rotation, and allows that part of the brace 
below it to be thrown out and fixed at any angle with the part above ; for, 
when so fixed, and the brace secured to the foot and leg, any inversion ten- 
dency is combated by the entire brace, which thus acts as a powerful spring 
to keep the foot rotated outwardly. The second or pronation ratchet is 
placed where the side-strip passes under the shoe, and enables the surgeon 
to entirely prevent any tendency of the foot to turn under; for, if the side- 
strip be clamped by it at an angle of about forty-five degrees outward from 
the foot, and then brought up against the leg and secured by the girths, the 
foot will be turned in its long axis so that the patient will walk on the inner 
instead of the outer side. This effect may be varied by the ratchet in the 
side-strip, so that the brace may be anything from a simple vertical support 
to an agent for the production of valgus, so completely does this ratchet place 
the limb under the control of the surgeon. Contraction of the posterior 
muscles is combated by the use of elastic webbing, provided with hooks pass- 
ing from an eyelet in the sole opposite the base of the little toe to a point on 
the side-strip at about the lower girth. 
" In many cases it may seem preferable to allow a limited range of lateral 
movement of the foot, instead of having the eversion fixed by the clamp. 
This may be secured by having a loose rotary joint, and attaching a coiled spring to the side-strip, whose power can 
be regulated by a cog and catch, so that it may be 'wound up' to any desired degree of rotary power, thus combating 
the inversion by a constant elastic force without impairing support. 
" The physiological point to which I wish to draw attention is the necessity of rotating the foot outward (extreme 
eversion) before applying elastic force, if complete reduction of an equino-varus or an equinus be desired. Whenever, 
in these conditions, the os calcis is drawn upward and the astragalus projects, it is impossible to apply the upward 
elastic force advantageously in the median line until the foot is rotated outward, as the partial dislocation of itself pre- 
vents the normal degree of movement upward in the ankle-joint. The foot should be taken in the hands of the surgeon 
and forcibly everted, and, after passing the median line, pronated ; and it will then be found that the deformity can 
be relieved with much greater ease. It follows, therefore, that a brace, to be effective, should contain provision for these 
movements and afterward afford fixation in the corrected position, while not interfering with the normal motion of the 
ankle."-"A Contribution to the Treatment of Clubfoot," in N. F. Med. Journal, Oct. 20, 1883. C. F. Stillman, M.D. 
Measurements Required, 
Fig. 4259.-Nyrop's 
Talipes Valgus Shoe. 
I. Stillman's ankle brace with clamps. 
2. Resembling-varus or valgus ? 
3. Send us a well fitting shoe to lace. 
4. Length from sole to ankle joint, Inches. 
5. Length from sole to garter below knee, " 
6. Circumferences at garter, 
7. Circumference above ankle joint, . . . . 
8. Mention if for right, left or both ankles ? 
If you wish us to furnish shoes, send additional measurements as directed on page 741. 
" Nyrop's boot is highly recommended by Mr. Reeves. It consists of a stiff-soled lac- 
ing shoe, with a leg-collar and iron or steel bar attached to the outer side of the shoe, with 
a lateral hinge opposite the outer malleolus. To the inner side of the sole, near the heel, 
is attached a strong piece of elastic webbing, by which inversion of the foot is effected by 
buckling the strap to the collar near the knee."-"A Text Book on Surgery." Wyeth. 
Measurements required same as for Fig. 4258. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
737 
O^THOP/EDIC 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Talipes Varus et Valgus. Apparatus. 
Fig. 4260. 
Detmold's Scarpa Shoe. 
A shoe with a steel sole, an upright spring jointed at the ankle, and a spring in the 
direction from heel to toes, having a slight curvature in opposition to that of the foot. 
This last spring is worn inside of the shoe. The upright spring, by a peculiar bend, is 
made to evert the foot, so as to bring the sole flat to the floor and supporting the ankle; 
it is secured to the leg by a padded calf-band. The well padded uppers of the shoe are 
fastened by straps and buckles. An instep strap secures the foot in place. 
Measurements required same as for Fig. 4256. 
" The various theories as to the causes of congenital club-foot may be arranged under 
three heads: I. Mechanical; 2. Muscular; 3. Osseous malformation, or arrest of develop- 
ment. 
"Hippocrates, Pare, and Cruveilhier were supporters of the first view, and thought 
that abnormal pressure of the uterus on the fcetus through deficient liquor amnii, or com- 
pression of the uterus by another part of the fcetus, or the abnormal position and action 
of the umbilical cord or of the amniotic bands, would produce club-foot. But against 
this view the objections were that in most cases of club-foot it is impossible to find any 
compressing cause, either external or internal. 
" The muscular or musculo-nervous theory was maintained by Duverney, Rudolphi, Beclard, J. Guerin, and sub- 
sequently by Delpech. This theory supposes an unequal action of the muscles and ligaments, or an insufficient de- 
velopment of the calf muscles, or a disease of the nerve centres. Rudolphi attributed it to intra-uterine convulsions, 
and Chance and Little are somewhat inclined to support this view. Guerin stoutly supported this theory, and con- 
sidered club-foot as the result of convulsive muscular retraction consecutive to affection of the central nervous system, 
leaving, sometimes, manifest traces, and at others none whatever. 
"The theoiy of primitive osseous deformity and arrest of development has had weighty names in its support. 
Scarpa, Broca, Robin, Lannelongue and Thorens support the view of original osseous deformity; whereas Meckel, 
Geoffroy, Saint-Hilaire, Breschet and Eschricht upheld the view of arrest of development, and thought that at a certain 
period of intra-uterine life the infant's feet were in a position of varus, and there can be but little doubt but that this 
is more or less the case ; but it must be remembered that if this explains varus it throws no light on the other forms 
of club-foot."-Reeves. 
" The object of the appliance is to exert pressure under 
control of the operator in three directions, and also to en- 
able him to twist and raise the front of the foot. 
" The apparatus consists : I. Of a plate large enough 
for any foot; 2. Of three steel buffers or padded plates, 
which are attached at the ends to steel screw-rods playing 
through sockets with a female screw thread at the sides of 
the large plate. By turning the screws, which is done by 
the handles, the plates or buffers are pushed forward. They 
should be placed so as to press (i) upon the side of the first 
metatarsal; (2) on the side of the os calcis just beneath the 
inner malleolus ; (3) on the outer side of the foot over the 
projecting head of the astragalus. The female screw through 
which the male screw plays is adjustable upon an arm, curved, 
so that pressure can be applied when it may be found neces- 
sary. The socket and arms are arranged so that they can be 
shifted and placed at any point along the side of the large 
plate, or can be shifted from side to side, so that the appliance can be used for either foot. A straight rod, extended 
in the plane of the plate, gives increased power in raising the front of the foot. This is not always needed, and is not 
shown in the cut. 
" In operating upon obstinate cases of club-foot the method of procedure is as follows : Tenotomy is performed in 
the usual way, the plantar fascia divided first, the tibiales tendons (if contraction is present) and the tendo-achillis last 
(after the deformity at the arch of the foot has been in a degree corrected); the foot is then forcibly manipulated with 
the hands, pressure being exercised upon the projecting head of the astragalus by the thumbs, and force applied in a 
counter direction by the hands grasping the ankle and forepart of the foot. It will be found, in certain cases, that com- 
Fig. 4261.-Bradford's Tarso Corrector, 
for operating upon obstinate cases of club-foot. 738 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTJHOP/EDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Talipes Varus et Valgus. Apparatus. 
plete correction of the deformity can not be accomplished by the hands alone, and the hindrance will be seen to be not 
a shortened tendon or any tissue accessible to the tenotome. The instrument just described is then to be applied, and 
the screws turned and adjusted so that the plates will press upon the os calcis, the head of the astragalus, and the side 
of the metatarsal as far as its articulation with the tarsus. The foot will now be firmly held, and by additional turns 
of the screw force can be applied in the desired direction. Rotation upward and outward can be effected by twisting 
the plate, and the equinus deformity of the foot can be corrected by pressing the end of the plate upward. In case it 
is desired to increase the power in this direction this can be done by increasing the length of the handle. If the screw- 
plates are properly adjusted, it will be found that there is no danger of a fracture, as the pressure can be so directed 
that the ligaments will yield before any of the bones of the tarsus can be broken. An anaesthetic is, of course, required, 
and correction will be done gradually rather than by any sudden tear. The extent to which force can with safety be 
applied is with difficulty defined; it may be said, however, that experience shows a much greater pressure can be used 
than would at first be thought feasible-in a majority of cases enough force can be used to convert the foot from the 
position of varus to that of valgus, and to correct the equinus position. In the simpler cases this is always possible ; in 
the severer cases some minutes should be given to gradually stretch the foot. Sometimes complete correction is not 
possible at one sitting, and something will have to be left for after-treatment or for a second sitting. 
"After the foot has been brought into a position which is nearly normal, and the contracted tissues so stretched that 
the foot can be held without a great amount of force, the foot should be fixed in the corrected position. For this pur- 
pose nothing has been found so useful or comfortable as a plaster of paris bandage properly applied. The foot should 
be held in as nearly a normal position as is possible, grasped by one hand at the toes while counter pressure is exerted 
on the leg. Roller plaster bandages, prepared in the way that is customary for plaster jackets, are wound around the 
foot and leg, which are first to be covered with one layer of sheet-wadding. The bandages are to be applied without 
loosening the hold upon the foot, which is to be kept in the corrected position until the bandages have become suffi- 
ciently hard as not to yield when the hold of the foot is loosened, and additional turns are then applied around the 
toes. The bandage should be carried above the knee and half way up the thigh, and the leg should be flexed at the 
knee, thus preventing any subsequent rolling of the limb within the plaster bandage. After the dressing has become 
stiff, and before it is absolutely hard, it can be cut through by two cuts along the dorsum of the leg and foot, and cross 
cuts over the foot and thigh, so that the lid of the plaster-box may be lifted and the parts inspected subsequently, 
when necessary, without destroying the bandage. 
" There should be no wrinkles in the bandage, and no pressure should be made upon the dorsum of the foot while 
the gypsum dressing is hardening. After ten days to three weeks the stiff bandage may be removed, and, if the foot 
is sufficiently corrected, a walking shoe applied."-Medical Record, March 22, 1884. E. H. Bradford, M. D. 
An instrument employed by Dr. C. F. Stillman to twist the anterior portion 
of the foot on the posterior at the medio-tarsal joint, and also to gradually and 
painlessly alter the angle of the foot with the leg at the ankle joint. It consists 
of a local extender, provided with a slotted arch for graduated movement, placed 
each side of the ankle joint, and another placed in front of the arch of the foot. 
These are attached to a flexible felt or leather sole on which the foot is firmly 
fastened by bandages; above they are connected to metal terminal plates, which 
are bound down to the leg by some immobile dressing. This splint allows the 
foot to be twisted into shape ; it provides a local extension which relieves the parts 
from strain and attrition, and also allows the patient to walk without interfering 
with the action of the instrument-the foot being completely under the control 
of the surgeon. 
"Shaffer's club-foot extension apparatus (Figs. 4263, 4264 and 4265) consists 
of the ordinary uprights, A, A, fastened to the conventional heel-piece, E, by 
a plain joint on one side and an endless screw, C, on the other. This screw, C, 
allows us, by using the key, D, to place the foot-piece of the apparatus, as a 
whole, in any antero-posterior position we choose, and to alter it at will, either 
before or after application to the foot. The dotted line, P, P, is supposed to 
represent the arc of a circle, the centre of which is the screw, C. That part of 
the foot-piece, E, which corresponds with the tarsus and metatarsus, is joined 
by a common extension rod, F (shown in Fig. 4264), to the portion which lies 
under the os calcis. With the key, G, we are enabled to extend the anterior part 
of the foot-piece, E, at pleasure. 
Fig. 4262. 
Stillman's Club-Foot Twister. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
739 
ORTHOP/EDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Talipes Varus et Valgus. Apparatus. 
Fig. 4263.-Shaffers 
Club-foot Extension Apparatus. 
" Fig. 4264 shows the apparatus lying on its side, with a full view of the 
under surface of the foot-piece, E, and the extension rod, F. At K, K, is 
a leather or rubber heel, built up on either side of the extension cylinder, 
and L represents a wooden sole, which is elevated to a height corresponding 
with the rubber heel. So far as this apparatus is concerned I may say that it 
presents no novelty, save the extension rod, and the modifications which this 
addition to the apparatus makes necessary. 
"To apply this instrument, we first, by means of the key, D, place the 
foot-piece in a position that will exactly correspond with the antero-posterior 
position of the foot-whether tenotomy has been performed or not. We 
then secure the heel by tying the heel-strap, H, as represented in Fig. 4265. 
We then bind the foot, anterior to the medio-tarsal joint, to the extension 
part of the foot-piece, E, by means of adhesive plaster, wide Fig. 4265. 
We first apply four or five strips to the plantar integument, which are 
reversed as they pass over the end of the foot-piece, and are then fastened 
to the under (wooden) part of the foot-plate. Five or six strips are now passed 
longitudinally over the toes and underneath, where they are also secured. 
Transverse pieces are then passed around the 
tarsus and metatarsus, also underneath the 
foot-plate, and secured at convenient points. 
[The plantar strips are not shown in the en- 
graving, and the artist has placed key G too 
far forward.] A bandage is then applied, 
to protect the adhesive plaster. The key, 
D, is now used to flex the foot in overcom- 
ing, to the desired extent, the tendo-achillis 
resistance."-Medical Record, November 23, 
1878. Newton M. Shaffer, M. D. 
Fig. 4264. 
Fig. 4265. 
Measurements required are the same as 
for Fig. 4256. 
" I have deemed it best, as a matter of experience, not to adopt the club-foot extension apparatus to the purely 
lateral deformity, as mentioned before. It is, ordinarily, and especially in infants, a very easy matter to rectify this 
by any lateral support of gutta-percha, tin, or other flexible material. In obstinate cases it is well to make subcuta- 
neous sections to save time. I have found a very useful lateral splint in a modification of 
Taylor's ankle support, which is represented in Fig. 4266. My modification consists in 
the substitution of the lateral hinge, A, and the endless screw, B, 
for the antero-posterior joint. The dotted lines show the movement 
acquired by using the key, C. This modification enables us to ap- 
ply the apparatus accurately to the extremes of varus or valgus, and 
to gradually, by means of the key, C, turn the foot to the desired 
extent. This splint is applied, as represented in Fig. 4267, to that 
side of the foot toward which the deformity looks. It should be 
secured by a bandage. The bandage is omitted in the engraving 
and two strips of adhesive plaster, Q, Q, are substituted, so that the 
application of the splint may be more easily shown. The counter 
extension surface being large and the resistance generally slight, the 
pressure may be very gradually applied. The foot can, under ordi- 
nary circumstances, be changed from the varus into a valgus position 
withoutany pain whatever."-" Modification of Taylor's Ankle Sup- 
ports," in Medical Record, Nov. 23, 1878. Newton M. Shaffer, M.D. 
1 Ankle^Support°r S 
Fig. 4267. 
Shaffer's Modifica- 
tion °f Taylor's 
Ankle Support. 740 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORT^OP/EDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Talipes Equinus. Apparatus. 
Fig. 4268. 
Talipes Equinus. 
"Talipes equinus is usually non-congenital. The treatment is operative and me- 
chanical. The tendo-achilles and plantaris may alone require division, or, in addition, 
the plantar fascia must be cut, as when the arch of the foot is strongly contracted ; the 
foot should usually be brought into position at once and retained by splints or the gyp- 
sum bandage. At the end of a week a shoe should be applied."-"Operative Sur- 
gery." Stephen Smith, M. D. 
Simple contraction of the tendo-achillis 
and consequent dropping of the toes, is conve 
niently corrected by means of an artificial elastii 
muscle, one end of which is fastened to the soli 
of the shoe, a, the other to the calf-band, b; i 
may be regulated to any degree of tension b; 
means of a buckle, e. In ordering the apparatu 
send the following description and measurements 
Fig. 4269. 
Talipes Equinus Shoe. 
i. Talipes Equinus Shoe, Fig. 4269. 
2. Patient's name (or sex). 
3. Patient's age. 
4. Right, left, or both feet ? 
5. Length from sole of foot to ankle joint, . . Inches. 
6. Length from sole of foot to calf, " 
7. Circumference of calf, " 
Fig. 4270. 
Sayre's Talipes Equinus Shoe 
"An ordinary shoe with steel supports on either side, jointed opposite the 
ankle and buckled around the leg above the calf, to give attachment to a rubber 
elastic which runs from a stirrup over the ball of the toes, for the purpose of 
elevating the foot. With this shoe on and the rubber properly adj'usted, the 
patient runs with perfect freedom and without the slightest limp."-Sayre. 
Measurements required same as for Fig. 4269. 
Hudson's apparatus, like the preceding one, has on the inner and outer sides 
of the leg light or heavy (as the patient may require) steel bars, j'ointed at the 
ankle to a foot-piece which is securely riveted to the shoe sole. On top these 
two steel bars are fastened to a well padded collar, encircling the leg in the 
region of the garter. 
The improvement by Dr. Hudson consists in attaching the artificial muscles 
at the j'oints of the apparatus, in which position they work more effectively 
and are not so liable to catch anywhere or trip the patient. The muscles are 
constructed of strong elastic webbing ; secured to their lower ends are pieces 
of catgut, which in turn are securely fastened to the lower ends of the semi-circular 
grooved guides attached to the foot-piece ; the catgut plays in the grooves of the semi- 
circular guides. 
Sewed to the upper ends of these elastic webbings are strips of perforated leather, 
which fasten on metal buttons placed for this purpose on each side of the garter band. 
The tension of the artificial muscles can be regulated by buttoning the perforated straps 
high or low, and by their aid the foot retained in its normal position. 
Fig. 4271. 
Hudson's Talipes Equinus 
Apparatus. 
Measurements Required. 
1. Send us a well-fitting shoe or shoes, to lace. 
2. Length from sole to ankle joint, Inches. 
3. Length from sole to garter (below the knee), 
4. Circumference at garter, . 
5. Right, left or both feet ? 
If you wish us to furnish shoes, send additional measurements, as on page 741 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
741 
ORTHOPEDIC. 
KYLLOSIS, CLUB-FOOT, TALIPES. 
Talipes Calcaneus. Apparatus. 
Fig. 4272 
" Talipes calcaneus is both a congenital and non-congenital affection. 
In congenital cases the deformity is of the simplest kind, the position of the 
foot being an exaggerated degree of flexion. In ordinary cases the treat- 
ment required is passive exercise and the use of a soft padded splint applied 
in front of the leg and foot. In severe cases much contraction of the ante- 
rior muscles, the tendons of the tibialis anticus, extensor proprius pollicis, 
extensor longus digitorum, and peroneus tertius should be divided. Non- 
congenital calcaneus is usually the result of infantile paralysis, and, as a 
consequence, tenotomy is seldom required; palliative treatment alone must 
be attempted by the application of a proper shoe."-"Operative Surgery." 
Stephen Smith, M. D. 
We prefer to have patients send us their own laced shoes for attachment 
to braces, but can furnish them if desired on receipt of the following : 
a. Length of sole of foot, Inches. 
b. Circumference ball of foot, " 
Measure for Shoes. 
c. Cimcumference of instep, Inches. 
d. Circumference above ankle, " 
Fig. 4273. 
Calcaneus Shoe. 
This instrument consists of a pair of steel stems fastened to a shoe, provided with 
joints at the ankle and secured to the leg with a calf-band. A strong elastic cord, or 
webbing, is fastened posteriorly to the calf-band above, and to a spur-like piece of steel 
at the heel of the shoe below. By drawing this cord tight, the uplifted sole is faced 
downward, and the strain on the tendo-Achillis is diminished ; at the same time the 
contracted muscles in front of the leg are extended. 
Fig. 4274. 
Apparatus for 
Talipes Calcaneus. 
Fig. 4274 shows the same apparatus, with this difference : 
instead of the cord, or elastic webbing, contracting poste- 
riorly in Fig. 4273, we have a steel spiral spring, placed on 
a pivot and playing between brackets of the leg and ankle 
stem, to depress the front part of the foot by extension. 
There is not so much danger of falling with this apparatus 
when descending stairs, the spurs, shown in Fig. 4273, be- 
ing dispensed with. 
Measurements Required 
I. Patient's name. 
2. Patient's weight. 
3. Patient's age. 
4. Right or left foot ? 
5. Length from sole to ankle joint, Inches. 
6. Length from sole to calf, ... " 
7. Circumference of calf " 
8. Apparatus, Fig. 4273 or 4274 ? 
Pes Planus. Flat Foot. 
Fig. 4275.-Eclipting Spring for Flat Feet 
For flat feet we make a plain steel sole, well tempered and shaped 
to approach an ideal arch of a foot (see Fig. 4275). These soles are 
covered with buckskin and fastened inside of a common shoe with a 
single screw, leaving the anterior portion free to move as the weight of 
the body is thrown upon it. They afford a person afflicted with flat 
foot immediate relief. They should be thin to yield a little, but strong 
enough to keep the bones arched. In ordering the steel sole for flat 
feet, state if they are wanted for the right, left, or both feet, and send 
the shoes, or the outlines of the soles of the shoes, traced on paper. 742 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
KYLLOSIS, DEFORMITIES OF THE FEET. 
Pes Planus, Flat Foot. 
FlC. 4276.-Sayre's Appara 
tus for Flat Feet. 
Sayre's apparatus (Fig. 4276) consists of upright steel bars, one on either side 
of the leg, with joints at the ankle, and secured to the sole of the shoe. They ex- 
tend nearly to the head of the tibia, and are secured by a well-padded steel band 
behind and buckle in front. From the top of these bars, passing over rollers, a web- 
bing runs down inside the shoe under the arch of the foot, the inner webbing having 
a few inches of elastic insertion. This webbing can be made taut or loose at the top 
of the bars by a buckle, so that the arch of the foot is sustained by the extra sup- 
port given it by the piece of webbing. 
i. Send us a well-fitting shoe or shoes to lace. 
2. Length from sole to ankle-joint Inches. 
3. Length from sole to garter (below the knee), 
4. Circumference at garter, 
5. Mention if for the right or left foot. 
Measurements Required 
" Professor Stokes, in a paper on this subject, draws attention to the usually ac- 
cepted theories as regards the etiology of flat foot, viz.: ligamentous relaxation and 
a paralytic condition of certain muscles connected with the ankle and foot. He ad- 
duces various arguments to disprove these views. Attention is called to Prof. Ogston's researches in this direction, 
and an account given of the operation he has devised for the cure of the deformity in question ; and objections to it 
are taken, based on the operation being complicated and difficult, and followed necessarily by an obliteration of the 
medio-tarsal joint. Mr. Stokes believes that the defect causing flat foot is due, primarily, to alteration in the tarsal 
bones, notably the astragalus, which change in it may be either congenital or the result of disease (probably rickets), 
and that this stretched rather than relaxed condition of the ligaments is secondary rather than a primary change. In 
illustration of this view he exhibited a specimen of the deformity taken from the museum of Trinity College, and for 
which he was indebted to Prof. Bennett. Having regard to the fact that in the irreducible cases of flat foot osseous 
deformation is the chief factor, Prof. Stokes believes that the rational treatment for such cases should be to deal ex- 
clusively with the deformed astragalus, and to do so without necessarily obliterating Chopart's joint. This he did in 
the case of a youth aged fourteen, and with complete success. The parts to be operated upon were rendered perfectly 
aseptic, and an incision an inch and a half in length along the inner edge of the foot made, the centre of which in- 
cision was the prominence caused by the head of the astragalus. At the centre of the incision another was made at 
right angles to it, a little behind the situation of Chopart's joint, and the two triangular flaps of skin dissected back for 
about half an inch. A wedge-shaped piece of bone from the enlarged head and neck of the astragalus was then re- 
moved with an osteotome, and it was then found that, by adducting and supinating the foot, the arch was perfectly 
restored. The wound during its union was aceptic throughout, and the patient afebrile. The method Prof. Stokes 
adopted for keeping the foot in a position of adduction was by the application of a Dupuytren's splint, applied as in 
a case of Pott's fracture of the fibula. The result of the operation 
was most satisfactory, and casts of the foot, taken before and after the 
operation, were exhibited."-The Lancet, May 9, 1885, p. 848, 
Treatment by Astragaloid Osteotomy. 
Fig. 4277.-Apparatus to Evert the Feet. 
Abnormal Eversion and Inversion. Apparatus. 
This apparatus (Fig. 4277) answers well for in-door exercise, but 
patients cannot get up or down stairs, nor walk on uneven ground 
without being in constant danger of falling. An apparatus carried 
up to a pelvic band, made in two halves, answers this purpose better. 
This pelvic band, being made in two sections, admits of adjusting the 
feet in proper position. By tightening the posterior buckle the toes 
are everted, while tightening of the front buckle inverts them. All our 
pelvic bands on the apparatus for the lower extremities are arranged 
>n this manner and answer the purpose very well. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
743 
ORTHOPEDIC 
KYLLOSIS, DEFORMITIES OF THE FEET 
Abnormal Eversion and Inversion. Apparatus. 
Fig. 4278. 
Sayre's Rotator. 
" It frequently happens, in bad cases of varus and varo-equinus, that after we have re- 
stored the foot to its normal shape, either by the constant use of elastic tension or by 
tenotomy of the tendo-Achilles and plantar fascia combined with elastic tension, as the 
case may be, that the foot, although perfect in shape, cannot be held in the proper posi- 
tion, but will remain inverted on account of the paralysis of the rotator muscles of the 
thigh ; and, to correct this deformity, it becomes necessary to evert or rotate outward the 
entire limb." (See page 663, " Sayre on the Anatomy of the Ankle-Joint.") 
"To accomplish this object I had constructed a shoe with the additional attachment 
of a rotating screw, which fulfills the indication completely. It is the application of the 
same principle which I have for so long a time used in the outward rotation of the femur 
in the third stage of hip-disease. In applying this force for the outward rotation of the 
foot, in cases of club-feet, a light metallic rod or shaft is secured to the bottom of the 
shoe, in front of the heel, passed up on the outer side of the limb, and connected with 
a well padded pelvis belt, having joints, of course, opposite the ankle, knee and hip. 
Just below the joint, opposite the hip, the shaft is divided into two sections, and at this 
point is an endless screw, placed transversely to the shaft. The screw is worked by a 
key, and is capable of producing rotation through two-thirds of the arc of a circle. There 
is a well padded belt just above the ankle and another belt above the knee."-" Ortho- 
paedic Surgery and Diseases of the Joints." Lewis A. Sayre, M. D. 
Measurements Required. 
1. Send a well fitting strong lace shoe. 
2. Circumference of body between crest. 
3. Circumference of middle of thigh. 
4. Circumference at garter below knee. 
5. Length from sole to ankle joint. 
6. Length from sole to knee joint. 
7. Length from sole to hip joint. 
8. Right or left ? 
" Dr. C. F. Stillman, of New York, writes thus in the New York Medi- 
cal Record : * If we examine the ligamentous structure of the ankle joint 
we observe that externally the ligaments are placed so as to allow more mo- 
bility than internally-nature evidently relying upon the inherent contractile 
power of the peronei muscles to hold the foot at its normal angles with the 
leg, and to perform all necessary eversion. The weakness or insufficiency of 
these muscles is of itself a sufficient cause of the deformity we are consider- 
ing, even though the supports of the joints be otherwise normal; but these 
may also be unduly relaxed. A tendency to turn the ankle under, to have it 
give way externally, to point the toes inward and downward, and an habitual 
stumbling, shuffling gait are the main symptoms displayed. * * * ' 
' ' I have devised an apparatus for the cure of this condition which exhibits 
several principles distinct from any heretofore introduced to the profession. 
I. It consists of a steel strip worn outside of the leg only, so that there is no- 
thing on the inside to interfere with the child's walking. 2. It can be worn 
with any shoe and is detachable at pleasure. 3. It is attached to the bottom 
of a shoe by a pivot, thus allowing lateral motion in the ankle, a feature not 
possessed by any other form of apparatus. 
"There are two essentials to the complete and perfect action of this 
brace: first, the pivot should be located at or near the centre of motion of 
the foot; and second, if any everting cord be used, the girth about the leg 
should be prevented from rotating. 
" The centre of motion is the point where two bisecting lines meet when 
drawn through the foot while rotated at different angles; and when a person 
stands erect, a line drawn vertically through the hip-joint should pass at or 
near this point; and this is the proper position in which to place the attach- 
ment between the brace and shoe." (See page 744.)-London Medical Re- 
cord, February 15. 1882. E. Noble Smith, M. D. 
Fig. 4279. 
Stillman's Local Eversion Brace. 744 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
O^THOp/EDIS. 
KYLLOSIS, DEFORMITIES OF THE FEET. 
Abnormal Eversion and Inversion. Apparatus. 
Fig. 4280, 1, exhibits Stillman's pivotal attachment of the brace to the shoe 
when the everting cord is not attached ; and Fig. 4280, 2, shows the change 
produced by the action of the everting cord when attached. 
Fig. 4480. 
Fig. 4281. 
Doyle's Spiral Spring Rotator. 
See Stillman's 
Local Eversion Brace, Fig. 4279. 
uoyie s rotator consists ot a pelvic 
band buckled about the body and pre- 
vented from turning by shoulder-straps. 
From this extends a steel spiral or 'flex- 
ible shaft,' as it is called by machinists, along the outside of the leg, to b< 
fastened into the shoe. This is three-eighths of an inch in diameter, and i: 
held in position by straps encircling the thigh and leg. From the calf to th< 
foot additional strength is secured by a steel upright riveted to the sole of th< 
shoe and jointed at the ankle. 
" The rotator is to be worn under the outer clothing. It is very light anc 
causes no inconvenience to the wearer. In applying it for cases of club-foot 
the pelvic belt is first to be fastened in place, and, when necessary to evert th< 
foot, the shoe, to which the spiral spring is attached, is to be rotated inward. 
one, two, or as many times as the case may require. The foot is then to b< 
placed in the shoe and secured there, and the straps are to be buckled. It wil 
be seen at once that the spring's tendency to resume its former position will ro- 
tate the foot outwards. 
" In cases of everted or splay-foot, it is evident that to invert the foot the 
shoe should be rotated outwards so that the spring, in resuming its former posi- 
tion, will rotate the foot inwards."-''Philadelphia Medical Times, Decembei 
18, 1880. 
Measurements Required 
i. Circumference of body one inch below the crest of ileum, Inches. 
2. Circumference of middle thigh, " 
3. Circumference of middle calf, " 
4. Length from sole to knee joint, " 
5. Length from sole to crest of the ileum, ...... " 
6. State whether for right or left foot, or for both. 
" This instrument, which I devised in 1884 for the treatment of club- 
foot, and have called the 'rectangle,' is constructed, as will be seen by the 
illustration, of single ankle braces attached to shoes that are opened down 
to the toes. The shoes are attached to one another by a crossbar which, by 
means of set-screws, can be made to hold the feet at any outward or inward 
angle desired. Spiral springs or elastics are attached to the outside of the 
soles of the shoes near the toes, and by them the feet can be held at right 
angles with the legs, thereby accomplishing what the mother or nurse could 
do by continually holding the feet in a normal position with her hands. 
" This apparatus is intended to do away with the necessity of using plaster- 
of-paris, or of strapping, bandaging, &c. It can be taken off and applied by 
the mother or nurse as often as desired, thereby allowing frequent bathing, 
massage, &c. It can be worn night and day, and when the child is old enough to walk the crossbars can be occasion- 
ally removed to allow of practice in locomotion. 
"This apparatus is supplementary to the spiral spring rotator which I devised in 1879. The latter is more 
adapted for children when they are able to run about. An extended experience with the rectangle proves it to be of 
great service in the immediate treatment of infantile club-foot."-Gregory Doyle, M. D., Syracuse, N. Y. 
Fig. 4282.-Doyle's Rectangle. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
745 
ORTHOP/EDIC. 
DEFORMITIES OF THE FEET 
Bunions, Hammer-Toe. Apparatus. 
Fig. 4283. 
Bigg's Apparatus for Bunions. 
This apparatus consists of a delicate lever of spring steel, with an oval ring 
in the centre, which is provided with hinges at its anterior and posterior margin. 
The apparatus is attached to the instep by a laced band, and the toe to the ex- 
tremity of the spring by a piece of webbing. It affords the articulation freedom 
of motion in the natural plane, whilst the malposition of the toe is gradually 
rectified by constant lateral traction. It can be worn in a shoe. 
Directions for Measurement. 
I. Place the foot on paper and trace with pencil. 
2. Circumference of ball of foot, Inches. 
3. Circumference of instep, '* 
Fig. 4284.-Apparatus for 
Over-riding or Hammer-Toes. No, 
Fig. 4285. 
Apparatus for Over-riding Toes. No. 2. 
The apparatus for over-riding or "hammer toes" consists of a 
steel sole arranged with slits corresponding to the spaces between 
the toes. A strap of webbing is passed through these slits and 
over the contracted toe (or over each and all, as the case may re- 
quire), and buckled or tied under the sole, tense enough to straight- 
en the toe. This apparatus is kept in place by a thin silk, linen 
or cotton covering, laced to the instep, and may be worn in an 
ordinary shoe. 
i. Place the foot on paper and trace with pencil. 
2. Circumference of ball of foot, .... Inches. 
3. Circumference of instep, " 
Directions for Measurement. 
Nail and Corn Instruments. 
' The nail consists of the flattened cells of the papillae of the posterior part of the matrix, and of the mucous 
layer of the beds of the matrix; the former are pushed forwards along the beds in ridges, and the latter are added to 
the under surface of the nail (Virchow). 
"Inflammation, acute, may follow injuries, as blows, the penetration of sharp bodies ; the chronic is caused by syphi- 
lis, eczema, psoriasis ; the result may be irregular growth of the nail, or its destruction by suppuration and ulceration ; 
in unhealthy children the inflammation may be followed by ulceration of the matrix. The treatment should be to relieve 
the inflammation by the removal of the cause, and such general and local remedies as the special conditions demand. 
" In atrophy the functions of the matrix are diminished, and the nail may become thin, small, narrow, soft, or be 
wholly lost. In hypertrophy, the functions of the matrix are increased, and, as a consequence, the nail may be of un- 
usual length and width, or the substance of the nail may be thickened throughout, or in the form of a cone or wedge, 
raised in a shapeless hump, often continued in a long, straight or curved tap-shaped excrescence. 
" The treatment of these affections is the same so far as they depend upon the same conditions. All sources of 
local irritation should first be removed ; syphilis requires the ordinary general treatment, and the local application of 
mercurial plaster wound around the ungual segment of the finger or toe, so that it compresses the fold of the nail. 
Non-syphilitic affections require the same treatment as in other parts, but special effort must be made to secure the 
effect of the remedies upon the matrix and bed of the nail. In hypertrophy, india rubber worn upon the part soon 
macerates the epidermis and diminishes hypereemia of the papillary layer (Hebra). The local treatment should aim 
to remove such excrescences as are deformities and annoyances, by means of scissors, the knife, bone-nippers, or a fine 
saw, care being taken not to extract the nail from its bed. 746 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
ORTHOPAEDIC. 
DEFORMITIES OF THE FEET. 
Nail and Corn Instruments. 
"Ingrowing is a curving downward of the margin of the nail, and in general is found on the external border of 
the nail of the great toe. It is due to the pressure of tight boots and shoes, and especially when the nail is hyper- 
trophied. The fold of the nail becomes inflamed, the skin ulcerates; red, spongy granulations appear, and the part 
becomes exquisitely tender ; the ulcerative process may extend backward, and finally the matrix and the whole end 
of the toe may be involved in the inflammation. The treatment at first should consist in attempts to heal the ulcerated 
point where the nail penetrates the skin. When the inflammation involves the whole fold and extremity of the toe, 
extirpate the portion of the nail involved, as follows: with sharp-pointed scissors slit up the nail, then seize the offend- 
ing portion, and with a slight twist remove it from the matrix. When the inflammation extends completely around 
the nail, the entire nail should be removed and the matrix excised. Drop a four per cent, solution of cocaine hydro- 
chlorate upon the raw surface in the furrows on each side of the nail; apply a cloth soaked with the solution against 
the upper surface of the toe, and inject the fluid in two or three places into the matrix; after an interval of fifteen 
minutes the nail may be removed without pain (F. P. Porcher). 
" The claw-like nail, onichogryphosis, depends upon a hyperplastic state of the entire matrix of the nail. The 
only reliable remedy is complete removal of the nail and its matrix (T. Bryant), with such general treatment as the 
case requires. 
"Horny growths resembling exostoses sometimes appear at the margin of the great toe, and create much suffering. 
The only treatment is excision (T. Bryant). 
"Psoriasis appears as a thickened, rough, scabrous, and usually convex condition of the central portion of the nail. 
The appearance of the nail is improved by smoothing with glass or sand-paper, or by friction with dilute acetic acid."- 
"Operative Surgery." Stephen Smith, M. D. 
Fig. 4288.-Pocket Case Scalpel, for Corns. 
Fig. 4291.-Dissecting Scalpel, for Corns. 
Fig. 4287.-Nail Cleaner and File. 
Fig. 4290.-Splinter Forceps. 
Fig. 4292.-Corn Knife (spring handle). 
Fig. 4286.-Corn Knife and File. 
Fig. 4289.-Nail Nippers. 
Fig. 4293.-Nail Extracting Forceps. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
747 
ORTHOp/EDie. 
DEFORMITIES OF THE FEET. 
Nail and Corn Instruments. 
Fig. 4294.-Van Buren's Sequestrum and Nail Extracting Forceps. 
Fig. 4295.-Spring for Inverted Nails. 
Goldberg's Chiropodist's Pocket Set, with 
Tiemann & Co.'s Patent Catch Instruments. 
$37- 
3 Tenotomes. 
2 Curved Bistouries (strong edge and strong point for 
cutting nails). 
3 Scalpels, assorted sizes. 
1 Finger Knife. 
I Metacarpal Saw. 
1 File-cut Knife. 
I Sharp-pointed Bistoury. 
i Probe-pointed Bistoury. 
I Exploring Needle. 
3 Ivory Handles to fit the above blades. 
i Hard Rubber and Platina Caustic Holder? 
I Stout Dressing Scissors, nickel-plated. 
I Delicate Curved Scissors, nickel-plated. 
I Straight Blunt Scissors, nickel-plated. 
i Dressing Forceps, with three points. 
i Splinter Forceps. 
2 Silver Probes. [plaster. 
i Morocco Case, with three pockets for carrying 
PROSTHETIC. 
COMPENSATIVE APPLIANCES. 
Pseudarthrosis, Dangle Limbs, Artificial Limbs. 
"Operative surgery may not only fail to correct deformities, but in its effort to save life may sacrifice useful parts 
and leave the patient with maimed or defective limbs. The application of apparatus to compensate the loss of parts 
may be regarded as the fulfilment of the final obligation of the surgeon to his patient. Too often this important duty 
is either imperfectly performed or entirely neglected. But, in the present advanced state of mechanic art, the surgeon 
is culpable who does not exhaust its resources in the effort to restore both the function and the symmetry of lost parts. 
It is the duty of every surgeon, therefore, to have that knowledge of compensative appliances which will enable him to 
prepare the maimed limb for the best possible apparatus, and to guide the patient to a judicious selection. The follow- 
ing principle should always govern in the selection of prosthetic apparatus, namely: in construction the mechanism 
should so conform to the anatomy of the lost part that all of the normal functions will be as exactly produced as pos- 
sible."-" Operative Surgery." Stephen Smith, M. D. 
Pseudarthrosis. 
" The failure of ossific union of the ends of the bones after fracture may result in (i) union by fibrous tissue ; (2) 
extreme mobility without union ; (3) a rounded and pointed condition of the fragments which are connected by fibrous 
bands ; (4) a dense capsule containing fluid and the ends of the bones round and smooth, false joints. The causes of 
non-union are numerous, and should be thoroughly studied in each case. It may be due to a want of proper apposi- 
tion, or syphilis, or drunkenness, or general feebleness. In the treatment the existing cause must, if possible, first be 
removed. The subsequent measures usually adopted generally have the following order: 1. Friction of the fragments 
is produced by rubbing them together briskly, and then the parts are kept for a time in a state of rest, or the patient 
is allowed to move the limb lightly ; 2. The drill is most useful in oblique fracture (see page 109); 3. Subcutaneous 
section ; 4. Resection and suture of the extremities of the bones. 
" In cases which resist operative measures, or which are not adapted for such treatment, the last resource is the 
application of suitable apparatus which will enable the patient to use the limb. It often happens that under such treat- 
ment the patient regains vigorous health and the bones become firmly consolidated. It is a question yet to be deter- 
mined whether these appliances ought not to be far more generally employed in place of the preceding operations."-- 
" Operative Surgery." Stephen Smith, M D. 748 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PROSTHETIC. 
COMPENSATIVE APPLIANCES. 
Pseudarthrosis. 
Fig. 4296.-Apparatus for False 
Joints in the Leg or Thigh result- 
ing from Resection or Fracture of 
the Bones (un-united). 
This apparatus consists of two lateral steel stems, the inner one of these is 
carried to the upper third of the thigh, the outer one terminates in a pelvic band 
situated an inch below the iliac crests. Calf and thigh bands, made either of 
sole-leather nicely moulded to the limb, or of sail-cloth, stayed by a number of 
steel springs, corset-like, and well-padded, connect the steel stems, which latter 
are provided with joints for the ankle, knee and hip. The strength of these 
stems must be in proportion to the patient's weight. The leather or sail-cloth 
casing is required only at the place of the false joint, the other band may be 
softer and smaller, as convenient. If desired, the knee-joint may be made to 
remain stiff when walking, and flexible when sitting down, by merely touching 
a spring with the hand outside the clothing. 
i. Patient's name. 
2. Patient's weight 
3. Right or left leg. 
4. Position of false joint. 
5. Length from sole to ankle, Inches. 
6. Length from sole to knee, " 
7. Length from sole to crutch (perinaeum) 
8. Length from sole to trochanter major 
9. Length from sole to iliac crest 
10. Circumference at 
1st buckle Inches. 7th buckle, ..... 
2d buckle " 8th buckle, 
3d buckle, .... " 9th buckle, 
4th buckle, .... " 10th buckle 
5th buckle, .... " nth buckle 
6th buckle " 12th buckle 
11. Circumference of pelvis one inch below iliac crests 
Directions for Measurement. 
If we are to furnish shoes the following additional measurements are required 
a. Length of the sole of foot Inches. 
b. Circumference of the ball of foot, 
c. Circumference of instep Inches. 
d. Circumference of ankle " 
Dr. H, M. Smith's Instruments for Treatment of Un-united Fracture by Pressure and Motion. 
(Figs. 4297, 4298, 4299, 4300.) 
In the application of Smith's apparatus let it be remembered: 1st. That the pressure at the seat of the fracture 
must be as great as can be borne without inflaming the skin ; hence the strap at this point must always be firmly drawn, 
so as to make the apparatus also act as a ferule around the ends of the fragments. 
2d. That in the lower extremities the weight of the body is sustained by the upper part of the hollow splint, jus*: 
as a stump is sustained in an artificial limb after amputation. The upper strip should, therefore, be firmly drawn when 
the patient is about to walk ; but it should be slackened, so as to be more comfortable, when the patient is in bed or 
sitting up in a chair. 
3d. When worn for several months the inside lining and stuffing should be renewed, so as to give accurate support. 
4th. When from union occurring it is proposed to lay aside the splint, let it be taken off at night for ten days, or 
while sitting up in a chair, before any attempt is made to walk without it. 
5th. It is useful in recent fractures, enabling the patient sooner to sit up. 
In the manufacture of these limbs the side bars, that are the main support, are of cast steel, one-half inch wide and 
one-eighth inch thick, which is strong enough to sustain any ordinary weight. For the back and front splints that sur- 
round the limb and act as a ferule at the seat of fracture, we take galvanized sheet iron, No. 6, stuffed with wool, 
covered by buckskin on the inside of the splint, and morocco on the outside. The attempts to make lighter limbs 
by using stiff leather and steel half rings has not proved advantageous. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
749 
PROSTHETIC. 
COMPENSATIVE APPLIANCES. 
Pseudarthrosis. 
FIG. 4297.-Smith's Brace, 
for Un-united Fracture of the Femur. 
A, pelvic band ; B, hip-joint; C, conical thigh piece which supports the 
weight of the body and makes pressure on the fractured ends of the bone, 
permitting sufficient friction to excite periosteal action; D, knee-joint in side 
irons; B, support at calf; B, laced shoe and ankle-joint. 
Directions for Measurement. 
I. Patient s name. 
2. Smith's artificial limb for un-united fracture of the femur (Fig. 4297). 
3. Right or left side. 
4. Position of false joint. 
5. Length from sole to ankle, Inches 
6. Length from sole to knee, " 
7. Length from sole to crutch (perineum), 
8. Length from sole to trochanter-major, .... " 
9. Length from sole to iliac crest, " 
10. Circumference above iliac crest " 
11. Circumference of thigh close to groin, ... " 
12. Circumference of middle of thigh, 
13. Circumference of middle of knee-joint, ... " 
14. Circumference around the tubercle of tibia, . . " 
15. Circumference of middle of calf, ' 
16. Circumference of ankle, 
Fig. 4298. 
Smith's Brace, 
for Un-united Frac 
ture of the Tibia. 
A, support at middle of thigh ; B, knee joint in side irons; 
C, main support of the body by accurate adjustment below the 
tubercle of the tibia ; D, ankle joint and boot. 
i. Patient's name. 
2. Smith's artificial limb for un-united fracture ot the tibia 
3. Right or left side. (Fig. 4298). 
4. Position of false joint. 
5. Length from sole to ankle joint Inches. 
6. Length from sole to knee joint, 
7. Length from sole to middle of thigh 
Directions for Measurement. 
8. Circumference around the ankle joint, Inches. 
9. Circumference below calf, .... 
10. Circumference around middle of calf, 
ii. Circumference around tubercle of tibia, Inches. 
12. Circumference around middle of knee joint, " 
13. Circumference around thigh above knee, ** 
if we are to furnish shoes, additional measurements are required as on page 748. 
Fig. 4299.-Smith's Brace, 
for Un-united Fracture of the Forearm 
A piece accurately embracing the arm ; B, joint for flexion and ex- 
tension of forearm at elbow ; B, pivot-joint permitting rotation of head 
of radius in semi-pronation and supination ; C, ensheathing piece for 
forearm ; a thick pad to press on styloid processes of ulna and ra- 
dius at their carpal surfaces, so as to preserve the parallelism of these 
bones. 
Directions for Measurement. 
1. Patient's name. 
2. Smith's artificial limb for un-united fractures of the forearm. 
3. Right or left side. 
4. Length from middle of humerus to external con- 
dyle, Inches. 750 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PROSTHETIC. 
COMPENSATIVE APPLIANCES. 
Pseudarthrosis. 
5. Length from condyle to styloid of radius, Inches. 
6. Length from internal condyle to styloid 
of ulna, " 
7. Circumference around middle of arm, . " 
8. Circumference at elbow joint, . . Inches. 
9. Circumference at upper end of forearm, " 
jo. Circumference at middle of forearm, " 
11. Circumference at wrist, .... 
Fig. 4300.-Smith's Brace, 
for Un-united Fracture of the Humerus. 
This apparatus fits close over the rotundity of the shoulder and fore- 
arm, and is accurately jointed at the elbow. 
Directions for Measurement. 
I. Patient s name. 
2. Smith's artificial limb for fracture of the humerus (Fig. 4300). 
3. Right or left side. 
4. Length from acromion to point of external condyle, . Inches 
5. Length from condyle to styloid of radius, .... 
6. Length from internal condyle to styloid of ulna, . . * 
7. Circumference from point of shoulder to opposite 
axilla, " 
8. Circumference around top of shoulder over deltoid, . " 
9. Circumference around middle of arm, " 
to. Circumference at elbow joint, " 
11. Circumference at upper end of forearm " 
12. Circumference at middle of forearm, " 
13. Circumference at wrist, . . " 
Be careful to take circumference at wrist while the radius and ulna are parallel, or between pronation and supi- 
nation. 
Dangle Limbs. 
Fig. 4301.-Artificial Humerus. 
The flail-like movement of the upper extremities after resection of b 
and exsection of joints frequently renders them entirely useless without a 
ratus, but with this, suitably constructed and adjusted, these limbs bee 
very serviceable. This is accomplished by substituting an external le 
upon which the muscles can act, for the injured bone. A brass cap, 
padded, is accurately fitted to the shoulder, and kept in place by axil 
straps and suspenders. To this cap we attach, by means of a sort of 
versal joint, a concave steel bar, covered with leather, fitting the arm 
buckled thereto just above the elbow joint and as high up as may be ne 
sary. With the aid of this apparatus a person can use his arm in many d 
tions. In order to make this apparatus fit well the patient must either 
us for adjustment, or, if this is inconvenient, the surgical attendant must s 
us an accurate plaster-of-paris cast of the shoulder and the following it 
mation : 
i. Patient's name (or sex). 
2. Right or left arm ? 
3. Length of the arm from axilla to forearm when flexed, Inches. 
4. Length from shoulder to elbow, " 
5. Circumference of the arm above the elbow, .... '• 
6. Circumference of chest under axillas ..... . . . " 
Directions for Measurement. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
751 
PROSTHETIC. 
COMPENSATIVE APPLIANCES. 
Artificial Limbs. 
"Artificial limbs are ingeniously contrived apparatus by which the loss of limbs in battle, &c., can be greatly palli- 
ated. "-Dunglison. 
First Artificial Limbs on Record. 
"To Mardonius, who was very desirous to begin the battle, the sacrifices were not very propitious ; but to him 
also, if he stood on the defensive, they were favorable : for he too adopted the Greek sacrifices, having for his diviner 
Hegesistratus, an Elean, and the most renowned of the Telliadae. This man, before these events, the Spartans had 
taken and bound for death, because they had suffered many atrocious things from him. In this sad condition, as being 
in peril for his life, and having to suffer many tortures before death, he performed a deed beyond belief. For, as he 
was confined in stocks bound with iron, he got possession of a knife, which had by some means been carried in, and 
immediately cut off the broad part of his foot-the most resolute deed I ever heard of. Then, as he was guarded by 
sentinels, he dug a hole through the wall and escaped to Tegea, travelling by night, and by day hiding himself in the 
woods and tarrying there. Thus, though the Lacedaemonians searched for him with their whole population, on the 
third night he arrived at Tegea ; but they were struck with great amazement at his daring when they saw his foot lying 
on the ground and were not able to find him. In time, cured of his wounds, he procured a ivooden foot, and became 
an avowed enemy to the Lacedaemonians."-Herodotus. John L. White's (LL.D.) Edition, page 311. 
" The cripple may go out on the Sabbath with his wooden leg, such is the dictum of Rabbi Meir ; but Rabbi Jose 
prohibited it."-Mishna. "American Mechanical Dictionary." Knight. 
Artificial Legs, 
Fig. 4302. 
Bucket Leg. 
Fig. 4303. Fig. 4304. 
Thomas' Artificial Legs. 
The bucket leg, Fig. 4302, consists of a hollow sheath or bucket, accurately conformed to the shape of the stump, 
and having, in lieu of the more symmetric proportions of the artificial leg, a pin placed at its lower end to ensure 
connection between it and the ground. This form of leg really fulfils all the conditions (excepting external similitude) 
embraced by a better piece of mechanism. It is employed with benefit by those patients who, from lack of confidence, 
prefer learning the use of an artificial leg by first practicing with this substitute. 
"As regards artificial limbs, the principle which Thomas has embodied in his knee splint, of bearing the body upon 
a pelvic ring encircling the upper part of the thigh, may very conveniently be applied to them."-" Clinical Notes," 
by Mitchel Banks, F.R.C.S., Liverpool Royal Infirmary. February, 1884. 
Thomas' artificial leg (Fig. 4304) is for amputations above the knee. Fig. 4303 is for amputations below the knee. 752 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
PROSTHETIC 
COMPENSATIVE APPLIANCES. 
Artificial Limbs. 
*** For want of space we have illustrated only the most simple forms of artificial limbs. Information regarding the 
various patterns of arms and legs now in use will be cheerfully furnished on application. 
Fig. 4305.-Bigg's Instrument 
for Short Leg. 
This instrument is very useful where shortening of the limb is the result of 
anchylosis of the knee-joint. It is a modification of Bigg's, and consists of a 
thigh-trough, well padded, and attached to a strong steel stem, bifurcating below 
the knee and running down each side of the leg, terminating in a socket which 
is fitted up with a rubber bottom to rest on the ground. The thigh is secured 
into the apparatus by straps and buckles, and the weight of the body transmitted 
to the ground by the side stems without straining the knee. For further comfort 
the knee may be kept in place by a knee-cap. A strap is passed over the middle 
of the leg, while the foot rests on a swivelled plate placed between the bifur- 
cated stem. 
Directions for Measurement. 
I. Patient's name. 
2. Right or left leg? 
3. Length from sole of foot to knee joint, Inches. 
4. Length from knee joint to upper third of thigh, 
5. Circumference of the thigh, 
6. Circumference of the calf, 
7. Degrees of the angle of flexion " 
8. Distance from the heel of the patient's shoe to the ground 
when standing erect, " 
See other forms of shoes for short leg on page 710. 
" This substitute for the hand 
enables a person to hold a pen or 
pencil, and with the same instru- 
ment to grasp the handle of a hoe, 
hammer or shovel. A conception 
of the instrument will readily be 
obtained by a glance at the cut. 
" The apparatus is fastened 
to the investment of the limb by 
means of a screw, and, by aid of 
the other hand, it may readily be 
replaced by a fork, if it is not 
preferred to hold the fork in the 
grasp of the instrument, or a 
gloved hand can be screwed on 
in place of the useful instrument. 
" The fenestrum is for holding a whip or hammer, and its size is regulated by a screw, so as to fit objects of 
different sizes. Small objects are held in the fork at the end of the apparatus, and, by screwing down more or less 
the lever which constitutes one side of the fenestrum, the grasp can be accommodated to the size of a needle or pencil. 
The instrument is represented in the cut as not quite closed, for small objects. 
" The screw, which constitutes the shank of the instrument, is so arranged that it can be made stationary, a neces- 
sary condition in holding a whip or hammer, or left to rotate, as would be necessary in holding the handle of a plough. 
It will be seen that the instrument has great variety of adaptation. 
"There are elastic straps, attached to the investment of the arm and to a shoulder-cap, and passed around the 
chest to prevent the whole apparatus from sliding off in pulling or in carrying a weight. The instrument is very far 
from being an adequate substitute for the natural hand, but it is believed that it combines the utility of a grasp for 
large objects combined with the capability of holding small things better than any instrument which has yet been de- 
vised."-David Prince, M.D. 
Fig. 4306.-Prince's Artificial Hand. 
Artificial Hand. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
753 
PROSTHETIC. 
COMPENSATIVE APPLIANCES. 
Artificial Arm. 
Fig. 4307. 
Artificial Arm and Hand. 
When the stump of the amputated arm is moderately long, an artificial 
one, as represented in the cut, is made by us. It is of graceful appearance, but 
is not intended for heavy work. By a simple mechanism of the hand other in- 
struments may be adapted, as follows: 
" By fixing a spring within the centre of the thumb, a sufficient amount of 
pressure is exercised between thumb and forefinger to admit a pen being mani- 
pulated, a neckerchief tied, &c. The flexibility of the natural hand being thus 
to some extent imitated, leaves nothing to be desired in the way of symmetry. 
Often, indeed, the artificial hand is more symmetrical in aspect than the natural, 
and, in a spirit of coquetry, the gloved substitute is frequently displayed in pre- 
ference to the real hand. But stu:h a hand possesses no grasping power, except- 
ing only the feeble pressure already mentioned between the thumb and the finger. 
Provision has, therefore, to be made for attaching instruments to its palm, simi- 
lar in character to those made in the stump-arm. The hand, indeed, acts as an 
elegant shield for the mechanism by which various instruments are held."-Bigg. 
Fig. 4308.-Hand Hook. 
Fig. 4309.-Driving Hook. 
" This mechanism and some of its applications are shown above, and in the 
following illustrations. Fig. 4308 represents a simple hook with spring fastening, 
by which it can be secured to the palm of the hand and removed from it at pleas- 
ure. The office of the hook is important, enabling the artificial hand to fulfil 
any act of ordinary lifting, &c. There are various modifications of the hook, 
such as the driving hook (Fig. 4309), composed of a double tenaculum, which ad- 
mits of reins being separated, and thus held in the same position as they would 
be by the natural fingers. 
Loss of the hand by the explosion of a gun occasionally occurs, and it 
happens sometimes that the accident does not quench the desire of the 
sportsman for a renewal of his amusement. This desire, when the right 
hand still remains, is easily accomplished by affixing to an artificial hand 
a hook so shaped as to hold the barrel of the gun (Fig. 4310). 
Another kind of hook is one capable of being fastened to the arm plate. 
Fig. 4310.-Gun Holder. 
Fig. 4311.-Fork. 
Fig. 4312.-Pen Holder. 
Amongst the instruments 
to be adapted to an artificial 
arm, the knife and the fork 
hold the foremost place. 
When a stump is short a 
certain amount of difficulty occurs to the patient in getting the fork to the mouth, but this can easily be overcome 
if a particular set or shape be given to its stem (Fig. 4311). 
If the right hand be lost, it is necessary to furnish some mechanical means for enabling the wearer of an artificial 
arm to employ his pen. For this purpose a metal holder inserted into the palm of the hand has been devised, and by 
its aid the patient can grasp a pen with sufficient power to write tolerably well (Fig. 4312). SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Until recently, those who had the misfortune to lose an eye have provided 
themselves with artificial ones of glass to hide their deformity. The glass 
eye has many defects, among which may be mentioned its liability to be 
broken, and the hard pressure of its edges on the fleshy parts. A fall or a 
blow will often break it, or it will sometimes crack spontaneously, and in 
addition to the loss of the artificial eye the patient's eyelids are frequently 
wounded. Children were seldom provided with glass artificial eyes, on ac- 
count of their not being able to handle them intelligently and without danger 
to themselves ; but this new patent eye can be provided for very young 
children-preventing a distortion of the face. The face of a child will be distorted, if no artificial eye is worn, 
by the falling in of the parts about the stump. 
The above eye is made of glass and a composition, the iris only being made of glass. It has been patented, in 
1881, in America, Germany and England. It is not liable to breakage, and furthermore also possesses the advan- 
tages of lightness (a glass eye is heavier, and although the difference in weight is very little, patients have informed 
us that they can readily feel the difference in weight when the eyes are inserted), and the sclerotica, of composition, 
may be trimmed with a penknife or a file to adjust it accurately and comfortably to the parts. 
These eyes have been favorably known for some time in Europe. They are more natural and more beautiful than 
the glass eyes, and have been recommended by the majority of oculists, particularly on account of the ease with which 
they may be trimmed for adjustment, after the correct match in color has been found. They do not reflect the sun- 
light as glass eyes do, and are therefore not so easily detected and are not heating to the parts. 
The patentee and manufacturer states that no hospital in London uses the glass artificial eyes at present, and even 
Paris, which has furnished the greater part of artificial eyes for the world heretofore, has ordered great quantities dur- 
ing the last year. 
We have on hand a large assortment of all colors, forms and sizes, for the right and left eye, from which personal 
selections may be made, or we can send them by mail upon receipt of price. When ordering send an old artificial eye 
(even if broken), or, if that is impossible, send the following particulars: 
Fig. 4313. 
A New Patent Artificial Eye. 
1. Right or left eye ? 
2. Diameter of iris of well eye. 
3. Normal diameter of the pupil. 
4. Estimated diameter of well eyeball. 
5. A painting (natural size) representing accurately the eye region of both eyes, the color 
of the iris and sclerotica. 
N. B.-Eyes cannot be returned after they have been cut or trimmed. The eye must not be brought in contact 
with a flame. 
Compression of the Carotid Arteries, for Arresting Convulsions in Epileptics. 
" That portion of the continuity of the common 
carotid artery which I have found best suited to the 
application of instrumental compression is situated 
opposite a point which is located slightly above the 
juncture of the thyroid with the cricoid cartilage. 
The operator must use all diligence to avoid com- 
pressing the internal jugular, and, although much 
can be obtained by instruments, the final success 
attending their use will depend greatly on the dex- 
terity of the practitioner himself. 
" The chief features of this instrument are two 
curved metallic armatures, to each of whose extremi 
ties is attached an adjustable pad, which may be so 
arranged that the artery can be compressed away from the jugular vein and in the direction of the spinal column. 
[Dr. Corning's instrument has a handle, to which the armatures are attached, which allows the operator to exert his 
strength to the best possible advantage during the act of compressing.] 
" With this and similar instruments I compressed continuously (night and day) the carotid arteries of a number of 
epileptics, who exhibited all the usual symptoms of the disease (periodicity of attack, frothing at the mouth, biting of 
tongue, &c.) Although, at the time I began my experiments, some of these patients were having as many as three 
attacks every twenty-four hours, I was enabled to arrest the convulsions entirely during the space of several weeks-in 
fact, as long as compression was continued."-J. L. Corning, M. D., in Medical Record, February iS, 1S82. 
Fig. 4314.-Carotid Artery Compressor. 
754 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
755 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig.4315. 
Sherwell's Nasal Scissors. 
Fig. 4316. 
Sherwell's Nasal Scissors, 
Fig. 4317. 
Sherwell's Laryngeal Scissors. 
Fig. 4318.-Sherwell's Laryngeal Scissors. 
Fig. 4319.-Gleitsman's Laryngeal Dilator. 
Fig. 4320.-Bosworth's Nasal Saw, down-cut and up-cut. 
Fig. 4321.-Bucklin's Nasal Saw. 
Fig. 4322. 
Turnbull's Nasal Speculum. 756 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SUPPLEMENT 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4323.-Gerster's Tampon Canula. 
Fig. 4324.-Cohen's Trachea Tube 
Fig. 4325. 
Cohen's Antero-Posterior Pharyngeal Forceps, 
Fig. 4326.-Cohen's Wire Snare, 
Fig. 4327.-Cohen's Laryngeal Stenosis Dilator. 
Fig. 4330.-Cohen's Powder Blower. 
Fig. 4328.-Cohen's Combination Snare. 
Fig. 4331.-Cohen's Larynx Curette 
Fig. 4329.-Cohen's Sponge Forceps, 
three different sizes. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
757 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4332. 
Denhard's Modification of O'Dwyer's Gag, 
Fig. 4333. 
Roswell Park's Aluminium Trachea Tube. 
" This modification of O'Dwyer's gag I have devised to meet a 
serious objection to an otherwise excellent instrument. No matter 
how firmly the child's head is held, the left shoulder is frequently 
forced against the arms of O'Dwyer's gag, thus displacing the in- 
strument, to the physical discomfort of the physician's finger and 
possible laceration of the gums or the cheek of the little patient. 
In the modification, as will be seen in the above cut (Fig. 4332), 
the arms of the lever are directed straight backward toward the ear, in place of being inclined down as in the original 
instrument. The assistant, standing behind the patient, can readly include the gag within his grasp while holding the 
head of the child. The catch also has been modified, the ring of the original being replaced by a dentated spring, 
allowing the jaws to be separated to the desired degree. The instrument has been used by myself and friend, Dr. 
Huber, in at least fifty instances with entire satisfaction."-Charles E. Denhard, M. D. 
A consists of two circular plates of 
steel connected by four posts. Between 
the two plates is a stout steel wire run- 
ning around through the posts. The 
lower plate, which is the one nearest 
the skin, is perforated and is covered 
with perforated chamois skin. Upon 
the upper plate are four steel spring 
catches. C is the pad, made of woven 
wire and also covered with perforated 
chamois skin. The screw of C works 
in the centre piece of B and has a loose 
attachment to the pad, so that when in 
position, and more pressure is desired, 
it can be screwed down by the key D 
without scrubbing on the skin of the 
patient. 
The four arms of B are made to slip 
under the four catches in the upper 
plate of A. By means of the screw, 
the centre pad C can be made to pro- 
, ject from one-half to One inch below 
the lower plate of A. The whole apparatus is fastened to the body by strips of adhesive plaster, which are attached 
to the wire between the upper and lower plates of A, and which radiate over the abdomen, as shown in the illustration. 
The objects obtained by the use of this apparatus are : 1st. The pain in the back is obviated ; 2d. By use of the 
perforated lower plate of A and the centre pad C the air has constant access to the skin, preventing its chafing ; 3d. 
By screwing down the centre pad, C, any amount of pressure desired can be made ; and, 4th. When the patient lies 
down and the bowel is not so likely to come out, the whole centre portion can be instantly removed by giving a little 
twist sidewise on the arms of B, and the skin has a rest from pressure as long as desired. 
Fig. 4334.-Wilcox's Umbilical Truss, 758 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES 
Fig. 4335.-Wilcox's Foot-piece 
for Taylor's Hip Splint. 
" This consists of a pair of crutch ferules with their rubber tips attached to the 
lower section of an ordinary Taylor's brace. The two ferules are united by a Il- 
shaped piece of steel passing behind the limb. From the lower end of the ferules 
run straps of elastic webbing, to be buckled to the adhesive straps on the leg, for 
the purpose of making extension-counter extension being made in the usual man- 
ner by means of the perineal band. The extension is increased by the usual key and 
ratchet apparatus, which carries the foot-piece with it. 
"The advantages of this foot-piece over the ordinary cross-bar are : ist. It is 
much easier for the patient to walk, as he does not have to be strung up so high in 
order to keep him from treading on the cross-bar; 2d. The foot swings free be- 
tween the ferules without the danger of the patients treading on the cross-bar ; 3d. The extension 
is made constant by means of the elastic straps which take up all the slack caused by the stretch- 
ing of the adhesive straps."-Sidney F. Wilcox, M. D., New York. 
Measurements required same as for Sayre's lone splints. Fins. 4062, 4063. 
Fig. 4336.-Prince's Cocaine Pipette. 
ig. 4337.-Prince's Shell-plate Eyelid Hook. 
Fig. 4338.-Prince's Spool Eye Needle 
"For eradicating powder-marks, by entirely taking away the 
portion of integument involved in the colored scar. They are 
small cutaneous trephines, or punches, with a sharp cutting 
edge ; the diameter of the cutting edge varying from one milli- 
metre upwards - each larger trephine having a diameter one- 
half a millimetre greater than the next one below it. These little instruments, by being placed upon the skin and 
sharply rotated, will cut out a circular piece of integument of the size corresponding to their own lumen, and the 
depth of the portion to be excised can be varied according to pressure. 
"After the colored spot has been surrounded by the circular incision made by the punch, and shows slightly above 
the surface, it is seized by a pair of fine toothed forceps, slightly pulled upon, and snipped away with a pair of small 
scissors curved on the flat. The little bloody pits in the skin are allowed to fill with coagulated blood, and left with- 
out any dressing, as the bleeding promptly ceases. 
" I have also used the instrument to take away from the face of young ladies, and fastidious young gentlemen, 
small moles and other disfigurements. I have found it possible, in some instances, by carefully circumscribing the 
pigmented area, to cut away the colored deposit through the continuity of the true skin, without destroying the entire 
thickness of the felted sub-papillary layer beneath, in this way removing the discoloration with a minimum of the re- 
sulting scar. I think that these uses, and a number of other similar ones which readily suggest themselves, are suffi- 
cient to commend this little instrument for general adoption among dermatologists."-Keyes. 
Fig. 4339.-Keyes' Cutaneous Punch. 
Fig. 4340.-Hanks' Perineal Needle. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
759 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4343.-Hank's Combined Tenaculum and Counter-Pressure Hook. 
Fig. 4342.-Hanks' Tenaculum, with Steel Shank, 
Fig. 4344.-Freeman's Electrolysis Needles. 
Fig. 4345.-Fritsch's Uterine Dilators. 
Fig. 4341.-Skene's Wire Ecraseur. 
Fig. 4346.-Kelsey's Rectal Retractor. 
Fig. 4347. 
Nunns Pad for Emmet's Speculum 
Fig. 4348. 
Walker's Rectum Speculum (three sizes in one handle), 
Fig. 4349.-Keith's Ligature Forceps. 760 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4350.-Bozeman's 
Utero-Vesical Drainage Support. 
Fig. 4351.-Bozeman's Vulvo-Vaginal Drainage Dilator. 
Fig. 4352. 
Bozeman's Intra-Vaginal Drainage Dilator. 
Fig. 4353.-Bozeman's Utero-Vesico-Urethral Drainage Support 
Fig. 4354.-Skene's Pessary, for Prolapsus of the Bladder. 
Fig. 4356. 
Skene's Cervix Needles (actual size). 
Fig. 4355.-Skene's Button-Hole Scissors, for the Bladder. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
761 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
The Treatment of Affections of the Respiratory Passages and of Blood Poisonings 
by Gaseous Enemata. 
Fig. 4357--Carbon-dioxide Generator and Reservoir, and Glass Tube containing 
Volatile Medicament between two Tampons of Cotton. 
"The apparatus for gene- 
rating the carbon dioxide (Fig. 
4357) consists of a bottle in 
which three tablespoonfuls of 
sodium bicarbonate are placed. 
The bottle is hermetically closed 
by a rubber cork with two aper- 
tures, through one of which a 
glass tube extends to the bottom 
of the bottle, the upper portion 
being expanded into a funnel 
and reservoir for the dilute sul- 
phuric acid, beneath which is a 
stopcock to regulate the descent 
of the liquid. The second ap- 
erture in the cork is filled with 
a curved glass tube for the es- 
cape of the gas, and this exit 
tube is prolonged by a section 
of rubber tubing for attachment 
to a rubber bag of six litres ca- 
pacity, in which the carbonic 
acid gas is to be collected. The 
mouth of this bag is furnished 
with a stopcock. The sodium 
bicarbonate being placednn the 
bottle, the cork is inserted, and 
the stopcock of the sulphuric 
acid reservoir is closed. This 
reservoir in then filled with the 
dilute sulphuric acid, say four 
ounces, and the stopcock is 
turned so as to allow the acid 
to drip on the soda. The car- 
bonic acid gas is evolved imme- 
diately, the activity of the dis- 
engagement being controlled 
by the stopcock. A little gas is allowed to escape into the atmosphere, so as to drive off the atmospheric air in the 
bottle. Meanwhile the reservoir is rolled tightly, so as to drive out all the air it contains, as far as possible, and is then 
attached to the exit tube for the gas and allowed to become filled with the carbolic acid. It is then removed and its 
stopcock is closed. It must be removed before the stopcock is turned, in order that pent-up gas in the bottle shall 
not break the apparatus. This is one of the points to which the physician must direct the attention of his nurse before 
entrusting the patient to the attendant. Another point upon which stress must be distinctly laid is the rolling of the 
bag to prevent retention of atmospheric air. 
" The gas is now ready for use. The reservoir is attached to a handball aspirator with check valves at each end 
(Fig. 4358). This is attached to a metallic T tube, passing through a cork which is intended to be placed in the neck 
of a bottle containing the medicated solution, preferably a highly charged natural sulphur water. The vertical portion 
of the tube is furnished with a double valve, to prevent aspiration of the liquid through which the carbonic acid gas 
bubbles, and contains an orifice at top for the escape of the gas into the distal horizontal branch, to which is attached 
a tube connected with a nozzle for introduction into the rectum. This T branch is placed in a bottle three-fourths 
filled with the sulphurous water-in this instance the Red Sulphur Spring Water of Virginia-and the aspirator is 
worked two or three times to drive out the atmospheric air in the bottle: another point to which the physician must 
emphatically direct the attention of his nurse. The nozzle is then inserted into the rectum of the recumbent patient 
and the injection made slowly. All clothing must be loose. With the hand on the abdomen, the amount of distention 
Fig. 4358.-Filled, and attached to Aspirator. 762 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
The Treatment of Affections of the Respiratory Passages and. of Blood Poisonings 
by Gaseous Enemata. 
of the coion is noted, and when this is marked, or when pain is complained of, the process is suspended until absorp- 
tion takes place, as manifested by relaxation of the tension; and then the process is resumed. Fifteen to twenty 
minutes are consumed in the process of driving the six litres of carbon dioxide through the sulphur water. The sul- 
phur salt-e. g., sodium sulphide-is decomposed, hydrogen sulphide being formed, a portion of the carbon dioxide 
taken up to form sodium carbonates. 
" The only modification of the process I have permitted myself (for I deem it due in justice to Dr. Bergeon and 
Dr. Morel to test their method of administering the gas in their own way) is to place the mineral water bottle in a 
bath of warm water, which renders the injection more grateful. Within four minutes, sometimes within one, the sul- 
phuretted hydrogen can be perceived in the breath, and be detected by paper saturated with plumbic acetate. It is 
prudent to have a bed-pan at hand in case there should be a call to stool. The injection should not be made upon the 
full stomach. This may produce emesis, it is said. You want all the room possible in the abdomen to prevent pres- 
sure upon a distended stomach and upon the diaphragm. 
" Three or four hours after a meal, or just before one, is the best time for injection. Two injections are given 
daily. I have found three hours after breakfast and three hours after supper the best periods. My patients have slept 
better after an injection just before bedtime, than after one, three or four hours after the midday meal. 
"At the first injection but half the contents of the reservoir of carbonic acid should be used, so that the parts and 
the system may be gradually accustomed to the process. 
" If the bottle of sulphurous water remain strongly impregnated after the injection, it may be tightly corked for 
use a second time. It is not necessary to have the bowels moved before an injection. Haemoptysis and the presence 
of the menstrual period do not contraindicate the process. Indeed, Dr. Bergeon has seen amenorrhoea relieved during 
this treatment, even when that condition had failed to yield to the ordinary methods of treatment. 
"When the pulmonary lesions are extensive, and, in consequence, elimination of the gas takes place slowly, the 
injections must be made very slowly, or they will produce sensations of fulness in the thorax and in the abdomen. 
" Now, as to therapeutic results. All published observations recount rapid amelioration of the suppurative phe- 
nomena; a marked diminution in cough, expectoration, dyspnoea, and night-sweats being noted within two or three 
days. Similar prompt improvement, with reduction of temperature, has been noted in some of my own cases, not in 
all. Some of his more than two hundred patients Dr. Bergeon considers cured. These, he states, no longer expec- 
torate, and present no other stethoscopic evidences than the dry sounds due to cicatrized or ciatrizing cavities, or to 
cicatricial bands consecutive to old lesions. Some of them have been able to resume laborious occupations, and to 
ascend several flights of stairs many times a day without injury to their respiratory apparatus, or loss of the amelior- 
ated condition which had been secured. Some, who considered themselves cured at the end of a few weeks, abandoned 
treatment, despite the advice of Dr. Bergeon, and underwent recurrence. It is, therefore, important that the treat- 
ment should be continued for some months, until all the pulmonary lesions have been cured, lest incompletely cica- 
trized surfaces undergo suppurating afresh, and reproduce septicaemia. They should be renewed from time to time, 
even after apparent cure, and especially upon any reappearance of cough, expectoration, fever or emaciation. 
" Not only are pulmonary lesions said to be cured by these enemata, but pharyngeal and laryngeal tuberculous 
ulcerations are said to undergo cure likewise, and that without any topical applications whatever, simply from the con- 
tact of the gas in its elimination from the lungs. 
"Of the cases treated under my own supervision I have as yet little positive to state. With a single exception, 
they have done quite well so far, and some of them are very pronounced cases-cases that I have had no hope of bene- 
fiting very greatly by any treatment with which I am more familiar. One of my patients insists that she is well, but she 
is not. Some of these cases are here for the purpose of receiving the treatment in your presence. They will answer 
for themselves that they are better in several ways. Hope of recovery has much to do with this, but not all. I went 
through a similar experience more than twenty years ago with inhalation of oxygen in phthisis. Hope buoyed the 
patients up until they found that oxygen had not the power of curing them, and then some of them, I fear, sank all 
the sooner for the disappointment. In the present instance the prospect is better, the treatment being more in accord 
with scientific principles, despite the awkwardness of the method. In the one instance it is hardly to be supposed 
that your patients will have been injured ; in the other, they will have had all the advantage of an early resort to a 
beneficial agent. 
" Should it be desired to administer some volatile medicament, as iodoform, carbon sulphide, eucalyptol, or the 
like, the bottle of mineral water is replaced by a bottle of common or distilled water, and between the T tube and the 
injection-pipe a glass tube is inserted, in which the volatile substance has been introduced between tampons of cot- 
ton."-"The Medical Mews, April, 2, 1887. J. Solis-Cohen, M. D. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
763 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4359.-Wyeth's "United States" Scale. 
Fig. 4360.-Wyeth's Conical Steel Bougies (straight and curved). 
Fig. 4361. 
Keyes' Perineal Retractor, for holding up upper angle 
of the vesical wound in Supra-Pubic Cystotomy. 
Fig. 4362.-Keyes' Device 
for applying Perineal Drainage through the smallest possible 
perineal incision in cases of Supra-Pubic Cystotomy. 
Fig. 4363. 
Kiefer's Urethral Irrigation Nozzle. 
Fig. 4364. 
Keyes' Tube for Supra-Pubic Vesical Drainage. 764 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4365.-Otis' Latest Urethrometer. 
Fig. 4369.-Rushmore's Grooved Velvet-eye Catheter. 
Fig. 4368.-Keyes'-Ultzman Syringe. 
Fig. 4366.-Klotz's Endoscope. 
Fig. 4367.-Abbott's Combined Curette and Double Catheter. 
T? A 
Fig. 4370.-Walker's Urethrotome. 
Fig. 4371.-Woodward's Syringe for Nitrate of Silver Applications to the Uterus. 
Fig. 4372.-Fluhrer's Aluminium Bullet Probe. 
Fig. 4373.-Bozeman's Renal Sound. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
765 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4374. 
Gerster's Iodoform Duster, 
Fig. 4375.-Large Blunt Hook. 
4376.-Small Blunt Hooks and Retractor. 
Fig. 4377. 
Haemostatic Needle. 
Fig. 4378.-Thiersch's Spindles and Forceps. 
Fig. 4381.-Diefenbach's Needle Forceps. 
Fig. 4382.-Dawbarn's Aseptic Saw. 
Fig. 4379.-Van Arsdale's Set of Periosteum Elevators. 
Fig. 4380.-Sharp Periosteum Lever. 766 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4384.-Gerste/s Mallet. 
Fig. 4385.-Volkmann's Retractor, 
Fig. 4386.-Volkmann's Spoon. 
Fig. 4383.-Gerster's Chisels. 
Fig. 43S7.-Hahn's Artery Forceps. 
Fig. 4388.-Riesenhaken (Giant Hook). GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
767 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4389.-G. Tiemann & Co.'s Patent Needle Forceps, 
with either Rectangular or Oblique Jaw. 
The usual round or triangular 
needles are grasped by the jaws 
at the apex, while the flat Hage- 
dorn needles-either straight, half 
or full curved-are firmly held in 
a rectangular or oblique position by 
the sliding bar on one side of the 
jaw, as shown in the accompanying 
cut. The ordinary needles are with- 
drawn from the suture by the front 
jaws, the Hagedorn needles by the 
slide lever. 
The hard-rubber handles being 
vulcanized on (baked on) the steel 
shanks makes the instrument asep- 
tic. 
Fig. 4390.-Dawbarn's Needle Forceps. 
Fig. 4391.-Lavage Apparatus, 
for Washing the Stomach. 
Fig. 4392.-Flood's Artificial Leech Glass, to attach to 
Tiemann & Co.'s Aspirator. 
Fig. 4393.-Sexton's Ear. 
Syringe, with Air-Tight Cap. 
Fig. 4394.-Getz's Set of Aspirating Trocars. 
Fig. 4395.-Fluhrer's Cautery Protector. 768 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4396.-Dr. Daggett's Examining and Operating 
Table, No. 1. 
these tables are without the complicated mechanical 
appliances required to adjust a chair or lounge to such pur- 
poses. 
Figure No. i exhibits the table closed. It will be ob- 
served that the platform is carried in out of the way, so that 
a person may sit at the table for writing, reading, &c. 
Figure No. 2 exhibits the same with a slide drawn out 
at each end, thus making it a six-foot examining or operat- 
ing table. The platform and sliding step serve as a con- 
venient shelf. 
Figure No. 3 exhibits the same as gynaecological table 
arranged for the back position. The portable and com- 
bined head board, knee guide and ankle rest are in place, 
the ankle rest being turned back. The adjustable stirrups 
and the step are drawn out. 
Figure No. 4 exhibits the gynaecological table arranged 
for the side or Sim's position. The ankle rest is swung into 
place. The declinations may be given either 
before or after the patient takes her place, by 
lifting the top at its side or end respectively, 
and are supported by automatic rails. These 
rails work together or independently. 
With this adjustment the patient is directed 
to take her place upon the step, arrange her 
clothing, rest her left thigh across the end of 
the table, guide her left knee against the rail, 
lay her head upon the pillow, carry her left 
arm backward and her left leg upon the ankle 
rest, and draw the right leg upon the rail. 
'Thic will crivA Lav Qim'c nncitinn 
Table No. 2. 
Table No. 3. 
Table No. 4. 
There are three grades of these tables made: 
First Grade-Has no platform, and is made of the cheaper woods ; has the side rail and ankle rest. Price, $25. 
Second Grade-Has a single slide for step and platform, the hinged rail and ankle rest. Price, $35. 
Third Grade-Has engraved legs, double platform, high head board, and elegant finish, and is made of the 
best woods. Price, $45. 
For upholstered tops add five dollars to these prices. 
We also make a folding cushion adaptable to these tables, which cost from three to twenty dollars. With an up- 
holstered top only a pillow is required. Tops are finished in wood unless otherwise ordered. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
769 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4397.-Ware's 
Ligature Bottle. 
Fig. 4398.-Shufford's Rectal Speculum. 
Fig. 430a.-Walker's Drainage Tubes 
Fig. 4400.-Thomas' Clamps, 
for compressing vaginal wounds. 
Fig. 4402.-Blitz's Canalicula Dilator. 
Fig. 4401.-Otis' Malgaigne Hook, 
Fig. 4403.-Carmalt's Punch for Transplantation, 
Fig. 4404.-Tape Measure. 
Fig. 4405.-Bozeman's Delicate Knife. 770 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
SUPPLEMENT. 
MISCELLANEOUS INSTRUMENTS AND APPLIANCES. 
Fig. 4406.-Noeggerath's Clamp for Prolapsed Vaginae. 
Fig. 4407.-O'Dwyer's Laryngeal Snare. 
Fig. 44M--Whitehead's Urethrotome. 
Fig. 4408.-Cleborne's Artery and Tissue Forceps. 
Fig. 4409.-Goodwillie's Nasal Dilator. 
Fig. 4410.-Hanks' Uterine Scissors. 
Fig. 4413.-Reverdin's Needle. 
Fig. 4411.-Keyes' Stone Searcher THE METRIC SYSTEM. 
Certain French scientists of the last century, in order to establish a universal cosmopolitan 
measure, proposed to base our conceptions of size, weight and money on the well-known and 
beautiful Decimal System of numbers-this being understood by all men alike, however dif- 
ferent in nationality or language. 
The terms applied to the length-unit, "Metre," and to the weight-unit, "Gramme," were 
taken from the Greek language. The names expressive of fractions of the above, are formed by 
combination with the following Latin words: 
Latin. 
Decem, ten, Decimetre, equal to 0.1 Metre. 
Centum, hundred, Centimetre, " 0.01 " 
Milk, thousand, Millimetre, " 0.001 " 
The terms applied to the upper divisions, expressing certain pluralities of the same, are 
formed of synonymous words taken from the Greek. 
Greek. 
dena, ten, Decametre, equal to 10 Metres. 
enarov, hundred, Hectometre, " 100 " 
thousand, Kilometre, " 1,000 " 
fwpiot, ten thousand, Myriametre, " 10,000 " 
Gramme, the weight measure, is divided into- 
Deci- Centi- Milli-gramme. 
Deca- Hecto- Kilo-gramme. 
Litre, the capacity measure, is divided into- 
Deci- Centi- Milli-litre. 
Deca- Hecto- Kilo-litre. 
Arranged into a Table it reads thus: 
LENGTH. 
WEIGHT. 
10 Millimetres make 1 Centimetre. 
10 Centimetres " 1 Decimetre. 
10 Decimetres " 1 Metre, equal to 39.368 
American inches. 
10 Metres " 1 Decametre. 
10 Decametres " 1 Hectometre. 
10 Hectometres " 1 Kilometre. 
10 Kilometres " 1 Myriametre. 
10 Milligrammes make 1 Centigramme. 
10 Centigrammes " 1 Decigramme. 
10 Decigrammes " 1 Gramme, equal to 
15.433 grains Troy. 
10 Grammes " 1 Decagramme. 
10 Decagrammes " 1 Hectogramme. 
10 Hectogrammes " 1 Kilogramme. 
10 Kilogrammes " 1 Myriagramme. 
CAPACITY 
10 Millilitres make 1 Centilitre. 
10 Centilitres " 1 Decilitre. 
10 Decilitres " 1 Litre, equal to 2.113 
pints American. 
10 Litres " 1 Decalitre. 
10 Decalitres " 1 Hectolitre. 
WEIGHT OF WATER 
AT MAXIMUM DENSITY. 
Millier (or Tonneau) 1,000,000 Grammes, equal to 1 Cubic Metre. 
Quintal 100,000 " " 1 Hectolitre. 
Myriagramme 10,000 " " 10 Litres. 
Kilogramme (or Kilo) 1,000 " " 1 Litre. 
Hectogramme 100 " " 1 Decilitre. 
Decagramme 10 " " 10 Cubic Centimetres. 
Gramme 1 " " 1 " " 
Decigramme 0.1 " " 0.1 " " 
Centigramme 0.01 " " 10 " Millimetres. 
Milligramme 0.001 " " 1 " 
Square and Cubic Measures are deduced by arithmetic rules: A Square Decametre is called 
"Are" ; a Cubic Metre is called "Stere." INDEX AND PRICE LIST. 
Fig. Page. Price. 
4367 764 Abbott's Curette and Double Catheter .... $6.00 
33 0 9 454 Wire Cutter... 6.00 
28 0 8 329 Abdominal Bandage 6.00 
2805 328 Belt, Elastic, Cotton 8.00 
Belt, Elastic, Silk 12.00 
Belt, Canvas 4.00 
Belt, Riding, with Stays, lined with 
Chamois 6.00 
Belt, Satin Jean 6.00 
3731 533 Needle, with Fixed Handle .75 
2751 312 Pad, for application of Heat or Cold. 8.00 
3733 533 Pad, for application of Heat or Cold. 8.00 
520 Section, see Laparotomy and Ovario- 
tomy. 
Supporter, Boston 6.00 
2801 328 Supporter, Bow-spring 4.00 to 5.00 
Supporter, Braun's 6.00 
Supporter, Dugas' 5.00 
2802 328 Supporter, Eugene's 6.00 
2803 328 Supporter, Fitch's 4.00 to 6.00 
28 0 9 329 Supporter, Hofman's 6.00 
2804 328 Supporter, London 5.00 
28 0 7 328 Supporter, Noeggerath's 6.00 
Supporter, Phelps' 5.00 
28 0 6 328 Supporter, Thomas' 8.00 
1420 87 Abscess Knife and Scalpel 2.75 
1419 87 Lancet 1.00 
740 Achilles, Tendo. 
2021 186 Acoumeter, Politzer's 3.50 
Acoustic, see Ear Trumpets, Stethoscopes 
and Tuning Fork. 
39 Actual Cautery. 
124 0 39 Blowpipe 4.00 
123 9 39 Blowpipe, Wight's 11.00 
1242 39 Irons, each 1.50 
2743 312 Irons, each 1.50 
124 1 39 Irons, set 4.50 
1243 39 Irons, set 5.50 
2742 312 Irons, set 4.50 
2732 311 Irons, Smith's Serrated, set 6.00 
1238 39 Naevus Needle .50 
1479 93 Acupressure Forceps, Allis' 1.75 
1480 93 Allis' 1.75 
147 3 93 Allis' 2.00 
1474 93 Allis' 1.75 
1475 93 Allis' 1.75 
147 8 93 Milne's 1.50 
1469 93 Acupressure Pin .25 
27 0 3 307 Acupuncture Trocar 1.50 
2706 308 Adams'Haemorrhoidal Syringe 4.50 
1920 163 Iris Knife 1.50 
2215 217 Rhinoplastos 3.00 
1632 110 Subcutaneous Section Knife 1.50 
1633 110 Subcutaneous Section Saw, Large-. 4.00 
1634 110 Subcutaneous Section Saw, Small 3.50 
Adhesive Plaster, Moleskin, per yard 1.50 
on Twilled Goods, per yard 1.50 
Plain, per yard -_ .75 
157 Advancement of the Rectus : 
1882 157 Forceps, Prince's 2.00 
1883 157 Needle, Prince's 2.50 
3578 501 Ady's Uterine Dilator 14.00 
1065 10 -Esthesiometer, Carroll's 4.00 
1068 11 Elsberg's 7.00 
1066 10 Hammond's 3.00 
Fig. Page. Price. 
1064 10 Aesthesiometer, Sieveking's $4.00 
1067 10 Vance's 5.00 
10 .Esthesiometric. 
3836 561 Agnew's Adjuster and Forceps 2.50 
1809 148 Canalicula Knife 1.75 
1824 149 Eye Douche 3.50 
2768 318 Hernia Instrument 6.00 
1897 162 Iridectomy Knife 1.75 
1823 149 Lachrymal Syringe 5.00 
3835 561 Needle Holder and Needles 4.50 
3836 561 Seizing Forceps.'. 2.50 
179 Set of Eye Instruments 66.50 
562 Set of Instruments for Ruptured Pe- 
rineum 24.35 
154 Strabismus Hook, with Eye 1.25 
1980 175 Spring Tattoo 4.50 
1983 175 Tattooing Needle 2.00 
25 8 4 285 Air Pump and Receiver, Sass' 
2 5 8 7 285 Air Pump, Double-acting 
2 5 8 5 285 Novelty 
2421 251 Air Receiver 
2422 251 Air Receiver 
2423 251 Air Receiver 
2424 251 Air Receiver 
289 Alimentary Canal, see also CEsophageal, 
Rectal and Stomachal. 
303 Alimentation by the Rectum, see also Rec- 
tal Feeding, Infusion, and Rectal Injec- 
tors and Irrigators. 
2066 193 Allen's Polypus Forceps 4.50 
306 1 399 Alligator Forceps, Urethral, Curved 6.00 
30 6 0 399 Straight 5.50 
2730 310 Allingham's Ligature Carrier 3.50 
23 6 7 237 Mouth Gag (Annandale's) 7.00 
Pile Clamp 12.00 
2690 306 Scissors and Director 7.00 
1473 93 Allis'Acupressure Forceps 2.00 
1474 93 Acupressure Forceps 1.75 
147 5 93 Acupressure Forceps 1.75 
1479 93 Acupressure Forceps 1.75 
1480 93 Acupressure Forceps 1.75 
1249 43 Ether Inhaler 4.00 
2762 316 Herniatome 7.00 
1323 80 Suture Forceps 2.00 
1040 6 Allison's Differential Stethoscope 4.50 
1925 164 Althof's Iridectomy Scissors 5.00 
40 2 9 627 Aluminium Caustic Holder 2.25 
Probe, Pocket Case, pair .75 
Probe, Uterine 1.25 
2 5 5 2 278 Trachea Tube, Little's 6.00 
1365 83 American Bullet Forceps, G. T. & Co.'s 2.25 
2844 340 Scale for Urethral Instruments 3.50 
3785 548 Amniontome, Wenck's 2.50 
63 Amputating Case, T. & Co.'s Compact Set. 33.50 
63 T. & Co.'s Set, No. 1 25.00 
63 T. & Co.'s Set, No. 2 30.00 
63 T. & Co.'s Set, No. 3 35.00 
96 Amputating Knives, Aseptic Handles : 
15 1 0 96 Bistoury, Probe-pointed 1.50 
1509 96 Bistoury, Sharp-pointed 1.50 
1505 96 Catling, Long 5.00 
1506 96 Catling, Medium 4.00 
Catling, Small 3.00 
1507 96 Finger Knife 2.50 
150 8 96 Finger Knife 2.00 
773 774 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
96 Amputating Knives, Aseptic Handles : 
1 50 2 96 Liston's Knife, Long $5.00 
150 3 96 Liston's Knife, Medium 4.00 
1504 96 Liston's Knife, Small 3.00 
1512 96 Scalpel 1.50 
1513 96 Scalpel 1.50 
1514 96 Scalpel 1.50 
1515 96 Scalpel 1.50 
1516 96 Scalpel.. 1.50 
95 Amputating Knives, Ebony Handles : 
1491 95 Cartilage Knife 1.50 
1492 95 Cartilage Knife 2.00 
95 Catling, Long... 4.50 
95 Catling, Medium 3.50 
149 5 95 Catling, Small 2.50 
1501 95 Conant's Knives and Saw, set 10.00 
149 9 95 Liston's Long 4.50 
Liston's Medium 3.50 
149 7 95 Liston's Small 2.50 
1498 95 Parker's 5.50 
1500 95 Wight's Folding 5.50 
1496 95 Wood's Circular 4.00 
1490 95 Scalpel 1.50 
1493 95 Scalpel 1.00 
152 9 97 Amputating Saw, Bow, T. & Co.'s 8.50 
152 8 97 Capital, Parker's 5.00 
152 7 97 Capital, Satterlee's 5.00 
1526 97 Capital, T. & Co.'s 5.00 
1530 97 Lewis' Folding 2.50 
1525 97 Lifting Back, Large 4.00 
Lifting Back, Medium 3.00 
152 2 97 Lifting Back, Small 2.50 
1521 97 Metacarpal 1.50 
152 4 97 Metacarpal, Detmold's 1.50 
152 3 97 Metacarpal, Lente's 1.50 
Amputating Scissors, Cervix Uteri, see 
Hysterectomy. 
148 9 95 Amputating Tenaculum. 1.25 
1494 95 Amputating Tenaculum 1.00 
Aseptic Handle 1.50 
63 Amputating and Trepanning Set 44.25 
2740 311 Amusat's Hsemorrhoidal Clamp and Cau- 
tery 8.00 
48 Anaesthesia, Local. 
1259 48 Richardson's Spray for, Silver 5.50 
43 Anaesthetic. 
1249 43 Anaesthetic Inhaler, Allis' 4.00 
1252 45 Cheatham's 3.50 
1251 44 Chisolm's 2.50 
1256 47 Heuel's 10.00 
1253 45 Hutchison's 4.00 
12 5 8 48 Junker's Methylene 12.50 
1248 43 Lente's 3.50 
12 5 5 46 Mitchel's 2.00 
125 7 48 Morton's 5.00 
2575 283 Nichols' 5.00 
125 4 46 Speirs'-George's 3.50 
1250 44 Squibb's 1.50 
36 8 7 520 Thallon's 20.00 
297 Anal, see also Rectal. 
26 4 7 300 Dilator 10.00 
26 5 0 300 Dilator, Sims' 4.50 
26 5 2 300 Dilator, Thebaud's, Sphincter Ani 12.00 
2674 306 Fissure Knife, Blandin's 8.00 
26 7 5 306 Fissure Knife, Bodenhammer's 5.00 
26 4 2 299 Speculum, Bivalve 5.00 
26 4 9 300 Speculum, Bivalve 4.50 
2640 299 Speculum, Gorget Formed 2.00 
See also Rectal Speculum. 
2750 312 Anal Supporter, Mathieu's Prolapsus Ani_ 5.00 
2749 312 Prolapsus Ani and Pile 8.00 
Analysis, see Urinary Examination Appa- 
ratus. 
1008 3 Analysis, Graduated Tube for 1.25 
Fig. Page. Price. 
Anatomical Models, imported to order. 
1100 14 Anatomical Syringe $35.00 
671 Anchylosis. 
Apparatus, see Orthopaedic : Diseases 
of the Joints. 
4113 667 Andrew's Apparatus for Inflamed Ankle 
Joint 
1447 91 Andrew's Artery Forceps 2.50 
4021 626 Artery Forceps 2.50 
670 Elbow-Joint Splint 
4133 676 Instrument for Straightening Bent 
Knee 
4094 658 Knee-Joint Splint 
40 5 7 638 Morbus-Coxarius Splint 12.00 
67 Pocket Case 28.00 
4144 685 Spine Brace 20.00 
30 7 0 400 Stone Searcher 2.50 
670 Wrist Splint 
1820 149 Anel's Eye Syringe, Silver, with Silver and 
Gold Point, in Case.... 12.00 
1820 149 Anel's Eye Syringe, Hard Rubber, with Sil- 
ver and Gold Point, in Case 5.00 
1 786 147 Anel's Probe .50 
Aneurism Needle, see Artery Needle. 
2050 191 Angular Ear Hook 1.50 
2013 185 Ear Probe .75 
271 7 309 Pile Needle 1.00 
2708 308 Pile Scissors 1.50 
1404 85 Scissors, Operating. 1.50 
1880 154 Scissors, Strabismus 1.50 
4 1 3 5 678 Angular Curvature of Spine. 
74 Animal Ligature, Dry, per yard .25 
Lister's American, per bottle .50 
Lister's English, per bottle .75 
Silk-worm Gut, per coil .03 
Whale Tendon, per coil .40 
4202 710 Ankle, Brace for Weak 5.00 to 10.00 
420 1 709 Detmold's Spring for 4.00 to 6.00 
3959 601 Splint for Fracture of, Left. .75 to 1.50 
3960 601 Splint for Fracture of, Right .75 to 1.50 
115 6 24 Ankle Band, Voltaic <1.00 
4 1 08 665 Ankle Compressor, Sayre's 6.00 
4113 667 Ankle-Joint, Andrew's Apparatus for In- 
flamed 
665 Ankle-Joint, Apparatus for Diseased 
663 Diseases of the. 
4112 667 Hutchison's Splint for 
4 1 08 665 Sayre's Rubber Compressor for 6.00 
4109 666 Sayre's Splint for 22.00 
4114 668 Stillman's Splint for 15.00 to 20.00 
2367 237 Annandale's Mouth Gag 7.00 
692 Anterior Curvature of the Spine, see also 
Spinal (Lordosis) Braces. 
720 Anterior Curvature of Tibia. 
4231 720 Brace for Correcting 12.00 to 18.00 
39 7 5 608 Anterior Splint, Smith's 3.00 
50 Antiseptic, see also Aseptic. 
96 Amputating Knives, see Aseptic Am- 
putating Knives. 
3853 566 Antiseptic Ball. 
1260 49 Antiseptic Spray, Hank's 15.00 
126 3 50 Heuel's 6.00 
126 2 50 Little's 5.00 
1261 49 Weir's 15.00 to 24.00 
74 Antiseptic Surgery Materials : 
Adhesive Plaster, per yard .75 
Animal Ligature, Dry, per coil .25 
Cotton, Borated, per pack .25 
Cotton, Dennison's Absorbent, per 
pack .30 
Cotton, Von Brun's, per pack .90 
Gauze, Eucalyptol, per 5 yards 1.25 
Gauze, Iodoform, per 5 yards 1.75 
Gauze, Lister's, per 6 yards .90 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
775 
Fig. Page. Price. 
74 Antiseptic Surgery Materials : 
Gauze, Thymol, per 5 yards $1.25 
Lister's Catgut, American, per bottle .50 
Lister's Catgut, English, per bottle-- .75 
Lister's Silk Protective, per yard 
McIntosh's Cloth, per yard 1.50 
Oiled Silk, per yard 1.50 
50 Antiseptic Trocar and Knife, Cousin's 4.00 
230 Antrum, Abscess of the. 
1536 98 Antrum Drill, Pope's 3.50 
313 Anus, Artificial. 
2752 313 Depuytren's Enterotome 5.00 
1435 89 Aorta Compressor 5.00 
31 4 5 423 Aponeuro tome 2.00 
20 25 187 Apparitor Auris, per pair in Case 6.00 
Applicators, see Aural Applicator, Insuf- 
flator, Laryngeal Applicator, Larynge- 
al Powder Blower, Nasal Applicators, 
Rectal Applicators, Urethral Syringes 
and Applicators, Uterine Applicator. 
Arm, Artificial, see Artificial Arm. 
1156 24 Band, Voltaic 2.00 
1208 35 Electrode ' 2.00 
1657 116 Junod's Dry Cupping 25.00 
393 1 591 Sling 4.50 
3926 589 Splint, Bancroft's 
39 2 7 589 Splint, Condyle and Humerus .75 to 1.25 
3928 589 Splint, Condyle and Humerus, 
Jointed 1.00 to 1.50 
39 2 4 589 Splint, Dressing for Humerus. 
39 2 5 589 Splint, Jointed 2.00 to 2.50 
1156 24 Armadillo, Voltaic, for prices see page 24. 
Armlet, Elastic, Cotton 2.00 
Elastic, Silk 3.00 
1035 5 Arnold's Flexible Stethoscope 1.50 
3001 376 Arnott's Grooved Probe 1.50 
1348 82 Arrow Forceps, Bills' 2.50 
88 Arterial: 
1479 93 Acupressure Forceps, Allis' 1.75 
1480 93 Acupressure Forceps, Allis' 1.75 
14 7 3 93 Acupressure Forceps, Allis' 2.00 
1474 93 Acupressure Forceps, Allis' 1.75 
1475 93 Acupressure Forceps, Allis' 1.75 
1478 93 Acupressure Forceps, Milne's 1.50 
1469 93 Acupressure Pin .25 
143 2 89 Bandage Clamp, Esmarch's .75 
1434 89 Bandage Clamp, Langenbeck's 1.50 
1435 89 Arterial Compressor, Aorta 5.00 
142 7 88 Briddon's 60.00 
1428 88 Buck's 35.00 
4314 754 Carotid Artery -- 8.00 
1433 89 Erichson's 25.00 
1472 93 Gross' 5.00 
1426 88 Skey's 24.00 
See also Tourniquet. 
1488 94 Arteriversion Tenaculum, Weber's 1.50 
27 2 0 309 Artery and Needle Forceps 2.50 
1449 91 Old's 2.25 
14 7 0 93 Artery Clamps, Bilroth's 8.00 
147 1 93 Mattock's .50 
See also Serrefin. 
Artery Clamp Forceps, Halstead's 2.50 
Koeberle's 2.50 
1484 94 Little's 2.25 
148 1 94 Nott's - 6.00 
148 6 94 Pean's 2.25 
148 3 94 Sabine's 2.50 
148 5 94 Tait's 2.50 
1486 94 Wood's 2.25 
1482 94 Wyeth's 2.50 
1468 93 Artery Claw Forceps, Steam's 8.00 
1487 94 Artery Constrictor, Speir's 4.00 
1447 91 Artery Forceps, Andrew's - 2.50 
145 9 92 Bigelow's.., 3.50 
Fig. Page. Price. 
1443 91 Artery Forceps, Coxeter's $1.00 
1454 91 Esmarch's Bulbous 2.50 
1453 91 Esmarch's Fenestrated 3.00 
1455 91 Esmarch's Torsion 2.50 
1452 91 Fenestrated Spring Catch 2.00 
4022 626 Forcipressure 2.50 
4387 766 Hahn's ..... 2.50 
1448 91 Hamilton's 2.50 
1457 91 Hewson's 8.00 
1456 91 Hunter's 2.50 
1449 91 Old's 2.25 
1451 91 Phelps' 4.50 
1445 91 Plain .75 
1442 91 Prince's Tenaculum 6.00 
1444 91 Spring-Catch 1.50 
1446 91 Torsion 2.50 
1450 91 Wheeler's 7.00 
146 5 92 Wight's 1.75 
92 Artery Needles and Ligature Carriers : 
13 7 8 84 Aneurism 1.25 
1463 92 Aneurism, Plain .75 
1461 92 Crampton's, pair 5.00 
146 2 92 Fletcher's Aneurism 3.00 
1464 92 Helical, Suture and Ligature 1.75 
146 7 92 Helmuth's 3.50 
138 6 84 Little's, Aneurism 1.50 
1460 92 Mott's Set of Aneurism 2.75 
146 6 92 Ostrom's 3.00 
Parker's (Mott's) 3.00 
See also Ligators. 
1403 85 Artery Scissors 1.75 
313 Artificial Anus: 
Bandage 8.00 
2752 313 Depuytren's Enterotome 5.00 
43 0 7 753 Artificial Arm and Hand 75.00 to 150.00 
Extras for same: 
4309 753 Driving Hook 
4311 753 Fork 
43 1 0 753 Gun Holder 
43 0 8 753 Hand Hook 
4312 753 Pen Holder 
203 Artificial Ear 100.00 
43 1 3 754 Eye, Composition 8.00 
1990 177 Eye, Glass 10.00 
43 0 6 752 Hand, Prince's 60.00 
430 1 750 Humerus 35.00 to 70.00 
2 5 2 4 276 Larynx, Gussenbauer's-Foulis' 
2 5 2 3 275 Larynx, Park's 
4392 767 Leech, Flood's, each 1.25 
1660 117 Leech, Heurteloup's 8.00 
1661 117 Leech, Reese's 4.50 
1659 116 Leech, Tiemann & Co.'s 7.00 
4302 751 Leg, Bucket 20.00 to 25.00 
4304 751 Leg, Thomas', above Knee.. 15.00 to 20.00 
43 0 3 751 Leg, Thomas', below Knee- 15.00 to 20.00 
751 Limbs, see Pseudarthrosis. 
730 Artificial Muscles, Attachments for Apply- 
ing: 
731 Barwell's Rubber, per foot .12 
4242a 731 Barwell's Eyes, each .10 
4242c 731 Barwell's Hooks, each .10 
4242c 731 Barwell's Tin, each .20 
Moleskin Plaster, per yard 1.50 
4243 731 Tins for Sayre's Method, each .15 
2 1 4 7 203 Artificial Nose 50.00 to 125.00 
160 Pupil. 
1887 162 Pupil Knife, Jaeger's 1.75 
1888 162 Pupil Knife, Jaeger's 1.50 
See also Ophthalmic : Keratomes. 
20 23 187 Tympanum, Toynbee's, Gold Wire - .50 
20 23 187 Tympanum, Toynbee's, Silver Wire- .30 
Vesico - Vaginal Fistula, see Kolpo- 
Cystotomy. 
1348 82 Arrow Extractor, Bill's 2.50 776 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
96 Aseptic: 
Amputating Knives, see Amputating. 
4040 629 Operating Set, Smith's $200.00 
4041 . 
4042 630 Operating Set, Tremaine's 175.00 
4043' 
Aseptic Pocket Set, Bingham's 30.00 
Brigg's 32.00 
73 Hayward's 21.00 
Lilliputian 26.00 
Parkinson's 40.00 
73 Park's 28.00 
Smith's, Large 29.00 
Smith's, Medium 28.00 
4039) ^ Smith's, Compact 18.00 
1276 71 T. & Co.'s Patent "B" 28.00 
T. & Co.'s Patent "P," Small 20.00 
U. S. Army 28.00 
Walker's 30.00 
73 Wright's * 38.00 
43 8 2 765 Aseptic Saw 4.50 
2636 298 Ashton's Speculum Ani 1.00 
3175 431 Speculum Vaginae 1.00 
3840 561 Perineum Needle 1.00 
2737 311 Pile Clamp 3.00 
129 Aspiration. 
Aspirator and Hypodermic Syringe 5.50 
173 7 132 and Injector 14.00 
1732 129 bieulafoy's, Large 50.00 
1732 129 Dieulafoy's, Small 40.00 
1738 133 Emmet's 12.00 
1741 133 Fitch's 5.00 
1711 126 Flint's 5.00 
4394 767 Getz's 8.50 
1736 132 Higgins' 25.00 
1733 130 Hospital 60.00 
1740 133 Miller's 7.00 
Munde's 12.00 
1734 130 Steurer's 35.00 
1735 131 Tiemann & Co.'s 14.00 
1735 131 Tiemann & Co.'s Small 12.00 
Aspirator Needle, Billroth's 5.00 
Fitch's 2.50 
4035 628 Heuel's 1.25 
Phelps' 6.00 
Plain 1.25 
1739 133 Warren's 3.00 
3704 528 Atlee's Clamp 6.00 
3586 501 Uterine Dilator 2.75 
Atomizer, see Spray Apparatus. 
182 Aural, see also Eustachian Canal and Mas- 
toid Process. 
Aural Applicators : 
2013 185 Angular Probe 75 
2091 195 Buck's Cotton Probe .50 
2014 185 Buck's Silver Probe .60 
20146 185 Buck's Silver Probe .75 
2093 195 Buck's Port Acid Glass .10 
2090 195 Elastic Caustic Holder 2.00 
2094 195 Knapp's Powder Blower 1.50 
2092 195 Sexton's Powder Blower 3.00 
20 70 193 Vulcanite .75 
182 Aural, Diagnostic : 
2021 186 Acoumeter, Politzer's 3.50 
2015 185 Diagnostic Tube, Toynbee's .75 
2017 185 Explorer, Toynbee's .75 
2016 185 Manometer, Politzer's .50 
2018 185 Mirror, Blake's Inner Ear 8.00 
1997 183 Mirror, Troeltsch's 3.00 
2008 184 Otoscope, Brunton's 6.00 
2005 184 Otoscope, Clark's 12.00 
2020 185 Otoscope, Ely's 7.00 
Fig. Page. Price. 
Aural, Diagnostic: 
2004 183 Otoscope, Hassenstein's $5.00 
2012 184 Otoscope, Park's 
2011 184 Otoscope, Rumboldt's 2.50 
2019 185 Otoscope, Siegel's 5.00 
2000 183 Otoscope, Simrock's __ 4.00 
2009 184 Speculum, Bivalve 1.50 
1996 183 Speculum, Gruber's H. R., set of 3 1.50 
2003 183 Speculum, Knapp's, Plated, set of 3._ 3.00 
2003 183 Speculum, Knapp's, Silver, set of 3 __ 4.50 
2007 184 Speculum, Kramer's, Plated 1.75 
2007 184 Speculum, Kramer's, Steel 2.50 
2001 183 Speculum, Milikin's 1.50 
2010 184 Speculum, Speir's 1.50 
1999 183 Speculum, Speir's, Self-Retaining ___ 3.00 
2002 183 Speculum, Toynbee's, Plated, set of 3 2.50 
2002 183 Speculum, Toynbee's, Silver, set of 3- 4.50 
1998 183 Speculum, Wilde's, H. R., set of 3 1.50 
1998 183 Speculum, Wilde's, Plated, set of 3 __ 2.50 
1998 183 Speculum, Wilde's, Silver, set of 3... 4.00 
2006 184 Speculum, Wilde's Gorgeret 1.00 
2022 186 Tuning Fork, A or C 1.50 
114 Aural Douches and Syringes : 
20 76 194 Bag Syringe .75 
2080 194 Buck's Nozzle .75 
2075 194 Hard Rubber Syringe 1.25 
2077 194 Kramer's Syringe 4.50 
20 7 7 194 Kramer's Syringe, with Stopcock.... 5.50 
20 74 194 Lucae's Reflux Douche 1.50 
20 82 194 Pomeroy's Syringe 6.00 
20 79 194 Sexton's Douche 
43 9 3 767 Sexton's Syringe 10.00 
2081 194 Smith's Syringe 4.00 
20 78 194 Soft Rubber Syringe .50 
1192 34 Aural Electrode.. 75 
190 Aural, Foreign Body and Polypus : 
2044 191 Curette, Buck's .75 
2051 191 Curette, Quire's 2.25 
2068 193 Curette, Sexton's 2.00 
2048 191 Curette, Speir's 1.25 
20 66 193 Forceps, Allen's 4.50 
20 56 192 Forceps, Avery's 4.50 
2067 193 Forceps, Bacon's 2.50 
2062 192 Forceps, Bumstead's 4.00 
2060 192 Forceps, Hinton's 4.00 
2061 192 Forceps, Hinton's, Double Joint 4.50 
2043 191 Forceps, McKay's 2.50 
2072 193 Forceps, Noyes' 4.50 
2052 191 Forceps, Politzer's, Cotton-Wool .... 1.75 
20 59 192 Forceps, Politzer's Polypus 2.00 
20 5 5 192 Forceps, Pomeroy's 2.50 
2054 191 Forceps, Sexton's Dressing, each 1.75 
20 71 193 Forceps, Sexton's Foreign Body 4.50 
2058 192 Forceps, T. & Co.'s, and Reflector... 4.50 
20 5 7 192 Forceps, T. & Co.'s Foreign Body 2.25 
20 6 5 193 Forceps, T. & Co.'s Universal 5.00 
2050 191 Hook, Angular 1.50 
2053 191 Hook, Devil's Screw 1.75 
2047 191 Hook, Elsberg's Angular Screw 2.00 
2046 191 Hook, Gross', and Spoon .75 
2049 191 Scoop, Fenestrated 1.50 
2046 191 Spoon and Hook, Gross' .75 
2045 191 Spoon, Politzer's Hard Rubber .75 
2064 192 Snare, Blake's 3.50 
2042 190 Snare, Bosworth's 4.50 
2063 192 Snare, Wilde's 3.50 
196 Aural, Membrana Tympani and Inner Ear : 
2 1 07 196 Bistoury, Buck's Probe-pointed 1.50 
2106 196 Bistoury, Buck's Sharp-pointed 1.50 
2101 196 Eyelet, Politzer's' .30 
2101 196 Eyelet Forceps, Politzer's 1.50 
2102 196 Furuncle Knife, Buck's 1.50 
2099 196 Myringotome, Angular or Straight 1.00 
2103 196 Myringotome, Buck's 1.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
777 
Fig. Page. Price. 
Aural, Membrana Tympani and Inner Ear : 
2104 196 Myringotome, Prout's $1.00 
20 97 196 Scissors, Gruber's 4.50 
2098 196 Scissors, Simrock's 4.50 
2 1 00 196 Syringe, Blake's 4.50 
20 96 196 TensorTympani Instrument,Gruber's 2.50 
20 9 5 196 Tensor Tympani Instrument, Weber's 8.00 
2099 196 Tympanum Perforator, Angular 1.00 
2105 196 Tympanum Perforator, Straight 1.00 
187 Aural, Microcoustic, see also Ear Trumpet. 
195 Aural Pus Basins and Spouts : 
2086 195 Bonder's Spou t .75 
2087 195 Brass, Nickel-Plated, Large 3.00 
Brass, Nickel-Plated, Medium 2.50 
Brass, Nickel-Plated, Small 2.00 
2088 195 Hard Rubber, Large 3.00 
Hard Rubber, Medium 2.50 
Hard Rubber, Small 2.00 
2089 195 Hard Rubber, Triangular 3.00 
2084 195 Hosner's Spout .50 
20 83 195 Spout and Hose 1.00 
2085 195 Up de Graff's 1.50 
202 Aural, Sets of Ear Instruments in Cases : 
202 Buck's 35.00 
202 Roosa's 43.40 
202 Politzer's 22.00 
202 Sexton's 35.00 
2073 193 Sexton's (7 Instrumentsand Handle). 12.00 
202 Toynbee's 23.20 
202 Turnbull's 68.00 
Aural Syringe, see Aural Douches and 
Syringes. 
1995 182- Aural Trocar 1.50 
199 Auscultating the Middle Ear. 
5 Auscultation, see also Stethoscopes. 
1682 121 Auspitz's Dermal Scoop 2.00 
285 8 344 Urethroscope 20.00 
2193 211 Auto-Insufflator, Bridge's .75 
1333 80 Automatic Suture, Hoff's 5.50 
17 Autopsic, see also Post Mortem. 
3650 512 Aveling's Polyptome 8.00 
1662 117 Transfusion Apparatus 4.50 
117 Transfusion Apparatus, with Scalpel 
and Forceps, in Case 8.00 
20 56 192 Avery's Ear Forceps 4.50 
1014 4 Axilla Thermometer 2.50 
Axis-Traction Obstetrical Forceps, Breus' 20.00 
3 7 7 8 542 Burge's- 30.00 
3777 542 Corning's 12.00 
37 7 9 543 Lusk's. 24.00 
Simpson's 16.00 
37 7 6 542 Tarnier's Original 30.00 
Tarnier's Improved (1887) 30.00 
179 Ayres'Set of Eye Instruments, Large 84.65 
179 Set of Eye Instruments, Small 49.25 
1903 162 Baader's Linear Knife, Left 1.75 
1902 162 Linear Knife, Right 1.75 
34 5 5 487 Babcock's Pessary, with Belt 15.00 
24 4 2 259 Baber's Pocket Laryngoscope 7.50 
3793 548 Bachelder's Embryotomy Forceps 12.00 
3796 549 Perforator 5.00 
2067 193 Bacon's Curette Ear Forceps 2.50 
3972 605 Patella Support 18.00 
3037 387 Bag and Stop-cock for Catheters 3.00 
2076 194 Bag Ear Syringe .75 
2078 194 Bag Ear Syringe .50 
3 7 0 6 528 Baker Brown's Clamp 12.00 
3853 566 Ball, Antiseptic. 
27 77 322 Ball and Socket Truss, Self-adjusting 3.00 to 5.00 
12 1 0 35 Ball Electrode .75 
1985 175 Ball's Double Hook 3.00 
3185 435 Speculum Vaginae 11.00 
Fig. Page. Price. 
3 5 2 9 494 Ball's Stem Pessary $1.50 
35 7 6 500 Stem Pessary 1.50 
35 7 7 500 Stem Pessary 1.50 
3 5 7 4 500 Uterine Dilator, Original 10.00 
35 7 5 500 Uterine Dilator, Modified 10.00 
39 2 6 589 Bancroft's Arm Splint 
2808 329 Bandage, Abdominal 6.00 
1440 90 Esmarch's 3.50 
12 7 8 74 Martin's. Prices on page 74. 
12 7 7 74 Roller, per pound 1.50 
2 7 9 9 327 Umbilical 6.00 to 8.00 
38 7 7 574 Bandage Knife, Esmarch's 3.00 
38 7 6 574 Bandage Roller 3.00 
38 8 3 575 Bandage Shears, Brun's 10.00 
38 7 8 574 Esmarch's 4.50 
38 7 9 575 Henry's 7.50 
3884 575 Sayre's 7.00 
3881 575 Szymanowsky's 9.00 
38 8 0 575 Wackerhagen's 6.00 
38 8 2 575 Wight's 3.50 
569 Bandaging, Methods of. 
28 8 0 346 Bank's Bougies, Whalebone, each 1.25 
2 9 7 1 364 Urethrotome 20.00 
1021 5 Barclay's Stethoscope 1.25 
3401 477 Barker's Ointment Bougie 1.25 
3218 442 Barnes'Speculum Vaginae 2.50 
2567 282 Spirometer 10.00 
Suppositor 2.50 
34 1 0 478 Tampon Speculum 2.00 
36 0 5 504 Uterine Dilator 1.00 
Uterine Dilators, set of 3, with Stop- 
cocks and Syringe 6.00 
3667 515 Wire Ecraseur 5.00 
3625 507 Barrett's Chloride of Silver Battery 
36 2 8 508 Current Meter 
3627 508 Electrodes 
36 2 6 507 Elements 
1042 6 Bartlett's Stethoscope 7.00 
28 2 8 336 Baruch's Circumcision Scissors 2.50 
424 1 730 Barwell's Artificial Muscles, per foot .12 
4242 731 Barwell's Attachments : Hooks, each .10 
Tin Plate, with Loop, each .20 
41 70 ; Wire Eyes, each .10 
4 1 71 )'694 Barwell's Scoliosis Brace 12.00 to 15.00 
4169 694 Sloping Seat 8.00 to 15.00 
42 5 4 734 Talipes Shoe, each 15.00 
42 5 5 734 Talipes Shoe, Sole of. 
299 1 373 Bates'Urethral Haemostat 4.00 
2969 363 Urethrotome 15.00 
1828 150 Bath, Eye .50 
2573 283 Hot Air 5.00 
122 Bath, Mercurial Fumigation : 
1695 122 Bumstead-Lee Lamp 3.00 
1696 122 Maury's Apparatus 12.00 
1694 122 Van Buren's Apparatus 2.50 
1246 42 Bath, Warm Water, for Arm 15.00 
124 7 42 Warm Water, for Lower Extremity.. 15.00 
10116 3 Water, Urinary Examination 2.50 
3 1 84 433 Bath Speculum 3.00 
115 5 24 Battery, Faradic : Gaiffe's 10.00 
1155 24 Gaiffe's, Nickel-plated 12.00 
Gaiffe's, Extra Trough 2.00 
Gaiffe's, Extra Zinc .25 
1164 29 McIntosh's Family 10.00 
1161 27 McIntosh's Physicians' 18.00 
1163 28 McIntosh's Physicians', No. 3 30.00 
36 2 5 507 Battery, Galvanic : Barrett's 
1157 25 McIntosh's, 18 Cell 40.00 
1159 26 McIntosh's, 24 Cell 55.00 
1153 23 Stoehrer's, 8 Cell 20.00 
Stoehrer's, 16 Cell 30.00 
Stoehrer's, 32 Cell 55.00 
Battery, Galvanic and Faradic Combined : 
1162 27 McIntosh's, 12 Cell.. .40.00 778 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Battery, Galvanic and Faradic Combined : 
1158 25 McIntosh's, 18 Cell ..$52.50 
1 160 26 McIntosh's, 24 Cell 67.50 
1165 29 Battery, Magneto-Electric 10.00 
Baudelocque's Pelvimeter. 8.00 
40 6 7 644 Bauer's Morbus Coxarius Splint 25.00 
408 1 652 Wire Breeches 15.00 to 25.00 
1693 122 Baunscheidt's Lebenswecker 2.50 
Oil, Genuine, per bottle.. 2.50 
Oil, Imitation, per bottle 1.50 
3215 442 Baxter's Speculum Vaginae 4.00 
222 Bayonet Tooth Forceps, Nos. 1, 3, 11, 12, 39, 
47, each 2.00 
1616 107 Bead Saw, Stohlmann's 6.00 
117 0 32 Beard's Base Needles, each .75 
1 167 30 Current Changer 10.00 
1166 30 Electrode, Adjustable, with Band 1.50 
1069 11 Piesmeter 3.50 
1799 148 Beaumont's Concealed Canalicula Knife... 8.00 
12 7 2 55 Bed, Crosby's Invalid 
38 0 8 550 Bedford's Guarded Blunt Hook and Crotchet 6.00 
3 7 6 2 540 Obstetrical Forceps 8.00 
38 0 2 549 Perforator 3.00 
553 Set of Obstetrical Instruments 28.00 
Bed Pan, Emmet's 6.00 
Hank's 3.00 
34 1 3 479 Hospital 4.00 
1892 162 Beer's Cataract Knife or Keratome 1.50 
1893 162 Cataract Knife or Keratome 1.50 
1894 162 Cataract Knife or Keratome 1.50 
1941 166 Cataract Knife or Keratome 1.50 
1942 166 Cataract Knife or Keratome 1.50 
190 7 163 Cataract (Iris) Needle 1.25 
19 76 174 Cataract (Iris) Needle 1.25 
28 7 3 345 Bell's Ball, Urethral Sound 1.25 
2196 212 Belocq's Canula, Plated 2.00 
2196 212 Canula, Silver 3.00 
Belt, see Abdominal Belt. 
Benique's Sound 1.50 
2850 342 Curve (C, B, D). 
2184 210 Bennett's Posterior Nares Syringe 10.00 
3 7 3 9 537 Bethel's Obstetrical Forceps 8.00 
2208 215 Bettman's Jarvis' Snare Ecraseur 8.50 
3239 446 Biart's Speculum Vagin® 
22 3 7 222 Bicuspid Forceps, Upper, No. 4 2.00 
22 5 9 224 Wolverton's, Lower, No. 26 2.00 
2258 224 Wolverton's, Upper, No. 25 2.00 
14 5 9 92 Bigelow's Artery Forceps 3.50 
2920 351 Catheter Syringe - -. 6.00 
3993 615 Dislocation Apparatus 
3099 407 Evacuating Apparatus 12.00 
3 1 00 407 Evacuating Apparatus, with Stand16.00 
3 1 02 409 Evacuating Apparatus, Latest 30.00 
3094 406 Lithotrite -- 40.00 
3095 . 
to >406 Lithotrite, Improved 40.00 
3098 ' 
42 8 3 745 Bigg's Bunion Apparatus 8.00 to 12.00 
4225 718 Bow-Leg Brace 6.00 
43 0 5 752 Instrument for Short Leg 35.00 
24 0 3 244 Billing's Tonsilotome 12.00 
1348 82 Bill's Arrow Extractor 2.50 
147 0 93 Bilroth's Artery Clamps 8.00 
15 59 100 Retractor, 2 Pronged 3.00 
1558 100 Retractor, 3 Pronged 3.00 
307 1 400 Sounding Board 1.50 
3 1 37 421 Bisector, Wood's 4.50 
2107 196 Bistoury, Aural, Buck's Probe-pointed 1.50 
2106 196 Aural, Buck's, Sharp-pointed 1.50 
14 1 5 86 and Scalpel -- 2.50 
1416 86 and Tenotome 2.50 
1367 84 Bistoury (Finger Knife) 1.25 
1382 84 Little's 1.50 
1396 85 Plain 1.00 
Fig. Page. Price. 
26 8 7 306 Bistoury, Hernia : Cooper's $1.25 
1397 85 Cooper's, Plain 1.00 
2758 316 Cooper's, Pocket 1.75 
1384 84 Little's 1.50 
See also Herniotomy: Herniotomes. 
3127 419 Bistoury, Lithotomy: Depuytren's 24.00 
3114 417 Little's.. - 1.75 
3124 419 Wyeth's, Aseptic Handle 2.00 
See also Lithotomy: Lithotomes. 
1 368 84 Bistoury, Minor Surgery : Blunt-pointed .. 1.25 
1370 84 Probe-pointed 1.25 
1398 85 Probe-pointed, Curved 1.00 
138 3 84 Probe-pointed, Little's 1.50 
1369 84 Sharp-pointed 1.25 
1385 84 Sharp-pointed, Little's 1.50 
13 9 9 85 Sharp-pointed, Plain 1.00 
Bistoury, Pocket Case, see Pocket Instru- 
ments. 
26 7 7 306 Bistoury, Rectal 1.75 
2340 234 Staphyloraphy 2.00 
1876 154 Strabismus 2.50 
26 7 6 306 Bistoury-Cache, Bodenhamer's 10.00 
28 8 7 347 Civiale's „ 5.00 
3127 419 Depuytren's 24.00 
1800 148 Jaeger's 8.00 
267.9 306 Rectal 7.00 
2682 306 Rectal 7.00 
Bisulphate of Mercury, per ounce .25 
26 4 2 299 Bivalve Anal Speculum, Large 5.00 
26 4 9 300 Anal Speculum, Small 4.50 
2009 184 Aural Speculum, German Silver 1.50 
2 1 5 1 205 Nasal Speculum 1.50 
3177 431 Vaginal Speculum 5.00 
3 1 9 6 437 Vaginal Speculum 5.00 
3198 439 Vaginal Speculum, Steel 5.50 
57 Blackman's General Operating Set 136.75 
1553 100 Retractor 1.50 
382 Bladder : 
394 Digital Exploration of, see also 
Thompson's Instruments for. 
390 Dilatation of the. 
384 Evacuative Catheterism, see also 
Catheters. 
383 Extrophy of. 
3013 383 Extrophy Apparatus, T. & Co.'s 35.00 to 75.00 
398 Foreign Bodies, see also Urethral: 
Foreign Body Extractors. 
383 Incontinence of Urine, see also Urinals. 
388 Bladder, Irrigation of the : 
3043 389 Keyes' Irrigator 5.50 
4369 764 Rushmore's Catheter 1.50 
See also Double Current Catheter. 
390 Bladder, Puncture of the, Tapping the : 
1730 128 Buck's Rectum Trocar 3.50 
3049 392 Cock's Trocar 15.00 
3012 381 Fitch's Trocar-Catheter 6.00 
30 4 8 391 Harrison's Trocar 11.00 
1729 128 Parker's Guarded Trocar 4.50 
30 5 0 393 Thompson's Prostate Sound 5.00 
3050c 393 Thompson's Prostate Tube 3.00 
1728 128 Trocar 2.50 
1731 128 Van Buren's Double Tube 4.00 
384 Bladder, Retention of Urine, see also Cath- 
eters. 
400 Bladder, Stone in the, see also Stone. 
3183 433 Blakeley's Resilient Speculum Vaginae 3.00 
2018 185 Blake's Inner Ear Mirror 8.00 
2100 196 Inner Ear Syringe 4.50 
3 7 5 9 539 Obstetrical Forceps 8.00 
20 64 192 Polypus Snare 3.50 
34 3 5 484 Blake White's Metratrep 14.00 
3197 437 Speculum, Nott's 5.00 
32 2 9 444 Speculum, Sims' 2.50 
Syringe, Pulmonary 6.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
779 
Fig. Page. Price. 
19 70 173 Blanchet's Cataract Exhauster $2.25 
1552 100 Blandin's Bone Staff 3.00 
26 7 4 306 Fistula Knife 8.00 
Bleeding, see Phlebotomy. 
4402 769 Blitz's Canalicula Dilator 4.00 
1984 175 Extirpation Forceps 3.00 
3121 417 Blizard's Lithotomy Knife (Am. Pattern).. 1.75 
3120 417 Lithotomy Knife (English Pattern)-_ 2.00 
117 Blood, Transfusion of, see also Transfusion 
Apparatus. 
90 Bloodless Operation, Esmarch's Method. 
1440 90 Esmarch's Tourniquet 3.50 
Blood-letting, see Phlebotomy. 
3804 550 Blot's Perforator 6.00 
1106 15 Blow-Pipe, Post Mortem .25 
1144 19 Physiological Experiment 2.50 
1240 39 Self-Acting, for Heating 4.00 
123 9 39 Wight's 11.00 
3134 421 Blunt Gorget, Lithotomy 2.50 
3135 421 Keyes'Lithotomy 2.50 
43 7 5 765 Blunt Hook, Large (Retractor) 3.00 
43 76 765 Small (Retractor) , 3.00 
1138 19 Physiological Experiment 1.25 
2342 234 Staphylorhaphy 2.00 
28 0 6 550 Taylor's Obstetrical 2.50 
25 3 9 277 Tracheotomy 1.50 
38 0 5 550 Blunt Hook and Crotchet 1.50 
3808 550 Bedford's 6.00 
38 0 7 550 Guarded 4.50 
2 6 7 7 306 Blunt-pointed Bistoury, Rectal 1.75 
1879 154 Strabismus Scissors, Curved 1.50 
1374 84 Tenotome 1.25 
267 5 306 Bodenhamer's Anal Fissure Knife 5.00 
26 7 6 306 Bistoury Cache 10.00 
2674 306 Blandin's Knife 8.00 
2724 310 Curvilinear Forceps 4.50 
26 5 6 301 Rectal Exploring Sounds, 10 sizes, ea. 1.00 
2673 305 Rectal Irrigator 3.00 
2651 300 Recto-Colonic Endoscope 7.50 
2634 298 Reflector and Lens 20.00 
2727 310 Spring Ligating Forceps 4.50 
39 7 0 604 Boisnot's Patella Splint 12.00 
2747 312 Bolton's Pile Bougie 1.25 
2134 199 Bonafont's Eustachian Catheter Holder2.00 
2150 205 Nasal Speculum 2.50 
108 Bone Drill, see Osteotomy Drill. 
106 Exsecting Set 65.60 
Forceps, see Forceps, Bone Cutting. 
1133 18 Forceps, Physiological 3.50 
1132 18 Forceps, Spinal Canal 3.50 
102 Gouges, see Osteotomy: Gouges. 
103 Gouging Forceps, see Osteotomy : 
Forceps and Rongeurs. 
101 Holding Forceps, see Osteophor. 
99 Bones, Skeleton, see Osteological: Human 
Skeleton. 
1156 116 Boot, Junod's 25.00 
Borated Cotton, per pack .25 
3694 525 Borck's Cyst Elevator 1.50 
2189 211 Bosworth's Applicator 1.50 
Electrodes in Case 33.00 
2207 215 Jarvis' Snare (Ecraseur) -- 5.00 
2218 217 Nasal Clamp 2.50 
4320 755 Nasal Saws, each 2.00 
2160 206 Nasal Speculum 1.50 
2042 190 Polypus Snare 4.00 
Polypus Snare, with Curved and 
Straight Ends 5.00 
2217 217 Rhinoplastos 3.50 
2381 238 Tongue Depressor 1.25 
125 Bottle, Patent, for Hypodermic Syringe.-- .20 
2148 204 Bougie, Nasal, Yearsley's .50 
See CEsophageal Stricture Dilators. 
See Pile Bougie. 
Fig. Page. Price. 
See Rectal Bougie. 
See Urethral Stricture Dilators. 
See Urethral Stricture, Exploring. 
718 Bow-Leg, see also Genu Varum. 
3494 491 Bow Pessary, Fowler's SI.75 
1 604 104 Saw, Butcher's 16.00 
152 9 97 Saw, Tiemann & Co.'s 8.50 
280 1 328 Spring Abdominal Supporter.. 4.00 to 5.00 
2 7 7 8 323 Spring Truss 1-. 3.50 
2795 327 Spring Umbilical Truss 5.00 
2 7 9 8 327 Spring Umbilical Truss, Child's 2.50 to 3.00 
423 1 720 Bowed Tibia, Brace for 12.00 to 18.00 
1808 148 Bowman's Canalicula Knife 1.75 
1972 173 Cataract Exhauster 4.50 
1807 148 Director .50 
1856 152 Eye Speculum 4.00 
1955 168 Lens Spoon, Concave 1.75 
1953 168 Lens Spoon, Flat 1.50 
17 8 7 147 Probes, Silver, per set 3.00 
17 8 7 147 Probes, Silver, each .75 
1978 174 Stop Needle 1.75 
3284 452 Bozeman's Angular Scalpel 1.75 
3611 505 Angular Scissors 4.50 
3324 457 Button, per dozen 1.50 
33 2 9 457 Button Adjuster 2.25 
33 2 3 457 Button Shaper 3.50 
457 Button Suture. 
33 1 8 456 Blunt Hook 1.50 
3244 447 Columning Specula, set of 3 9.00 
331 8 456 Counter-Pressure Hook 1.50 
3644 511 Curette 2.25 
32 8 6 452 Curved Scissors 4.50 
44 0 5 769 Delicate Knife 1.75 
3247 448 Depressor 2.50 
32 4 8 448 Depressor, Double Hooked 3.00 
3253 448 Depressor, Urethral and Perineal 2.50 
3285 452 Double Curved Scissors 4.50 
3384 475 Dressing Forceps 2.50 
3214 442 Duck-Bill Speculum 2.50 
34 2 3 482 Intra-Uterine Back Flow Tube 3.00 
43 5 2 760 Intra Vaginal Drainage Dilator 5.00 
3294 452 Knife 1.75 
3322 457 Needle, per dozen 1.50 
33 2 2 457 Needle Holder 5.00 
1264 51 Operating Chair 35.00 
32 5 3 448 Perineal Depressor 2.50 
33 2 7 457 Perineal Elevator 5.00 
351 9 493 Pessary, Smith's Modified 1.00 
4373 764 Renal Sound 6.00 
3284 452 Scalpel, Angular 1.75 
3283 452 Scalpel, Straight 1.75 
3611 505 Scissors, Angular 4.50 
32 8 6 452 Scissors, Curved 4.50 
3285 452 Scissors, Double Curved 4.50 
3519 493 Smith's Pessary 1.00 
32 2 6 443 Speculum Vaginae 12.00 
3263 449 Tenaculum 1.50 
3266 449 Tenaculum, Long 1.50 
32 5 3 448 Urethral and Perineal Depressor 2.50 
43 5 0 760 Utero-Vesical Drainage Support 10.00 
43 5 3 760 Utero-Vesico-Urethral Drainage Sup- 
port 10.00 
3241 446 Vaginal Dilator 1.00 
3242 446 Vaginal Dilator 1.00 
344 1 486 Vaginal Dilator 1.00 
3459 488 Vaginal Support 2.00 
462 Vesico-Vaginal Fistula, Set of Instru- 
ments 100.00 
43 5 1 760 Vulvo-Vaginal Drainage Dilator 6.00 
3328 457 Wire Adjuster -. 2.00 
1531 98 Brace and Guarded Crown 21.00 
1531 98 Brace for Trephines 15.00 
1989 176 Bradford's Electro-Magnet- 25.00 
1994 178 Eye Speculum 780 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
426 1 737 Bradford's Tarso Corrector $40.00 
1966 172 Twin Cataract Needle 
162 5 109 Brainard's Bone Drills, Set of 5 3.50 
1110 15 Brain Knife 1.50 
Braun's Abdominal Supporter -_ 6.00 
38 2 0 552 Cephalotribe 18.00 
3 7 8 4 547 Colpeurynter 3.00 
3810 550 Decapitating Hook 3.00 
3 7 8 1 545 Obstetrical Forceps, Triform 
Simpson's Obstetrical Forceps 8.00 
3411 478 Tampon Expeller 2.50 
38 1 2 550 Trephine Perforator 15.00 
3400 477 Uterine Syringe 2.50 
3670 515 Braxton-Hick's Ecraseur 15.00 
3671 515 Ecraseur, Modified 15.00 
Breus' Obstetrical Forceps 20.00 
3190 435 Brewer's Speculum Vaginas 4.00 
1 7 90 147 Brewster's Lachrymal Cupped Sound 2.50 
3736 536 Brickell's Obstetrical Forceps 8.00 
3847 562 Perineal Stay .75 
553 Set of Obstetrical Instruments 48.00 
142 7 88 Briddon's Artery Compressor 60.00 
2193 211 Bridge's Auto-Insufflator .75 
2192 211 Nasal Douche .75 
3130 419 Brigg's Lithotome 7.00 
26 1 3 292 Bristle Probang 1.50 
2614 292 Stanford's 2.50 
2543 278 Bronchotome, Pilcher's 6.00 
Bronchotomy, see Tracheotomy. 
3 1 68 428 Brown's Air Tampon 4.00 
3706 528 Clamp, Ovariotomy 12.00 
1 708 125 Hypodermic Syringe 2.50 
34 8 9 490 Pessary--- .75 
69 Pocket Set 30.00 
2562 281 Spirometer.- - 10.00 
2908 350 Syringe and Applicator 24.00 
29 8 9 371 Urethrametome 27.00 
42 3 0 720 Bruce's Bow-Leg Apparatus, per pair 
20.00 to 24.00 
38 8 3 575 Brun's Bandage Shears 10.00 
2499 269 Epiglottis Pincette 4.50 
2008 184 Brunton's Otoscope 6.00 
1196 34 Brush Electrode 1.00 
1211 35 Electrode .75 
1216 35 Electrode 2.50 
2459 264 Brush Holder, Child's 2.50 
24 6 7 264 Leffert's 2.50 
24 5 8 264 Mackenzie's 1.50 
2463 264 Noyes' 2.25 
269 7 307 Rectal 2.50 
2466 264 Ruppaner's 1.00 
2462 264 Seeger's .... 2.50 
246 5 264 Wagner's, with one dozen Brushes 2.50 
291 7 351 Bryce's Urethral Applicator 5.50 
3122 417 Buchanan's Rectangular Staff 2.50 
4321 755 Bucklin's Nasal Saws, per set 4.00 
1428 88 Buck's Arterial Compressor 35.00 
2107 196 Bistoury, Probe-Pointed 1.50 
2106 196 Bistoury, Sharp-Pointed 1.50 
1610 106 Chain Saw Conductor 3.00 
2112 197 Chisel, Mastoid 1.25 
2113 197 Chisel, Mastoid 1.25 
2091 195 Cotton Probe .50 
2014 185 Cotton Probe, Silver .60 
20145 185 Cotton Probe, Silver .75 
2044 191 Curette, Ear.- .75 
2201 213 Curette, Nasal and Ear 1.00 
1619 108 Drills, Mastoid 3.00 
1630 109 Drill, Mastoid 5.00 
2127 197 Drill, Mastoid 3.00 
39 0 6 582 Extension Apparatus, Complete 10.00 
Consisting of: 
3 9 0 7 582 Adhesive Plaster and Webbing. 
3908 582 Perineal Band. 
Fig. Page. Pricx 
Buck's Extension Apparatus, continued : 
39 1 0 582 Splints, Coaptation. 
39 0 9 582 Wooden Upright and Sandbag. 
3911 583 Extension Fulcrum $3.00 
3911 583 Extension Fulcrum and Weights 4.00 
2 1 02 196 Furuncle Knife 1.50 
56 General Operating Set 190.00 
2 1 08 197 Mastoid Process Knife 1.50 
2 1 03 196 Myringotome 1.00 
1417 86 Needle (and Post's) for Pocket 2.50 
2080 194 Nozzle, Ear .75 
2110 197 Periosteotome 2.50 
1318 79. Pin Conductor, Slide Catch 1.75 
2316 231 Pin Conductor, Slide Catch 1.75 
Pin Conductor (Plain) 1.00 
2093 195 Port Acid Glass .10 
2014 185 Probe, Silver .60 
20146 185 Probe, Silver .75 
1730 128 Rectum Trocar 3.50 
202 Set of Ear Instruments 35.00 
2461 264 Sponge Holder 1.25 
3885 577 Suspension Apparatus. _ 18.00 
25 1 0 270 Throat Forceps 2.50 
2391 242 Throat Lancet. 2.50 
2533 277 Tracheotomy Guide 2.00 
3 7 5 3 538 Budd's Obstetrical Forceps 8.00 
553 Set of Obstetrical Instruments 40.00 
1444 91 Bull-Dog Artery Forceps, Spring Catch 1.50 
1134 18 Forceps for Gastric Fistula 2.50 
1987 175 Forceps for Extirpation of Eye 2.50 
82 Bullet Extracting. 
1364 83 Extractor, Mose's 3.50 
1365 83 Bullet Forceps, American, Tiemann & Co.'s 2.25 
1357 83 Flexible, Tiemann & Cd.'s 6.00 
136 1 83 Gross' 2.50 
136 0 83 Hamilton's 2.50 
13 5 6 83 Thomasin's 2.50 
1365 83 Tiemann & Co.'s 2.25 
136 3 83 U.S. Army 7- 2.00 
1358 83 Weisse's 10.00 
1351 82 Bullet Probe, Eldridge's .75 
43 7 2 764 Fluhrer's Aluminium 4.50 
1353 82 Hamilton's, per set 2.50 
1354 82 Long, Silver, each .75 
1350 82 Nelaton's .60 
1352 82 Sayre's 8.00 
1355 82 Tiemann & Co.'s and Lint Carrier.-. .75 
1359 83 Bullet Scoop 1.75 
1362 83 Screw 2.00 
134 9 82 Seeker 1.00 
2062 192 Bumstead's Canulated Forceps 4.00 
2943 358 Holt's Divulsor 20.00 
169 5 122 Lee's Lamp 3.00 
29 5 4 360 Maisonneuve's Urethrotome 14.00 
2906 350 P. P. Syringe .75 
2900 349 Retention Catheter 3.50 
28 5 0 342 Sound Curve, F, B, E. 
2910 350 Urethral Syringe 2.50 
2967 363 Urethrotome 50.00 
4283 745 Bunion Apparatus, Bigg's 8.00 to 12.00 
1011e 3 Bunsen Burner 1.50 
Burdick's Obstetrical Forceps 12.00 
1010a 3 Burette, Mohr's 2.50 
2 5 8 7 285 Burge's Air Compressor, Double Acting 
3943 594 Fracture Apparatus 50.00 
3778 542 Obstetrical Forceps 30.00 
2932 354 Stricture Dilator, Curved 10.00 
2933 354 Stricture Dilator, Straight 10.00 
2 5 0 8 270 Throat Forceps 4.50 
1623 108 Burnett's Mastoid Knife 1.50 
2 1 09 197 Mastoid Knife 1.50 
2 6 0 0 288 Burrall's Atomizer i 1.75 
1027 5 Burrows' Stethoscope 2.25 
3133 421 Bush's Gorget 4.50 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
781 
Fig. Page. Price. 
2713 309 Bush's Pile Needles and Holder $3.00 
2709 308 Pile Scissors 1.50 
1604 104 Butcher's Saw 16.00 
1172 32 Butler's Electro-Massage Instrument 
2902 350 Buttles' Gonorrhoea Syringe 5.00 
2144 201 Inhaler 2.00 
351 0 492 Pessary .50 
3511 492 Pessary .50 
3623 506 Scarificator 1.25 
3614 506 Scarificator and Tenaculum 2.50 
33 5 2 471 Set of Uterine Instruments 23.00 
3761 539 Buzzle's Obstetrical Forceps 10.00 
37 1 8 530 Byford's Clamps, per set 18.00 
Pelvimeter 8.00 
3977 608 Byrd's Wire Gauze and Smith's Splint 5.00 
2711 308 Byrne's Double Spring Tenaculum 6.00 
34 1 9 482 Reflux Catheter and Adjuster 2.50 
3208 441 Speculum Vaginae 11.00 
3556 497 Tenaculum Forceps 6.00 
3555 497 Uterine Fixator 2.50 
3655 513 Vulsellum Forceps 3.00 
3656 513 Vulsellum Forceps ... 3.00 
4274 741 Calcaneus Apparatus, each 10.00 to 12.00 
4273 741 Shoe, each 10.00 to 12.00 
398 Calculus, Urethral, see also Urethral : 
Foreign Body Extractors. 
400 Calculus, Vesical, see also Stone in the 
Bladder. 
58 California General Operating Set 69.30 
2464 264 Sponge or Brush Holder 2.00 
128 7 75 Callender's Drainage Canula 3.00 
1125 16 Calvarian Clamp, Satterthwaite's 5.50 
1120 16 Hook 1.50 
1038 6 Cammann's Auscultator, Cylindrical 1.25 
1037 6 Auscultator, Intra-Costal 1.50 
1058 8 Cardiometer 4.50 
1036 6 Stethoscope 4.50 
3 1 6 7 428 Campbell's Canula and Cotton Introducer_ 
3566 498 Intra-Uterine Stem, per set 4.50 
34 8 2 490 Pessary, Soft Rubber .75 
3460 488 Pneumatic Uterine Repositor .25 
3661 513 Tumor Forceps 8.00 
Canalicula, see Ophthalmic, Lachrymal. 
2038 188 Cane Ear Trumpet 
1883 157 Canthoplasty Needle, Prince's 2.50 
3 1 70 429 Canula, a Chemise 1.50 
2196 212 Epistaxis, Belocq's, Silver 3.00 
2731 310 Gooche's 6.00 
1792 147 Lachrymal Canula, 50c.; Style .75 
3664 514 Levret's , 6.00 
2203 213 Nasal Polypus .. 1.50 
Trachea, see Trachea Canula. 
2209 215 Canula Scissors, Smith's 5.00 
63 Capital Operating Set -.52.00 
64 Conant's 53.95 
62 U. S. Army 102.50 
62 U. S. Army, Staff Surgeon's 137.10 
152 8 97 Capital Saw, Parker's 5.00 
1527 97 Satter lee's 5.00 
1526 97 Tiemann & Co.'s 5.00 
1965 172 Capsulotome, Knapp's 1.75 
168 Capsulotomy. 
4357 I 
(761 Carbon-Dioxide Generator 10.00 
4358 ' 
1058 8 Cardiometer, Cammann's .. 4.50 
8 Cardiometric. 
631 Care of the Insane, see also Restraints. 
3790 548 Carey's Lever, Placenta 1.00 
678 Caries of Spine, see also Spinal Braces. 
17 56 144 Carmalt's Perimeter 
4403 769 Punch, Transplantation 6.00 
2194 212 Caro's Nasal Clamp..... .75 
Fig. Page. Price. 
Caro's Urethral Speculum . $2.50 
4314 754 Carotid Artery Compressor, Corning's 8.00 
1065 10 Carroll's -Esthesiometer 4.00 
27 2 1 309 Knot Tier 2.00 
2823 333 Orchitis Compressor 1.25 
3523 493 Retroflexion Pessary .75 
1063 9 Stethometer 3.00 
3437 485 Uterine Repositor 3.50 
1668 120 Vaccinator .25 
183 5 150 Carron de Villard's Eye Needle 1.25 
18 5 8 152 Fixation Forceps 3.00 
1771 145 Lid Forceps 4.00 
1136 19 Cartilage Knife 1.50 
149 1 95 Knife 1.50 
1492 95 Knife 2.00 
1103 15 Knife, Steel Handle .60 
29 1 8 351 Caspar's Ointment Bougie 2.00 
Cataract, see Ophthalmic, Cataract. 
2183 210 Catarrhal Douche, Warner's 1.00 
See Nasal Douche. 
Catgut, see Ligature. 
1300 77 Catheter, Compound, Parker's 4.50 
130 5 77 Compound, Plated 1.50 
1305 77 Compound, Silver 2.50 
3036 387 Cowan's, Vertebra ted 8.50 
Catheter, Double Current: 
Gum Elastic, English 2.50 
Hard Rubber 4.00 
30 4 4 389 Marcy's 2.50 
342 1 482 Nott's 3.00 
34 2 2 482 Nott's 2.50 
30 4 6 389 Nott's 3.00 
34 2 0 482 Reliquet's 3.50 
3045 389 Silver 5.00 
3044 389 Soft Rubber, Velvet-eyed 2.50 
Catheter, English Gum Elastic : 
Double Current 2.50 
Double Web, Best .25 
Mercier's Curve 1.00 
Olive-pointed, Black .50 
Olive-pointed, Red .50 
Open-end .75 
Prostatic .75 
30 2 7 385 Silk Web 1.00 
30 2 8 385 Silk Web (Bougie) 1.00 
3029 385 Silk Web 1.00 
Catheter, Eustachian, see Eustachian 
Catheter. 
Catheter, French Gum Elastic: 
Conical .50 
3 0 2 6 385 Curved .75 
Curved, Olive-pointed 1.00 
30 2 9 385 Cylindrical .25 
30 2 5 385 Mercier's Double Elbowed 1.00 
30 2 4 385 Mercier's Elbowed 1.00 
30 2 2 385 Olivary ,50 
3023 385 Olivary .50 
3021 385 Prostatic 1.00 
289 5 348 Catheter, Gouley's Tunnelled 2.50 
304 1 387 Gross'Flexible... 2.00 
Hard Rubber 1.00 
Hard Rubber, Double Current 4.00 
30 4 7 390 Harrison's Pessary Catheter 4.00 
30 2 0 385 Hutchinson's Prostatic 5.00 
304 0 387 Huter's, Flat 2.00 
3019 384 Male and Female, Plated 1.50 
30 1 9 384 Male and Female, Silver 2.50 
30 2 5 385 Mercier's Double Elbowed 1.00 
3024 385 Mercier's Elbowed 1.00 
3042 388 Mercier's, Invaginated 3.50 
Catheter, Nickel-plated : Female .50 
Male 1.00 
3019 384 Male and Female 1.50 
3018 384 Parker's 2.50 782 
GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Catheter, Nickel-plated : Prostatic §1.50 
3018 881 Catheter, Parker's, Compound, Plated 2.50 
3018 384 Parker's, Compound, Silver 4.50 
Catheter, Prostatic: 
3021 385 French Gum Elastic 1.00 
3020 885 Hutchinson's 5.00 
Plated 1.50 
3031/386 Soft Rubber, Velvet-eyed 1.00 
Silver 2.25 to 4.00 
Catheter, Retention: 
2895 348 Gouley's 2.50 
2899 349 Otis' 3.00 
28 9 7 348 Thompson's 3.00 
2900 349 Thompson's-Bumstead's 3.50 
Teevan's 2.50 
Catheter, Silver: 
Double Current 5.00 to 7.00 
Female 1.00 
Male, according to size 1.50 to 4.00 
30 1 9 384 Male and Female 2.50 
3018 384 Parker's, Combined 4.50 
Parker's Female and Caustic Case..- 3.00 
Prostatic 2.25 to 4.00 
3279 451 Catheter, Sims'Sigmoid, Hard Rubber.... 1.00 
3279 451 Sims'Sigmoid, Silver 1.50 
32 7 9 451 Sims' Sigmoid, Tin.- 75 
334 1 466 Skene's, Double Perforated 2.00 
3340 466 Skene's, Self-retaining 1.00 
Soft Rubber, see Catheter: Vulcan- 
ized India Rubber. 
3035 387 Squire's Vertebrated 6.00 
2897 348 Thompson's Retention 3.00 
1306 77 Tiemann's Flexible Joint 4.00 
30 3 6 387 Vertebrated, Cowan's 8.50 
3035 387 Vertebrated, Squire's 6.00 
Catheter, Vulcanized India Rubber (Soft 
Rubber): 
Jaques' 1.00 
Nelaton's .50 
3031a 386 Tiemann's Velvet-eyed .75 
30316 386 Tiemann's Velvet-eyed .75 
3031c 386 Tiemann's Velvet-eyed 1.00 
3031d386 Tiemann's Velvet-eyed 1.50 
3031c 386 Tiemann's Velvet-eyed .75 
3031/386 Tiemann's Velvet-eyed 1.00 
3031^ 386 Tiemann's Velvet-eyed 1.00 
30316 386 Tiemann's Velvet-eyed .75 
3031 i 386 Tiemann's Velvet-eyed .75 
3044 389 Tiemann's Velvet-eyed, Double Cur- 
rent 2.50 
3038 387 Catheter, Warren's Door 6.00 
3039 387 Warren's Vermicular 3.00 
Catheter Electrode, Newman's 4.00 
1176 32 Nunn's 4.00 
1202 34 Metallic, Silver 2.50 
1203 34 Metallic, Silver 2.50 
3032 386 Catheter Guide, Keyes'.- .75 
3033 386 Otis' 1.25 
3034 386 Catheter Holder .50 
2920 351 Catheter Syringe, Bigelow's 6.00 
2914 351 Dick's 3.50 
2898 348 Otis' 4.50 
Catling, Long 4.50 
Medium... 3.50 
149 5 95 Small - 2.50 
Catling, Aseptic, Hard Rubber Handle: 
1506 96 Long 5.00 
150 6 96 Medium 4.00 
Small 3.00 
Caustic Case, Aluminum 2.25 
1308 77 Hard Rubber and Silver 1.00 
1299 77 Silver. 1.50 
1303 77 Caustic Holder, Child's 2.50 
2480 266 Concealed, Laryngeal 2.50 
Fig. Page. Price. 
1302 ' Caustic Holder, Dugas' §5.00 
2090 195 Elastic, Ear 2.00 
1308 77 Hard Rubber and Silver 1.00 
2482 266 Jarvis' Applicator, Laryngeal 10.00 
248 1 266 Lente's Probe 1.25 
24 7 9 266 Lente's Cup 3.50 
130 0 77 Caustic Holder and Catheter, Parker's 
Plated 2.50 
1300 77 Parker's Silver 4.50 
1304 77 Caustic Holder and Curette 2.50 
248 1 266 Caustic Probe, Lente's 1.25 
2920 351 Caustic Syringe, Bigelow's 6.00 
2908 350 Brown's 24.00 
2914 351 Dick's 3.50 
Cautery, see Actual Cautery, Galvano-Cau- 
tery, Thermo-Cautery. 
1032 5 Cedar Stethoscope, Hard Rubber Ear-Piece 1.50 
1028 5 Short.... .75 
1039 6 Vulcanite Ear-Piece 1.50 
38 2 0 552 Cephalotribe, Braun's 18.00 
Hicks' 24.00 
38 2 2 552 Lusk's 18.00 
382 1 552 Simpson's 15.00 
3818 551 Van Huvel's .... 
162 Ceratomy, see also Ophthalmic: Keratome. 
1 884 159 Chadwick's Pterygium Scissors 6.00 
1126 16 Chain Hook.... .25 
1114 16 Darling's .50 
1609 106 ChainSaw 10.00 
1612 106 Chain Saw Carrier 2.00 
1610 106 Buck's 3.00 
1611 106 Post's 4.00 
1613 106 Prince's 3.50 
354 1 495 Chambers'Stem Pessary, per set 3.00 
3478 490 Chamberlain's Pessary 1.50 
34 7 9 490 Pessary 1.50 
Uterine Tube, Glass 1.00 
2589 286 Chapin's Spray for Trypsin in Croup 4.50 
2181 210 Chapman's Nasal Spray 5.00 
3357 473 Probe and Sounds 4.00 
361 5 506 Uterine Scarificator 1.50 
362 1 506 Uterine Scarificator, Pocket 2.50 
4211 712 Charcot and Cazenave's Apparatus for 
Writer's Cramp 
3991 614 Charriere's Luxation Forceps 9.00 
1090 13 Microscopic Section Knife 8.00 
2965 363 Stricture Cutter 14.00 
1431 88 Tourniquet 2.50 
4213 713 Writer's Cramp Apparatus 
1284 75 Chassaignac's Drainage Trocar 4.00 
3663 514 Ecraseur 25.00 
2 5 4 8 278 Tracheal Dilator 3.00 
2784 324 Chase's Truss 4.00 
2794 327 Umbilical Truss 4.00 
1252 45 Cheatham's Ether Inhaler 3.50 
23 6 2 236 Cheek Retractor, Jointed 3.00 
2353 236 Langenbeck's 2.50 
23 6 5 236 Left 1.00 
2364 236 Luer's 2.00 
23 6 3 236 Right 1.00 
2366 236 Roe's 2.50 
2459 264 Child's Brush and Caustic Holder 2.50 
2797 327 Children's Umbilical Truss 2.50 to *1.00 
2 7 9 8 327 Umbilical Truss 2.50 to 3.00 
Chinese Bead Silk, Black and White, Skein .20 
2112 197 Chisel, Buck's „ 1.25 
2113 197 Buck's 1.25 
1577 102 Darby's, and Gouges, per set 7.00 
1119 16 Dissecting .75 
43 8 3 766 Gerster's 
1578 102 Linhardt's 1.50 
1639 112 Macewen's 6.00 
157 5 102 Osteotomy 1.25 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
783 
Fig. Page. Price. 
2118 197 Chisel, Schwartze's $1.25 
2119 197 Schwartze's 1.25 
2 1 20 197 Schwartze's 1.25 
2121 197 Schwartze's 1.25 
2122 197 Schwartze's 1.25 
3110 412 Chismore's Evacuating Lithotrite 24.00 
1251 44 Chisolm's Ether Inhaler 2.50 
Chloroform Inhaler, see Anaesthetic In- 
haler. 
2388 239 Church's Tongue Depressor 6.50 
17 7 3 146 Cilia Forceps 1.00 
See also Epilating Forceps. 
3666 515 Cintrat's Ligator 2.50 
3682 519 Needle 1.75 
3683 519 Serre-Noeud 10.00 
1618 108 Circular Saw, Graefe's 20.00 
4232 723 Roberts', Electro 
1617 107 Tiemann & Co's 12.00 
2826 335 Circumcision Ring, Ross' 1.00 
2828 336 Scissors, Baruch's 2.50 
288 7 347 Civiale's Bistoury Cache 5.00 
30 8 3 403 Lithotriptor 25.00 
29 6 4 363 Urethrotome 12.00 
2310 231 Clamp, Harelip, Hutchison's 3.00 
2313 231 Harelip, Prince's 3.00 
2314 231 Harelip, Smith's 6.00 
2312 231 Harelip, Whitson's 3.00 
2194 212 Nasal, Caro's .75 
Ovarian, see Ovariotomy : Pedicle 
Clamps. 
Pile, Allingham's 12.00 
2740 311 Pile, Amussat's 8.00 
2737 311 Pile, Ashton's 3.00 
2733 311 Pile, Kelsey's 6.50 
2734 311 Pile, Smith's 6.50 
2735 311 Pile, Tiemann & Co.'s 6.00 
2819 332 Scrotal, Henry's 8.00 
2816 332 Scrotal, Lewis' 4.00 
281 7 332 Scrotal, Williams' 4.00 
2818 332 Scrotal, Williams' .75 
4406 770 Vaginal, Noeggerath's 7.00 
44 0 0 769 Vaginal, Thomas' 6.00 
3962 601 Clark's Fracture Splint 30.00 
2 1 76 209 Nasal Douche 1.50 
3930 590 Olecranon Splint 5.00 to 8.00 
2005 184 Otoscope 12.00 
1271 55 Physician's Office Chair 
1030 5 Stethoscope 1.25 
3679 516 Tooth-edged Scissors 9.00 
610 Clavicle, Dislocated: 
3983 611 Cooper's Apparatus 5.00 
3985 612 Mayor's Apparatus 5.00 
3981 610 Pulleys, Brass, per pair 7.00 
3984 612 Smith's Apparatus 
587 Clavicle, Fractured: 
3921 587 Fox's Splint.. 5.00 
39 2 0 587 Levis'Splint 5.00 
39 2 2 588 Richardson's Splint 6.00 
39 2 3 588 Sayre's Dressing 
2478 266 Clay's Powder Insufflator 2.00 
209 Cleansing and Medicating the Nasal Pas- 
sages, see also Nasal Douches. 
194 Cleansing the Ear, see also Aural: Douches 
and Syringes. 
564 Cleansing of Wounds, see also Wounds and 
Injuries. 
4408 770 Cleborne's Artery and Tissue Forceps 3.50 
1325 80 Pocket Instrument 7.00 
2595 287 Tongue Depressor and Insufflator 8.00 
2594 287 Tongue Spatula and Atomizer 
2670 305 Clendinen's Rectal Irrigator 6.00 
39 7 9 609 Suspending Splint 
2407 245 Tonsil Haemostatic 2.25 
3601 504 Climax Uterine Dilator 15.00 
Fig. Page. Price. 
4 Clinical Thermometers: 
1014 4 Axilla, Ivory Scale $2.50 
1013 4 Constricted Stem 1.50 
Dunster's, in Silver Case 4.50 
Hicks' Indestructible Index 2.00 
1019 4 Hicks'Lens Front 3.50 
Hicks'Minute 5.00 
1012 4 Self-registering, Straight 1.50 
1013 4 Self-registering, Straight 1.50 
1016 4 Surface, Fahrenheit 2.00 
1017 4 Surface, Seguin's 2.00 
1015 4 Tiemann's Bent 3.50 
Tiemann's Bent, with Lens Front 4.00 
1018 4 Twisted Stem 2.00 
2580 284 Clinton's Atomizer 1.75 
3112 415 Clover's Crutch (Peter's) 15.00 
30 9 3 405 Evacuating Apparatus 14.00 
2374 237 Mouth Gag - 3.50 
725 Club-foot, see also Orthopaedic: Deformi- 
ties of the Feet. 
3910 582 Coaptation Splints 
43 3 6 758 Cocaine Pipette, Prince's .75 
3049 392 Cock's Trocar 15.00 
432 5 756 Cohen's Antero-Posterior-Pharyngeal For- 
ceps 4.50 
4328 756 Combination Snare 
4331 756 Larynx Curette, each 2.50 
43 2 7 756 Laryngeal Stenosis Dilator 10.00 
43 3 0 756 Powder Blower 2.00 
Tongue Depressor 1.50 
43 2 4 756 Trachea Tube 8.00 
4329 756 Sponge Forceps, three sizes, each ... 4.00 
43 2 6 756 Wire Snare (Bosworth's) 4.00 
28 3 7 337 Cohn's Phimosis Forceps 9.00 
2751 312 Coil, Cooling, Abdominal 8.00 
38 51 565 Cooling, Esmarch's 
Cooling, Head 8.00 
40 Cold and Heat, Application of. 
29 2 5 352 Cold Sound (Psychrophor), Silver 4.00 
3522 493 Cole's Anteversion Pessary 3.00 
3530 494 Galvanic Pessary 2.00 
3743 537 Obstetrical Forceps 8.00 
3 52 1 493 Retroversion Pessary - 3.00 
34RA I 
3487 ' 490 Coleman's Pessary .40 
591 Colles' Fracture Apparatus : 
39 3 2 591 Coover's Splint 1.50 
394 1 593 Hewitt's Splint 7.00 
3940 592 Shrady's Splint 2.00 
3939 592 Smith's Splint 
39 3 3 591 Stillman's Splint 
24 4 7 261 Collin's Lamp.. 7.00 
30 6 4 399 Foreign Body Instrument 30.00 
2 1 57 205 Nasal Speculum 3.50 
Pelvimeter 8.00 
26 5 3 301 Colonic Exploring Sound 8.00 
3 7 8 4 547 Colpeurynter, Braun's 3.00 
3147 423 Guyon's-Peterson's 1.50 
3147 423 Guyon's, with Stopcock 2.00 
1195 34 Comb Electrode 1.50 
2 7 9 6 327 Combination Supporter, Walker's 12.00 
1674 120 Comedone Extractor, Piffard's .75 
1675 120 Comedone Extractor and Acne Lancet 2.50 
63 Compact Amputating Set 33.50 
61 Field Set, Otis' U. S. A 160.00 
179 Set of Eye Instruments 28.00 
130 5 77 Compound Catheter, Plated 1.50 
130 5 77 Catheter, Silver 2.50 
130 0 77 Catheter, Parker's, Plated 2.50 
130 0 77 Catheter, Parker's, Silver 4.50 
Compressor, Arterial, see Arterial Com- 
pressor. 
28 2 3 333 Scrotal, Carroll's, Orchitis 1.25 
282 1 333 Scrotal, Hawes', Orchitis 3.00 784 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
2811 331 Compressor, Scrotal, Miliano's, Varicocele. $2.00 
28 2 2 333 Scrotal, White's 3.00 
28 1 4 331 Seminal Cords, Doisneau's 4.00 
126 7 53 Comstock's Gynaepod 20.00 
126 7 53 Gynaepod, with Speculum 25.00 
3 7 4 2 537 Obstetrical Forceps 8.00 
150 1 95 Conant's Knives and Saw 10.00 
64 Operating Set. 53.95 
3 5 2 8 494 Stem Pessary 3.00 
137 2 84 Concave-edged Tenotome 1.25 
39 2 7 589 Condyle and Humerus Splint .75 to 1.25 
39 2 8 589 Jointed 1.00 to 1.50 
Congester, Penis 5.00 
4205 710 Contracted Wrist Apparatus 20.00 to 30.00 
2036 188 Conversation Tube, Mohair, Cylindrical- 2.50 
Mohair, Conical 4.00 
Silk, Cylindrical 4.00 
Silk, Conical 6.00 
Silk, Conical, Ivory Fittings 16.00 
2041 189 Conversation Tube, Currier's, Conical 
2040 189 Duplex 
1373 84 Convex Edged Tenotome • 1.25 
2751 312 Cooling Coil, Abdominal 8.00 
3851 565 Esmarch's 
Head 8.00 
Cooling Sound, Winternitz's, Rubber 2.50 
292 5 352 Winternitz's, Silver 4.00 
3983 611 Cooper's Clavicle Bandage 5.00 
1371 84 Hernia Knife 1.25 
1397 85 Hernia Knife 1.00 
1413 86 Hernia Knife 1.75 
2758 316 Hernia Knife 1.75 
39 3 2 591 Coover's Splint, Arm and Hand, each 1.50 
3780 544 Cord Carrier (Fillet) 6.00 
3789 548 Scholler's 4.00 
163 Corectopy. 
309 1 405 Cornay's Washing Bottle 
Corneal Instruments, see Ophthalmic: Cat- 
aract. 
2039a 188 Cornets, Ear, Silver, per pair 2.50 
20395 188 Silver, per pair 3.00 
4314 754 Corning's Carotid Artery Compressor 8.00 
3 7 7 7 542 Obstetrical Forceps 12.00 
745 Corn Instruments : 
4292 746 Knife 1.00 
42 8 6 746 Knife and File .75 
4291 746 Scalpel, Dissecting ... .60 to .75 
42 8 8 746 Scalpel, Pocket Case 1.00 
Corset, Sayre's Spinal 20.00 to 25.00 
4166 692 Smith's „ 20.00 to 25.00 
1117 16 Costotome, Chisel 1.50 
154 9 99 Rib Shears.. 6.00 
Rib Shears, plain. 5.00 
2091 195 Cotton Wool Carrier, Buck's .50 
26 9 4 307 Kelsey's Applicator .75 
2726 310 Porte Meche 75 
20 70 193 Vulcanite-. .75 
1974 174 Couching Needle 1.25 
1836 150 Couching Needle 1.25 
582 Counter Extension : 
3906 582 Buck's Apparatus, complete 10.00 
Consisting of: 
39 0 7 582 Adhesive Plaster and Webbing- 
3908 582 Perineal Band 
3910 582 Splints, Coaptation 
39 0 9 582 Wooden Upright and Bag 
3911 583 Fulcrum and Weights, Buck's 4.00 
3912 583 Fulcrum and Weights, Levis' 5.00 
391 3 583 Fulcrum, Sayre's-Buck's 4.00 
3913 583 Sayre's Extension Sundries 1.00 
122 Counter-Irritation: 
1693 122 Baunscheidt's Lebenswecker 2.50 
Baunscheidt's Oil, Genuine--. 2.50 
Baunscheidt's Oil, Imitation 1.50 
Fig. Page. Price. 
3828 557 Counter-Pressor, Skene's 81.50 
3319 456 Counter-Pressure Fork, Nilsen's 1.75 
33 1 8 456 Hook, Bozeman's 1.50 
3317 456 Hook, Emmet's 1.25 
3336 464 Staff, Harris' ... 2.00 
3320 456 Tenaculum, Hanks' 2.00 
38 2 9 557 Cowan's Trachelorrhaphy Forceps 4.00 
3607 504 Uterine Dilator, set of 3 _. 2.50 
30 3 6 387 Vertebrated Catheter 8.50 
1608 105 Cowgill's-Hey's Saw 3.50 
Cowhorn Tooth Forceps: 
2252 223 Lower Molar, Left 2.00 
22 5 1 223 Lower Molar, Right 2.00 
22 5 3 224 Molar, Either Side 2.00 
22 4 2 222 Upper Molar, Either Side 2.00 
224 1 222 Upper Molar, Left 2.00 
2240 222 Upper Molar, Right 2.00 
1443 91 Coxeter's Artery Forceps 1.00 
1108 15 Dissecting Forceps .50 
3534 494 Stem Pessary 1.50 
2609 291 Cracour's CEsophageal Dilator, each 2.50 
32 2 0 443 Speculum Vaginae .. 6.50 
3958 601 Cradle, Salter's 20.00 
4185 699 Wolff's Spinal 10.00 to 15.00 
1461 92 Crampton's Artery Needles, per pair 5.00 
38 1 9 552 Cranioclast, Simpson's 10.00 
3813 551 Tarnier's (Basiotribe) 35.00 
3817 551 Craniotomy Forceps, Meigs'... 3.50 
3816 551 Meigs'Angular 3.50 
38 1 5 551 Meigs'Straight 3.50 
38 1 9 552 Simpson's 10.00 
3814 551 Thomas' 6.00 
Crawcour, see Cracour. 
2442 259 Cresswell-Baber's Laryngoscope 7.50 
1851 151 Critchett's Eye Speculum, Over Nose 3.00 
1852 151 Eye Speculum, Over Temple.... 2.50 
1910 163 Iris Needle 1.25 
1957 168 Lens Spoon, Concave 1.50 
1956 168 Lens Spoon, Flat 1.50 
1875 154 Strabismus Hook 1.25 
12 7 2 55 Crosby Invalid Bedstead 
69 Crosby's Pocket Set.... 15.00 
1766 145 Cross-Bar Entropium Forceps 2.25 
3805 550 Crotchet (Obstetrical) and Blunt Hook 1.50 
38 0 8 550 Bedford's 6.00 
38 0 7 550 Guarded 4.50 
2 5 7 7 283 Croup Kettle.. 4.50 
1534 $8 Crown Trephine and Handle 4.00 
153 1 98 Crown Trephine, Guarded 6.00 
1531 98 with Brace 21.00 
39 4 9 597 Crutches. Prices on page 597. 
1930 164 Culbertson's Iricystome 16.00 
1934 164 Iris Hook... 12.00 
1790 147 Cupped Sound, Brewster's Lachrymal 2.50 
2916 351 Van Buren's Urethral 2.00 
116 Cupping, Dry : 
1657 116 Junod's Arm .....25.00 
1656 116 Junod's Boot ..25.00 
1658 116 Thomas'Dry Cupper 1.50 
115 Cupping Cup, Glass, per dozen 1.50 
1654 115 Glass and Rubber .75 
1655 115 Glass, with Brass Fitting .60 
1653 115 Tiemann's Soft Rubber 1.00 
Tin .20 
Stopcock for .50 
1655 115 Cupping Pump 2.50 
1651 115 Cupping Scarificator, Ten Bladed 4.50 
1652 115 Scarificator, Twelve Bladed.. 4.50 to 8.00 
1660 115 Scarificator, Tiemann's 7.00 
115 Cupping Set, No. 1, without Scarificator... 9.00 
115 No. 1, with Scarificator 13.00 
115 No. 2, without Scarificator 10.50 
115 No. 2, with Scarificator 15.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
785 
Fig. Page. Price. 
3163 428 Curette, Bladder, Mussey's $4.50 
43 8 6 766 Bone, Volkmann's 2.50 
1682 121 Dermal, Auspitz's 2.00 
1691 121 Dermal, Piffard's, each 2.25 
2067 193 Ear, Bacon's 2.50 
2044 191 Ear, Buck's .75 
2051 191 Ear, Quire's 2.25 
2068 193 Ear, Sexton's Double 2.00 
2048 191 Ear, Speir's 1.25 
1832 150 Eye, Daviel's 1.25 
2502 269 Laryngeal 3.00 
2201 213 Nasal, Buck's 1.00 
2604 289 Pleural, Westbrook's 2.50 
510 Curette, Uterine: 
3644 511 Bozeman's 2.25 
3634 511 Emmet's, Enucleator 1.50 
3635 511 Emmet's, Forceps 3.50 
Engelman's 3.00 
3633 510 Hanks' 2.00 
Munde's, Blunt 3.00 
Munde's, Sharp 3.00 
Munde's, Placenta 1.50 
3639 511 Richardson's 6.00 
3640 511 Siemon's 2.50 
3641 511 Siemon's 2.50 
3631 510 Sims' 1.75 
3632 510 Sims' 3.00 
3637 511 Skene's 1.75 
3630 510 Thomas' 1.50 
3636 511 Thomas' 1.50 
3629 510 Thomas', 3 with one handle 4.50 
3643 511 Thomas', Serrated 3.50 
3639 511 Yarrow's, Enucleator 4.50 
3306 454 Currie's Canulated Needle 7.00 
2041 189 Currier's Conversation Tube 
2040 189 Duplex Conversation Tube 
1081 12 Curtis'Section Knife 3.50 
1081 12 Section Knife and Frame 15.50 
677 Curvature, Spinal. 
720 Tibial. 
2850 342 Curve for Urethral Instruments. 
1863 152 Curved Fixation Forceps 1.50 
187 7 154 Strabismus Forceps 1.50 
3205 441 Cusco's Speculum Vaginae 4.00 
2390 239 Tongue Holding Forceps 4.50 
3729 532 Cushing's Pelvic Abscess Dilating (Forceps) 
Trocar 5.50 
3662 513 Vulsellum Forceps 3.00 
4339 758 Cutaneous Punch, Keyes' 2.50 
1689 121 Cutipuncture, Sherwell's 5.00 
1681 120 Cutisector, Piffard's 5.00 
1083 13 Piffard's 5.00 
Cutter' s Auto-Laryngoscope 
34 4 0 486 Cup Pessary, with Belt 2.50 
3 5 0 2 492 Pessary, with Belt 2.50 
34 5 7 487 Ring Pessary, with Belt 2.50 
1055 8 Cyrtometer, Flint's 10.00 
1057 8 Warren's Conformator 6.00 
1056 8 Wood's 10.00 
8 Cyrtometric. 
3694 525 Cyst Elevator, Borck's Ovarian 1.50 
33 3 7 464 Cystitis Eyelet, Emmet's .25 
3 5 0 0 491 Cystocele Pessary, Skene's 2.00 
1947 168 Cystotome (Ophthalmic) 1.50 
1948 168 Graefe's 1.50 
1946 168 Knapp's 1.75 
1949 168 and Spoon 2.50 
400 Cysto-Lithic, Lithiasis Cystica, Vesical or 
Urinary Calculus. See Stone in the 
Bladder; Stone Operations; Stone 
Searcher ; Lithoclast. 
406 Cysto-Lithic, Litholapaxy. See Lithoto- 
my ; Lithotrity. 
2 1 7 5 208 Czermack's Uvula Hook 2.50 
Fig. Page. Price. 
43 9 6 768 Daggett's Examining and Operating Table. 
750 Dangle Limbs. 
430 1 750 Artificial Humerus $35.00 to $70.00 
1597 103 Darby's Bone Holder and Rongeur 4.00 
15 7 7 102 Chisel, Gouges and Levator, per set. 7.00 
37 0 5 528 Clamp 7.00 
1114 16 Darling's Chain Hook .50 
17 Dissecting Set 5.75 
1101 15 Scalpel .75 
3230 444 Darrow's Speculum Vaginae, with 2 Blades. 12.00 
Davidson's Syringe, No. 1 2.00 
Syringe, No. 2 1.50 
1832 150 Daviel's Curette 1.25 
1165 29 Davis and Kidder's Magneto-Electric Ma- 
chine 10.00 
2767 317 Davis' Hernia Instrument 15.00 
4093 658 Knee-Joint Splint 
405 5 638 Morbus-Coxarius Splint 15.00 
3754 539 Obstetrical Forceps 7.50 
4 1 36 678 Spine Brace 20.00 
1041 6 Stethoscope 4.50 
43 8 2 765 Dawbarn's Aseptic Saw 4.50 
4390 767 Needle Forceps 7.00 
1234 38 Dawson's Cautery Electrodes, per set 35.00 
3 7 0 9 529 Clamp, Ovariotomy 8.00 
3237 446 Erich's Speculum 14.00 
1232 37 Galvano-Caustic Battery 60.00 
33 0 8 454 Needle Forceps 3.50 
2617 292 (Esophageal Forceps 
3216 442 Sims'Speculum 5.00 
32 1 7 442 Sims'Speculum, Dilating 7.00 
166 7 120 Vaccinator 3.50 
3321 456 Wire Twister 2.50 
3 1 63 428 Debris Curette, Mussey's 4.50 
Evacuators, see Lithotrity; Debris 
Evacua tors. 
3164 428 Syringe, Van Buren's 3.50 
3165 428 Tube and Obdurator 2.50 
38 0 9 550 Decapitating Hook 3.00 
38 1 0 550 Braun's 3.00 
Deformity Apparatus, see Orthopaedic. 
1336 80 DeGaine's Russian Needle Holder 4.00 
2771 319 De Garmo's Hernia Syringe 8.00 
2545 278 Delaborde's Tracheal Dilator 5.00 
1860 152 De la Roza's Fixation Forceps 2.00 
1937 165 Iris Needle 1.75 
4167 692 Delicate Brace for Lordosis 40.00 
4405 769 Knife, Bozeman's 1.75 
1342 81 Probe Director and Tongue Tie 1.00 
43 3 2 757 Denhard's-O'Dwyer's Gag 7.00 
3 7 5 1 538 Denman's Obstetrical Forceps 7.00 
Dennison's Absorbent Cotton .30 
3968 603 Extension Windlass 1.50 
Stethoscope 12.00 
12 1 7 35 Dental Electrode 1.00 
221 Extraction of Teeth. 
222 Forceps, First Quality 2.75 
222 Forceps, Second Quality 2.00 
222 Forceps, Third Quality 1.50 
222 Forceps, Fourth Quality 1.25 
2305 229 Gum Lancet 1.00 
2308 229 Gum Lancet, Tortoise Shell 1.75 
2308 229 Gum Lancet, without Catch 1.00 
2302 229 Root Elevator, Screw 1.00 
230 1 229 Root Elevator, Stagfoot 1.00 
2303 229 Root Extractor 1.00 
2304 229 Root Extractor 1.00 
2307 229 Root Extractor, Angular 1.00 
23 0 6 229 Root Extractor, Curved 1.00 
2299 228 Turn Key, Removable Fulcrum 2.50 
2300 229 Turn Key, Rotating Fulcrum 2.50 
2297 228 Turn Key, Spring Bolt 3.00 
22 9 8 228 Turn Key, Spring Bolt 3.00 
1776 146 Depilator, Henry's . 2.50 786 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
2815 331 Depilator, Henry's $2.50 
Depressor, Tongue, see Tongue Depressor. 
32 5 3 448 Urethral and Perineal 2.50 
3247 448 Perineal, Bozeman's 2.50 
32 3 5 445 Vaginal, Garrigue's 2.00 
3252 448 Vaginal, Hunter's 1.50 
32 3 4 445 Vaginal, Nott's 1.50 
3249 448 Vaginal, Nott's 1.50 
3250 448 Vaginal, Sims' 1.50 
32 51 448 Vaginal, Sims'Double 1.50 
3127 419 Depuytren's Bistoury Cache ...24.00 
2752 313 Enterotome 5.00 
3956 600 Fibula Splint 
3123 417 Lithotomy Scalpel 1.75 
3 1 5 6 426 De Rigal's Stone Holder, Perforator and 
Breaker 60.00 
120 Dermic : 
167 5 120 Acne Lance and Comedone Extractor 2.50 
1674 120 Comedone Extractor, Piffard's .75 
1691 121 Curette, Piffard's 2.25 
43 3 9 758 Cutaneous Punch, Keyes' 2.50 
1689 121 Cutipuncture, Sherwell's 5.00 
1681 120 Cutisector, Piffard's 5.00 
1683 121 Depilating Forceps, Henry's 2.50 
1685 121 Epilating Forceps 1.50 
1687 121 Galvano-Depilator, Duhring's 3.00 
1688 121 Galvano-Depilator, Fox's 3.90 
1678 120 Grappling Forceps 3.00 
1686 121 Irido-Platinum Needle, Piffard's 1.00 
1680 120 Milium Needle, Piffard's 1.25 
1690 121 Naevus Needle .50 
1688 121 Needle Holder, Fox's 3.50 
1676 120 Pleximeter, Glass, Hess' .50 
16 79 120 Scarifying Spud, Piffard's 1.25 
1682 121 Scoop, Auspitz's 2.00 
1677 120 Skin-grafting Scissors 10.00 
1684 121 Tattooing Instrument, Piffard's 4.50 
1818 149 Desmarre's Cautery Iron 3.00 
1764 145 Entropium Forceps 3.00 
1854 151 Eyelid Retractor 1.75 
1855 151 Eyelid Retractor 1.75 
1819 149 Many-pronged Hook.. 2.00 
1889 162 Paracentesis Trocar 1.75 
1 780 146 Scarificator . 1.50 
2856 343 Desormeaux's Endoscope 60.00 to 125.00 
4201 709 Detmold's Ankle Spring 4.00 to 6.00 
152 4 97 Metacarpal Saw 1.50 
42 6 0 737 Scarpa Shoe 5.00 to 8.00 
2053 191 Devil's Screw Hook 1.75 
3790 548 Dewey's Placenta Hook 1.00 
1 Diagnostic. 
2015 185 Tube, Toynbee's .75 
186 Diapason. 
28 6 9 345 Dick's Bougie a Boule 1.00 
2914 351 Caustic Syringe 3.50 
3405 477 Caustic Syringe -. 3.50 
3204 439 Dicken's Speculum Vaginae 9.00 
4381 765 Diefenbach's Needle Forceps 3.00 
1 732 129 Dieulafoy's Aspirator, Large 50.00 
1732 129 Aspirator, Small 40.00 
1040 6 Differential Stethoscope, Allison's 4.50 
394 Digital Exploration of the Bladder : 
394 Thompson's Method. 
3051 394 Thompson's Urethral Knife 1.75 
30 5 2 394 Thompson's Vesical Director 2.50 
30 5 3 395 Thompson's Vesical Forceps 5.50 
3054 395 Thompson's Vesical Forceps 5.50 
3055 395 Thompson's Vesical Forceps 5.50 
390 Dilatation of the Bladder. 
2898 348 Dilating Catheter and Syringe, Otis' 4.50 
33 0 2 453 Forceps, Vesico-Vaginal, Thomas'... 3.00 
2647 300 Dilator, Anal 10.00 
2650 300 Anal, Sims' 4.50 
26 5 2 300 Anal, Thebaud's 12.00 
Fig. Page. Price. 
44 0 2 769 Dilator, Canalicula, Blitz's.... $4.00 
1793 147 Canalicula, Galezowsky's 2.50 
1788 147 Canalicula, Weber's 1.00 
1 789c 147 Canalicula, Williams' 1.00 
Laryngeal, see Laryngeal Dilators. 
3 1 49 425 Lithotrity, Dolbeau's 24.00 
3 1 50 425 Lithotrity, Guyon Duplay's 45.00 
28 6 3 344 Meatus Urinarius, Otis' 1.50 
2 1 49 205 Nasal, Woakes' 18.00 
2148 204 Nasal, Yearsley's 50 
See (Esophageal Stricture Dila- 
tors, Prostatic Dilator, Rec- 
tal Dilator, Tracheal Dilator, 
Urethral Stricture Dilator, 
Uterine Dilator and Vaginal 
Dilator. 
2031 188 Dionisius' Ear 16.00 
2029 188 Dipper Ear Trumpet.. 4.50 
1807 148 Director, Bowman's .50 
1346 81 Hamilton's, per set 2.50 
Herniotomy, see Herniotomy Director. 
1347 81 Hunter's .75 
3113 417 Little's 1.50 
1345 81 Director and Aneurism Needle .75 
1342 81 Director and Tongue Tie 1.00 
1344 81 and Tongue Tie .50 
1213 35 Disk Electrode .50 
12 1 9 35 Electrode 1.00 
610 Dislocation and Luxation : 
3993 615 Bigelow's Apparatus 
611 Dislocation of Clavicle: 
3983 611 Cooper's Apparatus 5.00 
3985 612 Mayor's Apparatus 5.00 
3984 612 Smith's Apparatus 
614 Dislocation of Phalanges : 
3991 614 Charriere's Luxation Forceps 9.00 
3987 614 Levis'Splint 1.50 
3990 614 Luer's Luxation Forceps 8.00 
3989 614 Plain Luxation Forceps 4.00 
611 Dislocation of the Shoulder Joint: 
3982 611 Apparatus for Preventing.... 6.00 to 9.00 
3981 610 Dislocation Pulleys, Brass, per pair 7.00 
3992 615 Japanned, per pair 5.00 
483 Displacements, Uterine. 
17 Dissecting Cases. (Lists and Prices, p. 17.) 
1143 19 Forceps 1.00 
1141 19 Forceps .75 
1142 19 Forceps 75 
1108 15 Forceps, Coxe ter s' .50 
1102 15 Forceps, Plain - .50 
1104 15 Hook .50 
1123 16 Hook, Grappling .60 
1126 16 Hooks, Chain .25 
1114 16 Hooks, Darling's .50 
1121 16 Hooks, Double .50 
1103 15 Knife, Cartilage .60 
1101 15 Scalpel, Darling's .75 
Scalpel, Glazed .60 
1105 15 Scissors .75 
Scissors, Curved 1.00 
Dittel's Elastic Ligature, per yard .25 
Divulsor, see Urethral Stricture Divulsor. 
1833 150 Dix's Spud 1.25 
2570 282 Dobell's Residual Air Pump 3.00 
1025 5 Stethoscope 1.50 
2389 239 Tongue-Holding Forceps 4.50 
2814 331 Doisneau's Compress 4.00 
3149 425 Dolbeau's Dilator 24.00 
3 1 51 425 Guide for Lithoclast 3.50 
3 1 52 425 Lithoclast 7.00 
424 Operation. 
3172 431 Dome Top Speculum Vaginae 1.50 
1 722 127 Dome Trocar, Fitch's Aspirating (4, 5) 2.50 
17 22 127 Fitch's Ovarian (1, 2, 3)... ...14.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
787 
Fig. Page. Price 
3 5 3 9 495 Donaldson's Flexion Pessary $2.00 
3540 495 Flexion Pessary 2.00 
3456 487 Uterine Supporter 2.50 
2086 195 Donder's Ear Spout .75 
3422 482 Double Current Catheter, Nott's, Female.. 2.50 
30 4 6 389 Nott's, Male 3.00 
30 4 5 389 Silver 5.00 
3044 389 Tiemann's "Velvet Eyed," Soft Rub- 
ber 2.50 
1914 163 Double-Edged Iris Knife 2.00 
1873 154 Double Hook, Eye, Sedillot's 1.50 
1868 152 Fixation 1.50 
1390 84 Operating, Ferruled 2.50 
Operating, Riveted 2.00 
39 4 6 597 Double Incline Plane (Splint) 4.00 to 6.00 
1122 16 Double Rachitome ' 15.00 
3558 497 Double Tenaculum, Emmet's 5.00 
3559 497 Sims'. 3.50 
3556 497 Double Tenaculum Forceps, Byrne's 6.00 
3553 497 Hanks' 3.00 
3557 497 Wooster's 2.50 
35 5 4 497 Wylie's 3.00 
2074 194 Douche, Aural, Lucae's Reflux 1.50 
2079 194 Aural, Sexton's 10.00 
2183 210 Catarrhal, Warner's 1.00 
1824 149 Eye, Agnew's 3.50 
Nasal, see Nasal Douche. 
Uterine, see Uterine Irrigation, Douch- 
ing. 
Vaginal, see Vaginal Syringe. 
2144 201 Vapor, Buttle's 2.00 
2141 201 Vapor, Hardy's 4.00 
127 9 75 Wound Cleansing 6.00 
38 5 0 564 Wound Cleansing, Esmarch's 4.50 
38 5 4 567 Wound Cleansing, Wyeth's 4.00 
3131 421 Dowell's Gorget and Staff 5.50 
2764 317 Hernia Needle, Curved 1.00 
2764 317 Hernia Needle, Straight 1.00 
3182 433 Speculum Vaginae 1.50 
3131 421 Staff and Gorget 5.50 
42 8 2 744 Doyle's Rectangle. 
428 1 744 Spiral Spring Rotator, Double 28.00 to 35.00 
4281 744 Spiral Spring Rotator, Single. 20.00 to 25.00 
75 Drainage. 
Drainage, Supra-Pubic Vesical: 
43 6 2 763 Keyes' Device for 
43 6 4 763 Keyes' Tube for 
See also Aspirator, Trocar, Ova- 
riotomy Drainage. 
128 7 75 Drainage Canula, Callender's 3.00 
128 6 75 Punch, Heuel's 1.50 
128 4 75 Trocar, Chassaignac's 4.00 
Trocar, Southey's 5.00 
75 Tube, Chicken Bone. 
128 2 75 Tube, Ellis' Spiral .75 
2126 197 Tube, Gruening's Mastoid .75 
2 1 24 197 Tube, Knapp's Mastoid .75 
2 1 25 197 Tube, Knapp's Mastoid .75 
Tube Ovariotomy, see Ovariotomy, 
Drainage. 
Tube, Tiemann's Velvet-eyed 2.00 
1283 75 Tube Carrier, Hamilton's 5.00 
1466 92 Tube Carrier, Ostrom's 3.00 
128 5 75 Tubing, Black Rubber, per yard .40 
3 7 6 4 540 Draper's Obstetrical Forceps 8.50 
26 9 3 307 Dressing Forceps, Anal 2.00 
128 8 76 Pocket Case 1.50 
1290 76 Pocket Case 1.50 
129 3 76 Spring 1.00 
3378 475 Uterine - 2.00 
33 7 9 475 Uterine 2.50 
33 8 3 475 Uterine 2.00 
33 8 4 475 Uterine, Bozeman's 2.50 
3383 475 Uterine, Elliott's 2.00 
Fig. Page. Price. 
3381 475 Dressing Forceps, Uterine, Jones' $6.00 
3377 475 Uterine, Nunn's 6.00 
33 7 6 475 Uterine, Slide Catch.... 3.00 
33 8 2 475 Dressing Forceps and Scissors, Nunn's .... 5.00 
129 5 76 Old's 3.50 
74 Dressing of Wounds, Materials for, see 
Antiseptic Surgery Materials. 
128 9 76 Dressing Scissors 1.2 > 
39 5 7 600 Splints, Set of 5 .50 
Splints, Basswood, Set of 12 1.00 
Drill, Mastoid, see Mastoid Process Drill. 
1129 18 Medulla Oblongata 1.75 
Osteotomy, see Osteotomy Drill. 
1827 150 Drop Glass for the Eye .20 
247 1 265 Tube, Laryngeal, Hartwell's 2.25 
40 Dry Cold and Heat. 
116 Dry Cupping: 
1657 116 Junod's Arm ■ 25.00 
1656 116 Junod's Boot 25.00 
1658 116 Thomas' Dry Cupper 1.50 
1388 84 Dry Dissector, Hamilton's 1.50 
1389 84 Hamilton's 1.50 
1393 84 Hamilton's 1.50 
1394 84 Hamilton's. 1.50 
120 5 34 Duchenne's Electrodes, per pair 2.50 
1075 12 Exploring Trocar 2.50 
1076 12 Exploring Trocar 3.50 
1070 11 Dudgeon's Sphygmograph 25.00 
1857 152 Dudley's Fixation Forceps 3.00 
1341 81 Needle Forceps 4.50 
1 744 134 Ophthalmoscope 30.00 
Dugas' Abdominal Supporter 5.00 
1302* Caustic Case 5.00 
72 Dressing Case 18.00 
72 Pocket Case 56.00 
1687 121 Duhring's Galvano Depilator 3.00 
40 7 0 645 Duncan Eve's Splint 50.00 to 60.00 
Dunster's Dressing Forceps 1.50 
172 5 127 Ovarian Trocar 6.00 
Thermometer 3.50 
3 1 5 0 425 Duplay's Dilator, Lithotrity 45.00 
2170 208 Rhinoscope 8.00 
1555 100 Durham's Retractor 3.00 
23 2 7 232 Seizing Forceps 4.50 
23 9 8 243 Seizing Forceps 4.50 
25 5 6 279 Trachea Canula 10.00 
1061 9 Dynamograph 75.00 
1059 9 Dynamometer .... 8.00 
1060 9 Hamilton's 5.00 
203 Ear, Artificial 100.00 
2031 188 Dionisius' 16.00 
Ear Instruments, see Aural. 
Ear Trumpets: 
20 25 187 Apparitor Auris, per pair 6.00 
2026 187 Auricles 5.00 
20 24 187 Compact 3.00, 3.25 and 3.50 
2036 188 Conversation Tube, Mohair 2.50 
Conversation Tube, Mohair, Conical. 4.00 
Conversation Tube, Silk 4.00 
Conversation Tube, Silk, Conical 6.00 
Conversation Tube, Silk, Conical, 
Ivory Fittings 16.00 
20 34 188 Corrugated Trumpet 4.00 
2041 189 Currier's Conical Conversation Tube. 
2040 189 Currier's Duplex Conversation Tube- 
2029 188 Dipper Trumpet 4.50 
2 0 3 7 188 Dome Trumpet , 2.50 to 5.00 
2031 188 Ear of Dionisius 16.00 
2027 187 German Silver 6.00 
20 28 187 Japanned, Conical 3.00 
2032 188 London Hearing Horn 4.00 to 5.50 788 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Ear Trumpets: 
2033 188 Long, Japanned $2.25 to $4.00 
2030 188 Martineau Hearing Horn 4.50 
2039a 188 Silver Cornets, per pair 2.50 
20395 188 Silver Cornets, per pair 3.00 
20 3 5 188 Telescopic Trumpet 4.50 
2023 187 Toynbee's Artificial Tympanum .30 
2038 188 Walking Cane Trumpet 6.00 to 25.00 
1054 7 Echoscope, Speir's 6.00 
42 7 5 741 Eclipting Spring for Flat Feet, per pair5.00 
Ecraseur (see also Ligator): 
3667 515 Barnes' Wire 5.00 
2208 215 Bettmann's Snare 8.50 
2064 192 Blake's Snare 3.50 
2207 215 Bosworth's Snare 5.00 
2042 190 Bosworth's Snare' 4.00 
Bosworth's Snare, with Straight and 
Curved End 5.00 
3670 515 Braxton Hicks' - 15.00 
3671 515 Braxton Hicks', Modified 15.00 
123 3 37 Cautery Sling 16.00 
3663 514 Chassaignac's 25.00 
3666 515 Cintrat's Ligator 2.50 
3683 519 Cintrat's Serre Noeud. 10.00 
4328 756 Cohen's Combination Snare 
43 2 6 756 Cohen's Snare 4.00 
3673 515 Edward's 18.00 
3665 514 Emmet's 35.00 
2497 268 Gibb's Laryngeal 3.00 
2205 214 Jarvis'Snare 4.00 
3684 519 Koeberle's Serre Noeud, per set 12.00 
2434 254 Penn's 5.00 
3675 516 Sajou's - 4.00 
Sajou's, -with Straight and Curved 
Ends 5.00 
3677 516 Sims'Porte Chain - 35.00 
4 34 1 759 Skene's Wire 7.50 
3669 515 Smith's Wire, Curved 6.00 
3668 515 Smith's Wire, Straight 5.00 
3672 515 Thompson's 25.00 
3674 515 Tiemann's Long Chain 20.00 
Tiemann's Small Chain 12.00 
Tiemann's Small Chain, Straight .... 10.00 
2063 192 Wilde's Polypus Snare.- 3.50 
Ectropium, see Ophthalmic, Palpebral. 
33 9 8 476 Edward's Caustic Holder 2.50 
3673 515 Ecraseur. 18.00 
3542 495 Stem Pessary 3.00 
25 8 3 284 Edson's Spray Producer 
Ehrich's Speculum 13.00 
Eiterbecken, see Pus Basin. 
Elastic Belt, see Abdominal Belt. 
2090 195 Elastic Caustic Holder 2.00 
Elastic Ligature, Dittel's, per yard .25 
128 3 75 Elastic Ligature Carrier, Hamilton's 5.00 
146 7 92 Helmuth's 3.50 
146 6 92 Ostrom's 3.00 
26 8 8 306 Elastic Probe 50 
2810 330 Elastic Stockings. Prices on page 330. 
670 Elbow and Wrist Splint, Andrew's 
4 1 25 669 Stillmann's 25.00 
613 Elbow-Joint, Dislocation of. 
4 1 34 676 Elbow Splint, Stromeyer's 18.00 
135 1 82 Eldridge's Bullet Probe .75 
288 1 346 Path-Finder, Urethral 35.00 
1154 23 Electric Disk, Garratt's. Prices on page 23. 
1208 35 Electrode, Arm 2.00 
1192 34 Aural and Nasal .75 
1210 35 Ball. 75 
1170 32 Beard's Base Needles, each .75 
116 7 30 Beard's Current Changer - 10.00 
1166 30 Beard's, with Band 1.50 
Bosworth's, Set in Case 33.00 
1196 34 Brush, Metallic 1.00 
Fig. Page. Price. 
1176 32 Electrode, Catheter, Nunn's $4.00 
1202 34 Catheter, Silver 2.50 
1203 34 Catheter, Silver 2.50 
1195 34 Comb 1.50 
1217 35 Dental 1.00 
1213 35 Disk, each .50 
1219 35 Disk, Insulated Points 1.00 
1205 34 Duchenne's, per pair 2.50 
120 9 35 Ear.. 2.75 
122 5 36 Ear, Double 2.00 
1200 34 Elastic, Urethral or Uterine 3.00 
1212 35 Eye .75 
1214 35 EyeCup 2.00 
12 1 5 35 Faradization Points 1.00 
1181 33 Foot Plate, Flannel Covered 4.00 
1231 36 Foot Plate, Metallic .50 
1216 35 Hair Brush 2.50 
1180 33 Hand Plate 1.50 
1206 34 Laryngeal - 1.50 
1207 34 Laryngeal. 1.50 
1204 34 Laryngeal- 1.00 
2498 269 Laryngeal, Mackenzie's 3.50 
1182 33 Long Handle 1.50 
1231 36 Metallic Foot Plate .50 
1218 35 Metallic Handle, per pair 1.50 
1215 35 Metallic Points, Faradization 1.00 
1211 35 Metallic Scourge .75 
1226 36 Metallic Sound .75 
1191 34 Nasal 1.00 
1192 34 Nasal and Aural .75 
1208 35 Neck. 2.00 
1229 36 Needle Holder, No. 1, for One Needle. .60 
1229 36 No. 2, for Two Needles 1 00 
122 9 36 No. 3, for Three Needles 1.25 
1229 36 No. 4, for Four Needles 1.50 
1229 36 No. 5, for Five Needles 1.75 
1229 36 No. 6, for Six Needles 2.00 
117 6 32 Nunn's Catheter 4.00 
1198 34 Olives, each .20 
1221 35 Pole Changer 5.00 
1174 32 Post's Warm Water 2.75 
1183 33 Rectal, Ball 1.25 
1230 36 Rectal, Insulated 2.50 
1185 33 Rectal, Insulated 2.00 
1184 33 Rectal, Nickel-plated 1.25 
1 188 33 Rectal, Nickel-plated, Large 1.40 
122 6 36 Sound. 75 
1199 34 Spiral, Uterine or Urethral 1.25 
1182 33 Sponge-covered 1.50 
1220 35 Sponge Cup .50 
1187 33 Sponge Cup 1.00 
1186 33 Sponge Holder 50 
1224 35 Sponge Holder and Current Breaker _ 4.00 
1194 34 Tongue 1.00 
1193 34 Tonsil 1.00 
1179 33 Universal Handle, per pair 1.50 
1201 34 Urethral.... 1.25 
1201 34 Uterine 1.25 
1 197 34 Uterine, each 2.00 
1228 36 Uterine 2.50 
1200 34 Uterine, Elastic 3.00 
1199 34 Uterine, Spiral 1.25 
1222 35 Vaginal, Insulated 4.00 
1223 35 Vaginal, Insulated 4.00 
1190 33 Vaginal, Insulated 2.50 
1189 33 Vaginal, Nickel-plated 1.50 
1178 33 Wheel - 5.00 
31 Electrodes in Cases, Set No. 1 30.00 
31 Set No. 2 15.00 
1161 31 Tiemann & Co.'s Set 12.00 
1989 176 Electro-Magnet, Bradford's 25.00 
1840 150 Gruening's 12.00 
1177 32 McIntosh's, without Cell 10.00 
1177 32 McIntosh's, with Cell 15.0 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
789 
Fig. Page. Price. 
176 Electro-Magnet in Ophthalmic Surgery. 
1172 32 Electro-Massage Instrument, Butler's $ 
1171 32 Post's 
37 Electro-Surgery, see also Galvano-Cauterv. 
23 Electro-Therapeutic: 
1156 24 Armadillo. Prices on page 24. 
1154 23 Garratt's Disks. Prices on page 23. 
See also Battery and Electrode. 
1227 36 Electrolysis Needles, each 1.00 
122 7 36 Platinum 2.00 
4344 759 Platinum, Freeman's 5.00 
2286 227 Elevating Forceps, Dental 2.75 
2302 229 Elevator, Screw 1.00 
1544 98 Trepanning 1.00 
Uterine, see Uterine Repositor. 
154 5 98 Elevator and Lenticular Knife 1.75 
1547 98 Elevator and Rasp 1.25 
3589 502 Ellinger's Uterine Dilator 10.00 
3595 503 Uterine Dilator 10.00 
35 7 3 500 Elliott's Intra-Uterine Speculum 7.00 
374 7 538 Obstetrical Forceps 9.50 
553 Set of Obstetrical Instruments 35.00 
471 Uterine Set 25.00 
3431 483 Uterine Sound 7.00 
1024 5 Elliottson's Stethoscope 5.00 
1282 75 Ellis'Drainage Spiral .75 
1068 11 Elsberg's JSsthesiometer 7.00 
2047 191 Angular Screw Hook 2.00 
2474 265 Insufflator 2.00 
2153 205 Nasal Speculum 5.00 
24 4 5 260 Pocket Laryngoscope 6.00 
24 7 4 265 Powder Blower 2.00 
2469 265 Sponge Holder and Throat Forceps- 6.00 
2386 239 Tongue Depressor 4.50 
2549 278 Trachea Tube, with Valve 8.00 
2020 185 Ely's-Siegle's Otoscope 7.00 
14 Embalming. 
1099 14 Pump 22.00 
3793 548 Embryotomy Forceps, Bachelder's 12.00 
379 1 548 Tiemann & Co.'s 3.00 
625 Emergency Operating Sets: 
4017 625 Heuel's Pocket Set 60.00 
4038 628 Smith's Compact Pocket Set 18.00 
40 4 0 629 Smith's General Operating Set 200.00 
4041 630 Tremaine's Operating Bag 175.00 
3394 476 Emmet's Applicator 1.50 
1738 133 Aspirator 12.00 
3300 453 Ball and Socket Knife 5.00 
Ball and Socket Knife, Improved 7.00 
Bed Pan, Copper 6.00 
33 4 3 466 Buttonhole Scissors 8.00 
3317 456 Counter-pressure Hook 1.25 
3635 511 Curette Forceps 3.50 
33 3 7 464 Cystitis Eyelet .25 
3558 497 Double Tenaculum 5.00 
3665 514 Ecraseur 35.00 
3634 511 Enucleator 1.50 
3338 465 Fistula Tube .30 
132 0 79 Needle, per dozen 1.50 
3307 454 Needle Forceps 3.00 
1723 127 Ovarian Trocar 4.50 
Perineal Retractor 7.00 
34 6 5 489 Ring Pessary .50 
32 9 9 453 Scissors, Double Curved 4.50 
32 9 7 453 Scissors, Knee Bent 4.50 
32 9 8 453 Scissors, Slightly Curved 4.50 
462 Set of Vesico-Vaginal Instruments-_ 80.00 
350 1 491 Smith's Pessary .50 
3236 445 Speculum Vaginae 7.00 
3600 504 Sponge Dilator 2.50 
32 5 7 449 Tenaculum 1.25 
3258 449 Tenaculum 1.25 
32 5 9 449 Tenaculum 1.50 
3261 449 Tenaculum 1.25 
Fig. Page. Price. 
3 5 58 497 Emmet's Tenaculum, Double $5.00 
33 1 5 456 Twisting Forceps 3.00 
33 4 3 466 Urethral Buttonhole Scissors 8.00 
3603 504 Uterine Dilator 2.00 
3427 483 Uterine Elevator 4.50 
3300 453 Uterine Knife 5.00 
1441 90 Uterine Tourniquet 5.50 
3676 516 Uterine Tourniquet .- 5.50 
3824 554 Uterine Tourniquet 5.50 
3603 504 Water Dilator 2.00 
305 Enema Apparatus, see also Rectal Infusors, 
Injectors and Irrigators. 
Endermic, see Hypodermic. 
2858 344 Endoscope, Auspitz's 20.00 
2856 343 Desormeaux's 60.00 to 125.00 
28 52 343 Glass (Meatoscope), each .50 
28 5 5 343 Laveur's 20.00 
43 6 6 764 Klotz's 8.50 
2857 343 Otis' Endoscopic Tube 1.50 
2860 344 Plain, Glass Front 
2861 344 Skene's 2.75 
2854 343 Skene's Urethral Speculum 2.50 
28 5 9 344 Smith's Urethroscope 8.50 
2853 343 Weir's Meatoscope 1.25 
Engelman's Placenta Curette 3.00 
2842 339 English Sound Guage 3.50 
65 Enos' Minor Operating Set 33.00 
1107 15 Enterotome 2.50 
2752 313 Depuytren's 5.00 
17 66 145 Entropium Forceps, Cross-Bar 2.25 
1764 145 Desmarre's 3.00 
17 60 145 Knapp's 4.00 
1765 145 Laurence's 3.00 
1768 145 Prout's 4.00 
1762 145 Roehrich's 3.00 
1761 145 Snellen's 2.50 
1763 145 Tiemann & Co.'s 7.00 
17 6 7 145 Tiemann & Co.'s 7.00 
1986 175 Enucleation Scissors 1.50 
1988 175 Spoon, Wells' 2.75 
3634 511 Enucleator, Emmet's 1.50 
3652 512 Sims' 3.50 
3653 512 Sims'Blunt Hook 3.50 
3638 511 Yarrow's 4.50 
255 Epiglottis. 
249 9 269 Pincette, Brun's 4.50 
17 73 146 Epilating Forceps, Cilia 1.00 
1775 146 Gruening's a 1.75 
17 76 146 Henry's 2.50 
1774 146 Piffard's 1.50 
562 Episiorrhaphy. 
212 Epistaxis. 
2196 212 Canula, Belocq's, Plated 2.00 
2196 212 Canula, Belocq's, Silver 3.00 
2194 212 Clamp, Caro's .75 
2195 212 Tampon, Rubber .75 
1433 89 Erichson's Arterial Compressor 25.00 
1454 91 Esmarch's Artery Forceps, Bulbous 2.50 
1453 91 Artery Forceps, Fenestrated 3.00 
1455 91 Artery Forceps, Torsion 2.50 
40 2 0 626 Artery Forceps, Torsion 2.50 
1440 90 Bandage, Tourniquet 3.50 
1432 89 Bandage Clamp .75 
387 7 574 Bandage Knife 3.00 
3878 574 Bandage Shears 4.50 
90 Bloodless Method. 
385 1 565 Cooling Coil. 
3850 564 Irrigator 4.50 
38 7 7 574 Knife and Wedge 3.00 
1298 76 Knife and Wedge 3.00 
3715 530 Ovariotomy Clamp 6.00 
4404 620 Splint, Ankle 
3996 617 Splint, Langensalza 
3994 617 Splint, Wrist 790 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
3852 565 Esmarch's Syphon for Cooling Wounds.T- $ 
1440 90 Tourniquet 3.50 
Ether Inhaler, see Anaesthetic Inhaler. 
28 0 2 328 Eugene Abdominal Supporter 6.00 
199 Eustachian Canal. 
2130 199 Eustachian Catheter, Coin Silver 1.50 
2138 199 Ferguson's... 2.00 
2136 199 Fitzgerald's - 2.50 
2 1 30 199 Hard Rubber .75 
2 1 30 199 Nickel-plated .75 
2 1 35 199 Noyes', Left 2.50 
2135 199 Noyes', Right. 2.50 
2 1 30 199 Pure Silver 2.00 
2132 199 Sexton's 1.25 
2 1 30 199 Silver (Coin) 1.50 
2137 199 Woake's 1.50 
2134 199 Eustachian Catheter Holder, Bonafont's .. 2.00 
2133 199 Pomeroy's 3.50 
2131 199 Wire Clamp 1.00 
201 Eustachian Tube Inflators; 
Politzer's Air Bag 1.50 
2139 201 Politzer's Air Bag 2.00 
2140 201 Roosa's-Politzer's Air Bag 3.50 
2142 201 Sexton's Insufflator 2.00 
2 1 4 5 201 Sexton's Nozzle 1.00 
2143 201 Eustachian Spray, Hackley's 6.50 
201 Eustachian Vapor Douches: 
2144 201 Buttle's Inhaler 2.00 
2141 201 Hardy's Chloroform Douche 4.00 
Evacuating Apparatus, see Lithotrity: De- 
bris Evacuators. 
65 Eve's Minor Operating Set 33.50 
4070 645 Leg Extension Brace 50.00 to 60.00 
Eversion of Feet, see Orthopaedic: Deform- 
ities of the Feet. 
216 Evulsion of Hypertrophied Nasal Tissue. 
2210 216 Robinson's Forceps for 4.50 
22 8 3 227 Excising Forceps, Dental 2.75 
22 8 4 227 Dental 2.75 
616 Excision of Joints. 
69 Exhibition Pocket Set 100.00 
Expeller, see Sponge Tent Expeller. 
394 Exploration, Digital, of the Bladder. 
2017 185 Explorer, Toynbee's .75 
130 9 77 Exploring Director 1.00 
130 7 77 Needle .75 
199 the Eustachian Canal. 
1079 12 Exploring Trocar 1.50 
1075 12 Duchenne's 2.50 
1076 12 Duchenne's 3.50 
1077 12 Noegerrath's 3.50 
1078 12 Tiemann & Co.'s 2.50 
1715 126 Exploring Trocar and Case 2.50 
104 Exsection, see also Osteotomy. 
619 Excision of Joints. 
106 Case, Set of Instruments 65.60 
4002 619 Drills, Wyeth's, per set 7.00 
Saw, see Osteotomy: Resection and 
Exsection Saws. 
4001 618 Spike, for Transfixion of Bones .75 
617 Exsection Splints, for Securing Immobility: 
4004 620 Esmarch's Ankle 
3996 617 Esmarch's Elbow, " Langensalza" ... 
3994 617 Esmarch's Interrupted, for Wrist.... 
4003 619 Packard's 5.50 
4008 620 Liillman's Ankle Bracket 
3997 618 Stillman's Elbow Bracket 
3998 618 Stillman's Wrist Bracket 
4006 620 Volkmann's Dorsal 
4000 618 Watson's Suspension Bar 
1614 107 Exsector, Gowan's 24.00 
1615 107 Wyeth's 20.00 
3948 597 Extension Bar for Thigh Fractures 5.00 and 6.00 
4203 710 Extension for Short Leg (Shoes extra) 9.00 
Fig. Page. Price. 
4204 710 Extension for Short Leg, and Weak Ankle 
Brace (Shoes extra) $18.00 
576 Extension and Counter-extension. 
3906 , 
to <582 Buck's Extension, Complete 10.50 
3910 ' 
3911 583 Buck's Fulcrum and Weights 4.00 
39 1 2 583 Levis'Fulcrum 3.50 
39 1 2 583 Levis'Fulcrum and Weights 5.00 
39 1 3 583 Sayre's Extension Sundries 1.00 
39 1 3 583 Sayre's Extension Sundries and Buck's 
.Fulcrum.. 4.00 
175 Extirpation of the Eye-Ball: 
198 5 175 Ball's,Double Hook 3.00 
1984 175 Forceps, Blitz's 3.00 
198 7 175 Forceps, Bull-dog 2.50 
1986 175 Scissors 1.50 
1988 175 Spoon, Wells' 2.75 
See also Enucleation. 
383 Extrophy of Bladder. 
30 1 3 383 Tiemann's Apparatus for.. 35.00 to 100.00 
4313 754 Eye, Artificial, Composition 8.00 
1990 177 Artificial, Glass 10.00 
1828 150 Eye Bath Glass 50 
179 Eye Cases, Sets of Instruments. 
1214 35 Eye Cup Electrode 2.00 
1824 149 Eye Douche, Agnew's 3.50 
1825 149 Stop-cock for 1.00 
1212 35 Eye Electrode, Small .75 
134 Eye Instruments, see Ophthalmic. 
2101 196 Eyelet, Politzer's .30 
2101 196 Eyelet Forceps, Politzer's 1.50 
2401 244 Fahnstock's Tonsilotome 8.00 
747 False Joints (Pseudarthrosis). 
1569 101 Faraboeuf's Osteophor 7.00 
1164 29 Faradic Battery, McIntosh's Family 10.00 
1161 27 McIntosh's Physicians' 18.00 
12 1 5 35 Faradization Points 1.00 
84 Fasciotomy, see also Minor Surgery Instru- 
ments. 
2 5 0 3 269 Fauvell's Laryngeal Polypus Forceps 4.00 
2 5 0 6 270 Throat Forceps 6.00 
Feeding Tube, English, Plain 1.50 
26 2 2 294 English, Funnelled 1.75 
26 2 7 296 English, Funnelled 1.75 
2626 296 French, Funnelled 1.00 
26 2 0 294 Paine's Nasal, " Velvet Eyed " 1.00 
26 6 5 303 Tiemann's "Velvet Eyed," Rectal 1.50 
2621 294 Tiemann's "Velvet Eyed," Stomach. 1.50 
2621 294 Tiemann's "Velvet Eyed," Stomach, 
Long.. 2.00 
Feet, Bones of the, see Osteological. 
Deformities of the, see Orthopaedic. 
1005 3 Fehlich's Flask, Burner and Curette 4.75 
Femur, Fractureof, see Fracture of Femur. 
Un-united Fracture of, see Pseudar- 
throsis. 
Felt, Russian, per square foot .80 
4 1 6 5 692 Felt Jacket, Spinal 25.00 
577 Felt Splints. Send for Price List. 
1452 91 Fenestrated Artery Forceps 2.00 
2049 191 Ear Scoop. 1.50 
1959 168 Lens Scoop, Levis' 1.50 
2 1 38 199 Ferguson's Eustachian Catheter 2.00 
1565 101 Lion-jaw Bone-holding Forceps 3.00 
1567 101 Lion-jaw Bone-holding Forceps 3.00 
307 8 402 Lithotrite 25.00 
3 1 74 431 Mirror Speculum, Glass .50 
1568 101 Sequestrum Forceps 2.50 
1033 5 Stethoscope 1.50 
26 3 5 298 Tubular Speculum, Glass .50 
Tubular Speculum, Hard Rubber 1.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
791 
Fig. Page. Price. 
Ferguson's Tubular Speculum, Hard Rub- 
ber, with Nickel-plated Metal Mirror, $1.50 
3171 431 Tubular Speculum, Metal 1.50 
1366 84 Feruled Operating Scalpels, &c. 1.25 
Ivory Handled 1.50 
1429 88 Field Tourniquet, Prussian .75 
1429 88 U.S. Army... 1.00 
2876 345 Filiform Bougie, Nos. 0, 1, 2, each .50 
2880 346 Banks' Whalebone 1.25 
28 7 8 346 Gouley's Whalebone .50 
37 8 0 544 Fillet, Obstetrical 6.00 
1007 3 Filtration Apparatus, Rapid 5.00 
1396 85 Finger Knife 1.00 
136 7 84 Knife, Bistoury 1.25 
1507 96 Knife, French 2.50 
1508 96 Knife, French 2.00 
Luxation of, see Luxation. 
2783 323 Pad Truss, Tiemann's 5.00 
25 2 9 277 Protector.... 2.00 
24 5 7 264 Sponge Holder 1.50 
1109 15 Finnell's Knife, Saw and Handle 4.50 
1317 79 Post Mortem Needle .20 
17 Post Mortem Set 12.50 
1940 165 Fischer's Iris Forceps 1.25 
2830 336 Fisher's Phimosis Forceps 3.00 
Fistula Lachrymalis Knife, see Ophthal- 
mic: Lachrymal. 
33 3 8 465 Fistula Tube, Emmet's .30 
448 Vesico and Recto-Vaginal. 
449 Vesico-Vaginal. 
2803 328 Fitch's Abdominal Supporter 4.00 to 6.00 
1722 127 Aspirator Needles, Nos. 4, 5 2.50 
1722 127 Clamp Forceps, No. 6 4.50 
3012 381 Dome Trocar Catheter 6.00 
1741 133 Handy Aspirator 5.00 
1 722 127 Ovarian Dome Trocar, Nos. 1, 2, 3 14.00 
336 9 474 Uterine Sound 2.00 
3316 456 Wire Twister 4.50 
2 1 36 199 Fitzgerald's Eustachian Catheter 2.50 
1859 152 Fixation and Tumor Forceps 1.50 
152 Fixation Forceps (Ophthalmic): 
18 58 152 Carron de Villard's 3.00 
1863 152 Curved 1.50 
1860 152 De la Roza's 2.00 
18 5 7 152 Dudley's 3.00 
1862 152 Graefe's 2.00 
1864 152 Jaeger's 8.00 
1861 152 Noyes' 3.00 
152 Fixators (Ophthalmostate): 
1868 152 Double Hook 1.50 
1864 152 Jaeger's 8.00 
186 5 152 Noyes' 2.00 
1866 152 Pamard's Pique 1.50 
186 7 152 Three-pointed 1.50 
35 5 5 497 Fixator, Uterine, Byrne's 2.50 
See Uterine Tenaculum and Uterine 
Tenaculum Forceps. 
741 Flat Foot. 
4275 741 Eclipting Spring for, per pair 5.00 
4276 742 Sayre's Apparatus for, each 12.00 
146 2 92 Fletcher's Aneurism Needle 3.00 
1357 83 Flexible Bullet Forceps, Tiemann's... 6.00 
1358 83 Bullet Forceps, Weisse's 10.00 
26 8 9 306 Director, Silver 1.50 
1020 5 Stethoscope 1.25 
1035 5 Stethoscope, Arnold's 1.50 
1711 126 Flint's Aspirator and Trocar 5.00 
1055 8 Cyrtometer 10.00 
1050 7 Percussor, Hard Rubber Handle .75 
1050 7 Percussor, Steel Handle 1.00 
18 Physiological Armamentarium 70.00 
1046 7 Pleximeter .35 
1711 126 Trocar and Aspirator 5.00 
1000 1 Urine Test Apparatus 70.45 
Fig. Page. Price. 
2 Flint's Urine Test Extras. Prices on page 2. 
4392 767 Flood's Artificial Leech Glass, each $1.25 
4372 764 Fluhrer's Aluminium Bullet Probe 4.50 
43 9 5 767 Cautery Protector 
4010 621 Crochet Drill.. 2.00 
4011 621 Fork 3.00 
4012 621 Grooved Retractor 2.50 
Set for Wiring Bones 18.00 
2 59 1 286 Spray Tube 5.00 
4 1 26 670 Swinging Cradle 
4013 621 Wire Suture, each .50 
3849 563 Folding Litter 
153 0 97 Saw, Lewis' 2.50 
2384 238 Tongue Depressor 1.25 
23 7 8 238 Tongue Depressor, Green's 2.25 
23 8 5 239 Tongue Depressor, Pocket .75 
23 8 3 238 Tongue Depressor, Steel 2.50 
33 6 7 474 Uterine Sound 2.50 
3 7 8 7 548 Vectis 3.50 
2 1 66 206 Folsom's Nasal Speculum 1.50 
2786 324 Truss 20.00 
1181 33 Foot Plate Electrode, Flannel-covered 4.00 
123 1 36 Metallic .50 
306 1 399 Forceps, Alligator : Curved Urethral 6.00 
2072 193 Noyes' Ear 4.50 
3060 399 Straight Urethral 5.50 
1348 82 Forceps, Arrow Extracting, Bill's 2.50 
Artery, see Artery Forceps. 
103 Forceps, Bone Cutting: 
1566 101 Hamilton's Serrated Cutter 10.00 
1596 103 Heuel's 3.50 
1595 103 Isaac's, Large 7.00 
1595 103 Isaac's, Small 4.00 
1589 103 Liston's, Best 3.00 
1589 103 Liston's, Second 2.50 
1594 103 Liston's, Extra Sizes 4.00 to 7.00 
1591 103 Liston's, Curved on the Flat 3.50 
1592 103 Liston's, Knee Bent 3.50 
Liston's, Knee Bent, Extra Large 
4.00 to 7.00 
1593 103 Satterlee's, Large 3.00 
1 593 103 Satterlee's, Small 2.50 
1600 103 Velpeau's 4.00 
103 Forceps, Bone Gouging (Rongeur): 
1599 103 Curved , 3.50 
1597 103 Darby's 4.00 
1 590 103 Hoffman's 4.00 
1620 108 Post's 3,00 
1598 103 Straight 3.50 
101 Forceps, Bone Holding : 
1569 101 Farabeuf's Osteophor 7.00 
1565 101 Ferguson's Lion-jaw 3.00 
1567 101 Ferguson's Lion-jaw 3.00 
1568 101 Ferguson's Sequestrum 2.50 
1570 101 Hamilton's Osteophor 4.00 
1572 101 Hamilton's Sequestrum 2.50 
1571 101 Markoe's Sequestrum 3.00 
1537 98 Van Buren's Sequestrum 2.50 
1444 91 Forceps, Bull-dog : Artery 1.50 
1987 175 Extirpation of Eye 2.50 
1134 18 Gastric Fistula 2.50 
Forceps, Bullet Extracting, see Bullet For- 
ceps. 
Forceps, Canulated: 
2066 193 Allen's Aural 4.50 
2056 192 Avery's Aural 4.50 
2062 192 Bumstead's Aural 4.00 
20 58 192 Tiemann & Co.'s Aural 4.50 
1919 163 Wilde's Ophthalmic 12.00 
3388 476 Forceps, Caustic: Gardner's 3.00 
33 8 7 476 Sims' 3.50 
1773 146 Forceps, Cilia 1.00 
17 7 5 146 Cilia, Gruening's 1.75 
1776 146 Cilia, Henry's 2.50 792 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
17 7 4 146 Forceps, Cilia, Piffard's ..$1.50 
1481 94 Clamp, Nott's 6.00 
3 7 0 3 528 Clamp, Wells' 8.00 
Craniotomy, see Craniotomy For- 
ceps. 
Dental, see Dental Forceps. 
1683 121 Depilating, Henry's 2.50 
2815 331 Depilating, Henry's 2.50 
3302 453 Dilating, Thomas' 3.00 
Dissecting, see Dissecting Forceps. 
Dressing, see Dressing Forceps. 
Ear, see Aural : Foreign Body and 
Polypus Forceps. 
3793 548 Embryotomy, Bachelder's 12.00 
3 791 548 Embryotomy, Tiemann & Co.'s 3.00 
Entropium, see Entropium Forceps. 
2499 269 Epiglottis Pincette 4.50 
Epilating, see Epilating Forceps. 
1984 175 Extirpating, Eye- 3.00 
1130 18 Extirpating, Nerve 2.00 
Eye, see Ophthalmic : Entropium, 
Enucleation, Epilating, Extirpa- 
tion, Fixation, Iris and Strabis- 
mus Forceps. 
2101 196 Eyelet, Politzer's 1.50 
3148 423 Forcipressure 2.50 
4022 626 Forcipressure 2.50 
16 78 120 Grappling, Piffard's 3.00 
Gullet, see (Esophageal Forceps and 
Throat Forceps. 
Harelip, see Harelip Forceps. 
Iris, see Ophthalmic: Cataract, Iris 
Forceps. 
Laryngeal, see Laryngeal Forceps. 
1960 168 Lens and Foreign Body 3.00 
1771 145 Lid, Carron de Villard's 4.00 
2727 310 Ligating, Bodenhamer's 4.50 
2724 310 Ligating, Bodenhamer's 4.50 
146 5 92 Ligature, Wight's 1.75 
3141 421 Lithotomy 3.00 
3139 421 Lithotomy, Curved 3.00 
3140 421 Lithotomy, Little's 3.00 
3991 614 Luxation, Charriere's 9.00 
3990 614 Luxation, Luer's 8.00 
3989 614 Luxation, Plain 4.00 
1096 13 Microscopic, Curved .75 
1095 13 Microscopic, Straight .75 
Midwifery, see Obstetrical Forceps. 
2394 243 Musseux's, Seizing 2.50 
Nail, see Nail Extracting Forceps. 
Nasal, see Nasal Polypus Forceps, 
Nasal Septum Forceps. 
Necrosis, see Rongeur. 
Needle, see Needle Forceps. 
Obstetrical, see Obstetrical Forceps. 
36 9 6 526 Pedicle, Wells' Angular 5.00 
3697 526 Pedicle, Wells'Straight 5.00 
36 9 8 526 Pedicle, Wells'T Shaped . - 5.00 
Phimosis, see Phimosis Forceps. 
Pile, see Hsemorrhoidal Clamps. 
3 7 9 5 548 Placenta 2.50 
Placenta, Bozeman's 3.00 
Placenta, Loomis' 6.00 
See also Embryotomy Forceps. 
129 0 76 Polypus. 1.50 
See Nasal Polypus Forceps ; also 
. Uterine Tumor and Polypus 
Forceps. 
3610 505 Punching, Thomas' 6.00 
Rongeur, see Rongeur. 
2262 224 Root, Dental 2.00 and 2.75 
22 6 3 225 Root, Dental 2.00 and 2.75 
3693 525 Sac, Thomas' 3.50 
3695 525 Sac, Wells' 4.50 
Fig. Page. Price. 
36 9 2 525 Forceps, Sac, Wilcox's $5.50 
Seizing, see Seizing Forceps. 
Sequestrum, see Sequestrum Forceps. 
39 7 6 608 Shrimpton's, for Shaping Splints 3.00 
229 1 227 Splitting, Goodwillie's 2.75 
4329 756 Sponge, Cohen's, each 4.00 
1877 154 Strabismus, Curved 1.50 
1881 154 Strabismus, Straight 1.25 
1323 80 Suture, Allis' - 2.00 
Tonsil, see Tonsil Forceps. 
Throat, see Throat Forceps. 
3269 449 Tissue, Thomas' 4.50 
2 3 9 0 239 Tongue, Cusco's 4.50 
23 8 9 239 Tongue, Dobell's 4.50 
Tooth, see Dental Forceps. 
Torsion, see Torsion Forceps. 
2528 276 Tracheal, Tiemann & Co.'s 4.50 
2 5 2 5 276 Tracheal, Trousseau's 2.50 
1537 98 Trepanning, Van Buren's 2.50 
1772 146 Trichiasis, Ratti's 3.00 
Tumor, see Tumor Forceps, Uterine 
Tumor and Polypus Forceps. 
Urethral, see Urethral Foreign Body 
Extractors. 
2412 246 Universal, Tiemann's 2.50 
22 6 2 224 Universal Tooth 2.00 and 2.75 
22 7 6 226 Universal Tooth 2.00 and 2.75 
Uterine, see Uterine Dressing Forceps. 
30 5 3 395 Vesical, Thompson's 5.50 
3054 395 Vesical, Thompson's 5.50 
3055 395 Vesical, Thompson's.. 5.50 
Vulsellum, see Vulsellum Forceps. 
Wire Cutting, see Wire Cutter. 
Wire Twisting, see Wire Twisting For- 
ceps. 
3818 551 Forceps Saw, Van Huevel's 
Foreign Body, Aural, see Aural; Foreign 
Body and Polypus. 
2200 213 Hook... 1.00 
Laryngeal, see Laryngeal Forceps. 
Nasal, see Nasal Polypus Forceps. 
(Esophageal, see (Esophageal and 
Throat Forceps. 
Ophthalmic, see Ophthalmic: Foreign 
Body Instruments. 
Urethral, see Urethral: Foreign Body 
Extractors. 
371 4 530 Forne's Serre Noeud 
1265 51 Foster's Operating Table 100.00 
1268 53 Speculum Holder, with 2 Blades 15.00 
3414 480 Vaginal Syringe 4.00 
2 5 2 4 276 Foulis'Artificial Larynx 
1421 87 Four-bladed Pocket Instrument 6.00 
66 Four-fold Pocket Case 21.00 
3 861 569 Fowler's Antiseptic Ligature Carrier 3.50 
3494 491 Bow Pessary 1.75 
Needle Holder 6.00 
3481 490 Pessary 1.25 
392 1 587 Fox's Clavicle Splint .. 5.00 
1688 121 Electrolysis Needle and Holder 3.90 
Head Band 8.00 
576 Fracture: 
3906 582 Apparatus, Buck's Extension 10.50 
38 8 5 577 Apparatus, Buck's Suspension 18.00 
39 5 2 598 Apparatus for Gun-shot Fracture 
10.00 to 25.00 
3942 591 Bed, Skinner's 25.00 
3917 584 Box 3.00 to 4.00 
3961 601 Box, Fry's 6.00 
3918 585 Box, Petit's 
3958 601 Cradle, Salter's 20.00 
3914 584 Rest, Volkman's Sliding 4.50 to 6.50 
577 Splints, Adaptable Felt. Send for 
Price List. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
793 
Fig. Page. Price. 
589 Fracture Splints, Arm, Humerus. 
Splints, Day's, per set $50.00 
580 Splints, Levis', per set 15.00 
3915 584 Splints, Volkman's T 5.50 to 6.50 
591 Fracture, Colles', see also Colles' Fracture 
Apparatus. 
605 Fracture, Compound. 
3974 607 Fracture, Dressing. 
Extension, see Extension and Counter- 
Extension. 
587 Fracture of Clavicle : 
3921 587 Fox's Splint 5.00 
3920 587 Levis'Splint 5.00 
39 2 2 588 Richardson's Splint 6.00 
39 2 3 588 Sayre's Dressing. 
589 Fracture of Elbow: 
3930 590 Clark's Splint 5.00 to 8.00 
39 2 9 590 Hamilton's Splint 
593 Fracture of Femur : 
39 4 3 594 Burge's Apparatus . 50.00 
39 4 6 597 Double Incline Plane 4.00 to 6.00 
39 4 8 597 Extension Bar 5.00 to 6.00 
39 5 2 598 Gun-shot Apparatus 10.00 to 25.00 
39 4 4 595 Lente's Hospital Splint 18.00 
39 4 7 597 Liston's-Mclntyre's Splint 16.00 
39 5 0 598 Munger's Splint, Complete 6.00 
39 4 2 594 Skinner's Fracture Bed 25.00 
599 Fracture of Fibula and Tibia : 
39 5 9 601 Ankle Splints, Left .75 to 1.50 
3960 601 Ankle Splints, Right .75 to 1.50 
39 6 2 601 Clark's Splint and Cradle 30.00 
3956 600 Depuytren's Fibula Splint 
3957 600 Dressing Splints, set of 5 .50 
39 5 3 599 Hodgen's Splint 6.00 
3955 600 Raphael's-Pott's Splint 5.00 
39 5 8 601 Salter's Cradle 20.00 
39 5 4 600 Wackerhagen's Splint 
590 Fracture of Forearm and Wrist: 
3932 591 Coover's Splint, each 1 50 
39 3 7 591 Interosseous Splint .30 to .70 
3935 591 Left Radius Splint .50 to .80 
3934 591 Right Radius Splint ... -. .50 to .80 
39 3 8 592 Smith's Splint 
39 3 9 592 Smith's Splint 
3936 591 Squire's Forearm Splint 1.00 to 1.50 
3933 591 Stillman's Bracket 
3931 591 Tiemann & Co.'s Sling 4.50 
589 Fracture of Humerus : 
39 2 6 589 Bancroft's Arm Splint 
39 2 7 589 Condyle and Humerus Splint.. .75 to 1.25 
3928 589 Condyle and Humerus Splint, Jointed, 
1.00 to 1.50 
3924 589 Dressing for Neck of Humerus. 
39 2 5 589 Joint Arm Splint 2.00 to 2.50 
586 Fracture of Inferior Maxilla : 
39 1 9 586 Hamilton's Bandage 5.00 to 12.00 
39 0 2 581 Levis'Metallic Splint... .75 
590 Fracture of Olecranon : 
39 3 0 590 Clark's Splint 5.00 to 8.00 
3929 590 Hamilton's Elbow Splint 
602 Fracture of Patella : 
39 7 2 605 Bacon's Support 18.00 
3970 604 Boisnot's Splint 12.00 
3968 603 Dennison's Windlass, each 1.50 
3971 604 Hamilton's Splint 8.00 to 10.00 
3964 602 Hartshorn's Splint 7.00 
39 6 6 603 Jointed Splint, with Screw 2.00 to 2.75 
39 6 7 603 Levis'Splint 6.00 
4401 769 Otis'-Malgaigne's Hooks. 5.50 
39 6 5 603 Splint . .80 to 1.25 
39 6 9 604 Stillman's Brackets 
3973 605 Tiemann's Support 5.50 
39 6 3 602 Turner's Splint 12.00 
586 Fracture of Ribs. 
Fig. Page. Price. 
608 Fracture of Thigh and Leg : 
39 7 7 608 Byrd's Wire Gauze and Smith's Splint, $5.00 
3979 609 Clendinen's Splint 
39 8 0 609 Hodgen's Suspending Apparatus 5.00 
3975 608 Smith's Anterior Splint 3.00 
39 7 8 609 Suspension Splint 20.00 
586 Fracture, Passive Motion. 
585 Fracture, Simple. 
Fracture, Un-united, see Pseudarthrosis. 
2 1 5 5 205 Fraenkel's Nasal Speculum 3.50 
2560 281 Pneumatic Apparatus 15.00 
2 1 71 208 Rhinoscope 8.00 
2174 208 Uvula Hook 2.50 
28 2 5 335 Fraenum Probe and Spatula 1.00 
4 1 84 699 Frame, Stillman's Horizontal 
4 1 83 699 Stillman's Vertical 
3415 481 Fraser's Intra-Vaginal Syringe 3.00 
3480 490 Frazer's Pessary 1.25 
4344 759 Freeman's Electrolysis Needle, Large 5.00 
43 4 4 759 Electrolysis Needle, Small 2.00 
284 1 339 French or Metric Scale, Steel Guage 3.50 
2790 325 Truss, Adjustable, Double 8.00 
2 7 7 5 322 Truss, Adjustable, Single 4.50 
2 7 8 9 325 Truss, Double 6.00 
2774 322 Truss, Single, Soft Pad 4.00 to 5.00 
3 1 81 433 French's Speculum Vaginae 1.50 
43 4 5 759 Fritsche's Uterine Dilators, each 1.50 
Bozeman's Reflux Catheter 5.00 
341 6 481 Frost's Vaginal Douche 2.50 
39 61 601 Fry's Fracture Box 6.00 
32 3 3 445 Fryer's Self-retaining Speculum ... 12.00 
323 1 444 Sims'Speculum Vaginae 2.00 
1663 118 Transfusion Apparatus 6.50 
1146 21 Fuller's Pocket Medicine Case, Style 1 2.75 
1146 21 Pocket Medicine Case, Style 2 3.00 
1146 21 Pocket Medicine Case, Style 3 3.50 
1146 21 Pocket Medicine Case, Style 4 5.00 
1146 21 Minim Measure, No. 2 .75 
1146 21 Minim Pipette, No. 1 .50 
1146 21 Vial, No. 3, per dozen .35 
1146 21 Vial, No. 4, per dozen .35 
Vial Labels, Adhesive, per sheet .03 
2 5 9 7 287 Fullgraf's Flat Bill Laryngeal Spray 6.00 
2186 211 Laryngeal and Posterior Nares Douche 3.00 
2597 287 Laryngeal Spray, Flat Bill 6.00 
2 5 9 0 286 Laryngo-Tracheal Douche 6.00 
2180 210 Nasal Douche 3.50 
122 Fumigation Apparatus, Mercurial: 
1695 122 Bumstead's-Lee's Lamp 3.00 
1696 122 Maury's Apparatus 12.00 
1694 122 Van Buren's Apparatus 2.50 
1694 122 Van Buren's Lamp 1.50 
3 7 8 6 548 Funis Clamp, Pulling's .40 
2102 196 Furuncle Knife, Buck's 1.50 
23 6 7 237 Gag, Allingham's 7.00 
23 6 7 237 Annandale's 7.00 
23 7 4 237 Clover's 3.50 
43 3 2 757 Denhard's 7.00 
23 4 7 235 Goodwillie's 7.00 
2372 237 Goodwillie's Elastic 3.00 
23 6 9 237 Mussey's 7.00 
2519 274 O'Dwyer's 6.00 
23 7 0 237 Parker's .. 2.50 
23 6 6 236 Roe's 2.50 
23 71 237 Weir's 7.00 
2122 I 
2323 > 233 Whitehead's.. 12.00 
See also Lock-Jaw Instruments. 
1 15 5 24 Gaiffe's Battery 10.00 
Battery, Nickel-plated 12.00 
1627 109 Gaillard's Bone Drill 2.50 
1845 151 Galante's Eye Speculum 4.00 794 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
1793 147 Galezowsky's Canalicula Dilator $2.50 
17 5 8 144 Strabismometer 6.00 
Galt's Trephine and Handle 4.50 
1 534 ' 
Galvanic Battery, see Battery, Galvanic. 
1154 23 Disk, Garratt's, prices on page 23. 
1156 24 Disk, Voltaic Armadillo, prices, p. 24. 
35 3 0 494 Pessary, Cole's 2.00 
1 175 32 Pessary, Hanks' 1.50 
117 3 32 Pessary, Intra-Uterine 1.50 
Pessary, Simpson's 1.00 
3 5 3 3 494 Pessary, Thomas' 1.50 
37 Galvano-Cautery. 
123 2 37 Galvano-Cautery Battery, Dawson's 60.00 
Galvano-Cautery Electrodes: 
Bosworth's Nasal, per set 33.00 
123 4 38 Dawson's Universal 35.00 
123 6 38 Lincoln's Laryngeal 20.00 
123 5 38 Schroetter's Laryngeal, Complete.... 16.00 
No. 1, Snare 3.50 
No. 2, Lancet. 3.00 
No. 3, Porcelain Burner 3.50 
No. 4, Knife. 3.00 
No. 5, Voltolini's Knife 3.25 
No. 6, Blunt Cautery 3.00 
123 3 37 Galvano-Cautery Sling 16.00 
1687 121 Galvano-Depilator, Duhring's 3.00 
1688 121 Fox's, Holder and Needle 3.90 
1158 25 Galvano-Faradic Battery, Eighteen Cells . 52.50 
1162 27 Twelve Cells 40.00 
1160 26 Twenty-four Cells 67.50 
3388 476 Gardner's Caustic Forceps 3.00 
3 3 8 9 476 Caustic Holder 2.50 
3429 483 Manifold Instrument, Complete 12.00 
3351 470 Uterine Set 46.00 
Gariel's Air Pessary 1.50 
1154 23 Garratt's Electric Disks. Prices on page 23. 
14 7 6 93 Garrigue's Serrefln .25 
1664 118 Transfusion Apparatus 4.00 
3235 445 Vaginal Depressor 2.00 
1131 18 Gastric Fistula Tube, No. 1 1.50 
1131 18 No. 2 2.50 
26 2 4 295 Gastro-Mundator 8.50 
Gauze, Antiseptic, see Antiseptic Surgery 
Materials. 
129 1 76 Gay's Open Ring Scissors 1.50 
69 Pocket Set 22.00 
2 5 7 4 283 Gedding's Respirator 5.00 
3499 491 Gehrung's Anteversion Pessary .50 
Retroversion Pessary .50 
56 General Operating. 
General Operating Sets: 
57 Blackman's 136.75 
56 Buck's 190.00 
58 California 69.30 
60 Hamilton's ....101.85 
58 Little's'. 100.00 
58 Markoe's 67.45 
60 Mott's 72.85 
59 Parker's 104.90 
57 Post's 150.95 
59 Seymour's 176.70 
40 4 0 629 Smith's 200.00 
404 1 630 Tremaine's 175.00 
56 Wood's 74.55 
60 Wright's 140.00 
2 5 51 278 Gendron's Split Trachea Canula 8.00 
1815 149 Gensoul's Cautery Canula ... 3.00 
713 Genu Valgum, see also Orthopaedic. 
718 Genu Varum, see also Orthopasdic. 
1254 46 George's Ether Inhaler 3.50 
German Students' Lamp 6.00 
Truss, Double 4.50 
2 7 7 6 322 Truss. Single 3.00 
Fig. Page. Price. 
1051 7 Gerne's Pleximeter - $2.50 
43 8 3 766 Gerster's Chisels 
43 7 4 765 Iodoform Duster 1.50 
4384 766 Mallet ... .50 
2 5 5 7 279 Tracheal Tampon 18.00 
4223 756 Tracheal Tampon, Improved 18.00 
4 3 9 4 767 Getz's Set of Aspirating Trocars 8.50 
43 8 8 766 Giant Hook (Riesenhaken) 5.00 
24 9 7 268 Gibb's Laryngeal Ecraseur 3.00 
24 7 7 265 Laryngeal Spray 3.00 
2725 310 Gibson's Ligature Instrument.. 3.00 
3375 474 Gidding's Uterine Sound 2.00 
3 7 4 8 538 Gilette's Obstetrical Forceps ... 9.50 
1802 148 Girard Teuton's Canalicula Instrument.... 8.00 
28 3 6 337 Girdner's Phimosis Forceps 3.50 
Glass Brush 25 
28 5 2 343 Meatoscope, each 50 
1048 7 Pleximeter .50 
16 76 120 Pleximeter, Hess' .50 
292 1 352 Gleet Syringe, Harrison's 3.50 
See also Urethral Syringe. 
4319 755 Gleitsmann's Laryngeal Dilator 8.50 
Rhinoplastos 12.00 
34 6 3 488 Globe Pessary, Glass 50 
34 6 4 488 Hard Rubber 1.00 
34 6 4 488 Silver 8.00 to 10.00 
4208 711 Glove for Paralysis 20.00 to 30.00 
Gnawing Forceps, see Rongeur. 
1324 80 Goetz's Suture Instrument 10.00 
747 Goldberg's Chiropodists'Pocket Set 37.00 
2902 350 Gonorrhoea Syringe, Buttle's 5.00 
292 1 352 Harrison's 3.50 
See also Urethral Syringes. 
2731 310 Gooche's Canula 5.00 
Goodell's Speculum 7.00 
3 5 9 6 503 Uterine Dilator, Large 10.00 
3 5 9 5 503 Uterine Dilator, Small (Ellinger's) ... 10.00 
1581 102 Goodwillie's Levator, Curved 2.00 
1582 102 Levator, Half Curved 2.00 
23 4 7 235 Mouth Gag 7.00 
2 3 7 2 237 Mouth Gag, Elastic 3.00 
4409 770 Nasal Dilator, Soft Rubber. 75 
2158 205 Nasal Speculum 1.00 
1602 104 Oral Saw 3.50 
23 6 8 237 Speculum Oris 8.00 
2289 227 Spicula Forceps 2.00 
229 1 227 Splitting Forceps 2.75 
23 4 9 235 Staphyloraphy Knife 1.50 
23 5 0 235 Staphyloraphy Knife 1.50 
23 51 235 Staphyloraphy Knife 1.50 
23 4 6 235 Staphyloraphy Needle, Set in Case .. 12.00 
2379 238 Tongue Depressor 2.50 
2288 227 Tooth Forceps 2.00 
2290 227 Tooth Forceps 2.00 
2293 228 Tooth Forceps 2.00 
22 9 5 228 Tooth Forceps 2.00 
22 9 6 228 Tooth Forceps 2.00 
Gorget (Lithotomy): 
3 1 34 421 Blunt 2.50 
3133 421 Bush's 4.50 
3131 421 Dowell's, and Staff 5.50 
3146 423 Hooked 3.00 
3135 421 Keyes'Blunt.. 2.50 
31 32 421 Physick's, Two Blades... 6.50 
29 9 7 375 Teale's.... 2.50 
2 6 4 0 299 Gorget-Formed Anal Speculum 2.00 
1574 102 Gouge, Bone 1.50 
1579 102 Curved, Hand 1.50 
1621 108 Curved, Hand 1.50 
2111 197 Curved, Hand 1.50 
1577 102 Darby's, and Chisels, per set... 7.00 
1834 150 Ophthalmic, Foreign Body 1.50 
21 29 197 Politzer's 2.50 
2114 197 Schwartze's, Mastoid 1.25 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
795 
Fig. Page. Price. 
2115 197 Gouge, Schwartze's, Mastoid $1.25 
2116 197 Schwartze's, Mastoid 1.25 
2117 197 Schwartze's, Mastoid 1.25 
1573 102 Szymanowsky's 2.50 
Gouging Forceps, see Rongeur. 
30 0 0 376 Gouley's Beaked Bistoury 1.50 
2998 376 Catheter Staff 2.50 
30 0 3 378 Cysto Pylometer 24.00 
2972 364 Dilating Urethrotome, in Case 15.00 
29 4 0 356 Dilator for Over-distending 12.00 
3001 376 Director, Arnott's 1.50 
2945 358 Divulsor 12.00 
2 9 4 5 358 Divulsor, in Case 14.00 
376 External Urethrotomy: 
300 1 376 Arnott's Probe 1.50 
30 0 0 376 Beaked Bistoury 1.50 
29 9 8 376 Catheter Staff 2.50 
29 9 9 376 Tenaculum 1.50 
2842 / 
oo.o (339 Guage, English and Metrical 3.50 
£o4o ' 
28 7 8 346 Guides, Whalebone, each .50 
28 9 6 348 Guides, Whalebone, each .50 
3166 428 Hydro-Hajmostat 2.50 
2940 356 Instrument for Over-distending 12.00 
3 1 53 425 Lithoclast, Double Lever 10.00 
3154 426 Lithoclast, Single Lever 8.00 
3088 404 Lithotrite 35.00 
2888 347 Meatotome 3.00 
2219 217 Nasal Clamp 5.00 
29 4 0 356 Over-Distender 12.00 
30 0 7 379 Prostatectome 40.00 
30 0 9 380 Prostatic Gland Dilator 16.00 
3 0 6 6 400 Searcher for Stone 1.50 
2930 354 Sound r 1.25 
396 Stricture Set, Compact 50.00 
396 Stricture Set, Complete 109.00 
29 9 9 376 Tenaculum 1.50 
2895 348 Tunnelled Catheter 2.50 
2939 356 Tunnelled Sound 2.50 
29 5 5 361 Tunnelled Urethrotome 5.00 
2 9 5 6 361 Tunnelled Urethrotome, Improved... 12.00 
29 3 7 355 Whalebone Bougie .50 
29 3 8 355 Whalebone Bougie .50 
1614 107 Gowan's Exsector 24.00 
1003 3 Graduated Measure Glass .75 
1391 84 Surgical Knife, White's 3.00 
1008 3 Tube, Analysis 1.25 
1618 108 Graefe's Circular Saw 20.00 
166 Corneal Incision. 
1948 168 Cystotome 1.50 
1842 151 Eye Speculum 2.50 
1862 152 Fixation Forceps 2.00 
1935 165 Iris Forceps 1.75 
1950 168 Lens Tractor 1.75 
1898 162 Linear Knife 1.50 
180 Set of Eye Instruments 46.00 
1871 154 Strabismus Hook, Large 1.25 
1872 154 Strabismus Hook, Small 1.25 
121 Grafting, Skin. 
1677 120 Scissors 10.00 
34 7 0 489 Graily Hewitt's Pessary 1.00 
34 8 8 490 Pessary 1.00 
2460 264 Granger's Sponge Holder 2.00 
24 9 3 268 Grant's CEdema Glottis Instrument 1.50 
1678 120 Grappling Forceps, Piffard's 3.00 
1123 16 Hook, Dissecting .60 
3210 441 Graves'Speculum Vaginae 5.00 
23 9 5 243 Green's Double Hook 2.50 
Forceps 3.00 
124 Hypodermic Case 10.00 
Hypodermic Syringe Needle .60 
23 7 8 238 Tongue Depressor 2.25 
23 9 7 243 Tonsil Bistoury 2.00 
2400 243 Tonsil Hook 1.75 
Fig. Page. Price. 
3659 513 Greenhalgh's Tumor Forceps __ $6.00 
1801 148 Greenslade's Concealed Canalicula Knife.. 8.00 
Greensville Dowell's, see Dowell's. 
1472 93 Gross' Artery Compressor 5.00 
3 1 69 428 Artery Compressor 5.00 
4226 719 Bow Leg Brace (Shoes extra), per pair, 
25.00 to 35.00 
1361 83 Bullet Forceps 2.50 
2046 191 Ear Spoon and Hook .75 
40 3 4 628 Ear Spoon and Hook .75 
29 7 0 364 Exploratory Urethrotome 1. 6.00 
304 1 387 Flexible Catheter... 2.00 
3121 417 Lithotomy Knife, Blizard's American, 1.75 
68 Pocket Set 22.00 
68 Pocket Set, Fine 26.00 
2197 213 Polypus Forceps 2.25 
2376 237 Speculum Oris 5.00 
1437 89 Tourniquet 12.00 
2946 358 Urethral Dilator 14.00 
2883 346 Urethrameter 20.00 
2961 362 Urethrotome, Curved or Straight.... 6.00 
2970 364 Urethrotome, Exploring 6.00 
1996 183 Gruber's Ear Speculum, Hard Rubber, ea. .50 
Ear Speculum, Hard Rubber, Set of 3, 1.50 
20 9 7 196 Ear Scissors 4.50 
Polypus Knife, Sickle Shaped 1.50 
20 96 196 Tensor Tympani Instrument 2.50 
1 840 150 Gruening's Electro Magnet 12.00 
1775 146 Epilating Forceps 1.75 
2 1 26 197 Mastoid Drainage Tube 1.00 
180 Set of Eye Instruments 71.00 
339 Guages, or Scales for Urethral Instruments : 
2844 I 
2845 > 340 American, Van Buren and Keyes .... 3.50 
2842 I „„„ English and Metrical Diameter, 
2843* Gouley 3.50 
284 1 339 French, or Metric, and English Num- 
bers, Bumstead 3.50 
28 4 7 340 Handerson's American, English and 
French 6.00 
2848 I „ Metric, and Approximate English 
2849 * " Numbers, Otis' 3.50 
28 4 6 340 Thomas' Adaptable Metric 
43 5 9 763 United States, Wyeth 3.50 
38 0 7 550 Guarded Blunt Hook and Crotchet 4.50 
1531 98 Crown Trephine 6.00 
153 1 98 Crown Trephine, with Brace 21.00 
1622 108 Drills, Bone 7.00 
3707 529 Gueride's Clamp, Ovariotomy.. 6.00 
34 2 8 483 Guernsey's Uterine Elevator 1.50 
28 7 8 346 Guide, Gouley's Whalebone, each .50 
28 9 6 348 Gouley's Whalebone, each .50 
30 3 2 386 Keyes' Catheter .75 
30 3 3 386 Otis' Catheter . 1.00 
Otis' Whalebone .75 
Guillotine, see Tonsilotome and Uvula tome. 
Gullet Forceps, see CEsophageal Forceps 
and Throat Forceps. 
23 0 5 229 Gum Lancet, Plain 1.00 
23 0 8 229 Tortoise Shell Handle 1.75 
141 2 86 Tortoise Shell Handle, Slide or Spring 
Catch 1.75 
14 1 4 86 Gum Lancet and Tenaculum, Slide Catch _ 2.50 
14 1 8 87 Spring Catch 2.75 
68 Gunn's Pocket Set 20.00 
606 Gun-shot Fracture. 
3 9 5 2 598 Apparatus for 10.00 to 25.00 
Gutta Percha, for Splinting, per lb. 3.00 to 4.00 
3 1 47 423 Guyon's Colpeurynter 1.50 
3147 423 Colpeurynter, with Stopcock 2.00 
430 Gynaecological: 
430 Female Bladder. 
432 Female Rectum. 
432 Female Urethra. 796 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
430 Gynaecological, Female Organs of Generation: 
438 Ovaries. 
431 Uterus. 
432 Vagina. 
440 Gynaecological Instruments, Care in the Ap- 
plication of. 
470 Gynaecological Operating and Dressing Sets. 
470 Uterine Sets. 
462 Vesico-Vaginal Fistula Sets. 
See the following: 
Ecraseur. 
Hysterectomy. 
Hysterotome. 
H ystero-Trachelorraphy. 
Kolpo-Cystotomy. 
Kolpokleisis. 
Laparotomy. 
Obstetrical. 
Ovariotomy. 
Perineorrhaphy. 
Pessary. 
Stone in the Female Bladder. 
Urethral and Uro-cystic. 
Urethra, Female. 
Uterine. 
Vaginal. 
Vesico- and Recto-Vaginal Fistula. 
Vesico-Vaginal Fistula. 
126 7 53 Gynaepod, Comstock's $20.00 
1267 53 Comstock's, with Speculum 25.00 
2143 201 Hackley's Eustachian Spray 6.50 
1071 11 Heemarumascope, White's 2.50 
308 Haemorrhoidal. 
2720 309 Haemorrhoidal Artery and Needle Forceps, 2.50 
Bougie, see Pile Bougie. 
Haemorrhoidal Cautery Irons: 
2743 312' Set of 2 3.00 
2742 312 Set of 3 4.50 
2732 311 Smith's Serrated, per set. 6.00 
Haemorrhoidal Clamps: 
Allingham's Pile.. ..... 12.00 
274G 311 Amussat's Cautery 8.00 
2737 311 Ashton's Pile 3.00 
2733 311 Kelsey's Pile 6.50 
27 1 0 308 Skene's Haemorrhoidal 6.00 
2734 311 Smith's Pile 6.50 
2735 311 Tiemann's, Ivory Plate 6.00 
2739 311 Haemorrhoidal Ecraseur, Smith's Wire .... 6.00 
Haemorrhoidal Ligators: 
2730 310 Allingham's Ligature Carrier 3.50 
2724 310 Bodenhame.r's Curvilinear Forceps _. 4.50 
2727 310 Bodenhamer's Spring Ligating For- 
ceps 4.50 
272 1 309 Carroll's Knot Tier 2.00 
2725 310 Gibson's Instrument 3.00 
2731 310 Gooche's Canula 5.00 
27 1 8 309 Lente's Ligature Carrier . 1.25 
2728 310 Van Buren's Ligator 7.00 
2723 310 Verona's Winch 3.50 
Haemorrhoidal (Pile) Needles: 
2717 309 Angular Pile 1.00 
2713 309 Bush's Pile Needles and Holder 3.00 
27 1 6 309 Helical 1.75 
27 1 9 309 Hutchinson's Ligating 2.50 
271 5 309 Ruptured Perineum 1.00 
2722 309 Skene's... 1.75 
2729 310 Haemorrhoidal Pin, for Transfixion .25 
2708 308 Haemorrhoidal (Pile) Scissors, Angular 1.50 
27 0 9 308 Bush's 1.50 
271 2 309 Haemorrhoidal Suture Forceps, Sims' 2.50 
2714 309 Haemorrhoidal Suture Needle, Curved, per 
dozen 1.00 
Fig. Page. Price. 
Haemorrhoidal Suture Needle: 
2714 309 Half Curved, per dozen $1.00 
2714 309 Straight, per dozen .50 
27 0 6 308 Haemorrhoidal Syringe, Adam's 4.50 
2 7 0 5 308 Kelsey's 5.50 
2707 308 O'Neal's 5.00 
2711 308 Haemorrhoidal Tenaculum, Byrne's Double, 6.00 
428 Haemostatic, after Lithotomy : 
3168 428 Brown's Air Tampon 4.00 
3167 428 Campbell's Canula, with Cotton In- 
troducer 
3 1 70 429 Canula a Chemise 1.50 
3 1 66 428 Gouley's Hydro-Haemostat 2.50 
3 1 69 428 Gross'Artery Compressor 5.00 
373 Haemostatic, after Urethrotomy: 
299 1 373 Bates'Urethral Haemostat 4.00 
2994 374 Hunter's Urethral Tourniquet 5.50 
2 9 9 2 373 Otis' Perineal Tourniquet 5.00 
29 9 3 373 Otis' Urethral Haemostatic Tube .75 
Haemostatic Forceps, see Artery Clamp 
Forceps. 
43 7 7 765 Needle .15 
3310 455 Hagedorn's Needle, per Card 3.00 
Needle, per dozen 1.50 
331 2 455 Needle Holder 8.00 
4387 766 Hahn's Artery Forceps 2.50 
2309 230 Hainsby's Cheek Compressor o.OO 
1216 35 Hair-Brush Electrode 2.50 
3769 541 Hale's Obstetrical Forceps 7.00 
3 1 99 439 Speculum Vaginae 5.00 
1932 164 Hall's Iris Scissors 6.00 
1448 91 Hamilton's Artery Forceps 2.50 
1566 101 Bone Cutter, Serrated 10.00 
1629 109 Bone Drills 7.00 
1360 83 Bullet Forceps . .. .. 2.50 
1353 82 Bullet Probe and Director 2.50 
1346 81 Director Probes, per set 2.50 
1283 75 Drainage Tube Carrier 5.00 
1629 109 Drills 7.00 
1388 84 Dry Dissector 1.50 
1389 84 Dry Dissector 1.50 
1393 84 Dry Dissector 1.50 
139 4 84 Dry Dissector 1.50 
1060 9 Dynamometer 5.00 
3929 590 Elbow Splint 
60 General Operating Set 101.85 
2320 231 Harelip Scissors 1.50 
4083 )653 Hip-Joint Splint 15.00 
1580 102 Levator 1.50 
1283 75 Ligature Carrier 5.00 
39 1 9 586 Maxillary Bandage 5.00 to 12.00 
1570 101 Osteophor 4.00 
3971 604 Patella Splint... 8.00 to 10.00 
68 PocketSet 32.00 
124 5 40 Revulsor 8.00 
1572 101 Sequestrum Forceps 2.50 
1 566 101 Serrated Bone Cutter 10.00 
2405 245 Tonsilotome 15.00 
Hammer, see Mallet. 
Percussion, see Percussion. 
1116 16 Post Mortem 2.50 
745 Hammer Toe. 
4284 745 Apparatus No. 1, each 6.00 to 12.00 
42 8 5 745 Apparatus No. 2, each 7.00 to 15.00 
1066 10 Hammond's ^Esthesiometer 3.00 
4307 753 Hand, Artificial 75.00 to 150.00 
4306 752 Artificial, Prince's 60.00 
Bones of the, see Osteological. 
15 79 102 Gouge 1.50 
1621 108 Gouge 1.50 
2111 197 Gouge 1.50 
1180 33 Plate Electrode 1.50 
1541 98 Trepan... 2.50 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
797 
Fig. Page. Price. 
2847 340 Handerson's Guage.... §6.00 
1741 133 Handy Aspirator, Fitch's 5.00 
126 0 49 Hanks'Antiseptic Spray 15.00 
Bed Pan 2.50 
3633 510 Curette 2.00 
3320 456 Counter-Pressure Tenaculum 2.00 
1175 32 Galvanic Pessary i 1.50 
35 1 7 493 Galvanic Pessary 1.50 
3424 482 Intra-Uterine Douche Tube 1.50 
Needle Forceps 4.00 
3691 524 Ovarian Trocar 4.50 
4340 758 Perineal Needle 1.75 
35 71 499 Rapid Uterine Dilator, Set of 10 5.50 
3228 444 Speculum Vaginae 13.00 
2593 286 Spray Tubes, Laryngeal, each 1.00 
4342 759 Tenaculum, Steel Shank 1.75 
4343 759 Tenaculum and Counterpressor 2.00 
3 5 5 3 497 Tenaculum Forceps 3.00 
2544 278 Tracheotome 9.00 
3 5 7 0 499 Uterine Dilators, set of 12 5.00 
4410 770 Uterine Scissors 5.00 
2182 210 Hard Rubber Laryngeal and Posterior 
Nares Syringe 1.25 
2141 201 Hardy's Chloroform Douche 4.00 
230 Harelip. 
23 1 3 231 Clamp, Prince's 3.00 
2312 231 Clamp, Whitson's 3.00 
2310 231 Forceps, Hutchison's 3.00 
2311 231 Forceps, Parallel 9.00 
2314 231 Forceps, Smith's 5.00 
2318 231 Pin, Plastic, per 100 .40 
2319 231 Pin, Removable Point 50 
2316 231 Pin Conductor, Buck's 1.00 
2317 231 Pin Conductor, Post's 1.00 
2315 231 Scalpel .75 
2321 231 Scissors, Angular 1.50 
2320 231 Scissors, Hamilton's 1.50 
4229 720 Harris'Bow-Leg Spring, per pair - 4.00 
33 3 6 464 Counter-Pressure Staff 2.00 
2246 223 Tooth Forceps 2.00 and 2.75 
2247 223 Tooth Forceps 2.00 and 2.75 
2248 223 Tooth Forceps 2.00 and 2.75 
22 4 9 223 Tooth Forceps 2.00 and 2.75 
22 5 0 223 Tooth Forceps 2.00 and 2.75 
2254 224 Tooth Forceps 2.00 aud 2.75 
22 5 5 224 Tooth Forceps 2.00 and 2.75 
2256 221 Tooth Forceps 2.00 and 2.75 
1714 126 Harris'-Wood's Trocar 5.00 
2913 351 Harrison's Pessary Catheter 4.00 
30 4 7 390 Pessary Catheter 4.00 
3011 381 Prostatic Dilators, each 1.50 
30 4 8 391 Trocar and Canulas 11.00 
292 1 352 Urethral Irrigator 3.50 
1853 151 Hart's Eye Speculum 1.50 
3964 602 Hartshorn's Patella Splint 7.00 
2471 265 Hartwell's Drop Tube 2.25 
36 8 9 521 Harvard Operating Chair 
2004 183 Hassenstein's Otoscope 5.00 
282 1 333 Hawes'Orchitis Compressor 3.00 
1022 5 Hawksley's Stethoscope 1.25 
1905 163 Hayes'Knife Needle 1.50 
73 Hayward's Aseptic Pocket Set 21.00 
249 6 268 Haywood Smith's Scissors, Laryngeal 12.00 
330 1 453 Uterine 12.00 
4189 701 Head Rest, Torticollis, Wood's 5.00 
1137 19 Heart Catheter 1.00 
40 Heat and Cold, Application of. 
2751 312 Abdominal Pad 8.00 
124 5 40 Hamilton's Revulsor 8.00 
1244 40 Spinal Ice Bag 2.00 to 4.00 
26 0 3 288 Heat to the Chest, May's Steam Jacket 35.00 
2770 319 Heaton's Hernia Syringe 4.00 
1587 102 Hebra's Bone Scoop 2.50 
2625 296 Hegar's Infusor 
Fig. Page. Price. 
Hegar's Uterine Dilators, Set of 25 §14.00 
1607 105 Heine's Osteotome --300.00 
2373 237 Heister's Speculum Oris 6.00 
2716 309 Helical Needle, Haemorrhoidal - 1.75 
3838 561 Ruptured Perineum 1.75 
146 4 92 Suture and Ligature 1.75 
1467 92 Helmuth's Ligature Carrier 3.50 
72 Pocket Set 32.00 
2639 299 Rectal Speculum 3.50 
3144 423 Sonde a Dard 6.00 
4 1 96 707 Hemiplegia Apparatus, for one Leg (Shoes 
extra) 30.00 to 40.00 
3879 575 Henry's Bandage Shears 7.50 
2443 260 Bull's Eye 9.00 
2820 332 Cartilage Scissors 5.00 
1683 121 Depilating Forceps 2.50 
1776 146 Depilating Forceps 2.50 
2815 331 Depilating Forceps 2.50 
2832 336 Phimosis Forceps 4.50 
28 1 9 332 Scrotal Clamp 8.00 
315 Hernia. 
315 Hernia, Abdominal. 
321 Reduction of. 
321 Retention of. 
See also Truss. 
333 Hernia, Humoralis : 
2823 333 Carroll's Orchitis Compressor 1.25 
282 1 333 Hawes'Orchitis Compressor 3.00 
2822 333 White's Orchitis Compressor 3.00 
328 Hernia, Hypogastric, Perineal, Umbilical 
and Vaginal. 
See also Abdominal Bandage, Ab- 
dominal Belt, Abdominal Sup- 
porter, Umbilical Truss. 
315 Hernia, Radical Cure of. 
2768 318 Agnew's Hernia Instrument 6.00 
2771 319 De Garmo's Hernia Syringe 8.00 
2764 317 Dowell's Hernia Needles, each 1.00 
2770 319 Heaton's Hernia Syringe 4.00 
2767 317 Redfern Davis' Hernia Instrument - 15.00 
2769 318 Spanton's Strephotcme 2.00 
27 7 2 320 Warren's Hernia Syringe, No. 1 35.00 
27 7 3 320 Warren's Hernia Syringe, No. 2 18.00 
2765 317 White's Hernia Ligator 10.00 
2766 317 Wutzer's Hernia Instrument 12.00 
2755 316 Hernia Director 2.00 
2756 316 Director, Hinged 1.50 
2754 316 Director, Hunter's .75 
2757 316 Director, Levis' 1.50 
2753 316 Director, Peter's 2.00 
2758 316 Knife, Cooper's 1.75 
2759 316 Knife, Stewart's 5.00 
2764 317 Needle, Dowell's 1.00 
2763 316 Saw 2.00 
2771 319 Syringe, De Garmo's 8.00 
2770 319 Syringe, Heaton's 4.00 
2772 320 Syringe, Warren's, No. 1 35.00 
2 7 7 3 320 Syringe, Warren's, No. 2 18.00 
2762 316 Herniotome, Allis' 7.00 
2760 316 Warren's 6.00 
316 Herniotomy, for the Relief of Strangulated 
Hernia. 
2762 316 Allis' Herniotome 7.00 
2758 316 Cooper's Hernia Knife 1.75 
2755 316 Hernia Director 2.00 
2763 316 Hernia Saw 1.50 
2756 316 Hinge Hernia Director 1.50 
2757 316 Levis'Hernia Director 1.50 
2753 316 Peter's Hernia Director 2.00 
2759 316 Stewart's Hernia Knife 5.00 
2760 316 Warren's Herniotome 6.00 
167 6 120 Hess'Glass Pleximeter .50 
1263 50 Heuel's Antiseptic Spray 6.00 
4035 628 Aspirating Needle 1.25 798 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
4025 626 Heuel's Bone Forceps $3.50 
15 9 6 103 Bone Forceps 3.50 
40 3 3 627 Bone Scoop and Levator 2.50 
1256 47 Ether Inhaler 10.00 
4026 626 Hypodermic Syringe 2.50 
1331 80 Needle Forceps 4.00 
132 7 80 Pin Conductor 1.00 
4036 628 Pin Conductor 1.00 
1286 75 Punch. -1.50 
4037 628 Punch. 1.50 
4017 625 Pocket Case, Complete 60.00 
40 3 0 627 Probes and Directors.... 3.50 
40 3 2 627 Scoop and Spade 2.50 
1 660 117 Heurteloup's Artificial Leech, in Case 8.00 
30 7 9 402 Lithotrite and Mallet 25.00 
3941 593 Hewitt's, Colles'Fracture Splint 7.00 
34 8 3 490 Pessary 1.00 
3 1 5 9 427 Staff and Knife 4.00 
1457 91 Hewson's Torsion Forceps 8.00 
1128 18 Hey's Saw 1.75 
153 9 98 Saw 1.75 
1 54 3 98 Saw 1.50 
3670 515 Hick's, Braxton, Wire Ecraseur... 15.00 
3671 515 Wire Ecraseur, Modified 15.00 
Hick's Cephalotrite 25.00 
Thermometer, Indestructible Index . 2.00 
Thermometer, Minute 5.00 
1019 4 Thermometer, Patent Lens Front 3.50 
Higbie's Speculum 4.00 
17 36 132 Higgins'Aspirator 25.00 
2756 316 Hinge Hernia Director 1.50 
2060 192 Hinton's Polypus Forceps 4.00 
2061 192 Polypus Forceps, Double Joint 4.50 
637 Hip-Joint, Morbus Coxarius. 
See also Orthopaedic: Diseases of the 
Joints. 
34 9 6 491 Hitchcock's Anteversion Pessary .75 
3 7 3 4 536 Hodge's Obstetrical Forceps 8.00 
553 Obstetrical Set 16.00 
3473 489 Pessary .50 
3472 489 Pessary - .50 
3490 490 Pessary, Closed Lever 50 
3484 490 Pessary, Horse-shoe .50 
39 5 3 599 Hodgen's Fracture Splint 6.00 
39 8 0 609 Suspending Apparatus 5.00 
133 3 80 Hoff's Automatic Suture 5.50 
1590 103 Hoffmann's Gouge Forceps 4.00 
1047 7 Pleximeter 1.25 
3461 488 Hofmann's Pelvic Pessary 1.50 
2809 329 Supporter, Abdominal 6.00 
2416 248 Holbrook Curtis'Post Nasal Forceps 4.50 
1045 7 Holden's Resonator 2.50 
13 1 9 79 Hollow Needle, Tiemann's 4.00 
37 9 8 549 Holme's Perforator 5.00 
29 4 2 357 Holt's Divulsor, in Case 20.00 
4101 661 Holthouse's Spiral Spring Extender 10.00 to 15.00 
Hood's Truss -- 8.00 
Hook, Aural, see Aural Hook. 
Blunt, see Blunt Hook. 
Foreign Body, see Foreign Body and 
Polypus. 
Iris, see Ophthalmic, Cataract: Iris 
Hook. 
Strabismus, see Ophthalmic, Strabo- 
tomy. 
Tenaculum, see Tenaculum. 
Tonsil, see Tonsil Hook. 
Vulsellum, see Vulsellum Hook. 
3146 423 Hooked Gorget 3.00 
4 1 30 675 Hooper's Knee Extension Splint 35.00 
34 5 4 487 Hornby's Pessary 6.00 
27 8 2 323 Horse-shoe Pad Truss, Wood's 5.00 
330 Hose, Elastic, Prices on page 330. 
2084 195 Hosner's Ear Spout .50 
Fig. Page. Price. 
1733 130 Hospital Aspirator $60.00 
34 1 3 479 BedPan _ 4.00 
65 Minor Operating Set 74.80 
66 Pocket Set 18.00 
3 9 4 4 595 Splint, Lente's 18.00 
2573 283 Hot Air Bath 5.00 
3017 383 Water Bag, Van Buren and Keyes'___ 5.00 
124 6 42 Water Bath, Arm, Forearm and Hand, 15.00 
1247 42 Water Bath, Lower Extremity 15.00 
41 Water in Surgery. 
1626 109 Howard's Bone Drills 7.00 
3202 439 Speculum Vaginae 6.00 
Tarnier's Obstetrical Forceps 24.00 
3592 502 Uterine Dilator 9.00 
3728 532 Howe's Soft Rubber Drainage Tube 2.50 
427 1 740 Hudson's Talipes Equinus Apparatus, 
12.00 to 18.00 
4206 711 Wrist Drop Apparatus 25.00 to 40.00 
2 7 8 0 323 Hull's Truss 2.00 
4301 750 Humerus, Artificial 35.00 to 70.00 
589 Fracture of Neck of. 
750 Humerus, Un-united Fracture of. 
4300 750 Smith's Brace for 35.00 to 70.00 
1456 91 Hunter's Artery and Needle Forceps 2.50 
3252 448 Depressor 1.50 
1347 81 Director .75 
2754 316 Director .75 
29 8 7 371 Divulsor and Urethrotome 35.00 
3 2 4 5 447 Ehrich's Speculum Vaginae 9.00 
28 7 9 346 Filamentous Wedge .75 
2 5 7 9 284 Inhaler .. 1.50 
3 7 4 0 537 Obstetrical Forceps 9.00 
3495 491 Pessary 1.50 
3201 439 Speculum Vaginae 6.00 
30 7 6 402 Trilabe. 20.00 
2994 374 Urethral Tourniquet 5.50 
3582 501 Uterine Dilator 14.00 
3 3 6 5 474 Uterine Sound 1.25 
Hurd's Pessary, Anteversion 1.50 
34 6 2 488 Pessary, Retroversion 1.50 
2 5 6 3 281 Hutchinson's Spirometer 32.00 
41 12 667 Hutchison's Ankle-Joint Splint 
2911 350 Catheter, Ointment, in Case 10.00 
12 5 3 45 Ether Inhaler 4.00 
4 0 7 2 647 Extension Shoe (Shoes extra) ..j 7.00 
23 1 0 231 Harelip Forceps 3.00 
40 6 9 645 Hip-Joint Splint 25.00 to 40.00 
4095 659 Knee-Joint Splint 15.00 
2719 309 Ligating Needle 2.50 
3129 419 Lithotome 7.00 
3402 477 Ointment Syringe, with 1 h. r. Tube 3.00 
34 0 2 477 OintmentSyringe, with 3 silver Tubes, 10.00 
1642 113 Osteotome 6.00 
17 Post Mortem Set 24.00 
28 2 7 336 Prepuce Forceps 2.25 
1665 119 Transfusion Apparatus 25.00 
3040 387 Huter's Flat Catheter 2.00 
334 Hydrocele. 
1712 126 Bag and Stopcock 3.00 
1719 126 Trocar and Canula 1.50 
See also Trocar. 
214 Hypertrophied Nasal Tissue. 
378 Prostate. 
123 Hj'podermic. 
1709 125 Hypodermic Needles : 
Gilt.. .75 
Gold 1.00 
Greene's .60 
Nickel-plated 65 
Steel. - .50 
Hypodermic Syringe and Aspirator 5.50 
17 06 125 Hypodermic Syringe Bottle, Tiemann's.... .20 
1708 125 Hypodermic Syringe, Brown's Pocket Case, 2.50 
2 7 0 5 308 Kelsey's Hamiorrhoidal 5.50 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
799 
Fig. Page. Price. 
169 7 123 Hypodermic Syringe, No. 0 $3.00 
1698 123 No. 1 4.00 
1699 123 No. 2. 3.00 
1700 123 No. 3 2.50 
123 No. 4 2.50 
1701 123 No. 5 3.00 
1702 123 No. 6 3.00 
No. 7, Vance's 4.00 
No. 8„ - - - 2.50 
123 No. 9 3.00 
1703 124 No. 10 5.00 
No. 11 4.00 
No. 12 4.00 
1705 124 Nunn's, and Pellet Holder .. 6.50 
2 7 0 7 308 O'Neal's J. 5.00 
125 Repairing of. 
17 0 7 125 Tiemann's Pocket Case 2.50 
1 7 04 124 Tyndale's Intra-Pulmonary 5.50 
519 Hysterectomy, per Abdominal Section : 
3683 519 Cintrat's Serre Nceud 10.00 
3682 519 Curved Needle 1.75 
3684 519 Koeberle's Serre Noeud, Forceps and 
Skewer 12.00 
3685 519 Sims' Abdominal Protectors, with 2 
Skewers 4.00 
516 Hysterectomy, per Vaginam: 
3678 516 Kiichenmeister's Scissors 6.00 
3680 516 Scissors for Amputating Cervix 6.00 
3681 517 Thomas'Forceps for Amputating Cer- 
vix 35.00 
3679 516 Tooth-edged Scissors, Clark's 9.00 
3686 519 Wilcox's Pin 1.00 
34 7 4 489 Hysterophore, Zwank's 1.50 
505 Hysterotome, Metrotome, Uterotome : 
3611 505 Bozeman's Angular Scissors 4.50 
36 1 3 505 Peaslee's Uterotome, with 1 Blade 4.50 
36 1 3 505 Peaslee's Uterotome, with 2 Blades _. 6.50 
36 0 9 505 Simpson's Hysterotome 7.00 
3612 505 Stohlmann's Hysterotome 7.00 
36 1 0 505 Thomas'Uterine Double Scissors 6.00 
36 0 8 505 White's Hysterotome 12.00 
553 Hystero-Trachelorrhaphy: 
38 2 9 557 Cowan's Trachelorrhaphy Forceps... 4.00 
3824 554 Emmet's Uterine Tourniquet 5.50 
44 1 0 770 Hanks'Trachelorrhaphy Scissors..._ 4.00 
38 2 8 557 Skene's Counterpressor 1.50 
3826 556 Skene's Hawk-bill Scissors 10.00 
38 2 7 556 Skene's Needle Forceps 5.50 
38 2 5 556 Skene's Tenaculum Forceps 3.00 
38 3 0 557 Skene's Uterine Sector 11.00 
3831 558 Van de Warker's Needle Forceps .... 7.00 
38 3 3 559 Von Ramdohr's Needle Forceps 10.00 
1 7 8 5 146 Ice Bag, Eye, Turnbull's 2.50 
1244 40 Spinal 2.00 to 4.00 
Illuminator, see Endoscope, Laryngoscope, 
Ophthalmoscope. 
383 Incontinence of Urine : 
3014 383 Urinal, India Rubber 2.50 
30 1 5 383 Urinal, India Rubber 6.50 
301 6 383 Urinal, India Rubber 2.50 
3445 486 Inflatable Ball Pessary, with Stop-cock.... 1.00 
34 4 2 486 Ring Pessary, without Stop-cock .50 
34 4 3 486 Inflated Pessary .50 
200 Inflation of the Cavity of the Tympanum. 
303 Infusion. 
Inhaler, Anaesthetic, see Anaesthetic Inhaler. 
Pneumatic, see Pneumatic Apparatus. 
See also Respirator and Spirometer. 
283 Inhaler, Spray, Steam, Fumes and Vapor : 
2 5 8 7 285 Burge's Air Compressor 
2600 288 Bur rail's Atomizer, 2.25 
43 5 7 761 Carbon-Dioxide Generator 10.00 
Fig. Page. Price. 
Inhaler, Spray, Steam, Fumes and Vapor : 
2 5 8 9 286 Chapin's Laryngo-Tracheal Spray .-. $4.50 
2 5 9 4 287 Cleborne's Spatula and Atomizer 
2 5 9 5 287 Cleborne's Spatula and Insufflator--- 8.00 
2 5 8 0 284 Clinton's Atomizer 1.75 
C. and S. Atomizer 5.00 
2 5 7 0 282 Dobell's Residual Air Pump 3.00 
2 5 8 3 284 Edson's Spray Producer 
2 59 1 286 Fluhrer's Spray Tube 5.00 
2597 287 Fullgraf's Flat-bill Laryngeal Spray. 6.06 
2590 286 Fullgraf's Laryngo-Tracheal Douche 6.00 
2 5 9 3 286 Hanks' Spray Tubes, each 1.00 
2 5 7 9 284 Hunter's Inhaler 1.50 
2576 283 Mackenzie's Eclectic Inhaler 6.00 
2 5 9 2 286 Newman's Atomizer 6.00 
2575 283 Nicoll's Inhaler 5.00 
2 5 7 7 283 Porter's Croup Kettle 4.50 
2 5 6 9 282 Ramage's Inhaler 1.25 
26 0 2 288 Richardson's Spray Producer : 
3 Hard Rubber Tubes 3.00 
1 Silver Tube 5.50 
3 Silver Tubes 6.50 
2578 283 Roe's Inhaler 2.00 
2 5 9 6 287 Sass' Hand Ball Spray Producer 5.00 
2 5 8 4 285 Sass'Spray Producer, with Receiver 
and Air Pump 
2588 286 Sass' Spray Tube and Bottle 
2 5 8 2 284 Seeger's Steam Nebulizer 12.00 
2 5 9 8 287 Spray Tubes and Stand 
2581 284 Tiemann's Steam Atomizer 5.00 
2599 287 Wight's Continuous Spray Apparatus, 5.00 
2 5 8 6 285 Wile's Compressed Air Spray Appa- 
ratus 
30 4 3 389 Injection, Bladder, Keyes'Irrigator ... 5.50 
See also Double Current Catheters. 
Hypodermic, see Hypodermic Syringe. 
Rectal, see Rectal Infusor, Injector and 
Irrigator. 
Uterine, seeUterine Irrigation, Douching. 
Vaginal, see Vaginal Syringes. 
289 Injuries and Diseases of the Chest. 
631 Insane, Care of. 
Restraints for, see Restraints for the 
Insane. 
2193 211 Insufflator, Bridge's Auto .75 
24 7 8 266 Clay's Powder 2.00 
43 3 0 756 Cohen's Pharyngeal Powder 2.00 
24 7 4 265 Elsberg's Pharyngeal Powder 2.00 
2094 195 Knapp's Powder, Aural 1.50 
2476 265 Laryngeal Powder 1.50 
2433 254 Lefferts' Laryngeal 2.00 
2432 254 Lefferts' Nasal 4.00 
3 7 9 2 548 Lusk's, Asphyxia 1.25 
2432 254 Nasal 4.00 
2187 211 Powder Tubes, Post Nasal, each .25 
24 7 5 265 Rauchfuss'Powder 2.00 
2704 307 Rectal Powder 2.50 
3 7 9 4 548 Robinson's Asphyxia 1.50 
2188 211 Robinson's Powder 3.00 
2 1 42 201 Sexton's Aural 2.00 
117 6 32 Insulated Catheter, Nunn's 4.00 
1201 34 Urethral and Uterine Electrode 1.25 
Internal Urethrotomy, see Urethrotomy, In- 
ternal. 
1 523 97 Interosseous Saw, Lente's 1.50 
39 3 7 591 Splint .30 to .70 
1173 32 Intra-Uterine Galvanic Pessary 1.50 
3530 494 Galvanic Pessary, Cole's 2.00 
Simpson's 1.00 
35 3 3 494 Thomas' 1.50 
Intra-Uterine Speculum, see Uterine Spec- 
ulum. 
Intra-Uterine Stem Pessary, see Stem Pes- 
sary. 800 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
274 Intubation of the Larynx : 
2519 274 O'Dwyer's Gag $6.00 
2 5 2 1 274 O'Dwyer's Scale.... .50 
274 O'Dwyer's Set, Complete, in Case 35.00 
2 5 2 0 274 O'Dwyer's Tube and Obdurator 3.00 
2 5 2 2 274 O'Dwyer's Tube Extractor 5.00 
2 5 2 0 274 O'Dwyer's Tube Introducer 5.00 
Inversion of Feet, see Orthopaedic: Deformi- 
ties of the Feet. 
43 3 0 756 Iodoform Duster, Cohen's (Vienna) 2.00 
43 7 4 765 Gerster's 1.50 
1930 164 Iricystome, Culbertson's 16.00 
160 Iridectomy. 
160 Iridodialysis. 
1686 121 Irido-Platinum Needle, Piffard's- 1.00 
160 Iridotomy. 
Iris, see Ophthalmic : Cataract, Iris. 
Iron Suture Wire, per coil .02 
30 4 3 389 Irrigator, Bladder, Keyes' 5.50 
See also Double Current Catheter. 
Irrigator, Nasal, see Nasal Douche. 
Rectal, see Rectal Injectors, Irri- 
gators. 
Uterine, see Uterine Irrigation, 
Douching. 
Vaginal, see Vaginal Syringe. 
38 5 0 564 Wound, Esmarch's 4.50 
38 5 4 567 Wound, Wyeth's 4.00 
1 595 103 Isaac's Bone Forceps, Large 7.00 
1595 103 Medium - 5.00 
1595 103 Small. - 4.00 
78 Ishiguro's Whale Tendon Ligature, per coil, .40 
37 5 8 539 Ives'Obsterical Forceps 7.00 
1049 7 Ivory Pleximeter 1.00 
1014 4 Scale Axilla Thermometer 2.50 
4 1 65 692 Jacket, Felt 25.00 
4174 696 Sayre's Plaster 
4049 631 Straight, Long ...10.00 
4049 631 Straight, Short 8.00 
3074 !■ 401 Jacobson's Lithotrite - 30.00 
3075 > 
74 Jaconet, Carbolized, per yard - 
1887 162 Jaeger's Angular Keratome - 1.75 
1800 148 Bistoury Cache 8.00 
1864 152 Ophthalmostate 8.00 
1 770 145 Plate Lid Holder, Hard Rubber 1.00 
1 7 70 145 Plate Lid Holder, Tortoise Shell 2.00 
1888 162 Straight Keratome 1.50 
Jaque's Catheter 1.00 
3031a 386 Tiemann's Velvet Eyed .75 
2228 219 Jarvis'Excisor 5.00 
2220 218 Fenestrated Cartilage Forceps 4.50 
2482 266 Laryngeal Applicator 10.00 
2222 218 Nasal Rongeur 4.50 
2227 4219 Nasal Septum Forceps (Punch) 8.50 
2 1 62 206 Nasal Speculum 75 
2161 206 Nasal Speculum, Operating 3.00 
22 2 9 220 Rhinometer 9.00 
21 68 208 Rhinoscopic Mirror and Tongue De- 
pressor --r 4.00 
2227 219 Steele's Septum Forceps 8.50 
2169 208 Tape Holder .75 
2206 214 Transfixion Needle .75 
2221 218 Trimming Scissors 9.00 
2205 214 Wire Snare, Ecraseur 3.00 and 4.00 
Wire Snare with Curved and Straight 
Ends 5.00 
Jaw, Fracture of, see Fracture of Inferior 
Maxilla. 
Lock, see Lock-Jaw Instruments. 
2 5 6 8 282 Jeffrey's Respirator for Mouth 2.50 
25 6 8 282 Respirator for Mouth and Nose 3.00 
Fig. Page. Price. 
3757 539 Jenks' Obstetrical Forceps, Long $8.50 
3756 539 Obstetrical Forceps, Small 7.50 
3195 437 Speculum Vaginae 8.00 
3361 473 Uterine Probe 1.75 
Uterine Scissors 4.50 
3371 474 Uterine Sound 3.50 
Jennison's Sound 3.00 
1080 12 Jewett's Microscopic Section Cutter 9.00 
3 7 7 5 541 Obstetrical Forceps, Aseptic 10.00 
2556 279 Johnson's Double Canula and Obdurator __ 10.00 
635 Joints: 
Diseases of the, see Orthopaedic : Dis- 
eases of the Joints. 
Dislocation of the, see Dislocation 
and Luxation. 
Resection and Exsection of, see Os- 
teotomy : Resection and Exsec- 
tion 
Jones Artery Clamp Forceps 2.50 
Articulated Scissors 2.50 
Ecraseur 15.00 
3 1 81 475 Uterine Dressing Forceps 6.00 
1258 48 Junker's Methylene Inhaler 12.50 
1657 116 Junod's Arm 25.00 
1656 116 Boot 25.00 
4142 684 Jury Mast, Sayre's 12.00 
Kaemmerer's Uterine Sounds, 4 in Set 6.00 
3206 441 Keene's Speculum Vaginae 7.00 
2 5 5 8 279 Trachea Tube 6.50 
371 9 530 Keith's Clamp, Ovariotomy 10.00 
37 1 6 530 Compressing Forceps, 2 Sizes, 3.00 and 4.00 
3 7 2 5 531 Drainage Tube .75 
4349 759 Ligature Forceps 1.50 
3 7 3 0 533 Needles, each .10 
3 1 42 423 Tenaculum 1.25 
Kelly's Powder Blower 3.00 
3 3 9 6 476 Silver Uterine Syringe 5.00 
26 9 4 307 Kelsey's Applicator .75 
2678 306 Fistula Knife 2.50 
2 7 0 5 308 Haemorr'hoidal Syringe • 5.50 
2733 311 Pile Clamp 6.50 
2681 306 Proctotomy Knife 1.75 
2657 301 Rectal Bougie, Soft Rubber 1.50 
43 4 6 759 Rectal Retractor 3.50 
26 3 8 299 Rectal Speculum 6.00 
269 1 307 Scoop, for Impacted Frnces 2.50 
2738 311 Tumor Forceps 2.50 
Keratome, see Ophthalmic, Cataract: Ke- 
ratome. 
162 Keratomy. 
174 Keratonyxis. 
2 5 7 7 283 Kettle, Croup 4.50 
228 Key, Dental (Turn Key): 
22 9 9 228 Removable Fulcrum.. 2.50 
2300 229 Rotating Fulcrum 2.50 
2298 228 Spring Bolt 3.00 
22 9 7 228 Spring Bolt, Double 3.00 
30 4 3 389 Keyes' Bladder Washer 5.50 
30 3 2 386 Catheter Guide .75 
43 3 9 758 Cutaneous Punch 2.50 
43 6 2 763 Device for Vesical Drainage 2.00 
3107 412 Evacuating Tube, Curved 9.00 
3106 411 Evacuating Tube, Straight 8.00 
3 1 3 5 421 Gorget, Blunt 2.50 
3043 389 Irrigator 5.50 
3109 412 Lithotrite, Large 35.00 
3108 412 Lithotrite, Small 35.00 
335 on Hydrocele. 
4361 763 Perineal Retractor 2.50 
Pocket Set 23.00 
4411 770 Stone Searcher 
Stop-cock, Two Way 2.50 GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
801 
Fig. Page. Price. 
43 6 4 763 Keyes'TubeforSupra-Pubic Vesical Drain- 
age, with Urinal $6.00 
4368 764 Ultzman's Syringe 6.00 
2824a 334 Varicocele Needle 1.75 
28245 334 Varicocele Needle 1.75 
Varicocele Needle, Improved 6.00 
43 6 3 763 Kiefer's Urethral Irrigation Nozzle 1.50 
3227 444 King's Pelvimeter 4.00 
3526 493 Kinloch's Anteversion Pessary 1.25 
3 5 2 5 493 Polypus Vesicae Pessary 2.50 
3543 495 Retroflexion Pessary 2.00 
3544 495 Retroflexion Pessary 1.25 
2968 363 Urethrotome 25.00 
4366 764 Klotz's Endoscope 3.50 
196 5 172 Knapp's Capsulotome 1.75 
1817 149 Caustic Holder 1.00 
1885 159 Caustic Holder 1.00 
1964 171 Cystotome (Needle) 1.75 
2 1 24 197 Drainage Tube .75 
2125 197 Drainage Tube .75 
2003 183 Ear Specula, Plated, Set of 3 3.00 
20 03 183 Ear Specula, Silver, Set of 3 _ 4.50 
17 60 145 Entropium Forceps 4.00 
1829 150 Foreign Body Hook 2.00 
18 38 150 Foreign Body Hook 2.00 
1826 149 Lachrymal Syringe 4.00 
1964 171 Needle Cystotome 1.75 
1781 146 Needle Holder 3.50 
1749 140 Ophthalmoscope, Double Disk 35.00 
1752 143 Ophthalmoscope, Metric System .... 32.00 
174 3 134 Ophthalmoscope, Single Disk 20.00 
12 6 9 54 Operating Chair 70.00 
2 0 94 195 Powder Blower 1.50 
1965 172 Scalpel Needle 1.75 
180 Set of Eye Instruments 73.75 
672 Knee, Anchylosis Apparatus. 
See also Orthopaedic: Diseases of the 
Joints. 
1156 24 Knee Band, Voltaic 2.25 
330 Cap, Elastic, Prices on Page 330. 
See also Fracture of Patella. 
4085 654 Compressor, Sayre's 6.00 
653 Joint, Diseased, see also Orthopaedic : 
Diseases of the Joints. 
. Knife, Amputating, see Amputating Knives. 
1110 15 Brain 1.50 
149 1 95 Cartilage 1.50 
1492 95 Cartilage 2.00 
Cataract, see Ophthalmic, Cataract: 
Keratome. 
Iris, see Ophthalmic, Cataract: Iris 
Knife. 
Lithotomy, see Lithotomy Knife, Lith- 
otome. 
Mastoid, see Mastoid Process Knife. 
Microscopic, see Microscopic Section 
Knife. 
1139 19 Nerve 1.50 
Uterine, see Uterine Knife. 
1043 6 Knight's Stethoscope 7.50 
Knock Knee, see Genu Valgum. 
28 7 2 345 Knotted Bougie 1.25 
2721 309 Knot Tier, Carroll's. 2.00 
241 1 246 Knox's Uvula tome 6.50 
2834 336 Phimosis Forceps 4.00 
3684 519 Koeberle's Serre Nceud, Forceps and Skewer, 
with Cap 12.00 
464 Kolpo-Cystotomy: 
3 3 3 8 465 Bache Emmet's Fistula Tube .. .30 
3337 464 Emmet's Cystitis Eyelet 25 
3336 464 Harris' Counter-pressfire Staff 2.00 
3339 465 Skene's Urinal Cup Pessary 2.50 
562 Kolpokleisis. 
2628 296 Korup's Infusor- 
Fig. Page. Price. 
20 07 184 Kramer's Ear Speculum, Plated $1.75 
2007 184 Ear Speculum, Steel 2.50 
2077 194 Ear Syringe, Metal 4.50 
20 7 7 194 Ear Syringe, with Stopcock 5.50 
2 1 33 199 Eustachian Catheter Holder. 3.50 
3678 516 Kiichenmeister's Scissors 6.00' 
1339 81 Kiister's Swan Needle Holder 3.50 
Kyllosis, see Orthopaedic : Deformities of 
the Feet. 
Kystotome, see Cystotome. 
430 Labia. 
3 1 80 433 Speculum 2.00 
Lachrymal, see Ophthalmic : Lachrymal. 
2912 351 Lallemand's Porte Caustique, Urethral 4.50 
34 0 6 477 Porte Caustique, Uterine 4.50 
26 3 4 298 Lamp, Bodenhamer's Reflector and Lens.. 20.00 
1695 122 Bumstead's-Lee's 3.00 
2447 261 Collin's 7.00 
24 4 3 260 Henry's Bull's Eye Illuminator 9.00 
1695 122 Lee's-Bumstead's .3.00 
24 4 0 259 Mackenzie's Light Concentrator 7.50 
169 6 122 Maury's Mercurial Fumigation 12.00 
2446 261 Pocket Illuminator 4.50 
245 1 263 Roe's Laryngoscope 45.00 
2448 262 Seeger's Laryngoscope 34.00 
24 3 7 257 Tobold's Laryngoscope and Lamp 30.00 
16 94 122 Van Buren's Mercurial Fumigation.. 2.50 
14 1 9 87 Lancet, Abscess 75 
Gum, see Gum Lancet. 
Phlebotomy, see Phlebotomy Lancet. 
Spring, see Spring Lancet. 
Thumb, see Thumb Lancet. 
Vaccinating, see Vaccinating Lancet. 
1846 151 Landolt's Eye Speculum 4.00 
1556 100 Lange's Retractor... 3.00 
Trachea Tampon 18.00 
Tracheotomy Set 60.75 
Langenbeck's Artery Forceps 1.50 
1434 89 Bandage Clamp 1.50 
1 588 102 Bone Hook and Levator 1.75 
23 5 3 236 Cheek Retractor 2.50 
1 560 100 Retractor, Blunt 2.50 
1561 100 Retractor, Sharp 2.50 
2399 243 Seizing Forceps 2.50 
23 2 6 232 Seizing Forceps 2.50 
1477d 93 Serrefln 50 
2 5 4 2 277 Tracheotome 4.00 
2539 277 Tracheotomy Blunt Hook 1.50 
2 54 1 277 Tracheotomy Double Hook 3.00 
236 Uraniscoplastic Instruments: 
23 5 4 236 Double Edged Knife 2.50 
23 5 5 236 Double Edged Knife 2.50 
23 5 6 236 Double Edged Knife 2.50 
23 5 9 236 Concave Edged Knife... 2.00 
23 5 7 236 Convex Edged Knife 1.75 
2353 236 Retractor 2.50 
23 5 8 236 Slightly Concave Knife 1.75 
2326 232 Seizing Forceps r 2.50 
2361 236 Suture Holder 3.00 
23 6 0 236 Tenaculum 1.50 
1933 164 Lanne's Forceps Needle, Iris 4.50 
520 Laparotomy. 
43 7 5 765 Large Blunt Hook 3.00 
See also Retractor. 
250 Laryngeal. 
Laryngeal Applicators and Brushes : 
24 5 9 264 Child's Brush and Caustic Holder.... 2.50 
24 8 2 266 Jarvis' Applicator 10.00 
24 6 7 264 Lefferts' Brush Holder 2.50 
2481 266 Lente's Probe 1-25 
24 5 8 264 Mackenzie's Brushes, each 1.50 
24 6 3 264 Noyes' Brush Holder 2.25 802 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. • Price. 
Laryngeal Applicators and Brushes : 
246 6 264 Ruppaner's Brush Holder $1.00 
24 6 2 264 Seeger's Brush Holder 2.50 
24 6 5 264 Wagner's Brush Holder and Brushes. 2.50 
. See also Laryngeal Powder Blow- 
ers, and Laryngeal Sponge 
Holders. 
251 5 272 Laryngeal Catheter, Schroetter's 3.00 
2480 266 Caustic Carrier, Concealed 2.50 
2502 269 Curette 3.00 
433 1 756 Curette, Cohen's, each 2.50 
43 2 7 756 Dilator, Cohen's 10.00 
43 1 9 755 Dilator, Gleitsmann's 8.50 
251 2 271 Dilator, Mackenzie's 20.00 
2517 273 Dilator, McSherry's, with Tube 16.00 
2514 272 Dilator, Navratil's 
24 9 5 268 Dilator, Whistler's, per set 18.00 
2471 265 Drop Tube, Hartwell's 2.25 
2497 268 Ecraseur, Gibb's 3.00 
120 6 34 Electrode 1.50 
120 7 34 Electrode 1.50 
120 4 34 Electrode 1.00 
Electrode, Bosworth's Set 33.00 
2498 269 Electrode, Mackenzie's 3.50 
Laryngeal Forceps: 
2499 269 Brun's Epiglottis Pincette 4.50 
2510 270 Buck's Throat 2.50 
2 5 0 8 270 Burge's Throat 4.50 
4329 756 Cohen's Sponge, each 4.00 
24 6 9 265 Elsberg's Throat 6.00 
2503 269 Fauvel's 4.00 
2 5 0 6 270 Fauvel's Throat 6.00 
24 8 6 267 Mackenzie's Forceps, Scissors and 
Ecraseur 25.00 
2511 270 Mackenzie's Antero-Posterior 2.75 
2509 270 Mackenzie's Lateral 2.75 
2 5 0 7 270 Mathieu's Throat 6.00 
2500 269 Noyes' Throat 4.50 
24 9 4 268 Rumbold's Forceps and Scissors 
2 50 1 269 Simrock's 4.50 
2504 269 Tiemann's Flexible 4.50 
Waxham's 5.00 
Laryngeal Knife, see Laryngeal Lancet. 
Laryngeal Lancets: 
2493 268 Grant's GEdema Glottis Instrument.. 1.50 
2485 267 Mackenzie's, 2 Blades 12.00 
24 8 3 267 Mackenzie's, 3 Blades 14.00 
2484 267 Schroetter's Lancet and Forceps .... 15.00 
24 8 7 267 Tobold's Concealed 4.00 
2490 268 Tobold's Knife 1.50 
249 1 268 Tobold's Knife 1.50 
2492 268 Tobold's Knife 1.50 
24 9 5 268 Whistler's Cutting Dilators 18.00 
Laryngeal Mirror, see Laryngoscopic Mir- 
ror. 
Laryngeal Powder Blowers: 
2478 266 Clay's Insufflator 2.00 
24 7 4 265 Elsberg's Insufflator 2.00 
2476 265 Hard Rubber 1.50 
24 7 3 265 Leffert's Powder Blower 2.00 
2433 254 Leffert's Insufflator 2.00 
24 7 5 265 Rauchfuss', with Mouth-Piece 2.00 
2481 266 Laryngeal Probe, Lente's 1.25 
2456 264 Mackenzie's, each 1.25 
Laryngeal Scissors: 
24 9 6 268 Haywood Smith's 12.00 
43 1 7 755 Sherwell's 14.00 
43 1 8 755 Sherwell's 7.00 
24 8 8 267 Tiemann & Co.'s 8.50 
2489 267 Tobold's 6.00 
2494 268 Laryngeal Scissors and Forceps, Rumbold's, 
2505 269 Scoop, Tiemann's 6.00 
4407 770 Snare, O'Dwyer's 3.50 
Fig. Page. Price. 
Laryngeal Sponge Holders : 
2461 264 Buck's $1.25 
2464 264 California 2.00 
24 6 9 265 Elsberg's . 6.00 
24 5 7 264 Finger - 1.50 
24 6 0 264 Granger's 2.00 
2468 265 Mackenzie's, with Safety Wedge 6.00 
2463 264 Noyes' 2.25 
2462 264 Seeger's, and Brush Holder 2.50 
24 7 7 265 Laryngeal Spray, Gibb's 3.00 
2470 265 Syringe, Hard Rubber 1.25 
24 7 2 265 Syringe, Tobold's 2.50 
2442 259 Laryngoscope, Baber's Pocket 7.50 
2447 261 Collin's Lamp 7.00 
2445 260 Elsberg's Pocket 6.00 
2443 260 Henry's Bull's-Eye 9.00 
24 4 0 259 Mackenzie's Light Concentrator 7.50 
2446 261 Pocket Illuminator 4.50 
2444 260 Pomeroy's 7.00 
2451 263 Roe's-Tobold's 45.00 
2438 258 Schroetter's 6.50 to 8.00 
24 4 8 262 Seeger's-Tobold's 34.00 
244 1 259 Simrock's, with Mirror 9.00 
24 3 5 257 Tiemann's, with Head Band 7.00 
24 3 7 257 Tobold's Large (Lamp extra) 24.00 
Tobold's Pocket 15.00 
257 Use of the. 
2439 258 Laryngoscopic Mirrors, each 1.25 
Mirrors, Universal Handle, per set.. 5.50 
2450 262 Set, Lefferts' 26.00 
256 Set, Lefferts' (List of Contents) 26.00 
256 Set, No. 1 12.00 
256 Set, No. 2 18.00 
256 Set, No. 3 23.00 
256 Set, No. 4 .. - 26.00 
271 Laryngoscopy, Infra Glottic. 
271 Laryngo-Tracheal Stenosis: 
3512 271 Mackenzie's Laryngeal Dilator 20.00 
2514 272 Navratil's Laryngeal Dilator 
O'Dwyer's Intubation Set, Adult 45.00 
274 O'Dwyer's Intubation Set, Infant 35.00 
251 5 272 Schroetter'.s Laryngeal Catheter 3.00 
See also Laryngeal Dilator. 
275 Larynx, Artificial: 
2 5 2 4 276 Faulis'Modification of Gussenbauer's 
Apparatus 
2 5 2 3 275 Park's Modification of Gussenbauer's 
Apparatus 
4331 756 Larynx Curette, Cohen's, each 2.50 
274 Larynx, Intubation of: 
274 O'Dwyer's Complete Set, in Case .... 35.00 
2519 274 Mouth Gag.. . 6.00 
2521 274 Scale of Lengths for Tubes .50 
2 5 2 0 274 Tube and Obdurator 3.00 
2522 274 Tube Extractor 5.00 
2 5 2 0 274 Tube Introductor 5.00 
255 Larynx, Organ of Voice. 
Lateral Curvature of the Spine, see Sco- 
liosis. 
17 6 5 145 Laurence's Eyelid Tourniquet 3.00 
17 5 9 144 Strabismometer 2.25 
Lavage, see Stomachal. 
2855 343 Laveur's Endoscope 20.00 
3404 477 Lawson's Applicator 4.00 
Lawson Tait's, see Tait's. 
3355 473 Leaden Uterine Probe .40 
15 76 102 Lead Mallet for Osteotomy 2.50 
1693 122 Lebenswecker, Baunscheidt's 2.50 
1660 117 Leech, Artificial, Heurteloup's 8.00 
1661 117 Reese's Uterine 4.50 
1659 116 Hemann's Patent 7.00 
4392 767 Leech Glass, Flood's, each 1.25 
116 Leeching. 
1695 122 Lee's Lamp, Modified by Bumstead 3.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
803 
Fig. Page. Price. 
2420 251 Lefferts'Compressed Air Spray Apparatus, $ 
2450 262 Examination Case 26.00 
256 Examination Case (List of Contents), 26.00 
2467 264 Laryngeal Brush Holder A 2.50 
2433 254 Laryngeal Insufflator 2.00 
2432 254 Nasal Powder Insufflator 4.00 
2417 249 Nasal Spray Apparatus 4.00 
2418 249 Nasal Syringe 3.00 
2419 250 Palate Hook 2.00 
2415 248 Post Nasal Curette 2.50 
2414 248 Post Nasal Forceps 4.50 
2473 265 Powder Blower 2.00 
Lenneker's Knife, Right and Left, each ... 2.00 
Lens, see Ophthalmic : Cataract. 
2481 266 Lente's Caustic Probe 1.25 
3392 476 Double Bulb Probe 1.75 
1248 43 Ether Inhaler, Modified 3.50 
3944 595 Hospital Splint 18.00 
1523 97 Interosseous Saw 1.50 
2718 309 Ligature Carrier 1.25 
3403 477 Ointment Syringe 4.50 
34 0 7 477 Ointment Syringe 8.00 
1692 122 Platina Cup.„ 3.50 
3393 476 Platina Cup 3.50 
1546 98 Lenticular Knife 1.50 
1 545 98 Knife and Trepanning Elevator 1.75 
3200 439 Leonard's Speculum Vaginae 6.00 
34 3 6 485 Uterine Repositor 11.00 
3370 474 Uterine Sound 5.50 
3368 474 Uterometric Sound 3.25 
30 6 2 399 Leroy d'Etiolle's Articular Urethral Curette 12.00 
2876 345 Filiform Bougies, each .50 
1581 102 Levator, Goodwillie's Curved 2.00 
1 582 102 Goodwillie's Half Curved 2.00 
1580 102 Hamilton's 1.50 
1588 102 Langenbeck's, and Hook 1.75 
30 7 7 402 Lever Lithotrite 25.00 
261 8 293 Stomach Pump 16.00 
1912 163 Levi's Cataract Needle 1.25 
19 6 7 173 Cataract Needle 1.25 
179 5 147 Lacrymal Probe 2.00 
1959 168 Lens Spoon, Fenestrated 1.50 
1795 147 Probe 2.00 
3920 587 Levis'Clavicle Splint 5.00 
3987 614 Dislocation Splint 1.50 
391 2 583 Extension Fulcrum 3.50 
391 2 583 Extension Fulcrum and Weights 5.00 
2757 316 Hernia Director 1.50 
3897) 
to ?580 Metallic Splints, Set of 21 15.00 
3905 ' 
3967 603 Patella Splint 6.00 
2833 336 Phimosis Forceps 3.50 
3664 514 Levret's Double Canula 6.00 
153 0 97 Lewis'Folding Saw 2.50 
281 6 332 Varicocele Clamp 4.00 
1769 145 Lid Compressor, Stoke's 3.00 
1771 145 Forceps, Carron de Villard's 4.00 
See also Ophthalmic : Palpebral. 
1770 145 Plate, Jaeger's, Hard Rubber 1.00 
17 70 145 Plate, Jaeger's, Tortoise Shell 2.00 
17 7 7 146 Scalpel 1.50 
17 78 146 Scalpel 1.50 
1779 146 Scalpel 1.50 
1780 146 Scarificator, Desmarre's 1.50 
1848 151 Liebold's Eye Speculum 2.50 
1822 149 Subpalpebral Syringe 1.50 
1850 151 Liebreich's Eye Speculum 2.50 
1938 165 Iris Forceps 6.50 
1899 162 Linear Knife 1.50 
1742 134 Ophthalmoscope 4.50 
1742 134 Ophthalmoscope, Extra Fine 7.50 
1811 148 Probe and Fistula Knife 2.00 
1145 19 Lifting-Back Saw, Large 4.00 
Fig. Page. Price. 
1525 97 Lifting-Back Saw, Medium $3.0G 
152 2 97 Small. 2.56 
2730 310 Ligator, Allingham's Carrier 3.56 
2724 310 Bodenhamer's Curvilinear Forceps - 4.56 
1458 92 Carroll's Knot Tier 2.0C 
3666 515 Cintrat's 2.5< 
2725 310 Gibson's, in Anal Fistula 3.0( 
2731 310 Gooche's Canula 5.06 
3664 514 Levret's Double Canula 6.06 
2728 310 Van Buren's 7. Of 
2723 310 Verona's Winch, Haemorrhoidal 3.5C 
See also Artery Needles. 
3862 569 Ligature, Catgut, Am Ende's 1.0C 
Catgut, American, per bottle .56 
Catgut, English, per bottle .75 
Catgut, Dry, per coil .25 
Dittel's Elastic, per yard .25 
Hard Ash .10 
Hemp .05 
Iron Wire .02 
131 0 78 Satin Silk, per skein .15 to .70 
Satin Silk, per spool .50 
Satin Silk, 1 size on card .40 
Satin Silk, 4 sizes on card .75 
1311 78 Silk, Black Iron-Dyed, per reel .10 
Silk, Chinese Bead, White or Black, 
per skein .25 
13 1 2 78 Silk, Closely Twisted, per skein .35 
Silk, Ordinary, per reel .10 
Silk, Ordinary, per skein .05 
Silkworm Gut, per coil .05 
Silver Wire, per coil .50 
78 Whale Tendon, per coil .40 
Ligature Carrier, see Ligator. 
Ligature Carriers (Reels and Bottles) : 
3862 569 Am Ende's 1.00 
3861 569 Fowler's 3.50 
4863 569 Spools and Jar .75 to 1.50 
4397 769 Ware's 1.50 
4397 769 Ware's, Hospital Size 3.00 
Liliputian Pocket Case 26.00 
1236 38 Lincoln's Laryngeal Cautery Electrode 20.00 
1903 162 Linear Knife, Baader's, Left 1.75 
1902 162 Baader's, Right 1.75 
1898 162 Graefe's 1.50 
1899 162 Liebreich's. 1.50 
1900 162 Noyes' 1.50 
15 78 102 Linhardt's Knife Chisel 1.50 
3957 600 Lining Splints, Set of 5 .50 
Lint, per pound 1.00 
135 5 82 Lint Carrier (Porte Meche) .75 
566 Lister's Method of Antiseptic Dressing. 
See also Antiseptic Surgery Materials. 
149 9 95 Liston's Amputating Knife, Long 4.50 
Amputating Knife, Medium 3.50 
1497 95 Amputating Knife, Small 2.50 
1 50 2 96 Aseptic Amputating Knife, Long 5.00 
150 3 96 Aseptic Amputating Knife, Medium. 4.00 
1504 96 Aseptic Amputating Knife, Small ... 3.00 
1 589 103 Bone Forceps 2.50 and 3.00 
15 94 103 Bone Forceps, Large 4.00 to 7.00 
1591 103 Bone Forceps, Curved on the Flat 3.50 
1592 103 Bone Forceps, Knee Bent 3.50 
39 4 7 597 McIntire's Splint 16.00 
425 Lithoclasts (Stone Crushers) : 
3156 426 De Rigal's Stone Holder, Perforator 
and Breaker 60.00 
3152 425 Dolbeau's Lithoclast _ 7.00 
3 1 51 425 Dolbeau's Guide for Lithoclast 3.50 
3153 425 Gouley's Lithoclast, Double Lever 10.00 
3154 426 Gouley's Lithoclast, Single Lever.... 8.00 
3 1 5 5 426 Maisonneuve's Stone Crusher 20.00 
406 Litholapaxy. 
See also Lithotrite and Lithotrity. 804 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. " Price. 
413 Lithotomy. 
3112 415 Anklets, Peter's $15.00 
3111 415 Anklets and Wristlets, Pritchard's .. 8.00 
3 1 4 5 423 Aponeur otome 2.00 
3137 421 Bisector, Wood's 4.50 
3114 417 Bistoury, Little's 1.75 
3124 419 Bistoury, Wyeth's 2.00 
3127 419 Bistoury Cache, Depuytren's 24.00 
3 1 4 7 423 Colpeurynter, Guyon's-Peterson's-.. 2.00 
3113 417 Director, Little's 1.50 
See also Lithotomy Staff. 
3 1 3 9 421 Forceps, Curved 8.00 
3140 421 Forceps, Little's 3.00 
3141 421 Forceps, Straight 3.00 
See also Lithoclast. 
3 1 34 421 Gorget, Blunt 2.50 
3133 421 Gorget, Bush's 4.50 
3131 421 Gorget, Dowell's, and Staff 5.50 
3 1 46 423 Gorget, Hooked 3.00 
3135 421 Gorget, Keyes' 2.50 
3132 421 Gorget, Physick's, Two Blades 6.50 
3168 428 Hsemostat, Brown's Air Tampon 4.00 
3 1 7 0 429 Haemostat, Canula & Chemise 1.50 
3167 428 Haemostat, Campbell's Canula 
3 1 4 8 423 Haemostat, Forcipressure Forceps... 2.50 
316 6 428 Haemostat, Gouley's Hydro- 2.50 
3169 428 Haemostat, Gross' Artery Compressor, 5.00 
3121 417 Knife, Blizard's American- 1.75 
3120 417 Knife, Blizard's English 2.00 
417 Knife, Gross' 1.75 
Lithoclast, see Lithoclast. 
3130 419 Lithotome, Brigg's 7.00 
3129 419 Lithotome, Hutchison's 7.00 
3128 419 Lithotome, Smith's 12.00 
3123 417 Scalpel, Depuytren's 1.75 
3118 417 Scalpel, Probe Pointed 1.75 
3116 417 Scalpel, Sharp Pointed 1.75 
3157 426 Scoop, Luer's 2.50 
3136 421 Scoop and Conductor 2.50 
397 Set in Case 47.00 
397 Set in Case, Little's 54.00 
397 Set in Case, May's 89.00 
397 Set in Case, Van Buren and Keyes' ..134.75 
3143 423 Sonde a Dard 3.50 
3 1 44 423 Sonde a Dard, Helmuth's 6.00 
3122 417 Staff, Buchanan's 2.50 
3131 421 Staff, Dowell's, and Gorget 5.50 
3159 427 Staff, Hewitt's, and Knife 4.00 
3125 419 Staff, Lateral 2.00 
3115 417 Staff, Little's 2.00 
3113 417 Staff, Little's (Director) 1.50 
3117 417 Staff, Markoe's 2.00 
3126 419 Staff, Mason's 5.00 
3119 417 Staff, Steel 2.00 
3 1 38 421 Staff, Wood's 2.00 
3 1 42 423 Tenaculum, Keith's 1.25 
401 Lithotrites: 
3094 406 Bigelow's 40.00 
3095 4061 
to > Bigelow's Improved 40.00 
3098 407' 
3110 412 Chismore's Evacuating 24.00 
30 8 3 403 Civiale's 25.00 
30 7 8 402 Ferguson's 25.00 
3088 404 Gouley's 35.00 
30 7 9 402 Heurteloup's, and Mallet 25.00 
3076 402 Hunter's Trilabe.. .20.00 
30 7 4 401 Jacobson's 30.00 
3109 412 Keyes', Large .35.00 
3108 412 Keyes', Small ..... . ..35.00 
3 0 7 7 402 Lever 25.00 
30 8 2 403 Teevan's 35.00 
3081 403 Thompson's 35.00 
401 Lithotrity. 
Fig. Page. Price: 
405 Lithotrity, Debris Evacuators : 
3102 409 Bigelow's Latest,. $30.00 
3099 407 Bigelow's Original 12.00 
31 00 407 Bigelow's Original, with Stand 16.00 
3093 405 Clover's Apparatus 14.00 
309 1 405 Cornay's Washing Bottle 25.00 
3107 412 Keyes'Evacuating Tube, Curved 9.00 
3106 411 Keyes'Evacuating Tube, Straight .. 8.00 
30 9 2 405 Mercier's Washing Bottle 
30 9 0 405 Nelaton's Apparatus 30.00 
3103 410 Otis' Evacuator 30.00 
3103 410 Otis'Evacuator, without Basket 25.00 
3101 408 Thompson's Evacuator 15.00 
3089 405 Van Buren's Catheter and Bag 7.00 
3105 411 Walker's Evacuator 22.00 
3104 411 Weiss'-Thompson's Evacuator 30.00 
424 Lithotrity, Perineal, Dolbeau's Operation : 
3 1 49 425 Dolbeau's Dilator 24.00 
3151 425 Dolbeau's Guide for Lithoclast 3.50 
3152 425 Dolbeau's Lithoclast 7.00 
3 1 50 425 Guyon Duplay's Dilator 45.00 
See also Lithoclasts. 
3849 563 Litter, Folding 
1386 84 Little's Aneurism Needle 1.50 
126 2 50 Aseptic Spray 5.00 
1484 94 Artery Clamp Forceps 2.25 
1383 84 Bistoury, Probe Pointed 1.50 
138 5 84 Bistoury, Sharp Pointed 1.50 
1382 84 Bistoury, Straight 1.50 
3113 417 Director 1.50 
58 General Operating Set 100.00 
1384 84 Hernia Knife 1.50 
3114 417 Lithotomy Bistoury 1.75 
3 1 40 421 Lithotomy Forceps 3.00 
3115 417 Lithotomy Staff 2.00 
397 Median Lithotomy Set 54.00 
64 Minor Operating Set 40.00 
64 Minor Operating Set, Ivory 45.00 
127 0 54 Operating Lounge 50.00 
67 Pocket Set 25.00 
1376 84 Retractor 1.50 
13 7 9 84 Scalpel 1.50 
138 0 84 Scalpel 1.50 
138 1 84 Scalpel- 1.50 
30 6 7 400 Searcher for Stone 3.50 
2 5 5 2 278 Trachea Tube, Aluminium 6.00 
138 7 84 Tenaculum 1.50 
1716 126 Trocar 2.50 
48 Local Anaesthesia. 
1259 48 Richardson's Spray Apparatus 5.50 
237 Lock-Jaw Instruments: 
23 6 8 237 Goodwillie's Speculum Oris 8.00 
23 7 6 237 Gross' Speculum Oris 5.00 
237 3 237 Mott's-Heister's Speculum Oris 6.00 
2375 237 Westmoreland's Speculum Oris 6.00 
22 3 2 220 Loewenberg's Pharyngotome 5.00 
3 7 6 8 540 Loewenthal's Obstetrical Forceps 20.00 
2804 328 London Abdominal Supporter 5.00 
2032 188 Hearing Horn 4.00 to 5.50 
4128 674 Long Anchylosis Splint 35.00 to 40.00 
13 5 4 82 Bullet Probe, Silver .75 
3674 515 Chain Ecraseur, Tiemann's 20.00 
1 182 33 Handle Electrode 1.50 
29 0 7 350 Pipe Urethral Syringe.. 1.25 
13 5 4 82 Silver Bullet Probe .75 
358 8 502 Long's Uterine Dilator and Injector 10.00 
1026 5 Loomis'Stethoscope 1.75 
Urinary Examination Set 32.00 
4 1 64 692 Lordosis. 
Lordosis Braces: 
4167 692 Delicate Brace.l 40.00 
4 1 6 5 692 Porous Felt Jacket 25.00 
4 1 6 5 692 Russian Felt Jacket .25.00 
4 1 6 6 692 Smith's Corset, Serpentine Springs... 20.01 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
805 
Fig. Page. Price. 
Lordosis Brace, Tiemann's $35.00 
1747 137 Loring's Ophthalmoscope, Seven Lenses .. 9.00 
1745 134 Students' 22.00 
1748 138 Twelve Lenses 14.00 
1751 141 Upright Image, Double Disk 32.00 
1750 141 Upright Image, Single Disk 28.00 
20 74 194 Lucas's Reflux Ear Douche 1.50 
2364 236 Luer's Cheek Retractor 2.00 
3157 426 Lithotomy Scoop 2.50 
3990 614 Luxation Forceps 8.00 
2736 311 Polypus Forceps 6.00 
3657 513 Polypus Forceps 6.00 
3822 552 Lusk's Cephalotribe 18.00 
3792 548 Insufflator 1.25 
37 7 9 543 Tarnier's Obstetrical Forceps 24.00 
1911 163 Luzardi's Hooked Needle 1.50 
3991 614 Luxation Forceps, Charriere's 9.00 
3990 614 Forceps, Luer's 8.00 
3989 614 Forceps, Plain 4.00 
3987 614 Splint, Levis' 1.50 
Lyman's Tube 2.50 
1639 112 Macewen's Chisel, 3 Sizes, each 6.00 
1641 113 Mallet .60 to 1.00 
1640 112 Osteotome, 3 Sizes, each 6.00 
Set of Chiselsand Osteotomes, in Case, 36.00 
2511 270 Mackenzie's Antero-Posterior Throat For- 
ceps 2.75 
2 5 7 6 283 Eclectic Inhaler 6.00 
2458 264 Laryngeal Brushes, each 1.50 
2512 271 Laryngeal Dilator 20.00 
24 9 8 269 Laryngeal Electrode 3.50 
2486 267 Laryngeal Forceps, Scissors and Ecra- 
seur 25.00 
24 8 5 267 Laryngeal Lancet, 2 Blades 12.00 
24 8 3 267 Laryngeal Lancet, 3 Blades 14.00 
2456 264 Laryngeal Probes, each 1.25 
2509 270 Lateral Throat Forceps 2.75 
2440 259 Light Concentrator 7.50 
2610 291 CEsophagotome, Internal 15.00 
24 6 8 265 Sponge Holder, with Safety Wedge .. 6.00 
240 6 245 Tonsilotome 9.00 
2413 246 Uvulatome 9.00 
3450 Macintosh's Battery, see Battery. 
to >487 Uterine Supporter, each 5.00 
3453 ' 
1177 32 Magnet, Electro 10.00 
1 177 32 Electro, with Cells 15.00 
1989 176 Electro, Bradford's 25.00 
1840 150 Electro, Gruening's 12.00 
116 5 29 Magneto-Electric Machine 10.00 
315 5 426 Maisonneuve's Stone Crusher 20.00 
2952 360 Urethrotome 14.00 
63 Major Surgery: 
63 Amputating Set, Tiemann's Compact, 33.50 
63 Amputating Set, Tiemann's No. 1 25.00 
63 Amputating Set, Tiemann's No. 2 30.00 
63 Amputating Set, Tiemann's No. 3 .... 35.00 
63 Amputating and Trepanning Set 44.25 
63 Capital Operating Set 52.00 
64 Conant's Capital and Minor Operat- 
ing Set 53.95 
Malgaigne's Hooks 6.00 
4401 769 Hooks, Modified by Otis 5.50 
43 8 4 766 Mallet, Gerster's. .50 
15 7 6 102 Leaden 2.'50 
1641 113 Rawhide.. .60 to 1.00 
1116 16 Steel, Post Mortem 2.50 
28 7 0 345 Mallez's Bougie a Boule 1.25 
2919 351 Powder Insufflator 1.75 
1816 149 Manfredi's Speculum, Ophthalmic 5.00 
2016 185 Manometer, Politzer's .50 
Fig. Page. Price. 
30 4 4 389 Marcy's Double Current Catheter $2.50 
38 3 4 560 Perineal Safety Pin .50 
1072 11 Marey's Sphygmograph 75.00 
Marine Lint, per pound, in Box 1.00 
58 Markoe's General Operating Set 67.45 
1571 101 Sequestrum Forceps 3.00 
3117 417 Staff, Lithotomy 2.00 
4 1 92 702 Torticollis Brace 35.00 to 45.00 
1631 109 Marshall's Osteotrite 2.50 
1 023 5 Martin's Combination Stethoscope 5.00 
Forceps 2.75 
Needles, each .25 
12 7 8 74 Rubber Bandages, Prices on page 74. 
Vaccine Virus, 10 Points 1.00 
2030 188 Martineau Hearing Horn 4.50 
3126 419 Mason's Catheter Staff 5.00 
64 Minor Operating Set 44.00 
Pocket Set 30.00 
263 1 297 Masticator 8.00 and 12.00 
2959 362 Mastin's Stricture Cutter 8.00 
29 6 3 362 Maisonneuve's Urethrotome 14.00 
197 Mastoid Process: 
198 Abscess, Peroxide of Hydrogen in. 
2112 197 Chisel, Buck's 1.25 
2113 197 Chisel, Buck's 1.25 
2118 ( 
to >197 Chisels, Schwartze's, each 1.25 
2122 ' 
2126 197 Drainage Tube, Gruening's 1.00 
2124 197 Drainage Tube, Knapp's .75 
2 1 25 197 Drainage Tube, Knapp's .75 
1619 108 Drill, Buck's 3.00 
2127 197 Drill, Buck's 3.00 
1624 108 Drill, Plain 1.75 
1622 108 Drill, with Guard 7.00 
1621 108 Gouge, Hand 1.50 
2111 197 Gouge, Hand 1.50 
2129 197 Gouge, Politzer's 2.50 
1620 108 Gouge, Post's Rongeur 3.00 
21 1 4 y 
to > 197 Gouges, Schwartze's, each 1.25 
2117 
2 1 08 197 Knife, Buck's 1.50 
1623 108 Knife, Burnett's 1.50 
2 1 09 197 Knife, Burnett's 1.50 
2128 197 Knife, Politzer's 2.00 
108 Perforating the. 
197 Perforation of the. 
2110 197 Periosteotome, Buck's 2.50 
1620 108 Rongeur, Post's 3.00 
2129 197 Scoop, Politzer's 2.50 
3771 541 Mathew's Obstetrical Forceps 8.00 
Obstetrical Forceps, with Screw 9.50 
2750 312 Mathieu's Prolapsus Ani Supporter 5.00 
2507 270 Throat Forceps 6.00 
2402 244 Tonsilotome 12.00 
3058 398 Urethral Lithotrite 15.00 
4212 712 Writers'Cramp Apparatus 6.00 
421 5 713 Writers' Cramp Apparatus, for 3 Fin- 
gers 6.00 
1328 80 Mathis'Needle Holder 5.00 
1471 93 Mattock's Key Ring Artery Clamp .50 
1924 164 Maunoir's Scissors 1.50 
1696 122 Maury's Fumigation Apparatus 12.00 
26 6 7 305 Maw's Enema Pump 4.50 
586 Maxilla, Fracture of. 
1603 104 Saw, Left 1.75 
1601 104 Saw, Right 1.75 
397 May's Lithotomy Set 39.00 
26 0 3 288 Steam Jacket J 35.00 
142 5 88 Tourniquet 15.00 
3985 612 Mayor's Apparatus for Dislocated Clavicle, 5.00 
3660 513 McClintock's Polypus Forceps 6.00 
1821 149 McFarlan's Lachrymal Syringe 3.00 806 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price 
37 4 5 537 McFerran's Obstetrical Forceps $12.00 
McIntosh's Battery, see Battery. 
3450 , 
to >487 Uterine Supporter, each 5.00 
3453 ' 
Waterproof Cloth, per yard 
3947 597 McIntyre's Splint 16.00 
2043 191 McKay's Ear Forceps 2.50 
36 0 6 504 McLean's-Barnes'Dilator 2.50 
3597 503 Dilator Introducer 4.50 
3 7 4 9 538 Obstetrical Forceps 8.00 
251 7 273 McSherry's Laryngeal Dilator 11.00 
25 1 6 273 Tracheotomy Tube 5.00 
3194 437 Meadow's Quatrivalve Speculum 15.00 
3186 435 Trivalve Speculum 10.00 
2894 347 Meatometer, Piffard's 1.50 
28 5 2 343 Meatoscope, Glass, each .50 
2853 343 Weir's 1.25 
2887 347 Meatotome, Civiale's (Bistoury Cache) 5.00 
2888 347 Gouley's 3.00 
28 8 9 347 Mitchell's 22.00 
2891 347 Otis' 1.75 
2892 347 Piffard's 2.00 
2890 347 Piffard's Fossal Stricture Knife 10.00 
Meatus, Auditorius Externus, see Aural: 
Diagnostic. 
343 Urinarius. 
5 Mediate Auscultation. 
See also Stethoscope. 
7 Mediate Percussion. 
See also Percussion. 
Medical Saddle Bags: 
1149 22 With 16 Vials 6.00 
1150 22 With 16 Vials. 10.00 
1151 22 With 16 Vials 10.00 
1149 22 With 20 Vials 7.00 
1150 22 With 20 Vials 11.00 
1151 22 With 20 Vials 11.00 
1149 22 With 24 Vials 8.00 
1150 22 With 24 Vials 12.00 
1151 22 With 24 Vials 12.00 
Send for complete Price List. 
1148 22 Medicine Chest 20.00 to 35.00 
1147 22 Chest No. 1 12.00 
1147 22 Chest No. 2 15.00 
1147 22 Chest No. 3 18.00 
1147 22 Chest No. 4. 6.00 
Send for complete Price List. 
19 Medicine Pocket Cases : 
1146 21 Fuller's, Style 1 2.75 
1146 21 Fuller's, Style 2.. 3.00 
1146 21 Fuller's, Style 3 3.50 
1146 21 Fuller's, Style 4 5.00 
Send for complete Price List. 
1129 18 Medulla Oblongata Drill 1.75 
3816 551 Meigs'Craniotomy Forceps, Angular 3.50 
38 1 7 551 Craniotomy Forceps, Curved 3.50 
38 1 5 551 Craniotomy Forceps, Straight 3.50 
196 Membrana Tympani. 
See also Aural: Membrana Tympani. 
30 2 5 385 Mercier's Double-Elbowed Catheter (Bicou- 
dee) 1.00 
30 6 3 399 Duplicator 25.00 
3024 385 Elbowed Catheter (Coudee) 1.00 
3092 405 Evacuating Apparatus, or Washing 
Bottle 
30 0 4 379 Excisor, First 40.00 
30 0 6 379 Excisor, Last 50.00 
3005 379 Incisor and Ecraseur, Combined 60.00 
3042 388 Invaginated Catheter 3.50 
3008 380 Prostatic Gland Dilator 10.00 
3002 378 Rectangular Sound 1.50 
122 Mercurial Fumigation Apparatus: 
1696 122 Bumstead's-Lee's Lamp 3.00 
Fig. Page. Price. 
Mercurial Fumigation Apparatus : 
1696 122 Maury's Apparatus $12.00 
1694 122 Van Buren's Apparatus, complete 2.50 
1694 122 Van Buren's Lamp only 1.50 
152 1 97 Metacarpal Saw 1.50 
1524 97 Detmold's 1.50 
152 3 97 Lente's Interosseous 1.50 
152 5 97 Lifting Back, Large 4.00 
1525 97 Lifting Back, Medium 3.00 
1522 97 Lifting Back, Small 2.50 
123 1 36 Metallic Foot Plate Electrode .50 
12 1 8 35 Handle Electrode, per pair 1.50 
1215 35 Points for Faradization 1.00 
1211 35 Scourge, Electrode .75 
122 6 36 Sound, Electrode .75 
3435 484 Metratrep, White's 14.00 
284 1 339 Metric Scale for Urethral Instruments _ 3.50 
2848 341 Scale, Otis' 3.50 
771 System. 
3380 475 Metrorganon, Newman's 3.00 
Metrotome, see Hysterotome. 
187 Microcoustic, see also Ear Trumpets. 
1074 12 Microscope 45.00 to 100.00 
12 Microscopical. 
1086 13 Microscopic Bistoury, Probe Pointed 1.25 
1087 13 Bistoury, Sharp Pointed.. - 1.25 
17 Dissecting Set 15.00 
1079 12 Exploring Trocar 1.50 
1075 12 Exploring Trocar, Duchenne's 2.50 
1076 12 Exploring Trocar, Duchenne's 3.50 
1077 12 Exploring Trocar, Noeggerath's 3.50 
1078 12 Exploring Trocar, Tiemann's 2.50 
1096 13 Forceps, Curved .75 
1095 13 Forceps, Straight .75 
1092 13 Needle, Curved or Straight .50 
1091 13 Needle Holder 1.25 
1085 13 Scalpel, Fixed Handle .75 
1088 13 Scalpel, Folding Handle 1.00 
1073 12 Scissors, Transplantation 10.00 
1080 12 Section Cutter, Jewett's 9.00 
1084 13 Section Knife 1.50 
1090 13 Section Knife, Charriere's 8.00 
1081 12 Section Knife, Curtis' 3.50 
1083 13 Section Knife, Piffard's 5.00 
1093 13 Section Knife, Small.. .50 
1094 13 Section Knife, Spear Pointed .75 
1082 12 Section Knife, Valentine's 8.00 
1081 12 Section Knife and Frame 15.50 
1089 13 Section Razor 2.00 
1097 13 Syringe, Brass 6.50 
1098 13 Syringe, Brass, No. 1 10.50 
1097 13 Syringe, Hard Rubber 5.50 
Midwifery, see Obstetrical. 
2811 331 Miliano's Compressor 2.00 
61 Military Surgery: 
1273 61 Otis' U. S. A. Field Set 160.00 
62 U. S. A. Capital Operating Set 102.50 
62 U. S. A. Staff Surgeons' Capital Ope- 
rating Set 137.10 
62 U. S. A. Staff Surgeons' Minor Ope- 
rating Set 136.00 
1680 120 Milium Needle, Piffard's 1.25 
1740 133 Miller's Aspirator 7.00 
Obstetrical Forceps 8.00 
3763 540 Obstetrical Forceps, Jointed 15.00 
3 5 9 0 502 Uterine Dilator 10.00 
2001 183 Millikin's Ear Speculum 1.50 
14 7 8 93 Milne's Artery Compression Forceps 1.50 
2982 370 Dilating Urethrotome 17.00 
2631 297 Mincer (Masticator) 8.00 and 12.00 
1146 21 Minim Measure, No. 2 .75 
1146 21 Pipette, No. 1 50 
Minor Operating, see Minor Surgery. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
807 
Fig. Page. Price. 
64 Minor Surgery Cases or Sets : 
65 Enos' $33.00 
65 Eves' 33.50 
65 Hospital 74.80 
64 Little's 40.00 
64 Little's, Ivory Handles 45.00 
64 Mason's 44.00 
65 Plain 18.00 
64 Powell's 85.00 
65 Tiemann's 25.00 
Minor Surgery Instruments: 
1404 85 Scissors, Angular 1.50 
1403 85 Scissors, Artery 1.75 
140 5 85 Scissors, Curved on the Flat 1.50 
1406 85 Scissors, Straight 1.00 
Minor Surgery Instruments, Ebony Han- 
dles, Feruled: 
1378 84 Aneurism Needle 1.25 
1386 84 Aneurism Needle, Little's 1.50 
138 3 84 Bistoury, Little's, Probe Pointed 1.50 
138 5 84 Bistoury, Little's, Sharp Pointed 1.50 
1382 84 Bistoury, Little's, Straight 1.50 
1370 84 Bistoury, Probe Pointed 1.25 
136 9 84 Bistoury, Sharp Pointed 1.25 
136 8 84 Bistoury, Straight, Blunt Pointed.... 1.25 
1388 84 Dry Dissector, Hamilton's 1.50 
1389 84 Dry Dissector, Hamilton's 1.50 
1393 84 Dry Dissector, Hamilton's 1.50 
1394 84 Dry Dissector, Hamilton's 1.50 
136 7 84 Finger Knife 1.25 
139 1 84 Graduated Knife 3.00 
1371 84 Hernia Knife, Cooper's 1.25 
1384 84 Hernia Knife, Little's 1.50 
1376 84 Retractor, Little's 1.50 
1366 84 Scalpel, 4 Sizes, each 1.25 
1379 84 Scalpel, Little's 1.50 
1380 84 Scalpel, Little's ' 1.50 
138 1 84 Scalpel, Little's 1.50 
13 7 7 84 Tenaculum 1.25 
138 7 84 Tenaculum, Little's 1.50 
1374 84 Tenotome, Blunt Pointed 1.25 
1372 84 Tenotome, Concave Edged 1.25 
137 3 84 Tenotome, Convex Edged 1.25 
1375 84 Tenotome, Sharp Pointed 1.25 
1392 84 Tissue Separator, Post's 1.50 
Ivory Handles, 25 cents extra. 
Minor Surgery Instruments, Ebony Handles, 
Riveted : 
1398 85 Bistoury, Probe Poin ted 1.00 
1399 85 Bistoury, Sharp Pointed 1.00 
1397 85 Cooper's Hernia Knife 1.00 
1396 85 Finger Knife, Straight 1.00 
1400 85 Scalpel .75 
1401 85 Scalpel .75 
1402 85 Scalpel .75 
1395 85 Tenaculum .75 
See also Pocket Instruments. 
71 Minor's Pocket Set 22.50 
29 3 6 355 Stricture Dilator, per set 3.50 
2555 279 Trachea Retractors 4.50 
84 Miotomy. 
See also Minor Surgery Instruments. 
199 7 183 Mirror, Ear, Troeltsch's 3.00 
20 1 8 185 Inner Ear, Blake's 8.00 
Laryngoscopic, see Laryngoscopic 
Mirror. 
Speculum, see Specula. 
1255 46 Mitchell's Ether Inhaler 2.00 
28 8 9 347 Meatotome 22.00 
2923 3521 Reflux Catheter, with Tiemann's Pa- 
tent Velvet Eye .75 
181 Mittendorf's Set of Eye Instruments 50.00 
278 1 323 Moc-Main Truss 8.00 
1010c 3 Mohr's Beaker .10 to .30 
Fig. Page. Price. 
1010g 3 Mohr's Burette $2.50 
1010& 3 Stand 1.50 
Molar Forceps, see Dental Forceps. 
Moleskin Adhesive Plaster, per yard 1.50 
2526 276 Mop for Cleansing Trachea Canulas .15 
637 Morbus Coxarius. 
See also Orthopaedic: Diseases of the 
Joints. 
Morgan's Needle .30 
Suspensory 1.50 
1257 48 Morton's Ether Inhaler 5.00 
1364 83 Mose's Bullet Extractor 3.50 
3536 494 Mossman's Stem Pessary 5.00 
146 0 92 Mott's Aneurism Needles, per set 2.75 
60 General Operating Set 72.85 
1554 100 Retractor, per pair 1.50 
23 73 237 Speculum Oris 6.00 
1436 89 Tourniquet 2.00 
221 Mouth and Throat. 
Mouth Gag, see Gag. 
Mouth Specula (Specula Oris), see Lock-Jaw 
Instruments. 
24 9 6 268 Movable Point Scissors, Haywood Smith's. 12.00 
2488 267 Tiemann & Co.'s 8.50 
68 Multum in Parvo Pocket Set 19.00 
Munde's Applicator, Hard Rubber .50 
Aspirator and Hypodermic Syringe.. 12.00 
Counter-pressure Hook 1.50 
Curette, Placenta 3.00 
Curette, Uterine, Blunt 1.50 
Curette, Uterine, Sharp 1.50 
472 Gynaecological Pocket Case 16.00 
Ointment Tube 2.00 
Pessary, Anteversion 1.25 
Placenta Forceps 3.00 
26 7 2 305 Rectal Irrigator 1.50 
32 4 6 447 Speculum Vaginae 3.50 
3950 598 Munger's Splint, Complete 6.00 
3486 562 Munson's Quill Suture Stay, per pair .75 
1169 32 Murray's Electrolysis Needle 1.25 
2394 243 Musseux's Forceps, Vulsellum 2.50 
3163 428 Mussey's Bladder Curette 4.50 
2369 237 Mouth Gag 7.00 
2103 196 Myringotome, Buck's 1.00 
2099 196 Politzer's, Angular 1.00 
2 1 05 196 Politzer's, Straight .... 1.00 
2104 196 Prout's 1.00 
1753 143 Nachet's Trial Set 
3772 541 Naegeli's Obstetrical Forceps 8.00 
3797 549 Perforator 4.00 
1690 121 Naevus Needle .50 
745 Nail: 
747 Chiropodists' Pocket Set, Goldberg's, 37.00 
42 8 7 746 Cleaner and File .50 
42 9 3 746 Extracting Forceps 2.50 
42 9 4 747 Extracting Forceps, Van Buren's .... 2.50 
42 8 9 746 Nippers 3.00 
42 9 5 747 Spring for Inverted Nails .25 
29 8 6 370 Nall's Dilating Urethrotome 40.00 
203 Nasal: 
2189 211 Applicator, Bosworth's 1.50 
2193 211 Applicator, Bridge's Insufflator .75 
2432 254 Applicator, Lefferts' Insufflator 4.00 
Applicator, Sajou's Acetic Acid 10.00 
Applicator, Sajou's Chromic Acid ... 10.00 
2191 211 Applicator, Smith's 2.50 
2218 217 Clamp, Bosworth's 2.50 
2194 212 Clamp, Caro's .75 
2219 217 Clamp, Gouley's - 5.00 
2201 213 Curette, Buck's 1-00 
2051 191 Curette, Quire's 2.25 
4409 770 Dilator, Goodwillie's .75 808 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Nasal: 
2149 205 Dilator, Woakes' .. .$18.00 
2 1 48 204 Dilator, Yearsley's .50 
2192 211 Douche, Bridge's .75 
2181 210 Douche, Chapman's Spray 5.00 
2 1 7 6 209 Douche, Clark's 1.50 
2180 210 Douche, Fullgraff's 3.50 
2186 211 Douche, Fullgraff's Posterior 3.00 
2177 209 Douche, Thudichum's 1.50 
2183 210 Douche, Warner's Catarrhal 1.00 
2178 209 Douche, Weir's Sniff Glass 75 
2 1 7 9 209 Douche, Woake's Irrigator 1.25 
Duct, see Ophthalmic, Lachrymal. 
1192 34 Electrode .75 
1191 34 Electrode 1.00 
2196 212 Epistaxis Canula, Belocq's, Plated... 2.00 
2196 212 Epistaxis Canula, Belocq's, Silver 3.00 
2194 212 Epistaxis Clamp, Caro's .75 
2195 212 Epistaxis Tampon, Rubber 75 
2620 294 Feeding Tube, Paine's 1.00 
2200 213 Foreign Body Hook 1.00 
2226 219 Plug, Hard Rubber .75 
2203 213 Polypus Canula 1.50 
2209 215 Polypus Canula Scissors, Smith's 5.00 
Nasal Polypus Ecraseurs: 
2208 215 Bettman's-Jarvis' Snare 8.50 
2207 215 Bosworth's-Jarvis' Snare 5.00 
2205 214 Jarvis'Snare 3.00 and 4.00 
Jarvis' Snare, with Curved and Straight 
Ends 5.00 
3675 516 Sajou's Snare 4.00 
Sajou's Snare, with Curved and 
Straight Ends 5.00 
2210 216 Nasal Polypus Evulsion Forceps, Robinson's, 4.50 
2199 213 Nasal Polypus Forceps 1.50 
2198 213 Crossing Blades 1.50 
2197 213 Gross'.. 2.25 
2202 213 Simrock's 2.50 
2204 213 Nasal Polypus Syringe, Upson's 14.00 
2206 214 Polypus Transfixion Needle 75 
Nasal Rhinoscope, see Rhinoscope and Rhi- 
noscopic. 
43 2 0 755 Nasal Saws, Bosworth's, each 2.00 
432 1 755 Bucklin's 4.00 
2231 220 Woake's... 2.00 
Nasal Scissors, Potter's 4.50 
Roe's 4.50 
43 1 5 755 Sherwell's 5.00 
4316 755 Sherwell's 7.00 
2209 215 Smith's 5.00 
217 Nasal Septum: 
2220 218 Cartilage Forceps, Jarvis' 4.50 
2218 217 Clamp, Bosworth's 2.50 
2219 217 Clamp, Gouley's 5.00 
2224 219 Double Gouge Forceps, Weir's 3.50 
2228 219 Excisor, Jarvis' 5.00 
22 3 0 220 Exostosis Trocar, Wilkerson's 3.50 
2227 219 Punching Forceps, Jarvis' 8.50 
2223 219 Punching Forceps, Roberts'. 6.00 
Punching Forceps, Sajou's 20.00 
2225 219 Punching Forceps, Steel's 10.00 
22 2 9 220 Rhinometer, Jarvis' - 9.00 
2215 217 Rhinoplastos, Adams' 3.00 
2217 217 Rhinoplastos, Bosworth's 3.50 
2216 217 Rhinoplastos, Weir's 3.00 
2222 218 Rongeur, Jarvis' 4.50 
Saw see Nasal Saw. 
2214 217 Septometer, Seiler's 4.50 
2221 218 Trimming Scissors, Jarvis'... 9.00 
2230 220 Trocar, Wilkerson's 3.50 
Nasal Speculums: 
2151 205 Bivalve 1.50 
2 1 50 205 Bonafont's 2.50 
2160 206 Bosworth's 1.50 
Fig. Page. Price. 
Nasal Speculums: 
2 1 5 7 205 Colin's S3.50 
2 1 5 3 205 Elsberg's 5.00 
2166 206 Folsom's ...... 1.50 
2 1 5 5 205 Fraenkel's 3.50 
2 1 58 205 Goodwillie's 1.00 
2 1 62 206 Jarvis' .75 
2161 206 Jarvis'Operating 3.00 
2 1 5 6 205 Robert and Colin's 3.50 
21 6 5 206 Sexton's 1.00 
2 1 54 205 Shurley's, Right and Left, each 3.50 
2 1 5 2 205 Simrock's 1.50 
2 6 6 3 206 Smith's, Andrew H. 1.50 
2164 206 Thudichum's, Right and Left, each . .75 
43 2 2 755 Turnbull's 6.00 
2 1 59 206 Zaufal's, 3 Sizes, each ' 1.50 
2417 219 Nasal Spray, Lefferts' 4.00 
24 1 8 249 Syringe, Lefferts' 3.00 
215 Tissue, Hypertrophied. 
2210 216 Tissue, Robinson's Evulsion Forceps, 4.50 
216 Nasal Turbinated Bones : 
2213 216 Woakes'Plough, R. and L., each 2.50 
2212 216 Woakes'Plough Guide, R. and L., ea., 3.75 
2211 216 Woakes' Scissors, R. and L., each 6.00 
220 Naso-Pharyngeal, see also Pharyngeal. 
220 Evulsion of the Pharyngeal or Lusch- 
ka's Tonsil: 
22 3 2 220 Loewenberg's Pharyngotome .. 5.00 
22 3 3 220 Wagner's Post Nasal Forceps.. 3.50 
2514 272 Navratil's Laryngeal Dilator 
2582 284 Nebulizer, Seeger's, Steam.. 12.00 
See also Inhaler and Spray. 
1208 35 Neck Electrode .. 2.00 
Necrosis Forceps, see Rongeursand Seques- 
trum Forceps. 
3 73 1 533 Needle, Abdominal, Fixed Handle 75 
38 3 5 561 Agnew's, and Holder, per set 4.50 
1983 175 Agnew's Tattooing 2.00 
1463 92 Aneurism, Plain .75 
See also Artery Needle. 
3840 561 Ashton's Perineum 1.00 
1982 175 Baader's Tattooing 2.00 
197 8 174 Bowman's Stop 1.75 
33 2 2 457 Bozeman's, per dozen 1.50 
13 1 8 79 Buck's Pin Conductor 1.75 
1883 157 Canthoplasty, Prince's 2.50 
13 1 9 79 Canulated .... 4.00 
1835 150 Carron de Villard's, Eye 1.25 
Cataract, see Ophthalmic: Iris Needle. 
1325 80 Cleborne's (Tenaculum Needle and 
Wire Twister) 7.00 
1461 92 Crampton's Artery, per pair 5.00 
2764 317 Dowell's, Hernia, each 1.00 
Electrolysis, see Electrolysis Needle. 
132 0 79 Emmet's, Suture, per dozen 1.50 
1784 146 Eye, Suture, per dozen 1.50 
131 7 79 Finnell's, Post Mortem, each .20 
1462 92 Fletcher's, Aneurism 3.00 
2346 235 Goodwillie's, Staphylorraphy, per set, 12.00 
Hsemorrhoidal, see Haemorrhoidal 
Needle. 
437 7 765 Haemostatic, each .15 
33 1 0 455 Hagedorn's, Suture, per card 3.00 
33 1 0 455 Hagedorn's, Suture, per dozen 1.50 
1905 163 Hayes'Knife Needle 1.50 
14 6 4 92 Helical 1.75 
146 7 92 Helmuth's (Ligature Carrier) 3.50 
Hernial, see Hernia: Radical Cure of. 
271 9 309 Hutchison's 2.50 
125 Hypodermic, Prices on page 125. 
Iris, see Ophthalmic, Cataract: Iris 
Needle. 
3 7 3 0 533 Keith's Abdominal, each .10 
28 2 4 334 Keyes' Varicocele, each 1.75 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
809 
Fig. Page. Price. 
Needle, Keyes' Varicocele, Improved $6.00 
,1314 79 Ligature and Perineum 1.00 
Martin's .25 
1092 13 Microscopic, Straight or Curved .50 
1680 120 Milium, Piffard's 1.25 
Morgan's .30 
146 0 92 Mott's, Aneurism, per set 2.75 
1690 121 Naevus .50 
1321 79 Open Eyed .25 
146 6 92 Ostrom's (Ligature Carrier) 3.00 
Paracentesis Corneae, see Ophthal- 
mic : Paracentesis Corneae. 
3842 561 Parker's Perineum, per set 5.00 
3732 533 Peaslee's Perineum 3.00 
38 3 9 561 Peaslee's Perineum, per set 3.00 
3841 561 Peaslee's Perineum, R. and L., each- 1.75 
Perineal, see Perineorrhaphy. 
Pile, see Haemorrhoidal Needle. 
1321 79 Platt's Open-Eyed .25 
Polk's, for Extirpation of Uterus .... 4.50 
1326 80 Post's (Pin Conductor) 1.00 
14 1 7 86 Post's and Buck's (Pin Conductors) - 2.50 
23 4 8 235 Prince's, Staphylorraphy 10.00 
2352 235 Prince's, Tenaculum Needle 10.00 
44 1 3 770 Reverdin's, in Fixed Handle 6.00 
Reverdin's, in Folding Handle 6.00 
132 0 79 Sims' Suture, per dozen 1.50 
3722 760 Skene's, Cervix, per dozen 1.50 
3843 561 Skene's, Perineum 1.75 
Staphylorrhaphy, see Staphylorrha- 
■ phy Needle. 
Suture, see Suture Needle. 
Tattooing, see Ophthalmic: Tattoo- 
ing Needle. 
Thomas', for Extirpation of Uterus- 4.50 
Uterine, see Uterine Needles. 
Wackerhagen's 1.00 
1975 174 Walton's Reclination - 1.25 
23 3 4 233 Whitehead's Spiral 1.75 
1918 163 Wilde's Canulated Forceps, Forceps- 
Needle and Scissors 15.00 
'1316 79 Wire Suture, per dozen .50 
Needle Forceps (Holders or Carriers) : 
2720 309 Artery and 2.50 
1449 91 Artery and, Old's 2.25 
33 2 2 457 Bozeman's 5.00 
43 9 0 767 Dawbarn's 7.00 
3308 454 Dawson's 3.50 
1336 80 De Gaine's " Russian " 4.00 
438 1 765 Diefenbach's 3.00 
1341 81 Dudley's-Sand's 4.50 
3307 454 Emmet's 3.00 
Fowler's 6.00 
1688 121 Fox's 3.50 
33 1 2 455 Hagedorn's 8.00 
1331 80 Heuel's 4.00 
1781 146 Knapp's 3.50 
1339 81 Kiister's 3.50 
1328 80 Mathis' 5.00 
1091 13 Microscopic 1.25 
1329 80 Needle Forceps 3.50 
33 5 9 473 Nott's-Roux's 4.50 
1449 91 Old's Artery and 2.25 
Otis' Combination 11.00 
1335 80 Parker's 4.00 
3313 456 Parrott's 5.00 
1340 81 Prout's 3.50 
1332 80 Reiner's 4.00 
1334 80 Roux's 4.50 
1336 80 Russian 4.00 
1341 81 Sand's 4.50 
1337 81 Sims' 2.50 
27 1 2 309 Sims' 2.50 
3303 454 Sims' 2.50 
Fig. Page. Price. 
38 2 7 556 Needle Forceps, Skene's $5.50 
1338 81 Stimson's 3.50 
33 0 4 454 Tiemann's Combination 6.00 
3831 558 Van de Warker's 7.00 
38 3 3 559 Von Ramdohr's 10.00 
Wight's 3.50 
1330 80 Wyeth's 4.50 
Wyeth's Combination 6.00 
1350 82 Nelaton's Bullet Probe .60 
Catheter .50 
3090 405 Evacuating Apparatus 30.00 
3647 512 Pedicle Forceps 3.50 
28 2 9 336 Phimosis Forceps 5.00 
3654 512 Tumor Forceps 3.50 
3 0 5 7 398 Urethral Foreign Body Instrument- 40.00 
3 1 9 1 435 Nelson's Speculum Vaginae 4.50 
3 59 1 502 Uterine Dilator 5.50 
1139 19 Nerve Knife 1.50 
701 Nerves, Affections of. 
623 Wounds and Injuries of. 
321 8 442 Neugebauer's Speculum 2.50 
2 5 9 2 286 Newman's Atomizer 6.00 
Electrolysis Catheter 4.50 
Electrolysis Bougie a Boule 2.50 
Electrolysis Sound _ 3.00 
Electrolysis Sound, Tunnelled 4.00 
3380 475 Metrorganon 3.00 
3766 540 Obstetrical Forceps 7.00 
Ointment Tube, Hard Rubber 1.50 
2 5 7 5 283 Nichols'Inhaler 5.00 
331 9 456 Nilsen's Counter-pressure Fork and Tier .. 1.75 
2 5 7 2 282 Nitz's Respirator 1.50 
44 0 6 770 Noeggerath's Clamp 7.00 
1077 12 Exploring Trocar 3.50 
34 6 8 489 Pessary 2.00 
2807 328 Supporter 6.00 
3433 483 Uterine Elevator 9.00 
214 7 203 Nose, Artificial 50.00 to 125.00 
34 0 8 477 Nott's Applicator 4.50 
1481 94 Artery Clamp Forceps 6.00 
32 3 4 445 Depressor 1.50 
32 4 9 448 Depressor 1.50 
3421 482 Double Current Catheter 3.00 
34 2 2 482 Double Current Catheter 2.50 
30 4 6 389 Double Current Catheter 3.00 
34 0 9 477 Hard Rubber Uterine Syringe 2.50 
32 9 0 452 Knife, Vesico-Vaginal Fistula 1.50 
3291 452 Knife, Vesico-Vaginal Fistula, Angu- 
lar 1.50 
35 5 9 473 Needle Holder, No. 1 4.50 
37 0 8 529 Rectilinear Ecraseur 12.00 
472 Set of Uterine Instruments 111.46 
3211 441 Speculum Vaginae 4.00 
3552 497 Tenaculum .25 
3314 456 Twisting and Needle Forceps 3.00 
3581 501 Uterine Dilator 3.50 
33 5 9 473 Uterine Instruments, per set 10.00 
34 0 9 477 Uterine Syringe 2.50 
2463 264 Noyes' Brush Holder 2.25 
1806 148 Canalicula Knife, Movable 4.00 
180 5 148 Canalicula Knife, Plain 1.75 
1804 148 Canalicula Knife, Stilling's 1.75 
2072 193 Ear Forceps 4.50 
2135 199 Eustachian Catheter, R. and L., ea., 2.50 
1849 151 Eyelid Retractor 1.75 
1861 152 Fixation Forceps 3.00 
1844 151 Improved Eye Speculum 4.50 
1844 151 Improved Eye Speculum, Gilt 5.00 
1927 164 Iris Scissors 4.50 
1814 149 Lachrymal Gouge 2.50 
1746 135 Lens Holder 6.00 
19 5 4 168 Lens Spoon 4-- 1.75 
1900 162 Linear Knife 1.50 
1865 152 Ophthalmostate 2.00 810 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
1843 151 Noyes'Plain Eye Speculum $1.75 
181 Set of Eye Instruments 70.00 
1804 148 Stilling's Knife 1.75 
2500 269 Throat Forceps 4.50 
3391 476 Nunn's Applicator 75 
1176 32 Catheter Electrode 4.00 
1705 124 Hypodermic Syringe and Pellet Holder, 6.50 
43 4 7 759 Pad for Emmet's Speculum 1.25 
3243 447 Speculum Vaginae 12.00 
3 3 7 7 475 Uterine Dressing Forceps 6.00 
3382 475 Uterine Dressing Forceps and Scis- 
sors 5.00 
4210 712 Nussbaum's Bracelet for Writer's Cramp.. 6.00 
4 1 56 689 Nyrop's Spring Shoulder Brace 18.00 
4259 736 Talipes Valgus Shoe 10.00 to 12.00 
O'Bierne's Tube, 12 inch 1.00 
Tube, 18 inch 1.50 
3785 548 Obstetrical, Amniontome, Wenck's 2.50 
3823 552 Bag 5.00 and 6.00 
3813 551 Basiotribe, Tarnier's 35.00 
3806 550 Blunt Hook, Taylor's 2.50 
3805 550 Blunt Hook and Crotchet 1.50 
3808 550 Blunt Hook and Crotchet, Bedford's. 6.00 
38 0 7 550 Blunt Hook and Crotchet, Guarded.. 4.50 
Obstetrical, Cephalotribes: 
3820 552 Braun's 18.00 
Hicks' 25.00 
38 2 2 552 Lusk's 18.00 
3821 552 Simpson's 15.00 
3818 551 Van Huvel's 
Obstetrical, Cord Carriers: 
3 7 8 0 544 Filet 6.00 
Plain 2.50 
3789 548 Scholler's 4.00 
381 9 552 Obstetrical, Cranioclast, Simpson's 10.00 
Obstetrical, Craniotomy Forceps: 
3816 551 Meigs', Angular 3.50 
3817 551 Meigs', Curved 3.50 
3815 551 Meigs', Straight 3.50 
38 0 9 550 Obstetrical, Decapitating Hook 3.00 
38 1 0 550 Decapitating Hook, Braun's 3.00 
Obstetrical, Embryotomy Forceps: 
3793 548 Bachelder's 12.00 
3791 548 Tiemann's 3.00 
See also Obstetrical: Placenta 
Forceps. 
Obstetrical Forceps: 
Barnes' 8.00 
3762 540 Bedford's 8.00 
3739 537 Bethel.... 8.00 
3 7 5 9 539 Blake's 8.00 
Braun's-Simpson's 8.00 
378 1 545 Braun's Triform 
Breus'-Tarnier's 20.00 
3 7 3 6 536 Brickel's 8.00 
3 7 5 3 538 Budd's 8.00 
Burdick's 12.00 
37 7 8 542 Burge's 30.00 
37 6 1 539 Buzzle's 10.00 
3743 537 Cole's 8.00 
Cole's-Tarnier's 24.00 
3 7 4 2 537 Comstock's 8.00 
37 7 7 542 Corning's-Tarnier's 12.00 
3754 539 Davis' 7.50 
37 5 1 538 Denman's 7.00 
37 6 4 540 Draper's 8.50 
37 4 7 538 Elliott's 9.50 
3 7 4 8 538 Gillette's 9.50 
3769 541 Hale's 7.00 
3 7 3 4 536 Hodge's 8.00 
Howard's-Tarnier's 24.00 
3 7 4 0 537 Hunter's 9.00 
Fig. Page. Price. 
Obstetrical Forceps: 
3 7 5 8 539 Ives' $7.00 
3 7 5 7 539 Jenks', Long 8.50 
37 5 6 539 Jenks', Short 7.50 
3775 541 Jewett's 10.00 
3 7 6 8 540 Loewenthal's 20.00 
Lusk's-Simpson's 8.00 
3779 543 Lusk's-Tarnier's 24.00 
3771 541 Mathew's 8.00 
Mathew's, with Screw . 9.50 
37 4 5 537 McFerran's 12.00 
3 7 4 9 538 McLean's 8.00 
Miller's 8.00 
3763 540 Miller's, Jointed 15.00 
3 7 7 2 541 Naegeli's 8.00 
Neal's-Tarnier's 24.00 
3 7 6 6 540 Newman's 7.00 
3750 538 Osborn's 8.00 
Pierce's 7.50 
3774 541 Robertson's 8.00 
3 7 3 7 530 Robinson's 8.00 
3770 541 Rockwell's 8.00 
37 6 5 540 Roller's 8.00 
3760 539 Sawyer's 7.00 
3 7 4 4 537 Sawyer's, Long 10.00 
3 74 1 537 Sawyer's, Short 8.00 
3773 541 Schuyler's 11.00 
3782 546 Simpson's, Long 8.00 
Simpson's, Short , 7.00 
Simpson's-Tarnier's 16.00 
3776 542 Tarnier's (Original) 30.00 
Tarnier's (1887) 30.00 
37 3 5 536 Tarsitani's 12.00 
3 7 4 6 538 Taylor's. 11.00 
3 7 5 2 538 Thomas' 7.00 
3 7 5 5 539 Trueheart's 12.00 
3 7 6 7 540 Vedder's.... 13.00 
Wallace's-Hodge's 8.00 
3 7 3 8 536 White's... 8.00 
3786 548 Obstetrical: Funis Clamp, Pulling's .40 
Obstetrical, Insufflators: 
3 7 9 2 548 Lusk's. 1.25 
3794 548 ' Robinson's 1.50 
Obstetrical Lever, see Obstetrical Vectis. 
Obstetrical Manikin, American 45.00 
French, Imported to Order. 
Obstetrical, Perforators: 
3 7 9 6 549 Bachelder's 5.00 
3802 549 Bedford's 3.00 
3804 550 Blot's 6.00 
3812 550 Braun's Trephine 15.00 
3798 549 Holme's 5.00 
37 9 7 549 Naegeli's 4.00 
3800 549 Simpson's 3.00 
38 0 3 549 Smellie's 2.50 
3813 551 Tarnier's Basiotribe 35.00 
3801 549 Thomas' 8.00 
3811 550 Trueheart's Trephine 8.00 
37 9 9 549 White's 4.50 
547 Obstetrical, Placenta Praevia : 
3 6 0 5 504 Barnes'Dilators, each 1.00 
36 0 5 504 Barnes' Dilators, Set of 3, with Stop- 
cock and Syringe 6.00 
37 8 4 547 Braun's Colpeurynter 3.00 
36 0 7 504 Cowan's Dilators, Set of 3 2.50 
3606 504 McLean's-Barnes' Dilator 2.50 
3 5 9 7 503 McLean's Forceps, for Introducing 
Dilator 4.50 
See also Uterine Dilators. 
Obstetrical, Placenta, Removal of: 
3790 548 Hook and Lever, Dewey's 1.00 
37 9 5 548 Placenta Forceps 2.50 
. Placenta Forceps, Bozeman's 3.03 
Placenta Forceps, Loomis' 6.03 GEORGE TIEMANN A CO.'S SURGICAL INSTRUMENTS. 
811 
Fig. Page. Price. 
Obstetrical Sets, in Cases : 
553 Bedford's $28.00 
553 Brickell's 48.00 
553 Budd's 40.00 
553 Elliott's 35.00 
553 Hodge's 16.00 
553 Taylor's 28.00 
553 Thomas' 66.00 
553 Tiemann's 72.00 
Obstetrical Vectis 2.50 
37 8 7 548 Folding _ 3.50 
37 8 8 548 Ryerson's 7.00 
3783 546 White's 2.50 
542 Obstetrics, Axis Traction. 
546 Delivery in Obstructed Labor. 
534 Labor or Parturition. 
274 O'Dwyer on Intubation of the Larynx. 
2519 274 O'Dwyer's Gag 6.00 
44 0 7 770 Laryngeal Snare 3.50 
2521 274 Scale of Lengths for Tubes .50 
274 Set, Complete in Case 35.00 
25 2 0 274 Tube. 2.00 
Tube and Obdurator 3.00 
25 2 2 274 Tube Extractor 5.00 
2520 274 Tube Introducer 5.00 
2493 268 (Edema Glottis Instrument, Grant's 1.50 
OCsophageal Forceps: 
2617 292 Dawson's 8.00 
2616 292 Tiemann's 5.00 
See also Laryngeal Forceps and 
Throat Forceps. 
CEsophageal, Foreign Body Instruments : 
26 1 3 292 Probang, Bristle 1.50 
2612 292 Probang, Silver Bucket 3.50 
Probang, Sponge .25 
2614 292 Probang, Stanford's 2.50 
2615 292 Scoop, Schaffer's 8.00 
CEsophageal Stricture Dilators: 
2609 291 Crawcour's, each 2.50 
2606 291 Hard Rubber 1.00 
26 0 5 290 Hard Rubber and Whalebone, per set. 4.00 
26 0 7 291 Roe's, each 1.00 
2610 291 CEsophagotome, Mackenzie's 15.00 
2608 291 Roe's 15.00 
2611 291 Sands' 40.00 
3602 504 Ohr's Uterine Dilator and Corrector 7.50 
Oiled Silk, per yard 1.50 
2916 351 Ointment Bougie '. 2.00 
3401 477 Bougie, Barker's 1.25 
2918 351 Bougie, Caspar's 2.00 
29 1 5 351 Bougie, Van Buren's 2.00 
34 0 2 477 Syringe, Hutchison's, with 1 Hard 
Rubber Tube 3.00 
3402 477 Syringe, Hutchison's, with 3 Silver 
Tubes - 10.00 
3403 477 Syringe, Lente's 4.50 
3407 477 Syringe, Lente's 8.00 
1449 91 Old's Artery and Needle Forceps 2.25 
129 5 76 Dressing Forceps and Scissors 3.50 
34 4 9 487 O'Leary's Pessary 5.00 
589 Olecranon. 
39 2 9 590 Apparatus for Fracture of 
2867 345 Olivary Bougie, Gum Elastic .50 
2864 345 Bougie, Whalebone .75 
28 7 7 345 Catheter, Gum Elastic .50 
3022 385 Catheter, Gum Elastic .50 
3031 d 386 Catheter, Tiemann's Velvet-eyed 1.50 
1198 34 Olive Electrodes, each .20 
2707 308 O'Neal's Haemorrhoidal Syringe 5.00 
26 4 5 299 Rectum Speculum 6.50 
Operating Cases: 
62 Capital. 
56 General. 
63 Major Surgery. 
Fig. Page. Price. 
Operating Cases: 
61 Military Surgery. 
64 Minor Surgery. 
66 Pocket Cases. 
51 Operating Furniture: 
1264 51 Bozeman's Operating Chair $35.00 
1271 55 Clark Office Chair 
12 6 7 53 Comstock's Gynaepod : 20.00 
1267 53 Comstock's Gynaepod, with Speculum, 25.00 
1272 55 Crosby Invalid Bedstead 
43 9 6 768 Daggett's Examining and Operating 
Table 25.00 to 45.00 
1265 51 Foster's Combined Gynaecological 
Table and Instrument Case 100.00 
126 8 53 Foster's Speculum Holder, with 2 
Blades 15.00 
36 8 9 521 Harvard Physicians' and Surgeons' 
Chair 
1269 54 Knapp's Oculists' Operating Chair-.. 70.00 
1270 54 Little's Operating Lounge 50.00 
134 Ophthalmic: 
158 Anatomy of the Globe. 
153 Anatomy of the Muscles. 
Artificial Eye, see Artificial Eye. 
160 Artificial Pupil, see also Ophthalmic : 
Cataract. 
1828 150 Bath Glass .50 
1827 150 Drop Glass .20 
165 Ophthalmic, Cataract and Artificial Pupil: 
166 Corneal or Flap Operation. 
166 Linear Extraction. 
166 Modified Linear or Spoon Operation. 
174 Needle Operation. 
174 Secondary and Capsular Cataracts. 
173 Soft Cataract, Suction. 
1965 172 Ophthalmic,Cataract: Capsulotome,Knapp's,1.75 
Ophthalmic, Cataract, Cystotomes: 
1947 168 Cystotome 1.50 
1949 168 Cystotome and Spoon 2.50 
1948 168 Graefe's 1.50 
1946 168 Knapp's 1.75 
1964 171 Knapp's Needle-C.vstotome 1.75 
Ophthalmic, Cataract, Fixators: 
18 5 8 152 Carron de Villard's Fixation Forceps, 3.00 
1863 152 Curved Fixation Forceps 2.00 
1860 152 De la Roza's Fixation Forceps 2.00 
1868 152 Double Hook 1.50 
185 7 152 Dudley's Fixation Forceps 3.00 
1859 152 Fixation and Tumor Forceps 1.50 
1862 152 Graefe's Fixation Forceps.... 2.00 
1864 152 Jaeger's Ophthalmostate 8.00 
1861 152 Noyes'Fixation Forceps 3.00 
1865 152 Noyes' Ophthalmostate 2.00 
1866 152 Pamard's Pique 1.50 
1867 152 Three-pointed Ophthalmostate 1.50 
Ophthalmic, Cataract, Iris Forceps : 
1940 165 Fischer's 1.25 
1935 165 Graefe's, Angular 1.75 
1933 164 Lanne's Forceps-Needle 4.50 
1938 165 Liebreich's 6.50 
1936 165 Straight-- 1.50 
1939 165 Walton's, Self-Holding 2.50 
1919 163 Wilde's, Canulated 12.00 
Ophthalmic, Cataract, Iris Hooks : 
1934 164 Culbertson's 12.00 
1921 163 Tyrrell's. Blunt 1.25 
1922 163 Tyrrell's, Sharp 1.25 
1944 167 Weber's 1.50 
Ophthalmic, Cataract, Iris Knives : 
1920 163 Adams' 1.50 
1914 163 Double Edged 2.00 
1905 163 Hayes' Knife-Needle 1.50 
1913 163 Knife 1.50 
1916 163 Knife-Needle 1.50 812 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Ophthalmic, Cataract, Iris Knives : 
1915 163 Knife, with Stop $1.75 
1904 163 Sichel's 1.75 
1906 163 Sickle-shaped 1.75 
Ophthalmic, Cataract, Iris Needles : 
1907 163 Beer's 1.25 
1966 172 Bradford's Twin 
1910 163 • Critchett's Hooked 1.25 
1937 165 De la Roza's 1.75 
1905 163 Hayes' Knife-Needle 1.50 
1933 164 Lanne's Forceps-Needle 4.50 
1912 163 Levi's 1.25 
1911 163 Luzardi's Hooked 1.50 
1908 163 Narrow, Straight 1.25 
1909 163 Scarpa's Curved 1.25 
1917 163 Wilde's Needle, Canulated 12.06 
1918 163 Wilde's Set, in One Handle 15.00 
Ophthalmic, Cataract, Iris Scissors : 
1925 164 Althof's Iridectomy 5.00 
1930 164 Culbertson's Iricystome 16.00 
1923 164 Curved 1.50 
1932 164 Hall's. 6.00 
1924 164 Maunbir's - 1.50 
1927 164 Noyes' 4.50 
1929 164 Strawbridge's Keratome Scissors 10 00 
1926 164 Straight 1.50 
1928 164 Wecker's Iridotomy 8.00 
1931 164 Welker's Iridectomy Instrument 12.00 
1918 163 Wilde's Canulated Set - 15.00 
Ophthalmic, Cataract, Keratomes: 
1897 162 Agnew's Iridectomy Knife 1.75 
19 0 3 162 Baader's Linear Knife, Left 1.75 
1902 162 Baader's Linear Knife, Right 1.75 
1892 162 Beer's 1.50 
1893 162 Beer's 1.50 
1894 162 Beer's 1.50 
1889 162 Desmarre's Paracentesis Trocar 1.75 
1898 162 Graefe's Linear Knife 1.50 
1887 162 Jaeger's Angular 1.75 
1888 162 Jaeger's Straight 1.50 
1899 162 Liebreich's Linear Knife 1.50 
1900 162 Noyes'Linear Knife 1.50 
1890 162 Paracentesis Needle, Broad 1.25 
1891 162 Paracentesis Needle, Extra Broad 1.25 
1896 162 Section Knife, Angular 1.50 
1895 162 Section Knife, Straight 1.50 
1943 167 Weber's, Angular and Concave 2.50 
Ophthalmic, Cataract, Lens Spoons : 
1955 168 Bowman's Concave 1.75 
1953 168 Bowman's Flat 1.50 
1957 168 Critchett's Concave 1.50 
1956 168 Critchett's Flat 1.50 
195 0 168 Graefe's Tractor 1.75 
1952 168 Hard Rubber .75 
1960 168 Lens Forceps 3.00 
1959 168 Levi's, Fenestrated 1.50 
19 54 168 Noyes' - 1.75 
1958 168 Silver, and Cystotome 2.50 
1951 168 TortoiseShell 2.00 
Ophthalmic, Cataract Needles: 
19 7 6 174 Beer's Straight 1.25 
19 78 174 Bowman's 1.75 
1974 174 Couching 1.25 
1979 174 Curved 1.25 
1977 174 Narrow, Straight 1.25 
1975 174 Walton's Reclination 1.25 
Ophthalmic, Cataract, Ophthalmostate, see 
Ophthalmic, Cataract: Fixators. 
Ophthalmic, Cataract, "Soft," Extraction 
Instruments: 
1970 173 Blanchet's Instrument 2.25 
12 72 173 Bowman's Instrument 4.50 
1967 173 Levi's Needle, with an Eye 1.25 
Fig. Page. Price. 
Ophthalmic, Cataract, "Soft," Extraction 
Instruments : 
19711 
1973 J 173 Teale's Instrument, in Case $5.00 
1968 173 Walton's Grooved Needle 2.00 
1969 173 Wecker's Canulated Needle 2.00 
175 Ophthalmic, Enucleation or Extirpation of 
the Eyeball: 
1985 175 Double Hook, Ball's 3.00 
1984 175 Forceps, Blitz's 3.00 
198 7 175 Forceps, Bull-dog 2.50 
1986 175 Scissors 1.50 
1988 175 Spoon, Wells' 2.75 
Ophthalmic, Foreign Body Instruments : 
1835 150 Carron de Villard's Needle 1.25 
1836 150 Couching Needle 1.25 
1832 150 Daviel's Curette 1.25 
1833 150 Dix's Spud 1.25 
1 177 32 Electro-Magnet 10.00 
1 177 32 Electro-Magnet and Cell 15.00 
1989 176 Electro-Magnet, Bradford's 25.00 
1834 150 Gouge 1.50 
1837 150 Hard Rubber Spoon .75 
182 9 150 Knapp's Hook 2.00 
1838 150 Knapp's Hook 2.00 
1840 150 Magnet, Gruening's 12.00 
1830 150 Pocket Gouge and Spatula 2.50 
1839 150 Pocket Spud and Needle 2.50 
1831 150 Spatula, German Silver 1.25 
1831 150 Spatula, Hard Rubber .75 
17 8 5 146 Ophthalmic Ice Bag, Turnbull's 2.50 
1 792b 147 Ophthalmic, Lachrymal Canula .50 
1792e 147 Lachrymal Canula .50 
1992 178 Lachrymal Canula, Prince's, per pair, 1.50 
1794 147 Lachrymal Canula, Wecker's 1.25 
1796 147 Lachrymal Catheter, Speir's 1.00 
Ophthalmic, Lachrymal (Canalicula) Dila- 
tors : 
44 0 2 769 Blitz's 4.00 
1793 147 Galezowsky's 2.50 
17 88 147 Weber's 1.00 
1 789c 147 William's 1.00 
Ophthalmic, Lachrymal (Canalicula) Knives: 
1809 148 Agnew's 1.75 
17 99 148 Beaumont's 8.00 
1808 148 Bowman's 1.75 
1807 148 Bowman's Director, for Knife .50 
1802 148 Girard Teuton's 8.00 
1801 148 Greenslade's 8.00 
1 800 148 Jaeger's Bistoury Cache 8.00 
1811 148 Liebreich's, and Probe 2.00 
1806 148 Noyes', Movable 4.00 
1805 1 48 Noyes', Plain 1.75 
1804 148 Noyes'-Stilling's 1.75 
1813 148 Parker's Fistula Lachrymalis 1.50 
1812 148 Petit's Fistula Lachrymalis 2.00 
1810 148 Prout's 2.50 
1803 148 Stilling's ... 1.50 
1 798 148 Weber's, Curved 1.75 
17 9 7 148 Weber's, Half Curved 1.75 
Ophthalmic, Lachrymal Probes: 
1786 147 Anel's-- .50 
1787 147 Bowman's, Hard Rubber, each .50 
1787 147 Bowman's, Silver, each .75 
1 787 147 Bowman's, Silver, per set 3.00 
1 790 147 Brewster's Cupped Sound 2.50 
17 9 5 147 Levi's. 2.00 
1791 147 Theobald's, per set 4.00 
1789a 147 William's, each .75 
1 7 8 9 147 William's, per set, complete 3.50 
1924 164 Ophthalmic, Lachrymal Scissors, Mau noir's, 1.50 
Ophthalmic, Lachrymal Styles: 
1 792b 147 Canulated, Silver .75 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
813 
Fig. Page. Price. 
Ophthalmic, Lachrymal Styles : 
1792d 147 Hard Rubber $0.50 
1792a 147 Silver. .50 
1792e 147 Silver, Canulated .75 
1789dl47 William's, Silver .50 
1789e 147 William's, Silver .50 
Ophthalmic, Lachrymal Syringes: 
1823 149 Agnew's 5.00 
1820 149 Anel's, Hard Rubber, with 1 Gold and 
1 Silver Point, in Case 5.00 
1 820 149 Anel's, Silver, with 2 Gold and 1 Silver 
Point, in Case 12.00 
1826 149 Knapp's 4.00 
1821 149 McFarlan's 3.00 
1993 178 Prince's 1.00 
1991 178 Tansley's, Silver 15.00 
Ophthalmic, Lachrymal, Nasal Duct and 
Sac, Cauterizing and Obliterating: 
1818 149 Desmarre's Cautery Iron 3.00 
1819 149 Desmarre's Many-pronged Hook 2.00 
1815 149 Gensoul's Canula 3.00 
1817 149 Knapp's Caustic Holder 1.00 
1816 149 Manfredi's Speculum 5.00 
1814 149 Noyes'Gouge 2.50 
Ophthalmic, Operating Sets: 
179 Agnew's 66.50 
179 Ayres', Large 84.65 
179 Ayres', Small 49.25 
179 Compact 28.00 
180 Graefe's 46.00 
180 Gruening's 71.00 
180 Knapp's 73.75 
181 Mittendorf's 50.00 
181 Noyes' 70.00 
179 Strabismus Set ' 9.50 
181 Webster's New York Polyclinic Eye 
Set 72.00 
145 Ophthalmic, Palpebral. 
Ophthalmic, Palpebral, Entropium Forceps: 
17 66 145 Cross-Bar 2.25 
17 64 145 Desmarre's 3.00 
1760 145 Knapp's 4.00 
1765 145 Laurence's 3.00 
17 68 145 Prout's 4.00 
1762 145 Roehrich's 3.00 
1761 145 Snellen's 2.50 
17 69 145 Stoke's 3.00 
17 63 145 Tiemann's 7.00 
1767 145 Tiemann's 7.00 
Ophthalmic, Palpebral, Epilating Forceps : 
1773 146 Cilia 1.00 
17 7 5 146 Gruening's -- 1.75 
17 76 146 Henry's 2.50 
1774 146 Piffard's T 1.50 
1769 145 Ophthalmic, Palpebral: Lid Compressor, 
Stoke's 3.00 
1771 145 Lid Forceps, Carron de Villard's 4.00 
1854 151 Lid Holder, Desmarre's 1.75 
1855 151 Lid Holder, Desmarre's 1.75 
1849 151 Lid Holder, Noyes' 1.75 
1 7 7 0 145 Lid Plate, Jaeger's, Hard Rubber 1.00 
1 770 145 Lid Plate, Jaeger's, Tortoise Shell 2.00 
1777 146 Scalpel 1.50 
1778 146 Scalpel 1.50 
1779 146 Scalpel 1.50 
1780 146 Scarificator, Desmarre's 1.50 
1772 146 Trichiasis Forceps, Ratti's 3.00 
159 Ophthalmic, Paracentesis Corneae: 
1890 162 Broad Needle 1.25 
1889 162 Desmarre's Trocar 1.75 
1891 162 Extra Broad Needle- 1.25 
159 Ophthalmic, Pterygium and Pannus : 
1884 159 Chadwick's Scissors 6.00 
1303 77 Child's Caustic Holder 2.50 
Fig. Page. Price. 
Ophthalmic, Pterygium and Pannus : 
1885 159 Knapp's Caustic Holder $1.00 
1886 159 Prince's Divulsion Hook 1.50 
Ophthalmic, Soft Cataract, Extraction In- 
struments : 
1970 173 Blanchet's Instrument 2.25 
1972 173 Bowman's Instrument 4.50 
1967 173 Levi's Needle 1.25 
1971 173 Teale's Instrument, in Case 5.00 
1968 173 Walton's Grooved Needle 2.00 
1969 173 Wecker's Canulated Needle 2.00 
Ophthalmic, Speculums: 
1856 152 Bowman's 4.00 
1994 178 Bradford's 
1851 151 Critchett's, Over Nose 3.00 
1852 151 Critchett's, Over Temple 2.50 
1845 151 Galante's 4.00 
1842 151 Graefe's 2.50 
1853 151 Hart's 1.50 
1846 151 Landolt's 4.00 
1848 151 Liebold's 2.50 
1850 151 Liebreich's 2.50 
1844 151 Noyes' Improved 4.50 
1844 151 Noyes'Improved, Gilt 5.00 
1843 151 Noyes'Plain 1.75 
1841 151 Plain Wire.. _ -. .75 
1847 151 Schwatka's 2.50 
Tiemann's 3.50 
153 Ophthalmic, Strabotomy: 
154 Agnew's Strabismus Hook 1.25 
1880 154 Angular Strabismus Scissors 1.50 
187 9 154 Blunt-pointed Strabismus Scissors, 
Curved 1.50 
1875 154 Critchett's Strabismus Hook 1.25 
18 7 7 154 Curved Strabismus Forceps 1.50 
1871 154 Graefe's Large Strabismus Hook 1.25 
18 7 2 154 Graefe's Small Strabismus Hook 1.25 
1882 157 Prince's Advancement Forceps 2.00 
1883 157 Prince's Needle for Advancement and 
Canthoplasty 2.50 
1 878 154 Probe-pointed Curved Scissors 1.50 
1873 154 Sedillot's Double Hook 1.50 
18 76 154 Strabismus Hook-Bistoury 2.50 
1881 154 Straight Strabismus Forceps 1.25 
187 0 154 Theobald's Crotchet Strabismus Hook, 1.50 
1874 154 Wecker's Strabismus Hook 1.25 
1869 154 Wecker's Strabismus Hook, Double.. 4.00 
1784 146 Ophthalmic, Suture Needle, per dozen 1.50 
Ophthalmic, Suture Needle Holders : 
1781 146 Knapp's 3.50 
17 83 146 Prout's 3.50 
1782 146 Sand's 4.50 
175 Ophthalmic, Tattooing: 
Ophthalmic, Tattooing Needles: 
1983 175 Agnew's 2.00 
1980 175 Agnew's Spring Tattoo 4.50 
1982 175 Baader's 2.00 
1981 175 Grooved 2.00 
17 5 4 143 Ophthalmophantome 20.00 
1 744 134 Ophthalmoscope, Dudley's 30.00 
1 749 140 Knapp's Double Disk 35.00 
17 5 2 143 Knapp's Metric System 32.00 
1 743 134 Knapp's Single Disk 20.00 
1742 134 Liebreich's 4.50 
1742 134 Liebreich's, Extra Fine 7.50 
174 7 137 Loring's, 7 Lenses 9.00 
1 748 138 Loring's, 12 Lenses 14.00 
1751 141 Loring's Double Disk..- 32.00 
1750 141 Loring's Single Disk 28.00 
1745 134 Loring's Students' 22.00 
134 On the Use of the. 
Ophthalmoscopic Accessories: 
1 746 135 Lens Holder, Noyes' 6.00 
17 5 6 144 Perimeter, Car malt's 814 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Ophthalmoscopic Accessories : 
1757 144 Pupillometer $5.00 
17 5 8 144 Strabismometer, Galezowsky's 6.00 
17 5 9 144 Strabismometer, Laurence's 2.25 
1753 143 Trial Glasses, Nachet's 
Ophthalmostate, see Ophthalmic Cataract: 
Fixators. 
1755 143 Optometer, Thompson's 2.00 
Oral Instruments, see Antrum, Cheek Re- 
tractor, Dental, Gag, Harelip, Lock- 
Jaw, Staphylorrhaphy, Tongue Depres- 
sor, Tonsil, Uraniscoplastic, Uvula, &c. 
1602 104 Oral Saw, Goodwillie's .' 3.50 
26 3 0 297 Screw, Hard Rubber 1.00 
Specula, see Gag. 
333 Orchitis. 
28 2 3 333 Compressor, Carroll's 1.25 
2821 383 Compressor, Hawes' 3.00 
2822 333 Compressor, White's 3.00 
26 4 4 299 O'Reily's Rectum Speculum 4.50 
Ormsby's Inhaler 12.00 
633 Orthopaedic. 
747 Orthopaedic, Compensative Appliances. 
See also Prosthetic. 
747 Orthopaedic, Dangle Limbs, see also Pseu- 
darthrosis. 
724 Orthopaedic, Deformities of the Feet: 
745 Bunions. 
42 8 3 745 Bigg's Apparatus 8.00 to 12.00 
Corns, see Corn Instruments. 
742 Eversion and Inversion, Abnormal: 
42 7 7 742 Apparatus to Evert the Feet, 
5.00 to 10.00 
Apparatus, with Pelvic Band „ 30.00 
4282 744 Doyle's Rectangle 
428 1 744 Doyle's Rotator, Double.. 28.00 to 35.00 
Doyle's Rotator, Single 20.00 to 25.00 
42 7 8 743 Sayre's Rotator 25.00 to 35.00 
42 7 9 743 Stillman's Local Eversion Brace- 
745 Hammer Toes: 
42 8 4 745 Apparatus No. 1, each 6.00 to 12.00 
4285 745 Apparatus No. 2, each 7.00 to 15.00 
Nail, see Nail. 
741 Pes Planus, Flat Foot: 
4275 741 Eclipting Spring, per pair 5.00 
42 7 6 742 Sayre's Apparatus, each 12.00 
726 Talipes Calcaneus: 
4274 741 Apparatus for, each 10.00 to 12.00 
4273 741 Calcaneus Shoe, each 10.00 to 12.00 
726 Talipes Equinus: 
4271 740 Hudson's Apparatus, ea. . 12.00 to 18.00 
42 7 0 740 $ Sayre's Shoe, each 10.00 to 15.00 
4269 740 Talipes Equinus Shoe, ea., 8.00 to 12.00 
727 Talipes Varus et Valgus : 
4254 734 Harwell's Talipes Shoe, each 15.00 
426 1 737 Bradford's Tarso Corrector 40.00 
42 6 0 737 Detmold's Scarpa Shoe--- 5.00 to 8.00 
42 5 9 736 Nyrop's Shoe, each 10.00 to 12.00 
42 5 3 734 Reeve's Scarpa Shoe 12.00 
42 51 734 Reeve's Universal Shoe 8.00 
4249 733 Sayre's Shoe, each 10.00 to 14.00 
42 6 3 739 Shaffer's Apparatus 10.00 to 12.00 
42 6 7 739 Shaffer's-Taylor's Ankle Support, 
each 6.00 to 8.00 
42 5 8 736 Stillman's Ankle Brace.- 15.00 to 20.00 
42 6 2 738 Stillman's Clubfoot Twister 
42 6 6 739 Taylor's Ankle Support- 6.00 to 8.00 
4256 735 Tiemann's Shoe, Large, each 14.00 
4256 735 Tiemann's Shoe, Medium, each __ 12.00 
4256 735 Tiemann's Shoe, Small, each 10.00 
42 5 7 735 Tiemann's Weak Ankle Brace, 
8.00 to 10.00 
4250 733 Wyeth's Talipes Shoe, each 6.00 
Fig. Page. Price. 
635 Orthopaedic, Diseases of the Joints : 
670 After Treatment: 
4126 670 Fluhrer's Swinging Cradle $ 
670 Massage, Passive Motion. 
4 1 2 7 671 Sayre's Knee Support 30.00 to 40.00 
671 Anchylosis, Complete or True. 
672 Anchylosis, Fibrous. 
Anchylosis of Elbow-Joint: 
4134 676 Stromeyer's Elbow Splint 18.00 
Anchylosis of Knee-Joint: 
4 1 33 676 Andrew's Apparatus 
4130 675 Hooper's Knee Splint 35.00 
4 1 28 674 Long Anchylosis Splint... 35.00 to 40.00 
4 1 32 675 Roberts'Elastic Extension Splint, 35.00 
4129 674 Short Anchylosis Splint.. 25.00 to 30.00 
4131 675 Stromeyer's Knee Extension 
Splint 35.00 
Ankle-Joint Apparatus: 
4113 667 Andrew's, for Inflamed Ankle .... 
4112 667 Hutchison's Splint 
4 1 09 666 Sayre's Splint 22.00 
4 1 08 665 Sayre's Rubber Compressor 6.00 
41 14 668 Stillman's Splint 15.00 to 20.00 
669 Elbow and Wrist Joints : 
670 Andrew's Splint 
4125 669 Stillman's Wrist Splint 25.00 
Hip-Joint Apparatus (Morbus Coxarius): 
40 5 7 638 Andrew's Splint 12.00 
4067 644 Bauer's-Andrew's Splint 25.00 
4081 652 Bauer's Wire Breeches... 15.00 to 25.00 
4055 638 Davis'Splint 15.00 
40 7 0 645 Duncan Eve's Leg Brace . 50.00 to 60.00 
40 8 2 653 Hamilton's Splint 15.00 
4072 647 Hutchison's Extension Shoe 7.00 
See Crutches. 
4069 645 Hutchison's Splint 25.00 to 40.00 
40 7 8 650 Roberts'Long Splint 30.00 to 40.00 
40 7 7 649 Roberts'Short Splint 22.00 
40 8 0 651 Sayre's Cuirass, Large 45.00 
4080 651 Sayre's Cuirass, Medium 35.00 
4080 651 Sayre's Cuirass, Small 25.00 
40 6 2 642 Sayre's Long Splint 25.00 to 45.00 
40 6 3 642 Sayre's Long Splint, with Socket, 
30.00 to 50.00 
40 5 6 638 Sayre's Original Short Splint, 
15.00 to 18.00 
40 5 9 639 Sayre's Short Splint, Improved, 
17.00 to 20.00 
4065 644 Shaffer's Splint... 30.00 to 35.00 
40 6 8 645 Smith's (Stephen) Splint 9.00 
40 7 5 648 Stillman's Hip Brace, No. 1 45.00 
40 7 6 648 Stillman's Hip Brace, No. 2 40.00 
4074 648 Stillman's Sector Splint 10.00 
4064 643 Taylor's Long Splint 25.00 to 40.00 
646 Thomas' Patten 2.50 
40 71 646 Thomas'Posterior Splint 10.00 
40 8 4 653 Wackerhagen's Bed Rest 20.00 
4066 644 Washburn's Splint 7.00 
43 3 5 758 Wilcox's Splint 
4079 650 Willard's Splint 30.00 to 50.00 
4073 647 Wyeth's Combination Method. 
653 Knee-Joint Apparatus: 
40 9 4 658 Andrew's Splint 
40 9 3 658 Davis' Splint 
4101 661 Holthause's Spiral Spring Exten- 
der 10.00 to 15.00 
40 9 5 659 Hutchison's Splint 15.00 
4100 661 Roberts'Splint, Plain 25.00 
40 9 7 660 Roberts' Splint, Tibial Rotation . 35.00 
4092 658 Sayre's Double Extension. 
4087 656 Sayre's Double Extension of Knee 
Joint. 
40 8 5 654 Sayre's Rubber Compressor 6.00 
40 8 6 655 Sayre's Splint 20.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
815 
Fig. Page. Price. 
Orthopaedic, Diseases of the Joints : 
Knee-Joint Apparatus: 
656 Sayre's Splint, Manner of Applying. 
4096 659 Shaffer's Extension Splint-$50. to 60.00 
4102 661 Stillman's Bracket and Sector 10.00 
4 1 03 661 Stillman's Extension Splint, 
35.00 to 40.00 
668 Shoulder-Joint Apparatus: 
4117 1 
to - 668 Stillman's Cable Splint. 
4122' 
706 Orthopaedic, Paralytic and Spastic Deform- 
ities : 
4 1 96 707 Hemiplegia Apparatus 30.00 to 40.00 
4 1 97 708 Paraplegia Apparatus 35.00 to 70.00 
4198 708 Partial Paralysis of Leg and Thigh Ap- 
paratus 25.00 to 30.00 
4 1 99 708 Smith's (Stephen) Paralysis Appara- 
tus 40.00 to 50.00 
42 0 0 709 Support for Weak Legs, for Adults, 
35.00 to 70.00 
42 0 0 709 Support for Weak Legs, for Children, 
25.00 to 35.00 
4203 710 Short Leg Patten 9.00 
709 Valgus Ankle, Weak Ankle : 
4201 709 Detmold's Ankle Spring.._ 4.00 to 6.00 
4202 710 Weak Ankle Brace 5.00 to 10.00 
4204 710 Weak Ankle Brace and Extension 
for Short Leg 18.00 
710 Wrist, Contracted: 
4205 710 Apparatus for 20.00 to 30.00 
711 Wrist Drop: 
4206 711 Hudson's Apparatus for.. 25.00 to 40.00 
712 Writer's Cramp. 
Writer's Cramp Apparatus: 
4216 713 Apparatus 6.00 
4211 712 Charcot and Casenave's 15.00 
4213 713 Charriere's 9.00 
4217 713 Index and Middle Finger 5.50 
4212 712 Mathieu's, for Two Fingers 6.00 
4215 713 Mathieu's, for Three Fingers 6.00 
4210 712 Nussbaum's Bracelet 6.00 
4214 713 Pince Porte Plume 5.00 
4209 712 Velpeau's 10.00 
713 Orthopaedic, Paralytic, Spastic and Rachi- 
tic Deformities: 
720 Bowed Tibia. 
4231 720 Brace for Correcting 12.00 to 18.00 
713 Genu Valgum or Knock Knee : 
Genu Valgum or Knock Knee Apparatus: 
4218 715 Brace 30.00 to 40.00 
4222 717 Roberts' Brace 
4220 716 Stillman's Apparatus 30.00 to 40.00 
4219 716 Trueheart's Brace 35.00 to 40.00 
4221 717 Wilcox's Brace 30.00to35.00 
721 Genu Valgum, Varum, Bowed Tibia : 
721 Mechanical Treatment. 
722 Operative Procedures. 
4232 723 Roberts' Electro-Osteotome 
4233 724 Roberts'Protecting Retractors - 
718 Genu Varum or Bow-Leg. 
718 Genu Varum or Bow-Leg Apparatus: 
4225 718 Bigg's Brace, each 6.00 
4223 718 Brace, with Thigh Band, per pair. 
25.00 to 30.00 
4230 720 Bruce's Apparatus, per pr.,20.00 to 24.00 
4226 719 Gross'Brace, per pair 25.00 to 35.00 
4229 720 Harris'Spring, per pair 4.00 
4224 718 Short Brace 10.00 to 15.00 
4227 719 Stillman's Brace, Long, per pair- 
30.00 to 40.00 
4228 719 Stillman's Brace, Short .. 20.00 to 25.00 
677 Spinal Column. 
704 Spinal Cord. 
Fig. Page. Price. 
678 Orthopaedic, Spinal Diseases and Deformities. 
677 Spinal Curvature. 
See also Spinal Braces. 
37 5 0 538 Osborn's Obstetrical Forceps $8.00 
114 Osteoclasis. 
1644 114 Osteoclast, Poore's 35.00 
1644 114 Rizzoli's 35.00 
99 Osteological. 
154 8 99 Human Skeleton : 
Female Pelvis, with Ligaments 
and Foetal Head 20.00 
Female Pelvis, without Ligaments, 
Foot, Articulated, on Catgut 3.00 
Hand, Articulated, on Catgut 3.00 
Skeleton, Articulated, Grade 1 60.00 
Skeleton, Articulated, Grade 2.- 50.00 
Skeleton, Articulated, Grade 3_- 45.00 
Skeleton, Disarticulated 45.00 
Skull, 1 Cut 10.00 
Skull, 2 Cut 14.00 
Skull, 5 Cut 20.00 
Skull, Disarticulated 20.00 
Skull, Plain 10.00 
Osteophor (Bone-Holding Forceps): 
1569 101 Farabeuf's Osteophor 7.00 
1565 101 Ferguson's Lion-jaw Forceps 3.00 
1 567 101 Ferguson's Lion-jaw Forceps 3.00 
1570 101 Hamilton's Osteophor 4.00 
See also Sequestrum Forceps. 
1607 105 Osteotome, Heine's 300.00 
1642 113 Hutchison's 6.00 
1640 112 Macewen's 6.00 
Macewen's Set of 3 Osteotomes and 3 
Chisels, in Case 36.00 
1643 113 Poore's, each 6.00 
Smith's 6.00 
100 Osteotomy: 
1575 102 Chisel 1.25 
15 7 7 102 Chisel, Darby's Set 7.00 
15 78 102 Chisel, Linhard's Knife-Chisel 1.50 
1639 112 Chisel, Macewen's 6.00 
1549 99 Costotome or Rib Shears 6.00 
109 Osteotomy Drills: 
162 5 109 Brainard's, Set of 5 3.50 
1619 108 Buck's 3.00 
1630 109 Buck's 5.00 
1624 108 Drill 1.75 
1622 108 Drill, with Guard 7.00 
1627 109 Gaillard's 2.50 
1629 109 Hamilton's 7.00 
1626 109 Howard's 7.00 
1631 109 Marshall's Osteotrite 2.50 
1628 109 Tiemann's Drill Stock and Drills 7.00 
4002 619 Wyeth's, per set 7.00 
106 Osteotomy, Exsection, see also Osteotomy: 
Resection and Exsection. 
106 Exsec ting Set 65.60 
103 Osteotomy, Forceps and Rongeurs : 
1599 103 Curved Rongeur 3.50 
1597 103 Darby's Rongeur and Bone Holder 4.00 
1566 101 Hamilton's Serrated Bone Cutter 10.00 
1596 103 Heuel's Bone Forceps 3.50 
1590 103 Hoffman's Gouge Forceps 4.00 
1595 103 Isaac's Bayonet Bone Forceps, Large. 7.00 
1595 103 Isaac's Bayonet Bone Forceps, Med'm. 5.00 
159 5 103 Isaac's Bayonet Bone Forceps, Small _ 4.00 
1589 103 Liston's Bone Forceps, I 3.00 
1589 103 Liston's Bone Forceps, II 2.50 
1591 103 Liston's Bone Forceps, Flat Curved- 3.50 
1 592 103 Liston's Bone Forceps, Knee Bent 3.50 
Liston's Bone Forceps, Knee Bent, Lge. 7.00 
1 594 103 Liston's Bone Forceps, Large. 4.00 to 7.00 
1620 108 Post's Rongeur 3.00 
1 593 103 Satterlee's Bone Forceps, Large 3.00 816 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Osteotomy, Forceps and Rongeurs : 
1593 103 Satterlee's Bone Forceps, Small $2.50 
1 598 103 Straight Rongeur 3.50 
1600 103 Velpeau's Curved Bone Forceps 4.00 
102 Osteotomy, Gouges: 
1579 102 Curved Hand Gouge 1.50 
1621 108 Curved Hand Gouge 1.50 
15 74 102 Gouge.... 1.50 
1587 102 Hebra's Bone Scoop 2.50 
1573 102 Szymanowsky's Gouge 2.50 
1632 110 Osteotomy, Knife, Adam's 1.50 
102 Osteotomy, Levators (Periosteotomes) : 
1581 102 Goodwillie's Curved Levator 2.00 
15 82 102 Goodwillie's Half-Curved Levator ... 2.00 
1580 102 Hamilton's Levator 1.50 
1 588 102 Langenbeck's Hook and Levator 1.75 
1584 102 Sands' Periosteotome 2.50 
1583 102 Sayre's Pcriostcotome 2.00 
1586 102 Whitehead's Hoe 1.50 
Osteotomy, Mallets: 
15 76 102 Lead 2.50 
113 Macewen's 1.00 
1641 113 Rawhide .60 to 1.00 
43 8 4 766 Wood, Gerster's 50 
Osteotomy, Periosteotome, see Osteotomy 
Levator. 
104 Osteotomy, Resection and Exsection: 
Saws and Conductors: 
1616 107 Bead Saw, Stohlmann's - 6.00 
1604 104 Bow Saw, Butcher's 16.00 
Capital Saw, see Capital Saw. 
1609 106 ChainSaw... 10.00 
1612 106 Chain Saw Carrier 2.00 
1610 106 Chain Saw Carrier, Buck's 3.00 
1611 106 Chain Saw Carrier, Post's 4.00 
1613 106 Chain Saw Carrier, Prince's 3.50 
1608 105 Cowgill's-Hey's Saw 3.50 
43 8 2 765 Dawbarn's Aseptic Saw 4.50 
1602 104 Goodwillie's Oral Saw 3.50 
1614 107 Gowan's Exsector 24.00 
1618 108 Graefe's Circular Saw 20.00 
1607 105 Heine's Osteotome 300.00 
1539 98 Hey'sSaw 1.75 
Metacarpal Saw, see Metacarpal 
Saw. 
1603 104 Maxillae Saw, Left .. 1.75 
1601 104 Maxillae Saw, Right 1.75 
4232 723 Roberts' Electro-Osteotome 
1605 104 Stohlmann's Rotating Saw 35.00 
1617 107 Tiemann's Circular Saw 12.00 
1606 104 Tiemann's-Szymanowsky's Saw .. 20.00 
1615 107 Wyeth's Exsector 20.00 
617 Splints, for Securing Immobility. 
Osteotomy, Retractor, see Retractors. 
158 5 102 Scalpel and Raspatory 1.50 
1587 102 Scoop, Hebra's 2.50 
1 568 101 Sequestrum Forceps, Ferguson's 2.50 
1572 101 Sequestrum Forceps, Hamilton's 2.50 
1571 101 Sequestrum Forceps, Markoe's 3.00 
1537 98 Sequestrum Forceps, Van Buren's.... 2.50 
15 52 100 Staff, Blandin's 3.00 
1651 100 Staff, Prince's 3.50 
110 Osteotomy, Subcutaneous Section of the 
Neck of the Thigh Bone : 
1632 110 Adam's Knife 1.50 
1633 110 Adam's Large Saw 4.00 
1 634 110 Adam's Small Saw 3.50 
1635 110 Shrady's Saw and Knife 7.00 
1636 111 Shrady's Saw and Knife, Angular Han- 
dle 7.00 
1637 111 Shrady's Saw and Knife, Improved _. 8.00 
1638 111 Wyeth's Saws, per set 8.00 
15 63 100 Osteotomy, Tenaculum, Stout, Double 2.50 
1564 100 Tenaculum, Stout, Triple 2.50 
Fig. Page. Price. 
Osteotomy: 
1 562 100 Tenaculum, Stout, Single $2.00 
1631 109 Osteotrite, Marshall's 2.50 
14 6 6 92 Ostrom's Drainage Tube and Ligature Car- 
rier 3.00 
2973 365 Otis' (F. N.), Bulbous Sound, Set of 33, and 
Handle 17.50 
2 9 7 8 368 Bulbous Urethrotome 18.00 
2886 347 Bougie a Boule, each .50 
Cocaine Tube 1.50 
30 3 3 386 Catheter Guide 1.00 
2898 348 Dilating Catheter and Syringe 4.50 
29 7 5 367 Dilating Urethrotome, No. 1 40.00 
2 9 7 6 368 Dilating Urethrotome, No. 2 40.00 
29 7 9 369 Dilating Urethrotome, No. 3 30.00 
2980 369 Dilating Urethrotome, No. 4 30.00 
2981 369 Divulsing Urethrotome 40.00 
28 5 7 343 Endoscopic Tube 1.50 
3103 410 Evacuator 30.00 
Evacuator, without Basket 25.00 
30 6 9 400 Exploring Sound 5.50 
Guide, Whalebone .. .75 
289 1 347 Meatotome 1.75 
28 6 3 344 Meatus Dilator 1.50 
2848 I Metric Scale and Approximate English 
2349 > Numbers . 3.50 
29 9 2 373 Perineal Tourniquet 5.00 
30 3 3 386 Prostatic Guide 1.00 
28 9 9 349 Retention Catheter 3.00 
2850 342 Sound, F. B. E. 1.25 
290 1 349 Syringe Nozzle 1.00 
29 9 3 373 Urethral Haemostatic Tube .75 
4 3 6 5 764 Urethrometer, Latest 24.00 
Urethrometer, Spring 18.00 
29 7 4 366 Urethrometer, Spring-Hinged 22.00 
1273 61 Otis' (G. A.) U. S. A. Compact Field Set .. .160.00 
440 1 769 Otis'(W. K.) Malgaigne's Hooks 5.50 
Needle Forceps 11.00 
Otoscope, see Aural, Diagnostic: Otoscope. 
522 Ovariotomy. 
370 1 527 Artery Torsion Forceps, Wells' 3.50 
3694 525 Cyst Elevator, Borck's 1.50 
36 8 8 520 Director, Sims' 1.50 
531 Ovariotomy, Drainage. 
Ovariotomy Drainage Tubes: 
3728 532 Howe's Soft Rubber 2.50 
3725 531 Keith's .75 
3726 531 Schapp's Spiral 1.50 to 3.50 
37 2 7 532 Sims' 1.50 
3 7 2 4 531 Tait's .75 
3720 531 Thomas', Curved .40 
37 2 2 531 Thomas', Curved, Perforated .60 
37 2 3 531 Thomas', Double 3.50 
3722 531 Thomas', Perforated .60 
3721 531 Thomas', Straight .40 
Tiemann's Velvet-Eyed 2.00 
4399 769 Walker's, Curved and Straight, each, .60 
528 Ovariotomy, Pedicle Clamps: 
3 7 0 4 528 Atlee's 6.00 
3706 528 Baker-Brown's 12.00 
371 8 530 Byford's, Complete 18.00 
3 7 0 5 528 Darby's 7.00 
37 0 9 529 Dawson's 8.00 
371 5 530 Esmarch's.. 6.00 
37 1 4 530 Forne's Serre-Noeud 
3 7 0 7 529 Gueride's 6.00 
3719 530 Keith's 10.00 
3708 529 Nott's Rectilinear Ecraseur 12.00 
37 1 3 529 Skene's Cautery 15.00 
3711 529 Storer's Clamp Shield 11.00 
36 9 9 527 Tait's 12.00 
37 0 0 527 Thomas' 12.00 
37 1 0 529 Thomas' 4.50 
3712 529 Wells'. 6.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
817 
Fig. Page. Price. 
Ovariotomy, Pedicle Clamps : 
3702 528 Wells', Set of 3, and Levers .'....$25.00 
37 0 3 528 Wells' Clamp Forceps 8.00 
Ovariotomy, Pedicle Forceps : 
3696 526 Wells', Angular 5.00 
369 7 526 Wells', Straight 5.00 
36 9 8 526 Wells', T Shaped 5.00 
Ovariotomy, Sac Forceps • 
36 9 3 525 Thomas' 3.50 
36 9 5 525 Wells' 4.50 
36 9 2 525 Wilcox's 5.50 
Ovariotomy Trocars: 
1725 127 Dunster's 6.00 
1723 127 Emmet's 4.50 
1 722 127 Fitch's, Nos. 1, 2, 3 14.00 
3691 524 Hanks' 4.50 
1726 128 Tait's 18.00 
Tait's, Plain 4.50 
1721 127 Thomas' 20.00 
1 724 127 Warren's 
17 20 127 Wells' 10.00 
17 20 127 Wells'Curved 11.00 
1727 128 Wells'Latest 20.00 
4003 619 Packard's Splint 5.50 
26 2 0 294 Paine's Nasal Feeding Tube 1.00 
Palatorrhaphy, see Staphylorrhaphy and 
Langenbeck's Uraniscoplastic Instru- 
ments. 
Palmer's Stethoscope 7.50 
3 5 9 4 503 Uterine Dilator 5.00 
3 5 9 8 503 Uterine Dilator, 2 Sizes, Latest 5.00 
Palpebral, see Ophthalmic : Palpebral. 
1866 152 Pamard's Pique 1.50 
159 Pannus, see also Ophthalmic : Pterygium 
and Pannus. 
1237 39 Paquelin's Thermo-Cautery 
126 Paracentesis. 
See Aspirator, Ovariotomy Trocar, Trocar. 
Paracentesis Corneae, see Ophthalmic: Para- 
centesis Corneae. 
390 Paracentesis Vesicae. 
See also Bladder: Puncture of the, Tap- 
ping the. 
2311 231 Parallel Harelip Forceps 9.00 
706 Paralytic and Spastic Deformities. 
See also Orthopaedic : Paralytic and 
Spastic Deformities. 
4197 708 Paraplegia Apparatus 35.00 to 70.00 
43 3 3 757 Park's Aluminium Trachea Tube 6.00 
73 Antiseptic Pocket Set 28.00 
2 5 2 3 275 Artificial Larynx 
20 1 2 184 Electric Otoscope 
149 8 95 Parker's Amputating Knife 5.50 
146 0 92 Artery Needles (Mott's) 2.75 
1528 97 Capital Saw 5.00 
2914 351 Catheter Syringe (Dick's) - 3.50 
130 0 77 Compound Catheter, Plated - 2.50 
3018 384 Compound Catheter, Silver 4.50 
130 0 77 Compound Catheter, Silver 4.50 
1813 148 Fistula Lachrymalis Knife 1.50 
59 General Operating Set 104.90 
23 7 0 237 Mouth Gag 2.50 
133 5 80 Needle Holder - 4.00 
38 4 5 562 Perineum Needle and Clamp .50 
3842 561 Perineum Needles and Handle 5.00 
67 Pocket Set 18.00 
67 Pocket Set, Fine 25.00 
1729 128 Rectum Trocar 4.50 
1550 100 Retractors, per pair 1.50 
152 8 97 Saw, Capital - 5.00 
29 2 2 352 Urethral Tube .50 
3 3 9 7 476 Uterine Applicator, Velvet-Eyed 1.25 
Fig. Page. Price. 
26 7 1 305 Parker's Vaginal and Rectal Syringe $3.00 
34 1 7 481 Vaginal and Rectal Syringe 3.00 
Parkinson's Inhaler 14.00 
2277 , 
to >226 Parmly's Tooth Forceps 2.00 and 2.75 
2282 > 
33 1 3 456 Parrott's Needle Forceps 5.00 
4198 708 Partial Paralysis of Leg and Thigh Appa- 
ratus 25.00 to 30.00 
586 Passive Motion. 
Patella, see Fracture of Patella. 
2881 346 Pathfinder, Eldridge's 35.00 
28 8 2 346 Tieinann's-Eldridge's 3.50 
4203 710 Patten, to Elevate a Short Leg 9.00 
1486 94 Pean's Artery Clamp Forceps __ 2.25 
3 7 3 2 533 Peaslee's Perineum Needles, Detachable 
Handle 3.00 
3839 561 Perineum Needles, Detachable Han- 
dle 3.00 
384 1 561 Perineum Needles, Right and Left... 1.75 
Pessary, Ring .50 
470 Set of Uterine Instruments 60.00 
3535 494 Stem Pessary 1.50 
3569 499 Uterine Dilators, per set 6.50 
3613 505 Uterotome, 1 Blade 4.50 
Uterotome, 2 Blades 6.50 
Peck's Bladder Syringe 2.50 
Pelvimeter, Baudelocque's 8.00 
By ford's 8.00 
Colin's 8.00 
3227 444 King's. - 4.00 
Schultz's 8.00 
Penis Congestor 5.00 
2434 254 Penn's Catgut Ecrascur 5.00 
3651 512 Catgut Ecraseur 5.00 
7 Percussion, Mediate: 
1054 7 Echoscope, Speir's 6.00 
1053 7 Percussion Hammer, Winterich's. 2.50 
1050 7 Percussor, Flint's, H. R. Handle.-.75 
1050 7 Percussor, Flint's, Steel Handle 1.00 
1052 7 Percussor, Whalebone Stem 1.00 
1046 7 Pleximeter, Flint's .35 
1051 7 Pleximeter, Gerne's , 2.50 
1048 7 Pleximeter, Glass .50 
1046 7 Pleximeter, Hard Rubber .35 
1047 7 Pleximeter, Hoffmann's 1.25 
1049 7 Pleximeter, Ivory 1.00 
182 Perforating Lobe of Ear : 
1995 182 Trocar for 1 1.50 
Perforating Scissors, see Obstetrical: Per- 
forators. 
17 5 6 144 Perimeter, Car malt's 
Perineal Lithotrity, see Lithotrity: Perineal. 
390 Puncture of Bladder : 
3048 391 Harrison's Trocar 11.00 
2992 373 Tourniquet, Otis' 5.00 
559 Perineorrhaphy: 
3836 561 Agnew's Forceps and Adjuster 2.50 
3835 561 Agnew's Needles and Holder 4.50 
562 Agnew's Set of Instruments for Rup- 
tured Perineum 24.35 
3840 561 Ashton's Perineum Needle 1.00 
3847 562 Brickell's Perineal Stay .75 
43 4 0 758 Hanks'Perineal Needle 1.75 
38 3 8 561 Helical Needle 1.75 
Jenks' Knife 2.00 
Jenks' Scissors 4.50 
38 3 4 560 Marcy's Perineal Safety Pin .50 
38 4 6 562 Munson's Quill Suture Stay, per pair, .75 
38 4 5 562 Parker's Perineum Needle and Clamp, .50 
3842 561 Parker's Perineum Needles and Han- 
dle 5.00 
3839 561 Peaslee's Perineum Needles, Detach- 
able Handle 3.00 818 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Perineorrhaphy: 
384 1 561 Peaslee's Perineum Needles, Right 
and Left $1.75 
3837 561 Shot Compressor 2.50 
38 4 3 561 Skene's Perineum Needle 1.75 
3844 561 Usual Perineum Needle .75 
2110 197 Periosteotome, Buck's 2.50 
1584 102 Sands'. 2.50 
1583 102 Sayre's... 2.00 
1586 102 Whitehead's Hoe 1.50 
23 3 2 233 Whitehead's Hoe 1.50 
Periosteum Levators: 
1581 102 Goodwillie's, Curved 2.00 
1 582 102 Goodwillie's, Half Curved 2.00 
1580 102 Hamilton's 1.50 
4380 765 Sharp Lever 2.00 
4 3 7 9 765 Van Arsdale's Elevators, Set of 3 6.00 
3331 458 Perry's-Abbott's Wire Cutter 6.00 
3 5 4 9 496 Instrument for Flexion of Uterus.... 5.00 
Pes Equinus, Planus, &c., see Orthopaedic : 
Deformities of the Feet. 
3455 487 Pessary, Babcock's, with Belt 15.00 
3 5 2 9 494 Ball's Stem 1.50 
3519 493 Bozeman's-Smith's 1.00 
3459 488 Bozeman's Vaginal Support 2.00 
3489 4C0 Brown's .75 
3510 492 Buttles' .50 
351 1 492 Buttles'.. .50 
34 8 2 490 Campbell's, Soft Rubber.. .75 
35 2 3 493 Carroll's, Retroflexion .75 
3478 490 Chamberlain's 1.50 
34 7 9 490 Chamberlain's 1.50 
3 5 4 1 495 Chambers', Stem 3.00 
3522 493 Cole's, Anteversion 3.00 
3 5 3 0 494 Cole's, Galvanic 2.00 
3 5 2 1 493 Cole's, Retroversion. 3.00 
3487 ^^ Coleman's .40 
3528 494 Conant's Intra-Uterine Stem.. 3.00 
Concave, Glass .50 
3444 486 Concave, Hard Rubber... .50 
3 5 3 4 494 Coxeter's, Stein.. 1.50 
3 5 0 2 492 Cutter's, with Belt 2.50 
34 4 0 486 Cutter's Cup, with Belt 2.50 
3457 487 Cutter's Ring 2.50 
3539 495 Donaldson's Flexion 2.00 
34 5 6 487 Donaldson's Uterine Supporter 2.50 
3 5 4 2 495 Edward's Stem 3.00 
34 6 5 489 Emmet's Ring .50 
3501 491 Emmet's-Smith's .50 
348 1 490 Fowler's 1.25 
3494 491 Fowler's Bow 1.75 
3480 490 Frazer's 1.25 
3499 491 Gehrung's Anteversion .50 
Gehrung's Retroversion 50 
3 4 6 3 488 Globe, Glass .50 
34 6 3 488 Globe, Hard Rubber.. 1.00 
3464 488 Globe, Silver 8.00 to 10.00 
351 7 493 Hanks'Galvanic 1.50 
3470 489 Hewitt's (Graily) 1.00 
3488 490 Hewitt's (Graily) 1.00 
3483 490 Hewitt's 1.00 
34 9 6 491 Hitchcock's Anteversion. .75 
3472 489 Hodge's Closed Lever .50 
3473 489 Hodge's Closed Lever .50 
34 9 0 490 Hodge's Closed Lever .50 
3484 490 Hodge's Horseshoe .50 
346 1 488 Hofmann's Pelvic 1.50 
34 5 4 487 Hornby's.. 6.00 
3495 491 Hunter's 1.50 
Hurd's Anteversion 1.50 
3462 488 Hurd's Retroversion 1.50 
34 4 5 486 Inflatable Ball, with Stop-cock 1.00 
3442 486 Inflatable Ring, without Stop-cock .. .50 
Fig. Page. Price. 
Pessary: 
3443 486 Inflated . $0.50 
3 5 2 6 483 Kinloch's Anteversion.... 1.25 
3525 493 Kinloch's Prolapsus of Bladder 2.50 
3 5 4 3 495 Kinloch's Retroflexion 2.00 
3 5 4 4 495 Kinloch's Retroflexion . . 1.25 
34 5 0 487 McIntosh's Uterine Supporter 5.00 
3 5 3 6 494 Mossman's Intra-Uterine Stem 5.00 
3468 489 Noeggerath's 2.00 
34 4 9 487 O'Leary's.... 5.00 
Peaslee's Ring .50 
3535 494 Peaslee's Stem. . 1.50 
3549 496 Perry's Flexion 5.00 
34 3 9 486 Ring, Elastic 50 
Ring, Hard Rubber .50 
3442 486 Ring, Inflatable .50 
34 4 3 486 Ring, Inflated .50 
3465 489 Ring, Metal .50 
3471 489 Ring, Wilhoff's .50 
3446 486 Rozer's 6.00 
3 5 3 7 495 Sims'Stem 2.00 
3 5 5 1 496 Sims'(H. Marion) Stem 1.75 
3 5 0 0 491 Skene's Cystocele 2.00 
3485 490 Sleigh 75 
3508 492 Smith's.. .50 
3527 494 Stem. .50 
3531 494 Stem .75 
3532 494 Stem. .50 
3477 489 Taliaferro's Retro Displacement .75 
34 7 5 489 Taliaferro's Universal .75 
^!^r493 Thomas'Anteflexion 2.00 
3515 ' 
or J« f 493 Thomas'Anteversion 1.25 
3518 ' 
35 2 4 493 Thomas' Anteversion 1.25 
3491 491 Thomas'Anteversion 1.25 
3493 491 Thomas' Anteversion 1.25 
3504 492 Thomas'-Cutter's Anteversion 2.50 
3506 492 Thomas'-Cutter's Anteversion 2.50 
3505 492 Thomas'-Cutter's Anteversion, with 
Cervical Rest 3.50 
3458 487 Thomas'-Cutter's Cup 3.50 
3503 492 Thomas'-Cutter's Retroversion 2.50 
3 5 0 7 492 Thomas'-Cutter's Retroversion, with 
Cervical Rest 3.50 
3 5 3 3 494 Thomas'Galvanic Stem 1.50 
3 5 4 5 495 Thomas' Intra-Uterine Stem, Ante- 
flexion 2.50 
34 9 2 491 Thomas'-Hewitt's Retroversion 1.00 
351 4 493 Thomas'Retroflexion, Hard Rubber. .75 
3514 493 Thomas'Retroflexion, Soft Rubber.. 1.00 
35 1 2 492 Thomas'Retroversion .75 
34 4 7 486 Tiemann's Uterine Supporter 5.00 
34 7 6 489 Todd's 3.00 
3467 489 Trask's. .75 
34 6 9 489 Trask's 1.50 
344 8 496 Van deWarker's Anteflexion,with Stem 1.75 
35 5 0 496 Van de Warker's Retroflexion 1.75 
35 2 0 493 Von Ramdohr's 1.50 
3547 496 Wallace's (Spring Tent) 1.50 
35 4 6 495 Weber's 4.50 
3471 489 Wilhoff's .50 
3 5 3 8 495 Wilhoff's Stem .75 
3497 491 Woodward's 1.25 
3498 491 Woodward's 1.25 
3474 489 Zwank's (Hysterophore) 1.50 
3047 390 Pessary Catheter, Harrison's 4.00 
3466 489 Pessary Introducer, Sims' 8.00 
2753 316 Peter's Hernia Director 2.00 
3112 415 Substitute for Wrist and Ankle Band, 15.00 
29 6 6 363 Urethrotome 6.00 
314 7 423 Peterson's Rectal Colpeurynter 1.50 
3147 423 Rectal Colpeurynter, with Stop-cock, 2.00 
1812 148 Petit's Fistula Lachrymalis Knife 2.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
819 
Fig. Page. Price. 
3918 585 Petit's Fracture Box $ 
1430 88 Spiral Tourniquet 2.00 
Phalanges, see Dislocation of Phalanges. 
247 Pharyngeal. 
4325 756 Cohen's Antero-Posterior Pharyngeal 
Forceps 4.50 
4330 756 Cohen's Powder Blower 2.00 
24 1 6 248 Holbrook Curtis'Post-Nasal Forceps, 4.50 
2418 249 Lefferts' Anterior and Posterior Nasal 
Syringe 3.00 
2432 254 Lefferts' Nasal Powder Insufflator 4.00 
24 1 7 249 Lefferts'Nasal Spray Apparatus 4.00 
2419 250 Lefferts'Palate Hook 2.00 
24 1 5 248 Lefferts'Post-Nasal Curette 2.50 
2434 254 Penn's Catgut Ecraseur 5.00 
2414 248 Post-Nasal Forceps 4.50 
Troutman's Spoon 2.50 
Pharyngeal Medication, see Insuffla- 
tor and Spray. 
247 Pharyngoscopy. 
247 Pharyngotomy. 
Phelps' Abdominal Supporter 5.00 
1451 91 Artery and Torsion Forceps 4.50 
335 Phimosis. 
28 3 7 337 Forceps, Cohn's 9.00 
28 3 0 336 Forceps, Fisher's 3.00 
2836 337 Forceps, Girdner's 3.50 
2832 336 Forceps, Henry's 4.50 
2827 336 Forceps, Hutchison's 2.25 
2834 336 Forceps, Knox's 4.00 
28 3 3 336 Forceps, Levis' 3.50 
2829 336 Forceps, Nelaton's 5.00 
2831 336 Forceps, Roger's 3.00 
2835 336 Forceps, Skillern's 2.50 
28 2 5 335 Probe and Spatula 1.00 
2826 335 Ring, Ross' (Circumcision) 1.00 
28 2 8 336 Scissors, Baruch's (Circumcision) 2.50 
28 3 8 337 Scissors, Curved on Flat 1.50 
2839 337 Scissors, Taylor's 5.00 
2840 337 Syringe, Taylor's - 1.50 
115 Phlebotomy. 
Phlebotomy Lancets: 
1649 115 Spring Lancet 1.50 
1648 115 Spring Lancet, Button 2.50 
1647 115 Spring Lancet, Tiemann's 2.50 
1646 115 Thumb Lancet, Broad Pointed .75 
1645 115 Thumb Lancet, Spear Pointed, Evans',. 1.00 
1645 115 Thumb Lancet, Spear Pointed, Plain, .50 
1645 115 Thumb Lancet, Spear Pointed, Tie- 
mann's .75 
1 152 22 Physicians' Hand Bag, according to size, 
4.00 to 5.00 
Vial Cases, see Medicine Pocket Cases. 
3 1 32 421 Physick's Gorget, 2 Blades 6.50 
18 Physiological Experiments: 
18 Armamentarium, Flint's 70.00 
1144 19 Blowpipe, 2 Points, Mouth-piece and 
Stop-cock 2.50 
1138 19 Blunt Hooks, for Roots of Spinal 
Nerves, each 1.25 
1132 18 Bone Forceps, for Opening Spinal 
Canal 3.50 
1133 18 Bone Forceps, with Rings 3.50 
1134 18 Bull-dog Forceps, for Drawing-out 
Stomach 2.50 
1136 19 Cartilage Knife, Stout 1.50 
1137 19 Catheter, for Catheterizing Heart.- 1.00 
1143 19 Dissecting Forceps, Long 1.00 
1142 19 Dissecting Forceps, Medium .75 
1141 19 Dissecting Forceps, Small .75 
1129 18 Drill, Medulla Oblongata 1.75 
1130 18 Forceps, with Catch, for Extirpating 
Spinal Accessory Nerve 2.00 
1131 18 Gastric Fistula Tube, No. 1 1.50 
Fig. Page. Price. 
Physiological Experiments : 
1131 18 Gastric Fistula Tube, No. 2 $2.50 
1128 18 Iley's Saw 1.75 
1139 19 Knives, for Intra-Cranial Division of 
Root of Fifth Nerve, each 1.50 
1145 19 Lifting Back Saw, Large 4.00 
1145 19 Lifting Back Saw, Medium 3.00 
1145 19 Lifting Back Saw, Small 2.50 
1140 19 Piques, for Irritation of Floor of Fourth 
Ventricle, each 2.50 
1127 18 Portal Vein Ligator 1.75 
1135 18 Probe-pointed Scissors 1.25 
Pierce's Obstetrical Forceps 7.50 
1069 11 Piesmeter, Beard's 3.50 
1675 120 Piffard's Acne Lance and Comedone Extrac- 
tor 2.50 
1674 120 Comedone Extractor .75 
1083 13 Cutisector , 5.00 
1681 120 Cutisector y 5.00 
1691 121 Dermal Curette, each 2.25 
1 685 121 Epilating Forceps 1.50 
1774 146 . Epilating Forceps 1.50 
28 9 3 347 Fossal Bougie a Boule .50 
28 9 0 347 Fossal Stricture Knife 10.00 
1678 120 Grappling Forceps 3.00 
40 2 3 626 Grappling Forceps 3.00 
1686 121 Irido-Platinum Needle.... 1.00 
28 9 4 347 Meatometer 1.50 
2892 347 Meatotome 2.00 
1680 120 Milium Needle 1.25 
1009a 3 Measuring Pipette .50 
10096 3 Fermentation Test 
1679 120 Scarifying Spud 1.25 
1691 121 Sharp Spoon, each 2.25 
1684 121 Tattooing Instrument 4.50 
Urine Test Apparatus 83.50 
H Water Oven Attachment 1.50 
1011a ' 
3690 523 Pilcher's Aseptic Scalpel 1.50 
2 5 4 3 278 Bronchotome ____ 6.00 
2537 277 Supra-Sternal Retractor 2.50 
2540 277 Tracheotomy Retractor 2.00 
2745 312 Pile Bougie and Prolapsus Ani Supporter __ 1.25 
2747 312 Bougie, Bolton's 1.25 
2748 312 Bougie, Reed's 1.25 
2744 312 Bougie, Swift's .__ 1.50 
2746 312 Bougie, Trousseau's 2.75 
See also Prolapsus Ani Supporter. 
Clamp, see Haemorrhoidal Clamp. 
Needle, see Haemorrhoidal Needle. 
2708 308 Scissors, Angular 1.50 
2709 308 Scissors, Bush's 1.50 
Syringe, see Haemorrhoidal Syringe. 
4214 713 Pince Porte Plume 5.00 
Pin Conductor, Buck's... 1.00 
2316 231 Conductor, Buck's, Slide Catch 1.75 
1327 80 Conductor, Heuel's 1.00 
2317 231 Conductor, Post's 1.00 
1326 80 Conductor, Post's 1.00 
2319 231 Harelip, Removable Point .50 
2729 310 Transfixion, Haemorrhoidal .25 
2318 231 Plastic, per 100 .40 
Suture .40 
1140 19 Pique, for Irritating Floor of Fourth Ven- 
tricle 2.50 
1866 152 Pamard's 1.50 
25 3 8 277 Pitha's Tracheotome and Dilator 3.50 
3795 548 Placenta Forceps 2.50 
Bozeman's 3.00 
Loomis' 6.00 
Munde's 3.00 
See also Embryotomy Forceps. 
547 Placenta Praevia. 
See also Uterine Dilators. 820 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
1445 91 Plain Artery Forceps $0.75 
65 Minor Operating Set 18.00 
1841 151 Wire Eye Speculum .75 
Plaster, Adhesive, per yard .75 
Moleskin, per yard 1.50 
572 Paris Bandage. 
573 Paris Dressing. 
Paris Shears, see Bandage Shears. 
2318 231 Plastic Pin, per 100 40 
1692 122 Platinum Cup, Lente's 3.50 
Pleximeter, see Percussion, Mediate. 
2560 281 Pneumatic Apparatus, Fraenkel's 15.00 
2564 281 Tobold's 
2561 281 Waldenburg's 
2565 281 Pneumatometer, Waldenburg's 8.00 
Pocket Cases: 
67 Andrews' 28.00 
Bingham's, Aseptic 30.00 
Briggs', Aseptic 32.00 
69 Brown's 30.00 
69 Crosby's 15.00 
72 Dugas' 56.00 
72 Dugas' (Dressing Case) 18.00 
69 Exhibition.... 100.00 
66 Four-fold 21.00 
69 Gay's 22.00 
68 Gross' 22.00 
68 Gross', Fine 26.00 
58 Gunn's 20.00 
68 Hamilton's... 32.00 
73 Hayward's, Aseptic 21.00 
72 Helmuth's 32.00 
4017 . 
to >625 Heuel's 60.00 
4037 ' 
66 Hospital 18.00 
Keyes' 23.00 
Lilliputian, Aseptic 26.00 
67 Little's.. 25.00 
71 Minor's 22.50 
68 Multum in Parvo .... 19.00 
73 Park's Aseptic 28.00 
67 Parker's 18.00 
67 Parker's, Fine .... 25.00 
Parkinson's Aseptic 40.00 
Porter's Aseptic 12.00 
72 Regimental 23.00 
66 Sayre's 23.50 
4039 ^628 Smith's Compact, Aseptic 18.00 
Smith's Large, Aseptic 29.00 
Smith's Medium, Aseptic 28.00 
66 Three-fold 15.00 
1274 70 Tiemann's Patent, "A" 33.00 
1276 71 Tiemann's Patent, "B," Aseptic 28.00 
Tiemann's Patent, "B,''Aseptic, Small, 20.00 
66 Two-fold 10.00 
66 Two-fold 12.00 
U. S. Army, Aseptic 28.00 
67 Van Buren's 22.00 
Walker's, Aseptic 30.00 
67 Weir's 30.00 
69 Wight's 37.00 
Wight's Latest 20.00 
68 Wood's 27.50 
71 Woodworth's 22.00 
73 Wright's, No. 1 28.00 
73 Wright's, No. 2, Aseptic 38.00 
1830 150 Pocket Gouge and Spatula 2.50 
2446 261 Illuminator 4.50 
Pocket Instruments: 
1419 87 Abscess Lancet .75 
1423 87 Seton Needle 1.00 
1839 150 Spud and Needle 2.50 
Fig. Page. Price. 
Pocket Instruments: 
1274 70 Tiemann's Patent Catch, "A" : 
Blades, each $1.25 
Handle, each 1.50 
1276 71 Tiemann's Patent Catch, "B " : 
Blades, each 1.25 
Handle, each 1.50 
23 8 6 239 Tongue Depressor .75 
142 4 87 Pocket Instruments, Double, Plain Shell 
Handles 1.50 
Any other combination, same price. 
Pocket Instruments, Double, Slide Catch, 
Shell Handles: 
1416 86 Bistoury and Scalpel 2.50 
1416 86 Bistoury and Tenotome 2.50 
1414 86 Gum Lancet and Tenaculum 2.50 
14 1 7 86 Post's and Buck's Needles 2.50 
Any other combination, same price. 
Pocket Instruments, Double, Spring Catch, 
Shell Handles: 
14 1 8 87 Gum Lancet and Tenaculum 2.75 
1420 87 Syme's Abscess Knife and Tenaculum, 2.75 
Any other combination, same price. 
1421 87 Pocket Instruments, Four Bladed, Spring 
Catch... 6.00 
Any other combination, same price. 
142 2 87 Pocket Instruments, Single, Plain Shell 
Handle.. 1.00 
Any style of blade, same price. 
Pocket Instruments, Single, Slide Catch, 
Shell Handles: 
14 1 3 86 Cooper's Hernia Knife 1.75 
1411 86 Curved Probe-pointed Bistoury 1.75 
140 9 86 Curved Sharp-pointed Bistoury 1.75 
14 1 2 86 Gum Lancet 1.75 
140 8 86 Scalpel 1.75 
1410 86 Tenaculum... 1.75 
140 7 86 Tenotome. 1.75 
Any other style of blade, same price. 
Pocket Instruments, Single, Spring Catch, 
Shell Handle, any style of blade. 1.75 
1221 35 Pole Changer 5.00 
2021 186 Politzer's Acoumeter 3.50 
2139 201 Air Bag 1.50 and 2.00 
2052 191 Cotton Wool Forceps 1.75 
2045 191 Ear Spoon, Hard Rubber.... .75 
2101 196 Eyelet, each .30 
2101 196 Eyelet Forceps 1.50 
2016 185 Manometer... .50 
21 28 197 Mastoid Knife 2.00 
2129 197 Mastoid Scoop 2.50 
2099 196 Myringotome, Angular 1.00 
2105 196 Myringotome, Straight 1.00 
2059 192 Polypus Forceps 2.00 
202 Set of Ear Instruments 22.00 
2022 186 Tuning Fork 1.50 
2099 196 Tympanum Perforator, Angular 1.00 
2 1 05 196 Tympanum Perforator, Straight 1.00 
Polk's Needle, for Extirpation of Uterus .. 4.50 
3650 512 Polyptome, Aveling's 8.00 
Polypus, see Aural: Foreign Body and Poly- 
pus, Nasal Polypus, Uterine Tumors and 
Polypi. 
1290 76 Polypus Dressing Forceps 1.50 
Ecraseur, see Ecraseur. 
Snare, see Wire Snares. 
2204 213 Syringe, Upson's 14.00 
20 5 5 192 Pomeroy's Ear Forceps 2.50 
20 82 194 Ear Syringe 6.00 
2133 199 Eustachian Catheter Holder 3.50 
24 4 4 260 Reflector and Holder.... 7.00 
114 Poore's Osteoclast 35.00 
1643 113 Osteotomes, each 6.00 
1536 98 Pope's Antrum Drill. 3.50 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
821 
Fig. Page. Price. 
20 93 195 Port Acid Glass, Buck's $0.10 
Caustique, see Caustic Holder. 
130 4 77 Caustique and Eye Curette 2.50 
Cordon 2.50 
1127 18 Portal Vein Ligator 1.75 
1292 76 Porte Meche .40 
2726 310 Porte Meche and Tampon .75 
2577 283 Porter's Croup Kettle 4.50 
3434 484 Uterine Repositor 6.00 
Post's Brush Electrode 2.50 
1611 106 Chain Saw and Ligature Carrier 4.00 
1171 32 Electro-Massage Roller 8.00 
57 General Operating Set 150.95 
1417 86 Needle, with Buck's, in One Handle.. 2.50 
23 1 7 231 Pin Conductor 1.00 
1326 80 Pin Conductor 1.00 
2123 197 Rongeur.. 3.00 
1620 108 Rongeur 3.00 
1392 84 Tissue Separator 1.50 
4 1 87 700 Torticollis Brace 12.00 
1 174 32 Warm Water Electrode 2.75 
2184 210 Posterior Nares Syringe, Bennett's 10.00 
2182 210 Hard Rubber 1.25 
2418 249 Lefferts' 3.00 
2185 210 Yearsley's 2.50 
207 Posterior Rhinoscopy. 
See also Rhinoscope and Nasal Speculum. 
678 Posterior Spinal Curvature. 
15 Post Mortem and Dissecting. 
1100 14 Anatomical Syringe 35.00 
17 Post Mortem Examination Sets : 
17 Hutchison's Set, No. 2 24.00 
17 Finnel's Set 12.50 
17 Set No. 1 28.00 
17 Set No. 3 22.00 
Post Mortem Instruments: 
1106 15 Blow-pipe .25 
1110 15 Brain Knife 1.50 
1125 16 Calvarian Clamp, Satterthwaite's ... 5.50 
1120 16 Calvarian Hook 1.50 
1126 16 Chain Hook .25 
1119 16 Chisel .75 
1117 16 Costotome Chisel 1.50 
1108 15 Coxeter's Dissecting Forceps .50 
1114 16 Darling's Chain Hooks .50 
1101 15 Darling's Dissecting Scalpel .75 
1102 15 Dissecting Forceps .50 
1104 15 Dissecting Hook .50 
1121 16 Dissecting Hook, Double .50 
Dissecting Scalpel .60 
1122 16 Double Rachitome 15.00 
1107 15 Enterotome 2.50 
1109 15 Finnell's Knife and Saw 4.50 
1123 16 Grappling Hook .60 
1116 16 Hammer 2.50 
Needle .15 
Needle, Bayonet .25 
1115 16 Rachitome, Chisel 2.00 
1122 16 Rachitome, Double Saw 15.00 
1118 16 Rachitome, Satterthwaite's 5.00 
1111 15 Reamer 1.00 
1113 15 Saw, Knife and Handle 5.50 
1105 15 Scissors, Dissecting .75 
1103 15 Steel Handle Cartilage Knife .60 
1124 16 Tripod, Head Rest 3.00 
1112 15 Warren's Demonstrating Knife 1.25 
24 1 5 248 Post-Nasal Curette, Lefferts' 2.50 
24 1 4 248 Forceps.. 4.50 
2416 248 Forceps, Curtis' 4.50 
678 Pott's Disease. 
See Spinal Braces. 
3955 600 Pott's Splint (Raphael's) 5.00 
Powder Blower, see Insufflator. 
2187 211 Powder Blowing Tubes for Post-Nares, ea., .25 
Fig. Page. Price. 
29 4 8 359 Powell's Dilator $35.00 
64 Operating Case 85.00 
335 Prepuce Instruments, see Phimosis. 
1882 157 Prince's Advancement Forceps 2.00 
43 0 6 752 Artificial Hand 60.00 
1551 100 Bone Staff . 3.50 
1883 157 Canthoplasty Needle 2.50 
433 8 758 Canthoplasty Needle, with Spool 4.50 
4336 758 Cocaine Pipette .75 
43 3 7 758 Eye-lid Hook 2.25 
2313 231 Harelip Clamp.. 3.00 
1993 178 Lachrymal Syringe.. 1.00 
1992 178 Medicating and Drainage Canula, ea. .75 
188 6 159 Pterygium Divulsion Hook 1.50 
2666 304 Rectal Obturator, without Syringe ._ 3.50 
1613 106 Retractor and Chain Saw Carrier .... 3.50 
4338 758 Spool Eye Needle . 4.50 
1551 100 Staff 3.50 
23 4 8 235 Staphylorraphy Needle 10.00 
1442 91 Tenaculum Forceps 6.00 
2352 235 Tenaculum Needle 10.00 
3111 415 Pritchard's Anklets and Wristlets 8.00 
2957 361 Pritchett's Rotating Urethrotome ... 25.00 
26 1 3 292 Probang, Bristle 1.50 
2612 292 Silver Bucket 3.50 
Sponge .25 
2614 292 Stanford's 2.50 
300 1 376 Probe, Arnott's, Grooved L50 
1349 82 Bullet, Burr-Head Seeker 1.00 
135 1 82 Bullet, Eldridge's .75 
4372 764 Bullet, Fluhrer's Aluminium 4.50 
13 5 3 82 Bullet, Hamilton's Set 2.50 
13 5 4 82 Bullet, Long, Silver .75 
13 5 0 82 Bullet, Nelaton's .60 
13 5 2 82 Bullet, Sayre's Vertebrated 8.00 
1355 82 Bullet, Tiemann's .75 
1342 81 Director and Tongue-Tie 1.00 
20 1 3 185 Ear, Angular, Steel .75 
2014 185 Ear, Buck's, Silver .60 
2014!) 185 Ear, Buck's, Silver .75 
Lachrymal, see Ophthalmic: Lachry- 
mal Probes. 
26 9 5 307 Rectal, Silver 1.25 
26 96 307 Rectal, Silver 1.25 
1343 81 Silver, per pair .75 
Uterine, see Uterine Probes. 
1370 84 Probe-pointed Bistoury 1.25 
13 8 3 84 Bistoury, Little's 1.50 
1086 13 Bistoury, Microscopic 1.25 
13 9 8 85 Bistoury, Plain 1.00 
1135 18 Scissors 1.25 
268 1 306 Proctotomy Knife, Kelsey's 1.75 
705 Progressive Locomotor Ataxia. 
2749 312 Prolapsus Ani Supporter 8.00 
2750 312 Ani Supporter, Matthieu's 5.00 
See also Pile Bougies. 
Prolapsus Uteri Supporter, see Abdominal 
Supporter, also Pessaries. 
381 Prostate, Tunnelling the : 
30 1 2 381 Fitch's Dome Trocar Catheter 6.00 
378 Prostatic. 
427 Calculi. 
Catheters, see Catheter, Prostatic. 
3009 380 Dilator, Gouley's 16.00 
3011 381 Dilator, Harrison's, each 1.50 
3008 380 Dilator, Mercier's 10.00 
3010 381 Dilator, Walker's 35.00 
3 1 60 427 Dilator, Walker's Divulsor 2.00 
3032 386 Guide, Keyes'-.. .75 
3033 386 Guide, Otis' 1.00 
3002 378 Sound, Mercier's 1.50 
379 Prostatotomy and Prostatectomy : 
30 1 2 381 Fitch's Dome Trocar Catheter 6.00 
30 0 7 379 Gouley's Prostatectome 10.00 822 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Prostatotomy and Prostatectomy: 
3004 379 Mercier's First Excisor 840.00 
3006 379 Mercier's Last Excisor 50.00 
30 0 5 379 Mercier's Last Incisor and Ecraseur 
combined 60.00 
See also Prostatic Dilator. 
747 Prosthetic, see Artificial Arm, Artificial 
Hand, Artificial Humerus, Artificial 
Leg, Dangle Limbs, Pseudarthrosis. 
43 0 5 752 Short Leg, Bigg's Apparatus for 35.00 
17 68 145 Prout's Entropium Forceps 4.00 
1810 148 Lachrymal Knife 2.50 
2 1 04 196 Myringotome 1.00 
1340 81 Needle Forceps 3.50 
1783 146 Needle Forceps 3.50 
142 9 88 Prussian Field Tourniquet .75 
747 Pseudarthrosis: 
42 9 6 748 Apparatus for False Joints in Leg or 
Thigh, for Adults 40.00 to 75.00 
42 9 6 748 Apparatus for False Joints in Leg or 
Thigh, for Children 25.00 to 35.00 
430 1 750 Artificial Humerus 35.00 to 70.00 
4297 749 Smith's Brace, for the Femur, 50.00 to 75.00 
4299 749 Smith's Brace, for the Forearm, 
35.00 to 60.00 
43 0 0 750 Smith's Brace, for the Humerus, 
35.00 to 70.00 
4298 749 Smith's Brace, for the Tibia . 30.00 to 40.00 
29 2 5 352 Psychrophor, Winternitz's, Silver 4.00 
29 2 5 352 Winternitz's, Soft Rubber... 2.50 
1886 159 Pterygium Divulsion Hook, Prince's 1.50 
1884 159 Scissors, Chadwick's 6.00 
3981 610 Pulleys, Dislocation, Brass, per pair 7.00 
Dislocation, Japanned, per pair 5.00 
3 7 8 6 548 Pulling's Funis Clamp .40 
11 Pulsometric: 
1070 11 Dudgeon's Sphygmograph 25.00 
1072 11 Marey's Sphygmograph 75.00 
1071 11 White's Haemarumascope 2.50 
25 8 5 285 Pump, Air, Novelty 
2 5 8 4 285 Air, Sass' 
Aspirator, see Aspirator. 
Cupping, see Cupping Pump. 
Enema, see Rectal Infusors (Injec- 
tors), &c. 
Stomach, see Stomach Pump. 
1757 144 Pupillometer 5.00 
Pus Basin, Agate, Large 3.00 
Agate, Medium .... 2.50 
Agate, Small 2.00 
2087 195 Brass, Large 3.00 
20 8 7 195 Brass, Medium 2.50 
2087 195 Brass, Small 2.00 
20 88 195 Hard Rubber, Large 3.00 
2088 195 Hard Rubber, Medium 2.50 
20 88 195 Hard Rubber, Small 2.00 
2089 195 Triangular, Hard Rubber 3.00 
1281 75 Triangular, Hard Rubber 3.00 
1 28 0 75 Warren's, Soft Rubber 3.50 
1062 9 Quain's Stethometer 10.00 
1034 5 Stethoscope 2.00 
3 1 94 437 Quatrivalve Speculum Vaginae, Meadow's. 15.00 
3 1 92 437 Speculum Vaginae, Tiemann's 10.00 
38 4 6 562 Quill Suture Stay, Munson's, per pair .75 
2051 191 Quire's Nasal and Ear Curette 2.25 
713 Rachitic Deformities. 
See also Orthopaedic: Paralytic, Spastic 
and Rachitic Deformities. 
1115 16 Rachitome, Chisel 2.00 
1122 16 Double Saw 15.00 
Fig. Page. Price. 
1118 16 Rachitome, Satterthwaite's 85.00 
39 3 5 591 Radius Splint, Left .50 to .80 
3934 591 Right 50 to .80 
2569 282 Ramage's Inhaler 1.25 
39 5 5 600 Raphael's-Pott's Splint.... 5.00 
1007 3 Rapid Filtration Apparatus 5.00 
153 5 98 Raspatory 1.75 
1547 98 and Trepanning Elevator 1.25 
158 5 102 and Trepanning Scalpel 1.50 
154 2 98 U. S. Army 2.50 
2 7 7 9 323 Ratchet Truss 4.50 
17 7 2 146 Ratti's Trichiasis Forceps 3.00 
24 7 6 265 Rauchfuss'Powder Blower 2.00 
1 Re-agents, Urine Test, Prices on Page 1. 
1111 15 Reamer, Post Mortem 1.00 
1976 174 Reclination Needle, Walton's. 1.25 
303 Rectal Alimentation. 
26 9 4 307 Applicator, Kelsey's .75 
Bistoury, see Rectal Stricture: Fis- 
tula and Fissure. 
26 6 5 301 Bougie, English, Conical 1.25 
26 5 4 301 Bougie, English, Cylindrical 1.00 
Bougie, French .75 
2657 301 Bougie, Kelsey's 1.50 
266 1 302 Bougie, Wales', for Prices see Wales' 
Rectal Bougie. 
269 7 307 Brush Holder. 2.50 
2743 312 Cauteries, each 1.50 
See also Haemorrhoidal Cautery 
Irons. 
26 9 2 307 Curette 2.00 
Rectal Dilators: 
26 4 7 300 Anal Dilator.... 10.00 
2646 300 Rectal Dilator 10.00 
26 6 0 300 Sims' Anal Dilator... 4.50 
26 5 2 300 Thebeaud's Sphincter Ani Dilator 12.00 
26 5 8 302 Whitehead's Instrument for Dilata- 
tion 3.00 
See also Rectal Bougie and 
Rectal Specula. 
2689 306 Rectal Director, Flexible Silver 1.50 
307 Dressing. 
See also Rectal Applicator, Rectal 
Brush Holder, Rectal Curette, 
Rectal Exploring Trocar, Rec- 
tal Forceps, Rectal Insufflator, 
Rectal Porte Caustique, Rectal 
Probe, Rectal Scoop, Rectal 
Sponge Mop Holder, Rectal 
Suppository, Rectal Syringe. 
2739 311 Rectal Ecraseur, Smith's*Wire 6.00 
Rectal Electrodes: 
1183 33 Ball 1.25 
123 0 36 Insulated 2.50 
118 5 33 Insulated with Hard Rubber 2.00 
1 188 33 Large, Nickel Plated 1.40 
1184 33 Nickel Plated 1.25 
2656 301 Rectal Exploring Sound, Bodenhamer's, ea. 1.00 
2 7 0 3 307 Exploring Trocar 1.50 
26 6 5 303 Feeding Tube, Tiemann's 1.50 
26 9 3 307 Forceps 2.00 
Rectal Infusors, Injectors and Irrigators : 
26 7 3 305 Bodenhamer's Irrigator 3.00 
26 7 0 305 Clendinen's Irrigator 6.00 
Davidson's Syringe, No. 1 2.00 
Davidson's Syringe, No. 2 1.50 
26 6 7 305 Maw's Enema Pump 4.50 
267 2 305 Munde's Irrigator 1.50 
2 6 7 1 305 Parker's Syringe 3.00 
2 6 6 6 304 Prince's Obturator, without Syringe. 3.50 
2668 305 Syphon Syringe 2.50 
26 6 5 303 Tiemann's Rectal Feeding Tube 1.50 
2 7 0 4 307 Rectal Insufflator ; 2.50 
Pile, see Haemorrhoidal. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
823 
Fig. Page. Price. 
2736 311 Rectal Polypus Forceps, Luer's $6.00 
26 9 9 307 Porte Caustique 3.00 
2726 310 Porte Meche and Tampon .75 
2 6 8 8 306 Probe, Elastic .50 
2695 307 Probe, Silver 1.25 
26 9 6 307 Probe, Silver 1.25 
2680 306 Scarificator 1.50 
2691 307 Scoop, Kelsey's 2.50 
2741 311 Scoop, Siemon's Sharp 2.50 
Rectal Specula: 
26 3 6 298 Ashton's Fenestrated 1.00 
26 4 2 299 Bivalve 5.00 
2649 300 Bivalve, Small 4.50 
265 1 300 Bodenhamer's Recto - Colonic Endo- 
scope 7.50 
26 3 4 298 Bodenhamer's Reflector and Lens.... 20.00 
2635 298 Ferguson's Tubular, Glass 50 
2635 298 Ferguson's Tubular, Hard Rubber.._ 1.00 
2635 298 Ferguson's Tubular, Hard Rubber and 
Metal 1.50 
26 3 5 298 Ferguson's Tubular, Metal 1.50 
2640 299 Gorget-formed 2.00 
26 3 9 299 Helmuth's 3.50 
26 3 8 299 Kelsey's 6.00 
4346 759 Kelsey's Retractor 3.50 
26 4 5 299 O'Neal's.. 6.50 
26 4 4 299 O'Reily's 4.50 
Reed's 3.50 
43 9 8 769 Shufford's 
26 4 8 300 Sims' 5.50 
26 3 2 298 Tiemann's Trivalve 12.00 
2 6 3 3 298 Tri valve Trellis 16.00 
26 3 7 299 Van Buren's 3.50 
264 1 299 Van Buren's Depressor 2.50 
43 4 8 759 Walker's, Set of 3, with 1 Handle .... 15.00 
2643 299 William's 4.50 
William's, Fenestrated 5.00 
2702 307 Rectal Sponge Mop Holder .75 
306 Rectal Stricture, Fissure and Fistula: 
26 9 0 306 Allingham's Scissors and Director for 
Fistula en Ano 7.00 
26 7 7 306 Bistoury, Blunt Pointed, Small 1.75 
2682 306 Bistoury Cache, for Fistula 7.00 
2679 306 Bistoury Cache, for Stricture 7.00 
26 8 7 306 Bistoury, Cooper's 1.25 
2 685 306 Bistoury, Curved, Probe-pointed 1.25 
2686 306 Bistoury, Curved, Sharp Point 1.25 
2 6 8 4 306 Bistoury, Straight, Round Point 1.25 
2683 306 Bistoury, Straight, Sharp Point. 1.25 
2 6 7 5 306 Bodenhamer's Anal Fissure Knife 5.00 
26 7 4 306 Bodenhamer's-Blandin's Knife 8.00 
2678 306 Kelsey's Knife, Fistula 2.50 
2681 306 Kelsey's Proctotomy Knife.. 1.75 
2701 307 Rectal Suppository, Hard Rubber 1.50 
2698 307 Rectal Syringe, Hutchison's, with 1 Hard 
Rubber Tube 3.00 
26 9 8 307 Hutchison's, with 3 Silver Tubes 10.00 
271 1 308 Rectal Tenaculum, Byrne's Double 6.00 
Rectal Trocars, for Rectal Puncture of the 
Bladder: 
1730 128 Buck's Trocar 3.50 
30 4 9 392 Cock's Instrument 15.00 
1729 128 Parker's Guarded Trocar 4.50 
1728 128 Trocar 2.50 
1731 128 Van Buren's Double Tube, Silver... . 4.00 
2738 311 Rectal Tumor Forceps, Kelsey's 2.50 
3122 417 Rectangular Staff, Buchanan's 2.50 
3 7 0 8 529 Rectilinear Ecraseur, Nott's ' 12.00 
Recto-Colonic: 
26 5 1 300 Endoscope, Bodenhamer's 7.50 
2 6 6 9 305 Enema Apparatus .... 16.00 
2653 301 Exploring Sound 8.00 
2767 317 Redfern-Davis'Hernia Instrument 15.00 
Redressors, see Uterine Repositors. 
Fig. Page. Price. 
2748 312 Reed's Pile Bougie $1.25 
Rectum Speculum 3.50 
1661 117 Reese's Uterine Leech 4.50 
3620 506 Uterine Leech . 4.50 
42 5 3 734 Reeve's Scarpa Shoe, each.... 12.00 
4251 ( 
. i"734 Universal Talipes Shoe, each 8.00 
420Z ' 
34 1 9 482 Reflux Catheter, Byrne's 2.50 
See also Catheter, Double Current. 
72 Regimental Surgeons'Pocket Set 23.00 
Reginald Harrison, see Harrison. 
3240 446 Reid's Speculum Vaginae 6.00 
133 2 80 Reiner's Needle Forceps.. 4.00 
3645 511 Reinstetter's Rinse Curette 4.00 
34 2 0 482 Reliquet's Double Current Catheter 3.50 
30 5 6 398 Urethral Stone Crusher 15.00 
Repositors, see Uterine Repositors. 
616 Resection. 
See Exsection, also Osteotomy : Resec- 
tion and Exsection. 
1045 7 Resonator, Holden's . ...... 2.50 
Respirators: 
2 5 7 0 282 Dobell's Residual Air Pump.. 3.00 
2574 283 Gedding's 5.00 
2 5 6 8 282 Jeffrey's Mouth 2.50 
Jeffrey's Mouth and Nose ... ... 3.00 
2 5 7 2 282 Nitz's 1.50 
2 5 6 6 282 Richardson's In str ument to Re-estab- 
lish Respiration in Asphyxia 4.50 
2571 282 Tyndale's Antiseptic Oro-Nasal Res- 
pirator 3.50 
280 Respiratory Apparatus. 
See also Inhaler. 
761 Respiratory Passages: 
4357 I „g^ Carbon-dioxide Generator and Reser- 
4358 ' ' ' voir 10.00 
631 Restraints for the Insane : 
4052 631 Anklets, with Large Buckle 6.00 
40 5 0 631 Anklets, with Small Buckle 6.00 
405 1 631 Buckle 2.50 
4045 631 Buckle, alone j._. 2.00 
4045 631 Buckle, with Strap 2.50 
40 5 4 632 Lynch's Lock Buckle, alone .. 2.00 
40 5 4 632 Lynch's Lock Buckle and Strap...... 2.50 
4046 631 Lynch's Muff 8.00 
40 4 7 631 Mitts.... •_ 8.00 
4053 631 Shoe Buckle, with Strap and Loop ... 1.00 
40 4 9 631 Straight Jacket, Long 10.00 
4049 631 Straight Jacket, Short 8.00 
40 4 8 631 Wristlets ... 5.50 
28 9 5 348 Retention Catheter, Gouley's 2.50 
28 9 9 349 Catheter, Otis' .... 3.00 
Catheter, Teevan's... ..J. 2.50 
2897 348 Catheter, Thompson's .... 3.00 
2900 349 Catheter, Bumstead's-Thompson's... 3.50 
384 of Urine. 
See Catheters. 
1011a 3 Retort Stand 1.50 
1558 100 Retractor, Bilroth's, Three-Pronged 3.00 
15 59 100 Bilroth's, Two-Pronged j 3.00 
1553 100 Blackman's 1.50 
1552 100 Blandin's (Bone Staff) 3.00 
Cheek, see Cheek Retractor. 
1854 151 Desmarre's, Eyelid 1.75 
1855 151 Desmarre's, Eyelid 1.75 
1555 100 Durham's 3.00 
Emmet's, Perineal ; 7.00 
15 5 6 100 Lange's 3.00 
15 60 100 Langenbeck's, Blunt 2.50 
1561 100 Langenbeck's, Sharp.. - 2.50 
4 3 7 5 765 Large Blunt Hook 3.00 
13 7 6 84 Little's.. 1.50 
2364 236 Luer's, Cheek 2.00 
2 5 5 5 279 Miner's, Trachea 4.50 824 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS 
Fig. Page. Price. 
15 54 100 Retractor, Mott's, per pair $1.50 
1849 151 Noyes', Eyelid 1.75 
15 5 0 100 Parker's, per pair 1.50 
2537 277 Pilcher's, Supra-Sternal. 2.50 
2 5 4 0 277 Pilcher's, Tracheotomy 2.00 
1551 100 Prince's (Bone Staff) 3.50 
1613 106 Prince's, and Chain Saw Carrier 3.50 
4388 766 Riesenhaken (Giant Hook) 5.00 
15 5 7 100 Roberts' 1.50 
42 3 3 724 Roberts' Protecting 
2 5 3 4 277 Rose's, Tracheotomy 1.00 
3335 461 Simon's, Plain 3.00 
33 3 4 461 Simon's, Serrated 3.50 
4 3 7 6 765 Small Blunt Hook 3.00 
1 563 100 Tenaculum, Double 2.50 
1562 100 Tenaculum, Single 2.00 
1 564 100 Tenaculum, Triple 2.50 
4 3 8 5 766 Volkmann's 3.00 
2532 277 Well's, Tracheotomy 2.00 
4413 770 Reverdin's Needle, Fixed or Folding Handle, 6.00 
1245 40 Revulsor, Hamilton's 8.00 
Reynold's Vaginal Douche 2.50 
2229 220 Rhinometer, Jarvis' 9.00 
2215 217 Rhinoplastos, Adams' 3.00 
2217 217 Bosworth's 3.50 
Gleitsmann's 12.00 
2216 217 Weir's. 3.00 
203 Rhinoplasty. 
2170 208 RhinOscope, Duplay's 8.00 
2 1 7 1 208 Fraenkel's 8.00 
2 1 7 2 208 Simrocks... 8.00 
205 Rhinoscopic: 
2 1 68 208 Mirror, Jarvis' 4.00 
2167 207 Mirror, Plain, each 1.25 
206 Set, Wagner's. 
Speculum, see Nasal Speculums. 
207 Rhinoscopy, Posterior. 
1 549 99 Rib Shears, Costotome 6.00 
1259 48 Richardson's Atomizer, Hard Rubber 3.00 
1259 48 Atomizer, Silver 5.50 
3639 511 Finger Elongator 6.00 
2 5 6 6 282 Instrument to Re-establish Respira- 
tion in Asphyxia 4.50 
39 2 2 588 Splint (Clavicle, Scapula and Hume 
rus) 6.00 
4191 701 Richter's Torticollis Brace 
Riding Belt, see Abdominal Belt. 
43 8 8 766 Riesenhaken 5.00 
34 3 3 486 Ring Pessary, Elastic .50 
Hard Rubber .50 
34 4 2 486 Inflatable 50 
34 4 3 486 Inflated 50 
34 6 5 489 Metal. .50 
Meyer's .50 
Peaslee's .50 
3471 489 Wilhoff's .50 
Ripley's Catheter 2.00 
1644 114 Rizzoli's Osteoclast 35.00 
2 1 5 6 205 Robert and Colin's Nasal Speculum 3.50 
4 1 32 675 Roberts'Elastic Knee Extension Splint ... 35.00 
4232 723 Electro-Osteotome 
4222 717 Genu Valgum Brace 
40 7 8 650 Hip Splint, Long 30.00 to 40.00 
4077 649 Hip Splint, Short 22.00 
4 1 95 703 Jury Mast 25.00 
4100 661 Knee Splint, Plain 25.00 
40 9 7 660 Knee Splint, with Tibial Rotation 35.00 
1713 126 Pericardial Trocar 3.50 
42 3 3 724 Protecting Retractors 
15 5 7 100 Retractor 1.50 
2223 219 Septum Punching Forceps 6.00 
4 1 86 699 Spinal Extension Jacket 20.00 to 30.00 
4194 703 Torticollis Brace 25.00 
1001 2 Urine Test Apparatus 25.00 
Fig. Page. Price. 
3 7 7 4 541 Robertson's Obstetrical Forceps $8.00 
2210 216 Robinson's Evulsion Forceps 4.50 
3794 548 Insufflator, Asphyxia 1.50 
3737 536 Obstetrical Forceps 8.00 
2188 211 Powder Blower 3.00 
3770 541 Rockwell's Obstetrical Forceps 8.00 
2578 283 Roe's Inhaler 2.00 
23 6 6 236 Mouth Gag and Cheek Retractor 2.50 
2607 291 CEsophageal Dilators, each 1.00 
2608 291 CEsophagotome 15.00 
2451 263 Tobold's Laryngoscope *45.00 
24 5 2 263 Uvula Hook 1.00 
1 762 145 Roehnch's Entropium Forceps 3.00 
29 9 0 372 Rogers' Dilating Urethrotome and Ure- 
thrometer 40.00 
2831 336 Phimosis Forceps 3.00 
1277 74 Roller Bandage. Send for Price List. 
3 7 6 5 540 Roller's Obstetrical Forceps 8.00 
Rongeurs (Gouging Forceps): 
1599 103 Curved Rongeur 3.50 
15 9 7 103 Darby's Rongeur and Bone Holder 4.00 
1590 103 Hoffmann's Gouge Forceps... 4.00 
1620 108 Post's Rongeur 3.00 
2 1 23 197 Post's Rongeur 3.00 
1598 103 Straight Rongeur 3.50 
2140 201 Roosa's Politzer's Bag 3.50 
202 Set of Ear Instruments 43.40 
Root Extractor, see Dental, Root Extractor. 
Root Forceps, see Dental, Forceps. 
2 5 3 4 277 Rose's Trachea Retractor 1.00 
2826 335 Ross' Circumcision Ring 1.00 
2209 215 Rotating Scissors, Smith's Canulated 5.00 
330 1 453 Smith's (Heywood) 12.00 
24 8 8 267 Tiemann's 8.50 
133 4 80 Roux's Needle Holder 4.50 
3446 486 Rozer's Pessary 6.00 
74 Rubber Bandage. Prices on page 74. 
2011 184 Rumbold's Acou-Otoscope 2.50 
24 5 3 263 Laryngeal Mirror.. 10.00 
2494 268 Scissors and Forceps for Laryngeal 
Tumors 
24 5 5 263 Soft Palate Retractor 7.50 
2 3 7 7 238 Tongue Depressor, with 3 Blades 6.00 
2454 263 Uvula Retractor 2.00 
24 6 6 264 Ruppaner's Brush Holder 1.00 
Ruptured Perineum, see Perineorrhaphy. 
271 5 309 Perineum Needle 1.00 
43 6 9 764 Rushmore's Grooved Catheter 1.50 
1336 80 Russian Needle Holder 4.00 
3 7 8 8 548 Ryerson's Adj ustible Vectis 7.00 
1483 94 Sabine's Artery Clamp Forceps 2.50 
Saddle Bags, see Medical Saddle Bags. 
Sajou's Acetic Acid Applicator 10.00 
Chromic Acid Applicator 10.00 
Laryngeal Forceps 4.00 
Nasal Insufflator, for Patient's Use.. .50 
Nasal Saw 2.00 
Nasal Speculum 2.50 
Palate Retractor 3.50 
3675 516 Polypus Snare, Plain 4.00 
3675 516 Polypus Snare, with Curved and 
Straight Ends 5.00 
Polypus Snare, with Scissor Handles. 11.00 
Septum Punch 20.00 
Tonsilotome 12.00 
3675 516 Wire Ecraseur 4.00 
78 Salmon-Gut Suture, per package 1.50 
39 5 8 601 Salter's Cradle 20.00 
3345 467 Sampson's Urethral Speculum 6.00 
1341 81 Sands'Needle Forceps 4.50 
1782 146 Needle Forceps 4.50 
2611 291 CEsophagotome 40.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
825 
Fig. Page. Price. 
1 584 102 Sands' Periosteotome __ $2.50 
2596 £87 Sass'Hand-Ball Spray Producer 5.00 
2584 285 Spray Producer, with Receiverand Air 
Pump 
2588 286 Spray Tube and Bottle 
23 8 0 238 Tongue Depressor 3.50 
1593 103 Satterlee's Bone Forceps, Large 3.00 
1 593 103 Bone Forceps, Small 2.50 
1527 97 Capital Saw 5.00 
Saw, Amputating, see Amputating Saw. 
Metacarpal, see Metacarpal Saw. 
Nasal, see Nasal Saw. 
Resection and Exsection, see Osteo- 
tomy : Resection and Exsection 
Saws. 
37 6 0 539 Sawyer's Obstetrical Forceps 7.00 
3 7 4 4 537 Obstetrical Forceps, Long 10.00 
3741 537 Obstetrical Forceps, Short 8.00 
4 1 08 665 Sayre's Ankle Compressor, Rubber 6.00 
4109 666 Ankle Joint Splint 22.00 
42 7 6 742 Apparatus for Flat Foot, each 12.00 
38 8 4 575 Bandage Shears 7.00 
1352 82 Bullet Probe 8.00 
3923 588 Clavicle Dressing. 
4246 
4247 732 Clubfoot or Talipes Shoe, ea. 10.00 to 14.00 
4248 ' 
4249 733 Clubfoot or Talipes Shoe, im- 
proved, each 10.00 to 14.00 
4080 651 Cuirass, Large 45.00 
4080 651 Cuirass, Medium 35.00 
4080 651 Cuirass, Small 25.00 
4092 658 Double Extension, Knee-Joint 20.00 
4087 656 Double Extension, Knee-Joint. 
3913 583 Extension Sundries 4.00 
40 6 2 642 Hip Splint, Long 25.00 to 45.00 
4063 642 Hip Splint, Long, with Socket Attach- 
ment on Shoe 30.00 to 50.00 
40 5 8 639 Hip Splint, Short, Improved- 17.00 to 20.00 
40 5 6 638 Hip Splint, Short, Original „ 15.00 to 18.00 
4174 696 Jacket for Lateral Curvature. 
695 Knitted Seamless Shirt-. 2.00 to 4.00 
Lacing and Trimming6.00 to 12.00 
4142 684 Jury Mast ... 12.00 
40 8 6 655 Knee-Joint Splint 20.00 
4127 671 Knee Support, for After Treatment in 
Joint Disease 30.00 to 40.00 
42 4 2 731 Method of Attaching Barwell's Muscles: 
Hooks, each .10 
India Rubber, per foot .12 
Moleskin Plaster, per yard 1.50 
Tin Plate, with Loop, each .20 
Wire Eyes, each .10 
1583 102 Periosteotome 2.00 
23 3 3 233 Periosteotome 2.00 
4 1 74 696 Plaster Jacket. 
4140 682 Plaster of Paris Jacket. 
4143 685 Plaster of Paris Jacket and Jury Mast. 
66 Pocket Set 23.50 
42 7 8 743 Rotator 25.00 to 35.00 
4108 665 Rubber Compressor, Ankle 6.00 
40 8 5 654 Rubber Compressor, Knee-Joint6.00 
695 Seamless Shirt 2.00 to 4.00 
4173* Suspension. 
38 8 4 575 Shears, Plaster Bandage 7.00 
Spiral Spring Corset 20.00 to 25.00 
4141 683 Suspension Apparatus, Japanned.8.00 
41 40 682 Suspension Apparatus, Nickel Plated, 12.00 
42 7 0 740 Talipes Equinus Shoe, each _ 10.00 to 15.00 
4249 733 Talipes Shoe, each 10.00 to 14.00 
1374 84 Tenotome, Blunt Pointed 1.25 
1372 84 Tenotome, Concave Edged 1.25 
1373 84 Tenotome, Convex Edged 1.25 
Fig. Page. Price. 
13 7 5 84 Sayre's Tenotome, Sharp Pointed $1.25 
4140 682 Tripod 10.00 
Scales, see Guages. 
Scalpel, Amputating, see Amputating Knives. 
1 512 ? 
to V 96 Aseptic, each 1.50 
1516 ' 
3123 417 Depuytren's 1.75 
13 6 6 84 Feruled, Four Sizes, each 1.25 
2315 231 Harelip .75 
1777 146 Lid, Large 1.50 
17 7 9 146 Lid, Medium 1.50 
1778 146 Lid, Small _ 1.50 
Lithotomy, see Lithotomy Scalpel. 
138 1 84 Little's, Large 1.50 
1380 84 Little's, Medium 1.50 
13 7 9 84 Little's, Small 1.50 
Microscopic, see Microscopic Scalpel. 
3 6 9 0 523 Pilcher's Aseptic 1.50 
1 400 I - . 171V TT JI 
( or Plain, Ebony Handle .75 
1402^ ° Ivory Handle 1.00 
Pocket, Plain 1.00 
140 8 86 Pocket. Slide Catch 1.75 
Pocket, Spring Catch 2.00 
Tracheotomy, see Tracheotomy Scalpel. 
1538 98 Trepanning 1.50 
1651 115 Scarificator, 10 Bladed 4.50 
1652 115 12 Bladed 4.50 to 8.00 
1780 146 Desmar re's Eyelid 1.50 
2 6 8 0 306 Rectal 1.50 
1650 115 Tiemann's Patent .... 7.00 
Scarifyer, see Uterine Scarificator. 
1679 120 Scarifying Spud, Piffard's 1.25 
1909 163 Scarpa's Iris Needle 1.25 
2615 292 Schaffer's Throat and Uterine Scoop 8.00 
3 7 2 6 531 Schapp's Spiral Drainage Tube 1.50 to 3.50 
3 1 93 437 Schlotterbeck's Speculum Vaginas 7.00 
3789 548 Scholler's Cord Carrier 4.00 
25 1 5 272 Schroetter's Laryngeal Catheter 3.00 
1235 38 Laryngeal Cautery Electrodes Com- 
plete... 16.00 
No. 1, Snare 3.50 
No. 2, Lancet 3.00 
No. 3, Porcelain Burner 3.50 
No. 4, Knife 3.00 
No. 5, Voltolini's Knife 3.25 
No. 6, Blunt Cautery 3.00 
2484 267 Laryngeal Lancet and Forceps 15.00 
24 3 8 258 Laryngoscope 6.50 to 8.00 
251 5 272 Stenosis Tube 3.00 
Schultz's Pelvimeter 8.00 
278 5 324 Schuppert's Galvanic Truss 15.00 to 20.00 
3232 445 Schuyler's Combination Speculum 12.00 
3773 541 Obstetrical Forceps 11.00 
2118 ■ 
to >197 Schwartze's Chisels, each 1.25 
2122' 
2114^ 
to > 197 Gouges, each 1.25 
2117' 
1847 151 Schwatka's Eye Speculum 2.50 
29 4 9 359 Schweig's Urethral Stricture Dilator 10.00 
2690 306 Scissors, Allingham's, Fistula in Ano 7.00 
1925 164 Althof's, Iridectomy 5.00 
3680 516 Amputating, Cervix Uteri 6.00 
1404 85 Angular, Operating 1.50 
2708 308 Angular, Pile 1.50 
140 3 85 Artery 1.75 
3611 505 Bozeman's, Angular 4.50 
3 2 8 6 452 Bozeman's, Curved 4.50 
32 8 5 452 Bozeman's, Double Curved 4.50 
2709 308 Bush's, Pile 1.50 
1884 159 Chadwick's, Pterygium 6.00 826 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
3679 516 Scissors, Clark's Tooth-edged $9.00 
140 5 85 Curved-on-flat 1.50 
Dissecting, Curved ... 1.00 
1105 15 Dissecting, Straight .75 
1289 76 Dressing 1.25 
32 9 9 453 Emmet's, Double Curve 4.50 
32 9 7 453 Emmet's, Knee Bent 4.50 
32 9 8 453 Emmet's, Slightly Curved 4.50 
1107 15 Enterotome 2.50 
1986 175 Enucleation 1.50 
1291 76 Gay's Open Ring 1.50 
20 9 7 196 Gruber's, Ear 4.50 
2 7 0 8 308 Haemorrhoidal, Angular 1.50 
27 0 9 308 Haemorrhoidal, Bush's . 1.50 
193 2 164 Hall's, Iris 6.00 
4410 770 Hanks' Uterine 5.00 
232 1 231 Harelip, Angular 1.50 
2320 231 Harelip, Hamilton's.. 1.50 
3301 453 Heywood Smith's 12.00 
24 9 6 268 Heywood Smith's 12.00 
Iridectomy see Ophthalmic: Cata- 
ract • Iris Scissors. 
Jenks'Uterine 4.50 
3678 516 Kuechenmeister's 6.00 
Laryngeal, see Laryngeal Scissors. 
1924 164 Maunoir's, Eye 1.50 
3301 453 Movable Points, Smith's 12.00 
24 8 8 267 Movable Points, Tiemann's 8.50 
Nasal, see Nasal Scissors. 
1295 76 Old's, and Dressing Forceps 3.50 
1406 85 Operating, Straight 1.00 
Operating, Straight, Larger 1.25 
Perforating, see Obstetrical Perfora- 
tors. 
Phimosis, see Phimosis Scissors. 
Pile, see Pile Scissors. 
Plaster Paris, see Bandage Shears. 
1135 18 Probe-pointed 1.25 
328 1 452 Sims', Curved, Sharp Points 4.50 
3 2 9 5 453 Sims', Curved.... 4.50 
32 9 6 453 Sims', Straight 3.50 
38 2 6 556 Skene's Hawk-bill 10.00 
20 98 196 Simrock's, Ear.. 4.50 
1677 120 Skin-Grafting 10.00 
330 1 453 Smith's 12.00 
2 3 2 8 232 Staphyloraphy 4.50 
Steven's, Eye 4.50 
Strabismus, see Ophthalmic: Strabo- 
tomy. 
2536 277 Tardieu's Trachea 5.00 
2839 337 Taylor's 5.00 
2488 267 Tiemann's, Movable Points. 8.50 
23 9 3 243 Tonsil 4.50 
3679 516 Tooth-edged, Clark's 9.00 
25 3 6 277 Trachea, Tardieu's 5.00 
Uterine, see Uterine Scissors. 
24 0 8 246 Uvula 5.50 
24 0 9 246 Uvula, with Claws 5.50 
1918 163 Wilde's, Canulated (Scissors alone) ._ 12.00 
32 7 8 451 Wire Cutting, Sims' 3.50 
693 Scoliosis. 
Scoliosis Apparatus: 
r694 Harwell's Scoliosis Brace.... 12.00 to 15.00 
4171' 
4 1 69 694 Barwell's Sloping Seat 10.00 to 15.00 
4 1 86 699 Roberts' Spinal Extension Jacket, 
20.00 to 30.00 
4 1 74 696 Sayre's Plaster Jacket. 
417 3 695 Sayre's Suspension Apparatus, Ja- 
panned 8.00 
4173 695 Sayre's Suspension Apparatus, 
Nickel Plated 12.00 
4 1 7 2 694 Sayre's Tripod 10.00 
4 1 7 5 696 Squire's Spineyard 7.50 
Fig. Page. Price. 
Scoliosis Apparatus : 
4184 699 Stillman's Horizontal Frame 
4 1 82 699 Stillma n's Vertical Extension Brace, 
30.00 to 40.00 
4183 699 Stillman's Vertical Frame 
4 1 80 698 Stillman's V Lever Brace, Combined 
with Corset £0.00 to 60.00 
417 6 697 Tiemann's Scoliosis Brace 35.00 
4177 697 Tiemann's Scoliosis Brace, Extra Light 
and Fine 40.00 
4 1 85 699 Wolff's Spinal Cradle 10.00 to 15.00 
15 8 7 102 Scoop, Bone, Hebra's 2.50 
2 1 29 197 Bone, Politzer's .. 2.50 
2502 269 Laryngeal 3.00 
2505 269 Laryngeal, Tiemann's 6.00 
3136 421 Lithotomy 2.50 
3157 426 Luer's 2.50 
Rectal, see Rectal Scoop. 
2741 311 Siemon's . 2.50 
3641 511 Siemon's 2.50 
3643 511 Thomas', Serrated 3.50 
30 56 398 Urethral, Reliquet's 15.00 
Uterine, see Uterine Curette. 
See also Curette. 
3 2 9 2 452 Scott's Knife 1.50 
23 0 2 229 Screw Elevator, Dental 1.00 
Scrotal, see Varicocele. 
Searcher, see Stone Searcher. 
Sea-tangle Tent, see Tents. 
Section-Cutter, see Microscopic. 
Section-Knives, see Microscopic. 
Section-Razor, see Microscopic. 
1873 154 Sedillot's Double Hook 1.50 
24 6 2 264 Seeger's Brush Holder 2.50 
2 5 8 2 284 Steam Nebulizer - 12.00 
24 4 8 262 Tobold's Laryngoscope 34.00 
Seeley's Pile Pipe 2.00 
3179 431 Segala's Speculum Vaginae 8.00 
1017 4 Seguin's Surface Thermometer 2.00 
2214 217 Seiler's Septometer 4.50 
Seizing Forceps: 
23 9 8 243 Durham's 4.50 
2399 243 Langenbeck's 2.50 
23 9 4 243 Musseux's 2.50 
32 7 2 449 Self-closing .. 2.50 
2325 232 Self-closing 2.50 
32 7 3 449 Sims' 3.00 
32 6 7 449 Skene's 2.00 
32 6 8 449 Skene's, with Lock 3.00 
32 6 9 449 Thomas'Tissue - -- 4.50 
23 2 4 232 Whitehead's 4.50 
See also Vulsellum Forceps. 
2777 322 Self-Adjusting Truss 3.00 to 5.00 
694 Self-Suspension in Spinal Curvature : 
14 7 3 695 Pulleys and Head Rest, Japanned ... 8.00 
1473 695 Pulleys and Head Rest, Nickel-plated, 12.00 
147 2 694 Sayre's Suspension Apparatus, with 
Tripod 18.00 and 22.00 
2814 331 Seminal Cord Compress 4.00 
2214 217 Septometer, Seiler's 4.50 
1568 101 Sequestrum Forceps, Ferguson's 2.50 
1 572 101 Hamilton's 2.50 
1571 101 Markoe's 3.00 
153 7 98 Van Buren's 2.50 
1476 93 Serrefln, Garrigue's 25 
1477d 93 Langenbeck's .50 
1471 93 Mattock's .50 
14776 93 Vidal's .25 
1477c 93 Vidal's .25 
142 3 87 Seton-Needle 1-00 
Seuter's Bandage Shears 5.00 
Sexton's Cotton Carrier •. .50 
2068 193 Ear Curette, Double 2.00 
20 79 194 Ear Douche 10.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
827 
Fig. Page. Price. 
2054 191 Sexton's Ear Dressing Forceps, each $1.75 
43 9 3 767 Ear Syringe 10.00 
2132 199 Eustachian Catheter 1.25 
20 69 193 Folding Tongue Depressor 2.50 
2071 193 Foreign Body Forceps 4.50 
20 7 3 193 Handle and 7 Instruments, in Case - 12.00 
2142 201 Insufflator 2.00 
Mouth Spa tula .60 
2 1 6 5 206 Nasal Speculum 1.00 
2145 201 Nozzle for Politzer's Bag 1.00 
2092 195 Powder Blower 3.00 
Probe, Double .50 
202 Set of Ear Instruments 35.00 
2073 193 Set of 7 Instruments and Handle, in 
Case 12.00 
2069 193 Tongue Depressor 2.50 
59 Seymour's General Operating Set 176.70 
42 6 7 739 Shaffer's Ankle Support, each 6.00 to 8.00 
4 1 88 701 Ball and Socket Pivot 20.00 to 25.00 
42 6 3 739 Club-foot Extension Apparatus, each, 
10.00 to 12.00 
40 6 5 644 Hip Splint 30.00 to 35.00 
40 9 6 659 Knee Extension Splint 50.00 to 60.00 
4145 686 Plaster Zone 
26 1 5 292 Scoop 8.00 
154 9 99 Shears, Rib 6.00 
Rib, Plain 5.00 
Plaster Bandage, see Bandage Shears. 
1689 121 Sherwell's Cutipuncture 5.00 
43 1 7 755 Laryngeal Scissors 14.00 
4318 755 Laryngeal Scissors 7.00 
4315 755 Nasal Scissors t 5.00 
43 1 6 755 Nasal Scissors 7.00 
4 1 29 674 Short Anchylosis Knee Splint 25.00 to 30.00 
1028 5 Cedar Stethoscope .75 
43 0 5 752 Leg Apparatus, Bigg's 35.00 
4203 710 Leg Extension (Patten) 9.00 
4204 710 Leg Extension and Weak Ankle Brace, 18.00 
38 3 7 561 Shot Compressor 2.50 
Perforated, per 100 .30 
Shoulder Braces (for Round Shoulders): 
4 1 5 7 690 Elastic Shoulder Brace 2.00 to 3.50 
4 1 58 690 Elastic Shoulder Brace 2.00 to 3.50 
4156 689 Nyrop's Spring Brace 18.00 
4 1 5 9 690 Steel Back Brace 4.00 to 5.00 
4 1 60 690 Stillman's Spondylitis Brace, 35.00 to 50.00 
3982 611 Shoulder Dislocation Brace 6.00 to 9.00 
3940 592 Shrady's Splint for Colles' Fracture 2.00 
1635 110 Subcutaneous Saw and Knife 7.00 
1636 111 Subcutaneous Saw and Knife, Angu- 
lar 7.00 
1637 111 Subcutaneous Saw and Knife, Im- 
proved 8.00 
39 7 6 608 Shrimpton's Forceps 3.00 
Shufford's Haemorrhoidal Needle 2.50 
43 9 8 769 , Rectum Speculum 
2 1 54 205 Shurley's Nasal Speculum, with Ivory Slide, 
Right and Left, each 3.50 
1904 163 Sichel's Iris Knife 1.75 
1906 163 Sickel-shaped Iris Knife 1.75 
20 1 9 185 Siegle's Otoscope 5.00 
3640 511 Siemon's Curette, Blunt 2.50 
2741 311 Curette, Scoop 2.50 
3641 511 Curette, Sharp . 2.50 
33 3 5 461 Retractor, Plain 3.00 
33 3 4 461 Retractor, Serrated 3.50 
Retractors, Set of 5, and 1 Handle- 9.00 
3332 461 Set of 4 Simon-Bozeman's and 4 Simon- 
Sims' Specula, with 2 Socket Han- 
dles 20.00 
33 3 3 461 Set of 8 Flat Shaped Specula, with 2 
Socket Handles 20.00 
1064 10 Sieveking's ^Esthesiometer 4.00 
2904 350 Sigismund's P. P. Syringe .75 
Fig. Page. Price. 
32 7 9 451 Sigmoid Catheter, Sims', Hard Rubber $1.00 
32 7 9 451 Sims', Metal .75 
3279 451 Sims', Silver 1.50 
Silk, see Ligature. 
Silk Catheter, Conical 1.25 
30 2 7 385 Catheter, Cylindrical. 1.00 
Catheter, Mercier's 1.25 
Catheter, Olive 1.25 
Bougie, Conical 1.25 
30 2 8 385 Bougie, Cylindrical 1.00 
Bougie, Olive 1.25 
1343 81 Silver Probes, Pocket Case, per pair .75 
See also Probes. 
Silver Wire for Suture, per coil .50 
Simon, see Siemon. 
382 1 552 Simpson's Cephalotribe 15.00 
381 9 552 Cranioclast 10.00 
36 0 9 505 Hysterotome 7.00 
3782 546 Obstetrical Forceps, Long 8.00 
Obstetrical Forceps, Short 7.00 
38 0 0 549 Perforator 3.00 
Tarnier's Obstetrical Forceps 16.00 
3579 501 Uterine Dilator 4.50 
3 5 6 8 499 Uterine Dilators, Set of 12 7.50 
Uterine Porte Caustic 2.50 
Uterine Sound .... 1.25 
3364 474 Uterine Sound, Graduated 1.50 
2 50 1 269 Simrock's Laryngeal Forceps 4.50 
2441 259 Laryngoscope 9.00 
2 1 52 205 Nasal Speculum 1.50 
2000 183 Otoscope, with Lens 4.00 
2202 213 Polypus Forceps 2.50 
2172 208 Rhinoscope 8.00 
20 98 196 Scissors for the Ossicula Auditus 4.50 
3685 519 Sims' (H. Marion) Abdominal Protectors 
and Skewers x 4.00 
3632 510 Curette 3.00 
3727 532 Drainage Tube 1.50 
Inhaler 1.50 
36 8 8 520 Ovariotomy Director 1.50 
26 4 8 300 Rectal Speculum 5.50 
3551 496 Stem Pessary 1.75 
Urethral Speculum.- 4.50 
23 3 5 233 Sims'(J. Marion) Adjuster 1.50 
2337 233 Adjuster 1.50 
3277 451 Adjuster 1.50 
26 5 0 300 Anal Dilator 4.50 
3219 443 Bivalve Speculum 5.00 
32 7 5 450 Blunt Hook 1.25 
33 8 7 476 Caustic Forceps 3.50 
3631 510 Curette 1.75 
3632 510 Curette 3.00 
325 0 448 Depressor 150 
3251 448 Double Depressor 1.50 
3559 497 Double Tenaculum 3.50 
3677 516 Ecraseur, Porte Chain 35.00 
3652 512 Enucleator 3.50 
3653 512 Enucleator Blunt Hook 3.50 
3287 452 Holder and 4 Knives 10.00 
32 9 3 452 Knife, Probe-pointed 1.50 
3282 452 Knife, Rotating 4.50 
132 0 79 Needle, per dozen 1.50 
1337 81 Needle Forceps 2.50 
2712 309 Needle Forceps 2.50 
33 0 3 454 Needle Forceps 2.50 
330 5 454 Needle Forceps, with Catch 4.00 
3466 489 Pessary Introducer 8.00 
3677 516 Porte Chain Ecraseur 35.00 
2338 233 Pulley 1.25 
32 7 6 450 Pulley or Fork... 1.25 
3282 452 Rotating Knife _ : 4.50 
328 8 452 Scalpel 1.50 
32 9 5 453 Scissors, Curved, Blunt Pointed 4.50 
328 1 452 Scissors, Curved, Sharp Pointed 4.50 828 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
3296 453 Sims' (J. Marion) Scissors, Straight $3.50 
3278 451 Scissors, Wire Cutting 3.50 
32 7 3 449 Seizing Forceps 3.00 
32 7 9 451 Sigmoid Catheter, Hard Rubber 1.00 
3279 451 Sigmoid Catheter, Metal .75 
3279 451 Sigmoid Catheter, Silver 1.50 
3212 442 Speculum 2.50 
321 9 443 Speculum, Bivalve 5.00 
32 7 4 450 Sponge Holder .75 
3537 495 Stem Pessary 2.00 
3386 475 Tampon Screw 1.25 
2 3 3 6 233 Tenaculum 1.25 
32 5 6 449 Tenaculum 1.25 
3 5 5 9 497 Tenaculum, Double 3.50 
32 6 4 449 Tenaculum, Long 1.25 
23 3 9 234 Twisting Forceps. 3.00 
3278 451 Twisting Forceps. 3.00 
3 5 8 7 502 Uterine Dilator, Three Bladed 12.00 
Uterine Dilator, Two Bladed 6.00 
3425 483 Uterine Elevator, No. 1 6.00 
34 2 6 483 Uterine Redressor, No. 2 6.00 
Uterine Sound 1.25 
Uterine Stem, Glass .25 
470 Uterine Surgery Set 125.00 
32 1 3 442 Vaginal Dilator, Glass .50 
3213 442 Vaginal Dilator, Hard Rubber .75 
462 Vesico-Vaginal Fistula Set 55.00 
462 Vesico-Vaginal Fistula and Uterine 
Set 75.00 
3646 512 Vulsellum Hook 5.50 
3277 451 Wire Adjuster or Fulcrum 1.50 
32 7 8 451 Wire Cutting Scissors 3.50 
3278 451 Wire Twisting Forceps 3.00 
Skeleton, Human, see Osteological. 
4 3 5 5 760 Skene's Buttonhole Scissors 6.50 
43 5 6 760 Cervix Needles, per doz 1.56 
3717 530 Compressing Forceps 5.50 
3828 557 Counterpressor 1.50 
3637 511 Curette 1.75 
3500 491 Cystocele Pessary 2.00 
3341 466 Double Perforated Catheter...' 2.00 
3432 483 Elevator and Curette 10.00 
33 4 6 467 Endoscope 2.75 
2861 344 Endoscope 2.75 
33 4 9 469 Fissure Knife and Probe, each .75 
3348 468 Folsom's Speculum 1.50 
28 6 2 344 Folsom's Speculum 1.50 
27 1 0 308 Haemorrhoidal Clamp 6.00 
3826 556 Hawk-bill Scissors... 10.00 
3342 466 Instillation Tube .50 
33 9 5 476 Instillation Tube .50 
38 2 7 556 Needle Forceps 5.50 
371 3 529 Ovariotomy Cautery Clamp 15.00 
2 7 2 2 309 Perineum Needle 1.75 
38 4 3 561 Perineum Needle 1.75 
43 5 4 760 Pessary for Prolapsus of the Bladder, 2.00 
33 5 0 469 Reflux Catheter 2.00 
32 6 7 449 Seizing Forceps 2.00 
32 6 8 449 Seizing Forceps, with Lock 3.00 
3280 451 Self-retaining Catheter 1.00 
3340 466 Self-retaining Catheter 1.00 
33 7 4 474 Sound 3.50 
36 1 8 506 Sound and Scarificator 6.00 
3825 556 Tenaculum Forceps 3.00 
33 4 7 467 Urethral Speculum 2.50 
28 5 4 343 Urethral Speculum 2.50 
3339 465 Urinal Cup Pessary 2.50 
396 Uro-Cystic and Urethral Set.... 63.35 
38 3 0 557 Uterine Sector 11.00 
471 Uterine Set of Instruments 54.25 
33 7 4 474 Uterine Sound 3.50 
Vulsellum Forceps 3.00 
4341 759 Wire Ecraseur 7.50 
1426 £8 Skey's Arterial Compressor 24.00 
Fig. Page. Price. 
2 8 3 5 336 Skillern's Phimosis Forceps $2.50 
121 Skin Grafting. 
16 7 7 120 Grafting Scissors 10.00 
3942 594 Skinner's Fracture Bed 25.00 
Skull, see Osteological. 
3485 490 Sleigh Pessary .75 
3366 474 Sliding Uterine Sound 3.00 
3803 549 Smellie's Perforator 2.50 
3 5 0 8 492 Smith's (Albert H.) Pessary .50 
2209 215 Smith's (Andrew H.) Canula Scissors 5.00 
2081 194 Ear Syringe 4.00 
2191 211 Nasal Applicator 2.50 
2 1 63 206 Nasal Speculum 1.50 
2188 211 Powder Blower 3.00 
2859 344 Smith's (George K.) Urethroscope 8.50 
2984 370 Urethrotome 30.00 
2739 311 Wire Ecraseur, Curved 6.00 
3669 515 Wire Ecraseur, Curved 6.00 
3668 515 Wire Ecraseur, Straight 5.00 
Smith's (Gregg) Clamp and Knife, Right 
and Left, each 10.00 
2732 311 Smith's (Henry) Cauteries, Serrated, per set, 6.00 
23 1 4 231 Harelip Forceps 5.00 
2734 311 Pile Clamp 6.50 
24 9 6 268 Smith's (Heywood) Scissors 12.00 
42 9 7 749 Smith's (H. M.) Brace for Femur.. 50.00 to 75.00 
42 9 9 749 Brace for Forearm 35.00 to 60.00 
4300 750 Brace for Humerus 35.00 to 70.00 
4298 749 Brace for Tibia 30.00 to 40.00 
397 5 608 Smith's (Nathan R.) Anterior Splint 3.00 
3128 419 Lithotome 12.00 
3938 592 Smith's (Samuel 55'.) Arm Splint 
3984 612 Clavicle Apparatus 
4040 629 Smith's (Stephen) Aseptic General Operat- 
ing Set 200.00 
4039'628 Aseptic Pocket Case, Compact 18.00 
Aseptic Pocket Case, Large 29.00 
Aseptic Pocket Case, Medium 28.00 
4 1 66 692 Corset, with Serpentine Springs 20.00 
40 6 8 645 Hip Splint - 9.00 
4 1 99 708 Paralysis Apparatus 40.00 to 50.00 
Snare, sec Wire Snare. 
1761 145 Snellen's Entropium Forceps 2.50 
Snowden's Eye Speculum 
Stethoscope 2.50 
1 156 24 Soles, Voltaic Armadillo, per pair 1.00 
3 1 43 423 Sond a Dard .* .. 3.50 
3 1 44 423 Helmuth's 6.00 
Sounds: 
2 9 7 3 365 Bulbous, Otis', Set of 33 and Handle . 17.50 
29 3 0 354 Conical, Steel, Curved 1.25 
29 2 9 353 Conical, Steel, Straight 1.25 
29 2 5 352 Cooling, Winternitz's, Silver 4.00 
Cooling, 55'internitz's, Soft Rubber .. 2.50 
1 790 147 Cupped, Brewster's Lachrymal 2.50 
29 1 5 351 Cupped, 5'an Buren's 2.00 
30 6 5 400 Cylindrical 1.00 
122 6 36 Electrode. 75 
Electrolysis, Newman's 3.00 
30 6 5 400 for Stone in the Bladder 1.00 
3071 400 for Stone in the Bladder, with Bill- 
roth's Sounding Board 2.50 
See also Stone Searchers. 
28 51 342 Gouley's Conical, Steel 1.25 
2930 354 Gouley's Conical, Steel 1.25 
29 3 9 356 Gouley's Tunnelled 2.50 
17 9 0 147 Lachrymal, Brewster's... 2.50 
28 8 6 347 Otis', Bulbous, each .50 
2973 365 Otis', Bulbous, Set of 33and 1 Handle, 17.50 
Otis', Conical Steel 1.25 
293 1 354 Teft's 1.25 
Uterine, see Uterine Sounds. 
29 3 0 354 Van Buren's Conical 1.25 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
829 
Fig. Page. Price. 
29 3 5 355 Sound, Weisse's $1.00 
43 6 0 763 Wyeth's, Straight or Curved 1.25 
Southey's Drainage Trocar and 4 Canulas _ 5.00 
2769 318 Spanton's Strephotome 2.00 
1831 150 Spatula, Eye, German Silver 1.25 
1831 150 Eye, Hard Rubber .75 
1296 76 Pocket Case, Hard Rubber .60 
1296 76 Pocket Case, Steel .60 
1297 76 Spatula and Elevator, Pocket Case .60 
Speculum, Anal, see Rectal Specula. 
Ear, see Aural: Diagnostic, Speculum. 
Eye, see Ophthalmic : Speculums ; also 
Ophthalmic, Palpebral: Lid Holder. 
Nasal, see Nasal Speculum. 
Oris, see Cheek Retractor, Gag, Lock- 
Jaw Instruments, Tongue Depressor. 
Rectal, see Rectal Specula. 
Urethral, see Endoscope. 
Uterine, see Uterine Dilator. 
Vaginae, see Vaginal Specula. 
Speculum Chairs, see Operating Furniture. 
148 7 94 Speir's Artery Constrictor 4.00 
2048 191 Ear Curette 1.25 
1999 183 Ear Speculum, Self-retaining 3.00 
2010 184 Ear Speculum, Wire '... 1.50 
1054 7 Echoscope 6.00 
1796 147 Lachrymal Catheter 1.00 
1254 46 Speirs-George's Ether Inhaler 3.50 
Spencer Wells, see Wells. 
2924 352 Spermatorrhoea Ring .75 
1070 11 Sphygmograph, Dudgeon's 25.00 
1072 11 Marey's (imported to order) 75.00 
2289 227 Spicula Forceps, Goodwillie's 2.00 
Spinal Braces: 
for Angular Curvature, Caries, Spon- 
dylitis, Pott's Disease or Pos- 
terior Curvature: 
4144 685 Andrews'Spine Brace 20.00 
4 1 3 6 678 Davis'Apparatus for Caries 20.00 
4142 684 Sayre's Jury Mast 12.00 
4 1 40 682 Sayre's Plaster of Paris Jacket „ 
4143 685 Sayre's Plaster of Paris Jacket 
and Jury Mast 
4 1 4 1 683 Sayre's Suspension Apparatus, 
Japanned 8.00 
4 1 4 1 683 Sayre's Suspension Apparatus, 
Nickel-plated- 12.00 
4 1 4 5 686 Shaffer's Plaster Zone Apparatus, 
4162 691 Stillman's Antero-Posterior Brace, 35.00 
4 1 63 691 Stillman's Antero-Posterior Brace 
with Head Rest u.„- 60.00 
414 8 687 Stillman's Lever Brace 35.00 
4 1 5 0 687 Stillman's Lever Brace, with Cor- 
set 40.00 
4 1 60 690 Stillman's Spondylitis Brace----- 
35.00 to 50.00 
4 1 37 678 Taylor's Apparatus for Caries, 
24.00 to 30.00 
4 1 52 688 Tiemann's Brace for Posterior 
Curvature ... 35.00 
4 1 38 679 Washburn's Spine Brace, 15.00 to 20.00 
See also Shoulder Braces. 
for Anterior Curvature (Lordosis): 
4 1 6 7 692 Delicate Brace 40.00 
4165 692 Felt Jacket, Porous 25.00 
4 1 6 5 692 Felt Jacket, Russian 25.00 
4166 692 Smith's Corset 20.00 
for Antero-Posterior Curvature: 
See Shoulder Braces, also Spinal 
Braces for Angular Curvature. 
for Scoliosis, Lateral or Rotary La- 
teral Curvature: 
4 1 70 694 Barwell's Scoliosis Brace, 12.00 to 15.00 
4 1 7 1 694 Barwell's Scoliosis Brace, 12.00 to 15.00 
Fig. Page. Price. 
Spinal Braces, for Scoliosis, &c.: 
4169 694 Barweirs Sloping Seat-_$10.00 to $15.00 
4186 699 Roberts1 Spinal Extension Jacket, 
20.00 to 30.00 
4174 696 Sayre's Plaster Jacket. 
Knitted Shirts 2.00 to 4.00 
- Lacing and Trimming Jacket, 
6.00 to 12.00 
4 1 73 695 Sayre's Self-Suspension. 
Apparatus, with Pulleys and 
Hook, Japanned 8.00 
Apparatus, with Pulleys and 
Hook, Nickel-plated 12.00 
4 1 72 694 Apparatus with Tripod, 
18.00 and 22.00 
Tripod alone __ 10.00 
4175 696 Squire's Spineyard 7.50 
4184 699 Stillman's Horizontal Frame 
4 1 82 699 Stillman's Vertical Extension 
Brace 30.00 to 40.00 
4183 699 Stillman's Vertical Frame 
4181 698 Stillman's V Lever Brace, 50.00 to 60.00 
4 1 80 698 Stillman's V Lever Brace and Cor- 
set, Combined 50.00 to 60.00 
4 1 7 6 697 Tiemann's Scoliosis Brace 35.00 
4 1 7 7 697 Tiemann's Scoliosis Brace, Extra 
Fine and Light 40.00 
418 5 699 Wolff's Spinal Cradle.... 10.00 to 15.00 
for Torticollis, Wry-Neck: 
4192 702 Markoe's Torticollis Brace, 
35.00 to 45.00 
4 1 8 7 700 Post's Torticollis Helmet 12.00 
4191 701 Richter's Torticollis Brace 
4195 703 Roberts'Jury-mast 25.00 
4194 703 Roberts'Torticollis Brace 25.00 
4188 701 Shaffer's Ball and Socket Pivot for 
Malformation of the Head, 
20.00 to 25.00 
4190 701 Stillman's Lever Brace, with At- 
tachment for Cervical Caries, 
45.00 to 50.00 
4193 702 Torticollis Brace 80.00 to 90.00 
4 1 89 701 Wood's Head Rest 5.00 
1244 40 Spinal Ice or Hot Water Bags 2.00 to 4.00 
417 5 696 Spineyard, Squire's 7.50 
1199 34 Spiral Electrode, Uterine or Urethral 1.25 
25 6 7 282 Spirometer, Barnes' 10.00 
25 6 2 281 Brown's 10.00 
25 6 3 281 Hutchinson's 32.00 
Tiemann's 10.00 
Splint, see Fracture, also Orthopaedic: Dis- 
eases of the Joints. 
4290 746 Splinter Forceps l.oo 
2285 227 Splitting Forceps, Dental 2.75 
229 1 227 Splitting Forceps, Dental, Good Willie's 2.75 
143 9 89 Spohn's Rubber Ring Tourniquet, 7 in Set_ 3.50 
678 Spondylitis. 
1182 33 Sponge Covered Electrode, Long Handle.- 1.50 
122 0 35 Cup Electrode .50 
1187 33 Cup Electrode 1.00 
3600 504 Dilator, Emmet's 2.50 
43 2 9 756 Forceps, Cohen's, 3 sizes, each 4.00 
122 4 35 Holder and Current Breaker 4.00 
1186 33 Holder (Electrode) .50 
3255 448 Holder, German Silver .75 
32 5 4 448 Holder, Iron, Ebony Handle .75 
Holder, Laryngeal, see Laryngeal Ap- 
plicators. 
36 0 4 504 Tent, per dozen 1.50 
35 6 2 498 Tent, Wallace's, each 1.50 
35 6 3 498 Tent Expeller .75 
3 5 6 4 498 Tent Expeller .75 
3567 498 Tent Expeller .75 
35 6 5 498 Tent Expeller, Willhoft's 4.00 830 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
3863 569 Spools and Jar, Ligature .$ 
439 7 769 and Jar, Ligature, Ware'g 1.50 
1691 121 Spoon, Piffard's, each 2.25 
4386 766 Volkmann's 2.50 
See also Curette. 
251 Spray. 
Spray Apparatus: 
2421 251 Air Receiver 
2422 251 Air Receiver ... 
2423 251 Air Receiver 
2424 251 Air Receiver- - 
Antiseptic, see Antiseptic Spray. 
1239 39 Cautery, Wight's, Complete 11.00 
250 for Direct Medication : 
26 0 0 288 Burrall's 1.75 
243 1 253 Hand Atomizer 1.50 
2430 253 Hand Atomizer, Hard Rubber 3.00 
2420 251 Leffert's Compressed Air Appara- 
tus, Complete 
Millard's, No. 2 1.50 
1259 48 Richardson's, 3 Hard Rubber 
Tubes 3.00 
1259 48 Richardson's, 1 Silver Tube 5.50 
Richardson's, 3 Silver Tubes 6.50 
24 2 7 252 Spray Tube, with Bayonet Fitting, 
2426 252 Spray Tube, with Bayonet Fitting 
and Cut-off 
24 2 8 252 Spray Tube, with Plain End 
201 for Eustachian Canal: 
2143 201 Hackley's Instrument 6.50 
for Inhalation, see Inhalers. 
2417 249 Nasal, Lefferts' 4.00 
Nasal, Millard's 1.50 
2 5 9 8 287 Tubes and Stand 
42 9 5 747 Spring, for Inverted Nail .25 
1648 115 Lancet, Button Trigger 2.50 
1649 115 Lancet, Spring Trigger 1.50 
1647 115 Lancet, Tiemann's 2.50 
3 547 496 Tent, Wallace's, each 1.50 
1 833 150 Spud, Dix's Foreign Body 1.25 
1679 120 Piffard's Scarifying 1.25 
1839 150 Spud and Needle 2.50 
1 250 44 Squibb's Ether Inhaler 1.50 
3936 591 Squire's Forearm Splint 1.00 to 1.50 
4 1 7 5 696 Spineyard 7.50 
30 3 5 387 Vertebrated Catheter 6.00 
Staff, see Lithotomy Staff, also Urethro- 
tomy, External. 
62 Staff Surgeons' Capital Operating Set 137.10 
62 Surgeons' Minor Operating Set 136.00 
2301 229 Stag-foot Elevator 1.00 
38 7 2 573 Stanchion for Counter Extension - 5.00 to 8.00 
2614 292 Stanford's Bristle Probang 2.50 
232 Staphyloraphy: 
2340 234 Bistoury, Curved 2.00 
2342 234 Blunt Hook 2.00 
23 4 5 234 Knife, Curved, Right or Left 1.75 
2344 234 Knife, Double-edged 2.50 
23 4 9 235 Knife, Goodwillie's 1.50 
23 5 0 235 Knife, Goodwillie's 1.50 
2351 235 Knife, Goodwillie's 1.50 
2354 236 Knife, Langenbeck's 2.50 
23 5 5 236 Knife, Langenbeck's 2.50 
2 3 5 6 236 Knife, Langenbeck's 2.50 
23 5 7 236 Knife, Langenbeck's 1.75 
23 5 8 236 Knife, Langenbeck's 1.75 
23 5 9 236 Knife, Langenbeck's 2.00 
233 1 233 Knife, Whitehead's, Gum 1.50 
2332 233 Knife, Whitehead's, Hoe 1.50 
2329 232 Knife, Whitehead's, Paring 1.50 
23 6 7 237 Mouth-Gag, Annandale's 7.00 
2347 235 Mouth-Gag, Goodwillie's 7.00 
23 2 3 232 Mouth-Gag, Whitehead's - 12.00 
See also Gag. 
Fig. Page. Price. 
Staphyloraphy: 
2343 234 Needle, Bent $2.00 
234 1 234 Needle, Curved 2.00 
23 4 6 235 Needle, Goodwillie's, per set 12.00 
23 4 8 235 Needle, Prince's 10.00 
23 5 2 235 Needle, Prince's Tenaculum Needle.. 10.00 
2334 233 Needle, Whitehead's Spiral 1.75 
2333 233 Periosteotome, Sayre's 2.00 
23 3 2 233 Periosteotome, Whitehead's 1.50 
23 2 8 232 Scissors 4.50 
2325 232 Seizing Forceps 2.50 
2 3 2 7 232 Seizing Forceps, Durham's 4.50 
23 2 6 232 Seizing Forceps, Langenbeck's 2.50 
23 2 4 232 Seizing Forceps, Whitehead's 4.50 
2361 236 Suture Holder, Langenbeck's 3.00 
23 3 0 232 Tenaculum 1.25 
2342 234 Tenaculum, Blunt 2.00 
23 6 0 236 Tenaculum, Langenbeck's 1.50 
2336 233 Tenaculum, Sims' 1.25 
2352 235 Tenaculum Needle, Prince's 10.00 
Wire Suture: 
23 3 5 233 Adjuster, Sims'- 1.50 
23 3 7 233 Adjuster, Sims' 1.50 
23 3 8 233 Pulley, Sims'.. 1.25 
2339 234 Twisting Forceps, Sims' 3.00 
Startin's Wire Needle, Hollow 5.00 
2580 284 Steam Atomizer, Clinton 1.75 
Codman's 5.00 
2 5 8 2 284 Seeger's. - 12.00 
2581 284 Tiemann's 5.00 
See also Antiseptic Spray. 
26 0 3 288 Steam Jacket, May's 35.00 
146 8 93 Stearns' Artery Claw Forceps 8.00 
29 8 3 370 Dilating Urethrotome 12.00 
29 4 7 359 Dilator- 5.00 
4 1 59 690 Steel Back Shoulder Brace 4.00 to 5.00 
Sound, see Sound. 
3401 618 Spike for Transfixion of Bone .75 
Staff, see Lithotomy Staff. 
23 8 3 238 Tongue Depressor, Folding 2.50 
2225 219 Steel's Septum (Punch) Forceps 10.00 
3344 467 Stein's Urethral Dilator, 3 Bladed 6.00 
Urethral Dilator, 4 Bladed 10.00 
Ureter Evacuator - 12.00 
Stem Pessaries: 
3 5 2 9 494 Ball's. 1.50 
3 54 1 495 Chamber's, with Introducer 3.00 
3530 494 Cole's, Galvanic 2.00 
3534 494 Coxe ter's 1.50 
3539 495 Donaldson's 2.00 
3 542 495 Edward's 3.00 
3 5 4 3 495 Kinloch's 2.00 
3536 494 Mossman's 5.00 
3535 494 Peaslee's 1.50 
3549 496 Perry's 5.00 
35 51 496 Sims' (H. M.). 1.75 
3 5 3 7 495 Sims'(J. M.) 2.00 
3 527 494 Stem Pessary .50 
3 53 1 494 Stem Pessary, each .75 
3 5 32 494 Stem Pessary .50 
3545 495 Thomas' * 2.50 
3533 494 Thomas', Galvanic 1.50 
3548 496 Van de Warker's Anteflexion 1.75 
3550 496 Van de Warker's Retroflexion 1.75 
3547 496 Wallace's 1.50 
3 5 4 6 495 Weber's 4.50 
3 5 3 8 495 Wilhoff's. .75 
1063 9 Stethometer, Carroll's 3.00 
1062 9 Quain's 10.00 
9 Stethometric. 
Stethoscopes: 
1040 6 Allison's, Differential 4.50 
1035 5 Arnold's, Flexible 1.50 
1021 5 Barclay's 1.25 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
831 
Fig. Page. Price. 
Stethoscopes: 
1042 6 Bartlett's $7.00 
1027 5 Burrows' 2.25 
1036 6 Cammann's Binaural, with Snelling's 
Rubber Bell 4.50 
1038 6 Cammann's Cylindrical Auscultator. 1.25 
1037 6 Cammann's Intra-Costal Auscultator, 1.50 
1032 5 Cedar, Hard Rubber Ear Piece 1.50 
1028 5 Cedar, Short .75 
1039 6 Cedar, Vulcanite Ear Piece 1.50 
1030 5 Clark's 1.25 
1041 6 Davis' 4.50 
Denison's 12.00 
1025 5 Dobell's 1.50 
1024 5 Elliottson's - 5.00 
1033 5 Ferguson's 1.50 
1020 5 Flexible 1.25 
1022 5 Hawksley's 1.25 
1045 7 Holden's Resonator 2.50 
1043 6 Knight's 7.50 
Laenec's 7.00 
1026 5 Loomis' 1.75 
1023 5 Martin's Combination 5.00 
Palmer's 7.50 
1034 5 Quain's Telescopic 2.00 
1028 5 Short Cedar.- .75 
1054 7 Speir's Echoscope . 6.00 
1031 5 Stokes' 1.00 
1029 5 Walsh's 1.00 
1044 7 Ware's 4.50 
17 34 130 Steurer's Aspirator 35.00 
2950 359 Urethral Dilator 8.00 
Stevens' Eye Speculum 2.00 
Sub-conjunctival Tenotomy Scissors, 4.50 
Tendon Hook 1.25 
Toothed Forceps 2.00 
2759 316 Stewart's Hernia Knife 5.00 
1803 148 Stilling's Knife, for Stricture in the Lach- 
rymal Passages 1.50 
42 5 8 736 Stillman's Ankle Brace with Clamps, 
15.00 to 20.00 
41 14 668 Ankle Splint 15.00 to 20.00 
4162 691 Antero-Posterior Brace, Spinal 35.00 
4 1 63 691 Antero-Posterior Brace, with Head- 
Rest 60.00 
4227 719 Bow-Leg Brace, Long, pair - 30.00 to 40.00 
4228 719 Bow-Leg Brace, Short, pair-. 20.00 to 25.00 
40 0 8 620 Bracket, Ankle 
3997 618 Bracket, Elbow 
39 6 9 604 Bracket, Knee 
3998 618 Bracket, Wrist 
39 3 3 591 Bracket, Wrist 
4 1 02 661 Bracket and Sector 10.00 
4117 i 
to - 668 Cable Splint. 
4124* 
4262 738 Club-foot Twister 
407 5 648 Hip Joint Brace, No. 1 45.00 
407 6 648 Hip Joint Brace, No. 2 40.00 
4 1 84 699 Horizontal Frame 
4 1 03 661 Knee Extension Brace 35.00 to 40.00 
4107 662 Knee Splint, with Large Sectors 40.00 
4220 716 Knock-Knee Apparatus 30.00 to 40.00 
4147 . 
to -687 Lever Spinal Brace 35.00 
4149 ' 
4 1 90 701 Lever Spinal Brace, with Attachment 
for Cervical Caries 45.00 to 50.00 
4279 743 Local Eversion Brace 
313 Method for Radical Cure of Haemorr- 
hoids without an Operation. 
4 1 02 661 Sector and Knee Bracket 10.00 
4 1 07 662 Sector, attached to Knee Splint 40.00 
4074 648 Sector Splint - 10.00 
Fig. Page. Price. 
4 1 60 690 Stillman's Spondylitis Brace $35.00 to $50.00 
4180 698 V Lever Brace and Corset Combined, 
50.00 to 60.00 
4182 699 Vertical Extension Brace-- 30.00 to 40.00 
4 1 83 699 Vertical Frame 
4 1 2 5 669 Wrist Splint 25.00 
1702 123 Stimson's Hypodermic Syringe 3.00 
1338 81 Needle Holder and Cutting Forceps . 3.50 
28 1 0 330 Stockings, Elastic. Prices on Page 330. 
Stoehrer's Galvanic Battery, see Battery, 
Galvanic. 
247 1 265 Stcerk's Drop Tube 2.25 
1769 145 Stoke's Eyelid Compressor 3.00 
1031 5 Stethoscope 1.00 
1616 107 Stohlmann's Bead Saw 6.00 
36 1 2 505 Hysterotome 7.00 
3 1 89 435 Speculum Vagina; 8.00 
293 Stomachal: for Instrumental Introduction 
of Food into, and Lavage of the 
Stomach: 
26 2 4 295 Gastro Mundator, Tiemann's 8.50 
26 2 5 296 Hegar's Infusor 
26 2 8 296 Korup's Apparatus 
4391 767 Lavage Apparatus 2.50 
2631 297 Masticator 8.00 and 12.00 
Stomach Pumps: 
26 1 9 294 Hollow Piston 10.00 
26 2 4 295 Tiemann's Gastro Mundator 8.50 
26 1 8 293 Tiemann's Lever Pump 16.00 
2 6 2 3 295 Toswill's . 2.50 
Stomach Tube: 
English 1.50 
2627 296 English, Funneled End 1.75 
26 2 2 294 English, Funneled End 1.75 
26 2 6 296 French 1.00 
2620 294 Paine's Nasal Feeding Tube 1.00 
2 62 1 294 Tiemann's Patent "Velvet Eye," Soft 
Rubber 1.50 
262 1 294 Tiemann's Patent "Velvet Eye," Soft 
Rubber, Long- 2.00 
2629 297 Stomach Tube Attachment for Aspirator _ 6.00 
Stone in the Bladder : 
463 Female. 
400 Male. 
401 Methods of Removal. 
413 Operations, Ancient. 
414 Operations, Modern. 
See also Litholapaxy, Lithotomy, 
Lithotrity. 
Stone Searchers: 
30 7 0 400 Andrew's 2.50 
3071 400 Billroth's Sounding Board 1.50 
3071 400 Billroth's Sounding Board and Sound, 2.50 
3066 400 Gouley's 1.50 
4411 770 Keyes'... 4.00 
400 Langlebert's Lithophone 
30 6 7 400 Little's 3.50 
3069 400 Otis' Exploring Sound 5.50 
30 6 5 400 Steel Sound 1.00 
3068 400 Thompson's 4.00 
30 7 2 400 Thompson's 4.00 
3073 400 Thompson's Measure 12.00 
1655 115 Stopcock, Brass, for Cupping Pump .50 
182 5 149 Eye Douche, Hard Rubber 1.00 
389 Keyes' Two-way 2.50 
371 1 529 Storer's Clamp Shield 11.00 
32 0 5 441 Speculum Vaginae 4.00 
3 6 2 2 506 Uterine Scarificator - 6.00 
1563 100 Stout Tenaculum, Double 2.50 
1562 100 Single 2.00 
15 64 100 Triple 2.50 
3430 483 Stowe's Retroversion Elevator 4.50 
1758 144 Strabismometer, Galezowsky's 6.00 
1759 144 Laurence's 2.25 832 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Strabismus, see Ophthalmic : Strabotomy. 
179 Set of Instruments $9.50 
Strabotomy, see also Ophthalmic : Stra- 
botomy. 
Straight Jacket, Long 10.00 
4049 631 Short 8.00 
See also Restraints. 
1 929 164 Strawbridge's Keratome Scissors 10.00 
2769 318 Strephotome, Spanton's 2.00 
Stricture, (Esophageal, see (Esophageal 
Stricture. 
Rectal, see Rectal Stricture. 
Urethral, see Urethral Stricture. 
4 1 34 676 Stromeyer's Elbow Splint 18.00 
4 1 3 1 675 Knee Extension Splint 35.00 
17 Students' Dissecting Sets, Prices on Page 17. 
Lamp 6.00 
1745 134 Ophthalmoscope, Loring's 22.00 
2236 222 Stump Forceps, Dental 2.00 and 2.75 
Styles, see Ophthalmic : Lachrymal Styles. 
Subcutaneous, see Osteotomy: Subcutaneous 
Section. 
Syringe, see Hypodermic Syringe. 
34 5 9 488 Support, Vaginal, Bozeman's 2.00 
Supporter, Abdominal, see Abdominal Sup- 
porter. 
Pile, see Pile Bougie. 
Uterine, see Uterine Supporter, also 
Pessary. 
Suppositor, Barnes' 2.50 
2701 307 Suppository Tube 1.50 
420 Supra-Pubic Cystotomy (Lithotomy). 
393 Supra-Pubic Puncture of the Bladder. 
3978 609 Suspending Splint 20.00 
3 9 7 9 609 Clendinen's 
39 8 0 609 Hodgen's '5.00 
3885 577 Suspension Apparatus, Buck's 18.00 
39 8 0 609 Hodgen's 5.00 
4 1 4 1 683 Sayre's, Japanned 8.00 
4141 683 Sayre's, Nickel-plated 12.00 
Suspensory Bandage: 
2814 331 Doisneau's Compress 4.00 
2813 331 Double Front, Cotton .50 
2813 331 Double Front, Linen , .75 
28 1 3 331 Double Front, Silk 1.00 
2811 331 Miliano's Compressor 2.00 
Morgan's 1.50 
Silk Elastic Compressor 2.50 
28 1 2 331 Single Front, Cotton .. .50 
2812 331 Single Front, Linen .75 
28 1 2 331 Single Front, Silk 1.00 
Syracuse .35 to 2.50 
356 0 498 Sussdorf's Tupelo Dilators, Hollow, per doz. 3.00 
3561 498 Tupelo Dilators, Solid, per dozen .... 1.50 
133 3 80 Suture, Automatic, Hoff's 5.50 
132 3 80 Forceps, Allis' 2.00 
1325 80 Instrument, Cleborne's 7.00 
132 4 80 Instrument, Goetz's 10.00 
3 8 5 5 568 Interrupted. 
Knots: 
3 8 5 7 568 False or Granny. 
3860 568 Fold Suture. 
3855 568 Interrupted Suture. 
3856 568 Reef or Cross Knot. 
38 5 8 568 Surgeons' Knot. 
3 8 5 9 568 Twisted Suture. 
Suture Needles: 
Bozeman's, per dozen 1.50 
Cole's, .per dozen 1.50 
13 1 3 79 Curved, per dozen 1.00 
Dawson's, per dozen 1.50 
Dickinson's, per dozen. 1.50 
2764 317 Dowell's, each .'. 1.00 
132 0 79 Emmet's, Round-Pointed, per dozen . 1.50 
Fig. Page. Price. 
Suture Needles : 
Emmet's, Triangular Pointed, per doz. $1.50 
1784 146 Eye, per dozen 1.50 
13 1 7 79 Finnell's, each .20 
13 1 3 79 Full Curved, per dozen 1.00 
Goodell's, per dozen 1.50 
33 1 0 455 Hagedorn's, per card 3.00 
Hagedorn's, per dozen 1.50 
13 1 5 79 Half Curved, per dozen 1.50 
Intestinal, per dozen 1.50 
3 7 3 0 533 Keith's, each .10 
Lyman's, per dozen 1.50 
Martin's, each .25 
Morgan's, each .30 
132 1 79 Open-eyed, Platt's, each .25 
Schnetter's, per dozen 1.50 
Siemon's, per dozen 1.50 
132 0 79 Sims', Round-Pointed, per dozen 1.50 
Sims', Triangular-Pointed, per dozen, 1.50 
4 3 5 6 760 Skene's, per dozen 1.50 
Spohn's, each .50 
13 1 6 79 Straight, per dozen 50 
13 1 9 79 Tiemann's, Hollow 4.00 
1322 79 Van Brun's 1.00 
132 0 79 Vesico-Vaginal Fistula, per dozen ... 1.50 
Wackerhagen's, each 1.00 
Wathen's, per dozen 1.50 
13 1 6 79 Wire Suture, per dozen .50 
Wylie's, per dozen 1.50 
Suture Needle Holders, see Needle Forceps. 
2318 231 Suture Pins, plain, per 100 • 40 
Lance Point, per dozen .25 
Suture Threads, see Ligature. 
2744 312 Swift's Pile Bougie.. 1.50 
142 0 87 Syme's Abscess Knife and Scalpel 2.75 
29 9 5 374 Staff 2.00 
3852 565 Syphon. 
Douche, see Nasal Douche. 
26 2 3 295 Stomach Pump, Toswill's 2.50 
2668 305 Syringe, Rectal 2.50 
3418 482 Syringe, Vaginal, Woodward's 2.50 
1100 14 Syringe, Anatomical 35.00 
Caustic, see Caustic Syringe. 
Ear, see Aural: Douches and Syringes. 
2902 350 Gonorrhoea, Buttle's 5.00 
See also Urethral Syringes. 
Haemorrhoidal, see Haemorrhoidal Sy- 
ringe. 
Hypodermic, see Hypodermic Syringe. 
Lachrymal, see Ophthalmic : Lachry- 
mal Syringe. 
26 6 7 305 Maw's Enema Pump 4.50 
Microscopic, see Microscopic Syringe. 
Nasal, see Nasal Douche, Nasal Spray. 
2204 213 Nasal Polypus, Upson's 14.00 
29 0 6 350 P. P. Bumstead's .75 
29 0 5 350 P. P. Hard Rubber 1-50 
2904 350 P. P. Sigismund's .75 
Rectal, see Rectal Infusors, Injectors 
and Irrigators. 
2601 288 Universal, Tiemann's 10.00 
Urethal, see Urethral Syringes. 
Vaginal, see Vaginal Syringes. 
2901 349 Syringe Nozzle, Otis' -- 1.00 
388 1 575 Szymanowsky's Bandage Shears 9.00 
1573 102 Gouge. 2.50 
1606 104 Saw 20.03 
1485 94 Tait's Artery Clamp Forceps 2.50 
36 9 9 527 Clamp.... 12.00 
3724 531 Drainage Tube .75 
Ecraseur 6.00 
1726 128 Ovariotomy Trocar 18.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
833 
Fig. Page. Price. 
Tait's Ovariotomy Trocar, Plain $4.00 
Screw Forceps 2.50 
Taliaferro's Obstetrical Forceps 7.00 
34 7 7 489 Recto-Displacement Pessary .75 
3221 443 Speculum Vaginae 2.50 
347 5 489 Universal Pessary .75 
Talipes, see Orthopaedic: Deformities of 
the Feet. 
2195 212 Tampon, Epistaxis .75 
2557 279 Tracheal, Gerster's 18.00 
42 2 3 756 Tracheal, Gerster's Latest 18.00 
Tracheal, Lange's 12.00 
2 5 5 9 279 Tracheal, Trendelenburg's 12.00 
3410 478 Tampon Expeller, Vaginal, Barnes' 2.00 
3411 478 Vaginal, Braun's 2.50 
3412 478 Vaginal, Thomas' 1.50 
1991 178 Tansley's Lachrymal Syringe 15.00 
44 0 4 769 Tape Measure, Linen (according to length), 
.75 to 1.50 
Steel (according to length) 1.50 to 3.50 
2536 277 Tardieu's Trachea Scissors 5.00 
3813 551 Tarnier's Basiotribe 35.00 
3776 542 Obstetrical Forceps 30.00 
Obstetrical Forceps, 1887 30.00 
3 7 3 5 536 Tarsitani's Obstetrical Forceps 12.00 
1684 121 Tattooing Instrument, Piffard's 4.50 
See also Ophthalmic: Tattooing. 
321 Taxis. 
42 6 6 739 Taylor's Ankle Support 6.00 to 8 00 
38 0 6 550 Blunt Hook 2.50 
4064 643 Long Splint, Hip Joint 25.00 to 40.00 
3 7 4 6 538 Obstetrical Forceps 11.00 
28 3 9 337 Phimosis Scissors 5.00 
553 Set of Obstetrical Instruments 28.00 
3238 446 Speculum Vaginae 4.00 
4137 678 Spine Brace 24.00 to 30.00 
28 4 0 337 Syringe, Sub-preputial .' 1.50 
19711 
1973 ' 1^3 Beale's Cataract Exhauster, in Case 5.00 
29 9 7 375 Probe Gorget 2.50 
Teevan's Lithotomy Forceps, Fenestrated, 3.00 
30 8 2 403 Lithotriptor, Handle I 
30 8 7 404 Lithotriptor, Jaws ' 
Retention Catheter 2.50 
2958 362 Stricture Cutter 12.00 
293 1 354 Teft's Sound 1.25 
20 3 5 188 Telescopic Ear Trumpet 4.50 
3173 431 Speculum, Thomas' 5.00 
1669 120 Teller's Vaccinator ' 2.50 
1395 85 Tenaculum . .75 
148 9 95 Amputating 1.25 
1494 95 Amputating 1.00 
32 6 3 449 Bozeman's 1.50 
3266 449 Bozeman's, Long 1.50 
2711 308 Byrne's, Double 6.00 
3262 449 Double 1.75 
15 63 100 Double, Stout 2.50 
3 2 5 7 449 Emmet's 1.25 
3258 449 Emmet's 1.25 
3261 449 Emmet's 1.25 
3265 449 Emmet's 1.25 
3558 497 Emmet's, Double 5.00 
32 5 9 449 Emmet's, Heavy Shank 1.50 
1377 84 Feruled 1.25 
3142 423 Keith's 1.25 
138 7 84 Little's 1.50 
32 7 0 449 Long, Angular 1.50 
3271 449 Long, Stout 1.50 
3 5 5 2 497 Nott's, for Speculum .25 
1377 84 Operating, Feruled 1.25 
139 5 85 Operating, Plain .75 
1563 100 Osteotomy, Double 2.50 
15 62 100 Osteotomy, Single 2.00 
1664 100 Osteotomy, Triple 2.50 
Fig. Page. Price. 
3260 449 Tenaculum, Perry's, Barbed $1.50 
Pocket Case, Plain 1.00 
1410 86 Pocket Case, Slide Catch 1.75 
32 5 6 449 Sims' 1.25 
3264 449 Sims', Long 1.25 
2330 232 Staphyloraphy 1.25 
2396 243 Tenaculum Forceps 2.50 
3556 497 Byrne's 6.00 
38 2 9 557 Cowan's 4.00 
3 5 5 8 497 Emmet's 5.00 
3 5 53 497 Hanks' 3.00 
35 5 9 497 Sims' 3.50 
38 2 5 556 Skene's 3.00 
3 5 5 7 497 Wooster's 2.50 
3 5 5 4 497 Wylie's. 3.00 
Tendo Achilles: 
42 6 9 740 Talipes Equinus Shoe, each.. 8.00 to 12.00 
4271 740 Talipes Equinus Shoe, Hud- 
son's, each 12.00 to 18.00 
42 7 0 740 Talipes Equinus Shoe, Sayre's, 
each 10.00 to 15.00 
Tenotomes: 
1517 96 Aseptic 1.50 
15 1 8 96 Aseptic 1.50 
151 9 96 Aseptic 1.50 
152 0 96 Aseptic 1.50 
13 7 4 84 Blunt-pointed. 1.25 
1372 84 Concave-edged 1.25 
13 7 3 84 Convex-edged 1.25 
Pocket Case, Plain 1.00 
140 7 86 Pocket Case, Slide-catch 1.75 
14 1 6 86 Pocket Case, Double 2.50 
1375 84 Sharp-pointed 1.25 
Tents, Elm, Curved, per dozen 2.00 
Elm, Hollow, per dozen 1.50 
Elm, Solid, per dozen..' 1.00 
Sea Tangle, Hollow, per dozen 2.00 
Sea Tangle, Solid, per dozen 1.50 
3604 504 Sponge, per dozen 1.50 
3 5 4 7 496 Spring, Wallace's, each 1.50 
3 5 6 0 498 Tupelo, Hollow, per dozen 3.00 
3 5 6 1 498 Tupelo, Solid, per dozen 1.50 
1901 162 Test Drum .75 
1 Tubes and Stand 3.38 
Tube Stand 75 to 2.50 
1802 148 Teulon's Canalicula Instrument 8.00 
36 8 7 520 Thallon's Ether Inhaler 20.00 
26 5 2 300 Thebeaud's Sphincter Ani Dilator 12.00 
29 5 1 359 Urethral Stricture Dilator 10.00 
1791 147 Theobald's Probes, per set 4.00 
1870 154 Strabismus Hook 1.50 
1237 39 Thermo-Cautery, Paquelin's .... 
Thermometer, see Clinical Thermometer. 
43 7 8 765 Thiersch's Spindles and Forceps 8.00 
1156 24 Thigh Band, Voltaic Armadillo 2.50 
284 6 340 Thomas' (C. H.) Gauge 
4304 751 Thomas' (Hugh Owen) Artificial Leg, above 
Knee 15.00 to 20.00 
4303 751 Artificial Leg, below Knee 15.00 to 20.00 
4071 646 Posterior Splint, with Patten, for Hip- 
Joint Disease 12.50 
597 Crutches. Prices on page 597. 
2513) 
r 493 Thomas' (T. Gaillard) Anteflexion Pessary. 2.00 
3515' 
[^93 Anteversion Pessary 1.25 
3518' 
3524 493 Anteversion Pessary 1.25 
3491 I 
3493'$1 Anteversion Pessary 1.25 
3 7 0 0 527 Clamp, Ovariotomy 12.00 
37 1 0 529 Clamp, Ovariotomy 4.50 
440 0 769 Clamp, Vaginal 6.00 
38 1 4 551 Craniotomy Forceps 6.00 
3630 510 Curette 1.50 834 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Thomas' (T. Gaillard): 
3636 511 Curette $1.50 
3629 510 Curettes, 3 with one Handle 4.50 
32 0 3 439 Cusco's Speculum 4.00 
3 5 04 492 Cutter's Anteversion Pessary, with 
Belt.. 2.50 
3 5 0 6 492 Cutter's Anteversion Pessary, with 
Belt- 2.50 
3 5 0 5 492 Cutter's Anteversion Pessary with 
Cervical Rest, with Belt.. 3.50 
345 8 487 Cutter's Cup Pessary (Prolapsus) 3.50 
3 5 0 3 492 Cutter's Retroversion Pessary, with 
Belt... 2.50 
3 5 0 7 492 Cutter's Retroversion Pessary with 
Cervical Rest, with Belt 3.50 
3302 453 Dilating Forceps 3.00 
36 1 0 505 Double Scissors 6.00 
3 7 2 0 531 Drainage Tube, Curved .40 
3 7 2 3 531 Drainage Tube, Double 3.50 
3722 531 Drainage Tube, Perforated .60 
3721 531 Drainage Tube, Straight .40 
1658 116 Dry Cupper 1.50 
36 1 9 506 Dry Cupper 1.50 
33 6 2 473 Elastic Probe 1.25 
3681 517 Forceps for Amputating the Cervix.. 35.00 
3 5 3 3 494 Galvanic Stem Pessary 1.50 
Glass Stem Pessary .25 
33 5 4 473 Hard Rubber Probe 1.25 
3492 491 Hewitt's Retroversion Pessary 1.00 
354 5 495 Intra-Uterine Stem Pessary 2.50 
Needle for Extirpation of Uterus 4.50 
3 7 5 2 538 Obstetrical Forceps 7.00 
1721 127 Ovarian Trocar 20.00 
380 1 549 Perforator 8.00 
35 1 4 493 Retroflexion Pessary, Hard Rubber _ .75 
3514 493 Retroflexion Pessary, Soft Rubber 1.00 
35 1 2 492 Retroversion Pessary .75 
36 93 525 Sac Forceps 3.50 
32 2 4 443 Self-retaining Speculum 18.00 
3643 511 • Serrated Scoop 3.50 
553 Set of Obstetrical Instruments 66.00 
471 ' Set of Uterine Instruments 46.00 
32 2 2 443 Sims' Speculum 10.00 
33 2 5 443 Speculum 10.00 
28 0 6 328 Supporter 8.00 
3448 487 Supporter, Cedar Pad .. 2.50 
3412 478 Tampon Expeller 1.50 
3 1 7 3 431 Telescopic Speculum 5.00 
3 2 6 9 449 Tissue Forceps 4.50 
1721 127 Trocar, Ovarian 20.00 
3176 431 Tubular Speculum 3.00 
3 5 8 0 501 Uterine Dilator 5.00 
36 1 0 505 Uterine Double Scissors 6.00 
33 6 2 473 Uterine Probe, Elastic 1.25 
33 5 4 473 Uterine Probe, Hard Rubber 1.25 
3360 473 Uterine Probe, Whalebone .50 
44 0 0 769 Vaginal Wound Clamp 6.00 
13 5 6 83 Thomasin's Bullet Forceps 2.50 
28 7 5 345 Thompson's Bougie, Leaden Stileted 1.00 
394 Digital Exploration of the Bladder. 
29 4 4 358 Divulsor 10.00 
3672 515 Ecraseur 25.00 
3 1 0 1 408 Evacuator 15.00 
3104 411 Evacuator, modified by Weiss 30.00 
308 1 403 Lithotrite 35.00 
30 7 3 400 Measure 12.00 
17 5 5 143 Optometer 2.00 
30 5 0 393 Prostatic Sound 5.00 
3050c 393 Prostatic Tube 3.00 
28 9 7 348 Retention Catheter 3.00 
30 6 8 400 Searcher 4.00 
30 7 2 400 Searcher 4.00 
30 5 9 399 Urethral Forceps 2.00 
30 51 394 Urethral Knife 1.75 
Fig. Page. Price. 
3052 394 Thompson's Vesical Director 82.50 
30 5 3 395 Vesical Forceps 5.50 
30 5 4 395 Vesical Forceps . 5.50 
3 0 5 5 395 Vesical Forceps 5.50 
29 2 2 352 Thornton Parker's Urethal Tube .50 
66 Three-fold Pocket Case 15.00 
1867 152 Three-pointed Ophthalmostate 1.50 
221 Throat. 
Throat Forceps: 
25 1 0 270 Buck's 2.50 
2508 270 Burge's 4.50 
2 5 0 6 270 Fauvel's 6.00 
251 1 270 Mackenzie's Antero-Posterior 2.75 
2 5 0 9 270 Mackenzie's Lateral __ 2.75 
2 5 0 7 270 Mathieu's 6.00 
2 5 0 0 269 Noyes' 4.50 
2504 269 Tiemann's Flexible 4.50 
See also Laryngeal Forceps and 
CEsophageal Forceps. 
239 1 242 Throat Lancet, Buck's 2.50 
2 1 7 7 209 Thudichum's Nasal Douche 1.50 
2 1 64 206 Nasal Speculum, each .75 
1646 115 Thumb Lancet, Broad-pointed .75 
1645 115 Spear-pointed, Evans' 1.00 
1645 115 Spear-pointed, Plain .50 
1645 115 Spear-pointed, Tiemann's .75 
4231 720 Tibia Curvature Brace 12.00 to 18.00 
See also Fracture of Fibula and Tibia. 
393 1 591 Tiemann & Co.'s Arm Sling 4.50 
1659 116 Artificial Leech - 7.00 
553 Aseptic Obstetrical Case __ 72.00 
1735 131 Aspirator 14.00 
1735 131 Aspirator, Small 12.00 
2 5 8 1 284 Atomizer, Steam 5.00 
38 7 6 574 Bandage Roller 3.00 
152 9 97 Bow Saw, 2 Blades 8.50 
4152 688 Brace for Posterior Curvature 35.00 
136 5 83 Bullet Forceps 2.25 
1357 83 Bullet Forceps, Flexible 6.00 
1355 82 Bullet Probe .75 
152 6 97 Capital Saw 5.00 
1617 107 Circular Saw 12.00 
42 5 6 735 Club-foot (Talipes) Shoe, each, 
10.00, 12.00 and 14.00 
1438 89 Direct Pressure Tourniquet 2.00 
30 4 4 389 Double Current, Soft Rubber Catheter, 2.50 
1628 109 Drill Stock 7.00 
2057 192 Ear Forceps, Foreign Body 2.25 
20 6 5 193 Ear Forceps, Universal 5.00 
20 58 192 Ear Forceps, with Reflector 4.50 
3674 515 Ecraseur, Long Chain 20.00 
Ecraseur, Small Chain 12.00 
Ecraseur, Small Chain, Straight 10.00 
2882 346 Eldridge's Pathfinder 3.50 
1168 31 Electrodes, per set 12.00 
3 7 9 1 548 Embryotomy Forceps 3.00 
17 6 7 145 Entropium Forceps 7.00 
1 763 145 Entropium Forceps 7.00 
1078 12 Exploring Trocar 2.50 
2783 323 Finger Pad Truss 5.00 
130 6 77 Flexible Joint Catheter 4.00 
2 5 0 4 269 Flexible Throat Forceps 4.50 
393 1 591 Forearm Splint 4.50 
2624 295 Gastro-Mundator 8.50 
2735 311 Haemorrhoidal Clamp 6.00 
1319 79 Hollow Needle 4.00 
2619 294 Hollow Piston Stomach Pump 10.00 
1706 125 Hypodermic Springe Bottle .20 
3 5 7 2 500 Intra-Uterine Speculum 4.50 
3 5 8 5 501 Intra-Uterine Speculum 7.00 
39 7 3 605 Knee Cap, Patella 5.50 
2 5 0 5 269 Laryngeal Scoop 6.00 
1659 116 Leech, Artificial 7.00 
261 8 293 Lever Stomach Pump 16.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
835 
Fig. Page. Price. 
3674 515 Tiemann & Co.'s Long Chain Ecraseur $20.00 
65 Minor Operating Set 25.00 
24 8 8 267 Movable Point Scissors 8.50 
3304 454 Needle Forceps for Hagedorn's and 
other Needles 6.00 
4389 767 Needle Forceps for Hagedorn's and 
other Needles, Latest 6.00 
20 1 6 292 (Esophageal Forceps 5.00 
39 7 3 605 Patella Support 5.50 
1015 4 Patent Bent Thermometer 3.50 
Patent Bent Thermometer, with Hick's 
Lens Front 4.00 
26 2 4 295 Patent Gastro-Mundator 8.50 
43 8 9 767 Patent Needle Forceps 6.00 
4389 767 Patent Needle Forceps, Aseptic 7.00 
127 4 70 Patent Pocket Set "A" 33.00 
1276 71 Patent Pocket Set " B " 28.00 
Patent Pocket Set "B," Small 20.00 
3031a 386 Patent Velvet Eye Catheter .75 
30316 386 Patent Velvet Eye Catheter .75 
3031c 386 Patent Velvet Eye Catheter 1.00 
3031d 386 Patent Velvet Eye Catheter 1.50 
3031c 386 Patent Velvet Eye Catheter .75 
3031/386 Patent Velvet Eye Catheter , 1.00 
3031£r386 Patent Velvet Eye Catheter 1.00 
30316 386 Patent Velvet Eye Catheter .75 
3031 i 386 Patent Velvet Eye Catheter .75 
3044 389 Patent Velvet Eye Catheter, Double 
Current 2.50 
26 6 5 303 Patent Velvet Eye Rectal FeedingTube, 1.50 
26 21 294 Patent Velvet Eye Stomach Tube - 1.50 
2621 294 Patent VelvetEyeStomachTube, Long, 2.00 
2882 346 Pathfinder 3.50 
1707 125 Pocket Case Hypodermic Syringe 2.50 
3 1 92 437 Quatrivalve Speculum 10.00 
2 6 6 5 303 Rectal Feeding Tube, Velvet Eye 1.50 
1650 115 Scarificator 7.00 
4176 697 Scoliosis Brace 35.00 
4177 697 Scoliosis Brace, Extra Lightand Fine, 40.00 
1082 12 Section Knife 8.00 
3188 435 Speculum Vaginae, Trivalve 12.00 
4152 688 Spine Brace, Posterior 35.00 
1647 115 Spring Lancet 2.50 
2581 284 Steam Atomizer 5.00 
4027 627 Sterling Silver Male and Female Cath- 
eter 4.00 
261 8 293 Stomach Pump, Lever 16.00 
262 1 294 Stomach Tube, Velvet Eye _ 1.50 and 2.00 
4256 735 Talipes Shoe, Large, each 14.00 
4256 735 Talipes Shoe, Medium, each 12.00 
42 5 6 735 Talipes Shoe, Small, each 10.00 
24 0 4 244 Tonsilotome 15.00 
1438 89 Tourniquet 2.00 
2 5 2 7 276 Tracheal Aspirator 2.50 
2528 276 Tracheal Forceps 4.50 
2 5 3 0 277 Tracheotome and Dilator 3.50 
2632 298 Trivalve Speculum Ani 12.00 
3 1 88 435 Trivalve Speculum Vaginae 12.00 
1279 75 Universal Douche 6.00 
2065 193 Universal Ear Forceps 5.00 
24 1 2 246 Universal Forceps 2.50 
2 601 288 Universal Syringe 10.00 
3 5 7 2 500 Uterine Speculum 4.50 
3 5 8 5 501 Uterine Speculum 7.00 
34 4 7 486 Uterine Supporter 5.00 
1673 120 Vaccinating Scarificator 5.00 
16 72 120 Vaccinating Trocar 2.50 
1082 12 Valentine's Knife 8.00 
Velvet Eye Catheters, &c., see Tie- 
mann & Co.'s Patent Velvet Eye 
Catheter, &c. 
42 5 7 735 Weak Ankle Brace, each - 8.00 to 10.00 
1540 98 Tirefond 2.00 
3269 449 Tissue Forceps, Thomas' 4.50 
Fig. Page. Price. 
139 2 84 Tissue Separator, Post's $1.50 
24 8 7 267 Tobold's Concealed Laryngeal Lancet 4.00 
24 3 7 257 Large Laryngoscope 24.00 
Student's Lamp 6.00 
24 9 0 268 Laryngeal Knife 1.50 
249 1 268 Laryngeal Knife 1.50 
2492 268 Laryngeal Knife 1.50 
24 7 2 265 Laryngeal Syringe 2.50 
2564 281 Pneumatic Apparatus 
2489 267 Polypus Scissors, Vocal Cord 6.00 
34 7 6 489 Todd's Pessary 3.00 
Toes, Luxation of, see Luxation Forceps. 
42 8 4 745 Overriding Apparatus, No. 1, ea.6.00 to 12.00 
42 8 5 745 Overriding Apparatus, No. 2, ea.7.00 to 15.00 
Tongue Depressors: 
2381 238 Bosworth's 1.25 
2388 239 Church's 6.50 
Cohen's 1.50 
23 8 6 239 Elsberg's 4.50 
23 8 4 238 Folding 1.25 
2379 238 Goodwillie's 2.50 
23 7 8 238 Green's Folding 2.25 
2382 238 Hard Rubber 1.50 
Leale's .75 
23 8 5 239 Pocket .75 
23 7 7 238 Rumbolds, with 3 Blades 6.00 
2 3 8 0 238 Sass' 3.50 
2383 238 Steel, Folding 2.50 
2387 239 Turk's, 3 Blades 4.50 
2390 239 Tongue Holding Forceps, Cusco's 4.50 
2 3 8 9 239 Dobell's 4.50 
1194 34 Tongue Plate Electrode 1.00 
1344 81 Tongue-Tie and Director .50 
239 7 243 Tonsil Bistoury, Green's 2.00 
1193 34 Electrode 1.00 
2398 243 Forceps, Durham's 4.50 
23 9 9 243 Forceps, Langenbeck's 2.50 
2394 243 Forceps, Musseux's 2.50 
2396 243 Forceps, Tenaculum 2.50 
24 0 7 245 Haemostatic, Clendinen's- 2.25 
2400 243 Hook, Green's 1.75 
2395 243 Hook, Green's Double 2.50 
2392 242 Knife, Yearsley's 2.25 
241 Scarification of. 
2391 242 Buck's Throat Lancet 2.50 
23 9 3 243 Scissors 4.50 
240 Tonsillar. 
Tonsilotomes: 
24 0 3 244 Billing's-. 12.00 
Charriere's 15.00 
Elsberg's- 10.00 
240 1 244 Fahnstock's 8.00 
24 0 5 245 Hamilton's 15.00 
2406 245 Mackenzie's 9.00 
2402 244 Mathieu's 12.00 
Sajou's 12.00 
Schweig's 10.00 
2404 244 Tiemann & Co.'s 15.00 
Tooth Elevators, see Dental Root Elevators. 
Forceps, see Dental Forceps. 
1446 91 Torsion Forceps 2.50 
1455 91 Esmarch's 2.50 
1457 91 Hewson's 8.00 
1450 91 Wheeler's 7.00 
700 Torticollis, see also Spinal Braces for Tor- 
ticollis. 
26 2 3 295 Toswill's Stomach Pump 2.50 
Tourniquets: 
1431 88 Charriere's 2.50 
1441 90 Emmet's Uterine 5.50 
1440 90 Esmarch's 3.50 
1432 89 Esmarch's, Clamp .75 
142 9 88 Field, Prussian .75 
1429 88 Field, U. S. Army 1.00 836 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Tourniquets : 
1437 89 Gross' .812.00 
143 4 89 Langenbeck's Bandage Clamp 1.50 
1765 145 Laurence's Eyelid 3.00 
142 5 88 May's. 15.00 
143 6 89 Mott's. 2.00 
143 0 88 Petit's 2.00 
143 9 89 Spohn's Rubber Ring, Set of 7. 3.50 
1438 89 Tiemann's Direct Pressure 2.00 
20 23 187 Toynbee's Artificial Tympanum .30 
2015 185 Diagnostic Tube .75 
2002 183 Ear Specula, Plated, Set of 3 2.50 
2002 183 Ear Specula, Silver, Set of 3 4.50 
2017 185 Explorer.. .75 
202 Set of Ear Instruments 23.20 
Trachea Canula or Tubes : 
43 2 4 756 Cohen's 8.00 
25 5 0 278 Double, Movable Plate, Silver 6.00 
2547 278 Double, Plain, Silver 5.00 
Durham's 12.00 
2549 278 Elsberg's, with Valve 8.00 
2551 278 Gendron's Split, Silver 8.00 
4323 756 Gerster's Tampon Canula 18.00 
2554 278 Hard Rubber 2.50 
25 5 6 279 Johnson's Double, with Obdurator 10.00 
2558 279 Keene's 6.50 
2552 278 Little's Aluminium 6.00 
43 3 8 757 Park's Aluminium 6.00 
2553 278 Silver 4.00 
25 5 9 279 Trendelenburg's Tampon Canula .... 12.00 
2526 276 Tube Mop .15 
2527 276 Tracheal Aspirator, Tiemann's 2.50 
2 5 4 8 278 Dilator, Chassaignac's 3.00 
25 4 5 278 Dilator, Delaborde's 5.00 
2546 278 Dilator, Trousseau's 2.50 
2528 276 Foreign Body Forceps, Tiemann's.... 4.50 
252 5 276 Foreign Body Forceps, Trousseau's.. 2.50 
2 5 5 5 279 Retractor, Minor's 4.50 
2 5 3 7 277 Retractor, Pilcher's 2.50 
2 5 3 4 277 Retractor, Rose's 1.00 
2532 277 Retractor, Well's 2.00 
25 3 6 277 Scissors, Tardieu's 5.00 
2557 279 Tampon, Gerster's 18.00 
4323 756 Tampon, Gerster's 18.00 
Tampon, Lange's 12.00 
2 5 5 9 279 Tampon, Trendelenburg's 12.00 
Trachelorrhaphy, see Hystero-Trachelorr- 
haphy. 
Trachelotomy, see Hystero-Trachelorrha- 
phy. 
2544 278 Tracheotome, Hanks' 9.00 
2542 277 Langenbeck's 4.00 
2543 278 Pilcher's Bronchotome 6.00 
2 5 3 8 277 Pitha's 3.50 
2 5 3 0 277 Tiemann & Co.'s 3.50 
277 Tracheotomy. 
2 5 3 9 277 Blunt Hook 1.50 
2 54 1 277 Double Hook, Langenbeck's.. 3.00 
25 3 3 277 Guide, Buck's 2.00 
2531 277 Scalpel, Probe Point 1.50 
2 5 3 5 277 Scalpel, Sharp Point 1.50 
Tube, see Trachea Canula or Tube. 
25161 -Tube and Laryngeal Dilator, McSher- 
2517 ry's.. 16.00 
Tractor, see Retractor. 
117 Transfusion. 
Transfusion Apparatus: 
1662 117 Aveling's.. 4.50 
Aveling's, with Scalpel and Forceps, 
in Case 8.00 
Colin's 17.00 
1663 1-8 Fryer's 6.50 
1664 118 Garrigue's 4.00 
1665 119 Hutchison's... 25.00 
Fig. Page. Price. 
Transplantation, see Skin Grafting. 
44 0 3 769 Punch, Carmalt's §6.00 
1073 12 Scissors 10.00 
34 6 7 489 Trask's Pessary .75 
34 6 9 489 Pessary 1.50 
29 6 0 362 Trelat's Urethrotome 16.00 
2 6 3 3 298 Trellis Speculum Ani 16.00 
4041 ( 
to >630 Tremaine's Antiseptic Surgery Case 175.00 
4043 ' 
2 5 5 9 279 Trendelenburg's Trachea Tampon 12.00 
1541 98 Trepan 2.50 
98 Trepanning: 
1531 98 Brace Trephine and Guarded Crown _ 21.00 
154 4 98 Elevator, Plain 1.00 
1545 98 Elevator and Lenticular Knife 1.75 
1547 98 Elevator and Raspatory 1.25 
1537 98 Forceps, Van Buren's 2.50 
1541 98 Hand Trepan -. 2.50 
1539 98 Hey's Saw.... 1.75 
154 3 98 Hey's Saw 1.50 
1 546 98 Lenticular Knife ... 1.50 
154 5 98 Lenticular Knife and Elevator 1.75 
Macewen's Elevator 1.50 
Macewen's Skull Saws and Rasps, per 
set 7.50 
1535 98 Raspatory 1.75 
1542 98 Raspatory, U. S. A 2.50 
1538 98 Scalpel 1.50 
72 Set of Instruments, in Case 16.00 
154 0 98 Tirefond 2.00 
] eox ! 98 Trephine, Crown and Handle 4.00 
1 534 1 
Jeoxf 98 Galt's and Handle 4.50 
1 544 ' 
153 1 98 Guarded, with Brace .... 21.00 
98 Guarded, with Handle 6.00 
1753 143 Trial Set, Nachet's 
1281 75 Triangular Pus Basin, Hard Rubber 3.00 
1772 146 Trichiasis Forceps, Ratti's „. 3.00 
1124 16 Tripod, Post Mortem Head Rest 3.00 
4140 682 Sayre's 10.00 
26 3 2 298 Trivalve Speculum Ani 12.00 
3186 435 Speculum Vaginae, Meadow's 10.00 
26 3 3 298 Trellis Speculum Ani 16.00 
Trocar, Abdominal, see Ovariotomy Trocar. 
199 5 182 Ear.. 1.50 
1079 12 Exploring 1.50 
1075 12 Duchenne's 2.50 
1076 12 Duchenne's e.- 3.50 
1077 12 Noeggerath's 3.50 
1078 12 Tiemann's 2.50 
1715 126 Trocar and Case 2.50 
Hydrocele and Ascites: 
1714 126 Harris' 5.00 
1716 126 Little's- 2.50 
1718 126 Set of 3 4.50 
1710 126 Set of 4- 6.00 
1719 126 Trocar and Canula 1.50 
1717 126 Warren's.... 6.00 
1714 126 Wood's 5.00 
Ovariotomy, see Ovariotomy Trocar. 
Paracentesis Vesicae. 
17 30 128 Buck's Rectum Trocar 3.50 
3049 392 Cock's Rectum Trocar 15.00 
30 1 2 381 Fitch's Dome Trocar Catheter ... 6.00 
3048 391 Harrison's Trocar 11.00 
1029 128 Parker's Guarded Rectum Trocar, 4.50 
30 5 0 393 Thompson's Sound and Tube 8 00 
1731 128 Van Buren's Double Silver Tube . 4.00 
Thoracic: 
1711 126 Flint's Trocar and Aspirator 5.00 
1713 126 Robert's Pericardial 3.50 
See also Aspirators. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
837 
Fig. Page. Price. 
17 9 7 183 Troeltsch's Ear Mirror $3.00 
2746 312 Trousseau's Pile Supporter 2.75 
2546 278 Trachea Dilator 2.50 
2 5 2 5 276 Trachea Forceps 2.50 
Troutmann's Spoon for Pharynx.. 2.50 
4219 716 Trueheart's Genu Valgum Brace.. 35.00 to 40.00 
3 7 5 5 539 Obstetrical Forceps 12.00 
3811 550 Trephine Perforator 8.00 
Trumpet, see Ear Trumpet. 
Truss (for Retention of Hernia): 
2788 325 Ball and Socket, Double 6.00 to 8.00 
2 7 7 7 322 Ball and Socket, Single 3.00 to 5.00 
2 7 9 5 327 Bow Spring, Umbilical 5.00 
2798 327 Bow Spring, Umbilical, Child- 
ren's 2.50 to 3.00 
2 7 7 3 323 Bow Truss 3.50 
Chase's, Double 6.00 to 8.00 
2784 324 Chase's, Single 4.00 
2794 327 Chase's Umbilical 4.00 
2 7 9 8 327 Children's Bow Spring 2.50 to 3.00 
2 7 9 7 327 Children's Umbilical 2.50 to 3.00 
Elastic, Double 5.00 
Elastic, Single 3.50 
28 0 0 327 Elastic Umbilical 2.50 to 3.50 
Finger Pad, Tiemann's, Double 10.00 
2 7 8 3 323 Finger Pad, Tiemann's, Single 5.00 
2786 324 Folsom's 20.00 
2 7 8 9 325 French, Double 6.00 
2 7 7 4 322 French, Single 4.00 to 5.00 
2790 325 French, Adjustable, Double 8.00 
2775 322 French, Adjustable, Single 4.50 
German, Double 4.50 
27 7 6 322 German, Single 3.00 
Hull's, Double 3.50 
2780 323 Hull's, Single 2.00 
Moc Main, Double 14.00 
2781 323 Moc Main, Single 8.00 
2 7 8 7 325 Plain, Double 4.50 
Plain, Single 3.00 
Ratchet, Double.. 8.00 
27 7 9 323 Ratchet, Single 4.50 
2 7 8 5 324 Schuppert's Galvanic 15.00 to 20.00 
2 7 8 8 325 Self-adjusting, Double 6.00 to 8.00 
2 7 7 7 322 Self-adjusting, Single 3.00 to 5.00 
2 7 9 9 327 Umbilical Bandage 6.00 to 8.00 
2 7 9 6 327 Walker's Combination 12.00 to 18.00 
2792 326 Warren's, Double 8.00 to 10.00 
27 9 3 326 Warren's, Single 5.00 to 7.00 
2791 326 Warren's Umbilical 25.00 to 30.00 
• Wood's Horse-shoe Pad, Double 8.50 
2782 323 Wood's Horse-shoe Pad, Single 5.00 
33 3 0 458 Tucker's Wire Cutter 6.00 
2738 311 Tumor Forceps, Kelsey's 2.50 
3654 512 Nelaton's 3.50 
3648 512 Up de Graff's 12.00 
See also Uterine Tumor and Poly- 
pus Forceps. 
2022 186 Tuning Fork, Politzer's, A or C 1.50 
289 5 348 Tunnelled Catheter, Gouley's 2.50 
29 3 9 356 Sound, Gouley's 2.50 
2955 361 Urethrotome, Gouley's 5.00 
2956 361 Urethrotome, Gouley's Improved 12.00 
3560 498 Tupelo Dilators, Sussdorf's, Hollow, per doz. 3.00 
356 1 498 Sussdorf's, Solid, per dozen 1.50 
216 Turbinated Bones. 
See also Nasal Septum, Nasal Turbin- 
ated Bones. 
23 8 7 239 Turk's Tongue Depressor, 3 Blades 4.50 
17 8 5 146 Turnbull's Ice Bag.. 2.50 
4322 755 Nasal Speculum 6.00 
202 Set of Ear Instruments 68.00 
3390 476 Turner's Applicator 1.50 
3963 602 Patella Splint 12.00 
2299 228 Turn-Key, Removable Fulcrum 2.50 
Fig. Page. Price. 
2300 229 Turn-Key, Rotating Fulcrum $2.50 
2297 228 Spring Bolt 3.00 
2298 228 Spring Bolt 3.00 
1018 4 Twisted Stem Thermometer 2.00 
Twisting Forceps: 
3315 450 Emmet's 3.00 
33 1 6 456 Fitch's 4.50 
33 1 4 456 Nott's 3.00 
32 7 8 451 Sims' 3.00 
See also Wire Twisters. • 
66 Two-fold Pocket Set 10.00 
66 Pocket Set 12.00 
20 23 187 Tympanum, Artificial, Toynbee's .30 
Tympanum Perforators: 
2 1 03 196 Buck's Myringotome 1.00 
2096 196 Gruber's Tensor Tympani Instrument, 2.50 
2099 196 Politzer's Angular Myringotome 1.00 
2105 196 Politzer's Straight Myringotome 1.00 
2 1 04 196 Prout's Myringotome 1.00 
2095 196 Weber's Tensor Tympani Instrument, 8.00 
25 71 282 Tyndale's Antiseptic Oro-Nasal Respirator, 3.50 
1704 124 In tra-Pulmonary Syringe 5.50 
1921 163 Tyrrell's Iris Hook, Blunt 1.25 
1922 163 Iris Hook, Sharp. 1.25 
29 0 9 350 Ultzmann's Deep Urethral Syringe ... 4.00 
2 7 9 9 327 Umbilical Bandage 6.00 to 8.00 
2 7 9 5 327 Truss, Bow 5.00 
2 7 9 8 327 Truss, Bow, Children's 2.50 to 3.00 
2 7 9 4 327 Truss, Chase's 4.00 
2 7 9 7 327 Truss, Children's 2.50 to 3.00 
28 0 0 327 Truss, Elastic, with Celluloid or Horn 
Pad 2.50 to 3.50 
2 79 1 326 Truss, Warren's .... 25.00 to 30.00 
Una's Bougie 2.00 
1045 7 Unison Resonator, Holden's 2.50 
12 7 9 75 Universal Douche, Tiemann's 6.00 
24 1 2 246 Forceps, Tiemann's 2.50 
1179 33 Handle Electrode, per pair 1.50 
2262 224 Root Forceps 2.00 and 2.75 
2276 226 Root Forceps 2.00 and 2.75 
2601 288 Syringe, Tiemann's 10.00 
22 7 5 226 Tooth Forceps 2.00 and 2.75 
Un-united Fracture Apparatus, see Pseu- 
. darthrosis. 
2085 195 Up de Graff's Ear Basin 1.50 
234 Staphylorraphy Set, in Case 9.00 
3648 512 Tumor Forceps 12.00 
2204 213 Upson's Syringe and Applicator 14.00 
236 Uraniscoplasty, see also Langenbeck's 
Uraniscoplastic Instruments. 
1006 3 Urea Tube 2.00 
466 Urethra, Female: 
469 Douching the. 
466 Inspection of the. 
469 Stricture of the. 
467 Tumors of the. 
338 Urethra, Male. 
343 Inspection of the, see also Endoscopes. 
338 Urethral: 
Applicators, see Urethral Syringes and 
Applicators. 
Catheters, see Catheters. 
1201 34 Electrode 1.25 
398 Foreign Body Extractors : 
3061 399 Alligator Forceps, Curved 6.00 
3060 399 Alligator Forceps, Straight 5.50 
30 6 4 399 Colin's Foreign Body Instrument, 30.00 
30 6 2 399 Leroy d'Etiolle's Curette 12.00 
30 5 8 398 Mathieu's Urethral Lithotrite.... 15.00 
30 6 3 399 Mercier's Duplicator 25.00 
30 5 7 398 Nelaton's Instrument 40.00 838 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Urethral, Foreign Body Extractors : 
3 0 5 6 398 Reliquet'sUrethral Stone Crusher.815.00 
30 5 9 399 Thompson's Urethral Forceps 2.00 
343 Inspection, see also Endoscopes. 
339 Scales, see also Guages. 
Sets of Instruments: 
396 Catheters, Set of Silver 25.00 
396 Gouley's Compact Stricture Set.. 50.00 
396 Gouley's Complete Stricture Set .109.00 
397 U. S. A. Genito-Urethral Set, No. 1, 75.00 
397 U. S. A. Genito-Urethral Set, No.2,140.00 
396 Van Buren and Keyes' Set, Com- 
pact 76.21 
396 Van Buren and Keyes' Set, Com- 
plete 121.55 
Sounds, see Sounds. 
Specula, see Endoscopes. 
Staffs, see Lithotomy Staffs. 
345 Stricture. 
Stricture Cutters, see Urethrotomy. 
353 Stricture Dilators (Gradual Dilatation): 
Bougie, Conical, English, 1 to 12. .50 
Bougie, Conical, English, 13 to 16. .75 
Bougie, Conical, French .50 
Bougie, Conical, Silk 1.00 
2926 353 Bougie, Cylindrical, English, Ito 12, .25 
Bougie, Cylindrical, English, 13 to 16, .50 
29 2 6 353 Bougie, Cylindrical, French .25 
29 2 7 353 Bougie, Olivary, English, 1 to 12, .50 
Bougie, Olivary, English, 13 to 16, .75 
Bougie, Olivary, French .50 
Bougie, Olivary, Silk 1.00 
29 2 8 353 Bougie, Van Derveer's, Soft Rubber, .75 
29 3 2 354 Burge's Curved Dilator 10.00 
29 3 3 354 Burge's Straight Dilator 10.00 
2939 356 Gouley's Tunnelled Sound 2.50 
29 3 6 355 Minor's Dilators 3.50 
2930 354 Steel Sound, Conical, Curved 1.25 
2929 353 Steel Sound, Conical, Straight ... 1.25 
Steel Sound, Cylindrical 1.00 
285 1 342 Steel Sound, Gouley's 1.25 
Steel Sound, Otis' 1.25 
293 1 354 Steel Sound, Teft's 1.25 
Steel Sound, Van Buren's 1.25 
4360 763 Steel Sound, Wyeth's, Curved and 
Straight, each 1.25 
29 3 5 355 Weisse's Urethral Sound 1.00 
357 Stricture Divulsors, Rapid Dilatation 
and Divulsion: 
2945 358 Gouley's Divulsor 12.00 
2940 356 Gouley's Over-distender 12.00 
2946 358 Gross' Urethral Dilator 14.00 
29 4 2 357 Holt's Divulsors, per set 20.00 
2943 358 Holt's Divulsors, modified by Bum- 
stead, per set 20.00 
2949 359 Schweig's Dilator 10.00 
29 4 7 359 Stearns' Dilator 5.00 
29 5 0 359 Steurer's Dilator 8.00 
29 5 1 359 Thebeaud's Dilator 10.00 
2944 358 Thompson's Divulsor 10.00 
2941 357 Voillemier's Divulsor 22.00 
345 Stricture Exploring, Bougies and 
Sounds: 
2880 346 Banks' Whalebone Bougies, ea. .. 1.25 
2873 345 Bell's Ball Sound 1.25 
2874 345 Bougie a Boule 1.00 
28 6 9 345 Bougie a Boule, Dick's 1.00 
2870 345 Bougie a Boule, Malez's 1.25 
28 8 6 347 Bougie a Boule, Otis', each .50 
2893 347 Bougie a Boule, Piffard's .50 
29 3 4 355 Bougie a Boule, Weisse's 1.00 
28 7 2 345 Bougie a Noauds 1.25 
28 7 1 345 Bougie a Trois Noeuds 1.25 
28 6 8 345 Bougie Conique .50 
Fig. Page. Price. 
Urethral: Stricture Exploring, Bougies 
and Sounds: 
28 6 6 345 Bougie Conique a Ventre $1.50 
28 7 6 345 Bougie, Filiform .50 
28 6 7 345 Bougie, Olivaire .50 
28 6 5 345 Bougie, Olivaire a Ventre 1.50 
28 7 4 345 Bulbous Bougie 1.00 
2881 346 Eldridge's Pathfinder 35.00 
2937 I 
. f®5 Gou ley's Whalebone Bougies, ea... .50 
28 7 8 346 Gouley's Whalebone Guides, ea. .. .50 
2879 346 Hunter's Filamentous Wedge .75 
2872 345 Knotted Bougie 1.25 
2876 345 Leroy d'Etiolle's Filiform Bougie. .50 
28 6 4 345 Olivary Whalebone Bougie .75 
28 7 3 365 Otis'Bulbous Sound, Set of 33, and 
Handle 17.50 
2886 347 Otis'Metallic Bougie a Boule, ea.. .50 
28 9 3 347 Piffard's Fossal Bougie a Boule .. .50 
28 7 5 345 Thompson's Leaden Stiletted Oli- 
vary Bougie 1.00 
2882 346 Tiemann's-Eldridge's Pathfinder. 3.50 
28 8 5 346 Warren's Exploring Sound 2.50 
Stricture Exploring, Catheters: 
29 0 0 349 Bumstead's Retention Catheter .. 3.50 
2895 348 Gouley's Tunnelled Catheter 2.50 
2877 345 Olivary Gum Elastic Catheter .50 
2898 348 Otis'Dilating Catheterand Syringe, 4.50 
28 9 9 349 Otis'Retention Catheter 3.00 
28 9 7 348 Thompson's Retention Catheter . 3.00 
2894 347 > Stricture Exploring, Meatometer, Pif- 
fard's .50 
Stricture Exploring, Meatotome, see 
Meatotome. 
Stricture Exploring, Urethrameter, 
see Urethrameter. 
Syringes and Applicators: 
2920 351 Bigelow's Catheter Syringe 6.00 
29 0 8 350 Brown's Syringe and Applicator . 24.00 
29 1 7 351 Bryce's Urethral Applicator 5.50 
29 0 6 350 Bumstead's P. P. Syringe .75 
2910 350 Bumstead's Urethral Syringe .... 2.50 
29 0 2 350 Buttle's Gonorrhoea Syringe 5.00 
29 1 8 351 Caspar's Ointment Bougie 2.00 
2914 351 Dick's Caustic Syringe 3.50 
29 0 5 350 Hard Rubber P. P. Syringe 1.50 
291 3 351 Harrison's Pessary Catheter 4.00 
292 1 352 Harrison's Urethral Irrigator.... 3.50 
291 1 350 Hutchison's Catheter for Apply- 
ing Ointments, in Ca^se 10.00 
43 6 8 764 Keyes'-Ultzman's Syringe 6.00 
43 6 3 763 Kiefer's Nozzle 1.50 
29 1 2 351 Lallemand's Porte Caustique 4.50 
2907 350 Long Pipe Syringe 1.25 
2919 351 Mallez's Powder Insufflator 1.75 
29 2 3 352 Mitchell's Reflux Catheter .75 
2916 351 Ointment Bougie 2.00 
290 1 349 Otis'Syringe Nozzle 1.00 
2904 350 Sigismund's P. P. Syringe .75 
2922 352 Thornton Parker's Tube .50 
29 0 9 350 Ultzmann's Deep Urethral Sy- 
ringe 4.00 
2915 351 Van Buren's Cupped Sound 2.00 
29 0 3 350 Wheelock's Reverse Flow Syringe, 2.00 
29 2 5 352 Winternitz's Psychrophor, Silver, 4.00 
Winternitz's Psychrophor, Soft 
Rubber 2.50 
382 Urethral and Uro-Cystic, see also Bladder. 
2883 346 Urethrameter, Gross' 20.00 
2974 366 Otis', Hinged 22.00 
Otis', Spring 18.00 
4365 764 Otis', Spring, Latest 24.00 
28 8 4 346 Weir's. 18.00 
Urethrotome, see Urethrotomy, Internal. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
839 
Fig. Page. Price. 
360 Urethrotomy: 
374 External Perineal: 
377 Cock's Operation. 
30 4 9 392 Cock's Trocar $15.00 
375 Gouley's Method. 
See also Gouley's External 
Urethrotomy. 
374 Syme's Operation. 
2995 374 Syme's Staff 2.00 
375 Wheelhouse's Operation. 
29 9 7 375 Teale's Probe Gorget 2.50 
29 9 6 375 Wheelhouse's Staff 2.00 
373 Haemostatic: 
299 1 373 Bates'Urethral Haemostat 4.00 
2994 374 Hunter's Urethral Tourniquet 5.50 
2993 373 Otis' Urethral Haemostatic Tube. .75 
29 9 2 373 Otis' Perineal Tourniquet 5.00 
360 Internal (Instruments cutting from 
before backward): 
29 5 4 360 Bumstead's-Maisonneuve's Ureth- 
rotome 14.00 
29 5 5 361 Gouley's Tunnelled Urethrotome, 5.00 
29 5 6 361 Gouley's Tunnelled Urethrotome, 
Improved 12.00 
29 61 362 Gross'Urethrotome 6.00 
29 52 360 Maisonneuve's Urethrotome 14.00 
29 6 3 362 Mastin's-Maisonneuve's Urethro- 
tome 14.00 
29 5 9 362 Mastin's Stricture Cutter 8.00 
2957 361 Pritchett'sRotatingUrethrotome, 25.00 
2958 362 Teevan's Stricture Cutter 12.00 
29 6 0 362 Trelat's Urethrotome 16.00 
29 5 3 360 Voillemier's Urethrotome 16.00 
29 6 2 362 Westmoreland's Urethrotome 12.00 
44 1 4 770 Whitehead's Urethrotome 15.00 
363 Internal (Instruments for retrograde 
operation): 
2 9 7 1 364 Banks'Urethrotome 20.00 
29 6 9 363 Bates' Urethrotome 15.00 
29 6 7 363 Bumstead's-Peters' Urethrotome. 50.00 
29 6 5 363 Charriere's Stricture Cutter 14.00 
29 6 4 363 Civiale's Urethrotome 12.00 
29 7 0 364 Gross'Exploratory Urethrotome- 6.00 
29 6 8 363 Kinloch's Urethrotome 25.00 
29 7 8 368 Otis' Bulbous Urethrotome 18.00 
29 6 6 363 Peters' Urethrotome 6.00 
2 9 6 0 362 Trelat's Urethrotome 16.00 
364 Internal Dilating, Urethrotomes : 
2989 371 Brown's Urethrametome 27.00 
29 7 2 364 Gouley's Dilating Urethrotome - 15.00 
2987 371 Hunter's Divulsor and Urethro- 
tome 35.00 
2982 370 Milne's Dilating Urethrotome.-_ 17.00 
29 8 6 370 Nall's Urethrotome 40.00 
29 7 8 368 Otis' Bulbous Urethrotome 18.00 
2975 367 Otis'Dilating Urethrotome, No. 1, 40.00 
29 7 6 368 Otis'Dilating Urethrotome, No. 2, 40.00 
29 7 9 369 Otis'Dilating Urethrotome, No. 3, 30.00 
29 8 0 369 Otis'Dilating Urethrotome, No. 4, 30.00 
298 1 369 Otis'Divulsing Urethrotome 40.00 
29 9 0 372 Rogers' Dilating Urethrotome and 
Urethrameter 40.00 
29 8 4 370 Smith's Urethrotome 30.00 
29 8 3 370 Stearns'Dilating Urethrotome... 12.00 
43 70 764 Walker's Urethrotome 35.00 
White's Urethrotome 35.00 
29 8 5 370 Wyeth's Urethrotome 35.00 
2988 371 Young's Dilating Urethrotome 50.00 
383 Urinals for Incontinence : 
3016 383 India Rubber 2.50 
30 1 4 383 India Rubber, Male 2.50 
3015 383 India Rubber, Male or Female 6.50 
3013 383 Tiemann's Instrument for Extrophy 
of Bladder 35.00 to 100.00 
Fig. Page. Price. 
1 Urinary Examination Apparatus : 
1011e 3 Bunsen Burner $1.50 
1005 3 Fehlich's Flask, with Burner and Bu- 
rette 4.75 
1000 1 Flint's Apparatus 70.45 
2 Flint's Extra Apparatus, Prices on p. 2. 
1003 3 Graduated Measure Glass .75 
1008 3 Graduated Tube for Approximate An- 
alysis 1.25 
1001 2 Lewis'Urine Test Apparatus 25.00 
Loomis'Apparatus 32.00 
1010? 3 Mohr's Beaker .10 to .30 
1010a 3 Mohr's Burette 2.50 
10106 3 Mohr's Stand 1.50 
Piffard's Apparatus 83.50 
1009a 3 Piffard's Measuring Pipette .50 
1007 Rapid Filtration Apparatus 
1011a 3 Retort Stand 1.50 
1001 2 Roberts'Urine Test Apparatus 25.00 
1006 3 Urea Tube (Tube only) 2.00 
1004 3 Urinometer .50 to 1.25 
1002 2 Vance's Urine Test 6.00 
10116 3 Water Bath 2.50 
Water Oven 1.50 
1011d > 
384 Urine, Retention of. 
See also Catheters. 
1004 3 Urinometer .50 to 1.25 
382 Uro-Cystic, see also Bladder. 
430) .. 
... c Female Bladder. 
466) 
396 Skene's Uro-Cystic and Urethral Set. 63.35 
1363 83 U. S. A. Bullet Forceps 2.00 
62 Capital Operating Set 102.50 
142 9 88 Field Tourniquet 1.00 
397 Genito-Urethral Set, No. 1 75.00 
397 Genito-Urethral Set, No. 2 140.00 
1273 61 Otis'Compact Field Set 160.00 
Pocket Set, Aseptic 28.00 
72 Regimental Surgeon's Pocket Set 23.00 
62 Staff Surgeon's Capital Operating Set, 137.10 
62 Staff Surgeon's Minor Operating Set, 136.00 
38 4 4 561 Usual Perineum Needle 75 
473 Uterine: 
Uterine Applicators: 
340 1 477 Barker's Ointment Bougie __ 1.25 
3 3 9 8 476 Edward's Caustic Holder 2.50 
33 9 4 476 Emmet's Applicator 1.50 
33 8 8 476 Gardner's Caustic Forceps 3.00 
3389 476 Gardner's Caustic Holder 2.50 
34 0 4 477 Lawson's Applicator 4.00 
33 9 2 476 Lente's Double Bulb Caustic Probe - 1.75 
Munde's Applicator .50 
Munde's Ointment Tul?e 2.00 
34 0 8 477 Nott's Applicator 4.50 
3391 476 Nunn's Applicator .75 
33 9 7 476 Parker's Uterine Applicator, with 
Velvet Eyes 1.25 
Simpson's Porte Caustic 2.50 
33 8 7 476 Sims' Caustic Forceps 3.50 
3 3 9 5 476 Skene's Instillation Tube .50 
33 9 0 476 Turner's Applicator 1.50 
3385 475 Wackerhagen's Applicator .10 
3372 Wylie'sCervical Protector and Appli- 
3373* 4,4 cator 3.50 
510 Uterine Curettes, Enucleators, Scoops : 
3644 511 Bozeman's Curette 2.25 
3635 511 Emmet's Curette Forceps 3.50 
3634 511 Emmet's Enucleator 1.50 
3633 510 Hanks'Curette t 2.00 
Munde's Curette, Blunt 1.50 
Munde's Curette, Sharp 1.50 
3645 511 Reinstetter's Rinse-Curette 4.00 
3639 511 Richardson's Finger Elongator 6.00 840 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Uterine Curettes, Enucleators, Scoops : 
3640 511 Siemon's Curette, Blunt $2.50 
3641 511 Siemon's Curette, Sharp _' 2.50 
3631 510 Sims'Curette- 1.75 
3632 510 Sims'Curette 3.00 
3637 511 Skene's Curette _ 1.75 
3636 511 Thomas'Curette 1.50 
3630 510 Thomas'Curette , 1.50 
3629 510 Thomas'Curette, 3 with 1 Handle.._. 4.50 
3643 511 Thomas'Serrated Scoop 3.50 
3642 511 Three Curettes, each. . 1.75 
3638 511 Yarrow's Enucleator 4.50 
See also Curette, Uterine. 
473 Uterine Diagnosis, see also Uterine Appli- 
cator, Uterine Tumor and Polypus For- 
ceps, Uterine Probe, Uterine Sound. 
498 Uterine Dilators: 
3 5 7 8 501 • Ady's 14.00 
3586 501 Atlee's 2.75 
3 5 7 5 500 Ball's, Modified 10.00 
3574 500 Ball's, Original 10.00 
3 5 7 6 500 Ball's Stem Pessary 1.50 
3 5 7 7 500 Ball's Stem Pessary 1.50 
Barnes', each 1.00 
Barnes', with Stopcock, each 1.50 
36 0 5 504 Barnes' Set of 3, with Syringe and 
Stopcocks 6.00 
3 5 6 6 498 Campbell's Intra-Uterine Stem, per 
set 4.50 
3601 504 Climax 15.00 
3607 504 Cowan's, per set 2.50 
35 8 9 502 Ellinger's 10.00 
35 9 5 503 Ellinger's 10.00 
3 5 7 3 500 Elliott's Intra-Uterine Speculum7.00 
3600 504 Emmet's Sponge Dilator.. 2.50 
3603 504 Emmet's Water Dilator 2.00 
43 4 5 759 Fritsch's Uterine Dilators, each 1.50 
3 5 9 6 503 Goodell's, Large 10.00 
3 5 9 5 503 Goodell's, Small 10.00 
3 5 7 0 499 Hanks', per set 5.00 
3571 499 Hanks' Rapid Uterine Dilators, Set of 
10 5.50 
Hegar's, Set of 25 14.00 
3 5 9 2 502 Howard's 9.00 
3582 501 Hunter's 14.00 
Kaemmerer's, Set of 4 6.00 
3 5 8 8 502 Long's Dilator and Injector 10.00 
McGillicuddy's 6.50 
36 0 6 504 McLean's-Barnes'Bag 2.50 
3 5 9 7 503 McLean's Introducer 4.50 
3 5 9 0 502 Miller's 10.00 
3591 502 Nelson's 5.50 
3681 501 Nott's 3.50 
3 6 0 2 504 Ohr's Dilator and Corrector 7.50 
3 5 9 4 503 Palmer's 5.00 
3 5 9 8 503 Palmer's Latest, 2 sizes, each 5.00 
3 5 6 9 499 Peaslee's, Set of 5 6.50 
3 5 7 9 501 Simpson's 4.50 
3 5 6 8 499 Simpson's, Set of 12, in Case 7.50 
Sims', 2 Bladed 6.00 
3 5 8 7 502 Sims', 3 Bladed .12.00 
35 6 0 498 Sussdorf's Tupelo, Hollow, per doz... 3.00 
3 561 498 Sussdorf's Tupelo, Solid, per doz 1.50 
Tent, see Tents. 
3580 501 Thomas' 5.00 
35 7 2 500 Tiemann's Intra-Uterine Speculum._ 4.50 
3 5 8 5 501 Tiemann's Intra-Uterine Speculum.. 7.00 
3593 502 Vanderveer's 5.50 
3 5 62 498 Wallace's Spring Tent, each 1.50 
Wathen's, 2 sizes, each 8.00 
3583 501 Wessinger's 4.50 
3584 501 White's 4.50 
Wilson's 9.00 
35 9 9 503 Wylie's 6.00 
Fig. Page. Price. 
475 Uterine Dressing, see also Uterine Appli- 
cators. 
Uterine Dressing Forceps: 
3384 475 Bozeman's ....S2.50 
33 7 6 475 Dressing Forceps 3.00 
3 3 7 8 475 Dressing Forceps 2.00 
3379 475 Dressing Forceps 2.50 
3 3 8 3 475 Dressing Forceps 2.00 
Elliott's 2.00 
338 1 475 Jones' 6.00 
33 8 0 475 Newman's Metrorganon 3.00 
3 3 7 7 475 Nunn's Folding Forceps 6.00 
3382 475 Nunn's Forceps and Scissors Com- 
bined .. 5.00 
478 Uterine Dressing, Vaginal Tamponade : 
34 1 0 478 Barnes'Tampon Speculum 2.00 
341 1 478 Braun's Tampon Expeller 2.50 
34 1 2 478 Thomas'Tampon Expeller 1.50 
Uterine Electrodes: 
1228 36 Cup and Stem 2.50 
1197 34 Cup-Shaped, 3 sizes, each 2.00 
1200 34 Elastic 3.00 
1201 34 Insulated 1.25 
1199 34 Spiral 1.25 
Uterine Elevators, see Uterine Repositors. 
Uterine Enucleator, see Uterine Curette. 
Uterine Excision Instruments, see Hyster- 
ectomy, also Hysterotome. 
3 5 5 5 497 Uterine Fixator, Byrne's 2.50 
See also Uterine Tenaculums. 
Uterine Forceps, see Uterine Tumor and 
Polypus Forceps. 
3359 473 Uterine Instruments, Nott's, per set 10.00 
479 Uterine Irrigation, Douching: 
34 2 3 482 Bozeman's Intra-Uterine Back-flow 
Tube . 3.00 
34 1 9 482 Byrne's Reflux Catheter and Adjuster, 2.50 
34 1 4 480 Foster's Intra-Vaginal Syringe 4.00 
3415 481 Fraser's Intra-Vaginal Syringe 3.00 
3416 481 Frost's Vaginal Douche 2.50 
3424 482 Hanks'Intra-Uterine Douche Tube .. 1.50 
3413 479 Hospital Bed Pan 4.00 
342 1 482 Nott's Double Current Catheter 3.00 
34 2 2 482 Nott's Double Current Catheter 2.50 
34 2 0 482 Reliquet's Double Current Catheter . 3.50 
34 1 7 481 Thornton Parker's Vaginal Syringe __ 3.00 
3418 482 Woodward's Uterine Syphon Douche. 2.50 
Uterine Knives: 
3294 452 Bozeman's 1.75 
32 8 4 452 Bozeman's, Angular, Right and Left, 
each 1.75 
4405 769 Bozeman's, Delicate 1.75 
3283 452 Bozeman's, Straight 1.75 
3300 453 Emmet's, Ball and Socket 5.00 
Emmet's, Ball and Socket, Improved, 7.00 
Jenks' 2.00 
3624 506 Knife 1.50 
36 1 7 506 Leuneker's, Right and Left, each.... 2.00 
32 9 0 452 Nott's 1.50 
329 1 452 Nott's, Angular 1.50 
36 1 6 506 Probe Pointed 1.50 
32 8 9 452 Scalpel, Right and Left, each 1.75 
32 9 2 452 Scott's 1.50 
3 2 8 7 452 Sims' Holder and 4 Knives 10.00 
32 9 3 452 Sims' Probe Pointed 1.50 
3282 452 Sims' Rotating 4.50 
32 8 8 452 Sims'Scalpel 1.50 
See also Hysterotome, Metrotome, 
Uterotome. 
36 2 0 506 Uterine Leech, Reese's 4.50 
Uterine, Malignant Disease, see Hysterec- 
tomy. 
483 Uterine Malpositions, Displacements. 
See also Pessary, Uterine Repositors. GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
841 
Fig. Page. Price. 
Uterine Needles: 
Bozeman's, per dozen $1.50 
Cole's, per dozen 1.50 
Dawson's, per dozen 1.50 
Dickinson's, per dozen 1.50 
132 0 79 Emmet's, Round Pointed, per dozen _ 1.50 
Emmet's, Triangular Pointed, per doz. 1.50 
Goodell's, per dozen 1.50 
3310 455 Hagedorn's, per dozen 1.50 
Lyman's, per dozen 1.50 
Martin's, each .25 
Schnetter's, per dozen 1.50 
Siemon's, per dozen 1.50 
132 0 79 Sims', Round Pointed, per dozen 1.50 
Sims', Triangular Pointed, per dozen, 1.50 
4356 760 Skene's, per dozen 1.50 
Wathen's, per dozen 1.50 
Wylie's, per dozen 1.50 
506 Uterine Plethora: 
3619 506 Thomas'Dry Cupper 1.50 
See also Uterine Leech, Uterine 
Scarificators. 
Uterine Polypus, see Uterine Tumors and 
Polypi. 
Uterine Powder Blower, Kelly's 3.00 
Uterine Probes: 
335 7 473 Chapman's, per set 4.00 
3361 473 Jenks' 1.75 
3 3 5 5 473 Leaden .40 
3356 473 Silver 1.25 
3363 473 Silver 1.25 
33 6 2 473 Thomas', Elastic 1.25 
33 5 4 473 Thomas', Hard Rubber 1.25 
33 6 0 473 Thomas', Whalebone .50 
33 5 8 473 Wyeth's 1.00 
See also Uterine Sound. 
483 Uterine Repositors, Redressors : 
34 3 5 484 Blake White's Metratrep 14.00 
34 6 0 488 Campbell's Pneumatic Repositor .25 
3437 485 Carroll's Repositor ... 3.50 
343 1 483 Elliott's Sound 7.00 
34 2 7 483 Emmet's Elevator 4.50 
3429 483 Gardner's Manifold Instrument, Com- 
plete 12.00 
34 2 8 483 Guernsey's Elevator 1.50 
3436 485 Leonard's Repositor 11.00 
34 3 3 483 Noeggerath's Elevator 9.00 
3434 484 Porter's Repositor 6.00 
34 2 5 483 Sims' Elevator, No. 1 6.00 
34 2 6 483 Sims'Redressor, No. 2 6.00 
3432 483 Skene's Elevator and Curette 10.00 
3430 483 Stowe's Retroversion Elevator 4.50 
34 3 8 485 White's Repositor 5.00 
Uterine Scarificators: 
3623 506 Buttles' 1.25 
3614 506 Buttles', and Tenaculum 2.50 
3615 506 Chapman's 1.50 
362 1 506 Chapman's 2.50 
36 1 8 506 Skene's Sound and Scarificator 6.00 
3622 506 Storer's 6.00 
See also Uterine Knives. 
Uterine Scissors: 
3680 516 Amputating Cervix 6.00 
3611 505 Bozeman's 4.50 
32 8 6 452 Bozeman's, Curved 4.50 
32 8 5 452 Bozeman's, Double Curved 4.50 
3679 516 Clark's Tooth Edged 9.00 
Dawson's 5.00 
Emmet's (Bladder) 4.50 
32 9 9 453 Emmet's, Double Curve 4.50 
329 7 453 Emmet's, Knee-bent 4.50 
3 2 9 8 453 Emmet's, Slightly Curved 4.50 
4410 770 Hanks' 5.00 
3301 453 Heywood Smith's 12.00 
Fig. Page. Price. 
Uterine Scissors : 
Jenks'. $4.50 
3678 516 Kuechenmeister's 6.00 
Serrated, Curved 5.50 
Serrated, Straight.... 5.00 
32 9 5 453 Sims', Curved 4.50 
328 1 452 Sims', Curved, Sharp Points 4.50 
3 2 9 6 453 Sims', Straight 3.50 
38 2 6 556 Skene's, Hawk-bill 10.00 
Skene's, Wire 5.00 
361 0 505 Thomas', Double 6.00 
3830 557 Uterine Sector, Skene's 11.00 
Uterine Sets of Instruments, in Cases : 
33 5 2 471 Buttles' 23.00 
471 Elliott's 25.00 
335 1 470 Gardner's 46.00 
3353 471 Hunter's Gynaecological Bag 
472 Munde's 16.00 
472 Nott's 111.46 
470 Peaslee's „ 60.00 
470 Sims' 125.00 
471 Skene's 54.25 
471 Thomas' 46.00 
472 Wylie's Office or Polyclinic Set 45.00 
472 Wylie's Bellevue Hospital Clinic Set.100.00 
473 Uterine Sounds: 
33 5 7 473 Chapman's, per set 4.00 
33 6 9 474 Fitch's 2.00 
3 3 6 7 474 Folding 2.50 
3375 474 Gidding's 2.00 
33 6 5 474 Hunter's 1.25 
3 3 7 1 474 Jenks' 3.50 
Kaemmerer's, Set of 4. 6.00 
33 7 0 474 Leonard's 5.50 
33 6 8 474 Leonard's Uterometric 3.25 
Simpson's 1.25 
33 6 4 474 Simpson's, Graduated 1.50 
Sims'. 1.25 
3374 474 Skene's 3.50 
33 6 6 474 Sliding 3.00 
Uterine Speculums: 
3573 500 Elliott's 7.00 
3 5 7 2 500 Tiemann's 4.50 
35 8 5 501 Tiemann's 7.00 
3372 1 
3373 > 474 Wylie's Cervical and Applicator 3.50 
505 Uterine Stenosis, see also Hysterotomes. 
Uterine Supporters: 
3456 487 Donaldson's 2.50 
3450 1 
to >487 McIntosh's, each 5.00 
3453 ) 
3448 487 Thomas' 2.50 
3447 486 Tiemann's „ 5.00 
See also Pessaries. 
Uterine Syringes: 
34 0 0 477 Braun's 2.50 
Buttles' 2.00 
34 0 5 477 Dick's Caustic 3.50 
34 0 2 477 Hutchison's Ointment, with 1 Hard 
Rubber Tube 3.00 
34 0 2 477 Hutchison's Ointment, with 3 Silver 
Tubes 10.00 
33 9 6 476 Kelly's, Silver 5.00 
3403 477 Lente's, Ointment 4.50 
34 0 7 477 Lente's, Ointment 8.00 
Long Pipe 1.25 
Munde's 2.00 
3409 477 Nott's, Hard Rubber 2.50 
4371 764 Woodward's, for Nitrate of Silver ... 4.00 
449 Uterine Tenaculums: 
32 6 3 449 Bozeman's 1.50 
32 6 6 449 Bozeman's, Long 1.50 
3262 449 Double 1.75 842 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
Uterine Tenaculums: 
32 5 7 449 Emmet's $1.25 
3258 419 Emmet's 1.25 
3261 449 Emmet's 1.25 
3265 449 Emmet's 1.25 
3558 497 Emmet's, Double 5.00 
3259 44J Emmet's, Heavy 1.50 
32 7 0 449 Long, Angular 1.50 
3271 449 Long, Stout 1.50 
3552 497 Nott's, for Speculum .25 
3 2 6 0 449 Perry's, Barbed 1.50 
3256 449 Sims'.. 1.25 
32 6 4 449 Sims', Long 1.25 
Uterine Tenaculum Forceps: 
3 5 5 6 497 Byrne's 6.00 
3558 497 Emmet's 5.00 
3553 497 Hanks' 3.00 
3559 497 Sims' 3.50 
38 2 5 556 Skene's 3.00 
3557 497 Wooster's 2.50 
3554 497 Wylie's 3.00 
Uterine Tourniquet, Ady's 4.00 
3676 516 Emmet's 5.50 
510 Uterine Tumors and Polypi. 
See Uterine Curettes, also Ecraseurs. 
Uterine Tumor and Polypus Forceps: 
3650 512 Aveling's Polyptome 8.00 
3655 513 Byrne's Vulsellum 3.00 
3656 513 Byrne's Vulsellum 3.00 
3661 513 Campbell's Tumor 8.00 
3662 513 Cushing's Vulsellum 3.00 
3659 513 Greenhalg's Tumor 6.00 
3657 513 Luer's Polypus 6.00 
3660 513 McClintock's Polypus 6.00 
3647 512 Nelaton's Pedicle 3.50 
3654 512 Nelaton's Tumor 3.50 
Sims'Polypus... 3.50 
3652 512 Sims'Enucleator 3.50 
3653 512 Sims'Enucleator Blunt Hook 3.50 
3646 512 Sims'Vulsellum Hook 5.50 
3648 512 Up de Graff's Tumor 12.00 
3658 513 Wales' Polypus 3.00 
36 9 2 525 Wilcox's 5.50 
See also Galvano - Cautery and 
Ligator. 
36 1 3 505 Uterotome, Peaslee's, with 1 Blade 4.50 
36 1 3 505 Peaslee's, with 2 Blades 6.50 
See also Hysterotome, Metrotome. 
Uvula Forceps: . 
2412 246 Tiemann's 2.50 
24 1 0 246 Vulsellum 3.00 
Uvula Hooks: 
2 1 7 5 208 Czermack's 2.50 
21 74 208 Fraenkel's 2.50 
2169 208 Jarvis'Tape Holder .75 
2419 250 Lefferts' 2.00 
24 5 2 263 Roe's 1.00 
24 5 4 263 Rumboldt's Retractor.. 2.00 
24 5 5 263 Rumboldt's Spreading Retractor .... 7.50 
Sajou's 3.50 
2 1 73 208 Voltolini's 2.50 
24 0 8 246 Uvula Scissors 5.50 
2409 246 Scissors, with Claws.... 5.50 
2411 246 Uvula tome, Knox's 6.50 
2413 246 Mackenzie's 9.00 
166 6 120 Vaccinating Lancet 75 
1671 120 Lancet, Weir's .75 
16 70 120 Lancet and Comb, Weir's 1.00 
16 7 3 120 Scarificator, Tiemann's 5.00 
1672 120 Trocar, Tiemann's 2.50 
1668 120 Vaccinator, Carroll's .25 
166 7 120 Dawson's 3.50 
Fig. Page. Price. 
1 669 120 Vaccinator, Teller's §2.50 
Vaccine Virus, Martin's, per package of 10 
points 1.00 
Vacker's Obstetrical Forceps, Rotating... 8.50 
Vaginal Depressors: 
3247 448 Bozeman's 2.50 
3248 448 Bozeman's, Double Hooked 3.00 
32 5 3 448 Bozeman's, Urethral and Perineal.._ 2.50 
323 5 445 Garrigue's 2.00 
3252 448 Hunter's 1.50 
3234 445 Nott's.... 1.50 
3249 448 Nott's 1.50 
32 5 0 448 Sims' 1.50 
3251 448 Sims', Double-..- 1.50 
Vaginal Dilators: 
3241 446 Bozeman's 1.00 
3242 446 Bozeman's 1.00 
3441 486 Bozeman's 1.00 
3213 442 Sims', Glass 50 
3213 442 Sims', Hard Rubber .75 
Vaginal Douche, see Vaginal Syringe. 
1222 35 Vaginal Electrode 4.00 
122 3 35 Electrode 4.00 
1190 33 Electrode, Insulated 2.50 
1189 33 Electrode, Nickel-plated 1.50 
480 Injection, see also Vaginal Syringe. 
3335 461 Retractor, Simon's, Plain 3.00 
3334 461 Retractor, Simon's, Serrated 3.50 
Vaginal Speculums: 
3 1 7 5 431 Ashton's, Glass 1.00 
3 1 85 435 Ball's 11.00 
3218 442 Barnes'-Neugebauer's 2.50 
31 84 433 Bath 3.00 
3215 442 Baxter's 4.00 
32 3 9 446 Biart's 
3177 431 Bivalve 5.00 
3 1 96 437 Bivalve.. 5.00 
3198 439 Bivalve, Steel 5.50 
3 1 83 433 Blakeley's- 3.00 
3 1 9 7 437 Blake White's-Nott's 5.00 
3229 444 Blake White's-Sims' 2.50 
3226 443 Bozeman's 12.00 
3244 447 Bozeman's, Columning, 3 Blades 9.00 
3214 442 Bozeman's, Duck Bill 2.50 
3190 435 Brewer's 4.00 
3208 441 Byrne's 11.00 
32 2 0 443 Cracour's 6.50 
3230 444 Darrow's, 2 Blades 12.00 
32 1 7 442 Dawson's Dilating 7.00 
32 3 7 446 Dawson's-Ehrich's 14.00 
32 1 6 442 Dawson's-Sims' 5.00 
32 0 4 439 Dickens' 9.00 
3172 431 Dome Top 1.50 
3182 433 Dowell's 1.50 
Ehrich's 13.00 
3236 445 Emmet's 7.00 
3174 431 Ferguson's Tubular, Glass, Mirror .50 
Ferguson's Tubular, Hard Rubber.- 1.00 
Ferguson's Tubular, Hard Rubber, 
with Nickel-plated Metal Mirror. 1.50 
3171 431 Ferguson's Tubular, Metal 1.50 
3 1 8 1 433 French's. 1.50 
3231 444 Fryer's.-, 2.00 
3233 445 Fryer's Self-retaining 12.00 
Goodell's 7.00 
3210 441 Graves' 5.00 
3 1 99 439 Hale's. 5.00 
3228 444 Hanks'-Ehrich's 13.00 
32 0 2 439 Howard's 6.00 
320 1 439 Hunter's - 6.00 
32 4 5 447 Hunter's-Ehrich's 9.00 
3195 437 Jenks' 8.00 
32 0 6 441 Keene's 7.00 
3 1 80 433 Labia. 2.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
843 
Fig. Page. Price. 
Vaginal Speculums ; 
3200 439 Leonard's $6.00 
3194 437 Meadow's Quatrivalve 15.00 
3186 435 Meadow's Trivalve 10.00 
3246 447 Munde's. 3.50 
31 9 1 435 Nelson's 4.50 
3211 441 Nott's 4.00 
3243 447 Nunn's 12.00 
Record's 5.00 
3240 446 Reid's 6.00 
3 1 93 437 Schlotterbeck's 7.00 
3232 445 Schuyler's 12.00 
3179 431 Segala's.. 8.00 
Simon's Set of 5, and 1 Handle 9.00 
3332 461 Simon's Set of 4 Simon-Bozeman's, and 
4 Simon-Sims' Blades, with 2 Socket 
Handles 20.00 
33 3 3 461 Simon's Set of 8 Flat Shaped Blades, 
with 2 Socket Handles 20.00 
3212 442 Sims' 2.50 
3219 443 Sims'Bivalve 5.00 
31 89 435 Stohlmann's 8.00 
3207 > 441 Storer's 4.00 
3221 443 Taliaferro's 2.50 
32 3 8 446 Taylor's 4.00 
322 5 443 Thomas' 10.00 
32 0 3 439 Thomas'-Cusco's 4.00 
3224 443 Thomas' Self-retaining 18.00 
3222 443 Thomas'-Sims' 10.00 
3173 431 Thomas'Telescopic 5.00 
3 1 7 6 431 Thomas'Tubular 3.00 
3 1 92 437 Tiemann's Quatrivalve 10.00 
3188 435 Tiemann's Trivalve 12.00 
3209 441 Wackerhagen's 10.00 
3 1 78 431 Weber's 7.00 
3 1 8 7 435 Weiss' 16.00 
44 1 2 770 Woodward's 5.50 
3223 443 Yarrow's 8.50 
3254 448 Vaginal Sponge Holder .75 
34 5 9 488 Vaginal Support, Bozeman's 2.00 
See also Pessary. 
Vaginal Syringes: 
Davidson's, No. 1 2.00 
Davidson's, No. 2 1.50 
3414 480 Foster's 4.00 
34 1 5 481 Fraser's 3.00 
34 1 6 481 Frost's 2.50 
34 1 7 481 Parker's 3.00 
34 1 8 482 Woodward's 2.50 
See also Uterine Irrigation, Douching. 
1090 13 Valentine's Knife, Charriere's Model 8.00 
1082 12 Knife, Tiemann's Model 8.00 
709 Valgus Ankle: 
4201 709 Detmold's Ankle Spring, ea. _ 4.00 to 6.00 
4202 710 Weak Ankle Brace, each 5.50 to 10.00 
Valgus, Talipes, see Orthopaedic: Deform- 
ities of the Feet: Talipes Valgus. 
43 7 9 765 Van Arsdale's Periosteum Elevators, Set 
of 3 6.00 
Syringe, Antiseptic 13.00 
1322 79 Van Brun's Needle 1.00 
2915 351 Van Buren's Cupped Sound 2.00 
3164 428 Debris Syringe 3.50 
1731 128 Double Silver Tube 4.00 
30 8 9 405 Evacuating Catheter and Bag 7.00 
1694 122 Fumigation Lamp 2.50 
2728 310 Ligator 7.00 
67 Pocket Set 22.00 
264 1 299 Rectal Depressor 2.50 
26 3 7 299 Rectal Speculum 3.50 
42 9 4 747 Sequestrum and Nail Extracting For- 
ceps 2.50 
1537 98 Trepanning and Sequestrum Forceps- 2.50 
Fig. Page. Price. 
2844 340 Van Buren and Keyes'American Scale $3.50 
396 Compact Set of Urethral Instruments, 76.21 
30 1 7 383 Hot Water Bag 5.00 
397 Set of Instruments for Stone 134.75 
396 Set of Urethral Instruments 121.55 
1067 10 Vance's ^Esthesiometer 5.00 
1002 2 Urine Test 6.00 
29 2 8 353 Van Derveer's Urethral Bougie, Nos. 10 to 30, 
French 75 
29 2 8 353 Urethral Bougie, Nos. 31 to40, French, 1.00 
3593 502 Uterine Dilator 5.50 
3548 496 Van de Warker's Anteflexion Pessary 1.75 
3831 ) 
ooon C Needle Forceps and Needle 7.00 
oooZ * 
3 5 5 0 496 Retroflexion Pessary 1.75 
3818 551 Van Huvel's Forceps Saw 
2144 201 Vapor Douche, Buttle's Inhaler 2.00 
2141 201 Hardy's Chloroform Douche 4.00 
331 Varicocele: 
2820 332 Henry's Cartilage Scissors 5.00 
2815 331 Henry's Depilating Forceps 2.50 
2819 332 Henry's Scrotal Clamp 8.00 
28 2 4 334 Keyes'Varicocele Needles, each 1.75 
Keyes' Varicocele Needle, Improved- 6.00 
28 1 6 332 Lewis'Varicocele Clamp 4.00 
28 1 7 332 Williams'Varicocele Clamp 4.00 
28 1 8 332 Williams'Varicocele Clamp .75 
See also Suspensory. 
330 Varicose Veins. 
330 Elastic Stockings. Prices on p. 330. 
330 Varix. 
Elastic Belts. Prices on page 330. 
3787 548 Vectis, Folding 3.50 
I lain 2.50 
3788 548 Ryerson's Adjustable 7.00 
37 8 3 546 White's 2.50 
37 6 7 540 Vedder's Obstetrical Forceps 13.00 
1600 103 Velpeau's Bone Forceps 4.00 
4209 712 Writer's Cramp Apparatus 10.00 
3031a 386 Velvet Eye Catheter .75 
30316 386 Catheter .75 
3031c 386 Catheter.. 1.00 
3031 <Z 386 Catheter 1.50 
3031c 386 Catheter .75 
3031/ 386 Catheter 1.00 
30310 386 Catheter 1.00 
30316 386 Catheter .75 
3031; 386 Catheter .75 
3044 389 Catheter, Double Current 2.50 
26 2 0 294 Nasal Feeding Tube 1.00 
Perineum Tube 1.00 
266 5 303 Rectal Feeding Tube 1.50 
2621 294 Stomach Tube 1.50 
2621 294 Stomach Tube, Long 2.00 
1140 19 Ventricle Pique 2.50 
2723 310 Verona's Winch 3.50 
677 Vertebral Column. 
703 Accidents to. 
See also Spinal Braces. 
448 Vesico- and Recto-Vaginal Fistula. 
469 Vesico-Urethral Fissure. 
3349 469 Skene's Fissure Probe and Knife, ea. _ .75 
449 Vesico-Vaginal Fistula. 
457 Bozeman's Button Suture. 
459 Simon's Operation. 
448 Sims' Operation. 
464 Vesico-Vaginal Fistula, Artificial. 
See also Kolpo-Cystotomy. 
Vesico-Vaginal Fistula Sets: 
462 Bozeman's 100.00 
462 Emmet's 80.00 
462 Sims' 55.00 
Vial Cases, see Medicine Pocket Cases. 
4044 630 Vial for Iodoform or Chloride of Mercury- 844 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
1477c 93 Vidal's Serrefin, Angular $0.25 
14776 93 Serrefin, Straight. 25 
Vivisection, see Physiological Experiments. 
294 1 357 Voillemier's Stricture Divulsor 22.00 
29 53 360 Urethrotome.. 16.00 
4006 620 Volkmann's Dorsal Splint 
4 3 8 5 766 Retractor. 3.00 
3914 584 Sliding Rest 4.50 to 6.50 
4386 766 Spoon. 2.50 
39 : 5 584 T Splint 5.50 to 6.50 
1 156 24 Voltaic Armadillo. Prices on page 24. 
2 1 73 208 Voltolini's Uvula Hook 2.50 
3 8 3 3 559 Von Rarridohr's Needle Forceps, per set... 10.00 
3520 493 Pessary 1.50 
2396 243 Vulsellum Forceps 4.50 
2410 246 Forceps 3.00 
3655 513 Forceps, Byrne's 3.00 
3656 513 Forceps, Byrne's 3.00 
3662 513 Forceps, Cushing's 3.00 
2 3 9 4 243 Forceps, Musseux's 2.50 
3646 512 Hook, Sims' 5.50 
33 8 5 475 Wackerhagen's Applicator .10 
3880 575 Bandage Shears 6.00 
4084 653 Bed Rest. 20.00 
Needle 1.00 
129 4 76 Plaster Shears 6.00 
3209 441 Speculum Vaginae 10.00 
39 5 4 600 Splint................ 
2465 264 Wagner's Brush Holder and 12 Brushes.... 2.50 
2190 211 Post-Nasal Brush, 2 Stems and 12 
Brushes 2.50 
22 3 3 220 Post-Nasal Forceps 3.50 
206 Rhinoscopic Set 
1156 24 Waist Band, Voltaic 5.00 
2 56 1 281 Waldenburg's Pneumatic Apparatus 
2 5 6 5 281 Pneumatometer 8.00 
2761 316 Wales'Herniotome and Rectotome 1.75 
3658 513 Polypus Forceps 3.00 
2 6 6 1 303 Rectal Bougies, Soft Rubber : 
Nos. 1, 2, 3, each.... 1.50 
Nos. 4, 5, 6, each 2.00 
Nos. 7, 8, each 2.50 
Nos. 9, 10, each 3.00 
Nos. 11, 12, each 3.50 
2662 302 Sheath for Bougies .50 
2 6 5 9 302 Recto-Colonic Bougie, Nos. 4, 5, 6, ea. 3.50 
26 6 4 302 Rubber Bag Syringe 3.00 
26 6 3 302 Scale of Sizes for Bougies. 
2796 327 Walker's Combination Supporter.. 12.00 to 18.00 
43 9 9 769 Drainage Tubes, each .60 
3105 411 Evacuator .... 22.00 
3010 381 Prostate Gland Dilator 35.00 
3 1 60 427 Prostatic Divulsor : 2.00 
43 4 8 759 Rectum Specula, 3 with 1 Handle.... 15.00 
4370 764 Urethrotome, Dilating 35.00 
3 1 6 1 427 Urethrotome, External 1.75 
3162 427 Urethrotomy Staff .. 2.00 
Wallace's Obstetrical Forceps 8.00 
3 5 4 7 496 Spring Tent, each 1.50 
3 5 6 2 498 Spring Tent, each 1.50 
1029 5 Walsh's Stethoscope 1.00 
1968 173 Walton's Grooved Needle 2.00 
1939 165 Iris Forceps 2.50 
197 5 174 Reclination Needle 1.25 
43 9 7 769 Ware's Ligature Bottle 1.50 
Ligature Bottle, Hospital Size .'. 3.00 
1044 7 Stethoscope 4.50 
41 Warm Water in Surgery. 
1246 42 Warm Water Bath, Forearm and Hand.... 15.00 
1247 42 Lower Extremity 15.00 
2183 210 Warner's Catarrhal Douche 1.00 
1739 133 Warren's Aspirator Needle 3.00 
Fig. Page. Price. 
1057 8 Warren's Conformator $6.00 
1112 15 Demonstrating Knife 1.25 
30 3 8 387 Door Catheter 6.00 
2885 346 Exploring Sound 2.50 
2 7 7 2 320 Hernia Syringe, No. 1 35.00 
2 7 7 3 320 Hernia Syringe, No. 2 18.00 
2760 316 Herniotome 6.00 
Mouth Gag 4.00 
1724 127 Ovarian Trocar 
128 0 75 Pus Basin.... 3.50 
1717 126 Trocar 6.00 
2 7 9 2 326 Truss, Double.. 8.00 to 10.00 
2 7 9 3 326 Truss, Single 5.00 to 7.00 
2 79 1 326 Truss, Umbilical 25.00 to 30.00 
30 3 9 387 Vermicular Catheter 3.00 
40 6 6 644 Washburn's Hip-joint Splint 7.00 
4 1 38 679 SpineBrace. 15.00 to 20.00 
Washing the Bladder: 
3044 389 Double Current Catheter, Velvet Eye, 2.50 
3043 389 Keyes'Irrigator 5.50 
See also Catheter, Double Current. 
41 Water, Hot, in Surgery. 
10116 3 Water-Bath 2.50 
124 6 42 for Arm and Hand 15.00 
1247 42 for Lower Extremity 15.00 
3 Water-Oven, Piffard's.. 1.50 
1011d> 
37 3 3 533 Water-Pad for Application of Cold or Heat, 8.00 
Wathen's Cervix Scissors 7.00 
Dilator, 2 sizes, each 8.00 
Double Tenaculum Forceps 10.00 
Needle, per dozen 1.50 
3999 618 Watson's Suspension 
4000 618 Suspension Bar 
Waxham's Intubation Set 47.00 
Laryngeal Forceps 5.00 
4202 710 Weak-Ankle Brace 5.50 to 10.00 
4204 710 Ankle Brace and Extension for Short 
Leg, Combined, Shoe extra 18.00 
420 1 709 Ankle Spring, Detmold's 4.00 to 6.00 
42 0 0 709 Legs, Support for, Adult's size 
35.00 to 70.00 
Legs, Support for, Child's size 
25.00 to 35.00 
1488 94 Weber's Arteriversion Tenaculum 1.50 
1798 148 Curved Canalicula Knife 1.75 
1788 147 Graduated Dilator, Lachrymal 1.00 
1797 148 Half-curved Canalicula Knife 1.75 
1944 167 Iris Hook, Double 1.50 
1943 167 Keratome 2.50 
3546 495 Pessary 4.50 
3178 431 Speculum Vaginae 7.00 
2095 196 Tensor Tympani Instrument 8.00 
181 Webster's N.Y. Polyclinic Set of Eye Instru- 
ments 72.00 
1969 173 Wecker's Canulated Needle 2.00 
1963 171 Corneal Incision. 
1869 154 Double Strabismus Hook .. 4.00 
1928 164 Iridotomy Scissors 8.00 
1794 147 Lachrymal Canula 1.25 
1874 154 Strabismus Hook 1.25 
1056 8 Weed's Cyrtometer 10.00 
1261 49 Weir's Antiseptic Spray 15.00 
Antiseptic Spray, with Gauze 16.00 
Antiseptic Spray, with Gauze and 
Movable Tube 17.00 
Antiseptic Spray, with Gauze and 
Movable Tube, Large 21.50 
Antiseptic Spray, with Gauze and 2 
Movable Tubes, Large 24.00 
2224 219 Double Gouge Forceps 3.50 
2853 343 Meatoscope 1.25 
2371 237 Mouth Gag 7.00 
67 Pocket Set 30.00 GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
845 
Fig. Page. Price. 
Weir's Pocket Set, Aseptic $20.00 
2216 217 Rhinoplastos 3.00 
2 1 78 209 Sniff Glass .75 
2884 346 Urethrameter 18.00 
1671 120 Vaccinating Lancet .75 
1670 120 Vaccinating Lancet and Comb 1.00 
3 1 8 7 435 Weiss'Speculum 16.00 
3104 411 Thompson's Evacuator 30.00 
2934 355 Weisse's Bougie a Boule 1.00 
13 5 8 83 Bullet Forceps 10.00 
2935 355 Urethral Sound 1.00 
1931 164 Welker's Iridectomy Instrument 12.00 
1988 175 Wells'Enucleation Spoon 2.75 
2 5 3 2 277 Retractor, Tracheotomy 2.00 
3 7 01 527 Wells'(Spencer) Artery Torsion Forceps .. 3.50 
371 2 529 Clamp 6.00 
3 7 0 3 528 Clamp Forceps 8.00 
1 720 127 Ovariotomy Trocar 10.00 
Ovariotomy Trocar, Curved 11.00 
172 7 128 Ovariotomy Trocar, Latest 20.00 
3702 528 Pedicle Clamps, Set of 3, with Levers, 25.00 
36 9 6 526 Pedicle Forceps, Angular 5.00 
3697 526 Pedicle Forceps, Straight 5.00 
3 6 9 8 526 Pedicle Forceps, T Shaped 5.00 
3695 525 Sac Forceps 4.50 
378 5 548 Wenck's Amniontome 2.50 
3583 501 Wessinger's Uterine Dilator 4.50 
2 6 0 4 289 Westbrook's Curette, for Pleural Cavity 2.50 
2 3 7 5 237 Westmoreland's Speculum Oris 6.00 
29 6 2 362 Stricture Instrument 12.00 
28 8 0 346 Whalebone Bougie, Banks', each 1.25 
28 79 346 Bougie, Hunter's .75 
2864 345 Bougie, Olivary .75 
2878 346 Guide, Gouley's, each .50 
Guide, Otis' .75 
2612 292 Probang, with Silver Basket 3.50 
Probe, Buttles' .50 
33 6 0 473 Probe, Thomas' .50 
78 Whale Tendon Ligature, Ishiguro's, per 
coil .40 
1178 33 Wheel Electrode 5.00 
1450 91 Wheeler's Torsion Forceps 7.00 
29 9 6 375 Wheelhouse's Staff, Urethrotomy 2.00 
29 0 3 350 Wheelock's Reverse-flow Syringe 2.00 
24 9 5 268 Whistler's Cutting Laryngeal Dilator 18.00 
White's (Blake), see Blake-White's. 
28 2 2 333 White's Elastic Scrotal Compress 3.00 
1071 11 Hsemarumascope 2.50 
2765 317 Hernia Ligator 10.00 
3608 505 Hysterotome 12.00 
3 7 3 8 536 Obstetrical Forceps 8.00 
2 8 2 2 333 Orchitis Compressor 3.00 
3799 549 Perforator 4.50 
Urethrotome (Blake White's) 40.00 
3 5 8 4 501 Uterine Dilator 4.50 
3438 485 Uterine Repositor 5.00 
3783 546 Vectis 2.50 
2331 233 Whitehead's Gum Knife 1.50 
1586 102 Hoe ... 1.50 
2332 233 Hoe 1.50 
232 3 232 Mouth Gag 12.00 
23 2 9 232 Paring Knife, Right and Left, each.. 1.50 
26 5 8 302 Rectal Dilator 3.00 
23 2 4 232 Seizing Forceps f 4.50 
2334 233 Spiral Needle, Right and Left, each.. 1.75 
3158 427 Staff and Knife 12.00 
4414 770 Urethrotome 15.00 
2312 231 Whitson's Harelip Clamp 3.00 
1500 95 Wight's Amputating Knife 5.50 
146 5 92 Artery and Ligature Forceps 1.75 
38 8 2 575 Bandage Shears 3.50 
123 9 39 Blowpipe 11.00 
69 Pocket Set 37.00 
Pocket Set, Aseptic 20.00 
Fig. Page. Price. 
25 9 9 287 Wight's Spray Apparatus $5.00 
4335 758 Wilcox's Foot Piece for Taylor's Hip Splint 
4221 717 Genu Valgum Brace 30.00 to 35.00 
3686 519 Hysterectomy Pin 1.00 
3 6 9 2 525 Sac Forceps 5.50 
4334 757 Umbilical Truss 20.00 
1919 163 Wilde's Canulated Forceps 12.00 
1918 163 Canulated Forceps, Scissors and For- 
ceps-Needle 15.00 
2006 184 Gorgeret 1.00 
2063 192 Polypus Snare 3.50 
1998 183 Tubular Ear Speculum, Set of 3 : 
Hard Rubber 1.50 
Plated 2.50 
Silver 4.00 
2 5 8 6 285 Wile's Spray Apparatus 
3471 489 Wilhoff's Pessary .50 
3 5 3 8 495 Stem Pessary .75 
3 5 6 5 498 Tent Expeller 4.00 
2230 220 Wilkerson's Revolving Trocar 3.50 
40 7 9 650 Willard's Hip-joint Splint 30.00 to 50.00 
1 789c 147 Williams' Lachrymal Dilator 1.00 
1 789a 147 Lachrymal Probe .75 
17896 147 Lachrymal Probe .75 
1789(1 147 Lachrymal Style .50 
1789e 147 Lachrymal Style .50 
264 3 299 Rectal Speculum 4.50 
2818 332 Varicocele Clamp .75 
28 1 7 332 Varicocele Clamp 4.00 
Wilson's Uterine Dilator 9.00 
1053 7 Winterich's Percussion Hammer 2.50 
29 2 5 352 Winternitz's Psychrophor, Silver 4.00 
Psychrophor, Soft Rubber 2.50 
3328 457 Wire Adjuster, Bozeman's 2.00 
327 6 450 Adjuster, Sims' 1.25 
3277 451 Adjuster, Sims' 1.50 
3309 454 Cutter, Abbott's 6.00 
3331 458 Cutter, Perry's 6.00 
3278 451 Cutter, Sims' Scissors 3.50 
3330 458 Cutter, Tucker's 6.06 
3675 516 Ecraseur, Sajou's 4.00 
434 1 759 Ecraseur, Skene's 7.50 
2739 311 Ecraseur, Smith's, Curved 6.0C 
3668 515 Ecraseur, Smith's, Straight 5.00 
See also Ecraseur. 
1841 151 Eye Speculum .75 
4083 ^$53 Gauze Hip Splint, Hamilton's 15.00 
39 7 7 608 Gauze Splint, Byrd's 5.00 
2131 199 Nose Clamp 1.00 
2064 192 Snare, Blake's 3.50 
2208 215 Snare, Bettman's-Jarvis' 8.50 
2042 190 Snare, Bosworth's 4.00 
Snare, Bosworth's, with Curved and 
Straight Ends 5.00 
2207 215 Snare, Bosworth's-Jarvis' 5.00 
4326 756 Snare, Cohen's 4.00 
43 2 8 756 Snare, Cohen's Combination 
2205 214 Snare, Jarvis' 3.00 and 4.00 
Snare, Jarvis', with Curved and 
Straight Ends 5.00 
3675 516 Snare, Sajou's 4.00 
Snare, Sajou's, with Curved and 
Straight Ends 5.00 
Snare, Sajou's, with Scissor Handles. 11.00 
Snare, Stoerk's 11.00 
2063 192 Snare, Wilde's -- 3.50 
Suture, Iron, per dozen coils .25 
Suture, Silver, per coil .50 
13 1 6 79 Suture Needles, per dozen .50 
39 7 9 609 Splint, Clendinen's 
39 7 5 608 Splint, Smith's 3.00 
See also Wire Gauze Splint. 
332 1 456 Twister, Dawson's 2.50 846 
GEORGE TIEMANN & CO.'S SURGICAL INSTRUMENTS. 
Fig. Page. Price. 
3316 456 Wire Twister, Fitch's ..34.50 
Twister, Tiemann's 4.50 
33 1 5 456 Twisting Forceps, Emmet's 3.00 
33 1 4 456 Twisting Forceps, Nott's ... 3.00 
621 Wiring Bones. 
4010 . 
to >621 Fluhrer's Set for Wiring Bones 18.00 
4013 ' 
22 3 4 222 Wisdom Tooth Forceps 2.00 and 2.75 
2235 222 Tooth Forceps, Lower 2.00 and 2.75 
2137 199 Woakes'Eustachian Catheter 1.50 
2149 205 Nasal Dilator 18.00 
Nasal Drill - 24.00 
2 1 79 209 Nasal Irrigator 1.25 
2213 216 Nasal Plough, Right and Left, each.. 2.50 
2212 216 Nasal Plough Guide, R. and L., each, 3.75 
223 1 220 Nasal Saw - 2.00 
2211 216 Nasal Scissors, Right and Left, each, 6.00 
418 5 699 Wolff's Spinal Cradle 10.00 to 15.00 
Wolverton's Tooth Forceps: 
22 5 9 224 Lower Bicuspids 2.00 and 2.75 
225 7 224 Lower Molar, either side 2.00 and 2.75 
226? Lower Roots, each 2.00 and 2.75 
2258 224 Upper Bicuspid 2.00 and 2.75 
148 6 94 Wood's Artery Clamp Forceps 2.25 
3137 421 Bisector. 4.50 
1496 95 Circular Knife 4.00 
1056 8 Cyrtometer .... 10.00 
56 General Operating Set 74.55 
68 Pocket Set 27.50 
3138 421 Staff 2.00 
4189 701 Torticollis Head Rest 5.00 
1714 126 Trocar 5.00 
Truss, Double 8.50 
2782 323 Truss, Single 5.00 
3497 491 Woodward's Pessary 1.25 
34 9 8 491 Pessary 1.25 
4412 770 Speculum Vaginas 5.50 
Uterine Scarificator 3.50 
34 1 8 482 Uterine Syphon Douche 2.50 
4371 764 Uterine Syringe for Nitrate of Silver, 4.00 
1275 71 Woodworth's Pocket Set 22.00 
3 5 5 7 497 Wooster's Tenaculum Forceps 2.50 
563 Wounds and Injuries: 
See also Fracture, Dislocation, Ex- 
section. 
Adhesive Plaster, see Adhesive Plaster. 
38 5 3 566 Antiseptic Ball. 
566 Antiseptic Dressing, Lister's. 
Antiseptic Spray Producers, see Anti- 
septic Spray. 
Antiseptic Surgery Materials, see 
Antiseptic Surgery Materials. 
569 Bandaging: 
38 7 6 574 Bandage Roller 3.00 
571 Hardening Bandages. 
387 5 574 Roller Bandage. Send for Price List. 
3851 565 Cooling Coil, Esmarch's. 
3958 601 Cradle for Protecting ...... 20.00 
12 7 9 75 Douche, Tiemann's 6.00 
38 5 4 567 Douche, Wyeth's 4.00 
74 Dressing Materials. 
See also Antiseptic Surgery Ma- 
terials. 
Fig. Page. Price 
Wounds and Injuries: 
38 5 0 564 Irrigator, Esmarch's .. §4.50 
38 6 2 569 Ligature, Antiseptic 1.00 
3861 569 Ligature Carrier, Fowler's 3.50 
43 9 7 769 Ligature Carrier, Ware's 1.50 
3849 563 Litter. 
Pus Basin, see Pus Basin. 
Shears for Removing Plaster Bandages, 
see Bandage Shears. 
38 6 3 569 Spools and Jar 
38 7 2 573 Stanchion 5.00 to 8.00 
Suture, see Ligature, also Suture. 
73 Wright's Antiseptic Pocket Set, No. 2 38.00 
60 General Operating Set... 140.00 
73 Pocket Set, No. 1 28.00 
1156 24 Wrist Band, Voltaic 1.00 
4205 710 Contracted, Apparatus for... 20.00 to 30.00 
4206 711 Drop, Hudson's Apparatus for, 25.00 to 40.00 
Wristlet, Cotton 1.25 
Silk 1.75 
Writer's Cramp Apparatus: 
4216 713 Apparatus 6.00 
4211 712 Charcot's and Cazenave's 15.00 
4213 713 Charriere's 9.00 
4217 713 Index and Middle Finger 5.50 
4212 712 Mathieu's 6.00 
4210 712 Nussbaum's 6.00 
4214 713 Pince Porte Plume 5.00 
4209 712 Velpeau's 10.00 
Wry-neck, see Spinal Braces for Torticollis. 
2766 317 Wutzer's Hernia Instruments 12.00 
148 2 94 Wyeth's Artery Clamp Forceps 2.50 
4073 6|7 Combination Method for Morbus Cox- 
arius. 
43 6 0 763 Conical Steel Bougies, Straight or 
Curved, each 1.25 
38 5 4 567 Douche 4.00 
4002 619 Drills, per set 7.00 
1615 107 Exsector 20.00 
3124 419 Lithotomy Bistoury 2.00 
133 0 80 Needle Forceps 4.50 
Needle Forceps, Combination 6.00 
1638 111 Subcutaneous Section Saws, per set - 8.00 
42 5 0 733 Talipes Shoes, each 6.00 
29 8 5 370 Urethrotome 35.00 
43 5 9 763 U. S. Scale .. 3.50 
33 5 8 473 Uterine Probe 1.00 
Wylie's Cervical Plugs, set of 9, each .75 
3372 I 
3373 ' 4 Cervical Speculum and Applicator .. 3.50 
472 Gynaecological Operating Set 100.00 
3554 497 Tenaculum Forceps (Angle Forceps). 3.00 
3 5 9 9 503 Uterine Dilator 6.00 
3638 511 Yarrow's Enucleator 4.50 
3223 443 Speculum Vaginae 8.50 
2148 204 Yearsley's Naso-Gutteral Probe .50 
2185 210 Naso-Pharyngeal Syringe 2.50 
23 9 2 242 Tonsil Knife 2.25 
29 8 8 371 Young's Dilating Urethrotome 50.00 
2 1 59 206 Zaufa J's Trichter Specula, 3 sizes, each ... 1.50 
34 7 4 489 Zwank's Hysterophore 1.50