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           SYSTEM


                    OF



    SURGERY:




           BENJAMIN BELL,
MEMBER OF THE ROTAL COLLEGES OF SURGEONS OF EDINBURGH AND
  IRELAND, ONE OF THE SURGEONS TO THE ROYAL INFIRMART,
     AMD FELLOW OF THE ROTAL SOCIETY OF EDINBURGH.



    ILLUSTRATED WITH COPPERPLATES.



              VOLUME  IV.
SECOND AMERICAN, FROM THE SEVENTH EDINBURGH EDITION,


           CORRECTED AND ENLARGED.      ^

                                 r  ■     ' ■ ?

                               CO j  ',  * <* T»^
TROY, NEW-YORK:
^•SV
       PRINTED BY O. PENNIMAN AND CO.

roR themselves; thomas and Andrews, boston; t. s. arden,

     NEW-YORK ; AND J. CONRAD AND CO. PHILADELPHIA.
                .................                 f
                  I 804. 
 
EXPLANATION
       OF THE


PLATES.
                    Plate  I.

    FIGURE .1.  A flat trocar.
     Fig. 2.  A curved grooved director, for introdu-
cing a feton or cord along the courfe of an abfcefs.

                   Plate II.

   Fig. i. A fcrew tourniquet, defcribed in Volume I.
Chapter VII.  Every  part of this inftrument is repre-
fented of the full fize.  It may  either be made  of
brafs or fteel, and the  flrap mould be  of ftrong un-
yielding materials, at  leaft  an inch broad,  and  of a
length fufficient  to pafs eafily round the  largeft cir-
cumference of any of the extremities.
   Fig. 2.  A  fpring fleme, defcribed in Chapter XIII.
Section I.

                   Plate III.

   Figs. i. and 8. Two forms of a tenaculum, for the
purpofe of pulling out  blood veflels to be tied  with
ligatures.
   Figs. 2. and 4. Two needles, fomewhat different in
the curve from  thofe  in common ufe: the handles
being nearly ftraight, they are thereby managed  with
more  eafe than  the   others, particularly  in  deep
wounds.
a 2 
4            Explanation of the Plates*

   Figs. 3. and  5.  Two needles of the ufual form, but
neither thefe nor the other two have an edge on their
concave parts.   They are fomewhat round like a lan-
cet, both on their convex and concave  fides ;  which
adds to their ftrength, and  makes them  enter with
more eafe than  the thick round form of the others.
   Figs. 6. and  7.  Two ftraight needles for futures of
the inteftines, and  other delicate parts.
   Many inftruments have been propofed for holding
needles, when employed in deep wounds :  the  porte-
aiguille, reprefented  in Plate IV. fig. 1. anfwers this
purpofe as well as  any other, but inftruments of this
kind are  feldom needed.  All thefe inftruments are
reprefented of a proper lize for ufe.

                   Plats  IV.

   Fig. 1.  A Porte-aiguille, mentioned  in  the  expla-
nation of Plate  III.
   Figs. 2. 3. and 4.  Gold pins,  ufed in the twifted
future, defcribed in Vol. I. Chapter VI. Section V.
   Fig. 6.  A gold  pin, with a fteel point, alfo ufed
fpr the twifted future.
   Fig. 7.  A moveable point of fteel, fitted to the gold
pin, fig. 8.
   Fig. 5.  A flat needle, fometimes ufed, in  fecuring
blood veffels contiguous to bones.
   All thefe inftruments are here of a full fize for ufe,

                    Plate  V.

   Fig. 1.  A fcarificator with fixteen lancets ; the dif-
ferent parts  of  which  are fo generally  well  known,
that it is not neceffary to defcribe it.
   Fig. 2.  A cupping glafs, fitted with an exhaufting
fynnge, for the purpofe of  extrading  blood  from
wounds made by the fcarificator, fig. 1.
   Figs. 3. and 4. The different parts of fig. 2.  repre-
fented feparately. 
Explanation of the Plates*
S
   Fig.  5., A ftrong curved needle, with a round,
though fomewhat  iharp point.   This inftrument  an.
fwers the purpofe better than any other yet propofed
for paffing ligatures below the artery in the operation
for the aneurifm, and beneath the fpermatic  cord in
the operation of calibration.

                   Plate  VI.

   Figs. 1.  and 2.  The beft forms pf lancets  for  the
operation of bloodlettings defcribed in Vol. I. Chapter
VIII. Section I.
   Fig.  3.  reprefents the broad  mouldered lancet in
common ufe,  but  which, from its form, is evidently
ill fuited for this nice operation.
   Figs. 4^ and 5. reprefent two different forms of fcal-
pels in common ufe : either of them anfwer the pur-
pofe, but fig. 5. cuts more eafily than the other. Fig.
4. proves ufeful in fome of the leffer operations, fuch
as opening the fac in  the fiftula lachrymalis.  This
laft is of a  full fize for thefe purpofes; but the larger
fcalpels fhould be fix inches long, and ftronger than
they are ufually made.

                   Plate  Vlf,

   Fig. 1. A reprefentation of the trephine of a  full
fize for ufe.
   Fig. 2. Forceps for the purpofe  of removing  de-
tached portions of a fractured fkull.   They are^lfo
ufed for taking out pieces  of the fkull that have been
feparated or cut out by  the  trephine, when they  do
not come away in  the head of the inftrument.
   Fig. 3. A head  of a trephine with larger teeth than
the inftrument in common ufe j  and along the courfe
of the faw, there are three vacuities in which the teeth
are entirely wanting :  by this it is  fuppofed  that a
piece of bone may be cut out more quickly than with
the common trephine, and that tjie  inftrument need 
 6           Explanation of the Plates*

 not be fo frequently removed for  the  purpofe  of be-
 ing cleared of the fmall fragments of bone produced
 by the faw: when the teeth of this faw are firm and
 properly fet, it  cuts both quickly and fmoothly, but
 not better than the inftrument in common ufe.

                   Plate  VIII.

   Fig. i. This figure reprefents the inftrument, com-
 monly named a  trepan.   As the page does not admit
 of the full fize, every  part of it is  about one-third lefs
 than it ought to be.   The upper part of the handle is
 of timber ; the reft fhould all be polifhed fteel.
   For reafons that I have given  in Chapter X. Vol.
 II. every operator fhould be provided with this inftru-
 ment as well as  with  the trephine, Plate VII.  fig.  i.
 the fame heads being made to fit both inftruments.
   Fig. 2. This inftrument is commonly termed a len-
 ticular.   It is ufed  by fome for fcraping the edges of
 the opening in the bone formed by the trepan, when
 they are found  to  be rough and  unequal:  for this
 purpofe, it is fharp on one fide, and the button on the
 top is meant to protect: the brain,  and to  receive the
 pieces that fall  from  it.   There  is rarely, however,
 any caufe for ufing it: I have  never found it  necef-
 fary, but I have  given a view of it, as it forms part of
 the apparatus of every furgeon for the operation of
 the trepan.
   Fig. 3. A rafpatory for removing the pericranium,
 beijp-e applying the trepan ; but no more of the fkull
 fhould ever be denuded than is  merely neceffary for
 the purpofe.

                   Plate IX.

   Figs.  1. and 2. Two inftruments termed probangs,
for the purpofe  of pufhing  fuch fubftances into the
ftomach as are fixed in  the cefophagus.   It  confifts
of a piece of foft fponge,  firmly tied  to  a piece of 
Explanation of the Plates.             J
flexible whalebone, fifteen or fixteen inches in length.
The whalebone fhould be well polifhed ; and in order
to render the introduction of it as eafy as poflible, it
mould be dipped in fine oil.
   Fig. 3. A fcarificator, for the purpofe of opening
abfcefles  in the fauces, or for fcarifying the amygdalae
when inflamed.
   Fig. 4. The fcarificator covered with a fiiver canu-
la.  A, The handle of the fcarificator ; B,  a fcrew-
nail fitted to the hole in the fcarificator ;  by which
the length of the point to be left uncovered at the ex-
tremity of the canula C, may be exactly regulated.

                    Plate X.
   The figures in  this plate reprefent all the parts of
the trephine feparately.
   Fig. 1. The handle of the trephine^ which fhould
be made of timber, and of the form here reprefented.
   Fig. 2. The faw or head of the trephine : the up-
per part of it fhould fit  with much exactnefs an open-
ing in the under part of the handle, fo that when in-
ferted into  it the hole  B may be oppofite to the end
of the fcrew A,  when by turning the fcrew A, the two
parts of the inftrument  may  be firmly connected to*
gether.
   C,  the nut of a fcrew palling through a flit in the
handle of the head, and fixed in the upper part of a
moveable pin, D.   In ufing this inftrument, the point
of the pin D is  made to project paft the  teeth of the
faw, till an imprefiion is  made  upon the fkull^)f a
fufficient depth  for retaining it, when the pin fWuld
 be removed : this  is eafily done, by moving the nut
 C to the upper  part of the flit, and fixing it there by
 turning  the fcrew.   All the parts of the trephine are
 here alfo reprefented of a full fize for ufe : the diam-
eter of the  faw  fhould not be lefs than an  inch.   Of
this fize it is ufed  with the fame eafe as faws of the
fmalleft  diameter, and the opening formed by it  being
larger, it anfwers the intention of the operator better. 
8
Explanation of the Plates.
  Fig. 3.  A head of a fmall fize fuch as is common-
ly ufed:  the pin E  is in this inftrument fixed by  a
fcrew into the  bottom of the head, and is taken out
by means  of the key, fig. 4- but the method of mov,
ing the fcrew, as reprefented in fig.  2. is in every re-
fpect better.
  Fig. 5.  A perforator for forming a fmall hole in
the centre of the piece of bone on which the head of
the trephine is to be applied, and into which the pins
D,  E, figs. 2. and 3. muft be inferted.  The perfora-
tor fhould be exactly fitted to the handle of the in,
ftrument,  fig.  1. to which it muft be fixed  by the
fcrew A in the  manner directed for fixing  the head
to it.
                   Plate XI.
  Figs. 1. and 3. reprefent the different parts of a le*
Vator nearly the fame with that of Mr. Petit.   Fig. 1.
a frame fupported by  two feet with a  pin and movea-
ble ball on the  upper  part of it: this pin muft  be of
a fize correfponding  to  the holes in the levator, fig.
3, and the ball fhould move with freedom in every di-
rection, by which the point of the inftrument may be
carried with eafe from one part to another, while the
frame on which it is fixed is kept firm in its fituation
by an afliftant.
   Fig. 2. The two  parts of this inftrument joined to-
gether, and ready for ufe.
   Fig 4.  The levator  in common  ufe ;  but this in-
ftrument, while it elevates one part of the fkull, muft
prefs with fo much force upon another, that it never
ou^t to be ufed, efpecially as the levator, fig. 2. an-
fwers with perfect fafety every purpofe for which the
other can be employed.

                   Plate XII.
   Fig.  1. A delineation of fome parts of the eye, re-
 ferred to  in different parts of Chapter XL*
  * Vide Defcriptioncm Anatomicam Oculi, Ieonibus I!hifh"af.am.  Auc-
tore johanne Gctfrcid, Zinn. M. D, 
Explanation of the Plates..            9
  a, Thefe points reprefent the openings or orifices
of the glands of Meibomius ;  by which, a vifcid glu-
tinous fubftance, commonly termed the gum of the
eyes, is feparated and discharged.
  d, The caruncula lachrymalis.
  c, The membrana femilunaris, which feems to have
fome effed in direding the tears  towards the punda
lachrymalia b, from whence they are conveyed by their
corresponding duds into the faccus lachrymalis <?, and
afterwards to the noftril by the nafal dud.
  In the cure of the fiftula lachrymalis, it is of much
importance to be well  acquainted with the anatomy
of thefe  parts ; of which this delineation will convey
a more exad idea than could  be given by description.
  Fig. 2. A fharp pointed inftrument, from its figure
termed a hafta, by which the  eye may be fixed in ex-
trading  and  couching the catarad; but it does not
anfwer the purpofe fo well as  different inftruments to
be hereafter defcribed.
  Fig. 3. A fpeculum oculi in common ufe,  but  it
does  not fix the eye fo well or fo eafily as the fpecu-
lum delineated in Plate XIII.  or  the  inftrument,  fig,
5. Plate  XXII.              »
  Fig. 4.* A very ufeful form of knife for various op-
erations on the eyeball and eyelids,  particularly for
cutting or fcarifying turgid blood veffels on the eye:
a lancet is commonly ufed for this ; but this knife  is
ufed with more fteadinefs, and being round or blunt
on the back, it does not fo readily injure the contigu-
ous parts.

                   Plate XIII.

  The figures in this plate reprefent different views of
an inftrument frequently mentioned in  the courfe of
this work.  Various forms of a fpeculum oculi have
been delineated in books; but they have feldom been
ufed in pradice.  They have  in  general  been  found
either to comprefs the eye too much, fo as to induce 
10
Explanation of the Plates.
pain and inflammation; or not to fix it fufficiently.
The inftrument here reprefented, when properly pol-
ifhed, creates little uneafinefs, at  the fame time that
the eye may be fo compreffed with it as  to  be kept
perfedly fteady.  The handle may be either of fteel
or timber, but the reft of it fhould be  made of filver
or fine polifhed fteel.   Operators fhould be provided
with fpecula of different fizes.  The views here delin-
eated are taken from a fize that anfwers for moft part
of adults.
   A well adapted fpeculum is an ufeful inftrument in
many difeafes of the eyes, but particularly in the op-
erations of couching  and extrading the cataract.
Some having imagined, that it may be an advantage
to be able to withdraw the fpeculum while the knife
or needle remains in the eye, it has been  propofed to
leave a vacant fpace  for this purpofe in the circle of
this inftrument, which furrounds the  eyeball, as is re-
prefented in fig. 3.  The fpeculum fhould be always
kept, however, upon the eye, as long as either the ex-
trading knife or couching needle remains in it, other-
wife the eye  cannot be rendered  fufficiently fteady:
but to thofe who are of a different opinion, this form
of the inftrument delineated in fig. 3. will anfwer the
purpofe.
                   Plate XIV.

   Fig.  1.  A bandage for the eyes, ufually termed
gogles, by which any quantity of light can be admit-
ted that a patient may wifh for, while,  at the fame
ttoie, the eyes are fufficiently proteded, without being
kept too warm, or too clofely  tied  down, as is com-
monly done with the bandages ufually employed.   It
confifts of two pieces of polifhed timber, excavated in-
to the form of cups, but open at both ends, and cor-
refponding to  the fize of the eyes for which they are
intended :  and thefe being covered with black or green
 gauze, they  are fixed by  the riband tied round  the
 head. 
Explanation of the Plates*
n
  Fig. 2.  A cup of an oval form, for the purpofe of
bathing the eyes either with water or any other liquid.
Being of an oval form correfponding to the fize and
figure  of  the orbit,  the eye  can fje more effedually
wafhed or bathed  in any liquid contained in it than in
any other  manner.
  Fig. 3.  A bag of refin elaftica, fitted with an ivory
pipe for the purpofe of injeding  warm water between
the eyelid and ball of the eye, in order to remove fand,
lime, or any other extraneous matter that happens to
be lodged between them.
  Figs. 4. and  5. Pipes of different forms, that may
be occafionally  fitted to one of thefe bags.
  Fig. 6.  A flat hook, either of polifhed filver or fteel,
for feparating the eyelids from  each other.   This is
commonly done by the fingers of the operator, or by
an afliftant; but in many of the more minute opera-
tions on  the eye, this kind  of flat hook is employed
with much advantage : fo that every furgeon in  this
branch of bufinefs fhould be  poffeffed of it.

                    Plate XV.

  Fig. 1. A couching needle of the beft form that  I
have feen.  It  penetrates the eye  more readily than
the round needle, fig.  2. and the catarad is  more ea-
fily depreffed with it.
  Fig. 3. A needle of a flat  form, fimilar to  fig. j.
with a fmall curve near to the point.  With this curve
I have fometimes found that  the catarad is more eafi-
ly depreffed than with a ftraight needle;  but  I haVe
not yet ufed it  fo frequently as to be able to fpeak with
certainty about it.
   Figs. 4. and 5.  Two needles for performing  the
operation of couching, by entering the inftrument at
the internal angle of the eye, and pufhing it out to-
wards the other.   By which  means the operation may
be  done  upon the  right eye with the right hand;
whereas,  with  the common  ftraight needle, the left 
 12            Explanation of the Plates*

hand  muft be ufed for the right eye;  a degree of
fteadinefs, which fome praditioners cannot always at-
tain with the left hand*
  Ail thefe inftruments are delineated of a fize fit for
ufe.   The handles fhould be made  of light timber,
and the fteel part  of them polifhed in the moft exqui-
fite manner.  None of them fhould exceed forty grains
in weight, including that  of the handle.

                  Plate XVI.

  Fig. i.  A form of a knife for the operation of ex-
trading the catarad.   It  fhould be tolerably firm, and
highly polifhed.   Near the point both  fides of the
knife  fhould be  fharp, by which the cornea is more
eafily  penetrated, but backwards the upper edge of it
fhould be round;  which  not only gives more ftrength
to the inftrument, but makes the rifk lefs of hurting
the iris.
  Fig. 2.  A knife of the  fame form in the cutting part
of it with fig. i.   But by means of the bend, the op-
eration may be performed on the right eye with the
right hand of the  furgeon.
  Fig. 3.  A knife commonly ufed in Germany in ex-
trading the catarad,
  Fig. 4.  A fmall fcoop for removing either the whole
body' of the lens, or any part of it, when in extrading
the catarad it happens to  lodge either in  the pupil or
anterior chamber  of the  eye, between  the  iris and
tranfparent cornea,

                  Plate  XVII.

  Fig. 1. A delineation of the eye with the couching
needle inferted into it.
  Fig. 2.  The knife employed for dividing the cor-A
nea in extrading the catarad, is here inferted acrofs'
the eye, between the cornea and iris.  And in fig. 4.
the cut is delineated which ought to be formed in the 
Explanation of the Plates'*
*3
cornea in the ufual method of performing this opera-
tion.   Fig. 3. reprefents the cornea divided in the fu-
perior part of it, in the manner I have  mentioned in
defcribing the method of extrading the cataract.

                 Plate XVIII.

  Fig. 1.  A view of the right eye with one.of the
curved needles of Plate XV. inferted into it; by which
it is evident that a catarad  may be  couched in the
right eye with the right hand of the furgeon.
  Fig. 6.  Reprefents a curved knife inferted beneath
the cornea in the operation of extrading the catarad
with the right hand from the right eye.
  Fig. 2.  A  fharp curved probe for removing the cat-
arad, by making an opening behind  the iris, in the
manner I have advifed in the Chapter on that opera-
tion.
  Fig. 4.  Small forceps* which may occafionally be
employed for the fame purpofe.
  Fig. 5.  A flat curved probe, either of gold or fil-
ver, for inferting through the pupil,  in  order to  tear
or form an opening in the capfule of the lens, fo as to
admit of an eafy expulfion of the catarad.
  Fig. 3.  A  tube of fteel, with  an edge  fufficiently
fharp for penetrating a hard bone, by which a portion
of the os unguis, correfponding to the fize of the tube,
may be removed, when in the operation for the fiftu-
la lachrymalis this may be judged proper.

                  Plate XIX.

  Fig. 1.  An inftrument for the purpofe of comprefC-
ing the lachrymal fac.   AA, a curved  plate of fteel
covered with flannel or  filk, and adapted to the fore-
head, upon which it is fixed by the ribands CC.  B,
Another plate of fteel conneded to the former; which
paffing  back towards the occiput, ferves  to  fix the
machine with more certainty by  means  of the riband 
14          Explanation of the Plates.

C at its extremity.  D, a fmall moveable bar of fteel,
paffing through an opening in the plate A A, to be
firmly  fixed at any particular height by the  fcrew F.
G, a fmall cufhion or button of fteel covered wif£ filk
or foft flannel; which being placed upon the Corner
of the eye immediately above the lachrymal fac, any
neceffary degree of preffure may be applied by means
of the fcrew H.   The moveable bar D is feparated in-
to two pieces by a fcrew at E ; fo that by turning this
fcrew,  the cufhion G may be turned more or lefs out-
ward at pleafure,  according to the particular  form of
the part on which it is to be applied.
  The inftrument here delineated is intended for the
left eye; but it is eafily made to anfwer the right eye,
by moving the bar D into the flit or opening on the
oppofite fide of the plate  A A.
  Fig. 2. A trocar and canula, for perforating the os
unguis in the operation for the fiftula lachrymalis.
  Fig. 3. The ftilette ; and, fig. 4. the canula, repre-
fented  feparately.
   Fig. 5. A curved trocar ; the inftrument common-
ly employed for  the  fiftula lachrymalis j  but the
ftraight trocar, fig. 2. anfwers better.

                   Plate XX.

   Fig. 1. A filver fyringe, for the purpofe of throw-
ing  liquids  into the lachrymal paffages.  Fig. 4. A
curved tube, adapted to the fyringe, and  of  a proper
fize for being inferted by the noftril into the extremi-
ty of the nafal dud of the lachrymal fac.  Fig. 5. A
fmall tube, of a  fize correfponding to the lachrymal
punda, for throwing injedions through thefe openings
into the fac.  Figures 6. and 7. Tubes of a larger
fize, for throwing liquids through the fac into the nofe
by an external opening,  when  this  has either been
made by an incifion, or  when the fac has  burft, in
confequence of tears and matter colleding in it. 
             Explanation of the Plates*            15

  Figs. 2. 3. 8.  9.  10. and 11. Tubes of different
forms, which have been employed in operating for the
fiftula lachrymalis, when the paffage  through the os
unguis cannot in any other manner be kept free and
pervious.   Of thefe, however, figs. 3. and  10. are the
beft.   The fmall bulge with which they are  formed,
not only prevents them from paffing through the open-
ing altogether into the nofe, which cylindrical tubes
are apt to do, but when they are once properly fixed,
it prevents them from rifing againft  the fkin, which
they are otherwife ready to do.  The tubes here  re-
prefented, are of fizes, both as to length and  thick-
nefs, which anfwer for the moft part of adults; but
thefe are circumftances which muft depend upon the
nature of every cafe, and will accordingly be liable to
fome variety.  Tubes for this purpofe fhould be made
of gold, polifhed in the fineft manner.

                   Plate XXL

   Fig. 1. A curved fcalpel, employed by fome prac-
titioners for extirpating the eyeball.   By its form it is
fuppofed to be well fuited for this purpofe;  but the
common ftraight fcalpel I have  repeatedly found to
anfwer better.
   Figs. 2.  3. and 4.  Curved probes, of a proper fize
for inferring by the noftril into the nafal dud of the
lachrymal  fac, by thofe who wifh to clear thefe paf-
fages in this manner.
   Figs. 5.  and 6.  Probes of a fmaller fize, for infert-
ing into the lachrymal punda.

                  Plate  XXII.

   Fig. 1. The knife commonly ufed by Mr. Pellier
in extrading the catarad.  It  fhould be highly pol-
ifhed,  and fo fharp as to penetrate the eye with eafe,
at the fame time that  it fhould be fufficiently ftrong
for dividing the  cornea without yielding.   This, as 
 16           Explanation of the Plates.

well as the other two knives in this  plate, are made
to fit the handle reprefented in Plate XXIII. fig. i.
   Fig. 2. A knife exadly of the fame form and fize
with  the other •* only in this,  that fide which paffes
next the iris is round or convex, with a view to pro*
ted that membrane from  being injured,  which it is
apt to be when the common flat knife is employed in
eyes that are not prominent.
   Fig. 3. A probe pointed knife, which in fome cafes
may be employed with advantage for finifhing the op-
eration, when by any accident  the aqueous humour
efcapes before the point of the  other knife has pierc-
ed the oppofite fide of the cornea : but for a more
particular account of the method  of ufing it,  I muft
refer to what has been faid in defcribing the  different
fteps of the operation.
   Fig. 4.  Curved  fciffars of a proper fize for every
operation on the eyes where fciffars are needed :  in-
deed every praditioner who operates on the eyes fhould
have them.
  Fig. 5. This is the only fpeculum  which Mr. Pel-
lier employs.  It may be made  of gold or filver wire,
or of any other metal.  It is here reprefented of a full
fize for adults, both in length and'  thicknefs  of wire.
In ufing it, one of the curves is placed upon the up-
per eyelid, diredly behind the cartilaginous  border ;
and being given to an  affiftant, a  degree of force is
applied with it fufficient for fixing the eye  ; which is
eafily done,  if the operator at  the fame time makes
fome refiftance, by placing the index and  middle fin-
gers of one  hand on  the under edge of the orbit, fo
as to comprefs the  eye beneath.
  All the inftruments of this plate  are reprefented of
the full fize.

                 Plate  XXIII.

  Fig. 1. A knife  ufed by Mr. Pellier in fome cafes
for extrading the catarad.  It is fixed in the handle 
              Explanation of the Plates.           17

at B by a male fcrew, fitted to a female fcrew, which
is turned by  the nut A.   This handle may be made
to anfwer figures 4. and 5. as well as every knife em-
ployed in operations of the eyes.
   Fig. 2.  An  inftrument for depreffing the under
eyelid.   When an affiftant cannot  be procured, it
may often prove ufeful.  The two flat hooks at  the
upper end of  it  being fixed on the cartilaginous edge
of the eyelid, the other end of  it hanging over the
cheek, by its weight draws it down.
   Fig. 3. An inftrument for determining the quanti-
ty of fkin to be  removed in operating for the trichia-
fis or inverfion of the eyelids.   When it is found ne-
ceffary to remove a portion of flcin from beneath the
under eyelid, or from the fuperior part of the upper
palpebra, it may be done with a common fcalpel, while
an affiftant fupports it from the parts beneath either
with his fingers alone or  with forceps made for the
purpofe ;  but this inftrument anfwers better, as by
means of it the quantity of parts to be removed can
be afcertained, and cut off with more precifion.
   Fig. 4. A  knife for  opening fmall  colledions of
matter on any part of the eyeball.  Being blunt on
the back, and round on the end,  it  is ufed without
any rifk of injuring the contiguous parts.
  Fig. 5. A fharp pointed  curved knife for dividing
the veflels of the eye or of the palpebrae.
  Thefe inftruments are all delineated of the full fize,

                  Plate XXIV.

  Fig. 1.  A curved needle fixed in a handle, for paff-
ing ligatures beneath the  pterygium and other fmall
excrefcences fometimes met with on the external fur-
face of the eyelids, and not unfrequently on the eye
itfelf.   Fig.  1. is intended for tumors on the right eye,
and to be ufed  with  the left hand  of the  furgeon*
  Vol. IV.        B 
 18           Explanation of the Plates.

Fig. 4.  is for the  left  eye, to be ufed with the right
hand.
  Figs.  2. and 3. An inftrument termed a ciftatome,
being meant for opening the capfule. of the cryftalline
lens.  It may be made  of gold  or  any other metal.
It is held between the thumb and fore and middle
fingers of the right hand, care being  taken to  place
the thumb upon  the button A or C, which is conned-
ed with  a fheath  that covers the  fharp point B.   The
hand being fupported on the cheek by the ring finger
and little finger, the point of the inftrument  covered
with the fheath muft be cautioufly paffed through the
pupil till it reaches  the lens ; when the button C be-
ing drawn back  with the thumb, the  point of the in-
ftrument is thus fet at liberty,  without the hand being
moved.   This is  an ingenious invention, and  anfwers
the purpofe with  eafe and fafety.
  Thefe inftruments are all reprefented of the full fize.

                  Plate XXV.

  Fig. 1. A fmall fcoop, which anfwers better than
any other inftrument for removing fmall ftones, peas,
and fuch like fubftances, from the noftrils or ears.
  Figs.  2. 3. 4. 5. and 6. Are inftruments employed
by Mr. Pellier for the operation of the fiiftula lachry-
malis.   Fig. 2. is a perforator and condudor for clear-
ing the paffage through the os unguis into the  nofe.
Figs.  5.  and 6.  are tubes  for leaving in the  paffage.
Fig. 3. is a compreffor for fixing them after they are
inferted  ; and the eafieft method of inferting a tube
is by putting it  upon the condudor after it is paffed
through the  compreffor, as  is reprefented  in fig. 4.
The condudor, armed with  the tube and compreffor,
being paffed through  the paffage into  the nofe,  muft
be withdrawn ; when, by  means of the compreffor,
the tube may be  firmly fixed.
  Thefe inftruments are all reprefented of the full fize. 
Explanation of the Plates.           i9
                  Plate XXVI.

   Fig. 1.  Forceps of a convenient form for extrading
fmall bones or other  fubftances from the throat.
   Fig. 2.  An inftrument for preventing the noftrils
from collapfing after the operation defcribed in  Vol.
II. Chap. XII. Sed.  IV.  A B, Two moveable tubes
for inferting into the  noftrils, to be retained  in their
fituation by a riband  paffed  through the opening CD,
and tied on the back part of the head.
   Fig. 3.  A fide  view of one of the tubes..
   Thefe inftruments are all  reprefented of  the  full
fize.  They, as well as  fome others in this volume,
are taken from fome  elegant engravings publifhed by
Mr.  Bambrilla of Vienna.
   Fig. 4.  A tube for the purpofe of conveying a wax-
ed ligature through one of the noftrils into  the fauces,
when the ligature being  drawn out at the mouth,  a
cufhion or pad is  attached to it, when it is drawn forc-
ibly into the back part of the nofe, for the  purpofe of
putting  a flop to hemorrhagies from the  noftrils  that
do not yield in any other manner.   See Vol. II. Chap.
XII. Sed. II.
                 Plate XXVII.

  The figures in  this plate reprefent inftruments of
Mr. Wathen's for the cure  of the fiftula lachrymalis.
  Figs.  2. and 3. A  tube and tent for inferting  into
the natural paffage between  the lachrymal fac and the
nofe : thefe inftruments may either be of lead, filver,
or gold  : when of filver or  gold, it is neceffary to have
one or two turns of a female fcrew in the top of the
cup or cylinder ;  but not when formed of lead.
   Fig. 4.  The ftile of the tube.
  Fig. 5.  The ftile of the tent.
  The ftiles are meant to condud their correfponding
tubes and tents into the paffage.   And,
              b 2 
24
Explanation of the Plates.
   Fig. i. A fcrew ftile for the  purpofe of removing
 the tubes or tents when neceffary, for which purpofe,
 however, fmall forceps anfwer better.
   Figs. 6. and 7. A tube and tent with a firing fixed
 to an aperture at the top of each.
   Figs. 8. and 9. A tube  and  tent with a  ftile and
 firing  united to each, and ready for ufe.
   Thefe tubes and tents,  Mr.  Wathen obferves, are
 of the  largeft fcale : there are two inferior fcrews ; the
 middlemoft of which proves moft generally applicable.
   1 have thus given a delineation of this part of Mr.
 Wathen's apparatus, with which I doubt not that the
 fiftula  lachrymalis may be cured ; but I confider it in
 every  part as inferior to what  I have delineated  in
 Plate XXV. both  for the form of tubes and method
 of introducing them.  For  a more  particular  detail,
 however, than can be given here of the method of uf-
 ing Mr. Wathen's apparatus, his book fhould be con-
 fulted ; in which many valuable obfervations will be
 met with.*

                  Plate XXVIII.

  Fig. 1.  Mr. Berenger's knife  for the operation of
 extrading the cataract.
  Fig. 3.  Baron  Wenfel's  knife.
  Fig. 4,  Dr. Richter's knife.
  Fig. 2.  A fpeculum  oculi,  the  invention  of my
 friend  Dr. Wardrop, whofe experience in difeafes of
 the eyes has been very extenfive.
  This fpeculum  will be found  very ufeful when the
operator cannot have the aid of  a good affiftant.   In
fcarifying  the  veffels of the eye, this inftrument an-
 fwers the purpofe of holding back the eyelids com-
pletely, and gives a fufficient degree of fteadinefs to
the ball of the eye.  The infide  of the eyelids are alfo

  • Vide A New and Eafy Method of curing the Fiftula Lachrymalis;
the fecond edition, &c.  By Jonathan Wathen Phipps, furgeon, London. 
Explanation of the Plates*           ai
 turned outwards, at the fame time that they are pufh-
 ed backwards, fo as to expofe the parts in the moft
 complete manner.
   The hinge fhould be made very eafy, that the op-
 erator may have little refiftance to overcome, and thus
 he will be more fenfible of the degree of preffure  to
 be made upon the eye.  The other parts muft be fo
 firm as not to yield to any force that may be employ-
 ed.   The points of the forceps are conneded with the
 femicircular pieces obliquely, to prevent the hand that
 holds  the inftrument from obftruding the light.
   Thefe femicircular parts fhould be covered with thin
 leather that has fome degree of roughnefs.
   In ufing the inftrument,  it fhould be placed fhut
 upon the eyelids, and gradually opened as the eyelids
 are pufhed backwards : thereafter as much preffure is
 to be made as may be found neceffary.
   Fig. 5.  Small forceps, ufed by Baron Wenfel, for
 taking out the capfule of the lens, when in the oper-
 ation  of  extrading the catarad  it is found  to be
 opaque.

            Plates XXIX. and XXX.

   The figures in thefe plates form a very ufeful part
 of the apparatus of an oculift.  It is employed by Mr.
 Bifchoff.*
   All the figures of Plate XXIX. reprefent a chair on
 which the patient  is placed during the  operation of
 extrading the catarad, by which his head is kept much
 more fixed and fteady than it can  poflibly be in the
 ufual way,  fupported  on the breaft of an affiftant;
 and as fteadinefs is  of the greateft importance in all
 operations on the eye, the  ufe  of this chair  may be
 extended to many others.

  * For a more particular account of this apparatus, fee a Treatife on th«
Extraction of the Cataract, by Frederick Bifchoff, F. M. S. Oculift to hit
Majcfty in the Electorate of Hanover, and to her Majefty in England. 
22           Explanation of the Plates.

  Figs. i. and 2. Reprefent a ftrong made chair, to
which  is faftened a  back A,  which on each fide by
means  of a fcrew B,  moves backwards and  forwards.
In the  top D, which  can at C, if neceffary, be turned
back, is a concave cloth cufhion for the greater  fecu-
rity of the head, and to prevent it from flipping : be-
ing made of a height to admit of the operator Hand-
ing, there are different pieces of wood, Plate XXX.
fig. 1.  to put under the cufhion, fig. 2. each of thefe
pieces  of wood  have two pegs E F, which fit corre-
fponding holes in the feat of the chair :  the cufhion,
fig. 2. Plate XXX.  is made  in a wooden frame, to
which  is fixed two projeding pieces of iron, which go
through  the holes  E  F  in the chair,  fig. 2. Plate
XXIX. and faften at  the back, in the back part of the
chair with an iron peg, fig. 3. HH.
  In fig. 3.  Are two bars I I, to fupport the top : K
is a ftand to prevent  the top from falling, received in-
to the  notches L, which enable the operator, by their
different diftances,  to incline the moveable  top  more
or lefs  backwards as  he may find convenient.
  Fig. 3.  Plate  XXX. reprefents a very  ufeful band-
age for different operations on the eyes, particularly
for the after treatment of the operation for the cata-
rad.   It confifts of a double piece of linen AA, about
three fingers broad, and proportioned in length to the
circumference of the head : at each end  are fixed two
firings BB to tie it on  the forehead : to  this piece of
linen are fewed two pieces of double, dark coloured
filk or linen, CC, about fix fingers fquare, fo that the
piece which covered  the difeafed eye fhould be a little
under  the other  piece,  that no light may poffibly reach
the eye on which the operation has been  performed ;
while fome degree of light, if the operator thinks pro-
per, may be admitted to the other.
   Fig. 4. is a knife for extrading the catarad, nearly
the fame, although fomewhat different from Dr. Rich-
ter's, Plate XXVIII.  fig. 4. 
              Explanation of the Plates*           13


                  Plate XXXI.

   Fig. 1.  A double canula for fixing ligatures upon
 polypous excrefcences either in the nofe, throat, ears,
 or vagina.  The ligature may either be of catgut or
 pliable filver wire.
   Figure 4. Another canula for the  fame purpofe.
 When the other is ufed, the ligature is tied round the
 handles of the inftrument.  In this the ligature paffes
 through a moveable  handle, and is eafily turned to
 any degree of tightnefs.
   Fig. 2.  Is a canula of the fame kind with the oth-
 ers ; but being crooked, it is better calculated for re-
 moving polypi deeply feated in the throat.   The me-
 thod of ufing thefe inftruments is defcribed in differ-
 ent  parts of Chap. XII. Sed. V.
   Fig. 3.  Is an inftrument for paffing a ligature over
 the  uvula.  A thread being paffed through the tubu-
 lar part of the handle with  the probe A, a noofe is
 then formed on it; and being lodged in the groove
 on the infide of the rin^, the other end of the thread
 is paffed through the two fmall holes on the outfides
 of the ring ; and thus it is ready for ufe.  This is
 Commonly termed the  ring of  Hildanus, from  the
 name  of its inventor.   All thefe inftruments are re-
 prefented of the  full fize.

                 Plate XXXII.

   Fig. 1. A fedion of the bones of the head, repre-
 fenting a polypus in the throat hanging down behind
 the  velum pendulum palati,  with  a ligature  paffed
 over it and fixed at the root of it,  with  a double  ca-
 nula inferted through one of the  noftrils.
   Fig. 2. This figure is  taken from Mr.  Chefelden.
 It reprefents a polypus  in the nofe, with part  of it
paffing back to the  throat, and the reft into the nof-
tril,  with a ligature inferted from the noftril  into the 
24           Explanation of the Plates.

throat, in fuch a manner as to include the root of the
excrefcence in its doubling.  By afterwards  twilling
the ends of the ligature, a degree of compreflioii may
be applied upon  the root of the polypus fufficient for
making it drop off; but it would not anfwer in every
cafe; and as the  method with the canula, Plate XXXI.
is not only more eafy but more  effedual, the other
will never probably be ufed.

                 Plate  XXXIII.

  Fig. i. A polypus of fuch a fize that^ it filled thr
noftril completely, and was removed with a ligature
as is here reprefented.  A, The extremity of the po-
lypus which appeared without the noftril. C, A probe
of filver or any other metal, fplit at the end^ in fuch
a manner as to retain a piece of catgut or filver wire;
the doubling of  which being inferted into  the flit,
fhould be pufhed up to the root of the  polypus on
one fide, while the tube B being'pafied  upon the two
ends of it, muft be pufhed up to the root of it on the
oppofite fide, when the ligature may be eafily drawn
to any neceffary  degree of tightnefs.
  Fig. 3. A flit  curved probe, which may be ufed for
the fame purpofe, namely, for applying  a  ligature  to
the root of a polypus in tumors feated  in the throat.
By this fimple invention a ligature may  be carried  to
the throat of almoft every polypus that can occur.

                 Plate  XXXIV.

  Fig. 1. An inftrument for applying cauftic to any
part of the mouth or throat.   It may be made of fil-
ver or any other metal. A, a moveable tube in which
the cauftic is fixed, v/hen by pulling the ring at the
other end, it muft be drawn fo far into the furround-
ing canula as to  be completely covered with it; when
v\c end of the inftrument  being applied  upon the part 
Explanation of the Plates.           25
affeded, the cauftic muft be again pufhed forward to
a proper length, which may be always afcertained with
accuracy by means of the fmall pin tied by a thread
to the ring at the oppofite end of it.  This, as well as
the inftruments of Plate XXXIII. I am favoured with
by Dr. Monro, whofe improvements in furgery are
numerous and important.
   Figs.  2. 3. and 4. are  different parts  of an inftru-
ment mentioned in Sedion V. Chapter XII. Vol. II.
for the purpofe of putting a ligature round a polypus
in the throat.
   Fig, 2. A waxed  thread with  a noofe adapted to
the fize of the groove in the ring C D, fig. 3.  ED,
E C, Two tubular pieces of brafs, each of which is
two inches and a half long, fupporting the ring which
is placed horizontally upon them. At the upper ends
of each  they  fhould be made perfedly fmooth and
round, fo as to allow the thread to flide eafily, and to
prevent it from being cut by the edges  of the tubes.
C D, The apertures  where the ends of the thread are
inferted.  E,  One of the openings at which they are
brought  out.  The other  opening cannot be feen in
this view of the inftrument.   The handle of the in-
ftrument is of ftrong wire, feven or eight inches long,
and bent a little that it may be the more eafily intro-
duced.
   Fig. 4. An inftrument for making a fecond noofe.
F, Two brafs wheels fixed in a fmall cafe of brafs.
The two wheels are five-eighths of an inch broad, and
half an inch deep. After forming a fecond noofe, the
ends of the thread fhould  be paffed over the wheels
in the manner here reprefented, when the handle of
the inftrument being pumed upwards, a knot may be
formed of any degree of tightnefs.
   This inftrument is evidently formed upon the fame
principle with the ring of Hildanus, Plate XXXI. fig.
3. and was the invention, I believe, of the late inge-
nious Mr.  Dallas, furgeon in Muffelburgh. 
i6
Explanation of the Plates.
                 Plate XXXV.

  Fig. i.  Curved forceps for extrading polypi from
the throat, and  from behind  the  velum pendulum
palati.
  Fig. 2.  Straight forceps for extrading polypi from
the noftrils.
  Fig. 3.  Forceps for the fame purpofe with the laft,
but fomewhat different  in  form.  The method  of
ufing both thefe and the others, is defcribed in Sed.
V. Chap. XII. Vol. II.

                Plate XXXVI.

  Figs. 1. 2.  and 3. Different  forms  of curved fcif-
fars, for extirpating tumors within the mouth, as well
as for other purpofes.
  Figure 4.  An  inftrument  nearly of the  form of a
fleme, which anfwers better than any other for fcari-
fying the gums of children in dentition.

                Plate  XXXVII.

  Fig. 1.  A fcarificator for feparating the gums from
the roots of teeth intended to be extraded : it  fhould
be very fharp, but at the fame time not fo fine  in the
point or edge as to  be  hurt by being infinuated be-
tween the gums and the teeth.
  Fig. 2. A  curved  trocar for perforating the an-
trum maxillare.
  Figs. 3, and 4. Two diffeding hooks with two and
three prongs, which anfwer better for many purpofes
than the finglc pronged hook in common ufe.

                Plate XXXVIII.

  Fig. 1.  An inftrument for paffing a ligature round
the uvula  or any other pendulous excrefcence  in the 
             Explanation of the Plates.           27

throat; but although the propofal is ingenious, it does
not anfwer the purpofe fo well as the inftruments de-
lineated in Plate XXXI. figs. 1, 2, 3, and 4.
   Fig. 2. An inftrument firft propofed by Mr. Chef-
elden for tying a knot upon fchirrous amygdala? after
paffing a ligature through the bafis of the tumor, in
the manner reprefented in fig. 3.  The pin in fig. 2.
is meant to reprefent  a part upon which a knot is to
be formed.
                 Plate XXXIX.

   Fig. 1. An inftrument for removing the uvula by
excifion.  That  part of the uvula intended to be re-
moved being paffed through the opening in the body
of the inftrument, the  cutting Aider, which ought to
be very fharp, muft be  preffed  forward with fufficient
firmnefs  for dividing it from the parts above.
   Fig. 3. A curved probe pointed  biftoury,  for re-
moving fmall tumors in the throat or any part of the
mouth ;  and fig. 2. forceps for laying hold of tumors
intended to be removed in this manner.

                   Plate XL.

   Figs. 1, and 3. Two fcarificators of different forms
for opening abfeeffes in the throat, and for fcarifying
the amygdalae.   The two wings with which the canu-
la of fig. 1. is furnifhed, are intended for comprefling
the tongue, while the point of the inftrument is paffed
more deeply into the throat.
   Figs. 2, and 4. Mr.  Mudge's machine for convey-
ing  fteams of warm water and other liquids  to  the
throat and breaft.   Fig. 2. The inhaler as it appears
when fitted for ufe, except that the grating A, which
then ought to cover the hole, is now turned back, to
fhew the opening into  the valve.  Fig. 4. A fedion
of the cover, in which is fhewn the conftrudion of
the cork  valve B, and  alfo the conical  part C, into
which the flexible tube  D is fixed. 
; 8            Explanation of the Plates.

  When the inhaler, which holds about a pint, after
bcra- three parts filled with hot water, is fixed at the
armpit under the bedclothes, the end of the tube E is
to be applied to il:e mouth ; the air, in the ad of re-
fpiration, then rufhes into the apertures  F, and  paff-
ing through the hollow handle, and afterwards into a
hole in the lower part,  where it is foldered to the
body,  and therefore  cannot be  reprefented, it  rifes
through the hot water, and is received into the lungs,
impregnated  with  vapour.  In exfpiration,  the  con-
tents of the lungs are difcharged upon the furface of
the  water ;  and  inftead of forcing the water back
through the hollow handle,  the air efcapes  by lifting
the round light cork valve B, fo as to fettle upon the
furface of the body under the bedclothes.
  Thus  the whole  ad  of  refpiration is performed,
without removing the inftrument from the mouth.
  The flexible part of the tube D is about fix inches
long, fitted with a wooden mouth piece E at one end,
and a part G of the fame materials at the other, to be
received into the cone C on the cover.   This flexible
tube is made by  winding a long flip of filk oil fkin
over a fpiral brafs wire;  which is then  covered  with
one of the fame fize, of thin filk, and both fecured by
ftrong fewing filk wound fpirally round them. Some
length and degree of flexibility is  neceffary to  this
tube, for the fake of convenient accommodation to
the mouth when the head is laid  on the  pillow.
   Care fhould be taken to make the cover fit very
exadly ; otherwife the defed fhould be remedied by
winding a piece  of cotton wick, or fome fuch  con-
trivance, round the rim  beneath the cover, fo as to
make  it air tight.   The  cork,  likewife,  which forms
the  valve, fhould, for the  fame reafon  be made as
round as poffible.  It  is alio neceffary to remark, that
the area of the holes on the upper part of the handle
taken together ;  the fize of the hole in the lower part
of the handle which opens into the inhaler ; the open-
ing of the conical  v,!ve itfelf; and that  in the mouth 
             Explanation of the Plata.           29

piece ; as well as the cavity or infide of the flexible
tube, fhould be all equally large, and of fuch dimen-
fions, as to equal the fize of both noftrils taken to-
gether ;  in fhort, they fhould be feverally fo large as
not only not to obftrud each other, but that reipira-
tion may be performed  through them  with no more
labour than is exerted in ordinary breathing.

                   Plate  XLI.

   Fig. 1. A fpeculum oris, which I propofed a con-
fiderable time ago, and which in different  cafes has
been ufed with advantage.   By occupying lefs fpace
in the mouth than the  inftruments in common ufe,  it
may be employed where they are inadmiffible.  B, a
handle of timber, through which the  fcrew A C  is
paffed, by which the plate of iron. D may be more or
lefs feparated from the fixed plate E, by turning the
nut A.  The plates D E fnould be fufficiently firm for
refilling the  preffure  of the jaws, and covered with
leather or cloth to prevent the teeth from being injured.
   Fig. 2. Another form of a fpeculum  for the mouth.
G H, Two firm iron plates, which being inferted be-
tween the teeth of the upper and  under jaws, may be
feparated to any neceffary degree  by turning the han-
dle F.   The farther extremity of the plate G is inten-
ded to comprefs the tongue,  an addition which may
be eafily made to fig.  1.
   Fig. 3. The inftrument in common  ufe as a fpecu-
 lum oris ; but it is fo  defedive that it can feldom be
 ufed  with advantage.

                   Plate  XLII.

   Fig. 1. A kind of cutting forceps, the invention of
 the late Dr.  John Aitken: they may be employed
either in the hare lip,  or for the removal of cancer of
the lip : one blade of the forceps is a plane fmooth
furface, while the other is furnilhed with a fharp cut- 
 30           Explanation of the Plates.

 ting edge.   In ufing  this inftrument the two  blades
 muft be preffed againft each other with one hand with
 a force fufficient to divide the parts that are meant to
 be cut; while the other hand is employed in fecuring
 the handles.
   Figs. 2.  and 3.  Forceps, for laying hold of the  lip
 in performing the  operation for the hare lip, or in re-
 moving cancers of the lip, by which the parts are more
 fecurely fixed, and may be more neatly cut than when
 held with the fingers only.
   In fig. 2. the blades are both lined with timber, and
 the blade A  A being  confiderably broader than the
 other, the lip may be divided by cutting diredly down
 upon it, and carrying the fcalpel in clofe contad with
 the fide of the oppofite blade.

                  Plate XLIII.

   Fig. 1.  Sciffars  of a fufficient fize and ftrength for
 dividing the parts  in the operation for the hare lip.
  Fig. 2.  Cutting pliers for the purpofe of removing
 fmall fplinters of bone wherever they are met with, par-
ticularly in the amputation of limbs.

                  Plate XLIV.

  As the cure of the hare lip is a point of much im-
portance, I have judged it proper to delineate the ap-
pearance of the difeafe, together with that of the parts
in which it is feated during the different flages of the
operation and cure.
  Fig. 1.  A  hare lip, in its moft common form.  A,
 One of the incifores appearing in the centre of the
opening, which ought to be removed before  the  ope-
ration, as a tooth in this fituation is very apt to interrupt
the cure.   B B, The unequal edges of the fiffure with
which hare lip is very commonly attended.
  Fig. 2. The appearance of the parts after the edges
of the fiffure have been removed and the  pins intro- 
Explanation of the Plates.            31
duced.   C C, The edges of the cut, which ought to
be fmooth, equal, and exadly of the fame length on
each fide, fo that when drawn together no inequality
may take place.  The firft pin fhould be inferted near
to the under part of the lip, and the  upper pin near
to the fuperior point of the fiffure.  The pins repre-
fented in this figure are furnifhed with moveable fteel
points, fo that the points may be taken away on the
ligatures being applied, as  is done in fig. 3. which ex-
hibits the appearance of a  hare lip immediately after
the operation.
   Fig. 4. A lip after the cure is finifhed.   D, Repre-
fents the appearance of the cicatrix, which in general
fhould be nearly a ftraight line.
   Fig. 5. A flat pin for the operation  of the hare lip.
The pin itfelf, fig. 6. fhould be of gold, and the point,
fig. 7, of fteel.
                  Plate XLV.

   Figs. 1, 2, 3, 4, and  5. Different forms of fcaling
inftruments for removing  tartar and other extraneous
matter from the teeth.
   Figs. 6. and 7. Inftruments that may be employed
either for burning the nerve of a tooth, or for fluffing
a hollow tooth with gold or lead.  Fig. 8. may like-
wife be  employed for the fame purpofe, but it is more
frequently ufed for fearching behind and between the
teeth, when there is any fufpicion of a latent caries
that is not readily difcovered.
   Fig. 9. Another inftrument for fluffing carious teeth.
And,
   Fig. i o. A handle to which  all thefe inftruments
may be fitted.
                 Plate  XLVI.

   Fig. 1. The inftrument commonly termed a  key
for extrading teeth.   After many alterations being
made in it, the one here delineated is the beft I have
ever ufed. 
32           Explanation of the Plates.

  In fig. 2. the inftrument in common ufe, the claw
is fixed, and can only be moved by taking out the
fcrew by which it is conneded with the inftrument;
but in fig. i. the claw can be moved from one fide to
another,°merelv by preffmg upon the nut A, by which
the fpring B is'raifed  out of a niche in a wheel which
is thus rendered moveable, and in which  the  claw  is
fixed.   C, The  heel of the inftrument which is here
reprefented not only of a greater depth, but confider-
ably longer than ufual:  of this length it is applied to
a confiderable extent  of gums, by w hich the jaw is not
fo apt to be injured as when the heel is much fhorter ;
and of this depth it ads with more power than when
of the uiual form.  This part of the inftrument fhould
no; only be well polifhed,  but thickly covered with
feveral plies of foft old  linen  in order to render the
preffure produced by  it upon the gums as eafy as pof-
fible.  The handle E is fometimes made of iron ; but
it anfwers better  either of ivory or timber.
  Fig. 3. A claw bent  in fuch a manner, that when
the heel of the inftrument C is placed upon any part
of the gums, the fecond or third tooth farther in the
mouth, may be pulled with it.   This proves fometimes
ufeful, where the gums oppofite to the affeded tooth
are particularly  tender ; and it fhould always be em-
ployed  when it  is meant  to pull either of the two
fartheft molares of the lower jaw outwards ; for in
ufing the common inftrument for thefe teeth, the gums
that cover the projeding part of the coronoid procefs
of the jaw are always much lacerated.
   Figs. 4. and 5.  Two claws of different fizes of the
ordinary form.

                  Plate  XLVII.

   Figs. 1. and 3. Two inftruments much employed
 in different parts of Europe for extrading teeth. They
 do not, however, poffefs any advantage over  the key
 inftrument j  and they are liable to this objedion, that 
             Explanation of the Plates*           33

they cannot be ufed where a tooth muft be turned to-
wards the infide of the mouth.
   Fig. 1. A, The fulcrum, which ought  to be  well
covered with foft old linen or cotton :  B, the  claw
fixed to the handle D, by a fmall hole in  the end  of
it, which receives a knob of  a correfponding fize, at
C, and is retained in its fituation by a moveable  plate
of polifhed iron D.   The handle fhould be wood, and
all the reft of the  inftrument iron or fteel.  Fig.  2.
A claw with a confiderable degree of curvature, for
extrading teeth at a greater depth in the mouth  than
the fulcrum can be placed at.
   Fig. 3. F, The fulcrum.  E, A ftraight claw fixed
to the inftrument by a fcrew at H.  I, The handle,
which fhould be of wood.

                 Plate  XLVIII.

   Figs. 1.3. and 4. Different forms of forceps for ex-
trading teeth.  Fig. 3. is the moft ufeful of any that
I have feen.
*   Fig. 2. Small diffeding forceps employed in differ-
ent operations in the mouth, as well as in other parts.

                  Plate  XLIX.

   Fig.  1. Teeth forceps with moveable claws,  A.
And,
   Fig. 2. A fulcrum to be ufed  along  with  the for-
ceps, fig. 1. both defcribed in Vol. II. p. 426.
   Fig. 3.  An inftrument for dividing the  frsenum
linguae,

                    Plate  L.

   Figs. 1, 2, and 3. Different forms of  a punch or
lever for extrading flumps of teeth.  Figs. 1. and 3.
are the beft.   They confift of two parallel plates of
   Vol.  IV.        C 
34           Explanation of the Plates.                j

polifhed iron, which may be feparated more or lefs bj   f
preffing the moveable Aiders A B higher or lower.
  Figs. 4, 5, 6, and 7. Different forms of files for re-    ;
moving inequalities upon teeth.   Some of thefe fhould    1
have one fide entirely fmooth, fo that in ading upon   t
a difeafed tooth, the contiguous  fountf tooth may not
be injured.

                   Plate LI.

  AH the figures of this Plate reprefent the edges of
wounds, drawn together and retained by adhefive plaf-   h
ters ;  for an account of which fee Volume I. Chapter
III. Sedion II. when treating of the cure of fimple in-    i
cifed wounds.

                   Plate LII.

  Figs.  1,  2, and 3.  Different forms  of inftruments
employed for concentrating found in cafes of deafhefs.
  Fig. 4. A fyringe of a proper fize for  wafhing the
meatus auditorius.                                  ."j.
  Figs. 5. and 6. Inftruments for perforating the lobes
of the ear.

                  Plate LIII.

  All the figures in this  plate reprefent glaffes for
drawing milk from the breafts of women.  With figs.
1. and 3. the breaft  may either be fucked by the per-
fon herfelf, or by an affiftant; and  fig. 2. is a  glafs
cup,  mounted with a  bag of elaftic gum.   A, The
glafs cup joined to the bag C by the intervention of a
brafs  tube B.

                   Plate LIV.

  Fig. 1. An inftrument for fupporting the head af-
ter  the operation for the wry neck.   A B C, A curv- 
Explanation of the Plates.
25
ed plate of iron, covered with foft leather and proper-
ly fluffed, fitted to the fhoulder, and fupporting anoth-
er plate, to the top of which is conneded the  plate
D E F, upon which  the head  is meant  to reft, and
which fhould alfo be  covered with foft leather or cot>
ton.  G H I, A buckle and ftrap for fixing  the in-
ftrument round the neck.
   Figs. 2, 3, and 4.  Different kinds of cups, which
may be either of ivory, lead or filver, for covering and
proteding the nipples, when they are either chopped
or otherwife difeafed.  The holes in their brims are
for receiving pieces of fmall tape for fixing them round
the body.
   Fig. 5. A broad flat needle, of a lancet form for
introducing cords or fetons in different parts of the
body.

                   Plate LV.

   Fig. 1. A very ingenious improvement of  the  key
.inftrument by Mr. Robert Clarke, furgeon in Sunder-
land.  The points in which this inftrument chiefly dif-
fers from the key in  common ufe, are the manner in
which it is conneded with  the handle A B, the form
of the claw  C, and of the fulcrum or reft F,  and the
bend in the fhank at D E, by which in drawing teeth
inwards, the foreteeth are more certainly avoided than
can be done with the common inftrument.
   This  inftrument is alfo, fo contrived that the claw
can be quickly changed or  turned to an oppofite di-
redion, by means of a Aiding bolt paffing through the
claw, inftead of  a fcrew: but  for a  more particular
account  of it, fee Medical Fads and  Obfervations,
London,  Vol. VI. Art. VIII.  by which Mr. Clarke
feems to have made fome alterations in  the  form of
the inftrument;  the  one that he there defcrfbes being
fomewhat different from that which the cutlers here
have made of it.
c 2 
*6           Explanation of the Plates.

  Fig. 2.  Is an inftrument, from which, in particular
circumftances of incontinence of urine,  much advan-
tage may  be derived.   It was worn by a Dutchman
Who presented himfelf at this place three winters ago
with a fingular and curious conformation  or  part ot
the organs of urine  and generation, of which an ac-
count has already been publifhed.
  ABC, The body of the inftrument  fo conitructed
as to be exactly adapted to the parts on which it is
applied : this, as well as  all the reft of the machine,   -
fhould be  made of filver, with the edges properly fluff-   ]
ed with leather, flannel, or cotton, for proteding the
fkin on which it refts, and which is eafily done by
means of a number of fmall holes round the whole of
it at C.  It is fixed to a circular belt round the loins
by  two pieces of tape, one  at  the  opening  A, and
another on the oppofite fide of the inftrument, which
in this view of it cannot be feen,  and  at  E there is
another piece of tape which goes between the legs,
and fixes it to the circular belt behind.
  This inftrument proves particularly ufeful to all who
are diftreffed  with incontinence of urine, accompanied
with fiftulous openings in  the fcrotum or  contiguous
parts that communicate with the urethra, and it is ev-
en eafily adapted to thefe parts, fo as to cover  entire-
ly the  fcrotum and penis, by which it may be employ-
ed with advantage in every variety of the difeafe.
   When  urine paffes either from the penis, or from.
fiftulous openings that communicate  diredly with the
bladder, it runs down to D, the entrance into the re-
ceptacle E F, which contains feveral ounces, and from
whence the urine cannot again return, but paffes out
at the outlet  G, as  often as the patient finds it con-
venient to remove a well adapted cork with which the
opening G fhould be furniftied.

                  Plate LVL
   In this  plate is reprefented what I confider as an
important improvement on the apparatus for perforat- 
Explanation of the Plates.
37
ing the bladder above the pubes, an operation of much
moment, in fo far as it is never performed but in cafes
of great danger, and although eafily done, is apt to
induce fuch a  number of diftrefsful confluences, as
nothing but a continued courfe of attention, combin*
ed with much experience, and many opportunities of
performing the operation, can tend to obviate.
   By experience I have found, that the common tro-
car does not anfwer fo well for this operation, as one
of a larger diameter, and one  of a round form anfwers
better than a flat one, for a large round one does not
fo readily injure the bladder.
   Fig. i. A trocar of a proper fize,  both in length
and diameter.  A A, a  moveable cape or fhield, fixed
on the canula B by means of a fcrew, and from which
it can at any time be eafily removed.   The Aits and
holes in the cape, as may  be  more particularly feen in
the  front view of it, fig. 5. ferve  to attach  pieces  of
tape, for the purpofe of fixing the canula to a circular
belt previoufiy fixed round the loins j  as it is a point
of much importance in  this operation, to have the ca-
nula kept fteadily in its place, I have fometimes done
it by fixing adhefive plafters  to the cape of the canula,
and applying the plafters firmly upon the contiguous
parts : with fome, this has anfwered better than ban-
dages, but others have preferred the tapes attached to
a circular belt. In one cafe, where it anfwered remark-
ably well, the cape of the canula was fewed to the cir-
 cular band, by paffing the threads through the few fmall
round holes, and the canula, as well as the  belt, was
prevented from moving either upwards or downwards,
by two double pieces of tape, attached to the canula
at the long Aits,  two paffing  over the fhoulders were
carried backwards and fixed  to the circular band be-
hind, while the other two being carried downwards,
one on each fide of the fcrotum was  alfo fixed to  it
behind.   In this manner, after various methods had
been tried in vain,  the canula  was eafily kept in its
fituation. 
38           Explanation of the Plates*

   The next objed of importance, is  to  prevent  the
back part of the bladder from being hurt by the fric-
tion of the canula :  this we endeavour to do by ufing
a trocar that will not probably reach fo far ; but even
with this in view, the fharp  edges  of  the canula  are
apt to hurt the bladder.  It is however effedually pre-
vented by the addition of fig. 3, a firm filver wire with
a round button or Hopper of filver E,  which removes
the fliarp edges of the canula, as is feen at C,  fig.  2.
If E is exadly adapted to the canula, no urine gets in-
to it, by which no calculous incruftation  forms in  it,
as is apt to happen where this precaution is omitted.
D being a plug of common cork, the flopper is there-
by prevented from falling out.
   The patient fhould be warned to remove  the flop-
per frequently, and to empty the bladder ; for where
this is negleded, the urine neceffarily efcapes between
the bladder and  canula.
   It is fcarcely neceffary to  remark, that the  canula
muft in every inftance be worn till the urine flows free-
ly off by the urethra.   In a great proportion of cafes
this happens in the courfe of a fhort time, but in fome
not till many months have  elapfed.   During the  in-
flammatory ftate of the difeafe, the bladder  common-
ly forms fuch  adhefions to the contiguous parts, that
after the canula has remained long inferted, we might
in various inftances, withdraw it for the purpofe  of
clearing away, any incruftations that form in  it,  as  in
a great proportion of cafes, it could be eafily inferted
again : but as  thefe adhefions do not always happen,
and as much danger would occur from our  not being
able to replace the canula, it ought never to  be with-
drawn till another canula  is inferted,  which is eafily
done in the following maner :
   Let a canula be provided, fomewhat more than dou-
ble the length  of the other, and of a fize  that admits
of its paffage eafily through it: this canula muft con-
fift of two  pieces fcrewed together, as is reprefented
at F, fig.  4.  The  fhorteft  piece being  exadly the 
Explanation of the Plates.            39
  length of the canula of the trocar, being all paffed in-
  to it, the canula of the trocar is then to be withdrawn,
  by pulling it along the whole length of the tube : af-
  ter clearing the canula of the trocar, an attempt may
  be immediately made to replace it, by pufhing it along
4 fihe tube into the bladder;  and in fuch attempts we
  commonly fucceed : but we derive a very important
  advantage from having the long tube previoufiy infer-
  ted, as the patient remains  in fecurity in the event of
  our not being able to pafs  the other again into  the
  bladder, as in fome inftances  has been the cafe : in
  this cafe, a  cape or fhield, with  an opening fitted to
  the diameter of the fmall tube, muft be fixed upon it
  at  the fcrew H, when by  undoing the connedion of
  the two parts of the tube at the fcrew F, a canula is
  left exadly of the fame length with that of the trocar,
  to be fixed in the fame manner, and fitted with a cor-
  refponding plug or ftopper, fimilar to fig. 3.

                    Plate  LVII.

    The figures in this plate  reprefent a fet of inftru-
  ments for the  fame purpofe as thofe in the preceding
  plate, a very neat and elegant invention by I)r. Mon-
  ro, and the following explanation of them is  in  the
  Dodor's own words :
    Fig. 1. A trocar of an ordinary fhape, and of a pro-
  per fize.
    Fig. 2. A fteel canula with a handle:  the  canula
  is open on one fide, and thin at its point, that it may
  pafs eafily with the trocar into the bladder.
    Fig. 4, Gives a fide view of a blunt  filver  canula,
  which, after the trocar is withdrawn, is to be introduc-
  ed through the fteel canula, which has a broad fhield
  with holes in it for fixing it by ligatures in its  place :
  two views are given of the canula;  the oblique view
 of it fliews the diredion that it fiiould have in paffing
 into the  bladder, which fhould be  downwards and
 backwards, that it  may  be in lefs danger of injuring 
4"o           Explanation of the Plates.                 .1

the back part of the bladder.   A, a plate to be held    1
between  the finger and thumb, while the fteel canula     |
is withdrawing.  B, the end of the filver canula, to     J
be paffed through a hole in a piece of waxed or oiled    J
filk, and then tied to it: this piece of waxed filk faves^ , M
the fkin from being excoriated, and ferves, befides, to\
dired, occafionally, the urine into a bafon.
  Fig. 5. A fmall filver plug to  be put into the end
of the filver  canula, in order to prevent  the conftant
efcape of urine : this is to be taken out from time to
time, and the urine received into a bafon.
  Fig. 6. A perpendicular view of the fhield.   A,
The top of the canula.  B, a plate of  metal  which
ferves as  a handle, and likewife to conned the canula   |
to the fhield.   C, a large opening through which the
handle A of the fteel tube,  fig. 3.  may  pafs, and as
the oppofite fide  of the fteel tube has a flit in it, the
fteel tube can be withdrawn after the filver canula has
been paffed through it into  the bladder.
  D D D D, Holes in the Aiield, by means of which,
a circular ftrap  put round the  body, may be readily
conneded with it for fupporting it exadly in its pro-
per place.

                  Plate  LVIII.

  • The figures of this plate  reprefent an apparatus for
the cure  of hydrocle with injedions :  the method of
ufing it is defcribed in Chap. XXIV. Volume III. page
87.   The fyringe, Plate LXVII. fig. 5.  may alfo be
adapted to fig. 2.  of this plate, and ufed inftead of the
bag of refina elaftica, fig. 1,

              Plates LIX. and LX.

   The inftruments of both thefe  plates reprefent a
very ingenious improvement of the gorget by Dr. Jef-
fray of Glafgow ;  in which, befides an alteration in
the form of the gorget, a blunt and cutting gorger, 
Explanation of the Plates.
41
are very neatly conneded together, as may be feen by
the following explanation.
   Fig. i.  Reprefents a double  gorget  with  a fpring,
having the cutting gorget drawn back.
   a, a, The handle,  b, b, The blunt gorget, with c,
its knob, whofe fpine runs, for fome way,  down on
the blade,  d, d, The cutting  gorget.  /, A flit, in
the anterior end of the cutting gorget;  on the right
of this flit, the edge is fharp; on  the left, it  is  blunt.
g, A thumb piece,  h, A flat fpring paffmg down from
the bafe of the cutting gorget into the hollow handle
a, a.   k, k, Two nails conneding the two gorgets to-
gether in a way afterwards defcribed.
   Fig. 2.  Reprefents the fame gorget, having the cut-
ting gorget pufhed forward and prepared for the op-
eration.
   a, a. The handle,   b, The blunt gorget with c its
knob.  d, The cutting gorget, with its fliarp edge pro-
jeding, and its flit receiving, and  kept  from moving
to either fide, by the fpine of c.  e, The thumb piece
raifed.
   Fig.  3.  Plate LX. A back view of the gorget,  a,
The back  plate,  thin, and flightly convex,  covering
parts reprefented in the following figures.
   Fig. 4.  A front view of the blunt gorget,   a, a,
The metallic part of the handle,  with  holes^ in it for
the fcrew nails that fix on it  the hollow  wooden  part
of the  handle  reprefented in fig.  5.  b, The blade of
the blunt gorget,   c, A  long flit in b, in which are
two nails.  d,f, e, The flat thin  head, the fcrewed
point, and the  roller of thefe nails,   g, g, Their heads,
and refting lightly on the blunt gorget,   h, h, Their
rollers, in the flit, on a level with the anterior furface
of the blunt gorget, their diameter being  fomewhat
lefs than the breadth of the Ait, that they may turn,
in the Ait, eafily  on their nails.   /", /', Their points.
When the two gorgets are to be put together as in fig.
1.  and 2. Plate LIX. the back of the cutting  gorget
•is applied to the face of the blunt cne.   The two roll- 
 4a           Explanation of the Plate*.

 ers are laid in the flit of the blunt gorget over the two
 holes of the cutting  gorget feen at k, k, fig. i. the
 nails  are paffed through the rollers and fcrewed into
 the holes k, k, till their  flat heads touch  the  back of
 the blunt gorget.  The back plate is then fcrewed on,
 covering the heads of the  nails and the  flit,  making
 the back of the inftrument fmooth.   Thefe nails there-
 fore not only hold the two gorgets together, but with
 the fpine on the knob of the blunt gorget permit the
 cutting gorget to move  backwards and forwards only,
 while the  rollers make  that  motion fweet and  eafy.
 k, Another flit in the blunt gorget, in which the heel
 of the thumb  piece moves.   It likewife is covered by
 the back plate.
   Fig. 5.  A back view of the cutting gorget,   a, The
 wood in part of the handle hollowed out to receive b9
 the flat fpring that is conneded (fig.  1. and 2.) to the
 bafe of the cutting gorget, and terminates in a flat
 button like head c.   d, The fpiral fpring, that fur-
 rounds the flat fpring.   One  end of this fpiral fpring
 refts againft or may be fixed into the flat head of b;
 the other refts againft or may be fixed into d,' d9 the
 cheeks or anterior end of the groove in the  wooden
 handle,   e, e,  The holes for  the conneding  and di-
reding nails,  f The back of the thumb piece  con-
neded by a tranfverfe fcrew  nail to two projedions
from the back of the cutting gorget,   g, g, Holes for
the nails that conned the wooden and metallic parts
of the handle together.  N. B. Both the cutting and
blunt  gorgets diminifh a little in breadth from heel to
point, by which  the cutting gorget when  pufhed  for-
ward is broader than that part of the blunt gorget im-
mediately  behind it.   When, however, the  cutting
gorget is drawn back, it is narrower, and is defended
by that part of the  blunt gorget before which  it lies.
  From the figures and  the description of this inftru-
ment, the manner of ufing it will be underftood.  The
furgeon  holding it in his right hand as he does the
common gorget, raifes the thumb piece, and applying 
Explanation of the Plates.
43
 his right thumb to it, pufhes forward the cutting gor-
 get till the anterior conneding nail reaches the end of
 the flit, the button like head of the flat fpring, follow-
 ing the cutting gorget,  compreffes the fpiral fpring.
 The cutting edge now projeding, and the inftrument
 being  in every effential  point like the common cut-
 ting gorget, is introduced into the bladder in the ufual
 way ;  but as foon as this is done, the furgeon,  with-
 out taking his left hand from the flaff, or deranging
 his right hand, raifes his right thumb ; the cutting
 gorget is inflantly drawn back,  the thumb piece falls
 down; and the gorget, now in every material article
 a blunt gorget, remains in the wound, prefenting a
 fmooth furface, for conduding the finger or forceps,
 into the bladder, in queft of the flone.

              Plates LXI. and LXIL

   In  thefe  plates are reprefented an apparatus for re-
 moving  curvatures of the fpine.  The invention is
 very ingenious, and we owe it to Mr. Le Vacher, who
 made  it public in the year 1768, in the fourth volume
 of Memoires de L'Academie Royale de Chirurgie de
 Paris.  It has  fince that period been improved by Mr.
 Philip Jones of London.
   The chief intention of this inftrument is to  fupport
 the head, and gently to ftretch the fpine :  the flays
 D D, Plate  LX1I. to which the inftrument  is  attach-
 ed, muft be exadly fitted to the patient: E E E, are
 three loops  of iron fixed to the flays, through which
 a firm fteel  rod A B C is paffed to fuch a height, that
 the point of the curve at A may nearly touch the fore-
 head : G, is another curve of polifhed fteel,  neatly
 adapted to the upper part  of the head, over which it
 paffes from  ear to ear; and it is attached in a pendu-
 lous  ftate by  the  fcrew K to the rod ABC, upon
 which  it moves backward from A at pleafure.  HH H
is a ftrap of firm leather,  covered with filk,  pafling
round  the occipur, and fixed fufficiently tight on two 
 44           Explanation of the Plates.

 hooks or knobs to the two ends of the curve G.   II
 is another ftrap of the fame kind that paffes  beneath
 the chin, and 'is alfo attached by knobs or hooks to
 the. curved plate G.  On a proper application of thefe
 ftraps, the  utility of the inftrument in a great meafure
 depends.   The one  fhould cover the chin,  and the
 other be entirely below the occiput, and both of a de-
 gree of tightnefs adapted to the feelings of the patient.
   The inftrument being fitted  to the patient in the
 manner reprefented in Plate LXI. the head is thereby '•*
 completely fupported, at the fame time that the body
 is kept ered by the fteel rod ABC.  This rod fhould  a
 at firft be placed as high as the patient can eafily bear
 it, and every three or four days it  fhould  be raifed,  i
 which is eafily done by touching the fpring  F ; and
 after drawing  the rod upwards, it is again firmly fix-
 ed by letting the  fpring fall  into the correfponding
 notch.
   In all curvatures of  the  fpine, this machine proves
 ufeful, particularly where the difeafe is recent;  but it
 requires to be worn for a great length  of time : it
foon tends  to lefien the deformity, but the parts quick-
ly return to the fame degree of curvature if it be not
continued for  two or three years.

                  Plate  LXIII.

   Figs, i,  2, and 3, reprefent  different parts of a ma.
chine for injeding  tobacco fmoke into the redum.
   Fig. 1.  A brafs  box for containing the burning to-
bacco.  The  mark A is a bottom or divifion in the
infide of the box, perforated with' fmall  holes to ad-
mit the paffage of  the fmoke to the extremity of the
box B ; which, by a male fcrew, is adapted to a brafs
tube, fig.^ 3, at C, which is again fitted to  an elaflic
leather pipe D, terminated by  a common glyfter pipe
E.  The pipe D is made of waxed leather, proteded
by brafs wire rolled fpirally round it from one end  to
the other. 
Explanation of the Plates.           45
  Fig. 2, reprefents the covering of the box, figure 1,
to which it muft  be exadly fitted.   F, a divifion of
thin brafs, perforated with a number of fmall holes
for  admitting the paffage of the  air from a  pair of
bellows fitted to the opening G.
  Fig. 4.  The inftrument completely fitted on a fmall
fcale.  H, a pair of double bellows, whofe tube I is
fitted by a fcrew to an  opening  in the cover of the
box K, which again is terminated by the brafs tube L,
the  leather pipe M,  and the ordinary glyfter pipe  N.
  The box K being filled with burning tobacco, and
the glyfter pipe N  being inferted into the anus,  by
working the bellows H, any neceffary quantity of
fmoke may be very quickly thrown  up.
  It is fcarcely  neceffary to obferve, that all the  parts
of this machine ought to be exadly fitted to  each
other, with a view to prevent the efcape of fmoke at
any of the joints.
  Bellows of the ordinary  fize anfwer the purpofe %
and are preferable to thofe that  are  fmaller, as being
better calculated for injeding the fmoke quickly. The
brafs box for the  tobacco fhould be about an inch and
half in diameter, by three inches in length from the
brim to the  bottom ; the  brafs  tube conneded with
the box fhould  be fix inches in length, by a quarter
of an inch in diameter.   The  leather pipe ought to
be of nearly  the  fame diameter with the tube, and
about two feet and a half in length.  When  of this
length, it is  eafier  managed than when fhorter; and
it ferves more effedually  to cool the fmoke before it
reaches the bowels.
  The glyfter  pipe, at  the  end of the leather pipe, »
ought to be fomewhat larger and wider than thofe in
ordinary ufe.

                  Plate LXIV.

  Fig. 1.  Another  inftrument  for  injeding tobacco
fuioke, originally  invented by the celebrated Profeffor 
46            Explanation of the Plates.

Gaubius.   The principal difference between this and   "i
the inftrument reprefented  in Plate LXIII. is, that in
this the tobacco box A, is fitted to the air hofo of the
bellows; fo that in working the bellows, the air with
which they are fupplied entering at the openings  B,
the fmoke of  the burning  tobacco muft accordingly
pafs through them ;  and from the bellows it is thrown
into the other parts of the inftrument, and in that
manner tranfmitted to the interlines.
  The  inftrument reprefented in Plate  LXIII.  is
wrought with  more eafe than the one here delineated.
  Fig. 4. A crooked biftoury,  with a blunt or probe
point.   The curve here reprefented is much lefs  than
is ufually given to this inftrument, and the blade  is al-   1
fo much narrower : it ought, indeed, to be altogether
ftraight, excepting a very flight curvature towards  its
point.
  This biftoury is well calculated for  dividing the
flridure in cafes of hernia ;  for opening finufes in ev-
ery fituation ;  and particularly for dividing the redum
in the operation of the fiftula in ano.
  Fig. 3. A bandage for compreffing the temporal ar-
tery.   It is made of a well tempered fteel fpring, cov-
ered with foft  leather, and of the fame ftrength  with
what  is ufed  for the trufs of a hernia.  It fhould be
three quarters  of an inch broad, and fourteen or fif-
teen inches in  length.  I once had a fcrew, fitted with
a button to this bandage, the button, by means of the
fcrew being made to prefs upon the divided artery ;
but a comprefs of linen anfwers better,  and  is eafier
for the patient.  Bandages of linen, or other materials
of a yielding nature, do not anfwer fo  well for this
purpofe as thofe  of fpring  fteel, which remain  with
more certainty on the fpot on which they  are firft
placed.
  Fig. 2. A biftoury with a greater curvature  than
the other,  which in- finufes of particular  diredions
fometimes prove ufeful. 
             Explanation of the Plates.            47


             %    Plate  LXV.

   Fig. 1. A fpring trufs for  an inguinal or femoral
 hernia of the right fide.   A, the bolder or pad for
 preffing upon the opening at which the parts protrude.
 B, a ftrap with holes in it for fixing upon the  knobs
 on the back part of the pad.   C, a ftrap hanging
 down from the back part of the bandage, to be paffed
 between the legs of the patient, and to be alfo  fixed
 upon the knobs  of the pad  by the holes in its ex-
 tremity.
   This ftrap is intended to fix the bandage firmly in
 this fituation ;  but  if the bandage is properly made,
 and the fteel fpring of which  it is compofed is fuffi-
 ciently elaftic,  there is no neceffity  for  this  ftrap,
 which always frets and galls  the parts upon which it
 is made to pafs.
   Fig. 2, reprefents a bandage alfo for the right fide,
 but with no back ftrap, and by means of a retch the
 pad  can  be made to comprefs the parts more or lefs
 even after the belt is fixed.
   Figure 4.  A double bandage for a hernia on each
 fide, with two back ftraps conneded with it.
   The fteel  of which thefe  bandages are made fhould
 be covered with thin foft leather, properly fluffed with
 wool or flannel.  The pads fhould  be broader than
 they are ufually made, with a prominence or flight el-
 evation in the middle, and their fides perfedly flat.
   Fig. 3.  Reprefents a bandage for umbilical rup-
 tures.  A, a fteel fpring to be applied upon the um-
 bilicus after  the hernia has  been reduced, and to be
 retained in its fituation by the bandage B ; which, by
means of the ftraps C C C  and  the buckles  D D D,
 may be kept at any  degree of tightnefs.   E E, two
ftraps for paffing over the fhoulders ;  and  F, a  ftrap
for paffing between the legs,  the whole to be  fixed
upon knobs  on  the back part  of the bandage oppofite
to the frying A.    By  means of thefe  buckles  and 
48            Explanation of the Plates.

ftraps, the bandage may be preferved very firmly in
its fituation.                         40
  The belt B fliould be five or fix inches broad, and
the fteel  fpring A fhould be of a fize proportioned to
the opening  it is intended to prefs  upon.   All the
parts  of the  bandage fhould  be of foft leather, lined
with flannel or cotton.*

                   Plate LXVI.

  Fig. 1. A penary for herniae falling into the vagina:
it may be made either of refina elaftica, ivory, or lig-
num vitas.
  Fig. 2. A flat  hook, for the purpofe of elevating
Poupart's ligament in operating for a crural or femo-
ral hernia.
  Fig. 3. A fmall diredor, open at the point or ex-
tremity,  a very ufeful inftrument in the operation for
the redudion of ftrangulated hernia.
  Fig. 4. A filver canula for paffing into the urethra
after amputating  the penis : the threads attached to
it are meant to fix it to a fmall circular roller round
the penis.

                  Plate  LXVIL

  Figure 2. A trocar, the invention of Mr. Andre.
Fig. 3. The  canula of this inftrument is  formed of
two hollow plates  of elaftic  fteel, firmly  united to-
gether at their larger extremities  by two fcrew nails.
The tube formed by thefe two hollow plates is of fuch
a fize as  to allow the perforator, fig.  1. to be pufhed
into it with very little force ;  and the elafticity of the
plates, which admits of their yielding to this paffage
of the perforator, enables  them to return inftantly to
form  the fame  fize  of tube, as foon as the large extre-

  * The fpring here reprefented is taken from a  figure reprefented by
the late Dr. Monro in hi» treatife on that fubjedt  Set; his works in 4to< 
Explanation of the Plates.
49
mity of the inftrument A has fairly paffed the extre-
mity of the plates.
   The point of the perforator with a fmall portion of
the extremity of the tube being puflied into the vagi*
nal coat,  the  perforator is  to be then  withdrawn,
which,  when the inftrument is properly  made, may
be done without much force.
   The chief advantage of this inftrument is, that the
point of the perforator making a larger opening than
the canula, the latter thereby enters with much eafe.
   But although this invention of Mr. Andre's is neat
and ingenious, it does not appear to be very neceffa*.
ry j for, when the flat trocar, fig. 4, of the fame plate
is well finifhed, and the filver at the extremity of the
canula is thin and properly fitted to the perforator, it
enters with fufficient eafe, as alfo happens  with the
trocar of Mr. Wallace,  defcribed in figure 1, Plate
 LXXIII. while neither of thefe inftruments is liable to
 the important objedion that occurs to that of Mr.  An-
 dre',  noticed  in the explanation  of  that plate.  The
 canula  of Mr. Andre's inftrument has alfo this difad-
 vantage, that  being made of polifhed fteel, it is almofl
 impoffible to make it fo dry after being ufed as to  pre-
 vent it  from fuffering with ruft, where the two plates
are fixed  together by fcrew nails.
   Fig.  5. A fyringe for throwing liquids into  the tu-
 nica vaginalis teftis in the cure of hydrocele  by injec-
 tions, for which purpofe it requires to be exadly fitted
 to the tube fig.  2. Plate LVIII.

                  Plate LXVIII.

    Figs. 1, 2, and 3, reprefent a fet of inftruments for
 the operation of the phymofis, defcribed in  Chapter
 XXVIII. Vol. III. page  140.

                   Plate  LXIX.
    Figs. 1,  and  3.  Staffs for the purpofe of founding.
      VbL.  IV.       D 
 50           Explanation of the Plates.

   Fig. 2. A grooved flaff for the operation of lithot-
 omy, with the groove on one  fide.  This improve-
 ment was fuggefled for the purpofe of paffing the gor-
 get more eaiily into the bladder ;  but the ufual form
 of the flaff is found to condud  the gorget with much
 eafe; fo that this alteration has  not been generally
 adopted.
   Fig. 4. A common ftaff  of  the  ufual form, with
 the groove on the convex part of it.
   The curvature here given to thefe inftruments has
 by experience been found to anfwer better than any
 other: there is no neceffity for that degree of convex-
 ity generally given to flaffs :  the form here reprefen-
 ted is introduced with  more eafe ;  and does not in-
jure the urethra, which thofe with a greater curvature
 very commonly do.   A found  entirely  ftraight may
 be eafily paffed into the bladder, merely  by ftretching
 the penis in fuch  a manner,  that the urethra may be
 kept  in  a dired  line with the arch formed  by the
jundion  of the offa pubis : but  a ftaff entirely ftraight
 is  ill  fitted  for exploring the different  parts  of the
 bladder ; fo that fome degree of curvature is with
 much propriety given to it.
   A  flaff for a  full  grown  male fubjed fhould be
 twelve inches long, befides the handle ;  and feven or
 eight  inches for children of feven years and under.

                  Plate LXX.

   Fig. 1. A fide view of the cutting diredor defcrib-
 ed in  Vol. III. Chap. XXIX.  Sed. VII.   This inftru-
 ment  for adults fhould be five inches and a half from
 A to  B, and three inches from B to C.
   Fig. 2. reprefents a front view of the  fame inftru-
 ment.
  Fig. 3, affords  a back view of it;  and figure 4, a
 tranfverfe fedion.
  This diredor, in the grooved  part of it, fhould be
three-eighths of an inch broad, namely from D to E j 
Explanation of the Plates.
5»
and the cutting part  of it,  from F  to  G  mould  be
nearly an inch.  The beak fhould be  exadly fitted
to the groove of the ftaff with which it is to be ufed.
   In  order to obtain a free  paffage for the ftone, it
has been propofed to increafe the breadth of the cut-
ting part of Mr. Hawkins's gorget to a great extent:
by fome, it has even been faid, that it may be two
inches broad.  This, however, proceeds from inatten-
tion to the anatomy of the parts concerned in the op-
eration ; for that part of the  urethra through which
the gorget muft pafs to the bladder, is fo much con-
fined by the contiguous bones, that it is not poffible
to pafs a gorget  of this fize into it in a proper direc-
tion.   The proftate gland fhould  be divided laterally
in a horizontal diredion.  Now, this cannot be done
with  an inftrument  of this breadth.   But, even  al-
though it were eafily pradicable, there is no neceffity
for fuch an extenfive wound as this  inftrument would
 make.  I have elfewhere faid, that nothing fhould be
left for the diredor or gorget to divide but the prof-
tate gland, together  with a very fmall portion of  the
neck of the bladder ; and as  this is  done in the moft
complete manner, both by the cutting diredor of this
plate, and the improved gorget of Mr. Hawkins  in
figs,  i, and 2, Plate LXXI. an inftrument of a greater
breadth is not neceffary.
   The back part of the cutting diredor being confid-
erably narrower than the common gorget, it ought to
be fufficiently ftrong to overcome any refiftance with
 which it may  meet in paffing into the bladder.  The
 tranfverfe fedion, fig. 4, fhows the ftrength of it.
   For children  from three to feven years of age, this
 inftrument fhould not exceed three inches in length ;
 and  one  of four  inches will anfwer  for every  age
 above this to the twentieth year.
   The cutting edge of this  diredor, as well  as  the
 cutting part of the gorget in  Plate LXXI. is reprefen-
 ted upon the right fide of the inftrument, by which
       r        d 2 
52           Explanation of the Plates.

the wound in the operation of lithotomy is made in the
left fide of the patient: but for a furgeon who operates
with his left hand, this muft be reverfed, fo that the
cut may be made in the  right fide of the perinaeum.
  Fig. 5.  A grooved ftaff for the operation of lithot-
omy in females.

                 Plate LXXI.

  This inftrument fhould, for  adults,  be five inches
and a half in length befides the handle;  an inch and
a quarter broad at its wideft part, and made to con-
trad gradually to the  point: the beak fhould be ex-
adly adapted to the grooves of the ftaffs with which
it is ufed ; and  fhould be turned a little forward, in-
ftead of being perfedly  ftraight or turned  back as is
fometimes done  :  by this  means it is carried  with
more fteadinefs along the groove of the ftaff than can
otherwife  be done.   In  Vol. III. Chap. XXIX. Sed.
VII. I have mentioned fome objedions to this gorget,
and the reafons that induce me to confider the altera-
tions made upon it in fig. 1. and  2. of the fame plate,
as well as  the cutting diredor  Plate LXX. as  prefer-
able inftruments.  In fig. 1, and  2, the left or blunt
fide of the gorget is not near fo broad as in the gor-
get of  Mr. Hawkins, by which it enters with more
eafe, and does not tear the parts fo much.  The han-
dle goes off  nearly at a  right angle from the body of
the inftrument, inftead of having  an oblique diredion
as in figure 4; and  being made of timber  inftead of
fteel, the  furgeon iiolds it  with more eafe and firm-
nefs.
  Fig. 3.  A female catheter.   This inftrument is re-
prefented  ftraight, as being more eafily  introduced
than when much crooked :  a found for females how-
ever, fhould have a fmall curvature, as being better
adapted for difcovering a ftone  in  the bladder  than a
ftraight ftaff.  A grooved ftaff of this form is repre-
fented  in fig. 5, Plate LXX. 
             Explanation of the Plates.           53

  Fig. 4.  The cutting gorget of Mr. Hawkins, with
the edge made to expand more  than  the^ ufual form
of this  inftrument,  by which it divides the proftate
gland more freely.

                 Plate  LXXJI.

  Fig. 3.  An inftrument I have named a fearcher.
  In lithotomy it frequently happens, that the ftone is
not readily felt with the forceps.   When not difcover-
ed by the  other means I have advifed, it may frequent-
ly  be  found by introducing this  inftrument at the
wound j being thick it anfwers better for this purpofe
than a common found;  and when once the ftone is
difcovered, the fearcher fhould be kept in clofe con-
tad with it with one hand, while the  forceps are con-
duded  to  the ftone  by means of it with the other. In
this manner, flones  are fometimes  difcovered, which
could  not otherwife be met with.  This inftrument
fhould be  made of fteel,  and fliould be nine or ten
inches in length.
  Fig.  2.  A male catheter of filver.  The fmall holes-
near the extremity  of this inftrument  anfwer  better
than a flit on each fide, as with thefe it does not fo
readily catch the membrane of the urethra.  Catheters
have likewife been made of other materials, namely,
of leather, and of flexible filver wire rolled into the
form of a  tube, and covered with bougie plafter ; and
a few years ago a very neat invention appeared,  pre-
pared of refina  elaftica.  Thefe laft prove particularly
ufeful in cafes that require catheters to remain in the
bladder for fome days together  ; and of late I  have
found,  that when properly prepared,  they retain their
firmnefs for a confiderable time.  I have kept a cathe-
ter  of this refin in the blbidder for three weeks togeth-
er,  without being hurt by the urine.
  Fi ..r.  1.  Is an improvement on the gorget by Dr.
Monro.   It confifts of a common gorget A B, with a
blunt gorget C D fitted  to it: the nail  E fixed in the 
 54           Explanation of the Plates.

 cutting gorget paffing through the flit in the blunt gor-
 get F, the latter is thus made to run eafily upon it.  In
 ufing this inftrument, the blunt gorget muft be pulled
 back, fo as to admit of all the cutting part  of the oth-
 er to projed before it: and as foon as it has  reached
 the bladder, the blunt gorget fhould be pufhed for-
 ward ;  by which means the contiguous  parts are  ef-
 fedually proteded from  farther injury, as the fide  of
 the blunt gorget fhould be made considerably deeper,
 fo as to projed over the cutting edges of the other.
   This is an ingenious contrivance ; arid  it  anfwers
 the purpofe completely, of proteding the furrounding
 parts, while the  inftrument is withdrawing;  a  point
 of  much importance, and* not  always  duly attend-
 ed to.

                 Plate LXXIII.

   Fig.  i. A flat trocar, a very  neat invention of Mr.
 Wallace, a furgeon of eminence in Glafgow. This in-
 ftrument confifts of a ftilette or perforator,  fig. 3. ex-
 adly adapted to the  filver canula, fig. 2.   The canu-
 la is open on one fide, which admits of the  perforator
 being broader than itfelf, as is reprefented  in fig.  r.
 By this means an opening is made by the perforator,
 which  allows the canula to pafs with eafe, and as the
 fides of the canula do not fall together on the perfo-
 rator being withdrawn, this inftrument is not liable  to
 an objedion that occurs againft the trocar of Mr. An-
 dre, reprefented in Plate  LXV1I. fig. 2.  with which
 there is fome rifk of the fteel  plates doing harm to the
 contents of the abdomen on thefe plates falling togeth-
 er, which they do with fome force on the canula be-
 ing withdrawn.
  Fig. 4. A  trocar of a common triangular form, for
 the purpofe  of punduring the  bladder : the round
 or triangular form of this inftrument makes it more
 proper for this operation  than trocars with a lancet
point, which are not fo well adapted for  the different 
Explanation of the Plates.            55
fleps of the operation ; and the groove in the flilette
or perforator, by commencing at the point, and being
continued through the  whole length of it,  ferves to
mark with much certainty its entrance into the  blad-
der, for the urine flows along the groove immediate-
ly on the point of it having entered the bladder.
   Fig. 5.  A flat filver canula, with a fmall curvature
for leaving in the opening after the operation  for the
empyema.

                 Plate LXXIV.

   Fig. 1. An inftrument invented by Dr. Butter for
injeding liquids into the  bladder :  A A, the  handles
of two thin plates of timber, which ferve to  comprefs
a bladder placed between them,  in  which  the liquor
to be injeded is contained.  B, the flop-cock of a pipe,
with which the bladder  muft be conneded: and to
the extremity of this fhort pipe a larger tube C  is
adapted, to be inferted into the urethra when the liquid
is to be injeded.   Fig. 4. is  a  funnel  for conveying
the liquid into the bladder, by inferting the fmall end
of it into the fhort pipe near to B, on the tube C be-
ing removed.
   Fig. 2. and 3. Two peffaries for fupporting the pro-
lapfed parts in cafes of prolapfus uteri,  and  for  com-
preffing the urethra in incontinence of urine.  Before
being introduced, they fhould be immerfed in oil; and
they fhould be made to lie diredly acrofs the  vagina,
fo as to fupport the prolapfed parts as  much  as  poffi-
ble.  Thefe inftruments  may be made of any timber
capable of receiving a fine polifh : but much attention
I may remark, is neceffary to this circumftance; for
unlefs they are perfedly  fmooth, they  cannot  be con-
tinued.   Peffaries  tend to fupport  the relaxed  parts
better than any other remedy ; but even polifhed in
the beft manner, they are apt to excite fo much  irrita-
tion as to become altogether inadmiffible. 
56           Explanation of the Plates.


                 Plate  LXXV.

  Fig. 1. and 2. Forceps of different fizes for extrad-
ing ftones from the bladder.  For a full grown adult
they fhould be  ten inches long and  proportion ably
ftrong.  Every operator ought  to be  furnifhed with
three or four fizes from thofe of ten inches to fuch as
do not exceed  feven.  I have already defired, that the
blades  of the forceps may not meet when fhut; other-
wife they are apt to lay hold (jf the bladder:  and for
the fame reafon, their teeth  ought not to be long.
The hollow  part of the blades  fhould be rough, by
which  they fix the ftone with fufficient firmnefs ;  but
even this roughnefs fhould be confined to within an
inch of the point; for when it  extends to the joint,
fmall ftones  are apt to fix in this part, and to dilate
the blades of the inftrument much more than they oth-
erwife  would do.
  Fig. 3.  Forceps with a fmall curvature.   When
the forceps of the ufual form  do not eafily 'lay hold
of a ftone, fuch as are fomewhat crooked will fome-
times meet with  it:  in general, however, ftraight for-
ceps anfwer all  the purpofes of the others;  and as
ftones, when laid hold of, are always more eafily tak-
en  out with ftraight forceps, they fhould commonly
be preferred.

                 Plate LXXVI.

  Fig. 1. and 2. Different views of Frdre Cofme's in-
ftrument for the operation  of lithotomy.  Fig.  1. Re-
prefents the inftrument fhut ; and fig. 2. gives a view
of it open.   The handle A, with which the niches B
are  conneded,  being kept in the fituation  reprefented
in fig.  1. hy the fpring C being  fixed in one of the
niches, the knife is  thus kept  fhut.    But when  the
fpring  C is  preffed upon, fo as to raife it out of the
niche, as the handle A is made to move upon a pivot, 
Explanation of the Plates.           57
it may now be turned ; and the projeding  part of it
D, being turned fully round, if preffure is now appli-
ed to E, it will  raife the knife F, fig. 2. with which it
is conneded, to the elevation here reprefented.  The
point G fhould be  made blunt and round, fo as to run
with eafe and freedom in the groove of a ftaff.  The
length of this inftrument, including the handle, fhould
be ten inches.
  The method of ufing it, is as follows: all the pre-
vious fleps  of the  operation being finifhed, and the
urethra being cut in the manner I  have direded in the
lateral operation, the beak of the inftrument G is to
be conveyed into  the  groove of  the ftaff, and while
fhut  pufhed  into the bladder.   The ftaff is  now to be
withdrawn ; and preffure being applied to E, fo as to
elevate the knife F, it is now to be drawn out  in fuch
a diredion as to divide the  proftate gland laterally,
when the forceps  may be either introduced by run-
ning them in upon the forefinger of the left hand, or
upon a blunt gorget employed for the purpofe.
  Various inftruments of this  kind have been invent-
ed ;  but this is the moft fimple, and in every refped,
indeed, the beft of any that I have feen.  As the op-
eration  is ftill  performed with it  in different parts of
Europe, particularly in France, I think it right to  re-
prefent it, but not  with a view to recommend it. The
objedions which  occur to it are  thefe : although by
the form of the handle the blade  or cutting  part of
the inftrument may be elevated to  any neceffary de-
gree, vat this docs not enfure the formation of a wound
of a  fixed and determined fize.   It  has  indeed  been
afferted by thofe who think favourably of this inftru-
ment, that  a wound of any determined fize may be
made with it; but this is by no means the cafe;  and
whoever will give it a trial will find, that the  wound
which it makes varies in fize in every two that are cut
with it, even with the blade at the fame degree of ele-
vation ; for  the cutting part of it i\; at fuch a diftance
from the handle, that it is impofiible for a furgeon al- 
 5 8           Explanation of the Plates.

ways to withdraw it fo fteadily, as to cut uniformly in
the fame diredion ; and if in one cafe  it is  made  to
prefs more to  one  fide than  in another, the wound
Which it forms will not only be of a different fize, but
different parts  may be cut by it.
   But the moft material objedion to this  inftrument
is,  that it is apt  to  injure more of the bladder than
ought to be cut.  The proftate gland only,  together
with a fmall portion of the neck of the bladder, fhould
be divided by  this knife ; but as it is always neceffary
to infert the point to a confiderable depth, before this
can be done, the fides and even fundus  of the bladder
are in this manner very apt to be injured.
   The only advantage which this inftrument is  fup-
pofed to poffefs over  the cutting gorget  or diredor is,
that being inferted fhut,  and withdrawn open, only
one cut is made in the parts through which it is made
to pafs ; whereas, it is alleged, that  in the ufual  me-
thod of employing the gorget or diredor, one incifion
is formed by the introdudion of the inftrument,  and
another when  it is withdrawn.  But, by .attending to
the diredions that I have given in Chap. XXIX.  this
inconvenience, commonly attributed to the gorget,
and confequently to the diredor, may be always avoid-
ed ;  and as thefe inftruments form  a more  free cut
than the lithotome cachee, while they do not fo read-
ily injure any part of the bladder which ought not to
be cut, they fhould therefore be preferred.
  Fig. 3.  Forceps with a fcrew H paffing  through
their handles.  When a ftone is properly fixed in the
forceps, various inventions have  been propofed for
preferving them in their  fituation ;  but thofe that I
have here  reprefented are the beft and the  moft fim-
ple of any that I have feen.

                Plate  LXXV1I.

  Fig. 1.  A jugum for compreffing  the penis, and  it
fhould be  made to fit upon the parts without produc- 
Explanation of the Plates.            59
ing pain or uneafinefs.   It confifts of a piece of elaftic
fteel lined with velvet or foft flannel.   By means of
the fcrew A, it can be made wide or ftrait at pleafure;
and the cufhion B being placed upon the urethra, any
neceffary degree of preffure may be made with it, by
turning the fcrew with which the cufhion is conneded.
By means of this cufhion and fcrew,  the preffure is
chiefly confined to  the urethra ;  fo that the circula-
tion is  fcarcely  interrupted through the reft  of  the
penis.
   Fig. 2. A receptacle for the urine.  It may be made
either of tin, filver, or  any other metal.  It  is fome-
what convex on one fide, with a concavity on the op-
pofite fide, fitted to the infide of the patient's thigh.
D E, Two tubes for fixing two pieces of tape, by which,
when the penis is put into the neck of the inftrument,
it may be tied to a circular bandage round the body ;
and the tube F ferves to fix a piece of tape for tying
it round the thigh of the patient.
   This inftrument, when properly fitted, fits eafily,
and has frequently proved ufeful to patients who could
not retain their urine,  and with whom the jugum, for
the reafons  I have formerly enumerated,  could not be
employed.
   A receptacle of this kind, of a fize fufficient to con-
tain three or four gilis, may be fo adapted to the thigh
as to admit of every neceffary exercife.
   Fig. 3. A  bandage,  originally  invented  by  Mr.
 Gooch, for retaining the redum" in prolapfus am.  I,
 a plate of elaftic fteci covered with  foft leather, exad-
 ly fitted to the parts on which it refts ; and the cufh-
 ion K fhould be fluffed in fuch a manner as to produce
 an equal and  eafy preffure on being applied to the end
 of the gut after it is replaced.  H  a ftrap to be fixed
 with a buckle on the forepart of the, body  above the
pubes; and G G, two ftraps conneded with the up-
per part of the inftrument,  which, by paffing over the
 flioulders, and being fixed by fmall knobs on each fide
 of the buckle, ferve to retain it exadly in its place. 
Co           Explanation of the Plates.


                PlXte LXXVIII.

  When treating of lithotomy, in Chap. XXIX. I had
occafion to notice the rifk attending the extradion of
a large ftone ; and when a ftone proves to be fo large
as to give caufe to fufped that it cannot with fafety be
taken out entire, I have given it as my opinion, that
it fliould  rather be broken into diflerent pieces : for
this purpofe various  inftruments have been propofed.
Fig.  i. reprefents forceps with long teeth,  by which
almoft any ftone may be broken.  By the fcrew and
lever conneded with it, a much greater force may in-
deed be employed than will commonly be  required:
thefe  forceps fhould be twelve inches in length, and
of a fufficient firmnefs  in every  part, particularly in
the joint, for bearing any force that may be needed.
  Fig. 2. A fcoop for extrading fuch fmall pieces of
ftone as cannot be taken out with common  forceps.
  Fig. 3. A  filver canula for inferting into the wound ,
after the operation of lithotomy, for compreffing fuch
arteries as lie too deep to be tied with ligatures. This
tube fliould be of a flat form : for a full grown adult,
an inch broad, and four inches in length ;  and before
being introduced, it  fhould be covered with feveral
plies of foft old linen.  There fhould be two holes in
the brim of the inftrument for conneding it by means
of two pieces of tape to  a circular belt  round the
bodv.

                Plate LXXIX.
  The figures in this Plate reprefent an apparatus for
the cure of a rupture of the tendo achilles ;  of which
an explanation is given in Volume I. Chapter III.
Sedion VII.

                 Plate LXXX.
  This figure h the invention of Mr. Chabet of Paris,
and is  takeu from ;i.e fecond  volume  of Memoirs of 
Explanation of the Plates.           61
 the Royal Academy of Surgery : it is the beft inftru-
 ment that has yet been publifhed for compreffing the
 jugular vein.

                 Plate LXXXI.

    Fig. i. A fplint of timber for a fradured leg ; A A
 two loops for retaining leather ftraps,  as  reprefented
 in the front view of the fame fplint in figure 2, C C.
 B, an  opening for receiving the external maleolus,
 when the leg is placed upon the outfide.
    Figures 3, 4, 5, and 6, are perhaps  the beft fplints
 hitherto difcovered for fradures of any of the extre-
 mities.    They may be  made of different forms, but
 one or other of thefe will anfwer almoft for any pur-
 pofe : they are made by gluing a piece of thin tim-
 ber, about the tenth part of an inch in thicknefs, up-
 on leather. The timber is afterwards cut down to the
 leather, either with a fine faw or a knife fet to a pro-
- per depth, in the manner reprefented in the figures.
    Thefe fplints are preferable to thofe  of pafteboard ;
 for while they are longitudinally  perfedly firm, they
 are tranfverfely fufficiently  flexible for plying to the
 form of  the limb.   For the method of ufing them, I
 muft refer  to different parts of Sedions  IX. X. XL
 and XII. of Chapter XXXIX.
    Splints made  in this  manner have long been ufed
 by individuals ;  but Mr. Gooch was the firft who
 gave any defcription of them.

                 Plate LXXXII.

    As the fplints ufed by Mr. William Sharpe are ftill
 preferred by fome praditioners, I have given a repre-
 sentation of them in this Plate.
    Thefe fplints,  figs. 3, and 4, are formed of ftrong
 pafteboard  made with  glue ; and  are fixed upon a
 fradured leg with three ftraps which furround the
 whole. 
6a            Explanation of the Plates.

  Figure 4, reprefents an under fplint of an irregular
form, fuitable to that  part of the leg which it is meant
to cover :  it is a little convex externally, and concave
internally.  The length for a middle fized man,  eigh-
teen inches from E to E ; the width, two inches and
three quarters at the ftrap near the knee, and two
inches and a quarter at both the other ftraps.
  D F, D F, D F, three leather ftraps from fifteen to
twenty inches long, and  one inch wide, .having two
rows of holes fo placed, that  every hole in each row
may be oppofite to a  fpace in the other.   Thefe muft
be  fewed  faft to the middle and outfide of the under
fplint.   The portions of ftraps D D D, on the  ante-
rior part of the fplint, muft be fhorter than thofe on
the pofterior, F F F, which are to furround the  more
mufcular part of the leg.
  G, a part  to fupport the foot from the point E to
the heel H, five inches long at  an  angle of fixty de-
grees.
.  C, The foot-ftrap,  twelve inches  long, fewed to the
bottom of the under fplint, within two inches of the
point, to pafs under the heel, and through the leather
loop B on the upper fplint, to be fixed to the loweft
pin A, in fig. 3.
  1, An irregular  oval hole, two inches long,  and al-
moft one wide in the  loweft part, but  decreafing up-
wards, to receive the  maleolus externus, or lower ex-
tremity of the fibula.
  Figure 2, reprefents the  leg raifed up,  to fhew the
fituation of the under fplint, when properly applied.
  Fig. 3,  The upper fplint.  A A A,  the pins upon
which the ftraps of the under  fplint  are to be fixed,
by  means of the holes D D D, F F F.   B, The leath-
er loop for receiving the foot-ftrap C, in fig. 4.
  Fig. 1, reprelents a fradured leg when laid within
the fplints, having the foot of a flocking and a flioe
fixed on it. 
             Explanation of the Plates.           6$

                Plate LXXXIII.

   In this plate I have  delineated  the inftruments re-
 commended  by the late Mr. Gooch, for preferving a
 fradured thigh and leg in a ftate  of extenfion,  as  is
 mentioned more particularly in Volume III. page 360,
 and which I  fhall defcribe in his own words.
   Fig. 1. A machine for extending a fradured leg.
 The tranfom to which  the fole is fecured, is made to
 be opened and fixed by a pin ;  and the machine may
 occafionally be made wider, as appears by other holes
 in the tranfom ; about which, on each fide of the fole,
 fillets  are to be tied,  coming  from a dimity piece
 quilted for eafe, and laced round the heel and inftep,
 to make the extenfion upon the working of the fcrews;
 but buff leather may poffibly  anfwer better for pro-
 teding the parts even than dimity.
   Fig. 2, fhews the machine, and one of the fplints
 in Plate LXXXI. together upon the limb.
   *%• 35 The longitudinal parts  of the machine for
 the thigh are defigned to move  upon  the circular
 plates  ; by which means it  may be accommodated to
 limbs  of different fizes  : and as there is a pin at  each
 end of the circular plates, if the limb happens to be
 larger  than ordinary, ftraps of leather may be added.
   Fig. 4, fhews the machine with the cafe  upon the
 thigh.
   Fig. 5. The key to work the fcrews.  There fhould
 be two fuch keys, that  the machine  may occafionally
 be wrought on both fides at the fame time.

                Plate LXXXIV.

   In  Volume III.  page 360, I have obferved,  that
fome improvements had been made by the late Dr.
Aitken upon  Mr. Gooch's inftruments, reprefented in
the preceding plate,  for extending fradured limbs :
in this  plate I have given a reprefentation of thefe im-
provement*. 
64           Explanation of the Plates.

  Fig. i, reprefents a machine for keeping the frag-
ments of the thigh bone in fitu after being fet, whe-
ther the fradure is fimple or compound, on the neck
or body of this bone.   AAA, the  upper circular
which applies round the pelvis, like the  top  band of
a pair of breeches.   It refts on the fame parts, and h
fixed or buttoned in the fame manner, by the ftuds
and correfponding holes H.
  B B,  Two foft fluffed ftraps fixed to the back part
of this circular, of fuch lengths as to pafs between the
thighs from behind forward, to tie round the forepart
of the fame circular, by means of their forked extre-
mities C C. Thefe effedually fecure the circular from
moving upward.   There are two obfeure joints KK,
in the back part of this circular, to facilitate its appli-
cation ; but it applies readily enough without them.
  D D, The lower  circular which fixes  above the
knee at the gartering place.
  E E E, Three graduating fteel fplints which extend
from the one circular to the other : their upper extre-
mities are fixed to the  upper circular by vertible flat
headed  ftuds, fimilar to thofe at F F  : their lower ex-
tremities pafs through the iron fcrew plates G, firmly
rivetted to  the lower  circular.  The fplints are pro-
vided with a number of impreflions or holes, in which
the fcrew nails which pafs through the plates are fix-
ed.  By pufhing the fplints from below upward, the
diftance between the circulars is increafed ; and by
turning the fcrew nails, it is maintained: confequenfr
ly,  that part of the thigh included between the circu-
lars can be kept extended at pleafure.  The  fplints
here are fixed for the right thigh ;  the pricked lines
on  the other fide, fliew how they may be  accommo-
dated for the left thigh, or for both at the  fame time.
  The larger circular AAA, confifts of  a piece  of
thick  faddle leather; all except  its  perforated part,
and about a quarter of an inch on each edge, is cov-
ered on the infide with  a flexible thin iron  plate, fuch
as is fometimes ufed by  tin plate workers  : over this 
Explanation of the Plates*           65
it is lined with the fofteft buff, or fhamoy leather, be-
tween which and the plate a thin layer of hair or wool
is  interpofed : the lining ought to projed on both
fides half an inch or  more, to prevent  it in any de-
gree from preffing on the fkin.
   The fmall circular D D, or inferior fixed point, is
exadly fimilar to  the large one in  ftrudure, the tin
plate excepted : which, on account of its fmaller di-
ameter, was found to be unneceffary.
   The breadth of the upper circular, when extended
for an adult, may be from three to four inches : that
of the under circular fhould be in  the fame  propor-
tion.
   The graduating fteel fplints  E E Ej muft be fuffi-
ciently long to extend from the upper circular to the
lower, and to projed over it about a hand breadth :
they require to be about four or five eighth parts of
an inch broad, and about one-eighth part of an inch
thick.
   Fig. 2. A machine conftruded  on the fame princi-
ple with  fig. 1, for the retenfion of a fradured leg.
   A A, a circular which applies below the knee joint.
   B B, Another which fixes at the ankles.
   C C C, The graduating fplints fimilar to  thofe of
the thigh machine, both in conftrudion and adion.
  Fig. 3. A fradure box mentioned in Vol. III. page
379, as the invention of Mr. James Rae, furgeon  of
this place, improved by Mr. John Rae, his fon.
  A, The fole or  bafe, which fhould be a firm board,
an inch  and half thick.   B B, the two ends which
fupport the fide beams C C C C.  D, a  brafs hinge,
which, with a correfponding hinge on the other end
of the machine, admit of the ends folding down fo as
to render it more portable than it otherwife would be.
L L, two parallel grooves for receiving two projeding
parts of  the correfponding end of the machine, by
which the fame inftrument may be extended or fhort-
ened fo as to fit  any length of member.  EEEE,
  Vol. IV.       E 
66
Explanation of the Plates.
Two lateral beams, which by their holes in their ex-
tremities, will ferve for any length to which the inftru-
ment may be extended : and by a pin at each end paf-
fing through the holes in the end beams, any one of
the fides, or both of them, may be raifed at pleafure.
   G G G G,  &c.  Twelve or fourteen buckles on
each fide of the  machine,  with correfponding pieces
of girth two inches broad, on  which the member is
fupported by buckling them exadly to the form of the
limb.   H I, H I, Two ftraps, with correfponding buc-
kles for fixing the bafe of the machine to the bed. The
limb is fixed to the  machine by two ftraps and buc-
kles, one fixed at each end.
   The advantages of this inftrument are, that in com-
pound fradures the fores can be infpeded  and dreff-
ed without deranging or moving any part of the limb,
merely by removing fuch of the ftraps as are oppofite
to the fores.  Inftead of a  twelve or eighteen tailed
bandage of the common form, feparate pieces of flan-
nel fhould be ufed ; fo that fuch of  thofe as  are  wet
with the difcharge can be eafily moved without touch-
ing the reft.
   In this manner fores may be daily dreffed  without
being moved till a cure is accomplifhed,  while the
limb may be raifed to any angle, by  heightening  one
or other of the ends of the  lateral beams by means of
the holes and pins at each end.

                 Plate LXXXV.

   Fig. i.  A fradured limb dreffed  with  an eighteen
tailed bandage, and laid upon the  outfide with the
knee bent.
   Fig. 2. A fradured limb with an eighteen tailed ban-
dage, and one  of the flexible fplints in Plate LXXXI.
There is alfo placed beneath the limb a firm unyield-
ing fplint, fuch as is reprefented in the fame Plate,
fig. 2. 
Explanation of the Plates.
67
                Plate  LXXXVI.

   Fig. i. A machine for retaining the different parts
 of a fradured patella.
   A, a ftrap to be fixed by meams of the buckle at
 one end on the upper part of the leg immediately be-
 low the knee.  B, a fimilar  ftrap to  be fixed  above
 the knee.
   Fig. 2. A back view of the fame machine.  F, a fe-
 milunar comprefs of cork covered with fhamoy leather,
 to be placed immediately above the upper part  of the
 patella.  G, a fimilar comprefs  for fupporting the
 inferior part of the bone.
   Thefe compreffes  being properly placed, may be
 drawn to any degree of tightnefs by means of the ftraps
 and buckles C D E.
   Fig. 3. A limb  with a fradured patella, and the
 bandage fig. 1. applied to it.   In this figure the ftrap
 H is added to it: being fixed to the point of the fhoe,
 and conneded with one of the buckles above the knee,
 the limb is thereby kept extended ; by which there is
 no rifk of the fradured parts of the patella being for-
 cibly pulled from each other, as would neceffarily hap-
 pen were the limb to be fuddenly bent before the cure
 fhould be complete.

               Plate LXXXVII.

  Fig. 1.  This reprefents the  ambe of Hippocrates,
for the redudion of luxations of the humerus : it con-
 fifts of a fulcrum and moveable lever.   As it is ftill
ufed by fome praditioners, I  judged it proper to men-
tion it; but I have elfewhere had occafion to remark,
that it  is a dangerous inftrument, and ought never to
be employed.   My reafons  for thinking fo are enu-
merated in Chap. XL. Sed. IX.
              e 2 
6S           Explanation of the Plates.

  Fig. 2.  Mr. Peril's inftrument for reducing luxa-
tions of the humerus.   A A, Two arms or horns, by
which the fcapula is kept firm  during the  extenfion.
B B,  The other end of the inftrument refting upon
the ground ;  C, the pullies ; D, ropes, by winding up
which with the handle E, the limb may be flowly and
gradually extended to any neceffary degree.
  Fig. 3.  G, an opening through which the  arm is
paffed ;  F F,  two apertures for receiving the ends A A
of the inftrument, fig. 2.  This being made of firm
leather,  the inftrument, is thereby prevented from fret-
ting or galling the fkin.

               Plate  LXXXVIII.

  Fig. 1.  The ambe of Hippocrates, reprefented by
itfelf in the preceding Plate, is here applied, and rea-
dy to be ufed.
  Fig. 2. Pullies for extending diflocated bones.
  Fig. 3.  This is  a very ufeful part of the  apparatus
for  extending diflocated limbs : it is formed of thick
fhamoy  or buff leather.  By tying it firmly  round the
limb with  the broad ftraps at each end, a very confid-
erable force may be  applied by affiftants pulling the
ropes or ftraps paffed over the hooks : it  anfwers the
purpofe both  more eafily and  more effedually  than
the common  method of extending  the limb  with
towels.

               Plate LXXXIX.

  In this Plate I have delineated one  of the beft in-
ftruments hitherto known for diflocations of the fhoul-
ders, when more than ordinary force is required.  It
is the invention of the late Mr.  Freke of London.
  As inftruments  of this kind require to be very por-
table, Mr. Freke has paid particular attention xp this
circumftance.   The box, fig. 5.  contains the whole
apparatus: when fhut, it is only only one foot eight 
Explanation of the Plates.           6*9
 inches long, nine inches broad, and three inches and
 a quarter deep.   Fig. 4. reprefents the inftrument op-
 en, the two fides of the box being firmly fixed togeth-
 er by brafs  hinges at C, and with two hooks and eyes
 on the other fide of the box.  When one end of it is
 fixed on the ground, the other ftands high enough to
 become a fulcrum or fupport for the lever B B, which
 is fixed on  the roller E  by a large fcrew  of wood,
 which turning fideways, as well as with the roller, it
 obtains a circumrotatory motion, fo that it may ferve
 with  proper attention to reduce a luxation either back-
 ward, forward, or downward.
   The roller on which the lever  is fixed is juft the
 diameter of the depth of one of the boxes, into which
 are driven two iron pins,  the  ends  of which are re-
 ceived by the two fides of the box, which are an inch
 thick.
   The lever is two feet four inches long, and is cut
 and joined again by two hinges at C, to fold up fo as
 to be contained in the box: on the back fide of it is
 a hook to keep it ftraight; the other end of it hangs
 over  the roller an inch and a half, which is to be ex-
 cavated and covered with buff leather for the more
 eafy reception of the head of the os humeri.
   The iron roller E, has two holes through it for re-
 ceiving two cords from a  brace, fig, 3, fixed on the
 lower head  of the os humeri, for on no other part of
 the arm above the cubit can a bandage for this  pur-
 pofe be ufeful;  for, if the furgeon  applies it on the
 mufcular part of the arm, it never  fails to flip down
"to the joint  before the limb can be extended.
   The iron roller E has a fquare end, on which is fix-
 ed a wheel D, notched round, which works as a ratch-
 et on a fpring ketch under the lever; by which  it  is
 flopped as it is wound up with a winch, fo that at plea-
 fure it may  be let loofe by difcharging the ketch.
   The brace, fig. 3. confifts of a large piece of buff
 leather, large enough to embrace the arm, fewed on
 two pieces  of ftrong iron curved  plates  rivetted to- 
 70           Explanation of the Plates.

 gether, one of them having an eye at each end  to
 faften two cords in : the other is bent at the ends into
 two hooks, which receive the cords after they have
 crofted the arm above.
   In order to keep the patient fteady in his chair, and
 to prevent the fcapula from raifing  or  depreffing the
 lever, after the limb  is drawn forward by the winch,
 there  muft be fixed over  the  fhoulder a girth with
 two hooks at  the end of it, fuch as is reprefented  in
 fig.  2.  The girth fhould be long enough to reach the
 ground on the other fide, where it muft be  hooked
 into the ring B,  fcrewed into  the floor for that pur-
 pofe, as in fig. i.

                    Plate XC.

   The figures in  this  plate reprefent an inftrument
 mentioned in Chap. XLI. for the purpofe of remov-
 ing  contradions of the ham-ftrings or flexor tendons
 of the leg.
   Fig. i. A front view of the inftrument:  A A-, two
 curved fteel plates conneded together by a firm fteel
 fplint D, in fig. 2.   One of thefe is to be applied to
 the back part of the thigh, and the other to the up-
 per and back  part of the leg ; while, by means of the
 leather ftraps E E, fuch a degree of preffure is made
 as the patient  is able to bear.
   B B, fig. 1, is a foft cufhion of quilted cotton for
 furrounding the limb to prevent excoriation by the
 leather ftraps.  The curved plates A A fhould for the
 fame purpofe be lined with  fhamoy.
   Fig. 2.  A back view of the fame inftrument.
   Fig. 3.  A limb with the inftrument applied on it.

                  Plate  XCI.

  Fig. 1.  A biftoury with a probe  of flexible filver
joined  to it, for the operation of the  fiftula in  ano,
which in various inftances I  have ufed.  It will be rea- 
Explanation of the Plates.
7*
 dily underftood, that this inftrument will not anfwer
 where the finus does not communicate with the gut.
   Fig. 2. A bandage, for the paracentefis of the ab-
 domen,  originally invented  by the late Dr. Monro.
 This bandage fhould  be made  of  foft  leather, lined
 with flannel.  A, the body of the bandage, which
 fhould be of fuch a length as to pafs from one os ili-
 um, acrofs the abdomen, to the other, to be there fix-
 ed by the ftraps B B B B to the  buckles C C C C.
 The ftraps D D, by paffing over the fhoulders, ferve
 to fix the buckles E E, which  pafs through between
 the thighs ; by which almoft every part of the abdo-
 men may be fufficiently comprefied.  When the ope-
 ration of tapping  is to be performed, the bandage
 fhould be fixed in this manner, care being taken to
 leave the hole F open, exadly oppofite to the fpot in
 which the perforation is to be  made, which for  this
 purpofe  fhould be previoufly marked with ink.   On
 the water being all drawn off, and  a pledget applied
 upon the wound, the opening F muft be fhut by the
 ftrap G, and the buckle H, as reprefented by the let-
 ter I.
   In this manner, any neceffary preffure may be ap-
 plied, which, after this operation, is of  much  impor-
 tance, and ought not to be omitted.

                  Plate XCII,

   Fig. i. An inftrument for fixing the canula after
 the  operation of bronchotomy.  A, a plate of thin
 polifhed  fteel, with a curvature  correfponding to  the
 anterior  part of the neck.  B B, The extremities of
 the plate A, with which the ftraps C C are conneded,
 for the purpofe of fixing the inftrument by means of
 a buckle on the back part of the neck.   E, A move-
 able frame, which fhould be made to pafs eafily up
 and down on the two perpendicular branches of pol-
 ifhed fteel D D, fixed to the infide of the plate A.   In
ihis frame there is  an opening a little above E, for re- 
72           Explanation of the Plates*

ceiving the double canula reprefented by  the  inferior
letter F.   The letter F oppofite to E, reprefents a fmall
fcrew, which paffes through the under  part of the
frame ;  and by preffing upon the under part of the ca-
nula, it thus ferves to fix it exadly where it is placed
after the operation.
  As the frame is made to Aide eafily upon the two
branches D D,  and as the  double canula F can be in-
ferted to any depth in the  trachea,  and can be  fixed
by  the fcrew paffing through the under part of the
frame, this inftrument is accordingly found to anfwer
every purpofe expeded from it.  It is the invention
of Dr. Monro, and it has in different cafes been em-
ployed with advantage.
  Fig. 3.  An inftrument for perforating  the  trachea
in the operation  of bronchotomy.  G, The point of
the perforator paffing through the double canula Ii.
  Fig. 2.  A reprefentation of the double canula un-
conneded with the perforator.

                  Plate  XCIII.

  Fig. 1.  A machine invented by an ingenious trades-
man of this place, the late Mr.  Gavin Wilfon, fordif-
tortions of the  leg.  This  fubjed  was treated  of in
Chap.  XLI.  A, a cafe of firm leather open before,
for receiving the diftorted  leg and foot.  B,  a  fplint
of iron for giving additional firmnefs to the cafe.  The
leg being placed in this cafe, the foot is  fixed down
to the bottom  or fole by the ftrap H paffed through
the hole I; and the leg itfelf is gradually drawn ei-
ther to one fide or another according to the nature of
the diftortion,  and fecured by a proper application of
the ftraps D F, fixed upon the brafs hooks G E. By
a due perfeverance in the ufe of this machine, many
bad cafes  of diftorted limbs have been completely
cured.
  Fig* 3*  A Pah* of fhoes  which have  proved ufeful
in-fome cafes cf diftorted ankle joints, where the toes 
Explanation of the Plates.           j$
have  been turned too much inward.   Being light,
they may be ufed even in early  infancy.  After the
feet are fixed in the fhoes by the laces before, the toes
may be feparated  to a proper diftance, and preferved
in this fituation by the apparatus at A; which confifts
of three fmall iron plates, more particularly delineated
in fig. 5. and at B, fig. 4.  Fig. 5. confifts of two
parallel thin plates, fixed with nails to the outfide of
the fole of one flioe ;  and they are fo far feparate from
each other, as to  receive the round  plate B  between
them, the end of  which is fixed to the fole of the oth-
er fhoe.   The three plates are conneded together  by
a nail pafling through the hole in the centre of all of
them.   This admits of a confiderable degree of mo-
tion, by which the toes may be moved either outward
or inward ; but they can be eafily fixed at any partic-
ular point by a  fmall iron pin at A paffed through one
or other of the holes in the fide of the plates B.

                  Plate XCIV.

  In this Plate I have delineated  an apparatus  men-
tioned in  Chap. XLI. for diftortions of the legs.
  Fig. 1.  A B, An iron fplint properly covered with
foft leather fixed  in an iron frame C. The fplint may
be made to fix on either fide of the frame according
as the leg is curved to one fide or another.   In a dif-
torted leg the foot is to be fixed down  to the frame
C by  means of the fhoe reprefented in fig 3.   This is
eafieft done by paffing a nail through the heel of the
fhoe into the frame, upon which the fhoe may move.
If the leg  is bent  outward, the fplint A B, fig. 1. is
placed on the infide, and it fliould be of fuch a length
that the pad B may reft upon the internal condyle of
the knee  joint, where it fhould be fixed by  the ftrap
E, fig. 3.   When the bones are bent inward, the fplint
muft be placed  on the outfide of the leg.
  The ftraps F F muft be paffed two or  three times
round the convex part of the leg, which it ought to 
74           Explanation of the Plates.
 comprefs with fome degree of force toward the fplint;
 and by increafing the preffure from time to time, the
 curvature or convexity will be gradually leffened till
 at laft it may in many inftances be  totally  removed.
 By means of the  ftrap G,  fig. 3. the toes are to be
 drawn from that fide to which they incline, and fixed
 to the oppofite fide of the frame.  The fcrew nail D,
 fig. 1. determines what is gained from time to time,
 by  moving  it from one hole in the frame to another.
  Fig. 4.  A machine invented by the late Mr. Gooch,
 for giving fupport to weak limbs as well as for remov-
 ing diftortions.  AAA, three fteel bows made thin
 and very  elaftic : they muft fland clear of the tibia ;
 muft pafs about half round the limb, and be fixed with
 ftraps of leather upon round  headed pins.
  B B B,  a  longitudinal plate, to  be made  of tough
 fluff, as the  workmen term it, and as light as poffible
 with fufficient ftrength.
  C, the fhank to pafs into the focket, in  that part of
 the machine which is to be fixed into the heel of the
 fhoe or laced boot, and confined there by  a fcrew  at
 the bottom.
  D, The fcrew to keep the  fhank in the focket.

                  Plate XCV.

  I have here  delineated  a fradure box,  mentioned
in Vol. III. page 368.
  Fig. 1.  A A, The bafe or bottom of the box, form-
ed of deal  an inch and half thick.  B B,  Two ends
rifing from the bafe, and terminating  in  the pillars
C C C C.   D D, An excavated moveable  piece  of
timber ,for fupporting the fradured limb.   This move-
able part of the inftrument may be  raifed and fupport-
ed at any height by the pins E E paffing through the
holes  in the  pillars C C C C ; and it may  at pleafure
be raifed at one end and depreffed  at the other.
  H H, Two ftraps conneded with  buckles on the
oppofite fide for fixing the  limb  after ir is properly 
              Explanation of the Plates.           j$

 placed.   Before laying  down the leg, the dreffings
 fhould be all applied, and the excavated board fhould
 be completely lined  with foft wool.   G,  a hole for
 receiving the heel to prevent  it from  being hurt when
 the leg is ftretched out in the manner  reprefented in
 figure 2.
   The ends, B B, may either be fixed  to the bafe of
 the inftrument, or,  in order to render it more porta-
 ble, they may be made moveable,  and fixed for ufe
 by a double pin at each end,  F.

                  Plate XCVI.

   In Chapter XXXIX. Sedion X. as well as in other
 parts  of this work,  I had occafion  to recommend a
 cafe for fupporting the fore-arm  as preferable to any
 bandage.  A reprefentation is given  of it in fig.  i.
   A A,  a cafe or frame of firm leather, properly  lin-
 ed with flannel or wool,  of a  fufficient length for cov-
 ering the arm from the elbow to the  point of the  fin-
 gers.   This is intended for the left arm.  B, a collar
 of foft buff leather for pafling over the  right arm, in
 order to fupport the forepart of the cafe by the ftrap
 F paffing over the left fhoulder, to  be fixed to a buc-
 kle at C, to prevent the collar B from flipping down.
 G H, Two ftraps and buckles for fixing the arm down
 to the inftrument.
   The application of this inftrument will be better un-
 derftood  by the view of it in fig.  2.
   I was favoured with this inftrument by Dr. Monro,
 to whom, I believe, it was fent by Mr.  Park of Liv-
 erpool.
   Figs. 3. and 4. Two artificial legs,  delineated by
Mr. White of Manchefter in his Cafes in Surgery.
Fig. 4. A, a hollow leg made of tin, and covered with
thin leather.  B a leather ftrap with a buckle on the
outfide, for  fixing it  below the knee.   C D, longitu-
dinal fteel bars, to be made as tough and light as pof-
fible, with fufficient ftrength.  Thefe  bars are joined 
 j6        ■  Explanation of the Plates.

by  a moveable joint, to be placed exadly oppofite to
the knee joint.   E, a fteel bow made thin and elaftic,
to pafs about two-thirds round the lower part of the
thigh, and fixed with  ftraps of leather to buckle on
the forepart.
  Fig. 3.  Another artificial leg made  in the  fame
manner with fig. 4. with the addition of a foot  made
of light wood and moveable joints, fo as to imitate
pretty nearly the natural motions of the joints of the
ankle and toes.

                  Plate XCVII.

  Fig. 1.  A fmall fpring faw ufed in amputating fin-
gers and toes.
  Figs. 2. and  3.  Retradoxa made of thin iron plates
for drawing up and fupporting the mufcles and  other
foft parts in amputating limbs while the faw is applied
to the bones.    They fhould be kept with openings of
different fizes, fo that they may  anfwer whether  the
bone is large  or fmall.   Thefe  retradors were firft
propofed by Dr. Monro, and they anfwer the purpofe
with much eafe to the operator, and perfed fafety to
the patient.
  Fig. 4.  A piece of firm flit leather, which alfo an-
fwers the  purpofe of a retrador.   Leather is better
fuited for this than linen, which is generally ufed, but
neither the one nor the other anfwer fo well as plates
of iron.

                 Plate  XCVIII.

  Fig. 1.  The faw that I always ufe in amputating
legs  and arms :  it fhould be feventeen inches in length,
including the handle, and two inches and a quarter in
breadth at its broadeft part.
  Fig. 2.   A fmall double edged  knife,  commonly
termed a catline, for dividing the interoffeous ligaments 
Explanation of the Plates.           77
and other foft parts in amputating the leg and fore-
arm : it fhould be nine inches long.
  Fig. 3. An amputating knife, which anfwers either
for the thigh, leg, or arm :  it fhould be thirteen inch-
es in length.
  Fig. 4. A fmall crooked knife for feparating  the
mufcles from the bone in the  manner I have advifed
in Chap. XLIV. Sed. IV.

                 Plate XCIX.

  In Chap. XLVIII. I gave fome account of an inge-
nious propofal by Mr. Moore of London, for dimin-
ifhing and preventing  pain in feveral  operations of
furgery.   It is done by compreffing the nerves of the
limb upon which an operation is to be performed.  In
this Plate, I have reprefented the  apparatus recom-
mended by Mr. Moore for this purpofe.
  Fig. 1. A, The compreffing inftrument, being for-
med of a curved piece of iron covered with leather, and
of fufficient capacity  to contain the thigh within  its
curve.
  B, A firm comprefs of leather at one  extremity of
the inftrument, to be placed on the fciatic nerve.
  C,  An oval  comprefs fixed on a fcrew, paffing
through a hole at-the other extremity of the inftru-
ment.  This comprefs is placed on the  crural nerve.
  When the inftrument is to be ufed,  it is neceffary in
the firft place to fearch for the fciactic nerve: for this
purpofe,  let the operator feel for the tuberofity of the
ifchium, and then for the great trochanter; and fup-
pofing a ftraight line drawn from the one to the other,
apply the comprefs B about an inch above the middle
of that line.
  The crural nerve is found by the .pulfation of the
crural artery, which runs  contiguous  to  it; the  oval
comprefs C muft next be applied above it; and upon
turning the fcrew  conneded with it, the  fciatic nerve
is preffed by B againft the edge of the fciatic  notch, 
78            Explanation of the Plates.

and the crural nerve againft the os femoris to any de-
gree that is neceffary.
  Fig. 2. Reprefents the inftrument  adjufted to the
thigh ; and fig. 3. a fmaller compreffor fuited to the
arm.

                   Plate C.

  In this plate I have given a reprefentation of an ar-
tificial leg and arm made by an ingenious artift of this
place, who I have in different parts of this work had
occafion to mention, the late Mr. Gavin Wilfon.
  Fig.  1. An  artificial leg  made  of firm  hardened
leather.
  A, An oval piece of the fame kind of leather,  lined
with fhamoy, fixed upon a plate of iron C, and  mov-
ing upon an axis at the knee.  The ftrap, with the
buckle conneded with it, ferves to fix it to the thigh.
There muft alfo be an  oval piece  conneded  with  a
fimilar iron plate on the oppofite fide of the  thigh:
thefe  iron plates and  oval pads fhould together go
about nine inches up the thigh.
  B, a ftrap that comes from the fole of the foot, and
goes up the infide of the leg to the middle of the thigh,
where it is fixed by a buckle to a ftrap  coming  from
the oppofite fhoulder; this ferves to fupport the leg,
and to take the weight of it more effedually from the
weak fide than any invention I have met with.
  Fig. 3.  The oval piece of leather and iron fplint to
which it is fixed.
  Fig. 4.  A piece of foft fhamoy leather, which fix-
es by a buckle and  ftrap round the condyles at the
knee.  In this kind of leg, the perfon's weight  refts
upon the condyles and patella, the flump itfelf hang-
ing quite free within the leg.  The band  or ftrap ferves
in the moft effedual manner to prevent pain and ex-
coriation, which otherwife would probably enfue from
the fridion of the leg againft the knee. 
Explanation of the Plates.           y$
  Fig. 2. A fore-arm and hand made of the fame kind
of leather, and made to fix to the arm and  fhoulder
by the ftraps D E.
  Thefe artificial legs and arms are preferable to any
I have ever feen.   The leg, when properly fitted,
proves equally ufeful with the common timber leg, and
it is preferable by being neater; at the fame  time that
it i» not apt to break, an accident to which the others
are liable:  and it anfwers better than a leg  made  of
copper, from being confiderably lighter, and not apt
to be  hurt in its fhape by bruifes.
  Mr. Wilfon makes three different kinds of legs cor-
refponding to  the part at which the limb is  amputa-
ted.   In amputating the leg lower than the ufual part,
that is, in fuch  a manner that the motion  of the knee
is to be retained, it anfwers  better at the  diftance of
nine or ten inches from the condyles of the knee than
either higher or lower.   When higher, the remaining
part of the leg does not fupport  the artificial leg in
walking;  and  when much  lower, the machine muft
be thicker about the ankle  than  would otherwife  be
required, by which it is rendered clumfy and heavy.
Fig. i. in this  plate reprefents a leg for this  part.
  The fecond kind of artificial leg  which Mr. Wilfon
makes is  intended for thofe who have loft the  leg at
the ufual  place below the knee,  where the  weight of
the body refts on the knee joint and upper part of the
leg upon a foft fluffed cufhion.
  Thefe legs have no flexion at the knee,  and the hol-
low for receiving the thigh  goes up near to  the hip:
it opens  behind to admit the thigh;  it is fixed with
three  ftraps and hooks, which laft are not only ftrong-
er, but lefs bulky than buckles.
  When a limb is  amputated above the knee, a joint
is  formed  in the artificial leg at the knee.   In-walk-
ing, the limb is made fteady by a fteel bolt running in
two ftaples on the outfide of the thigh, being pufhed
down ; and when the patient fits down, he renders the
joint flexible by pulling  the bolt up.  This is eafily 
8o           Explanation of the Plates.

done, and  it adds much to the utility of the inven-
tion.
  The reft or fupport in this leg is  obtained  in part
from  its embracing the upper part of the thigh tight-
ly, but chiefly from the back part  of the thigh box
being ftuffed in fuch a manner that  the lower part of
the hip  refts upon it with nearly the fame eafe that one
does in  fitting on a ftuffed chair; and, in fad, a per-
fon fits on it when he either ftands or walks ;  by
which, and by the ftrap carried  up  from the  fole of
the foot to the  fhoulder,  the  limb is eafily  carried
about.
  Mr. Wilfon's artificial arms, befides being made of
firm hardened leather, are covered with white lamb-
fkin, fo tinged  as to refemble the human fkin.  The
nails are made of white horn, tinged in fuch a man-
ner as to be an exad imitation of nature.
  The wrift joint is a ball and focket, and anfwers all
the purpofes of flexion, extenfion and rotation.  The
firft joints of the thumb and fingers  are alfo balls and
fockets  made of hammered plate brafs,  and  all the
balls are hollow to diminifh their weight.  The fec-
ond and third joints are fomewhat fimilar to that which
anatomifts term ginglimus, but they are fo far differ-
ent as to admit of any motion, whether  flexion, ex-
tenfion, or lateral.
  The  fingers and  metacarpus  are  made up to the
fhape, with foft  fhamoy leather and baked hair.   In
the palm of the hand there is an iron fcrew, in which
a fcrew nail is  occafionally faftened.   The head  of
this nail is  a fpring plate, contrived in  fuch a manner
as to hold a knife or a fork, which it does with per-
fed firmnefs; and by means of a brafs ring fixed on
the firft and fecond fingers, a pen  can be ufed with
fufficient exadnefs for writing.
  When only a hand and fore-arm is needed, it is fix-
ed to the arm above the elbow by a ftrap of  leather
fewed to one of the fides of the artificial forearm. Af-
ter  making a turn  and a  half juft  above the elbow, 
             Explanation of the Plates*           81

the ftrap is fixed on the back part of the limb at D,
figure 2.
   When the arm is amputated above the elbow, the
artificial limb is made with an elbow joint.  This part
of it is made of wood, and has a rotatory  motion as
well as that of flexion and extenfion.
   I have given this particular account of Mr. Wilfon's
invention, from a convidion of its being fuperior to
any  with  which the public is acquainted : 1 am alfo
pleafed at  having it in my power to let the merit of
fuch an artift be more generally known than it other-
wife might be.   Indeed his merit was fo confpicuous,
that his death I confider as a public lofs, at the  fame
time that  I often wifhed  that fome public encourage-
ment had  been  given him, to enable him  to  commu-
nicate as much as poffible the refult of his experience
to others.
                    Plate CI.
   In this  plate  I  have delineated two machines for
fupporting  the  head and fhouiders, commonly em-
ployed in diftortions of the fpine.
   Fig.  i. A, An iron collar properly covered for paf-
fing round the neck.   By means of  the long iron
plate conneded with it, it may be raifed or depreffed
at pleafure.  B B B, a broad iron  plate fitted to the
back and  fhouiders.  C C,  two  ftraps to be carried
over the fhouiders;  and  being brought through be-
neath the armpits, to be fixed,  of a fufficient  tight-
nefs, on two knobs on the fhoulder-plates, as may be
feen in fig. 2.   D, a ftrap for fixing the plate  going
down the back, by tying it round the body.
   Fig. 3. an iron or fteel inftrument, delineated by
Heifter for the fame purpofe with the preceding.  A A,
its tranfverfe part, to  which are fattened iron rings
C C for  retaining and keeping back  the fhouiders.
B, the perpendicular part going down the back.  D,
a band or ligature paffing through an aperture in the
lower end of the plate B for tying it  firmly  to the
body.
   Vol. IV.       F 
Zz           Explanation of the Plates.
                   Plate  CII.

   In this and the four following plates, I have delin-
eated the inftruments  employed in midwifery.
   The forceps is perhaps the beft,  as it is  the  fafeft
inftrument employed by the accoucheur.
   Various  forms of it have been recommended by
praditioners; but the one delineated in this plate has
been found to anfwer  perhaps better  than any other.
It  is fufficiently long, and the blades  apply with  per-
fed exadnefs to the child's head.
   This inftrument fhould meafure eleven or twelve
inches in length.  Some have alleged that they fliould
be longer, in order to prevent their locking within the
vagina, and that they  may with more eafe be  applied
when the head of the child  lies high in  the  pelvis;
but the length I have mentioned  is  by experience
found to be fufficient.

                   Plate CIII.

   Fig. i.   Sciffars ufed for perforating the fkull of
the foetus where the pelvis is fo narrow that delivery
cannot be  otherwife accomplifhed.   After emptying
the cranium of its contents, the child is extraded piece-
meal either with the crotchet  or blunt hook,  fig. 2.
Plate CIV. or with the forceps, figures 1. or 3. of the
fame plate.
   The fciffars here reprefented are thofe recommend-
ed by Dr. T)enman.
   Fig. 2.  A fingle blade of the common crotchet, an
inftrument  employed for tearing away the foetus piece-
meal when it cannot be delivered entire.   From the
form of this inftrument, it obvioufly cannot be ufed
but with much rifle even of hurting the mother.  The
beft rule for preventing this is to keep the point al-
ways towards the foetus. 
Explanati n of the Plates.            S$
  Fig. 3.  The two blades of the crotchet locked to-
gether ; in which way they may be ufed with perfed
fafety to the mother.

                  Plate  CIV.

  The forceps, figures 1. and 3. as well as the blunt
hook, figure 2. of this plate, are intended, as was men-
tioned in the explanation of the preceding plate, for
extrading the  fcetus piecemeal, when it is judged ne-
ceffary to accomplifh delivery in'this manner.

                   Plate  CV.

  The inftruments in this plate, and the fillet, fig. 3.
in Plate CVI. are the invention of my friend  the late
Sir Thomas Bell, a praditioner of eminence in Dub-
lin.   They are chiefly  intended for  extrading the
head of the foetus, when by accident or improper man-
agement it is feparated from the body in cafes of nar-
row pelvis.
  By  a proper  application of the fillet the  head  is
fteadily fixed till it is fufficiently opened for difcharg-
ing the brain ; when, with the forceps here delineated,
the parts are extraded.  Thefe forceps confift of two
blades ; one nearly of the ordinary  form ; the  other
convex ; and  its convexity being adapted to the con-
cavity of the other, the two  occupy much lefs  fpace
than they otherwife  would do ; by which they are pe-
culiarly well fitted for ading in a narrow pelvis. The
teeth  with which one of the blades is furnifhed, give
thefe  forceps a very firm hold of any part to which
they are applied : and as they may be ufed with fafe-
ty, I think it probable that  in  many cafes they may
fuperfede  the ufe of the  crotchet.

                    Plate CVI.
  Fig. 1. A fillet of whalebone covered with a fheath,
which by fome is employed, in difficult labours,  for
               f 2 
84           Explanation of the Plates.
 pulling down the head of the foetus.  In general, how-
 ever, the forceps anfwer better.
   Fig. 2.  A curved inftrument, with an  opening at
 one end, for applying  ligatures round polypous ex-
 crefcences in the uterus.  It is the invention  of the
 late Dr. Hunter of London, and  it anfwers the pur-
 pofe in the eafieft and moft  effedual manner.
   Fig. 3.  A fillet mentioned in the explanation of the
 preceding plate as the invention of Sir Thomas Bell
 of Dublin: it is a material improvement of the com-
 mon fillet reprefented in figure 1. of this plate.

                  Plate CV1I.

   Fig.  1. I have here delineated a  night cap, fixed in
 fuch a manner as to  ferve  as one of the beft bandages
 for the head.
   Fig. 2. The common triangular napkin, or couvre
 chef of the French, ufually employed as a bandage for
 the head.
   Fig. 3. The radiated  bandage, as it is ufually term-
 ed.  It is commonly employed for compreffing the
 temporal artery ;  and it anfwers equally well for flop-
ping hemorrhagies in any arteries of the head, as may
 be feen in fig. 4. where  the knot or turn  is made at
 the angle of the jaw.
  Fig. 5. The bandage ufually employed for fradures
of the lower jaw,  as well as for wounds and other in-
juries of the under lip and  chin.
  Fig. 6. A bandage for fupporting the head.   It is
formed  by a proper application of the double headed
roller, fig. 2. Plate CVIII.

                 Plate  CVIII.

  Fig.  1. A common fingle  headed roller; a  band-
age that anfwers for various purpofes in furgery.
  Fig.  2. A double headed roller. 
Explanation of the Plates,           85
  Fig. 3. A double headed roller with a flit  in the
middle, forming what is termed the uniting bandage.
  Fig. 4. A four headed roller, ufually employed for
fradures of the lower jaw and injuries of the contig-
uous parts.
  Fig. 5. A bandage with twelve heads  or  tails ap-
plied to a leg.  This, as I have had occafion to ob-
ferve in various parts of this work, is the moft ufeful
bandage for fradures, as well as for many  other af-
fedions of the thighs and legs.  In fig. 7. I  have re-
prefented a  bandage of the fame kind, made in a
manner commonly  ufed in fome of the London hof-
pitals.
  Fig. 6. The uniting bandage, fig. 3. applied to a
wound in the arm.

                  Plate  CIX.

  Figs. 1. and 2. A front and back view of the nap-
kin and fcapulary, the moft ufeful bandage for almoft
every part of the thorax and abdomen.
  Figs. 3. and 4. Different forms of the T  bandage.
This bandage proves  particularly ufeful in difeafes of
the anus and perineum.   D, a hole for admitting the
penis.   At E, that part of the bandage which paffes
between the legs is divided into two ; one  part of it
pafling on one fide of the penis and fcrotum, and the
other on the oppofite  fide.

                   Plate  CX.

  In this plate I have delineated the different forms
of fufpenfory  bandages for the fcrotum.  They may
be made either of linen, cotton, or flannel;  but foft
cotton anfwers beft.
  Each bandage confifts of a circular A, which is fix-
ed round the body above the bones of the pelvis, and
a pouch or bag conneded with this: the principal dif-
ference between them confifts in the form of the pouch, 
86           Explanation of the Plates'.
and in the manner by which it is fixed to the circular.
In figs. i. 2. 3. and 4. the  pouch is conneded with
the circular both before and behind.   Of thefe, fig. 3.
I think is the beft.
   Where the fcrotum is of fuch a fize, that the pouch
or bag, when fixed upon it, will remain, the two bands,
which  pafs between the thighs for fixing it behind, are
unneceffary :  fig. 5. reprefents a  form of it for this
purpofe.

             Plates  CXI. and CXII.

   In thefe two plates  I have delineated  inftruments
for a pocket cafe, for which furgeons have daily oc-
cafion.
   Plate CXI. fig.  1. forceps.  Fig. 2. a round edged
fcalpel.  Fig. 3. crooked fciffars.  Fig. 4. a cafe  for
cauftic and red precipitate.
   Plate CXII.  figs.  1. and  3,   different  forms of
probes. Fig. 2. a fpatula. Fig. 4. a  diredor.
   Thefe  with a probe pointed biftoury, fig. 2. Plate
LXIV. a tenaculum, Plate III. fig, 1. and 8. a fcarifi-
cator,  Plate XXXVI.  fig. 4. and a  few crooked nee-
dles of different fizes,  form a very complete fet for a
pocket cafe,

                  Plate CXIII.

   The figures of this  plate  reprefent a fet of inftru-
ments for the cure of hydrocele with a feton defcrib-
ed in Chap. XXIV. Volume III. pages 64, 65.

                  Plate CXIV.

   A tube of copper for conveying fumes of cinnabar
to ulcers in the throat or,nofe : A B, a box of copper,
containing  a  heater of iron of the  fame form,  and
nearly  of the  fame fiz~, but fomewhat lefs, that it may
be eafily put In and taken out: on this  piece of iron. 
             Explanation of the Plates.            8^

 when red hot, the cinnabar is put, and the cover C D
 with the tube E F attached to it, being fcrewed upon
 the  box  A B,  all the fumes  muft neceffarily pafs
 through F, by which they may with eafe be conveyed
 to any particular fpot.
   In operating for the fiftula in ano with a probe point-
 ed biftoury, when the parts to be cut are thick, fome
 difficulty  is  occafionally experienced in paffing the
 knob of the inftrument through them : this, as I have
 elfewhere obferved,  may, with due care and attention,
 be eafily overcome ; but fome who are not in the fre-
 quent pradice of this operation, may do it more readi-
 ly with the inftruments, figs.  2. and 3. of this Plate,
 a very neat invention for which  I am informed we are
 indebted to the ingenious Mr. Cruickfhank  of Lon-
 don.                                            *
  Thefe figures are in every other refped the fame,
 only the one is  ftraight, and the other crooked ; and
 fig. 2. gives  a back view of the inftrument;  and fig.
 3. a front view  of it.
  This inftrument confifts of three principal or mate-
 rial parts.  The handle  A B.   A probe pointed bif-
 toury, C D, and a fharp pointed biftoury, D E.
  The fharp  pointed biftoury  is  made to Aide fmooth-
 ly upon the other, to which it muft apply fo  clofely,
 that the point F, fig. 1.  may not be felt  as it moves
 along, and they are  attached to each other by a fcrew
 nail at I, fig.  3.  paffing through  the flit C in the blunt
 biftoury C D into the end of the fliarp pointed biftou-
 ry at E.
  In operating the  forefinger of the left hand" is in-
 troduced into the anus.  The  inftrument with the
 fharp pointed biftoury drawn back as in fig. 2. is then
 paffed into the finus till  the blunt end of it D reaches
 the top of it, and is  felt  by the finger in the redum:
an opening is now to be made in the redum with the
fharp pointed biftoury, which is done by preffing it for-
ward, by applying the forefinger of the right  hand to
the knob E.  This being done, and we know that the 
88           Explanation of the Plates.
opening is completed by the finger in the redum, the
fharp pointed brftoury is again drawn back, when the
probe pointed biftoury D, being paffed into the open-
ing newly made in the redum, the operation is finifh-
ed in the ufual  way, as is done with the  common bif-
toury.

                  Plate  CXV.

   The three firft  figures of this Plate reprefent an ap-
paratus delineated by the late very ingenious Mr. John
Hunter, for the application of cauftic to ftridures in
the urethra.
   Fig. i.  A ftraight filver canula, with a plug at the
end  of a filver wire projeding beyond the end of it,
fo as to form a round knob : at the other end of the
wire, is a fmall port crayon, in which is  reprefented a
piece of cauftic.
   Figure 2. A flexible canula for applying cauftic to
ftridures in the bend of the urethra.   The wire, with
the fmall port crayon, is pufhed out beyond its end.
   Fig. 3.  A piece of filver wire, with the plug at the
end, to be introduced into the canula, as in fig. 1.
   In ufing thefe inftruments,  figure 1, or 2, with its
projeding knob, is paffed into the urethra till it comes
in contad with the ftridure, in which  fituation the
tube is kept, and  the wire being withdrawn, the port
crayon, with cauftic fixed in it, is paffed  through the
tube, and kept applied to the ftridure as long as may
be judged proper, when, on being Dulled into the
tube, the  whole  is withdrawn.   I t^ve  elfewhere,
however, endeavoured to  fhew, that little advantage is
to be expeded from this inftrument, while much harm
may be done  by it.*  Where ftridures are of the
length of a third or fourth  part of an inch, as they
often are, I conceive it to be impoffible to remove them

  * Vide Trcatife on Gonorrhoea Virulenta, and Lues Venerea, by Ben-
jamin Bell. 
Explanation of the Plates.
89
with cauftic, while there is always fome rifk, with
whatever caution it may be managed, of" the cauftic
breaking off and  remaining in the urethra ;  as there
alfo is, of our bringing the cauftic into immediate con-
tad with the found part of the urethra, inftead of ap-
plying it diredly to the ftridure itfelf.
   Fig. 4. A ftraight filver canula, with a ftilette, fur-
nifhed with  a fliarp trocar point.  Where ftridures
are not more extenfive than the thicknefs of a fheet
of paper or two, but yet too firm to be paffed with a
bougie or common ftaff, by paffing the canula of this
inftrument till it comes in contad with the ftridure,
the ftilette  may then  be eafily pufhed  through it,
when the whole being withdrawn, a bougie  may be
inferted,  and  the  cure completed by a  proper  and
continued ufe of bougies.   By  means of the fmall
holes  and fcrew nail  near the handle  of  the ftilette,
the length  of the  pointed part of this inftrument is
eafily graduated ;  but I need fcarcely obferve,  that
even with this it requires to be ufed  with great cau-
tion, and ought not to be employed but by thofe who
are much verfant in the treatment of obftrudions of
the urethra. 
 
INDEX.
                                                     Page
     ABDOMEN and its contents, anatomical  defcription
      of,                                       vol. i. 270
                wounds of,                             ib.
                wounds of, diftinclions of,              275
                external wounds of,                     ib.
                                  treatment of,       278
                penetrating wounds of,                 279
                                caufe of danger in,     ib.
                                treatment of,          280
                paracentefis of, method of performing,
                                               vol. ii. 521
                                when neceffary,       517
                                fhould  be  early  per-
                                  formed,            518
Abfcefs Lumbar.  See Lumbar.
        when to be opened,                      vol. i.  28
        ending fatally from improper treatment,          29
        different modes of opening,                      30
        method of opening by cauftic,                    ib.
                         by incifion,                   ib.
                         with a cord,                   33
Abfcefs, in the globe of the eye, cure of,          vol. ii.  185
        near the anus, treatment of,             vol. iii.  2go>',
Accidents external, may induce  cancer,           vol. i. 416
Acid vitriolic, its ufe in gangrene,                       47
Air, its bad effects on fores,                             365
     admiffion of, caufe of danger in compound fractures,
                                              vol. iii.  372
Albugo, where  fituated,               *         vol. ii.  204
        different appearances of,                        205
        treatment of,                                  207
        ufe of mercury in,                             208
        efcharotics, ufeful in,                           210
Alimentary canal, wounds of, how diftinguifhed,   vol. i.  290
                 when completely divided, how treated,  294
                 wounded and mortified, how treated,   297
                 wound of, proguofis in,                ib.
Alkohol, its ufe in gangrene,                             47
Alanfon, Mr. his method of amputating,         vol. iii.  486
             obfervations  on his method of amputating
               limbs,                                 488 
92                     INDEX.
                                                      Pag*
Alum calcined, a good efcharotic in ulcers,        vol. i. 369
Ambe of Hippocrates,                          vol. iii. 415
Amputating at the hip joint.   See Hip.
Amputation of leg.  See Leg.
Amputation with flap.  See Flap.
            of the arm at the fhoulder.   See Shoulder.
            fometimes neceffary in mortification,   vol. i.  49
            fometimes neceffary in carious ulcers,        406
Amputation,  in  compound  fractures, when  neceffary,
                                              vol. iii. 372
              operation of,                             457
              caufes that render it neceffary,            458
              fometimes neceffary in compound fractures,  ib.
                                 in wounds,            460
              neceffary  in gunfhot wounds,              461
                         mortification,                 462
              when neceffary in white fwellings,         464
                               exoftofis and ulcers,     465
                               cancer,                 466
                               tumors,                467
              fometimes neceffary in aneurifm,          468
                                   diftortions,         469
                                   necrofis,            47c*
              various medes of performing,              ib.
              of thigh.   See Thigh.
              methods of fecuring veffels in,            477
              method of drefling ftump in,               ib.
              Alanfon,  Mr. his method of operating in,  486
Amygdalae, difeafes of, requiring extirpation,      vol. ii. 346
              fchirrus of, not frequent,                   ib.
              methods of removing,                    348
An'afarca.   See Oedema.
Anatomy of parts concerned in herniae,            vol. ii. 527
Anchylofis often fucceeds fractures of the wrift,   vol. iii. 352
Aneurifm, general remarks on,                   vol. ii.   11
          varieties of,                                  ib.
          encyfted cr true, fymytoms of,                  12
                   caufes of,                             13
          varicofe, what,                                15
                  method of diftinguifhing,              16
          diffafed, fymptoms of,                         18
                  obfervations on,                       19
                  cafe  of, by Dionis,                     20
                  confequences of,                       21
                  caufes of,                              22
                  rarely produced by a burfting  of the
                     encyfted aneurifm,                   23
          may be confounded with other difeafes,          21 
                       INDEX.                    93
         *                                            Page
Aneurifm, characterise fymptoms of,              vol. ii.  24
          prognofis in,                                  2°
          treatment of,                                  32
          operation for,                                  33
          objections to Mr. Lambert's method of operat-
             ing in,                                  #   3"
Angina, definition and treatment of,               vol. 1.  59
Ani prolapfus,                                 vol. iii. 281
               caufes of,                                 "*
      fphincter, relaxation of,                            28a
               debility of, how to be obviated,            283
Antimonials, their ufe in cutaneous eruptions,      ^-.j* 437
Antrum maxillare, abfcefs in, caufes of,           vol. ii. 385
                             cure of,                    387
                   blood collected in,                    39°
                   where it may be opened,               ib.
Anus, fiftula in.   See Fiftula in Ano.
       imperforated,                             vol. iii. 284
                   method of cure,                      ib.
                   after treatment difficult,              285
Arm, not the beft part for the operation of  bloodlettmg,
                                                 vol. i. 524
      fling for, in fradures of the clavicle,         vol. iii. 338
      amputation of,                                   51&
 Arfenic, an efcharotic in ulcers,                   vol. i. 376
         obfervations on its ufe in cancer,              ^ 428
• Artery, intercoftal, how to be tied,                vol. i. 257
Arteries, ligature of,                                   475'
                    needles, feldom neceffary in,         480
                    obfervations on,            481 and 485
                    how beft performed,                482
                    nerves, to be avoided in,            483
                    ufe of forceps in,                   484
          wounds of, how diftinguifhed,                  5°^
                    treatment of,                       5.°9
                    inutility of preffure in,                ib.
 Arteriotomy, method of performing,              vol. ii.    3
 Afcites, fymptoms of,                                  5*7
         ufe  of frictions in,                              525
                             B.
 Bandage, uniting, ufeful in fimple wounds,        vo^..!'  l86
 Bandages, general obfervations on,              vol. iii.  547
           various kinds of, for the head,                 549
           for different parts  of the body,                 55°
 Bandage, ufed in dropfy,                                5Sl
           twelve tailed, beft for compound fractures,      379
 Buk, Peruvian, its utility in gangrene,            vol. i.   44
                beft mode of exhibiting,                  4J 
94           ""        INDEX.             «#
                                                       Page
Bark, Red, an account of its effect,                vol. i.   46
      Peruvian, its utility in fcorbutic ulcers,             456
                          ,  fcrcfula,                    461
Barytes muriata, ufe of, in fcrofula,                      123
Bath, tepid, ufeful in fractures,                   vol. iii. 326
Bilguer, Mr. his opinion of amputation in gunfhot wounds,
                                                 vol. i. 327
Bifchoff, Mr. his obfervations on cataract,         vol. ii. 23^
Biftoury, probe pointed, its utility  in fiftula ani,    vol. iii. 295
Biftoury for fiftula ani, obfervations on,                  312
Bladder, wounds of, how difcovered,               vol. i. 304
         wounds of, treatment of,                        305
         ftricture of,         -           -        vol. iii. 156
         caufe of being improperly wounded in lithotomy 185
         punctures of,           -            -           233
                     above the pubes,       -           ib.
                     from the perinasum,        -       235
                     from the rectum,     -       -     236
         comparative view of the different modes cf punc-
           turing,         -           -                237
         puncture of, in females,       -       -         239
         affected in fiftula ani,          -          -       310
         ulceration of in fiftula ani, how diftinguifhed,     ib.
                                  fatal,        -        311
Blifters, ufe of, in refolving inflammation,         vol. i.   1$
Blood effufed, renders fractures ditficult to cure,    vol. iii. 331
Bloodletting, local,      -                 -      vol. ii.   5
                  ufe of in phlegmon,            vol. i.   15
                           fractures,     -        vol. iii. 325 '
             nicety requifite in performing,      vol. i. 493
             various kinds of,       -         -        494
             general rules for performing,        -       495
             inftruments for performing,      -         497
             choice of a vein in,        -         -       499
             rules f r performing with a lancet,         500
             oblervations en,         -         -       504
             after treatment of,       -          -       505
             confequences of,      -       -           507
             in the arm,  hazard in performing,          524
                         method  of performing,         525
             may be performed, wherever a vein is evident 526
             in the jugular vein,  method of performing,  527
             in the ankles and feet, how performed, v. ii.    i
Bones, difeafed, fometimes the caufe of fiftula ani, vol. iii.  311
       fractured, retention of, how accomplifhed,         324
       metacarpal, treatment of fractures of,              353
       ends of, may fometimes be  removed,        -      . 517
„ •           objections to removing,         -         520 
                      INDEX.                    95
                                                     Page
Bougies, erroneous opinions concerning,       •         246
         compofition of,          -         -           249
         formation of,         -       -        -      25°
         method of ufing,         -         -         252
         length  of time they fhould be worn,            254
         their utility in gleets,         -        -      257
Brain, affeftions  of, from external violence, chap, on, v. ii.   47
       anatomical defcription of,         -                5°
       part of it  deftroyed with no dangerous confequences   56
       compreflion of, fymptoms of,         -            5**
                     how produced,         -       •   59
                     from extravafated fluids,            95
       concuflion of,         ,-         -         -       86
                    how it operates on the fyftem,        91
                    how diftinguifhed from inflammation  104
                                         compreflion,  IO<5
       concuflion of, bloodletting hurtful in,       -      ib.
                    treatment of,       -       -        107
       inflammation of, fymptoms of, "    -       -     no
                      how produced by external violence 114
                      cured by local bloodletting,         ib.
                      obfervations on,         -         116
                     ■trepan never to be applied in,      123
                      obfervations on,         -         134
       fuppuration of, treatment of,         -      -     120
       affections of, recapitulation of remedies ufed in,     137
Brandy, ufeful in promoting cicatrization,       -     _    369
Brittlenefs of bones, caufe of,          -        vol. iii. 318
Bromfield, Mr. his method of amputating at the flioulder,  515
Bronchocele, what, and fymptoms of,      -       vol. i.  138
             varieties of,         -           -          139
             treatment of,           -         -        141
Bronchotomy, when to be advifed,        •      vol. ii.  465
              not dangerous,         -       - ■■<       ib.
              method of performing,        -        ..   470
Buboes, venereal, nature ofy       -       -       vol. i.   70
                  difcuflion of,       -         -         ib.
                  method of bringing to fuppuration,       72
                         of opening,         -      -   ib.
                  ufe of cicuta in,       -          -       75
                       efcharotics in,        -           76
                       opium in,         -         -     ib.
Bubonocele, or  inguinal hernia, fymptoms of,     vol. iii.    1
             difeafes with which it may be  confounded,      2
             method of performing the operation for,        4
             fituation of the fpermatic cord in,      -       5
             adhefions fometimes occur in,          -        6
             fac always to be  opened in operations for,     17 
96                    INDEX.
                                                       Page
Bubonocele, ligatures on the fac not admiflible,    vol. iii.   11
            cale of, where a portion of gut was  twilted
               round another,         -         -        18
            more frequent in men than women,            20
Burns, varieties of,         -          -           vol. i. 331
       treatment of,           -         -         "332
       vefications in, when to be opened,        -       333
       attended with lofs of fubftance, how treated,      334
       from gunpowder, treatment of,         -         335
       treatment of ulcers arifing from,           -       ib.
Burfae mucolae, what, and tumors tf,         -           ic8
               tumors in, operation for,                 109
                            C.
Czfarean fection, when it fhould be performed,    vol. iii. 535
                 method  of performing,       -         536
Calculi, where moft apt to form,       -          -      149
        nuclei of,      -         -         -           151
        urinary, general remarks on,      -             149
        urinary, caufes of,         -           -         ib.
                 characteristic fymptcrrs of,              154
Callofity fhould not be confounded with ichirrus,          307
Callus, redundant, how managed,        -          -      326
Cancer, caufes of,         -         -            vol. i. 409
Cancers, at firft commonly local,         -         -     418
         treatment of,           -             -          419
         dreflings after extirpation of,       -         •   422
         fymptoms of, how palliated,             -       425
Capfular ligaments, collections h\,       -          -     no
                                treatment of,           112
                   concretions in,         -             113
                                operation for removing 115
Carbuncles, obfervations on,      -       -       vol. i.  38
Caries, fimilar to mortification in the foft parts,       *   399
Cataplafms, emollient, their utility in callou.s ulcer,        391
Cataract, defi ution of,                           vol. ii.  223
         diieafes with which it may be confounded,       225
         different appearances of,        -       -       226
         eafily diftinguifhed from other difeafes,          225
         membranous, what,       -         -           226
         fecondaire, what,            -         -       290
         attended with imperforated iris,       -          289
         fometimes leated in the capfule of the lens,      247
         various confiftences of,          -          -      225
                colours of,       -         -            303
         caufes of,       -         -         .          226
         cures of,           -.           -              227
         operations for,         -            -            228
         couching, or depreffion of,       -        -      229 
I N P E X.		91 Page
Cataract, method of couching, -	Vol. ii.	233
in the right eye,		240
various needles for couching,		242
extraction of, what, and inftruments for,		244
by whom invented,	-	243
method of performing,		244
with the left hand,		248
treatment after,	.	ib.
frequent caufe of failure in,		260
objections to,		251
propofed improvement in,		252
Cauftic, utility of, in the cure of ulcers,	vol. i.	376
method of curing hydrocele with,	vol. i".	84
Cauftics, their utility in callous ulcer,	vol. i.	390
venereal ulcers,		45!
Cautery, actual, obfervations on the ufe of,		401
Cerate calamine, ufeful in ulcers,		369
Chancres, how treated,		449
Charpee, dry, promotes cicatrization,	.	169
Chilblains, what,	.	88
treatment of,		89
Cicuta, obfervations on,		419
ufe of in buboes,		75
Cilia, inverfion of,	Vol. ii.	169
Circocele, what,	vol. iii.	116
Clavicles, fractures of,		337
how diftinguifhed,		ib.
how managed,		ib.
luxation of, how known,		405
treatment in,		406
Clcanlinefs, influence of, in cutaneous eruptions,	voLf.	436
Cold, external application of, in hernise,	vol. ii.	545
Compreffion, effects of in the cure of ulcers,	vol. i.	357
Condylomata, produced from the cuticle,	vol. iii.	279
Contra fiffure of the cranium,	vol. ii.	65
Contufions, effects of,	vol. i.	91
Cornea, flefhy excrefcences on,	vol. ii.	179
Corn§, treatment of,	vol. i.	150
Corollaries, general, relative to the cure of ulcers,		462
Couching the cataract, operation of,	vol. ii.	229
Cranium, contra fiffures of, afcertained,		65
depreffions of, never without fracture,		72
treatment of,		69
means formerly ufed for elevat-		
ing,		70
diploe, not always found in,		81
fiffures of, treatment of,		130
                with what they may be confounded, 131
Vol. IV.        G. 
o8                    INDEX.
*                                                      Page
Cranium, fiffures of, do  not always require the trepan,
                                                vol. ii. 133
          fractures of, obfervations on,                    49
                     how afcertained,                    69
          injuries done to, refult of,                      l3%
          internal table of, may be fractured alone,        64
          inftruments for perforating,                     71
          luxations of the bones of,              vol. iii. 395
          parts of, to be avoided in the trepan,    vol. ii.  76
          fimple fiffures,  and fractures of,                129
          fimple fiffures of, treatment of,                 J3^
          finufes of,                                      5"
          varieties of fractures of,                      _   "°
Criftffi produced from the cuticle,                vol. iii. 279
       fici and condylomata, treatment of,                280
Crufta lactea, what,                               vol. i. 442
Cupping and fcarifying, operation of,             vol. 11.    7
         dry, ufeful in promoting fuppuration,     vol. i.  27
Cutaneous affections, general remarks on,                43°
                            D.
Dead bodies, method of opening,                vol. ui. 542
Deafnefs, caufes of,                 >             vol. ii. 451
          occafioned by wax in the ear,                  457
          treatment of,                                 45 2
          inftruments for remedying,                    459
Dentition, effects of,                                    37<>
          cure of fymptoms of,                          »b.
Diaphoretics, ufe of, in affections of the brain,     vol. ii.  119
Diaphragm, wounds of, fymptoms of,              vol. i. 267
                        treatment in,                   268
Diathefis, putrid, how corrected,                         455
Diet, nourifhing, its utility in fcurvy,                 w 45 6
Diploe, not always met with,                    vol. ii.   81
Director and fcalpel, not admiffible in fiftula ani,  vol. iii.  297
 Diftorted limbs, caufes of,                              442
                 treatment of,                           443
                 varieties of,                          _ 444
 Douglas, Dr. his improvement of the trepan,      vol. ii.   82
          Mr.  his cure of hydrocele of the vaginal coat,
                                                vol. iii.   62
 Duct, parotid, divifion of,                        vol. ii.  448
                         method of curing,              449
 Dry cupping, what,                                       8
 Dura mater, little danger from opening,                 ioi
                             E.
 Ears, difeafes of,                  -             vol. ii.  451
       extraneous bodies impacted in,       -      -       454
       inflammation of,                           vol.  i.  58 
                      INDEX.                    99
                                                     Page
Ears, lobes of, method of perforating,       -     vol. ii. 460
Ecchymofis, difference between and thrombus,     vol. i. 507
            and thrombus, treatment of,      -      -   ib.
            following fractures, how produced,   vol. iii. 318
Elbow joint, luxations of how diftinguifhed,       -      422
                            reduced,       -       -  423
Elfe, Mr, his method of curing hydrocele by cauftic,
                                              vol. iii.  62
Embalming, method of,                -       -       545
Emollients, improper for refolving inflammation,   vol. i.   11
           ufe of, in inflammation,      -       -         i£
                    white fwellings,      -      -     *34
Emphyfema, fymptoms and caufes of,       -    vol. ii. 512
Empyema, produced by fractures of the fcapula,  vol. iii. 345
           rapid progrefs of fymptoms,           vol. ii. 513
           treatment of,       -         -       -       5H
           fymptoms of,                t         -    507
           caufes of,      -         -       -      »■   508
           operation for,       -         -       -        ib.
           ufe of tubes in         -         -          511
Encyfted tumors, what,         -         -      vol. i.   96
                varieties of,                            98
                fituation of,                            99
                how produced,       -           -      97
                treatment of,        -      -          102
Epigaftric artery, difficulty in tying,       -     vol. iii.  25
Epilepfy, operation of trepan employed in,        vol. ii. 128
Eryfipelas, what,      -                -       vol.  i.   9
           nature of,                  -7         $$
           treatment of,       -       -       -          56
Efcharotics, a remedy in fungous ulcers,       -      r  382
Exfoliation of bones, how promoted,      -         -    400
Exoftofis, what,       -        -       -         -      15l
         treatment of,       -       -       -      -    154
         operation for removing,       -       -          ib.
Extirpation the only certain remedy in cancer,    -       420
           in cancer not always admiffible,      r       423
Eye, anatomical defcription of,      -       -    vol. ii. 142
     abfcefs in  the globe of, how produced,       -       185
     arteries of,       -         -      -       -        148
     ball, blood effufed into the cavity of,       -        194
          ulcers of,       -       -      -       -       196
          dropfy of, fymptoms and  cure of,       -      191
     cancer of, fymytoms of,       -       -     -       217
     cancer of, treatment of,       -       -    -        218
     excrefcences on, operation for removing,       -     203
     extirpation of, method of performing,       -       220
     inflammation of,         -         -       -       151 
 ioo                   INDEX.
                                                       Page
 Eyelafhes or cilia, inverfion of,          -         vol. ii. 169
 Eyelids, gaping of, caufes and treatment erf",        -      174
         concretion of, caufes of,      -       -         178
                       how treated,       *       -       ib.
         ulcerations of,       -         -       -        157
         tumours of,          -         -          -      164
         wound* of,          -      -       .           160
         protrufion of, caufes of,      -       -         213
                       cafes of, difficult of cure,    -     215
                       cure of a bad cafe,       -         ib.
                       treatment of                      ib.
 Eye, fpecks on.  See Albugo.       -       -       -      204
     fpeculum for fixing,       -      -       -         240
     ulcers on, remedies in,       -       -      -       i-j-j
     artificial',          -          .         -       -     222
     wounds of, often prove dangerous^     -       -      162
                             F.
 Fabre and  Louis, their obfervations  on the cure of ulcers,
                                                 vol. i. 355
 Face, fractures of the bones of,       -       -    vol. iii. 333
                 how treated,        *•       -         334
      wounds of,                        .        vol. i. 239
                treatment of,                            ib
 Fetor, how corrected in cancerous ulcers,       -         426
                       carious uleers,       -            403
 Femur, fractures of,        -         -           vol. iii. 354
                   die neck of, how diftinguifhed,        ib,
                                   reduced,     -       357
                                   retained,     -       358
       means of retaining fractures of,         -         36P
       fractures of, difficult cure  of,         -       -    356
Fibula, fractures of, obfervations on,         -       -    369
Fici, produced from the cuticle,         -                279
Fingers, amputation of,         -      -         -511
        fractures of the bones of,         -         -353
Fiffures of cranium, treatment of,     -       ►    vol. ii. 129
Fiftula in ano, what,       -      -       -     vol.  iii. 288
             general obfervations on,      -       -    311
             varieties of,         -         -        -   288
             moft frequent caufe of,    -         -     289
             cure of, how retarded,   -         -      301
             callous parts in, when  to be extirpated,     309
      occult, of the anus, description of,       -       .   304
                        how difcovered,        -          ib.
                        method of cure,       •         305
      lachrymalis, what,          -         -     vol. ii.  261
                  obfervations en,       -       -       349
                  fymptoms of,        . -       -       264 
                      r N D  E X.                   ioi
                                               •    .. Page
Fiftula lachrymalis, how produced,        -       vol. ii. 262
                  commonly feated in the nafal duct,    267
                  when owing to obftructions of the
                    pundta lachrymalia,     -       -   268
                  prognofis in,      -       -    -    265
                  incurable when proceeding from
                    fyphilis,       -      -       -     285
                  various modes of treating,       -    269
                  actual cautery, dangerous  in,         278
                  ufe of probes in, and objections to,    270
                         quickfilver in,       -    -    272
                  operation in,      -       »       -  273
                  method of perforating the os un-
                    guis in,       -      -            279
                  tubes ufed in the cure of,       -     284
       in perinaeo, definition of,       -     -     vol. iii. 260
                  a diftrefsful variety of,     -      -  269
                  caufes of,         -          -        261
                  operation for,      -       -    -   263
Flap, amputating with,        »                 -       497
     operation below the knee, method of performing,    508
             immediately aboye the knee,      -       5°3
                               improvement in,        508
Flaps, method of amputating with two,       -          507
Flefhy excrefcences, what, and treatment of,       vol. i.  149
Flores martiales, obfervations on the ufe of, in ulcers,     429
Foot, amputation of, when neceffary,       s      vol. iii. 509
      and toes, fractures of, how treated,       -         370
      luxations of, at ankle joint,       -         -       439
                ✓             treatment  of,        -      ib.
      bones of, luxation of, and treatment of,        -     441
Forearm, fractures of, how difcovered,     -       -     349
                          treated,        -       -       350
         luxations of, at the elbow,      -      •     422
Fradures, chapter on,         -        -        -        314
          varieties of,                                    ib.
          exiftence of, how afcertained,      -      -      315
          longitudinal, not eafily -difcovered,     -      317
          ufual fymptoms of,       -      -      -     316
          confequences of,       -        -       -       318
          prognofis in,      -       -       -       -     ib.
          indications of, cure in,       -        -        322
          how to be reduced,       -      -      -      323
          difficulties in the cure of, how obviated,        328
          compound, definition of,        -       -       371
                     dangerous from the  admiffion  of air,  372
                     cure of, difficult,       -     -     321
                     treatment of,       -      -       377 
 !o»                    I  N D E X.
                                                       Pa£e
 Fractures, inflammation in, how guarded againft, vol. iii.  379
 Fraenum, divifion of,       -       -       -       -      147
         linguae, divifion of,       -       -      vol. ii.  447
 Franco, Pierre, his operation of lithotomy,        vol. iii.  175
 Freke, Mr. his inftrument, for the reduction  of the hume-
   -  rus,       -       -       -       -       -       421
 Frere Cofme, his improvement in lithotomy,       -      2 >o
 Frere Jacques, his operation in lithotomy,        -        182
                            G.
 Gall bladder, wounds of,        -        -        vol. i.  301
 Gangrene,  dry, fymptoms of,       -        -      -      36
           white,       -       -        -       -       37
           caufes of,       -      -    '  -      -      39
           prognofis in,        -        -        -       41
           termination of, uncertain,        -       -  .     7
           treatment of,                                 42
           bloodletting, fometimes ufeful in,       -      43
 Gaftric juice of fheep, not ufeful in ulcers,    -     -      377
 Gaftroraphy, what, and how performed,     -     -      287
 Ganglion, what,       -       -        -       -         106
          treatment of,        -        -        -         107
 Glands, indurated, to be extirpated along with cancerous
    ulcers,      -      -       -      -      -        420
 Glovers future, how performed  on the inteftines,    vol. i.  292
 Goulard's cerate, ufeful in cutaneous ulcers,       -       438
                mode of preparing,      -      -       363
 Gooch, Mr. his apparatus for fradures of the thigh
                                              vol. iii.  360
            his trufs for prolapfus ani,       -      -      283
 Granulations remarks on  the growth of,      -     vol. i.  351
            formation of, how to be promoted,          359
Guaiacum, its utility in cutaneous eruptions,      -       437
Gums, warm, obfervations on the ufe of,     -     -     400
Gum  boils, what,       ...       vol. ii. 382
           treatment of,        -                        383
Gums, excrefcences on, nature of,        -       -        393
                  treatment of,        -        -        394
       laceration of, treatment of,       -       -        423
Gunfhot wounds, in what different from others,    vol. i. 315
                dangerous fymptoms in,        -        316
                hemorrhagies from,      -      -      323
                inutility of fcarifications in,       -      324
                bloodletting in, highly ufeful,           317
                extraneous bodies in, how removed,      ib.
                counter openings in, when advifeable,    319
                formation of matter in, how promoted,   320
                caution  with regard to,        -        321
                mortification in, how managed,          325 
                      INDEX,                   103
                                                      Page
Gunfhot wounds, amputation fometimes neceffary in,
                                               vol. i. 327
                           in, when to be advifed,      328
Gutta ferena, fometimes confounded with cataract, vol. ii. 223
                           H.
Hematocele, what,      ...      vol. iii. 110
             how produced,       -       -       -       ib.
             diftinguifhing marks of,      -      -      in
             treatment of,       -       -       -       ib.
Hemorrhage, obfervations on,       -       -      vol. i. 491
             from the furface of a wound,      -       487
             means employed by nature to cure,          ib.
             ufe of ftyptics in,        -        -        49x
             from piles, how flopped,      -     vol. iii. 275
                  cancer, how treated,           vol. i. 427
             various  means of putting a flop to,         475
Hemorrhoids, what,       ...     vol. iii. 271
             caufes of, and method of cure,      -      273
             tumors, how extirpated,       -      -     276
Hare lip, what,        ...       vol. ii. 355
         intention of operation for,       -       -       356
         method of performing operation for,      -     359
         double operation in,        -         -         363
         ufe of fciffars in operation for,  **     -        365
Hawkins, Mr. his gorget,       -       -       vol. iii. 192
                        improvement of,        -         ib.
Head, luxations of, obfervations on,       -       -      400
                   how reduced,       -       -       401
       contufions of, indications in,        -       vol. ii. 115
Heart, wounds of, obfervations on,        -        vol. i. 266
Heat, its effect in promoting fuppuration,       -         23
      beft means of applying,       ...      25
Heifter, his method of removing the penis,       vol. iii. 146
Hernia, definition  of,                            vol. ii. 526
        why termed rupture,       -       -       -     527
        varieties of,       -       -       -      vol. ii. 526
        anatomy of parts concerned in,        -        527
        fymptoms of,      -       -       -       -    537
        caufes of,       -       -        -       -       534
        ftrangulated,  remedies for,        -       -      539
        purgatives in, not to be ufed,       -       -    542
        operation  for, not always a radical cure,    -    548
        pernicious practice of itinerants in,       -       550
        fpurious, an unneceffary diftinction in,     vol. iii.   36
        congenita, what,        -         -        vol. ii. 533
                  fituation of parts in,    -     vol. iii.   21
        erural, its fite,        -         -        -        23 
,04                    INDEX.

Hernia crural, previous treatment and operation for, vol. iii. 24
              improvements propofed  in  the operation
                  for,                    -      -       26
        humoralis, rarely terminates in farcoccle,         123
        of the foramen ovale, treatment of,        -        31
        of the omentum, feldom dangerous,       vo^.!!' 537
        umbilical, how produced,        -        vol. iii.  28
                 operation for,        -        -        29
                 improper treatment of, by old authors,  ib.
        of the urinary bladder, no fac in,         -         32
                              fymptoms of,      -       33
                              caufe of, and treatment of,  34
                              ftones, fometimes met with
                                in,       -      -       ib.
        ventral, treatment of,                         #   3°
        truffes, neceffary in,       -      -       vol. ii. 551
Herpes, different varieties of,       -       -      vol. i. 431
        combined with itch, how treated,        -        440
                      lues venerea, how treated,         439
Hill, the late Mr. James, his fuccefsful practice in cancer, 413
Hip joint, amputating at,       -       -        vol. iii. 499
          luxations of,        -        -        -        42**
          may be luxated in various directions,     -     429
          luxation of, fymptoms of,      -       -       430
                     reduction of, confidered,     -     431
Hippocrates, his ambe, for reducing luxations,     -      415
Humerus, fradures of, how treated,      -       -       346
          diflocations of, obfervations on,        -        410
          diflocation of, at the fhoulder,        -        409
                        redudion of,       -       -     412
          diflocated, different means of reducing,         414
Humor, vitreous, fometimes efcapes in extrading the cat-
   arad,               -       -       -        vol. ii. 245
                 may be regenerated,      -      -      249
Hunter, John, his opinion on abfceffes of the antrum max-
   illare,       ....        -        386
                        on inflamed internal furfaces of
                           veins,     -     -    vol. i. 515
Hydrocele,  definition of, and general remarks  on, vol. iii.  36
           pathology of, not underftood till lately,         37
           anatomy of parts concerned in,         -       38
           varieties of,                                  4°
           cure of, by excifion, generally laid afide,        84
                   by injedion, hiftory of,     -    -     85
                               how performed,      -     ib.
                               arguments againft,        91
                    by the feton, fallen into difufe,         84
            smafarcous, of the fcrotum,       -      -      40 
                      INDEX.                   105
                                                      Page
Hydrocele, anafarcous, of the fcrotum, and appearances
  in,       ...                    vol. iii.  40
           operation for,       -       -       -        41
                     of the fpermatic cord, obfervations
                        on,                            101
           of a hernial fac,       -       -      -        97
                          conneded with congenite her-
                            nia,       -        -       98
                     charaderiftic fymptoms of,         ib.
           of the tunica vaginalis, obfervations on,         52
                          feldom the caufe of farcocele, 122
                          difeafes with which it may be
                            confounded,        -       49
                          may be miftaken for farcocele,  76
                          fymptoms of,     -      -     47
                          fituation of the teftes  in,       48
                          ftate of the teftis in,     -     68
                          methods of cure of,     -     54
                          palliative cure  of,       -      55
                          cure of by cauftic,      -     62
                                    excifion,      -     61
                                    incifion,            65
                          fometimes double,            49
                          method of cure, when double, 68
                          tefticle,  fometimes protrudes
                            after operation for,         70
                          comparative view of the differ-
                            ent operations for  the cure
                            of,        -        -       74
Hydrocele of the tunica vaginalis, inflammation  after
  operation for, how produced,      -     -    vol. iii.  81
Hydrops pericardii, charaderiftic marks of,       vol. ii. 495
                   operation for,       -        -        501
Hydro-farcocele, what,         -         -     vol. iii.  51
Hypopion, what, and how diftinguifhed 4rom ftaphyloma,
                                               vol. ii. 187
           treatment of,       -        -       -        190
                            I.
Jaw, under, fradures of, obfervations on,        vol. iii. 335
                       method of treatment of,          ib.
           obfervations on the articulation of,      -    396
           luxations of,'        -         -       -    397
                       how diftinguifhed,      -       ib.
                       treatment of,       -       -    398
Inflammation, general remarks  on,      -    -    vol. i.    1
              places moft liable to be attacked with,      17
              fymptoms of,         -                     5
  Vol. IV.         H 
106                   INDEX.
                                                       Pag«
Inflammation, eaufes of,         -         -         voL i.  3
              prognofis in,         -         -       "     7
              refolution of, not always advifable,            8
Injedion, mode of curing  hydrocele with,         vol. iii.  84
Injedions, aftringent, hurtful in fiftula ani,         -      294
                    improper in wounds of the cheft,
                                                 vol. i. 370
          efcharotic, fometimes ufed in finu us ulcer,     386
Inoculation, various modes of performing,         vol. iii. 527
Inteitine mortified,  method of treatment of,               13
         large portion of,  mortified and removed,          14
Joints, ob ervations on the ftrudure of,                   3^6
       artificial, formation of, in fradures,                328
       wounds of do not always require amputation, vol i. 237
Iris, what,         ...         vol ii. 145
     imperforated,         -         -                   289
Iffues, definition of,         -         -           vol. iii 522
       how uieful,      -                    -          ib.
       general rules for  the fituation of,        •           523
       ways of forming,         -                        ib.
       the manner in which they ad,         -    vol. i. 342
       debilitating effeds of, accounted for       •         ib.
       ufeful in filtula ani,         -        -    vol. iii. 301
       ufe of, in the cure of ulcers,       -        vol. i. 341
       obfervations on their ufe in cancer,       •         422
       in cutaneons ulcers,      -         *       "437
Jugular vein, bloodletting in,       -         -          527
Jultamond, Mr, his efcharotic in cancer,         -        428
                            K.
Kidneys, anatomy of,       -         -          vol. iii. 155
         wounds of,  *       -           -       vol. i. 303
Knee joint, luxations of,        -           •   vol. iii. 437
                       treatment of,       -       -      438
                            L.
Lachrymal fac, dropfy of,         -          •    vol. ii. 263
Lambert, Mr, his operation for aneurifm,         -        36
             firft cured hydrocele by injedion,   vol. iii.  85
Lancet, forms of, and method of ufing,            vol. i.  498
Laxatives, their utility in cutaneous eruptions,             437
Lead preparations, how they ad,         -       -        10
                  feldom hurt,        -         -       12
      beft mode of ufing,         -         -              13
      fugar of, not hurtful when taken into the ftomach,   314
Le Cat, his opinion  of the  extirpation of cancer.          424
Le Dran, his method cf flitching  the inteftines,    -      291
Leeches, mode of applying,       -         -    vol. ii.    9
Leg, amputation of, wnere to be performed,      vol. iii. 492 
                      INDEX.                   t©7
                                                     Page
Leg, amputation of, feldom done immediately below the
                     knee,          -          vol. iii. 494
                   method of performing       -         ib.
     fradures of,         -           -                3°^
     treatment in fradures of,            -              3^7
Lens, capfule of, never to be extraded,          vol. ii. 302
      may diffolve in the bottom of the eye, after
        couching,         -         -         -         257
Levator, beft form of,         -         -                84
Lever, not to be employed in luxations of the humerus,
                                              vol. iii.  421
Ligaments, become fenfible from difeafe,           vol. i.  232
           wounds of,         -                  -     ib.
                      fymptoms attending,    -        233
                      method of cure,     -      -      ft>.
                      inflammation produced by, how
                      obviated,       -        -      236
           capfular, whether ruptured in luxations,
                                               vol. iii. 387
Ligature, fometimes proper in the  fungous ulcer,   vol. i. 383
         how applied in fungous ulcers,        -         3^4
Ligatures, not to be ufed  in fiftula ani,     -     vol. iii. 298
Lime water, ufeful in cutaneous eruptions,         vol. i. 436
             its ufe in ulcers,       ...      369
Lint or charpee dry, not proper in fimple ulcers,    -     365
Lips, cancerous, method of extirpating,     *      vo^.jj'  37©
Lithontriptics, obfervations on,        -         vol. iii.  164
Lithotomy.  See Stone.
Liver, inflammation of, obfervations on,     -     voi. i.   61
                       treatment  of,        -       -       62
                       ufe of bark in,                    65
       wounds of, how diftinguifhed,        -      -      300
                  treatment in,        -        -        301
Lues venerea, a caufe of brittlenefs in bones,     vol. iii.  318
Lumbar abfcefs, what, and fymptoms of,    -    vol. i.   77
                 how diftinguifhed,        -      -       78
                 treatment of,        -      -       -     81
                 whether to be  opened or not,      -      82
 Lungs, why liable to inflammation,     -      -      -      5
        wounds of, danger attending,      -      -      260
                   treatment of,        -         -        ib.
                   treatment of abfcefs in,        -       261
        protrufion of, in wounds, how healed,      -      265
 Luxations, chapter on,      -       -            vol. iii. 383
            definition of,                                 ib.
           vareties of,       -       -             -     ib.
            fymptoms of,       -        -        t       384
           bow produced,        -                       ib- 
io8                    INDEX.
                                                       Page
Luxations, prognofis in,        -         -        vol. "'• 3&5
           indications of cure in,        -        -        39°
           how to be reduced,         -        -        39'
           rules for the extenfion of bones in,      -      392
           how retained after redudion,      -      -     393
           inflammation after, how managed,      -      394
           complication of, with fradure,    -     -     388
           complicated with fradures, how treated,       394
           compound,  how to be treated,     -      -     ib.
           from internal caufes, treatment in,      -      395
           of the foot at the ankle.  See Foot.
Luxation of the knee joint.  See Knee,
         of os calcis.  See Os Calcis.
         of patella.  See Patella.
Lymphatics, wounds of, how treated,       -       vol. i. 224
                            M.
Mad dog, bite of, obfervations on,       -       -       312
Mamma, cancerous,       -                      vol. ii. 483
                   fhould be early extirpated,  -   -     484
                   method of extirpating,       -       486
                   inflammation of, treatment of, vol. i.  66
Matter of ulcers, does not previoufly exift in the  blood,    343
                and varieties of, how produced,         344
Mead, Dr. his improvement in tapping the abdomen,
                                                vol. ii. 519
Meatus auditorius, excrefcences in,      -       -       455
                  externus imperforated, treatment of,    45 3
Mediaftinum, wounds of,         -       -       vol. i. 269
Mercury, obfervations on in fyphilis,       -      -       449
          diffolved in fpirit of nitre, an ufeful cauftic,      382
          hurtful in fcorbutic ulcers,       -       -      457
          folution of, its utility in fungous ulcer,          382
          corrofive, its utility in cutaneous  ulcer,         439
Mefentery, wounds of,        -        -        -
Metacarpus and fingers, luxations of,      *     vol. iii. 427
Metatarsal bones, removal  of,         -          -        5°9
Midwifery, general obfervations on,       -      ^       533
Mollities offium,       -       -        -        -        3l5
Monro, Dr. for his improvements of various chirurgical
   inftruments, fee explanations of feveral of the  plates.
Moore, Mr. his method of diminilhing pain,       -     .  531
Mortification.  See Gangrene,      -      -       vol. i.  36
             definition of,        -        -       -       3
Myrrh, tindure of, promotes  cicatrization in fores,  vol. i. 369
                            N.
Noevi materni, operation for removing,      -       vol. i. 146
Necrofis, what,        -       -        -        vol. iii. 451
         fymptoms of,        -        »        -        45 * 
                     INDEX.                   i<>9
                                                     Page
Necrofis. caufes of, ,             -       -      ™1. iii. 453
        cure of,      -        -      -       "       454
Needles, beft form of,       -      -       -   .   voL u 4*7
        method of ufing in the ligature of arteries,      4«°
Nephrotomy,       -                           voL Ul" "*
            when advifable,         -         -
Nerves, wounds of, how produced in bloodletting,  vol. 1. 512
                  how avoided,       -       -       5*3
                  treatment of,       -       -       5 * 7
       tendons, pricks of,       -        -        vol. i. 225
               wounds of, treatment of,       -       22°
Nipples, difeafes of,                             vo1- »• 4? *
        ulcerations of,      -       -       -       "
Nitre, obfervations on, in  the cure of ulcers,        vol. 1. 379
Nodes, venereal, what,       -        -        - .       l52
                how to  know when they originate in the
                  bone,        -       -       -       l6°
                treatment of,        -         -         *57
Nofe and fauces, anatomical defcription of,        vol. it. 312
     fradures of,                               voL "»•  332
     luxations of,       -       -        -       -       39°
                 how managed,        -        -        *"•
     and throat, polypi of.  See Polypi of Nofe and
        Throat.
Naftrils, imperforated, treatment of,      -      vol. n. 323
        hemorrhagies from,       -       -      -      315
                            O.
Obftrudions in gliinds may induce  cancer,        vol. i. 417
Oedema, what,       -        -       -       -       IJ7
         treatment of,        -       -        -       *}*
         uie of punctures in,      -       -       -      "*•
Oefophagotomy,  when neceffary,        -        vol. ii. 475
                a dangerous operation,        -        476"
                 method of performing,     -      -     478
Oefophagus, wounds of, may be cured,         -         477
                        treatment of,       -      vol. i. 244
O'Halloran Mr. his  improvement  on the flap  operation,
                                               vol. iii. 498
                    advantages thereof,        -       5°^
Oils, emollient, ufeful in fradures,       -        -     # 326
Ointments, proper in carious ulcers,       -       vo^..!* 4°4
Olecranon, fradures of, how cured,"      -      vol. iii. 351
Omentum, wounds of,       ...     vol. i. 299
           bad effeds of ligatures  of,      -      vol. iii.   12
           method of removing a  portion of,          _   13
           treatment of, when  mortified,     -      -      12
Operation for fiftula in ano, how performed,      vol. iii. 294
              imperforated anus,        -        -        2&4 
iia                   INDEX.
                                                       Page
Ophthalmia, fymptoms and varieties of,     -     vol. ii.  151
            confequences of,       -       -       -     152
            caufes of,                                   ib.
            indications of cure in,       -       -       153
            method of fcarifying the eye in,      -      15$
            from extraneous bodies, treatment of,        153
            venereal and fcrofulous, difficult of cure,     152
Opiates, fometimes ufeful in the cure of ulcers,     vol. i.  375
Opium, ufe  of, in fpafmodic twitchings,                  489
              venereal buboes,      -      -      vol. i.   76
Os  calcis, how luxated, and treatment of,         vol. iii.  440
    coccyx and os facrum, fometimes affeded in fiftula ani,  311
                         fradures of, treatment of,       343
          luxations of, how treated,       -       -      403
Offa innominata, fradures of, treatment of,       -       344
Ovaria, dropfy of,                      -       vol. ii.  522
Ozasna, what, and how occafioned,       -       -       319
        may be confounded with colledions in the antrum
          maxillare,       -       -      -       -      320
        remedies ufed in,       -       -        -        319
        mercury ufed in,       -       -        -        321
        ule of efcharotics in,                             322
                            P.
Pain, method of diminifhing in chirurgical operations,
                                               vol. iii.  530
     in cancer, how relieved,       -      -      vol. i.  426
Pancreas, wounds of,        ...         302
Paracentefis of abdomen and thorax.  See Abdomen and
  Thorax.
Paraphymofis, what,      ...      vol. iii.  142
              caufe of,'       -       -        -         143
              treatment of,      -       -       -       ib.
Park, Mr. his method of removing the end of bones,
                                               vol. iii.  517
                                obfervations on, vol. i.  406
Paronychia  See Whitlow.
Parotid dud.  See Dud Parotid.
Patella, fradures of,                            vol. iii.  361
                   treatment of,       -       -        362
        bandage for retaining fradures of,       -        364
        how it nnty be luxated, and treatment of,         435
Pcllier, Mr,  his obfervations on catarad,          vol. ii.  268
            opinion on the extradion of the lens,          301
Pelvis, defcription of,       -          -      -   vol. iii.  156
Penis, anatomy of,       -           -              .157
      difeafes of,                 -            -          139
      amputation of, when neceffary,       -             145
      method of amputating,         -           -         ib. 
                      INDEX.                    m
                                                      Page
 Pericardium, wounds of,         -          -     vol. i.  269
 Peritonaeum, anatomy of,     -         -        vol. ii.  529
 Petit,. Mr, his improvement on the tourniquet,      vol. i.  476
 Phleme, mode of ufing,      -         -         -       497
 Phlegmon, definition of, and terminations of,       vol. i.    2
            refolution of,         -            -          ib.
 Phymofis, what,           -             -      vol. iii.  139
          caufes of,                               -     ib.
          improvement in the operation for,       -       140
          circumcifion, when neceffary in, and how per-
             formed,       -         -        -          142
 Plafters, adhefive, when ufeful,       -      -     vol. i.  473
                 ufeful in the cure of wounds,            187
Pneumatocele, a rare occurrence,        -       vol. iii.  118
 PoLoned wounds, how inflided,       -      -    vol. i.  309
Polypi of nofe, fituation of,       -         -     vol. ii.  325
              and throat, various opinions concerning,    329
                         nature and confiftence of,       326
                         fymptoms  of,     -        -     ib.
                         fuppofed caufes of,             327
                         prognofis in,       -         -   329
                         ufe of aftringents in,            330
                         utility of bougies in,     -       332
                         ufe of feton and bougies in,     341
                         methods of removing,          332
Porte aiguille, ufe of,       -           -         vol. i.  471
Pott, Mr, his method of curing hydrocele by feton,  vol. iii.  64
Poultices, warm, their utility in wounds,     -      vol. i.  192
         of carrots, ufeful in fcorbutic ulcers,      -      457
         warm, improper in hernias,       -      vol. ii.  544
Preffure in the cure of ulcers, how applied,         vol. i.  359
Prolapi'us ani, how to  be reduced,       -        vol. iii.  282
Punctum aureum, method of performing,         vol. ii.  550
Pupil, method of enlarging,       -      -       voL ii.  305
Purgatives, ftrong, improper in herniae,          542  and  543
Pus, definition of,       ...        vol. i.  18
     formation of, opinions concerning,         -         19
     does not exift in the blood,        -        -        20
     is formed from ferum,       -       -        -       ib.
     Sir John Pringle's and Gaber's experiments on,       ib.
                            R.
Radius and  ulna, luxation of at their  connedion  with each
  other,       -       -       -       .        vol. iii. 424
Rae, Mr. James, his box for  compound fradures,          379
Ranula, nature of, and fymptoms of,        -      vol. ii.  441
        treatment of,                                   442
Rau, his  improvements in lithotomy,      -       vol. iii.  184
     objedions to his  operation of lithotomy,       .       ib. 
H2                     INDEX.
                                                        P.,ge
Receptactflum chyli, wounds of,          -         vo1'.1' 3°3
Redum, different terminations of,        -        vol.  iii. 284
         feparation of, from contiguous parts,      -      302
Redus mufcle, rupture of the tendon of,         -         365
Red precipitate, its utility in ulcers,       -       vol. i. 376
Reft of body, a requifite in the cure of ulcers,      -      370
Rhubarb, powder of, of no utility in the fimple ulcer,  ^   377
Ribs, fradures of, how difcovered,       -        vol.  iii. 337
                 treatment in,      -                    ib.
      luxations of,       -       -       -        -        4p7
                 fymptoms of,         -        -        ib.
                 treatment in,        -        -        4°&
Richter,  Dr. his improvement of bronchotomy,   vol. ii. 471
                             of polvpi forceps,           345
                             S.
Sac, herniary, what,       -       -      -               53^
             has been reduced,         -        vol.  iii.  19
Saccharum faturni, ufeful in the cure of ulcers,    vol. i. 369
Sal ammoniac, ufeful in gangrene,       -        -        48
Sarcocele, definition of,        -        -        vol.  iii. 119
          progrefs  of the fymptoms of,      -       -      ib.
          prognofis in,         -         -          -     126
          not to be cured,         -            -         128
          operation for, when to be performed,            ib.
                       how to be performed,      -      129
                       difficulties attending,             133
          treatment of, after operation for,        -        132
          a variety of, peculiar to workers in foot,        136
                      how cured,       -          -     137
Sarfaparilla, ufeful  in cutaneous ulcer,       -    vol. i. 437
Saturnine applications, their utility in herpes,              438
                                    fcrofulous ulcers,    460
Scalpel, preferable to cauftic, in extirpating cancer,        420
Scapula, fradures of,          -           -       vol. iii. 345
                 how difcovered,       -       -          ib.
                 how treated,       -              -     346
Scarifications proper in carious ulcers,             vol. i.  407
Sciffars, employed in hare lip,            -        vol.  ii.  365
Scrofulous tumors,  diftindion of from fchirrous,    vol. i.  124
                   whether they fhould be opened,        123
                   treatment of,          -         -     122
Scrotum, bandages  for,       -             -    vol. iii. 552
         cafe of mortification of,       -         -        43
Skull.  See Cranium.
        matter colleded between and pericranium, vol  ii. 120
Sea fcurvy, a caufe of brittlenefs  in bones,        vol. iii.  315
Sedatives, their utility in inflammation,      -      vol. i.   10
Seton, when ufed,        ...        vol. iii. 525 
                      INDEX.                  H3
                                                      Page
Seton, method of introducing,       -      -      vol. i.  35
      cafes in which it proves ufeful,       -       -      36
      ufe of in gunfhot wounds,        -       -        32Z
              pundured wounds,      -       -       210
      its utility in finuous ulcers,       -        -       3^7
Sharpe, Mr. on extirpation of the amygdalae,      vol. ii. 347
           opinions on hydrocele confufed,      vol. iii. 108
           opinion on the radical cure of hydrocele,      79
           fingular opinion on farcocele,        -       129
Shoulder joint, obfervations on,         -       -        409
              amputating arm at, method of,     -     513
Sling for fradures of the humerus,               -       347
Smallpox inoculation for, various modes of,       -       527
Sounding.  See Stone.
Spermatocele, what, and how produced,        -        II7
              treatment of,               -              lb.
Spina bifida, what,       -       -               vol. i. 119
            fatal nature and treatment  of,       -       ib.
      ventofa, fymptoms of,       -        -       -      152
              fometimes ends in white fwellings,         153
              treatment of,       -        -       -      160
Spine,  diftortions  of,                            vol. iii. 448
                   effeds of,                             ib.
                   caufes of,    ■"              -        449
                   treatment of,       -        -        ib.
Spine,  luxations of, obfervations on,       -      -      401
6pirits, ardent, promote the cicatrization of fores,   vol. i. 369
Spleen, wounds of,       -       -      -       -      302
Splints, for fractures of the forearm,        -      vol.  iii. 350
       ufe of in fradures of the humerus,        -       347
Sprains, effeds of,       -       -        -       vol. i.  91
        and contufions, ufe of a roller in,         -        95
                       treatment of,      -       -      92
Staff, grooved, beft kind of,        -       -      vol.  iii. 186
Staphyloma,  what,      -       -       -       vol. ii. 185
             operation for,       *       -       -        188
Sternum, fradures of,         -        -         vol.  iii. 341
                     how treated,       -       -       342
          perforation of, when ufeful,      -       -      ib.
Stocking, laced, advantages of in callous ulcer,    vol. i. 391
Stomach, wounds'of, how diftinguifhed,        -        298
                    prognofis in and treatment of,        ib.
Stone, founding for,         -          -         vol. iii. 155
       anatomy of parts concerned in,      -       -      ib.
       prognofis in the operation  of,        -       -       166
       operation for by the leffer apparatus,      -       168
                          greater apparatus,            173
   Vol. IV.         I 
tt+                   INDEX.
Png«
 Stone, hemorrhage in, operation for, how managed,
                                               vol. iii. 202
       high operation for,       -       -       -        176
       lateral operation for, dangerous fymptoms in,       205
                           a large incifion neceffary tn>  189
                           mufcles cut in,       -        ib.
       operation for in females,        -        »         207
                              from the vagina,          208
       lateral operation for, propofals for improving,       210
 Stones rarely adhere to the bladder,       -      -       197
       when very large, fhould be broken,      -        201
       in the kidneys, fymptoms arifmg from,     -      216
             urethra, fymptoms of,       -      -       218
                     means of removing,       -        220
 Stye, nature  and treatment of,         -         vol. ii.  164
 Styptics, feldom ufeful,        -         -        vol. i.  478
         their utility in the produdion of a cieatrii,        361
 Sulphur, its utility in herpes,       -       .       -       44!
 Suppuration, what,      -      -       .      .        18
             means of promoting,       -       -        22
 Sutures, varieties of,                 .        *          464
 Suture, glovers, method of performing,        -        469
       interrupted, method of performing,      -       465
       quilled, method of performing,         -         468
       twifted, advantages of,        -        .        469
               method of performing,     -     -      4.71
               general utility of,       •       -       474
Sutures of the cranium, advantages of,           vol. n.  52
Swellings, white, what,         -         -       vol. i.  125
                fymptoms and caufes of,       .        ib.
                appearances of, on diffedion,    -      127
                varieties of,         -         -         125
                fymptoms of, rheumatic,       -        ib.
                             fcrofulous,        »        128
                treatment of,        -        .        131
Symphyfis pubis, divifion of,       -       .     vol. iii.  538
                          method of performing,     *  539
Synovia, never infpiffated,        -       .       vol. i.  133

T bandage, ufeful in prolapfus ani,       -      vol.  iii  283
Teeth, anatomy of,       ...      vol. ii.  371
       number of,       -      -       .       .        *«.
       carious, often a conftitutional difeafe,      .       409
              ought feldom to be filed,        -         ^n
              method of fluffing,       -      .        412
              effed of damp fituations on,      -        414
       derangement of, caufes of,        -       vol.  ii.  379
                      method of removing,      -       380 
                      INDEX.                    *i*
                                                     Page
 Teeth, decay of enamel of, caufe of,       -       vol. ii.  406
       inftruments for extrading,       -       -        417
       new inftrument for extrading,      -       -     420
       forceps, with moveable claws,      -       -     426
       method of extrading,       -      -       -      418
       never to be pulled haftily,       -       -        422
       extradion of, hemorrhage proceeding from,        424
       foulnefs of, caufe of,       -      -      -       398
                  how prevented,       -       -       403
       method of cleaning,      ...       400
       caufe of their becoming loofe,      -             396
       loofe, treatment of,       -       -       -       395
       tartar of, what,       ...        399
       tranfplanting of,        -        -        -        435
                      feldom done with the molares,    436
                      danger attending,       -        440
       flumps of, treatment of,                 -        428
 Teguments, external, prefervation of in extirpating cancer,
                                                vol. i. 420
' Tenaculum, advantages of in the ligature of arteries,     481
            method of ufing,       -                    484
 Tendons, pricks of, operation for,       *       •       521
          ruptured, treatment of,       *       -       227
 Teftes, fituation of in the foetus,         «        vol. ii. 530
       a particular difeafe of,      *      r       vol. iii. 138
       inflammation of, caufes and treatment of,   vol. i.  68
                       feldom terminates in fuppuration,  69
 Tetanus, fometimes produced by wounds,        -       203
                                       how cured,     204
 Thigh, amputation of,       .         *         vol. iii. 475
 Thoracic dud, wounds of,      *               vol. i. 267
 Thorax  and contents, anatomical defcrfption of,          246
         air, extravafated in.   See Emphyfema.
         method of expelling air from,      -      vol. ii. 50Q
         colledion of pus in.   See Empyema.
                    ferum in, fymptoms of,        -      495
     •   effufions of blood into, fymptoms and caufes of,   504
                             operation for,       -     506
         paracentefis of, when applicable,        -        494
                      not to be done on both fides at
                         once,        -        -       499
                      method of performing,      -     497
         wounds in,       ...        vol. i. 246
                of, obfervations on,       -       -      247
         penetrating wounds of, how diftinguifhed,        248
                              dangerous,       -       256
                              how treated,      -      257
                              blood effufed in, how re-
                                moved,       -        259 
  u6                   INDEX.
                                                        P»gc
  Throat, fcarifying and fomenting,        «•        vol. ii. 353
  Thrombus, what,        -        -       -       vol. i. 507
  Tinea capitis and crufta ladea, varieties of herpes,        442
              cure of,                                    ib.
  Tobacco fmoke, ufe of in hernias,        vol. ii. 542 and 543
  Toes, amputation of,          -         -        vol. iii. 511
  Tongue, extirpation of,         -         -        vol. ii. 446
          ulcers on, caufes of,                            444
                   treatment of,        -        -         ib.
          and cheek, cancer of, operation for,       -      445
 Tonics, their utility in fcrofula,     -      -      vol. i.  461
 Tonfils.   See Amygdalae.
 Toothache, caufes of,        -       -             vol. ii.  404
           from inflammation,        -        -         430
           from the nerve being laid bare,        -        405
           means of preventing,        -        -        411
           method of removing,        -        -        414
           ufe of cauteries in,       -       -      -      41J
 Tourniquet, invention of,        -       -       vol. i.  475
             method of applying,        -        -        477
 Trachea, wounds of,         -           -       vol. i.  241
                    treatment of,     -           -         ib.
                    method of applying ligatures in,       242
 Tracheotomy.  See Bronchotomy.
 Trepan, ufe of,  operation of,       -         *    vol. ii.   74
        danger attending the operation of,         r      127
        never to be employed to prevent fymptoms,        68
        inftruments neceffary in thev operation of,      -    77
        preferable to the trephine,       -        -       79
        circular form of, the beft,                         83
        treatment after the operation of,     -       -      138
        operation of, employed in  epilepfy,     -          128
 Trocar for the hydrocele, improvement of,       vol. iii.  5$
        lancet pointed, propofed for tapping,       vol. ii. 520
 Truffes for hernia;,         -         -                  552
 Tubes for imperforated noftrils, ^     -         -         324
 Tumors, definition of,  **                  -      vol. i.*  51
         divifion of into  claffes,       -          -        55
         inflammatory.  See Tumors, acute.
         acute,  concerning,          -            -        55
         chronic or indolent, charader of,     -       -    96
         encyfted.  See Encyfted Tumors.
                  objed  in the cure of,    -     vol. iii.   60
         fcrofulous.  See Scrofulous Tumors.
Tympanites, tapping to be performed in,     -     vol. ii.  524
                            U.
Ulcer, definition of,         -           .        vol. i.  336
Ulcers, general obfervations on,       -           r        ib. 
                      INDEX.                   117
                                                      Page
Ulcers, caufes of,          -           -            v°l- >• 338
       prognofis in,         -         -                339
       cure of, whether always to be attempted,         340
       long continued, bad effeds of,       -        -   347
       caufes tending to retard the cure of,       -      36°
       matter of, how preferved in a purulent ftate,      366
       general arrangement of,        -                337
       callous, obfervations on,         -           -   3^9
               cure of,         -           -           39°
       cancerous, obfervations on,       -         -     4°^
       carious, definition of,          -         -        392
               obfervations on,         -            -    ib
               cure of,       .           •        -      399
       cutaneous, obfervations on,       -          -    43°
                 cure of,         -         -        -  433
       fungous, defcription of,       -         -       3 8°
               cure  of,       -         -              3^*
     ■• fcorbutic, obfervations on,     -         -        452
                fymptoms of,         -           -     »b.
                caufes  of,         -             -      454
                cure of,       -         -              455
       fcrofulous, obfervations on,     -         -       45^
                 fymptoms of,        -            -    ib.
                 cure of,       -         -             459
       fimple purulent, fymptoms of,           -       350
                       indications of cure in,       -    362
                       ufe of compreffion in,     -      368
                       diet in,       -            -      372
             vitiated, obfervations on,       -       -   373
                     fymptoms and  caufes of,           ib.
                     cure of,         -                374
       finuous, defcription of,       -           *      3^5
               cure of,       -        -         -     386
       venereal, obfervations on,     -         -        444
                varieties of,       -         -           ib.
                diagnofis in,         -         -       445
                primary and  fymptomatic,        -      447
                cure of,       -       -       -       449
Underwood, Mr. his opinion on the  cure of ulcers,        371'
Unguentum album, fometimes ufeful in ulcers,           369
            cerae, ufeful in purulent matter,        -      363
            citrinum, its utility in herpes,        -       441
Unguis os, method of perforating       -         vol. ii. 279
Ureters, wounds of,       -       -       -       vol.  i. 303
Urethra, defcription of,      -  -        -        vol. iii. 157
         where to be cut in the lateral operation of lithot-
           omy,       ....       189
         abfcefs in,  when to be opened,         -        245 
 ril                    INDEX."
                                                        Page
IJrethra, burfting of, a caufe of anafarcous hydrocele,
                                                vol. iii.   44
         incomplete, operation for,       -       -        148
         obftrudions in,       -        -        -        241
                    of in females,       •       -       257
                    in, caufes of,        -        -        242
         caruncles in, not frequent,        -       •       241
         obftrudions in, cure of,        •■       •        245
Urine, incontinence of, caufes of,        -       -        225
                      cure of,         -         -        226
                      from lithotomy, how treated,      227
       ftrppreflion of,         -         -         -        229
                      how produced,       •«      -      ib.
                      method of cure,         -         230
Uterus-and vagina, fituation of,        -        -        157
       its appendages, wounds of,        -        vol. i.  306
       wounds of, fymptoms and treatment of,            307
Uvula, extirpation of,         -         -        vol. ii.  351
                            V.
Valgi and vari, what,         -          -       vol. iii.  445
Vafa deferentia, defcription of>       -          -          158
Varicofe aneurifm, cafes of,       «.          -    vol. ii.   27
Varicocele, what,         -         -             vol. iii.  116
         .and circocele, how produced,          -         ib.
                        treatment of,       ■•      -      ib.
Vegeto-mineral water, method of preparing,        vol. i.   14
Verdigris, an efcharotic in ulcers,       *         -       376
Vertebrae, fradures of,           -            -  vol. iii.  343
                     generally fatal,    -         .      ib,
                     how treated,     -         -         ib,
Viper, bite, fymptoms of,         -            »   vol. i.  310
           how treated,       -                           ib.
Vitriol, blue, an efcharotic in ulcers,       »            -  369
                            W.                           *
Warm bath, ufe of in herniae,       -         -   vol.  ii.  544
Warts, what, and treatment of,        -        .  vol. i.  147
       venereal, treatment of,            -            -   148
Waters, chalybeate, ufeful in fcrofula,         -          460
        fulphureous, ufeful in herpetic eruptions,          439
White, Mr. his method of reducing diflocations of the hu-
  merus,       ...        vol. iii.  416
Whitlow, what,      -           -               vol. i.   84
          caufes and treatment of,       -           .8$
          tife of incifions in,       -            -           86
Wounds, definition of,         -            -      vol. i.  163
         phenomena of, various,        -          -        165
         fymptoms of,       -            -          -     167
         way in which nature ftops hemorrhagies  from,    165 
                     INDEX.                    ir9
                                                     Page
Wounds, prognofis in,         -         •         vol. i.  170
         requifites in the cure of,       -           -    168
         fimple, cure of, on what principles,     -        182
         cure of by firft intention,       -                185
                               not always admiffible,   191
         means of obviating inflammation in,             189
         formation of purulent matter in,       -         167
         fimple dreffings ufed in,         -         4    194
         general rule for removal of dreffings in,         195
         means of alleviating pain in,         -          197
         partial divifion of nerves and tendons in, how
           treated,       -           -           -     200
         convulfions produced by, how obviated,         202
         of veins,       -           -                  223
         in veins, treatment of,        -           -     ib.
         of the abdomen. See  Abdomen, wounds of.
         in the thorax.  See Thorax, wounds in.
         Gunfhot. See Gunfhot wounds.
         lacerated and contufed, dangerous,      -      215
                              fometimes produce mor-
                                 tification,             216
                               gangrene in, whence ari-
                                 fing,       -         217
                               treatment of,    -       ib.
                               ufe of poultices in,       218
         contufed, frequently end in mortification,        169
         poifoned. See Poifoned wounds.
                  by the matter of difeafes, how treated, 313
         from the bite of a mad animal,         -        312
         pundured, what,       -           -          207
                   treatment of,         .         -    209
                   ufe of injedions in,           -       212
                   why dangerous,      -         -    169
Wrift, fradures of the bones of,         -        vol. iii. 352
                             how treated,       -        ib.
      luxations of,       -           -           -      425
                  how  treated,           -             426
Wry neck, how produced,      .         -     vol. ii. 462
          operation for,           '                     ib,
Zinc, ointment of, its utility in  cutaneous ulcers,   vol. i. 438 
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