terminal injection of the fluid, we have it spread at right angles to the needle, and, therefore, gain a better distribution upon the hernial rings internal and external, at the same time avoiding the application of the fluid to the peritoneum, which we wish

Fig. 7.

Fig. 8.

to irritate as little as possible. The needle has a round shank playing through a collar, which is attached by a screw thread to the neck of the barrel. It does not bore the tissues in passing, but turns around in a spiral manner as it advances; and the same can be said of all the other revolving and vermicular pointed instruments described, except the aspirating needle, which is twisted in through the tissue by slight pressure and revolving it at the same time.

I finally show you a very handy and useful instrument for a variety of surgical operations, which was devised by my son, Charles Everett Warren, A.B., student in medicine, for a dissecting instrument (Fig. 8). It is called the demonstrator's knife. It is of the shape of the clavicle or line of beauty. One end is sharpened on both edges, the other being blunt and spatula-like. From the spear shape of the cutting part it is found very convenient in dissecting veins, arteries, nerves, and other minute anatomical parts, as by its peculiar shape it can cut at any desired angle. The unsharpened end can be used to elevate and expose to view any nerve or vessel in the deeper seated parts. I think every anatomist will very readily appreciate an instrument of this shape when it is placed in his hands for practical use.

As a surgical instrument it will be found very good for operations on the mouth and throat in uterine surgery, operations for varicocele, for enucleating the eye, and for numerous other minor cases.

The hernia syringe is manufactured by Messrs. Codman and Shurtleff, of Boston; the other instruments by Geo. Tiemann & Co., of New York.

A NEW SYSTEM OF SURGICAL MECHANICS.

BY CHARLES F. STILLMAN, M.D.,

NEW YORK.

GENTLEMEN OF THE AMERICAN MEDICAL ASSOCIATION:

I WISH to invite your attention to a recital of the methods by which I have partially developed a new system of surgical mechanics, comprising the applications of the sector splint to various diseases of the joints and their deformities, and in order to more fully understand the splint I shall first briefly state a few of the historical facts connected with its development.

Among the surgical appliances which were included in the armamentarium of St. Francis Hospital, New York City, during my term of service as House Surgeon in 1876, was this plain bracket called the "Esmarch" bracket (Fig. 1). This was used

Fig. 1.

Esmarch's joint bracket.

to produce fixation of a joint, and yet allow exposure of surface, but did not allow extension, except such as was produced and imprisoned before the plaster-of- Paris attachments had had time to become firm.

Now, since joints are so constructed that their articular surfaces are held together by muscles, having insertion below and origin above them, it follows that in order to obtain perfect results in the treatment of inflammatory conditions, we must reduce the contractile power of these muscles to a minimum and relieve superincumbent weight-thus removing pressure

from the opposing surfaces. There are several methods in vogue for doing this, but the method I wish particularly to call your attention to to-day, is based upon the proposition that we should endeavor to effect a complete reduction of the contractility of muscles affecting the inflamed joint without diminishing their vitality, relieve superincumbent weight, and yet allow all necessary motion.

This can only be produced by a splint allowing a local extension, i. e., a splint which confines its action solely to the part or joint which is to be treated.

Buck's extension, the modification of the long splint, Hutchinson's method, and that of Thomas, of England, do not possess this qualification, because they involve a whole limb in their action and are general instead of local.

The splint I have just shown you would produce a local fixation, but would not allow extension or motion.

Now, motion must be allowed when necessary, and our model of a local joint splint should include the power to 1st. Overcome contractility of the muscles. 2d. Relieve superincumbent weight. 3d. Afford support to the joint at any angle the limb may assume. 4th. Allow any degree of flexion. 5th. Allow fixation at any angle. In other words, our local extension splint should produce perfect rest of a joint by producing a symmetrical extension of the muscles which govern it, and transferring to the

Fig. 2.

GTIEMANN.CO.NY.

splint the weight of the body and the functions of the joint-leaving the joint itself in the relaxed condition of the joint of a corpse -free from pressure and yet allowed to change its angle as in health.

Prof. Lewis A. Sayre, of New York, is the inventor of a knee splint which allows local extension in a straight position alone (Fig. 2). This is an improvement upon the one just shown, because while possessing the same local fixation it adds to it the power of increasing the extension at will, but only in a straight line. Now, so long as there is no tendency to flexion, and no necessity for a long-continued fixation, this would be all that would be required, but in reality the greater number of cases which a surgeon is called upon to treat are those in which flexion has already taken place, for as

Sayre's knee splint.

a joint begins to inflame, effusion occurs and flexion invariably follows. The application of this splint at such a time is disastrous, because the extension is not exerted in the axes of a limb, and the suffering is increased rather than diminished, for a local splint made to extend a joint when the limb is straight cannot do so properly when it is at an angle, unless it is provided with a joint opposite the affected joint, thus enabling the extension power always to be exerted in the axes of the limb at right angles to the attachments. Recognizing this fact, I devised a bracket in which the bridge was composed of two slotted flat strips, lying one over the other, and connected by two thumb clamps (Fig. 3). This gave me extension and fixation

Fig. 3.

Stillman's slotted joint bracket.

in a straight position, and also enabled me to allow motion by removing one of the clamps.

But this motion was not the automatic motion of a joint, because the one clamp did not possess sufficient fixation to keep itself opposite the joint, and therefore the patient could not use the splint while walking, unless with the limb in a straight position. It, however, did very well for passive motion, which we could exercise, and then lock the joint up in its original position. I subsequently added the sector of a circle, also slotted, both at the centre and circumference, and the mechanical extension joint was complete. You see it before you (Fig. 4). The two slotted strips are now attached to the sector by three clamps, which allow them to play upon a fixed centre taken in space, and when properly applied is capable of the following combinations without removal from the limb: