CIHM
Microfiche
Series
(lUlonographs)

ICMH

Collection de
microfiches
(monographies)

Canadian Institute for Historical Microraproductlons / Institut Canadian de microreproductions historiques

Technical and Bibliographic Not** / Notes techniques et bibliographiques

The Institute has attempted to obtain the best original
copy available for filming. Features of this copy which
may be bibliographically unique, which may alter any
of the images in the reproduction, or which may
significantly change the usual method of filming, are
checked below.

L'Institut a microfilmi le meilleur exemplaire qu'il
lui a eti possible de se procurer. Les details de cet
exemplaire qui sont peut-4tre uniques du point de vue
bibliographique, qui peuvent modifier une image
reproduite. ou qui peuvent exiger une modification
dans la mithode normale de f ilmage sont indiques
ci-dessous.

Coloured covers/
Couverture de couleur

Covers damaged/
Couverture endommagte

□ Covers restored and/or laminated/
Couverture resUurte et/ou pellicula

D
D
D
D

Cover title missing/

Le titre de couverture manque

Coloured maps/

Caites giographiques en couleur

Coloured ink (i.e. other than blue or black)/
Encre de couleur (i.e. autre que bleue ou noire)

Coloured plates and/or illustrations/
Planches et/ou illustrations en couleur

Bound with other material/
Relie avec d'autres documents

Tight binding may cause shadows or distortion
along interior margin/

La reliure serrfe peut causer de I'ombre ou de la
distorsion le long de la marge interieure

Blank leaves added during restoration may appear
within the text. Whenever possible, these have
been omitted from filming/
II se peut que certaines pages blanches ajouttes
lors d'une restauration apparaissent dans le texte,
mais, lorsque cela etait possible, ces pages n'ont
pas ete filmees.

□ Coloured pages/
Pages d« couleur

Q Pages damaged/
Pages endommagies

□ Pages restored and/or laminati '
Pages restaurees et/ou pellicul' < <

Pages discoloured, stained or foxe<l/
Pages decolortes, tachetees ou piqu

□ Pages detached/
Pages ditachies

0Showthrough/
Transparence

I I Cc

Quality of print varies/
Qualite inegale de I'impression

Continuous pagination/
Pagination continue

eludes index(es)/
Comprend un (des) index

Title on header taken from: /
Le titre de I'en-tite provient:

n Title page of issue/
Page de titre de la livraison

□ Caption of issue/
Titre de depart de la livraison

□ Masthead/
Gener

ique (periodiques) de la livraison

Additional comments:/
Commentaires supplementaires:

This Item is filmed at the reduction ratio checked below/

Ce document est filme au taux de reduction indique ci-dessous.

10X 14X 18X

22X

:6x

30X

12X

16X

20X

24 X

28 X

32*

Th« copy filmed hare hat b««n reproduced thanks
to the generosity of:

L'exempiaire film* fut reproduit grice A la
g4n4roeit* da:

University of Toronto Archives

The images appearing here are the best quality
possible considering the condition and legibility
of the original copy and in keeping with the
filming contract specifications.

Original copies in printed paper covers are filmed
beginning with the front cover and ending on
the last page with a printed or illustrated impres-
sion, or the back cover when appropriate. All
other original copies are filmed beginning on the
first page with a printed or illustrated impres-
sion, and ending on the last page with a printed
or illustrated impression.

The last recorded frame on each microfiche
shall contain the symbol — *- (meaning "CON-
TINUED"), or the symbol V (meaning "END"),
whichever applies.

Las images suivantes ont 6t* reproduites avec le
plus grsnd soin, compte tenu de la condition at
de la nattet* de lexemplaire film*, et en
conformity avec les conditions du contrat de
fiimage.

Les exemplaires originaux dont la couverture en
papier est imprimAe sont filmte en commenpant
par le premier plat et en terminant soit par la
derniire page qui comporte une empreinte
d'impression ou d'illustration, soit par le second
plat, salon le cas. Tous les autres exemplaires
originaux sont filmis en commenpant par la
premiere page qui comporte une empreinte
d'impression ou d'illustration et en terminant par
la derniire page qui comporte une telle
empreinte.

Un des symboles suivents apparaitra sur la
dernlAre image de cheque microfiche, selon le
cas: le symbols — »• signifie "A SUIVRE", le
symbols V signifie "FIN".

Maps, plates, charts, etc., may be filmed at
different reduction ratios. Those too large to be
entirely included in one exposure are filmed
beginning in the upper left hand corner, left to
right and top to bottom, as many frames g»
required. The following diagrams illustrate the
method:

Les cartes, planches, tableaux, etc., peuvent Atre
filmAs A des taux de rMuction diffirente.
Lorsque le document est trop grand pour Atre
reproduit en un seul clichA, 11 est tMmi d partir
de Tangle sup^rieur gauche, de gauche A droite,
et de haut en bas, en prenant le nombre
d'images nicessaire. >Les diagrammes suivants
illustrent la m6thode.

A New Wrench for Use in the

Correction of Stubborn

Deformities*

Jl jt BY ji ji

GEORGE A. PETERS, M.B., F.R.C.S. (Eng.).

AsKociati' l'rofe««or of Surgery and Clinical Surgerv, University "f Toronto ; Suriteon, Toronto (leneral
tlospital ; Surgeon, llorpital lor Sick Children, Torotito.

ReprinUd ffom ** The Canadian Journal of Medicine and Satgtty,"
December, 1901.

A NEW WRENCH FOR USE IN THE CORRECTION OF
STUBBORN DEFORHITIES.

BY OEORGE A. I'ETERS, M.B., K.H.C.S.(ENG.),

Aiwot-iaU- Fmfeaaor i>( Murder;' ami Clininal Sunfcry, l"ni\ei>iiv u( T.iroiilo ; Surgwiii, Tiimiito ileiicnil
Iloapiul ; Siiiyeon, Ilo«pital lor Siik ( hildren. Torontii.

Ix the correction of (loforiuitics either in children or adults all
surgeons, of course, agree that there is no other power which is so
useful as that exerted by the subtle, intelligent, naked human
hands. There is in power so applied a precision and nicety of
direction and adjustment which cannot be imitated in any mechan-
ical appliance. Moreover, the skin of the hand produces no injury
to the skin of the part operated upon ; so that in the correction of
any deformity in which sufficient strength is supplied by the sur-
geon's hands, the use of any such apparatus os the one described is
not to be eount*:nanced. But there are cases within the experience
of every surgeon, such as stubborn deformities in children of eight
years or over, and in practically all cases of club-foot in adults,
and of the knee joint in both children and adults, in which he
feels that the powers of his own hands are totally inadequate. It
is in such cases that the use of the apparatus described below is of
great value. It is not contended that any such powerful appar-
atus as this wrench shall do away with the necessity of tenotomy
and fasciotomy — in fact any retaining structure that can be divided
safely and subcutaneously should be divided just as in the case of
correction by hand power ; but it is within the experience of every
surgeon to find cases in which, after every possible retaining band
has been divided subcutaneously, the power exerted by the human
hand alone is quite inadequate to overcoi ■ the remaining obstruc-
tion, and in order to achieve his object ho must then have recourse
to mechanical aid.

It was with a view to meeting and overcoming these diffi-
culties that the author devised the apparatus about to be described.

The wronch is made of round bar steel about 5-8 of an inch in
diameter. The shape is sufficiently indicated by the accompany-
iiijr sketch (Fip. 1). Tlie reverse extremity of the wrench is ex-
pniuled into a Ixnv shape, m, that in operating, for example, on an
adult club-foot, the foot may be passed through this end and the
wrench then slid into position. The apparatus is equipped with
two movable bars, one (h) upon the upright limbs of the wrench,
the other (c) upon the horizontal limlm. The bar (h), as shown
in the figure, is bent towards the bow end of the wrench to the
nxtent of alxmt an inch and a half, and is provided with two
thumb-screws which fit into small depressions on the upright
linibs, so that it can be set accurately in any desired position.
Tlic bar (c) is attached by a close-fitting collar to one limb only

Fio 1 -^ the horizontal limbs exjuindtd into a bov;. B the bar on the verti.al lin.b« prov ,de<l
with set strews. The bar C on the horizontal linibs is iho« i partlv lilted, D Joins the two lin.b, so as
to prevent the collars from " hinilinu"

of the horizontal portion of the wrench, the other end of the bar
having merely a concave groove which fits upon the opposite limb.
This bar is, of course, also provided with a set-screw. By this
means the bar can be opened out completely, so as to allow the
wrench to be slid over the foot up to any desired position between
h and c. The bar (c) is made slightly concavo-convex on its upper
surface, so as to fit the limb, while bar (h) is also concavo-convex
on Its under surface for the same purpose. It will be observed
that the bowing of bar (b) towards the body of the wrench allows
the two bars (h) and (c) to be practically placed one under the
other when in position on tlie foot, and thus the fullest possible
extent of short leverage is permitted. In my first wrench the
vertical limbs terminated by free ends above the bar (h), as in

Fig. 2. It was found, however, in practice that the slight spring
between the limbs caused the collars on (b) to " bind," and the
connection (d) bent to correspond to {b) was a valuable suggestion
In my confrere, Dr. ( larcnce L. Starr.

Tn operating with the wrench, the skin over the part may Iw
f\irther protected by placing blocks of ''rubter sponge" between the
bars (b) end (c) and the limb. The total length of the wrench
i(» nb«ut two feet, and the width between its limbs from centre to
centre four inches. This will l)e fmind to he. large enough for
almost anv limb, and to be also small enough for children of such

Ki.t i -Sho»i..K ..,etho,l of ,..,.„; Uu- »re„<h. Notice that .hv .urvo on l>ar B bring, it tol««
,.a. external tualleolu., an,l aln.ost op.KMite l>ar C on Ih. horirontal limb,, ,hu« >ncre«»ng the
Icvera^'e.

an age ns to require the use of such a powerful wrench. Of course
for any special case a larger or smaller one might be used.

I have nsed repeatedly the wrench described and figured above
in children eight to ten years of age, and al o on the knee of an
average-sized ad ilt. However, if I were having one made espeo
ally for the knee, 1 should have the limbs five inches apart from
centre to centre. Of course a much lighter wrench would do for
voung chil.lren, but it should in any case be perfectly rigid, so
tliat no spring in tiic wrench ilsolf should take place, even when
the surgeon was using all th.> eifort he .loomed wise. In practice

thii wrench is found to be extremely useful. There is practicailj
no limit to the force that can be applied by its use. The limit,
indeed, is iixed by the resisting power of the soft tissues, and with
the use of the spongy rubber I have never yet seen any consider-
able injury done to the skin or muscles.

The apparatus, being made entirely of metal, can be perfectly
sterilized either by heat or by immersion in antiseptic solutions.

I have not used the instrument in cases of bow-legs or knock-
knees, requiring fracture, and so cannot speak in regard to its
suitability for such cases. I have, however, not the slightest doubt
that sufficient power could be exercised through its use to fractiiro
a bone in a young person, and I think without any undue injury
to the soft parts. However, the ooen operation in these cases is
I'sually so satisfactory, and accompanied by such slight danger,
that any mechanism for producing subcutaneous fracture seems
almost to be uncalled for.

102 College Street, Toronto.