Licence: Public Domain Mark
Credit: Surgery / by John Allan Wyeth. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![Fig. 25 represents an excellent holding or sequestrum forceps. In trephining, the dura may be exposed by the careful use of a small sharp curved chisel and light mallet, although tlae trephine (Fig. 26) is more satis- factory. Gait's instrument has a conical burr five eighths of an inch in diameter at the cutting edge, gradually enlarging to seven eighths at the base. It is so constructed that as soon as resistance in front ceases, the side teeth take hold so greedily that further rotation is difficult, and the o]ierator is thus warned that the dura has been reached. Undue force will, however, injure this membrane. In its employ- ment, the central bit should be advanced about one eighth of an inch beyond the level of the teeth, so as to fix and steadv the instrument in the bone rmtil a Fig. 26.—Gait's treiihine. well-marked circle is cut. The bit is then withdrawn, as the trephine can be held in place in the circular trench already made. In osteoplastic operations on the skull where rapid work is necessary a machine trephine is very desirable. In controlling hajmorrhage, the flat elastic Esmarch bandage or rubber tubing may be employed. For squeezing the blood out of an extremity this apparatus is invaluable. For simple constriction, the plain rubber tube is preferable, although the Esmarch may be used for both. The danger of injuring nerves and producing paralysis by too strong constriction should not be overlooked. Hcemostatic Forceps.—The scissor-handle clamps of various sizes and shapes (Fig. 27) are in general use. An operating outfit should have from twelve to twenty-four of these, also dissecting forceps with moiise-tooth and corrugated points. The author's suture forceps, with perfectly smooth and non-cutting point, is useful for holding the first knot of a suture or ligature immovable iintil the second knot is tied. A needle-holder, one or two of the best modern patterns, should be had, and should be constructed to hold any size or shaped needle, from the very smallest curved instrument to the large square Haa'cdorn.^ Scissors curved on the flat, and dull pointed, and others fashioned straight, are very necessary. Much cutting and practically all dry or dull dissection may be done with the scissors. Some of these should be long, others short. Proles of malleable material, preferably silver, of various sizes and dull pointed, are required, and there should be a grooved director of the same material. Other instruments for special operations will be given later. ' The p,uthor's combination needle-holder and Reichert's are in general use.](https://iiif.wellcomecollection.org/image/b21203647_0024.jp2/full/800%2C/0/default.jpg)
