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. 
 
 D 
 
 
 Coloured covers/ 
 Couverture de couleur 
 
 Covers damaged/ 
 Couverture endommagte 
 
 □ Covers restored and/or laminated/ 
 Couverture resUurte et/ou pellicula 
 
 D 
 D 
 D 
 D 
 
 n 
 
 n 
 
 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. 
 
 n 
 
 □ 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 
 
 n 
 
 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 
 
 TT 
 
 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 
 
 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. 
 
 1 
 
 2 
 
 3 
 
 1 
 
 2 
 
 3 
 
 4 
 
 5 
 
 6 
 
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.