Reprint from St. Louis Medical Review, July 27, 1895. 
Removal of Ingrowing Toe-Nail.—A Sim- 
plified Operation by Means of a 
New Instrument. 
BY A. H. MEI8ENBACH, M.D., ST. LOUIS , MO., 
Professor of Surgery in the Marion-Sims College of Medicine. 
Read before the St. Louis Medical Society, June 8, 1895. 
The operation on the ingrowing toe nail which I wish to 
describe is one in which it is necessary, on account of the 
condition of the soft parts, to remove a portion of the 
toe nail, either combined with excision of the overly- 
ing soft parts or not, as the case may be. It is not 
necessary to enter into the causes of ingrowing toe-nail, 
nor the indications for operative interferences, as these 
are generally well understood. 
Although the operation for ingrowing toe nail is one 
of the simplest in surgery, it is one with which a good 
deal of pain is connected, and in most cases it is neces- 
sary to give an anesthetic or cocainize the parts. Any 
one who has carried out the operation as ordinarily de- 2 
scribed, by means of the scissors, scalpel and dressing 
forceps, can readily understand why it is painful, when 
he takes into consideration the amount of gouging, dig 
ging, pulling and tearing that is indulged in to remove 
as simple a thing as a nail. 
Let us see for a moment, how the operation is ordi- 
narily done. The first step usually, is to slit the nail 
from the free border through to the root by means of a 
scalpel or scissors. This first step is the most brutal 
part of the operation, and the amount of gouging the 
sensitive matrix receives can readily be imagined, and, 
without an anesthetic, is worse than pulling a tooth. 
The second step is to free, from its bed or matrix, the 
portion of the nail that is to be removed, so that it can 
be seized with a dressing forceps and evulsed. The 
second step is also a very painful procedure and is done 
with scissors or scalpel. The third step is to seize the 3 
partly freed portion of nail with a pair of dreesing for- 
ceps and evulse it. This, practically, is the operation 
for ingrowing toe nails, modified, if necessary, by re- 
moval, in aggravated cases, of a portion of the over- 
hanging soft parts. 
For the operation I wish to demonstrate, I have de- 
vised an instrument by means of which the first two 
steps above described are combined; t. e., incision of 
(division) and elevation or separation from the matrix 
of the portion of the nail to be removed. By the use 
of this instrument the operation is simplified, and is 
free from the gouging and digging so characteristic of 
this operation as usually performed. It can also be 
done so quickly that an anesthetic in most cases is un- 
necessary. 
The instrument consists of a gouge, the blades of 
which are set at right angles. The blades merge into a 
shaft which is set into a strong firm handle. The blades 
of the instrument are about three* to four-sixteenths of 
an inch wide and are very thin. The angle where the 
blades join is shaped so that each blade presents a 4 
rounded end. By this construction it can be used 
either right or left sided. 
The use of the instrument is as follows: The point 
of the horizontal blade is inserted under the free end of 
the nail so that the perpendicular blade represents the 
point at which the nail is to be divided. With a firm 
stroke the instrument is pushed under and through the 
nail until the same has been completely divided from 
free edge to root. It will be found that the nail is cut 
and elevated from the matrix and can be easily seized 
with dressing forceps. The thinness of the blades of 
the instrument allows it to pass between the rail and 
matrix with but very little pain.