THE LAY PUBLIC has long identified a surgeon by his or her "cutting" instruments. To incise with a scalpel, to dissect with a scissor, to sew with a needle, have been regarded as the trademarks of a busy practicing surgeon. Yet, the art and craft of surgery does not always require a knife, scissor, and needle. This was most dramatically demonstrated when Lewis Sayre authored his renowned monograph, Spinal Disease and Spinal Curvature: Their Treatment by Suspension and the Use of the Plaster of Paris Bandage in 1877. This book and its 21 albumen prints (a landmark in American medical photography since it was the first known full-length surgical text to contain actual mounted photographs) shows several patients with Pott disease and spinal curvature being treated with Sayre's tripod suspension derrick.