This is an elaborate device patented November 19, 1861. Inside the top of the case are full directions for using the syringe to inject fluids into the bowels. There are nine different metal tubes and there was once a rubber bulb -- but as the directions indicate that some substances are harmful to the rubber, it is likely that the bulb did not stand the test of time. Most interesting, and always neat to come across new inventions of the period reminding us how very primitive medicine was just 150 years ago! The syringe is encased in an oval cardstock container covered with black leatherette. The two front latches are intact.