"The Pear" was (while closed) inserted into either anus, vagina or the mouth. The hangman's assistant would then turn the handle, in order to spread out the 'wings', until reaching an approximate with of one foot. The 'wings' were often spiked, to increase the pain by ripping the tissue or - in case of anal application, ripping the intestinal wall, resulting in peritonitis (as well as other infections)..