These are known as chain adders. By inserting a stylus and dragging the chain down, you increment the register. You can see the carry mechanism in this video, which uses a spring-loaded tooth that rides along the outside of the gear and engages with the next gear only after 9.
The chain only moves in one direction, so to subtract you have to use the complements method. To subtract 42 from 31342, I add 9999958.
Multiplication is repeated addition, shifting left for each digit in the multiplier. Here is 12 x 12. Because of the extended complements for subtraction method, division is possible but not ideal.
Dragging the chain and hearing the gears click into place is very satisfying--nice tactile feedback. However, carrying a one across the whole register takes some force. It looks nice and is OK as a small desktop calculator, but subtracting w/ it makes me prefer the Addometer.
To clear the register, you turn the knob on the bottom right side anti-clockwise until all the digits say 0.