A DESRCIPTION O F Two New MACHINES For the Conveyance and Cure of Fractured LEGS. [ Price One Shilling. ] THE CONDUCTOR, AND Containing Splints: Or a Description of Two New Invented Instruments, For the more fafe Conveyance AS WELL AS The more Easy and Perfect CURE O F FRACTURES of the LEG, Whether Simple or Compound. TO WHICH ARE ADDED, Three Copper-Plates,, fhewing theJConftrudion and Aonlication of the CON D.XtCT OR. By Jonathan Wat hen, Sui-geon. Author of a Tranfiation of Boerhaave’s Le&ures on the Lues Venerea. Practical Obfervations on the Cure of the Venereal Difeafe by Mercurials. And an Anfwer to the Letter of J. Keyfer, Surgeon at Paris. THE SECOND EDITION. Printed for, and fold by J. and F. Riving ton in Sc. Paul’s Church-Yard. 1767- LONDON: PREFACE. THE Reception this little Effay has met with from the World, is the more agreeable, as it affords me an Oppor- tunity in this Edition, of acknowledging the Obligations 1 am under to the Body of Sur- geons in general; who fo far from depreciat- ing, have, on the contrary, ingenuoufly ap- proved and adopted both the Conductor and the Splints into their private and Hof- pital Practice : In fo many Places, and with fo many liberal Tedimonies of their Expe- diency and Utility, that were I to mention them, it would favour of an Odentation and Vanity I am not capable of indulging. The real Excellency and Ufefulnefs of a new Invention, is not always fufficient to re- commend it to even a Trial in Surgery : It is natural to be prejudiced in Favour of what has been long made ufe of, efpecially if at- tended with fome Degree of Succefs; befides, the Reputation of the Individual is fomewhat hazarded by new Applications: Such was the Attachment to the old Apparatus for fradured Legs, and which could never be expeded fo fpeedily to have given Place to a new. tho’ever fo fuperior a Method of Treat- ment. I was fo fenfible of this Difficulty, that I ffiould not have had a Refolution to encounter commonPrepoffeffions and Opini- ons : I too well know that Succefs itfelf is invidious, and the want of it irretrievably diigraccful, and ihould in all Probability have confined this Invention to my own Practice, and deprived the Public of its Benefits, had I not been flickered by the Approbation and Sanction of Gentlemen of the highefi; Rank in their Profeffion, whofe Names are a fuf- ficient PafTport to every ufeful Invention ; and who not content with ferving the Public themfelves, have the Generofity and Candor to patronize every thing calculated for the Benefit of Mankind. Some Gentlemen of the Faculty havemade Objections to the Weaknefs and Pliability of the Splints ; others, to their too great Stiff- nefs and Rigidity : But a Proof of their real Excellency is, whether they are of one Kind or the other, they have univerfally fucceed- ed. For my own Part, I prefer thofe that are fomewhat limber and compilable, and covered with foft Leather, fo contrived as to lace above and below. 1 have taken Care however, that they may be furnilhed by Mr. Mellor, with fuch as are very ftiff and rigid, of a middling, or of a loft and more yielding Temperament; to thefe lad the Lacing is applied. I have obferved that they all anfwer, be- caufe they are moulded in general to the Shape of the Leg; but the Circumftance for which 1 prefer the laft mentioned is, their ComphabJenefs to the Make of every parti- cular Leg, having Strength enough at the fame Time to retain the broken Parts accu- rately and immoveably ; they are all of them however more fimple, and give lefs Trouble to the Surgeon than any before made Ufe of, and perform their Office with the great- eft Eafe to the Patient, efpecially if the fol- lowing Notices be obferved with Helped!: to the Polition of the Limb. The Knee ffionld be a little bent when the Splints are firft applied, and thus continued, tho’ not without fome Variations as to more or lefs, till the Leg be cured. This Pofture is neceffary on many Accounts j the Mufcles are hereby re- laxed, the Bones eafilycome, andarepreferved ftrait with little or no Force ; the Veffiels are rnore at Liberty, and better perform their Office, fo that the Swelling, &c. foon fub- hdes; the Patient is alfo more at Eafe than when the Thigh and Leg are in a ftrait Line : A rigid Adherence to that Pofture in the old Method, was doubtlefs the Caufe of many painful and dangerous Symptoms, from which the Patient is hereby exempted, as may readily be accounted for, when we refledt that this is the natural Pofition of the Leo in a State of Reft. The Knee ftiould alfo be a little infle&ed,wh£n the Condudor is applied, and whilft.it is kept on, for the fame Reafons. The Author of the 42b Article in the Monthly Review of July laft, afks whether two wood- en extemporaneous Splints fecured by Ban- dages, might not anfwer the fame Purpofe, where a Conductor is not at hand ? Alfo, Will not the Condudor be fufficient to keep the Limb duly fixed in Bed ? When it might be drefied and embrocated atPleafure without being encumbered with Splints. In anfwer to the firft, I obferve, there never was a Time but fomething was ufed, of the Kind he recommends, or the common Junks j but of late, what is much fuperior to either, the long Splints of Mr. Gooch, The Necef- fity of keeping a fradured Leg as ftrait and fteady as poffibie, during its Conveyance, was always a Circumftance too important and obvious for total Negled, It was the Infuf- ficiency of thefe, and indeed of all other Means yet known, which rendered fuch an Inftrument as the Condudor abfolutely ne- ceflary. Bythefecond Qoeftion, I Ihould fuppofe, the Author had not the Opportunity of feeing either the Splints or Condudor applied in Pradice, without which a mere Defcription of their Strudure and Ufes cannot be right- ly underftood; for Inftance, the Condudor evidently appears to be a Machine that has l?ower to extend the fradured Limb to any Degree, and capable of Retention in any Point, by which the Bones however over- lopped, are brought in Appofition and pre- ferved immoveablyin that State. The Sliders and Grooves, as he obferves, allow fufficient Space for Embrocations, Bandages, and even Cataplafms, without the Incumbrance of Splints : But Experience, and that only, will inform us, that the Force by which this is done, terminating at the Knee and Ancle Bands, will, after a few Days Preflure, be- come too painful for a long Continuance. In feme few compound and oblique Erasures, indeed, there is a Kind of Neceffity for a per- petual Extenfion, [See Not. Pag. 5.) where the above-mentioned Inconveniencies are in fome Meafure obviated. The principal Defign of the Conductor is for conveying a fractured Leg with Security* And the Splints for letting and retaining it till cured. Both which Offices they do mod effedual- ly and completely anfwer, and fill up two capital DefJerata in the Practice of Surgery. Devonjhire-fquare, ■dug. 20, 1767. PART I. T H E CONDUCTOR. FRACTURES of the larger Bones in the human Body, are frequently- attended with fevere, and fometimes fatal Confequences. But as the Leg of all other Members is moft commonly expofed to, and differs the greateft Injuries from Accidents of this Kind ; fb many and various are the Ma- chines and Contrivances which at different Times have been invented and applied in fuch Cafes, with confidcrable Succefs. Thofe of the ingenious Mr. Petit, and of our. Countryman Mr. Gooch of Norwich, arc, I believe, the heft and mod: ufeful of any yet known : They are however greatly deficient in fome needfary and capital Points of Uti- lity. My prelent Intention is to fupply the De- ficiencies of thefe, and indeed of all others hitherto recommended, or received into Pradice. This Defign may be reduced into two Heads. The eafy and fafe Conveyance of the Patient from the Place wherever the Ac- cident may happen, to his being placed in Bed for the neceffary Time of his Cure. And next the Prefervation of the fradured Bones in their natural Politico, until that Cure be perfedly accomplifhed. In both which I would be underllood to mean, not only all fimple, but alfo com- pound Fradures to a certain Degree. The firft Intention may be accomplifhed by the Conductor, fo called from its Ufs and fafe Purpofc of Conveyance , the fecond by Splints or Side Pieces : In which the fradured Limb may be compleatly re- ceived, and lodged till the Cure is performed. Itlhould be obferved, that very few Writers have conlidered the Neceffity of fuch an Affiftant Infirument as the Conductor •, at lead they have not produced any one com* pleatly qualified for the needful and fafe Conveyance of the Patient, in that critical Time of Danger. The Machines which have bed: fucceeded. are deflined merely to Setting and Retention, and can be applied only after the Patient is placed in Bed ; fo that, however judicioufly confiruded in thofe Refpeds, they cannot prevent many of the Evils attendant on Fractures of the Leg which were already- produced, antecedent to their Application : And farther, the Patient is very often un- happily deprived for a confiderable Time, of receiving any Service from them •f*, as will evidently appear by attending to the follow- ing- Circumftances. When a Fradure happens to the Leg, fo that both Bones are broken, the inferior Part becomes pendulous and liable to Flexi- ons every Way. Neverthelefs the Patient muft be removed from the Place where the Accident happened to his own Habitation, generally up one or more Stories; or, if deftitute and indigent, to the next adjoining Hofpital. It is therefore impofiible (from any Means yet known) but that in fuch a Conveyance the Limb will be frequently and varioufly contorted, and bent; by which the Parts furrounding the Bones are bruifed, pricked, and lacerated by the Extremities of thefradured Pieces; whence Pain, Swelling, Inflammation -f*, Convulflons, Mortifications, arife; and often Death itfelf, if not pre- vented by a fpeedy Amputation of the Limb. Three melancholy In fiances of this Kind (which were lately under my Care) firongly induced me to wiih that Something could t + See Note, Page 4. B 2 be invented, which might cffedlually pre- vent the Injuries fudained by fuch a Patient in his Removal from the Place where the Accident was received, to that where he mud remain till cured. The Importance of fuch a Contrivance 'will appear mod evidently, if we reflect on the State of the Patient when the Hurt is fird received; perhaps the Fradture was then merely Ample, if fo, the Injury is (compa- ratively fpeaking) but inconflderable. Ne- verthelefs, by the ufual Methods of convey- ing him Home, however prudently conduct- ed, ContuAon and Swelling * may be pro- duced, if not a compound Fradure. This lad Misfortune frequently fucceeds what was at Aril a Ample Fradure only, when, fhould the Leg be preferved, the Cure will, notwithdanding the greated Care and Affiduity, be uncertain, imperfect, unfatisfadory to the Patient, and often dif- honourable to the blamelefs Surgeon, Though thefe Effects do not always attend every broken Leg, it is owing more to Chance than DeAgn. If the Fradlure be oblique, complicated, or the Bones forced through the Skin, &c. the aforefaid Injuries are proportionably aug- * When thefe Symptoms proceed to any confiderable De- gree, every Surgeon defers the Application of llrait Ban- dage, Splints, &c. or what'is called fetting of the Limb, till they are removed. merited, and aimed inevitably determine the immediate Lofs of the Limb to prevent that of Life * Such are the Confequences of Motion to a Patient with a broken Leg. Influenced by thefe Conflderations, which arofe from repeated Proofs of what is above advanced, 1 have contrived a very Ample Machine, which may be mod eaflly and expeditioufly applied as foon as poflible after, or on the Spot where the Accident is received, by which the Limb may be immediately flrait- ened, and the Bones reduced and retained in. their proper Place, foftrongly andfirmly, as to refill any Probability of being difplaced h)' any Conveyance whatever. Nor has this Afiertion of its Utility a Foundation in Theory and Speculation only, but it is fupported by the repeated Pradlice and Experience of feveral Surgeons of re- putation, and greatly approved of by others * If the Fraflure be very oblique, and the fubfequent Splints f found incapable of fufficiently counteracting the comra£li!e Force of the Mufcles, and preventing the over- lopping of the Bones, the Conductor may ftill be kept on the Limb, by which its due Length will be preferved, with very little Inconvenience to the Patient, if the following Cautions beobferved. Cut the Stocking off above the Mal- leoli, leaving the Remainder on the Foot, over which mud be wore an eafy high quartered Shoe buckled ; which will be found fufficient to fecure the Heel from that Heat or Sorenefs, which would otherwise arife from a long conti- nued Preflure of the inferior Part of the Conductor. -}- See Fart 11, of the fir ft Eminence ; among ft whom I have the Honour and Permiffion to mention Meftrs. Hawkins and Gataker, Surgeons to St, George’s Rofpital; Mr. Baker, Senior Surgeon to St. Thomas’s, and Mr. Warner, Surgeon to Guy s, &c. By the Order of the ftrft of thefe Gentlemen, this Inftrument has been ufed in St. George’s for many Months, with entire Satisfaction. To thefe Tefti- monials I have the Pleafure to add that of Dr. Hunter, who frequently vifits the Hof- pital firft mentioned, and who aftlires, ine he is thoroughly convinced of its great Im- portance. Mr. Gervats, Houfe Surgeon to St. George’s, greatly efteemed for his Induftry and xAhili- tics in his Profeflion, was the Perfon ap- pointed to make Trial of this Inftrument; who fays, the Patients felt fo much Eafe the Moment it was put on, that they ufually exprefted it by defining to walk, declar- ing they were perfectly free from Pain; in which State, notwithftanding all fubfe- qusrnt Motions, they continued till the Inftru- ment wras taken off, which was after the Pa- tient was placed in his Bed, Bleeding, Clif- terf&c. adrriiniftered, and the proper Appa- ratus got ready for treating the Fraicure agreeable to its variousCircumftances; when another important Advantage of this Inftru- ment mfcovered itfelf, for as it reftored the Bones to their proper and natural Pofition at its firft Application, fo all further Ex- tenfion was thereby rendered imneceffary. We mmc therefore take it off from the fractured Limb with the greatefl Cauti- on, lo as not to difturb or mifplace the 1 icces, which are to be retained as exadly as poffible in the fame State till the Cure is ac- complifhed by other Applications; concern- ing which I lhall juft obferve, that the Ap- paratus hitherto made Ufe of for the Trcat- nlerJt Ample or compound Fradures j *S not com as could be wifhed : So that in Fad, a perfed and lightly Cure is rather to be imputed to the okiil and Care of the Surgeon, and the fa- vourable Circumftancesof the Fracture, than to any Perfedion in the Machinery f. I (hall only add one Obfervation more in Proof of e Utility of the Inftrument here mention- ed, derived from the illSuccefs of Amputa- tion after Fradures of the Leg, viz. That we fhall find upon fair Enquiry, that not a ove one Patient in three furvive that Deration. I have now fhewn, that the aule by which Amputation is rendered o frequently necefiai-y, is the Want of an n’lrU*meurCaPable Preventing the Ac- cidents before-mentioned, and what great t See Pan 1L Advantages may be derived from this which 1 now offer to the Public, .viz. The Pre- fervation of the Limb, frequently of Life, and an Exemption from a Variety of other Evils to the Patient. t/Ae //'iJd SUeAji/ /LujS)-ran»ti /r. TJm P+VpeotS/ / ttf/jy. /£> /y.^.. ,-//£, f{i./s/i /n>m /V td/Si/)y* . l*lafc /. f'//rf y'/VW (*'H