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CIRCULAR No. 3.
SURGEONS' SPLINTS,
AND
IMPROVED
APPARATUS FOR FRACTURES.
BY
BENJAMIN WELCH, M. D
'■ h *> C,
mi
JOSEPH RUSSELL, PRINTER,
    No. 79 JOHN STREET.
1861. 
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ADDRESS.
To Surgeons and Physicians :

  Some general observations on the principles of treatment in frac-
ture seem necessary, in describing a  new  form of apparatus for
giving mechanical  support, that its advantages may be properly
estimated, and to direct to the most successful manner of applying
it.  These observations being entirely practical,  and the result, it
will be  admitted, of not very limited  experience, will not, it is
hoped, though appearing  in the not very inviting form of an ad-
vertisement, be found altogether unworthy of consideration, inde-
pendently of the  apparatus they are especially intended to illus-
trate.
  The opinion expressed  in a former  Circular, that some more
available, convenient, and effectual means of giving mechanical
support in this important class of injuries, and for maintaining the
position of injured or diseased parts, than any before in use, was a
desideratum, and would be appreciated by the profession, has been
confirmed, and my anticipations of encouragement fully realized.

    On Mechanical Support of the Muscles implicated in Fractures.
  The importance of giving  support to  the Muscles in the treat-
ment of Fractures, to  me appears to have  been strangely disre-
garded.   This subject was cursorily alluded to in  my former Cir-
cular, and I propose now to give it more extended, though it must
still be limited, consideration.
  Absolute rest of all  the muscles giving motion to a fractured
bone, is demanded.  To procure  this, the natural longitudinal sup-
port afforded by the bones, in a suitable position of the limb, it is 
4
known, is necessary.  Their contractile power is excited either by
over-extension, or when natural support  is withdrawn.  Uniform
lateral support is no less important, and uniform compression im-
pairs or overcomes the contractile tendency, while unequal pressure
is a source of  irritation, and excites it.  Much has been said and
written in relation to the position giving the most equal support to
the muscles, and, therefore, the most  favorable for replacing the
bones,  and maintaining rest; comparatively  very little  has  been
said, and  apparently little  notice has been taken  of the effect of
compression, or the lateral support of the muscles,  although its in-
fluence in subduing  contractile power, as a  physiological fact, is
well known, and may  be  turned  to much  practical  advantage.
Incidentally some lateral support, much even, may be given to the
muscles by the ordinary  process of bandaging with cushions  and
splints.  This, however, has been  applied chiefly  with a view to
prevent swelling, and  as a  covering  by which  the irritation of
splints is avoided, and  to confine the dressings to the limb, rather
than for any other object.   The late  Prof. Nathan  Smith, of New-
Haven, directed  that in all  cases the splints  should  enclose one-
half of the circumference of the fractured limb, while the  other
half was supported by  a bandage.  This  was, however, with a
view to the advantage of a broad surface to give  support to the
bones,   and  maintaining coaptation.   Similar advantages result
from the  use of the Grum, Starch,  or Dextrine bandages, at one
time so popular,  and which, in  fact, under favorable circumstan-
ces, and when skilfully applied, have performed remarkable cures.
Notwithstanding all this, the  necessity  of lateral support of the
muscles, with a  view  to preventing contraction,  and  to prevent
misplacement of the  bones, or shortening  of the limb, or the
spasms, often  so  troublesome, is nowhere  once alluded to in any
system of Surgery with which  I am acquainted ;  on the contrary,
dressing is often  recommended and practised, without  any lateral
support of the muscles whatever.
  As  examples  of  this  mode  of dressing,  I will first  mention
Fractures of  the  Femur,  a single  bone  supporting  the entire
weight of the  body in all its movements, surrounded  by the  most
powerful muscles, and where shortening of the limb is the admit-
ted rule, and  perfect cures the exception, which  is often treated,
both in Hospital  and private practice, only by the  long side-splint, 
5
extending from the axilla, along  the side  and limb, beyond the
foot, for  maintaining  extension, and  the  support  of the  bed on
which it  rests  in  an unchangeable  position, prescribed  by the
Surgeon.  Prof. W. Gibson recommends the treating of this injury
by two long splints, one upon each side of  the body,  with  a cross-
piece beyond the feet,  to which  the feet are confined, for  making
extension,  without the  slightest  dressing applied to the thigh.
(See Gibson's Surgery,  vol.  i., p. 445.)   Or the same injury is
treated by elevating both feet upon an inclined plane, extending from
the hips beyond the feet,  with a foot-piece, to which the  feet are
confined for making extension, and no dressing applied to the thigh.
(See p.  450.)   James L.  Van Ingen's Method, as reported  by Prof.
Hamilton, in the last volume  of Transactions  of the  American
Medical Association,  consists in  converting the whole  bed, upon
which the patient rests, into an  inclined  plane, by  elevating the
lower bed-posts  upon small blocks  or bricks,  and  maintaining
extension by confining the foot of the fractured  limb to a cross-
piece, extending between the posts, and the  thigh only supported
by cushions  underneath.   In various contrivances for permanent
extension in fractures of  the leg, we find  the same  total neglect
of  lateral support to the muscles.  With proper dressing, in frac-
tures of the  leg, permanent extension is certainly seldom,  and. we
believe, never required.
   The late Prof. Dudley,  of Transylvania University, Kentucky,
was the first, and,  so far  as I am  acquainted, is still, the only wri-
ter who has given this subject the prominence it  demands.  He,
with the enthusiasm of a reformer, goes so far as to recommend,
in  the  treatment of  compound fractures, complicated by exten-
sive lacerations  and gunshot wounds, to trust solely to the position
and the omnipotence of the bandage, of which he has been justly
denominated " the hero."   He tells us not only " all contraction,
but all susceptibility to muscular action, is effectually suspended,
by a sheath or case of properly prepared canvas."
   It is many times recommended to delay  the dressing of fractures
for several days, placing the limb  in an easy position, as it is called,
upon a pillow, and enjoining rest  until inflammation  has subsided :
because the  pressure of the bandage and splints is supposed to in-
crease it.  This is another instance in which the principle we are
considering is disregarded;  and is nothing less than to delay the 
6
 most efficient remedy, both of pain and  inflammation, until the
 most urgent necessity for it is removed.   Proper support is a direct
 means of preventing both inflammation and  pain;  and if it is
 delayed under the mistaken  idea of avoiding irritation, and,  as
 described by Liston,  "no efficient  means are employed to prevent
 the spasmodic action of the muscles, the startings of the limb, the
 jerkings of the broken ends, and the displacement of the fragments,
 then, assuredly, in spite of all local and general measures, there
 will arise frightful swelling, pain, tension,  and  heat; the  inter-
 muscular tissue will  be gorged with blood, and the circulation of
 the limb roused  to a dangerous and alarming degree."

              Pain and Spasms attending Fractures.
   Pain or spasm, beyond what necessarily attends the injury to
 the soft parts, is not a necessary condition of the  union of frac-
 tures.   Healthy bone itself is perfectly insensible, and  is no more
 sensible than the soft parts during the process of healing, unless
 inflamed,  when  it becomes  most  exquisitely sensible and painful.
 In fractures of the superior extremity we seldom hear  more com-
 plaint than would be expected from the manifest inflammation
 and injury to  the  soft parts, without  spasm  or twitching of the
 muscles, obviously because the fragments of bone are not allowed
 to rub upon or irritate each other.   But  not so in fractures of the
 leg and thigh.   The greater  weight of the parts to  be  supported,
 and the means of support employed, altogether  more  inadequate,
 and the restraint imposed upon the patient being more severe and
 more imperfectly complied with, and in  addition to  all this, the
 dressings  such as are used often  being unskilfully applied, we
 should expect involuntary twitchings of the muscles would be
 excited by the constant irritation ; that sleep would be disturbed,
 and its approach regarded with terror in consequence of the spasms,
 which only await  its  approach; that finally, inflammation of the
bone itself would be  excited,  as well as  in  the surrounding soft
parts, so that we should have irritation, fever, pain, such as inflam-
mation of bone only can produce.   All this, as an abstract propo-
sition and physiological fact, is well known by the intelligent prac-
titioner, but greatly at variance with popular notions in relation to
fractures; and practically, surgeons, I fear,  will  not be ready,  in
all cases, to stand manfully to the test, and attribute the pain and 
7
spasmodic twitching of the  limbs  of their patients to their own
defeotive or unskilful dressing.

                       Union of Fractures.
  The union of fracture of  the bones is the result of the laws of
health—healthy action developed in the recuperative power of the
animal  economy—strong, in proportion  as the vital powers are
vigorous and  healthy—weak, in  proportion as they are feeble or
disordered.
  It hence follows, that all the appliances of art must  be wholly
powerless in  any degree to  promote or accelerate the process any
further  than we can remove hindrances  to the development of
healthy action.
  Thus far I shall not be disputed ; yet the principle  seems to be
too much lost siglit of and neglected  in practice.  As the obvious
effects of this tendency of  nature, we have a  certain amount of
inflammatory action, accompanied by some increase of heat, pain,
and swelling of the soft  parts.  If these fail, the process is inter-
rupted or retarded.  On the other hand,  these  symptoms being in
excess,  instead of a  secretion at first  fluid, then fleshy and vascu-
lar, then ligamentous and flexible, and finally unyielding bone, we
have the common results of high  inflammatory excitement, great
swelling and pain, and it may be  the formation of pus and exten-
sive suppuration or  gangrene of the  part.  Hence indiscriminate
flooding by  wet  applications, and by cold,  or unnecessarily en-
cumbering the parts, and increasing heat by a multitude of cush-
ions and  bandages," cannot but be highly injurious  and censur-
able.
  Another point to which I especially wish to draw  attention : as
the process is a  natural one, so also nature has  established a
period for the accomplishment of  her purposes,  which must, while
the laws of the animal economy remain the same, remain unalter-
able.   We do not, therefore, expect to expedite  the process beyond
what is already known as the period of health.   On the contrary,
by  the perfection of  our  instruments we  may even retard  union;
and not unfrequently the most perfect cure is rather slow in its
accomplishment.  Let there be some imperfection in the adjust-
ment of the bones—let there  be some irritation in consequence of
imperfect support of the parts, there will be  an exuberant and 
8
rapid growth of callous—a large ridge may be formed  around the
place of fracture, it becomes quickly solid, and the patient has the
use of his  limb, it may be somewhat deformed, but still  quickly
restored.
  Bearing these principles in mind, we are at no loss in accounting
for an admitted fact, that bones of the superior extremity usually
heal much more rapidly than those of the inferior ;  for there is less
of absolute restraint,  less to impair the energies of  healthy action,
and all the processes of health are more fully sustained.  The ribs,
when fractured, though never at rest, heal with remarkable rapidity.
So  also with the  bones of animals : the animal  limping and de-
formed, yet the bones solid and healed in a remarkable short space
of time.  The very obvious import of this is an important practical
lesson: that  is, in all  cases, allow as much  motion and general
exercise  as  is consistent  with the  paramount objects  of  exact
coaptation of the bones, and safety as regards the  reproduction of
the fracture.

             Un-united or Tardy Union of Fractures.
  This apparatus, on account of its lightness, and being accurately
fitted to the limb, is peculiarly adapted  to Amesbury's method of
promoting union, by compression  in both the lateral and longitudi-
nal direction  of the bones, by which absorption  of the  perhaps
superabundant soft and yielding substance which has accumulated
between  the fragments of bone is promoted,  a degree of  healthy
action excited, and  soon  bony matter deposited, and  finally solid
union produced.
  Such, I can confidently assert,  from repeated trials, will be the
result  in most of what may be  termed recent  cases.  I believe
very few if any cases of not more than  ninety days' duration will
be found to resist this method of treatment.  I have met with none.
Perhaps not the least efficacious  part of the treatment consists in
allowing a very considerable amount of bodily exercise, without
endangering a reproduction of  the fracture.
  The system has become debilitated by long confinement—vas-
cular action in the affected limb is especially weak—when suffered
to remain in a depending position it becomes livid—when blood  is
pressed from the capillaries by the finger, it is slow in returning ;
but by resuming, as  the patient  may now be  allowed to do,  some 
9
general exercise, such as hopping on crutches, riding, or, if no more,
than sitting up and removing from the bed to the chair, with fric-
tion, showering, stimulating lotions,  &c,  to the limb, health  im-
proves, circulation becomes  more vigorous, the bones evidently
become more unyielding, and soon union is complete.

         Conditions other than Fractures requiring Splints.
   These are sprains,  inflamed joints, rheumatism  and  wounds,
either incised, contused, or  lacerated, extending to  muscles,  ten-
dons, or joints.  To  describe  all these cases particularly, would
exceed my limits, and is not necessary.   These  splints  are  well
adapted to all such  cases, and  there can be no doubt  that the
advantages of mechanical support have been strangely overlooked,
since motion  and the  separation of  divided parts are in all cases
the principal obstacles to union.
   In cellular and muscular structures, this especially holds true—
perfect apposition or contact, and perfect rest, in the healthy consti-
tution, are the only conditions required for union by first intention.
If means to diminish inflammatory action  are required, as washes
or wet applications, it is because there exists partial disorganization
in consequence of contusions, or too much heat is excited by im-
proper dressings or  other applications, or excessive general excite-
ment or feverish action exists in the system.
   Incised wounds of  the  knee or other joints, which are justly re-
garded with terror, and  are in a high degree dangerous if neglected,
heal with the same, or perhaps I should say, almost the same, cer-
tainty as wounds of other parts,  if the conditions above stated are
strictly complied with.
                                                 B* Welch.
   Lakeville (Salisbury), Conn., Feb. 1, 1858.

                      Apparatus  Described.
   The splints  consist  of light  and elastic cases or coverings,
 formed  of very thin  strata  or  layers of  wood or " cut  veneers,"
 cemented together  by interlayers of gutta percha,  of such thick.
 ness as is required  to maintain  their form, and  pressed into the
 form of the part for which  they  are  designed.   By  this method  of
 constructing splints,  the fibres of the wood all run  longitudinally
 or parallel with the surface, which gives them great superiority  to 
10
 splints  carved  from solid blocks of wood, however skilfully  per-
 formed  and fitted to the part.   For when so  thin as to be elastic,
 they are necessarily liable to split and  break, and do not retain
 their form when wet.
    Gutta Percha used by itself, was at one time supposed to con-
 stitute the  ne plus ultra as a dressing  for fractures, on account of
 its perfect  plasticity and  strength, and resistance to the action of
 fluids ;  but experience soon demonstrated that it had not sufficient
 firmness at the temperature of the  body, to resist the pressure to
 which it was exposed.
   This  may  be introduced in  any proportion  required to give
 strength and durability and resistance to the action of  fluids, and,
 when properly applied, it adheres with  more firmness to the wood
 than the fibres of  the wood do  to themselves.  Another circum-
 stance attending this arrangement, of considerable practical impor-
 tance is, that the splints are made more flexible and elastic in the
 lateral  or parallel  direction of the fibres of the wood, than in the
 longitudinal;  hence, what may seem somewhat paradoxical, they
 readily accommodate themselves to changes in the dimensions of
 the limb, resulting from  increase or diminution of inflammation,
 or from  interstitial  absorption, while they give perfect support to
 the injured  or diseased part.  When necessary to  adapt them to
 limbs of individuals differing in the form and size of their  limbs,
 they are made sufficiently flexible by immersion in  hot water, or
 simply  enveloping  the splint,  or such  portion of  it as may be
 necessary, in cloths wetted with hot water for a few minutes, and
 then, on cooling,  they will immediately become  unyielding and
 elastic as before.  This peculiarity can scarcely be too highly appre-
 ciated, for of all the materials heretofore proposed capable of being
 moulded to the part and  hardening  after the splints are applied,
 none has been found which has  not  proved decidedly defective in
 practice.  They possess great  strength and durability, so that the
same splint may be used  a long time, and  for the  treatment of
many cases of fracture.   They do not preclude the use of evaporat-
ing lotions, water-dressings, or moisture  in any manner applied,
except when heated much above the temperature of  the body!
They are applied with great facility, rendering the dressings simple
and easy to both surgeon and patient, and allow constant access to
the injured part, to detect  inflammation at its commencement, or 
11
any irregularity in  the  position of the bones;  and after the ten-
dency to inflammation has subsided, dressing or examination by the
surgeon is required  much less  frequently than  when ordinary
splints are used.  In short, they have, combined with the property
of being made sufficiently soft and yielding  to  be moulded, with
accuracy, to  the surface of the part for which they are designed,
all the properties of insolubility, lightness, elasticity, strength, and
firmness, necessary to constitute a perfect Splint.
  In connection with the above splints is apparatus for maintaining
permanent extension  in fractures of the thigh,  and for fixing the
joints of both the superior and inferior extremities in the extend-
ed  position,  or at any degree of flexion of the limb required.
These  will be described with  the consideration of particular in-
juries.
  The entire  apparatus is made  with especial  reference to allay-
ing the tedium of confinement consequent to fractures, by allowing
changes of position and exercise,  not inconsistent with the perfect
quiet of  the  particular muscles  implicated in the injury, and
allowing  such removals  as  circumstances  often  imperiously de-
mand, as when persons  are injured at a distance from their homes;
and this will not be found so inconsistent with the greatest suc-
cess in the treatment as has been generally supposed, for the more
complete the support given, and the more perfectly the action of
the muscles  is suppressed,  the  greater may  be  the amount of
general exercise without deranging the fracture.

                          ------•♦•------

             EXPLANATION OF THE PLATES.

  The  Plates I and II (fronting title page) represent cases or sets
of splints and apparatus, described in the following pages,  adapted
to the treatment of all fractures of the extremities.

                           Plate  I.

      SPLINTS FOR  THE  SUPERIOR EXTREMITY.

  Fig.  1.  " Dorsal Forearm Splint."
  Fitted to the dorsal side of the Forearm. 
12
   Fig. 2. "Palmar Forearm Splint."
   Fitted to the palmar side of the Forearm.
   Fig. 3. "Wrist Splint (right and left)."
   Fitted to the palmar side of the right and left forearm and hand
 —the hand being strongly flexed outward.  This splint is for the
 treatment of fracture of the radius near the wrist, or dislocation of
 the ulna at the inferior extremity, or both  combined.
   Of each  of the  above splints, in each case,  there are three
 sizes—fifteen splints.
   Fig. 4. " Straight hollow Splints for the Arm."
   Several sizes—six splints.
   Fig. 5. " Shoulder Splint, adapted to the  top  of the  shoulder
 and outside of  the arm.  The joint  is required to accommodate
 the cap or upper portion of  the splint to the different positions of
 the shoulder."
   Fig. 6. " Elbow Splints."
   For Fractures near the  Elbow.   These splints arc fitted to the
 two sides  of the arm, and  connected  at the elbow by  double
 hinges, which  fix the  arm at any degree of flexion or extension
 required, and  the position may be changed by turning the screw,
 which serves also as a  pivot for  the  hinge.   The hinges  may be
 easily transferred to splints of different sizes.  The usual arm and
 forearm splints are used for  this purpose.
   (See Transactions of  the American Medical Association, Vol. 9,
p. 230;  also, Hamilton on Fractures, &c, p. 250.)

       SPLINTS FOR THE INFERIOR EXTREMITY.
   Fig. 7. " For Fractures of the  Fibula, or inner malleolus of the
 Tibia,  with  displacement of the foot  in the direction of the frac-
ture, or for fracture of both Tibia and Fibula near the ankle."
   Tor the treatment of these injuries the lower portion  of the Ad-
justable Side Frame, plate II, fig. 1, is used. The  lower side piece
of each  side of the frame attached to the  flexible side  splints by
the connecting screws and  foot piece, as here represented, is all
that is required.
                          Plate II.
   Fig. 1. "  Adjustable  Side Frame," for Fractures of the Leg.
   This  may be flexed  or extended, and fixed in  the position re- 
13
quired by the hinges.   This is done by means of pinion-like teeth
at the circumference of the hinges, which are  held  in contact or
separated, by screws, forming the pivots of the joints.  It is fitted
to limbs differing in length by sliding joints at the sides of the
limb, and in the splint which supports the under side of the limb.
The depth is increased or diminished by turning the screw at the
bottom of the foot-piece.
   Figs. 2 and 3. " Flexible Side Splints,"
   The side splints are moulded to the inside and outside of the leg,
and are of three sizes—six splints.  A straight hollow splint should
be placed upon the thigh to support the thigh straps.
   Fig. 4.  " Thigh Apparatus."
  ' a. "Upper extremity, broad and well cushioned, so as to rest
 easily against  the  side of the body.   The breadth of  this por-
 tion of the splint assists also in preventing its rotation.   It is fur-
 nished with rings for the perineal  band."
   b. Brace for fixing a joint;  to be used only in packing.
    c. Screw for adjusting a sliding joint, for the purpose of length-
 ening or shortening the splint.
    d.  Thumb screw for making extension.
    The hollow splints represented  below, can be moved upon each
 other by a joint opposite the ham, and their position secured by a
 moveable bar.   They may also be lengthened  or shortened.  There
 is a joint  corresponding to the heel and  another opposite the sole
 of the foot.
    " The apparatus  may be used as a double inclined  plane, or as
 a straight splint."—Transactions of American Medical Associa-
 tion, Vol.  10, p. 432.
    Fig. 5, 5, 5.—Straight hollow  Splints for  the  Thigh, several
  sizes—six splints.
    Fig. 6.  A form of Gaiter, for making extension  in Fractures of
  the Thigh. 
14
GENERAL  DIRECTIONS   FOR  THE  APPLICATION  OF
                       THE  SPLINTS.

  The splints, if not perfectly adapted to the surface, are first im-
mersed in water as hot as can be borne by the hand, until they are
sufficiently flexible ; or,  if more convenient, and only portions need
to be changed in form, envelope either the  entire splint, or such
portions  as may be necessary, in cloth  wet with hot  water.   If
water, at or near the boiling temperature, be used, some care is re-
quisite that it is not continued so long as to completely melt  the
gutta percha, so as to separate the layers of veneers.  Then a cloth,
or if preferred, a very thin cushion of cotton batting, is laid on  the
splints, and they are fixed upon the  limb by a bandage.   For a
bandage  I usually prefer the roller, which is applied with more
ease and uniformity, and gives better  support to the muscles than
the bandage of  strips or  Scultet's bandage.   This is  first bound
upon the limb from the  inferior portion of it upwards, the  splints
are then  applied, and secured by the roller passed downwards over
the splints.   If it is afterwards desired to convert this into Scul-
tet's bandage,  as  it  may be,  especially the portion of it which
comes in immediate contact with the limb, divide the alternate
turns with scissors at convenient distances, and they may easily be
drawn to suitable positions on the limb.
  A still lighter, and an effectual method of confining the  splints,
is by four or  five tapes or straps passed through perforations or loops
at the two sides of one of the splints,  then doubled  back, and tied
or buckled over the  loose splint.   The  splints  being  secured in
this way, the bandage over the splint  may  be altogether omitted.
Simple as this method of securing is,  it is a valuable improvement
entirely preventing the sliding of the straps in any direction upon
the splints, or any change in the  position of the  splints upon  the
limb.  The straps for securing splints should never be  allowed to
pass around the  limb,  unless immovably attached  to  one of  the
splints. 
15
  APPLICATION TO  PARTICULAR  FRACTURFS  AND
                          INJURIES.

                    Fracture of the Forearm.
   For Fractures of the Radius, or  Ulna, or both these bones  to-
gether, the apparatus required is—
   1.  The Forearm Splints, palmar  and dorsal.
   2.  Compresses,  to be applied along the interosseous space.
   3.  The Roller.
   After adjusting  the bones, first  apply the  compresses to  com-
press the  muscles  between the bones; then  the roller, previously
moistened, from the roots of the fingers to the  elbow ;  after this,
the splints ; then complete the dressing by passing the roller down-
wards to the ends of the fingers.  Or the method of securing  the
splints  by tape or  straps, as above described, may be adopted, then
the bandage over the splints may be entirely omitted.
   This method of dressing fractures of the forearm is at once sim-
ple, easy,  light, and effectual in all cases, except where the fracture
is seated very near the joints, either of  the  elbow or wrist; then
other methods of maintaining  the  position of  the  bones are re-
quired.

Fracture of the Radius near  the Wrist, and Fracture with  Disloca-
               tion of the small Head of the  Ulna.
   Next to the common form of fracture of  the forearm, near  the
middle of the bones, the treatment  of which is so simple and satis-
factory, we  are  immediately met  by one of the  greatest annoy-
ances in the entire range of fractures, being  accidents  of frequent
occurrence,  and  annoying  to the patient,  because unavoidably
painful, slow in recovering,  the fingers and wrist remaining a long
time stiff, and rotation of the hand  difficult or permanently impair-
ed, and sometimes, also, resulting in permanent deformity of  the
joint; and annoying to the surgeon, because  it  is-difficult to per-
suade the patient that an injury so trifling in appearance is neces-
sarily attended with consequences so serious.
   Simple  fraeture  of the radius at  the  lower  extremity near  the
wrist, as it  usually appears, when  resulting  from falls upon  the
hands with projection of the inferior  portion on the back of  the
wrist, and corresponding projection of the superior portion anteri- 
16
 orly, can only be mistaken for dislocation of the wrist backwards.
 If such a mistake occurs, and the case is relinquished after reduc-
 tion, without mechanical support, the displacement quickly returns,
 and the  deformity is as unsightly as  before.   A careful examina-
 tion will enable the surgeon to easily discriminate the injuries.  In
 fracture, rotation  is particularly painful, and  the displacement is
 increased by pressing the radius with the thumb in the palmar di-
 rection,  while we rotate the hand outwards.    The precise point of
 the displacement may be  more accurately detected by flexion and
 extension of the hand.  Too much reliance must not be placed on
 the absence of crepitation, as this symptom can only be produced
 by forcible  extension with rotation  of  the hand, and sometimes
 not even then.   It will usually be perceived at the time of replac-
 ing the fracture, and other  attempts  to produce  it  only occasion
 unnecessary pain.  There are  cases of this   accident with  only
 slight displacement, which, in the swollen condition  of the parts,
 cannot be detected.  The principal characteristic is,  then,  painful
 rotation, with the pain referred to this portion of the  bone;  but
 guided by this circumstance alone, subsequent developments will
 not often show the surgeon at fault in his diognosis.
   The difficulty in the  treatment of this injury is greatly increased
 when complicated  by either fracture or dislocation of the ulna,
 but especially by dislocation.   Dislocation of the head of the ulna,
 from the radius,  may occur also without fracture of the, radius,
 but the fracture is much  more  commonly present.  All these dif-
 ferent forms of injuries  are usually produced  by the same cause,
 that is, falls upon the hand, and require essentially the  same  form
 of  mechanical  support for their  treatment.    The dislocation,
 whether  complicated or simple,  is known by the absence of the pro-
 minence  on the outside  of the wrist caused by the small head of the
 ulna, with a corresponding projection in the palmar  direction, the
 head  of  the  ulna  lying nearly  on a level with  the os-pisiforme. '
 This is the direetion of  the dislocation, at least in all the  cases I
have  witnessed.   When reduced, there is always great  liability to
 displacement, owing to  the small and superficial articulating sur-
face of the radius.   When there is also fracture of the radius, the
tendency to displacement is increased by the strong  action  of the
muscles of the forearm,  and the  difficulty of  binding the head of
the radius to the ulna, without compressing the superior fragment 
17
so far into the interosseous space as to prevent rotation of the fore-
arm, and occasion very considerable deformity of the wrist.  In the
worst forms of the accident there is much injury of the soft parts,
followed by high inflammation and severe pain, which wholly pre-
clude efficient bandaging until the  inflammation has subsided.  I
have, in repeated instances, witnessed this form of injury occurring,
to a greater or less extent, in both the wrists at  the same time, by
persons who, in  falling from a height, and naturally projecting the
arms to save themselves,  have received  the principal force  of the
fall upon the hands.
   The treatment of these accidents  is, it  appears to me, but im-
perfectly  considered in  the books.   Boyer  remarks, concerning
fractures of the  radius near the wrist, that  " There is always, in
this case, a considerable  swelling of the  adjacent articulation, and
afterwards more or less difficulty in its movements ;" and in com-
plicated fracture, "As we cannot foresee the period when we can
apply the apparatus, and  as  at this time the  bones  may have
united in an unnatural position, it is  proper to  advise the patient
of the probable  loss or difficulty in  the action  of  pronation and
supination."
   So far as the difficulty in these cases arises from the difficulty of
retaining the bones in  their proper position, it may, I think, in all
cases, be overcome, provided the necessary applications are made
speedily after the injury is  inflicted, before inflammatory action
has commenced, and the  patient will exercise any tolerable share
of submission to the restraints imposed upon him.
   The  indications  are, first, to secure absolute  rest of the part,
with the thumb pointing upward.  2. The ulna being regarded as
the fixed point of supporl, the inferior portion of the  radius is to be
constantly and forcibly impelled toward it.   3.  The head  of the
radius  and hand, strongly abducted, are  to be  retained in their
proper position in relation to the shaft of the bone.
   The  first and second  of these indications may  be fulfilled by
means  of what I have denominated the ulnar splint, in a  former
circular.  See duplicate splints, p. 25. To simplify  somewhat the
dressing in  these cases, we have constructed  a  single splint, in
which is combined nearly the form of both the ulnar and palmar
splints,  fitted to the palmar and ulnar sides of  the forearm, with
the hand strongly abducted, making a more convenient, and, per-
                             2 
18
 haps, equally efficient mode of  dressing.   After  replacing  the
 bones and wrist, apply a sufficient compress along the ulna; after
 this, what  I have  called the wrist splint (PI. 1, fig. 3) upon  the
 palmar side of the arm, and the  usual  dorsal  splint to the dorsal
 side of it, and secure these by straps or tapes, as described (page
 14).   The  bandage may be then continued downward over  the
 whole to the fingers.  It is an improvement to bandage each finger
 separately,  to prevent swelling, before commencing dressing the
 arm.  I can assert the complete  success  of this method of treat-
 ment in numerous cases, and without any  failure, where the pre-
 scribed directions have  been complied with.
   The ridigity of the tendons and stiffness  of the  fingers  which
 harass the patient for so long  a  period  after this injury, may be
 diminished,  by early resorting ^to passive  motion  and  frequent
 dressings, with frictions during convalescence.

                  Fractures of the Elbow-Joint.
   This  comprehensive  and rather indefinite  title is chosen, be-
 cause all the injuries included by it are  treated by the same form
 of apparatus, viz., the hollow-jointed elbow splints.   (See Plate 1,
 fig. 6.)
   These splints are adapted to the two sides of the arm, are capa-
 ble of any desired  change in regard to flexion or  extension, are
 readily adapted to limbs differing in size or length, giving com-
 plete support to the joint, and thereby preventing all motion or dis-
 placement of parts ;  they are at once convenient and effectual, and
 the intention is so fully accomplished, by means so entirely simple,
 that there seems to be little  room for more to be expected  or de-
 sired.

           Fracture of the Inferior Extremity of the Humerus.
   Whether  the fracture is  oblique, separating either the internal
 or external condyle, or transverse, including both, or  if with the
 last, as  occasionally happens,  a  longitudinal fissure, extending
 from the transverse, through the  cavities for receiving the olecra-
 non  and coronoid processes to  the  joint, separates both the con-
 dyles ; in either  case the apparatus consists of: 1. The  hollow
jointed splints for the outer and inner  sides  of  the arm.  2. A
 compress and one or more rollers of sufficient length to  extend 
19
from  the  hand  to  the shoulder,  including  the necessary turns
about the elbow, and then from the shoulder to the hand, including
the splints.   3.  If the fracture is transverse, with projection of the
detached portion backwards, resembling  dislocation of the elbow
in that  direction, a  light narrow splint  to extend from the point
of the olecranon nearly to the shoulder.
   Manner of Dressing.—This consists in first bending  the arm,
and when  the fracture is transverse,  drawing it downwards and
forwards to effect a replacement  of  the bones:  then applying the
splint to the back side of the arm, and extending to the olecranon,
with  a proper compress resting upon the point  of the bone.  The
arm is then held by an  assistant, while  the surgeon applies the
rollers from the  roots of the fingers to the shoulder, making several
turns around the elbow.  Then  the side splints, fixed at the re-
quired angle, are placed  on the sides of the limb, and the dressing
is  completed by  continuing  the bandage  downward  from the
shoulder to the  hand.   If  the  condyles  are fractured obliquely,
with  displacement of the forearm,  either  outward or inward, first
place a compress on the  round side of the limb, extending to the
elbow;  then place the arm on the splint fixed at the proper angle,
and these being held by  an assistant, the roller is applied from the
fingers to the shoulder;  then  the other  splint is applied,  and the
roller continued downward  again to the hand.   Lotions should  be
applied to prevent or reduce inflammation.
   After the first week or ten days, changes should be made in the
position of the  arm at  every dressing.  These should be more or
less extensive, according to the  amount  of  inflammation existing
at the time.  The arm  may'in this way be gradually brought to
the extended position, and  then again to the flexed, and, by this
means,  the liability either  to deformity or anchylosis is prevented.

                    Fracture of the Olecranon.
   Apparatus required.—1. The jointed  elbow splint fitted to the
outside of the arm.  2.  Three rollers, one to be expended on the
forearm with a few turns about the elbow—the  second to be pass-
ed from  the  top of the  shoulder of th'e injured arm around the
body  under the opposite arm, to prevent  the  bandage  slipping
down ;  it is  then  continued from the top  of  the shoulder to the
elbow.   The last is used to confine the arm upon the splint.  3. A 
20
compress and flexible hollow splint fitted to the back side of the
arm.  4. Adhesive straps one and  a half inches or  more in width,
and twelve or more in length.
  Method  of Procedure.—Extend the  forearm, bring down the
detached olecranon process  in  close contact with the ulna, and
retain it in this position by the adhesive straps, one on each side of
the arm, passing spirally and crossing immediately above the ole-
cranon, and thence down upon the  sides  of the forearm, drawing
downwards the detached portion of bone, to be held in this position
by an assistant, while the  surgeon applies the first bandage  from
the roots  of the  fingers  to  the elbow;  the  compress and flexible
splint are then  applied over  the triceps  and supporting the  ex-
tremity of  the olecranon, and then the second bandage is applied.
After this the  jointed splint  is  placed upon the arm, fixed in the
extended position, and confined  by  the third roller, extending  from
the fingers  to the shoulder.
  As this injury is usually produced by direct falls upon the elbow,
and attended with considerable contusion, it may be necessary for
the inflammation resulting from this to subside before the apparatus
can be efficiently applied.  An obvious  necessity  exists  for the
splint on the back  of the arm.   The  insertion of the tendon of the
triceps muscle into the olecranon is such as to leave a considerable
space at this  point between  the  humerus  and  tendon;  conse-
quently, pressure directly upon the  tendon must force it too closely
inward, and by tilting the superior portion  of the fractured  bone
upon the humerus, throw outward and separate the lower portion
from its attachment to the ulna, leaving too great a space for  bony
union to be accomplished.   Hence,  in  this fracture we  almost
uniformly have only ligamentous union, with some separation be-
tween the  fragments, and " owing to this, the arm long remains
weak,  and sojnetimes never  recovers its former strength."—(Prof.
Gibson.)

         Fractures in  the Middle or Body of the Humerus.

  The treatment of these"easily-managed fractures, which seldom
result  in  deformity,  scarcely  needs explanation.    Two splints
(PI.  1, fig. 5) may be  applied to the back and foreside of the arm,
and both  secured in   the usual  manner by  a roller ; then two 
21
similar splints may be applied to the outer and inner sides of  the
arm, and in like manner secured upon it by the bandage.

              Fractures of the Neck of the Humerus.

   This fracture, though not difficult to manage, is but little bene-
fited by ordinary  splints, which, owing to the form of the part,
and shortness of the detached fragment of bone, can  give but little
support.  The splints always project, giving an unwieldy appear-
ance to the dressings, and require the additional support of paste-
board, leather, or other flexible material.
   The form of splint here recommended for this fracture is original,
forms  a neat and convenient  dressing, and fixes the bone in its
proper position with great security and firmness.  It is represented
PI. 1,  ficr. 7.  No directions  are required for its application, except
that one or more  turns of  the roller should be continued from the
top of the injured shoulder, around the body, under the  opposite
 arm, to keep the dressings in place.
    This form  of  splint is also well adapted to cases of delayed or
 non-union of fracture of the humerus.   Here, it seems, the weight.
 of the arm operating constantly to  keep the portions of fractured
 bone separate, while the natural contractile tendency of the mus-
 cles to overcome any bandaging and compresses over the muscles,
 acts as a cause of non-union of the bones.  This is  a cause of this
 unfortunate result, more frequent  in  this than any other bone of
 the body, which has not before been pointed out, but I am confident
 will  prove the true one.   With  this splint it is easy to maintain
 constant support, or, if need be, compression, in the direction of
 the shaft  of the bone.  The shoulder-cap  is confined upon the
 shoulder, and prevented from sliding outward by a band passing
 from rings upon the cap of  the splint, around the body, under the
 opposite arm.  The arm being flexed, another band, with a  com-
 press  or pad, is  placed under the elbow, and secured by hoops or
 rings  at the lower end of the splint; and this may  be drawn with
 any degree of firmness to give the  necessary support.   A bandage,
 of the form of the figure 8~ may also be applied from the top of the
 shoulder of the injured  arm, around under the elbow to the top of
 the shoulder, under the opposite arm, and again to the top of the
 shoulder ;  and this may be repeated two or three times.  In no 
22
 case may bandages be applied around the arm to confine it to the
 body except directly at the  elbow.   If higher on the arm it oper-
 ates as a fulcrum  over which the arm is liable to  be bent at the
 seat of the fracture.

               Fractures of the Inferior Extremity.

   It will be convenient here, as in the consideration of apparatus
 for the superior extremity, to  commence with the more simple,
 these being the inferior portions, first.  It is not necessary here to
 make comparisons between  the apparatus described and a multi-
 tude  of very  excellent forms which have from  time to time ap-
 peared and had their day, and have been superseded by others, or,
 as would now seem to be the tendency, by none at  all.   However
 others may regard  the  subject, I have no expectation that, in pri-
 vate  practice  at  least, surgeons will  often recommend  to  their
 patients, or  that patients will be often found to submit to dole
 away their thirty, forty, or sixty days of  absolute confinement in
 a prescribed position, without the relief of such changes of posture,
 and such movements of the  body or limbs as  can only be allowed
 where a good  apparatus is used.   With such help, experience has
 abundantly demonstrated that in many  cases free motion, and in
 some almost unlimited exercise, may be safely allowed.

          Improved Apparatus for Fractures of the Leg.

   These fractures  may all  be  well and  conveniently treated by
 either the form of apparatus represented, Plate II, fig. 1, and flex-
 ible side splints, figs. 2 and 3, or the improved Amesbury's appa-
 ratus,  page 27.  Both differ from any of the  forms now in com-
 mon use : Firstly, in the arrangement of the joint for the knee, by
 which flexion and extension of the limb may be performed without
 changing the relative length of  the splint and the fractured bone.
 This is effected by a joint at the side, instead of under the knee,
and as high on the  limb as the centre of motion of the joint, giving
a more extended motion opposite, corresponding  to the  ball and
socket.  This alone is of sufficient importance to give this appara-
tus a decided advantage over all others in which this circumstance
is disregarded.  To illustrate the absurdity of attaching the joint
in the ordinary manner,  under the  knee, we have  only to place 
                              23

a common jointed measuring rule  under the limb, with the limb
flexed to a right angle, then extend the limb and the rule together,
and it will be found that the relative length of the limb below the
knee  and the rule  will have  changed  from one  to two  inches.
The  neglect of attention to  this circumstance is, I do not doubt,
often  the cause of displacement of the bones, and shortening of
the limb.  Secondly, in fig. 1, the screw, which serves as a pivot
for the joint,  also fixes the  joint in the position required, by means
of pinion-like teeth  at  the circumference.   Hence, we  avoid the
inconvenience of  a projecting rod or screw under the knee, which
is employed  in  all other forms of apparatus extending to the
thigh, that have  come  to  my  observation.   ^Thirdly, the  sliding
joints for adapting  the apparatus  to limbs differing in  length,
are,  in  one,  placed under the limb, in the other at  the sides,
avoiding  the  encumbrance  of  a  projection  beyond  the  foot.
Fourthly, the method  of  attaching the foot-piece to the main
support,  by  which  the depth of  the  instrument may  be in-
creased or diminished,  and the foot raised or depressed, and by
which also the different portions of the  apparatus  are connected,
giving it firmness and strength without increasing the weight, are
also original.  All these improvements, as well as  the material of
which the flexible portions are  constructed, I consider give  to both
these forms of apparatus a sufficiently distinctive character to be
designated as  new and improved.
   In all  cases where the fracture of the bones is  situated above
the middle .of the leg, the  support should extend to the thigh, and
be capable of  fixing the joint,  though occasional changes  in the
position should be allowed.
   The method of dressing is simple  and easy.   The limb having
been prepared by the reduction of  displacements or coaptation of
the fractured  bones, a roller  is passed from  the toes to  the knee.
The side splints,  softened by hot water,  are  then adjusted to the
limb,  and secured by the  bandage continued down again to the
foot.   The limb  is now placed on the frame, slightly cushioned
with cotton or folds of cloth to receive it, when it is secured in the
proper position by the screw at the  side of the foot-piece and the
side straps, and  the joint at the knee is also fixed at the degree of
flexion required.  At a subsequent dressing the bandage, or either
portion of it,  if preferred,  can  be converted, as  before described,
into a bandage of strips. 
24
          Improved Apparatus for Fractures of the Thigh.
   The apparatus for the thigh possesses all  the  advantages which
 have been shown to distinguish  the apparatus for  the  leg, and is
 adapted either to the flexed or extended positions of the limb,  as
 the practitioner  may prefer, or the circumstances of the case may
 require.   The ability to change the position of the  limb, I regard,
 in some circumstances, as essential to success, and the only pos-
 sible means of avoiding very serious  deformity.  This  is  true  of
 some cases of fracture below the  neck of the femur, but near
 the hip, and also of some cases of oblique fracture, near the knee.
 It is also important to be able to flex or extend the joints to some
 extent after union of  the  fracture is  accomplished, during the
 period of convalescence.  We may thereby very much diminish
 the protracted stiffness caused by fractures near the joints, when
 kept constantly  in the extended position.

          Directions for Dressing Fractures of the Femur.
   If, as is now  frequently practised, adhesive straps are used for
 making permanent extension, the straps  prepared  with tapes  or
 loop-holes at the lower extremity, by which they may  be secured
 to the foot-piece of the apparatus, are applied, extending from near
 the knee, or near to a level with the bottom of the foot.  A roller
 is now applied, commencing with the foot, and extending upward
 nearly to the fracture.  Another bandage is secured  by a few turns
 about the pelvis, and after proper adjustment and coaptation of the
 bones, is continued downward upon the thigh,  connecting by a few
 turns with the first-mentioned bandage.   Flexible splints of wood
 and gutta percha are now applied to. the sides and top of the thigh,
 of the length of the thigh, and secured  by the remaining turns  of
 the bandage.   A sufficient cushion of cotton or cloth being  placed
 upon the double  inclined  plane  or  bed-splint, the limb is  placed
 upon it, and the necessary extension made by means of the counter-
 extending perineal band and adhesive strap or gaiter,  or both,  as
 may be preferred; the whole is then secured by the straps passing
around the  limb, and a band around the pelvis. 
£5
Duplicate Forms of Apparatus for Treatment of particular Fractures.
ULNAR  SPLINT.
   This splint is specially indicated in dislocations of the small ex-
tremity of the Ulna, and  fracture of the  Radius, near  the  wrist,
or both these injuries combined.  It is fitted to the outer or ulnar
side of  the forearm and hand, with  the hand strongly flexed out-
ward, and will be found an  effectual method of dressing  when
other  methods fail.   It  does not so far enclose  the forearm as to
enable us to dispense with the usual forearm splints when there is
fracture of the Radius, and  in  connection with  these  splints is a
more complicated form  of dressing  than  the wrist splint—Pt. 1,
fig. 3.
                   The Longitudinal Half-Boot.
   For the introduction of this form of splint we  are indebted to
the late Professor Nathan  Smith, M. D., of Yale College.  For all
the important fractures of the leg, he required splints to be  nicely
carved from  solid blocks of  wood, to fit  every particular case of
fracture, which can only  be well  accomplished  by an artist, at
considerable expense, and the  same  splint  will  seldom serve for
the treatment of more than a single case of fracture.  This splint,
and the mode of treatment adopted by Dr. Smith,  are described
in the American Medical Review, published at Philadelphia, A. D.,
1825,  vol. 2, p. 355.   Splints of similar  form, constructed of
wood and gutta percha, may be adapted to limbs differing largely
in size, and either to the inside or outside of the limb, as the case
may require, and will serve for the treatment of many cases of
fracture.
   They are adapted to all cases of fracture  of the inferior third of
the leg.   In  fractures  of the fibula,  or  inner malleolus of  the
tibia, we  apply the  splint to  the  side of the limb opposite the
fracture, with a compress extending from  the ankle-joint upward;
then applying a roller from the toes  to the knee,  the splint  is se-
cured to the  leg, and the foot is forced in  the direction opposite to 
26
the displacement.  When both bones are fractured, the splint may
in general be most conveniently applied to  the outside of the
limb.
  We have substituted  for the boot-splint the form of splints here
represented, which  is more easily constructed and  fitted to the
limb, and  equally  effectual  in maintaining the position  of the
bones.   It consists of two pieces.   One is moulded to the form of
the side of the leg and  foot; the other is the common leg splint,
outside or inside, as the case may require.   These are connected
by straps, as represented in the figure.  This  is a sufficient support
for most of the fractures at the lower third of the leg.  A roller is
first applied from the toes to the knee, then the two splints to the
two sides of the  leg, protected by sufficient covering or padding
upon the splints, and secured by straps passing through rings at-
tached to the edges of one splint, and buckled over the opposite,
as represented  in the plate, and over these the bandage may be
continued  down again to the  foot.  If the fracture consists of
fracture of the fibula, or internal condyle of the tibia, with dislo-
cation of the ankle, a sufficient compress is applied to the sound
side of the limb, extending as low as the joint, and  secured by a
bandage extending  from the toes to the knee ; then over the com-
press the  splint with foot-piece, to  prevent  motion of the  ankle-
joint, and the common leg splints, to the opposite side ; then  these
are  secured  by  the straps and  bandage,   as  before  described,
with sufficient turns of the  bandage  around  the  ankle to  press
the foot in the direction of the foot-piece of  the splint. 
27
Improved Double-Inclined-Plane for the Leg.
   This is a modification of Amesbury's  Splint for fractures of the
leg, with Roe's improvement  in the method of making the splint
adjustable to different sized limbs, which consist in having several
splints of different sizes fitted  to the under side of the limb, which
can be connected  to the main splint, or removed as required, by
means of sliding joints or screws.   It is  here further improved by
an original form of hinge corresponding with the knee, in which the
centre° of motion  in the  splint, when flexed «;r  extended, corres- 
28
ponds with that of the knee, and the limb can be flexed or extended
with little or no change in the relative length  of the limb and the
splint.  The splint can also be made longer or shorter to corres-
pond with limbs of different lengths, or to make extension in dres-
sing, by turning the screw at the heel; this  does not  make any
projection of the splint beyond the foot.   The brace for fixing the
knee at the angle required, is regulated, as delineated in the plate,
by a screw parallel with  the thigh  piece, or  by  a vertical  screw
and slide, as in Amesbury's Splint.   The former has the advantage
of making flexion and extension by a more gradual  and uniform
motion, when only slight motion can be allowed in consequence of
inflammation or injury of the joint.

Apparatus for Hip-Joint Disease  and  Fracture of the Neck  of the
                            Femur.
  The apparatus for fractures of the femur,  before  described, is
peculiarly adapted to  fracture of  the neck of  the bone.   The ap-
paratus specially intended for the treatment of this injury is valu-
able, as it enables us earlier to allow changes from the horizontal
position and confinement to the  bed, to  sitting  in a chair and
exercise upon crutches—a matter  of great importance in  these
protracted cases in aged persons, to whom the  injury is principally
confined.   It consists of a splint fitted to the  outside of the body
and limb, extending from midway between the axilla  and  spine
of the ilium to the bottom of the foot, and has  joints corresponding
to the joints of the limb, which can be fixed by  means of the pinion-
like teeth of the hinges at any degree of flexion or extension requir-
ed, and has the usual means of maintaining  extension and counter-
extension.
  The apparatus for the hip-joint disease of children is precisely the
same  in form, differing only in  size, and is believed to be better
adapted to  maintaining perfect rest or allowing  passive motion of
the joint than any other in use.

                     The Clavicle Adjuster.
  This is a  modification  of  the  writer's  apparatus, described  in
the  Transactions of the American Medical Association, vol. viii.,
p. 441; and " Hamilton on Fractures," etc., p. 197.
  We have not space here for a further description, but give the 
29
following testimonials just now received from G. B. Hawley, M. D.,

and P. W. Ellsworth, M. D.


Dr. Welch,
  Sir: The success with which I have applied  your  clavicle splint, has been
gratifying to myself and a blessing to the patients; I most cheerfully recom-
mend it to the profession.
                             Yours truly,
                                                   G. B. Hawley.
  Hartford, Ct., Feb. 12,1861.
      Benjamin Welch,  M. D.
Dr. Welch,
  Dear Sir: I have used your apparatus for fracture of the clavicle but in a
single case; that, however, was an unusually bad  one.  The failure of all
other dressings to keep the parts in apposition, led me to try yours, as it ap-
peared to possess a combination of qualities which I desired.   The result was
most happy:  and I therefore  cheerfully recommend the apparatus both for
the perfection of its mechanical principles and the ease it  is worn by  the

Patient                                   P. W. Ellsworth, M. D.
  Hartford, Ct., Feb. 12, 1861.
                     BUSINESS  NOTE.

  The Apparatus  and  Splints here described, are manufactured
by Welch, Seymour & Co., Lakeville,  Litchfield county, Conn.;
and  the Splints being  secured  by Letters Patent of the United
States,  can be obtained only of them, or agents supplied by  them.
All orders accompanied by a remittance will be promptly attended

to, and on the most reasonable terms.

   Lakeville, Conn., Feb.  1858. 
t
30
EDITORIAL  NOTICES.
 Notice by J. V. C. Smith, M. D., Editor of the Boston Medical and Surgical
     Journal.
   Surgeon's Splints.—At Lakeville, Conn., is a manufactory of splints, made
 of alternate layers of wood and gutta percha, which recommend themselves at
 bight.   They are  extremely light, elastic,  and moulded to fit every limb, and
 can be also readily adjusted to persons of different forms, size, or height. Even
 a permanent extension of the lower  limbs  is admirably maintained.  Dr. B.
 Welch, the inventor, has fairly distanced all competitors, and furnished the
 surgeon with splints that meet all conditions of broken bones.   There is a
 finish to them, quite unusual in such apparatus;  and instead of being injured
 by use, there is no reason why a set of them should not last fifty years.   In
 hospital as well as  in private practice, it is presumed they will supersede all
 others now in  use.  By simply dipping one of them in warm water, it is
 instantly moulded to any shape required, and there it holds.   Those parts
 which are designed for bracing joints, are curious, as individual specimens of
 mechanism, to assist nature in keeping injured parts in place, while the heal-
 ing process is being accomplished.


                     Opinion of Doctor  E.  H. Dixon.

 ft,Wk have received from Dr. Welch a complete'set of this most scientific and
 satisfactory apparatus.
   If we have occasion to revere the surgical science of England,  France, and
 America, and to bow with reverence to their  great teachers, what shall we say
 of the genius of our own countrymen, in applying the great practical principles
 they develop to the_ casualties of mechanic and rural life ?   The first tells  us
 the great physiological principles which should guide us in attempting to save
 a limb, and the cautions to be observed ere we  pronounce  it  incurable;  the
 second gives  us almost a  living substitute  from  the  work-bench !   Scarcely
 have we been able to realize the wonder of  the Palmer Leg, when Dr.  Welch
 spreads before us, for every conceivable variety of fracture, the most beautiful
 and comprehensive apparatus that ever delighted  the  eye of the conservative
 surgeon, or the  practical mechanic.  The truth is, we lack  words to express
 our admiration of it.  Extremely  light,  wonderfully  simple and adaptable,
 capable of elongation and shortening to any required extent, for every limb in
 the body—knee-caps, and  elbow-joints, wrists, ribs, sternum, clavicles, and
 every other part, are  kept in any required position, and accessible in a moment
 by loosing a single strap, while the inexpressible  comfort of  a change of posi-
 tion, even to mounting on crutches,  is immediately attainable.   All is as beauti-
fully made, and as simple in its uses and  adaptation as  a gentleman's toilette
case.  A single box, one foot by two,, contains the  whole, and a beautiful  and
 highly creditable essay on fractures, and some complete drawings of the mode,
ot application, render the whole affair a most acceptable present, for which we
return Dr. Welch our hearty thanks and congratulations.   Many a limb will
 be saved by  it from the amputating  knife, when it is thoroughly known
throughout the country.                                       °  J
                               Edward H. Dixon, M. D.,
   W™7 r ;  ^t0^0f1thAr"Sc^te!'',' and °PeratinS and Consulting  Surgeon
   Scalpel, Iol. V., No. 1, Nov., 1852.]          42 Fifth Avenue, New-York. 
31
Opinion of  D. Meredith Reese, M. D., LL. D., Editor of the New-York
    Medical Gazette.

  Dr. Welch's Splints and Apparatus for Fractures, announced in another
column, are worthy of universal adoption, in lieu of any other before the pro-
fession.  Their ingenuity and surgical adaptation to the  purposes for which
they are intended, should give them preference and patronage.   They will be
found invaluable for  country physicians who often find it  difficult to adjust
and retain the fractured limbs of their patients, for want  of the conveniences
and appliances which  are only attainable in the  cities.   By providing  them-
selves with a  complete set, they will be prepared to treat fractures in  either
of the limbs with facility and success.  The whole apparatus ought to be pos-
sessed by every practitioner in city and country, since they are as indispensable
in practice  as are other Surgical  instruments, and should be in readiness for
emergencies.
  The Judges for the late Fair of  the American Institute awarded the medal
to Dr. Welch for his meritorious improvements.
  Dr. Welch, of  Lakeville, Conn.,  has been making important  improvements
in his apparatus for fractures, &c,  which, with his flexible  splints, cannot fail
to  take  precedence over  all the  cumbersome and complicated  instruments
heretofore in  use.


 Opinion of S. W. Butler, M. D., Editor of the New-Jersey Medical Reporter.
     Vol. vii., No. 7.   July, 1854.

   Welch's Splints.—We have recently procured a set  of these splints, the
 invention of  Benjamin Welch, M. D., of Lakeville, Conn.  We have, as yet,
 had  no practical experience with  them, but they possess  features which com-
 mend them to the attention of surgeons.  Their  peculiarity consists  in the
 combination of the firmness of woody fibre with the elasticity of gutta percha.

   " The splints consist of light'and elastic cases or coverings, formed of very
 thin strata or layers of wood, or " cut veneers/ cemented together by interlayers
 of gutta percha, of such thickness as is  required to maintain their form, and
 prelsed into the form of the part for which they are designed.   *   *
    " This may be introduced in any proportion required to give strength and
 durability and resistance to the  action of fluids, and when properly applied,
 it  adheres with more firmness  to  the wood than the fibres of the wood do  to
 themselves.  Another circumstance attending  this arrangement, of considera-
 ble practical importance, is that the splints are made more  flexible and elastic
 in the lateral or parallel direction of the fibres of the wood than in the longi-
 tudinal • hence, what may seem somewhat paradoxical, they readily accommo-
 date themselves to  changes in the dimensions of the limb, resulting Irom  in-
 crease or diminution of inflammation, or  from interstitial absorption, whue
 they give perfect support to the  injured or diseased  part.  M hen necessary
 to adapt them  to limbs of individuals differing in the form and size of# then-
 limbs, they are made sufficiently flexible by immersion  in hot water, or simply
 enveloping  the splint, or such portion of it as may be necessary in cloths wet
 with hot water for a few minutes, and then, on cooling, they will immediately
 become unyielding and elastic as before.  This peculiarity  can scarcely be  too
 highly appreciated, for  of all  the materials  heretofore  proposed capable of
 being moulded to the part, and hardening  after the sphntsare applied, none
 has  been found which has not proved decidedly defective in practice.  They
 possess great strength  and durability, so that the same  splint maybe used a
 fon  time, and for the treatment of many cases of fracture..  They, do not pre-
  clude the use of evaporating lotions, water-dressings or moisture,^in ^7 man-
 ner  applied, except when heated much  above the temperature of the bod}. 
32
  Thoy are applied with great facility, rendering the dressings simple and easy
  to both surgeon  and patient, and  allow constant access to the injured part, to
  detect  inflammation at its commencement, or any irregularity in the position of
  the bones; and  after the tendency to  inflammation has subsided, dressing or
  examination by the surgeon is required much less frequently than when ordinary
  splints  are used.  In short, they  have combined with  the property of being
  made sufficiently soft and yielding, to be moulded, with accuracy, to the sur-
  face of the part for which they are designed, all the properties of insolubility,
  lightness, elasticity, strength, and firmness,  necessary to  constitute a perfect
  splint."


  Opinion of James Bryan, M. D., Editor of the  Philadelphia Medical and Sur-
      gical Journal, Professor of Surgery in the  Philadelphia College  of Medicine,
      and in  Geneva College, N. Y., <£c.

  Surgeons'  Splints  and  Improved Apparatus  for  Fractures.   By  Benjamin
      Welch, M.  D.

    " The splints consist of light  and elastic cases or coverings, formed of very
  thin strata or layers of wood, or ' cut veneers,' cemented together by interlayers
  of gutta percha, of such thickness as is required to maintain their form, and
  pressed into the form of the part for which they are designed.  By  this method
  of constructing splints, the fibres of the wood all run longitudinally or parallel
  with the surface, which gives  them  great superiority  to splints carved  from
  solid blocks of wood, however skilfully performed and fitted  to the part; for
  when so thin  as  to be elastic, they are necessarily liable to split and break,
  and do not retain  their form when  wet."
    These splints are very neat, flexible, and appropriate.  Dr. W. has succeeded
 admirably in adapting his splints  to the fractures of  the  humerus near the
 shoulder; of the olecranon process;  of  the bones of the forearm, particularly
 those  of the distal  third of the radius, and those of the thigh.   The whole
 apparatus is light, neat, and  strong.  The style  of ratchet designed to change
 the angle of the  joints at  the elbow  and knee is very good.   The splints
 appear to combine all the qualities of the flat or straight ones, with all those
 of the curved ones.   (See Phil. Med. and Surg. Journal, Vol. I., No. 18.)


 Opinion of S. [II.  Potter, M. D.,  Professor of Surgery  in Syracuse Medical
     College, Editor of the Syracuse  Medical and  Surgical Journal.

   Welch's Flexible Gutta Percha Splint.—About one year ago I received
 through the agent  of Dr. Welch,  a full and complete  set of his  Surgeon's
 Splints,  and, after applications of the different kinds, suited to every species of
 fractures, I am happy to assure my friends that they have, in every instance
 proved perfectly satisfactory.                                             '
   These  splints are superior to others, from the fact that they are flexible, and
 readily moulded to every part of the  human body where splints are required
 Yet they are sufficiently substantial, so as to combine the character of a  wet
 Kl ttt  ' m^to m°uld ^the part, and at the same time be as substan-
 lal as the wooden splint.   Dr. Welch has really manifested  great ingenuity in
 the  invention, and lias made  himself  lastingly  useful  to his  professional
 brethren.  (See Syracuse Medical and Surgical Journal, Vol. vi, No 11)


     Opinion of II. G. Beardsley, M. D.  Notice in Hamilton Reflector.

n,DR',YELCIf-n  SuRGICAL  Splints for  Fractures.—I  have  iust  examined
 C^nectuf fleXlWe GUtta PerCha ***** °f Dr- Ben^in Wel"h> SalTbury' 
33
  They consist of a full set of splints for fractures of the arm and leg—are
adapted to all  ages and all conditions of fractures, and are the greatest im-
provement on splints of the age, and are so admirably constructed that they
can be softened in warm water, and moulded to any part of the arm or leg, so
as to fit exactly, and when they become dry are firm and unyielding,  keeping
the fractured end of bones in complete coaptation until union is effected.
  By proper  adjustment of these splints,  in  cases  of fractures, there is no
chance for bones to become displaced, causing deformities, as is often  the case
with other splints, and imperfect dressings.
  Dr. Welch has contributed much to the cause of scientific surgery;  and the
profession, on becoming acquainted with his apparatus, and its mode of appli-
cation, will doubtless appreciate its worth, by the use of it in their practice.
                                              H. D. Beardsley,  M. D.
  Hamilton, N. Y., July 20,1854.
FROM  THE  TRANSACTIONS  OF  THE  CONNECTICUT  MEDICAL
                               SOCIETY.

  John H. Welch, M. D., exhibited a Surgical Apparatus in the form of a
fracture splint, the invention of Benjamin Welch, M. D., for the examination
of the members of the Convention.
  Whereupon Abrara Talcott, M. D., S. T. Salisbury, M. D., and M. W. Wilson,
M. D.,  were appointed a Committee to examine said splint,  and report their
opinion of the same to the Convention.
  The Committee having made an examination of the  Fracture Apparatus,
made the following report to the Convention:

  The  Committee to whom were referred  the examination of Dr. B. Welch's
Fracture Apparatus, beg leave to report—
  That they have attended to  the duties of  their appointment.   That the
apparatus is, in their opinion, a very ingenious and useful one, well calculated
to answer the intention of its inventor, and eminently entitled to the confidence
of the  profession; and they recommend it to the favorable notice of the Medi-
cal Society.
                                           Abram Talcott, Chairman.
  Report unanimously accepted.
                               (Attest,)
                                           J. G.. Beckwith,
                                                 Sec'y Con. Med. Society,
                                    3 
34
MEDAL AWARDED BY THE ASSOCIATION FOR THE EXHIBITION
             OF THE INDUSTRY  OF ALL NATIONS.
                                  Crystal Palace, New-York, 1853.

  The Medal of the Association was awarded to Dr. Benjamin Welch, for im-
provements in Surgeon's Splints and Apparatus for Fractures.

                              Jui ors:
Prof. J. Renwick, Chairman.
Prof. Ai.onzo Clark, M. D., College of
  Phy<i'ians and Surgeons, N. Y.
Dr Caillardet,
Dr. Ellet,
A. B. Durand, Esq.,
Prof. T. L. Buckingham,
Geo. W. Blunt, Esq.,
Dr. Park man.
AY. Darling Campbell, Esq.,
Lieut. A. Noble, R. A.,
 Prof. J. N. Carnochan, M. D., New-
   York Medical College.
 II. R. KlMBERLEY, Esq.,
 Capt. Fox,
 Gen. T. S. Cum minus,
 Dr. E. G. Ludlow,
 Prof. Willard Parker, M. D., College
   of Physicians and Surgeons, N.  Y.
 Dr. J. Trenor,
| Dr. E. Parmi.ey,
I Dr. C. E. Allen.

T)r.  J. BRYANT  SMITH,

                 Acting Secretary. 
35
MEDAL OF THE AMERICAN INSTITUTE.
  The Judges for the Fair of the American Institute in New-York, A. D. 1852,
in their Report, noted the  Splints and Apparatus for Fractures as " highly
meritorious," and awarded to Dr. Welch, for this improvement, the Silver
Medal of the Institute.
                               Judges.

  D. Meredith Reese, M. D., LL. D., Late Physician to Bellevue Hospital.
  Willard Parker, M. D., Professor of Surgery in the College of Physicians
and Surgeons, and Surgeon of New-York Hospital.
  Prof. C. R Gilman, M. D., College of Physicians and Surgeons, N. Y.
   MEDAL OF THE METROPOLITAN MECHANICS' INSTITUTE

  The Metropolitan Mechanics' Institute of Washington, D. C, presented to
Dr. Welch  their Silver Medal, in testimony of the merits of his Splint and
Apparatus for Fractures.
MEDAL OF THE CONNECTICUT STATE AGRICULTURAL; SOCIETY.

  The  Connecticut State  Agricultural Society, at their late  Exhibition in
Hartford, awarded Dr. Welch their  Gold Medal, for his improved Surgeon's
Splints and Apparatus for Fractures. 
36
TESTIMONIALS  FROM SURGEONS.
From Jonathan Knight,  M. D., Charles Hooker, M. D.,  and P. A. Jew-
    ett. M. D., Professors in the Medical Institution of 1 ale College.

                                        New-Haven, Jan.  10th, 1855.

  I have been acquainted with the Splints for fractures, prepared by Doctor
Benjamin AYelch, for two or  three years past, and have frequently employed
them in fractures.  In the excellence of material of which they are composed,
in their ready adaptation to  limbs of various size and form, in  their various
contrivances to change the  position^pf the  limbs, while  they remain applied,
and in the means to keep up extension and counter-extension, when they are
required, they seem to me  to be more  complete than any others which  have
fallen under my observation.
                                                         J. Knight.

  I fully concur in the opinion above expressed by Doct. Knight.
                                                      Chas. Hooker.
   I cheerfully concur in the above.
                                                      P. A. Jewett.
                      From  G. B. Hawley, M. D.

                                         Hartford,  Feb. 12th, 1861.

  Dear Doct.:—I have used your Splints for the various fractures, with great
satisfaction.  The  success with which they  are applied, and the ease with
which any part of the injured  limb can be examined, without  disturbing the
other parts, highly recommend them to the profession.
                                Yours, truly,
                                                     G. B. Hawley.
  Benjamin Welch, M. D.
          From  Professor Valentine Mott, M. D., of New-York.

  I have examined  the apparatus invented by Doct. B. Welch, of Lakeville,
Connecticut.  In  it  is combined the splint of Amesbury and the seven princi-
ples of Boyer, for the lower extremity.
  The splints are composed  externally, of very delicate slips of wood, with
gutta-percha  between  them.  By this arrangement, when dipped  into hot
water, they become flexible, and will adapt themselves  neatly to the parts.
  He has adapted sets of them to the upper extremity  also.
  They are very  cheap, and well  adapted  to all the various fractures  of the
upper and lower  extremities.
                                                   Valentine Mott.
  New-York, Dec. 10, 1853. 
37
         From Professor Robley Dunglison, M. D., Philadelphia.

  Dear Sir:—The splints and apparatus, which you  have kindly submitted to
my inspection, appear to  me to  be admirably adapted to the purposes for
which they are designed.
  The material of which they are composed  renders their adaptation easy ;
and the whole arrangement of the apparatus  is such  as to  facilitate the treat-
ment of an important class of surgical ailments.
  I hope that the patronage of the profession  will reward your brother for the
time and ingenuity which he  has bestowed on their construction.
                              I am, dear sir,
                                    Yours truly,"
                                                   Robley Dunglison.
   To Doct James Welch,
                West Winsted, Ct.
            From Professor Ackley, Cleveland Medical College.

  I have examined Benj. Welch's improved Surgeon's Splints and apparatus
for fractures, and have no hesitancy in stating that I consider them superior to
any previously in use.                            .
  The whole apparatus  constitutes an extensive variety of splints, and enables
the surgeon to resort to all the various modes of dressing fractures, according
to the necessity of each individual case.
             J                              II. A. Ackley, M. D.,
                                      Prof. Surgery, Cleve. Med. College.
  Given at Cleveland,
         February 5, 1853.
        From Professor Geo.  C.  Blackman, M. D., Cincinnati, Ohio.

                             Burnet House, Cincinnati, Dec. 27th, 1855.

  I regard Welch's Splints with much favor, and employ them in the surgical
wards of the Commercial Hospital, and in private practice.
  Thev are of easy application, and, in my  opinion, fulfil the indications in
the treatment  of fractures better than any other with which I am acquainted.
                                     Geo. C Blackman,
                      Professor of Surgery in Medical College of Ohio, and
                                Surgeon of Commercial Hospital.
                 From Professor J.  N.  McDowell, M. D.
                                                   St. Louis, Missouri.

  I have examined Welch's apparatus for fractures and dislocations, and think
them valuable, and would advise the profession to obtain  and  use them.
                            With respect,
                                              N. McDowell,
                                    Professor of Surgery, New  University. 
3S
                      From Professor  C.  Pope, M."D.

                                           St. Louis, Feb. 26th, 1856.

  I take pleasure in recommending Welch's Gutta Percha Splints, as from my
experience in  the use of the substance, they will most completely fulfil their
intention.
                                                   Charles A. Pope.
                 From Professor J. E.  Hawley, M. D.

                                        Ithaca, N.  Y, May 30, 1857.

Mr. William E. Chapman :
  Sir:—Y'ou desire me to give you my opinion of AYclch's Splints.   It affords
me pleasure to say that I have been  in possession of a set of them for some
year^, and that circumstances have required me to use something of this kind
quite frequently, and that in  all the emergencies that  have demanded the  use
of such instruments, 1 have ever found them  available, and entirely adequate
to perform all that is claimed for them.
                                        J. E.  Hawley, M. D.,
                        Late Prof, of Surgery in Geneva Medical College.
  I have used Welch's Patent Gutta Percha Splints in my practice, and con-
sider them superior to any splint which is  not  flexible.   I  can  cheerfully
recommend them to all surgeons as being just the article they need.
                                              Geo. W. Saxton, M. D.
  Ithaca, May 30th,!1857.
From Dr. B. Bontecou,  M. D.

                      Troy, N. Y.,  Oct. 1, 1853.
  Dear Sir:—In  answer to your inquiry, " how I like the splints you left with
me," I cheerfully  reply that I am very much pleased with them.  They are so
much preferable to any I have before met with, that  I am using them to the
entire neglect of all my old ones.  Two  cases of compound dislocation of the
ankle with fracture, which I have recently treated  on  your skeleton splint for
the leg, have satisfied me of the great convenience and  beauty of the splint for
severe injuries of  that class.
                                               R.  B. Bontecou, M. D.
                                          Troy, N. Y., June 13, 1857.
  Dear Sir .-—I cheerfully consent to the use you  propose making of my re-
commendation given some years since, for I  could not speak too complimentarv
oi  your ingenious and useful apparatus.
                             Respectfully yours,
  x>     -iit      »,  ^   ,  ,   ,                    Reid B.  Bontecou.
  Benj. Welch, M. D., Lakeville, Conn. 
39
         From Professor J. C. Hughes, M. D., of Iowa University.

                                       Keokuk, Iowa, June 13th, 1856.

  To the Profession:—I have carefully examined  the Surgeons' Splints of Dr.
Welch, which are now being offered to the  profession  of this State by Mr. A.
N. Poyneer, and find them admirably calculated to fulfil the want of the sur-
geon.  Their easy applicability to the different cases gives them the preference
over any splints which  have been, and  are now  being offered to the^ profes-
sion.
                                  J. C. Hughes, M. D.,
                    Prof, of Surgery, Medical Department, Iowa University.
           From Professor L. Freeman, M. D., Cincinnati, Ohio.

  This is to certify that I have carefully examined Welch's Patent Gutta Per-
cha Splints, and find them better adapted to the purpose for which they were
designed than any splints that I have ever used.  Their flexible character, and
apparent  perfection is, indeed, a  desideratum which  surgeons  have long de-
sired.  I have purchased a full set as my opinion of them.
                                    L. Freeman, M. D.,
              Prof, of Surgery, Eclectic Medical Institute, Cincinnati, Ohio.
   Cincinnati, Dec. 29, 1855.



           From  Doctors R.  S. & 0.  E.  Newton, Cincinnati, Ohio.

                                             Cincinnati, Jan.  1st, 1856.

   Having purchased, for the use of our office and  Newton's Clinical Institute,
 a set of Doct. Welch's Surgeons' Splints and  Improved Apparatus for  frac-
 tures  we take pleasure in stating that, after a careful examination of them,
 we find they are the most  complete and best adapted to  the purposes for
 which they are designed, of any similar articles we have ever seen, and there-
 fore confidently recommend them to the  profession.
                                                R. S.  & 0. E.  Newton.
                From A. G. Walter, M. D., Pittsburg, Pa.

                                           Pittsburg, Sept. 29th, 1855.

  T have examined the splints and apparatus of Doc. B. Welch, and am free
tn ndmit thatTev are destined to fulfil desiderata for which they are mtended.
  It h       theTant in Surgery, of materials which will shape itself when
app^^the configuraUon &*-*■*   *fi^££ £J!£.
^teT^^            UFeor°lighPtness and pliability they are 
40
nity of trying the splints and apparatus, but feel confident that they will fulfil
my expectations.
                                         Albert G.  Walter, Surgeon.

  Since writing the above, I have applied Doct. AYelch's Splints  and appara-
tus, and cannot but admire their construction, &c.
                                              A. G.  Walter, Surgeon.
  October 1, 1855.
              From George Dock, M. D., Harrisburg, Penn.

  I have examined carefully Welch's apparatus for fractures, and consider it
decidedly the most unique and valuable apparatus for the treatment of frac-
tures that has come before me; while  it fulfils all the desired  objects in  the
dressing of a fracture, it possesses the quality of neatness and lightness, which
make it more agreeable to the patient and less cumbersome.
  I have purchased one of them, and can  cheerfully recommend the article to
the notice of the profession.
                                               George Dock, M. D.,
                                                    Harrisburg, Penn.
  August I, 1855.
            From J. II. Stewart, M. D., St. Paul, Minnesota.

  My Dear Doctor:—The splints arrived just in  time to be applied to a frac-
tured leg, and I never saw such  magical results; they exceeded my expecta-
tions greatly.
                             Truly yours, &c,
                                                      J. II. Stewart.
  St. Paul, Minnesota, July 29, 1857.
  This will certify that I have been using AYelch's Splint3 for the last eighteen
months in my practice, and that I am satisfied of their great utility and con-
venience to the surgeon and general practitioner; and would recommend them
to the favorable consideration of the profession.
                                                      J. J. Crawford.
  Williamsport, Lycoming county, Pa.,
            July 6th, 1857.
                                   Steubenville, 0., January 10, 1860.
  I have had in use in my practice " AYelch's Splints " for the past four years*
and believe them to be far superior  to any other splint that has come under
my observation.  They are not only easily adapted to fractures, but are dura-
ble intheir structure.
                                                 Wm. Stanton, M.  D. 
41
                                             Easton, Md., Feb. 9,1859.
  I have carefully examined  Doct. B. Welch's Fracture Apparatus, and have
no hesitation in recommending it as superior to any other within the range of
my knowledge and experience.   Its prompt and  admirable adaptability  to
every form of fracture renders it especially valuable to the  country surgeon.
I should certainly  regard my own surgical appliances  incomplete without
Welch's Splints.
                                      Chris. C. Cox, M.  D.,
                       Ex-President of the Medical and  Chirurgical Faculty
                           of Maryland, and Oliver Professor Institutes  of
                           Medicine and Medical  Jurisprudence in the Phil-
                           adelphia College of Medicine.
From Professors C. B. Gibson, M. D., and A. E. Petticolos, M. D., Virginia.
                                              Richmond, May 13, 1858.
  I have carefully examined Welch's Gutta Percha Splints, and believe they
will completely fulfil their intention.
  The splints for fracture of the  lower end of the radius, for fracture of  the
anatomical neck of the humerus, and for fracture of the condyles, I regard as
decided improvements.
                                                Charles  Bell Gibson.
                                                Richmond, May, 1858.

  I  have examined, with some care, Welch's  Fracture  Splints, and regard
them as well adapted to their purpose.   They are neat, light, and sufficiently
strong, and  so modelled as to meet most of the indications presented by frac-
ture of, the limbs.
  The existence of a layer of gutta percha between the laminae of wood, of
which they  are  composed, admits  of their being moulded to suit individual
peculiarities of form.
  The metallic joints appear better fitted to give alteration of position without
loss of extending power than those of any similar apparatus that I have seen.
                                               A. E. Peticolas, M. D.
                                           Augusta, Ga., April 4,1859.

  We have examined and purchased Welch's Fracture Apparatus, believing it
to be superior to any other which we have examined.
                                  Robt.  Campbell, Jr., M.  D.,
                  Demonstrator of Anatomy in the Medical College of Georgia.
                                 Henry F. Campbell, M. D.,
                        Professor of Anatomy Medical College, Georgia.
                                 R. C. Carroll, M. D.,
                          Resident Physician, Jackson-street Hospital. 
42
                                          Augusta, Ga., April 2, 1859.

  I have examined the " Surgeon's Splints" devised by Doct. Benj. Welch, and
find them remarkably  well  adapted to the purposes  for  which  they  are

 eSlgDe  '                           L. A. Dugas, M.  D.,
                         Professor of Surgery Medical Gollege of Georgia.
                From H. A. Mettauer. M. D., Macon, Ga.

Mr. A. N. Poyneer:
  Dear Sir: Having treated several cases of fracture with the set of " Welch's
Splints"' vou furnished me, I can say, without hesitation, that they are the best
instruments I have ever used.   They are more easily applied than any others,
less confining to the patients, fit the form of the limbs better.  Indeed, in every
respect, they, in my estimation, are  greatly superior^ to any other splints now
in use.
                       Yours, &c,                    H. A. Mettauer.
                                         Columbus, Ga., Jan. 27, 1859.

  I have used " AYelch's Gutta Percha Splints" for  several years past, with
great advantage  in the treatment of fractured bones.  They are durable and
convenient, and applicable to many cases of fracture where the ordinary home-
made splint is not adapted.
  Country surgeons especially will find them useful, who do not always have
the means of having suitable splints manufactured at short notice.
                                            James F. Bozeman, M. D.
                                         Columbus, Ga., Jan. 26, 1859.

  This is to certify that we have used AYelch's Gutta Percha Splints for the
past three years.  AYe have found them to answer a most excellent purpose in
all the cases in which they have been applied.  AYe think that no other splints
are better  adapted  for the general treatment of fractures, and  they are as
durable as  serviceable.
                                                    Schley  & Davis.
COMMUNICATED BY A. N, POYNEER, AGENT, TRAVELLING IN THE STATE OF MAINE


                                        Portland (Me.), Sept. 13,1860.
  I have examined and purchased the splints made by Dr. Benjamin Welch,
of Lakeville, Conn., and am very much interested  in the principles involved
in their construction, and am perfectly pleased with their material and mechan-
ical structure.  I think they will admit of more general application than any
hitherto invented.
                                                   Simon  Fitch, M. D. 
43
                                             Portland, Sept. 18,1860.
  Having  examined the Gutta Percha Splints of Dr. Benjamin Welch, I am
convinced  of their  excellence, and should prefer them to any other set I am
acquainted with.
                                                Israel T. Dana, M. D.
                                       U. S. Marine Hospital,     )
                                           Portland, Sept. 17, 1860. }
  This is  to  certify, that  I have carefully examined Dr. Welch's Surgical
splints, which are  now being offered  to the medical profession of this  state,
and I can cheerfully say, that they are in my opinion better adapted  for the
purpose for which  they are intended than any splints or mechanical appliance
that I have ever used.  Believing  this apparatus to be the best in all respects
of any that are now in use, I have  purchased a full set, and  recommend  them
to the profession generally in this state.
                                               S. H. Tewksbury, M. D.

  I fully and cheerfully concur in the opinion above expressed by Dr. Tewks-
bury.
  Augusta, Sept.  25, 1860.                            H.  H. Hill, M. D.
                                                 Bath, Sept. 19,1860.
A. N. Poyneer :
  Dear Sir: I  have  examined Welch's Apparatus for  treating fractures, and
consider it decidedly  the best that has come under my observation.
                                                  A. J. Fuller, M. D.
                                       Brunswick (Me.), Sept. 19, 1860.
  I have thoroughly examined Welch's  Gutta Percha Splints, and have been
so^ much pleased with them as to puchase a set, though most liberally supplied
with a variety from different manufactories.
                                              John D. Lincoln, M. D.
                                        Gardiner (Me.), Sept. 22, 1860.
Mr. A. N. Poyneer :
  Dear Sir: About four years ago I purchased  a set of Welch's Surgical
Splints, and have used them with entire satisfaction for fractures of the thigh,
leg, arm, and fore-arm.   Also for dislocation of wrist and ankle with fracture.
I now use them to the exclusion of all others.   I would cheerfully recommend
them to the profession, as  in  my opinion  superior to any other apparatus or
appliance now in. use for the same purpose.
                               Yours, very respectfully,
                                                  S. AYhitmore, M. D. 
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