US1641A

US1641A - Improvement in surgeon s trusses

Info

Publication number: US1641A
Authority: US
Publication date: 1840-06-17
Anticipated expiration: 1857-06-17

Description

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' UNITED STATES PATENT OFFICE.

W. B. DODSON, OF LOUISVILLE, KENTUCKY.

IMPROVEMENT IN SURGE-ONS TRUSSES..i

Specification forming part of Letters Patent No. 1,641, dated J une 17, 1840.

To all whom it may concern,.- y

Be it known that, I, W. B. DODSON, of the city of Louisville and State of Kentucky, VVhave invented, constructed, made, improved, and applied to their intended purpose new and useful instruments, Improvements von the Truss with Appendages, and have discovered the method of applying the same in the cure of several species of hernia, to which mankind is liable.

The following` is a full and correct description of the said instruments, with the manner of applying the same as invented and improved by me.

The inguinal or scrotal block, as shown by Figure 4 in the accompanying Drawing No. 4, may be said to be semi-oviform, with the convex surface or portion pressed a little to one side of a central longitudinal line, the mostprominent part being nearer the anterior end of the block than the center. On the upper and thin edge of the block is a rim or flange, Fig. l, about three-eighths of an inch in Width, more or less, as the case may require,

(sometimes chamfered a little on its outer' edge,) extending about half the circumference of the block, increasing to considerable extent its surface, thereby giving greater ease and comfort to the patient than any other form. It enableshim to usea spring of asufficiently retentive power, when the ring is large and the parts lax, to prevent that protrusion of the hernia which would be liable to take place with the use of a spring wanting in strength with a block of the ordinary shape. The rim is also designed to prevent the block from pressing or sinking so deeply into the ring as to be productive of pain and inconvenience to the patient, which must necessarily followV when the ordinary block is used with a spring sufficiently strong to prevent the above-named protrusion. The re entro -inguinal block, Drawing No. l, is in shape very much like the body of the former, alittle more elongated and prominent at its anterior portion, with a depression or excavation on the inner surface and .lower edge of the block, Fig. 4, to admit the spermat-ic vessels without inconvenience when on the iliac side of the ring or outer side of the hernia.

The femoral block, as shown in Fig. 3, Drawing No. 2, is somewhat of an elongated semiovoid shape, with the pubic or upper end a .of the spring.

little thicker or more prominent than the lower end, with a continuous rim or ange a little wider on the outer side, upper and lower ends, than it is on the inner side, forming a part of the outer surface or face of the block. The object of the rim or iiange is, first, to increase the inner surface of the block, it being necessary that the entire bulk should be small, owing to the anatomy of the part to which it is applied; second, by preventing the inner or prominent part of the block from sinking too deep, which would be liable to injure the femoral vessels when the force of a very strong spring is required to prevent a protrusion of the hernia; third, more equable pressure is maintained, and it is less liable to produce excoriation than any other form of block with which I am acquainted; fourth, the block is retained in its situation or position with less difficulty-than other forms.

The specific dimensions or admeasurements of the block cannot be given, as the indications vary and require to be met by the skill` of the surgeon. They are, for insta-nce, the presence or absence of adipose substance about the pubic region, the size of the ring, the irritability of the patient, the force with which the hernia protrudes, &c.

In Drawing No. 3 the neck and head of the spring, figure or letter d l), consist of a single `piece of softiron about three inches long. The posterior end, which is attachedto the anterior end of a steel spring, is flattened to the Width Immediately from the end of the latter it is contracted into nearly a round body or wire shape about five-eighths or three-fourths of an inch in length and about two ylines thick, slightly curved downward and inward. From the neck it expands abruptly to about five-eighths of an inch in width, one inch and three-eighths in length,

and oneand a half lines in thickness, which must be equable. The edge is beveled, which makes the inner or posterior surface wider and longer than the anterior or outer surface, the

two anterior corners being cut off at an anglev of about one hundred and thirty-five degrees, as shown in the drawing Fig. 4. -Longitudinally through thecenter of theabove-described head is a fenestra window openingor narrow space seven-eighths of an inch, more or less, in length, and two lines wide, through the 2 f i y 1,641

center of which ascrew with a knob-head (h ereinafter to be described) passes and fastens into a brass plate, also to bedescribed. The use of the above-named opening or narrow space is to admit of lengthening or shortening the instrument by sliding the block forward and downward or backward andV upward.

By this arrangement and disposition of the vscrews diagonally-one in the anterior and upper hole, the other in the posterior and lowerhole--theplatecanbemovedthesmallest distance desired and firmly fixed as before, hereas, with two screw-holes only, and they in a central line of the plate, thisresultcould not be obtained. Moreover,in the latter case where they both strike the v same grain or growth of the wood splitting of the block is a com rnon result. v

The knob-headed screw before namedas shown ih Drawing` No. 8, gure or letter C, consists of a head, neck, shoulder, and screw. The head is about one-fourth of an inch broad, with a slit the same as a common screw and for the same purpose.` The shoulder is a little smaller than the head. The screw part is about one-fourth of an inch in length and as thick as the' open space in the head of the spring is wide, so as to admit of no lateral motion; The knob-headed screw answers a double or triple purpose: first, to secure the head ofthe spring firmly to the brass plate; secondly, as a fastening for the anterior end of the perineal strap, being at the most favorable point for that purpose 5 thirdly, by loosening the screw the block may be turned upon it asa center and secured in the most favorable position without removing it from the patient. Further, the extent of mobility in elongating or shortening the instrument, which is very desirable, is considerably increased by means of a single screw.

Drawing No. 16 is an inguinal block adapted particularly to recent cases of inguinal hernia, where the internal and external rings have not approximated each other. The abovenamed block on4 its lupper and inner surface is of an elongated semi-oviform shape, term-inating at its lower and inner edge abruptly and nearly of an equal thickness about an inch and three-fourths of its length, as shown in drawing Fig. `5, asufficient space to admit of equal compression on the external ring, inguinal canal, or space between the'two rings and internal ring. In a natural condition of the parts the space between the rings is about an inch and a half in length.

The second form of block for ventral, or direct hernia, asit is called, (shown in Drawing No. 15,) resembles the inguinal block last described, with this` difference: On the inferior or outer edge is ar rim or iiange, Fig. 4, about three-eighths of an inch wide extending a little more than one-third of its circumference, forming o n that side a sulcus or long and nearly triangular space. In consequence of the rim it has not so much the appearance of being compressed to one side from 'the center Vas the formenbut throws the most elevated part of the block longitudinally,

nearly equidistant between the two extreme edges. It also differs from the former in not maintaining an equal thickness to the same extent. It gradually diminishes from its anterior greatest prominence tothe posteriorend, it not being necessary in acase indicating the use of this block to make compression on the internal ring. In this species of ventral hernia, inakingitsexitfrom behind and over Pouparts ligament, as if it had made anattempt to escape through the femoral ring, much difficulty 'will be experienced in preventing a protrusion with the other forms of block, which are liable to ride down over the ligament if the perineal strap is drawn tight,pro

ducing eXcoriation and soreness. Onthe other hand, if the perineal `strap remains loose in particular attitudes of the body, the instrument will be 'carried upward, and the hernia will escape from underneath the block. In the above description of block the. difficult-ies just named are eectually obviated by the addition of the rim or flange, which, when applied, rests on and overlaps Ithe superior and anterior edge of the Pouparts ligament, the latter resting in the sulcus or triangular space formed by the rim and body of the block. In this situation it is secured by the perineal strap so firmly as to eiectually prevent any protrusion.

Drawing No. let, Fig. 3, is a neck and head, differing not Very materially from the one before described, except that the neck is bent inward, f/orming an obtuse angle, Fig. 3, by which the head of the spring is set a little more than its own thickness within a line parallelto the inside of the spring-cover. The particularadvantages derived from the bend or angle in the neck, as above described, are that the instrument is rendered less complicated by dispensing with the brass plate to advantage, much less force being required to secure ihc head of the springl to a plane of wood or other yielding substance than to one ying withina parallel line of the-inside of the spring-cover.

The knob-headed screw, Fig. 2, is precisely like the one before described,except the screw v part, which is longer than the former, resemvarious elastic fabrics in thel following man-I ner, viz: The wood corresponds t'o thegeneral contour of the block orpad, excep vbeing iiaton the posterior su.rface`.y j1Ita'l stit'utes vabout one-half ofaitswholebnik,for anterior face or planeof the block.y fThepos-f terior surface of the block to the edge 'ofthef plane is covered with hrm twilledcottorrfabl' ric, made fast to the block with glue, upon which are placed several layers of very tine thick elastic woolen fabric, each successive'f' layer being cut smaller than the one next preceding it, by which the conyexity or promi` hence of the block is formed, the whole ofl which is covered with a piece ofthe fsame, terminating with the edge of the first partial covering above described. With the aid of compression the elasticity of that portion of the block or pad is regulated to meet the indication. Over this is firmly drawn a second covering of twilled cotton a little larger than the formenand secured by a draw-string or otherwise. The outer and last covering is of silk, enveloping the whole, except a small elongated space on the anterior face or plane of the block. The above is applicable to the various sizes and forms of blocks or pads.

The semi-elastic block is peculiarly adapted to various abnormal conditions of the inguinal region. For instance, if from previous ulceration, which is not uncommon in that part, a cicatrice of largeorsmall size remains, the semi-elastic block will meet the various indications more successfully than any other form, and particularly if the hernia protrudes with so much force as to require the application of a very strong spring. The integument, having lost its natural elasticity and pliancy, is sure to ulcerate under the pressure of a non-elastic substance, which is entirely' obviated by the use of the semi-elastic block. Ventral or direct hernia, passing out Very close to the pubic bone and protruding with great force, is more effectually and securely retained with this than the hard block, in consequence of the unyielding parts-viz., the pubic bone and Pouparts ligam ent-being accommodated by the yielding or pliant surface of the semi-elastic block; also, when the patient is of a nervous temperament, easily excited and excoriated, greatinconvenience will result to him from the application of an unyielding substance, while the semi-elastic block will be worn with comfort, if Well constructed, answering the indications in the a paaien treatment for retention or radical cure of hernia.

The umbilical truss shown in Drawing No. l2 is constructed with a steel spring similar tov other umbilical springs. anterior end of the spring is a double neck and head, Fig. 1, about two and one-fourth inches in length, including the lap on 'the spring, one of which is fixed stationary to the inside of the spring by a rivet and knobheaded screw, Fig. 2, the rivet being anterior to the screw on which the other neck turns on the outer side of the spring. The object of the knob-screw being placed in the usual situation of the rivet will be readily seen, it being to diminish mobility at the situation of the curyed screw, Fig. 3, and to bring theseparation of theinner edges of the two blocks nearer upon E lpneck and headis of a own,l in the drawings, achenecl about threeeighths of an inch fronnthe anterior end of the spring, through which .a1 curvedscrew passes, Fig. 4, and beingrivetednnito the peculiar shap stationary neck. The mobility of thef otherA governed by a thumb burr or nut on eof the neck, Fig. 5. From theabovey"projections the heads diverge in and are iiattened, with a screwhole about "he center of each head, Fig. 6, through whicliscrews pass, fixing the blocks to the heads of the spring. Each block, Fig. 7, presents the form of a crescent on its outer plane surface and is convex on its inner surface, with a slight depression or excavation on the inner edge of the most prominent part. The two surfaces designed to grasp the neck of the sack, and which are made to approximate each other, or vice versa, by means of the curvedv screw, are slightly concave and have their edges rounded olf, adapted to the contour of the part to which they are to be applied. The periphery or semi-lunar edge terminate in a narrow rim or flange, Fig. 8. The spring-cover does not differ materially from others in use, except that it has aty the posterior end, asit is called, instead-of a strap of leather with button-holes, a small buckle attached, Fig. 9.` On the plane of each block, between it and each head of the spring, is secured the end of a small narrow strap, Fig. 10, about four inches in length, and fastening' intothe buckle on the end of the spring-cover before described, Fig. 11, secures the instreument in its place.

The above-described instrument is the size required for a child about three years of age. The spring guard or check, Drawing No. 13, is made of iron or other suitable metal, consisting of two square bars, Fig. 10, running parallel to within about two inches of the anterior end, where they are bent downward as an btuse angle, Fig. 11, slightly converge, and are joined together by a cross-bar about an inchin length with a small screw-hole in the center, Fig. 12, the posterior ends being joined in the same way at a distance of about Attached to the one anda half inch. It is semicircular, corresponding to the shape of the spring to which it is applied, (see Drawings No. 18 and 19,) with the anterior-end resting on the plane of the block, each side bar passing backward above and below the edges of the spring to about the center of the back, where the crossbar or posterior end rests on the outer 'side of the spring, and is secured in its place by a short strap attached to the outside of the spring-cover, passing under the cross-bar,

turns back upon itself, and is made fast by means of a small'buckle.

The object of the above-described instrument is to coniine the action of the spring to certain limits to prevent its being forced out by any sudden propulsion of the abdominal Viscera, which may give exit to the hernia. By fixing the anterior end to the plane of the block with a screw passed through the screwhole before described, undue pressure from the use of a very strong spring while in a recumbent position may also-be obvated.

What I claim isy 1. Constructing the ventre-inguinal block `(Nos. l and 4 of the accompanying drawings) with a depression on the inner and lower edge and surface of it, so as to admit of the descent of the spel-matic vessels without press'- ure when on ythe iliac side of the ring.

2. Constructing the block for ventral or direct hernia (No. 15 in'drawings) with a sulcus or depression on its lower and inner edge, so formed that it will rest on Pouparts ligament and prevent the block from sinking too deeply and its being drawn downward by the perineal strap, asset forth.

l3. The combinationof the check or guard (No 13 in drawings) with the truss-spring, as set forth.

4. The manner in which I have constructed the block for umbilical hernia (see Drawing No. 12) byforming it in two pieces and connecting each of the pieces with the spring of the truss by a curved piece of iron, and a regulating-screw passingthrou gh those pieces for theipurposey of separating or approximating the parts of the divided block so as to produce a greater -or lessdegree of pressure on the hernial sack or tumor, all as herein set forth. 5. The method of treating umbilical hernia by means of a truss, (see Drawing No. 12,) constructed and operating, substantially in the manner herein Vset forth.

. y YW. B. DODSON. Witnesses:

HENRY STONE,

W. P. N. FITZGERALD.