IMPROVEMENTS IN APPARATUS FOR FACILITATING THE REDUCTION OF FRAC- TURES AND DISLOCATIONS OF BONES, AND FOR MAINTAINING THE PARTS IN THEIR JUST POSITION, communicated me by aer
Year: 1844

page_text: TO ALL TO WHOM THESE PRESENTS SHALL COME, I, EZRA
JENKS COATES, of Bread Street, Cheapside, in the City of London, Merchant,
send greeting.
WHEREAS Her present most Excellent Majesty Queen Victoria, by Her
Letters Patent under the Great Seal of Great Britain, bearing date at West-
minster, the Eighth day of February, in the seventh year of Her reign, did,
for Herself, Her heirs and successors, give and grant unto me, the said Ezra
Jenks Coates, Her especial licence, full power, sole privilege and authority,
that I, the said Ezra Jenks Coates, or such others as I, the said Ezra
Jenks Coates, my exors, aduňors, or assigns, should at any time agree
with, and no others, from time to time and at all times during the term
of years therein expressed, should and lawfully might make, use, exercise,
and vend, within England, Wales, and the Town of Berwick-upon-Tweed,
and in the Islands of Jersey, Guernsey, Alderney, Sark, and Man, and
in all Her Majesty's Colonies and Plantations abroad, the Invention
of "IMPROVEMENTS IN APPARATUS FOR FACILITATING THE REDUCTION OF FRAC-
TURES AND DISLOCATIONS OF BONES, AND FOR MAINTAINING THE PARTS IN THEIR
JUST POSITION, communicated to me by a certain foreigner residing abroad;"
in which said Letters Patent is contained a proviso, that I, the said Ezra
Jenks Coates, shall cause a particular description of the nature of the said
Invention, and in what manner the same is to be performed, to be enrolled
in Her said Majesty's High Court of Chancery within six calendar months
next and immediately after the date of the said in part recited Letters Patent,
as in and by the same, reference being thereunto had, will more fully and at
large appear.

page_text: NOW KNOW YE, that in compliance with the said proviso, I, the said
Ezra Jenks Coates, do hereby declare that the nature of the said Invention,
and the manner in which the same is to be performed, are fully described
and ascertained in and by the following statement thereof, reference being
had to the Drawings hereunto annexed, and to the figures and letters marked
thereon, that is to say, I denominate the said machine or apparatus "the
adjuster." The Drawings accompanying the following Specification are referred
to therein, and constitute a part thereof.
The first portion of the machine may be termed the case; its form is
exhibited at B in one of the Drawings. It may be constructed of any suitable
material, such as wood, brass, or iron; but brass is supposed to be the best. It
may be cast (if of brass), about one-eighth of an inch in thickness and twelve
inches in length, the edges being turned at right angles with the plate, and
prejecting therefrom about one-fourth of an inch, as seen at k, k, the case being
about one and one-fourth of an inch wide, except at one end, where a pinion
wheel, marked D in the Drawing, is to be fitted, the case at this end being.
formed a little wider, or so as to correspond with the said pinion wheel, as
represented in the Drawings. A cap E is to be secured to the case by screws
passing through screw holes (marked m, m, m, &c.) in the cap, and n, n, n, &c.
in the case.
The case should be about one-half an inch in thickness, and its
interior should be divided longitudinally by a partition h; thus, the edge k of
the case, the partition h, the bottom of the case, and the cap E form the four
sides of a passage or way for the reception and movements of the rack C, to be
hereinafter described. The opposite edge of the case, the partition h, bottom
of the case, and cap thereof constitute the four sides of another passage for the
reception of the screw f of the fork A, to be herein-after described, the said screw
f moving or working in a female screw cut in the end of the passage, or at g, the
said end being suitably formed for the purpose. At or near the opposite end of the
case a pinion wheel D is to be arranged as seen in the Drawing, and so that
its teeth shall engage with those of the rack C. A ratchet wheel (F) fixed
upon the shaft G of the pinion D is arranged on the exterior of the plate or
cap of the case, and has a catch or a dog H connected with it, the same catch
turning on a fulcrum or pin, and being pressed against the ratchet wheel by a
spring g, suitably arranged. The shaft G projects a short distance beyond the
face of the ratchet wheel, and is formed square, or in any other proper shape,
to receive upon it or to enter within the head or end of a key lever I. The
said lever may be about six inches in length, its end having a suitable mortice
or orifice formed in it, so that it may be applied to the projecting end of the
pinion shaft, and removed therefrom at pleasure.

page_text: The second portion of the apparatus may be denominated the fork. It is
represented at A in the Drawing. It may be made of any form, and suitable
metal, but steel is supposed to be the best. Its arms (marked a, a,) consist of
a thin plate of such metal, about three-fourths of an inch wide, and long enough
to extend a little more than half around the upper part from the inside of the
thigh; and at the same time each arm, the one forward and the other backward,
rises by a gradual curve, until the ends of the arms reach an imaginary transvere
line crossing the os ilium. The curve and form of the arms are particularly
represented in the Drawings. The said arms should stand at such a distance
from each other as to readily and easily incompass the part to which they may
be applied, and their ends should each terminate in a rectangular notch, as
seen at c, c. A small and flat button 6 should be attached to the outer side of
each arm and near the extremity thereof. A screw f should project from the
point of union of the two arms, and should extend in nearly an opposite direc-
tion to that of the arms. The length of this screw may be about two inches;
its object is to diminish or extend the length of the instrument, and to allow a
free rotary motion to the case, or what in other words may be termed a trans-
verse movement of the said case upon the screw, in order to readily adapt the
apparatus to the dislocated limb. From the extremity of the screw shank,
where it is attached to the arms, a small pin d projects about one-fourth of an
inch, the curve-K, to be herein-after described, being placed upon this pin by
inserting the pin in a corresponding hole e, formed through the covered piece of
metal K.
The third member of the apparatus, which I have herein-above denominated
as the cure, consists of a piece of metal bent into a parabolic form, or nearly so,
and having its ends about one inch in breadth, and terminating in rectangular
notches, as seen at c, c. Each end has a small button b attached to its exterior
surface, as seen in the Drawing. A hole e is formed through the central part
of the curve K to admit the pin d, which projects from the top of the screw of
the fork A.
The fourth member of the apparatus is the rack bar, which is represented
in the Drawing at C. It may be constructed about one-half an inch in width,
and one-fourth of an inch in thickness; in length it should be about thirteen
inches between its extremity of i and the land or angle of the foot of the
point o; teeth to match with those of the pinion D are to be formed on its
edge. From the angle or bend at o (which should be a right angle or there-
abouts) to the end p a distance of about four and one half inches should inter-
vene, the bent end or part of the rack extending in the direction denominated
by the Drawing. This bent end may be termed the foot of the rack.

page_text: The fifth part of the apparatus I denominate the transvecture. It consists
That
of three separate parts, as seen at P, Q, and R, in the Drawings.
represented at P is a lever, about fourteen inches in length, and of a curved
form; it has a pin (u) attached to one end of it by a hinge joint (v), the said
pin being about one and one-half in length, and terminating in a screw, upon
which is to be screwed the femoral plate R, a screw hole w being formed
through the centre of the said plate. This plate is about six inches in length,
one and one-half inches in width, and of the proper thickness and curve to fit
the inside of the thigh. At about two and one-half inches from the hinge
joint on the lever P the fulcrum Q is to be attached by a joint which will per-
mit of the requisite movement of the lever in a direction from or towards the
case B. The said falcrum should be so fitted to the case B that it may be
slipped upon or off the same at pleasure, and when on that it may hold the
transvecture firmly to the case. The tranvecture is intended to produce
lateral or transverse motion, at the option of the operator, who produces the
same by the application of his own hand or that of an assistant to the leaver P.
The sixth part of the apparatus I denominate the tibia fork, the same being
represented at T in the Drawing. It may be of the same material as the fork;
it should have a short screw (one and one-half inches long, or thereabouts),
fastened to it at right angles with the arms or steel plate constituting the fork,
the same being as represented in the Drawing. In its form this plate is simi-
circular, its width being about one-half an inch, and its length that of the
semicircumfrance of a circle six inches diameter. The screw should be cut
with the same size of thread and of the same diameter as the screw f, before
described. The tibia fork is intended to be used (instead of the fork) in all
fractures and dislocations occuring below the knee joint, and when used its
constitutes the point of counter-extension of the instrument.
The seventh part of the apparatus, which I call the brachi fork, is seen in
Plate 2 at U. It should consist of a screw (about one and one-half inches in
length, and having the same diameter and thread as the screw f before de-
scribed has), terminating, as seen in the Drawing, in a shank or stem about
about three and one-half inches in length, whose extremety, or where it is
united to the screw, is bent, or stands divergent from the axis of the screw, as
represented in the Figure. From the other end of the stem, and at a right
angle with it, a curved bar of metal should extend in the form of a semicircle
of about four inches in diameter. The bachi fork is intended to be used
instead of the tabia fork in most cases of fracture or dislocation occurring
below the condyles of the os humerii. For such purposes it is to be connec-
tion with the case B by inserting its screw in the end thereof, or in the screw

page_text: hole of the screw f, and where thus employed it constitutes the counter-extend-
ing point of the instrument. When in use the case B lies on the front of the
fore arm, the curve of the bachi fork passing around the back of the arm, and
close to the condyles at the elbow joint.
The eighth part of the apparatus may be denominated the straps or rolls, of
which there should two, viz., one for the fork A and the other for the curve K.
They may consist of leather, cloth, or any other suitable strong and pliable mate-
rial, covered with some soft fabric, such as velvet or Canton flannel. They should
be made hollow, and stuffed with some elastic substance (curled hair being sup-
posed to be the best), leaving the ends of the roll L free thereof for some dis-
tance for a number of small button holes to be made therein, for the purpose
of fastening or buttoning the same over the buttons b, b, before mentioned,
each end of the roll M having a button hole formed in it. The roll L is to be
applied to the fork A at the ends of the arms a, a, thereof, and should be long
enough to hang between them, as seen in Plate 2; the roll M is applied to
the curve K in a similar manner or as seen in the Drawing thereof in Plate 2.
The afore-mentioned rolls, when both are used, form the counter-extending
point of the instrument when the parts to which they separately belong are
also used.
The ninth part of the apparatus I term the belts, of which there should
be two, as denoted at N and O in the Drawing. The one at N should
be fitted to firmly clasp the thigh close to and above the condyles of the os
femoris, or the arm close to, and the os humeri. The other belt, videlicet O,
should be made on the same principle, and to fit the ancle above and close to
the malleolus processes, or the fore arm of the wrist. The loops, which are
shewn at 2, %, &c. may be of iron, cloth, or any strong and suitable material, and
fastened firmly to the belts in the positions as seen in the Drawings. The said
loops are to be connected to the foot p of the rack C by strong cords passing
through the loops and over the foot p and made fast thereto.
The tenth part of the apparatus is simply a strap of leather or cloth, having
a loop at one end to slip into the arm of the fork, and a buckle attached at or
near the middle of it; a series of holes is punctured through the other end or
part of the strap for the tongue of the buckle to pass through in the ordinary
manner. When this strap is in use, it passes over the dorsum ilii, and confines
the arms of the fork outward. It is represented at S in the Drawing. The
following is the mode of using the above-described apparatus. It is believed
that a description of the manner of employing it in two dislocations (videlicet,
one of the hip joint and the other of the elbow joint,) and in two fractures
(videlicet, one of the thigh bone, and the other of the leg bones,) will be.

page_text: sufficient explanation for all who are acquainted with the science or practice of
surgery.
First, for a dislocation of the thigh bone upward and outward the head of
the bone, and the trochanter resting on the dorsum of the ilium.-Let the
several parts of the apparatus be combined together as represented in Plate 2.
This being accomplished, next let the belt N be buckled around so as to clasp
the thigh firmly above and close to the condyles of the thigh bone, the loops of
the belt standing towards the knee joint, one being on either side of the limb
and strong cords being passed through them. Now let the roll L be applied
closely in the angle between the perinæum and inside of the thigh, the arms of
the fork, the one forward and the other backward, reaching nearly as high as
the top of the os ilium; fasten the strap S to the arms crossing the dorsum
of the os ilium so as to confine the arms outward; fasten the loops by the
cords already passed through them to the foot of the rack. Now let a com-
mon handkerchief, or anything convenient for that end, be passed around the
limb and instrument close to the knee, and then tied, in order to confine the
instrument to the limb; let the leg be bent at right angles with the thigh, and
the thigh placed in a line with the body; next cause an assistant to take
hold with one of his hands of the limb to be operated upon, at the foot thereof,
and with the other hand at the knee thereof, another assistant having hold of
the lever of the transvecture; let the operator now apply one of his hands to
the lever I and elongate the limb (by moving the said lever) until with the
other hand he feels the round head of the femor descend to a transverse line
with the acetabulum; now let the assistants (the one having hold of the
lever P and the other of the limb) operate simultaneously, the one by means
of the lever P casting the limb outward from the body, and the other by
throwing the foot inward and the knee outward, so as to rotate the thigh on
its own axis. The operator now finds the head of the bone directly over the
acetabulum, into which he restores it (if need be) by gently pressing with the
hand on the trochanter major, while extension in the limb is gradually relaxed.
Second, to reduce and treat in the bent position an oblique fracture of the
thigh bone (os femoris).-Let the transvecture be removed from the case and
place the curve K on the pin d; apply and fasten the instrument as before
described, except that the handkerchief may be dispensed with. Now place
the limb (having the instrument affixed to it) upon a double inclined plane,
provided with the necessary bandages; let the operator extend the limb (by
turning down the lever I, as before described,) until a just co-aptation of the
ends of the bones may be readily effected by him; apply the proper splints,
ban lages, &c., agreeably to approved methods in surgery), and keep up such

page_text: an extension of the limb as will preserve its due length, and relieve it from
any attending spasmodic contractions; lastly, remove the instrument when no
longer necessary for either purpose.
Third, to apply the apparatus when the straight position of the limb is to be
preserved, it is only necessary to elongate the instrument by running out the
screw of the fork and the rack sufficiently to adapt the length of the apparatus
to that of the limb. The bent end of the rack or point of extension should
be made fast by cords to the belt buckled around the ancle, the said end
extending beneath the foot, the counter-extending point or other end of the
apparatus being applied, as before mentioned and described, in the angle
between the perinæum and thigh. Two long splints (one long enough to
reach from the perinæum to the sole of the foot, the other from the top of the
os ilium to the sole of the foot, and each about two and one-half inches wide,
and about one-third of an inch thick), are to be folded in a cloth of cotton or
flannel, so as to form a casement or box for the limb to be laid in. The
"adjuster" is to be applied and made fast after the limb is laid in the above
encasing or box. Now let the operator extend the limb as before to effect
co-aptation; let the adjuster and splints be now tied firmly together, by passing
two tapes (one above and the other below the knee) around the limb, and
tyeing them strongly thereto.
Fourth, to reduce and treat an oblique fracture of the leg wherein strong
muscular contractions are to be overcome.-In order to avoid danger to the
patient or deformity of the limb, apply and fasten the belt N immediately
below the knee and around the leg, also the belt O to the ancle, as before;
remove the fork A from the case and insert the tibia fork in its place; slip the
arms of the tibia fork through the loops of the belt N, and fasten by strong
cords the loops of the belt O to the foot of the rack below the sole of the foot.
The limb should now be placed on the double inclined plane, as before de-
scribed, the proper bandages being previously laid on the plane. This being
accomplished, the operator is to lengthen the limb to its due extent by turning
the lever I, so as to throw or extend the rack from its case.
Let the surgeon
adjust the fractured bones, and dress with splints, bandages, &c. in the most
approved manner, at the same time maintaining such extension of the limb
(by the adjuster) as will be necessary to relieve undue muscular contraction,
and preserve the proper length of the limb.
Fifth, to reduce a dislocation of the elbow joint, where the coronoid process
of the ulna lies in the posterior fossa of the humerus.-For the reception of the
olecranon process of the ulna, remove the tibia fork from its case, and insert
the brachi fork in its stead, and run the rack so far within the case that the

page_text: instrument at least shall be as long as the fore arm and hand combined; buckle
the belt N around the arm and close to the condyles of the humerus, the loops
thereof being on the back of the arm, and close to and immediately above the
olecranon process of the ulna; also buckle the belt O around the wrist, so that
the loops of it (having strong cords passed through them) shall lie the one on
the front and the other on the back of the wrist. Now let the curve of the
brachi fork be passed through the loops (of the belt N) on the back of the
The case now lying on the front of the fore arm, let the foot of the rack
be closely fastened to the wrist by means of the cords of the loops of the
belt O; now let the operator by a gradual and steady motion so far throw the
rack out that the coronoid process of the ulna may ride over and lie in front of
the pulley-like surface of the humerus, as he performs the necessary fluxion of
the fore arm, in order to bring the process into its place.
arm.
The Invention herein-above described is believed to differ from all others
(heretofore known and used) in several important particulars, to wit:-In
the use of the lever, pinion, and rack, to produce extension and counter-
extension, and the use of the transvecture to produce lateral or transverse
motion in reducing dislocations and fractures of bones; also, in the use of
a ratchet wheel and dog or catch to maintain such extension and counter-
extension; also, in such an arrangement or combination of the screw and rack
in one case that the apparatus may be readily adjusted to any length or position
of limb, and adapted to reduce any form of fracture or dislocation of any of the
(so called) long bones, and many others, indeed all where the principle of
extension and counter-extension apply to their reductions.
Having thus explained the Invention, I declare that I claim the combina-
tion of the rack bar and screw, or other contrivances of similar character, in
and with one case, the whole being arranged and operating in connection with
the forks, rolls, belts, &c. applied thereto and used therewith, substantially
in the manner and for the objects as herein-before set forth; also, the com-
bination with the case or apparatus of similar character of the transvecture, or
any instrument of like description, for the purpose of producing lateral or
transverse motion, in the manner as herein-before specified, the said trans-
vecture being constructed and applied substantially as represented in the
Drawings, and as herein-before explained.
In witness whereof, I, the said Ezra Jenks Coates, have hereunto set my
hand and seal, this Sixth day of August, in the year of our Lord One
thousand eight hundred and forty-four.
E. J. (L.s.) COATES.

page_text: AND BE IT REMEMBERED, that on the Sixth day of August, in the
year of our Lord 1844, the aforesaid Ezra Jenks Coates, Esq, came before
our said Lady the Queen in Her Chancery, and acknowledged the Specification
aforesaid, and all and every thing therein contained and specified, in form
above written. And also the Specification aforesaid was stamped according
to the tenor of the Statute made for that purpose.
Enrolled the Eighth day of August, in the year of our Lord One
thousand eight hundred and forty-four.
Enrolled the Eighth day of August, in the year of our Lord One
thousand eight hundred and forty-four.