IMPROVEMENTS IN HERNIAL AND OTHER ORTHOPEDIC APPARATUS, AND IN PESSARIES AND OTHER INSTRUMENTS
Year: 1862

page_text: PROVISIONAL SPECIFICATION left by William Clark, at the Office of
the Commissioners of Patents, with his Petition, on the 24th June
1862. A communication from abroad. by Pierre Ferdinand Lelanquais,
of 29, Boulevart St. Martin, Paris, Surgical Bandage Maker.
I, WILLIAM CLARK, of 53, Chancery Lane, in the County of Middlesex,
Engineer and Patent Agent, do hereby declare the nature of the said
Invention for "IMPROVEMENTS IN HERNIAL AND OTHER ORTHOPEDIC APPARATUS,
AND IN PESSARIES AND OTHER INSTRUMENTS," to be as follows:-
All the different systems of trusses in use to the present day have been in
some way or other objectionable. In some cases the parts project too much,
owing to the various mechanical devices made use of in their construction,
which proves
sincommodious to the wearer when sitting down; they are, besides,
either too apparent outwardly, or liable to jerk, and to a cessation of pressure,
whereby the wearer is either too much or too little compressed,, causing in the
first case great pain, whilst in the second case the hernia would break out
afresh.
Further many improvements have been obtained separately in certain appa-
ratus, but the difficulty of combining the mechanical movements necessary for
a perfect application, viz., thirteen movements for a plain truss and twenty for a.
complex one, has never been surmounted, at the same time all these movements

page_text: should be hid so as not to appear outwardly, and the apparatus is required to
be at once very light and strong. After twelve years practice and investi-
gation, I have discovered the best and most durable mechanical movements,
which I have applied to the apparatus forming the object of the present
application for Letters Patent.
I will proceed to describe these improvements, which I may apply to
trusses, orthopedic apparatus, pessaries, and other surgical instruments.
Sheet 1, Fig: 1; shows a front view of the movements of the reversable pad;
Fig. 2, a side view of the same; Fig. 3. is an under side view of the pad a,
showing one of the movements separately. I will afterwards illustrate the
combination of movements of the entire mechanism. Fig. 5 shows separately
the eccentric which operates the plate. In order to be effective, the reversing
of the truss plate should take place by degrees, which can be obtained by
mounting the end of the rod c in a guide formed on the plate, and by which
a finger on the end of said rod is operated. The pin x passing through the
plate, moves in a groove formed therein, or it may move in the groove on the
eccentric, the latter being rotated in any direction. A second means for
obtaining the gradual reversal of the plate without any outward projection, is
shown in Fig. 6, in under side view, while Fig. 7 shows a top view thereof;
Figs. 8, 9, 10, 11, and 12, show, in detail, or separately, the parts,made
use of to impart the movement. The rod a, to which is connected the
spring R, derives a progressive movement from a rod b, which has between
its forked parts or prongs a finger c, connected to the rod a, as shown in side
view Fig. 8, and end view Fig. 9. The connecting rod 6 derives its move-
ment from a part d, which is formed with teeth externally, while it has an
internal screw taking on the wormed part of the connecting rod b, and
connected thereto by the part F. Figs. 10 and 11 show in elevation and
section details, of said parts, a disc 9 formed with holes, Fig. 12, causes the
nut d to rotate, and act successively upon the teeth of the part d, which enter
the holes h in disc g, so that it suffices to move the latter by means of a knob i,
to slightly vary the inclination of the rod a, relatively to the truss carrying
plate.m, and thus ascertain the most suitable position for it, which has never
been obtained hitherto by the jerking movements above alluded to. The holes'h
are sufficiently close to one another that when one of the teeth of nut d has
escaped, another shall engage the next hole in its rotary motion. These teeth
cause the nut to move forward by degrees the screw which terminates the
connecting the rod b, whereby the rod a is rotated, and yields the effect
desired. A third movement, by which a gradual reversing is obtained without
any part projecting externally, is shown in Fig. 13, which represents a plan

page_text: of the movement, and in Fig. 14 showing an under side view of the same,
Figs. 15, 16, 17, 18 and 19, showing the details thereof. This consists in
engaging in a connecting rod o, the finger k, which operates the rods, said
rod o forming the collar of an eccentric p, which may be rotated either by
means a key. q, seen in plan and elevation in Figs. 15 and 16, or by a ring,
or in other suitable manner. In order to allow of the movement of finger k,
the plate is formed with a slot x, and to secure the excentric p, which imparts
the movement to the rod o, a plate y is fixed on plate t, which hides the
whole movement as shown at Figs. 14 and 19. A fourth movement, by
which the reversal of the pad may be effected progressively without any
outward projection, is shown in plan Fig. 1, Sheet 2, of the Drawing annexed
at Fig. 2, in section and in plan at Fig. 3.
A is the truss or plate, of which the branch B receives its inclination
through an excentric C, acting on the projecting part of D, in connection'
with the rod B. The part D consists of a cam, which is constantly pressed
against the excentric C by the spring F, so that said excentric in its
rotation may force back the cam D, thereby causing the rod B provided
with the supporting truss spring to rotate; this spring may be altogether
dispensed with, and instead of a single cam a forked or complex cam may
be employed. A fifth mechanical movement, 'by which the progressive
reversal of the pad can be obtained without any outward projection; is
shown in Figs. 4, 5, and 6, wherein are seen the details of truss G in plan,
section, and under side views. In this arrangement the inclined movement
is imparted to the rod II by rotary motion imparted to the wormed rod J,
by a cranked part K; on turning this part K by means of the knobs I, I,
the part L is caused to traverse the wormed rod J; the part L is furnished'
with a projecting part M in connection with rod H, thus by raising and
depressing said part L the rod H is inclined as desired. A sixth mechanical
movement; by means of which the progressive reversal of the pad is obtained
without any outward projection, is shown in Sheet 2, at Figs 7, 8, anil 9. Fig. 8
shows separately a detail of the part P, which effects the inclination' of the
truss rod Q; this movement is imparted by' means of a key as shown, which
key turns a part P furnished with a projection R on the axis of said part P in'
the form of a screw thread; or of other like form. The rod Qhas' a two-fold
projecting part: S, which surrounds the projection R of the part P, from which
arrangement it results that the part P, in its rotation, raises' the part S; in
consequence of the curved form of the part R, and hence effects the inclination
of the spring carrying rod Q.
In the two last arrangements I have described the use of different appli

page_text: ances to those before described but producing the same results.
As regards
the fourth arrangement above described, the excentric is likewise different in
its application, although it will be readily understood by reason of its simplicity.
I claim the application of all movements above described whatever may
be their position, size, and the material they are made of, and whatever be
the form of the plates I should choose to apply. As I have before mentioned,
mechanical arrangements have been already employed for reversing and
inclining the pads, for lengthening and shortening the springs on the back
part, for lengthening or strengthening the collar or neck, and for increasing or
diminishing the pads so as to press back the intestines; but all these devices
bave been applied separately, and further, the movements obtained were
produced by jerks and liable to stoppage, and had not that regularity and
solidity required for being efficient; again, none of these movements can be
compared to those I have described as regards simplicity and strength.
Moreover, all the arrangements I apply are new to this day, and also the
arrangements to be herein-after described, and which I claim as of this.
Juvention. The most celebrated physicians will admit, for the reduction and
cure of hernia, of no other application but that of a truss perfectly adjusted
and fitted; but there lies the difficulty. Supposing; indeed, that an apparatus
is obtained which at first fulfils all requirements, experience will prove that
after a few months wear, owing to the effects of perspiration which oxidizes
the steel parts, the energy and pressure required for an efficient reduction of
the hernia will no longer exist; and there, indeed, lies the greatest danger.
The patient, quite confident in the apparatus he is wearing, will not forsee the
danger of exposing himself to daily labours, and it frequently happens that
at an unexpected moment, the apparatus being no longer able to maintain its
position, gives way, thereby producing lamentable results. An apparatus
should, then, in order to be well and constantly adjusted, undergo numerous
modifications, the most indispensable among which I will herein-after enu-
merate. I will first describe the mechanical arrangements which I make
use of for answering all requirements, still observing that all are progressive
in their action, or, in other words, operating by degrees. The necessary
movements for a plain truss are thirteen in number, namely; 1st, mobility of
the dorsal pad on the loins in every direction, Sheet 3; 2ndly, elasticity of the
dorsal pad, Sheet 3; 3rdly, elasticity of the pubic belt, Sheet 3; 4thly, facility
of lengthening or shortening the connecting parts of this belt, Sheet 3; 5thly,
extension of the spring on the back part, Sheet 3; 6thly, shortening the same
spring on the back part, Sheet 3; 7thly, increasing the power of the spring,
Sheet 3; 8thly, lengthening the spring on the front collar, Sheet 3; 9thly,

page_text: shortening the same on the front collar, Sheet 3; 10thly, inclination of the pad
to facilitate the fitting thereof on the hernial ring, Sheet 3; 11thly, reversing
the pad for obtaining a slight compression towards the pubis for the purpose
of preventing the slipping out of the hernia, Sheets 1 & 2; 12thly, .the
drawing back of the pad so as to compress the abdominal parietes for the
purpose of preventing any intrusion of the hernia within the channel, Sheet 3;
13thly, elasticity of the pad, Sheet 3. The following are the nine movements
for a double truss; they are exactly similar to those first described, excepting.
the movements indicated under the Nos. 1, 2, 3, 4, which are the same both.
in plain and double or complex trusses.
I will first describe the movement No. 1, Sheet 3. The dorsal pads are at
present secured by means of a screw which, in case the spring is badly
supported on the fore part, will cause the pad which bears only on one part
to rest on a defective fulcrum, thereby producing a painful pressure on the
lumbal parts and even scoriations. Further, the fixing of the dorsal pad to
the spring prevents its following all the motions of the body; the screws may
besides get loose and be lost and would require an expense for repair, as the
dorsal pad will for this purpose require fresh stuffing. Fig. 16, Sheet 3, shows
the various arrangements which. I have contrived in order to render the pad
movable on the leather piece 1. I fix a metal disc 2, at the centre of which
is a hole having an interior worm 3, and into which are screwed the back.
ends of the springs. By this arrangement it will be readily understood that
the dorsal pad is constantly applied flat against all the parts of the boily and
rests on and follows all its movements, which has never before been attained
to this day.
The movement No. 2 described.-In order to obtain the elasticity of the
dorsal pad, or in other words, to allow of its being distended by any motion
of the body, tending to increase its size al out the hips, in the act of sitting
down, for instance, an inconvenient amount of compression is undergone
by the wearer when using the ordinary truss, which compression besides
cannot be prevented, as in a standing posture the same compression would
prove insufficient. According to the improvement of this Invention such
inconvenience ceases, as the trusses distend as the patient sits down, and
reassumes its normal position when the patient is standing. For obtaining
this movement I make use of two discs, which I connect together either by
a spiral spring, shown in red outlines, Fig. 16, or by an india-rubber band
or tube fixed to both ends.
The movement No. 3 described.-Fig. 19 shows the pubic elastic belt
intended to be applied radially to the dorsal pad. This elasticity of the pubic

page_text: belt is obtained either by means of a round or flat spiral spring, or by means
of an india-rubber band or tube connected to two pieces of leather, or to a
small steel rack piece, which is illustrated in Figs. 20 and 21. The two ends
may also be either small leather bands or rings, or any other suitable arrange-
ment may be adopted. By this means a powerful compression of the belt
on the end of the pad is obtained.
The movement No. 4 described.-This movement is obtained by means of
holes formed at certain distances from each other in leather bands or small
steel plates.
The movement No. 5 described.-To obtain the lengthening of the spring,
the end of the back part is wormed, as also are the two discs fixed to the
dorsal pad, Fig. 16, before described, with reference to movements Nos. 2
and 3. The truss is adjusted on the wearer towards the middle part of the
screw thread, so as to permit of its being extended nearly an inch on both
sides, should any circumstance whatever require it.
The movement No. 6 is the same as movement No. 5.
The movement No. 7 described. To obtain an incréasc or diminution of
spring power, and to act upon the circumference of the latter, I proceed as
follows: The end of spring 16, Fig. 23, is hinged at 15 to the screw rod 17,
formed with a projection 18, into which takes a screw 19; the end of which
bears upon the spring, and causes the latter to turn in either direction, and
imparts to the projection 18 a slight movement, which influences the pads so
as to bring them nearer together, or extend then farther from each other, and
thus increase or diminish the circumference of the spring. Instead of causing
the screw to pass through projection 18, it may take into the spring, and in
this case its end would bear upon a projection formed on the screw rod, which
would answer the same purpose. As shown at Fig. 22, the screw rod and
ring may Le furnished with a part 21 wormed inside, so as to admit a screw 22,
either straight or slightly curved. A sliding spring, Fig. 24, would by varying
its position produce an equally effective result.
The movement No. 8 described. In the sheath o, which is wormed inter-
nally, I introduce the wormed end N of the spring, in order to secure it when
the desired length is obtained; on the wormed part I arrange one or two
parts for the screws to bear upon, or, which is preferable, a groove is made
throughout the whole length of the worm large and deep enough to admit
the end of the screw P, Fig. 1; a similar arrangement may be employed for
the extension of the spring by the end of the latter being wormed internally,
into which is introduced a corresponding screwed part fixed to part 12, as
shown. Fig. 2. ·

page_text: The movement No. 9 is the same as that described at No. 8.
The movement No. 10. described. The inclination of the pad has been
hitherto effected by means of an elbow joint, consisting of a ball and socket,
the result of which means were first to effect said inclination with a jerk,
besides which it only permitted of a limited inclination, and as regards. the
compression of the inguinal channel by means of the joint aforesaid, it would
frequently happen that the end of the pad rested upon the end of the
inguinal channel leaving the passage of the internal ring free, besides that
it allowed the groin too voluminous dimensions for apparatus of this descrip-
tion; and, further, this apparatus was destitute of the means of being fixed.
This inclination I obtain by means of gearing, A, B, Fig. 1, and I secure it
when once adjusted at the desired point by means of screws C, D, which press
on each side of the teeth, as shown at Fig. 1, Sheet 3. Fig. 2 shows an
arrangement with one toothed segment, the teeth of the remaining one being
made longer and stronger, so that the screws shall answer the same purpose
as in Fig. 1. Fig. 3 shows another arrangement, in which the gearing is
dispensed with altogether, and instead of which I apply a disc E thinned
round its periphery, upon which act two set screws F. G. I may likewise
punch holes in the cheeks of the disc in the manner shown in Fig. 4, and it
will suffice in this case to introduce one or two screws, which entering the
holes will bear on its surface. Fig. 5 shows a screw H engaging a nut I
binged to the rod K of the pad by causing the said screw to turn in either
direction, the depression or the raising of the pad is readily obtained.
The movement No. 11 described. When the pad is properly fitted to the
exact part of the hernial ring it should be capable of being reversed, in order
to exert a pressure on the pubic, so that the hernia can be prevented from
sliding into.the scrotum, and also to permit of its tight applications to. any
individual, whatever may be his conformation. Thus, for a fat person the pad
must be entirely reversed, while it should be nearly straight for a thin one.
The various progressive reversing movements are illustrated in Sheets 1, 2,
Figs. 1, 2, 3, 4, 5, and 6.
The movement No. 12 described.-I have found from experience and
practice that different descriptions of pads should be adopted according to the
nature of hernia to be treated, and made of different thicknesses. To this
end, I have contrived a compressing pad, which has the advantage of
admitting of a variation in thickness, to the extent of rather more than an
inch; and so that. the stuffing or padding thereof never presents. any looseness
or slack, but always compresses in a regular manner the abdominal parietes.
Figs. 6, 7, 8, 9, 10, 11, and 12, show separately these compressing parts ready

page_text: set up. The plate R of the pad is formed with a hole, through which passes
a screw S, secured to the plate by the nut T, without interfering with its
rotation; this screw moves in a cylinder Ụ, wormed internally, at the upper
part of which is maintained and turns freely the cap V. To allow of the
cylinder U moving upwards without turning, grooves are formed on two
opposite sides thereof, into which fit the pins X on the socket Y, which is
secured to the plate R. It will be understood that by turning the knob. of
screw S the screw is started, and the cylinder U and its cap thereby
raised..
The movement No. 13 described. The description of No. 12 may apply
to this movement, except that the cap is fixed to the end of the spiral spring,
Fig. 15, while by means of the cylinder U, Fig. 6, the slack or sinking of the
pad can be limited by making the cylinder of suitable depth. In order to give
the compressing pad in this system all the desired elasticity, I cover the cap
with some elastic substance, enclosed in a vulcanized india-rubber covering, or
as shown in Fig. 5, in an air-tight vulcanized india-rubber covering, so that
a constant pressure may be obtained, owing to the elastic agents, viz., the truss
spring, the spiral spring, the elastic stuffing material, and the pubic elastic
curve.. These two systems of pads have the advantage of assuming when
distended a somewhat. conical form, which has for result to limit the pene-
tration of the pad into the hernial ring, and prevents besides the introduction
of the hernia into the scrotum. Instead of the cap V, Fig. 6, a plate hinged
next the collar may be substituted, which may be increased or diminished in
size by means of the cylinder U, Fig. 6.
The apparatus above described may be readily established so as to be quite
imperceptible, in the manner illustrated in Sheet 2, Fig. 11; but as its high
price would render it inaccessible to workmen and professional people, I
have devised a new means of stuffing these apparatus, and of cutting and
sewing them mechanically, quite as strongly as could be done by manual
labour. In order to make this improved method of manufacture better under-.
stood, I shall refer to Sheet 4, the various Figures of which represent the
different improvements in the pads thus obtained by means of sewing machinery.
I proceed as follows, viz., I take a chamois or other skin, which I dress, size,
and afterwards stretch and nail or otherwise fix on the boards A, as shown at
Fig. 1. This sizing or dressing is intended to impart to the skin, as it does to
other fabrics and tissues, a rigidity which makes it suitable to be worked by
sewing machinery, and I do not claim, therefore, the material whereby this
result is attained, as any suitable compound usually employed for dressing
fabrics and tissues of all sorts may answer the purpose; hemp, cotton, cloth,

page_text: paper, or any other lining, may also be applied on the skin, the whole being
dressed in the same manner to impart rigidity to the skin, which dressing,
however, may be dispensed with if the expense be an objection. As regards.
economy this dressing process is very important, for the skin thus dressed and;
stretched is lengthened about a fifth, which would prove of great advantage
when operating on a large scale. The skin thus prepared is cut into strips as.
usual to form the different parts of the truss, and before submitting it to the
action of the sewing machine I proceed in the following manner :-I take a
plate of metal, wood, hardened india-rubber, horn, gutta percha, or other rigid
substance, which I enclose or cover, as shown at Figs. 2 and 3, Sheet 4, with
chamois skin after cementing the two edges by a thread, and thus forming the
laps, which, owing to the previous dressing the skins have undergone, will
readily be made secure. I form the pad in the same manner by introducing:
one, two, three, four, or more pieces of wool, cotton, or other stuff, of suitable
form. This method of stuffing is far easier and more regular than by super-
posing layers of wool or other materials as usual, the regularity of which layers;
can never be well ensured, besides, the truss spring being, after the sewing:
operation, lodged between two layers of thick material, is more efficiently
preserved against the effects of oxydation..
.: 3
It will be easily understood that for invisible trusses the strips of skin may
be replaced by some waterproof material such as waxed or gummed taffeta,
india-rubber, or other suitable tissue, either impervious or otherwise. The
cloth and stuffing materials are then superposed as usual, and as shown at
Fig. 4, and afterwards submitted to the action of the sewing machine. The
rigidity, however, imparted to the skin by the dressing operation, which
facilitates the work in a great measure does not suffice for obtaining a regular
stitch, as the strokes of the foot presser and feeder work so as to form a very
irregular stitch, according to the different thicknesses. of the skins.to be acted
upon. I prevent this by using the. mechanical arrangement shown at Fig. 5.
I fix in any suitable manner upon the sewing machine a small cylinder C, under
which I pass a belt D, one end of which is connected to the truss pad while the
other end carries a weight F, by the constant action of which the work is easily
drawn, so that the stitch formed may always be of equal length, and preventing
all puckering of the skin under the action of the machine, as would be in-
variably the case when operating without the aid of said device. The same
contrivance may be applied to all. sewing machines not only for the purpose
above specified, but, whenever long stitches are required to be formed on broad
slightly resisting fabrics. Every one of the improvements described, however.
simple they may appear to be, are indispensable, and they enable me to

page_text: manufacture trusses by machinery, which has never yet been attained hitherto,
In order to facilitate the insertion of the double springs into the pads, I intro-
duce them before screwing the knob on that part of the spring which has
previously been backed with a wormed counter plate.
I will now proceed to describe the improved mechanism for drawing in the
front pads of the truss by degrees, whereby they may be varied in thickness
and length some fractions of an inch. I further apply the same drawing in
mechanism. to other similar apparatus, such as pessaries, for instance..
Sheet 4 of the Drawing annexed, represents an improved pessary, for
producing the instantaneous return of the basin..
This apparatus presents great advantages over those usually employed..
Fig. 9, Sheet 4, shows the apparatus in red outlines, as it is being introduced,
and in black lines when in its normal position. Fig. 10 indicates' in
horizontal section the position of the mechanism, and Fig. 11 shows the form
of the hinges, which permits of the basin assuming the position required for
facilitating the insertion. The basin A, which may be of india-rubber;
hardened or otherwise, porcelain, boxwood, ivory, silver, or other suitable;
substance; is carried by a collar B, to which are fitted hinged rods C; but this
connection of the basin to the rods C may be otherwise effected, thus
rendering the motion of the basin easier at this part. The rods C
engage in
grooves provided for the purpose, between movable part D and stationary
cover E; the movable part D is wormed internally, so as to admit a screw F,
whose rotation in either. direction produces the raising or depression of said.
part D. In order to prevent this part from turning with the screw, I form it
with two longitudinal grooves, in which gear two screws, while a small
projecting edge is formed on part E, which works in the two grooves. The
other two screws K engage in the flat parts of the hinged rods, which are.
provided for that purpose at their ends with a projection, so that the two
screws K prevent the rods from escaping. Other systems of pessaries have
been before made, which, although inclining, for the purpose of rendering the
insertion: easier, can only be reversed very slowly, which I have endeavoured
to improve. The horizontal position is somewhat difficult to obtain, as the
part where the apparatus is laid cannot be observed,, and it may occur that,
owing to a wrong inclination, the uterus may be badly directed, in which case;
the apparatus will prove rather hurtful than useful. An experienced practi-
tioner may object, perhaps, that this position may be well regulated by hand;
supposing this: to be true, which is not quite my opinion, yet in most cases it
happens that the wearer is incapable of properly performing. said operation;
to remedy which I cause the basin to return of itself to its original position at

page_text: For this purpose I arrange on the collar B, and opposite to each other
two elastic cords M, or two, india-rubber tubes, or, it may be, one or more
straight or spiral springs, by whose action the basin is returned to its normal
or horizontal position from the vertical position it had assumed, in order to
facilitate its introduction as indicated by the red outlines, Fig. 9, so that any
one can readily apply this pessary in its right place.
The basin once in position may be afterwards raised at certain periods as the
cure progresses, by means of the arrangement which I have before described
for hernial pads. This reversal of the basin may likewise be obtained by.
means of a non-elastic spring cat-gut, or by means of a flexible plate of metal,
one part of which not in connection with the basin, passes as represented at
Fig. 10, through a hole made in the plate for the purpose; and I may also
apply the same mechanical arrangement as described, to apparatus for appli-
cation to the rectum, and to umbilical apparatus, with such modifications in
size as may be desirable for suitable application thereto.