IMPROVEMENTS IN SURGICAL APPARATUS FOR THE TREATMENT OF FRACTURES, OSSEOUS REGENERATION, COXALGIA, AND OTHER AFFECTIONS OF THE BONES AND JOINTS
Year: 1881

page_text: LETTERS PATENT to John Clayton Mewburn, of 169, Fleet Street, in the City
of London, Patent Agent and Consulting Engineer, for an Invention of
"IMPROVEMENTS IN SURGICAL APPARATUS FOR THE TREATMENT OF FRACTURES,
OSSEOUS REGENERATION, COXALGIA, AND OTHER AFFECTIONS OF THE BONES
AND JOINTS." A communication from abroad by Dr. Eugene Bonnefoy,
of Paris France.
.
PROVISIONAL SPECIFICATION left by the said John Clayton Mewburn at
the Office of the Commissioners of Patents on the 5th August 1881.
JOHN CLAYTON MEWBURN, of 169, Fleet Street, in the City of London, Patent
Agent and Consulting Engineer. "IMPROVEMENTS IN SURGICAL APPARATUS FOR
THE TREATMENT OF FRACTURES, OSSEOUS REGENERATION, COXALGIA, AND OTHER
AFFECTIONS OF THE BONES AND JOINTS." [A communication from abroad by
Dr. Eugene Bonnefoy, of Paris, France.]
Hitherto in order to ensure immobility of the parts in the treatment of fractures,
Osseous regeneration, and coxalgia, it has been the practice to employ plaster, which
has been applied to the fractured or affected limb. There are serious objections to
this method; for example, it does not allow of the articular movements of the
limb, it renders the treatment very difficult, and it prevents the progress of the
case being watched.
Now the object of this Invention is to substitute a method which will allow of
producing an immediate and absolute immobility of the parts, assured by perfect
coaptation and complete consolidation, with capability of allowing the joints to
act without affecting the place of fracture. Besides, with my method I can not
only give immediate and absolute support to the parts in the axis of the limb, but
also if required bring them together or move them apart. Further, my method
gives free access to the parts affected. Thus with my method not only can simple
fractures of the limbs be treated, but also compound fractures of the limbs, of the
vertebral column, and of the pelvis, as well as osseous regeneration and coxalgia.
These results are obtained by means of the apparatus which I will now proceed
to describe. The body of this apparatus is a frame forming a sort of litter, and is
[Price 6d1

page_text: .
composed of longitudinal beams connected by transverse pieces. The longitudinal
beams are jointed at the middle, so that the apparatus can be folded for transport.
To consolidate the two parts I fit below the joints cramps which are screwed into
the front part and fixed to the back part by bolts. The apparatus is provided
with short legs, so that the patient can be easily placed on it, and with louger legs
to raise him to a convenient height for the operations of the surgeon. All these
legs are connected to the body of the apparatus by joints. Screws fix the
legs when the apparatus is open. The longer legs have casters which can
be rendered immovable by nuts and spring plates. Above the body or litter
is binged a movable back for the patient. It is raised to the required position
by means of a rotating handle, the movement of which is transmitted to rods
hooked to pieces which slide along the body or litter, and serve as bearings to
the shaft of 2 toothed wheels. Arms fixed to this shaft hold up the movable
back. The rods above described in their longitudinal movement draw the sliding
pieces and the toothed wheels, which run on longitudinal racks, and consequently
the lower ends of the supporting arms, which by their upper ends lift the movable
back. A ratchet and paul retain this back in the required position. When the
patient is laid on the apparatus, the line of articulation of the back perfectly
corresponds with the centre of the hip joints. It is here that I also take the points
of articulation for the parts of the apparatus which support the lower limbs, and
also the points of counter extension which maintain the pelvis in front on a stuffed,
fixed, and immovable support, which can be represented by a curved line carried in
front over the ischia, and the upper and lower part of the thighs, and by a straight
line traversing the pelvis and passing through the centre of the hip joints.
The large hinge or joint in the middle maintains the 2 parts of the body in
perfect symmetry while allowing them to move on it. It is this which gives me
my pelvio-counter-extension; without it the fragmentary counter extension, that
is, the immobility of one of the parts in order to adapt the other thereto, is not
possible. The pelvis also rests on a small mattress, which can be raised or lowered
by straps fixed to the stuffed support before described, and winding on a transverse
shaft, which can be rotated by a handle, and is fitted with a ratchet and paul.
This movement of the mattress gives free access to the pelvis in case of injury,
and also allows the patient to relieve nature.
For the support of the lower limbs I employ at the front of the litter an
arrangement composed of two parts perfectly symmetrical independent of each
other, and fixed to the litter in the same manner. Each of these parts rests at each
side on 3 fixed points of support, that which is nearest to the line of the main joint
of the apparatus being attached to the litter by a bayonet joint, and the 2 others
laterally by screws. These two points are connected by square rods, along which
two movable points of support slide. The two outer points of support are con-
nected together by a fixed bent arm, to which are joined two outer rods; the lower
of these rods is fitted with a roller, and the upper one is covered with buckles. At
the inner side there is no bent arm analogous to that above described, and no
upper rod, but a rod is jointed directly to the fixed support. The upper ends of
the rods are jointed at the same level as arms whose other end is jointed to one of
the movable supports. This arrangement of arms and rods thus forms a support
for the thighs. For the legs I add another rod, which starts from the upper level
of the rods already described, and is jointed to another arm connected to the
second movable support. The point from which this rod starts corresponds with
the knee, and in order that the apparatus may be adapted to persons of various
heights the rods are made in 2 pieces; one piece is hollow and carries a roller,
the other piece is solid and screw threaded and enters the hollow piece. By the
movements of the roller the rods can be lengthened more or less. In order to effect
the elongation and contraction with mechanical accuracy and mathematical
certainty, the upper.surface of the screw is made flat and has divisions. The ends
of the rods for the patient's legs also have divisious, and receive sliding pieces
connected by a cross piece likewise divided. This cross piece slides in a piece

page_text: which carries a sandal for the patient's foot. These arrangements allow of adjusting
the parts in any determined position. The sandal can also have a circular move-
ment, so that it can be inclined; an index and scale at the bottom of the sandal
allow of these movements being regulated, and a screw fixes the sandal in the
required position.
The parts before described for supporting the lower limbs are capable of being
partly or entirely raised or bent. For this purpose I arrange on transverse rods
which connect the movable supports an endless screw fitted with a handle; on this
screw is a nut to which is attached a piece carried by a rod which connects the movable
supports to some of the arms which support the lower limbs, as before described.
Another handle placed at the front of the apparatus actuates another endless screw,
on which is a piece which can be connected to the transverse rods by means of
bolts. The movements of this endless screw displace the points of support of the
arms which support the patient's legs. The combination of these movements
permits of displacing the lower limbs without deranging the positions. To allow
the patient to effect the different movements, I employ a sheath or tube in which
is a rod worked by a handle within the patient's reach; this rod through the
intermediation of a bevel pinion acts on the last named endless screw.
sheath or tube is movable and is attached to the litter by a bayonet joint.
For the upper limbs I adopt similar arrangements to those described for the
lower limbs, and I arrange them laterally on the movable back.
The said
The .movable back, the parts for supporting the limbs, and the sandals, carry
buckles and straps with which the whole body, bust, and limbs are supported below
without interfering with the movements and positions. At the side are the other
straps, which may be required.
The sandals are strengthened by bent rod and straps, which latter are fixed to
the sandals and are carried round the rods. Another rod carries adjustable
buckles, to which are fastened straps for the pelvis. This rod may also serve to
support a small platform or table for the use of the patient. The straps should be
so arranged that immediately one ceases to pull on them they remain fixed, so
that the part acted upon may become immovable without any compression or
deformation. There is a second set of straps below the first to constitute a sort of
mattress.

page_text: SPECIFICATION in pursuance of the conditions of the Letters Patent filed
by the said John Clayton Mewburn in the Great Seal Patent Office on the
4th February 1882.
JOHN CLAYTON MEWBURN, of 169, Fleet Street, in the City of London, Patent
Agent and Consulting Engineer. "IMPROVEMENTS IN SURGICAL APPARATUS FOR
THE TREATMENT OF FRACTURES, OSSEOUS REGENERATION, COXALGIA, AND OTHER
AFFECTIONS OF THE BONES AND JOINTS." (A communication from abroad by
Dr. Eugene Bonnefoy, of Paris, France.)
Hitherto in order to ensure immobility of the parts in the treatment of fractures,
osseous regeneration, and coxalgia, it has been the practice to employ plaster,
which has been applied to the fractured or affected limb. There are serious
objections to this method; for example, it does not allow of the articular move-
ments of the limb, it renders the treatment very difficult, and it prevents the
progress of the case, being watched.
Now the object of this Invention is to substitute a method which will allow of
producing an immediate and absolute immobility of the parts, assured by perfect
coaptation and complete consolidation, with capability of allowing the joints to
act without affecting the place of fracture. Besides, with my method. I can not
only give immediate and absolute support to the parts in the axis of the limb, but
also if required bring them together or move them apart. Further, my method
gives free access to the parts affected. Thus with my method not only can simple.
fractures of the limbs be treated, but also compound fractures of the limbs, of the
vertebral column, and of the pelvis, as well as osseous regeneration and coxalgia.
These results are obtained by means of the apparatus which I will now proceed
to describe. Figure 1 of the annexed Drawing is an elevation of the apparatus ;
Figure 2, a plan; and Figure 3, a front view; Figure 4 is a longitudinal section
of the movable back and the corresponding portion of the frame or litter;
Figures 5 and 6 represent two arrangements of mechanism for moving the lower
limbs, these arrangements being capable of acting together or separately; Figures 7
to 10 represent details.
The body of the apparatus is a frame forming a sort of litter, and is composed
of longitudinal beams A, A, connected by transverse pieces, A¹, A¹. The longi-
tudinal beams A, A, are jointed at the middle a, a, so that the apparatus can be
folded for transport. To consolidate the two parts I fit below the joints cramps
b, b, which are screwed into the front part and fixed to the back part by bolts c, d.
The apparatus is provided with short legs B so that the patient.can be easily placed
on it, and with longer legs C to raise him to a convenient height for the operations
of the surgeon. All these legs are connected to the body of the apparatus by
joints marked respectively i, i, and j, j. Screws k, k, k, fix the legs when the
apparatus is open. The legs C have casters which can be rendered immovable by
nuts h, h, and spring plates f, g. Above the body or litter is hinged at a a
movable back D for the patient. It is raised to the required position by means
of a rotating handle E, the movement of which is transmitted by endless screws
in the sheaths E', E', to rods F, F, hooked to pieces 1, 2, which slide along the body
Arms n, n,
or litter and serve as bearing to the shaft o of toothed wheels m, m.
fixed to this shaft hold up the back D. The rods F, F, in their longitudinal
movement draw the sliding pieces 1, 1, and the toothed wheels which run on
longitudinal racks p, p, and consequently the lower ends of the supporting arms
n, n, which by their upper ends lift the back D. A ratchet r and paul g retain
this back in the required position. When the patient is laid on the apparatus,
the line of articulation of the back D perfectly corresponds with the centre of the

page_text: hip joints; this is an important feature of the apparatus. It is here that I also'
take the points of articulation for the parts of the apparatus which support the
lower limbs, and also the points of counter extension which maintain the pelvis in
front on a stuffed, fixed, and immovable support G, which can be represented by
a curved line carried in front over the ischia and the upper and lower part of the
thighs, and by a straight line traversing the pelvis and passing through the centre
of the hip joints.
The large hinge or joint in the middle maintains the two parts of the body in
perfect symmetry while allowing them to move on it. It is this which gives me
my pelvio-counter-extension. Without it the fragmentary counter extension,
that is, the immobility of one of the parts in order to adapt the other thereto is
not possible. The pelvis also rests on a small mattress H, which can be raised or
lowered by straps t fixed to the support G and winding on a shaft o¹, which can
be rotated by a handle I, and is fitted with a ratchet 1 and paul q¹.. This move-
ment of the mattress gives free access to the pelvis in case of injury, and also
allows the patient to relieve nature.
For the support of the lower limbs I employ at the front of the litter an
arrangement composed of two parts perfectly symmetrical, independent of each
other, and fixed to the litter in the same manner. Each of these parts rests at
each side on 3 fixed points of support u, u, u, that which is nearest to the line of
the main joint of the apparatus being attached to the litter by a bayonet joint, and
the two others laterally by screws. These two points are connected by square
rods v, v, along which two movable points of support u, u, slide. The two outer
points of support u, u, are connected together by a fixed bent arm x, to which
are jointed two outer rods a¹, all, the lower all, of these rods is fitted with a roller
and the upper one is covered with buckles w, w. At the inner side there is no
bent arm analogous to the arm x and no upper rod, but a rod TV is jointed
directly to the support u. The upper ends of the rods are jointed at the same
level y as arms, whose other end is jointed to one of the movable supports u³.
This arrangement of arms and rods thus forms a support for the thighs. For the
legs I add another rod I, which starts from the point y and is jointed to another
arm II connected to the second movable support u¹. The point or joint y corre-
sponds with the knee, and in order that the apparatus may be adapted to persons
of various heights, the rods ", Y, and 21, are made in two pieces (see Figures 7,
8, and 9); one piece M is hollow and carries a roller N, the other piece P is solid
and screw threaded, and enters the piece M. By the movements of the roller N
the rods can be lengthened more or less. In order to effect the elongation and
contraction with mechanical accuracy and mathematical certainty, the upper surface
of the screw P is made flat and has divisions. The ends of the rods I also have
divisions and receive sliding pieces ull connected by a cross piece v₁ likewise
divided. On this cross piece slides a piece Q which carries a sandal K. These
arrangements allow of adjusting the parts in any determined position. The sandal.
can also have a circular movement around the point q" so that it can be inclined;
an index q¹¹ and scale at the bottom of the sandal allow of these movements being
regulated, and a screw q fixes the sandal in the required position.
The parts before described for supporting the lower limbs are capable of being
partly or entirely raised or bent. For this purpose (see Figure 5) I arrange ou
rods T, which connect the movable supports u', an endless screw vll, fitted with a
handle I; on this screw is a nut to which is attached by the screw k¹ a piece
carried by a rod T¹, which connects the movable supports u' of the arm av.
Another handle E" placed at the front of the apparatus actuates another endless
screw V, on which is a piece Z which can be connected to the rods T, T, by
means of bolts. The movements of this endless screw displace the points of.
support of the arms VII. The combination of these movements permits of
displacing the lower limbs without deranging the positions. To allow the patient
to effect the different movements I employ a sheath or tube S in which is a rod
worked by a handle I" within the patient's reach; this rod through the intermediation

page_text: of a bevel pinion V, acts on the endless screw 111. The said sheath or tube iş
movable and is attached to the litter at 8 by a bayonet joint.
For the upper limbs I adopt similar arrangements to those described for the
lower limbs, and I arrange them laterally on the back D. This back, the parts for
supporting the limbs, and the sandals, carry buckles and straps V with which the
whole body, bust, and limbs are supported below without interfering with the
movements and positions. At the side are the other straps, which may be
required.
The sandals K are strengthened by bent rods R', R", and straps, which latter
are fixed to the sandals and are carried round the rods. Another rod R¹¹¹, carries
adjustable buckles to which are fastened straps for the pelvis. This rod may also
serve to support a small platform or table P for the use of the patient. The
straps should be so arranged that immediately one ceases to pull on them they
remain fixed, so that the part acted upon may become immovable without any
compression or deformation. This arrangement of the straps is an important
feature of the apparatus; Figures 7, 8, and 9, represent fixed buckles, and
Figure 10 additional buckles, which are employed in case of the lengthening of
the rods. There is a second set of straps V₁, V₁, below the first to constitute a
sort of mattress.
The apparatus may be modified according to whether it is intended for private
houses, for ambulances, or for hospitals; when for ambulances. it is surrounded
with curtains attached to rods which are fixed in the sockets Z'; it is light and
easily carried, and for this purpose there are recesses or guides s³ to receive
carrying bars or poles. When the apparatus is made for hospitals the middle
joint of the frame is not necessary.
Having now described the nature of the said Invention, as communicated to me,
and in what manner the same is to be performed, I declare that I claim, the
improvements, hereinbefore described with reference to the annexed Drawings, in
surgical apparatus for the treatment of fractures, osseous regeneration, coxalgia,
and other affections of the bones and joints.
In witness whereof, I, the said John Clayton Mewburn, have hereunto set my
hand and seal, this Third day of February, One thousand eight hundred
and eighty two.
J. C. MEWBURN. (L.S.)