382

GENERAL OBJECTIONS TO BANDAGES.

at hand. Really no ingenuity whatever is required to use them. The majority of medical practitioners throughout the land, such as are nearest to the patient at the time of the accident, are neither skilled in mechanics nor ingenious. It is not surprising, then, that such simple apparatus should become the sole reliance of most practitioners. As to the results, if union is obtained without external deformity, the case is regarded as successfully treated; and yet in all but the simplest cases it will be found upon a close scrutiny by an expert that the grinding surfaces of the teeth of one or both fragments have lost their natural occlusion with their antagonists. Frequently only a moiety capable of actual contact remains, and thus more than half the power of the masticatory apparatus has been sacrificed.

The objections to the bandage and its adjuncts are, that to do their work effectually the lower jaw must be bound immovably against the upper. This prevents the patient from being properly fed, as only fluid nourishment could be received, and not even that if the dental arch be unbroken. To meet this objection, the corks or wedges were introduced; but again, when there is a strong tendency to displacement, they do not prevent it. In cases of oblique fractures the action of the bandage causes the fragments to overlap, and especially in cases of necrosis it contracts the jaw. In a majority of cases of complicated fractures in the author's practice, it has required great strength to right the pieces, and it has been almost impossible to bring them into accurate articulation with the upper jaw; and immediately upon the power being relaxed, some portion would drop out of line before even any bandage could be applied. Hamilton's objections are, that "nearly all the bandages and slings recommended for this fracture are inefficient, and are exceedingly liable to displacement. That portion of the apparatus especially which in most forms of dressing passes in front of the chin, and is made fast under the occiput, intended only to prevent the sling from sliding forward, does not fail to depress the

NECESSITY OF MORE EFFICIENT APPARATUS.

383

chin, and increase the tendency to overlapping of the fragments."

This condition of things was recognized long ago, and showed the necessity of appliances operating upon an entirely different principle from any described. These principles, and the apparatus which has been devised from time to time in their application, should be more fully apprehended than they are generally by surgeons of the present day; and to this end the author has made an exhaustive investigation of this subject in all its history.

CHAPTER XVII.

INTERDENTAL SPLINTS.

INTERDENTAL splints have been the occasional recourse of surgeons for a hundred years. They were first recommended by Chopart and Desault in 1780. The earlier forms were nearly always used in conjunction with a submental compress and a clamp, which will be described hereafter. The

later forms have had a bandage sometimes for an adjunct, and at others have acted entirely by fixation within the mouth. Since the discovery of the value of gutta-percha and of vulcanized rubber, this form of apparatus has been carried to great perfection.

Dr. T. B. Gunning, of New York, seems to have been the first who used vulcanite for splints for fractured jaws. It can hardly be regarded as a remarkable invention, as the same material was then in common use among dentists for splints in regulating teeth. In 1861 he made a splint similar

BEAN'S INTERDENTAL SPLINT AND BANDAGE.

385

to Fig. 263, which held the jaws apart and covered both upper and under teeth. An opening was made in front for the reception of food, and the lower jaw was bound into the splint by a bandage over the head. The plan of this splint was the same as that made by Nasmyth and used by Liston many years before. Subsequently Dr. Gunning made other splints, which covered the lower teeth only and left the jaw free to move. These latter were made fast sometimes by

thread or wire ligatures around the teeth, and at others by screws passing into holes drilled into the teeth.

In 1864 Dr. J. B. Bean, of Atlanta, Georgia, who afterward lost his life on Mont Blanc, treated many cases of fractured jaws which occurred in the Confederate army. His interdental splint was much the same as Gunning's, but his compress and bandage were different. (See Fig. 264.) This bandage will be recognized as similar to Hamilton's, but the mental compress is made of a thin piece of wood with a suitable padding. Dr. Bean's success in forty cases which he treated was undoubtedly the result of the nice mechani

386

SUERSEN'S CASES OF GUNSHOT FRACTURES.

cal skill with which he made the interdental splint. His plan involved taking casts of both jaws, and reconstructing the model of the fractured jaw by articulating it to the model of the upper. His splint made upon such a model would produce results in accordance with his skill in restoring his model.

Dr. Wilhelm Suersen, of Berlin, reports the treatment, with an interdental splint, of a number of cases of gunshotwounds of the jaw, which occurred during the FrancoGerman war of 1870. His splint was made of vulcanite upon a reconstructed plaster model, which method he de

scribes as original with him, but which was the same as used by Tomes, Bean, and Gunning, and also described and published several years before that date by the author. Fig. 265 shows a case which came under his care five weeks after the accident. Fig. 266 illustrates the splint left open along the top for cleansing. After its introduction it was not removed for fourteen days. At the end of seven weeks the jaw was in a normal condition and perfectly healed.

Fig. 267 shows a case of double fracture occurring on each side near the canine teeth. The splint made for this, shown in Fig. 268, did not include the anterior fragment. When the splint was applied that portion was easily pressed into place, and remained so until the cure was complete, which occurred in about six weeks.