DEVELOPMENT IN NINETEENTH CENTURY 357 



sion in the treatment of fractures, and the use of the sand-bag was 

 introduced by Hunt, of Philadelphia, in 1862. In fracture of the 

 clavicle, Sayre has originated a dressing which is not only unique, 

 but which is accepted as the simplest, most reliable, and most 

 satisfactory of all the different forms of apparatus. Physick suggested 

 the two angular splints for treating fracture of the lower end of the 

 humerus, and Gunning and Bean the interdental splint in the treat- 

 ment of the fracture of the lower jaw. Allis first called attention to 

 the pathologic condition found in fractures of the lower end of the 

 humerus, and suggested new principles in the treatment to prevent 

 deformities. In 1861 Mason devised a new method of treating 

 fractures of the nasal bones by passing a curved needle under the 

 fragments and elevating them. In the treatment of fracture of the 

 patella by the use of the metallic suture, American surgery can claim 

 the operation as far as priority is concerned, since Rhea Barton 

 wired a fractured patella in 1834, and McClellan, in 1838, and Cooper, 

 of San Francisco, in 1861, and after him Logan and Gunn. 



While American surgery cannot justly claim the priority of this 

 operation as practiced by Lister with the modern aseptic technic, she 

 can at least claim to having brought the operation to its present 

 perfected technic, and can point to the fact that in New York the 

 operation has been performed more times than it has been in any 

 city, or in any country in the world. While the operation is not 

 one to be recommended universally, it is an operation yielding 

 brilliant results in suitable cases and in the hands of aseptic surgeons. 

 The first time that fractures of the lower jaw were treated by metallic 

 suture was by Kinloch of South Carolina. In the management of 

 ununited fractures, American surgery stands preeminent. In 1802 

 Physick passed a seton between the ends of an ununited fracture of 

 the humerus. In 1830, or twenty-eight years after the operation, 

 Physick obtained the specimen. The use of the metallic suture 

 was first successfully tried in 1827, by J. Kearney Rodgers, in a case 

 of ununited fracture of the humerus. 



Perforation of the ends of the bones in an ununited fracture of 

 the tibia was accomplished in 1850 by Detmold. In 1825 Brainard 

 introduced the operation of drilling the fragments. In 1857 Pancoast 

 used the iron screw to accomplish the same object. In 1878 Pilcher 

 first pointed out the correct pathology and the treatment of fractures 

 of the lower end of the radius. Before dismissing the subject of 

 fractures, the work of Hamilton and Stimson must not be overlooked, 

 since they did more to systematize and to perfect the treatment of 

 fractures in general than any other surgeons. The saw devised by 

 Shrady for performing a subcutaneous section of the bone is an 

 instrument worthy of the highest commendation. Excision of the 

 superior maxillary bone, with the exception of the orbital plate, was 



