s "■'*»■ i PRACTICAL ELUCIDATIONS THE NATURE OF HERNIA, TOGETHER WITH SOME REMARKS ON THE HITHERTO USED FOR ITS CONFINEMENT. WITH AN EXPLANATION OF The experienced utility and effectual cures, OF THE / INSTRUMENT NOW RECOMMENDED. BY A. Ct. HULL, WL D. INVENTOR AND PATENTEE, PERMANENT MEMBER OF THE STATE MEDICAL SOCIETY, AND LATE PRESIDENT OF THE ONEIDA MEDICAZ...SOCIETY. He maketh tore and he bindeth up; he wouhdeth, and his hands maketh whole.—Job, NEW-YORK: PRINTED BT HENRY SPEAR, 119 Fly-Market-street 1824. PREFACE. The author of these lew practical observations, during twenty-five years' practice in surgery, having witnessed the dreadful consequences incident to ruptures, the indescribable agony attending them, and the loss of many valuable lives, of both sexes, almost uniformly the result of bad and ineffectual Trusses, or neglecting to use any—was prompted by feelings of humanity, professional duty and pride, to devote a share of his time and attention ("during the last seven years) to the disease of hernia, and the construction of an instrument for the different species of that disease, and without arrogating to himself superior powers, or intelligence, he is now satisfied that he has brought into successful opera- tion an improved Truss, happily adapted to all cases of ruptures, of both sexes. By his own experience, and that of many others, he does not hesitate to an- nounce to the world the efficient powers combined in his contrivance. The benefits already derived to thousands by the use of this instrument, has given the inventor gratification better felt than can be ex- pressed. The use of this instrument is no longer a subject of doubt or experiment; for the excellency of any useful innovation is always known by its ef- fects. The author feels satisfied in having given to the world an important alleviator, as well as a proba- IV i'REFACU. ble cure, of a disability or disease, which hitherto the pride of professional science has unwittingly too much neglected : and he feels a conscious pleasure that he has not derogated from scientific surgery by making use of mechanical skill. Hereafter surgeons may do more in various other diseases or casualties : with regard to rupture, it is believed, that now all it- done that can be even desirable; that which has never been contemplated—a complete cure. Every benevolent heart will sympathize and re- joice with the author and inventor for a surgical im- provement now known and acknowledged as an ef- ficient remedy on the plan of prevention and the on- ly cure of a dangerous and distressing disease, one so common and so little attended to by scientific men that misery instead of comfort has been the result, from want of skill and ingenuity in adapting an in- strument. One is now offered and fearlessly declar- ed to be the desideratum of ages and the proved cures of hundreds. Whatever effect ignorance or prejudice may have upon the minds of individuals, the enlightened part of the profession will acknowledge, as an important acquisition to the healing art, an improvement which has already received the sanction and patronage of many of our most distinguished citizens: and what- ever should hereafter be the fate of the improvement it will ever be to the author a source of conscious pleasure, that it has already relieved much of the distress of his fellow-men, and no doubt preserved to their friends and the community many valuable lives TRUSSES. Among the various causes of human misery, few are productive of so much distress as the disease of Hernia. So long baffled in their attempts to cure the complaint, surgeons appear to have abandoned it to mechanics, and to have confined their research to the best mode of reduction and operation, with- out thinking it possible to obviate, almost entirely, the necessity of so difficult, dangerous and painful a resource. For the purpose of confining the viscera within the parietes of the abdomen,, many differently constructed instruments have been invented, but all without any reference to the anatomy, or physiology of the parts concerned ; and it has been a subject of serious regret that they have hitherto proved not only ineffectual, but, in their application to the body, distressingly inconvenient. If we investigate the cause of these difficulties, we shall find them to have resulted necessarily from the method usually em- ployed to fix the pad in a given position, and from >he form of this part of the instrument. It must be obvious to every individual, who is in the least acquainted with the mechanical operations of the human body, that any mode of fixture by an encircling belt, must be entirely inefficient; since it must be sufficiently tight to overcome the contractions of the muscles, and impede the motions of the body, or be liable to vary its pressure, and be flung from its position by their alternate contraction and relaxation. Not only h itie cicular bell, but other straps or ia^ieniugs air required to retain them upon the rupture opening. These always eveoriate and inflame the parts to which they are applied, and with all their compli- cation are inadequate to secure the protuding in- testine. These remarks are particularly applicable to the Truss recommended by Dorsey and Cooper, nor are '.hey the only objections which may with propriety be urged against it. The cue tuon being immoveable, except with the inolio:'- of the spring to which it is attached, is liable to be flung from the aperture in different positions of the body, particularly by those motions which call into action the muscles upon the outer part of the pelvis. The viscera are thus suf- fered to escape, and are liable to be caught and bruised between the pad and the resisting parts of the body. This has been acknowledged by sur- geons of experience, to be a very frequent cause of the most obstinate strangulation. To these objec- tions, however, the ingenious instrument of Salmon, Ody, &, Co. are sin exception; and from the honour- able mention they have lately rcreived, are deserv- ing of particular attention. In their mode of appli- cation they are similar to those ^e have presented to the public, and by some have been thought to be not essentially different: but a little attention to their construction, with a knowledge of their effects de- rived from experience, will be sufficient to convince any rational mmd, that notwithstanding they retain their position with a uniform pressure, they still ex- hibit a train of objections which ought for ever to prohibit their application. The pad of this truss, it will be recollected, is connected to the spring by a ball and socket joint, which is almost unlimited in the extent of its motion. This renders the pad which << oval and convex in its figure, liable, in particular motions of the body and aided by the force of the pro- truding intestines, not only to be rolled on its axis like a wheel, thereby losing its intended position, but to be rolled upon its edge. The gut is thus not only suffered to escape, but the integuments are bruised and injured by its frequent occurrence. This is not mere supposi- tion of what may happen, but is what does actually take place; and we have seen a most irritable excres- cence produced by the edge of the pad, thus bruis- ing the integuments, keeping them constantly inflam- ed, the patient in torture, and subjected to the dan- ger of strangulation. There is another difficulty which this instrument possesses in common with all others hitherto used, which, if possible, is still worse J ban that already described: 1 allude to the con- vexity of the pad, which resembles the bowl of a spoon, and is mechanically designed, though erro- neously, to £v:c-~3 into the rupture opening; thus con- stantly dilating the aperture, and increasing the dif- ficulty it was intended to remedy. The convexity of the pad of this truss is greater than most others in use. and is on that account proportiona bly objectionable. When this Tcuss has been applied,'and great pres- sure was required, we have seen the ring dilated al- most to the full size of the pad. It will be further observed, that a greater pressure is necessary to se- cure a rupture with this form of pad than with one which is flat or concave : for tho intestine always searching for an opening, meeting with this convex surface, is reflected from the centre, and when it can find the least aperture between the pad and the walls of the abdomen, will operate upon the princi- ple of the wedge to roll the pad upon its edge. With all these objections apparent, it is somewhat singu- lar, that a learned annotator in this country (though not a native) should have given the preference to this instrument. We are unwilling to think it was through any pre- dilection for the inventions of his own countrymen. 8 but suppose it to have originated from an entire want of reflection upon its pernicious tendency, and of experience in the proper mode of its application. This we are the more inclined to believe, as he does not appear to be aware of the evil consequences re- sulting from a convex surface applied to the rupture- ed part, and from the circumstance of the awkward manner in which these trusses are usually applied.* This instrument, invented by Salmon Ody & Co., is, we humbly conceive, intended to extend from the centre of the spine, round one hip, to the rupture opening upon the opposite side, and not, as most persons suppose to apply upon the nearest ring, with the spring playing loosely upon the hip, or turned up over the spine of the ilium, and " resting upon the soft muscles of the abdomen." A truss ap- plied in this manner is not only extremely awkward, but useless : awkward, because the form of the spring would be rendered more visible through the dress, and very troublesome in certain positions of the bo- dy : useless, because, without embracing the swell of the abdomen it would be constantly slipping from its positon. The double Truss of Salmon Ody & Co. is applied in a different manner from their sin- gle. It eonsits of two springs attached to a single pad which rests upon the centre of the spine. The rupture pad of each spring applies to the nearest abdominal ring. To retain them in this position, it is found necessary to connect the two pads by means of a strap passing from one to the other. This pre- vents their receding from each other, which any person can perceive would evidently be their ten- * It is proper to notice that this gentleman having since the first edition of this work, obtained a knowledge of the true merits of this in-trument has most ingenuously acknowledged his conviction of its superior advantages. lJ dency, from the slope of the parts upon which the pads are placed. The same would be the tendency of the single Truss, if applied in the manner usually recommended. I cannot here omit to mention the restless efforts of mechanics, who, while totally ignorant of the object to be attained, are torturing their inventions to com- prehend ingenious principles of mechanical action; resulting in a troop of a utomatons, obtruded upon the community from month to month and from year to year. With a view to obviate all preceding diffi- culties and to render the rupture pad less liable to slide fromjits position, Mr. Charles Reade of this city, some 10 or 15 years since, affixed the spiral spring very ingeniously between the pad and belt, for which he procured a patent. Since which, Mr. John Beath of Boston made some improvement on Mr. Reade's spiral spring,* and in fact spiral springs variously modified, have been used from the days of Benja- min Bell to the present time ; and, in the opinion of the author, arrived to their maximum in the hands of Mr. Reade. But spiral springs fixed to rupture plates, must, if they are allowed any action at all, inevitably tilt them upon their edges, than which nothing can be farther from answering the above in- tentions ; for the equal centre pressure looked for in them, is uniformly defeated by their constant liabili- ty to be thrown from it by the slightest impulse made * A most flagitious attempt has quite lately been made to revive the spiral spring as used by Mr. Beath, l>y a mechanic of Norwich, in this state, calling himself Bela Farr. Now it seems that this Mr. Farr has added Reade's spiral spring, precisely on the plan of Mr. Beath, to my entire truss ; thinking, no doubt, by this sub- terfuge to cover a silly misbegotten claim to originality ! in which he has so far succeeded as to obtain a patent. The venal nature of this transaction will be readily seen by reference to Thatcher's Modern Practice, page 661. o w upon one side : a fact well known and confirmed by the complaint of ruptured persons who have worn them, as might naturally be expected in certain atti- tudes of the body and motions of the muscles. All which complicated mechanism, vague in intention and effect, hazardous and distressing in its progressive use, may now be dismissed for one based on experi- mental pathology, simple yet appropriate in con- struction—and at once palliative and curative in its progress : an instrument possessing the utmost perfection of mechanical principles for the treat- ment of hernia—and at this time of day predicated on the unprejudiced, authentic and highly success- ful experiment of medical men and thousands of suf- ferers, both scientific and illiterate. It is a matter of the deepest regret, that circum- stances of so much consequence to an unfortunate class of our fellow-men should have been so little attended to in the construction and application of the prevenlive means for the different species of Herniae : and that Trusses, combining so few of the principles which lead to the prevention of this cala- mity, and many of them evidently calculated to in- nease the difficulty and danger of the patient, should have obtained such general use, and been recom- mended in so many works of merit, which but tends to propagate error, and to prepetuate that obstinacy of prejudice for which the faculty are already but too justly distinguished. It was witnessing the above enumerated defects of all Trusses, and the dreadful effects attendant up- on rupture, which first led us to reflect upon the nature of the complaint, and to search for some more efficient means to mitigate the distress, and preserve the lives of our fellow-men. As a compensation for our research, is the gratification that we have thus fsr been enabled not onl\ to secure cverv instance of reducible hernia, but to restore to perfect health a great proportion even of very aged sufferers. In the almost innumerable cases of children when this instrument has been applied, not a single instance has occurred, (within our knowledge,) which has not been cured in less than eighteen months, and few have exceeded six. In opposition to the opinion of all surgeons, it is found by experience, that there is no necessity for continuing the application of the Truss during the night.* On the contrary, we have thought a cure was hastened by the rest which the muscles obtained while the patient is in a recumbent posture. In this position there is little chance for the descent of the bowel, and even if such an occurrence take place, there is no more foundation for the assertion of Mr. Cooper, "that all hope of a radical cure is destroy- ed in a moment," than there was formerly for the opinion, that the least motion of a fractured limb would destroy the whole progress it had made in uniting. The qualities we have united in the Truss, are equally applicable to every species of Hernia, and we can say, without the fear of contradiction, that the proportion of cures it has effected is altogether unparalleled. It may, perhaps, be an interesting in- quiry to some, how this instrument produces its ef- fects ; and we think, after considering its construc- tion, this question can be answered to the satisfac- tion of every rational mind. It will be observed, that this Truss presents a concave surface to the rupture opening. The concavity of the plate is oc- cupied by an elastic cushion, the resistance of which * For the safety and convenience of those who may fancy it ne- cessary to wear any thing in the night, the author has invented a Nocturnal Truss, so modified as to maintain the same principle. IJ is sufficient to reduce the protruding intestine while it is prevented escaping to any considerable distance by the pressure of the metallic plate. Which pres- sure being greatest at the circumference and diminish- ing toward the centre tends constantly to approxi- mate the hernial parietes and afford them res.t and mechanical support. It is therefore obvious that noth- ing is suffered to intervene between thelips of the open- ing, as is the case when the intestine protrudes, or a convex pad is applied, but a fair opportunity is pre- sented for the fibres to recover their tone, or to heal; when any laceration has been produced by violence done to the parts. It is a law of the animal economy, particularly noticed by Dorsey, that all hollow parts of the body, have a tendency to adapt themselves to their contents. For the cure of Hernia then, it is only necessary to remove every obstacle which counteracts this ten- dency. This indication is certainly very far from be- ing answered by the convex pad, and we think it can only be fulfilled by one which shall reduce the bowel without dilating the ring; with this view, we have applied the concave pad, which has more than answered our expectations, in preventing a decent of the gut, and in restoring the fibres, which it undoubt- edly greatly facilitates by its constant and uniform pressure. But without investigating the modus operandi, it is sufficient for the patient, and for all practical purposes, for the physician to know, that with this instrument Hernia may always be secured. If applied in cases of umbilical, or congenital Hernia m children, it will in every instance, remove the ne- cessity of an operation. In cases of congenital Her- nia, it should be applied before adhesion takes place but not until the testicle has made its decent. If this particular period should be more carefully observed nv surgeon-, and the application of the Truss (in- 13 stead of being abandoned to mechanics) receive a greater share of their attention, they might be instru- mental in obviating much of the distress which has been entailed upon the world. It is a fact well known to the profession in the County of Oneida, and has been a subject of con- gratulation in their Medical Society, where the Truss was invented and first brougnt into use, that from the year 1800 to '819 from three to five per- sons were annually the subjects of operations from strangulated Hernia: and that from the year 1819 to 1822, not a single case had occurred within the knowledge of any individual member of the society. This surprising alteration was attributed, solely, to the general use of the instrument now under consid- eration. With all these facts before the public, we are sor- ry to observe, that many of the faculty are still de- termined to be sceptical, and to persevere in giving the preference to the convex pad. It is a knowledge of this fact, and we trust, a just sense of the duty we owe to the public, which has iiduced us to make so many observations in recommending our own im- provements. We are not unconscious that the mali- cious may attribute it to a less worthy motive; but as we have thus far, (in introducing what we con- sider a valuable instrument,) had the mortification to encounter the sneers of our brethren, and the inde- pendence to disregard them, we shall not probably at this late period, shrink fron the task assigned us, i4 through fear to cope malicious censure.'''' A. G HULL. MODE OF APPLICATION. After having stated the manner in which we con- ceive this Truss produces its effects, and the autho- rity in testimony of its superior utility, we deem it important to make a few remarks, particularly re- garding its aplication. This is the more indispen- sable, since surgeons, who alone are. sufficiently ac- quainted with the different species of the disease, the anatomy of the parts, and the proper adaptation of the Truss, have abandoned their charge to apo- thecaries, and men entirely ignorant of the com- plaint. We also find that the most ingenious sur- geons, misguided by tic instruments formerly in use, and forgetting the important principle, that the pres- sure should be made perpendicular to the rupture, have \ ery frequently applied them upon the wrong side of the patient. In this manner the spring pro- jects some inches beyond the body, (unless it is much smaller than it should be when properly ap- plied) making a very unseemly appearance, and by flinging the pressure upon the edge of the pad, de- stroys the principle of the instrument. For the pur- pose of rendering these instruments less liable to be wrongly applied, these remarks are accompanied with a plate representing them as adapted to the different species of Hernia. H—represents the umbilical truss ; A—the situation of the rupture pad in umbilical Hernia, resting with its centre directly over the rup- 10 lure opening. The spring of the pad passes close to the side, as represented by the plate. D—represents the situation of the back pad upon the centre of the spine in corpulent persons, but a little beyond on spare or emaciated.* 1—is a representation of the Double Truss, when upon' the body the principal part of the pressure is made upon the end pad, C; that should, therefore, be applied to the worst rupture. The degree of pressure upon the second pad, B, is regulated by a cork wedge, which is made to slide between the main spring, and small spring, to which the second pad is attached. The application of this Truss is represented by the letters K B C. The back pad resting upon the sacrum, as shown by the letter E. The rupture pads should apply immediately over the rupture opening, the lower edge just touching the edge of the pubis. The spring should pass in a horizontal line, and be neither so large as to be in- convenient, or so small as to press upon any part of the body. The force of the spring should be suffi- cient to keep the gut always reduced. The greater pressure the patient can bear, the more perfect is his security, and the greater the prospect of radical cure. G—represents the single Ing. Truss; it differs in no respect from the double, witrmut the addition of the second pad. If the'rupture be in the right groin, this Truss comes on from the left side, as represent- ed by K. And the same Truss reversed for a rup- ture in the left groin. Fig. F—represents the instrument as applied in femoral Hernia. The curve in the spring at F, is * Except in cases where the greatest pressure is required, the counter pad should be made to rest on the muscular cushion on each side of the spine. lb for the purpose of dropping the rupture pad lower in the groin, while the back pad retains the position E In these cases it will be generally found neces- sary to turn up a little the upper and lower edge ot the pad to prevent its chafing the integuments ol the abdomen and thigh If proper attention is paid, it will be dirhcult to mistake the application of this instrument. The one first applied may not be the best adapted, but the opportunity afforded of trying the several degrees of pressure will at least secure the rupture, if it does not go to the extent of cure. PERSPECTIVE VIEW OF THE TRUSS The great desideratum in all improvements of me- chanical instruments, is to make a paramount com- bination of simplicity of structure and facility of ef- fect. The Patentee respectfully invites the attention of all persons versed in the surgical anatomy of the parts concerned, to the following brief exposition of the dis- tinctive merits of this Truss. Firstly.—The concave internal surface of the rup- ture pad ; from its pressure being greatest at the cir- cumference, tends constantly to approximate the her- nial parietes, affording them rest and mechft£ic$L support. 5J| Secondly.—The combined hinge and pivot mocre ofcQnnection between the spring, and pad, by means of a tenon and mortice so constructed as to preserve a double hinge and limited joint, acting in every di- rection , thereby securing the uniform pressure of the spring on the pad. and sustaining the same nic«* 17 coaptation of the pad and rupture opening, as well under the varied ordinary desultory muscular ac- tions, as when the body is in a recumbent posture. Thirdly.—The graduating power and fixture of the pad to the spring, rendering, as will be readily per- ceived, the position of the pad perfectly controlla- ble, even to nameless minuteness. Also resulting from this mechanism, is the advantage of accommo- dating a large truss to a small person : hence the facility of supplying without disappointment, persons at a great distance. Fourthly.—The Double Inguinal Truss; being simply the addition of another pad, attached to a short elastic metalic plate ; this plate with its pad move on the main spring by the same power of ad- justment and fixture as the first pad, the pressure of the pads Nbeing graduated at pleasure by an inter- vening cork wedge. Thus, dismissing all the complicated mechanism of straps, belts and spiral springs hitherto used, and but too often ineffectually used, is this distressing class of hernia managed with the same ease and cer- tainty of success as the single rupture ! In the investigation of the virtues of this instru- ment, it is with the utmost assurance that we advert to several years successful experiment, the only true basis for assertion :— And hence the Patentee hesitates not to affirm, that, in combining its qaulities, such advantage has been taken of mechanical principles, as to leave neither necessity nor possibility of improvement. Late accounts from professional men, as well as my numerous agents, together with my own expe- rience, w arrant the highly interesting and auspicious conclusion, that the complete cures which are effected on persons from 10 to 15 years of age—may with safety be computed at an average of 1 in 3—and universally on children ! An account of some of the most strik- ing instances of cure on aged persons is annexed. 18 I he Patentee is iruly gratified that the success of his Truss has given them an introduction to the navy and army of the United States. The approval and recommendation to general use by the Medical So- cieties of the State of New-York, and by many of the most respectable Medical Institutions, as well as medical practitioners in this and most other states, should be sufficient. As further evidence of the superior merits and growing utility of the patentee's Truss, in addition to former certificates, he takes pleasure in presenting to the public the following late testimony. Extract from the Minutes of the Medical Society of the City on ft- County of .Ycic-Vork, May 10, 1821. FELIX PASCALIS, M. D. from the committee, (consisting ot VALENTINE MOTT, M. D. JAMES R. MANLEY, M. D. JOHN C. CHEESEMAN, M. D. and J. KEARNEY RODGERS. :M. D.) to whom was referred Doctor A. G. HLLL's communi- ■ n and Trusses, reported favorably of the same, and a copy of said report was ordered to be furnished to Dr. Hull on applica- tion. COPY OF REPORT. The Committee to whom was referred the communicatijn ol Dr. Hull, respectfully report. That they have examined with a considerable degree of atten- tion various models of the Truss of Dr. Hull submitted to their in- spection, and give it as their opinion that this new kind has the fol- lowing advantages over all other Trusses known to your commit- tee, viz : It has ahingc motion in place of the simple pivot motion' which obtains, in all the most approved of the kinds. The shape of the pad itself being rather concave than convex, presents ad- vantages that must be obvious to the attentive surgeon, inasmuch as its pressure is made upon the side of the ring rather than upon the centre of the Hernial Tumour itself, but perfectly safe ; and.in case of double Hernia requiring double pad in one Truss, the fix- ture of a wedge sprir.i. in order to graduate the pressure of the nearer pad has hitherto been considered a great desideratum in all kinds of Trusses, and gives to this a manifest advantage over all others that have been or continue to be in use. All which is re- spectfully submitted. ' (Signed) FELIX PASCALIS, Chairman. Ww-York, May 7. 1f;i2i. 19 Extract oj a letter from Dr. Caleb Samson, enclosing the certificate of the members of Oneida Medical Society, and other well known gentlemen, whose names have been given in recommendation of the Instrument. New-Hartford, March 24th, 1821. Dr. A. G. Hull—Dear Sir—Having known several complete cures effected by your Hinge Truss, I cannot conscientiously omit nny endeavours to extend its use. It unites, to a degree hitherto unknown, the useful qualities required in an instrument of this kind. The enclosed certificates of the members of the Medical Society of this county, does not derive its value from its number, but from the worth of the signers; to which I add with great pleasure, the concurrent opinion of many of our most distinguished citizens, and am with sentiments of esteem and respect, your obedient, CALEB SAMSON, M. D. Certificate of the members of Oneida Medical Society. We, the undersigned, members of the Medical Society of the County of Oneida, sensible of the indefatigable exertions of our President, Dr. A. G. Hull, in inventing and bringing into use his valuable Truss.: and repeated instances having come within our knowledge, of its effecting radical cures on very aged people, who had been ruptured the greater part of their lives, render it, in our opinion, superior to any other introduced in Europe of Ameri- ca. We most sincerely congratulate the public on an improve- ment so well calculated to relieve the distressed, and to save the lives of many valuable citizens. ARBA BLAIR, V. PresH. JOSIAH NOYES, Prof, of LAURENS HULL, Del. Chem. Ham. Coll. SETH S. PECK, Secretary. SEW ALL HOPKINS, SETH HASTINGS, Jun. Tr. MARCUS HITCHCOCK, ELNATHAN JUDD, ) SETH CAPRON, CHARLES BABCOCK, > Censors. CALEB SAMSON. EZRA WILLIAMS, tin. 11 :, \ Ce Certificate from the Hon. Ezekiel Bacon, Hon. Morris S. Mitten, Hon. Nathan Williams, Hon. Thomas R. Gold, Hon. W. Kirkpa- trick, and the Rev. S. C, Aikin. We are happy to join with the above gentlemen of the faculty, in congratulating the public on an invention so beneficial to the community as Dr. Hull's Truss—are gratified to state, that we are acquainted with the fact, that a number of aged and respectable 20 citizens of our vicinity, from the use of this instrument have ex perienced radical cures ; and that the unfortunate class ot people labouring under the distressing disease of rupture, are presented with flattering prospects of rehef and cure, from the use of the same. EZEKIEL BACON, THOMAS R. GOLD, MORRIS S. MILLER, NATHAN WILLIAMS, W. KIRKPATR1CK, S. C. AIKIN. <* ■ The following is from the undersigned Professors of the College oj Physicians and Surgeons of the Western District, Fairfield, New- York. This certifies, that we have examined the Patent self-adjusting Hinge Truss, invented by Doctor Hull, and have no hesitation in stating, that in our opinion it is far superior to any now in use. A simple mode of application, a constant, easy, and an effectual pres- sure on a given point, without liability to be displaced, or to impede the free motions of the body, are qualities which it unites. These are qualities not to be found in the ordinary kinds, and which entitle his invention to the entire approbation of physicians, and to the notice of the public. College of Physicians and Surgeons of the Western District Dec. 1818. JAMES HADLEY, Prof. Chcm. Jcr. WESTEL W1LLOUGHBY, Prof. Obstets. Extract from the published transactions of the New-York State Med- ical Society—Session 1823. " The Committee report, that from an examination of Dr. A. G. Hull's Truss, that they have no hesitation in stating, that from the entire new principles on which it acts, with the effective qualities which it unites, it is far superior to any other in use, and, in their opinion, is entitled to the entire approbation of Physicians, and the encouragement of the public." Jin extract of a letter from Samuel L. Mitchell, M. D. LL D F. R. S. Dr- JJull: New-York, April, 7th, 1823. Dear Sir—Since you have brought me an introductory note from one of the first gentlemen, a good friend, from Oneida county, I sought opportunities of hearing your discourses upon rupture and the mode of moderating and removing it by the mechanism of ■ your invention. I have been on several occasions highly gratified 21 by the manner in which you presented and explained the disease and the mode, not only of making patients comfortable, but sound and well, by your remedial apparatus. From the combination of physiological science and mechanical skill displayed in its construc- tion and use, I am satisfied it ranks among the very valuable aids to lessen human misery. SAMUEL L. MITCHELL. Extract of a certificate from Valentine Mott, M. D. Professor of Sur- gery, University of New-York. I have paid considerable attention to the construction of Trusses, and it gives me pleasure to state, that the Truss invented by Dr. A. G. Hull, possesses in my opinion advantages over every other in- strument of the kind with which I am acquainted, experience has confirmed me in the utility of this instrument which is indeed the only true test of its merits. Dr. Hull is entitled to the thanks of the public for having directed his attention to the construction of this instrument; possessing professional knowledge united with mechanical ingenuity would alone entitle his invention to the no- tice and regard of his surgical brethren. Extract of a certificate from Nathan Smith, M. D. C. S. M. S. Lon- don, Professor of the theory and practice of Physic, Surgery, and Obstetrics, Yale College. This may certify, that I have examined Dr. A. G. Hull's self adjusting Patent Hinge Truss, and* have applied it in several cases of Hernia. From my knowledge of the principle on which it acts, and from its effects, I do not hesitate to give it a decided preference to any thing of the kind I have ever seen. NATHAN SMITH. Copy of a Letter from Samuel R. Marshall, Hospital Surgeon, Uni- ted States Navy, New-York, to F. Le Baron, Esq. Apothecary General, United States Army. Dear Sir—This will be handed you by Dr. Hull, the inventor of a Truss which promises to be extremely useful in every species of Hernia. It is, in my opinion, so far superior to all the Trusses hitherto used, that I have determined to make use of them in all the United States ships, which may be fitted out at this port. As a production of American ingenuity,, it is entitled to a fair trial; and I am persuaded you will take pleasure in affording it that justice, by employing it in the army. With great respect and esteem, I amy Dear Sir, truly your obedient servant, SAMUEL R. MARSHALL New-York, June 24, 1819. 2'2 Joseph Lovell, Surgeon General ■*>/' the U. S. Army Since the above, Joseph Lovell, Esql Surgeon General of tin United States, has, in his public capacity, sanctioned these Trusses, and given to them his professional recommendation. A letter from Doct. John F. Gi ay. Dated University of the State of New-York, Feb. 25th, 1825. A. G. Hull, M. D. SIR, allow me to acknowledge myself highly gratified and much enlightened by your discourse on medical science generally und hernia particularly. In seeking these opportunities during a few months stay in New- York, my attention has been by you directed to the surgical anato- my of the different hernial channels, as well when deranged, as when in situ naturale. And to the tendency of this texture to re- sume its healthy function, on being relieved from overdistention on being mechanically supported. Collateral with the conviction of these facts, is the truly grateful impression, that your Truss is preeminently (and I hesitate not to say, perfectly) well calculated to answer these intentions. I am happy to inform you that professor Mott of the University of New-York, developed these points in a characteristic manner, at once simple and profound ; and concluded his public course on hernial, after carefully canvassing the merits of others, by unequiv- ocally recommending your Truss as the only safe resort in reducible hernia. To a mind formed like your's", ever assiduous in abbreviating the sura of human suffering, it must be no mean solace to see this impor- tant acquisition to surgery—addressing itself to the investigation of men of high rank and attainments, and I hail it as an era in pre- ventive surgery, an era—which must elicit the gratitude of genera- tions yet unborn. With such sentiments permit me Dear Sir to tender my most grateful acknowledgements. Amos G. Hull, M. D. Dear Sir—Since our interview at my house, I have the satis- faction to inform you that I have been cured of a rupture of 15 years continuance by the use of your Truss. 1 found on the first tri»l that it was more effectual in retaining the bowel than any in- itrument I have ever used. I soon found that a favorable change had taken place and I supposed myself cured-. About this time I was reduced very low with Typhus fever, as I began to recover I agam found appearance of the rupture. I applied the Truss again and in a few weeks found myself cured. I continued the instru- ment about one year when I left it off and for the last three years 23 have been quite tree from the complaint. I am respectfully your Friend and Sevt. SAMUEL B. WOODWARD, M. D Wethersfield, (Conn.) Jane 1, 1824. Extract of a certificate from Dr. Sa nuel Osborn. Since I have become acquainted with the Truss of Dr. Hull, I have not known a case of rupture but could be satisfactorily se- cured by that instrument, and with a reasonable prospect of a com- plete cure. I have never seen any other form of pad adequate to those intentions, nor have I ever before or since the introduction of Dr. Hull's form of patf, and hinge joint, graduating motion at will, heard of or seen a suggestion of a similar thing, except such as have been made in imitation of his, with variations to evade his right or claims ; and those variations such as to impair the useful- ness of the instrument. New-York. April 29, 1824. ' SAM. OSBORN, M. D. Certificate of Dr. Hunter. It is with peculiar pleasure that I can say that my experience in the use of Trusses for many years in Europe, and for the last five years in America, has made me acquainted with the superior advan- tages of Dr. Hull's Patent Truss over all others that I have heard of or seen. A striking instance of a radical cure under my own in- spection, was effected by the use of Dr. Hull's instrument, on two .cases of bad scrotal hernia in less than one year, after a long and in- effectual use of the Racket Truss approved by the celebrated Dr. Lawrence, and the Ball and Socket Truss of Salmon, Ody, & Co. London. New-York, October 27, 1824. WM. HUNTER, M. D. Dr. A. G. Hull, Dear sir__My partner, Dr.-Nash, has been ruptured from his infancy up, and found no effectual means of relief till he applied your Truss, and says it has been one of the greatest comforts of his life, and to all appearance has effected a cure. DAVID HULL, Fairfield Con. Copy of a letter from Mason F..Cogswell, M. D. to the Patentee. Doctor Hull, Hartford, July 23, 1819. Sir—It is with real satisfaction I comply with your request, in living my opinion of your improved Trusses. The simplicity of their construction, the facility with which they may be applied. nnd their perfect adaptation to nil the variety of cases wiHch may 24 -xxui, render them tar superior to any thing of the kind 1 have ever seen. I have witnessed their efficacy in a variety of instan- ces, and do not hesitate to recommend them, in the strongest terms, to the public use and patronage. MASON F. COGSWELL. We hereby certify, That having attentively examined the im- proved Trusses of Doctor A. G. Hull, feel fully warranted in re- commending them as greatly superior to any others now in use within our knowledge. ALEX. COVENTRY, M. D. JOHN McCALL. M. D. Utica, April 6, 1822. Extract of a letter from Dr. C. Stockman. New-York, May 1, 1824. 1 do hereby certify, that for six years I have witnessed the sur- prising and admirable effects of Dr. Hull's Patent Truss. Many unfortunate sufferers have been rendered by that instrument not only Yjasy and secure from strangulated Hernia, but have obtained a complete and happy cure. The qualities which the Doctor has happily combined in his instrument, I believe to be his original in- vention, affording an appropriate adaptation to the anatomy of the parts, on true surgical principles. Its beautiful simplicity bears the stamp of genius, aud, in my opinion, cannot be altered to advantage. I confidently believe that it has never before been adopted, and only by him brought into successful operation. CHRISTIAN STOCKMAN. Certificate of Dr. B. Coe, President of the Oswego Medical Society. As a practitioner of physic and surgery, I have made a thorough trial of Dr. Hull's patent Trusses, and am convinced, from the number of permanent cures of ruptures effected by them under my own inspection, that they justly claim a decided superiority over any thing of the kind hitherto invented. Thefiollowing certificate relative to the Patentees Truss, is from the Honourable, the Vice Pressident of the United States. Dr. Hull Has been highly beneficial tome and in truth, saved my life by his advice and remedy. DANIEL D. TOMKINS. 2r» Extract of a letter from, Wm. Thornton JEsq. • Much gratification is expressed by the Patentee in being able to state from so respectable a source as the Patent Officer of the United States, (Dr. Wm. Thornton,) extensively known as an able artist and a competent judge of mechanical and machinic improve- ments generally, and particularly qualified as a scientific Surgeon, to appreciate improvements for Suigical use, that with some trivial alterations in the mechanism of my Trusses, (which has already been embraced in my latest improvements) "They are the he*i Trusses that ever were made by man." Extract of a letter from Dr. S. S. Peck, of Whitesboro' Dr. Hull.—Sir.—In addition to the numerous and distinguish- ed cures of rupture, effected by the use of your Truss, I state you a case that came under my care,—April 20th, 1818.—Visited Mr. Edmond Wells, afflicted with a Strangulated Hernia, attended with most alarming symptoms. Immediately after his relief, I di- rected him to you for a Truss. After using it about 18 months. he declared himself entirely cured; much to the surprize and satisfaction of himself and friends :—particularly as he was an infirm man, at the advanced age of 73, had laboured under his complaint many years : and used a variety of other Trusses with- out relief. SETH S. PECK. Whitesboro'. March 31, 1820. Oswego July 26th, 1823. Doctor A.G. Hull. Dear Sir—Permit me to inform you that I have been com- pletely cured of a very bad rupture by the use of your Patent Hinge Truss ; after the use of it one year I was to all appearance perfectly cured. It is now more than a year since I have discon- tinued the use of it and I find myself perfectly cured of the dis- ease. The firm and easy adaptation to the ruptured part and the probability of its effecting a perfect cure when timely applied, renders your instrument in my opinion one of the greatest impor- tance to the public. You r Obedient Servant, MATTHEW McNAIR. Hartford August 6th 1824- Doct. A. G .Hull. Sir—Being desirous of making further known to those afflict- ed with Hernia, the salutary effects produced by the Patent Hinge Truss of your invention, I would observe, that after having for ma- ny years used a Truss constructed on the most approved old prin- ciple. which produced no other good effect than erely sustain 2b int; the bowel, and being then more than eighty years of age 1 sp plied one of yours, after wearing which about six months I found myself perfectly cured, and I have the best reason to believe, it was effected by means of your instrument. I am of the opinion that your Truss cannot be improved on in principle, as to its utility in effecting cures, or in comfort to the wearer I am Sir yours, ISAAC BULL Oswego, August 28th, 1823. Doct. A. U. Hull. Dear Sir—1 have been for twenty years past much troubled, with two bad ruptures one in each groin. Eighteen months since I was advised to procure one of your Trusses. I procured one of your double hinge Trusses, which in the course of 15 months com- pletely cured one of my ruptures and relieved the other very much. Indeed I have, but little doubt but it would «ure that also (which was i \eiy bad one) if I should live a few years longer, I am now -eventy eight yearsof age. I believe that from the perfect adapta- tion to the ruptured part the ease with which it is worn, and the probability, and 1 may say almost certainty of its finally effecting a perfect cure, renders your invention one of the greatest import- ance to your fellow creatures. In fact I think a better instru- ment of the kind could not be invented. I remain your friend and humble servt. ELI PARSONS. We the undersigned, after having nearly abandoned all hqpes of obtaining any means of relief for the dreadful disease of rupture tvith which we have long been afflicted, have recently experienc- ed in the use of Dr. Hull's truly useful improvement, that ease comfort, and ability to labour, which by long experience in the use of other Trusses, we are confident cannot otherwise be found- and we esteem it as a circumstance of no trifling consideration that suchtan invaluable instrument canbe obtained. With grateful feelings we sincerely congratulate Dr. Hull on the ready adoption of his Truss, so highly and justly recommended by some of the most respectable medical institutions, and skilful surgeons of our country. We doubt not that every feeling heart will unite with us, and be highly gratified to have it in their power to encourage and extend the use of an improvement so admirably calculated to teuxTt,h^.mi!l?ri^S an<* reinove the danSers of this dreadful disease. JOHN MILES,New-Haven, JOEL HALL, Wallingford ISA AC GILBERT, do. NATHAN CHITTENDEN Guilford 27 A few of the most striking instances of cure are presented, as follows. Isaac Bull, Hartford, aged 82 years ; cured in less than one year. Aug. 6, 1824. Thomas Hath, Carpenter, New-York, cured in about 8 months July 1824. Col. Eli Parsons, Oswego, cured in 15 months—aged 78 years. August 21, 1824. Eli Bristol, Oneida, aged 65, cured in 2 years, after having been ruptured 30 years. Deacon Benjamin Maltby, Connecticut, aged 65, cured in six months. Dr. Nash, Fairfield, (Conn.) aged 40, ruptured from his infancy up, cured in 12 months. T. Smith, Deerfielrf, aged 78, cured in less than 2 years. William M. Cheever, Whitesborough, aged 40, cured in ten months. Edward Wells, Oneida, aged 65, cured in less than 2 years. Joseph House, Westminster, (U. C. ) aged 45, cured in less than one year, after being ruptured 25 years. A lady in Sangerfield, (N. Y.; cured of an alarming Femoral rupture in less than 1 year. Communicated by Dr. S. A. Mea- cham. An aged woman of Utica, cured of a large navel rupture in less than 12 months. Hon. Matthew McNair, Oswego, aged more than 40, cured in 1 year. " It is now more than one year since I discontinued the use of it." July 26, 1824. John Tilman, Utica, aged 65, cured in less than 10 months. H. L'Homedieu, of Catskill, perfectly cured in less than 10 months, aged 72. Several aged persons, of this City, who have experienced great utility and perfect cures. Reference to them may be had at this office. Also several aged persons of Brooklyn and its vicinity (L I.) who have experienced effectual relief and complete cures ; communicated by Drs. Ball, Wendel and Smith, Brooklyn, and Dr. Van Deveer Flatbush. Dr. Hull particularly invites the attention of females, to an Umbilical Truss, which he has recently invented and adapted to ruptures, at, or about the navel. Females and children being more commonly subject to navel ruptures, and therefore to them of great importance and comfort; being worn with perfect ease and effect, and without the aid of straps and bandages, so distressmgh inconvenient in those formerly used. The almost universal neglect of parents in regard to children afflicted with rupture is really melancholy, as the. unfortunate child m growing up !m manhood, is liable to linger out a pamlul exist- ence, or be hastened to an untimely grave. But parents may now 'earn that by a timely use of Dr. Hull's Truss, a perfect cure may be expected in all cases of ruptured children, from the earliest period to the age of fifteen years, and most generally in less than ten months. Amos G Hull. N. B. The above described articles are to be obtained at most of the Druggist's stores in this City and in the United States. The dealers, or those who wish to hecome dealers in the above, are informed, that they Ciin at all times be supplied in any quantity, af the oOW of the Patentee