J
STRUCTIONS
IN THE USE OF
THE PERFECT ADJUSTER:
i
ZIMRI HUSSEY, M. D,
Engravings	by N.	H. Taylor,	Chi	llico the,	Ohio " Lj. v., i
	CINCINNATI				
MARSHALL & LANGTRY,		PRINTERS,	NO.	3 PUBLIC	LANDING,
1854. 
          [ Entered according to Act of Congress, in the year 1854, by
                          ZIMRI  HUSSEY, M. D.,
in the Clerk's Office of the District Court of the U. States for the District of Ohio.] 
HUSSEY'S  PERFECT   ADJUSTER,
  No instrument, however  perfect its adaptation to the end proposed,
can supply the place of skill in the one who handles it;  therefore, in
presenting to the surgeon the "Perfect Adjuster," the inventor does
not propose to supersede the necessity for judgment and tact in its ap-
plication; but he does intend to furnish a complete apparatus to aid
the operator in the accomplishment of important purposes. 
 
ADDRSSS.
   The undersigned would respectfully say to the surgeon, that, having spent much labor and pains
 to bring  his Adjuster to a state of comparative perfection, he  now presents it for the  test of ap-
 proval.
   A careful examination of contrivances heretofore employed for the purpose of effecting extension
 and counter-extension, and for preserving coaptation of parts in the treatment of  fractured bones,
 and also for reducing luxations of joints consequent to the extremities of the human body, inspires
 the writer with confidence in presenting his apparatus for thorough disquisition.
   The present edition of "Instructions" is not offered as a treatise on surgery, but is  merely in-
 tended to illustrate the applications of the Adjuster, in  the hands of persons conversant with this
 branch of practice.  In order to present these various applications at once to the comprehension, a
 number of wood cuts are introduced, accompanied with references and brief explanations.
   Without speaking disparagingly of other apparatus in use, or pretending to have discovered  new
 principles in surgery, the inventor offers his Adjuster as one possessing a happy combination of
 mechanical principles, carefully adapted to the purposes it is intended to fulfill.
   First.   As an efficient extending and  counter-extending power, applied in a direct line with the
 shaft of the bone.
   Second.  With it the extension may be made rapidly or slowly—may be retained, or remitted
 gradually or immediately.
   Third.  While extension is being effected, the limb may be moved in any direction necessary to
 aid in reducing a luxation.
   Fourth. It furnishes ample facilities for preserving the points of extension and counter-exten-
 sion precisely at the desired limits, and  of maintaining, undisturbed, the  coaptation of parts.
   Fifth.  It is  so constructed that either half of the double-incliued plane is  a complete Adjuster
 for the part to which it is applicable—the upper half to fractures of the shaft of the femur, and the
 lower half to fractures below the  knee.
   Sixth.  It is  constructed with special  reference to the successful treatment of all cases of fractures
 and dislocations requiring extension and counter-extension;  and for effectually preserving the con-
 tact and correct position of parts in all fractured bones in connection with the lower extremities.
   An apparatus capable of exerting an  extending  force equal to almost  any emergency, com-
 bining in itself a well  adjusted  and  equal counter-extending fixture—with movements " gentle,
 continued and directed by the surgeon's mind "—can not fail to commend itself to an intelligent
 profession.  And when we duly consider the fact, that "it is now generally agreed, among the most
 eminent surgeons, that force should be  only gradually applied," we will be likely to draw the con-
 clusion,that the "sudden, violent, and often ill-directed efforts of assistants," should, as far as possi-
 ble, be dispensed with.  " For sudden violence is as likely to tear sound  parts as to reduce those
 which are dislocated; and it  is apt to excite all the powers of resistance in opposition to the efforts
 of the surgeon." (See Cooper on  Dislocations and Fractures, p. 67.)
   Another peculiarity of this apparatus is, that it is  furnished with metallic bands for the purpose
 of being passed  around  near the  ends of the splints, and securing them upon the limbs in cases of
 fractures of the long bones.  These splints being covered, are placed  directly upon the limb—two,
 three or four in  number—and fastened  by these bands at any required degree of tightness. This
 leaves the limb accessible to  constant inspection of its  condition, and affords  opportunity for
necessary  attention to flesh wounds and contusions, in cases where they occur.  These privileges are
allowed without any disturbance  to the apposition of fractured bones, or derangement of the limb,
 in any way—the splints being secure in their  places, and extension  and counter-extension main-
tained.  The importance of these advantages will be at once obvious to the experienced surgeon.
  The Perfefc<AdjusterJ0dnanufactured under njjr own supervision,^ Mr.ifenry Kriifrd^of Chilli-
 cothe, 0.—a praHMjajcmechanic of no ordinaJjQkill and experience—^Swj^will  be £j*rnishea\to the
 profession, andatfierp«rsons  interestedjj^ns distribution, on reasonajrfe teft»$juroin the best style.
  ChillicotheJV., June l&h,  1854. /^                        yS        zlSfUSSEY, M. D. 
# 
     THE  PERFECT  ADJUSTER.

EXPLAINED  AND   ILLUSTRATED  BY  ENGRAVINGS.
  Two methods of putting up the Adjuster, for sale, have been adopted,
as represented in the figures 1 and 2.  The first (fig. 1) is constituted
of two double-inclined planes, a, a, with movable foot pieces attached,
b, b: the inclined planes are connected at  their upper ends with a seat
piece, c. with a back, i, supported at any degree of inclination by braces,
                         [FIGURE I.]
g, g, and a rest for the  head, /.  Crutches, e, e, are attached to the
sides of the seat, capable of being lengthened, shortened or removed, at
pleasure.  Two semi-circular metallic braces, i, i, for inclosing the hips,
are  placed upon the seat piece, near the front  edge, secured by bolts
passing  through it and the upper ends of the inclined planes.  These
braces can be made fast at a greater or less distance apart—are concave
on their outer faces for the purpose of receiving straps, that inclose each 
8
PERFECT ADJUSTER FOR
a limb at the groin.   These straps are clothed with  pads that rest upon
the perinseum, and, with the braces they include, constitute  the princi-
pal counter-extending part of the apparatus.  For the purpose of effect-
ing extension of the limbs, a kind of shoe, k, k, incloses each foot at the
ankle, and is laced upon the  instep.   These are attached to the foot
pieces by straps secured around them.   There are also bands, m, m, for
effecting extension at the knees.   They are  buckled around  the limbs
just above  the knee joints, and are furnished with loops that inclose the
horns of the knee fork, more fully described hereafter.   The metallic
bands, I, I,  I, I, I, I, I, I, for  securing splints upon the limbs, are  passed
through loops upon the double-inclined planes, and fastened, at   any re-
quired  length, by sliding loops and screws.   Two  braces, h, h,  are at-
tached to the seat, each one adjustable to the os ilium immediately below
its crest, effectually to prevent rotating of the pelvis.  This precaution
should never be neglected in cases of  fracture of the neck of the  femur,
and is also indispensable where its shaft is broken obliquely and exten-
sively injured.
  The mechanical power employed  for effecting extension and counter-
extension, is fixed upon  the side of the inclined plane, as exhibited at n,
and will be illustrated and described hereafter.
  The  two double-inclined planes and the  seat are  furnished with
cushions, and, together with the  back and  other appendages  attached,
constitute a couch upon which the entire person may be kept perfectly
in line, if necessary, and upon which the cripple may be safely and con-
veniently moved from place to place, any required distance.
[ FIGURE II. I
  The Adjuster, in its single form, is represented by figure 2.   A block
is placed upon the tenon, at the upper end of the double-inclined plane,
to fit it for receiving the hip brace, strap and pad, for counter-extension.
The knee fork is adjusted to its place, and the shoe secured to the foot
piece.  The bands for inclosing the splints are also exhibited.   The hip
brace  and appendages for counter-extension are alike secure, fastened
right or left upon the inclined plane; making it applicable alike to the
adjustment of any limb. 
FRACTURES AND DISLOCATIONS.               9
  The double-inclined  plane  is  securely hinged together at the knee.
Each half is made of parts that slide upon each other, and are secured by a
bolt and screw at any desired point of extension—the extending power
being applicable alike to both the upper and lower half.
  The middle portion of the plane  is exhibited by figure 3, illustrating
the attachment of the knee  fork, and the manner (by dotted  lines) of
changing it from one to the other half of the double-inclined plane.
                            [FIGURE III.]
__f
J


-^
[FIGURE IV.]
When  fastened to the upper half, it is employed  to effect extension—
when attached to the lower half, to  secure a point of counter-extension.
                                        The knee fork is  delineated
                                     in figure  4.   When  used for
                                     extending the limb, it is made
                                     fast by bolt and screw, upon the
                                     lower end of the upper half of
                                     the plane, just above the joint;
                                     the base of the horns presenting
                                     in the direction of the foot, and
                                     the horns themselves at a right-
                                     angle with  the  upper side of
                                     the plane. The change, in order
                                     to attach it to the lower half of
                                     the plane, is sufficiently repre-
                                     sented in figure 3, and the man-
                                     ner in which it is made available,
in effecting extension and counter-extension, is fully presented in the
following pages.
  The mechanical power employed in accomplishing the  work of exten-
sion is  shown in figure 5, and called, in familiar language, the jack.  It
consists of  a brass box, half an inch thick, near an  inch wide and nine
    2
 
10
PERFECT ADJUSTER FOR
and a half inches long.   Near the left end of this box or case is a semi-
circular projection containing a pinion-wheel, with teeth matching those
in an iron rack bar—the latter  running the entire length of the case.
The shaft of the pinion-wheel projects without the case on one side, and
holds upon it  a ratchet-wheel, into the teeth of which the point of a
catch is made to drop by the pressure of a spring.   From the right hand
end of the box, and the left end of the rack bar, square projections will
be found  three-eighths of an inch long.  These projections fit into cor-
responding  openings  in the sides of the  double-inclined planes, both
above and below their joints.  Should you wish to make extension upon
the upper half of the plane, lay the brass case directly along and against
its side, with the projections fitting into the openings made  to receive

                             [FIGURE v.]
                                                         3
them;  place the lever upon the square end of the shaft protruding from
the ratchet-wheel—see that  the  bolt  passing  through the slot in  the
movable portion of this half of the plane is slack—turn the end of  the
lever round to the right, and the  plane will be lengthened.
  In the bulbous end of the lever will  be found a square opening, used
for unscrewing the head of the pin passing through the hinges that con-
nect the two halves of the plane.
  The Perfect Adjuster, in its double form (figure 1), with all necessary
appendages, is securely packed in a neat box, nineteen inches long, nine
and  a half inches wide and fifteen inches deep, and weighs, including
box, thirty-four pounds.  The Adjuster  in the single form (figure 2)
with the extending power, cushions, straps and all the fixtures belonging,
is furnished in a box seventeen inches long, nine and a half inches wide,
and less than four inches thick;  all weighing twelve pounds.
 
               FRACTURES AND DISLOCATIONS,


APPLICATIONS  OF  THE PERFECT  ADJUSTER,
ILLUSTRATED BY ENGRAVINGS.
[FIGURE VI.]
   In the treatment of oblique fractures of the shaft of the thigh bone,
 great difficulty has been experienced in preventing shortening and dis-
 tortion of the limb.
   The engraving above (figure 6) illustrates the application of the  Ad-
 juster for the purpose of effecting extension and counter-extension in the
 treatment of fractures of the femur.  Remove the lower half of the
 double-inclined plane, place the upper half  directly along and beneath
 the thigh—the hip brace and block being previously made fast upon the
 upper end, and the knee fork secured in its place—bring the strap up
 and over the perinseum (the pad being properly adjusted upon it), fasten
 it on  the button at the top of the brace, and buckle it on the outside.
 Buckle the knee strap and pad around the knee, just above the swell of
 the joint;  place two loops on each side, that come  nearest the center of
 the limb, upon the horns of the knee fork; adjust the jack upon the side
 of the plane, as indicated in the foregoing cut, and turn the lever steadily
 till the limb is restored to its proper length.  Now, take the wrench pro-
 vided for the purpose, and screw the brass tap beneath upon the bolt
 that passes through the slot in the center of  the sliding portion  of the
 plane, till the parts are made fast together—when the jack may be re-
moved.  In some cases of transverse, or nearly transverse, fracture of
the bone, it may be well for the surgeon, during the  process of  exten-
sion, to maintain, with his hand, the bone in a bent position, in the di-
rection to which it is inclined, and extend steadily till the ends of the
fragments mount upon each other, when their complete apposition should 
12
PERFECT ADJUSTER FOR
be established, the limb straightened and  done up as represented in
figure  7.
  As many splints as the surgeon may think necessary should be applied,
and  secured  as here represented.   A roller  bandage may also be used
in all cases where it is thought advisable, either with or without the me-
tallic bands.  The special object of their employment has been mentioned
heretofore.
                            [FIGURE vn.]
  The application of the lower half of the double-inclined plane, for the
purpose of accomplishing  extension and counter-extension, in cases of
fracture below the knee, is well represented in figure 8.
[FIGURE vni.]
  It will be perceived that the knee fork is here fastened upon the upper
end of the lower half of the plane, its point of attachment reversed from
what it is  in the preceding figure, and that, in this place, it  is used to
effect  counter-extension—the  padded  band being fastened around the
limb, and  resting against the swell of the knee below the joint, with its
loops thrown over the horns of the knee fork, standing upward upon the
limb. 
FRACTURES AND DISLOCATIONS.
13
  To accomplish extension, the broad band or shoe piece is laced around
the ankle, its straps passed around the sole or foot piece, and secured by
the pressure of a screw; the jack is then adjusted to its place on the side
of the plane, and the desired extension effected.  This being done, the
bolt through the plane is made tight, as before directed, and the extend-
ing power removed.  It now remains to dress the limb, as indicated by
figure 9, or in any other way that  may be better adapted to the special
case under treatment.  The mind of the surgeon should be fruitful in de-
vising expedients, and ready in the application of his knowledge to the
difficulties presented to the exercise of his skill.

                            [FIGURE IX.]
   The human extremities include  such  diversities in figure and general
 aspect, that the same splint can not be expected to fit the same part of
 every limb, though of the same length.   Some are straight, tapering and
 symmetrical, with joints smooth and free from protuberances.   Others
 are  flattened, bowed and unshapely, with  projecting angles about the
 joints.  It will  be found to require much  more address to apply the
 Adjuster properly to some limbs than to  others.   Every fractured limb
 should be restored to the form of  its fellow that  has not  been injured.
 And if both are broken, recover their original form as nearly as possible.
 Attempt to correct nature only in cases of real deformity.
   I  will here remark, that the method of applying the Adjuster, repre-
 sented in figure 8, will also  apply, with such modifications as the pecu-
liarity of special cases may indicate, to dislocations of the ankle  joint.
In compound dislocations of this joint, the  shoe  may be adapted to the
condition of the part by removing a portion of  the  upper half, or by
making such holes in it as will give access to the ruptured integuments
and ligaments.  In order to afford  opportunity for passive motion  of
the joint, let the extention be effected with  the  straps passing around
the foot-piece  so lengthened as to leave  an open  space  of an  inch be- 
14
PERFECT ADJUSTER FOR
tween it and the sole of the foot; have this space filled with  a roll of
muslin, smoothly folded.   When  passive  motion is desired, this roll
should be removed, and the motion of the joint made at the suggestion
of the attending surgeon.   A soft flannel  bandage,  or  other necessary
protection to the skin, is always admissible between the shoe and the ankle.
  The method of applying the Adjuster to effect extension of the whole
limb, applicable to cases of fracture occurring in  the leg and thigh at
the same time, is represented in figure 10.  It will  be perceived that
the knee fork is not used in this instance, and that counter-extension is
secured as in figure 6, and extension effected as in figure 8;  only that,
in this case, the extending  power is applied to  the  upper half of the
plane instead of to the lower.   This, however, is a matter of choice, and
makes no difference in the result.
                              [ FIGURE x. ]
  In applying the Adjuster to a limb, lengthen its parts  to suit that
limb; secure, in their appropriate places, the extending and counter-ex-
tending fixtures, tighten the bolt passing through one-half  of the plane
so that the parts can not slide  upon each other, apply the extending
power to the other half of the plane and effect the necessary extension,
then tighten the bolt through this half of the plane, remove  the jack
and dress the fractured parts as illustrated in figure 11, with such mod-
ifications as may be indispensable in the case being treated.
                            [FIGURE XL]
  In all important cases presented for investigation  or treatment, the
latent energies of the surgeon should be stimulated, and his reason and
judgment called  into exercise, that he may make the instructions fur- 
FRACTURES AND DISLOCATIONS.
15
nished by the  experience of others a part of his own  knowledge, and
apply that knowledge to the case before him, that he may be enabled
to overcome its difficulties.
   The double Adjuster, including the  appendages necessary to consti-
tute it a couch, with a person in it, is  represented by figure 12.   The

                            [FIGURE XII.]
method of effecting extension and counter-extension of the lower limbs,
has been illustrated and explained already, and need not here be re-
peated.  In order, however, to exemplify the applicability of the instru-
ment to difficult  cases, this cut  is introduced—representing a person
with his left thigh and right leg broken, and so adjusted upon the ap-
paratus as to allow of his removal from place to place, without danger
of disarranging the fractured parts, or retarding the progress of recov-
ery.
             DISLOCATIONS OF  THE  HIP JOINT.
  Before proceeding to illustrate the application of the Adjuster to lux-
ations of the hip joint, I will state that, when any violence is exerted
upon the bone of the thigh, adequate to the  removal of its head from 
16
PERFECT ADJUSTER FOR
the acetabulum, or socket, in which it rotates, it is generally thrown in
one of four  directions, from the  influence of muscles upon  the  part:
First, upward, or upon the dorsum of the ilium;  secondly, downward,
or into the foramen ovale;  thirdly, backward and  upward, or into the
ischiatic notch; and, fourthly, forward and upward, or upon the body of
the pubes.
   To effect  reduction of the first, where the head of the femur  rests
upon the dorsum  of the ilium—with the patient lying on his  back, the
knee of the  dislocated limb elevated about ten inches, and brought over
the other limb (which should lie  straight)  just above the knee—apply
the Adjuster as in figure 6.  In this  case, however, for  the support of
the knee and leg,  the lower half of the plane may remain in connection
with the upper. The extending power should be exerted  with  consider-
able force, at intervals, till the muscles become wearied, and the bulb is
brought upon the border of the cavity, when, by a  little increased ex-
tension and rotating of the limb, the bone will rest in its socket.
[FIGURE XIII.]
  To reduce the second variety of dislocation  of the hip joint, where
the head of the femur is thrown downward into the foramen ovale, take
the lower half of the double-inclined plane (the foot-piece and knee-fork
made secure upon it), place it across the back at the  hips, with  the toe
of the foot forward;  take two strong leather straps, an inch  or more in
width and of sufficient length, pass one of these around the  luxated
thigh, at the pudendum, and secure it over  the waist  of  the foot-piece; 
FRACTURES AND DISLOCATIONS.
17
the other, as a counter-extending force to preserve stationary the pelvis,
is passed completely around both ilia, secured upon the lower  horn of
the knee-fork and  rested upon the end  of  the plane; the extending
power  is  now adjusted on  the plane and extension effected.   (See
figure  13.)   The  extension  should be steady,  and accompanied  with
well-directed manipulation,  in order that the parts  may be promptly
adjusted.   During this operation, the patient  should recline  toward
the well side, the head and shoulders being supported.
   The means to be employed for reducing the third variety of disloca-
tion of the hip, where the head of the femur is  thrown backward  and
upward into the ischiatic notch, differ  but little  from those given for the
first, where the head of the bone rests upon the  dorsum ilii; but, in the
latter  case, the dislocated limb should be  brought  across the  other,
higher up. during the effort to effect reduction.   And, as this kind of
dislocation is very difficult to reduce, I would advise,  in addition to the
directions heretofore given for extending  the limb, the disconnecting of
the lower half of the double-inclined plane, and its application, in this
 case, precisely as illustrated and described in connection with figure 13,
 and the employment of the  extending power, alternately,  upon the two
 halves of the plane:  upon the one adjusted to the  limb,  for extending
 it—upon the one adjusted, as in figure 13, in  order to lift the head of the
 femur out of the ischiatic notch, and, together with the extension,  pass
 it over the edge of the acetabulum. These directions, strictly followed, with
 well directed manipulations, can scarcely fail to succeed in any recent case.
                              Figure  14 gives a front view of the appli-
                          cation of the Adjuster, as represented in fig-
                          ure 13,  with the  addition of a strap passed
                          over the  shoulder,  and  supporting  in its
                          place the extending part.
                             In the management of the  fourth variety
                          of dislocation  of  the hip joint, forward and
                          upward, or upon the  body of the pubes, ex-
                          tension  should be made as in figure 6, only,
                          that the knee should be  drawn some inches
                          downward, or back of the  line of the body.
                          During  the process  of  extension, a towel
                          should be passed  under the upper part of the
                          thigh, and, with the left hand  steadying the
                          pelvis, and the right  grasping  both ends of
                          the towel,  the head  of the bone should be
                          steadily lifted  over the pubes and edge of the
                         acetabulum, and restored to its cavity.
[FIGURE XIV.]
 
18
PERFECT ADJUSTER FOR
  In other anomalous dislocations of the head  of the  femur, the Ad-
juster is useful for the accomplishment of extension and counter-exten-
sion, and should be aided  by such manipulations and other assistance
as may be essential in the case under treatment.
     FRACTURES  OF THE NECK  OF  THE THIGH BONE.
  In the treatment of fractures  of the cervix femoris, hope of success
must depend  almost entirely upon  perfect apposition of the bones
being established and preserved till ossific union has had time to be ef-
fected.  It is not to  be expected that a bony connection will take place
in all, or most, cases of fractures of this part, even  under the most
favorable  circumstances.    Many reasons  are  furnished, by  surgical
writers, for this  general failure,  evincing a  good degree of plausibility.
In regard to the probability of effecting a cure, however, there is diver-
sity of opinion.
  So far as the management of these fractures is concerned, one purpose
should be kept steadily in view:  to establish ossific union wherever it is
possible.  To  this  end, place the  patient upon  the double Adjuster
(figure  1), the two double-inclined planes, the seat  and back pieces all
lying horizontally.   Secure the extending and counter-extending fixtures
upon the parts to which they are applied, on  both limbs;  adjust the
crutches in their places, having them both exactly of a length; introduce
the braces for the ilia (placing suitable pads between them and the parts
against which they rest), and so establish them  as effectually to prevent
rotating of the pelvis. Now see that  the whole person is perfectly in
line; apply extension first upon the well  limb till it is tense; then
extend the fractured limb till it is precisely  the length of the other; place
a suitable girth or  strap, three  inches in  width, around the  body di-
rectly over the hip  joints, and secure it sufficiently tight to maintain a
firm apposition of the fractured bones.  The well limb may now be liber-
ated, and the crutches removed; but the pelvis must remain fixed, with
extension upon  the  fractured limb.  In  cases where  it is necessary to
continue extension  and counter-extension  for a considerable length of
time, extension  may be made a part of the time at the knee, and then
changed to the foot. 
FRACTURES AND DISLOCATIONS.
19
          APPLICATION  OF THE ADJUSTER
TO  DISLOCATIONS IN CONNECTION WITH  THE SUPERIOR EX-
                          TREMITIES.
ILLUSTRATED BY ENGRAVINGS.
[FIGURE XV.]
  The application of the Adjuster for reducing luxation of the shoulder
joint, is shown in figure 15.   Take the upper half of the double-inclined
plane, with the block, hip brace and knee fork secured in their places upon it.
Lay the plane directly along the back of the arm, with the hip brace passing
forward over the shoulder; bring the strap round under the arm (the pad
resting against the body) and make it fast upon the brace.  This much for
counter-extension.  Fasten a leather strap—provided for that purpose—
around the arm just above the elbow, with a loop furnished for that ob-
ject, and buckle the ends  over  the  horns of the knee fork ; apply the
jack, and  extend, as indicated.   While extension is going on, the arm
may be moved freely in any necessary direction.  Extension may also
be immediately remitted.
                          [FIGURE XVI.]
   The use of the Adjuster in dislocation of the elbow joint is presented
in figure 16.  Counter-extension as in figure 15;  the point of extension
just below the elbow, the arm a little flexed.  The  illustration is so plain.
that a lengthened description is deemed unnecessary.  The mode of ap-
plication for extending the arm at length, is given in figure 17. 
20
PERFECT ADJUSTER
  The double-inclined plane is here employed entire.  The inside of the
arm is presented to view.   Counter-extension as in the two figures  last
preceding.   Extension at or below the wrist joint.  Applicable to dis-
location at the wrist, and also to fractures anywhere between the shoulder
and wrist joints.
                           [FIGURE XVII.]
  As an illustration of  the applicability of  the  Adjuster for extension
upon the phalanges, figure 18 is introduced.
  It is not designed, on any occasion, to continue the apparatus  upon
the superior  extremities; other  appliances  being deemed sufficient  to
maintain the  proper position of the parts, when once restored.
[FIGURE XVIII.]
  My purpose is not to enumerate the variety of fractures and disloca-
tions to which the Adjuster may be advantageously applied; but to illus-
trate its adaptation to such a deversity of cases as will enable the skillful
surgeon to employ it efficiently in almost any case requiring extension
and counter-extension; and effectually to preserve the coaptation of parts
in the  most difficult  cases of fractures.   How far  this purpose is  now
accomplished, others  will decide.