Critical Remarks 
UPON THE 
Misstatements as to Interdental Splints 
IN THE 
SURGICAL TREATISE 
OF 
Professor D, Hayes Agnew, M, D, 
BY 
THOMAS BRIAN GUNNING, D. D. S„ 
NE'V YORK. 
Reprinted from the New England Journal of Dentistty 
April, 1884. Critical Remarks 
UPON THE 
Misstatements as to Interdental Splints 
IN THE 
SURGICAL TREATISE 
OF 
Professor D, Hayes Agnew, M, D, 
BY 
THOMAS BRIAN GUNNING, D. D. S„ 
NEW YORK. 
Reprinted from the New England Journal of Dentistry 
April, 1884. REMARKS. 
34 East 21 st Street, 
New York, November 26, 1883. 
Po D. Hayes Agnew, Esq., M. D., L. L. D., Professor of Surgery in 
the Medical Department of the University of Pennsylvania. 
Sir : In the preface to your recently completed work, “ The Prin- 
ciples and Practice of Surgery,” you say: “ In the composition of 
its pages, while I have expressed my own views independently on all 
subjects, I have also endeavored, as far as was consistent with the 
scope and limits of the work, to record those of other writers, not 
only that the student and the practitioner may be made familiar with 
the literature of their profession, but also that they may be able in 
their observation and practice to contrast different plans of treatment, 
and in this way draw their own conclusions in regard to the relative 
merits of the various modes of managing surgical disease. Whatever 
may be the defects of the work—and none can be more sensible of 
these than myself—I have endeavored most conscientiously to furnish 
a safe and reliable guide for the surgical practitioner.” 
With this in view, those for whose instruction you wrote could not 
suspect that the work contains statements which are untrue, and mis- 
lead in regard to the treatment of any important injury. Yet the 
section on “ Fractures of the Inferior Maxillary Bone ” contains such 
statements. To give a clear understanding of the matter to you, and 
to all who may read this letter, I quote from your article verbatim and 
remark upon the misrepresentations. In Vol. I., page 846, you refer 
to the interdental splints devised by me and used in treating fractures 
of the maxilla, as follows : 4 
“Among the simplest of Gunning’s splints are the forms shown in 
Figs. 642 and 643, which receive all the teeth of the lower jaw, 
Fig. 642. 
Gunning’s Interdental Splint. A 
points to perforations for injecting 
water. 
Fig. 643. 
Gunning’s Interdental Splint. 
extend a short distance over the gum, and have perforations through 
which to throw a stream of liquid for the purpose of cleanliness. 
This splint when placed in position forms a cap, and is kept in place 
by securing the jaws together with a bandage, or by means of screws 
passed between the teeth.” 
Now my splint No. i (your figure 642), was expressly devised to 
be used without a bandage; it holds the fragments of the jaw in 
place by means of the teeth without anything external to the mouth, 
and it allows the jaw to move and to be used in eating and speaking ; 
and this form of splint is adapted to the large proportion of fractures 
of the maxilla. If the patient can be depended on, never, however, 
if a child, this splint may in many cases only be fitted to the teeth, 
and without screws in or between the teeth, or any ligatures, the frag- 
ments of the jaw will be held firmly together. For in eating or in 
closing the splint against the upper teeth the muscles carry the broken 
jaw up and keep the fragments in place, the muscles and the sur- 
rounding soft parts forming a counter support to the interdental 
splints. 
This splint, No. x, was first applied on February 12, 1861. It was 
used on the jaw of a Spanish seaman in the naval hospital, New 
York, and it cured the patient, although he had been subjected to 
four months’ unsuccessful effort of the government surgeons, assisted 
by others in the vicinity. Thus the surgeons were spared the morti- 
fication of sending the man home uncured. A similar splint was 
shown to the New York Academy of Medicine, January 7, 1863, with 5 
another case in which it was used, then published with illustrations in 
their Bulletin, and in February brought before the Medical Society of 
the State of New York, as shown in the Transactions for 1863 ; and 
in the Medical Report of the Centennial Commission, 1876, this 
splint was admitted to be the first splint ever used without an appli- 
ance outside of the mouth. Surely this splint should have been fairly 
reported and truly described in your work on “The Principles and 
Practice of Surgery.” Had this been done, other sufferers could have 
the use of it; whereas, your book misleads the surgeon and student 
in regard to it. 
Even in the few injuries where the fractures are such that it is nec- 
essary to use the upper teeth as a base to hold the broken lower jaw 
still, as in fractures in the ascending rami, or say all fractures back of 
the teeth, my splint No. 2, just now showm, is not kept in place, as 
you say, by securing the jaws together with a bandage. This splint, 
B, triangular opening, of which one 
side corresponds to the cutting edge of 
the lateral incisor, which tooth stood in 
the end of the fragment most displaced 
before the splint was applied. C, open- 
ing for food, speech, &c. D, channel 
for the saliva from parotid gland to enter 
the mouth, its fellow being seen on the 
other side of the splint. E, screw 
opposite lower canine tooth, head of the 
left screw being just discernable. E, 
head of screw opposite upper first molar 
tooth, end of its fellow being seen on 
the other side.* 
Fijf. 2. 
like No. i, holds the fragments of the jaw by means of the teeth only, 
without any bandage ; and while the patients wear this splint they 
may follow, as with No. i, their usual occupations. 
Of my splint, No. 3, you say : “ A third splint of Dr. Gunning’s, 
one which he uses in cases where the teeth have been lost, is formed 
by connecting steel branches with the interdental part of the appa- 
ratus, of which the upper branch passes along the superior part of the 
face, and the lower one along the outside of the lower jaw; these 
are kept in place by three bands, one being placed at the chin in 
order to hold the jaw up in the splint, one running from the metal 
band to the back of the neck, and one passing to a cap which is worn 
over the head, and with which the splint is connected.” 
♦This figure 2 was left out in the letter sent to Professor Agnew, liut it is here shown in 
order that the reader may compare it with Dr. Agnew’s figure 643, which is the same cut with 
the letters erased. 6 
Gunning's Interdental Splint. 
This is my plate 3, with its reference 
letters cut away, and your description 
leads the reader to suppose that a 
band of metal goes under the chin to 
hold the jaw up in the splint, and that 
metal bands are used instead of 
strings of tape to hold the splint by 
means of the cap and to keep a metal 
band from slipping over the chin. 
But no metal band is used anywhere 
nor spoken of by me. In the absence 
of teeth, the wings are used, two on 
each side, the upper range over the 
malar bones and the lower along the 
jaw ; and from the cap on the head, tape strings pass down on each side 
to the upper wings and hold the splint against the upper gum, while 
the broken lower jaw is held up in the splint by a single thickness of 
linen or other thin material, which extends across under the chin from 
one lower wing to the other, while the lips, cheeks and all the face 
are left free from pressure. 
This statement would place the splint plainly before your readers, 
and give them the use of it, for their patients, when they needed or 
preferred it. This description is also briefer than your deceptive text. 
Certainly this splint, No. 3 (your figure, 644), deserves fair notice, it 
having been successfully used on the bad fractures of the Hon. Wm. 
H. Seward subsequent to the attempt to assassinate him. 
Surgeon General Barnes and Surgeon Basil Norris, of the army, 
together with Dr. Whelan, chief of the medical bureau of the navy, 
and others, had signally failed to secure by ligatures and bandages 
the fractures received in falling from his carriage, before the Secretary 
was cut so terribly on the night that President Lincoln was killed. 
Further, I did not take charge of the case nor set the fractures 
until twenty-five days after the accident, fifteen after the attempt to 
kill him ; yet this splint with upper wings held the double and com- 
pound fractures of the jaw securely for sixty-eight days without a 
moment’s intermission. 
I described this splint, No. 3, to the New York Academy of Med- 
icine, June 1, I864, but the upper wings were never used until I 
applied them, May 2, 1865, in Mr. Seward’s case. 
Since then a severe fracture without a tooth in the mouth has been 
Fig. 644. 7 
successfully treated, in which both upper and also the lower wings were 
used. It was applied in May, 1879, to the jaw of a farmer, seventy 
years old, with such good result, by Dr. Adams Bishop, reported in 
Johnston's Dental Miscellany, Vol. VII., page 63, and in the hide- 
pendent Practitioner, Vol. II., page 108. Thus the splint, No. 3, has 
been fully tested, for this patient’s fracture could not be held by the 
bandages used by the physicians who first attended the case. I 
devised this splint for fractures without teeth to hold by, and it has 
proved to be a perfect control for such cases ; for the Secretary of 
State attended to the duties of his office while wearing it, and the 
farmer walked around at once, and followed his plough and did heavy 
work before his splint was left off, although he wore it only six weeks. 
The deception of your text in regard to my treatment of these 
injuries is made complete by leaving out my splint, No. 4, here 
shown. 
This splint, made of tin, and ap- 
plied to the teeth of the fractured 
jaw by means of a lining of gutta- 
percha, or of plaster of Paris, was 
devised in 1863 for hospital use and 
for practitioners out of the reach of 
a dentist. It is cast with a handle 
in front, so that it is an impression 
cup such as dentists use, but when 
applied as a splint, the handle is cut 
off, and, if needed, wings are soldered 
on, and from these, when the splint 
is worn, a single thickness of roller passes under the jaw from one 
wing to the other. 
I reported this splint to the New York Academy of Medicine, June 
1, 1864, in answer to their request and letter of thanks in 1863. 
Within the week after reading the paper, I applied this splint, No. 4, 
to the jaw of a boy under Dr. Freeman’s treatment, and in July I 
usecj the same splint with a new lining on the jawr of a boy sent to 
me by Dr. King. The indentations shown in the cut represent those 
made by the upper teeth of both boys when eating. 
These splints, Nos. 1, 2, 3, 4, with cases to explain and illustrate 
the treatment, are clearly shown in my paper on the Treatment of 
Fractures of the Lower Jaw by Interdental Splints, first published in 
full in the New York Medical Journal, in 1S66; they are also dis- 
FiS. 4. 8 
tinctly and fairly shown in every edition of that unique work, 
Injuries and Diseases of the Jaws, by Christopher Heath, F. R. C. 
S., published by John Churchill & Son, London, and by Lindsay & 
Blakiston, Philadelphia. (This work is the Jacksonian Prize Essay 
of the Royal College of Surgeons of England for 1867.) 
The splints are also described at length and favorably noticed in 
the Report of the Judges of Group XXIV. on Medicine, Surgery, 
and Prothesis, transmitted by the Secretary, J. H. Thomson, A. M., 
M. D., to Prof. Francis A. Walker, Chief of the Bureau of Awards, 
and edited by him for the U. S. Centennial Commission, and issued 
by your own Publishers, J. B. Lippincott & Co., Philadelphia, before 
your work, “ The Principles and Practice of Surgery.” In all these 
publications the splints are explained and illustrated by the same 
plates used in your articles upon “ Fractures of the Lower Maxilla.” 
But your book shows my plates with the reference letters cut away, 
except to the holes for syringing, and states that the splints are held 
in place by securing the jaws together with a bandage. Whereas, my 
interdental splints were expressly devised to obviate the use of these 
bandages, which are cumbersome, unreliable and often destructive. 
These splints are not, as you intimate, merely supplemental; each 
one is a complete and reliable support. 
The first is for all injuries in which the fractured jaw is allowed in 
my methods to move naturally while under treatment, and by far the 
larger proportion of fractures can be thus treated. 
The second splint is for fractures in which the broken jaw is held 
in fixed relation to the upper one ; and in some of these cases this 
splint does not cover the front teeth, so that, when worn, it is unseen. 
All the splints have small openings to allow observation of the 
teeth which are near the fractures, so that the position of the broken 
ends of the bone can be learned at any time without removing the 
splint; and in fractures in which the lower jaw is held in fixed rela- 
tion to the upper one, the splint has channels for the saliva from the 
parotid glands to pass in around the tongue. 
You leave these important devices unnoticed, and cut away the 
letters of reference, yet, in the text given (say seven lines) to my 
splints, 1 and 2, you twice remark upon keeping the splint clean, and 
twice say or suggest that they cover all the teeth of the lower jaw, 
and then leave your readers ignorant and misled in respect to the 
radical features of the splints. But, in less than the room given to 
the repetition, you could have told that these splints hold the frag- 9 
meats of the bone in place securely, without anything outside the 
mouth ; are quite comfortable, and the patients attend to their busi- 
ness and move about as when their jaws are sound. They do this 
even when the fractures are so severe that the jaw is held in fixed 
relation to the upper teeth, for in such cases the opening in front 
affords room through which to speak and receive food. But in most 
fractures, as before stated, the jaw is allowed to move, and the top of 
the splint is used in eating. 
The eight cases in my paper which show the complete control 
attained by means of these splints were carefully selected; and with 
the four cuts spoken of in this letter, place my treatment, shown fully 
in 1866, at the service of all. Mr. Christopher Heath quotes from the 
New York Medical Journal and the British Journal oj Dental Sci- 
ence, 1866, and his book shows my treatment clearly. In its appen- 
dix, case six, is my report verbatim of the Hon. Wm. H. Seward’s case. 
The official report of the United States Centennial Commission 
closes, in respect to my treatment of fractures of the maxillae, as 
follows : 
“ In connection with the splints shown, was a series of casts illus- 
trating the double-compound fracture of the jaw of the late Hon. 
William H. Seward, showing the jaw broken on both sides between 
the bicuspid teeth. Also a double cast of the upper and lower jaw 
as held by the splint for sixty-eight days. As no teeth were left in the 
upper jaw, the wings and cap were used, as shown in Fig. 3. The 
result was thoroughly satisfactory.” 
The Secretary, I)r. J. Henry Thompson, who transmitted this report 
of tlie Judges of Group XXIV., was a resident of Washington, where 
I treated the Secretary of State. 
In addition to all this, your own city, Philadelphia, has in one of 
its prominent men a proof of the superiority of my treatment by 
splint over that by bandage, as used by Professor Buckingham of the 
Medical School of Harvard University. The fracture was received in 
the terrible stage accident in the White Mountains, in 1873, and the 
jaw, when the patient was brought to me, was so deformed that I had 
to break it apart. The splint was shown in the Centennial Exhibition 
of 1876, and the case is fully reported in the Independent Practitioner, 
Vol. I., page 526. 
I have said that you leave out my splint 4 ; but, worse still, you 
place next after my Fig. 3 a splint which you show as Kingsley’s, 
preceded by a description which ends as follows : “ When applied, 10 
the teeth occupy the cavities in the splint, the latter being kept in 
position by a strip of roller passing beneath the chin from one arm 
of the apparatus to the other.” 
Now this method, the splint and the wings (arms) were devised by 
me. The splint, with its wings, was shown on the patient to the New 
York Academy of Medicine, October 21, 1863. It was for showing 
this apparatus that the Academy passed the resolution thanking me, 
and requesting me to report further; and, in response to which, I 
read the paper, June 1, 1864, which explained my four splints. See 
Bulletin, Vol. II., pages 153, 168, 307. 
Kingsley does not use the splint nor the roller, as you say, but 
applies a sub-mental splint or compress, which is by means of some 
apparatus or band kept in connection with the interdental splint, the 
broken jaw being between them, and he maintains that this is 
necessary. But for fracture at the angle of the jaw, or in the parts 
above, he says that an interdental splint is useless, and that a band- 
age is indicated ; that is, a bandage around the jaw and head. Thus 
Kingsley uses appliances external to the mouth in all cases, although 
my interdental splint, which, by enclosing all the lower back teeth, 
holds in the angles of the jaw has been in use since February 12, 
1861, his treatment of fractures of the jaw is no improvement upon 
that of twenty-five years ago. In fact, he advises for fracture in 
front of the jaw, that which is inferior to Hayward’s plan of 1858, in 
which a metal cap was fitted to several teeth on each side of the 
fracture, and from the upper surface of the cap a stout wire went out 
of each corner of the mouth to a gutta-percha splint under the chin, 
and from beneath this a four-tailed bandage passed behind and over 
the head; thus the lower tails passed outside the angles, which could 
therefore be held in with pads. Whereas, Kingsley says : “ If the 
fracture is in front, the splint need not cover all the back teeth ; but 
if it be at the side, it is better to cover all the teeth of that side. It 
is also better to set the ends of the upper and lower jaws in an artic- 
ulator, and thus make prints of the upper teeth in the wax, to be 
retained in the splint.” But with the splint so cut off as not to 
enclose the back teeth, the angles will be forced out by the muscular 
traction on the inside of the chin, for the outside wings cannot be 
used beyond the ends of the splint, as they would lift it up from the 
front teeth. In fact, the muscular traction on the inside of the chin 
might alone wring the fractured ends out of the splint by forcing the 
latter up the outer surfaces of the canine or bicuspid teeth. Again, 11 
if the splint only covered the teeth on the fractured side, then those 
of the other would have no bearing, and no eating could be done 
except on the splint over the fracture ; and if the patient should 
happen to use the uncovered teeth on a large morsel, it might force 
the fractured ends apart, whether they were in the side or in the front 
of the jaw. Dr. Kingsley’s examples of the application of this splint 
to double or triple fractures are quite as bad as his advice in regard 
to single fractures. All he shows of importance, was first devised, 
used and published by others before him; it is, as told by him, of 
little service to the reader, because of its intermixture with statements 
which are not in accord with the facts of history nor of science. 
Yet your text is such as leads the reader to adopt his treatment and 
reject my methods—this, not because of any want of clearness in my 
description, for you could have quoted from my paper in the Nfw 
York Medical Journal, Vol. III., page 434 : “ When a well-adapted 
splint is on the teeth and gum, the other parts around the bone are, 
to a great extent, a counter-support to the splint .... Mean- 
while, the motions of the jaw are in most cases unrestricted, and the 
cheeks and lips always left free.” Ibid, 442, “ Fig. 1, is the repre- 
sentative splint for treatment of cases in the first class or those in 
which the jaw is left free. Fig. 2, for the second class, or those in 
which the jaw is held still.” 
Yet, with this plainly stated, you class these splints together, and 
say : “ This splint, when placed in position, forms a cap, and is 
kept in place by securing the jaws together with a bandage, or by 
means of screws passed between the teeth.” Your text, on page 
847, confirms this, as follows: “The splint of Dr. Bean resembles 
closely that of Dr. Gunning.” . . . “ The splint, when applied, 
is kept in position by straps which pass over and around the head, 
and also behind the neck.” Your text again misleads the student, 
for you admit that Bean’s splint “ is fitted to the teeth of both the 
upper and lower maxilla,” in which cases my splint is screwed to the 
teeth, and while I use nothing outside the mouth, you lead the reader 
to suppose that I use a bandage around the jaw and head, and you 
do this, although my treatment of fractures, with the splint illustrated 
by Fig. 2 (your Fig. 643) is related in the New York Medical Jour- 
nal, Vol. IV., page 16. In case five it is distinctly shown that the 
surgeon in Bellevue hospital who had charge of the woman, tried to 
hold the jaw up in the splint with Hamilton’s bandage, but on the 
third day he requested me to screw the splint fast to the teeth, as the 12 
bandage was painful and useless. The splint was screwed to the 
teeth, and the jaw united in forty days. 
In January, 1861, Dr. Benjamin Franklin Bache, U. S. Navy, advised 
that I should be asked to treat a Spanish seaman, whose fractured 
jaw was found to be incurable at the Naval hospital, N. Y. Howard 
Hayward’s method of treating these injuries was then the most 
advanced, and although it was very imperfect, did much to prepare 
the minds of surgeons to accept the co-operation of dentists, at least 
in Great Britain. After study of the literature of the subject, say as 
given for twenty-three centuries back, and then making careful allow- 
ance for the muscular action involved, I devised the splints and 
methods of applying them, which were fully published; and the cor- 
rect action of the muscles which control the jaw was shown to guide 
the surgeon. This was necessary, as I demonstrated that the exter- 
nal pterygoid muscles depressed the jaw and opened the mouth, 
instead of the digastrics, as maintained by Hunter. I also explained 
that the lower jaw is the lever by which the head is held forward, so 
that, when the jaw is broken, it requires firmer control than can be 
given by appliances which rest upon the soft parts external to the 
mouth. In the years which have since passed, my experience has 
suggested nothing which I think necessary to perfect my treatment 
of fractures of the maxilke. 
You however do not show my splints and methods fairly, in order 
that your readers may contrast my plans with others, and judge of 
their relative merits, as the student is led to believe by your preface. 
I trust that you have been yourself imposed upon, and that you 
will now and in the future, as far as possible, correct the wrong which 
has at present the sanction of your name. I am, Sir, 
Yours respectfully, 
THOS. BRIAN GUNNING. 
Philadelphia, 1611 Chestnut Street, 
December i, 1883. 
Dr. Thomas Brian Gunning. 
Dear Dr.: I am indebted to you for an accurate description of 
your interdental splints for fracture of the jaw, and shall with great 
pleasure make the correction in the next edition of my book, should 
it reach a second edition. 
Very truly yours, etc., 
D. HAYES AGNEVV.