t A TREATISE HERNIA, PROLAPSUS UTERI, DISPLACEMENTS OF PARTS OF THE HUMAN SYSTEM; REQUIRING THE USE OF BANDAGES, SUCH AS TRUSSES, Spring Bandages for females, Russia Bells, Suspensory Bandages, 4v. ISSUED FROM THE NEW-YORK >"Yc,*. SURGEON'S BANDAGE INSTITUTE, NO. 1 ANN STREET, (UNDER THE AMERICAN MUSEUM.) THIRD EDmifei. ---—^T^ NEW-^ORK : SACKETT & SARGENT, PRINTERS, No. 1 Nassau-street, cor. of Wall. 1840. Wo N55fc )84o PREMISE. An Institution has been established under the direction of J. Knight, M. D. a Surgeon of much experience in the use of Bandages ; many valuable improvements having been made by him in this particular branch of his profession. This Institution is intended to be exclusively kept for the reception and sale of the most approved bandages, and the treatment of diseases re- quiring their use. That such an Institution is much wanted in the City of New- York, is very apparent to the afflicted, as they are most fre- quently much imposed upon by pretenders to surgical skill in the construction of Trusses, &c. Such Bandages are frequently constructed and sold to the afflicted, and by their use much suf- fering engendered, and even their lives endangered. Not long since, a patient applied to this Institution for a Truss, for a rup- ture at the naval, who was then wearing a Truss made to fit the groin, and declared that it had actually been applied to him by the vender , as a suitable Truss for his case; and the conse- quence was, that his rupture had much enlarged and became very painful. This is not the only instance, similar cases have been presented to this Institution ; and it now depends much upon the afflicted whether such imposters shall be sustain- ed any longer, as there is a place where they may be assured they will not be imposed upon. Physicians and Surgeons are particularly invited to call and examine the Bandages kept in this Institution, and also pass their opinion upon their stiucture, as none will be kept that are not constructed upon sound Surgical principles. Officers of charitable institutions can effect arrangements with this Institution, to have a certain number of the poor and afflic- ted fitted to, Instruments at very moderate prices, and thus many may be enabled to support their dependant families, such as poor females who follow washing for a living, also, infants who are ruptured and whose parents are unable to purchase iv premi^i:. a Truss, can by this means be supplied and the child cured by the charitable act of some benevolent society, who will thus rescue a fellow being from a most .deplorable condition—that of being compelled to wear a Truss through life. Such are the in- tentions of this Institution. This pamphlet is intended (in addition to inviting attention to the Surgeon's Bandage Institute,) to inform the afflicted of the best possible means of obtaining relief, and of giving them such information as will in a measure be a preventative to impo- sition, as the cause and actual condition of the several diseases treated of, are set forth in plain and familiar language—not intended for classical criticism—in a word, it is to benefit the afflicted, and to such it is respectfully presented. TREATISE. This pamphlet is most respectfully presented to the afflicted and others, who may feel interested in the subject of the follow- ing diseases :—Hernia, or Rupture—Prolapsus Uteri, or Fulling of the Womb—Prolapsus Ani, or Protrusion of the boioel at its extremity—Piles—Tumours in the abdomen— Extreme Corpulence, and over distention of the abdomen, preventing the individual from taking healthful exercise. These are diseases some of which afflict many of the human family, both males and females, infants and adults, yet have elicited but little attention as to curative means ; other than from those wholly unacquainted with the conformation of the human system ; consequently, the afflicted-have suffered much, when a skilfully constructed Bandage would have given imme- diate relief, as Bandages are very applicable to the relief of the above enumerated diseases, when skilfully constructed and pro- perly applied, and as auxiliaries, they are very desirable. DESCRIPTION -OF HERNIA. Hernia. This term is derived from the Greek language and signifies a limb, or proceeding from, as a portion of the bowels proceeds from the whole mass, and passes through the walls of the abdomen, carrying before them most generally, a thin mem- brane called the peritoneum, which forms a sack, and is called the hernial sack. This sack containing the bowels, forms a bulging out or tumour at the point wherever it protrudes under the skin, and when distinguished from other tumours, is called a rupture. This protrusion of the bowels takes place most frequently in the groin and at the naval; and occasionally cases present, of a protrusion at various other parts of the abdomen. These tu- mours sometimes are so small as not to be discovered by the af- flicted, and to such, occasionally the most fatal consequences ensue, as the real difficulty is not discovered, and the patient dies from a strangulation of the bowels, a small portion having been forced through a very small opening, which becomes swol- len and contracted, and if not relieved by the knife, or the infla- mation subdued so as to relieve the compressed intestine; it is as sure death as if we were to tie the bowel with a cord and permit it to remain so. This state of disease frequently takes place where a large portion of the bowels are protruded, but, in 6 such cases, we are not generally deceived as to the difficulty ; consequently we would admonish all who are afflicted with rup- ture, (let it be large or small,) to wear a Truss which will not permit the intestine to escape. For however skilfully treated, when strangulation of the bowel takes place, their lives are en- dangered ; as gangrene or mortification of the bowel may take place after it is replaced; from the injury it has sustained by pressure, or from the inflamation which may ensue after a skil- ful operation has been performed. CAUSES OF HERNIA. There appears to be a predisposition to Hernia in some per- sons, dependant upon the laxity of their systems, and in others at particular times, after a protracted illness, the system being in a debilitated condition, the bowels descend, (the attachments being relaxed,) and bare forcibly upon the lower and front part of the abdomen, and there being natural openings there, called rings, for the passing out of ligaments, blood vessels^ &c, (and these openings also relaxed,) a slight exertion induces a small portion of the bowels to enter, and thus gradually the aperture is enlarged and a large portion of them protrude. In some in- stances ruptures are produced by accidents, such as falls, &c. also from active exertion after eating hearty, or by coughing, lifting, jumping and dancing. Another prolific cause of rup- tures, is steping unprepared and suddenly off" the curbstone of the sidewalks in the City, or into holds, and especially after eat- ing hearty or drinking much. From this brief enumeration of causes, others may be inferred. TREATMENT OF HERNIA. To treat Hernia skilfully., an intimate acquaintance with the anatomical structure of the parts effected is very essential.— Trusses at this day are most generally relied upon, and they ought to be constructed upon sound Surgical principles, so as not only to close the aperture through which the instestine has es- caped, but also remove the predisposition to an escape, and not make pressure upon important parts, such as blood ves- sels and nerves. Patients have had their lower extremities paralyzed by the use of Trusses improperly constructed, and other serious inconveniences have been the result of the use of instruments constructed by ignorant pretenders to surgical skill. Properly constructed Trusses are the only sure and safe means for the relief and cure of Hernia, and nearly all recent cases can be cured by proper attention and the use of a suitable Truss. 7 CONSTRUCTION OF TRUSSES FOR HERNIA. If a Truss spring is not properly tempered, there is danger to be apprehended from its liability to brake and wound the wearer or to bend and press upon some important nerve or blood vessel. This difficulty may also arise from the form of a spring applied by a person unacquainted with the location of such nerve or blood vessel. The construction of pads or cushions invites particular atten- tion : if a pad is too convex, it will enlarge the aperture through which the intestine has escaped^ and if too concave, it will re- tain the intestine in its cavity, and thus subject the patient to strangulated hernia, yet there are persons so formed as to require a convex or a concave pad. Pads that are hard and unyielding as wooden, are dangerous in the extreme, unless the'patient is under the attention and direction of a skilful Surgeon. Such pads will excite an inflamation which may extend to -the perito- naeum, and thus cause the death of the wearer, or the inflama- tion may be confined to the ring or aperture through which the intestine escapes, and if a small portion should protrude, strangulation would be most likely to ensue, or the intestine be bruised by such a pad, and mortification take place. Firm pads are necessary and such as will retain their form. If a pad looses its form by wearing, as those constiucted by layers of blanketing piled upon a level plate of metal, the pading will be pressed from the edge and the bowel thus be permitted to escape and be liable to get bruised by the edge of the metal plate. In the combining of the several parts of a Truss much is to be observed—if a Truss is so combined as only to press the cush- ion upon the opening through which the intestine has escaped, it will not remove the predisposition to Hernia, that is, it will not elevate the whole mass of bowels and restore tone to their re- laxed attachments ; again such a Truss is very uncomfortable to wear, as the whole force of the spring required to keep the bowel in, is thrown upon the two ends and concentrated upon the rup- ture and spine, and if much pressure is required, there is danger of paralyzing the lower extremities, and especially in children. In some Trusses of this kind, these objections are in a measure obviated by the use of a very elastic spring placed upon the back of the front pad, so as to be pressed upon by the spring en- circling the body,also a very long back pad is used, by these means much elasticity is obtained, and is of great advantage to the pa- tient. Having made very brief remarks upon the construction ol Trusses, much is to be inferred, as this statement is only intend- ed to invite attention to the subject. VYe will now give a brief 8 description of what wc conceive to be a suitable instrumeivt for the relief and cure of Hernia, and is not a mere surmise, as such an instrument was constructed by Dr. Knight and many made since and used by hundreds of persons, who bear testimony to the fact of their usefulness ; and as a further proof of their superiority over such as were then in use, such instruments have been mod- ified so as to act somewhat similar to his Truss ; and at this day, nearly all Trusses used have this modification, that is, of turning in on the lower edge of the front pads, so as to have a tendency to lift the whole mass of bowels : but they have in a measure all failed to accomplish the desired effect, in our opinion. If a pad is not constructed so as to conform to the rotundity of the abdomen, the turning in on the lower edge of the pad, is an actual preventative to retaining the bowel en situe, as pressure is made by the lower edge of the pad alone, and the bowel permitted to escape on either side of the pad, and this is the difficulty to be apprehended from Trusses thus constructed. To obviate the difficulty just stated,'much pressure is requisite so as to force the pad deep into the walls of the abdomen, and it is then said, their Truss will retain the bowel—true, but at the expense of much unnecessary pain to the wearer. The Truss constructed by Dr. K. for the relief and cure of rupture, consists of a broad and very elastic spring, intended* to encircle two thirds of the body around the upper parts of the hips, the front-half crossing the pendent part of the abdomen and placed so high as not to be to be moved by the motions of the thigh, this being a very permanent location for the spring, as there is no muscular motion there to displace it, and to its ends is attached a leather strap, which completes the circle around the body, and the spring being placed so high on the hips, the strap has no tendency to cause the spring to rise and dis- place-the pads attached to it, as is the case with those Trusses that are applied low in the groins and the'spring fastened to the centre of the bacfc.of the rupture pad, consequently such, are very hable to be thrown out of place by the movements of the thigh. See p. 13, No. 4, Dr. K's Truss. The springjust described as used by Dr. K. and its proper place of location when applied, clearly points out its operation- . rt gives support to the pendent part of the abdomen and thus susta.ns the whole mass of bowels and prevents them from bear ,ng forcibly upon the relaxed rings or openings through whfch the intestines has escaped ; and by this meansfthe predlsnosit on o rupture is removed, and a much less pressure is required tor" ta.n the bowels ; consequently, the tone to those parts is m - readily restored, as the pressure required to retain th* }JL i ^ not sufficient to impede the, circulation, as l^"those"^TrusTes be- fore described, where so much pressure is required to retain the bowel in its proper place. The pad which Dr. K. used, is so constructed as to correspond to the actual shape of the abdomen, and attached to the spring just described, by means of curved springs, having a lateral movement, the upper edge of the pads being from a half to an inch below the horizontal spring, to which they are attached at right angles. The curvature of these pad springs, places the pads in such position as to act like that of the hand applied to reduce the bowel and lift the lower part of the abdomen ; and the pads having a firm margin and an elastic centre facilitates a cure. An explanation of the mode of action of this Truss appears essential; as some have said its elastic force upon the wearer is destroyed by the strap which completes the circle arotfnd the body. This has been said, we presume, without reflecting upon the conformation of the instrument- When it is placed upon the 1)ody, and before fastening the strap, it will be observed that the lower edge of the front pads touch the abdomen, and when the strap is drawn so as to bring the front half of the horizontal spring (or in other words the spring that encircles the body) close to the abdomen, (as it sets out some distance,) it is contorted or twisted, and a constant tendency to straighten gives, an elastic force to the rupture pad, the spring being broad and light; and here it will be observed, how permanent these pads are when applied, and what an equable force is,given under all possible in- flections or attiudes of the body. Again, the pressure is equal- ized around the hfldy and no danger to be apprehended from pres- sure on the back or spine. In all cases of single rupture, we think it very advisable to wear a double Truss, that is, aj)ad in each groin, as they will be worn with much more comfort and prevent a second rupture, which most frequently takes place," as it appears that the balance is destroyed by the pressure upon one side, and thus another rupture is induced. This is the opin- ion of many modern Surgeons, and experience appears to prove it to be a fact worthy of notice. There are several diseases peculiar to the parts affected by rupture, and are frequently mistaken for the latter ; such as a swelling of the glands in the groin, dropsy of the neighboring parts, technically called Hydrocele, and an enlargement of the veins called Varicocele, an application of a Truss intended for rupture, is very injurious in either of those diseases, although frequently applied to persons thus affected, and hence, the neces- sity of being examined by an experienced Surgeon whenever affected in those parts. It* is well, perhaps, here to mention the fact that sometimes after a suitable Truss is worn for an actual 10 rapture, Hydrocele takes place, and Surgeons without reflecting upon this fact, pronounce the person who applied the i russ, an ignorant pretender, when in fact it ought to be said of them- selves, as frequently they are not aware of the fact, that the lor- y mer disease might be the cause of the then present disease. It would appear that the disease is induced by the lormer disten- tion of parts. A suspensory bandage ought to have been appli- ed, and indeed, whenever there has been much protrusion of bowels, the latter ought to be used, and is very applicable in the treatment of those diseases. PROLAPSUS UTERI. Prolapsus, to fall or slip down. Uterus the womb. A dis- location or falling of the womb is one of the most distressing diseases with which females are afflicted, and none to which they are more subject. There are various stages of this disease, a complete protrusion but seldom takes place, hence it is that so many are deceived as to what is their disease ; and the slight dis- placement of that organ makes such a decided impression upon the whole nervous system, as to be well calculated to deceive not only the patient, but the medical attendant. Thus are many doomed to drag out a most miserable existence, receiving the taunts of unfeeling friends, who accuse them of being hysterical, and their disease only existing in their imagination, and frequent- ly this is said by their physician, who first gives credit to such a supposition in order to save his own reputation as practitioner, when he is confident th;it he is unable to discover the cause of the difficulty. •> CAUSES OF PROLAPSUS UTERI. The primary cause of this disease is dependant upon all such agencies as have a tendency to debilitate and relax the sys- tem, whilst ordinary exertion most frequently completes the de- rangement. Tight lacing and dancing in warm weather, are also prolific causes of this disease amongst young females ; dancing soon after a protracted illness, or rising to soon after confinement heavy lifting when much fatigued ; as in the exercises of wash- erwomen, stepping from an eminence unprepared when the sys- tem is relaxed, or at such times standing for a great length of time, or taking very long walks so as to become very much fa- tigued. There are numerous other causes than those enumerat- ed and which produce the disease in the following manner-__ The ligaments which sustain the bowels, \ ields to the weight or gravitating force and permits them to descend-consequently there is a great fullness of the lower part of the abdomen • this 11 condition is facilitated by tight lacing—the bowels do not long continue in this location, they descend downward and backward ; press upon the womb and slightly displace it, and cause un- natural discharges and excrutiating distress at particular periods, also by the pressure, costiveness, piles, and protrusion of those parts take place with a numbness of the thighs—bearing down sensations, the nervous system becomes excited, and other parts are affected by sympathy ; the patient becomes dyspeptic, feels a kind of voidness at the pit of the stomach—pain in the back and in the side—cough ensues, and by the irritation, consumption is established in the lungs or bowels and diarrhoea commences, and after months and years of the most distressing torment, har- rassed by the alternating of hope and despair—taking nauseous drugs, many of which by their anodyne effects, in a measure quiet the pain : but alas ! they soon fail to give relief although increased to an alarming extent; when some other of the same class, but more powerful, is administered, until the nerves over- powered, fail to give signals of distress ; and the patient expires. All this frequently takes place when there is but a very slight displacement-of parts, and which is readily relieved by the use of a bandage properly constructed, and a few of the tonic medi- cines to restore the tone of the system and taking care to avoid the above enumerated causes. TREATMENT OF PROLAPSUS UTERI. The treatment of this disease as has just been intimated, is most readily relieved, by the use of a proper bandage, and giv- ing particular attention to avoid all such agencies as have a ten- dency to produce the stated effects, but in some instances, the system is so much impaired, that it requires much care and di- rection from a skilful physician, when the patient will frequent- ly recover, as it were from death's cold embrace; they have re- covered after having been confined to their beds for years ! CONSTRUCTION OF BANDAGES FQR PROLAPSUS UTERI. In the construction of a suitable Imndage for the relief and cure of falling of the womb, or in other words to lift the super- incumbent weight off of that organ and support the relaxed parts, we have only to bear in mind the existing difficulties under which the patient is laboring, to have the construction of an ap- paratus clearly indicated, that is, to an anatomist; but even those professing to possess such knowledge, have erred in the con- struction of such an apparatus, and yet with this glaring fact be- fore us, we evtry day are presented with some fanciful instru- ment, constructed by some daring pretender, who has the assu- I 12 ranee to tamper with the health and life of liis fellow creatures, and suffer himself to be thus prompted by an avaricious mo- tive alone. It is by such imposition that the afflicted are de- ceived in the use of proper restorative means, and accordingly condemn their use. Professor Hamilton, of Edinburgh, says he has always found a properly constructed bandage to give relief, and we have always-found it sufficient to give relief to all the dis- tressing sensations, and in a very short time, the patient en- abled to throw it aside, its use no longer being required. We here introduce an engraving of the muscles forming the front Avails of the abdomen, in order to enable the reader to comprehend the operation of Dr. Knight's Spiing Bandage for Females, which we believe to be the most applicable to give relief in cases of the falling of the womb. No. 1 represents two straight muscles arising from No. 4, the Pubi3, (or bone that crosses the lower front of the abdomen,) and ascends to the Sternum No. 5, (or breast bone)—liga- mentous bands cross these muscles, and thus motion is confined to a part or the whole of these muscles. No. 3 represents .two pyramidal muscles arising from the Pubis No. 4, in front of the two muscles fjust described, and increases the strength of those muscles ; also the thickness to this particular part of the abdomen, capa- ble of resisting the force of a pad applied directly against them, and consequently, Dr.*!. uses two pads to make pressure by their lower edge on each side of those mus- cles, (on the oblique muscles No. 2 ;) which form the sides of the abdomen. The fibres of the latter muscles running in an ob- lique direction, and being much thinner than those in front, yield most readily to Dr. K's two pads, and the bowels eleva- ted without giving pain and the superincumbent weight tak- en off of the womb—consequently a soft hair stuffed cushion attached to a cross strap to make pressure between the limbs is sufficient to accomplish th^desired effect in all cases of complete falling of the womb. DESCRIPTION OF THE FOLLOWING ENGRAVINGS. No. 1, is an Umbilical Truss applied: this instrument is most frequently required by eorpulent persons, and infants, thev being most liable to Umbilical Hernia. We have descriptions of similar instruments, having been used in the earliest ages of the profession ; two springs to encircle the body are here repre- sented which we have found to be an improvement. U\ No. 2 is Dr. Knight's Truss, or Spring Bandage, applied for falling of the Womb. The spring is seen to pa^s around the hip below the edge of that bone, and the lower edge of the pads, placed above the pubes, or bone that crosses the lower.part of the abdomen : these pads admit of a lateral motion for convenience in adapting them to the patient; and previous to fastening the fctrap ; (that completes the circle around the body,) the spring sets out from the abdomen, and is drawn in by the strap; and when thus applied, the force given by the instrument has a tendency to restore the bowels to their natural position; supposing them to have been dislocated and bearing upon the lower part of the front walls of the abdomen. No. 3 the front part of the cross strap which passes between the limbs. Second figure, No. 1, 2 and 3 represents the proper position of the instruments on the back. No. 4 is Dr. Knight's Double Inguinal Truss ; which answers also, for a femoral hernia, by lowering its position. It will be observed, that the spring 's carried across the abdomen, which is for the purpose of giving a more uniform support to the walls of the abdomen, as in most cases of single rupture, a double truss of this kind ought to be used. It is obvious that if the intes- tines haye descended upon the hernial parieties, they will affect both sides equally; yet, may protrude only on one side, from some fortuitous circumstance ; leaving the other side liable to a protrusion. The following letter will illustrate the effects of Dr. Knight's intruments in curing persons whilst laboring at some of the most laborious trades. This letter was presented for publication, by a young gentle- man about twenty-one years of age, who followed the labo- rious occupation of ship-joiner. He had been in the habit ot It lifting very heavy bodies, (having much muscular strength,) and by scTdoing, unfortunately became ruptured in both groins ; and having been badly treated, the intestines protruded to such a de- gree that either of the sacks Avould have measured six inches in circumference ;* his back was much excoriated by the back pad of the Truss he was then wearing, of which he complained, and said he was unable to continue its use, as such severe pressure was required. Baltimore, June 12, 1832. Dr. J. Knight, Dear Sir,—Being anxious that your invaluable Truss should become more generally known, you will confer a favor by publishing this letter. I was ruptured in both groins by heavy lifting, and was advised to get one of the most approved kind of Trusses, which I obtained, but was unable to wear one strong enough to keep up my intestine, as it gave me the most ex- cruciating pain, from the pad on the back and each pad in the groin; conse- quently my ruptures became very bad. Seeing your advertisement, I called and had one of your Trusses applied,* after which I felt quite comfortable, experiencing no pain whatever, either from the Truss or rupture. I went to work at my trade, and labored_as hard as ever I had before, and in six months' time from its first application^no appearance of a rupture could be seen! I continued its use for a few months longer, and have now thrown it aside, believing myself to be perfectly cured. Yours respectfully, HENRY DIGGS. Many such letters could be produced if we felt disposed to publish a list of them; but deem it useless to publish a large volume containing nothing but a repetition of cures and recom- mendations. It is of more actual advantage to the afflicted to give them reasonable argument respecting their diseases, and what ought to be done in order to give relief, and let them determine how much of the desired effect has been accomplished in the construction of an instrument. In order that they may more fully comprehend the construction of the instruments, wood v cuts is added, giving a correct view of the several kinds, also of their application. This is of more value than a quarto volume of a thousand pages containing recommendations. Here are actual facts, determined by the sense of sight and the power of reason; which is frequently thrown aside when recommenda- tions are offered as given by men of great celebrity. Some may say, they have no recommendations from influential men in the medical profession. In order to reverse this opinion we will present some two or three; one is from that truly cele- brated Surgeon, the late Philip S. Physic, M. D., Professor in the University of Pennsylvania, and who was celebrated for his candour in deciding on improvements in Surgery, and who add- ed many valuable improvements to that branch of our pro- * See engraving (last figure. No. 4, the kind of Truu alludeTtc^ \ ' If) fession. This gentleman said, when examining one of Dr. Knight's instruments and its application on a patient, '•' This is the most simply constructed and effectual instrument for this purpose that I have ever seen." The following is a note from that pious and candid physician, the Rev. Samuel K. Jennings, M. D. Professor in Washington Medical College, Baltimore. Having had occasion to apply Dr. James Knight's Truss, and found it quite pleasant and effectual, I am inclined to think very favorable of it; and to believe it will give general satisfaction to those who may find it necessary to try its effects. SAMLEL K. JENNINGS. The next is a recommendation from the Physicians and Sur- geons of the Baltimore General Dispensary, given in March, 1831; which shows the instrument has had ample time to have been tested and abandoned long ere this, if it was useless; but the testimony of thousands prove it to be otherwise. We would respectfully recommend to the attentive consideration of the Faculty, and of the public generally, the Truss recently invented by our enterprising fellow-citizen, Dr. James Knight. We know of no instru- ment constructed for a like purpose that promises equal advantages. It is exceedingly easy of application, and effectively adapts itself to the most va- ried muscular motion, preventing at the same time a recurrence of the pro- trusion. It appears to us to be decidedly superior to any form of Truss hith- erto used. john b. Mcdowell, m. d. . wm. e. piper, m. d. caleb jones, m. d. Baltimore, March 10, 1831. This Trus3 is approved of by many of the most celebrated Surgeons both in America and Europe. A gentleman from Baltimore City who was. wearing one of these Trusses, when in London, obtained the advice of Sir Astley Cooper relative to an aneurism, under which he was.also laboring, and at the same time asked his opinion as to the Truss he was then wear- ing for hernia. This very celebrated Surgeon expressed him- self in the following words, "Your Truss portrays the ingenui- ty of your countrymen in its very simple and skilful combina- tion, and I would advise you to wear it in preference to any other Truss." These Trusses have been presented for examin- ation to most of the Professors of Surgery in the United States, and the afflicted are respectfully requested to ask the opinion of such,if they have the least doubt as to their superiority over others in point of surgical design. In the City of New-York the fol- lowing gentlemen are respectfully referred to, if parents are desirous of obtaining advice before purchasing a Truss :— Dnetors Chcesman, J. K. Rodgers, U- K. Hoffman, A. C. \G Post, Gilbert Smith, A. (u)ld-Sniith, A.T. Hunter, E. Delnficld, King, T. l!ovd, Blakeman, Gunn, and all other respectable Physicians and Surgeons; also, as to the utility and Surgical design of the Truss or Spring Bandage for Females, and their superiority over the use of pessaries, for falling of the womb. Various kinds of bandages will be kept at this Institution, such as the most approved Trusses for the several kinds of rup- ture, and every necessary care taken to have patients properly fitted, and who are requested to return from time to time until they are suited. Trusses, or bandages, if covered with India Rubber Cloth, must be re-covered with old calico or muslin, to prevent irrita- tion, and be frequently changed for comfort to the wearer. Russia Belts for the relief of persons laboring under general debility; also, a modification of these belts, an admirable ban- dage for females in confinement. The Russia Belt has long been used and much approved of for pain in the side, back and loins, and for horsemen. There is no doubt but their use has been a preventive to many troublesome diseases, as they give much relief to persons of a lax habit. Also, will be kept Suspensory Bandages, these ought to be worn by all men who have to stand much or ride on horseback, many troublesome diseases.may thus be prevented, as many are cured and others relieved by their use. Also, Shoulder Braces, an apparatus to draw back the shoulders and expand the chest, by this means the chest is much relieved from pain, and persons on the very verge of consumption, restored to health. Perineal Supporters, an invaluable apparatus for the relief and cure of the Piles and relaxations of those parts. Spring bandages for deformities, as distorted spine, crooked limbs, and enlargements, which will be made to order, and be constructed upon sound surgical principles. Bandages will also be made to order to suit special cases, as an Instrument Maker is employed to attend to the demands of the Institution. Persons from abroad can obtain instruments by sending the measure of their hips, and if for rupture, the side affected if a single Truss is wanted. Trusses and Bandages can be re- turned if they do not fit, and others obtained. All letters must be post paid. NLM041394086