MR.

G U N N I N G A N D HIS SPLINT

W. FRASER-MOODIE,F.D.S.R.C.S.(Eng), L.R.C.P., L.R.C.S.

Department of Oral Surgery, Central Middlesex Hospital

'To know just what has to be done then to do it, comprises the whole philosophy of practical life.' This aphorism, written by William Osier epitomises the contribution by Gunning to the art of healing. Thomas Brian Gunning was born here in London in I813. His ancestors came from Normandy in the fifteenth century and the family name at that time was Gonning. Their settlement in Cornwall was known as Tregonning (the prefix Tre meaning 'the place of') and today is Tregony--the village near Truro. After IOO years branches of the family went further afield--to Ireland, Somerset and Kent. Thomas Brian Gunning was descended from the Irish branch. Bryan was the maiden name of one of the ancestors. At an early age Gunning was taken to the United States, commenced his dental training in 184o under John Burdell, a famous dental surgeon of that time, and later practised in New York City until three years before his death in 1889. His work received world-wide acclaim during his lifetime, and his practical approach along scientific lines embraced many aspects of his professional activities. When he presented his paper 'On the Physiological Action of the Muscles of Mastication', his contention that the displacement of fragments following fracture was governed by muscle action was contrary to the view held by eminent surgeons of that time. They, in turn, maintained that the displacement was produced by the fracturing force. His study and articles on 'The Larynx, the Source of Vocal Sounds' and 'The use of the muscles of the Uvula in Deglutition' had a practical outcome--his obturator. This he described at the International Exhibition in 1876 under the title 'Hard Rubber Appliance for Congenital Cleft Palate'. The verdict of this exhibition was 'a very marked improvement over all previous appliances'. Gunning himself referred to it as a 'simple remedy'. At the International Medical Conference in I88I in the absence of Gunning, his paper 'The Causes of Irregularities o f Position of Teeth' was read by the secretary, Mr. Charles Tomes. It is remarkable that a man who had been denied the advantage of training at a dental or medical school should produce such erudite and valuable work. We know, however, it was the result of his experience with Burdell and his own natural inventive genius. His successful methods of treating fractures brought him wide recognition. Gunning maintained that fractures should be reduced immediately and also that fixation, wherever possible, should be so arranged as to permit function. In the treatment of fractures within his own province he was successful in breaking through the confines of contemporary surgical practice which considered that rest 'enforced, uninterrupted and prolonged' was essential to obtain satisfactory results. Gunning described four types of splints for use in treating jaw fractures, full details of which were widely published in I866-67. It is interesting to note
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that in 1867 Christopher Heath included accounts of these splints in his Jacksonian Prize essay of this Royal College. Figure I shows the inner surface of a vulcanite splint, which encloses all the teeth and some of the soft tissues of the lower jaw and rests against the upper teeth when the jaws are closed. This splint was specially adapted for the treatment of all cases with teeth in both fragments. Gunning generally used this splint without any additional retention but sometimes found it advisable to secure it by pack-thread, wires or screws. Small openings were made opposite particular teeth to check for acceptable reduction of displacement. Of this splint Gunning writes, 'the teeth and gum of the fractured jaw are alone used to control the fractured bone and the jaw is allowed to move naturally'. Figure 2 depicts a splint for those cases in which it was found impracticable to hold the fragments together except by keeping the fractured bone immobolised by intermaxillary fixation. This vulcanite splint enclosed the upper teeth in addition to fitting the teeth of the lower jaw. In this illustration B is a triangular opening which corresponds to the incisal edge of the lower lateral, this tooth being

FIG. I

FIG. 2

in the end of the fragment most displaced before the splint was applied. C is the opening left for nourishment and speech. D is described as a channel for the saliva from Stenson's duct. E and E' are retaining screws. The splint with extra-oral wings represented graphically in Figure 3 was designed for treating fractures in edentulous cases. The ends of the wings were embedded in a vulcanite splint similar in principle to that shown in Figure 2. F and G are the wings. H is a mental band made of linen to hold the jaw up in the splint. I is a neck strap to keep the band back and K is named the balance strap to hold the cap in position. This is an elastic strap which passes from the back of the cap down around a heavier non-elastic strap which extends across the shoulders and in turn is fastened to them by elastic loops. Figure 4 portrays a splint devised in 1863 for use by practitioners and surgeons who were unaccustomed to treat mandibular fractures. The splint was made of cast tin and was applied with a gutta-percha lining. It was shaped like an tray and there were seven stock sizes. In 1865 Gunning treated William H. Seward, Abraham Lincoln's Secretary of State. Seward was severely injured in a carriage accident on 5th April. Reports read: 'his right arm was broken close to the shoulder joint and his jaw (mandible)
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BRITISH JOURNAL OF ORAL SURGERY

FIG. 4

FI~. 3

was broken in two places but the serious injury was concussion'. On the evening of I6th April about the time Lincoln was assassinated in the President's Box at Ford's Theatre, another would-be assassin gained admittance by a trick to Seward's sick-room and dealt slashing blows with a knife at Seward's face and neck (Fig. 5). Attempts by the surgeons attending Seward to treat the fractured mandible by means of bandages and ligatures around the teeth had been unsatisfactory, and, eventually, on I6th April the eleventh day after the injury, Gunning was first called to treat the Secretary of State. There were bilateral fractures of the

FIG. 5

Fie. 6

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mandible--between the bicuspids. Gunning proposed using his new interdental splint--the type 3 with wings--but this was rejected by the service surgeons after consultation with members of the family. Thereupon Gunning left but offered to return should his services be required subsequently. He was recalled to Washington another twelve days later, 28th April, and requested to treat the case by his own 'method'. Reports read: 'this was 23 days after the accident and severe suppuration now complicated the picture'. Figure 6 reproduces a sketch of the splint in position. There is a record that Seward attended a cabinet meeting the day after the splint was applied. Union was slow but eventually Gunning reported 'the whole jaw moved quite well and firmly'. Gunning's contribution to his professional colleagues extended even to the realms of administration and in 188o, through his efforts, the dental profession was spared the annoyance and trouble of making returns of all dental appliances to the Bureau of Statistics. When he was 67 years old, just nine years before his death, the Baltimore College of Dental Surgery conferred on Gunning an honorary degree--his only degree. In November I89O, Dr. Richard Grady, wrote to the Editor of the D e n t a l C o s m o s - - a leading journal of dental science in the States at that time--informing him that he had received a letter--a pathetic letter--from Miss Gunning. She complained that no mention of her brother's death appeared in the obituary notices in the D e n t a l Cosmos, and that his name did not appear in the register of deaths at the Dental College which made him an honorary graduate in I88O. An adoring sister grieved that Thomas Brian Gunning was apparently so soon forgotten and his death overlooked. It has been said that 'the names of the prime movers of science, disappear gradually in a general fusion and the more a science advances, the more impersonal and detached it becomes'. In the crowded curriculum of today students have no time to trace the derivation and history of eponyms and thus cannot appreciate the true significance of many of them. They are disappearing from our terminology. Professor Neville Whyment in one of his books referring to similar human failings in peoples of this age concludes: 'There is no time for thought, for faith, for song, No time for verse; these things bring in no gold, We have been shackled to the wheel too long, Before we are grown up, we are too old, Oh, Senseless age of men who have no time for things sublime.' May the members of this Association in our generation remember the name of this pioneer and perpetuate his memory by continuing to use the eponym-Gunning's Splint. ACKNOWLEDGEMENTS
The author wishes to acknowledge with thanks the help he has received from many sources in the preparation of this paper. References and articles were kindly provided by the President of this Association, Mr. B. W. Fickling, Mr. Lester Cahn and Colonel Bob Coombs of the U.S.A.F.O. Some information was sent by members of the Gunning family--Mr. C. H. Gunning and Professor Paul Heins. The author is most grateful to Mr. A. G. Booker of the Medical Photographic Unit at the Central Middlesex Hospital for his assistance in preparing the illustrations, and also to Miss Sheila Fraser-Moodie for her skill and ingenuity in tracing the family tree of the Gunnings for over five and a half centuries.