The History of the Treatment of 
Spondylitis and Scoliosis by 
Partial Suspension and 
Retention by means 
of Plaster-of-Paris 
Bandages. 
LEWIS A. SAYEE, M. D. 
BT 
The Plaster of Paris, Wood, Alu- 
minum, and other Spinal 
Supports. 
BT 
A. M. PHELPS, M. D. 
REPRINTED PROM THE 
Wcto ¥orft fHeStcal .fournal 
for March 16, 23, and 30, 1895. Reprinted from the New YorTc Medical Journal. 
THE HISTORY OF THE 
TREATMENT OF SPONDYLITIS AND SCOLIOSIS 
BY PARTIAL SUSPENSION ANI) 
RETENTION BY MEANS OF PLASTER-OF-PARIS BANDAGES, 
Together with the Present Status of this Plan of Treatment 
before the Profession of the World.* 
Bv LEWIS A. SAYRE, M. D. 
When any new mode of treatment is advanced in 
medicine or surgery, its advocates are apt to be overen- 
thusiastic, and many of their readers, misled by apparent 
brilliancy of immediate results, often fall into extravagant 
praise, which further investigation leads them to mod- 
ify ; and, at times, discoveries which have been heralded as 
striking boons to humanity have afterward been so com- 
pletely forgotten that subsequent investigators have sup- 
posed them original when they rediscovered them for a 
second time, as was so admirably shown in the historical 
sketch of spinal supports read before you last year by Dr. 
Phelps. 
It is now twenty years since I first applied plaster-of- 
Paris jackets for the treatment of Pott’s disease and lateral 
* Read before the New York Academy of Medicine, January 31, 1895. 
Copyright, 1895, by D. Appleton a - d Company. THE PLASTER-OE-PARIS JACKET. 
curvature of the spine, and when your president did me the 
honor to ash me to read a paper before you, it seemed to me 
that I could find no better way of occupying your time than 
by presenting for your consideration a resumS of the origin 
of the plan, and of the opinions of the medical profession 
of the world at large in regard to this mode of treatment 
after this lapse of time. That the treatment has not re- 
ceived universal acceptance is plain from a reading of the 
medical journals, though, in my opinion, the objections 
which have been advanced against it are, for the most 
part, due to a lack of comprehension on the part of the 
objectors of the principles which I have advocated, and 
their failure to properly carry out the mode of applying 
these principles ; while, on the other hand, some of the more 
enthusiastic advocates of this method have gone to the 
other extreme, and claimed for it more than I have ever 
asked. As twenty years have now elapsed since I first 
practiced this method of treatment, it may not he without 
interest if I briefly review the manner in which I first came 
to adopt it. 
For many years I was in the habit of treating most of 
my cases of Pott’s disease with the “ Taylor brace.” 
I used to treat those who were too poor to pay for the in- 
strument by applying what I called the “ turtle shell ” to 
the back. 
This was made by laying the child on its belly across 
my lap, with the legs hanging over one side and the arms 
over the other, I then separating my legs so as to extend 
the spine and straighten it as much as possible, and until 
the child was perfectly easy and comfortable, which was 
made manifest in many cases by the improved respiration 
and the disappearance of grunting or jerking of the dia- 
phragm. 
While the child was held in this position a piece of THE PLASTER-OF-PARIS JACKET. 
3 
linen or cotton cloth was accurately cut and shaped to the 
entire back, and two thirds around the entire trunk. In 
cases where the disease was in the cervical region the 
cloth was cut to extend to the top of the back of the head. 
Two or more pieces of cloth cut after the same pattern 
were then dipped in a mixture of plaster of Paris and 
water and laid smoothly over the first one. In the cases 
where the disease was in the cervical vertebrae, several 
thicknesses of this plaster bandage were put on the back 
of the neck, to give firm support to the head. Another 
piece of the cloth cut on the same pattern was then placed 
over the whole, and, while the spine was well stretched by 
separating my legs, an assistant applied a smooth roller 
bandage around the entire body and head, fitting it nicely 
into all the irregularities, and especially over the crest of 
the ilium, thus giving perfect support and preventing any 
motion of the spine. 
When the plaster had become set, the child was then 
laid in the “ turtle shell ” on his back on a pillow, and the 
mother could sew a neat-fitting front to the sides of the 
plaster shell, and, lacing it in the center from pubes to 
sternum, make it give firm support to the spine, while at the 
same time it could be removed for purposes of cleanliness. 
In very many cases this simple plan of giving rest to 
the spinal column was attended with very satisfactory re- 
sults, especially where the disease was in the cervical re- 
gion, in which location, if the head and neck had been well 
extended while the plaster bandages were applied, and re- 
tained in this position till the plaster was set, the weight 
of the head was removed from the neck and supported by 
the shoulders by the closely fitting plaster cast, and at the 
same time the whole spine was absolutely immovable—that 
is, no movements could take place between the separate 
bones. 4 
TIIE PLASTER-OF-PARIS JACKET. 
In November, 1874, a little boy was brought to me 
having a sharp posterior curvature of the last three dorsal 
and the first lumbar vertebrae, and there was also partial 
paralysis of the rectum and one leg. As it was impossible 
to send the child to the hospital, as he did not live in the city, 
and I had no time to apply the “turtle shell,” I felt com- 
pelled to devise some plan by means of which the boy could 
be made comfortable while being transported to his home at 
Chatham Four Corners, Putnam County, New York, nearly 
one hundred and fifty miles distant. Having studied the 
subject for some time, and questioned myself regarding 
the propriety of completely incasing the trunk with a plas- 
ter dressing, I had finally resolved to make the experiment 
as soon as a suitable opportunity was offered. It seemed 
to me that the opportunity had then come, and that the 
circumstances justified the measure. Accordingly, I di- 
rected one of my assistants to suspend the boy by the 
arms in order to see what effect wrould be produced, and I 
noticed that, as soon as the boy was made pendent, there 
was more motion in the paralyzed limb than before, that 
the girdling pain around the belly was very much relieved, 
and that the patient was breathing much easier. While he 
was suspended in this manner, I pulled down his shirt and 
tied it between his legs, thus making it fit the body closely 
and smoothly, and then took some plaster-of-Paris band- 
ages which had been prepared in the ordinary manner to 
be used in the treatment of diseased ankle joints, and, 
commencing at the pelvis between the trochanters and the 
crest of the ilium, completely encircled the entire trunk to 
the axilla. At first I was anxious concerning the effect 
that would be produced upon the respiration, but, inasmuch 
as the boy cried lustily, all my fears in that direction were 
quickly dispelled, and I went on, reversed the bandage, 
brought it back to the pelvis, and so went on until four or THE PLASTER-OF-PARIS JACKET. 
5 
five thicknesses of the roller were made to completely era 
brace the body. He was kept suspended by the hands of 
my assistant for about twenty minutes, until the plaster of 
Paris became hard. He was then laid upon his face on a 
sofa, and was to remain there until the plaster had become 
firmly set. I left him upon the sofa and went to my lunch, 
and when I returned, I found, to my complete astonish- 
ment, that the little fellow had got up and walked across 
the office, and was then looking out of the window. Still 
fearing that respiration might be interfered with too much, 
I cut through the dressing from the top of the sternum to 
the pubes, thus allowing it to gap considerably and permit 
of a more complete expansion of the chest. The boy, how- 
ever, did not feel as comfortable after as before the incision 
through the front part of the jacket was made. I then ap- 
plied a roller bandage around the pelvic portion of the 
jacket and again brought its edges together, but left the 
upper portion to separate as much as the movements of 
respiration seemed to require. In order to give security to 
the upper or thoracic portion, and at the same time to per- 
mit free expansion of the chest walls, I took the mother’s 
elastic garter, cut it into six strips, fastened them upon each 
side of the slit in the jacket, and then tied them in front. 
The dressing now being completed, I requested the 
parents to return with the child at the end of a week or 
ten days, when 1 would have a Taylor’s brace ready and 
would adjust it. The plaster jacket had been put on sim- 
ply for the purpose of rendering the child comfortable 
while being carried home. That was the last I saw of either 
the child or the parents until the following February, four 
months and a half, when he again returned. 
In the meantime the boy had grown considerably, 
looked healthy, was able to walk without assistance, and 
was not obliged to support the upper portion of the trunk 6 
THE PLASTER-OF-PARIS JACKET. 
by placing his hands upon his knees. Without waiting to 
make any further examination, I at once took the patient 
in my carriage and started for my clinic at Bellevue Hos- 
pital Medical College. The streets were covered with holes 
and elevations formed by the ice and snow, and the jolting 
was almost intolerable, yet the boy made no complaint 
whatever. That fact of itself showed how efficient the 
dressing was for securing absolute rest to the diseased 
parts. At the college the jacket was removed in the pres- 
ence of the class, when it was found that the curvature was 
much less, but now the boy was unable even to sit up. As 
soon, however, as the dressing was reapplied, the mother 
remarked: “ He can now sit up and walk again.” 
This, in brief, is the history of the first case in which I 
applied the plaster dressing completely around the body 
from the pelvis to the axilla. Since that time it has con- 
stituted almost the only treatment which I have adopted 
for Pott’s disease. 
The Proper Manner of Applying Plaster-of-Paris Band- 
ages in Spondylitis.—Crossbarred muslin or crinoline should 
be the material used in making the bandages. Frequently 
the kind of sizing used in the manufacture of this muslin 
prevents the plaster from setting quickly. It should there- 
fore be washed to get rid of the superfluous sizing before 
being torn into strips from three to four inches in width 
and three yards in length. Of course the selvage is to be 
torn off. These strips are drawn through a tray filled with 
freshly ground plaster of Paris, and enough rubbed into 
the muslin to fill all the meshes. The bandages are then 
rolled moderately tight and laid in an air-tight tin until 
required for use. 
The patient should have the body covered with a tightly 
fitting knitted or woven woolen shirt, without sleeves, tied 
tightly over the shoulders and drawn down and securely THE PLASTER-OF-PARIS JACKET. 
7 
pinned over a folded towel in the perinaeum. For this pur- 
pose a safety pin should always be used. If the patient is 
a female, pads of proper thickness should he placed over 
the mammae and under the shirt, which pads are to be re- 
moved whe; the plaster sets, thus preventing pressure on 
the glands. Another towel, folded in such a shape as to 
cover the stomach and bowels, called the “ dinner pad,” 
which also is to be removed after the plaster sets, is placed 
inside the shirt, thus providing space for the expansion 
of the stomach during the process of digestion. If the 
patient has partaken of a hearty meal just previous to 
the application of the plaster, this dinner pad may be 
omitted. 
The patient, being now prepared for the application of 
the plaster, is placed in the suspending apparatus, which 
has been heretofore accurately described in my several 
works on this subject, care being taken that the traction be 
evenly divided between the head and axilbe. 
Traction is now made very slowly and gently, and only 
carried to the point of giving the patient perfect comfort, and 
never beyond that point. 
In some cases the heels will be slightly raised from the 
floor before this point is reached, but in many instances 
the heels will not be raised from the floor at all; and as 
the sensations of the patient are the only guide as to the 
amount of traction needed, an anaesthetic should under no 
circumstances ever be given, as has been done by some sur- 
geons, as one requires the intelligent co-operation of the 
patient himself in regard to the amount of traction re- 
quired. If it is a child not old enough to talk and tell its 
feelings, watch carefully the expression of its countenance; 
and when it is changed from pain to pleasure, there stop, 
never making traction beyond that point, and immediately 
apply the plaster bandages with great care and accuracy, 8 
THE PLASTER OF-PARIS JACKET. 
pressing them into all the irregularities and covering the 
entire trunk from the pelvis to the top of the sternum. 
If the patient is kept suspended in this position till the 
plaster is set, it will retain the body in the position of perfect 
comfort which suspension has given it. 
In applying the bandages, one should be placed on 
end in a basin or pail of tepid water, deep enough to com- 
pletely submerge it, when hubbies of gas will at once be- 
gin to escape. As soon as the bubbles cease, the plaster 
will he all moistened and the bandage ready for use. Do 
not add salt to the water, as it renders the plaster brittle. 
Squeeze out the superfluous water before applying it, and 
place another roll, end up, in the water, which will be ready 
for use by the time the first one has been applied, and pro- 
ceed thus until the entire jacket has been completed. The 
reason for placing the bandages on end in the water is that 
the gas may escape and thus enable all the plaster in the 
roll to be evenly moistened. If laid on the side, the mois- 
ture will only extend to some parts, leaving others dry and 
unfit for use. 
The patient being suspended, the jacket is applied by 
the sui-geon, standing or sitting at the back of the patient, 
while an assistant sits in front, steadying the patient by his 
knees and rubbing and smoothing the bandages which are 
being applied. 
Begin at the waist, taking one or two turns around the 
smallest part of the body, and then going down in a spiral 
form, each layer overlapping the other half or two thirds 
of the width of the bandage until reaching the trochanters ; 
then, having taken one or two turns around the pelvis, re- 
verse the bandage, and gradually proceed in the same spiral 
manner upward until you have covered the entire body to 
the top of the sternum. 
This process is repeated till there are a sufficient num- THE PLASTER-OF-PARIS JACKET. 
9 
ber of thicknesses to support the body, the number of 
bandages to accomplish this object, of course, depending 
on the size of the patient. 
In cases where the disease is in the lower dorsal or 
lumbar vertebrae this is all that is required. If the disease 
is at the mid-dorsal or cervical vertebrae, it then becomes 
necessary to add the jury-mast to the jacket in order to 
take off the weight of the head from the vertebral column. 
In many instances great advantage is derived from the 
addition of Whitman’s shoulder brace to keep the chest 
well expanded, and press the shoulders back into the jacket. 
In the great majority of cases the jacket can be applied 
while the patient is suspended vertically, with the greatest 
ease to himself and the surgeon; but in exceptional cases, 
where there is paralysis, where the heart is too weak to 
allow the patient to remain upright for any length of time, 
or in cases of excessively fat and feeble people, Davy’s 
hammock, with holes cut to allow projection of the head 
and feet, is to be preferred, traction being made at both 
ends of the body to the point of comfort while the jacket 
is being applied. 
Now, to pass to the subject of lateral curvature of the 
spine, a deformity which has nothing in common with 
spondylitis, except that they both affect the spine—and I 
might say in passing that, surprising as it may seem, there 
appears to be in the mind of the profession at large very 
often a hazy mingling of these two troubles, which bear 
about the same relation to each other as tumor albus and 
genu valgum, and, although I have written repeatedly and 
at length on the different modes of employing plaster of 
Paris in the treatment of these two affections, it seems to 
me, from the papers I read in the various medical journals, 
that a number of physicians are still under the erroneous 
impression that I use gymnastic exercises in cases of Pott’s 10 
THE PLASTER-OF-PARIS JACKET. 
disease, and employ immovable plaster jackets in cases of 
lateral curvature. In the treatment of lateral curvature the 
position that I hold is, that a large number of cases if seen 
early may best he treated by improvement of the general 
tone of the system, increasing muscular strength, and edu- 
cating the muscular sense of the patient to the correct car- 
riage of the body without the aid of any mechanical sup- 
port whatever. In other cases it is not sufficient to rely 
upon the patient alone, but recourse must be had to artifi- 
cial support to hold the trunk in a correct position until the 
patient is capable of voluntarily maintaining it so ; and in 
a third class, where marked deformity is present, often- 
times accompanied by great pain and disability, artificial 
aid is often necessary to support the body in an improved 
position during the entire life. One of the most useful 
means, in my experience, of rectifying lateral curvature of 
the spine has been vertical, partial self-suspension ac- 
companied by manipulation, and with me nothing has been 
so serviceable in holding this improved position as a corset 
made of flexible material applied to the body in its im- 
proved position, which, then hardening, retains this im- 
proved shape ; and of the various plastic materials that I 
have tried, plaster of Paris has answered my purpose bet- 
ter than anything else. I wish to raise my voice in em- 
phatic protest against what many gentlemen seem to regard 
as my method of treatment in lateral curvature—namely, 
placing the patient in a plaster jacket and leaving her there 
for a number of months, then removing the jacket and re- 
placing it by a second. The plaster corset is simply for 
the purpose of holding such improvment in position as you 
have been able to obtain by your manipulations, and does 
not in any way improve the shape of the patient beyond 
this, and should be renewed as often as improvement in the 
form justifies, and worn only so long as the patient is un- THE PLASTER-OF-PARIS JACKET. 
11 
able voluntarily to maintain an equally good position with- 
out its aid ; and during the treatment it is essential that the 
corset be removed while the patient exercises daily for the 
purpose of gaining that increased physical health and mus- 
cular tone which are necessary to the successful treatment 
of lateral curvature of the spine. 
In applying plaster-of-Paris bandages in cases of lateral 
curvature, a shirt of double length is used, pads are placed 
over the mammae, and a strip of tin two inches wide is placed 
next the skin from the sternum to the pubes, on which to cut 
off the plaster; and, instead of being suspended by the head 
and axillae, the patient suspends herself by pulling on the 
free end of the rope which passes from the head-swing over 
the pulley, while she keeps the arms outstretched, the upper 
hand being on the concave side. As soon as the plaster is 
set, which should be the case by the time the corset is fin- 
ished, it is split open down the front and removed while the 
patient is still suspended. A thin slice is then taken from 
each edge of the slit and the corset held together by a rol- 
ler bandage and dried. When dry, the next day, it is put 
on the patient while again self-suspended, and fastened by 
a roller bandage; then trimmed out under the arms and 
above the thighs until comfortable, and removed. The 
extra length of shirt is then reversed over the jacket and 
sewed to itself, covering in all the plaster, and lacings are 
sewed on in front. 
Without wearying you further by speaking of my own 
ideas on these two subjects, I would pass to the opinions 
of others, as any treatment which will not stand the test of 
time and criticism is not worthy of acceptance. 
While the first demonstrations of this method of treat- 
ing Pott’s disease and lateral curvature were received with 
marked enthusiasm in all parts of the world, wherever the 
demonstrations were made, it remains to be seen whether, 12 
THE PL ASTER-OF-PARIS JACKET. 
after the lapse of twenty years, the same enthusiastic ap- 
proval will be accorded to it, and T accordingly have writ- 
ten the following letter to some hundred of the most distin- 
guished orthopaedic surgeons in various parts of the world : 
285 Fifth Avenue, New York, November 19, 189Jf.. 
Dear Sir : I have been invited to read a paper before the 
New York Academy of Medicine on January 3, 1895, on The 
History of the Treatment of Spondylitis and Scoliosis by Partial 
Suspension and Retention by Plaster-of-Paris Bandages—set- 
ting forth the present status of this form of treatment before 
the medical profession of the world after twenty y ears of ex- 
perience. 
Will you kindly let me have, at your earliest convenience, 
your views on this subject, whether for or against the plan of 
treatment, together with such other suggestions as you may 
choose to make, in order that I may embody them in my report. 
Trusting that I may have the pleasure of an early reply, 1 
am, Yours very truly, 
Lewis A. Sayre, M. D. 
I have received answers from a large number of them, 
and have embodied extracts from them in this report. 
Those that are opposed to it I will read entire; of those 
in favor I will use only extracts. 
Robert Jones, Liverpool, said : “ I am not favorable to sus- 
pension in the treatment of lateral curvature, and would trust 
entirely to exercises, muscle-beating, and, where necessary, ele- 
vation of the heel of the boot.” 
E. Muirhead Little, London, says: “In re gypsum jackets, 
I have not used one for many years. I prefer poro-plastic, 
felt, or steel supports.” 
Bernard Roth, London : “ I have treated with much success 
upward of two thousand cases of scoliosis, including many of 
extreme deformity, by my method of posture and exercise, 
without any mechanical support whatsoever, and I never found 
suspension of any use in scoliosis. 
“ In reference to spinal caries, for the first ten years of my THE PLASTER-OF-PARIS JACKET. 
13 
practice as an orthopaedic surgeon I applied your plaster-of- 
Paris bandages almost exclusively with varying success, but for 
the last ten years I have discarded them altogether in favor of 
the late H. O. Thomas’s spinal splint with axillo-spinal straps. 
1 have modified this splint, so that the patient’s hack can he 
uncovered for examination and the instrument replaced and re- 
fixed while the patient is lying prone the whole time.” 
Noble Smith, London : “ Probably the most fallacious form 
of treatment is that of applying plaster-of-Paris jackets. Among 
the many enthusiastic surgeons who at first made use of them, 
there are very few having had much experience who have not 
now given them up as a failure. Plaster-of-Paris jackets ought 
to be utterly condemned, because, first, of their great weight; 
second, their interference with free respiration and cleanliness; 
and third, the fact that they act simply as heavy, unscientific 
corsets, pressing upon the chest, and add very little to the sup- 
port of the spine.” 
B. E. McKenzie, Toronto: “ With the exact manner of 
treatment referred to I have had but little experience. For 
several years I have employed some form of gymnastic treat- 
ment associated with the employment of forceful correction 
through suspension, with lateral traction, manipulation of the 
spine, etc. The objection which presents itself to me in the 
use of any retentive appliance is that it tends to atrophy and to 
produce weakness of the trunk instead of aiding in the develop- 
ment and strengthening of the parts.” 
H. Hodgen, of St. Louis, does not think he has ever seen a 
very good result in scoliosis from the use of the jacket, and pre- 
fers the steel assistant. 
John Ridlon, Chicago : “ I have used the permanent plaster- 
of-Paris jacket in spondylitis from time to time during the last 
twelve years, applied as you directed, with the patient partially 
suspended, when I have been unable for any reason to obtain an 
antero-posterior steel spine brace of the Taylor pattern. I 
have also used the plaster jacket in certain cases of spondylitis 
where the lateral deformity was so great that the steel brace 
could not be satisfactorily adjusted. In all those cases where 
the jacket has been used for the posterior curvature simply I 14 
THE PLASTER-OF-PARIS JACKET. 
have not been able to prevent an increase of the deformity, and 
in all those cases that have come under my observation after 
having been treated by other surgeons I have been given a his- 
tory of steadily progressive increase of the deformity. ... In 
those cases, however, where there has been marked lateral de- 
formity I have found the deformity progressively diminish under 
treatment by the plaster jacket; but in these cases I have not 
continued the treatment with the jacket after the lateral de- 
formity had disappeared and with the posterior curvature in- 
creased to any considerable extent. 
“ In scoliosis it has been my custom for the past two or three 
years to use the laced plaster jacket in all cases except the very 
slight ones. I use it in connection with partial suspension and 
pressure by the squeezing machine, and I am satisfied that I 
have obtained a much greater degree of correction of the de- 
formity than I had been accustomed to obtain either with exer- 
cises alone, after Roth’s method, or with the use of the leverage 
lateral brace formerly applied, and perhaps still used, by Dr. 
Shaffer of your city. Under treatment by Dr. Shaffer’s brace I 
used to find nearly all my cases grow somewhat more deformed. 
None of them made any material gain, although treated for long 
periods. Under the exercise treatment of Roth very slight 
cases at times fully recovered ; moderately severe cases gained 
somewhat, and rarely ever grew worse; in severe cases the de- 
formity did not in any way diminish, and some few did not ap- 
pear to receive any benefit whatever. At this time I am satis- 
fied that the plaster corset used in connection with the squeez 
ing machine and exercises gives in my hands the best result in 
the treatment of scoliosis.” 
James K. Young, Philadelphia: “In answer to your favor 
of November 28th, asking for my views upon ‘ The Treatment 
of Spondylitis and Scoliosis by Partial Suspension and Reten- 
tion by Plaster-of-Paris Bandages,’ I can best answer by quot- 
ing from my recent work, Treatise on Orthopedic Surgery, 
1894, under the treatment of these two subjects: 
“ Spondylitis.—After describing the technique now em- 
ployed, I say : ‘ While possessing certain advantages of econo- 
my, requiring less special experience in its application, and be- TIIE PLASTER-OF-PARIS JACKET. 
15 
ing entirely beyond the control of the patient or attendants, 
there are certain positive disadvantages—the encircling of the 
body within a solid support, the inability to inspect the condi- 
tion of the skin and note the progress of the affection, the for- 
mation of excoriations, ulcerations, and abscesses without the 
knowledge of the surgeon, the lack of cleanliness, etc.—which 
relegate it and its modifications to a secondary position. When 
split, furnished with lacings, and applied and removed at will, 
it loses part of its efficiency, but there is a gain in comfort and 
cleanliness. It is of decided value, however, for patients who 
are unable to bear the expense of even the cheapest apparatus; 
in such cases, with attention to detail, a cure may often be 
effected, and the writer has in public practice frequently 
proved this statement, especially when the disease was located 
in the lumbar region. 
“ ‘ In justice to this mode of treatment it must be added that 
there are certain cases in which it is the best and most efficient; 
this applies particularly to the lateral deviation of the spinal 
column present in certain cases of Pott’s disease and in lower 
lumbar disease. It is, moreover, important that the surgeon be 
familiar with both the plaster-of-Paris jacket and the spine 
brace, adapting each to the special requirements of the individ- 
ual case.’ Individual experience leads me to employ the steel 
spine brace wherever it can be carefully adjusted at short inter- 
vals under personal supervision. 
“ Scoliosis.—I believe in and employ partial suspension, but 
do not now employ plaster-of-Paris jackets in the treatment of 
scoliosis. I prefer to treat these cases early by mild, long-con- 
tinued movements, exercises, posture, and massage—methods 
by which I have achieved the greatest success.” 
Thomas G. Morton, Philadelphia: “ In private practice I do 
not use the plaster apparatus you refer to, but at the Orthopae- 
dic Hospital we now and then resort to it when the patient is 
unable to procure the Lentz spinal apparatus which we com- 
monly use.” 
Joel E. Goldthwait, Boston : “ I would say that for routine 
treatment I use a form of back brace, practically the Taylor, 
reserving the suspension and jackets (plaster) for those cases 16 
THE PLASTEK-OF-PARIS JACKET. 
which the brace fails to hold, or in which there is lateral de- 
formity. 
u In these cases, if ambulatory treatment is desired, I think 
the jacket is by all odds the best form of treatment.” 
Charles L. Scudder, Boston: “ I have nothing novel or new 
to add to the common experience of surgeons with this form of 
retentive apparatus. I would say simply that in cases of caries 
of the spine below the tenth dorsal vertebra in which for some 
reason or other it may be undesirable to use steel braces, I find 
the plaster of-Paris jacket, applied well over tbe hips and up to 
the axilla, efficient. 
“ In the application of this plaster dressing I am inclined to 
use more and more the hammock as a means of extension rather 
than the tripod and sling.” 
Eobert W. Lovett, Boston: “I have used in the treatment 
of lateral curvature the plaster jacket, I think in all its forms, 
and with certain modifications I still continue to use it. Be- 
lieving as I do very firmly in gymnastic treatment as an essen- 
tial part of the treatment, I have abandoned the use of the fixed 
jacket except in unusual cases, where I apply it to a patient 
who is forcibly corrected, leaving it on only for a short time. 
This measure I have found of use in some of the very severe 
cases. It is applied under suspension. 
“ A method which I have used extensively has been to ap- 
ply a jacket to the patient while suspended, cut the jacket off 
down the front, and fill it with plaster, thus obtaining a of 
the body; then, by the method described by Dr. Bartow, of 
Buffalo, I remove the prominence on the convex side of the 
cast, building it up on the opposite side; in some cases.over- 
correcting the deformity, in other cases bringing them nearly 
to the straight line. To this cast I apply a jacket over an under 
vest, cutting it down the front and having it provided with lac- 
ings. This I have been accustomed to use in connection with 
gymnastics and forcible correction. It represents the patient’s 
condition as it would be if a decided impi-ovement had taken 
place, of course. I am a believer in the efficiency of this ‘ cor- 
rected ’ jacket. 
“ I have also used braces to accomplish the same purpose. I THE PLASTER-OF-PARIS JACKET. 
17 
can not account myself an advocate of the jacket to the exclu- 
sion of the brace, and I use sometimes one and sometimes the 
other. In milder cases I depend for the most part on gymnastic 
treatment. I trust I have answered your inquiries.” 
133 Newbury Street, Boston, December 10, 1891/,. 
My dear Dr. Sayre : In reply to your communication, let 
me say that I find the treatment of Pott’s disease by partial sus- 
pension and retention by plaster-of-Paris bandages in a large 
number of cases of caries of the spine to he most beneficial. It 
is particularly adaptable for cases of disease below the seventh 
dorsal. In the convalescent stage I use removable jackets— 
either plaster, leather, paper, or aluminum removable corsets— 
where these are within the means of the patient. In a number 
of cases, however, I make use of braces. These are largely in 
the cases that are in the upper portion of the spine and where 
careful nursing can he given. In such cases, where thorough 
nursing can be given, I am in the habit of making an antero- 
posterior support. In certain acute cases a fixed plaster jacket 
seems to give a more thorough support than the brace as ordi- 
narily applied. It has seemed to me that an antero-posterior 
support could be made to hold as well as a plaster jacket even 
in the portion of the spine to which the plaster jackets are most 
suitable, but practically, in the majority of cases of the acute 
sort, certainly in poorer practice, a plaster jacket will he found 
the readiest and most efficient. In lateral curvature I am also 
using plaster-of-Paris jackets with partial suspension, but I 
have combined with it also a later traction and direct pressure. 
Here, again, I am in the habit of using substitutes for plaster 
jackets—namely, leather, paper, and aluminum. 
With sincere regards, E. II. Bradford. 
Henry O. Marcy, Boston : “ I thank you for calling my atten- 
tion to the paper which you have in preparation. I am sure 
that I can add very little of value upon the subject, since from 
the first I have considered you my master, and take pleasure in 
writing you the reasons which caused me to first seek your ac- 
quaintance. The first article which you published upon the 
treatment of angular curvature of the spine by means of suspen- 18 
THE PLASTER-OE-PARIS JACKET 
sion and the application of the plaster jacket impressed me so 
favorably that after its careful study 1 went to New York for 
the sole purpose of seeking your instruction, and, thanks to your 
courtesy, I did not return until I had familiarized myself with 
every detail. 
“ It is very probable that I was the more favorably im- 
pressed with your method, since for some years I had used plas- 
ter bandages for almost every variety of fracture. . . . Another 
case which I cited, of a woman confined to the bed because of 
a dorsal curve, at once commenced her work after the applica- 
tion of the jacket, at which time she was three months preg- 
nant. She refused to part with her jacket or have it replaced 
by another, chipping away in front as the enlarging abdomen 
demanded, until her labor commenced. No other jacket was 
applied, and somewhat recently I had the good fortune of ex- 
amining her, all these years the resulting cure having remained 
complete with only a slight deformity. As you are well aware, 
procedures emanating from any other source have been ac- 
cepted by the Boston profession only after repeated proofs of 
real merit. To this conservatism your teaching proved no ex- 
ception. I was not alone the first to introduce plastic splints 
to the profession of Boston, but also your methods of the appli- 
cation of the plaster jacket, and unweariedly wrote and talked 
upon the subject. Much excellent work has been done here 
for a good many years, especially at the Children’s Hospital, 
but unfortunately the general profession are still wanting in 
technique and training. I inclose you a reprint of 1877 upon 
Plastic Splints in Surgery, and call your attention to its closing 
sentences. What I then said I now repeat, but more than all 
as the outcome of your teaching upon this subject do I prize a 
personal friendship.” 
Albany, N. Y., December llj,, 1894- 
Lewis A. Sayre, M. D., New YorTc City : 
My dear Doctor: In reply to your letter of November 
19th, I am reminded largely of the early history of your work 
in the treatment of spondylitis and scoliosis when first present- 
ing the subject to the attention of the New York State Medical THE PLASTER-OF-PARIS JACKET. 
19 
Society. You will remember that I was the first who presented 
a case—that of Miss M.—for your treatment, application of the 
bandages, etc., and the result was quite decidedly satisfactory. 
While for the past five years my line of practice has been away 
from orthopaedic surgery, yet my impressions, in answer to your 
questions, would he that my results in the treatment of angular 
curvatures of the spine have been decidedly satisfactory. In 
the treatment of lateral curvature I can not speak so emphatic- 
ally. For angular curvature I applied the first plaster-of-Paris 
dressing put on in this city, after having read a report of one 
of your clinical lectures at Bellevue Hospital on the subject. I 
applied the bandages directly to the surface of the body, and 
had the pleasure of seeing the little patient do remarkably well. 
Hoping these few stray notes will be of service to you, and 
that you will pardon my delay in answering, believe me, 
Sincerely yours, A. Vandeb Yeeb. 
Lewis Balch, of Albany : “ I have not applied a plaster jacket 
for six or eight years. From the time you put on one before 
the State Medical Society, in the winter of 1878—I think that 
was the date—up to 1886, I used the jacket for all cases of 
spinal curvature coming under my charge. In general I can 
say the treatment was successful, hut I noticed in some cases 
of rotary lateral curvature the patient seemed to slip down 
through the jacket, no matter how carefully it was applied, and 
the treatment failed. Eventually I had better success in ante- 
ro-posterior curvature than in the other. 
“I know the jackets were properly applied, for you taught 
me how to put them on both here and in your own office.” 
M. II. Burton, Troy: “ I have used the Sayre jacket in 
treating cases of spondylitis and scoliosis in the Troy Hospital 
and in private practice with decided and manifest success. I 
have witnessed its use in Marshall’s Infirmary, Troy, FT. Y., 
and the results were not gratifying. I have seen cases also 
which had been treated by yourself, and found complete recov- 
ery the result. It would not be within my province to suggest 
to you in regard to the Sayre jacket or the counterpart appli- 
ances. 20 
THE PLASTER-OF-PARIS JACKET. 
“Your experience and knowledge in the matter preclude 
such suggestions, if I had any to make—which 1 have not. As 
compared with other jackets or appliances, I find no single 
point in their favor, so far as experience and observation give 
me knowledge. 
“ In all respects I find the Sayre plaster-of-Paris appliances 
or jackets the most efficacious, convenient, and valuable, and 
the ones causing the greatest success in the treatment of the 
diseases for which we apply them.” • 
R. B. Bontecou, Troy : “ Your letter of November 19th was 
duly received, and I have nothing more to state than what 
the profession at large have stated and will state in admiration 
of your device to accomplish physiological rest by fixation, 
which I believe is the great principle to observe in the treat- 
ment of disease of the spinal column and the greater joints. I 
have relieved and cured a multitude of suffering humanity by 
your method, both in hospital and private practice -adults as 
well as children. Of late years I have substituted water glass 
of heavy specific gravity for the plaster, finding it equally re- 
sistant and durable, and lighter, and can be cut open when ne- 
cessary and used as a corset more readily than plaster. 
“ I have also, in children with posterior spinal deformity, 
often substituted the prone position in a hammock of cotton 
flannel, with advantage, utilizing the hammock as one of the 
envelopes. It is certainly more comfortable for children than 
the vertical position.” 
Ansel G. Cook, Hartford: “ About eighty per cent, of my 
cases of spondylitis wear solid plaster-of-Paris jackets, with 
or without the jury-mast; about fifteen per cent., plaster or 
leather corsets made to lace in the front; and about five per 
cent., for various reasons (position of abscesses, imperfect de- 
velopment of hips, complications of other joints, etc.), wear 
various forms of braces. This does not include the very severe 
cases that are confined on wire or plaster and board cuirasses, 
or a class of cured or convalescent adults whose backs are not 
strong and who require some support. These do best, I find, 
with a light back brace, padded the whole length of the brace, 
worn under an ordinary pair of corsets. THE PLASTER-OF-PARIS JACKET. 
21 
“ The mild cases of scoliosis I treat with exercises alone ; 
the more severe, with exercises supplemented with braces that 
do not hold, but compel the patient to hold himself, in a cor- 
rected position (you will note the distinction); and the most se- 
vere, with plaster-of-Paris or leather corsets. I hope your pa- 
per will touch on the subject of suspension, forcible correcti on 
and retention, which has so many enthusiastic advocates at 
present. 
“A great deal of trouble, I think, arises from improperly 
made and badly fitting jackets; it certainly requires consider- 
able practice to make a good one, and when a man condemns 
plaster jackets you are inclined to agree with him when you 
see the thing he has made and calls a jacket. On the other 
hand, the man who sends his patient to an instrument-maker to 
have a brace fitted, without giving accurate directions as to how 
the brace shall be made, and attending personally to the fititng 
of it, is not likely to get any satisfactory result.” 
Dr. Lewis A. Sayre: Buffalo’ Becemher 5’ 
My deae Doctoe : In reply to your favor of November 19th, 
asking my views in the matter of the treatment of spondylitis 
and scoliosis by plaster-of-Paris bandages, I would say about as 
follows: First of all, I would wish to acknowledge the benefits 
which I, like all other surgeons, have received from the views 
upon treatment which you have published so widely and with 
which your name is so inseparably connected. 
So far as the treatment of acute spondylitis is concerned, and 
at that time when absolute fixation is so absolutely necessary, 1 
must say that I know of nothing that can take the place of a 
plaster-of-Paris corset. With regard to the later treatment at 
a time when plaster has become irksome, or when the acute 
stage is past and the patient’s personal comfort can be more 
consulted, I must say that, for my own part, I think that other 
mechanical devices can be substituted which permit of suffi- 
ciently frequent removal to keep the patient more comfortable. 
I do think that braces or jackets of various kinds can be de- 
vised that give sufficiently complete fixation to meet the indica- 
tions, and that are much more agreeable for the patients. But, 22 
THE PLASTER-OE-PAKIS JACKET. 
in the early and very acute stages, and in a certain class of hos- 
pital and dispensary patients, I think that plaster or its equiva- 
lent, yet to be discovered, more completely fills the indications 
than anything else. 
With regard to scoliosis, it is not my own personal custom 
to resort much to plaster jackets, except as I may put one on in 
order to obtain a cast of the body around which to construct a 
suitable brace. I think these cases are more often injured by 
too long rest of the muscles, and for all except the inveterate 
cases I much prefer a movable corset which will permit massage 
or very much more active muscle training. The more I study 
and have to do with lateral curvature, especially in the young 
and growing, the more I believe in the expediency of gymnastic 
treatment, and the less absolute reliance I like to place upon 
support. I may sum it all up by saying that in my estimation 
a happy combination of the two constitutes the best treatment. 
I appreciate your request for my own views, which I ad- 
vance with no little hesitation to such an authority as yourself, 
and am, very sincerely yours, Roswell Park. 
Kansas City, Mo., December 4, 1894- 
Dr. Lewis A. Sayre, 285 Fifth Avenue, New Yoric : 
My dear Doctor: Yours of the 19th just to hand, and I 
would say in reply that in spondylitis of the upper dorsal and 
cervical region I have used with good results and advocate re- 
cumbency. Where the disease is manifest below this part, I use 
suspension and retention by plaster-of Paris bandages—fixed 
dressing if the trouble is active, and movable apparatus or laced 
plaster-of-Paris dressing if angular curvature has taken place. 
In scoliosis I find the suspension and retention by the plaster- 
of-Paris bandages, cutting down and lacing, my best method. 
Your friend, J. D. Griffith. 
Minneapolis, December 8, 1894- 
Dear Dr. Sayre: In reply to your kind letter, would say 
in the majority of cases of spondylitis I use partial suspension 
and retention by plaster of Paris, and when I do use a steel sup- 
port it is usually to cater to the prejudice of my patient, for 
since 1 have known how to apply the jacket properly I have THE PLASTER-OF-PARIS JACKET. 
23 
been able to do more good to a greater number with it than 
with any other means at my command. 
For the past two years in treating scoliosis I have aban- 
doned braces and supports of every kind, and I believe with 
advantage to my patients, except in cases in which the de- 
formity is increasing very fast, and then I apply a plaster jacket 
until I have had time to build my patient up and get her able to 
stand alone as it were. Fraternally, J. E. Hoobe. 
Hunter McGuire, Richmond, Va. : “Your letter of Novem- 
ber 19th has been received. In the treatment of spondylitis 
nothing, in my opinion, is better than partial suspension and 
retention by plaster-of-Paris bandages. Having a son with this 
disease, there is nothing in medical literature on this subject 
that I have not studied. I have practiced several other devices, 
but have never found anything equal to the plaster-of Paris band- 
ages. When I use them in scoliosis, however, I always arrange 
them so they can be removed, and endeavor to strengthen the 
muscles by massage, electricity, and gymnastics.” 
116 South Eighteenth Street, 
Philadelphia, November 28, 189 
My dear Dr. Sayre : In all cases of spondylitis in the early 
stages, where the patient is not confined to bed, I use plaster-of- 
Paris bandages, as suggested by you. Later, in private practice, 
I use some form of steel supporting apparatus. In my hospital 
work and among the poor I usually employ plaster-of-Paris 
jackets from the beginning to the end of the treatment of the 
case, and at all times when the cost must be considered. 
In scoliosis I use the plaster-of-Paris jacket, which is re- 
applied at short intervals, to support the spine and overcome 
the deformity, believing that we can accomplish better results 
in this way than by more expensive and cumbersome apparatus. 
When the curvature has been overcome I apply some form 
of light supporting apparatus. Of course in scoliosis I do not 
neglect to use stretching and pressure, with gymnastic exercises, 
to increase the flexibility of the spine. 
I shall be glad to give you more details if this short account 
is not sufficient. Believe me, very truly yours, 
William J. Taylor, M. D. 24 
THE PLASTER-OF-PARIS JACKET. 
.. November 28, 1894- 
Dr. Lewis A. Sayre, 285 Fifth Avenue, New York: 
Dear Dr. Sayre: In reply to your note of the 19th I would 
most gladly say that the profession owes much to you for de- 
veloping the use of plaster of Paris as a surgical dressing in a 
great variety of cases and conditions. In regard to its use in 
spondylitis, it has been a Godsend to hundreds of poor people 
who would otherwise have been without this most economical 
and effective method of fixing the spinal column until repair 
takes place. I know of no method so convenient for producing 
absolute fixation of the bones of the spinal column. It certainly 
has its disadvantages; but your work in this line has stimulated 
efforts at substitution which have obviated its disagreeable fea- 
tures. The great principle underlying the treatment, however, 
that of rest and fixation, has steadily and persistently taken 
firm hold upon the profession at large. While method and 
means may change, the principle will live. 
In regard to self-suspension for scoliosis, it is one of the 
helpful means of rectification, and I value it highly. I am op- 
posed to apparatus for scoliosis, both on theoretical and practi- 
cal grounds, whenever it can he avoided. I belie-ve in strength- 
ening the muscular power by active and passive gymnastic 
movements, as I consider them the essential elements in effect- 
ing a cure. At the same time I do not deny that there are cases 
rapidly growing worse which require permanent support. 
When plaster of Paris is used in these cases it should, in my 
judgment, be employed as a corrective agency, with constantly 
increasing pressure upon the projecting portions of the body, as 
advocated by yourself and by the plan of Bartow. Thanking 
you again for the earnestness with which you have pursued this 
branch of surgical work, I am 
Yours very sincerely, De Forest Willard. 
John Chalmers De Costa, Philadelphia: “ The custom in the 
Philadelphia institutions with which I am connected is to treat 
acute and early spondylitis by means of rest in bed, and to rely 
entirely upon plaster of Paris, applied during suspension by your 
method, for the completion of all cases and the cure of pa- 
tients.” THE PLASTER-OF-PARIS JACKET. 
25 
1611 Spruce Street, Philadelphia, November 30, 1894- 
My dear Dr. Sayre : I am in receipt of your letter of No- 
vember 19th. I am very strongly in favor of the plan of treat- 
ment by plaster of Paris, applied during partial suspension, in 
cases of spondylitis below the mid-dorsal region, also as a means 
of holding a jury-mast in cases above mid-dorsal region. I am 
strongly opposed to the use of plaster of Paris applied in any 
position for scoliosis where it is allowed to remain for more 
than one week’s time, because it tends to increase the muscular 
atrophy from disuse. I believe that it would interfere with the 
object of your paper did I do more than briefly state my views 
as above. I can but believe that the mechanical advantages of 
plaster of Paris have been seriously interfered with by the in- 
judicious employment of it in unsuitable cases and in an unme- 
chanical manner. It has often appeared to me that plaster of 
Paris was applied apparently with the idea that it acted as a 
therapeutic measure by absorption in some such way as many 
of the nostrums are supposed to act. It is only in this way that 
I have been able to explain the irrational manner of its applica- 
tion. I remember saying in one of my clinical lectures that it 
seemed a great misfortune that Professor L. A. Sayre could not 
communicate his skill in selecting the cases suitable for the 
method as well as his skill in applying plaster of Paris, to pre- 
vent the terrible abuse to which it has been subjected. 
Yours most sincerely, II. Augustus Wilson. 
B. Merrill Ricketts, Cincinnati: “ In reply to your request 
for my opinion concerning the treatment of spondylitis and 
scoliosis by partial suspension and retention by plaster-of-Paris 
bandages, I will say that this method is, I believe, the best thus 
far presented when applied with skillful hands. 
“ Its advantages. 
1. Non-elasticity. 
2. Perfect adjustment. 
3. Inexpensiveness. 
4. Convenience. 
5. Rapidity. 
6. Frequent reapplication. 
7. Continuous adjustment. 
Disadvan tages. 
1. Uncleanliness. 
2. Excessive weight. 
3. Liability to fracture. 
4. Irritation by small particles 
of plaster. 
5. Absorption of secretions. 26 
THE PLASTER-OF-PAR1S JACKET. 
“ To overcome the disadvantages, I have, as a rule, used the 
leather jacket supported by steel made from the original plaster 
cast. The leather jacket does not meet as many requirements 
as the plaster, but, nntil some of the disadvantages of the plaster 
are overcome, I believe it will be necessary to use the leather, 
believing that it excels the other substances, such as metal, 
wood, paper in any form, or any of the various apparatuses.” 
Edmund Andrews, Chicago : “The plan is a valuable one in 
many varieties of cases. One of the important advantages in 
the West is that family physicians in distant mountain and 
prairie regions, far away from instrument-makers, can always 
make use of it. 
“ Another advantage is that by its use the remote physician 
protects his patient from getting useless and injurious braces 
made by city instrument houses from inadequate measurements 
sent by mail. 
“The practical difficulty as to its use by distant country 
practitioners is the tendency of some of them to leave it on 
without change so long that the skin becomes foul and offensive, 
and their neglect to guard the prominences of bone, thus pro- 
ducing ulcers by the pressure. 
“ As the patient may be ten or fifteen miles distant over bad 
roads, they think they can not go to him very often. 
“It is a serious question for a far-off country doctor as to 
what he can do for a distant spinal case having scanty pecuniary 
means. My extensive correspondence with these people has 
impressed me'strongly with their difficulties I use the plaster 
jacket frequently, but in many other cases I prefer apparatus of 
other material.” 
W. R. Whitehead, Denver: “I recently received your let- 
ter about spondylitis, and hasten to reply at my earliest conven- 
ience. I wish that I could add something really valuable and 
interesting to what I have already expressed concerning your 
treatment of this disease. I am sui’e, my dear doctor, that no 
one appreciates your efforts in this matter better than those 
who have profited, as I have, by your instruction in the appli- 
cation of this the most valuable means of treatment, in my 
opinion, of Pott’s disease of the spine, which is one of the THE PLASTER-OF-PARIS JACKET. 
most troublesome surgical affections with which we have to 
contend. 
“ I am opposed to all stiff braces as inefficient, painful to 
the patient, and often a most useless expense. The trouble 
is, generally, that the Sayre jacket is not properly applied; it is 
almost always, in my experience, too heavy, or the plaster is of 
poor quality; sometimes the piano-felt pieces about the hips 
are omitted, or there is something about the jacket that shows 
inefficiency in its application, or a want of proper knowledge 
of or proper appreciation of the purposes for which it is ap- 
plied, as simple as they are. These things are not the fault of 
the Sayre jacket, but the fault of those who sometimes attempt 
to avail themselves of this excellent device—indeed, the fault of 
the medians imperatus with which this country is abundantly 
supplied. Take, for example, an intelligent country doctor, far 
removed from all the conveniences of a city, and if he understands 
how to apply your jacket properly, and has any ingenuity at all 
and a little good plaster of Paris, he can, in my humble opinion, 
make for his patient a better and more comfortable and more 
useful appliance for the treatment of spondylitis than all the 
nickel-plated steel braces and other spinal 1 contraptions ’ offered 
for sale and advocated by instrument-makers and recommended 
by their inventors.” 
“ P. S.—Some doctors, it seems, are invited to send east a 
mold of the bust in plaster, and a jacket will be furnished 
shaped after such a mold. My comments are that a doctor who 
has not experience and sense enough to make a suitable jacket 
can not make a good mold.” 
Henry M. Sherman, San Francisco: “ I am very glad indeed 
to submit to you, my old master in my art, my experiences and 
conclusions in regard to the plaster-of-Paris jacket, and to let 
such of them as merit it reach the profession through your 
paper. 
“I advance the following propositions: 
“1. In cases of vertebral tuberculosis, when the lesion is 
below the ninth dorsal vertebra, the treatment by ‘ partial sus- 
pension and retention by plaster-of-Paris bandages’ is incompar- 
ably the best, always excepting those cases in which for special 28 
THE PLASTER-OF-PARIS JACKET. 
and obvious reasons—hernia, abscess, sinuses, etc.—no plan 
which contemplates the rigid enveloping of the body can be al- 
lowed. I am sure this contention can be made, though I have 
been obliged to modify my earlier views of the 4 work ’ of a 
jacket both as a splint and as a support. 
‘4 2. In cases of vertebral tuberculosis, when the lesion in- 
volves the eighth and ninth dorsal vertebras, the choice lies be- 
tween the jacket and a brace, the former being suitable for 
milder cases, and those in which a compensatory lordosis could 
be easily developed both above and below the kyphos. 
“ 3. In cases of vertebral tuberculosis, in which the lesion is 
above the eighth dorsal vertebra, the plan of treatment should 
include carriage of the head by apparatus, and in all such cases 
the supporting point of the mechanism is the pelvis, which is 
embraced by a jacket of plaster of Paris or a pelvic belt of 
leather. For the support and carriage of the head I prefer the 
steel fork and aluminum chin collar which I have described. 
“4. In cases of scoliosis the plaster-of-Paris jacket as a 
rigid all-embracing splint on the trunk is the most satisfactory 
means to hold and make permanent the correction gained by 
gymnastics, forcible correction of deformity, etc.; but its function 
is purely that of a splint—i. e., retention, not correction—and, 
like all splints, muscular weakness of the muscles corrected and 
aided by it results from its too exclusive and too prolonged use. 
I am myself working with a fair amount of success on the lines 
of these proportions. Of course, I can not claim them to be 
universally applicable, and have myself exceptions to them in 
my practice, but they are a more than good set of working 
rules.” 
R. II. Plummer, San Francisco: <4My experience in this 
method of treatment reaches through a period of fifteen years, 
during which time I have applied it not only in private prac- 
tice, but in Cooper Medical College Dispensary as well, and it 
affords me great pleasure at this time to testify to you in no 
uncertain terms my appreciation of the merits of the method of 
treatment. . . . That the method has not given unqualified sat- 
isfaction to all who have attempted to use it goes without say- 
ing. Failures arise from various causes, as improperly selected THE PLASTER-OF-PARIS JACKET. 
29 
cases (incurable) ; improper materials used, as unsuitable sbirts; 
unskillful application of the bandages; and a general injudicious 
management of the case as to exercise, etc. All these deficien- 
cies may be summed up in four words—viz., ‘ ignorance of the 
method.’ If all who essay to use it would first familiarize 
themselves with your writings upon the subject, and especially 
if they could avail themselves of the benefit of your personal 
instruction as to details, etc., the method would not suffer at 
their hands, and their patients would invoke blessings on tbeir 
lives.” 
L. C. Lane, San Francisco : “ I fully approve of your method 
of suspension and retention by plaster-of-Paris bandages in the 
treatment of spondylitis and scoliosis. I regard this plan of 
treatment as one of the most important additions made to sur- 
gery during the present century.” 
S. H. Pinkerton, Salt Lake City: “ In the treatment of 
spondylitis I consider the partial suspension and a properly ap- 
plied plaster-of-Paris jacket (with its modifications) superior to 
all mechanical appliances. 
“ In scoliosis I have had very good results with a removable 
plaster of-Paris jacket (or corset) together with gymnastics.” 
William E. Wirt, Cleveland: “ It has been my experience as an 
orthopaedic surgeon to have applied at least two hundred, possi- 
bly double that number, of plaster-of-Paris jackets to cases of 
Pott’s disease. I consider this jacket a great boon to these 
unfortunate children, especially when the disease occurs among 
the poor and ignorant—in fact, nothing can take its place. 
Among the wealthy and intelligent, and more especially those 
whom we may trust to carry out directions, 1 have found a modi- 
fied Beely corset to be more satisfactory. In certain cases of 
Pott’s disease, where I had ordered a spinal brace, I have found 
that no amount of fitting and adjusting would make it com- 
fortable to the patient, and in such cases would have to return 
to plaster jacket or felt corset. 
“ In scoliosis I do not favor the plaster jacket as a measure 
of treatment, but I simply use it as a means of getting a mold 
which I still further improve in shape (over that gained by sus- 
pension) before molding upon it a felt corset.” 30 
THE PLASTER-OF-PARIS JACKET. 
S. A. Wright, Manchester : “ In reply to your question : 
“ 1. I have never used any fixed apparatus for scoliosis. 
“ 2. For caries of the raid and lower dorsal and lumbar re- 
gion I have always used, and do still use, Sayre’s jacket largely, 
but not in cases where there is an abscess, nor in cases where 
the disease includes the upper dorsal region. I am not strong- 
ly impressed with the value of any form of jury-mast, and 
where the jacket is inapplicable I prefer bed or a metal spine 
spring.” 
0. IT. Golding-Bird, London: “ Re Scoliosis: (a) Plaster 
Bandages.—After a continued trial of the bandages in these 
cases I abandoned them; not that they did not at first give the 
greatest support, keep the spine straighter, allow of the chest 
being kept (in bad cases) more expanded, but because I found 
these results to be but temporary. In spite of the exercise with 
the tripod I did not find that the musculature of the trunk im- 
proved to the degree requisite for the patient’s maintenance, as 
the improved position is to be obtained rather by the best pos- 
sible development of the muscles (whereby the wearing and 
wearying muscle pain attendant on these cases is abolished and 
the patient rendered able to be about with comfort) and not by 
the most perfectly shaped back, if the muscle tone can not at 
the same time be maintained to the full. I less and less, there- 
fore, use supports, preferring to throw the onus of maintain- 
ing an improved position on the patient’s own muscles, being 
careful to give alternately with calisthenics such rest as in each 
case is needful. 
“ Where patients are already cripples and a lifelong sup- 
port is necessary, then doubtless the jacket gives the maximum 
of comfort; but in practice I have found, in every station of 
life, that where such support is requisite the patient after a 
time prefers an apparatus (felt or otherwise) that can be re- 
moved for toilet purposes to the plaster that is immovable and 
that has to be reapplied at stated intervals, even at a loss of 
some of the support that the bandage gives. 
“lie Scoliosis: (b) The Tripod Exercise.—This can hardly 
be improved upon; and it remains the type of what technical 
calisthenics in these cases should be. THE PLASTER-OF-PARIS JACKET. 
31 
“ With due attention to the patient’s environment of place 
and habit, the muscles soon develop and harden under its proper 
use; and it brings the greatest number of trunk muscles into 
play at a given time, with a minimum of fatigue; in this sur- 
passing other and more popular forms of exercise. 
“ Even in confirmed scoliotic cripples, I have seen the daily 
expansion of the chest by the tripod exercise improve the 
heart’s action and materially aid in the restoration of the pa- 
tient’s health, by mechanically permitting the better oxygena- 
tion of the blood and the freer action of the heart. 
“ I consider it of more value than the plaster jacket in the 
Sayre method of treating scoliosis. 
“ Re Spondylitis : (a) The Plaster Jacket.—In spondylitis 
the jacket fulfills all that its inventor claimed for it, allowing 
patients to be about and in the open air instead of being kept 
always on their backs ; and they recover, where the jacket is effi- 
ciently and sufficiently often applied, with as slight deformity 
as though they had been kept lying down all the time. 
“ I know of no disability attending the employment of it 
important enough to prevent its universal application ; but at 
the same time, 1 have never known any treatment introduced 
into surgery that was less understood, or about which less trou- 
ble was taken to understand it practically. 
“ While I still employ it in public practice, it is many years 
since I did so in private. The agitations of those who had 
‘ vested interests’ in spinal cases, and the prejudice of the pub- 
lic against an appliance that could not be removed for the bath, 
in a few years caused it to fall into disrepute, and save for hos- 
pital cases I do not think it is ever now employed. 
“ The public refused to regard the benefit the jacket afford- 
ed as in any way weighing against any slight disagreeables it 
might possess; and an otherwise intelligent mother informed 
me once that she declined to go on with a treatment in which 
a surgeon’s personal attention was necessary at intervals of two 
or three months, when her instrument-maker could supply her 
with a steel and leather support that would last for years! 
And this may be taken as a fair sample of what many said or 
implied. THE PLASTER-OF-PARIS JACKET. 
“ When I add that leading instrument-makers advertised in 
the past that they put on ‘ Sayre’s jackets ’ for the profession, 
and also that leading surgeons sent their cases to them for the 
purpose, and when I know of my own knowledge that the 
jackets were nothing but stiff plaster belly-bands, rapidly ex- 
coriating the flanks, and worse than useless, and their useless- 
ness made known as demonstrative of the futility of ‘ Sayrism ’ 
—it is not surprising to find that the plaster jacket had to give 
way to steel, leather, and felt, which materials now reign 
supreme! 
“ However, the lesson taught by Sayrism has not been lost 
entirely ; felt jackets, though an imperfect support, more nearly 
fulfill the principles of that system than the old steel and 
leather supports; and even those who still use the latter en- 
deavor to get them more body-fitting than formerly. 
“ Re Spondylitis: (b) The Tripod Exercise.—I only use the 
tripod for the application of the jacket. In a stage when exer- 
cise might indeed somewhat unfold the spine by extension upon 
recently formed reparative material, I should consider its use 
as an exercise unwise ; while where consolidation has occurred, 
it would be useless. 
“ The exception I make is in the case of deformity, after 
consolidation, being such in the dorsal region as to cause the 
chest to assume the position of deep expiration; then exercise, by 
acting through the thoraco humeral muscles, undoubtedly, as in 
old scoliotics, gives for the time free heart-play and better 
mechanical opportunity for the oxygenation of the blood, and 
thus the general condition of the patient is much improved.” 
Edmund Owen, London : “ For a good many years I used 
suspension in the treatment of children with Pott’s disease 
when applying plaster-of-Paris jackets ; but, in due course, 
experience showed me that I got equally good results by apply- 
ing the jackets as the child stood on the ground, the arms be- 
ing held up out of the way. I am not a believer in extension 
of a carious spine. I found the plaster of-Paris-jacliet treat- 
ment cheap, handy, and efficient; but, as a kind Providence 
has removed me from further charge of out-patients, I no 
longer have occasion to apply the jackets personally. Still, I THE PLASTE R-OF-PARIS JACKET. 
33 
have firm faith in them, and constantly get them applied by my 
house surgeons and dressers in Pott’s disease. 
“ 1 consider their use in lateral curvature (curvature with 
rotation) to be injurious in childhood; though I freely admit 
that in the case of some limp and crumpled adults with lateral 
curvature, a gypsum corset may be applied with great advan- 
tage, especially if the patient be suspended during the applica- 
tion. Indeed, without suspension the jacket would be of little 
avail.” 
MacNaughton-Jones, London: “In reply to your letter I 
send you the photograph of the first patient on whom a plaster- 
of-Paris jacket was put in Ireland in the year 1876. It was ad- 
justed by me prior to your visit to Cork that same year. Since 
that date to the present I have practiced the treatment there 
advocated by you, so far as suspension and support are con- 
cerned. Necessarily of late years my work has not carried me 
so much into this field of surgery as it did in Ireland. As you 
know, I published the results of my cases up to a certain date in 
the Dublin Monthly Journal of Medical Science. You want to 
know what is my present view of the results of your plan of 
treatment in spondylitis and scoliosis. 
“ First, Spondylitis.—I regard the plaster jacket well ad- 
justed in the early stages of the disease as the most valuable 
support to the diseased structures I know of (I include in this 
statement all the hybrid deviations which imitators of your 
method have adopted), so long as the integrity of the support 
is secured and maintained. This, so far as I can judge, is 
essential. The head support I also include in this view. The 
treatment in the early stages should be, I hold, combined with 
a fair amount of rest in the horizontal position and all the 
other hygienic and locomotive aids which are so essential in 
this treatment. 
“ Given a fair case and prudent supervision with judicious 
change of the support, it is the treatment which I should adopt 
in the case of a child of mine affected with the disease. Cer- 
tain cases of spondylitis, in which general tubercular affections 
of the various bones are present, can be cured by no treatment 
I know of. Deformity is inevitable, do what we will. I do 34 
THE PLASTER-0F-PARIS JACKET. 
not suspend in Pott’s disease save in placing the jacket on the 
patient. This latter is no hindrance to treating the complica- 
tions of the disease. This I have proved many times. In the 
latter stages, when the support has done its work, I resort to 
the well-fitting poroplastic jacket with steel stays and the 
softened portion for the affected area. This I can combine 
with light arm supports and the head rest if necessary. This 
is my view of the plan you advocated, and which has stood 
(thougli so often twisted and turned for some faddist’s personal 
advertisement as hardly to be recognized as yours) the test of 
the last twenty years. If the principle has failed, it has been 
from trial when no cure was possible, in cases in which noth- 
ing was to be expected from any plan of treatment, or it has 
been carried out ineffectually and imperfectly. 
“ Scoliosis.—I can not speak too warmly of my experience 
of the suspension treatment in scoliosis. 1 may have departed 
in a degree from my original practice in always employing the 
plaster jacket, perchance unwisely in some instances. I now 
rarely, in the cases that I am consulted in, use plaster. I use 
the poroplastic felt, carefully molded and applied under sus- 
pension, in all cases. I support the jacket with stays of steel 
where required, and combine at times light axilla props. I in- 
variably insist on the practice of suspension by the neck at 
home, and combine the treatment with gymnastic exercises and 
the usual rules of hygiene and diet followed in such cases. I 
can unhesitatingly say that such treatment gives but the best 
results. I have never, since I put on the jacket I send you the 
photograph of, resorted to any other mode of treatment in any 
form of lateral curvature. I believe it to be the best. As a 
general rule, it has given me such good results that I have 
never been tempted to go outside it. Even in old and irre- 
mediable cases it has given the greatest comfort and relief from 
pain. 
“ In conclusion, let me, as one who has on many an occasion 
reaped the benefit of your inventive skill and sound practical 
teaching in this branch of orthopaedic surgery, as in many oth- 
ers, pay no mere flattering tribute to the system of treatment 
you so graphically introduced into this country. But the real THE PLASTER-OF-PARIS JACKET. 
35 
testimony to its worth is one you may neither see nor hear. It 
is the unrecorded and unspoken gratitude of the many whose 
lives have been spared, whose sufferings have been mitigated, 
and deformities removed through your own work, and not of 
those who have followed in your footsteps. This is true of the 
past, it is equally so of the present, and it is my belief it will 
be so in the future.” 
E. Luke Freer, Birmingham : “ My experience with plaster- 
of Paris jackets dates from Dr. Sayre’s demonstration in Bir- 
mingham some fifteen years ago, one of the patients being sup- 
plied bj me from the Birmingham Royal Orthopaedic Hospital, 
where I then held the post of honorary assistant surgeon. In 
that capacity I applied every plaster jacket for my senior col- 
leagues (in those days everything ‘spinal ’ was turtle-shelled in- 
discriminately), and I might almost have been dubbed ‘honor- 
ary plasterer ’ to the hospital. As might have been expected, 
the results were not universally satisfactory. As honorary sur- 
geon, I have dealt only with my own cases, but my applications 
have numbered over three thousand altogether, and I am now 
as firmly convinced as ever of the superiority of the plaster 
cuirass over all other methods for the treatment of spondylitis; 
where recumbency was necessary in cases of abscess, etc., I 
have found Thomas’s double hip splint very serviceable. In 
high dorsal and cervical caries I have preferred Furneaux Jor- 
dan’s modification, and in some cases Thomas’s collar, to the 
jury-mast, as giving more complete fixation. In scoliosis (unas- 
sociated with spondylitis) I still use the cuirass, but only when 
the patient has to pursue his or her ordinary vocations, or at 
the commencement of treatment, until the muscles and muscular 
sense have been sufficiently re-educated and strengthened by 
systematic and harmonious kinetics and the correction of faulty 
positions, never when reclining or performing the exercises. I 
consider the constant use of the cuirass prejudicial in these 
cases, and I always use the divided cuirass with elastic lacing 
in scoliosis. I am convinced that the opposition to the cuirass 
has been mainly due to improper application, and the omission 
of the long ‘ reflected ’ vest which meets all objections on the 
score of ‘ chipping.’ Elaborate instruments with ratchets and 36 
THE PL AST E R-OF-PA R1S JACKET. 
pads I consider are worse than useless —the tortures of the Span- 
ish Inquisition would seem to be the models on which some of 
them were fashioned. 
“If I may be allowed to speak freely, I think that much of 
the present antagonism to the cuirass is due to the fact that 
Professor Sayre, in his excellent and explicit monograph, was 
rather too sanguine in stating that any practitioner could apply 
it. Many of the so-called plaster jackets I have seen were sim- 
ply burlesques of the principles involved, and in this country 
the application has most frequently been relegated to nurses. I 
know of no operation, however, that depends more on strict 
attention to minor details for success, which details are only to 
be learned by experience. Poroplastic I have entirely discarded, 
as it is impossible to get it perfectly and accurately molded to 
the body, even where the deviation from the normal is slight. 
Again, it has nothing to recommend it even on the scores of ex- 
pense or weight. Several of my cases have worn the divided 
plaster cuirass for more than twelve months with perfect com- 
fort, the weight being no more than poroplastic. I continue to 
use partial suspension also in addition to other kinetics, espe- 
cially in high dorsal curves and torticollis, with the best re- 
sults.” 
W. Bayard, St. John, N. B.: “It affords me much pleasure 
to say to you, and I do so in all sincerity, that I consider your 
‘ plaster jacket ’ a boon to the profession and to the unfortunate 
sufferer with spondylitis. I have used it largely for many years— 
indeed, I use none other—and I can point with pride to individ- 
uals walking our streets who, but for Sayre’s jacket, would in 
all probability be in their graves. 1 have added various mate- 
rials to the plaster with the view of rendering it less brittle, but 
I have found its porosity injured, so that I now use nothing but 
the plaster. 
“In some instances I have inserted strips of steel, such 
as are used in ladies' corsets, between the bandages with 
benefit. When applying the bandage I always allow the pa- 
tient’s feet to touch the floor, and if he complains of pain in 
his legs I cease suspending, and I open the jacket for ablution 
purposes. THE PLASTER-OF-PARIS JACKET. 
37 
“I prefer the plaster jacket for scoliosis to any mechanical 
application I have seen, hut I never trust to it alone, recom- 
mending such muscular exercises as the particular case de- 
mands. 
“I may mention a traumatic case where the jacket an- 
swered admirably. A man was sitting under a heavy wheel 
when the supports broke; the wheel caught him on the shoul- 
ders, doubling him forward. I saw him immediately after the 
accident; he had no power in his legs, but yelled with the pain 
in them. I had him placed face down, with a man at each 
shoulder and at each foot, directed to make steady extension, 
while I made gentle pressure upon the prominence produced by 
the altered position of the vertebrae. In a moment or two the 
power of motion returned and the pain ceased. lie was taken 
home on a door; the next day I placed your jacket on him, and 
kept him in bed ten weeks. He wore a jacket for two years, 
after which he was as strong as ever.” 
J. Nicolaysen, Christiania, Norway: “I have used your 
treatment of spondylitis and scoliosis by partial suspension and 
retention by plaster-of-Paris bandages since the time you first 
brought it forward for the public. 
“I have always been very content with the results of this 
treatment; the results have naturally been more or less perfect 
after the condition of the patients, especially after the stadium 
of the diseases, when the treatment could be instituted; but 
always the condition has been bettered, in most cases for the 
life; I know not of any better treatment.” 
Enrique M. Porto, Havana: “ ... In conclusion: In angu- 
lar curvatures of the spine the Paris-plaster bandage is the only 
and exclusively local treatment, and in light lateral curvature 
partial suspension and exercise combined is a good treatment, 
but I find it better if aided by retention of body by plaster-of- 
Paris bandage.” 
Cork, Ireland, November 30, 1894■ 
Since 1877 I have treated most of my cases of spondylitis 
by means of the plaster-of-Paris jacket, using very slight exten- 
sion, always taking care not to break up or injure any bony 
adhesion of the spinal column. 38 
THE PLASTER-OF-PARIS JACKET, 
The great majority of patients treated in this manner did 
well. When this treatment failed, rest on a couch, together 
with some form of extension, was adopted, and after a time the 
plaster-of-Paris jacket was reapplied. 
With regard to scoliosis, I have had the great privilege of 
seeing many cases treated by Professor Sayre himself. I have 
adopted and highly approve of his method of treatment by ex- 
tension, using the exercises recommended by Dr. Reginald 
Sayre, and the cuirass as a support during the day in severe 
cases. But I have substituted the felt poroplastic jacket for 
the plaster cuirass, because I found that, owing to the extreme 
dampness of our climate, I was not as successful with my 
plaster-of-Paris work as Dr. Sayre had been with his. 
Nicholas Grattan. 
H. Ilingston, Montreal, Canada: “In those cases of curva- 
ture arising from disease when uniform and comfort-giving 
support is of advantage, no surgical appliance, however well 
fashioned it may have been, gives me anything like the satis- 
faction I have had in the use of the simple and inexpensive 
support Dr. Lewis A. Sayre has given to the profession.” 
Pittsburgh, Pa., December 31, 1894- 
Dr. Lewis A. Sayre, New York : 
Dear Doctor: I find that I will be unable to have the paper, 
now in preparation, upon Spondylitis and Scoliosis, completed 
in time to send you an advance copy, as per promise. It will 
not likely, however, contain anything that would be of particu- 
lar value to you in the preparation of your paper. My treat- 
ment for the cases is based upon the plan as carried out by 
yourself and others. I use suspension, gymnastics, forcible cor- 
rection, and retention by plaster-of-Paris bandages. 
Shall look forward with a great deal of interest for the ap- 
pearance of your paper, which I know will be of great value 
to us. Yours truly, S. L. McCurdy. 
Dr. Redard, Paris: “ In answer to the questions which you 
have been kind enough to ask me, I would say, 1 am a con- 
inced partisan, first, of suspension and piaster jackets in the THE PLASTER-OF-PARIS JACKET. 
39 
treatment of scoliosis; second, of plaster jackets in the treat- 
ment of Pott’s disease at a certain stage. 
“In the treatment of scoliosis I recommend vertical suspen- 
sion in cases of slight rigidity of the spinal column, and daily 
exercises as a preparation for the application of plaster jackets. 
“ Vertical suspension is the basis of a great number of exer- 
cises carried out with the different apparatus which are de- 
scribed in my work on Orthopaedic Surgery. 
“ In a great number of cases where there is pronounced 
rigidity of the spinal column, I use my apparatus for lateral 
suspension. 
The removable corset gives excellent results in a great num- 
ber of cases of scoliosis which, in my opinion, however, are 
not obtained solely by it's use, but in conjunction with proper 
exercises to strengthen the vertical muscles and restore the 
flexibility and proper position of the spinal column. 
“ It is of particular value where the spine is movable and 
not rigid, and where suspension corrects the deformity to a 
great extent; in these cases the faulty attitude is partially over- 
come, the lateral curve is very much modified, and the height 
of the patient is increased. In the interval between the exer- 
cises the patient is well supported, the pressure on the various 
points of the thorax forces him to take a correct position, and 
he does not lose the benefit gained by the various exercises 
used to correct the deformity. 
“ To sum up, the plaster corset is of particular value as a 
means of support after the rigid spinal column has been ren- 
dered flexible by the methodical use of exercises properly car- 
ried out. 
“Experience has taught me that it exercises very little in- 
fluence on the deformity of the ribs, or the twisting of the 
spinal column. 
“ I would further say I do not use plaster corsets in the 
early stages of scoliosis. I recommend it in cases where there 
is a lateral flexion and where the vertical curve has been par- 
tially overcome by the use of vertical suspension. I have ob- 
tained excellent results in some cases of scoliosis in its second 
stage, by combining the treatment of plaster jackets and exer- 40 
THE PLASTER-OF-PARIS JACKET. 
cises with mechanical force in straightening the spinal column. 
The plaster jacket has been particularly valuable in my hospital 
practice, in very marked cases of scoliosis accompanied by pain 
and disturbances both of circulation and respiration. In these 
cases it has been of great benefit by supporting the body, pre- 
venting injurious compression of the organs of the thorax and 
abdomen, and greatly diminishing the pain. 
“In the treatment of Pott’s disease, when the disease is in 
the cervical region or accompanied by paraplegia, I employ 
suspension, placing the patient in an oblique or vertical position 
on a padded board. 
“ In the first stage of Pott’s disease I prefer absolute rest in 
the horizontal position. I have obtained excellent results from 
the application of the plaster jacket at the period of reparation 
and consolidation of the spinal column, when it has been pos- 
sible to prevent deformity and often pain has entirely disap- 
peared, the result of entire rest in the horizontal position. 
“ According to my experience in some exceptional cases, 
the plaster jacket prevents, to some extent, the deformity in 
Pott’s disease. 
“ I do not agree with some authors that this jacket can 
give extension to the two segments of the spinal column, and 
reduce pronounced curvature. The principal function of the 
apparatus is to obtain absolute rest and immobility for the dis- 
eased parts, and thus arrest the progress of the disease. 
“ In cases of Pott’s disease in the cervical region the plas- 
ter jacket is of little use.” 
From this number of letters which, I take it, expresses 
pretty fairly the general opinion of the medical profession, 
I find six who condemn the plan altogether, or, at any rate, 
say that they do not use it; seven who say that in certain 
cases it is of use, and in others less serviceable in their 
hands than different means, and thirty-five who employ 
this mode of treatment altogether. Among the objections 
to their use, which have been set forth in the letters I have 
received, are those of Noble Smith, who says that “plaster- THE PLASTER-OF-PARIS JACKET. 
41 
of-Paris jackets ought to he utterly condemned—first, be- 
cause of their great weight; second, their interference with 
free respiration and cleanliness; and, third, the fact that 
they act simply as heavy, unscientific corsets, pressing 
upon the chest, and add very little to support the spine.” 
I may simply answer these objections by saying that a 
properly made plaster jacket is but slightly heavier than a 
steel support, and in many instances is even lighter; that, 
when properly applied, embarrassment of respiration is 
caused by the pain which free respiratory movements give 
the spine in Pott’s disease, and not on account of constric- 
tion of the plaster jacket; and that, as far as cleanliness 
goes, the patients who are clean before the application of 
the jacket, and are properly attended to by careful parents 
or nurses, remain clean, and that the accumulated evidence 
of many prominent physicians is a better refutation than 
anything I personally can say of the charge that they are 
“ heavy, unscientific corsets, pressing upon the chest, and 
adding very little to support the spine.” 
Of the various substitutes that have been used instead 
of plaster of Paris, silicate of sodium can be as accurately 
fitted; but it is so much longer in setting that it is ex- 
tremely difficult to make a good-fitting jacket on the patient, 
unless a plaster shell is placed outside of it to retain it in 
position until the silicate of sodium has become hard, or else 
the silicate jacket is made over a model, which adds greatly 
to the trouble of making the jacket. It also has the dis- 
advantage of not allowing the insensible perspiration to 
pass through it, as does the plaster of Paris. This is ap- 
parent from the illustration of these two models, which 
represent two plaster jackets, covered in, top and bottom, 
with a small hole in one end to allow of the insertion of 
the stem of a tobacco pipe. One has been varnished and 
the other has not. Through the unvarnished one you see 42 
THE PLASTER-OE-PARIS JACKET. 
the smoke passes freely when I blow it inside the jacket; 
the other is impervious. In regard to felt, paper, wood, 
aluminum, leather, and celluloid, I would say that the felt, 
to my mind, is decidedly inferior to the plaster of Paris, 
being very little lighter, and in hot weather much more 
offensive. The objection to leather is that it is more liable 
to warp, and also the fact that it becomes offensive in 
hot weather. The celluloid, wood, paper, and aluminum 
jackets are lighter than the plaster of Paris, but have this 
disadvantage, that they require the services of a skilled 
artisan to construct them, and that they are beyond the 
reach of people of small means, who live at a distance from 
large towns, and a practical experience with them, as worn 
by different patients and manufactured by different sur- 
geons, has shown me that they are much more difficult to 
adjust, so as to give comfort to the patient equal to that 
afforded by the plaster jacket. The principle, however, is 
that for which I strive—namely, the adapting of some 
plastic material to the body in cases of Pott’s disease, in a 
position of comfort, and in lateral curvature in the posi- 
tion of best possible form, for the purpose of retaining the 
body continually in these improved positions—and the ma- 
terial of which the jacket is constructed is not essential, so 
long as the principle is carried out, though I think, in the 
vast majority of cases, that plaster of Paris will be found 
greatly superior to the other materials that I have men- 
tioned on account of its cheapness and case of application. THE PLASTER-OF-PARIS JACKET. 
43 
APPENDIX. 
Berlin, December 23, 1894. 
Dear Dr. Sayre: Owing to an unaccountable error I was 
under tbe impression that you would not deliver your address 
before January 15th, and therefore I had hoped to employ some 
leisure time at Christmas in fulfilling your request. To my 
great dismay, I see that the date is January 3d, not 15th, and 
that it is scarcely possible now for my answer to reach you in 
time. 
I should feel inconsolable for this mistake were it not for 
the conviction that I can give you no information of impor- 
tance, so that for you it is a matter of comparative indifference 
whether you receive my answer before or after your address. 
From your great good nature I will trust that you will 
pardon me and not judge me too harshly. 
With this letter I venture to send you a short article pub- 
lished in 1880, not because I think that it possesses any value, 
because your adjustable jackets are much simpler and more prac- 
tical, but I wish to show you that I have always felt a keen 
interest in your method of treatment, which I consider a great 
advance on previous methods. 
That I have, however, used portable plaster jackets only in 
a few cases during the last ten to twelve years is owing prin- 
cipally to reasons which in themselves have but slight connec- 
tion with your method. 
These reasons I will endeavor to give you briefly. 
There is no necessity for me to enlarge at present upon the 
advantages of your beautiful plaster jackets, which are as famil- 
iar to yourself as to me. They are readily applied, are light, 
porous, cheap, obtainable anywhere, and—a fact upon which I 
lay as much stress as you do—they enable the physician to treat 
the case personally from beginning to end. 
My reasons for adopting other styles of jackets in spite of 
all this are as follows : 
In spite of all my efforts I could not succeed in giving the 44 
THE PLASTER-OF-PARIS JACKET. 
plaster jackets that durability which many of my patients re- 
quired. A large proportion of my patients I see hut once a 
year, some of them but once in two or three years, or not even 
so often as this, as they do not live in Berlin, and not a few— 
especially the older ones—require that their jackets should last 
several years. 
The plaster jackets, like all which are of unyielding material, 
do not allow of sufficient discrimination; in slight or severe 
scoliosis the same jacket is always employed. As I treat even 
the mild cases with jackets, as well as gymnastics and massage, 
and consider the use of the jacket as the most important part 
of the treatment, it becomes necessary for me to have jackets 
of varied construction to suit special cases. In slight scoliosis 
I use simpler forms, which are, of course, less constraining. In 
severe scoliosis and spondylitis 1 use more complicated forms. 
Elderly people, especially women, feel very uncomfortable 
in the stiff jackets; they complain of pressure, impeded breath- 
ing, etc., inconveniences which can be avoided by the use of 
steel drill* jackets without losing the advantages of a sufficient 
support to the body. 
Very young women often assei’t that the plaster jackets, and 
those of felt and wood, disfigure them more than the scoliosis 
itself, greatly increasing the size of the waist; further, they find 
them especially unpleasant in dancing. These disadvantages 
are not so manifest in the steel-drill jackets. 
From my own observation I am of the opinion that the 
muscular tissue wastes away more quickly under the rigid ma- 
terial than under the steel-drill jackets. 
Therefore I now use the plaster jackets only among the 
poorer classes, or in cases of spondylitis where a good support 
is required, until a suitable felt jacket can he provided. 
In cases of severe scoliosis of little children, as also in spondy- 
litis—in acute stages of the latter as a temporary means—I use 
felt-steel jackets made on a plaster model and working in exactly 
the same way as your plaster jackets. So soon as the pelvis is 
sufficiently developed to give a proper support, I prefer to use 
* That is, cloth supported by steel bands. THE PLASTER-OF-PARIS JACKET. 
45 
in spondylitis the steel-drill jackets with hip attachments and 
firm arm supports. 
Partial suspension I make use of in preparing the models for 
felt-steel corsets and also as a gymnastic exercise in the treat- 
ment of scoliosis. For the latter purpose it is widely used in 
Germany. 
Begging once more that you will kindly pardon my neglect, 
and that you will remember me most cordially to Dr. Reginald 
Sayre, I remain with much esteem and best wishes for the new 
year, Yours most truly, Flor. Beely. 
Odessa, December 23, 1894- 
Dear Sir : In answer to your kind letter I communicate you 
what follows: 
In the treatment of spondylitis and scoliosis I consider por- 
tative apparatus as a very important factor. 
In the beginning of my six-years-long practice I used to 
employ with success in the polyclinical cases the immovable 
plaster-of-Paris corsets; in private practice, when the patient’s 
means allowed it, I applied wooden stays. Lately, in the first 
above-mentioned case I continue to use the same corsets, while 
in the last I apply Hessing’s stuff-stays. 
I use the plaster-of-Paris stays in the following way : 
Partial suspension after “ Beely,” with that difference, that 
at Beely’s the patients touch earth only with the tiptoes, while 
I find it sufficient when they touch it swiftly with the whole 
sole. On the body of the patient, done over with vaseline or 
covered with thin jersey, I apply a slight layer of ordinary 
richly gypsumed bandages of starched stiff gauze (not above 
two millimetres). When, after one to two minutes, that layer 
is congealed, I do it over again on of stays, bandages (thick- 
starched stiff gauze, little gypsum). When the layer has at- 
tained the thickness of three to four millimetres and is hard, I 
take off the whole by making a slit in front and immediately 
take out from inside the first thin layer, which parts very easily, 
as it is separated from the plaster-of-Paris corset itself by a 
layer of vaseline. 46 
THE PLASTER-OF-PARIS JACKET. 
The advantages of the method are: 
1. The absence of folets on the inner part of the stays. 2. 
On the hardened surface the stays become firmer, thinner, 
neater. 
After having been dried in the drying room, or in summer 
in the sun, such stays fit exactly the body, as they contract 
while dried. 
The dry stays are covered inside and outside with jersey by 
means of starch gum, their edges finished with dogskin; the 
stay lace is sewed on, etc. 
The technique of wooden stays is explained in the herewith 
joined article. The technique of Hessing’s stays is described, as 
you know, in the Lehrbuch der orthopdd. Chir., von Albert 
Hoffa. 
In the present time I use the plaster-of-Paris stays only 
when Hessing’s stays are inaccessible for the patient on ac- 
count of their price. The fixation of Hessing’s stays is the 
most perfect, as well in cases of spondylitis as in those of sco- 
liosis. The wearing of stuff stays, bound with steel, is much 
more agreeable to the patient than that of any hard stays, even 
the most perfect. 
Patients that have worn hard stays, even of the lightest 
kind—as those of felt, of wood, or of celluloid—when they get 
Hessing’s stays, that weigh much more, assert them to be 
much lighter, because they lie softly on the body. I consider 
as the principal defect of all hard stays, not excepting the 
plaster-of-Paris corsets, that they do not Jit firmly in the waist. 
That defect impedes, especially in the treatment of spondylitis 
of the higher pectoral vertebrae, when the jury-mast is added 
to the stays, for the fixation of any hard stays on the pelvis is 
precarious. 
As the use of hard stays is inevitable, Hessing’s stays being 
dear, I consider the plaster-of-Paris stays as the best on account 
of the following reasons : 
1. They are cheap. 2. They are easily adapted directly on 
the patient without pattern. 3. They do not alter their shape 
and are not deflected by heat. 4. It is easy by means of a 
hammer to make a soft place in them. Their solidity, when well THE PLASTER-OF-PARIS JACKET. 
47 
executed, is quite sufficient for children, when stays have to be 
changed every four to five months. They are less convenient 
when there is no necessity for such frequent change. 
Hoping, dear sir, to have answered in a satisfactory way to 
your kind inquiry, Yours truly, 
J. Waltuch, M. D. 
1532 Pine Street, Philadelphia, February 14., 1895. 
Dr. Lewis A. Sayre: 
Dear Doctor: I may briefly add that my feeling with re- 
gard to the use of plaster-of-Paris bandages, in accordance with 
your suggestions in the treatment of spondylitis and scoliosis, is, 
that so far as spondylitis is concerned it affords the readiest and 
best mode of treatment that has ever been suggested for physi- 
cians residing at a distance from centers of population, who are 
unable to avail themselves of the aid of the instrument-maker. 
With regard to scoliosis, I have not felt so well assured as 
to the expediency of using it. In the treatment of this latter 
affection it is necessary to continue our mechanical support for 
such a very long period, in order to obtain lasting results, that 
I have somewhat feared the effect of the necessary compression 
of the chest on the general development and nutrition of the 
patient. My theory in the treatment of the latter affection has 
been to make use of elastic force applied simply in the direc- 
tions opposed to the deformity. 
Looking at the entire question from a more general stand- 
point, I wish to say that nothing in the modern history of ortho- 
paedics has done so much to bring about a revival of interest in 
this class of cases on the part of the general practitioner, or to 
conduce to a rational and effective management of spinal affec- 
tions, not in this country alone, hut throughout the world, as 
your able advocacy of the methods introduced by you. 
Yours fraternally, Benjamin Lee. THE PLASTER OF PARIS, WOOD, ALUMINUM, 
AND OTHER SPINAL SUPPORTS.* 
By A. M. PHELPS, M. D. 
I am exceedingly obliged to Dr. Sayre for the courtesy 
which he has extended by asking me to discuss the paper 
of the evening. On nearly all of the points which have 
been raised in this paper I fully agree with him. And that 
the plaster-of-Paris corset is one of the best supports for 
Pott’s disease of the spine ever devised my experience veri- 
fies. Without it it would be difficult for me to conduct 
the clinics and dispensaries of which I now have charge. 
While it has many defects and demerits, its good qualities 
will more than overbalance the bad, and because of this, 
and because its application is based upon accurate scientific 
principles, I give it a most hearty indorsement. 
I have used the plaster-of-Paris corset from its very 
first inception. I have watched its growth from the time 
of its first application ; I have seen it fail through bad mate 
rials and worse application; I have seen it bitterly fought 
against by its opponents, receiving just and unjust criticisms. 
I have watched its methods of application gradually recon- 
structed, the materials from which it is made improved, 
* Prepared to be read before the New York Academy of Medicine, 
January 31, 1895, in the discussion of Dr. Sayre’s paper published in 
pie Journal for March 16th and 28d. 50 
SPINAL SUPPORTS. 
and I am free to say, after fourteen years of experience, 
that it is one of the best supports to be used in Pott’s dis 
ease of the spine the world has ever seen. The arguments 
which have been urged against its use are most fallacious. 
That it does not support is argued by some of its bitter 
adversaries. But when in Pott’s disease of the spine a 
patient is suspended and a jacket properly adjusted, he is 
at once relieved from a condition of pain and suffering, and 
to that extent that any amount of pressure upon the shoul- 
ders does not produce pain. I am convinced that some- 
thing does support. If it is not the jacket, what is it ? A 
patient with lateral curvature of the spine is suspended ; a 
plaster corset with lacings is made to fit him in this sus- 
pended and straightened position. After the corset has 
been adjusted the patient is three inches taller than before 
its application. If the corset does not support, what makes 
him three inches taller ? I have personally observed this 
change in many cases, and no amount of argument ad- 
vanced by the opponents of the plaster of Paris corset can 
possibly disprove a clinical fact. One fact is worth more 
than a thousand theories. The first book written on steam 
navigation by an Englishman, in which he attempted to 
prove that a steamship could not cross the Atlantic Ocean, 
was a failure, because, after his book was printed, it was 
brought to this country by the first steamship. And so it is 
with this argument. The patient is three inches taller with 
the corset than he is without it. What makes him three 
inches taller ? Support. It is true that this corset becomes 
filthy ; vermin invade it; but it is inexp nsive, and can be 
changed, if necessary, once a month. Much better this 
than the application of a steel brace that a mother or nurse 
can remove at liberty, handling the child in such a manner 
as to produce trauma and injury to the diseased vertebra. 
The steel braces must be frequently removed or else excoria,- SPINAL SUPPORTS. 
51 
tions will occur. They excoriate and are uncomfortable 
if they give support, which is one of the strongest argu- 
ments against their use in Pott’s disease of the spine. 
We are all agreed, I believe, that the best orthopaedic 
machine ever devised is the human hand; guided by in- 
telligence, it applies forces for the correction of deformity 
more delicately and perfectly than any inanimate object 
ever invented. Plaster of Paris is applied to the deformi- 
ty. WThile in the plastic state the hands mold it to the 
corrected position, and hold it there until it is hard or set. 
Can you not see that now the plaster of Paris continues to 
do the work exactly as the human hand did it ? In other 
words, plaster of Paris is effective as a brace or support 
only in proportion to the amount of gray cerebral matter 
concerned in its use. In the absence of the latter it is 
worthless. Proper materials must be used, else the plaster 
will not set rapidly. H. B. Claflin & Company make me a 
perfect hospital crinoline, No. 100, containing just the 
proper amount of sizing and no indigo. The White Dental 
Manufacturing Company, of New York, puts up the plaster 
in tin cans hot from the oven. These two materials make, 
when put together properly, a perfect bandage that will set 
in five minutes. This rapid setting of the plaster is neces- 
sary, because the hand holds it to the corrected position of 
the deformity. This material, with the stockinet sold by 
Ford, completes the materials necessary to make a perfect 
corset. The crinoline costs six cents a yard, the plaster of 
Paris three cents a pound, and the stockinet thirty cents 
a yard. A corset for a child six years old should weigh 
not to exceed one pound and a quarter, and for an adult two 
pounds and three quarters. This makes a support as light 
or lighter than the steel brace, and it supports as the steel 
brace can not. 
What the profession wants is a proper brace—one that 52 
SPINAL SUPPORTS. 
will apply extension and relieve pressure, and also act as an 
antero-posterior support, transmitting the weight of the 
body through the transverse and articular processes, there- 
by relieving the bodies of the diseased vertebrae. Such a 
support is to be found in the plaster-of-Paris corset; it re- 
moves from the nurse 
or the mother the pos- 
sibility of interfering 
with the dressing. By 
its particularly broad, 
even surfaces, if prop- 
erly applied, it does 
not excoriate, and can 
be worn for one or two 
years with comfort. 
Springing or bending 
the corset antero pos- 
teriorly makes it an 
antero-posterior sup- 
port. Thus we see 
that it combines the 
good qualities of all 
the steel braces that 
have ever been devised, 
and one more, and that 
is extension for the relief 
of pressure. The cor- 
set is heavy when im- 
properly made. It is 
not so porous as we 
are led to believe. Its thickness makes it objection- 
able to women. This has led me to substitute for it the 
wooden corset (Fig. 1); the paper corset, made from pa- 
per such as is used in making paper boats ; and the alu- 
Fig. 1. SPINAL SUPPORTS. 
53 
minum corset (Fig. 2). These corsets combine all the good 
elements of the plaster-of-Paris corsets, and, in addition to 
these, lightness, durability, and thinness, which do not in- 
terfere with the clothing of women. 
In clinical work and among the poor patients the plas- 
ter-of-Paris corset fills the gap that nothing else can pos- 
sibly fill. These patients, supported by steel braces, I am 
informed, and I have observed, almost invariably go on 
from bad to worse as re- 
gards deformity; they cer- 
tainly do in disease above 
the eighth dorsal verte- 
bra. I feel satisfied that 
in this class of patients the 
steel braces will be utter- 
ly abandoned in the very 
near future ; they certainly 
should be in lateral curva- 
ture of the spine in any 
case. Now, in private 
practice, I know of no bet- 
ter dressing for Pott’s dis- 
ease than a light and thin 
plaster corset during the 
acute stage, after that the 
corsets that I have al- 
ready mentioned, the use of which will be found to be more 
comfortable and agreeable to the patients. The difficulty 
with leather corsets is that they fail to support, because 
they do not retain their shape; as a boot changes on one’s 
foot, so will a leather corset change upon the body. 
The spinal support for Pott’s disease of the spine must 
be unyielding and firm. The paper corset first made by 
Vance is, in some respects, a good corset; but it is not 
Fig. 2. 54 
SPINAL SUPPORTS. 
desirable; it is difficult to make, and it is somewhat ex- 
pensive. Since the time of Vance other paper corsets have 
been made according to different formulae; but they are 
made of paper and are really only modifications of Vance’s 
idea. The corset made by Weigel, of Rochester, N. Y., 
from the paper pulp used by printers in making their ma- 
trices, he alleges, is durable and comfortable. The cor- 
sets made for me by Horace Waters & Co., of Troy, N. Y., 
after the paper-boat formula, have proved most satisfactory ; 
but it is more bother to get them than I care to endure. 
Other corsets made in this city, similar to that made by 
Vance, are open to the same criticisms as those mentioned. 
The jury mast and corset, when adjusted so as not to lift 
the head, but to draw it backward so as to transmit the 
weight of the head through the transverse and articular 
processes, makes the most efficient dressing that I know 
anything of, and particularly in upper dorsal and cervical 
disease. So far as I have observed, the deformity does not 
increase, as is the case with a steel apparatus in diseases 
of the upper dorsal region. 
Professor Sayre has accomplished much by his constant 
and indefatigable hammering at the profession toward in- 
troducing the idea of partial suspension and fixation in 
Pott’s disease of the spine; but the idea of partial suspen- 
sion and fixation in Pott’s disease of the spine carries us 
back almost to the traditions of medicine. Ambroise Pare, 
in 1579, used a fixation apparatus made from steel which is 
almost identical with the aluminum corset which I am 
using. 
In 1696 von Nuck made a suspension apparatus which 
has been in almost constant use in Europe since that time. 
It is very similar to that used to-day bearing the name of 
the distinguished author of the paper of the evening. In 
1700 Heister devised an antero-posterior support which in SPINAL SUPPORTS. 
55 
principle is the same as Taylor’s brace used to-day. It 
has been in use in England since that date. In 1754 
Ilauermann made a modification of von Nuck’s suspension 
apparatus, which seems, however, to be more a change of 
material than principle. In 1764 Levacher devised the 
jury mast, which was attached to a corset made of steel and 
canvas, and was used precisely as the jury mast is used to- 
day. Portal, in 1772, slightly modified the jury mast, but 
attached it to a corset in the same manner. In 1825 De 
La Croix still further modified it by adding the chin 
piece. Heine, in 1832, still further modified Levacher’s 
jury mast by adding a chin piece and attaching it to a 
steel hip-band corset. These jury-mast suspensions, taken 
together with the description of their use, are identical with 
those in use at the present time. About the only thing 
that this generation can claim in regard to spinal support- 
ing is in the change of materials, using the principles laid 
down in the last century and the beginning of the present. 
They have been in constant use since then, and also the 
principles, as exemplified here to-night. I believe them to 
be correct. The profession owes a debt of gratitude to the 
author of the paper for having forced upon the American 
profession the idea of partial suspension and fixation in the 
treatment of Pott’s disease of the spine. 
I offer the aluminum corset not as a substitute for 
many of the braces and corsets now worn in the acute 
forms of Pott’s disease and lateral curvature; I suggest it, 
rather, to take the place of such braces in cases requiring 
permanent bracing, or in individuals who are desirous of 
securing a support at any time which combines durability 
with lightness and comfort. So soon as a case of lateral 
curvature has been arrested, or the greatest amount of bene- 
fit has been derived from treatment, the aluminum corset 
will then be found a most agreeable permanent support. 56 
SPINAL SUPPORTS. 
The aluminum corset has these qualities to recommend it 
to the patient: 
1. Lightness. 
2. Durability. 
3. It is thin, and does not interfere with the form and 
clothing. 
4. Being extensively perforated makes it the coolest 
and most agreeable of supports. 
5. The patient can wear it during bathing. 
An ordinary eorset weighs from one to two pounds, de- 
pending upon the size. To prevent cracking and to pro- 
tect it from perspiration, it is covered with a waterproof 
enamel which is applied by heat. 
The steps of its construction : Make a plaster form of 
the body ; send this form to the foundry and have a cast- 
iron anvil made ; polish this, and then at a certain tem- 
perature the workmen will bend on to it two sheets of alu- 
minum representing the two lateral halves. The frequent 
heating and hammering, together with the cylindrical 
shape, make the corset almost as strong as steel. The 
two halves are hinged in the back and closed with auto- 
matic clasps in front, which stop at any notch to accommo- 
date itself to the body before and after eating. This cor- 
set completes my armamentarium in cases requiring spinal 
supports—viz.: 
1. Plaster of-Paris corsets for acute Pott’s disease. 
2. The wood corset for lateral curvature and cured 
or convalescent cases of Pott's disease. 
3. The Beely corset for mild forms of lateral curvature, 
particularly in girls. 
4. The aluminum corset for permanent bracing. 
5. The celluloid corset which, in a way, takes the place 
of the aluminum. 
I visited Dr. Waltuck, of Odessa, Russia, in 1888, and SPINAL SUPPOETS. 
57 
from him personally I learned the details of making the 
wood corset (Fig. 1) after several days of hard work. I 
found that Professor Lorenze, of Vienna, had been using 
the corset for some time, and was much pleased with it. 
At that time, however, many of their corsets proved to be 
inefficient on account of errors in their construction. We 
have used the corset constantly since that time, and, with 
the modifications which we have made, it is one of the 
most efficient, comfortable, and suitable braces that I 
know of. 
It has been with the greatest difficulty that we have 
succeeded in getting the proper materials for constructing 
the corset, and even now it is cheaper and better to import 
the wood from Vienna. The spruce timber which grows 
there makes a better shaving than any timber that we have 
attempted to use which grows in America. It is tougher 
and works better with the glue. 
An impression is made of the body with plaster band- 
ages. This mold is filled with plaster of Paris, which 
makes a perfect cast of the body. The corset is now made 
over this cast. The cast is changed somewhat in shape to 
make the form even straighter than the body in the sus- 
pended position. 
Corsets made according to the method followed at the 
time I observed the process were not so perfect as they 
should be. The slightest excess of glue, moistened by the 
perspiration of the body coming in contact with the shirt 
or the skin, was exceedingly disagreeable. The perfora- 
tions in this corset weakened it and allowed the glue to 
exude daring perspiration. 
To obviate all this I had the corset perforated, as seen 
in Fig. 1, in which perforations eyelets were punched. A 
special machine facilitates the perforating and the punch- 
ing of the eyelets. The lacings are stitched - on as in Fig. 58 
SPINAL SUPPORTS. 
1. Trim tlie top and bottom with kid. The entire corset 
is covered inside and outside with two or three coats of 
shellac, which render it impervious to moisture, the eyelet 
holes ventilating it perfectly. The improvements which 1 
have made in the corset consist in coating it with shellac 
on the inside and outside and putting eyelets in the eyelet 
holes, which add to the strength of the corset and ventilate 
it perfectly. 
An ordinary corset for an adult weighs from a pound 
to a pound and a half. They are very durable, very com- 
fortable to wear, and thus far I believe they are the best 
spinal braces yet devised. 
I will add, by wav of parenthesis, that the corsets, 
when completed, can be covered with silk or with stockinet, 
or they can be left in the linen finish. The New York Medical Journal. 
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