IMPROVED APPARATUS FOR POTT’S 
DISEASE OF THE SPINE. 
BY 
HENRY LING TAYLOR, M. D., 
NEW YORK. 
REPRINTED FROM THE CANADA MEDICAL RECORD, 
NOVEMBER, 1893. 
MONTREAL 
JOHN LOVELL SON, PUBLISHERS. 
1893- IMPROVED APPARATUS FOR POTT’S 
DISEASE OF THE SPINE. 
13Y 
HENRY LING TAYLOR, M. D., 
NEW YORK. 
REPRINTED FROM THE CANADA MEDICAL RECORD, 
NOVEMBER, 1893. 
MONTREAL 
JOHN LOVELL 6- SON, PUBLISHERS. 
1893- REPRINTED FROM THE CANADA MEDICAL RECORD, NOV., 1893.] 
IMPROVED APPARATUS FOR POTTS 
DISEASE OF THE SPINE.* 
BY 
HENRY LING TAYLOR, M.D., 
NEW YORK. 
The indications for treatment in Pott’s 
disease are to relieve the carious vertebrae 
from pressure and shock with a minimum 
of confinement and a maximum of comfort. 
There are no more powerful stimuli to gene- 
ral and local nutrition in these cases than 
the relief from mechanical and nervous 
strain, and the access to fresh air made 
possible by the use of an efficient spinal 
splint. This should be in effect an artifi- 
cial and temporary backbone, giving firm 
support and protection at the point of dis- 
ease, and receiving, partially at least, the 
strains that would otherwise fall upon the 
diseased vertebral bodies, and assist in their 
disintegration. 
Recumbency for short periods and ab- 
stention from standing and walking for 
longer periods are necessary during the 
* Exhibited to the Sui’gical Section of the Pan-American 
Medical Congress, Washington, September 6, 1893. 4 
acuter stages, but the prime indication from 
the start is for definite spnal support, for 
which no period of recumbency alone, how- 
ever long or strict, can be successfully 
substituted. 
It is now over thirty years since Dr. C. 
Fayette Taylor described* the early diag- 
nostic signs of Pott’s disease, and showed 
the indication for treatment by antero- 
posterior support and protection, that 
is, by leverage fixation. His later im- 
provements in the apparatus designed to 
meet this indication are shown in this 
paper. 
Much ingenuity has been wasted in the 
endeavor to apply a continuous extending 
force to the spine, in an apparatus to be 
worn on the person. As this appears to be a 
practically insoluble problem, it is fortunate 
that a vertically extending force is not 
needed. Antero-posterior leverage alone 
is used, because by that means pressure 
can be most directly and perfectly trans- 
ferred from the diseased vertebral bodies in 
front to the sound arches behind. 
* The mechanical treatment of angular curvature, or 
Pott’s disease of the spine, New York State Medical Soci- 
ety, February, 1863. 5 
How then about the plaster of Paris 
jacket ? Bradford and Lovett in their ex- 
cellent work on Orthopedic Surgery give 
the following answer, pp. 60, 61 and 71 : 
“The undoubted beneficial effect of 
plaster jackets is due, not to the separation 
of the affected vertebrae, but to a fixation 
support in an improved position. In short 
the plaster jackets afford an excellent 
antero-posterior support.” “ Unfortunately, 
however, the plaster jacket does not of 
itself, by its hold upon the thorax, main- 
tain a continued extension, but the jacket 
and thorax so adapt themselves to each 
other that active suspension ceases. The 
jacket, however, does act as an antero- 
posterior support, until it becomes loose and 
inefficient.” We prefer, as do the authors of 
the foregoing sentences in most cases, if 
I understand their practice, a properly 
adapted steel leverage apparatus to jackets 
of any make or material, on account of its 
greater precision, adjustability and cleanli- 
ness ; but it should not be overlooked that 
as regards results the workman is more im- 
portant than his tool, and that better results 
will be obtained with a jacket in skillful 
hands than with the most perfect apparatus 
carelessly or unintelligently used. 6 7 
The improved spinal apparatus is shown 
in the figures. 
It differs from the apparatus shown to 
the New York State Medical Society in 
1863 in the following points: 
1. The vertical parallel bars have been 
lengthened, and end in hooked pieces, pass- 
ing well over the shoulders near the neck- 
2. The hinges differ somewhat in con- 
struction 
and are screwed to the bars, being retained 
for purposes of adaptation and adjustment 
only. 8 
3. The horizontal hip-band is discarded,, 
and is replaced by a rigid steel bar or 
vertical hip-band having the shape of an 
inverted U ; to the upper horizontal part 
of this band the lower ends of the vertical 
bars are firmly attached. The ends of the 
f}-shaped band are protected by hard-rub- 
ber plates, and rest in the post trochanteric 
sulcus on either side, and together with 
the hooked pieces at the base of the neck, 
fix the apparatus laterally, and assist in 
vertical and antero-posterior fixation. 
4. Hard rubber pads are used instead of 
the soft pads formerly employed, to trans- 
mit the leverage of the apparatus to the 
region of the spine which it is desired to 
protect. 
5. For counter pressure at the upper 
part of the chest, instead of the straps 
encircling the arms formerly used, a “ chest 
piece ” 9 
is employed, consisting of two triangular 
hard-rubber pads, fitted below the clav- 
icles and resting upon the pectoral muscles 
at the sides of the chest; these pads are 
joined by a steel bar curved forward to 
escape the chest, and so contrived that the 
distance between the plates may be in- 
creased or diminished at will. The chest- 
piece is buckled to straps coming from the 
hooked shoulder-pieces above, and below 
it is strapped to buckles at the angles of 
the hip band on either side, leaving 
the arms and axillm free. 
6. The apron which holds the whole 
apparatus forward reaches to the posterior 
border of the axilla on either side, and 
from the trochanter to the arm laterally, 
and is secured by straps and buckles to 
the apparatus. 
7. Perineal straps may pass from the 
lower border of the apron in front, under 
the thighs, to the ends of the vertical hip, 
band to aid in fixing the apparatus. 
It is to be understood that appropriate 
modifications of the form of the apparatus 
are made to correspond with the indica- 
tions presented by disease in the different 
regions of the spine, and by the character 10 
and amount of the deformity. Most cases 
above the ninth dorsal will require, in addi- 
tion, Dr. Taylor’s circular pivoted head- 
support or chin rest, 
which is easily fitted 
to this apparatus. 
The treatment of 
this affection, while 
remarkably satisfac- 
tory in the main, 
would be less tedious, if the nature and seri- 
ous character of the disease were earlier re- 
cognized, and proper management inaugu- 
rated without delay. The first months of 
the affection often pass entirely unnoticed, 
owing to the absence of pain, and if, later, 
symmetrical pains at the sides, over the 
abdomen or down the legs appear, they 
are frequently attributed to digestive or 
other troubles. The short, rapid breathing 
caused by disease in the upper dorsal 
region may lead to the suspicion of pulmon- 
ary trouble, as in a case which came 
after having been treated two years for 
asthma. The breathing became natural 
after proper support was applied, and 
the disease was entirely cured with but 11 
slight deformity. In another case of 
disease in the lower dorsal region, poor 
nutrition and pains were attributed to in- 
digestion, and valuable time was lost in the 
endeavor to correct the digestive disturb- 
ance, which together with severe pains in 
the legs permanently disappeared soon 
after the spine was properly supported, 
with speedy and marked improvement in 
the patient’s health. An early diagnosis 
can often be made before the appearance of 
pain or deformity, from spinal stiffness, 
shown in the attitude and movements, the 
tendency to lean on chairs and tables or up- 
on the mother’s lap for support, the careful 
shuffling gait, failing health and nocturnal 
restlessness. At this stage the happiest 
results follow thorough treatment, for half- 
way measures taken with the idea that the 
trorf-ble will disappear in a few weeks are 
of no avail, even in the earliest stages. The 
symptoms will temporarily subside, as in- 
deed they frequently do for a time without 
treatment, only to reappear later with in- 
creased intensity, unless the spine is effi- 
ciently and persistently supported. 
It should never be forgotten in the 
treatment of these cases that an apparatus 12 
is intended to be an aid in the general and 
local hygiene of the patient, who should be 
under constant supervision and regulation, 
and such changes made in the mechanical 
appliance and other elements of manage- 
ment as the progress of the case may 
demand.