IMPROVED 
Plaster of Paris Jacket, 
OR 
"CUIRASS E," 
For Posterior Spinal Curvature in the Middle 
and Upper Dorsal Regions. 
BY EUGENE C. GEHRUNG, M- D. 
ST. LOUIS. 
[Reprint from St. Louis .Courier of Medicine, December, 1880.] 
ST. LOUIS: 
NIXON & PENN, Printers. 
1880. PLEASE RETURN THIS SLIP, WHETHER THE ARTICLE IS WANTED OR NOT, 
AND SAVE US TROUBLE AND EXPENSE 
dr. A. E. FOOTE 
MINERALS and BOOKS 
MEDICAL, AGRICULTURAL, HORTICULTURAL, EDUCATIONAL, ETC. 
1317 ARCH STREET 
PHILADELPHIA, PENNA., U. S. A. IMPROVED PLASTER OF PARIS JACKET, OR 
"CUIRASSE" FOR POSTERIOR SPINAL CURVA- 
TURE IN THE MIDDLE AND UPPER DOR- 
SAL REGIONS. 
Eugene C. Gehrung, M. D., St. Louis. 
Read in abstract before the Medico-Chirurgical Society of St. Louis, April l'2th, '80. 
IN 1876, while attending Mrs. W., she asked me whether 
I could not do something for her son, who was the sub- 
ject of posterior spinal curvature, and who had been for 
some time under the care of various physicians and sur- 
geons without receiving much, if any benefit. The lady 
supplied me with the following history: 
John, aged six years, was a healthy child up to the age 
of three years, when he had an attack of pneumonia, after- 
wards sore mouth and running ear. His mother thinks the 
otorrhea was checked too rapidly, on account of which 
the child became afflicted with a "disease of the eyes," 
lasting about two years. His eyes getting well, his gain 
became gradually worse until the spinal disease was finally 
noticed, and all that the parents knew how to do, and 
money could procure was done for him ; as strapping down 
in bed, wearing of different braces, but without success. 
I told the lady that I was convinced the disease could 
be arrested, but as this was out of my line of practice, she 
would better call op one of our orthopedic surgeons. 
Whereupon, October 27th, 1876, Dr. L. Bauer was called 
in, who treated the child with various orthopedic appli- 
ances for about six months without much benefit. On May 
12th, 1877, Dr. Bauer had recourse to Sayre's plaster of 
Paris jacket, which was applied and re-applied secundum 
artem as often as necessity required for twelve months 
with apparently little or no advantage. During this period 4 
Plastor of Paris Jacket. 
a very troublesome cough developed itself, that became 
gradually worse despite all treatment. On May 3d, 1878, 
when a new bandage was again to be applied, Dr. Bauer 
remarked to me, that unless something else was done, 
the disease would not probably get well. With this opin- 
ion I the more readily coincided, as I had arrived at the 
same conclusion some time before, and had devised a plan 
which I felt almost convinced from former experience 
gained by the use of similar means in dissimilar cases 
reported elsewhere,1 would succeed, should the other fail. 
This plan I now communicated to Dr. Bauer who was well 
pleased with its (theoretical) modus operandi, and, instead 
of repeating the former apparatus, Dr. Bauer, with my 
assistance, applied the "cuirasse." 
The curvature being in the upper dorsal region from the 
2nd to the 6th vertebrae, the apparatus of Dr. Sayre, reach- 
ing from the axillae to the hips, could evidently cover it but 
partially; the weight of the shoulders, head and neck 
derives its support, not from the jacket, but from the dis- 
eased spinal vertebrae. This permitted motion where at 
least partial rest is necessary, and perfect rest desirable. 
Thus consolidation was prevented, and nothing but the 
addition of the "jury mast" in addition to the already 
cumbersome apparatus seemed to promise relief. 
Perfect rest could only be obtained by completely pre- 
venting the movements of the ribs, the scapulae and clavi- 
cles, and by removing the superincumbent weight of the 
upper extremities, shoulders, head and neck. The experi- 
ence with Sayre's "jacket" has clearly demonstrated (?) 
that such tight bandaging, as to fuliill these indications, 
is not admissible. 
Nevertheless, one of the main features of my " cui- 
rasse," consists in its tight application, even tight enough 
to obtain by it the requisites just mentioned. On account 
of the difficulty of obtaining a fixed point for the support 
1 Rest in certain Diseases of the Chest, Stf. Louis Med. and Surg. Journal 
November, 1873. 
The Circular Bandage as 'a Remedy in Thoracic Affections.-American 
Practitioner, August, 1877. Plaster of Paris Jacket. 
5 
of orthopedic appliances for spinal curvature, the crest of 
the ilium has from time immemorial been utilized for this 
purpose, and consequently even the most recent inventions 
depend upon it as a point tVappui. Without completely, 
encircling the abdomen, this point cannot be utilized, since 
any movement would displace the apparatus. 
Thus Sayre's jacket necessarily interrupts the abdomi- 
nal respiration as well as the thoracic, and consequently 
would cause apnoea if tightly applied. 
With the " cuirasse," support from the hips is not neces- 
sary, as it finds all its points of support in the thorax, and 
leaves the abdomen and loins entirely free. It can, for 
that reason, be applied much more tightly than the jacket, 
even to complete immobility of the ribs, clavicles, and 
shoulder-blades ; and, in consequence of this immobility of 
the entire thorax, it carries easily the superincumbent 
weight without molestation of the affected structures. 
The " cuirasse," or vest, as Dr. A. J. Steele calls it, may be 
made, like Sayre's jacket, of other material, or of plaster of 
Paris rollers and strips of tin or veneering. The patient 
being suspended and provided with a thin, tightly fitting 
undershirt, as directed by Dr. Louis A. Sayre, rolls of 
cotton or folded cloth are stitched to the undershirt on 
either side of the curvature. The bandage is applied first 
by a few circular turns around the chest, sufficiently tight 
to prevent the respiratory motion of the ribs, then obliquely 
across the shoulders so as to immobilize the clavicles and 
scapulae. This is continued by means of an occasional 
reverse of the roller until the entire chest is covered, 
reaching down behind to the twelfth dorsal vertebra, from 
thence along the lower border of the ribs and costal carti- 
lages to the inferior extremity of the sternum, and above 
from the vertebra prom'mens, along both sides of the neck 
to the upper border of the sternum in front, thus covering 
the thorax completely as by a shell. This bandage, when 
tightly applied and allowed to harden before the suspen- 
sion is interrupted, will keep up every advantage gained 
by the suspension, since on account of its tight applica- 6 
Plaster of Paris Jacket. 
tion, it sustains the chest rigidly in the shape thus given 
to it. Respiration is henceforth altogether abdominal. 
The diseased vertebrae are free from pressure, and undis- 
turbed by the motions of the loins and hea l, and by the 
fixation of the shoulder-blades and clavicles, of those of 
the upper extremities. They are also pressed as nearly as 
possible in a line with their healthy neighbors without 
pressure on the prominent spines, because of the lateral 
pads ; their healthy parts sustain the weight, while the dis- 
eased bodies of the vertebrae are left free and unincumbered. 
Thus the " cuirasse " is to the chest as solid and complete a 
splint as ever was applied to any single fractured bone. 
The necessary exercise for the maintenance of the general 
health is greatly favored by it on account of the perfect 
freedom of all the customary motions. When the patient 
is dressed it is so nearly invisible, that none but tliose in- 
itiated will notice its presence. 
On May 3d, Dr. Bauer applied the bandage skillfully 
and neatly, not, however, without misgivings as to the 
consequences. After the application the patient was ap- 
parently comfortable. Dr. Bauer promised to return after 
about two hours, and requested me to call two hours 
later so as to keep the case under sharp surveillance. 
On my return I was informed that the apparatus had 
proved a complete failure, and that Dr. Bauer had 
promised to re-apply Sayre's jacket in the evening. The 
child complained bitterly of pain in the precordial region 
and of difficulty inbreathing, and refused to sit or stand up. 
On inspecting the apparatus, I found that a few turns of 
the bandage had accidently been applied lower down in 
front than desired, i. e., over the epigastric region, and 
thus interfered considerably with abdominal respiration. 
With my pocket-knife I scraped and cut a triangular piece 
out of the bandage so as to make it correspond to the line 
of the costal cartilages in that region, to the great comfort 
of the child. When we met in the evening for the pur- 
pose of re applying the old apparatus, we found it unnec- 
essary, as the patient stated that this felt very coni fort a- Plaster of Paris Jacket. 
7 
ble, in fact much more so than anything he had worn 
before, and that it enabled him to perform a great vaiiety 
of movements without the least inconvenience or pain, 
which he dared not. if he could have attempted before. 
The troublesome cough had ceased with the application of 
the bandage, not again to return. The "cuirasse" was com- 
fortably worn for nine weeks. Being more tightly applied, 
it has to be removed sooner than the Sayre's jacket, as it 
is more quickly outgrown. 
A new bandage was applied July 12th, but in conse- 
quence of the inferior quality of plaster accidentally used, 
the apparatus soon crumbled, and accordingly a new one 
was substituted on August 2nd. Dr. Bauer being out of 
the city at the time, Dr. A. J. Steele was called in for that 
purpose, and the apparatus now for the third time suc- 
cessfully applied. As the child was to be removed for the 
hot season to the North, his parents desired that the splint 
should be fixed so that they could easily remove it, should 
necessity require. To meet their wish, I cut it open over 
one (the left) shoulder and down on the same side, break- 
ing the plaster with a dull knife and hammer by gentle 
blows on the opposite shoulder and side, so as to make the 
remaining cloth act as a hinge, then separating the cut 
edges made the boy, his right arm extended horizontally, 
step out of the shell to the left. Along the cut edge, over 
the side and shoulder I had buckles and straps attached. 
During his sojourn in the North, the boy fell twice out 
of a skiff into the water, which weakened the splint to 
some extent,'but, since he did not complain, he was allowed 
to wear it thus until his return. It was then (middle of 
September) found badly damaged, but it was considered 
unnecessary to make a new one, as the disease was ap- 
parently cured. He still continued, however, to wear it for 
two or three weeks, wdien it was entirely discarded. 
On a verbal report of this case before the Missouri State 
Medical Association, May 22nd, 1878. it was objected by 
Dr. Wm. Porter, of this city, that such a confinement of 
the chest might be the cause of tubercular degeneration in 8 
Plaster of Paris Jacket. 
the apices of the luags. I am now prepared to state that 
the boy never showed the least sign of trouble in the 
lung, and is to-day, more than two years after the removal 
of the " cuirasse," as healthy a child as can be found any- 
where. The remaining curvature is probably not greater 
than it was during suspension. 
The advantages of this " cuirasse " are obvious : 
1st. Its useful action begins where that of Sayre's jacket, 
without the addition of a jury mast, becomes doubtful or 
ceases. 
2nd. It makes an absolute splint for the whole chest, 
and consequently enhances the rapidity of the cure. 
3d. All the natural motions of the body (except those of 
the thorax) are free and undisturbed, to the great comfort 
of the patient and benefit of his general health. 
4th. It is less cumbersome and weighty than the jacket 
alone, and still less so than when a support for the head 
is added. 
Its disadvantages are, that it is not applicable in curva- 
tures of the lumbar region, nor in the cervical, unless a 
head rest is affixed to it. 
The feasibility of immobilizing the chest to such an 
extent without detriment to the patient being once recog- 
nized, this "cuirasse" may find more extended application, 
as for instance in fractures or dislocations of the clavicle,s 
scapulae, ribs and vertebrae.