5070 AUG 11 1899 MARYLAND MEDICAL JOURNAL Vol. XXXIX. No. 1. A Weekly Journal of Medicine and Surgery. BALTIMORE, APRIL 16, 1898. Original Articles. THE PLASTER-JACKET versus By R. Tunstall Taylor, B.A., M.D., READ BEFORE THE MEDICAL AND CHIRURGICAL FAC- OWING to the general abuse of the plaster of Paris jacket as a "cure-all" for every form of spinal disease from hump Whole No. 890 cumbency has caused a subsidence of the This is often lost sight of in many cases treated in general dispensaries, hospitals and elsewhere as judged by the examples seen, having marked deformity from inadequate treatment. No matter what part of the spine was diseased, and how obviously impossible it was to support. the vertebral column on either side of the diseased focus by a plaster of Paris jacket alone, we learn in nearly all of these cases that one had been applied without other form of support calculated to remove or lessen at least the weight of the head and the dragging forward and 111 111 FIGURE 1. back, no matter in what part of the ver- The aim of treatment, after fixative re downward of the segment above the seat of the disease. A plaster of Paris jacket alone, in general terms, may be said to be incapable of preventing an increase in the deformity when the disease is above the ninth dorsal vertebra, but below this point it is nearly perfect as a support. To quote L. A. Sayre's original state the diseased bodies back on the healthy articular, transverse and spinous processes. It, however, does not matter by what means the jacket is applied, whether by Sayre's suspension sling(3) or on Brackett's hammock() or on the plaster jacket stool I advised, so long as the weight is removed as far back as possible from the diseased area and the spine is immobilized. It is a mistake to make the plaster jackets removable for dispensary cases, as nine times out of ten the ignorant parents will take off the support just when it should be worn, and in endeavoring to reapply it may not get it on properly. FIGURE 2. Lower dorsal disease treated by a plaster of Paris jacket applied in a moderate fordosis on the Plaster Jacket Stool. ment, we find he says:(1) "There are some cases of spondylitis in which the cervical or upper dorsal vertebrae or both are involved. In these cases treatment by the plaster jacket alone can do but little if any good. It then becomes necessary to treat the disease by an instrument which I call the "'jury-mast.'" And yet notwithstanding this statement and caution over twenty years ago from the originator of the plaster of Paris jacket I cannot find in my histories of over 100 cases of Pott's disease a single one of upper dorsal disease which had been referred to me wearing plaster jackets in which any provision had been made to antagonize the superincumbent weight above the diseased focus. To apply a plaster jacket I prefer the method I suggested in 1895, (2) while the patient is in a position of moderate lordosis, for we thus, to a certain extent, transfer the superincumbent weight from FIGURE 3. Lower dorsal and lumbar disease treated with the Taylor Back Brace, preferable to the plaster jacket in hot weather and for cases with intelligent parents. |