—Those general measures so necessary for the treatment of any tuberculous lesion, namely, hypernutrition, fresh air, and general constitutional measures, are needed here as in any other such disease. Physiological rest, i. e., absolute rest in a bed without springs, the patient lying flat on the back or on the face, and not on the side, and lying quietly, constitutes the best part of local treatment. In the case of children it is best to have a gaspipe frame, across which cloth may be stretched, on which a fretful child can be secured by straps across the shoulders, pelvis, and knees. This frame may be laid upon the bed and lifted from it while a cross-piece is removed for toilet purposes, or a suitable opening may be left if a single piece of cloth be stretched across it. If the patient can be made to submit to this repose, then a pad may be placed under the projection. After a sufficient length of time, with the desired improvement, a plaster shield may be molded to the back, with the patient lying upon his face; and then, after removing and suitably trimming and lining this mold, the patient can be returned in it to the previous position in bed, from which he may gradually be raised. This is the best method to follow in acute or severe cases, or when the disease is higher up in the spine. It will also best serve the purpose when the case is complicated by abscess. To it may be added, if necessary, traction upon the head ([Fig. 255]).
Fig. 255
Child in bed-frame, with head traction. (Lovett.)
Fig. 256
Jury-mast for high dorsal and cervical caries. (Lovett.)
Treatment by Apparatus.
—The simplest of all apparatus is the plaster jacket, or corset, which was brought into favor in this country by Sayre, although not invented by him. It is usually applied in suspension, i. e., with the patient in the erect position beneath the frame, from which hangs a support by which firm traction can be made, both upon the head and the arms or the shoulders. The intent of such a jacket is to apply it with the patient so stretched out that a certain degree of the projection will at least be eliminated and the back made more nearly straight than it otherwise would be. In cases where this is impossible it at least affords better expansion of the thorax and supports the ribs in better relation to the spine, affording more chest room. The plaster is not applied next to the skin, but a thin undershirt or its equivalent of woven materials should be applied, care being taken to see that it fits snugly and is not allowed to fold in ridges. After the patient is completely suspended to a degree where discomfort begins, then a small “stomach pad” is slipped beneath the under-jacket, in front, in order that more room may be given for enlargement of the abdomen after a full meal. Finally with the first turns of the plaster a strip of tin or a couple of strips of moistened pasteboard should be applied directly over the middle line in front and incorporated in the successive turns of bandage, in order that there may be material there which may be cut down in removing the jacket. Small pads should be placed over the iliac crests and over the protrusion if it be at all marked or tender. Now by the use of a series of bandages of gauze, in which reliable plaster of Paris has been incorporated, the entire trunk is enclosed within a corset, which will quickly harden as the plaster becomes firm. It should extend well down over the pelvis and nearly to the trochanters, since from this portion it takes its fixed support. It should then be extended as high as can be permitted under the arms and higher yet over the chest and back. Enough material should be used along with the plaster-of-Paris cream, as the former is applied, to ensure sufficient firmness and strength. If the plaster be reliable it will not be necessary to keep the patient suspended more than a few moments after the completion of the jacket. The finishing touches may be given it after he has been taken from the frame and placed again upon a soft surface.
Another method of application is to have the patient recumbent and properly supported, and this is particularly necessary in acute cases, where suspension is likely to cause faintness or unpleasant symptoms. In this attitude the spine is really put in better position. The method is not at all available in those few cases of lateral curvature which demand jackets ([Fig. 256]).