Substitutes for these jackets are made of various materials, such as leather, rawhide, aluminum, thin strips of veneering, celluloid, paper, glue, etc. These have to be constructed over a mold which is taken from a plaster jacket. When the disease extends above the level of the fifth dorsal vertebra there should be incorporated within the jacket a support for the head, known since Sayre’s time as a “jury-mast.” This consists of a metal upright, with cross-pieces, which are incorporated with the jacket and which is curved up behind and over the head and made to carry the frame from which the leather straps and supports pass beneath the occiput and the chin, and thus give to the head a certain amount of fixation. The support is so arranged as to permit of sliding and of sufficient expansion so that traction upon the head can be made effective.
Fig. 257
Frame for application of plaster jackets in recumbent position. (Lovett.)
[Fig. 255] shows the application of traction to the head, while [Fig. 256] illustrates one form of apparatus by which the jury-mast is made effective in producing traction on the head in the upright position. [Figs. 257] and [258] show a convenient frame and method for making plaster-of-Paris corsets with the patient in the recumbent position. [Figs. 259] and [260] show another form of apparatus intended for the same purpose.
Fig. 258
Application of a plaster jacket in the recumbent position. (Lovett.)
The variety of apparatus which has been devised for the maintenance of rigidity and correction of deformity, and, in suitable cases, traction upon the head, is to be measured almost by the number of orthopedic specialists, nearly every surgeon inclining to some device or at least modification of his own. Judson probably has formulated the best rule covering the entire matter when he says: “The apparatus may be considered as having reached the limit of its efficiency if it makes the greatest possible pressure upon the projection compatible with the comfort and integrity of the skin. It is essential that the brace is efficient; second, that it is one that can be constantly worn, if necessary, or can be easily detached from the body if not to be worn at night.” Certain ambulant cases can be treated by an effective brace through the day, and rest at night upon a reasonably hard mattress, with traction upon the head. Concerning the multitude of these special aids to treatment it hardly seems worth while to go into any elaborate description in this place, inasmuch as one who is incompetent to judge as to what is best should not retain the management of such a case, while one who is really competent will probably desire to make his own selection, and the writer’s recommendation would count for but little. Every case must be a law to itself, and every special brace must be constructed especially for the individual for whom it is meant; otherwise it loses all its serviceability.