CARIES OF SPINE.
The constitutional treatment is identical with that of phthisis or other tuberculous affection—viz., open-air life when possible, overfeeding, the use of Cod-Liver Oil, Iodide of Iron, Creosote, Ifypophosphites, &c.
Complete rest and immobilisation of the spine must he insisted upon from the first with the view of hastening repair and preventing angular deformity. The patient should he kept in the supine position upon a firm mattress without a pillow, and this position must be maintained for many months, in some cases for a period of i to 2 years. till all symptoms have disappeared. The practice of fixing the spine in an immovable plaster jacket as introduced by Sayre and allowing the patient to walk about should be abandoned. When the symptoms are acute, with much pain or paraplegia, such an appliance is of much value. but only when the recumbent position at the same time is rigidly enforced. A moulded leather or poroplastic jacket is, however, preferable. and in the case of dorsal caries in children Jones' abduction frame. In cervical caries the frame should be fitted with a headpiece. The use of these mechanical contrivances enables the patient to be safely transferred to a couch which can be wheeled out into the open air, and sometimes a carriage drive may even be permitted when the supine position is strictly maintained. Their employment is also imperative in all cases where the child is restless and tosses or turns over in bed. They are a valuable help during the con valescent stage of the disease, when the patient is first permitted to assume the vertical position, especially in low dorsal or lumbar caries. in which case the jacket should embrace the pelvic bones, reaching downwards to the great trochanters.
For the application of a plaster of Paris jacket, the patient should be stripped of all clothing, and a neatly-fitting woven merino vest. without buttons, should be put on. It should reach below the buttocks. He is then suspended by the usual pulley and cord appliance, by means of a strap passing below the chin and occiput, and another under each armpit. It is not necessary to raise him entirely off the `round: his toes should be left touching, as it gives confidence to him, and if absolutely complete extension be needed, by flexing the knees very slightly the toes will, of course, leave the ground, or the jacket may be applied in the recumbent position by using Davy's hammock.
The vest is gently pulled downwards and all wrinkles removed, and a pad placed inside it over the pit of the stomach. This is to be slipped out afterwards, its object being to leave room for distension of the abdomen after meals. It can be dispensed with if a window he cut in the jacket before hardening is complete. Coarse muslin (crinoline muslin) bandages, thickly sprinkled over with dry Plaster of Paris, are to be rapidly immersed in warm water containing a little alum, slightly squeezed out and applied over the vest in layers, extending from about an inch below the iliac spines to the armpits. An assistant smoothes down each layer of bandage as it encircles the trunk, and from time to time applies with his hands some more plaster, made into a cream with water; or, if the bandage appears to have been too well moistened, he rubs over it a little dry plaster as the operation proceeds.
In thin patients small pads of wadding may be placed over any bony prominences outside the vest before the application of the first bandage, which may be passed round the pelvis and brought obliquely upwards as it encircles the abdomen, fixing permanently in their position all woollen pads over the iliac spines or prominent vertebrae. After the application of the last bandage the assistant applies some fresh plaster, rubs it down with his hand, and finishes the jacket off, leaving a smooth and even surface. It sets in a few moments, and the patient may be taken down and laid flat upon a hard mattress before the fire for a short time before being carried to bed. By turning up the tails of the merino vest over the plaster, near the end of the operation, a more presentable finish off is obtained. The jacket may be cut up, punched with holes, and laced on again if found quite satisfactory.