Finally, there is the appearance of a small Ignuekle of bone projecting somewhere in the line' of the spinous processes, which goes on increasing.
Treatment. — The object of treatment is threefold: (1) to give rest to the spine, in the hope that the disease may begin to mend when the irritation, constantly occasioned by the slightest movement, is removed;. (2) to give support to the spine, so that, by removing the weight from the diseased bones, the in process may proceed as little as possible ; and (3) to support the strength and increase it as far as may be, since lowness of health is a feature of the disease, and death by exhaustion one of its not infrequent terminations. Now, formerly, the first two of these conditions were fulfilled by keeping the sufferer strictly fined to a bed or sofa, lying on the back. The objection to this is manifest; it impaired seriously the patient's vigour, and, if anything, aided the progress of the affection. Mechanical meausof fulfilling the ditions naturally enough were resorted to, and rious complicated kinds of :qv:traits have been invented and used for the purpose. These, however, were so cumbersome as to be irksome and borne with difficulty by those who could afford them at all, while they were quite beyond the reach of the poor owing to their cost. Sonic years ago, ever, a method was vised by Professor Sayre of New York, which tirely fulfils the tions, is not attended by the objections mentioned, and has produced in many cases marvellous results. Simply stated it consists in applying to the patient's body from the hips to the arm-pits a continuous bandage of plaster of Paris, which, when "set", ought to be quite hard and stiff, and so affords a perfectly adjusted and close fitting support. Next the skin the patient has a tight-fitting knitted worsted jersey. The bandages are of wide-meshed material, into which the line plaster of Paris is rubbed dry, and the bandage then rolled tip into a regular roll. The bandages are placed, end up, in a basin of water, five or ten minutes before being required for use. In order to stretch the spinal column and take off from it all pressure, before the bandage is applied, the patient is suspended by the head and shoulders, so that the tips of the toes just touch the ground. The apparatus by which this is done
consists of a tripod, which suspends a pulley • (Fig. 30). Passing over the pulley is a cord, one end of which has attached to it a cross bar. From the bar there hang two well-padded slings, one of which is placed under the arm pit of each side, and there is also a padded circular strap which supports the chin and back of the head (Fig. 31). When the slings and strap are adjusted the patient can be raised, or can even raise himself, by pulling on the other end. The same sort of apparatus could be employed without the tripod by means of a hook screwed into a roof or door sill. On the patient, thus suspended, the bandage is applied on the top of the jersey. Beginning below just over the hips, the oper ator winds it regularly upwards, turn after turn, till the arm pits are reached.
To make it stiff enough several layers will be ne cessary, requiring perhaps 25 to 35 yards of bandage.
After one layer is complete it is well to cover it with a •roam-like paste made of the plas ter of Paris and water, putting it on and smooth ing it over with the hands. An other layer of bandage and another quantity of the paste are then used, and so on. Still further to strengthen the plaster, strips of perforated tin about the length and breadth of corset whale bone or steel are introduced at the sides and back, and additional layers of the bandage over them. The tin is perforated because the rugged edges of the holes cause the strips to "grip" well. When suflicieet of the bandage has been put on, the patient is carefully lifted down from the suspending apparatus, not being himself allowed to move the slightest degree, and, being kept quite straight, is laid down so on a hard mattress on the floor to allow the plaster to "set" thoroughly. This probably will be accomplished in half an hour. Then lie may put on his clothes and go about. Very often the application of this bandage has enabled persons to walk who were previously quite helpless.