A SUCCINCT HISTORY 
OF THK 
PLAN OF TREATMENT 
OF 
POTT’S DISEASE 
BY SIJSPELTSIOIT 
AND THE 
USE OH PLASTER OF PARIS BANDAGE. 
BY — 
LEWIS A. SAYRE, M. I)., 
Professor of Orthopedic Surgery, Fractures and Dislocations and Clinical 
Surgery in Bellevue Hospital Medical College, New York. 
FROM JANUARY NO. RICHMOND AND LOUISVILLE MEDICAL JOURNAL. 
LOUISVILLE, KY.: 
RICHMOND AND LOUISVILLE MEDICAL JOURNAL BOOK AND JOB STEAM PRINT, 
104 Green Street, 2d door west of Post-office. 
1878. A SUCCINCT HISTORY 
OF THE 
PLAN OP TREATMENT 
OF 
POTT’S DISEASE 
33"5T STTSZPZEZLNTSIOIISr 
AND THE 
USE OF PLASTER OF PARIS BANDAGE. 
BY 
LEWIS A. SAYRE, M. D., 
Professor of Orthopedic Surgery, Fractures and Dislocations and Clinical 
Surgery in Bellevue Hospital Medical College, New York. 
FROM JANUARY NO. RICHMOND AND LOUISVILLE MEDICAL JOURNAL, 
LOUISVILLE, KY.: 
RICHMOND AND LOUISVILLE MEDICAL JOURNAL BOOK AND JOB STEAM PRINT, 
104 Green Street, 2d door west of Post-office. 
1878. A Succinct History of the Plan of Treatment of Pott’s Disease 
by Suspension and the Use of Plaster of Paris Bandage. 
OIPIEZDsT LETTER. 
Dr. E. S. Gaillard, Editor of the Richmond and Louisville 
Medical Journal. 
New York, December 6, 1877. 
Dear Doctor,—As yours was the only medical journal in tbe 
country (so far as I am aware) that defended my character in 
my recent absence in Europe against the foul slanders and false 
assertions of the “ Lexington Daily Press,” of August 17,1877, 
I have taken the trouble to collect all the facts and evidence in 
the matter, which I now forward to you, to prove to you and the 
world that you were correct in the honorable course you have 
pursued, and at the same time to thus publicly return to you 
my warmest thanks for your honorable, masterly and unanswera- 
ble defence. 
For the past twelve years I have been in the habit of treating 
my patients who were suffering from Pott’s disease and who 
were too poor to buy a Taylor’s brace or any other expensive 
apparatus, by laying them on the stomach, and then extending 
them as much as possible, or until they were more comfortable 
than they were before, and then covering the entire back 
from pelvis to axilla with plaster of Paris, carrying it two- 
thirds, or even more, around the body, and securing it in front 
by elastic webbing. In cases of caries of the cervical vertebrae, 
I extended a branch of the shell up the neck, and the head 
being extended by an assistant, the plaster was carried well up 
under the occiput and half-way around the head, and secured 
in front by a ribbon or band passed around the forehead. 
This plan of treatment I called “turtle-shelling,” and all the 
students who have attended my lectures at Bellevue Hospital 
Medical College for the past ten years are perfectly familiar 
with it. 4 
pott's disease. 
In the fall of 1874 a boy named Willie Pulver, between three 
and four years of age, was sent to me from Chatham Centre, 
Putnam county, New York, with Pott’s disease of the two last 
dorsal and first lumbar vertebrae, with a very sharp angular 
curve—partial paralysis of the right leg—and very imperfect 
control of the bladder and rectum. As he was unable to stand 
up while Mr. Rynders measured his back for the purpose of 
fitting a “Taylor’s brace,” which I intended putting on him, I 
had my son lift him up by the arms while Mr. Rynders made 
the necessary measurement. 
When he was thus held up his back became very percep- 
tibly straighter, and I observed that he had more motion of his 
paralyzed right foot. This experiment was tried several times, 
with the same result at each suspension. As Mr. Rynders 
could not supply him with an instrument for some days, and 
the parents had to return to the country by the next train, and 
as I had no time to apply to him my “ turtle-shell ” dressing, 
I therefore concluded to apply a plaster of Paris bandage 
from pelvis to axillae completely around the body, in order to 
get an accurate fitting mould, and then cut it down through 
the centre in front similar to “Darrach’s celluloid jacket.” 
My son Charles got upon the sofa and held the boy suspended 
by the arms, while my assistant, Dr. L. M. Yale, pulled his 
flannel-shirt down between his legs, making it to fit him almost 
as tight as his skin. While he was thus held I applied the 
plaster bandages, usiDg the same as we were in the habit of 
doing at Bellevue Hospital in cases of fracture. 
At first we were all apprehensive that by completely encir- 
cling the thorax we might interfere with his respiration, but 
his lusty cries dispelled our fears, and I continued the band- 
aging from pelvis to axillae, completely around the body, until 
several thicknesses had been applied. We then laid him upon 
the sofa until the plaster could “set,” before dividing the shell. 
When we returned to him, in about half an hour, he had got- 
ten off the sofa, walked across the office, and was standing by 
the window looking into the street. His mother stated that he 
had done this without any assistance. 
I then divided the shell in front its entire length, secured the pott’s disease. 
5 
lower or pelvic portion very tightly together by a firm and in- 
elastic roller bandage, allowing the upper or thoracic portion to 
gap a little, and secured it by three elastic straps on each side, 
which were tied together sufficiently tight to give him firm 
support. 
We all observed that he did not breathe as deeply or seem as 
comfortable after the division of the jacket as he did before it 
was divided. Still this did not make much impression on us at 
the time, and he was sent home with directions to return the 
following week and have the instrument applied, which Mr. 
Rynders was to make. The plaster was applied merely as a 
temporary expedient to get the child home comfortably, and 
was put on in the manner above described instead of by my usual 
mode of "turtle-shelling,” because it could be done so much 
more quickly, and I was just then very much cramped for 
time. 
The child did not return for his instrument the following 
week, as directed, and after some time had elapsed without my 
hearing from him, I applied it to another child whom it hap- 
pened to fit. I never saw or heard from the child again until 
the 10th of March, 1875, when he was again brought to my 
office just as I was going to my clinical lecture at Bellevue 
Medical College, and I took him in the carriage with me to 
the college and exhibited him to the class. 
The mother had returned with the child because he was 
bleeding slightly from the navel. Upon examination I found 
that I had left a thread of the plaster bandage uncut, and as the 
child had grown considerably stouter, it had chafed his navel, 
and produced quite a granular excrescence, which bled quite 
freely. This fungus mass was touched with nitrate of silver 
and dressed with styptic cotton, and the cuirass reapplied; 
telling the mother that she would have to get a new instrument 
made, as the one she had ordered had been given to another child, 
and as this plaster jacket seemed to do so well, she must keep 
it on until the "Taylor brace” could be made. 
After the cuirass was readjusted the mother remarked that 
the child could stand, and when I asked her if he could not do 
so when it was off, she said no. I then removed it again before 6 
pott’s disease. 
the class and found that she was correct. After reapplying it 
the child could not only stand, but ran around quite lively with- 
out any assistance; and when the cuirass was off he could not 
even stand without support. I immediately became quite en- 
thusiastic, and spoke probably rather extravagantly of its 
inestimable value, and prophesied that it would be the future 
treatment for Pott’s disease. 
This lecture was phonographically reported at the time by 
one of the students, now Dr. W. A. George, and published in 
the “Philadelphia Medical Times” of April 10, 1875. 
From this time on I applied it almost every week in public 
at Bellevue, and in May, 1875, I applied it before the surgical 
section of the American Medical Association in Louisville, 
Kentucky, on a little child from Texas. 
In January, 1876, my work on Orthopaedic Surgery was 
issued by Appleton & Co., in which the process is fully described, 
and I was applying it almost daily at my office, a fact well known 
to many of the physicians in New York. And yet during all 
this time I never heard the name of Dr. Bryan mentioned in 
connection with this plan of treatment from a single human 
being, and never knew or heard that he had ever applied it in 
practice. 
Dr. A. B. Judson, of this city, read a most valuable paper on 
“Rotary Lateral Curvature,” before the Academy of Medicine, 
on April 6, 1876, and an anonymous correspondent of the “Lou- 
isville Medical News,” in commenting on my remarks on this 
paper, refers to Dr. Joseph Bryan, of Lexington, Kentucky, as 
having ante-dated me in this plan of treatment. This was the 
first intimation that I ever had of his name in connection with 
the subject, and I immediately wrote him the following letter, 
which will explain itself, as well as my motive in writing: 
285 Fifth Avenue, May 23, 1876. 
Joseph Bryan, M. D., Lexington, Ky.: 
Dear Doctor,—In the “Louisville Medical News” of May 20, 
1876, on page 258, the “New York correspondent,” in com- 
menting on Dr. Judson’s paper, read before the “New York pott’s disease. 
7 
Academy of Medicine,” on the “ Causes of Dotation in Lateral 
Curvature,” says “Dr. Sayre was delighted with it, and said 
he had been treating patients on this principle without being 
able to exactly define his reason. 
He suspends his patients by supports under the occiput, chin, 
and shoulders, and while in this pendent state he puts on the 
plaster of Paris bandage. He seemed to lay claim to the plaster 
treatment in this disease, but I understand from a reliable in- 
formant that it was first proposed and used by Dr. Joseph 
Bryan, of Lexington, Kentucky, while on the staff of Bellevue 
Hospital.” 
Will you be kind enough to inform me the date when you 
first suspended a patient and applied the plaster of Paris band- 
age completely around the body from pelvis to axilla, and 
where I can find a published account of the same. 
For many years I have treated “ Pott’s disease” by extension 
and plaster of Paris on the back, going half or two-thirds 
around the body, and then completing the front part by an 
elastic insertion. This plan I called “ turtle-shelling,” and I 
think you dressed a number of cases for me in this manner 
when you were in Bellevue Hospital, but I was not aware that 
you had ever applied the plaster completely around the body 
for either “Pott’s disease” or “lateral curvature,” or I cer- 
tainly would have given you credit for the same. 
And it is for the purpose of giving you full credit, and not 
claiming for myself what rightly belongs to another, that I ask 
for the above information. An early answer will greatly 
oblige, Yours respectfully, Lewis A. Sayee. 
The following is Dr. Bryan’s reply: 
Lexington, Ky., May 29, 1876. 
Dr. Lewis A. Sayre: 
Dear Doctor,—Yours of the 23d instant reached me to-day, 
and I take the earliest opportunity of answering. Some time 
during the months of July or August of 1874, I applied my 
first plaster of Paris splint to the back for “ Pott’s disease ” of 
the spine. Patient’s name was Bose Brennan, fourteen years old, 8 
pott’s disease. 
and the disease was situated in the second and third lumbar 
vertebrae. 
On entering the hospital she was unable either to sit or stand 
on account of pain, and was run down in general health. The 
plaster of Paris dressing was suggested to my mind by the 
following conditions of case: 
I could find no splint that would produce enough extension 
to take all the weight of body off the diseased bones; and 
second, I could find no splint that would take firm enough hold 
of the pelvis to completely prevent motion in the lumbar 
spine. The plaster was applied as follows : First, I had a flan- 
nel bodice made to fit the body evenly and smoothly, and ex- 
tending from the axilla to trochanter major of femur. I then 
suspended her to the ceiling by supports under the axilla, 
using the old compound pulleys of Bellevue, and then applied 
the plaster all the way around the body, using narrow strips 
of zinc in making the splint like the ribs in a pair of corsets. 
I did this to make a light splint and at the same time give it the 
required amount of strength. My splint extended from the 
axilla to upper border of the trochanter major, taking firm hold 
of the pelvis and going all the way round the body. I have 
never seen your “turtle-shell” splint, and never had the oppor- 
tunity of applying it for you while in Bellevue. 
My case did remarkably well, and was able to sit up and walk 
about the very next day after the splint was applied; in three 
months she was perfectly cured. I have a photograph of it by 
Mason. Dr. Erskine Mason, Dr. Stephen Smith, Dr. V. P. 
Gibney, and Dr. B. J. Harlan, all of New York, saw it and 
were much pleased with it. 
Dr. Harlan, my associate at the time in the hospital, used it 
in several instances and with good results. In a report of one 
of your clinics last winter, I saw that you supposed that you 
were the first to use it, and I intended to write you in regard 
to it, but neglected it, and finally forgot all about it. I do not 
know who the “ New York correspondent ” could have been. 
An account of my splint has never been published. 
Am glad you wrote to me, Doctor, and trust that the splint pott’s disease. 
9 
whoever be the author of it, will prove of advantage to the 
Profession in treating a very tedious and intractable disease. 
Very truly yours, J. W. Bryan. 
The following is an exact copy of the records of this case as 
taken from the books at Bellevue Hospital, and which I have 
only recently found: 
Pott's Disease of Spine.—Ward 30, Dr. Shaw; House, Dr. 
Bryan, Senior; Dr. Bates, Junior. Bosanna Brennan, 15; single; 
United States; minor; admitted August 8, 1874; family history 
not good; patient’s father died (in prison) of what disease she 
is ignorant. Mother perfectly healthy; has had two brothers 
and two sisters; both brothers dead; one died of disease of the 
spine or hip, does not know which; patient does not know cause 
of other brother’s death. Of the two sisters, the younger one 
has always been healthy; the elder when almost eighteen years 
old had a cough which lasted her a long time, but of which she 
finally recovered. Patient says that she, herself, has always 
been perfectly well until about three months ago, when she began 
to have pains in her back, more especially in the lumbar region. 
She applied for relief at the Forty-second-Street Hospital, when 
it was found she had a prominence of spine in lumbar region 
and very tender. She also complained of pain extending down 
her lower extremities. The doctor at Forty-second street told 
her she had disease of the spine, and fitted and applied a spinal 
splint, but it did not relieve the pain, and she therefore 
came to this hospital. On examination, discovered a promi- 
nence in lumbar region, probably at fourth and fifth lumbar 
vertebrae. Pressure on the prominence gives her intense pain. 
Patient is unable to stand, and says it gives her a great deal 
of pain to stand long. While in the standing posture pressure 
of shoulders_gives her pain. Patient appears fairly nourished; 
appetite not very good; says she does not sleep very well. 
August 16.—Dr. Mott saw the patient and ordered a seton put 
in the back near the point of tenderness. To-day carried out 
Dr. Mott’s directions and put an issue-pea near point of tender- 
ness, and applied the spinal brace, made by Dr. Knight’s direc- 
tion, of Forty second-Sfcreet Hospital. Patient complained of 
pain during the afternoon, and had to go to bed again. 10 
pott’s disease. 
August 21.—Applied her splint again to-day, but she com- 
plained so much of pain that we had to remove it again. De- 
termined to apply a plaster of Paris splint. 
August 22.—Applied a plaster splint extending from axilla to 
one inch above trochanter major, so if possible to prevent any 
movement in the lumbar region of spine. 
August 24.—Had a fenestra cut out over the point of the 
prominence, so as to be able to dress the issue daily. Patient 
feels perfectly comfortable with her splint on; is to-day up and 
about the ward; general condition good. 
August 31.—Since the application of the plaster of Paris 
splint patient has done remarkably well; suffers no pain and is 
able to be up and about the ward all day. General health ex- 
cellent; takes cod-liver oil and iron, and a generous diet. 
September 10.—Since date of last note patient has been up and 
about all the time. She, however, complains of severe pains in 
her legs and in her upper extremities, but do not think they 
are referable to her spinal disease. Issue is dressed daily, and 
discharges considerable; patient’s general condition excellent. 
September 17.—Patient still continues to do remarkably well; 
issue discharges considerably; is dressed by nurse daily. 
October 10.—Patient has been doing finely; is about the ward 
daily; walks without crutches, and suffers no pain in the back 
whatever; issue still kept open. 
This is the last note of the case. From the above description 
of the case, taken from the hospital records, it does not appear 
that Dr. Bryan is entitled to any more credit than Dr. Shaw, 
house-surgeon, or Dr. Bates, junior assistant; there is certainly 
no evidence that the patient was suspended in the manner I ad- 
vise to be done while the jacket is being applied; and there was 
also an issue put in her back, which I certainly do not advise; 
therefore I can see no similarity in the plans of treatment. 
In looking over the photographic gallery of Mr. Mason, con- 
nected with the hospital, I find a card ordering the picture of 
this case to be taken, signed by Dr. Shaw, and counter-signed 
by Dr. A. B. Mott; Dr. Bryan’s name not appearing on the 
order or on the photograph. Notwithstanding this absence of 
all evidence in the records of the hospital to sustain Dr. Bryan's pott’s disease. 
11 
claim, and based simply on his statement in the letter above 
quoted, that he had thus treated a case of Pott’s disease, I 
made the following statement in my “ report on Pott’s disease,” 
read at the meeting of the American Medical Association in 
June, 1876, at Philadelphia, and which will be found on page 
685 of their transactions for that year. 
“ Having recently understood that Dr. Joseph Bryan, of Lex- 
ington, Kentucky, had used plaster of Paris in this way in the 
treatment of Pott’s disease prior to my first application of it, 
I wrote to Dr. Bryan on May 23, 1876, asking for information 
on the subject, and where I could find an account of the same.” 
He replied in a letter dated Lexington, Kentucky, May 29, 
1876: “ Some time during the months of July or August, 1874, 
I applied my first plaster of Paris splint to the back for Pott’s 
disease of the spine. ***** An account, of my 
splint has never been published. ***** The case 
was shown, according to Dr. Bryan, to Drs. Erskine Mason, 
Stephen Smith, V. P. Gibney, and B. J. Harlan, who were much 
pleased with it; but as no account of it was ever published, and 
as none of the gentlemen mentioned seem to have been suffi- 
ciently impressed with its importance to put it into practical use, 
1 must at least claim priority in bringing it before the profes- 
sion and into general use, and was not aware of Dr. Bryan 
ever having applied it until I received his letter of May 29, 
1876, or I should have given him credit for it in my previous 
publications upon this subject."* 
This same quotation was republished in a very large edition 
of the “ Richmond and Louisville Medical Journal ” for May, 
1877, and is also inserted in full in my work on “Spinal Dis- 
ease and Spinal Curvature—their treatment by suspension, and 
the use of the plaster of Paris bandage ”—recently published 
by Smith, Elder & Co., of London, and J. B. Lippincott, of 
Philadelphia 
I therefore claim that I have given full credit to Dr. Bryan 
in every publication of mine upon this subject, since the first 
time that I ever heard his name mentioned in connection with 
* The italics have been added to the quotation. 12 
pott’s disease. 
it. I feel quite confident that every honorable member of our 
profession will agree with me in this opinion. 
Notwithstanding this fact, the “Lexington (Kentucky) Daily 
Press,” of August 17, 1877, published during my absence the 
following foul slander against my character: 
“Dr. Lewis Sayre—How he Claimed an Invention that 
belonged to another—Something about Bryans Process.—The 
name of Dr. Lewis Sayre is not unfamiliar to the people of Lex- 
ington. As a surgeon be has same reputation. He is an in- 
dustrious, pushing man, who knows the value of an advertise- 
ment, and does not underrate the effect of self-assertion. It is 
supposable that a man who has earned as much glory in the 
course of his brilliant career would hesitate to rob a young 
practitioner of the honors he had fairly won. Yet this, or 
something like it, appears to be the case. 
“Some time in 1874, Dr. Jos. Bryan, a young physician now 
practicing in this city, was in charge of one of the wards of 
Bellevue Hospital, New York. Among his patients were sev- 
eral suffering from Pott’s disease of the spine, better known as 
curvature of the spine. The young surgeon had great com- 
miseration for these sorely-afflicted people, for hitherto the dis- 
ease had been incurable, and the sufferers, with a slowly de- 
creasing power of enjoying life, died in the greatest pain. Dr. 
Bryan conceived the idea that by lifting the super-iocumbent 
weight off the diseased spot in the spine, and keeping the body 
in that attitude, it might not only relieve the pain, but bring 
about a cure. The practice had heretofore been to send a 
patient to an instrument-maker, and the result was mechanical 
appliances without much beneficial effect. He concluded to 
try an experiment with a plaster of Paris splint, the material 
being strong and rigid. The first patient operated upon was a 
girl sixteen years of age. She was placed sitting upon a stool, 
and then a rope attached to pulleys in the ceiling was passed 
under her arms, and the weight of her body above the diseased 
part of the spine was gradually lifted up. When the pain was 
entirely relieved by this process, and the spine somewhat 
straightened, a plaster of Paris jacket was put on, resting upon 
the hips and gradually built up to armpits, strips of zinc pott’s disease. 
13 
having been put in, like ribs in a corset, to make the splint 
tougher and lighter. When the plaster had hardened, the rope 
was removed, and the weight which it sustained was now sup- 
ported by the plaster splint, which had the additional advantage 
of allowing no lateral motion to disturb the natural healing 
process. In a surprisingly short time the case was a perma- 
nent cure. In the other instances the splint was applied with 
remarkable success. Dr. Bryan made no publication of his 
discovery. He intended to watch the effects still further, and 
note many cases before giving his observations to the world. 
He left the hospital without having advertised himself or his 
success. 
“Dr. Lewis Sayre was an attendant physician at the hospital, 
and of course saw Dr. Bryans process and its effect. Some 
time after the young man had left for his Kentucky home, Dr. 
Lewis Sayre made one of the splints and lectured upon it to his 
class, claiming the invention as his own. Afterwards at the 
meeting of the American Medical Association at Philadelphia, 
Dr. Sayre exhibited the splint and read a paper on the subject, 
again claiming the invention as his own. Some of the surgeons 
who were present and knew the facts exposed the assumption, 
and the great surgeon had to admit that he had laid claim to 
what did not belong to him * How he is in London with this 
same invention, or, as it is called, “Sayre’s Process,” curing 
curvature of the spine, and coining money off the result of 
another man’s brains. If he had given to the operation the name 
of the inventor, it might be some recompense to the youthful 
enthusiast. But no; without a shadow of authority he has- 
given to it his own name. 
“Dr. Bryan is a man who makes few pretentions. He is 
modest and capable, and of his own motion would not open his 
lips upon a matter that so nearly concerns him. He has been 
quietly and very successfully experimenting with his plaster 
splint, making improvements as his added experience suggests, 
until now it is one of the greatest boons to suffering humanity. 
But the story is instructive as showing how some men accumu- 
late reputation.” 
* The italics are mine. 14 
pott’s disease. 
Two of the above assertions, which I have italicised, are pos- 
itively and absolutely false, and no one knows this fact better 
than Dr. Bryan himself. He knows perfectly well that in the reor- 
ganization of the Bellevue Hospital Medical Board in 1874, 
that I was not put in that Board, and was not appointed in the 
new Board until January, 1876. I was also absent from the 
city from the 2d of August, 1874, to the 15th of October; and 
on my return to the city finding that I had been removed from 
the hospital, of course I did not go into it, and therefore could 
not have seen his case; and this fact Dr. Bryan must know per- 
fectly well, for he was connected with the hospital at the time, 
as he says in his letter to me that he showed his case to Dr. 
Erskine Mason, the very surgeon who was appointed to fill 
my place. 
The second falsehood is in relation to the transaction at the 
meeting of the American Medical Association in Philadelphia. 
No such occurrence as is here described ever took 'place there. 
And Dr. Bryan also knows this fact perfectly well, for I sent him, 
myself, a copy of my report on this subject, being a reprint of 
the “ transactions,” and in it, as will be seen by referring to 
page 585, full and ample justice was done to Dr. Bryan—vol- 
untarily on my part—and no member of the Association called 
my attention to him, as here described. In fact, his name was 
not mentioned by any one but myself, and that was in my re- 
port. I appeal to the records of the Association and to every 
member of the profession who was present at that meeting, to 
prove that the assertion in the “Daily Press” is wholly and 
absolutely false, and without even the slightest shadow of a 
foundation. 
The slander and falsehoods above referred to appeared in a 
daily newspaper, during my absence from the country, and the 
paper was issued in the city of Lexington, Kentucky, where Dr. 
Bryan resides. It is hardly possible, therefore, that he could 
have been ignorant of it. One would naturally suppose that 
he must certainly have heard of it in so small a city as Lex- 
ington, or probably even seen the article. How he can recon- 
cile it to his conscience as a man, or sense of justice and honor 
as a gentleman, to allow it to go uncontradicted when he knew pott’s disease. 
15 
it to be false, as I have proved above that he must have known, 
I leave it for him to answer before the bar of professional and 
public opinion. 
In my report to the American Medical Association in 1876, 
and in all my publications on the subject since, I have given 
Dr. Bryan credit for priority in this plan of treatment, and 
claimed for myself simply “priority in bringing it before the pro- 
fession and into general use" I now find that I have been wrong 
in this respect, and have -given Dr. Bryan credit for what he is 
not entitled to, for he was preceded by Dr. St. John in 1871, who 
put up a case of caries of the spine, at my suggestion, with plas- 
ter of Paris, and also treated a case of fracture of the ribs by 
carrying the plaster of Paris bandage completely around the 
body. (See “American Journal of Medical Sciences” for 
July, 1872, pages 100-101.) 
Dr. Bryan, therefore, has no right to claim priority in this 
plan of treatment, and as he never gave to the Profession even 
the little that he did do, he has no right to claim anything 
whatever in connection with it. 
As I have proved above that I could not have seen Dr, 
Bryan’s case in the hospital, I must therefore, if I received my 
views from him, have obtained the information from some one 
of the four persons to whom he says in his letter he showed the 
case, viz: Drs. Mason, Gibney, Harlan, and Stephen Smith. In 
order to be positive upon this subject I wrote to them for inform- 
ation, and append their answers. I have received no reply 
from Dr. Harlan, although I addressed my second letter to Co- 
lumbia, Tennessee, where Dr. Bryan wrote me that he now 
resided. 
135 242d Street, New York, Nov. 9,1877. 
Lewis A. Sayre, M. D.: 
My Dear Doctor,—Yours of the 6th inst. reached me only 
yesterday, and in reply to your question whether I ever spoke 
to you of Bryan’s case, or described his mode of treatment 
prior to November, 1874, I can safely say that I did not speak 
to you of his case prior to November, 1874, and that I have 
never described the method publicly. 
I remain yours truly, V. P. Gibney. 16 
pott’s disease. 
113 West Fourth St., November 8, 1877. 
Professor Lewis A. Sayre, M. D.: 
Dear Doctor,—In reply to your note of November 6th, re- 
ceived to day, asking me if I ever described to you Bryan’s 
mode of treatment of Pott’s disease prior to November., 1874, 
I would say, I have no recollection of ever speaking to you on 
this subject. Yours truly, Erskine Mason. 
New York, 52 West 42d St., November 8, 1877. 
Professor Sayre: 
My Dear Doctor,—In reply to your note of the 6th inst., I 
would reply that I have no recollection of having spoken to 
you in regard to the case of caries of the spine treated by Dr. 
Bryan previous to November, 1874, nor subsequently until 
within the present year. 
The case was treated in my division, but attracted no special 
attention, as plaster of Paris was then being employed in a 
great variety of cases in Bellevue Hospital. It certainly had 
no other relation to the present systematic treatment of 
spinal caries by gypsum than ante-dating its present general 
employment. Even in that respect it has no special merit, for 
Dr. St. John, house-surgeon of the same division, applied the 
plaster of Paris to a case of caries of the spine as early as 1871. 
(See his paper in “American Journal of Medical Sciences,” July, 
1872, page 101.) Very truly yours, Stephen Smith. 
On referring to the very elaborate and most valuable paper 
of Dr. St. John on “ Plastic Apparatus and Surgery,” to which 
Dr. Smith alludes, I find that be has ante-dated both Dr. Bryan 
and myself in completely encircling the body in plaster of Paris 
bandage in case of fractured ribs in 1871. And on page 101, 
of his paper, I found the following sentence: “In one case I 
applied a gypsum apparatus, at the instance of another surgeon, 
as a brace in incipient caries of the spine* but was not able to 
follow up the case.” I therefore wrote to him asking for the 
name of the surgeon to whom he referred, and received the fol- 
lowing letter in reply: 
* The italics are mine. pott’s disease, 
17 
214 West 43d Steeet, Nov. 12, 1877. 
Dr. L. A. Sayre: 
Dear Doctor,—Yours of yesterday, asking about the applica- 
tion of plaster of Paris in Pott’s disease, alluded to in my article 
in the “American Journal of Medical Sciences,” 1872, is 
just at hand. I have no claims whatever in the matter. The 
case alluded to was one of your own (as you surmised), and you 
invited me to apply the apparatus, as I was then serving as 
interne in your wards at Bellevue Hospital, and you were kind 
enough to consider me tolerably adroit in the use of that 
method of surgical appliance. The case, as I remember it, 
was a lad of fifteen or seventeen years—slight knuckle in 
dorsal region. We made a sort of turtle-shell, extending from 
neck to sacrum, and covering the posterior half of the body 
only. The intention was to have it laced up in front, but I 
never saw it after the day when it was made, and I do not know 
whether that was done; nor have I ever heard how it served 
the purpose for which we intended it. 
As I said at first, I have nothing to claim except, perhaps, 
your indulgence for not having said “Dr. Sayre” instead of 
“ another surgeon,” in my paper. Had I known that it was 
the initial step to such a valuable improvement in surgical 
science as the “ plaster jacket” for “ Pott’s disease” has proved 
to be, you may be assured I would not have omitted the name. 
So far as I can find out, I was the first to use the plaster 
apparatus for fracture of the clavicle, fracture of the ribs, and 
dislocation of the clavicle (acromial end) upwards, and for an 
apparatus for treating exsection of the hip, to take the place of 
the wire breeches. I also suggested extension by means of your 
extension splints, having the rings embedded in plaster applied, 
through which extension might be made on the dorsum pedis 
and on the pelvis. Yours very truly, 
S. B. St. John. 
The “Lexington Daily Press," after referring to the above case 
of Rosanna Brennan, says: “In the other instances the splint 
was applied with remarkable success.” 
This sentence, when taken in context with another part of 18 
pott’s disease. 
the article, which says : " Among his patients were several suf- 
fering from Pott’s disease of the spine, better known as curva- 
ture of the spine,” would lead the reader to infer that Dr. 
Bryan had applied this treatment in a number of cases. Dr. 
George F. Bates, of No. 161 West Twenty-third street, who 
was Dr. Bryan’s assistant in the hospital, writes me that he 
assisted Dr. Bryan in the application of the plaster Paris band- 
age to Rosanna Brennan, and also in one other case, “ a sailor 
named Frank Clifford, in ward 2” (a transfer from ward 5), and 
closes his letter with the following sentence: “ The above were 
the two, and the only cases in which Dr. Bryan used the plaster 
dressing for Pott’s disease during his service as interne in Belle- 
vue Hospital.” 
In Dr. Bryan’s letter to me of May 29, 1876, he says: “I 
have never seen your ‘ turtle-shell ’ splint.” This may be true 
but it only shows that he was not very observant of what was 
being done in the hospital quite frequently and was quite 
familiar to the rest of the staff, as will be seen by the follow- 
ing letter just received from one of the former house-surgeons, 
and which was sent to me unsolicited and unexpected: 
101 North Sixth St., Newark, Nov. 23, 1877. 
Professor Lewis A. Sayre: 
Dear Doctor,—Having noticed some discussion in reference to 
the time you first used the plaster jacket (turtle-shell, as you 
then called it), it may be of interest to you to know that I “put 
up” a case of Pott’s disease of spine for you in this way during 
my service as interne at Bellevue Hospital from April, 1871, 
to April, 1873. 
I remember the case well; it was a child in ward 30, second 
surgical division, and your directions were as follows: The 
child was to be placed across my knees, face downwards, the 
arms hanging over one knee, the thighs over the other; then, 
by gradually abducting my thighs, I was to make extension 
until the child was easy, and the back in good position, when 
plaster of Paris and an old blanket were applied, nearly meet- 
ing in front. This was allowed to dry with the child still in 
position, and the edges were then bound, and elastics inserted pott’s disease. 
19 
in front. The child experienced great comfort from this appa- 
ratus, and was able to go about the ward. I remember one 
case, a fractured rib, which was treated during the same ser- 
vice by a plaster bandage going entirely around the chest. 
I am quite sure, moreover, that the case I referred to above 
was not the first or only one treated in this way at the hospital; 
I think it had been used, perhaps, during Dr. St. John’s service, 
as he belonged to the second surgical division also. 
Allow me to congratulate you on the splendid success of this 
method in the form in which you have developed it, and on the 
unanimous acceptance of your demonstrations by the English 
surgeons last summer. 
Very sincerely, 
George A. Van Wagenen, M. D., 
House-Surgeon Bellevue Hospital, 1871-73. 
The “ Lexington Daily Press ” says: “ Dr. Bryan made no 
publication of his discovery. He intended to watch the effects 
still further, and note many cases before giving his observa- 
tions to the world.” This sentence would lead us to infer that 
Dr. Bryan was still experimenting with this plan of treatment, 
and intended to give it to the profession so soon as he had per- 
fected it and proved it to be useful. By referring to Dr. Bryan’s 
letter to me of May 29th, 1876, it will be seen, as he says, he 
had “ forgot all about it,” and could not therefore have been 
very much interested in it, according to his own testimony. 
And it will be seen by the following letter from him to me that 
he had not again put it in practice up to the 5th of March, 
1877: 
Lexington, Ky., March 5, 1877. 
Dr. Lewis A. Sayre: 
Dear Doctor,—Yours of tlie 28th of February reached me 
yesterday. In reply, I must say, that being a party in the 
question, I am not in a position to decide as to whether you 
have done me perfect justice in regard to the “plaster jacket” 
in your book. Elsewhere, as far as 1 am able to judge, you 
have given me all the credit due me. Am glad to know the 
splint is becoming so popular with physicians. I believe now, 20 
pott’s disease. 
as I have always believed, that it is capable of doing great good 
in capable hands. The great trouble will be, however, in getting 
physicians to understand its proper application. It has been 
used here by a physician in one case, but was not properly 
applied, and consequently failed to accomplish the desired object. 
Hoping you will succeed in your endeavor to popularize the 
splint, and in the end get physicians to apply it properly, 
I remain your affectionate pupil and friend, 
Joseph Bryan. 
As my book to which he refers was published in January, 
1876, nearly three months before I ever heard of his name in 
connection with the subject, I certainly can not be censured for 
not referring to him, particularly as he distinctly states that he 
never published an account of it anywhere, and only showed it 
to four other persons, three of whom have written to me that 
.they did not speak to me on the subject, and the fourth one, 
Dr. Harlan, having removed from the city, I have been unable 
to find. Dr. Bryan says: “Elsewhere, as far as I am able 
to judge, you have given me all the credit due me." As I 
distinctly published in the paper here referred to that “ I was 
not aware of Dr. Bryan ever having applied it until I received 
his letter of May 29, 1876, or I should have given him credit 
for it in my previous publications on the subject,” I must in- 
sist upon my right to assert that I have done Dr. Bryan no in- 
justice; but, on the contrary, have given him full justice, as I 
have always conscientiously endeavored to do to every other 
member of our honorable profession. Having now given all 
the facts in connection with this subject, I leave it to the pro- 
fession, whose judgment, I am convinced, will always side with 
honor, truth, and justice. 
I hope those journalists who have done me injustice and 
great professional injury by publishing vile slander, will at 
least take the trouble to read this evidence, and then make such 
comments as a sense of honor and justice demands. 
Again thanking you for your great kindness in allowing me 
to occupy so much space in your valuable journal, 
I remain your grateful friend, Lewis A. Sayre. 
285 Fifth Avenue, November 25, 1877. pott’s disease. 
21 
Addenda.—Since the above was sent to the press, I have 
received a letter from Dr. Harlan in answer to my second letter, 
dated Columbia, Tennessee, November 23, 1877, in which he 
states that he did speak to me of “ Bryan’s method of treating 
Potts’ disease very soon after he applied the splint to his first 
case.” As I could not recall the conversation, and as I was 
absent from the city from the 4th of August until the 12th of 
October, in 1874, I wrote the Doctor the following letter, to see 
if he could possibly connect it with some incident or circum- 
stance by which my memory would be refreshed: 
285 Fifth Avenue, November 26, 1877. 
Dr. B. J. Harlan: 
Dear Doctor,—Yours of 23d instant just received. I have 
not the slightest recollection of your speaking to me of Bryan’s 
method of treating “ Pott’s disease,” and will feel deeply obliged 
if you could possibly refresh my memory by referring to any 
incident occurring in the conversation, where it took place, and 
as nearly as possible when, what month, etc., etc. 
It is singular that what I consider so important a subject 
could have been described to me so as to make me understand 
it, and that I should have so perfectly forgotten it. The first I 
ever knew of the subject was in a letter from Bryan himself, in 
1876, in answer to mine about the anonymous correspondent of 
the “ Louisville News.” I wish you could inform me where 
and when you told me, who was present, or refer to anything 
by which I can recall it to mind. 
Please answer immediately. Yours truly, 
Lewis A. Sayre. 
I have just received the following reply : 
Columbia, Tenn., November 30, 1877. 
Dr. Lewis A. Sayre: 
Dear Sir,—Your favor of the 26th instant received. The 
conversation I had with you about Bryans' treatment of Pott's 
disease took place in your office; I think there was a lady and 
her little girl present; I believe you were applying electricity to 22 
pott’s disease. 
the girl's leg.* I can not state with any degree of accuracy in 
what month or at what season of the year the visit was made. 
In your article in the Transactions of the American Medical 
Association, after quoting from Bryan’s letter to you, you go on 
to say that none of the gentlemen mentioned seemed to think 
much of the apparatus. When Bryan first used it, he told me 
how much it had relieved the patient, and took me to see the 
apparatus. As soon as it was explained to me and I had seen it 
in use, I then and there, and several times afterwards, earnestly 
urged Bryan to write an article for some journal on the subject. 
He always replied that he expected to do so when he had had 
more experience with the apparatus. 
I used the same apparatus on a patient under my care for an 
injury to the spine in October, 1874. I did not suspend the 
patient, as that part of the treatment I did not think needed in 
his case. Name of patient was Charles Walker, and you will 
find a meagre history of his case in the Hospital .Records of the 
second surgical division for 1874. I only write these personal 
details to let you know that I had sense enough, when the 
matter was explained to me, to see what an immense improve- 
ment it was on all previous methods of treating Pott’s disease. 
Yours truly, Benj. J. Harlan. 
As I am not accustomed to have strangers present when I am 
engaged in so delicate an operation as the application of elec- 
tricity to the leg of a young lady, I deem further comment on 
the above letter entirely unnecessary. Again, Dr. Bryan applied 
his splint August 22, 1874. I was then absent, and did not 
return until October 15 of that year. Dr. Harlan could not 
have mentioned the matter to me “ very soon after ” the splint 
was applied. Shortly after I returned, I applied the plaster of 
Paris jacket upon Willie Pulver at the store of Mr. Reynders, 
in this city. These are succinctly the facts, and I leave them 
with the professional public. 
* The italics are mine. PERIODICAL MEDICAL L1TERATDRE. 
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