Reprint Albany Medical Annals, July, 1888. 
CLINICAL REPORTS. 
III. 
TREATMENT OF THE PRESSURE PARALESES 
OF POTT'S DISEASE BY THE PLASTER- 
OF-PARIS JACKET. 
By HENRY HUN, M.D., 
Professor of Diseases of the Nervous System and of Psycho- 
logical Medicine in the Albany Medical College. 
ALBANY, N. Y., 
Fixation and extension of the verte- 
bral column by means of either plaster- 
of-Paris jackets or iron braces is, in this 
country at least, the almost universal 
treatment of Pott's disease. The same 
treatment is also the most efficacious that 
we possess for the compression paralyses 
due to Pott's disease, and it seems strange 
that Striimpell, in his excellent " Text- 
Book of Medicine," American edition, 
p. 581, should speak in such doubtful 
terms of the value of this form of treat- 
ment in such cases. The following cases 
show the value of the application of 
these jackets. 2 
Case I.-H. G., get. Entered 
Child's Hospital March 20, 1884. Dur- 
ing the past three years there has been 
an angular curvature in the upper dorsal 
region of the spine. During much of the 
time the boy has been running about 
and playing, but frequently he had such 
severe pain in his back that he was 
obliged, on account of it, to lie in bed 
for a few days or weeks at a time. In 
February, 1884, he commenced to lose 
power in his legs, and at the end of a 
week he was unable to walk at all. On 
entrance into the hospital the patient 
could neither walk nor stand, but he was 
able to move his legs feebly. The cuta- 
neous and tendon reflexes were exagger- 
ated. There was no disturbance of sen- 
sibility and no disturbance in defecation 
or micturition. There was an angular 
curvature in the spine extending from 
the first to the sixth dorsal vertebra, with 
a corresponding bend in the sternum. 
The patient was kept in bed, and the 
galvanic current was applied to the spine 
and legs daily for a couple of months, 
during which time there was no improve- 
ment. In June a plaster-of-Paris jacket 5 
spine during a couple of weeks, one 
sponge being applied above, the other 
below, the jacket. 
After the application of the jacket the 
patient steadily improved, and in No- 
vember, 1884, he could walk perfectly 
well without a cane, and thought that he 
could walk two or three miles without 
difficulty, and said that his legs felt 
nearly as strong as ever. Sensibility of 
al] kinds and the cutaneous reflexes were 
normal. Exaggerated knee-jerk and 
ankle-clonus were still present in both 
legs. In January, 1885, the knee-jerk 
was normal, and there was no ankle- 
clonus. In March, 1885, he ceased wear- 
ing jackets, and during the years 1885 
and 1886 he felt perfectly well and did 
light work. In the fall of 1887 he devel- 
oped pulmonary tuberculosis, which 
steadily progressed and caused his death, 
without any return of the paralysis, in 
March, 1888. 
Case III.-C. W., aet. 9. Entered 
the Child's Hospital June 19, 1883, with 
the history that her back had been dis 
eased for two years, and that her legs had 
been paralyzed for the same length of 4 
ever he coughed or sneezed this band 
was very painful. In February, 1884, 
he commenced to feel a numbness in his 
feet, and this numbness gradually ex- 
tended over the entire lower portion of 
the body up to the band about his chest, 
and at the same time his legs became 
weak. In May the patient could walk 
only with great difficulty with two canes, 
and when so walking his whole body 
trembled violently. He could not stand 
on either leg alone, and could scarcely 
stand on both feet. Slight anaesthesia 
to tactile sensations below the band 
about chest, and some loss of muscular 
sensibility in the legs. Sensibility un- 
impaired for painful and thermic impres- 
sions. Exaggerated knee-jerk and ankle- 
clonus in both legs. The plantar and 
cremasteric reflexes were also increased. 
No disturbance of motion or sensation 
in any part of the body above the band 
about the chest. There is a slight angu- 
lar curvature of the spine, with projec- 
tion backwards of the spinous process of 
the sixth dorsal vertebra. On May 24th 
a plaster-of-Paris jacket was put on, and 
the galvanic current was applied to the 5 
spine during a couple of weeks, one 
sponge being applied above, the other 
below, the jacket. 
After the application of the jacket the 
patient steadily improved, and in No- 
vember, 1884, he could walk perfectly 
well without a cane, and thought that he 
could walk two or three miles without 
difficulty, and said that his legs felt 
nearly as strong as ever. Sensibility of 
all kinds and the cutaneous reflexes were 
normal. Exaggerated knee-jerk and 
ankle-clonus were still present in both 
legs. In January, 1885, the knee-jerk 
was normal, and there was no ankle- 
clonus. In March, 1885, he ceased wear- 
ing jackets, and during the years 1885 
and 1886 he felt perfectly well and did 
light work. In the fall of 1887 he devel- 
oped pulmonary tuberculosis, which 
steadily progressed and caused his death, 
without any return of the paralysis, in 
March, 1888. 
Case III.-C. W.,' eet. 9. Entered 
the Child's Hospital June 19, 1883, with 
the history that her back had been dis 
eased for two years, and that her legs had 
been paralyzed for the same length of 4 
ever he coughed or sneezed this band 
was very painful. In February, 1884, 
he commenced to feel a numbness in his 
feet, and this numbness gradually ex- 
tended over the entire lower portion of 
the body up to the band about his chest, 
and at the same time his legs became 
weak. In May the patient could walk 
only with great difficulty with two canes, 
and when so walking his whole body 
trembled violently. He could not stand 
on either leg alone, and could scarcely 
stand on both feet. Slight anaesthesia 
to tactile sensations below the band 
about chest, and some loss of muscular 
sensibility in the legs. Sensibility un- 
impaired for painful and thermic impres- 
sions. Exaggerated knee-jerk and ankle- 
clonus in both legs. The plantar and 
cremasteric reflexes were also increased. 
No disturbance of motion or sensation 
in any part of the body above the band 
about the chest. There is a slight angu- 
lar curvature of the spine, with projec- 
tion backwards of the spinous process of 
the sixth dorsal vertebra. On May 24th 
a plaster-of-Paris jacket was put on, and 
the galvanic current was applied to the 9 
of extension and fixation of the spine in 
the compression paralyses of Pott's dis- 
ease ; and although some advise that, in 
addition to the jacket, iodide of potassium 
should be administered in large doses, 
yet these three cases, in which no iodide 
of potassium was given', show that the 
jacket is the more essential factor of the 
two in producing the cure. 
We have, then, in the plaster-of-Paris 
jacket an agent of the greatest value in 
the treatment not only of Pott's disease, 
but also of the paralysis which this dis- 
ease sometimes causes. In each of these cases the improvement 
must be ascribed to the plaster-of-Paris 
jacket. There was no medicine given, 
and the galvanic current was used for too 
short a time in the second case to have 
been of any benefit, while in the first and 
third cases when used alone for a long 
time it produced no good effect. In the 
first two cases, in which the paralysis 
was never complete, the patients recov- 
ered perfectly their lost power of motion 
and sensation; and in the third case, in 
which the paralysis of motion and sensa- 
tion was complete, the patient was appar- 
ently going on to a perfect recovery when 
an attack of pneumonia caused her death. 
The fact that in the second case tubercu- 
losis developed in the lungs and caused 
the death of the patient does not invali- 
date the claim of the case to be consid- 
ered one in which the compression paraly- 
sis was cured by the repeated application 
of plaster-of-Paris jackets. In each of 
the cases the exaggerated tendon reflexes 
were the last symptom to disappear. 
Quite a number of observers, in this 
country especially, have reported cases 
similar to the above to show the value 
8 9 
of extension and fixation of the spine in 
the compression paralyses of Pott's dis- 
ease ; and although some advise that, in 
addition to the jacket, iodide of potassium 
should be administered in large doses, 
yet these three cases, in which no iodide 
of potassium was given, show that the 
jacket is the more essential factor of the 
two in producing the cure. 
We have, then, in the plaster-of-Paris 
jacket an agent of the greatest value in 
the treatment not only of Pott's disease, 
but also of the paralysis which this dis- 
ease sometimes causes. In each of these cases the improvement 
must be ascribed to the plaster-of-Paris 
jacket. There was no medicine given, 
and the galvanic current was used for too 
short a time in the second case to have 
been of any benefit, while in the first and 
third cases when used alone for a long 
time it produced no good effect. In the 
first two cases, in which the paralysis 
was never complete, the patients recov- 
ered perfectly their lost power of motion 
and sensation; and in the third case, in 
which the paralysis of motion and sensa- 
tion was complete, the patient was appar- 
ently going on to a perfect recovery when 
an attack of pneumonia caused her death. 
The fact that in the second case tubercu- 
losis developed in the lungs and caused 
the death of the patient does not invali- 
date the claim of the case to be consid- 
ered one in which the compression paraly- 
sis was cured by the repeated application 
of plaster-of-Paris jackets. In each of 
the cases the exaggerated tendon reflexes 
were the last symptom to disappear. 
Quite a number of observers, in this 
country especially, have reported cases 
similar to the above to show the value 
8