THE WOOD CORSET. WITH IMPROVEMENTS, FOR THE TREAT- MENT OF LATERAL CURVATURE AND POTT'S DISEASE OF THE SPINE. BY A. M. PHELPS, M. D., NEW YORK. REPRINT FROM THE New England Medical Monthly For February, 1892. Danbury, Conn., THE DANBURY MEDICAL PRINTING COMPANY, 1892. THE WOOD CORSET. WITH IMPROVEMENTS, FOR THE TREATMENT OF LATERAL CURVATURE AND POTT'S DISEASE OF THE SPINE. THE question of a suitable spinal support in lateral curvature of the spine and convalescent cases of Pott's disease has been before the pro- fession from the earliest time, and not until Dr. Sayre devised the plas- ter-of-Paris corset did we have a brace that accomplished nearly all that is desired in a support. The plaster-of-Paris corset I believe to be one of the most efficient of supports. It certainly has the ad- vantage of cheapness, and is well adapted for use in clinics and dispen- sary practice. It has, however, the disadvantage of weight. Steel braces have been made. Many of them, when suitably applied, furnish very good results. Dr. Vance constructed, to take the place of the plaster-of- Paris corset, a paper corset. If the profession could have at their disposal a corset which com- bines strength, durability, porosity, and lightness, it would meet a long- felt want. I had heard something of the wood corset but knew nothing of its construction. Therefore, three years ago I visited Europe for the express purpose of learning the de- tails of its construction. On my re- turn, I presented the corset at the New York Academy of Medicine, Surgical Section. I visited Dr. Waltuck, of Odessa, Russia, and from him personally I learned the details, after several days of hard work. I found that Profes- sor Lorenze, of Vienna, had been us- ing the corset for some time, and was much pleased with it. At that time, however, many of the corsets proved to be inefficient on account of errors in their construction. We have used the corset constantly since that time, and with'the modifications which we have made, it is the most efficient, comfortable, and suitable spinal brace that I know of. It has been with the greatest diffi- culty that we have succeeded in get- ting the proper materials for con- structing the corset, and even now it is cheaper and better to import the wood from Vienna. The spruce tim- ber which grow there makes a better shaving than any timber that we have attempted to use which grows in America. It is tougher, and works better with the glue. The materials necessary for mak- ing the wood corset are: One dozen plaster-of-Paris bandages; one tight- fitting shirt, fifty pounds plaster-of- 2 Paris, two pounds oakum, two yards of raw unbleached linen, a blue pen- cil, one pound of Cologne glue, a lit- tle glycerine, a knife for splitting wood, a glue-pot, a hammer, a large clothes brush, some towels, two sand- bags, a quantity of wood shavings, some shellac, an eyelet punch, a line, stir water into the plaster-of- Paris and oakum until it is of the con- sistency of thick mud. Apply this over the inside of the corset to the thickness of three inches. After it is set, remove the corset, and a per- fect cast of the body will be the re- sult. The blue line will be trans- Fig. 1. number of eyelets, and hook lacings, and two yards of knit shirting. All of these articles are kept in stock by Messrs. John Reynders & Co., 303 Fourth Avenue, New York, who have kindly imported for me such materials as could not be pro- cured in New York. The Details of the Work.-Sus- pend the patient after the tight-fit- ting shirt has been applied. Indicate with the blue pencil mark around the body on the shirt, the length of the corset desired. Apply the plas- ter-of-Paris bandages as in making an ordinary plaster-of-Paris corset. When the plaster is set, remove it from the body by cutting it down in in front. Strip out the shirt from the corset, when the blue pencil marks will be seen on the inside of the plaster corset. A few turns of the plaster bandage around the plas- ter corset is necessary. Put in a large dish a quantity of oakum picked up finely. Mix with this a 'quantity of plaster-of-Paris. After having greas- ed the inside of the corset with vase- ferred from the plaster mould to the cast. The oakum is put in the plas- ter to facilitate the modelling, and also to make the cast tough, because considerable hammering has to be done upon it. The cast should dry two or three days in a temperature not exceeding one hundred and fifty Fig. 2. .T,fte.yndersfrCo. Fig. 3. degrees. Any imperfection . in the cast should be remedied with plaster- of-Paris, building out such points over the breast and hips and de- formed portions as may seem neces- sary to make an artistic corset. Cover the cast with raw linen which has 3 been wet for the purpose. Some The layers of wood and linen are difficulty will be experienced unless explained in Fig. 8, the dotted lines the workman has seen the work being linen, the black lines wood, done. The cast is placed on a table Fig. 4. Fig. 5. Fig. 6. Fig. 7. with the sandbags, as seen in Fig. i. The wood from which the corset is made is taken from the edge of a plank the grain of which is as seen and it will be seen that there are three layers of linen and two of wood in the front of the corset, with three layers of linen and three layers of wood in the back and side. Over the hips extra pieces are put in, making it even thicker, which will JReynders'&Co. JRe.yn.<ler§ & Co. Fig. 8. Fig. 9. in Fig. 2. Fig. 3 shows imperfect grain. The grain running as in Fig. 2 makes a tough strip that will bend as seen in Fig. 4. When the grain be explained later. The cast is now laid with the back up. Draw three longitudinal lines, one in the centre in front, and one on yuders &Co Fig. 10. runs as in Figs. 6 and 7 and the wood is bent, it will present the appearance of Fig. 5, which has an element of weakness. each side, dividing the cast into three equal parts. Cut several strips of wood in length long enough to overlap the lateral lines two inches. 4 With the tool, Fig. 9, split the ends of the wood as seen in Figs. 10 and 11. The object of this is to allow the ends of the wood to spread or to overlap, so as to fit all inequali- A strip of wood is covered with glue, and the brush drawn along the part of the cast where the wood is to Fig. 11. Fig. 12. ties, as seen in Figs, n, 12, 13, 14 and 15. Prepare the glue by soaking it in water over night, then melt it. To a pot (holding one quart) of glue, be laid, beginning at the top of the cast with a transverse layer; strip after strip is applied, and overlapping the strip above one- eighth of an inch. Cover this layer of wood with the linen and glue, and hammer the whole together. Turn the cast on the side, and working JReynlers&Co. Fig. 13. Fig. 14. Fig. 15. add one tablespoonful glycerine. Dip the glue-brush into the glue, wiping it as dry as possible on the edge of the pot so as to use the least possible quantity. from the centre in front, put the strips on horizontally, over-lapping the strips already on, two inches. Cover this with linen, lapping on the back two inches. Finish the opposite 5 side in the same manner. See Fig. 16. Beginning in the back, put on the mer. Now stay the corset with wood, as seen in Figs. 17 and 18, over the hips, and also strengthen the corset Fig. 16. Fig. 18. strips longitudinally, overlapping four inches in the centre of the cast from the top and bottom. See Figs. by putting on another layer of wood diagonally from the shoulder to the opposite hip, meeting at a point in the centre of the waist. Cover the entire work with linen, putting the least amount of glue on the wood before the linen is applied. After twenty-four hours the corset can be Fig. 17. Fig. 19. i7, 18, and 19, left side. Hammer the wood well together with an ordinary shoemaker's ham- removed from the cast, fitted to the patient, and sent to the trimmer who will treat it in the following manner. 6 Corsets made according to the method followed at the time I Ob- i. The slightest excess of glue moistened by the perspiration of the body coming into contact with the shirt or the skin, was exceedingly disagreeable. 2. The perforations in this corset weakened them, and allowed the glue to exude during perspiration. To obviate all this, I had the corset perforated, as seen in Fig. 20, in which perforation eyelets are punch- ed. A special machine facilitates the perforating and the punching of the eyelets. The lacings are stitched on as in Fig. 20. Trim the top and bottom with kid. The entire corset is shellaced inside and outside with two or three coats of shellac, which renders it impervious to moisture, the eyelets ventilating it perfectly. A corset made as I have described, it will be observed, differs from that of Dr. Waltuck in the layers applied as seen in Fig. 18. Is no better, but somewhat easier to make. The improvements which I have made in the corset, consist in shellac- Fig. 20. served the process were not as per- fect as they should be. Fig. 21. ing it on the inside and outside, and putting in the eyelet holes, eyelets, 7 which add to the strength of the corset and ventilate it perfectly. An ordinary corset, for an adult, weighs from one to one and a half pound. They are very durable, very comfortable to wear, and thus far I believe that they are the best spinal braces yet devised. I have made from the paper used in the manufacture of boats, a corset which answers the purpose equally as well as the wood corset. It is much Another use to which the wood shavings are applied is in working them with plaster-of-Paris in the treatment of fractures of osteotomies or excision of joints. Being thin and narrow, they admirably adapt them- selves to the parts, and the plaster- of-Paris holding them in place, they fit more accurately than any me- chanic could shape a solid piece of wood to fit. Again roll two layers of crinoline, Fig. 22. lighter, and seems to be as durable, and I am not sure but it will take the place of the wood corset. Time will determine. The process of mak- ing the paper corset is similar to that of making the wood corset, so far as making the cast is concerned, after which the cast is sent to the paper- boat manufacturer, who applies the paper according to the process em- ployed in making boats. between which wood strips have been placed, as shown in Fig. 21 and 22. Roll up four yards of this, as seen in Fig. 22. With a saw, cut this into rolls four inches in length. Immerse one of these ban- dages in water, and it will be found an admirable dressing when applied to a limb in cases of joint disease, or where a slight support is required to hold a limb in a proper position. The 8 starch of the bandage soon hardens, so that we really have a starch ban- dage reinforced by wood shaving. There are many cases in surgery where this bandage can be used to great advantage, and applied over surgical dressings it takes the place of plaster-of-Paris. It is light and just as strong as plaster-of-Paris, and it has the advantage over the starch bandage of keeping its position after it is applied, even before it is dry. The corset is somewhat difficult to make. It requires a good worker in wood and glue, and a plant for doing the work. It would hardly pay a general practitioner, who possibly would not use more than four or five corsets during the year, to go to the trouble and expense of making his own corset. If those gentlemen who de- sire to use the corset will make a plaster-of Paris corset as described in the beginning of this paper, and send it to the workshop of the Post- Graduate School and Hospital, the men there will make the corset, and Messrs. John Reynders & Co., will satisfactorily trim it. I will say, by way of parenthesis, that the corsets, when completed, can be covered with silk or with stockinet, or they can be left in the linen finish. They are not so warm for summer use in the linen finish.