Braces of tin, slit at short intervals along their entire length, and about one inch from the edge toward the centre, like a many-tailed bandage, in order to make them more flexible in adjusting, three or four inches wide at top, and five or six inches at bottom, reaching from near the axilla to a point beyond the crest of the ilium, and partly to the rear of the hipjoint, are next placed in position, bent to meet the natural curve of the body, and covered with muslin wet with the silicated solution. I would here draw your attention more particularly to the position of these braces. The one on the left

side of the jacket before you shows the brace as resting upon the crest of the ilium, bearing the weight of the thorax and upper extremities of the body. Much inconvenience and uneasiness are occasioned by the jacket with the brace in this position. For weeks, and even months, particularly in spare persons, the patient is compelled to lift it up and out of place, thereby defeating the object intended. But when the brace is placed partly to the rear of the crest of the ilium, as is shown on the right side of the jacket, the weight is carried by the glutei muscles, they being large form a cushion for the brace to rest upon, and are largely concerned in the station and progres

sion of the lower extremities, carrying the weight without the least inconvenience to the patient. Other braces of tin, an inch wide, and extending from the junction of the fourth rib with the os sternum to a point near the symphysis pubis, are placed, leaving a space of about two inches on each side of the median line, where the jacket will be cut for the purposes of eyeletting. Still another brace of tin, one or one and a half inch wide, is placed along the spine, shaping it also to meet the contour of the parts. Should there be posterior curvature, and some of the spinous processes extend out more than natural, it is better to lay two narrow strips of tin, one on each side of the prominent vertebræ, for the reason that the diseased structures will not tolerate any undue pressure. Now, a bandage similar in dimension to the one alluded to prior to applying the braces, being saturated, as it advances, with the silicated solution, the patient is now extended (was on a stool before) by some suitable apparatus. Care should be taken not to trice the individual up so high that the support afforded by the heels is lost, as, in my opinion, without this precaution the spinal column is too much straightened by the weight of the lower extremities, and the natural curvature thereby lessened.

This latter bandage secures the tin braces firmly in position, and retains them there without further support. A second or outer bodice, made exactly like the first, is now framed and applied, using the solution of silicate of soda freely, in order to secure its uniform adhesion to all the inequalities which the surface of the jacket now presents. This completes the process for the present, and the patient, being lowered, is laid upon a firm bed (care being taken in the transit to disturb the set of the jacket as little as possible), and allowed to remain at perfect rest for two or three hours, at the end of which time the silicated material will have become sufficiently firm to admit of further manipulation. I have observed that a temperature of about 70° F. in the room will hasten the stiffening process, and would recommend the apartment to be kept in that condition.

The jacket is removed from the body by making an incision along the centre, in front, and carefully slipping it off. Before cutting, however, it should be carefully marked and trimmed— where trimming is necessary-under the arms and bottom. It may be cut off at top, both back and front, as low as the patient may desire, provided, always, that it is not so low as in the

judgment of the physician will interfere with the proper support of the affected structures.

At bottom, it should be made to extend several inches below the crest of the ilium, and cut off in the direction of the symphysis pubis, so that the lower part of the jacket, when the patient is seated, will not rest heavily upon the thighs, thus pushing it up and out of place, rendering the patient uncomfortable, and defeating the object intended, a perfect support. If, after cutting the jacket prior to its removal, the edges should lap when brought together, showing too much material, they should be trimmed off so as not to meet by about one inch. In trimming off the front edges, care should be taken to divide the space equally between the two sides, where the centre of the jacket is the part manipulated, otherwise it will give the apparatus a one-sided appearance.

For convenience in the further mechanical construction, I remove the jacket to my office. It is yet in a semi-plastic state, the heat of the body not being sufficient to render it as hard as it must be to answer the purpose for which it is intended.

I place it upon a table and smooth out all the folds and wrinkles on the inner surface, taking great care not to destroy the shape.

This done, it is removed and placed upon a clothier wire frame, and dried carefully at a stove. When the material is sufficiently hardened, place it over a rounding block, and with a round faced hammer pound down all the roughness and projections left upon the inner surface. I sometimes line the inside with pieces. of muslin, using as an adherent the silicated solution, and bind the arm spaces, and all other trimmed edges with pieces of muslin cut bias, not sewed on, but attached by the use of the soda. This is done to prevent the separation of the different cut edges, and render the jacket more durable. The front edges are now eyeletted or supplied with eyeletted cloth riveted on; several rows of holes about the size of a No. 16 catheter should be made in several places with a steel punch over a hard block of wood. This will allow the escape of the natural exudations of the body, and will afford all necessary ventilation. All openings should be made from the inner surface outward, in order to prevent the formation of prominences on the inside of the jacket. The instrument is now ready to be placed upon the patient.

In order to ascertain whether the curves in the jacket, particularly that of the region commonly termed "the hollow of the back," correspond with those of the body of the patient, careful measurements of the patient should be taken and compared with those of the jacket. This is most conveniently done with a common yardstick, by placing one end upon the bony prominence of the scapular region, and the other upon the nates, and measuring the are described between the straight edge and the body with a common foot rule. The anterior curve, or that of the region commonly denominated "the hollow of the back,” is ordinarily from an inch and a quarter to an inch and one half in the adult, and the jacket should be made to have this curve in order to give that support to the diseased structures which is necessary to a successful treatment.

In posterior curvatures it will be impossible to adhere to the rule laid down above, yet the patient needs support as much as any other class of cases who may apply for treatment. If any alteration in the jacket is necessary to its proper conformity, it may be accomplished by slitting the jacket at that point and removing an elliptical or wedge-shaped piece. The opening thus made is drawn together by puncturing holes in either edge and drawing together by means of a lacer or linen tape, I have now carefully and minutely described the mechanical construction of my jacket, and I feel assured that if my professional brethren will follow my process strictly, success will attend their efforts, not only in the construction of the jacket, but in affording relief to those of their unfortunate patients to whose infirmities support is rest, and rest is the natural therapeutic agent for the relief of pain. When about to adjust the jacket upon the patient finally, he or she should be extended in the manner formerly described. The jacket is then put around the body and set to its place. If too hard to adjust easily it may be softened by the application of hot water. It is now ready for lacing. Begin with a long lacer about the third or fourth hole from above down, lacing until you reach the umbilical region, there drawing it through and making a loop long enough to tie on either side, proceeding to lace tightly until the lower edge is reached, where it is fastened. The object of leaving the tie loop in the umbilical region is to draw it tightly together at that point, thus making extension and counter extension at the same time. The bony structure of the scapular and iliac region

serves as a fulerum upon which to have the weight of the space between.

Then begin with a short lacer and lace it through the four upper holes, draw it as tightly as the patient will allow and tie. The object of this short and separate lacer is, if the patient is a female, to relieve the mammæ from undue pressure. It is my custom to protect the mammæ in females from any undue pressure by artificial breast shields made for that purpose. No dinner pad is necessary with this jacket, as the patient may find relief after a hearty meal by simply loosening the tie loop in the umbilical region, the lacer at top being sufficient to hold the jacket in place. In females who suffer from uterine displacement, this jacket has so far presented no ill effects resulting from its use.

It is lighter than any similar appliance and quite inexpensive, the quantity of the solution of the silicate of soda used being from two to four pounds, one-half being wasted in the construction of the jacket, costing about thirty-five cents, and muslin at eight or ten cents a yard will not add greatly to the cost of the whole. The silicated solution does not set near so quickly as plaster of Paris, does not crack or crumble, and is more durable. The lacing admits of its removal at any time for the purpose of cleansing the body, and after the first adjustment, no extension being required, the patient takes it off and puts it on without assistance.

The length of time one can be worn I am unable to say. I have a number of patients who have worn them constantly for two, now going on three, years, and to-day they are as firm and neatly shaped as when first put on. In fact, the only case in which I have been called upon to replace them with new ones is where the patient, being a very young person, has grown out of them, the original jacket preserving its shape and texture.

The weight of this large jacket, suited to a person weighing 140 pounds, is two pounds eight ounces, and the small one, suited to a child between one and two years old, weighs 10 ounces. The time required to mould one upon the body is from thirty to forty minutes.

A Method of Ascertaining the Extent of Curvatures.—I have found that careful measurement from the acromion process of the scapula to the symphysis pubis anteriorly, and from the same process to a central point in the sacro-vertebral region posVOL. XXXI.-58