While reviewing the case study, consider the following questions:
From Lateral Curvature Vol. 1, pages 50-51.
The patient is a fifteen-year-old girl from New York City. She is being treated for lateral curvature of the spine (scoliosis). Before seeking treatment from Sayre, C.C. was treated by another doctor who prescribed a brace. Sayre first saw C.C. on June 2, 1883. He recommended a treatment of self-suspension and gymnastic exercises. He also built C.C. a Plaster of Paris jacket. For a year, C.C. continued to visit Sayre for follow-up appointments and adjustments of her jacket. He describes modifying the jacket to better fit her body. In his last entry, Sayre notes that the patient has not continued the exercises he prescribed.
To page through Sayre's clinical notes and read the transcribed patient narrative for C.C., use the arrow icons to scroll through the gallery.
In a lecture delivered in the Bellevue Hospital Amphitheater on December 24, 1879, Sayre described lateral curvature as a condition that “occurs most frequently in young girls about the age of puberty, and it is a result, commonly, of unequal contraction of the muscles of the two sides of the body.” Although contemporary medicine no longer supports his belief that asymmetrical muscle development is the direct cause of scoliosis, Sayre’s emphasis on physical therapy and supportive bracing treatments for the condition is similar to the non-surgical interventions used today.
As seen in C.C.’s case above, Sayre recommended the use of gymnastic exercise and self-suspension to elongate the spine and relieve discomfort for the patient. Self-suspension was a treatment developed by Dr. Benjamin Lee and adopted by Sayre, in which patients used a rope and pulley device with a chin strap to lift their feet from the ground. Self-suspension was intended to activate the patient’s thoracic muscles and relieve pressure on the spine, decreasing their spinal curvature.
Sayre noted that “as soon as self-suspension is discontinued they will, of course, relapse into their former shape, and something is necessary to retain them in the improved position which self-suspension gives them.” To help patients maintain the posture created by self-suspension, Sayre developed his Plaster of Paris jacket. Plaster bandages were shaped into a corset and allowed to harden while the patient’s spine was artificially straightened through suspension. Patients then wore the jackets beneath their clothes during the day as a supportive brace. The malleable quality of Plaster of Paris meant that jackets could be modified to an individual patient’s body, as in the case of C.C., whose shoulder position required Sayre to cut a window in her jacket. Sayre replaced or adjusted his patients' Plaster of Paris jackets every few months and intended them to be combined with his prescribed strengthening exercises.
Image: Patient practicing self-suspension. From Sayre's Lectures on Orthopedic Surgery and Disease of the Joints, 1885.