Sunday, 24 August 2008

Making plaster beds – a film about how they did it

Since the blog has gone a bit quiet, I though this might be a good time to share my rather curious experience of watching this film, last year before we started the blog. I thought it might interest especially those of us with TB spines, who spent much of our time at MHMH on plaster beds. I've mentioned my memories of this a couple of times (28 April 08, and again on 9 July when I promised to come back to it in more detail). So here it is.

It all started when I went to the internet to check some facts about how spinal TB was treated, including the use of plaster beds. I googled “tuberculosis of the spine”, and came across a reference to a film held at the Wellcome Library in London, called “A demonstration by diagram and illustration of preparing anterior and posterior shells in the treatment of tuberculosis of the spine in children”. So I decided to follow it up.

Because the film is very old, you have to view it with a member of the library staff in a special viewing room. So last July I made my first visit to the library – I’ve been a few times since then, and it’s a fascinating place with lots of interesting medical history documents, objects and pictures. My appointment was with Angela Saward, Wellcome’s curator of moving images, and I went with her to view the film in a special viewing room. She made sure I was comfortable and in a position to take notes, and offered to stop the film if I needed time to write, which I did at a couple of points. In fact, I was rather glad to have her there and that the viewing was set up in this rather academic way – it kept me fairly detached from what I was watching, rather than projecting myself into it more personally, as I might have done had I seen it on my own.

It’s a black and white silent film, quite grainy and faded in places, so the only sound effects were the whirring of the projection, and my own hasty scribblings. It was made in 1936 at Abergate Sanatorium, Manchester, and donated to the Wellcome Library by the British Medical Association Film Archive. Angela thought it might have been a training film to spread best practice at a time when there was no centralized training system.

It shows the making of two plaster beds on a small boy – an “anterior shell”, for him to lie on his front – and a “posterior shell”, for lying on his back. As the film progresses, the different stages of the process are illustrated with diagrams at the bottom of the film. I’ve tried to reproduce some of these to illustrate the stages. My drawing skills are not very sophisticated, but I hope the diagrams will help make the process clear.

The posterior bed they made in the film went up over the child’s head, as though for patients who had upper spinal problems, like some of you who have contributed to the blog. For this, the boy was placed face down on a frame, with a crossbar passing roughly under the stomach, to “ensure a degree of hyperextension of the spine” it said; in other words to keep it stretched and not curving inwards. His legs were bent and the shins and feet were raised by another pair of crossbars, one over the knees and one under the ankles – so that the finished bed would keep his legs slightly bent. (See diagram 1).

Diagram 1: Patient lying face down for making of
"posterior shell"

Next he was rubbed all over with Vaseline, and his head wrapped in a cloth. Then they laid strips of bandage-cloth impregnated with wet Plaster of Paris on the child’s body in a carefully designed pattern, slightly overlapping and patted down till they all melded into a single piece (see Diagram 2 below).

Diagram 2: Patient lying face down for making of "posterior shell". The numbers show the order in which the strips were placed, and the arrows the direction of the strips

In the film, the first strip went from the bottom of the child’s torso (leaving the behind clear) right up the centre of the back and over the head, and was carefully tucked in to follow the curve of the neck (1). Next came side slabs (2). Then a curved slab was placed round each shoulder just touching onto the central one (3), and another went across all three (sorry, I omitted this from the diagram, and I don’t want to re-scan it). For the legs, a single strip was placed along the back of each leg, from the groin right down to the ankle (4). Then bandages soaked in plaster of Paris were rolled back and forth crossways to this slab, moving from thigh to ankle and creating a curved shell (5). As the different sections were applied, they were smoothed and slathered down very firmly until they form a continuous whole, with seam-lines down them which looked like those on a certain design of dress, or the taped joins of the ‘liberty bodices’ I remember wearing later on.

Finally, presumably when the plaster had dried enough to keep its shape, you saw the whole shell being removed, and placed on a wooden frame. The final frames show the child lying on his back in the plaster bed on the frame.

The process for the anterior bed – made on the front of the body for lying in face down – was pretty similar, except that the child’s legs were straight, and there weren’t any crossbars to maintain the correct position of the spine. In this one, the leg slabs went to just above the knee, with no further bandaging to and fro.

As to how it all relates to what I remember, this is quite a difficult question. Angela asked me if we had been as compliant as this child, who kept so still I thought they must have used a doll – which Angela doubted – or that he was anaesthetized. Both processes, but particularly the one for the ‘posterior bed’, looked extremely uncomfortable, so perhaps anaesthetization was used. Yet I don’t remember any such discomfort, and I was certainly conscious throughout. What I do remember vividly was the feel of the plaster slabs, warm, wet, sticky and smelly, and the slapping and smoothing involved in their application. I imagine the Vaseline-ing must have been a strange sensation, too, though I don’t remember that either. I wonder how they cleaned it off us afterwards – we must have had to have some sort of bed bath, I suppose.

I mentioned this film to Cynthia Coultas when we had a long talk on the phone not long ago. It seems that by the time Cynthia was involved in this process at Thorpe Arch, they used single sheets, rather than strips, laying them over the whole back, or front. Apparently, each patient had an anterior and a posterior bed made, because we had to be turned frequently to prevent bed sores. Funnily enough, I have no memory of being turned, yet from what Cynthia says it must have been quite a frequent process.

So watching the film jogged my memory, but also left me with a whole series of questions. For instance, I wonder what happened to our muscles over so many years of lying flat, and what kind of preparatory physiotherapy we were given before the magic moment when we actually stood up to walk. Without any at all our legs would surely have crumpled under us!

I wonder, too, why I didn’t ask more questions about this all once I’d come out. I suppose at that age children take an awful lot for granted, and don’t question something which, though it appears peculiar with hindsight, was our ‘normality’. Then, coming home, it must have all faded into the background as I moved forward into a new ‘normal life’. I did tend to explain my inability to perform certain physical activities in terms of my having been in hospital – for instance, I always found it very difficult to sit on the ground cross-legged, but really without analysing it too much at all.

Does any of this jog memories for anyone else? Does it contradict your memories, or help fill them in? Or does it jog other memories altogether? Perhaps Cynthia will have a look at this, too, and fill in details from the nursing point of view. Please comment and add details, questions, differences of view, and so on.

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