Medicine: The Role of the Turtle

When she was eleven, Margaret Bilotti, stage-struck elder daughter of a Manhattan construction worker, collaborated with another East Side youngster in writing a play, the proceeds to buy Christmas toys for underprivileged children (gross take from ticket sale: "over $2"). Soon afterward an uncle noticed that as Margie sat on a hassock she looked crooked, and her right shoulder blade protruded. The family doctor prescribed a corset, which soon broke and was discarded. Eventually a neighborhood hospital referred the Bilottis to one of the few places in Manhattan that specialize in treating conditions like Margie's, the Hospital for Special Surgery.

The trouble with Margie was scoliosis, a sidewise curvature of the spine. As in 80% to 90% of cases, no cause for her condition could be found, and nobody knew when the trouble began. Neither Margie nor her mother had noticed it, and, like most victims, she had begun to compensate for it by shifting her body to achieve a comfortable balance.

Reverse Curves. At the Hospital for Special Surgery, doctors took X rays. The curvature, when looked at from behind, appeared like a reversed letter C; for no known reason most such curves are in this direction. Because it was a single curve it was certain to be deforming—many scoliosis cases have two curves, one right and one left like a letter S, which cancel each other out and leave a good balance, with no worse effect than a shortening of the trunk. And Margie's case was severe. Special Surgery doctors grade cases by a technique developed by one of their leading scoliosis specialists. Dr. John R. Cobb; with a protractor, applied to the top and bottom vertebrae of the curve on the X ray, they measure the total deviation from a straight line. Up to 30° is rated mild, rarely needing operation; 30° to 60° is moderate, and beyond that, severe. Margie's had reached 97° by the time she was admitted last fall.

Having decided that operation was unavoidable, the surgeons prepared for a long, complicated siege. Off came Margie's long, glistening black hair. Her entire torso and part of one thigh, her shaved head and her neck were encased in a monstrous plaster cast known among doctors and nurses as a "turtle." The cast was hinged in the middle. Joining the halves on the left, and spanning the spinal curvature, was a turnbuckle. Every day or two the doctors extended the turnbuckle by a couple of turns. As it was lengthened, it flattened and almost erased the curve. But unaided, the spine would not be able to maintain its restored straightness.

Fused Vertebrae. The surgeons cemented the two parts of the cast together and removed the turnbuckle. To make doubly sure of holding the shape, they affixed a curved iron bar to serve as a flying buttress on the right side. By this time they were about ready for a tricky piece of surgery they call "fishing through the ice." Last week they interrupted Margie's eighth-grade studies (a New York City schoolteacher keeps children in the hospital plugging at their work), used an instrument like poultry shears to cut a rectangular hole in the back of the cast, over the spot where the curve had been sharpest. More X rays showed the new position of the vertebrae, indicated how many would have to be fused.