The development of the operation which I shall describe may perhaps be made clearer if I outline the steps of its gradual evolution.
On my return from the war in 1919, I undertook the treatment of a number of patients with scoliosis, among whom was J. M., a boy who had already been under treatment for a number of years. This treatment had consisted of jackets of various types, none of which had succeeded in checking the progress of his deformity, which went on, as may be seen in the accompanying illustrations, to the most distressing extreme. The rotation of the vertebrae and the consequent distortion of the ribs made so sharp a convexity posteriorly that in spite of the most careful padding and personal application of the jacket, the patient would from time to time develop a pressure sore. He would then enter the hospital, have his jacket removed