A57628 7 6 CONTENTS. The Russian Bath, invented by Dr. Roth...... 4 The first Movement-cure Establishment...... 5 Difference of the Medical Movements from those used in Gymnastics 5 The Aim of Ling's Movements........ 6 Number and Selection of Curative Movements...... 6 The various Classes of Movements....... 6 Diseases in which the Movements have been successfully applied. 7 Scientific Educational Gymnastics....... 10 Bad Gymnastics........... 11 List of Continental Institutions....... 12 Scientific Gymnastics in Lunatic Asylums...... 12 Government Institutions.......... 12 Advertisement of Dr. Roth's Institutions in London and Brighton 13, 14 List of Dr. Roth's works on the Movement-cure, and on Scientific. Educational Gymnastics...... 15, 16 7 by the assistant only on the patient, and comprising frictions, kneading, pressure, vibration, percussion, sawing, fulling, etc. 3. Movements in which the gymnast, to the extent, and in the direction specified in the prescription, resists the patient's effort, or in which the patient resists the gymnast's effort of making a certain and determined form of movement. In the gymnastics in common use, only active movements are known; we find none either of the second or third class of movements, although there is the greatest curative power in the two latter classes, which fact is abundantly proved by the vivifying effects and increased strength experienced by the patient himself. Want of space will not allow me to enter into the details of Ling's ingenious system, which has been more perfected since his death, by his disciples and other zealous advocates of his ideas; and I may observe that those interested in the subject, will find information in the books which I have published on the Movement-cure, and which are, hitherto, the only ones in which the English student can find any practical information-the titles are to be found at the end of this pamphlet.J Although I am very zealous in my advocacy of the treatment by Movements (which is also called Kinesitherapy, Kinesiatric, Swedish medical gymnastics, and must not be confounded with the old medical gymnastics), I wish it clearly to be understood that I do not recommend it as a panacea in all diseases. It will be useful in one stage or in one form of a disease, and not in another; it will suffice in one case, and will not help in another, without other remedial agents, which it does not exclude, except they are physiologically opposed to the effect to be produced by the Movements. Among the Ailments in which the.fovements have been successfully applied I will mention the following:1. Those DISEASES or THE CHEST which, under the form of consumption and asthma, destroy so large a proportion of the human family, and are known to receive but little benefit from * With the exception of some fragments on scientific gymnastics which have been left by Litg, in the Swedish language (translated by Dr. Massinan into German), and the German works of M. Rothstein and Dr. Newihan, no guide or handbook of the Movement-cure has been published in any language. 8 any kind of medicine as yet employed. The statistics of the Stockholm and other Institutions abundantly prove, on the other hand, that this dreadful malady is frequently under control, and is, in many instances, radically cured by the mode of treatment I am advocating. Daily experience proves, that the formation of the chest in consumptive people is, for the most part, such as would predispose to the development of the disorder; the shoulders are brought forwards, the anterior of the chest is contracted and flat, while the posterior surface is constantly found rounded and larger than the anterior, and this mischief is brought about by the muscles not acting uniformly over the whole surface of the chest. It is self-evident that this state cannot be changed by the internal administration of mfedicine, the use of mineral waters, or change of air alone. By the second and third class of movements, however, it is possible to strengthen such muscles, to remove congestion of the blood, to restore, by degrees, the capacity of the chest to a healthy standard, and thus to bring the organs, particularly the lungs, to a condition in which they may perform their functions in a normal way. It may perhaps be objected to this assertion-how is it, then, that common gymnastic exercises are found to be so often prejudicial to consumptive patients? But gymnastics, as now usually practised, embrace only active movements, which, by bringing into play the greater part of the muscles of the whole body, increase the circulation of the blood to an inordinate degree, and oblige the lungs to act more frequently than in the natural state, and thus obviously tend to hurry on the disease. 2. That class of diseases generally known as NmEvous IDEBILITY, combined with disordered nutrition and irregular formation of blood, as they appear frequently in young females, under the form of chlorosis; too much or too little periodical secretions, nervousness, spasms, bad digestion, etc.,-all of which have been removed by this system of treatment, while medicine alone rarely contributes to their cure. 3. IEADACHE, CONGESTION TO THE MEAD, CONSTIPATION, CONGESTION OF THE LIVER, etc., accompanied with a state of weakness, are another class of ailments from which many persons labour, they are only palliatively treated and only temporarily re 9 lieved by medicines; these are frequently and permanently removed by the method under consideration and a suitable regimen. 4. For CURVATURnES on DISTORTIoNs OF THE SPn-vE, exercises have been prescribed as a remedy, and would, no doubt, act beneficially, if the right movements were applied on the right place. By movements of the second and third class, and by knowledge of the diseased structure, a certain set of muscles can be acted on as the case requires, and thus antagonistic effects on the spinal column may be neutralized. This mode of treatment by Movements will be hailed as the greatest of blessings by those afflicted by spinal disease, who have undergone the tedious process of lying in bed for years, and whose general health has thus been more or less undermined-to say nothing of the tortures of pitch plasters, issues, setons, moxas, etc., applied from one end of the backbone to the other. I may observe that all deformities of the spine or limbs are treated by this system, without the aid of any of the machines as at present used in the so-called orthopoedic institutions, and,'in general, without any machine at all. In the cure of distortions, deformities, and curvatures of the spine, the Movements have this advantage over any other treatment-that the improvement is not merely apparent, like that produced by a steel corset or any other machine, by which a deformed person is suddenly made to appear straight. A cure of spinal deformity by Movements is a gradual one; because the parts which contribute to hold the spine upright must be made strong, in order to obtain support from the increased strength of these parts, and not from an external mechanical contrivance. This explains also why no relapse of the curvature takes place, if actually cured by the Movements; and I agree entirely with the following advice given to the parents and friends of those who suffer from deviation of the spine:" a. Seek the cure at the very onset of the disease, but do not use half measures, such as supporting stays and machines, or the lying-down system, on prone couches or extension beds. If the disease is taken in time, it may in all cases be completely cured by Ling's specific movements. " b. Do not expect that an already established curvature will disappear of itself; you lose valuable time, during which the evil increases, and at last becomes incurable... '.i 10 " c. Do not intelTupt the cure as long as any amelioration is apparent or is still possible. The same rules apply to children or youths of consumptive tendency, and to those threatened with apoplectic fulness of the brain. " 5, PARALYTIC AFFECTIONS are a class of diseases in which the usual remedies have, in. general, no prominent effect, and in the majority of inveterate cases nothing is even attempted for restoring the patient's power of movement. The passive movements, by acting on the part which cannot be moved by the patient himself, improve a large number of cases, and the instances of radical cure are also not rare.i "6. In CONTRACTIONS OF THE LIMBS, STIFFNESS, and other AFFECTIONS OF THE JOINTS, of a chronic nature, the Movements are most beneficial. " 7. RUPTURES. Many cases, not only of considerable improvement but of radical cure, of umbilical and inguinal ruptures by the Movement-cure have been recorded. This important discovery will save many ruptured persons not only the inconvenierce of wearing a truss during their whole life, but also the danger of undergoing a perilous operation. " 8. GoITRE, TuMOURs, and SWELLING OF THE GLANDS, SOROFULA, tRIORETS, HYPOCHONDRIASIS, HYSTEBJA, and several MENTAL and mANY oTnRa DISEASES, may be alleviated or cured by these Movements alone, or in conjunction with other curative agents. The history of numerous cases, and the prescriptions of the Movements applied in each individual case, are to be found in the "IHandbook of the Movement-cure," " Cure of Chronic Diseases by Movements." Scientific.Educational Gymnastics. Those interested in matters of education will find in Ling's system the most complete and most scientific practical system of training the body, which is the only way of counteracting the effects of the now so fashionable practice of cramming to the utmost degree the brains of our children and youths; a practice which, unhappily, the parents themselves encourage in the * For further information on these complaints, see " Contributions ta the Hygienic Treatment of Paralysis and Paralytic Deformities," by Dr. Roth. Groombridge and Sons, 1860. H1 mayrtity of cases, in order to shorten as much as possible the time of education, and thus to save a sum of money, very small in comparison to what is afterwards expended in attempting to reatore health, when too late. Bad Gymnastics. At present, the majority of teachers, principals of educational establishments, directors of institutions for the education of the blind, the deaf and dumb, and idiots, head masters of colleges, tutors, parents, medical and even military men, are generally unacquainted with rational or scientific gymnastics, or the art of simultaneous and harmonious development of body and mind; and the few who do think about physical education at all separate mind from body, and believe that climbing poles, ascending ropes, leaping, flinging the body round and round a bar, and other feats of strength, as practised in the majority of the so-called gymnasia, constitute gymnastics. " They forget that it is a soul, not a body only which we must educate; it is a man, of whom we must not make two; we must not train the one without the other, but must guide and lead them like a pair of horses harnessed to one shaft" (A1onteigne). The consequence of this erroneous idea of gymnastics is, that drill sergeants, teachers of calisthenic movements and of common gymnastics, and dancing and fencing masters, are intrusted with the management of what is called physical education. Apparatus od various kinds-masts, poles, bars, ropes, vaulting-horses, etc. -are provided, on which the pupils may hang, climb, swing, or make any other exercise at their option; and thus all rational instruction in this branch is neglected, and indeed impossible, because the teachers themselves have not been taught the elements of anatomy and physiology, so indispensable in this branch of education. Their aim is only to produce brute muscular strength. So that a being endowed with reason is worse trained than even the lower animals. " It is very singular that we would not confide the care and training of a valuable horse to a man who had not the knowledge of the animal's anatomy and physiology, while the man who is intrusted with the development of the human body is not expected to possess any knowledge whatever of such sciences" (Rothstein). 12 "With regard to the advantages to be derived from scientific gymnastic training, I refer to a letter which I have addressed to Earl Granville, as President of the Council on Education, under the title, " On the Importance of Rational Gymnastics as a Branch of National Education," etc. List of Continental Institutions for the Treatment of Diseases by the Mfovement-cure, with the names of their Medical Superintendents. Berlin (three), Drs. Neuman, Eulenburg, L6wenstein. Bonn, Dr. Budge. Breslau, Professor Remer. Christiania, Dr. Fugelli. Cassel, Dr. Becker. Dresden (two), Professor Richter, Dr. Flemming, and Dr. Friedrich. Freiberg, Mr. Nitzsche. Giessen, Drs. Weber (father and son). Hamburg, Mr. Scheerer. Heringsdorf, Dr. Wallenstadt. Konigsberg (two), Dr. Yogelgesang and Dr. Miinchenberg. Kinigsbrunn, Mr. Wilbold and Dr. Putzar. Leipzig, Dr. Schreber. Lago di Como, Dr. Mayer. Liebenstein, Dr. Martini. Misdroy, Dr. Oswaldt. Prague, Dr. Spott. Stuttgardt, Dr. Steudel. Stockholm (two), Professor Branting and Dr. Sitherberg. Petersburg, Dr. Berglind. Vienna (two), Dr. Melicher and Dr. Streintz. Wiesbaden, Dr. Genth. Wiirzburg, Dr. Confeld. Also Bromberg, Crefeld, Graudenz, and Posen, and many other towns have such Institutions." Scientific Gymnastics in Lunatic Asylums. In the Lunatic Asylum of Vienna, at Sonnenstein, in Saxony, Rational Gymnastics are introduced; and Dr. Laehr has introduced the treatment in his private asylum near Berlin. Government Institutionsfor Scientific Educational Gy mnastics. Sweden, Russia, Prussia, Saxony, Austria, and Hesse-Darmstadt have normal training Institutions for educational and military gymnastics, supported by the Government, where anatomy, physiology, and hygiene are taught; the knowledge of these sciences being considered indispensable for the teacher of scientific gymnastics. Professor Branting at Stockholm, M. Rothstein at Berlin, M. de Ron at St. Petersburg, Mr. Spiess at Darmstadt, and Mr. Kloss at Dresden, are at the head of these Institutions, in which thousands of pupils have been trained in a rational way. * The Institutions at Stockholm and St. Petersburg are partly.supported by the Government. WORKS BY M. ROTH, M.D., PHYSICIAN TO THE INSTITUTION FOR THE TIEATMBNT OF DEFORMITIES AND CHRONIC DISBASES BT MOVEMENTS AND THE RUSSIAN BATH, ETC.t ETC. 'rice IOs, with Ninety Engraing, THE PREVENTION AND CURE OF MANY CHRONIC DISEASES BY MOVEMENTS. An Exposition of their Principles and Practice, for the Correction of the Tendencies to Disease in Infancy, Childhood, and Youth, and for the Cure of many Morbid Affections in Adults. " The work before, usproposes to cure......diseases through the beneficial influence of movements and mechanical appliances......In certain chronic and functional maladies, physic alone will not achieve the results desired..... The most rational section in the work is that on dress......Dr. Roth insists, and very properly, on the ill consequences of stays; and when the matter is seriously considered, we believe that an immense amount of human suffering, and even great saving of human life, would be consequent upon the total discarding of stays. The illustrative engravmgs are admirably executed, and the book well got up."-L-ancet. "1 Dr. Roth's is the first work that has appeared in England, which gives a clear and lucid account of the practice, and we hail its appearance with great satisfaction."-British Journal of Homeopathy. "This is altogether a novel but valuable addition to our medical literature......The most prominent feature of the present system is its extension beyond the limits of ordinary gymnastics to diseases other than spinal curvatures, club-foot, contractions, etc, In the present work we find indications for its application in asthma, incipient consumption, contracted chest, and many diseases of internal organs......Dr. Roth deserves our best thanks for the publication of this system for the first time in an English dress, thereby opening up a novel and very important branch of professional knowledge to our study."-Hom. Times., Second Edition, price 2s. 6d., with Fifty-eigbLt ll2ustrations, THE GYMNASTIC FREE EXERCISES OF P. H. LING, ARRANGED BY H. ROTHSTEIN. TRANSLATED, WITH ADDITIONS, BY M. ROTH: M.D. A Systematized Course of Gymnastics, without Apparatus, for the Development and Strengthening of the Body and Improvement of the Figure. Adapted to the use of medical men, teachers, military men, and parents, Price Is., Second Edition, THE RUSSIAN BATH; Published with a view to recommend its Introduction into England for Hygienic as well as Curative Purposes; with some Suggestions regarding Public Health, addressed, by permission, to the.1ight Hon. W. F. COWPER, President of the Board of Health. " Dr. Roth's book gives a brief account of the Egyptian, Turkish, Russian, and other Baths, and ought to be read by the members of our profession as well as by the public."-Aledical Circular. "We have the testimony of many distinguished continental physicians to the wonderful remedial powers of this kind of bath, and we are glad to learn that Dr. Roth has not contented himself with describing its benefits, but has actually set about the construction of such a bath, on a large scale, in connection with his Gymnastic Institution. We recommend a perusal of Dr. Roth's little Pamphlet, and we heartily join the author in his hope that it may be the means of introducing the Russian Bath into general use in England."-Brit..Hom. Journal. With Forty Illustrations, price 6d., A TABLE OF A FEW GYMNASTIC EXERCISES WITHOUT APPARATUS, ACCORDING TO THE RATIONAL SYSTEM OF P. H. LING. For the due Development and Strengthening of the Body and Improvement of the Figure. Adapted to the use of teachers and pupils. Third Edition, with 42 Illustrations, price is., MOVEMENTS OR EXERCISES ACCORDING TO LING'S SYSTEM, For the Development and Strengthening of the Human Body in Childhood and in Youth. London: GaooMramDGE AND Sons, 5, Paternoster Row. Price Is., ON THE IMPORTANCE OF RATIONAL GYMNASTICS AS A BRANCII OF EDUCATION. A LETTER TO EARL GRANVILLE. London: GBooacBRnoDG AND SONS, 5, Paternoster Row. LATEST WORKS ON THE MOVEMENT-CURE. Just published, price 10s., with 155 original Engravings, THE HANDBOOK OF THE MOVEMENT-CURE. By M. ROTTH, M.D. Physician to the Institution for the Treatment of Diseases by Movements and the Russian Bath, Old Cavendish Street, London, and to the Institution, Gloucester Place, Brighton, etc., etc. Dedicated to those Mledical Practitioners who Examine before they Condemn. CONTENTS.-Description of the Positions, Movements, and Manipulations used for Preventive and Curative Purposes, according to the system of Ling and his disciples; with Cases illustrating the treatment of Spinal and other Deformities, of Pulmonary and Abdominal Complaints, of Paralysis, Goitre, Ruptures, Hypochondriasis, Hysteria, and other Chronic Diseases, by the scientific application of Movements. London: GRoonrBIIDGn AND So s, 5, Paternoster Row. Justpublishied, price 3s. 6d., with 38 _Engravings, CONTRIBUTIONS TO THE HYGIENIC TREATMENT OF PARALYSIS, AND OP PARALYTIC DEFORMITIES. Illustrated by Numerous Cases. With a Short Sketch of Rational Medical Gymnastics, or, the Movement-Cure. By M. ROTH, M.D. Dedicated to Medical Practitioners who, unwarped by preconceived notions, consider it their duty to examine new applications of known means or new methods of treatment, and, if convinced of their efficacy, have the courage to advocate them, although they may not be approved by orthodox and common routine practitioners, who condemn what is unknown to them, without taking the trouble to investigate it. London: G-ooMBRIDGao AND SoNs, 5, Paternoster Row. Just published, price Is., with 38 Engravings, A SHORT SKETCH OF RATIONAL MEDICAL GYMNASTICS, OR THE MOVEMENT-CURE. BY M. ROTH, M.D. Lonon: GRooMBacmmD E Aino Soss, 5, Paternoster Row. TaoxAS HAinrtD, Printer, Salisbury Square, Fleet Street, London. ILLUSTRATED WORKS BY DR. ROTH, Physicin to the Pricalte Inltitltions, Old Cavendish Street, London, and Gloucester Place, Brighton. 1. TIE PREVENTION AND CURE OF MuANY CHRONIC DISEASES BY 3IOVfEMENTs. With ninety Eugravings. 10s. 2. THE HANDBOOK OF TIHE IOVEMENT-CURE. With one hundred and fifty-five original Engravings. 10s. 3. CONTRIBUTIONS TO TiE IHYGIvENIC TREATMENT OF PARALYSIS, AnD OF PARALYTIC DEFORMITIES. With thirty-eight Engravings. Illustrated by Numerous Cases. With a Short Sketch of Rational Medical Gymnastics, or, the Movement-Cure. 3s. 6d. 4. THE PREVENTION OF SPINAL DEFORMITIES, ESPECIALLY 01O LATERAL CURYATURE; with notes on the causes, the artificial production, and the injurious mod es of treatment of these complaints. TWith fifty-three Engravings.:3s. G6d. 3 A SHonT SKETCH OF RATIONAL MEDICAL GYMNASTICS, 0R, THE MIOTEM ENT-CURE. With thirty-eight Engravings. is. 6 TABLE, showing a few injurious Positions to be avoiled during the time of Education and Growth, and some deformities of the Spine, produced partly by bad positions, and partly by tight lacing. With forty-six Engravings. 6d. 7 A Table of a FEW GYrMNASTIC EXERCISES WITHOUT APPARATUS. With thirty-three wood Eng(ravings. Gd. S. Two Tables of GYMxASTIC EXERCISES WITHOUT APPARATUS; with explanations. Is. 9. GYMAiSTic EXERCISES ON APPARATUS, according to the Rational System of Ling. With eighty Illustrations. Is. 10. ON THIE IMPORTAN'CE OF RATIONAL GYMNASTICS AS A BRANCHjr or, NATIONAL EDUTCATION: a Letter to Lord Granville. Is. 11. EXERCISES OR MIOVEMENTS ACCORDING TO LING'S SYSTEM. With forty-two Illustrations. For the Development and Strengthening of the H-uman Body in Childhood and in Youth. Fourth Edition. Is. 12. THE GTYMNASrTIC EXERCISES OF LINSa, arranged by Dr. Rothstein: translated by Dr. Roth. Second Edition. 2s. Gd. 13. Dr. Roth's GYM.NIASTIC GAM.ES. 2s. 14. THE RUSSTIA BATH: published with a view to recommend its introduction into England for H-ygienic as well as Curative purposes, with some Suggestions regarding Public Health. Second Edition. is. 15. ON THE CAUSES OF THE GREAT MORTALITY OF CHILDREN, AND THE M1EANS OF DDIINISHING THEM. 16. COPIES OF THE GYMNAtSTIC MODELS, anId of Dr. ROTH'S C01 -lection in the South Kensin0gton Museum, of the means of Scientific Physical Education, as well as all the works named in this list, can be had at MESSRS. N. M3YERS & Co., 15, Berners Street, Oxford Street, London, W. Prize Medals have been awarded at the International Exhibitions of London in 1862, and Paris, 1867, for Dr. Roth's Gymnastic works, models, etc. LosToN: GROOMI3BRIDGE & SONS, 5, PATERNOSTER Row; H. TURINER, M7, FLEET STREET. BRInGnToN: TREACBER'S LIBRARY. LONDON: W. DAVY AND SON, GILBERT STREET, W. iv. in a number of cases., either prevent them entirely, or at least arrest at the beginning their further progress. He should have some notion of the treatment adopted by those who have paid more attention to the subject. These few remarks must serve as an apology for the reprint of an incomplete paper, written under the pressure of professional engagements for a medical quarterly, with the hope of inducing young practitioners to pay some attention to the prevention and treatment of deformities and other complaints by hygienic means in general, but especially by prophylactic and medical gymnastics. There are still many, even among my elder colleagues, who have never heard of the great progress which has been made during the past fifteen or twenty years in the scientific application of curative movements and medical gymnastics. There is a large field open for many young medical men willing to devote their special attention to a branch of medical knowledge, the' importance of which is daily increasing, although it has been hitherto appreciated in this country only by a 'Small number of unprejudiced practitioners., whom I feel it a duty to thank for the disinterested mode in which they have, during the past ten years, placed many of their patients, and members of their own families, under my treatment, and who have thus given me an opportunity for proving practically the truth of the views I advocate regarding the prevention- and cure of many chronic ailments by hygienic means and medical gymnastics. M. ROTH. April, 1861. 16A, Old Cavendish Street, - London, W. Vi. Sect. Page 28. Mothers, Governesses and Schoolmistresses should be taught how to preserve the health of those who are placed under their care - - - - - - -24 29. Pupil Teacher's Work - - - - - 26 30. Occasional Causes of Curvatures in young Men - -27 81. The predominant use of the right arm erroneously considered as a cause of Right Lateral Curvature - - 27 32. Age at which Curvature occurs - - - -28 33. Neglect of Treatment and Injurious Treatment - - 29 34. Treatment by Mechanical Supports - - - -30 35. Sad Effects of the Treatment by Violent Pressure - 30 36. Treatment of Curvature by Mechanically Stretching the Body on Orthopeedic Machines - - - - -31 37. The Lecturers of our Medical Schools are responsible for the Ignorance of Young Practitioners - - - 32 38. Examination of the Curvature - - - 32 39.,,,- - - 32 40.,,, - - - - - 32 41. Inspection of the Spine - - - - - 33 42. Sopae Movements Useful for the Diagnosis of Curvatures - 35 43. Inspection of Spine continued - - - - 35 44. Mode of Taking the Outlines of Curvatures - - -36 45. Prognosis - - - - - - - 37 46. Length of time required for the Treatment of Curvatures - 38 47. The Aim of the Medical Treatment of Curvatures - 39 48. The Preventive Treatment - - - - 39 49. First Rule: To provide, day and night, a constant supply of fresh air - - - - - - 39 50. Second Rule: Wash and rub, daily, the skin all over- - 40 51. Third Rule: Attend strictly to the quality and quantity of food - -. - 41 52. Fourth Rule: Attend to proper- dress - - - 42 53.,, -, - 42 54.,,,,- - - 42 55. Fifth Rule: Avoid bad positions - - - 43 56. Sixth Rule: Attend to Rational Physical Training - 44 57. Boys are less subject to Lateral Curvatures than Girls - 44 58. Curvatures and other complaints artificially produced in Girls 44 59. Importance of Rational Gymnastics - - - -45 60.,,,. - -45 61. Importance of Physical Training - - - -46 62. Overstraining of the Mental Faculties produces many Diseases and Deformities - - - - - -48 63. Case of-bad effect of early Mental Overwork - - 49 6 4. InJudicious Exercise, and its bad Effect - - -50 Vii. Sect. Page 65. The Neglect of Rational Gymnastics by Medical Men is the principal cause why the public apply to Empirics, Anatomical Mechanicians and Anatomical Corset Makers, to Drill Sergeants and Dancing Mistresses, Professors of Calisthenics, of Ordinary Gymnastics, and to Rubbers and Quacks - - - - - - -51 66. Injurious Effects of Mechanical Supports - - - 52 67. Practice of Rubbers - - - - - -54 68. Treatment of Curvatures - - - - 55 69-70. The Aim of the Curative Treatment of Muscular Lateral Curvature - - - - - - - 56 71. Standing - - - - - - - 59 72. Sewing - - - - - - - 60 73. Sitting at the Framework- - - - - 62 74. Ironing - - - - - - 63 75. Nursing Children - - - - - - 64 76. Reading - - - - - - - 65 77. Writing - - - - - - - 67 78. Drawing - - - - - - 68 79. Practising on the Piano - -- - 68 80. Playing the Harp - - - - - - 70 81. Riding - - - - - - - 71 82. Lying Position - - - - - 72 83. The Chair and Couch - - - - - 73 84. Sitting- - - 74 85. Breathing - - - - - - 75 LIST OF ENGIRAVINGS. Fig. -Page 1. Outline of the posterior aspect of the spine in its normal state 2 2., right dorsal lateral curve - - - 2 3., left lumbar lateral curve - - - 2 4., of secondary or compensatory curve - 3 5. Outline. of a healthy spine seen laterally - - - 3 6., an anterior curvature, - - 4 7., a p-osterior,,,). - 4 8. Scheme of gradual development of lateral curvature, and of the height of the spine.- - - 6 9. Part of a curved spine, with wedge-shaped intervertebral cartilages - - - - -. - 8 4 On Curvature of the Spine, Fig. 6 and 7 show the prominent characters of an anterior 6. Anterior curvature. 7. Posterior curvature. and posterior curvature; (sketches of skeletons corresponding to these figures are to be found in Prof. Alber's Pathological Anatomy). 6. COMPLICATED CURVATURES. The three elementary forms of curvatures-the lateral (scoliosis), the anterior (lordosis), and the posterior (kyphosis), can be and are combined in numerous ways; while one form predominates, the two others can be present to a higher or smaller degree; not only one but several secondary curves can co-exist which are also named tertiary; they contribute to preserve the equilibrium of the body, and often enable the patient-although affected with the most complicated curvature-to walk about, if bad and injudicious treatment does not interfere with the process of forming secondary or tertiary curves, which is usually going on when nature is permitted to have its own course. 7. DEVELOPMENT OF MUSCULAR LATERAL CURVATURES. The mode of development of the muscular lateral curvatures which form the great majority, (as they amount to 80-85 per cent.) of all lateral curvatures, is the following: The spine requires, in order to be kept erect, (as shown injigs. I and 5) the perfect antagonistic equilibrium of the surrounding muscles, otherwise (as it is very flexible, especially in its cervical and lumbar part), it cannot afford a firm basis to the head and the organs of the trunk which are attached to it, nor will it be able by Dr. Roth. 5 to serve as a point of support to the various movements of the trunk and limbs. All the influences which disturb the muscular equilibrium, necessarily change the regular form of the spine, which deviates always in the direction of those muscles which, by their prolonged or permanent contraction, cause the vertebre to which they are attached to approach each other. 8. ABNORMAL STATE OF THE MUSCLES, IS THE CAUSE OF MANY LATERAL CURVATURES. At present it is generally admitted that the principal and immediate cause of the majority of lateral curvatures is an abnormal state of the muscles attached to the spine; this state is proved either-I. By diminished, increased, or any other irregular nervous influence, the effect of which is either contraction, relaxation, or even paralysis of the muscles; or II. By an idiopathic affection of the muscles caused by all those complaints to which the cellular, muscular, tendinous and other tissues which enter into their composition are subject. Drs. Neumann, Eulenburg, Schreber, and many other continental authors on this subject, having considerable experience in the treatment of deformities, assert that, whatever the primary cause may have been, the disturbed antagonistic function of the muscles produces first a temporary deviation, which in proportion to the time of its duration is soon or late changed into a permanent deformity, which, as long as the shortened muscles yield to external influences, can be still remedied; although the will of the patient is not sufficient for counteracting the effect of the muscles shortened, in consequence of the relaxation of their antagonists being also permanent. 9. CAUSES OF OTHER (NOT MUSCULAR) LATERAL CURVATURES. Fifteen to 20 per cent. only of all lateral curvatures are not muscular; their causes are diseases of the vertebrae, cartilages, ligaments, synovial membranes, empyema, retarded development of a limb by paralysis, any complaint producing contraction of a lower extremity, (as for. instance hip disease, rheumatic G On Curvature of the Spine, inflammation of the knee or hip joint), mechanical injuries, rickets, tuberculosis, scrofula, and other constitutional diseases. 10. DESCRIPTION OF THE MOST FREQUENT LATERAL CURVATURE KNOWN AS SCOLIOSIS HABITUALIS. Either the primary dorsal or primary lumbar curvature, see fig. 2 and 3, forms the first stage of lateral curvature, and a secondary curve is also possible before the curvature has entered into its second stage. The lines in fig. 8 show the theoretical a b c d e f g 8. Scheme of gradual development of lateral curvature and diminution of the height of the spine. scheme of gradual transition of the lateral deviation from its beginning to the highest degree of deformity: a is the straight and normal line of the spine as seen in the dorsal aspect of the erect body (see fig. 1); b and c represent the very beginning and a more advanced right lateral curvature in its first stage; d and e are two outlines of scoliosis in the second stage, and f and g two forms in the third stage. When these six outlines are compared with each other we observe that the elongated (a segment of an ellipse) form of b and c is slightly changed in d and e into an intermediate to the more round one (segment of a circle) of f and g, which appear transversely somewhat compressed. The intermediate lines showing the transition from one stage to the other can be considerably increased, as many authors divide the development of scoliosis into five and even six stages; by Dr. Roth. 7 I have limited the number of curves to two for each stage, as the division into three stages is merely a theoretical one, although useful for practical purposes, especially for the prognosis; the transition of the elongated into the rounded line may be considered as the end of the first and beginning of the second stage; it is not so easy to fix the limits between the end of the second and beginning of the third stage; these two stages rarely exist without being complicated with a slight anterior or posterior curve, and never without a twist which extends over one or more of the vertebrae. 11. FIRST STAGE OF MUSCULAR LATERAL CURVATURE. In the first stage of muscular scoliosis the muscles on the convex part of the curve are slightly relaxed, and consequently their antagonists on the concaye side contracted in the same proportion; the patient makes less use of his relaxed muscles during his daily occupations, but is still able to place his spine for a short time in the natural position, if his will is more intensely directed to the retention of the erect position; as it is impossible to keep up for a long time the energetic influence of the will, necessary for the contraction of the relaxed parts, the patient soon falls back into the curved position; the intervertebral cartilages are more compressed on the concave side, the ligaments and muscles on this side'begin to shorten; if the patient is constitutionally weak or attacked by another complaint, especially of an acute character, or his general health and strength fail, or he is obliged to remain in positions favouring the development of the curve, which is either a primary dorsal, or primary lumbar, the secondary and compensating curve must very soon be developed, otherwise the patient inclining very much to one side would lose his balance. The formation of the secondary compensating curve being always combined with a twist of the spine round its vertical axis, the bodies of the vertebrae are turned in the opposite direction to their spinal processes, which during the examination form thle visible and tangible outline of the curve; the head is slightly bent forwards, and also slightly turned to the side of the convexity of the upper curve. 8 On Curvature of the Spine, 12. SECOND STAGE OF LATERAL CURVATURE. In this stage the compression of the intervertebral cartilages on the concave side is still more marked, and they assume the form of a wedge. On the concave side the height of the bodies of the vertebrm participating in the curve is only diminished when the cartilage has been absorbed to such an extent that the bodies of the vertebre touch each other Fig. 9 represents a part of a curved spine in its anterior aspect; the cartilages have the wedge form, which is most distinctly seen at the deepest point of the concavity; the transversal processes and ribs on the convex side of the curve (in its second stage) are more distant from each other; the ribs change their natural form and protrude the shoulder on this side; such protrusion and unequal positions 9. Wedge-shaped in- of the shoulders are seen in fig. 10, which retervertebral cartiterertebral carti- presents transversal sections of the back across lages. e ^ the shoulders, which I have carefully taken by applying a strap of lead on the surface of the body and cutting the form on paste-board-the artist (Mr. Bdhm) has with great exactitude copied the lines from my paste-board forms; the tranversal sections are marked with letters corresponding to the longitudinal outlines of (figs. 11 ICa ' 10. Transversal sections of six lateral curvitures. Sby Dr. Both. 9 "cI l//e I/. 11 and 12. Longitudinal section of six lateral curvatures. and 12) scoliotic persons under my treatment. As the eyes of some of my readers might not be sufficiently practised in observing the differences of the various lines, I have added the longitudinal and transversal outline, fig. 13 and 14, of the normal body, and a vertical line is traced behind each of the irregular forms; the position of the head, the distance of the cervical and lumbar curves from the perpendicular, the length of the dorsal curve must be compared with each other in the six irregular as well as in the normal form. Another mode of observing the differences is by throwing the lateral shadow of an upright person on the wall-to trace its outline, and afterwards to plade the same person in positions which are similar ' 7 u in their outlines to those I 13. have taken from patients. section of the The will of the patient is 14. Transversal section, or normal -spine, bird's - eye view of the not sufficieht in the second normal body. stage to replace the spine in its perfect natural state; a passive elongation of the spine by external aid is possible in many cases; but not in those with prevalent rigidity of the ligaments and muscles when the joints of the curved part of the spine appear almost aukylosed. Deficient general health, great languor, and feeling of heaviness all over the body, neuralgic pains, iml~ediS,....*..c-i by Dr. Roth. II Figs. 18, 19, 20 is a girl of 18; strumous constitution; engaged for years as a needlewoman.-See the note on sewing. 13. THE THIRD STAGE OF LATERAL CURVATURE. Here the deformity has attained a higher degree than in the second stage; there are anterior or posterior curves combined with the lateral curve, the compression of the intervertebral cartilages, the absorption of the vertebree, the contraction of the muscles, and the rigidity of the ligaments on the concave side of the various curves are very much increased when compared with the second stage; the relaxed state of the emaciated muscles on the convex side is increased, and the muscles almost paralysed in consequence of the long inactivity, while the ligaments of the convex side are also elongated; the longitudinal and the oblique transversal diameters of the cavity of the chest are considerably diminished by the deformities of the ribs, and the shortening of the longitudinal axis of the spine; the functions of the respiratory organs are impeded, and feeling of oppression, asthmatic sensation, shortness of breath, palpitation of the heart, and even incapability of walking without the assistance of another person, in consequence of the entire loss of balance, are symptoms of the third stage, besides many other functional derangements and painful sensations in the head and other parts of the body. 14. CAUSES PREDISPOSING TO SPINAL DEFORMITIES. Any cause which has a weakening influence on the constitution, predisposes to spinal curvatures. This is the reason why after any acute disease the body (especially during its growth) is liable to a deviation of the spine, which is only temporary if health and strength are soon recovered, but which remains permanent either when the convalescence is prolonged, or when the patient indulges in positions which increase one of the natural curves of the spine, or during which the spine is bent in a lateral direction. In large cities spinal curvatures are more frequent than in the country, amongst the wealthy more than among the working classes, if these are not overworked, and provided with sufficient and good food; amongst civilised nations more frequent c2 On Curvature of the Spine, than among uncivilised tribes. Humboldt, when speaking of the Chaymas,* says, " I have never seen any individual with a natural deformity amongst the many thousands of Caraibs, Munysios, Indians, Mexicans and Peruvians whom we have observed during five years." Lymphatic, strumous, rickety, scrophulous, chlorotic and anaemic individuals, are more liable to spinal curvatures than others. 15. OPINIONS OF MEDICAL AUTHORS ON THE PREDISPOSING CAUSES OF SPINAL DEFORMITIES. Some authors, as Sabatier and Bouvier, assume that the normal position and the pulsations of the aorta, predispose to scoliosis habitualis. This hypothesis has been ably refuted by Eulenburg. Otiers think that the spine in its normal state is slightly curved, and that a convexity to the right in the "upper dorsal vertebrm is constant; but exact measures of the healthy body at various stages have proved the fallacy of the assertion. Curvatures are considered by some writers as the necessary consequence of the natural tendency of using the right hand most frequently. Others believe that abnormal positions, which retain the spine for a long time in curved positions, are the principal predisposing cause of these deformities. Disease of the intervertebral cartilages (Delpech); a relaxed state of the ligaments, and changes of the structure of the vertebrae and intervertebral cartilages (Adams); a dyscrasia producing softening of the vertebrae (Lorinser); a paralytic affection, peculiar to the left musculus serratus anticus major (Stromayer); derangement of muscular equilibrium (Hard-ShawLachaise); a peculiar affection of the nervous system (Blasius); disease of the left lung at an early age, and absorption of empyema (Riecke); affections of the heart and liver (Bilhring); are named by Eulenburg as the most frequent predisposing causes of lateral curvature. 16. A WEAK CONSTITUTION IS THE PRINCIPAL PREDISPOSING CAUSE. According to my experience during the last eleven years, when I began to pay particular attention to this class of disT'oiaqges en Begions Equinoctiales. 14 On Curvature of the Spine, 19. SOME EXTERNAL CAUSES DURING INFANCY AND CHILDHOOD. Want of exercise in the open air, restraint of the activity and vivacity of children, too much and uninterrupted sitting, especially on forms without backs, during the period of growth, tight dresses, low dresses fastened across and over the arms, tight lacing, neglect of the beginning of slight lateral inclination of the spine, muscular debility, bad positions; the carrying of infants always on one and the same arm; taking hold of infants and children always on the same arm; always advancing with the same leg while walking up stairs; the use of one arm only when little children play at ball, when they pull their little carts and toys, &c.;-are mentioned by Schreber and Ulrich as occasional causes of curvatures. 20. EXTERNAL CAUSES INJURING GIRLS BEYOND THE AGE OF CHILDHOOD. a. Tight lacing. As long as the notion prevails that a waist similar to that of a wasp or of an hour glass, is beautiful; so long as it is considered graceful to have a smaller circumference round the waist than round the head; so long as the phrase, " her waist is so small you might span her with your hands," is thought to be a praise when uttered by ignorant men; so long -as mothers and governesses find fault with their daughters and pupils when they are plump and not tightly laced, or well compressed by a tight dress; and as long as medical men do not object to their wives and daughters crippling themselves by stays; we shall always find a predisposition to curvatures; because ignorant and vain women will 'undergo any amount of uneasiness for the sake of vanity and the opinion of others. Although apparently incredible, I heard lately of a young lady going to bed tightly laced, in order to have a smaller waist than her sisters, who did not suspect and could not find out the cause of their sister's deformity, which was called beauty, until the painful symptoms following this injurious practice brought to light the cause of the small waist. by Dr. Roth. 15 A very renowned teacher of singing has several times sent adult female pupils to me for examination, because notwithstanding an apparently nice figure, they could not breathe deep (inhale) freely. The lateral expansion of the chest during inspiration was entirely deficient, especially in the lower part of the chest. In several of these cases the cause was vertebral curvature with compression of the lower ribs and perfect relaxation of the muscles of the back, produced by tight lacing and leaning with the anterior part of the chest on the busk; the body was merely mechanically kept up by the stays. b. Ignorance of Mothers and Governesses. 21. Want of elementary knowledge of the structure and functions of the respiratory organs on the part of mothers, governesses, and adult girls, is the most frequent cause of our girls being permitted artificially to deform themselves. Deformed young mothers propagate the seeds of an hereditary weakness to their children; such mothers must suffer during the periods of pregnancy and confinement more than others, and afterwards being unable to nurse their own babies, additional evils must frequently ensue. By the want of mother's milk and the infant's bad assimilation, scrofula, rickets, and other diseases are produced; or if a wet-nurse is engaged, she must give up the nursing of her own babe, which practice, as is proved in many cases, is followed by the death of her own infant. c. Positions which are not Lady-li/ce. Many mothers and governesses do not permit the young ladies to lean while sitting, and make them sit only on the front part of the chair. The girls are soon tired, and notwithstanding their leaning forwards on the busk, they involuntarily sink either towards one or the other hip, which favors very much the development of lumbar curvatures. At other times young ladies are not permitted to stand with their feet a few inches apart, or to sit with their knees slightly (removed) from each other, because this is considered by the prude governess, or the lady-superintendent of the finishing educational institute, or by the mother, " not lady-like," to which 16 On Curvature of the Spine, expression every body must bow, and the consequence is that a habit of standing on one leg, generally the right one, is artificially provoked,-a position which predisposes to primary lumbar curvatures-or the knees or legs are constantly crossed while sitting, or the feet are twisted round the legs of the chair, or other unnatural positions are chosen. Professor Richter mentions a case of lumbar curvature artificially produced, merely by long continued crossing of the legs during writing, which a strong and healthy girl did daily for several hours. d. Mental Over-exertion. 22. As girls or young ladies must not look too robust, or have a rosy and healthy appearance, which do not give what people call a lady-like appearance, they are soon rendered pale, languid and thin by too much reading, and the want of proper exercise in the open air as well as at home. The governesses or the lady-superintendents of educational institutions are not alone to be blamed for injuring many of their pupils by working them so hard from the early morning to the late evening. The parents must also share the blame for insisting upon their daughters being constantly mentally engaged without any or scarcely any interruption; as the time for meals, and half an hour or an hour's daily obligatory lady-like walk (or what might be more appropriately called creeping along) in the open air in pairs, and once a week a lesson in dancing or deportment, can scarcely be called an interruption sufficient for counteracting the mental overstraining which exhausts all nervous powers. e. Sad Efect of too much Brain-work and want of exercise. 23. I remember a case of a young lady who was sent to me by Dr. Madden for examination at a time when she was slightly curved, and when there was still reasonable hope for a cure. She was placed in an institution founded for the purpose of giving what is called a first rate education at a considerably reduced rate; the founder is a benevolent man, but probably entirely ignorant of the most elementary sanitary knowledge, as is proved by the following mode of education and management pursued in that institution, tho rules of which prevented this young lady by Dr. Roth. 17 from continuing the treatment which was begun during the holidays. This girl continued to remain a year longer in that institution, when she was again sent to me; but the mode of life in that establishment, and the constant mental labour which necessarily must undermine the health of many young girls, changed her to such an extent, that the previously plump girl was perfectly emaciated, her health and strength entirely lost, and the slight curve was changed into a complication of lateral, anterior and posterior curves, which had advanced to such a degree, that notwithstanding the care of kind friends, (with whom she lived after leaving the institution,) I could not hold out any hope for a cure, and all that could be expected under the most favourable circumstances, was only a slight improvement of the spinal deformity. f. Forcing or Hot-house production of Diseases and Deformities during Education. 24. The following extract gives an idea of what I call " hothouse production" of spinal curvatures and other diseases which is going on during the education of our girls at home under the eye of their parents, as well as in many educational establishments. The paper was written in answer to my inquiries regarding the mode of life in that educational institution, in which the patient whose case I have named in the preceding paragraph was placed. By publishing this extract, I hope to induce my professional brethren not only to pay more attention to some of the most prolific causes of chronic ailments and deformities, but that they will also enlighten parents, governesses and tutors on the disastrous consequences of the very prevalent and injurious modes of education, where all pains and trouble are taken for the development of the mental faculties of the pupils, while a simultaneous crippling of the body is involuntarily but systematically pursued. 2.5. THE RULES AND REGULATIONS OF AN EDUCATIONAL INSTITUTION. (Extracted from thLe Beport of the Patient wwhose case is mentioned in Section 23.) "There are study classes, each having its own governess, and 20 20 On Curvature of t/he Spine, "At ten minutes to one the bell called for silence and a return to lessons, generally either preparation for the next day's lessons or to practise. "ccAt ten minutes to two., still quite silent, all went into dinner. The food was quite good, except sometimes little or no salt in the bread or sour bread; but ' accidents will occur in the best regulated families;-well, after dinner all of us went to wash our hands, &c., during which time (about five or ten minutes), all the school, ýf they could spare the time, might talk English; at ten minutes to three the hell again sounded for us generally to go out from three o'clock to ten minutes to four; when again in perfect silence, 'we went to lessons till a six o'clock tea. "This was just like hreakfast, only without horrid reports After it, still silent, we all went again to another hour's lessons, generally preparation or practice, except the sixth or seventh classes, who had the first half hour for play if they had heen good. "At half-past seven a hell rang when all went to the diningroom, to talk freely their own tongue for about ten minutes, unless they had, as was often the case, a number of lessons for the-next day not done, or perhaps they took that time to console or encourage each other. "At the next hell silence again followed, and in five or less minutes, all were there or marked for not being so seated for Scripture preparation, which was only for a quarter of. an hour; when another bell sounded, and all rose and stood till the superintendent lady came into prayers, which was singing, reading, and praying. "ccThen all the girls went quite silently to bed, and were reported if not in bed by nine. Those who wished often learnt their Scripture then, for which a quarter of an hour bad proved but a short time for the task. On Wednesday evenings those of us who learnt harmony, stayed up till nine to prepare it for the lesson. So ended the days. "ccNow for some of the rules, for which reports were sen~t in if broken by the pupils. " Silence when we rise till breakfast. by Dr. Roth. 21 " Silence when in the passage.,, at ten minutes to nine till dinner, except the hour on the Cliff. at dinner.,, from ten minutes to three till out of the house. 52, four till 6 o'clock.,, at tea and after till half-past seven.,, from the end of prayers to six next day. "Rise directly the bell rings. Make our own beds-as soon as out of them-but leave the top clothes turned down so as to air the mattress, &c. Walk one by one in the passages. Never go up stairs in the day-time. Never drink water or anything in the day or night, except at meals. Never write to friends, only home, and that once a week. All letters to and from pupils read by the superinte.ndent. Always to be in place in time. Keep lockers, drawers, and cupboards tidy. Every Saturday we heard our weekly marks for studies, music, and conduct, and received our weekly pocket-money; those whose parents wished them to have any sum. Keep the account of our own washing, and mend our clothes every Saturday. Brush our hair a quarter of an hour every night before we got into bed, and show it to our clothes governess twice a week. One of those times we called our Saturday's dessert, because it followed immediately after dinner, and that day we had no pudding. Never run in the passages. See friends, with carte-blanche of the founder of the Institution, once a month, for two hours. Go out with guardians and parents, if not too often, at any time. If too ill to study, go to the sick-room.. Never ask for medicine without leave of the superintendent lady. On Sunday first and second class to church. Write the sermons from memory in an hour's time. At the end of every half year we had a fortnight's examination-generally two in a day. Only Scripture repetition, poetry, articles of religion, collects, and German poetry were verbal examinations. Everything else was done by writing. From two to four hours were given for the respective studies, during which time we had all to sit perfectly still, silent, and 22 On Curvature of the 8pine, steady. If any of us had answered our questions before the time was over, we had to sit still, silent, and steady, just the same. We were all seated at fixed places, no two of any class being allowed to sit together. The examination time was the most exciting, partly from the fear of trying to get higher places, and also from its being so near the time for 'Going Home!' " Some of the rules I forgot to name were-' Never to leave the room we were in without permission. Always to shut the pianos after us, and never to go into the music rooms without leave. Always to bring pen wipers and aprons to writing class. When we came down in the morning to bring down all we required for the day. Never to lend books or any goods without leave. Never to help each other in any lessons or exercises.' Every month, when our weekly letters went home, monthly reports were sent to our parents or guardians, which told our -place in the class, and what improvement we had made in our previous studies. This was really the only outward notice we had for getting on, as no prizes were given for anything. The studies named in the reports were as follows:"No. of Class, 1st.:-Place in Class, 4. Health.-Good. Writing.-Takes pains. Conduct.-Satisfactory. Deportment.-Attentive. Scripture Studies.- Harmony.-Satisfactory. English Studies.- Music.-Satisfactory. French Studies.- Singing.-Satisfactory. German.--Improved. Drawing.-Takes pains. "This is, of course, a make up report-just as an example of one. Happy the girl who gets it. " When new pupils came, if considered young, they were put under the care of some elder pupil, who had to teach them in the morning, make their beds, and mend their clothes for them. These girls were called mothers. As they had to be dressed quite as soon as we, they were allowed to rise before the bell rang, but nobody else was allowed to do so. But if the mothers by Dr. Roth. 23 attended properly to their children, they were given fifty marks more to their conduct at the end of the half year. " The governesses had monthly half holidays-on Wednesdays -when they went where they liked, and did what they liked. Wednesdays were always called our half-holidays; but they consisted of one hour on the Cliff, one hour writing letters-wheni not a word might be spoken-one hour preparation for the next day's lessons; tea: during which we might talk English (but the noise was too much for the superintendent lady) who consequently had tea in her own room, and an hour afterwards, when those who had not to practise or study might do what they liked-if they had time to spare. " Our holidays were from June 1st in summer to August4th; and from December 22nd at Christmas for about three weeks. Then at Easter, we had Easter Sunday, Monday, and Tuesday; half holiday on the superintendent lady's birthday, and a whole holiday sometimes on Michaelmas day. "The rules might only be broken with leave of the superintendent, for some good reason. " Of course the number of pupils caused the rules to be much stricter, and they did not seem half so strict to keep as to read and talk of." The Cramming System is very general. 26. I have given a long extract of the plan pursued in one educational Institution, but while inquiring into the causes of chronic diseases and spinal curvatures, I find that in many private Institutions-in so called finishing schools for young ladies-a similar cramming and training system is pursued, at the request of the parents, as the superintendents justly say; very little or no attention is paid to regular and obligatory exercise in the open air; no systematic physical training is carried on and no instruction given in the elementary knowledge of preserving health. The patient who at my request gave me the particulars of her case, had not the slightest idea that the mode of life carried on for one year in the educational Institution was the cause of her very complicated and almost incurable spinal curvature. Having by Dr. Roth. upon school-masters and school-mistresses; and as the ignorance of the latter regarding the elements of hygiene and physical training is very general, I formed last year with the aid of the Ladies' Sanitary Association, a class of school-mistresses and pupil-teachers, connected with several poor infant and children's schools. They were instructed in a popular way in all matters concerning their own health as well as the health of the children placed under their care. The notes on "pupil-teachers work" were written, in answer to my enquiries, by one of the more intelligent of the class, and will easily explain why so many school-mistresses and teachers lose their health and suffer from spinal curvatures. To show how deep rooted the desire of a small waist and the belief in its beauty is, I may mention that towards the end of the course one fourth of the girls were still tightly laced in stays with strong whalebone husks, after I had taken the trouble of repeatedly showing and explaining to them particularly on the skeleton, on one of Dr. Auseaux's anatomical figures of the human body, which can be taken to pieces, and by diagrams, how injurious the effects of the compression of the chest and diminution of its size, and of the constant involuntary leaning on the busk are on the functions of respiration and circulation, &c. One of my female assistants had also trained these girls for weeks in the educational and hygienic part of Ling's exercises. These girls were aware that they are prevented from moving freely their body and limbs while tightly laced, and they could not plead ignorance; they were told that they. commit a-great fault by voluntarily and artificially crippling themselves, and thus making themselves incapable of attending to the moral and physical well-being of those placed under their care, and all this was in vain. How can we then expect that other school-mistresses and pupil-teachers who have not any knowledge of physiology and rational physical training should attend to the health of their pupils, and to the prevention of many complaints, as far as this depends upon them. 28 On Curvature of the Spine, of the dorsal vertebrae. Although this hypothesis is not entirely false, it has contributed to preserve one of the traditional errors which prevail regarding the explanation of the pathological progress of scoliosis; it is an error to believe that by using the right arm the muscles on the right side of the dorsal vertebre are more prominently brought into action, and that the dorsal vertebre are pulled from the mesial line to the right; it is an error to suppose that the strong (actively contracted) muscles are on the convex side, and the weak (relaxed) muscles on the concave side of the curve. This error is still more propagated by the false opinion that the prominence on the right convex side of the curve is thick and hypertrophied muscular substance.* "Although the predominant activity of the right arm may contribute to the greater frequency of right scoliosis, it is a fact that by carrying a weight with the right arm, or by using it in any other way, the spine is bent to the left to prevent the body from being pulled by the weight to the right; the flexion of the spine to the left is caused by the contraction of the muscles situated on the left side of the spine while their antagonists on the right are extended and almost inactive. Mechanical and physiological laws prove that the weak (relaxed) muscles must be on the right (convex) side of scoliosis habitualis recta, which fact is also confirmed by pathological anatomy, as the muscles on the convex side in post mortem examinations are found extended, pale, thin, and atrophic, while those on the concave side of the curvature are (corrugated) folded together, contracted, well coloured, and their nutrition normal. " A similar pathological process also takes place in the primary (left) lumbar curvature." (Eulenburg.) 32. AGE AT WHICH CURVATURE OCCURS. According to my observations, the majority of lateral curvatures begin between the seventh and sixteenth year. Although "* This error is the cause that even at present the routine practitioners treat the parts on the convex side of the curve with fatty inunctions, and the supposed weak parts on the concave side with aromatic spirits and energetic exercises of the left arm. 82 On Curvature of the Spine, spinal deformities, upon the erroneous principle of violent pressure of projecting parts, and of violent extension of the spine, where medical men can convince themselves of the truth of my statemetit. 37. THE LECTURERS OF OUR MEDICAL SCHOOLS ARE RESPONSIBLE FOR THE IGNORANCE OF YOUNG PRACTITIONERS. The professors and teachers in our medical schools are responsible for the ignorance of the majority of young medical men regarding the diagnosis and treatment of spinal curvature, a complaint which, although so frequent, is never admitted to the wards of a hospital; thus no opportunity is afforded for watching the slow but sure progress of these cases, and for studying their preventive and curative treatment. The few who pay some attention to these cases among the outpatients of orthopmdic hospitals are taught to consider deformities and spinal curvatures merely as objects of mechanical treatment, but not as symptoms of many constitutional and other complaints. (See ~ 65.) 38. EXAMINATION OF THE- CURVATURE. Before proceeding to the inspection of the spine, it is desirable to ascertain whether there is any member of the family suffering from a spinal disease or curvature, or whether there is any constitutional taint in the family. All previous diseases must be ascertained, and the time at which the mother (who is generally the first), the patient, or anybody else have observed any alteration of form; any awkwardness of the gait or of other movements; any difference in the position during the usual occupation, as, for instance, an inclination of the head forward, or otherwise; a projection or higher position of the shoulder; a permanent inclination of the body in any direction, or constant standing upon one leg, or leaning with a hip towards a fixed object, placing one or both elbows on the hip, raising both shoulders while in the erect, position, or any other abnormal actions or movements, which is frequently the necessary consequence of a weak spine. The dress betrays also the beginning of an abnormal position of the spine; low dresses 0 by Dr. Roth. 33 fall down more on one shoulder than from the other; the skirt appears longer on one side; the bodice or body of the dress is in folds on one side of the back; the shoes are frequently torn on the inside, corresponding to the place of the projecting ankles; one projecting ankle is often found in lateral curvature. 39. It is necessary to inquire whether any particular position or movement produces pain, whether a constant dull sensation of uneasiness and languor, sometimes amounting to pain, is present, and whether any mechanical injury, or an accident has not caused these sensations-rude romping amongst children; throwing stones on the spine; falling from a horse or down stairs; too great a strain while nursing sick people; too long protracted bodily labour; and shortsightedness in persons obliged during a long time to write, to engrave, or to do other work requiring close application of the eyes, and consequently, stooping position of the head, are a few of the numerous mechanical causes to which I have seen traced the origin of many curvatures. 40. This preliminary enquiry enables the medical man to direct more attention to some parts of the spine, to bring this part of the spine in different positions, and to watch the various movements in regard-to their effect upon this part. A minute and detailed examination into all circumstances preceding the complaint, into the mode of life, habits, &c., is, in spinal curvatures, as important as in any other complicated chronic disease, where the pre-disposition is to be brought in connection with the occasional or external causes, which enable us to trace the beginning and greatest development of the curve, which is in many cases but the symptom of another complaint. 41. INSPECTION OF THE SPINE. Whenever practicable, the spine should be examined while the patient stands upright. The examiner sits behind the patient, whose feet and legs are placed close to and touching each other at their internal sides; the legs are well stretched and the knees straight; the patient is undressed to the height of the edge of the hip-bones (a shawl or cloak can be fastened 36 On Curvature of the Spine, diagnosis of the sometimes very complicated affections of the spine. The head counterpoises the body, especially when the patient is passive; this is the reason that the head is bent forwards when the natural lumbar curve is diminished, and the lumbar vertebrae form a straight line instead of a curve; in lumbar curves, with the convexity to the left, the head bends slightly to the left; in kyphotic curves of the dorsal vertebre, the head is slightly bent back, sometimes the chin higher than the back of the head, and the neck almost entirely hidden between the raised shoulders; the upper arms are frequently not only raised but also turned forwards and inwards; a cavity is formed under the clavicles on both sides of the upper and outer part of the chest; one humerus is found higher and also pushed more forward by increased action of the pectoral muscle of its side; this is also the cause of the inequality of the lateral lines from the ears down to the acromion, which is a circular segment on one side and more elliptic on the other; if an oblique line is drawn from one acromion to the hip on the opposite side, it is longer on one side than the other; each spinal process should be first slightly touched, and if not painful, either pressed harder or a percussion made; or if that cannot be borne, a slight longitudinal friction from the head downwards, with more or less pressure, is made along the spine. This manipulation several times repeated leaves for a short time a red mark along the spinal processes, which gives an exact outline of the position and form of the spine. 44. MODE OF TAKING THE OUTLINES OF CURVATURES. If the mere inspection is not sufficient, a strip of lead, about half an inch wide, one-eighth of an inch in thickness, and of the length of the spine, can be placed and slightly pressed along the spine; the strip of lead thus takes the shape of the spine, which is cut out in pasteboard. The transversal outline, fig. 10, of the back across the shoulders is also taken in a similar way; and the outline of the spine in figs. 11 and 12, have been drawn from outlines taken in the manner just described, which, if I am not mistaken, was first used by 38 On Curvature of the Spine, least if the patient is kept in a horizontal position from the beginning of the complaint, and his diseased constitution improved by hygienic and medicinal means; unhappily in the majority of cases they are placed under treatment when the disease has made too great ravages, and a humpback produced; in such a case the treatment can, when most successful, but arrest the further progress of the deformity, and improve the position of those parts of the spine only which are above and below the diseased part. 46. LENGTH OF TIME REQUIRED FOR THE TREATMENT OF CURVATURES. While naming approximately the periods of time required for the improvement or cure of a curvature, we must always take into account the constitutional strength and the most favourable circumstances. The following refers to the average of those cases in which the general power of reaction is still satisfactory. In predisposition to lateral curvature, or where a slight. inclination of the spine is observed in a lateral direction, three or four months of treatment are sufficient, but in order to prevent a relapse, constant attention must be paid to general health, and to the removal of all injurious influences; all the rules named in the preventive treatment must be attended to, especially during the period of growth, and the dangerous epoch of education. Four to six months are wanted, in favourable cases, for the cure of beginning lateral curvature, and the same time for a considerable improvement of such a curve in its first stage, and while changing towards the second stage. In the second stage one or two years are wanted for obtaining the maximum of improvement or effecting a cure; but some improvement is already noticed after the first three months. In the third stage real and lasting improvement is scarcely to be expected under eighteen months or two years. In kyphosis a similar period of time is required, if the general health is not impaired by the continuation of the constitutional 40 On Curvature of the Spine, filled with such bad air that I could not remain there without immediately opening the window. You will, probably, think that the room was very crowded by its little inmates and their mothers; this was not the case, but all ventilators had been closed, and placed so high that they could not be opened, except the porter was called, who had to ascend a ladder before reaching the ventilators, which, under such circumstances, were scarcely, if ever, used. I could tell similar tales of many a nursery or dormitory in the houses of the rich. People are afraid of catching cold, but not of poisoning themselves with carbonic acid; they think that fresh air cannot enter the room without causing draughts, although these are easily prevented. My patients open the top-window about half an inch or an inch, and the window-curtains prevent the draughts. 50. SECOND RULE.-WASH AND RUB, DAILY, THE SKIN ALL OVER. Bath-rooms are wanted in every house, but still more in all educational institutions, and wherever many persons live together. At present one bath per week is considered, in many homes and in very good educational institutions, the maximum of luxury required for cleanliness, and for preserving the regular functions of the skin; I am in the habit of prescribing, not only to children, but also to many adult patients suffering from chronic diseases, before they go to bed to be well washed with yellow soap, or another soap containing much soda or potash, which, under the form of a lather, is applied to the skin with a coarse flannel; every limb, and afterwards chest and back, are separately treated in this way and, when washed and dried, well rubbed either with a coarse flannel or glove. The patient, especially the weak, derives the full advantage of the manipulations if they are done by another person. The temperature of the water varies according to the power of reaction. The patient must feel, for some time after the washing, a general feeling of comfort and warmth. When warm water is used in the beginning, it should be changed only by degrees (every second day half a degree less warm) to tepid, and when required, to cold. In the morning a quick sponging, 42 On Curvature of the Spine, 52. FOURTH RULE.-ATTEND TO PROPER DRESS. The materials of the dress must vary according to the season; it must be always sufficiently loose to permit the free use of the limbs and body, and not interfere with the full expansion of the chest and abdomen during a deep inspiration ~ 20. My female patients are not permitted to wear stays and corsets; the injurious effects of these have been mentioned. The bodies of their dresses and under-clothes must have large armholes; shoulder-straps or tapes across the shoulder, which are constantly falling down to the humerus, interfere with the free action of the arm, and oblige the wearer to use, and to raise frequently the shoulder-blades beyond their normal position. Petticoats should be attached to bodies, or fastened by broad and circular bands across, but not above, the hip-bones; these bands are of a circular cut, with the smaller circle at the top to prevent any transversal pressure across the abdomen. Too heavy dresses, pressing especially on the abdomen or hanging heavily on the shoulders, are injurious. Garters which are usually tight interfere with the circulation, produce swelling in legs and feet, also varicose veins; it is better to fasten the stockings by loops attached to a circular waistband. The soles of the shoes should be as large as the sole of the foot when the entire weight of the body is pressing upon it, and it is in this position that the measure of the outline of the sole should be taken; while the measure of the arch of the foot is taken while no weight is pressing upon it, as, for instance, in the sitting position.53. Many persons suffering from lateral curvature have one or both ankles relaxed, and mostly projecting inwards; besides the special manipulations and exercises selected, according to the case, for strengthening this joint, I recommend a soft pad of * Patterns of good dresses for children and adults are to be obtained at the Ladies' Sanitary Association's office, 14A, Princes Street, Cavendish Square, London; and those interested about how a good shoe should be made, will find the details in Professor Meyer's little pamphlet, Why the Shoe Pinches (which can also be obtained at the office); and in Dowie's book, The Foot and its Covering, which contains Camper's treatise, The Best Form of Shoe. 44 On Curvature of the Spine, 56. SIXTH RULE.-ATTEND TO RATIONAL PHYSICAL TRAINING. Train growing as well as adult persons by a rational mode of exercise, that the body and limbs may be under the control of the mind, and thus made useful for the purposes of life. The preventative treatment is more required by girls than boys, especially by those delicate girls who have a hereditary predisposition to tubercular, chlorotic and aneemic diseases, and spinal curves. All practitioners having experience in the treatment of spinal curvatures, however they may differ regarding the treatment of curvatures, agree that besides the hygienic influences which contribute to the general improvement of health, rational exercise is the most suitable for the prevention of curvatures. 57. BOYS ARE LESS SUBJECT TO LATERAL CURVATURES THAN GIRLS. The greater freedom permitted to boys during their education, their games and sports in the open air, the greater ease with which they can move in their dress, are considered to be the principal causes to which we must attribute the smaller number of lateral curvatures occurring amongst boys--the proportion being one boy to ten or twelve girls. 58. CURVATURES AND OTHER COMPLAINTS ARTIFICIALLY PRODUCED IN GIRLS. The following extract from a Continental writer, on the mode of bringing up children, can justly be applied to this country, and will sufficiently explain how curvatures can be artificially reared:"We will not inquire how a child has been brought up to its sixth year with regard to food, clothing, dwelling, and exercise; but we will assume that it has been treated rationally, and is sent at that age as a healthy child to the public school. Now the childish play ceases, instead of the exercises and games which had been strengthening the body, the school is sub 46 On Curvature of the Spine, name of Free Exercises, form a part of Ling's system are entirely unknown. It is strange that many parents object to a Rational Gymnastic instruction, under pretence that it is contrary to propriety, while the same parents have not the slightest objection to send their daughters to dancing lessons, where familiar embracings with the other sex form a necessary part of the lesson, where they are taught to hold themselves in constrained unnatural positions, and where coquetry is practically taught. (Battcher.)"* 60. These evils of our modern civilization-when parents believe that the finishing-stroke of their daughters' education must be given at the completion of their seventeenth or eighteenth year-can only be counteracted by suitable hygienic means, amongst which rational exercise is a very important one, as it aims at the harmonious development of the mental and bodily faculties, which can be obtained only by degrees, as the mind -by the influence of the will on the training of the body-is one of the agents in producing this harmony. 61. IMPORTANCE OF PHYSICAL TRAINING. The following notes, taken from Mr. Chadwick's Biographical Notice of the late Horace Grant, confirm the importance of rational physical training:" Every one must have noticed the great bodily and mental exercise gone through by a healthy child, at perfect liberty to do what it likes; the innumerable objects observed, inquired into, and experimented on; the endless reasonings, imaginings, inventions; and the worlds of fancy into which his old materials are constantly being marshalled. Yet all this hard work is pleasure to the child,-it is play; but such play makes men. Shall we attempt (imperfectly at best) to continue the course thus indicated by nature, or shall we disregard the requirements * A Letter to the Rt. Hon. the Earl of Granville, Lord President of the Council of Education, &c., &c., on the Importance of Rational Gymnastics as a Rranch of National Education, and as a means of Elementary Instruction; on the Advantages arising therefrom to the Industrious Classes, and the Effect upon the Public Health, the Fine Arts, Military Affairs, and the Diminution of the Poor's Bates. By M. Roth, M.D. Groombridge & Sons, London. 48 On Curvature of the Spine, and with the sanitary philosopher who specially studies the whole special means-mechanical, administrative, and otherof prevention." The medical attendants in public and private schools, and the parents who send their children-especially girls-to boarding-schools, should inquire whether the few hygienic rules named above are strictly attended to, as far as they regard constant ventilation in dormitories and school-rooms, frequent bathing, and the positions in which the pupils are during their occupations; also, the time spent in the open air and the time passed while engaged in mental work should be strictly inquired into. 62. OVERSTRAINING OF THE MENTAL FACULTIES PRODUCES MANY DISEASES AND DEFORMITIES. The bad results of mental overstraining are not sufficiently known to teachers and parents; and although I have named some of the bad effects on pupil-teachers and those who are trained as governesses, I wish to quote the opinion of an eminent physician on this subject, which is ably expressed in the following extract. I have only added or changed the few words in italics. " In the affluent classes, wherever the hygiene of children or adolescence is neglected, or is ordered by the sovereign crotchets of some energetic parent, many maladies will creep in; and here I would raise my voice against that pernicious system of brain work, miscalled infantile education. It ignores, or is ignorant of, the laws both of the physical and functional development of this most important organ. It neglects the sequences under which its various faculties appear. It has little regard to the laws under which the senses educe the powers of the brain. It either crushes the imagination, so active in childhood, by a premature development of the reflective faculties; or it overwhelms a faculty which requires no stimulus, by a host of artificial expedients. Hence the greater development of early madness; hence the instances of disproportionate faculties, the wayward will, the unbalanced conduct, the physical by Dr. Roth. 49 exhaustion and cramped development of the body, the result of the contention of inharmonious and disordered powers and passions. The chapter on the early training of childhood is yet to be written; and even were it at hand, I believe that the errors of the present system are so methodized and enrooted, so many prizes are offered for threading its paths, that few would listen to, and fewer practise its precepts. One of the most thoughtful minds of our time (Sir B. Brodie) in pointing out some of its vices, has all but preferred leaving the brain fallow, to storing it as it is now stored, in infancy and childhood."-(Ferguson's Prefatory Essay to Gooch's Diseases of Women. Sydenham Society.) 63. CASE OF BAD EFFECT OF EARLY MENTAL OVERWORK. While writing these notes I have an opportunity of seeing a sad instance of the effects of such mental overstraining in a young man of twenty-one, who since his earliest childhood and during adolescence, was obliged to read and to say prayers very frequently during the day, to read and to think of religious and philosophical matters which were far beyond his comprehension. For years every effort was directed to the development of the brain with an entire neglect of the body; notwithstanding he has been lately for months living in the open air and taking horse exercise, he is suffering in a high degree from various nervous symptoms, fears, and bad spirits; has no idea of form, numbers and mathematical combinations; frequently complains of sickness and gastralgia; sometimes a ravenous appetite and at other times apepsia; his head stoops, the spine is laterally curved, the chest flat, the breathing only abdominal; he is inclined to make involuntarily grimaces, consisting in a particular sniffling movement of the face, with lifting the cheeks and mouth, the origin of which he explains thus: being obliged to say in his childhood short prayers, he soon got tired of them and used merely to mutter the prayers; he afterward said only " amen," and finally made only the movements of praying, and finishing with a repeated grimace for " amen." With his right fore finger he makes also involuntarily movements, which are the effect of having constantly made, concurrent 50 On Curvature of the Spine, with the prayers, the sign of a short cross. When sitting he moves the body forwards and backwards, a movement I have frequently seen amongst the blind left without regular occupation or training. He corresponds perfectly to the picture drawn by Dr. Ferguson, and serves as a warning to those parents who are fond of the great and premature cleverness of their children, whom they overburden with ideas beyond their powers of comprehension. I have notes of many other cases of curvatures and general derangement of health in consequence of early mental overstraining, and have just examined a young lady 23 years of age who suffers from headache, spinal irritation, slight curvature, beginning loss of sight, and general weakness; all these symptoms being principally ascribed to mental overexertion during the time of her education. 64. INJUDICIOUS EXERCISE, AND ITS BAD EFFECT. For prophylactic purposes, the most useful gymnastic exercises-that is, such as are well executed with regard to quality, quantity, and intensity-are, in the first place, breathing exercises; next, those which develope the extensors of the spine and head, the muscles which enlarge the chest and retain the shoulder-blades in their place, and the exercises by which the limbs are simultaneously strengthened.* The individual state of health and strength must be the standard according to which the quality, quantity, and intensity of the exercise must be regulated. Much mischief is done by a general and indiscriminate recommendation of exercise, by placing weak persons, and especially children and youths, in the same class with healthy and strong ones, who go through a series of educational or hygienic exercises suitable to the healthy, but extremely injurious to the weak and those predisposed to curvatures. These, although not able to move like the strong, try to imitate or rival them, and, by doing so, place themselves in abnormal positions, which produce unequal development, and, instead of improvement, an increase of the primary weak* See Gymnastic Free Exercises of Ling, published by Groombridge & Sons, 5, Paternoster-row. by Dr. Roth. to this torturing steel contrivance; or that they lose the power of balancing the body to such an extent, that they are unable to make a few paces without the assistance of another person. Such a painful picture is at this moment presented to me by a young lady 19 years old, who for six years has been treated in this way, and has named the anatomical mechanicians and the three orthopeedic surgeons who have, during this long period, directed the treatment by machines, which require every week, once or twice, a screwing up, arranging or adjusting of their various parts, which operation is performed by the specialist, and rewarded by a fee. Under such circumstances, the pertinacity with which such treatment is advocated at the expense, although not in the interest of the patient, is easily understood, and also why its advocates oppose the only rational mode of treatment, which aims at the improvement of general health and the increase of power in the parts affected by simple hygienic and medical means. Many family doctors are most innocently reproached by their patients that they-bhaving no experience in the treatment of deformities-have sent them to those professional men who are the staunch advocates of such purely mechanical treatment. About two years ago the leading medical journals contained a large prospectus for the formation of a limited liability company, under the title of The Spinal and General Orthopaedic Association, with a capital of ~ 20,000, for the manufacture and loan of these orthopedic machines; the profits to be made at the expense of the unhappy patients were advertised as sufficient not only for a fair dividend to the shareholders, but also for paying fees to a staff of superintending; consulting, assistant and district surgeons, etc. None of the editors of those medical papers opposed such a scheme, which happily failed, otherwise it would have been as degrading to medical men as injurious to their deformed victims. At present we see the advertisement of an anatomical mechanician who, being probably aware of the injuries produced by spinal apparatus, advocates the use of gymnastic exercises as practised abroad, in combination with the mechanical contrivances he manufactures; while another, who calls himself an 56 On Curvature of the Spine, curved, and can have no relation to the cause of the affection. It is not treated as a medical subject, for every plan has for its object the restoration of the spine to its natural figure by mechanical means, and acts on the principle that that which is bent may, without regarding the cause, be forced back again. " Suppose all that was intended accomplished, and that the vertebrae were again in their proper positions, by what means are they to be preserved there? The source and spring of the evil still exists; the cause of the curvature still continues to act; and when mechanical support is withdrawn, the curvature generally reappears. "The attempt to cure, if it will bear the name, has had respect only to the preservation of the position. * * *The sufferer having only the option of mechanical means, when these fail no resource remains; the symmetry and the health of the system must therefore every soon become the prey of the malady." * Similar opinions were expressed also by John Shawe and William Ward forty years ago, but all in vain, the public and many medical men are still in favor of machine treatment. 69. THE AIM OF THE CURATIVE TREATMENT OF MUSCULAR LATERAL CURVATURE ISTo improve the general health; To restore the normal antagonism of the muscles of the spine; and To arrest the further increase of the lateral curve; to imimprove or to restore the normal form of the spine. I. In the majority of cases attention to the hygienic means, mentioned in the preventive treatment, is sufficient to improve the general health; in other cases, medicinal means, adapted to the individual cases, must be selected to obtain this object, also applications of water in its various forms-swimming, the Russian bath and sea-bathing-will be found useful in combination with other means. * Dr. Jarrold, E lqmiry into tihe Causes of the Curvatures of the Spine. 58 On Curvature of the Spine, constantly either twisted or crooked when placed in a right position, and as long as the patient does not think of the right position, but remains in those positions only in which he falsely believes himself to be straight, the progress of improvement is very slow; therefore, it is very important to convince the patient that he is not straight when he fancies himself to be so; the patient's will and energy must also be roused so that he himself may assist as far as it depends upon him to carry out the instructions given for his own good. 70. As I have no intention to enter into all the details of the curative treatment of the habitual lateral curvature, I will mention only the following:1. Lateral curvature should be treated as soon as observed. 2. Every day prolongs the time of treatment, and is frequently the cause that a previously curable case can only be improved. 8. Attention to the improvement of the general health and strength, by hygienic or medical means, must either precede or go hand in hand with the local treatment. 4. The local treatment can include not only passive manipulations and exercises, acting especially on the -relaxed parts, but also applications of steam douches, cold or warm water showers and baths, compresses, and all other means which increase the strength of the weak parts. The influence of the patient's will on the relaxed muscles is essential.*- To rely only on mechanical supports, corsets, machines, &c., is extremely injurious. 5. As long as improvement is going on the treatment should not be interrupted, otherwise the patient is exposed to the danger of a relapse. 6. It is not enough to improve only the appearance of the patient, but it is essential that his health and strength should be really restored, that he may be able to bear with impunity mental or bodily exertion of various kinds; his flabby relaxed muscles must be changed into firm and robust ones; the previous languor must have disappeared; in fact, he must not only look, but really be a healthy person, then only can the treatment be called successful. * Dr. Kjdlsted's treatment is based only on the energy of the will, and it is mentioned that lie was very successful in many cases. by Dr. Roth. 59 Little a The following illustrations refer to ~ 55. 71. STANDING. ttention is paid in schools and educational establishments to the right mode of standing. In many schools it is a practice to make the children stand while reciting their lessons; they are obliged to stand with the feet closed and the arms crossed, as seen in figure 21. The school-mistress has not the slightest idea that the difficulty of standing upright is increased in proportion to the smallness of the basis, and that the crossing of the arms induces the child to bend the body forward, that the convexity of the lumbar curvature is backward, and that the head must necessarily bend forward to preserve the balance of body. The easiest way of standing is with the feet placed slightly apart, or one foot placed before the other, while the weight of the body rests on both legs. 22 and 23. Standing positions. F2 by Dr. Roth. 61 ribs, &c., to which needlewomen and other persons engaged in sewing are subject. I may add that these bad effects are still more quickly produced in - q large establishments, where the needle - women have Sscarcely elbow room, and are heaped together either in underground rooms, or at the top of the house in rooms with ceilings, where the ven- tilation is very deficient, and "- the girls wishing to be smart, and rival one another in the Fig. 25. smallness of their waists, are tightly laced, when they are frequently obliged to work for twelve, fourteen, or even eighteen hours, and kept awake by tea or coffee, while the small pay is only sufficient for very scanty meals. Fig. 26 shows the right position, and that the back should lean on the chair, that the work should be near to the body, but not the head near the work; that the needle-women - I J // should have weight cushions " - on a table before them to I lattach their work, and the legs not crossed, which predisposes very much lumbar curvatures, while the use of a long thread must be avoided, because it causes a movement / in the shoulder, which is Fig. 26. raised, while the arm is stretched to its full length; the repetition of the movement, which amounts to several thousands per hour, causes also frequently pains in the spine and under the shoulder. The introduction of sewing machines should be always advocated by medical men, because their general use will prevent 62 2On Curvature of the Spine, many diseases among the working class, the origin of which depends upon the bad position and the ten or eleven millions of movements of the right arm per annum, which an unhappy needle-woman makes, who works at an average of twelve hours, and six days per week, in one year, and generally confined in rooms with vitiated air. A needlewoman makes in 1 minute........ 50 stitches, 1 hour............ 3,000,, 1 day (of 12 hours).... 36,000,, 1 week........ 216,000,, 1 year........ 11,232,000,, Girls 10 to 12 years are apprenticed as needlewomen, and admitting that they work only a third or fourth part as much as an adult and practical woman, it will be easily understood why the frame of the growing girl is in a short time marked by a predisposition to many chest and abdominal complaints, as well as various deformities of the ribs and spine. Fig. 18 is a portrait of one of these unhappy girls, scarcely 18 years old, who besides the spinal curvature was suffering from fever, pain in the chest, headache, cough, and blood spitting. 73. SITTING AT THE FRAMEWORK. The stooping position over the frame, and the leaning on it with the lower part of the left side of the chest, not only produces deformities in the anterior part of the ribs and of their cartilages, "" ij but also a predisposition - \ to spinal curves; when the / \ ame is to be arranged for the-work, the girls and women are in the habit of pressing the frame with all their power towards their WIN chest, which is also very Fig. 27. injurious, and would be by Dr. Rolth. 63 easily prevented by placing a few screws in the frame; the working girl should be taught during her apprenticeship to use alternately both arms and hands above the frame, which would prevent a constant flexion to one side of the spine in its lumbar part, and thus indirectly a lumbar curve. 74. IRONING. The girls in the laundry, whose constant occupation consists in ironing, are frequently subject to spinal curvatures; I have traced the cause in many instances to the ironS'/ - ing table being too high, and the weight of the iron being too heavy for the girls, they are consequently induced to / |raise the elbow beyond its natural height, and to assist the lifting of the heavy iron by raising the shoulder; but f I as both these actions (of raising the parts beyond their natural height) are more easily performed when the spine is bent to the opposite side, Fig. 28. it is easily understood, why a weak girl working for days in a standing position will soon suffer from languor, pain, and lateral lumbar curve. As long as we have not ironing machines the girls should be accustomed to iron alternately with both hands; change of occupation-as housework, washing, scrubbing, &c., are very good antidotes to the bad effects of ironing; the introduction of ironing desks instead of tables, and a contrivance for raising and lowering the desk, according to the height of the working person, is desirable. It is to be hoped that the ingenuity of some engineer will soon be directed to the invention of a mechanical contrivance for ironing which would certainly contribute to the diminution of the complaints to which the ironers are at present subject. 04 On Curovaure of the Spine, 75. NURSING CHILDREN. The custom prevalent in some classes of society of hiring girls of 8 to 15 years as nurses of infants and children, is also indirectly a "cause of spinal deformities in a large number of these young nursery-maids, who are frequently seen in the streets carrying with the greatest effort very heavy children even of 4 to 5 years. As nurses in general (even the adults and strong ones) are in the habit of carrying / it their living burden always on the same side, namely, the left, they injure not only themselves, but also the children. Some practitioners attribute the frequency of certain deformities among rickety children to their being carried always Fig. 29. on the same side. Babies and infants should always be carried either in a horizontal or slightly inclined position with the head raised; the nurse should use alternately both arms; when children are too heavy to be carried a long distance, the old fashioned basket-carriages (on small wheels) in which they can be placed horizontally or in a reclining position are to be preferred to perambulators, which should only be used when children are strong enough to sit upright for some time without letting the head drop and the body incline and bend forwards. It is in the interest both of nurses and children that the former should be strong, well developed, and straight, that they may be able to fulfil conscientiously their most important duties, of which the majority of them have scarcely any idea, as they have never been trained for their employment, which they are expected to know instinctively; there is an ample field for the Society for the Employment of Women to find the ways and means for training intelligent and well educated girls in the theoretical and practical knowledge of the art of bringing up judiciously, according to hygienic laws, our infants and children; I am sure the 66 On Curvature of th1 SPine, with braces, induces the shoulders to shrug, while 'the very tightly bound laced boots interfere with the firee circulation in Fig. 30 and 31. the feet, and produce cold feet. Fig..81 shows the boy in a good position, only the desk should be slanting, or the book supported, as in fig. 33; the back should be always leaning on the chair; the reading-desk, or table, should be high enough to support the forearms, and the feet should touch the floor. Fig. 32, considered by many girls very comfortable, is there Fig. 32 and 33. fore often to be seen; the bad effects of the crooked position in the low and tight dress are not confined to the spine, but show themselves in various forms of abdominal derangements. 68 On Curvature of the Spine, 78. DRAWING. Drawing can be injury to the body, practised in a natural position without any as seen in fig. 37. The injurious effects of bad positions while drawing are similar to those mentioned in the preceding note on Writing. The great inclination of the body, not placing the ob- ject to be drawn or copied in front of the person drawing, add to the mischief of the position; the easel on which the girl in the bad position, fig. 36, leans should be discarded, and the person drawing should always be able to sit upright, and to lean. The hand and fingers should be taught to draw without additional movements of the arm, which /movements are also often Sseen during writing. Fig. 3( Fig. 37. 79. PRACTISING ON THE PIANO. To play the piano is considered one of the most important parts of modern education for a girl in the higher classes, as well as in that part of the middle classes which ape those above them. It does not matter whether the young lady has any talent, wish, or ear for music, she must be able to play a tune; and for years, one, two, and in some cases even more hours, are daily devoted to obtain this indispensable accomplish by Dr. Roth. 69 ment. It does not matter whether the young lady is constitutionally weak, anmemic, predisposed to curvature, to chest or other complaints; whether she has what is called a high shoulder or a high hip; whether she is short-sighted or has a pain in the neck;-all this is of no consequence: our young lady must practise the piano, and must do it only on a round music-stool, which can be screwed higher or lower, and consequently is not very firm. Fig. 38 illustrates one of the Fig. 38 and 39. favourite positions in which the predisposition of the tightly dressed or laced young lady to any of the ailments I have named is soon and successfully developed, if it did not previously exist. If the tenth part of the time and attention bestowed on music were directed to an elementary knowledge of the most simple sanitary rules, and to the rational physical development of our girls, they would enjoy much better health; we should hear much less of the many hysterical and uterine complaints at present so prevalent amongst the classes which are at the top of society, and they would still be able to play the piano nicely. Fig. 39 shows that the body can be in a natural position, and that the back of the chair can, without any inconvenience, support the body beyond the small of the back, up to the lower part of the shoulders. I may add, that the movements required 70 70 On Curvature of the Spine, for practising on the piano are not at all interfered with, as I know by experience; and thus many of the injurious effects are prevented. Short-sighted persons will injure themselves much less by using spectacles. I wish to guard against being considered an enemy to the most civilising of arts-music; my object is only to caution against its becoming the cause of many complaints, and against the very frequent fashion of forcing girls from eight, twelve or fourteen years of age to remain daily, for hours, in bad positions. 80. PLAYING THE HARP. Too much practice on the harp, especially in a bad position, is also injurious. The harp should never be practised by those suffering from irritation of the spinal nerves or predisposed to spinal deformities, because the raising of the arms is thus constantly accompanied with raising of the shoulders. The pressure with the chest on. the instrument should always be carefully guarded against. The remarks mentioned regarding the bad position while, practising on the piano refer also to the harp. Fiqs. 40 and 41 illustrate a good and a bad position. Fi m. 40 and 41. 72 On Curvature of the Spine, 82. LYING POSITION. Fig. 44 shows the curved position of the spine produced'by Fig. 44. using more than one pillow, which is sufficient to support the head, as shown in Fig. 45. Fig 45. Another lying position which is fi-equently assumed, especially in cold weather, is to crouch to such an extent that the knees almost touch the chin, while the shoulders are pulled up and brought forward, the spine very much curved in its longitudinal axis, with the convexity backwards, and. the chest compressed" this position is generally chosen while the head is covered with the blanket, in order to warm the bed with the air which has been breathed out; this air, vitiated by carbonic gas, is again breathed, and not only languor in the morning, but an imperfect sanguification and circulation, with all their bad effects, is the consequence. The excuse for all this is, that the bed being so cold, the body must warm a larger part of it, if not in such a bad crouching position. Although A by, Dr. Roth. 7 75 the patient so comfortable that he may be able to begin the respiratory exercises in the reclined position, which is intermediate hetween sitting and lying. Fig. 46 shows such a position in the chair; the small of the back or the loins should touch the wedgeshaped pillow, which is placed with the thick end down, as seen in the engraving, the easel or reading desk being moveahle in all directions,, prevents the patient from raising his shoulder while holding a book, and from bending the head forward while reading, and serves, also, as a writing desk or as a table. The foot board can, if required, he raised to the horizontal position to support the legs, which is desirable when patients complain (as is frequently the case in the beginning of treatment) of a dragging sensation *in the loins; a leather or other strap can be fastened on the top on both sides of the back of the chair, and being provided with a huckle, like the arms of an armchair., serves for the support of the arms when the weak patient -wishes to make use of his forearm and hands; these straps act like the arm slings in a carriage, and are very useful when the movements of the upper arms., or the holding of the arms in a certain position, produce pain o 'r irritation in the spine. Having made an extensive use of these conch-chairs, with various modifications required hy some cases of chronic diseases, and especially of spinal deformities, J am able to speak of the ease and comfort they afford to the patients, who, being tired of one position., can frequently change and still enjoy much rest; they also enable them to use their limbs -with greater ease, while their spine is supported in a good and natural position by the chair. On this chair many passive, active, and so-called resistance movements can be carried out, so that the chair is useful during the preventive 'as well as curative treatment. Many patients also make use of this chair while writing, reading or drawing; they are thus prevented from placing themselves in bad positions during these occupations. This chair is also much cheaper than the very complicated spinal couches, and as no particular mechanism is required, every carpenter can make it. I, 76 On Curvature of the Spine, 85. BREATHING, The importance of breathing exercises has not yet been sufficiently appreciated as a remedial agent in many chronic diseases, with irregular circulation, and inactivity of the majority of respiratory muscles, and which are constantly accompanied by abdominal breathing only. In the majority of spinal curvatures the intercostal and other respiratory muscles are either partially or totally inactive, the form of the ribs more or less changed. In some cases there is on one or both sides of the stomach pit a depression of the ribs in the form of a longitudinal or circular scoop (concavity on the surface), or the interval between the ribs (the intercostal space) is in some parts very much diminished. In these and many other deformities the patient must be placed in a position suitable to the individual case before he does the various breathing exercises, which are not confined to the three elementary motions of each act of breathing, but are modified to a great extent, either by increasing the quantity or modifying the quality of each single motion. In the positions,fig. 46 and 47, the patient is first taught to breathe very slow and deep, to control his breathing movements, to retain the air in the chest when this has been well filled, and to breathe out (to emit the air) very slowly by permitting only a small quantity of air to escape; the mouth being closed, the patient inhales through the nose, and breathes out (expires) by a very small opening between the lips, which is scarcely larger than when whistling: during these breathing exercises another person places the palms of both hands either on both sides of the lower part of the chest, or on the upper and anterior part, below the clavicles, or on any depressed part of the ribs, while the patient is encouraged to act or push by his deep breathing, and by filling his chest to its full extent, against the part on which the hand or fingers have been placed. The single parts of each breathing movement must not be done too long, so as to exhaust. To assist the patient, the exercise is done by the word of command, and the (inspiration) breathing-in is designated by one, the retaining of the air in the chest by by Dr. Roth. 77 two, and the breathing out by three. These three parts form the respiratory exercise, which is repeated only three or four times, but can be done several times in the course of the day. The filling the chest with air, or the retaining the air in the chest, must not be prolonged too much, because the veins in the head and face will become turgescent, and great flushing and heat produced in these parts. The too prolonged repetition of the breathing exercises is also bad, because it produces an aching in the frontal part of the head; this has been frequently observed among soldiers when trying to light their camp fires by repeated and frequent blowing on the fire: anyone who continues for some time this blowing exercise will soon feel a heaviness in the forehead. The Cong-fu, a Chinese mode of treatment for many chronic complaints, consists essentially in the application of the modified breathing exercises, performed in various positions suitable to the individual case; the followers of Tao-se prepare the patients by a particular diet for the treatment, and combine many religious ceremonies with the process.* The breathing exercises are also very useful for the expansion of the chest in persons predisposed to chest complaints; reading, singing, breathing through a tube with a very small opening, exercises on the spirometer, &c., are only modifications of breathing movements and have been used successfully. Autenricth recommends the following as one of the most important means for the expansion of the chest and invigorating the lungs of persons predisposed to consumption. " Breathe deeply, slowly, and with energy a quarter to half * In the Memoire concernant les Chiwois, par les Missionaires de Peking (Paris, 1779), in the chapter " du Cong-fu des Bonces Tao-se," an extract from which I have published in Rothlstein's Athenceum fiir Rationelle Gymnastik (Vol. II., Berlin, 1855), more details on this subject will be found. Dally, in his Cyneology (Paris, 1857), has also reprinted the chapter on the Cong-fu, with a copy of the twenty positions contained in the original, which serve only as a specimen of the thousands of positions in which the respiratory exercises are performed. A few years ago Dr. Neumann, in Berlin, published " die Athmungs-Kunst," The Art of Breathing, adapted to the treatment of diseases. HISTORICAL GIFT BOOK. Handsomely bound in Royal Scarlet cloth, gilt, price 5s., post-free for 60 stamps. ROYAL CHILDREN. THE CHILDHOOD AND SCHOOL-ROOM HOURS OF ROYAL CHILDEEN. BY JULIA LUARD. CONTENTS. 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