A57628 7




6




NOTES
ON
THE MOVEMENT-CURE,
OR
RATIONAL     MIEDICAL   GYMNASTICS,
THE DISEASES IN WHICH              IT IS:USED,
AND ON
BY
M. ROTH, M.D.,
PHYSIOIAN T TO H1 PRIVATE INSTITUTION FOE THE TENATMENT OP DEPORMITIS AND
CHRONIC DISEASES BY MOVERENTS AND THE RUSSIAN BATH, IN OLD
CAVENDISH STREET, LONDON, AND TO THE INSTITUTION
IN GLOUCESTER PLACE, BRIGHTON.
LONDON:
GROOMBRIDGE & SONS, 5, PATERNOSTER ROW.
xDoCCC$




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








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THE MOVEMENT-CURE.
THE following few observations on this treatment, which has
been introduced in several countries on the Continent,` are published with the view of calling the attention of medical men to
its study, and to induce patients to avail themselves of a mode
of treatment which, although based on simple principles, is
remarkably efficacious in its results.
The first Institution for the Cure of Disease by Physiological
J3ovements.
For the last thirty-eight years there has been an Institution
at Stockholm, established and kept up at the expense of the
Swedish Government, in which many thousands of persons, of
every age, sex, and rank, afflicted by diseases, which in many
instances were considered incurable, have been treated by Movements, and for the most part successfully. Ling, an eminent
member of the Royal Swedish Academy (born 1777, died 1839),
who first introduced the curative Movements now made use of,
was appointed as Director and Professor at this Institution, at
the head of which he remained for twenty-six years.
Difference of the Mlfovements, accordinq to Ling's system, from
those used in common Gymnastics.
The Movements of Ling differ entirely from those generally
used in our gymnastic and orthopoedic institutions, to which they
have scarcely any resemblance; they are based on the most
accurate knowledge of anatomy, physiology, and pathology, and
are used either for the prevention or cure of disease; the
hygienic and educational movements are used for the strengthening of the healthy adult, and for the development of the human
frame during its growth; they combine mental with bodily
development, and act through the mind on the body. The
ordinary medical gymnastic treatment is applied only for the cure
* See, at page 12, the list of Institutions established during the last
few years.




6


of malformations, and not for the cure of internal complaints,
as Ling's movements are.
The Aim of Ling's llfovements.
The aim of these movements is, in the healthy state, to
develope in the growing person and to preserve in the adult, the
harmony between mind and body, and to restore such a harmony
in the diseased organism.
The treatment by Movements aims at an increase and development of the vital and nervous power, which can be directed
to any part of the body; it serves to draw    the -blood from  one
set of organs and bring it to others; to develope the strength in
one part and to diminish it in another; to remove congestion
from internal organs, and to make the circulation more uniform
throughout the body; to increase absorption in one part and nutrition in another; to relax the contracted muscular fibre, and to
contract it when relaxed; to restore the disordered muscular,
tendinous, elastic, and cellular tissues to their normal conditionin short, to substitute health for disease.
Number andcl Selection of Jfovementsfor Curative Purlposes.
The number of curative movements suitable to every individual case varies from eight to twelve, which are selected according to the cause and symptoms of the disease, and according to
the general state of the patient and the local state of the affected
part. The movements are set down in the form of a prescription,
according to certain rules, regulating the quantityS and intensity
of the single operations. The prescription or only some of the
movements are changed, as the case requires, every fortnight or
month. The patient is placed by the medical man and his assistants in the prescribed positions, which may vary for each movement, and may be lying, half-lying, sitting, kneeling, etc. The
assistants (generally called gymnasts), instructed in the elements
of anatomy and physiology, are well skilled in the movements
and manipulations, and aid the patient in the execution of those
which are requisite.
Th7e various Claases of Movements.
These are-1. Active; that is, executed by the patient alone,
or with the help of the assistant.  2. Passive; that is, executed




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.




DR.       ROTH'S' INSTITUTION,
16a, OLD CAVENDISH ST., CAVENDISH SQUARE, LONDON, W.,,
ESTABLISHED 1850; FOR THE TREATMENT OF          ~
dafrmities anh mamq ~%n                          c LEeseV
AND FOR THE
STRENGTHENING AND DUE DEVELOPMENT OF THE HEALTHY BODY,
AND IMPROVEMENT OF THE FIGURE.
OPEN DAILY, FROM TEN A.M. TO SEVEN P.M.
PATIENTS desirous of being treated by Movements have a preliminary consultation with Dr. ROTH, without which he cannot prepare the prescription of Movements suitable to their case.
In this Institution NO RATIONAL MODE OF TREATMENT WHICH CAN
CONTRIBUTE TO THE CURE OF DEFORMITIES AND CHRONIC DISEASES IS EXCLUDED, but the principal means employed are:SI. The Medical Gymnastics comprised in the system of LING, a system
altogether different from Gymnastics as hitherto practised, and also known
as the Swedish Gymnastics.
II. The (so called) Russian Bath, a combination of the various local and
general applications of cold and warm water and vapour, according to Dr.
ROTH'S invention.
III. The Water Cure, as commonly practised in Hydropathic Institutions.
No machines or straining instruments are used in the treatment of
spinal diseases, and the torture of lying constantly on the back or stomach
is entirely avoided.
Patients are not received as inmates, but there are many establishments in
the immediate neighbourhood where Board and. Lodging may be conveniently procured.
The Patients perform the Movements prescribed by the assistance of Dr.
ROTH or male or female attendants.
TERMS FOR       PATIENTS.
First professional consultation, One Guinea. Weekly charge for professional advice and daily treatment, either by Movements, or the Russian
Bath, or the Water Cure, or all in combination as may be required, varies
from One to Six Guineas, according to the amount of time and attention
demanded by the individual cases. For the Bath or Water Cure alone,
One to Two Guineas Weekly.
HEALTHY PERSONS, whether youth or adults, desirous of learning and
practising the Exercises especially invented by LING for the healthy, with
a view to the strengthening and developing of the body and the improvement of the figure, meet twice or four times a week in classes, Ladies and
Gentlemen separately.
TERMS FOR HEALTHY PERSONS IN CLASS.
Meeting twice a week, One Guinea and a Half per Month; Four Guineas
per Quarter.  Four times a week, Three Guineas per Month; Eight Guineas
per Quarter.




DR. ROTH'S INSTITUTION,
21, GLOUCESTER PLACE,
BRIGHTON,
ESTABLISHED FOR THE TREATMENT OF
ffnrmit'i6          r       mangq     trainnin      Wmnmtf,
AND IMPROVEMENT OF THE FIGURE, BY I0VEM2ENTS,
ANiD FOR TH
BY SCIENTIFIC EDUCATIONAL GYMNASTIOS,
OPEN DAILY, FROM      NINE A.M. TO FOUR P.?.
'For instruction in rational educational Gymnastics, classes, of various
ages, will be formed, as the movements taught and practised vary according
to the age of the pupils. Rational Gymnastics tend to the harmoniowa
development of body and mind, and every one must first learn the elements,
after which the instruction proceeds by degrees; the classes for healthy persons are conducted by Dr. ROTH's assistants.
No child or adult having any deformity, or labouring under
any disease, can be admitted to these Classes; for such persons
the Exercises performed might be highly injurious, and therefore special movements, suited to the individual case, are pre-, scribed.
TERMS FOR HEALTHY PERSONS, PER QTUARLER.
For Two Hours Weekly.
CLAss I. Children, not exceeding the age of eight, One Guinea and a Half.
",, II. Children, from eight to twelve     Two Guineas.,, III. Youths, from twelve to sixteen  ),, IV. Persons of any age above sixteen, Two Guineas and a HalF.
For Four Hours per Week the Terms are Three, Four, and Five Guineas.
The use of the Apparatus is included, and no extras whatever are charged.
Loose Dresses, not interfering with the various Movements, are indispensable,




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.




THE


PREVENTION
OF
SPINAL DEFORMITIES,
ESPECIALLY OF
LATERAL CURVATURES,
WITH NOTES
ON THE CAUSES, THE ARTIFICIAL' PRODUCTION & THE INJURIOUS
MODES OF TREATMENT OF THESE COMPLAINTS,
With Numerous Illustrations.
BY
MATHIAS ROTH, M.D.,
Physician to the Private Institutions for the Treatment of Chronic Diseases and Deformities
in Old Cavendish Street, London, and Gloucester Place, Brighton,
Author of the " Handbook of Movement Cure," and other Works on Medical Gymnastics.
[EXTRACTED FROM THE British Journal of Homaoopathy, No. LXXVI.]
PUBLISHED BY
GROOMBRIDGE & SONS, 5, PATERNOSTER ROW, LONDON,
HENRY TURNER & CO., 77, FLEET STREET, E,C.
1861.




LONDON: W. DAVY AND SON, GILBERT STREET, W.




INTRODUCTION.
I BELIEVE that the highest aim of medicine is the lnrevention
of diseases; and when this cannot be accomplished, that the
patients should be relieved or cured by hygienic means
alone, but not by medicines and surgical appliances as long
as the hygienic means suffice to attain this aim.
Having acted, and I may say not unsuccessfully, on this
principle for twenty years, I wish to induce my younger
professional brethren to act in a similar way, although they
may find it very difficult to give up the prejudices with which
they have been imbued during their studies, when the
majority of them have had no opportunity of observing the
beneficial influence and curative effects of air, water, exercise,
and dietetic regimen in general, properly used and carefully adapted to the individual cases. Many medical students,
having worked very hard in order to pass a good theoretical
examination, and having obtained their degree without a
previous practical instruction in the preventive treatment of
some chronic complaints which have never been admitted to
the wards of the hospital, are in the beginning of their
practice, very much puzzled what to do when their advice
and assistance are required in complaints they have never
seen.
Spinal curvatures belong to those complaints which are
not admitted to general hospitals, yet require special attention for their treatment; and although not every young
practitioner can make them a subject of peculiar study, he
should at least be acquainted with the causes and the mode
of the artificial production of these deformities, that he may,




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.




TABLE    OF   CONTENTS.
Sect.                                                        Page
1. Definition of Deformity.....  1
2. Development of Deformities....     1
3. Varieties of Curvature-Lateral Curvature  -      -      -  1
4. Secondary or Compensatory,,           -      -     2
5. Anterior and Posterior,,       -      -      -  3
6. Complicated Curvatures.....     4
7. Development of Muscular Lateral Curvature -      -      -  4
8. Abnormal state of the Muscles is the cause of many Lateral
Curvatures-......         5
9. Causes of other (not Muscular) Lateral Curvatures    -     5
10. Description of the most frequent Lateral Curvature, known as
Scoliosis habitualis....-              6
11. First stage of Muscular Lateral Curvature     -     -      7
12. Second,,,,            -      -      -  8
13. Third                                  -      -      -    11
14. Causes predisposing to Spinal Deformities  -     -      - 11
15. Opinions of MedicaI Authors on the Predisposing Causes of
Spinal Deformities.....     12
16. A Weak Constitution is the Principal Predisposing Cause  - 12
17. Idiopathic Causes -.     -      -.           -     -     13
18. External (Occasional) Causes....- 13
19. Some E ternal Causes during Infancy and Childhood    -    14
20. External Causes Injuring Girls beyond the age of Childhood - 14
21. (a) Tight Lacing......     15
(b) Ignorance of Mothers and Governesses  -     -      - 15
(c) Positions which are not lady-like.-..            15
22. (d) Mental Overexertion....- 16
23. (e) Sad Effect of too much Brain-work and Want of Exercise  16
24. (f) Forcing, or Hot-House Production of Diseases and Deformities during Education  -..... 17
25. The Rules and Regulations of an Educational Institution, from
the Report of a Patient...... 17
26. The Cramming System is very general....-23
27. The Injuries produced by Cramming the Girls are not suffi.
ciently known...... 24




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




viii.
Fig.
10. Six outlines of dorsal transversal sections of scoliotic patients
11-12. Six outlines of longitudinal sections of the same patient -
13. Longitudinal section of the body in its normal state
14. Transversal section and bird's-eye view of the same -
15-16-17. Posterior, lateral and transversal aspect of a girl of
fifteen affected with right dorsal and left lumbar curvature18-19-20. Posterior, lateral and bird's-eye view of a needlewoman, eighteen years old, suffering from lateral curvature in its second stage  -    -      -      -      -
20a. Inspection of spine      -      -      -      -      -
21. Bad position of a school-girl who stands while saying her
lesson        -      -      -      -      -      -
22-28. Bad and good position of a girl while standing  -
24. A volunteer with a right lumbar curvature, and with the
right shoulder higher than the left   -      -      -
25. A needlewoman in her usual bad position, while at work -
26.,,        a good position,
27. Injurious position of a girl working at the frame
28.,,,,     while ironing    -      -      -
29. A young girl affected with lumbar curvature produced by
carrying a baby  -      -       -     -      -      -
30. Bad position of a boy sitting on a form while reading
31. Good position of a boy sitting on a chair with a back
32-33. Bad and good position of a young lady while reading
34-35.,,,,,    writing -
36- 37.,,,,,,    drawing     -
38-39.,,,,,,    practising on the


Page
8
8
9
9
10
10
34
59
59
60
61
61
62
63
64
66
66
66
67
68
69
70


40-41.
42-43.


piano
back


t, r,,,    playing the harp,,   riding on horse

-


44-45.,,,
46. Chair with reading desk     -      -
47. Chair used as a couch    -      -     -
48. Outline of the Venus of Medicis
49. Outline of a woman compressed by stays
50. The natural form of the chest
51. Deformity of the chest caused by stays
52. The natural form of the spine
53. Spine deformed by stays         -     -


-   -       -  71
lying in bed -      72
-   -       -  73
-      74
-   -       -  78
-     -      78
-   -       -  79
-     -      79
-   -       -  80
-     -      80




ON CURVATURE OF THE SPINE, &c., &c.
1. DEFINITION.
ANY unnatural state, or irregularity of the shape or form is
called deformity;-(the following remarks do not refer to such
irregular forms as are produced by swelling, and diseases of
glands and soft parts which may occur anywhere in the body)the term deformity is here restricted to the abnormal forms of
the joints in general;-deformities of the spine usually affect
simultaneously several intervertebral joints, and thus one or
more curves are produced; hence deformities of the spine are
usually called spinal curvatures.
2  MODE OF DEVELOPMENT OF DEFORMITIES.
The process of the development of deformities of the limbs is
analogous to that of the spine; without an actual disease a
single joint changes its form, as the bones (which constitute the
joint) approach each other on one side of the joint while a proportionate removal of these bones takes place on the opposite
side; thus when two vertebrce forming a joint approach each
other on one side, and if a similar process takes place in several
contiguous joints of the spine, a curve is produced with the convexity on that side where the vertebrm are removed from each
other, while the concavity of the curve is on the side where the
vertebra3 approach each other.
3. VARIETIES OF CURVATURES.
Lateral Curvature.
When we look at the back of a healthy person in an crect
position the spine shows a straight line as in fig. 1; suppose
B






On Curva ture of the Spine,


that two or more dorsal vertebre are permanently (not momentarily as in a physiological flexion of the spine) removed from
each   other on the right side, they      must approach     each
other on the other side, and form a curve as seen in fig. 2,
I (
2. Right dorsal lateral
1. Healthy spine.                       curve.
which represents a primary lateral curvature usually called
right dorsal curvature; a similar curve in the lumbar vertebre
vwhich are diverging from  each other on
the left side as seen in fig. 3, forms a primary left lumbar lateral curvature; the
distinction of "right or left" applies to
the convex side of the curve; both are
lateral, because the deviation of the spine
from  the straight line is either to one
or the other side, and the curves illustrated by figqs. 2 and 3 are primary to
distinguish them from   the secondary or
compensating curve, which takes place
Left               later and is then a necessary consequence
3. Left lumbar lateral cur- to the first.




by Dr. Roth.


3


4. SECONDARY OR COMPENSATORY CURVATURE.
An upper or dorsal lateral curvature does not, and 'cannot,
remain for a long time stationary without being compensated by
a second curve in the lumbar vertebrae;
the convexity of the secondary curve is
always on the side opposite to the convexity of the upper dorsal curve, in order
to keep up the balance of the body, and
r    \ -    hence the secondary curve is called compensatory or compensating curve; if the
lumbar curve is the first (primary curve)
the compensation takes place in the upper
(dorsal) vertebrme.  The compensating
curve is usually co-existent with a twist
of the spine, around one or more parts
4       n   of its longitudinal axis. In fig. 4 a
4. Secondary or compensatory curvature,  secondary dorsal curve is seen.
5. ANTERIOR AND POSTERIOR CURVATURE.
Fig. 5 represents the lateral view of the normal and erect
spine; with the natural curve of the cervical
vertebrae and the convexity forwards; the second
(dorsal) curve forms with its convexity the outline of the back, the third (lumbar) curve with
the convexity forwards form what is called the
small of the back, and the lowest or fourth curve
with the convexity backwards is in the lowest
part of the spine, and extends over the chine
bone (os sacrum).
If any of the four normal curves just named is
increased or diminished in its natural extent,
either an anterior or posterior curve is formed,
and the vertebrEe are removed from each other
5. Lateral section of healthy either forwards or backwards, when the convexity
spine.      of any of the curves increases.




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




10


On Curvature of the Spine,


ments in the respiration, circulation, and digestion are more
frequent in this stage.
The following figures represent various stages of lateral
curvature, the transversal section of the projection of the shoulder
blades, with lateral outlines of the corresponding curves.
15             16


L
-y


17


18


19


20


15, 16, 17, 18, 19 and 20. Lateral curvatures in the beginning and end oF second
stage, with posterior aspect, lateral and bird's-eye view.
Fzqs. 15, 16, 17, is a girl of 15 years, fair, of nervous constitution; the curvature came on for several years without any
known disease; a particular awkwardness only, was observed
whilj;wailkig       s.




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.




by Dr. Roth.


13


eases, and having examined or treated more than six hundred
cases of lateral curvature, the predisposing cause is in the
majority of cases a weak constitution. This is either congenital
as in children of old fathers, or of tuberculous, anaemic, and
scrofulous mothers, (which is less frequent,) or produced by
acute or chronic disease, by bad assimilation, by want of proper food or by overfeeding, by neglect of attention to the most
simple hygienic influences, by antemia or chlorosis, by bodily
or mental overexertion during the period of growth, mechanical injuries, &c. I admit that many occasional causes, if
acting for a long time on the healthy body, can also produce
curvatures, but this effect will be always very slow, while the
same injurious influence will soon produce its effect on a weak
constitution.
17. IDIOPATHIC CAUSES
Are all complaints of the component parts of the spine, of
the spinal chord and its membranes. The vertebrae, the cartilages and intervertebral cartilages, ligaments and muscles, with
the various synovial and other membranes, can be congested or
inflamed either spontaneously or by mechanical injury. Some
of the parts mentioned are sometimes diseased by gout, rheumatism, or other complaints.
18. EXTERNAL (OCCASIONAL) CAUSES.
Among the external causes which promote the development
of spinal curvatures in weakly constituted persons, are bad
positions while lying, standing, and sitting, and during various
occupations, as sewing, writing, drawing, reading, playing the
piano and harp, i'iding on horseback, and many trades, &c.
Thus, occupations during which our shoulder blades and arms
are raised will tend to develop the primary dorsal vertebrae;
while standing on one leg, crossing the legs, sitting on one
side of the seat, leaning on one hip, &c., will help the development of the primary lumbar curvature. To this class of causes
belong also tight dresses, stays, corsets, and bodices with steel,
whalebone, or wooden busks, injuries and diseases of the limbs,
hip disease, and paralytic affections of the lower extremities, especially when accompanied with retarded growth of the limb.




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




18


On Curvature of the Spine,


also clothes classes, under the care of certain ladies. The
French and German languages were the only foreign ones
taught; the former was obliged to be learnt by all the pupils,
the latter was considered as an extra part of the education.
Music was learnt by nearly all the pupils, and drawing by about
forty pupils. Those who were past fifteen, were, if they wished it,
allowed to learn singing, which was taught by a lady, and practised between lessons with the governesses. Harmony lessons
were given to a few pupils once or twice a week for two hours;
one of which was given to each of the two divisions into which
the pupils were divided. Those who did not learn dancing were
obliged to have two hours drill in the week, which was with
chest-expanders, and other exercises, without the fun or dancing
part.'
" In the summer, and generally in the winter also, we rose at
six o'clock, when a bell rang which awoke all the house, and
the governesses set over the different dormitories, went round
them to see that all the sleepers were up. Perfect silence, however, was obliged to be kept by all. At five minutes to seven a
bell was rung, at the sound of which all had to leave their
rooms, and by seven o'clock all were obliged to be seated at
their clothes' classes-still quite silent-when they were examined by their governesses to see if they were properly dressed.
"At a quarter past seven another bell gave notice that breakfast was ready; and directly it left off ringing, the classes were
called out one after the other to go to the dining-room. But
not a word was allowed to be spoken all the time. There were
six long narrow tables which stretched from side to side of the
room, and three governesses had their settled places at each.
At the end of breakfast, books were sent up to the head governess from different teachers, containing all the breaches of rules
committed by the pupils individually the previous day. This
was the most disagreeable thing in the Institution--as all
the governesses as well as the pupils were present. After all this
business was over, we rose from table and went quite silent into
the school-room, one by one, for prayers. As soon as all were
seated a bell rang, and the governess who read the "reports"
at breakfast came in to read prayers. There was a nice organ




by Dr. Roth.


19


which was played, and we sang a hymn before reading. After
prayers the classes were called separately to go to their proper
places in the room for a half hour's Scripture class, when we
repeated what we had learnt the day before, and, if there was
time, read a chapter of some special book in the Bible, which
was being studied by all the classes for the half year examination.
At half-past eight we generally rose from the class and were
allowed to do what we liked till ten minutes to nine. The first
and second classes if they even had time to talk then, though
lessons which we had not had time to finish had then to be
hastily and therefore imperfectly done, were obliged to talk
French or German, as English might only be spoken by
them a few minutes after dinner.
"At ten minutes to nine another bell rang, at which perfect
silence was resumed; the room was prepared by the monitresses
(the girls in every class take turns by the week to keep the
rooms in right order, and attend to the wants of the class), and
at the sound of the nine o'clock bell all those who were not
seated in their proper class places had their names put down,
for "not in place in time;" for which, after the report was read
next day, they lost a certain number of conduct marks. A bell
was rung every half hour for the music pupils to know when to
leave off practising or to go to it or music lessons, as some of
them practise for an hour, and others for an half hour at a time.
Every hour all the classes change lessons.
" Generally from 12 to 10 minutes to one they either go out,
drill, go to dancing, knitting, or some other lesson, and as some
teachers were kind enough to give their lessons half-price,
there was no wonder our staying in to go to them. Besides we
liked it, for if we did go out, we either taught each other some
lesson, or else had to talk French. Our walks were sometimes on the downs, now and then on the beach in very hot
weather. After August we bathed each about three times in a
fortnight, if we liked it; and the rest of the year it was arranged
that we should each have a tepid bath once a week, the first and
second classes in the morning, getting and emptying the water
ourselves, and the little ones had warm baths at night.




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




24


On Curvature of the Spine;


made an abstract of her report, I find that the daily mental,
work, including music lasted........ 10 hours
Time for meals............  2,,
Time for dressing, washing, and mending clothes................  1,, 30 min.
Time for speaking English........  0,, 50,,
15 hours.
I leave it to others to make remarks on the silent systemz
which is considered a great punishment for criminals in our
prisons, but is certainly not a very cheering influence for young
girls whose brains have been overworked. Since this was written
I have examined another girl placed in the same institution,
whose spine is considerably curved; and as circumstances do
not permit her being removed, there is not the slightest doubt
that she will be very soon crippled, while mentally benefiting
through the instrumentality of the philanthropic founder of the
institution. Being an orphan her friends take care of herthey wish to train her for a governess-but how can she be
able to fulfil conscientiously the heavy duties which will be
imposed upon her if she is already crippled during her apprenticeship?
The Injuries, produced by Cramming the Girls, are not
sufficiently known.
27. As long as parents and guardians are ignorant of the injurious and lasting effects of cramming their daughters and
wards, whom they desire at the age of 16 or 18 to be possessed
of all the accomplishments required by the present fashion, even
those very few lady-superintendents of educational establishments
and governesses who know the value of good health and'a sound
body, are obliged to give way to their ignorant employers, because the young lady is either placed in another institution orthe governess is changed.
Mothers, Governesses, and Schoolmistresses should be taught
how to preserve the health of those who are placed under
their care.
28. Being convinced that the prevention of many chronic diseases and spinal deformities 'among the working and other
classes does not depend upon medical men only, but especially




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.




26


On Curvature of the Spine,


29. PUPIL-TEACHER'S WORK.
(Extract from the report of a School-mistress.)
"Meet at 7 A.M.; listen to lesson given by the mistress, or reproduce those previously prepared till 8-45.  Then arrange
school-room; open school; recommence at 9; teach till 12;
close; meet again at 1-30; teach till 4; close.
" Pupil-teachers' home work will require two hours study each
evening. Lessons given to the children will require about four
or five hours on Saturday. The rest of that day being often
occupied in regaining the tim'e lost through inability to study
sufficiently during the week. On Sunday all attend the school,
and take the children to church both morning and afternoon.
"It need scarcely be added, that from fifteen to twenty minutes
must necessarily elapse between the dismissal of the children
and that of the teachers.
" The subjects of instruction include-scripture, arithmetic,
school management, grammar, domestic economy, geography,
history, and a considerable amount of general information, to
enable them to give lessons to the advanced classes.
" In winter the teachers meet at 8 A.M., and remain to
4 or 5 P.M.
" Age of pupil-teacher.-Thirteen years is the lowest age at
which a pupil teacher can be apprenticed; sixteen the highest;
the period of service is five years.
" No information on health, dress, food, air, exercise, and other
matters concerning the preservation of health is given; a
knowledge of the contents of a small book on Domestic Economy-almost silent on the means of preserving health - is
deemed sufficient for this subject. I have attempted to impart
such information as has been gained by contact with sickness,
my own ill health, and by reading.
"No exercise is obligatory.
" The dress of pupil teachers is managed by their friends:
three out of four wear stays. Nearly all wear high heels.
" Pupil-teachers sit very little while the children are in
school; when they do, in nearly every instance on a seat without a back. Their work necessitates much bending forward,




by Dr. Roth.


27


both of the body and head; there is also a great tendency to
raise the shoulders.
"Pupil teachers' health in these schools very imperfect. Very
rarely indeed all can work at once. Suffer from extreme weariness, an aching sensation in the chest, and continual headaches."
We find here also about ten hours' obligatory daily mental
work, and the pupil-teachers who wish to get a good certificate
add one or two hours more daily in crowded and badly ventilated school-rooms; they are easily predisposed to many complaints, amongs which spinal curvatures are not the least numerous.
30. OCCASIONAL CAUSES OF CURVATURES IN YOUNG MEN.
Young (especially military) men are sometimes foolish
enough to make their appearance with a small waist; tight belts
laced or buckled across the lower part of the chest and across
the loins, substitutes for the stays of girls. As young men lead
a more active life, and have open air exercise, this counteracts
partly the bad effects of the belt on the strong, but does not
prevent the weak from acquiring a predisposition to lumbar
curves. Too much drilling, and carrying the rifle always on
one side, has caused pain and increased a slight lumbar lateral
curve in a young man over zealous in his exertions as a volunteer; the predisposition was due to a mechanical injury in
boyhood. It happens often that carrying a burden for a long
time and always on the same side increases lateral curves in the
adult in the same manner as in weak nursery girls, who carry
young children always on the left arm.*  Reading in a stooping
position for hours daily during the last few months before their
examination, also considerably increases slight curvatures in
young men.
31. THE PREDOMINANT USE OF THE RIGHT ARM ERRONEOUSLY
CONSIDERED AS A CAUSE OF RIGHT LATERAL CURVATURE.
"The predominant use of the right arm is frequently accused of
being the principal cause of the right (dorsal) lateral curvature,
that is, where the convex side of the curve is on the right side
* See note on nursing children, ý 75, and on standing Fig. of volunteer, ý 71.
D2




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.




by Dr. Roth.


29


many of the patients come much later under treatment, the
complaint can be traced to the age I have mentioned; under
the age of seven, and even in the first year, kyphosis occurs as
a symptom of rickets or of tubercular destruction of the vertebrEe. The following table is copied from Eulenburg's statistics of 304 cases of scoliosis, classed according to age:
Age.                  Cases.             Per Cent.
1  year.................  2...................  0 66.
2  to  3....................  3....................  1.00.
3,,  4....................  8....................  2 66.
4,,  5....................  5....................  1 66.
5,,  6....................  8.................   2"66.
6,,  7................7..   71..................  23"66.
7,,  10................  159.................  5300.
10,,  14...................  38................  12 66.
14,,  20....................  7....................  2"33.
20,,  30........................................  1 00.
33. NEGLECT OF TREATMENT AND INJURIOUS TREATMENT.
The belief that spinal curvatures in the first stage can improve without special attention and treatment is erroneous.
I have but too frequently occasion to observe the bad and
frequently irreparable consequences of such a mistake on the part
of medical men, by which parents are encouraged to neglect
the treatment of this complaint at a time when still perfectly
curable. Not only general practitioners, but eminent surgeons
and physicians considered to be at the head of the profession,
believe it too insignificant to pay much attention to a slight
degree of lateral curvature; they take scarcely the trouble of
examining minutely these cases; and look at them only superficially while the patients are placed in a stooping position,
and if the spinal processes do not much project in this position, a favourable opinion is given, and the patient advised
either to  do  nothing, or, as a celebrated surgeon is in
the habit of saying to the mothers of girls affected with
an incipient lateral curve, "let your daughters hang on the
door,"-which advice is accompanied either by a prescription of




30


On Curvature of the Spine,


aperient pills, or of a mixture containing iron or bark, and not
the slightest notice is taken of the patient's habits, mode of
life, etc.
84. TREATMENT BY MECHANICAL SUPPORTS.
Some medical men are satisfied to mark with ink every spinal
process, while the patient's spine is considerably bent forward,
and to look at the direction of these black spots while the
patient is erect; if the line is not very crooked, not much
notice is taken of the curve, which is left to nature for improvement, although it gets generally worse, when another medical
man, vulgarly called a spinal doctor, is consulted, whose
invariable practice is to order for the patient a mechanical
support, more or less expensive according to the circumstances of the patient; this support consists of a steel
band fastened on the hips, which band serves as a point of support for two crutches placed under the arm pits, while moveable
steel plates are fixed to the verticals of the crutch to press
upon the projecting ribs or shoulder blades. If the crutches
raise the shoulders they scarcely diminish the weight of the superincumbent spine upon the curve; if the steel plates press hard
on the projecting ribs or shoulders (which projections are only
the effects of the disease), these parts are partly absorbed, and
the double object for which the support and pressure is prescribed is not obtained, but more injuries added to those
already present.  (See ~ 66.)
85. SAD EFFECTS OF THE TREATMENT BY VIOLENT PRESSURE.
Other spinal doctors condemn their patients to a constant
horizontal position, with daily friction and pressure of the
projecting part; this pressure is done very violently, and the
following is an extract from the letter of a patient treated in
this way, addressed to her friend, who gave me this letter:
"My wretched bones were pressed on Tuesday for the first
time, and though he only pressed with his hand for about three
minutes, the effect no one would believe; all the strength I had
has gone, almost; a general sensation of dislocation pervades
the system, and exhaustion unto fainting if I remain on the




by Dr. Roth.


31


couch. I feel now sure that I am not anything like strong
enough to bear this. Say nothing about this, nor by letter, I
implore you, as I feel I must give up. I feel as though I had
been thrown off my horse on to a mass of flints backwards,
when I am carried from the bed to the sofa. I say nought.
Pray the Lord for me that I may be led to do, in submission to
his own will, that which he alone approves. I cannot endure
this, for the exhaustion is oppressive, that is evident."
This patient, although very soon removed to the seaside,
wanted many months for the recovery of that amount of strength
which she had before undergoing this, as it is called, mild
treatment, because its advocates compare it with the following.
36. TREATMENT OF CURVATURES BY MECHANICALLY STRETCHING THE BODY IN ORTHOP1EDIC MACHINES.
The patient lies horizontally on an orthopmdic bed, in
order to be stretched for hours by the most ingeniously contrived machines, pulleys and screws, etc. In other cases, the
stretching is performed with the help of machines while the
patient is sitting or lying on an inclined board, or standing, or
walking in a circle; in all these positions the patient's head is
pulled with the help of a collar surrounding the neck and
throat in the direction of the longitudinal axis of the body;
sometimes an apparatus under one or both shoulders, to help
the elongation of the spine, is combined with the collar. Those
who wish to know more of this injurious mode of treatment, I
must refer to the works of French and. English orthopedic
practitioners, and to those orthopmedic institutions in which these
means are used.
Other medical men, without any knowledge of the complaint,
call a slight curve a trick, a bad habit, want of attention to a right
position, laziness, etc., which confirms the parents in their opinion
that there is nothing the matter with their daughters, and the aid
of the drill-sergeant and the dancing mistress, etc., are again put
in requisition, till another spinal doctor recommends the lying
on the prone couch, and the patient is recommended to practise
the most violent exercises with the arms. There are special
private and public institutions devoted to the treatment of




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




34


On Curvature of the Spine,


round the neck and hangs loosely down the chest); the examiner places his feet along the external edge of the patient's
feet, and fixes with his knees those of the patient, fig. 20a,
A4        or they are fixed by a second
Sperson kneeling before the
patient, whose hips, which
are often twisted, are placed
in a straight line, and fixed
S   therein; the object of this
Sfixing is to give the patient
a firm and straight basis, so
that the slightest inclination,
deviation, or twist of the
spine can easily be observed;
_                 the patient leaves, at first,
Sthe upper part of the body
20a. Inspection of spine.  (viz., that above the hips),
in its usual position, without any effort to show  his body
more erect, or straight, than he is habitually; while thus
placed, we must look whether the position of the head is normal,
or whether it is bent or turned in any direction; the two outlines from the head along the lateral sides of the neck down to
the passive and hanging   arms, which   are carefully compared with each other; the relative position of the shoulderblades is to be watched with regard to their height, projection,
and distance from the spine; the distance of the arms from the
body on both sides, and the difference of the shape of the
space between body and arms compared; the outlines of both
sides of the thorax, of the posterior and lateral part of the ribs,
and the transversal lines formed by the ribs, as well as the line
of the spinal processes, and the muscles of the back must be
inspected, not only while the patient remains passive, but also
while he is doing various movements with the head, arms, and
trunk, and  still without special endeavour to stretch the
spine.
Only when this part of the examination is finished the patient
must be encouraged to stretch his body, and to elongate his spine
when he goes again through the various sijpple movements.




by Dr. Roth.


35


The difference of the outlines on the two sides of the spine and
body is very striking where only a slight deviation exists, and
even the unpractised eye of an attentive observer will soon find
it out.
42.   SOME MOVEMENTS USEFUL.FOR THE DIAGNOSIS OF
CURVATURES.
The movements which are most useful for the examination
are-I. A slow and alternate flexion of the head forwards and
backwards, and from one side to the other; also a slow turning
of the head to one side and then to the other, while the rest of
the body remains immoveable.
II. Raising of the arms slowly to the height of the shoulders,
first forwards, and afterwards on both sides of the body; also
stretching the arms in a vertical direction to their full extent
upwards and parallel to each other; some rotatory movements,
during which the arms describe a curve, the basis of which is
gradually increased in circumference; the head and body remain
immoveable, while one or both arms are moved in the directions
just named.
III. The patient bends the trunk slowly forwards, backwards,
and sideways; he twists the body while in the vertical line from
one side to the other; the examiner fixes the hips during the
various trunk movements, so that the lumbar part of the spine
should be brought into action. Sometimes it is desirable to
resist the patient slightly while he is trying to execute a movement, in order to find the weak muscles or the irregularity of
the form.*43. INSPECTION OF SPINE CONTINUED.
This is not the place to enter into the details of the changes
which are produced by these few movements in the various
forms and stages of spinal curvature; my object is only to call
the attention of the examiner to an easy mode of making a good
"* These three groups are illustrated and fully described in The Cure of
Chronic Diseases by Movements, and in the translation of Rothstein's The Free
Exercises, by Ling; published by Groombridge & Sons.




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




by Dr. Roth.


37


Ling. If casts, in plaster or gutta percha, are to be taken, I
would advise my professional brethren to employ very skilful
and practical workmen-the quicker such a cast or mould is
taken the better it is-because it is difficult for the patient to
remain for some time motionless; even deep breathing and
speaking is often a cause of failure, as the position of the
thorax and of the ribs is changed, and interferes with the
solidification of the plaster.
45. PROGNOSIS.
Every lateral curvature while in its first stage predisposes
to the second and third stages, and is never cured without
treatment; unfavourable circumstances acting injuriously upon
the general health, bad positions kept up for a long time, acute
and chronic disease, hasten (in females quicker than in males)
the progress of the complaint.
The muscular lateral curvature in its first stage is always
curable, if the suitable treatment is not delayed, and if the
patients are able to do all that is required for their benefit;
when the second stage is fully developed, the curvature can be
very considerably improved, but rarely perfectly cured; while
in the third stage the improvement of the form which can be
obtained, shows itself more in the secondary and tertiary curves
and the general health; the diminution      of the painful
symptoms which I have named as the consequences of the
highest degree of deformity, is here the principal object of the
treatment. The other (not muscular) lateral curvatures do not
admit such a favourable prognosis.
In kyphotic curvatures, which frequently occur in rickety
children in their first year up to the sixth, or in children of
tuberculous parents, or in adults suffering from caries of the
vertebrae, the prognosis is always bad, because tubercular
infiltration takes place in the body of the vertebrae, and destroys
it, or the want of osseous matter prevents in rickets the firmness
and the right form of the vertebra; caries destroys the body of
one or more vertebrae; in all these cases the happiest termination is ankylosis of the vertebrae, and the deformity is the




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




by Dr. Roth.


39


disease, and if no suppurative process prolongs the disease for
many years.
47. THE AIM OF THE MEDICAL TREATMENT OF CURVATURES
is to prevent the development of the spinal curvature as soon as
the predisposition to this complaint is observed; to cure it in
its first stages, or at least to improve where the cure is beyond
our power. Circumstances frequently prevent the patient from
being placed at the right time under any, or a rational treatment, while neglect of the complaint, or its injudicious treatment continued, in hope of a recovery, for years, with much
perseverance, increases the curvature to such an extent that
neither a cure nor a considerable improvement of the deformity
is to be expected. In these cases our object will be to arrest
the further progress of the disease, and to relieve the painful
symptoms it has caused.
Prevention is only possible when the causes of the threatening
curvature can be removed, while a real cure, even after the
removal of the causes, can be only effected when the deformity
is not too far advanced.
48. THE PREVENTIVE TREATMENT
begins properly with a rational rearing of babies and infants,
and a rational physical training of children, youths, and
adolescents; it is essential to attend, from the first infancy
during the various stages of growth, to a few elementary hygienic
rules, which, because they appear very simple, are generally
neglected, although they are the only real means for preventing
many diseases.
49. FIRST RULE.-TO PROVIDE, DAY AND NIGHT, A CONSTANT
SUPPLY OF FRESH AIR.
In nurseries, bedrooms, dormitories of public and private
educational and other institutions, much is still to be desired
respecting the sufficient supply of fresh air. Perforated glass
or zinc plates are the best ventilators, and also those which are
constantly open, and can never be entirely shut. I have visited
lately the day-nursery of a metropolitan workhouse which,
although abundantly supplied with ventilators in all parts, was




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,




by Dr. Roth.


with tepid or cold water, of the whole body precedes the general
friction. Very weak patients are not washed all over at once,
and are well covered after the washing to assist the production
of warmth and comfort.
51. THIRD RULE.-ATTEND STRICTLY TO THE QUALITY
AND QUANTITY OF FOOD.
The Food must be simple, and not too much seasoned or
spiced. Hunger must induce to eat, but the appetite must
not be artificially stimulated by bitter and similar substances.
A mixture of animal and vegetable food is the best. Water
and milk is the usual beverage; sometimes a glass of wine or
beer is given, but I have never recourse to brandy or rum.
The meals should be taken at regular hours, and the principal meal during the middle of the day, at 1 or 2 P.M. Three
meals a day are sufficient; children under three years may
have a fourth meal. Bad assimilation amongst the poor is
often the consequence of scanty and bad food: while the rich
suffer frequently from the same complaint by eating too
often, too much, and too rich food. The different quality of
food can be made use of as a means of counteracting some
symptoms-thus, where the action of the bowels is sluggish
and the digestion not deranged, brown unfermented bread and
oatmeal porridge will be useful; mix wheatmeal (with all the
bran it contains) with water and salt in the requisite proportion,
have it well kneaded for five or ten minutes in order that a sufficient quantity of air may be taken up by the dough, and when
well baked it forms a very savoury brown bread, containing all the
gluteiL of the wheat, counteracting the predisposition to constipation, and it is much more liked than the white bread, and
does not produce acidity or flatulency.  The brown bread,
according to Dr. Dauglish's process, is also good, but cannot
be had always and everywhere. The white of an egg mixed
either with milk alone or with the addition of a small quantity
of cream, given to weak and rickety children three or four
times a week is very useful. Every practitioner can and must
prescribe such food as is most adapted to his patient's constitution and complaint.
E




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.




by Dr. Roth.                    43
cotton or horsehair, covered with silk or chamois-leather,
corresponding to the shape of the hollow of the foot, the sole
of the shoe having a thinner and moveable middle-piece adapts
itself to the shape of the foot, and as the pad raises slightly the
middle part. and. internal edge of the foot, the boot (which
reaches above the ankles and is laced in front) assists the foot
at every step, and brings it into a more normal position. I
have elsewhere * mentioned the bad effects of high as well as
of small heels.
Stockings with toes are preferable, because they would
prevent the toes from bending, and thus diminishing the basis
of the foot; while corn-cutters, chiropodists, and foot-doctors
would be less wanted.
-54. Boys and men should leave off tight hats, stocks (which
produce headache and other disagreeable symptoms in the face
and head), tight belts, and braces (the two last compare in their
effects with shoulder-straps and corsets); trousers fastened by a
half circular band in front, an elastic and strap on the sacrum.,
made on the same principle as the bands of petticoats, will
answer all purposes without interfering with tbe digestion, by
pressure on the stomach and abdomen.
55. FIFTH RtULE.-AVOID BAD POSITIONS.
Avoid during the usual occupations of life, but especially
during the period of education, such positions as contribute to
the development of the predisposition to curvatures., or increase
a beginning curvature. By looking on the engravings of the
bad- positions drawn from life, and which I have chosen because
they are very frequently observed., it will be easily understood
why they have such an injurious influence on weakly constituted persons, especially on growing girls-and why those who
are suffering even from the slightest curve, must be constantly
watched, that they may not choose these bad positions, which
they do unconsciously and involuntarily.
* Cure of Chronic Di-sease bykXMovements, on Dress, p. 260.


E 2




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



by Dr. Roth.


45


stituted in all its earnestness and rigour for six hours a day.
School is not a place where labour is united with play; and
application with pleasure, but one for labour and application
only. When boys, however, return from school they are usually
permitted to exercise themselves freely, and to find for themselves opportunities of making their bodies strong, flexible, and
healthy; but this is not the case with girls, they must bear
themselves from infancy with the strictest propriety, and their
out-of-school hours are therefore employed in sitting occupations, such as reading, writing, and sewing. The only recreation
permitted them is playing with toys, which neither rouses the
mind nor exercises the body.    As girls become older, the
requirements of the school become greater; lessons to be done
at home diminish their leisure time perhaps by two hours. If
the girl is to be introduced into the world in her fourteenth
year as a well-endowed young lady, she must begin at least in
her tenth year to play the piano and to learn French. Thus
the lessons are spread over two hours more, and the mind is
daily occupied for ten hours, while nothing is done for the
body.
" Can we, then, wonder that in the fair sex of the present
day, especially in large towns, among the middle and higher
classes, ailments of the muscular and nervous system, deficient
development of the bones, and consequently curvatures of the
spine, glandular and scrofulous diseases, green sickness, cardialgia, fainting fits, disorders of the sexual functions, etc.,
occur so frequently! No one who does not wilfully shut his
eyes can fail to observe the evil of the prevailing fashion of
female education.
59. IMPORTANCE OF RATIONAL GYMNASTICS.
"The only preventive and remedy for this unnatural and
irrational state of things is to be found in the adoption of
Rational Gymnastics.   The only substitutes at present employed, and those at the best insufficient, often unfit, and in
many cases even injurious, and at present confined in a great
measure to the better classes, are dancing and the so-called
calisthenic exercises, while those exercises which, under the




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.




by Dr. Roth.


47:


of the complicated and delicate structure with which we are
entrusted, and force down indigestible matter as if it were fit
nourishment, exclaiming always, that nothing can be more
pernicious than to overwork the mind or body of a child?'
"*  *  *  *   Mr. Grant fully comprehended, as expressed
shortly in the passages hereinbefore cited, the necessity of
keeping the physical training  coincident with the mental
exercises for mental development, and he has provided for
exercises for the body, in his 'Exercises for the Senses of
Young Children,' in the infantile stage. I know, from conversation with him, that his views extended to the whole educational course up to manhood, and would have comprised the
health gymnastics, as developed by Ling in Sweden, and promoted by Dr. Schreber in Germany, but complete and systematised. As an example of the closeness of his observation,
where he indicates, as a probable source of the disposition to
mischief, and of the more unfavourable and troublesome of the
characteristics of town boys-the irritation of body caused by
the want of good air and active exercise-I may state that
in some large public establishments exclusively occupied by
children, where systematised exercise has been given to them in
the form of the military or-naval drill, or gymnastics, or labour
in the fields, with half-time book instruction, those unfavourable manifestationh have' been ehtirely suppressed.  Where,
however, from ignorance, the drill has been discontinued, and
the active bodily exercise has been greatly reduced, the troublesome mischief has invariably re-appeared, the premises and
bedding materials have been injured, irrepressible disorder in
the school-rooms and dormitories has arisen. But when the
active bodily exercise, by the drill or otherwise, has been
restored, and the suppressed energy which burst out in mischief
has been allowed to have vent, the mischievousness has been
invariably eradicated, and order and quiet sleep in the dormitories restored, and the work of the school performed satisfactorily. The bodily training necessary to sustain mental as
well as bodily power, and to ward off disease and pain, and
premature loss of power, will, however, lie with the physiologist
and with the physician, who has to mitigate the evils of neglect,




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.


51


ness. I could quote many instances of weak persons being sent
to an ordinary gymnasium, where they have been obliged to go
through a series of exercises 'similar to the diilling of healthy
recruits, or where everybody, according to his fancy, takes hold:
either of dumb-bells, clubs, heavy weights, ropes, climbing-:
poles and masts, &c., and does what he likes; where the'
ambition is roused to lift the heaviest weight or to carry it the
longest distance, to leap the highest, and in general to perform
the most difficult, or most daring feats. That not the slightest
notice is taken of the individual weakness in such a gymnasium
is quite obvious. The practice of such rough exercises produces
on persons who are not strong bad effects, which vary according
to the individual predisposition to various complaints; and this
abuse of gymnastics is the cause of the disrepute into which
even the most cautious scientific application of medical gymnastics has fallen.
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, ORDINARY GYMNASTICS, AND TO RUBBERS AND QUACKS.
How can we expect 'a scientific use of this branch of the
healiing art as long as medical students leave their schools
without the slightest knowledge of the existence of such a curative agent; as long as medical men believe it to be under their
professional dignity to apply personally medical gymnastics for
the prevention, relief, and cure of many chronic complaints;
and as long as the teachers of medical schools ignore the
importance of this subject.*
In consequence of this' neglect on the part of medical men,
* It is mentioned in the Medical Times and Gazette of January, that at the
University of Prague, one of the oldest in Germany, Drs. Spott and Bohn
have been appointed as' professors of the theory and practice of medical
gymnastics: it would be too sanguine to hope that the English schools of
medicine will imitate this good example.




52


On Curvature of ihe Spine,


drill sergeants, dancing mistresses, teachers of calisthenics and
ordinary gymnastics are entrusted with the treatment of what
people are in the habit of calling a high shoulder, a high hip,
an awkward walk, a stoop, a bent back, etc.; of symptoms
depending upon constitutional weakness and other morbid
causes, the removal of which requires a deeper knowledge of
the state of the healthy and diseased body, and which is certainly not to be found among the persons I have named, who
indiscriminately direct their efforts only to the diminution of
the visible and more prominent symptoms, without having the
slightest notion that the mechanical pulling and pressing down
of a high shoulder or high hip is frequently followed by a still
higher degree of a twist or curve of the spine. If the persons
just named do not succeed, as it happens in the majority of
cases, recourse is had to a so-called anatomical corset maker,
a mechanician whose epithet of anatomical impresses the
public (generally very ignorant upon everything which concerns
its health) with a particular awe, while the prevailing idea that
the human body can, like a piece of wax, be moulded mechanically into any shape, induces many people to make use of the
nicely polished spine redressers, steel supports, or of softly
padded, silk-covered corsets, hiding under their pleasant exterior steel plates, steel busks, etc.
66. INJURIOUS EFFECTS OF MECHANICAL SUPPORTS. -
All these mechanical contrivances have this in common, that
they give immediately to the dressed young ladies a better
appearance,* that they increase the weakness and inactivity of
those muscles which, instead of being strengthened, are still
more weakened and relaxed: by degrees such an effect is produced, that many of the unhappy victims, after years of
suffering, patiently passed in the vain hope of an ultimate
recovery, are even unable to turn in bed without being cased
in their anatomical corset, a name which is given in preference
* A sad advantage, but highly appreciated by the ignorant parents, who do
not mind if their daughters suffer from any other complaint, but are particularly anxious that they should not look crooked or deformed.




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




54


On Curvature of the Spine,


orthopredic, anatomical, and gymnastic machinist, advocates
gymnastics at home, because he has no gymnasium connected
with his manufacture of machines, and sells apparatus on which
exercises are most rudely performed. This is another proof
that any curative means neglected by medical men will and
must necessarily fall, into the hand of empirics.
67. PRACTICE OF RUBBERS.
If professional men would pay more attention to the pathogenesis, development and treatment of deformities, they would
not complain of their patients placing themselves under, and
sometimes being cured by, the treatment of rubbers, bone
setters, synovia dispellers, and similar classes of persons, who
promise to cure every complaint and deformity either by
the application of pitch plasters, aromatic and other stimulating
embrocations, or by rubbing the parts merely with oil and fat,
which is sometimes done for three or four hours a day. The
pitch plaster keeps up an equal temperature, and as it is first
stuck on the lower part of the spine, and then pulled upwards
all over the back and shoulders to the upper part of the chest,
it sticks to all these parts as well as to both sides of the chest,
and serves as an artificial support to some patients suffering
from  what they call a weak back; these plasters are very
roughly and quickly torn down twice or three times a week, and
the stimulating frictions applied for twenty to forty minutes
before a new plaster is stuck on. A shrewd rubber, whom one
of my colleagues calls the prince of rubbers, tells many of his
ignorant patients that they suffer from softening of the brain,
and that they must go to the madhouse if they discontinue his
treatment. Such a patient, who was pronounced to have softening of the brain, was a short time ago under my treatment,
suffered from sympathetic headaches, caused by a uterine complaint. I was also requested, a few weeks ago, to examine a
child suffering from neuralgia, who was treated for more than a
year with opiates of every kind, without the slightest relief;
the crouching position during the long period of time, has produced a lumbar kyphosis. The rubber applied, as usual, his
plaster, which produced when torn off such excruciating pains,




by Dr. Roth.


55


that the plastering treatment was discontinued. Dr. Madden
has seen with me both these cases, which I mention because
I believe it a duty to state such facts, as there are, unhappily,
amongst the profession men who believe in the wonders of such
quacks, patronize their proceedings, and thus help to maintain
the ignorance and credulity of the public. By a coincidence of
circumstances, or by some other chance, it happens that the
same medical patrons are particularly recommended by the
quacks to those patients who, not satisfied with the plastering
and rubbing process only, wish also to; have medical advice.
68. TREATMENT OF CURVATURES.
The common sense expressed in the following extract, written
forty years ago, cannot be sufficiently repeated, as it takes a
long time to eradicate prevalent errors of treatment:" When a lateral curvature of the spine has existed any
considerable period, it is so commonly accompanied by a feeble
and emaciated frame as to warrant the conclusion that some
specific disease exists; which disease is the cause or consequence of the curvature  *  *  *  *
" But what is the disease that acts upon the system? what
its nature and character?  Unless this is ascertained, and we
know the source, we shall at best but palliate, not remove the
evil.
"Plans of cure have been proposed without a reference to
the cause of the affection they profess to remedy. The eye is
struck with the fact that the spine is bent, and upon this fact,
solitary and uncombined, plans of cure have been originated.
One proposes a well-contrived machine, to bear off the weight
of the head from the part which has protruded. Another purposes to accomplish the same end by confinement to an horizontal posture for several successive months. A third recommends the carrying a weight upon the head, and, by the
exertion thus occasioned, to compel the muscles to force back
again the yielding parts to their natural position.
"As the plans of mechanicians these are certainly very
precious and appropriate  *  *  *   *  but it is evident that
theseplans only relate to the spine as having been mechanically




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.




by Dr. Roth.


57


II. The normal muscular action is restored by movements
acting especially on the relaxed muscles. The movements are put
down in the form of a prescription,which the patient goes through
either daily, or every other day, while assisted by the medical
man himself or by one of his assistants trained for this purpose.
Those who wish to know how to select the right movements for
the individual cases, and how to apply them with regard to
time, quantity, intensity, I must refer to the various publications on rational medical gymnastics or movement cure.*
The study of this branch of medical science will convince them
how the present empiric application of exercises, on the polymachion, on the portable gymnasium, or on similar mechanical
contrivances, and the calisthenic treatment on   continental
and other principles, must prove very 'injurious in spinal curvatures, which require for their treatment, not merely mechanical
or automatic exercises, but all the means suitable to counteract
the causes which have impaired the general health.
III. In order to arrest the further increase of the curve, to
improve it, or to restore the normal forms of the spine, the
patient must avoid any position in which the spine is placed
some time in an abnormal form-a reclined position as in fig.
46-or a lying position as in fig. 47, is very useful. These
positions must not be kept for more than half-an-hour to one
hour at a time; but the patients must at times during the
day be placed in such comfortable positions, in which they do
the breathing and other exercises adapted to their case. In
the resting position they can read, write, or do any other work.
Some of the bad positions which, during the period of education and during various occupations, are frequently observed,
have been illustrated for this paper with the view of showing
how bad the effects must be in delicate and weak persons.
The alternate use of rest and exercise, selected according to
the state of the patient's health, strength, and curvature, is very
efficacious, especially when the patient is made conscious of the
usual positions in which he twists or bends his spine, or combines both these actions to make himself comfortable; he feels
* A list of them is to be found amongst the advertisements at the end.
I1"




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




60


On Curvature of the Spine,


Fig. 23 shows the natural mode of standing of a girl whose
chest is well developed, and whose dress does not interfere with
the free use of the body and limbs; while fig. 22 shows the
usual position of many girls whose chests have been for years
compressed by tight stays and dresses, and who are and have
been always leaning on the whalebone
or steel busk of their stays; the chest
is concave instead of being convex, the
head stooping, and the spine weak. The
artist has not drawn the fashionable crinoline, in order to show better the characteristic position which is very fre-..-. quently to be met with.
Carrying the rifle for a long time on
one side, was mentioned as one of the
causes by which a very slight lumbar
curvature was increased. Fig. 24 shows
a volunteer who appears straight, but
on a close inspection we observe the
right shoulder higher than the left;
further, the right'elbow-joint is nearer to
the body than the left, and the hollow
space between arm and body on the right
Sside is smaller than on the left. These
differences are produced by the lumbar
curve, which is-increased by the weight
24. Standing position of a of the rifle, which induces our volunteer
oun it      pine is bentl  t  to bend the lumbar part of his spine to
the left.
72. SEWING.
Fig. 25 shows one of the many bad positions assumed during
sewing, which have this in common, that the head stoops down
to the work; while the body is crooked, the right leg crossed
over the left, and the right foot twisted round the left calf;
thus headaches, pains in the chest, bad digestion, and other
abnormal complaints, and cramps of the legs are produced, besides the predisposition to various deformities of the spine and




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




6y Dr. Roth.


society I have named would thus be the means not only of
benefiting the community at large, but also of providing for a
class of persons most necessary to mankind in general, without
simultaneously neglecting the propagation of a knowledge in
which every adult girl, without any regard to her future position
in life, whether rich or poor, whether destined to remain single
or to be married, should be versed, and thus be enabled to make
herself useful either in her own future family circle, or to her
friends and relations, or to the still larger circle of her fellow
creatures.
The female compositors, readers, printers, book-keepers, and
copyists, whom the Society for the Employment of Women trains
at present will probably be very useful persons, but will they
be less subject to complaints than their male fellow workers,
and is the market overflowing with a stock of educated nurses,
who would be better paid than at present the majority of
governesses?  The position of a nurse would be raised if intelligent girls were educated and trained for it, who would have
the advantages of being alone in the market-no opposition on
the part of male nurses of children is to be feared-and (what
is besides not entirely to be despised, they would, like their
American sisters who have been trained as school-mistresses)
soon find a husband and an opportunity of applying their knowledge for the benefit of their own children;-they would then
make room for others; and nobody will deny that theirs would
be the right employment for women.
76. READING.
Notwithstanding the attention of educators, heads of private
and public schools and school-inspectors, has been often called
to the necessity of abolishing forms, they are still to be found
in the majority of schools; the fig. 30 shows not only the
stooping and crooked position into which the boy, after a short
time, must fall, but also the uncomfortable dress of many a
charity school boy;-to save a few inches of cloth the jacket is
made so tight that the boy cannot breathe freely in it when it is
buttoned; he is thus obliged to bring his shoulders forward, and
to narrow his chest. The dragging of the trousers, fastened




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.




by Dr. Roth.


67


77. WRITING.
Boys and girls are cbnstantly reminded to hold the paper on
which they write straight before them; much attention is also
paid to the position of the hand, and the mode of holding the
pen, but the position of the body is not at all cared for, and
no notice is taken whether the body is twisted to one, or bent
to another side-whether one shoulder is higher than the other
a-whether the head leans to the left hand and turns to the
right, &c. &c.
1jT6.
34 and 35. Writing.
There are many bad positions to be observed in every
school. I have chosen only one of the most frequent, and not
of the, worst kind, to show its bad effects on the spine, and as
it iý the fashion in some schools to let the girls write for several
hours a-day, as many lessons are done in writing, this will
easily explain how the predisposition to spine curves can, and,
I am sorry to say, is in a short time artificially produced.
Slanting desks which support both forearms in their full length,
that the weight of the upper part of the body should be equally
distributed; a chair with a back, that the lumbar part of the
spine may lean on it; a slightly oblique.position of the paper,
and shortening of the time for writing, are the principal means
for preventing the bad effects.




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.




by Dr. Roth.


71


81. RIDING.
This healthy and good exercise is often the cause"of lumbar
curvatures, because
very  young   girls,
whose spine is not
Ssufficiently strong to
remain erect, are put
/         on a horse, and withi                         out changing their
position remain there
for  one  to three
h\ ours.                  The older
\              girls, tightly laced
\        and dressed, are fre^^    c nquently seen in similar bad positions to
that of the illustra_,_  '    tion.  Girls under,,--                   the  age  of eight
Fig. 42 and 43.         years, and older ones
predisposed to a spinal curve, should not ride; the older ones
not remain more than half-an-hour, or an hour, on the horse.
They should be taught to ride on both sides, and never have
stays. If riding girdles are used (which are not necessary)
they should not be tight. Loose jackets are always preferable
to the tight riding gowns. The Spanish or Hungarian round
hat, with holes for ventilation, which is carried on the whole
upper surface of the head, is better than the chimney-pot hat
which presses mostly on the forehead. The fig. 43 shows the
influence of the bad position on the spine, and why exercise on
horseback must be injurious to the spine, if girls are in any
other position but that shown in fig. 42.




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.


73


no advocate for hot bottles, I prefer that the part of the bed
where the cold feet are placed should be warmed before the
patient goes to bed; this causes the legs and feet to be stretched
out. Another and more rational way of preventing this bad
position is to give one or two additional blankets, and to warm
the feet by exercises before going to bed.
In consequence of an unfounded prejudice, people are prevented from sleeping on the back, which is the most resting
position, especially when the legs do not cross each other,
and when the arms are placed on both sides of the body, but
not across the chest. A mattress slightly inclined, so that
the part destined for the upper part of the body and head
should be raised six to eight inches, is very comfortable for
supporting the body in a lying position on the back, in
which the respiratory functions go on with the greatest ease;
only the head requires a pillow, which must not reach under
the shoulder; feather underbeds and pillows should never be
used; all parts of the bed should be daily aired, and the bed
linen frequently changed.
83. THE CHAIR AND COUCH.
In the preventive and curative treatment of lateral curvatures,
the patients make exercises of the head, arms, feet and legs,
while in a lying position on a couch thus constructed, that it
can serve as a reclining chair.


Fig. 46. Chair with reading desk.


G




74


On Curvature of the Spine,


The foregoing figure shews the construction of this chair: the
middle part serves as a seat; the upper part can be more or
less inclined, or placed horizontally, in the same manner as the
flap, which serves as a support for the legs and feet; the whole
couch is padded in order not to hurt the prominent shoulder
blades or other parts of the body, which I have seen sometimes
red and sore because the patients have been obliged to lie for
hours either on the bare floor, or on the once very fashionable
hard reclining board.
A pillow of the length and width of the upper part of the
chair, and of a wedge-shape, is placed with the thick end, about
47. Chair used as a Couch.
three or four inches high, under the head, while the patient is
lying, and thus the upper part of the body and the head are
slightly raised, while the hollow of the neck is supported by a
soft horsehair pillow, two inches in diameter and four to six
inches in length; the wedge shaped pillow is placed with the
thick end to the loins when the patient is sitting on the chair.
84. SITTING.
Many scoliotic patients have a contracted chest, a stooping
head, or tendency to fulness of the head or headache, and other
symptoms, which prevent them from making uise of the couch
described and illustrated in ~ 83. In such cases the couch is
changed into a chair with a reclining back; this back forms an
oblique angle with the seat, which varies from 1150 to 1350 or
155~. An angle is chosen in the beginning, in which the patient does not feel any oppresion in the chest, or a choking sensation in the throat, frequently produced by placing the head accustomed to stoop into the natural position; it is desirable to make




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.




78


On Curvature of the Spine,


an hour; which exercise is to be repeated several times a day,
and to be continued regularly for some time."
Although the breathing exercises which I am in the habit of
prescribing are not practised for more than five minutes at a
time and repeated several times during the day, very good
effects are produced not only in deformed and consumptive
persons but also in other chronic diseases, when the patients
are scarcely able to make any other movement.
The most important part of the treatment of certain kinds of
stammering consist in the practice of various breathing exercises.
The faculty of breathing to the full extent of the capacity
of the lungs is very much interfered with by the still prevalent


Fig. 48. Outline of the Venus of Medicis.


Fig. 49. Outline of a woman as compressed by stays.




by Dr. Roth.                     '


79


fashion of wearing stays, corsets, bodices, or any similar article
of dress, the object of which is to diminish the circumference
of the lower part of the chest, and to give artificial support to
those whose physical training has been neglected. Although
many medical authors and educational writers have condemned
the use of stays, of tight lacing, of compressing tbe waist, and
have published long lists of diseases and deformities caused by.this bad practice, the use of corsets is still very general, and.I
am sorry to say that as long as the majority of medical men
(to whom the plea of ignorance cannot avail), continue to permit their wives. and daughters to be exposed to all the bad
effects of this injurious fashion, there is no hope that these
medical men will earnestly oppose among their patients a bad


Fig. 50. The natural form of the chest of Fig. 51. Deformity of the chest caused
the Venus.                              by stays.




80


80         On Curvature of the Spine.


habit, -which, to use the mildest term, they are too- indifferent
to check in their own families.
Those who wish for more information on this subject I must
refer to a paper "' On Dress,"' * of which my reviewer in the Lancet
says-" Dr. R. 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.")


Fig. 52. The natural form of the spine.  Fig. 53. Spine deformed by stays.
The previous illustrations show why the capacity of breathing must be diminished by the deformities caused by stays and
by tight lacing.
*Published in the Cure and Prevention of Disease by Movements.Groombridge & Sons.








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