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their bad and good effects on back-strain and static backache.
In connection with the effect of the bad corset Figure 8 possesses illustrative interest. This is an accurate outline reproduction of a composite photograph. The model was first told to stand at ease on the balance plane, then to bend forward, and exposures were made of each position on the same plate. The dial of the scale was included in the plate and was entirely to rest at the same point in both attitudes. The model (who was entirely ignorant of the purpose of the experiment) had instinctively preserved her normal balance, and the relation of the center of gravity to the base of support was unaltered, but its relation to back-strain is seen at a glance to have been utterly different. The stippled position in Figure 8 is, in fact, only an exaggeration of the position induced by bad corsets (compare Fig. 5) as contrasted with the normal, the inclined position of the back subjecting the posterior musculature to increased strain in the dorsal and gluteal regions. No one will doubt that the erect position is one of comparative ease to the posterior musculature, nor that the forward bent position would produce backache if long persisted in.
SELECTION AND MANUFACTURE OF PROPER THERAPEUTIC CORSETS
The recommendation of any specific make of corsets is impossible, even if for no other reason, because there is no make of corsets appropriate to all figures; and there is no make of corsets which remains stable under the changing fashions. There have been times in the past when most of the ready-made corsets belonged distinctly to the bad type. There have been periods in the past when the ready-made corset frequently tended toward the good effect. At the present time, as has been said, most ready-made corsets are inefficient or neutral. A ready-made corset of more or less neutral type can often be so altered by taking up its seams that it produces a fairly good effect, and this can be increased when necessary by the use of a Cook's back splint,[1] but the manufacture of a good corset by a skilful corsetière to fit the individual wearer is preferable when practicable.
In the production of the desired effect which should be produced by a "good" corset three points are important: 1. It is essential that the more important seams run diagonally forward and downward in order to secure the proper lines of strain in the cloth. 2. The bones which serve to keep the corset from wrinkling should run in such directions as not to interfere with these strains. 3. The patient should be taught to apply it properly after it has been properly made. These points seem to us so important that they are presented somewhat in detail.
1. In having corsets made for patients the easiest method of obtaining therapeutic results is to have the corset brought, to the office after it has been cut and stitched together, but before it has been boned. It should then be somewhat large for the patient, and, after being placed on her, should be made to fit her by pinching up the seams one by one and securing them with pins. In Figure 6 the seams which are especially likely to need tightening in this way are marked with a broken line. The corset when completed should fit very tightly in the space between the trochanters and the iliac crests. This anchors the corset and in many figures prevents its rifling up without the use of the objectionable front garter. It should merely fit the patient over the iliac crests and immediately above them, as tightness at this point is uncomfortable and makes the corset ride up. In the back it should fit the hollow of the waist snugly, being hollowed in at the back, but not at the front, and above the waist it should be left as loose as the patient will wear it. In the front it should be straight, without constriction at the waist.
2. The anterior bones should run from above downward and strongly forward.
3. To be properly applied a corset must be laced in three sections, sacral, lumbar, and dorsal. Before it is put on, all the lacings must be widely loosened. The corset must then be settled into place as low as it can be worn, and clasped. The patient should then pass the hand inside it and lift the abdomen into it, settling the front of the corset as low as possible. The lumbar lacing should be pulled comfortably snug. The sacral lacing should then be made as tight as can be borne, and if the corset is so made as to spare the iliac crests, and properly cut out for the thighs in front, very tight lacing around the solid pelvis is comfortable to the patient. The dorsal lacing should be left as loose as is comfortable.
The clinical test, of the completed corset are that it should be comfortable to the wearer and that it should produce to the eye of the observer the effect illustrated in Figure 6.
THE EFFECT ON BALANCE OF HIGH-HEELED SHOES
The question of body balance as affected by shoes of different kinds has been ably discussed by Cook of Hartford, and our results by measurement correspond closely to those reached clinically by him.[2]
In speaking of high-heeled shoes, it should again be particularly noted that we are speaking only of the effect of such shoes on balance and not of their effect on the foot. Our observations dealt with the effect on balance of shoes with heels varying from 1½ to 2¼ inches in height.
Preliminary experiments with composite photographs and the balance apparatus led us to the belief that raising the heel of the unshod foot by means of a book placed underneath tipped the body forward, and that compressing the front of the bare foot by a bandage without raising the heel tipped the body balance back, and we inferred that the effect of the high-heeled shoe was merely the resultant of these two opposed elements. But with the perfection of our apparatus we found that neither of these two component effects was constant, whereas the effect of the high-heeled shoe was constant. After a long series of experiments it became evident that high-heeled shoe, tip the body back as a whole without making any appreciable change in the lumbar curve. Figure 9 is an instance of these records. There was but one exception to this effect in our observations on high-heeled shoes. This was in a rather degenerate type of girl whose center of gravity was naturally abnormally far back, and it is probable that her inability to tip further back without falling, forced her to compensate by forward muscular effort against the shoes. This was, at all events, the only exception among many observations.
One possible source of experimental error must be mentioned, for the sake of possible future observers, in connection with this conclusion that the body is tipped back by high-heeled shoes. In overlaying the tracings for comparison the malleoli must correspond rather than
