CHAPTER IX.
ON SPINAL DEFORMITIES.
Pathological disquisitions form no portion of the task which we have allotted ourselves to perform; we must however speak cursorily of some things, the full description of which belongs more properly to the anatomist and surgeon, because, if we avoided the matter entirely, we should be unable to show the reasonableness of many of our adaptations, and the special cases in which they should be employed. Besides this, it must be borne in mind that our labours are confined to ladies and children, and that even with them we never pretend to take the place of the medical adviser. Medicine is not our vocation; but, when medical men seek us, then we can give to the body that support necessary to enable it to regain the erect position.
We cannot insist too often, nor too strongly, upon the necessity of early and proper exercise. To use the language of an accomplished writer: "If the days of childhood were devoted to the goddess Hygeia, and the perceptive faculties allowed to exercise themselves by observing the wonders of art and the beauties of nature, then civilization would add to all positive blessings, and a higher advantage co-existing with rude good health. It is true, that if these views were generally entertained, there would be less work for all kinds of medical professors, and they might exclaim, 'Othello's occupation's gone.' "
But the world would be spared much suffering and vast inconvenience. Physical health is one of the greatest sources of happiness to the child. Its value may be estimated by watching the gambols of well-informed children, with cheeks in which the rose and lily blend most harmoniously, giving brightness to their laughing, happy-looking eyes, as they throw their pliant bodies and vigorous limbs into the most graceful attitudes whilst bounding over the greensward, like young gazelles, positively intoxicated with the joys of mere physical existence! or watch them pursuing with agility the gay butterfly, or gathering wild flowers; every sense has its full pleasure of enjoyment, and the stock of health thus daily laying up is a treasury of "inexhaustible pleasure."
Unhappily there are but few parents and teachers who have ever formed any definite conception of the importance of proper early training, and that simply because they never understood its importance; nor is it possible that they ever should, until they have some knowledge of the structure and functions of the body which they have to train and develope. We propose therefore, in this chapter, to give some general idea of the structure and functions of the spine, as well as a brief description of some of the curvatures to which it is subject.
The distinctive character of man is the erect posture. No other animal enjoys a physical conformation which will enable him to permanently assume this majestic attitude, although there are several in whom it may be maintained for a short time. The head of the human being is comparatively heavier than the trunk, and this, added to the weight of the viscera in front, would naturally induce a stooping forward, were there no especial means provided for its prevention. The necessary appliances are, however, afforded in the following manner. The spine, on the top of which the head is articulated, is a highly-flexible column, capable of moving in any direction which may be necessary, and during its movements forming a series of elegant curves, so truly described by the ancients as the serpentine line of beauty; these curves also serving to keep the head within a line drawn from the top of the head to the ground, called the centre of gravity. Were it not for this provision, the erect position could not be maintained for even a short period. In erecting a column, the builder will take care to make the base broader than the apex; but the contrary is the case in the human figure. The want of this peculiar elasticity is the reason why artists have never succeeded in constructing statues which would stand without a pedestal, and such would also be the case in the human conformation were it not for the action of the muscles by which the spine is supported.
As we have already described, the clavicles or collar-bones exercise considerable influence in expanding the shoulders and chest; and this is an essential provision, for the purpose of counteracting the traction of the pectoral muscles, or those of the chest, whose tendency is to pull the shoulders forward, and by their action diminish the size of the thoracic cavity. The clavicles, however, would form but an insufficient means of accomplishing this end, were it not for the muscles of the back, which, when properly developed by exercise, neutralize the action of those of the chest, and keep the shoulders properly expanded. We lay a stress upon the necessity of exercise, for it must be remarked, that the greater its amount the greater the waste of substance, and the greater the quantity of blood carried to the wasting organ for its repair; while, provided the exercise has been moderately taken and properly conducted, the greater will be the strength of the muscles thus thrown into action. For the preservation of the erect position no less than five layers of powerful muscles are placed along the spine, many of them taking their origin from the back of the head, and being inserted into various processes of the vertebral column; and it is by their action, combined with the elasticity of the spine and its cartilages, that we are enabled to stand upright, and to perform all the varied movements of which the human form is capable. The power of the muscles is so accurately balanced, that, provided all be in a normal condition, no difficulty is experienced in maintaining the erect attitude for a very considerable time. The spine has also natural curves, which act as springs to diminish the concussions which the brain would receive in walking were it not for those curves and the elasticity of the intervertebral cartilages. To use a familiar simile, we may liken the head to that of a hammer, which is placed on a straight stick or handle. Everyone knows that the surest way to fasten the head is to knock the handle on the ground, as the concussion drives it further in; so that, if the human head were carried on a straight support, similar concussions would be caused to the brain and other vital organs, to their serious if not fatal injury. Of course, extra muscular strength is required to support the increase of weight caused by those curves; and this is effected by an extra stress on the muscles of the back. "The waving line of the column arising from a series of alternate curves in opposite directions is altogether peculiar to man; it allows a proper distribution of the weight with respect to the centre of gravity, the line of which, carried through the entire trunk, must fall within the entire space covered by the feet, or by one foot when we support the body by one only. As this line passes through all the curves, motion is allowed in the upper regions without impairing the general equilibrium."*[1]
The portions of the spine situated in the region of the neck and loins are those most likely to yield at an early period of life; the reason of which is, that these parts are kept in the erect position merely by the action of the muscles. The neck has to support the weight of the head, while the lumbar vertebræ bear that of the thoracic and abdominal viscera. In early infancy, the muscles of the neck and back are totally inadequate for the performance of their functions, as, from not having been brought into action, they have not acquired sufficient strength; and we therefore find that the head of a newly-born child will always have a tendency to fall forward, or from side to side, unless supported by the protecting arm of the nurse or mother. It is usually said that gentlemen are unwilling to handle a newly-born infant; and this cannot be a matter of wonder, since they probably fear the dislocation of the poor baby's neck, which certainly might occur under their generally uncouth nursing; while the muscles of the back and loins being also, from the same cause, in a very weak state, yield from the superincumbent pressure, and the infant becomes hunched up, as it is commonly called, on the unskilful nurse's arm. Of course, as the child stoops forward, the arms hang beyond the centre of gravity, the shoulders are consequently more rounded, the strain on the muscles of the back considerably increased, and, if this influence were suffered to continue, a permanent deformity would be the necessary result.
Nor is deformity of the spine the only consequence of this, forward tendency of the head, when unsupported by the due action of the muscles of the back. As will be seen by an examination of the models in my museum, which have been constructed for the express purpose of illustrating this important point, when the head falls forward the spine becomes bent, the intervertebral cartilages thinned on the inner portion of the vertebral column by the pressure, and the ribs are forced into a totally different position than that ordained by Nature. Instead of standing out at a considerable angle from the spine, and thus affording free scope for the action of the heart and lungs, which are the organs essential to existence, the chest falls downwards, pressing on the abdominal cavity, the ends of the ribs are brought into closer approximation, the sternum or chest-bone is forced inwards, and the cavity of the chest considerably diminished. In addition to this, the contents of the abdomen are prevented from acting properly, as the space is encroached upon by the organs of the thorax, which are pressed downwards by the drooping of the ribs.
Now in respiration a constant alternate motion takes place between the chest and abdominal cavity which we may as well explain here, as many ladies think that so long as the chest remains free from pressure the abdomen may be tightened without danger or inconvenience. The division between the chest and abdomen is formed by a strong muscle called the diaphragm or midriff, which is nearly circular in form, and is attached in front, under the cartilages of the breast-bone along the sides, to the cartilages of the six lower ribs, whilst at the back it is firmly fixed to the first lumbar vertebra. It occupies an oblique position in the centre of the body, rising into the thoracic cavity during expiration; and, as we inspire, it is pressed downward into the abdominal cavity, materially assisting digestion by its action. Of course, as the diaphragm descends the capacity of the chest becomes enlarged to a considerable extent, while at the same time the abdomen is pushed outwards to make room for the inflation of the lungs. The intercostal muscles, or those between the ribs, also exert a very considerable influence in raising the ribs during inspiration, and thus increasing the size of the thoracic cavity; and if these be prevented from performing their natural functions, breathing must be carried on solely by the action of the diaphragm, as we find to be the case in almost every instance of consumption or thoracic disease.*[2] It has been frequently asserted that deformity of the spine is usually the result of disease, but this is contradicted by experience; and we do not feel disposed to concur with any fallacy, simply out of deference to the authorities by whom it is promulgated or supported; for, so far from deformity being occasioned by disease, disease is ordinarily the result of deformity. In our museum we have a specimen of deformity of the spine of the most serious and extraordinary character, on a close inspection of which it will be seen that the bones themselves are in a perfectly healthy condition, although one side of the intervertebral cartilages have given way in consequence of absorption.
"It must be borne in mind that children have few chronic diseases, and that consequently those with which they are affected must be acute. It must also be remarked that acute diseases are detected by immediate symptoms, the first of which is pain—a child never losing its appetite and becoming dull, without some organic disease or eruptive fever making its appearance in a few days; for the alleviation or cure of which prompt remedies are required.
" But when you see a lively, active child becoming dull and slow, abandoning his favourite games, losing his activity and appetite, looking serious and pensive, without being able to assign any reason for it; when days pass over in the same condition without his complaining of any pains, but getting more sullen and morose, looking pale and languid, anxiety appearing on his face, seeking for rest, leaning on the objects around him, taking all sorts of awkward positions, and seeming to crawl rather than to walk, you have the forerunners of deformity. If, then, immediate means are not adopted you soon see what is called a shoulder growing out—the head projecting forward, stooping of the body, standing on one leg, &c. When this second set of symptoms appears, depend upon it that the spine is already crooked. It generally happens that the first stage of deformity is only detected some years after its origin, and when the curve has attained a certain degree. Then the pressure which takes place causes the deformity to increase with great rapidity, the organs are in danger of injury, and unless immediate measures are adopted the consequences may be fatal."*[3]
Another injurious result of the poking forward of the head is the contraction of the trachea or windpipe, and the consequent alteration and deterioration of the voice. Shakespeare says that a soft voice is "an excellent thing in woman;" and with that opinion most of our readers will cordially concur. But a sweet, sonorous, and delightful voice can never proceed from a contracted chest and a cramped larynx; nor can any external show compensate for the want of it. Dress may hide In any other deficiencies, but it can never mitigate this. And we know of nothing that is more disagreeable than the union of a pleasing face and elegant costume with a poking head and a hoarse discordant voice.
"The spine itself is composed of twenty-four bones, each of them possessing fourteen different parts, such as the body, the spinous and transverse processes, the articulating surfaces, &c.; it results that the bony construction of the spine presents 336 different parts, without the cartilages, ligaments, and a proportionate number of muscles, blood vessels and nerves. Is it not astonishing that this wonderful piece of mechanism operates during the whole life without getting out of order? and, when there is a derangement, may we not more reasonably refer it to its complicated structure than to the presence In the body of some hereditary or other disease?
"There are four kinds of spinal deformity :—the cyphose, or outward curvature; the lordose, or inward curvature; the scoliose, or lateral curvature; and compound, viz. with torsion of the spine on its axis, and abnormal protrusions of various kinds.
"The first is accompanied by morbid symptoms, and frequently terminates in ankylosis, or the union of several bones into one, by which the solidity of the spine is restored. When the distortion is not great, this in general cures the disease, and leaves the vital functions unimpaired.
"The second and third curvatures are those which begin in the simplest way, and if neglected assume the most formidable character. It is generally manifested on the right side, and may frequently be traced to the habit of lying upon and using the right members exclusively. When the deformity increases, the capacity of the chest must be diminished and its functions impaired, and the heart, lungs, and other vital organs injured; and to this crushing may be attributed the loss of health, general debility, and organic disease.
"Now there are no deformities of the spine, whatever may be the primary causes, without five different organs being concerned.
"First, the fibro-cartilages; that elastic substance interposed between each vertebra, on the regularity of which depends the normal direction of the spine. When, by any cause, that substance loses its natural form, the vertebræ are thrown out of their place.
"Second, the bones; which deviate, protrude, and recede in different ways.
"Third, the ligaments; which become stretched on one side and relaxed on the other, losing their firmness and power.
"Fourth, the muscles; which always present their antagonist relaxed or contracted.
"Fifth, the tendons; which, under the same influence, are changed in their direction, and act as new vehicles to the distortion. "—Abridged from Dr. Caplin's Lectures.
Having, then, taken into consideration the cause and nature of the deformity, the next thing will be to see what can be done in order to restore the proper equilibrium of the body. Let us suppose that the Venus was unable to rise from this position; it will be evident to anyone, that what we want to find here is a point of support, from which the body may be elevated towards the erect attitude; and this we shall discover in the hip or pelvis, from which the deviation has taken place. It was this discovery that led to the invention of our Invisible Crutch, by which the body may be elevated a full inch the very first day that it is worn, and when the organs have attained some strength in that posture the frame may be again raised, and this process be repeated until the normal position has been fully attained and the cure is complete. And all this, be it observed, may be attained without lying on the back or chest, constant confinement, pain, or inconvenience—not even the derangement of the dress. The
VENUS.
support is as invisible as it is efficient, and affords nothing but pleasure and comfort to the wearer.
All our adaptations are constructed upon the same principle.
The poking of the head is remedied by our Patent Collar for the Neck, which fits under the chin, and supports it in its natural position. It is worn without any pressure. The elastic nature of the substance allows of perfect free motion of the neck.
In connection with the subject, we may mention, that when the head is held on one side, this is occasioned by the tension of the sterno-cleido- mastoideus muscle of the affected side, and the laxity of the corresponding muscle on the opposite side. This is also remedied by a similar contrivance, which is now extensively patronized.
It is worthy of remark, that the distortion of the neck is often complicated, with roundness of the shoulders, in consequence of the violent contraction of the pectoral muscles, which are not properly counterbalanced by the muscles of the back. To remedy this, we have invented a Scapula Contractor, which may be worn either inside or outside the dress, without being noticed as anything singularly conspicuous.
SCAPULA CONTRACTOR.
This Scapula Contractor may be worn with or without the patent neck collar, according to the nature of the case; and when both are required, they can be united by a simple contrivance. They invariably tend to check the distortion, which first suggested their absolute necessity. The Scapula Contractor would be of great advantage in schools, to prevent the constant bending of the head forward, and is therefore adopted as an essential part of the dress of a young lady at the age when such habits are likely to be formed, as then even the slightest deviation would be effectually avoided. For these advantages, either to prevent or correct those habits, it has been strongly recommended by the medical profession, as the shoulders are by its use drawn backwards, the clavicles straightened, the chest enlarged; whilst, by the erect position it insures, the abdominal functions are normally performed. These results are effected by means of an elastic substance, arranged with a perfect regard to anatomical data, and, as a consequence, have never yet failed in their desired object.
The use of art is to give support where it is needed, and that the material of which it is constructed should act for the weaker muscles, and have as nearly as possible the contractibility of these organs which they are designed to assist. If the muscles are weak the support should be strong.
We have noticed the habit of standing on one leg as a frequent cause of distortion: to correct this, we have invented a Juvenile Rverso-tractor, or Monitor Bodice, which acts by reminding the child of that injudicious habit, and induces it to make an effort to discontinue the practice, as effectually as if constantly admonished by its parents.
Should the deviation have become serious, we introduce by various means different contrivances into the bodice, which invisibly support the failing side; the support being supplied without the injurious aid of springs or any unsightly mechanism. The object designed by the Reverso-tractor in these cases, as in every other of our inventions, is to aid nature by strengthening the muscles of the back, to keep the body erect, to preserve the flexibility of the spine and ribs, to enlarge the capacity of the thorax, and to insure the means of healthy development to the whole organization, and the ultimate strength, beauty, and symmetry of the body.
In all matters relating to the spine, we cannot too often repeat the old adage—prevention is better than cure; and hence, in all cases when there is the least tendency to stooping or roundness of the shoulders, aid should be immediately sought; and even this, trifling as it may appear, ought to be prevented. In our registered CHILD'S BODICE this has been provided for by placing the braces in such a manner, and making them of such materials, that they prevent the slightest tendency of the shoulders to depart from their normal position.
Another thing which we have secured in this bodice is, that it shall always fit. In the ordinary fastening, in the hurry of dressing, or through the carelessness of the servant, it is often drawn unevenly together; but in ours this cannot happen. Instead of laces we employ hooks and eyes, which are placed on a straight line, and are arranged so as to be adapted to the varying size of the body, and will not remain fastened out of their place: they also keep the whole weight of the clothing equally balanced.
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So far as our space and the nature of the subject will permit we have discussed this question in relation to the spine. In a work which we are now preparing for the press we shall consider the question of the relation of the whole of the clothing to the bodily health, and shall then have to say much more upon this subject. At present we can only add—live according to nature: study her dictates, and she will reward you with good health and natural beauty.
- ↑ * Laurence's Lectures on Man, p. 105.
- ↑ * We have often been asked if we can do nothing for gentlemen, who are almost as apt to stoop as ladies are; and our reply has been the invention of a pair of braces, which every gentleman who has tried declares to be excellent. They give support to the back, keep the shoulders in their proper position, and are most comfortable to wear; but, as this is a ladies' book, we do nothing more than present an illustration to show their construction.
Braces. BRACES.
- ↑ * Dr. Caplin's Lectures on Deformities of Spine, 1849.
