GEN. I. SPEC. III. Entasia Muscular more frequent direction they take, from the causes noticed, they, by this movement, push out or backwards the heads of the ribs of the left side, and force their sternal Rhachybia. extremities considerably forward, because of the quick distortion of circular turn which the ribs make between their angles the spine. and their points of attachment to the vertebræ, and the very small motion, from such a formation of them, requisite here to produce them. Together with this movement of the ribs, which produces the projection of the left side of the chest in front, they are also made, from their double attachment to the vertebræ, to fall down and approximate, or, as it were, overlap each other, at their angles. This causes that hollowness or sinking in of the left side of the chest behind. The falling down of the ribs here described appears to me to be in part owing, also, to the permanent contraction of the sacro-lumbalis muscle, which is inserted into all their angles. While these movements take place with the ribs on the left side of the body, the very opposite, of necessity, happens to those on the right. By the rotatory movement of the vertebræ, the ribs on the right side have their heads contrary to those on the left, drawn inwards, and their sternal extremities made to recede backward: while their double connexion with the vertebræ causes them, contrary also to those of the left side, to be raised up and separated from each other at their angles. This rising up and separation of the ribs at their angles, is what produces the projection of the right side of the chest behind.” From this general change of position, and particularly the twist of the ribs, Dr. Dods accounts for the unnatural situation of the scapulæ, and in many instances of the clavicles and the sternum, with the falling down of the right shoulder. He observes, moreover, that though the contortion of the spine most frequently takes place to the right side, yet that it occasionally takes place to the left. That the whole column is not always moved round, but only a part of it; and that hence, instead of a profile of three morbid flexures brought into view, which invariably follows in the former case, we have often a profile of only two: and that where the muscles of both Morbid si tuation of the scapulæ accounted for. GEN. I. SPEC. III. Entasia sides of the column become contracted from position, which sometimes takes place, the greater number of the verteRhachybia. bral joints acquire an ancylosis, and the body is arched backwards. Muscular distortion of the spine. ingenious: There is much ingenuity through the whole of this exHypothesis planation, which plausibly accounts for that ridgy line of projection so frequently felt on the left side of the loins, when the morbid curvation is on the right, ascending nearly to a level with the spinous processes, while there is not only no such ridge on the opposite side, but even no appearance of the transverse processes. Upon the hypothesis before us these processes are conceived to be equally elevated on the one side and depressed on the other, which gives us the two phænomena of an unnatural and ridgy prominence in the former line, and of an unnatural disappearance in the latter. The hypothesis nevertheless (for at present it cannot be entitled to a higher appellation) requires further elucidation and support: and, after all, can never altogether reach the precise object at which it aims, that of establishing itself at the expense of every other view, and especially of subverting the doctrines of a diseased action of the other moving powers or their appendages, the ligaments of the spinal muscles, or the cartilages into which they are inserted; a morbid condition of which is often capable of proof from the very limited area of pain and tenderness to which, on pressure, the disease seems to be confined to say nothing of the affection of the vertebral bones themselves, in which, as already observed, spinous distortion sometimes commences, though from a very different source, and in which, even when derived from the source now contemplated, it sometimes terminates. but cannot be adopted exclusively. The muscu lar form of distortion most common in the present day. Explained. There can be no doubt, however, that the spinal distortion of the present day is a disease far more frequently of the muscles and their appendages than of the bones, and is the result of a want of equilibrium between the antagonist forces on the one side and on the other of the vertebral column, as well those of the trunk as of the back; in consequence of which this column is deranged in its natural sweep, and either twisted or deflected in particular parts, GEN. I. SPEC. III. or in its whole length: all the other changes in the general Rhachybia. distortion of It is hence a disease of muscular debility or irregular, and hence clonic, action in the fibres of the yielding muscles, and an inability to resist the encroachment that is debility the made on them by their more powerful antagonists. Muscular proximate cause. Commence where chiefly The complaint almost invariably shows itself from the age of puberty to that of mature life, though sometimes ment of the later; and is nearly limited to females, and among fe- disease, males, to those of delicate habits, and who are especially found. disciplined in the false and foolish rules for obtaining a fine figure. It is hence a perpetual inmate in our public female schools, and is by no means an unfrequent attendant upon domestic education. The progress of the disease may be so easily collected from the physiological survey we have already taken, that a few words in addition is all that is necessary to be added. The complaint first shows itself by a general listless- Progress. ness and aversion to muscular exertion of any kind, and an unwonted desire to lounge and loll about. No signs of constitutional disease, however, are as yet manifest; the nights are not disturbed, the appetite does not fail, the evacuations are regular, and the pulse unaffected. There is soon afterwards a sense of weariness, and even at times uneasiness, about the back and especially the loins ; and if the muscles of these parts be minutely examined, several of them will give proof of flaccidity and extenuation. If no steps be taken at this time to arrest the disease in its march, or if the steps taken be injudicious or inadequate, the vertebral column will soon be involved in the morbid action; and especially, as Mr. Ward observes, "on the occurrence of any particular disturbance to the constitution "*; its numerous joints will lose their nicely • Practical Observations on Distortions of the Spine, Chest, and Limbs, p. 36, 8vo. 1822. SPEC. III. Entasia Rhachybia. distortion of Muscular the spine. Sequel of general and constitutional mischief. The GEN. I. adjusted poise; they will in various parts be left too loose on the one side, and dragged too rigidly on the other; and the elegant contour of the spinal chain will progressively be broken in upon. All the other changes, whether upon the general form or the general health, which progressively take place in the advance of the disease, are entirely consecutive upon the symptoms before us, and may be anticipated by any one. From the morbid contest which is thus continually going on between the antagonist muscles, their internal organization must necessarily become greatly affected, and the growing debility which is manifest in the contractile and extensile power of their aggregate fibre, will enter into every part of every separate fibril, and affect their vis insita. flow of nervous power, instead of being uniform, will take place in irregular jets; and, for reasons already urged in a preceding part of this work, a clonic though occult agitation, will succeed to a tenour of measured energy. The debility and irregular action of one muscle will spread by sympathy or association to various others; and from the derangement of the bones of the spine and the chest, the functions of respiration and digestion, and consequently, in a greater or less degree, all the other functions of the body must be interfered with in their respective powers, so that there is scarcely any other disease but may follow and the frame will become generally emaciated. As the proximate cause is debility of the extensor muscles of the back or loins on either side, the occasional cause will consist in whatever has a tendency to produce such debility. Too rapid growth is a frequent source of this complaint; a casual strain of the muscles on either side is a source not less common; chlorosis or any other constitutional weakness may lead to the same effect; and assuredly the use of stiff and girding stays, or any other part of that fashionable compression which is discipline of designed in the school-discipline of the present day to Occasional causes. Too rapid growth: strains : chlorosis: school the day. : mould the form into a somewhat different and more grace *Clonic Spasm, infrà, Cl. iv. Ord. 111. Gen. 11. 1 GEN. I. SPEC. III. Entasia Muscular How far such disci pline may be salutary: ful shape than perhaps the niggard hand of nature has intended-such as back-boards, braces, steel-bodices, or steel-crutches, spiked collars, neck-swings, and even edu- Rhachybia. cation-chairs. The tendency of all these to produce de- distortion of formity where it does not exist, and to aggravate it where the spine. it does, is forcibly pointed out by Dr. Dods; who nevertheless seems to censure, with rather more acrimony than needful, the whole system of school-drilling education as practised in many of our most fashionable establishments. A course of discipline for giving grace and elegance to the growing form, if conducted with judgement, devoid of rigorous compression to the expanding organs, and allowing a sufficient alternation of relaxation and ease, so far from being injurious to the health and strength of the general frame, has a natural tendency to invigorate it. But the greater frequency of the lateral distortion of the spine in our own day, compared with its apparent range in former times, together with the increased coercion and complication of the plan laid down in many of our fashionable schools for young ladies, seems clearly to indicate that some part at least of its increased inroad is chargeable to this source: and the following remarks of Mr. but appears Pott upon the various instruments applied to a growing too far in girl in order to prevent a crooked shape, have a wider many claim to attention in the present day than when they were as justly "These", says first given to the world. 66 he, are used observed by with design to prevent growing children from becoming crooked or mis-shapen; and this they are supposed to do by supporting the back-bone, and by forcing the shoulders unnaturally backwards. The former they cannot do; and in all cases where the spine is weak, and therefore inclined to deviate from a right figure, the latter action of these instruments must contribute to, rather than prevent, such deviations, as will appear to whoever will, with attention, examine the matter. If, instead of adding to the embarrassment of children's dress by such iron restraints, parents would throw off all of every kind, and thereby give nature an opportunity of exerting her own powers; and if, in all cases of manifest debility, recourse to be carried places: Pott. |