Spinal curvature, its theory; its cure: giving a description of the anatomy of the spine and the parts in relation thereto

Front matter

o

* t

SPIN A L C U R V A T URE.

Preface

The great object in publishing a book should be to demonstrate, through its medium, something tending to the good of the human family : this cannot but be satisfactory ; for although we may traverse the same ground which others have already traversed, there is work still left, and our labours, with such object in view, will never be unrewarded. Subjects like the one which we now take under consideration can be advantageously reiterated. We have to demonstiate that, the importance of which will at once be acknowledged * foi sufficient evidence can be deduced from multiplied experiences to prove, that, in the whole category of physical misfortunes which afflict our race, none is more serious in its results than is that of spinal curvature.

Of so vast an interest is this subject, that, it might almost be advanced, few families at least in this country, where so many of the habits and conventions of society form an antagonism against health and happiness, and where but a small number oppose conventions albeit inimical to themselves— few families, we say, it might be with little probability of contradiction asserted, are without an especial cause, of more or less interest, in this subject. How

Vlll

PREFACE.

frequently, all must have observed, children at a very early age lose both the physical beauty of childhood, and the peculiar gaiety and buoyancy which ever characterize that period when attended by health, and become, so to speak, old men and women ; perhaps in consequence of some fall, thought, at the time of its occurrence, to be a trifling circumstance, and left neglected, hut which gave the spinal column a wrong bias at a time when such an injury is likely to become the beginning of effects felt afterwards for life. Young people, more particularly young females, whose occupations are very generally such as will probably induce a degree of unnatural curvature of the spine, are thence rendered unfit for the duties which await them, as well as for the higher enjoyments which unfold before them : they pine away, or suffer severe pains, are subject to frightful contortions, and become unable to use their limbs at all, or if at all, occasionally only, and with difficulty. Often, too, the brain is seriously affected from the same cause, inducing fits of a most distressing nature, delirium,

imbecility. There is, perhaps, no source more fertile of brain affection than is this of the curved spine, for numerous ramifications of nerves and vessels

from the spine spread themselves over the surface of the brain, as throughout the whole human structure, all of which must, by the displacing of the spine, be disturbed in their course, and modified in their action ; and it will therefore be clearly seen that an important organ like the brain — of most exquisitely delicate texture moreover, soft and fibrous, and requiring a skilful piece of machinery for its protection, must be very materially affected by an interference of this kind. In fact, the spine being thrown out of its natural position, must necessarily press unduly on all the vital organs, or force them from their natural position ; they are thus compressed, and incapacitated for performing their allotted

PREFACE.

IX functions, the performance of which functions with more or less precision is absolutely necessary to health. Persons in more mature life thus afflicted aie, many of them, given up as incurables, with confirmed diseases called by a variety of names, and drag on a miserable, and to them and their friends hopeless existence i some imagining themselves victims of one disease, some of another, and others of a third, and so on, distressing themselves with violent internal remedies, and torturing outward applications, burnings, cuttings, and mechanical contrivances without end : all worse than useless while the cause of the evil is unknown, and the certain mode of cure unrecognized. We say worse than useless, for the constitution is considerably debilitated by the various medical agencies used, and thus the natural power of resistance is lessened.

In all these cases, through the admirable method, and assisted by the experiences of Dr. Harrison, whose attention was for many years devoted exclusively to this branch of the profession, certainty of cure is attainable, and that without having recourse to the torturing proceedings to which so many hundreds of our fellows have been submitted ; but by entire recumbency of posture together with, and which is equally essential, skilful and judicious pressure applied in accordance with scientific principles ; and followed by careful rubbings by persons engaged for the purpose. This is frequently a long and tedious process foi the patient, undoubtedly ; but how much less long and tedious and painful than other methods, those best can tell who have placed themselves under the treatment recommended by Dr. Harrison, after having adopted other methods. I he length of time occupied in the attainment of cure, it must be evident, as it is reasonable, will vary with the age of the patient, and with the nature of b

X

PREFACE.

the curve. Generally youth is the time most favourable for cure, the bones being then less hard, and all the ligaments more pliable and capable of yielding in the process. But frequently in youth, and even in childhood, very serious cases of curvature occur, with often also the distressing concomitant of a delicate constitution, and inability to hold out under the numerous evils resulting from the undue and unnatural pressure of the spine in wrong directions.

Acquaintance with the structure of the spinal column being essential both as respects prevention and cure, we have considered it desirable to present an exact picture of its entire economy ; ignorance of which has doubtless been the cause of most of those evils which have resulted from what is termed curvature, a term by which we designate curves not in accordance with the perfect and natural form of the spine. For with a knowledge of the remarkable mechanism of the spine, and of the extreme delicacy, vast number, and specific duties of the various nerves and vessels leading from the spine to every part of the body, must necessarily be seen the great importance of preserving the same in its proper position; and the importance being thus perceived, parents will be enabled to prevent much evil: they will avoid, in dress, all undue pressure, setting themselves against bandages and stays, while both in the occupations and the sports of their children they will guard the spine with the utmost care. As little would those acquainted with the structure of the spine and its dependencies, allow a child or delicate young person to carry an infant, or any disproportioned weight, as they would commit on such child or delicate person any other cruelty. Equally small is the probability that, with such knowledge, the accomplishments of drawing and music would be allowed to over-

PREFACE.

XI balance the happiness arising from a healthy performance of the functions of the vital organs ; and the same with respect to needle works, and other sedentary occupations. So in cases of accidents from falls or otherwise, immediate attention would be given to the spine ; it would be watched with extreme interest, and serious curvature be avoided ; while, should young persons themselves have their minds directed to this branch of study, hitherto almost wholly neglected, they would learn to respect the spine, and might guard it from many injuries. To all the knowledge is of advantage.

As we have deemed this picture of the spine essential, so, to disabuse the mind of errors, we have considered it advisable and even necessary to bring forward various modes of treatment which have been unsuccessfully resorted to ; for between so many methods, each one of which, it is professed, is the true method, the mind must remain uncertain and vacillating, until well assured that the cause of non-success with respect to such methods, is, that they are not founded on the principles of science, and act in a direction contrary to nature ; and that a cure effected by such means would be a violation of the order of nature, and more to be wondered at than want of success. Remedies to be effectual in cure must act harmoniously with nature, not in opposition to it: their application must be the result of successful experiences, and in conformity with fixed laws: thus only can they bear the test of sound reasoning. It is necessary only to bring forward to the light of superior intelligence the various modes of treatment of spinal curvature, to show that they will not bear this test, that they are not the result of

such experiences, but the contrary, and are opposed to natural laws.

b 2

Xll

PREFACE.

The propositions which we leave rather to be deduced from statements contained in the following pages, than seek elaborately to work out, are —

First, That man to enjoy the degree of health which he may reasonably expect, must have the spine precisely in that position which nature indicates that it should maintain, a proposition based upon the invariable antecedent and consequent of spinal curvature , and diseased states.

Secondly, That the curved spine being restored to such position, the diseased conditions disappear and health returns, other things being equal.

Thirdly, That science, as applied to such purpose by Dr. Harrison, gives a certain mode of restoring the curved spine to such position.

The cases which might be brought forward to prove that whenever the spine receives injury the health suffers as a consequence, would fill volumes: numerous also are the cases of perfect cure through the adoption of that mode of treatment which it is our object to commend. Some from among the more striking of these are presented, several of them treated by Dr. Harrison himself, and so remarkable and well attested as to carry conviction to every candid mind. These, therefore, we consider sufficient as illustrating the point advanced ; and they perhaps require no further introductory comment.

79, Audley Square , May Fair , October 23rd, 1849.

GEORGE N. EPFS.

Chapter II. On The Injuries Resulting From Spinal Curvature

The principal vessels, &c., as positioned immediately anterior and attached to the bodies of the vertebrae, viz. : — The ganglia of the sympathetic system ; the heart, and the large artery (aorta) ; the principal veins ; the spinal column ; the thoracic duct; the oesophagus, or gullet; the intestinal tube. (Plate VII.) . .13

Section I. — On the Varieties of Spinal Curvature. — The lateral curve, frequent

among females of rank . . . . . 17

The posterior or outward curve, or hump-back . . . .18

The anterior or inward curve, its injurious effects upon the lungs, heart, rectum,

bladder, and uterus . . . . . 18

Sufferings the most formidable and distressing during the progress of child-birth . IS Curvature in relation to single vertebrae . . . . 19

XIV

CONTENTS.

. Page

Curvature causing lameness, unattended with malformation of the lower limb itself

(Plate I.) jg

Case of Mr. T., and another case of spinal curvature, which came under the author’s care, in which, very absurdly, the tendo-achillis in both heels had been cut . . . . 19

Case, by Dr. Harrison, of a man who had fallen from his horse, and apparently

“ broke his neck ” 20

In the prosecution of field sports, the mode adopted for killing wounded hares and rabbits 21

Section II. The various Theories and Modes of Treatment of Spinal Curvature. — The theory of Glisson . . .21

The theory of Mayow . 22

The muscular system — its fallacies . . . 23

Spinal curvature may be produced in a person previously healthy .. . 23 ‘

The Lancashire and Rotherham colliers . . . . .23

The Athenian rowers deformed in the shoulders ... 24

The Thames watermen . . . . # .24

The bargemen in the Queen’s ships become “ bible-back ” . . 24

Certain religious fanatics of the East .... 24

Long-continued playing upon the pianoforte . . . .25

The opinion that muscular action can restore ligaments to their natural state

The statement that muscular action restores a dislocated arm to its socket . 26

Muscular treatment inefficient : — First, In restoring the bones to their natural position ; Second, In preserving them in that position, or as nearly as possible ; Third, In giving the opportunity to the intervertebral substance to recover its natural shape, by removing pressure from it; Fourth, In allowing the ligamentous tissue enveloping the vertebral joints to recover its primitive shape : to be recovered only by its regaining its natural elasticity . 27

The theory of Pott, that in spinal curvature there is a “ Morbid state of the bony column, and that no cure can be effected until the carious bones have begun to “ incarn ” . . . . . .28

Pott’s practice in accordance: Caustic issues: Professor Rust remarks, from numerous observations and experience, they frequently accelerate the progress of the disease . . . . . . .29

CONTENTS.

XV

Page

Pott did not seek to effect a cure, his object being mereliy to arrest the progress of

the caries, and, further, was content with a permanent deformity . 29

Mr. Cheshire’s plan ; case illustrative of . . . .30

I his plan (with modifications) that adopted by most practitioners : its common

result is pulmonary consumption .... 30

Chapter IV

ON DR. HARRISON S THEORY AND TREATMENT OF SPINAL CURVATURE.

Section I. Di. Hairison thought that the disease must be wholly confined to the

connecting ligaments of the vertebrce .... 39

Section II. Ihe Iheory upon which Dr. Harrison founded iiis Practice . 39

Section III.- The Treatment adopted by Dr. Harrison as founded upon iiis Theory. 1st. Ihe removal ot all causes which could add to, or keep up the spinal curve or deformity. 2nd. The mechanical means, acting most efficiently in removing the curve or deformity. 3rd. The means to prevent a return of the curve or deformity . ^

To lealize these objects, the following is the treatment: — Horizontal recumbency ;

Extension; Friction; Pressure , u

Chapter V

cases illustrative of the efficacy of dr. Harrison’s mode of treatment.

Case I.— M. P. Case of curvature of the dorso-lumbar region, of eleven years’ standing, cured in a period of only seven months. (Plate VIII.)

Case II.-— Miss D. J. Case ot lateral curvature, progressing towards the second stage of consumption, cured

Case III.-A case of inequality of the lower limbs, dependent on spinal curvature, cured by removing the curve

( ASE IV.— Miss M. H. A case of a paraplegic patient, who had lost the entire use of her lower extremities, cured

c ASE V.— The Rev. Mr. Case of paralysis of the arms and the legs, dependent

on spinal curve, removed by removing the curve

Dr. Hoffman’s admirable reply to a friend, who was in search of a medical adviser

49 49

XVI

CONTEXTS.

Page

Case VI. — Miss D. Case of spinal curvature affecting the respiratory, digestive, and

uterine system, cured, with disappearance of the symptoms . . 50

Case VII.- — Miss W. Case of spinal curvature, attended with cough, cured . 5]

Case VIII. — Case of spinal curvature, causing coldness of the legs, cured, and the coldness ceasing . . . . . a .52

Case IX. — Mr. C. D. Case of outward curvature, attended with affection of the heart

and affection of the sight, cured . . . . ‘ 52

Case X. — Master G. A. Case of outward curvature, attended with shortness of the left

leg, cured. (Plate X.) . . . . . .54

Case XI. — Mrs. A. B. Case of lateral and outward curvature, cured . . 57

Case XII. — Mrs. W. Case of outward and lateral curvature, with loss of power in the

lower limbs, and partial loss in the upper, cured . . .60

Case XIII. — Miss E. F. Case of outward curvature, attended with some extraordinary

symptoms, cured ...... 63

Case XIV. — Miss R. Case of outward curvature, attended with many distressing-

symptoms, cured. (Plate XI.) . . . . .68

Case XV. — Miss P. Case of outward curvature, attended with palpitation, difficulty of

breathing, tightness of chest, hysteria, and other anomalous symptoms . 72

Case XVI. — Miss M. D. Case of spinal affection, attended with affections of the pulmonary and digestive organs, cured . . . . 73

Case XVII. — Master T. C. Case of partial palsy, affecting the right leg, cured by

correcting the lumbar spinal curvature .... 74

Case XVIII. — Miss FI. Case of lateral and outward curvature . . .77

Case XIX. — Miss M. FI. Case of curvature of the spine, with one limb shorter than the other, and attended with the loss of the power of using the lower limbs, cured ....... 78

Case XX. — Miss S. S. T. Case of outward curvature, cured. (Plate XII.) . . 79

Case XXI. — The case of Sarah Flawkes. (Plates XIII. and XIV.) . . 82

Case XXII. — Miss J. R. Case of double lateral and posterior curvature, cured.

Directions for patients ...... 91

Chapter I. A General Outline Of The Spinal Column And Its Contents

AND OF THE PARTS IN RELATION THERETO.

SECTION I.

THE BONES OF THE SPINE.

The spinal column may be considered as the centre or fundamental part of the whole bony or osseous system of man. It supports on its upper extremity the skull ; progressing downwards, the ribs ; which latter in union with the sternum , or breast-bone, (to which the ribs are joined in front,) form an arch, in the hollow of which are placed the organs of respiration and circulation. The spinal column further, by means of muscular and ligamentous attachments on the external surface of the ribs, supports the superior extremities , or the arms; while, at the lower extremity of this column, will be found that junction of bones, called the pelvis , to which are attached the loiver extremities , or the legs.

The spinal column or back-bone of man, is composed of twenty-four distinct parts, called vertebra, (plate 2,) each vertebra being kept in position by strong ligaments. Some of these ligaments, as will be hereafter illustrated, pass simply from vertebra to vertebra, while others extend the entire length of the spinal column, having attachments to each vertebra.

A vertebra, (plate 3,) presents several parts : a foramen or hole , (plate 3, fig. 3 a). The holes of the twenty-four vertebrae with the hole of the sacrum form one

B

OUTLINE OF THE SPINAL COLUMN.

continuous tube, called the spinal canal , (plate 2, fig. 3 aa). The foramen (foramen magnum, ) for explanatory arrangement, may be called the centre of a vertebra. In front of this central hole is placed a mass of bone called the body , (plate 3, fig. 3 b.) the first vertebra alone (plate 3, fig. 5 a.) not having a body : at each side of this central hole is placed a plate of bone, which plates meeting posteriorly, form what is called the arch of the vertebra, (plate 3, fig. 3c.); and at the junction posteriorly of these plates to form the arch, a projection or process of bone, called the spinous process, is given off, (plate 3, fig. 3 d.) which spines being in the whole collection of vertebrae arranged perpendicularly, cause the column formed by the juxta position of these bones, to be called the spinal column, (plate 2, figs. 1, 2. 3.)

To repeat, the ring or hole is formed, at its anterior side, by the body ; at its lateral sides, by the plates ; which two plates meeting posteriorly form the arch, from which arch the spinous process is given off.

A more minute examination of plate 3, fig. 1, will show, at the junction of the body and lateral plates of the vertebra on its superior and inferior margins, four projections of bone, (bbbb.) named (as all these projections are) processes , and further characterized as oblique , from their oblique direction, one on either side at the upper margin, and one on either side at the lower margin, making in the whole, four: the upper for articulations with the vertebra above, and the lower for articulations with the vertebra below. On examining the external surface of these lateral plates, (plate 3, fig. 4,) two additional processes (bbb b.) are found, ( transverse,) which transverse processes in the dorsal region are for the articulation of the tubercles of the ribs, (plate 3, fig. 1 c.)

In plate 3, fig. 4 c c. a notch is visible between the body of the vertebra and the oblique process, and in plate 3, fig. 4 d. a hole is perceptible, being formed by the juxta position of two vertebrae, the upper notch of the lower vertebra uniting with the lower notch of the upper vertebra : an mter-vertebral foramen is thus formed between every two vertebrae. Through these several foramina the nerves, given off from the spinal cord throughout its entire length, pass out. (Plate 6d )

OUTLINE OF THP SPINAL COLUMN.

From this description it must appear that any slight deviation in the arrangement of the bones of the spine may, by disarranging the proper apposition of the notches, produce pressure upon the nerve in its passage from the spinal cord to the part which it supplies. The effect of such deviation is seen in plate 3, fig. 6 a a a. Pressure on nerves, according to its degree, produces weakness, wasting, or total palsy of the part to which the nerve gives, when unimpeded in its action, the power necessary for the performance of its functions.

The twenty-four vertebrae are arranged by anatomists, for convenience of description, into three classes, (plate 2, fig. 1,) viz. the cervical , ( a .) i. e. the neck vertebrae, seven in number ; the dorsal , ( b .) i. e. the rib vertebrae, twelve in number, to which are attached the ribs ; and the lumbar , (c.) i. e. the loins vertebrae, five in number.'

Each class of vertebrae presents to the anatomist many distinguishing points.

In the vertebrae of the upper part of the vertebral column the foramen magnum, oi central hole, is much larger relatively than in the vertebrae of the lower part of the column: an arrangement allowing the head and the neck to have a greater extent of rotation than otherwise would be admissible without producing pressure on the delicate tenant of the column, the spinal cord.

The doisal vertebra (plate 2, fig. 1 6.) having to support the weight of the whole of the upper part of the body, and, to a great extent, the contents of the chest, are more strongly formed, having larger bodies ; but, not having so great a rotatory motion, the foramen is smaller. These vertebrse have, as already hinted, articulating surfaces on their bodies, (plate 3, fig. 1 a.) and likewise on their transverse processes, (c.) with both of which the ribs articulate. Progressing further downwards to the lumbar vertebrae, (plate 2, fig. 1 c.) the bodies are still further

enlarged, and the foramen magnum again becomes larger, a greater extent of rotatory motion being required in this region.

Such, in relation to the subject of this work, are the bones of the spinal column.

THE LIGAMENTS.

SECTION II.

THE LIGAMENTS.

The vertebrae are held together and retained in position by ligaments, aided by a peculiar substance or cushion, styled fibro-cartilage, being partly fibrous and partly cartilaginous.

Some of these spinal ligaments have in connexion with them peculiar membranes or oil bags, secreting an oily viscid fluid termed synovia , the membranes themselves being hence termed synovial.

Synovial membranes are met with in all joints, and also where tendons in moving, move over an angular surface, and consequently cause friction.

The ligaments of the spine are

1st. The anterior common ligament.

2nd. The posterior common ligament.

3rd. The inter-vertebral substance.

4th. The articulating processes ligaments.

6th. The supra-spinous ligament.

7th. The inter-spinous ligament.

8th. The inter-transverse ligaments.

9th. The ribs articulation ligaments with the spinal column.

10th. The ligaments of peculiar articulation to individual vertebra.

1st. — The anterior common ligament, (plate 4, fig ha.) consists of a strong band of fibres, extending the entire length of the spinal column, on its anterior surface from the second vertebra, termed aocis , being the axis on which the head by means of the

Pi'J ■)

a

- •

.

.

THE LIGAMENTS.

first vertebra rotates (plate 2, fig. 2 a.) to the first bone of the sacrum, (plate 2, fig. 2b.) This ligament consists of longitudinal fibres, dense, firm, and well marked, the external fibres extending from a given vertebra to the fourth or fifth vertebra below it ; the next layer, extending from a given vertebra to about the third below it ; and the sub-layer of all, extending from one given vertebra to its neighbour.

2nd. — The posterior common ligament, (plate 4, fig. 3 a.) is situated on the posterior surface of the bodies of the vertebrae anterior to the spinal cord in the spinal canal ; adherent to a greater extent laterally to the inter-vertebral substance (bb.) than to the bodies of the vertebrae, (ccc.)

3rd.— The inter-vertebral substance, (plate 4, figs. 1, 3, 45.) is situated between each pair of vertebrae, from the second vertebra to the base of the sacrum, and is attached anteriorly to the anterior common Hgament,(fig.5 ^posteriorly to the posterior common ligament, (fig. 3 a. ) and in the dorsal region it has ligamentous attachments with the heads of all the ribs. Eight of the twelve ribs, it may be repeated, articulate each with the bodies of two vertebrae, (plate 4, fig. 7.) Of the other four the first rib has a single articulating surface with the first dorsal vertebra, the tenth rib has a single articulating surface with the tenth dorsal vertebra, the eleventh rib has a .single articulating surface with the eleventh dorsal vertebra, and the twelfth rib has a single articulating surface with the twelfth dorsal vertebra.

I he inter-vertebral substance or cushion is composed towards its circumference of thin plates, of fibro-cartilage, resting on their edges, and placed one within the other, as it were, concentrically, (plate 4, fig. 1 b.) Thus the outer Plate like a rim runs round the disc, its lower edge resting on the vertebra beneath it ; its anterior or convex surface being subjacent to the anterior common igament, whilst its concave surface is in opposition with and connected by some es to the plate next within it. The plates are not vertical in their direction, (plate 4, fig. 1 h.) On making a vertical section of a disc it will be seen, that a tain numbei of those plates nearest to the circumference curve outward, while others situated more inwards curve inward, (plate 4, fig. 4 b). The former are

THE LIGAMENTS.

more compacted together when the spine is bent in any direction, the curves formed by the different layers are augmented on the side towards which the column is inclined.

The interstices between the plates are filled up by a pulpy and apparently elastic substance; and as the number of plates gradually decrease towards the centre, whilst the pulpy matter increases, the quantity of the latter is such, that, when the pressure which confines it is taken off, by cutting through the external part of the inter-vertebral substance, it will rise so as to assume a conical form. (Plate 4, fig. 6 b.)

Upon a more minute examination of the layers forming the plates of the inter-vertebral substance singly, they are found to consist, for the most part, of fibres extending obliquely between the vertebrae, into both of which they are firmly fixed ; and the direction of the fibres varies from layer to layer, in one being from right to left, and the next the reverse ; some fibres are found nearly horizontal. (Plate 4, fig. 4 6).

Such is the provision of nature with reference to the laminae or the plates of the intervertebral substance ; the external plates being directed outwards, and the inner plates inwards, forming together a circle. Further in the centre of this circle is placed the pulpy or elastic substance, (plate 4, fig. 4a & fig. 66) serving, like buffers to railway carriages, to qualify the shock arising from any sudden pressure of the vertebrae when coming together. Take an example : suppose a person has another step to go down when under the impression of being at the bottom of the stairs, in the action, the heel will come in contact with the ground sooner than the toes, and consequently the shock will be great to the system. Again, when jumping down, if possessed of forethought, we come upon our toes, slightly bending all our joints, ankles, knees, &c. to relieve the inter-vertebral substance, and by consequence the spinal column, of a portion of the force to which it would be subjected.

When in the upright position, a greater amount of direct pressure being on the spinal column, then it is that the pulpy elastic substance has the greater

THE LIGAMENTS.

amount of duty to perform in the way of resistance. The inter-vertebral substance forms nearly a fourth of the whole moveable column, and of this total the cervical and the lumbar regions have the greater amount, exhibiting another wise provision of nature, since those portions of the spinal column, the cervical and the lumbar, have the greater amount of freedom of action, both with reference to the angular motion of bending and the circular motion of rotation.

In the cervical and in the lumbar regions the inter-vertebral substance varies with the curves in the spine itself; thus, in the cervical region the anterior portion ot the inter-vertebral substance is the thickest, and in the lumbar, the reverse is the case.