Practical observations on the causes and treatment of curvatures of the spine

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Preface

The great increase of spinal distortion, particularly of ' late years, and its alarming prevalence at present, together with the various and discordant opinions which have long existed as to the causes of the disease, and the most efficacious plan of treatment, will, it is presumed, furnish a sufficient apology for the publication of another treatise on the subject.

The author's attention has been particularly directed to the study of this disease, from the circumstance of his having been, some years ago, afflicted with a morbid sensibility of the spine, during the progress of which, his sufferings were very considerable, and necessarily productive of great inconvenience. The facts and observations which he now submits to the consideration of his medical brethren, are the result of careful investigation, both as respects his experience in his own case and in those

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11 PREFACE.

of the patients who have been under his care. Having* had, in the course of a long continued practice, (nearly forty years having elapsed since he first entered the profession,) abundant reason to conclude that his opinions and consequent mode of treatment are founded upon correct principles ; and being able, moreover, to record what may be considered surprising instances of success, even in cases of the worst description., he is led to conclude that it would be neglecting an obvious duty, were he longer to refrain from giving them publicity. Some of the most important of these cases are detailed in the course of the volume, and he is inclined to anticipate, that they will be perused with some degree of interest by the profession, and also by those who are suffering from the baneful effects to which they refer.

In treating of the causes of distortion, he has endeavoured to impress upon the minds of his readers the indisputable fact, that the principal source of the production of one species of the disease, and that the most common, the lateral curvature, is to be attributed to the improper adaptation of modern female attire, and more especially, to the injurious pressure occasioned by the excessive constriction of corsets : with a view to make this still more apparent, he has given a brief, but comprehen-

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PREFACE. Ill

sive sketch of the anatomy of the spine and chest, an attentive perusal of which will, he hopes, enable the non-professional reader easily to understand the manner in which the injury is inflicted. It is to be hoped, that the repeated admonitions and warnings which have, from time to time, been given by medical men on the pernicious tendency of the prevailing custom of tight lacing, will, at length, have some effect in opening the eyes of young females and their mothers to the danger of the practice.

In that part of the work which treats on excurvation and incurvation, the author has considered it unnecessary to enter very largely. There is much in each species that is of a similar character, and therefore, after having given a full description of curvature in general, and lateral in particular, it was less necessary to enlarge on the other species separately. Though they do not all originate in the same cause, yet their symptoms and the usual train of suffering are very similar, and the treatment they require is, with the exception of different mechanical adaptations, for the most part, the same.

In the chapter on treatment, which will be regarded as an important part of the treatise, the author has considered it requisite to be somewhat particular in his directions : in the part relating to mechanical treatment, he

IV PREFACE.

has given a description of an apparatus, which he has found of the most decided advantage in the various cases of spinal affection which have come under his care.

The chapter on spinal irritation, under which term are included those affections of the spine which have their origin in nervous irritability, and which, though not always accompanied with deformity, are yet highly susceptible, and occasion mental and corporeal suffering of a very peculiar, disagreeable, and painful nature, can scarcely fail to be interesting to such as are unhappily under the influence of such a morbid state.

For the reasons therein assigned, a concluding chapter or appendix has been appropriated to the consideration of pdmoB^y consumption. The ™ to ™he, *, fa,

the attention of the profession to this, in consequence of his having noticed the decided advantage attending the use of the apparatus in cases where there was strong reason to apprehend tuberculous disease of the lungs.

The engravings, which are inserted at the commencement of the chapters on the respective species of the.curvature to which they refer, and which are intended to illustrate the disease and its treatment, have been executed with the greatest care, and may be altogether

PREFACE. V

relied upon for their fidelity.* The surprising improvement they display in the contour of the figure, will be the best criterion of the merits of the treatment under which such favourable results were obtained.

In offering this little work to the public, the author can truly affirm that he wishes the labours of others, no less than his own, to receive that deference and encouragement to which they are entitled. His object has not been so much to produce a large book, as to give a full, though condensed, account of the nature of the disease and its remedies ; in doing this, he has endeavoured to touch on every essential particular; — some may, perhaps, think with too much minuteness — while others may imagine he has been too concise.

In respect to the execution of his undertaking, he would bespeak the candour and indulgence of the reader. The avocations of a busy life have left him little leisure for its composition ; he has only been enabled to devote to it small portions of his time taken from more urgent and pressing duties. He does not, therefore, think so highly of its performance, as not to be conscious that the critical reader may find in it some faults and imperfections. Per-

* To ensure this, not only the drawings, bat the casts themselves, were sent to the Engraver.

VI PREFACE.

haps, in some instances, there may be in the expressions, a similarity of language or of opinion, foe the writer felt loth to destroy the force of facts for the inferior purpose of critical nicety, thinking it better to incur the risk of repetition, rather than fail to place an important truth in a prominent point of view ; hence, public utility, rather than literary embellishment, has been his aim, — being anxious, by every means in his power, to effect a diminution in the sufferings of a large and interesting class of society, whose condition, as regards the disease under consideration, he cannot but consider as capable, in most cases, of complete and permanent cure, and in all, of great and satisfactory amelioration.

26, East Parade, Leeds, 29th September, 1838.

Introduction

The human body exhibits an indubitable evidence of consummate skill. The more attentively its component parts are studied, the more deeply will the conviction be felt, that it is the production of a Being of infinite power and wisdom.

Nor is the goodness of the Creator less conspicuous than his other perfections. The body is as perfect in its design, as it is wonderful in its formation ; it is not only pre-eminently distinguished for the symmetry of its proportions and the excellence of its mechanism, but also for its adaptation to the convenience, the comfort, and the enjoyment of its possessor. None but a Being, whose essential attribute is boundless beneficence, could have originated a performance so benevolent and complete.

In the splendid chain of animated existence unfolded to view by the master-hand of nature, Man occupies the highest position. Our view is indeed limited in its range, and obscure in its perception ; nevertheless, it exhibits an almost endless variety of beings, rising one above another in the scale of progressive gradation; dis-

B playing different degrees of dorporeal/femd instinctive excellence; and terminating in himself/ as vastly superior to the rest in intelligence, and as the delegated master of them all. Whatever, then, materially affects the welfare of a being so eminently distinguished by his Maker,— whatever tends, in an especial manner, to meliorate his condition and promote his happiness, — must be considered as all important, and worthy the attentive consideration of every rational being on the great theatre of the world.

In its natural state, the state of health, this grand animated machine performs, with ease and freedom, all the various operations of active life ; and, when not enfeebled by disease, disfigured by intemperance, or injured by improper management, displays the highest degree of vigour, grace, and beauty.

Possessed of a frame so admirably adapted and kindly contrived, how much is it to be lamented, that man, either through ignorance or folly, should so often be instrumental in causing the derangement, and defacing the beauty of such excellent workmanship. He does not in general act thus from deliberate choice — he does not, knowingly and intentionally, prefer pain to pleasure — disease to health — misery to happiness ; inadvertency, and the want of more general information on the privileges and consequent duties of existence, are the primary sources of these frequent errors.

Man is not naturally indifferent to his own welfare, and that of his species ; — but he is, emphatically, the creature of circumstances. His ideas, his wishes, his pursuits are powerfully influenced by the position in which he happens to be placed. His temper, disposition, and indeed his entire character receive a tinge from those of the individuals by whom he is more immediately surrounded. He is too apt to be swayed and governed by the customs and opinions that are prevalent around him.

Many noxious practices are eagerly followed by the multitude, for no other reason than that they are generally adopted, without a thought being devoted to the consideration of their expediency or usefulness. But there can be no doubt, that there are numbers in the world, who would have sufficient resolution to emancipate themselves from such unnecessary thraldom — such self-imposed fetters, were they fully aware of theif nature and tendency.

These remarks, though obviously applicable to numerous other diseases, have a particular reference to those of the spine.

In tracing the origin of spinal distortion, an evil much more prevalent, particularly among the female sex, than is commonly imagined, an attempt will be made to point out the injurious and sometimes fatal effects of the prevailing mode of fashionable attire. Fashion is ever characterized by its fondness for extremes — and all extremes in the article of dress, are, in some respects, prejudicial to health, and are even sometimes productive of extensive mischief and serious distress.

That the mode and materials of dress have an intimate connexion with these subjects, will, it is presumed, be rendered sufficiently obvious by the arguments adduced in the following pages ; and particularly when it is clearly understood that one of the principal causes of curvature of the spine, now so alarmingly prevalent, is the use of improper stays and the lacing of them to excess.

The enjoyment of a sound state of the constitution, and its necessary concomitant, good health, is the greatest sublunary good. Destitute of this paramount, this master blessing, all other advantages lose their sweetest relish, and become, comparatively, joyless and insipid. What does it avail the sick to possess all the gaieties and splendour of affluence ? they cannot, of themselves, remove disease, or alleviate pain ; nor communicate that tone and buoyancy to the spirits, which the poor but healthy labourer enjoys amidst all his toil. Equally impotent are the dignities of rank and station, to confer immunity from the casualties and sufferings attendant upon the common lot of human-kind. Nor does disease pay any deference to distinctions of this nature, which are powerless in shielding the possessors from its indiscriminating attacks. Hence, it ought to be a source of constant satisfaction to the poor, amidst all their sufferings and apparent inferiority in the general distribution of temporal happiness, (often more apparent than real) — that, in the most essential and truly valuable blessings, all ranks of mankind are much upon an equality.

Has the great Creator then displayed such amazing knowledge, power and goodness in the formation of the body he has bestowed on man, and shall not he, on whom so rich a gift is conferred, proportionably value it ? Ought he not carefully to abstain from whatever is injurious to it ? Ought he not, by every means in his power, to seek its preservation and to promote its welfare ?

That department of physiology which comprises the promotion and preservation of health, commonly expressed by the term, Hygiene, is as yet but very imperfectly understood by the generality of mankind. An extensive field of usefulness is here presented to the mind of the philanthrophist, when we consider how much yet remains to be done, by means of the diffusion of plain, practical information of this nature, to enable the great bulk of mankind duly to appreciate their own interest. It is by the accumulation of experience and observation throughout succeeding ages, that a valuable store of varied knowledge is produced, by which mankind obtain a gradual increase in such practical measures as are best calculated to effect their comfort and happiness.

In presenting this little work to the profession, the author is influenced by a desire to contribute, in some small degree, to the efforts of the humane and intelligent, in their laudable .endeavours to benefit their fellow-creatures ; and by the pleasing anticipation, that his mite will not be altogether unacceptable. It assumes, indeed, no lofty pretentions, it arrogates no exclusive merit — it founds its claim to public acceptance and favour on its motive and tendency, — its design being to promulgate some useful and important truths, in a plain and familiar manner.

The writer who labours to induce mankind to pay proper attention to the subject of health, has the satisfaction to reflect, that he advocates the cause of the happiness and virtue of the human race, because health is most fully eqjoyed by the temperate, the active, and the moral. To recommend mankind, therefore, to study how best to attain and preserve so great a blessing, is to allure them into the paths of morality and virtue, and consequently, to insure their happiness. And as education becomes more and more extended, and knowledge, in consequence, more widely diffused, this branch of information, as well as others affecting the true interests of the great family of man, will doubtless be more generally cultivated, and therefore better understood.

Sapid advances have, particularly of late, been made in the circulation of general information ; — its attainment is gradually becoming mrfre easy — Mind will ultimately predominate over all the obstacles that retard its progreps ; and its possessor, feeling the superior advantages resulting from its culture, wffl redouble his exertions in the acquisition of solid information — will become more intellectual, and thus attain a more elevated rank in the scale of existence.

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Chapter I. Causes Of The Disease

Spinal diseases originate in a variety of causes. Among the principle may be enumerated,

1. The injudicious management of infants, children, and those of somewhat riper age ; i. e. throughout the whole period of growth.

2. Impropriety of dress, and want of sufficient exercise, more especially in reference to young females.

3. Inattention to the state of the digestive organs, and to the general health and vigour of the body.

Other minor causes, accessory to the production of the deformity, will be discussed in the progress of the work. They are such however, as will seldom be able to effect much mischief, unless the constitution be previously in a state of disease. The great predisposing cause is a deterioration of the health, arising either from congenital organization, or in consequence of some of the infantile diseases, which, not having received requisite attention, have left the body in a debilitated state.

Section I. Management Of Infants, Etc

When it is considered that the infant contains the elements of the future man, and that the subsequent welfare of the latter, as respects good or bad health, enjoyment or non-enjoyment of the great boon of existence, depends mainly upon the attention which is paid to the first stages of vitality, it will readily be conceded that the subject is one of no ordinary importance. It involves considerations which have a continued and influential effect on the whole period of human life ; even the duration of that life is more dependent upon the proper management of infancy and childhood, than is usually supposed. Diseases contracted at that period, and not effectually cured, exert a morbid influence on the whole of life, — embittering its condition, and rendering' it more liable to be prematurely destroyed. A prudent architect in constructing an edifice, is especially careful that the foundation be made strong and efficient, in order that the superstructure may be reared with safety : and shall the groundwork of the noble fabric of life be deemed less worthy the assiduous care of those under whose superintendence it is placed ? Shall the erection of the great structure of human existence be considered of less value and importance, than that which is inanimate and void of sensation ?

The mortality which prevails during infancy, to an extent vastly disproportionate to the other periods of life, is, notwithstanding the advance of medical knowledge, and the general introduction of vaccination, still so large, as to call for the serious consideration of parents and the profession.* And though this disparity may not be so great as in former times, still the period under consideration is a critical one, and one of deep solicitude ; and any suggestions, which will be calculated to smooth the path of duty, and render its performance more agreeable and secure, cannot but be received with deep interest by the anxious parent

FOOD.

Throughout the whole range of animated existence, the young of the human species is the most helpless, and continues longest to require assistance ; among no other animals is there so great a mortality during infancy. These facts show in the most forcible manner, the necessity of well directed parental tenderness and care. The love of offspring is a feeling so deeply implanted in the human breast, that there are very few who do not wish to perform their duty in this respect. The neglect of it arises more generally from defective information, than from want of inclination. Viewed in the

* From the abstract of the parish register for the United Kingdom, for 1831, printed by order of the House of Commons, 2nd April, 1833, (vide vol. 3, page 468,) it appears— that out of every thousand who died during eighteen years,— .18] 3—1 830, —345 were under five years of age— i. e. one third and seven sixty-ninths.

C light of a great, important, and universal duty, the proper discharge of the necessary office of nursing, is imperative on all mothers who are able to perform it The future comfort and welfare of the individual who is the subject of it, depends much on its efficient performance.

To the tender infant, a supply of food is furnished exactly suited to the nourishment of its delicate frame — a frame comparatively feeble, yet containing within itself the elements of future strength and stability. Unquestionably, the mother's milk is the best, and should be the only nourishment of an infant, until it acquires teeth for the mastication of solid food. Instances rarely occur of the failure of an adequate supply of this nutriment, when the mother possesses tolerable health, and lives in a proper manner. In cases where the milk of the mother, or that of a healthy nurse, cannot be obtained, recourse should be had to that description of aliment which bears the nearest resemblance to it. In the first instance, barley water, with a small proportion of fresh cream, sweetened, and administered through a suckling glass, is one of the best substitutes,* and should be varied as may be deemed necessary, according to the directions of the medical adviser. In a more advanced period, preparations of bread may be made use of, but it ought to be unfermented, — biscuit powder is used by many, and is perhaps the most proper.

Every thing that is calculated to irritate and disor-

* Burns, recommends an equal quantity of new made whey and cows milk, a sixth part of fresh cream, and a little sugar j— .Principles of Midwifery, 6th Edition page 601.

der the stomach and intestines should be carefully avoided ; for if articles of this description be attended with destructive effects to the body, when fall grown and robust, how greatly must the evil be increased, when the recipient is but just commencing its career of life, and all its organs and functions are immature, and easily susceptible of derangement and injury. The inconsiderate use of opiates and stimulating liquors is highly reprehensible ; such pernicious expedients may indeed produce a temporary respite for the jaded and weary nurse, but the repose they procure for the infant is unnatural, as is sufficiently indicated by the convulsive starts, the raised and quivering eye-lid, and the irregular motions of the muscles. Another very common practice, and one equally deserving censure, is that of over feeding.

If we direct our attention to the operations of nature, we shall find them always executed with unerring precision, — her indications are, on reflection, always clear and easy to be understood. In all our proceedings, we have only to follow her obvious dictates, and to keep within the bounds of reason : — whilst we do this, we shall rarely err, but if, as is too frequently the case, we act in opposition to her admonitions and disregard her warnings, we shall, assuredly, bring upon ourselves disappointment and regret.

Both as it respects children and adults, she is an unerring guide in this, as in other cases, and will not fail to indicate, when sufficient nourishment has been received : it is possible, and indeed not unusual, for these indications to be slighted, and a fictitious appetite induced, the indulgence of which, particularly in infancy and declining years, invites or facilitates the approach of disease and often contributes to shorten life.

There can he no douht that man, during the greater portion of his life, consumes much more, both of solid and of liquid food, than is necessary for the due maintenance of health and strength, — nay in many instances, under a mistaken notion that he is thereby promoting the energy of his physical powers, is actually doing violence to his constitution, and curtailing the natural period of existence*

In reference to the infant, it should be remembered, that not having yet attained the faculty of speech, it has not the same means of denoting when it has had a sufficient supply, as is the case in childhood and youth ; and even the latter, unless subjected to some salutary restraint, will often, by eating to excess that which pleases the palate, so overload the stomach as to occasion a temporary derangement of the heajth. Children have not the same experience to guide them in this respect as an adult, neither have they occasion for the same reason, being under the care and control of those who ought to prevent their acting wrong or receiving injury. By improper indulgence they are often induced to eat to excess ;— their stomachs are distended and consequently weakened, and the seeds of disease are thus thoughtlessly sown by those who vainly imagine, that the means they are using are calculated to promote the growth and vigour of their charge.

It may further be remarked, that a very common practice, immediately on a child's beginning to be uneasy or to cry, is, to attempt to appease it by giving it food. A healthy child, when properly nursed, will seldom cry. It will generally be found, that when children become troublesome in this way, they are at the time in a state of suffering, either from some derangement in their digestion, some disagreeable restraint or annoyance in their clothing, or occasionally from the want of sustenance, but their uneasiness is attributed to the last cause much oftener than it ought to be ; the cause being removed, the distressing cry, being the only means they possess of making known their wants or sufferings, will immediately cease. Children, when very young, are apt to acquire a habit of eating their food too quickly or eagerly, particularly fruit and other articles of which they are fond ; mastication is thereby imperfectly performed, digestion impaired, and the health consequently injured.

EXERCISE.

Widely different is the physical state of an infant, from that of an adult ; the newly formed bones of the former are soft and flexible, and may easily be made to assume any form, especially when the body is in a diseased state. This accounts for the common origin of such irregularities of form, as are not congenital, but occur at an early period of life. In proportion, therefore, to the delicacy of the infant, will be the care required in its rearing. Much has often been effected in this way by constant and

22 MANAGEMENT OP INFANTS.

persevering attention ; and many weakly and unpromisingchildren have, by judicious management, been raised to maturity, and have passed through life in the enjoyment of a considerable share of health and vigour. A finely formed body is favourable to the enjoyment of sound health. Every one is struck with the commanding figure, the graceful appearance of a person so formed, but few enquire into the reason why all are not so gifted. If parents would have their offspring free from personal defects, if they would have their limbs moulded into the form indicative of grace, activity, and strength, they 'must commence their attention to them from the time of birth ; and although they may not always succeed in securing for them the highest state of physical perfection, yet they will generally be able to effect such an improvement in their constitution, as will form the basis of future health. Children should not be too early set upon their feet, but should rather be placed on their backs upon the floor, that they may exercise their limbs with freedom ; the former practice is a frequent cause of malformation in the lower extremities. Especial care should be taken that the spinal column, so tender in young children, may not take a wrong direction. The manner in which a child and especially a delicate one, is suffered to sit on the nurse's arm should be carefully attended to ; and until it have acquired sufficient strength to keep itself erect, its back ought to receive proper support. By being suffered to sink into a crouching posture, with the head and shoulders inclining forwards, and the back projecting, a bad habit is soon contracted, which often leads to distortion of the spine. Neither is it in the arms alone, that this attention is required ; the effect is

J not less injurious, if the child be suffered to sit long in a chair, as, when fatigued, it will naturally adopt that position, which at the moment affords most ease. Here, it may not be irrelevant to notice the very common and reprehensible practice of raising a young child by its arms, in such a manner, that the sides of the chest being pressed by the hands, or rather the knuckles, of the nurse, its cavity is diminished, the sternum or breast bone pushed out, and that deformity produced in delicate children, commonly called "pigeon breasted.''

A too softened state of the bones, so common with children born of unhealthy parents, reared in unhealthy situations, or improperly managed in their infancy, is the principal cause of that peculiar condition of the body, known by the familiar epithet of rickets, as a a great predisposing cause of distortion of the spine. Under these unfavourable circumstances, the organs of nutrition cannot efficiently perform their functions, the circulating system is inadequately supplied with the requisite materials for the deposition of the earthy part of the bones, which, from their softness, are incapacitated for sustaining the superincumbent weight.

In all cases where a child is delicate and puny, and supposed to suffer under the effects of diseased organization, when the symptoms are such as denote weakness of the back, and consequent incapacity to support the weight of the head and shoulders, it ought without delay, to to be minutely examined. It cannot be too forcibly or too frequently impressed upon the minds of parents and others who are entrusted with the care of children, that this disease, if attended to on its first appearance, admits of an easy and speedy cure, but that the longer it is neglected, the more tedious will be the treatment, the greater the suffering, and the more dubious the result. The propriety of this caution is the more necessary, as cases are of frequent occurrence, where, by early investigation, incipient curvatures of the spine have been detected, which were not even suspected to exist. Important as the subject must, on consideration, appear to be, it is obvious, that the periods of infancy and childhood do not generally receive that degree of attention, which they so urgently require. Does the horticulturist, in the prosecution of his calling, find it necessary to be unremitting in his attention to his young plants? do the sportsman and others, engaged in the rearing of a superior breed of the irrational animals, find the advantage of superior care and assiduity in training ; and shall man be indifferent, as to the means of effecting improvement in his own species ? Surely, if the remark of a celebrated poet, that