THEORY AND PRACTICE I OF THE MOVEMENT-CURE: OK, THE TREATMENT OF LATERAL CURVATURE OF TIIE SPINE ; PARALYSIS ; INDIGESTION ; CONSTIPATION; CONSUMPTION J ANGULAR CURVATURES, AND OTHER DEFORMITIES \ DISEASES INCIDENT TO WOMEN ; DERANGEMENTS OF THE NERVOUS SYSTEM J AND OTHER CHRONIC AFFECTIONS, BY THE SWEDISH SYSTEM OP LOCALIZED MOVEMENTS. BY *r CHARLES FAYETTE T ( AYLOR, M.D. mitt) KUustvations. PHILADELPHIA : LINDSAY & BLAKISTON. 1801. WBC T23Ti ¦ Entered, according to Act of Congress, ia the year 1860, by CHAELES FAYETTE TAYLOR, In the Clerk's Office of the District Court of the United States for the Southern District of New York. Davies & Kent, 8tere0typers and ele0teotyfee8, 113 Nassau Street, JV. Y. TO BARON WILLIAM DE WETTERSTEDT, MINISTER RESIDENT FROM SWEDEN AND NORWAY TO THE UNITED STATES, AS A TOKEN OF PERSONAL REGARD, AND AS AN EXPRESSION OF GRATITUDE TO THE COUNTRY HE REPRESENTS, WniCH HAS PRODUCED, NOT LEAST AMONG HER SONS OF " UNPRETENTIOUS GREATNESS, WITH A CELSIUS, A LINNJEUS. A BERZELIUS, AND A EET2IUS, PETER HENRY LINO, POET AND PHILOSOPHER, TO TEACH US NOT ONLY TO DESPISE EFFEMINACY, AND TO EMULATE THE PHYSICAL NOBLENESS OF THE OLD NORSE HEROES, BUT TO BANISH DISEASE BY THE BEAUTIFUL SYSTEM nE ORIGINATED, IS RESPECTFULLY DEDICATED BY THE AUTHOR. PREFACE. I make no apology for bringing a new book on a new subject before the medical profession. There is need of information on the subject of which it treats; and that this need is felt is shown by the numerous inquiries directed to me by physicians from all parts of the country, and by the hearty encouragement extended to me by the profession of this city. Having made the somewhat hazardous attempt to introduce a new and distinct practice —and that a specialty—it is gratifying to know that the Movement-Cure treatment has met with the cordial approbation of every physician whose attention has been directed to its merits. It is to supply an apparent demand that this work—which at best can be considered as but an incomplete elucidation of the subject—has been prepared. In this circumscribed but new fjeld of medical inquiry there is a rich harvest to reward patient investigation. Such investigation I in- VIII PEEFACE. tend to continue; and at a future day, with ampler materia], I hope to give to the profession a worlf. of more lasting value than this unpretending book. But, till a better one is written, the present volume is respectfullysubmitted. CHARLES FAYETTE TAYL0E. NewYork, December, 1860. CONTENTS CHAPTER I. Caused by Oxydation of Tissues under Sl mulus 44 1* Method of Contraction 48 MUSCULAR CONTRACTION. CHAPTER II. They are partially Separable 41 Muscular and Nervous Fatigue different 41 Relative Action of Muscular and Nervous Systems 41 Tissue Metamorphoses caused by Muscular Action not in the Ratio of Fatigue. 40 Mental Influence—Can be made Remedial 86 Medical Uses of theso 85 Direct and Reflex Action '. 84 Vegetative and Animal Life 88 Influence of the Nervous System 83 Regulation of Functions by controlling the Circulation / 81 Functions are performed only by presence of Arterial Blood. 80 Circulation governed by Muscular Action, Endosmotic as well as Capillary.. 27 Increases Affinity between the Blood and Oxygen of Respiration 26 Causes Oxydation of the Tissues ' 26 Muscular Motion promotes Tissue Transformation 25 Digestion not Nutrition 25 Tissue Transformation necessary to Purity of the Blood 28 Tissue Formation analogous to Excretion 22 Conditions op Nutrition 21 THE NUTRITIVE PROCESSES. X CONTENTS. Repair 45 Blow Movements diffuse the Contraction 45 Food, Drink, and Respiration vary in amount with the Use of the Muscles 46 Muscles are Levers to move all Vital Phenomena 46 Pathology is altered Physiology 46 "We should modify the Latter as indicated by the Former. 4T How to do this 47 Eccentric and Concentric Contractions 47 Effects upon the Circulation 48 Retraction and Relaxation of Tissues 51 How caused 62 Endosmose and Exosmose ; 62 AH Organs, when Abnormal, have one of these Conditions 63 Correspondence of Concentric and Eccentric Contraction and Relaxation and Retraction of Tissues 54 How to control Capillary Circulation according to these Conditions of tho Tissues 55 CHAPTER III. PHYSIOLOGY OP GENERAL EXERCISE. Motion affects all other Tissues as well as the Muscular 58 The whole Part moved must be Considered 69 Illustrations CO Exercises should be varied for different Individuals and Classes 61 Relation of Exercise to the Nervous System 65 Sensation and Volition 66 To Feel and to Execute 66 Exercise and Labor 67 What Kinds to be Used 68 For Invalids there should be a definite governing Idea 68 Contortions not Beneficial 69 Fatigue 69 When Proper and when Injurious 70 Neglect of Physicians to Instruct Patients how to Exercise 71 Exhaustion, Evil Effect of 72 Increased by Sudden Efforts 72 Dress 72 False Action caused by Slight Hindrance of Dress 73 Muscles refuse to act against an Impediment 73 Actual Confinement not necessary to effect Injury 74 Ladies' Dress 74 Effect upon Chest, Abdomen, and Pelvic Organs 75 High Heels and Effect upon tho Spinal Column 76 Wholesome Influence of Exercise upon the Mind 77 XI CONTENTS. Common Exercise uses most the unaffected Muscles 127 Indications for Treatment 126 The Proper Hygiene 125 Medication in First Stages deprecated 124 After the Shock, Reaction should take place before beginning Treatment 128 Organic and Functional Paralysis 119 Its Pathology Hf Its Curability not determined by the amount of Paralysis 118 Paralysis not a Disease of the Muscles, but of the Nerves 116 PARALYSIS OF MOTION. CHAPTER V. Admeasurements HI Concluding Remarks. 118 Corsets for Lateral Pressure 110 Supporters—when allowable 109 The last to yield 10T How Remedied 108 The Ribs. . 104 How produced 104 Deformity of Chest 108 A Complex Movement 98 Illustrations , 91 Localized to act differently on different Muscles 91 Concentric Movements for Expanded Side and Eccentric for Contracted Side.. 90 Retraction and Relaxation on opposite sides of Spine 90 Should Reverse the Process which produced it 89 Treatment of Lateral Curvature 89 Over-Action of certain Muscles 89 Weak Ankles and improper Fositions 88 Curvatures generally caused by Muscular Weakness 87 Crescentic Curvature 85 Sigmoid Curvature 84 Why more often to the Right 83 The different kinds of Unequal Action and Resulting Curvatures 88 How Effected 82 Caused by Unequal Action of the Muscles 81 Lateral Curvature 80 Introductory Remarks 79 LATERAL CURVATURE OF THE SPINE. CHAPTER IV. CONTENTS. XII PACK IIow to Reverse this 128 Concentrating the wiLfupon raralyzed Muscles by Localized Movements 128 The process by " Exclusion" 129 Double Efforts of Corresponding Affected and Unaffected Parts 132 The Circulation in Paralyzed Muscles 133 Reflex Nervous Action 134 The process by "Concentration" 135 Constipation of Bowels in Paralysis < 137 Spasms of Muscles 139 Inducing Paralyzed Patients to make Efforts 140 The use of Electricity 140 Contrast with Innervation 141 Dr. Todd's Views 143 " Apoplectic Diathesis" denied 144 Tabular Statement of Cases •. 145 Remote Causes of Paralysis 147 Difference between Certainty and Readiness of Muscular Action 143 Explosive Movements 149 Cases of Local Paralysis, Paraplegia, Hemiplegia, Atrophied Muscles, etc 150 Cases and Remarks 150 Infantile Paralysis 155 " "Withered Limbs" 156 Favorable Results of Trc atment 157 Cause of Infantile Paralysis 160 CHAPTEE VI. TIIE CIRCULATION OF TH.E BLOOD. Controlling the Circulation 162 Cold Extremities the Cause of Congestions 163 Why Voluntary Exercise does not always induce a Peripheric Circulation 164 Localized Movement on Extremities 165 Strong Localized Muscular Action without increased Arterial Action 168 Centrifugal Circulation 169 Physiological and Mechanical Effect of Muscular Contraction on the VenouB and Arterial Circulation 173 Stretching the Muscles 173 CHAPTER VII. CONSTIPATION OF THE BOWELS. Constipation seldom Cured by Physic 174 PATnoLOGY of Constipation 175 Inadequate Capillary Circulation 176 Eccentric Movements 176 Mechanical Action of Movements on the Contents of the Bowels 177 Localized Movements 179 Counteracting Movements to bo Avoided 180 XIII CONTENTS Mechanical Stimulus J 8 * Vibrations of Abdomen J 88 Stimulating Afferent Nerves I s * The Liver • S* General Directions " i I Eesults of Treatment 183 CHAPTER VIII. CHRONIC DIARRHEA. Its Pathology.... I 90 Opposite to Constipation 190 Irritability and Relaxation of the Tissues 191 " Irritate the Muscles" 191 Concentric Movements 191 Kneading Relaxed Abdomen 192 Engorgements of the Liver 193 Dissipating Congestions , 198 Constitutional Treatment 194 CHAPTER IX. DYSPEPSIA. Its Frequency 195 Chasing " Symptoms" Deprecated 196 Forms of Dyspepsia , 196 Chronic Gastritis 196 Atonic Dyspepsia 197 Constitutional'Causes 198 Treatment 198 Peripheric Circulation 199 Rule—Acting on the Stomach 200 Atonic Dyspepsia 203 Treatment 204 Localized Movements 204 CHAPTER X. PULMONARY CONSUMPTION. Movement-Cure not Exclusive 208 Tubercle the product of Imperfect Nutrition 209 Nutrition and Digestion 210 Interchange between the Blood and Tissues and Blood and Oxygen 210 The Use of the Muscles 211 Exhausting Exercise Injurious -. 211 XIV CONTENTS, FAOB Nervous Debility and Irritability > 212 Treatment 213 Pulmonary Circulation and Peripheric Circulation 218 Expanding tho Chest 218 Stiffness of the Muscles over Diseased Portions of the Lungs 214 Dr. Corson's Paper at the Academy 214 Developing the Stiffened Muscles 215 Its Influence on the Lung beneath 215 Illustrated Localized Movements and Explanations 216 Dissipating Pulmonary Venous Stagnations 222 Chest Vibrations 228 Prescriptions of Movements 224 Effect of Muscular Contraction, on the Lymphatics 226 Increased Oxydation in Consumption Denied 227 Deficient Oxydation the true Pathology 227 Relief obtainable by Treatment 227 CHAPTER XI. ANGULAR CURVATURE OF THE SPINE. Its Cause 228 Absorption of Vertebrae 228 Constitutional Treatment 229 Hygienic Agencies 229 The Use of Supporters 280 The Formation of the Curvature 281 Increased Pressure at the Point of Disease 231 Action of Spinal Muscles 282 Assisting the Muscles by Apparatus 282 Points to Consider 282 The " Spinal Assistant" 233 Its Superiority over other Instruments 284 The Principle of its Construction 284 Alternate Action and Rest of the Muscles 235 Freedom of Motion 285 When Aid is Useful 286 Special Movements 287 Results 288 CHAPTER XII. DEFORMITIES OF THE LIMBS. Result op Hip Disease 289 Securing Mobility of the Hip Joint 240 Accelerating the Growth of the Legs 240 Flexion at the Hip 240 Mode of Extension 240 Retkacted Muscles 241 —Relaxation of (heir Antagonists. , 841 CONTENTS XV PACK Eccentric and Concentric Movements 242 Appliances for Extension 242 General Application of the Treatment in the arrest of Development and Deformities 242 CHAPTER XIII. CHRONIC INJURIES TO THE FOOT AND ANKLE. Repeated Sprains 24ft Weakness 248 Retarded Venous Circulation 244 Aggravated by ISligbt Causes 244 Exercise and Rest 244 Treatment 245 Dissipating Venous Congestions 245 Passive and Concentric Movements— 245 Mode of Treatment 245 Arab Doctors 246 " Natural Bone-Setters" 246 Injury to the Nerve •. 247 Tight Shoes 247 CHAPTER XIV. DISEASES INCIDENT TO WOMEN. Necessity for Improved Treatment 248 Constitutional Origin of Uterine Diseases ¦ 250 Attending Symptoms not always of Uterine Origin 251 Spontaneous Recovery 252 Predisposing Causes 258 American Women 254 Why disposed to Uterine Diseases 254 Boarding-Schools 255 " Taking Exercise" 255 Stimulating the Nervous System 256 School Over-work 25T Softness of Muscles 257 Muscular Relaxation > 258 Depression of Chest and Abdomen 258 First Indication of Treatment t $59 Imperfect Circulation 259 Cold Extremities • 259 Second Indication ( 2fio Healthful Blood 260 Thibd Indication _ 260 Common Exercise ' 261 Why not Sufficient 261 Rule for employing Muscular Action in these Diseases 261 CONTENTS. XVI PAflW The Nervous System 262 First Class 2 J*j Suppbkssion of Mknstbtjation 268 Its Treatment 26 j| Second Class 2 <*j Symptoms Constitutional Treatment 266 Voluntary Exercise insufficient 266 How the Muscles may be Strengthened 267 Weakness of Back, Chest, and Abdomen 270 How to overcome it 27 ® Third Class 272 Pbolapbus, Indications, etc 272 Treatment 273 Stretching the Muscles 274 Contiguous Development 275 "Spinal Irritation" 276 Back-ache 277 Its Muscular Origin 277 Amelioration of Incurable Prolapsus 279 Conclusions, etc 280 CHAPTER XV, DERANGEMENTS OF THE NERVOUS SYSTEM. Nebvofs Ibbitability 284 How Produced ' 285 A Distinct Disease 285 Illustrated by Paralysis 286 Expenditure of Force 286 Undue Waste of Nervous Force 286 " Irritate the Muscles" 287 " Bbd-Riddkn" Women ' 287 Illustrated by Fright 288 Treatment 288 Counter-Development . 288 Charlatans 288 Applicability of the Movement-Cure ; . 289 A Case to Illustrate *• 289 Treatment 289 Analogous Cases 290 Nervous Irritability and Muscular Action 290 Nervous Depression 291 The Difference 291 APPENDIX. Life of Ling, and History of the Movement-Cure 293 LIST OF ILLUSTRATIONS. 83- " " (lying) 179 87— Expanding Abdomen (kneeling) 177 86— Hanging—Leg Separation 171 85— Stretch Standing—Leg Extension 170 84— Bending and Extending Arms and Legs 169 83— Rotation of the Foot 166 82— Bending the Knee 184 81— Extending the Leg _. 182 80— Raising the Leg 131 28— Measures of the Deformity Ill 29— Bending the Arm 128 27— Corset for Lateral Pressure 110 26— Instrument for Lateral Action 108 25— Eccentric Couch 105 24— Distortion of the Ribs 108 23— Section of Spine 102 22— Localized Movement 100 21— Complex Movement 9 3 20— Twisting the Trunk 97 19— Another Bending to the Right 9 6 18— Bending to the Right 98 16— Raising Trunk to the Right 9 * 17— Hanging by Left Arm 95 15— Lying, supported by Head and Hips 98 14— Movement by Left Arm 92 12— Stretching up the Arm and Standing on one Foot 9t) 13— Trunk Raising over the Bar • 9 1 10— Crescentlc " " j~ 11— Standing on one Foot 88 9- Sigmoid Lateral Curvature 88 5_Waves of Contracting Muscular Fiber 6-8ingle « " " JJ 7 and 8—Concentrlo and Eccentric Contraction 43 8— Capillary Vessels 7* 4—Areolar Tissue 82 2— The Myolemma jj No. a Fbontispibob • 1— Muscular Fiber ™ XVIII LIST OP ILLUSTRATIONS. No. Pagb 89—Rotation of the Trunk at Hips . 180 40— Kneading the Abdomen 188 41— Knocking over the Sacrum 1S6 42— Vibration of the Liver 186 43— Compression of the Stomach 201 44— Shaking the Sides 203 45— Vibrating the Stomach 204 46— Rotation of the Hips 205 47— Bending the Trunk Sideways 206 48— Expanding the Chest (passive) 216 49— Drawing up the Arms 217 50— Expanding the Chest (backward bending) 218 51— Expanding Chest between Poles 219 52— Developing Respiratory Muscles 219 58—Expanding one Side of the Chest (twisting) 220 54— Vibrating the Chest (by the Arms) 228 55— " " (vibrating board) 223 56— Angular Curvature of the Spine 281 57— Section of Diseased Spine » 281 58— " Spinal Assistant" (applied) 233 59— " " (front viow) 288 CO—Stretching the Arms (lying) 287 61— Raising the Leg (forward lying) 287 62— Leg Abduction 263 68—Twisting Leg at the Hip 265 64:—Swinging Pole Exercises (forward and backward) 268 65— " " " (sideways) .". 269 66 — Bending Backward 2W 67— Twisting the Trunk 271 68— Raising the Hips 278 69— Passive Stretching of the Muscles 274 70— Separating the Knees (lying) 275 71— Raising the Knee 276 THEORY AND PRACTICE OP THE MOVEMENT-CURE. r THE MOVEMENT-CURE. first fart. - PHYSIOLOGICAL. CHAPTER I. THE NUTRITIVE PROCESSES. Conditions of Nutrition — Tissue Formation analogous to Excretion — Tissue Transformation necessary to Purity of the Blood — Digestion not Nutrition— Musoulab Motion promotes Tissue Transformation—Causes Oxydation of the Tissues —Increases Affinity between the Blood and Oxygen of Respiration— Circulation governed by Muscular Action, Endosmotic as well as Capillary- Functions are performed only by presence of Arterial Blood — Regulation of Functions by controlling the Circulation — Influence Of the Nervous System — Vegetative and Animal Life—Direct and Reflex Action—Medical Uses of these— Mental Influence—Can be made Remedial — Tissue Metamorphoses caused by Muscular Action not in the Ratio of Fatigue—Relative Action of Muscular and Nervous Systems—Muscular and Nervous Fatigue different—They are partially Separable. In proposing any new method of medical treatment, the first inquiry should be, whether it is in accordance with, or antagonistic to, physiological laws, for all legitimate remedial means are employed because of their assumed ability of so modifying the processes of nutrition, that a more healthful action shall take the place of a diseased one. Hence, any means which can do this must be remedial. In the endeavor to see how far these processes of nutrition can be controlled by purely mechanical agencies and the dynamic powers 22 THE NUTRITIVE PROCESSES. within us, without the aid of chemical means, it becomes necessary to look at some of the conditions under which these processes take place. It may be said that proper corporeal nutrition constitutes perfect health. Passing by those important and interesting processes of digestion, absorption, etc., by nutrition, I refer to those interstitial changes by which the integrity of our tissues is maintained against the destructive agencies of time, and the wear and tear occasioned by those functional activities common to all animal organisms. The conditions necessary for this proper nutrition seem to be : First. A right state and composition of the blood, or other nutrient material.* That vital endowment of the cell-structure of every tissue and organ, by which they select from the blood only those materials necessary for their peculiar structures, is the most perfect arrangement by which the blood itself is constantly kept at its greatest purity. The law of Treviranus is, that " each part of the body, in respect of its nutrition, stands to the whole body in the relation of an excreted substance."f In this sense we may say that the nutrition of any one tissue is a purifier of the blood for the uses of all other tissues. Abundant illustrations of this principle can be seen on a little reflection. The amount of carbonate of lime contained in the fluids of an oyster or snail would o Paget. f Carpenter's Principles of Human Physiology, p. 327. Paget's Surgical Pathology, p. 21. 23 SELECTIVE ENDOWMENT. seriously interfere with the development of the other tissues of these mollusca, were it not elaborated in the form of shell. In those that have no shell, it forms a simple secretion from their fluids, which is washed away by the waters. So of the carbonates, phosphates, and other components of animal bone ; if they were not selected from the blood in the formation of osseous tissue, but were allowed to remain as a component part of the circulating fluid, they must wholly unfit it for the proper nutrition of other tissues. The same principle must hold good with regard to all tissues; the muscle as well as bone, selecting from the common blood those materials which, remaining, would be inimical to the best development of other structures. This mutual interdependence of function upon function, and organ upon organ, is well illustrated by such organs as the kidneys. It is said that if, in a healthy man, the secretion from the kidneys be suddenly suspended, he can not live much beyond seventy hours. In that time the urea which has accumulated in the blood is sufficient to destroy life, by its interference with organic processes. It is true that the kidneys are excreting organs, and that the substance separated by them from the blood has already been used in formative processes, and is now on its downward course toward inorganic compounds ; but the process by which this selective separation is performed, is as much a functional act of cell-formation as the nutrition of muscle or nerve—only the resulting products are different. 24 THE NUTRITIVE PROCESSES. Even from the partial suspension of any of the nutritive processes —as of the muscular, when an active man is obliged to suspend activity; or of the sanguineous, when a large arterial trunk is tied-—there is always more or less disturbance of the system, arising from deterioration of blood from this cause. Every interstitial process, whether of secretion, excretion, innervation, or new formation, may be called nutrition, for all of these are themselves processes of cellgrowth. But the only manner by which any part or organ can be maintained in its integrity, is by the performance of that particular function for which it was specially created. A function itself has reference to all other organs; the performing of the function is self-reparative to the organ performing it. Those progressive and regressive * molecular changes occurring in every tissue, simultaneously with every functional act, have relation to the purity and right condition of the blood, not only by selecting from the blood those materials necessary to the proper nutrition of every tissue, thereby preparing a more perfect plasma for other tissue formations, but the blood itself is thus enabled to perfect its own organization. The blood, if not a tissue, is at least an organ, having its own progressive and regressive processes, subject to all the liabilities of other organs, and whose special function it is to carry nutrition to the other tissues, and bring back, for purification or excretion, the general waste. But if tissue transformation take ° Lehmann. 25 THE BLOOD AN ORGAN. place inadequately, the blood, independent of all other considerations, must deteriorate from sheer want of opportunity to perform its special function, upon the performance of which, as with all other organs, its healthy condition depends. It is tied up, as it were, like a bandaged limb, and languishes for the want of something to do. It has been said that, " when we have the most perfecf health, we die the fastest;" that is, in the most perfect nutrition, molecular death takes place the most rapidly, in consequence of the great functional activity ; all of which, as before stated, are accompanied by progressive and regressive metamorphoses. All these influences upon healthy nutrition, as well as that exercised through the nervous system —which will be considered further on—take place entirely independent of the mere act of digestion of food, which is simply the first steps of the preparation of material for nutrition, but is not of itself a nutritive act. Thus we see the importance to the physician of understanding all the conditions under which nutrition or molecular transformation takes place. He will also begin to appreciate how important, in disease, it is to be able to control these processes in accordance with the indications of the case. That he Can exercise control within certain limits, must be apparent, when we reflect that at least one half of the gross weight of the body is muscular tissue; and from the great supply of blood to muscle in active use it is probable that, with ordinary activity, three fourths of the aliment " 2 * 26 THE NUTRITIVE PROCESSES. taken into the body goes to supply the voluntary muscular system, over which we have entire control. The amount and direction of muscular nutrition depend entirely upon the amount and direction of the muscular motions which we employ; for every motion is the result of the calling into action of muscular contractility—which is the only function of muscle—with its accompanying formative progressive and regressive changes, the material for which is furnished by the increased supply of blood induced by the muscular action. But perhaps the most important of all the results of muscular motion is the increased oxydation of the tissues, and the consequent increased introduction of oxygen through the lungs. ISTot that the respiration is necessarily accelerated, but that the affinity of the blood for oxygen is increased in the ratio of the tissue metamorphoses, consequent on the muscular contraction. Now, when it is recollected that in all diseases the introduction of oxygen is always less than in health— because the transformation of tissue is always less— it will be seen how important a part this increased oxydation must have in the cure of disease. Lehmann says: " There are no acute and but few chronic diseases in which the oxydation of the constituents of the blood is not diminished or impeded;" and again : "There is no disease characterized by too rapid or too sudden oxydation of the blood."* Since oxygen plays an essential part in all vital manifestations, and ° Lehmann's Physiological Chemistry, p. 199. 27 INTRODUCTION OF OXYGEN. since all diseases are characterized by a deficiency of that element, and since muscular contraction is a function requiring a large supply of oxygen for its manifestation—urea, the result of muscle-oxydation, being abundant after muscular exertion—it follows that this presents very proper conditions for the correcting of those states of the system depending on imperfect oxydation of the blood and tissues, by favoring a larger introduction of that element. Thus it will be seen that, at least as far as the muscular system is concerned, comprising the great mass of all nutrition, we do have intimate control of all the molecular transformations. It will be seen, byand-by, that we can influence the quality of those changes as well as their amount and direction. And thus, in so far as the purity of the blood depends on the nutrition of the muscular system, according to the preceding view, we are enabled to exercise a most important and controlling influence. In the second place, a proper circulation of the nutrient fluids is essential to perfect nutrition in this connection. By proper circulation it is not meant that which takes place in the vessels by virtue of the heart's action, for rapid circulation in the vessels merely is an unfavorable condition for the passing out from the vessels into the tissues, of the nutrient material. Rapid circulation is indeed a symptom of diseased action, and co-exists with the poorest condition of nutrition. But the kind of motion here referred to is that which takes place in and among 28 TILE NUTRITIVE PROCESSES. the tissues as a consequence, directly or indirectly, of change of their substance involved in every functional act. Motion is an essential quality of all organized bodies. Indeed, we can not conceive of any, even the very lowest organisms, before there are either nerves or special organs of motion, where molecular movements are not only essential to the development and growth, but even the existence of tjie organism. "What is life itself but the capability of specific motions that enables certain elements of matter to assume certain forms? In the lowest forms of animal life this capability of motion or nutrition is entirely confined to cell-endosmose and exosmose. It is still the same in the higher orders of animal life, but with the circulation in the vessels superadded. Still, it is estimated that the quantity of the fluids circulating outside of the blood-vessels is as great as that within them. The proper circulation of the fluids by endosmose is as important as the proper circulation of the blood in the vessels, and both are indispensable to perfect nutrition. The following cuts, from " Peaslee's Human Histology," will sufficiently illustrate the "formation Fig. 1. A, B, fragments of striated muscular fibers ; C, D, more highly magnified fibers, detached. of the muscular and elastic tissues, and the blood capillaries, with which we have more particularly at present to deal. CIRCULATION OF FLUIDS. 29 Fig. 1 represents fragments of muscular fiber magnified three hundred times, showing the fibrillse detached at the end. (B;) More highly magnified fibrillse are seen detached at C, D. "Without at all entering into histological discussions, it will be recollected that the muscular fiber, like that of all other tissues, is of cell-formation, each fibrilla being a row of cells with its enveloping myolemma, and that an accumulation of these with their investment forms the muscular fiber; an aggregation of such fibers constituting the muscle proper. It will also be recollected that the muscular fibercell performs every functional act, whether of contraction or nutrition. Fig. 2 represents the myolemma, the membranous envelope of the fiber-cells clinging between the fragments of a torn muscular fiber. Fio. 8. Fig. 2. The myolemma of torn muscular fiber Capillaries of a small fasciculus of muscular fibers, from the neck of the dog. a, terminal twig of artery ; *, commencing twig of vein; c, capillaries; /, single muscular fiber to show the relative size and direction of those to which the capillaries here represented are distributed. Fig. 3 represents the capillaries of the muscular 30 THE NUTRITIVE PROCESSES. system. The capillaries lie between the fibers, principally in the longitudinal direction, with numerous frequent communications between them, as shown in the cut. It will be noticed that their arrangement is exceedingly favorable for their contents to be affected by the pressure upon them of the contracting muscle. The lateral expansion of the fiber during contraction encroaches upon the space occupied by the capillaries, forcing the blood in these vessels forward toward the veins, the capillary valves rendering a regurgitation toward the arteries impossible. It will be remembered that there is no direct communication between the muscular fibers and the capillaries, but that the nutritive material passes through the walls of the capillary vessel, the myolemma, and fiber-cell. Muscular contraction, causing progressive and regressive changes in the fiber-cell, is the incentive for endosmotic and exosmotic action to take place, provided there is the presence of arterial blood in the capillary net-work. For the presence of arterial blood is necessary to the performance of any vital act, and the act is weak or intense according to the purity and the plentiful supply of blood. Paralysis would result as speedily, if it were possible wholly to cut off the supply of blood, as if the-nerve were severed that supplied the part with nervous stimulus. We have, therefore, independently of the heart's action, a most important portion of the circulation under the control of the will. That the heart alone is quite insufficient to keep up the circulation is appa- 31 CONTROLLING THE CIRCULATION. rent when any cause —fright, cold, strong emotion, the deoxygenated air of close rooms, etc. —operates to partially suspend the nutritive processes in the tissues, causing sudden recession of the blood toward the heart and other internal regions, faintings, apoplexy, etc. In such circumstances we are obliged to assume the most favorable conditions, in order that the circulation, partially unaided —for total suspension would be death—by organic changes, may be kept up. Consumption—a most wasting disease —is characterized by rapid pulse and feeble nutrition. I have often remarked, that if the muscles of a consumptive patient be put into strong contraction under circumstances where the heart's action is not increased, that is, by having the patient's muscles stretched by another withoufcmuch effort or fatigue to himself, the pulse invariably falls from five to fifteen beats per minute immediately after the operation. The increased muscular nutrition had aided the capillary and interstitial circulation, and thus relieved the heart. Those writers who attempt to account for the circulation of the blood, besides the impulse given to it by the heart, by suggesting the " viscidity" of the blood and its " capillary attraction," seem to have overlooked the fact, that the variations in the rapidity and quality of the pulse is always in the exact ratio of the disturbance of nutrition, i. e., of molecular motion. " The desire for food or drink," says Dr. Neumann, speaking on this point, " may be increased by strong movements of the body. This could not arise except 32 THE NTJTEITIVE PEOCES8E8. from great and rapid changes in the formative processes in the body, which is caused by the movement of the jnuscles in connection with the general organic movements. Thus the fluids of the body must become rapidly diminished, because the exhalation through the lungs and skin and the external and internal capillary net-work is increased, and because at the same time a great quantity of the fluids have been changed into solids." We are, therefore, to conclude that the circulation, both within and without the vessels, is very sensibly influenced by the nutrition and its accompanying molecular movements in the substance of the tissues, and of which the muscular tissue forms the most important part. Tkere is another tissue, which, though generally Fio. 4. roftion of areolar tissue inflated and dried, showing the general character of its larger meshes. Each lamina and filament here represented contains numerous smaller onos matted together by the mode of preparation minutely described by anatomists, is often practically overlooked by physiologists. The areolar tissue of modern authors is here alluded to. Fig. 4 gives a good illustration of the structure of this tissue. The areola is the true investing and connecting tissue. It isolates the various organs, dipping down between them and supporting them. It accom- 33 VEGETATIVE AND ANIMAL LIFE. panies the veins, arteries, and even surroundo the capil- • laries, and often the nerves also. " Indeed, it enters to such an extent into every part and organ, that if all the other tissues were entirely removed from the body, its conformation would still be preserved in every part by the areolar tissue ; and except from the removal of the osseous and muscular tissues, its weight would be but slightly diminished." " It invests the muscles and gives off prolongations investing the fasciculi of the fibers."* This tissue is capable, by its relaxation or retraction, of causing mechanical variations in the capillary circulation, and of other fluids generally, and in this way seriously interfering with nutrition; thus affording the basis of several pathological conditions, to be considered hereafter. The areolar tissue connecting together into one mass all the parts adjacent to the muscle, by its strength and elasticity, subjects the whole to the peculiar mechanical influence, to say the least, of every contraction, extending even to quite distant parts. The third point to consider, is the influence of the nervous system upon the nutritive processes. Vegetative life is common to all organized beings, but in the higher orders this vegetative life has super-imposed on it the dynamic or animal life, whose medium is the nervous system. The animal life furnishes the conditions for the vegetative life to operate in. In other words, while the cell-formations take place by virtue of their own endowments, the nervous * Peaslee. 2* 34 THE NDTRmVE PROCESSES. system controls many of the conditions under which this inherent plastic power must operate. Through the influence of the nervous system, there is kept up the most complete inter-relations of part to part, organ to organ, and function to function. The sensitive, motor, and sympathetic nerves have actual fibrillated connections and a mutual dependence, so that it is impossible to influence one without influencing in some measure all the rest. The nervous system is a republic, delegating, it is true, certain duties to each member, but never giving up the dependence of each part upon the whole body politic. Every action of one part engages the attention of all the rest. Dr. Marshall Hall's doctrine of the reflex action of the cerebro-spinal system explains many of the phenomena of nutrition, and by the Movement-Cure is made of practical use in medicine. The idea of reflex action, of afferent and efferent nerves, is something more than a mere abstraction, or even than a wellestablished but simply curious and interesting matter of physiology. It is a matter of precise gunnery—a means of hitting the mark without roundabout or doubt, and of producing in a given part or organ those conditions of nutrition required to promote a right instead of a wrong functional manifestation, What can be more plain ? To act upon it we have only patiently to investigate the laws under which these manifestations of the nervous system take place. It has been long known that the irritation of the sensitive loops of an afferent nerve will produce a 35 KEFLEX NERVOUS ACTION. similar irritation (pathological) in the organ upon which the efferent nerve is distributed; such, for instance, as the production of vomiting by tickling the throat, uterine contractions by irritating the breasts, etc. But while physicians have followed the pathological manifestations of the law by the use of the whole batch of counter-irritants, both internal and external, they have entirely ignored its physiological manifestation. It surely is a perfectly philosophical practice, and one entirely consistent with the wellestablished doctrine of physiology here alluded to, to cause a healthy instead of a diseased condition in the region of the afferent nerves, if we would produce a healthy manifestation in the organ to which the efferent nerves are distributed. Thus we see that in a particular muscular effort made to correct a certain abnormal condition, we must in selecting it not only recognize the nutrition (general, so far as the plastic material is concerned; local, that the right- action be produced specifically at the right point; and of the blood, that it shall flow in accordance with the indication, as increasingly toward the extremities to relieve a congestion), but the particular condition of the nervous system must also be taken into the account. It may not be muscular action simply that we want; but muscular action modified as indicated by the state of the nervous system. For instance, in case of wasting disease—as consumption—increased muscular nutrition and increased peripheric circulation are desirable, nothing more so; 36 THE NUTRITIVE PROCESSES. but with the nervous depression incident to the disease, muscular action, if not made under such circumstances as will diminish, rather than increase this nervous depression, will not promote either better circulation or better muscular nutrition, and may diminish both. Only when muscular action is had corresponding with the state of the nervous system, that is, not increasing exhaustion or irritation, will the nutritive processes be favorably affected. The special influence of the mind and will upon the general bodily nutrition is daily manifested and acknowledged by every physician. " The patient must keep up his hope," says the doctor; " he must have confidence in me, or my efforts will be unavailing," says another, and so on. Hope to the sick man brings life and health ; despair to the well man brings disease and death. Each mental manifestation has not only its natural language of position and motions peculiar to itself and different from all others (thus affecting of course the nutrition of the muscular tissue employed in maintaining that position), but there is always more or less disturbance of other functions with their corresponding change of organic processes. When luscious fruits are presented to the eye, we not only reach forth the hand to receive them, but the " mouth waters " —the salivary glands pour out their secretion. Bad news impairs the appetite and the secretion of gastric juice ; while good news increases both. Melancholy destroys the action of the bowels, causing constipation; while sudden apprehension often 37 MENTAL INFLUENCE. produces a cathartic effect.* Fear acts upon the skin, causing a " cold sweat" to bedew its surface. Sympathy, contrition, grief, produce tears, and so on. Now, all this indicates that there may be a Medical Psychology; that, as both general and local variations of the formative processes take place in accordance with mental manifestations, so these manifestations may be so directed as to control nutrition for special purposes. For instance, it is easy to conceive that, so far as a change of matter is concerned, a muscular contraction under the influence of volition would be different and more than muscular contraction produced by reflex action. If, now, a movement is made for a special purpose, with pre-determination and precision, the muscular contraction advancing slowly and uniformly, that the nutrition of the muscular tissue is affected by the contraction, every one knows; but is not the steady, unvarying direction of volition upon it for promoting a special functional manifestation particularly favorable to its proper performance? When a patient is conscious that his efforts are for a specific purpose, the localization of the effort is peculiarly favorable to the production of the desired effect. Not only is there specific local muscular action in contradistinction from general action, but the concentration of the will must produce a controlling • The writer knows a lady who, though an excellent specimen of health, regular in all respects, yet fifteen minutes of anxiety for her husband or child produces a violent purging, six or eight times in an hour, and till the anxiety is removed. 38 THE NUTEITIVE PE0CE8SES. influence on the dynamic forces of the parts. There is no doubt but that the effect of all modes of treatment is much influenced by what may be termed the " medical psychology." This view may account for the wonderful results produced, generally among ignorant and superstitious people, it is true, by various means wholly absurd and inefficient in themselves, such as the laying of hands over diseased parts, incantations, etc., but if we are to believe evidence, with all due allowance for exaggeration, producing often manifestly favorable results. If it be true, as it is sometimes ably maintained,* that all the phenomena of mesmerism, and kindred manifestations of a peculiar kind, can be explained, or if any of them can be explained by the actual influence of the person's own mind over bodily functions under peculiar circumstances, we need not descend to the vague and mysterious in making available the same forces as remedial agents. For instance, it is said, and it seems probable, that the process of mesmerism, biology, etc., is simply such that it serves to concentrate the attention upon one object or class of objects till the attention becomes wholly absorbed in it, and wholly withdrawn from all other objects. Under such circumstances the mind becomes exalted and exceptional with reference to those objects within its narrow range, and wholly oblivious to every other contemplation or impression. As this explanation coincides with what happens in our everyday experience, it is no doubt the true one. * New Englander for May, 1858. 39 MENTAL INFLUENCE. For instance, two persons engaged in animated conversation, or persons closely occupied in thought or deep study, do not hear sounds or see sights which they would if their attention were not thus pre-occupied, though the sounds fall on the ear, and the image is formed on the retina just the same; still they are unconscious of sight or sound, simply because their attention is drawn in another direction. It often happens that persons no more absorbed than usual about their ordinary business affairs, are so oblivious to all else except what is passing at the time in their brain, that they may be subjected to actual bodily harm, can be pricked or pinched and handled in various ways, and be unconscious of it till it is carried to the extent of actual pain. These facts are important to be understood, for they explain how patients can disturb their own functions by unwise attention to them. Many a man has given himself the dyspepsia in consequence of reading books very good in themselves, but which turned his thoughts too constantly to his food and his stomach. It is often noticed that medical students, during their first course of lectures, experience in their own persons all the symptoms they hear described by the professors. There can be no doubt but that by trying long enough in many cases they might actually have the disease also. But this condition also carries with it the remedy. The good influence of withdrawing the contemplation from a diseased organ or condition is equally manifest, whatever may have been the origin of the disease. 40 THE NUTRITIVE PEOCE88E8. And the further good effect of making stated and vigorous efforts to accomplish certain purposes—not only those which are apparent to the eye and senses, but any physiological purpose —is equally manifest and as sure to follow. Common experience illustrates this. Physicians often advise —and if carried out, the advice is as often followed by the desired results —their patients troubled with constipation of the bowels to make regular stated efforts to produce alvine discharges. This habit is often efficient when the seat of the constipation is much higher up than the locality of the voluntary muscles of the rectum. As constipation results from insufficient intestinal fluids as well as insufficient propelling force, the will must have had effect in increasing the secretion of the glands of the bowels, as well as promoting vermicular motion. In both cases the circulation of the blood in the capillaries must primarily have been affected by the will. In the treatment, by movements, now under consideration, where the patient is literally handled and made to do certain definite things as indicated by his condition, the favorable influence of the mind, and of the nervous system generally, is one very happy element of the treatment. The law of the expenditure of nervous force seems to be that it is in the ratio of its intensity. In other words, fatigue seems to be caused in the ratio of the effoi't made, without reference to the amount of contractions in the muscles, at least till a certain point is reached. For instance, a certain number of steps can be taken in EXPENDITURE OF FORCE. 41 walking with perfect ease, which it would be-wholly impossible to take running. And so of all our voluntary movements. But habit may in part supersede volition —as where dexterity is acquired—in which case the movements are automatic, the spinal cord presiding over them, which causes very little nervous fatigue. Again, movements directed by another require only slight volitionary effort, and therefore produce a small expenditure of nervous force, compared with the amount of muscular contraction secured, especially if that contraction be slow, uniform, and prolonged. If we can control the action of the nervous system, regulating the amount and direction of the expenditure of its force, separating it, to a certain extent, from the muscular, we shall have gone far toward regulating all physiological phenomena of the individual. Thus we would have it in our power to answer the indications in many chronic derangements, and to substitute a normal for an abnormal condition, removing at the same time the cause of the disease and the disease itself—subject only to the greater or less impressibility of the system. Some of the most important conditions of nutrition have now been barely hinted at; only enough to form the basis of a treatment pretending, in a natural, physiological way, of being capable, by regulating these nutritive processes, of substituting the harmonious play of all the forces instead of the deranged conditions called disease. To do more would be to reproduce the 42 THE NUTRITIVE PEOCE8SE8. whole of physiology. Modern physiological science, so generally treated of in the books, and regarded by medical men too much as simply curious and interesting subjects for the student, but having little relation to the purely experimental systems of medicine, is by the Movement-Cure made the basis of an exact science of healing. CHAPTER II. MUSCULAR CONTRACTION, Method or Contraction—Caused by Oxydation of Tissues under Stimulus—Repair —Slow Movements diffuse the Contraction—Food, Drink, and Respiration vary in amount with the Use of the Muscles—Muscles are Levers to move all Vital Phenomena— Pathology is altered Phybiolooy— We should modify the Latter as indicated by the Former—How to do this—Eccentric and Concentric Contractions—Effects upon the Circulation—Retraction and Relaxation of Tissues- How caused—Endosmose and Exosmose —All Organs, when Abnormal, have one of these Conditions —Correspondence of Concentric and Eccentric Contraction and Relaxation and Retraction of Tissues—How to control Capillary Circulation according to these Conditions of the Tissues. Muscular contraction depends upon the primary fact that muscular fiber, under appropriate stimulus, shortens itself. This shortening of fiber under stimulus is the result of the shortening of the fiber-cells in length, and their corresponding increase in diameter. But it must not be inferred that this action takes place in the whole muscle, or even in the whole length of any one fiber, at the same moment of time. " Different portions of the length of the fiber assume this condition at different moments, and hence the whole structure is thrown into a form which recalls the motion of a worm." The different degrees of energy with which a muscle contracts do not depend so much upon the energy with which each fiber-cell contracts, as upon the number brought into action at one time.* * Draper's Physiology, p. 439. 44 MUSCULAR. CONTRACTION. Fio. 5. Muscular fiber previous to and in successive stages of* contraction, showing that only a part of the fiber is in action at one time. Fig. 5 represents stages of contraction seen in the skate. The uppermost figure shows the state previous to the commencement of active contraction, a a a, successive " waves" of contraction seen moving along one margin of the fiber, marked by a bulging of the fiber, an approximation of the transverse stripes, and a conse- quent darkening of the spots, b b b, similar " waves" still moving along the fiber, but engaging its whole thickness.* Fig. 6 is a muscular fiber of the dytiscus, contracted at its center, with the myolemma raised on the surface. Fio. 6. Muscular fiber contracting ; the length shortened and diameter increased; the myolemma raised in bullae on the surface. Dr. Draperf lias very clearly shown that muscular contraction is the result rather than the cause of muscular waste ; that the oxydation in the cells caused by a stimulus occasions an actual change in the structure of the fiber—the waste matters passing by exos- * Peaslee's Human Histology. f Draper's Physiology, p. 446. 45 THE TIME REQUIRED. mose into the venous capillaries—and that the contraction is the mechanical result; supply and repair taking place immediately from the arterial blood. But it is sufficient for us to know that actual loss of tissue takes «. place with every muscular contraction, which is immediately supplied from the blood by the plastic power of the fiber-cells themselves. But this repair is not immediately perfected, and hence we are obliged to spend at least one third of our lives in the total unconsciousness and inactivity of sleep, that the reparative process* may be completed for the activities of each succeeding day. It is evident that to produce the greatest change in the nutrition of muscle, some time must be allowed for the successive "waves" of contractions to be propagated along the whole length of the fiber —as it occupies the same spot only a moment at a time —or resistance should be opposed, in order to bring a larger number of the fibers into action at the same moment to overcome such resistance; or, still better, both the slow and the resisted movement should be employed. It can readily be seen that such a contraction would affect a much greater part of the muscle ; and besides, it would cause but a slight expenditure of nervous force, for we have seen that nervous exhaustion is in the ratio of the intensity of its action, and in such a movement it would have very little intensity. Thus it will be seen that a large and important portion of the nutritive processes whereby our systems are built up and sustained, is under a certain amount of 46 MUSCULAR CONTRACTION. control of the will. A large or small amount of food and drink is required—varying in quantity at least one half, according as we create a necessity for it by using our muscles. Even the amount of the air we breathe—the vital oxygen of which is concerned in the minutest changes of the constituents of our tissues —is greater or less, as we will it to be, being regulated according to the amount of those changes which our own volition has caused to take place. And not least of all vital phenomena, the manifestations of the nervous system are capable of precisely the same voluntary regulation. Indeed, all vital phenomena are so far under our control as to be at least, directly or indirectly, modified at will. The great lever, or certainly the most convenient lever, by which to move and modify all other manifestations of force, is the muscles. Having the handle of this great lever in our hands, it becomes a matter of intense interest how we shall move it so as to elevate depressed faculties. Can we so control the action of the muscles as to influence pathological processes ? And what is pathology ? " Pathology," said an eminent lecturer, " is simply modified physiology; it is only, a variation one way or the other of the ordinary physiological action which we call health." If pathology is modified physiology, and if we can produce a modified physiology corresponding with and opposed to the pathological state, and the result is a physiological or normal state, we must thereby cure 47 REGULATING THE CONTRACTION. the disease. For instance, if a patient suffer from " rush of blood to the head," and has cold feet, if we can act on the muscles of the feet and can induce a free circulation there, we produce a derivative effect and relieve the head. What was before pathological is now physiological, and brought about by purely physiological means. Let us proceed to illustrate how this may be done. From the construction and arrangement of muscular fiber (fig. 1), the arrangement of the capillaries (fig. 3), and the method of contracting (figs. 5, 6), it will be seen that with every contraction there is also a mechanical effect within that tissue itself; the capillaries are mechanically pressed upon, driving the blood along into the capillaries nearest the veins, and ultimately into the veins themselves; at the same time all the fluids, from the pressure, more or less change places. This mechanical effect of propelling the venous blood forward by the pressure of muscular contraction, can be well enough seen by seizing the arm just above the elbow with one hand so as to stop the return of blood in the large veins, and suddenly contracting the muscles of the fore-arm ; the superficial vein's will immediately be filled. But while this effect is taking place in the contracting muscle during a movement, its antagonist is placed in just the opposite state, *, e., it is being drawn out, and its capillary net-work relieved from pressure. 48 MUSCULAR CONTRACTION. Figs. 7 and 8, which are representations of the flexion and extension of the forearm, will convey a Fi0. T. Flexion of the forearm, showing that while the contracting muscle a b shortens itself, its antagonist c d is drawn out longer, illustrating that while the pressure of contraction in a b forces the fluids into the venous capillaries, the relief from pressure in c d allows arterial blood to flow into the capillaries. clear idea of the different relative physical states of flexors and extensors in every movement. Suppose a b to be the biceps flexor, and c d the triceps extensor of the forearm. Now, when the arm is motionless, the Fia. 8. Extension of the forearm, showing that a' b', previously shortened, is now tilled with arterial blood by being drawn out, and its capillaries relieved from pressure, while c' d', by its contraction and consequent pressure, forces its previously accu. mulated blood into the venous capillaries. 49 CONCENTRIC AND ECCENTRIC. relative condition of both muscles is exactly alike. But if the forearm be moved from 1 to 2, it is done by the contraction of c'd'; but a b is by no means passive, but contracts constantly, else the movement would be made by a sudden jerk—only c' d' contracts just enough more than a b to overcome the latter, meantime c d is shortened from d to d\ and a b is lengthened from b to V. Therefore the contraction in c' d' is called " concentric," because that muscle shortens itself, and the contraction in a b is properly called " eccentric," because it is drawn out longer, while still contracting itself. Now, while the "concentric" contraction in c'd' is going on, and as we have seen with the effect of driving the fluids along toward the veins—the " eccentric" contraction in a b (the muscle being actually drawn out by the superior force of the antagonist muscle, c' d') causes the capillary net-work to be relieved from pressure, and there is no hindrance to the influx of blood or other fluids. But blood can not return from the venous capillaries on account of the valves, and hence must flow in through the arterial capillaries, especially since the contraction itself creates a physiological demand for arterial blood. In the ordinary flexions and extensions in the use of the muscles, the combined influence of the concentric and eccentric contractions is to promote the normal circulation and nutrition of the muscles employed. But suppose that in moving the arm (figs. T and 8) from 1 to 2, resistance be applied at the hand by 3 50 MUSCULAR CONTRACTION. another force than its own antagonist muscle, then a b will not contract during the movement, the normal stimulus to contraction being withdrawn in consequence of an opposing force being already supplied by the resistance from without; and though drawn out, it remains relaxed and flabby during the movement, having neither the physiological nor mechanical condition for the influx of arterial blood. Hence we have isolated the effect of the movement upon the single extensor muscle c' d'. Again, suppose that force is applied at the hand—that is, suppose the extension of a b is made by another person instead of the antagonist muscles —and a b is this time drawn out by that force instead of the contraction of c' d f , then in that case the extensor muscle c d will not contract, its force being supplied from without, and it will possess neither the physiological nbv the mechanical condition for propelling forward the venous circulation, but will remain entirely inactive. Hence the only result of the movement is the eccentric contraction of a b with its influx of arterial blood, which effect is therefore also isolated—that is, there is no corresponding effect in the other muscle. Furthermore, it is very clear that if the movement were made with resistance both ways, from 1 to 2 and from 2 to 1, the contraction would be first concentric in c d, and then also concentric in a b, without any eccentric contraction being employed. Or if force be used to move from 1 to 2, then a b will be occentric, and if force be also used to move from 2 to 1, then c d will also be eccentric, and there will bo 51 MU8CULAB EXHAUSTION. no con-centric effect of the combined movements. Thus we have the power, if it be necessary to accomplish a useful purpose, to produce different and opposite conditions in the muscles —conditions often indicated in chronic disease. We can not only make local impressions, but we can vary the quality of those local impressions as indications may require. But it should always be borne in mind that, to secure the best results upon local or general nutrition, the muscular effort should never be carried too far— never to approach exhaustion —for in that case a certain amount of the plastic power of the fiber-cells will be exhausted, which would destroy the effect sought to be produced. After the required impression has been produced upon a part with sufficient perseverance or intensity to incite its proper healthful functional activity, the impression should cease before there is a chance for reaction to follow, and all the progressive and regressive changes are taking, and can continue to take place in the most perfect and vigorous manner. It is not the amount, but the quality, of these changes that insures the most perfect nutrition. Corresponding to the manner of muscular action just described, we find there are conditions of the tissues produced by various causes. Thus, it has been previously stated, that in health the ingress and egress of the fluids in the tissues are the same; that is, the circulation in the arterial and venous capillaries, and the passing in and passing out of the fluids through the cell-walls, the myolemma 52 MU8CULAR CONTRACTION. and the areolar tissues maintain a constant equilibrium. But when defective nutrition or disease has impaired the chemical qualities of the fluids, so that the proper alkalinity and other conditions necessary to secure the proper affinities of the nutrient and other fluids are out of proportion, or if the cell-walls, the myolemma, and other tissues from their vital or mechanical conditions, do not afford the normal conditions for proper endosmotic and exosmotic interchange of fluids, then there must necessarily arise one of two conditions, viz.: either endosmose must exceed exosmose, or the latter must exceed the former. If it be the former—that is, if more fluids pass into the cells of the tissues than pass out, then there arises a retardation or stagnation of this endosmotic and exosmotic circulation, the cellmembranes become expanded, thinner, and more feeble in their vital endowments, the myolemma, the areolar, and other tissues partake of the same characteristics, and the venous capillaries are less able to carry forward the general waste resulting from the progressive and regressive changes—themselves more feeble. This condition constitutes a condition of RFXAXATION. But suppose, on the other hand, that the disposition of the fluids within the cell-walls and other membranes is greater to pass out through the membranes than for the nutrient fluids to pass in, then, in that case, exosmose will exceed endosmose; the cell-walls and other membranes will become contracted, thicker, harder, 53 RETRACTION AND RELAXATION. and present both physiological and mechanical impediments to the circulation in the arterial capillaries. Such a tissue presents a condition of retraction. A retracted muscle is shorter, smaller, and harder than in the healthy state, and differs entirely from the temporary contraction of healthy muscular fiber. In contraction the muscle swells in the middle, while the tendons at the origin and insertion lie buried deep in the parts, and relaxation after contraction speedily ensues. But in retraction the muscle does not swell in the middle, but seems to rise up out of the tissues, like a cord, during its whole length. This condition of retraction exists in all stages, from slightly indurated and thickened tissues to complete atrophy. A muscle in a state of relaxation is longer, larger, softer, more feeble, and is entirely without that tonic firmness characteristic of healthy muscle when not in active contraction. This condition may also exist in all stages, from simple feebleness to actual paralysis. Now it is believed, and in most cases it can be demonstrated, that this condition of retraction or relaxation — i. e., of disproportion of endosmotic and exosmotic circulation, and consequent disproportion of the arterial or venous capillary circulation, exists in all tissues in all forms of chronic disease. That is to say, any variation from the proper and normal condition of the circulation and nutrition of the tissues is accompanied by either one or the other of these physical conditions. This being the case, to correct this condition of retraction or relaxation in the tissues where it 54 MUSCULAR CONTRACTION. exists, would, all other things being equal, present the conditions for proper nutrition and a consequent restoration to health. It will be seen that the eccentric and concentric movements supply precisely the conditions for remedying the physiological and mechanical impediments to healthful nutrition in both the retracted and relaxed states of the tissues; the eccentric movements producing a more perfect supply of arterial blood and consequent effusion of organizable plasma; and the concentric movements accelerating the egress of the fluids from the tissues to the venous capillaries and veins. This is very apparent, so far as the muscular system is concerned, which, by acting on the various levers of the body, can be put in the desired states. But the application of this principle is confined to derangements of the muscular system, or even to the general effects upon the quality of the nutrient fluids, as previously explained, but even the organs of the viscera can be acted on by mechanical means to promote their healthful nutrition in accordance with their pathological states. All organs have their mechanical stimuli, and not less so because they may not be contractile tissue or muscle. For instance, a kneading of the relaxed abdomen would affect its contents differently from kneading the expanded abdomen; or a vibration of the chest and lungs in a stooping, contracted position would affect those organs opposite from a vibration of the expanded chest, with the hands stretched up over the head. In fact, the first movements mentioned in each case would be appropriate for a condition of relax- 55 VISCERA AFFECTED. ation of the parts, and the second would be useful to correct a retracted state. But there is still another very important consideration to remember. In all cases of disease of internal organs there is secondarily produced a similar condition in the muscular tissues adjacent or containing those affected organs. For instance, in consumption, where there is a retracted state of the parenchyma of the lungs, there is always a shrunken condition of the chest; the muscles are thin and hard, and their appearance is so characteristic, that all physicians understand the outward appearance of the chest as indicating the condition of the organs within. So in constipation, the muscular coverings of the abdomen are hard and unyielding, and present the usual appearance of retracted tissues, which is the condition of the intestines beneath; while in chronic diarrhea, which is a relaxed condition of the abdominal organs, the muscular coverings are also relaxed and flabby. The importance of appreciating these facts can not be over-estimated ; for, by producing in the coverings the condition indicated by the pathological state of the visceral organ, aside from direct mechanical effect in the organ itself, there is also a secondary effect in turn on the organ beneath, in consequence of the primary condition being produced in the muscular coverings. Thus if, in constipation, movements be given which expand the abdomen— i. e\, eccentric movements—the contents of the abdomen must also be expanded, which would of itself promote a better 56 MUSCULAR CONTRACTION. arterial circulation and consequent nutrition in them ; but at the same time, while an arterial condition is also produced in the retracted abdominal muscles, the same condition would be secondarily produced in the abdominal contents, on the same principle that the muscles were retracted in the first place by the retracted condition of the abdominal organs. The same idea has been carried out in a very crude way, from the earliest periods of medicine, by the use of issues, setons, plasters, blisters, etc., over a visceral organ —as the lungs for instance—for the purpose of producing an impression in an organ having no direct connection with the part irritated—that is, " counterirritation ;" but a physiological counter-irritation must be at least as philosophical as that produced by pathological means. It seems to be a law, whose constant operation is secured through the intimate connection of the blood-vessels, lymphatics, and the everacting circulation of fluids by endosmose, as well as through the influence of the nervous system, that a perfectly healthy organ can not exist in juxtaposition with a diseased one. And on the other hand, it is equally true, that to cause a healthy nutrition in an organ near a diseased one, is to secure a more perfect nutrition in the diseased organ itself. For instance, in caries of the spine, instead of destroying the tone of the spinal muscles by braces and pads, pressing on the point of disease, those muscles should, by every possible means, be kept in the highest vigor and most perfect health they are capable of, not only for their 57 CONTROL OF FUNCTIONS. aid as the natural supports of the spinal column, hut as the direct means of causing a healthy, instead of the ulcerative process in the bones beneath them. Thus it will be seen that the various movements of the body, both voluntary and involuntary, though not of service in every case of disease—perhaps in"no case of acute disease—can be so controlled and directed as to secure very many of the conditions of proper nutrition or health ; the healthful quality and purity of the blood ; its proper and equal distribution ; the just and unperturbed influence of the nervous system ; and general and normal nutrition in all the tissues of the body. So- also the special correction of particular conditions unfavorable to right nutrition in different parts, in accordance with the nature of the pathological states, whether of external or internal organs, whether of the muscular or involuntary system, can also be brought under intelligent control. All this in connection with or without any other medical means, as the indications of the case may require. Here we have the basis for establishing a medical treatment, which, though occupying a limited field, will be purely scientific and in accordance with physiological principles. With none of the elements of empiricism it will be simply auxiliary to all legitimate methods. In all ages and in all times the same ideas have been acted on, and the same processes undertaken, but not until the last fifty years has there been any attempt to reduce what was formerly esteemed simply hygienic to become a regular medical system. 3* CHAPTER III. PHYSIOLOGY OF GENERAL EXERCISE. Motion affects all other Tissues as well as the Muscular—The whole Part moved must be Considered—Illustrations—Exercises should be varied for different Individuals and Classes—Relation of Exercise to the Nervous STBTEM-Sensation and Volition—To Feel and to Execute—Exercise and Labor—What Kinds to be Used—For Invalids there should be a definite governing Idea - Contortions not Beneficial—Fatioue—When'Proper and when Injurious-Neglect of Physicians to Instruct Patients how to Exercise—Exhaustion, Evil Effect of—Increased by Sudden Efforts—Dress—False Action caused by Slight Hindrance of Dress- Muscles refuse to act against an Impediment—Actual Confinement not necessary to effect Injury- Ladies' Dress—Effect upon Chest, Abdomen, and Pelvic Organs —High Heels and Effect upon the Spinal Column—Wholesome Influence of Exercise upon the Mind. In order fully, to comprehend the medieal uses of bodily movements, it will be necessary first to consider the physiology of exercise in general. It is commonly supposed that the effect of exercise is principally on the muscular tissue, but such is not the case, for movements with muscle alone would be impossible except in a few insignificant instances. Every movement requires not only the muscles engaged, but also every other part of the organ moved— vessels, tendons, ligaments, and bone. It is not the muscle alone, but the limb that moves. And if development is the result, the muscular tissue receives only its share of such development. It is just as necessary to the development of bone that it should perform its part in the exercise—that is, to sustain the muscles, their origins and insertions—as it is for the muscles to 59 UNITY OF MOVEMENTS. perform their part in the movement of the member. It can be easily seen that the bones and all other tissues besides the muscular are necessary to the perfect action of the leg, and that the development of all these tissues is as much dependent on and affected by the exercise which all are employed in making, as any one tissue. But this is equally true of every other part of the body ; of the trunk as well as of the extremities. The muscles of the chest, for instance, can not act independently of the lungs beneath them, but taking the thorax as a whole, the lungs form a part of that apparatus, and the force, direction, and perfection of all motions of that part of the trunk depend directly on the condition of the thoracic contents. And every movement implicates the lungs, heart, etc., as a part of the moving apparatus y and the result of the movement, whether it be development or exhaustion, embraces the contents of the chest as well as the bones, ligaments, and muscles, for the reason already given, that the contents were necessary to the perfect movement. We move in general exercise not the muscles of the body alone, but the body as a whole, and hence the nature of the exercise we take affects us as a unit. This is plainly seen in the physical characteristics, anatomical conformations, peculiar diseases,-and even marked intellectual and moral distinctions in different classes of men, according to their trades and avocations, amusements and recreations. It is admitted that sedentary people need systematic 60 PHYSIOLOGY OF GENERAL EXERCISE. exercise, but it is a great mistake to suppose that the laboring man does not also need it. He needs physical training, perhaps, to undo the injurious effects of his occupation; but of course of a different kind from the professional man. As we do not trust to the spontaneous development of the mind, but aid its growth by suitable mental gymnastics, called systematic education, neither should we allow the body to take its chance of proper or improper development. Professor Retzius, of Stockholm, Sweden, has in his ethnological cabinet many specimens that show the influence of occupation on nutrition. " A person who for a trifling and transient lameness took up the occupation of begging, used to sit at the end of a bridge receiving alms during the rest of his life. The favored limb, though long since perfectly recovered from its lameness, was used as little as possible to keep up the semblance of lameness. The thigh-bone of this limb is nearly three quarters' of an inch less in circumference than the other, and more than one inch shorter. A criminal who was confined by a chain attached to one ankle for five years, died by frost in making his escape ; although the bone of the unused limb had not materially changed its size, it feels as light as pine wood. An old lady sat knitting in the alms-house the last years of her life; the ribs were so pressed together that the transverse diameter of the chest was only five inches, and the pelvic bones were inclined backward in a direction opposite the healthy position, so that it was only' nine inches from the top of the sternum to the pelvis. The 61 EFFECTS OF OCCUPATIONS. chest of one who has died of consumption generally measures three or four inches over the ribs less than that of a person who has died of any other disease. The vertebrae of a carpenter or of any one who has followed any similar occupation, are shown here by numerous examples to be not only larger but heavier in proportion to size than those of a tailoror shoemaker."* Now the faulty nutrition induced by occupations, or by any course of life approaching the civilized, should be counteracted by art, so that a harmonious development may be possible for all, in spite of evil tendencies. The too laborious farmer or mechanic should be softened down, by appropriate physical culture suited to his requirements, which would be those that give flexibility, activity, and impressibility, rather than those which would still further increase and harden the muscles ; while the too sedentary people of the towns should be hardened up to the proper standard by such a course of exercise as would principally develop muscle. The only use of systematic exercise is not, as is generally supposed, simply to increase the quantity of muscle—for excessive exercise may decrease it—but different kinds and qualities of exercise are capable of making very different and distinct impressions upon the system, according to their nature, as we see every day in over-worked men and animals. With regard to the hygienic effect of different exercises, the following extract of a letter from a very intel- • Dr. Geo. H. Taylor. 62 PHYSIOLOGY OF GENERAL EXERCISE. ligent gentleman so aptly illustrates the main ideas of the text that it is introduced here: " I have recently received from my friend and relative , two pamphlets written by you, on the subject of the 'Movement-Cure,' which I have read with much interest. They have brought to my mind some facts in my own experience, which occurred more than thirty years ago. In my early boyhood, I lived some years at Long Branch, in New Jersey, and, while there, had several severe attacks of fever and ague. In my fourteenth year I went to New England for an education, and, soon after I was of age, I settled in one of the eastern towns of Connecticut, in the practice of law. While there, and about seventeen years after I had left New Jersey, I was attacked with severe pain in the side, and, on stating the symptoms to my physician, he told me they were caused by a diseased condition of the spleen, arising from badly-treated attacks of fever and ague ; and in a few weeks, under his care, I was entirely relieved. Some years after, however, the pains returned, accompanied with cough and other pulmonary symptoms ; and fearing I was threatened with consumption, to which my mother's family were subject, I removed to Baltimore and went into the drug business there with my father. I took charge of the books, correspondence, etc.; but soon found all my unfavorable symptoms aggravated by this employment, and I quitted the desk and took charge of the retail department, and was soon relieved. I went to the desk again, and my old pains and cough returned ; but a few days at the retail shelves relieved me. I began to inquire why such different effects resulted from these two employments. I always stood very erect at the desk, never allowed myself to lean against it, or to bend or contract my chest, and I wrote there with so much ease, that the labor was not at all severe. Our principal retail shelf was high, and the bottles on it large (half-gallons), so that I had to stretch up to my full height, and use both hands, to take down the bottles ; our retail business was good, and the employment quite laborious. After considering the subject for some time, I concluded it was the peculiar kind of of exercise (or movement, if you please) that benefited me, and I set about trying to get it in some other way. I stretched a rope across a large back room, near the ceiling, passed a ring over it, so that it would slide easily on the rope and attached a cord to the ring, and let it hang down so that I could just reach it vfithboth hands. To the lower end of this cord I fastened a stick about three feet long, and when I felt any unpleasant effects from too long confinement at the desk (where my services were very much needed), I went to my swing, took an end of the stick in each hand, and ran backward and forward, and 63 • SPECIAL EXERCISES. danced, jumped, and exercised as much as I thought necessary, and always found relief from it, and was finally entirely cured of the disordered condition of the spleen, and have never suffered from it since. My cough, however, continued, and after two years in Baltimore, I went, by the advice of my physicians, Professors Potter and Hall, to Florida, where I lived six years. I was there in the very seat of empire of fever and ague and other kindred diseases, and disordered spleens were the rule, and not the exception. I recommended my swing, and in hundreds of cases in which it was tried, it never failed. Your pamphlets, it appears to me, afford a solution of the principle involved, and I thought, perhaps, you would regard the facts as affording some support to your certainly very plausible theory, and therefore I communicate them. Numerous other facts have, doubtless, been observed by others, showing the effects of particular forms of exercise or movement on disease, which, from not knowing on what principle they could be explained, have been regarded as accidental, and not worth the trouble of examination. It is so in all matters of investigation, and, doubtless, so in this." It will be seen by the above interesting narrative that the gentleman employed, in a crude way, the very means that answered the indications.* At first, the reaching up, while holding heavy bottles—which, from the nature of their contents, must be carried slowly— no doubt often rising on the toes to increase the height, and afterward the hanging by the hands, while exercising the legs, were very effectual means, and, for not too feeble cases, very proper means of promoting a peripheric circulation, and consequently relieving the congestion of the spleen, etc. At the same time, the raising and falling of the chest and diaphragm, alternately compressing and relieving the visceral organs, produced an excellent kneading effect, and supplied n local means of disgorging venous stagnations. It is hardly necessary to remark that almost any other labor * See Chapter VI. 64 PHYSIOLOGY OF GENERAL EXERCISE. or exercise that he could have taken would not have had the same result, which seems to have been the case in this instance. This corresponds to the wellknown practice in Ireland of hanging by the hands, from the limb of a tree, to cure complaints of the liver. In contrast with the above account of the excellent effects of proper movements, the following case will show the harmful effects of improper ones : A lady received advice for dyspepsia. She was directed how to take a certain number of movements in a particular order and manner. In a few days she came back very much worse. On inquiry, it was found that she had taken only those most conveniently performed, which happened to be the trunk bendings and twistings / which, without being administered with a proper number of peripheric movements, produced actual gastric congestion. Her form of dyspepsia was what is called chronic gastritis, and hence she was made worse in every respect. Her fault was explained to her when, by pursuing the proper course, she was soon relieved of all unpleasant symptoms. The object of this work is not to discuss general exercise in its merely hygienic relations —that would be a fertile field, yet distinct from the present inquiry —but to investigate the strictly medical uses of active, passive, and other localized movements. But it may be remarked, in passing, that a great deal of harm is often done, and generally much less good is effected than might otherwise be, by the want of particular "taking exercise." 65 directions and explanations, according to a patient's temperament, age, sex, disease, and -other requirements in giving the common advice to " take exercise." What is it to take exercise? It is evident that an invalid should have as definite directions, founded upon as clearly understood principles, and which should appear as reasonable to his judgment as his directions governing his diet, clothing, avocation, medicines, etc. Physicians have paid too little attention to this subject. Exercise, as previously shown, has an intimate connection with the general nutrition, but it has an equally profound influence upon, and can and does control the manifestation of the nervous system also. The amount of nervous force (so called) possessed by any individual may be considered as the measure of that individual's capacity. This capacity may be divided into the two great manifestations of sensation and volition, i. e., what we experience and what we do. In perfect health, where every functional manifestation is reciprocally well balanced, the sensations, or the capacity to receive impressions, and the volitionary force, or the capacity to make impressions, are equal. But each of these manifestations of the functions of the nervous system is capable of cultivation. Indeed, this cultivation is the essence of civilization, and to be perfect, needs only to be harmonious. The reciprocal relations of sensation and volition may be illustrated by comparing the nervous force, or individual capacity, to a river of definite size, but separated into two streams of equal dimensions by an 66 PHYSIOLOGY OF GENERAL EXERCISE. island at its mouth. Now, if by any means the channel on one side of the island becomes widened and deepened, of course more water will run through it, and therefore less water will be left to flow through the other channel. Now, if one channel is called sensation, and the other volition, the illustration is perfect. Excessive sensational capacity precludes excessive volition or force, and so, on the other hand, great muscular force is not joined to great sensitiveness to outward impressions. By great and small I refer to the standard of the individual, for what might be much for one, might be little for another. Now, as we would lessen the larger stream by increasing the smaller one, in the illustration, so we may lessen the capacity for sensations by cultivating volition; or to speak to the practical point, our ability to be affected by impressions from without is, within certain limits, in the inverse ratio of the cultivation of our muscles. Your fine lady, reared on sweetmeats, educated at a boarding-school with all the " accomplishments," every sense gratified, arrives at a point where a breath of wind gives her a cold; she feels the changes in the weather like a barometer, and is really capable of making only the slightest exertion, even to help herself to the ordinary necessities of life, without inconvenient physiological disturbances, and perhaps pathological consequences. A slight injury or transient illness prostrates her, not with imagined, but with actual suffering; while Bridget in the kitchen, who has been accustomed to execute rather than to feel, breaks her 67 SENSATION AND VOLITION. arm and walks about without inconvenience until it is healed. Any one who has frequented the hospitals, or even the college " clinics," must have been struck by witnessing how much greater an amount of disease those patients will carry about with them, and with less disturbance of the system (not of the mind) from it, than is the case in private practice among the more cultivated classes. This has nothing to do with fortitude, which is a mental quality, and mostly belongs to the higher classes. Extremes are always pernicious. The 6avage, with a complete animal nature, lacks the cultivated intellect and perceptions to direct bis brute force into useful channels, and civilization loses much of its nobleness by pandering to appetites and sensations, while the noblest resolves fall to the ground because there is no power to execute! It is easy to see the practical bearing of the foregoing. Properly adapted exercises will not only correct the vicious tendency of certain occupations by their counteracting influence—elevating the lower classes of society by increasing their means of enjoyment, and making them more impressible—but will diminish suffering and give executive ability, character, and force to the more refined. The exercises for the first class, to give flexibility to muscle, to increase the higher sensations, should be light and active, such as games, sports, dances, and those generally requiring more agility than force; while those exercises for developing volition and power, and diminishing mor- 68 PHYSIOLOGY ON GENERAL EXERCISE. bid excitability of the nervous system, should be slow, uniform, easily executed, non-exhausting movements, and those requiring a certain continuance of action; in a word, such as will act on the muscles by their continuance and force, rather than on the nervous centers by their intensity. And as we have seen that the effect of every movement upon (i. e., changes produced in) the tissues is in the ratio of its continuance, and that the effect upon the nervous centers is in the ratio of the intensity of the effort made to accomplish the movement, we have then an unerring guide in this respect as to the character of the exercises that it is proper for different classes of people or for invalids to take. As the necessities of labor are compulsory (fortunately), there is no escape from the conditions attending it; we can only enjoy the good, and remedy, so far as possible, the evils attending what is unavoidable; but in voluntary exercise for hygienic purposes we should always have a definite object in view, of which the various bodily movements are only the means to accomplish an end. Unfortunately, gymnastics have been too much considered as certain contortions to be done, instead of certain physiological impressions to be made, corresponding, more or less, to the needs of the system at the time, for the securing of which this or that particular exercise is best adapted. It is often remarked, for instance, that to strike the. back of the hands together behind the back at the height of the shoulders, is a feat worth striving for; whereas the development resulting from such 69 AMOUNT OF EXERCISE. a movement would be much less than if the arms were carried only just back of a line parallel with the shoulders. Indeed, if a person be so loose-jointed as to be thus capable of contorting himself, that would be sufficient reason why he ought not to do it, till he has developed himself by proper exercises up to the point where his muscles, tendons, and ligaments hold his joints so firmly together, that such a contortion would be impossible. But the details of gymnastics are foreign to the object of this work; only those physiological principles relating to exercise in general will be considered here. But when exercise in any form is taken to secure tissue transformation and growth, there are two considerations that should never be lost sight of. "While in perfect health, it undoubtedly happens that the greatest amount of tissue-metamorphosis occurs at the moment when the nervous centers give warning, by weariness, that a similar condition has taken place in them also; yet in civic life it much more frequently happens that the best results of the exercise have been secured long before there is any sense of weariness, in which case exercise beyond that point would destroy, more or less, the good already accomplished. Or, on the other hand, and as always happens in feeble persons, there is weariness so soon that there has been comparatively little change wrought in the tissues. In the first case, as with literary people, school-girls, or where there have been previously large draughts made upon the nervous system, the exercises should never be 70 PHYSIOLOGY OF GENERAL EXERCISE. pushed too far; while, in the second case, the exercises should be of such a nature as to call out but very little nervous force, thus making the greatest impression upon the tissues with the least waste of innervation. It is equally true that there are cases where the principal object of the exercise is to produce fatigue. In people who are perfectly well, but from the nature of their employments there is no chance to "work off" the constantly generated nervous force, and where there is already sufficient development of muscle, any kind of exercise where considerable force is expended would be appropriate. But it unfortunately happens that, in our present state of society, such cases seldom fall under the eye of the physician. It is generally only after years of neglect of bodily exercise, coupled with constant and exhausting drains upon the nervous system—when the health is completely broken down— that the physician's aid is invoked. In such cases, the greatest care should be used in recommending only such kinds of voluntary exercise as the patient can take without fatigue, especially at the commencement of an increase of active exercise. (See chapter on Nervous Diseases.) It is quite erroneous —but an error often entertained by lay people—to suppose that the amount of good one may receive from an exercise is in the ratio of the fatigue produced by it. As a general thing, people in ill health ought not to be required to exercise to weariness, because sickness implies, generally, a certain depression of the nervous system, which should not be EXERCISE OF INVALIDS. 71 increased; but, if it is necessary to make still deeper impression upon the muscular system, then the medical uses of bodily movements —that is, the "Movement- Cure"—will be found necessary. Free exercise would not then be sufficient, but the patient would require appropriate, regulated, or localized exercise or movements, such as would answer the indications. But it may happen, in some instances, that it is the functions of the nervous system mainly that need to be called out and exercised as the principal means of affecting the organism. When this is done in such a manner as to develop that function, by acting through it, so as to produce harmony between it and other manifestations, nothing could be more proper. When the will power is feeble from non-use merely, whether or not accompanied with certain phases of hypochondria, then to produce fatigue will be a strengthening instead of exhaustive process, independent of the general physiological effect of the exercise upon the muscular system. But nothing is more promotive of mischief than the general indiscriminate recommendation of physicians to their patients to " take exercise," without any instruction as to kind, quality, or manner of taking it. Even the free exercises of invalids should always be in accordance with the indications. In connection with what has before been said, it should be remarked that while habit —implying the presidence of the spinal cord over the continuance of what volition has set in motion—allows a much greater amount of muscular force to be employed without 72 PHYSIOLOGY OF GENERAL EXERCISE. fatigue than could otherwise he endured, it also should be recollected that all sudden, indefinite, unexpected movements require a vast expenditure of nervous force. A short succession of sudden trips, mis steps, or blunders will speedily exhaust even the strongest man. And there is no doubt but that the present style of long skirts for ladies' dresses, requiring, as it does, constant, uncertain, often unsuccessful efforts to snatch the skirt away from the advancing feet, to keep them from tripping; the getting into stages and ascending stairs in crouching, unsteady attitudes, holding up the dress meantime, and all similar spasmodic efforts, require such a fearful expenditure of nervous energy, that it is, of itself, sufficient in many cases to bring on a train of the most distressing symptoms. Indeed, the whole subject of dress, in all its influence upon bodily movements, requires consideration. Any style of dress is faulty that confines or impedes ever so slightly the simplest movement. It is not enough that the movement may be made with comparative ease and in the most perfect manner, but it ought to be perfectly free, else there will be next time an instinctive reluctance on the part of the muscles to perform it, or a shrinking from it, involving other parts not necessary to the original motion, with a corresponding profitless waste of power. But still worse; by persistence, this false action— this escaping from a hindrance, instinctive at first— becomes a permanent habit. For instance, the slight impediment to the movements of the arms, especially 73 INFLUENCE OF DRESS. the upward movement, occasioned by some styles of ladies' dresses, is injurious, not so much from the actual resistance of the dress to the action of the deltoid and other elevator muscles, but because the resistance, though trifling, being persistent, causes an equally persistent shrinking away from the point of expected resistance. This style of dress—especially for females, they having fewer counteracting influences—constantly tends to produce narrow and shrunken chests, depression of the diaphragm, falling of the bowels, and injury to the pelvic organs, besides general debility from imperfect respiration. The pernicious effects of tight lacing need not be argued here. But what is tight lacing? for no lady admits that she laces tightly, and many honestly deny it who still are daily suffering from its evil influences. When viewed in the light of the foregoing remarks on impeded motion, and the tendency of parts to recede from persistent resistance, it follows that a very slight resistance to the action of the respiratory muscles—a resistance falling far short of actual compression of the chest—must be extremely harmful—harmful to a degree not often contemplated even by the medical man. The fastening of tight cords or bands about the waist to sustain gentlemen's " pants" or ladies' skirts is injurious from two causes, viz.: the soft parts of the loins and abdomen are easily compressed, forcing downward the contents of the abdomen, impinging upon and displacing the organs beneath, and interfering with their functions as well as with muscular motions. 4 74 PHYSIOLOGY OF GENERAL EXERCISE. The diaphragm is dragged downward by the superincumbent weight, followed by the lungs, and the abdominal contents are forced down into the pelvis. This is more especially true in females, because of their larger abdomen and pelvis, and less power of resistance in the muscles and other tissues, and fewer opportunities to counteract by exercise the weakening effects of such malpositions of organs. The fashion of wearing very long, especially pointed waists, that obtained a few years ago, and is liable at any time to be re-introduced, is no doubt the cause of mucli of the present female suffering. The abdominal organs, by such a dress, are forced low down, and fixed there so permanently, that it has been often remarked by ladies that they "could make themselves longwaisted" by persevering in that style of dress. Long stays, though more perfectly fitting the form, passing far down, as they do, over the abdomen, must press upon it with great force from their stiffness, in all forward flexions of the trunk, which, together with having the objections of long waists, more than counteracts all the fancied relief said to be afforded by sustaining the skirts.* But there is another still more serious objection to stays. The support they give to the upper part of the trunk weakens the muscles which alone are competent to hold the form properly erect. Even if the muscles can not sustain the trunk without too much fatigue, there can not be anything gained by holding ° Skirts should be held up either by the shoulders, or. by a broad band passing around the hips and below the abdomen. 75 INFLUENCE OF DRESS. them up ever so slightly by support. Fatigue indicates rest, and not assistance. It would be better for the patient to lie down part of the time, with the advantage to the muscles of alternate action and rest, than to receive constant support, which they so soon learn to rely upon. "With reference to the clothing worn on the lower extremities, it may be mentioned that coldness of the feet is sometimes caused by wearing too tight fastenings to the stockings, thus impeding the capillary circulation in the legs, and the return of blood to the heart.* Internal congestions may thus become more liable. The shape of the shoes is of great importance. Man has a much narrower base of sustentation than most other animals, which renders it important that that base should not be lessened by cramping the feet in narrow shoes, rendering progression difficult, awkward, and quickly fatiguing. But probably the most serious fault in the feet coverings is the elevated heel often given to them. By elevating the heel, besides the still narrower base given, whether in progression or standing, the anatomical relations of the whole body as an instrument of locomotion are materially changed. As in lateral curvature of the spine, a deviation from the proper position at one point may cause several other compensating curves at other points, so an im- • The best means of holding up the stocking, besides tapes from the hips, is the old-fashioned woolen knit garter, its fibrous nature allowing it to be lightly put around the leg, while the common elastics must be so tight as constantly to compress the leg, or they will not stay up. 76 PHYSIOLOGY OF GENERAL EXERCISE. proper position of one part of the locomotive apparatus will cause a succession of other false positions of other parts. By elevating the heel, and constantly keeping the flexors of the feet on the stretch, relief to them is instinctively sought by a slight flexion at the knee; this would destroy the perpendicularity of the figure, were not another slight flexion made at the hips; but as this would throw the trunk forward, still another flexion backward is required, and then forward, etc. But in the spinal column a compromise is effected by a forward curve and inclination of the head. Thus, high heels tend to produce and permanently establish a succession of zig-zags from the ankles upward, with the weight of the body supported by the tension of the muscles, and not, as in erect stature, by the bony frame-work. The injurious results of persistence in such positions fall not so much on the legs as on the trunk and its contents. The head inclines forward, the chest sinks, the spine curves forward, the abdominal coverings are relaxed, and the belly pendulous, with its contents pressing down into the pelvis. From their characteristic anatomy, smaller feet, broader pelvis, larger abdomen, and weaker muscles, it must be evident that women must suffer much more from this cause than the other sex. It will be seen that, as regards the relations of dress to human anatomy and movements, the faults above pointed out all center in the female about the pelvis, and becoming cumulative, even without apparent wrong-doing on the part of the subject, may be amply sufficient, in 77 THE BODY AND MIND. connection with other causes, to account for the large proportion of uterine derangements among our countrywomen. It may also shed some light upon the ill success that has hitherto attended the medical treatment of those diseases, and point a way to better success in future. It has been previously mentioned that the mind exerts a powerful and often a controlling influence upon corporeal nutrition; it is equally true —such are the inter-relations of mind and matter—that bodily conditions influence mental manifestations, and the relation of corporeal exereise and mental manifestations has probably a more intimate connection than any other vital phenomena. The performance of function, whether of mind or muscle, is necessary to health, and these functional activities can not be separated one from another without detriment. Aside from the general hygienic influence of muscular activity, and the consequent purity of blood, the elimination of carbonic acid, and the introduction of an increased amount of oxygen, so enlivening to the brain and nervous system, there is a positive and immediate correspondence between muscular and mental activity. Harmony is the great law of nature. With the body trained to vigorous health —not the stupid blunting of the sensations by muscular overwork—the health and proper activity of every function of the mind must be wide aw r ake to the perception of moral or of scientific truths. But beware of systems of ethics emanating from a connection with paralytic muscles, or theological dogmas receiving their inspiration 78 PHYSIOLOGY OF GENERAL EXERCISE. from bad digestion. This is a,practical question, and will ere long become an agitated question in its application to the rising generation. There can be no just education which ignores physical training. Education does not consist in efforts of the memory alone, but in the developed power to properly use facts and principles, as we would use our muscles. Exercise and ratiocination are almost convertible terms. The pleasure of exercise, that peculiar feeling of physical enjoyment which the normal manifestation of any function always imparts, is enhanced as the clear and coursing thoughts occupy one's mind after such exercises as are adapted to one's wants. THERAPEUTICAL. CHAPTER IV. LATERAL CURVATURE OF THE SPINE. Introductory Remarks—Lateral Ccbvatitbe—Caused by Unequal Action of the Muscles—How Effected—The different kinds of Unequal Action and Resulting Curvatures—"Why more often to the Bight—Sigmoid Curvature—Crescentie Curvature—Curvatures generally caused by Muscular "Weakness —Weak Ankles and improper Positions—Over-Action of certain Muscles—Treatment of Lateral Curvature—Should Beverse the Process which produced it—Retraction and Relaxation on opposite sides of Spine—Concentric Movements for Expanded Side and Eccentric for Contracted Side—Localized to act differently on different Muscles—Illustrations—A Complex Movement—Deformity of Chest—How produced—The Bibs—The last to yield—How Remedied—Admeasurements— Concluding Remarks. Having in the first part of this work taken a brief survey of the physiological relations of bodily movements to the most important functional manifestations which come directly or indirectly under our control, or are capable of being modified as indications may require, it becomes necessary in this, the second part, to show by what means this modification is to be effected. In order to reduce this exposition to the smallest possible compass consistent with giving a clear and full view of the subject, several affections have been chosen as being well adapted to illustrate the practical 80 LATEKAXi CURVATURE OF THE SPINE. application of the general principles previously set forth. The' Movement Cure treatment is simply certaiu physiological principles put to practice. That, by a right employment of the muscles, we can produce mechanical results and alter the form of the body can be illustrated in the treatment of spinal curvatures and other deformities; that we can produce, by a modification of the same means, a special impression on the nervous system, can be seen in treatment of paralysis; and that the general physiological processes can be wholesomely affected, will be shown in the treatment of indigestion, consumption, and various other chronic affections. First, and simplest of all to understand, is LATERAL CURVATURE OF THE SPINE. The pathology of uncomplicated lateral curvature of the spine is exceedingly simple. It is invariably produced, in the first instance, by unequal action of the muscles; generally, but not always, accompanied by muscular weakness. The spinal column consists of twenty-four vertebrae, —little blocks of bone piled one on top of the other, with the intervertebral cartilage as elastic cushions between each, and all held strongly, but not immovably, together by the various ligaments; the whole forming a very flexible column, with little power to sustain itself in the upright or any other position in 81 THE SPINAL COLUMN. which it may be placed, without the aid of the muscles. The spinal column is necessarily so formed in order to allow flexion in every direction, to accommodate the various motions of the body, and to secure pliability and elasticity in connection with firmness and strength—qualities, in this particular instance, necessary to co-exist in the same organ: the latter to enable it to sustain the burdens imposed upon it, and the former to secure immunity from shocks and the operation of counter forces. The muscles of the trunk, secured to the pelvis below as a base, are attached all along the spine as "guy-ropes;" and, in several layers and groups, by their uniform, co-ordinated action, sustain the spine in place, or move it about in any required direction in the most symmetrical and perfect manner. Excepting the slight curvature, forward in the lumbar, and backward in the dorsal regions, the position of the spine and shape of the spinal column at any moment, in health, depend on the muscles. "When the muscles act in harmony—the different groups being properly set-off by their respective antagonists—then the spinal column, whether at rest or in motion, is always where it should be. But if the action of certain muscles is not properly antagonized— for some muscles do not act with the same degree of force as their mates —then this harmony and co-ordination are lost, and the spine makes a greater flexion toward the point where is the stronger muscular action, if this action is in the transverse direction, as of 4 * 82 LATERAL CURVATURE OF THE SPINK. the scapular muscles acting at the middle of the flexible column; hut from the stronger muscular force, when acting from one side at the ends of the flexible column longitudinally. That is, the spinal muscles act like a string to a bow, and if they contract more on one side, the ends of the spine are made to approximate toward that side, making the spine to swell out toward the other side ; but the scapular muscles acting at the middle would draw the spine toward themselves, and thus this unequal muscular action may cause the spine to deviate to the right or left, to or from the stronger muscles, according as they may happen to be, those that act longitudinally or transversely. We have thus a deviation from the normal direction of the column ; or, what is called a curvature of the spine. This deviation from the proper direction may occur anywhere in its length, but is most liable to occur at the upper extremity; which liability rapidly decreases from above downward. A forward inclination of the neck, in consequence of the greater weakness of the dorsal and cervical muscles—often brought about by the excessive strain to which these muscles are subjected by bad positions in study and various avocations—is the most common deformity to be met with. This makes one stoop-necked, round-shouldered, etc. But this condition, though a real deformity, and a great detriment to personal appearance, yet is so common, and causes so little physical inconvenience, that it is generally overlooked or ignored, or is erroneously considered a natural defect. The latter opinion is a 83 CURVATURES TO'THE RIGHT. mistake. It is really a deformity, produced in the manner above mentioned, and might be the subject of medical treatment. The next most frequent curvature of the spine is in the dorsal region, and is caused by the unequal action of antagonistic muscles at each side of the spine ; the deviation and bending being toward one side—most frequently, by far, to the right. This deformity—viz., lateral curvajture to the right—is the one now under consideration. Why it is that, in lateral curvature, the deviation is more frequently to the right (it has been stated to happen three times in every four), is probably partly explained by the fact that the right arm is used the most, and is consequently stronger than the left, especially about the scapular muscular attachments. Printers who have worked for a long time at the hand-press, frequently have the spine pulled to the right by the powerful muscles about the right shoulder made by the constant use of that arm. It has also been suggested that the right lung, being/ the larger, may have some predisposing influence; but faulty positions in sitting, standing, and at the writing or study desk, increase this ten- Fig. 9 Sigmoid curvature of the spine to the right. 84 LATERAL CURVATURE OF THE SPINE. dency to a great degree. However, the treatment for the one, reversed, would be the treatment for the other, and the reader will bear in mind that I speak of the curvature to the right. Fig. 9 is an excellent illustration of the most common form of lateral curvature. It presents, as will be seen, a double or sigmoid incurvation, with the principal and p rimary curve in the middle of the dorsal region, to the right, and a smaller secondary curve in the lumbar region, to the left. There is also another secondary curve in the cervical region. These latter curves are in consequence of, and for the most part are dependent on the principal primary curve in the middle of the back. Here is where the evil generally first commences, and to this part must our treatment, to be successful, be principally directed ; because the curves above and below, being dependent on this first and largest curve, will be restored at the same time and in the same proportion with it. By examining the cut, which very truly represents these cases, the spine is seen crowding up and under the right shoulder-blade, making that shoulder higher and more projecting than natural; and the ribs behind, on the right side, make a shorter bend, while on the left side they are much straightened and turn downward, and the shoulder-blade of that side is lower and less prominent than natural. Many people think that this difference in the appearance of the shoulders is owing to some disparity in the shoulders themselves ; but this is never the case. The shoulders are really PROMINENT SHOULDER AND HIP. 85 alike, and any difference in appearance is always owing to a deviation of the spine in that region toward one side, and medical aid should immediately be sought before the curvature becomes fixed and, irreparable. Again, many suppose that one hip—generally the right—is larger or higher than the other, when this difference is only apparent; the incurvation of the dorsal spine toward the left side draws in the body-line on the right side (fig. 9), leaving the right hip prominent, and making an acute angle and deep indentation over the hip on that side; while on the .left side, the line is straightened, and the natural angle of the bodyline nearly or quite obliterated. This obscures the left hip, making it less prominent, as it is partly hid in the tissues. Although habitual standing on one foot, as will be presently shown, favors the formation of a curvature, still it is difficult to see how one hip can really be higher than the other while standing on both feet, unless there be a difference in the length of the legs. There is another species of lateral curvature, differing somewhat from that just described and is seen represented in fig. 10. Fig. 10. Crescentic curvature of the spine to the right Thi3, for the sake of distinction, may be called the 86 LATERAL CURVATURE OF THE SPINE. crescenlic form. In this form the spine takes a single sweep in one direction, without the compensating curves toward the opposite side, above and below, as in the previous instance. The only reason that I can assign for this is the fact, that, in the crescentic curvature, the point of greatest deviation is much below what it is in the common sigmoid variety; and, probably, there is too little room for a compensating curvature in an opposite direction in the lumbar region, and no necessity for it above. This seems to be a sufficient explanation. The appearance of the shoulders in the latter case is not so much altered as in the first or sigmoid variety—not generally so much as shown in the cut ; but the hip is prominent on the opposite side from the curvature, instead of on the same side, as in the sigmoid variety, in consequence of the angle of the body-line on that side being increased, and diminished on the same side of the curvature. In this respect it is the opposite of the common sigmoid curvature. This should be borne in mind, or else it may lead to serious mistakes in diagnosis. The crescentic variety is much less frequently met with than the other kind ; it is probably as frequent on one side as on the other, and, in my experience, is much more difficult to treat, it being so low down, that muscular action can influence it in fewer directions. However, the same principles are to be observed in the treatment in both cases. These two kinds of lateral curvature —the sigmoid and the crescentic—are the types of all lateral curvatures. There are, of course, a great variety in the ap- 87 CAUSES OF LATERAL CURVATURE. pearance of lateral curvatures, but they may all be reduced to these two as the starting-point. General muscular weakness in a young person renders such liable to spinal distortion, though this weakness be not at first accompanied by- unequal action of the muscles. But, while this delicacy exists, any little • faults of position or carriage, in sitting, lying, or walking, may subject certain groups of muscles to what is to them, in their weak condition, excessive strain and fatigue. Now, if this disproportionate fatigue of certain groups of muscles be kept up a certain length of time, the unequal action of the muscles becomes habitual and fixed, and we have the spinal column deviating from its proper direction in obedience to the force acting upon it. The most favorable situation for a young person to acquire the deformity under consideration, seems to be among the inmates of our popular boarding-schools, and it is notorious how many young ladies are thus afflicted. The hard, exhausting study, little proper exercise, faulty positions at desk, high bolsters, and much else that might be pointed out, if the subject were entered into, all conspire to induce this deformity; and, considering such special provisions made for it, the only wonder is that so many actually escape. Weak ankles, often the result of the ungraceful and in other respects pernicious fashion of wearing high, narrow-heeled shoes, straining them by their rolling about, etc., may be an exciting cause of lateral curvature of the spine. The weaker ankle is generally the 88 LATERAL CURVATURE OF THE 6PLNE. left, and the individual soon forms the habit of standing on the right foot. Fig. 11 shows the effect of persistence in this habit. The lower portion of the spine is thrown to the left, and the dorsal portion necessarily thrown to the right. This does no harm in strong Fig. 11.* Unequal muscular fatigue and consequent curvature caused by habitual standing on one foot. persons; but in the weak, certain muscles are subjected to great fatigue, by which they are rendered disproportionally feeble. The muscles subjected to the extra strain are those on the right side of the dorsal region (see fig. 9), or on the convexity of the distortion. But, as before intimated, weakness is not always or necessarily a concomitant of this deformity. It may exist in persons of both sexes who are muscularly strong. It is still caused even in these cases by unequal action of co-ordinate muscles, but produced by owr-action of some muscles in certain regions, as the first is produced by under-actxon of the opposite and antagonistic groups ; in either case, the balance is destroyed. Every one is familiar with the causes capable of producing strabismus, talipes, etc. From some unexplained cause, some muscles seem to take on a species of tetanic action, and after a time become shortened or retracted, and fixed in that state. ° These figures are, many of them, shown in mere rude outlines, so as to better show the position of the parts, but, of course, in treatment, any ordinary loose dress which will allow of free motion is worn. 89 ILL-EFFECT OF 8UPPOETEE8. Strabismus is most frequently the result of disordered digestion, and I have generally found, by diligently tracing the history of the patient back to the early stages of the disease, that lateral curvature of the spine in strong persons had almost always followed a long period of dyspepsia or other phase of disordered digestion. Unequal muscular action from this cause no doubt exists in all parts of the body; but, generally acting against the end of a single inflexible bone, no deformity can occur; while in the case of the spinal column, a deformity must exist whenever the conditions previously described are found. But, given the deformity, what shall be the treatment ? Shall we tie up all the muscles, and still further increase their weakness and irritation by wearing a M supporter ?" Shall we ignore the physiological and anatomical relations of the different parts, and use an apparatus that acts upon the trunk as a whole, and by screws and braces attempt to straighten it out, as we would a crooked stick ? There is a better way. It is very simple, and consists of reversing the process that produced the distortion. For curvature to the right, we must establish the conditions for causing a curvature to the left (should it be continued long enough), and continue the process till the spine is brought back to the proper position. In this deformity, the two conditions of retraction and relaxation exist in the muscles acting longitudinally, respectively, in relation to the concave and convex sides of the spinal column; and our effort must 90 LATERAL CURVATURE OF THE SPINE. be directed in accordance with these conditions. By using eccentric movements on the concave side, to expand the retracted muscles, and concentric movements on the convex side, to contract and increase the power of the expanded muscles on the convex side— acting in the direction of this relaxation —we use the proper means to overcome the deformity. But it Fig. 12. Restoring equal muscular action and ' reducing curvature, by standing on left foot and stretching up left hand. requires the nicest discrimination so to adapt a movement that the proper muscles will be affected in the right way, or else we may do harm instead of good. For instance, it was stated that a curvature may be produced by stronger action of the muscles of the right side. But this stronger action must come in a transverse direction—as by the scapular muscles, while those muscles acting longitudinally, as the intercostales, erector-spinse, etc., are expanded, lengthened, and weakened by the bulging out of the convexity of the curvature; while too great action of those muscles acting longitudinally would act like a string to a bow, and produce the curvature to the left. Our effort must be, then, to place the patient in such positions and using such movements that these several different actions will be produced on different sections and opposite sides of the spine at the same time. We find that, almost without exception, in curvature 91 CORRECTING UNEQUAL MUSCULAR ACTION. to the right, the left ankle is much weaker than the other. Movements of the foot must be employed, such as inward and outward flexion, twisting the whole leg from the hip, and many others calculated to strengthen'the left leg, ankle, and hip. The position shown in fig. 12 increases the strength of the left leg and ankle, and, at the same time, the lower part of the spine is thrown to the right, while the upper or dorsal portion is powerfully drawn to the left, by the position of the left arm. This position is opposite that represented on page 88, fig. 11. The patient makes a strong effort to reach up, and remains in that state a certain length of time—if possible, a minute. It will be seen how, in this movement, the left side of the spine in the upper part is expanded, and in the lower part contracted; while on the right side, the upper portion is contracted, and the lower portion expanded, all of which tends to unbend and straighten the S-shaped spine. Fig. 13 represents one method of causing such a regulated action of the spinal muscles as. Fio. 18. Acting concentrically on scapular muscles, and eccentrically on longitudinal muscles of left side. that, while some portions are expanded, others are shortened, and thus the spine is bent in a direction Op- 92 LATERAL CURVATURE OF THE SPINE. posite to the deformity. The patient, with the left arm stretched up, leans over a bar, with his thighs resting against it, while the assistant grasps the left wrist, and presses upon the right shoulder. The patient now slowly raises the trunk from a to b. By the assistant's pulling at the left arm, the long leverage causes the scapular muscles attached to the spine—the lower portion of the trapezius, rhomboidii, etc.—to act powerfully in drawing that part of the spine to the left, Avhile the pressure of the hand upon the right shoulder still further aids this action. The spinal muscles act the same as described in fig. 12; eccentric and concen- Fig. 14. I'nited action of scapular and spinal li.uscles to force the spine into its place. trie, on alternate sections and opposite sides of the spine. This latter result is still better secured if the right foot is carried away a little to the right, so that the principal weight of the body will fall on the left leg. The movement represented in fig. 14 secures all of the actions previously enumerated, and is especially powerful in drawing the spine toward the left. The patient stands with the right foot carried a short distance away from the other, so that the weight of the body is sustained principally by the left leg; he then CORRECTING UNEQUAL ACTION. 93 takes hold of the pin, at the height of the shoulder, with the left hand only, and then settles down, as seen at a. He now slowly draws himself up, against the resistance of the assistant —who holds him by the hips, as seen —to b, and finally to