[Reprinted from MEDICAL BRIEF, April, 1897.] CYCLOPATHY. BY WILLIAM EDGAR DARNALL, A. B., M. D„ ATLANTIC CITY, N. J. Are we to become a hump-backed race is a question that has been asked since the advent of the widespread bicycle epidemic. Equally as pertinent is the question: Are we to be a generation characterized by genito-urinary disor- ganizations and disorders? The bicycle ought to be a perfect boon to humanity in encouraging those accus- tomed to sedentary habits and physically inactive lives to regular and systematic exercise. It is this very class of people who constitute at the same time our greatest thinkers, as well as our worst nervous wrecks. To keep up with our rushing civilization, it seems that all the time often has to be given to brain work to the detriment of the muscular system. The brain has too much to do while the muscles do not have enough. The ten- sion of the nervous system is wrought higher and higher by this process, while the .muscles become flabby and weak. This habitual state of disturbed equilib- rium soon results in a general condition of lowered vitality. Too often such sub- jects are at the same time high livers. They ingest enough food stuffs to sup- port a day laborer, instead of taking only as much as they can utilize. This unjust tax on the digestive organs be- comes burdensome. The system is en- gorged; the liver becomes torpid. The nervous system now becomes rebellious at having all the work of life shifted to its shoulders. "The willing horse is worked to death." It is this one-sided modern civilization that is wrecking the flower of our manhood and womanhood in their prime of life. The bicycle then becomes a great blessing if it will change these existing conditions, and aid in the production of mens sana in corpore sano. The best of institutions, however, are often abused by man. The wheel is no exception. It is time physicians should study the question of the use and abuse of the bicycle so that a timely word of warning may be raised. Outside of the general principles regu- lating the amount of any physical exer- cise the result of improper riding may be divided into two classes-(a) Those due to depressed handle bars, (b) Those due to the saddle. In the first class the results are mainly mechanical. The average male rider assumes a posture in which he leans forward, in order to grasp depressed handle bars, the "cow horn" bars being the worst form of these. In so doing the shoulders are thrown forward, and the thoracic cavity diminished in vol- ume. The lungs which should under the stimulation of exercise have the fullest play in their expansion are compressed. The heart's action is also interfered with to some extent by the pressure. More respirations per minute have to be taken, on account of the exercise, and smaller lung space, in order to aerate the blood. The heart now must beat faster and faster to force the blood through the lungs and meet the emergency. It be- comes overworked. Finally a condition of hypertrophy results, and the most important perhaps of the life organs of the body is weakened and unfitted for duty, while the rider becomes a round- shouldered, hollow-chested deformity. The second class of troubles following the abuse of the bicycle are saddle in- juries. These require perhaps a more intricate study of the anatomy and phy- siology of the parts. As the first were mechanical in their action, these are reflex. The subjects of these injuries are of two classes: (a) Those who, al- though they assume the correct upright position in riding, yet use a saddle with a pommel which irritates delicate parts, (b) Those who assume the leaning for- ward posture to grasp depressed handle bars, allowing the weight of the body to rest on the soft structures of the pelvis rather than the haunches which were intended for that purpose. To fully understand how serious re- sults may follow a bad saddle or this unnatural posture in riding, an accurate knowledge of the anatomy and physi- ology of the parts involved, with special reference to the blood and nerve supply, is requisite. The latter is most intricate as well as the most important. The pel- vic structures are supplied by branches from the lumbar, sacral and sympathetic plexuses of nerves, as follows: The scrotum and labia receive their supply from the ilio-inguinal, inferior pudendal and perineal branches of the pudic. The spermatic canal, cremaster muscle and upper inner thigh are furnished fibres from the ilio-inguinal and genito-crural nerves. The pelvic viscera, viz.: the bladder, rectum, uterus and vagina are supplied by the anterior divisions of the sacral plexus, while the pudic nerve furnishes the anus, penis and four mus- cles of the perineum. In the reflex neuroses and pelvic con- gestions incident to injudicious cycling an even more important role is played by the hypogastric plexus of the sympa- thetic, which controls the vasomotor action of these parts. This important plexus is subdivided into five subor- dinate plexuses, each bearing the name of the part to which it is distributed: (a) The inferior hemorrhoidal control- ling the rectum. (b~) The vesical sup- plying the bladder, seminal vesicles, vas deferens and spermatic cord, (c) The prostatic giving fibres to the prostate gland, seminal vesicles and erectile structures, (d) The uterine, and (e) the vaginal plexuses supplying these organs. This whole region indeed is permeated by an inextricable meshwork of nervous elements, highly organized and very del- icate and sensitive to injury. Cycling is characterized by a contin- uous succession of bounces, as the wheel encounters the uneven places in the roads. If an improper saddle is used there is much friction to the perineum and upper inner thighs. If the rider assumes the forward position the results are infinitely worse. Here the weight of the body is resting on the soft struct- ures of the perineum instead of the ischiatic tuberosities which are the normal supports for the weight of the body in the sitting posture. Every bounce of the wheel bears with it a shock to the nerves, supplying these parts, while the cutaneous nerve ter- minals are constantly irritated by the undue friction. It is therefore not un- common for the business or professional man tired of the confinement of his office, and going out in the afternoon for a spin, for exercise and recreation, to come home feeling depressed, out of sorts and sore. He perhaps feels weak and exhausted. A bad seat, more fre- quently a bad posture in riding has been followed by a mild degree of shock to his nervous system. The ride which should have exhilarated him has done him more harm than good. Over-irritation of the nerves supply- ing these parts is attended with height- ened reflex irritability. In the lumbar portion of the cord are to be found the centers for micturition, copulation, def- ecation, parturition in the female, and the cremasteric reflex. The sensitive- ness produced therefore by this over- irritation is followed by irritable bladder, and even cystitis; increased sexual de- sire in both sexes; nocturnal emissions of abnormal frequency; abortion in the pregnant female, and rectal irritability, while the difficulty incident to urethral strictures is an old story with bicycle riders. The equilibrium of the vaso- motor system is unbalanced. The cap- illaries becomes dilated under reflex stimulation; varicocele is encouraged; congestions occur. Enlarged prostate, prostatitis, proctitis, epididymitis and orchitis may follow, though the two latter are usually the result of direct injury in the form of blows or bruises. In the female, metrorrhagia, endome- tritis and pelvic peritonitis inflict their penalty for riding during menses; while if pelvic inflammation already exist it is greatly aggravated by the increased amount of congestion through reflex vasomotor influence. This brings to mind the old hue and cry raised against the use of the sewing machine by pregnant women, or during menses, or when suffering from uterine troubles. The bicycle is of course much worse in these conditions, yet one often sees women who exercise reasonable care in regard to the former, mount their wheels and go on long and tiresome rides upon them. Clearly the public needs some education in these matters. It is claimed that certain low forms of chronic pelvic inflammation maybe ben- efited by this modern form of exercise, the benefit accruing from general im- provement in the circulatory system. It is also said that internal hemorrhoids are benefited; external hemorrhoids are as a rule aggravated. The diagnosis of many of the inflammatory forms referred to is often difficult, the symptoms ob- scure, and the existing condition un- certain. Positive statements therefore either pro or con must be received with the customary grano salis until their diagnosis can be cleared of the doubts surrounding them; usually, existing pel- vic inflammations of all forms are only aggravated by riding. From the foregoing statements we con- clude that the bicycle intelligently and properly ridden is one of the greatest institutions of modern times in the maintenance of a healthy constitution. To the sedentary and nervous it is a god- send, in the stimulation of such subjects to regular and systematic exercise, af- fording at the same time pleasant recrea- tion. Healthy riding consists in com- fortable saddle without pommel; straight handle bars, upright position in riding, good judgment in the case of woman- kind as to when not to ride, and an accurate estimate of the proper amount of exercise to be taken. Even so good a thing as the bicycle will not, however, keep nature from resenting an injury done in violation of her laws. Bad saddle, a forward position in riding; overtaxing the strength by long rides, and an abuse of the wheel, espe cially by women will be visited on the abuser by untold suffering, which is buc the just penalty of such violation.