Reprinted from 
Annals of Gynecology and Pediatry, 
April, 1893. 
A CLINICAL LECTURE ON THE PREVENTION OF 
IDIOPATHIC ROTARY LATERAL CURVA- 
TURES OF THE SPINE. 
By H. Augustus Wiuson, M.D., 
Professor of General and Orthopaedic Surgery in the Philadelphia Polyclinic ; Clinical Professor 
of Orthopaedic Surgery in the Jefferson Medical College. [Annals of Gynaecology and Podiatry, May, 1S93]. 
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Idiopathic Rotary Lateral Curvatures of the Spine. {Annals of Gynecology and Pediatry, May, 1893]. 
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Idiopathic Rotary Lateral Curvatures of the Spine. A Clinical Lecture on the Prevention of Idiopathic Rotary 
Lateral Curvatures of the Spine. 
BY H. AUGUSTUS WILSON, M.D., 
Professor of General and Orthopcedic Surgery in the Philadelphia Polyclinic; 
Clinical Professor of Orthopcedic Surgery in the fefferson Medical College. 
It will not be the purpose of this 
lecture to refer to that larger class of 
cases of rotary lateral curvatures of 
the spine where that deformity is 
produced by asymmetry of the legs 
or arms, but attention will be directed 
only to those that have no such 
apparent cause, and therefore would 
be classed idiopathic. 
Without entering upon the large 
subject of theoretical aetiology, it may 
be concisely stated that idiopathic 
rotary lateral curvatures of the 
spine are produced or influenced by 
two factors, namely: Constitutional 
debility, or enfeebleness, and pro- 
longed maintenance of an altered 
relationship normally existing be. 
tween the shoulders and hips. 
It will be apparent, therefore, that 
the prevention of the occurrence, as 
well as the arrest of the progress of 
this deformity, will depend upon the 
early removal .of those conditions 
which tend to the production and 
progress of this deformity. 
In the group of illustrative cases,1 
photographs of which are here given, 
constitutional debility was a con- 
spicuous element. Scoliosis is first 
noticed usually from about the age 
of eight to sixteen years, during that 
period of life when rapid growth and 
development mark the transition into 
young womanhood. Occasionally the 
1 Eight of these photographs were loaned to the 
Editors of the " American Text Book of Surgery," 
and will explain their presence there and here. 2 
H. AUGUSTUS WILSON. 
same condition is found in boys of 
the same age, but this is rare, and 
the deformity assumes precisely the 
same character as seen in Figs. 15 
and 18. 
It will require no argument to im- 
press the absurdity of relying upon 
more or less rigid shoulder braces or 
apparatus, or requiring a patient to 
remain in bed, or in any recumbent 
or quiet position, when such proced- 
ures or restraint can have but one 
object, and that to increase the en- 
feebleness already present. It would 
be as rational to attempt to prepare 
college athletes for field or aquatic 
sports by prolonged rest in bed so 
that they should become rested, and, 
therefore, ready for the severe exer- 
tions to which they were to be sub- 
jected, or to permit them to exercise 
once a week for an hour and then so 
encase their bodies as to prevent 
muscular effort, and, therefore, 
fatigue. 
The constitutional debility peremp- 
torily demands well-directed hygienic 
surroundings and the gradual and 
judicious development of the entire 
muscular system as well as the 
adjustment of the clothing to permit 
unrestrained action of those muscles 
whose function it is to hold the spinal 
column in the normal position. 
The clinical features of this form 
of spinal curvature are well shown 
in the photographs of the illustrative 
cases which are given here to afford 
an opportunity of studying a group 
rather than a single case. The gen- 
eral character of the deformity will be 
found to be the same in all of these 
cases, some features being more 
marked at times, such, for example, 
as the position of the greatest curve. 
The existence of some deviation from 
the normal positions of the shoulder, 
or shoulder blades, is usually first 
observed by the dressmaker, when 
she finds differences upon the sides 
of the patient, or the necessity for 
filling in the dress waist with cotton 
batting or other material in order to 
make the dress fit nicely. Sometimes 
there is observed an undue promi- 
nence of one hip, making the waist 
slanting, and the skirt is noticed to 
drag upon the ground upon one side. 
It occasionally occurs that a careful 
mother will observe the elevation of 
one shoulder and the undue promi- 
nence of one shoulder blade, but this 
rarely occurs until the deformity has 
progressed sufficiently to make it 
markedly conspicuous. It not infre- 
quently occurs that the corset maker 
is the one who finds out that the girl 
is crooked. Often the mother, dis- 
tressed at the habitual faulty positions 
assumed by the daughter, will exam- 
ine the back to find a cause, and the 
characteristic appearances will be 
observed. 
The patient standing firmly and 
evenly on both feet, with the body 
uncovered from the hips up so that 
a free inspection may be made, it 
will be observed that the right shoul- 
der is higher than the left, as shown 
in Fig. i ; that the right scapula is 
not only more prominent at its angle, 
but occupies a position posterior to 
that of its fellow, as shown in Fig. 12 ; 
that the ribs upon the right side, 
posteriorly, are more or less bulged 
out laterally and posteriorly, as shown 
in Fig. 2. Upon the left side there 
is a corresponding depression into 
which the left scapula sinks in pro- 
portion to the extent of the curva- 
ture shown in Fig. 15, and that upon 
examination of the spinous processes, PREVENTION OF CURVATURES OF THE SPINE. 
3 
by using the first and second fingers, 
placed one upon each side, pressing 
upon each side of the spinous pro- 
cesses, that a gradual curvature or 
deviation from the middle line will be 
observed. The most convenient 
method of making this inspection is 
to begin with the seventh cervical 
vertebra ; passing the fingers down 
with slow, firm pressure to the sacrum, 
turning the patient about so as to 
face you, the opposite conditions will 
be observed ; that the bulging of the 
ribs is upon the left side anteriorly, 
with a corresponding depression of 
the right side. It, however, not in- 
frequently occurs that although there 
may be a very considerable amount 
of deviation of the spinal column 
posteriorly, there may be very slight 
deformity manifested in front, shown 
in Figs. 23 a and 23 b, and I have 
rarely found it necessary to examine 
the front of the body to confirm a 
diagnosis. 
In Fig. 19 b there is a conspicuous 
prominence of the right hip in front 
and an apparent obliquity of the line 
of the waist, giving the appearance 
that would be present in a case with 
the right leg several inches longer 
than the left. The view of the back, 
as seen in Fig. 19 a, will show the 
low dorsal and lumbar lateral curva- 
ture, but it is the great rotation of 
the lumbar vertebrae in this case that 
so alters the contour as to make the 
right hip unnaturally prominent. 
The legs were found to be within a 
quarter of an inch of the same length, 
and could not, therefore, have pro- 
duced the apparent obliquity of the 
pelvis. I say apparent obliquity, 
because it was found to be apparent 
only, as the measurements from the 
anterior superior spinous process of 
the ilium demonstrated. 
It generally occurs, however, that 
no evidence of curvature is found in 
the front of the body, as well demon- 
strated by Fig. 23 b, where the con- 
tour is even and regular, as though 
there were no abnormality. The 
inspection of the back, however, as 
seen in Fig. 23 a, shows a decided 
lateral curvature, and the prominence 
of the right scapula demonstrates the 
presence of rotation. Occasionally 
the inspection of the front of the 
body reveals an apparent enlarge- 
ment of the left mammary gland, but 
this is found to be due to the torsion 
of the vertebrae throwing the ribs for- 
ward and therefore making the mam- 
mary gland of that side seem larger 
than its fellow. 
The character of the curvature is 
that of a slow or gradual curve in 
more or less of an S shape, proceed- 
ing with great regularity from the 
pelvis to the neck. The curvature 
may now be made more conspicuous 
by having the child fold her arms in 
front and bend forward from the 
hips, with the knees straight. In 
this position, by laying a ruler across 
the back, the scapula of the right 
side will be found to occupy a differ- 
ent plane from that of its fellow. 
Any irregularities of contour, such 
as unduly prominent hips, as seen in 
Figs. 1, 12, 15, 16, 19 and 20, will 
now be found not to depend upon 
unequal lengths of the legs, but to 
rotation of the lumbar vertebrae. 
Any doubt in this regard may be 
easily removed by measuring the 
length of the legs, or by measuring 
the distance from the floor to the 
great trochanters on each side as the 
patient stands erect. The patient, 
standing erect, should be requested' 
to slowly bend the body first to the 
right side and then the left, when it 
o z 4 
H. AUGUSTUS WILSON. 
will be perceived that an inequality 
of freedom of motion exists, which 
will be made more apparent by re- 
questing the patient to turn her 
entire body, without moving the feet, 
first to the right and then to the left. 
The character of the curvature is, 
as already stated, a gradual curve, as 
shown in Figs. 1 and 2, and is totally 
unlike the angular curve of lateral 
deviation sometimes seen in Pott's 
disease, an illustration of which is 
afforded in Fig. 3. In the latter, the 
deviation is that of two straight lines 
bending at a single point, and the 
differences of appearance is so great 
that it would appear to be impossible 
to mistake them. But this case, No. 
3, was treated for a time as scoliosis, 
while the case shown in Fig. 28 was 
treated for Pott's disease, and is evi- 
dence, therefore, of the possibility of 
confusion. 
A reference to the illustrations of 
pathological specimens from the 
Mutter Museum of the College of 
Physicians of Philadelphia will not 
only explain the characteristic curva- 
tures of each, but will plainly show 
the presence of rotation as an impor- 
tant element of scoliosis. Fig. 5 will 
show the resulting bone changes in a 
confirmed case such as Fig. 1 was 
when I first saw the case. The line 
of the spinous processes shows the 
curve of the lateral curvature, while 
the positions occupied by the ribs 
upon the right side will explain the 
undue prominence of the right shoul- 
der blade so well shown in Figs. 1, 
2, 11, 12, 13, 16, 22 and 27 when these 
patients were standing in a relaxed 
position. The undue prominence of 
the angle of the left scapulae, as 
shown in Figs. 14, 15, 18 and 20, is 
explained by the patient's efforts to 
stand erect and hold the shoulders 
evenly. By reference again to Fig. 
5 it will be seen that in the rotation 
of the vertebrae the shoulder joint is 
carried forward upon the left side, 
and any attempt in confirmed cases 
to make less apparent the appear- 
ances of the shoulders or scapulae 
would tend to throw out conspicu- 
ously the angle of the scapulae, as 
already referred to. 
Fig. 6 is a photograph of the front 
of the same specimen as Fig. 5, and 
shows the anterior view of the bodies 
of the vertebrae and clearly shows not 
only the lateral curvature, but, as 
well, the rotation of the vertebrae. 
Figs. 7 and 8 are larger views, and 
will show more in detail the ultimate 
bone changes that occur, and will be 
perceived to be such as would be 
produced by compression of India 
rubber balls. In the specimens, the 
changes in the lower lumbar verte- 
brae are so slight as to easily escape 
notice, and are most conspicuous at 
the points of greatest curvature. 
Here the bodies will be found to be 
wedge shaped, as though having 
yielded to pressure unequally applied. 
The rotation of the spinal column 
will also be better seen in detail in 
these two specimens by comparing 
the articulations of the ribs upon 
each side. These changes in the 
bodies, spinous processes and ribs 
may be due to compression while 
they are soft, or may be due to their 
more rapid growth in those parts 
where the resistance is the least, or 
as appears more probable to a combi- 
nation of these two elements. 
The changes in the chest walls as 
the ribs become distorted naturally 
produce alterations in the thoracic 
and abdominal cavities in proportion PREVENTION OF CURVATURES OF THE SPINE. 
5 
to the severity of the deformity. Not 
alone is the trunk, i. e., from the 
shoulders to the hips, shortened, but 
the unnatural positions of the ribs 
impairs their free movement in res- 
piration. Fig. 6 will clearly demon- 
strate these changes, and show the 
enlarged space in the thorax upon 
the left side and the diminished space 
upon the right, and the reverse of 
these conditions in the abdominal 
cavity. 
In marked contrast to those four 
specimens of resulting bone de- 
formity, Figs. 9 and io may now be 
studied in connection with Fig. 3 and 
its profile, as seen in Fig. 4. In the 
curvature of Pott's disease the curva- 
ture is angular, following the destruc- 
tion by bone disease of one or more 
vertebrae, throwing the upper part of 
the body forward. In cases where 
there is a lateral deviation, as shown 
in Fig. 3, it is undoubtedly due to 
one side of a body of a vertebrae 
yielding first and thus throwing the 
upper part of the trunk to one side 
at the same time that it goes forward. 
In well-marked cases of deformity 
there can be no difficulty in distin- 
guishing the character of the curva- 
ture, but in slightly-marked cases 
like Figs. 24, 28 and 29, it can be 
understood how the two first men- 
tioned were treated as Pott's disease. 
In these cases of slight curvature the 
diagnosis is often one of very 
great difficulty and must be made 
with great care, as the curvatures 
dependent upon active bone destruc- 
tion from inflammation will require 
immobilization, whereas rotary lateral 
curvature requires active movements 
and freedom from restraint. 
The most pernicious errors occur- 
ring in connection with scoliosis are: 
(a) That the patient will outgrow 
the slight deformity present at the 
beginning, and, therefore, requires no 
attention. 
(£) That shoulder straps or braces 
of any kind, especially when re-en- 
forced with pads, will, by concealing 
the deformity, be efficacious in its 
correction. 
(y) That any of the so-called plans 
of treatment will correct all cases. 
(d) That as it is a curvature of the 
spine it is to be considered to be 
amenable to the same plans of pro- 
cedure as are applied to curvatures 
produced by tubercular ostitis or 
Pott's disease. 
(<?) That being a spinal curvature it 
is hopeless to try to do anything for it. 
(/) That its occurrence cannot be 
prevented. 
(a) That a patient will not only not 
grow out of, but will, more or less rap- 
idly, grow into a permanent defor- 
mity is a matter of experience. Such 
an assurance was given to the case 
shown in Fig. n, which at the age of 
18 had become confirmed beyond pos- 
sibility of correction. 
Ignoring its existence made it nec- 
essary to increase the application of 
pads in the clothing to keep it con- 
cealed, and as these became oppres- 
sive, and as the patient did not out- 
grow the deformity, it was deemed 
wise to have an additional profes- 
sional opinion, which was now of no 
avail. 
There is no deformity more insidi- 
ous in its progress than scoliosis, for 
its growth is very slow, and without 
pain or inconvenience it seizes the 
patient, whose hopefulness and nat- 
ural languor tend to postponement of 
inspection and the application of 
rational measures of relief. 6 
H. AUGUSTUS WILSON. 
(b) That shoulder straps or braces 
of any kinds, especially when rein- 
forced with pads, will, by concealing 
the deformity, be efficacious in its 
correction. 
What a blessing it would be if all 
shoulder straps could be strapped 
upon their originators and makers to 
make them prove the assertions so 
freely made to cure those conditions 
which are, I believe, made worse by 
their use. 
In a clinical lecture entitled, " A 
Demonstration of Some of the Causes 
of Rotary Lateral Curvature," pub 
lished in the Journal of the American 
Medical Association, April 2, 1892, I 
showed the manner in which the head 
and shoulders are held erect in nor- 
mally constructed bodies. " The pres- 
ence of correlation of muscular force 
prevents a normal body from being 
deformed, and I believe its re-estab- 
lishment will correct deformity if ap- 
plied rationally and prior to serious 
bone deformity." 
"The spinal column is made up of 
a number of small bones or vertebrae 
so arranged that they tilt on one an- 
other at the will of the person, by the 
exertion of muscular force in the de- 
sired direction. What holds up this 
movable spinal column is the action 
of muscles, which by contracting force 
each vertebra against its fellow, mak- 
ing the column rigid." 
If the normal spinal column is capa- 
ble of being held in an erect position 
by muscular exertion, it is rational to 
believe that when the shoulders droop 
because a girl is feeble, that that fee- 
bleness will not be improved by con- 
structing a derrick to hold those 
shoulders in their proper places. That 
the use of supports will produce an 
atrophy from disuse, and although the 
muscular strength was not sufficient 
to hold the shoulders the time would 
speedily come when they could not 
hold the added weight of the shoulder 
braces. The progressive atrophy would 
then require more or less extensive 
braces or supports, rendering it pos- 
sible to dispense with muscles for 
the purpose for which they were 
made. 
Fig. 21 shows a brace that is in 
common use; it is a combination of 
steel-bound corset, shoulder straps, 
and padding combined, and when ap- 
plied it certainly conceals all appear- 
ance of a deformity. The deficiency 
upon the left side, posteriorly, being 
well concealed by the heavily-quilted 
pad, while a similar arrangement in 
front performs a similar office. 
In the illustrative cases may be 
found confirmation of the statements 
already made. 
Fig. i had worn braces for seven 
years. 
Figs, ii, 12, 14, 16, 20, 22, 23, and 
28 had all worn braces of more or less 
elaborate construction for periods ex- 
ceeding four years, and the appear- 
ances of their backs will best tell the 
benefit or disadvantage to be derived 
from dependence upon such plan of 
procedure. 
(o') That any one so-called plan of 
treatment will correct all cases. The 
various plans advocated at various 
times by various writers may be 
grouped under the headings of oper- 
ative, section of muscles, now obso- 
lete ; prolonged recumbency, in either 
recumbent or prone positions; me- 
chanical, by some form of brace or 
apparatus ; gymnastic, by any of the 
many methods. 
It would be just as proper to treat 
all cases of pneumonia, or any other PREVENTION OF CURVATURES OF THE SPINE. 
7 
disease, on exactly the same plan as it 
would be to treat all spinal curvatures 
alike. There can be no doubt that 
cases have been benefited or cured by 
the plans referred to, but it is safe to 
say that there must have been many 
that were injured by the injudicious 
application of a single favored method, 
to the exclusion of all else. 
When it is recognized that the 
bones must be softer than natural in 
those patients who have rotary lateral 
curvature, and that the erect posture 
is sometimes prejudicial, that faulty 
positions are thereby induced, it will 
be apparent that a careful combina- 
tion or skillful application of such of 
those plans as are required should be 
resorted to. That to prevent further 
bone deformity by rigid restraining 
apparatus increased atrophy of mus- 
cles is apt to be induced, and that the 
attempt to increase the muscular 
power too vigorously may increase the 
bone deformity, and thus it will be 
apparent that great care and discern- 
ment is required to proceed on the 
safe course. 
(a') That being a spinal curvature 
it is considered to be amenable to the 
same plan of procedure as are applied 
to curvatures produced by tubercular 
ostitis, or Pott's disease. This error 
has already been shown in reference 
to improper use of braces. 
(e) That being a spinal curvature 
it is hopeless to try to do anything 
for it, is unwarranted, in view of the 
many absolute cures that have oc- 
curred in cases where the deformity 
was recognized in time, that is, prior 
to the occurrence of serious bone 
changes. Even after such changes 
have occurred the progress of the de- 
formity cannot only be arrested but 
often corrected in part, if not abso- 
lutely. 
Fig. 27 a will show the conditions 
present in a case that was again pho- 
tographed two years later and shown 
in 27 b, while Figs. 24 and 28 show 
cases that have been corrected with 
such slight remaining evidence of the 
previously existing deformity that it 
is difficult to believe that they ever 
were deformed. 
It is not the province of this 
lecture to speak of the treatment 
after a deformity has occurred, but 
rather to attempt to refute the last 
error referred to,/. That its occur- 
rence cannot be prevented. 
(/) The attention attracted by 
physical culture during the past few 
years clearly shows that its necessity 
was apparent for other reasons than 
in the prevention of rotary lateral 
curvature. A similar enthusiasm has 
been elicited in the subject of dress 
reform, and these two subjects, 
properly applied, will be all that will 
be required to prevent rotary lateral 
curvature, because the proper hygi- 
enic surroundings will naturally ac- 
company them. 
It is a mistake to depend upon 
gymnastic apparatus of any kind; 
although they may often prove an in- 
centive, they are never essential. 
The human form contains all the 
apparatus that can be required for its 
own development, and it needs simply 
a knowledge of how to obtain the best 
use of it. There are many so-called 
systems of gymnastics without ap- 
paratus, known as the German goose- 
step drill, the Dio Lewis, the South 
Kensington, Swedish, and they are 
very ingenious in their conception 
and execution. 
A wealth of information may be 
obtained from such works upon this 
subject as Schreiber's "Massage and 
Exercise;" Blakie, "How to Get 8 
H. AUGUSTUS WILSON. 
Strong;" Checkley, " A Natural 
Method of Physical Training;" Har- 
telius, "Home Gymnastics," and 
other similar books. 
Of great importance is the matter 
of dress for such exercises, and I have 
found the skirt to be so much in the 
way of free, unrestrained movements 
that I have adopted a suit, made in 
one piece, consisting of very full 
trousers going below the knee, and a 
very full blouse open in the back. 
At the neck, waist and knees elastic 
bands assist in holding this garment 
so that it will not drag, and at the 
same time to avoid restraint. A pair 
of dark stockings and loose, soft slip- 
pers completes the costume, as shown 
in Fig. 25. The material should be 
preferably of dark flannel, to absorb 
the perspiration and protect the body 
from changes of temperature. 
The most convenient time for exer- 
cises is upon rising and upon retiring, 
and should other times be required an 
hour and a half after breakfast or 
dinner will be found most beneficial. 
To obtain the greatest benefit from 
exercises a cold shower-bath with a 
quick, hard rubbing should always 
follow, and where this is too severe 
for a delicate patient a sponge-bath, 
or even the rubbing only, may be re- 
sorted to. If this is followed with 
a prolonged rest of half an hour to an 
hour, with or without sleep, the pa- 
tient will be refreshed and not apt to 
become over-fatigued. Prudence dic- 
tates the advisability of covering the 
patient warmly after the exercises to 
avoid chilling. 
The most satisfactory results are 
usually obtained by giving the patient 
prescribed exercises to occupy a given 
time, and to add to them as the indi- 
cations of the case warrant, thus 
making them progressive. 
When a patient has been taught the 
value of self-resistance in exercise she 
will have within her control a method 
of obtaining exercises that will dis- 
pense with gymnastic appliances and 
at the same time avoid the risk of 
over-straining. The resistance will 
naturally be not of so many actual 
pounds but of a character adapted to 
meet the individual requirements. 
This may be illustrated by the use of 
the hand. 
If the arm is held in front of the 
body and flexed at the elbow and the 
flexor muscles of the forearm are 
brought into play to lift the hand or 
flex it, the action will require very 
slight effort upon those flexor mus- 
cles, simply enough to raise the 
weight of the hand. The exercise is 
therefore confined to'the flexors, while 
the extensor muscles remain largely 
inactive. If the patient is now in- 
structed to contract the extensor 
muscles at the same time the flexors 
are contracted and to repeat the exer- 
cise already given, it will be apparent 
that the flexor muscles will require 
greater exertion than when the hand 
was raised without impediment. The 
effect of this can be seen by watching 
the flexor tendons at the wrist, which 
are not especially apparent when the 
extensor muscles remain passive, but 
come into marked prominence when 
the resistance of the extensors is 
applied. 
Every group of muscles in the 
body has opposites or opposing mus- 
cles which can be taught to resist the 
action of those muscles, and in so 
doing increase the strength of both 
groups. The well-known method of 
showing the development of the bi- 
ceps muscle is illustrative of this re- 
sistance, for the biceps is made to 
contract and assume its much-sought PREVENTION OF CURVATURES OF THE SPINE. 
9 
contour, either by the resistance 
afforded by the contraction of the tri- 
ceps or by grasping in the hand some 
fixed article that will enable the bi- 
ceps to forcibly contract. 
The advantages to be derived from 
gymnastics depend upon the inter- 
mittent character of the exercises as 
well as the avoidance of fatigue and 
over-exertion. In evidence of this it 
is but necessary to refer to the scriv- 
ener's palsy and the blacksmith's 
atrophy. The great variety of move- 
ments adapted to physical culture and 
training give ample scope for the 
selection of those that will be the best 
adapted and most easily accomplished 
by the patient, and it is a matter of 
interest that over three thousand such 
movements have been devised. 
A very simple prescription, appli- 
cable to a very weak girl, may be 
given as an illustration of what these 
movements mean: 
Lying flat upon back, arms at sides. 
1. Movements:-Both arms raising 
and full stretching upward. Five 
times without resistance. 
2. Repeat with resistance. Once. 
3. Right leg raising straight with- 
out resistance. Five times. 
4. Repeat with resistance. Once. 
5. Both arms stretching upward and 
sideways. Five times. 
6. Repeat with resistance. Once. 
7. Left leg raising straight without 
resistance. Five times. 
8. Repeat with resistance. Once. 
9. Both legs raising straight-touch 
fingers to toes-without resistance. 
10. Repeat with resistance. Once. 
11. Arise to sitting position without 
use of arms. 
12. Recline with resistance. 
13. Both legs raising and open side- 
ways without resistance. 
14. Repeat with resistance. 
15. Both legs raising with knees 
bent-touch knees to chin without 
resistance. 
16. Repeat with resistance. 
A brief explanation may make these 
simple movements clearer: 
In the first movement the arms, 
fully extended, start from the sides of 
the body, are slowly raised and carried 
above the head, and then brought 
down into the position from which 
they started. 
2. Requires no explanation further 
than the movement is necessarily 
very much slower because of the 
resistance. 
3. In order to afford a complete rest 
to the muscles just in action the right 
leg is now brought into play, and the 
intermittent character of applied 
mecano-therapy is demonstrated. 
While these movements and exer- 
cises might appear to be directed to- 
ward improvement of the legs and 
arms they will, upon reflection, be 
found to act most upon the muscles of 
the trunk. The muscles of respira- 
tion are greatly affected by the arm 
movements, especially when they are 
performed with resistance. .In the 
leg exercises the abdominal muscles 
are especially developed, and thereby, 
by their opposites, are affected in- 
directly when the same movements 
are performed with resistance. 
If the entire body is made stronger 
and the faulty positions referred to 
are carefully avoided, the tendency to 
assume them will disappear. The 
rational procedure of making a weak 
girl stronger, instead of increasing 
her enfeebleness, would naturally in- 
dicate that while it was efficacious in 
the prevention of the occurrence of 
the deformity that it was also appli- 10 
H. AUGUSTUS WILSON. 
cable in the correction of similar 
curvatures already existing. 
That such is the case is well attested 
by those whose attention is directed 
to the prevention and correction of 
deformities, but unfortunately its 
limits of full usefulness are narrowed 
to those cases that have not gone so 
far as to have the resulting perma- 
nent bone deformity. 
Many of these confirmed cases can 
be benefited or restrained by the 
judicious resort to mechanical appara- 
tus, the efficiency of which depends 
upon frequent adjustment to meet the 
changes that occur. 
Frequent visits to girls' schools 
where a pretense of calisthenics or 
the advantage of a gymnasium are 
offered, it has been found that an 
hour once or twice a week was all 
that was deemed expedient to devote 
to the subject. The possible benefit 
derived from such inadequate en- 
couragement to become strong was 
vitiated by improper clothing and 
disregard to the faulty positions at 
the desk or table, in sitting and in 
lying. 
If a girl is too weak to hold her 
shoulders erect and in the proper 
position-if she is so feeble as to re- 
quire recumbency or shoulder braces, 
she should be taken to Annapolis or 
West Point and see the transformation 
that so often occurs in the slouchy, 
slovenly carriage of the new cadet. 
His erect, graceful and manly bearing 
is in marked contrast to that before 
his training began. What is accom- 
plished in the cadet can just as effi- 
ciently be gained by the school-girl, 
with the result of preventing rotary 
lateral spinal curvature, as well as a 
host of other malformations and at- 
tendants upon the enfeebling methods 
now too frequently resorted to.