Robert L. Dickinson

“ My observation contradicts the claim that low abdominal girdling and "lifting" have taken the place of waist-line pressure. Tests show that in two-thirds of the cases there was greater pressure at the waist than lower on the abdomen, one-third being equal. In thin women neutral conditions were general. Pressures on the lower ribs still ran high. In one-half the cases all pressures ran high. The spring or gap of the corset when unhooked gives an excellent practical measure of the amount of pressure exerted, two and a half inches being the most that should be tolerated. ”

“ Tight lacing may act on the liver in three ways—according to the situation, the tightness, and the duration of the constricting cause.
"a. The liver may be displaced upward or downward according as the pressure is applied below or above. The precise situation where the pressure is applied will vary with the prevailing fashion of dress; but most commonly in this country the displacement is downward, and this may be to such an extent that the lower margin reaches the ilium, and the liver appears to fill up the whole of the right side and front of the abdomen." ”

“ Indeed, Braun asserts that "it is open to proof that the form of the liver is not an independent one, but varies with the pressure and volume of neighboring organs; so that in a normal condition it must possess a softness of structure which can be compared with fat and connective tissue, and which yields to the movements and change of position of the organs in contact with it." ”

“ It is only in an occasional flabby abdomen that pressure has been low with a wide gaping opening, but in such instances the mobile abdominal contents have been subjected to a considerable range of displacement upward or downward, so that the rule is not vitiated that reads "the wider the gap the greater the tension." ”

“ SUMMARY OF ORDINARY OFFICE TESTS, AND DIRECTIONS TO PATIENTS. Posture.—The patient stands on a mark on the floor, sideways to a paper on the wall, and shoulder-blade and buttock are in­dicated on the paper. The difference in these two points, with the corset and without, shows in a moment whether the corset affects the posture favorably or unfavorably and correction is required. Pressure.—The hand passed within the corset, together with a note of the distance between the steels as they spring open, give the location of pressure—whether down-thrusting or lifting—and its degree. ”

“ The thoracic organs may readily accommodate themselves to a pressure that simply squeezes out some residual air, the abdominal viscera must be displaced. Accommodation can only be favored by expulsion of blood from the cavity and reabsorption of the gases distending the intestine. Let us first consider the cavity of the chest. ”

“ The practical application of this study is that, with a certain flexibility in our ideas, without straight-lacing facts to fit a theory, without attempting to girdle within one general rule all the variety of conditions, and with the expectation of failures at first, the practitioner may secure a number of excellent results, particularly in cases of displacement and defective posture. ”

“ Relaxation and habit seem to affect these factors largely. The capacity for expansion of the chest was found to be restricted one fifth when the corset was on. The thoracic character of the breathing in women is largely due to corset-wearing. The thoracic cavity is less affected by the corset than the abdominal. The abdominal wall is thinned and weakened by the pressure of stays. The liver suffers more direct pressure and is more frequently displaced than any other organ. The pelvic floor is bulbed downward by tight lacing one third of an inch (0.9 cm.) ”

“ In other words, in normal individuals the pressure from above meets opposition and accommodation and a balance is established. The corset can harm strong women little, weak women much.
Whether intra-pelvic pressure can be lowered by any so-called lifting action applied to the lower abdomen seems to me doubtful, and no such condition has been found in these tests. A better corset substituted for a vicious one, with bettered posture, lessens intra-pelvic pressure. ”

“ In a man of five feet one inch the vital capacity averages 175 cubic inches, and it varies eight cubic inches for each inch in height. I have not been able to find the average height of woman, or any statements relating to her vital capacity as compared with man's. From occasional measurements in gymnasiums, however I know that it is less than man's in proportion to her height.
Effects of the Pressure on the Abdomen,—The abdominal cavity has far greater pressure and much more marked alteration in shape to stiffer than the thoracic. ”

“ In noting pressures, in office work, manometer readings are needed only for research or to convince the skeptical—though to one's manometer hung on a wall the attachment of an extra under-corset-testing-bag by a T connection is a small matter. In practice, the test of the hand run down inside the corset suffices. The ribs first. Have they decently easy play? Is the epigastrium practically without pressure? Is the pressure in the umbilical region moderate—somewhat more than a man's summer belt? Is the suprapubic pressure more than the umbil­ical? It must be greater. ”

“ That the compression acts on muscle as well as fat is clear when we call to mind the contrast between the hard abdominal parietes of the average man and the lax belly of most women. How could the gynæcologist make his bimanual were it otherwise? Engel reports cases in which the peristaltic movements could be watched through walls thinned from tight lacing. Of course disuse and the less need of constantly balancing the body has much to do with the atrophy of the abdominal muscles of the female. ”

“ A second patient comes in. She is round shouldered; her viscera sags and she has constant backache. She brings, to be tested before wearing, the new corset we prescribed. Her posture without the corset is noted by the method given above. She puts on the corset according to the instructions of the corsetiére or the office nurse, fastens the garters and drapes the sheet, and stands against the wall again. At once it is evident that the shoulders have gone backward, the hips forward, the whole center of gravity backward. ”

“ Tracings from their costal and abdominal respiratory movements showed a very close analogy to those of the civilized male, and that, "so far as the Indian is concerned the abdominal is the original type of respiration in both male and female, and that the costal type in the civilized female is developed through the constricting influence of dress around the abdomen. ”

“ Comparison of the girth over the corset with that measured around the undershirt is worthless as an index of constriction. Interior tests showed little effect on increase in vaginal pressures in corseted women whose abdominal walls and pelvic floor were firm, but they indicate a marked rise in intrapelvic pressure from exertion in corseted women whose muscles are flabby and interior supports relaxed. The tight corset harms vigorous women little, weaker women greatly. ”

“ So that we find that (1) where the solid organs are, the greatest pressure comes; (2) where the hollow viscera lie, little pressure comes; (3) on organs that are comparatively fixed in their places, much stress is brought to bear; and (4) on organs freely movable, like the intestines, less direct displacing force is exerted.
Effect of Pressure on the Abdominal Wall.—Long-continued compression of the wall of the abdomen in the epigastric and hypochondriac regions gradually brings about a thinning of its adipose layer.* Below the ring of constriction the fat accumulates. ”

“ Curiously, too, when abdominal walls are firm, either by reason of strong muscle or dense adipose, the intra­pelvic pressures seem increased nearly equally as between a fairly loose and very tight corset. ”

“ If we were forced," he says, "to the admission that the activity of infra-clavicular respiration-movement in the female is in the main designed by nature"—
for which no cause can be detected—" and independent of extraneous influence, still I can not help thinking that the great excess of that movement and the limitation of thoracic play to the upper thorax in the civilized adult female are due in no small part to the unyielding cases interfering with inferior costal and phrenic action. The agricultural woman, who knows not stays, breathes more like a man than the town female. ”

“ Pressure should be greatest around the hips, carefully and snugly adjusted, diminishing above this zone, being less at the waist line than below the waist. The lower ribs must have play. With regard to posture or carriage the shoulders must not be thrown forward and hips backward, the comparison being made first in undershirt and then after corset is put on. Large or
relaxed breasts are to be supported independently, from the shoulders. Front or back lacing has to be chosen for the par­ticular case. ”

“ The form of the chest and the respiratory movements do not differ perceptibly in girls and boys below the age of ten. Although the form of the chest remains nearly the same until the age of twelve, the abdominal movement is then somewhat less and the thoracic somewhat greater in girls than boys. At this age and earlier stays are Worn and though they do not compress the body materially, yet they restrain the free expansion of the lower ribs during free exercise. After the age of fourteen the form of the chest and the respiratory movements differ materially in females and males. ”

“ Where a new corset of special fit and shape is needed, most com­monly such can be found in a large ready-made stock, the altera­tions made when buying—say for from $3 to $6—from a cor­setiére who has been taught to understand medical needs. Corsets made to order expertly by those trained to our ideas are to be had for $12, while corsets of the most durable material, least likely to alter in shape, run up to $25 from expert hands. Often with the well-to-do one may elect to begin with a cheaper fitted corset, in order to bring about the desired result by degrees. ”

“ The corset reverses this. The constriction binds closest the broadest part; the viscera are displaced downward; the lower umbilical region swells out; the greatest area must grow small, and the smallest enlarge.
The point of greatest pressure, we have seen, was over the cartilages. On both sides the liver will be pressed upon, and this at a point where it is covered by lung only during deep inspiration (Fig. 12) . The lateral pressure will crowd liver and spleen toward the median line. ”

“ One occasionally finds a "weak back" that sways and that cannot be steadied until a course of muscular exercise has been taken (Fig. 41.) · It would appear that while the normal posture may call for a line from the back of the buttocks to the back of the shoulders with the shoulders not more than an inch in front of the perpen­dicular, yet a few women are found whose scapular line is three inches anterior to the curve of the nates and who show neither ache, nor rigidity of back muscles nor of gastrocnemius. ”

“ All these are women who work, and, consequently, should have a more vigorous muscular system and better expansion than wealthier corset wearers, although Dr. Hall states that these servants lace tighter and are less healthy in appearance than the young ladies of the institution in which the observations were made. Among women who lead less active lives, while wearing closer-fitting street- and evening- dresses, it might be expected that the interference with expansion would be greater and of more serious import. ”

“ When taken off, laces must be loosened. When front lacing permits, women with large or relaxed abdomens should put on the corset while lying on the back, raising the body on the heels to send the organs upward. ”

“ Flabby, old, or obese persons are especially prone to pile up panniculus adiposus below the navel. I have examined many stout young men in good condition, and have yet to find one in whom this tendency is evident. On the contrary, the fatty layer above the umbilicus is usually thicker than that below it. These men wear suspenders. In eleven healthy women below thirty who have been in the habit of wearing corsets (of varying degrees of tightness) the fat below the navel has always been found to be more than twice as thick as that above, while one to three is no uncommon ratio. ”

“ Their aim should not be wholly to make a corset that reduces the size of the waist. They should study to provide corsets adapted to different types of individuals that do not unduly compress and restrain, that neither fatigue nor grievously deform. ”

“ It will be seen that without the corset the breasts project beyond the abdomen, just as in a finely developed man the pectorals first touch a perpendicular; whereas, when the corset has raised the "bust" and crowded the abdomen down and out, the supra-pubic wall becomes the most prominent and projecting part of the profile. ”

“ Is there present a type of body, of abdominal support, of c displacement, to be much affected by pressure or In the ordinary routine observation of the corset of a patient suffering from pelvic or abdominal disorder, the time required is five minutes, and the outlay a few cents. Two clips to hold a
FIG. 31.—Pressure measurements. An aneroid (sphygmomanometer) hanging on the wall, is connected by tubing with a bag that is slipped under the corset. sheet of wrapping paper against a wall, and a mark on the floor, suffice. Manila paper in rolls runs 2 feet wide. ”