Scoliosis

“ The causes of one leg being shorter than the other are numerous and varied; they include such conditions as unilateral congenital dislocation of the hip, fractures united with overriding of the fragments, diseases of the joints, e.g., hip disease, or of the bones, especially such as interfere with the function of ossifying junctions; and acquired deformities such as unilateral flat-foot, knock-knee, or bow-leg. Clinically, this type of scoliosis is identified by observing that when the patient sits down the deviation of the spine disappears ”

“ Unilateral paralysis of muscles acting on the trunk may also cause a lateral deviation of the spine, as is well seen in paralysis of the trapezius, which results in a cervical scoliosis with the convexity to the non-paralysed side. ”

“ When a primary curvature is present one or two secondary curvatures usually appear to preserve the equilibrium of the body. With a Dorsal kyphosis there is often a Lumbar lordosis and sometimes less marked lordosis in both Cervical and Lumbar. With a primary right scoliosis in the Lumbar there will be a secondary left scoliosis above. The secondary curvature is called compensatory. In selecting vertebrae for adjustment it is well to neglect the compensatory curvature as much as possible, leaving it to right58 itself as the primary one is corrected. ”

“ Kyphosis, in which it is unduly arched backwards; and Scoliosis or lateral deviations, in which the spine deviates to one side of the middle line.
Lordosis or anterior curvature of the spine with the convexity forwards, is chiefly met with in the lumbar region as an exaggeration of the natural curvature. A minor degree of lordosis sometimes occurs as a peculiarity in the conformation of the individual and may be present in several members of the same family; also in street-hawkers and others who carry weights suspended in front of them; in very obese persons ”

“ The head is inclined slightly forward, the shoulder is depressed, the arm hangs heavily by the side and is slightly rotated forward, the scapula is drawn away from the spine and rotated on its horizontal axis, and there is slight cervical scoliosis with the concavity towards the affected side. The trapezius is markedly wasted, and is, therefore, less prominent in the neck than normally, and the functions of the arm and shoulder are impaired, especially in making overhead movements. In time other muscles compensate in part for the loss of the trapezius. ”

“ These results are borne out by general practice, and it is conclusively proved that the oblique middle position of the Copy Book not only induces the inclination of the head, but draws the body after it, bending and twisting the spinal column, thus producing according to Dr. Schenk that form of spinal curvature which we find described as the most frequent and characteristic school Scoliosis.
It is moreover an error to suppose that everything has been done, if the child is protected hygienically in the School building itself. ”

“ For the present edition, the work has been thoroughly revised, and enlarged with numerous additions, many of them confirmatory of statements previously regarded as doubtful. Two new chapters have been added—one on local massage for local neurasthenia, and the other on the treatment of scoliosis by means of massage. Much new and valuable information from European doctors is introduced on the uses of massage in affections of the ear, in scoliosis, in affections near and into joints, and in affections of the abdominal organs. ”

“ A very high proportion of older children suffering from the graver neuroses, such as chorea, syncopal attacks, phobias, tics, and so forth, show defective physical Page 121 development. Scoliosis, lordosis, knock-knee, flat foot, pigeon chest, albuminuria, cold and cyanosed extremities, are the rule rather than the exception. If the body of the child is developed to the greatest perfection of which it is capable we shall not often find a too sensitive nervous system. The boy of fine physique may have many faults. ”

“ Juvenile is defined as 5 through 10 years of age M41.112 Juvenile idiopathic scoliosis, cervical region M41.113 Juvenile idiopathic scoliosis, cervicothoracic region M41.114 Juvenile idiopathic scoliosis, thoracic region M41.115 Juvenile idiopathic scoliosis, thoracolumbar region M41.116 Juvenile idiopathic scoliosis, lumbar region M41.117 Juvenile idiopathic scoliosis, lumbosacral region M41.119 Juvenile idiopathic scoliosis, site unspecified M41.12 Adolescent scoliosis Note: Adolescent is defined as 11 through 17 years of age M41.122 Adolescent idiopathic scoliosis, cervical region M41. ”

“ Hence if children are set in stocks with their heels touching each other as they sit, and are then made to rise up, till they stand erect, the socket or head of the thigh-bone becomes injured, especially in those children, whose bones are soft; and a shortness of that limb succeeds either by the bending of the neck of the thigh-bone, or by its getting out of the acetabulum; and a consequent rising of one shoulder, and a curvature of the spine is produced from so distant a cause. ”

“ In trying to pick up anything from the floor he keeps his back straight and bends his knees. If the disease is in the neck-region he cannot easily look upwards, and, instead of turning his head to look sideways, he wheels round his whole body. In some cases, though the disease is far advanced, there have been no complaints of pain in the back. As the bodies of the vertebrae crumble away, the spine bends forwards under the influence of the weight of the head and of the upper part of the trunk, and a projection may appear in the middle, line of the back. ”

“ In adolescents and adults the limbs seldom become affected; the bones composing the spinal column are the seat of the disease, and, along with the distortion of the spine, the position of the ribs is necessarily altered. Certain rare cases have occurred, in which all the bones of the adult were softened to a very great degree. In one remarkable instance, the patient complained of an annoying sense of tightness in the limb most affected, and, on examination, the softened bone was found greatly depressed at that point, as if a strong ligature had been drawn tightly round it. ”

“ The head, which is covered with cartilage, except for an oval depression for the attachment of the ligamentum teres, one of the ligaments of the hip-joint, and which articulates with the hollow of the acetabulum in the os innominatum, projects considerably upward, inward, and forward from the shaft, the neck varying much in length and angle. It is generally more [Pg 188] horizontal in women than in men and in rickets the great weight on the softened bone tends to press the head down, causing the deformity known as “coxa vera”, in which the neck is almost horizontal. ”

“ When hyperostosis and sclerosis of the bone is attended with severe pain which does not yield to blistering, the periosteum may be incised and the sclerosed bone perforated with a drill or trephine.
Lesions of Bone in Inherited Syphilis.—Craniotabes, in which the flat bones of the skull undergo absorption in patches, was formerly regarded as syphilitic, but it is now known to result from prolonged malnutrition from any cause. Bossing of the skull resulting in the formation of Parrot's nodes is also being withdrawn from the category of syphilitic affections. ”

“ As you will see by the picture, the spinal nerves, which are given off from the cord in the lower part of the neck and between the shoulder blades, are gathered together into a great loose bundle to form the long nerve-wires needed to supply the shoulders and arms. Those given off from the small of the back just above the hips also run together to form, first a network and then a big single nerve-cord, called the sciatic nerve, which many of you have probably heard of from the frightfully painful disease due to an inflammation of it, called sciatica. ”

“ Add to this, that the child's head naturally sinks on the left shoulder, the muscles of the right side of the neck are elongated, those of the left side contracted, and an incipient distortion is the result. Mothers frequently, though unconsciously, aid this mischief by the habit of suckling exclusively on the left side—a practice which is not only injurious to themselves, but a remote cause of deformity to their little ones. Due caution should be observed also in washing and dressing the infant, and the head be so supported by the hand, as to obviate the danger of dislocation of the vertebræ. ”

“ The neural spine and zygapophyses are as in the lumbar region. Projecting laterally from each sacral vertebra, forming a close, sutural joint with both centrum [57] and neural arch, is a heavy bone shaped like a truncated pyramid (4) ; the base of the pyramid is ankylosed with the ilium. These bones seem to be much thickened transverse processes, but since they are not completely fused with their respective vertebræ and are said to ossify separately they should probably be called sacral ribs. The two sacral vertebræ do not seem to be any more closely united than are any other two vertebræ. ”

“ In general paralysis, as in all other mental diseases dependent upon destructive disease of the brain, there is not only decompounding, but decomposing and disintegrating, of the structure of the brain.
Posterior spinal sclerosis is frequently found. If alone or predominating over sclerosis of the lateral columns of the cord, the knee-jerk is abolished if the morbid process has gone far enough. If descending degeneration of the lateral columns is chiefly found, and is sufficiently advanced, the knee-jerk is increased. ”

“ Bone diseases such as rachitis osteomalacia, etc., and especially Potts’ Disease, or spinal caries, make marked changes in the shape of vertebrae. Also a subluxated vertebra may gradually assume a shape suited to the abnormal position it occupies, the commonest change being the assumption of a wedge shape by the centrum. This is a great obstacle to adjustment, as the abnormal shape of the vertebra makes it tend to settle after each movement into the old abnormal position.
There are few spines without some more or less misshapen vertebrae. ”

“ That such trouble can be corrected by straightening the bones of the spine, seems perfectly reasonable; but like most people with a new idea, the discoverers proceed to carry it to absurd extremes. I have before me an official chiropractic pamphlet which states that vertebral displacement is "the physical and perpetuating cause of ninety-five per cent of all cases of disease; the remaining five per cent being due to subluxations of other skeletal segments." Naturally people who believe this will devote nearly all their study to the bones and the nervous system. ”

“ The age when the malady usually appears is that of second infancy, hence its name of spinal curvature of the adolescent; spinal curvature caused by rickets, which appears in early [Pg 53] childhood, is rarer, and is of less direct interest to us here. The commonest cause, and that on which our attention should be primarily concentrated, is the vicious attitude adopted by the majority of our pupils during their school work; this cause is so universal that we may call spinal curvature the professional disease of the pupil. ”

“ In other words, the symptoms about the head, frontad of the lesion, are the same as those we produce experimentally in animals by section of the cervical sympathetic or of the lower cervical cord. In hemi-lesion of the cord, in man as in animals, these symptoms are unilateral, on the same side as the injury.
Another point to be remembered in the study of transverse lesions of the spinal cord is that the lesion may involve enough of the anterior [p. 77] gray horns to give rise to atrophic paralysis with De R. in some few muscles deriving their motor innervation from the focus of disease. ”

“ X-ray appearances in periosteal tubercle: the surface of the cortical bone in the area of disease is roughened and irregular by erosion, and in the vicinity there may be a deposit of new bone on the surface, particularly if a sinus is present and mixed infection has occurred; in syphilis the shadow of the bone is denser as a result of sclerosis, and there is usually more new bone on the surface—hyperostosis ”

“ The loss of symmetry and diminution of height from deformed spines are minor considerations, compared with the distortions that the chest experiences, thereby impairing respiration and inducing diseases of the heart and lungs. The 61 invasion of the functions of these two important organs lessens the vitality of the whole system, and causes general ill health. Again, the curvature of the spinal column is frequently attended by irritation and disease of the spinal cord.
Why does the right shoulder project more frequently than the left? ”

“ Fracture of the pelvis may occur, perhaps with injury to the viscera. The acetabulum may be fractured or the sacrum broken, with injury to the sacral plexus of nerves, causing paralysis of the lower extremities and of the sphincters, with resultant involuntary passage of urine and feces, and in childbirth the coccyx is often broken. In rickets there may be great deformity of the pelvis, causing trouble in childbirth later in life. Osteomalacia is a disease of adults, in which the bones are soft and the weight pushes the promontory of the sacrum forward and approximates the sides of the pelvis. ”

“ He should let his eye camp day and night on the spinal column; to know if the bones articulate truly in all facets and other bearings, and never rest day or night until he knows the spine is true and in line from atlas to sacrum, with all ribs known to be in perfect union with processes of spine. In reasoning for probable causes of diseases of chest, we are met with the fact that the heart and lungs are housed up, and out of [Pg 70] reach of the hand and eye. We hear a cough, see blood and other substances after they pass out of the lungs ”