Young ladies should also be directed, where two sleep in a bed, to change every night, or every week, their sides of the bed; which will prevent their tendency to sleep always on the same side; which is not only liable to produce crookedness, but also to occasion diseases by the internal parts being so long kept in uniform contact as to grow together. For the same reason they should not be allowed to sit always on the same side of the fire or window, because they will then be inclined too frequently to bend themselves to one side.

Another great cause of injury to the shape of young ladies is from the pressure of stays, or other tight bandages, which at the same time cause other diseases by changing the form or situation of the internal parts. If a hard part of the stays, even a knot of the thread, with which they are sewed together, is pressed hard upon one side more than the other, the child bends from the side most painful, and thus occasions a curvature of the spine. To counteract this effect, such stays as have fewest hard parts, and especially such as can be daily or weekly turned, are preferable to others.

Where frequent lying down on a sofa in the day-time, and swinging frequently for a short time by the hands or head, with loose dress, do not relieve a beginning distortion of the back, recourse may be had to a chair with stuffed moveable arms for the purpose of suspending the weight of the body by cushions under the arm-pits, like resting on crutches, or like the leading-strings of infants. From the top of the back of the same chair a curved steel bar may also project to suspend the body occasionally, or in part by the head, like the swing above mentioned. The use of this chair is more efficacious in straightening the spine, than simply lying down horizontally; as it not only takes off the pressure of the head and shoulders from the spine, but at the same time the inferior parts of the body contribute to draw the spine straight by their weight; or lastly, recourse may be had to a spinal machine first described in the Memoirs of the Academy of Surgery in Paris, vol. iii. p. 600, by M. Le Vacher, and since made by Mr. Jones, at No. 6, North-street, Tottenham-court Road, London, which sus

pends

pends the head, and places the weight of it on the hips. This machine is capable of improvement by joints in the bar at the back of it, to permit the body to bend forwards without diminishing the extension of the spine.

The objections to this machine of M. Vacher, which is made by Mr. Jones, are, first, that it is worn in the daytime, and has a very unsightly appearance. Mr. Jones has endeavoured to remedy this, by taking away the curved bar over the head, and substituting in its place a forked bar, rising up behind each ear, with webs fastened to it, which pass under the chin and occiput. But this is not an improvement, but a deterioration of M. Vacher's machine, as it prevents the head from turning with facility to either side. Another objection is, that its being worn when the mus cles of the back are in action, it is rather calculated to prevent the curvature of the spine from becoming greater, than to extend the spine, and diminish its curvature.

For this latter purpose I have made a steel bow, which receives the head longitudinally from the forehead to the occiput; having a fork furnished with a web to sustain the chin, and another to sustain the occiput. The summit of the bow is fixed by a swivel to the board going behind the head of the bed above the pillow. The bed is to be inclined from the head to the feet about twelve or sixteen inches. Hence the patient would be constantly sliding down during sleep, unless supported by this bow, with webbed forks, covered also with fur, placed beneath the chin, and beneath the occiput. There are also proper webs lined with fur for the hands to take hold of occasionally, and also to go under the arms. By these means I should hope 'great advantage from gradually extending the spine during the inactivity of the muscles of the back; and that it may be done without disturbing the sleep of the patient; and if this should happen, the bow is made to open by a joint at the summit of it, so as to be instantly disengaged from the neck by the hand of the wearer. This bow I have not yet had opportunity to make use of, but it may be had from Mr. Harrison, whitesmith, Bridgegate, Derby.

It will be from hence casily perceived, that all other methods of confining or directing the growth of young people should be used with great skill; such as back-boards, or bandages, or stocks for the feet; and that their application should not be continued too long at a time, lest worse consequences should ensue than the deformity they were designed to remove. To this may be added, that the stiff erect attitude taught by some modern dancing-masters does not contribute to the grace of the person, but rather militates against it; as is well seen in one of the prints in Hogarth's Analysis of Beauty; and is exemplified by the easy grace of some of the ancient statues, as of the Venus de Medici, and the Autinous, and in the works of some modern artists, as in a beautiful print of Hebe feeding an eagle, painted by Hamilton, and engraved by Eginton, and many of the figures of Angelica Kauffman.

Where the bone of one of the vertebræ of the back has been swelled on both sides of it, so as to become protuberant, issues near the swelled part have been found of great service. This has induced me to propose in curvatures of the spine, to put an issue on the outside of the curve, where it could be certainly ascertained, as the bones on the convex side of the curve must be enlarged; in one case I thought this of service, and recommend the further trial of it.

In the tendency to curvature of the spine, whatever strengthens the general constitution is of service; as the use of the cold bath in the summer months. This, however, requires some restriction both in respect to the degree of coldness of the bath, the time of continuing in it, and the season of the year. Common springs, which are of forty-eight degrees of heat, are too cold for tender constitutions, whether of children or adults, and frequently do them great and irreparable injury. The coldness of river water in the summer months, which is about sixty-eight degrees, or that of Matlock, which is about sixty-eight, or of Buxton, which is eighty-two, are much to be preferred. The time of con. tinuing in the bath should be but a minute or two, or not so long as to occasion a trembling of the limbs from cold.

In respect to the season of the year, delicate children should certainly only bathe in the summer months; as the going frequently into the cold air in winter will answer all the purposes of the cold bath.

Claudicatio coxaria. Lameness of the hip. A nodding of the thigh bone is said to be produced in feeble children by the softness of the neck or upper part of that bone beneath the cartilage; which is naturally bent, and in this disease bends more downwards, or nods, by the pressure of the body, and thus renders one leg apparently shorter than the other. In other cases the end of the bone is protruded out of its socket, by inflammation or enlargement of the carti lages or ligaments of the joint, so that it rests on some part of the edge of the acetabulum, which in time becomes filled. up. When the legs are straight, as in standing erect, there is no verticillary motion in the knee-joint; all the motion. then in turning out the toes further than Nature designed, must be obtained by straining in some degree this head of the thigh-bone, or the acetabulum, or cavity, in which it moves. This has induced me to believe, that this misfortune of the nodding of the head by the bone, or partial dislocation of it, by which one leg becomes shorter than the other, is sometimes occasioned by making very young children stand in what are called stocks; that is, with their heels together, and their toes quite out. Whence the socket of the thigh bone becomes inflamed and painful, or the neck of the bone is bent downward and outwards.

In this case there is no expectation of recovering the straightness of the end of the bone: but these patients are liable to another misfortune, that is, to acquire afterwards a distortion of the spine; for as one leg is shorter than the other, they sink on that side, and in consequence bend the upper part of their bodies, as their shoulders, the contrary way, to balance themselves; and then again the neck is bent back again towards the lame side, to preserve the head perpendicular; and thus the figure becomes quite distorted like the letter S, owing originally to the deficiency of the length of one limb. The only way to prevent this curvature of the spine is for the child to wear a high-heeled C 3

shoe

shoe or patten on the lame foot, so as to support that side. on the same level with the other, and thus to prevent a greater deformity.

I have this day seen a young lady about twelve, who does not limp or waddle in walking; but nevertheless, when she stands or sits, she sinks down towards her right side, and turns out that toe more than the other. Hence, both as she sits and stands, she bends her body to the right; whence her head would hang a little over her right shoulder: but to replace this perpendicularly, she lifts up her left shoulder and contracts the muscles on that side of the neck; which are therefore become thicker and stronger by their continued action; but there is not yet any very perceptible distortion of the spine.

As her right toe is turned outward rather more than natural, this shows the disease to be in the hip-joint; because, when the limb is stretched out, the toe cannot turn horizontally in the least without moving the end of the thigh bone; although when the knee is bent, the toe can be turned through one third or half of a circle by the rotation of the tibia and fibula of the leg round each other. 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.

M. M. An elastic cushion made of curled hair should be placed under the affected hip, whenever she sits; or should be fitted to the part by means of drawers, so that she cannot avoid sitting on it. A neck-swing, and lying down in the day, should be occasionally used to prevent or remove any curvature of the spine.

Spina protuberans. Protuberant spine. One of the bones of the spine swells, and rises above the rest. This is not an uncommon disease, and belongs to the innutrition of the

bones,