588 GYMNASTIC EXERCISES AND THERAPEUTIC GYMNASTICS. 



Kneading, pressing, and stroking the muscles (massage) also promote the 

 circulation of blood through them. These procedures may, therefore, be applied 

 with advantage to muscles that are so enfeebled by disease that independent, 

 systematic training by exercises or gymnastics can no longer be successfully pur- 

 sued. 



Derangement of normal movements may occur in the apparatus concerned in 

 passive movements, namely the bones, joints, ligaments, and aponeuroses, or in 

 apparatus concerned in active movements, namely the muscles with their ten- 

 dons and motor nerves. 



Fractures, caries, and necrosis, and also inflammatory processes, which render 

 movements of the bones painful, impair such movements or even render them wholly 

 impossible. A similar result is caused by dislocations or inflammations of the 

 joints, relaxation of the articular ligaments, or firm adhesions between the articular 

 surfaces (ankylosis) or between the ligaments and soft parts surrounding the 

 joint. Deviations from the normal function may further be caused by abnormal 

 curvatures of the bones, enlargements (hyperostosis) , or outgrowths (exostosis). 

 Among the abnormal positions of the skeletal parts that occur frequently are to 

 be included curvature of the spinal column laterally (scoliosis) , backward (kypho- 

 sis) , or forward (lordosis) . These also give rise to disturbances of the respiratory 

 movements. In the lower extremities, which have to bear the weight of the body, 

 genu valgum (knock-knee) develops, especially in flabby, tall, young persons 

 engaged in trades requiring much standing. The opposite curvature of the legs, 

 genu varum (bowlegs), is usually the result of rachitic disease. Flat-foot (pes 

 valgus) is due to depression of the arch of the foot, which then no longer rests 

 upon its three normal points of support. This condition is often due to the same 

 causes as genu valgum. The ligaments of the small tarsal joints are stretched, 

 and the longitudinal axis of the foot is usually directed outward in marked degree. 

 The inner border of the foot is brought closer to the ground. Pains in the foot 

 and the malleoli render walking and standing difficult. Club-foot (pes varus) 

 is the condition in which the inner border of the foot is raised, and the point of 

 the foot is turned upward and inward; it is caused by a fetal arrest of develop- 

 ment. All children are born with a slight degree of this position. Pointed toe 

 (pes equinus) is the condition in which the point of the foot touches the ground; 

 pes calcaneus, that in which the heel touches the ground. Both are usually de- 

 pendent upon contracture of the muscles causing these positions, or upon paralysis 

 of their antagonists. 



Persistent absence of earthy salts from the food results in a deficiency of 

 these in the skeleton; the bones become thin, transparent, and even flexible. 

 Rickets in children and the identical lameness in young domestic animals are 

 caused by the fact that the calcium-salts of the food cannot be absorbed, on 

 account of persistent disturbances of digestion. Analogous disturbances of the 

 motor functions develop if the fully developed bones subsequently lose their 

 calcium-salts to the extent of one-third or one-half (halisteresis) , and thus become 

 brittle and soft osteomalacia. A certain minor degree of fragility of the bones 

 and halisteresis occurs in old age. 



With regard to pathological alterations in the muscles, it should first be 

 pointed out that the normal nutrition of muscular tissue can only take place 

 if a sufficient supply of sodium chlorid and of potassium-salts is provided in the 

 food, as these are integral constituents of muscular tissue. Otherwise, the muscles 

 atrophy, and their reconstruction is prevented. Under such conditions, further, 

 the central nervous system and the digestive apparatus also suffer, and the animals 

 perish. The extent to which the muscles suffer in a state of inanition is described 

 on page 440. Muscles and bones that for any reason are thrown out of function 

 also undergo atrophy. In the atrophic muscles associated with ankylosis there 

 is often found an enormous proliferation of the muscle-corpuscles, occurring as an 

 "atrophic proliferation" at the expense of the contractile substance. A certain 

 degree of muscular atrophy takes place normally in old age. 



The great reduction (from 1000 to 350 grams) in the muscular structure of 

 the uterus after parturition is especially noteworthy. This is due in part to 

 the diminished vascularization of the organ. In cases of lead-poisoning the 

 extensors and interossei especially undergo atrophy. Atrophy and degeneration 

 of the muscles give rise to secondary shortening and thinning of the bones to 

 which they are attached. 



Section and paralysis of the motor nerves cause inactivity and finally de- 

 generation of the muscles. Inflammation, softening, and sclerosis of the ganglion- 



