208 



The Spinal Column 



towards the right. The chest on that side, therefore, is 'full,' but on 

 the left the ribs are crowded together and the lung space is diminished ; 

 such a diminution may happen after em- 

 pyema, when the lung is permanently 

 collapsed. But, as a rule, the curvature is 

 caused by an uneven transmission of weight 

 down the spine, especially in girls who are 

 outgrowing their strength, and who sit or 

 stand long at lessons or work. The muscles 

 growing tired, the girl arranges her pos- 

 ture so that the ligaments, fasciae, and 

 articular processes, which are incapable of 

 feeling fatigue, may bear the strain. 



Often the curvature is caused by a 

 difference in the length of the legs causing 

 the pelvis to be tilted. 



In addition to this lateral bending 

 there is a strange rotation of the affected 

 vertebrae, the spinous processes being 

 tilted sideways into the concavity of the 

 lateral curve. 



The proper way of dealing with the 

 ordinary case of lateral curvature is to 

 keep the girl as much as possible in the 

 fresh air, and to make her strengthen her 

 flabby muscles by exercises such as her 

 brothers delight in ; by not allowing her 

 to resume the vicious lolling attitudes, 

 and by employing massage and special 



Lateral curvature; spinous processes J . " J * 



rotated into concavities of curves, gymnastics. The worst * treatment ' is to 

 lock her up in a spinal support. 5 When 



the lateral curvature is severe that is when the bones have become 

 misshapen and the girl's growth has ceased the condition is past 

 help. 



Spinal caries ; angular curvature. When the bodies of the ver- 

 tebrae, destroyed by caries (ulceration), begin to fall together, the spinous 

 processes are necessarily thrown backwards ; and if the disease be in 

 the dorsal segment the processes, which in that region are already very 

 prominent, stand out in a very conspicuous manner. But if the caries 

 be in the cervical or lumbar region the falling together of the bodies is 

 not at first accompanied by a corresponding projection of the spinous 

 processes, because the neck-region and the loin-region of the spine 

 are concave backwards. But instead of this the concavity is effaced. 

 Thus, in the cervical and lumbar regions a straightness of the spine is 

 as pathognomonic of vertebral caries as is the angular projection in 

 the case of dorsal caries. In every case the disease is accompanied 



