GYMNASTICS, MASSAGE, AND CHANGES IN MUSCLE. 503 



little energy, we select a position in which the corresponding muscle is already 

 shortened. 



All the fasciae of the body are connected with muscles, which, when they contract, alter the 

 tension of the former, so that they are in a certain sense aponeuroses or tendons of the latter 

 {K. Bardeleben). [For the importance of muscular movements and those of fascise in connection 

 with the movements of the lymph, see 201.1 



307. GYMNASTICS; MOTOR PATHOLOGICAL VARIATIONS. Gymnastic exercise is 



most important for the proper development of the muscles and motor power, and it ought to 

 be commenced in both sexes at an early age. Systematic muscular activity increases the 

 volume of the muscles, and enables them to do more work. The amount of blood is increased 

 with increase in the muscular development, while at the same time the bones and ligaments 

 become more resistant. As the circulation is more lively in an active muscle, gymnastics favour 

 the circulation, and ought to be practised, especially by persons of sedentary habits, who are 

 apt to suffer from congestion of blood in abdominal organs {e.g., haemorrhoids), as it favours 

 the movement of the tissue juices [ 201]. An active muscle also uses more and produces 

 more C0 2 , so that respiration is also excited. The total increase of the metabolism gives rise 

 to the feeling of well-being and vigour, diminishes abnormal irritability, and dispels the 

 tendency to fatigue. The whole body becomes firmer, and specifically heavier (Jdger). 



By Ling's, or the Swedish system, a systematic attempt is made to strengthen certain weak 

 muscles, or groups of muscles, whose weakness might lead to the production of deformities. 

 These muscles are exercised systematically by opposing to them resistances, which must either 

 be overcome, or against which the patient must strive by muscular action. 



Massage, which consists in kneading, pressing, or rubbing the muscles, favours the blood- 

 stream ; hence, this system may be advantageously used for such muscles as are so weakened by 

 disease that an independent treatment by means of gymnastics cannot be adopted. [The 

 importance of massage as a restorative practice in getting rid of the waste products of muscular 

 activity has been already referred to ( 304).] 



Disturbances of the normal movements may partly affect the passive motor organs (e.g., 

 the bones, joints, ligaments, and aponeuroses), or the active organs (muscles with their 

 tendons, and motor nerves). 



Passive Organs. Fractures, caries and necrosis, and inflammation of the bones, which make 

 movements painful, influence or even make movement impossible. Similarly, dislocations, 

 relaxation of the ligaments, arthritis, or anchylosis interfere with movement. Also curvature of 

 bones, hyperostosis or exostosis; lateral curvature of the vertebral column (Scoliosis), back- 

 ward angular curvature (Kyphosis), or forward curvature (Lordosis). The latter interfere with 

 respiration. In the lower extremities, which have to carry the weight of the body, genu 

 valgum may occur in flabby, tall, rapidly-growing individuals, especially in some trades, e.g., 

 in bakers. The opposite form, genu varum, is generally a result of rickets. Flat foot depends 

 upon a depression of the arch of the foot, which then no longer rests upon its three points of 

 support. Its causes seem to be similiar to those of genu valgum. The ligaments of the small 

 tarsal joints are stretched, and the long axis of the foot is usually directed outwards ; the 

 inner margin of the foot is more turned to the ground, while pain in the foot and malleoli 

 make walking and standing impossible. Club-foot (Talipes varus), in which the inner margin 

 of the foot is raised, and the point of the toes is directed inwards and downwards, depends 

 upon imperfect development during fcetal life. All children are born with a certain very 

 slight degree of bending of the foot in this direction. Talipes equinus, in which the toes, 

 and T. calcaneus, in which the heel touches the ground, usually depend upon contracture of 

 the muscles causing these positions of the foot, or upon paralysis of the antagonistic muscles. 



Rickets and Osteomalacia. If the earthy salts be withheld from the food, the bones 

 gradually undergo a change ; they become thin, translucent, and may even bend under 

 pressure. In certain persistent defects of nutrition, the lime and other salts of the food are not 

 absorbed, giving rise to rachitis, or rickets, in children. If fully formed bones lose their lime- 

 salts to the extent of \ to \ (halisterisis), they become brittle and soft (osteomalacia). This 

 occurs to a limited extent in old age. 



Muscles. The normal nutrition of muscle is intimately dependent on a proper supply of 

 sodium chloride and potash salts in the food, as these form integral parts of the muscular tissue 

 (Keimnerich, Forester). Besides the atrophic changes which occur in the muscles when these 

 substances are withheld, there are disturbances of the central nervous system and digestive appa- 

 ratus, and the animals ultimately die. The condition of the muscles during inanition is given 

 in 237. If muscles and bones be kept inactive, they tend to atrophy ( 244). In atrophic 

 muscles, and in cases of anchylosis, there is an enormous increase, or "atrophic proliferation," 

 of the muscle-corpuscles, which takes place at the expense of the contractile contents 

 (Cohnhcim). A certain degree of muscular atrophy takes place in old age. The uterus, after 

 delivery, undergoes a great decrease in size and weight from 1000 to 350 grammes due 

 chiefly to the diminished blood supply to the organ. In chronic lead poisoning, the extensors 



