in the natural condition of the chest, lies below it. This is one of the causes of the lower angle of the scapula being occasionally so elevated, and, at the same time, so loosely bound down to the chest, as to permit the hand to be passed between the scapula and ribs. The deformity thus produced is very great, and is often increased from the other muscles, which are connected with the shoulder, being so much deranged by the change in their relative positions, that they become almost incapable of acting, and thus appear paralytic.

When a child, predisposed by rachitic diathesis feels pain in any part of the spine, it is to be feared, that this part of the spine is the forerunner of an angular deviation. This pain sometimes extends the whole length of the spine, and may last several months before the deviation is apparent; this deformity, which is nearly always rachitic, is accompanied by other symptoms, which serve to make the case known. If the child be very young, it strives to lie on its nurse's knees; if it tries to walk, the feet cross each other, and the falls are constant; the head is too heavy for the muscles, draws the trunk forward, and the child endeavours to support it in every attitude.

The general and particular symptoms we have traced, seem to be adapted for all mothers; they would indeed be culpable, if they carelessly allowed the increase of any deviation from the

normal state; and deviations ever become worse, if due care be not taken to arrest their progress; they cause disorder in the internal functions, the lungs, the heart, the stomach; while regularity of these organs are necessary to the preservation of life.

Much has been said of curvatures, which are called temporary, and we have seen many in our own practice. An interesting girl, of eighteen, was perfectly straight, a fortnight after having advice, but again suddenly became crooked; the rectitude had returned without any known cause, and again disappeared. M. Bouvier very justly observed, that a number of attitudes lead to deviations, which are never temporary but with the weak and lymphatic, whose bones give way to different attitudes; and we have observed that even when the vertebral column appeared right, the pains in the heart, or near the liver, still existed. All that can strengthen and improve the constitution has, in similar cases, the happiest results.

CHAP. X.

Of the various Deviations of the Spine.

WE have already shewn that deviations of the spine are due to the state of the constitution, or to habitual attitudes. We do not now intend to speak of caries of the vertebræ, nor of fractures, nor sprains; these subjects are rather in the province of surgery, and we shall treat of them in a work specially dedicated to scientific men; but at present we confine our attention to the deviations of the spinal column, which commence as slight curvatures, and through neglect become deformities. The most common deviations are lateral, that is, to the right or left: but as the spinal column is composed of twenty-four moveable pieces, deviations are seldom simple, but mostly composed; in the majority of cases, deviations of the spinal column are triple.

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There are," says Bichat, "lateral curvatures as bad as anterior curvatures, and they offer a remarkable phenomenon; viz., that while there exists one in a given direction to one region, the other regions have inverse curvatures. Suppose, for instance, that the cervical portion of the spine be forced to the right, in order to maintain the centre of gravity, the dorsal region bends to the left, and the lumbar region to the right; so

that the trunk soon feels the vicious attitude of an isolated part of the spine.

If spinal deviations are not carefully attended they become worse; the ribs are soon greatly altered. Those responding to the concavity of the lateral curve are lowered, and turned inwardly; they seem to be situated one on the other like a fan half shut; when close together they adhere one to the other; and seem, that if free, they would pass through the lungs. Thus on the side of the cavity of a great lateral deviation, there is necessarily narrowness of the chest, compression of the lungs and heart, and disorder in the respiration and circulation; so that it may justly be said, that spinal deviations when allowed to reach a high degree, change and distort the animal frame; form, as it were, a new economy, with organs and functions so modified, so altered, that there results a special life for those who have undergone so serious a revolution. It is no longer the thorax, nor lungs, nor heart, nor liver, nor vertebral canal, nor marrow, nor stomach, nor intestines, in the connexion determined by nature; it is another respiration, another circulation; it is a general revolution; so that if we did not daily witness this most remarkable transformation, and if, while this transformation was accomplished, the economy had not time gradually to adapt itself to the new conditions of

existence which are imposed, we could never understand the possibility of life with such deep alterations. Let it not be supposed that life on these conditions is free from disorder, for palpitations of the heart, oppression, coughing, imperfect digestion, thinness, stoppage of growth, paralysis of certain limbs, general weakness, and distaste for the usual occupations of life, are the inevitable results of this melancholy state.

What is applicable to lateral concavity, is equally so to anterior concavity; the muscles of the abdomen and diaphragm undergo remarkable changes; the respiration is affected; there is a commencement of asthma; and pulmonary or cerebral congestion is to be feared. Delpech very justly thought that compression of the lungs might bring on consumption when predisposition existed. The convex part of these great deviations when lateral, shew the ribs separated from each other, and evidently want the strength necessary to counterbalance the effects of the gravity and false attitudes which incline the body in a different direction; and we must here recognize the propriety of Bichat's observation when he said, that in the different deviations of the spine the muscles followed the inclination of the bones, being lengthened on the side of the convexity, and shortened and swelled on the side of the concavity: the observations on the muscles are equally applicable to the ligaments.

"The lateral deviation of the spine," says