Duval, "should be considered at two different periods of life; the first septennial, which comprises the first and second dentition; and from that age to the time of puberty" Lymphatic temperament predominates in weak and sickly children with a nervous or scrofulous diathesis; whilst first dentition is always difficult and complicated by convulsions. At other times reaction takes place on the digestive canal, on the lymphatic glands, the ligaments, bones, and generally on all the tissues which protect or strengthen the articulations or joints.

In the second period, the weakest have a temperament more lymphatic than sanguine, combined with great susceptibility of the digestive organs and brain.

The progress of growth is then more marked in the osseous system than in other parts, particularly towards the age of fourteen or fifteen.

During the first seven years the lateral deviation is as frequent in boys as in girls, and more commonly met with among the poor inhabitants of large cities than among the rich; these deviations are due to constitutional causes, and to the in fluence of physical agents; but after the seventh year, lateral deviations are more usually found in girls than boys; and these deviations are mostly due to constitutional causes, and to the influence of ill-directed physical education. Several anatomists have observed, that towards the approach of puberty, the growth or develop.

ment of the spinal column causes great increase of height; and as we have observed, that when the organs are subjected to sudden growth they are weakened, so also is the spine more liable to be deviated at this period of life, either through excess of growth, disease, habits, or attitudes.

Deviations of the spine always cause an alteration in the shape of the chest. When these deviations are lateral, it may be observed that, on one side the thorax is narrow and convex, the shoulder elevated, the arm distant from the body, and the breast low.

On the opposite side the anterior part of the chest is flattened; the shoulder forward and low; the arm leans on the ribs; and the breast is high, and sometimes drawn under the arm.

This alteration in the shape of the chest should alone be a powerful motive for giving constant attention to spinal deviations; the lungs must suffer from the alteration in the shape of the thorax; and to this cause may probably be attributed the pectoral irritation sometimes mistaken for a consumptive symptom.

Lateral deviations of the spine may commence in all regions of the rachis, but arise usually in the lumbar and lower dorsal regions; the convexity is mostly directed to the left; the deviation is in the two or three first lumbar vertebræ, and in the upper dorsal, but is not always evident; and sometimes when medical advice is asked there is no deviation to be seen. After a

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deviation has existed some time in the lambar region, a second deviation takes place in an inverse direction in the dorsal region, and a third in the cervical region; and this treble deviation is complicated by torsion, formed by the unequal power of the muscles: it is most common among fashionable young ladies, wanting a sufficient degree of exercise, or who give more motion to one side of the body than to the other.

Torsion may exist without lateral deviation; but they are mostly found together. Many authors have mistaken the two states of the spinal column, torsion, and lateral deviation; yet it is important to know that they may exist separately, and that they require peculiar modification as to curative means.

Hump backs or posterior deviations are less common than lateral deviations: this deformity depends on the alteration of one or more vertebræ, or fibro-cartilaginous ligaments, and when connected with one of the morbid diathesis we have described, admits of much less hope of cure than lateral deviations in healthy subjects, occasioned by bad habits and ill-directed education. Anterior deviations are very rare, and found only in rachitic subjects.

CHAP. XI.

On Orthopedia; or means employed to prevent or cure spinal deviations.

IT has been unjustly said, that nature tended to its own re-establishment and regular conformation. Rousseau's imitators have asserted, that a crooked plant, if left to itself, grew straight, and thought this observation was equally applicable to the human body. Unfortunately, Rousseau's statement will not suffice to establish an opinion daily contradicted by facts and long experience. There is no example of spinal deviations cured by the mere efforts of nature, but there are on the contrary, many cases, which prove that if the assistance of art be not sought before growth has ceased, spinal deviations, when they do not become worse, remain stationary; cure is out of the question. Among the few affections cured by the sole efforts of nature, scrofula, rachitism, constitutional or acquired deformities must never be numbered. In the case of a fractured arm, if the assistance of art be not sought to set the parts, keep them in their right place, and to prevent inflam mation, it will soon be evident whether nature unassisted tends to its re-establishment; and more particularly, whether it tends to regularity of shape. "Very different from numerous

other affections," says Lachaise, “curvatures of the spine, of whatever nature, seldom have a tendency to return to the normal state. New causes on the contrary, are daily added to the primitive ones, and increase the extent of the curvature."

The first man formed by the hands of God was undoubtedly perfect, but as his descendants increased and multiplied, all the deleterious consequences we have noticed, more or less altered the primitive constitution. The existence of deformities may be considered nearly as ancient as the human species.

The writings of Hippocrates, Celsus, Galen, Oribaze, of Paul of Egina, Albucasis d'Avicennes, contain various indications as to the treatment of deformities. Ambroise Paré, Andry, and Ludwig, sought to leave some useful rules on the art of curing deformities of the osseous system; but it was only towards the end of the latter century that Pott, Vicdazyr, Portal, Paletta, and Scarpa, endeavoured to call attention to deformities of the human body. In 1822 the Medical Society of London selected as subject for the Hunterian prize, " To determine the utility of mechanical means in the treatment of deformities of the spine." This gave rise to some excellent works, which brought this scientific subject on a level with the highest surgical questions. Shaw, Bamfield, and Sir Charles Bell, in England; Dupuytren, Delpech, and Pravaz, in France; Wentzel and Sterderich,