The rational treatment of scoliosis (in the following pages only non-tubercular conditions are considered) requires the assistance of many methods. First among these is gymnastics. Other therapeutic factors, such as massage, forced straightening with or without subsequent treatment by plaster-jacket, various forms of jacket, a sole under one foot, cushion to sit upon, etc., however necessary they may sometimes be, are only indicated in certain cases. Gymnastic treatment, on the contrary, is never useless, unless there is some insuperable difficulty in the way, e.g., infancy, and in nearly every case it is necessary; also many cases require no other treatment. I will explain somewhat in detail how this gymnastic part of the treatment of scoliosis is carried out in a medico-mechanical institute, but would point out once more that in many cases it must be supplemented by other methods.

First a few words concerning the indications which gymnastic treatment of this disease must fulfil.

Scoliosis is a disease which causes asymmetric changes in bones, ligaments, and joints as well as in muscles. In which of these the scoliotic processes begin is a question which is answered in various ways in different schools, and is still far from decided; but as the disease develops all these parts are affected. In bone arise the well-known deformities such as wedge-shaped vertebrae and bulging of the ribs; the ligaments contract or are compressed on one (the concave) side of the curve, and are stretched on the other (convex) side; the muscles similarly are shortened or stretched, and also lose their tone and elasticity.

To counteract these changes gymnastic treatment aims : -

(1) At mobilising the scoliosis by stretching contracted ligaments and muscles;

(2) At producing a strengthening and tonic shortening of the lengthened muscles by giving a predominating amount of exercise to them, and in this way causing the patient himself to correct the already mobilised curve by means of his own strength.

On the bone itself gymnastics has no direct influence. But these are not dead, but living parts, and their form may be influenced to some extent, especially during the period of growth. Just as a vertebra from being symmetric has been able to grow wedge-shaped, so it may, to speak boldly, also grow symmetric again. But for this a long time is necessary, and strong work; "nothing can make a crooked thing straight, but it may be compelled to grow straight" (G. Zander). In order to fulfil this special indication plaster bandage or treatment by a jacket is certainly the most effective, but gymnastic treatment also is important in this respect, owing to its powers of improving the habitual position of the patient, and consequently equalising the asymmetric pressure to which the bones are subjected.

According to what has been said above, gymnastic treatment is advantageous in all forms of scoliosis which are not fully fixed, from the simplest early forms to the most severe cases. The improvement which can be obtained varies extremely in different cases, depending on the one hand partly upon the degree which the deformity has reached, partly upon the greater or lesser extent to which the special case lends itself to treatment (an extremely interesting and important matter, which has hitherto been too little considered), and on the other hand upon the insight, perseverance, and energy with which the treatment is carried out. In a great many cases considerable improvement of the deformity can be produced, sometimes practically almost complete correction; in other cases one must content oneself with less improvement, or even only with the maintenance of the status quo, a condition by no means to be despised where it is a question of a disease which in so many cases has a marked tendency to get worse.

The possibility of benefiting a scoliosis patient by gymnastics is not, however, limited to this. There are cases which do not come for treatment until it is too late for gymnastics to have any effect on the deformity, i.e., when the deformity is absolutely fixed. Persons affected with such severe scoliosis usually cannot do much in everyday life, as. they easily tire with even the gentlest physical exertion. By means of cont nual and consistent gymnastics, however, these patients obtain considerably increased power of work.

For example, it is found that such patients, after having continued gymnastics for several years, have often attained, certainly not any decrease of their deformity, but sufficient strength for the strenuous work of a medical gymnast or nurse - a better result from the patient's point of view than lessening of the deformity produced by redressement force combined with a very low power of work.

In passing on to a description of the means which the medico-mechanical scoliosis treatment has at its command we must begin with apparatus designed for measuring the trunk. The treatment is combined so closely with that part of the examination of the patient carried out by means of this apparatus that a short description of it and its uses must precede the description of the treatment.

The apparatus (Fig. 158) has a foot-piece, a, upon which the patient stands; by means of a pair of sliding bars, which can be placed at different heights, the patient's pelvis is fixed in the middle of the apparatus. Above his head is a headpiece, b, which, without moving the head from its natural position, is placed so that it exactly touches the crown of the head and embraces* the temples, by means of which it partly measures in millimetres the length of the body and the deviation of the head from the middle line, partly fixes the head for measurement in its own position. At the sides of the apparatus there are two parallel vertical poles for measurement of the height c, graduated in millimetres and giving the distance above the footboard. These are combined with one another by means of horizontal cross-pieces one above and one below under the foot-board, and may be turned around the patient and placed in different vertical planes; in so doing the angle of relation of the frontal plane to that marked upon the footboard is marked as 0°, that of the sagittal plane as 90°. From the movable sockets in the height scale, cross-pieces run in a horizontal direction t, forming short measuring-rods, also graduated in millimetres, by means of which the distance of the inner end from the middle of the apparatus may be read. At this end there are fastened, while measuring different pieces for different purposes, cross-rods, points, and the so-called double measurer, which is used to measure the line of the spinal column, and by means of which the distance of a point from the middle line both in the frontal and sagittal directions can be measured.

Fig. 158.