A Praeternatural curvature of the bones generally produces ſome diſorders in the oeconomy of the human body; but, that of the ſpine in par⯑ticular, gives riſe to the moſt alarming ſymptoms, which may lead on to the death of the patient: this will not appear ſur⯑priſing, if we conſider the importance of thoſe functions, which may be obſtructed or injured in this diſeaſe; for from the union of all the vertebrae together, a bony pyra⯑mid preſents itſelf, forming a canal lined by the membranes proceeding from the brain, which contains the ſpinal marrow, and ſerves to defend it from external injuries. The column of the ſpine makes alſo a part of the cavity of the breaſt, bears up the ribs, ſupports internally ſeveral organs eſ⯑ſential to life, and connects the mediaſti⯑num, that membrane, which divides the breaſt into two cavities, for the lodgment of the lungs. We readily conceive if this column ſhould be thrown out of its natu⯑ral direction, it is impoſſible, but that the marrow which it contains ſhould ſuffer in a greater or leſs degree. The nerves which [4]iſſue from the diſtended or compreſſed part, will act but imperfectly upon the parts to which they are diſtributed; from whence proceed that weakneſs and exte⯑nuation obſervable in the lower extremities of moſt deformed perſons; if the ſpine is bent in ſuch a manner as to take off from the cavity of the breaſt, the diſorder be⯑come ſtill worſe in its conſequences, for the lungs not finding room enough to ex⯑pand, cannot draw in a quantity of air ſuf⯑ficient for each inſpiration; ſo that the maſs of blood bereft of the advantages derived from a free and uninterrupted reſpiration, becomes ſo impoveriſhed, as hardly to ſuf⯑fice for the ſimple nouriſhment of the parts, much leſs, to contribute what is neceſſary for their growth. The heart even is con⯑fined by the male conformation of the tho⯑rax, and is incapable of exerting its whole power in expelling the blood; the circula⯑tion therefore is more ſlowly carried on, the ſecretions are imperfect, and all the vital functions become languid, not only the important organs of life within the breaſt are injured by this diſorder, but its effects are ſometimes manifeſted alſo in the total deſtruction of the animal oeconomy, and ſome of the ableſt practitioners have traced [5]moſt fatal accidents from this cauſe: often⯑times the pleura being ſtretched or ob⯑ſtructed, becomes inflamed, and forms prae⯑ternatural adheſions with the lungs, or elſe the veſſels of that membrane being incapa⯑ble of abſorbing the ſuperfluous part of that fluid with which it is lubricated, a dropſy is formed, which is the more dan⯑gerous, as the cauſe which firſt produced it, is continually increaſing: at other times, the lungs become ſchirrous, or ab⯑ſcede; and an empyema enſues, which is generally mortal. Doctor Gliſſon, in his treatiſe on the rickets, declares, that, in the courſe of his enquiries, with regard to the cauſes and effects of this diſorder, he had often found appearances ſimilar to thoſe abovementioned, in the breaſt of children who had died of the rickets: without paying any attention to the ſtate of the bones which enter into the compoſition of the breaſt, he aſcribes all thoſe effects to the immediate impreſſion of a virus which he calls ricketty, upon the injured organs; but, ſince it is well known that the form of the breaſt is frequently much altered in ricketty perſons, is it not more reaſonable to imagine, that the morbid appearances obſerved by Gliſſon, were either owing to [6]the ſtretching of the pleura, or the preſ⯑ſure upon the lungs, by the ribs, the ſter⯑num, or the vertebrae warped. This change in the make of the breaſt is not always productive of ſuch fatal conſequences; it ſhould ſeem, as if the organs could ſome⯑times accommodate themſelves to confine⯑ment; when the alteration takes place very gradually; at other times, the new form which the breaſt acquires, preſerves the ſame extent of cavity, as it would have had in the natural ſtate; we need not therefore be ſurprized, to ſee many people living for many years, with this infirmity; nor even, to find ſome amongſt the number, who en⯑joy a tolerable ſtate of health. But, we ſhould be greatly miſtaken, if we were to infer from hence, that the curvature of the ſpine is never the cauſe of death; on the contrary, however frequent the inſtances may be of perſons living a length of time with this complaint, the number of thoſe who periſh by it, is certainly more con⯑ſiderable.

This diſorder may ariſe from various cauſes, among the moſt frequent, we may reckon the neglect of thoſe, who have the care of children; either in dreſſing them improperly, or ſuffering them to throw [7]themſelves into, and habitually contract improper attitudes. A natural or acciden⯑tal weakneſs of the ligaments or muſcles of the ſpine, may alſo give riſe to this diſ⯑eaſe; as it muſt neceſſarily take off from the ſtrength of the column, which will therefore give way, and bend under the weight of the head, and the upper extre⯑mities; a greater or leſs power of the muſ⯑cles on one ſide of the ſpine, than on the other, may be reckoned as another cauſe of its deformity; but, it is moſt generally owing to a ricketty habit of body.

Although moſt authors concur in aſſign⯑ing this diſpoſition as the moſt frequent cauſe of the curvature of the ſpine, yet they by no means agree about the manner in which it acts ſo as to produce this effect; Gliſſon aſcribes it to an irregular diſtribu⯑tion of the nutritious juice in the bones; which being more liberally diffuſed upon one ſurface than another, will not allow them as they are growing, to preſerve their natural form.

The late Mr. Petit, member of the aca⯑demy, in his excellent treatiſe on the diſ⯑eaſes of the bones, ſays after Mayow, that bones will not bend, unleſs they have been previouſly ſoftened by a vitiated ſtate of [8]the juices, which ſerve to nouriſh them; that, in that caſe, the muſcles and tendons being extenuated, and ſhortned by the ricketty virus, pull the bones by their elaſ⯑tic power more forcibly on one ſide, than on the other, ſo that they are obliged to give way, as a bow does, when its ſtring is ſhortned.

However ſpecious this explanation may appear, it is certainly difficult to deter⯑mine whether the bones are made crook⯑ed, becauſe they are drawn to one ſide, by the muſcles being previouſly ſhortned, or, whether the muſcles do not rather ſhorten themſelves, by their own power of contraction, after the bones have been once bent, and can no longer counterpoiſe that action, as they were uſed to do: either of theſe ſolutions appearing equally probable, there is certainly, independent of them, ano⯑ther more apparent cauſe of this diſorder, which is, the weight of the head and the upper extremities, upon the ſpine. This circumſtance has not eſcaped Mr. Petit's obſervation, who takes notice of it as con⯑curring with the other cauſes. What has been ſaid, relates only to children, or ſuch as are young; but there are cauſes which may throw the ſpine out of it's natural direction, [9]at all times of life; ſuch as, any hard work, which keeps the body conſtantly bent, and habituates it little by little to re⯑main in that ſtate; thoſe who carry heavy burdens on their head or ſhoulders, and thoſe who manure the ground, have com⯑monly the ſpine bent forwards; as well as moſt old huſbandmen. Old age, which debilitates the action of the ligaments and muſcles, frequently produces the ſame ef⯑fect, but in theſe inſtances the diſorder is attended with few if any bad ſymptons; becauſe, the curvature is made very gra⯑dually, and that the extent of the thorax is not diminiſhed by it. There are even ſome perſons in whom this crookedneſs throws the ſternum at a greater diſtance from the ſpine; in theſe, the cavity acquires a greater extent, and a remarkable ſtrong voice, which they are often obſerved to have, plainly indicates, that their lungs are not in the leaſt confined. I ſhall not enter into a more explicit account of the cauſes and effects of this deformity; my preſent deſign, being only to propoſe a new method, to prevent, or ſet it to rights, when it will admit of a cure. The chief curative indi⯑cation is to reſiſt the progreſs of the diſeaſe in the beginning; and if the ſpine is already [10]bent, to endeavour to make it ſtraight again, by a conſtant and gradual extenſion. The means heretofore uſed, to anſwer this pur⯑poſe, have been inſufficient; the method which I propoſe will always ſucceed, when employed in proper caſes, and put in prac⯑tice with neceſſary precaution. To be con⯑vinced of the truth of this aſſertion, we need only conſider, that a ſtick, however ſlender it may be, can ſupport a conſidera⯑ble weight, while it remains ſtraight and upright, but, if it happens to deviate in the leaſt from the ſtraight line, it ſoon gives way entirely to the weight. The ſame thing may be ſaid of the vertebral column; if by any accident it ſhould be thrown out of it natural direction, the weight of the head and upper extremities, will not fail to increaſe the deviation; eſpecially in chil⯑dren, whoſe bones have not yet acquired a neceſſary firmneſs; and, in a ſhort time dif⯑ferent ſymptoms ſhew themſelves agreeably to the different way in which the ſpine may be bent. It may perhaps be objected that although the ſpine is naturally bent in ſeve⯑ral places, yet it is not leſs capable of ſup⯑porting the weight of the incumbent parts: but this will be readily anſwered if we con⯑ſider that nature, by giving the ſpine theſe [11]various incurvations, has divided the preſ⯑ſure, and by this means guarded the co⯑lumn, againſt the effects which the weight of the parts, it is deſigned to ſupport, might otherwiſe have produced, and, that the ſpine reaps this advantage from the ſi⯑tuation of thoſe organs, by which is is ena⯑bled to perform it's various motions: but, the poſition of the muſcles, which is only relative to the natural inflexions of the ſpine, cannot poſſibly be of any ſervice when the bones are warped inwards, or to either ſide; to put a ſtop therefore, to the progreſs of the diſeaſe it is neceſſary, that the vertebrae ſhould be brought back to their natural poſition, and that they ſhould be ſo maintained, till ſuch a time as the ſpine has acquired a degree of firmneſs, ſuf⯑ficient of itſelf, to counteract a power which is always attempting to bend it more and more.

It has always been thought neceſſary to apply for help in theſe caſes, and parents, alarmed merely by the idea of deformity which their children are threatned with, never fail to conſult ſome perſon whom they can confide in; but, how manifold ſoever may have been the means hitherto uſed for this purpoſe, they have been all contrived upon one and the ſame principle, which is, [12]a certain degree of preſſure upon the moſt projecting part.

Sometimes, a bodice is uſed, made firm with whalebone, and guarded in thoſe parts where it is intended to preſs; ſometimes, it is a croſs made of iron, and at other times in ſhort, it is ſome kind of machine invented for compreſſion: but, the ſlighteſt reflection upon the ſtructure of the parts, will readily account for the little ſucceſs all theſe trials have been attended with. What effect indeed can preſſure poſſibly have in thoſe caſes where the ſpine is bent inwards or latterally; eſpecially, if the curvature is at the middle or lower part of the column? The compreſſing machines have then no immediate bearing upon the ſpine; they muſt therefore act upon the ribs: but, theſe buttreſſes, whoſe poſition is oblique, will more readily give way according to the mo⯑tion of their articulation, than they will be able to force out the vertebrae; this preſ⯑ſure which muſt neceſſarily therefore incom⯑mode of reſpiration, loſes alſo its effect on the ſpine, more particularly on account of the circular form of the ribs, and their flexibility; ſo that the proportion of force acting upon the vertebral column is reduced almoſt to nothing. The vertebrae of the loins when bent laterally or inwards, are [13]not more likely to be redreſſed by any preſ⯑ſure of this kind, for the thickneſs of the muſcles and integuments which cover this part, does not make a ſufficient reſiſtance, to communicate the effect which the com⯑preſſing body ſhould have upon the verte⯑brae: to theſe impediments, we may add the weight of the head and upper extre⯑mities, which will always act upon the ſpine, unleſs the patient is kept conſtantly in bed, which might be attended with many other inconveniences.

The only caſe therefore, in which this preſſure could take any effect, would be, where the ſpine was bent from within out⯑wards: for then by acting immediately up⯑on the vertebrae projecting, the progreſs of the diſorder might perhaps be prevented; but the pain and conſtraint which muſt ne⯑ceſſarily follow ſuch an operation would be almoſt inſupportable. The ſpinal proceſſes of the vertebrae are ſo projecting in theſe patients, that the ſlighteſt degree of preſ⯑ſure cauſes great pain, and whatever care we may take in wadding and guarding both the compreſſing bodies, and the parts which are to be compreſſed, they are never able [14]to bear this preſſure for any length of time^*.

Gliſſon being himſelf convinced of the inſufficiency of all theſe methods, acknow⯑ledges the neceſſity of extending the ſpine in order to make it ſtraight again; but the ſort of extenſion which he propoſes not be⯑ing conſtant, is ſtill inadequate: this me⯑thod, practiſed in England, is called ſwing⯑ing; it conſiſts, in ſuſpending the child with ſtrings diſpoſed in ſuch a manner, that the body may be entirely ſupported by the head and upper extremities; and to in⯑creaſe the degree of extenſion, weights are ſometimes added to the feet. In this ſitua⯑tion they endeavour to divert the child, that he may be induced to continue this ex⯑erciſe as long as poſſible; but however delighted he may be at firſt, at feeling him⯑ſelf ballanced in the air, yet a wearineſs ſoon ſeizes all his limbs, and at the end of a quarter of an hour at moſt, he begs to be releaſed from his confinement. It is evident, that the effect of extenſion for ſo [15]ſhort a time, muſt be very trifling; and the weight of the parts during the reſt of the day, ſoon deſtroys any little advantage which may have been gained by it. If the ſame exerciſe is repeated, the alternate exten⯑ſion, and greater bearing down of the parts after the fatigue of it, weakens the muſcles and ligaments ſo much that the ſpine becomes more pliant, and its curvature is increaſed.

From what has been ſaid, it is evident, that nothing but a conſtant and gradual ex⯑tenſion can poſſibly prevent, or redreſs a praeternatural inflexion of the ſpine; and that none of the methods hitherto practiſed, are ſufficient for this purpoſe. It remains there⯑fore that the method which I now offer to the public ſhould be proved fully to anſwer this intention, and that it is conſequently far more beneficial than any yet propoſed. The two moſt eſſential circumſtances in this method are a whalebone bodice, and a ma⯑chine rather complicated in its ſtructure, though extremely ſimple in its effect.

The whalebone bodice differs from a common quilted waiſtcoat only, in being laced at the fore part, and being fitted cloſe to the hips and os ſacrum.

The machine may be divided into three pieces. The firſt, is a plate of braſs having the form of a rectangle, a little blunted at [16]the angles, at each of which there is a per⯑foration made, to receive the flat heads of ſome ſcrews, after they have paſſed through correſpondent holes made for that purpoſe, through the whole thickneſs of the bodice; this plate, by its conſtruction, ſerves to ſup⯑port the beam or ſuſpenſory, which is the ſecond piece; this beam is made of a piece of well tempered ſteel, the body and foot of which are of equal thickneſs; it muſt be two lines and an half in breadth; the foot and body of the beam muſt be ſtraight, and continued, ſo as to extend as far as the curvature in this ſame piece, which terminates at the fore part of the head. If the head is thrown ſo much to one ſide, as [...]o cauſe what is called the caput obſtipum, [...]he beam muſt then be twiſted, and its [...]pper branch bifurcated.

The third piece, or head dreſs, is the moſt complicated part of the machine; it conſiſts firſt in a cap made of any kind of ſoft cloth, the borders of which are to be [...]our fingers broad, and to have two button [...]oles made through them; ſecondly, in a [...]illet, made long enough to ſurround the [...]ead; thirdly, in a buckle, with a double [...]hape, each chape, furniſhed with two [...]ongues; the fourth part of the head dreſs, [...] a fillet of braſs which becomes gradually [...]in, it is bent towards it's flat ſurface, and [17]is fitted to the double buckle. The fifth part is a ſmall plate of braſs or ſteel made round, through a hole in the middle of which, paſſes a pretty large hook, which is ſituated underneath this plate, in order to receive, or let through the end of the beam, which by ſupporting the head and upper extremities, gradually lengthens the ſpinal column, and preſerves it in its natural and perpendicular direction. It may be imagined from the number of pieces which this machine is compoſed of, that it's ap⯑plication is very difficult, but any perſon who has the care of a child, and who has ever ſo ſmall a ſhare of underſtanding may be taught in time to manage it with ſuc⯑ceſs.

I have alſo other methods beſides this Machine, for perſons of a more advanced age in whom it is ineffectual, without the uſe of a ſwing, in which I put them for ſeveral hours together. My ſwing differs from GLISSON'S eſſentially, ſince it neither confines nor gives any pain to the patient. and that his limbs do not grow benumbed as they do with the other ſwing commonly uſed in this country; and which cannot be continued longer than a quarter of an hour at a time. I can even venture to ſay, that any perſon who will confine himſelf much [18]to his bed, may be cured in the ſpace of three months.

The advantages of this machine are evi⯑dent; it keeps the ſpine extended as much and for as long a time as one may think neceſſary; the patient is able to walk with it, and can even employ himſelf as much as he pleaſes. It does not hinder young ladies from playing on the harpſichord, learning to dance, to draw, or to write. Children, who from the dangerous ſtate of their health have been obliged to wear it all night long, have ſtill ſlept as uſual. I even ſaw an in⯑ſtance of a girl of eight years old at Paris, who finding herſelf relieved, fell ſo faſt a-ſleep in her chair immediately after the machine had been put on, that her mother thought her dead, and told me the next day, that being at firſt apprehenſive that the ma⯑chine had killed her child, ſhe had a great mind to take the whole off.

This is not a matter of mere ſpeculation, for although the reaſons here alledged, might be ſufficient to prove that this method is preferable to any other, yet the great ſuc⯑ceſs which has attended the practice of it, in all the caſes where it has been hitherto uſed, will eſtabliſh this preference in a [19]more inconteſtable manner; which I ſhall endeavour to do by the following obſervations.

In the month of September 1764, a lady twelve years old was ſeized with a violent and conſtant cough, which could not be appeaſed; this was accompanied with a fe⯑ver which extenuated her to a terrible degree. The remedies which were adminiſtered to her in a provincial convent, where ſhe was, proved unſucceſsful. Her parents had her brought back to Paris, where all the aſſiſtan⯑ces which medicine could furniſh were again tried with as little efficacy as before; and ſhe was thought to be in great danger of her life. I perceived, although I only ſaw her in bed, that ſhe kept herſelf always bent; and that her face bore evident marks of a ricketty habit. I deſired leave to look at the ſpine, which I found very much warped laterally in two places, the five upper vertebrae of the back were thrown from the right to the left ſide and forwards; the three following vertebrae were in their natural direction, but were twiſted ſo that their bodies bearing to the left, diminiſhed conſiderably the right ſide of the thorax; the ſour lower vertebrae of the back and the three upper vertebrae of the loins were incurvated from the left to the right ſide; ſo that when ſhe was ſitting, the whole body bore upon the right hip.

I told the parents that all the bad ſymp⯑toms which this child laboured under, were owing to a confinement of the organs within the breaſt; and that, inſtead of giving her medicines internally, the only way to effect a cure, was, to ſet the ſuffering parts at eaſe quickly. The little ſucceſs which was to be expected from the methods commonly uſed, induced me to contrive a machine, nearly ſimilar to the one above deſcribed. This machine although very rude at that time, and much leſs convenient than the one I uſe at preſent, had notwithſtanding ſo good an effect, that in a ſhort time, the ſymptoms which endangered life being re⯑moved, the lady recovered her uſual full⯑neſs and health. The curvature of the ſpine has alſo diſappeared, and ſhe is at preſent very well ſhaped.

This was the firſt trial of the machine; the ſucceſs attending it, and the frequent opportunities which have ſince offered of applying it, have induced me to endeavour to bring this method to a greater degree of perfection; and the courſe of three years application to this circumſtance, has taught me the following particulars.

By this method therefore, we may expect to cure any children whoſe ſpine is crooked, [21]provided that their age does not exceed 12 or 13 years; and provided, we may depend upon the perſons who have the care of them, ſo far as to be aſſured that they will oblige them to wear the machine conſtantly. The number of children who have been cured at this age is too conſiderable to give an ac⯑count of them here, it may be ſufficient to ſay, that many cures of this kind have been performed, under the inſpection of ſome mem⯑bers of the academy: Mr. Louis, the perpetual ſecretary, has ſeen one inſtance in a little girl between 7 and 8 years of age: Mr. Andouillè firſt ſurgeon to the king in reverſion, has ſeen, with Mr. Didier, a member of this academy, another young lady who has been ſet to rights in a ſhort ſpace of time; ſhe was only ſix years old, and the curvature was not yet very conſiderable; the ſame Mr. Didier has ſeen other patients cured in the ſame manner. A young lady of nine years old has been cured under the inſpection of Mr. De la Malle, counſellor of the academy; and the cure of another of eight years old has been ſeen by Monſieur Ruffell, director of the academy. When a more advanced age fruſtrates the hopes of an entire cure, on account of the ſpine not having a ſufficient degree of flexibility to give way to the force [22]of the machine, it may then be applied with intention to put a ſtop to the farther progreſs of the diſorder, and it ſhould be wore in ſuch circumſtances till age has ſo far ſtrengthened the ſpine, that all danger is removed, Mr. Houſtet, antient director of the academy, entruſted to my care a lady of 14 years old, whoſe ſhape was deformed; this lady has not been quite cured though ſhe wore the machine for one year and an half; but the inconvenience, far from in⯑creaſing as it would have done done without this aſſiſtance, has been much leſſened, ſo that there is now no appearance of any de⯑formity when the lady is dreſt.—When the crookedneſs of the ſpine has begun very early in life, and has gained very conſidera⯑bly, we cannot aſcertain the cure, but ſtill the caſe is not to be given up as irreme⯑diable; eſpecially, if there is no diſtortion of the vertebrae: Mr. Duclos, member of the academy, ſent me in the year 1765, a little boy, aged 9 years, whoſe ſpine was ſo very crooked, that his chin was ſupported by his breaſt; and the ſternum made a very great projection forwards; the lower ex⯑tremity on the left ſide being weaker than on the right, had given way to the weight of the body, and was conſiderably bent in⯑wards at the articulation of the thigh bone [23]with the tibia: the child could ſcarcely ſupport himſelf; he could not ſleep, and, cried out ſo much in the night time, that his parents were afraid he ſhould die. When the child had wore the machine for a fort⯑night, he began to grow better in his health, his ſleep and appetite returned, and he ſoon after recovered, and became plump as uſual; his ſhape now deviates very little from the natural ſtate, and what is ſtill more remark⯑ble, his limb recovered itſelf ſo far without any other aſſiſtance, that there now remains but a very ſlight bend, which will probably wear off in time. The diſtortion of the vertebrae reſiſts the power of the machine more than other circumſtances; on which ac⯑count, we ſhould take care not to make an inconſiderate prognoſtic. In thoſe caſes where the age of the patient, or the advanced ſtate of the diſeaſe, will not permit us to expect a compleat cure, the machine will always be of ſo much ſervice, as to reſtore health. Two ladies who were each of them between 14 and 15 years age, were reduced to ſuch a degree of Maraſmus, that it was concluded they had but a ſhort time to live; the ſpine was ſo crooked that the natural length of their ſhape was diminiſhed by one half at leaſt; the breaſt had almoſt loſt all marks of its firſt appearance, and conformation; [24]their breathing was ſhort, their power o [...] digeſtion was deſtroyed, and they ſuffered continual pains all over the body; ſo that theſe children could ſcarcely be ſaid to live, but rather ſeemed to be going ſlowly and gradually down to the grave. The uſe of the machine has reſtored health to each of them; they have recovered their fullneſs, one of them is even grown fat; they can both go up the ſteepeſt ſtair-caſe without be⯑ing out of breath; which they could not have done before without infinite trouble and op⯑preſſion; their ſhapes are not entirely rectified, the little deformity remaining, can eaſily be hid by their dreſs.

Such are the ſimple means, to which many perſons owe the recovery of their health, and the beauty of their ſhapes. My wiſhes would be fulfilled, if by adopt⯑ing this invention, practitioners ſhould con⯑firm the poſſibility of curing a diſorder, the moſt moderate effect of which, is, to occa⯑ſion a deformity which laſts as long as life.