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McGill University, Montreal.
Dr. R. Tait McKenzie, of McGill University, Montreal, informs me that 12% of the men examined there have "either drooping of one shoulder or actual deviation of the spine, more or less severe," and he comments: "This would indicate that young boys with slight curvatures do not grow out of them, as many are inclined to believe, but that an early slight curable curvature tends to become, later on, a permanent deformity." (See 11, page 501.) Yale.
The record of Yale students, from which some facts were kindly given me by Dr. Seaver, show that about 6% have lateral curvature; and of these 60% have a lateral tip of the pelvis of at least 10 mm. Also Dr. Seaver reports about 4% of men entering college with hernia.
On many defects such as heart lesions, abnormally small chest capacity, digestive errors, and many other defects, the data is as yet too incomplete for reliable generalization, but the evils exist and need careful study.
enough thought to warrant even an assumption. In many families after the child is old enough to dress itself the mother seldom sees the naked child, and the teacher never. Even in the cases where the parent does habitually see the unclothed child there is seldom a sufficient degree of intelligent observation to detect the beginnings of deformity, or sufficient knowledge to correct it if noted.
Thus slight developments begin and develop unnoticed and unhindered until the plastic organism, hardening in the years after puberty, matures misshapen and deformed, perhaps actually limited in its capacity for usefulness, certainly deficient in symmetry and grace. School a new environment for the child.
It is a critical period in the history of a child when its free and unrestrained life of play comes to an end and the restrictions of school life begin. Until then the child has had its option of standing or sitting, of running, walking, or climbing, of indoors or outdoors, and the limitations of clothing are at a minimum. It is seldom that deformities appear under these
CARELESSNESS AND IGNORANCE ABOUT DEFECTS OF conditions, but with school days the trouble
The foregoing facts and figures have been given to show the inevitable results of heed lessness and neglect during the all-important years of a child's growth, for, excepting illness or accident, the defects of college days are always and only developments. We need, then, in the case of the child, to study the causes which lead to the beginnings of evil and the means which shall be used, the courses which shall be followed, to counteract evil tendencies and hab its already begun. The old saying, "An ounce of prevention is worth a pound of cure," applies to this subject with startling force.
Here, at the University of Nebraska, many photographs of young women taken in the last few years have shown deviations of the spine, uneven shoulders and hips, of which not only the young women concerned, but also their parents, were in blissful ignorance up to date.
Children who are markedly deformed, so much so that clothing does not hide the defect, are favored, watched, and treated as the case demands, while with all the rest the sinfully unwarranted assumption is made that everything is all right and will continue so. I say the assumption is made. It would be nearer truth to say that the subject seldom receives
The child must now sit or stand in specified places for stated periods. The conventionalities of dress become more and more of a burden and the restriction upon freedom of move. ment and hygienic conditions are generally less favorable.
Deteriorating effect of school life.
Dr. Kellogg, in a paper delivered before the National Educational Association at Buffalo last year (see No. 9), reports a typical instance of the effects of school life upon children.
He chanced at one time to be among the Yuma Indians in Arizona. The old warriors were much concerned about the school, "as it did not agree with the children, for after being in school a few months they were far less robust and vigorous than before and suffered from indigestion, catarrh, and other diseases from which they were before as free as the birds, the antelopes, and the prairie dogs among which they lived." The chiefs had been called together to be convinced that the children should be educated, even at the cost of their hardihood, independence, and physical vigor. They were convinced, and Dr. Kellogg, visiting the same place some years later, "found the school flourishing, to the great delight of
the good sisters in charge, but the children per ishing; their forest air of rollicking freedom had disappeared and the evidences of physical depression and deterioration were more apparent. Civilization had conquered."
This is by no means an unusual instance. Dr. Kellogg comments (see No. 9, page 2), "the deteriorating influence of school life upon children has been so long and so generally recognized that I do not need to undertake the demonstration of the reality of the stupendous evil."
The more we study the human machine the more wonderful does it appear and the more keenly do we appreciate its susceptibility to influence. Like a bit of down floating in the air blown hither and thither by the faintest breath, so the frame of childhood, delicately poised upon its bony support, responds to every movement of arm or leg and is formed or deformed according to the character of these movements and the positions habitually assumed.
Posture and movement.
The words sound simple enough, but in them are wrapped up problems of vital importance to the child. With growing children the repetition of faulty positions results in: (1) A tend ency to permanency in the malposition; (2) exaggeration of the malposition; (3) fixation of this exaggerated malposition (see No. 3, page 10).
Thus the great advantage lies in correct beginnings. Probably no one in this country has given more thought and investigation to these problems than Dr. Eliza Mosher, now of Ann Arbor. Much attention has been given of late years to the proper seating of school children and to the results of carelessness in this respect. Reference is made later to a number of reports containing valuable data on this line, but neither time nor space will admit of giving more than brief mention of important points involved.
the body is kept from falling forward either by the complicated work of the pelvic muscles or by some sort of a prop in front.
(3.) That in which the line of gravity falls behind the line of the seat bones, and the trunk supported, as before, either by muscular action or by a posterior prop.
With a large majority of school seats at present "there is presented a constant invitation, unrecognized as such by the child and unconsciously accepted,-an invitation to hold the spine out of plumb." Other bad positions are with head and shoulders in front of trunk, or with one arm supported, or both, and the combinations of these various malpositions are numerous. (See No. 2, page 17; No. 3, page 9; No. 4, page 344.)
The seats themselves may be too broad or too narrow,-too low or too high. The back of the seat may not afford the proper support behind or the desk in front, and the seat may not be in the right relation to the desk. The discussion here of the various positions of the child is out of the question, but their relation to the child's welfare is vital and unquestioned.
Faults in seating.
The usual method of seating children has been to assign seats according to age, and even then the different sizes of desks and chairs has been very limited. In Scudder's Report of School Seating (see No. 3, Boston, '92) some interesting facts are given. In various rooms he found girls differing seven years in age and 57 cm. in height sitting at the same sized desks and in seats equally distant from the floor and from the desks. (No. 3, page 8.) In one school there were 91 girls in attendance varying in age from 16 years and 6 months to 11 years and 4 months, and in height from 170 to 139 cm. All were sitting at desks unsuited to them and 18% could not touch the floor with their heels when sitting back in their seats.
In another class of 161 pupils, varying from nine to seventeen and differing 45 cm. in height, There are three typical and fundamental po- all sat at desks of uniform size and in seats of sitions assumed in sitting:
(1.) That in which the gravity line of the trunk falls between the tubera ischii. The trunk is then held erect by a minimum amount of muscular action and with the least possible fatigue. .
(2.) That in which the line of gravity falls in front of the line between the seat bones, and
equal height placed at the same distance from the desks. the desks. As the result of malposition due to defective seating, 20% of the girls in the grammar school grades of Boston are decidedly round-shouldered. (No. 3, page 11.)
Of 8,000 public school children examined by Dr. J. Gardner Smith in New York City, about 10% had an apparent lateral curvature, and of
these 80%, after eight months of physical train- lation, the head drops forward farther and ing, improved.
The habit of sliding forward upon the seat and thus supporting the trunk by hips and shoulders while the intervening part sags between like a hammock, must necessarily produce antero-posterior curvatures and round. shoulders.
farther, to be supported by the hands or twisted down close to the desk, as in writing. Adjustable seats and desks and the recent system of vertical writing reduce this tendency to a miniThere is
The "normal" child was mentioned. but one way to determine whether or not the In addition, however, to abnormal curvatures vision is normal and that is by an examination.
of the spine, habitual malpositions result in mis placement of the internal organs, both of abdomen and pelvis.
Ill-adjusted distances between eyes and desks are directly responsible for very much of the near-sightedness of school children. With proper adjustment the normal child can study in a correct position and without injury to the eyes; but with the desk and chair in wrong re
Uncorrected defects of vision are very many times responsible for much of the blame that the child receives, either on account of apparent bad behavior or of lack of ability in its lessons.
But the standing position must not be neglected, though with children in school the sitting position is of greater relative importance. And here, again, I must refer the reader to the valuable articles of Dr. Mosher. (See references 4, 5, 6, and 7.) In a masterly way she shows how the position of the pelvis, which is at once the supporter of the trunk, arms, and head, and the protector of extremely delicate organs, is of fundamental importance.
With feet together and the weight on both legs, supposing them to be of equal length, the lateral diameter of the pelvis will be horizontal. If, then, the weight be thrown on the balls of the feet, the knees extended to their limit, and the hips and head thrown back, the chest will necessarily be thrown forward, and a correct standing position will have been assumed.
But the variations from this position are legion and their results vital. In the correct standing position the pubic bone is so far downward in the horizontal plane and so far backward in the vertical plane that it, with the adjacent abdominal walls, acts in large measure as a support of the coils of intestine, which are only in part supported from above. Thus, the intra-pelvic organs are largely relievel from the pressure of the abdominal organs.
Incorrect positions and results.
When, however, the knees are relaxed and the weight is on the heels the pubic bone rises upward and forward until it is in the same vertical plane with the front of the abdominal wall, and the upper part of the trunk moves backward to a plane directly over the pelvis. Then the coils of intestine sag directly into the pelvis, displacing the organs there forward or backward.
But the positions just described, bad though they are, are still symmetrical, and when, in addition, the pelvis is supported on only one
Many of the pains, disorders, and irregularities which arise as the girl merges into the woman result directly from habitual carelessness in standing, and surgical interference in later years often follows as an inevitable result of allowing such displacements to become permanent.
"How great a matter a little fire kindleth," and how apparently simple is the remedy; yet, simple as it is, it falls somewhere between home and school and the responsibility is assumed by no one.
Where shall the responsibility fall?
leg its lateral diameter deviates from the horizontal and a whole new train of deformities and defects appears. Habitual standing on one leg, as is so frequent among children, and espe cially among girls, brings definite results. For example, habitual standing on the right leg results in a lowering of the left hip, the right side of the body becomes shorter, the left side longer, the left shoulder will be raised, and the spine will be bent with its convexity to the left. Under these conditions the weight of the intestines will not fall symmetrically into the pelvis, but upon one side-in this case the left side, thus displacing the pelvic organs to the right.
and neither can take the place of the other; but considerations of uniformity, both in the securing of facts as well as in the application of principles, point to the school as providing the best conditions for work.
NEED OF PHYSICAL EXAMINATIONS.
It will be seen from the preceding that children entering school perfectly formed and symmetrical are allowed to fall into shiftless and dangerous habits of posture, and that deformities already begun are not only not detected but progress from bad to worse toward permanency. The only remedy for these conditions