Douching, massage and electricity should form a portion of all treat ment in order to improve the tone and strength of the involved muscles.
Many cases of spinal curvature due to muscular weakness, if recog nised early, can be rectified by the great principle which is adopted in cases of Infantile Paralysis—viz., the prevention of over-stretching of paretic muscles. This can best be accomplished by the application of a well-fitting plaster of Paris jacket, with a large window cut out over the lower ribs on the side of the concavity. This allows the chest to bulge out on this side, and thus the patient's respiratory movements contribute to the cure of his deformity.
Extension of the spine has been employed in various ways, including forcible traction under general anaesthesia and the Sayre's tripod. Jones in some cases advocates the application of a plaster jacket to the spine, whilst extension is made in the horizontal or recumbent position, and various devices and forms of apparatus have been employed to effect a pull upon the spine. Spinal supports should not be depended upon for curing lateral curvature. In the early stages, when a cure by suitable gymnastic exercises can be obtained with certainty, their use causes a positive injury. Only in the hopeless cases with much rotation and rigidity arc steel supports ever warranted, and even then they should be removed daily whilst massage and exercises arc being employed to prevent further deformity and wasting of the muscles.
The scoliosis of rickets is to be treated by the recognised remedies mentioned under Rickets and by absolute rest in the horizontal position. The condition is usually the result of carrying the rachitic child about on the arm of the nurse. If not comfortably stretched upon a padded board,
when it can be conveyed into the open air, it should be placed in the hori zontal position on a firm mattress in a perambulator sufficiently roomy for the recumbent posture. Massage and douching may he utilised during recovery from the rickety condition to strengthen the muscles. Kyphosis, or deformity of the spine caused by a backward convexity, resembles the displacement due to l'ott's disease. 1 t is usually the result of rickets or of faulty positions, in which latter case the deformity shows itself in an aggravation of the " round-shouldered " condition frequently seen in studious myopic subjects.
The treatment is obvious—rickets must be dealt with by suitable antirachitic agents and rest maintained in the horizontal position with a pillow opposite the convexity and the head kept low. In older children myopia must be corrected, and the faulty attitude prevented by a strict, attention to the normal posture and to suitable gymnastic exercises, the best routine exercise being that of swinging on the horizontal bar or on rings attached to two vertical ropes, or the judicious use of crawling as already mentioned.
Lordosis seldom calls for special treatment; the condition disappears when the primary cause—hip-joint disease—can be removed; the de formity, being a compensatory one, is, in the majority of instances, best left alone.
Spondylitis Deformans is nearly always part of a general chronic rheumatoid arthritis resulting in rigid fixation of the entire spinal column, which is beyond the reach of treatment, medical or surgical.