The Frequency of Scoliosis Scoliosis is the most frequent deformity, as 2:5 to 30 per cent. of all school children are scoliotic. In schools for boys the percentage ratio is not quite so high, but most of the marked eases are found among boys. The reason for this condition is, in all probability, that in boys little attention is paid to an erect posture and the resulting scoliosis remains neglected.
fate of a scoliotic child depends, as a rule, on the time treatment can be instituted. Spontaneous recovery from a true case of scoliosis must not be expected. Many laymen as well as physi cians are still of the opinion that scolioses are outgrown in the course of years, i.e., disappear of their own accord, but it must he explained that such cases are mistaken for eases of "uncertain posture" which we have described above. The uncertain posture really disappears without the use of any therapeutic measures. We have never noticed that an old scoliosis. without any treatment whatever, disappears spontaneously.
Fortunately, but few cases of scolinsis attain to a marked degree of deformity. However, we do not know of any criterion which enables us at once to predict whether a scoliosis shows any inclination to grow worse. Aggravations occur even later than the twentieth year,—for instance, in pregnant women. Scoliosis destroys much of the pleasure and happiness of life in young girls, besides involving internal organs (tuberculosis of apices of lungs). The importance of early diagnosis is still much underestimated in daily practice.
detailed discussion of the diagnosis of scoliosis may, therefore, be permitted. To secure a natural attitude uninfluenced by a sense of modesty, the clothing should be held together with a belt just below the trochanters and the breast covered with a towel fastened with a safety-pin at the back of the neck. The back of the child is placed in good light. Each spinous process and the spines and inner borders of the scapulae are marked with blue pencil.
Comparison with a vertical line is essential to determine the presence of a curve of the spine. A weight may be suspended from the ceiling or a water-level as used by carpenters may be set up in a vertical position beside the tioned line. After mining the course of this line, the lateral contours of the trunk, and ally the symmetry of the waist triangle, are care fully examined. Irregularity of the waist triangle lines always indicates
a scoliosis of the lumbar region, even if the spinous line presents very little deviation. Examination of the scapulce reveals whether the spines of both seapulte are located in the same horizontal plane, whether the inner scapular borders arc held at equal distances from the line con necting the spinous processes of the vertebrae, or whether torsion of a scapula has taken place. A difference in the position of the scapu1 is very frequently noted, especially in patients who in their occupation make use of only one side of their bodies, and this must not be mistaken for a symptom of paralysis of the shoulder muscles.
Finally, torsion is carefully sought for. Marked degrees are easily recognized: light symptoms of torsion, however, are often overlooked. Especial attention should be paid to torsion of the cervicodorsal and lumbar regions of the spine. They are often the only symptoms of pensatory curvatures. If the spiuous line remains straight in these regions or follows the course of the main curvature, the upper and lower symptoms of torsion arc readily misjudged. In ease the sco]iosis as the result of this mistake be treated as total scoliosis, the compensatory curvatures at the upper and lower ends increase very quickly and affect the result attained in the main curvature.
We believe that a carefully made drawing is indispensable in mak ing an exact diagnosis of a case of scoliosis. A great variety of drawing apparatus has been suggested. For scientific examinations, Schulthess' ingeniously constructed drawing apparatus is especially well suited. (The apparatus has been accurately described in Sehulthess' text-book on Pathology and Treatment of the Deformities of the Spine.) The apparatus which I have suggested i( sufficient for the general use of practitioners. It consists principally of a vertically placed glass plate on Which the lateral contours of the trunk, the spinons line and the scapular outlines are drawn life size (Fig. Si). To avoid mistakes in the transmission of lilies the physician looks through a tube, the so-called diopter (Fig. S5), which is fastened vertically to the glass plate.