The prognosis is dependent mostly upon the already existing rigid ity. To give an exact prognosis, the course the line connecting the spi nous processes takes when the patient bends over as far as possible to the right and left sides must be determined. in Figs. SGa and SGb motions are reproduced from a still curable, fairly lax scoliosis; in Figs. S7a and S7b, motions from a fairly rigid and therefore incurable case of scoliosis.
Treatment of Scoliosis Prophylactic measures, as mentioned in the chapter on round shoulders, may be employed in eases of scoliosis; strong muscles, good nutrition, correct attitude when seated, restriction in school attendance, etc., all prevent development of scoliosis to a certain degree. Playing in the open air also helps to prevent a lateral curvature, provided the games do not call for muscular activity of one side only. Lawn tennis, however, and other games of that kind may result directly in the develop ment of scoliosis, because the right arm only is used. Such games should, therefore. as a matter of principle be played with the right and left arms alternately. The same principle should govern the carrying of school books. Children who always sleep on one side simply for the purpose of facing the light or turning from it, must be forced to change their posi tions by placing the pillow at the foot of the bed every other night.
Just as soon as a diagnosis of scoliosis is confirmed treatment must be begun. Many orthopaedic authors maintain that scoliosis can be treated successfully only in orthopaedic institutions, or in schools espe cially designed for scoliotic children.
But when we recall the fact that 25 to 30 per cent. of our own school girls suffer from scoliosis, treatment of such great numbers seems im perative, and the cooperation of general practitioners is indispensable. We will, therefore, discuss at this point the treatment of scoliosis as far as it does not pertain to special orthopaedic measures. Physicians, however, who undertake the responsibility of treating a case of scoliosis should remember that a careful drawing of each patient must be made to be used at any time as a control.
In the very first stage of scoliosis treatment—aside from regulating the entire mode of life and habits—consists in the performance of hanging exercises and equilateral action of the muscles of the back as described above in the treatment of round shoulders (1 to 2 hours daily). If the
case be fully developed, such equilateral exercises are insufficient. Exer cises must he added which aim at bending the scoliotic part of the spine —and this part alone—so as to stretch the shortened tissues on the con cave side and strengthen the overextended erector spins of the convex side. This may, in an imperfect way, be accomplished by gymnastics.
For example, in a case of lumbar scoliosis convex toward the left, the patient places the hands upon the head and assumes an erect position. At, the command "One" the right leg is quickly and energetically bent at the knee-joint, thing the right half of the pelvis and temporarily changing the convex lumbar scoliosis to the left into a convex curvature to the right (Fig. l8S). At "Two " the first attitude is slowly resumed without exertion.
The overeorrection of a convex dorsal scoliosis to the right may be accomplished by having the patient place the left hand on the head and the right below the costal hump. At the command 'One" the patient raises the left elbow, while the hand remains resting on the head. At the same time the right hand exerts strong pressure against the costal hump, bending the dorsal scoliosis over to the other side (Fig. 89).
Iu the case of double curvatures both exercises may be combined FO that upon command "One" the lumbar scoliosis, and upon "Two" the dorsal seoliosis, is corrected and the first position is resumed at "Three." According to my experience creeping exercises, recently recommended by Klapp in the treatment of scoliosis, produce active and passive overcorrection only- in rare cases of total scoliosis. We can not consider them permissible in the more frequently occurring cases of double curvature, because the bending is not confined wholly to the scoliotie part of the spine and hence favors the development of com pensatory curvatures.
A great variety of apparatus has been recommended for the me chanical correction of seoliosis. Passive and active overcorreetion are simultaneously produced by the excellent but rather complicated and expensive apparatus of Schulthcss.