It is manifest that the more complicated apparatus invented by Sehulthess, 'Zander, and others, used in medico-mechanical institutions, may also be employed \vitt' very good results.
Aside from these methodical muscular exercises, children with round shoulders should play out in the fresh air daily, to overcome as far as possible the disadvantages which accompany school attendance.
In order to increase nutrition, daily massage of the muscles of the back is recommended as shown in Fig.
72. In ease of inclination to rigidity special exercises must be added in stretch the shortened parts located on the anterior aspect of the spine.
Hanging from Glisson's suspension apparatus, or from rings, or reclining over a cross-bar may be tried. These active and passive exercises must he kept up daily for from one-half to one hour, according to the seriousness of the case.
In children with round shoulders especial attention must be paid to the construction of seats. If the seat is without an adequate back children will surely assume a kyphotic posture.
Because most of the desks and chairs do not conform to medical de mands and besides are quite expensive, it may be well to describe how to manufacture a cheap and good desk chair.
A common wooden or cane-bottomed chair with a somewhat inclined back suffices. The height of the chair must correspond to the length of the legs (Figs. 74b, 74e). If the chair is too high an adequate footstool must be placed under the feet. The depth of the seat corresponds with the measurements taken from the posterior pelvic surface to the popliteal space (Figs. 74a, 74b). If the chair is too deep a thick cushion must be fastened to the back to allow the child to lean comfortably against it with the entire dorsal surface. Under all circumstances a small pillow
5-8 cm. thick should be fastened to the chair in the line of the waist to encourage the child to assume a lordotie curve of the spine (Fig. 74a, d) . To force a child to lean back against the chair shoulder bands may be employed (Fig. 7.1a). The height of the top of the desk should respond with the xiphoid process. Round and oval tops are detrimental. To obtain a good support for the elbows an excavation may be made in the table as reproduced in Fig. 7-lb. Chair and child must be so near the desk that a distance of not more than 5 cm. separates the chest and the edge of the desk.
In ease the child is accustomed to holding his head forward, I fasten to the desk a forehead support such as is used by oculists, consisting principally of an iron rod bent thus: U.
Finally, the employment of braces to straighten the body must be discussed. We recommend making as little use of them as possible, because all braces as long as they are in use exclude muscular activity and therefore weaken the muscles. We use braces only during school time. We know of no model among the large as sortment of braces advertised in news papers which would not be objectiona ble in some respect. In smaller children we employ a brace modeled after a plaster-of-Paris cast which does not cover the chest and abdomen.
In older girls we fasten to the corset strong dorsal splints which are adapted to a marked lordosis of the spine and felt padded bands are passed over the shoul ders to pull them backward (Fig. 75).