CHAPTER VII
HYGIENE OF THE BONES.
129. The bones increase in size and strength by use, while they are weakened by inaction. Exercise favors the deposition of both animal and earthy matter, by increasing the circulation and nutrition in this texture. For this reason, the bones of the laborer are dense and strong, while those who neglect exercise, or are unaccustomed to manual employment, are deficient in size, and have not a due proportion of earthy matter to give them the solidity and strength of the laboring man.
Observation. The tendons of the muscles are attached near the extremities of the bones. Exercise of the muscles increases the action of the vessels of that part to which the tendons are attached, and thus increases the nutrition and size of this portion of the bone. Hence the joints of an industrious mechanic or farmer are larger than those of an individual who has not pursued manual vocations.
130. The gelatinous bones of the child are not so well adapted for labor and severe exercise as those of an adult. 1st. They are liable to become distorted. 2d. They are consolidated by the deposition of earthy material before they are fully and properly developed. If a young animal, as the colt, be put to severe, continued labor, the deposition of earthy 54 matter is hastened, and the bones are consolidated before they attain full growth. Such colts make small and inferior animals. Similar results follow, if a youth is compelled to toil unduly before maturity of growth is attained. On the other hand, moderate and regular labor favors a healthy development and consolidation of the bones.
129–148. Give the hygiene of the bones. 129. What effect has exercise upon the bones? What effect has inaction? Why are the joints of the industrious farmer and mechanic larger than those of a person unaccustomed to manual employment? 130. Give the first reason why the bones of the child are not adapted to severe exercise. The second reason.
131. The kind and amount of labor should be adapted to the age, health, and development of the bones. Neither the flexible bones of the child nor the brittle bones of the aged man are adapted, by their organization, to long-continued, and hard labor. Those of the one bend too easily, while those of the other fracture too readily. In middle age, the proportions of animal and earthy matter are, usually, such as to give the proper degree of flexibility, firmness, and strength for labor, with little liability to injury.
132. The imperfectly developed bones of the young child will not bear long-continued exertions or positions without injury. Hence the requisitions of the rigid disciplinarian of schools, are unwise when he compels his pupils to remain in one position for a long time. He may have a “quiet school;” but, not unfrequently, by such discipline, the constitution is impaired, and permanent injury is done to the pupils.
133. The lower extremities, in early life, contain but a small proportion of earthy matter; they bend when the weight of the body is thrown upon them for a long time. Hence, the assiduous attempts to induce children to stand or walk, either naturally or artificially, when very young, are ill advised, and often productive of serious and permanent evil. The “bandy” or bow legs are thus produced.
What effect has moderate, regular labor upon the growing youth? 131. What remark respecting the kind and amount of labor? At what age are the bones best fitted for labor? 132. What effect has long-continued exertions or positions on the bones of a child? What is said of the requisitions of some teachers, who have the famed “quiet schools”? 133. Why should not the child be induced to stand or walk, either naturally or artificially, at too early an age?
134. The benches or chairs for children in a school-room should be of such a height as to permit the feet to rest on the floor. If the bench is so high as not to permit the feet to rest upon the floor, the weight of the limbs below the knee may cause the flexible bone of the thigh to become curved. The child thus seated, is inclined to lean forward, contracting an injurious and ungraceful habit. Again, when the feet are not supported, the child soon becomes exhausted, restless, and unfit for study. In the construction of a school-room, the benches should be of different heights, so as to be adapted to the different pupils, and they should also have appropriate backs.
Fig. 29.
Fig. 30.
Fig. 29. The position assumed when the seat is of proper height, and the feet supported.
Fig. 30. The position a child naturally assumes when the seat is so high that the feet are not supported.
134. What is said of the benches or chairs in a school-room? What is represented by fig. 29? By fig. 30? What is the effect when the lower limbs are not supported?
135. Compression of the chest should be avoided. In children, and also in adults, the ribs are very flexible, and a small amount of pressure will increase their curvature, particularly at the lower part of the chest, and thus lessen the size of this cavity. The lower ribs are united to the breast-bone, by long, yielding cartilages, and compression may not only contract the chest, but an unseemly and painful ridge may be produced, by the bending of the cartilages, on one or both sides of the sternum.
Fig. 31.
Fig. 32.
Fig. 31. A natural and well-proportioned chest.
Fig. 32. A chest fashionably deformed.
135. Why should compression of the chest be avoided? What is represented by fig. 31? By fig. 32?
136. Again, the cartilages on one side may be bent outward, while those on the opposite side are bent inward, thus forming a depression parallel with the sternum. In some instances, the anterior extremity of the lower ribs on each side 57 are brought nearly or quite together. In these instances, the movable extremities of the ribs are drawn down toward the haunch-bones, while the space between the ribs is lessened. All this may be effected by tight or “snug” clothing. Therefore the apparel of a child should be loose, and supported over the shoulders, to avoid the before-mentioned evils. The same may be said of the clothing for adults.
137. The erect position in sitting and standing should be assiduously observed. The spinal column, in its natural position, curves from front to back, but not from side to side The admirable arrangement of the bones, alternating with cartilages, permits a great variety of motions and positions; and when the spine is inclined to either side, the elasticity of its cartilages tends to restore it to its natural position. For this reason we may incline the spinal column in any direction for a short time, without danger of permanent curvature, if, afterward, the erect position is assumed.[4]
138. But if a stooping position, or a lateral curved posture, is continued for a long time, the spinal column does not easily recover its proper position, for the compressed edges of the cartilages lose their power of reaction, and finally one side of the cartilage becomes thinned, while the other is thickened; and these wedge-shaped cartilages produce a permanent curvature of the spinal column. In a similar way, the student, seamstress, artisan, and mechanic acquire a stooping position, and become round shouldered, by inclining forward to bring their books or work nearer the eyes.
136. May simply “snug” clothing compress the cartilages? How should the apparel of a child be worn? 137. In what direction does the spinal column, in its natural position, curve? What restores it to its natural position when curved laterally? 138. What is the effect if a lateral curved position of the spinal column is continued for a long time? 139. When one shoulder is elevated for a long time, what is the effect upon the spinal column?
139. Pupils, while writing, drawing, and sometimes while 58 studying, frequently incline the spinal column to one side, in order to accommodate themselves to the desks at which they are seated. Often, these are higher than the elbow as it hangs from the shoulder while at rest. This attitude elevates one shoulder while it depresses the other; consequently, the upper part of the spinal column is inclined toward the elevated shoulder, and the lower part is curved in the opposite direction, giving the form of the letter S to the supporting column of the body.
Fig. 33.
Fig. 33. The table is of proper height, the position is correct, and the spinal column, 1, 1, is straight, while the shoulders are of equal height.
What does fig. 33 represent?
Experiment. Let a pupil be placed at a desk or table with one elbow raised, as is frequently seen while writing, or at study, and observe the condition of the shoulder and spinal column in this position. Place another pupil at a table no higher than the elbow when it hangs by the side while sitting, and observe the appearance of the shoulders and spinal column. By a comparison of the two attitudes, the preceding remarks will be comprehended and appreciated.
Fig. 34.
Fig. 34. The table is too high, and the position is oblique and improper. The right shoulder is seen higher than the left, while the spinal column, 1, 1, exhibits three curves.
140. One shoulder may be elevated, and no injurious results 60 follow, provided care is taken not to keep it in the raised position too long, or if the opposite shoulder is elevated for the same period of time. The right shoulder projects more frequently than the left. This arises from the greater use of the right hand with the shoulder elevated, and not unfrequently the oblique positions assumed in performing the daily vocations of life. With proper care, and by calling into action the left shoulder, this deformity can be prevented.
What experiment is mentioned? What does fig. 34 represent? 140. How can one shoulder be elevated and no injurious results follow?
Fig. 35.
Fig. 35. A representation of a deformed trunk.
141. The loss of symmetry and diminution of height from deformed spines are minor considerations, compared with the distortions that the chest experiences, thereby impairing respiration and inducing diseases of the heart and lungs. The 61 invasion of the functions of these two important organs lessens the vitality of the whole system, and causes general ill health. Again, the curvature of the spinal column is frequently attended by irritation and disease of the spinal cord.
Why does the right shoulder project more frequently than the left? How can this deformity be prevented? 141. What is said of deformed spinal columns?
142. Eminent physicians, both in this country and France state that not more than one female in ten, who has been fashionably educated, is free from deformities of the shoulder or spinal column. Teachers, as well as mothers, should notice the positions of the child in performing the tasks allotted to it, whether studying or pursuing any employment. The feebler the organization of the child, the more frequently should there be a change of position.
143. When a slight projection of the shoulder, with a curvature of the spine, exists, it can be improved by walking with a book, or something heavier, upon the head; to balance which, the spinal column must be nearly erect. Those people that carry burdens upon their heads seldom have crooked spines.
Observation. Persons from the North, in travelling through the Southern States, are surprised to see the heavy burdens that the porters carry on their heads. It is not unusual to see them walking at a rapid pace, with one or two trunks, weighing fifty or eighty pounds each, upon their heads. Occasionally, we meet an itinerant toy-man, with his tray of fragile merchandise upon his head, walking with as much apparent security, as though his toys, or images, were in his hands. This is the easiest method of carrying burdens, because the position of the head and spinal column is erect.
144. If the animal and earthy matter of the bones is not deposited in proper proportions, they are deficient in strength. If the gelatin predominates, the bones are weak, and become 62 distorted. When nutrition is defective in the cylindrical bones, the heads are generally enlarged, and the shafts crooked; if in the spinal column, it may be curved; or in the cranium, it may be enlarged. This disease is familiarly known by the name of rickets. It is most common among these who have poor and insufficient food, live in dark, damp rooms, and breathe a vitiated air. The prevention and remedies for this disease are cleanliness, regular exercise, pure air, and nutritious food.
142. What statement by eminent physicians respecting deformities of the spine? What caution to teachers and mothers? 143. Why should we stand and sit erect? How may slight deformities of the spine be prevented? What is frequently noticed in travelling South? 144. What is the effect upon the bones when the gelatin preponderates?
145. When a bone is broken, some days elapse before the substance that reunites it is thrown out from the blood. In young persons, it may be secreted during the second or third week, and in individuals advanced in life, usually during the third and fourth week. When the bone is uniting, during the second, third, or fourth week, the attention of a surgeon is more needed than during the first week. At this time, the ends of the bone should be placed together with accuracy, which requires the careful application of proper dressing. After the bones have united, it will take some weeks to consolidate the uniting material and render the “callus,” or union, firm. During this time, the limb should be used with care.
Observation. When a bone is fractured, a surgeon is immediately called, and the bone is “set.” While the limb remains swelled and painful, the surgeon is required to attend and keep the dressings (bandages and splints) on. When the swelling has abated, and the pain subsided, frequently the patient intimates to the surgeon that his services can be dispensed with, as the “limb is doing well.” This is the most important period, as the bone is uniting, and, unless the ends are nicely adjusted, the dressing properly applied, the person 63 will find, on recovery, a shortened and crooked limb. The surgeon is then censured, when he is not blamable.
What is one cause of rickets? What are the prevention and remedies for this disease? 145. Does the time vary when the reuniting substance of the bone is secreted from the blood? When is the surgeon’s care most needed? Why?
146. It is seldom that a bone is displaced without injury to the connecting ligaments and membranes. When these connecting bands are lacerated, pain, swelling, and other symptoms indicating inflammation succeed, which should be removed by proper treatment, directed by a surgical adviser.
147. In sprains, but few, if any, of the fibres of the connecting ligaments are lacerated; but they are unduly strained and twisted, which occasions acute pain at the time of the injury. This is followed by inflammation and weakness of the joints. The treatment of these injuries is similar to that of a dislocated bone after its reduction. The most important item in the treatment during the few first days, is rest.
148. In persons of scrofulous constitutions, and those in whom the system is enfeebled by disease, white swellings and other chronic diseases of the joints frequently succeed sprains. Such persons cannot be too assiduous in adopting a proper and early treatment of injured joints.
146. What parts are injured in the displacement of a bone? 147. What causes the acute pain in sprains? What is a good remedy for this kind of injury? 148. What caution to persons of scrofulous constitutions?