The Quarterly Journal of Science, Literature and the Arts, July-December, 1827

by Various

There is one mode which, to a person ignorant of anatomy, seems to be particularly well adapted for this purpose; but it is, in fact, more objectionable than the plan of tying the head back with a riband. A piece of lead, of some pounds weight, [p239] is slung over the back in such a way that it must be supported by a riband put around the head.

Although this contrivance prevents the head for a time from falling forwards, its bad effects may be demonstrated. When the weight is on, the muscles of the back of the spine are passive, while those on the fore-part of the neck are necessarily brought into action to prevent the head from being pulled too far back: this is easily proved; for if we put the fingers on the sternal portions of the sterno-cleido muscle, which, with the small muscles on the fore-part of the throat, pull the head forwards, we shall feel them tense and in action. The increased activity of the muscles on the fore part, and the passive condition of those of the back, may be further exemplified by raising the weight when the girl is not aware of our doing so; the head will then be immediately poked forwards.

We have many opportunities of observing the incorrectness of the principle on which all similar plans for the cure of a stoop have been founded. For instance, porters who carry burthens on the back, by the assistance of a band round the forehead, always stoop; while those who carry baskets before them suspended by a band round the back of the neck, are peculiarly erect. But the most remarkable example of the effect of the head being pulled back by a weight hung behind, is the condition of the women who carry salt in the streets of Edinburgh, for they may be recognised as much by their miserable Sardonic grin, which is caused by the constant excitement of the platysma myoides muscle, as by their stoop.

Very annoying and even distressing consequences may ensue from any system of treatment where a constant resistance to the muscles of the fore-part of the neck is kept up. A gentleman had for many years worn one of the collars invented by Mr. Chesher; after some time, the muscles of the back became so weak, as to be incapable of supporting the column, while those on the fore-part of the neck were so disproportionately increased in strength, by the constant resistance opposed to them by the strap passing from the suspending rod under the chin, that whenever the strap was loosened, the chin was forcibly drawn towards the chest. As the muscles of the back part of the neck did not offer any counteracting resistance, the [p240] windpipe was now pressed down, or almost doubled itself. As soon as this took place (and it was almost immediate on the attempt to sit up without the collar,) the patient was seized with such a sense of suffocation, as to be obliged to throw himself on his back. As he was able to breathe with ease as he lay on his back, his advisers were led to believe that it was the weight of the head which pressed down the windpipe. To counteract this pressure, various contrivances had been proposed to support the head. Indeed, the patient himself was so convinced, from what he had heard, that it was the weight of the head which pressed down the windpipe, and so alarmed had he become from the certainty of having a fit of suffocation when the head was left unsupported, that there was much difficulty in persuading him to believe that if the head could be made heavier, the sense of suffocation would be relieved. He was at length induced, although with great dread of the consequence, to allow about fourteen pounds of shot to be placed on the top of his head. He was very much alarmed, but it was highly gratifying to witness his surprise and pleasure in finding that, instead of his head being weighed down, he could support it, and could breathe with ease while in the upright posture. The following is the principle on which this plan was proposed:—the muscles of the back part of the neck had been brought into such a state, that their ordinary stimulus was not sufficient to excite them to the action necessary to counteract the efforts of those on the fore-part of the neck, which had been evidently increased in strength. The placing a weight on a certain spot on the head formed an additional stimulus to the muscles of the back part of the neck; a fact which the reader may prove by an experiment on himself.

By proceeding on this principle, by combining a variety of exercises, and by gradually diminishing the weight carried on the head, this gentleman was soon able to walk and sit in a state of great comfort, without being obliged to use any artificial support.

It is well known, that the neck-collars support almost the whole weight of the head and shoulders by the strap which passes under the chin. It must also have been observed, that the wearer very frequently pushes down the head against the [p241] chin strap. In this way, the muscles on the fore-part necessarily become stronger, while those of the back, being deprived of their natural stimulus to action, in consequence of the rod superseding their office, become diminished in power. Even were there no change in the degree of strength in the muscles on the fore-part, the head would naturally fall, if the support afforded by the chin strap were removed; but as these muscles are increased in power, while those of the back are diminished, the head must not only fall, but even be pulled down.

However, although the collars and the lead weight, as they are generally used, are not only inefficacious; but even hurtful, they may occasionally be useful in keeping the head in a certain position, after it has been brought to it by such exercises as tend to strengthen those muscles of the back which support the shoulders and head. But the opinions commonly entertained, as to the means of counteracting an habitual stoop, are so erroneous, that even the position of a tailor sitting on his shopboard is better than the plans generally recommended. This at first appears ridiculous; but the manner a tailor holds his body when he walks, proves that there is something in his habits which tends to the correction of a stoop; for he is quite a caricature of a strutting erect figure, especially in the way he bends in his loins and carries his head.

The peculiarity of the tailor’s gait proceeds, in a certain degree, from the bent position in which he sits: but this explanation is not at first satisfactory, since it may be observed that other tradesmen, who also stoop while at work, generally have their head inclined forwards, and have also a distinct and habitual bend in the neck; such, especially, is the condition of persons who sit at a table and stoop forwards, as watchmakers, engravers, &c. It is not difficult to explain the cause of the difference, and the inquiry will assist in directing us to the principles which we ought to recollect in our operations upon the spine.

In the sitting position of the tailor, the head hangs so low, and so complete an arch is formed between it and the pelvis, that the muscles of the spine are called into strong action to support the head; the necessary consequence of this is, that these muscles become even unnaturally strong, or at least so strong as to predominate over those by which the spine is [p242] pulled forward. But the bent position is not the only cause of increase in the strength of the muscles, for it depends also on the exercise given by frequently jerking the head backwards. In those who stoop from the middle of the body, as in writing or working at a table, the muscles of the spine are not called into action; for, while the head is in this position, it rests or is supported by the ligament of the neck. The ligament, being thus kept constantly on the stretch, becomes lengthened, instead of being made more contractile, as muscles would be; and hence the stoop is increased. When this is combined with the consequences of the want of muscular action, the deeper ligaments, which bind the upper vertebræ, gradually yield; if the operation of these causes continues for a certain time, the bones and cartilages themselves become altered in shape, and consequently an almost irremediable stoop is produced[39].

This view derives confirmation, from what may be observed in the shape of the tailors in some parts of Germany, who, instead of having the erect figures of London tailors, are quite bent. On inquiring into the cause, we find that, instead of sitting as tailors do in this country, a hole is cut in the table, and a seat is placed within it; so that their position, while working, becomes nearly the same as that of persons who stoop while sitting at a table.