I wish to point out to my readers that it is not well for people with no medical training (masseur-gymnasts) to undertake the treatment of cases other than those of the first, or possibly slighter cases of the second degree. In all severe cases the treatment, consisting of a thorough combination of orthopaedics, gymnastics and massage, should be entrusted to a doctor trained in mechano-therapy and with special experience of such cases, i.e., the director of an orthopaedic institution. Treatment by spinal jackets should only be prescribed by highly trained specialists.

I have two further suggestions to make in all good-will to masseur-gymnasts without medical training with regard to their treatment of scoliosis, besides advising them only to undertake less severe cases : -

(1) To treat these cases preferably by massage and symmetrical movements.

(2) Not to employ too many movements, but carefully to supervise those which are used.

Asymmetrical movements involve more risk than symmetrical, but it ought to be possible to entrust even comparatively inexperienced gymnasts with a few such movements.

A masseur-gymnast can treat slight cases in the following way and be assured that he will do no harm, but only good, and may hope to prevent the further development of the scoliosis, or even to produce some lasting improvement.

This treatment consists of massage of the whole body, with special attention to the back muscles, or massage of the latter only.

The following positions and movements are used : -

1. Hanging Fundamental position.

2. Stretch-standing Heel-raising.

3. Wing-standing Trunk-bending-forward and -raising.

4. Wing-leg-forward-lying Holding.

5. Wing-arch-leg-forward-lying Holding.

6. Stretch-stride-sitting Double Arm-flexion and -extension.

7. Stretch-stride-stoop-sitting Trunk-raising with rod.

One may even restrict oneself to the use of Nos. 1, 2, 5, and 7. I have rather a weakness myself for No. 5 and No. 7, which involve strong action of the back muscles. I refer my readers to Arved-son's chapter for the technique. In using No. 7 I generally recommend a rod; the patient often performs the movement better if he holds a rod between his hands.

Of the asymmetrical movements I only recommend two for the use of inexperienced gymnasts, one for a C curve and the other for an S curve.

For C curves and all single curves in the lumbar region we use ordinary side-flexions and side-lying starting position. It is a mistake to use the standing position as a starting position in these cases. Flexion must be taken towards the side of the convexity, but if this is done in standing position the force of gravity saves the muscles on this side from much concentric work, but, on the other hand, the muscles on the concave side are forced to perform such work to regain the starting position. Thus the movement exercises the strong instead of the weak muscles, and in quite the opposite way to that in which they should be exercised. With all C curves, and generally speaking with all simple curves, especially simple curves in the lumbar region, we therefore use Zander's side-lying-side-flexion apparatus (L2) or Ling's side-arch-leg-lying Holding (see Arvedson's chapter, p. 280, Fig. 133). The patient lies, of course, on the side of the concavity, and, if necessary, may receive slight help from the gymnast during the movement or in holding the position.

The gymnast should restrict himself to the use of stretch-spring-sitting-Holding when treating S curves (see Arvedson's chapter, p. 184, Fig. 51). With the more common right dorsal left lumbar curve we use left-stretch-left-spring-sitting Holding; with the less common left dorsal right lumbar curve we use right-stretch-right-spring-sitting Holding. Stretching the arm helps to correct the dorsal curve, stretching the leg to correct the lumbar curve.

Dr. Klapp's creeping exercises have been recently much used in Germany, but the results have been very differently, often very severely, criticised. Many eminent German specialists consider that on the whole this treatment has done more harm than good.

For my own part I have never used this treatment, but partly from what I have read, partly on theoretical ground, I have a great distrust of it. Dr. Klapp devised the treatment with the object of making the spine more mobile, on the ground that four-footed animals have more mobile spines than human beings, and the treatment consists in creeping "on all fours" in different ways according to different curves. But I maintain that we human beings are not quadrupeds, and that it is just in this respect that there is such a difference between children and, for example, kittens. In kittens the spine is placed horizontally and is supported both by the fore and hind paws; in children the spine is placed vertically and is supported directly merely by a part of the pelvis, indirectly by the lower extremities. If kittens, with their peculiarly mobile spines, were all required to walk upright (an amusing flight of imagination !), they would all become very scoliotic, whereas now a scoliotic kitten is, if zoologists will excuse the expression, a rarissima avis! This domestic animal, charming and graceful as it is, would then develop the most grotesque deformities, and a universal scoliotic "katzenjammer" would form a considerable addition to the "groans of creation" and the trials of this world.

The diminished mobility in the spine of a scoliotic child prevents further development of the deformity. The creeping treatment is a crude one-sided mobilising treatment which may lead to the neglect of other treatment. Since this result has been made known in the German literature on the subject, I consider it legitimate to draw attention to the doubtful value of this importation.