THE RELATION OF STATIC DISTURBANCES OF THE ABDOMINAL VISCERA TO DISPLACEMENTS OF THE PELVIC ORGANS. By J. H. Kellogg, M. D., Member of the British Gynecological Society, the International 'Periodical Congress of Gynecology and Obstetrics, American and British Associations for the Advancement of Science, the Societl D’ Hygiene of France, American Society of Microscopists, American Cli- matological Society, American Elec- tro- Therapeutic Association, Tri-State Medical Society, American Medical Association, Michigan State Medical Society, Superintendent of the Battle Creek (Mich.) Sanitarium. REPRINTED FROM THE PROCEEDINGS OF THE INTERNATIONAL PERIODICAL CONGRESS OF GYNECOLOGY AND OBSTETRICS,. 1892. Modern MedicineFdb. Co., BATTLE CREEK, 1894. / THE RELATION OF STATIC DISTURBANCES OF THE ABDOMINAL VISCERA TO DIS- PLACEMENTS OF THE PELVIC ORGANS* BY J. H. KELLOGG, M. D., Battle Creek, Mich. The most characteristic feature of the new medical science to which the present century, and particularly the last half of it, has given birth, is the idea that health getting is not a matter of magic or of pill swallowing, but instead, in the majority of cases, at least, a matter of education and training. The chronic invalid is ill because he or she has violated the laws of health. Rational medicine regards disease as the result of the operation of nature’s laws, and not a conse- quence of chance or of supernatural agencies. It would seem self-evident that the tissue changes, the functional disturb- ances, the pathological processes, which result from the long- continued violation of nature’s laws, are not to be remedied by the most ingeniously managed medicinal antidoting any more than by the blind hopefulness of the faith healer or the mummeries of the mind curist. Nevertheless, it is a sad fact that too many members of the medical profession have failed to recognize that in its onward march of progress, true medical science has left behind the specifics and panaceas of the old regime, along with the astrology and alchemy of an earlier age, and are still engaged in combating disease on the basis of an effete and false philosophy, or else blindly following an unphilosophical and ever changing empiricism. This state- * Proceedings of the International Periodical Congress of Gynecology and Obstetrics, 1892. 3 4 ment is true of every branch of medicine, but perhaps applies with less force to the department of gynecology than to any other, for the reason that this branch of medical science is almost wholly a creation of the last half century, and hence carries a smaller number of the ancient barnacles which adhere so tenaciously to almost every branch of practical medicine. Rational medicine, as expounded first by Bigelow, then Holmes, and later by a whole generation of laboratory-trained physicians, recognizes as necessary, in chronic cases, the control of the entire life of the invalid. Grave chronic dis- ease involves not a single organ, but many, usually, in fact, the entire body ; and its cure necessitates, first of all, that the habits of the patient shall be strictly conformed to such prin- ciples and rules as will efficiently and curatively modify his disordered vital processes. Health is as much a matter of growth and development as is the sprouting of an acorn, the growing of an oak, or the raising of a crop of wheat. The rational physician keeps ever in mind the fact that the real curative force resides not in his medicine case, but in the constitution of the patient. Nature is the real curative agent. The physician really assists his patient toward recovery only when he studies the purpose of nature in her efforts, and sup- plies conditions which will aid nature in her work. In no department of medicine do these principles find a better opportunity for eminently apt and proper illustration than in gynecology. But the purpose of this paper is not to dwell upon general principles, but to elucidate the governing ideas and to illustrate the practical application of a single point in etiology and therapeutics. The facts presented in this paper support the following propositions: — 1. Displacement of the pelvic viscera is not, as a rule, an isolated pathological conditio7i, but is associated with similar static disturbances of the viscera of the abdominal cavity. 2. The principal causes of uterine and ovarian displacements are such as affect the static relations of the viscera of the abdo- men as well as those of the pelvis ; and hence the rational treat- ment of pelvic displace7ne7its requires the removal of all causes of displacement of the abdo7ninal as well as of the pelvic viscera, and the restoration of the normal supports of these organs. TABLE OF STRENGTH MEASUREMENTS. Arranged from the Measurements of 100 Adult WOMEN, taken and compiled under the direction of J. H. KELLOGG, M. D., Battle Creek, Mich. | PER CENT HEIGHT (inches). j WEIGHT. | ARMS LEGS TRUNK. RESPIRATION. TOTALSTRENGTH s 8 pi « p* 1 i « E I ■O 1 •4 1 5 H T3 i « E 1 I 3 >4 j R. Forearm Pronators. £ £ ! £ •4 E 2 1 ! u* pi L. Forearm Supinators. s 1 1 Pi 1 S •4 £ £ I 1 « E 1 u 1 •4 d 3 s « •d s s •4 ai | •4 s « j 4 I i '3 E* 1 a s XJ § j O. Inspiration—Waist Expana’n (in.) Inspiration—Chest Expans’n (in.) |Y S lit 11 1* £ f fr w s 0 2 B 1 S. o> 2 t w W to* O Pi H H 00 W s >> O 3 l M 1 68.5 175 112 no 110 2525 6055 72 65 60 50 60 55 60 58 90 .90 95 90 80 82 300 300 88 80 145 140 168 165 170 168 120 115 111 106 115 490 140 1352 865 65 65 165 Wo 6.0 5.660 255 1232 2337 1103 386 505S r: 2.5 68.0 168 107 2324 5253 68 57 47 41 52 61 52 55 89 85 92 82 76176 284 278 84 80 125|U8jl59 154 156 154 98 104 110 99 110 446 132 127 2 66353 60 152 193 5.3 5.357 237 1130 2155 1017 346 4648 ~~^5 5 67.1 159 102 92 2221 4849 51 51 40 38 48 49 46 49 82 79 77 74 7071 263 256 78 79 108 104 131 127 136 134 88 95 106 90 103 386 121 1222 56048 49 129 158 4.9 5.151 224 1018 1936 914 288 4166 a 10 66.0 148 88 79 19 18 4243 48 46 35 33 44 42 43 42 77 71 63 63 61j62 232 235 71 74 96 88 112 108|ll8]l23 83 87 91 '84 93 329 108 1122 35542 41 107 135 4.24.446 213 896 1724 803243 3666 10n 15 65.4 141 81 74 18M5 3939 45 42 33 32 42 38 41 40 73 67 58 58 5857 219 225 68 70 88 83 108 100 109jll4 79 81 80 76 87 304 104 1052 25089 37 97 121 3.84.l(43 207 836 1615 748 219 3418 15 20 64.8 135 76 70 TTnfc 36 36 42 39 30 30 39 34 39 38 68 63 63 63 54 53 207 217 65 66 82 77 103 94 102|106 74 75 72 71 82 276 99 99 C4536 34 87 109 3.53.940203 778 1518 691 197 3184 30 25 64.4 131 l72 66 7 1 ?! 34 40 36 29 28 36 32 37 36 64 59 60 49 51 50 201 208 63 63 76 72 100 89 95 101 71 71 68 68 77 252 95 95 94334 32 81 102 3.3 3.838198 732 1447 647 184 3010 25 30 63.9 127 68 63 ft- 32 32 37 33 27 27 83 29 35 34 59 65 46 45 48 47 194 197 60 60 70 69 95 85 . 90 -95 67 67 64 64 72 225 90 90 84032 30 75 96 3.1 3.6 35193 ”684 1372 597 172 2825 30 35 1 63.7 125 65 61 m 30 31 35 31 n 25 31 28 33 32 66 63 44 42 45 44 189 189 68 67 67 66 85 *82 85 90 63 64 61 62 69 205 86 85 713830 29 72 90 2.9 3.4 34188 649 1307 559 163i 2678, 35 40 63.3 122 _5§ 13 IS —4— 28 29 32 29 fe?24 V31 53 49 41 39 4240 181 180 56 63 62 61 80 P 81 84 69 60 57 68 65 178 80 80 5B528 27 67 84 2.83.3 32 183 608 1230 508 152 2498 40 j |45. 63.1 120 /59 ;5f> 1241 2727 31 28 22 *W- *26 2430 0( 60 47 38 36 3938 174 172 61 60 58 58 76 -4 77 81 66 67 64 55 61 172 76 76)1 4 13® 25 64 79 2.63.1 30 179 676 1170 484 144 2373 45 Iso 62.8 irs 56 y3 1110 ,2626 29 2d 20 20 24 22|28 27 46 45 36 34 3635 167|l62 47 46 63 64 72 70 72 75 62 62 61 51 54 149 71 7 Ji 3 !1 hi % 74 2.43.0 28 173 539 1099 436 134|2208 50 46 62.6 ll4 53 50 9 -W4 26 m 22 20,27 25 43 42 3832 157153 43 42 48 50 65 65 67 70 47 47 52 128 66 6(1 15 22 21 531 692.32.8 25 ijb olio 1015 397 125|2037 45 ' I40 62.4 112 51 48 8 7 E3 23 25 M 1716 20 19 26 24 I41 39 B2 29 31®9 149146 39 39 45 46 62 62 64 65 (4 45 43 48 116 .62 6 20 20 62 \ 64 2.2 2.7 24 164 47\ 953 365 TO 1906 40 85 62.1 jo 9 47 44 7 7 E2 21 23 16]15 18 1624 22 138 37 r 30 26 2921 140136 35 33 /& -41 57 66 59 60 140 41 44 103 56 5 i ] 19 18 48 22 159 435 330 108 J748 35 30 62.0 107 45 42 7 6 'll 20 J,2 _20 l4|l3 16 15|23 21 r5 3ff 28 25 2623 130129 30 37 3^ ,62 52 65 j 36 37 37 3fe 41 95 52 5 L 92317 17 44 551.19 2.4 20 154 408 SjOO 3/5 99 l\j512 30 j25- 61.7 104 41 38 6 5 1 18 J2I 18 12 11 14 1322 19 12 26 23 2321 Vl8[116 24 32 32 V7 46 60 4d ‘32 32 34 3d 36 85 48 45 82215 15 39 IJ 501.T 2 2 1 148 371 714 275 89 1449 25 fao 61.4 102 38 34 5 6iVn 19 IT 11 10 12 1220 18 29 24 22 2019 i08iptf 22 22 30 29 ■42 29 29 31 28 V 32 A l 44 < 1 72013 13 35 461.a n 143 342 647 247 81 1317 20 15 61 .p 100 33 30 5 filSllA 18 15 9 9 .11 1018 15 26 25 21 20 1512 89 18 18 26 22 36 35 39 38 24 26 27 24 *69 V 15 51911 11 30 39 1.4 i.g 304 542 218 69 1133 15 10 60/7 98 29 27 4 416 15 16 14 8 8 10 1015 14 22 21 19 18 1210 79 70 14 14 22 17 33 32 33 34 21 24 22 22 * 61 —V 33 30 II 61710 9 25 33 1.3 11127 270 459 191 68 978 10 5 59.7 96 25 •23 3 31412 15 10 6 6 6 7 9 9 18 17 13 14 9 7 58 51 10 9 14 10 25 26 26 26 19 19 17 18 21 47 26 24 512 7 7 18 261.0 1:5 8114 208 344 149 44 745 5 . 2.5 58.6 89 23 20 — _2 21010 12 9 5 5 5 ' 5 5 5 12 12 10 9 5 5 37 34 7 6 6 6 17 17 18 18 12 12 11 . 13 20 32 22 20 410 5 5 12 24 .9 1.5 5 ‘78 161 223 118 36 538 2.5 1 58.0 79 20 20 2 21010 8 5 5 '4 5 5 5 6 10 JO 8 6 5 5 20 15 5 5 6 5 10 10 10 10 10 10 10 10 20 30 20 20 2:10 6 5 10 20 .8 1.5 5 60 139 145 112 30 426 1 \ 1 1 — m i EXCEPT WHEN OTHERWISE INDICATED, QUANTITIES ARE EXPRESSED IN POUNDS AVOIRDUPOIS. Strength Measurements of Wi...... Taken 189 189 • 189 189 by Copyrighted 1891, by J. H. KELLOGG, M. D., Battle Creek, Mich CHART I. TABLE OF STRENGTH MEASUREMENTS. Arranged from the Measurements of 100 Adult WOMEN, taken and compiled under the direction of J. H, KELLOGG, M. D., Battle Creek, Mich. EXCEPT WHEN OTHERWISE INDICATED, QUANTITIES ARE EXPRESSED IN POUNDS AVOIRDUPOIS. PER CENT HEIGHT (Inches). H W- o i ARMS LEGS TRUNK. RESPIRATION. TOTAL STRENGTH is w V W CL R. Hand Flexors. L. Hand Flexors. R. Hand Extensors. R. Forearm Pronators. L. Forearm Pronators. R. Forearm Supinators. | L. Forearm Supinators. R. Arm Flexors. 1 1 1 H-i | R. Arm Extensors 1 L. Arm Extensors. [ R. Deltoid. [ L. Deltoid. j R. Pectorals. j L. Pectorals. j R. Shoulder Retractors. j L. Shoulder Retractors | R. Foot Flexors. | L. Foot Flexors. £ § a £ 1 « g V. w 1 J j R. Leg Flexors. £ 1 E 1 1 s « 1 1 w s m) 1 U* J3 3 H « L. Thigh Flexors R. Thigh Extensors L. Thigh Extensors R. Thigh Abductors L. Thigh Abductors g § •O ■< L. Thigh Adductors j Trunk Anterior. j Trunk Posterior j Trunk R. Lateral. I Trunk L. Lateral Neck Anterior. | Neck Posterior. | Neck R. Lateral. I Neck L. Lateral. •a £ J, .§ w j Inspiration—Chest. Inspiration—Waist Expans'n (in.] Inspiration—Chest Expans’n (in.] 2 SB- I r 1 .5 & w j Expiration—Spirometer(Cubic in.) W CO O 3 i CHEST. ENTIRE BODY. 5 10 3 1 68.5 17 5 112 no 252 560 55 72 65 60 50 60 55 60 58 90 90 95 90 80 82 300 300 88 A0 145 140 168 165 170 168 120 115 111 105 115 490 140 135 65 65 65 165 220 6.0 5.5 60 255 1232 2337 1103 386 5058 i 8.5 68.0 168 110 107 23 2 452 53 58 57 47 41 52 61 52 55 89 85 92 82 76 76 284 278 8f 125 118 159 154 156 154 98 104 110 99 110 446 132 127 63 53 60 152 193 5.3 5.3 237 1130 2155 1017 M0 4648 2.6 6 67.1 159 102 92 222 148 49 51 51 40 38 48 49 46 49 82 79 77 7.4 70 71 263 256 ft 79 108 104 131 127 136 134 88 95 106 /to 103 121 122 60 48 49 129 158 4.9 5.1 5l 224 1018 1936 914 288 4166 a 10 66.0 148 88 79 191 842 43 48 46 35 33 44 43 42 77 71 63 63 61 62 232 235 hi 74 96 88 112 108 118 123 83 87 93 329 108 112 23 42 41 107 135 4:2 4.4 213 896 1724 803 243 3666 10 , 15 65.4 141 81 74 181 639 39 45 42 33 32 42 /38 41S 40 73 67 58 58 58 57 219 22j 68 70 i 88 83 108 109 114 81 §0 87 304 104 101 2250 37 97 121 3.8 4.1 43 1207 836 1615 748 219 3418 15 20 64.8 135 76 7q 536 36 42 39 30 30 34 39 68 63 53 53 54 5c 60S 65 66 V82 77 10^ ' 94 iote 74 75 72 71 82 276 99 91 2045 36 87 109 3.5 3 40 bo3 778 A8 691 197 3184 20 23 64.4 131 16 434 34 40 36 29 28 P6 32 37 39 64 69 J49 5\ do 201 208 63 .63 '72! 89 95 101 71 *71 68 68 77 252 95 96 1943 34 32 yi 102 3.3 3 38 98 732 444\ 647 184 3010 25 30 63.9 127 E8 63 15: 32 32 37 33 27 27 I&3 29 35 34 \?9 /S5 46 45 48 47 194 197 60 60 70 69 95 85 ,90 95 67 67 64 64 72 225 90 1840 32 30 7^ 96 3.1 3 635 lp3 68/1 1372 \697 2825 3Q 33 63.7 125 165 61 141 8130 31 35 31 25 25 [81 28 33 32 TO 63 44 42 45 44 189 18.9 58 67 67 66 85 82 85 90 63 64 61 62 169 205 86 85 17 38 30 29 .72 2^9 3 434 18& s^49 1307 163 2678 36 40 63.3 122 '62 58 131 28 29 32 29 24 24 28 26 31 30 53 49 41 39 42 40 181 180 56 53 62 61 80 76 81 84 69 60 57 58 165 178 /&) 80 15 35 28 27 67 84 2 3 332 183 608 1230 508 152 2498 40 4a 63.1 120 59 56 121 27 27 31 28 2j6 26 24 30 29 50 47 38 36 39 38 i74 172 61 60 68 58 76 74 77 81 56 67 64 55 El J 76 \jl6 14 33 27 25 64 79 2.6 1 30 179 576 1170 484 144 2373 45 50 62.8 111 56 53 111 i 26 26 29 24 22 28 27 46 45 36 34 36 35 167 162 '47 46 53 54 72 70 72 75 52 52 51 51 149 71 Tl 13 31 24 23 59 74 2.4 0]28|l73 539 1099 436 134 2208 50 45 62.6 111 53 50 9 t 24 24 26 12-1 19 h 22 20 27 25 43 42 34 31 33 32 157 153 43 •42 48 60 65 65 67 70 48 48 47 47 52 128 66 66 12 30 22 21 55 69|2.3 2.8|25 168 600 1015 397 125 2037 45 40 62.4 11£ 61 48 8 7 23 23 25 23 17 16 20 19 26 24 •41 39 32 29 31 29 149 146 39 39 45 46 62 62 64 65 44 45 44 43 48 116 .62 61 11 27 20 20 62 64|2.2 2 7 24 164 471 953 365 117 1906 40 35 62.1 109 47 44 7 7 22 21 ‘22 16 15 18 16 24 22 38 37 30 26 29 26 140 136 35 33 43 41 57 56 69 60 40 41 40 39 44 103 56 55 10 25 19 18 48 60 2.0 2.622 159 435 875 330 108 1748 35 30 62.0 ip7 45 42 7 m ■"22 20 14 13 16 15 23 21 35 35 28 25 26 23 130 129 30 29 37 37 62 52 55 65 36 37 37 35 41 95 52 51 923 17 17 44 55 1.9 2.420 154 408 800 305 99 1612 30 25 61.? ioi 41 38 6 520 18 21 18 12 11 14 13 22 19 32 32 26 23 23 21 118 116 26 24 32 32 47 46 60 49 ‘32 32 34 32 36 85 48 46 822 15 15 39 50 1.7 2 17 148 371 714 275 89 1449 25 20 102 38 34 5 619 17 19 17 11 10 12 12 20 18 30 29 24 22 20 19 108 106 22 22 30 29 •42 42 45 45 29 29 31 28 .32 77 44 41 7 20 13 13 35 46 1.6 2 1 16 143 342 647 247 81 1317 20 15 61.2 100 33 30 5 518 16 18 15 9 9 .11 10 IS 15 26 25 21 20 15 12 93 89 18 18 26 22 36 35 39 38 24 26 27 24 29 69 39 35 5 19 11 11 30 39 1.4 1 9 13 135 304 542 218 69 1133 15 10 60.7 98 29 27 4 416 15 16 14 8 8 10 10 15 14 22 21 19 18 12 10 79 70 14 14 22 17 33 32 33 34 21 24 22 22 26 61 33 30 517 10 9 25 33 1.3 1 8 11 127 270 459 191 58 978 10 5 59.7 96 25 '23 3 314 12 15 10 6 6 6 7 9 9 18 17 13 14 9 7 58 51 10 9 14 10 25 26 26 26 19 19 17 18 21 47 26 24 512 7 7 18 26 1.0 1 5 8 114 208 344 149 44 745 5 2.5 58.6 89 23 20 .2 210 10 12 9 5 5 6 " 5 5 5 12 12 10 9 '5 5 37 34 7 5 6 6 17 17 18 18 12 12 11 13 20 32 22 20 410 6 5 12 24 .9 1 5 5 '78 161 223 118 36 538 2.5 1 58.0 79 20 20 2 2|l0|l0 8 5 5 '4 5 5 6 5 10 40 8 5 .5 5 20 15 5 5 5 5 10 10 10 10 10 10 10 10 20 30 20 20 2110 6 5 10 20 .8 1 .5 5 60 139 145 112 30 426 1 Tr T Strength Measurements of Taken spiUHS, 189 189 189 by...9^.... Copyrighted 1891, by J. H. KELLOGG, M. D., Battle Creek, Mich. CHART II. 5 During the twenty years that I have been engaged in the study and practice of medi- cine, my attention has been constantly called to the utility of exercise in the treat- ment of diseases pe- culiar to women, and my medical work has fallen in such lines as have given me an op- portunity to make a special study of this subject from a prac- tical point of view. A Graphic Study of the Proportionate Strength of the Trunk and the Extremities. — Nearly ten years ago I constructed a dynamometer (Fig. i). by means of which the energy exerted by any group of muscles in the body might ber determined. The ap- paratus consists of a vertical rod, or rods, upon which moves a carriage bearing handles and levers, to which the various parts of the body to be tested are con- nected, and two cylin- ders, in one of which Fig. i.—A Dynamometer adapted to testing the strength ot the muscles of the human body. 6 moves a piston to which the power is applied. A second cylinder is connected to the first, and receives at its upper end a glass tube which reaches to the bottom of the cylinder. The first cylinder is filled with oil ; the second cylinder con- tains mercury, water, and oil. The difference in specific gravity of the three liquids keeps the mercury at the bottom, the water next above it, and the oil uppermost. When the piston is pressed upon, a portion of the oil is displaced from the first cylinder into the second, and as both cylinders are completely filled (care being taken to remove every particle of air), the mercury in the second cylinder is forced up into the vertical glass tube, the upper end of which is closed. A scale placed behind the tube enables one to read by the height of the column of mercury, the amount of power applied, or its equivalent in pounds or kilograms. The data obtained by means of this apparatus have rendered possible the construction of a chart upon which may be made a graphic representation of the condition of a person’s mus- cular system. The chart or table referred to consists of a tabulated arrangement of the averages obtained by measuring the strength of each of the principal groups of muscles of the body in a hundred adult women in ordinary health. In making a graphic representation of a person’s strength, it is only necessary to place a dot at each of the numbers on the chart corresponding to the results obtained by testing with the dynamometer, and then to connect these points with a continuous line. The chart of an ideally symmetrical person would exhibit a straight line running horizontally across the sheet. Such a person is never found in practice, and the greater the deviations of the line, the greater is the asymme- try of the individual examined. By the aid of the assistants whom I have trained for the work, I have constructed charts from several hundred persons of each sex, and in a comparative study of them have noted many interesting facts. The following table represents the strength of various groups of muscles when compared with the weight of the body in both men and women, the weight of the body being considered as unity : — 7 Man. Womail. The grasp of the hand 7 •5 * Total strength of legs 13- 9-4 Total strength of arms , .... 8. 4.6 Total strength of trunk . .... 8. 5- Total strength of all the muscles of the body .... ....30. >9- Several facts of interest will be noted in the above com- parative table. The total strength of the arm muscles in man is nearly two thirds that of the leg muscles, while in women it is only one half. In both men and women the total strength of the arms is practically the same as that of the trunk and chest, the cause of which is readily understood when it is remembered that the vigorous use of the arm muscles requires fixation of the shoulders by contraction of th.e trunkal muscles. Charts I and II are fair examples of the muscular type characteristic of women suffering from pelvic displacements. The low level of the figures indicating the strength of the anterior, posterior, and lateral muscles of the trunk, is a clear evidence of the feebleness of the development of these structures. The only exceptions to this type found are those in which the displacement is clearly due to inflammatory processes or accidents at childbirth. In one hundred cases of pelvic visceral displacement taken without selection, I found the average total strength of the entire body to be 24. per cent less than that of the average woman, while the total strength of the trunk muscles in the same persons was 35 per cent less than the average. These figures are simply the numerical .expression of the same fact which is graphically shown in Charts I and II. In Chart II the total strength is above the average, which is found in the middle line of the chart. This unusual circum- stance was due to the fact that the person was a teacher of gymnastics, who had by her exercise acquired a considerable degree of strength, although her crippled condition, due to the wearing of the ordinary dress, had prevented proper development of the muscles of the trunk. The weakness of the legs shown in Chart I was due to the fact that the patient, 8 in addition to a complete retroversion, had been obliged to keep her bed for a considerable portion of the time for a number of months, owing to an inflammatory disease of the ovaries. In the great majority of cases the anterior trunk muscles are found to be disproportionately weak as compared with the posterior muscles, as is seen in Chart I, in which, however, this characteristic is not so marked as in a large proportion of cases. Every experienced gynecologist must have noted the fre- quent association of pelvic diseases with changes in the external conformation of the body. The employment of various forms of abdominal supports in the treatment of uter- ine displacements, is a recognition of the relation between abnormal static conditions of the abdominal viscera, and a similar condition of the viscera of the pelvis. The Relation of the External Form of the Trunk to Visceral Prolapse.— Quite a number of years ago I began the study of the relation of deviations from the normal state in the outlines of the body to various forms of pelvic and abdominal dis- eases by the aid of a simple apparatus which I had con- structed for the purpose, by means of which it is possible to make an exact profile of the body in an upright position in any plane. The apparatus consists of the following parts : i. A frame attached to a close back of proper width and height, the upright bars in front of the back of the appa- ratus being exactly parallel with it; 2. A pencil carrier which is placed against, and made to move upon, the two uprights in any position in a plane parallel with the back. The pencil carrier is always at exactly right angles with the. back. In preparing the apparatus for use, a piece of strong paper of proper size is fastened upon the back by means of thumb tacks. The patient is then made to stand with the back against the paper, with the heels, hips, and shoulders touching the paper, and the hands grasping the sides of the apparatus to secure absolute steadiness during the tracing. The patient is protected in the meantime by a sheet attached to a cord loosely tied about the neck, and when in place, the pencil carried is placed in position, and an outline of the figure rapidly drawn. Another paper being placed in posi- 9 Fig. 2.—Apparatus for tracing an outline of the body. 10 tion, the side profile is taken in a similar manner. For convenience in measurement and to facilitate the location of the parts, the exact size and position of which it may be nec- essary to indicate upon the outline, a vernier is placed upon each one of the four uprights of the apparatus. By means of a leveling rod passed through the center of the pencil carrier, and used in connection with the vernier, it is possible to locate and represent exactly the position of any organ of the body. The outlines shown in connection with this paper were made with this apparatus, which is represented in Fig. 2. Fig. 5, page 12, shows the outlines of a healthy woman. Figures 1-4, 6-9, and 11-14, show outlines of women suffering from various forms of visceral displacement. Relation of the Proportions of the Trunk to Visceral Prolapse. — For some years I have made careful anthropometric studies of all my patients, making measurements according to the rules generally followed in observations of this kind. I have extended my study to the peasant women of various nationali- ties, especially French, German, Italian, and Chinese women, a single tribe of East Indian women, and the women of a number of the primitive American Indian tribes of Arizona, Old Mexico, and the Indian Territory. The studies which I have made in this direction have developed the fact that the waist of the average American woman is much smaller in proportion to the height than that of the savage or semi- civilized woman, or the women of other civilized nations. The following table briefly summarizes some of the results obtained : — Av. height Av. waist Av. waist percentage of height American women * 24.79 *n- 40. Telugu u 24.65 40.6 French “ (peasants) 28.00 45-4 Chinese «< 57-85 26.27 45-4 Yuma Venus de u Milo 36.84 55-2 47.6 The Telugu women of India, whose waist proportion is 40.6 per cent of the height, are the only race which ap- proaches American women in the smallness of the waist, and Dr. Cummings, who made for me a considerable number of measurements of the women of this tribe, stated that it was 11 their custom to support the skirt, which forms their principal article of dress, by means of a cord tied about the waist and drawn as tightly as possible. This fact evidently explains the reason of the unusual smallness of waist in Telugu women, and suggests the cause of the same deformity in civilized American women, a peculiarity that is not exhibited by the aboriginal women of this country. Mrs. Langtry, the famous English beauty, whose pro- portions were recently published, gives her height as 67 inches and her waist as 26 inches, a waist proportion of 38.8 per cent. If Mrs. Langtry is a representative of the women of her country, English women have still smaller waists than American women; but the average waist propor- tion of twelve English women, brick-makers, whom I measured a few years ago at Lye, in the so-called “black country” of England, I found to be 41.3 per cent, which is a trifle more than that of American women. The waist average proportion of 2000 men measured by Dr. Seaver, of Yale, I find to be 42.7 per cent, figures which are slightly exceeded by the proportion determined by my own measurements of men. That this smallness of waist of the civilized woman is an acquired deformity, is evident from a study of the Venus de Milo and other ancient Grecian statues, in which I find the waist proportion to be very much greater than that of the civilized woman of the present day, and also by the recog- nized anatomical fact that the pelvis of the civilized woman is much broader than in women of savage tribes and semi- civilized nations. The physiological cause which gives rise to increased capacity of the pelvis in civilized women cer- tainly would not at the same time produce a diminution in waist capacity. Considering the abnormal smallness of waist in American women as an acquired deformity, we should expect to find this peculiarity of figure accompanied by a very considerable disturbance in the static relations of the abdominal viscera, especially when recalling the fact that all the solid viscera of the abdomen are placed at its upper part, and are included within that zone of the trunk usually termed the waist, so that the smallness of the waist would indicate either a corre- 12 Fig. 1. Reformed corset wearer. Fig. 2. The same with corset. Fig. 3. Young woman whose “clothes were never tight.” Fig. 4. Side view of same. Fig. 5. A German peas* ant woman. Fig. 6. Effects of corsets and tight bands, on an American woman of same age. Fig. 7. Effects of tight bands and heavy skirts, PLATE I.—Deformities Resulting 13 Fig. 8. Front view of same. Fig. 9. Effects of corset- wearing and tight bands. Fig. 10. Man who had worn a belt. Fig. 11. Effects of a “health corset.” Fig. 12. Front view of same. Fig. 13. Displaced spleen from corset-wearing. Fig. 14. Front view of same. From Waist Constriction. 14 sponding diminution in the size of the viscera occupying this portion of the trunk, or a downward displacement of these organs. Since a comparative study of the viscera of men and women shows that the liver, the principal viscus located in this region of the body, is proportionately larger in women than in men, it is evident that the only explanation of the smallness of the waist in civilized women is to be found in the lowering of the position of the organs of the lower trunk cavity and not a diminution in size. Another evidence of deformity of the figure associated with prolapse of the viscera of the trunk, is the lowered position of the umbilicus. The extensive researches of Dr. Giovanni, recently published by him in a remarkable work upon the morphology of the human body, have established the normal position of the umbilicus as midway between the lower extremity of the sternum and the pubes, not including the xiphoid cartilage. In one hundred cases of displacement of the pelvic viscera, I found the umbilicus to be, on an aver- age, one inch below the normal position, due to the sagging of the bowels. This observation agrees with that of Mr. Lockwood, of St. Bartholomew’s Hospital, in London, who has shown by elaborate post-mortem studies, that hernia is accompanied with prolapse of the mesentery and the attached bowel to the extent of four to nine inches. Mr. Lockwood, in a public address upon the subject, called attention to the influence of tight lacing in producing this prolapse in women. Relative Frequency of Displacement of the Abdominal and Pelvic Viscera.— By a study of the position of the abdominal and pelvic viscera in relation to each other and to their normal position, and with special reference to the normal configuration of the body, I have noted some facts which have been to me of very great interest, and which seem to agree fully with the views above presented. Figures 1-4 and 7-14 present typical examples of a large number of cases which I have met, and show both the general configuration of the body and the position of the principal viscera of the lower cavity of the trunk. The association of a small or 15 flat waist and prominent abdomen with displaced viscera is extremely constant in my observations. In a series of 517 cases of women suffering from visceral prolapse affecting either the organs of the abdomen or pelvis, studied with reference to the relative frequency of static disturbances of the abdominal or pelvic viscera respectively, my observations were as follows : — Cases of marked displacement of abdominal viscera (stomach, colon, liver, kidneys, spleen) 479- Cases of displacement of the pelvic viscera 276. Cases of displacement of abdominal viscera without displacement of pelvic viscera 241. Cases of displacement of the pelvic viscera without displacement of the abdominal viscera 38. Per cent of cases of prolapse of abdominal viscera without displace- ment of pelvic viscera 50.3 Per cent of cases of displacement of the pelvic viscera without displace- ment of the abdominal viscera ; 13. The particulars respecting the displacement of the abdomi- nal viscera are as follows : — Cases of prolapse and dilatation of the stomach and prolapse of the colon (the stomach being considered dilated or prolapsed when the lower border reaches the umbilicus, as determined by clapote- ment) 382. Cases in which one or both kidneys were distinctly movable and floating, usually the right 203. Cases of marked downward displacement of the liver. 16. It is hardly necessary to comment upon the above fig- ures, as they show so clearly a very positive and intimate rela- tion between visceral displacements in the pelvis and the same condition in the abdomen. It seems to be a legitimate conclusion from the facts above presented that visceral dis- placements of the pelvis are not usually a disease of this region of the body alone, but are simply a local expression of a general disorder, which affects more or less extensively the entire viscera of the trunk below the diaphragm. The great frequency with which displacements of the abdominal viscera are found when attention is directed to the static relations of these organs as compared with static disturbances of the pelvic viscera, is quite in harmony with the anatomical fact that the pelvic viscera are surrounded with much more efficient safeguards against displacements than are the viscera of the abdomen. 16 A careful analysis of the symptoms presented in several thousand cases of women presenting distinct evidences of pelvic disease, has convinced me that a large share of the nervous and other functional disorders from which these patients suffer, are due not so much to the pelvic disorders themselves, especially in cases of displacement of the pelvic viscera, as to the condition of general visceral prolapse involv- ing nearly all the organs of the lower half of the trunk. Dr. Trastour has clearly shown the important relation of the normal statique abdominale to health in both men and women. Any considerable change in the static relations of the abdominal viscera results in disease as certainly as does a similar disturbance of the pelvic viscera. The strain upon, and the constant irritation of, the great sympathetic centers of the abdominal region, resulting from displacement of the colon, kidneys, or liver, is a constant source of reflex irritability, which, acting first upon the great centers of the brain and spinal cord, may be reflected to any or all parts of the pe- ripheral nerve ramifications. That such an irritation exists is shown by the fact that tenderness of the solar plexus, of one or both of the lumbar ganglia, or of the lumbo-aortic plexus, either one or all of the conditions named, was found in a large proportion of the total number of cases to which the above statistics relate. It is doubtless true that in some of these cases the irritation of the sympathetic ganglia may have been the result of peripheral irritation in the pelvic viscera; but that irritation of the ganglia is not generally the result of peripheral irritation in the pelvis is evidenced by the fre- quency with which a hyperaesthetic state is encountered in women who present no abnormal condition of the pelvic viscera, and in men equally free from pelvic disease. Prolapse of the organs of the abdominal cavity necessarily tends to produce displacements of the pelvic organs, although it is surprising to note with what obstinacy the viscera of the pelvis not infrequently resist the disturbing influences of the extensive static disturbances of the viscera of the abdomen. How displacements of the stomach, colon, liver, or kidneys may occasion disease is a pathological question which need not here be discussed, since the perversions of the tissue meta- 17 morphosis naturally resulting from a disturbance in the blood supply, and from the development of abnormal and perni- cious nerve reflexes, are etiological factors, the influence of which is well known, and which are certain to come into action in an organ crowded by abnormal pressure out of its proper place. Prolapsed intestines become congested, and not infrequently a pseudo-stricture of the large intestine is occa- sioned by a folding of the viscus upon itself. Stasis of the contents of the intestines leads to fecal accumulation and con- sequent dilatation and atony, and thus the causes which tend to produce visceral displacements in the pelvis are ac- cumulated and aggravated. Causes of Visceral Displacement.— Respecting the causes of visceral displacements of the abdomen and pelvis, I believe that too much attention has generally been given to etiological factors, which though in themselves potent causes of static dis- turbance, are not infrequently, and even usually, the results of other causes more fundamental in character, but which are commonly overlooked. As regards American women, I have become quite con- vinced that the principal predisposing causes of visceral pro- lapse in the abdomen and pelvis are, first, an unhealthful mode of dress in which the central portion of the trunk is abnormally constricted ; and secondly, a neglect to secure by proper muscular exercise that vigorous and symmetrical phys- ical development which is essential to the health of the entire body as well as that of the organs which occupy the cavity of the trunk below the diaphragm. In referring to the pernicious influences of the ordinary civilized dress, I do not speak of tight-lacing for the reason that the dress worn by the civilized woman is, with the rarest exceptions, universally open to criti- cism on the ground of abnormal pressure upon the abdominal contents. Women rarely admit themselves to be guilty of tight lacing. But even in the cases of those who consider themselves examples of moderation in this respect, the tapeline drawn about the waist will disclose the fact that the clothing fits the form so tightly that the amount of room left for expansion in breathing is scarcely a quarter or a half of an inch, and in many cases even less. It is not tight lacing which 18 does the great majority of civilized women injury, but a dress which fits the form so snugly in the narrow zone of the waist that the increased thoracic space demanded in respiration can be secured only by a downward displacement of the viscera to an abnormal extent. The injury resulting from the mode of dress common among civilized women, is chiefly due, first, to mechanical displace- ments through constriction of the trunk in its most yielding part; and secondly, interference with respiration. In Figures 1-4 and 6-14 are shown the deforming influence of waist constriction and the displacing influence of heavy skirts hanging upon the waistbands, which, though often loose when applied to the body, become tight by the downward traction of their weight, and exert a powerful displacing influ- ence upon the viscera. I recently made a comparative study of the effects of the common dress of men and women, selecting for the purpose 71 working women and 50 working men, all of whom were in ordinary health. In the 71 women examined, prolapsus of the stomach and bowels was found in 56 cases. In 19 of these cases the right kidney was found prolapsed or movable, and in one case, both kidneys. The 15 cases in which the stomach and bowels were not prolapsed were all persons under 24 years of age. None of these had ever laced tightly, and four had never worn corsets or tight waistbands, having always worn clothing sus- pended from the shoulders. It is noticeable that in a number of cases in which corsets had never been worn, tight waist- bands had produced very extensive displacement of the stom- ach, bowels, and kidneys. In one of these the liver was displaced downward. In the 50 men were found only six in whom the stomach and bov/els could be said to be prolapsed. In one the right kidney was prolapsed. In only three was the degree of prolapse anything at all comparable with that observed in the women, and in these three (and in one other of the six cases, making four in all), it was found on inquiry that a belt or something equivalent had been worn as a means of sustaining the pantaloons. In one case the patient attributed 19 his condition to the wearing of a truss supported by a belt drawn tightly about his waist. This belt had been worn a sufficiently long time to be an ample cause for the displace- ments observed. In the two cases of slight visceral prolapse in which belts had been worn, there was considerable de- formity of figure, due to general weakness, and the habit of standing with the weight upon one foot. By comparison, we see the relative frequency of visceral prolapse in the men and women examined, was 12 per cent for the men and 80 per cent for the women. In other words, visceral prolapse was found to be six and three-fourths times as frequent in women as in men. It is also noticeable that, with the exception of two cases, visceral prolapse in men was due to the same cause which produced visceral prolapse in women; viz., constriction of the waist. It makes no difference, of course, whether the constriction is applied by means of a corset, a waistband, or a belt. I have met a number of cases of visceral prolapse in men in which the disease was directly traceable to the wearing of a belt. One case was that of a military officer who wore a tight sword belt by which he carried almost constantly a heavy sword. I have observed one case of prolapse of the kidneys in a blacksmith in which it was due -to the practice common among this class of mechanics of sustaining their pantaloons by means of the strings of their leather aprons tied tightly about the waist, the suspenders being loosened so as to give greater freedom to the movements of their arms. Leaving out of consideration the four cases of men in whom the visceral displacement was due to the same causes which produce this morbid condition in women, I find but two cases in which the viscera had become displaced from other causes, or one in twenty-five,—a frequency just one twentieth of that in which this diseased condition is found in women who con- sider themselves in ordinary health. The downward displacement of the abdominal viscera resulting from limitation of the waist movements in respira- tion, is shown in Fig. 2. This effect becomes especially ap- parent in forced respiration. Normally the lower abdomen is slightly drawn in at the end of a full inspiratory effort; 20 but when the waist is so disabled by a corset or bands that normal expansion in this region cannot occur, the increased thoracic inspiration can be acquired only by downward dis- placement of the viscera, which is increased by the exaggera- tion of the intra-abdominal pressure resulting from the increased respiratory effort required to secure the needed amount of air. Amount of Pressure Exerted by Tight Bands and Corsets.— As the result of a large number of observations, I have found the average pressure exerted at the waist by a tight corset or tight waistbands to be, in ordinary respiration, about .3 of an inch of mercury. The measurements were made by means of a mercurial manometer. In forced respiration, I found the pressure exceedingly variable, ranging from one to twenty inches, the equivalent of which in pounds is about one half to ten pounds per square inch. In taking these measurements, the rubber bulb connected with the dynamometer was placed underneath the corset next to the body, and, of course, the results given do not represent accurately the amount of pressure exerted within the abdominal cavity or pelvis; nor is it to be supposed that the force indicated is exerted on every square inch of the entire area of the corset, but only over the area of the greatest constriction. A Study of the Influence of Waist Constriction, by Graphic Methods.— The observations were made by means of an air pessary with a recording tambour, the movements of which were registered upon a kymographion in the usual manner. Plate II, Fig. 1, exhibits the movement of the pelvic organs produced by respiration, ordinary and forced, in a patient in a horizontal position, and without constricting bands of any sort. Plate II, Fig. 2, shows the movement of the pelvic organs, resulting from ordinary and forced respiration, patient horizon- tal, as before, but wearing a corset moderately tight. The difference between the two tracings is noticeable in that the movement of the pelvic organs is less when the corset is tight than when it is loose. The reason for this is made ap- parent by the tracing shown in Fig. 3, Plate II, the first part of which shows ordinary respiration without a corset; the last part, ordinary respiration after the corset had been Graphic Representation of the Effect of Waist Constriction upon Intra-abdominal Pressure. Without Corset. Tightening Corset. With Corset. Ordinary. Fig. 1. Respiratory Tracing (Vaginal). Fig. 3. With and without Corset. Forced. PLATE II. With Corset. Fig. 2. Vaginal Tracing with Corset. Fig. 4. Coughing (Vaginal Tracing). Ordinary. Forced. Without Corset. 22 applied. . The sudden elevation in the center of the tracing indicates the downward movement of the pelvic organs occa- sioned by the tightening of the corset. Plate II, Fig. 4, shows the same thing, and also exhibits the influence of coughing upon the pelvic organs. The enor- mous curve produced in the act of coughing indicates a corresponding amount of displacement of the uterus and its adnexa in a downward direction. Another point in this trac- ing to which I wish to direct attention, is the greater amplitude of movement when the corset was loosened, which coincides with what is learned by comparison of the tracings shown in Figs. 1 and 2, or the first and last portions of Fig. 3. This lessened amplitude of movement at first surprised me ; but on consideration, the reason is plain. It is due to two causes : 1. The compression of the abdominal wall crowds a portion of the abdominal contents upward, while another portion is crowded downward. By this displacement of the viscera the movements of the diaphragm are restricted. This muscle not being able to descend to the usual degree, there is less movement of the pelvic viscera than without the corset. 2. The degree of easy mobility of the uterus in the direction of the longitudinal axis of the body is lessened by the com- pression of the corset, as shown by Fig. 3. Consequently the excursions produced by ordinary respiratory movements, or by the extraordinary movements of forced respiration, coughing, etc., are necessarily more limited under the restrict- ing influence of the corset than without it. Plate III, Fig. 1, shows the relative influence of different positions of the body upon intra-pelvic pressure. It will be noticed that the greatest change in pressure occurs in rising from the horizontal to a vertical position, and in assuming the genu-pectoral position. The facts elicited by the tracing agree precisely with what have been held as accepted facts, but for which heretofore we have had no scientific or exact representation, for which reason, chiefly, I offer them as being of interest. Plate III, Fig. 2, exhibits the influence of certain movements of the body upon intra-pdvic pressure. It is noticeable that bending backward increases the pressure, while bending for- Standing. Sitting. Lying on Back. Lying on Side. Lying on Face. Knee-chest Position Fig. i. Influence of Position on Intra-pelvic Pressure. Backward. Forward. Fig. 2. Influence of Bodily Movements upon Intra-pelvic Pressure. Costal. Abdominal. Costal. Abdominal. Fig. 3. Woman a Week before Confinement. Fig. 4. Man with Enlarged Spleen. PLATE III. 24 ward lessens the pressure. Under the influence of a tight corset, the degree of pressure induced by bending backward was increased, while the decrease of pressure in bending for- ward was greatly lessened, or was more than neutralized by the pressure of the corset upon the lower portion of the abdomen. The facts elicited by my observations of the respiratory movements of the pelvic viscera present themselves as fol- lows : — 1. There is a normal movement of the pelvic viscera cor- responding to those of respiration. 2. These movements are lessened by the constriction of the waist, inducing the costal type of respiration, as the result of two factors, (a) the lessened movements of the diaphragm, and f>) the downward displacement produced by the pressure of the corset upon the abdominal walls. Effect of Constriction of the Waist upon Intra-pelvic Press- ure.— The tracings which I have exhibited show merely rela- tive pressures. In order to obtain at least an approximate idea of the amount of pressure to which the pelvic organs are normally subjected, and to which they are subjected by the wearing of a corset or other constricting articles of dress, I have made a number of observations by means of a mercurial dynamometer, adapted to the purpose. In using the instru- ment for testing intra-pelvic pressure, I filled with water the bulb of an ordinary air pessary previously placed in the vagina, and connected it with the cistern of the dynamometer. I have made many measurements with this instrument in this manner, and have obtained some most interesting results, which I have tabulated. Without reviewing the whole number of measure- ments recorded in my tables, I. will present the following, which have a most important relation to the subject under considera- tion : — (The measurements were taken with the patient in three positions, lying, sitting, and standing, and both with and with- out a corset in all these various positions.) In a case which may be considered an average one (a young woman of twenty years of age) starting with an initial pressure of eight tenths of an inch of mercury, with the patient lying down, the mercurial column was raised in ordinary Expiration. Inspiration. Fig. 1. Pneographic Tracing of a Healthy Woman. Expiration. Inspiration. Costal. Fig. 2. Pneographic Tracing—Woman in Corset. Waist. Costal. Waist. *-‘g. 3- Man. Fig. 4. Woman in Corset. Fig. 5. Chippewa Indian Woman. Costal. Costal. Waist. Waist. Fig. 6. Woman Who Never Wore a Corset. Costal. Fig. 7. Man in Corset. Waist. Fig. 8. Dog. Costal. Waist. Fig. 9. Dog with Corset on. PLATE IV. Graphic Representation of the Effects of Waist Constriction upon Breathing Movements. 26 breathing from .01 to .05 of an inch by each respiratory move- ment. In forcible respiration, the mercurial column was raised from .35 to 1.7 inches. Such acts as laughing, coughing, or blowing the nose raised the mercurial column from 1 to 4. x inches. When the initial pressure was 1. 5 inches, bending forward lowered the column from .0 to .5 inches; bending backward raised it .2 inches. On tightening the corset, the mercurial col- umn was raised .5 of an inch ; in forced respira- tion, from .2 to .5. Rising to a standing position, the initial pressure increased .5 inches, and other pressures increased in proportion. I have not yet pur- sued these studies as far as I desire to do, and hope to perfect my apparatus so as to be able to obtain a very accurate idea of intra-pelvic pressures, and the extent to which aberrations from the average normal pressures are possible; but I think I have, at least, shown that varia- tions in pressure, corresponding to the tracings made by the recording tambour and kymo- graphion, represent changes which are very considerable in degree and of important patho- logical import. This will be more fully appre- ciated, perhaps, when it is remembered that an inch of mercury represents about one half pound of pressure, and that even so small a pressure as .5 of an inch of mercury, or four ounces avoirdupois, amounts to a very consid- erable aggregate when applied to each square inch of the pelvic floor. Direct Measurement of the Amount of Displacement of the Uterus Induced by Constriction of the Waist, etc.— Finding no convenient method of measuring the actual amount of move- ment of the uterus along the axis of the body, I devised an instrument (Fig. 3) by means of which the movements of the uterus in relation to the longitudinal axis of the body are so magnified as to render apparent slight movements of ascent or Fig. 3. Instrument for Measuring Vertical Move- ments of the Uterus. 27 descent which might otherwise escape detection. The action of the instrument will be easily understood from the accom- panying cut. By means of this instrument, I find that the movements of the uterus up and down in ordinary breathing are from .1 to .3 of an inch. Coughing or deep breathing, straining, and similar movements may increase this to .5 of an inch. By the application of the corset, or other constricting means, I find the uterus is lowered in the pelvis from .2 to .5 of an inch. By means of another in- strument, shown in Fig. 4, which I have constructed for the purpose, I have un- dertaken to measure the amount of displacement of the abdominal viscera through waist constriction, by observing the changes in the position of the per- ineum in relation to the longitudinal axis of the body under the influence of pressure. The instrument consists simply of a lever sustained by an upright and adjustable support, fur- nished with a vernier, against which the end of the long arm of the lever plays while the short arm is applied to the perineum. The fulcrum of the lever is so placed that the recording end of the lever has an amplitude of movement just five times that of the end placed against the pelvic floor. The instrument can be used with the patient lying or standing. By use of this instrument, I find that lacing of the corset as tight as ordinarily worn, depresses the pelvic floor from five to twelve millimeters. I have some- times observed a rise in the pelvic floor, of fifteen millimeters immediately after the corset was loosened. The interference of waist constriction with respiration is Fig. 4. Instrument for Measuring Movements oi the Perineum. 28 also evident from a study of the tracings shown in Figs, i and 2, Plate IV, which were obtained by means of a pneo- graph, shown in Fig. 5. This instrument consists essentially of two chambers separated by a diaphragm of thin rubber. One of these chambers is connected with a recording tambour which writes upon a sheet of smoked paper carried by a revolv- ing cylinder such as is used with the ordinary pneumograph. With the other chamber is connected a breathing mask, which in use is placed over the mouth and nose. This chamber is provided with a second opening, the size of which is controlled by a shutter, which can be adjusted at will. In use, the pa- tient under examination breathes into this chamber, which may be called the breath- ing chamber of the instrument. With the chamber completely closed, the breath would simply pass from the mouth into the chamber and back again, there being no change of air, but with the shutter open, the air is drawn into the chamber with each inhalation and expelled at each exhalation. The resistance which the air meets in passing through the shuttered opening gives rise to changes in pressure within the breathing chamber, the pressure being diminished during inspiration and increased during expiration. The amount of this change in pressure will depend in part upon the size of the opening, and can be measured by connecting the breathing chamber with a water column. The average pressure which I have observed is equivalent to a column of water one half inch in height. This is certainly an amount too small seriously to modify the form of the respiratory movements. The changes in pressure in the breathing chamber of course give rise to movements of the rubber diaphragm separating the two chambers of the instrument. These movements act- uate in turn the diaphragm of the recording tambour, which writes upon the recording cylinder in the usual way. That Fig. s. Pneograph. 29 portion of the curve above the base line represents expiration, that below, inspiration. The difference between the curves shown in Fig. i and those in Fig. 2, Plate IV, suggests the interference with respiration through the increase of abdominal pressure resulting from waist constriction. Gynecologists have often called attention to the baneful influence of high heels in producing pelvic disease. Many of the outline tracings which I have made, very clearly confirm this opinion. Forward carriage of the hips results in a depres- sion of the chest and in an increase of the normal posterior dorsal curve, lessens the chest capacity, and depresses the viscera which occupy that portion of the trunk lying between the diaphragm and the lower part of the ribs. Prof. Dr. E. Meinert, of Dresden, kindly sent me a few months ago a number of photographs in which the evil effects of waist constriction in causing visceral displacement is very clearly shown by outlines traced on the skin. In a letter accompanying the photographs, Dr. Meinert, who had seen some of the outline tracings which I have made, kindly says, “So far as I have made studies in the same direction, I can verify your opinions on every point.” Dr. Meinert’s method of investigation is a very original and ingenious one, and possesses the merit of accuracy in the highest degree. Injuries Resulting fro7n the Common Mode of Dress through Interference with Normal Respiration. — What is normal respira- tion in a woman? — Thirteen years ago, in a published article upon this subject, I wrote as follows : — . “It is undoubtedly true that most women do breathe almost exclusively with the upper part of the chest : but whether this is a natural peculiarity, or an acquired and unnatural one, is a question which I am decidedly inclined to answer in harmony with the latter supposition, basing my conclusion upon the fol- lowing facts:— “1. In childhood, and until about the age of puberty, respiration in the boy and girl is exactly the same. “2. Although there is a change in the mode of respiration in most females, usually soon after the period of puberty, marked by increased costal respiration, and diminished ab- 30 dominal or deep respiration, this change can be accounted for on other than physiological grounds. ' “ 3. I believe the cause of this modification of respiration is the change in dress which is usually made about t'he time of puberty. The young girl is now becoming a woman, and must acquire the art of lacing, wearing corsets, stays, and sundry other contrivances which will aid in producing a fine form. “ 4. I have met a number of ladies whose good fortune and good sense had delivered them from the disturbing influence of corset-wearing and tight-lacing, and have invariably observed that they are as capable of deep respiration as men, and prac- tice it naturally.” 1 am thoroughly convinced that this so-called physiological difference between man and woman is really a pathological rather than a physiological difference. In short, I believe that the only reason why women do not, under ordinary cir- cumstances, breathe as do men, is simply that they cannot breathe naturally. Five years ago, I improved the opportunity afforded by a journey through the western portion of the United States, to take pneumographic tracings of the breathing movements of the women of various Indian tribes, together with more than twenty Chinese women in San Francisco, Cal. I have also obtained graphic representations of the breathing movements of the lower animals, chiefly those of dogs. The results, some of which are presented in Plates III and IV, show most con- clusively that there is but one normal type of respiration in human beings, and that the so-called “female type” of respira- tion is only the result of a mode of dress which restricts the natural respiratory movements of the lower portion of the chest. It is a mistake, however, to consider abdominal respira- tion as the natural mode of breathing in either men or women. In normal respiration, the chief movement of the chest is neither in the upper thoracic region, nor that which has been denominated abdominal respiration. The principal movement of the chest is in the inferior costal region. The anatomical structure of the skeleton and the arrangement of the muscles and their relation to the chest naturally give to this portion of the thoracic cage the greatest degree of mobility. It is, in fact, 31 only by expansion of the lower portion of the chest that the diaphragm can act efficiently in increasing the thoracic capac- ity in the longitudinal diameter. The action in normal breath- ing begins with expansion, first of the sides, then in front, then a slight elevation of the upper chest, and, in forced respiration, a slight drawing in of the lower abdomen at the same time. In ordinary respiration, there is simply a lifting forward of the whole front wall of the chest and abdomen, the movement extending all along the line from the upper end of the sternum to the pubes. The so-called abdominal respiration is not only unnatural but unhealthful; indeed, it has been, in many cases, productive of serious injury. Correct breathing is as necessary to the health of the pelvic and abdominal viscera as to a healthy condition of the lungs ; for the inspiratory act not only pumps air in and out of the body, but draws blood to the heart, assisting particularly the portal circulation, and thus also aiding in the absorption of the products of digestion, and so facilitating the digestive pro- cess. It is quite possible, also, that the rhythmical move- ments imparted to all the viscera of the trunk by normal respiration are a sort of vital gymnastics, essential to the health of each organ. The effect of inspiration is to increase abdominal tension. This is accomplished by the flattening of the diaphragm, which is facilitated by the increase in the lateral transverse diameter of the lower part of the chest, induced by contraction of the inspiratory muscles. The effect of the in- creased abdominal tension is to facilitate the emptying of the veins of the portal circulation, in which there is a natural ten- dency to congestion, as the result of the resistance of the hepatic capillary system, which intervenes between them and the general venous system. In normal respiration, in which the intra-thoracic pressure is diminished to t the necessary degree by proper expansion of the chest cavity, the emptying of the portal circulation is greatly facilitated. When the waist is constricted, both elements of the respira- tory process through which the abdominal and pelvic circulation is assisted are seriously weakened. The increase of the abdomi- nal tension, resulting from the pressure of the diaphragm, is 32 prevented by the fact that the transverse diameter of the lower portion of the chest is not only diminished, but fixed. The lateral attachments of the diaphragm are thus approached in such a manner that this muscle is rendered incapable of efficient contraction. At the same time, the intra-thoracic negative pressure is diminished through the crippling of the inspiratory act. The lower portion of the chest being held firmly, any increase in the transverse diameter of this part is impossible. The normal descent of the diaphragm being pre- vented, the longitudinal diameter of the chest cannot be increased to the proper extent. In consequence of the con- striction and the compression of the abdominal walls by the corset, the inspiratory force is largely expended upon the organs of the pelvis, which are forced down out of position. The pelvic floor is more yielding than the rigid walls of the upper chest, and is depressed, thus laying the foundation for chronic displacement. A civilized woman, wearing the ordi- nary dress, cannot expand her waist more than one fourth of an inch when taking a deep inspiration. Expansion must occur somewhere, and the abnormal mode of dress necessi- tates that it shall be at the upper and lower extremities of the trunk. The greater resistance of the upper ribs, and the yield- ing character of the. structures which form the pelvis, lead to a lowering of all the organs which are dependent upon the latter for support. The injuries resulting from abnormal breathing movements do not require for their production an extreme degree of waist constriction. They are commonly met with as the result of the ordinary mode of dress, the wearers of which would doubt- less defend thems.elves against the charge of “lacing.” It is only necessary that the clothes should fit the body snugly when the chest is in repose, to bring into play all the disturb- ing forces to which attention has been called, as soon as increased muscular activity produces deeper or more vigorous respiratory movements than usual, and consequently a demand for more waist room. Muscular Weakness as a Cause of Visceral Prolapse.— The general neglect of such exercise as will result in a vigorous and symmetrical development of the muscular system prevalent 33 among women addicted to waist constriction, is a natural result of the interference with muscular activity which the wearing of such a dress involves. By the inactivity of the muscles of the trunk and the failure of development due to continued pressure, the muscles of the central and anterior portions of the trunk become abnormally weak, so that their natural tone is insufficient to support the abdominal contents in their normal position. An additional injury results from the failure of these weakened muscles to perform their duty as guys, which balance the upper half of the pelvis upon the trunk, and by their efficient action in health maintain a graceful and healthful poise of the body. The strong and beautiful curves which are observed in a spirited horse are not only attractive from an aesthetic point of view, but are also of the highest significance from a physio- logical standpoint. In the healthy, vigorous animal, one observes that the head is held high, the neck and back strongly curved, the limbs firmly set, and the whole expression indicates vigor and strength. The same is equally true of the human body. An erect head, well curved back, prominent chest, retracted abdomen, and firmly set limbs are indicative of an energized carriage of the body which is characteristic of health. The flat chest, posterior dorsal curve, projecting chin, and protruding abdomen are equally indicative of a relaxed and weak carriage of the body, characteristic of feebleness and disease. The spiritless and tired horse does not hold his head down ; he lacks the vigor and disposition to hold it up. So the woman who has been accustomed to the support of stays of steel or bone finds herself, when without these means of support, feeling, as she says, as though she would fall into pieces. The muscles of the waist lack the ability to balance the chest and shoulders upon the hips. The direct effect of the corset, and of any constriction of the waist, is to break down the natural curves of the back, straightening the spine, thus depressing the chest, and causing the shoulders to fall forward, and producing general collapse of the front wall of the trunk. In consequence of the weakening of the muscles which sup- port the trunk, and especially weakness of the waist muscles, 34 an ungraceful and unnatural carriage of the body appears, not only in walking and standing, but in sitting. The weak-waisted woman is comfortable only when sitting in a rocking or easy chair. She cannot be comfortable unless the back is sup- ported ; consequently, in sitting, the muscles of the trunk are completely relaxed, thus Causing collapse of the waist and pro- trusion of the lower abdomen by the compression at the waist occasioned by the depression of the ribs. Such persons, in standing, assume a great variety of awk- ward and unhealthful positions. The most common faults are, dropping the shoulders, projecting the chin, hips too far for- ward, weight resting upon the heels or upon one foot, and a general lack of even and graceful balance of the body. In walking, the forward position of the hips makes it impossible to plant the whole sole of the foot down at once and firmly, so the weight is thrust continually upon the heels. This difficulty is increased by wearing high-heele’d shoes. A swinging, sway- ing, wriggling, or otherwise awkward gait is the most common mode of walking one sees in women, very few of whom are good walkers, in consequence of the inability to balance the body well, through weakness of the muscles of the waist. The extreme frequency of spinal curvatures of various forms in woman and their comparative infrequency in men is an evi- dence of the prevalent weakness of the muscles of the trunk in women, winch results from their neglect of active physical exercise ; at least this is true of American women. A notable degree of spinal curvature, sufficient to produce asymmetry of the body, may be found in the great majority of American women. I made recently a careful examination, with special reference to bodily symmetry, of 200 students in attendance at a college, seventy-five of whom were young women and 125 young men. Of the young women, whose ages were from eighteen to thirty, only four were found who did not present some degree of lat- eral curvature of the spine, which in a number of instances was so exaggerated as to interfere seriously with respiration. Marked posterior curvature of the spine was prominent in a large proportion of the cases, especially in the middle and 35 upper dorsal region, resulting in forward carriage of the chest and head. Among the much larger number of young men, scarcely a dozen cases were found in which the spine was per- ceptibly curved, and only one very decided lateral curvature. The showing for the young men in this instance was, perhaps, unusually good, owing to the fact that they were largely from the country, and had been all their lives accustomed to active out-of-door work and sports. Sir John Forbes, who has made quite extensive investiga- tions upon this subject in schools for young women in Eng- land, records that on visiting a boarding school containing forty girls, he found, on close inquiry, that there was not one girl who had been in the school two years who was not more or less crooked, doubtless as the result of lack of muscular exercise. An examination of the young ladies’ seminaries in this country would doubtless disclose a similarly deformed condi- tion of the young women students. The young woman who grows up in a rocking-chair or behind the ordinary school desk, cannot escape a greater or lesser degree of distortion of the trunk. The Relation of Neglect of Exercise to the Function of the Round Ligatnents.— I recorded in a paper presented ■ at the annual meeting of the Association of Obstetricians and Gynae- cologists, in 1889, and published in the Transactions of the Society, observations concerning the function of the round ligaments, which showed that they are capable of voluntary contraction. The observations were made in the course of operations for shortening the ligaments, for the relief of retroversion. After carefully isolating a ligament, I applied, successively, a faradic, a galvanic, and a magneto-electric current, with the result of obtaining vigorous contraction in each case. The ligament contracted in such a manner that it was not only drawn back into the body, but was actually shortened in its length. I observed, also, that the contrac- tions of the ligaments were nearly as vigorous when the elec- trodes were placed, one in the vagina, and the other on the abdominal wall a few inches from the ligament, as when they 36 were applied directly to the ligament itself. With the elec- trodes placed as described, an energetic contraction of the ligaments occurred whenever the abdominal muscles were made to contract by closing the circuit. This observation led me to believe that the normal action of the round ligaments is as follows : The uterus being placed at such an angle with the longitudinal axis of the body that it rests upon the bladder, is brought forward and downward by such acts as coughing, lifting, straining, etc.; this tends to force the abdominal and pelvic contents downward through contraction of the abdominal muscles, by which also there is a tendency to crowd the uterus backward. When the fundus of the uterus falls backward to such a degree as to allow the top of the organ to be engaged by the intestines, it is usually crowded down upon the sacrum, and drags the ovaries after it. In a healthy woman, as I think my experiments, which were many times repeated, have clearly shown, the round ligaments contract with the abdominal muscles, and by taking up the slack in the ligaments which exists when they are in a passive state, these structures are rendered taut, and thus the uterus is saved from displacement. [This view of the action of the round ligaments in con- nection with the abdominal muscles is confirmed by the fact which I have demonstrated, that the cremasteric reflex which causes elevation of the testicle in the male, in the female causes contraction of the muscular fibers lying just above Pou- part’s ligament and on either side of the inguinal canal.] This view explains how it is that the muscular structures of the ligaments are maintained in a normal state. A muscle soon loses its efficiency when under constant strain. It be- comes tired out, relaxed, and undergoes atrophic changes. The normal slack of the round ligaments, when their functional activity is not required, gives them an opportunity to rest. When their service is needed, the same nervous impulse which produces contraction of the abdominal muscles also brings into play the round ligaments. The slack of the ligaments is taken up, and the retreating uterus is snatched forward or caught in position in time to prevent its being forced back. In nearly 200 cases upon which I have operated for shortening the 37 round ligaments, I have, in a great number of cases, found these structures so attenuated and degenerated as to have no functional activity. I have observed constantly that ligaments of this sort are found only in the cases of young women of very feeble muscular development, or those in whom the retro-displacement has ex- isted for a number of years. Ligaments of the kind described will not contract under the stimulus of electricity, either faradic or galvanic, and hence are functionally dead. It is evident, then, that neglect of physical exercise, par- ticularly neglect to develop the muscles of the trunk, by which means alone the round ligaments can be developed, is a powerful predisposing factor in the production of certain forms of uterine displacement. Therapeutic Indicatio?is.— If the observations which are recorded in this paper are admitted to be accurate (and I am glad to say that many of them are in accord with the re- sults of the studies of Mays, Dickinson, Meinert, and others), it seems scarcely necessary to emphasize their importance as bearing upon the question of therapeutics in relation to dis- placements of the pelvic viscera, and more or less directly also in relation to many functional disorders of the organs of the pelvis. It is evident that medicated pledgets and pes- saries, pelvic massage, local applications of electricity, and even operations upon the perineum, the vagina, the round ligaments, and I may also include ventral fixation, are meas- ures capable of giving nothing more than temporary relief to a woman suffering from displacement of the pelvic viscera as a part of a general static disturbance which involves all the viscera below the diaphragm. And yet such are the means relied upon by the majority of physicians, for the relief of displaced pelvic organs. The “pessary mongers,” to borrow a phrase from Dr. Lawson Tait, have waxed rich through the production and sale of a vast variety of ingenious me- chanical contrivances which are capable of affording nothing more than temporary relief and palliation, and then only in very exceptional cases, and which are certainly responsible for a vast amount of mischief-making. Gynaecologists who undertake to cure women suffering from 38 uterine or ovarian displacements without correcting their mode of dress, commit the same error as would a donkey driver in attempting to help an overburdened and prostrated beast to his feet without first removing his excessive load. A reform in dress must include the discarding of all bands and constrictions about the waist, and the adoption of gar- ments light and sufficiently loose to allow the fullest and freest activity of the lungs, followed by carefully graduated and appropriate exercise. These measures are sufficient in them- selves to accomplish a radical cure in a few cases of uterine and ovarian displacement, and, in the majority of cases, the relief afforded by these measures is very marked. Neverthe- less, a radical cure requires, in the great majority of cases, a combination of hygienic measures with all the' advantages afforded by gynaecological therapeutics, surgical and medical, which may be appropriate in any given case. I do not plead for the substitution of healthful clothing and exercise for therapeutic measures, but that therapeutics alone shall not be relied upon for a cure of cases which de- mand a removal of causes and the building up, by natural agencies, of parts which are weak as the result of disease or lack of development. Exercise inappropriately applied may be the means of great mischief in the treatment of this class of cases, causing as much harm as good, or even more, as has been done by the careless and unskilled prescription of exercise for women suffering from pelvic disorders. Sending a woman to a gym- nasium -frith instruction to exercise, or telling her to exercise on general principles, without specific directions, is as absurd as to send a patient to a drug store with instruction to swallow medicine without any prescription respecting the kind or quan- tity. First of all, the specific weaknesses of the patient must be ascertained by careful physical examination, which shall include an exact test of the strength of the principal muscular groups of the body. A graphic representation of the results of such an examination, as I have shown in connection with this paper, which I believe embodies the first attempt of this sort that has ever been made, greatly facilitates the making of a proper prescription for exercise. It is only necessary that 39 the physician shall know what exercises are necessary for the best development of specific muscular groups to enable him to make at once a prescription exactly adapted to his patient’s case, after he has obtained a graphic representation of her condition as regards muscular strength. A mere glance at the chart shows what is needed. The low points represent weak muscles ; the high points, strong muscles. The distance between the low points and the high points represents the de- gree of muscular unbalance or asymmetry. The employment of such exercises as will strengthen the weak muscles and bring the low points up to the level of the high ones is all the patient requires. I have for nearly twenty years employed, with great satisfaction and success, the system of exercise commonly known as Swedish gymnastics. Both the medical and the pedagogical forms of this system are of the greatest possible service in the treatment of all forms of visceral displacement pertaining to the abdomen and pelvis, and indeed it appears to me next to impossible to treat successfully this class of patients without the aid of this valuable system. I divide my patients into grades, or classes, according to the indications of the chart obtained for each. Special sets of exercise are prepared for each class, and in addition, special exercises with apparatus designed to meet still more exactly individual requirements, are prepared. The amount of daily work expressed in foot pounds required for each of the six classes, into -some one of which most of my patients fall, is as follows : — (i) 36005(2)7000; (3) 18,000; (4) 42,000; (5) 96,000; (6) 120,000. The amount of work indicated for each class is increased, on an average, fifty per cent by the special prescription made to meet the requirements of each individual case. Various walking exercises and light leg movements, club swinging, and exercise with apparatus of various kinds are necessary meas- ures for a hospital or sanitarium largely devoted to this class of patients. I have devised various forms of special appa- ratus in the effort to meet special requirements, one of the most useful of which is shown in Fig. 6, the operation of which will be easily understood. The weight lifted by the patient 40 consists of two cylinders partly filled with water. These cyl- inders are attached to an arm upon which they are rotated, on an axis supported by the upright standard. When not in use, Fig. 6. Equalizing Apparatus for Exercising the Trunkal Muscles. the cylinder hangs vertically. Grasping the handles while sit- ting in an upright position, chest well forward, the patient raises them, thus making the cylinder move through the an- terior half of a circle, of which the elbow is the center. The TABLE OF STRENGTH MEASUREMENTS. Arranged from the Measurements of 100 Adult WOMEN, taken and compiled under the direction of J. H. KELLOGG, M, D., Battle Creek, Mich. EXCEPT WHEN OTHERWISE INDICATED, QUANTITIES ARE EXPRESSED IN POUNDS AVOIRDUPOIS. PER CENT HEIGHT (Inches). ARMS. LEGS. TRUNK. RESPIRATION. TOTAL STRENGTH. PER CENT. WEIGHT. R. Hand Flexors. L. Hand Flexors. R. Hand Extensors. s 1 1 I h) R. Forearm Pronators. L. Forearm Pronators. R. Forearm Supinators | L. Forearm Supinators. R. Arm Flexors. L. Arm Flexors, | R. Arm Extensors | L Arm Extensors | R. Deltoid* •d 2 S j 1 R. Pectorals. 1 i n4 | R. Shoulder Retractors | L. Shoulder Retractors R. Foot Flexors. L. Foot Flexors. R. Foot Extensors. L. Foot Extensors E S X L. Leg Flexors. E § 1 w is x L. Leg Extensors. R. Thigh Flexors L. Thigh Flexors R. Thigh Extensors L. Thigh Extensors 1 I < wO bC 3 H « L. Thigh Abductors R. Thigh Adductors. L. Thigh Adductors Trunk Anterior. 1 Trunk Posterior J Trunk R. Lateral | Trunk L. Lateral J Neck Anterior. J Neck Posterior. J Neck R. Lateral. Neck L. Lateral. I Inspiration—Waist. J Inspiration—Chest. Inspiration—Waist Expans’n (in. Inspiration—Chest Expans’n (in. d 0 ~ •§ i f • | § z B .§ p. C/) ; 1 1 « .5 3* B* w OT C/5 O 3 e H CC § 8 a 0 CA Vi W 1 68.5 175 112 110 25 25 60 55 72 65 60 50 60 55 60 58 90 90 95 90 80 82 300 300 88 80 145 140 168 165 170 168 120 115 111 105 115 490 140 135 28 65 65 65 165 220 6.0 5.56 0255 1232 2337 1103 386 5058 1 , 2.5 68.0 168 110 107 23 24 52 53 58 57 47 41 52 61 52 55 89 85 92 82 76 76 284 278 84 80 125 118 159 154 156 154 98 104 110 99 110 446 132 127 26 63 53 60 152 193 5.3 5.35 7 237 1130 2155 1017 346 4648 2.5 5 67.1 159 102 92 22 21 48 49 51 51 40 38 48 49 46 49 82 79 77 74 70 71 263 256 78 79 108 104 131 127 136 134 88 95 106 90 103 386 121 122 25 60 48 49 129 158 4.9 5.15 1224 1018 1936 914 288 4156 5 10 66.0 148 88 79 19 18 42 43 48 46 35 33 44 42 43 77 71 63 63 61 62 232 235 71 74 95 88 112 108 118 123 83 87 91 84 329 108 112 23 55 42 107 135 4:2 4.44 6213 896 1724 803 243 3666 10 15 65.4 141 81 74 18 16 39 39 45 42 33 32 41 73 67 58 58 58 57 219 225 6§ 4o 88 83 108 100 109 114 79 81 80 l) 87 304 104 105 39 3) 97 121 3.^ Jptl4 3Sfo7 836 1615 748 219 3418 15 20 64.8 135 17 15 36 36 42 39 30 30 h 34 39 38 68 63 53 53 53 207 217 /65 66 82 77 103 94 102 106 74 3 A2 71 82 276 99 99 bo 45 36 34 >87 3.B4 \778 1518 691 197 3184 20 25 64.4 131 72 16 14 34 34 40 36 29 28 * 36 32 37 36 \64 69 60 h 51 29^ 63 63 76 72 100 89 Al 71 68 68 77 -9o 19 43 34 32 81 102 3 3 3.Is m 1447 &VI 184 3010 25 30 63.9 127 68 63| 15 14 37 33 27 2j S3 29 35 34 '45 48 47 194 197 60 60 170 Jo 9 95 85 90 95 67 67 64 64 72 225 90 90 18 40 30 75 96 3 1 3.6JB 0/93 684 1372 59*1 17^ 3Q 35 63.7 125 65 61 (4 13 is 3% 1 35 31 28 33 32 66 63 \d 42 45 44 189 189 68 57 V) '66 85 *82 85 90 63 64 61 62 69 205 86 85 17 38 29 .72 90 2.9 3.41 41188 649 1307 559 2678 36 40 63.3 122 62 58 13S 28 29 29 24 24 28 26 31 53 49 4? 39 42 40 181 180 56 63 to 61 80 76 81 84 69 60 57 68 178 80 80 15 35 8 57 67 84 .8 3.33 J183 1608 1230 508 152 2498 40 ,45 63.1 12C 56 12 11 27 27 31 28 22 22 26 24 30 50 47 38 36 39 38 1U i72 51 60 68 58 76 74 77 81 56 67 64 55 172 76 76 14 33 !7 64 79 .6 3.13 0 179 y76 1170 484 144 2373 45 50 62.8 117 L 53 11 10 26 26 29 26 20 20 24 22 2£ 21 46 45 36 34 36 35 1E7 lffi 47 46 63 64 72 70 72 75 62 52 61 51 149 71 71 13 31 24 23 59 74 :.4 3.02 8173 939 1099 436 134 2208 50 45 62.6 ilk p3 BO 9 8 24 26 24 19 19 22 202T 21 43 42 34 33 32 157 151 43 •42 48 50 65 65 67 70 48 48 47 47 152 128 66 66 12 3( 22 21 \55 69 !.3 2.82 5168 ebo 1015 397 12512037 45 40 '2.4 112 I51 8 7 23 25 23 17 16 20 19 24 [■41 32 f2£ 31 29 149 14d 39 39 45 46 62 62 64 65 44 45 44 43 148 l16 62 61 11 2 20 20 52 64 2.2 2.72 4164 4\ 953 365 117 1906 40 35 ■2.1 109 147 7 23 21 23 22 16 15 56 24 22 \38 B7 26 29 26 140 136 135 33 43 41 57 56 59 60 40 41 40 39 f 44 J03 fa 53( 10 9 > 19 18 61 2.0 2.52 2159 43o \S15 108 1748 35 30 62.0 lt»7 '45 42 7 21 bo 22 20 14 13 i6 15 23 21 135 J35 28 25 T 23 130 129 B0 29 37 37 62 62 55 65 36 37 37 3a 41 152 51 \9 fa 17 17 51 1.9 2.42 0154 408 '305 V J^12 30 25 61.] 104 41 38 \6 20 B8 21 18 12 11 fa 13 22 19 B2 (32 26 23 2B 21 118 116 E6 24 32 32 r 40 ,60 49 ‘32 32 M 36 r 48 46 K22 15 15 39 1.7 2.21 7148 371 714 275 89 1449 25 20 GU4 101 38 34 6 A9 17 yl7 11 10 12 12 20 18 29 24 22 2( lj 108 106 29 (■42 42 45 29 /si 28 32 44 41 720 13 13 35 1.6 2.11 6143 342 647 247 81 1317 20 15 61.) 10h 33 30 5 5 18 *18 9 9 11 10 IS 15 25 21 20 15 93 89 18 18 26 36 35 39 24 27 24 29 69 39 35 519 11 11 30 39 1.4 1.91 3135 304 542 218 09 1133 15 10 60.7 29 27 4 4 16 1? 16 14 18 10 10 15 14 22 21 19 18 12 79 70 14 14 22 17 33 32 33 34 21 24 22 22 26 61 33 30 517 10 9 25 33 1.3 1.81 1127 270 459 191 5i- 978 10 5 59.7 S6 25 '23 3 3 14 12 15 10 6 7 9 9 18 17 13 14 9 7 58 61 10 9 14 10 25 26 26 26 19 19 17 18 21 47 26 24 5 12 7 7 18 26 1.0 1.5 8114 208 344 149 44 745 5 2.5 58.6 89 23 20 2 2 10 10 12 9 6 ' 6 5 5 12 12 10 9 5 5 37 34 7 6 6 6 17 17 18 18 12 12 11 13 20 32 22 20 4 10 5 5 12 24 .9 1.5 5'78 161 223 118 36 538 2.5 1 58.0 79 20 20 2 2 10 10 8 5 6 6 5 6 5 10 JO 8| 5 5 5 20 15 5 5 6 5 10 10 10 10 10 10 10 10 20 30 20 20 2 10 5 5 10 20 .8 1.5 5 60 139 145 112 30 426 1 X 1 Strength Measurements of. '0.-. Taken/A'. 189 /. 189./.. 189 189 by Copyrighted 1891, by J. H. KELLOGG, M. D., Battle Creek, Mich. CHART III. TABLE OF STRENGTH MEASUREMENTS. Arranged from the Measurements of 100 Adult WOMEN, taken and compiled under the direction of J, H. KELLOGG, M. D., Battle Creek, Mich EXCEPT WHEN OTHERWISE INDICATED, QUANTITIES ARE EXPRESSED IN POUNDS AVOIRDUPOIS. >*, to cn cn 01 SI 8 to ft: CO ° CO cn 45 © 45* cn cn O 4* 9. S 03 o« 63 O *3 cn 8 cn O Cn ! to . : bt -1 PER CENT Ot 00 cn 3r cn 05 O HI 05 05 05 r. 05 to b 05 to 05 to b 05 to 05 05 to no 05 1 05 CO CO b I CO 05 CO b 05 CO b ft b 05 45“ bo 05 cn 45“ 05 05 b 05 | 05 HJ CD b 1 b 05 GO cn HEIGHT (inches). hH CD c o i=ft 0 CD to IS H4 HI to 1 to i to 0 to ! or to HJ CO t—4 CO cn ft. ft cn CD 05 00 H] cn WEIGHT. to to to to CO* 45. 45-. 4^ cn "*uT co cn 05 I os cd 1 to | cn 05 GO HJ to HJ 05 00 s O to 0 ft R. Hand Flexors. £ a CD to to to CO 4“ ►£* ■ & cn cn CO oT! ffi 1 &■ 05 05 05 HJ O HJ 45“ HJ CD CD to Oj H HJ I Q f L. Hand Flexors. HJ HJ £ CO 45“ cn £ CD to ro to co to i . cnj R. Hand Extensors. CO 05 00 to to 4-“ to | cn L. Hand Extensors. tS- TO" fw- 4-. to 05 to —r to CD CO to CO 45“, CO 05 CO CD 45“ to ft cn to 05 : 0 1 R. Forearm Pronators. to i2. to CO CO 45“ CO CO CD 45“ CO 45“ CD cn co cn j cn L. Forearm Pronators. ft-4 to to to CO to to- CO CO CO cn CO HJ 45“ O 45“ to 45“ cn ft cn cn CD HJ . to ’ R. Forearm Supinator a —1 ft-4 00 to o to to to CO to to 00 to CD co CO co CO 05 CO CD 45“ to 45“ 05 cn Ox HJ 05 • cn L. Forearm Supinators. CD to to 45“ to cn to HJ to CD CO 0 CO CO CO Cn •4-“ O 45“ HJ 05 , 0' R. Arm Flexors. to to to to HI ro CO 0 CO to CO CO CO 00 45“ g L. Arm Flexors, M ft-4 —1—1— ft-4 H4 ! tO to* to to CO CD co 05 CO CD 45“ to ft ft cn to g R. Arm Extensors ft-4 Hi i H* 05 ! CD to to 05 00 to CD CO to 2 CO GO ft 45“ CD cn cn cn L Arm Extensors ft-4 : to to to to CO 2 SH to 00 CO 0 CO co co CO cn CO CO CD 45“ t-4 45“ co 45“ 05 cn to 05 0 1 R. Deltoid.. to to to to cn' to CD CO O co to CO 4-“ CO 05 co 00 45“ 0 4^ to ■4^ CD Ol cn cn CD L. Deltoid. to to CO CO CO co b 45. 45.' cn cn cn 05 4“ 05 00 HJ CO HJ HJ 00 to CD CD CD O R. Pectorals. to to CO CO CO CO 45. 4“ 4*2 cn cn cn CD 05 co 05 HJ HJ HJ CD 00 cn CD O L. Pectorals. ft-* to 2 to to CO CO co CO 4“ £■ cn 0 cn co cn 00 05 CO HJ HI CD to CD cn R. Shoulder Retractors to to to to to 05 to CD CO CO 4— 05^ co ,CD 45“ to 45“ cn 4^ CD cn CO 85 05 co HJ 45“ 00 to CD 0 L. Shoulder Retractors to to to to co CO CO CO CD 4“ cn ft cn cn 45“ cn 00 05 V-4 HJ O HI 05 CD 0 R. Foot Flexors. (r1 to to to to O £ 45“ cn O cn co cn HJ 05 to —4 05 CD to L. Foot Flexors. to CO H| CD o CO £ IS CD cn HJ 05 -T ft-4 00 (—4 00 CD CD 45“ to 0 to 0 HJ to CD to CO ro to C5 CO to 2 CO 0 0 R. Foot Extensors. CO cn 00 CO IS ! cn 05 HJ CO .00 CD I—4 CD -4 to 0 00 to ft-4 HJ to to cn to CO cn to cn 05 to CO CO 0 0 L. Foot Extensors ft-4 ft-4 to CO CO coTJ?*- cn Cn 05 cn CD 05 O 05 co 05 cn £> 00 HJ >—4 HJ 00 2 CO CD R. Leg Flexors. H» to to CO CDjjb cn cn Ox HJ 05 O 05 CO 05 05 HJ O HJ 45“ HI CD co 0 CO O L. Leg Flexors. ft-4 to CO CO CO 45. • £- cn cn 05 05 HJ HJ O HJ -05 00 to $ CD cn 00 to Cn ft-4 45“ Or R. Leg Extensors. CO CO $ —H— 4“ , cn cn cn 05 05 05 HI HJ 00 CO S 2 H4 00 ft L. Leg Extensors. CO CO ft- 4^. c 1 05 ; 05 HJ HJ CO 0 00 cn CD cn 0 0 O CO 0 00 ro co Cn CD 05 CD R. Thigh Flexors O r/3 ft-4 lo CO CO fc' 4“ cn Zr 05 05. HJ HI 45“ *ni co' CD cn co CD 45“ H4 0 0 0 00 to HJ 2 05 cn L. Thigh Flexors to co CO 4^ cn a cn 05 05 HJ HJ 00 00 CD CD ;0 0 CD CD CO 05 cn 05 HJ O R. Thigh Extensors ft-4 ’ CO 45“ CO 00 4^ cn 45- CD cn cn 0s 05 O HJ cn 00 2 CD O CD cn 0 0 05 IS to CO CO 45“ cn 45“ 05 CD L. Thigh Extensors ft-4 to £ to CO CO 4“ 4^ 45. cn cn- 05 cn CD ffi 05 HJ HJ HJ 45“ HJ CD CD CO CO 00 CD CO to O R. Thigh Abductors 2 to to CO co 4=“ 'IS cn cn —4 05 0 05 HJ HJ HJ cn 00 00 HI CD Cn 2 cn L. Thigh Abductors - to s 2 CO 45. £ 4“ cn Cn 4“- a 05 05 45“ 05 GO HI to 00 0 CD O 05 O ft-4 R. Thigh Adductors. ft-4 _ to to to CO co cn 4^ CO 4“- HJ cn cn- cn cn 00 05 to 05 45“ 05 00 HJ HI 05 2 CD O CD CD O cn L. Thigh Adductors to to o to to 05 to CD CO to CO 05 45. £ g cn 45- 05 05 cn 05 CD HJ to HJ HJ GO to 00 HJ CD CO O CO O ft-4 Ox Trunk Anterior. w cl 51 ft CO CO 4“ 05 05 CD HI —J GO cn 0 CO 05 to 00 4“ CD ft-4 HJ to HJ 00 to O cn to to cn to cn to to HI 05 CO 2 CO to CD CO GO 05 .ft 05 4“- CD ,o Trunk Posterior to to to 05 CO CO CO CD £ & cn to cn 05 05 to 05 05 HJ HJ 05 00 0 CO 05 CD 0 CD cn CD CD 2 O GO to I—4 CO to IS O Trunk R. Lateral. to to to CO CO 4** 4^ HJ HJ 00 a CD CD CD O t—4 to to HJ CO Trunk L. 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O cn O i an , 1 bi V-4 PER CENT. Strength Measurements o’... Taken 189 \ 189 A/N( 189 by V l5 V 80 Copyrighted 1891, by J. H. KELLOGG, M. D., Battle Creek, Mich. CHART IV. 41 peculiar feature of the machine is the character of the weight, which, as stated, consists of a cylinder partially (about two thirds) filled with water. As the handles are raised, the water flows toward the upper end of the cylinder, thus adjusting the weight to the lifting ability of the muscles, which decreases in proportion as the muscles shorten in contraction. By this means, the muscular equilibrium is maintained to the fullest degree possible, and better results are obtained than can be reached when the weight is not made to vary automatically in adjustment to the varying lifting capacity of the muscles. The work required of the muscles of the trunk in steadying the body during the use of this apparatus rapidly increases their strength and tone. Chart III shows the improvement in muscular strength and symmetry made by a patient under treatment and training dur- ing four months. In this case no displacement of the pelvic viscera existed, only general debility and weakness. Chart IV shows the gain made in two and one half months by a young woman who had suffered a number of years from chronic retroversion and prolapse. The most marked improve- ment was in the strength of the anterior muscles of the trunk, which increased more than 250 per cent. In conjunction with carefully adjusted and graduated exer- cises, I find electricity to be an invaluable aid in treatment, and have, since 1883, employed a current supplied by an alter- nating magneto-electric machine, which possesses the peculiar property of being able to excite vigorous muscular contractions without sensory effects. My usual method of applying this cur- rent is by means of a divided pole electrode placed in the va- gina, and a sponge electrode applied to the abdomen. When used in this way, it produces vigorous action of all the muscles of the lower abdomen, the perineum, and in several groups of muscles of the thighs. Contractions so vigorous as to produce violent shaking of the patient’s body, and even the table as well, can be easily produced in most patients without other sensa- tion than that of motion. The special properties of this cur- rent are due, I think, to the peculiar construction of the machine producing it, by means of which currents of great uniformity are produced. 42 I have shown, at Fig. 7, the curve produced by this ma- chine, which is in strong contrast to that produced by an ordinary faradic machine, shown at Fig. 8. I do not wish to be understood as indicating that all or any considerable proportion of cases of chronic displacement of the pelvic viscera can be cured even by the removal of proxi- mal causes and a faithful application of all hygienic means. Even a combination of hygienic and medical therapeutic meas- ures will fail in the great majority of cases of long standing. Such surgical measures as may be appropriate in each indi- vidual case must be resorted to in the great majority of chronic Fig. 7. Fig. 8. cases. This fact, however, does not detract from the impor- tance of the considerations presented. In the writer’s opinion, neglect of these principles has often led physicians to subject patients to long-continued, and not infrequently mischief-producing, treatment for pelvic ailments of a trifling character which were wholly secondary factors in the case, the main features of which were the outgrowth of static disturbances of the abdominal viscera which required treatment by the application of suitable therapeutic means. A considerable number of cases have come under my observa- tion which have been subjected to surgical procedures for the relief of retro-displacements of the uterus, and even extirpation of the ovaries for prolapse of those viscera, in which the patients were in nowise better for the operations which had 43 been performed upon them, simply because of the neglect of the operator to recognize the displaced condition of the ab- dominal viscera, and the irritability of the abdominal sympa- thetic, and the perverse reflex activity arising therefrom. The facts and conclusions presented in this paper may be summarized as follows :—. 1. Women suffering from visceral displacement of the ab- domen or pelvis present a peculiar muscular type, character- ized by weakness of the trunk muscles. 2. Cases of this sort also present peculiar deviations from the normal type of the human female figure, the most char- acteristic of which are a depressed or narrowed waist, flat or hollowed chest, round shoulders, prominent abdomen, forward carriage of the hips, and depressed position of the umbilicus. 3. A very large proportion of cases of displacement of the pelvic viscera present also displacements of the abdominal viscera of various forms and degrees. 4. The chief causes of visceral displacement in civilized women are an unhealthful mode of dress, and a lack of vigor- ous and symmetrical muscular development. 5. The so-called feminine type of respiration, or what is sometimes called costal breathing, is not a natural character- istic of the human female, but is the result of a mode of dress which restricts the normal respiratory movements of the lower chest.