Exercises._--Rudolf Klapp has devised a series
of exercises designed to strengthen the muscles and ligaments of the
spine, and to increase the mobility of the column. To take the weight
of the body off the spine, and to render both ends of the column
mobile, these exercises are carried out in the "all-fours" attitude,
the patient crawling in imitation of a quadruped, that is, in such a
way that the hand and knee of one side are approximated, while those
of the other side are separated; in other words, the hand and knee of
one side should not move forward simultaneously (Fig. 230). With each
step the spine is curved laterally, the concavity of the curve being
towards the side on which the hand and knee are approximated. The
exercises, for a case of dorsal curvature with the convexity to the
right, for example, are graduated as follows: (1) The child crawls in
a straight line till he has acquired the "quadruped gait"; (2) with
each step forward the head is inclined towards the side on which the
hand and knee are approximated; (3) at each step the hand and knee
which are wide apart are brought over and cross the limbs on the other
side; (4) to open out the concave left side, he crawls in a circle
towards the right. The exercises are practised morning and afternoon
for from fifteen to sixty minutes at a time. If there is a marked
_double_ curve, it is best neutralised by imitating the "pacing"
action of a quadruped, _i.e._, the limbs of the same side moving
forward together. The hands, knees, and toes should be protected by
suitable gloves and leather pads. Hot-air baths and massage are useful
adjuvants to the exercises.

[Illustration: FIG. 230.--Diagram of attitudes in Klapp's four-footed
exercises for Scoliosis.]

Abbott has introduced a method of treatment applicable to cases in
which the deformity has become permanent. Under general anaesthesia,
the patient being slung in a bracket-frame with the spine flexed, the
curvature is over-corrected and a plaster-case is then applied to
maintain the attitude; the plaster-case is renewed at intervals of two
or three months.

CHAPTER XIX

THE FACE, ORBIT, AND LIPS

FACE--Congenital malformations: _Hare-lip and cleft palate_;
_Macrostoma_; _Microstoma_; _Facial cleft_; _Mandibular
cleft_--Injuries of soft parts: _Wounds_; _Burns_--Bacterial
diseases: _Boils_; _Anthrax_; _Glanders, etc._; _Lupus_;
_Syphilis_. Tumours: _Epithelioma_. ORBIT--Injuries: