strengthen irritated muscles at the outset by further use, but by temporarily putting them at rest by relieving the strain of the posterior musculature.

A properly fitting corset with a tight pelvic hold not only improves balance, but incidentally serves as a splint and support. The blacksmith who is to do heavy work with his arm puts a leather strap around his wrist to enable his muscles to work to better advantage. He gains. thereby an extra annular ligament.

Proper corsets, then, accomplish three things in the relief of this condition:

1. . They tend to corred vicious balance by carrying the center of gravity backward, thus relieving muscular shain.
2. . They partially splint the lower back.
3. . They furnish an artificial annular ligament to the glutei museles.

High-heeled shoes are also to be recommended temporarily, when comfortable to the patient, because experimental observation has shown that they carry back the center of gravity, and clinical experience is generally confirmatory of their good effect.

If lateral deviation of the spine exists, it is to be improved by an extra lift on the shoe of the side to which the body leans.

In the more severe cases the actiye day should be a short one and recumbency for some hours during the day should be insisted on. It is only necessary to allude to the fact that the general condition of the patient must, of course, he attended to from the outset. After a week or two of such treatment, aimef1 at resting tired and irritated muscles, the patient is generally ready for the second stage of the treatment. mmeular development as a means to the attainment of a permanently correct attitude. In irritable cases the exercisès should be given at first in the recumbent position and later only in the erect position. The whole temleney of most medical gymnasts is to overdo hoth the massage and exercise at first. It must be remembered that the maximum museular stimulation from massage is reached at the end of five minutesl0 and that, after that, deterioration of muscular strength follows. Increase of backache following the execises is a sign of too active exercises or too long a period of them. They are hest taken once a day, the length of the period being gradually inereased.

It must be admitted that, irrational as it is, many cases of backache are relieved try the use of corsets and hig-heled shoes aloue. In a larger number this is a most useful preliminary to further attempts at radical cure, and we mUcit remember that we shall be really curing such patients only when we have found and removed the condition which cansed the disturbance of balance induring the bark-strain.

We beliere that static backache is essentially a mechanical disorder; that is, that it is the result of loss of balanee producing local strain on the tissues in the lumbosacral region and elsewhere in the posterior musculature. We further belieye, nnd regard it is our most essential point, that whatever the local mechanism which produces the symptoms may be, such backache is in a large proportion of all cases not a disease in itself (as suggested by such terms as "hysterical spine," "relaxation of the sacro-iliac joints," etc.), hut is a mere symp-

10. McKenzie: Exerise in Education and Medicine, Philadelphia, 1909, p. 47.

tom-complex due to an abnormal attitude induced by peculiarities of the skeleton, lack of proper muscular balance, or abnormal conditions in the abdomen or elsewhere. We believe that in diagnsis the local condition should be regarded as primary only after every cause elsewhere has been exeluded.

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