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by making little or no change in their dimensions, notwithstanding hard and persevering efforts in the gymnasium.

I soon discovered that measurements were of very little value indeed in dealing with adult invalids, however useful they may be in the management of the physical training of growing boys and girls and undeveloped youths. I learned that quality rather than quantity was the thing important in dealing with adults at least invalid adults. Through the assistance of Prof. Sargent I possessed myself of all the various forms of dynamometers which had been constructed for use in testing the strength of the muscles of the human body. I found, however, that these dynamometers had so little range of adaptability that only a few muscular groups could be studied by their aid, and finding myself daily embarrassed in consequence of my inability to meet the requirements of my patients, and being unable to avoid most unhappy blunders in my exercise prescriptions, in sheer despair I sought to attempt to devise some accurate means of testing muscular strength which could be adapted to the principal muscular groups of the body.

Having become accustomed, in the accustomed, in the physiological laboratory, to the use of the mercurial column as a pressure indicator, I adopted this as a source of resistance, and arranged a simple apparatus consisting of a cistern containing about half an inch of mercury, which received the lower end of a long piece of barometer tubing. The space above the mercury in the cistern was completely filled with water, and with the cistern was connected, by means of three or four feet of rubber tubing, a strong rubber bulb about the size of an ordinary atomizer bulb. These were also completely filled with water. By compression of the bulb, the water contained in it was forced through the tube into the cistern, displacing an equal quantity of mercury, which was forced up into the glass tube. I found that a tube nine feet in height was sufficient to provide for as much resistance as was needed to balance all the force that could be brought to bear by a strong man in pressing the bulb. By means of various accessories, I arranged to apply to this bulb the force. of all the principal muscular groups of the body, extensors as well as flexors,-including the muscles of the trunk.

I encountered various difficulties, however, the chief of which were the gradual deterioration of the rubber bulb in use, and the frequent admission of air to the cistern by a change in level of the rubber bulb, causing the mercury column to disappear from the glass tube. Closure of the upper end of the glass tube enabled me to shorten the tube and diminish some difficulties, but it increased others. After several years' experimenting with the various forms of apparatus, I finally substituted a steel cylinder and piston for the rubber bulb, and connected this with the cistern by a metal tube, placing the apparatus upon a carriage which was made to slide up and down a vertical rod, so that there should be at no time any change in the relative positions of the cylinder and the cistern. In this arrangement I substituted oil for water, as in using water my steel cylinder and piston would soon become useless from rust. To my dismay, however, I soon discovered that the oil entered into combination with the mercury, and deposited a gummy precipitate upon the sides of the cylinder, seriously interfering with the movements of the piston, which must necessarily be as sensitive and delicate as possible. I tried various sorts of liquids without any advantage. Finally the thought occurred to me that the oil and mercury might be separated by means of water, the relative specific gravity of which would keep the oil above and the mercury below. This simple device enabled me to overcome the last serious difficulty in the construction of the machine, and some three years ago I had constructed the apparatus, a cut of which is herewith shown. This apparatus has since been in constant use in the Anthropometric Department of the Sanitarium at Battle Creek, Mich. It was also on exhibition in the Anthropological Department of the World's Columbian Exposition, and during the last year the dynamometer has been employed in connection with the Physical Culture Department of the Battle Creek College.

The dynamometer shown by Prof. Seaver in his work on Anthropometry, and which he has the kindness to commend, is my first instrument, which I discarded several years ago for the improved form which I have very briefly described.

In order to dispense with the long tube, Prof. Seaver suggested using a shorter

tube and closing the upper end. I have adopted this suggestion, and now use a tube one meter in length. At the upper end of the tube is placed a metallic stopcock, which is closed after the machine is adjusted, so that the amount of air in the tube always remains the same. The scale of the instrument is made by the application of weights of known value to the lever connected with it, and has a range of one pound to 1000 or more pounds as the air contained within the tube is capable of affording an infinite amount of resistance.

With this dynamometer, which I have very imperfectly described, but which I think will be clearly understood by reference to the cut, I have made, and had made by my assistants, careful tests of the strength of the principal groups of muscles in several thousand adultsmen and women. The muscular groups tested are as follows: Hand flexors and extensors, forearm pronators and supernators, arm flexors and extensors, deltoids, pectorals, and shoulder retractors, for the upper extremities; for the lower extremities, foot flexors and extensors, leg flexors and extensors, thigh flexors and extensors, thigh abductors and adductors; for the trunk, anterior, posterior, and right and left lateral muscular groups; for the neck, anterior, posterior, and right and left lateral muscles; for the chest, inspiration,- the force of waist expansion; expiration being measured by means of Waldenburg's pneuma

tometer.

After obtaining the necessary data in the cases of 100 men and an equal number of women, I constructed a physical chart on a percental plan somewhat similar to that followed by Prof. Seaver in his anthropometric chart. In making this chart, the tedious mathematical work of which was done by one of my medical students, Mr. W. A. George, the figures obtained for each group of muscles were arranged in a column in regular order from the highest down to the lowest. Obtaining the sum of fifty per cent, of those found in the middle column, and obtaining the average, the result was put down in the center of the corresponding column on my chart. Forty-five per cent reaching five per cent above the upper level of the middle fifty per cent, were next massed together and the average found, and the result placed in the same

[merged small][graphic][merged small]

make a graphic representation of the strength of the body, just as bodily dimensions have heretofore been graphically represented upon anthropometric charts and tables.

At the right-hand side of the chart, I arranged five columns for the totals of the arms, legs, trunk, chest, and the entire body, so as to bring under the eye at a single glance both the relative and the actual strength of the principal divisions of the body.

I was Prof.

I have since prepared two other sets of tables, one based upon the data obtained from testing 600 adult men and an equal number of adult women of various ages between eighteen and sixty years, and another based upon the data obtained from 200 young men twenty to thirty years of age and an equal number of young women of the same ages. surprised to find, as, however, Seaver had predicted would be the case, that the figures obtained from the examination of 600 persons differed very little from those obtained in the examination of 100 persons of the same class. The chart based upon the examination of 200 healthy persons between twenty and thirty years of age, differs from the other chiefly in that the figures start at a higher level. In transferring the graphic representation of a person's muscular strength from one to another of these tables, I find that the characteristics, although slightly modified, always remain. the same.

As a further test of the value of the chart, I have platted the figures obtained for the various groups of muscles, and find that excellent curves are made. In the case of the left foot flexors, for example, an almost absolutely perfect binomial curve is obtained.

The best test, however, for the value of this method of obtaining a basis for a prescription for exercise, is the fact that it meets in a most admirable manner the purposes for which it is designed.

The data afforded furnish exact information concerning the capacity of each of the principal groups of muscles in the body. Knowing the capacity of each muscle, it is easy to proportion the work. in such a manner as to secure symmetry of development. My plan of accomplishing this, is as follows:

Taking 300,000 foot-pounds, one sixth of a full day's work, as the proper daily

dose of exercise for a man whose total strength capacity is 10,000 pounds, corresponding very nearly to the greatest capacity shown upon my table prepared from 200 young men in vigorous health, I undertake to establish the definite relation between the strength capacity and the total amount of work to be performed.. This is easily accomplished by dividing the total amount of work done by the total capacity of the muscles; that is, 300,000 is divided by 10,000 giving 30 as the result. This indicates that in a symmetrically developed man with a total strength capacity of 10,000 pounds, each muscle, in order to do its proportion of the 300,000 foot-pounds' work prescribed, must do work to the amount of thirty times its lifting capacity represented in footpounds. It is only necessary, then, in order to ascertain the exact amount of work to be done by each group of muscles, to multiply by 30 the figures in each column of the horizontal line at the top of the table, multiplying each successive total by 30, and for each individual group of muscles by the same means.

I have made a careful approximate calculation of the amount of work to be done in each exercise, or set of exercises, with each apparatus in my gymnasium. It is necessary to know the strength of the medicine as well as the needs of the patient. Knowing the amount of work required for each individual and for each set of muscles, and also the result obtained from each exercise, it is very easy to construct tables of exercises exactly adapted to any capacity.

To make a prescription for exercise, I first note the total capacity of the individual, and write down a number which indicates the day's order which would secure for an individual of the given capacity the proper amount of work. Then glancing over the chart, I note the low points, and check or underscore each of these, which indicates to the assistant who superintends the exercise in the gymnasium, that the work is to be doubled on all such points, so as to secure to the weak muscle such rapid development and growth as will enable it to overtake the rest of the body, and thus secure muscular symmetry.

In practice, I find that this method never results in giving to a muscle more than a full day's work, and consequently there is no danger of injury resulting from

this doubling of the amount of work required of weak muscles. In case of complete paralysis of the muscle, it is neces

sary, at the beginning, to administer the ex

schedule of work at each of the levels indicated by the several quantities representing total muscular capacity.

The ratio which I have established be

[graphic]

PHYSICAL CHART

Arranged from the results obtained in testing the strength of the individual groups of muscles in 600 WOMEN, by means of a Universal Mercurial Dynamometer, made and compiled under the direction of J. H. KELLOGG, M. D., Superintendent of the Sanitarium and Hospital, Battle Creek, Michigan.

Chart No.

ercise by

electrical or mechanical

means.

As a rule, I find it sufficient, for practical purposes, to divide the series of total capacities represented upon my table into. five groups, instead of making a distinct

tween the muscular capacity and the

sons in vigorous health; but I find it well suited to the class of persons who come under my observation, who are for the day's work is probably too small for per

The

most part invalids or semi-invalids. man who is in training and desires to develop his whole body to its highest capacity, should of course be required to execute a full day's work, or 1,800,000 foot-pounds, and even more. In arranging a day's order of exercise, due account is of course taken for the work done in walking, running, and similar exercises which may be made a part of the program.

The patient does not undertake to do all the exercises prescribed in the series the first day, but gradually takes them up from day to day as he learns them and becomes able to do them, and by the end of two or three weeks is expected to have thoroughly mastered all the exercises given him, and to have become able to take each day all the exercises given him in his prescription.

At the end of a month, another chart is made and the changes noted, and a new prescription made according to the requirements. It is a matter of frequent observation that the points which at the first examination are lowest on the chart, are so improved by the specific exercise directed to these particularly weak muscles that the lowest points become the highest ones upon the second chart.

By means of this method, it is possible to obtain exact knowledge respecting the requirements of each individual case. Possessed of this exact knowledge, it is possible to make a prescription which will be exactly adapted to the wants of the individual. It is possible to make in less than a minute's time, a prescription which is more exactly adapted to the wants of the individual examined than could be made by the most elaborate study and the consumption of any amount of time, without the aid of the accurate data obtained by this method.

One of the charts herewith presented, that of Mr. A., shows the value of this mode of investigation in the diagnosis of morbid conditions affecting the motor system.

This patient was suffering from paresis of the left arm. This would be apparent from the chart alone, without other evidence, as will be readily seen. The dynamometer picks out the particular groups of muscles which are affected by paresis or paralysis, and thus gives important indications respecting the location of the central lesion, of which the paralysis is merely a symptom. This chart

also shows in a most interesting manner, the value of the dynamometer as a means of indicating the progress made by a paretic patient under treatment.

Another advantage in this mode of studying the motor apparatus is the fact that the dynamometer tests not only the muscles, but the nerves and nerve centers as well, so that it is a precise measure of the condition of the individual's motor apparatus. It is a true measure of the dynamic energy of the body, and shows the actual ability of the individual to manifest energy through his muscular system as a whole and through each particular part of it. The tape-line merely gives the dimensions of a man,

- it tells nothing as to whether he is alive or dead. A dynamometer gives us an accurate picture of the living, active man. The chart obtained by means of the dynamometer enables the physical director to make a precise prescription for exercise without even seeing the subject, whereas the data furnished by the measurements of the tape-line may relate to a man who is dead, or so completely paralyzed that all forms and degrees of exercise are alike impossible; so that without the aid of the dynamometer, anthropometry is a most unreliable guide and almost altogether useless, unless the subject is before the director, who, even then, is obliged to depend upon his intuitions and his experience in arranging a program for gymnastic work, rather than upon the indications of the tape-line.

After several years' use of my dynamometer and the charts which it has enabled me to prepare, I am so thoroughly dependent upon these means of directing the gymnastic work of my patients that I should be utterly at a loss to know how to prescribe for them without this or some equally good means of exact diagnosis.

I ought, perhaps, to have said another word respecting the method of using the dynamometer. I have worked out an exact mode of testing each group of muscles. This method is followed with precision in each test made. The general principle which I have followed is that the resistance of the dynamometer should be applied at the distal end of the bone which is operated upon by the group of muscles under examination, and in such a manner as to give the muscle an opportunity to act to the best advantage, at the

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