the muscular pulls are arranged according to the same system as in the previous model, but the difference here is that the vertebra may revolve on either one or two axes, a primary axis representing the axis of motion of the whole rib ring regarded as one piece and a secondary axis representing the axis of motion. of the vertebra by itself. In order to hold the vertebra to the primary axis, a retaining peg is used. In this way the vertebra may be revolved either on the primary or by itself, depending upon whether the retaining peg is in place.

The first motion to illustrate is lateral bend (Fig. 10), and with the retaining peg in place holding the vertebra to the

primary axis, a position is obtained corresponding to the lateral bend of the first model. The result of peripheral strain is just the same as in that model, being expressed by the contraction of the rib ring on the one side and the relaxation on the other. The main question here is, what is the effect of the potential strain in the rib ring upon the individual vertebra? To answer this, the retaining peg is removed, thus permitting the vertebra to rotate on its own axis if the tendency is there. The result is (Fig. 11), as you see, an actual rotation of the vertebra so that its arrow points to the side on which the rib ring is contracted. This movement may be referred to as a retrogression and bears out

the tentative deduction, earlier made, as to the effect of rib strain on the individual vertebra.

Let us next illustrate twist. With the retaining peg in place holding the vertebra to the primary axis, we again obtain a position of the rib ring corresponding to the twist of the former model (Fig. 12), and the result, as you might expect, is a spiral tension of the elastic tapes with some distortion of the rib ring similar to that of the former model. We again ask the question, what is the effect of the potential strain on the vertebra as stored up in the rib ring thus placed? To answer this the retaining peg is removed (Fig. 13), and we immediately note that the

vertebra rotates to the side on which the contraction of the rib ring becomes greater. Comparing this position with the final position of lateral bend, we note that they are almost the same, and by manipulating this model we are able to ascertain that the position of the vertebra and the shape of the rib ring are dependent upon the actual point at which the vertebra rests, no matter by what path it arrives there, because the final position is simply one of equilibrium for that point.

The relation between a normal tendency and a pathologic fact: In this way I have illustrated the tendencies of posture in the normal. It seems to me that I have presented sufficient.

evidence to offer an explanation of the important points in the pathologic as based upon these normal tendencies. For if our conception of normal strains in terms of distortion is correct, then we may assume that these distortions become permanent if the strain is carried beyond the limits of elasticity. We may suppose that prolonged or repeated strain, or diminished resistance in the skeleton, may bring this about. So in making our explanation, if we simply assume that the limits of elasticity have been overstepped and that the bones have taken a permanent set, we can readily understand how a normal tendency results in a pathologic fact.

Chief distortions of the scoliotic specimen: Before making the explanation, let me briefly run over a few of the important findings in the pathologic. Taking a typical scoliotic (Fig. 14), you will note the thorax contracted on the one side and expanded on the other. On the side of the contraction the ribs have also given at their angles, descending in an up and down plane. In the column, you will note the curve. The bodies of the vertebræ form a greater curve than the spinous processes, the rule being that the fronts of the bodies point toward the side of the convexity of the lateral curve. These are the essential points but there are other points to which I will refer more fully as I develop the explanation.

distortions of thorax.

(Concluded in November issue)

Observations on the Medical Progress
in the Orient

By IRVING LUDLOW, M. D.

Surgical Pathologist, Lakeside Hospital, Cleveland, O.

We are all well aware of the fact that it is the natural inclination of those who travel to record their observations. It is also true that some who have written concerning foreign lands have given us views which have been based upon the observations of others rather than upon their own personal experience. Sometimes the traveler has simply entered the port cities of some great country and then written articles or even books upon topics with which he is little conversant or upon information gained from hearsay. In the medical centers of Europe, there are constantly large numbers of our fellow countrymen and we are frequently favored with most excellent accounts of the medical work in that part of the world. It was only after writing this, that the excellent paper of Dr J. E. Mears, of Philadelphia, entitled "Modern Medicine and Surgery in the Orient," was brought to my notice, and when read it was found that we had visited many of the same places. There are however comparatively few medical men who have had an opportunity to observe the progress which is being made in the Oriental countries, especially China, Corea and parts of India, teeming with their millions of people.

A large part of the progress has been made through the efforts of physicians from our own country in whom we, as members of the medical fraternity, should have great interest. It is my firm belief that it is only lack of information that has been responsible for this apparent indifference and anything which might be done by me to awaken interest in their behalf would only in small measure repay them for their great kindness and courtesy during my visit. In order that you may be familiar in general with the territory covered, the following outline of our trip may be of value. The first place visited was Honolulu where two weeks were spent. After two months in Japan a four months sojourn was made in China and Manchuria followed by three months in Corea. Returning to Japan the trip was continued westward to the Straits Settlements and Burmah. The next three months were spent in India and the remaining six weeks were occupied in visiting Ceylon and making the homeward trip to New York. After four years in one of our home hospitals and a year's visit to the hospitals of Europe you can well imagine my