OCR Text |
Show 0? THE CURVED SPINE.' or THE cunvnn SPINE. 8'9 A ffik‘A‘--‘-%'fi"<‘,‘.r - In the latter stage of the disease there is pain of the back or CHAPTER IV.- OF TllE DISEASE AND INJURY OF THE SPWE. OF THE CURVED SPINE. g i i s. 'l‘nls term does not include the distortions of the spine, from rickets or lnollities ossium, but that only which is the consequence of an ulceration and wasting of the bodies of the vertebrae, a disease most frequent in the lower vertebra: of the back. ' In an infant these are the symptoms: the mother tells you that the child was strong and healthy, and perhaps that he. had begun to use his feet, and could stand upright with little assistance, but that of late he does not try to stand, and when laid over her knee, he dbes not struggle as children naturally do With their feet. You find the child's flesh soft ; and par ticularly the skin and muscles of the lower extremities, soft and woolly; upon examining his back, you find one or two of the spinous processes of the vertebrae particularly prominent. If the child be old enough to have walked, he is gradually deprived of the use of his legs ; he complains of languor and fatigue; he is listless and unwilling to move ; his legs are apt to cross, and he stumbles often, being unable accurately to direct the feet. He leans forward, and there is a projection in the spine. Large abscesses sometimes form and drop down upon the loins, and appear externally in the top of the thigh, or a tumour is formed by the side of the vertebrx of the loinv. loins, which even in bed is tormenting and incessant; the breathing, and indeed the whole functions of the thoracic and abdominal viscera, are oppressed by the chest falling down in consequence of the great curvature of the spine. The urine and faeces are passed insensibly, and in consequence of this perhaps as much as by sitting on the insensible buttocks, (the perpetual pressure on which gives no token of the degree of injury they sustain), deep sloughing or horrible ulcers take ‘ place. This is a scrophulous disease, which begins in the bodies of the vertebrae of the back or loins. By dissection I find that the first stage of the disease is not an increase of vascularity and softening of the bodies of the vertebra; so that they sink under the weight of the body; but the progress of the destruction of bone proceeds by the entire absorption of several intermediate portions of the body of the vertebrae, leaving the spine supported by the remaining firm parts, which are sometimes like columns standing betwixt that which is decayed. ( I have given a plate of this early appearance of the disease). The destruction of the bone having gone thus far, the affected bodies of the vertebrae sink under the incumbent The paralysis of the weight of the head, chest, and arms. lower extremities is new for the most part distinctly marked, but as I have seen this symptom before the sinking of the vertebra; I have concluded that the neighbourhood of the dis- eased bone has involved the spinal marrow in the morbid action, so that its function has suffered-The cessation of the disease relieves the paralysis ; which is accounted for by supposing that the spinal marrow and the tube of the vertebrae become adapted to each other ; but the circumstance is v'qualiy well explained by supposing this to be the result of the i"*ssati011 of the diseased action. la a young person who has shot up to great height, and whose muscular strength is not great, there is a possibility mm; a curve of the spine may arise from a bad habit merely, but these curvatures are generally lateral. In the true distnr. \ |