Before discussing the treatment of these cases, it is necessary to say a word regard. ing an important preventive measure. When a girl is defective in muscular power, dis inclined to take exercise, and prone to distortion of the spine, the sitting position does not afford her rest, in consequence of the great efforts she has to make in order to keep the body erect. A patient in that condition will derive benefit from being obliged to lie for two or three hours daily, at divided intervals, on a sofa or board. When the deform ity has actually occurred, gymnastic exercises suggested by the medical attendant will not unfrequently, when continued for some time, have the effect of loosening the con nection of the hones, of their falling into their proper places, when exten tion is employed, and of restoring to the spine a portion of its lost suppleness. Mr. Shaw suggests the following simple plan for attaining the same end: " Let the patient lie on one side, with a firm cylindrical pillow, 6 in. in diameter, placed under the gibbosity of that side, and let her rest her weight on the pillow: the effect will be to counteract and reverse the curve. The same may be done alternately on the two sides. The posture may be continued each way for a quarter of an hour at a time, and be repeated twice or thrice daily."—Op. cit., p. 858. There are two methods of extending the curved spine, viz. (1), by stretching the body while the patient is recumbent; and (2) by letting the patient remain upright, and using spinal supports. As each method has its own advantages, a combination of them will often afford the best results. The chief objections to the former are the necessary confinement, comparative seclusion, and interference with the routine of study. Any mode of treatment with the view of pro ducing extension of the spine must be continued for months in order to be of any avail. It would be altogether out of place to notice in this article the various extending beds, apparatuses for exercise, and different kinds of spinal supports that have been devised by surgeons and anatomical mechanicians, and we will merely observe that mechani cal supports must be tried with great caution. They are always more or less irksome to bear, and if they are not doing good, arc almost sure to be doing harm. On this sub
ject, the reader may consult Heather Bigg's work entitled The Spine and Upper Extrem ities.
Angular curvature consists, as already mentioned, of caries of certain vertebra;, which first consumes the bones and tibro-cartilages, and subsequently excites a discharge of pus. The first symptom of this affection is the appearance, at the seat of the caries, of a prominence of one or more of the spiuous processes. This " growing out" of the back, as patients frequently term it, is due to the destruction of a portion of the column. In an advanced stage the spinal ridge will stand out prominently, the knob of each process being distinctly visible; and finally, a distinct angular projection is developed. The consequences of this disease are thus summed up by Druitt: " 1. In favorable cases the diseased bones collapse, and are anchylozed; abscesses, if they form, are healed, or their matter is absorbed, and the patient recovers in two or three years, with more or less deformity, which is, of course, incurable. 2. In seine fatal cases the patient dies suddenly from two or three of the diseased vertebrae giving way, and crushing the spinal cord; or from dislocation of the odontoid process, owing to ulceration of its ligament; or from the bursting of abscesses into the spinal cord; or from their bursting into the pleura or peritoneum; but more frequently death is caused by slow irritation and exhaus tion, consequent on the formation of psoas or lumbar abscesses."—The Surgeon's Vude mecum, 8th ed. p. 348. The most essential point in relation to treatment is rest, and the .most effectual method of arresting motion between the diseased vertebrae, and of keeping them at rest is by placing the patient in a recumbent position on his back. If possible, an invalid bed should be procured, provided with contrivances for enabling him to lie upon it, day and night, without rising. Local counter-irritants, such as compound tincture of iodine, are often useful; and good diet, backed, if necessary, by cud-liver oil and tonics, must be prescribed. In conclusion, sufferers from any form of real or suspected spinal disease are earnestly warned to avoid the numerous quacks, whether in or out of the medical profession, who have taken up the spine as a specialty.