These changes in the membranes will naturally affect the organ they cover. Its room in the spinal canal is narrowed, the circulation in its blood- and lymph-vessels is interfered with, until finally the cord itself suffers from the increasing pressure and is disturbed in its functions. The oedema alone may seriously affect the cord, according to Schmaus, and cause paralyses; though this will he still more pronounced when the granulations break through and produce tuberculous changes in the meninges (Fig. 131).
Alteration in the position of the vertebrte as regards each other may bend the cord upon itself, or protruding sequestra or spurs at the site of the deformity may injure the cord.
Formation of Abscesses. — Abscesses which protrude or break through may act in a similar manlier. But usually the abscess will follow gravity downward along the large vessels, then along the psoas muscle, filling the fossa iliaca and appearing below Poupart's ligament (Witzel).
As we have mentioned before, the pus may also ascend in the loose tissues and appear in the neck near the cervical blood-vessels. In spondylarthritis and suboccipitalis the pus usually breaks through backward under the skin, or it may sink downward and forward, thus forming the retropharyngeal abscess al ready described, and which may also be caused through ascent by tuberculosis of the upper and middle cervical vertebra.
The pus from the lower cervical vertebra3 follows the blood-vessels and may appear at the ribs along the intercostal vessels, but it usually sinks downward and then will take the ordinary route to Poupart's ligament..
Abscesses from the lower vertebrx follow the same course. Much more rarely the pus breaks through the back or follows other struc tures it meets (sciatic nerve, periproctitic ab scesses).
are caused by the inter ference with the function of the spine by the disease.
Very early symptoms are segmentary pains which the children always speak of as a stom ach ache (Judson). These are caused by the compression of the diseased vertebrm stein) (pressure upon the nerve-roots), and they are similar to other neuralgias.
The children will soon learn to eliminate the pains which arise when ever the spine is moved, by carefully fixing it by means of the muscles. Their carriage is tense, scared, as if they were listening (Fig. 133a).
This is still more pronounced in their cautious gait.
When they are sitting, they brace themselves with the arms; in walking they clutch the nearest object for support or hold on to their own thighs to relieve the weight upon the spine (Figs. 133a, 133b).
When the spondylitis is high up, they support the head upon the Arms, bracing the elbows, in order to lighten the spine.
When we ask these patients to pick something up from the floor, they bend only the hip and knee-joints and climb up on their legs with their hands, carefully holding the spine stiff (Fig. 135). When we ask them to turn or bend the body sideways, we observe that this is never done in the spinal joints, but in the hips.
In advanced cases the children cry when placed in an upright posi tion and are afraid to be touched by other people; in short, they avoid everything which might cause a painful motion in the spinal joints.
Nerve disturbances may appear very early, even before the deformity.
Beside the affections of the roots spastic disturbances of motion will be observed as the result of compression of the cord by the disease (oedema). Increase of the patellar reflexes, appearance of ankle-clonus, and rigidity of the muscles are the first symptoms.
The motor nerves are younger, biologically, and are therefore first affected, long before the sensory nerves and the vegetative ones show an affection of any account, because these are much older and better established.
Spastic affections in the motor sphere appear first, and long after ward the first indications of sensory disturbances, such as formica lion and lancinating pains in the limbs. Motor paresis and paralysis always antedate the disappearance of the sensibility, only a long time after this conies the total interruption of the tracts for the bladder and rectum.
The deformity of the spine begins soon after the initial symptoms. First one vertebra protrudes like a button And increases very gradually. In some cases of a sudden breaking down of the destroyed vertebra this will appear rather quickly. As the protrusion increases, the above described compensatory curvatures follow. When the focus is located laterally in the body of the vertebra, a scoliosis develops which is fixed just as carefully as she kyphosis.