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Spinal Curvature

disease, vertebrae, front, body, bones, death and sudden

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The bones of the backbone are, equally with other bones, liable to inflammation and its various consequences; but here the results are much more serious and much more marked.

It is usually the bodies of the vertebrae, in front, that are attacked. They get softened and break down, in fact ulceration (caries) of the front of the bodies takes place A large portion, therefore, of the body of one or several of the vertebrae gets scooped out, the intervening cushions of gristle suffering as well. The result of this will be vious. The vertebral column transmits the weight of the body downwards. In quence of this weight, therefore, the softened tebra: will get crushed gether in front, and ing of the backbone will result, a projection behind being formed. (Fig. 29.) Angular or Posterior Curvature is the term applied when the projection is back ward, or POTT'S CURVATURE, after an English surgeon, who first described it as a separate disease; and a more technical name is kyphosis, when the curve is backward, and lordosis when the curve is forwards. When the vertebrae have thus become crushed together the disease may cease, and a cure be effected by union taking place between the bones, though this may take two or three years. Not infrequently, however, this crushing together has a fatal effect. The spinal cord is inclosed within the ' spinal canal formed for its protection. When the curvature occurs the bending may produce pressure upon the cord, and death may be due to its being crushed. Death is, however, gene rally due to exhaustion.

The broken-down matter of the bones is often of very considerable amount. Like any other fluid it will seek the lowest level, and so will work its way through cellular tissue and between muscles until it is able to reach the skin, where it points in the form of an abscess. There are several special places where these abscesses make their appearance, places deter mined by the position of the disease, of which the chief are (1) low down in the back—lumbar region—forming lumbar abscess, and (2) at the upper portion, and in front, of the thigh, forming psoas abscess, from the name of the muscle over which it lies. The abscesses, in stead of coming to the outside, may burst into the lungs, or into the spinal canal, or into the cavity of the belly, &c., and so cause death.

Signs.—The disease progresses slowly, and at its commencement the symptoms may be very vague. A peculiar awkwardness and stiffness of walk and carriage may first be noticed about the person. When lie stoops to lift something from the ground the back is held stiff instead of curving round. There is loss of sprightliness and elasticity ; and the person walks, moves, sits down, or rises up in a way to prevent jars. Jumping or a high step is avoided, great distress being often occasioned by a sudden slip. It often begins with symptoms due to pressure on the spinal cord, causing irritation, such as weakness, cold ness and numbness of the legs, and perhaps twitchings, and even paralysis. The digestion is disturbed ; the bowels are costive ; and if the disease be high up among the dorsal vertebrae the breathing is difficult and distressed, sudden and shooting pains being complained of through the chest arid abdomen. There are several ways of obtaining symptoms of the disease. If it is suspected in a young child it should be stripped and laid across the knees, face down wards. When the knees are slowly separated the spinal column is slightly lengthened out, pressure is taken off, and the child will give signs of relief. Then bring the knees together again, place one hand on the top of the head and one on the buttocks, and let the hands push against one another. The vertebrae are pressed together, and the child shows signs of pain. Tapping with the knuckle down the back, over the spinous processes, will often produce a sudden shrinking of the body from the touch when the place over the diseased part is struck. Similarly, when cold and hot sponges are passed alternately down the back, distinct shrinking occurs on passing the seat of disease. Children do not so much complain of the spinal tenderness, but with adults the tapping produces a sickening sensation. When the vertebra) of the neck are affected the head is held very stiffly, and not moved sideways, the person preferring to turn the whole body. There will be difficulty in supporting the head, which the patient steadies with his hands.

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