128 CLINICAL APPLIED ANATOMY. 



caries may complain of pain in the abdominal wall, which may be 

 attributed to intestinal colic, rather than spinal disease. 



Tuberculous disease involving the occipito-atloid joint has 

 referred pain over the mastoid process, on account of the termi- 

 nation of the suboccipital or first cervical nerve in this region ; 

 and again the same lesion in the atlo-axoid joint is associated 

 with pain in the occipital region of the scalp, from the distribution 

 of the great occipital branch of the second cervical nerve. In 

 atlo-axoid disease the transverse ligament behind the odontoid 

 process may be eaten through, and in consequence the head, 

 together with the atlas, slips forward, and the odontoid crushes 

 the spinal cord and induces instant death. 



Paraplegia may occur in the course of tuberculous disease of 

 the spine, occasioned by the pressure of tuberculous granulation 

 tissue derived from the diseased centres of the vertebrae. The 

 posterior common ligament, so long as it remains intact, offers a 

 barrier for the extension backwards of the inflammatory products, 

 but when it is eroded, or is rendered flaccid by the falling together 

 of two or more vertebral bodies, pressure is allowed upon the 

 anterior columns of the spinal cord through the thecal sheath, 

 and paraplegia results. It is seldom that the actual bony tissue 

 in curvature of the spine induces the pressure upon the cord. 



It is obvious that from its position it is a difficult matter to 

 reach this mass of granulation tissue in order to remove it and 

 thus relieve the pressure upon the cord. If it is approached from 

 behind by laminectomy, the whole thickness of the cord lies 

 between the operator and the tuberculous material which is 

 producing the deleterious pressure. 



DISEASES OF JOINTS. 



SynoYitis. In synovitis there is secreted an increased amount 

 of synovial fluid, causing the joint cavity to be filled and the 

 synovial membrane to bulge. The actual space within a joint is 

 relatively small. Thus, in the case of the largest joint in the 

 body that of the knee it requires only two ounces of fluid to 



