Tubercular Disease of the Spine. 527 



and eleventh ribs were found wanting for a distance of from two inches to 

 two and three-quarter inches from the middle line. At the same time, 

 the patient could localise the touch of a finger or the point of a pin all 

 over the back and lower extremities, being in this respect much better than 

 before. On October 7th it was noted that the disappearance of the ribs 

 was progressing. On October 11th Mr Miller cut down upon the affected 

 ribs on the right side to discover the cause, if possible, of the ati'ophy. 

 The ribs when traced, he observed, became suddenly rough and nodular, 

 and smaller in bulk. Portions were removed, placed in absolute alcohol, 

 and sent to Drs Woodhead and Bruce for examination. The wound 

 turned septic, and on October 23rd secondary hemorrhage occurred, and 

 despite all efforts to stop it, returned repeatedly, until the patient died 

 on November 10th from exhaustion. 



The specimen shows many points of great interest. The 

 lower part of the bodj'- of the eighth, the whole of the ninth, 

 and the upper part of that of the tenth dorsal vertebrae are 

 wanting, and a bridge of new bone unites the eighth and tenth 

 dorsal bodies in front, preventing the one from sinking down 

 upon the other. 



The spinous processes seeii in the preparation are those of 

 the sixth, eighth, eleventh, and twelfth dorsal vertebrae. The 

 spinous process of the seventh vertebra has practically dis- 

 appeared, so that the projection below the sixth is really the 

 remains of the eighth spine. The ninth spine was wanting 

 when the spine was trefined, and what remained of the tenth 

 spine was then removed. The great part of the lamina of the 

 tenth dorsal vertebra has also disappeared. 



The vertebral ends of the ninth and tenth ribs are also 

 wanting. 



The intervertebral foramen for the eighth dorsal nerve has 

 been displaced backwards, so that the nerve emerges below the 

 lamina near the spine. The ninth nerve crosses the space in 

 which no bone is present at all, and the tenth nerve comes 

 through a small aperture in what seems to be the remains of 

 the tenth lamina. 



The remains of the soft parts in the neighbourhood of the 

 diseased portion are covered by recent lymph and discoloured 

 blood-clot, the result of the aliscess following the second opera- 

 tion. 



