210 



Disease of Spine 



be pains, possibly called ' head-ache,' over the area of the occipital 

 branches from the second cervical nerve ; or in that of the great auri- 

 cular from the second and third. A little girl suffered constant pain, 

 darting over the region between the chin and the sternum, which she 

 described as * belly-ache in the neck ' ; it arose from pressure upon the 

 trunk of certain nerves as they issued from the diseased region of the 

 column. The third nerve joins in the formation of the transverse super- 

 ficial cervical nerve, which supplies the skin over the front of the neck. 

 Pains due to caries of the atlas are generally confined to one side because 

 only one lateral mass, at any rate at first, is implicated. 



If the disease be lower in the neck, symmetrical pains may be re- 

 ferred to the pectoral or deltoid regions, where the supraclavicular 

 branches are distributed, as shown in the figure on p. 145. 



If the lowest cervical vertebrae be inflamed the nerve-trunks of the 

 brachial plexus are liable to compression, pain being referred to the 

 shoulders, elbows, or even to the fingers. 



When the dorsal vertebrae are diseased neuralgia may be felt in 

 the intercostal nerves, or their peripheral branches. And when any 

 part of the lower half of the dorsal column is affected pain may be 

 referred to the epigastric or umbilical region, or even to the skin over 

 the ilium, where the lateral cutaneous branch of the last dorsal nerve 

 is distributed. 



With lumbar disease the pains are referred to the ilio-hypogastric 

 and ilio-inguinal nerves, or the genito-crural or external cutaneous. 



Pains in the front of the thighs, that is, over the region of the 

 anterior crural or obturator nerves, should direct attention to the neigh- 

 bourhood of the third and fourth lumbar vertebrae. If it happen that 

 the nerve-fibres destined for the long saphenous branch are irritated 

 as they leave the column, pains will be referred to the inner side of the 

 leg or foot, or to the ball of the great toe. Unfortunately obscure pains 

 are too often ascribed to rheumatism and gout. Symmetrical pains are 

 the result of central mischief, and generally of spinal disease. 



Spinal abscess. Spinal caries, like ulceration elsewhere, is usually 

 accompanied by suppuration, and, unless the disease be very quiet, 

 abscess forms in front of the vertebrae. Thus cervical caries gives rise 

 to post-pharyngeal abscess, the bulging against the back of the pharynx 

 causing difficulty in breathing and swallowing. The abscess has to be 

 opened, the patient inclining the head forwards for that purpose ; if the 

 abscess were allowed to burst spontaneously, the pus might be drawn 

 into the larynx, and the patient might die of suffocation or of septic 

 pneumonia. 



Sometimes the abscess from cervical caries points in front of or 

 behind the sterno-mastoid, or follows the oesophagus into the posterior 

 mediastinum. 



In dorsal caries the pus collects in the posterior mediastinum, from 

 which it may pass between the transverse processes to the back, there 



