SPINE. 



mefial plane. The following is a lift of the mufcles which 

 carry it forwards ; including both thofe which aft dirtftly 

 and the indireft ones. 



Peftorales majores and minores ; ferrati magni ; obliqui 

 externi abdominis ; obliqui interni abdominis ; tranfverfi ab- 

 dominis ; refti abdominis ; pyramidales ; pfoae magni and 

 parvi. 



The mufcles moving it backwards are, trapezii ; rhom- 

 boidei ; latiflimi dorfi ; ferrati poftici fuperiores and infe- 

 riores ; facrolumbales ; longiflimi dorfi ; fpinales dorfi ; femi- 

 fpinales dorfi ; multifidi fpinae ; interfpinales ; intertranf- 

 verfarii dorfi and lumborum ; quadrati lumborum. 



The mufcles of the neck may be arranged in like manner 

 into the two claffes of (i) thofe which incline it forwards; 

 and (2) thofe which incline it backwards. In both claffes, 

 thofe which are to the right or left of the mefial plane, will 

 infleft the cervical column to their refpeftive fides. Thefe 

 lilts include, befides the mufcles which aft immediately on 

 the neck, thofe which influence it through the head. 



1. Mufcles bending the neck forwards: latiflimi colli; 

 biventres maxillx ; mylo-hyoidei ; genio-hyoidei ; genio- 

 hyoglofii ; omo-hyoidei ; iterno-hyoidci ; thyro-hyoidei ; 

 llerno-maftoidei ; refti capitis interni majores and minores ; 

 refti capitis laterales ; longi colli ; fcaleni antici. 



2. Mufcles bending it backwards : trapezii ; rhomboidei 

 minores ; ferrati poftici fuperiores ; fplenii capitis and colh ; 

 complexi ; trachelo-maftoidei ; cervicales defcendentes ; 

 tranfverfales cervicis ; fpinales cervicis ; ferai-fpinales cer- 

 vicis ; multifidi fpinae ; refti capitis poltici majores and mi- 

 nores ; obliqui capitis fuperiores and inferiores ; fcaleni pof- 

 tici ; and levatores fcapularum. 



The fcaleni medii and intertranfverfales can only infieft 

 laterally. 



Spine, Difeafe and Curvature of, m Surgery. In the pre- 

 fent article we mtend to confider a particular difeafe of the 

 fpine, attended with a total or partial abolition of the power 

 of ufing, and fometimes even of moving, the lower extre- 

 mities. 



It was that eminent furgeon Mr. Pott, who gave the firfl 

 iccurate defcription of this ferious affliftion. To this dif- 

 temper, he obferves, children are the moft fubjeft ; adults 

 are by no means exempt from it ; but it hardly ever affefts 

 perfons after the age of forty. In infants, the true caufe of 

 the paralytic diforders of the lower limbs is feldom difco- 

 vered by parents or nurfes, who never imagine that it is 

 fituated in the back-bone. When the difeafe affefts a child 

 who has been able to walk, the lofs of the ufe of his legs is 

 gradual, though not very flow. He at firft complains of 

 being very focin tired, and is unwilling to move about much ; 

 and very (hortly afterwards he frequently trips and ftumblcs, 

 although there be no impediment in his way. Whenever he 

 attempts to move brifkly, he finds that his legs involuntarily 

 crofs each other, by which he is frequently thrown down. 

 Upon endeavouring to Hand ereft, even for a few minutes, 

 his knees give way and bend forward. 



When tlie diltempcr is a little farther advanced, it will be 

 found that tiie patient cannot, without much difiiculty and 

 deliberation, direft either of his feet precifely to any exaft 

 poi.'it ; and very loon after this, both thighs and legs lofe a 

 great deal of their natural fenfibility, and become pcrfcftly 

 ufelefs for all the purpofes of locomotion. In adults, Mr. 

 Pott obferved, that the progrefs of the difeafe was rather 

 quicker than in children. 



The affeftion of the lower limbs is fomewhat different 

 from a common nervous pally. The legr. and thighs are ren- 

 dered unfit for all the purpofes of locomotion, and do alfo 

 lofe much of their natural fenfibility ; but they have neither 



the flabby feel which a truly paralytic limb has, nor that 

 feeming loofenefs at the joints, nor that total incapacity of 

 refiftance, which allows the latter to be twiiled in almofl all 

 direftions. On the contrary, the joints are often very ftiff, 

 and the feet frequently cannot be placed flatly on the ground, 

 in confequence of the toes pointing downward. 



The difeafe of the fpine varies in fituation, extent, and 

 degree ; being either in the neck, back, and fometimes, 

 though very feldom, in the upper part of the loins ; fome- 

 timeo comprehending only two vertebn, fometimes three;, 

 or more. ^ 



Some patients are rendered totally incapable of walking 

 at a very early period of the dillemper ; others can manage 

 to move about with the help of crutches, or by grafping 

 their own thighs with their hands. 



When a weak infant is the fubjeft, and the curvature re- 

 fulting from the morbid flate of the fpine is in the vertebrse 

 of the back, it is not unfrequently produftive of deformity, 

 by rendering the back humped, and by alterations which the 

 pofition of the ribs and fternum undergoes, in confequence 

 of the flexure and morbid flate of the fpine. 



The general health does not feem at firil to be materially 

 affefted ; but when the dillemper of the fpine has made 

 much progrefs, many complaints come on, fuch as difficulty 

 in refpiration, indigeflion, pain, a fenfe of tightnefs in the 

 ftomach, obftinate conftipations, purgings, involuntary dif- 

 charge of the urine and feces, &c. 



The paralytic affeftion of the legs is certainly owing to 

 the particular ftate in which the fpinal marrow, furrounded 

 by the difeafed vertebrae, is placed. When the dillemper has 

 exifled only a fhort time, the ligaments connefting thofe 

 vertebras which form the curve are fomewhat thickened ami 

 relaxed, and the bodies of the bones affefted with a change, 

 fimilar to what takes place in the heads of the bones in cafes 

 of white-fwelling. (See White-swelling.) When the 

 complaint has been of longer exillence, the ligaments are 

 now manifeflly thickened, and the bones more obvioufly al- 

 tered, and even becoming carious. The quantity of elaltic 

 fubftance between the bodies of the vertebrse is much di- 

 minifhed ; and, after death, in advanced cafes, the bones 

 are always found carious, while a quantity of fanious fluid is 

 lodged between them and the membrane inveiting the fpinal 

 marrow. The corpora vertebrarum, howfoever foftened, 

 difeafed, or rendered carious they may be, are never 

 found fpread and enlarged in their texture. Mr. Pott was 

 well convinced that the bones were not expanded. The dif- 

 eafe feems to be very analogous to the affeftion of the heads 

 of the bones in the fcrofiilous white-fwelling, and as we 

 know that this latter diforder is commonly unattended with 

 any real increafe in the dimenfions of the difeafed parts of 

 the bones, we ought indeed to expedl that no fuch change 

 would prevail in the dillemper now under confideration. 



The convexity of the curvature is always from within 

 outwards, and is invariably preceded, as well as the para- 

 lytic afleftion of the legs, by a diftempered Hate of the liga- 

 ments and bones. 



The only thing from which relief is ever obtained in the 

 prefent dillrefiing aflliftion, is an ifliie, made on each fide of 

 the fpin(jus procelies of the affefted vertcbrre. The befl 

 mode of forming the iflue is to rub the potaffa cum calc£ 

 upon the fkin until the part turns brown. To accomplifh 

 this objcft in a neat manner, it is as well to cover and defend 

 the integuments with adhcfive plafter, excepting the two 

 longituiimal portions, about half an inch broad, whiih are to 

 be converted into efchars by the application of the cautlic. 

 The end of this fublUnce is to be dipped in water, and 

 freely rubbed on the fituation of the intended iilues. As 



foon 



