750 SURGERY. 
which has not been violent enough to break the vertebrae, effected by placing the patient on his back, or on an inclined 
may be sufficiently powerful to cause either a very dangerous 
commotion of the delicate production which they contain, 
or an effusion of blood within the theca, or the substance 
of the medullary matter itself. Some surgeons have cut 
tlirough the skin and muscles, and raised a portion of the 
ring of the vertebrae, by means of Hey's saw, but the practice 
has been attended with no success; all that our art can do, 
is to keep down inflammation, by general treatment, and 
trust the rest to nature. 
Dislocations of the vertebrae, when complete, are always 
fatal, and when higher than the origin of the phrenic nerve, 
immediately so. The danger is always proportionate to the 
height at which the column is dislocated. Persons with dis¬ 
location low down, live sometimes for a considerable period. 
The spine is frequently diseased either in its osseous, liga¬ 
mentous, or muscular structure, so that it does not properly 
support the superincumbent weight of the cranium ; and con¬ 
sequently bending in various directions, deforms the whole 
trunk of the body, or, by its pressure on the spinal marrow, 
causes palsy of the limbs. 
Children who grow fast, and otherwise are of a feeble con¬ 
stitution, especially if they live in great towns, and do not 
take much exercise, are liable to slight distortions of the spine: 
it is observed, that one of their shoulders is higher than the 
other. If they are removed into the country, induced to take 
exercise, bathed occasionally, and when they are fatigued, 
instead of being allowed to sit down, directed to take rest by 
lying on their backs, a cure may be soon effected. These 
measures should not be neglected, because, though many 
children outgrow these slight deformities, so great is the mi¬ 
sery the disease inflicts, if it becomes established, that such 
an event should never be trusted to chance. 
Curvature of the spine has often a deeper and more irre¬ 
mediable source. A caries of the bones, or ulceration of the 
intervertebral cartilages too often produce it. 
The first symptom which engages the attention, in these 
cases, is palsy of the limbs—a palsy, however, in which the 
limbs are not flabby and relaxed, but permanently contract¬ 
ed or extended.—This symptom cannot, of course, exist 
until the disease of the skin has continued some time, and 
permanent disorganization is established. Unfortunately, 
the preceding or preliminary symptoms are very obscure. 
Mr. Brodie says, there is pain, and some tenderness over 
the affected vertebra, uneasiness at the pit of the stomach, and 
in the abdomen generally, with disturbance in the functions 
of that cavity, weakness, aching, and occasional cramp in the 
muscles of the leg.—These, however, are of course, symptoms 
that must rather follow some degree of irritation of the spinal 
marrow, than precede it. Pott states that lassitude, a sense of 
coldness in the thighs, and dull pain in the loins precede, 
with adults, the attack; and that in children, the coming of 
the disease may be foretold by the coming on of an incapa¬ 
city of using the limbs steadily or with precision. The little 
patient being apt to totter, or to cross the legs involuntarily, 
when walking. 
There does not appear to be any difference in the symp¬ 
toms, whether the curvature be produced by caries of the 
bone, or suppuration of the cartilages,—the former sort of 
disorganization is said, however, to advance more rapidly 
than the latter, but not to produce such extensive mischief. 
The disease, except when it arises from accident, which, 
however, is its rarest source, is mostly traceable to a disorder¬ 
ed state of the general health, and especially to scrofula. 
As to the treatment of curvatures of this kind, they are re¬ 
solvable into three principles:—To improve the constitutional 
disorder which has given rise to the disease—to prevent the 
weight of the head from pressingdown, and thereby still further 
distorting the spine—to promote anchylosis of the diseased 
vertebrae. The first indication would, of course, behest pro¬ 
moted by air and exercise. Unfortunately, active exercise, 
cannot be taken, or even attempted, on account of the stateof 
the spine. A removal into good air is, however, one great step 
towards improving the general health, and passive exercise 
may be pushed to any extent. The second end may be 
plane, and regulating its inclination by the severity of the 
disease. It is clear, that by means of machinery, a plane of 
this kind may be moved in any required direction, and with 
as much velocity as may be desirable. To the two great pur¬ 
poses of securing rest to the diseased parts, and improvement 
to the general health, there are still to be added the use of 
some agents which seem to expedite the cure. Thus issues, 
or moxa, applied to the back, on the sides of the spines of 
the vertebra are very useful. Formerly these were entirely 
depended on; at present their use is confined to keeping 
down, by their counter-irritation, the inflammatory action 
of the bone or cartilage until the general treatment has 
had time to take effect. 
Spina bifida is a swelling situated on the spines of infants, 
commonly on the lumbar vertebrae, occasionally on the 
dorsal, or cervical ones, and sometimes, though less fre¬ 
quently, on the os sacrum: it is filled with a limpid fluid, 
and arises from an imperfection of the bones, and a protru¬ 
sion of the membranous lining of the spinal canal. 
In spina bifida, the swelling is soft, and gradually dimi¬ 
nishes, or even quite disappears on pressure; but, the tu¬ 
mour returns immediately the pressure is removed. The 
fluctuation of a fluid is distinctly perceptible to the touch. 
The integuments retain their natural colour and appearance. 
However, the children seem to experience pain, when the 
tumour is compressed, or when they are placed on their 
backs. The size of the swelling is very various. 
The generality of children affected with spina bifida, are 
deficient in strength and vigour, and are subject to frequent 
diarrhoea. Some cannot retain their urine and feces. A 
weakness and emaciation are often particularly observable in 
the lower extremities, which, indeed, are sometimes almost 
paralytic. Though most cases agree with this account, 
some children are, in every respect, except the tumour, 
perfectly healthy, and well formed. 
The swelling consists of a sac, filled with an aqueous 
fluid, and composed of the integuments, and of the mem¬ 
branous sheath, which lines the canal for the spinal marrow. 
The lining of the spinal canal protrudes through a fissure in 
the vertebrae. This fissure is owing'to an imperfect forma¬ 
tion of these bones, and is commonly found at their pos¬ 
terior part, w’here the spinous processes would otherwise be. 
The preternatural opening is sometimes confined to one 
bone, and then the swelling often has a small base. In 
many instances, several vertebrae have not their ossification 
completed behind, so that the canal for the spinal marrow 
resembles an open furrow. Even the whole spine, from 
one end to the other, has been found thus imperfect. 
The sac is commonly filled with a clear, transparent 
fluid; but, occasionally, it is turbid, yellowish, and bloody. 
The portion of the spinal marrow, surrounded by the fluid, 
is generally softened, and almost like mucus, or thin matter. 
Children afflicted with this disease, seldom live longer 
than a year after birth; but are observed to live longest 
when the swelling is remote from the head. The instances 
of persons attaining a middle age with this disorder, are rare, 
and they have mostly had their lower extremities in a para¬ 
lytic, useless state. 
Experience has fully proved, that puncturing the tumour 
with a lancet, and thus discharging the fluid, either at once, 
or gradually, cannot be done without putting the patient in 
the greatest danger, the consequences being for the most 
part fatal in a very short space of time. Some years ago, 
Mr. Abernethy suggested the method of letting out the fluid, 
of closing and healing the puncture immediately afterwards, 
and repeating the same proceedings, as often as necessary. 
Sir Astley Cooper tried the effect of thus puncturing spin® 
bifid®, but he did it with a fine pointed needle, instead of a 
lancet, and promoted a closure of the opening in the spine, 
by applying a compress and bandage. In one case he thus 
accomplished a perfect cure. 
The region of the loins is liable to the formation of a very 
large abscess, called the psoas abscess, from its situation 
over that muscle. In the beginning, this disease is not, in 
general. 
