Treatment

When the inflammation is acute, blood may be taken from the tender spot, by means of leeches, or by cupping-glasses applied along the sides of the spine. Perfect rest in the horizontal posture is necessary.

In more chronic forms of inflammation within the spinal canal, in addition to the application of leeches or cupping, we can frequently do good by means of issues made on one or both sides of the spine; these may be kept open, or allowed to heal, and renewed at another spot, till they are no longer necessary, or the state of the patient shows that their longer continuance would be useless.

The strength must be kept up by means of nourishing food; and any of the Tonics recommended in this work may be given. The bowels maybe regulated either with small doses of Castor Oil; or injections may be given.

Curvature of the Spine, (lateral). Curvature of the Spine presents many varieties, some of which arise from mere debility, while others are caused by the destruction of portions of the spinal column by disease. What is called the lateral curvature was very common in young girls from the age of ten to sixteen, some years ago. This affection is readily caused by occupations or postures that tax one side of the body more than the other; particularly if at the same time the patient be deprived of proper exercise.

The first thing that attracts attention is a projection of one shoulder, or of one side of the bosom, or an elevation of one shoulder, (most commonly the right). On examination, the spine is found to be curved; the right shoulder projecting, and the right side of the chest, and the left hip unnaturally convex; while the chest on the left side and the loins on the right are correspondingly curved inwards.

Treatment

Attention must be paid to the following circumstances; position, exercise and rest. In the first place the patient must be watched, in order to find out from what particular habit or attitude the distortion takes its rise. Standing on the right leg-is the most frequent, for in this posture the left side of the loins is thrown upwards,and the patient is obliged to raise the right shoulder to keep the body perpendicular. A habit of raising the right shoulder whilst writing, or drawing, or playing the harp, or riding on horseback, or of sleeping constantly on one side, with too high a pillow, or the custom of wearing dresses made low on the chest, so that the patient hitches her frock up on one shoulder and lets it fall off at the other are also occasional causes. All these and every other one-sided posture, should be vigilantly prohibited. The patient should take free exercise in the open air, walking or riding or indulging in any games or sports, such as dumb-bells, the skipping-rope, drawing a light garden roller, etc. These exercises should never be carried so far as to fatigue; and after using them the patient should lie down on her back on a flat inclined plane, although any easy posture on a bed or sofa, or on the floor will do as well. She should never be forced to stand longer than is perfectly agreeable, and when sitting should rest herself well against the back of the chair. Her seat should be wide enough to reach to the knees, and the feet should be well supported. These measures, combined with Tonics, good diet, pure air, bathing, friction of the back night and morning with horsehair gloves, and attention to the health, may be sufficient to cure mild cases, and to mitigate severer ones. She may take the following Mixture and Pills.

Wine of Iron, (commonly called Steel Wine).....................................Six Drams.

Tincture of Orange Peel...................One Ounce.

Syrup...........................................Half an Ounce.

Water, sufficient to make Half a Pint. A tablespoonful may be taken three times a day. This dose is for a girl of twelve years old, and may be increased or diminished for other ages.

Compound Rhubarb Pill...................72 grains.

Divide into twenty-four pills. One may be taken every night at bedtime.

Angular Curvature

This disease is produced by decay of the bones of the spinal column, or ulceration of the substance between the bores, a disease which generally affects scrofulous children or adults. It begins with symptoms that indicate irritation of the spinal cord; the patient complains of weakness, coldness and numbness of the legs, and incapability of making exertion; and these symptoms are followed by twitchings and spasms of the legs, and afterwards by palsy. The bowels are costive; and there is difficulty sometimes in passing,sometimes in retaining the urine,which is generally pale and alkalescent. Children rarely complain of much pain in the back,but, if the patient is an adult, there is generally a heavy, dull,aching pain, aggravated by motion, together with great tenderness on pressure; and a peculiar dead sickening sensation like that of a decayed tooth, if a smart blow be struck on the diseased part with the knuckles.

If the disease is situated in the bones of that portion of the spine forming the back of the chest, it will be accompanied with tightness of the chest, and difficulty of breathing; and if above that, one or both arms will be palsied, and there will be a difficulty in supporting the head. As the disease advances, the back becomes curved forwards, and the spinous portions of the diseased bones project backwards, so as to cause great deformity; abscesses form, and the patient exhibits great constitutional derangement and hectic.

In favourable cases, abscesses, if they form, are healed, or their matter is absorbed; the diseased bones collapse; and the patient recovers with more or less deformity, which is, of course, incurable. In some fatal cases the patient dies suddenly from two or three of the diseased vertebrae giving way and crashing the spinal cord, or from the bursting of abscesses into the spinal cord, or into some visceral cavity; but more frequently death is caused by slow irritation and exhaustion.

Treatment

Rest in the horizontal posture is absolutely necessary. A water-bed or fracture-bed may be used, if easy or convenient. But the patient must not be taught to lie on his back, nor must any means be used with a view of straightening the spine, as they would merely impede the natural process of recovery, by preventing the remains of the diseased vertebrae from falling together. Issues should be made and kept open on each side of the spines of the diseased vertebrae. At the same time the constitution must be thoroughly supported by nourishing diet; boiled mutton, fresh fish, poultry, light puddings, and things of that kind; with a little good wine.

The following may be taken:

Citrate of Iron and Quinine...............Three Drams.

Tincture of Orange Peel...................One Ounce.

Syrup...........................................One Ounce.

Water, sufficient to make.................Four Ounces.

A teaspoonful may be taken (for a grown person) three times a day, in a little water. Ten grains of Bromide of Potash may be taken at bedtime. If the bowels are confined they may be cleared out by means of injections.

Rickets

The characteristic marks of this disease are great size of the head, swelling ,of the joints, flattened ribs, curved spine, distortion of the cylindrical bones, protuberance of the belly, and general emaciation.

Rickets is an hereditary disease in some families, though parents that have been affected with it have sometimes healthy and robust offspring. The children of the poor, who are badly nursed in general, are those most usually afflicted with Rickets; but there are many circumstances which conduce to this disease; such as a damp and cold residence, impure air, inattention to cleanliness, want of due exercise, a deficiency of food, and, in consequence, of debility.

The disease seldom appears before the ninth month, and very rarely shows itself after the second year of a child's age. It usually comes on slowly, and the first appearances of it to be observed are, a flaccidity of the flesh, emaciation of the body, paleness and loss of colour in the cheeks, if they have been rosy, and a slight degree of tumefaction of the face. The head at the same time appears large with respect to the body. The head continuing to increase in size, the forehead becomes at length unusually prominent, and the neck appears very slender in proportion to the head. Teething is at the same time very slow, and much later than usual, and the teeth that do appear soon spoil, and are apt to fall out. The ribs lose their convexity, the breast bone protrudes in the form of a ridge, the spine becomes curved, the joints become swelled, while the limbs between the joints appear to be more slender than before, and become at last much distorted.

With these symptoms there is a great diminution of strength, the child seems averse to making the least exertion, and is unable to walk. Its appetite is not often much impaired, but its stools are usually frequent and loose, and its abdomen appears uncommonly full and tumid. With regard to its mental faculties, the understanding is generally very mature, but in a few cases stupidity or fatuity ensues. At the commencement of the disease there is no fever present, but in its more advanced stage, a frequent pulse, with other febrile symptoms of a hectic nature, attend.

In some cases the disease proceeds no further, and the child gradually recovers its health and strength, the limbs being left, however, in a distorted state. In others it continues to increase till it ends in death.

The Rickets, though attended with much distortion of the bones, and various other unpleasant symptoms, very seldom proves fatal; and we are only to regard it as attended with danger where the distortion becomes so great as to affect the action of the lungs and other organs; or where the enlarged size of the head shows that it contains a considerable quantity of water within it; or where the food is passed unchanged by digestion, which denotes a highly diseased state of the mesenteric glands. Children at the breast are more exposed to peril, than those who have reached three or four years.

Treatment

All means calculated to nourish and invigorate the system must be adopted. The food should be of the most nourishing kind; good milk, beef tea, bread soaked in gravy, calf s foot jelly, eggs or custard, corn starch, oatmeal porridge with milk, etc, with wine, if the child is not feverish. Cold bathing, if the weather will allow or it, and friction with flannels after the bath. The child should be carried in a horizontal position. From three to ten grains (according to the age of the child) of Phosphate of Soda may be given three or four times a day, in a little milk.

Lumbar And Psoas Abscess

These are abscesses arising from that diseased condition of the spine that has been described; they are named according to the point at which they show themselves; they must be treated like other abscesses.