Spinal diseases: with an improved plan of cure. Including what are commonly called nervous complaints. And numerous examples, from upwards of one hundred and fifty cases

Front matter

o-

S

Mr'

Preface

Spinal Curvature, about which so much has been written of late, it should be recolleeted, is itself, in very many instances, but a minor evil, existing often without producing inconvenience, beyond personal deformity ; and, unless on the increase, requiring little interference.

Numerous cases are met where complete cure of the Curvature may be pronouneed certain ; others, again, where it is either hope¬ less, or, for reasons of the patient's own, need not be attempted.

It is of the highest importance, however, in every instance where they exist, to fi-ee the patient from those sufferings which are the consequences of Curvature.

The experience of vei’y many cases, scattered over more than a dozen of years, has convinced me of the perfect certainty, and even facility, with which the subjects of Curvature can be freed from its but too common and distressing consequences.

A certain share of consideration has been given in these pages to one form of disease which is frequently mistaken, and more often met than all the other affections of the Spine put together.

In the method of relieving by the large Dry Cup, and the succe.ssful application of Acupuncture to these cases, I believe myself

II Preface

entitled to whatever merit may attach to originality ; nor am I, nor my professional friends, aware, that Cups of the kind used and recommended by me are, or hitherto have been, employed by the Profession.

It was my intention to have added a few cases, out of very many, illustrative of the instant removal of Rheumatic Affections, by means of these Glasses.

In Lumbago, and Chronic Rheumatism in Gouty habits, their ap¬ plication is as agreeable to the feelings of the patient, as their effects are beneficial and surprising.

Since the Chapter on Steel Stays was written, subsequent expe¬ rience has more and more convmced me, that, in too many instances. Steel Stays, while worn to prevent or to cure Curvature, only act as a blind, — preventing the patient and relations from noticing the deformity that, either hi spite of, or more probably with the assistance of, these Stays, has been steadily mcreasing. On ultimately dis¬ covering this increase, the bad fit of the Stays, or some other equally silly reason, is given, — the bad fit being a consequence of the altered condition of the back, and demonstrative of the uselessness of the Stays as a means of prevention.

More extended observations on the arresting, permanent cure, and prevention of Spinal Curvature, and other personal deformities, and on certain important improvements recently proposed to be introduced into this department of practice, are reserved for a future volume.

CHAPTER 1. Page

Introductoby Observations, .... 9

1. The Spine, Short Account of, . . . . .11

2. Dislocation of the Spine, without Fracture, impossible, . 12

3. Origin of the Name Spine, . . . . .12

3. Spinal Nerves, ....... 13

6. Fifth Pair — a Spinal Nerve, ..... 13

7. Double Roots and Double Function of Spinal Nerves, . . 14

8. Eft’ects of Injury to, or Pressime on, a Nerve, . . .15

9. Use assigned by Sir Charles Bell to Middle Part of Cord, . 16

10. Effects of Pressure on, or Injui'y of, the Spinal Cord, . . 17

11. Pressure at the Origin of a Nerve, produces Pain in its Course,

and at its Termination, . .... 18

CHAPTER 11.

Forms of Disease to which the Spine is Liable, . 19

1 . Appearance of the Spine in Curvature, . . . .20

2. Unequal Height of Shoulders, ..... 20

3. Effects of Curvature, ...... 21

4. Irritation, or Disturbed Function of the Spinal Nerves, the most

5. “ Irritation,” not a Good Word, . . . .22

6. Continued Derangement of Function producing Alteration of

Structure in a Nerve, ...... 22

7. In the majority of Cases, Disease produced by Pressui-e upon a

Spinal Nerve, ....... 23

8. Pressure produces more Mischief than merely Interruption to

the Passage of the Nervous Fluid, . . . ,23

CHAPTER III.— SYMPTOMS. Page

1 . Very many, and apparently of the most Opposite Description, . 2(i

2. “ Nervousness,” a Prominent Symptom, . . .26

3. No Pain, in many instances, felt in the Back, . . .28

4. Patient does not know her Back to be Affected, . . 28

5. Females are too frequently unwilling to admit the Existence of

any Disease connected with the Spine, . . .28

Chapter Iv.— Causes

1 . Method in which they Act, . . . . .29

2. Continued Application at School, . . . .30

3. Way in which this induces Curvature, . . . .30

4. Long-continued Position of the Body, . ; . .31

5. Carrying Children, a Cause, . . . . .32

6. Inconveniences produced by the upright backs of Church Seats, 32

8. Their Effects, when Tight Laced, . . . .34 and 38

9. Effects of Compression on Muscular Structure, . . 35

10. How the Slu'ivelled Limb of the Beggar is produced, . . 35

11. Exercise of an Organ essential to its Healthy Condition, and

even Preservation, . . . . . .36-7

12. Effects of Diminution, or Cessation of Function on ISIuscidar

13. Can Ladies Lay aside their Corsets ? . . . .37

14. Hereditary Predisposition, .... 39 — 46

Chapter V

Cr.ASSES OF Persons among whom we find Spinae Diseases.

1. More Common in Women, than in Men, . . .40

2. Age at which they prevail most, . . . .40

.3. Proportion of Married, to Unm.arried Cases. . . .40

4. Spinal Disease not confined to the Rich, . . .41

5. Nor to the Female Sex, ...... 42

6. Table of the Per Centage, and Proportion of Disease in Males

.and Females, and at different ages, . . . .42

7. Cases in Married Females, . . . . .4.3

8. Connection of Marriage with Spinal Disease, . . .44

9. Table of Male Cases, arr.anged according to the occupation of

the Patient, ....... 44

10. Table of Female Cases, arranged in a similar manner, . . 45

CONTENTS. V

Page.

11. Not confined to Patients Living in Towns, . . .46

12. Fine-looking Women frequent Subjects of Spinal Disease, . 46

14. Spinal Disease in Delirium Tremens, . . . .47

CHAPTER VI. Concerning the Examination of the Back

1. Propriety of Examining, and Difficulty in getting many Females

to permit it, . . . . . . .48

2. If refused, preferable to decline treating the Patient, . . 49

3. Neither Indelicacy nor Exposure in making a proper Examina¬

4. Mode of Conducting the Examination, . . . .51

5. How to employ Pressure with the Fingers, . . .51

6. Parts found Diseased, to be Marked, . . . .52

7. Pressure to be made over the Transverse, as well as Spinous

8. Pressure on one part of the Back, producing Pain in another

farther down, ....... 54

9. Sometimes the entire Back found Diseased, . . .54

10. In those Cases, only part at a time to be treated, . . 55

CHAPTER VII. Nature of the Disease often Mistaken, . . 56

1. Patient often Complains of no Pain in the Back, and does not

know it to be affected, ...... 56

2. Instance of a Patient persisting in declaring there was nothing

wrong with her Back, . . . . .56

3. Fruitlessness of Treating mere Symptoms, . . .57

4. Spinal, frequently Confounded with other Diseases, . . 58

Chapter VIII — Nervousness

1. Nerves, in Medical Language, . . . . .59

2. Nerves, as understood in Ordinary Conversation, . . 59

3. Patients find it very difficult to tell what they mean by being

4. Nervousness allied to, but not Hysteria, . . . .60

5. Supposed to Depend on Deranged Uterine Function, . . 60

6. Reasons for refusing Assent to this, . . . .61

7. Nervousness, caused or influenced by condition of Spinal Nerves, 61

VI Contents

Page.

8. Explanation of the Symptoms, . . . . .62

9. Disturbed States of the Cord, or its Nerres, produce Imitations

of almost every Disease, . . . . .63

10. Nervousness not looked on by Patients as a distinct Disease, . 63

CHAPTER IX. Difference between Practising among the Upper and

Lower Classes of Society, . . . .65

1. Disinclination, on the part of the Poor, to allow their “ Skin to

2. “ Bleeding,” a Favourite with them, . • . . . 66

3. Imprudence of Objecting to Treatment, . . . .67

Chapter X _ Means Of Cure

1. Symptoms produced by Curvature, capable of being Removed,

without waiting for the Removal of the Curvature, . . 68

I. — Of Leeches ; and Cupping, Dry and Wet, . . 69

1. Dry-Cupping Recommended, ..... 70

2. Cases wherein it is Serviceable, ..... 71

3. Method of Applying the Cups, . . . . .72

4. Great Power of the Cups, . . . . .73

5. Difference between Dry and Common Cupping, . . 73

II. — Explanation of the Process of Cupping, . . 74

1. Theory of its Action, . . . . . .75

2. The Process of Professed Cuppers Inferior in power to that de¬

III. — Improved Form of Cupping Gl.asses, . . 76

1. Ordinary Glasses too Small, . . . . .76

2. Large Size, and Peculiar Shape of the Mouth of my Glasses, . 76

3. Facility with which they Act, ..... 77

4. Their Application productive of Instant Relief, . . 78

5. Not themselves Painful, . . . . . .79

IV. — Feeling of a Dry-Cupped Part, . . .81

V _ Appearance of a Dry-Cupped Part, . . 81

1. Ecchymosis produced, ...... 82

1. Superiority of their Action after the Dry Cups, . . 82

2. Advantages of being Spread on Paper, and their Active Prin¬

ciple made Soluble, ...... S3

3. Issues by means of Blisters, disapproved of, . . .84

CONTENTS.

VII Page

Vn. — Acupcnctuke, ...... 8.t

1. Cases where it is useful, ...... 85

2. To make Acupuncture Needles, . . . . .85

3. Mode of Insertion, ...... 86

4. Cautions to prevent Accident, . . . . .87

1. Practice liable to Abuse, . . . . .87

2. Absurdity of Treating Curvature by Issues, . . .88

3. When should an Issue be employed? . . . .88

4. Milder mode of making one, . . . . .89

CHAPTER XI. Curvature — Distortion — Stays — Steel Stays, &c. . 92

1. Symptoms frequently accompanying Curvature, . . 92

2. Must be Believed, though we, perhaps, cannot attempt to Ke-

move the Curvature, ...... 93

3. Steel Stays, — their Injurious Action, . . . .94

4. Curvature increasing during their use, . . . .95

5. Bandage Makers, and “ their Inventions,” . . .96

6. Should Stays be laid aside in Disease ? . . . .97

7. Deficient Construction of Modern Stays, . . .98

8. Simple and Efficient Back Stay, ..... 99

9. Importance of attending to this much-neglected Department of

CASES.

C.\SE I. — Mrs - . Curvature, — Steel Stays worn, — Distortion

on the Increase, and Severe Symptoms, . .101

Observations on Mechanical Contrivances for the Back, ...... 105

Difference in Height of Shoulders, . . . 106

Do Bandages Kemedy this ? . . . .107

Impropriety of using Machines, without proper

II. — Mrs G - , presenting the external Appearances of

Consumption, and had been treated for it, . . 108

III. — E. B - . Curvature, with Interrupted or Disturbed

Function of Spinal Nerves, . . . .Ill

VIII Page

Case IV _ Eliz. - , previously under Treatment for Two

Years, — Nervousness, Pain, Disturbed Spinal Func¬ tion, . . . . . . .113

V Mrs B - . Most Extensive Disease of the Back, . 115

VI. — Mrs - , an Officer’s Widow, four years ill, . 117

VII. — Christ. M - Disease in Back, reluctantly admitted, 118

VIII _ Miss M - . Case of a Young Lady, . . 119

The Amateur Practitioner, .... 121

IX _ W. G - , Tailor. Had been Treated for Diseased

X. — Curvature, and its Consequences, . . . 123

XI. — Miss - . Remarkable instance of Asthmatic Pa¬

roxysm, with loud Wheezing, in a Child of 6 years, long misunderstood, ..... 128

XII. — Cath. M‘L - . Case which had been supposed Con¬ sumption, and treated for it, ... 131

XIII. — Violent Pain in the Loins, resisting other means, and

yielding to Dry Cups, .... 132

XIV. — Anne T - . Examination of Back refused, . 134

XV. — Mrs K - Had been treated for Diseased Heart, 133

XVI. — Mrs M - Eight years ill — Weakness — Nervous¬

XVII Mrs - Posterior Roots of Spinal Nerves affected —

Nine years ill, . . . . .137

XVIII. — Anne M - . Pain, and constant Vomiting of Food, 138

XIX. — Mrs - . Pain, Arresting Breathing, &c. . . 138

XX. — Miss Agnes H - . Curvature, causing Numbness,

“ Sleeping” in Arms, &c. &c. . . . 139

XXI. — Mrs - . Pleurodynia, Simulated Pleurisy, . 142

XXII. — Cath. L - . Pain under Mamma, for two years, . 143

XXni. — Margaret R - . Cimvature, and its Consequences, . 144

XXIV. — Mrs - . Violent Pain after Miscarriage, . . 146

XXV. — Mrs E - . Sudden Attacks of Pain, Nervousness, &c. 147

Cases Tbeated by Acupunctube.

XXVI. — Miss Mary D - . Ten year’s iU, — ^remarkable Case, 148

XXVII. — Miss M - A . Five years iU, . . . 154

XXVm. — Miss C - S - Simulated Consumption, . 153

XXIX _ Anne C - . Curvature, and Consequences, . 156

XXX _ Mrs W - Partial Loss of Power in Limbs, . 158

DISEASES OF THE SPINE,

NERVOUS COMPLAINTS, &c.

Chapter I. Introductory Observations

Were any argument required to direct the most serious attention to the diseases that affect, in one way or other, the Spine, or the important parts in its immediate neighbourhood, it would be found in the necessity of the sound condition of this most influential portion of the body to the health or even comfort of the individual, — in the liability of certain forms of these diseases to be con¬ founded with others, — and in the frequency with which those conversant with these diseases, know them to exist.

It is scarcely to be believed, and yet, I am persuaded, it admits of the most ample proof, that of our female

n

INTRODUCTORY OBSERVATIONS.

population, especially those accustomed to town life, at least one-half, sometime in the course of their lives, sulfer, in one form or another, from this class of diseases.

This in part arises from the greater delicacy of organi¬ zation in females, — from their dress, their habits, or those in-door occupations wherein they minister to the wants or the comforts of others. The higher up the scale of society we make the investigation, and in proportion as the parties are removed from the necessity of actual labour, we find the per centage increasing; — so that, while down the scale of female life, especially among those engaged in sedentary employments, we find disease produced by too long continued exertions, which are necessary to their obtaining the means of existence, those who are alto¬ gether removed from this necessity, have at least an equal amount of disease, from apparently the most op¬ posite causes.

The dilference in the structure, habits, and education — the robust amusements of the youth, — and the generally active occupations of the adults of the opposite sex, ac¬ count satisfactorily for the comparative rarity w'ith which these complaints are found among them.

To understand the diseases that affect the Spine, the Spinal Cord, or its Nerves, it is necessary to have some idea of the structure and uses of these parts. A very short description will suffice, divested, as much as pos¬ sible, of professional phraseology.

STliUCTURE OF THE STINE.

1 I

THE SPINE

Is a chain of twenty-four bones ; each bone is called “ vertebra,” (from the Latin, ^^vertere,” to turn, on ac¬ count of their motion ;) there are seven in the neck, twelve in the body, and five in the loins. At the bottom of the back, there is a bone called “ sacrum,” (sacred, from being the part in animals offered in sacrifice,) con¬ sisting of a number of vertebrae, but called false,” because they have no motion. Each of these twenty-four bones is connected by a thick fibrous or cartilaginous substance; it is very powerful, elastic, and compressible. By means of this substance, (which is called “ inter¬ vertebral,” from being placed between the vertebrae) each bone is a joint, and the Spine an entire chain of joints, with limited motion, on account of the spinal marrow which runs through the centre of them.

These ligaments do not add much to the weight of the Spine, while they increase the length of it ; they permit of yielding, or flexibility; and by their elasticity, re¬ store the Spine to its upright position ; “ they lessen the effects of concussion, and prevent shocks being trans¬ mitted from the lower limbs to the brain; they constitute the Spine a sort of strong, flexible, and elastic spring, in which, while they admit of sufficient yielding in every direction, they at the same time resist too much flexion, extension, lateral, or rotatory motion.”

ORIGIN OF THE NAME “ SPINE.”

Each individual bone of the Spine, except the two first, has seven projecting points of bone, called by ana¬ tomists “ processes,” and intended to give insertion to strong ligaments and muscles, which assist still more in keeping each bone in its proper position.

So successful are they, and so watchful has Providence been to preserve from fatal injury the important organ within, that unless some of the bones be previously broken, dislocation of the Spine is believed to be im¬ possible.

Four of these processes are oblique, two are transverse, running across from each side of the Spine, and one standing out backwards, and which can easily be felt, enabling us with facility, in the living body, to count the bones of the Spine.

This process, or projection backwards, has, from its resemblance to a Thorn, been called Spinous, (from Spina, a Thorn,) and from it the whole chain of bones has been called Spine.

It is these last two processes, namely, the transverse and Spinous, to which particular attention should be directed, as will be seen when we come to the mode of examining the back.

There is a tube, or canal, running the whole way through this bony and cartilaginous chain, giving pas¬ sage to the soft white gray substance called marrow — most improperly, as there is no similarity either in

ON THE SPINAL CORD AND ITS NERVES.

appearance or function to marrow. This Spinal Cord, or Marrow, used to be thought a prolongation of the brain ; but the experiments of later and more accurate physiologists have decided that the brain is as much or more entitled to be allied a prolongation of the Spinal Cord.

“ As we pass, in the inferior animals, from the metre perfect organization to that which is less so, we find the brain disappears before the Spinal Cord.” That is, ani¬ mals exist with a Spinal Cord, and no brain, but none with a brain and no Spinal Cord.

From late observations made by Tiedemann and Series, on tlie development of the nervous system in the human foetus, we learn that the Spinal Cord is the part which is first formed, then the Medulla Oblongata, or upper part of the cord, next the cerebellum, and lastly the brain.

SPINAL NERVES.

From this Spinal Cord thirty pairs of nerves issue, one on each side, from between the vertebrae. There are eight on each side in tlie neck, called “ cervical;” twelve on each side in the chest or back, called “ dor¬ sal ;” five on each side in the loins, called “lumbar;” and five on each side from the sacrum, false vertebrae, or lower jiart of the back. The fifth pair, (of the brain,) distributed to the eye, and upper and lower jaw, is also,

DOUBLE ROOTS OF THE SPINAL NERVES.

from its peculiarity in structure and use, considered a Spinal Nerve.

These Spinal Nerves arise by two distinct roots from the sides of the Spinal Cord, are distributed to the parts in the neighbourhood and in front, and have the most intimate and intricate communications with other most important nerves.* “ They run out laterally to the regular divisions of the body, and never take a course longitudinal to the body.”

There is hardly any part, therefore, of the exterior head, or of the neck, throat, chest, arms, belly, or thighs, over which they do not exert an influence, or wdiich do not exert an influence over them. For the action of nerves is in this way double. If injured, compressed, or diseased, they will produce pain, disordered function, or both, in distant parts to which they run ; or injury, dis¬ ease, pain, or improper action in these distant parts will produce irritation, inflammation, or derangement in the action of the nerve ; and thus serve to keep up the pain or disordered function.

The discovery of the separate uses of these double roots is modern, and equally shared by M. Magendie, and Sir Charles Bell. The anterior root conveys motion ; the posterior, sensation. At first, on leaving the cord,

* “ The intestines get no supi)l3' of nerves immediately from the Spine, but the anterior branches (those of motion), communicate with the great sym¬ pathetic. The bladder gets its active nerves from the 3d and 4th Sacral.” — Sill Charles Beli., in Philosophical Transactions.

THEIR DOURLE FUNCTION.

they are quite distinct from each other; by-and-by, a little knot or ganglion is formed upon the posterior or sensitive root ; after this, they unite to form one nerve, and go to their destination as one nerve, but having this double office to perform. If one of these roots of the Spinal Nerves be cut across, the parts to which it is dis¬ tributed will be deprived either of voluntary motion or sensation, according as it may be the anterior or pos¬ terior root. If it be the anterior, voluntary motion will be lost, sensation remaining quite perfect ; if it be the posterior, then sensation will be lost, voluntary motion remaining quite perfect.

Should the division of the nerve take place not close to the Spine, but after the junction of the two roots, then the parts to which the nerve is distributed are in both respects paralysed, both voluntary motion and sen¬ sation being completely destroyed.

Complete pressure would be followed by similar effects. The knowledge of these beautiful facts makes what otherwise would appear most complicated simple and easily understood. Instances are constantly occurring where persons complain of dulness of sensation, dead¬ ness, they call it, of part of their body, without the least interruption to voluntary motion in the same parts. I have a case at present, w'here the skin and muscles on a man’s chest and belly have very little feeling, even when smartly pinched, (the motion of the parts being quite

Iti EFFECTS OF INJUltV

natural,) Others again where voluntary motion is impaired, the feeling of the parts being quite natural. There is a third class but too common, where both voluntary motion and sensation are diminished more or less.

In the first case, the disease is in the posterior root of the nerve or nerves. In the second, it is in the anterior root. In the third, both roots are diseased, and proba¬ bly the Spinal Cord itself involved.

The middle part of the cord, betw'een the origins of these nerves, is said by Sir Charles Bell, to be that destined for supplying the apparatus employed in the acts of breathing and expression ; but his proofs, exceedingly ingenious and interesting, are by some not yet con¬ sidered sufficiently satisfactory.

We have already alluded to the beautiful mechanism -exhibited in the chain of bones constituting the Spine, whereby we have the efibct of a powerful support for the upper parts of the body, the chest, and head, and at the same time the most perfect motion in the part, so far as would be consistent with the safety of the impor¬ tant organ contained within.

We have also seen, that to cut across any one of the nerves issuing from between the bones of the Spine, would paralyse instantly, depriving, both of motion and sensation, every part to which the nerve is distributed : presmre, it must also he known, icill produce, more or less, according to its degree, the very same effect. A slight

ON THE SriNAL NERVES OH CORD.

amount of pressure will merely produce partial inter¬ ruption to the function of the nerve, attended with con¬ siderable pain ; by-and-bj^, inflammation of its substance or sheath, producing still more pain and derangement of function; and if the pressure be complete, the function of the nerve will be altogether destroyed.

The Spinal Cord exhibits something like similar effects when cut across or compressed. If severely in¬ jured, or compressed at any one point, all voluntary motion and sensation below that is gone. The loss may be partial or entire, exactly according to the amount of injury or disease. If in the loins, the lower limbs can¬ not be moved, and there is no command over the bowels or bladder. Higher up, respiration and the heart’s ac¬ tion would be interrupted, and death at once ensue.

In the diseases that attack the Spinal Cord itself, we do not find patients_ suffer much from pain re¬ ferred to the part. More commonly, if not produced by pressure or injury, we form our opinion of these dis¬ eases by their impairing the motion or sensation, or both, of parts frequently at a distance. If a patient suffered pain at all, it would not be referred to the seat or origin of the disease, but to the course of the nerves, and especially to their terminations.

This is particularly true with regard to certain diseased conditions, called irritations of the Spinal Nerves. The pain is not felt but at the sentient extremity, often in

B

PAIN FELT AT A DISTANCE.

front of the body, and generally distant from the part requiring interference ; pressure of the finger on the pained part, at the sides or in front, will produce no impression ; but if the finger be placed over the nerve as it is issuing from the bony canal, just over and be¬ tween the transverse processes, pain will be at once ad¬ mitted, and the intelligent patient will tell you that when pressure is made there, pain streams round to the place complained of in front.

The profession are aware of many ordinary instances, where, during the progress of disease, the pain is felt principally at the termination or distribution of the nerve ; witness the pain in the shoulder, in diseased liver, the pain in the knee, in diseased hip, &c. &c.

This circumstance cannot be too well borne in re¬ collection, for I have not unfrequently met patients, who, complaining of severe pains in the front of the body, and seeing no evident connection between the back and front, could with great difficulty be persuaded even to allow me to examine the parts behind, which were the cause of all the inconvenience.

Chapter II. Forms Of Disease To Which The Spine Is Liable

Both the Spinal Cord, and the Spine itself, are subject to a number of diseases, which it is no part of the object of this paper to notice. The diseases we are for the present interested in are three, which are ex¬ ceedingly common, and quite distinct from each other. These are, —

1^?, Disease affecting one or more of the bones or car¬ tilages of the Spine, ending in pressure on the Spinal Cord, and partial or complete paralysis of the parts below.

2d, Lateral or serpentine curvature of the Spine; and

3fZ, Disordered condition of the Spinal Nerves.

The last form of disease is by far the most common of any. It is very often caused by the second form or curva¬ ture. In many cases it exists from pressure or injury, and even idiopathically, that is, without any evident cause in¬ ducing it.

The first of these is the most formidable. It is usually called Pott’s disease, from having been first accurately

ULCERATION. - SERPENTINE CURVATURE.

described by that gentleman. In it, caries, or ulceration, attacks the bones or intervertebral substances, and the Spine, worn away by this process in front, yields for¬ ward, producing compression on the Spinal Cord with¬ in, and at the same time, a projection of one or more of the spinous processes of the vertebrae behind.

The parts below are impaired exactly according to the degree of pressure, from numbness of the limbs, or trip¬ ping of the toes, up to actual and complete paralysis.

This is the sufficiently well known disease in which issues are used with so much benefit.

The second form, or lateral curvature of the Spine, is one which all but exclusively attacks the weaker sex. I have seen several cases in men and boys, but in them it is by no means so general or severe as in the other sex.

The Spine here assumes the form of an Italian f reversed. The convexity, or bend, is in the loins to the left side, and above, between the shoulders to the right; this is the most common occurrence, though some¬ times it is the opposite. The shoulders are of an unequal height, the right generally highest.

Besides the deformity hereby induced, in many in¬ stances great distress is brought on. When the bend or curve is very gradual, patients may continue a long time without much other inconvenience than the deformity, but when it is in the least sudden, then the nerves that issue on the concave side arc unduly compressed, while