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GEN. I.

Entasia

Muscular

the spine.

laterally, forming sometimes one great curve to one side, SPEC. III. and sometimes a more irregular figure, producing general Rhachybia. crookedness, and deformity of the whole trunk of the distortion of body, attended with many marks of ill health;"-yet admits that paralysis of the lower limbs never accompanies cases of this sort, so far as his experience had extended, nor even that untémpered, and mis-shapen structure of the spine which occurs at birth or during infancy from a rhachetic softness of the bony material. "I have never", says he, "seen paralytic effect on the legs from a malformation of the spine, however crooked such a malformation might have rendered it, whether such crookedness had been from time of birth, or had come on at any time afterwards during infancy.-None of those strange twists and deviations which the majority of European women get in their shapes, from the very absurd custom of dressing them in stays during their infancy, and which put them into all directions but the right, ever caused any thing of this kind, however great the deformity might be. The curvature of the spine which is accompanied by this affection of the limbs (i. e. that which takes place from a diseased condition of the bones themselves, subsequently to childhood, and from a supposed scrofulous diathesis), whatever may be its degree or extent, is at first almost always the same; that is, it is always from within outwards, and seldom or never to either side".

Pott's views too often mistaken,

and why.

Now it has unfortunately happened that, as Mr. Pott's remarks were written chiefly to explain this last form of spinal distortion, and addressed to the single cause of scrofula, the hints he has given respecting distortions from every other cause have been too often forgotten; and the moment a young female is found to have a tendency to a vertebral distortion of any kind, it has too generally been taken for granted that the bones were in a diseased state, or on the point of becoming so; that the patient was labouring under the influence of a strumous diathesis, which was manifesting itself in this quarter; and all the severe measures of caustics or setons, with an undeviating permanent confinement to a hard mattress, or inclined

plane, for many weeks or months, which a strumous affection of this kind calls for and fully justifies, has been improvidently had recourse to, with a great addition to the sufferings of the patient, and, in many instances, no small addition to the actual disease which has been so unhappily misunderstood.

GEN. I. SPEC. III.

Entasia Rhachybia. distortion of

Muscular

the spine.

Baynton :

Mr. Baynton seems justly chargeable with having Views of adopted this general view of the subject, and extending it indiscriminately to every case. Mr. Wilson, who though of Wilson: he conceived the disease to originate in a rachetic ra ther than a strumous diathesis, and had recourse, as we shall observe presently, to a different mode of treatment, seems to have stretched his parallel hypothesis over the same extent of ground. And Mr. Lloyd, who has lately of Lloyd: favoured the profession with a valuable work on the same subject, in like manner contemplates every case of spinal distortion as issuing from a common and that a strumous cause; to which cause also it has since as uniformly been assigned by Dr. Jarrold*. Mr. Lloyd, correctly indeed, and Jarrold. distinguishes between the angular and the lateral curvature; and with equal correctness observes that "in the former there is always some destruction of some portion of the vertebral column, and often, for a considerable time, progressive destruction of bone, cartilage, and ligament, and the vertebræ undergo precisely the same changes as the extremities of other bones in scrofulous diseases of the joints"; while he adds that " in the latter there is no destruction of parts, but merely an alteration of structure"; that "a wasting of the muscles always attends it in a greater or less degree"; and that " it has been supposed by some authors that the cause of the curvature is entirely in the action of the muscles. But although", he continues, "this may be and most probably is the immediate cause, I am much more inclined to believe that the primary cause is in the vertebræ: that scrofulous action is set up in them, which increases their vascularity, and softens their texture."

Enquiry into the Causes of the Curvature of the Spine, with Suggestions, &c. 8vo. 1824.

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GEN. I.

SPEC. III. Entasia Rhachybia. Muscular distortion of the spine. General admission.

Two chief and distinet forms of

spinal distortion.

lar most

common; and hence,

Here, then, is a distinct recognition of the two forms of morbid distortion of the spine, to which I am anxious to direct the attention of the reader: and each of them is allotted its peculiar seat, and diacritical signs; the bones, with manifest injury of the bones, and the muscles with manifest injury of the muscles. The rest is matter of mere hypothesis, and needs not urge us into a discussion.

So obvious and so much more common indeed is muscular than osseous distortion of the spine, that other pathologists, from this fact chiefly, have contended, that this The muscu- is the only form of the disease in its commencement. Such was the opinion of the late Mr. Grant, of Bath, and such is the opinion of Dr. Dods, of the same city, in an by some said to be the interesting tract he has lately published on this subject*: only form of while Dr. Harrison refers its origin to "the connecting Opinion of ligaments of the vertebræ. These", he observes, “get relaxed, and suffer a single vertebra to become slightly disof Harrison: placed"; in consequence of which, he adds, "the column seated solely loses its natural firmness, other bones begin to press

contortion.

Grant:

of Dods:

in the con

necting ligaments.

the rest too limited.

unduly upon the surrounding ligaments; they in turn get relaxed and elongated, by which the dislocation is increased, and the distortion permanently established. The direction becomes lateral, anterior, or posterior, according to circumstances: but the malady has, in every instance, the same origin and requires the same mode of cure." +

This last hyThere is much ingenuity in this explanation, and I pothesis like have no doubt that it is a correct expression of various cases of vertebral distortion. It chiefly fails, like the osseous hypothesis, in too wide a spirit of simplification, and in allowing no other origin in any instance than that which forms the key-stone of its own pretensions. AdIllustrated. mitting the disease to commence in the connecting ligaments, the associating muscles must soon be involved in the mischief, while, if it commence in the latter, the ligaments which unite them to the bones cannot long

*Pathological Observations on the Rotated or Contorted Spine, 8vo. Lond. 1824.

+ Lond. Med. and Phys. Journ. No. CCLXIV.

GEN. I.

SPEC. III.

Muscular

continue unaffected. So that the question is merely one of primogeniture, and imposes little or no difference in Entasia the mode of treatment. Nay, even the bones themselves, Rhachybia. by being irregularly pressed upon, may at length suffer in distortion of such parts from increased absorption, become thinner and the spine. more spongy, or even ulcerate and grow carious; so as, in process of time, to give a direct proof of osseous or angular contortion, though induced instead of taking the lead.

Whence the

change that occurs in the

relative po

sition of va

by Harri

son;

One of the chief difficulties, in cases where we have no reason to apprehend a morbid state of the bones, consists in accounting for the change that seems to take place in the relative position of several of the vertebræ or their rious verteprocesses; and especially in the greater elevation or pro- bræ or their minence of their transverse processes on one side, while processes. Subject difthose on the other are scarcely perceptible. And it is in ferently extruth chiefly to solve this question that most of the hy- plained: potheses of the present day are started in opposition to each other. The idea of an actual dislocation of the vertebral bones, which enters into that of Dr. Harrison, would sufficiently account for the fact, if such a dislocation could be unequivocally shown. But while the change of position does not seem in any instance to amount to a complete extrusion of a vertebra from its seat of articulation, the ease and quietude with which, under judicious management, it often seems to recover its proper position, and to evince its proper shapes, are inconsistent with the phænomena that accompany a reduction of luxated bones in every other part of the body.

The explanation therefore has not been felt satisfactory to a numerous body of pathologists; and Dr. Dods has by Dods. hence offered us another solution, which is also highly ingenious, and may perhaps in the end be found correct in those cases in which the miscurvature is very considerable, and especially where it becomes double or assumes a sigmoid figure. He supposes, in the first place, that the whole disease in its origin is seated in the extensor muscles of the back, or that part of them to which it is confined: more especially in the quadratus lumborum, sacro-lumba

GEN. I. SPEC. III. Entasia

Muscular

lis, and longissimus dorsi. He supposes, next, that the right hand being habitually more exerted than the left, Rhachybia. the effect of such surplus of force, in consequence of our distortion of throwing the body towards the left to preserve its centre the spine. of gravity, and hence strongly contracting the muscles of this side of the spine, must fall in a greater degree upon those muscles, and more dispose them "to suffer disorganization and become contracted"; and he hence accounts for the greater frequency of contortion on the right side than on its opposite. He then proceeds to account for Double cur- the single or double curvature which the contortion counted for. effects, by remarking that the morbidly contracted muscles of the left side, in overcoming the action of the Rotation of muscles of the right, do not drag the vertebræ forward

vature ac

the verte

bræ.

Effects of such rotatory change.

towards themselves in a direct line, but rotate the vertebræ to which they are attached, because of the angles formed, relatively, between the vertebræ and the pelvis (the points of origin and insertion of these muscles), and the force of their contraction acting upon moveable, horizontal, or transverse levers, namely, the transverse processes of the vertebræ*.

Morbid curvation of the spine, therefore, in the opinion of Dr. Dods, does not consist in an evulsion of separate vertebræ from their natural course and position, but in a twist of a great part or the entire column, by which means the morbid lateral flexure is nothing more than the natural sigmoid sweep of the vertebral chain, wrested more or less round to one side, as by the turning of a cork-screw.

Whatever displacement is met with in the ribs or the other bones of the chest, is necessarily a result of this first deviation from the line of health. "All the ribs", he observes, "have a double attachment to the vertebræ ; one, by their heads, to the bodies of them, and the other, by their tubercles to the transverse processes. When the vertebræ, then, are made to rotate upon each other, in the manner described, by the permanent contraction, and this, for example, to the right side, which is the

Ut suprà, p. 93.

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