Miscellaneous


Miscellaneous. 239. Angular Deformity of the Spine Kyphosis Pott’s Curvature

DEFINITION- An angular deformity of the spinal column due to erosion and de…


239. Angular Deformity of the Spine Kyphosis Pott’s Curvature

DEFINITION- An angular deformity of the spinal column due to erosion and destruction by tuberculous disease (q.v.) of the bone, on the anterior aspect of the column.

It is liable to be associated with the formation of large abscesses, and with nervous symptoms referable to pressure on the spinal cord. It may occur at any period of life, but in at least fifty per cent. of cases it attacks children below the age of ten.

The tuberculous process may affect any portion of the spine and as a rule is limited to one region. The spinous processes of the affected vertebrae project and form a prominence in the middle line of the back.

CAUSES- Sometimes a fall, or blow, or other local injury is referred to as the immediate cause of the disease but the true cause is tuberculous infection of the bones. The progress of the disease is not necessarily rapid, hence the deformity may not become prominent till adult life.

TREATMENT- Attention should be given to the constitutional cachexia, and the following remedies be administered as may be most appropriate:- Calc-Phosphorus, Calc-C., Ac-Phosphorus, Silicea, Hep-S., Sulphur, Asafoetida, Mez., etc. (See also the Section on “Tuberculosis.”)

One important feature of the treatment is to relieve the pressure on the diseased bones and cartilages; and to accomplish this rest to the affected part for a period of at least a year is absolutely required. This is attained by suitable apparatus which fixes and supports the spine. Generous, nutritious diet must be given, and deleterious elements avoided. Bathing and friction should be daily practiced. When sufficiently recovered, out of door exercise in fine weather, with the suitable supporting apparatus, should be secured.

230. Lateral Curvature of the Spine Scoliosis.

DEFINITION- A persistent deviation of the spine from the natural erect form to the right or left side; chiefly affecting females from about the age of ten to sixteen or upwards. A curvature is said to be right or left according as the convexity of the curve is towards one or other side. The spine assumes a double curvature one being termed primary the other is a compensatory curve in the opposite direction to restore the balance, disturbed by the primary curvature, and is termed secondary.

SYMPTOMS- The spine is curved something like the letter S, and also twisted in its long axis one of the scapulae, and the other side of the bosom project, and one (usually the right) shoulder and side of the chest are preternaturally high and rounded, while the opposite are depressed and concave. Correspondingly, the hip on the side opposed to the convexity projects, and the loin on the same side is curved inwards.

CAUSES- Spinal curvatures are readily produced, in weakly patients, by occupations and pastimes that tax one side of the body more than the other; bad postures while sewing, ironing, writing, drawing, reading, playing the piano, riding, carrying a child on one arm, and the exercise of many kinds of handwork. Even bad postures in lying, sitting, and standing are liable to cause Lateral Curvature. All occupations which require the raising of one shoulder-blade and arm, standing at ease on one leg, crossing the legs, sitting on one side of the seat, leaning on one hip; want of unrestrained open-air exercises; tight dresses stays and bodices with steel, whalebone, or wooden supports, may operate as causes of curvatures. One leg being shorter than the other, walking with an artificial leg, Hip-joint disease, Rickets, paralytic affections of the lower extremities, Rheumatism, etc., may also cause distortion.

Scoliosis is due to the combined influence of weak muscles and ligaments, imperfectly ossified bones, and the repeated, or habitual assumption of faulty attitudes. The excessive use of one arm in the carrying of weights, the habit of resting on one leg more than the other, or the occasional assumption of a faulty attitude, in writing or in playing the piano or violin, doubtless determine the seat and direction of the curvature, and when it has once commenced tend to aggravate and perpetuate it, but too much stress has hitherto been laid on such factors in the causation of the deviation.

The development of scoliosis is always slow and insidious. As a rule attention is first attracted to the deformity about the age of puberty, but in most cases it has existed for a considerable time before it is observed. The patient usually a girl, though it occurs in boys is easily fatigued, has difficulty in keeping herself erect, and often complains of pain in the back and shoulders, and along the spaces between the ribs on the side of the convexity. To relieve the muscles of the back she is inclined to lounge in easy and ungainly attitudes.

TREATMENT- This must be both constitutional and local, and be regulated by the nature, extent, and cause of the deformity. If treatment is neglected, curvatures, however slight, will certainly get worse, for the extreme flexibility of the spine in youth, while it offers a favourable condition for cure, equally tends to an aggravation of the deformity if treatment is neglected. Further, as rigidity of the column increases with years, so the prospect of improvement diminishes at the same time, and for the same reason, Curvatures of long standing are less likely to grow worse.

REMEDIES- Calc-Phosphorus, Calc-C., Ac-Phosphorus, Silicea, Pulsatilla, Sulph, etc. Externally, a weak Arnica Liniment may be used.

The child must not be allowed to assume awkward attitudes while reading, writing or playing the piano; she must sit on a low chair, the seat of which slopes slightly downwards and backwards, and the back-rest of which reaches as high as the shoulders, and is at an angle of 100 degree to 110 degree with the seat. The feet should rest on a sloping stool, and when the child is reading or writing, a desk sloping at an angle of 45 degree should be used. In weakly girls approaching the period of puberty, special care should be taken to avoid compression of the trunk by tight corsets. Adenoids or other sources of respiratory obstruction must be removed, and if the patient is short-sighted suitable glasses should be provided. Standing should be avoided as there is great tendency to throw the weight on to one leg, but walking, running, swimming and other exercises which bring both sides of the body into action equally are permitted under supervision. Horse riding is a suitable form of exercise, but girls must ride astride.

In mild cases the above measures must be rigidly enforced, and gymnastics exercises prescribed. These should not be commenced, however, until after a period of rest in the recumbent position, all pain and feeling of tiredness in the back have disappeared.

In cases in which the curvature is not obliterated by suspension the deformity is irremediable, but by suitable exercises it may be prevented from becoming worse.

Appliances, such as supporting jacket, have no curative effect and can only be expected to relieve symptoms.

231. Morbus Coxae Tuberculous Disease of the Hip-Joint.

This is a slow, insidious, and serious disease. The child is supposed to be suffering from “growing pains” for months before the disease assumes an active form.

SYMPTOMS- The first distinctive symptoms are slight pain, not infrequently referred to the knee lameness, and weariness, and the limb is flexed and relaxed. Remedies are often applied to the knee, but the disease is in the hip. As the disease progresses, the nates of the effected side waste and become flabby; the limb is shortened, either by caries of the neck of the femur, or by destruction of the ligaments of the joints and consequent dislocation of the joint upwards on the dorsum ilii. There is increased fulness about the limb, the pains increase in severity, especially at night, and there are often startings of the limb during sleep Abscesses form, and afterwards burst on the nates or groin, or burrow deeply and discharge their contents into the rectum. Wasting of the nates of the affected side is one of the earliest symptoms of disease of the hip.

The duration of the disease varies from two to three months to several years. But it is much modified, both as to its duration and results, by skilful treatment.

White swelling of the joints is a disease of similar character.

TREATMENT- The medicines likely to prove beneficial are Aconite, Belladonna, Tuberculinum bov., Coloc., Hep-S. and Arsenicum, in the early stage of the disease for special symptoms, Calc-C., Silicea and Phosphorus

ACCESSORY TREATMENT- Rest of the affected part; surgical appliances are necessary to insure it. The diet should be nourishing, and include Cod-liver oil. Pure air, and especially a change by the sea-side, will expedite the cure. (See under “Tuberculosis”).

232 Acute Abscess.

Acute circumscribed abscess is the term applied to a localized rapidly formed collection of pus in a cavity produced by the suppurative process.

(a) Acute Abscess commences with a sensation of tension, gradually increasing to a definite throbbing pain, tenderness, heat, bright redness, and swelling of the part; these symptoms are soon followed by suppuration, which is marked by an alteration in the colour of the skin, and a change in the character of the pain, the former being livid, and the latter less acute, being rather felt as a sensation of weight and tension. After this, the parts between the Abscess and the surface become successively softened and disintegrated. The tumour becomes more and more prominent the centre exhibits a dusky-red or bluish tint, the cutis ulcerates, the cuticle bursts, and the pus escapes. But where pus is formed under dense fasciae, or deep in the breast or pelvis, and cannot quickly make its way to the surface, the pain is not relieved, but much aggravated by the increase of distension; and constitutional fever and chills are much more intense.

Edward Harris Ruddock
Ruddock, E. H. (Edward Harris), 1822-1875. M.D.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.

Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."