The diagnosis of Pott's disease of the spine before the stage of deformity / by V.P. Gibney.

  • V. P. Gibney
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: The diagnosis of Pott's disease of the spine before the stage of deformity / by V.P. Gibney. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The little hands can often be seen grasping the chin or the side of the head so as to support it as steadily as ])ossihle. These signs and these manoeuvres once seen will not be forgotten. There will be a history of pain, usually, in the prone position, the mother will tell how sensitive the head is, will tell how much pain and dis- tress follows the slightest cough. Indeed, occipital neuralgia will almost always be present if the first or second cervical vertebrae are at all affected either primarily or secondarily, for the sub-occipital and the great occipital nerves emerge in this region. Mr. Marsh makes a very good point when he observes that in other regions of the spine pain, when it is present, is felt either at the affected part or below it and is very rarely situated at a higher level. Irregular action of the diaphragm will materially assist in making a topographical diagnosis, for the fourth and fifth cervi- cal pairs must necessarily be implicated by reason of the pressure from inflammatory products. The ordinary temporary deformities of the head and neck from cold sometimes puzzle one in making a dif- ferential diagnosis, but in these we have exaggerated deformities with histories of a brief duration. An ex- amination of the tonsils and pharynx is always neces- sary, and in children it is often very difficult to satis- factorily explore these parts ; yet the presence of hard or soft tumors along the post-pharyngeal w'alls can easily be recognized by the finger. If any doubt ex- ists this exploration should not be neglected. An abscess in this region will sometimes produce the most alarming laryngeal spasm. The symptoms already detailed apply more particu- larly to the disease as it affects infants and children. Jn adults we can get better examinations, we can ascer- tain more definitely the location of pain. Further- more, caries of the cervical spine in adults usually fol- lows some severe traumatism, as a fracture or a sublux- ation, for instance.