Caries of the spine : being an advance chapter of The spine its deformities, debilities, and deficiencies (third edition now in press) / by Heather Bigg.

  • Bigg, Henry Robert Heather, 1853-1911.
Date:
1902
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Licence: In copyright

Credit: Caries of the spine : being an advance chapter of The spine its deformities, debilities, and deficiencies (third edition now in press) / by Heather Bigg. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    may also be added that there is often a certain amount of inflammatory thickening in the tissues around the carious parts, which rather hides than accentuates deformity. Debris.—No destruction of tissue can take place without bhe formation and disposal of debris; and it is this considera- tion that brings me back to the statement I previously made, that three quite separate diseases have, from the angular de- formity they produce, as well as from the similarity of their surgical treatment, long been grouped together under the single name of caries, although in actual fact they are quite distinct. Apart from their intimate pathology (which I leave to others) their differences can be immediately appreciated by the ways in which their debris is disposed of, a point which I have illustrated in the adjoining diagrams, and which I will now briefly describe in main, leaving the details to be more fully dealt with when I come to the subject of ' Treatment,' In dry caries (Fig. 1) the debris of erosion is cleared off as fast as it is formed. There is therefore no en- croaching accumulation, and consequently no obtrusive pressure on any of the adjoining parts, and in particular no interference with the spinal cord. An accidental post- mortem specimen simply shows the body of the affected vertebra to be honey-combed into cavities which are filled with working granulations, and in which the cell-builders of the body are attempting to replace the eroded tissues. When a vertebra is sufficiently undermined to give way, it does so in the angular manner that has previously been described, and that is all. Any of the symptoms that have been hitherto detailed may lie found, but none of those that are to ]>e presently considered, in short, there is no abscess, there is no paralysis. The figures on the opposite page arc diagrammatic only, although based on actual specimens. Fio. 1 shows the absence of all obtrusive debris in dry caries. Fm. 2 exhibits the mass that very commonly grows to impingement on the spinal cord in cheesy caries. Fi«. 8 portrays an abscess in suppurative caries which has worked backwards to nip the spinal cord, but lias then escaped forwards so as to relieve the cord from pressure. Km. 4 illustrates the commoner course of such an abscess and it« passage forwards without interference with the spinal cord at all,