region--and there is marked
hyperaesthesia on making even gentle pressure over the spinous
processes. As the patients are usually thin, the pressure of the
corset is apt to redden the skin over the more prominent vertebrae, and
give rise to an appearance which at first sight may be mistaken for a
projection. The general condition of the patient, the freedom of
movement of the vertebral column, and the entire absence of rigidity,
are sufficient to exclude tuberculosis. The condition is treated on
the same lines as other hysterical affections.

#Acute osteomyelitis# of the vertebrae is a rare affection, and is met
with in young subjects. It attacks the more mobile portions of the
spine--cervical and lumbar--and may begin either in the bodies or in
the arches. It is attended with extreme sensitiveness on movement,
severe localised pain in the region of the vertebrae attacked, and a
marked degree of fever. Pus usually forms rapidly, but, being deeply
placed, is not easily recognised unless it points towards the
surface. The infection is liable to spread to the meninges of the cord
and give rise to meningitis, particularly when the disease begins in
the arches. A milder form occurs, in which the main incidence is on
the periosteum; the symptoms are less severe, it does not tend to
suppurate, and is usually recovered from. The treatment consists in
applying extension to the spine and in opening any abscess that may be
detected. The suppurative form usually proves fatal, and, indeed, is
often only diagnosed on post-mortem examination.

#Arthritis Deformans.#--This disease usually begins between the ages
of thirty-five and forty, and attacks men who follow some laborious
occupation which involves exposure to cold and wet. It is met with,
however, in women who lead a sedentary life. There is sometimes a
recent history of gonorrhoea, rheumatism, or other toxic disease, and
occasionally the condition follows upon injury. The discs disappear,
osteophytic outgrowths develop at the margins of the bodies and in
connection with the transverse processes, and bridge across the space
between neighbouring vertebrae (Fig. 218). The articulations between
the ribs and the vertebrae show similar changes, and the ligaments of
the several joints tend to undergo ossification, so that the bones are
fused together.

[Illustration: FIG. 218.--Arthritis Deformans of Spine. The vertebrae
are fixed to one another by outgrowths of bone which bridge