across the
intervertebral spaces, and there is a slight lateral deviation to the
left in the mid-dorsal region.

(Anatomical Museum, University of Edinburgh.)]

In the early stage the patient complains of pain and stiffness in the
back; later the spine becomes rigid, and gradually develops a
kyphotic curve, sometimes accompanied by lateral deviation. In some
cases, the curvature of the spine assumes an extreme type, the
shoulders are rounded, and the head depressed, the face approximating
the sternum, so that to see an object such as a picture on a wall, the
patient must turn his back to it. The chest is flattened and
restricted in its movements, with the result that respiration is
embarrassed and becomes almost entirely abdominal. The muscles of the
back, shoulders, and hips undergo atrophy, and may exhibit tremors,
and the deep reflexes become exaggerated. The nerves are liable to be
pressed upon as they pass through the intervertebral foramina, and
this gives rise to pain and other disturbances of sensation in their
area of distribution. These pains may simulate those associated with
renal or gastro-intestinal affections.

The disease may simulate tuberculous caries or malignant disease. The
changes in the bones are demonstrated by the use of the X-rays.

The treatment is carried out on general principles (Volume I., p.
530), but it is seldom possible to do more than arrest the progress of
the disease.

#Coccydynia# is the name applied to a condition in which the patient
experiences severe pain in the region of the coccyx on sitting or
walking, and during defecation. The pathology is uncertain. In some
cases there is a definite history of injury, such as a kick or blow,
causing fracture of the coccyx, or dislocation of the sacro-coccygeal
joint. These lesions have also been produced during labour. In other
cases the pain appears to be neuralgic in character, and is referable
to the fifth sacral and the coccygeal nerves, or to the terminal
branches of the sacral plexus distributed in this region. The
affection is almost entirely confined to females, and the patients are
usually of a neurotic type. On rectal examination the coccyx is
exceedingly tender, and it is sometimes found to be less movable than
normal, and unduly arched forward. When medicinal treatment fails to
give relief, the coccyx may be excised.

#Tumours of the Spinal Cord and Membranes.#--Tumours may develop in
the substance of the cord (_intra-