(1) Tuberculosis of the spinal column is local evidence of pre- existing general infection. The influence
of this conception on treatment is emphasised.
The mode of infection is discussed and the haematogenous route is favoured, but it is possible that the
lymphatic route may also play a part.
Attention is drawn to recent researches into the detailed anatomy of the intervertebral disc. In view of
these it is probable that in some cases the primary infection is in the disc.
(2) Attention is drawn to the fact that a large percentage of cases of spinal caries under the age of ten
years is BOVINE in type, and the bearing of this on the
preventive side of treatment is emphasised. It is insisted that a milk supply free from the infecting bacillus
is essential.
(3) A case is described of the rare condition of tuberculosis of the SPINE of a vertebra.
(4) Recent investigations show that a small percentage
of abscesses are sterile, due to the fact that the contained Bacilli are "dead". As a rule these do not refill
after aspiration.
(5) Modern opinion inclines to the belief that a causal relationship between trauma and osseous tuberculosis
is extraordinarily rare.
(6) It is emphasised that important points in the
taking of radiograms are, (a) that the tube must be
focussed directly over the affected disc, and (b) that
a low penetration, (45 to 55 Kv.) should be used in
children to obtain clear details of bone structure. Attention is drawn to the use of lipiodol in tracking sinuses and illustrative radiograms are given.
(7) A short description is given of Schmorl's researches on the anatomy of the intervertebral discs showing
that spondylitis deformans juvenilis is due to prolapse
of the nucleus pulposus rather than to abnormalities in
growth of the so- called epiphyses.
(8) A description is given of a rare form of osteochondritis vertebralis at first treated as a case of
Pott's disease.
(9) Pott's disease needs longer and more intensive
treatment than is commonly thought. A long period of recumbency is necessary, and institutional treatment is
considered essential.
(10) Details of the treatment of spinal tuberculosis
as carried out in Saint Andrew's Home, Millport, are
given.
(11) The advantages and disadvantages of nursing in
the ventral and dorsal positions are discussed, and the
technique followed in Millport is given in detail.
(12) The making of plaster half-shells and celluloid.
corsets is described.
(13) The dangers of mixed infection after sinus formation are emphasised and the importance of dealing with
the psoas abscess before it enters the thigh is stressed.
(14) The operative treatment of Pott's disease is considered. The conclusion is reached that it is practically never indicated in children, whilst in adults, it
is only indicated very exceptionally. It must not be
employed with a view to shortening the period of recumbency.
(15) A detailed description is given of cases personally studied, representative of the different sites
affected and the different complications met with, in
the treatment of Pott's disease.
