andages. As
with inflamed hip-joint absolute rest by lying in bed is of the greatest
importance.

If after a certain period of rest and application of the above-named
remedies no improvement in the state of health could be noticed, the
diseased joint was laid in plaster or confined with splints.

If even then, after such treatment for months, no improvement could be
noticed but rather that the general state of health was reduced, nothing
remained to be done excepting an operation, by which all the diseased
parts of the knee-joint were removed, or amputation, that is, the taking
off of the diseased limb. The latter method was generally adopted in the
case of feeble and emaciated individuals and those who had passed the
age of early manhood, as with these the removal of the diseased parts
did not, as a rule, result in an improvement of the general condition,
which was especially intended.

Now tuberculous inflammation of the knee-joint will be treated by Koch's
method and in extreme cases only will operation be necessary. At all
rates, an absolute cure will be easily effected.

Aside from the hip- and knee-joint the _spinal column_ is most
frequently attacked by tuberculosis. Here also it is the youthful age,
from the third year upward, that has to suffer most from this serious
disease. Adults are rarely attacked by it and with them it generally
appears in connection with general tuberculosis.

The tubercle-bacilli penetrate into the substance of the vertebrae,
destroy the same and transform it into purulent matter. As a result the
destroyed vertebrae sink or rather settle down and cause a curvature of
the spine, in other words a humpback.

In the beginning the symptoms of diseased spine are very indefinite and
misleading. The patient rarely complains of pain at first, and it is
only noticed that the sick child easily tires of standing or walking and
tends to hold on to chairs and similar objects with his hands to relieve
the spinal column of the weight. From such uncertain data it is of
course impossible to recognize the disease.

Only then when the softened vertebrae give way under the weight of the
body, that is when the humpback begins to develop, can tuberculous
inflammation of the spine be surmised with any degree of certainty.

As a rule two other characteristic phenomena appear which are dependent
on the pain in the affected spinal column. The child, while standing,
places his hand on the thighs and thus