directly supports part of the
weight of the trunk with the lower extremities; at the same time he
avoids bending the spinal column forward. This anxious care for the
diseased vertebrae is especially noticeable when the child attempts to
pick up an object from the floor. While the healthy child bends freely
forward, the sick one crouches down and while bending the knee and hip
keeps the spinal column as straight and stiff as possible. Frequently a
small spot on the spinal column is found to be extremely sensitive to
pressure in this stage; but such a subjective symptom must be considered
with caution especially with children.

This humpback, which is a result of tuberculous inflammation of the
spine, must not be confounded with the humpback caused by rickets. With
the latter the curvature is more uniform as a rule, and in the start at
least, disappears while in a horizontal position. Besides the humpback
resulting from rickets appears between the first and fourth years of
age, while tuberculous inflammation of the spine rarely begins before
the fourth year. And finally rickets never causes suppuration while this
is always the case with inflammation of the spine.

The progress of suppuration is downward as a rule and does not admit of
examination until it gets near to the surface of the body; before this
the feverish conditions toward evening are the only signs that indicate
beginning suppuration. Ardent fever is not attendant during this time;
the temperature does not exceed 38 or 38.6 deg. C. and even such trifling
increase of temperature may be wanting.

As soon as the skin is reached by the originally deepseated centres of
suppuration, it gradually becomes red and later on also suppurated. If
the skin is broken and the matter discharged, great care must be taken
to keep the wound clean, as otherwise the suppurative cavities may
suddenly become ichorous and lead to rapid death. In other cases this
extreme result is not caused and fistulae are formed from which the
ichor constantly flows. Small bits of mortified and broken off bones may
be thrown out with the matter.

As a result of the sinking and settling of the vertebrae the spinal
chord may suffer from pressure and contusion as it is contained in a
channel formed by the vertebrae. Aside from certain pain it may result
in paralysis of certain parts.

Formerly the diagnosis of tuberculous inflammation of the spine in its
beginning stages was very uncertain. A gre