An article on Pott’s disease does not really come within the province
of a practice of medicine. Still it will be acceptable to the
practitioners and students of osteopathy, as one of the objects of
osteopathic work is to improve, not only medical and obstetrical
practice, but also surgical practice, and besides the osteopath will
have many cases of spondylitis to treat. “Pott’s disease, or caries
of vertebral bodies, was first described by Percival Pott in 1779. It
consists of a destructive ostitis affecting the spongy tissue of one
or more of the bodies of the vertebræ. The ostitis is tuberculous, and
is similar in character to tubercular ostitis seen in the epiphysis
of the long bones. Owing to the superincumbent weight of the head
and shoulders pressing upon the carious vertebral bodies, the spine
and trunk become peculiarly and characteristically distorted. The
morbid process is limited, as a rule, to the bodies; the transverse,
articular, and spinous processes are rarely primarily affected.” (Park).
The first consideration in the =treatment= of Pott’s disease is rest.
If the disease is a progressive one, rest in bed in the recumbent
position is necessary. Naturally, the object of the treatment is to
secure resolution of the tubercular ostitis as soon as possible. To
do this, careful manipulative treatment should be applied to the
diseased vertebræ. The treatment must not be harsh, for there would
be danger of greater irritation to the parts, and possibly infected
particles from the destroyed tissue might gain entrance to the vascular
system. The osteopath must be extremely careful how he manipulates
the spinal column in Pott’s disease. The object of the manipulation
is not primarily to overcome the deformity, as some may think such an
act possible, but to separate the vertebræ enough to allow a freedom
of the circulation, and to remove impingements of the nerve tissue.
It is impossible to overcome the deformity to any extent when part
of the body of the vertebra is destroyed; but if one could treat the
case at the incipiency, most probably deformity would be prevented.
There is another danger in treating cases too severely, and that is
causing exhaustion of the patient. Treat the spinal column not only
to separate each articulation slightly, but to carefully crowd the
diseased vertebræ toward their normal position. When the disease is
in the dorsal region, considerable attention has to be paid to the
ribs, as they are invariably involved when the spinal curvature is
great. Hence it is necessary to treat each rib separately, and try to
correct them at least, and remove any obstruction to nerve fibres or
vessels that may be found. One of the strongest arguments against the
indiscriminate use of braces, jackets and various mechanical appliances
in spinal deformities, is that they tend to straighten the spine, by
simply crowding the vertebræ and ribs as a whole into place, besides
interfering with the cutaneous circulation. The osteopath should
realize that each vertebra and rib has to receive special treatment,
in order to correct the spinal column, and that mechanically exerting
pressure upon all the vertebræ at one time tends to lock the vertebræ
and ribs all the more securely. It is like trying to correct a certain
subdislocation of the cervical vertebræ by pulling and twisting the
neck instead of applying specific treatment—the lesion is all the more
firmly fastened. Young, in his Surgery, makes this observation: “Like
chronic abscess or chronic bone disease, this affection has its origin
in the fact that the tissues of the anterior parts of the bodies of
the vertebræ have been partly deprived of their nutrition because of
luxated ribs or subluxated or twisted vertebræ.”
After the tissue destruction has been limited, and the deformity
corrected as much as can be, an ankylosis should be secured if
possible. Promotion of ankylosis depends altogether upon the preceding
treatment—rest and an improved nutrition of the parts. A truss or
brace, if correctly applied, is often beneficial in such cases. The
treatment of spinal abscesses is entirely in accordance with surgical
treatment.
In all cases the general health of the patient has to be well taken
care of. The osteopath must not be over zealous for quick results.
It takes many months to perform a cure; however, there is always
a tendency toward a cure. Treatment of the spinal muscles and of
the limbs, and pure air, sunlight, massage and good food are very
necessary.