The restoration of the spine to its natural figure depends much on the early administration of the help proposed: though the distemper may be so far cured, as the patient may recover the use of his limbs, yet it is seldom possible to correct the curvature of the spine; and if the bodies of the vertebrae become completely carious, and the intervening cartilages are destroyed, no assistance is to be expected from any remedies. After the discharge produced by art for the removal of this disorder hath continued for some time, the patient begins to feel better health, he gradually recovers his appetite, is refreshed by his sleep, hath a more quiet and less hectic pulse; but the chief relief is from the loss of the distressing tightness about the stomach: in a little time a warmth and sensibility are felt in the thighs, to which the patient hath been long a stranger; and nearly about the same time the power of retaining and discharging the urine and faeces begins to be in some degree exerted. The first return of the power of motion in the limbs is rather disagreeable, as it is involuntary and spasmodic, principally in the night, and generally attended with sense of pain in all the muscles exerted. At this point it is not uncommon for the patient to remain for some time without making farther progress: this in adults occasions impatience, and in parents despair; but in the milder cases, the power of voluntary motion generally soon follows the involuntary. The knees and ankles by degrees lose their stiffness, and the patient can set his feet fiat upon the ground- a certain mark that the power of walking will soon follow. The joints, no longer rigid, are weak; and the first voluntary motions are liable to great variation, from a number of accidental circumstances, both external and internal. The first attempts to walk are feeble, irregular, and unsteady, and bear every mark of nervous and muscular debility; but from this point no instance hath occurred in which the full power of walking was not soon attained. When the patient can first walk, either with crutches or between two supporters, he is generally unable to resist or overcome the more powerful action of the stronger muscles of the thighs over the weaker, by which his legs are frequently brought involuntarily across each other, and he is suddenly thrown down. Adults find assistance in crutches, by laying hold of the chairs or tables; but for children a go-cart is the best assistant: it should reach up to the arm pit, and enclose the whole body. This takes off all inconvenient weight from the legs; and, at the same time, enables the child to move them as much as it pleases. Or the instrument of Mr. Jones should be worn, which, in all cases, would be serviceable, and in many a perfect cure, as it acts by taking off the superincumbent weight from the diseased vertebrae."see his Essay on Crookedness.

While the curvature of the spine remains undiscovered or unattended to, the case is generally supposed to be nervous; and nervous medicines are as generally administered, without advantage. When the case is known, recourse is too frequently had to steel stays, swings, screw chairs, etc. to restore the spine to its natural figure; but still the patient grows unhealthy, and, languishing under a variety of complaints, dies in an exhausted, emaciated state.

The remedy for this dreadful disease consists merely in procuring a large discharge of matter by suppuration, from underneath the membrana adiposaon each side of the curvature, and in maintaining such discharge until the patient shall have perfectly recovered the use of his legs. The effect of drains in all inflammations is well established; and it matters not by what means the dis-charge is procured, provided it be large, and from a sufficient depth.

In general, an eschar is made on each side of the curved part of the spine with a caustic: it should be of an oval shape, about an inch and a quarter in length, and three quarters of an inch in breadth, at the broadest part. Apply each caustic near the side of the curvature, so as to leave the portion of the skin covering the spinal processes of the protruded bones unhurt, and so large that the sores upon the separation of the eschars may easily hold, each, three or four peas in the case of the smallest curvature, but in large curves at least as many more. A few days after applying the caustics, the sloughs begin to loosen: it is then proper to cut out all the middle, and put into each a large kidney bean: when the bottoms of the sores are become clean in suppuration, sprinkle now and then a small quantity of finely powdered cantharides on them, by which they arc prevented from contracting, and the discharge is increased. The issues should be kept open until the cure is complete; that is, until the patient has not only the perfect use of the limbs, but also his former good health. By means of this discharge, the inflammation is checked, and the cartilages between the bodies of the vertebrae having been previously destroyed, the bones are united with each other. No degree of benefit, nor any tendency towards a cure, is to be expected until the caries be stopped: the larger the quantity of bones diseased, and the greater the degree of waste committed by the caries, the greater must be the length of time required for its correction, and for restoring to a sound state so large a quantity of diseased parts. Nothing can be more uncertain than the time required to accomplish a cure: sometimes it i, perfected in two months, and at others it requires two years; in the last circumstances,two thirds of the time have passed without any sensible amendment.

The discharge by means of the issues is principally requisite for the cure; yet every assisting means should be applied at the same time, in order to expedite it, such as the bark, cold bathing, frictions, etc. Yet, as we have already observed, general tonics and sea bathing have at times effected the cure without the issues; and in that case, nature, unassisted, restores the use of the limbs.

In the course of lecturing, in the year 1781, Mr. Pott observed, that it seems to be one of the few things that we may reason upon a priori, viz. that the whole train of the various symptoms of this disease are derived originally"from a constitutional predisposing cause; for, whenever, in a curvature of the spine, the discharge begins to have any effect, the lesser symptoms, if they may be so called, as pain in the stomach, tightness across the breast, incapacity of holding the urine or faeces, all give way, before the removal of the lameness from the curve begins to take place.

It is to be observed, a curvature of the spine may take place from the mollities ossium, the rickets, and from other causes of caries. An aneurism often produces a caries in the bones; so an aneurism near a vertebra may render it carious: the venereal disease sometimes attacks the vertebrae, and produces the same effect. The scrofula is said to be the constant cause of the angular protuberance, attended with a useless state of one or more of the extremities: but may not any cause, that produces a caries in the vertebrae, occasion the angular instead of the curved appearance of the spine? and when the carious vertebra happens, so as that it is nearly destroyed, may not all the same symptoms pro-ceed from its destruction, though the causes of the caries were various?

See Pott's Works on this subject; Jones's Essay on

Crookedness; Select Cases of the Disorder commonly called the Paralysis of the Lower Extremities, by John

Jebb, M. D. edit. 2; Bell's Surgery; Lond. Med. Journal vol. vi. p. 358; Earle on the Distorted Spine.