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Part 41

The vertebrae of the spine when contracted into a hump behind from disease, for the most part cannot be remedied, more especially when the gibbosity is above the attachment of the diaphragm to the spine. Certain of those below the diaphragm are carried off by varices in the legs, more especially by such as occur in the vein at the ham; and in those cases where the gibbosities are removed, the varices take place also in the groin; and some have been carried off by a dysentery when it becomes chronic. And when the gibbosity occurs in youth before the body has attained its full growth, in these cases the body does not usually grow along the spine, but the legs and the arms are fully developed, whilst the parts (about the back) are arrested in their development. And in those cases where the gibbosity is above the diaphragm, the ribs do not usually expand properly in width, but forward, and the chest becomes sharp-pointed and not broad, and they become affected with difficulty of breathing and hoarseness; for the cavities which inspire and expire the breath do not attain their proper capacity. And they are under the necessity of keeping the neck bent forward at the great vertebra, in order that their head may not hang downward; this, therefore, occasions great contraction of the pharynx by its [p. 238]inclination inward; for, even in those who are erect in stature, dyspnoea is induced by this bone inclining inward, until it be restored to its place. From this frame of body, such persons appear to have more prominent necks than persons in good health, and they generally have hard and unconcocted tubercles in the lungs, for the gibbosity and the distension are produced mostly by such tubercles, with which the neighboring nerves communicate. When the gibbosity is below the diaphragm, in some of these cases nephritic diseases and affections of the bladder supervene, but abscesses of a chronic nature, and difficult to cure, occur in the loins and groins, and neither of these carries off the gibbosity; and in these cases the hips are more emaciated than when the gibbosity is seated higher up; but the whole spine is more elongated in them than in those who have the gibbosity seated higher up, the hair of the pubes and chin is of slower growth and less developed, and they are less capable of generation than those who have the gibbosity higher up. When the gibbosity seizes persons who have already attained their full growth, it usually occasions a crisis of the then existing disease, but in the course of time some of them attack, as in the case of younger persons, to a greater or less degree; but, not withstanding, for the most part, all these diseases are less malignant. And yet many have borne the affection well, and have enjoyed good health until old age, more especially those persons whose body is inclined to be plump and fat; and a few of them have lived to beyond sixty years of age, but the most of them are more short-lived. In some cases the curvature of the spine is lateral, that is to say, either to the one side or the other; the most of such cases are connected with tubercles (abscesses?) within the spine; and in some, the positions in which they have been accustomed to lie cooperate with the disease. But these will be treated of among the chronic affections of the lungs; for these the most suitable prognostics of what will happen in these cases are given.

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