Tuberculosis in infancy and childhood : its pathology, prevention, and treatment . requent than tubercle of the an analysis made some years ago of his own cases, the writerfound that of 1,450 cases of tubercle of joints, S33 occurred in thevertebrae, 547 in the hips, and the remainder were distributed in orderof frequency between knee, ankle, elbow, wrist, and shoulders. Itoccurs almost equally in either sex. The disease may occur at anyage, but it is more frequently found between the ages of two and per cent, of the writers cases occurred between the agesot three an
Tuberculosis in infancy and childhood : its pathology, prevention, and treatment . requent than tubercle of the an analysis made some years ago of his own cases, the writerfound that of 1,450 cases of tubercle of joints, S33 occurred in thevertebrae, 547 in the hips, and the remainder were distributed in orderof frequency between knee, ankle, elbow, wrist, and shoulders. Itoccurs almost equally in either sex. The disease may occur at anyage, but it is more frequently found between the ages of two and per cent, of the writers cases occurred between the agesot three and six. The relative frequency of disease he found to be—cervical, 69; dorsal, 340: lumbar, 170. 176 TUBERCULOSIS IN INFANCY AND CHILDHOOD Pathology. Tuberculous changes take place in the spongy tissues of one ormany vertebral bodies usually just below the fibro-periosteal layer ofthe anterior longitudinal ligament. The granulation tissue oftenadvances, following the course of the vessels along the front of thespine, invading adjacent vertebral bodies. At times the process may. FIG. I. -TUBERCULOSIS OF THE DORSAL VERTIi begin within the body of a vertebra, which may so extend as to forma cavity, which sooner or later collapses from superincumbent body-weight. It is to this defect in vertebral substance that we owe thecharacteristic angular projection associated with spondylitis. Separatefoci of disease, though occasionally noted, are comparatively the disease creeps behind the longitudinal ligament, onlysuperficially affecting the bodies, and is known as spondylitis super-ficialis. Clinically, it runs a more rapid course, and is characterized TUBERCULOSIS OF THE SPINE 177 by rigidity without deformity. The tuberculous changes may extendbackwards, involving the cord by pressure, or tuberculous collectionsmay pass under the vertebral fascia into the surrounding takes place generally by ankylosis, which may be fibrous,cartilaginous, bony,
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