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.