The conflict of Osler's concept of "typhoid spine".

© 2011 Canadian Medical Association or its licensors CMAJ, April 19, 2011, 183(7) 773 The Canadian clinician William Osler (1849–1919) wrote the article on “typhoid spine” during the last year of his life while Regius Professor of Medicine at Oxford University. This commentary looks at Osler’s view of the psychogenic cause of ty phoid spine. Typhoid was a common disease in the late 19th century. According to Osler, a patient who survived typhoid was usually ill for about six weeks, and a conservative estimate of mortality was 12%– 15%. Official reports for 1906–1910 state that of the 51 American cities with a population of more than 100 000, only Cambridge, Massachusetts, did not have an annual mortality from typhoid of more than 10 per 100 000. The mortality rate exceeded 55 per 100 000 in Pittsburgh, Pennsylvania, Atlanta, Georgia, and Louisville, Kentucky. Virgil P. Gibney (1847–1927), an orthopedic surgeon from New York, introduced the term “typhoid spine” in 1889 for a syndrome that may develop during the convalescent phase of typhoid. The syndrome was predominated by pain and limited mobility of the back. Gibney attributed these symptoms to “perispondylitis, meaning an acute inflammation of the peri osteum and the fibrous structures which hold the spinal column together.” It was thought to be rare because many patients died of acute typhoid before the symptoms of the back could develop. The most recent review on typhoid spine was published in 1998. In 1886, the London neurologist William R. Gowers (1845–1915) described the symptoms that would come to be called typhoid spine: