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According to history books, tuberculosis was responsible for the death of Simon Bolivar at the age of 47 years in 1830. The results of an autopsy performed by Alexandre Prospere Reverend, the French physician who cared for him during the terminal phase of his illness, have long been regarded as proof of the diagnosis. On careful reanalysis of Bolivar's medical history and post mortem examination, we reach a different conclusion. On the basis of several critical clinical, epidemiological, and pathological features of his fatal disorder, we conclude that either paracoccidioidomycosis or bacterial bronchiectasis complicating chronic arsenic intoxication was more likely responsible for his death than was tuberculous "consumption.".

This article describes the use of the Hartshill rectangle for the correction of spinal deformity. The Hartshill system is a modification of the Luque method of segmental spinal instrumentation whereby rather than two separate "L" rods a welded rectangle is formed from a single stainless steel rod. A "roof is bent into each end of the rectangle so that it conforms with the lamina. The Hartshill rectangle avoids the problems of overlapping L rods and gives increased stability and correction of rotation.

Segmental spinal instrumentation with sublaminar fixation is widely used but a variety of materials and techniques are being employed for both scoliosis and other spinal surgery. This study addresses the question as to which is best. Both the materials and the methods of securing them were studied. The materials tested were stainless steel 316L, Ortron 90 high nitrogen steel, titanium alloys, nylon straps, and Mersilene tapes. Doubled cold-worked 00.84-mm diameter stainless steel formed in a knot with a twist proved to be the strongest and most secure means of fixation with a yield value of 1,610 N. Attention to the details of technique and material such as the incorporation of a secondary twist and avoidance of hot-worked stainless steel may reduce the incidence of implant failure.

The Hartshill rectangle fixation is a modification of the Luque system of segmental spinal instrumentation. The rectangle is formed from a 3/16-in stainless steel rod and incorporates a roof that allows it to fit snugly against the lamina and provides good rotational stability. The rectangle is secured to the spine by means of doubled 0.91-mm-diameter stainless steel wires. The technique of the Hartshill system in the lumbar spine is described in detail. The system has been used in 71 patients with good relief of pain and without major complication. In the first 45 cases, a simple, flat, unwelded rectangle was used, and in the last 26 the Hartshill rectangle was employed.

The first 69 cases with a minimum of 1 year follow-up using the Hartshill system for the internal fixation of unstable spinal fractures (cervical 11, thoracic 8, thoracolumbar 42 and lumbar 8 are reported. The instrumentation is uncomplicated but attention to detail in technique is important. The system allows secure stabilization of the spine and early mobilization, irrespective of any neurological damage incurred in the primary injury.

Members of the British Scoliosis Society were circulated a questionnaire in order to establish the morbidity of surgery for spinal deformity in the years 1983 and 1984 in Great Britain. Surgeons were asked to report the complications relating to all types of surgery for spinal deformity in order to establish the relative morbidity of segmental spinal wiring. Of the 1,121 patients reported, 1.4% suffered neurologic complications. In straightforward surgery for adolescent idiopathic scoliosis, there were four serious neurologic complications: three with Harri-Luque and one with routine Harrington distraction instrumentation. A plea is made that morbidity studies of spinal deformity surgery should compare all types of instrumentation and should be sufficiently detailed to allow statistical comparison.

Curve patterns and surgical treatment in 118 consecutive patients with post-poliomyelitic paralytic scoliosis are reviewed. The typical curve pattern was double structural curves, usually including the lumbar spine. Modifying the incision and altering the sequence of instrumentation facilitated both the exposure and instrumentation of the fourth and fifth lumbar bodies. Anterior fusion and Dwyer's instrumentation yield most of the correction of pelvic obliquity and significant correction of both the upper and lower curves. Two weeks of halofemoral traction did not achieve significant curve correction. It is suggested that staged anterior and posterior procedures result in structural correction of pelvic obliquity and paralytic scoliosis in severe deformities equal to the degree of correction obtained using posterior fusion and instrumentation alone in less severe cases.