VOLUME LIV NUMBER 13 ETHETR AND IMMUNITY--GRAHAM 1043

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AN EXPERIMANTAL STUDY OF CERTAIN

PHASES OF CHRONIC BACKACHE

A COMBISED GYXECOLOGIC AND ORTHOPEDIC

INVESTIGATION *

EDWARD REYNOLDS, M.D.

AND

ROBERT W. LOVETT, M.D.

BOSTON

DEFINITION OF CLASS OF CASES UNDER INVESTIGATION

For an indefinite time the medical profession has been confronted with a very common and perplexing dnss of Cllses, mostly in women, but occasionally in men, in which persistent backache is the chief subjective symptom. These cases present the following symptomatic pic­ture: The pain, generally dull in character .. is as a rule referred to the sacral or lumbar region and is frc~ quently felt iu one or both sacro-iliac joints; rarely it is complained of in the dorsal region. It also freqnently shoots clown one or both legs, in which case it is gen­erally classed as "sciatica" and is aggravated by forward bending or flexion of the thigh with the knee extended. The pain in the back and leg are aggra"ated by stand­ing, and especially by prolonged standing, such as is involved in the fitting of women's dresses. It is some~ times reli,eved by the recumbent position, but at times is at its worst ,rhen the patient rises in the morning. The pressure of the hand in the small of the back while sitting, or the use of a cushion in the same region in sitting or lying, are instinctive means of relief which every practitioner has seen these patients use. The pain is mo~t often aggravated during men:;;truation and in general is either unilateral or bilateral, but in the latter case on close questioning is usually found to be worse on one side than on the other. Local tenderness mav or may not he pre,ent. If the back is exposed and' the finger-tips are placed over the erector spinoo mUEc1es, perceptible spasm may be excited in these muscles by voluntary forward or lateral bending at the wai:::t~ and perfectly normal spinal mobility is unusual in the more marked ca5es. Bending is frequently better performed to one side than tn the other. The nervons element in thCi3C cases _ may be slight, or so severe as to dominate the whole picture. The condition sometimes originates from accidents, such as falls; it begins at other times as the remit of oyeruse or strain~ as in prolonged piano-playing, after heavy lifting, or nfter surgical operations. At other times it is founel ,vithout assignable cause. The affec­tion i;;, exceedingly persi~tent and seldom very Ee,erc, and 1t3 most :=::triking characteristic feature j~ the patient's insistence on ~ habitual pain for ,vlJieh nt) ade­quate cam=c is apparent. A search for that cau~e was the purpose of this iuyestigfltion. PHEST~XT TETDIJSOLOGY The cau~es or this condition have heen variously assigned by speeiali:3ts and the general practitioner to the pelvie organs. to the mU3cle,~ and joints. and tt) the nervollS sy.'3h:m. The uncertainty concerning it.;; true