An observing friend of mine divided men into two classes: those who fuss about their lame backs and those who ignore them. For all men have them unless they die young. The lame back has always been a prolific source of income, much of it received with clear consciences, for its obscurity and, presumably, many different causes have naturally led to many treatments. All the cults have had their own ways of treating it and often successfully, for nearly all of us have had our periods of remission, and the psychic factor is important.
Early in this century earnest and industrious gynecologists provided well for their families by doing "suspensions" on women with aching backs and tipped-back uteri. There are still lots of tipped uteri and lame female backs, but we are now pretty sceptical of the cause and effect. Right now I am thinking of one charming young woman, with a retroverted uterus and five or six children, whose dynamic life is still untroubled by low back pain.
Meanwhile, in the male sex, the sacroliac joints were usually held responsible for lame backs. One did not have to be well informed medically to tell one's friends glibly that one had a "sacroiliac." Probably most of you know that the lowest vertebra rests on a heavy wedge-shaped bone called the sacrum.
This, with its narrow portion down, fits, like the keystone of an arch, between the right and left ilia. On the surfaces between the bones there is cartilage as in a joint. There is little if any space in these joints and as little motion. However, they were blamed for much grief and finally a distinguished orthopedic surgeon developed an operation to fuse the joints. It is outmoded now.
A score or so of years ago it was shown that the disks of cartilage which lie between the vertebrae and act as shock absorbers could when ruptured cause severe back pain. They bulge out into the spinal canal and, as space is limited, they press on nerves. This may happen in the neck but it is far more common in the lower back where the five large lumbar vertebrae are supporting a lot of weight and are subject to severe strains. Since this has been understood, great numbers of ruptured disks have been recognized and operated upon. The methods of diagnosis have been made more accurate and the operation made much less elaborate. At the same time it has been shown that many cases, possibly most of them, do not require operation.
This episode demonstrates what we believe is the necessarily slow painstaking development of good medicine. About the turn of the century, Theodor Kocher, a great European surgeon, reported a case where the vertebrae had squeezed together and ruptured a disk which had bulged into the canal. But the man had fallen a hundred feet and died within a few hours. No surgical significance was attached to this. But the case was recorded. Years later, Dr. Walter E. Dandy, of Johns Hopkins, found cartilage sticking into the spinal canals of patients who had sciatica. In 1932 Dr. Jason Mixter, of Boston, operated on a patient with sciatica who had had an accident followed by pain in his lower back. Dr. Mixter and Dr. Joseph S. Barr recognized that the material which was projecting into the spinal canal was cartilage and they concluded that the patient had a ruptured disk. By the next year they were able to make the diagnosis, operate, and confirm it. And at the same time a doctor in France had arrived at the same conclusions.