Low Back Pain of Obscure Origin.

Every branch of surgery has its problem, and surely none has a more perplexing one than the low back pain of orthopadics. At one time this problem, with which we were confronted daily, seemed a hopeless one; but gradually, with increased knowledge and after an immense amount of carefully directed research, order and hope have evolved from chaos, and a more exact diagnosis has been made possible, so that now there is hope for the great majority of low back cases seen by the specialist orthopaedist. The evolution of the treatment of " backs" is interesting. There was an early period when little or no attempt was made to make an accurate diagnosis, and all backs were treated merely symptomatically. Shortly before the GreatWar the pendulum swung the other way and most cases were diagnosed as "sacro-iliac strain," so obscuring the essential problem. I believe that now an accurate diagnosis can be made in the great majority of cases so that, with a reasonable line of treatment ascertainable, the outlook is at least a hopeful one. There still remains, however, a group of cases in which the pathogenesis is indefinite and in which derangement can only be assumed. These cases are difficult to assess, to treat, or to forecast as to the future, and it is to this group that I particularly refer here.