A boy, just passing from the adolescent period, of a markedly neurotic type, and the offspring of somewhat 'highly strung' parents, was reported to have had a slight accident in the football field, followed by some pain and stiffness in the lumbar region. He apparently recovered, but as he walked rather stiffly and became easily tired, he was seen by a medical man, who, finding rigidity of the spine, came to the conclusion that the lad was the subject of tuberculous disease, and advised complete rest on the back for a period of twelve months, to be followed by the use of a spinal jacket. As this rather drastic suggestion came upon the parents as a complete surprise, they were reluctant at first to resort to the treatment without the support of a further surgical opinion. The physician concerned in the case consequently referred the boy to me. Upon examination, he was found to be an elongated 'weedy' looking subject, obviously still suffering from the nervousness of adolescence; discomfort in the lower part of the back was complained of, and he tired very quickly after exertion; he preferred to rest or loll on a sofa, etc, rather than to exert himself, on the grounds of the discomfort, sometimes amounting to pain, which followed any but the slightest efforts at movement. The whole of the lumbar and dorsal spine was stiff; at first sight absolutely so, but upon applying the test I have described a distinct quivering in the erector spinas soon commenced, and the typical stammering movements followed. Further careful examination having failed to elicit any other evidence whatever of tubercle, I advised massage and rational exercise under proper supervision ; these were subsequently carried out, with the result that in a couple of months the boy was sound and strong. He went at once to a public school, and never ailed anything afterwards, although it is some years since the treatment was carried out. It is clear that in this case a knowledge of the stammering symptoms in rigidity of the spine prevented the adoption of a treatment of long-continued confinement and rest, which from every point of view would have been bad.

A middle-aged man, who came of a tuberculous stock, complained of a very intractable kind of lumbago, which persisted so long as to become a serious obstacle to business. Upon examination the lumbar spine was apparently quite stiff, and remained so during the ordinary test of bending with immediate return to the erect position. The erectores spinae were very hard and rigid. Under the stammering test, however, the usual quiver in the muscles, followed by subsequent jerkings, was felt. The question of tuberculous disease having been thus eliminated the patient was sent to a continental watering-place and returned in good health. The occurrence of this symptom of stammering may be held to be absolute proof of the absence of organic disease of the vertebral column.

The Stammering Jerk

It is interesting to note, although I do not know that the fact is of any special clinical value, that in the stammering spine the jerks occur in two forms - in the one the first jerk, which is brief, is followed by a succession of increasingly long relaxations in the muscles until sometimes a condition of nearly natural suppleness is arrived at. The process may, in fact, be diagrammatically expressed by the following markings:

In the other form the first muscular relaxation is long, those which succeed becoming shorter and shorter until, in some cases, a condition of apparently complete rigidity may be resumed, the diagrammatic expression being thus:

The former type is, so far as I know, limited to cases of 'hysteria' and neuro-mimesis; the latter is mainly confined to cases of rheumatism and recent sprains and wrenches.