This book is one result of more than twenty-five years of experience in the treatment of backache from occiput to coccyx by traction and manipulation, and by operation. More than eleven hundred surgical operations have been done by the technique described in the text. In the course of the investigations, portions of spines were removed at one hundred and forty-seven routine autopsies, in which the ages varied from prenatal to ninety-four years. In each one, the intervertebral discs were examined in the gross, and many were examined miscroscopically. Many experiments were performed on intervertebral discs and on sections of spines; some yielded useful results.

Gratitude is expressed to the following learned friends who variously read parts or all of the text, examined specimens, engaged in many discussions, and made valuable suggestions.

General Practitioners: A. Horii, Vancouver; R. McEachren, Burnaby; H. J. Pickup, Alert Bay; H. Rutz, Langley; S. Slade, Squamish; G. J. Yamanaka, Ladner.

General Surgeons: L. H. Appleby, Vancouver; S. L. Ward, Vancouver.

Neurosurgeons: F. Emmons, Vancouver; W. J. Fowler, Vancouver; P. 0. Lehmann, Vancouver.

Obstetrics and Gynaecology: M. L. Gaudin, New Westminster.

Orthopaedic Surgeons: H. Jackson Burrows, London, England; J. Kennedy, London, Ontario; E. C. H. Lehmann, Vancouver; Bryan Macfarland, Liverpool, England; J. W. S. Melvin, Kingston, Ontario; William Mustard, Toronto, Ontario; F. P. Patterson, Vancouver.

Pathologists: C. J. Coady, New Westminster; H. K. Fidler, Vancouver; T. Harmon, Vancouver; H. H. Pitts, Vancouver; J. Sturdy, Vancouver; P. S. Vassar, Vancouver.

Physical medicine: James Cyriax, London, England.

Psychiatrist: D. C. MacDonald, Vancouver.

Radiologists: A. C. McCurrach, Vancouver; W. B. Parsons, Red Deer, Alberta; J. D. Stevenson, Vancouver; W. H. Thorlelfson, Vancouver; J. W. Vosburgh, Vancouver.

Scientists: Research Council of the University of British Columbia: A. W. Greenius, R. W. Klinck, B. H. Levelton, R. J. Saunders.

Professor W. 0. Richmond, Head of the Department of Mechanical Engineering, University of British Columbia. Professor Sheldon A. Jacobson, University of Oregon, and Herbert Lillie, Consultant Electrical Engineer.

Urologists: D. A. MacDonald, Vancouver; L. G. Wood, Vancouver.

Fred Richards, the artist, has for many years studied all aspects of the backache problem. He is a victim of multiple nuclear lesions of the spine, and as well as having had treatment on numerous occasions himself, he has observed the treatment of a great number of other patients. He found that the possession of the ailment was a great stimulus to interest. He has spent many hours sketching and painting in autopsy rooms. All the paintings made from specimens and patients were done with the intention of showing more clearly than photographs the points that we want to illustrate.

Thanks are due to authors and publishers for allowing Mr. Richards to copy their illustrations. Acknowledgements are made under the pictures.

Delightful and very helpful correspondence has been engaged in with every available author mentioned in the text. Effort has been made to give due credit in every case, but if there have been omissions, they are unintentional, and apologies are offered.

I should like as well to express my gratitude to my secretary, Miss Mona Brown, for her untiring efforts on behalf of this book.

In preparing the manuscript I have kept three quotations in mind.

First, the remark of Walter C. Alvarez, "Physicians ... are always looking for one thing, and that is something new, significant, important and useful.“ 1

Secondly, the rather depressing statement made by Sir William Osler, “In seeking absolute truth we aim at the unattainable, and must be content with finding broken portions.” 2

And finally, the observation made by George Perkins in his advice to medical authors that if a medical man is an able writer “he has missed his vocation.” 3

I hope that this book will help general practitioners, and perhaps others, to solve a great number of problems that at present seem to be insoluble.

Vancouver, 1964