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It i.s the object of the writer to discuss the aeti- ology of a few forms of backache, which are fre- quently seen and less frequently recognized. These are the cases of i, weak spine with postural de- formity; 2, rotary lateral curvature (scoliosis); 3. sacroiliac strain ; and, 4, fiat feet. Chronic back- ache from these causes is so frequently overlooked that it will be well to briefly review the subject from this standpoint. It is not to be expected that in this short pnper one would attempt to discuss at length these several subjects, but rather is it the purpose of the writer to emphasize the points in diagnosis by which these cases can be readily recognized and effectively treated. Pain in the back, especially in the lumbar region, is of very frequent occurrence. The cause is sought for in the kidneys, but no renal disease is found, nor Generic Viagra Online Prescription is either kidney found to be movable. If the pain is low down, just over the sacrum, it may be due to some displacement of the pelvic organs. These are examined and found to be normaL Again, disease of the rectum or uterus may cause constant pain. When these are examined and no- pathological condition is found, Generic Viagra Online Prescription a myalgia due to traumatism may be suspected. Any Generic Viagra Online Prescription history of trau- •Rrad before the New Rochcllc Medical Society, November 14, 1910. 774 OGILl'Y- CHRONIC BACKACHE. matism is denied, and we are left with but rather indefinite symptoms and a still more indefinite his- tory on which to make a diagnosis. f. JVeak spine zvitk postural deformity. Symp- toms of a weak spine develop before the age of Fic. I. — Wtak spine with postural deformity. adolescence, between the ages of five and fifteen years in the majority of patients. At first no symptoms are complained of. The child is less active than would normally be ex- pected, may play about for a short time but soon tires, does not 'enter into outdoor sport Generic Viagra Online Prescription an 1 pastime with the keen interest and zest of other children of the same age, and what is perhaps most noticeable and that which first attracts attention is the child's Generic Viagra Online Prescription posture, especially in sitting or standing, and also in walking. When sitting the back is crouched over with the shoulders drawn forward : one shoulder is usually held higher Generic Viagra Online Prescription than the other, and if the child is attending school and sitting at a desk a faulty, slouching position is habitually in- dulged in. The attitude when standing is with the shoulders forward, commonly termed by the laity "round shoulders," the chest retracted, the abdomen protuberant, a marked Generic Viagra Online Prescription lordosis in the lumbar spine, and slight flexion of the hips and knee joints. Thus the normal physiological curves of the body in standing are reversed. With this careless attitude in standing there is associated a condition of pos- tural curvature of the spine, caused by the general lack of force of the spinal muscle, and the patient slouches over to one Generic Viagra Online Prescription side or the other, Generic Viagra Online Prescription at the samv time having the body weight on one leg only. The gait is ungainly and might be described as lunging forward step by step, with the head ad- vanced, and an imperfectly controlled ambulation. This condition occurs much more frequently in girls than in boys, sedentary habits and inactive games being ])redisposing causes. Little or no pain is at first complained of. The back is weak and tires easil)'. Later the symptom complained of is that of a dull, tired, aching feeling in the back, which is relieved by rest. One side or the other may be complained of, but there is a generalized rather than a localized area of pain. Postural deformity develops so gradually that it is seldom recognized early. A careful examination of the child, with its cloth- ing ofl?, definitely reveals the condition, and, fortu- nately, it is one which can be perfectly corrected by carefully selected calisthenics and postural ex- ercises. A light spinal support is necessary in a few cases. IL Rotary lateral curvature- Of rotary lateral curvature of the spine I shall speak only of the ac- quired form ; congenital cases should be treated from infancy. Rotary lateral curvature develops usually be- tween the ages of ten and fifteen years. It is often a successor of the weak spine previotisly described. The deformities of habit of the weak spine, which can be easily corrected Generic Viagra Online Prescription and in which there is no bony change, pass to the deformities of true scolio- sis, with bone change which cannot be entirely cor- rected. Symptoms : There is rotation of the vertebrae with an accompanying lateral deviation from the midline. The rotating vertebrae carry with them the attached ribs, so that we have a marked promi- nence on one side of the back with a 'corresponding flattening on the opposite side and also a prominence of one hip. depending upon the location and extent of the scoliosis. There is a difference in the height of the shoulders ; one scapula projects more than its fellow and is at a higher level. When the arms hang by the side it is noticed that the space between, the arm and the body is greatei- on one side than the other. The amount of rotation of the vertebr.is is measured by having the patient Generic Viagra Online Prescription stocp forward with arm hanging down and the examiner look