DURING the past eleven years we have been obliged, from the type of our work, to become interested in the vertebræ, for the reason that we have acted not only as impartial physicians for the Industrial Accident Board in the State of Massachusetts, but also have had the opportunity to study a large number of cases of injury and disease of the vertebræ referred to us by various insurance companies. This industrial accident work necessarily opened up a new field of study differing in a good many ways from the study of the private patient. We soon came to realize that in industrial accident work the first objective was not only to determine as accurately as possible those changes, if any, which were the direct result of an injury, but also that the type of treatment might depend to a great extent upon this opinion. Again, closely allied with diagnosis and treatment was the question of immediate and future compensation. Consequently, we came to appreciate that the question of compensation was based more or less on the opinions passed by roentgenologists. We found very early in this study that theoretical diagnoses, which were not based upon known facts, or facts that were not easily demonstrable by the X-ray, led into difficulties, not only for ourselves but for the insurance companies, and eventually the Industrial Accident Board. Over this period of time we have gone through many phases of the work and many changing opinions, struggling to the best of our ability with apparently a difficult problem. We early realized the absolute necessity of giving opinions based on the X-ray studies, which were accurate and which could be proven and substantiated by facts and which were not theoretical. To accomplish this, it became necessary for us to classify our knowledge of the various spine conditions, normal or otherwise, visible in the X-ray. These observations may be simply grouped as follows: 1. The normal vertebra, including the many and varied anatomical variations; 2. Chronological, occupational or postural changes, which include scoliosis and hypertrophic changes; 3. The many changes due to remote and recent injury; 4. The chronic diseases, such as tuberculosis, arthritis, bone tumors and syphilis. (1) Notwithstanding the many opinions that have appeared in the literature in recent years to the contrary we believe that we can establish a normal vertebra as a standard for our study in the adult. This opinion is based upon a review of at least ten thousand cases, with this object in mind. This has been accomplished by a careful analysis of the vertebræ as it appears in the gastro-intestinal examinations, the genitourinary tract examinations, and in the special study of the vertebræ to determine the effect of injury and disease. During our service in the army a very good opportunity arose to make further investigation, particularly of the normal.
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George et al. (1924) studied this question.