Renal Calculus

Spinal rigidity, generally of the relapsing type, is met with in cases of renal calculus. I was consulted by a medical student, twenty-four years old, on account of a persistent pain in the spine over the dorso-lumbar region, which varied in degree from a dull ache to an acute agony; it was increased by movement, especially jolting. There was no tenderness or deformity, and violent succussion of the shoulders caused no increase of discomfort; on the right side the pain passed round the belly 'like half a girdle' When I first saw him the lower half of the vertebral column was quite stiff in all movements, and he walked in the constrained manner of a man with a stiff spine. The stammering test led to a quivering in the erector spinae, but the pain was so much increased by stooping that the test could not be fully carried out; but what I felt was sufficient to assure me that no organic disease of the spine existed. There were no symptoms referred to the kidney, and the urine was normal saving the existence of a few crystals of oxalate of lime. A week later, although the symptoms of pain, etc, were much the same as before, the spine was quite supple and the constrained gait in walking, which was present before, no longer existed. The renal region now was a little tender, and the muscles resented pressure to a slight extent. In five successive examinations the spine was quite stiff in two, quite supple in three. In the renal tenderness no change occurred, and the urine remained normal. An x-ray exposure was made, and there seemed to be an opacity in the right kidney, but the case occurred in the earlier x-ray period, and the result was too indefinite to be conclusive. I finally ex-plored the right kidney and removed an oxalate of lime stone as large as a hazel nut. The operation proved entirely successful, as all the symptoms disappeared and did not recur. The patient had unfortunately, in attempting to relieve the pain, contracted the morphia habit before I saw him, and the ultimate result was lamentable.

Stone In The Ureter

Within the last eighteen months I have seen a remarkable case of this kind in which spinal rigidity and pain were the conditions complained of. The patient was a stoutish, middle-aged man, of an obviously gouty habit. The pain, which was constant, was referred to the lumbar region, and was at times intense. When first seen, rigidity of the lumbar spine was apparently complete, and the lower dorsal vertebrae moved less freely than was normal. The stammering test established the fact that there was no organic disease of the spine. On one occasion the rigidity was altogether absent. The x-rays showed a stone of small size in the ureter. This, under the flushing-out treatment, was subsequently passed, and the symptoms complained of did not occur again.

Temporary Or Transient Rigidity

It is manifest that transient rigidity may arise from several conditions affecting the vertebral column apart from those the result of reflex causes. The only cause, however, which I need mention here is rickets. The general belief that the rickety spine is a supple spine is universally taught, and rightly so; but it is nevertheless a fact that during the gastrointestinal disturbance in rickets the spine may for a period be rigid.

In conclusion it may not be amiss to remind you that whilst on the one hand spinal rigidity is not necessarily an indication of disease of the vertebral column, its absence, on the other hand, does not show that the column is free from lesion, since in some cases of tubercle considerable changes in the condition of the column may occur without its suppleness being interfered with.