It is, I presume, hardly needful to say that symptoms are not always in proportion to the gravity of the disease by which they are caused, since it is common knowledge that grave disease may exist without noticeable symptoms, and that distressing symptoms may be associated with comparatively trivial complaints. It would be difficult to find a better illustration of this fact than that provided by certain cases of rigidity of the spinal column, a condition which, on the one hand, may be a symptom of the greatest moment, and on the other may be of no real importance at all provided that an accurate diagnosis of its causation be arrived at.

The cases included in the following table, which represents only those examples which have come under my personal observation, and is not intended to be a complete list, will show how large a field the question of rigidity of the spine covers, and how many factors are concerned in its production, more, I fancy, than are ordinarily realised: Table of Causes of Stiffness of the Spine Without Visible Deformity, and Exclusive of Acute Conditions.

Note - The lines in italics refer to the less commonly recognised causes of stiffness of the spine, and are those towards which the remarks in the lecture are mainly directed.

The whole subject is, as can readily be seen, a large one. All that I propose now is to call attention to certain broad features in some of the varieties of spinal stiffness, with a view especially to combat an impression which seems to be far too prevalent, that anything like pronounced rigidity of the spine, in the absence of congenital and acquired deformity, is a strong indication of tuberculous disease - an impression which I have reason to know too often leads to faulty treatment.