Dr. William J. Otto: This was the first admission to the Massachusetts General Hospital of a 25-year-old carpenter with the complaint of backache which started two years previously and had been increasing in severity. The pain was dull, nonradiating, partially relieved by rest, but sometimes was severe enough to awaken him at night. It was usually controlled with nonnarcotic analgesics. A few months prior to admission he noticed general malaise, weakness, night sweats, and weight loss. These symptoms made him seek medical attention.
On physical examination his vital signs were normal and the blood pressure was 120/70 mm Hg. Examination of the heart and lungs was not remarkable. The liver was barely felt just below the costal margin. The spleen was not enlarged and no masses could be palpated in the abdomen. The neurological examination was not remarkable. Point tenderness was found over the right sacroiliac joint. Laboratory data revealed
Mattoso LF, Stone DL. Low Back PainAn Unusual Cause of a Common Complaint. JAMA. 1965;192(12):1063–1064. doi:10.1001/jama.1965.03080250041009