Diagnosis and Treatment of Acute Low Back Disorders: A Reference Guide for Physicians. Everett J. Gordon. Printed for Riker Laboratories, Inc., Northridge, CA. 1973.
Contributor: Kim Adams
This book appeared mysteriously in the aftermath of Christmas. The day we took down the tree, which, as a consequence of everyone forgetting to water it, had become brittle and prone to shedding sharp cascades of its faded needles at the slightest touch, a great deal of cleaning took place, and it was decided, after much contemplation, to reorganize the bookshelves. Perhaps this was the reason Diagnosis and Treatment of Acute Low Back Disorders appeared two days later under the pile of prints that had been removed from the top of the bookshelf and not yet given a home in the new organizational structure. There are other possible culprits – it was suggested that Vanessa, a chronic sufferer of back pain, had brought it up from New York on her Christmas visit, or perhaps Gabriel? A young neurological resident with a taste for poetry, maybe he had taken up an interest in the history of his discipline? In any case, after having been printed in the U.S.A. in November 1973 (per the back cover), it came to be on the dining room table, somewhere around the tenth or eleventh of January in 2014, where, once unearthed from the cascade of variously rolled and stacked posters and prints, it sat, listlessly sunning itself every afternoon, until I finally picked it up and read it for this review.
I am breaking the conditions of the text in reading it, and perhaps even more so in sharing it with you. On the inside of the front cover, in place of a publication statement, there is a summary biography of our author, Everett J. Gordon, M.D., F.A.C.S., F.I.C.S., followed by a brief statement of provenance and intent, “This reference guide is sponsored by Riker Laboratories, Inc., and distributed to physicians only. It is not intended that it be shown to or used by patients.” (italics original).
Indeed the stakes are high in the Diagnosis and Treatment of Acute Low Back Disorders – “If the condition is wrongly diagnosed, therapy will be prolonged and unrewarding, resulting in a dissatisfied patient who may change physicians or perhaps seek help from a paramedical cultist” (3). I love the sneaky intrusion of the witchy and affect laden “cultist” into the impersonal didactic language of the consequence. But then again, I tend to love the simultaneous distance and precision of medical language, where one can find even the broadest of generalities appearing in the guise of exacting clarity. “In some instances the final diagnosis must be deferred until a trial with conservative treatment has been evaluated, permitting further observation and assessment. During that time inconclusive findings may become more definitive and the diagnosis more apparent” (4). The procedures for diagnosis are a research method. Admittedly an unstable one, as the text reveals, fraught with the instabilities of language mediating between bodies. What might a poetics of diagnosis look like? A poetics of treatment?
History begins by pointing: “1. Ask the patient to point to the part of his back where he feels pain or discomfort.” Pointing is better than speaking because of the referential difficulties that occur when two systems of mapping the body overlap; “Often the area involved will differ from the examiner’s interpretation of the terms used by the patient… the patient will state that he as pain in his hip, yet he points directly to the lumbosacral or lumbar region, which he as incorrectly interpreted as hip area” (5). A practical solution for the failure of indexicality, yet a blunt one. Can a gesture substitute for the tricky fissures of referentiality?
In section B, titled “Evaluation of Pain,” there are two sub-sections, the first of which describes the bodily location of pain associated with “Acute low back strain.” The second describes the bodily location of pain associated with “Herniated disc syndrome” followed by two related diagnostic criteria. The first criteria consists of “weakness, numbness, or tingling paresthesia” in the extremities, which accompanies pain, and is evidenced by “discomfort and an inability to lift after prolonged sitting or standing.” This diagnostic criteria figures as an imperative – the doctor is told unhesitatingly, “Determine if there is discomfort….” The second diagnostic criteria is common to both low back strain and herniated disc syndrome, and it again involves difficulty in movement after stasis, as well as a more general “limited capacity for walking.” These criteria are called “symptoms” – a word that forms a bridge to the curious next sentence: “Symptoms suggestive of genitourinary, gastrointestinal or other involvement should be followed by appropriate questions” (6). No appropriate questions are suggested.
Here my favorite part of the text begins: the illustrations. While other sections of the text could and should be interestingly palpitated (I suggest the Tenderness section on page 14), I won’t bore you with any more close reading, but simply refer you to the illustrations below.