This paper deals with 13 patients who were suspected of having a lumbar herniated nucleus pulposus because of their lumbar nerve root symptoms. In all the cause of pain and other findings was eventually found to be due to a lumbar, pelvic, or retroperitoneal malignancy. Several patients were thought to be either primarily psychotic, or at least psychoneurotic, because of their psychologic reaction to their pain. Study of these patients has enabled us to divide them into three groups.
The first group of three patients all seemed to have been in good general health prior to the onset of their back pain.
—The patient was a 62-year-old railroad employee with that type of back trouble supposedly common to railroad employees. He had been hospitalized for a period of time in December of 1954, and at that time films of the lumbar spine and chest were normal. He seemed