tion, in these cases, that we may present the merits or demerits properly before our courts of law.

classifica

In examining these cases, and in our tions, we have omitted the term "spinal concussion" altogether, and as standing for a pathological entity, and have proceeded with the examination solely with a view of ascertaining the exact condition of the nervous system. They naturally divide themselves into injuries to the peripheral nerves and functional and organic diseases of the spinal cord, brain and sympathetic. Of course we may have mixed cases, but it is usually possible to separate the symptoms and refer them to their proper seat. Peripheral nerve injuries are almost always accompanied by a loss of power in the muscles supplied by the nerve and in a loss of sensation in the skin, to which it is distributed. The nerve may be completely paralyzed for a few days and regain its function in a comparatively short time. The blow on the nerve may set up an exceedingly slow inflammatory process in the nerve that may lead to atrophy of the muscles supplied by the nerve, or to the wasting of an entire extremity by extension of the inflammatory process. As a rule, if no changes are apparent in the muscles of a part six months after an injury, we can exclude damage to the peripheral nerve. So far as we know, peripheral nerve trouble is always organic, the nerves having but the single office of conduction; their functional disorders are practically nil.

Trumatisms of the spine are divisible into three great groups; those of a functional character, which may be generally named by the term "spinal neurasthenia." They are characterized by fixedness of the spinal segments, pain on pressure and on motion, a subjective sense of weakness in the extremities. It is this form of spinal disturbance to which the term "spinal concussion" has been so frequently and so misleadingly applied. It may or may not be associated with some of the organic lesions of the cord which compose the second group of spinal

injuries, and which includes all of the systematic and unsystematized organic lesions to which the cord is liable. The third group includes injuries such as strains of ligaments and muscles, as well as fractures of the bones composing the spinal column, and which may be followed by the varying symptoms of sapondylitis.

We do not claim that the diagnostic differentiation here attempted is easy in every case. In many it can only be made by time; frequently the pain will be followed months after injury by a deviation of the spinal segments, or organic changes in the cord will show themselves a long time after the primary injury. What we do claim, is that it is possible to make a thorough analysis of each case upon these lines within one year of the receipt of the injury, and that we can formulate a prognosis that shall be approximately correct, a thing that is impossible under the symptom grouping of Erichsen's disease or spinal concussion.

The classification of head injury cases is the same that is followed in the spinal. We have first the functional, which includes the cerebral type of neurasthenia, then the group accompanied by mental changes, and thirdly, those which include the organic disturbances, such as hemorrhage, etc. Lastly, the class in which there is rupture of the membranes or fracture of the bone. Perhaps the frequency of a certain class, namely, the epileptics, would entitle them to separate mention.

We had hoped to present a summary of over one hundred cases of traumatisms of the nervous system, in support of the classification adopted in this paper, but found that it would consume an unreasonable amount of time.

It is claimed that the classification here adopted will enable us to make an accurate estimate of the nature and extent of injuries that are now obscured by the misleading and objectionable terms "spinal concussion," "Erichsen's disease," and the "traumatic neurosis."

Address of the President of the Section on Neurology and Psychiatry of the First Pan-American Medical Congress.*

By C. H. HUGHES, M. D., St. Louis, Mo.

COLLEAGUES

OLLEAGUES OF THE CONTINENT:-I bid you cordial welcome. For the first time in the history of the world the medical profession of all the Americas meets fraternally for mutual work and words of counsel for the welfare of the North and South American medical profession and people.

In this Neurologic and Psychiatric Section, brothers, we also, for the first time, grasp the hand of fellowship. We heartily clasp hands with you and in our hearts we embrace you, with the prayer that nothing shall ever dissever the friendship between the Northern and Southern American profession now so auspiciously consummated. May the final hand-shake between the profession of the North and South American States never be permitted to take place. We want your friendship forever. So long as "earth grows a plant or sea rolls a wave,' we pray that it may endure, growing closer and closer in ties of inseparable fraternity.

In our special departments of medical research and labor we have a common interest, and in every department of medical investigation and advance, our interests are likewise mutual. The sanitary welfare of all of the American States is alike. The same hygienic, therapeutic and pathologic problems press upon us all for solution; the medical discoveries of each one of these States redounds to the welfare of all the others.

To this end, therefore, we salute and welcome you, wishing you health and happiness, through a mutually

• Washington, D. C., September 5, 6, 7 and 8, 1893.

advanced and glorified medical profession, and in behalf of the Neurological Section of this great congress, I join you in the sentiment, "America laudamus-viva Americana!"

Before proceeding to the work before us, it may prove a source of pleasure and profit, and it certainly is flattering to our professional pride to note some of the neurological advances of our day and especially the contributions of neurology to general medicine and the consequent welfare of the world.

None of the many victories in the onward march of American medicine during the century now nearing its close, have contributed, or are destined yet to contribute, more to the happiness of mankind than the light which has been thrown by our researches on the nature and treatment of inebriety, dipsomania and chronic alcoholism and their neural sequelæ, especially multiple neuritis.

To a distinguished American physician, signer of that Declaration which gave a nation birth, Surgeon-General of the Continental Army and teacher of the Practice of Medicine in the first medical university founded in America, Dr. Benjamin Rush, the scientific world is indebted for having taught that inebriety is a disease. His followers, living in the Pan-American States, taking their cue from this distinguished pioneer medical savant, have pursued the study until the therapeutics of inebriety has become as successful as that of any other grave nervous disorder and its pathology as well understood, while medical philanthropy, following his advice,* has erected hospitals for the cure and care of its unfortunate victims, though, as yet, no monumental shaft mementoes, as it should, a nation's grateful memory of Benjamin Rush's noble work.

We record, also, with satisfaction scarcely exceeded by that we enjoy from contemplating the salvation of the inebriate, the successful cure of the opium habit and

* "Diseases of the Mind," 1812.

other kindred forms of baneful drug ensiavement. Yet it has not been long since that once brilliant litterateur, De Quincy, himself enthralled, proclaimed in despair the "pangs of opium" and the "Illiad of woes" its enslaved victims hopelessly endured.

The opium fiend, as he is with cruel facetiousness so often called, need not be longer regarded as a hopeless wreck if the hand of charity will only conduct him within the pale of professional resource. This and alcoholism and all similar forms of nervous derangement are now treated successfully much like certain forms of mental aberration are-by change of environment, by therapeutic repression, including hypnotic support and reconstruction of the damaged and aberrantly-acting neuropsychic centers. This is another jewel medicine offers for the crown of modern progress.

Notwithstanding the illustrious names which, in our own day, the world beyond our geographical boundaries has given to medical science, our American States have likewise their great physicians whose offerings on the altar of that science whose special care is the welfare of man, are worthy of exalted place beside the Old World's gods. For the Virchows, Charcots and Lombrosos, Maraglianos and Kowalewskys, Gulls and Horsleys, of worldwide fame beyond our shores, we have given to the world our Brown-Séquard, who went from America to cosmopolitan fame, our Hammond, another pioneer American neurologist whose books have been translated into all the languages of civilization, our Seguin likewise, and our Pepper, President of this Congress and the peer of Sir William Gull, of Great Britain, and Ferran, whose preventive inoculations against cholera Asiatica called the medical world's attention anew to the grandeur of Spanish medicine. If Wigan could conjecture the duality of the mind from theoretical considerations and the general division of the brain into hemispheres, Brown-Séquard later, and at the time an American, proved it, and even my own feeble contribution on the "Duality of Action