A most able and admirable editorial recently appeared in the Boston Medical and Surgical Journal, drawing attention to the sociological problems involved in the immediate and ultimate effect of traumatic or psychic shock on the nervous system. It speaks of the moral effect upon the community, particularly upon the working classes, of the more or less indiscriminate bestowal of damages for real and fancied injury, and the writer gives the views of a sociologist of distinction, who says that he regards the attitude of mind influenced by the general bestowal of damages in Germany and England as a most ominous and threatening problem. He calls the attention of physicians at large to the necessity of their having in these cases, when called upon to treat them, as clear an idea as possible of the subtlety of the problem and to realize fully the wide bearings of their expert decisions, averring that there is no doubt that many of the symptoms following accident are psychical, however they may be physically manifested. That a chance of money redress produces an inevitable tendency, inherent in human nature, "to exaggerate and, through more or less voluntary auto suggestion, to construct an organized complex of symptoms which might have sunk into the background of consciousness and disappeared." Trauma has come, in the popular mind, to be identified with "accident;" a "traumatic neurosis" means an “accident neurosis.". Experience will no doubt show that the term "traumatic neurosis" should be used with more and more caution and never as indicating a special disease. No doubt, both practically and scientifically, we would do as well to speak of "accident hypochondria," "accident neurasthenia" and "accident hysteria," since it is evident that not every trauma is due to an accident. Our author further shows that "socalled objective symptoms are in reality subjective and that their diagnostic worth lies in the fact that their presence points more or less distinctly to the absence of organic disease." For years we have maintained that there is no sharply defined type of disease which could be called traumatic neurosis. We believe that many cases are dependent entirely upon the force and conditions which are created. We quote from an article by the editor of The Railway Surgeon, in "Withrow and Becker's Medical Jurisprudence:" "While realizing that, owing to the by-play of extraordinary circumstances, trivial injuries, particularly with back symptoms, can readily shape themselves into neuroses, yet we believe that racial differences, perfection of physical condition and the multiplex force of surroundings are constantly modifying factors. We also believe that favorable surroundings and the influence of an unprejudiced and thoroughly impartial medical attendant will be productive of the exact condition of trauma as it exists." And if trauma produces a condition similar to hypnosis, as in traumatic hysteria, we cannot help believing that the existing force and predetermined mental condition of the medical attendant will oftentimes change trivial conditions into serious ones. It seems rather startling that the physician, by virtue of mental superiority, prejudice and suggestion, could create an essentially serious condition, but we candidly believe that it is possible in a weakened and receptive mind to suggest and develop consequences of a very serious nature. And if, as claimed by authority, such cases have been cured by hypnosis, it certainly seems natural that hypnotic suggestion would have equal effect in their causation when the conditions are favorable to it. There cannot be any doubt that accident traumatized minds, if we may so use the expression, absorb sensations not only directly from the effects of the injury, but also receive impressions produced by the suggestions of an already convinced mind, as exemplified in the description of cases given. Any case treated by Oppenheim, where the mind was in an hypnotic condition, certainly would partake of the character of Oppenheim's suggestion. We cannot believe that there is a typical complex of symptoms in every case possessing anything like uniformity, but the local trauma aids to develop the neurosis dependent upon predisposing central disturbances and peculiarities. But where we have physical perfection and mental strength trauma is very rarely likely to produce the psychic condition claimed to be peculiar to traumatic neurosis, for we find that where intelligence is blunted and where surroundings have made incidental elements of danger familiar, physical injuries are manifested as physical injuries only, and very rarely terminate in psychic troubles unless there exist extremes in intensity and a predisposition upon the part of the individual, either racial, inherited or acquired. Again the contributing elements of modern civilized life in generating psychic conditions are of undoubted force and effect, and when these conditions are added to injuries inflicted by corporations of responsible character, accident neuroses are of constant occurrence. These corporations are made the great prime cause when other contributing elements are infinitely more forceful. It is a well established fact that there is an enormous increase in hysteria under the peculiar influences of modern life. The excessive use of narcotics and stimulants, with little exercise, high living, the eating and consequent absorption of organic poison in tainted foods all tend in the direction of hysteria. Overwork and consequent fatigue are powerful causes. But mental conditions engendered by the use of narcotics, stimulants and improper food, overwork and fatigue count as naught in the production of accident neuroses, while the ability to pay of the inflicting party is the allpowerful disease-producing factor. Contributing elements are inoperative, and injustice is made potent and effective. Who can disen 养 tangle our idea of the cause from the effect by which many know it? In the interpretation of this modern social enigma the effect is made the substance, while the cause is ignored. All causes have power to produce effects, but in accident neuroses, we have heretofore perceived the event, change or phenomenon, and ignored the cause. The general idea of cause is that without which another thing called effect cannot be; hence, in accident neuroses, while every trauma is not the result of an accident, the accidents from cyclones are not as frequently followed by accident neuroses as are railway accidents, and simply for the reason that the surrounding conditions are oftentimes far more potent than the accident, and are justly the cause. But the brain of man is the organ which receives and manufactures suggestions, and these suggestions seem to shape themselves eternally to the wants of the individual possessing the brain. "In judgment of her substance thus they vary, SOME PSYCHIC CONDITIONS IMMEDIATELY FOLLOWING A CYCLONE. It may not be uninteresting to give our readers the impressions of the editor concerning the effects in a psychic way on some persons who passed through the St. Louis cyclone of May 27, 1896. An endeavor was made to study the general mental effect, facial expression, psychic anomalies and various subjective manifestations. Psychic shock or trauma under the influence of a cyclone seems almost the same as psychic shock from any other source, where sheer intensity of circumstance makes it productive of all the degrees of this passion as expressed by the words fear, dread, terror and consternation. Some moodily told how Some moodily told how they had passed through a more or less brief period of unconsciousness. "I did not know what had happened or where I was for some time afterward," was a common observation. The psychic condition was one of general obliquity to external impressions in which many voluntary acts were performed almost automatically; the higher mental faculties alone being in abeyance. Here strode a woman up the street immediately after the cyclone had ceased with her dress and underclothing high up around her waist, oblivious to surroundings with fixed look staring straight ahead, carrying beneath her arms a flower pot and in it a ruined plant. Another woman followed almost in a nude condition, carrying a bird cage minus its occupant. They acted as in a dream, thoroughly dazed and having the vacant stare of the hypnotic. Person after person aimlessly wandered, unconscious of their surroundings. surroundings or of the calamity which had occurred. One person informed me that he had wandered for four hours in this condition, utterly oblivious of what had occurred or where he was located; that he was so dazed that he lost his way home many times and at times found that he was talking at an excited rate; also that when he arrived home there was an almost irresistible impulse to still aimlessly wander. On the faces of many could be noticed a blank, yet pinched expression, an inattentive, blunted mentality, a seeming inability to concentrate attention or to think. While in others an increased impressionability arose, making them refrain from conversation and, as some expressed it, "Oh, I want to be alone; entirely alone." The change in voice was very noticeable; some talked with cyclonic explosiveness, while others had a halting speech, and again others a whispered utterance. In many claiming to be unaffected by the cyclone there was seen the hysterical involuntary symmetry of movement so frequently characteristic of this disease. Some would detail stories, showing plainly that peculiar excitability present in hysteria, where energetic movements were necessary to prevent irritating mental effects. Between psychic trauma producing many hysterical conditions of more or less severity, an unconsciously produced fatigue added bountifully to hysterical manifestations. Many persons spoke of the inordinate oppression of the silence which followed immediately after the terrific and almost stupifying roar of the cyclone. The influence of this silence seemed to add an intense impressionability in many persons, creating an additional element of hysterical cause. Said an intelligent gentleman: "I never knew the horror of an after cyclonic silence before; it is inde scribable. I remember once to have heard the following in relation to silence. Two adventurous and money-making men once fenced off the entrance to the Yosemite Valley in order to cheaply raise stock in the valley. A man was employed to take care of this stock and lived in a ranch house on the mountain side near by. This man spoke of the extreme oppressiveness of the silence by which he was surrounded. As night approached he would cook his supper and then go out and call in loud stentorian tones: 'Hello, someone, here is a good supper; come and eat it with me.' He would thus go and call in different directions; no one answering, he would irreverently grumble and become so mad that frequently he would leave the meal untouched. One day he appeared before his employers, some fifty miles distant, with as blank a looking face as was ever seen on a human being; his eyes protruded and glared, he had a begrimed countenance, he was hatless and almost without clothing. He told in slow and uncertain tones how in the early part of the night while reading he was suddenly aroused by the most awful and horrible noise as though the mountains were falling and the earth breaking in twain. Without hat or even looking back he started and ran and walked all night and all the next day, only intent on leaving behind him the cause of his terror. It was found upon investigation that the cause of his alarm was that a portion of the 'El Capitan' mountain at the entrance of Yosemite Valley, had fallen, undoubtedly producing a hideous enough noise to frighten anyone. This man averred that millions would not tempt him to undergo again this killing silence nor receive the shock which the falling mountain gave him. I now can well conceive of the demoralizing effects of excessive noise, followed by oppressive and overpowering silence. I certainly would at one time have given worlds to leave that ponderous silence." The immediate effects of the cyclone can now be seen in many cases, but its ultimate effects are as yet an unknown quantity. We candidly believe that the full effects are not yet manifest. Psychic shock, trauma, exposure and fatigue will be productive of many cases of well defined hysteria and neurasthenia. The permanency of their effects can only be determined by time. Notes of Societies. National Association of Railway Surgeons. Official report of the proceedings of the Ninth Annual Meeting, held in St. Louis, Mo, April 29, 30 and May 1, 1896. APRIL 29-FIRST DAY, MORNING SESSION. The association met in the Pickwick Theater, and was called to order by the chairman of the committee of arrangements, Dr. W. B. Outten, at 10:35 a. m. Dr. Outten made a brief report on behalf of the committee. He then introduced Dr. M. C. Starkloff, health commissioner of St. Louis, who delivered the address of welcome, published elsewhere in this issue, which was responded to by Dr. F. J. Lutz of St. Louis, as follows: Dr. M. C. Starkloff: Sir, I return to you in the name of the National Association of Railway Surgeons, thanks for the expressions of welcome which you have just voiced. I feel confident that the profession and the people of this fair city will redeem every pledge which you have made for them. The great city of St. Louis is no stranger to this association, nor do its members feel that they have come as strangers. The rapidly progressing age in which we are so fortunate as to live is typified by nothing more perfectly than by the railroad, and no unimportant factor in the management of the "iron horse" is he who is represented by membership in this association. The wisdom which prompts precaution against accident has not been unmindful of the necessity for providing means and methods for the correction of injury, the alleviation of suffering and the protection of the health of the traveling public, as well as of those engaged in the perilous vocation of railroading. In order to carry out more successfully the duty assigned to us as co-laborers in the advancement of modern means of travel, we make these annual pilgrimages. We endeavor to exchange experiences, to learn from our fellow surgeons, to observe the work of those conspicuous in the various departments of surgery, and to take with us into the field of our individual labors what may be conducive to the advancement of our profession. The encouragement which we receive from you, the representatives of this great metropolis, cannot fail to incite us to still greater efforts, and I again thank you in the name of this association for your words of wel come. Dr. Outten then presented the president of the association, Dr. J. B. Murphy of Chicago, who delivered the presidential address, published elsewhere in this issue. The treasurer, Dr. E. R. Lewis of Kansas City, read his report, which, on motion of Dr. Brock, was referred to an auditing committee. REPORT OF THE TREASURER. To the members of the National Association of Railway Surgeons: Gentlemen: It is with pleasure I am enabled to state that during the past year all old bills as well as new have been paid to date, and we open this meeting free from debt, and with an active working membership of nearly 1,200, every one of whom is imbued with the benign character of our work. Already many members who could not attend this meeting have, by mail, paid their dues for the coming year. No effort has been put forth to recruit our association, although I feel that in the future such effort should be made, for we are to-day building upon a rock, engraving our work upon its face, where time itself cannot eradicate it. Our membership continues to represent not alone the United States, but Canada and Old Mexico. Illinois leads with 116 members, Iowa second with 106 members, Missouri third with 97 members, Kansas fourth with 86 members, Pennsylvania fifth with 84 members. We have received during the year $5,580, and have paid the Railway Age and Northwestern Railroader $3,348, for new members registering during the year. We also paid the old debt we owed the Railway Age and Northwestern Railroader, which was amicably compromised, the association holding a clear receipt for the same on the old account. We have also settled an old bill with one of our members, who was generous enough to share liberally this expense with the association. It will be seen that we have been enabled to clear up these old debts, and leave the association free from debt, with enough money to close up the accounts of the present year. Twenty members had registered for the coming year before I left home, and everything bids fair to make the coming year the most satisfactory since the organization of the association. The auditing committee will find vouchers for every dollar expended during the past year, and I shall be pleased to turn the books over to that committee as early as possible for them to audit same. E. R. LEWIS, Treasurer. The secretary, Dr. D. Emmett Welsh, then read his report as follows, and on motion it was adopted: SECRETARY'S REPORT. The secretary begs leave to report the following: Number of letters sent out from this office, 1,341; number of vouchers drawn as per order of the chairman of the executive committee, thirty-two, viz.: Voucher No. 146. 153. June 5, '95, for A. J. Mullen, Chr. Ex. Com.. June 5, 95, for E. R. Lewis, Treas... 147. 148. 149. 150. 151. 152. June 5, '95, for Union Printing Co., Kansas City June 5, '95, for Union Bank Note Co., Kansas City.. June 5, '95, for Union Bank Note Co., Kansas City.. June 5, 95, for "Railway Surgeon," Chicago.. June 5, '95, for W. B. Outten, St. Louis June 29, '95, for S. S. Thorn, Toledo, Ohio.. 154. July 1, 95, for D. E. Welsh, cancelled. 155. July 1, 95, for D. E. Welsh, Sec'y. 156. June 25, '95, for D. E. Welsh, Sec'y. 157. July 3, '95, for Union Bank Note Co.. 158. July 11, 95, for E. R. Lewis, Treas.. 159. Aug. 7, 95, for Union Bank Note Co.. 160. Aug. 7, '95, for D. E. Welsh, Sec'y.. 161. Sept. 5, '95, for D. E. Welsh, Sec'y. 25.00 162. Sept. 6, '95, for A. J. Mullen, Chr. Ex. Com.. 24.05 163. Sept. 6, '95, for E. R. Lewis, Treas.. 125.00 164. Oct. 8, '95, for D. E. Welsh. 25.00 165. Oct. 8, 95, for Union Bank Note Co. 2.50 166. Nov. 4. '95, for "Railway Surgeon," Chicago. 36.49 167. Nov. 4, 95, for D. E. Welsh. 25.00 168. Nov. 4, 95, for S. S. Thorn, Toledo, Ohio. 169. Nov. 7, 95, for E. R. Lewis, Treas. 170. Dec. 4. '95, for D. E. Welsh, Sec'y. 21.65 25.00 171. Dec. 11, 95, for E. R. Lewis, Treas 125.00 172. Dec. 11, '95, for A. J. Mullen, Chr. Ex. Com. 59.19 173. Jan. 15, '96, for D. E. Welsh, Sec'y.... 25.00 174. Feb. 8, '96, for D. E. Welsh, Sec'y. 25.00 175. Feb. 29, '96, for D. E. Welsh, Sec'y. 176. March 7, '96, for Union Bank Note Co... 177. March 7, '96, for E. R. Lewis, Treas. 178. April 9, '96, for D. E. Welsh, Sec'y.. Total.. 3.00 $1,137.58 The secretary thanks the officers for their hearty co-operation with him during the past year in his endeavor to discharge promptly the duties of his office. On motion the association adjourned until 2 p. m. FIRST DAY-AFTERNOON SESSION. The association re-assembled at 2 p. m. and was called to order by the president. Dr. Outten stated that he had received an invitation from the Anheuser Busch Company, inviting the association to visit their brewing establishment, and that arrangements had been made to make this visit at 5 o'clock. The president called for the report of the committee on publication. Dr. Outten recommended, on behalf of the committee, that the arrangement for the publication of the Railway Surgeon be continued for another year with the present publishers, unless there was some objection on the part of the members. On motion, the report of the committee was accepted. The report of the executive committee was next in order, and was read by the temporary chairman, Dr. J. A. Barr, as follows: REPORT OF THE EXECUTIVE COMMITTEE. Gentlemen: Owing to the illness of Dr. Mullen, the chairman of this committee, we are unable to make a complete report. Those parts of President Thorn's address, which were referred to the executive committee, have received our careful consideration, and we desire to make the following report relative thereto: 1. In reference to the incorporation of this association, we are unanimous in the belief that such a step should be taken and recommend that the executive committee be authorized to perfect a legal organization. 2. In reference to the creation of a committee, which shall formulate all legislation, we recommend that all legislative matters be referred to the legislative committee, consisting of fifteen members present, to be appointed by the president, at the first session, whose reports shall be acted upon without discussion. J. A. BARR, Chairman, pro tem. The report of the committee was discussed by Drs. Eddy, Outten, Hoy, Bouffleur, Lane, Pierce, after which, on motion, it was adopted. Dr. T. H. Briggs of Battle Creek, Mich., read a paper entitled, "Surgical Treatment of Injuries of Spinal Cord and Column," which is published in this issue. The paper was discussed by Drs. Bouffleur, Hoy, Outten, Barr, Jackson and Murphy. Dr. S. R. Wooster of Grand Rapids, Mich., followed with a paper entitled, "Rupture of Bladder with no Evidence of External Injury." Discussed by Drs. Craig, Daugherty, Outten, Best, Buchanan and by the author of the paper. Dr. Cassius D. Wescott of Chicago read a paper on "Traumatisms of the Eyeball," which was discussed by Drs. Welsh, Ball and the author. The president then appointed the nominating committee, as follows: Dr. A. Craig, Columbia, Pa.; Dr. C. D. Wescott, Chicago, Ill.; Dr. B. F. Riordan, Toronto, Can.; Dr. F. Lawrence, Bangor, Mich.; Dr. J. F. Oldham, Wichita, Kan.; Dr. W. H. Elliott, Savannah, Ga.; Dr. C. W. P. Brock, Richmond, Va. On motion of Dr. Outten, the secretary was instructed to send a resolution of cheer and good will to Dr. J. B. Murdoch of Pittsburg, also expressing the regret of the association at |