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On motion of Dr. Stemen the thanks of the Society were tendered to Dr. Kemper by rising vote.

The President-Gentlemen of the Indiana Medical Society, I want to thank you all for your kind approval and the consideration you have given me, and for these many words of kindness you have spoken.

SPINAL CONCUSSION.

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BY WARREN R. KING, M. D., PHILADELPHIA, IND.

This disease has become one of more than ordinary importance in the last few years, owing to its alleged frequency in railroad accidents, and so much so that it has received the nomenclature of railway spine." However, one author claims that it frequently occurs from other causes. And if it is proper to give it a name from the source of its cause, so far as the history of two cases in Hancock county goes, it would not be improper to call them "highway spines."

It is said that John G. Johnston, of New York, is the authority for the statement "that the English railways paid in five years eleven million dollars as damages awarded by juries in cases of concussion of the spine. And while the statement seems almost incredible, yet the facts are ample to sustain it." And I am sure that the two cases above referred to are sufficient to divest the statement of all doubts as to its truth, and that a spine, claimed to be suffering from concussion, is a very profitable possession, if it can be proven that the alleged injury was the result of the negligence of a wealthy corporation. And while we are disposed to give every man his just dues, we are compelled to think, in some cases at least, that the ability of the defendant to pay has much to do with the severity of the ailment; and that the most efficient remedy is a judgment for six or ten thousand dollars, notwithstanding he frequently pays one-half or more of the same to his attorneys, whom he employs to portray his suffering condition to the tender sympathies of the jury and at the same time to use great care in magnifying the negligence and the abundant ability to pay of the corporation that may be so unfortunate as to be the defendant in the case.

The great diversity of opinion among those recognized as authority is remarkable, to say the least. To read John Eric Erichsen's little work on "Concussion of the Spine and Nervous Shock," one would be almost led to regard himself as a creature of special providence, from the fact that he has come so far along life's rugged path and escaped the dire calamities of this disease; while, on the other hand, to read other authorities, you may wonder how it can exist at all.

One of the arguments used by the skeptics is the anatomical construction of the surroundings of the cord as compared with that of the brain, which no one doubts can suffer from the effects of concussion, being inclosed as it is in a bony cavity, its outer surface lying against the inner table of the skull, save the intervening membranes; a blow received upon the outer table would be readily transmitted through the bony structure to the parts within, while the cord is suspended loosely within the cavity of the spine which is a flexible structure heavily clothed with muscles and ligaments upon the outer surface, and the intervening spaces between its sections filled with cartilage, all of which is calculated to break the force of a shock coming from any source.

Moreover, within the cavity we have the cord closely invested by the pia mater, then between it and the visceral layer of the arachnoid, an interval filled with the spinal fluid, and outside the arachnoid the loosely invested dura mater unattached to the bones, as in the skull, where it serves the purpose of the periosteum, but between which and the bone we have fat, watery connective tissues and the plexus of spinal vessels. Beside the structures we have the ligamentum dentaculum supporting the cord and the roots of the nerves in the most efficient way, pliable enough to yield and break the force of vibrations, and strong enough to sustain. That the spinal fluid is a preventive of shock, I think is, to say the least, open to controversy, as it is evident in some instances that it is transmitted by water, as where fish are killed by a heavy blow upon the ice over them when they are so far below that particles of the ice can not touch them. Then again a very common example with which every physician is familiar is when the shock is conveyed to the hand lying upon the abdomen when the opposite side receives the blow from the other hand, in a case of ascites.

Speaking of the disease in connection with railway accidents, Alexander Shaw in his monograph in Holmes' System of Surgery says, "that it does not appear that the term concussion of the spine, so often used in connection with them, is well chosen." And his reasons assigned are "that no one part of the body is particularly liable to suffer, but the whole body is in a concussion," and argues that "if any one organ more than another is liable to injury it would be the brain, while at the same time there are other organs just as liable to sustain injury, and that it can not be forgotten that the viscera, both of the thorax and abdomen, partake each, more or less the character of 'floating;' that they are suspended by ligaments or their equivalents," and goes to show "that these organs are liable to be bruised or lacerated, giving rise to ecchymosis, and their nerves on their passage may be stretched, torn or otherwise injured," and in conclusion says, "that all the great constituent parts of the nervous system, brain, spinal cord and sympathetic system are included in the common risk of the catastrophe."

Admitting that there is such a disease, we will quote from Erichsen as to the pathology. He says that "it would appear that surgeons and writers on diseases of the nervous system have included four distinct pathological conditions under this one term, "concussion of the spine," viz: A jar or shake of the cord, disordering to a greater or less degree its functions, without any lesion perceptible to the unaided eye. Second, compression of the cord slowly produced by the extravasation of blood. Third, compression of the cord by inflammatory exudations, serum, lymph, or pus within the spinal canal; and, fourth, chronic alterations of the structures of the cord itself as the result of the impairment of nutrition consequent on the occurrence of one or other of the preceding pathological states, but chiefly of the third, all of which are produced without any outward evidence of injury, such as the bruising of the integuments, or fracture of bones. Among the many symptoms that may follow are loss of motion, more particularly paraplegia, spasm of muscles, loss of sensation and control over the sphincters, and modification of the temperature. And here we find a diversion of opinion as to the effect of the lesion. One author claims that the symptoms may be developed immediately or delayed two or three months, or even more; while another claims that, by analogy, if unconscious

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ness immediately follows concussion of the brain, paraplegia should at once result from concussion of the cord. Again, as to the prognosis of the disease, we find authors do not agree. One, especially, gives a very unfavorable prognosis in many cases, while another says, if such be the case the lesion is more than concussion, and that rest is quite all the treatment necessary to restore almost every case of concussion of the spine.

Having admitted that such a disease can exist, does it occur so frequently as the statement in the beginning of this paper concerning the English railways indicates? We most certainly think not; and we assign the following reasons: First, that its obscurity opens up a great opportunity to unprincipled maligners, who may be suffering from some other disease for which the alleged accident was not responsible, the verdict being awarded them through sympathy of the jury; and, second, that history does not sustain the proposition. For the history of injuries our greatest resource is that of the war of the rebellion, the surgical history of which I carefully examined and found only eighty cases of injury to the spine recorded, of all kinds; and the author tells us that he derived his information not only from the hospital reports, but from the Pension Department as well.

Twelve of those cases were concussion of the spine; forty were classed as injuries without the cause being named. Even though we admit that a part of those cases were concussion, they are very insignificant compared with the many accidents that occurred during the war by the way of railway and those incident to the cavalry and artillery service.

Another source of no little importance for information, is that of the hospitals in our large cities and railway centers. William Hunt, in his monograph in Pepper's System of Medicine, says: "I can not, after thirty years of hospital and private practice, call to mind a single case of concussion of the spine, arising from other accidents than on railways, which has the terrible after history that is so often attributed to them;" and, further, he says, "I have examined many cases of claimed irreparable or serious injury to the spine in private, both for the plaintiff and defendant in impending suits, but I can not remember of a single applicant of a patient for admission to the hospital to be treated for the after effects of con

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