cussion of the spine, the original injury having been received in a railway collision."

An objection to the last statement could be urged that, generally speaking, those who seek hospitals for treatment seldom travel on railways, unless it be the employes of the roads. Then, with the foregoing diversities of opinion and history, what shall we do when called upon to testify and give an opinion in such cases? In the first place, each case must be closely studied and all subjective symptoms excluded, unless they are strongly sustained by objective symptoms. Call to aid every known test. Among the most prominent are anesthesiometer, dynamometer, thermometer, the watch and tuning-fork test for hearing, blindfolding the eyes, electricity, and by no means not the least thing to be diligently inquired into is the past history of life and the remedies used since the alleged injury was received and the probable effects they might have upon the system; and, as to the duty of courts in these cases, experts should be required to go upon the stand and testify immediately after the examination of the claimant.

My experience in cases of this kind is limited to only one alleged case, that being one of the two cases that occurred in our own county. I was the attending physician in the beginning of the ailment and must confess I was led from subjective symptoms to think I had spinal concussion to deal with.

The history of the case is as follows: In the month of April, 1885, I was called to see F. L., a married man about thirty-five years old, the father of three children, who was suffering from an apparent congestion of the lung, but no elevation of temperature. The congestion passed away in two or three days, followed after its subsidence, in three or four days more, by slight congestion of the brain, which very readily passed away by the administration of ergot and bromides, but was followed by a continual complaining of pain in the head and spine, with alleged loss of hearing, perverted taste, flashes before the eyes, tinglings and formication, and during the time claiming that the trouble originated in a fall in an accident wherein his team which was attached to a sled slipped off an icy grade that was an approach to a bridge, wherein he claimed to have sustained the injuries of which he complained. In due course of time claim was filed by his attorneys with the county

commissioners for ten thousand dollars damages, based upon the injuries alleged and the neglect of the proper officers to keep the highway in proper repair. Being called upon to testify before the board for the plaintiff in connection with Dr. N. P. Howard, Jr., who had been employed by the said board, we examined him for the objective symptoms, and although he was my patient and all my sympathies in his favor, I was compelled to admit that there were no objective symptoms upon which to base an opinion that he was suffering from spinal concussion, or an injury, and so testified. He passed from my hands in an irregular way to those of a so-called expert. The case was appealed to the Circuit Court, change of venue was taken to another county, and in due course of time the trial came

on.

The so-called expert appeared upon the witness stand and gave it as his opinion that the plaintiff was suffering from spinal concussion, based upon three objective symptoms, the only ones he had sought for, viz: a rapid pulse, a slight elevation of temperature, and an unequal dilatation of the pupils, produced, as I believe, by the fluid extract of ergot which, in connection with the bromide of soda, he testified he gave his patient week after week, months prior to the trial. If the ergot produced its reputed effects upon the muscular coats of the blood vessels causing anemia of the brain and spinal cord, the pneumogastric nerve was deprived of its proper stimulus, thereby lessening its inhibitory powers upon the heart, causing the rapidity of pulse. The slight elevation of temperature, if pathological, was the result of nervous irritability. Notwitstanding the testimony of other experts, some of whom stand at the head of the profession, that the claimant was not suffering from an injury, or spinal concussion, one of those paradoxical verdicts that now and then crop out in our jury system, followed: "That the defendant pay the plaintiff six thousand dollars and his cost." We have been informed that all medical testimony was waived in their deliberations, and the conclusion was that the county was abundantly able to pay. The plaintiff was a poor man.

If I have said enough in this paper, and presented it in a manner sufficiently forcible, to call the attention of the profession to the

medico-legal importance of this disease, I have done all I anticipated, believing that truth and justice should prevail, even though a corporation that is abundantly able to pay may chance to be the defendant.

DISCUSSION.

Dr. Fields—Mr. President, I concur in the sentiments expressed by the doctor, that corporations are sometimes greatly imposed on. I have long been of the opinion that there is a great deal of money taken from railroad corporations under false pretenses. A man claims to be hurt at a railroad crossing and suit is brought against the railroad company for a large sum of money, and in a large number of these cases the juries find for the plaintiff, and the railroad is compelled to take the matter to the Supreme Court. I do think it is time that medical men called upon as experts in such cases should try if possible to shield these companies from such losses.

Dr Stemen-I am much pleased with the paper, and think that the author has stated facts, as I have observed them in the practice of railway surgery. As to the remedy, what is to be done, is a very important question. I have known cases where a number of physicians have testified that there was no concussion of the spine, and yet, just as in the case that the doctor reported, the jury brought in a verdict in favor of the plaintiff; and, in my observation, it matters not what doctors may testify, if you have a wealthy corportion as defendant and a poor man as plaintiff, the probabilities are that the juries will give a verdict in favor of plaintiff. In my experience as surgeon for railroads, I remember a few years ago of a railroad attorney, in his annual settlements, having passed over only a part of the road, saying he had compromised over fifty thousand dollars of claims on account of personal injuries, rather than engage in litigation, knowing the uncertainties of the juries of our country in regard to these claims. Every surgeon knows what most of these claims are. There is nothing to be seen, but they affect to have been seriously injured, and appeal to the courts, and after they get their verdict they walk off just as well as other men do. I am glad that the doctor has written the paper and that it will be published, for the reason that I think the profession should

speak up on this subject. I know that in many cases corporations pay damages when they ought not to pay, and it occurs to me they ought to fight them more. A check for five hundred dollars is given because of a pain in the back. I think if they paid surgeons better salaries and not so much for these claims it would be far better.

Dr. Beard Mr. President, I appear before you as another one of the unfortunate railroad surgeons. I have been there, too. I know, only a short time ago, where a gentleman obtained a verdict for five thousand dollars for an injury that was alleged to be a permanent injury to the shoulder joint. There was no fracture, but, as claimed by his doctor, there was a bruise and indentation of the muscles. I testified against this theory as the representative of the road. But the jury paid no attention to the testimony of a railroad surgeon. They say we are the hired agents, and that it is only a part of the duty of a railroad surgeon to go before the court and swear to a lie to shield his company. That is the way it is looked on generally. Some years ago I told the attorney of the Ohio & Mississippi Railway, when they had no surgeons on that road, that they were paying surgeons' fees in damages to crippled men. Sometime after that they employed surgeons, and now pay them liberally. They endeavor to get the best men at each point where they need a surgeon. One reason for this was to protect the interests of the road. Now they complain we are no protection because juries don't believe us. There ought to be some remedy. I hope some gentleman of fruitful mind can invent some remedy. If something is not done, we may expect to go back to the old system. The remedy seems to me to be, well-I will not prescribe a remedy. I guess I had better quit.

Dr. Fields-Mr. President, I know where a railroad was mulcted in damages three thousand dollars. I heard every bit of the testimony, and there was no reason in the world for such a verdict.

Dr. Eastman-Mr. President, in a recent damage suit in this city, I had it direct that seven of the jurors positively refused to consider expert testimony at all. They said they would not notice one iota of it. The other five said: "If you will not notice it, we will stay here until you refuse to do anything." After seventy

two hours, they agreed to disagree. That is the noted suit against the Surgical Institute. A dozen doctors testified there. They had no connection at all with the Institute, but were from different departments of medicine in the city.

Dr. Comingor-Mr. President, my own opinion is that the profession has been very materially misled in regard to the concussion of the spinal cord. I have had the privilege of examining a great many of these cases, and I have been unable to find very few of a serious character. Unless, as the essayist says, there are very strong symptoms to warrant, we ought to be very slow to testify in regard to these cases. Now, I believe when an injury is received there at all it is, perhaps, from some extravasation of blood along some of the nerves, and that produces more or less irritation. It has been my practice, when I failed to find any substantial symptoms of disease, to decide that there was none. If there has been any serious injury to those delicate structures, as a matter of course it will manifest itself in an unmistakable way. I think it is time to call ourselves to a halt to consider whether there is any real merit in these cases. I admit you may at times, and under very peculiar circumstances, have serious injury to the cord, but when you get that you will get more than simple concussion; you will get an injury to the bony structure of the spine and to the nerves of that part. In all probability-I will say in nine cases out of ten-the injury will be outside of the cord. It is the duty of the profession, when called into court as experts, to testify as to the facts in regard to these matters and let the evidence help or hurt whom it may. I have been extremely skeptical in regard to concussion of the spinal cord. I am very slow even in private practice to accept statements of patients in regard to these injuries. Those of you who are fortunate or unfortunate enough to have been in the United States service during the late rebellion know there was a great deal of malingering going on, and one of the principal affections was a pain in the back. They knew it was not an easy matter to determine a fact, and they expected to get out by the surgeon giving them the benefit of the doubt. Especially in spinal affections, I do not believe it fair to give those who claim those injuries the benefit of the doubt. I tell you the profession ought to rally to a man and take very close cognizance of these cases, and not simply