give testimony and sympathy in favor of those who have these alleged injuries. In nine cases out of ten, if not a greater per cent. than that, those cases are feigned cases and do not develop into any serious trouble.

Dr. Steward—Mr. President, I have been interested in the paper that has been read, and have taken an interest in the discussion. I agree with the general tenor of the paper, and I think that the paper at least gives us a word of caution as to medical testimony. I had not intended to say anything on the subject, but the doctor in the rear who has just taken his seat called me out. I have a patient now under my care at New Albany, who fell from the top of a house and struck upon his spine. I found the lower extremeties paralyzed when I first saw him, an entire loss of motion and an entire loss of sensation. At the time I simply observed him and did but little for him, but waited developments. After a little sensation returned, and after a period of six weeks motion returned, just a very slight motion. That has been eight months ago. There was no destruction of bone; there was no break, no fracture of any kind, and but slight ecchymosis in the region of the spine. That has been eight months, and my man to-day is barely able to walk across the room by the aid of crutches, and perhaps to bend about somewhat. He had no fever during all that time, no elevation of the temperature to amount to anything, and a good appetite, and no objective symptoms. I class it as concussion of the spine. I can not say what the outcome will be. If that had been a railroad case-unfortunately for this man he was a poor-house contractor and there is no suit for damages, and he is not feigning—I might have given an opinion as so his final recovery. Of course I do not know whether he will recover. That is one case in which it seems to me there is spinal concussion. In my opinion his recovery is doubtful.

As to the necessity of caution in giving medical testimony I believe we ought to be more cautious than we are. I know the courts have paid too little attention to expert testimony. I must say that sometimes what is known as expert testimony is not of the very best. Expert testimony in courts is being carried too far. There are criminal cases in which experts are called across two or three

States to give expert testimony, and they are in the habit of being called, and I am afraid it is becoming too much of a trade with some of them.

Dr. Hibberd-It seems to me of more importance, Mr. President, that we pay more attention to the medical side than to the legal side. Of course as a witness a physician can not be on either side, either for the corporation or for the plaintiff, and it is of more importance that we review the medical symptoms than that we review the actions of juries. There is one thing that is very sure, that we can not see pain. A great many complain of pain in the back. Unless you find some structural change, or some perversion of the functions of the nerve, such as paralysis, you can be very sure that you have no concussion of the spine. We should look out for these symptoms, and unless we find some structural change or some paralysis we can not say we have concussion of the spine.

Dr. Boyd-Mr. President, I want to call attention to one singular fact. It is about the only time I ever knew so many doctors to agree. Just to break the monotony I want to say one word or two for the other side. It is generally understood of course, that sympathy has a great deal to do with juries, and we learn that in our part of the State, in controversies for damages against doctors, so much so that when I have a case of surgery I always have one of the best surgeons in that part of the State to see the patient during his treatment. I think it is the only safe way to pursue, or else utterly refuse to perform any surgery. In this case there are two sides to the question, everybody will admit. One party in every case has a claim that ought to be sustained, and honestly sustained, and it ought to be according to the truth. And yet I admit, too, that testimony is not always what it ought to be on account of the sympathies of the witness, as well as with the juries. There is one point on the other side, and that is that the money of a corporation is worth more than all the sympathy for a poor claimant. I thank the doctor for reading the paper. Taking the only light he had on this subject, he was on the right side of that question, but he had not light enough to decide all that should be decided. I have had no experience in that particular line, but some of my physician friends have had serious difficulty of that kind. If a

physician is sued there, it is pretty certain to go against him. Physicians are being classed among the moneyed men; they say that we make our money easy. But at the same time if I am to be one or the other, a poor man or a corporation, to have to go into a lawsuit, I would rather be the corporation every time. Corporations are not going to break up and quit just because juries go against them. There is just now a terrible strike against corporations. There is an effort of an eastern corporation, not only to keep up a monopoly on coal oil, but to add gas to it, and in Chicago it has both, and electricity too.

Dr. Green—Mr. President, I am not only surprised, but amused at the tenor of the paper and a large per cent. of the discussion we have had upon this subject. Medical men are liable to be on the extreme, one side or the other; but it does seem to me that this discussion has been all on one side of the fence. We have assumed that the juries of the country are all perjurers, who have no respect for any obligation they make, and that every person who is injured in a railroad wreck or a manufactory is a scoundrel. That is the drift of the discussion. I admit that possibly there are many of these cases. I know of a case that had no connection with corporations, where spinal concussion was received. It was done on the man's own farm; his daughters were thrown from a buggy on the hard ground, where there was no hope of recovering damages. They were both unconscious. Eighteen months have elapsed; one has recovered so that she can walk about without any evidence of injury to the bone. I have seen another case where a lady was injured in a railroad wreck, where there is no hope of damages. She was thrown so that she struck upon her shoulders; there was loss of motion and loss of sensibility, and the pain was so great that the patient could not turn herself in bed. She has also had other symptoms of spinal concussion. We should look at this thing in a fair and intelligent manner. We should not assume that no such injury exists because there are some cases that are feigned. I know a man who received an injury twelve years ago and received as damages fifty dollars and a suit of clothes. He hasn't done a bit of work since on account of disability. We should remember the delicate structure of the spinal cord.

Dr. Beard-Mr. President, there is no intelligent railroad surgeon claims there is no injury to the spine; that is not what we are talking about. We are protesting against this wholesale kind of business where there is no manifestation of disease whatever, but where they claim damages on account of an alleged injury, attributing it to concussion of the spinal cord. We know there are cases of diseases of the spine. In the cases the doctor speaks of there is no doubt there was an injury to the spine; the symptoms showed it very plainly.

Dr. King-Mr. President, and gentlemen of the Society, the object of this paper was not to cast any insinuation on any person who had received an actual injury in a railway, or any other accident; but the preposterous verdict that the jury gave in the case I spoke of struck me forcibly with the idea that nationalistic ideas are obtaining in this country in more ways than one, and it crops out in just such cases as this. Now, what was the history of that case? In examining that man for objective symptoms we stood him against the wall and required him to walk away, and he walked just as straight as I could. Among other things, we laid him upon the floor, with his hands across his breast, and he rolled over backwards and forwards without the use of his arms. We tested him with electricity. I went upon the stand and gave it as my opinion that the man was not so injured. He passed into the hands of a man who had wonderful experience as an expert, being bolstered up by parties who are using him. This expert goes upon the stand, and although such men as Dr. Weist and Dr. Fletcher gave it as their opinion that he was not suffering from spinal concussion, yet this expert's testimony was taken above theirs. Judge Burns said. to me during the trial: "It is a fraud; I do not believe there is anything in it." Yet the jury gave him $6,000 damages. The case struck me so forcibly that it induced me to write this paper, and I am glad it has called out the discussion that it has. I thank the Society for the attention you have given me and the kind words you have spoken.

CONCUSSION OF THE BRAIN, WITH REPORT OF A CASE

BY C. H. PARSONS, M. D., RUSHVILLE, IND.

There are many subjects treated of in medical literature wherein there is great diversity of opinion, and concussion of the brain is not an exception.

There are scarcely any two writers who agree upon just what it is, or define it alike.

The word concussion in its primary sense means a shaking together, and it has been applied to that condition wherein the tissues of an organ are crowded together so as to disarrange their relations to each other; and thus their functions are destroyed, until by elasticity, if the tissue may possess it, their relations are re-established.

Concussion of the brain then, is a commotion of the nerve fibers resulting in a disarrangement in their relations to each other.

Having thus defined concussion of the brain, the question arises, what will be the result following an injury sufficient to produce such a condition? Will it end in death? There is a class of medical writers, eminent in their profession, standing high in authority, who teach that all cases wherein a fall or blow upon the head has been received followed by, unconsciousness, which may last for a shorter or a longer period, or may result in death, to be concussion of the brain.

For example, if a man receives a blow upon the head and is only stunned for a shorter or a longer period they say concussion of the brain has happened. If a man fall a short distance alighting on his head, suddenly becomes unconscious and dies, they attribute his death to concussion of the brain.

Many after-death examinations of these so-called cases of concussion have been made, and these are the results: