From the Examiner. On Railway and other Injuries of the Nervous System. By John Eric Erichsen, Professor of Surgery and of Clinical Surgery in University College, London; Examiner in Surgery at the University of London. Walton and Maberly. change. The vital and animal functions were naturally performed. Respiration, circulation, digestion, secretion, and assimilation were all normal. There was a sensible increase in the frequency and volume of the circulation, and respiration was noticed to be slightly increased weight of the body became greater after than it in frequency above the normal standard. The had been before the injury, and the lower limbs retained their natural heat and physical development. (Greene, New York), and requested the ampu tation of his lower extremities, which he stated were a burdensome appendage to the rest of his body, causing him much labour in moving them, and stating that he wanted the room they occupied in his carriage for books and other articles. He insisted on the operation with his whom he consulted at first refused to consent wonted resolution and energy. The surgeon to amputation, not only objecting to so extensive a mutilation for such reasons as he gave, but fearing lest the vitality of the vegetative existence enjoyed by his limbs might be insufficient for a healthy healing process. The patient, still determined in his resolve to have the limbs cut off as a useless burden to the rest of the body, sought other advice, and at last had his wishes gratified. MANY a sign of progress has its drawback known to the physicians. It was The patient evinced an unusual share of menmuch to exchange the tinder-box for the tal vigour after the injury, and possessed a phosphorus match; but with the phosphorus resolution and determination that are described match came the new and terrible disease as truly surprising in his forlorn and helpless that ate into the jaws of many of its makers. condition. He threw himself into the midst of We have exchanged coach travelling at society for excitement, and was fond of traveleight or ten miles an hour for railway trav-ling, lying on his back in his carriage. elling at thirty or forty; but with the swift-sented himself in the County Medical Society In 1851, six years after the accident, he preer travelling comes the more violent concus sion; and even when there is no shock of accident, the daily traveller endures a chronic jar that has a serious effect upon the nervous system. This little book contains the substance of half-a-dozen hospital lectures given by one of the best English surgeons, who has thought it worth while to study carefully those obscure injuries to the spinal cord which are suffered frequently by persons who have been subjected to the violent shock of a railway collision. The frequency of this result has been imperfectly recognized. The hurt is obscure. It is usually not perceived at the moment. The sufferer, in the excitement of the scene thanks God he is unhurt, busies himself in care of the wounded, and goes home to experience next day, or in two or three days, the beginning of that gradual failure of power which is a common effect of concussion of the spine. A medical witness in an action for damages against the railway company may have reason to thank Professor Erichsen for having directed his attention to the significance of these obscure symp toms. Of the effects on the spinal cord of severe blows on the back Mr. Erichsen gives some instructive cases from his own hospital experience and from the records of others. The most curious of them is the following from the New York Journal of Medicine: A man, twenty-two years of age, in felling a tree, was struck on the back part of the head and between the shoulders by a large bough. This accident occurred in 1845. The force of the blow expended itself chiefly on the lower cervical spine and the shoulders. A complete paralysis of sensation and motion, of all the parts below this, was the immediate result. This condition continued without the slightest Both limbs were amputated near the hipjoints, without the slightest pain or even the tremor of a muscle. The stumps healed readily, and no unfavourable symptoms occurred in the progress of perfect union by the first intention. In this mutilated state he was perfectly unable to move his pelvis in the slightest degree. He resumed his wandering life, and travelled over a great part of the States. He died in May, 1852, of disease of the liver, brought on by his excesses in drink, to which he had become greatly addicted since his accident. No post-mortem examination was made. This case is a most remarkable one in several points of view, and in none more than in this, that a double amputation of so serious a character could be successfully practised on a person affected by complete paraplegia, and yet that the stumps healed by the first intention. Besides this remarkable fact, there are two special points of interest in this case which bear upon the subject that we are now cousidering, viz., that the weight of the body is stated to have increased after the accident, and that the limbs which were so completely paralyzed as to admit of amputation without the patient experiencing the slightest sensation of pain, had in no way wasted during the six years that they had been paralyzed, but retained" their normal physical development," as is expressly stated in the report of the case. We can have no stronger evidence than this to prove that mere disuse of a limb, for a lengthened period of years even, is not necessarily followed by the wasting of it. But the public is most interested in that slighter form of injury which some surgeons have even begun to call the Railway Spine,' though there is, of course, no special difference between concussion of the spine from a railway accident and its concussion by fall from a horse. The difference is in degree, with probability that the railway concussion will be more sharp and effectual. In a case of concussion of the spine in a One of the most remarkable circumstances farmer and miller who obtained 5,7751 dam- connected with Injuries of the Spine is, the disages, there was at the time of the accident proportion that exists between the apparently only a cut lip and a severe shaking. The and the real and serious mischief that has octrifling accident that the patient has sustained, sufferer proceeded on his journey. It was curred. Not only do symptoms of Concussion observed by a friend who drove him home of the Spine of the most serious, progressive, from the station that he did not seem to and persistent character, often develop themrecollect the road. He arrived home feeling selves after what are apparently slight inbruised, shaken, and confused, went to bed, juries, but frequently when there is no sign but did not consider himself ill enough to whatever of external injury. This is well exsend for medical advice till five days after- emplified in Case 9, the patient having been wards. It was fifteen months afterwards partially paralyzed simply by slipping down that Mr. Erichsen was consulted. He found a few stairs on her heels. The shake or jar that him unable to recollect numbers, the from the height of a few feet comes to the is inflicted on the spine when a person jumping ages of his children, for example, unable ground suddenly and heavily on his heels or in to transact business, troubled with frightful a sitting posture has been well known to surdreams, waking in terror, frowning habit- geons as not an uncommon cause of spinal weakually to exclude light from his eyes, unable ness and debility. It is the same in railway to read for more than two or three minutes accidents; the shock to which the patient is at a time. Vision and hearing were over-subjected in them being often followed by a sensitive on the right side and almost lost on the left; with like difference throughout the body; he was unable to walk without support, or to bend his spine in any direction without suffering severe pain, so that he sat always rigid and upright. Concussion of the spine, ending in paralysis, resulted, in one of the cases here given, from so slight an accident as a trip down two or three stairs and bumping forcibly upon the heels. In a railway accident, a throwing of the body from side to side may cause a twist of head and trunk, producing wrench of the spine. In the Staplehurst accident, an accomplished young lady, who had been an intrepid rider, a skilful driver, and an accomplished musician, had her neck so severely twisted and sprained that it lost the power of supporting her head, which fell from side to side as if the neck were broken. She could only keep her head erect by use of a stiff collar. The use of the left arm also. was lost. Mr. Erichsen train of slowly-progressive symptoms indicative Inflammation of the Cord and its Membranes. of Concussion and subsequent Irritation and But I may not only say that sudden shocks applied to the body are liable to be followed by the train of evil consequences that we are now discussing, I may even go farther, and say that these symptoms of Spinal Concussion seldom occur when a serious injury has been inflicted on one of the limbs, unless the Spine itself has at the same time been severely and directly of civil life meets with an injury by which one struck. A person who by any of the accidents of the limbs is fractured or is dislocated, necessarily sustains a very severe shock, but it is the rarest thing possible to find that the Spinal Cord or the Brain has been injuriously influ enced by this shock that has been impressed on the body. It would appear as if the violence of the shock expended itself in the production of the fracture or the dislocation, and that a jar avoided. I may give a familiar illustration of this from an injury to a watch by falling on the ground. A watchmaker once told me that if the glass was broken the works were rarely damaged; if the glass escapes unbroken, the jar of of the more delicate nervous structures is thus the fall will usually be found to have stopped the movement. How these Jars, Shakes, Shocks, or Concussions of the Spinal Cord directly influence its action I cannot say with certainty. We do not know how it is that when a magnet is struck a heavy blow with a hammer, the magnetic force is jarred, shaken, or concussed out of the horseshoe. But we know that it is so, and that the iron has lost its magnetic power. So, if the spine is badly jarred, shaken, or concussed by a blow or shock of any kind communicated to the body, we find that the nervous force is to a certain extent shaken out of the man, and that he has in some way lost nervous power. What immediate change, if any, has taken place in the nervous structure to occasion that effect we no more know than what change happens to a magnet when struck. But we know that a change has take place in the action of the nervous system just as we do in the action of the iron by the change that is induced in the loss of its magnetic force. Whatever the primary change, the secondary effects are inflammatory, and they are apt to develop themselves slowly. The sufferer does not know that any serious accident has happened to him: He feels that he has been violently jolted and shaken, he is perhaps somewhat giddy and confused, but he finds no bones broken, merely some superficial bruises or cuts on the head or legs, perhaps even no evidence whatever of external injury. He congratulates himself upon his escape from the imminent peril to which he has been exposed. He becomes unusually calm and self-possessed; assists his less fortunate fellow-sufferers, occupies himself perhaps actively in this way for several hours, and then proceeds on his journey. When he reaches his home, the effects of the injury that he has sustained begin to manifest themselves. A revulsion of feeling takes place. He bursts into tears, becomes unusually talkative, and is excited. He cannot sleep, or, if he does, the wakes up suddenly with a vague sense of alarm. The next day he complains of feeling shaken or bruised all over, as if he had been beaten, or had violently strained himself by exertion of an unusual kind. This stiff and strained feeling chiefly affects the muscles of the neck and loins, sometimes extending to those of the shoulders and thighs. After a time, which varies much in different cases, from a day or two to a week or more, he finds that he is unfit for exertion and unable to attend to business. He now lays up, and perhaps for the first time seeks surgical assistance. We have not touched on questions of pathology or other professional details which are discussed in this strictly professional work. But its main topic is one that concerns all travellers. We have now only to thank Mr. Froude for the vivid account which he has given in his last chapter of English misdoings in Ireland. That Ireland has been, and is, disaffected to England we cannot wonder, when we read of the fiendish wickedness by which men sought to keep Ireland in subjection to the English Crown, and to bring her into subjection to the English Church. Those days are past, but we are still paying the penalty of them; in all these cases of national wrong, the removal of wrong does not, perhaps for generations, carry with it the removal of the memory and sentiment of wrong. It is clear that the Englishmen of Elizabeth's time looked on Irishmen simply as wild beasts, as some Englishmen still look on negroes or even on Hindoos. Men rode out for some "killing' that is, for the indiscriminate murder of the natives of all ages and sexes, looked on seem ingly as a lawful occupation or rather amusement. As Mr. Froude says, they went beyond the cruelties of Alva; except in the sack of towns, where there is no great choice between one nation and another, Alva did not massacre women and children. But in the eyes of English soldiers and settlers an Irishwoman and her children were much on a level with a she-wolf and her cubs. It would have been a much milder fate for Ireland to have been conquered by Turks, who would have let the unhappy Papist pay tribute and worship after his own fashon. Indeed the Irish were worse off than the negroes, except on the doctrine that life in bondage is worse than death. It was a case in which the existence of slavery would have made matters a degree less horrible. Saturday Review. GENNESARET. (April, 1862.) I. BEHOLD, the Waster's peace is here: Of leaf and insect, fold and herd, In desolate rest, even since that day When up yon western horned hill * The long day's strife did roll and roar, Till broke the Christian arm and sword, And their faint few might strike no more. The controversy of the Lord His mindful mountains hear, until Their ancient strength shall melt away. They held their Bairâm feast that day With game of war and sport of love.. Their Syrian spring burn'd fiercely gay, And whispering waved the palms, above Volcanic fire that heaves and burns. IV. The lovely lake fills up the caves And though we mourn that Beauty dies, She hath her day, and it is well, A little while she flies, All marred and weeping, like Love's queen Renewed yet changeless, night and day, As with the breathing of God's breath, Hers are the gates of eve and morn, Whence she doth marshal cloud and light, Like hosts with banners manifold, From crimson wild to burning gold, To flame o'er fair things and forlorn. She is a sign of God to man, Even when his weariest work is done. And all the dancing streams that run Sadness grows dear and dulness bright, On purple dark of desert Night; With clear cold floods of dewy light. And o'er the savage Northern sea Hours of long sunset glow for thee In nameless hues of unthought sheen. But yester-eve we lingered late, (Being somewhat worn with sun and speed), To watch, beneath Tiberias' gate, The wild Hawâra play jereed. Looked wing'd and bird-like in his solle, So lithe and light he rode, Upon the broken battlement, All cloven the day when Safed fell * Hill of Kurûn Hattîn-scene of the Sermon on the Mount most probably, and of Saladin's victory over the last Crusaders. V. Feel bit and rein, draw girths, and mount. Of all that we shall see no more. The "Peace, be still " were lately said. Old Hermon's triple head. Cornhill Magazine. R. ST. J. T. END OF VOLUME XCI. |