Report on a case of railway injury / by Willoughby Francis Wade.

  • Wade, Willoughby Francis, 1827-1906.
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: Report on a case of railway injury / by Willoughby Francis Wade. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    I should add that; during the whole of his protracted examina- tions, there were no signs of hysteria, which so much excitement would almost certainly have induced in a person with enfeebled mind or softened brain. II. With regard to any prospect of future softening. It cannot be denied that persons who have had severe concussion of the brain are occasionally liable to softening thereafter, and (as is believed) therefrom, even after a lengthened interval of several months (12- 48) of apparently perfect health. In the absence of any present indications of such a process either existing or impending, this, should it be referred to by his medical advisers, should be treated as a remote contingency of inappreciable value. It is most probable that it will be contended on the part of the plaintif t\\^t he has sustained '^spinal injury and concussionas well as cerebral. It is not at all improbable that his case may be rested on this chiefly or even exclusively. Should this poitit not be raised the following considerations may be ignored. It is necessary to consider this question in detail. The. term “ spinal disease ” is often used in a very vague manner, and Mr. {the first medical witness to he examined for the plaintiff') should be pressed to say whether he supposes the disease to affect the muscles, ligaments, or bones of the spinal column, or the membranes of the spinal marrow (cord), or the spinal marrow itself. a. Membranes of the cord. It is highly improbable that a fall or concussion without fracture should produce any disease of the membranes alone; there are no symptoms of its existence; there is no pain in the lower extremities when they are moved, and no spasms, cramps, or twitches of them; neither is there any tucking up or contraction of the legs, nor any difficulty in bending them. Pain in the back is not of itself any adequate diagnostic symptom. h. The cord itself. An affection of the cord itself under such circumstances would be “ softening.'’^ This might be attended with pain at the seat of softening. But it would certainly by this time have produced symptoms of paralysis of the lower extremities, and probably of the bladder; and it would probably have been attended with cramps, pain, or spasm in the legs or thighs. None of these exist, as he himself admits. c. There is no pain on bending the back, therefore no injury to ligaments. d. There is no pain on pressing the muscles or on forcibly rubbing them, nor on motion, therefore no injury to muscles of back. e. Disease of the spinal column. He informed us that he had pain in the back, which is a symptom of diseased bones; but it was impossible to get him to be at all precise