Concussion of the Spinal 
Cord, Brain, Etc. 
BY 
B. A. WATSON, A.M., M.D., 
SURGEON TO THE JERSEY CTFT AND CHRIST HOSPITALS, JERSEY 
CITY, N. J. 
Read in Ike Section of Surgery and Anatomy at the Forty first Annual 
Meeting of the American Medical Association at Nashville, 
Tenn., May 20, i8go. 
Reprinted Irom the “Journal of the American Medical 
Association,” June 14, 1890. 
CHICAGO : 
Printed at the Office of the Association 
1890. CONCUSSION OF THE SPINAE CORD, 
BRAIN, ETC. 
The term ‘ ‘ concussion of the spinal cord ’ ’ is 
commonly used in a very loose and indefinite 
manner. In some instances its use is restricted 
to those cases in which the functions of the cord 
are temporarily disturbed, independently of any 
discoverable lesions ; while in other instances it 
is made to include cases in which there are haem- 
orrhagic extravasations into the substance of the 
cord, or even a contusion of its membranes. Mr. 
Erichsen has employed the term in even a broader 
sense than that which includes the punctate 
haemorrhages, etc., since he embraces the follow- 
ing conditions: i. A functional disorder. 2. 
Compression of the cord from extravasation ; 
compression of the cord by inflammatory exuda- 
tions ; nutritive cord alterations. It is therefore 
apparent that Mr. Erichsen, when he employs 
the term ‘ ‘ concussion of the spine, ’ ’ intends to 
include all morbid conditions arising either pri- 
marily or secondarily from traumatic injuries not 
connected with fractures or dislocation of the 
vertebrae. In our consideration of ‘ ‘ Concussion 
of the Spinal Cord, Brain, etc.,” we shall include 
all those morbid and pathological conditions 
arising from the application of concussive force 
to these organs.* By concussive force we mean 
that agitation communicated to one organ by a 
fall or blow upon another. For the purpose of 
illustrating this idea, let the force be’applied to 2 
the nates while the spinal column is maintained 
in an erect position, then there will be carried 
along this bony structure a vibratory motion 
which will also be imparted in varying degrees 
to the adjacent soft parts. A careful study of 
the anatomical structure of the spinal column 
and cord, their relation to each other, and like- 
wise their relation to other organs, especially the 
brain, lungs, liver and kidneys, when examined 
in connection with the seat of the application of 
the concussive force, possesses a very high degree 
of interest. It will be readily observed that the 
normal curves of the spinal column cannot fail to 
exert an influence on the localization and charac- 
ter of the pathological lesions produced by a con- 
cussive force applied to the nates. It is likewise 
true that these curves exert a modifying influence 
on all the lesions resulting from concussive force ; 
but the same can only be intelligently studied 
when the surgeon fully understands the nature 
of the power employed and the locality to which 
it has been applied. In order to illustrate this 
subject more clearly the reader’s attention is di- 
rected to the following cut, in which the antero- 
posterior curves of the spinal column may be 
studied. These curves correspond to the different 
regions of the column, and are designated cervi- 
cal, dorsal, lumbar and pelvic. 
The examination of this figure makes it readily 
apparent that if the concussive force is applied 
to the nates while the spinal column is maintained 
in the erect position, the greatest power will be 
brought to bear on the sacro-vertebral articula- 
tion. The chief factors entering into this calcu- 
lation are leverage and the 'superincumbent 
weight of the body. It likewise logically follows 
that if the centre of gravity be thrown either for- 
ward or backward the resulting traumatisms may 3 
be materially modified. I am now prepared to 
show by the results of numerous experiments 
that the conclusion which I have expressed is 
strictly correct. 
In a brochure which I have recently published, 
entitled, “An Experimental Study of Lesions 
Arising from Severe Concussions,” there will be 
found a report of 141 experiments. In 135 of 
these experiments the concussive force was re- 
ceived on the nates, and besides the other trau- 
matisms thus produced there were eleven cases 
of rupture of the spinal ligaments, and ten of this 
number occurred at the sacro-vertebral articula- 
tion, and the other between the fifth and sixth 
cervical vertebrae. It was still further observed 
that in six cases there was a considerable amount 
of blood extravasated within the pelvic cavity, 
and in five cases there were ecchimoses in the 
psoas muscles. The examination of the report 
of these experiments also shows that there were 
four cases of fractures involving the spinal verte- 
brae, and two of these were located in the lumbar 
region. I think it will now be readily admitted 
that true concussive force exerts the highest pos- 
sible degree of potency on the spinal cord when 
applied to the nates while the body is maintained 
in the erect position; and, furthermore, that the 
most marked and numerous traumatic lesions 
observed in these cases are associated with in- 
juries of the spinal column in the lumbar region. 
Let us now enter on the consideration of several 
important questions bearing on the etiology of 
spinal concussion. 
1. Are there any cases of this morbid condition 
arising from concussive force in which the func- 
tions of the spinal cord are temporarily disturbed, 
independently of any discoverable lesions ? 4 
2. Are any of the following pathological con- 
ditions, viz.: punctate haemorrhages, hyperaemia, 
blood in the perivascular spaces of the gray mat- 
ter, etc., ever produced by concussive force while 
the bony walls of the spinal column and the liga- 
ments of the same remain in the normal state ? 
3. How, and by what sort of force, are these 
morbid conditions most frequently caused ? 
Let us here attempt a seriatim reply to these 
queries. I therefore think it wise to inform my 
hearers that in my consideration of these questions 
I shall view my subject from the standpoint of a 
surgeon, rather than that of an alienist. The 
essential difference between the surgeon and the 
alienist is that the former presents his views from 
the standpoint of demonstrated facts, while the 
latter accepts a theory and then attempts to make 
all else conform to the god which he has erected. 
In other words, surgery is to-day essentially an 
exact science, while insanity rests entirely on a 
speculative basis, and, therefore, it can only be 
regarded as a pseudo science. 
It will be here observed that when this ques- 
tion is examined from a pathological standpoint 
there can be only negative evidence adduced, and 
this would scarcely justify an affirmative answer. 
My experimental studies have added nothing in 
the affirmative, but, on the contrary, have mate- 
rially strengthened the negative side of the ques- 
tion. I am therefore constrained, by the want of 
space, to answer this question negatively, al- 
though it is quite possible that by so acting I 
open myself to the charge of dogmatism. 
In attempting an answer to the second query I 
shall preface my efforts by calling attention to 
the anatomical structure of the spinal column 
and cord, and their relations to each other, and 
afterwards bring forwards the results of my ex- 5 
perimental studies for the further elucidation of 
this important question. 
It can be readily seen that no part of the hu- 
man skeleton plays a more important r61e in the 
preservation of life by protection of vital organs 
than the spinal column. Within this bony col- 
umn is situated the spinal canal, beautifully and 
perfectly arranged for the reception of the spinal 
cord. This highly important structure is com- 
posed of thirty-three vertebrae, and these are 
artistically and strongly fitted together in such a 
manner as to allow every necessary movement, 
since the spinal column is both flexious and flex- 
ible. The articular surfaces of the vertebrae are 
covered with cartilages exactly suited to their 
wants. The various bony processes projecting 
from the vertebrae serve as the point for the 
attachment of muscles, and at the same time as a 
cheval de frise in warding off blows from the cita- 
del. The numerous heavy muscles of the back 
serve to cushion externally, and thus protect the 
spinal column. In addition to this they afford a 
support and protection to the deeper seated tis- 
sues, and likewise give the required motions. 
The segmentation of the spinal column pos- 
sesses, in some cases, when the concussive force 
is applied in certain directions, a highly impor- 
tant modifying effect. The cartilagenous cover- 
ings of the articular surfaces, and also, to some 
extent, the osseous structure of the vertebrae 
themselves, act as cushions or buffers, by which 
the concussive force is greatly diminished at each 
articulation. This principle has been long under- 
stood, and is now generally applied to all the 
passenger trains on railways. L,et us now present 
a few practical points connected with the anatomy 
of the spinal canal and the spinal cord, without 
entering into a full consideration of the anatomi- 6 
cal structure of these parts, which can be readily 
examined by a reference to the text books on this 
subject. The spinal canal serves for the passage 
of the spinal cord, and presents everywhere a 
markedly smooth and even surface, which is lined 
by the medullary membrane. It is also so large 
that the spinal cord and its membranes are at no 
point adherent or in contact with it; in fact they 
do not nearly fill it. The bony wall of this canal 
is everywhere cushioned with connective or adi- 
pose tissue, and the intervening space is filled 
with spinal fluid. The spinal cord is wrapped by 
the spinal membranes, and this is surrounded by 
the spinal fluid, and every vertebral nerve is so 
placed as to act as a most efficient stay, thus pre- 
venting any swaying or other motion. Dr. Byron 
Bramwell, of Edinburgh, says: “The relation- 
ship of the cord and the nerve roots to the spinal 
membranes (dura, arachnoid and pia) is of great 
practical importance, and is as follows: The 
spinal dura mater is a dense, tough membrane, 
which is loosely attached externally to the bones 
of the spinal canal, being separated from the 
periosteum by loose areolar tissue, fat cells and 
blood vessels, which forms a loose covering or 
sheath for the spinal cord and its nerve roots, 
surrounded by the pia, arachnoid and spinal 
fluid.”1 The following illustration, it is thought, 
will greatly facilitate the study of the relationship 
of the cord and nerve roots to the spinal mem- 
brane, while it also affords a very correct idea of 
the relation of the spinal cord to the spinal col- 
umn and other important parts. 
Let us now turn our attention to certain ana- 
tomical peculiarities which possess important 
relative bearings on concussion in these organs. 
1 “ Diseases of the Spinal Cord,” p. 14 et seq., 2d edition, 1884. 7 
We have already observed that the spinal cord is 
wonderfully protected against any injury from 
concussive force. It will now be seen that the 
anatomical peculiarities of the surroundings of 
the brain especially endanger the safety of this 
organ from that force. It is stated in the stand- 
ard text books on human anatomy that the 
weight of the spinal cord is about thirty-three 
per cent, of the weight of the brain. 
The weight of the brain, being so much greater 
than that of the spinal cord, increases greatly the 
liability of this organ to injury from concussive 
force. All the advantages arising from the buffer 
action, which has been previously mentioned, is 
lost, in case the concussive force is applied to the 
cranium, and the whole momentum of the blow 
will be transmitted directly from the skull to the 
encephalon. 
Furthermore, we have called attention to the 
fact that the spinal canal is everywhere cushioned 
with areolar and adipose tissue, and likewise that 
the space intervening between this bony wall and 
the spinal cord is filled with spinal fluid. The 
encephalon, on the contrary, possesses no such 
protection against concussive force. In this case 
the membranes of the brain are placed in imme- 
diate contact with the bony walls of the cranium, 
without the intervention of soft tissue cushions 
or the presence of a water bed. The following 
cut presents a view of a portion of the encepha- 
lon, and likewise the entire spinal cord in its 
relation to the spinal nerve roots and some of the 
other surrounding parts. 
Our own experimental work was done on dogs; 
and, therefore, that the anatomical peculiarities 
of these animals may be compared with those of 
man, we have here introduced the following illus- 
tration, which presents both the anterior and 8 
posterior view of the spinal cord, spinal nerve 
roots, etc. 
The whole number of these experiments were 
141, but there were only 46 of these cases in 
which pathological lesions were produced in the 
cerebro-spinal axis or its membranes. 
There were twenty of these forty-six cases in 
which the post mortem examination distinctly 
revealed a want of continuity in the spinal col- 
umn, and these complicating injuries were as 
follows: Rupture of the vertebral ligaments, 
11; fractions involving the bodies of the verte- 
brae, 5 ; stretching of the vertebral ligaments, 4. 
It will now be observed that there are twenty-six 
cases in which the spinal column apparently re- 
mained uninjured. There were four cases in 
these twenty-six which were complicated with 
lesions which quickly terminated in death. 
It will likewise be seen by a reference to the 
accompanying explanatory notes1 that there are 
six other cases included in our total of cerebro- 
spinal lesions where the question of the causa- 
tion of these pathological changes justly raises 
the query—shall they not be excluded in this 
enumeration ?2 
Notwithstanding all this it must be admitted 
that these experiments have conclusively shown 
that pathological changes in the spinal cord, 
corresponding to those mentioned in the second 
query (2), may be produced by concussive force, 
while the bony walls of the spinal column and 
its ligaments remain in their normal state. The 
answer of the second query likewise includes in 
some degree the reply to the third question, 
since it shows that in the spinal cord concussive 
force may produce pathological changes. In 
fact, it must be self-evident to us that these path- 
ological changes occurring when there is neither 9 
a fracture of any portion of the spinal column, a 
rupture of the spinal ligaments, or a stretching of 
the same can only be caused by a true concussive 
force. 
The next point demonstrated by our experi- 
mental studies is, that the force required for the 
production of these lesions must be comparative- 
ly very great, since only a limited number of 
these injuries resulted from a large number of 
experiments, although the force employed was 
highly efficient, as is shown by the production of 
severe and numerous traumatisms in the other 
organs (4). 
In this connection it seems quite proper to call 
attention to the fact that the more limited the 
area to which the concussive force is applied, 
while the force remains otherwise unchanged, 
the more concentrated and destructive will be 
the effects produced by it, especially on animal 
bodies. It may therefore be logically assumed 
that the same concussive force when applied only 
to the nates will be much more effective than it 
would be if distributed over the greater portion 
of the posterior surface of the body. Bearing di- 
rectly on this point is the fact that I made six ex- 
periments in which the blows were delivered on 
the posterior surface of the body—along the 
course of the spinal column, which produced no 
evidence of any concussion. 
I will here affirm that my anatomical and ex- 
perimental studies of this subject have rendered 
me absolutely skeptical in regard to the produc- 
tion of pathological lesions in the spinal cord by 
any concussive force applied evenly over the 
greater portion of the posterior surface of the 
body. It must, however, be admitted, that if the 
concussive force be complicated with any other 
power which destroyed the continuity of the spi- 10 
nal column, then pathological changes in the spi- 
nal cord would be very likely to follow, although 
this is not an invariable result. True concussive 
force when thus applied would invariably produce 
death by traumatic lesions in other organs before 
its pathological effects would be manifested in 
the spinal cord. It may therefore be confidently 
asserted that these pathological changes in the 
spinal cord are commonly produced by a com- 
pound force. 
Let us suppose for the purpose of illustrating 
our views, that the spinal column has been struck 
by a musket ball which has in some degree im- 
paired its external continuity without producing 
any lesion in the osseous tissues of the canal; 
but there are discovered numerous pathological 
changes in the cord, how are these to be ex- 
plained ? 
It will readily be admitted that these lesions 
are produced in many casss by a direct and con- 
centrated concussive force applied to the spinal 
column which has been transmitted to the spinal 
cord. 
It will not, however, be claimed by any one 
that this injury done to the spinal column result- 
ed from concussive force. It will here be ac- 
knowledged by all that the injury done to the 
bony structures was caused by the projectile force 
given to the bullet by the explosive compound. 
In other cases a sudden wrench or strain, compli- 
cated or not with concussive force, may give rise 
to similar lesions in the spinal cord. 
Here, again, he who carefully studies the anat- 
omy of these parts will be compelled to acknowl- 
edge that great force, even of this sort, will be 
required to produce pathological changes in a 
healthy spinal cord. Observe the wonderful in- 
terlocking and bracing of these bony segments or 11 
vertebrae which form the spinal column. Behold 
the bony processes or projections thrown out in 
various directions from the bodies of the vertebrae 
to protect them from direct force! In addition to 
all this, contemplate the protection afforded by 
surrounding and covering these with heavy mus- 
cular cushions. It now becomes apparent to us 
that no trivial jar, twist or strain can result in 
any injury to the healthy cord; but, on the con- 
trary, it is self-evident that an extraordinary 
force will be required to produce pathological 
changes in this centre, a power which can never 
fail to do serious injury to other organs which 
are not so well protected. This point is clearly 
brought out in my experimental work, where I 
made 141 experiments especially directed to the 
production of lesions in the cerebro-spinal axis, 
studiously avoiding, so far as possible, the pro- 
duction of injuries in other parts of the body. 
The traumatisms were carefully delivered on that 
part of the body where the greatest portion of 
the force would be expended on the spinal col- 
umd; and what was the result ? There were 
more than three times as many lesions produced 
in the other organs of the body as in the cerebro- 
spinal axis. The query suggested by these re- 
sults is, that if severe traumatisms inflicted espec- 
ially for the purpose of producing lesions in the 
spinal cord give us so small a ratio, how fre- 
quently might pathological changes be expected 
to occur in this centre in injuries arising from 
miscellaneous accidents ? It is true that no reply 
approximating to a mathematical correctness can 
be here attempted ; but it may be reasonably in- 
ferred that their occurrence will be very rare, 
even exceptional, unless the force applied has 
involved the continuity of the spinal column. In 
the examination of these accidents the surgeon’s 12 
attention is first directed to the nature of the 
force employed, and, secondly, to that part of the 
body on which it was expended. 
It is by careful attention to these factors that 
this search for lesions will be primarily directed. 
Thus far we have only studied the effects of con- 
cussive force when applied to the nates and the 
posterior regions of the body. It therefore re- 
mains for us to consider the probable effects 
which arise from the application of concussive 
force on the other regions of the body. The 
statements already made while describing the 
effects of concussive force when applied to the 
nates are applicable, within -certain limits, to the 
same force when it is applied to the feet while 
the lower extremities and body are maintained in 
a fixed and erect position. But even under these 
circumstances there would be a considerable loss 
of power, referable to the buffer action in connec- 
tion with the articulations in the lower extremi- 
ties. 
However, a much more important subject for 
our contemplation in this connection is contained 
in the following question : Will not flexion occur 
at the articulations in the lower extremities with 
so much promptitude, under these circumstances, 
as to wholly obviate all danger? I think there 
is very little doubt on this point, and, therefore, 
feel strongly inclined to believe that no patho- 
logical changes can ever be produced in the spinal 
cord by concussive force applied to the feet. 
Furthermore, it may be boldly asserted, on the 
basis of correct anatomical knowledge and experi- 
mental research, that no amount of concussive 
force can ever be applied to the anterior or lateral 
regions of the body, which will be attended with 
the slightest danger to the spinal cord ; since that 
amount of force which would disturb in the 13 
slightest degree the functions of the cord could 
not fail to destroy life by injury to some of the 
abdominal or thoracic organs on which the power 
of the blow must be primarily received. 
Having completed our study of the so-called 
“concussion of the spinal cord,” from an ana- 
tomical and experimental standpoint, I am thor- 
oughly convinced that neither pathological le- 
sions, nor even functional disturbances, are ever 
produced in this centre, in a healthy cord, with- 
out the application of very great force. It is 
foolishly absurd to presume that these morbid 
conditions can have their origin in a slight jar, 
wrench, or even the application of a moderate 
concussive force. 
My distinguished predecessor, Dr. N. P. Dan- 
dridge, Chairman of this Section at the last meet- 
ing, gave us an elegant paper modestly entitled, 
“Surgical Interference in Fractures of the Spine;” 
but the principles enunciated in it are equally 
applicable to the treatment of nearly all spinal 
injuries. I cannot refrain, at this point, from 
citing a portion of this paper, on which my ex- 
perimental experience seems to have a very im- 
portant bearing. Dr. Dandridge informs us: 
“It is well known that not only a considerable 
number of these cases escape death, but entirely 
recover all their functions, even after the exist- 
ence of paralysis, incontinence and bed sores, ex- 
isting for a variable length of time. In a valu- 
able paper Burrill has investigated the results of 
all the cases which have occurred in the Boston 
City Hospital, eighty-two cases in all, of which 
eighteen survived. Divided into regions, we 
find twenty-eight cases of fracture of the cervical 
vertebrae gave two recoveries; twelve cases of 
fracture of the upper dorsal vertebrae, six recov- 
eries ; nineteen cases of fracture of the lower dor- 14 
sal, one recovery; twenty-three cases of fracture 
of the lumbar vertebrae, ten recoveries. Of the 
sixty-four fatal cases thirty-five died within five 
days, eight in from five to ten days, and seven in 
from ten days to one month. Five of these cases 
were submitted to operation, all of which were 
promptly fatal. In the eighteen who survived, 
the result was good in nine, and in nine complete 
disability remained permanent. The especial 
value of Burrill’s paper is that it is based on the 
entire number of cases treated in a single insti- 
tution, and gives, therefore, more reliable data 
for deductions than statistics made up of isolated 
cases. ’ ’ 
The statement made in this quotation, that not 
only a considerable number of cases of fracture of 
the spine escape death, but actually recover after 
having developed grave symptoms, is certainly 
not in accordance with the old preconceived no- 
tion. It has long been urged by many distin- 
guished surgeons, among others, Abercrombie, 
Sir Ashley Cooper, Sir Charles Bell and John 
Hunter, that even slight injuries of the spinal 
cord were very apt to lead to fatal terminations. 
Mr. Erichsen* has asserted, in this connection, 
that “in many of the cases in which sensation is 
more affected than motion, or in which the prin- 
cipal lesion consists in a modification of sensa- 
tion coming on immediately after the receipt of 
a blow on the back, there may be reason to sus- 
pect laceration of the gray matter, with extrava- 
sation of blood into it. Hammond mentions two 
cases in which incurable paraplegia followed sup- 
posed spinal haemorrhage. Speedy death, how- 
ever, most usually occurs as a consequence of 
such an injury.” 
* "Concussion of the Spine, Nervous Shock, etc.,” by John E. 
Erichsen, pp. 71 and 74. Wra. Wood & Co., New York, 1875. 15 
The same author has also added that ‘ ‘ Boyer 
had long since noticed the very interesting prac- 
tical fact that when the interspinous ligaments 
were ruptured, in consequence of forcible flexion 
of the spine forwards, no fatal consequences usu- 
ally ensue, the integrity of the parts being re- 
stored by rest; but that when the ligamenta sub- 
flava are torn through and the arches separated, 
paraplegia and death ensue. This he attributes 
to stretching of the spinal cord.” Sir C. Bell, 
however, with great acuteness, has pointed out 
the error of this explanation, and states that “ it 
is the progress of inflammation to the spinal mar- 
row, and not the pressure or extension of it, 
which makes these cases of subluxation and 
breach of the tube fatal.” .... ‘‘There can be 
no doubt that this explanation is the correct one, 
and that when once the spinal canal is forcibly 
torn open, fatal inflammation will spread to the 
meninges and to the medulla itself.” 
It will be observed that these quotations from 
Mr. Erichsen’s work are not in harmony with the 
statements made by Dr. Dandridge. In fact we 
discover here about the same difference which 
marks the writings of the first half of this century 
on abdominal surgery, and those of the present 
day on the same subject. My own experimental 
studies have an important bearing on this matter 
of difference between Dr. Dandridge and Mr. 
Erichsen, and therefore I shall here state briefly 
some of my observations. Permit me, therefore, 
to transcribe from my brochure the following : 
February n. Experiment 4. Normal condi- 
tion; mongrel, bull, male, set. about five years; 
weight, 51 y2 pounds; temperature, 102.2°; pupils 
natural; traumatized. The animal walked with 
some difficulty, apparently weakened in the hind 
legs. .Pupils were slightly dilated. 16 
Feb. 12. Temperature, 102°; pupils normal; 
the symptoms more marked to-day than yester- 
day. The animal stood on his hind legs with 
much difficulty; walked with an unsteady gait ; 
toilet neglected ; eyes dull; ate and drank, and 
was evidently suffering from incomplete para- 
plegia. 
Feb. 13. Temperature, ioi°; pupils normal; 
some slight improvement in other respects. 
Feb. 14. Temperature, 100.50; pupils normal; 
ate and drank fairly well. 
Feb. 15. Temperature, 101.80; pupils normal. 
Feb. 16. Temperature, 990 ; pupils normal. 
There had been some improvement in the para- 
plegia. 
Feb. 17. Temperature, 100.6°; pupils normal. 
Feb. 18. Temperature, ioo°; pupils normal. 
Feb. 19. Temperature, 102°; pupils normal. 
Feb. 20. Temperature, 100.70; pupils normal. 
Feb. 21. Temperature, iob°; pupils normal. 
Feb. 22. Temperature, ioi°; pupils normal. 
Feb. 23. Temperature, 100.80; pupils normal. 
Feb. 24. Temperature, 101.60; pupils normal. 
Post mortem.—This autopsy was made prompt- 
ly after the examination recorded on the 24th. 
There was found a simple fracture of the body of 
the last lumbar vertebra, external to which was 
a large blood clot, some part of which had evi- 
dently been absorbed, while the cauda equina 
showed signs of pressure from the coagulated 
blood, but none of an inflammatory character. 
There was also congestion of the cortical sub- 
stance of both kidneys and the lining membrane 
of the bladder. 
Microscopical report.—The brain was incised in 
several places, and it was found to be moderately 
hyperaemic ; otherwise normal. There was gen- 
eral hypersemia of the cord. The ganglionic 17 
cells were less distinct than in normal cords, less 
defined from their surroundings. The nerve ends 
were less sharply defined in the anterior and pos- 
terior columns, near the median commissure, than 
in the rest of the cord. This was more marked 
in the lumbar region. 
Observations.—It is highly important to ob- 
serve that in the case of this animal, the improve- 
ment was steady after the third day of the receipt 
of the traumatism until his death. In fact, so 
marked had been the progress, that I am fully 
assured, that had the dog been left to unaided 
nature, he would have entirely recovered. I 
will also add to the above record a few extracts 
from the same source, which will include all the 
other cases of fractures involving the spinal col- 
umn which occurred in my 141 experiments. . . 
First Series.—Experiment 3—traumatised— 
complete paraplegia. The hind legs absolutely 
powerless, but the animal drags himself, with 
much effort, over the floor with his fore legs. 
Post-mortem.—This examination revealed a 
comminuted fracture of the spinous process and 
body of the seventh dorsal vertebra. The spinal 
cord was exposed, and found to be completely 
crushed at this point, showing the result, like- 
wise, of inflammatory action in the congested 
and softened condition, which extended in both 
directions away from the seat of injury one inch 
or more.3 . . . 
Microscopical Report.—There was a break in 
the dorsal region of the cord. Above and be- 
3 The above record will, it is thought, enable the reader, to 
form his own opinion in regard to the causation in these cases, 
while the whole number interrogated is limited to six. The total 
number which terminated quickly in death were eight, while there 
were only four of these, in which there were found any lesions in 
the cerebro-spinal axis. See brochure, page 71, for complicating 
lesions. 18 
low this break the cord was softened and in- 
tensely hyperaemic. The central canal was 
dilated with blood. The cord was intensely 
hyperaemic throughout. In the cervical and 
lower lumbar regions no special change was 
noticed except the hyperaemia. 
Second Series.—Experiment 2. . . . Trauma- 
tised—Paraplegia. . . . Post-mortem.—This ex- 
amination revealed the following: A simple 
fracture in the body of a vertebra, in the upper 
half of the lumbar region; the injury to the 
spinal cord was very marked at this point. There 
was likewise found within the peritoneal cavity 
about two ounces of coagulated blood directly 
over the psoas muscles; these muscles were 
ecchymosed, the right more than the left. Both 
kidneys were congested. Meninges of the brain 
congested, especially over the occipital region ; 
spinal cord in a similar condition. . . . 
Microscopical Report.—Brain intensely hyper- 
aemic otherwise normal. The cord was hyper- 
aemic throughout. It had not hardened well, 
and the outlines of the fibres were indistinct, 
whether cut longitudinally or transversely. The 
ganglionic cells were perfectly distinct. 
Experiment 5.—Traumatised—Incomplete para- 
plegia ; pupils moderately dilated. Post-mortem. 
—This examination revealed the following le- 
sions : Congestion of both kidneys; in the 
pelvic cavity there was a quantity of extrava- 
sated blood, a deep ecchymosis involving the 
whole of the left psoas muscle, marked conges- 
tion of the meninges covering the vertex of the 
brain, and a slight congestion over other portions, 
the brain itself somewhat hyperaemic, cranial 
fluid increased in quantity. The spinal cord was 
likewise hyperaemic. A comminuted fracture of 
the body of the last lumbar vertebra and the 19 
presence of a blood clot within the canal at this 
point. . . . 
Microscopical Report.—“ The material was not 
received.” The injuries described in Experi- 
ment 3, First Series, wrould have sooner or later 
caused the death of the animal; but in the other 
cases recovery would have been the final termina- 
tion in each instance. It would be very interest- 
ing in this connection to take up separately the 
eleven experiments in which there was a rupture 
of vertebral ligaments, in order to show the na- 
ture of the pathological lesions in each case, and 
likewise the other complications ; but space will 
not permit; and therefore it is sufficient for me 
to say, that in each instance the improvement 
had been so marked before the animal was killed, 
as to justify me in asserting, that all of these 
animals would ultimately have recovered. 
There still remains a single point connected 
with fractures and other lesions of the spinal 
column, to which I desire to call especially the 
attention of surgeons. My experimental studies 
have conclusively shown that in all severe in- 
juries of the spinal column, cord, etc., there are 
complications involving more or less seriously, 
the organs within the thoracic, abdominal or 
pelvic cavities. I know of no reason wThy there 
should not be found similar complications in the 
human subject. In fact, I think it will be dis- 
covered when sought for in connection with 
spinal lesions. 
Explanatory Notes and References.—A brochure entitled 
“ An Experimental Study of Lesions Arising from Severe Concus- 
sions,” by B. A. Watson, M.D., p. 67 et seg. Philadelphia: P. Blak- 
iston, Son & Co.' The report of these cases maybe found by a 
reference to Nos. 20, 22 and 35, First Series, and No. 64, Second 
Series. The immediate cause of death in case " No. 20 was a rup- 
ture of the aorta.” . . . . In 22 it was “ chiefly due to deep lacera- 
tions in the lungs, injury of the liver, etc.” 
“ The cause of death in the 35th Experiment existed in the rup- 
ture of the right auricle and left pulmonary artery.” “ In the 64th 20 
Experiment the cause of death was the laceration of the liver, 
which gave rise to a profuse haemorrhage, although there were 
haemorrhagic infarctions in the lungs and a pre-existing pneumo- 
nia . . . . “The spinal and brain complications in the above- 
mentioned cases were as follows : In Experiment 22 there was 
intense hyperaemia of the brain and spinal cord, while in the 
20th and 35th Experiments there were found small haemorrhages 
into the gray matter of the cord. The complication in the 64th 
Experiment consisted of distension of the vessels of the mem- 
branes of the spinal cord, which had ruptured in several places, 
and haemorrhages of small size had occurred in the surrounding 
tissue.” 
These forty-six cases of pathological changes involving the 
various parts of the cerebro-spinal axis occurred as follows : (1) 
brain, 1; (2) brain and spinal cord, 12; (3) spinal cord, 15; (4) 
cauda equina, 2 ; (5) membranes of the brain and spinal cord, 3; (6) 
Brain and spinal cord ? 2 ; (7) brain and cauda equina ? 1; (8) spinal 
cord ? 2 ; (9) brain ? 1 ; (10) spinal cord and the membranes of the 
brain, 5; (11) membranes of the spinal cord? 1; (12) membranes 
of the brain and spinal cord ? 1. 
The attention of the reader is here called to the fact that in my 
brochure I have stated that there were fifty cases in which patho- 
logical changes occurred in the cerebro-spinal axis, but a more 
careful examination of these reports justify me in limiting the 
number to forty-six. 
2 It will likewise be observed in the above classification of 
these pathological changes that in some instances the interroga- 
tion point has been placed after the classification clause. In the 
cases thus marked the author thinks there is a reasonable doubt 
whether the pathological changes observed were due to the trau- 
matism or other complicating factors. Thus, in Experiment 10, 
First Series, the following facts are recorded : Post mortem.— 
“ Visceral organs of the thorax and abdomen healthy, with the ex- 
ception of the kidneys, which are both in a state of cystic degener- 
ation. The meninges of the brain seem to be congested. The 
quantity of cerebral fluid apparently somewhat increased. No 
softening (apparent to the unaided eye) of the brain and spinal 
cord 
Microscopical Report— Brain moderately congested. There are a 
few punctate haemorrhages in the anterior horns of the lumbar 
region of the cord. The cord is hypersemic throughout, but less 
so than in experiment 22.” The record in the 17th Experiment, 
Second Series, reads as follows : Post mortem.—“ This examina- 
tion revealed the following lesions: Rupture of the bladder, ab- 
dominal cavity distended with urine, the organs contained within 
it all more or less inflamed, lungs contained nnmerous haemor- 
rhagic infarctions and were considerably inflamed. The meninges 
of the brain were markedly congested, blood clot of considerable 
size beneath the dura mater, spinal cord seemed congested. ...” 
Microscopical Report.—“ The brain is intensely hyperaemic ; 
there is no lesion of the nerve cells or fibers. There are haemor- 
rhages in the meshes of the fibrous tissue of the dura mater and 
upon its inner surface. The vessels of the cord are very greatly 
distended with blood, but there are no haemorrhages and no lesions 
that can be distinguished in the ordinarily stained sections.” Fig. 1.—Lateral view of the spine. 
Figure 2. 
Figure 3. 
Figure 4.