microscope nor the means for preserving and hardening J the specimen being available. This is matter for regret, as it is possible that the existing lesions were not confined to the walls of the bloodvessels. ! These two cases seem to me to supplement one another, and although it is as a rule unwise to generalise from single examples, we know so much of the symptomatology and of the morbid appearances that indicate cerebral concussion that we could well anticipate similar conditions in a

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... onding injury to the spinal cord. In both events the spinal column was subjected to sudden and severe jar, and in both with a very similar and striking result. Admitting that the injury in the instance of the stag was an exceptionally severe one (for the contusing power of a ball travelling at a high rate of velocity is fully recognised), still in the case of A. Cthere were certain circumstances which tended to render the blow he received one of great severity. He fell backwards from a train moving at fair speed in the opposite direction, receiving thus a considerable impulse; and when thus impelled he probably struck, judging from the localised nature of the bruise found, upon a projecting surface. Such conditions must have caused a sudden and severe stroke, and probably produced in him similar lesions to, but slighter than, those found in the stag. Mr. Page, in his masterly and most valuable work upon "Injuries of the Spine and Spinal Cord,"p. 19, refers to a case recorded by Dr. J. Liddell, in which a Minie ball striking a man to the left of the second lumbar vertebra and emerging some inches to the right fractured in its passage its spinous process. Paraplegia and paralysis of the bladder were at once developed, but at the end of two months were being gradually recovered from. In this instance the circumstances which gave rise to the injury were identical with those which occurred in the case of the stag, and I take it that the symptoms developed in the man owed their origin to such lesions in the spinal cord as were found to exist in that of the animal. Here, however, I would state my belief that even in the spinal cord we may have symptoms of a passing "concussion" in which probably the stroke being less severe, the harm actually done is neither so marked nor so grave. My reason for thinking this is that I have known a deer shot in the neck fall instantly and lie apparently dead for some little time, but, when approached, gather itself up with a visible effort and go off at sufficient speed to lead to its escape. In it, I imagine, the ball passed immediately over the spinal column without perhaps actually injuring it, but sufficiently close to communicate to it such a jar as for the time being inhibited the action of the organ ib contained. What seems to render this more probable is the fact that a ball striking some other and non-vital part beyond, producing the sound of impact and the flight of the deer. would have afforded no immediate evidence of injury.2 Even, however, in these lighter shocks-these so called "concussions"-there is probably always a marked lesion existing. That this is usually so necropsies in fatal cases of cerebral concussion reveal to us, and in these the appearances found are precisely those which I have described as occurring in the spinal cord I examined. They are the coarse evidence of the jar the nervous mass has sustained, and the violence of which, so far as the naked eye carries us, seems to fall largely upon its vascular apparatus. Whether this be due, as Duret holds, to the result of force communicated to the cerebro-spinal fluid and its effects in the peri-vascular spaces, or to the vibratory thrill imparted to the mass itself, matters little; in either case what occurs is an apparently temporary, though happily incomplete, suspension of its essentially vital action. That this is the direct issue of the shake, and is independent of such vascular lesions as post-mortem examination reveals, is, I consider, probable ; for although these mark well and emphatically the severity and nature of the injury sustained, they are, as a rule, insufficient per se to have produced a fatal result. That such lesions exist to a greater or less extent in all cases of cerebral and spinal concussion which do not die wellnigh instantaneously is my belief, and they write the record that the notable disturbance of function observed depends upon organic injury. I have some doubt, however, that such evidence can never be absent, and it comes from the 2 In this reasoning I am not forgetful of the "knock-down blow" from general shock, familiar alike to the army surgeon and to the sportsman, which is apt to follow the blow of a missile, but where the recovery is, as a rule, rapid. observation of cases of cerebral concussion seen at themoment the injury was received. I vividly remember the case of one man-certainly the most striking in my experience-whom I saw fall from a height of some fourteen feet and alight upon his vertex in the hard roadway. The appearance be presented was very impressive : the terrible pallor of his face, the dropped jaw, the fixed pupil and insensitive eye, the arrested breathing, and the absence of all pulse at the wrist, made me believe he was dead. It was only when having bared his chest and put my ear over his heart, I could detect such far away and feeble sounds as mark generally a, rapidly ebbing life that I recognised that vitality was not quite extinct. Under the use of stimulants applied chiefly, externally he slowly rallied, and ultimately recovered. But my reflection was this : Suppose that man had diedas in the presence of a heart with feeble walls or one less stable in its ennervation, and in the absence of help, he' probably would,-what then would have been the appearances presented by his brain ? If, as the experiments of the most recent observers seem to show, a primary ansemiafrom arterial spasm, the result of a powerful peripheral irritation, be the primary step in the development of the phenomena. of concussion, and a congestive stage the sequel to this, it is, I think, probable that the blood extravasations so generally found can only occur after vascular relaxation y, and that, if cerebral shock be immediately fatal, a singularly pale brain with great turgidity of its veins may alone indicate the mode of dying. Such a belief is contrary to the teaching of the highest authorities, and it may be groundless ; but it is just possible that it may explain the absence of all coarse cerebral lesions in certain cases" attached to the records of which are the names of generally reliable observers. The occurrence of concussion of the brain, apart from, marked injury to its bony case, has always been admitted, but it has been notably otherwise with concussion of the spinal cord. The experience which prompts this note proves, I think, that such an injury may occur without important structural injury of the vertebral column, tha,'j it is the result of severe and direct injury, that its symptoms are at once apparent, and that when they are ptesent there is some easily recognisable lesion producing them. The further teaching is this, that the treatment of such cases should be that usually followed in those of cerebral concussions, the main indications being the pursuit of such measures primarily as will prevent the further effusion of blood from ruptured vessels, the prompt relief of that state of active congestion which, as in cases of cerebral concussion, may possibly supervene, and the allowance of such a period of rest as will enable nature to repair theimportant injuries the cord has certainly sustained. Cannes, France.