Whiplash injury and liability

The American VOLUME

94

Journal of Surgery

OCTOBER

1957

NUMBER

FOUR

EDITORIAL

Whiplash

Injury

ward in reIation to the body. (Fig. I .) Recoil from the impact then throws the unsupported head vioIentIy forward, compIeting the whipIash action. (Fig. 2.) In a minor coIIision this

has come to traumatic surgery. The victim of an automobiIe accident who has no apparent evidence of injury has at Ieast a “whiplash injury.” It suggests how punishing

S

and Liability

EMANTICS

FIG. I. The erect, unsupported head baIanced free over the trunk, on impact (especially from behind), is thrown backward by its own inertia, maximated by the density and roundness of the skull. The anterior Iongitudinal Iigament may tear and puI1 off fragments of the vertebrae.

FIG. 2. RecoiI (the result of eIasticity of the coIIiding body) affects first the trunk, which is in contact with the seat, and completes the penduIum swing of the head by throwing it forward onto the chest. FIesion of the cervica1 spine, bIocked by the bodies of the vertebrae, occurs onIy at the junction of the seventh cervical and first thoracic vertebrae. The dorsa1 ligaments may rupture here and strain (or tear) nearby remaining structures.

theEaccident has been and it is suff%ientIy descriptive of the action to sound quite technica1. In the mechanism of injury the back of the victim is the handIe of the whip and the cervical spine is the Iash. Impact in an automobiIe accident causes the patient’s body to be jerked by the back of the seat. Inertia causes the unsupported head to faI1 vioIentIy back-

cause onIy a miId sprain of the cervica1 vertebrae and possibly a strain of the muscIes of the neck and shouIders, yet this mechanism may be a vioIent occurrence in a high speed

may

535

American

Journal of Surgery,

Volume 94. October, ~957

Vernon accident. It is possibIe for the head of the victim to be found IOO feet down the road with the body stiIl within the wrecked car. It has been noted in airpIane accidents that whiIe the torsos of victims were recovered, the heads were often never found. The term whipIash in connection with injury to the neck is inaccurate; it suggests a mode of occurrence but not an exact Iocation or severity of the injury. When a so-caIIed whipIash injury has occurred, it is important to know whether there has been a minor or a major tear of Iigaments, disIocation or fracture, or both. Since the injury can range from temporary indisposition to decapitation, the use of the aII-incIusive term for such a wide disparity of severity is undesirabIe. A pole vauIt is not jumping part way to the moon, even if the jumper is getting away from the earth by a mighty effort. However, the word whipIash is highIy suggestive, caIcuIated to make a jury give a high award for

a miId sprain of the neck. The increasing tendency toward Iitigation should not be stimuIated by the misuse of words. On the other hand, the modification of motor vehicIe design with respect to possibIe injury to the neck shouId be given consideration. PossibIy motor car design can incorporate a suitabIe neck support that the pubIic wiI1 accept. This is a chaIIenge to insurance companies and automobiIe manufacturers. Safety beIts have been incorporated into cars and yet are probabIy not used. Most of them serve as a psychoIogic reminder that there are some advantages to driving more sIowIy. The average person resents overprotection, and wiI1 not accept a design that Iooks Iike wearing rubbers and a raincoat on a sunny day. However, the probIem shouId not be confused by the Iurid, Ioaded injury to the neck.” term, “whipIash SIDNEY VERNON, M.D.,

Willimantic, Connecticut

536