Brown, p. 424 Following a similar law in Germany, 78% of claims in the period 1871–1879 were for back injury. Claims for railway spine had subsided by 1900. From 1890 there were more claims for psychosomatic conditions such as hysteria and the neurasthenia of George Miller Beard rather than physiological conditions such as railway spine.
|
|
48 Bevan claimed to have cured one patient in ten minutes by standing him up and speaking to him forcefully. In Britain, a number of major train crashes led to parliament passing an act which compelled rail companies to pay compensation to victims of accidents. A large proportion of the thousands of resulting claims were for railway spine. In a five-year period in the 1870s English railway companies paid £2.2 million ($11 million) in claims for railway spine.
|
|
Dembe, p. 229 One common claim that was hotly debated by railway surgeons was the condition known as railway spine. Over a hundred papers were published on the subject in the medical literature for the period 1866–1890.Dembe, p.
|
|
Criticism of Erichsen and "railway spine" was particularly strident in the US with NARS and its journal, the Railway Surgeon leading the attack. So much effort was devoted to discrediting the condition as medically valid that one writer claimed the issue was the reason for existence of the association.
|
|
During World War I, hysterical men were diagnosed with shell shock or war neurosis, which later went on to shape modern theories on PTSD. The notion of male hysteria was initially connected to the post-traumatic disorder known as railway spine; later, it became associated with war neurosis.
|
|
In the second half of the nineteenth century, hysteria was well-established as a diagnosis for certain psychiatric disorders. Although the original anatomical explanation of hysteria, the so- called wandering womb, was by this point abandoned, the diagnoses remained associated with (gender stereotypes of) females and female sexuality in the minds of physicians. Hysteria was joined in 1866 by a diagnosis for a very similar set of symptoms: railway spine, a nervous disorder caused by witnessing the accidents that the dangerous railways of the time generated in large numbers. John Eric Erichsen, who first diagnosed railway spine, explicitly rejected the hysteria diagnosis for his patients, arguing that diagnosing men with hysteria was unreasonable, "this term [being] employed merely to cloak a want of precise knowledge as to the real pathological state".
|
|
The history of remote location stress reaction (RLSR) has shown a remarkable variation and subvariation in the interest and knowledge of those whose tasks it has been to deal with them. Kardiner and Spiegel writing in 1947 stated: During exploration in the American South, two conditions, “soldier's heart” and “nostalgia”, were basically RLSRs. Various epidemics of psychological disorders (e.g. passengers with railway spine) were recognised in the 1800s.
|
|
Exacerbating the problem was the fact that railway cars were flimsy, wooden structures with no protection for the occupants. Soon a group of people started coming forward who claimed that they had been injured in train crashes, but had no obvious evidence of injury. The railroads rejected these claims as fake. The nature of symptoms caused by "railway spine" was hotly debated in the late 19th century, notably at the meetings of the (Austrian) Imperial Society of Physicians in Vienna, 1886.
|
|
Germany's leading neurologist, Hermann Oppenheim, claimed that all railway spine symptoms were due to physical damage to the spine or brain, whereas French and British scholars, notably Jean-Martin Charcot and Herbert Page, insisted that some symptoms could be caused by hysteria (now known as conversion disorder). Erichsen observed that those most likely to be injured in a railway crash were those sitting with their backs to the acceleration. This is the same injury mechanism found in whiplash. As with automobile accidents, railway and airplane accidents are now known to cause posttraumatic stress disorder (PTSD) and other psychosomatic symptoms in addition to physical trauma.
|
|
Male "traumatic hysteria", as defined by Charcot, was a distinct disease from female hysteria in that it was linked to traumatic shock rather than sexuality or emotional distress, so the gendered stereotyping was still at work to an extent in Charcot's thinking. This new category subsumed what British and American physicians had understood as railway spine. From Paris, Charcot's theories traveled east, carried by visitors to Charcot's hospital: the Germans Max Nonne and Hermann Oppenheim, and the Austrian Sigmund Freud. Nonne was originally skeptical, but ultimately became a proponent of the male hysteria diagnosis when dealing with the neurotics produced by the First World War.
|
|
The addition of the term to the DSM-III was greatly influenced by the experiences and conditions of U.S. military veterans of the Vietnam War. Due to its association with the war in Vietnam, PTSD has become synonymous with many historical war-time diagnoses such as railway spine, stress syndrome, nostalgia, soldier's heart, shell shock, battle fatigue, combat stress reaction, or traumatic war neurosis. Some of these terms date back to the 19th century, which is indicative of the universal nature of the condition. In a similar vein, psychiatrist Jonathan Shay has proposed that Lady Percy's soliloquy in the William Shakespeare play Henry IV, Part 1 (act 2, scene 3, lines 40–62), written around 1597, represents an unusually accurate description of the symptom constellation of PTSD.
|
|
Herbert Page, by contrast, argued for the hysteria label, finding what Erichsen called railway spine a functional disorder that was too similar to hysteria to warrant a separate diagnosis. The situation gradually began to change: in 1859, Paul Briquet remarked that "we saw little hysteria in men because we did not want to see it", and between 1875 and 1902, some three hundred medical articles were devoted to the topic of male hysteria, as well as dozens of dissertations. Jean-Martin Charcot. Statistical work in the 1880s finally turned the conception of hysteria on its head. In 1882, Jean-Martin Charcot had made a "radical" move by citing Briquet's estimate of hysteria having a 1:20 ratio of incidence in males compared to females, and added a section for male sufferers of hysteria to his Paris hospital, the Salpetrière.
|
|
Oppenheim, on the other hand, was critical of Charcot's theories and sought to distinguish "traumatic hysteria" from "traumatic neurosis"; he and his colleague Thomsen found that the symptoms in their cases of railway spine were different enough from what was regarded as the symptoms of hysteria, at least in severity. Freud, in 1886, gave a paper about the topic of male hysteria to the Imperial Society of Physicians in Vienna. By this point, the incidence of "classical" hysteria in males was accepted by Freud's audience, but Charcot's traumatic variant was still controversial and evoked discussion among the present medical doctors. In later works, Freud would reject Charcot's distinction between the two types of hysteria, arguing that trauma is the cause of hysteria in both men and women, though he broadened the definition of trauma to include repressed memories of sexual experiences, and believed that recalling traumatic memories could cure hysteria.
|
|