follow accidents on railways are mental rather than physical and are the same as originate from any one of a great number of emotional experiences. And so "railway spine" passed away and in its place came physical injuries and several groups of psychic phenomena which a great German called the "traumatic neuroses"—"traumatic" because of the accident, "neuroses" because the nervous system, though out of order, has sustained no physical damage and is capable, sooner or later, of resuming its normal functions.
With the spread of industries and the ever increasing frequency of claims for damages for personal injuries, these cases have become everyday occurrences. Physicians the world over have had abundant opportunity to observe their mode of origin, their course, and (though this with greater difficulty) their final outcome. And there is almost universal agreement of opinion that fright at the time of the accident and anxiety after it are the true causes. The cuts and bruises which must be received if the injury is to be actionable (151 N. Y.) intensify the psychic factors. But they do not cause the nervous symptoms, though they may determine, to some extent, their trend.
That this agreement of opinion is not always manifest when these cases come to court may cause regret but not surprise. Witnesses are not always candid, nor experts always wise. And the individual case itself may present such baffling perplexities that it imposes not only on judge and jury, but on the most learned professors in the land.
In Erichsen's day, diagnosis was uncertain in all the disorders at present called the traumatic neuroses. Now, most of them, such as neurasthenia and the various trains of morbid thought which result from back-strain, can be recognized at their true value by any physician who is reasonably experienced and careful. Not so hysteria. This mocking psychosis, with its tragedy and humor, its counterfeits and its realities, its impositions and its appeals for pity, is ever on the watch to lead the unwary into error.
In September, 1899, in Norfolk, Va., the cart which a healthy farmer was driving was struck violently by a trolley car. The man was for a moment prostrate on the roadway, but whether he was thrown out or had jumped out was one of the questions which perplexed the jury. At any rate, he walked to the sidewalk and then swooned. He was carried to a neighboring house, where he had a series of convulsions. The bystanders, strong men, tried to restrain him, but he threw them off. He then fell to the floor in such a way that only heels and occiput touched it. And in this strange posture, with body arching toward the ceiling like a bow, his frame was shaken during several minutes by violent trepidations. He was finally carried to the hospital, apparently unconscious. No evidences of physical injury were found. But the next day he complained of pain down the whole right side and there were twitchings of the face and arm. A few weeks later he became