Railway spine: The advent of compensation for concussive symptoms

J Hist Neurosci. 2020 Apr-Jun;29(2):234-245. doi: 10.1080/0964704X.2019.1711350. Epub 2020 Jan 27.


The introduction of railway transportation in Great Britain in the early-nineteenth century saw an increased frequency of trauma cases involving persisting symptoms without objective evidence of injury. In 1866, a prominent surgeon, Sir John Eric Erichsen, attributed such symptoms to concussion of the spine (popularized as "railway spine") that involved an organic pathology, inflammation of the spinal cord in the absence of spinal fracture, with potential psychological overlay. This was widely accepted within the medico-legal context throughout the 1870s, whereby passengers sought compensation for collision-related injuries. In 1883, a railway surgeon named Herbert William Page countered the assertion that many of Erichsen's cases likely had sustained direct physical injury to the spine, the cord, and/or the spinal nerves; and in cases without such injury, the symptoms were psychogenic, as in traumatic neurasthenia and/or hysteria. Similarities between Erichsen's and Page's medico-legal positions, such as conscious and unconscious forms of symptom exaggeration that would both resolve upon settlement of the case, ushered in the era of medical injury compensation.

Keywords: Concussion of the spine; hysteria of traumatic origin; malingering; symptom exaggeration; traumatic neurasthenia; traumatic neuroses.

Publication types

  • Biography
  • Historical Article
  • Portrait

MeSH terms

  • Brain Concussion / history*
  • Compensation and Redress / history*
  • Compensation and Redress / legislation & jurisprudence
  • General Surgery
  • History, 19th Century
  • Humans
  • Liability, Legal
  • Male
  • Railroads*
  • Spinal Cord Injuries* / complications
  • Spinal Cord Injuries* / history
  • United Kingdom
  • Wounds and Injuries*

Personal name as subject

  • John Erichsen
  • Herbert Page