This list of symptoms resembles what we currently know as PTSD’s physical manifestations, but Erichsen thought that they are due to damage onto the central nervous system by the railway accident. He stated that there are two types of injury to the nervous system. One shows tissue damage, and the other shows no external signs of it, but has the "concussion of the spine" as the spine was subjected to a “sudden shaking or jarring”. Although railway spine eventually led to the concept of PTSD, what Erichsen thought about was that it was essentially a physical illness. Then it was Oppenheim, H., a German neurologist, who introduced the term “traumatic neuroses” (Oppenheim, 1889). As Erichsen did, he thought that the traumatic neurosis is caused by the injury to the nervous system. However, he did not limit his theory to trauma caused by railways, but trauma in general. Perhaps it is not surprising to think that Erichsen’s railway spine and Oppenheim’s traumatic neurosis are physical illnesses instead of mental illness, because they assume a presence of injury to the nervous system which result in physical symptoms. It might have been very natural for clinicians at that time to assume at that physical symptoms simply correspond to a physical or medical illness. What Erichsen and Oppenheim were concerned about is how to explain that there is a tissue damage if there is no external sign.
Oppenheim, H.(1889) Die Traumatiscren. The American Journal of the Medical Sciences. 97; 271-272, 1889.
Erichsen thought that it was due to the "concussion of the spine". Oppenheim proposed that the shock causes "molecular alterations" within the cerebrum. These explanations were basically speculative and not scientifically convincing, but they were well-meant, as they tried to demonstrate the validity of the illness and help those who suffered, repudiating the view that their condition was not a real illness but some thing like “compensation neurosis”. Although our understanding of the biological basis of PTSD got far advanced since that time, we might be still following Oppenheim’s steps in search for what his "molecular alterations" within the nervous system are exactly about. The only difference is that Oppenheim thought the alteration was due to direct physical impact from the accident whereas we now believe that trauma’s psychological impact might leave some biological change.
In the 20th century during the World War I, Myers, C. proposed the notion of “shellshock” along the line of Erichsen and Oppenheim (Myers, 1915). He thought that victims were suffering from the direct physical effects of shell blasts, echoing Erichson’s idea of ”concussion to the spine.” However, around this time, studies began to indicate that some of the shell shock patients did not really experience the impact of blast of the shell, and psychological impact, rather than physical trauma began to be paid more attention as a cause of this condition. (Mori, 2005).
Myers, C.S. (1915) A contribution to the study of shellshock. Being an account of the cases of loss of memory, vision, smell and taste admitted to the Duchess of Westminster's WarHospital, Le Touquet. Lancet, 185; 316-330, 1915.
Mori, S. (2005) Discovery of Trauma. Kodansha Sensho Metier, Tokyo.[Japanese]
Curiously enough, the notion of shell shock is revisited back again recently, with a hypothesis that direct impact of the blast to the nervous system can still be a plausible cause for the illness (Bhattacharjee, 2008). This new study indicates that in the victims of shell shock, the shock wave can run through the vascular system to the central nervous system and cause diffuse and widespread damage, resulting in various symptoms including psychological symptoms.
Bhattacharjee, Y. (2008) Neuroscience: Shell Shock Revisited: Solving the Puzzle of Blast Trauma Science 319;406-408.
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