University of York

The railway accident:
trains, trauma and technological crisis
in nineteenth-century Britain

Ralph Harrington

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When H. G. Wells suggested in 1901 that 'The nineteenth century, when it takes its place with the other centuries in the chronological charts of the future, will, if it needs a symbol, almost certainly have as that symbol a steam engine running upon a railway',[1] his comment reflected not only the economic, social and industrial importance of the railway in the nineteenth century, but also its significance as an expression of a characteristic Victorian ideology in which engineering achievement was identified with economic expansion and social progress. However, from the point of view of the modern historian -- and particularly the historian of trauma -- as a symbol of the nineteenth century a steam engine running off a railway and dragging its train to destruction behind it might serve equally well. The railway accident was as much a product of the industrial nineteenth century as the modern, sophisticated, steam-powered railway itself, and it embodies and symbolizes many of the age's apprehensions about progress, technological development and modernity as surely as the speeding express, the soaring viaduct and the bustling station express its positive belief in such concepts. Just as the Victorian railway was a vast, dramatic, and highly visible expression of technology triumphant, so the railway accident constituted a uniquely sensational and public demonstration of the price which that triumph demanded -- violence, destruction, terror and trauma.

The railway accident as an agent of traumatic experience occupies an important place in the history of mid- and late-nineteenth-century medical and medico-legal discourses over trauma and traumatic disorder.[2] In fact it can be argued that systematic medical theorization about psychological trauma in the modern west commenced with the responses of mid-Victorian medical practitioners to the so-called 'Railway Spine'[3] condition, which was characterized by the manifestation of a variety of physical disorders in otherwise healthy and apparently uninjured railway accident victims.[4] The investigation of this condition led many nineteenth-century surgeons[5] to examine the role of psychological factors -- variously referred to as 'fright', 'terror', or 'emotional shock' -- in provoking physical disorders, some thirty years before Freud and Breuer considered the matter in Studies on Hysteria,[6] and half a century before the advent of shell shock among the soldiers of the First World War brought a general recognition of the reality of the 'psycho-neuroses'.[7]

The railway accident as an event was significant not only as an agent of individual traumatic experience but as the cause of a collective trauma over railway safety and railway slaughter in Victorian society as a whole; as the Saturday Review commented in 1868, 'We are, in the matter of railway travelling, always treading the unknown … All that we know of the future is that it is full of dangers; but what these dangers are we cannot conjecture or anticipate.'[8] The numbers of accidents and the toll of deaths seemed to be mounting constantly, and in a society which increasingly ran on rails everybody felt threatened and vulnerable. A modern historian of accidents has written of that the later nineteenth century saw 'a transformation of the regard of accidents as more or less private (individualized) happenings to more or less public ones, affecting or concerning the whole of society';[9] and the railway accident played a central role in bringing about that transformation. For this reason it is my intention in this article not only to provide some account of the origins, development and significance of 'Railway Spine' but to embed the medical and medico-legal histories of the condition firmly in their social and cultural context -- a context in which the railway was uniquely vast and powerful presence, and the railway accident a uniquely terrible and traumatic event.

As accidents and casualties multiplied on Britain's railways between the 1840s and the 1860s, the notions that railway accidents were becoming more frequent, deadly and destructive and that railway companies were culpably indifferent to the safety of their passengers became firmly entrenched in public consciousness.[10] In reality, Victorian railways were generally safe and reliable, and were used more and more by an ever-increasing number of people;[11] yet below the surface lay a constant and deep-rooted anxiety, ready to resurface whenever an accident, or a series of accidents, made the headlines. By the middle decades of the century, the early extravagant fears of the dangers the railway represented -- the poisoning of air, earth and water, the mass suffocation or boiling of passengers -- had receded; but rather than disappearing altogether, the fear the railway provoked turned inwards, towards the internal world of the human mind and body, to become a fear of insidious internal rather than catastrophic external disruption.

The railway companies themselves recognised the existence of this subliminal fear. When the Railway Passengers Assurance Company was established in 1849 -- in itself a recognition of increasing public concern over railway safety -- the railway companies' booking clerks, who sold the insurance to travellers buying travel tickets, were instructed by their employers not to invite the taking of insurance directly, for fear that open discussion of potential disasters on the railway might increase anxiety among travellers.[12] Although shipwrecks, mining disasters, accidents on building sites, in factories and on the roads were all far commoner occurrences than serious railway accidents, and in each case such accidents killed and injured more people every year than did mishaps on the railways, it was the violence, destruction, terror and slaughter of the railway accident which dominated the headlines, commanded public attention and pervaded the contemporary imagination.

Disasters at sea had always happened, and generally occurred out of public view, in an environment known to be dangerous and travelled only by those who knowingly accepted the risk. Colliery accidents similarly took place in a hidden realm known for its perilous character; only miners suffered, and only mining communities grieved. But railway accidents happened in the landscape of towns, villages, streets, fields and farms in which everybody lived, and affected people from all classes of society, doing conventional everyday things -- travelling to work, visiting the market, going on holiday. They brought carnage and destruction on an unprecedented scale into the ordinary business of work and leisure, and everybody felt vulnerable. Writing of the terrible Abergele accident in 1868,[13] the Saturday Review commented that it was not the number of victims nor the particular horror of the event which caused it to make such an impression on the public mind, but 'its nearness to us all', for 'we are all railway travellers; these trains and collisions, these stations and engines, and all the rest of it, are not only household words, but part of our daily life.'[14]

The railway accident was also characterised by an arbitrariness in the origins and effects of its violence. When an accident occurred, one person could be killed outright while his or her neighbours escaped unhurt. Lord Colville of Culross was a passenger in one of the three trains wrecked in the Abbot's Ripton collision of 1876; he walked away unharmed from the disaster, but the two men sitting directly opposite him were killed.[15] At Abergele, the three front carriages of the passenger train were enveloped in flame and all inside them were killed; the remaining ten vehicles were pulled clear with all their passengers uninjured.[16] 'It has been death in a most dreadful form or an entire escape',[17] wrote the Illustrated London News of this disaster. Such tales of narrow escapes and chance precipitation into disaster demonstrated the terrible randomness with which the railway accident claimed its victims; a phenomenon which was exploited for literary ends by, among others, Tennyson, whose poem 'Charity' tells the story of a young bride who discovers the secrets of her husband's past life when

Two trains clashed; then and there he was crushed in a moment and died,
But the new-wedded wife was unharmed, though sitting close at his side.[18]

Furthermore, disaster on the rails could be brought about by the smallest of miscalculations: a fleeting moment of forgetfulness on the part of a signalman or a driver's slight misjudgement of speed could lead to disaster. The travelling public's sense of potential danger was only intensified by the apparent ease with which trains could be precipitated into calamity. 'Every train,' asserted Edwin Phillips in the Fortnightly Review in 1874, 'from its starting to its destination, goes through a series of the most marvellous hairbreadth escapes; and if the travelling public had an inkling of the pitfalls that beset them, comparatively few would venture from home',[19] while the Saturday Review characterised railway operation as a sequence of close shaves with catastrophe, as trains 'fly through junctions where the nodding pointsman has wakened with a start to turn the switches, and past sidings where an ill-coupled train of coal-waggons has lumbered off the line but a second before.'[20]

These aspects of the railway accident contributed to the way in which it was perceived as a modern phenomenon; not merely in the sense that it occurred on a modern, mechanised mode of transport but also in that it appeared to embody certain characteristic attributes of the condition of modernity, of technological, industrial, urbanised, mobile, mass-society existence. It denied its victims any chance of controlling their own fate; it crystallised in a single traumatic event the helplessness of human beings in the hands of the technologies which they had created, but seemed unable to control; it was a highly public event which erupted directly into the rhythms and routines of daily life; it was no respecter of class or status; it was arbitrary, sudden, inhuman, and violent.[21]

In the public mind, fear of the railway accident was combined with a deeply-felt hostility to the railway companies. It was widely believed that almost all railway accidents were unnecessary, being preventable by safety measures which the government was unwilling to force upon the railways,[22] and which the companies themselves were too miserly to implement. Newspapers and journals were relentlessly hostile to the railways and their directors.[23] In the opinion of the Saturday Review of August 1862, railway accidents were hardly accidents at all, but 'might be more correctly described as pre-arranged homicide', given the 'system of mingled recklessness and parsimony' which it accused the railways of operating.[24] The Lancet was equally critical, observing in 1857,

We doubt whether the whole world could produce despotism more absolute than that exercised by the great railway companies … They specially maintain, in a series of by-laws, their right to slay, smash, mutilate, or cripple their unlucky passengers, and take care that this right shall not fall into abeyance for want of exercise. They utterly ignore all responsibility for the occurrence of these little accidents.[25]

Against this background, railway companies were seen as fair game for injured passengers seeking recompense for their sufferings, and they received no sympathy from the press when they complained (as they did throughout the latter half of the nineteenth century with increasing frequency and bitterness) of the amount accident injury compensation settlements were costing them, and of the acts of fraud and dissimulation (countenanced, they claimed, by sympathetic judges and jurors) which they asserted were practised by plaintiffs seeking to extract substantial compensation payments from the railways.[26]

Litigation against railway companies by passengers claiming to have suffered injury in accidents, and by the relatives of those who had been killed, had been increasing steadily since the later 1840s.[27] An important precedent had been set by the passing in 1846 of Lord Campbell's Act, enabling the relatives of persons killed in accidents to claim compensation from those whose negligence caused the death, and encouragement had been further provided by a series of well-publicized court cases over the next few years in which railway companies were found strictly liable for injuries resulting from the negligence of their servants and were compelled to pay heavy damages.[28] Aggrieved passengers saw that substantial compensation could be obtained through personal injury cases, and lawyers, seeing the potential for almost risk-free earnings, were happy to encourage the growth of such litigation. In addition the rising number of railway accidents,[29] the high visibility of the railway companies and their profound unpopularity, and the particular horror which the railway accident had for the Victorian public, all encouraged the rapid increase in the numbers of compensation cases during the 1850s and 60s.[30]

Establishing the reality and the precise nature of the injuries which the victim claimed to be have suffered in an accident became the central focus of railway compensation cases from the early 1860s. By this time, the railways were losing almost every personal injury case which went to court and were paying out large, and increasing, sums in compensation every year.[31] Their reaction was to become more selective in their approach, settling claims out of court whenever possible, and only contesting those which they believed to be clearly exaggerated or fraudulent. Not only would the railway companies invariably have the claimant examined by one of their own doctors,[32] they also became adept at using private investigators and other sources of intelligence in their assessments of injury claims.[33] In 1868 John Charles Hall, a doctor who had frequently worked for railway companies in compensation cases, stated that 'persons who have received very slight injuries, frequently exaggerate their degree, or consequence, in order that they may induce a jury to give them a disproportionate compensation', and went on to explain:

When, therefore, I am asked to examine, for the purpose of legal investigation, one of these doubtful cases of impaired function -- said to have been the result of an accident -- I feel it incumbent to collect all the information in my power respecting the person's moral, and probable motives; and to enquire if the alleged causes of the disease are founded on fact, or probable.[34]

Where the claimed injury was of a nervous character, seemingly involving no obvious organic damage, there was undoubtedly scope for deception on the part of the plaintiff. The lack of physical evidence of injury, the delay in the onset of symptoms, the often long drawn out progress of the disorder, the necessity of relying largely or entirely on the plaintiff's own account of his or her sufferings with little or no corroborating physical evidence to support their testimony made railway passenger compensation claims in such cases an extremely complex and contentious area of medico-legal activity. As The Lancet commented in 1861,

The development of railway travelling has brought out quite a new subject of medical inquiry. The injuries to the human frame resulting from the various and numerous accidents to which railway trains are liable, have already furnished the material for many costly legal disputes, and not a few medical conflicts … The difficulties proverbially attached to the exposure of the tricks of military malingerers are as nothing compared with the task of determining the reality of some of the injuries to health, physical or mental, which those interested in recovering 'substantial' damages assign to railway collisions.[35]

Such cases would invariably see the plaintiff's doctors testifying as to the seriousness of the condition complained of, the depth of the victim's sufferings and the remoteness of any possible recovery, while the railway company would call medical experts to state that the victim's injuries were either non-existent or grossly exaggerated. As a result, doctors became increasingly concerned that railway cases were revealing medical men as unable to agree over the nature, or even the existence, of the injuries involved; or, worse, that doctors would be seen by the public as the paid stooges of the railways, 'at the service of a railway company to give evidence, pro or con, just as surveyors and architects are.'[36] As the British Medical Journal commented in 1865, 'we do not believe that railway companies have gained much by the practice of calling witnesses to declare that the plaintiff is doing something like attempting to humbug them; and we are sure that our profession has not gained much credit with the public by assisting the companies in the matter.'[37]

This was a thoroughly unsatisfactory situation for doctors to be placed in, at a time when the coherence, prestige and public image of their profession were matters of great importance to medical practitioners. Furthermore, the numbers of railway accidents and the numbers of compensation cases were rising continuously, indicating that the problem was going to become more acute as time went on. Thus the investigation of these troublesome disorders became a professional as well as a medical priority for many doctors. In 1861 The Lancet urged that this was 'a question deserving of the most painstaking clinical investigation', and appealed for a careful record to be made of cases of nervous disease 'particularly if following upon a fall or blow, or other accident involving shock … in order to elucidate the histories that are constantly being put before medical practitioners by plaintiffs against railway boards.'[38] Four years later the British Medical Journal similarly commented that a 'collection of certain of the consequences of these modern kind of accidents, with a true history of their results, would be a very valuable addition to our pathology.'[39] These appeals were answered during the 1860s by a small flood of publications devoted to the health aspects of railway travel, many of which focused specifically on the question of railway accident injuries.[40]

The earliest significant contribution to the subject was provided by The Lancet itself, with an eight-part report on 'The Influence of Railway Travelling on Public Health' which appeared in the journal between January and March 1862.[41] This series of articles provided the first detailed consideration of the railway accident disorders, preceding the first published work on this subject by J. E. Erichsen -- usually considered the medical pioneer in this field[42] -- by four years. The Lancet's report thus stands at the beginning of the medical and medico-legal debates over 'Railway Spine' and related conditions which were to burgeon over the following half-century, and serves to illuminate the mid-century perceptions of the health aspects of railway travel and railway accidents which gave rise to Erichsen's work.

Railway accidents were an important focus of the Report's attention; but in considering the consequences which they had for the health of their victims, The Lancet carefully distinguished between their 'primary' and 'secondary' effects.[43] The 'primary' effects were the obvious physical injuries such as broken bones, lacerations and burns. Such injuries could be very severe in 'railway-smashed'[44] casualties, but they were straightforward, well-understood, and treatable. Much more problematic were the insidious 'secondary' effects of accidents, which were characterized by a bafflingly broad range of symptoms: 'giddiness, loss of memory, pains in the back and head',[45] 'tingling and numbness of the extremities, local paralysis, paraplegia, functional lesions of the kidney and bladder', and even 'slowly ensuing symptoms of intellectual derangement'.[46] The term 'functional' is frequently used to describe these disorders, indicating that the injury was thought to be located in the nervous apparatus controlling the proper function of the affected organs, rather than in the substance of the organs themselves; an explanation which gave support to the journal's suggestion that the origins of the disorder lay in nervous damage of some description, perhaps produced by 'the violent concussion of the nervous centres experienced during the shock'.[47]

The Lancet went on to summarise some cases in which people who had seemingly escaped entirely unhurt in railway accidents, or had suffered only superficial injury such as bruising or abrasions, gradually succumbed to progressively worsening nervous complaints. One such case involved a Post Office employee, who had been aboard a mail-train involved in an accident in November 1860. He was 'thrown from one end of the carriage to the other, when he fell on the back of his neck, and was for a moment insensible.' However, he did not appear to be seriously injured, and 'was able to proceed to London the next morning, when he was seen by Dr. Waller Lewis, who found him suffering from giddiness, loss of memory, pains in the back and head, &c.' He took action against the railway company, winning £275 in compensation despite the assertion by the railway company's medical witnesses that 'there was nothing wrong with him'.[48]

The Lancet did not attempt any detailed analysis of such post-accident cases; it is not clear, for example, how far pre-existing conditions may have contributed to any of the disorders described, nor are the descriptions of symptoms particularly informative: 'slight headache', 'feverishness', 'much pallor', 'nervousness.'[49] However, the imprecision is typical of mid nineteenth century medical case histories, and serves to emphasise the vague nature of the nervous conditions with which the doctors were confronted. The unifying factor was that the disorders were seemingly out of all proportion to the minor physical injuries which the victims had actually sustained in the accident. In seeking to account for this, The Lancet focused on an issue which was to remain at the heart of the 'railway injuries' debate for the next half-century: the nature and significance of the shock which the accident inflicted upon the victim. As in the cases of American Civil War combat trauma and First World War shell shock, both of which are treated in detail elsewhere in this volume, the medical debates over 'Railway Spine' came to revolve around the precise nature of the shock which apparently acted as the catalyst for any ensuing disorder.

The Lancet particularly emphasised the unique degree of violence associated with the accident, and implied a link between this extreme violence and the nervous conditions subsequently suffered by the accident victims:

… neither the direct shocks produced by the accident, nor the physical injury inflicted at the time, afford any trustworthy indication of those insidious results which may subsequently ensue at a more or less distant period. That these are chiefly due to the violent concussion of the nervous centres experienced during the shock, is clearly shown by the character of the symptoms presented … The vehemence and suddenness of the jolts experienced during a collision exceed in violence any other kind of shock to which human beings are exposed in travelling … Persons escape the immediate danger, and, believing that they are uninjured beyond the severe mental impression of fright, go on their way rejoicing, and neglect the necessary precaution of affording that long period of perfect rest to the brain and spinal column which may enable them to recover from the shock.[50]

There is a recognition here of the presence of an important element of psychological as well as of physical shock in the experience of the railway accident in the mention of 'the severe mental impression of fright' suffered by the victims; but there is no suggestion that 'fright' contributes directly to the subsequent nervous disorder, which is explained as consequent on the physical jolts and shocks of the accident.

This explanation is consistent with the somaticist orientation of Victorian medicine; it is clearly within the 'firmly organicist tradition' of British nineteenth-century theorization of nervous and mental disorder to which Mark Micale has recently drawn attention.[51] There is, however, an important ambiguity in this model regarding the nature of the injury or disease produced by the accident. It is not clear whether the condition consists in pathological injury of the cerebral and spinal structures, or in physiological disruption of nerve function. The Lancet's own ambiguity, in the absence of clear organic evidence on which to base a conclusion, is clear in passages such as the following:

These symptoms are manifested through the nervous system chiefly, or through those physical conditions which depend upon the perfect physiological balance of the nerve-forces for their exact fulfilment. They vary … from simple irritability, restlessness and malaise after long journeys up to a condition of gradually supervening paralysis, which tells of the insidious disease of the brain or spinal cord, such as … follows on violent shocks or injuries to the nervous centres. These latter are the symptoms which frequently ensue from the vehement jolts and buffetings endured during a railway collision.[52]

The Lancet itself seems ultimately to favour a physiological model of nervous disruption rather than a pathological model of organic lesion, to judge from its suggestion that the severe physical shock experienced during the accident results 'in the nervous system being shaken, and, for a time, sometimes considerably weakened',[53] and that in its weakened condition an 'impairment of nervous forces'[54] supervenes, disrupting the action of muscles and organs throughout the body. This explanation essentially derives from the 'spinal concussion' diagnosis, developed in the early years of the nineteenth century[55] to account for symptoms of nervous debility in patients who had received a blow of some kind, often in the back, without sustaining any apparent serious organic injury. The prevalence of back pain in railway accident cases, the long-drawn out progress of the condition, and the perceived vulnerability of the spinal column to blows, jarring and straining during accidents made 'spinal concussion' an obvious model for The Lancet and later authorities to use in their discussion of the novel railway ailments. The ambiguity over the precise role of the physical concussion involved, and the nature of the injury which it produced remained, however, and continued to compromise all attempts to apply the spinal concussion model of injury to railway cases.

The first full-length medical text on 'Railway Spine' and related conditions appeared in 1866. The author was John E. Erichsen (1818-96), an eminent and well-respected surgeon. He was author of a highly successful standard surgical textbook, The Science and Art of Surgery, first published in 1853, which reached its tenth edition by 1895, and was to end his career as a surgeon to the royal household. Erichsen turned his attention to the medical sequelæ of railway accidents while holding the post of professor of surgery at University College, London, and his book, On Railway and Other Injuries of the Nervous System, was a collection of six lectures delivered by Erichsen to the medical students at University College Hospital in the spring of 1866. It is clear from his books on the railway issue and from a work he published in 1878 dealing with the role of the medical expert in court[56] that by the mid-1860s Erichsen had considerable direct experience of railway compensation cases through his work as a medical expert witness, and it seems that it was this experience which led him to address the topic of railway injuries in such detail after half a career in general surgery.

Erichsen's book was enormously influential; in 1894 a distinguished American neurologist, looking back over the previous thirty years of debate over the 'Railway Spine' condition, called it 'epoch-making.'[57] The book certainly had considerable impact within the medical profession, and was well-received by his fellow doctors who made extensive use of it as a diagnostic and practical manual. However, its influence was not limited to physicians and surgeons; for a medical text-book dealing with a fairly narrow field of interest, On Railway and Other Injuries had an unusually high public profile.[58] As The Spectator remarked upon reviewing the book, 'It is not often that a strictly medical book is reviewed in our pages … In the present instance, however, a surgeon of great repute … has given us … a careful opinion upon a point interesting to every member of the community.'[59] The continuing high incidence of railway accidents meant that the subject which the book addressed was indeed one of continuing general interest, and the extensive use of its various editions in the courtroom during railway accident compensation cases associated the name of Erichsen firmly with the 'Railway Spine' condition in the public mind. As the Philadelphia neurosurgeon S. V. Clevenger commented in 1889, 'Neurologists, surgeons and attorneys find so much useful information in Erichsen's book that lawsuits wherein spinal concussion is an issue are seldom undertaken without reference to this London surgeon's lectures.'[60] Similarly, those who believed the conditions Erichsen described to be entirely fictitious or grossly exaggerated, did not hesitate to blame him for producing 'a guide book that might mislead the dishonest plaintiff, if he felt so disposed, to set out upon the broad range of imposture and dissimulation with the expectation of getting a heavy verdict.'[61]

Erichsen put forward an explanation of 'Railway Spine' based essentially on the spinal concussion model of actual organic damage to the substance of the spinal cord. He sought to explain the lack of physical evidence in the form of bleeding, bruising or inflammation for 'any local and direct implication of the spinal column by external violence' in such cases by suggesting that the injuries which caused the nervous symptoms were 'of a more chronic and less directly obvious character … consist[ing] mainly of chronic and sub-acute inflammatory action in the Spinal Membranes, and in Chronic Myelitis, with the changes in the structure of the Cord that are the inevitable consequences of a long-contrived chronic inflammatory condition developed by it.'[62] Erichsen's claim was that 'the whole train of nervous phenomena arising from shakes or jars or blows on the body, and described … as characteristic of so-called "Concussion of the Spine," are in reality due to chronic inflammation of the spinal membranes and cord';[63] but he was continually forced by the complete lack of evidence in the majority of cases for any inflammation or other physical injury to distinguish 'mental' or 'emotional' shock from 'physical' shock and to accept, if only implicitly, the causative role of the former in provoking the disorders associated with 'Railway Spine'.

Thus, Erichsen's attitude towards 'Railway Injuries' was ambiguous; confronted, like all his contemporaries, by the undeniable power and danger of the railway, he accepted that the railway accident was an event of unprecedented violence and horror, but tended to resist any suggestion that the degree of psychological or mental shock associated with it could contribute directly to the nervous disorders suffered by its victims. This ambiguity was reflected in his concern to interpret the particular characteristics of railway injuries in the context of spinal and nervous injuries generally, rather than granting to them a unique medical status of their own; railway injuries, he asserted, were 'peculiar in their severity, not different in their nature from injuries received in the other accidents of civil life.'[64] Yet his emphasis on the degree to which railway accidents were set apart by their violent character and their infliction of a unique degree of psychological shock upon their victims compels him to allow some recognition to them as occupying a distinct category of their own:

… in no ordinary accident can the shock be so great as in those that occur on Railways. The rapidity of the movement, the momentum of the person injured, the suddenness of its arrest, the helplessness of the sufferers, and the natural perturbation of mind that must disturb the bravest, are all circumstances that of a necessity greatly increase the severity of the resulting injury to the nervous system, and that justly cause these cases to be considered as somewhat exceptional from ordinary accidents. This has actually led some surgeons to designate that peculiar affection of the spine that is met with in these cases as the 'Railway Spine.'[65]

Furthermore, by including in his list of factors 'the helplessness of the sufferers' and the 'natural perturbation of mind' associated with involvement in a railway accident. Erichsen moved towards an acceptance that the psychological effects of the experience could have a direct influence on any resulting nervous disorder.

When the British Medical Journal reviewed the book in December 1866 the reviewer perceived Erichsen's ambiguity and questioned his implicit identification of a category of 'railway injuries', linking this clinical categorisation clearly with its medico-legal consequences:

The only differences which, as far as we can see, are to be found between railway and other injuries, are purely incidental, and relate to their legal aspect. A man, whose spine is concussed on a railway, brings an action against the company, and does or does not get heavy damages. A man, who falls from an apple-tree and concussed his spine, has -- worse luck for him -- no railway to bring an action against.[66]

The BMJ reviewer went on to criticise the use of the title Erichsen on Railway Injuries on the cover and spine of the book, suggesting that this was 'calculated to mislead', for 'The book really contains an account only of the effect of shocks and concussion of the spinal cord and brain … It is, therefore, quite superfluous to make of them a special class of railway nervous injuries.'[67]

Erichsen immediately responded to the review with a lengthy letter of self-justification, in which he claimed (almost certainly justly) that the publishers alone were responsible for the title used on the outside of the book, and that his own title On Railway and Other Injuries, did reflect more accurately his own belief that railway injuries were indeed fundamentally the same as injuries from other causes.Yet he went on to justify the particular attention which he and (he clearly implies) other surgeons gave to railway injuries by stressing the ways in which they did differ from other, superficially similar, injury cases:

With reference to the term 'railway injuries,' I beg to say that I have used it in the same sense that the term 'gunshot injuries' is commonly employed by surgeons: not so much as denoting any specific difference in the nature of the injury, but rather as indicative of the peculiar and exceptional agency by which it has been occasioned. In this sense, the terms 'railway injury' or 'railway accident' are commonly used in ordinary hospital practice.

A surgeon asks his house-surgeon, 'Any fresh cases in to-day?' The answer is, 'Yes, sir, a bad railway case.' The house-surgeon would not say 'a bad cab case', or 'a bad horse case', or 'a bad brickbat case' … But he knows and recognises that there is a peculiarity about railway accidents that causes him to place them in a category by themselves …[68]

Erichsen's attitude towards this 'peculiarity about railway accidents' is equivocal. The peculiarity lay in the uniquely powerful forces unleashed in the railway accident, the extreme violence to which railway accident victims were subjected, and Erichsen repeatedly stresses that this is the only characteristic which distinguishes railway accident injuries from injuries suffered in other circumstances. His ostensible claim was not that railway accidents had created a new form of injury, but that an existing disorder, well-known to medical science, had been made more frequent and more serious by the appearance of railways. In the medical records of the late eighteenth and early nineteenth centuries, he claimed, there were 'many cases recorded that prove incontestably that precisely the same trains of phenomena that of late years have led to the absurd appellation of 'Railway Spine,' had arisen from accidents … a quarter of a century or more before the first Railway was opened'.[69]

However, Erichsen's repeated claims that the disorders associated with railway accident victims do not represent a new type of injury, but a more serious and widespread manifestation of an old one are undermined by the emphasis he continually places on the importance of that unique degree of violence and 'intensive shock to the System' occasioned by a railway accident. Despite his denials, he does appear to be suggesting that 'Railway Injuries' constitute a new form of medical condition:

These concussions of the Spine and Spinal Cord not unfrequently occur in the ordinary accidents of civil life, but none more frequently or with greater severity than in those which are sustained by Passengers who have been subjected to the violent shock of a Railway Collision … from the absence often of evidence of outward and direct physical injury, the obscurity of their early symptoms, their very insidious character, the slowly progressive development of the secondary organic lesions, and functional disarrangements entailed by them, and the very uncertain nature of the ultimate issue of the case, they constitute a class of injuries that often tax the diagnostic skill of the Surgeon to the utmost.[70]

Furthermore, the unique characteristics of the railway accident are not limited to the purely physical effects of sudden and extreme violence upon the body; Erichsen further distinguishes the railway accident as a cause of spinal concussion injuries leading to nervous disorder from other, similar accidents by emphasising the psychological effects of involvement in such an accident -- a highly significant admission of the role of non-somatic factors. Thus, Erichsen has not only implicitly accepted that the railway accident was an event of unprecedented violence and horror, but has also been forced to concede that there might be a direct connection between the psychological experiences of railway accident victims and the disorder, which he believed to be a physical disease, which they subsequently suffered; that is, he suggests that in the case of 'Railway Spine' victims, the mind is acting, through some little-understood mechanism, on the physical condition of the body.

In the second, considerably expanded and rewritten edition of his book, published in 1875 as On Concussion of the Spine, Nervous Shock, and Other Obscure Injuries of the Nervous System in their Clinical and Medico-Legal Aspects, Erichsen significantly altered his view of the pathology of 'Railway Spine', attempting to place the origins of the disorder with a disrupted nervous system rather than with any organic lesion: 'the primary effects of these concussions or commotions of the spinal cord are probably due to molecular changes in its structure. The secondary are mostly of an inflammatory character, or are dependent on retrogressive organic changes.'[71] However, in the face of the dearth of physical evidence for such organic changes, Erichsen had to plead the limitations of contemporary medical knowledge and the obscurity of the conditions which lay behind the nervous symptoms:

We should indeed be taking a very limited view of the Pathology of Concussion of the Spine if we were to refer all the symptoms, primary and remote, to inflammatory conditions … there are undoubtedly states, both local and constitutional that are primarily dependent on molecular changes in the cord itself, or on spinal anaemia induced by the shock of the accident acting directly on the cord itself, or indirectly, and at a later date …[72]

In the absence of any discernible physical injury, Erichsen was forced to admit that it was 'rather by clinical inference than by positive observation that such a state can be termed one of anaemia'.[73] However, by 1875, Erichsen's ideas had changed sufficiently to permit him to move towards a more open acceptance of the role which psychological factors could play in provoking nervous disruption than that which had characterised his views in 1866. He was now moving away from the spine altogether as the focus of the complaint towards the brain, and, by implication, the mind; his suggestion was that a condition of 'mental or moral unconsciousness' could be caused by the terror of the accident, producing a temporary breakdown in the brain's ability to control the nervous system:

The mental or moral unconsciousness may occur without the infliction of any physical injury, blow, or direct violence to the head or spine. It is commonly met with in persons who have been exposed to comparatively trifling degrees of violence, who have suffered nothing more than a general shock or concussion of the system. It is probably dependent in a great measure upon the influence of fear …[74]

This suggestion did not lead Erichsen to abandon his belief that the causes of the nervous disorders lay ultimately in some kind of physical injury to the nervous system, but his acceptance of the role played by a purely psychological influence, in the form of fright, as a causative agent in the traumatization of railway accident victims reflected a significant re-orientation of his medical thought.

Erichsen's books had immense influence, in both the legal and the medical worlds. It would be incorrect, however, to see them as creating an unchallenged medical orthodoxy. As we have seen, Erichsen himself had, against his own inclination, implicitly recognised the role of psychological factors in 'Railway Spine', and others were prepared to go further along the same road. In 1868 the prominent surgeon Frederic Le Gros Clark commented that:

there certainly are distinctive characteristics attending railway concussion of the spine, which are exceptional, to say the least, in a similar injury otherwise produced. And this exceptional character consists in the curiously diversified results which are met with; sequences which seem to be more allied with general nervous shock, and consequent deteriorated innervation, than upon special shocks or concussion of the spinal cord.[75]

Clark stressed that where the spine had clearly received a blow in the course of the accident, 'the symptoms are usually immediate and decisive, and assume very much the character of spinal shock from other causes.' Yet even in these apparently clear cases of spinal concussion, railway accident cases were differentiated by their unique psychological characteristics; in such cases, asserted Clark, 'very often, the sequelæ are more varied and protracted than in ordinary concussion; a circumstance which is probably explained, in a measure, by the influence of emotion'.[76] Clark accepted that some cases of 'Railway Spine' did involve spinal concussion as Erichsen suggested; but he claimed that that was an insufficient explanation in most cases. Physical shock had a role to play, but the direct action of a psychological shock on the nervous system -- producing an organic change of some kind which interfered with nervous function -- was, he suspected, the more likely cause of the disorder: 'I think it not inconsistent with acknowledged facts, to affirm that protracted functional disturbance, or even fatal disease, may be the consequence of a rude shock, simultaneously, to the nerve-centres of the emotions, of organic and of animal life.'[77]

The surgeon John Furneaux Jordan, writing in 1873, similarly emphasised the importance of taking account of both physical and psychological factors in considering such conditions, and stressed the uniqueness of the railway accident in the extremity of the 'psychical' shock which it inflicted on its victims:

The principal feature in railway injuries is the combination of the psychical and corporeal elements in the causation of shock, in such a manner that the former or psychical element is always present in its most intense and violent form. The incidents of a railway accident contribute to form a combination of the most terrible circumstances which it is possible for the mind to conceive. The vastness of the destructive forces, the magnitude of the results, the imminent danger to the lives of numbers of human beings, and the hopelessness of escape from the danger, give rise to emotions which in themselves are quite sufficient to produce shock, or even death itself … All that the most powerful impression on the nervous system can effect, is effected in a railway accident, and this quite irrespectively of the extent or importance of the bodily injury.[78]

This continuing ambiguity left the way open for an effective challenge to the dominance of the primarily organic model through a stronger emphasis on the psychological causes of the disorder, and such a challenge emerged in the mid-1880s with the work of Herbert Page, a railway company surgeon. In his Injuries of the Spine and Spinal Cord Without Apparent Mechanical Lesion (1883; revised second edition, 1885), Page was very critical of Erichsen's theories, asserting that it was very unlikely that the spinal cord could be injured without the spinal column showing signs of damage, and that there were 'few or no facts'[79] to support the theory of actual physical injury of any kind to the spinal cord being responsible for post-accident nervous disorder. Page's focus, from the outset, was on the mind. Erichsen had used the analogy of a watch dropped to the floor to explain why the nervous disorders rarely manifested themselves in individuals who had suffered a serious physical injury; if the watch-glass was broken, the mechanism was intact, whereas unbroken glass was indicative of a broken mechanism. Thus, he suggested, the patient who had received a major physical injury would tend not to suffer any nervous disorder.[80] The terms in which Page rejects this argument are revealing: 'we doubt the force of the analogy, unless, indeed, it can be shown that the watch has a nervous system or that it is a sentient organism like ourselves.'[81] Page placed great emphasis on the sentient, conscious mind as the channel through which the accident influenced the nervous system; a point he reinforced by asking why, if the consciousness and the mind played no role, did sleep -- as was well-known -- effectively protect accident victims from nervous disruption?[82]

Page echoed Clark and Jordan in going much further than Erichsen in emphasising the 'element of great fear and alarm' associated with railway accidents, 'which [is] perhaps altogether absent from what may be called the less formidable and less terrible mode of accident',[83] but it was this emphasis on the role of the mind which broke new ground. For Page, the emotion of fear alone was sufficient to inflict severe shock on the nervous system, and he saw the psychological effects of involvement in a railway accident as quite capable of inducing nervous illness and collapse:

… medical literature abounds with cases where the gravest disturbances of function, and even death or the annihilation of function, have been produced by fright and by fright alone. It is this same element of fear which in railway collisions has so great a share -- in many cases the only share -- in inducing immediate collapse, and in giving rise to those after-symptoms which may be almost as serious as, and are certainly far more troublesome than, those which we meet with shortly after the accident has occurred.[84]

Page did not seek to deny that a physiological process of some kind could underlay such nervous disorders, but he specifically rejected Erichsen's suggestion that organic lesions of the spinal cord were the cause. In 1891 he returned to the subject of railway cases in his Railway Injuries: with Special Reference to those of the Back and Nervous System, and clarified his view of the physiology underlying the disorder:

It has always been my opinion that some material or morbid change must underlie the nerve disorder, but it seems to me most unlikely that such a change can be of the same nature as the coarse pathological lesions, which we are wont to see in the post-mortem room, or which are shown us by the microscope. For all we know the change may be a chemical one, and the nervous disturbance altogether secondary.[85]

Whereas Erichsen saw the neuroses of 'Railway Spine' as the results of a physical concussion injury, Page saw the psychological influence of fear as the primary causative element, bringing about the symptoms of nervous disorder through physiological changes, perhaps chemical in nature, in the nervous system, directly induced by the reaction of the conscious mind to the terrifying circumstances of the accident. Thus, Page inverted Erichsen's model of 'Railway Spine'; for Erichsen, the physical injury to the spinal cord came first, and caused the nervous symptoms; for Page, the psychological shock suffered by the mind came first, and itself produced the physical changes in the nervous system which underlay the subsequent disorders. To accord with this new psychological model of post-traumatic nervous disruption, Page employed the concept of 'general nervous shock', which he defined in terms of 'some functional disturbance of the whole nervous balance or tone rather than any structural damage to any organ of the body.'[86] This might appear to echo the explanation offered by The Lancet in 1862, but Page accords no significance to the physical shock which was the basis of The Lancet's physiological model: 'The thing essential for suggestion to have any influence is the special psychic state, induced immediately by nervous shock',[87] that is, by the mental trauma, the terror of the accident.

While Erichsen's work had served the interests of those claiming compensation from railway companies for accident injuries, Page's books were much cited in defence of the companies, whose used them to claim that 'Railway Spine' and similar conditions had no basis in actual injury. This was something of a misrepresentation of Page's position; essentially his purpose was to free the model of post-traumatic nervous disorder from dependence on organic injury, whether sustained by the brain or the spinal cord. In 1895 he summarised his own view as deriving from his rejection of 'the opposing views of imposture on the one hand, and of hopeless injury to the spine and the contents of the spinal canal on the other', and from his conviction 'that the phenomena of railway injuries [are] to be explained on entirely different lines. Too much account [has], in fact, been taken of the body, too little of the mind.'[88]

This explanation owed much to evolving conceptualisations of hysteria, which in turn built upon the extensive work which had been carried out since early in the nineteenth century on distinguishing functional from organic disorders in cases where there was no detectable pathological injury.[89] This body of work had by 1890 created a somaticist model of hysterical nervous disorder which did not rely on lesions or other physical injury or disease in nerves, muscles or organs, nor necessarily on heredity or constitutional weakness (although such factors could play a part in making an individual vulnerable to hysterical disorders). The crucial element was the role of an 'idea', a mental impression of some powerful kind, in affecting the function of the nervous system through the mind, which opened the way for nervous and other disorders without any underlying structural pathology to account for them, being induced directly by psychological shock.

In 1866, Erichsen had characterised hysteria as 'a disease of women rather than of men, of the young rather than of the middle-aged and the old, of people of an excitable, imaginative, or emotional disposition rather than of hard-headed, active, practical men of business',[90] and had firmly rejected any suggestion that 'Railway Spine' and similar cases were hysterical in nature:

In those cases in which a man advanced in life, of energetic business habits, of great mental activity and vigour, in no way subject to gusty fits of emotion of any kind, -- a man, in fact, active in mind, accustomed to self-control, addicted to business, and healthy in body, suddenly, and for the first time in his life, after the infliction of a severe shock to the system, finds himself affected by a train of symptoms indicative of serious and deep-seated injury to the nervous system, -- is it reasonable to say that such a man has suddenly become 'hysterical' like a love-sick girl?[91]

He had taken a similar line in 1875, suggesting that 'We use the term "hysteria" to hide our ignorance of what this condition really consists';[92] that is, of the organic injury which actually underlay the condition. Page, however, while disliking the term 'hysteria' on the grounds of its imprecision,[93] was prepared to suggest that hysterical and post-traumatic disorders were manifestations of the same psychological and physiological processes. The model of the nervous system accepted by both Erichsen and Page was based on a hierarchy of nervous function, in which the highly-developed cerebral functions of the human mind kept the animal functions of the body in due subjection. For Erichsen, to suggest that an active, unemotional businessman was vulnerable to hysteria, and could be reduced to the condition of an animal through a breakdown of mental control was to undermine not merely a medical, but a moral model of what it meant to be a civilised human being. Page, by contrast, had no difficulty in asserting that the extreme emotional trauma of the railway accident was quite capable of shattering even the most resilient mind into hysterical splinters:

the 'hysterical' condition is essentially one in which there is loss of control and enfeeblement of the power of the will … there is loss of the habitual power to suppress and keep in due subjection the sensations, which are doubtless associated with the various functions of the organic life of the individual … Let some sudden, profound psychical disturbance arise, such as may well be induced by the shock and terror of a railway collision, forthwith the intellectual control is lessened, while organic sensations declare their being, and force themselves into the conscious life of the individual.[94]

In a lecture from 1885, Page sketches a model of traumatic nervous disruption in which hysterical symptoms develop when the shock and terror of the railway accident abruptly drains the nervous system of the force it requires to retain control over the organic functions of the body. Railway accidents, he explains, provide

… the requisite conditions for inducing profound exhaustion of the nervous system or traumatic neurasthenia … Railway collisions … provide the conditions for inducing severe effects upon the nervous system and they do so because the circumstances of most railway accidents are such as to produce a very profound mental impression upon many persons subjected to them … the determining cause of the nervous condition which underlies the neurasthenia is very largely fright and alarm.[95]

In this emphasis on the role of the instant of terror experienced by the railway accident victim, and this constant recourse to the pathogenic role of fear in provoking traumatic neurosis, Page anticipates certain diagnostic developments associated with Charcot, who was greatly interested in the English surgeon's ideas and cited his work with approval in his Salpêtrière lectures of the late 1880s.[96]

Page's comments on effects of the railway accident on the human mind and body return us to the ambiguity with which the railway was viewed in the nineteenth century. The railway, the great symbol of technological achievement, could, in a moment of catastrophe, strip the mantle of civilization from its passengers and make them revert to the level of beasts. Such themes are found in many contemporary literary works, from Charles Dickens's Dombey and Son (1848) to George Gissing's In the Year of Jubilee (1894),[97] but perhaps attained their most dramatic expression in Émile Zola's La Bête humaine (1890). For Zola's characters, the train is 'une belle invention', but it cannot change the basic animality of human nature: 'People travel fast and know more … But wild beasts are still wild beasts, and however much they go on inventing still better machines, there will be wild beasts underneath just the same.'[98] When an accident occurs on the railway, the catastrophe instantly destroys the veneer of civilization worn by the passengers in the doomed train. The victims in the shattered carriages at the front of the train lie amid the wreckage, uttering 'inarticulate animal yells', but it is the uninjured passengers from the intact rear carriages whose behaviour is suddenly that of primitive beasts, as they pour out of the train in a 'panicked throng':

They were stumbling over the line, picking themselves up again, fighting their way clear with fist and foot. Then, as soon as they felt they were on solid ground, with open countryside ahead of them, they took to their heels, jumping over hedges, cutting across fields, yielding to their overriding instinct to get far away from the danger, far, far away. Women, men, all screaming, disappeared into the woods.[99]

This outline of the development of the 'Railway Spine' concept between the 1860s and the 1890s has brought us from a condition produced by a jolted and shaken spinal cord to one of traumatically-induced mental and nervous collapse fraught with implications of hysteria, neurasthenia and degeneration. Against this background of evolving ideas, it can well be understood that for the Victorian doctors confronted with the condition, as well as for the public who read horrific reports of railway accidents in the press and followed the progress of compensation cases in the courtrooms (and many of whom undoubtedly felt a certain nervousness as they boarded the trains which took them to and from their daily activities) the mysterious disorders suffered by railway accident victims were more than merely the random injuries inflicted upon the unfortunate victims of a violent and terrifying event. They acquired a subtext of metaphorical and implied meanings, becoming emblematic of the condition of modern humanity, subject both to the remorseless efficiency of an increasingly mechanised civilization and the violent unpredictability of seemingly irrational and uncontrollable machines. On one level, the growth and elaboration of the railway system during the nineteenth century was an indicator of progress, of an increase in the complexity of the social and economic organism in accordance with the doctrines of evolution; but at the same time it also represented a restriction of human freedom by subjecting human behaviour to a high degree of regulation and control,[100] and a great increase in the risk to which people were exposed -- for the more complex and highly evolved an organism becomes the more fragile its organisation is, and the more dangerous are the consequences of a breakdown in that organisation. As Herbert Page wrote in 1895:

Elaboration of structure and complexity of function are indeed acquired at the risk of instability … not only is the organism brought into relation with changes going on around and outside it, with the environment … but inside it also the various bodily parts are kept in due relation and harmony with each other, so that if one member suffer all the members suffer with it.[101]

Just as the highly-developed circulatory systems of the railway showed themselves to be delicately balanced and vulnerable to the crisis of the railway accident, so the complex and highly-evolved human cerebral and nervous system, the summit of evolutionary development and the guarantee of the intellectual and moral elevation of humanity over the animal nature of the body, was shown to be fragile, easily unbalanced and thrown into crisis.[102] The traumas of rapid industrialization, of human independence surrendered to the vast powers of the machine, of uncontrollable speed, of sudden, shattering, catastrophe, found expression through the neuroses of the railway age. Conceptualizations of 'Railway Spine' had begun with shaken spines; they had ended with splintered minds.

© Ralph Harrington 1999. Except for bona fide individual or academic purposes, this paper may not be reprinted in whole or in part, or stored, or transmitted by any means, including electronic, without the prior written consent of the author. All commercial use, reproduction or transmission of this paper is strictly prohibited.

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[1] H. G. Wells, Anticipations of the Reactions of Mechanical and Scientific Progress upon Human Life and Thought (London: Chapman & Hall, 1902), p. 4.

[2] For some general discussion of the cultural significance of the nineteenth-century railway generally, and of the railway accident in particular, See George F. Drinka, The Birth of Neurosis: Myth, Malady and the Victorians (New York: Simon & Schuster, 1984), chap. 5 'The railway god', pp. 108-22; Ralph Harrington, 'The neuroses of the railway', History Today, vol. 44, no. 7 (July 1994), pp. 15-21; and Wolfgang Schivelbusch's The Railway Journey: the Industrialization of Time and Space in the Nineteenth Century (Oxford: Basil Blackwell, 1980), which is a fundamental text for this topic.

[3] The origins of the term 'Railway Spine' cannot be identified with certainty. The first printed reference I have found is in John Erichsen's On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866), in which it is clear that the term was already in common use at the time Erichsen was writing -- although it is not used by The Lancet in its report on 'The Influence of Railway Travelling on Public Health' in 1862.

[4] On 'Railway Spine', modern historical scholarship begins with the works of Esther Fischer-Homberger, 'Railway Spine und traumatische Neurose -- Seel und Rückenmark', Gesnerus, vol. 27 (1975), pp. 96-111, and Die traumatische Neurose: von somatischen zum sozialen Leiden (Vienna: Hans Huber, 1975). General historical accounts can be found in George F. Drinka, The Birth of Neurosis: Myth, Malady and the Victorians (New York: Simon & Schuster, 1984), and Wolfgang Schivelbusch, The Railway Journey: the Industrialization of Time and Space in the Nineteenth Century (Oxford: Basil Blackwell, 1980), while more detailed medical-historical analyses are given by Michael R. Trimble, Post-traumatic Neuroses: from Railway Spine to Whiplash (Chichester: John Wiley, 1981); Ralph Harrington, 'The "Railway Spine" diagnosis and Victorian responses to PTSD', Journal of Psychosomatic Research, vol. 40, no. 1 (January 1996), pp. 11-14; and Eric Caplan, 'Trains, brains and sprains: Railway Spine and the origins of psychoneuroses', Bulletin of the History of Medicine, vol. 69, no. 3 (Fall 1995), pp. 387-419.

[5] It is a fact that all the leading figures involved in the investigation of 'Railway Spine' in Victorian Britain were surgeons. This was presumably because the kinds of medical work in which railway accident casualties would be encountered, treated and, perhaps more to the point, physically examined in the course of preparing injury compensation cases, tended to be the preserve of surgeons. Historically, too, in Britain it was surgeons such as Sir Benjamin Brodie and Sir John Abercrombie who had investigated the structures and functions of the nervous system and who had developed the models of spinal concussion upon which much of the early theorizing about 'Railway Spine' was to be based.

[6] Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud, trans. and ed. James Strachey, 24 vols. (London: Hogarth Press/Institute of Psychoanalysis, 1955), vol. 2, Studies on Hysteria. Freud's own earliest writings on hysteria and trauma were prompted by the debates over railway accident cases to which he had been exposed in Paris and Berlin in the 1880s; see Freud, Standard Edition, vol. 1 Pre-Psycho-Analytic Publications and Unpublished Drafts, pp. 12, 51-3. For background, see Frank J. Sulloway, Freud, Biologist of the Mind: Beyond the Psychoanalytic Legend (New York: Basic Books, 1979), pp. 37-9.

[7] See Martin Stone, 'Shell shock and the psychologists', in The Anatomy of Madness, eds. W. F. Bynum, Roy Porter and Michael Shepherd (Cambridge: Cambridge University Press, 1988), vol. 2, pp. 242-71; Harold Mersky, 'Shell-shock', in 150 Years of British Psychiatry, 1841-1991, eds. German E. Berrios and Hugh Freeman (London: Gaskell/Royal College of Psychiatrists, 1991), pp. 246-7. For an interpretation of the significance of shell shock which tends to stress continuity in British medical approaches to traumatic neurosis and the continuing ascendancy of neurological rather than psychological approaches after the First World War, see Joanna Bourke, Dismembering the Male: Men's Bodies, Britain and the Great War (London: Reaktion Books, 1996), pp. 20-21 and 106-23, esp. 114ff.

[8] 'The railway calamity', Saturday Review, 29 August 1868, p. 281.

[9] Roger Cooter, 'The moment of the accident: culture, militarism and modernity in late-Victorian Britain', in Accidents in History: Injuries, Fatalities and Social Relations (Amsterdam: Rodopi, 1997). The italics are in the original. I am grateful to Roger Cooter for allowing me to see his manuscript in advance of publication.

[10] R. W. Kostal, Law and English Railway Capitalism 1825-1875 (Oxford, 1994), p. 280.

[11] In 1861 more than 163 million passenger journeys were recorded on Britain's 9,500 miles of railway, and in the same year (an exceptionally bad one for accidents) 46 passengers died in eight fatal accidents, an average of more than 3.5 million journeys safely undertaken for each fatality. Even allowing for the much more frequent occurrence of accidents involving no fatalities, the record is still an excellent one: the 385 non-fatal accidents serious enough to be reported to the Board of Trade during the period 1861-5 indicate an average of some 2.65 million accident-free journeys for every one disrupted by a significant mishap. These figures are derived from the Board of Trade's six-monthly accident returns, published in Parliamentary Papers, and from the detailed statistics in H. Raynar Wilson, Railway Accidents: Legislation and Statistics 1825 to 1924 (London: Raynar Wilson, 1925). On railway accidents generally, see L. T. C. Rolt, Red for Danger: a History of Railway Accidents and Railway Safety (London: The Bodley Head, 1955; 3rd edn., Newton Abbot: David & Charles, 1976), which is mainly concerned with technical and operational matters.

[12] See W. A. Dinsdale, History of Accident Insurance in Great Britain (London: Stone & Cox, 1954), pp. 54-5; Michael Stewart, The Railway Passengers Assurance Company, with Particular Reference to its Insurance Tickets (London: Transport Ticket Society, 1985), p. 7.

[13] This accident involved a collision between a runaway goods train and a passenger train, resulting in a fire; 32 people were killed. See L. T. C. Rolt, Red for Danger: a History of Railway Accidents and Railway Safety (London: The Bodley Head, 1955; 3rd edn., Newton Abbot: David & Charles, 1976), pp. 181-4.

[14] 'The railway calamity', Saturday Review, 29 August 1868, p. 281.

[15] Jack Simmons, The Victorian Railway (London: Thames & Hudson, 1991), p. 17. An account of this accident can be found in L. T. C. Rolt, Red for Danger: a History of Railway Accidents and Railway Safety (London: The Bodley Head, 1955; 3rd edn., Newton Abbot: David & Charles, 1976), pp. 114-9.

[16] See L. T. C. Rolt, Red for Danger: a History of Railway Accidents and Railway Safety (London: The Bodley Head, 1955; 3rd edn., Newton Abbot: David & Charles, 1976), pp. 181-4.

[17] Illustrated London News, 29 August 1868; quoted in Jack Simmons, Railways: an Anthology (London: Collins, 1991), p. 76.

[18] The Poems of Tennyson, ed. Christopher Ricks, 3 vols. (London: Longman, 1969; 3rd edn. 1986), vol. 3, p. 231.

[19] Edwin Phillips, 'The internal working of railways', Fortnightly Review, vol. 15 (1874, new series), p. 375. Phillips, as editor of the Railway Service Gazette during the 1870s, was a forthright defender of railway employees' rights and a vigorous critic of railway management.

[20] 'Railway reform', Saturday Review, 27 April 1872, p. 532.

[21] On the railway accident and the 'democratization of disaster', see Rosalind Williams, Notes on the Underground (Cambridge, Mass. & London: MIT Press, 1990), pp. 63-4.

[22] For the legislative framework within which the railways operated, and the attitude of the government to railway safety, see R. W. Kostal, Law and English Railway Capitalism 1825-1875 (Oxford, 1994), L. T. C. Rolt, Red for Danger: a History of Railway Accidents and Railway Safety (London: The Bodley Head, 1955; 3rd edn., Newton Abbot: David & Charles, 1976), passim, and Henry Parris, Government and the Railways in Nineteenth-century Britain (London & Toronto: Routledge/University of Toronto Press, 1965). On official enquiries into accidents, and the relationship between the Board of Trade and the railway companies, see Jack Simmons, 'Accident reports, 1840-90', in his collection The Express Train and Other Railway Studies (Nairn: Thomas & Lochar, 1995), pp. 213-33.

[23] See, for example, Jack Simmons, 'A powerful critic of railways: John Tenniel in Punch', in The Express Train and Other Railway Studies, pp. 133-57.

[24] 'A caution to railway directors', Saturday Review, 16 August 1862, p. 181.

[25] The Lancet, 10 January 1857, p. 43.

[26] R. W. Kostal, Law and English Railway Capitalism 1825-1875 (Oxford, 1994), p. 308. Even the hostile Lancet recognised that there was some justice in these claims, admitting in 1860 that 'railway companies are not infrequently exposed to claims for injuries so grossly exaggerated, if not wholly fictitious, that the most jealous precautions, aided by the appliances of the law, are necessary for protection against fraud'; The Lancet, 25 August 1860, p. 195.

[27] For a detailed account of the legal background, see R. W. Kostal, Law and English Railway Capitalism 1825-1875 (Oxford, 1994), chap. 7, '"The instrumentality of others": railway accidents and the courts, 1840-1875'. My discussion of the legal context for railway accident compensation is heavily indebted to Kostal's book.

[28] R. W. Kostal, Law and English Railway Capitalism 1825-1875 (Oxford, 1994), pp. 254-6 and 280-90.

[29] This is attributable more to the growth of the railway network and the increase in traffic during the mid-nineteenth century rather than to any actual decline in railway safety. Statistically, as Kostal points out (R. W. Kostal, Law and English Railway Capitalism 1825-1875 (Oxford, 1994), p. 280), British railways certainly became safer over this period, although this was not the public perception at the time. For railway accident statistics, see H. Raynar Wilson's invaluable compendium, Railway Accidents: Legislation and Statistics 1825-1924 (London: Raynar Wilson, 1925).

[30] R. W. Kostal, Law and English Railway Capitalism 1825-1875 (Oxford, 1994), pp. 290, 304.

[31] R. W. Kostal, Law and English Railway Capitalism 1825-1875 (Oxford, 1994), pp. 304-5.

[32] R. W. Kostal, Law and English Railway Capitalism 1825-1875 (Oxford, 1994), pp. 381-2. These railway medical officers were authorized by the company to offer a sum in compensation on the spot, on condition that the victim signed a release form guaranteeing that no legal action over the injury would subsequently be entered into. Such practices were the focus of some concern within the medical profession; see, for example, the editorial on 'Medical superintendents of railway companies', British Medical Journal, 22 August 1863, pp. 214-5.

[33] R. W. Kostal, Law and English Railway Capitalism 1825-1875 (Oxford, 1994), pp. 381-2.

[34] John Charles Hall, Medical Evidence in Railway Accidents (London: Longmans, 1868).

[35] The Lancet, 14 September 1861, p. 255

[36] 'Medical evidence', British Medical Journal, 8 April 1865, pp. 354-5.

[37] 'Medical evidence on railway accidents', British Medical Journal, 25 March 1865, p. 300.

[38] The Lancet, 14 September 1861, p. 255

[39] 'Medical evidence on railway accidents', British Medical Journal, 25 March 1865, p. 300.

[40] For example: Thomas Wharton Jones, Failure of Sight from Railway and Other Injuries of the Spine and Head (London: J. Walton, 1855; 2nd edn., 1866); William Camps, Railway Accidents or Collisions: Their Effects upon the Nervous System (London: H. K. Lewis, 1866); John E. Erichsen, On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866); Edwin Morris, A Practical Treatise on Shock after Surgical Operations and Injuries, with Special Reference to Shock caused by Railway Accidents (London: Robert Hardwicke, 1867); James Ogden Fletcher, Railways in their Medical Aspects (London: J. E. Cornish, 1867); John Charles Hall, Medical Evidence in Railway Accidents (London: Longmans, 1868). In other, more general medical works, authors made specific reference to railway injuries, e.g. Frederic C. Skey, Hysteria (London: Longmans, Green, Reader, & Dyer, 1867).

[41] 'The Influence of Railway Travelling on Public Health', The Lancet, 4 January 1862, pp. 15-19; 11 January, pp. 48-52; 18 January, pp. 79-83; 25 January, pp. 107-110; 1 February, pp. 130-2; 8 February, pp. 155-8; 1 March, pp. 231-5; 8 March, pp. 258-60. Also published as a self-contained pamphlet under the same title (London: The Lancet, 1862).

[42] J. E. Erichsen, On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866).

[43] The Lancet, 18 January 1862, pp. 83-4; 8 February 1862, pp. 156-8. A substantial portion of the section on 'Accidents, and their primary and secondary effects' was contributed by Dr Waller Lewis, principal medical officer to the Post Office, who had carried out an investigation of the effects of extensive railway travel on postal workers in 1859. That the Post Office had commissioned such a survey is itself an indication of the extent of contemporary concern over the health consequences of railway travelling.

[44] This graphic term is from a leading article on 'Medical superintendents of railway companies', British Medical Journal, 22 August 1863, p. 214.

[45] The Lancet, 8 February 1862, p. 157.

[46] The Lancet, 8 February 1862., p. 156 .

[47] The Lancet, 8 February 1862., p. 156.

[48] The Lancet, 8 February 1862., p. 156.

[49] The Lancet, 8 February 1862., p. 156.

[50] The Lancet, 8 February 1862., p. 156.

[51] M. S. Micale, Approaching Hysteria: Disease and its Interpretations (Princeton, N.J.: Princeton University Press, 1995), pp. 126-8.

[52] The Lancet, 1 March 1862, p. 234.

[53] The Lancet, 18 January 1862, p. 84.

[54] The Lancet, 8 February 1862, p. 158.

[55] See Michael R. Trimble, Post-traumatic Neurosis: from Railway Spine to Whiplash (Chichester: John Wiley, 1981), pp. 3-4. The surgeon Sir Benjamin Brodie was largely responsible for establishing the most influential model of spinal concussion injury: see his 'Injuries to the spinal cord', Medico-Chirurgical Transactions, vol. 20 (1837), p. 118. Erichsen trained as a surgeon under Brodie in the 1830s.

[56] J. E. Erichsen, On Surgical Evidence in Courts of Law with Suggestions for its Improvement (London: Longmans, Green, 1878).

[57] Charles D. Dana, 'The traumatic neuroses: being a description of the chronic nervous disorders that follow injury and shock', in Allan McLane Hamilton & Lawrence Godkin (eds.), A System of Legal Medicine (2 vols., New York: E. B. Treat, 1894), vol. 2, p. 299; quoted in Eric Caplan, 'Trains, brains, and sprains: Railway Spine and the origins of psychoneuroses', Bulletin of the History of Medicine, vol. 69, no. 3 (Fall 1995), p. 390.

[58] Public concern over 'Railway Spine' was reflected in the interest shown by general periodicals in medical publications on the subject. The Lancet's survey of 1862 was discussed in Cornhill, vol. 6 (July-December 1862), pp. 480-1, and The Spectator, 12 July 1862. Erichsen's 1866 book was also reviewed in The Spectator, 28 July 1866, as well as in medical periodicals, and James Ogden Fletcher's Railways in their Medical Aspects, published the following year, was reviewed in The Athenæm, 19 October 1867 and the Saturday Review, 16 May 1868.

[59] 'The "Railway Spine"', The Spectator, 28 July 1866, p. 834.

[60] S. V. Clevenger, Spinal Concussion (Philadelphia & London: F. A. Davis, 1889), p. 3. Clevenger suggested calling the Railway Spine condition 'Erichsen's Disease'; ibid., pp. 207-8.

[61] Allan McLane Hamilton, Railway and Other Accidents, with Relation to Injury and Disease of the Nervous System: A Book for Court Use (London: Balliere, Tindall & Cox, 1904), p. 2.

[62] J. E. Erichsen, On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866), pp. 112-3.

[63] J. E. Erichsen, On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866), p. 123.

[64] J. E. Erichsen, On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866), p. 46.

[65] J. E. Erichsen, On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866), p. 9.

[66] British Medical Journal, 1 December 1866, p. 612.

[67] British Medical Journal, 1 December 1866, p. 612.

[68] British Medical Journal, 15 December 1866, p. 678.

[69] J. E. Erichsen, On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866), pp. 10-11.

[70] J. E. Erichsen, On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866), p. 2.

[71] J. E. Erichsen, On Concussion of the Spine, Nervous Shock, and Other Obscure Injuries of the Nervous System in their Clinical and Medico-legal Aspects (London: Longmans Green, 1875), p. 15.

[72] J. E. Erichsen, On Concussion of the Spine, Nervous Shock, and Other Obscure Injuries of the Nervous System in their Clinical and Medico-legal Aspects (London: Longmans Green, 1875), p. 175.

[73] J. E. Erichsen, On Concussion of the Spine, Nervous Shock, and Other Obscure Injuries of the Nervous System in their Clinical and Medico-legal Aspects (London: Longmans Green, 1875), p. 193.

[74] J. E. Erichsen, On Concussion of the Spine, Nervous Shock, and Other Obscure Injuries of the Nervous System in their Clinical and Medico-legal Aspects (London: Longmans Green, 1875), p. 195

[75] F. Le Gros Clark, 'Lectures on the Principles of Surgical Diagnosis', Lecture VI, British Medical Journal, 3 October 1868, p. 355.

[76] F. Le Gros Clark, 'Lectures on the Principles of Surgical Diagnosis', Lecture VI, British Medical Journal, 3 October 1868, p. 355.

[77] F. Le Gros Clark, 'Lectures on the Principles of Surgical Diagnosis', Lecture VI, British Medical Journal, 3 October 1868, p. 355.

[78] J. Furneaux Jordan, Surgical Inquiries (London: J. & A. Churchill, 1873), pp. 37-8.

[79] Herbert W. Page, Injuries of the Spine and Spinal Cord Without Apparent Mechanical Lesion, and Nervous Shock, in their Surgical and Medico-Legal Aspects (London: J. & A. Churchill, 1883), p. 162.

[80] J. E. Erichsen, On Concussion of the Spine, Nervous Shock, and Other Obscure Injuries of the Nervous System in their Clinical and Medico-legal Aspects (London: Longmans Green, 1875), p. 156.

[81] J. E. Erichsen, On Concussion of the Spine, Nervous Shock, and Other Obscure Injuries of the Nervous System in their Clinical and Medico-legal Aspects (London: Longmans Green, 1875), p. 85.

[82] J. E. Erichsen, On Concussion of the Spine, Nervous Shock, and Other Obscure Injuries of the Nervous System in their Clinical and Medico-legal Aspects (London: Longmans Green, 1875), p. 85.

[83] J. E. Erichsen, On Concussion of the Spine, Nervous Shock, and Other Obscure Injuries of the Nervous System in their Clinical and Medico-legal Aspects (London: Longmans Green, 1875), p. 85.

[84] Herbert W. Page, Railway Injuries: with Special Reference to those of the Back and Nervous System, in their Medico-legal and Clinical Aspects (London: Charles Griffin & Co., 1891), p. 62.

[85] Herbert W. Page, Railway Injuries: with Special Reference to those of the Back and Nervous System, in their Medico-legal and Clinical Aspects (London: Charles Griffin & Co., 1891), p. 62.

[86] Herbert W. Page, Railway Injuries: with Special Reference to those of the Back and Nervous System, in their Medico-legal and Clinical Aspects (London: Charles Griffin & Co., 1891), p. 25.

[87] Herbert W. Page, Railway Injuries: with Special Reference to those of the Back and Nervous System, in their Medico-legal and Clinical Aspects (London: Charles Griffin & Co., 1891), p. 69.

[88] Herbert W. Page, 'On the mental aspect of some traumatic neuroses' (1895), in his Clinical Papers on Surgical Subjects (London: Cassell, 1897), p. 25.

[89] See M. S. Micale, Approaching Hysteria: Disease and its Interpretations (Princeton, N.J.: Princeton University Press, 1995), pp. 126-8.

[90] J. E. Erichsen, On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866), p. 126.

[91] J. E. Erichsen, On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866), pp. 126-7.

[92] J. E. Erichsen, On Railway and Other Injuries of the Nervous System (London: Walton & Maberly, 1866), p. 199.

[93] Herbert W. Page, Railway Injuries: with Special Reference to those of the Back and Nervous System, in their Medico-legal and Clinical Aspects (London: Charles Griffin & Co., 1891), p. 61.

[94] Herbert W. Page, Railway Injuries: with Special Reference to those of the Back and Nervous System, in their Medico-legal and Clinical Aspects (London: Charles Griffin & Co., 1891), pp. 52-3.

[95] Herbert W. Page, Clinical Papers on Surgical Subjects (London: Cassell, 1897) pp. 136-7.

[96] See Mark S. Micale, 'Charcot and les névroses traumatiques: scientific and historical reflections', Journal of the History of the Neurosciences, vol. 4, no. 2 (June 1995), pp. 101-19, especially 107-9. See also Kenneth Levin, 'Freud's paper "On Male Hysteria" and the conflict between anatomical and physiological models', Bulletin of the History of Medicine, vol. 48, no. 3 (1974), pp. 377-97, esp. 381-2.

[97] For an outline of the image of the railway in nineteenth-century literature, and particularly in Dickens, see Jack Simmons, The Victorian Railway (London: Thames & Hudson, 1991), chap. 8 'Literature', pp. 195-218.

[98] Émile Zola, La Bête humaine, trans. Roger Pearson (Oxford: Oxford University Press, 1998), p. 41. On modernity out of control and the image of the driverless train in Zola, see Daniel Pick, War Machine: the Rationalisation of Slaughter in the Modern Age (New Haven & London: Yale University Press, 1993), pp. 106-10.

[99] Émile Zola, La Bête humaine, trans. Roger Pearson (Oxford: Oxford University Press, 1998), pp. 290-1.

[100] For the application of models of modernist efficiency and machine metaphors to the human body, see Anson Rabinbach, The Human Motor: Energy, Fatigue, and the Origins of Modernity (Berkeley: Sage, 1991).

[101] Herbert W. Page, Clinical Papers on Surgical Subjects (London: Cassell, 1897), p. 15.

[102] See Sander L. Gilman, 'The image of the hysteric', in Hysteria Beyond Freud, eds. Sander L. Gilman, Helen King et al. (Berkeley, Los Angeles and London: University of California Press, 1993), pp. 417-8.