There is no class of cases in which medical men are now so frequently called into the witness-box to give evidence in courts of law, as in the determination of the many intricate questions that often arise in actions for damages against railway companies for injuries alleged to have been sustained by passengers in collisions on their lines and there is no class of cases in which more discrepancy of surgical opinion is elicited than in those now under consideration. The secondary effects of slight primary injuries to the nervous system do not appear, as yet, to have received that amount of concentrated attention on the part of surgeons that their frequency and their importance demands and this is the more extraordinary, not only on account of the intrinsic interest attending their phenomena, but also from their having become of late years a most important branch of medico-legal investigation.
#Art similar to the sufferer and the witness series
In his endeavours not only to unravel the complicated series of phenomena that they present, but also in the necessity that not unfrequently ensues of separating that which is real from those symptoms which are the consequences of the exaggerated importance that the patient attaches to his injuries, much practical skill and judgment are required. For not only have they, in consequence of the extension of railway traffic, become of late years of very frequent occurrence, but, 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 very utmost. These concussions of the spine and of the spinal cord not unfrequently occur in the ordinary accidents of civil life, but from 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 and it is to this particular class of injuries that I am especially desirous of directing your attention. My object in these Lectures will be to direct your attention to certain injuries and diseases of the spine arising from accidents, often of a trivial character-from shocks to the body generally, rather than from blows upon the back itself-and to endeavour to trace the train of progressive symptoms and ill effects that often follow such injuries. Neurosis and neurasthenia even, were unknown terms, and what I then, for want of a better name, called concussion of the spine, is now universally recognized and described under the more modern appellation of traumatic neurasthenia.” 5 At that time (1866), the pathology of the nervous system and injuries was very imperfectly understood, and even the nomenclature had not been invented. Shortly before his death, in answer to questions about his ideas, Erichsen responded: “Nearly 30 years have passed since I first brought the subject of railway and other injuries of the nervous system to the notice of the profession. These lectures are considered to be a seminal work in the development of present day concepts of psychoneuroses. In his lectures he pointed out the difficulties such cases caused in the courts as litigation for compensation moved through the courts.
Among the large numbers of cases of injuries of all varieties that he described, there was a group whose complaints he could not explain entirely on the basis of their pathologic findings. In 1866, Erichsen published his lectures, On Railway and Other Injures of the Nervous System, 3 in which he described and discussed cases of psychoneuroses developing after injuries. In addition to editions published in the United States, it was also translated into several foreign languages. This was the most popular textbook of surgery of the last 1/2 of the nineteenth century. Although he wrote several important papers dealing with air embolism and the effects of the ligation of the coronary arteries, he was best known for his textbook, The Science and Art of Surgery: Being a Treatise on Surgical Injuries, Diseases, and Operations, 4 which was first published in 1873. He returned to work at the University College Hospital, becoming the Professor of Surgery in 1850. His training was completed by an extended visit to hospitals and clinics in Paris. He studied medicine at the University College, London, where he was a pupil of Robert Liston. 2 His mother and grandmother were English, and Erichsen was sent to England for his education at the Mansion House School at Hammersmith. John Eric Erichsen, the son of a wealthy merchant, was born in Copenhagen.
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