; HYSTERIA AS AN ASSET 569 



follow accidents on railways are mental rather than physical and are 

 the same as originate from any one of a great number of emotional 

 experiences. And so " railway spine " passed away and in its place 

 came physical injuries and several groups of psychic phenomena which 

 a great German called the " traumatic neuroses " — " traumatic " be- 

 cause of the accident, " neuroses " because the nervous system, though 

 out of order, has sustained no physical damage and is capable, sooner 

 or later, of resuming its normal functions. 



With the spread of industries and the ever increasing frequency of 

 claims for damages for personal injuries, these cases have become every- 

 day occurrences. Physicians the world over have had abundant op- 

 portunity to observe their mode of origin, their course, and (though 

 this with greater difficulty) their final outcome. And there is almost 

 universal agreement of opinion that fright at the time of the accident 

 and anxiety after it are the true causes. The cuts and bruises which 

 must be received if the injury is to be actionable (151 N. Y.) intensify 

 the psychic factors. But they do not cause the nervous symptoms, 

 though they may determine, to some extent, their trend. 



That this agreement of opinion is not always manifest when these 

 cases come to court may cause regret but not surprise. "Witnesses are 

 not always candid, nor experts always wise. And the individual case 

 itself may present such baffling perplexities that it imposes not only on 

 judge and jury, but on the most learned professors in the land. 



In Erichsen's day, diagnosis was uncertain in all the disorders at 

 present called the traumatic neuroses. Now, most of them, such as 

 neurasthenia and the various trains of morbid thought which result 

 from back-strain, can be recognized at their true value by any physician 

 who is reasonably experienced and careful. Not so hysteria. This 

 mocking psychosis, with its tragedy and humor, its counterfeits and its 

 realities, its impositions and its appeals for pity, is ever on the watch to 

 lead the unwary into error. 



In September, 1899, in Norfolk, Va., the cart which a healthy 

 farmer was driving was struck violently by a trolley car. The man 

 was for a moment prostrate on the roadway, but whether he was thrown 

 out or had jumped out was one of the questions which perplexed the 

 jury. At any rate, he walked to the sidewalk and then swooned. He 

 was carried to a neighboring house, where he had a series of convulsions. 

 The bystanders, strong men, tried to restrain him, but he threw them 

 off. He then fell to the floor in such a way that only heels and occiput 

 touched it. And in this strange posture, with body arching toward 

 the ceiling like a bow, his frame was shaken during several minutes by 

 violent trepidations. He was finally carried to the hospital, apparently 

 unconscious. No evidences of physical injury were found. But the 

 next day he complained of pain down the whole right side and there 

 were twitchings of the face and arm. A few weeks later he became 



