An historical perspective on the human consequences of Railway Accidents

Accidents resulting in death and injury, to passengers and employees, were all too common on Britain’s railways in the late nineteenth century. Physical injury was obvious but the nature and consequences of mental trauma were poorly understood. The following article shows how one railway medical man of the time was starting to appreciate and describe a condition, occurring after railway accidents, which today we call “Post Traumatic Stress Disorder” or PTSD.

My interests are in railway history. I am not a psychiatrist and the following article should not be taken as a definitive description of Post Traumatic Stress Disorder.

PTSD following railway accidents in the nineteenth century.

Post Traumatic Stress Disorder (PTSD) is today a well recognised condition. It has though taken many decades to reach this position. Historically the medical profession and the military have been slow to reach a full understanding of its nature, prevalence and the need to help those affected. Only as recently as 1980 did the American Psychiatric Association officially add PTSD to its Diagnostic Manual of Mental Disorders.

The condition may occur when a person is exposed to an event involving actual or anticipated death or injury triggering a feeling of intense fear. The person then starts to avoid anything that will cause them to re-experience the event. There is a numbing outlook on life which interferes with personal relationships. They are less able to cope with normal daily life challenges and may be unable to do their job effectively. The affected individual tends to be in a constant state of arousal and is easily startled. The traumatic event persists as a dominating psychological experience causing flashbacks, disturbed sleep and nightmares.

In the UK it was soldiers returning home with “Shell Shock”  from the trenches of WW1 that brought about a general public awareness of a disturbance to the mind following exposure to frightening experiences. Perhaps most people still associate PTSD with soldiers but it can develop in anyone, in any walk of life, who experiences a very dangerous, terrifying, extremely stressful, or life threatening event.

In the second half of the nineteenth century railway accidents were a common cause of PTSD – but only now with the benefit of hindsight is this realized and understood.

In the 1880’s and 90’s the railways of Britain were killing around 500 employees each year. They were dangerous places for passengers too. Train speeds were increasing and carriages often loose coupled and of flimsy wooden construction. When accidents did occur there were often many deaths and injuries.

The medical profession was aware that some of those who survived these accidents did suffer a mental illness. However the consensus view of the time was that any disturbance to the mind was a direct result of, and linked to, the physical injury sustained in such an accident. Injuries to the back were very common. It was estimated that over 60% of railway injuries involved some hurt to the back. This was particular the case when passengers were subject to sudden acceleration or decelerations as in shunts or collisions causing what today would be termed  “whiplash”.  Indeed back injuries were so common that  “Railway Spine”  became a recognized medical term. The explanation for a disturbance to the mind was that as the back (spinal column) contained the spinal cord, which was connected to the brain, then an injury to the back could cause a disturbance to the mental functioning of the brain.

Herbert W Page was one who began to question this explanation. He was Surgeon (Chief Medical Officer) to the London and North Western Railway for 17 years and had the opportunity to travel around the railway system interviewing and examining accident survivors. In particular he noticed that sometimes the disturbance of the mind occurred in patients who’d experienced an accident but had suffered no significant physical injury. He developed the hypothesis that this psychiatric condition, which he termed “General Nervous Shock”, was an entity in itself and not a manifestation of a physical injury; though the two could exist together. He wrote up his views, with supporting evidence, in a book published in 1891 entitled, “Railway Injuries: in their Medico-Legal and Clinical Aspects”.  The medical terminology is different from that used today but in essence what he was describing was PTSD.

In his attempt to describe the condition he writes:

“In these purely psychical causes lies, I believe, the explanation of the remarkable fact that after railway collisions the symptoms of General Nervous Shock are so common, and sometimes so severe, in those who have received no bodily injury, or who have presented little sign of collapse at the time of the accident. The collapse from severe bodily injury is coincident with the injury itself, or with the immediate results of it, but when the shock is produced by purely mental causes the manifestations thereof may be both prolonged and delayed. Warded off in the first place by the excitement of the scene, the shock is gathering, in the very delay itself, new force from the fact that the sources of the alarm are continuous, that they may recur for days, and for a time be all potent for evil in the patient’s mind.”

He gives the details of several case histories but I quote here just one which I think illustrates many features of the condition.

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Case 10 – Severe General Nervous Shock – prolonged symptoms – physical injuries slight.

S.W., aged 46, a tall, somewhat powerful man, was in a very severe and destructive collision. He received bruises over both arms and legs, and also a blow upon the face which abraded the skin over, and fractured the bones of, his nose. He was not stunned. He lay for several days after the accident in a state of great nervous depression, with feeble and rapid pulse, an inability to eat or sleep. He suffered at the same time much distress from the fact that a friend sitting beside him in the carriage had been killed; and things seemed to prey constantly upon his mind.

The bodily injuries proceeded rapidly towards recovery, and in 17 days after the accident he was able to be moved home. Nine weeks after the accident he had fairly well recovered from his local injuries, and made no complaint of bodily suffering. Examination at this date discovered no structural disease, but he was evidently in the most feeble and wretched state. The ordinary functions of the body were natural, but his mental condition showed extreme emotional disturbance. He complained that he had suffered continually form depression of spirits, as if some great trouble were impending.

“He is easily upset and prone to cry. He says he used to cry whenever he spoke to anyone, but that now he has rather more control. He has been out of doors for a few yards, but was stopped by a sudden sensation as if his breathing were very short. His voice is very weak and indistinct, and occasionally he says it is almost inaudible. There is no disease of the larynx or adjoining parts. He sleeps very badly, waking frequently, and being constantly troubled by distressing dreams. His pulse is weak, 104. He occupies himself by a little reading and by occasionally going out, but he feels so shaken and weak that he is unable to do anything more. In many respects, however he is improving. The weight he lost is being regained. He can walk a little further, is not so ready to cry, and his voice is stronger.”

He remained in much the same condition for several months, though with undoubted tendency towards improvement. Fifteen months after the accident, several months, that is, after his claim had been settled, I learned that he was better, though yet very far from right, and he was considered wholly unfit for work.

His history, given four years after the accident by his medical attendant, is as follows:

“In my opinion he will never be anything like the same man again. His appearance is much altered. He looks much older, haggard, and has become very bald. His voice is very weak, almost gone at times, For some time he went about in search of health, but improved very slowly, if at all. Lately he obtained two posts, the work at which is of a very light nature.

I just jotted down the following symptoms as he mentioned them, and I feel sure he would not willfully exaggerate them. Very depressed spirits, sometimes palpitations, loss of sleep, bad dreams, very easily tired, can’t walk more than 2 miles, then gets very tired and quite loses his voice. Did nothing for two years after the accident. He lost all his energy. Sometimes has a great dread of impending evil.

He can travel by railway without feeling nervous, but can’t drive without feeling frightened all the time. Always gets very upset if dining in company or if many people are talking near him. I knew him well before the accident, and he was a very energetic and very honourable man.”

Three years later his symptoms were still subsiding. Since he began more regular work he has continued more markedly to improve.

It must be pretty obvious from this history that this man’s prolonged illness was due in only small measure to the bodily injuries which he received. From these injuries, indeed, he had recovered, as soon as if they had been inflicted in any other accident and in any other way. The cause of his illness and of his altered condition, even after the lapse of several years, was the mental shock, call it fright or what we may, which the whole circumstances of the accident wrought upon him.”

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Today life threatening railway accidents are thankfully rare. Few passengers board their train with any sense of fear. This was not so in the nineteenth century as the author explains:

“It is this element of fear, this great mental shock, which in railway collisions has so large 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 more troublesome than, those which we meet with shortly after the accident has occurred. The reasons for this are not far to seek. The incidents indeed of almost every railway collision are quite sufficient – even if no bodily injury is inflicted – to produce a very serious effect upon the mind, and to be the means of bringing about a state of collapse from fright, and from fright alone. The suddenness of the accident, which comes without warning, or with a warning which only reveals the utter helplessness of the traveler, the loud noise, the hopeless confusion, the cries of those who are injured ; these in themselves, and more especially if they occur at night or in the dark, are surely adequate to produce a profound impression upon the nervous system, and, even if they caused no marked shock or collapse at the time, to induce a series of nervous disturbances at no distant date.”

Though not recognised or described in terms we would use today Post Traumatic Stress Disorder was certainly a real, and maybe not uncommon, entity in the late Victorian railway age.

The dangers of working on Britain’s railways continued into the early twentieth century as evidenced by the following extracts from the records of Springs Branch depot in Wigan. These incidents can be multiplied across the hundreds of such depots in existence at the time: