The emergence of the concept of shell shock during the First World War had focused unparalleled attention to the issue of traumatic illness.

Today, the recognition of post-traumatic stress disorder (PTSD) has established in the minds of the public, media and the health professionals that war can produce long-term and severe psychological effects. However, it was not always so.

Vulnerability to Stress

In the late nineteenth century, passengers who had been exposed to a terrifying train crash were often diagnosed with “railway spine” to explain why their psycho-somatic symptoms endured after physical wounds had healed. Medical opinion was divided as to whether these were organic effects, related to lesions in the central nervous…