Post-concussion Syndrome - History

History

The symptoms that occur after a concussion have been known for hundreds of years. The idea that this set of symptoms forms a distinct entity began to attain wide recognition in the latter part of the 19th century. John Erichsen, a surgeon from London, played an important role in developing the study of PCS. The controversy surrounding the cause of PCS was started in 1866 when Erichsen published a paper about persisting symptoms after sustaining mild head trauma. He suggested that the condition was due to injury by "molecular disarrangement" to the spine, and the condition was originally called "railroad spine" because most of the injuries studied had happened to railroad workers. While some of his contemporaries agreed that the syndrome had an organic basis, others attributed the symptoms to psychological factors or to outright feigning. In 1879, the idea that a physical problem was responsible for the symptoms was challenged by Rigler, who suggested that the cause of the persisting symptoms was actually "compensation neurosis": the railroad's practice of compensating workers who had been injured was bringing about the complaints. Later, the idea that hysteria was responsible for the symptoms after a mild head injury was suggested by Charcot. Controversy about the syndrome continued through the 20th century. During World War I many soldiers suffered from puzzling symptoms after being close to a detonation but showing no evidence of a head wound. The illness was called shell shock, and a psychological explanation was eventually favoured. The current concept of PCS had replaced ideas of hysteria as the cause of post-concussion symptoms by 1934. British authorities banned the term shell shock during World War II to avoid an epidemic of cases, and the term posttrauma concussion state was coined in 1939 to describe "disturbance of consciousness with no immediate or obvious pathologic change in the brain". The term postconcussion syndrome was in use by 1941. In 1961, H. Miller first used "accident neurosis" to refer to symptoms of PCS and asserted that the condition only ever occurs in situations where people stand to be compensated for the injury, but this contention was widely challenged. The real causes of the condition remain unclear.