[Traffic accidents from the social medicine viewpoint--a medical history connection with present time]

A historically excursus seems sometimes useful to overlook actually problems in medicine. The example of the railway accidents shows the problems of the medical appraisal with regard to the consequences of an accident. After initiation of a third party insurance in Germany 1871 with reference to the new means of transportation a lot of people tried to get a compensation after imaginary or real injury following a railway accident. Very soon physicians had to give an expert's opinion on the complaints of those concerned. 1879 Rigler and 1918 Horn published monographs regarding this problem. Apart of real impairments very often complaints had no organic reason. Oppenheim introduced 1889 the concept of "traumatic neurosis". The scientific discussion remained in the following decades and finally it was rejected until to our times. Today the terms "posttraumatic stress disorder", "psychogenic pain disorder" or "adjustment disorder" are valid. In present times the problem of the whiplash injuries takes the place of the railway accidents. Here also are either organic reasons discussed or psychogenic reactions presumed. The modern techniques in neuroimaging and neuropsychology are inconsistent and the results not generally accepted. In the individual case they are often little helpful. The medicolegal problems are still important and often reason for prolonged forensic confrontations. The discussions more than 100 years ago seem nowadays still actual. The terms have changed, the problems remain.